Ticks – Snakes in the Garden of Eden

The dichotomy of good and evil is central to human perceptions of right and wrong. That which is good is right, generally promoting the continuity of life in harmony with nature. That which is evil is wrong, opposed to the sanctity of life and the dignity of the individual. Morality is the systematic assignment of qualitative goodness to any activity or belief which in some cases may be absolute but which is more often relative; it is one of the core principles of philosophy, literally the love of knowledge or wisdom. The philosophers of Ancient Greece eventually settled on its three essential elements: physics or the natural philosophy of material objects; ethics or moral philosophy – dealing with the freedom of material objects; and logic or formal philosophy – things not associated with material objects. Immanuel Kant took exception to conflating empirical philosophy which is bound to the material world of objects with pure philosophy; his ultimate purpose to establish “the supreme principle of morality.” Observing that “nothing can possibly be conceived in the world, or even out of it, that can be called good without qualification,” he ultimately concludes that “while we do not comprehend the practical unconditional necessity of the moral imperative, we yet comprehend its incomprehensibility (sic),” acknowledging that there is a universal kingdom “to which we can belong as members then only when we carefully conduct ourselves according to the maxims of freedom as if they were laws of nature.” [1]

The Bible is a tome of sixty-six books that institutes Judeo-Christian morality. The thirty-nine books of the Hebrew Old Testament consist of laws, history, poetry and prophesy; the balance form the Christian New Testament, mostly gospels and epistles supplemented by the historical acts of the apostles and a prophetic revelation. Genesis, as the first of the five introductory books called the Pentateuch or Torah, is traditionally ascribed to Moses. Scholarly exegesis has established that there are at least two and probably four different sources; two different names (Elohim and Yahweh) for the one and only God are among the more obvious fallacies of singular mosaic origin. [2] Genesis means origin; the book’s first chapter posits how God created everything: the sun, moon, and stars of the heavens; the waters of teeming creatures and the land of plants and wild animals of the earth; and, on the sixth day, man. Eve is created from Adam’s rib; they were “both naked and they felt no shame” in chapter two’s Garden of Eden. The third chapter is devoted to the morality of good and evil; the insinuating serpent induced Eve to eat of the fruit of the tree of knowledge which she shared with Adam; immediately “they knew that they were naked; and they sewed fig leaves together to make themselves aprons.” The wrathful God metes out eternal punishment for this the first transgression: slithering for snakes, painful parturition for women and eating thorns and thistles for men. [3] The importance of morality to western religion is evident in the sequence of these first three chapters, it is the very first act of God in dealing with his troublesome creation. It is a matter of some irony that nakedness is depicted as the first instance of evil, a complicating factor of religiosity that has banned bare bodies since, naked apes no more.

Theodicy is the justification that God can allow evil to exist. It is a necessary distinction when faced with catastrophe; the answer to “how could God let this happen?” The term was coined by the German polymath cum philosopher Gottfried Leibniz by combining the Latin words for god and justice; he is also noted for formulating the calculus concurrent with Isaac Newton. The moral conundrum is posed as a syllogism: If God is all-knowing and all-seeing, then He could have made the world without evil: “Therefore God did not choose the best course.” Leibniz argues in moral justification that evil can contribute to the greater good and therefore be acceptable: “For example, the general of an army will prefer a great victory with a slight wound to a state of affairs without wound and without victory.” He notes that similar conclusions were made by Saint Augustine and Saint Thomas Aquinas who both maintained that “permission of evil tends towards the good of the universe.” He further applied theodicy to biblical doctrine: “…the fall of Adam was termed felix culpa, a fortunate sin, because it had been expiated with immense benefit by the incarnation of the Son of God: for he gave to the universe something more noble than anything there would otherwise have been amongst created beings.” [4] While Leibniz’s evil as a greater good is surely conceptually valid, it misses a key point: Without evil there can be no good for there must be a relative benchmark; all good is no good. White is the symbolic color of goodness and purity (excepting Moby Dick) but it is really a combination of all colors. Black is the symbolic color of evil, the absence of all color. Gray is both black and white.

