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Mental Health in Singapore: The First Hospital for the Mentally Ill (1841-1928)
By Admin | June 6, 2008
by Tan Mei Yan
Continuing The Early Years (1819-1840)
Completed in 1841, the Insane Hospital was situated at the corner of Bras Basah Road and Bencoolen Street (Ng 2001, 9; IMH 2003, 16). In spite of the unfortunate death that occurred, due regard was still not given to mental health care. Conditions at the Hospital were not better than had been at Convict Gaol. It was a 30-bed hospital, and “the number of lunatics seldom exceeded 30 or 40” (Ng 2001, 9). The lunatics were taken care of by warders who also guarded the convicts jailed in the adjacent brick structure (Ng 2001, 9).
Colonel W. J. Butterworth was made Governor of the Settlements on 14 June 1843 (Lee 1978, 196). On his familiarisation tour of government institutions, he noticed the poor conditions at the Hospital (Ng 2001, 9; Lee 1978, 196). On 20 June 1844, the Singapore Free Press reported one of nine Presentations by the Grand Jury, who played an important role in influencing the management of lunatics in Singapore and whose role was different from those in criminal courts (Lee 1978, 195). The Grand Jurors had noted that little was being done to care for the mentally ill in addition to the lack of space at the Hospital (Lee 1978, 196).
Governor Butterworth was annoyed as he had believed improvements would have been made since his last visit (Lee 1978, 196). He then ordered that the Hospital be put under the personal charge of Dr Thomas Oxley, who had become Senior Surgeon in 1844 (Ng 2001, 9; IMH 2003, 16). Dr Oxley’s first step was to appoint Assistant Apothecary Henry Lloyd, a qualified medical person, to be in charge of the Hospital and personally answerable to him for the care of the lunatics (Lee 1978, 197).
By February 1846, Dr Oxley reported improvements in the Hospital conditions (Ng 2001, 9; IMH 2003, 16; Lee 1978, 197). He was also actively sourcing for avenues to supplement the Hospital income (Lee 1978, 197). Dr Oxley made three such attempts. The first was picking oakum for sale. The second was basket weaving (Ng 2001, 9; Lee 1978, 197), which was the earliest semblance to occupational therapy (IMH 2003, 16). The money earned from the sale of oakum and baskets provided for two sets of clothing per person (IMH 2003, 16).
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 (Lee 1978, 198). This failed because the Board found better quality ones could be produced elsewhere (Lee 1978, 198). Additionally, Dr Oxley introduced a system of non-restraint and attempted to change the Hospital’s public image. But the latter was to no avail due to prevalent misconceptions (Lee 1978, 197).
Throughout the colonial period, “isolation of the insane with proper justification was then thought necessary and custodial care was the mainstay of the day” (Ng 2001, 9). Treatments were administered under the belief that mental illness was caused by “a foreign body that had to be expelled from the body” (Ng 2001, 11). Hence, all lunatics were forced to take purgatives which induced diarrhoea and vomiting once every month, regardless of their physical condition. For those who were “under peculiar excitement”, “soothing medicines” were given and they were locked in their cells without restraints (Ng 2001, 18).
1847 and 1848 were uneventful save for the persisting shortage of accommodation at the Hospital. Under these circumstances, Dr Oxley was forced to discharge “harmless” patients to make room for more “dangerous” ones (Lee 1978, 197). Act IV of 1849 worsened the overcrowding (Lee 1978, 198). It stated that people who broke the law when of unsound mind would not be sent to jail but to the Hospital instead (Lee 1978, 198). 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, 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, 198). When the Grand Jury looked into the issue on 24 April 1850 following a spate of contagious skin disease in the Hospital, Dr Oxley took the chance to reiterate his point and highlight the poor living conditions at the Hospital (Lee 1978, 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, 198).
Together with the Superintending Engineer, Dr Oxley submitted a proposal suggesting that the old building be kept for those “whose insanity is at times of a violent character” and the new building for those who would respond to medical treatment. The plan was approved by the Government of Bengal on 9 August 1850 (Lee 1978, 199). Finally, the Hospital was enlarged in 1851, increasing accommodation to forty-eight beds (Lee 1978, 199). Unfortunately, this was for a hundred and thirty-one patients (Ng 2001, 11).
