Typhoid fever patients sometimes die suddenly in collapse when they are convalescent. The toxine of the typhoid bacillus often affects the heart, and causes what is called cloudy swelling of its muscular fibres. This decreases very notably their functional ability. Any sudden exertion, even sitting up in bed, may cause the heart to stop under such circumstances. The modern custom in hospitals is not to allow typhoid patients to sit up in convalescence until the head of the bed has been raised gradually for several days so as to accustom the heart to pumping blood up the hill to the brain. Priests must be careful, then, when they call to see convalescent typhoid patients, not to permit them to sit up [{153}] to greet them. The doctor's directions in this matter should be followed very carefully.
This sudden fatal collapse may occur after any of the infectious diseases. It is seen not infrequently after diphtheria. It occurs more rarely after scarlet fever, and even after some of the milder children's diseases. In rheumatism, especially where a heart complication has occurred, this rule with regard to sudden movements is extremely important Rheumatism is itself not a fatal disease, yet there are certain cases in which very high temperature sets in, causes delirium, and death ensues at times before the patient recovers consciousness. Where rheumatic patients show a tendency to run high temperatures, that is, 104° or higher, it is well to be prepared for this emergency.
Appendicitis is very much talked about in our day; but the fatal affection represented by the new word is no more frequent than it was half a century ago, or, for that matter, twenty-five centuries ago. People died of inflammation of the bowels and peritonitis then; and as the appendix was not known as the origin of the trouble, the fateful name was not the spectre that it is now. Practically all abdominal colic—and this means 90 per centum of all the acute pain which follows gastro-intestinal disturbance in young or middle-aged adults—is due to appendicitis. It comes on, as a rule, in the midst of good health. It is very treacherous, and when the patient is apparently but slightly ill, a sudden turn for the worse may assert itself, and an intensely painful and prostrating condition develop. Where symptoms of appendicitis are present, it is the part of safety to have the patient receive at least the Sacraments of Penance and the Holy Eucharist. When peritonitis develops, vomiting is the rule. Hence the advisability of prompt administration of Holy Communion. Extreme Unction can be given with some satisfaction, even during the disturbed period which follows a beginning peritonitis. For the peritonitis that sometimes results from appendicitis there is no hope of recovery except by operation. Operation, to be successful, must follow the perforation of the appendix not later than by a few hours.
Early pregnancy, that is, the first eight to ten weeks of gestation, is sometimes complicated by a set of symptoms the most prominent of which are sudden very acute pains in the lower part of the abdomen, followed by intense prostration, and then by the symptoms of internal bleeding,—namely, a soft pulse, pallor with cold extremities, sighing respiration, and marked tendency to faintness. When symptoms like these occur during the first three months of pregnancy, they signify, almost without exception, rupture of an extrauterine gestation-sac. Except where operation can be performed at once, these cases are almost invariably fatal. Extrauterine pregnancy occurs with greatest frequency in women who, having had one or more children, then have a period of five or more years without children, followed by pregnancy. Undoubtedly, extrauterine pregnancy, the knowledge of which is the result of medical advance in very recent years, and appendicitis, which is the growth of the last twelve years, were prominent factors in the production of many inexplicable deaths in history. These were not infrequently set down as due to poison.
Acute indigestion in elderly people is sometimes followed by sudden death. Observations in this matter have somehow become much more frequent of late years, and many of the so-called cases of heart failure belong to this group. The important nerve trunk that carries nervous fibres to the heart bears fibres to the digestive tract, the oesophagus, the stomach, the intestines, the liver as well, and also to the larynx and lungs. There is a certain intercommunication between the impulses which pass along these various nerve fibres. Intense irritation of the nerve endings in any one of these organs may be reflected back upon the heart. Curiously enough the nerve fibres to the heart that run in this trunk are many of them inhibitory; that is to say, they lessen the function of the heart or cause it to stop beating entirely. If an intense nervous irritation is set up in the stomach, reflex nervous impulses may cause the heart to stop completely and never resume its work.
Typical cases of this kind often occur during the first cold days of the winter time. Elderly people come to their meals cold and chilly, yet with appetite increased by the bracing air. They sit down at once, take a larger meal than usual, and then develop severe gastritis during the night. This is [{155}] relieved by purging and vomiting, and the pain yields to the administration of morphine. Their condition improves and all danger seems past, when, on sitting up suddenly the next day, or, if left alone, getting up to get something for themselves, they collapse and are dead before help can come to them. Deaths like this sometimes occur in dysentery also, the reason being the intense nervous reflex from the irritated intestinal nerve endings which exerts its influence upon the heart nerves.
Certain diseases practically always end in sudden death and must be taken special care of by the priest for this reason. Aneurism, for instance, is one of these. An aneurism is a widening or dilatation at some point of an artery. The most important aneurisms occur in the arch of the aorta, that is, in the large curved artery which comes directly from the heart itself and of which all the other arteries are branches. Aneurisms develop, according to the expression of a distinguished American physician, in the special votaries of three heathen divinities, Vulcan, Bacchus, and Venus,—that is, in those who have worked too hard, in those who have drunk too hard, and in those who have devoted themselves too much to the pleasures of the flesh. The most important factor of all is, however, the contraction of venereal disease, especially of that form known as syphilis.
The termination of aneurism cases is usually by rupture with profuse hemorrhage. Death takes place in a moment or two. Aneurisms often cause intense pain, which is sometimes thought to be rheumatic in origin. If the aneurism, in its enlargement, meets with bony structure, it produces absorption of the bone by pressure upon it and so finds a way even through the bone to the overlying skin. This process is always intensely painful, and shortly after the aneurism appears at the surface the pressure upon the skin causes it to become thin and the aneurism may rupture externally.
Addison's Disease always ends suddenly. This is a rare affection, described by Addison, an English physician, some fifty years ago, which develops in individuals whose suprarenal capsules are degenerated. The suprarenal capsules are little bodies of half-moon shape which lie above the kidneys. [{156}] Their degeneration produces a great lowering of blood pressure. The patient becomes intensely weak, muscular movement becomes impossible, intellectual processes cause great fatigue, and finally blood pressure becomes so low that fatal collapse ensues from lack of blood in the brain. The external symptoms of these cases is a pigmentation, that is, a very dark discolouration of the skin, which develops rather early in the disease. The tongue especially becomes a very dark brown. Areas of pigmentation also occur where the skin is irritated,—at the wrists from the irritation of the coat sleeves, at the edge of the hair from the irritation of the hat. Dr. S. Weir Mitchell, in his Autobiography of a Quack, has described one of these cases very strikingly. The hero of the tale is found dead one morning by the nurse in the hospital, after he has been feeling quite as well as usual for some time.