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MORTALITY REPORT OF THE GiFT J AN 23 1928 TENNESSEE STA TE BOARD OF HEALTH LiBRARV U- ■ 1915 ^Y .9°'°''^<^ 1'843 MOo.o Tuberculoeia (Pulmonars') _ 4085 179 8 Wtite.-". 2'.406 *14o'.6 Colored 1,679 •354.9 TuberciJosis (All Other Forms) 414 18 2 White 2.50 '14! 6 Colored 164 *34.9 Pneumonia (Lobar and Broncho) 2,451 107.8 Cancer (Including All Forms of Malignant Tiunors 775 34! 1 Typhoid Fever (Including Para-Typhoid) 906 39.8 Malaria 49I 2I.6 Pellagra 834 36 7 White.. 464 •27.1 Colored 370 *78.2 Measles 22 0.9 Whooping Cough 157 6!9 Scarlet Fever 33 1.4 Diphtheria and Ooup 489 21.5 Inlluecza 398 17! 5 Cerebro-Spiaal Meningitis 139 6.1 Diarrhea and Enteritis (under 2 years of age) 1,107 49.4 Puerperal Conditions (Total) .324 14.2 Puerperal Septicaemia 161 7.0 Puerperal ((Donditiona other tiian Septicaemia) 163 7.1 Homicides 400 17.6 Suicides I54 §^7 Piaiboad Accidents (All Forms) 132 5.8 Automobile Accidents 31 1.3 Accideut3 (All (Jther) 727 32.0 Smallpox 42 i.g 14,116 •As per Census 1910. To report in great detail on each preventable disease mentioned in Table No. 1 would require more space than is available in a short bulletin. We have there- fore chosen to report in detail on only five, viz., Tuberculosis, Tj^jhoid Fever, Pellagra, Diarrhea and Enteritis of Infants under 2 years of age and Malaria. These diseases constitute the major causes of preventable deaths and therefore offer the greatest hindrance to the progress of the State. —4^ TUBERCULOSIS In Table No. 2 will be found the number of deaths from tuberculosis, grouped according to color of decedent and according to the form of the disease, in each county of the State, together vi-ith the death rate of each, and the per cent of the total number of deaths of each due to tuberculosis. This is to enable a com- parison of the tuberculosis death rate of the State, and the rate of any county or city of the State, with that of any other county in Tennessee, and with the rates of the States given in Table No. 3. From the per cent of all deaths due to tuberculosis the reader is enabled to de- termine the relative importance of tuberculosis as a cause of death. If 20 per cent of the deaths of a county were due to tuberculosis, one out of every five deaths in the county was due to tuberculosis. Bearing in mind that it is by comparison that we determine our relationships with the world about us, we present in Table No. 3 the tuberculosis death rate of each of several States to enable the reader to determine the relationship which obtains between Teimessee and those States with respect to this major health problem. From the data here presented we may get a very broad view of the tuberculosis problem as it exists today in Tennessee. Broadly speaking, we may saj' that the fundamental causes of the disease are more effective, or that the fundamental defects, both indi\ddual and general, which bring about tuberculosis, are present in Tennessee to a more marked degree than in most other States. We would call particular attention to the difference in the White and Colored tuberculosis death rates in Tennessee. This difference is very striking, and in- dicates that the influences which cause tuberculosis predominate among the colored race. It would be improper to think that these 4,499 persons contracted tuberculosis and died of the disease in one year. These deaths, in a majority of cases, marked the ending of a long fight, in which the disease was conqueror. There are now as many more persons in Tennessee who are in the advanced stages of the disease, who will die in 1916, and as many more doomed to the same fate in 1917, which means that on January 1st, 1916, there existed