Condensed notes concerning the cases with pseudoparetic delusions follow. Two of them, it will be noticed, yielded some delusions also of an unpleasant nature.
CASE I. (D. S. H. 10940, Path. 999) was a clever business man, Civil War veteran, who began to lose ground at 75 and died at 84. He was given during his disease to boasting and perpetual writing about elaborate real estate schemes and said he owned a $100,000 concern for the purpose.
The case was clinically unusual in that the picture of a pseudoleukemia was presented, with demonstration at autopsy of great hyperplasia of retroperitoneal lymph nodes and grossly visible islands of lymphoid hyperplasia in liver and spleen. The brain weighed 1390 grams and showed little or no gross lesion, if we except a pigmentation of the right prefrontal region under an area of old pias hemorrhage. There was also a chronic leptomeningitis, with numerous streaks and flecks along the sulci, especially in the frontal region. There was little or no sclerosis visible in the secondary arterial branches and but few patches in the larger arteries. Microscopically the cortex proved to be far from normal: every area examined showed cell-loss, perhaps more markedly in the suprastellate layers than below.
CASE 2. (D. S. H. 11980, Path. 1024) was a Civil War veteran who failed in the grocery business, was alcoholic, was finally reduced to keeping a boarding-house and grew gradually queer. Mental symptoms of a pronounced character are said to have begun at 75. Death at 80. Delusions reminded one of general paresis: worth $5,000,000 a month, 108 years old, was to build a church: also, a woman was trying to poison him.
Autopsy showed caseous nodules in lung, coronary and generalized arteriosclerosis (including moderate basal cerebral), mitral and aortic stenosis (the aortic valve also calcified). The frontal pia mater was greatly thickened and, although no gross lesions were noted in the cortex, the microscope brings out marked lesions in the shape of cell losses (especially in suprastellate layers) in all areas examined. There were no plasma cells in any area examined.
CASE 3. (D. S. H. 12767, Path. 1185) was a widowed Irish woman, who died at 87. Previous history blank. Extravagant delusions of wealth were associated with a fear of being killed.
The autopsy showed little save chronic myocarditis with brown atrophy, calcification of part of thyroid, non-united fracture of neck of left femur, moderate coronary arteriosclerosis. The brain was abnormally soft (some of the larger intracortical vessels showed plugs of leucocytes possibly indicating an early encephalitis—Bacillus cold and a Gram-staining bacillus were cultivated from the cerebrospinal fluid.) Though the convolutions were neither flattened nor atrophied and absolutely no lesion was grossly visible, the cortex cerebri and also the cerebellum were found undergoing an active satellitosis with nerve-cell destruction in all areas examined.
The following three cases (IV, V, VI) present a certain identity from their delusions concerning messages from God (V thought he was God). It is very doubtful whether VI should be placed in the present group of Pleasant or Not Unpleasant Delusions, since the patient appears to have been "theomaniacal" as the French say, in a rather passive and unpleasant manner (God occasioned foolish actions!) Placed on general statistical grounds at first in the Not Unpleasant group, Case VI should be transferred to the Unpleasant group. Case V's delusion (identification with God, expression of atonement?) was in any event episodic in a septicemia. Case IV ("happiest woman in the world"), was phthisical (cf. VII) Notes follow:
CASE 4. (D. S. H. 4019, Path. 218) Housewife, 37 years always cheerful, became the happiest woman in the world, hearing God's voice and being specially under God's direction. "Acute mania." Death from bilateral phthisis with numerous cavities and bilateral pleuritis. There were no other lesions except a small sacral bed-sore, a small fibromyoma of the uterine fundus, small slightly cystic ovaries, a slight dural thickening, and possibly a slight general cerebral atrophy. (wt. app. 1205 grams, marked emaciation.)
CASE V. (D. S. H. 11742, Path. 852) was a victim of streptococcus septicemia (three weeks) who said he was God. Patient was a Protestant iron-worker of 59 years, who had lost an eye and had become unable to work about three months before death. Aortic, cardiac, renal lesions at autopsy. Prostatic hypertrophy. Dr. A. M. Barrett found few changes in nerve cells, except fever changes. One area in left superior frontal gyrus showed superficial gliosis.