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Prof. K. Sivapalan Regional meeting of the PSSL, Held in Jaffna on 29.06.2013.

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Presentation on theme: "Prof. K. Sivapalan Regional meeting of the PSSL, Held in Jaffna on 29.06.2013."— Presentation transcript:

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2 Prof. K. Sivapalan Regional meeting of the PSSL, Held in Jaffna on

3  Allopathic Medicine probably entered Sri Lanka with the arrival of Europeans.  It was introduced to general public with the arrival of American Missionaries. 29-Jun-13History of Medicine in Jaffna 2

4  The first batch of 5 Missionaries [Mr. Richards and Mr. Warren with some exposure to medicine] arrived in the island in  The intention of the American Mission Society had been to establish this Mission in India, but the East India Company forbade such an intrusion at that time.  So they arrived at Point de Galle and traveled to Colombo. 29-Jun-13History of Medicine in Jaffna 3

5  Their services in Ceylon also was not readily accepted by the then Governor.  They may have wanted to settle in close proximity to India  They may have wanted to become proficient in the language spoken in the south of India  If so why to Galle? 29-Jun-13History of Medicine in Jaffna 4

6  On arrival (1816), the mission started a hospital at Tellippalai ‘for the cure of both soul & body’.  This was the first non –official effort to introduce western medicine into the country.  They brought Western Medicine to the people of Jaffna, where it was received in lukewarm fashion.  Mr. Richards and Mr. Warren contracted tuberculosis and succumbed to the disease in 1821 and 1822 respectively 29-Jun-13History of Medicine in Jaffna 5

7  First dispensary in a thatched hut in Pandaitharippu on 18 th June  He carried out successful operations: Plastic reconstruction of mutilated ears, above knee amputation, excision of large tumours and even cataract operations. During those days there was no anesthesia, blood transfusions or antibiotics.  Dr. Scudder left Jaffna for Madras in 1836 and later shifted to Vellore.  Dr. Ida Scudder, Founder and Principal Emeritus of the Vellore Christian Medical College, was a granddaughter of Dr. John Scudder.  Dr Jonathan Ward succeeded and returned in Jun-13History of Medicine in Jaffna 6

8  Boston- Madras- Point Pedro  Ignorance and superstition was rife  The common diseases were frequent epidemics of cholera and small pox, fever and lung infection, an itch - perhaps scabies, fever and malaria, cancer of the mouth and the wealthy died of diabetes.  The first Tamil patient was a pundit who taught Tamil to missionaries.  He had fever which did not respond to the treatment of local practitioners and as a last resort they went Dr. Green. He diagnosed the abscess and after operation the patient improved tremendously and Dr. Green became famous. 29-Jun-13History of Medicine in Jaffna 7

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10  Dr. Green realized the need for increasing the number of medical practitioners and decided that the only way was to start a Medical College  He selected students from the Batticota seminary (presently the Jaffna College Vadduccoddai) and started a 3-year course in Medicine based on the curriculum in American Universities at that time.  The admission criteria is not specified anywhere but it could have been after graduation, as in America.  87 completed the course under him in 9 batches and 18 students of tenth batch and 15 students of eleventh batch completed after he left [total of 110].  The graduates found employment in the newer hospitals being established by the government or as General Practitioners and also in countries like India and Malaya 29-Jun-13History of Medicine in Jaffna 9

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13  The course was free of charge and the students were given a stipend of about 7 shillings per month  The medium of instruction was English initially and changed to Tamil in 1864 and he translated the books into Tamil and authored some in Tamil.  The reason for the change is not clear: two views are given in different sources: To increase the intake to meet the needs for doctors, he had to change the medium into Tamil Since the graduates did not stay to serve the local population, he thought of teaching them in Tamil 29-Jun-13History of Medicine in Jaffna 12

14  During the latter part of the 19 th century, Cholera, malaria and parangi were causing severe depopulation in Wanni. Dr. James Loos who was the Colonial Surgeon for the Northern Province in his report ended thus: “ in connection with the establishment of Hospitals and dispensaries, I recommend the adoption of a plan for medical education in the island itself. This good work is to a certain extent, being carried out among the Tamils by Dr. Green; but I think the benefits of improved medical practice deserves to be extended to other districts of the island and other classes of the community (and to protect patients from untrained quacks), and this is my opinion can be best accomplished by the establishment of a medical school in Colombo.”  This laid the foundation for the establishment of the medical school in Colombo on the first of June, 1870 with 25 students, 3 year course, fee of 2 pounds per session.  The Colonial Surgeons worked as administrators only. 29-Jun-13History of Medicine in Jaffna 13