in Tennessee 9,000 persons with the disease (tuberculosis) sufficiently advanced as to prove fatal within two years. It would be impossible to determine accurately the number of moderately ad- vanced and incipient cases existing. It would be reasonable to assume^ however, that there are ten of such cases for each death that has occurred in one year, which would mean that our mortality records indicate that there are now in the State 44,990 persons with a lesion of tuberculosis, of which the individual may, or may not be, aware. The tuberculosis process in these cases may be arrested, or be permitted to advance, depending upon the resistance of the individual. The average age at death from tuberculosis is 34 years. At least, one half of all the persons who died of the disease were either fathers or mothers. They have left the orphan handicapped by a hereditary predisposition to the disease; with the infection in their systems as a result of intimate contact, and in many in- stances in poverty as a result of the prolonged illness in the home. A large num- ber of these orphans as a result of all these circumstances will join the throng of advanced cases as the years go by. —5— There are many other visions of the tuberculosis situation one may get by a careful analysis of the data — a vision which would lead one to recognize that the combined influences which bring about the development of the advanced case of tuberculosis are cumulative in their action, and that some of them are so broad and so far reaching as to link the dead to the unborn. TABLE NO. 2 Showing the number of deaths from Tuberculosis, in its various forms, in each county and city in the State, together with the death rate of each per 100,000 population. Anderson Bedford Benton Bledsoe Blount Bradley- Campbell Cannon Carroll Carter Cheatham Chester Claiborne Clay Cocke Coffee Crockett Cumberland— *Da\idson Nashville Decatur DeKalb Dickson Djer Fayette Fentress Franklin Gibson Giles Grainger Greene Grundy Hamblen 'Hamilton Chattanooga. Hancocke Hardeman Hardin Hawkins Haywood Henderson. -- Henry -. Hickinan Houston Humphreys.. Jackson James Jefferson Johnson *Kcox Knoiville — Lake Lauderdale.. Lawrence Lewis Lincoln Loudon Macon McMinn McKairy... Pulmonary Tuberculosis WTiite i Colored 26 25 12 4 23 25 21 26 41 23 14 12 15 13 2J> 26 14 6 1 1 2 5 12 60 14S 6 S 24 55 15 43 4& Tuberculosis Ml Other Forms White Colored 10 3 2 2 i 3 4 2 1 2 1 4 1 6 20 1 1 3 2 1 3 6 8 C 6 7 1 1 3 4 1 4 2 2 2 6 6 5 1 2 2 2 1 1 1 10 1 1 4 18 1 1 2 5 5 6 1 2 5 13 1 1 3 2 4 1 1 1 4 1 Total No. Deaths 28 37 25 29 61 28 22 19 18 151 34 31 27 8 128 273 15 17 39 51 63 4 36 87 101 27 56 6 31 104 129 10 49 21 41 79 26 39 24 12 27 9 5 26 14 110 as 3 46 36 11 52 22 24 34 22 Death Rate Per 100,000 Populate Percent of Total Deaths 146 15 243 18 110 9 96 8.6 129 10 223 13 76 9 268 19 255 17 128 9 205 18 211 18 72 10 161 23 174 14 198 15 167 12 81 12 279 17 244 12 150 17 110 9 189 16 171 12 206 13 49 7 175 15 200 15 309 23 195 14 178 15 70 13 134 11 230 13 220 11 93 10 212 12 120 18 175 16 301 16 147 14 150 15 138 19 193 17 191 19 60 6 96 9 147 12 93 11 166 12 233 12 32 5 218 14 192 20 161 14 200 17 146 12 156 15 154 9 135 13 —6— •Madison.. - Jackson Marion Marshall Maury MeigB Monroe Montgomery Moore Morgan Obion Overton Perry Pickett Polk Putnam Rhea Roane Robertaon... Rutherford.. Scott........ Sequatchie.. Sevier 'Shelby Memphis Smith Stewart Sulli'/an Simmer Tipton Trousdale Unicoi Union VanBuren... Warren Washington - Wayne Weakley White Williamson.. Wilson Pulmr narv Tuberculosis Beath Tuberculosis AH Other Forms Total ilate Per No. Deaths 100,000 i'opulatn White Colored White Colored 18 22 2 42 181 16 21 ■i 1 40 226 16 10 1 27 137 28 8 3 1 40 232 33 48 3 4 88 215 7 1 8 131 31 6 2 39 178 41 55 7 1 104 309 10 1 11 229 15 1 16 129 30 14 4 2 50 162 33 2 35 204 17 17 193 4 4 80 6 6 39 27 4 1 32 148 16 9 2 27 169 37 6 3 2 48 205 14 24 48 187 39 27 3 4 73 214 10 9 12 86 8 1 9 195 26 1 3 2 32 138 27 124 8 159 243 108 270 14 26 418 286 25 / 2 2 36 194 22 8 30 207 29 2 1 38 121 56 33 7 4 100 396 9 34 2 1 46 155 4 5 9 155 6 1 7 80 28 3 31 271 6 1 t 259 30 6 4 40 242 10 8 4 3 90 278 7 3 2 12 100 38 13 3 1 55 166 34 1 1 36 235 16 13 1 2 32 132 28 22 3 2 55 217 2.406 1.679 250 164 4,499 108.1 Per cent of Total Deaths 13 13 13 17 17 12 14 19 21 10 12 22 18 5 5 14 14 16 11 16 11 23 13 13 12 20 14 U 26 12 13 7 24 28 20 15 9 15 20 12 18 •Outside City . Tuberculoffls, All Forms White Colored 'As per Census 1910 •Death rate Number per 100,000 Deaths Population 2,656 155.2 1,843 405.5 TABLE NO. 3 Showing the Tuberculosis death rates of all Registration States for the year 1913. California 202.2 Colorado 185.9 Conneeticut 140 , 5 Indiana 149.7 Kentuckj- 201.5 Maine 126. 9 Maryland... 194.5 Maasachusette _ 144.2 Michigan ._ 91.7 Minnesota 107. 4 Missouri _ . 143. 5 Montana... 108.8 Average Death Rate All Registration States Death Rate of Tennessee, 1915 White C olored New Hampshire. New Jersey New York Ohio Pennsylvania Rhode Island Utah Vermont Virginia Washington WiscoBsm 120.2 153.3 167.1 132.2 120.9 162.7 48.9 107.4 168.7 92.8 97.8 144.6 198.1 n55.2 •405. 5 There are two States with a tuberculosis death rate above that of Tennessee and twenty-one with rates below Tennessee. Avwage Death Rate of the Rural Part of all Registration States. .A.verage Death Rate of the Registration Cities Rural Part of Tennessee Cities in Tennessee *As per U. S. Census 1910. 126.6 165.5 180.8 240.9 TYPHOID FEVER The reader will please refer to Table No. 4 and compare the death rate of his county with that of the State, and with the rates of the States mentioned in Table No. 5. From this comparison the relationship which obtains between the various units mentioned may be determined with regard to the typhoid problem. Only 21 of the typhoid deaths occurred in March, 1915, whereas 135 occurred in August. The reason for this great difference is that the fly prevails in the sum- mer and fall seasons. It cannot be doubted therefore, that the fly is, by far the most important agent in the transmission of typhoid fever. The average age at death from typhoid fever is 28 years. A large majority of the persons who died of typhoid fever last year were between the ages of 20 and 40. Expert epidemiologists have estimated that about 18 cases of typhoid fever have occurred for each death that occurs in one yea.T. At this ratio there were 16,308 cases of typhoid in Tennessee last year. The mortality rate of typhoid fever may be properly interpreted as reflects the sanitary conditions of the various communities. TABLE NO. 4. TYPHOID FEVER. Showing the number of deaths from typhoid fever in each county in the State together with the death rate of each per 100,000 population. Anderson.. Bedford... Benton Bledsoe... Blount Bradley... Campbell.. Cannon Carroll.... Carter Cheatham. Chester daibonie. hsDea ith rate No. Deaths Death Rate 6 33.9 Clay. 1 10.7 14 61.9 Cocke -. 7 35.9 12 94.0 Coffee.. 9 57.6 4 75.2 Crockett 8 49.6 lU 46.3 Cumberland 2 20.4 4 24.0 •Davidson 22 46.3 6 18.7 Decatur. 8 80.0 8 74.0 DeKalb. 15 97.0 15 62.0 Dickson 9 43.7 8 37.0 Dyer... 22 74.0 b 46.7 Fayette 9 29.6 9 99.0 Fentress 4 49.3 1 4.0 Franklin... 34.1 -8— No. Deaths Death Rate Gibson - 22 51.4 Giles. -.-- 7 21.4 Grainga- - 4 28.9 Greene - 13 41.5 Grundy - 00 Hamblen. 7 49.5 •Hamilton. 10 22.1 Hancock 3 27.8 Hardeman 6 26.0 Hardin 2 11.4 Hawkins. 