A hundred years ago, practice of orthopaedics came within the domain of general surgeons. This was the state of the art, even in developed western nations. Since then
It has grown in to the specialty it is today, with even sub-specialization in areas such as arthroscopy and spinal surgery. All along, Sri Lanka has had as its model the British system of medicine and surgery and we have followed their trends.
Searching for the origins of orthopaedics, we not only have to trace it to Britain, but having looked thus far, reach out to other centres of development elsewhere in the world.
Orthopaedics in ancient times had its roots thousands of years ago when ‘physicians’ or practitioners, or merely the bold and enterprising, did this type of therapy. Millennia old artifacts are evidence of the practice.
Hippocrates of Greece, in the 4th century B.C., treated fractures and dislocations, his methods being handed down in remarkable detail to present times. Hippocratic method of reducing a dislocated shoulder is common knowledge. His methods such as of traction, splintage and bandaging are available, fascinating us for their scientific basis of practice.
Development in the field did not occur at his pace in the next 1800 years though trauma in various forms, in war, altercations, falls from trees and carriages, attacks by elephant and other animals would have been the norm in those troubled times. The reasons for this lack of progress are complex, a separate story by itself.
In much later times in England, around 700 years ago, barbers were cutting into abscesses and such like, gradually gaining respectability as the Company of Barbers, which centuries later was to transform into the Royal College of Surgeons of England.
In our own country an indigenous system of medicine prevailed from ancient times. This had a large input from nearby India and is known today as the Ayurveda system, Susruta and Charaka being two well known physicians in ancient times.
In Sri Lanka around the 4th century B.C., there were ‘hospitals’ of some sort in Sri Lanka, during King Pandukhabhaya’s reign, historical records being scarce.
‘Hospitals or halls for every ten villages’ were said to exist for man and beast in physician-king Budhadasa’s reign, circa 4th century A.D. Archeology gives credence to these claims.
Ayurveda practice, indigenous to the east, encompasses manipulations and splintage of fractures and dislocations, application of oils, massages and mobilizations and heat therapy, as practiced even in present times. A degree of specialization on trauma is seen by the existence of specialists for fractures - ‘kadum- bindum’, or falls from trees- ‘gus vedakama’.
Period of foreign rule
Portuguese writings on Ceylon around the 16th century praise certain local practices then carried out. To comprehend this view we should keep in mind that till the latter part of the 19th century, allopathic methods were not particularly more effective than the indigenous system. It is the advances in the last couple of centuries as anaesthesia, anti sepsis, Xrays, blood transfusions and antibiotics that allowed the ‘western’ system of medicine forge ahead.
European methods of treatment become evident in this country when the Portuguese occupied our maritime regions and built a few hospitals within their garrisons. Following them, the Dutch had a larger number, one built around 1650, existing today in a dilapidated state on Hospital St. Fort. Treatment was by a few doctors, missionaries and priests and not necessarily by the qualified. They did not in any way cater to the local people.
Early British Rule
As the entire country came under British rule from the early 1800’s, a system of allopathic hospitals and clinics gradually came up all around. These were primarily to serve the British and those who worked for them, labour from India being a large sector. Over time, the locals acquired know how and training in their methods and by the mid 20th century our health system was in the hands of Sri Lankans.
The era of the basic medical Doctor
Till specialisation into surgery, medicine, gynaecology, obstetrics and other fields began in the 20th century, a medical doctor was trained in and expected to look after all diseases and injuries.
Methodical training of the local doctors began from 1839, at the Bangal Medical School, Calcutta, though the first batch was all European.
The Mission Medical School in Manipay, Jaffna, managed by Dr. Green, an American, trained local doctors from 1848 in a three year course in Tamil. The well known surgeon S.C. Paul, father of Professor Milroy Paul, was a Manipay product.
The Ceylon Medical School was formed in 1870, shifting to the present premises on Kynsey Road, becoming the Ceylon Medical College in 1880.
The College began awarding the Diploma of Licentiate in Medicine and Surgery- the LMS (Ceylon), till 1941.
As the Medical College became a faculty of the University of Ceylon in 1942, the LMS was replaced by the MBBS qualification.
Specialisation into various fields began in the 20th century. General surgeons went to the U.K., qualifying in the FRCS on par with British surgeons. They were ‘head to foot’ surgeons looking after all things orthopaedic as well. By the 1920s surgeons Lucian de Zilwa, S.C. Paul and R.L.Spittel were practicing.
In the 1930s, many surgeons headed surgical units in the country. A majority served the General Hospital Colombo, the biggest in the country. It extended from Kynsey Rd, towards Town Hall across the Norris Canal Rd.
In these times of British occupation, the Director of Health was Brier Clief, but the surgeons were Sri Lankan. Many surgeons including DR. MVP Peiris, Professor Paul were in charge of surgery at the Military Hospitals and even junior doctors assigned to help during the Second World War. During the war the General Hospital O.P.D. was taken over as a Military Hospital and so were the premises of St. Peters College, Holy family convent and Nalanda College.
In the 1940s surgeons of the caliber of J.H.F. Jayasuriya, B.E. Fernando, G.S. Sinnatamby, V.Gabriel, A.S. Rajasuriya, M.V.P. Peiris and Professor Milroy Paul were in practice. Children at the Lady Havelock Hospital for Women and Children (later named Lady Ridgeway hospital) Borella, were looked after by Professor Paul.
