The Annual Report of the Commissioner of Public Health describes sanitation and disease in the urban environment of Manila from September 1903 to August 1904. During this time, Manila (as well as other areas in the Philippines) had been battling the bubonic plague, an epidemic that took place under American colonial rule. The Annual Report of the Commissioner of Public Health was therefore written by the American colonial authorities and presents public health interventions they implemented during the years of the plague outbreak. The report reveals many things about the American colonial perspective, particularly how important sanitation measures became, and how sanitation became associated with economic growth and prosperity, racial distinctions, and colonial governance. Ultimately, this report demonstrates that American officials viewed sanitation not only as a means of preventing disease, but also as an important tool for regulating urban spaces and the local population in those spaces.

This report reveals a significant connection between sanitation and economic growth. The Commissioner in the report stresses that while sanitation is clearly a humanitarian issue at heart, it should also be valued for economic reasons, arguing that public health investments would later on produce great financial returns.¹ This section of the report is most interesting, as it tries to convey that putting time, effort, money, and resources into sanitation is necessary for a number of reasons, not merely the more obvious health risks/issues associated with poor sanitation practices. This section of the report also reveals the motivations behind which issues the colonial administration chooses to prioritise, because the report very clearly connects sanitary efficiency with the prosperity of the Philippines, which also serves as a testament to the success of the American administration overseeing it.² Because of this, sanitation becomes an issue of high importance.

Aside from economics, the relationship between sanitation and colonial authority/administration is an important theme across many colonial territories, like that of colonial Singapore for example. The Annual Report of the Commissioner of Public Health and Brenda Yeoh’s examination of municipal sanitary surveillance in colonial Singapore have some significant overlaps that speak to colonial administrations and their aims and wishes for their territories. In Yeoh’s piece, Yeoh describes how the British authorities used sanitation and sanitary regulations to exert control over urban spaces in Singapore, which frequently disrupted already established practices among Asian inhabitants living there.³ The American authorities in Manila, as observed in the Annual Report of the Commissioner of Public Health, much like in Singapore, used sanitation as a way to expand government intervention into everyday/public life. As Yeoh argues, the regulation of sanitation played a key role in shaping the power dynamic between the colonial authorities and the populations they governed. (Yeoh, Contesting Space in Colonial Singapore, 102 )) Thus, both in colonial Singapore and Manila, sanitation served as an excuse to intervene and regulate daily life.

The Annual Report of the Commissioner of Public Health also provides important insight into social/racial distinctions prevalent in colonial Manila at the time (1903–1904). In the report, there is an examination of mortality statistics, comparing the death rates across different racial and national groups. There are several noticeable disparities in these statistics. The data provided shows that there were significantly higher death rates among the Filipino population than among the American colonists. The data also shows that certain districts were associated with different social and racial populations.⁴ Although these statistics are meant to reveal differences in mortality, the report reveals how disease was understood within the frameworks of certain pre-existing race/class hierarchies. This is evident through the mention of certain urban districts and how they were perceived as particularly unhealthy, while conditions contributing to disease were interpreted through the characteristics of their inhabitants. The report observes that districts with larger Chinese populations experienced lower mortality rates than those inhabited by the “poorer class of natives.”⁴ This quote demonstrates how American authorities interpreted patterns of disease, that is, through their existing racial and socioeconomic divisions, associating particular urban spaces with the populations inhabiting them.

These social and racial distinctions can be better understood in Colonial Pathologies by Warwick Anderson. In Colonial Pathologies, Anderson explains that the framework for American tropical medicine in the Philippines was shaped by racial assumptions and biased colonial ideas about hygiene and civilisation.⁵ The Commissioner’s language in the Annual Report of the Commissioner of Public Health is also reflective of this broader relationship between American medical knowledge and colonial authority. By discrediting Filipino practices and classifying them as insufficiently scientific, American officials could then justify more American intervention into local communities under the guise of helping the more “ill-informed” Filipinos. This here is an example of how the medical, administrative, and sanitary practices enforced by the American colonial authority in Manila all reinforced the supposed superiority of Western ideas.

The Annual Report of the Commissioner of Public Health is reflective of how colonial administrations and their regulations in Manila were concerned with far more than disease prevention in their sanitation efforts. By associating sanitation with economic prosperity, public health interventions became a high priority and, perhaps more importantly, a marker of the American administration’s success and legitimacy. It is no wonder sanitation and public health intervention measures became of the utmost importance during the plague outbreak. In many ways, sanitation efforts became a way to assert power over local Filipinos. Dismissing any Filipino opposition to colonial rule, as well as disregarding their medical practices, was justified through a composed colonial hierarchy where Filipinos fell beneath American colonists. The Annual Report of the Commissioner of Public Health shows just how vital a tool sanitation efforts came to be for keeping the control in the hands of the American administration.

1. Bureau of Public Health, Annual Report of the Commissioner of Public Health, September 1, 1903, to August 31, 1904 (Manila: Bureau of Public Printing, 1905), 7–8. [↩]
2. Bureau of Public Health, Annual Report of the Commissioner of Public Health, 8. [↩]
3. Brenda, S. A. Yeoh, Contesting Space in Colonial Singapore: Power Relations and the Urban Built Environment (Singapore: Singapore University Press, 2003), 102–104. [↩]
4. Bureau of Public Health, Annual Report of the Commissioner of Public Health, 11-12 [↩] [↩]
5. Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines (Durham, NC: Duke University Press, 2006), 132–133. [↩]