Environmental Health Engineering in

the Tropics Water Sanitation and

Disease Control Third Edition
Cairncross
Visit to download the full and correct content document:
https://textbookfull.com/product/environmental-health-engineering-in-the-tropics-water
-sanitation-and-disease-control-third-edition-cairncross/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Disease Control Priorities Injury Prevention and

Environmental Health 3rd Edition Vikram Patel

https://textbookfull.com/product/disease-control-priorities-
injury-prevention-and-environmental-health-3rd-edition-vikram-
patel/

Communicable Disease Control and Health Protection

Handbook 4th Edition Jeremy Hawker

https://textbookfull.com/product/communicable-disease-control-
and-health-protection-handbook-4th-edition-jeremy-hawker/

Handbook of Environmental Analysis: Chemical Pollutants

in Air, Water, Soil, and Solid Wastes, Third Edition
Pradyot Patnaik

https://textbookfull.com/product/handbook-of-environmental-
analysis-chemical-pollutants-in-air-water-soil-and-solid-wastes-
third-edition-pradyot-patnaik/

Disease Control Priorities Volume 8 Child and

Adolescent Health and Development Donald Bundy

https://textbookfull.com/product/disease-control-priorities-
volume-8-child-and-adolescent-health-and-development-donald-
bundy/
Introduction to control engineering modeling analysis
and design Third Edition Mandal

https://textbookfull.com/product/introduction-to-control-
engineering-modeling-analysis-and-design-third-edition-mandal/

Health Safety and Environmental Management in Offshore

and Petroleum Engineering 1st Edition Srinivasan
Chandrasekaran

https://textbookfull.com/product/health-safety-and-environmental-
management-in-offshore-and-petroleum-engineering-1st-edition-
srinivasan-chandrasekaran/

Flowmeters in water supply Third Edition Gemin

https://textbookfull.com/product/flowmeters-in-water-supply-
third-edition-gemin/

Micronutrients in health and disease Second Edition

Prasad

https://textbookfull.com/product/micronutrients-in-health-and-
disease-second-edition-prasad/

Growth hormone in health and disease First Edition

Casanueva

https://textbookfull.com/product/growth-hormone-in-health-and-
disease-first-edition-casanueva/
Environmental Health Engineering
in the Tropics

This fully updated third edition of the classic text, widely cited as the most
important and useful book for health engineering and disease prevention,
describes infectious diseases in tropical and developing countries, and the
measures that may be used effectively against them.
The infections described include the diarrhoeal diseases, the common gut
worms, Guinea worm, schistosomiasis, malaria, Bancroftian filariasis and other
mosquito-​ borne infections. The environmental interventions that receive
most attention are domestic water supplies and improved excreta disposal.
Appropriate technology for these interventions, and also their impact on infec-
tious diseases, are documented in detail.
This third edition includes new sections on arsenic in groundwater supplies
and arsenic removal technologies, and new material in most chapters, including
water supplies in developing countries and surface water drainage.

Sandy Cairncross is Professor of Environmental Health at the London

School of Hygiene and Tropical Medicine, UK. He has worked as a water
and sanitation engineer for the Governments of Lesotho and Mozambique,
set up Guinea worm eradication programmes in West Africa with UNICEF
and the World Health Organization (WHO), served on the Intergovernmental
Panel on Climate Change (IPCC) and for nine years on the board of WaterAid
and provided technical advice on water and environmental health to the UK
Department for International Development (DFID) and other agencies.

Sir Richard Feachem is Director of the Global Health Group at the

University of California, San Francisco (UCSF), USA, and Professor of Global
Health at both UCSF and the University of California, Berkeley, USA. He is
also a Visiting Professor at London University, UK, and an Honorary Professor
at the University of Queensland, Australia. From 2002 to 2007, Sir Richard
served as founding Executive Director of the Global Fund to Fight AIDS, TB
and Malaria, and Under Secretary General of the United Nations. From 1995
to 1999, Dr Feachem was Director for Health, Nutrition and Population at
the World Bank. Previously (from 1989 to 1995), he was Dean of the London
School of Hygiene and Tropical Medicine, UK.
Earthscan Water Text series

For more information about this series, please visit: https://​www.routledge.

com/​Earthscan-​Water-​Text/​book-​series/​ECEWT

Contesting Hidden Waters

Conflict Resolution for Groundwater and Aquifers
W.Todd Jarvis

Key Concepts in Water Resource Management

A Review and Critical Evaluation
Edited by Jonathan Lautze

Reconnecting People and Water

Public Engagement and Sustainable Urban Water Management
Liz Sharp

The International Law of Transboundary Groundwater Resources

Gabriel Eckstein

Water Governance and Collective Action

Multi-​scale challenges
Edited by Diana Suhardiman, Alan Nicol and Everisto Mapedza

Water Stewardship and Business Value

Creating Abundance from Scarcity
William Sarni and David Grant

Equality in Water and Sanitation Services

Edited by Oliver Cumming and Thomas Slaymaker

Environmental Health Engineering in the Tropics

Water, Sanitation and Disease Control
Sandy Cairncross and Sir Richard Feachem
Environmental Health
Engineering in the Tropics

Water, Sanitation and Disease Control

Third edition
Sandy Cairncross and
Sir Richard Feachem
Third edition published 2019
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2019 Sandy Cairncross and Richard Feachem
The right of Sandy Cairncross and Richard Feachem to be identified as authors of
this work has been asserted by them in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised
in any form or by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
First edition published by John Wiley & Sons Ltd. 1983
Second edition published by John Wiley & Sons Ltd. 1993
British Library Cataloguing-​in-​Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-​in-​Publication Data
Names: Cairncross, Sandy, author. | Feachem, Richard G., 1947– author.
Title: Environmental health engineering in the tropics : water, sanitation
and disease control / Sandy Cairncross and Sir Richard Feachem.
Description: Third edition. | Abingdon, Oxon ; New York, NY : Routledge, 2018. |
Includes bibliographical references and index.
Identifiers: LCCN 2018013633 | ISBN 9781844071906 (hardback) |
ISBN 9781844071913 (pbk.) | ISBN 9781315883946 (ebook)
Subjects: LCSH: Sanitary engineering–Tropical conditions. |
Sanitary engineering–Developing countries.
Classification: LCC TD126.5 .C35 2018 | DDC 628.0913–dc23
LC record available at https://lccn.loc.gov/2018013633
ISBN: 978-​1-​84407-​190-​6 (hbk)
ISBN: 978-​1-​84407-​191-​3 (pbk)
ISBN: 978-​1-​315-​88394-​6 (ebk)
Typeset in Bembo
by Out of House Publishing
Contents

