|Castle Street Hospital - then and now
Address delivered by Dr. Nalin Rodrigo, patron of the Sri Lanka College of Obstetri-cians and Gynaecologists and Medical Director of Asha Central Hospital, on the occasion of the 50th anniversary of the Castle Street Hospital recently.
I must thank you for doing me the honour of inviting me to deliver this keynote address at this meeting to celebrate the 50th Anniversary of the Castle Street Hospital. I believe I have been invited because I was one of the first House Officers at this hospital after it was made a specialist manned hospital, in the year 1953 at the beginning of career, and because later I completed my career also at Castle Street as Consultant for 12 years from 1977 till my retirement in December 1988.
This hospital was started as a Maternity Home to take over the surplus patients from the De Soysa Hospital where in 1949 there were over 13,000 deliveries and where in 1948, there had been a major outbreak of puerperal spesis. The hospital was declared open by Mr. S. W. R. D. Bandaranaike, the then Minister of Health and Local Government on the 4th of December 1950, seen here in the company of Dr. W. G. Wickremasinghe the then DM & SS. The first patient was admitted in the 11th of December 1950, and the first baby was born in the new hospital a girl named Kamala Sarojini on the 13th of December. The doctor attendance was Dr. (Miss) B. Jayasundera, later Mrs. Kulatunga. In 1951, Dr. S. D. Ratnapala was appointed as Senior Resident Obstetrician in charge of the hospital. He was a lecturer to the midwives and nurses and it is to his credit that he wrote an excellent book about pregnancy and labour in Sinhala and included Sinhalese terms for all the technical terms in obstetrics. His two sons SR and MK are both Obstetricians now.
Statistics for the first three years of Castle Street Hospital indicate that there were 23 deliveries in 1950, 1653 in 1951 and 4765 in 1952. The staff at the start of the hospital is shown here. The hospital in its earlier years had a number of House Officers who served for fairly short periods, apart from Dr. (Miss) Jayasundera, who later became a tutor to professor Attygalle, there was Dr. Dora Weerasiri (later Dr. Munasinghe), Dr. S. B. Talwatte, now the well known Radiologist, Dr. Blaze son of the then Deputy Director of Health Services. There was also the late Dr. Wijesinghe who later became the first Plastic Surgeon. I remember later at a union meeting somebody said that Dr. Wijesinghe had never worked outside Colombo and he (said) why not I have worked at Castle Street Hospital'. The hospital was at that time somewhat remote and on the outskirts of Colombo. Castle Street however was very old and very well known road and one of the most distinguished persons who lived down this road was Sir Oliver Goonetilleke who of course is the grandfather of Dr. Mrs. Hiranthi Wijemanne of the UNICEF.
In 1952 Dr. F. Noel Spittel who was the Senior Obstetrician at Kandy was transferred as the Consultant Obstetrician in charge to the Castle Street Maternity Hospital as it was then called. Dr. Noel Spittel who may be termed the father figure of the Castle Street Hospital, he was a descendent of Jan Laurence Spittel came to Ceylon from Saxony in 1760. His father was Dr. Fedrick John Spittel, Provincial surgeon. He was the brother of the famous Dr. R. L. Spittel, who was the Senior Surgeon of the General Hospital but was even better known as an authority on the jungles and the Veddha community of Ceylon. Dr. Noel Spittel was not only a strict disciplinarian but he also had a wry sense of humour. I remember one day the husband of a patient wanting some favour told Dr. Spittel 'Sir, I know your brother'. 'Then you must be a Veddha' said Dr. Spittel and moved on. Another day a man was visiting his wife outside visiting hours when Dr. Spittel was doing his ward rounds. The man tried to explain and said that he was an engine driver and said that as he was running his train at the time of the hospital visiting hours he had to come and see his wife at this time. Dr. Spittel said "I say, man if I am operating at the time your train is starting would you hold up your train until I come'. Unfortunately the engine driver could not quite understand the point and I can still remember the sense of bewilderment on his face as Dr. Spittel left the ward. Dr. Spittel was a top class Obstetrician and worked alone. He was on call, day and night every day! I remember the only time he called for a 2nd opinion was when he once called his friend Sir Nicholas to advice on a complicated case. I remember that when Sir Nicholas saw me there he said "Ah hh....this beggar is also here" and laughed loud.
