The Deadly 1902 Cholera Epidemic in the Philippines, with Special Interest on Its Consequences in Batangas

The disease cholera is an infection of the small intestines that leads to diarrhea, vomiting and muscle cramps. It is caused by a bacterium called vibrio cholera that can be transmitted by unsanitary water or food. Persons infected with the disease may suffer severe dehydration and electrolyte imbalance, which may, in turn, result into death. The mortality rate for the disease is anything from 5% to 50%, depending on the availability of treatment¹.

Occasionally, cholera epidemics worldwide reach pandemic levels, i.e. spread over a large region, multiple continents or even worldwide. The first pandemic to reach the Philippines was the one of 1852-1860, during the Spanish era². There were passing references to this in the barrio histories of Batangas called Historical Data³, so we know that the pandemic affected the province as well.

There is more available documentation on the sixth global pandemic which raged through the Philippines, including Batangas, from 1902-1904; and it is to this that we now devote our attention.

On 8 March 1902, American health officials in the Philippines received word that a strain of Asiatic cholera had appeared in Guangzhou, China; and that five days later it was also reported in Hong Kong. By 19 March, the chief quarantine officer issued an order “forbidding the importation” of vegetables as well as a directive to health officials to “be on the lookout for persons suffering from bowel trouble of a suspicious character⁴.”

Despite these measures, the cholera somehow managed to slip through. The following day, the Board of Health was informed by the San Juan de Dios Hospital that two patients were exhibiting symptoms of Asiatic cholera. By 22 March, the presence of the disease was confirmed. Despite efforts by American officials to contain the spread of the disease, before long it did so, in communities along the Pasig River, including Manila.

Quarantine guards were stationed “on all roads, paths and streams leading out from Manila” to prevent the disease from spreading to the provinces, but it did so, anyway. It was likely brought along with them by people who slipped quarantine by riding bancas or crossed fields instead of using roads to get out of Manila.

On 24 May, the first case of cholera infection in Batangas was confirmed in the town of Bauan. Before long, the disease started to spread. By July, cases were confirmed in the towns of Balayan, Batangas, Lipa, Taal, Lemery, Ibaan, San Juan de Bocboc, Tanauan and San Jose⁵.

By 1 September, 3,093 people had been afflicted; and of this number, a total of 2,340 would die for a staggering 75% mortality rate. These were just the cases that were officially reported and recorded.

How the cholera spread so swiftly was likely due to a number of factors. First, there was a “scarcity of doctors in the province⁶” which, in turn, made diagnosis and treatment not just of cholera difficult. Sanitary conditions were also understandably poor by present-day standards, and water for drinking and personal hygiene was fetched in many cases from open wells or rivers. In fact, when the Americans first tried to control the disease in Manila by distributing distilled water, many among the uneducated suspected that they were being poisoned.

When the first case of cholera was confirmed in Batangas, it had been just a month or so since Batangueños were allowed to return to their homes from the concentration camps, where they were forced to live by the United States Army since December of the previous year. The forced concentration was a tactical move to prevent the civilian population from supporting the guerrilla efforts of General Miguel Malvar’s forces.

After studying burial records in the towns of Lipa and Batangas, the historian Glenn A. May conjectured that “the zones (i.e. concentration camps) were unhealthy places to live (in) and that the number of deaths was extraordinarily high during the months of concentration⁷.”

In other words, the general state of health among Batangueños after their release from the concentration camps would have been poor, particularly in the face of a raging pandemic. This state of poor health would have continued even after the end of concentration because farms upon which families depended for subsistence had been neglected while people were in the camps. There would have been food shortages.

While the disease raged, the Board of Health decreed that no funeral services over the dead would be allowed in the churches of Batangas as a precaution against its spread. As a workaround, church services were held without the bodies of the deceased, which were often sent straight to the cemetery for burial.

In time, measures undertaken by the Board of Health would result in a decline of the disease’s spread. Among others, these included an educational campaign about how to avoid becoming infected by the disease; the distribution of free distilled water; a ban on the sale of food items deemed likely to carry the disease; and the quarantine of infected localities⁸.

Overall, however, by the time the Board of Health declared that the disease had disappeared from Luzon in 1904, in Batangas the final number of reported cases was 3,433 with 2,718 deaths. The mortality rate was a staggering 79%. There would be more outbreaks of the disease in the country in the coming years, but certainly not of the same scale as the pandemic that raged from 1902-1904.