7 29.6 Haywood 15 57.2 Henderson 13 76.4 Henry 19 73.0 Hickman 4 24.0 Houston ! 5 80.0 Himiphreys - 2 14.1 Jackfisn 9 60.0 James 2 38.4 Jefferson 6 33.8 Johnson 2 13.7 •Knox 16 24.1 Lake - 00 Lauderdale 16 75.7 Lawrence. 4 21.3 Lewis 3 43.7 Lincoln. 10 39.0 Loudon 6 39.8 Macon 9 58.4 McMinn 12 54.5 McNairy 3 18.4 •Madison 13 56.0 Marion 9 45.9 Marhsal! 18 107.1 Maurj' 11 27.2 Meigs 1 16.3 Monroe 10 45.8 Montgomerj-. 31 92.2 Moore 00. Morgan. 7 57.5 Obion.... 16 51.9 Overton 6 34.9 No. Deaths Death Rat« Perry 5 56.8 Pickett - 1 20.6 Polk 4 26.8 Putnam 10 46.0 Rhea... 5 31.4 Roane.. 6 26.2 RoberUon 13 50.7 Rutherford 14 42.2 Scott..... 2 14.3 Sequatchie 00. Sevier... 7 31.2 •Shelby 16 24.6 Smith .- 2 10.8 Stewart 16 108.1 Sullivan.. 5 16.8 Sumner 10 39.0 Titpon.. 11 37.3 Trousdale 3 51.7 Unicoi 2 25.0 Union 3 26.3 Van Buren 00. Warren 6 36.3 Washington 9 28.3 Wayne 5 41.6 Weakley 15 47.0 White 6 37.5 Williamson 13 53.7 Wilson _ - 11 43.4 Total Rural 784 41.3 Nashville.. 43 37.1 Chattanooga __ 12 20.5 Knoxville.. 12 31.3 Jackson. 9 51.1 Memphis 46 31.4 Total City 122 32.4 TotalState 906 39.8 TABLE NO. 5. TYPHOID FEVER. Showing the death rate of the registration area and of all Pvegistration States from t3T)hoid fever for the year 1913. Death Rate per Rural City 100,000 Pop. Death Rate Death Rate Entire Registration Area 17.9 CanfMTlia 15.9 15.1 10.6 Colorado 17.0 17.2 16.6 Connecticut... -.-- 11.3 7.8 12.9 Indiana 25.0 23.6 28.2 Kentucky . 42.7 46.2 27.1 Maine 12.0 10.4 17.3 Maryland... 33.3 36.6 29.5 Massachusetts 7.9 8.7 8.6 Michigan 18.4 13.9 25.4 Minnesota 10.8 9.1 14.1 Missouri 24.4 25.7 22.3 Montana 22.7 19.5 32.0 New Hampshire.... 11.2 11.8 12.1 NewJersey 9.6 8.7 10.2 NewYork - 10.3 11.8 9.9 •North Carolina 57.4 51.4 65.4 Ohio -.-. 24.0 K.O 22.9 Pennsylvania.. 18.1 16.2 ' 20.2 Rhodelsland 8.3 7.3 8.5 Utah 22.2 17.1 20.8 Vermont - 7.8 8.3 4.3 Virginia ... . 33.3 23.1 28.1 Washington 10.3 12.1 7.8 Wteoonsin 9.0 5.7 15. .=i •In incorporate towns of over 1,000 population. —9— DIARRHEA AND ENTERITIS OF INFANTS UNDER 2 YEARS OF AGE Insanitary conditions and improper diet are the two important factors which have contributed to the mortality from this cause. The deaths of many other children over 2 years of age occurred, but they are not tabulated for the reason the standard of 2 years had to be adhered to in order to enable an accurate comparison of the death rate of Tennessee with those of other States. TABLE NO. 6. Diarrhea and Enteritis of Infants Under 2 Years of Age. Showing the number of deaths in each county and city together with the death rate of each per 100,000 population. No. deaths Death rate 11 62.1 11 48.6 1 7.9 12 9 4 Anderson. -- Bedford Benton Bledsoe Blount Bradley Campbell- -- Cannon Carroll Carter Cheatham.. Chester Claiborne _ . Clay Cocke Coffee Crockett Cmnberland *Da\'idson.- Decatm' DeKalb_... Dickson Dyer Fayette 19 Franklin Gibson Giles .- Grainger... Greene Grundy . . . Hamblen... 'Hamilton.. Hancock .. Hardeman.. Hardin Hawkins Haywood-. Henderson. Henry Hickman... Houstoa... Humphreys Jackson James Jefferson... Johnson *Knoi Lake Lauderdale. Lawrence. - Lewis , Lincoln Loudon 00. 55.6 54.0 12.2 54.1 41.8 100. 9 84.1 33.0 56.2 21.5 66.6 64.1 74.9 00. 88.2 9.9 6.4 19.4 53.6 29.4 36.8 48.6 67.6 36.8 72.0 51.4 23.3 77.7 145.8 37.1 21.7 39.9 00. 95.2 52.8 34.5 18.1 00. 21.2 13.3 19.2 22.5 20.6 28.6 10.6 33.2 26.7 43.7 26.9 46.4 Macon McMinn McNairy •Madison Marion Marshall Maury Meigs Monroe Montgomery- Moore Morgan Obion Overton Perry Pickett Polk Putnam Rhea Roane Robertson Rutherford.. Scott Sequatchie... Sevier •Shelby Smith Stewart Sullivan Sumner Tipton Trousdale Unicoi - Union Van Buren.