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A MEDICAL HISTORY OF PULAU PINANG, 1900-1957, WITH SPECIAL ATTENTION TO MALARIA, TUBERCULOSIS AND LEPROSY LEE J. PETER FACULTY OF ARTS AND SOCIAL SCIENCES UNIVERSITY OF MALAYA KUALA LUMPUR University of Malaya 2017 A MEDICAL HISTORY OF PULAU PINANG, 1900-1957, WITH SPECIAL ATTENTION TO MALARIA, TUBERCULOSIS AND LEPROSY LEE J. PETER THESIS SUBMITTED IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY FACULTY OF ARTS AND SOCIAL SCIENCES UNIVERSITY OF MALAYA KUALA LUMPUR University of Malaya 2017 UNIVERSITI MALAYA ORIGINAL LITERARY WORK DECLARATION Name of Candidate: Lee J. Peter Registration/Matric No: AHA09090028 Name of Degree: Doctor of Philosophy(Ph.D) Title of Project Paper/Research Report/Dissertation/Thesis (“this Work”): A MEDICAL HISTORY OF PULAU PINANG, 1900-1957, WITH SPECIAL ATTENTION TO MALARIA, TUBERCULOSIS AND LEPROSY Field of Study: History of Malaysia I do solemnly and sincerely declare that: (1) I am the sole author/writer of this Work; (2) This Work is original; (3) Any use of any work in which copyright exists was done by way of fair dealing and for permitted purposes and any excerpt or extract from, or reference to or reproduction of any copyright work has been disclosed expressly and sufficiently and the title of the Work and its authorship have been acknowledged in this Work; (4) I do not have any actual knowledge nor do I ought reasonably to know that the making of this work constitutes an infringement of any copyright work; (5) I hereby assign all and every rights in the copyright to this Work to the University of Malaya (“UM”), who henceforth shall be owner of the copyright in this Work and that any reproduction or use in any form or by any means whatsoever is prohibited without the written consent of UM having been first had and obtained; (6) I am fully aware that if in the course of making this Work I have infringed any copyright whether intentionally or otherwise, I may be subject to legal action or any other action as may be determined by UM. Candidate’sUniversity Signature of Malaya Date: Subscribed and solemnly declared before, Witness’s Signature Date Name: Desingnation Date: ii ABSTRACT This study has been analysed against the broad historical framework of British Colonial Administration period from 1900-1957. The purpose of this research is to examine the medical history in the state of Pulau Pinang, which consist of Penang Island and Seberang Perai. This research will focus mainly on three infectious diseases, namely malaria, tuberculosis and leprosy during the British Colonial Administration period. This research defines the role of the British Colonial Administration and the Department of Health in providing healthcare services and helping to resolve problems caused by infectious diseases, mainly malaria, tuberculosis and leprosy in Pulau Pinang during that period. This study uses the historical research method. The discussion in the thesis will be based on qualitative research in which a thematic and descriptive/analytical approach will be used. For primary data, all data that compatible with this study was assimilated with the other primary data to form a new stronger fact. Secondary resources used as support to the existing data after selecting the compatible secondary material. This research shows that the British Colonial Administration faced many challenges in the prevention, treatment and cure of infectious diseases such as malaria, tuberculosis and leprosy in Pulau Pinang from 1900 to 1957. Despite this, the Colonial Government reduced the death rates and cured the patients who were affected by those diseases. This success was attributed to the good working relationship andUniversity coordination that existed between the Colonialof Government,Malaya the local authorities and the non-profit organisations which helped towards the prevention and eradication of these diseases in Pulau Pinang. iii ABSTRAK Kajian ini membincangkan sejarah kesihatan di Pulau Pinang sewaktu era pentadbiran Inggeris antara tahun 1900 hingga 1957 iaitu dengan memfokuskan kepada tiga jenis penyakit berjangkit utama iaitu penyakit malaria, batuk kering dan kusta. Kajian ini cuba meneliti peranan yang dimainkan oleh pihak Inggeris dan Jabatan Kesihatan dalam usaha menyediakan perkhidmatan kesihatan dan menyelesaikan masalah kesihatan yang berpunca daripada penyakit berjangkit yang terdiri daripada penyakit malaria, batuk kering dan kusta khususnya di Pulau Pinang. Dalam kajian ini, kaedah kajian yang dilakukan adalah menggunakan pendekatan penyelidikan sejarah. Perbincangan dalam kajian ini adalah berdasarkan kaedah penyelidikan kualitatif dengan mengguna pakai kaedah thematic dan diskriptif/analitikal. Bagi data-data yang menggunakan sumber primer pula, setiap