Nature is neither good nor evil; it is amoral. It has its own laws that dictate survive or demise; it applies equally to black panthers and white rabbits, good and evil are relative only to eater or eaten. Kipling’s Mowgli learns that the law of the jungle is the oldest law in the world from his mentor Baloo, the wise brown bear, it is a “Law that ye may not break.” It is fear. “Now ye shall know fear, and when ye have found him ye shall know that he is your master.” Fear holds sway over every activity as it is the fount of survival. The wolves who protect the man-child Mowgli in his innocence of fear from the tiger Shere Khan are his brothers whose codicils supplement the one law. “Ye may kill for yourselves, or your mates, and your cubs as they need, and ye can; But kill not for pleasure of killing, and seven times never kill man.” [5] Artistic license and anthropomorphic animals aside, there is considerable veracity here. Wolves eat only when they are hungry and are in great peril due to their hunting of humans, however rare. As Europe’s last surviving large predator, wolves were considered with some legitimacy to be inimical and warranted revulsion, due in no small part to attacks by rabid wolves. France has been a coherent nation state for centuries with vast expanses of forests and rural habitation; there are 5,379 records of both predatory and rabid wolf assaults between 1571 and 1890. Attacks on young children eaten bones and all led to a broad public abhorrence captured in fairy tales like Perrault’s Little Red Riding Hood. State sponsored bounty hunting for wolves led to their extirpation bin France by 1930. [6] The European immigration to North America included people, plants, animals and prejudice, the big bad wolf among them.

The Anthropocene Epoch will ultimately become a geologic stratum of plastic and concrete to mark its passage. In North America, it took just four centuries to cut, plow and then pave the land with concrete from one shining sea to the other, traversed by cars and planes made largely of plastic. Native flora and fauna have not fared well; old growth forests and predators like wolves have taken the brunt. Some prescient observers saw this coming, Aldo Leopold among them. “Only the mountain has lived long enough to listen objectively to the howl of a wolf. I now suspect that just as a deer herd lives in mortal fear of its wolves, so does a mountain live in mortal fear of its deer. The cowman who cleans his range of wolves does not realize that he is taking over the wolf’s job of trimming the herd to fit the range. He has not learned to think like a mountain. Hence, we have dustbowls, and rivers washing the future into the sea.” [7] There is hope, however, as the blinding flash of the obvious has now become mainstream and the need for a remediating balance is manifest in public policy. The reintroduction of wolves to Yellowstone National Park in 1995 ended the devastation of riverside willows by the grazing elk, a sequel is planned in Mozambique’s Gorongosa National Park to give rewilding a global scope. [8] Even coyotes may be getting a reprieve, a “uniquely American animal that has many of the traits that are admired around the country.” [9] It is becoming increasingly evident that Nature really does know what’s best.

The flora, fauna and fungi that live, reproduce and die in forests and fields do so according to the natural ‘law of the jungle.’ Their relationships were well established long before Homo sapiens happened upon the scene. While we have terraformed much of what once was, there are pockets of wilderness and swaths of reconstituted woods that remain. When we venture forth it is the wildness of the habitat that we seek, if only to escape, just for a time, the strictures of man-made.

Come forth into the light of things
Let Nature be your teacher

She has a world of ready wealth
Our minds and hearts to bless
Spontaneous wisdom breathed by health
Truth breathed by cheerfulness.

One impulse from a vernal wood
May teach you more of man;
Of moral evil and of good,
Than all the sages can.

And it is on the terms of the wild host that we visit, trespassing really, into their unsullied realm. The tables are turned. [10] The fittest that have managed to survive in the wild did so on their own terms, having nothing to do with us; thorns, bites and poisons evolved because they did, long before the tsunami of humanity. While the woods offer mental suasion against the cacophony of civilization, they brook no compromise to those who wander unawares. We seek solace but sometimes get stung, but we are drawn there, nonetheless. This is the law of the jungle. There will always be snakes in the Garden of Eden. Sometimes they are unseen like ticks, sometimes they are unnoticed like poison ivy and sometimes they attack out of nowhere, like kamikaze yellow-jacket wasps.

