فصل 3

CHAPTER 3

TURNING FROM THE WINDOW, Breuer shook his head to dislodge Lou Salomé from his mind. Then he tugged the cord hanging over his desk to signal Frau Becker to send in the patient waiting in the outer office. Herr Perlroth, a stooped, long-bearded Orthodox Jew, stepped hesitantly through the doorway.

Fifty years ago, Breuer soon learned, Herr Perlroth had undergone a traumatic tonsillectomy—his memory of that procedure so searing that, until this day, he had refused to consult a physician. Even now he had delayed his visit, but a “desperate medical situation,” as he put it, had left him no choice. Breuer immediately doffed his medical demeanor, came out from behind his desk, and sat in the adjoining chair, just as he had with Lou Salomé, to chat casually with his new patient. They talked about the weather, the new wave of Jewish immigrants from Galicia, the Austrian Reform Association’s inflammatory anti-Semitism, and their common origins. Herr Perlroth, like almost everyone in the Jewish community, had known and revered Leopold, Breuer’s father, and, within minutes, had transferred this trust for the father onto the son.

“And so, Herr Perlroth,” said Breuer, “how may I be of service to you?”

“I cannot make my water, Doctor. All day long, and night too, I have to go. I run to the toilet, but nothing comes. I stand and stand, and finally a few driblets come. Twenty minutes later, same thing. I have to go again, but. . . ” A few more questions, and Breuer was certain about the cause of Herr Perlroth’s problems. The patient’s prostate gland had to be obstructing the urethra. Now only one important question remained: Did Herr Perlroth have a benign enlargement of the prostate or did he have a cancer? On rectal examination, Breuer palpated no rock-hard cancer nodules but found instead a spongy, benign enlargement.

Upon hearing there was no evidence of cancer, Herr Perlroth broke into a jubilant smile and grabbed Breuer’s hand and kissed it. But his mood darkened once again when Breuer described, as reassuringly as possible, the unpleasant nature of the required treatment: the urinary passageway would have to be dilated by the insertion into the penis of a graduated series of long metal rods, or “sounds.” Because Breuer himself did not perform this treatment, he referred Herr Perlroth to his brother-in-law Max, a urologist.

After Herr Perlroth left, it was a little after six, time for Breuer’s late-afternoon house calls. He restocked his large black leather medical bag, put on his fur-lined greatcoat and top hat, and stepped outside where his driver, Fischmann, and his two-horsed carriage were waiting. (While he had been examining Herr Perlroth, Frau Becker had hailed a Dienstmann stationed at the intersection next to the office—a red-eyed, red-nosed young errand man who wore a large official badge, a pointed hat, and an oversized khaki army coat with epaulets—and given him ten Kreuzer to run to fetch Fischmann. More affluent than most Viennese physicians, Breuer leased a fiacre by the year, rather than hire one when needed.) As always, he handed Fischmann the list of patients to be visited. Breuer made house calls twice a day: early, after his small breakfast of coffee and crisp three-cornered Kaisersemmel; and again, at the end of his afternoon office consultations, as today. Like most internists of Vienna, Breuer sent a patient to a hospital only when there was no other recourse. Not only were people cared for better at home, but they were safer from the contagious diseases that often stormed through the public hospitals.

As a consequence, Breuer’s two-horse fiacre was in frequent use: indeed, it was a mobile study, and kept well stocked with the latest medical journals and reference works. A few weeks ago, he had invited a young physician friend, Sigmund Freud, to accompany him for an entire day. A mistake perhaps! The young man had been attempting to decide on his choice of medical specialty, and that day may have frightened him away from the practice of general internal medicine. For, according to Freud’s calculations, Breuer had spent six hours in his fiacre!

Now, after visiting seven patients, three of them desperately ill, Breuer had finished the day’s work. Fischmann turned toward the Café Griensteidl, where Breuer usually shared a coffee with the group of physicians and scientists who, for fifteen years, had met each evening at the same Stammtisch, a large table reserved in the choicest corner of the café.

But tonight Breuer changed his mind. “Take me home, Fischmann. I’m too wet and tired for the café.”

