Essays In Pastoral Medicine Part 16

During the century preceding Jenner's discovery of vaccination, according to Neimeyer's calculation 400,000 people died of smallpox each year in Europe. Bernouilli, a trustworthy statistician, says that during that same century, "Fully two-thirds of all children born in Europe were, sooner or later, attacked by smallpox, and on an average one-twelfth of all children born succ.u.mbed to the disease."

Early in the sixteenth century 3,500,000 people in Mexico had smallpox (Prescott's _Conquest of Mexico_). In 1707, in Iceland, 18,000 of the population of 50,000 died of smallpox; and in 1891, 25,000 persons in Guatemala died of this disease. In 1875 there were anti-vaccination riots in Montreal, and as a consequence most of the younger inhabitants of that city were not vaccinated. In 1885, smallpox was brought in from Chicago; 3,164 persons died of the disease; of these 2,717 were children under ten years of age, and thousands had the disease.

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[Ill.u.s.tration: ]

PRUSSIA.--With compulsory vaccination and compulsory revaccination at the age of 12.

HOLLAND--With compulsory vaccination of children before entering a school.

AUSTRIA.--Without compulsory vaccination.

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Vaccination may render one immune to smallpox for many years, but if the disease is epidemic it is well to renew the vaccination after about eight years. In normal vaccination, where the lymph has been derived from a reliable source, on the third or fourth day pale red papules develop at the point of inoculation, and about the tenth day these have become pustules. The vesicles dry gradually, and between the fourteenth and twentieth days the scab falls off, leaving a pitted scar. About the fifth day an aureola of inflammation forms around the pocks, from a quarter of an inch to two inches in extent, and the inflamed area may be somewhat sore. A shield should be kept over the vaccination spot for two days, and this is then to be replaced by a piece of sterile gauze held in place by narrow strips of sticking-plaster above and below the inflamed area. Sometimes hives and other rashes occur in vaccination, but they are unimportant.

Where there is a very sore arm or other trouble, the cause may be a pre-existing unhealthy condition, like scrofula for example, or the patient has scratched the pocks, or infected them from his clothing, or the vaccine lymph was unsterile. A careless and dirty vaccinator might infect an arm with pus organisms. If good glycerinated lymph, not too fresh or too old, is used, there is seldom any trouble; but in any case all the annoyance that may come from vaccination is infinitesimal when compared with the smallpox it averts.

We may take a smallpox case as a typical contagious disease in which the priest is to give the last Sacraments; and the disinfection and other precautions observed in such a visit will serve for any other very contagious disease. For only typhus and one or two other maladies are the precautions so elaborate as those needed in smallpox.

There is a dress, called "Dr. Hawes' Antiseptic Suit," and in time of epidemics a priest should have one of these suits, or one made after it as a pattern--they can be obtained in the shops for two or three dollars. They cover the entire person, even the shoes, and they make unnecessary the changing of clothing and the disinfection of the exposed parts of the body. The hands of the priest may be left bare after fastening the sleeves of the suit about the wrists, or he may wear surgeon's thin rubber gloves. In visiting a patient that has any of the contagious diseases mentioned in this chapter, the priest should never touch {177} his own face with his hands after he has entered the sick-room until he has washed them in a bichloride of mercury solution.

A ritual should not be taken into a smallpox room, because a book cannot be disinfected without rendering it useless. The priest should memorise the prayers and ceremonial, or write them out on paper which can be burned in the hospital or the patient's house.

The priest may be obliged to administer baptism, to hear confession, to give the Viatic.u.m and Extreme Unction. Before going to visit a smallpox patient let him find out from the physician in attendance whether the patient can receive the Viatic.u.m, whether he can swallow it or not, whether he can open his mouth enough to take it. Ask also about the possibility of vomiting. Only a very small particle is to be brought in the pyx.

The leather cover for the pyx should not be taken into a smallpox room. Set the pyx inside a corporal, wrap the corporal in paper, and put this package into the pocket of the Hawes suit before entering the room.

As to the use of a stole,--the moralists say "graviter peccatur ab eo qui sine urgente necessitate sine ulla sacra veste unctionem administrat." There is a grave necessity here for doing away with the stole because of the difficulty in disinfecting it, unless you have one made that can be put into boiling water for ten minutes before you leave the patient's house.

The oil-stocks should contain only as much oil as is necessary for the single occasion, because what remains, with the cotton, should be burned in the patient's house.

Do not remain in the room longer than you must unless you have had smallpox. If there is any prayer or ceremonial that can be omitted, by all means leave it out. Lehmkuhl says that the penitential psalms and the litanies may be omitted. Baptise by the short form.

St. Alphonsus Liguori (_Theol. Mor._, lib. 5, tr. 5, n. 710) tells us there is no obligation to anoint both eyes and both ears, "si adsit periculum infectionis," but danger of infection is not materially increased by anointing both sides. {178} Lehmkuhl adds, "excepta dispensatione Sedis Apostolicae addatur unctio pedum." When the feet are to be anointed do not touch the bed-clothing,--tell the nurse to uncover the feet.