A 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 9am and 3pm respectively. Meals were the same everyday – rice, curry and fish. Clothing was only changed every Sunday (Ng 2001, 11; Lee 1978, 199).
Only locals were admitted to the Insane Hospital. Europeans sent to the European Seamen’s Hospital as they considered it an “insult” (Ng 2001, 12) to be put among the locals. However, they caused serious problems as shown in a letter written by the Medical Officer in-charge dated 25 June 1850. A 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, 199).
As a result, policy was changed to authorise Medical Officers to send Europeans to the Insane Hospital (Ng 2001, 12; Lee 1978, 199). As expected, this policy was not well-received among the Europeans (Ng 2001, 12). For example, the French Consul had protested when Louis Allard, a Frenchman, was admitted in February 1852 (Lee 1978, 199). Hence, the few insane Europeans were sent back to Europe unless they were poor (Ng 2001, 12; Lee 1978, 199).
On 17 August 1853, the Grand Jury suggested that the old Hospital building be torn down because it was inappropriate for convicts to be put in the Hospital by the Superintendent of Convicts as punishment (Lee 1978, 199). Dr Oxley was infuriated as this was untrue. Admissions were approved of only by himself and the Superintendent of Police. Further worsening the overcrowding, lunatics from Malacca were transferred to the Hospital. Dr Oxley’s subsequent request for more staff was also turned down (Lee 1978, 200).
A few months before his retirement in 1857 (Ng 2001, 12), on 7 April 1856, Dr Oxley brought up the issue of overcrowding to the Governor once again (Lee 1978, 200). No action was taken until a donation of $3,600 was made by Low Joon Teck and Chung Sam Teo, two Chinese merchants who had government monopoly to sell opium in Singapore (Lee 1978, 200). The Governor immediately wrote to India to build “a medical complex which would include a new General Hospital, Lunatic Asylum, Medical Stores and Dispensary” (Lee 1978, 200). The Indian government approved, but stated that the Government would provide fully for the Asylum while the donation from the merchants would be used solely for the General Hospital and the Asylum should be separate from the General Hospital (Lee 1978, 200).
Ironically, the former decision slowed the process rather than hastening it. When the Indian Mutiny broke out on 10 May 1857 in Meerut, India, government spending was limited to those of military importance. Work on the General Hospital continued, but since no funds were available for the Asylum, the old one was simply repaired (Lee 1978, 201).
With an increasing number of people being admitted, inadequacy of existing facilities and the passing of Act XXXVI of 1858 that allowed for the Government to establish Lunatic Asylums, the Governor-General finally agreed to build the new Asylum as planned in 1856. There were also plans for the Asylum to cater to the needs of the entire Straits Settlements and hence the rejection of a proposal to build an Asylum in Malacca for lunatics there. The proposal had been made because those from Malacca were unwelcome due to the lack of space here (Lee 1978, 201).
1861 saw two changes to the Insane Hospital. Its premises was now at a site near Kandang Kerbau Maternity Hospital and the Hospital was renamed the Lunatic Asylum (Ng 2001, 13). The larger building was put aside for mild cases of lunacy while the smaller buildings, where confinement cells were located, were designated for dangerous lunatics (Ng 2001, 13; Lee 1978, 203). There was a deliberate effort to have “shrubs, flower beds and grass plots” (Ng 2001, 13) in the grounds around the Asylum in order to create a pleasant environment.
Although nearly doubling in size to 100 beds, the average number of lunatics admitted was 119 (Ng 2001, 14). The number of lunatics increased tremendously because few died or were ever discharged. The general consensus was that “mental maladies are seldom fatal and generally permanent” (Ng 2001, 13). Lack of space and facilities at the Asylum were constantly reported to the government in the 1870s, but to no avail (Ng 2001, 14).
Continue: Mental Health towards the Twentieth Century
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.
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