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.
{181}
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 OMALLEY.
{187}
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.
Many physicians are still under the grave error that diphtheria can
always be recognised without the aid of the microscope, and that
membranous croup commonly kills. All scientific writers upon
diphtheria agree that it is caused by the Klebs-Loeffler bacillus.
They also hold that there is a disease called membranous croup, as
distinct from diphtheria as typhoid is, but that membranous croup is a
comparatively harmless and non-contagious disease. Two per centum is a
liberal mortality in membranous croup, yet a certain class of
physicians are constantly reporting deaths from this disease. In a
series of 286 cases (not deaths) diagnosed as membranous croup by
physicians of New York {188} City a few years ago, Park found the
diphtheria bacillus in 229, or 80 per centum. I have never examined
the throat of a child dead from so-called membranous croup in which I
did not find the diphtheria bacillus. This is the experience of almost
every bacteriologist who has had to do with diphtheria. Some men
report deaths from diphtheria as thrush! These deaths might just as
truthfully be attributed to the wearing of linen collars.
On the other hand, according to Baginsky of Berlin, Martin of Paris,
Park of New York, and Morse of Boston, from 20 to 50 per centum of the
cases admitted even to diphtheria hospitals have not diphtheria at
all. Bacteriologists find that about 35 per centum of the cases
reported by physicians to be diphtheria are really nothing but
tonsilitis or pharyngitis, with now and then a case of membranous
croup. Without a bacteriological diagnosis, therefore, 35 families in
each 100 quarantined (where quarantine laws exist) are unjustly
quarantined and subjected to the trouble and expense of useless
disinfection. The suffering this can cause to a poor family, whose
small business is often ruined by quarantine, is a matter for very
serious consideration. Again, no matter what experience a physician
may have had, he can not in many cases differentiate diphtheria in its
early stages, or in children of good resisting power, from
comparatively harmless throat affections. The extraordinary resisting
power against diphtheria shown by some children and adults has been
described by Wassermann (_Zeitschrift f. Hyg._, 19 B., 3 H.). He found
one series of 17 children, from one and a half to eleven years of age,
and 34 adults, in which 11 children and 28 adults were not only immune
to diphtheria, but some of them had enough antitoxin in their blood to
neutralise a tenfold fatal dose of diphtheria toxin. This explains
many mysterious outbreaks of diphtheria: such immune persons are
infected and they carry about the disease unconsciously because they
are not ill themselves. I have seen a mother kiss a child dying of
malignant diphtheria and the woman did not get even a sore throat, but
I know of another case exactly like this in which the mother died from
the infection.
{189}
There are bad cases of diphtheria which the experienced physician can
diagnose as soon as he enters the patient's room without even looking
at the throat, but the lighter cases that are dangerous are not easily
recognised. I have seen two children of a family in Washington
attacked with a slight throat soreness after one child had died of
diphtheria in the house. The cases of these two children would never
even suggest diphtheria if that first child had not had the disease.
Both these patients died within ten days of syncope without the
formation of any membrane, but the diphtheria bacillus was present
microscopically. To the moment of death there was nothing in the
symptoms of these two children to show diphtheria to the naked eye.
From a personal experience with more than 800 cases of diphtheria in
hospitals and as a medical inspector, I feel certain that light
attacks of diphtheria can not be diagnosed without the aid of the
microscope.
The immunity mentioned above explains the fact that the Klebs-Loeffler
bacillus is sometimes found in healthy throats, and the person that
has such a throat is really more dangerous than a patient that is ill
with diphtheria, because we cannot guard ourselves against him.
School-children at times have what appears to be mere sore throat but
which is really diphtheria in the naturally immune.
All cases of sore throat in school-children should be examined
bacteriologically, but unfortunately the bacteriological examination
for diphtheria is a complicated process which requires an expert
bacteriologist and a laboratory. The cost of a laboratory fitted for
this diagnosis alone is not great, but it is not easy to persuade
small city governments that they need such plants.
The only resource, then, is to treat every suspicious case of sore
throat as if the disease were really diphtheria, until a diagnosis is
established as near the truth as possible. Children that are afflicted
with throat inflammations should be kept from school. The people
should be taught the necessity of isolation and disinfection; they
should be warned against patent disinfectants, and told to ask
competent physicians to advise them in disinfection.
{190}
Diphtheria is not directly caused by unhygienic surroundings. A
disregard for hygiene disposes a child for infection if the child is
exposed to the bacillus. The specific germ must be introduced into the
patient's mouth or nostrils. When a child is infected with diphtheria
the breath is not a medium of contagion. The sputum, spat out or
coughed out, is a means whereby the disease is spread. The bacillus is
in the patient's mouth and nostrils; it gets upon his hands by
contact, upon eating utensils, upon whatever touches the mouth of the
sick person. The bacillus does not float in the air of even the
sick-room, except in those cases where dried sputum is stirred up by
sweeping or attrition of other kinds.
In a boarding-school or family when a diphtheria patient is found,
select a room set off as far as possible from the rooms commonly used,
and before putting the patient into this room remove all curtains,
upholstered furniture and carpets from it that are not so cheap or so
worn that they may be destroyed after the patient's convalescence, or
which are of such texture that they will not be destroyed by water or
disinfection by heat. In any case the less there is in the room the
easier the disinfection will be.
Use the mattress upon which the patient had slept before you
discovered the nature of the disease. Books should be removed, because
an infected book can not be disinfected except upon the outside. The
room is not to be swept while the patient is in it,--dust may be wiped
up with a damp cloth. The cloth is to be disinfected before it is sent
out of the room.
The popular notions regarding sulphur as a disinfectant after
diphtheria are erroneous. Sulphur fumes in certain definite quantities
will disinfect after smallpox, scarlet fever, measles, and some other
diseases; these fumes will also kill the diphtheria bacillus, if the
bacillus is wet and exposed directly; but if it is buried in sputum or
in clothing the fumes will have no effect whatever upon it. The
disinfectants to use are acid bichloride of mercury and heat.
Formaldehyde does not penetrate well enough to be reliable in
diphtheria.
{191}