In context: What has happened to Kurtz out there in the African jungle? What are the different meanings given to his last words, “The horror! The horror!”? In the end, what are Marlow’s feelings about Kurtz?
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Kurtz lost all semblance of reality and became sick.... he lost his soul in his desire to take everything. The "horror" he pronounces on his deathbed is a judgment on how he has lived his life.