AT LOUGHTON, IN THE EPPING RURAL SANITARY DISTRICT***


Transcribed from the 1878 edition by David Price, email ccx074@pglaf.org





          Mr. W. H. Power’s Report to the Local Government Board
        respecting a Special Mortality among Infants at Loughton,
                  in the Epping Rural Sanitary District.


                                                   EDWARD C. SEATON, M.D.,
                                                     _Medical Department_,
                                                         _April_ 15, 1878.

On the 22nd March 1878, complaint was made by Mr. Octavius Deacon, of
Golding’s Hill, Loughton, to Mr. Secretary Cross, that a serious attack
by skin disease of his own infant had resulted from the use for nursery
purposes of violet powder, which on analysis by Mr. G. Jones, F.C.S., had
been found to contain in large proportion white arsenic; and further, Mr.
Deacon stated his belief that a large and fatal prevalence of skin
disease among infants in Loughton had been due to the use in a similar
way of violet powder of a like sort.  This representation was referred by
Mr. Cross to the Local Government Board.  On 25th March the Board
received a communication from the clerk to the Epping Rural Sanitary
Authority enclosing a statement by the Medical Officer of Health to the
effect that a special mortality among infants in his district, already
reported by him, had, he has now reason to believe, resulted from the use
of violet powder impregnated with arsenic.  Hereupon the present inquiry
was ordered.

I lost no time in putting myself in communication with Mr. Deacon and
with the several officers of the Epping Rural Sanitary Authority, and
from them received every assistance in carrying out my inquiry.
Especially am I beholden to Mr. Fowler, medical officer of health, who
has supplied me with important information respecting the occurrences
resulting in the mortality referred to; and to Mr. Bell, inspector of
nuisances, who has accompanied and assisted me day by day during my
investigations.  To Mr. Lewis district medical officer, and to other
medical men practising in Loughton, my acknowledgments are also due.

The result of this inquiry is as follows:—

Since early March 1877, 29 infants and children in Loughton have been
attacked by, and 13 have died of, a peculiar affection of the skin, that
had been regarded as an anomalous kind of erysipelas.  The disease was
described to me by the mothers or others nursing the cases as presenting
the following appearances:—

In fatal cases, a generally blackened condition of the skin of the groins
and pudenda, which quickly became somewhat swollen and hard; this was
frequently the first change observed.  Occasionally there was a like
condition of the abdomen about and below the umbilicus.  The skin of the
axillæ and folds of the neck was another part in which blackening and
swelling was commonly observed.  Invasion of these several parts, when it
occurred, was simultaneous.  In some instances vesication, variously
described as “little white blisters,” “yellowish bladders” or “bags of
water” preceded or appeared about the same time as the blackness; in
others, blackness with, or without, vesication was preceded by a short
interval by a bluish red condition of the parts affected.  The vesicles
breaking discharged clear fluid, and left raw black surfaces, which did
not, it would seem, take on suppurative or sloughing action.  In no
instance was a tense shining appearance of the skin spoken of; nor was
there, except in one case, any tendency of the blackened condition of the
surface to extend over the limbs or trunk.  The constitutional symptoms
seem to have been great restlessness, with fits of crying or screaming in
the first instance, passing soon into a condition apparently of collapse
in which the infant quietly died.  The average duration of illness in
these cases was four to five days.

In non-fatal cases, the symptoms varied much in severity.  In almost all,
blisters or bladders like those already spoken of formed between the
folds of the groins, in the armpits, and in the neck.  In some cases
these vesications broke and formed black excavated sores, in the
neighbourhood of which the skin became more or less indurated and
discoloured.  From some of the sores “cores came out,” and all discharged
yellowish matter.  In milder cases minute vesicles burst and left shallow
sores that were little if at all discoloured, and that quickly healed
under appropriate treatment.  The constitutional symptoms do not seem to
have been in any instance out of proportion to the local malady.  In few,
if indeed in any, cases were vomiting or purging prominent symptoms.