Memories- Dr.P.R.Anthonis 1930s
Dr. P.R.Anthonis LMS 1936, FRCS 1947, recalls the 1930s, “ I became a medical student in 1930, undergoing the ‘rag’ upstairs at the Mahamodiya Hotel in Pettah in the usual manner in the usual garb, with the usual discomfiture. Alcohol was forced down me by ‘senior’ Gerry Muller”.
He continues, “For old people, fracture femur often meant death, death from pneumonia and pressure sores. Plenty of splints and slings were used on fracture patients. In the Convalescence Hospital at Ragama, I was the first honorary House Officer, with one Apothecary to assist.. Most of the wards had galvanized ‘takarang’ roofs. One ward was reserved for orthopaedic patients under treatment from Colombo. In Colombo many wards down Regent St. were for private patients and only the chief surgeon had the right to private surgical patients there. Generals surgeons tackled all problems.” His salary was Rs. 250/ per month. (A teacher would receive about Rs.30/ at the time)
Two physiotherapists served the whole hospital.
All nursing care was by European sisters under a mother superior until the 1950s.
The O.T. ‘D’ was the major operating theatre with the new theatre complex A, B, C, commissioned from the late forties.
Orthopaedic origins in Colombo
Dr.M.V.P. Peiris, LMS (1925), FRCS (Eng) 1929, was in charge of the surgical department General Hospital Colombo from 1932 and was entrusted with organising an orthopaedic service. He set about the task till his retirement in 1949/50.
Khan Memorial Ward
The Khan Memorial ward (ward 51), came up in 1939, for care of children. Dr. Lakshman Rajakaruna, orthopaedic surgeon, recalls attending MVP’s clinic there in 1943 as a teenager for a fractured collar bone.
Orthopaedic Clinic Building
The present Orthopaedic Clinic building was a mustard gas air raid shelter during the war till 1945. It had a concrete slab for a roof. Dr. Francis Silva, M.O. was in charge of this shelter, and as assistant to Dr. M.V.P.Peiris, had suggested that it be converted to the O.C. which was duly carried out by the Public Works Department guided by Dr. Peiris. The then juniors remember sweating it out, assisting surgery under the hot concrete roof with fans blowing. The fans kept on blowing for a long time, through to the 1980s.
The Limb Fitting and Surgical Appliances Services.- Francis Road-Ward Place-Regent Street.
The Colombo work shop for these services was situated early on at the Civil Medical Stores on Francis Rd. near the anatomy ‘block’. It shifted later to the Civil Medical Stores at Ward Place. The service appears to have existed from early times.
In the 1940s the staff were four or five, trained on the job. A few were trained abroad for short periods.
Mr.D.C.S.Dillimuni the first workshop manager trained at the orthotics and prosthetics company Hangars, in the U.K. returning with the qualification, Fellow of the Institute of British Surgical Technology, (FIBST). He was the manager from 1947 to around 1969. Mr. Eddie Assauw, FBIST was an expert technician who stayed by the surgeon at clinics, to make appropriate appliances with minimal delay.
The workshop was shifted about 1947 to new buildings at the rear of the O.C.
The orthopaedic physiotherapy Unit
Two or three physiotherapy-assistants were trained, post- matriculation, on-the-job, with lectures, clinical discussions and ward rounds. Mr. Bertie Samarasinghe-I met him recently practicing at ‘Medicheck’ Colombo- was one of the earliest, working there from 1947 to 1952.
Later, in the 1950s, the upstairs was built to accommodate the orthopaedic physiotherapy unit and nurse’s rest rooms. The occupational therapy unit came up later. A chiropodist was employed as were a walking trainer and physical instructor.
In the 1930s and early 40s major surgeries were performed in OT -’D’, manipulations and most plaster applications being done at the O.C. and Khans ward.
The theatre complex, A, B, and C were functioning from the late forties. These were modern in design, air-conditioned. The OT ‘A’ was used for orthopaedics.
Adult orthopaedic patients were housed in Wards 57 and 58 and 40(check ward numbers please).
When Dr. MVP Peiris retired in 1949/50 a de facto functioning orthopaedic unit was in existence.. He will be remembered as the ‘father of orthopaedic surgery’. He joined the Medical Faculty as Professor of Surgery. to serve the hospital for another decade.
Dr. M.V. P. Peiris
Those who knew MVP remember his eminence as an ambidextrous surgeon, recalling many stories of humour and interest. Mr. Bertie Samarasinghe remembers a soldier admitted with a paralysed left arm. MVP asked a nurse to keep this arm held up over the patients head. MVP gripped the other arm securely and suddenly pulled down the patient’s pyjamas. The patient made a reflex grab at his trousers with the ‘paralysed’ arm resulting in a miraculous cure!
He had considerable respect for certain ayurvedic practitioners, sending patients to the priest – kadum bindung haamudurwo-down at Maria Kade for ‘oils’.
Dr.Peiris had special respect for another ‘kadum bindum’ specialist, known as ‘Lensuwa’ who seemed able to speed up recovery after initial fracture setting at the hospital using his oils on the exposed areas. Interestingly, ‘Lensuwa’ himself was in his ward sometime later with a fracture to get it set properly so that he could follow up with his own oils!
We have no first hand experience of practicing the ayurveda system but it should be borne in mind that the majority of fractures are stable and do not need to be set as observed by Charnley in his monograph on ‘Closed manipulation of Fractures’.
