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Bi-903 Jan. 128. UNITED STATES DEPARTMENT OF AGRICULTURE BUREAU OF BIOLOGICAL SURVEY TUL ABMIA, AN ANIMAL-BORNE DISEASE The disease "tularemia" has assumed such proportions in the United States that it appears desirable that the Biological Survey issue a statement summarizing the available information and the procedure that may be recommended by field representatives of the Bureau in their work with the public. The information here pre- sented has been endorsed by the Surgeon General of the United States Public Health Service, and the recommendations made are concurred in by him. NATURE AND HISTORY OF THE DISEASE: Tularemia is a plague-like disease of rodents transmissible to man, It was originally discovered in ground squirrels in Calif- ornia in 1910 by Dr. G. W. McCoy, of the United States Public Health Service. Later (1919) it was found in jack rabbits in Utah, in the work of Dr. Edward Francis and his assistants of the Public Health Service, and was definitely established as the debilitating, disabling, and frequently fatal disease locally known as "deer- fly fever," which was affecting residents and visitors locally in certain country districts in jtah. Of 500 human cases reported in the United States, 20 have terminated in death. Positive diagnosis of the disease, isolation of the causa- tive organism Bacterium tularense, and development of a successful cultural technique were important steps in the history of tularemia and of investigations of wild animals as carriers of this disease. Later work has disclosed human cases of the disease in all States except Washington, Wisconsin, New York, Delaware, and the New England States, twenty-five States having been added to the list in the two years 1925 and 1926, and four in 1927. The disease has also been definitely established as identical with the rabbit- borne disease in Japan, known as Ohara's disease, which affects people there. Discovery of tularemia has cleared up many puzzling cases of illness that in the past have doubtless been wrongly diagnosed as "flu," septic infection, blood poisoning, or other kindred dis- eases, because of a superficial resemblance of the symptoms at some stage of the disease. Human cases have been traced to rabbits or other animals in the locality or to shipments of diseased ani- mals sold in the public markets. This specific knowledge lays the foundation for intelligent action in maintaining essential safe- guards and in protecting the ptblic in the use of important game animals.
-2- Among game animals tularemia occurs in nature in jack rab- bits, snowshoe rabbits, and cottontail rabbits, and is responsible for some of the periodic epizootics that kill them off locally in great numbers. This provides a reservoir for infection of both wild animals and human beings. In the Western States the disease is carried from animal to animal and to man by the bites of infect- ed deer flies and ticks, and ticks also transmit the infection to man in the Southern States. Ticks carry the infection through the winter, and the females transmit it through the eggs to the next generation. Man also becomes infected by handling rabbit carcas- ses, as in dressing them for the table or cutting them up for such purposes as feed for dogs, hogs, foxes, or chickens, or as bait for fish or such carnivorous animals as coyotes. In the Eastern States direct contact in dressing the carcasses is the common means of infection. SYMPTOMS OF TE DISEASE IN MAN: Tularemia is likely to manifest itself first by pain, ten- derness, and swelling of lymph glands draining the region where the infection occurs, as those of the elbow or armpit when infection has occurred on the finger. These symptoms will probably occur withii two to five days after infection, An inflamed and painful ulcer may soon appear at a point where an insect bite occurred, or at an abrasion in the skin where the infection has gained entrance. This may be accompanied by sudden onsets of headache, aching pains, chills, prostration, general weakness, and fever. In some cases no external lesions are found. SYMPTOMS INWILD RABBITS: In wild rabbits a spotting of the liver and spleen with yellowish or whitish flecks is one of the most characteristic and easily recognized symptoms. Stupor or evidence of sickness in a rabbit should be regarded with suspicion, especially if an epi- zootic disease is prevalent. Diagnosis is made by inoculating guinea pigs or other susceptible animals with spleen or liver of a suspected rabbit or other wild animal and then examining a cul- ture isolated after the animals used in the experiments sicken or die. OTHER ANIMALS KNOVWN TO BE SUSCEPTIBLE: In addition to wild rabbits and hares, the California ground squirrel, Columbia ground squirrel, Utah ground squirrel, desert ground squirrel, pine squirrel, yellow-bellied chipmunnk, pocket go- pher, woodchuck, opossum, cat, porcupine, house mouse, deer mouse,