This is the twelfth instalment of a series on the history of medicine in Singapore.
After the medical school opened, the Federated Malay States (FMS) Hostel was also re-opened. Some other places for accommodation were acquired for students. The first to be converted was the Lay Superintendent's Quarters for 11 students, then the Sepoy Lines Golf Club for 25 students. In 1947, the Tan Tock Seng Hospital (TTSH) hostel was opened for 100 students. An old bungalow on Paterson Road was converted for 36 pre-clinical students. In 1948, a Japanese building in the College's sports field was converted into an annex of the FMS Hostel for 14 students, and was called the Stables. (In 1953, the Dunearn Road Hostel opened to replace the Paterson Road Hostel. In 1955, both FMS and TTSH hostels were demolished.)
The Medical Library, which had been left intact during the war years, was reopened and shifted to the ground floor of the College of Medicine Building in 1947. Mr George Ee was appointed the officer-in-charge of the Library. The Dental School also set up a small library around that time. The rehabilitation of the Pharmacy School was particularly difficult because the laboratory had been stripped of all benches and equipment by the Japanese, and had been converted into a cold room, which was dismantled in 1947. That same year, a young Mahathir bin Mohamad entered the portals of the King Edward VII College of Medicine, where Tun Dr Mahathir was to meet his future wife, Tun Dr Siti Hasmah bte Haji Mohd Ali. In 1949, Prof EK Tratman described in volume 86 of the British Dental Journal a previously unrecorded anomalous form of mandibular premolar, first described by Mr MO Leong, LDS, at an August 1946 meeting of the Malayan Dental Association.
Major CL Southall, who took charge of the Government Analyst Department in 1945, described his frustration of trying to restart the department and his account gave a glimpse of the ravages wrought on the local population by the war.1
"The Japanese removed most of the apparatus to the College of Medicine. I regret I have been unable to obtain permission from the Military to recover this, nor have I been permitted to inspect it to enable me to prepare a list of what replacements should be ordered. In consequence work has been carried out under what I consider are quite unnecessary handicaps. The majority of the former Asiatic staff have returned to duty. The Chinese assistants are in fair health. I wish to place on record my appreciation of their efficient work and cheerfulness in spite of their personal difficulties over housing, transport and food prices. The Indian assistants are all in very poor health and are incapable of sustained effort. No improvement is to be expected under prevailing conditions. Toxicology: The greater part of the work under this heading was in connection with the numerous fatalities which followed the drinking of illicit spirits. Many samples of Liquor coloured and flavoured to simulate the 'Whisky' and 'Brandy' produced under the Nipponese regime proved on analysis to contain from 18-34% by volume of Methyl Alcohol. In only one instance was mixture of Ethyl and Methyl Alcohol found. It is almost certain that the Methyl Alcohol was looted from Japanese supplies during the recent period of disorganisation. No deaths of Methyl Alcohol among Service Personnel have occurred since the third week in October, but civilians deaths continue indicating that this poisonous liquor is still on sale. During the course of this work, a rapid method of detecting with certainty as little as 0.001 cc Methyl Alcohol in 5 cc blood or C.S.F. was perfected. Atropine, Tuba resin, Morphine and Caustic alkali were the only other poisons detected in viscera specimens."
The activities of the Government Analyst Department were brought back in full swing under successive able leaderships - M Jamieson (1946 to 1949), AC Brooks (1950 to 1952), AW Burtt (1953 to 1955) and A Jackson (1956 to 1958). The ability of the Department to analyse for poisons appears to be quite sophisticated. In 1947, Jamieson wrote:2 "A case of accidental poisoning of great interest, in which 4 men entering a ship's hold to unload a cargo of oranges died from carbon dioxide poisoning was also investigated. Analysis of the atmosphere of the hold soon after the accident showed the composition to be Carbon dioxide 10.7 per cent, Oxygen 8.3 per cent, and Nitrogen 81.0 per cent. Experiments showed that oranges kept in a closed space produced, by respiration, a greater concentration of carbon dioxide than this, with a corresponding decreased in oxygen, within 24 hours. In this instance, the oranges had been stowed so as to leave a well in the middle of the hold, in which the vitiated atmosphere accumulated and into which the asphyxiated men descended."
