In 1891 morbidity of
............30.6 per cent.
" 1892 " " " ...........
" 1893 "
" 1894 " " " ...........
" 1895 " " " ...........
" 1897 " " "...........
The average yearly morbidity for the years 1870 to 1882 was 211.3 per cent., in contrast to 30.4 per cent, for 1891 to 1897.
The striking diminution of malaria in the army is to be referred in part to the improvement in the sanitary conditions, and in part to an independent decrease in endemicity.
On the Balkan peninsula, Albania and the majority of the coast towns of Greece are severely infected; among the islands, Crete, Cephalonia, Santa Maura, and Corfu.
The Apennine peninsula shows principally two great centers, one in the plains of the Po, the other the western coast from Pisa downward. Over the Lombard and Venetian lowlands are scattered mild or moderately severe foci. The worst infected places are the provinces of Novara and Cremona (the region between Pandino and Somino). On the Adriatic coast numerous extensive and severe centers are found in the provinces of Venice, Padua, Rovigo, and Ferrara.
On the west coast of Italy the malarial region begins at the mouth of the Arno and reaches its first high level in the neighborhood of Grosseto (Maremma Toscana), from where, to Civitavecchia, it lessens in severity. A little southwest from here begins the markedly infected Roman Campagna, which runs into the malarial hotbeds of the Pontine marshes between Velletri and Fondi. Particularly fatal are the surroundings of Sermoneta, Sezze, Roccasecca, Pros sedo, and Amaseno. Further south the banks of the Garigliano and Volturno are strongly infected; less so, the vicinity of Naples. To the south of Salerno, in the neighborhood of Paestum, an extensive focus is found, and from here downward numerous smaller more or less severe foci. Yet not alone the coasts of the peninsula, but also the interior of the country, especially the provinces of Molise, Apulia, and Basilicata, and, in a lesser degree, Calabrie, show numerous and sometimes very severe centers (Montefalcone, S. Croce, S. Bartolomeo, in Galdo, Castellucio, S. Mauro, etc.).
Sicily is more intensely infected than the mainland, both on the coast and in the interior, and especially the southern half of the island. Sardinia has also foci of the most virulent kind, and the same is true of the eastern coast of Corsica.
For the study of malaria in Italy we recommend the chart issued in the year 1894 by the "Direzione generale della statistica del regno." This shows in colors the malaria mortality for the three years 1890, 1891, and 1892. We draw from this splendidly executed chart that extensive foci (for instance, the Campagna) exist in Italy, in which the yearly malaria mortality amounts to 2 to 3 per cent, of the population. In a considerable number of places (the Pontine marshes, many places in Sardinia) the mortality exceeds 8 per cent.
The Pyrensean peninsula shows foci on the south and west coasts (fewer on the east coast) and along the marshy banks of the Guadiana, Guadalquiver, Tajo, etc. We find the disease also on the plains of Castile and Estremadura (Madrid and Merida). Among the Balearic Islands Majorca is strongly infected.
In France the most malaria is found in the south and west. On the west coast it is especially the salt marshes (Marais salants) employed in the salt industry between the Loire and the Seuclre that develop foci. Notorious is the vicinity of Rochefort, Marenne, and Brouage. Larger centers are found west of the Rhone delta. In the interior of France, Dombes, Sologne (Loire and Cher), and Brenne (Indre) are swampy and infected.
In Switzerland, in the southern portion of the Canton Tessin and surrounding the outlet of the Rhone into Lake Geneva, the disease is not uncommon.
In the southwest, on the banks of the Rhine (in lower Alsace and in the Pfalz and Rhine valleys) and along the lowlands of the Danube, malaria is not infrequently found. It is almost never seen in central Germany, but appears occasionally in the North-
German lowlands (along the course of the Vistula, Oder, Elbe, Weser, and the Rhine), in Schleswig-Holstein, Hannover, Oldenburg, Westphalia, and in the low regions of the lower Rhine.
Among the European countries Holland was, in the past, the worst infected, and even yet shows the disease widely distributed, though decidedly decreased in severity. The low lying districts of Belgium, especially the provinces of West Flanders and Antwerp, display numerous endemic foci.
Great Britain at the present clay is entirely free from the disease.
In Denmark it is endemic on the islands Laaland and Falster.
Though Norway is almost exempt, Sweden has recently shown several endemic foci (Hedemora, Kalmar, Hudiksvall).