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Mental Health in Singapore: Into the Twentieth Century

By Admin | June 6, 2008

by Tan Mei Yan 

Continuing The First Hospital for the Mentally Ill

The Grand Jury made their last Presentment on 18 October 1865, and was abolished by Ordinace VI on 1873 passed on 9 September 1873 (Lee 1978, 204). At that point of time, doctors had both clinical and administrative duties to fulfil (Ng 2001, 15). As a result, clinical matters took up the bulk of their time, while the running of the Asylum was neglected (Ng 2001, 15). Moreover, men had always been in-charge of caring for the lunatics at the Asylum. This was inconvenient due to lunatics in the female wards, so in January 1867 the first female employee to work in the Medical Department was sought (Ng 2001, 14).

The administration of the Straits Settlements was transferred from the India office to the Colonial Office on 1 April 1867, and the Settlements became a Crown Colony (Lee 1978, 205). The immediate impact on the Medical Department was an in-depth inquiry into the state of affairs in all hospitals. The Governor, Sir Harry Ord, was at first indignant until it was made clear that the purpose “was to indicate the standard of care expected” and not to put blame (Lee 1978, 205).

Since then, the Asylum was to be managed according to the Digest on Hospitals and Asylums, published on 14 January 1867 and sent to Singapore on 18 December 1867 (Lee 1978, 205). The law in place at the time of transfer was the Indian Lunacy Act of 1858, which was a simplified version of the Shaftesbury’s Act for the Regulation of the Care and Treatment of Lunatics passed on 4 August 1845. The Digest also incorporated the spirit of provisions of the English Act, and that was the benchmark expected after 1869 (Lee 1978, 206).

An outbreak of cholera in the Asylum and the surrounding Kandang Kerbau area in July 1873 (Ng 2001, 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, 7). Soon after, it was decided that the shift was to be permanent, so construction of a proper building began (Lee 1990, 7).

At the same time, a new site for the Asylum was being sought so that occupation therapy could be introduced (Ng 2001, 15). It was decided that the Asylum would also shift to Sepoy Lines (Ng 2001, 15). The General Hospital was completed in 1882 (Lee 1990, 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 2001, 16).

The new Asylum was built on cottage principles (Ng 2001, 16) with a series of detached buildings (Lee 1990, 7), and had accommodation and work facilities. Based on John Collony’s ideas, the lunatics were assigned accommodation first by gender and second by type of mental illness (Ng 2001, 16). Treatments no longer focused solely on purgatives and included sedatives.

Additionally, it was thought that “a medical man skilled in lunacy should be given charge of the Asylum” (Ng 2001, 17), so Dr William Gilmore Ellis, the first medical specialist to be appointed in Singapore, took over from Dr Tripp (Ng 2001, 18). He said that effective treatment was difficult because the lunatics came from all over the region and it was near impossible to gather each individual’s medical history (Ng 2001, 26). Dr Ellis also abolished strait jackets and the only mechanical restraint used was locked gloves (Ng 2001, 18). He showed that the mentally ill could be treated by doctors without loss of dignity, just like any other patient (Ng 2001, 2).

Treatment in those days was based on the idea that treatment should be “holistic and focused upon the lifestyle of the patient”, so “crucial elements included ‘kindness, freedom from restraint, regular hours, good food, open air exercise and occupation. Little luxuries such as betel-nut and tobacco were given’” (Ng 2001, 17).

Since the shift to Sepoy Lines, there were no big changes. In 1903, female lunatics were moved to the Pasir Panjang ward (which was used to house patients of beri-beri) to make way for the Straits and Federated Malay States Medical School (Ng 2001, 20; Samuel 1991, 185), later renamed as King Edward VII College of Medicine in 1921. Male lunatics remained at Sepoy Lines till overcrowding resulted in their eventual transfer to Pasir Panjang in 1907 as well, and then to Central Mental Hospital at Tanjong Rambutan in Perak in 1914 (Ng 2001, 21).

In the 1920s, the government decided to make use of the medical graduates to staff a new asylum (Ng 2001, 22). Right up to that point, care for the mentally ill was the responsibility of a few expatriate nurses and health attendants who lacked training in nursing (IMH 2003, 16). On 3 November 1924, the Legislative Council debated the construction of the new Mental Hospital (Ng 2001, 22). Construction began in early 1926 and was completed in the latter half of 1928. The Mental Hospital was located off Yio Chu Kang Road (Ng 2001, 22).

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 2001, 23) as causes of mental illness. 1928 also witnessed the introduction of farm work, which was the earliest semblance to rehabilitation (Ng 2001, 23). To further improve treatment and the overall running of the Hospital, a request was made in 1929 for an Assistant Medical Superintendent who had Diplomas in Psychological Medicine and Tropical Medicine and Hygiene, as well as experience in farming and gardening (Ng 2001, 23).

Two things were of particular interest at the Hospital. First was an attendance-taking machine. It was a metallic box installed with a ‘keying-in’ device (Ng 2001, 24). “Once ‘keyed-in’, a time-keeping device in the telephone operator’s room would be activated and a graph could then be plot” (Ng 2001, 24).

The second was the clock tower that carried the Hospital bell, which was cast in Leicester, England (Ng 2001, 24). “Each of the four sides of the clock tower had a clock face and was even illuminated in the hours of darkness. The bell was rung three times daily at 5.00am, noon and 4.30pm 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 2001, 24). The importance of the bell diminished with time and by the 1950s, it served only as a fire alarm and amusement for the inmates as some of them were known to have climbed up the tower to ring the bell for fun (Ng 2001, 24).

The author has just completed her first year as a Psychology major in the University Scholars Programme at the National Univeristy of Singapore. She is interested in social psychology, biological psychology and abnormal psychology. She hopes to work in a hospital setting in the future, and hence the choice of topic for the essay. The Institute of Mental Health is the largest local medical facility for the mentally ill and I feel it should have a properly compiled history. Outside my major, I love reading up on history, especially on ancient civilizations such as India and Athens, and mythology.

Reference List

Ng, Beng Yeong. 2001. Till the Break of Day: A History of Mental Health Services in Singapore, 1841–1993. Singapore: Singapore University Press.

Lee, Yong Kiat. December 1978. “The Lunatic Asylum in Early Singapore (1819-1869)”. Chapter 5 in The Medical History of Singapore. Singapore: Southeast Asian Medical Information Centre (SEAMIC), a special project of the International Medical Foundation of Japan (IMFJ) started in April 1977.

Institute of Mental Health/Woodbridge Hospital <(Singapore). 2003. Loving Hearts, Beautiful Minds: Woodbridge Hospital Celebrating 75 years. Singapore: Armour Publishing Pte Ltd.

Ng, Beng Yeong. 2001. “History of Psychiatry in Singapore”. Section 1, Chapter 2, in Psychiatry for Doctors, edited by Kua Ee Hock, Ko Soo Meng and Lionel Lim Chee Chong. Singapore: Armour Publishing Pte Ltd.

Lee, Edwin. March 1990. Historic Buildings of Singapore. Singapore: Preservation of Monuments Board.

“Indian Rebellion of 1857 – Wikipedia, the free encyclopedia.” Indian Rebellion of 1857. http://en.wikipedia.org/wiki/Indian_mutiny. (Accessed on 17 April 2008.)

Samuel, Dhoraisingam S. December 1991. Singapore’s Heritage: Through Places of Historical Interest. Singapore: Elixir Consultancy Service.

Topics: Singapore, Impressions | Conversations, singapore history, mental health, woodbridge hospital |

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