MALARIA A CHECK ON PROGRESS 321 
country are not available. From a table comprising 22 cities it appears that two- 
thirds of the deaths from malaria in the United States occur in the South—one- 
third only in the North. The death rate from malaria by States is available only 
for the following registration States : California, Colorado, Connecticut, District 
of Columbia, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hamp- 
shire, New Jersey, New York, Pennsylvania, Rhode Island, South Dakota, and 
Vermont, all of which are Northern States. For these States the census reports 
from 1900 to 1907, inclusive, give the following death rates: 
DeatTHs DUE TO MALARIA IN THE REGISTRATION STATES. 
1900-1907. 
Aambes of ates of 
eaths from eaths from 
Total deaths A Total deaths 
Year. aN ORIG from malaria.|| ¥€2?- Ow. aopue from malaria. 
lation. lation. 
1900 7.9 2434 1904 4.2 1391 
1901 6.3 A701 1905 3.9 1821 
1902 5.4 1738 1906 3.5 1415 
1903 4.3 1410 1907 2.8 1166 
“ Estimating, from the preceding table, the average annual death rate due to 
malaria, at 4.8 per 100,000 population, and considering that the registration area 
includes only 16 of the Northern States (assuming fairly, however, that the 
death rate in the other Northern States is the same), it seems reasonably safe to 
conclude that the death rate from malaria for the whole United States must 
surely amount to 15 per 100,000. It is probably greater than this, since the 
statistics from the South are city statistics, and malaria is really a country 
disease. Thus it is undoubtedly safe to assume that the death rate for the whole 
population of the United States is in the neighborhood of 15 per 100,000. This 
would give an annual death rate from malaria of nearly 12,000 and a total num- 
ber of deaths for the 8-year period 1900-1907 of approximately 96,000. 
“ But with malaria perhaps as with no other disease does the death rate fail to 
indicate the real loss from the economic point of view. A man may suffer from 
malaria throughout the greater part of his life, and his productive capacity may 
be reduced from 50 to 75 per cent, and yet ultimately he may die from some en- 
tirely different immediate cause. In fact, the predisposition to death from other 
causes brought about by malaria is so marked that if, in the collection of vital 
statistics, it were possible to ascribe the real influence upon mortality that 
malaria possesses, this disease would have a very high rank in mortality tables. 
Writing of tropical countries, Sir Patrick Manson declares that malaria causes 
more deaths, and more predisposition to death by inducing cachectic states pre- 
disposing to other affections, than all the other parasites affecting mankind to- 
gether. Moreover, it has been shown that the average life of the worker in 
malarious places is shorter and the infant mortality higher than in healthy 
laces. 
re But, aside from this vitally important aspect of the subject, the effect of 
malaria in lessening or destroying the productive capacity of the individual is 
obviously of the utmost importance, and upon the population of a malarious 
region is enormous, even under modern conditions and in the United States. 
It has been suggested that the depopulation of the once thickly settled Roman 
Campagna was due to the sudden introduction of malaria by the mercenaries of 
Scylla and Marius. Celli, in 1900, states that owing to malaria about 5,000,000 
acres of land in Italy remain—not uncultivated, but certainly very imperfectly 