There has now to be considered—What has been the nature of the disease,
and how did it come about?  Has it been erysipelas as it was at first
thought to be; or, has it been, as recently alleged, skin-poisoning?

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

                                    No
G.P. [1]             7  22 Feb.     No          26 March             5
                        1877                    1877
                    15              2 July                          15
                        2 July „    1877        6 Aug. „
                    17                                              17
                        16 Aug. „   16 Aug. „   20 Sept.
                    19                          „                   19
                        26 Sept.    No
                    22  „                       5 Nov. „            22
                                    15 Nov.
                    26  23 Nov. „   1877        17 Dec. „           28

                    32  14 Jan.     No          18 Feb.         —
                        1878                    1878
                                    No
                        7 March „                   —
S.P. [2]             4  19 Feb.     No          26 March             7
                        1877                    1877
                     8              No                               8
                        28 March                4 May „
                    13  „           No                              12
                                                9 July „
                    24  4 June „    22 Nov.                         23
                                    1877        17 Dec. „
                    25  28 Nov. „                                   26
                                    No          4 Feb.
                    28  31 Dec. „               1878                29
                                    No
                    36  13 Feb.                 18 March             —
                        1878        No          ,,

                        30 March                    —
                        „
G.P. [2]            16  3 July      No          9 Aug.              16
                        1877                    1877
                    20              No                              20
                        27 Sept.                5 Nov. „
                    31  „           19 Feb.                         31
                                    1878        25 March
                        18 Feb.                 1878
                        1878

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.

                                TABLE II.

   Locality.          Date of           Date of        Violet Powder        Remarks.
                       Birth.           Attack.         from one or
                                                        other of the
                                                         two Shops.
Forest Road       2 Oct. 1877       No                No                ?  Any powder.
Loughton Park     4 Oct. „          No                No
High Road         5 Oct. „          No                No
Baldwin’s Hill    6 Oct. „          25 Oct.           Yes
Epping New Road   15 Oct. „         No                No
Forest Road       18 Oct. „         No                       —          Born in a tent
                                                                        by roadside.
Forest Road       21 Oct. „         No                No
Ash Green         25 Oct. „         26 Oct.           Yes
Forest Road       26 Oct. „         No                No                ?  Any powder.
High Road         1 Nov. „          No                No
High Road         7 Nov. „          31 Dec.           Yes
Smart’s Lane      8 Nov. „          No                No
Baldwin’s Hill    11 Nov. „         15 Nov.           Yes
High Road         14 Nov. „         No                No
Forest Road       18 Nov. „         No                No                Only lived 15
                                                                        minutes.
Ash Green         20 Nov. ,,        22 Nov.           Yes
Smart’s Lane      20 Nov. „         No                No
England’s Lane    27 Nov. „         1 Jan. 1878       Yes               Habitually used
                                                                        starch.
Smart’s Lane      30 Nov. „         No                       —          Left district.
Loughton Road     16 Dec. „         No                No
Warren Hill       24 Dec. „         No                No
Smart’s Lane      24 Dec. „         No                No
Baldwin’s Hill    29 Dec. „         30 Dec.           Yes
Ash Green         30 Dec. „         14 Feb.           Yes               At first used
                                                                        powder from
                                                                        previous
                                                                        confinement.
Mutton Row        30 Dec. „         No                No
Golding’s Hill    2 Jan. 1878       20 Feb.           Yes
Trap’s Hill       3 Jan. „          No                No
York Hill         5 Jan. „          No                No
Forest Road       19 Jan. „         No                No
Forest Road       30 Jan. „         No                No
Smart’s Lane      5 Feb. „          No                No
Warren            8 Feb. „          No                No
Baldwin’s Hill    10 Feb. „         14 Feb.           Yes
Forest Road       12 Feb. „         No                No
York Hill         17 Feb. „         19 Feb.           Yes
Baldwin’s Hill    19 Feb. „         Mid. March        Yes
High Road         1 March „         No                No
High Road         11 March ,,       No                No
Golding’s Hill    13 March „        15 March          Yes

4.  Further and detailed evidence confirmatory in a high degree of
relation in the sense of effect to cause between the malady of infants
and the use of the particular powder, could, were it necessary, be given
in regard of most, if not all, of the cases attacked by the disease.  But
the following will suffice.  They are also explanatory of the interval
between birth and attack observed in certain cases recorded in the above
and in the previous table.

