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228
As already mentioned, there was some excess of
diphtheria in these streets (vide p. 223).
Consequent on the total increased prevalence of
the disease, there was a tendency to multiple infection,
the number of houses with more than one case
each (48) being 19 in excess of the number for 1898.
The analysis of the multiple infections in 1898 and
1899 is appended below:—
Houses with
1897.
1898.
1 case
200
108
2 cases
86
20
3 ,, in
8
7
4
3
—
5 „
1
—
6 „
—
1
8 „
—
1
Space will not allow of full details being set out
for each house or family from which two or more cases
were reported. An examination of a careful analysis
leads to the conclusions that in 20 instances, the infection
was transmitted direct from the first patient
to the secondary cases; that in 13 instances two or
more cases were simultaneously reported, either owing
to the patients being taken ill at the same time or to
the first case not being diagnosed until the occurrence
of the subsequent attacks; that in 5 instances the
subsequent cases occurred after the return of earlier
patients from hospital; and that in 2 cases the secondary
attacks occurred in children of a second family (in
each instance just about one month subsequent to the
first case). In one house, personal infection led to the