Ticks

Ticks are consummate parasites, so much so that the order to which they belong within the Arachnid Class of arthropods is named Parasitiformes. They live on blood and blood alone; their every action directed at its source, which includes mammals like humans. Because the life cycle of the tick involves three separate hosts for its sanguinary diet, it unwittingly transfers the fluids from one host to the other with not infrequently deleterious consequence. Ticks are second only to mosquitoes in the transmission of diseases to humans, an antibiosis that has profound effects on the health of those who traverse sylvan grasslands, most notably hikers. But one cannot but be impressed by the tenacity of ticks. If it were not for the fact that they somehow succeed, the improbability of their evolutionary life cycle would push credulity to its limits. How could it be that a virtually immobile and miniscule arachnid could hitch a ride not once but several times on an animal to feed on its blood as its sole source of nutrition? No matter how unlikely it may seem, surreptitiously sucking blood is a niche of global import. There are about one thousand named species of ticks worldwide and thirty times that number of their cousins the mites; it is estimated that there may be as many as a million more not yet identified. Ticks are subdivided into two families according to the nature of their exoskeleton. Soft ticks (Family Argasidae) have a dorsal integument that is leather-tough; they prey on birds and mammals that occupy stationary nests and generally have a singular host, the soft life of Riley. Hard ticks (Family Ixodidae) have a shield-like plate called a scutum on their backs; they are peripatetic, parasitizing mobile four-legged and occasionally two-legged mammals, the hard life of Stakhanov. [11] Hard ticks can only lie in wait for a passing animal to deliver dinner; a meal is mandatory before molting to the adult stage and laying the eggs for the next generation. Few succeed. [12]

The two to three year life cycle of hard ticks begins with an adult female tick laying thousands of eggs in one location, each hatching into a six-legged larva whose first and only order of business is to find a small mammal (rarely lizards). Their own mobility being limited by their miniscule legs (ticks do not jump or fly), a host blood source must happen by in close enough proximity for a direct encounter. If successful, a peripety by no means assured, the larva feeds on the blood of the animal and drops off to molt over a two-week period into an eight-legged nymph, which must repeat the process on a (presumably but not necessarily) different mammal for a second blood meal to molt into an adult. As only adults can breed, both the male and the female must not only independently find a source of blood but must also find each other with serendipity on the same host; randomly dropping to the ground and somehow meeting up seems too improbable to be of consequence. Then and only then can the female lay her eggs after which she will expire, following on the heels of the male who succumbs after intercourse, a Shakespearian drama quite common in nature as reproduction is nature’s singular goal; there is no reason to live after species survival is assured. [13]

The ability of the nearly immobile tick to connect with three different mobile hosts has been a matter or philosophical interest for many years. To the noted German biologist Jakob von Uexküll, the tick, which he calls “the blind and deaf bandit,” exemplified umwelt, German for the environment to which an animal interacts; he is credited with initiating the field of biosemiotics, the signs and symbols used by animals. The tick, according to umwelt, has three biosemiotics: butyric acid (animal fat) redolence of the host mammal to sense proximity; warmer temperatures to provide blood localization once on board; and sensitivity to hair as confirmation of proper placement. [14] More recent research has revealed a panoply of sensory stimulants employed by ticks including carbon dioxide, ammonia, lactic acid, moisture, vibration, and sensitivity to light. Tick evolution favored the latter as a means of accentuating the crucial host encounter. In seeking light, ticks crawl up the nearest plant stalk to its apex to reach out with the two foremost legs extended using heat sensors called Haller’s organs to search for and ultimately attach to a host, a behavior aptly known as “questing.” [15] The term captures the imperturbable optimism that evolution has imbued in the tick, resolutely poised to snare whatever happens to pass by in its quest to live to perpetuate genetic heritage. For most ticks, all is for naught; their love unrequited for want of a host.

Compared to the eviscerating rapacity of carnivores, the tick’s feeding process has the subtle finesse of chemical subterfuge. Ticks employ paired, specialized cutting organs called chelicerae to penetrate the epidermal layers. Once break-through occurs and a lesion is formed under the skin, the multifunctional and chemically complex salivary glands are activated, secreting a cement-like substance to anchor the tick to the extraction point. To ensure an unimpeded flow of the vital blood nutrients, ticks must overcome the platelets which would otherwise coagulate into a sealing clot. The saliva contains blood platelet aggregation inhibitors and anticoagulants to prevent hemostasis of the wound. Salivary anesthetics are injected to dupe the host into inaction; itchiness comes days later, long after the deed is done. During blood extraction, immunosuppressive and anti-inflammatory agents in the saliva turn back the mammalian defensive mechanisms and vasodilators increase blood flow. [16] The wound is kept free of impediments to flow during extraction by the continuous insertion of tick saliva to return water extracted from the blood back to the host. This allows the tick to collect only concentrated blood to store in its miniscule abdomen (which does swell considerably in some species). [17] The net result is a substantive exchange of body fluids between the tick and the host, an ideal arrangement for another exploitive species, microbes. Of the eighty species of ticks in North America, twelve are of major public health or veterinary importance due to the delivery service they provide for pernicious bacteria and viruses. There are three tick species that merit individual consideration due to their large population and the perils of the diseases that they convey: Wood ticks (Dermacentor variabilis) are carriers of the pathogens Rickettsia rickettsia causing Rocky Mountain Spotted Fever and Franciscella tularensis causing Tularemia; Lone star ticks (Amblyomma americanum) are vectors for Southern rash illness (Borrelia lonestari) and monocytic Ehrlichiosis (Ehrlichia chaffeensis); and Black-legged ticks (Ixodes scapularis) carry Borrelia burgdorferi, the bacterium of Lyme Disease. [18]

