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Louis L. Tureen, M.D.
JAMA. 1932;99(18):1501-1502. doi:10.1001/jama.1932.27410700004010b.
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Permar and MacLachlan,1 in December, 1931, reported a case of tularemic pneumonia and pointed out the grave prognosis of this condition. They state that 36 per cent of all fatal cases of tularemia reported had evidence of pulmonary involvement, either clinically or on postmortem examination. Of the eight cases which came to autopsy, seven showed pulmonary tularemic lesions, five of these being a diffuse pneumonic involvement. The pathologic lesion of tularemic pneumonia, as described by Permar and MacLachlan, is characterized chiefly by interstitial and alveolar necrosis, the basis of which apparently is arteriolar and venous thrombosis of the smaller caliber vessels. In detail, the lesion is one of intense acute inflammation, involving the interstitial tissues, the subendothelial layers and adventitia of the smaller vessels, and the alveolar spaces of the lungs. This is characterized by extreme edema with much fibrin and a cellular exudate chiefly of mononuclear leukocytes. The


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