An American Doctor’s view of colonial Ceylon in 1905
by Sachi Sri Kantha, February 16, 2020
In Chapter 10 of this series [https://sangam.org/from-sachis-files-chapter-10/] I provided the impression of an American nurse Ms. Annette Beals, in 1939. She reported about the medical conditions in Jaffna. In this chapter, I provide impression of an American doctor Nicholas Senn (1844-1908), in 1905. This was from a chapter of his book, ‘Around the World via India – A Medical Tour’, published by the American Medical Association Press, Chicago.
Nicholas Senn, in 1904
Thirty years ago, while I spent time at the then Medical College of Pennsylvania, Philadelphia, I came across this book on the library shelf, and copied this particular chapter, for my later use. Now, I transcribe the details verbatim here. Unlike Ms. Beals, Dr. Senn visited only Colombo and its suburbs (Hendala) as well as Kandy and Peradeniya. From internal evidence presented in the chapter, I could infer that Dr. Senn arrived in Colombo on August 24, 1904. And the note at the end of the chapter states, ‘Madras, India, Aug. 30, 1904’. As such, he had spent only a week in Ceylon. Therefore, his anthropological descriptions about Sinhalese character, and observations on ‘lowly-born Indian Tamil coolie’ were ephemeral at best. Some have to be taken for their face value only. A Wikipedia entry on Dr. Nicholas Senn can be accessed in the link, https://en.wikipedia.org/wiki/Nicholas_Senn
Nevertheless, Dr. Senn had provided thumb nail sketches on the prevailing diseases of the period conditions of hospitals (Colombo General Hospital, Leper Asylum at Hendala, and Kandy General Hospital), and most interestingly the few statistical details about the Ceylon Medical College and the composition of students and academics in 1904.
This year marks the sesquicentennial of the Ceylon Medical College. It was merged with the Ceylon University College in 1942, and became the first Faculty of Medicine of the newly established University of Ceylon. Dr. Senn records that the student number in 1904 was only 120, and the teaching faculty consisted of “32 professors, lecturers, demonstrators and assistants”. Most interesting statistic for me was, “The fee for the whole course in advance (to be paid in one sum at the commencement of the first college year), is 800 rupees ($256).” Look at that currency equivalent figure with the American dollar! 1 dollar equaled 3.1 Sri Lankan rupees. 115 years later, now 1 dollar equals 181 Sri Lankan rupees.
1905
Another interesting feature in the chapter is the photo (Fig. 36), Dr. Senn presents as the ‘Tooth of Buddha’, which is preserved in Kandy Sri Dalada Maligawa (Temple of the Sacred Tooth Relic). I provide a scan of this photo, nearby.
Dr. Senn’s book is NOT indexed in the ‘Bibliography of Medical Publications relating to Sri Lanka, 1811-1976’ compiled by Kamalika Pieris and C.G Uragoda in 1980, as well as in the 5 volumes of ‘A Bibliography of Ceylon (Sri Lanka)’ of H.A.I. Goonetileke, published between 1970 and 1983.
Chapter: Ceylon
[from the book, ‘Around the World via India – a Medical Tour’ by Nicholas Senn, American Medical Association Press, Chicago, 1905, pp.167-195]
The voyage from Adelaide to Colombo takes fourteen days. I left Adelaide August 11 and arrived at Colombo on the 24th, a little ahead of the stipulated time. The only rough weather we encountered was for four days in crossing the great Australian Bight, a part of the ocean that has an unenviable reputation with people who are subject to seasickness. Our good, staunch, storm-tried ship, the China, played with the foam-crested waves by a graceful combination of rolling and pitching which, unavoidable and well-intended, brought about the usual result – reversion of the peristaltic action of the stomach – in a fair percentage of cases among the small number of passengers. It seemed to me, however, that the Australian and English people are, on the whole, less susceptible to seasickness than the more nervous Americans, and a number of the lady passengers always occupied their places at the table during meal-time. A few hours’ stop was made at Freemantle, which gave me an opportunity to see this important western part of Australia and from there make an excursion by rail to Perth, 12 miles distant. Perth is a new and modern city with 25,000 inhabitants. The activity in the principal streets reminds one very much, at least on a small scale, of State Street in Chicago. The business importance of both these western Australian cities depends largely on the rich gold mines in that section of the country. Freemantle has a public hospital with accommodations for 40 patients; the hospital at Perth is a new and modern building with a capacity for 200 patients. As we left the harbor of Freemantle we were followed by our faithful escort of albatrosses, which had never deserted us in the open ocean since we left the New Zealand coast, but on this occasion these magnificent living kits of the air left us at dusk the first day out, never to return. With the exception of occasional schools of flying fish, water and air were sterile from coast to coast. Cool weather continued for two days after leaving Freemantle, when the winds gradually subsided, the sun displayed his tropical properties and the drizzling rains saturated the atmosphere with moisture, all of which made the heat very oppressive. Blankets and heavy clothing were laid aside and the officers set the example for the wearing of clothes appropriate for the tropics. The low palm-fringed coast of Ceylon, lightly veiled in a rising fog, came in sight Wednesday morning and during the forenoon we were comfortably quartered at the Grand Oriental Hotel, Colombo.
