I. As to erysipelas. From the above account it appears by no means surprising that the malady in its graver cases (many of the slighter ones did not come under medical treatment) should have been regarded as a disease of the nature of erysipelas. It resembled that disease in several important features, and the constitutional symptoms, particularly of the fatal cases, might well have belonged to erysipelas itself. On the other hand it may be remarked that the malady in question seems to have differed from erysipelas as ordinarily observed in certain not unimportant particulars. There was not, so far as I can ascertain, any of that marked, tense, glistening or shining appearance of the skin, almost invariably present in erysipelas of infants; moreover, the affection had commonly no tendency to wander over the trunk and limbs in the manner customary with such erysipelas; but instead remained localised almost from the first, in each instance, in the parts of the body primarily affected by it. This appears to have been specially notable as regards those slighter cases not medically treated; in such the vesication and subsequent abrasion and induration of the skin was observed only in the folds of the neck, armpits, and genital organs. Nevertheless, before discarding the hypothesis of erysipelas, I thought it well to inquire whether there had been any typical erysipelas among infants or others in the parish; and whether the facts of the distribution of the malady in question could be explained on the supposition that those attacked had had conveyed to them erysipelatous infection. In this sense inquiry has result as follows:—

(1.) As to typical erysipelas. Except two cases, occurring in adults, one in October the other in December 1877 (both it will be observed long after the earlier cases of the infantile malady), I cannot hear of any occurrence whatever in Loughton of ordinary erysipelas in persons of any age. Vaccination proceeded as usual and no erysipelas or other disease was observed in connexion with it.

(2.) As to likely channels for erysipelas propagation, one kind only seems of importance as being in any degree probable, viz., the baby linen clubs of the parish. These, the church club and the chapel club, have been instituted for the purpose of affording their subscribers body and baby linen during the month subsequent to confinement. One rule common to both clubs provides that clothing thus acquired shall be returned properly cleansed and got up within five weeks from the date of loan; and hence it might have happened that, assuming the disease to have been erysipelas, babies’ napkins imbued with specific contagion might have been returned to the club imperfectly cleansed or not properly disinfected, and have thus, on reissue, conveyed to other infants the infection of that disease. Examination of the operations of these two clubs shows that during the last 15 months there have been ten boxes or bags of baby linen in circulation, and that of the 29 sufferers by the malady 17 have received club linen, while 12 have not. On the other hand 33 other infants have during the same period had baby linen from one or other of the clubs without ill result. The 17 sufferers, with 19 others, were all of them members of the church club, the total operations of which during the period referred to are shown in detail in Table I.

Table I.

Box. Order
of
Issue. 		Date of Issue. Infant attacked. Date of Return
of Box. 		Order
of
Return.
C. C. [7] 1 5 10 33 13 Jan. 1877 20 Feb. „ 14 May „ 11 March 1878 Mid. March 1877 No No No 18 Feb. 1877 26 March „ 18 June „ — 1 4 10 —
C.G.H. [2] 2 21 29 20 Jan. 1877 26 Oct. „ 14 Feb. 1878 4 March 1877 26 Oct. „ 14 Feb. 1878 26 Feb. 1877 12 Nov. „ 18 Feb. 1878 2 21 27
S.P. [1] 3 9 12 14 34 14 Feb. 1877 5 April „ 4 June „ 30 June „ 14 March 1878 2 March 1877 No 5 June 1877 1 July „ 15 March 1878 23 March 1877 14 May „ 21 June „ 6 Aug. „ 3 9 11 14
C.G.H. [1] 6 11 18 23 27 30 35 21 Feb. 1877 28 May „ 27 Aug. „ 26 Nov. „ Jan. 1878 ,, 18 Feb. „ 29 March „ Early March 1877 No No 1 Jan. 1878 14 Feb. „ Mid. March 1878 No 27 March 1877 12 July „ 1 Oct. „ 1 Jan. 1878 — 20 March 1878 — 6 13 18 24 25 30 —
G.P. [1] 7 15 17 19 22 26 32 22 Feb. 1877 2 July „ 16 Aug. „ 26 Sept. „ 23 Nov. „ 14 Jan. 1878 7 March „ No 2 July 1877 16 Aug. „ No 15 Nov. 1877 No No 26 March 1877 6 Aug. „ 20 Sept. „ 5 Nov. „ 17 Dec. „ 18 Feb. 1878 — 5 15 17 19 22 28 —
S.P. [2] 4 8 13 24 25 28 36 19 Feb. 1877 28 March „ 4 June „ 28 Nov. „ 31 Dec. „ 13 Feb. 1878 30 March „ No No No 22 Nov. 1877 No No No 26 March 1877 4 May „ 9 July „ 17 Dec. „ 4 Feb. 1878 18 March ,, — 7 8 12 23 26 29 —
G.P. [2] 16 20 31 3 July 1877 27 Sept. „ 18 Feb. 1878 No No 19 Feb. 1878 9 Aug. 1877 5 Nov. „ 25 March 1878 16 20 31

The facts to be learned from the above table are not upon the whole suggestive of relation between the operations of the club and the attack of sufferers by the malady, and for the following reasons:—The four first sufferers, attacked almost simultaneously in March 1877, received each of them a separate box from the club, and in one instance only out of the four was the next reissue of the box associated with attack of the infant receiving it. Further, the interval between the issue of the box and attack of the infant, in families invaded by the disease, varied very oddly, and in a way too not easily reconcilable with such incubation period as might have been anticipated of erysipelas under circumstances of conveyed infection. In 8, including the four first sufferers, it varied from two to four or more weeks; in 7 it was nil or one day only; while in two the infant was attacked before receipt of the box. Examination of the same sort as regards the movements of monthly nurses gave similarly negative evidence. Apparently the disease, whatever may have been its origin, has not been carried from case to case by means such as might have conveyed erysipelatous or allied infection.

II. As to skin-poisoning. The malady from which the 29 infants have suffered has now to be dealt with in its relation to the particular violet powder that has been alleged to have been the cause of it. This powder had, in every instance that I myself investigated, been bought from one or other of two grocer’s shops situated, the one in the High Road, the other at Baldwin’s Hill, Loughton. From inquiries by Mr. Bell, inspector of nuisances, it would appear that of many shops in Loughton selling violet powder, these two, and these only, obtained such powder from a certain dealer in the East of London referred to by name by the medical officer of health in his statement already mentioned. Mr. Bell further ascertained that in Loughton this particular powder was sold by the retail tradesmen in small penny packets or boxes each of which bore the name and address of the wholesale dealer in question. The facts of the connexion between the powder thus sold in Loughton and the prevalence of disease are as follows:—

1. Of the 29 sufferers, 27 had the particular powder in use at or about the date of attack. Of the remaining two, the mother of one had the particular powder in the house at the time the infant was attacked, but did not, so far as she can remember, use it; the other mother (whose infant suffered very slightly) had no powder at all, and is of opinion that the soreness of her infant’s neck was the result of pressure from the instruments used in delivery.

2. The sufferers with few exceptions (all of whom however had the powder) were grouped near to one or other of the two shops which alone in this extensive parish sold the particular powder in question.

3. Infants using the particular powder, and those alone, were attacked by the malady. This is shown in the following table, which is an abstract of the results of personal inquiry to this end respecting infants born in the parish during the half year ended March 1878. Except where otherwise stated, violet powder of some sort was used to every child, and (with certain exceptions to be considered in the text) only one kind of powder was in use to the several children attacked by the malady.