data yang sesuai dengan kajian diambil dan disesuaikan dengan data-data primer yang lain bagi membentuk satu fakta yang lebih kukuh. Sumber-sumber sekunder turut digunakan bagi menyokong data-data yang sedia ada. Secara keseluruhannya, kajian mendapati bahawa pentadbiran Kolonial Inggeris telah menghadapi pelbagai dalam usaha pencegahan, rawatan dan penyembuhan penyakit berjangkit seperti malaria, batuk kering dan kusta di Pulau Pinang antara tahun 1900 hingga 1957. Namun begitu pihak Inggeris telah berjaya menurunkan kadar kematian akibat penyakit berjangkit tersebut melalui rawatan yang dilakukan ke atas para pesakit. Kejayaan ini disebabkan hubungan dan koordinasi yang baik antaraUniversity pentadbir Kolonial Inggeris dengan kerajaanof tempatanMalaya dan organisasi sukarelawan yang banyak membantu dalam usaha pencegahan, rawatan dan menghapuskan penyakit malaria, batuk kering dan kusta di Pulau Pinang. iv ACKNOWLEDGEMENTS Firstly, l would like to thank University Malaya for giving me this invaluable opportunity to learn and gain knowledge. Also, I would like to extend my appreciation to the academic and administrative staff of the Faculty of Social Science and the History Department, especially Emeritus Prof. Datuk Dr. Abdullah Zakaria Bin Ghazali, my Ph.D supervisor, who has given me invaluable support, critical comments and advice on the improvement and development of the thesis towards the completion to these writings. Thank you also to University Malaya for offering me a University of Malaya Fellowship Scheme to support my cost of living and tuition fees at University Malaya, Kuala Lumpur. I would like to extend my gratitude to staff and librarian at the The National Archives, United Kingdom, Arkib Negara Malaysia, Kuala Lumpur, Arkib Negara Malaysia Cawangan Pulau Pinang and University of Malaya Library, Kuala Lumpur for their concern, time and advice on the proper reading materials and documents needed to complete this thesis. Finally to all my friends and family members who have given me moral support and made sacrifices so that I could bring about the completion of this thesis. University of Malaya v TABLE OF CONTENTS PAGES ORGINAL LITRERARY WORK DECLARATION FORM ii ABSTRACT iii ABSTRAK iv ACKNOWLEDGEMENTS v TABLES OF CONTENTS vi-viii LIST OF FIGURES ix LIST OF TABLES x LIST OF SYMBOLS AND ABBREVIATION xiv LIST OF APPENDICES xvi CHAPTER 1: Introduction Introduction 1 Research Questions 7 Research Objectives 8 Importance of Research 9 Scope and Limitation of Study 10 Literature Review 11 Reseach Methodology 23 Thesis Organisation 24 CHAPTER 2: Historical Background of Pulau Pinang Introduction 29 Early History 30 Administration in Pulau Pinang 32 Colonial Era: Straits Settlements 38 World Wars 44 Demographic 47 Formation of a Multiracial Society 50 Trade and Economy 56 ConclusionUniversity of Malaya 59 vi CHAPTER 3: Medical History of Pulau Pinang, 1900-1957 Introduction 60 Administration of Medical Services 61 Sanitation and Healthcare Administrative Facilities 65 Education of Health Workers 67 Hospitals and Healthcare Services 77 Dispensary and Healthcare Facilities in Rural Areas 86 Non-Profit Organisation and Healthcare Organisation 90 Women’s and Children’s Health 92 Conclusion 107 CHAPTER 4: History of Malaria in Pulau Pinang, 1900-1957 Introduction 110 History and Nature of the Disease 111 Mosquito Nuisance 119 Education and Training 124 Research and Investigation 125 Prevention Measures by Colonial Government and Local Authorities 132 Malaria Control in Rural Areas 147 Treatment and Hospitals for Malaria Patients 160 Conclusion 169 CHAPTER 5: History of Tuberculosis in Pulau Pinang, 1900-1957 Introduction 175 Historical Background of Tuberculosis 176 The Role of Non-Profit Organisation 187 The Importance of the B.C.G. Campaign and Vaccinations 194 Awareness Campaign Against Tuberculosis 197 The Significance of X-Ray and Early Detection of Tuberculosis 200 Hospital and Treatment for Tuberculosis Patients 201 The Shorcomings in Treating Tuberculosis Patients 220 FinancialUniversity Aid and Allowances given to Tuberculosis of PatientsMalaya and their Families 224 Conclusion 226 vii CHAPTER 6: History of Leprosy in Pulau Pinang, 1900-1957 Introduction 232 History and Nature of the Disease 233 Early History of Leprosy in Malay Peninsula 242 The Importance of Pulau Jerejak Leper Settlement in the Region 250 Treatment for Patients at Pulau Jerejak Leper Settlement 260 Education and Employment for Leper Patients 267 Problems among Lepers and Limitation at Pulau Jerejak 269 Rehabilitation of Former Leper Patients from Pulau Jerejak 273 Conclusion 282 CHAPTER 7: Conclusion 286 BIBOLOGRAPHY 302 APPENDIX 320 University of Malaya viii LIST OF FIGURES Pages 4.1 Chart Projecting the Percentage of Total Admission in the Years