CEYLON
T
he island of Ceylon, called Singhala by the natives, is about 55 miles from the southern extremity of Hindustan, from which it is separated by Palk Strait. It lies between 5o and 9o N. latitude, hence in the very midst of the tropics. The interior is mountainous, the highest peaks being Pedrat, Allagalla and Adams’ Peak; the former rises to an altitude of 8,200 feet, the latter 7,420 feet. [Note by Sachi: Pedrat Allagalla split by a comma in the original text, is one name Pidurutalagala, aka Mount Pedro] The island is noted for its tropical forests, impenetrable jungles and luxurious vegetation. This island has had an eventful political history. It was taken possession of by the Portuguese in the seventeenth century, passed later into the hands of the Dutch by conquest, and was finally annexed to the British crown in 1795. The first two nations never conquered the entire island, and the British forces underwent many hardships and met with fierce opposition in the interior of the island before the last rebellion was suppressed in 1817. Since that time the peace of the island has never been disturbed and it has become, under a wise, conservative government, the wealthiest and most prosperous colony of the British empire. The principal articles of export are tea, coffee, cinnamon, cacao and cinchona bark. The cocoanut palm, which is found here in all its productiveness along the seashore, in the lowlands, valleys and high up on the hillside, not only furnishes the natives with a considerable part of their sustenance, but is an important source of revenue. The annual value of the produce of this tree alone amounts to $10,000,000. In looking at the palm forests of Ceylon o one could forget what this tree does for the untutored natives, as,
‘It is meat, drink and clothes to us.’ – Rabelais
And one who would not think almost instinctively of the beautiful words of the psalmist:
‘The righteous shall flourish like the palm tree; he shall grow like a cedar in Lebanon.’ – Psalms xcii, 12.
Ceylon supplies the markets of the world with cinchona bark, amounting to about a million of pounds a year. The cinnamon tree is indigenous and reaches height of from 40 to 60 feet and a circumference of from 3 to 6 feet. The cinnamon bark, however, is not obtained from the old trees, but from annual shoots from a very short stump, which is pruned and sprouts from year to year. Another important source of revenue is the more than 4,000 gem quarries. Ceylon has now more than 1,500 miles of railway, over 2,000 schools, 36 newspapers and upward of 100 hospitals and dispensaries. The Ceylon tea is the best in the world, and since it has been found that the hardy shrub which grows this commodity will thrive best at an altitude of 7,000 feet, the forests are rapidly making way for the tea industry up to an altitude of 6,000 feet. As an important protection against deforestation from this and the timber industry the government has wisely stopped the sale of timber land above an altitude of more than 6,000 feet. Ceylon is the paradise for the hunter, as large herds of elephants still inhabit the jungles at a safe distance from human habitations and buffalo, elk, deer, bear and wild boar, as a great variety of birds, are quite plentiful and furnish the best opportunities for most interesting sport. The scientist finds here an endless field for study and investigation. The great fertility of the soil, the copious rains and the variations in the climatic conditions on different parts of the island have created a vegetation noted for its luxuriance and endless variety. The forest trees alone are a great attraction. We find here the satin, sandal and ebony trees, from which the most valuable timber is obtained. It may not be generally known that less than one-third of the wood of the ebony tree (Diospyros ebenum) is black, and this is found in the center of the stem; the outer two-thirds of the wood is white and without value. In the botanical garden at Kandy I saw an India rubber tree (Ficus elastica), planted by the Dutch in 1833, which has reached a height of 130 feet, and the multiple stems and their colossal branches cover a circular area where several hundred people could find protection against rain and sunshine at the same time and be much less crowded than in the streets of Kandy at a Buddhist celebration. In the same place I saw a nux vomica tree more than 50 feet high with a graceful crown of small elongated deep green leaves in a state of budding for the next year’s crop of dis-like nuts so familiar to the physician as the source of strychnine. The bo-tree (Ficus religiosa) is one of the giants of the forests. Its broad acuminate leaves tremble in the breeze like the leaves of our aspen. The trunk is very short and from the top the treelike branches form a wide-spreading crown. This tree is worshipped and is held in great veneration by the Buddhists. A very strange tree is what is known as the jack tree, a large tree which beats the largest edible fruit known. The fruit is suspended from the trunk and the larger branches by a short stalk, and in several instances it sprouts from exposed roots. The edible part of the fruit is a yellow pulpy viscid mass. The smell and taste of the fruit when ripe are strong, and to the European unpleasant, but the flavor is akin to that of our may apple and quite agreeable, at least it proved so to me. The elephant is very fond of the leaves of this tree. The Areca palm, a very slender tree, rows a nut which bears in its structure a close resemblance to the nutmeg. This nut, scraped and mixed with a white paste made of slacked