JAMES J. WALSH.
XII
UNEXPECTED DEATH IN SPECIAL DISEASES
Besides the general systemic conditions in which sudden death may occur without anticipation, there are certain specific diseases of which unexpected death is sometimes a feature. For the clergyman to know the condition in which the sudden fatal termination is liable to occur is to be forearmed against the possibility of death without the Sacraments, or their enforced administration in haste, when the recipient is in a very unsatisfactory condition of mind and body. It has been said that if a normally healthy individual reaches the age of twenty-five he is reasonably sure to live to a good old age, provided he does not meet with an accident or catch typhoid fever or pneumonia.
Pneumonia is an extremely important affection as regards its prognosis. From 15 to 20 per centum of sufferers from the disease die; that is to say, about one in six of those attacked by the disease will not recover. It is a little more fatal in women than in men. It is especially serious for the very young and the old.
Healthy adults in middle life very rarely die from the disease. The prognosis of any individual case, it has been well said, depends on what the patient takes with him into the pneumonia. Serious affections of important organs nearly always cause fatal complications. If the heart is affected before the pneumonia is acquired, then the prognosis is very unfavourable, and a fatal termination is almost inevitable. If the kidneys are seriously diseased beforehand, death is almost the rule. Pneumonia developing during the course of pregnancy is fatal in more than one-half of the cases. At one time it was suggested that premature delivery of pregnant [{151}] pneumonia patients might save at least the mother's life. Experience in Germany, however, has shown that, far from making the prognosis more favourable, the induction of premature labour makes the outlook a little worse for the patient. Previous affections of the lungs, emphysema, or tuberculosis, are prone to make the prognosis of pneumonia much more unfavourable than under ordinary circumstances.
Deteriorated conditions of the blood, anaemia, chlorosis—such as occurs so commonly in young women—is prone to make the outlook in pneumonia more serious. Pneumonia of the upper lobes of the lungs is more apt to be followed by complications, and is therefore more serious than pneumonia of the lower lobes. Secondary pneumonia—that is, inflammation of the lungs which develops as a complication of some other disease—is much more unfavourable than primary pneumonia which develops in the midst of health. The amount of lung involved is of course a serious factor in the prognosis. If the whole of one lung is consolidated, or if considerable portions of both lungs are thus affected, the prognosis becomes extremely unfavourable.
In persons of alcoholic habits the result of pneumonia is always to be dreaded. The more liberal has been the consumption of alcohol, as a rule, the less hope is there of a prompt, uncomplicated recovery. Stimulants are of the greatest importance in pneumonia, and the less the patient has taken of them before the development of his pulmonary affection the more effective are they when the crisis of the disease comes. The less the alcohol that has been taken habitually before the development of pneumonia, the more surely will it do the work expected of it during the course of the pneumonia. It must be borne in mind that cases of pneumonia that occur in institutions, asylums, hospitals, and the like, and in crowded quarters in tenement houses or lodging houses, have a distinctly worse prognosis than those treated in private houses, and the priest must accordingly be more on his guard and give the Sacraments early.
In pneumonia, as in typhoid fever, so-called walking cases always have a serious prognosis. They occur in very strong patients who resist, not the invasion of the disease, but its [{152}] weakening influence, and keep on their feet for several days, despite the presence of symptoms that require them to be in bed. When a patient walks into a doctor's office in the third or fourth day of a pneumonia with most of one lung consolidated, exhaustion of the heart and of the nervous system, under these unfavourable conditions, will usually have made his resistive vitality very low. Such cases should be given the Sacraments early, while in the full possession of their senses. Conditions sometimes develop rather unexpectedly in which the administration of the Sacraments becomes unsatisfactory, because of the collapsed state of the patient.
This same advice holds with regard to walking cases of typhoid fever. Where strong patients suffering from the disease have insisted on being around on their feet for from six to ten days at the beginning of the affection, the prognosis becomes very unfavourable. Complications, such as hemorrhage or perforation of the intestine, occur about the beginning of the third week, and often prove fatal. All typhoid fever patients should receive at least the Sacraments necessary to give a sense of security to the priest and their friends during the course of the second week, even though they may seemingly be in excellent condition. When typhoid fever is fatal the complications occur suddenly, often without much warning; and if intestinal perforation, for instance, takes place, the peritonitis which develops makes the patient's condition very unsuitable for the reception of the Sacraments in a proper state of mind.