KAMALIKA PIERIS

The first contemporary monograph on western medicine in Sri Lanka was C.G Uragoda’s History of medicine in Sri Lanka from the earliest times to 1948, issued as the centenary publication of the Sri Lanka Medical Association in 1987. It recorded the   development of western medicine during the Portuguese, Dutch and British occupation and discussed the treatment and control of select diseases such as malaria which were prevalent in that period. This book was immediately recognized as a landmark publication.

The Sri Lanka Medical Association  (SLMA) followed this up with History of Medicine in Sri Lanka: 1948-2018’ issued in 2018, edited by Iyanthi Abeywickrama,  Palitha Abeykoon, Philip Veerasingam and Lakshman Karaliadde. Two years before, in 2016 Hillary Coorey and Dileepa de Silva published ‘One hundred years of Dentistry in Sri Lanka’ placing on record the achievements of dentistry in Sri Lanka.

Pediatrician Manouri P Senanayake provided a history of pediatrics in her work Pediatrics and child care in Sri Lanka” (2007) .She described the development of pediatric services in the island, with special emphasis on Lady Ridgway Hospital. She records the work of Sri Lanka Pediatric Association and Sri Lanka College of Pediatricians, and gives a list of those who had held office in these organizations. The book also carried biographies of prominent pediatricians, complete with photograph. Manouri followed this up with Women in Pediatrics, eight portraits” (2 ed. 2011) recording the achievements of eight prominent female pediatricians in Sri Lanka.

Lastly, Ravindra Fernando provided a history of the National Poisions Information Centre, the first in South Asia, titled ‘Twenty years of disseminating lifesaving information’, published by the Centre in 2008.

In 2022, the College of Surgeons of Sri Lanka celebrated its 50th anniversary by publishing, a History of Surgical services in Sri Lanka from the Earliest Times to 2021.” This is the newest addition to the histories of medicine in Sri Lanka and a very valuable one.  

The book examines both schools of surgery known in Sri Lanka, the indigenous system practiced in ancient times and the western one which is practiced today.  It offers much new information on the ancient system of surgery and provides for the first time, definitive information on the western system which replaced it.  The information on modern surgery fills a large gap in the literature on western medicine, making it a significant addition to the history of medicine in Sri Lanka.

The book documents the evolution of modern surgery in Sri Lanka, from its beginnings, when surgeons worked with the limited resources and produced good results. The book then goes on to provide a comprehensive, up to date, account of the development of contemporary operative surgery in Sri Lanka, with special emphasis on the individual surgeons who pioneered the sub-disciplines and those who are carrying on the tradition today.

The College of Surgeons said it had several goals in mind when it planned this book. Firstly, to ensure that present day surgeons know about the past, secondly, to show the steady evolution of surgery amidst odds” to the intelligentsia as well as the doctors,  and thirdly, to show the range of sub specialties that are now available island wide and how they were developed.  That explains the size of the book.

The book is a large, heavy tome of over 500 pages, profusely illustrated with fine color photographs on quality paper, making it look like a coffee table book, which it is not. It   is a very comprehensive, reliable academic work, consisting of texts written by experts, collated and edited by Channa Ratnatunga, a former President of the College of Surgeons , and  winner of the Hallett prize (1969) and  Moynihan lectureship ( 1995) . It is a mammoth work and   a magnificent achievement.  The editor, Channa Ratnatunga and  those who assisted him must be congratulated on this document.

The compilation arose as we realized that with time, we were losing the memory of our surgical predecessors, who had contributed to the development of surgery in the country, said the Editor. Many of them were not only practicing surgical giants of their day, but also pioneers, teachers, trainers and role models to the next generation of surgical trainees. 

‘The giants of the past did not measure what they did, they worked with what they had, grasped new developments and worked for improvement.  We set an example to many other countries. They did what they could with whatever they had, at personal cost of time and family time. They also fought to improve the situation, said Arjuna Aluwihare, in his foreword. ‘Anesthesia was primitive, most facilities we enjoy today were non-existent, only the surgical skills of the surgeon enabled the patient to survive and recover’.

Earlier surgeons had only their five senses, to diagnose disease, but with experience they also developed a sixth sense in diagnosis and treatment, Shelton Cabraal observed in his Presidential address to Sri Lanka Medical Association (1974).

 The book carries substantial accounts of these surgeons. The first generation started with E.L. Koch (1838-1877) J.J. Loos, W.G. Rockwood, T.F.Garvin, H.G. Thomas, S.C .Paul, H.B. Mylvaganam and others ending with A.M. de Silva (1907-1940).  A M de Silva was known to the next generation of surgeons and they were able to say something about him.   PR Anthonis said A M de Silva, was a fine diagnostician and a great teacher.

The first surgeons had gone to Calcutta to study at Medical College, Bengal (est. 1835) then to Aberdeen or Edinburgh for postgraduate training.  On their return they were employed in Colombo and also posted to outstations such as Galle, Matara, Kalutara, Kegalle, Kandy and Jaffna.   

These surgeons kept records of their cases and presented them at meetings of the Ceylon Branch of the BMA (British Medical Association) held in Colombo. No one who looked at these reports can fail to be inspired by the achievements of the pioneer surgeons of this country. Working in remote places, they laid the foundations of sound surgical practice in Ceylon, said H.S. Kirthisingha.

