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."
The more experience the specialist in mental diseases has, the less liable he is to give an opinion that will assure friends of the patient that relapses may not occur after any form of disturbed mentality. While this is true in mania, { 214} it is almost more generally admitted with regard to melancholia. Most patients who have one attack of severe depression of spirits will surely have others if they are placed in circumstances that encourage the development of melancholic ideas. Any severe emotional strain will be followed by at least some symptoms of greater depression than would be expected from the normal person under the same conditions.
Professor Kraepelin has pointed out that in about one out of six cases the patients who came to him supposedly for the treatment of primary attacks of melancholia proved to be really suffering from a relapse of severe mental depression. The careful investigation of the history of these cases showed that they had suffered from previous attacks of depression, though sometimes these were so slight as not to have attracted any special attention from the medical attendant,--if indeed one had been called in the case--and at times even failed to occasion more than a passing remark on the part of friends with whom the patient was living.