Mayhem in May: Singapore’s 1957 Asian Flu epidemic

“Let it burn out. We can do nothing about it.”

- Dr M Doraisingham, permanent secretary to the Ministry of Health, May 5th 1957, when the “outbreak” became an “epidemic”.

To be fair, it’s our present-day crises that nearly always prompt an interest in historical inquiry—a scramble for answers in the past. Disease historiography, for instance, flourishes best in times of disease; in the petri dish of epidemics and pandemics. Unsurprisingly, this impulse has bloomed over the course of the Covid-19 pandemic. In Singapore, where state-sanctioned narratives have overshadowed society and individuals in the writing of our popular national histories, disease seems to have left relatively few historical imprints on our national psyche. An absence of attention, however, should not imply an absence of effect. This brief retrospective on Singapore’s 1957 Asian Flu epidemic offers a distillation of a deceptively rhetorical question: what can we learn from an obscure influenza epidemic outbreak in Singapore that happened more than 65 years ago?

It is no good kidding the public. If there was a preventive like issuing masks and so forth, we would have done it willingly to factory workers and others but I said that there is no known preventive.

The only course - which was unthinkable - was to close the port of Singapore and all the ports of the Federation of Malaya and the Siamese border against the entry of any craft whatsoever, and impose martial law to keep people in their homes until the disease had spent itself on a worldwide career.

Braga’s description evokes the euphemistic ‘circuit breakers’ that were imposed to stop the spread of Covid-19 in modern Singapore. In 1957, however, the government’s political calculus was different. Despite being equipped by ordinances that empowered the state to impose quarantine orders, disease notification mandates, limitations on the destruction of contaminated property, and social and travel restrictions, the government deemed such measures “unthinkable”. It likely considered these socio-economic costs prohibitive relative to the perceived mild severity of influenza.

By the standards of modern medical science, Braga’s comments on the influenza’s mild clinical severity were justified to some degree. The Asian Flu’s causative agent was eventually identified as H2N2, a new subtype of Influenza A viruses that historically caused influenza pandemics. Furthermore, although the Asian Flu caused an excess of 1.1m deaths globally, it’s widely considered to be the mildest Influenza pandemic of the 20th century. This, however, excuses neither the semi-colonial government’s reactive responses nor the healthcare system’s shortcomings in addressing it. On May 7th 1957, an astute commentary in the Nanfeng Evening Post criticised the authorities’ failure to control the epidemic narrative. Noting the virus’s highly infectious but non-lethal nature, it exposed two major public health problems with clarity. First was the insufficiency of healthcare facilities (“醫院設備不足”): while it was ideal to quarantine patients in hospitals where medical personnel were available, the colony lacked such facilities, making it difficult to admit all infected persons. Second was the prevalence of high-density housing (“住戶太過擁擠”): in crowded urban areas, over 10 individuals occupied a single room—a single infection risked hundreds more as social distancing and quarantine were impossible. Recognising that they weren’t immediately resolvable, the author brought these problems to public attention in the hopes that they would be addressed later.

The influenza epidemic also strained the healthcare system and disrupted other healthcare priorities. The City Council’s 1957 Diphtheria Immunisation Campaign was “all but swept aside” as mothers stopped bringing their infants for inoculation at infant welfare clinics, while hundreds came forward for influenza treatment. With only 267 doctors and 1,830 nursing staff serving a roughly 1.4m population in 1957, the colony’s developing healthcare system faced real challenges in epidemic management. The General Hospital—today’s Singapore General Hospital—alone, recorded more than 1.2m outpatient cases for the entire year. While Singapore largely avoided this fate with Covid-19, our fears of a congested healthcare system have remained unchanged and arguably find their genealogical roots in such historical episodes. What has really changed are our governance and public health capacity; the semi-colonial government did not have the luxury of Phua Chu Kang jingles in their epidemic communication arsenal.