Preface to the first edition: environmental health engineering

and poverty xi
Preface to the second edition xiii
Preface to the third edition xiv
Acknowledgements xv

PA RT I
H ea l t h a n d pollution 1

1 Engineering and infectious disease 3

1.1 Introduction 3
1.2 Water-​related infections 4
1.3 Excreta-​related infections 11
1.4 Refuse-​related infections 18
1.5 Housing-​related infections 21
1.6 Public and domestic domains 22
1.7 Summary 24

2 Health and water chemistry 27

2.1 Introduction 27
2.2 The absence of necessary chemicals 27
2.3 Harmful organics 29
2.4 Harmful inorganics 31

3 Water quality and standards 36

3.1 Drinking water quality 36
3.2 Wastewater quality 46
3.3 Industrial wastes 49
3.4 Bathing water quality 50
vi Contents

3.5 Irrigation water quality 51

3.6 Water quality and fish 52
3.7 Water quality standards and QMRA 52

PA RT I I
Wa t er su p ply 59

4 Water supplies in low and middle income countries 61

4.1 The haves and have nots 61
4.2 Operation and maintenance 63
4.3 Appropriate technology 64
4.4 Benefits 66
4.5 Cost recovery and the private sector 69
4.6 Rural supplies and self-​help 71
4.7 Self-​supply 72
4.8 Hygiene promotion 73
4.9 Evaluation 76
4.10 Climate change and integrated water resource management 78

5 Rural water supply 83

5.1 Breakdowns and technology 83
5.2 Sources of water 84
5.3 Raising water 92
5.4 Storage 101
5.5 Treatment in a rural context 102
5.6 Water distribution 107

6 Urban water supply and water treatment 112

6.1 Introduction 112
6.2 Coagulation and sedimentation 113
6.3 Filtration 116
6.4 Disinfection 118
6.5 Distribution 124
6.6 Water demand management 129

PA RT I I I
Excreta and refuse: treatment, disposal and re-​use 135

7 Excreta disposal in low and middle income countries 137

7.1 The haves and have nots 137
 Contents vii

7.2 The evolving agenda of sanitation for the poor 137

7.3 Cities and the need for hygienic management of faecal sludge 140
7.4 Relative costs of sanitation systems 140

8 Types of excreta disposal system 145

8.1 Introduction 145
8.2 Pit latrines 145
8.3 VIP latrines 148
8.4 Difficulties with pit latrines 154
8.5 Pour-​flush toilets 159
8.6 Vault toilets and cartage 163
8.7 Septic tanks 164
8.8 Small-​bore sewers 166
8.9 Other systems 168
8.10 Communal latrines 171
8.11 Soil conditions 171
8.12 Soakaway designs 174
8.13 Personal hygiene 175
8.14 Sullage disposal 177
8.15 Nightsoil and sludge re-​use and disposal 177
8.16 Water availability 180

9 Planning a sanitation programme 183

9.1 Programme context and content 183
9.2 Sanitation marketing 186
9.3 Choice of system 191
9.4 Social factors 192
9.5 Costs 197
9.6 Operation and maintenance 200
9.7 Incremental sanitation 200

10 Wastewater treatment 205

10.1 Introduction 205
10.2 Waste characteristics 205
10.3 Waste stabilisation ponds 206
10.4 Aerated lagoons 217
10.5 Oxidation ditches 218
10.6 Pathogen removal 219
10.7 Sewage workers’ health 220
viii Contents

11 Surface water drainage 222

11.1 Introduction 222
11.2 Town planning implications 224
11.3 Technical aspects 225
11.4 Institutional aspects 229

12 Solid waste management 233

12.1 Introduction 233
12.2 Waste characteristics 233
12.3 Hazards of refuse mismanagement 235
12.4 Storage and collection 235
12.5 Treatment and disposal 237

13 Composting 242
13.1 Aerobic and anaerobic composting 242
13.2 Techniques 243
13.3 Carbon/​nitrogen ratio 246
13.4 Problems of composting 248
13.5 Individual composting toilets 249

14 Health aspects of waste use 251

14.1 Introduction 251
14.2 Health and agricultural use 251
14.3 Health and fish farming 256

PA RT I V
Envi ro n m e ntal modifications
a n d vect or-​b orne diseases 261

15 Engineering control of insect-​borne diseases 263

15.1 Introduction 263
15.2 Mosquito-​borne diseases 263
15.3 Fly-​borne diseases 278
15.4 Chagas disease and bugs 283
15.5 Lice, fleas, ticks and mites 285
15.6 Conclusions 286

16 Dams, irrigation and health 289

16.1 General considerations 289
16.2 Onchocerciasis 293
 Contents ix

16.3 Malaria 294

16.4 Arboviral infections 295
16.5 Bancroftian and Malayan filariasis 295
16.6 Spillways and reservoir release policies 297

17 Schistosomiasis 302
17.1 Introduction 302
17.2 Water supply and sanitation 306
17.3 Schistosome removal from water and wastes 308
17.4 Specific engineering and environmental methods in
schistosomiasis control 310

Appendix A: Biological classification conventions 323

Appendix B: Glossary 325
Appendix C: Checklist of water-​related and excreta-​related diseases 332
Appendix D: A brief primer on urban mosquito control 338
Appendix E: Units 353
Index 354
Preface to the first edition
Environmental health engineering
and poverty

The word ‘tropics’ in the title of this book refers only very loosely to the hotter
regions of the world. Most hot countries are poor countries, and most poor
countries have hot climates.The particular problems of engineering and of dis-
ease which are discussed in these pages are not confined to the tropics; many
of them apply to all poor communities, whether tropical or temperate. For
example, it has become clear in recent years that environmental health in many
rural areas of Eastern Europe is no better than can be found in parts of Latin
America, or even Africa.
Environmental health engineering is an important weapon in the fight
against disease. Many of the dramatic improvements in public health in the
developed countries over the last century or so are attributable to public health
engineers, at least as much as to doctors. But these improvements have yet to
reach the vast majority of the world’s poor, who still endure the high rates of
death, disease and disability which have always been associated with poverty.
It has become increasingly apparent in recent years that these effects of pov-
erty may be alleviated without a substantial increase in a country’s per capita
income.There are now a number of countries, such as the People’s Republic of
China and Sri Lanka, where, although the per capita income remains low, such
indices of the quality of human life as the infant mortality rate, life expectancy
and rates of infection with certain parasites, have improved significantly.
Our book is concerned with engineering methods for improving the health
of the poorest sections of the world’s population. It is not the rich who suffer
from the diseases we discuss, nor is it the rich who are deprived of the envir-
onmental services and facilities documented here. The rich in a developing
country do not suffer much from schistosomiasis, their children do not fre-
quently die of diarrhoea and malnutrition, they generally drink clean water
and have hygienic excreta disposal facilities. It is the poor who suffer from these
diseases and who live in conditions of environmental squalor.
The need for this book, then, and indeed the need for the consideration of
tropical environmental health engineering as a distinct subject, derives directly
from the needs of the poor. There is no point in offering technology to the
poor which is appropriate for the rich and industrialised countries, because the
xii Preface to the first edition

