10 
MALARIA 
Fig. 1. Average of officially reported indigenous malaria deaths in the United States, by counties, for 
the period 1929-1938. The solid black indicates an average of 50 or more deaths per 100,000 population; 
the heavy stippling, 25 to 49.9; the light stippling, under 25; and the unshaded areas, no reported ma¬ 
laria deaths for the decade. 
tistics provided by responsible officials of 
the departments of health of these states. 
Heavily endemic foci that have remained 
relatively constant during this decade are 
found in (1) a wedge-shaped sector of the 
Southeastern States, including areas in 
South Carolina, Georgia, Florida and two 
adjacent counties in Alabama; (2) the 
“delta area” of the lower Mississippi Val¬ 
ley from Cairo, Illinois, to Natchez, Missis¬ 
sippi; (3) the portion of the Red River 
Valley near the junctions of Oklahoma, 
Arkansas, Louisiana and Texas; and (4) a 
4-county section of Texas at the mouth of 
the Rio Grande. Except for the Alle- 
ghanies and Appalachian highlands, deaths 
from indigenous malaria have occurred 
within the decade surveyed in counties from 
northernmost New York almost without in¬ 
terruption down to the Gulf of Mexico 
(although much more consistently in the 
South than in the North), and with few 
county interruptions from Savannah to San 
Diego, and from Milwaukee to El Paso. In 
the North and West, reports on malaria 
deaths have frequently been accompanied 
by information indicating that the infection 
was acquired in the highly endemic South 
or in Tropical America. 
Within the past decade a cyclic low rate 
of malaria deaths was experienced in all of 
the Southeastern United States either dur¬ 
ing the year 1931 or 1932 (Fig. 2). How¬ 
ever, a year or two later all of these states 
had a decidedly increased malaria death 
rate, although in. South Carolina and 
Georgia the peaks were not reached until 
1936. There followed an unusually satis¬ 
factory decline in the rate through 1939, 
with an average rate-level for that year of 
4.4 per 100,000 population, the lowest on 
record. Cyclic increases and decreases in 
malaria customarily recur every five to 
seven years, but the increase expected 
in 1938-1939 failed to materialize except in 
Alabama (1939). Whether this satisfac- 