Resting his head on the black leather seat, he closed his eyes. This exhausting day had begun badly: he had been unable to return to sleep after a nightmare at 4:00 A.M. His morning schedule had been heavy: ten house calls and then nine office-consultation patients. In the afternoon, more office patients, and then the stimulating but enervating interview with Lou Salomé.

Even now, his mind was not his own. Insidious fantasies of Bertha seeped in: holding her arm, walking together with her in the warm sun, far from the icy gray slush of Vienna. Soon, however, discordant images intruded: his marriage shattered, his children left behind, as he sailed away forever, to start a new life with Bertha in America. The thoughts haunted him. He hated them: they robbed him of his peace; they were alien, neither possible nor desirable. Still, he welcomed them: the only alternative—banishing Bertha from his mind—seemed inconceivable.

The fiacre rattled crossing a plank bridge over the Wien River. Breuer looked out at the pedestrians hurrying home from work, mostly men, each carrying a black umbrella and dressed much as he was—dark fur-lined greatcoat, white gloves, and black top hat. Someone familiar caught his eye. The short, hatless man with the trim beard, passing the others, winning the race! That powerful stride—he’d know it anywhere! Many times in the Vienna woods, he had tried to keep pace with those churning legs, which never slowed except to search for Herrenpilze—the large pungent mushrooms that grew among the rootwork of the black firs.

Asking Fischmann to pull over, Breuer opened the window and called out, “Sig, where are you going?”

His young friend, wearing a coarse but honest blue coat, closed his umbrella as he turned to the fiacre; then, recognizing Breuer, grinned and replied, “I’m heading toward Bäckerstrasse seven. A most charming woman has invited me for supper tonight.” “Ach! I have disappointing news!” Breuer laughed in reply. “Her most charming husband is on his way home this very minute! Jump in, Sig, ride with me. I’m finished for the day, and too tired to go to the Griensteidl. We’ll have time to talk before we eat.” Freud shook the water off his umbrella, stamped his feet on the curbstone, and climbed in. It was dark, and the candle burning in the carriage generated more shadows than light. After a moment of silence, he turned to look closely at his friend’s face. “You look tired, Josef. A long day?” “A hard one. It started and ended with a visit to Adolf Fiefer. You know him?”

“No, but I’ve read some of his pieces in the Neue Freie Presse. A fine writer.”

“We played together as children. We used to walk to school together. He’s been my patient since the first day of my practice. Well, about three months ago, I diagnosed liver cancer. It’s spread like wildfire, and now he has advanced obstructive jaundice. Do you know the next stage, Sig?” “Well, if his common duct is obstructed, then his bile will continue to back up into the bloodstream until he dies of hepatic toxicity. Before that, he’ll go into liver coma, won’t he?”

“Precisely. Any day now. Yet I can’t tell him that. I keep up my hopeful, dishonest smile even though I want to say an honest goodbye to him. I’ll never get used to my patients dying.”

“Let’s hope none of us do.” Freud sighed. “Hope is essential, and who but we can sustain it? To me, it’s the hardest part of being a physician. Sometimes I have great doubts whether I’m up to the task. Death is so powerful. Our treatments so puny—especially in neurology. Thank God, I’m almost finished with that rotation. Their obsession with localization is obscene. You should have heard Westphal and Meyer quarreling on rounds today about the precise brain localization of a cancer—right in front of the patient!

“But”—and he paused—“who am I to talk? Only six months ago, when I was working in the neuropathology lab, I was overjoyed at the arrival of a baby’s brain so I could have the triumph of determining the precise site of the pathology! Maybe I’m getting too cynical, but more and more I grow convinced that our disputations about the location of the lesion drown out the real truth: that our patients die, and we doctors are impotent.” “And, Sig, the pity is that the students of physicians like Westphal never learn how to offer comfort to the dying.”

The two men rode in silence as the fiacre swayed in the heavy wind. Now the rain was picking up again and splattered down on the carriage roof. Breuer wanted to give his young friend some advice, but hesitated, choosing his words, knowing Freud’s sensitivity.

