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History & Culture / Southeast Asia

What was Singapore like 100 years ago? (Public Health)

Curious, we gathered answers from official colonial records. The British, in their administrative precision, kept tedious records of almost every aspect of their jurisdiction over the Straits Settlements, including public education, civic organisations, and public health. An investigation into these seemingly mundane colonial records yields an interesting picture about the daily lives of the communities living in Singapore 100 years ago.

In this series, we cover different segments of life and society in 1920s Singapore. The 1920s were among the most prosperous periods of the century. Singapore benefited greatly from the global recovery then as soldiers rejoined the economy after the First World War. The “Roaring Twenties”, as the period was known in the USA, reflected the economic dynamism and social exuberance of the time. Throughout these boom years, Singapore’s social services expanded, largely funded by the colonial government.

Previously, we looked at the existence of friendly societies in colonial Singapore— “What was Singapore like 100 years ago? (Friendly societies)”. Here, we look at the public health landscape during that same period.

At the turn of the 20th century, Singapore was plagued by all sorts of tropical diseases, such as beriberi, tuberculosis, dysentery, cholera, and malaria. Poor public sanitation and overcrowding among the destitute exacerbated these issues. Despite this, Singapore’s public health infrastructure was underdeveloped and inadequate. Western medicine and public institutions were largely reserved for the colonial elite or military needs.

For the masses, traditional medicine and medical practices were the main source of healthcare. Only a few charitable institutions—such as Tan Tock Seng’s hospital and the Thong Chai Medical Institution, which were financed by wealthy Chinese merchants—provided affordable treatment to the poor.

In the 1920s, the colonial government increased its investment in healthcare services and public sanitation significantly. This likely followed a social campaign mounted by Dr. Lim Boon Keng, a well-known and respected Straits Chinese, in the 1890s.

It was during this decade that major hospitals such as the Outram General Hospital (which has since become the Singapore General Hospital), the Trafalgar Home for Lepers, Woodbridge Mental Hospital, and Kandang Kerbau Maternity Hospital were opened.

Even in the 1920s, hospital care and beds were provided through a class system, where Classes 1 and 2 were reserved for the elite and Class 3 for the masses.

The number of patients admitted to and treated by government hospitals increased dramatically across the 1920s, possibly due to rising confidence in Western medicine among the population and an expansion of services.

Researchers have suggested that the Asian population at the time saw government hospitals as “places to die” in. Patients exhausted all traditional remedies before they resorted to hospital care.

Prominent diseaes in the 1920s

The colonial records reveal that malarial fevers, venereal diseases, ankylostomiasis, and tuberculosis were a few of the notable diseases in Singapore during the 1920s.

Malarial fever

Malarial fever cases spiked in 1926 due to low rainfall. Still water that would have usually been flushed out by rain developed into breeding grounds for mosquito larvae, and more of these reached maturity. Construction works, as well as the creation of new agricultural land, also potentially caused the increase in breeding sites.

Venereal disease

Cases of venereal disease were numerous throughout the 1920s, due to the lack of knowledge regarding the prevention of such diseases. To counter this, many propaganda activities and educational materials were organized and published by the Social Hygiene Office.


Cases of ankylostomiasis (a type of hookworm disease) increased in 1925 due to more accurate recording of patient numbers. That year, a hookworm survey was performed in preparation for the subsequent three-year Hookworm and Rural Sanitation Campaign.


Tuberculosis caused a relatively high number of deaths throughout the 1920s. This was likely due to the persistent problem of overcrowding, which spread the disease rapidly. The creation of more rubber plantations increased the need for labour in addition to the already high numbers of Chinese and Indian immigrants, contributing to the overcrowding issue.

Opium smoking

Opium smoking was possibly the worst scourge to plague the labouring population of Singapore throughout the colonial period.

A commission in 1907 concluded that while smoking opium “was a fairly harmless, fashionable vice among the rich”, it was extremely harmful to the poor, who could only afford to smoke the residue of used opium. Addiction was particularly prevalent among rickshaw pullers, who seldom lived past 35 to 40 years.

However, the tax on the opium trade, together with that on local alcohol, accounted for most of the colonial government’s revenue throughout the 19th century. Until the mid-1920s, the opium excise still accounted for half of the government’s receipts.

There were many efforts in the Chinese community to stamp out opium smoking. In 1906, the Singapore Anti-Opium Society was founded, and a rehabilitation centre was set up. The colonial government also set aside 8 hospital beds from March 1925 onwards to cure addicts of the habit on a voluntary basis. The number of beds quickly increased to 40 in the same month due to overwhelming demand.

While many benefitted from the programme and were cured of opium smoking, almost just as many fled from treatment. As the data shows, nearly half of each year’s patients absconded.

This story is the fourth, and final, part of a series on the life and society in 1920s Singapore. The first story was “What was Singapore like 100 years ago? (Demographics)”, followed by “What was Singapore like 100 years ago? (Education)”, and “What was Singapore like 100 years ago? (Friendly societies)”.

The 1920s were a remarkable period in Singapore’s history under colonial rule. The population grew rapidly; school attendance rose; the number of legitimate mutual-assistance groups grew; and infectious diseases were kept under control. It would not be the same again under British rule. Singapore only saw prosperity at this scale in the 1950s, after the Second World War.

A closer study of the combined colonial records will yield a comprehensive picture of life in colonial Singapore, and how the British colonial government sought to rule one of the most economically productive parts of its vast empire.

Story by Loh Pei Ying and James Lui
James Lui is a passionate and experienced historical researcher who has more than a decade of experience in the publishing industry. An established editor, his greatest wish is to marry his passion for history with his experience in publishing, and he is currently researching the British founding of Singapore in 1819.
Research by Gwyneth Cheng
Code by Siti Aishah
Design and illustrations by Amanda Teo and Munirah Mansoor


Data used in this article was taken and compiled from the Annual Departmental Reports, Colonial Office: Straits Settlements Sessional Papers (CO275/103-126), and the Blue Books, Colonial Office: Straits Settlements Miscellanea (CO277/72-82). It is important to note that data collection methods were not specified in the colonial records, and the numbers should be taken with a pinch of salt and room for error or bias in collection.


  • colonial government,
  • colonialism,
  • healthcare,
  • history,
  • hospital,
  • singapore,
  • Tropical diseases

Disclaimer: Our stories have been researched and fact-checked to the best of our abilities. Should you spot mistakes, inaccuracies, or have queries about our sources, please drop us an e-mail at


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