HOW SOME PEOPLE HAVE LIVED, AND NOT DIED, IN INDIA.
On a former occasion I ventured imperfectly—for India is immense, while a paper is small—to bring before the Association how people have died, and not lived, in India; how people may live, and not die, in India.
I used some of that great body of information brought together by the 'Royal Commission on the Sanitary State of the Indian Army,' which was at work during four years, 1859–1863, and was presided over, first by Sidney Herbert—whose statue still stands before the War Office as a witness in favour of progress—then by Lord Stanley, now Lord Derby.
Ten years have elapsed, during which most of the sanitary proceedings which have been initiated, and their results, have passed (on paper) through our hands. And we may now reckon up our gains.
2. I must begin by guarding myself and others.A caution. We have made an impression on the sanitary state of that vast country; but 'impression,' so far as this: only to show us the immense work that remains to be done; the immense success that can attend it—we cannot yet say the immense work that has been done.
But how much this is; what progress since the time we were taught to lament the 'hopeless Indian climate'!
What is the epidemic state. The caution is this: as in all epidemic countries, more than in most—the death-rates of the Indian Army had shown two characteristics: they fell and they varied according to the nature of the season and the prevailing 'epidemic state.'
(1) E.g., in past, and, alas! in present years, we can say approximately what districts will be visited by fever or by cholera in 'epidemic' times: 'if the drainage and water supply, and neighbouring ground are left in that bad state'—when comes the 'epidemic,' those dwellings may expect it. If air, earth, and water continue to be fouled, if foul damp ground be not drained, if the public ways be not better kept, when comes the 'fever,' when comes the 'cholera,' those districts will have it.
But why does not cholera come every year to those dwellings? Their state is the same. And why is fever not always in those districts?
We do not know.
All we can say is, we know into what dwellings cholera and fever will not come, however 'epidemic' the year; we can put towns and districts into such a state that the epidemic, like the mediæval witch, is exorcised, so that it cannot come near them.
More than this we do not know.
(2) In past years—not so long past—in a great town of England, 47 children out of every 100 used to die before they were five years old. But why those 47?
We do know how this infant mortality, or rather massacre of the innocents, can be mitigated or prevented; namely, by cleanliness of house and child, by fresh air, care as to food and clothes, whitewashing, by 'minding baby' in short, and by avoiding all 'soothing syrups' whatever.
But we do not know which babies will be taken and which not.
All this is pre-eminently true of India. From the great Sunderbunds, where cholera seems to have had its birth-place, and had not been born some centuries ago [great towns, shown in old Portuguese maps, now no longer to be found, seem to attest that the Sunderbunds were not then the home and hearth of epidemics], cholera sets forth on its terrible march over Asia, so reaching Europe; but why in one year and not in another we know not.
If the Sunderbunds were drained, cultivated, and again rendered fit for human habitation, would cholera disappear?
3. Now, after this caution, to proceed: The resultsSatisfactory Sanitary results in 1871. we find, in the last Report of the 'Sanitary Commissioner with the Government of India,' and in other District Reports, have been so striking, that they may be fairly accepted as showing, not that India has become 'healthy for ever' (the year 1871 was a non-epidemic year), but that we can grapple with—that we may one day finally subdue, if we will—spite of the bugbear 'climate'—those local conditions which in former days decimated the strength of the Army, and which, unless preventable and prevented, make up a terrible prospect—that only at such a price could India be held by a British force. And this when man's life was becoming every year more valuable.
In the first part of this century the Death-rate among British troops serving in India had revolved round 69 per 1,000 per annum; that is, 69 men out of every 1,000 died on an average every year.
The 'constantly sick' in hospital amounted in old times to ten per cent. of the strength; that is, out of every 1,000 men 100 were always ill in bed.
Or, in round numbers, the whole British Army went three times into hospital every year. The Royal Commission of 1863 gave a Table showing, as they state, 'that on an average in the stations of Bengal 84 men in a battalion of 1,000 were constantly in hospital, where 69 die annually.'
