FOOTPRINTS ON THE SANDS OF TIME
The visionary life and legacy of Dr. Samuel Fisk Green
by Dr. Thayalan Ambalavanar, October 15, 2022
Dear friends and colleagues,
The lives of great men and women leave indelible marks on the pages of history. They serve to act as role models and to inspire us as we strive to make our world a better place. Dr.Samuel Fisk Green was an inspiring figure whose vison and legacy altered the medical landscape of the island of Ceylon in ways that he may not have fully comprehended at the time. On his 200th birth anniversary it is only fitting that his legacy is recalled.
As a young medical student I had become very much aware of the significant contributions made by generations of American missionaries who had served in Jaffna and helped transform the social, cultural, educational and medical landscape of the peninsula in ways that are still evident. From my father, Bishop Ambalavanar, I absorbed the history of these contributions. From my mother, Dr.Chandra Ambalavanar, who worked in Green Memorial Hospital as an obstetrician and medical superintendent for many years I was able to understand the medical legacy of those missionaries who served in that hospital. As a young medical doctor I had the great privilege of also working in that hospital and understanding even more the greatness of this man Samuel Green. He has long been an inspiration and a hero to me.
Today in the 21st century, international travel is not something most people think twice about. Even if we have never been overseas before the internet enables us to be fully informed. This was certainly not the case when the American missionaries first set out to travel to distant lands. In the 21st century we are fully aware of the colonial context and dimensions of their work, particularly their determination to convert others. However, the American missionaries also had a deep commitment working for the holistic transformation of society by sharing the very best of the educational and scientific knowledge available to them. They also sought to address human suffering through medical work and by equipping local communities to develop that capacity for themselves. What we also need to remember is they themselves were exposed to the burdens of ill health and bore great personal losses in their journey to Ceylon and during their life here.
Samuel Green had the good fortune to get advice from Dr.John Scudder, the world’s first medical missionary, while the latter was in New York after returning from Jaffna and before leaving for Tamil Nadu. Both of them were graduates of the New York College of Physicians and Surgeons which is now the Vagelos College of Physicians and Surgeons under Columbia University. Green was a bachelor when he set out for Jaffna in 1847 on his own. Unlike these days of air travel, the journey took him four and a half months by ship. It is hard to comprehend such a journey nowadays. Such was the nature of the man though, that he used that time wisely by learning Tamil during the voyage.
Green the physician
The details of his early days and work have been chronicled well by many. Following his arrival in 1847, his acceptance and fame as a doctor followed his successful treatment of a well-known Tamil and Sanskrit pundit, Mr. Mutathamby, for a large abdominal abscess that had not responded to the ministrations of the traditional practitioners. He was an extremely successful doctor who served and saved thousands of patients at Manipay and Jaffna. To contemplate the hundreds of varied operations that he carried out with very basic or no anaesthesia is a cause for amazement. The operations varied from cataracts to removal of tumours, some of which were complex even by today’s standards including of the oral cavity, fixing of fractures, treating surgical infections and so on.
He quickly observed and understood the main medical problems of his time. He observed that oral cancer was common and that it was caused by the use of slaked lime on the betel leaves that were commonly chewed and that diabetes and obesity were a common problem. Infections such as cholera, small pox, malaria and pneumonias were also diseases that he had to deal with. He made the observation that in cases of ‘fever and ague’ (malaria) ‘the spleen becomes prodigiously enlarged, in many cases reaching over to the right side and nearly down to the hip bone’. He himself also got cholera.
Dr. Samuel Green’s first medical class 1848
Green and Medical Education
Many of us serving as doctors nowadays would be satisfied with just doing our work to the best of our abilities. Not so with Green. He understood that the needs for health care in the peninsula were far too much for him to provide on his own so he set about to solve that problem. How did he do that? By training young local men as doctors! He selected students who had studied in English and graduated from the Batticotta seminary (now Jaffna College) as his first students. In doing so in 1848 he established the first medical school in the island of Ceylon at Manipay and thus also made his American Mission Dispensary the first teaching hospital in the island! These are the traits of great leaders and visionaries.
