Directions: From the alternatives given, choose the one which will be a suitable substitute for the underlined expression in each of the following.

The civic authorities were at their wits end when, despite their best efforts, cholera was unchecked and beyond control among the citizens.

Endemic is used to term a disease under control, while this sentence is talking about an epidemic out of control of authorities. Epidemic is a noun and can be used to replace cholera and not the given expression of sentence. Spreading fits the sentence correctly, so keep it for final consideration. Word rampant means spreading, unchecked and widespread, you can see clearly that it perfectly replace the given expression. Therefore, option (4) is correct answer.