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JUST IN TIME Math
 S
JU T
IN
I M

E
Math
Catherine V. Jeremko

N E W YO R K
Copyright © 2004 LearningExpress, LLC.

All rights reserved under International and Pan-American Copyright Conventions.

Published in the United States by LearningExpress, LLC, New York.

Library of Congress Cataloging-in-Publication Data:

Jeremko, Catherine.
Just in time math / Catherine Jeremko.—1st ed.
p. cm.—(Rookie read-about science)
Includes bibliographical references.
ISBN 1-57865-506-6
1. Mathematics—Study and teaching (Elementary)
I. Title. II. Series.
QA135.6.J47 2004
372.7—dc22
2003019055

Printed in the United States of America

9 8 7 6 5 4 3 2 1
First Edition

ISBN 1-57685-506-6

For more information or to place an order, contact LearningExpress at:

55 Broadway
8th Floor
New York, NY 10006

Or visit us at:
www.learnatest.com
 ABOUT THE AUTHOR

Catherine V. Jeremko is a certified secondary mathematics teacher in New

York State. She was a contributing writer to 501 Quantitative Comparison
Questions, and is an expert math reviewer for LearningExpress. She currently
teaches seventh grade mathematics at Vestal Middle School in Vestal,
New York. Ms. Jeremko is also a teacher trainer for the use of technology
in the mathematics classroom. She resides in Apalachin, New York with
her three daughters.
 CONTENTS

Formula Cheat Sheet ix

Introduction xi
1 Study Skills 1
2 The Integers and Absolute Value 16
3 Properties of Numbers 36
4 Fractions, Decimals, and Ordering the Real Numbers 57
5 Ratio and Proportion 86
6 Percent 110
7 Powers, Exponents, and Roots 134
8 Geometry and Measurement Conversions 155
9 Statistics and Probability 199
10 Word Problems 233
Additional Resources 267

vii
 FORMULA CHEAT SHEET

PE R CE NT
part percent is percent change percent
  =  of =   = 
who le 100 100 original 100

DISTANCE FORMULA SIMPLE INTEREST FORMULA

D=R×T I=P×R×T

RULES OF EXPONENTS

x0 = 1 x–a = x1a xa × xb = xa + b xa ÷ xb = xa – b
xa 1 a
b
x = xa – b (xa)b = xa × b x a = x

PROBABILITY

# favorable outcomes
P(E) = # total outcomes P(E1) or P(E2) = P(E1) + P(E2)
P(E1) and P(E2) = P(E1) × P(E2)

GEOMETRY

Pythagorean Theorem: a2 + b2 = c2
Perimeter
Rectangle: P = 2 × l + 2 × w Square: P = 4 × s
Circumference of a Circle: C = π × d or C = 2 × π × r
Area
Triangle: A = 12 × b × h Rectangle: A = b × h
Trapezoid: A = 12 × h × (b1 + b2)
Volume
V = b × h (the area of the base times the height)
Rectangular Solid: V = l × w × h Cylinder: V = π × r2 × h
"

ix
 Introduction
Y ou have to face a big exam that will test your mathematical skills.
It is just a few weeks, perhaps even just a few days, from now. You
haven’t begun to study. Perhaps you just haven’t had the time. We are all
faced with full schedules and many demands on our time, including work,
family, and other obligations. Or perhaps you have had the time, but pro-
crastinated; topics in mathematics are topics that you would rather avoid
at all costs. Computation and word problems have never been your strong
suit. It is possible that you have waited until the last minute because you
feel rather confident in your mathematical skills, and just want a quick
refresher on the major topics. Maybe you just realized that your test
included a mathematics section, and now you have only a short time to
prepare.
If any of these scenarios sound familiar, then Just in Time Math is the
right book for you. Designed specifically for last-minute test preparation,
Just in Time Math is a fast, accurate way to build your essential computa-
tional and word problem skills. This book includes nine chapters of com-
mon mathematical topics, with an additional chapter on study skills to
make your time effective. In just ten short chapters, you will get the essen-
tials—just in time for passing your big test.

THE JUST IN TIME TEST-PREP APPROACH

At LearningExpress, we know the importance that is placed on test

scores. Whether you are preparing for the PSAT, SAT, GRE, GMAT, or
a Civil Service exam, or you simply need to improve your fundamental
mathematical skills, our Just in Time streamlined approach can work for
you. Each chapter includes:

• a ten-question benchmark quiz to help you assess your knowledge

of the topics and skills in the chapter
• a lesson covering the essential content for the topic of the chapter
• sample problems imbedded in the lesson with full explanations
xi
xii J U ST I N TI M E MATH

• calculator tips to make the most of technology on your exam

• specific tips and strategies to prepare for the exam
• a 25-question practice quiz followed by detailed answers and expla-
nations to help you measure your progress

The Just in Time series also includes the following features:

• Extra Help: refers you to other LearningExpress skill

O builders or other resources that can help you learn
more about a particular topic.

• Calculator Tips: offers hints on how your calculator can

•
T help you.

Glossary: provides critical definitions.

• Rule Book: highlights the rules and procedures you

E really need to know.

• Shortcut: offers tips for reducing your study and prac-

" tice time—without sacrificing accuracy.

• Formula Cheat Sheet: a tear-out page preceding this introduction

that lists important formulas from the chapters.

Of course, no book can cover every type of problem you may face on a
given test. But this book is not just about recognizing specific problem
types; it is also about building the essential skills, confidence, and processes
that will ensure success when you are faced with a math problem. The math
topics in this book have been carefully chosen to reflect not only what you
are likely to see on an exam, but also what you are likely to come across reg-
ularly in books, newspapers, lectures, and other daily activities.

HOW TO USE THIS BOOK

While each chapter can stand on its own as an effective review of mathe-
matical content, this book will be most effective if you complete each chap-
ter in order, beginning with Chapter 1. Chapters 2, 3, and 4 review the basic
mathematical knowledge of working with numbers. The remaining chap-
I NTR O D U CTI O N xiii

ters review higher mathematical knowledge that involves relationships

among numbers. The chapters are arranged such that material covered in
earlier chapters may be referenced in a later chapter.
Following is a brief outline of each chapter:

• Chapter 1: Study Skills reviews fundamental study strategies

including how to budget your time, how to create a study plan, and
how to use study aids such as flashcards.
• Chapter 2: The Integers and Absolute Value reviews how to
work with positive and negative numbers.
• Chapter 3: Properties of Numbers reviews the fundamentals of
working with numbers, a foundation for the rest of the book.
• Chapter 4: Fractions, Decimals, and Ordering the Real Num-
bers reviews the two most common ways to represent numbers and
how the numbers are ordered.
• Chapter 5: Ratio and Proportion reviews how numbers are
related to one another through comparisons.
• Chapter 6: Percent covers the most common use of ratio and pro-
portion on tests and in daily life.
• Chapter 7: Powers, Exponents, and Roots reviews the use of
repeated multiplication to represent rapid growth, the inverse oper-
ation, and roots.
• Chapter 8: Geometry and Measurement Conversions reviews
the ways that mathematics is used in measurement and the use of
common figures.
• Chapter 9: Statistics and Probability reviews the study of data
and chance.
• Chapter 10: Word Problems covers processes and strategies used
to solve mathematics in context.

