Changes in the Environment, Epidemic, and Politics in Health: Public Health in the Residency of in the Colonial Era

Imas Emalia [email protected] Mohammad Iskandar (Department of History University of ) [email protected]

Abstract

This paper aims to present the theme of history of health. The focus of this research is the change in the environment in Cirebon in the times of the Dutch colonial when there was an epidemic which influenced the politics in health. At the time when Cirebon and the surrounding area was deemed vital for the development of the economy of the Dutch colonial government, which led to a decision of turning Cirebon a gemeente or colonial town in 1906. Cirebon was turned from a traditional town (kingdom) into a modern town and since then the number of population rose which gave rise to slums and kampongs . It was the conditions of the kampongs that caused epidemic which spread to various regions in Cirebon. Since then, the state of health of the people of Cirebon deteriorated until the beginning of the 20 th century and the number of mortality rose. Boomgaard’s research on health explained the contributing factor which caused the state of public health was the unfair government policy. While according to Hesselink the condition was caused by the fact that the people opted to traditional treatment and rejected the modern treatments introduced by Europe. These two factors do not explain the influence of the environmental changes which actually triggered the epidemic. The history method with the social cultural approach by William H. Sewell will be used to explain this matter. Health as part of the real life is strongly sustained by the condition of the environment besides various rules.

Keywords: History on health, changes in the environment, Epidemic, Health Policies.

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Introduction Geographically, Cirebon has the characteristic of inland and coastal area and historically it was also known as the center of the spread of Islam in West . Since the 16 th century, Cirebon had already been known by people outside Cirebon as a bustling coastal area. This was because Cirebon became the center for the collection of trading goods either from local residents or external traders. Meanwhile, the hinterland became the supplier of various agricultural and plantation products such as vegetables, rice, coffee, wood and other goods. The economical life and activities of the Cirebonese were adjusted to the geographical conditions. They were maritime people living around Port of Cirebon and hinterland people who worked as farmers on their rice fields. The maritime people can also be found around the rivers that crossed their residences such as Cimanuk River, Pekik River, Kasunanan River and Losari River. The rivers became an important route which can be sailed by ‘jung (ships)’ to connect to the remote areas. The Cirebonese had been used to the maritime, farming and trading world for the interest of economic, politics and religion. More and more migrants came to Cirebon to sail or to do trading. In line with the rising popularity, more Europeans travelled more often to Cirebon, up to the point in 1681 when the Sultanate of Cirebon was conquered by the Dutch traders or the VOC ( Vereenigde Oost-Indische Compagnie ). The sultan did not have any authorities in the control of politics and economy anymore. Even up to the end of the colonial rule (VOC) (1799), the power of the Cirebon Sultanate was not acknowledged at all and did not function anymore. Meanwhile, The Dutch colonial government believed that the role of this region was essential due to the fact that this region was the transit place for export and import commodities to the remote areas and the surrounding areas. To support its economic activities both in the coast and hinterland, the Dutch colonial government carried out construction of social facilities. Since 1859, the improvement of the environment of Cirebon was continuously done. Cirebon increasingly became the attraction for outsiders for the development of the economy (Sulistityono; 1994; 146). Since 1870s, Cirebon had experienced modernization and industrialization period, but the problem was that it was after this period that epidemics of many diseases spread in the society. The

2 infectious diseases that became widespread were malaria, small pox, cholera and plague. Since the changes occurred in the environment of Cirebon, the natives who urbanized often suffered the diseases. The state of health of the natives deteriorated up to the mid of the 20 th century. Since then Cirebon became one of the regions which had the highest mortality rate caused by the outbreak of diseases. This was the factor that influenced the policy of the government on health in Cirebon. Some of the policies were the decentralization on the budget for the cost of health up to the establishment of special health office for the eradication of plague. Thus, the question which is raised in this discussion is why was the state of public health in Cirebon became one of the worst in Java after the changes in the environment in the colonial times and how were the political policies on health at that time? Boomgaard, who researched the history of health in the Dutch East Indies, explained that among the factors which caused the poor public health condition of the natives was the Dutch East Indies government unfair political policy in health. The health services were especially provided by the government to military personnel of the Dutch Army, citizen from Europe and China, while the natives were not provided with the same portions of health services. The health services were expensive for them and they were placed based on social status (Boomgaard; 1996). Sciortino is also of the opinion that the health services in the colonial period were owned by the military (Sciortino; 2007). In contrast with the opinions of Boomgard and Sciortino, Hesselink believes that the public health of the natives was terrible due to their own health behavior which preferred getting traditional treatments and not approving modern treatment system. This traditional culture was the cause of the epidemic among themselves to become more widespread (Hesselink; 2011). But, in the case of the epidemic in Cirebon, based on the government report in the Binnendlansch Bestuur 1893, it was explained that since the beginning of the 19 th century, the outbreak of disease which spread from Cirebon to Indramayu, Galuh, and Majalengka was malaria (Binnendlansch Bestuur; 1940-1942). The disease escalated especially after the construction of various infrastructures. The construction of main roads oftentimes caused malaria to occur and attacked the workers due to the lengthy construction process which caused puddles of water in the

3 site. Thus, the disease spread to other society. Besides malaria, influenza plagued the natives especially laborers like laborers in the train industry, port factories or plantations. After the environment of the city changed its function, almost all of the Residency of Cirebon became an area of epidemic starting from malaria, cholera to influenza (Paulus; 1917).

