Emma's Nose

Masson, J.M. (1985) (Ed.) The complete letters of Sigmund Freud to Wilhelm Fliess, 1887-1904. Cambridge: Harvard University Press.

March 8, 1895

Dearest Wilhelm,

Just received your letter and am able to answer it immediately. Fortunately I am finally seeing my way clear and am reassured about Miss Eckstein and can give you a report which will probably upset you as much as it did me, but I hope you will get over it as quickly as I did.

I wrote you that the swelling and the hemorrhages would not stop, and that suddenly a fetid odor set in, and that there was an obstacle upon irrigation. (Or is the latter new [to you]?) I arranged for Gersuny to be called in; he inserted a drainage tube, hoping that things would work out once discharge was reestablished; but otherwise he was rather reserved. Two days later I was awakened in the morning--profuse bleeding had started again, pain, and so on. Gersuny replied on the phone that he was unavailable till evening; so I asked Rosanes to meet me. He did so at noon. There still was moderate bleeding from the nose and mouth; the fetid odor was very bad. Rosanes cleaned the area surrounding the opening, removed some sticky blood clots, and suddenly pulled at something like a thread, kept on pulling. Before either of us had time to think, at least half a meter of gauze had been removed from the cavity. The next moment came a flood of blood. The patient turned white, her eyes bulged, and she had no pulse. Immediately thereafter, however, he again packed the cavity with fresh iodoform gauze and the hemorrhage stopped. It lasted about half a minute, but this was enough to make the poor creature, whom by then we had lying flat, unrecognizable. In the meantime--that is, afterward--something else happened. At the moment the foreign body came out and everything became clear to me--and I immediately afterward was confronted by the sight of the patient--I felt sick. After she had been packed, I fled to the next room, drank a bottle of water, and felt miserable. The brave Frau Doctor then brought me a small glass of cognac and I became myself again.

Rosanes stayed with the patient until arranged, via Streitenfels, to have both of them taken to Sanatorium Loew. Nothing further happened that evening. The following day, that is, yesterday, Thursday, the operation was repeated with the assistance of Gersuny; [the bone was] broken wide open, the packing removed, and [the wound] curetted. There was scarcely any bleeding. Since then she has been out of danger, naturally very pale, and miserable with fresh pain and swelling. She had not lost consciousness during the massive hemorrhage; when I returned to the room somewhat shaky, she greeted me with the condescending remark, "So this is the strong sex."

I do not believe it was the blood that overwhelmed me--at that moment strong emotions were welling up in me. So we had done her an injustice; she was not at all abnormal, rather, a piece of iodoform gauze had gotten torn off as you were removing it and stayed in for fourteen days, preventing healing; at the end it tore off and provoked the bleeding. That this mishap should have happened to you; how you will react to it when you hear about it; what others could make of it; how wrong I was to urge you to operate in a foreign city where you could not follow through on the case; how my intention to do my best for this poor girl was insidiously thwarted and resulted in endangering her life--all this came over me simultaneously. I have worked it through by now. I was not sufficiently clear at that time to think of immediately reproaching Rosanes. It only occurred to me ten minutes later that he should immediately have thought, There is something inside; I shall not pull it out lest there be a hemorrhage; rather, I'll stuff it some more, take her to Loew, and there clean and widen it at the same time. But he was just as surprised as I was.

Now that I have thought it through, nothing remains but heartfelt compassion for my child of sorrows. I really should not have tormented you here, but I had every reason to entrust you with such a matter and more. You did it as well as one can do it. The tearing off of the iodoform gauze remains one of those accidents that happen to the most fortunate and circumspect of surgeons, as you know from the business with your little sister-in-law's broken adenotome and the anesthesia. Gersuny said that he had had a similar experience and therefore he is using iodoform wicks instead of gauze (you will remember your own case). Of course, no one is blaming you, nor would I know why they should. And I only hope that you will arrive as quickly as I did at feeling sympathy and rest assured that it was not necessary for me to reaffirm my trust in you once again. I only want to add that for a day I shied away from letting you know about it; then I began to feel ashamed, and here is the letter.

Beside this, other news really pales. As far as my condition is concerned, you are certainly quite right; strangely enough it is far easier for me to be productive when I have mild troubles of this kind. So now I am writing page after page of "The Therapy of Hysteria."

An odd idea of a different sort I shall entrust to you only after we have Eckstein off our minds. Here influenza is quite widespread, but not very intense. Your mama is not yet quite well either.

I shall soon write to you again and, above all, report in detail on Emma E. Scientifically, otherwise quite desolate. Influenza has been eating up the practice of specialists. That it really took its toll of you I know. Just allow yourself a proper rest afterward. I am determined to do the same if it should strike me.

With cordial greetings,
Your
Sigmund

(Masson, 1985, pp. 116-118)