A SHORT HISTORY OF KANDANG KERBAU HOSPITAL AND THE MATERNITY SERVICES OF SINGAPORE YKLee ABSTRACT This article traces the history of Kandang Kerbau Hospital ("the hospital beside the Bukit Timah Canal") and the maternity and infant welfare services of Singapore from 1858 to the present. This includes the development of teaching of Obstetrics and Gynaecology to medical undergraduates and postgraduates, and the training and registration of midwives, and the resulting saving of maternal and infant lives. Why was Kandang Kerbau Hospital converted into a Maternity Hospital in 1924? Keywords: Maternal and infant mortality, Maternity and Infant Welfare services, Medical undergraduates and postgraduates, Midwives. SINGAPORE MED J 1990; Vol 31: 599 - 613 INTRODUCTION In 1858, a hospital was built at Kandang Kerbau which later became known as the General Hospital. It The district around the crossroads formed by Serangoon consisted of two sections. One, known as the Seamen's Road, Selegie Road, Bukit Timah Road and Rochor Road Hospital, was for Europeans, and the other, the Police is known in Malay as "Kandang Kerbau" ("Buffalo Hospital, for the local people. (The original Seamen's Enclosure", because in the old days, there was a buffalo Hospital was at Pearl's Hill, and patients were admitted pen in the locality), in Teochew and Hokkien as "Tek to the new hospital when it was ready for occupation in Kah" and in Mandarin as "Zhujiao" ("Below the clumps of 1860.) Built at the same time. next to the General bamboo", because in the early days, clumps of bamboo Hospital, was the Lunatic Asylum. grew on the hillocks in the district). This practice arose In 1870, in an attempt to control the spread of because the non-English educated local people had to venereal diseases, the Contagious Diseases Ordinance select distinctive landmarks to identify the various was passed. This Ordinance, amongst other things, made localities in early Singapore, as there were no proper the medical examination of prostitutes in brothels roads and addresses or they could not pronounce the compulsory, and if diseased, their admission into hospital English names. for treatment also compulsory. The examinations were Kandang Kerbau Hospital is today a maternity to commence on 1 January 1873, and hospital hospital. But it did not become one until 1924, although accommodation had to be provided. So in 1872, the there has been a hospital at the same site beside the Female Ward of the General Hospital was converted Bukit Timah Canal (which was originally a tidal creek) into a Lock Hospital with 20 beds for the treatment of since 1858. Moreover, Kandang Kerbau Hospital was venereal diseases in women. not the first maternity hospital to be founded in Singapore. In July 1873, cholera broke out in the Lunatic Asylum and the surrounding Kandang Kerbau district. Patients THE EARLY YEARS (I) from the General Hospital and the Lock Hospital were evacuated, those from the General Hospital to the Sepoy Why was this hospital beside the canal converted into a Lines, and those from the Lock Hospital to a rented maternity hospital in 1924? What were its functions house. The Lunatic Asylum at this time was very before that, and what part did it play thereafter in the overcrowded, and after the General Hospital patients development of the maternity services of Singapore which were transferred to the Sepoy Lines, "53 of the quiet and had started much earlier? well-behaved lunatics" were moved into the empty buildings thus relieving much of the overcrowding! After the cholera epidemic was contained, the women Toa Payoh Hospital returned to the Lock Hospital but not the patients of the Toa Payoh Rise General Hospital. They remained at the Sepoy Lines Singapore 1129 because the authorities decided that the locality was more suitable, and that the General Hospital should be Y K Lee, AM (S'pore), M.D., FRCP (Lond & Edin), used to increase the accommodation of the Lunatic FRACP Senior Consultant Asylum, and to supply more wards to the Lock Hospital. (Formerly Consultant Physician & Medical An order was passed by the Governor in 1884 making Superintendent of Kandang Kerbau Hospital) the Lock Hospital a hospital also for the treatment of licensed prostitutes suffering from diseases other than 599 venereal diseases. The first patient was admitted on 2 January 1889 On 1 January 1888, the law was changed, and and was safely delivered of her baby. There were a total compulsory examination and treatment were stopped. of 11 admissions in 1889 with 10 infants born alive and The Lock Hospital was converted into a voluntary well. All 11 mothers made good recoveries. institution. Admissions fell and cases of venereal diseases Although the patients were few in the first year, the increased. Efforts were made by the medical authorities Maternity Hospital did supply a want and was to play a to save the situation. An Outpatient