The following documents will help explain Freud’s case of Mathilde and its relation to the Mathilde in Freud’s dream of Irma’s injection in chapter 2 of The Interpretation of Dreams.

1) A chronological list of the topic of ‘injections’ in Freud’s writings and life 2) The Mathilde, Case of, entry from the International Dictionary of

Psychoanalysis. 3) Some addition information on Mathilde S from Lisa Appignanesi & John

Forrester’s book, Freud’s Women 4) My translation into English of the medical report by Freud, from the

Internationale Klinische Rundschau of 6 December 1891 5) The pages of the chapter 2, of the bilingual edition of The Interpretation of

Dreams where Mathilde S. is referred to. 6) A copy of the medical report in German, from the Internationale Klinische

Rundschau— but according to Albrecht Hirschmüller (see below at the end of the entry of the Case of Mathilda S.) this report, telegraphic in style, is [Wiedergabe aus zweiter Hand] “a second-hand rendering”, presumably by the editor, of the Internationale Klinische Rundschau, Dr. Johann Schnitzler.

7) An article, “Der Fall Mathilde S: Eine Akute Porphyrie. Bisher unbekannter klinischer Bericht von Sigmund Freud. Zum 100. Jahrestag des Sulfonal-Bayer” von Peter Voswinckel, in German, from Arzt und Krankenhaus, Bd. 61, (1988), S. 177-185.

FREUD’S INJECTIONS The metaphor of psychoanalysis as being a carefully wielded surgeon’s scalpel is well-known. Another tool from medical practice, that of the hypodermic injection, has been a topic of Freud from the start of his medical career to the very end of his life. (see Paul E. Stepansky’s Freud, Surgery, and the Surgeons) Here are a few highlights of the theme of injection in Freud’s life: 1884, Apr 30 Walpurgisnacht (identification w. Faust?) Freud takes cocaine for the first time 1884, Nov-Dec experiments with injections of cocaine on himself 1885, Jan Freud gave the first injection of cocaine to Fleischl von Marxow to rehabilitate him from his morphine habit 1885, Apr Fleischl von Marxow begins injecting himself w. cocaine 1890, Sep 24 Death of 26 year old patient, Martha Schleicher, due to an overdose of Sulfonal prescribed by S. Freud. Whether this overdose was

in the form of injections or in an oral form is unknown to me at this moment. 1891, Dec 6 publication of the medical report, by Sigmund Freud, of the death of Mathilde Schleicher, in the Internationale Klinische Rundschau. 1890’s injection of patient, an old woman, Therese Franckel, twice a day 1895, Jul 23-24 dream of Irma’s injection, chapter 2, The Interpretation of Dreams 1895, Sep 25, used his dream of Irma’s injection in section 21, Dream Consciousness in the Project for a Scientific Psychology 1901, “for at that point I did violence to or commited a blunder on ‘the old woman’[Therese Franckel]. Here again the bungled action was a harmless one; of the two possible errors, using the morphine solution for the eye or the eye lotion for the injection, I had chosen by far the more harmless one” The Psychopathology of Everyday Life, p 178. 1903, Jun 8 LTR xx/268 to Fliess “ My ancient lady [Therese Franckel], whom I have been visiting twice a day regularly, was taken to the country yesterday and I am looking at the clock every fifteen minutes to see whether I am not keeping her waiting too long for her injection.” 1932, “If what we believe were really a matter of indifference, if there were no such thing as knowledge distinguished among our opinions by corresponding to reality, …we might inject our patients with a decagram of morphine instead of a centigram…” New Introductory Lectures, XXV: The Question of a Weltanschauung, Page 176 1939, Sep 21, conversation with Max Schur about his previous agreement to give Freud, when the time comes, the injection that will end his suffering (and his life). 1939, Sep 22, morning of, Sigmund Freud was given an injection of 2 centigrams of morphine by Max Schur; and once again, 12 hours later. Max Schur, Freud Living and Dying. But was the 2nd injection given by