But men invalided 'are a total loss to the service as much as the men who die;'—indeed more so, as far as the country is concerned, for they have to be supported.
And the loss by invaliding was, as may be supposed, high in proportion:—in Bengal, as high as between 80 and 90 per 1,000 per annum, including all such casualties.
Steps had been taken before, steps were being taken during the inquiries in India of the Royal Commission, for removing some existing sanitary defects, with corresponding improvement of the health of troops.
The Report and evidence were printed, with an abstract of evidence from the Stations, by Parliament in August 1863.
In December, Sir John Lawrence was sent out as Governor-General (Lord Elgin's death impending), and almost immediately on beginning his vice-reign he formed an organisation for grappling with the evils, with this hundred-headed Hydra, in the localities themselves—in the home of the beast.
In this way of late years a vast amount of simple, inexpensive sanitary work has been done in respect of cleansing, draining, improving the water supply. In many of the cities and towns of the North-West Provinces this cleansing, the better making and keeping of public ways, the straightening and widening of streets, are now looked after.
In the North-West Provinces and in Oudh the civil stations have been improving their drainage, and the whole subject is marching on.
In the Central Provinces, we are told, improvements of various kinds are going on.
In Berar the people are thinking about it—thinking how bad is their water-supply. One trusts that they will go farther—though thinking is a good thing—and not only think but act.
In the Punjaub a good deal, we are told, is being quietly done in the towns.
In Bengal Proper, where most is wanted, least seems to be doing.
Many stations all over India—e.g., Barrackpoor, Umballa, Murree, Meean Meer—are supplying themselves with better water.
Many have had their barracks improved or reconstructed—not before it was wanted—and sometimes, it must be admitted, not in the most economical way.
Still the work has been done, and is being done, very zealously, as is shown by the Reports of Sanitary Commissioners, which give as striking instances of results to health from sanitary improvements as could well be imagined, were it even a Hercules who was working for us [these are real miracles of the present day] or as have been realised at home. And this has been done without burning down the city, which, it seems, was the only way of saving London from another great plague.
Army: Death-rate and Sick-rate in 1871. 4. And first, as regards the Death-rate of the Army:
For on this subject Dr. Cuningham gives some most important facts, especially as regards Bengal, formerly, as we know, the most unhealthy province—if province it can be called—a country of nearly 69,000,000—the most densely populated in the world.
Formerly the Death-rate for all India revolved round 69 per 1,000. In 1871 the Death-rate, including deaths among invalids after their arrival in England, was 18·69 per 1000. [The strength was 56,806 non-commissioned officers and men]; that is, 18 men died where 69 died before. Of the invalids sent home to England, 16·02 per 1,000 on a similar strength were discharged the service.
From these facts we arrive at this result: namely, leaving out the loss from invaliding in the old Indian Army altogether, the total loss to the present Indian Army in 1871 by deaths and discharges was 34·7 per 1,000, or just one-half of the loss occasioned by the old death-rate alone. In other words, we lost, in 1871, 18 men only by death—in India and England both—out of every 1,000 of the British Indian army; and 16 more were discharged as unfit for further service; that is, there was a saving of 51 men in every 1,000 in 1871 (a healthy year), or 2,858 men in an army of 56,806 were the savings of that year: one year's results: as compared with the average losses of old.
Let us remember, with the mercantile Briton's spirit, that every man costs with his arms 100l. set down in India: hence £285,800 was the money saving on recruits in that year.
But what is the value of a man otherwise?
To us these are not figures, but men.
Returning to the Bengal Presidency, we find in 1871 the deaths 17·83 per 1,000, where formerly the Bengal death-rate lay between 70 and 80 per 1,000, and annual losses from other casualties actually rose to between 80 and 90 per 1,000. In other words, 17 men only die instead of 70.