poor will be unable to afford it. Nor is there any point in waiting for that dis-
tant day when per capita incomes are sufficiently high that the poor can afford
to buy the services which the citizens of North America and Europe have long
enjoyed. Instead one must try to make available to the poor improvements in
their environment and in their life style which they can afford now, and thereby
seek to improve their quality of life despite their low incomes.
An improvement in the quality of life of the poorest sections of the world’s
population rests essentially on two requirements. The first, and most important,
is political will. Without a political commitment to distribute resources equit-
ably among the population and provide for the basic needs of the poor, there
can be little prospect of change for the poorest sections of any society. If we look
at the countries in which, although poor, the majority of the population has a
relatively good quality of life, we generally find them to be countries where this
political will is strong and where it has been strong for a number of years.
The second requirement is the one to which this book is addressed. That is
the availability of the know-​how and the technology to bring improvements
and facilities to the poor at a cost which they and their governments can afford.
In some fields the basic scientific and engineering understanding exists and
the technology is well tested, although often not widely used in practice. In
other fields, such as environmental methods for diarrhoeal disease control, our
understanding is less good and there is a need for fundamental scientific research
on which new technological advances can be based. It goes without saying that
this research must be poverty oriented, meaning that it must be directed at
problems which are experienced by the poor and must seek solutions which
the poor can afford.
Engineers whose work involves environmental health in a poor country rap-
idly find that they must concern themselves with a variety of issues for which
they are not traditionally trained. On the medical side, the diseases of the poor
in hot climates are very different from the diseases of the rich in temperate
climates, and public health engineers must understand these diseases if they are
to do their job properly. The economic picture, as has been said above, is also
radically different and public health engineers in a developing country must
have a fundamental grasp of the economic climate in which they are working.
Social and institutional problems are of the utmost importance, and it is neces-
sary that projects are designed in the full knowledge of the institutional and
social context in which they will be carried out. A broad range of skills and
abilities is therefore required and a high degree of interdisciplinary collabor-
ation is necessary. This collaboration is likely to require the participation of
engineers, doctors, biologists, economists, anthropologists and others. It is our
hope that this book will provide a useful introduction for those –​whatever
their specialist discipline –​with the will and interest to confront the problems
of environmental health in poor communities.
Sandy Cairncross
Richard Feachem
Preface to the second edition

In bringing this book up to date, I have tried to incorporate the main lessons
learned from the International Drinking Water and Sanitation Decade. Most
of these are not technical developments; though we have learned something
about subjects such as composting, waste re-​use and small bore sewers, these do
not involve radically new techniques. Indeed the main technical advance of the
Decade has been increased recognition for the low-​cost solutions which the
first edition sought to promote.
The most important lessons have concerned policy and strategies for
implementing water and sanitation programmes, and I have tried to summarise
these in Chapters 4 and 7. We have also learned to give more attention to
aspects of environmental health other than water supply and excreta disposal,
and this understanding lies behind the addition of a new chapter on drainage.
Above all, the bold assertions we made in the first edition are now supported
by much more published documentation; I have therefore overhauled the ref-
erence list at the end of each chapter to help the reader find it.
I would like to thank Ursula Blumenthal and Peter Kolsky for helpful
comments, and Mimi Khan and Caroline Smart for secretarial help. Finally,
thanks to Joy Barrett for drawing my attention to the fact that (thankfully!)
public health engineers are not all male.
Sandy Cairncross
Ouagadougou, 1993
Preface to the third edition

I had no idea when I embarked on this task that it would take so long to com-
plete. It soon became clear that every chapter needed a thorough revision, and
each revision needed a specialist peer review. I owe a deep debt of gratitude to
the reviewers, listed below. They are chiefly responsible for any improvements
in this edition –​though I am responsible for any shortcomings. I would also
like to thank my publishers, Earthscan, for their steadfast faith that this edition
would ultimately appear. My family, especially my wife Lois, were patient about
the amount of time I spent away from them and generous with their own time
when my absence meant more work for them. Last but not least, my thanks
to Leo Heller and the Universidade Federal de Minas, for providing a stimu-
lating but calm environment in Belo Horizonte for a month in each of three
successive years, without which this book might still be ‘Work in Progress’.

Reviewers Chapters
Professor Val Curtis, London School of Hygiene & Tropical Medicine 1 and 4
The late Professor Huw Tailor, University of Brighton 2 and 3
Dr Brian Skinner, University of Loughborough 5 and 6
Professor Barbara Evans, University of Leeds 7 and 9
Professor Duncan Mara, University of Leeds 8 and 10
Professor Pete Kolsky, University of North Carolina 11 and 15
Professor Andrew Cotton, University of Loughborough 12 and 13
The late Dr Jeroen Ensink, London School of Hygiene & Tropical 14 and 16
Medicine
Dr Jack Grimes, Imperial College 17
Dr Marion Jenkins, University of California at Davis All

Sandy Cairncross
newgenprepdf

Acknowledgements

This book contains a distillation of much knowledge and experience, and many
people have contributed to it in various ways. We wish to thank our colleagues
and students, past and present, many of whom may find their own ideas and
approaches in these pages. For the first edition, we were especially grateful for
the advice of David Bradley, Nicholas Greenacre, Duncan Mara,Warren Pescod,
John Pickford, Geoffrey Read, David Simpson, Brian Southgate and Graham
White. For the third edition, the help of Sue Cavill with photos, Rachel Pullan
with maps and Marion Jenkins with the final review deserves special mention.
More than anyone though, it is to the late Jeroen Ensink that I owe a debt
of gratitude; for his tireless support, for his surreptitiously slipping bureaucratic
burdens from my shoulders and for his joyful commitment to the study and
application of every field of knowledge in this book, I dedicate this edition
to him.
In memoriam,
Jeroen Ensink
(10 November 1974–​29 December 2015)
Part I

