The work directed against mosquitoes had an equally good effect upon malaria. While the work done with the view of getting rid of the stegomyia was effective to a certain extent against the anopheles, the principal anti-anopheles work was executed in the suburbs of the city. It is a general rule that malaria does not occur in the heart of a city, but generally in its outlying districts. The reasons for this will become evident when I describe anti-malarial work in one of our future chapters. DEATHS FROM MALARIA IN THE CITY OF HAVANA Year No. 1871 262 1872 316 1873 329 1874 288 1875 284 1876 334 1877 422 1878 453 1879 343 1880 384 1881 251 1882 223 1883 183 1884 196 1885 101 1886 135 1887 269 1888 208 1889 228 1890 256 1891 292 1892 286 1893 246 1894 201 1895 206 1896 450 1897 811 1898 1907 1899 909 1900 325 1901 151 1902 77 1903 51 1904 44 1905 32 1906 26 1907 23 1908 19 1909 6 1910 15 1911 12 1912 4 It will be seen from this table that before the year 1901 Havana had yearly from 300 to 500 deaths from malaria, rising as high in 1898 as 1,900 deaths. Since 1901 there has been a steady decrease in the malarial death rate until the last year of the table, 1912, when there were only four deaths. Four deaths from malaria in a city of the size of Havana, about 300,000 population, means the extinction of malaria in that city. For the island of Cuba is in the tropics, and there are many malarious localities through the country districts. Havana is the metropolis of Cuba, and has in its environs the largest and best equipped hospitals of the country, as well as the most distinguished surgeons and physicians. The sick, therefore, are brought from the country in considerable numbers, and a great many cases of malaria are brought in among these outside sick. The tables quoted above include all persons who died within the limits of the city of Havana, whether they came from the outside, or were residents of the city; whether they died in the large hospitals of the city, or in private houses. Four deaths in one year from malaria can very safely be put down as coming from the outside, and it can with equal safety be said that by 1912, malaria had become as completely extinguished in Havana, as had yellow fever in 1902.