Depending upon how much time you have before the exam, review as
much as possible. If time is short, start with the chapters addressing your
weak areas. The ten-question benchmark quizzes at the start of each chap-
ter can help you assess your strengths and weaknesses.
Finally, remain calm and think positively. Your big test may be just a short
while away, but you are taking the steps you need to prepare . . . just in time.
JUST IN TIME Math
 Another Random Document on
Scribd Without Any Related Topics
 Preston and Oldham, in Lancashire, are supplied with water from surface drainage on the
neighbouring hills, and there was scarcely any cholera at either of these places in 1849. The
greater part of the town of Paisley is supplied in a similar way; and I was informed that the
cases of cholera which occurred there in 1849 were confined to a quarter of the town to which
this supply of water does not extend. Nottingham is supplied with filtered water obtained from
the river Trent, some distance above the town. In 1832 this supply did not extend to all the
inhabitants, and the cholera was somewhat prevalent amongst the poor, of whom it carried off
289; the population of the town being 53,000. After that time the water was extended
copiously to all the inhabitants, and there were but thirteen deaths from the epidemic in 1849.
The local Sanitary Committee placed the supply of water amongst the chief causes of this
immunity from cholera, and I believe justly. There were but seven deaths from cholera in
Nottingham last summer.
CHOLERA IN Glasgow has been supplied, since the early part of the present
GLASGOW. century, with the water of the Clyde, obtained a little way above the
town, but within the influence of the tide, and consequently mixed with the contents of the
sewers. It is imperfectly filtered through sand. In 1847, however, the parish of Gorbals, which
forms the south part of Glasgow, was furnished with a supply of water collected on the
neighbouring hills; and Dr. Leech, of Glasgow, speaks as follows respecting the influence of this
water on the prevalence of cholera: “During the late cholera there was a remarkable
circumstance, which deserves notice as compared with the epidemic of 1832. Since the former
period, the population of Glasgow, south of the Clyde, has nearly doubled; and with this
exception, and the introduction of the soft-water supply, the circumstances might be
considered as the same at both periods. In one district, the parish of Gorbals, the attack in 1832
was fearful; while Glasgow, north of the Clyde, also suffered severely. During the late epidemic
[that of 1848–49], Gorbals parish furnished comparatively a small number of cases; while the
epidemic in other parts of Glasgow was very severe. The unanimous opinion of the Medical
Society was, that this comparative immunity was to be attributed to the soft-water supply.”[22]
CHOLERA IN I was informed that when the cholera was prevalent in Glasgow last
NEWCASTLE. winter, the parish of Gorbals again enjoyed a similar immunity from
the disease.
The following passage respecting the water supply of Paris is from Dr. Farr’s “Report to the
Registrar-General on the Cholera of 1848–49”:—“The supply of Paris is from various sources,
but four-fifths of the water is from the Canal de l’Ourque, which, by the decision of Napoleon,
was also appropriated to navigation. The water for some years, and in 1832, when the epidemic
was so fatal, was drawn from the dirty basin in which the boats and barges of the canals rested;
but is now drawn from the canal before it enters the basin.... The mortality of cholera in Paris
was excessive, and in 1832 varied from 80, of 10,000 inhabitants, in the elegant Chaussée
d’Antin and in Montmartre on the heights, to 530 and 520 in the low quartiers of the Hôtel de
Ville and the Cité.” (p. lxxviii.)
The town of Newcastle-upon-Tyne affords a remarkable instance of the influence of the
water supply on the prevalence of cholera. In 1831–32 there were no waterworks at Newcastle;
it was supplied, in an insufficient manner, with spring water, which generally had to be carried
some distance to the houses from “pants” in the streets. The epidemic was pretty severe at this
time. From November 1831 to November 1832 there were 801 deaths from cholera out of a
population of 42,760. The disease prevailed chiefly amongst the poor, and was worst in the
least elevated parts of the town, near the river. Subsequently to 1832, waterworks were
established on the river Tyne, a little above the town; but these were abandoned, in 1848, in
favour of a supply from a rivulet and springs at Whittle Dean, about ten miles distant. In 1849,
there were but 295 deaths from cholera in a population then increased to 71,847. In the
beginning of July 1853, two months before the reappearance of cholera in England, the Whittle
Dean Water Company found their proper sources insufficient for the demands of the
population and the various factories, and they made use of the former waterworks, mentioned
above, to obtain water from the Tyne. The point at which they obtained water from the river, is
scarcely a mile above Newcastle, and the tide flows for six miles above the town, carrying the
contents of the sewers with it. There are also villages, containing several thousands of colliers
and ironfounders, on the banks of the Tyne, above the waterworks. The water from the Tyne
was mixed, without filtration, with that from Whittle Dean, to the extent of one-third; and the
mixed water, so supplied, was discoloured, and contained the large quantity of 7·1 grains of
organic matter per gallon.
In the autumn of 1853, the cholera was prevailing extensively at Hamburgh, and in nearly all
the ports of the Baltic, whence a number of ships were arriving every day in the Tyne. The first
cases of cholera commenced, with diarrhœa, on the 27th and 28th August, at Bell Quay, on the
banks of the Tyne, three miles below Newcastle. One of the patients from Bell Quay was taken
worse whilst on a visit to her mother at Newcastle: she died on 2nd September. Her mother
was taken ill the same evening, and died on the following day. Other cases occurred in
Newcastle on the 1st and 2nd of September, having no connexion with these. A ship from
Bremen was lying at Bell Quay, opposite the house where the first cases occurred; but there
had been no illness on board this ship, and the precise way in which the cholera was introduced
on this occasion, is not known.
The disease soon spread to an extent almost unprecedented in this country: by the 15th of
September the deaths exceeded a hundred a day. In nine weeks there were 1,533 deaths from
cholera in a population of 86,114, being 178 to each 10,000 inhabitants; but the greater number
of these deaths occurred in a few days, as 1001 took place from the 13th to the 23rd Sept.
inclusive.[23]
Gateshead, which is situated opposite to Newcastle, on the other side of the Tyne, is supplied
with the same water; and in 1849 it shared with that town a comparative immunity from
cholera, whilst in the autumn of 1853, 433 persons died of that disease out of a population of
26,000, or thereabouts, being 166 to each 10,000 inhabitants.
The lowest streets in Newcastle and Gateshead are about five feet above high-water mark;
and only a few streets are situated at this level, for the banks rise very abruptly, at a little
distance from the river, on both sides. A great portion of each town is elevated nearly 200 feet
above the river, and some parts are nearly 300 feet high; yet the Water Company supplies all
these districts, and all were severely visited by the cholera, which on this occasion spared no
class of the community. In the districts which are most crowded, the mortality was greatest, the
deaths being much more numerous in the parishes which contained a great number of
tenements consisting of a single room, than in those which consisted chiefly of houses occupied
by one family.[24] This, however, is quite in accordance with the principles which I am
throughout endeavouring to explain. A great deal of stress is laid, very properly, by the
Commissioners who have reported respecting this outbreak, on the ill-arranged buildings, the
defective drainage, and want of privy accommodation, in Newcastle; but it must be
remembered that all these evils existed in 1849, when Newcastle escaped with less cholera than
most towns,—to a greater extent than they did in 1853, for many improvements had taken
place in the meantime.
In consequence of a great outcry on the part of the public, who naturally connected the great
fatality of cholera in some measure with the turbidity and offensive smell of the drinking water,
the Company entirely ceased to draw water from the Tyne on the 15th September; and
although the Tyne water was not entirely out of the pipes for a day or two, the deaths, which
had been rapidly increasing, began to diminish on the 17th, and were lessened considerably by
the 20th. The following is the course of the mortality in Newcastle, in the most fatal part of the
epidemic; and it began to decline at exactly the same time in Gateshead:

September 12 13 14 15 16 17 18 19 20 21 22 23
Deaths 38 59 90 106 114 103 103 111 85 68 82 60.
 The late General Board of Health directed one of their medical inspectors, Dr. Waller Lewis,
to make minute inquiry as to the relative effects produced by the use of pure spring water, and
that of the Water Company, during the epidemic of cholera in Newcastle; and it is much to be
regretted that the inquiry was not carried out. To have conducted the inquiry through the
whole of Newcastle and Gateshead would not have entailed a quarter as much labour as my
investigations in Lambeth, Newington, and the Borough. Dr. Lewis called on Mr. Main, the
secretary of the Water Company, and they made an inquiry in certain houses, taken at random,
through three streets, and also in Greenhow Terrace, where a severe outbreak of cholera had
occurred, although it was not supplied by the Company, but had what was reported to be good
spring water. Dr. Lewis gave up the inquiry because he could not find two places exactly alike
in all their physical conditions,—one place supplied with spring water, the other by the
Company. He made no report of what he had done; but Mr. Main sent a paper on the subject of
this commenced inquiry to the Pathological Society of Newcastle, an abstract of which
appeared in the “Medical Times and Gazette”.
By adding Greenhow Terrace to the streets partly supplied by the Company, and by including
cases of cholera, fatal or otherwise, with those of mere diarrhœa, Mr. Main was able to show a
result apparently in favour of the Company’s water. He was good enough, however, to send me
a copy of his paper, which contains the details of the inquiry as far as it extended; and I found,
on perusing it, that, leaving out Greenhow Terrace, which is not supplied by the Company at
all, there was no case of cholera, either fatal or otherwise, and no case, even of approaching
cholera, in any house which was not supplied with the Company’s water. All the deaths and all
the cholera occurred in the houses having this water, whilst in the houses having only pump-
water, there was simply diarrhœa. In the workhouse, supplied by the Water Company, and
having five hundred and forty inmates, there were twelve cases of cholera, or approaching
cholera, and seven deaths; whilst in the military barracks, supplied from wells on the premises,
and having five hundred and nineteen inmates, although there was a good deal of harmless
diarrhæa, there was no cholera, nor any case of approaching cholera.
CHOLERA AT The communication of cholera by means of the water is well
MOSCOW. illustrated by the instance of Moscow, which was severely visited by
that disease in 1830; but much less severely in the second epidemic. Subsequently to 1830 the
greater part of the town, which is situated to the north of the Moscow river, obtained a supply
of excellent water, conducted in pipes from springs at a distance; and the cholera in 1847 was
chiefly confined to those parts of the town which lie to the south of the river, to which the new
supply of water did not extend, and where the people had still only impure river water to drink.
[25]

