A colossal statue of the Buddha, surrounded by cells for monks who conduct daily prayer services. That might be how we imagine a Buddhist monastery today. But for many who lived in present-day Sri Lanka a thousand years ago, that was what a hospital looked like.
Religious leaders throughout history have sought to care for their followers in various ways, and Buddhists were no exception. In fact, excavation projects in Sri Lanka have come up with the ruins of medieval monastic hospitals of a scale that hasn’t yet been seen anywhere in South Asia—even in India, with its long-standing Ayurvedic tradition. With new archaeological data, historians can now reconstruct these medieval healthcare administrations, endowments, and facilities.
Heated pools and surgical tools
In the late 19th century, Indologist Wilhelm Geiger came across some rather strange-looking stone troughs in Sri Lanka. They had cavities roughly the shape of human beings and finely-carved exteriors decorated with mouldings and pilasters. He noted that they were being used to serve food to pilgrims, since their original purpose had been long forgotten. In Stone Sarcophagi and Ancient Hospitals in Sri Lanka, physician Heinz Mueller-Dietz mentions this story with a persuasive explanation: These were not originally feeding troughs but medical tubs. Filled with “plant liniments, milk, ghee, oils, and vinegar”, Mueller-Dietz suggests that they could have been used “for the treatment of rheumatism, haemorrhoids, fever, and snake bites”.
Since then, excavations across Sri Lanka have turned up more of these medical tubs, leading to at least four major monastic hospitals being identified across the island. Possibly the most impressive was at Mihintale, near the ancient Lankan capital of Anuradhapura, the primary seat of the island’s kings until the late 10th century CE. It is also the oldest-surviving structure dedicated primarily to healthcare. Archaeologist Leelananda Prematilleke published a study of the site in The Archaeology of Buddhist Monastic Hospitals, part of the volume The Archaeology of Buddhism: Recent Discoveries from South Asia.
Situated close to Anuradhapura, this complex consisted of two courtyards, the first of which had 25 cells and larger rooms arranged around a central shrine with a colossal Buddha statue. This opened to another courtyard with four to five adjoining rooms. Persian blue glass flasks were discovered in these rooms, along with mortars and pestles for grinding herbs and a pool with heating facilities.
Another hospital complex was found at Polonnaruwa, which became a major political centre after the Chola invasion of the island in the 11th century. Here, excavations found that ceramics imported from China were used for storing ingredients and medicines. An extremely fine scale balance was also discovered, measuring just 8 cm across and “possibly used to weigh medicinal materials such as musk, opiates, gold and mercury in the smallest of quantities”. In Surgical Instruments at the Alahana Parivena Hospital in Pollonaruwa, surgeon Arjuna Aluwihare suggests that these substances were used as anaesthetics. Forceps of varying sizes, specialised for everything from tissues to bone, were also found, along with scalpels for cutting through skin, small lances to drain pus, and so on. These tools are in line with those described in mainland texts such as the Ayurvedic Sushruta-Samhita and Charaka-Samhita. Medieval Lankans also had their own texts such as the Sarvatasangraha and Yogaratnakara, which may have drawn from similar medicinal traditions.
How were medieval hospitals run—and for whom?
Facilities like the ones mentioned above were expensive to build and run. The presence of imported ceramics, which were mostly used by wealthy elites across the Indian Ocean, strongly suggests that the patients in these hospitals were among Lanka’s wealthiest: Most likely a part of powerful Buddhist establishments, or members of royal courts. Some textual sources mention hospitals for the blind and women, but these have not yet been discovered in the archaeological records. Nevertheless, such a public (and otherwise rare) commitment to taking care of the sick may have been linked to Buddhist ethics and performing to Buddhist audiences.
A 10th-century inscription of the Lankan king Mahinda IV, discovered near the Mihintale hospital, mentions its patients in passing: “To the monks who are unable to attend [the morning prayer service] through illness, shall be granted a vasag [a measure of provisions] each, when recommended by the physicians.” (Epigraphia Zeylanica Volume I, page 100). Mahinda’s inscription also provides a large endowment to the facility, consisting of land and gold. It was also allowed to “appropriate” the produce of villages cultivated by “tenants”, thus suggesting that the monastic hospital was a landowner in its own right. It appears to have been attached to a larger monastery, but functioned semi-autonomously and focused on caring for sick monks.
Buddhist monastic hospitals employed physicians of various ranks. They included doctors, “persons dispensing medicinal remedies”, and those “applying leeches”. All were referred to (rather flatteringly) as “your lordship”. Their salaries consisted of land and rice, but not exactly in generous proportions. It is possible that they expected payments from patients or their sponsors.
Monastic hospitals also employed administrative officials, but on very strict terms. These officials were forbidden from giving orders to the medical staff and had to be very careful with managing the hospital’s lands lest they be investigated and banished. They were either paid a direct salary from hospital lands or granted their own land to cultivate as a “living” or “jivel”. This is an interesting similarity to practices known from mainland temples, which granted land to their officials and servitors for upkeep, using the term “jivitam”. More research remains to be done as to whether religious establishments in mainland India also ran such healthcare facilities, or whether they were a unique feature of the Lankan landscape. Either way, such administrative arrangements indicate that medieval South Indians and Lankans had much in common.
The tools discussed earlier also reveal that medieval Lankan physicians were familiar with South Asian medicinal practices. Prematillake claims that some Lankan manuscripts were discovered with acupuncture diagrams, which would indicate that physicians on the island were aware of East Asian medicinal practices as well. This is in line with recent scholarship showing that Lanka was an important node in the “Buddhist Cosmopolis”—a network of monasteries, courts, and patrons that spread through South, Southeast and East Asia. Pilgrims, merchants, and ritual experts moved through these nodes, carrying with them Buddhist texts as well as, it seems, medical practices. And as much as these practices might not be strictly “scientific” as we understand them, they were certainly based on systematic thought and investigation just as medieval rituals were. It is no surprise that both were transmitted together—or even that hospitalised monks, as Mahinda’s inscription above suggests, were expected to participate in religious services.
The globalised nature of the medieval world appears in the most unexpected of places—as does the deep intertwining of premodern religious belief, scientific practice, and political patronage.