Cholelithiasis, that is, stone in the bile duct, may not only cause severe pain, but may lead to rupture of the duct and a rapidly fatal termination. Owing to the practice of wearing corsets, gall-stones occur much more commonly in women than in men. Twenty-five per centum of all women over 60 years of age are found to have gall-stones. While these cases suffer from intense pain they are very seldom fatal. But it must not be forgotten that a fatal issue can take place either from collapse and stoppage of the heart, because of the intensity of the pain, or from perforative peritonitis.
The perforation of a gastric ulcer may cause symptoms which rapidly place the patient in a condition in which the administration of the Sacraments is very unsatisfactory. Gastric ulcers occur especially in young women, usually in those who follow some indoor occupation. Its favourite victims are cooks, though laundresses, seamstresses, and even clerks in stores, suffer from it much more than those engaged in other occupations. It occurs by preference in anaemic or chlorotic women. Sometimes, however, as in the case of cooks, the patients may seem to be in good health. Acute pain in the stomach region, followed by symptoms of collapse, should in such persons be a signal for the administration of all the Sacraments. Fatal peritonitis soon brings on a state of painful uneasiness ill adapted to the proper dispositions for the Sacraments.
Two diseases that are fortunately very rare, but which are almost uniformly fatal, deserve to be mentioned here. In both of them the symptoms of the disease are manifested through the nervous system. They are tetanus and hydrophobia. Tetanus occurs as a consequence especially of a wound which has been contaminated by the street dirt of a large city, or the refuse of a farm. It follows deep wounds such as are made by a hayrake or a pitchfork; or seared wounds, such as are made by a toy pistol. A serum for the treatment of the disease has been discovered, but unfortunately the first symptom of tetanus is not the first symptom of the disease, but the preliminary symptom of the terminal stage of the disease, the affection of the nervous system. Practically all cases of acute tetanus terminate fatally. As soon as a patient exhibits the characteristic symptoms, the lockjaw, the stiff neck, and the rigid muscles, all the Sacraments should be administered. In tetanus, as a rule, consciousness is preserved until very late in the disease. In severe cases, however, a convulsive state of intense irritability develops in which the slightest sound or effort brings on a series of spasmodic seizures. Patients must be prepared, then, early in the disease, if possible.
Rabies or hydrophobia is a disease which claims a certain number of victims every year in our large cities. [{162}] Its symptoms are the occurrence of fever and disquietude, with spasmodic convulsions of the muscles of the throat whenever an attempt is made to swallow. These symptoms come on from three to fifteen days after the bite of a mad dog. Unless the Pasteur treatment has been taken shortly after the bite of the animal was inflicted, no treatment that present-day medicine possesses is able to affect the course of the disease, and patients nearly always die. Their preparation, then, is a matter of necessity as soon as the first assured symptoms of the disease show themselves. [Footnote 4]
[Footnote 4: One cannot help but add a word here as to the cause of the disease, because clergymen can by their advice do something to remedy the evil which lies at the root of the infliction. Hydrophobia is due to stray dogs. In practically every case the fatal bite is inflicted by some animal that no one in the neighbourhood claims. Bites by pet dogs are rarely fatal. If clergymen would use their influence to suppress the dog nuisance we would soon have an end of hydrophobia.]
Alcoholic subjects are very liable to unexpected death from a good many causes. Patients suffering from delirium tremens, for instance, may die suddenly in the midst of a paroxysm of excitement. Such a termination is not frequent, but it has occurred often enough to make it the custom, at asylums for inebriates, to warn friends who bring patients of the liability of such an accident. It is not so apt to happen during a first attack of delirium tremens as during subsequent attacks. It is most frequent among those whose addiction to alcohol for years has caused repeated paroxysms of delirium tremens. The cause of the sudden death is usually heart failure. This term means nothing in itself, but it expresses the fact that a degenerated heart finally refuses to act. Alcoholic poison in the circulation has led to fibroid degeneration of the muscular elements of the heart and made them incapable of proper function, or at least has greatly hampered their action, and the heart ceases to beat.
It must be borne in mind that chronic alcoholism makes a number of serious organic diseases run a latent course. The patient is apt to attribute his symptoms to the after effects of the abuse of alcohol. Unless the doctor who is called in makes a very careful examination, serious kidney disease or even advanced pneumonia may not be discovered. Alcoholic subjects bear pneumonia very badly, and the preliminary [{163}] symptoms of the disease are often completely concealed by the symptoms due to the patient's alcoholism. Other infectious diseases, as typhoid fever, tuberculosis, and even various forms of meningitis, may run a very insidious course and give but very slight warning of their presence. The result is that these diseases are very frequently fatal in alcoholic subjects.
Old inebriates bear operations badly, and the mortality after any operation in such subjects is distinctly higher than in normal individuals. One reason for this is that considerably more ether or chloroform is required to produce narcosis in alcoholic subjects than in ordinary individuals. Ether and chloroform are very irritant to the kidneys. The kidneys are prone to be affected more or less in old alcoholic subjects. Death from oedema of the lungs or from some form of pneumonia is not infrequent in these post-operative cases, and gives as a rule but little warning of its approach.
It is clear, then, that alcoholic subjects must be prepared with special care whenever disease is actually present or an operation is to be performed. Too great care can scarcely be exercised in their regard. What would seem overcaution will save many a heartburn to friends and priest, for it is in alcoholic subjects especially that some of the saddest cases of unexpected death without preparation occur.