The above instances are probably sufficient to illustrate the widely-spread influence which
the pollution of the drinking water exerts in the propagation of cholera.
DIFFUSION OF After the Registrar-General alluded, in the “Weekly Return” of 14th
THE CHOLERA October last, to the very conclusive investigation of the effects of
POISON IN polluted water in the south districts of London, there was a leading
WATER.
article, in nearly all the medical periodicals,[26] fully admitting the
influence of the water on the mortality from cholera. It may therefore be safely concluded that
this influence is pretty generally admitted by the profession. It must not be disguised, however,
that medical men are not yet generally convinced that the disease is actually communicated
from person to person by the morbid matter being swallowed in the drinking water, or
otherwise. It used to be the custom of medical authors to speak of three kinds of causes of a
disease, viz. predisposing, exciting, and proximate causes. The proximate causes have been
given up, as being the diseases themselves; but authors still divide causes into predisposing
and exciting ones. It may be remarked, however, that in treating of certain communicable
diseases, the cause of which is thoroughly understood, as syphilis and the itch, predisposing
causes are never mentioned; and that they are rarely alluded to in treating of small-pox,
measles, and scarlet fever, whilst they continue to be appealed to in explanation of the various
continued fevers.[27] Now many medical men, whilst they admit the influence of polluted water
on the prevalence of cholera, believe that it acts by predisposing or preparing the system to be
acted on by some unknown cause of the disease existing in the atmosphere or elsewhere. The
following amongst other reasons prove, however, that opinion cannot long halt here, and that,
if the effect of contaminated water be admitted, it must lead to the conclusion that it acts by
containing the true and specific cause of the malady.
In my inquiries in the south districts of London I met with several instances in which
persons, especially maidservants and young men, died of cholera within a few days after
coming from the country to a house supplied with water by the Southwark and Vauxhall
Company. The Registrar of Waterloo Road (2nd) remarked as follows on this point, on 26th
August last:—“This is the third successive case of fatal cholera, where the patients have recently
come from the country. Similar instances have frequently attracted the Registrar’s notice.” I
found that the houses in which these cases occurred were supplied by the above-named
Company. The outbreak of cholera in the Baltic fleet, related at page 36, occurred within forty-
eight hours after the polluted water had been taken on board. And lastly, if the contaminated
water merely acted by predisposing or preparing the system to be affected by some other cause,
it would be impossible to explain why nearly all the persons drinking it should be attacked
together, in cases where a pump-well or some other limited supply is polluted, while the
population around experience no increase of the malady.
All the evidence proving the communication of cholera through the medium of water,
confirms that with which I set out, of its communication in the crowded habitations of the
poor, in coal-mines and other places, by the hands getting soiled with the evacuations of the
patients, and by small quantities of these evacuations being swallowed with the food, as paint
is swallowed by house painters of uncleanly habits, who contract lead-colic in this way.

There are one or two objections to the mode of communication of cholera which I am
endeavouring to establish, that deserve to be noticed. Messrs. Pearse and Marston state, in
their account of the cases of cholera treated at the Newcastle Dispensary in 1853, that one of
the dispensers drank by mistake some rice-water evacuation without any effect whatever.[28] In
rejoinder to this negative incident, it may be remarked, that several conditions may be
requisite to the communication of cholera with which we are as yet unacquainted. Certain
conditions we know to be requisite to the communication of other diseases. Syphilis we know is
only communicable in its primary stage, and vaccine lymph must be removed at a particular
time to produce its proper effects. In the incident above mentioned, the large quantity of the
evacuation taken might even prevent its action. It must be remembered that the effects of a
morbid poison are never due to what first enters the system, but to the crop or progeny
produced from this during a period of reproduction, termed the period of incubation; and if a
whole sack of grain, or seed of any kind, were put into a hole in the ground, it is very doubtful
whether any crop whatever would be produced.
EXPERIMENTS Dr. Thiersch is of opinion, as appears by a discussion which has
OF DR. recently taken place at Munich, that the cholera evacuations are not at
THIERSCH first capable of generating the disease; but that a decomposition takes
ANSWERS TO
place in them, and that in from six to nine days they become in a state
CERTAIN
OBJECTIONS. to induce cholera. He founds this opinion on experiments which he
performed by giving small quantities of the cholera evacuations to
white mice. Although it is not contrary to all analogy that some change or development should
take place in the cholera poison in the interval between its leaving one person and entering
another, it is most probable that the fatal bowel complaint produced in white mice by Dr.
Thiersch was not a specific disease, but the ordinary effect of putrifying ingesta. Many of the
best attested instances of the communication of cholera are those, such as were related at the
commencement of this work, where the patient is attacked in from twenty-four to forty-eight
hours after first being near another patient, and although an interval of a week or so, often
elapses between one case of the disease and those which follow, it is extremely probable that, in
these instances, the evacuations remain the greater part of this time in a dry state on the soiled
linen, without undergoing any change.
An objection that has repeatedly been made to the propagation of cholera through the
medium of water, is, that every one who drinks of the water ought to have the disease at once.
This objection arises from mistaking the department of science to which the communication of
cholera belongs, and looking on it as a question of chemistry, instead of one of natural history,
as it undoubtedly is. It cannot be supposed that a morbid poison, which has the property,
under suitable circumstances, of reproducing its kind, should be capable of being diluted
indefinitely in water, like a chemical salt; and therefore it is not to be presumed that the
cholera poison would be equally diffused through every particle of the water. The eggs of the
tape-worm must undoubtedly pass down the sewers into the Thames, but it by no means
follows that everybody who drinks a glass of the water should swallow one of the eggs. As
regards the morbid matter of cholera, many other circumstances, besides the quantity of it
which is present in a river at different periods of the epidemic, must influence the chances of
its being swallowed, such as its remaining in a butt or other vessel till it is decomposed or
devoured by animalcules, or its merely settling to the bottom and remaining there. In the case
of the pump-well in Broad Street, Golden Square, if the cholera poison was contained in the
minute whitish flocculi, visible on close inspection to the naked eye, some persons might drink
of the water without taking any, as they soon settled to the bottom of the vessel.
THEORIES OF It is not necessary to oppose any other theories in order to establish
THE CAUSE OF the principles I am endeavouring to explain, for the field I have
CHOLERA. entered on was almost unoccupied. The best attempt at explaining the
phenomena of cholera, which previously existed, was probably that which supposed that the
disease was communicated by effluvia given off from the patient into the surrounding air, and
inhaled by others into the lungs; but this view required its advocates to draw very largely on
what is called predisposition, in order to account for the numbers who approach near to the
patient without being affected, whilst others acquire the disease without any near approach. It
also failed entirely to account for the sudden and violent outbreaks of the disease, such as that
which occurred in the neighbourhood of Golden Square.
Another view having a certain number of advocates is, that cholera depends on an unknown
something in the atmosphere which becomes localized, and has its effects increased by the
gases given off from decomposing animal and vegetable matters. This hypothesis is, however,
rendered impossible by the motion of the atmosphere, and, even in the absence of wind, by the
laws which govern the diffusion of aeriform bodies; moreover, the connection between cholera
and offensive effluvia is by no means such as to indicate cause and effect; even in London, as
was before mentioned, many places where offensive effluvia are very abundant have been
visited very lightly by cholera, whilst the comparatively open and cleanly districts of
Kennington and Clapham have suffered severely. If inquiry were made, a far closer connection
would be found to exist between offensive effluvia and the itch, than between these effluvia and
cholera; yet as the cause of itch is well known, we are quite aware that this connection is not
one of cause and effect.
Mr. John Lea, of Cincinnati, has advanced what he calls a geological theory of cholera.[29] He
supposes that the cholera poison, which he believes to exist in the air about the sick, requires
the existence of calcareous or magnesian salts in the drinking water to give it effect. This view
is not consistent with what we know of cholera, but there are certain circumstances related by
Mr. Lea which deserve attention. He says that, in the western districts of the United States, the
cholera passed round the arenacious, and spent its fury on the calcareous regions; and that it
attacked with deadly effect those who used the calcareous water, while it passed by those who
used sandstone or soft water. He gives many instances of towns suffering severely when river
water was used, whilst others, having only soft spring water or rain water, escaped almost
entirely; and he states that there has been scarcely a case of cholera in families who used only
rain water. The rivers, it is evident, might be contaminated with the evacuations, whilst it is
equally evident that the rain water could not be so polluted. As regards sand and all sandstone
formations, they are well known to have the effect of oxidizing and thus destroying organic
matters; whilst the limestone might not have that effect, although I have no experience on that
point. The connection which Mr. Lea has observed between cholera and the water is highly
interesting, although it probably admits of a very different explanation from the one he has
given.