- Wanen Washington-. Wayne Weakley WTiite - Williamson.. Wilson No. Deaths Death 3 2 4 5 9 1 11 11 1 5 16 6 1 2 7 8 7 18 4 7 4 1 7 37 5 5 10 9 15 2 3 1 5 9 5 14 10 Total Rural 817 Nashville - 112 Chattanooga 35 KnoxviUe 22 Jackson 10 Memphis HI Total City 290 Grand total 1,107 •Outside the City. Rate 19.4 49.8 36.8 8.6 20.4 29.7 20.2 16.3 50.4 32.7 20.8 40.3 51.9 34.9 11.3 40.0 44.1 36.4 44.0 78.6 15.6 21.1 28.7 21.7 31.2 56.6 27.0 33.8 33.8 35.1 50.8 34.4 37.9 8.7 00. 30.0 27.8 41.6 43.9 62.5 24.7 31.5 96.3 59.7 57.4 56.8 75.7 48.2 —10— PELLAGRA As will be noted in Table Xo. 7 there occurred 839 deaths from pellagra in Ten- nessee in 1915. Only 11 of the ninety-six counties failed to have a death from pellagra, which indicates that the disease is well distributed over the State. Hard- eman county shows the highest death rate of any of the counties. This is prob- ably explained by the fact that the West Tennessee Hospital for the Insane is located in this county. But few of the States in the registration area have a verj- high death rate from pellagra; in fact, only 1,015 deaths occurred in the entire registration area in 1913> and a large number of these occurred in southern cities and in a few southern States. The Registration States with the greatest number of deaths in 1913 were as follows: Xorth Carolina (in municipalities of over 1,000 population) 157, Kentucky 10-1, Virginia 165. Tennessee had 644 deaths in 1914 and 839 in 1915, an increase of 31.6 per cent. It is difficult to determine as to whether or not the increase is actual or apparent. The question as to whether or not the disease actually increased as rapidh' as indicated above might be raised on the ground that the disease is always recog- nized now, whereas it was not always recognized in the past, but we are unable to determine as to whether or not this is true, or the extent it would affect the death rate if it were true. INTERPRETATION By reason of the fact that the exact cause of the disease is not known we are not in position to interpret our mortalitj' statistics. Accepting as true the recent announcements of Dr. Jos. Goldberger of the U. S. Public Health Ser\-ice, we would be justified in sa}-ing that our mortality rate indicates that a large number of people are eating an unbalanced diet, composed of a disproportionately- large amount of carbohydrate elements, such as bread, potatoes and sw^eets, and disproportionately small amount of proteid elements, such as eggs, meat, milk and legimies. Again one could not say definitely as to whether an unbalanced diet is eaten on account of inability to procure the necessarj' elements for a balanced diet, or on account of an eccentricity in diet. The disease occurrs chiefly among the poorer classes. This observation is made in every country in which the disease occurs. The proteid elements of diet are the most costly elements. The price of a dozen eggs will buy enough meal to last a family much longer than the eggs would last. We are in position to say definitely that a faulty diet is the only influence svhich we know to be a factor in producing the disease, and that a good, well-balanced (jjet is the only agent we know to be of value in curing the disease. Under present conditions then the disease is not susceptible of executive control. The people in the community in which the disease prevails may take the step which will lead to a reduction in the mortality rate of the disease if they feel disposed, by correcting the faults above referred to. —11— TABLE NO. 7. PELLAGRA. Showing the number of deaths from pellagra in each county together with the death rate of each per 100,000 population, for the year 1915. Number Rate per Counties Deaths lOO.OUO Anderson 14 77.9 Bedford-. - - 3 13.2 Benton 1 7.8 Bledsoe 2 37.7 Blount 5 23.1 Bradley 7 42.1 Campbell 5 15.3 Camion 2 18.5 Carroll 3 12.5 Carter. --- 4 18.6 Cheatham.. 