lime, served on a green leaf, is the betel so much in use by the natives as a chewing material. This practice is no worse from a hygienic and esthetic standpoint than the chewing of gum and tobacco by Americans, but the betel contains a red coloring material and its habitues do not improve their looks by the red lips, tongue and teeth, which looks to the uninitiated very much as though the chewers, instead of enjoying the pastime, might be the subjects of purpura hemorrhagica, or had just escaped from the chair of an aggressive dentist. How helpless the practitioner of medicine would be if Ceylon did not supply him with cinchona and nux vomica, to say nothing of cloves, cinnamon, cajeput, pepper, nutmeg and other aromatics and carminatives with which we are in the habit of disguising the taste and smell of more powerful drugs and which often prove so efficacious in the treatment of slight gastro-intestinal derangements. But there are still more remarkable trees in Ceylon, which prove the perfect foresight of the Creator in meeting urgent wants of man and beast. Wherever there are cocoa palms, man’s immediate wants are met, as it supplies him with drink and meat; the milk of the unripe fruit will quench his thirst and the meat of the ripe nut supplies him with food. The rain tree (Inga sausa) is a large tree with thick, short stems and widely spreading branches. Around the lake of Kandy these trees are of enormous size. It has a pinnatifid leaf like the acacia. In the evening these leaflets fold themselves into a small cup, in which the falling dew is collected and retained until sunrise, when it unfolds, and in doing so the thousands of drops of water give rise to a shower on a small scale, hence the name ‘rain tree’.
Ceylon is the home of a great variety of palms. Of these the talipot palm is one of the most remarkable. For the first ten years it grows only from scaped leaves. Next the stem grows as straight as a mast to a height of 100 feet. Each annual growth is indicated by a ring. The fan-shaped leaves are of enormous size, sometimes 15 feet in radius. They are so large that three leaves make an ample and waterproof tent. The leaf, cut into pieces of convenient size, has been used for centuries as a substitute for writing paper.
In the octagonal tower of the Temple of the Tooth at Kandy thousands of manuscript volumes record the early history of India on strips of the leaves of this palm. When the trea reaches maturity it develops a gigantic bud at the end of a pole-like prolongation projecting 10 to 15 feet above the crown of fronds. This bud in due time bursts with a report and a lovely white blossom unfolds itself and spreads with a pyramid of cream-colored flowers. After this final act of propagating its species the tree soon sickens and dies. It was my fortune to see one of these trees a very short time after bursting of its pod and expansion of the liberated flowers. The undergrowth in forest and jungle is represented by a variety of shrubs, the principal one being the nulu.
The density of the forest is increased by twining plants, many of which, especially the Thunbergia, with its beautiful pale blue flowers, reach to the very top of the highest trees. Orchids, pitcher plants, the gorgeous passion flower and several species of rhododendrons are worthy representatives of the rich flora of the island.
CLIMATE
When Nature goes to work to create a botanic garden she must necessarily have at her disposal a fertile soil and a hot, moist climate, a climate congenial to luxurious vegetation, but hostile to man. Such is the climate of Ceylon. The intensity of the heat is made almost intolerable during the rainy season, from February to July, by the saturation of the air with moisture. When I arrived in Colombo the rainy season was practically over and yet the atmosphere was so surcharged with moisture that in the absence of a breeze, natural or artificially produced by fan or punkah, breathing was a difficulty and the sense of heat distressing, although the thermometer in the shade only showed a temperature of 92 degrees F. The coolest months are October, November, December and January, and the hottest correspond with our spring months. In Colombo it is always hot and the use of blankets is almost unknown. The continuous heat from one end of the year to the other is depressing and Europeans find it necessary to seek a cooler climate every three or four years to recuperate, and have to abstain from hard work, mental and physical, as much as possible during the entire residence. In the mountains at an elevation of 2,000 and more feet the nights are cool, and even at Kandy 1,600 feet above the level of the sea, the nights are often chilly. The chains of mountains traversing the island have a marked influence on the rainfall and temperature of the high altitudes. It is often the case that on one side of the range it is sultry and fogs and rain prevail, while on the opposite side the atmosphere is dry and cool and a bright sunshine adds to the cheerfulness of the bracing mountain climate, with a reversal of climatic conditions occurring with a change of the prevailing winds. I is well known that a prolonged residence in Ceylon shortens the lives of the Europeans, and consequently those who are obliged to live there find themselves under the necessity of leaving the island every few years for several months in order to rid themselves of that lassitude and depression incident to a prolonged residence in the tropics, and to regain their recuperative power that is so essential in resisting the insidious influences of tropical and other diseases.