DURATION OF There are certain circumstances connected with the history of

CHOLERA IN cholera which admit of a satisfactory explanation according to the
DIFFERENT principles explained above, and consequently tend to confirm those
PLACES.
principles. The first point I shall notice, viz., the period of duration of
the epidemic in different places, refers merely to the communicability of the disease, without
regard to the mode of communication. The duration of cholera in a place is usually in a direct
proportion to the number of the population. The disease remains but two or three weeks in a
village, two or three months in a good-sized town, whilst in a great metropolis it often remains
a whole year or longer. I find from an analysis which I made in 1849 of the valuable table of Dr.
Wm. Merriman, of the cholera in England in 1832,[30] that fifty-two places are enumerated in
which the disease continued less than fifty days, and that the average population of these
places is 6,624. Forty-three places are likewise down in which the cholera lasted fifty days, but
less than one hundred; the average population of these is 12,624. And there are, without
including London, thirty-three places in which the epidemic continued one hundred days and
upwards, the average population of which is 38,123; or if London be included, thirty-four
places, with an average of 78,823. The following short table will show these figures in a more
convenient form:—

No. of Places. Duration in Days. Average Population.

52 0 to 50 6,624
43 50 to 100000 12,624
33} 100 and upwards { 38,123
34} { 78,823

There was a similar relation in 1849 between the duration of the cholera and the population
of the places which it visited; a relation which points clearly to the propagation of the disease
from patient to patient; for if each case were not connected with a previous one, but depended
on some unknown atmospheric or telluric condition, there is no reason why the twenty cases
which occur in a village should not be distributed over as long a period as the twenty hundred
cases which occur in a large town.
Even the duration of the cholera in a street, when compared to its duration in the individual
houses, points to the same conclusion. A table has been published[31] in the report of the late
discussion on cholera at Munich, which shows that whilst the epidemic remained three or four
weeks in a street, it only remained six or seven days in houses where several people were
attacked. Dr. Pettenkofer remarks, that “if the proximate cause of the disease had been
generally diffused over a certain number of streets or a certain district, and its invasion had
been opposed by individual disposition alone, one might have expected that both the cases of
disease and the instances of death would have occurred in single houses, where many such
appeared together, at similar periods of time throughout the whole street; but, supposing that
the proximate cause of the disease was not general, but local, then it would act in such a
manner that the period of time within which the disease would show itself in single houses
would be very different from that which was applicable to the entire street.” The local cause in
a house we know to be the illness of some individual, who, in many cases, has newly arrived
from some place where the disease was prevailing.
EFFECT OF Each time when cholera has been introduced into England in the
SEASON ON THE autumn, it has made but little progress, and has lingered rather than
PREVALENCE flourished during the winter and spring, to increase gradually during
OF CHOLERA.
the following summer, reach its climax at the latter part of summer,
and decline somewhat rapidly as the cool days of autumn set in. In most parts of Scotland, on
the contrary, cholera has each time run through its course in the winter immediately following
its introduction. I have now to offer what I consider an explanation, to a great extent, of these
peculiarities in the progress of cholera. The English people, as a general rule, do not drink
much unboiled water, except in warm weather. They generally take tea, coffee, malt liquor, or
some other artificial beverage at their meals, and do not require to drink between meals, except
when the weather is warm. In summer, however, a much greater quantity of drink is required,
and it is much more usual to drink water at that season than in cold weather. Consequently,
whilst the cholera is chiefly confined in winter to the crowded families of the poor, and to the
mining population, who, as was before explained, eat each other’s excrement at all times, it
gains access as summer advances to the population of the towns, where there is a river which
receives the sewers and supplies the drinking water at the same time; and, where pump-wells
and other limited supplies of water happen to be contaminated with the contents of the drains
and cesspools, there is a greater opportunity for the disease to spread at a time when unboiled
water is more freely used.
In Scotland, on the other hand, unboiled water is somewhat freely used at all times to mix
with spirits; I am told that when two or three people enter a tavern in Scotland and ask for a
gill of whiskey, a jug of water and tumbler-glasses are brought with it. Malt liquors are only
consumed to a limited extent in Scotland, and when persons drink spirit without water, as they
often do, it occasions thirst and obliges them to drink water afterwards.
There may be other causes besides the above which tend to assist the propagation of cholera
in warm, more than in cold weather. It is not unlikely that insects, especially the common
house-flies, aid in spreading the disease. An ingenious friend of mine has informed me that,
when infusion of quassia has been placed in the room for the purpose of poisoning flies, he has
more than once perceived the taste of it on his bread and butter.
Dr. Farr gives the following very important information respecting the sex of persons who
died of cholera at different periods of the epidemic.[32]
“It is worthy of remark, that at the beginning of the epidemic, the deaths of males exceeded
the deaths of females very considerably; the numbers in the months of October, November,
and December, 1848, were,—males 612, females 493; or in the proportion of 100 to 80....
“As a general rule, when the mortality from cholera attained a very high rate, the number of
deaths among females exceeded the deaths among males.
“In London a remarkable change was observed in the proportion of the sexes affected in the
course of the epidemic. In four weeks of October 1848, the deaths of 80 males and of 42
females by cholera were registered; in the thirteen last weeks of the year the deaths of 258
males and 210 females were registered; and there was an excess of males at all ages, but
particularly in the ten years of age 15–25. In the quarter ending March 1849, the deaths of
males amounted to 250, of females to 266: at the age of 25 and upwards the excess of deaths
among females was considerable. In June, at the commencement of the great outbreak, the
males again furnished the most numerous victims. At the close of July the females died in
greater numbers than the males, and continued to do so to the end. In the week that the
mortality was highest, the deaths of 895 males and of 1131 females were returned. In the
September quarter the deaths of males under the age of 25 exceeded the deaths of females; but
after that age the proportions were reversed.”
PROPORTION
OF THE SEXES
 WHO DIE OF The greater part of the female population remain almost constantly
CHOLERA. at home, and take their meals at home, whilst a considerable number
of the men move about in following their occupations, and take both food and drink at a variety
of places; consequently, in the early part of an epidemic, when the disease only exists in a few
spots, the male part of the population is most liable to come within the operation of the morbid
poison; but at a later period of the epidemic, when the cholera is more generally diffused, it
may reach those who stay at home as readily as those who move about; and in addition to the
risk which the women share with the men, they have the additional one of being engaged in
attending on the sick.
It is a confirmation of this view of the matter that, when the cholera poison is distributed
through the pipes of a Water Company, the above rule does not hold good, but a contrary one
prevails, owing, probably, to females being less in the habit of drinking beer than men, and
being therefore more likely to drink water. Of the 334 deaths detailed in the Appendix to this
work (286 of them amongst the customers of the Southwark and Vauxhall Water Company),
only 147 were males, whilst 187 were females. The deaths occurred in the first four weeks of the
recent epidemic. On the other hand, out of the 229 deaths from cholera which occurred in all
the rest of London during this period, 140 were males and only 89 females. When the mortality
of the whole of the metropolis during this period is taken together, there is a slight
preponderance on the part of the males; the numbers being,—males 287, females 276: total
563.
The deaths from cholera in England in 1849 were 53,293; of those, 14,718, or 27 per cent. of
the whole, occurred in children under 15 years of age. Of the 334 deaths which are recorded in
the Appendix to this work, 127, or 38 per cent., are those of children under 15, whilst of the
remaining 229 which occurred in the rest of London during the first four weeks of the
epidemic, only 61, or 26 per cent., took place before the age of 15,—a proportion nearly the
same as in the whole of England in 1849. The higher proportion of deaths amongst children in
the houses supplied with the impure water from the Thames at Battersea Fields, probably arose
from the circumstance that children are very fond of drinking water in warm weather. I often
heard such remarks as the following, in making my inquiries in the south districts of London:
—“My children like water better than tea or anything else, I cannot keep them away from the
water-butt;” or, “the child that is dead used to drink a great deal of that water, she was big
enough to reach to the butt herself.”
Dr. Guy, physician to King’s College Hospital, made a table showing the occupations of 4,312
males, of fifteen years of age and upwards, who died of cholera in London in the epidemic of
1848–49; together with the ratio which the deaths bear to the living, as well as it could be
ascertained from the census of 1841. I have not room for the whole table, but have selected the
occupations which suffered most, and those which suffered least. The following abstract of Dr.
Guy’s table contains all the occupations where the deaths from cholera equalled one-fiftieth of
the number living, and all those in which the deaths did not exceed one in two hundred and
fifty living.
PROPORTION In some of the occupations which show a high relative mortality,
OF DEATHS IN the number of living is too small to allow of any reliable statistical
DIFFERENT result, and the relative mortality is probably due to accidental
OCCUPATIONS.
circumstances quite unconnected with the occupation. In other cases,
however, the numbers are so considerable as to indicate something more than accident. The
299 sailors, for instance, constituted one twenty-fourth of the whole estimated number in that
occupation. The 7 ballast-heavers form just the same proportion of the whole in that
occupation, and the 53 coalporters and coalheavers constituted one in 32 of those so employed.
Now all those persons lived or were employed on the river, where it is the habit to drink water
drawn by pailfuls from the side of the ship. The 67 hawkers are one in 22 of the whole number.
These persons are constantly moving about, and are in the habit of living in crowded lodging-
houses, and consequently must be extremely liable to contract any communicable disease.
Tanners nearly all live in Bermondsey and Lambeth, supplied in 1849 with none but very
impure water, as was previously explained. The weavers probably suffered the high rate of
mortality from the crowding of their apartments in Spitalfields, and the uncleanness of their
habits.
The persons who suffered less from cholera than any other part of the male population, are
footmen and men-servants; and it is impossible to conceive a class less exposed to the disease.
They live in the best parts of London, and go from home much less than their masters. The low
rate of mortality amongst medical men and undertakers is worthy of notice. If cholera were
propagated by effluvia given off from the patient, or the dead body, as used to be the opinion of
those who believed in its communicability; or, if it depended on effluvia lurking about what are
by others called infected localities, in either case medical men and undertakers would be
peculiarly liable to the disease; but, according to the principles explained in this treatise, there
is no reason why these callings should particularly expose persons to the malady.

