152 N. J. Mosquito Extermination Association 



the summer and fall of 1920 at about two hundred. Only three 

 cases of malaria were reported to the local board of health that year, 

 and only four cases during the nine years for which we have official 

 records. Investigations conducted in other counties have shown 

 much the same conditions to have existed in at least one county in 

 the state. These are sufficient to show that a low malaria rate 

 based on official reports on file does not necessarily mean a malaria- 

 free locality in all instances. While it is unquestionably true that 

 a clinical diagnosis cannot always be taken without question in the 

 absence of a blood examination, in all probability the number of 

 unreported blood positive cases will far outnumber those erroneously 

 reported on clinical symptoms only. 



In considering indicated fatality rates, based on reported cases 

 and deaths, the Hudson County figures show conclusively one (or 

 possibly both) of two things; flagrant disregard of the law requir- 

 ing cases of malaria to be reported or, conspicuously erroneous death 

 returns. A 40 per cent, fatality rate from malaria, which is shown 

 in Hudson County during the past nine years, can hardly be con- 

 sidered seriously. 



That the case incidence should be higher in some counties than in 

 others is of course to be expected when the distribution of the Ano- 

 pheles mosquito in this state is taken into consideration. Sussex 

 County, the population of which falls almost entirely in the rural 

 -classification, shows by reported cases the highest malaria rate of 

 any county in the state. These figures, however, are far from com- 

 plete, as surveys in past years have shown. As a matter of fact 

 malaria is known to be far more prevalent in parts of Sussex County 

 than is indicated by reported cases. The marked falling off of the 

 number of cases reported from the county since 1914 is very largely 

 if not entirely due to the active anti-mosquito prevention work that 

 was begun about six years ago by local officials in Franklin Borough. 

 This work was immediately followed by a marked diminution in the 

 number of cases of malaria in that vicinity and has practically elim- 

 inated the disease from what was believed to be one of the worst 

 infected localities. If the work that has been carried on from year 

 to year in Franklin Borough since 19 14 was emulated by certain 

 other sanitary districts, Sussex County's high malaria rate would 

 soon correspond to the county's rating in other reportable commun- 

 icable diseases, which is the lowest in the state. 



In 19 1 8 the United States Public Health Service conducted a 

 malaria survey in a number of states, New Jersey being included 