Dr. Spittel started his ward rounds at sharp 8 a.m. and all of us had to be assembled to follow him.
The ward round was a grand procession led by him, followed by the ROO, then the house officers, the matron and in every ward, the sister and all the nurses had to join the procession. When he left the ward on one side the end of the procession was entering the ward on the other side. He examined every single patient both in the anti-natal and post-natal wards as well as in the labour room. He moved from ward to ward along the bathroom corridors inspecting the condition of the bathrooms. All the time he conducted a stimulating and often hilarious conversation on various topics and telling us many stories about his past career and experiences.
At this time the hospital consisted of 6 wards, 3 ante-natal and 3 post-natal in addition to the OPD, the labour room and a pre-mature baby unit which was opened in January 1952 and work had also begun on 4 additional wards, 2 operating theatres and a labour room.
With the appointment of Dr. Noel Spittel, the hospital ceased to be a glorified Maternity Home and developed into a first class Maternity Hospital, clean, efficient and very well managed. It was at this stage with the arrival of Dr. Spittel, that two ladies and I were appointed House Officers to the hospital. Dr. Tefny Fernando who later married Mr. Denzil Fernando who became an MP and a Minister and Dr. Maimoon Lebbe were my colleagues. Dr. Lebbe who is now Mrs. Fernando was the first Muslim lady doctor who qualified in this country. In addition to the three of us, Dr. Ratnapala continued as Senior Resident Obstetrician and there was Dr. (Mrs.) Yvonne Herft who was the RO. Each of three of us, House Officers, had to look after one ante-natal and one post-natal ward. One day we were on duty from 8 O'clock in the morning to 8 O'clock in the night. The next day we worked from 8 to 5 and then came on for night duty at 8 p.m. and the following day after night we worked till 12.00 noon when we were half day off. It was very hard work, especially as the boss insisted that all episiotomies should be sutured soon after the delivery. In my case I was fortunate though a bachelor, to have one of the quarters which are now called the Married Quarters a twin house. Mrs. Herft and her family occupied the other half.
Dr. W. H. Fernando the eminent Gynaecologist who was himself RO at Castle in 1960 and 1961, tells me that he himself was delivered by Dr. Spittel. WH's father was DMO Pussellawa and Dr. Spittel drove down from Kandy at 10.00 p.m. and reaching Pussellawa 2.00 a.m. WH was born later in the morning on 1st July 1927. Dr. Spittel was presented with a gold sovereign, the ultimate present in those days!
The Matron in my time was Ms. F. M. de Silva, she like most of the senior staff was hand-picked by Dr. Spittel.
Everyone of the sisters was very efficient and were strictly supervised by the Matron. One of our nurses at that time was Miss C. M. Perera who later married Dr. Mylvaganam, and is now one of the Matrons at Asha Central Hospital where I work.
At that time there was a jam fruit tree which I had planted at the front of our quarters which has now been cut down to erect a boundary wall between the quarters.
In the evenings I used to do my night rounds and after that I use to sit around and talk to the night staff. One day I remember telling a few ghost stories to the girls in the late hours of the night. Later when I was walking to my quarters I saw a ghost hanging from the lower branches of the jam fruit tree and it was slowly moving, more or less beckoning me. It was a frightening experience, I remember running back to the hospital and summoning some able-bodied labourers and finally we discovered that it was just a large distended plastic bag which was moving slowly in the wind in the moon light. This story went round all the house officers quarters and it took me a very long time to live this down. Matron Mylvaganam told me another story, that on several days at night the girls found an empty wheelchair moving rapidly down the dimly lit corridors. This created havoc among the nurses who thought that this was another ghost story. Later she tells me it was discovered that the only male House Officer, in the hospital at that time used to send this wheel chair careering down the corridor before he entered the labour room for a night call. Now that we are on the subject on this corridor I must relate another strange story which is not in the text and which took place many years later when I was a consultant. I was walking down the same corridor on to which some MOO rooms also open, followed by my retinue - Registrars SHOO and several HOO going to the clinic after the ward round. When I reached the clinic I noticed that two of my MOO were missing! The couple arrived in the clinic later. Looking a bit dishevelled to date, I don't know why.
