Part 17

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 Viaticum 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 Viaticum, 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; cum 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 Viaticum 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-knob 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 multitudes 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 space. 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 associated with typhus. It has a mortality that can go up to 14 per centum in unfavourable circumstances, 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-knob 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 sexual centres.

Scarlatina or scarlet fever first appeared in North America in Massachusetts 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, asses, 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 harassed, 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 class 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.

Actinomycosis ([Greek text], ray-fungus) is a disease caused by actinomyces, a micro-organism that partly resembles a bacterium and partly a fungus. The disease can be fatal. It is very improbable that it ever passes from man to man, but as a matter of prudence the priest should wash his hands in bichloride after anointing such a patient.

Septicaemia, or blood-poisoning, can be brought about by different pyogenetic bacteria,--the varieties of the staphylococci (irregularly grouped cocci), streptococci (chain-cocci), pneumococci, and others. The danger of infection is so slight that it may be neglected.

Erysipelas can be fatal, especially in alcoholics, the aged, and in chronic diseases. Erysipelas is contagious, especially if the bacteria get into an abrasion in the skin. Patients having this disease sometimes grow delirious and violent, and the priest should be careful how he handles them. Disinfect the hands after anointing such a patient.

Tetanus, or lockjaw, is not communicable except by inoculation. The bacillus, which was isolated by Kitasato, the Japanese bacteriologist, in 1889, is found everywhere in soil, hay dust, floors, on old nails, especially on the floors of old wooden slaughter-houses. It grows best in deep wounds {184} where it is shut off from the oxygen of the air. Hence the danger of treading upon a nail that has been lying near the ground.

Beriberi, a disease observed especially among seamen, appears at times in our coast towns. It is always a very serious malady and sometimes it is rapidly fatal. The infective agent, which is not known, is not undoubtedly communicable from man to man, but it is carried from place to place, and it clings to ships and buildings; it thrives in hot, moist, crowded places. The priest should disinfect his hands after visiting a case.

Anthrax, called also wool-sorter's disease and splenic fever, is a very fatal disease, and the bacillus is communicable to any one through an abrasion of the skin, through the intestines by swallowing it, or through the lungs by breathing it in in dust. Disinfect the hands and the shoes after visiting a patient. Be careful not to touch anything in his room.

The bacteria that cause typhoid fever, Asiatic cholera (which has been epidemic in America) and epidemic dysentery must get on the hands, or on food, or in water, and thus reach the mouth and be swallowed before they produce these diseases. Act in cholera as in anthrax, and disinfect the hands after visiting a case of typhoid.

The bubonic plague, the most fatal of all epidemic diseases, has already appeared in California and Mexico. It is caused by a specific bacillus isolated by Kitasato and Yersin in 1894. The disease is communicated by contact and it is seemingly also miasmatic.

The terrible plague of the Black Death that swept over Europe from 1347 to 1350 was a malignant form of the bubonic plague. Over 1,200,000 people died in Germany, and Italy suffered much more. In Vienna for some time about 1000 people a day died and were buried in great trenches. Venice lost 100,000 inhabitants, and London lost more than that. In both Padua and Florence only one-third of the inhabitants were left alive; at Avignon the Rhone was consecrated so that bodies might be thrown into it for burial; and ships drifted about the coasts of Europe {185} with dead crews. Hecker, in his study of this plague, says that nearly one-fourth of the population of Europe died in that visitation. Civilisation was wellnigh overthrown in the panic. In Germany, Italy, and France the Jews were accused of poisoning the wells and thus causing the plague, and they were slaughtered by thousands. At Strasburg 2000 Jews were burned to death in one holocaust; at other places, as at Eslingen, in despair the Jews set fire to their synagogues and destroyed themselves. The Great Plague of London in 1665, in which 70,000 persons died, was also the bubonic plague.

The mortality is about 90 per centum in some epidemics. The bacillus leaves the body in the faeces, flies carry it to food, it thus gets to rats and mice, and it is carried from place to place. Rats, however, are commonly infected as if by a miasm before the disease appears in man. There is dispute as to the communicability of the plague from man to man by contact with fomites, but it is practically certain the disease can be thus transmitted. Kitasato once succeeded in producing the disease in animals by inoculation with dust taken in an infected house. Merely touching a patient does not apparently convey infection, yet some authorities hold that in time of epidemic the contagion is transmitted even through the air, especially on the ground floor of houses. Perhaps mosquitoes are the medium of infection, as they are inclined to fly low.

In visiting a case of bubonic plague the priest should be as cautious as if he were attending a smallpox patient. After death by smallpox, plague, typhus, cholera, scarlatina, diphtheria, and measles the funerals should be private and the bodies should not be taken to the church.

Malta Fever, or bilious remittent fever, is found in some of the islands taken from Spain. It has a low mortality and is not contagious. Bruce in 1887 isolated the bacterium that causes it.

We do not know the cause of yellow fever despite the claims of Sanarelli that he has isolated the specific micro-organism. Recently American physicians discovered that it is transmitted from man to man by mosquitoes that belong {186} to the genus Stegomyia, the Stegomyia Fasciata especially. If a yellow fever patient is put into a room in which the mosquitoes have been killed and the doors and windows are screened, he is as harmless, as far as contagion is concerned, as a man with a broken leg. The disease is not spread by fomites.

Malaria is caused by plasmodia, which are protozoa, not bacteria, and it is carried from case to case by mosquitoes of the genus Anopheles. So certain are we that this is the mode of infection that the expression "no anopheles, no malaria" has almost become a medical axiom. A bite from an anopheles mosquito does not cause malaria unless the particular mosquito has previously bitten a malaria patient.

The stegomyia flies and bites in the early afternoon and again at night, the anopheles flies and bites after sunset. In visiting a case of pernicious malaria or one of yellow fever avoid the bites of mosquitoes by gloves and a piece of netting, and there is no danger whatever.

The stegomyia mosquitoes are tropical and subtropical, but they can live as far north as Philadelphia and even farther. The anopheles is especially a northern insect. The ordinary culex mosquito, when it alights upon a wall, stands with its body parallel to the wall, as a house-fly stands; the anopheles mosquito stands with its tail raised from the wall at an angle. A mosquito lays its eggs in any pool of still water, and the "wrigglers" seen in an open rain-barrel are the larvae from these eggs. The larvae come to the surface of the water to get air, and they may be smothered with petroleum; but the only effective way to get rid of malaria and yellow fever is to drain or fill pools of water and marshes. Mosquitoes will breed also in the small still bights along the edges of running streams; in old tomato cans that contain rain water; in any still water, fresh or salt.

AUSTIN ÓMALLEY.

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XV

INFECTIOUS DISEASES IN SCHOOLS

Cases of diphtheria, scarlet fever, measles, and even smallpox are not seldom found in schoolrooms, and much anxiety can be averted and the spread of infection can be wholly or in great part averted by a knowledge of disinfection.

The laity will often follow the advice of a priest in matters of hygiene when they are inclined to rebel against the regulations of health departments and the suggestions of physicians, therefore a preliminary explanation of methods for the prevention of infection in the family will be advantageous; prevention in the family is also intimately connected with prevention in the school. Methods useful in the family are useful also in convents and boarding-schools.

As regards diphtheria, the chief causes of the spread of this disease are mistaken diagnosis, imperfect isolation, incomplete disinfection, and, paradoxical though it may seem, a lack of susceptibility to the disease in a large number of children.