THE PEOPLE
The population in 1891 was 3,008,466. The natives are increasing very rapidly, as the estimated population of the island on December 1902 was 3,685,267. This is confirmed by the birth and death rate for the same year; 14,893 births were registered and 99,680 deaths. The birth rate was 39, against 37,5, and the death rate of 27.4 against 27.6 per mile in the previous year on the estimated population in the middle of the year (Medical Report of Dr. Allam Perry, principal civil medical officer and inspector general of hospitals, 1902). This record is not in accord with the fate of our Indians and the Polynesians of the islands of the Pacific, whose rapid decimation and eventual extermination followed so promptly the footsteps of civilization. Three explanations deserve consideration in accounting for this difference. The Ceylonese have for centuries been in touch with the outside world by much frequented waterways and they have, perhaps more than any other primitive race, retained more persistently their original habits, and as most of them are Buddhists they have escaped the fearful consequences of alcoholism so common among other savage races as soon as the white man satisfies their morbid desire for liquor. The Sinhalese and Tamil do not encumber themselves with European clothes; the comboy (loin cloth) is the only article of dress which he makes use of, and which continues to satisfy all his needs as far as appearance and protection are concerned. The diet, habits and manner of living remain the same. The population of Ceylon is a very mixed one, consisting of Sinhalese, Tamil, Portuguese, Dutch, Malays, Parsees, Turks, Afghans and half-castes of all shades of clor between almost pure white and jet black. The Sinhalese and Tamils, however, form the bulk of the population. The Europeans are in a very small minority. The Tamils are the Indian coolies who immigrated from the south-western part of India and became the laborers of the planters in the interior uplands of the island. The Singhalese are averse to hard labor and have always shown a preference for the plains and valleys. The Tamils are a low race, far beneath the Singhalese in intelligence. The Singhalese is proud of his race. Half-castes bear the humiliation brought on them by the admixture of European blood with a becoming patience and fortitude, but they regard the accident of their birth rather as a disadvantage than otherwise in their social position and best possibilities in life. The question of caste, even in Ceylon, plays quite an important role, consequently the Singhalese and Tamil seldom intermarry. The former is a gentleman by birth, and as such is averse to menial work, for which, if he can afford it, he hires the man of burden, the lowly-born Indian coolie, who in most respects resembles the low-caste Chinese and Japanese. The Singhalese is a very fine specimen of manhood, tall, slender, with long, very thin legs, face clean cut with regular outlines, well-shaped nose, high forehead, black eyes, bushy eyebrows of the same color, delicate hands, and in complexion varies from a sienna to almost as black as the negro. The hair is long and straight or wavy and is worn by combing it back or parting it in the middle, tied behind into a knot, which is surmounted by a semi-circular comb of tortoise shell. The manner of wearing the hair and the delicate face in the young men with scanty beard and similarity in dress makes it often very difficult to distinguish between the two sexes before advancing age draws more distinct facial lines. The young men appear very effeminate, more so than in any other race that I have ever seen. Tailors and shoe-makers do very little business in Ceylon. With a few yards of cloth men and women drape themselves very gracefully, leaving at least one-half of the body uncovered. The comboys differ only in length from a narrow strip of cloth to a petticoat reaching below the knees, worn by some men and all the women. Another two or three yards thrown over the left shoulder covers at least a part of the chest and leaves the right arm unencumbered. Hair and skin are kept saturated with palm oil, a very important hygienic measure, as it preserves the hair and protects the skin against the burning rays of the sun, rain and insects. The Singhalese are almost free from baldness, as they do not injure the nutrition of the hair follicles by the use of harmful head-dress and make free use of palm oil, which is undoubtedly an important nutrient to the hair and the hair follicles. The women are much smaller than the men and can make no pretensions to beauty. The flush of youth begins to decline before they are 30 years old, and then they are inclined to obesity. They are fond of jewelry. Many of them cling to nose and ear rings, toe rings, wristlets, anklets and arm bands of silver. The Singhalese has many excellent qualities; he is cheerful, content, honest and peaceable. Theft and robbery are almost unknown. Willful premeditated murder is very rare. During the year 1903, 36 men were sentenced to death for murder, and of these 22 were hanged; in the other cases the sentence of death was commuted to long terms imprisonment. Major de Wilton, inspector of police (Prison Report, 1903) makes the following comments on the crime of murder:
‘It is very difficult to make any conjecture as to the cause of the prevalence of the crime of murder. The offenders do not, as has been repeatedly pointed out, belong to the criminal class. They are, as a rule, men without previous convictions, who up to the time of the crime have lead a comparatively blameless life. The offense is not generally committed with the deliberation of the hardened criminal, but in the fiery heat of passion or under the influence of liquor, and it is a matter of regret that even the death penalty brings with it no direct effect.’
