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]