Since epidemic meningitis was first described as "spotted fever" a great deal of just criticism has been directed against the term. Even the earliest writers admit that skin manifestations occur in a comparatively small percentage of the cases—too small, indeed, to justify the use of the title.
In his treatise on "A Malignant Epidemic Commonly Called Spotted Fever," North1 draws attention to the fact that in the 1806-1807 epidemic in Massachusetts, skin eruptions were very common, while in the later epidemic of 1808-1809 they were almost never observed. "The size of the lesions varied from the head of a pin to a six cent piece and the distribution was more commonly on the face, neck and extremities." He believed that the color of the rash was a guide in prognosis; that is, the darker the shade the more hopeless the outcome.
In the Ireland epidemic in 1867, nearly every