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.