Introduction

“The History of Obstetrics and Gynaecology in Singapore” (publishers: Obstetrical and Gynaecological Society of Singapore and the National Heritage Board, Singapore; 736 pages) has been conceived to reflect the rich history of Obstetrics and Gynaecology (O&G or OBGYN). It chronicles O&G development in Singapore since 1888 when the first maternity hospital was established. The book has contributions from over 100 obstetricians and gynaecologists who are practicing or have worked in Singapore before. This is the first comprehensive book written on this subject (photo 1).

Figure 1

The book was launched on 21 November 2002 by Dr S Balaji, Minister of State for Health, Singapore at the Annual Oration and Dinner of the Obstetrical and Gynaecological Society of Singapore (OGSS). The book was also presented to His Excellency President SR Nathan, President of the Republic of Singapore on 22 March 2003 at the marking ceremony of Kandang Kerbau Hospital (KK Hospital) as a Historic Site by National Heritage Board, Singapore in recognition of its role in improving obstetrical and gynaecological standards and care in the Singapore community and the world.

History of KK Hospital

KK Hospital, birthplace of over 1.2 million Singaporeans and Asia's first IVF baby, was the former world's largest maternity hospital at a time, where home deliveries in many countries were still predominant. KK Hospital earned consecutive entries in the Guinness Book of Records from the 1950s to the 1970s as the world's largest maternity hospital. In 1966, the Hospital witnessed a peak of just over 40,000 babies from a total of 39,856 obstetric deliveries. KK Hospital also witnessed remarkable improvement in maternal and perinatal mortality rates. The maternal mortality rate dropped dramatically from 760 per 100,000 births in 1930 to 7 per 100,000 births in 1987 and the perinatal mortality rate decreased from above 50 per 1000 births in 1940s to less than 5 per 1000 births in 1990s.

The progress of obstetrics discipline of the world is mirrored by the remarkable progress of O&G standards of care in Singapore as evidenced from the outstanding improvements in maternal mortality rate, perinatal mortality rate and life expectancy. Indeed the history of O&G of Singapore is the history of KK Hospital, which has trained almost all the obstetricians and gynaecologists of Singapore. Singapore has been an important focal point of O&G practice in the world. Many came to KK to teach or to be trained. British, American, Australian, Swedish and Japanese influences are evident in Singapore's obstetrics and gynaecology practice. This book is a testimony to the dedication and diligence of obstetricians, doctors, midwives and nurses who have worked under tremendous pressure to improve obstetric care in the then world's busiest maternity hospital.

The history of OGSS and the development of the practice of O&G in Singapore are inextricably intertwined. Originating as a discussion group among doctors concerned with Obstetrics and Gynaecology in the 1950s in Kandang Kerbau Hospital (then the world's largest maternity hospital), the informal meeting coalesced into the professional body of the O&G society. Its membership embraced prominent gynaecologists, including the late Prof Benjamin Henry Sheares, the founder president of the O&G Society as well the late Prof SS Ratnam, past president of FIGO. Among the many successful scientific congresses which the OGSS organized and hosted, three significant O&G events were the 4th Asian Congress of Obstetrics and Gynaecology from 15 to 24 November 1968, the 12th World Congress on Fertility and Sterility (IFFS) from 26 to 31 October 1986 and the 13th World Congress of Gynaecology and Obstetrics (FIGO) from 15 to 20 September 1991. This publication traces the progress of the Society, before and after it became an autonomous body in 1972 and describes its association with and its contributions to the development of the practice of Obstetrics and Gynaecology in Singapore and to the world.

