Proce^edings 01^ Fi^TH Annual Me^e^ting 63 



theory of causation that they could not perceive the truly infinite 

 possibilities of the truth so near at hand. 



We, fortunately, in this country have not much malaria as far 

 as malaria prevalence goes in tropical countries ; but in the State 

 of Mississippi, for illustration, last year we had nearly one mil- 

 lion cases, equivalent to a rate of about 8 per cent. If for the 

 Southern States it is assumed that the case rate is only 2 per 

 cent, the resulting economic loss to the Southern people, and 

 indirectly to the nation at large, must be enormous. The practical 

 difficulty with malaria has always been that while the disease 

 prevalence is considerable, the resulting mortality is relatively 

 low. Malaria, however, complicates many other diseases, and 

 even surgical operations, and indirectly contributes substantially 

 toward a higher general death rate. In the State of New Jersey 

 deaths from malaria have been relatively few and far between, 

 but a review of the malaria data for almost a generation will 

 prove of interest in connection with the present discussion. 



In 1 88 1 we had in the State of New Jersey 431 deaths from 

 malaria, or, approximately, 3 per 1,000,000. In other words, as 

 a factor of mortality malaria in New Jersey has practically been 

 eradicated. But we never made as much progress in the forty 

 years preceding as we have made in the last five years ; more so, 

 when the fact is taken into account that to reduce a low death 

 rate is decidedly more difficult than to reduce a high death rate. 

 It will, therefore, be granted that the reduction in the mortality 

 from malaria in the State of New Jersey during a period of only 

 5 years from 1.2 per 100,000^ in 19 12 to 0.3 in 191 6 constitutes 

 a truly notable and really remarkable achievement. But even 

 the 10 deaths from malaria which occurred last year represent, 

 in all probability, not less than 1,000 cases, which complicate 

 many other diseases, especially such as Bright' s, bronchial pneu- 

 monia, and possibly appendicitis. We have no clear understand- 

 ing even to-day of how far latent malaria may be a seriously pre- 

 disposing cause of general ill-health in this state. We have never 

 made a complete parasitical survey or a blood index of the locali- 

 ties which continue to suffer from malaria in this state at the 

 present time; in fact, during recent years the disease has been 



