From Colony to Republic: Singapore’s Chapter in Global Urban Healthcare History

Alexandra Hospital was established during the last period of stable British rule in the region.

With Singapore’s multicultural society, there has always been a plurality of medical and healthcare practices.

Preceding and enduring alongside the Western medical practices introduced by the colonial government were traditional medical practices and home remedies derived from the various ethnic communities. Many relied on these practices and remedies. The Chinese sought medical treatment from sinsehs (traditional Chinese physicians), the Malays from bomohs or dukans (shamans), while the Indians relied on Ayurvedic medicine.

Even when Western medicine became more prevalent, the colonial government did not extend modern medical services to civilians. Instead, community leaders took responsibility. Business leaders financed hospitals such as the Chinese Pauper Hospital, founded by Tan Tock Seng in 1843.

The arrival of an expedition by the British East India Company, led by Sir Stamford Raffles to found a British colony on the island, included medical professionals who would attend to the healthcare needs of the European community and its troops. This included Thomas Prendergast, a sub-assistant surgeon, who was joined later by William Montgomerie, an assistant surgeon. Early health and medical services in colonial Malaya were provided primarily to colonial administrators, military and police personnel, and European residents.

Initially, there was little interest in managing the spread of tropical disease throughout the local population via legislation in the Straits Settlements. British colonial administrators soon found themselves having to address this growing need to provide healthcare to civilians and implement public health policies in the late 19th century, in parallel with Singapore’s ascent in importance as the seat of government for the Straits Settlements, which transitioned from rule under the British Raj to a Crown Colony under direct British rule from London in 1868.

In the early 19th century, the British government not only sought to provide healthcare to its personnel on the island of Singapore, but also anticipated public health management and hospital needs. Given its ongoing urbanisation, the young port city was vulnerable to issues of overcrowding and disease, which industrialised European port cities such as London and Marseilles were facing.

Colonial administrations needed to implement public health measures, manage tropical disease, and construct hospital buildings, resulting in the expansion and development of technical knowledge extending from the urban and infrastructural planning previously undertaken in their African and South Asian colonies. For example, the London School of Tropical Medicine was founded in 1899 after a donation from an Indian Parsi philanthropist.

While the appointment of Singapore’s first rural health officer took place in the late 1830s, it took several decades to establish comprehensive public health services and policies on the island.

It was in the 1860s that the British government began to implement various measures to prevent and manage infectious diseases in the Straits Settlements. In 1868, three laws came into effect in the Straits Settlements—the Registration of Births and Deaths, the Quarantine Ordinance, and the Vaccination Ordinance.

This was followed by the passing of the Contagious Diseases Ordinance two years later, under which prostitution became controlled by government policy. Various public agencies and organisations were established, including the Municipal Health Department (1887), the Rural and Urban Health Authorities (1896), and the Straits Medical Association (1890).

Entering the 20th century, after three decades largely focused on developing medical practices and technology within hospitals and the medical profession, the government expanded the scope of public healthcare to include sanitation of public spaces in the growing city.

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...there is no gainsaying the fact that the chief [concern] is the health problem among Europeans, for once disease commences to make havoc there comes in its train a wish on the part of the exile to pack up and flee to more temperate climes where the constitution can be given a fair chance.

Without health in Malaya, or in any other part of the tropics, nothing else really matters for the moment; but, with health, the other worries and troubles of life can be fought with comparative equanimity.”

—Times of Malaya, May 2, 1912, p. 6.

The early history of Singapore’s hospitals saw problems such as failing infrastructure, staff and labour shortages, overcrowding, cholera outbreaks, and later, world wars. The efficient, intelligent planning, and construction of military hospitals were informed by the British’s policies for developing hospital facilities in their colonies and benefitted the development of future civilian healthcare facilities.

Singapore’s first General Hospital was sited near the Singapore River in 1821, in the cantonment for the British military. The site was originally occupied by a shed constructed quickly of wood after the arrival of the British East India Company. This modest structure was soon replaced by the first General Hospital, which provided medical care to European soldiers, sepoys, seafaring traders who visited Singapore, and locals.

The first British Military Hospital in Singapore was a stripped neoclassical-style building compound built in the 1880s10 in Pulau Belakang Mati (present-day Sentosa), the island where Fort Serapong, Fort Connaught, and Fort Siloso were situated. The military hospital ceased operations in 1912 when the new Tanglin Military Hospital was opened at Tanglin Barracks.

The General Hospital eventually dedicated itself to providing medical care to civilians in 1926. It was relocated and rebuilt many times throughout the 19th century until overcrowding prompted the construction of the seventh General Hospital, opened on 29 March 1926 by Sir Laurence Nunns Guillemard (the then governor of the Straits Settlements).

The seventh General Hospital, sited at its current location, was heralded as a landmark in Singapore’s medical history for igniting the systematic development of hospital services. It was furnished with 800 beds and consisted of three separate blocks accommodating male and female wards.

The hospital was also distinct from its predecessors due to its emphasis on providing medical care for local civilians (it had mainly served seafaring traders, the Europeans, and the military in preceding decades). Following these military hospital projects were hospitals serving specific local communities, established by missionaries or community groups under the sponsorship of local philanthropists. Tan Tock Seng Hospital (TTSH) was built in 1844 at Pearl’s Hill, and St. Andrew’s Mission Hospital was established as a dispensary in 1913.