In these patients splintage is to reduce pain, and splints of bamboo or strips from coconut branches, applied and supervised regularly are more effective than plaster of Paris applied sans supervision as happens often enough even now.
Dr Peiris on retirement from the university as Professor went on to become our Minster of Health and Minister of Trade and Commerce in the 1960s.
Geometry theorems at age 70
Born in 1898, Dr. MVP is said to have had a photographic memory and at the age of seventy in1968 taught his sons geometry theorems! ( Source- son Prith Peiris, U.S.A.)
Professor Milroy Paul
Professor Milroy Paul working at the General Hospital was also in charge of one ward at the Children's Hospital. He had worked with Denis Browne and managed club feet in wooden splints strapped to both feet with elastoplast. This splint was easy to make not requiring any workshop work and cost nothing. The baby’s feet were traced on a sheet of paper and the parents took it to ‘Waravita’ the undertakers nearby, who cut out the splint from a left over piece of plywood. I was his house surgeon in 1963 and later as a specialist adopted the splint, finding it as effective as serial plasters and more effective than the rigid Denis Browne’s night splint. Milroy managed congenital dislocations of hips in frog plasters and did a large number of osteotomies for bowlegs on preschool kids. In the 1960s he referred special problems to the orthopaedic clinic.We place on record his invaluable service to orthopaedics.
The early orthopaedic surgeons
As Dr. MVP retired, in 1950, Mr.S.W.R.D Bandaranayake Minister of Health, invited Mr.Gerard.M. Muller, then an orthopaedic surgeon in London, to Colombo.
Mr. Gerard M. Muller
Mr. Muller LMS, FRCS assumed duties at the General Hospital Colombo as our first orthopaedic surgeon in 1950.
Dr. Muller, qualified in the LMS (Ceylon) in 1934, served the dept. of health including a period at Ratnapura, resigned in 1939 proceeding to the UK for higher studies. The reasons why Mr. Muller was invited at this juncture are not clear. Dr. M.H.G. Siriwardena FRCS, former senior surgeon, Colombo and Dr. Mark Amerasinghe orthopaedic surgeon, Kandy intimated that Mr. Muller had a proposal to appoint assistant orthopaedic surgeons to different hospitals with Mr. Muller in overall charge. He likely may have submitted the proposal in response to the Minister's wishes to develop Orthopaedics as a specialty. The economy was booming and improvements of many other hospitals were being carried out. Mr Bandaranayake had the vision but did not remain Minister for long.
Mr. Muller took over the orthopaedic unit, which included the clinic, Khans, orthopaedic wards and the OT ‘A’. Pin and Plate surgery had been initiated at the O.C. theatre in his time.
He was an innovative surgeon and had designed some instruments of his own.
He created a rubber footpiece for Symes amputees, the first time rubber had been used in the world, publishing the account in the B.M.J. Professor Sethi from Jaipur acknowledged this pioneering effort when introducing the Jaipur Limb years later.
The Transit Hostel for the Disabled
Muller was an active member and Vice-President of the Colombo Friend Need Society and with the help of Mr. Hunter, a European, got the Transit Hostel for Cripples built in their premises in 1955. The hostel serviced the O.C. patients arriving from afar. They were cared for at the hostel to be brought to the clinic. This invaluable service continued into the 1970s.
Dr. Bede, younger brother of Mr. Muller whom I met holidaying in Colombo recently, confirmed and provided much personal information. The Mullers lived in Kotahena and their father Dr. Wilfred Michael Muller LMS 1908 owned the ‘Womens and Childrens Hospital’ which is now known as the Cooperative Hospital Kotahena.
On a lighter note, Gerry was particular about his name being pronounced Muller- as in ‘fueller’. He also insisted, British surgeon style, on being addressed as ‘Mr’ and not ‘doctor’… This led to many humorous situations. Once he sent back to England a letter addressed to ‘doctor’ G. M. Muller.
A patient would engage him in dialogue as follows; “Doctor…”, “Mister!”, “Pardon doctor”, “Mister”, ‘I am Mrs. …”, “No, me..”. “Oh! Doctor”, “MISTER!”, “Pardon me Doctor?” …..
I met Mr. Muller at the Whittington Hospital London in 1972, running the orthopaedic clinic where I was registrar. Of medium build and complexion he spoke with a Lankan accent.
Dr. J. Francis Silva
The next orthopaedic surgeon in Colombo was Dr. J.Francis Silva.
Dr.Silva was house surgeon from 1941 to 1943 at the General Hospital. From 1942 to 1946 he was in charge of the Asiatic Wing of the Naval Hospital at the St. Peters College premises gaining experience on problems of the locomotor system under Commander Williams FRCS.
He assisted Dr. MVP Peiris from 1946 to 1948 and with MVP busy on many fronts looked after adult orthopaedics and children at the Khans Memorial.
He states that he learnt plaster-of-Paris technique from a Franciscan nun, in the Khan ward, its pantry then being used for P.O.P. applications.
Dr. MVP Peiris had promoted him to take to orthopaedics as a career.
Having sat the Primary F.R.C.S. exam held for the first time in Sri Lanka in 1948, Dr. Silva went to the U.K. on a Nuffield Scholarship, returning in December 1951.
