European health care in Malaya was first introduced into urban areas and only progressed to remote rural locations with the expansion of colonial authority (Manderson, 1996). This is in keeping with general colonial policy that health care should primarily serve the expatriate population, whether civilian or military; and in this respect care of insanity was treated in the same spirit, with the siting of asylums in areas of British influence (Bhugra, 2001; McCulloch, 2001). Consequently, the first recorded lunatic asylum in Malaya was built near the regimental hospital under the auspices of the colonial authorities in Penang, a Crown possession for some decades since 1786, to cater, it is claimed, for primarily syphilitic European sailors (Baba, 1992; Deva, 1992). By 1829 however, there were a mere 25 inmates in the Penang asylum, 23 men and two women, almost all being Chinese and Indian (Tan and Wagner, 1971).
Commensurate with the rapid expansion of the asylum system earlier in nineteenth-century England, the rapidly growing colonial settlement of Singapore saw the sequential building of several asylums, commencing with a comparatively small ‘Insane Hospital’ in 1841, where previously the insane were abandoned to the indifferent care of the local gaol (Ng and Chee, 2006, Tan and Wagner, 1971; Shorter, 1997). Eventually this situation culminated in the establishment of the large ‘New Mental Hospital’ in 1928 (Ng and Chee, 2006). However, in the nineteenth and early twentieth century, despite colonial concerns that asylums were required in Singapore, this does not imply that the perceived prevalence of insanity was comparable with that of England in 1900, where it was almost 30% higher than in the Singaporean community (Teoh, 1971).
By 1887, however, an English psychiatrist by the name of William Gilmore Ellis was appointed to take charge of a newly built asylum in the recently established colonial settlement of Singapore (Ng and Chee, 2006). This building, constructed in 1885 on the Sepoy Lines, replaced the original asylum of 1862, which, it seems, had been built to cater for predominantly Asian migrant labour following a murder at the local gaol. Due to overcrowding of the asylum, however, apparently a policy of repatriation of chronically ill Chinese and Indian inmates commenced, duly resonating with the accounts of Ernst and Jackson in this regard.
A further institution was opened in Penang in 1860 but this did not remain for long, with the Sepoy Lines asylum at Singapore being subsequently obliged to absorb their internee population following closure (Murphy, 1971). The next institution on Peninsular Malaya was not established until circa 1910 when the Central Mental Hospital was built in Tanjong Rambutan, a few miles from the tin-mining town of Ipoh in Perak (Tan and Wagner, 1971). Its name was changed to Hospital Bahagia in 1971.
Returning to Gilmore Ellis’ Singapore asylum, admissions in the late nineteenth century were noted to come from as far afield as Bangkok and Australia, where, in the latter case at least, psychiatric services were considered to be far more rudimentary (Teoh, 1971). Although in South Australia, at least, there had been an attempt to model them on British counterparts as a need for asylum care was recognised due to the repercussions of migration on the mental health of colonial settlers (Piddock, 2004). Apart from the Straits Settlements (Penang and Singapore), cases were referred from the States of Johore, Malacca and Selangor; the quality of early psychiatric services in Malaya at this time was evidently by no means deficient in comparison with other nations (Teoh, 1971). Even at the original Singapore asylum the number of psychiatric beds per capita was roughly equivalent to that of Britain and ahead of America, with conditions for patients considerably preferable compared to the community and institutional abuses of the insane in North America (Geller and Harris, 1994; Murphy, 1971). A fact perhaps not so surprising when put in the context of asylums in the British Raj, which were often superior to those in Britain and supported by comparatively enlightened policies and rapid responses to reform (Keller, 2001; Ernst 2010). This, notwithstanding a revisionist critique of the colonial authorities neglect of the vagrant mentally ill Indian beyond the walls of the asylum, and the overcrowding and racially-based differences in treatment within them (Ernst, 2010)
To return to historical Singapore, the types of admission to the new asylum were varied, with the first case of neurosyphilis in the Asian local population noted in 1906. By comparison in England, Shorter (1997) argues that neurosyphilis rose to epidemic proportions swelling the numbers of nineteenth-century asylums and resulting in mania, paralysis, dementia and death, with further cases of morbidity due to a rise in alcohol abuse. Accordingly, from the beginnings of the twentieth century the socio-economics of the period dictated that 20% of all admissions to the Sepoy Lines asylum were suffering from signs of neurosyphilis. Whilst equally by 1906 in grim comparison it was noted that similarly alcoholic psychosis was beginning to replace illnesses caused by opium consumption (Teoh, 1971).
Prior to Gilmore Ellis’ supervision of the new Singapore asylum the original hospital in Stamford Raffles’ Singapore had an enviable discharge rate of 89% with most cases admitted suffering from acute psychotic attacks after the use of opium and other narcotics; this situation was not to last however (Murphy, 1971). Madness and ethnicity were already viewed by medical authorities of the time as following certain racially determined lines, and consequently Chinese migrant workers were perceived as suffering from their own distinct forms of insanity and increasingly so, as Victor Purcell states:
Insanity among the Chinese was attributed to drinking, opium-smoking and gambling, and in some measure to speculation … Chinese lunatics suffered from dementia mostly, whereas the other races had mania, the former being due to gambling and opium-smoking (Purcell, 1948: 65).
Gambling, use of opium and more notoriously venereal diseases were a feature of life for nineteenth-century colonial Malaya where migrant labour was overwhelmingly made up of male Asian workers from China and the Indian subcontinent. These men were largely brought to work in tin mines, on estates and railways, and in small private enterprises, although in Sarawak Chinese farming skills were sought (Chew, 1990). By contrast, immigrant women were largely brought to work in brothels serving Asian migrant and white expatriate masculine needs (Manderson, 1996). Prostitution however, carried its own penalties in the form of syphilis, which was initially a rare occurrence amongst non-Europeans.
General Paralysis of the Insane, a syphilitic infection of the brain which causes insanity, was never seen among Asiatics. Practically all cases were among those of European stock and it was then considered that the disease was peculiar to Europeans only and was a disease of civilised life running at high pressure (Teoh, 1971: 20).
The inference here being that the pressures that the white expatriate community suffered from were similar to those of the Asian expatriate community, whereby socially sanctioned conjugal relationships were unlikely in a social environment characterised by a lack of eligible females. British civil servants in Malaya, in common with other colonial regions, required permission to marry from their employers and this only after many years of service, which consequently gave rise to the institution of concubinage of local women (Stoler, 1991). This, Stoler argues, was an expedient policy that preserved the health of expatriate males and helped to secure their continued employment and contentment in foreign regions.
In relation to this point, Teoh notes that the majority of admissions to the Singapore asylum at this time were in an appalling state of health; with women admissions, few though they may have been, in the worst physical condition of all (1971). A plausible inference may be drawn under the circumstances that these were due to the ravages of a life of prostitution and its concomitant hazards, as much as from any other form of disease and hardship.
The low admission rates in Singapore at the turn of the nineteenth