Max Schur or by Josephine Stross, a pediatrician friend and colleague of Anna Freud? And was there a 3rd injection given later? 1939, Sep 23 3:00 AM, on Yom Kippur, death of Sigmund Freud. Mario L. Beira, private communication about Freud dying on Yom Kippur Currently, there seems to be a question as to who administered this fatal dose of morphine to Freud and who was with him when he died--see the following abstract of an article by Roy B. Lacoursiere in American Imago- Vol. 65. No. 1 Spring 2008, pp. 107-128 Freud's Death: Historical Truth and Biographical Fictions In spite of the claims of Ernest Jones to have been "truthful" and of Max Schur to have achieved the "necessary objectivity" in their respective biographies of Freud, they notably failed to do so in their accounts of Freud's death. The existence of serious distortions is evidenced by the discrepancies between their statements about the time of Freud's death. Currently available portions of the Freud Archives at the Library of Congress make it possible to present a more accurate picture. On the basis of further new documentation, this paper shows that Max Schur was not present at Freud's death, as had been previously believed, and that the final injection that hastened Freud's death was administered by Josephine Stross, a longtime friend of Anna Freud's, whose presence at Freud's deathbed has heretofore been overlooked. MATHILDE, CASE OF from the International Dictionary of Psychoanalysis By Albrecht Hirschmūller, with a few additional comments [in brackets] by Richard G. Klein. The Mathilde case involves a patient of Freud’s whose death from a medical overdose, is discussed in his commentary on the “dream of Irma’s injection.’ Mathilde S[chleicher], a twenty-seven-year-old woman, came to see Freud in the beginning of 1889 for treatment. She presented signs of inhibition, self-reproach, and delusional melancholia. The trigger turned out to be a broken promise of marriage that had been made to her. After a significant improvement with hypnotic treatment, the patient decompensated while Freud was away, with polymorphic symptoms, and had to be hospitalized in October 1889 in a private psychiatric clinic [Svetlin] in Vienna. At the clinic it became obvious that the patient was developing erotomania, whose object was initially Freud, then a physician at the institution. The circumstances supported the diagnosis of a transference psychosis. It appears that the patient’s eroticized transference reinforced the ideas that Freud’s former teacher, the psychiatrist, Theodor Meynert, was defending at the time, specifically with respect to hypnosis.

While the patient was hospitalized, use was made of the entire range of medications available at the time: morphine, chloral hydrate, valerian, bromide, digitalin, opium, scopolamine, and sulfonal, a sedative that had recently been discovered. Unwanted and extremely severe side-effects resulting from the chloral hydrate endangered the patient’s life. But she recovered and left the [Svetlin] clinic in May 1890, still suffering from melancholia. Freud resumed treatment, prescribing alternating high doses of chloral hydrate and sulfonal, but apparently did not hypnotize her further. In the autumn she displayed a heightened pattern of vomiting, abdominal pains, and retention of urine, which was red in color. At the end of September the patient died. [24 September 1890] Shortly afterwards, a warning was issued against this kind of medication, and Mathilde’s clinical symptoms were recognized as the expression of the presence of a severe hepatic porphyria resulting from the medication. In a report that was succinct and clear, Freud assumed responsibility for the fatal consequences of his treatment. [the report is in the Internationale Klininische Rundschau, 16 December 1891—see the following document] Five years later [Jul 24 1895], as part of his associations with the dream of Irma’s injection, Freud recalled this case, and his feelings of guilt were plainly apparent when he made the connection between his fear for the life of his [oldest] daughter Mathilde [born 16 Oct 1887], who was suffering from diphtheria—Behring had just introduced the serum therapy that was to save so many lives—and this case with its dramatic outcome: “This Mathilde for the other Mathilde, an eye for an eye, a tooth for a tooth.” In the dream and its interpretations, feelings of guilt reappear concerning the failure to take medical precautions, and the secondary effects of the medication and the hypnosis; but along with these there is also present the fantasy of becoming a kind of “Behring of neurosis.” Freud, Sigmund. (1891e). Mitteilung ūber eine Sulfonalvergiftung [Wiedergabe aus zweiter Hand], in Adolf E. Jolles, Ǚber das chemische Verhalten der Harne nach Sulfonal-Intoxication—Internat. klin. Rdsch. Bd 5 (1891), Sp. 1913-1916, 1953-1959. Freud, Sigmund (1900a). The Interpretation of Dreams. S.E. 4-5. [111-117] Hirschmūller, Albrecht. (1989). Freud’s “Mathilde,” Ein weiter Tagesrest zum Irma-Traum. Jahrbuch fūr Psychanalyse, 24, 128-159. Lisa Appignanesi and John Forrester write about Mathilde Schleicher in their book, Freud’s Women page 127,”The three women, Freud told Abraham, are ‘Mathilde, Sophie and Anna…my daughters’ three godmothers, and I have them all!’ Where is Mathilde Breuer to be found in the dream? The name Mathilde figures as a direct association to Breuer repeating Freud’s examination of Irma, but it does so in connection with Mathilde S., a long-standing patient of Freud’s admitted to Svetlin

