Tut, Phoenix! We have talked about coincidence before, haven't we, lol. Just because a person is doomed to die of syphilis doesn't make them immune to being knocked down by a bus or indeed falling down a hole onto their head. The fall may have caused brain damage which caused delusions, but how could anyone in those days tell the difference? They could certainly diagnose syphilis but probably couldn't diagnose or differentiate brain damage caused by a fall. The only thing you can take from the death certificate is that he had syphilis and pthisis when he died. I sometimes think death certs tell you nothing at all of the life they lived - and of course, they aren't intended to.
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