Theoretical Framework To answer the problems aforementioned, the theory used in this discussion is structural theory from William H. Sewell who used the social-cultural approach (Spiegel; 2005). This theory will make it possible to understand the living practices of certain society of Cirebon in their new environment after the changes in the environment due to the formation of gemeente or colonial town by the Dutch East Indies government. The establishment of gemeente brought about certain consequences on the Cirebonese who were forced to abide by the rules of institutions or government in order to realize or to grasp the meaning of modernization. The ability of Cirebon people to adapt to new cultures or ideas influenced many different practices in life including on health.

Methods In this discussion, the method used is the method of history. The first step is heuristic in the form of finding primary and secondary sources. This stage prioritized more on archive research. The second step is history critics. The acquired sources are then verified, that is to choose then analyze based on the theme of research. The third step is to interpret that is to explain facts in line with the data found which is then arranged chronologically. The last step is to reconstruct events in history in the form of the work of history of historiography.

Preliminary Study The study on the history of health in Java in the Dutch East Indies era had been discussed in a book Health Care in Java: Past and Present edited by Peter Boomgaard. In the introductory, it is mentioned that since the 19 th century, health services had belonged to the Dutch military personnel.

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While the civil society especially the natives couldn’t access the services as easily as the military. Government’s injustice in providing health care became the factor why the state of health was in bad condition at that time (Boomgaard; 1996. 1993; 77-93). Similar studies conducted by Heselink explained that health policies implemented through various health educational institutions in the end of the 19 th century like the establishment of Sekolah Dokter Djawa (Djawa School of Medicine) and Sekolah Bidan (School of Midwifery) were aimed to improve the state of health of the natives. But due to the fact that the society still do traditional treatments, their state of health was still bad at that time (Hesselink; 2011). The two works on history has the same tendency in explaining the health dynamics in the time of the Dutch East Indies. Both revealed the dominancy of the government policy in determining the state of health of the people at the time. But both came up with a different analytical result. Boomgaard’s analysis showed that the government’s political interest for the rule of Dutch East Indies determine to the health care that was military oriented, whereas Hesselink showed the domination of the government in managing the public health of the natives as a new offer, had “forced” the society to accept modern European style treatments. But both analyses didn’t explain the main causing factor of the plague or epidemic in the society that caused the state of health in various regions at the time to be bad. Actually, the process of modernization carried out by the Dutch East Indies government originated from the change in the physical environment which was ecologically damaged and at the same time because of the change in the function of the city from traditional to colonial. All of these factors lead to the spread of various diseases among the citizen. In such conditions, modernization efforts were hampered and the government’s political stability was disturbed. The modern medical system became government projects which actually was a burden on its own. Various policies on health which were implemented were unable to improve the state of health of the people at that time.

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Changing Environment and Urban Dynamics Since the decentralization policy for several cities in Java and Madura in 1905 was set, the government had given special attention in line with the level of needs. Some of the aspects with special attention were the arrangements in finance, irrigation, city facilities and infrastructure including health (Staadsblad; 1905; 85. 1910; 95) encompassing allocation of fund, service system, facilities, health workers and epidemics (Staadsblad; 1910; 246). Decentralization for Cirebon was based on Staatsblad year 1906 No. 122. Then a decision on the formation of city or gemeente based on Staatsblad 1906 No. 276 (Staatsblad; 1906; 122, 276; 1- 3) was made. Since then on, Cirebon became a hectic and full of the colonial trading and political activities. Cirebon also became the capital of the Residency which controlled the economy through government politics at the local, afdeeling , and district level. Cirebon at that time oversaw some afdeeling such as Cirebon, Kuningan, Majalengka, Galuh, and Indramayu. The decentralization policy made an impact on the improvements of infrastructure which were enhanced to support the enhancement of the improvement of the government’s economy. The modernization process was followed by some development of the city’s facilities and infrastructure that follow the European style. Offices, factories and residences were developed to fulfill the needs in the city. Besides that, the lifestyle of the community in the city, professions and transportation facilities were increasing. The changes in the environment and function of this city gave a new color to the natives both in terms of physical culture and behavior. Repair of roads, railway tracks, ports, street lighting and center of trade were conducted. The development of the railway station (staatsspoor ) in Cirebon was carried out in 1912 to connect Batavia-Cikampek-Cirebon. The development was continued in 1916 to connect Cirebon-Kroya-Pekalongan (Paulus; 1917; 474. Zuhdi; 1997; 93-94). Besides that in 1917 repair of the roads and land filling of the Bacin River were performed (Stadsgemeente Cheribon; 1931; 93), and in 1930’s the paved roads towards the hinterland along 28,37 kilometer with street lighting (Sulistiyono; 1994). After the formation of gemeente Cirebon and various developments on infrastructures, Cirebon increasingly became an attraction to the natives to find jobs in the city. They went to the