“Sig, let me say something to you. I know how disappointing it is for you to go into the practice of medicine. It must feel like a defeat, like settling for a lesser destiny. Yesterday at the café, I couldn’t help overhearing you criticize Brücke for both refusing to promote you and advising you to give up your ambitions for a university career. But don’t blame him! I know he thinks highly of you. From his own lips I heard that you are the finest student he’s ever had.” “Then why not promote me?”

“To what, Sig? To Exner’s or Fleischl’s job—if they ever leave? At one hundred Gulden a year? Brücke’s right about the money! Research is a rich man’s work. You can’t live on that stipend. And support your parents? You wouldn’t be able to marry for ten years. Maybe Brücke wasn’t too delicate, but he was right in saying that your only chance to remain in research is to marry for a large dowry. When you proposed six months ago to Martha, knowing she would bring you no dowry, you—not Brücke—decided your future.” Freud closed his eyes for a moment before answering.

“Your words wound me, Josef. I’ve always sensed your disapproval of Martha.”

Breuer Knew how difficult it was for Freud to speak forthrightly to him—a man sixteen years older than he and not only his friend, but his teacher, his father, his older brother. He reached out to touch Freud’s hand.

“Not true, Sig! Not at all! We disagree only about timing. I felt you had too many hard years of training ahead of you to burden yourself with a fiancee. But we agree about Martha—I met her only once, at the party before her family left for Hamburg, and liked her immediately. She reminded me of Mathilde at that age.” “That’s not surprising”—Freud’s voice softened now—“your wife was my model. Ever since I met Mathilde, I’ve been looking for a wife like her. The truth, Josef, tell me the truth—if Mathilde had been poor, wouldn’t you still have married her?” “The truth, Sig—and don’t hate me for this answer, it was fourteen years ago, times have changed—is that I would have done whatever my father required of me.”

Freud remained silent as he took out one of his cheap cigars, then offered it to Breuer, who, as always, declined it.

As Freud lit up, Breuer continued, “Sig, I feel what you feel. You are me. You are me ten, eleven years ago. When Oppolzer, my chief of medicine, died suddenly of typhus, my university career ended just as abruptly, just as cruelly, as yours has. I, too, had considered myself a lad of great promise. I expected to succeed him. I should have succeeded him. Everyone knew that. But a gentile was chosen instead. And I, like you, was forced to settle for less.” “Then, Josef, you know how defeated I feel. It’s unfair! Look at the chair of medicine—Northnagel, that brute! Look at the chair of psychiatry—Meynert! Am I less able? I could make great discoveries!”

“And so you will, Sig. Eleven years ago, I moved my laboratory and my pigeons into my home and continued my research. It can be done. You’ll find a way. But it will never be the way of the university. And we both know it’s not just the money. Every day the anti-Semites grow more shrill. Did you see the piece in this morning’s Neue Freie Presse, about the gentile fraternities bursting into lectures and pulling Jews out of the classroom? They’re threatening now to disrupt all classes taught by Jewish professors. And did you see yesterday’s Presse? And the piece about the trial in Galicia of a Jew accused of a ritual murder of a Christian child? They actually claim he needed Christian blood for the matzo dough! Can you believe it? Eighteen hundred and eighty-two, and it still goes on! These are cavemen—savages coated with just the thinnest glaze of Christianity. That’s why you have no academic future! Brücke dissociates himself personally from such prejudice, of course, but who knows how he really feels? I do know that in private he told me that anti-Semitism would ultimately destroy your university career.” “But I’m meant to be a researcher, Josef. I’m not as suited as you for medical practice. All Vienna knows of your diagnostic intuition. I don’t have that gift. For the rest of my life, I shall be a journeyman doctor—Pegasus yoked to the plow!” “Sig, I have no skills that I cannot teach you.”

Freud sat back, out of the candle’s light, grateful for the darkness. Never had he bared so much to Josef, or to anyone except Martha, to whom he wrote a letter every day about his most intimate thoughts and feelings.

