Cholera outbreak of 1873



A cholera epidemic occurred in Singapore in July 1873 and lasted till September the same year, resulting in 857 reported cases and 448 deaths.1 The 1873 outbreak was particularly deadly with a mortality rate of 41.5 percent.2 Port health controls on immigrants and ships were introduced after this severe cholera epidemic.3

Background
Cholera is a food- and water-borne disease, prevalent in countries with poor sanitation and hygiene.4 The earliest known outbreak of cholera in Singapore was reported in 1841, which was caused by poor water supply and sewage disposal.5 Although some sanitation regulations were introduced as early as the 1850s, and the Contagious Diseases Ordinance was enacted in 1870, there were cholera outbreaks recorded in 1851, 1862, 1873, 1895 and in the early 20th century.6

Start of outbreak
Several weeks before the outbreak began in Singapore in July 1873, cholera had hit Bangkok, Siam (present-day Thailand). Despite imposing the Quarantine Ordinance on 5 July7 to quarantine all vessels from Siam, the disease surfaced in Singapore soon after.8


The outbreak in Singapore started at Kandang Kerbau and Kampong Kapor before spreading to Rochor and Kampong Glam.9 The initial cases involved patients at the lunatic asylum located next to the general hospital in Kandang Kerbau, with more than a dozen fatalities.10 The first case occurred on 13 July at the asylum, and soon spread to the surrounding areas.11

As Kandang Kerbau was swampy, made up of low-lying, flat land and hence suffered poor drainage, and coupled with dismal sanitation in the hospital’s vicinity – all of which contributed to the area’s high susceptibility to the spread of diseases – one of the immediate public health responses was to move all patients in the hospital and the lunatic asylum to the former military hospital building at Sepoy Lines along Outram Road.12

In August 1873, when the epidemic was under control, the principal civil medical officer of the Straits Settlements, H. L. Randell, recommended to the governor that the hospital and asylum remain there because of its favourable location: The Outram site was closer to town, spacious and located on high and dry grounds that facilitated good drainage, which reduced the chances of a cholera outbreak. Sepoy Lines thus became the permanent location for the General Hospital.13

Response of the locals
Many locals believed that cholera was caused by a spirit, referred to as hantu cholera” (hantu is Malay for “ghost). In an attempt to chase the spirit away, noisy processions were held at midnight, in tandem with loud prayers, beating of drums, setting of firecrackers and even throwing of flaming dammar, which is form of resin.14 These processions were disruptive and disturbed the peace, resulting in many complaints lodged with the inspector-general of police.15


One of the difficulties faced by authorities in the fight against cholera was the reluctance of some affected locals to seek medical treatment. The families of sufferers also hid the sick instead of encouraging them to seek proper treatment and more often than not, they refused to go to the hospital. This likely led to many deaths, particularly those from the Chinese community, going unreported and thus under-declared to authorities.16

End of the epidemic
Randell declared the end of the cholera epidemic on 10 September 1873. It was observed that the disease had “abated so considerably that it [was] no longer [an] epidemic”.17 Quarantine regulations were lifted the same month.18 By the end of the epidemic, there were 857 reported cases and 448 deaths.19

Public health officials identified the source of the cholera infection to be from Bangkok; however, the epidemic was exacerbated by bad sanitation and drainage, as well as a drought that had beset the island, which resulted in poor water supply and sewerage.20

Resultant measures
Stringent port health controls were introduced following the epidemic to prevent the spread of diseases brought in by ships.21

The acting master attendant, Henry Ellis, suggested the establishment of a quarantine station on St John’s Island to prevent epidemics from occurring due to importation of the disease. As a result of the earlier backlash from traders and merchants regarding the imposition of port quarantine measures that adversely affected their businesses, the government approved Ellis’s plan. The proposal in November 1873 included having a steam cutter for visiting incoming ships as well as constructing a floating police station, a hospital on St John’s and a burial ground on Peak Island.22

Recent cholera cases in Singapore
Today, strict sanitation regulations, modernised water supplies and good hygiene practices have led to a drastic reduction in cholera cases. In recent times, there were eight reported cases of cholera in 2001, and two cases each in 2002 and 2003.23 In 2013, two imported cases of cholera were reported.24