The knife is the implement most frequently used when violence is resorted to. The number of persons committed to prison for all kinds of offenses during the year 1903 was 2,396, a figure which shows well for the morale of the island. Of 2,508 convictions during the year 1903, 49 were Protestants, 361 Roman Catholics, 1,509 Buddhists, 314 Hindoos, 260 Mohammedans; other religions 15. Notwithstanding the heroic labors of missionaries of different denominations for the last two centuries and the expenditure of millions in efforts to convert the natives, the results have been very unsatisfactory. The mass of the people cling to their Buddhist faith with great tenacity. The bareheaded, barefoot, yellow-robed priests remain in power and attend to the spiritual needs of the people. The Roman Catholic church has accomplished more than any other denomination. Those who have abandoned Buddhism and have joined a church do not always live in accordance with the teachings of the new religion and continue many of their former customs and practices, which perhaps unconsciously cling to them from force of habit. For instance, Christianity has made very little impression on the morality of the people. The natives are a temperate people, as the teachings of Buddha prohibit the use of alcohol in any form, and with few exceptions, indeed, the Buddhists are total abstainers. The Sinhalese have taken kindly to the professions. The most prominent and successful physicians and lawyers in Ceylon are natives or half-castes.
PREVAILING DISEASES
The bubonic plague has never had a foothold in Ceylon. This is the more remarkable, as its harbors are visited daily by ships from all Oriental ports and the excemption from this scourge must be due to the extraordinary care exercised by the department of health. Accurate information regarding the present prevailing diseases can be gleaned from the Annual Report of Dr. Allan Perry, principal medical officer of the island.
Malaria – In the western, central and north central provinces malarial fevers were very slight. The disease is most prevalent in the northwestern and eastern provinces. The disease is quite prevalent in Colombo, and observations are now being made to determine the places where infection takes place.
Cholera – During the year 1902, according to this report, there were 179 cases of cholera, with 116 deaths. The largest number of cases occurred in Colombo and vicinity.
Smallpox – There were 146 cases of this disease, with 35 deaths, in the north of the island, and 118 cases were admitted to the Infectious Diseases Hospital, Kanatta, which, with two from another province, made 120, with 32 deaths.
Dysentery – This disease is equally distributed throughout the island. It was most prevalent in the central and western provinces. The largest number treated in any one institution was at the General Hospital, Colombo, where 488 cases were admitted, of whom 89 died.
Enteric Fever – The number of cases treated in the various hospitals throughout the island was 242, with 63 deaths. Pollution of water and milk are the commonest causes of this disease. The cesspit system, which exists in some of the large towns, notably Colombo, Kandy and Galle, has much influence in increasing the number of cases.
Leprosy – The total number of cases reported during the year 1902 was 560, against 590 in the previous year, being a decrease of 30 cases; 382 cases were treated in the leper asylum, Hendala, and 30 in the Kalmunai wards. The leper ordinance came into operation at the beginning of the year, and 113 cases have been reported.
Ankylostomiasis – It seems that this disease, which is so very prevalent, is constantly being introduced from India by Malabar coolies. The disease is increasing. There were 1,609 admissions in all hospitals, with 257 deaths. The danger of the disease to life is in the profound anemia, which so lowers the vitality that the victim is carried off by any insignificant intercurrent affection.
Plague – The Plague Committee is a standing committee, including besides the principal civil medical officer, the collector of customs of the ports, the government agent and the mayor of Colombo. Regular meetings are held and precautions instituted to combat an outbreak of the disease. All returns of plague from infected ports are received by the committee; telegraph accounts of plague occurring in places adjacent to Ceylon are received regularly. It is to the eternal watchfulness of this committee and the prompt action of the staff of port surgeons that is due the freedom of the island from this Asiatic disease. Galle continues to be the plague port; only one case of this disease was reported from the harbor of Colombo during the year. The patient contracted the disease at Hongkong and was landed and isolated at Galle, and the contacts for this port were placed in quarantine. The patient recovered. But destruction was carried out at the customs premises and by the municipalities of Colombo and Galle.
