The twentieth century marked a substantial reversal in the frequency of epidemics, prevalence of disease, and of deaths from waterborne diseases in South Asia. Studies of other regions of the globe have shown the importance of clean water and waste disposal systems in tackling diseases like cholera. Recent LSE graduate Sulaiman Faruqi asks: did public health factors such as these contribute to South Asia’s mortality decline? The case history of late-nineteenth and early-twentieth century Bengal suggests they did.
Bad drinking water can transport microbial pathogens to many people, causing illness and death. For a long time, Bengal was rife with cholera. In the nineteenth century Bengal did not have a sewage drainage system, and water sources were largely unregulated and infested by faecal waste. Then, the administration in Calcutta – the largest city in Bengal – implemented a new centralized sewage system in 1865 and a filtered water supply in 1869. These improvements led to a notable decline in cholera. Later, after breakthroughs in medical research, the colonial administration invested in sanitation projects across the region. Again, cholera declined.
At first only Calcutta endeavoured to make its water cleaner, because the drive to improve water quality and waste disposal was not strong enough elsewhere. Disputes amongst policymakers and medical experts, over the effectiveness of sanitary projects and over how disease travelled by water, obstructed large-scale sanitary transformation across the province.
Local governments more often undertook sanitation projects when and where disease threatened the lives of white settlers and military personnel. There was no scarcity of racial prejudice amongst colonial officials. And the lack of cooperation between colonisers and local populations made state intervention impossible at times. Indian hostility and distrust towards the colonial state, and popular association of epidemics with foreign rule, thwarted early attempts to combat cholera. The British administrator David Smith, the Sanitary Commissioner of Bengal in the late 1800s, cynically inferred that Indians thought it “better to be devastated by cholera” than subjected to state regulation. Sanitary reform in Bengal remained limited.
Then, in the face of the growing prevalence of waterborne disease and the recognition of cholera as a waterborne contagion, policymakers resolved their disagreements over wide-scale sanitary intervention. Bengal was struck by cholera epidemics in the closing years of the nineteenth century. Meanwhile, with the development of germ theory, the nature of waterborne contagions and their transmission through faecal contamination was by the 1890s universally recognised. The administration increased its investment in cleaner water and waste disposal systems across Bengal in the twentieth century.
In 1912, the central government paired local governing offices with central government health officers and provided local offices with funding for sanitation projects. Sanitary officers carried out thorough inspections in villages and towns and put forward plans to develop bespoke water supply and drainage systems to suit the needs of individual villages and towns. These measures laid the foundations for later advancements in the twentieth century.
Over the following twenty years colonial administrations expanded upon those early investments. They heavily invested in major waterwork and drainage projects in most of Bengal’s urban areas. By 1931, forty-one water supply systems had been completed, supplying over 15 million gallons of clean water a day on average across all towns.
Regression results show these sanitation investments reduced the prevalence of cholera. In towns that received investment in sanitation, cholera deaths dropped by an average of 37.42 deaths more than in towns without investment. The total effect of waterworks investments accounted for 17 percent of the provincial decline in cholera mortality. Cleaner water saved lives.
Waterworks mattered more than drainage and sewage because waterworks were more feasible projects than revamping drainage and sewage systems. Installing comprehensive drainage and sewage systems in most cases called for a complete restructuring of the local area. These projects often went beyond what the colonial administration was capable of carrying out at the time. Providing clean water in every town was a more achievable objective.
The discourse on the economic history of South Asia so far has been dominated by debates about colonialism and its legacies on South Asian development. The twentieth century was undoubtedly a traumatic period for South Asians in terms of political and social change, which has perhaps overshadowed the importance of public health and sanitary development in the region. It is important to shed light on these developments, not to form some verdict on colonialism, but to emphasise the importance of sanitary reform as a cause for the decline of waterborne diseases like cholera.