Dr. Francis Silva L.M.S.(Ceylon), FRCS, M Ch.(Liverpool) was the first in the country to obtain the M.Ch. Liverpool and the country’s first to have been sent for orthopaedic specialization.
On his return, after a year as resident surgeon and additional orthopaedic surgeon, he was appointed consultant orthopaedic surgeon, to a second unit in the G.H.C. in 1952.
General Surgical Wards 1950s
To recall the 1950s at first hand, the corridors of the general surgical wards were occupied by patients in plasters, Thomas splints, Steinman Pin traction on Balkan beams and Bohler frames. Most of them were yet managed by general surgeons as the initial treatment of trauma was in their hands with special problems referred to the orthopaedic surgeon.
The long stay patients occupied beds in surgical ward corridors, some having to lie on mats on the floor.
The general surgeons of the 1950s were Professor M.V.P.Peiris, Professor Milroy Paul, R.S.Rajaratnam, Noel Bartholomeuse, P.R.Anthonis, Clifford J.L. Misso, L.D.C.Austin, D.F.D.S. Gunawardena. They treated all trauma on their casualty, referring some to the orthopaedic surgeons. Dr.’Drogo’ Austin had a special interest in orthopaedics, having worked at the Park Royal hospital, Central Middlesex.
Orthopaedic surgery in the 1950s
A convalescent centre was established at Talagolla for orthopaedic patients around this time.
Dr. John R.Wilson MRCP chest physician, placed two wards in Welisara at Dr. Silva’s disposal and Francis was able to send patients with bone and joint tuberculosis there for non operative care.
Potts paraplegics were treated for months in a ‘Plaster bed cast’.
Poliomyelitis was common and so were appliances and braces
Hemi-arthroplasty of the hip for osteo-arthritis, avascular necrosis of the head of the femur and severe rheumatoid arthritis was introduced. The Judet acrylic prosthesis was used, later giving way to the Austin Moore and Thompsons prostheses. Knee arthroplasty was carried out after excision of the lower end of the femur for benign tumours using the Hermon Young Prosthesis. Short legs due to polio were lengthened by ‘z’ plasty of the tibia using the Roger Anderson apparatus. Scoliosis was treated with split Risser jackets and turn buckles to obtain maximum correction before fusion. Some elbows were replaced with the Judet acrylic joint..
Fixing fracture femur with Kuntscher nails reduced hospital stay and stiff knee joints considerably.
Fractures of the femoral neck were pinned with Smith Petersen’s tri-flanged Pin or Mac Laughlin’s Pin and Plate at the O.C. theatre. This surgery was done at the O.C. till the commissioning of the Finland building in 1991.
The author recollects labourer Jayatissa in the 60s regularly holding the Xray film to obtain a rush film of the pinning. Over the years he became mentally dulled and was diagnosed to have leucopaenia due to frequent Xray exposure.
The author was doing a Pin/ Plate surgery at the O.C. in the 1980s as consultant when the big theatre lamp fell off the ceiling, miraculously between the patient and surgeon.
It was dangerous!
Dr. Silva was a Hunterian lecturer, Royal College of Surgeons about 1957/58 on trauma of the elbow. He had expectations of joining the Medical Faculty as a Professor in Orthopaedics but this was not to be.. He had many publications by the time he left Ceylon and published many more while Professor of Orthopaedics in Malaysia.
He lectured to medical students. The author was one of them. His four lectures were all on internal derangement of the knee joint. He exhorted all to read the extensive two volumes of ‘Watson Jone’s Fractures and Joint Injuries’. Fortunately we also had clinical appointments and ward classes to learn orthopaedics.
Dr. Silva left in 1966 to become the first Professor of Orthopaedics at the University of Malaysia.
The1950s witnessed many future orthopaedic surgeons being trained in Colombo.
Dr.Lakshman Rajakaruna, was House Officers to Mr. Muller in 1951/52.
Dr.Rienzie Peirs worked with Dr. Francis Silva in 1954.
Dr. V.Rasanayagam worked with Dr. Francis Silva about 1957/58
Dr. T. Shanmugalingam worked with Dr. Francis Silva in 1957/58
Dr. Mark Amerasinghe worked with Dr. Rienzie Peiris in 1956/58
Dr. Rienzie Peiris M.B.B.S.(Ceylon) 1948, FRCS (England), FRCS (Edin) M.Ch. (Liverpool), returned from higher studies in the U.K. in 1957 and was appointed to the vacancy left by Mr. Muller who resigned to work in Ghana.
Soon after in 1958, a major upgrading of the orthopaedic unit occurred.
Commissioning the second floor- Bandaranayake Building -1958
The new 5 storied Bandaranayake Memorial building on Regent St. was commissioned in 1958. It was built after demolishing existing wards such as the Passengers Ward, on the land between the Merchants and Seamans Wards.
The whole of the second floor of this building was reserved for orthopaedics, comprising wards 2, 3 and the O.T.’E’.
Dr. Silva and Dr. Peiris were able to practice in these environs on par with the U.K. However, work loads were heavy, with many patients all over surgical wards, not conducive to an even standard of care for all.
Rienzie Peiris was a charismatic surgeon and teacher, who stimulated many of us to take to orthopaedics. He is remembered for his skill in surgery and teaching. The Finland Building construction was made possible due to much effort on his part.
He should equally be remembered for perseverance against great odds to regain the right to private practice of medical officers.