Wood ticks named for their generic habitat are also known as American dog ticks due to host association. Rocky Mountain spotted fever was the first tick borne disease to be isolated, its toponym due to its provenance in the Snake River Valley of Idaho late in the late 19th Century. The microbe was discovered in 1906 by H. T. Ricketts who died four years later while investigating and then succumbing to Mexican typhus; the microbe was named Rickettsia rickettsii in his honor. Its common name is a mnemonic; it results in a fever that is followed by a spotted rash. The name is now a misnomer, as it is most common in a latitudinal strip that runs from North Carolina through Tennessee to Arkansas, and it is a disease problem throughout the Western hemisphere, wherever ticks meet people. Before the advent of antibiotics (it is now normally treated with Doxycycline), thirty percent of all people infected died. [19] Tularemia or Rabbit Fever due to its primary host is also eponymously called Ohara’s disease; Hachiro Ohara discovered that the condition called Yato-Byo in Japan came from infected rabbits by rubbing blood on his wife’s skin inducing the ulcers that were its characteristic symptom (it is not reported whether she consented to the experiment). The responsible bacterium was identified from infected ground squirrels in Tulare County, California and extensive research was conducted by Dr. Edward Francis of the U. S. Public Health Service in the early 20th century, the euphonious name Franciscella tularensis the result. It has since been associated with numerous historical epidemics that have raged across Eurasia, most notably in Scandinavia in 1966; there are about 300 cases in the United States every year. Tularemia was delisted as a major disease by the CDC in 1994 due to a dearth of reported cases but reinstated six years later in reaction to bioterrorism concerns. It is considered an especially viable biological agent because it is effective, capable of being sprayed, incapacitating with a low lethality, and easy to decontaminate. The World Health Organization estimated that one hundred pounds of aerated bacteria would kill 19,000 and incapacitate 250,000 in a population of five million. [20]

Lone star ticks are identical to wood ticks in appearance with the addition of a starkly contrasting white dot in the center of the hard shell dorsal scutum; Texas has nothing to do with it. They were long considered innocuous, a nuisance species that would leave behind erythema and itching but not disease. Within the last twenty years, flu-like Ehrlichiosis and a new disease with symptoms similar to Lyme Disease currently known mostly as Southern rash illness for want of a less generic name have been attributed to microbes that lone star ticks carry. Due to warmed climate conditions, it is considered very likely that they will become as well known as their counterparts for disease transmission in the next 25 years [21] One of the more unusual tick related illnesses that has become manifest in the last few years might be called the revenge of the vegans; an allergic reaction to red meat. While still far from causation, there is a correlation between individuals who were bitten by lone star ticks and the presence of antibodies in the blood that result in the “delayed anaphylaxis of red meat.” This was characterized as the “first example of a response to an ectoparasite giving rise to an important form of food allergy.” [22] And probably not the last; warmer weather and increasing host populations are a recipe for tick proliferation and human dystopia.

The Black-legged tick is the hiker’s incubus, a nightmare vampire; succubus is more appropriate as many are female and sucking blood is what they do. They are also called deer ticks and bear ticks according to regional host association. Black-legged ticks are about half the size of wood ticks with the same cinnamon-brown scutum; the eight legs are much darker and appear black in contrast. Their diminutive size makes them difficult to see even as adults; the nymph, which can also carry diseases, is the size of a poppy seed. Mouse ticks might be a more appropriate common name, as white-footed mice are the microbial hosts from which Lyme disease emanates. When a tick egg hatches, the miniscule larvae immediately seek a blood meal and the scurrying mice of the forest, which number in the billions, are ideal candidates. Up to 90 percent of white-footed mice are infected with the Lyme disease microbe. The reason the mice are prone to infestation is speculative; the current belief is that they don’t have very active immune systems to ward off microbes that live in their body fluids and that they are ambivalent to the presence of feeding tick larvae. From the evolutionary standpoint this makes sense. Why should an animal that has a short life that usually ends brutally in the talons of an owl or the teeth of a fox waste energy creating antibodies or care about a few ticks? There is no indication that the predators that consume the mice and microbes are in any way infected as their digestive systems are effective in eliminating alien species. The mouse population is key to the prevalence of Lyme disease and the primary variable to mouse population size is food, primarily acorns. Mast years when many acorns are produced by oak trees are Lyme disease peak years. [23]

