Psychoses with Rheumatic Brain Disease and Other Late Cerebral Sequelæ Of Rheumatic Fever: (Collected Reprints.) Vol. II. By Walter L. Bruetsch, M.D. Indianapolis: Central State Hospital, 1944. Various pagination.

Dr. Bruetsch, in this collection of reprints, has demonstrated a well-known fact that a late sequel of rheumatic fever is an obliterating endarteritis which may involve the small meningeal and cortical vessels resulting in infarction of parts of the central nervous system. This chronic infectious process of the brain may produce a variety of mental symptoms. The author stresses that rheumatic heart disease is several times more frequent among mentally ill patients than in the general population. He describes two types of psychosis with endocarditis: 1. psychoses with subacute bacterial endocarditis terminating in death after a sudden onset of the mental symptoms, and 2. psychoses of a reaction type with a chronic rheumatic endocarditis. Some of the cases were diagnosed as dementia præcox, others as manic depressive or involutional psychoses. Nine per cent of the dementia præcox patients who were examined at autopsy showed signs of chronic rheumatic infection involving the brain as well as the heart valves. Bruetsch states that rheumatic alterations found in the brain consisted of a recurrent vascular process of an obliterating endarteritic type, affecting, in the dementia præcox group, mainly the meningeal and cortical vessels with subsequent degeneration in the cortex. He also described some patients who developed convulsions, which he designated as 'rheumatic epilepsy'. I am of the opinion that the mental picture in some of the cases diagnosed as schizophrenia, manic depressive, or involutional psychosis was not related to the rheumatic brain disease.