Appendix B. Surgical Notes

In the sixteen years during which Professor Pichler attended Freud he kept regular notes of the case, every visit being recorded and the details entered with an admirable exactitude. For months at a time there would be daily interviews, so hard was it to relieve the discomfort in the wound. The notes were made in a variety of the Gabelsberger system of stenography invented by Pichler's father and so were unintelligible to other people. After his death there was only one person who could decipher them, his old secretary. The indefatigable Max Schur, to whom Pichler had left his notes on his death, sought her out and persuaded her to undertake the labourious task of transcribing them: this in spite of the difficulty that all the medical expressions were indicated only by abbreviations. Even so the notes occupy 53 foolscap sheets of close type. They give an unforgettable picture of the long-drawn-out distress, or even agony, through which Freud passed in those years.

Dr. Lajos Levy has been good enough to translate these notes into English, and Dr. Schur has kindly checked the translation from his personal knowledge of the details. I have made a small selection of them, mainly for their medical interest, and append them here. But they can give little idea of the day-to-day struggle, by the countless manipulations and applications, to procure some relief for the continual discomfort and pain.

26.9.1923. Consultation with laryngologist Hajek who operated on a papillary proliferating leukoplakia at right anterior palatinal arch last spring, excision far into healthy tissue (histolog. carcinoma). Now recurrence at anterior edge of operation-site, at posterior end of superior processus alveolar, in form of crateriform ulcer extending over large part of buccal mucous membrane and small part of tongue and mandible. I construct prosthesis, then undertake on special request clearance of submandibular and cervical glands and ligature of carotis ext