Hospital in Vienna with the diagnosis of severe mania and erotic delusions concerning him, whose unexpected toxic reaction to the sulphonal he prescribed for her led to her death. He had turned at that time to Breuer for help, but to no avail. Three years later in 1893, when his six-year-old daughter Mathilde contracted diphtheria, Freud feared that she would die; ‘it struck me now almost like an act of retribution on the part of destiny. It was as though the replacement of one person by another was to be continued in another sense: this Mathilde for that Mathilde, an eye for an eye and a tooth for a tooth. What had saved her was her request for a strawberry; although it was not the strawberry season, a renowned shop came up with one. When she ate it, it provoked a coughing fit which immediately cleared the obstruction in her throat; the next day she was well on the way to recovery.’ On page 171 of Freud’s Women, there is more information. “Mathilde Schleicher, the twenty-seven-year-old daughter of the well-known Viennese painter Cölestin Schleicher, was treated by Freud and gave him a book in June 1889 as a token of gratitude and respect; he continued to treat her until at least October 1889.” From Internationale Klinische Rundschau 6 Dec 1891 Translation by Richard G. Klein Since this report is telegraphic in style, I have filled in the gaps with the words that are in the [brackets] in an effort to make more sense of this report.

Fall I.: (Freundlichst mitgetheilt von Herrn Doc. Dr. S. Freud.) Mädchen, 26 Jahre in einer zirkulären Verstimmung begriffen. Melancholie von 2 ½ Jahre Dauer, darauf Manie Anstaltsbehandlung. Abscene Abmagerung. Nach Entlassung wieder Verstimmung, Schlaflosigkeit, Apathie, auf’s Land ent- lassen. Ordination für die Zeit abwechselnd, 1 Woche Chloral- hydrat, was seit Jahren genommen. 1 Woche Sulfonal (2 gr pro die); hatte schon früher probeweise Sulfonal genommen, jedesmal sehr betäubt darauf. Case I: (Kindly communicated by Docent Dr. S. Freud.) Girl [unmarried], 26 years old, in the grip of a circulatory disturbance (Verstimmung). Melancholia lasting 2 ½ years, after that mania, [was] treated in an institution. Extreme loss of weight. After [her] release, again [a] disturbance (Verstimmung), sleeplessness, apathy, released to the countryside. Dosage for the time alternating, 1 week Chloral- hydrate, which [she has] taken for years, [with] 1 week Sulfonal (2 gr

per day), [she] had earlier already taken Sulfonal on a trial basis each time [after, she felt] very faint/dizzy [betäubt].

Wahrend des Sommers Nachricht von Harnverhaltung. Erbrechen einmal, bald vergangen. Nach 3 Monaten zurück, anämisch, sonst noch melancholisch. Einige Tage später: Er- brechen, Harnverhaltung, Schmerzen im Leibe, fieberfrei, Einige Tage später Harn mit Katheter, rothe Farbe. (Untersuchung Laboratorium Dr. JOLLES) Nie früher Eiweiss und renale Ele- mente . Schmerzen im Leibe, Angst, düster, klares Bewusst- sein, Erbrechen, Stuhlverstopfung anhaltend, Cyanose, Finger- spitzen. Darauf Puls klein, jagend, Zwerchfellämung. Tod bei klarem Bewusstsein – Ganzes Bild 5—6 Tage. During the summer, report of urine retention, Vomiting once, [which was] soon over with; 3 months ago, anaemic, apart from that, melancholic. A few days later, vomiting, retention of urine, pains in abdomen, but no fever, a few days later, urine [taken] with [a] catheter, red [in] color. (examination by the laboratory of Dr. Jolles). Never earlier [any] protein and renal ele- ments. Pains in abdomen, anxiety, gloomy [ideas], [but] clear conscious- ness, vomiting, prolonged constipation, cyanosis [turning blue], [in the] finger tips. After that, [a] weak pulse, [then] [a] racing [pulse], paralyzed diaphragm, Death[occurred]while fully conscious--the complete picture, [took] 5-6 days.