You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Kreuzlingen, 28 March 1923
135B
The To. case did not turn out as any of us expected. Breathing and cardiac action became gradually more impaired, so much so that we were left in no doubt that there was an organic cause. In the middle of the month large quantities of blood in the sputum with corresponding pulmonary symptoms suggested a pulmonary infarct associated with bronchial pneumonia. Cardiac action became sluggish. The former nephritis flared up again, there were deliria that quickly led to a comatose state to which the patient succumbed on the 26th inst. I had called the relatives to the sickbed just as soon as we were certain about the organic symptoms. They took it very well and greatly facilitated our task. A postmortem has fully confirmed the clinical diagnoses. Large organised thrombi were discovered in the heart.
One coronary artery was severely constricted and atheromatous. The major arteries of the base of the brain were badly sclerosed. It now appears, therefore, that neither the patient's depressive nor his hysterical symptoms during the past few months were purely psychogenic, but represented his specific reactions to incipient physical