St. Alphonsus (_loc. cit.,_ n. 729) speaking of extreme unction has these words: "Pastor ratione officii tenetur sub mortali dare lis qui petunt, nisi justa causa excuset: etiam tempore pestis, modo possit absque periculo vitae; c.u.m eo non teneri docent _Tann. Dian._," etc.

If you have not had smallpox you certainly risk your life by going into the room of a smallpox patient, and the danger of infection is greater in typhus; but suppose a pastor were inclined to take advantage of the excuse, he would be obliged at any risk to go into such a room to hear confession or to baptise, and if he hears confession he may as well stay for the anointing.

If you anoint a patient that has confluent smallpox you probably can not wipe away the oil, because the skin will be pustular. Wipe the oil-stock carefully; then all cotton used should be wrapped in paper and burned in the paper before you leave the house. After anointing, you had better wash your hands carefully in water in which a bichloride of mercury tablet has been dissolved--do not use soap and do not put the bichloride in a metal vessel. Wash your hands thus before you leave the sick-room.

If the patient can receive the Viatic.u.m let him lie on his back, and you should drop the Host into his mouth without touching him with your hand. St. Alphonsus says: "non licet tempore pestis porrigere Eucharistiam medio aliquo instrumento ... sed manu danda est" There is no need of an instrument. If there are any crumbs left in the pyx make the patient take them. St. Alphonsus says this may be done, and it would be almost certain infection to take them yourself if you have not had smallpox recently. Let as little ablution water as possible be given to the patient.

When you leave the room, put the pyx, oil-stocks, corporal, and stole in a pan of water and boil them for ten minutes. This will disinfect them thoroughly and will not injure them in any way. Then take off the Hawes suit as near the street-door as possible and wet it with bichloride {179} solution. Wash your hands again in the bichloride solution and rinse off the bichloride; take the pyx, oil-stocks, corporal, and stole and leave immediately. Do not touch the door-k.n.o.b when going out--let some one open the door for you--and do not shake hands with any one.

Typhus fever is now rare in America, but there was an outbreak in New York City in 1881. This was the fever that killed mult.i.tudes of Irish emigrants about the middle of the nineteenth century. It is called also spotted fever, camp, jail, ship, and hospital fever, and it has many other names. The name typhus is from [Greek text], a smoke or fog, and it indicates the befogged, stuporous condition of the patient. Typhoid fever is so called because it has some resemblance to typhus.

The specific cause of typhus is unknown, but the contagion develops and reproduces itself in the body of the patient. It is thought that the contagion exists in the secretions and excretions of the body and in the exhalations from the lungs and skin. The infection can certainly be carried by clothing, dust, furniture, conveyances of all kinds, and dead bodies, and it remains active for months. It may be transmitted through the air for short distances, not nearly so far as the air will carry the contagion of smallpox. In well-ventilated rooms there is less danger of infection, and a typhus patient should have at least 1,500 cubic feet of air s.p.a.ce. The contagion may be transmitted in all stages of the disease and during convalescence.

Physical weakness, anxiety and worry, improper food, and poverty, are disposing conditions for infection by typhus. The mortality is about 10 per centum--much less than that of smallpox.

In giving the last Sacraments to a typhus patient exactly the same method should be followed as that observed for a smallpox patient.

Keep as far from the patient as possible. After you touch him in anointing or in giving other Sacraments step away from him to say the necessary words. Do not stand between him and an open fireplace, window, door, or ventilator.

Relapsing fever, or famine fever, caused by Obermeier's {180} spirillum, is sometimes a.s.sociated with typhus. It has a mortality that can go up to 14 per centum in unfavourable circ.u.mstances, but the disease is not more contagious than typhoid under hygienic surroundings. Wash the hands in bichloride solution after visiting a case, and do not touch the door-k.n.o.b or things in the room.

Rabies (called also hydrophobia in man) is a rare disease. It is communicable by inoculation, but it is very doubtful that the disease has been communicated from man to man. The saliva from a person suffering with rabies if injected into a warm-blooded animal will cause rabies, and on that account it is prudent to use care in touching such a patient in administering the last Sacraments. The virus might enter through an abrasion on the priest's hand.

There is a false hydrophobia observed in excitable persons that have been bitten by a dog thought to be mad. The dog that has genuine rabies grows sullen, it hides in comers, and it snaps at everything presented to it A sticky, frothy mucus drivels from its mouth and its eyes become red. It will run straight ahead, snapping at anything it meets; it swallows small stones, chips, and similar objects; it does not avoid water. It howls, grows lean, and its hind legs and lower jaw become paralysed.

In man there is a premonitory stage; a furious stage, which lasts from about a day to three days; then a final paralytic stage. It is well to wait for the paralytic stage before anointing the patient, because in the other stages the slightest touch causes violent spasms. Confessors should note that the virus of rabies excites the s.e.xual centres.