Health and pollution

Chapter 1

Engineering and infectious disease

1.1 Introduction
Environmental health engineering concerns engineering methods for the
improvement of the health of the population. In practice it has come to focus
especially upon domestic water supplies and excreta disposal facilities. Other
engineering interventions, such as drainage, housing and irrigation scheme
design, are also relevant in the tropics. However their impact on public health
is generally smaller, less certain and less cost-​effective than investments in water
and sanitation (Cairncross et al. 2003).
One is unlikely to succeed in improving public health unless one understands
it, and in the tropics this understanding must apply chiefly to the infectious
diseases. Although most of these have now been brought under control or even
eliminated in the industrialised countries, they are still the principal cause of
ill-​health among the world’s poor.
An infectious disease is one which can be transmitted from one person to
another or, sometimes, to or from an animal. All infectious diseases are caused
by living micro-​organisms, such as bacteria, viruses or parasitic worms, and a
disease is transmitted by the passing of these organisms from one person’s body
to another.
During the transmission process, the organisms may be exposed to the envir-
onment, and their passage to the body of a new victim is then vulnerable
to changes in the environment. Environmental health engineering seeks to
modify the human environment in such a way to prevent or reduce the trans-
mission of infectious diseases.
Being infected is not the same as being ill. Very often, the section of the
population most involved in transmitting an infection shows little or no sign of
disease; conversely, people who are seriously ill with the disease may be of little
or no importance in its transmission. For example, when a cholera epidemic
sweeps through a community, those who show signs of cholera are only a small
minority of those who are infected with the disease. Anyone who is infected,
whether ill or not, is likely to pass it on to others.
4 Health and pollution

For the environmental health engineer, it is convenient to start by classi-

fying the relevant infectious diseases into categories which relate to the various
aspects of the environment which can be altered. The conventional generic
or biological taxonomy1 of disease classifies them according to the nature of
their pathogens2 –​the organisms which cause them. That classification system
is unhelpful to environmental interventions. For instance, smallpox is grouped
with hepatitis, and filariasis3 is grouped with Guinea worm. In this chapter,
infectious diseases are grouped in a way which is more helpful to the environ-
mental health worker.

1.2 Water-​r elated infections

A water-​related disease is one which is related somehow to water or to impur-
ities in water. In low and middle income countries it is usually the infectious
water-​related diseases which are of prime importance; these are the subject of
this chapter. We distinguish the infectious water-​related diseases from those
related to some chemical property of the water. Damage to the teeth and bones,
for instance, is associated in some countries with high fluoride levels; this non-​
infectious type of water-​related disease is dealt with in Chapter 2.

Classification of transmission mechanisms

Before we can classify the water-​related infections, we must define the four dis-
tinct types of water-​related route by which a disease may be transmitted from
one person to another. These are shown in Table 1.1, and are related there to
the environmental strategies for disease control which are appropriate to each.
The four routes are described below.

1. Water-​borne route
Truly water-​borne transmission occurs when the pathogen is in water which
is drunk by a person who may then become infected. Potentially water-​borne
diseases include the classical infections, notably cholera and typhoid, but also
include a wide range of other diseases, such as infectious hepatitis, diarrhoeas
and dysenteries.
The term ‘water-​borne disease’ has been, and still is, greatly abused so that
it has become almost synonymous with ‘water-​related disease’. It is essential to
use the term water-​borne only in the strict sense defined here.
Another source of misunderstanding has been the assumption that, because a
disease is labelled water-​borne this describes its usual, or even its only means of
transmission. The preoccupation with strictly water-​borne transmission has its

1 Appendix A is a guide to the conventions of biological species classification.

2 Words such as this are included in the Glossary in Appendix B
3 Appendix C is a checklist of relevant diseases.
 Engineering and infectious disease 5

Table 1.1 The four types of water-​related transmission route for infections and the
preventive strategies appropriate to each
Transmission route Preventive strategies
Water-​borne Improve quality of drinking water
Prevent casual use of unprotected sources
Water-​washed (or water-​scarce) Increase quantity of water available
Improve accessibility and reliability of
domestic water supply
Improve hygiene
Water-​based Reduce need for contact with infected water
Control population of aquatic hosts (e.g. snails)
Reduce contamination of surface waters*
Water-​related insect vector Improve surface water management
Destroy breeding sites of insects
Reduce need to visit breeding sites
Use mosquito netting
* The preventive strategies appropriate to the water-​based worms depend on the precise
life cycle of each species.

origins in the dramatic water-​borne epidemics of cholera and typhoid which

occurred in some European towns in the nineteenth and early twentieth cen-
tury, and were largely caused by urban water supplies with inadequate treatment
facilities. Similar epidemics sometimes occur in tropical towns today, but all
water-​borne diseases can also be transmitted by any route which permits faecal
material to pass into the mouth (a ‘faecal–​oral’ route).Water-​borne transmission
is merely the special case of ingesting faecal material in water, and any disease
which can be water-​borne can also be transmitted by other faecal–​oral routes.

2. Water-​washed route
There are many infections of the intestinal tract and of the skin which, especially
in the tropics, may be significantly reduced following improvements in domestic
and personal hygiene.These improvements in hygiene often result from increased
availability of water allowing the use of increased volumes of water for hygienic
purposes. Their transmission can be described as ‘water-​washed’; it depends on
the quantity of water used, rather than the quality.The relevance of water to these
diseases is that it is an aid to hygiene and cleanliness, and its quality is relatively
unimportant. A water-​washed disease may be formally defined as one whose
transmission will be reduced following an increase in the volume of water used for
hygienic purposes, irrespective of the quality of that water.
Water-​washed diseases are of three main types. First, there are infections of
the intestinal tract, such as diarrhoeal diseases, which are important causes of ser-
ious illness and death especially among young children in poor countries. These
include cholera, bacillary dysentery and other diseases previously mentioned
under the water-​borne route.These diseases are all transmitted by the faecal–​oral
6 Health and pollution

Handwashing with soap is an important method of interrupting water-​

Figure 1.1 
washed transmission. It is especially important after defecation, before
eating and before preparing food.
Source: Photo © LSHTM.

route; that is, by the pathogen passing out in the faeces of an infected person
and subsequently being swallowed by someone else. A faecal–​oral disease can be
transmitted either by a truly water-​borne route or by many other faecal–​oral
routes, in which case it is probably susceptible to hygiene improvements and is
therefore water-​washed. A number of investigations have shown that diarrhoeal
diseases, especially bacillary dysentery (shigellosis), were associated with a lack
of conveniently available water, a small volume of water used or failure to wash
hands (Figure 1.1), but not significantly with the microbiological quality of the
water (Khan 1982, Curtis and Cairncross 2003, Chompook et al. 2006). The
conclusion is that these diarrhoeal diseases, although potentially water-​borne,
were in fact primarily water-​washed in the communities studied, and were
mainly transmitted by faecal–​oral routes which did not involve drinking water
as a vehicle. Figure 1.2 illustrates the complexity of those routes and Figure 1.3
shows their importance as a global health problem.
The second type of water-​washed infection is that of the skin or eyes. Bacterial
skin infections such as impetigo and fungal infections of the skin are prevalent in
many hot climates, while eye infections such as trachoma are also common and
may lead to blindness. These infections are sometimes related to poor hygiene
and they are likely to be reduced by increasing the volume of water used for
personal hygiene.4 However, they are quite distinct from the intestinal water-​
washed infections because they are not faecal–​oral and cannot be water-​borne.
They therefore relate primarily to water quantity, not to water quality.
The third type of water-​washed infection also can never be water-​borne.
Infections carried by lice may be reduced by improving personal hygiene and
thus reducing the probability of infestation of the body and clothes with these
arthropods. Louse-​borne epidemic typhus (due to infection by Rickettsia prowazeki)