In the end, the only prominent public health measure enacted by the government was the 12-day closure of the colony’s schools, from May 8-19th, but even that appeared to have only been prompted by negative media coverage of school absenteeism and influenza infection rates.

Just like the swirling rumour-mills in WhatsApp groups and obscure internet forums that rapidly proliferated during Covid’s early days, popular discourse surrounding the mysterious influenza quickly whipped itself into a speculative frenzy. A sensational rumour alleging that the influenza was caused by “radioactive fall-out from Russian hydrogen bomb tests” held Chinatown and Queenstown in its riveting grip. A forum letter in The Straits Times (ST) later urged the destruction of “dirty notes” to stop the epidemic’s spread. Morbid speculations over the influenza’s fatalities turned into a hot button issue.

As the government’s passivity and resignation towards the epidemic became clear, colony residents embraced self-medication as one way of exercising individual agency and control over the situation. Demand for influenza curatives and preventives skyrocketed, leading to a commercial boom for the colony’s chemist shops, pharmacies and medical halls. Aspirin was in “great demand” while codeine-compound tablets—“cheapest and most effective” influenza cure—experienced record sales in chemist shops, with sales rising as much as three to four times, translating into “thousands of [Malayan and British Borneo] dollars” within the first week. Most customers were “self-doctoring” as they brought with them old labels and word-of-mouth recommendations. Opportunistic businesses crafted advertising with influenza rhetoric to exploit widespread health fears. From Aspro, BRAND’S Essence of Chicken and Ovaltine to Axe Brand Medicated Oil (斧標驅風油), Marmite and Ho Yan Hor Herbal Tea, a wide-range of products suddenly became touted as flu remedies regardless of their actual efficacies.

In April, for instance, BRAND’S Essence of Chicken was advertised with an eclectic mix of messages; in May, it was suddenly touted as the “best defence” against influenza.

Meanwhile, for products already known for influenza treatment in Singapore, the influenza epidemic proved to be an immense profile boost. Already advertised as a fever cure—albeit only once—in April 1957, Aspro aspirin tablets were aggressively marketed in May with taglines like “INFLUENZA HITS SINGAPORE” and “INFLUENZA HITS MALAYA” emblazoned across advertisements in both English and Chinese language newspapers, encouraging consumers to “fight flu with Aspro”.

While western medical products were advertised in both Chinese and English newspapers, traditional Chinese medicine (TCM) products were exclusively advertised in Chinese newspapers. These also found their way to other ethnic groups: a news report mentions “Indians” embracing a carrot-and-olive folk remedy popularised by Chinese newspapers.

First appearing in a May 6th Chung Sin Jit Poh column, “預防流行性感冒及治療方法” (Influenza Prevention and Treatment Methods), a concoction involving water boiled with carrot and olives—listed alongside other “民間療法” (folk remedies) like dripping garlic or onion oil into nostrils—became a veritable influenza craze. Intense price gouging ensued in the aftermath of the carrot-and-olive concoction’s rising popularity to the tune of a 10-fold increase in price. Chinatown’s markets were swamped by housewives in their rush for carrots and olives.

Some businesses saw their fortunes changed forever by the influenza epidemic. Such was the case of Ho Yan Hor Herbal Tea which became “famous” after being promoted as an effective influenza remedy. Buoyed by popular beliefs that medication hastened influenza convalescence, sales of Ho Yan Hor Herbal Tea soared. Daily sales at Chinatown and Upper Chin Chew Street exceeded well over 1,000 herbal tea packets. Stocks ran out so fast that additional supply had to be rushed over from Ipoh, Malaysia. The influenza epidemic was so lucrative that Ho Yan Hor Herbal Tea followed in the Asian Flu’s footsteps up north as the disease spread to the rest of the Malayan Federation. Ho Yan Hor Herbal Tea is today still regarded as a popular influenza remedy. The 1957 Asian Flu epidemic has even been incorporated into the company’s heritage branding.

