This is the fourteenth instalment of a series on the history of medicine in Singapore.
In 1959, Singapore attained self-government and the urban health services (Municipal Health Department) became assimilated into the Government Medical Department to form the Ministry of Health (MOH). In 1960, the MOH incorporated the City Analyst's department into the Government Analyst's department to provide a more integrated chemical service in Singapore. The formation of the MOH marked the 1960s as a period of reorganisation and consolidation of hospital services. Central control was established and health services were consolidated, with the start of open heart surgery, coronary care and haemodialysis.
In 1963, five honorary consultants selected from among specialist doctors who had retired from government or university service, or those who had gone into private practice, were appointed to the Singapore General Hospital (SGH). They were Prof Benjamin Henry Sheares (O&G), Prof Ernest S Monteiro (Medicine), Prof Yeoh Ghim Seng (Surgery), Mr Seow Li Jin (ENT) and Dr Robert Loh (Ophthalmology). Prof Yeoh was Head of the University Department of Surgery from 1955 to 1962; he later became Speaker of Parliament and acted as the President of Singapore for three separate times. Mr Seow contributed $1.5 million to start the National University of Singapore Professorship in Otolaryngology. Dr Loh was born in 1925, graduated from the University of Malaya in 1949 and obtained his Fellowship of the Royal College of Surgeons of Edinburgh in 1959. He was senior consultant ophthalmologist in the SGH until 1969. He obtained the Fellowship of the Royal Australian College of Ophthalmologists in 1973, and the Fellowship of the Royal Australasian College of Surgeons in 1974. Dr Loh was President of the SMA from 1964 to 1965, and was the founder president of the Ophthalmological Society of Singapore from 1963 to 1976. He was also Master of the Academy of Medicine, Singapore from 1975 to 1979. In 1978, he was conferred the Honorary Fellowship of the Royal College of Physicians and Surgeons of Glasgow. He was past-president of the National Council of Social Services.
The late 1960s saw marked improvement in the standard of living, urban renewal, industrialisation and large leaps in medical technology and science. 1961 saw the separation of Singapore' first Siamese twins – Karen and Kate; the surgery was conducted on 12 December, at the SGH, by Prof Yeoh Ghim Seng and Dr Choo Jim Eng. In 1962, the KK Women's and Children's Hospital (KKH) was reorganised into three training units – the University Unit and Training Units A and B. Under this new structure, the three units concentrated on complicated cases and the training of doctors, while the Maternity Home Unit undertook the bulk of routine delivery. As a result of the reorganisation, postings in the Training Units were recognised by the Royal College of Obstetricians and Gynaecologists in 1963 (KKH's University Unit moved to the National University Hospital in 1985).
In 1963, Singapore's first cardiac laboratory was set up at the SGH. In 1964, a new Emergency Unit was opened and a radioisotope laboratory was established. Singapore's first open intra-cardiac repair of an atrial septal defect using cardio-pulmonary bypass was done on 28 January 1965. Also that year, Prof Wong Hock Boon of the university's Department of Paediatrics, and Dr WR Brown, a Research Associate of the Hooper Foundation, completed their work on kernicterus in Singapore, which led to the screening of newborns in Singapore for glucose-6 phosphate dehydrogenase (G6PD) deficiency. In 1967, a Coronary Care Unit was established at SGH. Singapore's first renal transplant was done on 8 July 1970 on a 29-year-old female with chronic pyelonephritis.
In 1966, the Guinness Book of Records recognised KKH as having the largest number of babies born in a hospital in the world. The record "birthquake", as it was called, was 39,856 babies (more than 109 per day) in a year.1,2 This record would be held for the following ten years. In 1967, Prof VK Pillay and Mr WGS Fung were appointed the heads of the university department and government department of orthopaedic surgery, respectively, at SGH. The Singapore Orthopaedic Society held its inaugural meeting on 14 October 1967 with Mr Fung as the president and Prof Pillay as the vice-president. The Government Analyst Department was transferred to the Ministry of Science and Technology in 1968. At the KKH, the Domiciliary Delivery and Domiciliary Aftercare Services were stopped.
In 1968, the first two patients with chronic renal failure were started on regular haemodialysis at the SGH. The Department of Radiology was divided into two separate departments – Diagnostic Radiology and Radiotherapy. That year, the SGH was renamed Outram Road General Hospital.
