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Vienna, April 25, 1894
My dear friend,
You wrote so kindly that I cannot let you wait until I have something to say, but rather must report on everyday events.
I certainly consider you more competent than anyone else to make a differential diagnosis in these delicate matters; and I once again let myself be confounded in what to make of my condition. Breuer, for example, quietly accepted the possibility of a nontoxic heart condition. Apparently I do not have a dilation of the heart; split heart sounds, arrhythmia, and the like continue despite my abstinence. My libido1 has long been subdued. One gram of digitalis in two days has considerably diminished the subjective discomforts and apparently also influenced the arrhythmia, which, however, I detect whenever I find some resonance of my pulse. My mild depression, fatigue, inability to work, and the mild dyspnea have become rather worse.
That is the status idem. That I shall not leave this beautiful world without summoning you for a personal farewell has been settled in my mind ever since I began to feel ill. I do not think, however, that I shall be in a position to take you up on your offer in the near future; still, the torture and the useless slipping away of the present hurt me more than any possible unsatisfactory prognosis.
In a few days I shall send you several pages of raw material, a quick sketch of an analysis in which one can see down to the roots of the neurosis. I have not yet been able to pull myself together to make a summary for you, and that annoys me greatly. That was indeed very different in other times. The social and scientific dead