Syphilis – Colombo, Kandy and Galle are provided with a special hospital for the treatment of women suffering from venereal diseases. The total number of new cases admitted was 351 which, with 20 remaining from the previous year, makes a total of 371. Of the 371 women treated in these hospitals 27 were affected with primary syphilis, 68 secondary, 62 tertiary, 4 hereditary, 156 gonorrhea and 54 unclassified syphilitic lesions.
Parangi – The hospital records show that this disease has steadily increased during the last five years. The death rate is remarkably small; out of 3,434 admissions for this disease during the year there were only 10 deaths.
Vaccination – Vaccination is carried out vigorously in the island, as is shown by the Report on Sanitation. During the year 149,901 subjects were vaccinated; of this number, 7,760 were revaccinations.
Lack of Sewerage – In Colombo, Kandy and Galle the fecal matter is removed at night and buried. In Colombo the experiment was made of using the contents of the cesspits as a fertilizer, but it proved undesirable and was abandoned as a failure. What these cities need is a system of sewerage, as they all have an excellent location to carry out such a plan with success.
SOYSA BACTERIOLOGIC INSTITUTE, COLOMBO
Since its opening this institution has undertaken work of diverse character, and is now supplying a long-felt want in the colony by its researches in bacteriologic analyses of tissues, secretions, blood etc., so indispensable to scientific diagnosis of diseases. The acting director. Dr. S.C.Paul, FRCS, is consulted by government medical officers and private practitioners for reports on specimens submitted to him on bacteriologic and allied subjects.
CITY OF COLOMBO
The city of Colombo is an important port and the largest city in the island. It has a very mixed population of 128,000. More Europeans live here than anywhere else in Ceylon. The steamers ancor some distance from the wharf. It has excellent streets, the so-called red streets, a bright red from the color of the soil, electric lighting and electric tramways. The Grand Oriental Hotel, near the wharf, is the best hostelry in the island. Every room has an electric fan – a great comfort to the traveler throughout the entire year. The rooms of the hotel are never locked, as stealing and robbery are almost unknown. The crowd of chambermen and servants are always ready to wait on the guests and understand to perfection the system of exacting a substantial tip. At present writing the temperature in my room, in spite of the faithful fan, registers 91oF. The air is thoroughly saturated with moisture, which is accountable for the oppressive sensation of heat that every newcomer experiences.
The Cinnamon Gardens is the city park and is a lovely place. The drives along the coast are beautiful and disclose at every turn the luxurious vegetation of this wonderful island. The native policemen are courteous and devoted to their duties. They are fully impressed with the responsibility and dignity of their office, and cross and recross their beats with a keen eye for any evildoers. The city has a museum, free library and many charitable institutions for the sick and poor.
THE GENERAL CIVIL HOSPITAL
The hospital is made up of numerous one-story brick-and-mortar pavilions connected by roofed colonnade, cemented walks which impart to the whole complex of buildings a fine architectural appearance. The snow-white walls and pillars and the red tile roofs are in strong and beautiful contrast with the perennial green surrounding the building inside and outside of the large square court which they inclose. The income from pay patients is not large, but the government appropriations are liberal. All of the employes are salaried, including physicians, internes and nurses. Dr. Thomasz, one of the two attending surgeons, receives 4,000 rupees a year. He conducted me through the different wards and showed me many interesting surgical and medical cases. The nursing is in care of thirteen Anglican sisters and a number of women nurses, graduates from the Lady Havelock Hospital. A corps of native men and women act as helpers. The wards are airy, well lighted and furnished plainly but comfortably.
Echonococcus, so common in Australia, is not seen here; on the other hand, elephantiasis is quite common. Dr. Thomasz has operated on a number of cases of scrotal elephantiasis with success. The natives are not very good subjects for prolonged major operations, as they are very liable to inordinate shock. Chloroform is used as a general anesthetic, and in several thousand anesthesias only two deaths occurred. The operating room is old and not up to modern requirements. The equipments and appliances also leave much to be desired. Asepsis has not succeeded here as well as could be desired and the many failures to obtain primary wound healing having finally led to the abandonment of buried absorbable sutures of any kind. Silk is used almost exclusively and the sutures are removed from three to seven days after the operation. The same practice is followed in the Kandy General Hospital. In the outdoor department I watched an interne dress two recent wounds. He did not remove his coat, and a basin with some antiseptic solution was relied on in performing primary disinfection. Not much time or effort was expended in preparing the wounds for suturing, and I have little doubt that the sutures rather retarded than assisted Nature’s efforts in repairing the wound.