Scarlatina or scarlet fever first appeared in North America in Ma.s.sachusetts in 1735. It is especially an April disease here. One attack commonly makes the person immune for life. It is a disease of children, but it attacks adults, and it is fatal among children old enough to receive the last Sacraments. Some epidemics are very malignant; and in such times all the precautions mentioned in speaking of the visitation of smallpox patients should be observed. The contagion is spread just as that of smallpox is spread, except that it is not carried through the air so far.

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Diphtheria is a disease of children, but it also can be fatal to adults and to children old enough to receive the last Sacraments. It is caused by the Klebs-Loeffler bacillus, and it most frequently attacks the throat and nostrils. It can start in a cut in the skin, or on any mucous surface, as the inside of the eyelid. The contagion is not in the breath, but it can be coughed out. It is in the saliva of the patient and it gets on his hands and on what he and the nurse touch. It is not nearly so infectious as smallpox and scarlet fever.

In visiting such a patient the priest should be careful not to touch anything in the room, and he should wash his hands in the bichloride solution after a visit. He must also wet the soles of his shoes with the solution. He should be very careful lest a child suddenly cough fine sputum containing the bacillus into his eyes. Diphtheria in the eyes would destroy sight, and I have seen a pair of spectacles save a man in a case like that. A detailed description of the disinfection in diphtheria is given in the chapter on Infectious Diseases in Schools.

Glanders is sometimes transmitted from beasts to man, and it is almost always fatal in the human subject. The disease is caused by the glanders bacillus. Horses, a.s.ses, dogs, cats, goats, and sheep are susceptible to the disease; pigs are somewhat susceptible; cattle and birds are immune. The infection is in the discharge from the nose of the patient and on the skin eruptions. The same precautions are to be taken as are needed in a diphtheria case.

Influenza, called popularly the grippe, is caused by the bacillus influenzae, which was isolated by Pfeiffer in 1891. The bacillus is found in the nasal secretions and in sputum; it dies in from twelve to twenty-four hours when dried. The disease is contagious, and it is often fatal in alcoholics, the overworked and hara.s.sed, and in those that have chronic diseases. In any case it is a serious malady.

Disinfect the hands after visiting a case.

Dengue becomes epidemic at times, especially in the Southern States.

The disease is very severe, painful, and depressant, but the mortality is quite low except in complication with other maladies. Its cause is not known. It is {182} very contagious and has symptoms which belong to the cla.s.s of disease in which are scarlatina and measles. The priest should act as in a case of scarlatina.

There is a form of pneumonia which spreads so widely and rapidly that it is called epidemic pneumonia. In visiting patients afflicted with this disease the priest should act as in a diphtheria case.

Epidemic cerebrospinal meningitis is a very fatal disease at times in America. Even those patients that survive are frequently made blind or deaf, or are left injured otherwise. The malignant type is nearly always fatal. In some epidemics the mortality is as high as 75 per centum. The visiting priest should act as in a case of diphtheria, although the danger of direct infection is not great.

Tuberculosis is a chronic febrile disease, caused by the bacillus tuberculosis, a parasitic micro-organism discovered by Koch in 1882.

One-seventh of mankind die by this disease. The bacillus remains virulent a long time after it leaves the human body, but it is soon killed by sunlight.

Tuberculosis of the lungs is spread especially through sputum. In the room occupied by the patient, the clothes, furniture, walls, doors, and floor are infected by the bacilli coughed out, even when the consumptive is careful to disinfect the sputum, and, by the way, he rarely is careful. When the priest visits a consumptive's room he should disinfect his hands with bichloride.

Leprosy is caused by the lepra bacillus, discovered by Hansen in 1871.

It is present in many parts of the body, especially in the glands and nervous tissues, and it is found in the mucosa of the mouth and in the nasal secretions. It is very profusely distributed in the corium of the skin. The name comes from [Greek text], scaly.

Leprosy is present here and there along the Mississippi valley from Minnesota and Wisconsin to Louisiana. It is found also in California, Florida, and the Dakotas, in the Philippines, the West Indies, and the worst infected part of the world is the Hawaiian Islands.

The bacillus has not been found in rooms used by lepers, nor in the soil of their graves. Inoculation by leprous {183} material has failed so far undoubtedly to cause leprosy. There is much dispute concerning the contagiousness of this disease. The Dominican Sisters nursing in the Trinidad asylum have been in constant contact with the lepers for about thirty years but none of them has yet contracted the disease.

Zambaco Pasha tells of a family which has lived in the leper asylum at Constantinople for three generations and no one in the family has been infected. Father Damien, however, in Molokai, and Father Boglioli, in New Orleans, did contract the disease. There have been cases of infection from man to man, but ordinarily it seems that some unknown factor must be present to insure infection.

A priest need have no more fear in visiting a case of leprosy than he should have in visiting a case of tuberculosis--not so much. He may wash his hands in bichloride solution after anointing a leper, but it is scarcely necessary to do even that.