4 It is sometimes suggested that scabies is water-​washed, but the evidence for this is not conclusive.
However it does seem to be associated with overcrowded housing conditions (see Section 1.3).
 Water quality
Fluids
Sanitation

Fields
Food New host
Faeces
Flies

Fomites

Fingers Water quantity

Hand washing

Figure 1.2 The F-​ diagram, illustrating the many possible transmission routes for
faecal–​oral infections (shown here as arrows) and the role of water, sani-
tation and hygiene in preventing transmission. Fomites are objects such as
utensils or bedding which become contaminated and so serve as vehicles
for pathogenic organisms.

Europe

Americas
2000 2013
Western Pacific

Eastern Mediterranean

SE Asia

Africa

0 100 200 300 400 500 600

Deaths from diarrhoea of children under five years (thousands)

Figure 1.3 Diarrhoeal diseases kill millions of people, especially young children in low
income countries. In recent decades, the global death rate from diarrhoea
has been reduced significantly, mainly through improved case management,
particularly by oral rehydration. This involves encouraging the patient to
drink a solution of sugar and salt, or other available fluids.
Source: WHO.
8 Health and pollution

is mainly transmitted by body lice, which cannot persist on people who regu-
larly launder their clothes. (Note that these are not the same as head lice.) Louse-​
borne relapsing fever (due to infection by a spirochaete, Borrelia recurrentis) may
also respond to changes in hygiene linked to increased use of water for washing
(see Chapter 15).

3. Water-​based route
A water-​based disease is one whose pathogen spends a part of its life cycle in
a water snail or other aquatic animal. All these diseases are due to infection by
parasitic worms (helminths) which depend on aquatic intermediate hosts to
complete their life cycles. The degree of sickness depends upon the number
of adult worms which are infecting the patient and so the importance of the
disease must be measured in terms of the intensity of infection as well as the
number of people infected. An important example is schistosomiasis. Water,
polluted by excreta, may contain aquatic snails in which the schistosome worms
develop until they are shed into the water as infective cercariae and re-​infect
humans through the skin (see Chapter 17).
Another water-​ based disease is Guinea worm (Dracunculus medinensis,
Figure 1.4), which has a unique transmission route. The mature female worm
releases hundreds of thousands of microscopic larvae from a painful blister, usu-
ally on the leg of the human host. If, when the blister bursts, these are washed
into a pond or shallow well, they are eaten by tiny crustaceans called cyclopoids,
which then become infected. Cyclopoids are only 0.8 mm long and so are
easily consumed inadvertently in water from an infected pond or well. Any

Guinea worm disease (dracunculiasis). People soon learn that it is not

Figure 1.4 
advisable to pull out their emerging worms, as illustrated here, without
expert prior training.The risk is that the worm may break at a point which
has not yet emerged, releasing larval fluid back up the track, setting off a
systemic allergic reaction and far greater discomfort for the patient.
Source: Photo by A Tayeh.
 Engineering and infectious disease 9

Dracunculus worms they contain will develop further in the human host and any
fertilised female worm will make her way to the legs and form a new blister a
year later, ready to start a new cycle.
Provision of safe water supplies is the primary measure to control the disease,
especially in large communities. When the annual incidence is less than 10%,
most of the cases are likely to be caused by casual use of infected water sources
away from the home while working in the fields, visiting or travelling. In such
cases, or in very small villages where safe water supplies are not yet affordable,
the inhabitants must be encouraged to filter their drinking water through a
cloth to remove the cyclopoids and to ensure that people with blisters do not
enter ponds used for drinking water.
The complete eradication of Guinea worm disease has been adopted as a
goal by the World Health Organization. It has recently been eradicated from
Asia and from all but four countries in Africa. In 2016, a total of less than 100
cases remained in South Sudan, Chad, Ethiopia and Mali.
The other diseases in this category are acquired by eating insufficiently
cooked fish, crabs, crayfish or aquatic vegetation; they are clearly unrelated to
water supply, but they may be affected by excreta disposal (see Section 1.3).

4. Insect vector route

The fourth and final route is for water-​related diseases to be spread by insects
which either breed in water or bite near water. Malaria, yellow fever, dengue and
onchocerciasis (river blindness), for example, are transmitted by insects which
breed in water, while West African sleeping sickness is transmitted by riverine
tsetse flies (Glossina spp.) which bite near water. Environmental methods for
control of dengue are a particular concern, because:

• dengue (and often-​fatal dengue haemorrhagic fever) are becoming more

and more common worldwide (Guzman and Harris 2015)
•• no effective vaccine or drug treatment is available, so that vector control is
the only viable control method
• the same mosquito species which transmits dengue also transmits other
emerging viruses such as the zika virus.

Insect-​borne diseases are discussed in Chapter 15.

Classification of infections
Table 1.1 lists these four water-​related transmission routes and links them
to their appropriate preventive strategies. In order to create a classification
of diseases (Table 1.2), rather than transmission routes, a slight adjustment is
required because all the faecal–​oral infections can be transmitted by both water-​
borne and water-​washed routes. They are placed in a special category of their
Table 1.2 Environmental classification of water-​related infections
Category Infection Pathogenic agent
1 Faecal–​oral (water-​borne Diarrhoeas and dysenteries
or water-​washed) • Amoebic dysentery P
• Balantidiasis P
• Campylobacter enteritis B
• Cholera B
• Cryptosporidiosis P
• E. coli diarrhoea B
• Giardiasis P
• Rotavirus diarrhoea V
• Salmonella B
• Shigellosis (bacillary dysentery) B
• Yersiniosis B
Enteric fevers
• Typhoid B
• Paratyphoid B
Poliomyelitis V
Hepatitis A V
Leptospirosis S
2. Water-​washed
(a) skin and eye infections Infectious skin diseases M
(b) other Infectious eye diseases M
Louse-​borne typhus R
Louse-​borne relapsing fever S
3. Water-​based
(a) penetrating skin Schistosomiasis H
(b) ingested Guinea worm disease H
Clonorchiasis H
Diphyllobothriasis H
Fasciolopsiasis H
Paragonimiasis H
Others H
4. Water-​related insect
vector
(a) biting near water Sleeping sickness (W Africa) P
(b) breeding in water Filariasis H
Malaria P
River blindness H
Mosquito-​borne viruses
• Yellow fever V
• Dengue V
• Others V
B = Bacterium; H = Helminth; P = Protozoon; R = Rickettsia; S = Spirochaete;V = Virus;
M = Miscellaneous.
See Appendix C for further details
 Engineering and infectious disease 11

