• Interview

Hospitals Under King Jayavarman VII

• By Ky Soklim
• November 7, 2021 7:46 PM

With 102 functioning hospitals all across the kingdom during the reign of King Jayavarman VII, people of the Angkorian era possessed a great deal of knowledge on medication and the scientific as well as spiritual healing process. Cambodianess’ Ky Soklim interviewed historian Im Sokrithy of the APSARA National Authority as they visited the temple of one of these ancient hospitals and discussed how Cambodians’ ancestors were treating the sick and the wounded so they could recover and continue living a normal life.

Ky Soklim: As a historian with the APSARA National Authority in Cambodia, I have a question regarding the Leak Neang temple. As you mentioned, this temple is unique, different from the others because it was at a hospital. Would you tell us more about it? And did this temple have a medical school as well?

Im Sokrithy: The Leak Neang temple is one of the four temples located at the entrances of Angkor Thom. Let me explain. [The walled city of] Angkor Thom has the overall shape of a square in which the Bayon temple stands in the center. On each side is a gate to the city. Actually, there is a fifth gate, but let’s consider only the gates that are perpendicular to the Bayon temple.

In front of the Angkor Wat temple stands another temple called Prohm Kel, which is in fact a hospital. Similarly, there’s another temple at the western gate named Tramoung, which is also a hospital.  To the northern gate stands another hospital named Tonle Snguot. We now are at the Leak Neang temple of the eastern gate. At every gate of the city, there is a hospital. Specifically, an ancient hospital consisted of the medical-care building, the place where the physician could stay, the healing center, and the administration center. In every hospital compound, there’s a temple. Today, we would call it a shrine. The shrine was built for the people to worship. For example, this is a hospital. Back then, the hospital was usually built of wood with a tile roof. In that wooden hospital, there was a temple. It was for the sick to pray, worship, make offerings, or the doctors themselves to worship. What we are seeing today is the remaining stone temple whereas the wooden hospital with its tile rooftop might be laying around here somewhere.  

Ky Soklim: So, the wooden building is no longer here?

Im Sokrithy: Yes, it is not here anymore…because it was constructed of wood. However, we have discovered some pieces of the hospital’s roof tiles.

Ky Soklim: Were the roof tiles…all found in this area?

Im Sokrithy: No, they are scattered everywhere. As the building slowly crumbled, the pieces fell on the ground. And the surrounding forest eventually spread over the area. So, the temple was surrounded by the hospital. The overall structure and architectural design of each hospital is identical to one another. Thus, if we can recognize one hospital temple, we can easily spot the others. The temple is the clue or key for us to find where the hospital is. We cannot find the hospital itself without this clue because the wooden building is now gone. Fortunately, we are left with the temple. So, where the temple stands, the hospital stood. The hospital was not a place to teach. It was a place to heal the sick...The inscription at the Ta Prohm temple, which…is very near to where are we right now, contains details on how many medical schools or ak-roak-sala there were during that period. The “ak” in ak-roak-sala can translate into “Anti-Sickness Building.” The “ak” is a negative prefix. So, it is the place that cures diseases. There were 102 places that cured illness in the whole Khmer Empire during the reign of King Jayavarman VII.

Ky Soklim: There were 102 hospitals during the Khmer Empire?

Im Sokrithy: Yes, there were a total of 102 in the Khmer Empire that spread thousands and tens of thousands of square kilometers. Up to now, we have managed to find the locations of the hospitals through the temples. Some of them are in Leaw [Laos], Siam [Thailand], the Mekong Delta of Vietnam, the Angkor region, and other places. Also, in every province or commune, there is a “doctor’s house.”

Ky Soklim: Did they call it the “doctor’s house” during that period?

Im Sokrithy: yes.

Ky Soklim: Not hospital?

Im Sokrithy: Yes. According to the inscription, it is specifically called a place that cures diseases or ak-roak-sala. The place that heals all kinds of diseases. This place is similar to a ministry, consisting of a director, doctors, nurses, assistants, guards and much more.  

Ky Soklim: But, if I may ask, where do you get all the information? Do you find this through the inscriptions or are there documents about this?

Im Sokrithy: Mainly the inscriptions. There’s an individual inscription at every hospital. All of them have nearly the same content. It is as if the Angkorian government implemented a decree to have an inscription at every hospital. Because of the inscriptions, we are able to know more about the hospitals including the medications, the management, the origins of the medicines and so on and so forth.

Ky Soklim: Do you know what types of medicines were being used at that time?