E. W., born 6th October 1877; attacked 25th October.  Mother states that
for the first fortnight from birth she used for dusting the infant violet
powder purchased at a distance.  This being expended, she obtained a
packet of the particular powder from one of the two shops in the parish
selling it.  A day or two after using this fresh powder she noticed
redness, blackness, and swelling of the privates and neck of the infant;
in three more days it died.  C. N., born 7th November 1877; attacked 31st
December.  Mother from infant’s birth used for dusting it violet powder
from a chemist near at home, and perhaps some also from a friend.  On
29th December she attended her daughter in confinement and took with her
her own infant.  Here she used for both infants powder from one of the
two shops referred to.  On 30th December her daughter’s, and on 31st
December her own, infant was attacked.  Daughter’s infant died January
1st; her own recovered, but is much scarred.  P. S., born 30th December;
attacked February 14.  From birth until about February 11th the mother
used violet powder remaining in the house since her last confinement; she
also used starch.  About the last-mentioned date she obtained some of the
particular powder, and after using it perhaps three days noticed pimples
on the groins, under the scrotum, under the arms, and at both sides of
the neck.  The pimples soon turned black, and became deep holes
discharging much yellow matter.  Used the powder a few days only; “did
not like it;” “it was yellow;” burned it.  Child recovered.  E. D., born
2nd January; attacked about 20th February.  The mother used starch powder
from infant’s birth until two days before it fell ill, when, having no
starch powder, she procured a packet of the particular violet powder.
This was used two days only, but the infant suffered in the same way as
P. S.  It recovered, but is scarred.  H. J., born 19th February 1878;
attacked middle March.  The mother at and after infant’s birth used
violet powder received as a present from London.  The day before the
infant was attacked she commenced using some of the particular powder
recently purchased.  The groins only were affected in this case; they
became black and broke into sores.  The use of the powder was
discontinued as soon as the infant fell ill.  On one occasion, however,
it was used to a sister aged two years and four months; she suffered in
like manner.  Both children recovered.  A. W., born 26th May 1877;
attacked 9th June.  The mother states that until the infant was 11 days
old she had no powder at all.  About 5th June she purchased a packet of
the particular powder and used it to the infant in the ordinary way.  On
9th June she noticed that the privates were swelled, and that white
bladders as big as a hazel nut had formed thereon, as well as under the
arms and around the neck.  These changed colour and broke into deep
wounds which discharged yellow matter.  Cores came out from the sores
under the arms.  The use of the powder was discontinued after six days,
and in about two months the infant was fairly well.  Hereupon the mother
recommenced the use of the particular powder, and the same night the
infant was very restless and screamed a great deal.  Next morning “the
bladders were out again;” the powder was then burned.  The child
eventually recovered, but is deeply scarred about the scrotum, groins,
neck, and armpits, as if by sloughing of the soft parts hereabouts.  F.
W., born 20th February 1877; attacked early in March.  From birth the
mother used violet powder from a chemist near at hand, but when the
infant was about a fortnight old she bought, and used to the lower parts
of its body only, a packet of the particular powder.  Next day the infant
broke out into sores about the navel and pudenda.  The use of the
particular powder was at once discontinued and the infant shortly got
well.  Some months later the mother being out of violet powder, again
used the particular powder to the infant, and at once the sores
reappeared.  The powder was then burned.  A. D., aged three years, was
attacked about Christmas 1877 by varicella.  During recovery and while
the pocks were dying away, she herself purchased a packet of the
particular powder, which was then used for dusting the eruption about the
pudenda.  Almost at once the dying vesicles became sores which turned
black and discharged matter; on healing they left scars.  It is stated
that in this instance the powder was used on one occasion only.  T. C.,
born 15th August 1877.  36 hours after birth pimples and bladders formed
about the privates and navel, which parts swelled, turned black, and
became hard; no sores.  Infant died 21st August.  The particular powder
was used in this instance from birth.  Three months afterwards some of
the remainder of this powder was used for dusting sores on the head,
face, and arms of a sister aged four years who had recently suffered from
measles.  These sores became much worse and inflamed; those on the arms
have left large scars.