TABLE XIV.
 No. of
Ratio.
Deaths.
Agents 12 1 in 49
Bricklayers and builders 14 1 „ 39
Cowkeepers, dairymen, and milkmen 8 1 „ 20
Egg merchants 5 1„6
Fishmongers 11 1 „ 20
Fruiterers and greengrocers 12 1 „ 28
Jobmasters, livery-stable keepers 5 1 „ 37
Oilmen 13 1 „ 46
Paper-makers 2 1 „ 15
Poulterers 3 1 „ 32
Sail-makers 2 1 „ 30
Turners 2 1 „ 50
Ballast-heavers 7 1 „ 24
Coal-porters and coalheavers 53 1 „ 32
Dustmen and scavengers 6 1 „ 39
Founders 10 1 „ 12
Hawkers, etc. 67 1 „ 22
Lithographers 3 1 „ 48
Modellers 3 1 „ 41
Polishers 4 1 „ 36
Sailors, including Greenwich pensioners 299 1 „ 24
Tanners 22 1 „ 39
Weavers 102 1 „ 36

Physicians, surgeons, & general practitioners 16 1 „ 265

Magistrates, barristers, conveyancers, and attorneys 13 1 „ 375
Merchants 11 1 „ 348
Auctioneers 1 1 „ 266
Saddlers 1 1 „ 250
Brass-finishers 3 1 „ 318
Coach-makers 16 1 „ 262
Cork-cutters 2 1 „ 279
Footmen and men-servants 25 1 „ 1572
Jewellers, goldsmiths, and silversmiths 6 1 „ 583
Millwrights 2 1 „ 266
Tallow-chandlers 2 1 „ 430
Type-founders 1 1 „ 390
Undertakers 2 1 „ 325
Warehousemen 8 1 „ 472
Watchmakers 11 1 „ 364
Wheelwrights 8 1 „ 294
 ABSENCE OF There is one remarkable circumstance
DRAINAGE connected with Dr. Guy’s table. One master-
INCREASES brewer died of cholera, being 1 in 160 of the
CHOLERA.
trade; but no brewer’s man or brewer’s
servant is mentioned as having died of this malady, although these
men must constitute a very numerous body in London. There must
be a few thousands of them. I have, indeed, met with the deaths of
two or three of these persons, in looking over the returns of some of
the most fatal weeks in 1849; but the brewers’ men seem to have
suffered very slightly both in that and the more recent epidemics.
The reason of this probably is, that they never drink water, and are
therefore exempted from imbibing the cholera poison in that vehicle.
The great prevalence of cholera along the course of rivers has been
well known for a quarter of a century; and it meets with a satisfactory
explanation from the mode of communication of the disease which I
am inculcating. Rivers always receive the refuse of those living on the
banks, and they nearly always supply, at the same time, the drinking
water of the community so situated. It has sometimes been objected
to the propagation of the disease by the water of rivers, that the
epidemic travels as often against the stream as with it. The reply to
this is, that people travel both against the stream and with it, and
thus convey the malady from village to village and from town to town
on the banks, whilst the water serves as a medium to propagate the
disease amongst those living at each spot, and thus prevents it from
dying out through not reaching fresh victims.
The principles I have laid down afford a satisfactory explanation of
the circumstances, that absence of drainage promotes the prevalence
of cholera, and that it flourishes better on a clay soil than on
primitive rocks, sandstone, or gravel. Without drainage, the refuse of
the population permeates the ground, and gains access to the pump-
wells. Merthyr Tydvil, with 52,863 inhabitants, is entirely without
drainage, and the people derive their supply of water from pump-
wells. This place has suffered severely from cholera in every
epidemic. In 1849 there were 1,682 deaths from this disease, being
234 to each 10,000 inhabitants,—a rate of mortality as high as in
Hull and certain of the south districts of London, where the morbid
poison of cholera was distributed by the steam-engines of the water
companies. The primitive rocks, sandstone, and gravel, generally
cause the purification of the water by the separation or oxidation of
organic matters, whilst clay does not exert this salutary influence to
the same extent.