He was a generous and frequent host to the juniors, with beer and colourful stories on politics and prominent personae around in Colombo.
He retired in May 1984.
Dr. V. Rasanayagam
Dr.V. Rasanayagam M.B.B.S. (Ceylon), FRCS, M.Ch. Liverpool trained with Dr. Francis Silva and returned from the U.K. around 1960 to be the third orthopaedic surgeon Colombo.
He was a skilled surgeon. His ward classes were forceful and interesting, with bursts like, “What the …..!” and “Your ……!” aimed at the student, A kind man, he visited the Health Department Sports Club some evenings with Dr. Sandrasagara, paediatric surgeon, sure to offer a round of drinks to any of us juniors who dropped in, regaling us with tales, medical and otherwise.
He retired early to migrate to Australia around 1969.
Orthopaedic surgeons in the outstations
Appointment of orthopaedic surgeons to outstation hospitals began with Kandy in 1961 followed by Galle in 1962.
However all these appointments were made with no prior preparation of the infrastructure of the hospital, in contrast to Colombo.
Dr. D.Mark Amerasinghe M.B.B.S. (Ceylon), FRCS(England), M. Ch. (Liverpool), arrived in Colombo in 1961, and within a month assisting Dr. Silva, was appointed the first orthopaedic surgeon to the General Hospital Kandy on April 1st 1961.
Kandy General Hospital
Dr.Amerasinghe had to carve out a functioning unit over the next ten years. He recalls the help from Dr. Andrew Perera V.O.G. who allowed him some ward beds and operating time from his list three days a week! His clinic was at the Eye clinic by the grace of Eye Surgeon Lloyd Weerakoon.
Much later, with help from the Hope Ship Foundation he improved the workshops. With great personal effort he managed to do some Pin/Plate surgeries on a modified table bringing implants from Colombo. Some internal fixations were possible with a few plates and Rush nails available. Austin Moore prostheses became available ten years after ordering them.
He did much soft tissue surgery for polio and radical surgery on club feet. Informed and innovative, he had a trial with bamboo splints on fractured tibiae instead of the long-leg plaster, getting a lower incidence of non-union of the lower third of the tibia with early mobility than with the A.K. POP.
Peradeniya Medical Faculty
With the creation of the Medical Faculty Peradeniya, the Kandy Hospital became a teaching hospital for medical students who did their clinical training with Mark Amerasinghe.
Of aesthetic bent, Mark was an accomplished singer who performed at the highest level.
He retired prematurely in 1983 to go to Malaysia as Associate Professor and later to lecture in anatomy at the Peradeniya University.
Dr. M. Laskhman Rajakaruna
Dr. M.Lakshman Rajakaruna MBBS (Cey) 1950, FRCS, MCh Liverpool, trained under Mr. Muller in 1951/52, but resigned from service in 1954 to proceed to the UK. He rejoined the dept in 1960 as Resident Surgeon Colombo.
General Hospital Jaffna
Dr. Rajakaruna was appointed the first Orthopaedic Surgeon, Jaffna from 1961.
He too had to carve out a unit over the years with the help of colleagues.
Dr. Rajakaruna transferred in 1966 to Badulla Hospital replacing Dr.T.N. Shanmugalingam.
He transferred to Kurunegala in 1971 following Dr. D.D.Jayawickrema.
In 1972 he left the service to migrate to the UK.
Dr. D.D.Jaywickrama MBBS (1951) FRCS 1961 worked with Dr. Francis Silva for a period before going abroad. He did the Primary and the Final FRCS in the UK.
Returning in 1961, he was resident surgeon for a few months at the GHC.
His first appointment was to the General Hospital Galle in 1962, replacing
Dr. Shanmugalingam. He served Galle till December 1968.
General Hospital Kurunegala
In 1968 Dr. Jayawickrema transferred to the General Hospital Kurunegala as its first orthopaedic surgeon working there till around 1971.
Orthopaedic Surgeon in Charge Accident Service Colombo
Around 1971 Dr. Jayawickrema came over to Colombo as the first Orthopaedic Surgeon in Charge of the Accident Service. He was the first to be appointed solely to this post.
He retired about 1977 to work in Oman.
He was re-employed as Orthopaedic Surgeon Kalubowila from 1982 to 1985.
Dr. T.N.Shanmugalingam MBBS 1951, FRCS (England), FRCS (Edin), M.Ch. (Liverpool) trained with Dr. Francis Silva in 1957/58, was in the UK from 1959 to 1961.
General Hospital Galle
Dr.Shanmugalingam was appointed the first Orthopaedic Surgeon to the General Hospital Galle in1962.
However soon he transferred to the General Hospital, Badulla.
General Hospital Badulla 1960s
Dr. T.N.Shanmugalingam came to Badulla in 1963 as its first orthopaedic surgeon.
In the three years he worked there he set up an excellent unit with the help of Sister Carmen Tissera coming over from Colombo. Sister Tissera worked in the orthopaedic theatre in Colombo and trained in New Zealand in 1962-1963 together with Sister Jenny Nanayakkara.
DR.Shanmugalingam transfered to Colombo in 1966 as Dr. Francis Silva left
Establishment of the Colombo Accident Service 1965/66
1965 was a landmark year at the General Hospital Colombo in trauma management.
The first Accident Service of the General Hospital was created within the precincts of the Old Victoria Memorial Eye Hospital in 1965/66. The old Eye Hospital had shifted over to the new buildings on Deans Road.