Incidentally it is here shown that those parts only of infants bodies to
which toilet powder is ordinarily applied have been affected by the
malady; and further that such application of the particular powder has
been constantly followed in very few days by the symptoms complained of.
Additional evidence respecting the shortness of the interval between
application of the particular powder and the appearance of the symptoms
attributed to it, is afforded by the fact of 16 infants to whom this
powder was applied from birth onwards no less than 10 were attacked in
from one to four days.  Nor is the conclusion, irresistible from the
foregoing evidence, in any way weakened by the six instances in which the
attack was not immediate; for there must have been a beginning to the
mischievous quality of the powder bought at the shops of the vendors of
the particular powder.  These six cases were at the very commencement of
the total series.  All of them, and they were of various ages, from two
to 20 weeks, fell ill at the same time, viz., early in March 1877.  And
though all of them it would appear had used more than one packet of
violet powder from one or other of the two shops in question between
birth and the commencement of illness, in more than one instance a fresh
packet of powder is remembered to have been procured a day or two before
attack.  So far from weakening, these exceptions strengthen the
conclusion; more than that, they seem to indicate that not until the end
of February or early March of last year did violet powder bought at these
two shops in Loughton possess hurtful properties.

Probably enough has been made out to satisfy any reasonable doubt that
may have been entertained as to the connexion between the use in Loughton
of the particular violet powder and the lamentable effects attributed to
it.  It will be observed that the evidence is absolutely independent of
the nature of the irritating agent in the powder.  Whether or not that
agent may have been arsenic, as found by Mr. Jones in the specimens
submitted to him by Mr. Deacon, matters nothing to the proof I have given
of this connexion.  But I have submitted to Dr. Dupré for analysis
samples of the violet powder which I obtained from the mothers of three
of the sufferers from the malady, and when Dr. Dupré’s report is received
I shall append it.  Meanwhile I annex a tabulated statement of the cases
investigated.

                                                              W. H. POWER.

9 April 1878.

                                * * * * *




REPORT on three samples of VIOLET POWDER received from Mr. W. H. POWER,
April 4, 1878.


All the powders were of a very pale yellowish colour, and rather more
gritty to the touch than ordinary violet powder; they were also
appreciably heavier, bulk for bulk.  Taking the weight of a given bulk of
ordinary violet powder as 1, the same bulk of these powders would weigh
about 1.25.  Under the microscope they are shown to consist of potatoe
starch mixed with a very considerable proportion of crystalline matter,
among which regular octahedra (arsenious acid) can be distinguished.  On
burning they evolve a very powerful arsenical odour.

         Chemical analysis showed them to consist in 100 parts of

                                        A           B           C
Starch with traces of other              37.58       34.56       36.76
organic matter
Arsenious acid (white arsenic)           50.34       51.40       48.94
Oxide of lead {6}                         1.07        1.16        0.83
Other mineral matters chiefly            11.01       12.88       13.47
carbonate of magnesia
                                        100.00      100.00      100.00

                                                                 A. DUPRÉ.

Westminster Hospital, April 13, 1878.

                                * * * * *




29 cases dealt with in Mr. W. H. Power’s Report respecting a Special
Mortality among Infants in Loughton Parish.

