Cholera was originally an endemic disease of India. It is an acute infection of the small intestine caused by vibrio cholerae. It is characterized by sudden severe diarrhea often accompanied by vomiting, resulting in rapid dehydration of the inflected. The fatality rate of cholera exceeded 50%. In the 19th century, frequent international travel turned this endemic disease into at least six global pandemics. Cholera became an international infectious disease for the first time between 1817 and 1822, and the infection spread from Bangladesh, China, and Japan to the Arab region. Then between 1899 and 1920, the sixth cholera pandemic ravaged the East Asian region with Taiwan included. Statistics of seaport quarantine showed cholera as the main infectious disease introduced into Taiwan. It was brought in mostly by cargo ships from China, followed by vessels from places of origin including Japan, Southeast Asia and China. Cholera was introduced to Taiwan three times in 1902, 1912, and 1919, all due to epidemics in China.

Among them, the 1919 epidemic was the most serious, causing more than 6,000 infected and more than 4,000 dead, with the Taipei area suffering the hardest hit. The epidemic began in southern China, and the first case of Taiwan occurred in Penghu in July 1919. At that time, Kizu Uzunosuke, a Japanese antique dealer, arrived in Taiwan from Fuzhou, China on the Hubei Maru, and fell sick after landing at Keelung Port. Upon admission to Daojiang Hospital, he was confirmed to be infected with cholera. Meanwhile, the epidemic had gradually spread in Shihlin, Keelung and Dadaocheng.

In face of this epidemic, the Government-General of Taiwan proposed preventive measures including seaport quarantine, setting up quarantine committees and disinfection teams, implementing quarantine and home isolation, traffic control, promoting hygiene and vaccinations.

The epidemic was most serious in Taihoku Chō (臺北廳), the present-day Taipei, Keelung and New Taipei). Its Police Department had set up an epidemic prevention unit comprising police officers and doctors for implementing quarantine. Thanks to a series of related medical and emergency protective measures, cholera in Taihoku Chō gradually subsided in late September 1919. By early November, when the last cholera patient recovered, the epidemic finally ceased.

Following the outbreak of cholera in 1919, quarantine officers performed quarantine checks of vessels. In addition to tracing the travel route of incoming passengers, notifications were also sent to the local government of their destinations for the purpose of monitoring and tracking. Upon identifying the infected on board, the carrying ship had to be immediately disinfected and berthed in isolation. The crew quarantined on board had to undergo regular health checks.

 
Figure 17: Vehicles on dispatch carrying teams to perform disinfection at patients' homes
Source: Identifier: T0146P0002-0009-000, T0146P0002-0011-000, The Cholera Epidemic of 1919 in Taihoku Chō

In 1919, the quarantine office requisitioned a theater in Dadaocheng to serve as headquarters of disinfection with teams dispatched for performing disinfection at cholera patients’ home.


 Figure 18: A branch hospital of Daojiang Hospital
Source: Identifier: T0146P0002-0015-000, The Cholera Epidemic of 1919 in Taihoku Chō

Daojiang Hospital was formerly known as Taihoku Isolation Hospital. Following the outbreak of bubonic plague in 1896, it was established in Dadaocheng in October of the same year specially for treatment and isolation of patients with communicable diseases. When an epidemic broke out, branch hospitals, as required, were set up in different areas for patients put under isolation.


 Figure 19: Diary of Fu Xi-qi in 1919
Source: Identifier: T0889_0133-064、T0889_0133-069, Fu Xi-qi Papers (1902-1946)

Fu Xi-qi (1872-1946), a native of Tanzi, was twice appointed as the village head of Tanzi in Fengyuan District, Taichū shū (臺中州) for 11 years from 1920 to 1925 and 1929 to 1935. Before that, on August 19, 1919, he recorded in his diary that someone of the Taichung Railway Station was infected with cholera, which marked the attack of cholera on Taichung. September 6 was the day of mass vaccination of the entire village against cholera.


 Figure 20: Diary of Huang Wang-cheng in 1919
Source: Identifier: HW01_00_01_007_0131, Huang Wang-cheng and Huang Ji-tu Papers (1905-1978)

In September 1919, the crew of a Chinese junk moored at Nanliao Beach in Hsinchu were infected with cholera. In consequence, Nanliao Beach and the old port of Hsinchu were immediately closed. Huang Wang-cheng, a native of Hsinchu who was a family tutor in the house of Tsai Lian-fang in Qingshui, Taichung, recorded in his diary on September 5 that he had heard of the outbreak of cholera in Nanliao, Hsinchu. Sale and purchase of fish was thus prohibited so as to prevent transmission from excrement of patients to contaminated fish and then back to humans through improper handling of fish.


 Figure 21: Regulations on sale of preventive and treatment commodities by Institute of Research of Government-General of Taiwan in 1916
Source: Identifier: 000024900090183, Official Documents of Government-General of Taiwan (1895-1947)




Figure 22: Scenes of mass vaccination of people in Shihlin
Source: Identifier: T0146P0002-0035-000, T0146P0002-0036-000, The Cholera Epidemic of 1919 in Taihoku Chō

Vaccination is the most effective way to prevent Cholera. In September 1916, the Institute of Research of Government-General of Taiwan began manufacturing and selling preventive and treatment commodities. In other words, Taiwan could manufacture and sell serum vaccine. A 20-ml bottle of serum vaccine could vaccinate 10 people; a 10-ml bottle of sensitized bacterial vaccine could vaccinate 5 people. Between 1919 and 1920, the Government-General of Taiwan actively encouraged people to be vaccinated. About 3 million people were injected with vaccines manufactured by the Institute of Research of Government-General of Taiwan, totaling three-quarters of Taiwan's population at that time. Among the population of 550,000 in Taihoku Chō (臺北廳), 300,000 people were vaccinated.

 

To prevent the outbreak of cholera, the Taichung government vigorously promoted vaccination. In 1920, market vendors, hotel and restaurant staff, and those with frequent interaction with the public were first vaccinated, then followed by mass vaccination of the general public in July. On October 26, 1920, Chang Li-jun, a leading bao-cheng (from 1899 to 1918) of Xia Nankeng in Fengyuan, Taichung mentioned in his diary about the inspectors accompanied by doctors came on that day to supervise the mass vaccination of the local residents.


 Figure 24-1: Slide show on health and hygiene organized at Dadaocheng in 1919 (Left)
Figure 24-2: Transmission route of communicable diseases (Right)
Source: (24-1) Identifier: T0146P0002-0033-000, The Cholera Epidemic of 1919 in Taihoku Chō. (24-2) Identifier: T0321P0046_0005-001 Wall Chart for Home Economics and Ethics classes at Mandarin Training Center of Government-General of Taiwan