All surgical trauma casualties that previously flooded two surgical casualty wards were easily accommodated at this building. It was ample, well sited, well managed with a theatre, Xray dept, wards 52, 53 and 54 (ICU) plus a burns ward. The staff had spacious duty rooms.
Three teams of doctors worked round the clock. One resident surgeon and three post-Primary FRCS S.H.O.O. made one team. A duty anaesthetist was on site. Prompt attention was given to out-patients as well. I remember thoracic surgeons Dr. S.J. Stephens and Dr. Rudra Rasaratnam rushing in at midnight to operate on many occasions. At that time the knife was the most dangerous weapon in Sri Lanka mostly used on the Sinhalese New Year night! I was S.H.O. together with .M.N.T.Fonseka, later professor of Surgery, Galle, and N.A. Karunaratne my batch mate.
The nurses and other staff were keen and a pleasure to work with.
Baila with work- Accident Service
I remember well nurses Sumana, Tilaka, Abey and the baila queen Philomena who was much sought after at the Accident Service New Year Parties. It was not all work!
Credit must be given to the authorities and staff who made it all possible. As the then health minister remarked at the opening ceremony with Prime Minister Dudley Senanayake as the chief guest, “Doctors shall be waiting for you round the clock, night and day”.
And so it was till in1991 the service shifted to the new Finland Building.
These old buildings continue to be under the care of Surgeon in Charge Accident Service.
As Rienzie retired in 1984, Dr.Shanmugalingam became the senior orthopaedic surgeon, General Hospital. Shan as we called him was a store house of orthopaedic knowledge practicing a variety of surgeries.
Dr Shanmugalingam retired in 1988(check date)
Orthopaedic doldrums 1970s
In the 1970s progress in orthopaedics and trauma in the country was static. Pin and Plate surgery was no longer possible in Colombo by the 1980s. Most fracture neck of femora, including intra-capsular fractures were dealt with by simple traction and transfer to the local hospitals. Internal fixations of bones were a challenge with non functioning hand drills, just a few drill bits available and a shortage of plates and screws.
This was at a time when orthopaedics was advancing rapidly in other parts of the world.
In the early eighties, Dr. Peiris however managed to obtain a hundred Total Hip units with the support of the Prime Minister and this was the only advance in orthopaedics for over a decade.
Dr. T.Parameswaran MBBS (Ceylon), FRCS, M.Ch (Liverpool), worked with Dr. Rienzie Peiris in the 1960s.
As he arrived in Sri Lanka after post graduate studies, he was posted to Jaffna as orthopaedic surgeon about 1966. Dr.Rajakaruna had just left Jaffna for Badulla.
Around 1969 he transferred to Colombo replacing Dr. Rasanayagam who migrated Australia.
Dr. Parameswaran was conscientious and caring, an excellent colleague ever willing to help the juniors. He migrated to Australia in 1986.
Dr. Sydney. A. Ediriweera
Dr. Sydney A. Ediriweera MBBS (Ceylon) 1961, FRCS 1968 was trained by Dr. V. Rasanayagam in 1965 and was abroad from 1966 to 1968. On his return in 1968 he was R.S. Colombo.
General Hospital Galle 1970s
Dr. Ediriweera was appointed to Galle in January 1969 where he worked till 1975.
He published a book on Orthopaedics and Trauma in Sinhalese which was of great use to many. He transferred to Kurunegala in 1976 but transferred to Kalubowila in 1977.
General Hospital Kalubowila
Dr.Ediriweera was appointed the first orthopaedic surgeon to the hospital in 1977. He worked there for two years till 1979.
Dr. Ediriweera came to Colombo in 1979 as the surgeon in charge of the Accident Service and retired prematurely in 1991.
No-pay leave era-doldrums 1970
Going back to the 1970s, these were difficult times for post-graduates waiting to go abroad. Scholarships were drying up. The few available for finer specialties were granted to already practicing general surgeons by the Deputy Director Medical Services. Those who came back after orthopaedic training did not fill any orthopaedic posts. As a post Primary-FRCS S.H.O, I recall the tension, trying to go abroad for higher studies.
Much lobbying was done by all of us before the problem was solved by allowing those eligible, no-pay leave. The health minister responsible was W.P.G. Ariyadasa. The decision to grant no-pay leave was wise, allowing aspirants and even reluctant aspirants from other specialties sans qualifying exams too the same chance.
Are surgeons brainier?
At this stage I would comment on why so many doctors took to surgery in those days. The Primary FRCS was the only exam readily available for those who wished to pursue higher studies. Medicine was as attractive but one had to do 1 ½ years of recognised apprenticeship or wait five years after the MBBS before one was eligible to sit the M.D.(Ceylon). Often only about one candidate out of fifty passed the M.D. exam. In the Primary FRCS, the pass rate was about 15-20 percent.
Dr. V. Sivagnanavel MBBS (Ceylon) 1961, FRCS, FRCS(Orth) went on no-pay leave in 1971. He returned around 1972/73.
General Hospital Jaffna 1970s-1980s
Dr.Sivagnanavel was appointed Orthopaedic Surgeon Jaffna in 1975.
He went abroad in 1977 for a year’s training in Orthopaedics. He overstayed but returned sometime after 1980 with the qualification FRCS (Orth). The FRCS Orthopaedics examination in the U.K. was held for the first time in 1980.
