Part 29

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 OMALLEY.

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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.