Ovarian tumors are quite common, but myofibroma is rare among the native women. Women the subjects of ovarian cysts of enormous size frequently enter this hospital for operation. Little operating is done in the country villages and patients usually do not seek medical advice until they are much inconvenienced from the size of the tumor. Prostatectomy is performed by the suprapubic route. Stone in the bladder is not of frequent occurrence. Turberculosis of the lungs is quite common, as during one year, 1901-1902, 956 cases were admitted to the different hospitals. Surgical tuberculosis is much less prevalent, as during the same year only 60 cases of tuberculosis of the glands of the neck were treated, 32 of lupus and only 5 cases of tuberculosis of the joints. I did not see a single case of spinal deformity among the thousands of people I saw in Ceylon and only one case of ankyloses of the hip and 2 cases of ankylosis of the knee joint, and very few cases of tuberculosis of glands of the neck or its remote result, scarring of the neck. Only 12 cases of snakebite are reported for one year, of whom 2 died.
Septic Thrombophlebitis of the Spermatic Veins
Dr. Thomasz a few years ago described a form of septic thrombophlebitis occurring in young men the subject of variocele; the immediate cause is usually an injury of some kind which induces the thrombosis. When this has taken place the pus microbes find in the obliterated lumen of the veins a favorable soil for their reproduction, which leads very rapidly to pyemia and death. The disease pursues a very acute course and is nearly always fatal unless an early radical operation is performed, which must also include the testicle on the affected side.
CEYLON MEDICAL COLLEGE
The Ceylon Medical College was formally opened on June 1 1870, with one principal and three lecturers. The first intent of the school was to be ‘simply an elementary school’. The faculty was increased three years later and in 1888 it became a regular medical college with power to license in medicine and surgery. Lady students were admitted to the college for the first time on May 5, 1892. The one story building of the college, with library, lecture rooms and laboratories, was erected at the expense of the late Suzew de Soysa. The dissecting room is a separate building, as well as the laboratory for physiologic and pathologic chemistry. The clinics are given in the General Civil Hospital, opposite the college building. The course of study embraces five years. The teaching force consists of 32 professors, lecturers, demonstrators and assistants. T.F. Garvin, MBCM, Aberdeen, is a lecturer on surgery, and H.G. Thomasz is clinical lecturer. Physics, biology and elementary zoology are included in the primary branches. All the specialties are included in the faculty. The present attendance of students is about 120. The students are given ample opportunity to serve in the hospital as dispensers and dressers, and the clinical material for instruction is very large, including practical obstetrics in the De Soysa Lying-in Hospital. The school has also a department for apothecaries. The standards for admission and graduation correspond with those of the medical schools of the United Kingdom. The fee for the whole course in advance (to be paid in one sum at the commencement of the first college year), is 800 rupees ($256). A number of prizes and medals have been established by friends of the institution. At the close of the session 1901-1902, the school graduated 26, the following year only 9 candidates. Part of the entrance and professional examinations are conducted in the Tamil and Singhalese languages, of which the student must have a fair knowledge.
LEPER ASYLUM AT HENDALA
I visited this institution, which by the carriage drive is ten miles distant from Colombo. The road leads through a series of native villages, rice fields, marshes and strips of primeval forests and dense jungles. The colony is located on seventeen acres of land enclosed by a stone wall. The numerous one-story buildings of brick and mortar are connected by roofed cement walks. The entire settlement, exclusive of physicians, numbers 360, of whom there are only 69 women. The youngest patient is only 6 years old. One of the patients, a man 60 years of age, has been here for thirty years. He is afflicted with the anesthetic form of the disease, is totally blind and has lost all of his fingers and toes. The disease has cured itself, but has left the patient helpless, shapeless mass of flesh. It appears that the anesthetic and tubercular forms of the disease occur about with the same frequency. The institution is well managed and the nurses and two resident physicians do all in their power to render the existence of these hopelessly diseased victims as comfortable as possible. The patients appeared to be content with their fate and the humane restraint that is practiced. The law of segregation came recently in force, but the authorities find it difficult to carry it out with the strictness for which it is intended.