A few results for 1871, from different groups of formerly most unhealthy Bengal stations, tend to show that the improvement in health is going on; thus:
In Bengal Proper the death-rate for the ten years preceding 1870, including a time of sanitary improvement, was 29½ per 1,000; and the daily sick nearly 7 per cent., or 70 per 1,000. In 1871 the death-rate was 18·72 per 1,000, and the daily sick-rate 5 per cent., or 50 per 1,000.
General Sick Rate. Let us here add, that in round numbers the whole Indian Army went once-and-a-half times into hospital, and about 5½ per cent. of the force was always in hospital, during the year 1871, instead of nearly double the number.
Fort William. We all remember the frightful sickness and mortality of Fort William. Its sick-rate continues rather high, but its death-rate in 1871 was only 10 per 1,000, less than a tenth part of its former death-rate: and 2½ per 1,000 less than the death-rate of 1870.
Oudh. In Oudh the death-rate from 1860 to 1869 was 28½ per 1,000. In 1871 it was under 23. The constantly sick had also fallen from 69 to 61 per 1,000.
At Cawnpore much has been done to improve the site, and the station shows a death-rate of only 13; while Benares and Allahabad, in which less has been done, and Dinapore, in which we do not hear of much done, show quite double this rate of death.
Meerut. Meerut and Rohilcund, in the ten years before 1870, were sick at the rate of 72 per 1,000, and sick unto death at the rate of 26½ per 1,000. In 1870 these fell to 69 and 18½ respectively; and in 1871 to 65 and 16½. But in this group Roorkee, which has always distinguished itself, and Moradabad died at the rate of only 8 and 5½.
In Agra and Central India, for the ten years beforeAgra. 1870, the sick-rate was 74, and the death-rate 38½ per 1,000. In 1870, though the sick-rate was 77, of these there died only 22 per 1,000; and in 1871 there were sick only 64, and there died under 18½ per 1,000.
In the Punjaub, there has been apparently somePunjaub. progress in improving the heavy sick-list. The ten-year period shows sick at the rate of 56, and dead at 25; but 1870 gives daily sick at 69, and deaths at under 24½ per 1,000; and 1871, sick at 54, and dead at little more than 18 per 1,000.
Now the Hill stations come in. During the ten Hill Stations. years before 1870 the daily sick were 49, and the dead nearly 15 per 1,000. In 1870 the sick were 40, and the dead 11. In 1871, 48 and 9. But at one Hill station, Raneekhet, the death-rate was as high as 24; while at another, Chukrata, it was under 6½; and at Dugshai 5½.
Now for the convalescent depôts: These gave aConvalescent Depôts. death-rate of nearly 31 per 1,000, during the ten-year period; for the men seem to have died rather than convalesced—whereas in 1870 it was little over 22½, and in 1871 under 13 per 1,000.
The Army Sanitary Commission concludes its notice of this part of Dr. Cuningham's statistics by 'congratulation at the improvements already effected in the sanitary condition of stations and troops serving in the Bengal Presidency;' especially, it says, when the former history of the old Bengal European Army is considered, with its annual death-rate 'of from 70 to 80 per 1,000;' and 'its annual losses from other casualties of between 80 and 90 per 1,000.' But it warns us not to delay measures for making the statistics of 1871—'an avowedly healthy year'—the real representative statistics of every year in India.
For it must not be assumed that the work of improvement is done.
Far from it.
The general result only indicates progress towards realization: not realization.
As yet what is being done is all we have to show.
The Royal Commission pointed out that the death-rate, when we have prevented preventable diseases, ought not to be more than ten in the thousand.
The importance of the present results consists in showing that India is not necessarily fatal to European lives, and that the Government of India, the India Office at home, and the British public, have not only a common interest in the results already attained, but that they have a right to expect, and do expect, that their officers' hands shall not be stayed in this good work; that they shall be assisted in every possible way. Expense has been incurred—somewhat more perhaps in certain directions than was necessary. But has there been no gain?
It has been shown that we are in the way of regaining every year a large part of the outlay.