Im Sokrithy: The majority of the medicines were written in the Khmer alphabet through the Sanskrit language. So far, we know a little about it. But we are researching the matter. There were two categories of medicine being used at that time. The first category was imported from abroad. The second type of medicine was grown domestically. Perhaps the hospital had a garden to grow [medicinal plants and herbs] and produce medicine. The medications were extremely organic. We can see that it is in contrast with today’s medication, which involve [synthetic] chemicals. No, it is not like today. Back then, medicines were totally natural. Based on the inscriptions, most of the medicines were imported from India, another portion came from China, and some were grown locally as well. These medicines would go to the government. The government then would distribute the imported medicines and domestic ones. Whereas other medicinal plants and herbs could be grown around the hospital.

Ky Soklim: Were those medicines really ancient or were they actually modern medicines at that Angkorian time?

Im Sokrithy: At that time, the medical technology was quite advanced. Some of the ingredients were grinded, separated, formed into small tablets, and carefully stored. Since these medicines were organic, they could only be kept for a short period of time. Therefore, each hospital had to visit the royal storage in Angkor City every three months to get fresh medicine. The hospital directors had to journey to the main city to get new medicines and materials to supply their hospitals.

Ky Soklim: I recall your mentioning that there were numerous doctors back then. I suppose there must have been many medical schools as well, or was training only done through practice, the process of healing human beings

Im Sokrithy: Of course, there were schools. The hospital was solely used for medical practice whereas theories and lessons could be learned at school. The schools were actually the pagodas or the religious temples such as Ta Prohm, Preah Khan, or Banteay Kdei. These were universities. Even though they are sacred temples, all the huge temples were also a place for education. Moreover, higher degree of learning up to the university level for doctors, engineers, architects, and astrologists was available at the temples as well. Therefore, the temple had multiple functions aside from religious purposes. Furthermore, the teachers or professors who taught at the temples were sponsored by the government. Then, they could use their salaries to support and provide for themselves. The government also supported each doctor who worked at hospitals. A hospital had to have two doctors, probably 18 nurses and medical assistants, guards, people in charge of boiling water, people who grinded medicine, rice and more. So, there was approximately 90 to 98 people for a single hospital. This makes a hospital similar to a ministry.

Ky Soklim: So, is it fair to say that the education and medical sector must have skyrocketed during the 12th and the 13th centuries of King Jayavarman VII?

Im Sokrithy: Yes, but we are looking only at the last period of the Khmer Empire. There was a legacy from the earlier generations. It is not as if everything just suddenly appeared during the era of King Jayavarman VII. Obviously, there were people before him. Nevertheless, in terms of inscriptions or written evidence, it is clear that the details [regarding hospitals] were inscribed during King Jayavarman VII’s years. The medical and education sectors appeared earlier, before his reign.

Ky Soklim: But before King Jayavarman VII, were the education and medical sectors this flourishing?

Im Sokrithy: Definitely, they were the same. As we have translated 9th and the 10th century inscriptions, the written information mentions a variety of scholarships including age-oriented government sponsorships, food and even school supplies. In addition, the inscriptions also mention graduation events for individuals including the royalty and the king himself becoming teachers. But I would like to emphasize that no single inscription contains all of these details at once. Instead, this is the result of combining and saving inscriptions over the years. We have about 3,000 inscriptions and we try to study each of them and put them together to get the full picture. That’s why a research cannot come to conclusion based on a single piece of evidence. We have to put all the information together so that we can understand and, subsequently, compare and analyze disparities in the information.

Ky Soklim: As earlier, you stated that hospitals existed.  However, due to natural disaster, wars, and other factors, [continuity in research] was broken down. Does the APSARA National Authority have initiatives to find those broken or missing pieces in order to recreate the hospital [profile]?

Im Sokrithy: Of course, we have our own plans. As a matter of fact, it is progressing step-by-step. Our first project, which is nearly 100 percent completed, is the successful restoration of the Tonle Snguot temple. It is located in the northern section of Angkor Thom…Soon it will be open for the public to visit. The project focuses on the temple inside a hospital. Moreover, the study of hospital and medical procedures is still in progress. We have on our team a researcher. He is a modern-day physician who is living in Cambodia and has a Ph.D. degree in ancient medicines…Although he has not yet studied the historical research data, he is working on projects related to shastra [manuals of instruction] and ancient medications. He is entirely committed to helping the younger generation connect his field with archeology so that we can better understand ancient medications and hospitals. It is complicated to try to comprehend healing procedures. For us to do that, we must know the curative methods. There are some sculptures on temples that show how symptoms were detected. Let’s look for examples. For instance…this [Leak Neang] temple has illustrations on how to identify symptoms as we can see in this picture. This is such a significant sculpture, which demonstrates how diagnosis was arrived at. This is the patient right here and this is the doctor. The patient is laying his arm onto a pillow. Meanwhile, the doctor is studying the condition by placing his hand on the patient’s wrist.

