Medicine: Tularemia

Autumn had cleared Maine’s Moosehead Lake of its summer visitors and lonely little Kokadjo was lonelier than ever when Allen Macdougall, 61-year-old trapper, one day noticed a small infection on his leathery left hand. There had been a few scratches on it when he skinned some foxes a week or so before, but that seemed nothing. In his years of trapping he had had hundreds of scratches, skinned hundreds of foxes. Trapper Macdougall went on following his lines, coming home at night to sleep alone in his tiny, mud-chinked hut near the deserted sporting camp whose summer patrons he guided.

At Greenville (pop. 1,000), 22 mi. south of Kokadjo, Nurse Eleanor Hamilton got word from another trapper in mid-November that Allen’s hand was mighty bad. Snow had not yet shut Kokadjo in for the winter. Nurse Hamilton found the lean, grey trapper still up & around, but his hand was swollen like a puffball and he felt chilly and feverish. She bathed his hand, gave him some pills and something hot to drink. She came back off & on for two weeks but by then Trapper Macdougall was so much worse that she got a neighbor with an automobile to drive him into Greenville’s hospital. Greenville’s Dr. Norman Nickerson had never seen anything like the trapper’s illness. With his temperature rising and falling it seemed as if he had typhoid. Yet there were no other typhoid symptoms. Dr. Nickerson called in Dr. Coombs from Augusta and Dr. Donovan from Houlton. They had a look at the patient, nodded gravely. Outside his hospital door they admitted that they too had never before seen anything like it. The three adjourned to Dr. Nickerson’s office, thumbed through his medical books, returned to the hospital, then back to the books. Finally by a system of trial and error they diagnosed Trapper Macdougall’s ailment as tularemia. Only treatment they knew of was an early blood transfusion from a human being who had recovered from the disease. Their patient was already too far gone for that. Besides, no one in New England or Canada had ever before been known to have tularemia. All they could do was to make Allen Macdougall as comfortable as possible until, last week, he died. Though tularemia has of late years been observed in Russia and Japan, U. S. medical men boast of it as “the first American disease.” Butchers and trappers have long known that a strange sickness sometimes came from skinning rabbits. Beginning in 1907 various U. S. physicians described illnesses which they called “rabbit fever,” “deer-fly fever,” “a plaguelike disease of rodents.” In 1912 Drs. George Walter McCoy and Charles Willard Chapin of the U. S. Public Health Service isolated a new organism from sick ground-squirrels in Tulare County, Calif., named it Bacterium tularense after the county. Not until 1921 did Dr. Edward Francis of the U. S. P. H. S. discover that all the variously-named illnesses were the same disease, caused by Bacterium tularense. He named it tularemia. Periodically thinning out the rabbit population by thousands, tularemia also affects many another small animal. Its germ is carried from animal to animal by deer-flies, ticks, lice, fleas. Man may contract it from insect bites, or by direct contact with an infected animal. It usually begins with a small ulcer at the point of infection, followed by glandular swelling. Tularemia kills only about 4% of its human victims but illness is painful, convalescence slow. Up to 1924 only 15 human cases of tularemia had been reported in the U. S. As doctors began to recognize it the numbers jumped. Last year alone, there were 1,021 known cases, with some 50 deaths. No specific treatment for the disease was known until last year, when Bacteriologist Lee Foshay of the University of Cincinnati reported development of a curative antiserum. Commonest in Illinois, Ohio, Virginia, tularemia has been found in all states except Delaware, Washington and, until Allen Macdougall skinned a sick fox, New England.