5. Had time permitted, some account should have been given of the success of sanitary work in India in cities, and even in country districts.
But we must be content with a few illustrations.
Ten years ago I reported to the Royal Commission that no one of those three large and populous cities—seats of Presidencies—Calcutta, Bombay, Madras—Calcutta, Bombay, Madras.had as yet arrived at the degree of civilisation in their sanitary arrangements at which the worst parts of our worst towns had arrived before sanitary reform sprang up in England at all.
Yet all the fault of the inevitable results was laid to the 'climate.'
Bombay, the second city of our Empire, had, it is true, a better water-supply, but no drainage.
Calcutta was being drained, but had no water supply.
Two of the seats of Government had thus each one-half of a sanitary improvement, which halves ought never to be separated.
Madras had neither.
This was ten years ago.
Now (and I cannot but name the name of the CalcuttaCalcutta. municipality engineer, Mr. Clark, with this great improvement—let us give him a cheer), Calcutta has its water-supply complete: all classes, all castes, use it; and find, indeed, the fabled virtues of the Ganges in the pure water-tap.
Draining has been going on, subsoil and surface: the subsoil water-level effectually lowered; and not only this, but a fine current of water runs through the subsoil from the river on one side to drainage outlets on the other, carrying with it old sewage out of the subsoil. The main drainage of most of the town is complete, and native owners of houses are already applying for private drainage—a fact of great importance.
Still there remain to be provided for—to make the Sewerage perfect—connections between the main sewers and the houses (and especially in large districts of the poorer population, and in the Bustees—'temporary' villages, of mat and thatch and mud).
Many miles of ditches have been filled up, to the great detriment of mosquitoes and great comfort of the inhabitants.
Then, also, the sewage is being applied to agriculture.
And what has been the result of all this sanitary engineering?
From 1866, when the deaths from cholera in Calcutta were little short of 7,000, they have decreased to 800 in 1871, the lowest number of deaths on record. Calcutta in 1871 was more salubrious than Manchester or Liverpool, and may be considered soon a sanitarium compared with Vienna, or even with Berlin, where the city canals are still fouled with sewage.
Still we must not 'sing before we are out of the wood.' Much, as Mr. Clark and Sir George Campbell would tell us, remains to be done.
And before the inhabitants of Calcutta can hope to be free from finding themselves any morning in the claws of some epidemic disease, they must have done a great deal more to the houses of the people, crowded as they are on small unhealthy space, and to the undrained districts surrounding, and especially below Calcutta.
Caste prejudices have been alleged as insuperable stumbling-blocks in the way to sanitary improvement, but a curious and cheerful instance of caste prejudice being overcome is this: when the water-supply was first introduced into Calcutta, the high-caste Hindoos still desired their water-carriers to bring them the sacred water from the river; but these functionaries, finding it much easier to take the water from the new taps, just rubbed in a little (vulgar, not sacred) mud, and presented it as Ganges water.
When at last the healthy fraud was discovered, public opinion, founded on experience, had already gone too far to return to dirty water. And the new water-supply was, at public meetings, adjudged to be theologically as well as physically safe.
Besides its water-supply, then, the drainage of Calcutta bids fair to be a wonder of the world, when we remember what has been loudly said, even in this our day, that Calcutta at least was hopeless, because it lies close to the level of the river; and its public health has equally defied the prophets of irremediable evil, and will yet improve still further its powers of defiance, while the active—not prophets of evil, but performers of good—Mr. Clark, and the energetic Lieut.-Governor of Bengal, and other such authorities live.
Bombay. Now for Bombay—Bombay, hitherto the pioneer: Bombay the active, not to say restless, the energetic Bombay. Bombay has for years done everything to drain itself, except doing it: it has had the best engineer, Major H. Tulloch, to look at it, to plan for it; it has had surveys, plans, reports, paper, and print enough to drain all India—writing and talking enough for a thousand years. The only thing it has not done is to do it.