6 city since they had lost their rights on their land because they had rent their land to private plantations. Due to this urbanization, the population density in Cirebon increased. They lived in the vicinity of where they work such as near the port, trains stations and sugar cane plantations. Their neighborhood were crowded and unhealthy, the environment was dirty, slum and didn’t have the ideal distance among houses. The Europeans called the places as kampongs. The environment didn’t reflect the face of the city in line with the meaning of modernization which gave the impression of neat, clean and healthy. Cirebon which was initially a traditional city or kingdom city became a colonial city because it followed the process of modernization and industrialization which supported the economy, especially sugar cane. Up to 1918, the area of sugar cane plantations under the supervision of the regional government of Cirebon reached 13.000 bau which was scattered in East and West Cirebon. The consequence of having the large area of plantations was that it required a large number of workers. They were required in the plantations and grilling factories of sugar cane like the one in Eat Cirebon, namely in Sindanglaut, Karangsembung, Jatipiring, Tersana Baru, Leuweung Gajah, and Losari Baru; and in West Cirebon namely in Kadipaten, Jatiwangi, Parungjaya, and Arjawinangun (ANRI; 1976; CXXVII The work of the plantations and sugar cane factories took almost their life time, but their income was not balanced. Thus, there were quite a lot of laborers who were poor in the city of Cirebon and they experienced a decline in their welfare in their lives. For the immigrant workers, they became poor not only because the low income they got but also because of the loss of their farming land in the villages. This is reversed with what the Dutch colonial government got, according to Ricklefs; the Dutch government acquired a high economic exchange from the production of sugar cane in Cirebon (Reckless; 2002). Cirebon was really meaningful for the government, thus in 1926, the Dutch East Indies government included Cirebon together with other cities such as Java and Madura to be part of the cities the status of which was going to be raised to be stadsgemeente . This status enabled Cirebon to acquire more authority to manage its various own administration matters (Saatsblad; 1926). The higher status definitely supported the modernization and industrialization like most other cities that

7 experienced modernization and industrialization in Java. But, behind that according to Margana the birth of modern cities had given birth to various social problems such as crimes, poverty, urbanization, unemployment and high needs for health care (Margana; 2010; 1-11). The problems especially occurred to the natives who in the end find it difficult to survive, difficult to prosper and difficult to be healthy. Besides that, the population density rose due to the change in the environment and the change in the function. This gave rise to adverse consequences on the natives. The competition for quality environment (Ministry of Health; 2001) and urban space (Basundoro; 2013) which is clean and healthy which ultimately leads to the dynamics in health. As an illustration, the growth of population in Cirebon since the end of the 19 th century to 1930s had been explained by Wahid by quoting from Boomgaard in Changing Economy in Indonesia , as follows (Wahid; 2009; 46): Table 1: The Growth of Population of Cirebon in the end of the 19 th Century until 1930

No. Group of Population Year 1890 Year 1920 Year 1930 1. Natives 15.561 25.339 42.667 2. Europeans 398 971 1.653 3. Chinese 2.537 5.451 8.191 4. Other Asian Citizens 846 1.290 1.568 Total Number 19.342 33.051 33.051 Source: Wahid, Abdul, Bertahan di Tengah Krisisi: Komunitas Tionghoa dan Ekonomi Kota Cirebon , Yogyakarta: Ombak, 2009, page. 46.

According to Wahid, the growing population in Cirebon was due to the migration of people from outside the city be it Europeans, Chinese and especially the natives. The population growth occurred in almost all part of Cirebon. In his explanation based on the Colonial Verslag (1881) the growth in the population of Cirebon occurred since the end of the 19 th century, encompassing Europeans reaching 1.047 people, Chinese 15.740 people, Arabic 1.230 people, other foreigners 97 people, and the natives 1.609.228 people. After the change of status into gemeente , the number of