By 1970, the time was ripe for specialisation and a Committee on Medical Specialisation was set up by then Minister for Health Mr Chua Sian Chin; they were to recommend a programme to develop specialties that would meet Singapore's needs, and to make the Republic an internationally pre-eminent centre for treatment, training and research. The Committee recommended the development of five subspecialties; namely, neurosurgery, cardiothoracic surgery, plastic and reconstructive surgery, paediatric surgery and renal dialysis. The Committee also recommended that the specialties be developed as independent units, but should be grouped together in a hospital complex for economic, administrative and functional reasons. The Committee noted that for these subspecialties to develop, there would be a need for concurrent development of related specialties in the fields of radiology, anaesthesiology, laboratory services, gastroenterology, urology, intensive care, immunology, genetics, haematology and nuclear medicine, although not as separate units. The MOH set up a Child Guidance Clinic on SGH grounds on 7 April 1970, which was later moved to the Institute of Health in 1980.
As a temporary measure, the Neurosurgery and Cardiothoracic Units were developed in Tan Tock Seng Hospital under Mr Tham Cheok Fai and Mr Tan Ngoh Chuan, while the Burns and Plastic Unit was developed in SGH under Dr Wong Kum Leng. The Paediatric Surgery Unit was later established under Mr VT Joseph, while Nephrology and Renal Dialysis came under the charge of Dr Lim Cheng Hong. A ten-bed Dialysis Unit was set up in 1970. In 1972, the Plastic and Reconstructive Surgery Department was opened. In 1973, the Renal Unit became the Department of Renal Medicine. In 1974, the Emergency Unit was re-designated as the A&E Department, a gastro-endoscopic service was started, and a Paediatric Surgery Unit was established under the Department of Surgery. In 1975, the Surgical Intensive Care Unit was opened, and a Self Dependency Dialysis Unit was established. In 1977, the first two living-related renal transplants were carried out and orthopaedic surgeons began to perform microvascular surgery. In 1978, the A&E Department handled its first mass casualty disaster when a Greek tanker, Spyros, exploded. Thus, the 1970s saw the establishment of surgical subspecialties.
The withdrawal of the British Forces from Singapore in 1971 gave the Ministry two additional hospitals – Alexandra Military Hospital (renamed Alexandra Hospital) and the Naval Base Asian Hospital (renamed Sembawang Hospital). That year, in the Archives of Dermatology, volume 104, Dr Tay Chong Hai described a rare syndrome (associated with intellectual impairment, brittle hair, ichthyosis, decreased fertility and short stature) now known as Tay's or IBIDS (ichthyosis, brittle hair and nails, intellectual impairment, decreased fertility, short stature) syndrome, or trichothiodystrophy.
In 1972, the Ministry of Environment was set up to take charge of environmental health, thus MOH could concentrate its resources on hospital services, primary health services, dental services and support services. In 1975, Dr Toh Chin Chye was appointed Minister for Health (until 1981). In 1976, building started in the Institute of Dental Health, which was temporarily occupied by MOH in 1978.
Earlier in 1971, the Government appointed a firm of consultant planners to determine the requirements for hospital services over the next 20 years, to provide a plan to meet these requirements, and to advise on the redevelopment of the SGH. They produced a report in April 1972, and in November that year, the Government gave approval for the construction of a new hospital at the Outram Road area. A six-member Hospital Planning Committee was formed with Dr Kwa Soo Bee as the Chairman; the other members included Dr Lim Cheng Hong, Dr Charles Toh, Dr Leong Hin Seng, Dr Wong Kum Leng and Dr Ong Yong Wan. In 1978, Dr Kwa was appointed Medical Superintendent to oversee the implementation of the recommendations of the Committee on Medical Specialisation, and was also assigned to undertake the planning and building of the new SGH.
In 1975, KKH was recognised by the Guinness Book of Records as the world's largest maternity hospital in the era where home deliveries were still common in many parts of the world, and reported that it had 239 midwives, 151 beds for gynaecological cases, 388 maternity beds and an output of 31,255 babies in 1969.
In 1975, the foundation stone of the new SGH was laid. On 12 September 1981, the new eight-block SGH was officially opened by the then Prime Minister, Mr Lee Kuan Yew. The commissioning of the third SGH was completed in 1983 when the Supplies Department and the Linen Supplies Unit were transferred to Block 8. The new SGH had cost $194 million, excluding land costs. In 1976, the Government Analyst Department at Sepoy Lines changed its name again to the Department of Scientific Services, to reflect the wide range of new services that were incorporated in the department; namely, radiation, microbiology and chemical engineering, and was transferred to the MOH in 1983. Thus the current SGH, as we know it today, is the fourth general hospital to be built at the Sepoy Lines locality.