Medical education in the early years was almost exclusively for the British, until the establishment of King Edward VII College of Medicine on the island in 1907.
When Sir Stamford Raffles set foot on the island on 28 January 1819,[1] he had with him troops of the Bengal Native Infantry and Sub-Assistant Surgeon Thomas Prendergast, who was in medical charge of the whole expedition.
[9] As a result of this large influx of penniless people, overcrowding, bad living conditions and a habit of opium smoking led to a high rate of physical and mental illness.
[11] Provision of health and medical facilities and services was limited because the government felt that the population was made up of immigrants who were not planning to make Singapore their home.
[16] A similar item had been reported by acting Senior Surgeon W. E. E. Conwell, who had come in February 1828 on an inspection tour of the hospitals.
[17] In Conwell's report, it was noted that Hanson was being treated at the Singapore Infirmary and otherwise being confined in a jail since there was no suitable place for people like him.
[27] In the Singapore Free Press forum on 21 February 1838, it was argued that "it has been proved that in recent cases of insanity under judicious treatment, as large a proportion of recoveries will take place as from any other acute disease of equal severity"[28] and the Editor added his comments highlighting the fact that "there is space enough in the hospital yard to construct a suitable building for their reception, and we hope that the absolute necessity there exists for providing something in the nature of a Lunatic Asylum will not be overlooked.
[30] Bonham, who had become Governor by then, immediately requested that Montgomerie write "a report on the number and state of the lunatics under treatment, and also suggestions for their better management".
[33] In addition, floors "should be laid with bricks on edge, embedded in good mortar so as to admit of being washed, and prevent the patients lifting the floors, which constructed with tiles as in the Jail, they have been enabled to do so;"[34] and "wood for the walls and bed places in consequence of very bad effects having arisen from patients in the Jail having destroyed the bed places and by squatting on the floor and leaning against cold walls, have in several instances cramped their limbs and stiffened their joints so as to cause lameness".
[53] He then ordered that the Hospital be put under the personal charge of Dr Thomas Oxley, who had become Senior Surgeon by that time,[54] in 1844.
[63] The third was the manufacturing of gutta percha (nutmeg) sheets for surgical purposes to be sold to the Medical Board at Calcutta at ten percent below market rate.
[67] Throughout the colonial period, "isolation of the insane with proper justification was then thought necessary and custodial care was the mainstay of the day".
Under these circumstances, Dr Oxley was forced to discharge "harmless" patients to make room for more "dangerous" ones (Lee 1978, p. 197).
This was Singapore's first legislation regarding the mentally ill, and the first person committed under the Act was Lim Say Soon who was charged for murder on 21 August 1848 (Lee 1978, p. 198).
Since Dr Oxley's complaints about the overcrowding were ignored, on 11 April 1849, he wrote to absolve his staff from blame should anything untoward happen if more people were sent to the Hospital (Lee 1978, p. 198).
As a result, on 17 May 1850, the Governor gave orders for the Hospital to be disinfected as a temporary measure and that plans for a new extension to be submitted (Lee 1978, p. 198).
One typical day at the Hospital in the 1850s consisted of work (picking oakum and cleaning of dormitories) and exercise, as well as breakfast and dinner at 9 am and 3 pm respectively.
However, they caused serious problems as shown in a letter written by the Medical Officer in charge dated 25 June 1850, George Fox had struck a Chinese Toty (attendant) as a result of a lack of "means of properly confining or efficiently watching him" (Lee 1978, p. 199).
As a result, policy was changed to authorise Medical Officers to send Europeans to the Insane Hospital (Ng 2001a, p. 12; Lee 1978, p. 199).
No action was taken until a donation of $3,600 was made by Low Joon Teck and Chung Sam Teo, the two Chinese merchants who had government monopoly to sell opium in Singapore (Lee 1978, p. 200).
The Grand Jury had highlighted that the only female lunatic was "exposed to the view of the other inmates" (Lee 1978, 202), and this demanded rectifying.
There was a deliberate effort to have "shrubs, flower beds and grass plots" (Ng 2001a, p. 13) in the grounds around the Asylum to create a pleasant environment.
An outbreak of cholera in the Asylum and the surrounding Kandang Kerbau area in July 1873 (Ng 2001a, p. 15) necessitated a temporary shift of the Government General Hospital's patients to the military hospital at Sepoy Lines, an area adjacent to Chinatown and Pearl's Hill where Indian troops were stationed to guard Singapore (Lee 1990, p. 7).
A second cholera outbreak in August 1887 forced Dr Tripp, Acting Surgeon in charge of the Asylum, to call for an early shift to the new building (Ng 2001a, p. 16).
The new Asylum was built on cottage principles (Ng 2001a, p. 16) with a series of detached buildings (Lee 1990, p. 7), and had accommodation and work facilities.
Based on John Colony's ideas, the lunatics were assigned accommodation first by gender and second by type of mental illness (Ng 2001a, p. 16).
Male lunatics remained at Sepoy Lines till overcrowding resulted in their eventual transference to Pasir Panjang in 1907 as well, and then to Central Mental Hospital at Tanjong Rambutan in Perak in 1914 (Ng 2001a, p. 21).
Dr E. R. Stone had taken over as the first medical superintendent and in his 1928 report, he pinpointed "privation and starvation…heredity, alcohol, fevers and critical periods of life" (Ng 2001a, p. 23) as causes of mental illness.
The bell was rung three times daily at 5:00 am, noon and 4:30 pm to announce mealtimes, and chimed to herald festive occasions, to mark the change of work shifts and to alert staff of patients absconding from wards" (Ng 2001a, p. 24).
Psychiatry for Doctors, edited by Kua Ee Hock, Ko Soo Meng and Lionel Lim Chee Chong, Section 1, Chapter 2.