8 changes in the population increased with calculation of the increase consisting of Europeans 1.653 people, Chinese 8.191 people, and Asians 1.568 people (Wahid; 2009; 45-46). The environmental change has raised the number of population of Cirebon as a result of the change of Cirebon into a city which was densely populated, slum with high social-economy dynamics. The change in the environment also transformed the working culture/ethos of the natives, from farmers and land owners into plantation-processing laborers and other laborers. From having a managed behaviors in the village into being forced to adjust to the rule in the city. They adapt a lot with the new culture which was introduced by the Europeans. In his study, Braudel explained that population density which was triggered by the economic needs resulted in the growth of malaria disease seeds (Braudel; 1988. Hugo; 2001: xvii-xviii, 33 Gani; 2014). Malaria, although transmitted through mosquitos, can also be transmitted by other factors such as high contact among humans. This analysis is similar to the case in Africa where a research by Mansell Prothero revealed that definitively the migration of population in West Africa gave impact to the transmission of malaria. Population density made the neighborhood unhealthy and became a source where malaria infected mosquitos grow (Hugo; 2001: 33). This analysis is similar with the case occurring in Cirebon in the beginning of the 19 th century which was quoted in the newspaper Teradjoe , which said that since the dynamics of the people in Cirebon became complex in 1805, malaria epidemic became more widespread. In the government report on that year, Cirebon was considered as the first region where malaria started to spread (Teradjoe; 17/1/1927. Zuhdi; 1997; 123-124). Similarly, Breman in his notes informed that the density of the population in Cirebon which occurred in 1918 accelerated the spread of malaria both in the hinterland and the coastal areas (Breman: 1986; 65). The changes in the environment, population density and the appearance of diseases in the society in the end affected the government’s policy beside the economic sector. In this case, even the government needed the allocation of health funds to pay attention to health of its workers. But the allocation of funds was not proportional compared to the allocation for the development of economy. Thus in the Koloniaal Verslag it was mentioned that health funds had taken much of the

9 government fund budget. The fund was used for the prevention of diseases outbreaks, various trainings for vaccinators and midwives and dukun bayi (traditional midwives), hospitals, medicines, environment cleanliness and health facilities. The government feels that the subsidy of health funds had drained the state finances which were allocated for economic improvement. The government policy which only oriented on the modernization of the economy ultimately wasn’t able to improve the modernization on health. Health care could not be given well to all the society of Cirebon at that time. The natives who were forced to be conditioned with their new environment, namely by living in the city which was filled with buildings, offices and factories so that they could only live in slum areas or kampongs, had to behave in an unhealthy way in the environment (Paulus; 1917). After they got ill, they took medication in their own way usually by concocting their own herbal medicine and go to the dukun (shaman). They did all these due to the unaffordable modern medication. This was the beginning of the European views on traditional behavior or ‘traditional culture’ This view leads to a new view that it was the traditional culture that became source of the spread of contagious diseases and the terrible state of health in Cirebon. Actually, based on the aforementioned data the changes in the environment factor was the main factor that caused the epidemic and the terrible state of public health. Modernization had changed the environment and behavior of the people of Cirebon to be unhealthy causing the state of health to be low at that time

Epidemic in Cirebon The report of Resident of Cirebon Sebastiaan Cornelis Herman (Nederburgh) to the Dutch East Indies Governor General on May 11 1869, had reviewed the outbreaks of diseases besides malaria which occurred in Cirebon, namely fever, smallpox and pes. The report also mentioned that the outbreaks of diseases had drained the budget of government funds. The report of the resident became a note to the governor- it was even reported in his letter of Decision (Besluit Gubernemen) in December 1869, which stated that “… fever and smallpox epidemic occurred in Kuningan, Majalengka, Galuh, Plumbon, and Indramayu. This epidemic caused the slot in the government budget to run out” Besides that, it was also mentioned that the malaria epidemic had spread since

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1870 and had attacked the people living in the rural areas around Cirebon such as Cirebon, Kuningan, Majalengka, Galuh, and Indramayu. Besides reporting the malaria epidemic, the Resident of Cirebon also reported the presence of fever and smallpox epidemic in the whole Residency of Cirebon, and this had spent the slot from the government budget (ANRI; BB 1893). The report only slightly reported the cause of the outbreaks of contagious diseases from the environment factor. As reported before that the due to the dirty environment conditions factors of Cirebon since 1816-1870 and the extreme climate, many people suffered from cholera and fever. It was also reported that terrible health condition of the people of Cirebon was caused by the changing environment after Europeans seized control of Cirebon. The government had limited budget for health, incomparable with the budget for development. Besides that, the government had admitted the incomprehension of European scientist on the disease in the tropics which had continuously plaguing. Thus, the mortality rate in Cirebon rose. As of March up to May 1870, the population of Cirebon kept declining due to the outbreaks of smallpox, fever and cholera. The most affected regions were Indramayu, Galuh, Majalengka, and Kuningan (ANRI; K-7/66a.4. Medica 16, 20; 2500). Although the report on the environment condition was only little, but this report illustrates that it was not outbreaks of diseases that caused the low state of health and it was not the behavior of the people who performed traditional treatments that made the declining quality of health but the main factor that caused it was the government’s policy on the changing environment for the purpose of excessive economic modernization. The changing environment which was oriented towards economic modernization was the embryo of the spread of the outbreaks of disease in the society.