Since the latter part of 1848, when I first arrived at my present

conclusions respecting the mode of communication of cholera, I have
become more and more convinced that many other diseases are
propagated in the same way.
When the plague visited this country, it was most fatal in London,
York, Winchester, and certain other towns having a river of fresh
water passing through them. It resembled cholera also in being twice
as fatal in the districts on the south of the Thames as in those on the
north. The following passage from Stow’s “Survey”, published in
1633, shows the way in which Southwark was supplied with water
about the time of the great visitations of plague: “Southwark useth
chiefly the water of the Thames, that falls into a great pond at St.
Mary Overies, that drives a mill called St. Saviour’s Mill, the owner
whereof is one Mr. Gulston. The revenue thereof is supposed by
some to be worth 1,300l. a year.”
MODE OF Although some of the lower parts of the
PROPAGATION City were supplied with water from the
OF THE Thames, at the latter part of the sixteenth
PLAGUE.
and throughout the seventeenth century,
yet the greater part of London north of the Thames was supplied by
fountains and conduits, conveying spring water from a distance. The
following quaint but poetic account of the conduits of London cannot
fail to be interesting: “As nature, by veins and arteries, some great
and some small, placed up and down all parts of the body,
ministereth blood to every part thereof; so was that wholesome
water, which was necessary for the good of London, as blood is for
the good and health of the body, conveyed by pipes, wooden or
metalline, as by veins, to every part of this famous city.... They were
lovely streams indeed that did refresh that noble city, one of which
was always at work pouring out itself when the rest lay still.
Methinks these several conduits of London stood like so many little
but strong forts, to confront and give check to that great enemy, fire,
as occasion should be. There, methinks, the water was intrenched
and in-garrisoned. The several pipes and vehicles of water that were
within these conduits, all of them charged with water, till by turning
of the cock they were discharged again, were as so many soldiers
within these forts, with their musketry charged, ready to keep and
defend these places. And look how enemies are wont to deal with
these castles, which they take to be impregnable, and despair of
every getting by them,—that is, by attempting to storm them by a
close siege: so went the fire to work with these little castles of stone,
which were not easy for it to burn down (witness their standing to
this day); spoiled them, or almost spoiled them, it hath for the
present, by cutting off those supplies of water which had vent to flow
to them, melting those leaden channels by which it had been
conveyed, and thereby, as it were, starving those garrisons which it
could not take by storm. As if the fire had been angry with the poor
old tankard-bearers, both men and women, for propagating that
element which was contrary to it, and carrying it upon their
shoulders, as it were, in state and triumph, it hath even destroyed
their trade, and threatens to make them perish by fire who had wont
to live by water.”[33]
Dr. Farr makes the following remarks on the plague, in his report
on the cholera of 1848–9: “It is endemic in the Delta of the Nile, and
periodically decimates the population of Cairo and Alexandria.... It
grows gradually less fatal up the Nile, and is less frequent and
destructive in Upper than in Lower Egypt, in the high lands and in
the desert, than on the low lands on the shores of the
Mediterranean.” Speaking of Cairo, he says: “Through the midst of it
passes the Great Canal, into which the sewers are discharged over
carrion, excretion, and mud. At the yearly overflow of the Nile, its
waters, filling this canal, are distributed over the city, and drunk by
its wretched inhabitants.”
The plague resembles cholera in being much promoted by
crowding and want of personal cleanliness. The natives of Gurhwal, a
province in the north-west of British India, in which the plague has
been present for the last thirty years, believe that it may be
transmitted from one place to another in articles of diet, such as a jar
of ghee.[34]
MODE OF Yellow fever, which has been clearly
PROPAGATION proved by Dr. M’William and others to be a
communicable disease, resembles cholera
 OF YELLOW and the plague in flourishing best, as a
FEVER. general rule, on low alluvial soil, and also in
spreading greatly where there is a want of personal cleanliness. This
disease has more than once appeared in ships sailing up the river
Plate, before they have had any communication with the shore. The
most probable cause of this circumstance is, that the fresh water of
this river, taken up from alongside the ship, contained the
evacuations of patients with yellow fever in La Plata or other towns.
It was long ago observed, that dysentery was apparently
propagated by the drinking of water containing excrementitious
matters.[35] The frequent appearance of this disease in Millbank
prison, when the Thames water was used, is a confirmation of this;
and Dr. Bryson has lately related a number of instances where both
dysentery and fever seemed to be occasioned by the water of the
Yangtse-Kiang, the Canton river, and other rivers of China.[36] What
very much confirms this view of the case, is, that nearly all the
patients were afflicted with great numbers of intestinal worms
(lumbrici); for it cannot be supposed that the worms could proceed
from malaria, miasmata, or any of the causes which are frequently
believed to occasion dysentery and fever. The eggs of the lumbrici
were no doubt contained in great numbers in the water of the
densely populated Chinese rivers.
There are many facts which indicate that one at least of the
continued fevers—the typhoid fever with ulceration of the small
intestines—is also propagated in the same way as cholera. Dr. Jenner
called my attention some time ago to an instance occurring at the
village of North Boston, Erie County, N.Y., in which typhoid fever
was probably communicated to a number of families by the
contamination of the water of a well which they used.[37] The
epidemic which prevailed so extensively at Croydon two years ago
was of this character, as was verified by a Committee of the
Epidemiological Society, of which Drs. Sankey, Jenner, and A. P.
Stewart were members. Mr. Carpenter, of Croydon, has lately shown
very ably that this epidemic was connected with the pollution of the
pump-wells of the town, owing to the disturbance of the ground, and
of many old cesspools during the drainage operations of the Local
Board of Health.[38] The Board had supplied the town with good
water from a deep well in the chalk, but the population had a
prejudice against it and persisted in resorting to the water of the
shallow pump-wells. In the autumn of last year diarrhœa was very
prevalent in Croydon, and Mr. Carpenter found that this also was
caused by the impure water of the pump-wells. Nine-tenths of the
people of Croydon were drinking the new water supplied by the
Board of Health, but, out of thirty-two patients with diarrhœa who
came under the notice of Mr. Carpenter, twenty-five were drinking
well-water entirely, five drank water from both sources, and the
other two could not decidedly say that they had not drank well-water.
Intermittent fevers are so fixed to particular places that they have
deservedly obtained the name of endemics. They spread occasionally,
however, much beyond their ordinary localities, and become
epidemic. Intermittent fevers are undoubtedly often connected with
a marshy state of the soil; for draining the land frequently causes
their disappearance. They sometimes, however, exist as endemics,
where there is no marshy land or stagnant water within scores of
miles. Towards the end of the seventeenth century, intermittent
fevers were, for the first time, attributed by Lancisi to noxious
effluvia arising from marshes. These supposed effluvia, or marsh
miasmata, as they were afterwards called, were thought to arise from
decomposing vegetable and animal matter; but, as intermittent
fevers have prevailed in many places where there was no
decomposing vegetable or animal matter, this opinion has been given
up in a great measure; still the belief in miasmata or malaria of some
kind, as a cause of intermittents, is very general. It must be
acknowledged, however, that there is no direct proof of the existence
of malaria or miasmata, much less of their nature.
CAUSE OF That preventive of ague, draining the
INTERMITTENT land, must affect the water of a district quite
FEVERS. as much as it affects the air, and there is
direct evidence to prove that intermittent fever has, at all events in
some cases, been caused by drinking the water of marshes. In the
“General Report of the Poor Law Commissioners on the Sanitary
Condition of Great Britain,”[39] Mr. Wm. Blower, surgeon, of Bedford,
states that typhus and ague, which had long infested the village of
Wootton, near Bedford, had been much diminished by digging a few
wells, and obtaining good water. He also states that, in the
neighbouring parish of Houghton, almost the only family which
escaped ague, at one time, was that of a respectable farmer who used
well-water, whilst all the other families had only ditch water.
M. Boudin[40] relates a very marked instance in which intermittent,
and apparently also remittent, fever were caused by drinking marsh
water. It is as follows:—
“In July 1834, 800 soldiers, all in good health, embarked on the
same day in three transports at Bona, in Algeria, and arrived
together at Marseilles; they were exposed to the same atmospheric
influences, and were, with one essential difference, supplied with the
same food, and subjected to the same discipline. On board one of the
vessels were 120 soldiers: of these, 13 died on the passage, from a
destructive fever, and 98 more were taken to the military hospital of
the lazaretto at Marseilles, presenting all the pathological characters
proper to marshy localities. On seeing the physiognomy of these
patients, altogether so unusual for Marseilles, one would have said
that the Gulf of Mexico, the Delta of the Ganges, and the marshes of
Senegal and of Holland, had supplied passengers to this ship. In
short, by the side of a simple intermittent, there was a pernicious
fever. On an inquiry being instituted, it was ascertained that on
board the affected ship the water supplied for the soldiers, owing to
the haste of the embarkation, had been taken from a marshy place
near Bona; whilst the crew, not one of whom was attacked, were
supplied with wholesome water. It further appeared that the nine
soldiers who had escaped had purchased water of the crew, and had
consequently not drunk the marsh water. Not a single soldier or
sailor of the other two transports, who were supplied with pure
water, suffered.”
Mr. Grainger, who quotes the above circumstance in his Appendix
to the Report on Cholera, also says:[41] “Dr. Evans, of Bedford, related
to me an equally well-marked instance. A few years ago, he was
staying at Versailles, with his lady, when they both became affected
with the ague, and, on inquiry, the following facts were disclosed.
The town of Versailles is supplied with water for domestic purposes
from the Seine, at Marli. At the time in question, a large tank,
supplying one particular quarter, was damaged, and the mayor,
without consulting the medical authorities, provided a supply of
water, consisting of the surface-drainage of the surrounding country,
which is of a marshy character. The regular inhabitants would not
use this polluted water; but Dr. and Mrs. Evans, who were at an
hotel, drank of it unwittingly, and it was also used by a regiment of
cavalry. The result was, that those who drank the water suffered from
intermittent fever of so severe a type, that seven or eight of the
soldiers, fine young men, died on one day, Sept. 1, 1845. On a careful
investigation it was ascertained that those only of the troops who had
drunk the marsh water were attacked; all the others, though
breathing the same atmosphere, having escaped, as did also the
townspeople.”
In all the instances I have just quoted, the cause of ague, whatever
it may be, was swallowed with the water, not inhaled with the air;
and on questioning two patients, ill with this complaint, in St.
George’s Hospital, after harvesting in Kent, they told me that they
had often been obliged to drink water from the ditches. The disease
of the liver and spleen, to which persons are subject after attacks of
intermittent fever, also confirms the view that its material cause
enters the system by the alimentary canal, and not by the lungs; and
it is of importance to remark, that Hippocrates observed, that
drinking stagnating waters caused hard swellings of the spleen.[42]
Whether the unknown cause of ague has been produced in the
system of a previous patient, like the pus of small-pox and the eggs of
tape-worm, or whether it has been produced externally, there is, at
present, no sufficient evidence to show. In the case first supposed,
the disease would be a communicable one, in the second it would
not.
There is one circumstance which seems to indicate that the specific
cause of intermittent fevers undergoes a development or
multiplication within the system of the patient,—it is, that a period of
dormancy, or incubation, has been observed, in many cases, between
the visit to the unhealthy locality and the illness which followed; for,
as I have already remarked, every poisonous or injurious substance
causes symptoms as soon as it has been absorbed in sufficient
quantity.
The communication of ague from person to person has not been
observed, and supposing this disease to be communicable, it may be
so only indirectly, for the materies morbi eliminated from one
patient may require to undergo a process of development or
procreation out of the body before it enters another patient, like
certain flukes infesting some of the lower animals, and procreating
by alternate generations.

