Preliminary Remarks On Emma Eckstein's Case History

In a book I am preparing, Freud's Love Affair with the Seduction Theory, a chapter is devoted to Emma Eckstein. In the following I wish to present preliminary corrections of errors in the literature that surround her case history and treatment.

As is well known, Emma Eckstein was a patient of Freud's. Her symptomatology has not been precisely identified, but it is not unreasonable to assume that dysmenorrhea was one of her reasons for being in treatment. Freud was criticized for having agreed in 1895 with his friend Fliess, who, believing in a pathophysiological connection between the nose and the female genitalia, suggested as treatment the removal of the frontal third of the left middle turbinate bone, a small protuberance in the nasal septum. This sounds like an irrational decision, but it should be noted that dysmenorrhea is an extremely painful disorder that completely incapacitates the patient for days. Physicians at that time were unable to do anything but prescribe painkillers. Inasmuch as ovariectomy as an intended cure for hysteria was performed with some frequency in late-nineteenth-century Vienna, the removal of a little bone must have appeared to Freud as innocuous, particularly since he was assured that the surgical intervention was harmless and easily performed.

Indeed, the operation is harmless, but Fliess made a mistake that could not be have been anticipated: he failed to remove a half-meter long piece of iodoform gauze from the nasal cavity. When this foreign body was taken out thirteen days later, a profuse hemorrhage resulted. It was instantly stopped and a tampon inserted. The latter was removed in due course without ill effect, and no injury was observed in the nasal cavity. The patient appeared cured, but seemingly spontaneous profuse hemorrhages occurred thereafter. No one could explain their etiology; the greatest Viennese surgeon was called in as a consultant but could