Health Political Policy The government’s policy on the changing environment ultimately became a new offer for the culture or the behavior in public health. Since the beginning of the 19 th century, the government ‘offered’ modern medical system through European medical science to overcome the spread of

11 diseases. The government’s efforts in eradicating the diseases in Cirebon were reported by the Resident of Cirebon dated 12 June 1816 and 11 May 1869. The report explained that the eradication of diseases which occurred because of sporadic smallpox virus had been carried out. The Resident of Cirebon Nederburgh also reported on February dated 10 May 1870 that vaccination for smallpox had been performed throughout the regions of the Cirebon Residency. This effort used a large number of fund which was not budgeted by the Central government thus draining up the fund budget of the Regional government of Cirebon (ANRI; K-7/66a/4). According to Boomgaard and Sciortino this was the the main factor that caused the terrible health of the natives. It was because of this that there were late handling and eradication of various diseases. There were only a few government reports which explained the search for the main reason for the emergence of the parasites of diseases which plaguing the society. Regardless of the reason of the Europeans scientists lack of knowledge on tropical diseases, the health political policy seems to negate environmental factors which were the beginning of European modernization in Cirebon which can be seen as the trigger of the emergence of various parasites of diseases. Nevertheless, the government had tried to handle malaria in Cirebon. Since 1907, examination on the malaria inflicted corpse had been performed. This regulation was termed as verplichte doodschouw (mandatory coronary examination) which was requirement to get certificate of death. This action aimed to record the sort of the causes of death to know the ranking of causes and the ranking of kinds of death. The sequence of the causes of death in Cirebon were influenza, small pox, malaria, pes cholera and dysentery. All the diseases attacked both children and adult. (ANRI: BB; 1893). The government regarded this epidemic as “the enemy of the state” because it had disrupted the public welfare and health. But after the data collection, the efforts to eradicate were done in 1911 and 1914. The government made an embankment along the coastline which had the height higher than that of the seawater during high tide. Besides that, the government also made water channels which were headed to the beach. While the eradication of malaria for the remote areas were carried out by spreading the medicine or quinine poison in the ponds of freshwater fish. Whereas in 1924 the government sent health workers to various regions of Cirebon to eradicate the

12 spread of the outbreaks of contagious and deadly diseases (Paulus: 1917). Whereas, other efforts by the government were establishing hospitals and health organizations. On 31 August 1921 the government established Oranje Ziekenhuis or Orange hospitals as government hospitals. These hospitals were then functioned as city hospitals or gemeentelijk ziekenhuis on 1 September 1921. The first head of the hospital was dr. E. Gottlieb (www.cirebonkota.go.id). Besides that in 1929 the government formed Pes eradication Office or (Pesbestrijding Dienst). The officers of the pes eradication encompassed task area of Cirebon, Indramayu, and Tasikmalaya. But the number of pes diseases in the regions aforementioned during the third decade of the 20 th century had rapidly reduced the number of population. From the report of the Resident of Cirebon (1922-1930) it was informed of the high number of mortality due to pes (ANRI; 1976; CXLVI.). Through the health institutions, the European doctors, javanese doctors and the midwives, and other health workers tried to picture medical solution which were clean, rational and better compared to traditional medication. The native doctors were assigned to aid in checking health and performing other modern medication propaganda in various regions in Cirebon This task was meant to replace the position of the dukun . Along with the effort to eradicate diseases, some obstacles faced by the government appeared in a variety of forms. Besides the find in the budget, there was also a problem of the rejection of the natives for the effort. The people rejected modern medication with the reasons to maintain their belief on their own non-chemical medication, to show their disobedience to the colonialist, and the main reason was the late government late action in in responding to the outbreaks of diseases and access for modern medication which was expensive and discriminative. This was another reason as the cause of the spread of parasites (Sciortino; 2007). Besides that, according to Furnivall health behavior which was attempted by the government was not purely aimed to raise the state of health of but more to economic interests. Thus, Furnivall was of the opinion that the level of morbidity is high on the natives on the natives was not only merely as a result of traditional medication and the unwillingness to take up the government offer on modern medication, but it was more to the low level of welfare which was not the attention of the

