If a boy will smoke let him use a good long-cut tobacco which has little or no Perique tobacco in it, in a "Remington," "Edison," or similar wooden pipe. These are pipes with stems of large calibre, and in the stem there is a roll of absorbent paper or pith which keeps the pipe clean. Cigars, no matter how costly they may be, are too strong for a boy and for most men. A poor cigar irritates the throat aside from the regular effect of the tobacco, especially if there is much nitre in the wrapper. Meerschaum pipes are dirty and too strong. The tongue is irritated by a pipe that has a small bore in the mouthpiece: use a mouthpiece that has as large a bore as possible. Cigar smokers should, after cutting off the end of a cigar, blow the dust out of it from the lighting end to avoid inhaling this irritating dust.
AUSTIN ÓMALLEY.
XVII
MENTAL DISEASES AND SPIRITUAL DIRECTION
It is a well-recognised fact that persons suffering from many forms of beginning mental disease are likely to be affected by an exaggeration of religious sentiment. An unaccountable increase in piety is sometimes the first warning of approaching mental deterioration. It is not hard to understand why this should be, since religious feelings occupy so prominent a place in the minds of the majority of people, and the removal of proper control over mental operations of all kinds leads to an exaggeration, especially of those that have meant most for the individual before. Supposed religious vocations, especially when of sudden development, are sometimes no more than an index of disturbed mentality. Every confessor of lengthy experience has had some examples of this. This makes it important that clergymen should have a knowledge of at least the first principles on which the diagnosis of mental diseases is made. Superiors of religious communities, and especially those that have to decide as to the suitability of those applying for entrance to, or already in probation for, the religious life, need even more than others a definite knowledge of the beginning symptoms of the various mental diseases, and of the types of individuals that are most prone to suffer from them.
Besides, confessors and religious friends and advisers often gain the confidence of the mentally diseased much more fully than any one else. It is to them especially that the earliest symptoms of beginning mental disturbance are liable to be first manifested. After all, a pastor's and a [{212}] confessor's duty is bound up with the welfare of his spiritual children in every sense; and it would be supremely serviceable to the patients themselves and to their friends, if these earliest symptoms could be recognised and properly appreciated, and due warning thus given of the approach of further mental deterioration.
The mental diseases that are of special interest in this respect are the so-called idiopathic insanities. Idiopathic is a word we medical men use to conceal our ignorance of the cause of disease. Idiopathic diseases are those that have come of themselves, that is, without ascertainable cause. As a matter of fact, the most important group of mental diseases develop without presenting any alteration of the brain substance, so far as can be detected by our present-day methods of examination. The initial symptoms of these diseases, then, are of great importance, and not readily recognisable unless looked for especially. There is no physical change to attract attention, and the change of disposition and mental condition is often insidious and only to be recognised by some one who is in the confidence of the patient. It is in these idiopathic insanities, then, that the careful observation of the clergyman is of special significance. Needless to say, powers of observation to be of service must be trained.
While there are no known changes in the brain tissues in these diseases, it seems not improbable that the development of our knowledge of brain anatomy, which is especially active at the present time, will very soon demonstrate the minute lesions that are the basis of these mental disturbances. It seems not unlikely that the underlying cause of so-called idiopathic insanity is usually some change within the brain cells. Hints of the truth of this conjecture are already at hand. Meantime the actual observation of this class of patients in asylums and institutions, private and public, and the collation of the observations of authorities in psychiatry from all over the world, have thrown a great deal of light on these forms of mental disease. We know much more of the initial symptoms and of incipient conditions that threaten the development of mental [{213}] disequilibration than we did twenty-five years ago. With regard to prognosis especially, recent publications have added considerably to our knowledge, although it must be confessed that they have rendered our judgment of such cases much less hopeful.
The ordinary forms of mental diseases have sometimes been considered as passing incidents in the lives of patients suffering from such disorders. While it was generally understood that severe cases were apt to have recurrences, and that after persistence of mental symptoms for a certain length of time the outlook as regards eventual absolute cure is rather dubious, yet the general prognosis of such simple states as melancholia or simple mania was not considered to be distinctly unfavourable. Patients might very well recover their mental sensibility after even a severe attack, and never have a relapse.
It was something of an unpleasant surprise to the medical world, a few years ago, when one of the most distinguished authorities in Europe on the subject of mental diseases, Professor Kraepelin, of the University of Heidelberg, stated in his text-book of psychiatry, that among a thousand cases of acute mania he has observed only one in which the symptoms did not recur. Professor Berkley, of Johns Hopkins University, Baltimore, a conservative American authority, in discussing this subject of relapses after single occurrences of mania, is evidently of the opinion that Professor Kraepelin's opinion in the matter presents the inevitable conclusion that must be drawn from recent advances in the clinical knowledge of maniacal conditions. "Simple mania," he says, "is, according to the statistics now at hand, an exceedingly rare form of mental disease, and the physician should therefore be cautious in making a prognosis of final recovery. Relapses after a number of years, when stability is apparently assured, are frequent, as every one interested in mental medicine knows only too well."