DISTRIBUTION OF MALARIA 
with the tertian or quartan parasite. In 
areas where the tertian parasite alone is 
indigenous, accurate mortality records con¬ 
stitute a relatively faithful picture of this 
infection. 
Attempts to compare the number of re¬ 
corded cases of malaria in a given geo¬ 
graphical or political subdivision of a 
country with the number of malaria deaths 
have been consistently disappointing. Dur¬ 
ing the period 1917-1919 American white 
troops stationed in camps in malarious 
areas in the Southern United States had a 
ratio of one malaria death to 415 cases 
(Ireland 1925). This furnished a satisfac¬ 
tory check on the minimum of expected 
mortality, since all suspected cases were 
hospitalized and were checked by adequate 
blood-film examination. By contrast, the 
ratio of malaria deaths to cases reported to 
boards of health in certain southern states 
in 1934 ranged from 1:2.7 to 1:103.8 
(Faust and Diboll 1935). Moreover, al¬ 
though the ratio of reported death rates and 
case rates for malaria in the State of 
Georgia for the year 1939 was as high as 
1: 336 in one county, in three counties it 
was only 1: 2, in one, 2: 3, in five, 1:1, and 
in one county two deaths were listed with 
but a single illness recorded (Abercrombie 
1940). Since the maximum expected ratio 
in Tropical America is approximately 
1:100 under conditions of high endemicity, 
it is clear that only a fraction of malaria 
cases in many states is reported to the 
bureaus of vital statistics. 
In any malarious area, the economically 
lower strata of the population constitute 
the majority of the infected population, due 
to greater exposure and reduced resistance 
to infection and financial inability to pay 
for adequate treatment. Life insurance 
companies confining their business in the 
South to persons able to pay for standard 
policies have had no evidence of actuarial 
loss as a result of malaria (Faust 1939a). 
Infants are particularly susceptible to 
malaria and mortality is very high in the 
one-month to five-year age group. Toler¬ 
ance to infection tends to develop rapidly 
and reaches its height at adolescence. 
Later, especially after middle life, tolerance 
is appreciably reduced (Dauer and Faust 
1936). 
Distribution of MalAria in the United 
States and Canada 
Conservative evidence indicates that ma¬ 
laria is today indigenous in 36 of the United 
States. These include all of the southeast¬ 
ern states ( i.e Virginia, North Carolina, 
South Carolina, Georgia, Florida, Ken¬ 
tucky, Tennessee, Alabama, Mississippi, 
Arkansas and Louisiana); a large portion 
of Oklahoma and Texas; Missouri (espe¬ 
cially the southeastern section); several 
counties each in New York, Pennsylvania, 
New Jersey, Maryland, Ohio, Indiana, Illi¬ 
nois and Michigan; all three counties of 
Delaware; the counties in Wisconsin, Iowa 
and Minnesota adjacent to the Mississippi 
River; Southeastern Kansas and probably 
Gage County in Southeastern Nebraska; 
several counties in New Mexico, Arizona 
and California; two counties each in Wash¬ 
ington and Oregon; Boise County, Idaho, 
and possibly Mesa County in Central West¬ 
ern Colorado. The states apparently free 
of indigenous malaria today are the New 
England States, West Virginia, North Da¬ 
kota, South Dakota, Utah, Wyoming, Mon¬ 
tana and Nevada. 
Malaria is not, and has not been for many 
years, indigenous in Canada. 
Malaria Mortality in the United States 
While mortality rates by states are of 
some value, a much more accurate evalu¬ 
ation of malaria can be obtained from a 
map showing the relative mortality rates 
for each county. Such maps have been 
compiled by Maxcy (1923) for the entire 
United States for the period 1919-1921; by 
Faust (1932) for the Southern United 
States (1930); by Dauer and Faust (1936) 
for the Southern States (1929-1933); and 
by Faust (1940) for the Southern States 
(1929-1938). The accompanying map 
(Fig. 1) provides a 10-year average by 
counties for the entire United States for 
the period 1929-1938 and is based on sta- 
