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This is an impressive and complex book that investigates the origins of psychoanalysis from the interiority of Freud's self analysis of his dreams, centred on Irma's injection dream, and his then analysis of Emma Eckstein. Bonomi suggests that this dream discovery acts as a hinge between the pre-analytic world of Freud the medical doctor and paediatrician, and the founding of psychoanalysis around the hidden trauma of circumcision behind the analytic cornerstone of castration.
During 1860-90 it was normal practice for hysteria to be treated by gynaecologists by means of various surgical procedures such as amputation or scarification of the clitoris, on sexually mature women as well as little girls, as well as removal of the ovaries, cauterization of the labia, infibulations and circumcision (Hegar, Broca, Bohmi, Forel, Schroder, Tissier, Brown, Brown-Sequard, Kromer, amongst many surgeons of the time). In 1887 Friedrich Merkel noted in his book Beitrag zur Casuitistik der Castration bei Neurosen (Contributions to the Study of Castration in the Neuroses) that in just a few months the number of operations reported in the medical literature rose from 180 to 215 and listed 35 papers on the subject of castration as the treatment for hysterical women (Merkel, 1887). Between 1850 and 1879 masturbation was treated surgically more frequently than any other measure (Spitz, 1952, p. 499). Such castration practices involved punishment for neurosis and hysteria and were undoubtedly traumatic, attacking the body, the mind and the functioning of sexual life.
Around the same time, physicians were gathering observations on masturbation in babies and children into a theory that children needed to be protected from neurotic morbidity and general insanity due to such bad habits. For instance Behrend (1860) wrote
… we undertake a small operation in order to provoke such a pain with its wound that it would leave a child a lasting impression and would make any attempt at masturbation painful