LEPER BUDDHIST CELEBRATION
The day I visited the asylum was the annual celebration to the memory of Buddha. It was a gala day, the walk leading from the entrance to the little Buddhist temple was decorated with palm leaves. The procession was formed outside of the gate. There was no elephant to draw the shrine of Buddha perched on a rude cart, but a little humpbacked bullock answered the purpose very well, and he performed his part of the celebration with credit to his kind. A brass band with native instruments headed the procession, then came the shrine followed by a number of bronze-colored yellow-robed priests, and lastly the Buddhist lepers in all stages of the disease. Explosives were thrown against the stone wall, where they exploded with a terrible report, emitting at the same time a blue-black smoke which enveloped the slowly moving procession. The bombardment, with the ear-splitting music of the native band, imparted to the whole affair a weird appearance. When the procession entered the temple silence was restored, and only the murmurings of the priests could be heard outside of its sacred walls.
CITY OF KANDY
This little city of 20,000 inhabitants, the former residence place of the kings of Ceylon, has degenerated into a dilapidated mountain village. It is located in a valley in the subalpine region, surrounded by verdant hills and nestled around a little artificial lake of the same name. It is accessible from Colombo by rail, the road passing the first fifty miles through rice fields, marshes, then ascending for thirteen miles in a zigzag line to the height of 1,600 feet above the level of the sea, and then through a valley nine miles in length, when the little city suddenly comes into view. The beauty of Kandy and its environments have been greately exaggerated by sentimental writers. The town is noted for the Temple of the Tooth, an old, crumbling pile of stones which contains in is most interior and not accessible part a tooth of the famous prophet. I happened to be in the city on the day when the Buddhists turn out in masses to do honor and homage to their deity – Buddha.
THE ANNUAL BUDDHA CELEBRATION
For three days the little city was packed with a seething mass of humanity. In many places standing room was scarce. The great event took place at 9 o’ clock Saturday evening, August 27. The procession, headed by a band of native musicians and three elephants abreast with their riders, was made up of 26 other elephants, an army of chiefs gorgeously arrayed, and bare-headed yellow-gowned priests, dancers with faces disfigured by white stripes, screaming and yelling boys and the faithful followers of the god of whom at least one tooth had remained to testify that he once inhabited this earth; the tooth that was carried in the procession in a shrine carefully guarded. The most solemn celebrants were the 29 magnificent elephants, who marched with slow, thoughtful steps, their sly little eyes peeping through small holes in their masks of royal red, casting a glance now and then on the sea of humanity on either side of the road. The great mass of people who took an active part in this celebration and the enthusiasm aroused when the hiding place of the tooth of Buddha came into view showed only too clearly that this deity has not lost his influence and power among the natives of Ceylon.
BOTANICAL GARDEN
The botanical garden four miles from Kandy is the most interesting spot in this part of the subalpine region of Ceylon. It comprises thirteen acres of land, included in a horseshoe bend of the Mahaweli ganga. Every known variety of palm can be found here, as well as specimens of nearly all trees and shrubs of the tropics. I saw here a clove tree (Eugenia caryophylata) at least forty feet high, an ebony tree (Diospyros ebenum) and a nux vomica tree of about the same dimensions. The towering palms, the dark walks cut through the otherwise impenetrable jungles, and the gorgeous flowers, of trees, shrubs and plants, make this spot a real paradise on earth, a great contrast to the dilapidated city of Kandy.
KANDY GENERAL CIVIL HOSPITAL
This is a very pretty, comfortable, clean, well-managed general hospital, built on the same plan as the Colombo General Hospital. It is located outside of the depressing influences of a formerly famous, now crumbling city, in a little vale surrounded by green hills on all sides. The snow-white one-story pavilions and the connecting, roofed cement walks lined with square columns of the same color, around a central square ornamented with jack and bo-trees, palms and flowerbeds, give it the very picture of isolation, comfort and peace. The 243 patients inside of its walls enjoyed the blessings of careful nursing and the benefits of excellent surgical and medical skill.
Dr. James William de Hoedt is the physician and surgeon in charge, ably assisted by a woman house surgeon, Miss Winifred Nell, LRCP and SE. Dr. Nell is not only a very competent physician, but at the same time a skilled naturalist, as I had an opportunity to learn during the visit we made together to the botanical garden. The nursing staff is in charge of an Anglican sister, Sister Eustacia Mary, a well-trained nurse and charming lady. I found here a number of interesting emergency cases and the usual predominance of ankylostoma, malaria and enteric fever. There have occurred here in the small maternity ward recently five cases of puerperal tetanus, in all of which recovery took place. This hospital has a remarkable record in the treatment of tetanus, 3 cases without a death. Buried sutures are not employed, silk is used exclusively and the sutures are always removed. Chloroform is the favorite anesthetic and biniodid of mercury is largely relied on in hand and surface disinfection.
Madras, India, Aug. 30, 1904.
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[End of chapter on Ceylon]