        Locality in Loughton.      Date of         Date of         Result.      Remarks as to           Reference to in Report, under
                                    Birth.         Attack.                        use of the
                                                                                  particular
                                                                                   Powder.
                                                                                                    Table           Table          Detailed
                                                                                                      I.             II.          evidence.
1       Golding’s Hill          14 Feb. 1877    2 March 1877    Died 7 March    Powder from     No. 8                 —               —
                                                                1877.           one of the
                                                                                vendors of
                                                                                the
                                                                                particular
                                                                                powder used
                                                                                from birth
                                                                                onwards.
2       Baldwin’s Hill          7 Dec. 1876     4 March „       Died 6 March    Powder from           —               —               —
                                                                1877.           one of the
                                                                                vendors of
                                                                                the
                                                                                particular
                                                                                powder used
                                                                                from birth
                                                                                onwards.  Had
                                                                                four packets.
3       Baldwin’s Hill          20 Jan. 1877    4 March „       Died 8 March    Powder from     ,, 5                  —               —
                                                                1877.           one of the
                                                                                vendors of
                                                                                the
                                                                                particular
                                                                                powder used
                                                                                from birth
                                                                                onwards.
4       Baldwin’s Hill          17 Oct. 1876    Early March     Recovered       Powder from           —               —               —
                                                1877                            one of the
                                                                                vendors of
                                                                                the
                                                                                particular
                                                                                powder used
                                                                                from birth
                                                                                onwards,
                                                                                fresh packet
                                                                                just before
                                                                                attack.
5       Baldwin’s Hill          20 Jan. 1877    7 March 1877    Recovered       Powder from           —               —               —
                                                                                one of the
                                                                                vendors of
                                                                                the
                                                                                particular
                                                                                powder used
                                                                                from birth
                                                                                onwards till
                                                                                attack,
                                                                                probably
                                                                                fresh packet
                                                                                just before
                                                                                attack.
6       Golding’s Hill          12 Jan. „       Mid.  March     Recovered       Powder from          ,, 1             —               —
                                                1877                            one of the
                                                                                vendors of
                                                                                the
                                                                                particular
                                                                                powder used
                                                                                from birth
                                                                                onwards till
                                                                                attack,
                                                                                probably
                                                                                fresh packet
                                                                                about time of
                                                                                attack.
7       Ash Green               20 Feb. „       Early March     Recovered       Other powder    „ 13                  —         F. W., page
                                                1877                            till day                                        5.
                                                                                before
                                                                                attack, then
                                                                                particular
                                                                                powder.
8       High Road               4 June ,,       5 June 1877     Died 8 June     The             „ 10                  —               —
                                                                1877            particular
                                                                                powder used
                                                                                from birth.
9       Pump Hill               26 May „        9 June „        Recovered       The                   —               —         A. W., page
                                                                                particular                                      5.
                                                                                powder on and
                                                                                after 11th
                                                                                day from
                                                                                birth.  Was
                                                                                twice
                                                                                attacked.
10      Baldwin’s Hill          29 June „       1 July „        Recovered       No powder of    ,, 11                 —         (doubtful
                                                                                any kind.                                       case)
                                                                                Thought by
                                                                                mother to
                                                                                have had
                                                                                local injury
                                                                                at delivery.
11      Baldwin’s Hill          30 June „       2 July „        Died 7 July     The             ,, 21                 —               —
                                                                1877            particular
                                                                                powder used
                                                                                from birth to
                                                                                attack.
12      Baldwin’s Hill          — 1875          Aug. „          Recovered       The                   —               —               —
                                                                                particular
                                                                                powder
                                                                                exceptionally
                                                                                used to a
                                                                                chafed thigh.
13      Stoney Path             15 Aug. 1877    16 Aug. „       Died 21 Aug.    The             ,, 22                 —         T. C., page
                                                                1877            particular                                      5.
                                                                                powder used
                                                                                from birth
