The British impact on India perhaps was as profound on issues of the death rate and population growth as on political and economic development, but it has been less thoroughly examined.1 And in contrast to successes by the mid-twentieth century in limiting small-pox, malaria, and cholera, there was an earlier and darker tale, almost as obscure as the lives of the millions who perished in terrible epidemics in the late nineteenth and early twentieth centuries. This was how new economic conditions, ineffective village sanitary practices, the impact of modern transport and irrigation works, and population pressure and poverty all helped the spread of disease, and how public health measures failed to prevent a high mortality.

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