own. The second category is reserved for infections that are exclusively water-​
washed; the skin and eye infections plus diseases which are associated with lice.
Each water-​related infection can then be assigned to one of the following four
categories: (1) faecal–​oral: (2) water-​washed; (3) water-​based; and (4) insect-​
vectored. Table 1.2 lists the major water-​related infections and assigns them
to their category in addition to linking them to the type of organism which
causes them.
Estimating the relative importance to public health of the four groups of
water-​related diseases is tricky; it is difficult to compare one disease which
kills people in childhood, for example, with another which handicaps people
in middle age. By most yardsticks though, the faecal–​oral group accounts
for the majority of the burden of disease which can be prevented by water
supply improvements, and roughly 90% of the deaths (Cairncross and
Valdmanis 2006).

1.3 Excreta-​related infections

All the diseases in the faecal–​oral category mentioned above, as well as most
of the water-​based diseases and several others not related to water, are caused
by pathogens transmitted in human excreta, normally in the faeces. In a similar
manner to the water-​related diseases, the classification of these excreta-​related
diseases can help us to understand the effects on them of the various possible
engineering solutions to the problem of excreta disposal.

Rationale for the classification

Those of the excreta-​related diseases which are also water-​related can of course
be controlled, at least partially, by improvements in water supply and hygiene.
But these and the other excreta-​ related diseases may also be affected by
improvements in excreta disposal, ranging from the construction or improve-
ment of toilets to the choice of methods for transport, treatment and final dis-
posal or re-​use of excreta.To understand the effects of excreta disposal on these
diseases, a further classification is required (Table 1.3).

I. Faecal–​oral diseases (non-​bacterial)

Improvements in excreta disposal will have differing degrees of influence on
the various faecal–​oral diseases. Some of these infections, caused by viruses,
protozoa and a few helminths, can spread very easily from person to person and
are transmitted in affluent communities in Europe and North America which
have high standards of sanitary facilities and hygiene. Norovirus, hepatitis A,
giardia and cryptosporidium are examples. Changes in excreta disposal methods
are unlikely to have much effect on their incidence unless accompanied by
 newgenrtpdf
Table 1.3 Environmental classification of excreta-​related infections
Category Infections Pathogenic Dominant transmission routes Major control measures
agent (engineering measures in
italics)
I Faecal–​oral Poliomyelitis V Person-​to-​person contact Domestic water supply
(non-​bacterial) Hepatitis A V Domestic contamination Improved housing
Non-​latent, low infectious Rotavirus diarrhoea V Provision of toilets
dose Amoebic dysentery P Hygiene promotion
Giardiasis P Control of animals
Cryptosporidiosis P
Balantidiasis P
Enterobiasis H
Hymenolepiasis H
II Faecal–​oral Diarrhoeas and dysenteries: Person-​to-​person contact Domestic water supply
(bacterial) - campylobacteriosis B Domestic contamination Improved housing
Non-​latent, medium or high - cholera B Water contamination Provision of toilets
infectious dose, moderately - E. coli diarrhoea B Crop contamination Excreta treatment prior to
persistent and able to - salmonellosis B re-​use or disposal
multiply - shigellosis B Hygiene promotion
- yersiniosis B Control of animals
Enteric fevers:
- typhoid B
- paratyphoid B
III Soil-​transmitted helminths Ascariasis (roundworm) H Yard contamination Provision of toilets with
Latent and persistent with no Trichuriasis (whipworm) H Ground contamination cleanable floors
intermediate host Hookworm H in communal Excreta treatment prior to
Strongyloidiasis H defecation areas land application
Crop contamination
Another random document with
no related content on Scribd:
 When aunt Abby and Julia came back with the eggs, the flies were
stealing the sugar and the kittens were lapping the milk from the pan.
I wonder if those kittens told their mother that Ellen gave each of
them a rap on the ear.
 CHAPTER V.
A VISIT.

One morning Mr. Cary and uncle Benjamin started for a long day’s
ride.
When her papa kissed Julia good-by, tears came in her eyes.
“My heartache will come back again,” she said.
But work is a good thing for a sad heart, and aunt Abby had plenty
of that for Julia. There were a hundred babies in feathers, out of
doors, which Julia liked to feed. For breakfast, dinner, and supper,
and for lunches between, Julia carried them food in a tin pail.
There were turkeys, chickens, and ducks.
When they saw aunty and Julia and the tin pail coming, they knew
they should be fed. So out of the coops came chickens and turkeys,
peeping and chirping like little birds. And up from the little pond
waddled the tiny ducks. It was fun to see how fast they came; how
they tumbled down and hopped over one another in a hungry
scrabble.
Aunt Abby thought Julia would not miss her dear father so much if
she were with Anne and Rose. So after dinner they went to visit
them.
 The little girls had but few playthings, but the kitten made fun
enough for them. Anne had already taught her puss to play with a
string.
Before tea was quite ready for the grown folks, Anne and Rose
took a box of very small dishes out on the grass, and set a table of
their own. Their mamma gave them a part of each dish she had for
her own guest, which made a nice feast.
They laughed and ate a great deal, and drank a great many cups
of tea. But as the most of their tea came out of the milk-pitcher, and
the rest from the teakettle, it did not keep either of them awake that
night.
They had romped so hard, that soon after tea aunt Abby thought
best for Julia to say “Good-night,” and each of the little tea-drinkers
was soon asleep.
Julia told her papa the next day about her good visit, and said she
chased those same kittens all night. Aunt Abby said that was
because she had been so wild, and had got so tired.
 CHAPTER VI.
JULIA AND PUSSY GO HOME.

One morning Julia was riding with her uncle, when they passed
Anne and Rose on their way to school. Anne’s kitten had followed
them so slyly, it was not seen till they were near the schoolhouse
door.
Uncle Benjamin bade them teach the puss its a-b-cs.
 “Good-by!” said Julia. “I am going home to-morrow.”
Anne and Rose were sorry they could not see this dear little friend
again.
The next morning, when Julia awoke, Ellen had the bags and
baskets ready to take home again. No, not quite ready, for one
basket was to hold the kitten, and Ellen called Julia to get up and
catch it, to be in time for their journey.
Kitty seemed to know they wanted to take her away from her
mother and sister pussy, and she tried to keep out of their way.
 But Charley and Johnny were as cunning as she, and caught her
at last.

