Tularemia

Abstract

fULAREMIA is a topic of interest to the physician IL in general practice and to various specialists, including internists, surgeons, dermatologists, pediatricians, and even at times gynecologists.1' 23.5,9 It is by name an appropriate subject for consideration in Tulare County, California, from which it derives that name. In 1911 here in Tulare County, McCoy and Chapin isolated the bacterium tularense in ground squirrels which were dead or dying due to a disease affecting them at that time.3 The author has been told by oldtimers of this city that their field work was carried out in the area about 12 or 14 miles south of the town of Tulare. A guess is that McCoy and Chapin were most fortunate in locating a transitory localized epizootic. As a boy here, and sometimes in or near the very spots where they worked, I personally and with bare hands skinned or cut open numerous squirrels and rabbits, and knew dozens of other boys who did. Wearing gloves to do these things would have been ridiculous to us in those days, but I never heard of infection or sickness resulting. In the many years that I have practiced medicine here I have been interested in tularemia. I have always hoped to find a case and have had agglutination tests made in search of it innumerable times. But I had seen no tularemia in Tulare County until in June, 1946, I found a bona fide case of it which was contracted within this county. The disease must be *rare in this place of its scientific birth. Aside from the case I reported, I have been informed through the Tulare County Health Department that it has no record of any tularemia being reported in Tulare County from December 31, 1940, when reliable records on it were started, to the time of writing this, except one in 1944 reported by an osteopath. Of this last-mentioned case there is no record with the County Department (or with the State of California Department of Public Health) concerning the methods used to diagnose nor any follow-up report of the case. In the circumstances, I am inclined to withhold judgment as to its authenticity. Of course, the number of wild rabbits and squirrels in this vicinity has greatly decreased since 1911, but on the other hand the human population has greatly increased. The California State Department of Public Health has kept records on tularemia since 1927, and on June 2, 1928, the disease was made officially reportable in this state. In the period 1927 to 1946 inclusive, there have been only 322 cases reported to the State Department from all the counties of the vast area of California. Of these, 75 were not chargeable to any one locality and included were patients already ill or in whom the disease had been diagnosed before they entered this state, or who were itinerants. Although in Fresno County, which adjoins Tulare County on the north, just six cases have been reported in this period 1927 to 1946 inclusive, in Kern County, bordering us on the south, 48 cases have been reported during that time. But the state authorities waited ten years with special interest watching for a case from Tulare County, until in 1937 two cases were reported in that one year. Altogether there have been just six cases ever reported to the State Department from Tulare County, and in one of these the infected person had been skinning rabbits in Missouri. Since another case was the one reported in 1944, there remain only four cases, over a period of about 20 years, with officially established diagnostic reports, which in my opinion can be considered as probably having their source in Tulare County. After the work of Francis in 1919 it was known that the Pasteurella tularensis definitely caused the disease in humans.2 In scanning works upon the subject I get the impression that Foshay has given us more information than anyone else in recent years. Tularemia has sometimes been called Francis' disease, deerfly fever, rabbit fever, Ohara's disease, and several other names.3 The common methods of contracting infection with Bacterium tularense, such as skinning or dressing wild rabbits or squirrels, tick or horsefly bites, animal bites, and laboratory infections, are added to by numerous and various contacts with many kinds of other animal life. The disease can be caught by handling infected animals with no known abrasion of the skin being necessary, by ingestion of infected and insufficiently cooked flesh, and probably by inhalation.