As the training took place and he produced batches of students he was faced with new challenges, those that many countries continue to face today. The brain drain! He was so successful in his efforts at producing locally trained doctors that the British colonial government promptly gave them jobs not just in Jaffna but outside as well. The quality of training resulted in producing doctors of excellent standard. This was vouchsafed for by Rev.B. Bailey, the chaplain to the Bishop of Colombo, who during a visit to Jaffna saw one of Green’s students working at the government hospital and stated that he possessed! High praise indeed. This resulted in many of Green’s graduates being posted outside Jaffna and made Green wonder how he could reduce this problem. His solution was to teach medicine in Tamil so that the doctors trained would be better able to serve the local community and, hopefully, also remain in the area! This was not a popular move as the young men who came for training were looking for lucrative jobs with the government and worried that training in Tamil might disadvantage them.
For anybody in those days to undertake such a herculean task was challenging enough let alone an American. However, Green was not in the least daunted and with the help of his Tamil students proceeded to translate many of the medical books of his time into Tamil. These books included Cutter’s Anatomy, Physiology and Hygiene, Gray’s Anatomy, Maunsell’s Obstetrics, Druitt’s Surgery, Dalton’s Physiology and many more. His task was made easier by the fact that the American Mission had already established the first printing press in the north which was also producing the second oldest newspaper in Ceylon, The Morning Star. Many of the books that Green translated were in demand in the Tamil areas of south India as well.
Green’s views on translating books is best described in his own words. ‘Mere translations are comparatively useless. It is better to devise one’s own plan and compile freely from many authors, taking their ideas only…..adapt the book to the language of the people, avoiding a literal rendering and making it free and simple. Every book should be in simple, clear style and freely illustrated-‘.When you consider the fact that many new Tamil words and terms had to be created it is truly amazing. ‘His Tamil assistants were obliged to use scientific terms which he gave to their language and of which they had first learned from his explanations….’
The enormity of his achievement in translating these books into Tamil is borne out by the following anecdote that was recounted to my father by Prof.A.S. Fenn who was the Principal of Christian Medical College, Vellore at the time that I joined the college as a student. When Mr. M.G. Ramachandran became the Chief Minister of Tamil Nadu in 1977 he considered making Tamil the language of instruction in universities. MGR’s Health Minister, Dr. Hande, called the principals of all, the then, nine Tamil Nadu medical colleges for a meeting at which he asked them if they could teach medical studies in Tamil. Unsurprisingly, all the principals objected pointing out the difficulties because all the text books and journals were in English. Dr. Hande reached into the drawer of his table and pulling out a book asked, ’if an American missionary in Jaffna over a hundred years ago could translate Gray’s Anatomy into Tamil why can’t we do likewise now?!’
All in all he trained sixty one students of whom thirty three were taught in Tamil. Besides them he had started another eighteen well into their training before he finally left in 1873.
Green and Jaffna Hospital
Such was Green’s reputation as a doctor that in addition to his work at the hospital in Manipay, he was requested by the British Government Agent of Jaffna, Percival Dyke, to help support a hospital in Jaffna town. Thus did the Friends in Need Society Hospital in Jaffna get Green’s help in becoming a well-established hospital in 1850. This was to be the fore runner to today’s Teaching Hospital in Jaffna. Green served as a visiting surgeon and Superintendent for many years at the FINS hospital. It was his students who served that hospital as doctors till as late as 1907. The links between the two hospitals have remained strong. This was never better demonstrated than in 1990 during the civil war. The Teaching Hospital could not safely function due to the shelling of the town area from the army camp in the Jaffna Fort. The hospital also suffered damage. The hospital authorities requested the church for permission for the hospital to temporarily relocate to Green Memorial Hospital. My father who was the bishop at the time and my mother who was medical superintendent readily agreed. The Teaching Hospital was based at Manipay for around 6 months till it was safe to resume functioning in Jaffna town. Thus were the historical links between the two hospitals that Samuel Green had helped establish been restored in such dramatic fashion!
Ten years after arriving in Jaffna, Green returned to the US in 1857. This was mainly due to his poor health after suffering from Cholera. During the five years he was there he married Margaret. His mind remained very much in Jaffna and he was continuing his efforts at fund raising for his medical school and hospital as well as with the translation work. The mission considered sending him to South India to the Madurai Mission as they had done with others who served in Jaffna before him. Having heard of this one of his students sent Green a frantic appeal urging him to return to Jaffna as there were many who needed him there and young men awaiting his training.
