In the accumulating literature on clinical studies of tularemia there is expressed a growing belief that tularemic pulmonary complications are of ominous prognostic significance and that tularemic pneumonia is in itself the chief cause of death from this infection. Personal experience and a study of case records covering more than 750 cases of acute tularemia are not in agreement with this view. A survey of the morbidity and mortality data now available indicates that tularemic pneumonia cannot possibly be the chief cause of death.
Up to the close of 1935 there had been reported to the United States Public Health Service 6,206 cases of tularemia, with 299 deaths, a fatality rate for the series of 4.8 per cent. Despite accurate methods for diagnosis, many nonfatal cases and an unknown number of deaths escape detection annually. The typhoidal clinical type is the one most frequently misdiagnosed. Also, as I