Ky Soklim: Is it to check the pulse?

Im Sokrithy: Precisely, he is checking the pulse in order to understand the cause of the sickness. This is such a rare picture that can only be found inside this temple. The sculptor tells us about a common scientific medical practice, which was used to treat diseases in the past. But in present day, we still carry on some of these techniques in order to detect symptoms.

Ky Soklim: To arrive at a diagnosis…

Im Sokrithy: Yes. In the past, doctors examined the patient’s condition based on four main factors. These factors are linked to the four elements, which are water, earth, fire, and air. Our body is made of these four elements. Similarly, these elements will influence our health and that might be the cause of why we are feeling sick. In the instance of this case, they are treating the cause of sickness based on the element of air. For some other cases, the doctors will refer to the other three elements. The absence or imbalance in any element will unsettle our health. We could get sick. This traditional approach is being used today as well. Whenever one feels discomfort, one will say “chong kert k’chol” [catching-the-air or minor dizziness]. This is because the air element inside our body is imbalanced. Traditionally, in order to cure this illness, people would have to chase the air away through the gua sha body-massage technique. The massage will ease and stabilize the “air” in one’s body. Then, when one would start to feel more and more lightheaded, they would say “k’chol ko” (spinning air or fainting). Just like how it feels like when the wind is spinning. And if one is feeling heavier and heavier as if the air is turning into a tornado, they would exclaim “dach k’chol” (air disconnection or suffocation). This is the last and harmful part. So, you see, first it is “kert k’chol” (dizziness). Then, it will lead to “k’chol kor” (fainting). People will experience unsteadiness and headache at this point. And if it continues to get worst, it will be harmful.

Ky Soklim: I do have a question that is quite out of the topic of health as we were discussing earlier. People usually refer to the Angkor period as the most prosperous period of all. What does it mean? Why do people say that it was the most glorious period?  

Im Sokrithy: The reason why the Angkor period was so flourishing is neither because of the impressive temples or the excellent sculptures. Any country could have done the same thing. Instead, the reason for Angkor’s glory is what we have seen so far. There were hospitals and proper techniques used to diagnose, proper medications to cure diseases, skilled physicians, nurses, and first-aid staff. Moreover, another reason that contributed to this peak medical care is the temples. What do you think it means to have a temple inside a hospital? First of all, the temple is meant for the sick to perform monthly or annual ritual ceremonies. Inside the temple, there are two priests. One will assist with related religious activities while the other priest will treat the sick. In cases when doctors cannot identify a patient’s disease, then the priest will have to step in and examine the patient himself. In the end, they will use the two results from both religion and science to come to a conclusion. All those who enter the hospital will be cured and healthy once again for sure. If they are possessed by any spirits, the priest over there will know immediately

Ky Soklim: So, is the temple situated in the hospital or is it the other way around?

Im Sokrithy: The temple was small like this. The hospital was much more massive.

Ky Soklim: So, the hospital was bigger.

Im Sokrithy: As previously mentioned, a single hospital had about 90 to 98 employees. If the hospital was that small, there would have been no room for the people to walk. Moreover, this very field [where is the Leak Neang temple] was not for treatment. Instead, it was for worshipping. The treatment center was elsewhere.

Ky Soklim: Yes, indeed this was a place for worshipping and praying.

Im Sokrithy: At the same time, do not confuse the Neak Pean temple [built on a small island in the middle of the north baray at Angkor] with a hospital, which many people do. The Neak Pean temple is not a hospital for it does not have enough facilities for treatment. The Neak Pean temple is a whole other story…it is different from a hospital. There are even accommodations inside a hospital. In the past, a hospital was not only a place to cure diseases. A hospital was also a charity-and-rescue center like the present-day Red Cross. People also prepared food and water at the hospital for the poor and needy. They were allowed to eat there if they could not find food. There were shelters for the homeless to stay. Anyone could come to stay at the hospital or the rescue department if one did not have a place to go during the cold season. Therefore, the hospital was both a charity and rescue place. Furthermore, the hospital was a place that distributed donations. Every year, the hospital would donate to the poor and sick who were struggling. They could come to get medicines or goods directly from the hospital.