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Vienna, November 24, 1887
I., Maria Theresienstrasse 8
Esteemed friend and colleague:
My letter of today admittedly is occasioned by business; but I must introduce it by confessing that I entertain hopes of continuing the relationship with you and that you have left a deep impression on me which could easily lead me to tell you outright in what category of men I place you.
Since your departure Mrs. A. has consulted me and caused me some agonizing in coming to a decision. I have finally arrived at the conclusion that her case is not a neurosis; not so much because of the foot clonus + - (which at present is not in evidence) as because I do not find in her what I consider to be the most important characteristics of neurasthenia (other neuroses really cannot be involved). In the distinction, often so difficult to make, between incipient organic and neurasthenic affections I have been guided by one particular characteristic: in neurasthenia the hypochondriacal alteration, the anxiety psychosis, is never missing and, whether denied or admitted, betrays itself by a profusion of newly emerging sensations, that is, by paresthesias. Our case is almost devoid of such symptoms. She suddenly could not walk, but apart from heaviness in the legs complains of no other sensations — there is none of the pulling and pressing in the muscles, the manifold pains, the corresponding sensations in other parts of the body, and the like. You know what I mean. The so-called dizziness, which began years ago, turns out to have been a kind of fainting spell and not a true vertige;1 that, too, I cannot connect with the neurasthenic swaying when she walks.
On the other hand, as far as the other side of the diagnosis is