References
1. Legislative council. (1873, October 4). Straits Times Overland Journal, p. 7. Retrieved from NewspaperSG.
2. Tan, N. (1991). Health and welfare. In E. C. T. Chew & E. Lee (Eds.). A history of Singapore. Singapore: Oxford University Press, p. 341. (Call no.: RSING 959.57 HIS-[HIS])
3. Mills, L. A. (1942). British rule in eastern Asia: A study of contemporary government and economic development in British Malaya and Hong Kong (p. 247) [Microfilm no.: NL 25443]. London: Oxford University Press, H. Milford.
4. Koh, T. T. B., et al. (Eds.). (2006). Singapore: The encyclopedia. Singapore: Editions Didier Millet in association with the National Heritage Board, p. 119. (Call no.: RSING 959.57003 SIN-[HIS])
5. Tan, N. (1991). Health and welfare. In E. C. T. Chew & E. Lee (Eds.). A history of Singapore. Singapore: Oxford University Press, p. 341. (Call no.: RSING 959.57 HIS-[HIS])
6. Tan, N. (1991). Health and welfare. In E. C. T. Chew & E. Lee (Eds.). A history of Singapore. Singapore: Oxford University Press, pp. 341–342. (Call no.: RSING 959.57 HIS-[HIS]); Tate, D. J. M. (1979). The making of modern South-east Asia, Vol. 2: The western impact: Economic and social change. Kuala Lumpur: Oxford University Press, p. 252. (Call no.: RSING 959 TAT)
7. News of the fortnight. (1873, July 13). Straits Times Overland Journal, p. 12. Retrieved from NewspaperSG.
8. Lee, Y. K. (1978). The medical history of early Singapore. Tokyo: Southeast Asian Medical Information Center, p. 296. (Call no.: RSING 610.95957 LEE)
9. List of subscriptions. (1873, July 13). Straits Times Overland Journal, p. 14. Retrieved from NewspaperSG; Lee, Y. K. (1978). The medical history of early Singapore. Tokyo: Southeast Asian Medical Information Center, p. 71. (Call no.: RSING 610.95957 LEE); Buckley, C. B. (1965). An anecdotal history of old times in Singapore 1819–1867. Kuala Lumpur: University of Malaya Press, p. 415. (Call no.: RCLOS 959.57 BUC-[HIS])
10. List of subscriptions. (1873, July 13). Straits Times Overland Journal, p. 14. Retrieved from NewspaperSG; Lee, Y. K. (1978). The medical history of early Singapore. Tokyo: Southeast Asian Medical Information Center, p. 71. (Call no.: RSING 610.95957 LEE)
11. Lee, Y. K. (1978). The medical history of early Singapore. Tokyo: Southeast Asian Medical Information Center, p. 258. (Call no.: RSING 610.95957 LEE)
12. Koh, T. T. B., et al. (Eds.). (2006). Singapore: The encyclopedia. Singapore: Editions Didier Millet in association with the National Heritage Board, p. 119. (Call no.: RSING 959.57003 SIN-[HIS]); Lee, Y. K. (1978). The medical history of early Singapore. Tokyo: Southeast Asian Medical Information Center, pp. 258, 71. (Call no.: RSING 610.95957 LEE)
13. Lee, Y. K. (1978). The medical history of early Singapore. Tokyo: Southeast Asian Medical Information Center, p. 71. (Call no.: RSING 610.95957 LEE)
14. List of subscriptions. (1873, July 13). Straits Times Overland Journal, p.14; Omnium. (1873, August 9). Correspondence. Straits Times Overland Journal, p. 11. Retrieved from NewspaperSG.
15. Legislative council. (1873, September 6). Straits Time Overland Journal, p. 5. Retrieved from NewspaperSG.
16. Cholera — It was a case of kill or cure. (1958, August 13). The Singapore Free Press, p. 10; Legislative council. (1973, August 23). Straits Times Overland Journal, p.7. Retrieved from NewspaperSG.
17. Untitled. (1873, September 20). The Straits Times Overland Journal, p. 14. Retrieved from NewspaperSG.
18. Lee, Y. K. (1978). The medical history of early Singapore. Tokyo: Southeast Asian Medical Information Center, p. 296. (Call no.: RSING 610.95957 LEE)
19. Legislative council. (1873, October 4). Straits Times Overland Journal, p. 7. Retrieved from NewspaperSG.
20. Lee, Y. K. (1978). The medical history of early Singapore. Tokyo: Southeast Asian Medical Information Center, p. 258. (Call no.: RSING 610.95957 LEE)
21. Mills, L. A. (1942). British rule in eastern Asia: A study of contemporary government and economic development in British Malaya and Hong Kong (p. 247) [Microfilm: NL 25443]. London: Oxford University Press, H. Milford.
22. Lee, Y. K. (1978). The medical history of early Singapore. Tokyo: Southeast Asian Medical Information Center, pp. 296–297, 301. (Call no.: RSING 610.95957 LEE); Groom, P. (1958, August 13). Cholera – It was a case of kill or cure. The Singapore Free Press, p. 10. Retrieved from NewspaperSG.
23. Koh, T. T. B., et al. (Eds.). (2006). Singapore: The encyclopedia. Singapore: Editions Didier Millet in association with the National Heritage Board, p. 119. (Call no.: RSING 959.57003 SIN-[HIS])
24. Ministry of Health. (2014, November 13). Communicable diseases surveillance in Singapore 2013. Retrieved from Ministry of Health website: https://www.moh.gov.sg/content/dam/moh_web/Publications/Reports/2014/Communicable%20Diseases%20Surveillance%20in%20Singapore%202013/Food%20Water%20Borne%20Diseases.pdf



Further resources

Conservancy of the port. (1873, July 13). Straits Times Overland Journal, p. 12. Retrieved from NewspaperSG.

Legislative Council. (1875, January 18). Straits Observer (Singapore), p. 3. Retrieved from NewspaperSG.

Mills, L. A. (1942). British rule in eastern Asia: A study of contemporary government and economic development in British Malaya and Hong Kong [Microfilm no.: NL 25443]. London: Oxford University Press, H. Milford.

Pearson, H. F. (1985). Singapore: A popular history. Singapore: Times Books International.
(Call no.: RSING 959.57 PEA-[HIS])

Straits Settlements. (1876, August 5). Straits Times Overland Journal, p. 6. Retrieved from NewspaperSG.

The rainfall. (1874, May 16). The Straits Observer (Singapore), p. 2. Retrieved from NewspaperSG.

Thursday, 11th September. (1873, September 20). Straits Times Overland Journal, p. 14. Retrieved from NewspaperSG.



The information in this article is valid as at 27 July 2015 and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.

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