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Vienna, October 21, 1892
Dearest friend,
Only a piece of scratch paper, as we agreed. The introductions are always the reason one puts off writing. So you won't think I am disloyal, the following: about three weeks ago I was called to Mr. F., where I found Heitler, the family doctor, with Mr. F. stretched out
on the settee. Again pain in walking; discussed your diagnosis; the patient seems to have given up on Berlin. Heitler, ridiculing the diagnosis of flat foot, calls it neuritis. We let him show his feet; I really cannot see anything resembling a flat foot, and must admit that to Heitler, who seems to know all about it from personal experience. On the other hand, I am not ready to contradict you in an area with which I am not familiar and you certainly are; so I fight for you with a lion's courage and at least obtain agreement that he will show his foot to Professor Lorenz so that the latter can say whether or not it is a pes planus. Before we reached this compromise, I had requested that he go to Berlin to see you, as initially he himself had requested. Since that time I have heard nothing, as happens in Vienna, of man, doctor, or foot.
Now let me give you my private opinion. As you know, there is a 3-cm difference in the man's calves and a change in the consistency of the muscle. I do not know whether a pes planus is consistent with such a difference. Be that as it may. As far as I know, in pes planus the pain occurs in the tarsus, increases gradually, and does not subside quickly. In his case things are different: he has pain only in the calf, which after about five minutes becomes stiff; he then cannot go on, stops, pulls up the foot, shakes it violently a few times, and then he immediately can again walk well for a few minutes. That looks just like an ischemic or myositic failure of the muscles, like intermittent claudication, which also occurs in diabetes. I believe therefore that the man can be helped only by prolonged rest and little walking, which of cours