Part 28

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.