The measures which are required for the prevention of cholera,

and all diseases which are communicated in the same way as cholera,
are of a very simple kind. They may be divided into those which may
be carried out in the presence of an epidemic, and those which, as
they require time, should be taken beforehand.
The measures which should be adopted during the presence of
cholera may be enumerated as follows:—
1st. The strictest cleanliness should be observed by those about the
sick. There should be a hand-basin, water, and towel, in every room
where there is a cholera patient, and care should be taken that they
are frequently used by the nurse and other attendants, more
particularly before touching any food.
2nd. The soiled bed linen and body linen of the patient should be
immersed in water as soon as they are removed, until such time as
they can be washed, lest the evacuations should become dry, and be
wafted about as a fine dust. Articles of bedding and clothing which
cannot be washed, should be exposed for some time to a temperature
of 212° or upwards.
MEASURES 3rd. Care should be taken that the water
REQUIRED FOR employed for drinking and preparing food
THE (whether it come from a pump-well, or be
PREVENTION
OF CHOLERA.
conveyed in pipes) is not contaminated with
the contents of cesspools, house-drains, or
sewers; or, in the event that water free from suspicion cannot be
obtained, it should be well boiled, and, if possible, also filtered.
Works are in progress for supplying a great part of London with
water from the Thames, obtained, like that of the Lambeth Company,
above Teddington Lock. Although this is not the best possible source
for supplying a large town, it is a great improvement on the practice
of many of the water companies; and the water, owing to filtration,
and especially to its detention in large reservoirs, will probably be
quite salubrious: at all events it will be much safer than that of the
shallow pump-wells of London, which are fed from very polluted
sources. It is very desirable that the handles of nearly all the street-
pumps of London and other large towns should be fastened up, and
the water used only for such purposes as watering the streets. A
proper supply of water for the shipping in the Thames is much
wanted. Water acquires a flat taste by being boiled; but if it is filtered
after it becomes cold, it gets re-aerated, and the flat or vapid taste is
entirely removed.
4th. When cholera prevails very much in the neighbourhood, all
the provisions which are brought into the house should be well
washed with clean water, and exposed to a temperature of 212°
Fahr.; or at least they should undergo one of these processes, and be
purified either by water or by fire. By being careful to wash the
hands, and taking due precautions with regard to food, I consider
that a person may spend his time amongst cholera patients without
exposing himself to any danger.
5th. When a case of cholera or other communicable disease
appears among persons living in a crowded room, the healthy should
be removed to another apartment, where it is practicable, leaving
only those who are useful to wait on the sick.
6th. As it would be impossible to clean out coal-pits, and establish
privies and lavatories in them, or even to provide the means of eating
a meal with anything like common decency, the time of working
should be divided into periods of four hours instead of eight, so that
the pitmen might go home to their meals, and be prevented from
taking food into the mines.
7th. The communicability of cholera ought not to be disguised
from the people, under the idea that the knowledge of it would cause
a panic, or occasion the sick to be deserted.
British people would not desert their friends or relatives in illness,
though they should incur danger by attending to them; but the truth
is, that to look on cholera as a “catching” disease, which one may
avoid by a few simple precautions, is a much less discouraging
doctrine than that which supposes it to depend on some mysterious
state of the atmosphere in which we are all of us immersed and
obliged to breathe.
The measures which can be taken beforehand to provide against
cholera and other epidemic diseases, which are communicated in a
similar way, are—
 8th. To effect good and perfect drainage.
9th. To provide an ample supply of water quite free from
contamination with the contents of sewers, cesspools, and house-
drains, or the refuse of people who navigate the rivers.
10th. To provide model lodging-houses for the vagrant class, and
sufficient house room for the poor generally.
The great benefit of the model lodging-houses arises from the
circumstance that the apartments for cooking, eating, and sleeping,
are distinct, and that all the proper offices which cleanliness and
decency require are provided. The very poor who choose to avail
themselves of these institutions, suffer a rate of mortality as low as
that of the most opulent classes. The public washhouses, which
enable poor persons to wash the soiled linen of the sick or the
healthy, without doing it in the midst of the plates and dishes and
provisions of the family, are well calculated to prevent the spread of
disease.
11th. To inculcate habits of personal and domestic cleanliness
among the people everywhere.
12th. Some attention should undoubtedly be directed to persons,
and especially ships, arriving from infected places, in order to
segregate the sick from the healthy. In the instance of cholera, the
supervision would generally not require to be of long duration.
In the autumn of 1853, certain German emigrants, on their way to
America, who had crossed the sea from Hamburgh and Rotterdam,
where cholera was prevailing, to the port of Hull, and had gone
thence, by rail, to Liverpool, were seized with cholera (some of them
fatally) in the latter town; and it is most likely to the well-regulated
Emigrant’s Home, in which these cases occurred, that the town of
Liverpool owed its freedom from the epidemic at that time. And a
little medical supervision, and the detention of some of the
emigrants for a short time in Liverpool, before their embarcation,
would probably have prevented the great mortality which occurred in
some of the emigrant ships during their passage to America.
The measures which are intended to prevent disease should be
founded on a correct knowledge of its causes. For want of this
knowledge, the efforts which have been made to oppose cholera have
often had a contrary effect. In 1849, for instance, the sewers of
London were frequently flushed with water,—a measure which was
calculated to increase the disease in two ways: first, by driving the
cholera evacuations into the river before there was time for the
poison to be rendered inert by decomposition; and second, by
making increased calls on the various companies for water to flush
the sewers with,—so that the water which they sent to their
customers remained for a shorter time in the reservoirs before being
distributed. It should be remarked, also, that the contents of the
sewers were driven into the Thames by the flushing, at low water,
and remained flowing up the stream for four or five hours
afterwards. Flushing the sewers was not repeated during the recent
epidemic, but increased quantities of water were distributed by some
of the Companies, and at more frequent intervals, causing the water-
butts to overflow for hours together into the drains, and producing
nearly the same effect as flushing the sewers; in addition to which,
the water in the butts of the Southwark and Vauxhall Company’s
customers was prevented from settling, as it might have done if less
frequently disturbed.
I feel confident, however, that by attending to the above-
mentioned precautions, which I consider to be based on a correct
knowledge of the cause of cholera, this disease may be rendered
extremely rare, if indeed it may not be altogether banished from
civilized countries. And the diminution of mortality ought not to stop
with cholera. The deaths registered under the name of typhus consist
chiefly of the typhoid fever mentioned above. Its victims are
composed chiefly of persons of adult age, who are taken away from
their families and connections. In 1847 upwards of 20,000 deaths
were registered in England from typhus, and in 1848 upwards of
30,000 deaths. It is probable that seven times as many deaths have
taken place from typhus as from cholera, since the latter disease first
visited England in 1831; and there is great reason to hope that this
mortality may in future be prevented by proper precautions,
resulting from a correct knowledge of the mode of communication of
the malady.
 APPENDIX,

Containing the number of deaths from cholera registered in the

four weeks ending 5th August, 1854, together with the supply of
water in the houses in which the fatal attacks took place, in all
the sub-districts to which the water supply of either the
Southwark and Vauxhall or the Lambeth Company extends. (See
Table VII, page 84.) The registers of deaths are copied from the
Weekly Returns of the Registrar-General.
 St. Saviour, Southwark. Christchurch.
At 34, Charlotte Street, on 29th July, a stock-maker, aged 29,
“Asiatic cholera 18 hours”
Lambeth.

At 45, Gravel Lane, on 1st August, the widow of a farmer, aged 48,
“cholera 12 hours”
Southwark & Vauxhall.

At 1, Alpha Place, on 1st August, a barrister’s clerk, aged 57,

“cholera 24 hours”
Southwark and Vauxhall.
 St. Saviour, Southwark. St. Saviour.
At 1, Park Street, on 25th July, the wife of a labourer, aged 35,
“Asiatic cholera 14¹⁄₂ hours”
Southwark & Vauxhall.

At 40, Bankside, on 25th July, the son of a locksmith, aged 5 years,

“cholera 12 hours”
Southwark and Vauxhall.