Black-legged ticks are now well established vectors for Lyme Disease. Although the disease was known in Europe in the late 19th century by a number of different names and in the United States by its symptoms for a century, it was not until 1983 that it was linked to ticks in the area around Lyme, Connecticut. In the early 1970’s, Andrew Spielman of the Harvard School of Public Health sought to determine the etiology of the malaria-like illness babesiosis on the island of Nantucket, colloquially called Nantucket fever. His quest led him to the white-footed mouse and subsequently to a tick that he named Ixodes dammini, since found to be the same species as I. scapularis, the black-legged tick. [24] At about the same time, residents of Lyme, Connecticut noticed an alarming outbreak of arthritis among young children. They enlisted the services of a rheumatologist from Yale named Allen Steere who focused his epidemiological investigation not on the painful arthritic symptoms, but on patient reports of an unusual bull’s eye shaped rash. This rash was known in Europe to be the symptom of a tick bite called erythema migrans. In 1977, one of his patients saved a tick that was subsequently identified as I. dammini. The true culprit was not isolated until five years later, when Willy Burgdorfer of the National Institutes of Health identified a helical bacterium called a spirochete as the source, which was eventually given the eponym Borrelia burgdorferi. [25]

Burgeoning populations of mice, deer and humans provide a smorgasbord for black-legged ticks and a consequent haven for B. burgdorferi. The Centers for Disease Control (CDC) declared Lyme Disease to be a nationally notifiable disease in 1991 and recorded 89,000 cases between 1992 and 1998. As of 2019 about 30,000 cases are reported annually but it is estimated that there are as many as 300,000. [26] Lyme disease has many variable symptoms that are frequently placed in three categories: early localized, early disseminated, and late disseminated. Early localized is indicated by flu-like symptoms such as fever, chills and aching joints. The characteristic bull’s eye rash only occurs in about half of all cases and appears between 3 and 30 days after infection. Early disseminated occurs months later and is characterized by general fatigue and a variety of neurologic symptoms such as facial paralysis and cognitive problems. Late disseminated manifests over the course of years and may consist of chronic arthritis, profound fatigue and chronic neurological problems. The incidence of Lyme disease is frequently not recognized absent the ring as the symptoms can be mistaken for many other conditions ranging from chronic fatigue syndrome to arthritis. If left untreated, the multiplication and dissemination of the spirochete bacteria result in increasingly dire outcomes not unlike syphilis (which is also caused by a spirochete). Many people do not realize they have been bitten due to the small size of the parasite, its predilection for the nether reaches that are out of sight, and stealthy analgesic tick saliva. [27]

So what’s a hiker to do? The best defense against ticks has some semblance a military operation; eternal vigilance is the price of safety. There are four pillars: situational awareness; chemical weapons; physical security; and counterinsurgency. Situational awareness is recognizing tick habitats and avoiding them whenever possible. Ticks are rarely in open areas like trails but infest brushy areas where tall grasses afford questing access; don’t go where they are unless you have to. Chemical weapons are anti-tick sprays, those with DEET are generally recommended as repellents and are applied to the lower leg area to subvert the hidden enemy. For prolonged deep woods excursions, a more potent defense may be warranted; permethrin is a tick killer.  Physical security is dressing for ticks. Long pants tucked into socks establish an impenetrable barrier to the fleshpots of their desire. Light colors are preferable as the dark brown of the scutum is easier to spot due to contrast; ticks love dark colors. Counterinsurgency is the last and the most important principle. When a tick gets past your sprayed socks to the skin without being deterred or detected, the only way to find it is to look for it. This means stripping to “full monty” and examining every inch of every nook and cranny; hot showers mean nothing to ticks. While this is possible to do by yourself with a mirror and a flashlight, an intimate cohort is more thorough and objective. As long as the tick is located and removed within 24 hours, it is still setting the table; there is no risk of disease until dinner begins. Post-hike vigilance is the most important measure against ticks; it is absolute if done properly.