Ellen said puss had gone in the pantry. Charley peeped in, but did
not see her. He heard a stir of the paper on the shelf, and stood still
at the door. He saw a mouse leap off the shelf, and before he could
hit it with his cap, it had run into a hole in the floor, and got out of the
way of boy and kitten; for kitty jumped from behind the flour-barrel
where she had hid, and Charley caught her.
 Johnny held the basket while Charley put her in it. Then Ellen tied
the cover down. Julia had put in that basket some bits of meat for
kitty’s lunch; and in another she had a bottle of milk and Johnny’s old
tin cup, to give puss a drink while on the boat.
But before the carriage was out of the lane, the kitten was out of
the basket, and everybody saw her wildly running back to the woods.
“My kitty! O my kitty! I can never go without her!” cried Julia.
“Here, Johnny!” shouted uncle Benjamin, as he turned his horses
round, “you and Charley scamper after that kitten.”
The boys leaped over the stone wall.
“But this will make us late for the boat,” said Mr. Cary.
“Wont the cars do as well? I can’t bear to let the little girl go
without the kitten that was so ‘pesshus.’”
They drove back to the shade of the willow-tree by the gate. Aunt
Abby had stood there watching them. She said if kitty did not come
back soon, they must wait for her and take to-morrow’s boat. But
then they heard the boys shout, and soon the funny fellows came out
of the woods with the runaway.
Papa Cary tied the cover this time, and puss was surely fast.
Again the loving good-bys were said under the old willow, and
Julia could not tell if she were most glad or sorry to start for home.
Kitty did not get overboard. She drank a cup of city milk—poor
thing!—at bed time, beside the bed Julia and Ellen made for her in
the storeroom, where, cook said, there were plenty of mice.
 CHAPTER VII.
AT HOME.

Julia loved the kitten, and the kitten loved Julia. Once more the
halls rang with the little girl’s merry laugh.
Puss learned some smart tricks.
Mr. Cary showed Julia how she might teach the kitten to jump
through her arms.
Clasping her little hands, and holding her arms out like a hoop,
she would kneel on the floor. Puss would step over her hands, held
so low. Then Julia held her arms up a little; and soon the kitten could
hop through this pretty hoop. By-and-by Julia could stand up, and
the kitty would come when she called “Puss! puss!” and jump
through her arms, which was a pretty sight.
Ellen, too, grew fond of puss, and was very kind to her. She would
play with Ellen’s spools of thread, and roll about her ball of mending-
cotton, while the good nurse sat sewing with Julia beside her.
So this simple kitten, one of the humblest of God’s creatures,
helped to make poor motherless Julia a happy child.
 Transcriber’s Notes

pg 42 Changed: My heartache will come baek again

to: My heartache will come back again
 *** END OF THE PROJECT GUTENBERG EBOOK JULIA CARY
AND HER KITTEN ***

Updated editions will replace the previous one—the old editions will
be renamed.

Creating the works from print editions not protected by U.S.

copyright law means that no one owns a United States copyright in
these works, so the Foundation (and you!) can copy and distribute it
in the United States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part of
this license, apply to copying and distributing Project Gutenberg™
electronic works to protect the PROJECT GUTENBERG™ concept
and trademark. Project Gutenberg is a registered trademark, and
may not be used if you charge for an eBook, except by following the
terms of the trademark license, including paying royalties for use of
the Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is very
easy. You may use this eBook for nearly any purpose such as
creation of derivative works, reports, performances and research.
Project Gutenberg eBooks may be modified and printed and given
away—you may do practically ANYTHING in the United States with
eBooks not protected by U.S. copyright law. Redistribution is subject
to the trademark license, especially commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE
 PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free

distribution of electronic works, by using or distributing this work (or
any other work associated in any way with the phrase “Project
Gutenberg”), you agree to comply with all the terms of the Full
Project Gutenberg™ License available with this file or online at
www.gutenberg.org/license.

Section 1. General Terms of Use and

Redistributing Project Gutenberg™
electronic works
1.A. By reading or using any part of this Project Gutenberg™
electronic work, you indicate that you have read, understand, agree
to and accept all the terms of this license and intellectual property
(trademark/copyright) agreement. If you do not agree to abide by all
the terms of this agreement, you must cease using and return or
destroy all copies of Project Gutenberg™ electronic works in your
possession. If you paid a fee for obtaining a copy of or access to a
Project Gutenberg™ electronic work and you do not agree to be
bound by the terms of this agreement, you may obtain a refund from
the person or entity to whom you paid the fee as set forth in
paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be

used on or associated in any way with an electronic work by people
who agree to be bound by the terms of this agreement. There are a
few things that you can do with most Project Gutenberg™ electronic
works even without complying with the full terms of this agreement.
See paragraph 1.C below. There are a lot of things you can do with
Project Gutenberg™ electronic works if you follow the terms of this
agreement and help preserve free future access to Project
Gutenberg™ electronic works. See paragraph 1.E below.
1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the
collection of Project Gutenberg™ electronic works. Nearly all the
individual works in the collection are in the public domain in the
United States. If an individual work is unprotected by copyright law in
the United States and you are located in the United States, we do
not claim a right to prevent you from copying, distributing,
performing, displaying or creating derivative works based on the
work as long as all references to Project Gutenberg are removed. Of
course, we hope that you will support the Project Gutenberg™
mission of promoting free access to electronic works by freely
sharing Project Gutenberg™ works in compliance with the terms of
this agreement for keeping the Project Gutenberg™ name
associated with the work. You can easily comply with the terms of
this agreement by keeping this work in the same format with its
attached full Project Gutenberg™ License when you share it without
charge with others.

1.D. The copyright laws of the place where you are located also
govern what you can do with this work. Copyright laws in most
countries are in a constant state of change. If you are outside the
United States, check the laws of your country in addition to the terms
of this agreement before downloading, copying, displaying,
performing, distributing or creating derivative works based on this
work or any other Project Gutenberg™ work. The Foundation makes
no representations concerning the copyright status of any work in
any country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other

immediate access to, the full Project Gutenberg™ License must
appear prominently whenever any copy of a Project Gutenberg™
work (any work on which the phrase “Project Gutenberg” appears, or
with which the phrase “Project Gutenberg” is associated) is
accessed, displayed, performed, viewed, copied or distributed:
 This eBook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it away
or re-use it under the terms of the Project Gutenberg License
included with this eBook or online at www.gutenberg.org. If you
are not located in the United States, you will have to check the
laws of the country where you are located before using this
eBook.