At same house, on 26th July, the daughter of a locksmith, aged 9

yrs., “cholera 12 hours”
Southwark and Vauxhall.

At same house, on 28th July, the daughter of a locksmith, aged 13

yrs., “cholera 12 hours”
Southwark and Vauxhall.

At 97, Bridge Road, on 28th July, a hatter, aged 36, “Asiatic

cholera 24 hours”
Southwark and Vauxhall.

At 49, Great Guildford Street, on 29th July, a coal-porter, aged 44,

“cholera 12 hours”
Southwark and Vauxhall.

At 20, Zoar Street, on 31st July, a female, formerly a domestic

servant, aged 79, “diarrhœa 2 days, cholera 12 hours”
Southwark and Vauxhall.

At 22, America Street, on Aug. 1, the wife of an engine-driver, aged

38, “cholera 12 hours”
Southwark and Vauxhall.
 At 5, Pleasant Place, August 1, the daughter of a coal-porter, aged 5
years, “Asiatic cholera 13 hours”
Southwark and Vauxhall.

At 10, Castle Street, on 1st August, the son of an engineer, aged 7

years, “cholera 12 hours”
Southwark and Vauxhall.

At 36, New Park Street, on 1st August, the son of an artist, aged 2
years, “Asiatic cholera 10¹⁄₂ hours”
Thames water from the tank of a saw-mill.

At 54¹⁄₂, Great Guildford St., on 2nd Aug., a labourer aged 51,

“Asiatic cholera 47 hours”
Southwark and Vauxhall.

At the same house, same day, the wife of a labourer, aged 48,
“Asiatic cholera 12¹⁄₂ hours”
Southwark and Vauxhall.

At 2, Emerson Place, on 3rd August, the wife of an engineer, aged

30, “cholera 2 days”
Southwark and Vauxhall.

At 29, Norfolk St., on 2d Aug., the son of a labourer, aged 3 years,

“Asiatic cholera 12¹⁄₂ hours”
Southwark and Vauxhall.

At 68, Great Guildford St., on 3rd Aug., the widow of a labourer,

aged 40, “cholera 19 hours”
Southwark and Vauxhall.
At 10, Castle Street, on 3rd August, the daughter of a labourer,
aged 4 years, “cholera 12 hours”
Southwark and Vauxhall.

At White Hart Inn Yard, on 3rd August, the wife of a porter, aged
49, “cholera 14 hours”
 Southwark and Vauxhall.

At 22, America Street, on 3rd August, an engine-driver, aged 35,

“cholera 9 hours”
Southwark and Vauxhall.

At 15, Essex Street, on 4th August, a packer, aged 65, “diarrhœa 4

days, cholera 11 hours”
Southwark and Vauxhall.

At 17, Southwark Square, on 3rd August, the wife of an engineer,

aged 31, “diarrhœa 1 day, cholera 3 days”
Southwark and Vauxhall.

At 31, York Place, 5th Aug., the daughter of a labourer, aged 5 yrs.
“Asiatic cholera, 11¹⁄₂ hours”
Southwark & Vauxhall.

At 50, Great Guildford Street, on 4th August, a baker’s

shopwoman, aged 21, “Asiatic cholera”
Southwark & Vauxhall.

At 10, Russell Place, on 5th August, the widow of a steam-boat

stoker, aged 38, “diarrhœa 4 weeks, Asiatic cholera 20 hours”
Southwark and Vauxhall.

At 14, Keppel St., 31st July, the daughter of a cooper, aged 4 years,
“Asiatic cholera 12 hours”
Southwark & Vauxhall.

At 3, Bank End, on 2nd August, a widow of a coach-trimmer, aged

73, “Asiatic cholera 14 hours”
Thames water from tank at Messrs. Barclay & Perkins.
 St. Olave, Southwark. St. Olave.
At St. Thomas’s Hospital (from Grey Eagle Street, Spitalfields), on
27th July, a labourer, aged 32, “rheumatism, cholera 20 hours”. This
patient, named John Moull, was admitted with rheumatism on 25th
July. Water supply of hospital
Southwark and Vauxhall and pump-wells on the premises.

At 5, Marble Court, July 28, the son of a basket maker, aged 4

years, “malignant cholera 12 hours”
Southwark and Vauxhall.

At the same house, July 30, a stonemason’s daughter, aged 2 yrs.,

“choleraic diarrhœa 2 days”
Southwark & Vauxhall.

At 3, Gimber’s Rents, July 31, a labourer’s daughter, 13 months,

“Asiatic cholera 7 hours”
Southwark and Vauxhall.

At Guy’s Hospital, July 30, a dressmaker, aged 19, “cholera”;

admitted with cholera from 2, Port Place, Walworth Common
Southwark and Vauxhall.

At 3, Gimber’s Rents, Aug. 1, a labourer’s daughter, 3 years,

“Asiatic cholera 48 hours”
Southwark & Vauxhall.

On board the “Prince Cobourg”, Cotton’s Wharf, on August 2nd, a

seaman, aged 38, “Asiatic cholera 14 hours”
Most likely Thames water.

At 5, Marble Court, August 1, the daughter of a basket maker, aged

1 year and 4 months, “cholera, congestion of brain”
Southwark and Vauxhall.
 At 6, Darley’s Buildings, August 2, the daughter of a labourer, 2
yrs., “Asiatic cholera 14 hrs.”
Southwk. & Vauxhall.
At Guy’s Hospital, on August 1st, a sailor, aged 16, “cholera”;
admitted with cholera from a ship in the Thames
Most likely Thames water.
At Guy’s Hospital, on 2nd August, a bookbinder, aged 30,
“cholera”; was taken ill in the train on his way from Portsmouth
Water supply not ascertained.
At Guy’s Hospital, on 3rd August, the daughter of a block-turner,
aged 11 yrs., “cholera”; admitted with cholera from 7, Mint Street,
Southwark.
Southwark and Vauxhall.
At St. Thomas’s Hospital, supposed from Red Cross Street,
Southwark, on 31st July, a charwoman, aged 50, “cholera”
Water supply not ascertained.
At St. Thomas’s Hospital, from (28) Cole Street, Dover Road, on
2nd August, a cab-driver, aged 40, “cholera”; admitted with cholera
Southwark and Vauxhall.
At St. Thomas’s Hospital, from (1 Star Place) Star Corner,
Bermondsey, on 3rd August, a baker, aged 27, “cholera”; admitted
with cholera.
Southwark and Vauxhall.
At 10, Tattle Court, on 4th August, a labourer, aged 46, “Asiatic
cholera 12 hours”
Southwark and Vauxhall.
At 11, Green Bank, on 4th August, the daughter of a pavior, aged 3
years, “Asiatic cholera 18 hours.”
Southwark & Vauxhall.
At 24, Mellor Street, on 3rd August, a butcher, aged 73, “cholera 18
hours”
Southwark and Vauxhall.
At 194, Tooley Street, Aug. 5th, the son of a railway porter, aged 16
months, “cholera”
Southwark and Vauxhall.
 St. Olave, Southwark. St. John,
Horsleydown.
At 8, Charles Street, July 20, a carman, aged 42, “diarrhœa 3 days,
Asiatic cholera 22 hours”
Southwark & Vauxhall.
At 19, Bermondsey St., July 26, a labourer’s daughter, aged 5 yrs.,
“cholera Asiatica 4¹⁄₂ hours”
Southwark & Vauxhall.
At 4, Abdy Street, on 29th July, a corn-turner, aged 60, “Asiatic
cholera, with premonitory diarrhœa, 18 hours”
Southwark and Vauxhall.
At 12, Bermondsey Street, July 29, a railway porter, aged 34,
“malignant cholera 12 hours”
Southwark & Vauxhall.
At 5, Gibbon’s Rents, July 29, wife of a railway porter, aged 39,
“malignant cholera 16 hours”
Southwark & Vauxhall.
At 18, Parish Street, July 29, a carpenter’s labourer, aged 19,
“diarrhœa 4 days, cholera 3 days”
Southwark & Vauxhall.
At the Union Workhouse, on 30th July, a labourer, aged 40,
“Asiatic cholera 24 hours”; admitted with cholera from 4, Bethel
Place, Vine Yard
Southwark and Vauxhall.
At the Union Workhouse, on 31st July, an apprentice to the sea,
aged 16, “Asiatic cholera 36 hours”; admitted with cholera from on
board ship
Most likely Thames water.
At 5, Bethel Place, July 30, the wife of a corn-turner, aged 35,
“Asiatic cholera 4 hours”
Southwark and Vauxhall.
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