TULAREMIA

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Abstract
Within a period of two years, three fatal cases of tularemia have been observed at the Johns Hopkins Hospital. It is my purpose in this communication to report the clinical and pathologic data furnished by these three cases. The account graphically illustrates the evolution of the recognition of a disease the identity of which has only recently been established. The first patient died without a definite clinical diagnosis. Miliary tuberculosis seemed the most likely of the many diseases suggested, among which tularemia was not included. The pathologic changes were at first not definitely identified. The second case, occurring a year later, was diagnosed clinically only shortly before death, when a hitherto neglected primary lesion attracted attention. A more careful inquiry then elicited the story that shortly before the onset of his illness the patient had injured his thumb while skinning a wild rabbit. So strikingly did the results of the

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