196 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
probably 35th is more accurate. Further, the isothermal of 55 0 includes all these 
areas, while most of them lie within the isothermal of 6o°. The mean annual rainfall 
is as great as fifty inches in Louisiana, Mississippi, Alabama, Tennessee, Georgia, and 
Florida, while in the rest it lies between forty and fifty. 
Tennessee I have considered as positive, although I could find no actual state- 
ment regarding it, but 1 have inferred from the Tri-State (Alabama, Mississippi, 
Tennessee) investigation, of which an abstract only was available, that it occurs in 
Tennessee itself. 
It is possible, too, that blackwater may occur in Kentucky, Washington, and a 
few others with high malarial mortalities. The data, however, shew that between 
blackwater fever and severe malaria there is, in fact, an extremely close correspondence. 
Central America and W est Indies. 
References will be found in the bibliography to its occurrence in Central 
America, 58 Nicaragua, 50 Costa Rica, 60 Venezuela (Caracas, 01 and the Orinoco river 62 ), 
and in Cuba. 65 The history of its occurrence in the West Indies 64 is an ancient one. 
Dutrouleau 05 says it occurs particularly in the most intense malarial localities of 
Fort de France, Martinique, and Point a Pitre, Guadeloupe. Only exceptionally at 
St. Pierre and Basse Terre. It was observed by M. L' herminier as early as 1828- 
1838, and in 1853-1854. 'Continued longer, quinine treatment may be dangerous, 