1.E.2. If an individual Project Gutenberg™ electronic work is derived

from texts not protected by U.S. copyright law (does not contain a
notice indicating that it is posted with permission of the copyright
holder), the work can be copied and distributed to anyone in the
United States without paying any fees or charges. If you are
redistributing or providing access to a work with the phrase “Project
Gutenberg” associated with or appearing on the work, you must
comply either with the requirements of paragraphs 1.E.1 through
1.E.7 or obtain permission for the use of the work and the Project
Gutenberg™ trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is posted

with the permission of the copyright holder, your use and distribution
must comply with both paragraphs 1.E.1 through 1.E.7 and any
additional terms imposed by the copyright holder. Additional terms
will be linked to the Project Gutenberg™ License for all works posted
with the permission of the copyright holder found at the beginning of
this work.

1.E.4. Do not unlink or detach or remove the full Project

Gutenberg™ License terms from this work, or any files containing a
part of this work or any other work associated with Project
Gutenberg™.

1.E.5. Do not copy, display, perform, distribute or redistribute this

electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1 with
active links or immediate access to the full terms of the Project
Gutenberg™ License.
1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form,
including any word processing or hypertext form. However, if you
provide access to or distribute copies of a Project Gutenberg™ work
in a format other than “Plain Vanilla ASCII” or other format used in
the official version posted on the official Project Gutenberg™ website
(www.gutenberg.org), you must, at no additional cost, fee or expense
to the user, provide a copy, a means of exporting a copy, or a means
of obtaining a copy upon request, of the work in its original “Plain
Vanilla ASCII” or other form. Any alternate format must include the
full Project Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,

performing, copying or distributing any Project Gutenberg™ works
unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing

access to or distributing Project Gutenberg™ electronic works
provided that:

• You pay a royalty fee of 20% of the gross profits you derive from
the use of Project Gutenberg™ works calculated using the
method you already use to calculate your applicable taxes. The
fee is owed to the owner of the Project Gutenberg™ trademark,
but he has agreed to donate royalties under this paragraph to
the Project Gutenberg Literary Archive Foundation. Royalty
payments must be paid within 60 days following each date on
which you prepare (or are legally required to prepare) your
periodic tax returns. Royalty payments should be clearly marked
as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information
about donations to the Project Gutenberg Literary Archive
Foundation.”

• You provide a full refund of any money paid by a user who

notifies you in writing (or by e-mail) within 30 days of receipt that
s/he does not agree to the terms of the full Project Gutenberg™
License. You must require such a user to return or destroy all
 copies of the works possessed in a physical medium and
discontinue all use of and all access to other copies of Project
Gutenberg™ works.

• You provide, in accordance with paragraph 1.F.3, a full refund of

any money paid for a work or a replacement copy, if a defect in
the electronic work is discovered and reported to you within 90
days of receipt of the work.

• You comply with all other terms of this agreement for free
distribution of Project Gutenberg™ works.

1.E.9. If you wish to charge a fee or distribute a Project Gutenberg™

electronic work or group of works on different terms than are set
forth in this agreement, you must obtain permission in writing from
the Project Gutenberg Literary Archive Foundation, the manager of
the Project Gutenberg™ trademark. Contact the Foundation as set
forth in Section 3 below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend

considerable effort to identify, do copyright research on, transcribe
and proofread works not protected by U.S. copyright law in creating
the Project Gutenberg™ collection. Despite these efforts, Project
Gutenberg™ electronic works, and the medium on which they may
be stored, may contain “Defects,” such as, but not limited to,
incomplete, inaccurate or corrupt data, transcription errors, a
copyright or other intellectual property infringement, a defective or
damaged disk or other medium, a computer virus, or computer
codes that damage or cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except

for the “Right of Replacement or Refund” described in paragraph
1.F.3, the Project Gutenberg Literary Archive Foundation, the owner
of the Project Gutenberg™ trademark, and any other party
distributing a Project Gutenberg™ electronic work under this
agreement, disclaim all liability to you for damages, costs and
expenses, including legal fees. YOU AGREE THAT YOU HAVE NO
REMEDIES FOR NEGLIGENCE, STRICT LIABILITY, BREACH OF
WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE
PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE
FOUNDATION, THE TRADEMARK OWNER, AND ANY
DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE
TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL,
PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE
NOTICE OF THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you

discover a defect in this electronic work within 90 days of receiving it,
you can receive a refund of the money (if any) you paid for it by
sending a written explanation to the person you received the work
from. If you received the work on a physical medium, you must
return the medium with your written explanation. The person or entity
that provided you with the defective work may elect to provide a
replacement copy in lieu of a refund. If you received the work
electronically, the person or entity providing it to you may choose to
give you a second opportunity to receive the work electronically in
lieu of a refund. If the second copy is also defective, you may
demand a refund in writing without further opportunities to fix the
problem.

1.F.4. Except for the limited right of replacement or refund set forth in
paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED,
INCLUDING BUT NOT LIMITED TO WARRANTIES OF
MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied

warranties or the exclusion or limitation of certain types of damages.
If any disclaimer or limitation set forth in this agreement violates the
law of the state applicable to this agreement, the agreement shall be
interpreted to make the maximum disclaimer or limitation permitted
by the applicable state law. The invalidity or unenforceability of any
provision of this agreement shall not void the remaining provisions.
1.F.6. INDEMNITY - You agree to indemnify and hold the
Foundation, the trademark owner, any agent or employee of the
Foundation, anyone providing copies of Project Gutenberg™
electronic works in accordance with this agreement, and any
volunteers associated with the production, promotion and distribution
of Project Gutenberg™ electronic works, harmless from all liability,
costs and expenses, including legal fees, that arise directly or
indirectly from any of the following which you do or cause to occur:
(a) distribution of this or any Project Gutenberg™ work, (b)
alteration, modification, or additions or deletions to any Project
Gutenberg™ work, and (c) any Defect you cause.

Section 2. Information about the Mission of

Project Gutenberg™
Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new computers.
It exists because of the efforts of hundreds of volunteers and
donations from people in all walks of life.

Volunteers and financial support to provide volunteers with the

assistance they need are critical to reaching Project Gutenberg™’s
goals and ensuring that the Project Gutenberg™ collection will
remain freely available for generations to come. In 2001, the Project
Gutenberg Literary Archive Foundation was created to provide a
secure and permanent future for Project Gutenberg™ and future
generations. To learn more about the Project Gutenberg Literary
Archive Foundation and how your efforts and donations can help,
see Sections 3 and 4 and the Foundation information page at
www.gutenberg.org.

Section 3. Information about the Project

Gutenberg Literary Archive Foundation