A Special Mortality among Infants 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:—