Four years ago, the patient had a disturbance of vision primarily due to dysfunction of the eye muscles. For a period he had double vision. From this illness, he made an apparent complete recovery.
Two years ago he had a stroke, with weakness of the left side of the face, and impaired function of the right side of the body. Following the latter incident, impairment of gait, general weakness, and impairment of mental functions became increasingly apparent. From the middle of 1944 onwards, the patient became more and more dependent upon his wife; she was the only person who seemed to understand fully his speech and his needs.
On November 25th, 1944, he was proceeding from the garden towards the house, and suddenly seemed to run (propulsion gait). Just before reaching the house, he fell and injured his arm. As a result of this accident, he attended the local hospital for treatment, traveling by motor-car. On December 4th, whilst traveling to the hospital at Schwarzach-St. Veith, and asleep in the back of the car, the driver was compelled to swerve to avoid another vehicle, and to brake suddenly. Herr Krupp von Bohlen was thrown forward, and hit his forehead and the bridge of the nose against a metal rail behind the driver’s seat. He did not lose consciousness, but his condition was such that he was detained in the hospital for approximately eight weeks. During his stay in the hospital, he recognized his wife, his relatives and the members of his staff, and spoke to them, albeit haltingly.
Since the accident mentioned above, the general condition of the patient has deteriorated rapidly. The members of his staff had increasing difficulty in understanding him. At first, with the aid of two people, he was able to walk a few steps; until two months ago he sat for short periods in a chair. The assistance of men-servants was necessary for this task. He has been incontinent of feces and urine since returning from the hospital in February 1945. Since this date he has only spoken an occasional single word, the words being simple ones and without any rational association, apart from sporadic expletives, such as “Ach, Gott” and “Donner Wetter”, when disturbed. At times he has been exceedingly irritable and on occasions has had inexplicable bouts of weeping. During the past two months, he has become increasingly apathetic, and no longer recognized relatives or friends. Frau Von Bohlen thinks he may still recognize her as a familiar face, but he exhibits no emotional reaction to her presence. She thinks he realizes occasionally that strangers are in the room; e. g., members of the Allied services, and responds by being very tense.
Frl. Krone, secretary to the patient, stated that on returning to Blühbach in September 1944, after an absence since May 1944, she could no longer take down letters as dictated by Krupp von Bohlen. Normally he was a very punctilious man, and his diction and writing were correct and very precise. She stated that after September 1944 there were frequent interruptions in his flow of ideas, his syntax was faulty, and he occasionally did not appear to appreciate the meaning of certain words. She would get an idea of what he wanted to say, and then wrote the letter herself in accordance with what she understood to be his wishes. His handwriting also became increasingly illegible, and he had difficulty in signing his name when giving power of attorney to his relatives in January 1945.
The valet had been personal valet to Krupp for 20 years, and traveled all over the world with him. He described his master as a very active man, physically and mentally, extremely punctilious in all personal details. He took a great interest in his clothes, and was very observant of any slight defect. In his personal habits he was abstemious, never taking alcohol, and was also a non-smoker. Although a very excellent sportsman and physically capable of considerable feats of endurance when hunting, playing tennis or climbing, he never overdid things and took care of himself without in any way being overanxious about his health. The valet first began to notice serious changes in the patient’s personal habits two years ago, although in the valet’s opinion, he had been failing slightly for about four to five years. The degree of change, however, prior to two years ago, was so slight and his master was in his opinion such a “superman”, that the changes would not have been apparent to the casual observer. Two years ago he began to lose interest in the details of his personal clothing and to become careless with his table manners. For instance, when soup was served to him one day, he took his soup-spoon and used it to take water from his wine-glass. Latterly, he would sit at table and ask who was present, although the only people in the room were intimate members of his family. He would complain that the telephone bell was ringing, and of people speaking to him; these hallucinations became more frequent during the latter part of 1944. The valet was employed as caretaker of the main house by the American Military Government after the cessation of hostilities in Europe, and did not see his employer regularly after June 1945. On August 7, 1945, the occasion of Gustav Krupp von Bohlen’s birthday, he called to pay his respects, and for the first time he was not recognized, and his master showed no appreciation of his presence or his conversation.
2. General Appearance: The patient was lying rigidly in bed in a Parkinsonian position with fine tremors of the jaw and hands. The skin was atrophic and dry, and there was pigmentation of the dorsum of the hands. The temporal arteries were prominent and tortuous. The face was masklike, with dilated venules over the cheeks. There was evidence of considerable wasting of the body tissues, especially in the extremities, which also showed evidence of trophic and acrocyanotic changes.
3. Neuropsychiatric Examination: The patient lay in bed with a masklike face and in a fixed position on his back. The legs were partially flexed, and similarly the elbows, the latter being pressed firmly against the trunk. There was generalized muscular rigidity, due to hypertenus of an extra-pyramidal tract lesion.
On the physicians’ entering the room, the patient fixed his gaze on them, and replied to their greeting with “Guten Tag,” and gave his hand when they offered theirs to him. He shook hands normally, but he could not relax his hold or remove his hand, and continued to squeeze the physician’s hand; this was due to the presence of a forced grasp-reflex, which was more marked in the left than in the right hand. When asked how he felt, he replied “Gut,” but to all further questions he gave no reply at all. He was silent and showed no reaction to, or comprehension of, other questions, and simple commands, such as “Open your mouth,” “Put out your tongue,” “Look this way.” Only painful and disagreeable stimuli produced any reaction, and then it was merely a facial expression of discontent, sometimes accompanied by grunts of disapproval.
The disturbance of verbal response was not due to dysarthria, because the patient was able to pronounce such words as he did use, quite distinctly. Neither was it due to motor aphasia, because the few words he used were used correctly, and he never exhibited the jargon responses of the true aphasic when attempting to answer questions.