O&G Hospitals and Departments

“The History of Obstetrics and Gynaecology in Singapore” records the roles and contributions of various O&G elements in hospitals which have contributed to the practice of O&G in Singapore since the first Maternity Hospital in Singapore opened in 1888. They include O&G units in the government/restructured hospitals, namely KK Women's and Children's Hospital, Singapore General Hospital and National University Hospital, and also O&G practices within the private hospitals, namely Gleneagles Hospital, Mount Alvernia Hospital, Mount Elizabeth Hospital, East Shore Hospital, Thomson Hospital and the new Raffles Hospital. O&G departments which have since closed down, in Toa Payoh Hospital, Alexandra Hospital and of course the old Kandang Kerbau Hospital (KK or Tekka as it is also known) are also covered, lest their history fade into oblivion. Special mention is given to the unique main building of new extension wing of old KK Hospital which witnessed a record of over one million births from 1955 to 1997. Visitors can view this historical building as the old (Old and New Wings) as well as the new KK Hospital, adjacent to the Little India train station of Singapore's latest Mass Rapid Transit (underground subway) North East Line. It has been mentioned that no intact building in the world has witnessed as many human births as the main building of the New Wing of old KK Hospital (photo 2).

Figure 2

O&G Subspecialties

The specialty of O&G has matured with the development of subspecialties like Maternal Fetal Medicine, Gynaecological Oncology, Reproductive Medicine, Urogynaecology, Minimal Access Surgery and Menopause. The developments of these O&G subspecialties are traced in relation to contributions towards a higher standard of care. At the same time, the development of supporting specialties like Neonatology, O&G Anaesthesia and O&G Nursing and Midwifery (since the passage of the First Midwives Ordinance in 1915) are described.

The history and development of O&G would not be complete without mentioning the roles and contributions of various related O&G organizations and societies. These comprise the Chapter of O&G, Academy of Medicine; Singapore RCOG Representative Committee, Perinatal Society of Singapore, Society of Colposcopy and Cervical Pathology of Singapore, Menopause Research Society, Society for the Study of Andrology and Sexology of Singapore, Singapore Breastfeeding Promotion Committee and Singapore Planned Parenthood Association (previously Family Planning Association of Singapore).

Pioneers of the O&G Community

This publication has its largest section devoted to the members and pioneers of the O&G community whose industry, dedication and commitment have led to high standards of O&G in Singapore. It features Mrs IL Aeria, former Matron of KKH from 1957–1970; Prof JS English, Singapore's first professor of Midwifery and Gynaecology; and Prof Benjamin Henry Sheares, Malaya's local Professor of Obstetrics and Gynaecology in the University of Malaya. The late Prof Sheares was the Republic of Singapore's second President (probably he was the first and only obstetrician ever to become a head of state) and is regarded as the “Father of O&G in Singapore” by the Singapore O&G fraternity in view of his pioneering surgical, academic and leadership qualities in our discipline. Other pioneers featured include Prof Tow Siang Hwa, Prof SS Ratnam, Mr Lean Tye-Hin, Dr Oon Chiew Seng, and Dr Yvonne Salmon.

Some of the Book Chapters

Academic chapters included the Timeline of the Modern Practice of Obstetrics and Gynaecology (O&G) in the World; The World's Largest Maternity Hospital — How It All Began; Obstetrics And Gynaecology Undergraduate Medical Curriculum In Singapore; Obstetrics & Gynaecology Specialist Registration; The Post-Graduate Refresher Courses in Obstetrics and Gynaecology; Fertility Trends in Singapore Since Independence; The Development of Obstetrics and Perinatal Medicine in Singapore; Birth Trends in Kandang Kerbau Hospital and Singapore; Maternal Mortality in Singapore; Perinatal Mortality in Singapore; Cesarean Section in KKH and Singapore; Development of Obstetric Ultrasound & Prenatal Diagnosis in Singapore; Gynaecological Oncology in Singapore; Development of Minimally Invasive Surgery in Singapore; The Evolution Of Assisted Reproduction in Singapore; The Development Of Urogynaecology in Singapore; Menopause Management in Singapore; Reminiscences of Anaesthesia Services in KKH; The History of O&G Anaesthesia in Singapore; Development of Neonatology and Perinatology; Towards Comprehensive And Universal Newborn Care in Singapore and Vermont Oxford Network — The KKH Experience in International Benchmarking of Neonatal Intensive Unit Care

Midwifery Chapters included History of Midwifery and O&G Nursing in Singapore; Pioneer Maternity and Child Welfare Work in Rural Singapore from 1927 to 1938; History of the Maternal & Child Health Services in Singapore; The Midwives in Singapore — Changing Roles.