13 government. The government only focused on the goal of its own economic development. Whereas, the community was not able to guarantee their own health (Furnivall; 2009). The reason mentioned by Sciortino above is almost the same with that of Hesselink which stated that the cause of high morbidity is the health behavior of the natives which choose more to do traditional medication to the dukun rather than to the doctors. According to him, the establishment of various health institutions and doctors were the hard effort of the government to raise the public health of the natives. Although the government policy was “half-hearted” where they did it because they were focusing in their main modernization program, but according to Hesselink the government was successful to change some of the natives to use medication and serve people in European way. (Hesselink; 2011) Thus the efforts to handle public health both modern or traditional still encountered some obstacles. According to Sciortino, the obstacle from the government became a big threat for the poor condition of public health of the natives. An adverse public health policy made the people suffer from their illness more severely and longer. This occurred due to the fact that the natives had a top down health system which means that they depended on the success of the government in carrying out public health services (Sciortino: 2007). The report on the health condition of the people of Cirebon indicated that policies on health were made but was not the main focus. Polluted environment. dense settlements, bad sanitation were the negative consequences of the construction of infrastructures which were not oriented to health was the main cause of the bad condition of the state of health in Cirebon during the Dutch colonialism. At that time, the society were in the institusionalized system which forced them carry out their activities in the city. The government did not make efforts to clean the kampongs and to deal with the cleanliness of the city surroundings. The surrounding area of the kampongs became a hotbed for various infectious diseases (Paulus: 1917). Van Dijk called this kind efforts of the government more as an effort to create ‘modern city image’ aimed to eliminating and or differentiating with the previous surrounding area of the city (van Dick; 2011). Thus, the emergence of offices, government buildings, the factory of British American Tobacco (BAT) company, sugar factory, and hospitals, up to

14 the mid-20th century was an effort of creating an image of the modernization by the government and did not take any notice on the health factor. The land filling of Bacin River was carried out but there is no data which explains whether the river flow in the city was moved or it was completely closed. Various sources explained that after the various physical improvements of the city, more puddles of water can be found in the rainy season in some areas of Cirebon. Heaps of garbage were more commonly seen and caused floods in the rainy season. In dry season, small rivers were filled with garbage and dry grass. All of these caused various diseases to appear in the society (Paulus; 1917; 445-447). Since then on until the 1940s, disease outbreaks increased and spread evenly throughout Cirebon. The mortality rate of the people of Cirebon due to the outbreaks in that time frame was one of the highest compared to other regions in the Dutch East indies. Even in 1918, Cirebon was one of the worst five regions in Java that was attacked by the outbreaks of flu after Madura, , Kediri, and Surabaya (Margana; 2010; 9-10. Paulus; 1917; 477. Chandra; 2013; 185-193). Thus, the health dynamics in Cirebon illustrated that various health problems during the colonial times was closely related with the factor of the change in the environment which then influenced the political policy. The bad condition of the state of health in Cirebon at that time based on the data which was analyzed based on the theory of Sewell, was actually caused due to the fact that both the government and the people were felt “forced” in facing the health problem. The government was “forced” to fix the problem of the diseases outbreaks because diseases were considered to endanger status, culture, and its power While the natives were ‘forced’ to condition their lives to various change in the environment due to the disadvantageous government policies

Conclusion Thus, in assessing the history of health which discussed the epidemy of diseases, factors such as the environment, politics and the culture of the people are inseparable. In fact, the assumption that the more modern a region is the higher the state of health of the people is, actually cannot always be proven. The change in the environment as the beginning of modernization in Cirebon did not give any proof that the state of health improved. The state of health which became the

15 determining factor of the state of welfare and wealth of a region or city was getting worse after the changes in the environment due to modernization. Policies in health should have its own autonomy, namely for health and not aimed at other things whether for politics or economic. The case in Cirebon in the Dutch colonialism era proved that changes in the environment and function of a city which only aimed for economical modernization had caused problems in the field of health. The impacts caused were the appearance of diseases which as epidemic causing the reduction of the state of health of the people, especially that of the natives. This condition occurred almost throughout the Dutch colonialism era in Cirebon. Although government had made some efforts but the condition could not be solved until the end of the Dutch East Indies government rule. The health of the people of Cirebon had given a picture of the face of colonial city. The health of the people in Cirebon had given a picture of the face of a colonial city which was unobserved. In this regard, although the Dutch East Indies government mentioned by Hesselink to be the one which institutionally had laid the foundation of the health policies and which gave birth to ‘new healers’ with a new culture and introduce new medicines but the efforts to find the main cause of the epidemic were not carried out. Besides that, the European trained doctors and health institutions had made high social diversifications between the Europeans citizens and the natives. These groups of society according to the theory of Sewell belonged to the condition of ‘not having cultural autonomy.’ This means that they performed health measures to reach their respective goals in the state of being forced. The government’s efforts were done to give an image of the advancement of Europe and the resilience of its power meanwhile the efforts of the people were not to adhere to colonialism. Almost all of these point of views narrow down to a conclusion on the poor condition of the health of the people in the colonial era. The government policies were regarded not to have changed the fate of the natives to be more prosperous so that they could take medication with the fee which was determined by the government. This consequently cause the state of health of the natives to be still poor up to the beginning of the 20 th century. As a closing remark, it should be conveyed that the writing of this article is done under the guidance of the promotor of this research, Dr. Mohammad Iskandar to whom the writer would like