4 37.4 Chester 2 22.2 Claiborne 1 4.0 Clay 00. Cocke 2 10.2 CoSEee.. 1 6.4 Crockett .- 3 18.6 Cuiriberland 00. Davidson (outside) 29 61.0 Decatur 2 20.0 DeKalb .- 1 6-5 Dickson 5 24.2 Dyer 4 13.4 Fayette 18 65.5 Fentress 00. Franklin *> 14-6 Gibson 13 30.3 Giles 6 18.6 e=^:::::::::::::::::::: ^ Grundy 3 oo.a Hamblen...... 13 92.2 Hamilton (outside) 2< 59./ Hancock 1 „„?„ Hardeman 48 208.6 Hardin 00. Hawkins.. 2 8.6 Haywood - 19 72.1 Henderson 1 ^-^ Henry - 4 15.3 Hickman 3 18.0 Houston 4 64.5 Humphreys 1 ^.0 Jackson. - 00.0 James 2 d8.4 Jefferson 2 11.3 Johnson... - 00. Knox (outside 42 63.3 Lake.. 00. Lauderdale 6 28.4 Lawrence -- 4 il.-i Lewis 2 M.i Lincoln 6 23.0 Ix.udon — 3 20.0 No . Deaths Death Rate Macon... , 1 6.5 McMinn 16 72.7 McNairy _. 4 24.5 Madison (outside) 7 30.1 Marion .- 8 40.8 Marshall 00. Maury ..- 14 33.1 Meigs 00. Monroe - - 1 4.5 Montgomery 13 38.6 Moore « 00. Morgan 2 16.1 Obion.. 5 16.2 Overton 1 5.8 Perry 1 113 Pickett - 00. Polk .-- 3 19.3 Putnam 2 9.2 Rhea 11 69.0 Roane. H 48.0 Robertson.. 6 23.4 Rutherford .-- 00. Scott 2 14.4 Sequatchie 00. Sevier 1 4.4 Shelby (outside) S>4 143.9 Smith 1 5.4 Stewart 1 6.7 Sullivan 2 6./ Sumner 3 11.7 Tipton 11 37.2 Trousdale 1 17.2 Unicoi .- 1 12.6 Union 1 J-7 VanBuren 00. Warren 6 30.3 Washiagton 7 21.6 Wayne 2 16.6 Weakley 2 6.2 White 6 37.5 Williamson 3 12.4 Wilson.. 9 35.5 Nashville 34 29.3 Chattanooga 52 88.8 Knoxville 34 88.9 Jackson 8 4o.8 Memphis HO '6.8 Total 839 36.7 White-.-. 469 '27.4 Colored 370 '78.2 •As per census of 1910. —12— MALARIA In the table herewith presented mil be found the number of deaths from malaria in each county and city in the State, together mth the death rate of each from this cause for the year 1915. This disease is not so extensively distributed as other diseases. It prevails chiefly in one grand division of the State. One cannot accurately determine the number of cases of malaria that occurred last year, because this disease is not so fatal as many others; in fact, it has no definite mortality rate. It has been estimated, however, that at least 300 cases of the disease have occurred in one year for every death that occurs in this time. This is one of the most conservative of the many morbidity estimates made. At this rate there were 149,100 cases of malaria in Tennessee last year. The enormity of the amount of sickness from this cause in one year is therefore apparent. Some of the cases, of course, were more or less chronic; some were acute, and the amount of time lost by bread winners from gainful occupations cannot be determined. The financial loss which each community suffers in one particular may, however , be approximately estimated. Fertile lands in a malarial section will not sell for more than ten to twenty-five per cent of the price less fertile lands bring in a non- malarial section. The scientific questions involved in the prevention of malaria have been worked out probably more definitely than those of an}' other preventable disease, and the prevention of the disease can be accomplished probably as cheaply as any other. Its prevention, however, cannot be made so much an individual matter. It may be said that the prevention of malaria will be accomplished only by a concerted community effort. SCIENTIFIC CONSIDERATION The fundamental scientific facts upon which rests the structure of malaria pre- vention are these: 1. Malaria is caused by a germ — the Plasmodium malariae. 2. This germ is transmitted from person to person by one species of mosquitoes. 