The book carries descriptions of surgeries done in   colonial times. The first ever ovariectomy in the country was done by Dr P.D.Anthonisz In 1864, before a large audience.  He had also removed a thorny fish from a man’s throat, by going in through the side of the neck. The operation was acclaimed abroad, as no such operation had been attempted even in Europe. AM de Silva had removed a foreign body from the trachea of a patient using a magnet tied to a piece of string lowered into the trachea through a tracheotomy.

Surgery was reported from the outstations too. R.G Van Royen had removed a very large cyst at Haputale hospital in 1808 . Operations conducted between 1887 and 1890 were reported from Kalutara,  Galle,  Kegalle, Kandy,  Matara.The operations in those days had to be quick as chloroform, the anesthetic used,   was toxic to the liver. 

The book provides new information for the medical historian. Dr Nicholas Senn, Professor of Surgery at University of Chicago was in Ceylon in 1904 on a tour of inspection. He had  visited the General Hospital, Colombo and  described what he saw in  his work  Around the world via India, a medical tour” (1905). His  account is quoted in full in the book.

There are interesting extracts from the reminiscences of these surgeons. ATS Paul   had  recorded what he saw  in  the General Hospital Colombo  in the 1930s and 1940s.   Consultants wore waistcoats  despite the hot  weather,  said  Paul. Each week a day was  set apart  for operations of paying patients in an operating theatre specially reserved for them. It had marble flooring imported from Italy. There were only 10-20 medical students. They   were taught in the wards, there were no formal lectures.

When Milroy Paul  was stationed in Jaffna in 1931 , he found that the brass oil lamp  in the operating theatre was not to be used for operations. It must be kept intact for the annual audit. So no operations were performed at night. Milroy Paul   recalled that  surgical  gowns  were not sterilized, at that time,  they were dhobi washed and were worn before scrubbing..  

The book moves onwards from the British period to surgery in independent Sri Lanka .The first surgeons were General Surgeons” who were expected to   deal with all surgical cases that came their way.  They were sent to the provincial hospitals as well as the General Hospital, Colombo.   

 The book features, one by one, province by province, all the hospitals that offered general surgery. There is a descriptive note on each hospital and photographs of all the surgeons who are currently working there and those who were there in the past. There is also a brief account of the patterns of surgical disease  with comments on selected surgical conditions.

General surgery later gave way to surgical specialties.   The book allocates a separate chapter to each specialty, written by specialists in that subject.  The chapters follow a set pattern. How the specialty started, its entrenchment in Colombo and its development in each of the provinces. This is given in great detail, with much description, and includes a table which shows the expansion of the specialty in each province, by number of beds and number of surgeons. Every chapter carries biographical information on each of the surgeons,   past and present, who   practiced that specialty.

Some of the   chapters end dramatically with an eye catching map showing the surgeons available in this specialty in the island as at 2021. This is presented in a novel manner, with photographs of the surgeons, neatly blocked with arrows linking them to the province they are working in. This is original and very effective.

The book has a separate chapter  for  the teaching of surgery in the university .It has extensive sections on each of the university departments of surgery in Sri Lanka, located in the medical faculties of    University  of Colombo,  Peradeniya , Jaffna, Ruhuna, Kelaniya, Sri Jayawardenepura,  Rajarata,  Eastern, Wayamba and  the  Kotelawala Defense University. The history of each department of surgery, its beginnings,   subsequent development and the new services introduced to the hospitals by these departments are meticulously recorded.

The medical services which support surgery, Anesthesia, Intensive care, Blood transfusion, Imaging and   Pathology are also in the book. The history and development of each of these are given in great detail, including the doctors who worked in these departments. There are names, dates, quick description of services rendered by selected doctors accompanied by photographs.

The   nursing staff   are vital to the success of any surgical operation. They are not forgotten in this book. Among other references, there is special mention of an enthusiastic male nurse,  IWMP Wanigasuriya who was nurse in charge of the Endotherapy centre  in Colombo South Teaching hospital in 2001. He made an enormous contribution to the  development of the Centre and post graduate training. He had developed  a sustainable training program for endoscopy nurses. 

The editors have  used photographs, lists, tables and maps,  very cleverly  as a substitute for text. There is a  full list of the Sri Lanka surgeons invited to give the Hunterian Oration at the Royal College of Surgeons , London,  and those awarded the  Hallett prize. Historical information is also given via lists. There is a list of FRCS surgeons working in Colombo 1910-1948  and a list of the antiseptics available in 1946. For the  College of Surgeons, there is a list of the Orations given  ,winners of  awards  and even a list of  the names of the editors of its journal.

 Among the many tables in this book there is  one table showing the expansion of general surgeons in the public sector 1996 – 2019, another showing the provincial distribution of general surgeons  1948-2019   and a third table giving the number of beds in surgical wards, by district  1991- 2019.. 

The book ends with an extensive  account of the work of the College of Surgeons. The early history of the Association  is given. There is a chapter for each year, from 1971 to  2021, giving the names of President and  Council and the  main achievements for that year, with photographs. That section increases in size as it goes on, indicating that the College has  expanded its activities and is going from strength to strength. A  colour photograph of the staff  working  in the office of the College of Surgeons  is a nice touch.

The College of Surgeons was entrusted with the task of setting up the  SAARC Surgical Care Association .It did so successfully in 2002. The headquarters was to be in Sri Lanka and in 2012  the College  was able to set up a  SAARC SCA headquarters in a building owned by the College in Rajagiriya.  ( Continued)