An Unanalysed Case: Anal Erotism, Occupation and Illness1 (1921)

The old man whose case is here given came under observation in circumstances which rigidly excluded analytic investigation; the facts given below were poured forth by the patient and tell their own tale; this brief notice cannot convey the full impression his conversation left on the mind, his dramatic nods and grimaces illustrated his story when words failed him.

The patient is now aged sixty-five. He said he had bowel trouble for twenty-seven years, beginning with ‘diarrhoea and corruption and prolapse following the conception of my only son’; he had ‘no control over his bowels at all’. Since that time (1893) he had not had a single solid motion. I asked whether he had had treatment and what relief he had received. He replied that when going to a doctor he always said, ‘Now, doctor, don't interfere with my bowels whatever you do!’ Nevertheless he went to a famous hospital and was treated for six months. He kept ‘fit’ for twelve years and then became worse. At this point I asked how fit he was during that time. He said he was fit enough to work, he didn't go more than four times before he left the house in the morning; once immediately on rising, the second time after lighting the kitchen fire, then again after shaving and last after breakfast just before leaving for his work. I asked if the diarrhoea continued throughout the day and if his illness interfered with his work. He replied that usually he did not go more than eight times in the day and that he always knew how hard he was going to find the day's work by the way he went before breakfast, ‘more than four times and I know I am going to have a bad day.’