495 
was  25,735,  while  the  average  aclnnsbiuns  were  (2,433  or  33^2  per  cent, 
of  the  average  total  admissions.  That  is  to  say,  that  of  all  cases 
admitted  to  the  hospitals  of  the  Colony  one-third  are  due  to  malaria, 
and,  as  Dr.  Ritchie  of  Annotto  Bay  pointed  out  in  connection  with  his 
returns,  this  does  not  represent  the  total  amount  of  malaria,  as  a 
considerable  proportion  admitted  for  other  causes  are  complicated  with 
malaria. 
It  is  true  that  the  average  death-rate  from  malaria  in  the  hospitals, 
that  is  to  say,  the  case  mortality,  is  low  (i'5  per  cent.),  but  the 
importance  of  this  large  admission  rate  lies  not  only  in  the  loss  of 
labour,  but  in  the  great  expense  to  the  Colony.  Taking  the  figures 
from  the  Annual  Report  for  1907-8,  I  find  that  the  total  cost  of  the 
hospitals  (including  Kingston)  was  A  19,185  i8s.  7d.  But  a  third  of 
the  patients  were  admitted  for  malaria,  so  that  a  third  of  the  cost  may 
be  charged  against  them.  In  other  words,  the  cost  of  malaria  in 
1907-8  was  approximately  ^6,395,  and  this  amount  is  likely  to 
increase. 
From  this  point  of  view  alone  the  necessity  for  energetic  anti- 
malarial  measures  seems  amply  indicated. 
The  increase  appears  to  be  largely  due,  so  far  as  I  can  judge,  to 
a  rise  in  the  number  of  coolie  admissions,  and  the  hospitals  which 
show  the  largest  numbers  of  malarial  admissions  are  those  situated 
in  the  agricultural  districts  employing  a  large  number  of  coolies  and 
which  also  have  the  largest  number  of  coolie,  admissions.  In  more 
than  one  Annual  Report  expressions  like  the  following  occur :  — 
‘  Annotto  Bay  Hospital  comes  first  with  1,780,  while  Port  Antonio  runs 
a  good  second  with  1,61 1  cases,  Lionel  Town  coming  third  with  933 
cases.’  Statistics  as  to  the  number  of  coolie  admissions  to  hospital 
will  be  found  in  the  Annual  Report  of  the  S.M.O.  for  1907-8. 
And  as  most  of  the  coolies  are  indentured  and  are  under  strict 
regulations  this  is  a  factor  which,  as  I  shall  show  'when  dealing  with 
the  question' of  prevention,  it  should  be  possible  to  control  to  a  very 
considerable  extent. 
Malaria  on  Estates. 
In  order  to  obtain  an  idea  as  to  the  annual  loss  to  estate  owners 
from  sickness  among  coolies,  I  requested  Mr.  Pearce,  the  Director  of 
Immigrants,  to  be  kind  enough  to  supply  me  with  a  number  of 
