Tuberculosis — The Singapore Experience, 1867–2018: Disease, Society and the State by Kah Seng Loh and Li Yang Hsu (review)

Diseases rarely become a subject of historical studies in the region. This book is no doubt an important contribution, not only to the general historical studies of Singapore and Malaya, but also to the historical studies of diseases in the region. More importantly, unlike past historical studies of diseases, which were largely dominated by physicians, this book on tuberculosis in Singapore is co-written by a social historian, Loh Kah Seng, and an infectious disease physician, Hsu Li Yang. As the title of the book suggests, it is not a medical history of tuberculosis. On the contrary, it is a social and political history of the disease, which places the activities and views of various historical actors, including physicians, politicians, activists of NGOs, patients, Asians and Europeans, elites and working class, under the analytical gaze of the two authors. In short, this is a history of disease that goes ‘beyond hospitals and doctors’ (p. 155).

Drawing predominantly from colonial documents, and a small number of oral histories and personal memories, the book is divided into nine chapters including the introduction and conclusion. The narratives of the book flow chronologically to chart the social construction of tuberculosis from colonial to post-colonial era. Covering a period of over one and a half centuries, Singapore’s history of tuberculosis is periodised into different themes, reflected in the title of each chapter. On the outset, the authors conceptualize tuberculosis as ‘a social and intellectual construct and a political battlefield’ (p. 2). They contextualize the disease by situating it against the background of several social forces and trends, such as colonialism, migration, and transnational flow of ideas of sanitation and evolutionary theories during colonial era, the drive of decolonization during post-war years, and the desire of nation building after independence. Urban housing, conceived a cause as well as a solution to the spread of tuberculosis, is an issue of concern that cuts across all three eras. The dynamics between the metropole and the colony, between elites of different ideologies in the colonial administration, and between people at the giving and the receiving ends of social engineering, jointly shaped the evolution and the treatment of the disease.

Starting from the nineteenth century Singapore, tuberculosis was closely linked to pauperism and the development of pauper hospitals, which the colonial elites had little interest in. Not until twentieth century did the disease gain more colonial administrator’s attention, a timing when the medical and social meanings of the same disease had already been transformed, from a ‘glamorous hereditary affliction of beautiful and creative elites” to a ‘vile, contagious, and stigmatizing disease of the poor and the filthy’, in the West (Snowden 2019, 292). Hence, the romantic metaphor of the ‘consumptive look’ of tuberculosis sufferers as a mark of social standing and power of creativity, a social construct prevailing in the mid nineteenth century West during the pre-contagionism era, never took hold of the colony. Like its counterpart in the twentieth century West, tuberculosis in Singapore was associated not only with poverty, but also with immigrants. Similarly in both the West as well as in Singapore, the spread of tuberculosis coincided with the large influx of immigrants and rapid urbanization. While poor Irish and Italian immigrants were over represented among TB victims in New York, poor Chinese immigrants in overcrowded urban housing were the most afflicted ethnic group in Singapore. What was the colonial policy then? The Sanitary Condition of Singapore (1907), a report written by WJR Simpson, a physician who inspected Singapore’s shophouses in 1906, was a paradigm shift that shaped not only colonial policy on tuberculosis, but also that on urban housing. The report eventually became a template for today’s state built public housing in Singapore. Simpson’s suggestion was in line with comparable practices in the metropole, which viewed environmental deterioration and congested dwellings in urban space...