In the meantime it has had to thank its able Dr. Hewlett, the most vigorous of health officers—now alas! no longer at that post—for having, at a quite incredible cost of time and energy, in organising, personally superintending, and being as it were the constantly present head of an immense and most expensive system of hand-labour, saved them from cholera epidemics, and done that for them, single-handed, or rather single-headed, which should have been better and more cheaply done by the civilised hand of engineering and machinery. He has been a sanitarily engineered city in himself—his own Reports are his best witnesses.
As for the water-supply, much the same may be said. The increased water-supply needed by the city is still on paper, some small portion only having been obtained.
And what has Madras done—Madras which had neither—neither water-supply nor drainage?
Madras. Madras has obtained a water-supply, and has just improved it, and is applying part of her sewage to agriculture with success. In other respects she appears to be pretty much as she was, with her filthy Cooum estuary, and her foul, undrained area.
She has recently had the census taken, with the advantage of discovering that Madras is a very unhealthy city.
6. These illustrations would be incomplete if takenMadras Presidency. only from the large cities. Here, however, are a few experimental results described by the Sanitary Commissioner for Madras in his report on cholera of 1870. Cuddalore town had forty-two deaths from cholera out of a population of 28,421. Cuddalore jail with 301 prisoners escaped. The jail had those two indispensable requisites—good water and perfect cleanliness—which were absent in the town. Madura town contains 39,872 people, of whom 376 died of cholera, which, on arriving there, found bad conservancy, foul privy arrangements, foul subsoil, contaminated water. There are two jails at Madura, one old, the other new. The old jail had bad water and other insanitary conditions, and lost four out of fifty prisoners by cholera. The new jail contained 180 prisoners; these were the only persons not exposed to sanitary defects, and they all escaped cholera.
Rajahmundry town, where the population live under the usual Indian insanitary conditions, lost 147 people from cholera out of a population of 17,498. The district jail, situated within the town, and under similar conditions, lost 16 prisoners out of 89 by cholera. The new central jail, where the sanitary conditions were good, had not a single case of cholera among 845 prisoners, although the disease prevailed 'violently in all the country round.'
Vellore town lost 67 people out of 30,529 from cholera. It has two jails, one old, the other new. The sanitary condition of the old jail was rigidly attended to, and there was no cholera among its 152 prisoners. The new jail had 576 prisoners, but no cholera. It occupies a healthy site, and its sanitary arrangements were good.
More sanitary experiments of this kind could be cited, but here is one of special interest regarding villages:—
Mr. Kearns, a Church Missionary in Southern India, states that on his arrival at Puthian Puttur, in 1853, few villages had suffered more from cholera and fever. The place was wretched and foul, and had bad water. To remedy this state of things, wells were dug and properly protected; surface drainage was improved, rigid cleanliness enforced, trees planted, and other improvements introduced. Similar improvements were carried out in other villages.
And they escaped cholera.
It is worthy of remark that the facts were brought out, in reply to a statement made by the Madras Government, that this village was exempt from cholera, 'cause unknown.' Mr. Kearns replied to this by showing that he was perfectly well aware of the 'cause.' Quite recently, improvements of a similar kind, including reconstruction of houses, in the foulest and most unwholesome parts of the city of Madras, have been attended not only by an enormous diminution in the district death-rate, but the people have improved in civilisation as well as in health.
7. But one more word about country districts.Bengal. Country Districts and Villages.
And let us remember that Bengal is the most thickly populated country in the world—a country of villages.
Till country drainage is introduced, till agriculture is improved, till irrigation and drainage are combined—both better when together, the first dangerous when apart—no great improvement in health, civilisation, or vigour of the people can be expected.
The 'drain' in another sense, the drain upon human life and happiness, of fever in India is literally untold. But as far as can be told—in 1871, a peculiarly healthy year, about one-and-a-half millions of people died in India from fever, or nearly 12 in every 1,000, or 23 times as many as cholera destroyed.