In 1951, Brooks wrote:3 "In last year's report, reference was made to an unidentified alkaloidal poison, which had been twice encountered and which had on the second occasion caused the death of 2 and the acute illness of 3 Chinese women. The poison was in both cases derived from a root. This year the same alkaloid was found in two more fatal poisoning cases, both Chinese men, in neither of which was there any history of how the drug had been administered or its source. This poisonous alkaloid has now been identified, both by its colour reactions and by its absorption curve in the ultra violet as that occurring in Gelsemium elegans (Benth), a plant apparently well known in Hong Kong, but not hitherto encountered here." In the post-war years, with the advent of pharmacy and synthetic drugs, pharmaceutical products began to be appear as poisons.
To understand what happened next in the history of medical education and services, it is appropriate here to review briefly what happened to the Straits Settlements (SS) after the war. The British forces returned in September 1945 and Singapore came under the British military administration. When the period of military administration ended in March 1946, the SS was dissolved. On 1 April 1946, Singapore became a Crown Colony. Penang and Malacca became part of the Malayan Union in 1946 and later the Federation of Malaya in 1948. In Singapore, constitutional powers were initially vested in the Governor (the first Governor of the Crown Colony of Singapore was Sir Franklin Charles Gimson from 1 April 1946 to 15 November 1952), who had an advisory council that evolved into the separate Executive and Legislative Councils in July 1947. An election for six members of the Legislative Council was held on 20 March 1948. When the Communist Party of Malaya tried to take over Malaya and Singapore by force, a state of emergency was declared in June 1948 and lasted for 12 years. Towards the end of 1953, the British Government appointed a commission under Sir George Rendel to review Singapore's constitutional position and make recommendations for change. The Rendel proposals were accepted by the government and served as the basis of a new constitution that gave Singapore a greater measure of self-government.
On 28 May 1958, a Constitutional Agreement was signed in London, by which Singapore attained self-government in 1959. In May that year, Singapore's first general election for the Legislative Assembly was held. On 3 June 1959, a new Constitution confirming Singapore as a self-governing state was brought into force by the proclamation of the Governor Sir William Allmond Codrington Goode (Governor 9 December 1957 to 2 June 1959), who became the first Yang di-Pertuan Negara (Head of State) from 3 June 1959 to 1 December 1959. The first Government of the State of Singapore was sworn in on 5 June 1959. In May 1961, Malaya proposed a merger between the Federation of Malaya, Singapore, Sarawak, North Borneo and Brunei. Singapore approved the merger by a referendum on 1 September 1962. Malaysia was thus formed on 16 September 1963 and consisted of the Federation of Malaya, Singapore, Sarawak and North Borneo (now Sabah). Brunei opted out.
The General Hospital (GH) faced many problems – mainly a shortage of doctors, nurses, paramedical personnel and medical equipment. Admission was restricted to the acutely-ill patient and the hospital stay was kept as short as possible. The Maternity Wing of the GH at Sepoy Lines was closed and all obstetric and gynaecological patients were transferred to Kandang Kerbau Hospital (in 1946 there were about 5,000 births, in 1947 about 7,000, and in 1949 over 10,000). This caused a problem for medical students, because up till then, most of the practical obstetric work of students had been carried out at the Maternity Wing. Medical students then had to attend a given quota of 20 cases. The GH offered grants to pregnant women willing to be delivered by medical students. In 1948, the Casualty & Outpatient Services was set up in the GH.
Up to this point in time, it was realised there was no system of medical or surgical units. Medical officers and specialists might travel up to four miles a day to visit their patients in various wards in the hospital complex, and some patients did not get the attention that they otherwise would have. This situation where there were no medical and surgical units was severely criticised by a delegation from the General Medical Council. The health authority thus decided that patients of each specialist and his house staff would be grouped into contiguous wards irrespective of class. Thus, a system of medical and surgical units was instituted in 1947 in all hospitals, and each Unit had its own Head.
In the GH, there were three surgical units (A, B, D), an Ophthalmic Unit (thus making ophthalmic surgery the earliest subspecialty to be recognised in Singapore), and two adult Medical Units (I and II). (The third Medical Unit – the Children's Unit – was formed in 1965.) Surgical Unit A was headed by the Professor from the Medical School, while Surgical Unit B was headed by a senior government consultant surgeon, who also had to do ENT work. In 1951, Surgical Unit D became an Orthopaedics Unit, and was later divided into two units: O and C, in 1956. In 1957, the ENT Unit became the ENT Department.