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the pamphlet produced a great excitement in Middletown. The authorities of the city requested all the physicians to give written opinions respecting the disease then prevalent in the city. The majority of them certified that they saw no disease that answered the description given in the pamphlet in their own practice, but, on the contrary, the cases which they met with were such as required a different treatment. These certificates were published in the newspapers of the city. There was much party feeling in the place at that time, and an unwillingness to have the reputation of the city suffer from undue alarm in reference to the prevalence of the disease." [I may say in passing that I have had no opportunity to look up original sources bearing upon these statements of Dr. Catlin. However, from his character as a man, his nearness to the events, and his evident desire to relate them impartially, I see no reason for doubting his account.] "From subsequent experiences some of which will appear in my report, I was satisfied that there was a low fever prevailing in that region with symptoms different from the common typhus or typhoid fever which also was common at the same time. The similarity between this low fever and the spotted fever were the sudden attack, the cold or cool skin, the subsidentia or sense of sinking at the stomach, pains in the head, delirium, numbness and partial paralysis. It differed from the early disease in the almost entire absence of petechiae, they being present in only two cases of the three hundred and sixty (including the mild cases) in 1823, related by Dr. Miner, though it was said they were more common in 1825." He goes on to describe the symptoms in detail. Among other things he says, "I do not recollect seeing any petechiae or drawing back of the head like cerebro-spinal meningitis during my practice of nearly seventeen years in Middlesex County." In this connection it should be said. that the epidemic of 1807-10 furnished precisely parallel instances of the variability of certain symptoms. All observers were agreed that the petechiae were absent in a great majority of cases except in the first stages of the epidemic, and the inappropriateness of the name spotted fever was often remarked. Furthermore, as regards neck rigidity or head retraction, accounts

of the earlier epidemic laid little stress upon it as a characteristic symptom; in fact, it is not always mentioned, leading one to believe that it was decidedly inconstant and among the unusual symptoms, only present in severe cases.

From the evidence at hand it seems to me beyond question that the fever prevalent in Middletown and surrounding towns in 1823-27 was at least in part what we now know as the cerebrospinal fever, and was identical in character with and probably a lineal descendant of the earlier epidemic of 1807-10.

Dr. Miner's treatment involved the use of very heavy doses of opium, for example, half an ounce of the tincture in the course of an hour, or seventy-five to eighty grains of opium daily for three days. "Opium enough" was his motto. Dr. Catlin believed that it led to much bad practice, and that in some cases the peculiar symptoms resembling sinking typhus were really due to excessive doses of opium.

I will not attempt to follow further the ebb and flow of epidemic sickness in Connecticut, though the years following 1830 were marked by some outbreaks well worth record as complete and authoritative as possible. It should go without saying that in the foregoing account there is no pretense to completeness. I have purposely refrained from discussing malarial fever in this state, inasmuch as its history has been ably handled by Dr. Henry Bronson, as regards New Haven, in Proceedings of the Connecticut Medical Society 1872, and as regards the state as a whole in Report of State Board of Health 1881 by Dr. C. W. Chamberlain, Secretary of the State Board at that time. Nor have I attempted to cover with any fullness the history of smallpox in Connecticut. I am very well aware that I have probably missed sources of information that more time would have made available to me, and furthermore that a longer search might have disclosed valuable unpublished material. I might have said with Osler, "Even for this lesser task . . . I recognize the limitations of my fitness and am not unaware that in my ignorance I shall overlook much which might have rendered less sketchy a sketch necessarily imperfect."


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