But this is a mere trifle compared with the ravage fever commits in sapping the strength and vigour of the country, in making the young old, the healthy infirm for life, the industrious helpless invalids, the rich poor, the thriving country a waste.
The deaths must first be multiplied by 50 or 60 to give us the attacks.
Then, a man who has once had a bad attack of malaria has it for life.
And almost all this fever is malarial.
Cholera destroys life, but does no more.
Fever destroys the life of the country; saps the world in which it is.
Look at the Burdwan fever; look at the Dengue fever.
'Dengue' is rarely fatal, but in its districts 'Dengue' is master, and 60 or 70 out of every 100 are 'down' with it!
Irrigation. Irrigation is essential in many parts of India, but irrigation with stagnant water is almost as injurious to crops as to health. Irrigation should be accompanied by improving the natural drainages of the country, so as to keep the water moving, however slowly.
Let me tell a curious history told me by one of the members of the first Bengal Sanitary Commission. In 1857 nine miles of country, with twenty-five villages, were laid waste by fever; death came sometimes in three hours; of 600 in a village only a few in the centre houses lived. All the others died or fled. All the other houses were unroofed and tenantless. In the other villages nothing was left but pariah dogs. The crops were uncut. The dead lay about in the hollows, unburied and unburnt, for there was nobody left to bury them.
Where the people did live they degenerated mentally and physically.
The cause of all this was a screw turned by a coolie, which flooded the low lands from the Ganges canal faster than the water could be carried off. The man at the screw (at four rupees a month) ruled the destinies of a large population, not only as to health and life, but as to soul and mind, according as the screw turned to the right or to the left.
This, the cause, was found out—only a few months before my informant gave me the account, through an inquiry made by Sir John Lawrence.
And all the time the people were going on degenerating, except those who were dead.
This melancholy history is given here (merely as an illustration; did time permit, hundreds such might be told), not for our discouragement, but for our encouragement; not because it is so hopeless, but because it is so hopeful. If the screw turned too much brings fever, the screw turned just right brings plenty and health.
Let the people only see how much they can do for themselves in improving their surface drainage, in keeping their water supply free from pollution, in cleansing inside and out.
Let the Government see how much they can do for the people in introducing and stimulating better agriculture; irrigation, combined with drainage works in water-logged districts; for the two must never be separated there.
There is not a country in the world for which so much might be done as for India.
There is not a country in the world for which there is so much hope.
Only let us do it.
Drink. 8. Unfortunately there is one disease-cause in the British Army quite beyond the influence of engineering works, for every man is his own disease-cause, and must be his own remedy.
And this is: drink.
The quart of porter and quarter of a pint of spirit per day are still procurable at the canteen, and as much more as the men like (and as will destroy them) at the bazaar—and will always send to the graveyard and invaliding depôt a large number of men every year, until they are made to understand their own interest, and are furnished with employment.
Caution again. 9. I might have ended here by repeating the caution with which I began: not to stay our hand, because the year 1871 gave a death-rate of only 18 per 1,000; but the experience of 1872, just coming in, justifies, unhappily, but too well, all the caution that can be used.
The disease death-rate of 1872, minus the superadded epidemic death-rate, was as low as that of 1871. But cholera intervened, and raised the death-rate materially in Bengal, though very little in Bombay and Madras.
This is no reason for discouragement, but the reverse.
It is not a defeat, but an attempt of the enemy to turn our flank.
We know enough of his strength and his arms to turn the check into a victory, if we are only wise.
But is not the following an example of action quite other than wise?
The report by the 'Sanitary Commissioner withQuarantine. the Government of India' on this same cholera of 1872 tells that people have been trusting much to quarantine for safety, and that quarantine has been fully tried, with results such as the following: 'In a question so intimately connected with the happiness of the human race, it cannot be too widely known that quarantine was tried in the hope of protecting a number of the cantonments of Upper India; that in many of them it signally failed, and that in no single instance is there the smallest reason to believe that it was productive of any good. The direct evils of quarantine are great enough, but … by no means the least indirect evil is this, that so long as men believe that they can escape from cholera by such means, they will never be fully alive to the importance of the greatest safeguard, sanitary improvements.'