                                                                                till death.
14      Baldwin’s Hill          6 Oct. „        25 Oct. „       Died 28 Oct.    Other powder          —         No. 4           E. W., page
                                                                1877            till day or                                     4.
                                                                                so before
                                                                                attack, then
                                                                                particular
                                                                                powder.
15      Ash Green               25 Oct. „       26 Oct. „       Died 30 Oct.    The             ,, 6            ,, 8                  —
                                                                1877            particular
                                                                                powder used
                                                                                from birth
                                                                                onwards.
16      Baldwin’s Hill          11 Nov. „       15 Nov. „       Recovered       The             ,, 24           „ 13                  —
                                                                                particular
                                                                                powder used
                                                                                till attack,
                                                                                then
                                                                                discontinued.
17      Ash Green               20 Nov. „       22 Nov. „       Died 30 Nov.    The             „ 30            „ 16                  —
                                                                1877            particular
                                                                                powder used
                                                                                from birth
                                                                                till death.
18      Stoney Path             — 1873          — Nov. „        Recovered       The                   —               —         Sister to T.
                                                                                particular                                      C., page 5.
                                                                                powder
                                                                                exceptionally
                                                                                used to sores
                                                                                following
                                                                                measles.
19      Golding’s Hill          — 1875          Xmas „          Recovered       The                   —               —         A. D., page
                                                                                particular                                      5.
                                                                                powder
                                                                                exceptionally
                                                                                used to sores
                                                                                from chicken
                                                                                pox.
20      Baldwin’s Hill          29 Dec. 1877    30 Dec. „       Died 1 Jan.     The                   —         „ 23            Infant of
                                                                1878            particular                                      N.’s
                                                                                powder used                                     daughter,
                                                                                from birth                                      page 4.
                                                                                till death.
21      High Road               7 Nov. „        31 Dec. „       Recovered       Other powder          —         „ 11            C. N., page
                                                                                till 29 Dec.,                                   4.
                                                                                particular
                                                                                powder at and
                                                                                after that
                                                                                date.
22      England’s Lane          26 Nov. „       1 Jan. 1878     Recovered       Starch only     „ 16                 „ 18             —
                                                                                thought to
                                                                                have been
                                                                                used; but
                                                                                particular
                                                                                powder kept
                                                                                in house.
23      Ash Green               30 Dec. „       14 Feb. „       Recovered       Powder          ,, 17           ,, 24           P. S., page
                                                                                remaining                                       5.
                                                                                from previous
                                                                                confinement
                                                                                till few days
                                                                                before
                                                                                attack, then
                                                                                particular
                                                                                powder.
24      Baldwin’s Hill          13 Feb. 1878    14 Feb. „       Died 18 Feb.    The             ,, 7            „ 33                  —
                                                                1878.           particular
                                                                                powder used
                                                                                from birth
                                                                                till death.
25      Golding’s Hill          2 Jan. „        20 Feb. „       Recovered       Other powder          —         „ 26            E. D., page
                                                                                used till two                                   5.
                                                                                days before
                                                                                attack, then,
                                                                                for two days,
                                                                                particular
                                                                                powder.
26      Golding’s Hill          13 March „      15 March        Died 19 March   The             ,, 12           „ 39                  —
                                                1878.           1878.           particular
                                                                                powder from
                                                                                birth till
                                                                                illness.
27      Baldwin’s Cottage.      — Dec. 1875     Mid.  March     Recovered       The                   —               —         Sister to H.
                                                1878.                           particular                                      J., page 5.
                                                                                powder
                                                                                exceptionally
                                                                                used a day or
                                                                                so before
                                                                                attack.
28      Baldwin’s Cottage.      19 Feb. 1878    Mid.  March     Recovered       Powder from     „ 18            „ 36            H.  J., page
                                                1878.                           London till                                     5.
                                                                                day before
                                                                                attack, then
                                                                                particular
                                                                                powder.
29      York Hill.              17 Feb. „       19 Feb. 1878    Died 22 Feb.    The             ,, 36           „ 35                  —
                                                                1878.           particular
                                                                                powder from
                                                                                birth.

 NOTE.—Nos. 3 and 4, 13 and 18, 4 and 12, and 27 and 18 occurred, in each
                     instance, in the same household.

                                * * * * *

                                 LONDON:
            Primed by GEORGE E. EYRE and WILLIAM SPOTTISWOODE,
             Printers to the Queen’s most Excellent Majesty.
                   For Her Majesty’s Stationery Office.
                           [B 580.—100.—10/78.]




Footnotes.


{6}  The exact combination in which the oxide of lead occurs has not been
determined, whether as carbonate or combined with the arsenious acid or
in some other form.




***