On his return, Dr.Sivagnanavel was re-employed at the General Hospital Jaffna and held the post till he resigned in 1987 to migrate to the U.K.
Dr. J.K.S Weerasekera MBBS (Cey) 1963, FRCS (Eng) 1971, went abroad on no-pay leave, worked in the U.K for three years.
He came back in 1973, and was for 1 ½ years resident surgeon Accident Service Colombo.
Badulla General Hospital-1970s with Dr. Weerasekera
Dr. Weerasekera was appointed orthopaedic surgeon, Badulla in May 1975 where Dr. Shanmugalingam and Dr. Rajakaruna had created a well ordered orthopaedic unit.
One house officer assisted him.
Sister Carmen Tissera was in overall charge of wards, clinic and orthopaedic theatre work. A two-storied building had been constructed and two wards on the ground floor were commissioned for orthopaedic patients. Though soft tissue surgery was possible, few implants were available for internal fixation. As a consequence clubfooted babies and soft tissue problems received good attention with most fractures managed in plasters or traction. No Pin/Plate surgery was possible nor implants available for hip surgery. Steinman Pin traction in Thomas splints with Balkan beams was used for fracture femur giving excellent results.
Club feet deformities were corrected using Milroy Paul’s plywood splints or plasters. Radical surgery was performed when babies were about 3-6 months of age, Dr. Dawood anaesthetizing them with great care.
Dr. F.A.Dawood was a stimulating colleague to work with and gave epidurals to my patients with low back pain with promising results.. These were very early days for epidurals for this type of problems. But I went on transfer soon.
The workshop under the care of Mr. Lekamge was adequate and housed in new buildings opposite the hospital.
On his return in July 1988 assumed duties at the General Hospital, Galle.
The hospital was then sited at Mahamodera by the sea.
The orthopaedic wards were functioning under the general surgeons since Sydney Ediriweera left in 1975.
Facilities however were poor. Fractures of shaft of femur were managed with skeletal traction in Thomas splints. A few Kuntcher nails were kept in reserve. No Pin/Plate surgery was possible. No proper drills or implants for internal fixations were available. Some of the stuff was obtained from the Civil Medical Stores in Colombo with personal visits.
The Galle Teaching Hospital
The Galle Clinical Society formed in the 1950s was the forum for academic exchange had few in the audience early on but overflowed when the medical students came in 1980.
Dr. D.V.J. Harishchandra’s clinical demonstration, hypnotising patients on the podium who would carry out his orders in a trance, kept the house wide awake so that I could follow up with a discussion of Colles fractures before audience recovery!
The Hospital became a Teaching Hospital with the first batch of medical students arriving in 1980 after their second MB done elsewhere. All facilities at the hospital were shared with the faculty with no new buildings being available at that time.
The new Karapitiya Hospital was being constructed at a pedestrian pace and not completed for a decade or more.
Dr.M.N.T.Fonseka was Professor of Surgery. Clinical appointments in orthopaedics were begun within a year.
In this formative era I was visiting lecturer to the Faculty in Physiology as well as clinical teacher.
Social interaction so vital in a small community was frequent with get-togethers, some memorable free dinners at the new ‘five star’ hotels at Koggala, walks on the imposing Dutch Ramparts and sea baths at the famous Unawatuna Beach beset with the ever present danger of some tourists skinny dipping.
The annual cricket match with the lawyers topped the list, ‘no quarters given nor asked’ during the day followed by a close encounter of the other kind by night at the Galle Sports Club in the Fort.
Dr.J.K.S.Weerasekera came on transfer to General Hospital Colombo in May 1984.
At this time, facilities at the G.H.C. were far better than in the Galle, but dwindling rapidly.
The Finland Project Colombo
However from 1986 hospital life was exciting.
The hospital had come under the Ministry of Teaching Hospitals allowing for a greater degree of development. The Secretary Dr. Daya Samarasinghe and Director Dr. Lucian Jayasuriya were prime movers in finalizing an agreement with the Government of Finland to construct a new Orthopaedic and Accident Service at the General Hospital Colombo. Dr. Oliver Fernando Director ran the hospital efficiently giving whole hearted support to the building project. As mentioned earlier, Dr. Rienzie Peiris had initiated action on this project
The project began well before construction of the building..
From 1986 the Finland medical team initiated the Pilot Project in the Wards 2, 3 and theatre O.T. ‘E’ so as to upgrade methods and skills of all categories of staff before the new building came up.. Dr. Salaspuro was the leader of the Finnish team with Dr. Weerasekera in charge of the Project in its execution.
Teams of specialists came over to train the staff. Doctors and nurses were sent to Finland to assimilate methods practiced in their best hospitals. All aspects of orthopaedic care were upgraded in the next five years.
Weekly orthopedic clinical conferences were organised with Dr. Abeysinghe as administrative assistant to Dr Weerasekera.
Use of computers was introduced to the hospital for the first time with the pilot project in 1987.
New Accident and Orthopaedic Building 1991 G.H.C.
The Finland building was commissioned on 15th March1991 with Dr. Hector Weerasinghe appointed medical superintendent of the unit.
This seven storied building served trauma patients on the ground floor with a lecture hall and administrator’s offices on the first floor. Wards were on the upper floors. The two storied large theatre complex was to the rear, the upper floor designated for orthopaedic surgery and the CSSD while the ground floor had an intensive care unit managed by anaesthetists, with adjoining theatres for trauma surgery including neuro-surgery.