As far as I was concerned, I managed quite well during these strenuous duty shifts because the Health Department Sports Club was just next door and I use to walk there and the call book was brought there.
In those days in the early 50s, when I was a house officer at Castle, the practice of Obstetrics was different from now. For many reasons, Caesarean section was not performed very often. Deliveries were performed mostly vaginally and forceps mid cavity and even high forceps were performed. Kiellands forceps was used frequently and we became fair experts in the use of these instruments, especially the Kiellands, in fact I even bought a Kiellands forceps for my own use. Internal versions, decapitation and craniotomies were often performed. These are not procedures we would dare to do now I dread to think of this now, but they were common place at that time. I remember many cases of decapitation for prolapsed arm. This was a common procedure in those days especially as we got transferred cases coming in after many hours with a prolapsed arm, infection, and a tonic uterus. Most of the procedures were performed by Dr. Spittel under chloroform. Even, now it is sometimes difficult to get an anaesthetist, in those days it was almost impossible. I remember that one of those we managed to get to anaesthetize at that time was the late Dr. Leo Fernando who later founded the Philip Memorial Hospital in Kalutara. Chloroform was administered by us HOO. In time I became an expert in chloroform and other Anaesthesia. In fact, I remember a ceasarean section performed by Dr. Spittel with myself holding the chloroform mask.
Age tells and memory fades but I can remember that those days at Castle Street, though extremely strenuous and hazardous, was very rewarding in the big run.
I have always told my House Officers and I have had about 140 through the years, that if they work very hard during their internship they will continue to work hard for the rest of their career but that if they slack during their internship, they will be lazy and shirkers for the rest of their career. Gynaecology was started in 1955 and Dr. Spittel retired in 1956 and Dr. S. W. Jayaratnam succeeded him as Obstetrician in charge. In September 1954 I myself was transferred as Resident Obstetrician.
Kandy Hospital under Dr. P. de S. Wijesekera had tremendous experience and was a master of Obstetric vaginal examination and manipulations. It was rumoured that he had examined so many women that even when he walked he had the 2nd and 3rd fingers of his right hand stretched out ready for action! Kandy was an extremely heavy station as there were no specialist units in Anuradhapura, Polonnaruwa, Matale, Kegalle, Gampola and Nawalapitiya and all the complicated cases from these areas were transferred to Kandy. Several people protested saying that I was too junior to be appointed to this job and would not be able to manage the arduous duties as RO Kandy. However, due to the excellent training that I had under Dr. Spittel I managed. In later years Dr. Wijesekera went to the extent of asking me to look after the confinement of his own daughter who is married to my friend Dr. Atukorala, the eminent Dermatologist.
It was 23 years later in 1977, that I returned again to Castle Street Hospital for Women as it is now called, this time as Consultant in charge of Wards 3 & 4. The existing rule of grade seniority alone for Colombo was changed to a point system and at last the golden day dawned and I was able to get to Colombo on the 1st of January 1977, after 19 long years as a specialist in the outstations, 19 years as a Consultant in the outstations was then and I believe even now, a record.
When I returned to Castle Street in 1977, things were quite different. Not only had the practice of Obstetrics changed, the buildings and equipment in the hospital were also much more developed than when I was a House Officer in the early 50s, the historical landmarks up to this period are summarized here. There were now 10 wards with 5 consultants, where there was earlier, only 6 wards and one consultant, a new set of theatres, an excellent pre-mature baby unit, a large House Officers Quarters and a nurses quarters there was a blood bank and there was a pathologist, Dr. Meththananda de Silva, whose son is now a medical specialist at Sri Jayawardenapura Hospital.
