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more developed and alarming forms) that the matters which the
patient discharges from his stomach and bowels are infective.
Probably, under ordinary circumstances, the patient has no power of
infecting other persons except by means of these discharges; nor any
power of infecting even by them except in so far as these matters are
enabled to taint the food, water, or air which people consume.
Thus, when a case of cholera is imported into any place, the disease
is not likely to spread, unless in proportion as it finds, locally open to
it, certain facilities for spreading by indirect infection.
4. In order rightly to appreciate what these facilities must be,
the following considerations have to be borne in mind:—first, that
any choleraic discharge, cast without previous thorough disinfection
into any cesspool or drain, or other depository or conduit of filth, is
able to infect the excremental matters with which it there mingles,
and probably, more or less, the effluvia which those matters evolve;
secondly, that the infective power of choleraic discharges attaches to
whatever bedding, clothing, towels and like things have been imbued
with them, and renders these things, if not thoroughly disinfected,
capable of spreading the disease in places to which they are sent for
washing or other purposes; thirdly, that if, by leakage or soakage
from cesspools or drains, or through reckless casting out of slops
and waste water, any taint (however small) of the infective material
gets access to wells or other sources of drinking-water, it can impart
to enormous volumes of water the power of propagating the disease.
When due regard is had to these possibilities of indirect infection,
there will be no difficulty in understanding that even a single case of
cholera, perhaps of the slightest degree, and perhaps quite unsuspected
in its neighbourhood, may, if local circumstances cooperate,
exert a terribly infective power on considerable masses of
population.
5. The dangers which have to be guarded against as favouring the
spread of cholera-infection are particularly two. First, and above
all, there is the danger of water-supplies which are in any (even
the slightest) degree tainted by house refuse or other like kind of
filth; as where there is outflow, leakage or filtration, from sewers,
house-drains, privies, cesspools, foul ditches or the like, into springs,
streams, wells or reservoirs, from which the supply of water is drawn,
or into the soil in which the wells are situate; a danger which may
exist on a small scale (but perhaps often repeated in the same
district) at the pump or dip-well of a private house, or, on a large or
even vast scale, in the case of public water-works. And secondly,
there is the danger of breathing air which is foul with effluvia from
the same sorts of impurity.
6. Information as to the high degree in which those two dangers
affect the public health in ordinary times, and as to the special