Orthopaedic upgrade in Colombo 1991- Finland style
Within five years the standards of practice of orthopaedics had upgraded to international levels. The A-O system and principles of fracture treatment, Dynamic Hip Screw fixation utilizing Image Intensifier, internal fixation of joint fractures, total-knee replacements, arthroscopy, antibiotic policy based on clinical auditing, external fixators and flap grafting compound fractures were introduced.
The dedication of Finnish surgeons Soini and Antti Latvala, bacteriologist Ojajarvi, will be remembered as well as the nursing staff headed by Anika Pohto and Brigitta Rantakkari.
Dr.S.D.Atukorale our clinical bacteriologist and Dr.Ojajarvi succeeded in bringing down post operative infection rates to international levels with a clear antibiotic policy.
The plastic surgeons Dr. N.Y Wijemanne and Lalantha Amerasinghe were ever ready to help.
Sri Lankans will remember the people of Finland in gratitude for a long time.
The 1980s were trying times. Bomb blasts were occurring around Colombo. A Disaster Management plan was adopted for the hospital.
About the 1990s, there was a pressing need for artificial limbs for the injured forces personnel. The waiting list was long. However the Workshop Manager Mr. M. D. G. B. Basnayake managed to supply 280 limbs within 1 ½ years when the Army supplied the raw material.
Artificial Limb Production
At the Colombo O.C. workshop temporary prostheses were fitted to all amputees readily enough.
However few permanent limbs were supplied due to lack of funds for raw material. These were of the SACH foot type, and not quite suitable for the manual labour classes.
This led to long waiting lists so that patients were not able to obtain one even after ten years.
The Colombo Friend In Need Society.
The Colombo Friend In Need Society in 1985 took on the task of manufacturing the low cost Jaipur Limb introduced by Professor P.K. Sethi from 1985.
Soon branches were opened up in Jaffna, Kandy and Galle. Collectively they were able to cope with the demand. Today these societies continue to give service to the country.
The Ranaviru Sevana Workshop
This Limb Fitting Centre came up later on to serve the forces.
The Sri Lanka Orthopaedic Association
In 1992 (CHECK?) the Sri Lanka Orthopaedic Association (SLOA) was formed with Dr. R.B.J.Peiris as the Founder President. Created with a small number of members at the time (10?) it has continued to grow in numbers and influence. Dr. Antti Latvala of Finland was present as a distinguished founder member/guest.
He was appointed orthopaedic surgeon to Kurunegala in 1978 and transferred to Kandy in 1983 on the retirement of Dr. Mark.Amerasinghe. He transferred to General Hospital Ragama in ? 1996 and subsequently to the General Hospital Kalubowila in ……. and retired in ………
In 1983 Dr. Milton Solangarachchi MBBS (Colombo) FRCS who had qualified on his own was appointed orthopaedic surgeon, General Hospital, Ratnapura. He was the first orthopaedic at Ratnapura and did well to carve out a new unit. He came on transfer as Surgeon in Charge Accident Service Colombo in 1991. He met with his demise in October 1993.
Dr. D.H.C.Sunil Hendalage MBBS 1972 FRCS, worked with Dr. Rienzie Peiris in the 1970s, and resigned, went abroad to obtain the FRCS, joining Galle as orthopaedic surgeon from 1987 to June 1996. The hospital had by this time been shifted to Karapitiya. He also worked for a time as relief orthopaedic surgeon Colombo, in the vacancy created by Dr. Parameswaran’s resignation in 1985. He left Galle in 1996 to go abroad.
Dr. S. Sritharan MBBS 1971 (Colombo), FRCS (1978), M.Ch. Liverpool, FRCS (Orth) 1981 trained with Dr. Parameswaran, went abroad on his own to qualify, training in orthopaedics. He sat for the FRCS orth. in 1981, the second year of its inception.
He arrived in Sri Lanka in 1986 to go into private practice in Colombo. He introduced A-O instrumentation in the private sector bringing his own set of instruments. Practicing at Ratnams Hospital, Navaloka Hospital and later at Apollo Hospital he brought with him a high level of experience from the U.K. with a special interest in knee ligament surgery.
He was senior lecturer in orthopaedics at the private Medical college Ragama from1986 to1996 and is the first orthopaedic surgeon to have practiced at the General Hospital Ragama.
He continues in private practice to date, taking part in all academic activities of the Sri Lanka Orthopaedic Association, having been its president once.Dr. J. Randunna Corea MBBS (Peradeniya) FRCS, M.Ch.Liverpool, FRCS (Orth) 1980.
A graduate of Peradeniya he went to the U.K.on his own to train in Orthopaedics. He obtained the FRCS Orth as it was held for the first time in 1980. He was registrar to Mr. Harry Platt at Selly Oak Hospital, Brimingham who was a foremost surgeon on Scoliosis surgery using Harrington’s Rods. Randunna brought his experience to Sri Lanka in the 1980s as a private orthopaedic surgeon working in Colombo annually for short periods while holding a Professorial post at King Faizal Hospital, Saudi Arabia. He operated on a large number of scoliosis patients at the Sri Jyawardena Hospital Kotte.This type of surgery was not performed routinely in the country at that time. He met with his demise in 2008.
Private Hospitals in Colombo.