At the epidemic’s height in mid-May, Japanese facial masks, for instance, became a trendy influenza cure. Hilariously labelled a “WEIRD NEW FACIAL” by the front page of the Singapore Free Press, they were “probably quite effective,” but not recommended in lieu of aspirin.

Reports of “Nepalese hill-billies” who were “cashing in on the influenza epidemic” appeared in The Singapore Standard. Apparently well-known among Malayans for their pharmaceutical offerings and panaceas, the entrepreneurial charlatans found a ready-made niche market ripe for exploitation. Among their top-selling products were a supposedly constitution-strengthening potion derived from lion tail and a ‘cure-all’ medicine dubbed “Tabore” purportedly made from a rare fruit. Despite their peddling of often-fraudulent pharmaceuticals, these Nepalese merchants were still accepted as “shrewd, honest peddlars (sic).”

The prominence of folk remedies and vernacular medication among the colony’s tactics of self-medication was expected. As a Singapore Standard editorial explained, “the most outrageous rumours” always enjoyed currency among the “superstitious and the gullible” during epidemics in Singapore. It further accused their “destructive psychology” of causing Singapore’s carrot-and-olive craze, and urged the health ministry to “inject some sense into the minds of the ignorant.” Such an exhaustion of both medically legitimate and dubious avenues of self-treatment by the public may seem hilarious to us in hindsight, but it points to the desperation of colony residents in searching for care in the face of state apathy and inadequate healthcare provision.

As much as it stoked fears and commercial appetites within the colony, the state of suffering across the island also roused civic-minded individuals and medical practitioners to action. Throughout May, both English and Chinese language newspapers consolidated influenza explainers, prevention, and treatment advice from Western medicine and TCM practitioners alike for the benefit of the public. The causes of influenza were explained from both Western medical and TCM perspectives. News articles commonly advised the public to avoid crowded places and to exercise for influenza prevention while aspirin, hydration, and home rest were commonly recommended for treatment and convalescence. As the epidemic intensified around mid-May, TCM medical halls and practitioners even published TCM recipes (中藥方驗方) that were usually proprietary as “public service prescriptions” for the impoverished, as well as rural folk without healthcare access. Often detailed, these recipes were even tailored to specific influenza symptoms and categories of flu sufferers: in one instance, four different herbal concoctions were each tailored for influenza, high fever, children and weak constitutions.

Prominent citizens and medical professionals also came together to organise three free flu clinics in support of the overwhelmed healthcare system, as dire reports of influenza sufferers surfaced in the colony’s broadsheets. The Singapore Free Press, for example, painted a picture of Chinatown’s social tragedy from the perspective of social workers: welfare benefits were left uncollected, daily wage earners faced impoverishment and families laid “side by side praying for the infection to disappear.” The social workers even urged mobile medical teams to “visit congested areas and if necessary, force people to take medicine.”

While altruism, cooperation and mutual aid were arguably defining characteristics of the public’s responses towards the influenza epidemic, one particular epidemic incident stands out for its deft defiance of authority and media manipulation.

Around mid-May, local newspapers started to carry reports of dire starvation and overwhelming infection threatening the island of Pulau Sudong. As ST proclaimed, “flu and fear have gripped the inhabitants of tiny (half-a-square mile) Pulau Sudong.” In the span of 10 days, three fatalities and 300 infected cases, out of the island’s population of 455, were reported in the news. Starvation fears mounted as the influenza left the fishing community’s afflicted men unable to fish. Families were purportedly reduced to one meal a day as they were unable to barter for necessities. The Malay Welfare Council quickly organised a humanitarian trip, although the government initially remained reluctant to act and refused the island inhabitants “relief or special treatment,” for fear of setting a precedent for “all those suffering from flu all over Singapore.”

