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SUMMARY AND CONCLUSIONS

The paper deals with delusions of a personal (autopsychic) nature and is one of a series based upon certain statistics of Danvers State Hospital cases (previous work published on somatic, environmental (allopsychic) delusions and those characteristic of General Paresis). The previous work had suggested that somatic delusions are perhaps more of the nature of illusions in the sense that somatic bases for somatic false beliefs are as a rule found. On the other hand, delusions respecting the environment (allopsychic delusions) had appeared to be more related to essential disorder of personality than to actual environmental factors.

The fact that cases of paresis with delusions were found to have their lesions in the frontal lobe, whereas non-delusional cases showed no such marked lesions, is of interest in the light of the present paper because three cases of senile psychosis were found to have delusions of grandeur and, although they are demonstrably not paretic, they also show mild frontal lobe changes supported by microscopic study.

The Danvers autopsied series, containing 1000 unselected cases, was found to show 306 instances with little or no gross brain disease. Of these, 106 had autopsychic delusions and of these 106, 50 cases had delusions of no other sort. 15 of these 50 cases appeared to have been cases of General Paresis in which gross brain lesions were not observed at autopsy, and upon investigation 13 other cases were found to be, for various reasons, improperly classified. The residue of 22 cases was subject to analysis and readily divides itself into two groups of 11 cases each, or two groups of normal-looking brain cases having autopsychic delusions and these only are cases which may be termed the "pleasant" and

"unpleasant" groups, in the sense that the delusions in the first group were either pleasant or not unpleasant, whereas the delusions in the second group were of clearly unpleasant character.

Three of the "pleasant" delusion group were the three cases of grandeur and delusions in the senium above mentioned. Three others were cases of "theomania" in the sense that their delusions concerned messages from God. It is not clear that these three religious cases should be regarded as belonging in the group of "pleasant" delusions on account of the sense of constraint felt by the patients.

The remainder of the "pleasant group," as the delusions were originally defined, turned out for the most part to show either doubtful delusions or delusions involving a sense of constraint rather than of pleasure.

An endeavor was made to learn the relations of pulmonary phthisis to the emotional tone of the delusions. The few available cases in this series seem consistent with the hypothesis of phthisical euphoria (IV, "happiest woman in the world," hearing God's voice, VII and possibly XI).

The problems of the "pleasant" delusion group, as superficially defined, turned out to be a. the problem of a group of senile psychoses with grandiose delusions and frontal lobe atrophy; b. the problem of felt passivity under divine influence; c. the problem of phthisical euphoria.

The group of "unpleasant" delusions in the normal-looking brain group should be diminished by one on account of its positive microscopy (encephalitis). One case (XIII) is a case of mixed emotions of religious type, showing phthisis pulmonalis together with abdominal tuberculosis and nephritis. One case (XV) is doubtful as to delusions; the remainder are subject to renal disease, as a rule associated with cardiac lesions.

Two cases which were transferred from the "pleasant" to the "unpleasant" group on account of constraint feelings, were also renal cases,—VII and IX. The only exception to the universality of renal lesions in this group is the case in which religious delusions were probably based upon hallucinations for which hallucinations an isolated brain

lesion was found, very probably correlatable with the hallucinosis.

Virtually all of the eleven cases determined to belong in the "unpleasant" group are cases with severe renal disease as studied at autopsy.

Whether the unpleasant emotional tone in these cases of delusion formation is in any sense nephrogenic and whether particular types of renal disease have to do with the unpleasant emotion, must remain doubtful. A still more doubtful claim may be made concerning the relation of euphoria to phthisis. The renal correlation is much more striking as well as statistically better based. A further communication will attack the problem from the side of the kidneys in a larger series of cases.