PUBLIC HEALTH 9 



seaboard. As these malarious regions include a population 

 of about 40,000,000 people, it will be seen that the importance 

 of malaria from the standpoint of public health is very great 

 indeed. It must be remembered, however, that the incidence 

 of malaria varies widely, being greatest in the large south- 

 eastern area, and very much less in the more densely popu- 

 lated northern district. Thus in Mississippi about 80 cases 

 of malaria per 1,000 of population were reported during the 

 last year, or 158,000 for the entire state. Other southern 

 states do not report the disease so thoroughly and it is diffi- 

 cult to estimate to what extent they are affected. It would 

 seem, however, that one million cases each year would be a 

 conservative estimate, especially as von Ezdorf found in a 

 portion of one mill town in the endemic area that over 13 per 

 cent, or one person in seven, harbored the malarial parasite 

 in the blood, while 233 out of 500, or nearly 50 per cent, re- 

 ported having had chills and fever during the summer pre- 

 ceding his examination. Although the death rate from 

 malaria outside the tropics is not very great (9 per 1,000 

 calculated on the data for Mississippi cited above) it is by no 

 means inconsiderable in the mass. On the other hand, the 

 economic loss is enormous, due to inability to work during 

 the acute attack of the fever and due to a loss of efficiency 

 during prolonged periods following. That malaria responds 

 quickly to anti-mosquito work and quininization is shown 

 by the result following an application of these measures to 

 the mill town mentioned. Referring to von Ezdorf's report, 

 Trask says: "Measures were inaugurated to get rid of mos- 

 quito-breeding places and the use of quinine was encouraged. 

 A year later the town was again visited and the blood of 780 

 persons examined. Of these only 35, or 4.5 per cent, showed 

 infection. The health officer reported at this time that his 

 visits among the mill employees for several months had aver- 

 aged not over one a day, and that many of these were un- 

 doubtedly for old infections lasting over from previous years. 

 The malaria rate had continuously decreased during the 

 months when it was usually at its worst. The health officer 