Green returned to Jaffna in 1862 accompanied by his wife. He was to have four children (three daughters and a son) during this stay in Jaffna. He continued his immense work of service and training during the next ten years he was to be there. He left Jaffna for the last time with his family in 1873 but with the hope that he would be able to return.
A man ahead of his time
During the days of the current covid pandemic, hand washing and hygiene again came to the fore as one of the important measures to reduce the transmission of disease. It is greatly to the embarrassment of the present generation of medical practitioners that this practice was not given the importance that it should be in basic hygiene in healthcare settings. Green was carrying this out way back in 1850 as borne out by this quote from a letter he wrote. “A Brahmin wished me to examine his wife’s case when there was no crowd present, and to avoid putting my fingers in her mouth. I told him that I should touch her no more than was requisite and he need not fear pollution, for I should wash my hands immediately before; and she would not pollute me, as I should wash them just afterwards”. That is a quotation that every practicing and aspiring medic should be made to read!
A multifaceted man
Green was a man of many achievements. All that he did was founded on his deep Christian faith. He was a lover of nature and saw in it the hands of a creator. In his later years he used to often say “The casual observer looks at an object: the scientist looks into it: the Christian looks through it to its Creator”. He was a shrewd and keen observer of society and people .He had strong views on the caste system and strove to help break those barriers. He was a great supporter of indigenization as seen in the way he championed the use of singing lyrics in Tamil during church services. He had strong views on local practices and superstitions which in today’s world may not be considered politically correct or sensitive to local custom but some of these views were due to frustration he felt when treating illnesses that he felt had been ignored due to such beliefs .
The last farewell
Green departed the shores of Jaffna for the last time in 1873 though with the hope that he would return to continue his work. Though he did appeal to the American mission to send him back, they declined to do so as they felt that his health was not good and because he had a young family. This disappointed Green immensely but he continued to keep closely in touch with fellow missionaries in Jaffna and his former students through the exchange of numerous letters. He continued to help with translations of medical works and in getting the mission to support the medical work in Jaffna. In regard to the latter he was not fully successful as the mission decided not to continue funding the medical school. This was due to the fact that the British had started a medical school in Colombo in 1870.As the British government also stopped their subsidy to the medical school at Manipay it became impossible to continue it.
One wonders what might have been if Green’s medical school had continued to receive financial support. It might well have become another institution on a par with the internationally renowned Christian Medical College in Vellore which was started many years later by Dr.Ida Scudder, the granddaughter of Dr.John Scudder who had brought western medicine to Jaffna. That sadly was not to be. Jaffna had to wait another hundred years for the establishment of a medical school, the Faculty of Medicine, in 1978!
Nonetheless Green’s achievements in starting the first medical school left an indelible mark on medical education in Sri Lanka, the legacy of which is still present. The Colonial Surgeon and the first Principal of the Colombo Medical School in 1870, Dr.James Loos, put it best when he communicated to Green in 1873 when the latter was departing Jaffna for the last time. Dr.Loos said, “the work we are carrying on
(in Colombo ) – a work in which we are humbly imitating you. Medical education in Ceylon is deeply indebted to you and your predecessors”
Till his dying days Green’s thoughts were very much about Jaffna and its people. In his will he had stated that
‘should I ever have a gravestone, let it be plain and simple, and bear the following inscription:
Samuel Fisk Green,
Medical Evangelist to the Tamils.
Jesus my all’
He died on May 28 1884
The words of Green’s great compatriot of the same era come to mind when remembering the legendary life of Samuel Fisk Green.
Lives of great men all remind us
We can make our lives sublime,
And, departing, leave behind us
Footprints on the sands of time
-Henry Wadsworth Longfellow
Dr.Thayalan Ambalavanar
Visiting Lecturer in Surgery,
Faculty of Medicine
Jaffna
October 2022
Reference: Life and Letters of Samuel Fisk Green, M.D. of Green Hill compiled by Ebenezer Cutler