Forced removals of sick, especially of women, for quarantine purposes, and other restrictions 'set the people against everything that is done under the plea of the public health,' and the sanitary reformer is regarded 'as the greatest destroyer of their domestic comfort and happiness.'
As a consequence, cholera cases were concealed.
The troops also had to bear their share of this mediæval infliction. The evils are described as 'very great.' 'The troops are exposed to form cordons at the very time that exposure, and especially exposure to the night-air, is calculated to prove most mischievous.' Two stations, Meean Meer and Umballa, appear to have suffered from this. Both supplied complete cordons, and both suffered severely from cholera. No better reductio ad absurdum of the whole practice could be given than the fact that the fear of spreading cholera interfered with the more decisive moves of troops which were their best chance of safety from cholera.
And then, to crown the whole, there does not appear to have been a single instance in which quarantine could be rigidly enforced.
The Government of the Punjaub has taken the common-sense course of prohibiting quarantine except by special orders; and in the case of organised bands of pilgrims.
Sanitary reformers, like other reformers, have more to fear from their friends than their enemies—
Da chi non mi fido, mi guarderò io, Da chi mi fido, mi guardi Iddio.
Conclusion. But we must stop; only, however, to bear emphatic witness how great are the sanitary deeds already achieved, or in the course of being achieved, by the gallant Anglo-Indian, as formerly we bore emphatic witness against the then existing neglects.
Let but the Government of India continue to sustain the energetic efforts of their officers, and at the same time insist on the municipalities and local authorities prosecuting the good work. This was of importance for the Central Government to do ten years ago, seeing that there was no local self-government at all; it is, if possible, of still more importance now, when there is some local self-government; but it wants guidance: which does not mean that the Governor is to do municipality himself, even though a very good municipality he would make.
The natives are always ready to be taxed, as far as obtaining, at least, a purer and more plentiful water-supply goes. There is never any 'discontent' about this. What they do not like is paying the tax and receiving no water; and in this they are not so far wrong.
The Lieut.-Governor of Bengal has invited, by proclamation, the payers of some of his rates [this as regards roads] to claim the benefits (or their share of them) of what they pay for.
Thus it will be rendered not only an easy matter to hold the great Indian Empire by a British force, but benefits untold will be conferred on the vast populations of our fellow subjects of whom we have undertaken the charge.
Dr. Cuningham's Report, No. 8.
On the authority of Mr. Annesley.
In Bombay, sanitary reform began with Sir Robert Grant forty years ago, according to then lights; and subsequent Governors carried the work on, in advance of the then Indian ideas. The first scheme for an ample supply of good water to a city was matured in Bombay thirty years ago by Lord Elphinstone, and begun five years later—long before any such plans were believed to be possible in any other Indian city. Unhappily, since this was written, Mr. Clark has been obliged to come home invalided. As the meagrest discussion of the vital question of irrigation would occupy too much time here, it has been placed in an Appendix. Is there no possibility of checking drunkenness by a system like that of 'equivalents' in the Navy? so that a man might drink his ration of spirits, or have its equivalent in coffee, beer, meat, &c., or in money.
Would it not pay Government to give men 5 per cent. compound interest on the price of drams so foregone, either paying in a lump on discharge, or, better still, giving an additional pension?
'Every taxpayer is encouraged and invited to claim that the tax shall be fairly applied to the village roads or water channels in which he is interested. The Government will use every effort to see that such local claims are fairly met, and that every taxpayer derives a fair benefit from the tax which he pays.'
—Proclamation of Bengal Government, August 1873.
You may be interested in this paper's appendix offering several practical recommendations that could go a long way to improving the health of underdeveloped nations, titled How to Make Irrigation Healthy.