3. The germ remains alive in the blood of a person who has had an attack of the disease for years, provided treatment is not properly administered, or not con- tinued a sufficient length of time. These are called "malaria carriers," and con- stitute a constant source of infection. From these statements of facts we may arrive at three conclusions with respect to the prevention of malaria. We may conclude: First, that if there were no mosquitoes of a certain type malaria would cease to occur; second, if there were no malaria carriers there would be no source from which a mosquito could get the germ, and therefore the disease would cease to occur; third, if a well person could prevent an infected mosquito from getting access to him the disease would cease to occur. These conclusions suggest three lines of procedure in preventing the disease: —13— 1. That of mosquito eradication. 2. That of properly treating all malaria carriers. 3. That of screening the house so as to prevent the access of mosquitoes. Experience has taught that either of these lines of procedure may be pursued with pronl, but that the best results Nnll follow the adoption of all three of them- DESTRUCTION OF MOSQUITOES The destruction of the mosquito is accomplished by draining or treating stag- nant ponds of water of certain types. Fish and ducks may be employed to some advantage when neither of the other two methods are practicable. The treatment of a carrier should be administered by a physician. It can be carried out in winter, or in summer, and should be done in coimection with bac- teriologic work, in order that carriers may be diagnosed and their cure determined by this means. Screening should be a 2S-mesh, and should be well done, and they should be kept closed. One need only mention that the canal zone has a relatively small amount of malaria now as compared with previous years to convince the most skeptical that money properly spent in the prevention of malaria will accomplish gratifying results. TABLE NO. 8. MALARIA. Showing the number of deaths in each county and city, together with the death rate of each. Death rate No. deaths per 100,00 Anderson _ 00. Bedford 00. Benton 7 55.1 Bledsoe 00. Blount...- 00. Bradley 00. Campbell 00. Cannon 00. Carroll 11 40.0 Carter 00. Cheatham 5 40.7 Chester 3 33.3 Claibome 00. Clay 3 32.2 Cocke 00. Coffee 1 6.4 Croekett 6 37.2 Cimiberland 00. 'Davidson 00. Decatur 00. DeKalb 00. Dickson 2 9.7 Dyer 16 53.6 Fayette 16 62.2 Fentress... 00. Franklin 6 29.2 Gibson 19 44.3 GUes... 8 24.3 Grainger 00. Greene... 00. —14- Ko. Deaths Death Rate Grundy 00. Hamblen 00. *Hamilton 5 11.0 Hancock 60. Hardeman 6 26.0 Hardin 6 34.2 Hawkins 00. HajTTOod 16 61.0 Henderson 7 41.1 Henry 7 26.9 Hickinan 1 6.0 Houston 00. Humphreys 4 28.3 Jackson 00. James 1 19.2 Jefferson 1 5.6 *Knox 00. Lake 6 63.9 Lauderdale 23 109.0 Lawrence 00. Lewis 00. Lincoln 00. Loudon 00. Macon 00. McMinn 1 4.5 McNairj- 7 42.9 •Madison. 19 82.3 Marion 2 10.2 Marshall 3 17.8 Maury 1 2.4 Meigs 00. No. Deaths Death Rate Monroe 1 4.5 Montgomery 2 5.9 Moore 00. Morgan 00. Obion 15 48.7 Overton 00. Peny ..-.. 6 68.1 Pickett- 00. Polk 00. Putnam 00. Ehea 00. Roane 00. Robertson 1 3.9 Rutherford 1 3.0 Scott.-. --• 00. Sequatchie 00. Sevier 00. •Shelby 66 101.0 Smith 1 5.4 Stewart 5 33.7 SulKvan 00. Sumner 00. No. Deaths Death Rate Tipton 40 135.5 Trousdale 1 17.2 Unicoi.-- 00. Union 00. VanBuren.. 00. Warren 00. Washington 00. Wayne 3 24.8 Weaklev 5 15.6 White.;.- 6 37.5 Williamson 1 4.1 Wilson 00. Nashville 5 4.3 Chattanooga 00. Knoxville 00. Jackson 10 56.8 Memphis 106 72.5 Grand Total 497 21.6 'Outside city. —15— UNIVERSITY OF CALIFORNIA LIBRARY BERKELEY Return to desk from which borrowed. This book is DUE on the last date stamped below. LD 21-100jn-7,'52(A2528sl6)476 "^^sBIBflBI^ 6462o3 PUBLIC HEALTH UBRARV J //5' UNIVERSITY OF CALIFORNIA LIBRARY