My colleagues during my earlier years were the late Dr. Ashley Dassanayake who was the leading figure in Obstetrics at that time with an extensive practice who in his own words worked "round the clock". There was my old friend P. Dissanayake, who went to England with me and passed the membership with me, Dr. J. B. Gnanapragasam and the late Dr. W. S. C. Fernando. We got on extremely well and I cannot remember any problems between us. Gradually, one by one all my colleagues retired and were replaced by other senior consultants from the outstations. I must mention the name of Dr. Ashmore Atapattu who worked for 5 years and in addition to being a consultant, he also did the administration of the hospital. I must of course, mention Dr. Lakshman Fernando who is out of the island who started his Obstetric career with me in Negombo and was with me in Castle as Consultant for the last five years of my career.
When I was working as Obstetrician in Negombo we had a badminton team which played against many local teams. I was the captain, not because I was the best player but because I was the only Consultant on the side. I only played in the doubles and Dr. Lakshman Fernando who was MO, OPD was my partner. He covered the baseline and did a lot at running while I stood at net and did no running. At this time the post of RO, Negombo fell vacant and the Head Office asked me to nominate someone to act as RO. Although Lakshman had done no Obstetrics at the time, in order to safeguard my place in the badminton team, I recommended him and he got the job. There was no stopping him after that, later he became an assistant to Prof. Ranasinghe and had no difficulty with the membership examination.
Before us, many eminent consultants served at Castle Street. Among others those were Dr. S. H. P. Nanayakkara who set the pace especially in major gynaecological surgery for us to follow, there was Dr. S. Rajanayagam, Dr. A. G. Muthuthamby, Dr. E. W. Jayaratnam and Dr. S. Panchalingam.
I succeeded Dr. Miss Panchalingam who herself was a strict disciplinarian. Once her SHO Dr. T. Siriwardena now a busy Consultant was coming late for work. He had to pass her to get to the hospital before her and he ducked under his steering wheel of his car as his car went past her car. I am told that Ms. Panchalingam saw a driverless car passing her and was terribly distressed and had even wanted to inform the police and complained. Dr. Siriwardena himself who had told her that these areas being close to the cemetery were haunted and after this I am told she always came with a servant in her car.
I remember when I took over wards 3 and 4, out of about 20 lavatories only 3 were working and this was terrible for the patients. I told the PWD overseer several times but he did not do anything, saying that various items were out of stock, etc. At the end, I told him that I knew Mr. Premadasa very well and could speak to him and get whatever was needed. Mr. Premadasa was Minister in charge at that time, and I knew that he got things done! Although I told him that I knew Mr. Premadasa and could get the required parts actually I did not know Mr. Premadasa at all at that time but within 3 days of my telling this to the overseer the bathrooms had all been repaired. Later the wife of Mr. Ratnasiri Rajapakse, who was later Mayor of Colombo delivered in our ward I told him this story, that merely mentioning the name of Mr. Premadasa had bought spectacular results. He had repeated this story to Mr. Premadasa thinking he would be pleased about it but Mr. Premadasa sent word to me asking for the name of the overseer and saying that if he could have repaired it after his name was mentioned why he did not do it before, etc. I avoided this subject when Mr. Premadasa visited the hospital later and luckily he did not press on asking for the name of the Overseer.
I visited Castle Street hospital very recently in order to write this report and I was amazed at the progress that had been made after my retirement at the end of 1988. There is now a library, a new auditorium to seat 250 with a tutorial room and a mid level staff library. A powerful generator has been installed which can supply electricity to the entire hospital starting in 15 seconds. An Intensive Care Unit is in operation. An excellent Paediatric ICU is functioning. A new waiting hall is nearing completion and all over, there is activity. Even the road is being carpeted and what was a crying need in my time, a casualty operation theatre for emergency caesarian operations will shortly be commissioned. A model system of waste disposal has been put into place and administrators from all over the island come to study this.