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16  Since Dr.Green practiced abdominal surgery it is likely that he knew anesthesia, use of ether was first demonstrated at Massachusetts in1846  He might have used ether or administered opium with alcohol for anesthesia.  Dr. Sivarajah- his grandfather’s experience: four men held patient in position for the surgeon to operate.  Chloroform 29-Jun-13History of Medicine in Jaffna 15

17  The government decided to reduce its grant of Rs per year for 1883 to 1000 Rs and to stop completely after that.  This resulted in closure of the college  The reason behind this change in policy is not clear 29-Jun-13History of Medicine in Jaffna 16

18  Dr. Green had been a surgical giant of his day. According to his letter, in 13 months he had done over 800 operations, which included amputations, removal of cancers, strangulated hernias and fractures.  Dr. Green was very happy that native physicians bought his Tamil medical textbooks and some of them sent their sons to study western medicine under him  Returned to America due to ill health (?tuberculosis) in 1888, returned to Jaffna in 1862 and worked till  Dr. Benjamin A Mills stated on his demise in 1884, “During Green’s time, Jaffna was regarded as the headquarters of western medical science in South-East Asia”.  There are questions as to why Dr. Green is not respected as other Missionaries who contributed to Tamil Language.  Samuel Green Memorial prize is given to the best candidate once in 3 years, sponsored by JMA. 29-Jun-13History of Medicine in Jaffna 17

19 29-Jun-13History of Medicine in Jaffna 18 Inscription at “Late Green’s Gravestone ”

20  The medical registration ordinance was passed in  A sample- from a American Ceylon Medical College graduate practicing in Green Memorial Hospital Karithivu, Jaffna.  This hospital was built by one of Dr. Green’s students in 1897 and part of the cost was met by Dr. Green’s brother in America 29-Jun-13History of Medicine in Jaffna 19

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22  It was established by Ackland Dyke, the Government Agent, N.P., with the assistance of Dr. Green and in collaboration with the Friend-in-Need Society of Jaffna opened in  This hospital has grown into what is now the Teaching Hospital, Jaffna.  In 1863, Dr. Green took over the administration of this Hospital on the invitation of the then Government Agent.  Although the American mission had no connections with the Friend –in-need society, Dr. Green accepted the post for a trial period of 3 months, but eventually continued for 5 years.  The medical staff of the Jaffna Friend –in-need society hospital was drawn almost totally from the graduates of Dr. Green’s medical school. 29-Jun-13History of Medicine in Jaffna 21

23  After a lapse of 20 years during which period the Mission Hospital was looked after by the local graduates of the Medical School, a boost to medical education was given by the arrival of Dr. & Dr. Mrs. Scott.  Dr. Mrs. Scott was the first lady doctor to serve in Jaffna.  She started the first nursing school at Manipay –nearly 70 years before the present nursing school in Jaffna was established. 29-Jun-13History of Medicine in Jaffna 22

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25  Two sisters of the American Mission (Mary & Margaret Leitch) who had been in Jaffna since 1880 felt the need for a hospital for women.  In 1890 joined the Zenna Bible & Medical Mission of London and collected funds to build a hospital.  Subsequently in 1896 both the sisters re-joined the American Mission and transferred the hospital project to the American Mission.  The hospital was formerly opened in 1898 at Inuvil and named McLeod Hospital after Rev & Mrs. McLeod who contributed a major portion of the fund.  Since then the hospital has essentially served as a maternity and later children hospital. It was not until the 1970s that males were treated. 29-Jun-13History of Medicine in Jaffna 24

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27  Genuinely destitute patients, [25% of the total] were not charged for consultation and medicine.  A 25 cent ticket was required for admission to the dispensary (valid for three months)  If the patient is not cured, the money is refunded. Medicines were sold at cost plus a small amount for the salary of the dispenser and compounder.  Fee for surgical operations ranged from 25 cents to 25 rupees.  Private patients or home visits were charged at the rate of 5 rupees if transport was provided or additional charge for transport.  In-patients had to pay few cents to cover the cost of cleaning the premises.  The charges were enough to meet 3/4 th of cost of running the dispensary. 29-Jun-13History of Medicine in Jaffna 26