References

1. Kant, I. “Fundamental Principles of the Metaphysic of Morals” Harvard Classics, Literary and Philosophical Essays, French, German and Italian, P. F. Collier and Son Company, New York, 1910, Volume 32 pp 299-373
2. Ryrie, C. The Ryrie Study Bible, Moody Press, Chicago, 1986, pp 1-18.
3. The Holy Bible, Revised Standard Version, Thomas Nelson and Sons, Camden, New Jersey, 1952, pp. 1-4.
4. Leibniz, G. Theodicy, translated by E. Huggard, Routledge & Kegan Paul Limited, London, 1951 and Open Court Publishing Company, Peru, Illinois, 1985, p 215.
5. Beechcroft, J. Kipling, A Collection of his Stories and Poems, Doubleday and Company, Garden City, New York, 1956, pp 249-261.
6. Moriceau, J. “The Wolf Threat in France from the Middle Ages to the Twentieth Century” 2014 available at https://hal.archives-ouvertes.fr/hal-01011915/document
7. Leopold, A. A Sand County Almanac Oxford University Press, London, 1948 pp 9-11.
8. Pennisi, E. “Grazing animals shown to inhabit a landscape of fear” Science, Volume 363, March 2019, p.1025.
9. Montero, D. “Often reviled, coyotes start to gain some supporters” Washington Post, 2 April 2019.
10. Wordsworth, W. and Coleridge, S. Lyrical Ballads with a Few other Poems, Arch Gracechurch, London, 1798 at http://www.gutenberg.org/cache/epub/8905/pg8905.html the quoted verses are from Wordsworth’s “The Tables Turned,” an admonishment to put down books and seek wisdom in Nature.
11. Shabad, T. “Stakhanov, a Soviet miner, is dead; Name was byword for hard work” New York Times November 6, 1977. Stalin used Stakhanov’s coal mining prowess as the basis for the Stakhanovite Movement that extolled hard work as implicit in communism.
12. Milne, Lorus and Margery, National Audubon Society Field Guide to Insects and Spiders, Alfred Knopf, New York, 1980, pp 923-929.
13. https://www.cdc.gov/ticks/life_cycle_and_hosts.html The Centers for Disease Control has extensive information on ticks due to their role as disease vectors.
14. Von Uexkűll, J. A Foray into the Worlds of Animals and Humans: with a Theory of Meaning, University of Minnesota Press, Minneapolis, Minnesota, 2010, pp 45-53.
15. Stafford, K. “Ticks of the Northeastern United States” Tick Management Handbook Bulletin 1010, The Connecticut Agricultural Experimentation Station, 2007, p. 5.
16. Sauer, J. et al “Tick Salivary Gland Physiology” Annual Review of Entomology, 1995, Volume 40, pp 245-267.
17. There is a condition called tick paralysis that is a direct result of the salivary secretions of the wood tick that are immunosuppressive in nature. In severe cases, a progressive paralysis extends to the lung muscles, causing death by respiratory failure.
18. Stafford, K. Op. cit. p. 20.
19. “Rocky Mountain Spotted Fever” Encyclopedia Britannica 15th Edition. William and Helen Benton, Publisher, Chicago, 1973, Volume VIII, p.627.
20. https://www.dshs.texas.gov/preparedness/bt_public_history_tularemia.shtm A thorough review of the history of Tularemia as seen by the Texas Department of Health.
21. Childs, J. and Paddock, C. “The ascendancy of Amblyomma americanum as a vector of pathogens affecting humans in the United States,” Annual Review of Entomology, January 2003 Volume 48, pp 307-337.
22. Commins, S. et al, “The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose.” Journal of Allergy and Clinical Immunology, May 2011, Volume 127, pp 1286-1293.
23. Bever, L. “Why this adorable mouse is responsible for the spread of Lyme disease” Washington Post, July 17, 2017.
24. Goethert, H. and Telford, S. “Not ‘out of Nantucket’: Babesia microti in southern New England comprises at least two major populations.” Parasite Vectors, 2014 available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272771/
25. “Nantucket Fever” was published online by the Harvard School of Public Health at the website http://www.hsph.harvard.edu/review/nantucket_fever.shtml
26. https://www.cdc.gov/lyme/stats/graphs.html The CDC has a special website for Lyme disease with statistics by year and state and thorough protective measures.
27. Wade, C. “Keeping Lyme disease at bay, An integrated approach to prevention” American Journal of Nursing, Volume 100 Number 7 July 2000, pp, 26-31.