This slide shows the bathrooms and the toilets in Dr. Sirisena's ward. The Past Patients Association collected funds and completely renovated these toilets at a cost of 1 million rupees and now a cleaning service is paid Rs. 12,500 a month to clean the toilets. This I would imagine is the only public toilet where hot water showers are available. Incidentally I am glad to mention that Dr. Sirisena was also one of my past Registrars. Arrangements have also been made to notify the local midwife when a patient is discharged after delivery so that she can to be followed up. It is also noteworthy that at Castle Street Hospital, all national events such as Wesak, Deepawali, Christmas and Ramazan are celebrated at the hospital and this includes religious observations.
There is also a praiseworthy system of counselling of all the patients entering and leaving the hospital regarding their special needs and problems as shown here. This slide shows the neat verandah of Dr. Almeida's ward - these flower pots and chairs were all brought in by him.
It must be mentioned here that the first AIDS positive mother was delivered at Castle Street Hospital in 1990. It is praiseworthy that Dr. Marlene Abeywardena, who was the qualified RO, readily and willingly handled this case at this time.
Up to 1972 the babies were all kept in a special baby room. Then after a severe diarrhoea epidemic it was Dr. Lakshman Fernando who was instrumental in organizing the present system where babies are kept with their mothers after delivery.
Mention must be made of what happened in the hospital in March 10th this year. After the bombing at the Aurvedic Hospital junction, some of the terrorists ran along Castle Street Hospital shooting at random. They fired five shots into the hospital injuring 8 visitors and an RPG fell in the space between Dr. Senanayake's and Dr. Almeida's ward. Fortunately these two worthy gentlemen were not injured! One of the visitors was badly injured in the abdomen. He was the only male ever admitted to Castle Street Hospital and was operated by a team of young registrars and house officers led by Dr. Abeysinghe. This patient was saved due to the excellent service by the hospital and its young doctors (a window damaged by a gun shot as shown here.)
Dr. K. K. W. Karandagoda, the present Director is a very able man and a man with vision and it is noteworthy that the Castle Street Hospital in spite of financial and other constraints is moving forward under his able guidance.
Above all the hospital is now staffed, by an able and dedicated team of Obstetricians namely, Dr. L. A. W. Sirisena, Dr. Lakshman Senanayake, Dr. Ranjith Almeida, Dr. K. D. S. Ranasinghe and Dr. Desmond Warnakulasuriya who was recently appointed.
To end on a personal note, at this stage of my life and career when I have practically retired from active obstetric practice, I was extremely happy to have been given the opportunity to make this address. Dr. Senanayake told me not to make this a mere recital of facts but rather to make it contain more reminiscences and stories and this I have tried to do. It is extremely gratifying to me to find that most of our consultants in Obstetrics and Gynaecology now, have crossed my path, some time or other as medical students, HO, Registars, or colleagues.
Those doctors who worked in my own unit at Castle Street Hospital and are now distinguished Consultants include, Dr. Ranjith Pathiraja, Dr. Deepal Weerasekera, Dr. Rohana Haththotuwa, Dr. Hemantha Perera, Dr. Darshan Weerasena and to mention last but far from least, Dr. Kapila Gunawardena. Incidentally Prof. Malik Gunawardane, present here also worked here and Maud, his wife conceived and had her babies here. Professor Chamberlain, then President of the Royal College of Obstetricians and Gynaecologists who toured the island a few years ago when he was given a farewell dinner at Kandy and spoke after I did said, jokingly amidst laughter that he seemed to be the only Obstetrician in the country who had not worked with Dr. Rodrigo.
In preparing this paper, my thanks are due to the Director Dr. Karandagoda, to Dr. Lakshman Senanayake for his considerable help and specially to Lakshman's son Asela, the medical student who did the photography, to other Lakshman Fernando from whose paper the "Tale of two hospitals" I have quoted, and Sampath our Secretary, who typed this and had a tough job with my handwriting.
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