16 to extend gratitude. This research also has no personal goals or interests. This research is purely made for scientific purposes especially in the field of history. This research is sponsored by PITTA (Program Internasional Terindeks untuk Tugas Akhir) University of Indonesia 2017. Thus this research is purely conducted by Imas Emalia as student of the post graduate program (S3) of History Department of History, University of Indonesia who is conducting a research on health in Cirebon in the Dutch East Indies period to be made as a dissertation. This research is conducted together with Dr. Mohammad Iskandar as the lecturer of Department of History, University of Indonesia.

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A. Primary Source A.1. Handwritten Archives ANRI, “Laporan Negara tentang data orang-orang sakit kolera per-hari”, Medica 16, 11 Januari – 4 Juli 1870. ANRI, “Laporan Negara tentang data orang-orang sakit cacar dan demam” Medica 20 , No. 2500, 11 Januari – 4 Juli 1870. ANRI, ‘de koorts epidemie gaande weg in kracht afgenomen en de pokken gevollen/met uitzondering van Indramaijoe/zeldzamer’, Koleksi Arsip Cirebon, No. 66.a.4, 1869 dan 1870. ANRI , Koleksi Arsip Cirebon, K-7, No. 1/8 Politiek Verslag 1873 .

A.2. Print Archives ANRI, “Malaria Bestrijding Verordening Regentschap Koeningan”, Departement van Binnendlandsch Bestuur 1940-1942, No. 1893, Buku I. ANRI, Kolonial Verslag, 1883-1884. ANRI, Memorie van Overgave (Memori Serah Jabatan 1921-1930) Jawa Barat, Penerbitan Sumber- Sumber Sejarah No. 8, : ANRI, 1976. ANRI, “Malaria Bestrijding Verordening Regentschap Koeningan”, Departement van Binnendlansch 1940-1942, No. 1893 , Buku I. ANRI, Staatsblad van Nederlandsch Indie , No. 76 Tahun 1903, No. 172, Tahun 1905, No. 122 Tahun 1906, No. 276 Tahun 1906, dan No. 43 Tahun 1922.

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B.4. Books Atja, Menjelang Penetapan Hari Jadi Pemerintahan Kabupaten Cirebon , Cirebon: Pemda TK. II Cirebon, 1988. Basundoro, Purnawan, Merebut Ruang Kota: Aksi Miskin di Kota Surabaya 1900-1960 , Tangerang: Marjin Kiri, 2013. Boomgard, Peter, et al., Health Care in Java: Past and Present , Leiden: KITLV Press, 1996. Boomgaard, Peter, et al, Paper Landscapes Explorations in The Environmental history of Indonesia , Leiden: KITLV Press, 1997. Braudel, Fernand, Civilization an Capitalism 15 th -18 th Century: The Structures of Everyday Life The Limits of Possible , Vol. 1, Translation from the French Revised by Sian Reynold, London: Collins/Fontana Press, 1988. Breman, jan, Penguasaan Tanah dan Tenaga Kerja: Jawa di Masa Kolonial , terj., Jakarta: LP3ES, 1986. Cortesao, Armando, The Suma Oriental of Tomĕ Pires , London: Hakluyt Society, 1944. DEPKES RI, Keputusan Menteri Kesehatan RI: Pedoman Teknis Analisis Dampak Kesehatan Lingkungan, No. 876/Menkes/SK/VIII/2001, 2001. van Dick, Kees and Jean Gelman Taylor, (eds), Cleanliness and Culture Indonesian Histories, Leiden: KITLV Press, 2011. Furnivall, J.S., Hindia Belanda: Studi tentang Ekonomi Majemuk, Freedom Institute, 2009. Gani, A. Jaelani, Penyakit Kelamin di Jawa 1812-1942, Bandung: Syabas Books, 2013. Ingleson, John, Perkotaan, Masalah Sosial, & Perburuhan di Jawa Masa Kolonial , Depok: Komunitas Bambu, 2013. Hesselink, Liesbeth, Healers on the Colonial Market: Native Doctors and Midwives in the Dutch east Indies , Leiden: KITLV Press, 2011. Hugo, Graeme, Mobilitas Penduduk dan HIV/AIDS di Indonesia, UNDP-UNAIDS-ILO: 2001. Hydrick, M. D, Intensive Rural Hygiene Work in The Netherlands East Indies, The Series of Booklets, New York: Nederlands Information Bureau, 1942. Lapau, Buchari, Ahmad Fedyani Saifuddin, Epidemilogi & Antropologi: Suatu Pendekatan Integratif Mengenai Kesehatan , Jakarta: Kencana, 2015. Leirissa, R.Z., et al, Sejarah Perekonomian Indonesia, Jakarta: Depdikbud, 1996. Loedin, A. A., Sejarah Kedokteran di Bumi Indonesia , Jakarta: Grafitipers, 2010. Margana, Sri dan M. Nursam, (peny.), Kota-Kota di Jawa: Identitas, Gaya Hidup, dan Permasalahan Sosial, Yogyakarta: Ombak, 2010. Masduqi, Zaenal, Cirebon dari Kota Tradisional ke Kota Kolonial , Cirebon: Nurjati Press, 2011 Masyhuri, Menyisir Pantai Utara Jawa: Usaha dan Perekonomian Nelayan di Jawa dan Madura 1850- 1940 , Jakata: Yayasan Pustaka Nusatama-KITLV, 1996. Paulus. J., Encyclopaedie van Nederlandsch-Indie , Eesrte Deel, A-G, Leiden: ‘s Gravenhage-Martinus Nijhoff, E. J. Brill. 1917. Sciortini, Rosalia, Menuju Kesehatan Madani , Yogyakarta: UGM Press, 2007. 19