Department was great part in the years to come, although its existence started in the Lock Hospital for the benefit of women was precarious in the early years. It occasionally had to who wanted treatment but did not wish to be admitted. close when there was no staff, e.g. from 14 May 1890 to I will now deal with the history of the maternity 13 October 1890 when the Matron resigned and no services of Singapore and return to the hospital beside replacement could be found in Singapore, and had to be the Canal later. recruited from Madras. The hospital re -opened when Mrs Hennesey, the new Matron and Midwife, arrived. FIRST MATERNITY HOSPITAL In 1890, during the months when the hospital was opened, 8 confinements took place in it. All the mothers The founding of the first maternity hospital came about did well and the infants were born alive, although one in the most unexpected manner. was premature and died some days after its birth. In early 1885, when there was a proposal to employ The first admission of an Asian patient took place in nuns from the Convent as nurses in the new General December 1890. She was an Indian; all other patients Hospital at Sepoy Lines, there was opposition from some had been Europeans or Eurasians. of the prominent European inhabitants. They went so far as to petition the Secretary of State for the Colonies. During 1891, 12 Indian women were admitted. Up till then no Malay The Secretary of State noticed that one of the arguments or Chinese woman had applied for With adduced against the scheme was that the nuns were admission. 13 Europeans and 4 Eurasians, the total precluded by the rules of their Order from dealing with admissions were 29. Out of the 29 admissions, 25 confinements 4 had midwifery cases. He noted that this did not constitute a terminated naturally and "praeternatural" valid objection as general nursing and midwifery could (abnormal) labour, but in all cases, the mothers made recoveries. 8 not be safely combined, said that he assumed that in good Twenty-one boys and girls were - 1 Singapore, lying-in cases were separated and nursed born 24 full -term, 2 premature who died, entirely apart from others, and asked for more information stillborn and 2 miscarriages at 20 weeks. about maternity hospitals and the practice of midwifery. In 1892, the first Chinese patient was admitted into When his despatch reached Singapore, the authorities the hospital. were in a predicament as there were no facilities for The first set of twins were born in 1893, but the case maternity cases in the hospitals. In those days, women was complicated with interlocking of the heads at the gave birth at home attended by doctors, midwives (mostly pelvic brim. The first -coming child, already dead, was untrained), relatives or friends or were unattended. The decapitated to allow the birth of the second who was maternity mortality rate and the infant mortality rate were born alive. high. The manoeuvres that had to be performed for obstructed labour would There was a flurry of activity, and the Governor replied be unbelievable to the modern generation of - to the Secretary of State stating that he agreed that obstetricians decapitation, craniotomy, there was a need of suitable provision for lying-in cases. cephalotripsy, evisceration. He mentioned that in the past five years only two The hospital grew in popularity and admissions midwifery cases had come to the General Hospital, and increased yearly, but admissions dropped when hospital that Dr Rowell, the Principal Civil Medical Officer, had charges were increased from 1 October 1894 to make already pointed out the advisability of erecting a separate the hospital 'pay its way", compounded by the fact that Maternity Hospital, and assured the Secretary of State two midwives commenced private practice and charged that steps would be taken to start the Government fees lower than the hospital. maternity services as soon as possible. TRAINING OF MIDWIVES A building at the junction of Victoria Street and Stamford Canal opposite the was Convent converted In October 1894, during the debates in the Legislative into a maternity hospital. The upper was storey set apart Council on the Estimates for the next year, it was for the women. It accouchement of had accommodation suggested that the Maternity Hospital should be used as for 8 beds, 4 Europeans 4 for and for local people. It a school for training local women as midwives. was opened on 1 January 1888, but had to close a few Maternal deaths were first reported in 1894. Four out days later because the Municipal labourers in dredging of 71 women who were delivered. the canal threw up large quantities of black foul-smelling One died of cardiac failure, the second of puerperal septicaemia, the third of mud next to the hospital! It was re -opened on 1 October pulmonary embolism, and the of puerperal 1888 but had no patients when the year ended.