The public disclosure of the islanders’ apparent plight, however, likely pressured the government into action. A government medical team, led by Dr K Kanagaratnam and Dr Thung Ling Hooi, was dispatched to Pulau Sudong and examined 51 people. Only eight people, however, were found to be infected—in fact, two were new cases. The island’s penghulu (“chief”), Inche Bindol bin Bengol, had “grossly exaggerated” infection figures. News reports never mention the exact reasons for Inche Bindol’s deceit. Charitably interpreted, his lies were meant to seek state aid for Pulau Sudong inhabitants during the epidemic outbreak. After all, according to a Singapore Standard editorial, Pulau Sudong and the other 15 outer islands of Singapore were “forgotten isles” bereft of public services and amenities, and their island inhabitants barely thought about, “except when their votes are required.” Suffice to say, relations between the mainland government and Singapore’s outer islands did not seem harmonious. Despite the penghulu’s embellishments, Pulau Sudong fishermen likely did face difficulties in fishing while avoiding infection. More importantly, the incident revealed the state’s sensitivity to media pressure. In this case, it points perhaps to the press’s power and responsibility to serve as a watchdog that mediates healthy and constructive dialogue between the government and public-at-large.

Last but not least, our judgement of the different pandemic suppression strategies used to deal with the Asian Flu and Covid-19 must remain rooted in historical sensitivity. Perhaps the Labour Front government’s laissez-faire epidemic response stemmed in part from competing political priorities in the push for decolonisation and limited healthcare resources. Or maybe the epidemic might have paled in comparison to other more lethal and persistent diseases that plagued Singapore, like tuberculosis and diphtheria.

All this is to say, epidemic management is not just an issue of medicine or public health, but must also entail socio-political considerations. Perhaps the Labour Front government’s failure was less about the spread of a (relatively mild) disease than the lack of calm, measured communication—letting colony residents know that there was nothing much to fear.

As hinted at throughout, the colony’s English and Chinese newspapers were of paramount importance in keeping watch over the government’s epidemic response, and in surfacing the concerns and suffering of common folk during the influenza epidemic. In fact, they remain the singular most important primary source able to inform us of the experiences of everyday life during Singapore’s 1957 Asian Flu epidemic.

Whether reporting on the plight of foreign workers living in dormitories or the burnout faced by Singapore’s healthcare workers during Covid-19, the media’s role remains just as, if not more, essential in modern epidemics. Robust reporting and media coverage not only promotes transparency and clarity of thought, but it also effectively dispels public speculation and strengthens civic resolve in times of crisis. Most importantly, as the school closures and Pulau Sudong incident suggest, they are vital to holding those in power accountable for their response and reactions.

Compared to 1957, today’s government is far more well-resourced and enjoys a sovereign mandate. That, however, also necessitates a different relationship with constituents of today who charge the government with greater moral responsibility to render protection from threats and exercise biopower.

While government communication during Covid-19 was generally calm and reassuring, there’s room for improvement. For example, the decision to exclude migrant workers from national case reporting likely heightened bigotry towards them. Similarly, the failure, both by authorities and the mainstream media, to proactively report and investigate vaccine complication deaths, likely fed conspiracy theories around vaccines.

As digital communications continue to expand, it seems likely that by the time the next pandemic hits, there will be more organic and distributed forms of information. What rang clear and true, in 1957 and again in 2020, is the importance of clarity, transparency and a healthy, collaborative relationship between government and media—one in which the latter’s check on the former is understood as essential for societal well-being.

As a Yale-NUS College History graduate and a Master’s in Public Policy alumnus of the Lee Kuan Yew School of Public Policy, Liam Hoo is interested in exploring research areas within Singapore, South-east Asia and Asia. He looks forward to writing histories that integrate public policy perspectives and doing public policy work informed by history. In no particular order, he enjoys coffee, horror, and poetry for leisure.

Style note: While Jom's house style is to use simplified Chinese characters, for this essay, we have decided to keep the Chinese characters in their traditional form, as they were originally written in the news articles they were quoted from.

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