28  The FINS Hospital came under Civil Medical Department in 1907 and re-named as Jaffna Civil Hospital.  According to Sir William Twynam, Government Agent, N.P.: There are now besides the FINS Hospital and Dispensary, a Government Outdoor Dispensary, the American Mission Hospitals at Manipay and Inuvil, a small hospital at Karaidivu, hospital and dispensary at Chavakachcheri, Government Hospital at Point Pedro, Mannar, Mullaitivu, Vavuniya and a hospital at Mannar island. And in addition to these, there are about village dispensaries. 29-Jun-13History of Medicine in Jaffna 27

29  No significant development was observed at the Jaffna Civil Hospital during this period.  A prejudice prevailed among the people against the Civil Hospital and the hospital was referred to as the Pauper Hospital.  However 3 qualified Surgeons worked at the Jaffna Civil Hospital from the mid 1920s to early 1930s. They were Dr.I.T.Kunaratnam, F.R.C.S, Dr.A.H.C.de Silva F.R.C.S and Dr.Milroy Paul F.R.C.S.  Bed strength of the hospital was 200 with a 6 bed ward for private patients.  Dr.Paul records in 1931, post operative sepsis was uncommon in elective surgery which he felt was due to lack of overcrowding, the strict observance of asepsis and mostly to the excellent nursing in both the Theatre and the Ward. 29-Jun-13History of Medicine in Jaffna 28

30  Dr. W. Jameson was responsible for building the modern Manipay Green Memorial Hospital.  With his arrival in 1923 he transformed this hospital scene for the next 15 years and enjoyed tremendous popularity in Jaffna. He performed over 500 operations annually;  He raised the professional standard of his assistants by sending the doctors for postgraduate training abroad to such centers as London, Edinburgh, Berlin and Vienna.  He equipped the hospital with X-ray plant, ECG recorder, BMR apparatus and Choul apparatus for the treatment of cancer.  He attracted patients not only from Jaffna but from all over Ceylon. 29-Jun-13History of Medicine in Jaffna 29

31  Rapid expansion and development commenced  Specialists were appointed to the basic and sub- specilties and it became a General Hospital.  In the 1960s, it was a recognized centre for postgraduate training for the Final Examinations of the Royal Colleges of England.  Psychiatry was not given consideration or the importance it deserved  A few were perhaps treated inadequately by physicians qualified in western medicine, but the majority were treated by Ayurvedic physicians, spiritualists and faith-healers. 29-Jun-13History of Medicine in Jaffna 30

32  From the start of the Psychiatric Unit in Jaffna there was a rush of patients who were admitted voluntarily into two hospitals at Point Pedro and Kankesanthurai.  A special mention must be made of the pioneer psychiatrist, the late Dr.T.Arulampalam, who worked relentlessly to popularize psychiatry and dispel false beliefs and misconceptions.  In his first year, he treated 9,000 patients.  He gave several talks to the public – about 40 talks in four and a half years.  He established a society called ‘Friends of the Psychiatric Unit at KKS’ to encourage welfare of the mentally ill patients. 29-Jun-13History of Medicine in Jaffna 31

33  This was a period of time when community hospitals developed by the people on a cooperative basis became popular.  The most important hospital in this category was Moolai Cooperative Hospital.  From 1950s until early 1970s, this hospital was the scene of much development and popularity centred around the personality of Dr.N.T.Sampanthan FRCS.  Another Cooperative Hospital was established in Tellippalai. 29-Jun-13History of Medicine in Jaffna 32

34  The arrival of American Missionaries to Jaffna appears to be accidental.  Their primary purpose was to spread the message of Gospel.  Even though they tried to change the people into Christian Tamils, as Dr. Green observed they became Europeanized Hindus.  This did not affect the genuine concern of the Missionaries on the health of the people and people also accepted them for what they were.  Dr. Benjamin A Mills stated on the demise of Dr. Green in 1884, “During Green’s time, Jaffna was regarded as the headquarters of western medical science in South-East Asia”. 29-Jun-13History of Medicine in Jaffna 33

35  This presentation was prepared using the following materials: Life and letters of Samuel Fisk Green M.D. of Green Hill, compiled by Ebenezer Cutler D.D. (1891) Nineteenth Century American Missionaries in Jaffna, Ceylon with special reference to Samuel Fisk Green, by Thiru Arumugam (2009) Presidential address (JMA) 1980/1981 by Charls Wijayarajah Contributions of the American Mission in the field of Medicine by Dr.N. Sivarajah (1991) Dr.Samuel Fisk Green’s Contribution to Medical education, by Dr. N. Sivarajah, (1998) 29-Jun-13History of Medicine in Jaffna 34

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