Chapters on O&G fraternity included Prof J. S. English — Professor of Midwifery and Gynaecology, 1922–1948, Prof Benjamin Henry Sheares — Father of Modern Obstetrics & Gynaecology in Singapore; The Sheares Operation; Mr Lee Kuan Yew's Tribute in Parliament to the Late President Benjamin Sheares; The Changing Face of Obstetrics and Gynaecology in Private Practice; Obstetrics and Gynaecology Come of Age; Professor John Leland McKelvey; The Chiefs and Heads of the O&G Departments and Units as well as Sound of Memories — Recollections of Kandang Kerbau Hospital and O&G in Singapore. The last chapter of this section consists of interesting accounts and vignettes from many O&G pioneers and staff who had worked in KK Hospital. This included a comment on KK Hospital by Dr Mahathir bin Mohamad, Prime Minister Of Malaysia, on 18 November 2002 who was a medical student in KKH in the early 1950s.

There were special chapters which included Relationship of the Development of the O&G Specialty in Singapore and the Royal College of Obstetricians and Gynaecologists;

Singapore-Myanmar O&G Missions: The Road to Mandalay; The Big Flood in KKH; Operative Culdoscopy — A Sterilization Technique of the Past; Asia's First IVF Baby — A Personal Account; Transsexualism and Sex Reassignment Surgery (SRS) in Singapore

The KK Hospital Time Capsules; First Touch — First Time (Singapore First Television Serial on O&G); and History of Chinese Traditional Medicine and Women's Health in Singapore.

Chapters that dealt with the future & challenges of O&G included The Rapid Changes in O&G Practice over the Recent Decade; O&G Medico-Legal Risks and Liability — A Growing Crisis Worldwide and The O&G Profession in Singapore — Continuing the Tradition of “Mother and Baby Above Self”. The book has generous O&G print and photo archives related to KKH and O&G. A section on O&G Instruments features the vast array of O&G instruments and how instruments changes from the past till present.

‘As if it was a detective story'

Dr Lawrence Chan, retired O&G practitioner, former Master of Academy of Medicine, Singapore and former Chairman of Medical Board, Kandang Kerbau Hospital said in a preview of the book: “The editors and contributors have written a history, not only of the O&G Society of Singapore but also the development of O&G in Singapore. By doing so, they also have recorded the history of health care, medical education and the development of O&G through the years. I found it thrilling and could hardly put it down, as if it was a detective story. Indeed all aspects of the book – history, people, review articles and photos – are well recorded and written, and it must be preserved for posterity.”

Useful Reference Book

This comprehensive book with 151 chapters and weighing 2.5kg had a gestation period of just 36 week in 2002 and it is a product of close cooperation and hard work of the O&G community who produced this book in a record time of less than a year. It is a useful reference book for researchers or practitioners interested in history of obstetrics and gynaecology and enjoyed rave reviews from many who read it. The book is not for sale but is distributed to relevant libraries or individuals on request. An administrative and postage charges will be levied (total about US$85). For those interested, please contact the Obstetrical and Gynaecological Society of Singapore through Dr Kelvin Tan at kh@tan.net.

Correspondence to

Dr Kelvin Tan Senior Consultant & Head Perinatal Audit and Epidemiology Department of Maternal Fetal Medicine Division of Obstetrics & Gynaecology KK Women's & Children's Hospital 100 Bukit Timah Road Singapore 229899 Tel: 65-63941323 Fax: 65-62991969 Email: kh@tan.net