CASE 13. (D. S. H. 7361, Path. 499) was a somewhat defective Catholic woman (mother insane) always of a melancholy and reserved temperament. She had been ill-treated by husband, child had died, another had followed soon. She developed a belief that she was Eve and had to suffer. At hospital decided that she was in purgatory and expressed a variety of other religious beliefs. She also thought she was ill-treated at hospital. Her head was asymmetrical: skull thick and eburnated. Brain (1130 grams described as normal). Chronic interstitial nephritis. Pulmonary and mesenteric tuberculosis.
Of the remaining nine (XIV-XXII) all had grossly evident kidney lesions except two (XIV and XV). Of these two, XIV probably had renal arteriosclerosis and was in any case very gravely arteriosclerotic in general and suffered from cystitis. Case XV died apparently of starvation with hepatic atrophy; it is a question whether "poverty" was or was not a delusion. Notes of XIV and XV follow:
CASE 14. (D. S. H. 8741, Path. 500) was a German teacher, college-bred, of a reserved and melancholy turn of mind (mother insane). An attack at 39, another at 70. "Both poor wife and son will starve." "Perhaps they should be put out of reach of poverty," later felt he "had caused death of wife and son on account of his expensive living." Autopsy: chronic internal hydrocephalus, cerebral arteriosclerosis. Brain weight 1180 grams. Coronary sclerosis with calcification throughout, aortic and pulmonary valvular calcification hypertrophy of heart. Cystitis.
CASE 15. (D. S. H. 4454, Path. 237) was presumably a manic-depressive case, had in all four attacks, and died in the fourth attack (66 years). The day he arrived at the hospital, having not eaten for several days at the end of several months of delusions of poverty the case was called "acute melancholia," and the cause of death assigned was starvation. The liver weighed 1102 grams and was fatty. There was a diffuse thickening and clouding of the pia mater, and the dura was firmly adherent everywhere to the skull.
Notes follow of seven cases (XVII-XXII) which show many lesions, are in a number of instances cardiorenal and in all instances renal. If it is permitted to count XIV also as renal, a list of eight cases out of the original list of eleven unpleasant-delusion cases is obtained in which nephritis of some type has been found. Case XIII, nephritis and phthisis, belongs also in the renal group.
CASE 16. (D. S. H. 4168, Path. 226) feared death and refused food on the ground that she should not eat. Patient had always been of a despondent and reserved nature (sister also insane) and, after her husband's death, when she was 53, grew unable to carry on her house, dwelt constantly on griefs, entered hospital at 61, and died at 64 ("chronic melancholia"). Death from internal hemorrhagic pachymeningitis. The liver of this case weighed 1074 grams and was fatty. There was chronic interstitial nephritis.
CASE 17. (D. S. H. 4707, Path. 498) originally cheerful and frank, lost her situation as companion, grew despondent at failure to get employment, had a "hysterical" attack at 52. It is doubtful whether her beliefs were delusional: "can never be better," "will not be taken care of," "no place for her." "Subacute melancholia. "The autopsy showed gastric dilation (over 3000 cc.), and an atrophic liver and pancreas, and slightly contracted kidneys. The heart was normal. Death from ileocolitis. Moderate chronic internal hydrocephalus. Dr. W. L. Worcester's microscopic examination showed rather unusual degrees of nerve cell pigmentation (precentral and paracentral).
CASE 18. (D. S. H. 8898, Path. 570) was an unmarried daughter of a fire insurance company president. Both her mother and she developed mental disease after the company failed (Boston and Chicago fires). Both mother and father died, and patient was in several hospitals after 36, obscene, denudative, onanist. Delusions concerning crimes committed. Satyriasis. Could hear fire kindled to burn her. Diagnosis, "secondary dementia."
Death at 54 from bilateral bronchopneumonia. Atrophic uterus. Cystic right ovary with twisted pedicle: atrophic left ovary: contracted kidneys. The brain was not abnormal in the gross— but showed (Dr. W. L. Worcester) some acute changes (also larger cells pigmented).
CASE 19. (D. S. H. 10106, Path. 663) a cheerful Irish house-wife (mannerism of drawling words) underwent a maniacal attack at 41, and another at 44. Delusions: "sorry she had lived": "broken her religion" Given to self recrimination.