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Vienna, September 29, 1896
Dear Wilhelm,
I hope you and your wife and son are again installed most comfortably in the beautiful rooms of von der Heydtstrasse; that you are busily observing and calculating new periods of 28 and 23; that Ida is occasionally cursing under her breath about the six children from another family; and that Robert is always eager to reveal new things.1
I have not written to you until today because an influenza with fever, pus, and cardiac symptoms suddenly shattered my well-being; only today did I begin to have an inkling that health might again be possible. I would like so much to hold out until that famous age limit of approximately fifty-one, but I had one day that made me feel it was unlikely. The infection caught up with me on the last critical date, September 24, so that on September 25 I was hoarse and breathless; at the same time Martin went to bed with a throat infection. But now I can breathe freely again.
On Sunday I had to go and see the daughter of a colleague in Oderberg, where I was closer to you than I usually am. It is this constellation to which I ascribe my making a brilliant diagnosis and recognizing that it was a case of Erb-Goldflam's disease — ptosis ophthalmoplegia with normal pupils, paralysis of the palate and deglutition, paresis of the vagus, weakness of the vocal cords, attacks of choking, aspiration pneumonia, and large variations in the intensity of the symptoms. Several unusual features. Ptosis developed at age 4!; ophthalmoplegia gradually until age 13; the vagus and accessorius symptoms only from puberty to the present (15 years). But then I concluded further that these Erb-Goldflam affections must belong to the group of organic developmental illnesses, of the type resulting from [various] constitutions, which you are only now just envisaging (myxedema, Basedow's disease, acromegaly). The child has a special look, broad nasal septum, light mustache, extreme body length, thyroid not easily palpable, though she ha