Slamet, Juli Soemirat, Kesehatan Lingkungan , Yogyakarta: UGM Press, 1996. Soetomo, Sugiono, Urbanisasi dan Morfologi, Proses Perkembangan Peradaban dan Wadah Ruang Fisiknya: Menuju Ruang Kehidupan yang Manusiawi, Yogyakarta: Graha Ilmu, 2009. Stadsgemeente Cheribon , Gedenkboek der Gemeente Cheribon 1906-1931, Bandoeng-Cheribon: N.V.A.C.NIX & Co, 1931. Wahid, Abdul, Bertahan di Tengah Krisisi: Komunitas Tionghoa dan Ekonomi Kota Cirebon , Yogyakarta: Ombak, 2009. Wertheim, W.F., Masyarakat Indonesia dalam Transisi: Studi Perubahan Sosial, Yogyakarta: Tiara Wacana, 1999 Zuhdi, Susanto, ed., Cirebon sebagai Bandar Jalur Sutra: Kumpulan Makalah Diskusi Ilmiah , Jakarta: Depdikbud, 1997.

C. Unpublished Sources Sulistiyono, Singgih Tri, ‘Perkembangan Pelabuhan Cirebon dan Pengaruhnya terhadap Sosial Ekonomi Masyarakat Kota Cirebon 1859-1930’, Tesis , Yogyakarta: Universitas Gajah Mada, 1994. Wibowo, Priyanto, et al, ‘Menguji Ketahanan Bangsa: Sejarah Epidemi Influenza 1918 di Hindia Belanda’, Laporan Hasil Penelitian , Depok: Departemen Sejarah FIB UI, 2009.

D. Internet Sources Boomgaard, Peter, ‘The Development of Colonial Health Care in Java: an Exploratory Introduction’, Bijdragen tot de Taal-, Land-en Volkenkunde, Deel 149, 1ste (1993), hlm. 77-93, KITLV, Royal Netherlands Institute of Southeast Asian an Caribbean Studies, http://www.jstor.org/stable/27864426 , diunduh 4 Maret 2015. Chandra, Siddhart, ‘Mortality from the Influenza Pandemic of 1918-1919 in Indonesia’ dalam Population Studies, Vol. 67 No. 2, 2013, hlm. 185-193, http://dx.doi.org/10.1080/00324728.2012.754486 diunduh 6 Oktober 2016. Engel, Susan, & Anggun Susilo, ‘Shaming and Sanitation in Indonesia: A Return to Colonial Public Health Practices?’, Development & Change’, No. 45 (1), Australia: University of Wolongong, 2014, hlm. 157-178. Diakses dari http://ro.uow.edu.au/Ihapapers/1110 . ‘Malaria di Cirebon Masa Kolonial’ dalam http://kesehatanlingkungan.wordpress.com/penyakit- menular/malaria-pembunuh-terbesar-sepanjang-abad/ diunduh Sabtu 8 Oktober 2016. Suryawati, Chriswardani, ‘Memahami Kemiskinan secara Multidimensional’, JMPK Vol. 08/No. 3/September/2005/UGM Online Journal, diunduh 28 Januari 2016. Uddin, Baha’, ‘Dari Mantri Hingga Dokter Jawa: Studi Kebijakan Pemerintah Kolonial dalam Penanganan Penyakit Cacar di jawa Abad XIX-XX’, Humaniora , No. 3, Vol. 18, Oktober 2006, hlm. 286-296, http://jurnalugm.ac.id/jurnal-humaniora/article/viewfile/884/731 , diunduh 12 Mei 2015.

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