Emma Eckstein - Surgery

Surgery

Freud suspected, in addition to hysteria, a "nasal reflex neurosis", a condition popularized by his friend and collaborator Wilhelm Fliess, an ear, nose, and throat specialist. Fliess had been treating "nasal reflex neurosis" by cauterizing the inside of the nose under local anesthesia with cocaine used as the anesthetic. Fliess found that the treatment yielded positive results, in that his patients became less depressed. Fliess conjectured that if temporary cauterization was temporarily useful, perhaps surgery would yield more permanent results. He began operating on the noses of patients he diagnosed with the disorder, including Eckstein and even Freud himself.

Eckstein's surgery was a disaster. She suffered from terrible infections for some time, and profuse bleeding. Freud called in a specialist, his old school friend, Dr Ignaz Rosanes, who removed a mass of surgical gauze that Fliess had not removed. Eckstein's nasal passages were so damaged that she was left permanently disfigured. Freud initially attributed this damage to the surgery, but later, as an attempt to reassure his friend that he shouldn't blame himself, Freud reiterated his belief that the initial nasal symptoms had been due to hysteria.

Guilt over the episode has been identified as contributing to the dream of Irma's injection in The Interpretation of Dreams: 'Max Schur grasped right away the significance of the episode to the "Irma" dream...in his paper on the specimen dream'.