“But, Sig, don’t take it out on medicine. You are being cynical. Look at the advancements of just the last twenty years—even in neurology. Think of the paralysis of lead poisoning, or bromide psychosis, or cerebral trichinosis. These were mysteries twenty years ago. Science moves slowly, but in every decade we conquer another disease.” There was a long silence before Breuer continued.

“Let’s change the subject. I want to ask you something. You’re teaching a lot of medical students now. Have you run across a Russian student by the name of Salomé, Jenia Salomé?”

“Jenia Salomé? I don’t think so. Why?”

“His sister came to see me today. A strange meeting.” The fiacre passed through the small entranceway of Bäckerstrasse 7 and lurched to a sudden stop, making the carriage sway on its heavy springs for a moment. “Here we are. I’ll tell you about it inside.” They dismounted in the imposing sixteenth-century cobblestone courtyard surrounded by high, ivy-draped walls. On each side, above open ground-level arches braced by stately pilasters, rose five tiers of large arched windows, each containing a dozen wood-framed panes. As the two men approached the vestibule portal, the Portier, always on duty, peered out through the small glass panel in his apartment door, then rushed to unlock the door, bowing to greet them.

They ascended the stairs, passing Breuer’s office on the second story, to the family’s spacious third-floor apartment, where Mathilde waited. At thirty-six, she was a striking woman. Her satiny, glowing skin set off a finely chiseled nose, blue-gray eyes, and thick chestnut hair, which she wore coiled in a long braid on the top of her head. In a white blouse and a long gray skirt wrapped tight around her waist, she cut a graceful figure, though she had given birth to her fifth child only a few months before.

Taking Josef’s hat, she brushed his hair back with her hand, helped him off with his coat, and handed it to the house servant, Aloisia, whom they had called “Louis” ever since she had entered their service fourteen years before. Then she turned to Freud.

“Sigi, you’re drenched and frozen. Into the tub with you! We’ve already heated the water, and I’ve laid out some of Josef’s fresh linen for you on the shelf. How convenient the two of you are the same size! I can never offer such hospitality to Max.” Max, her sister Rachel’s husband, was enormous, weighing over two hundred sixty pounds.

“Don’t worry about Max,” said Breuer. “I make up for it with referrals to him.” Turning to Freud, he added, “I sent Max another hypertrophied prostate today. That’s four this week. There’s a field for you!”

“No,” Mathilde interjected, taking Freud’s arm and leading him toward the bath, “urology is not for Sigi. Cleaning out bladders and water pipes all day! He’d go mad in a week!”

She stopped at the door. “Josef, the children are eating. Look in on them—but just for a minute. I want you to take a nap before dinner. I heard you rustling around all night. You hardly slept.”

Without a word, Breuer headed toward his bedroom, then changed his mind and decided instead to help Freud fill the bath. Turning back, Breuer saw Mathilde lean toward Freud and heard her whisper, “You see what I mean, Sigi, he hardly talks to me!” In the bathroom Breuer attached the nozzles of the petroleum pump to the tubs of hot water Louis and Freud were carrying in from the kitchen. The massive white tub, miraculously supported by dainty brass cat claws, quickly filled. As Breuer left and walked down the hall, he heard Freud’s purr of pleasure as he lowered himself into the steaming water.

Lying on his bed, Breuer could not sleep for thinking about Mathilde confiding in Freud so intimately. More and more, Freud seemed like one of the family, now even dining with them several times a week. At first, the bond had been primarily between Breuer and Freud: perhaps Sig took the place of Adolf, his younger brother, who had died several years before. But over the past year Mathilde and Freud had grown close. Their ten years’ difference in age allowed Mathilde the privilege of a maternal affection; she often said Freud reminded her of Josef when she had first met him.

So what, Breuer asked himself, if Mathilde does tell Freud of my disaffection? What difference does it really make? Most likely Freud already knows: he registers everything that goes on in the household. He’s not an astute medical diagnostician, but he rarely misses anything pertaining to human relationships. And he must also have noticed how starved the children are for a father’s love—Robert, Bertha, Margarethe, and Johannes swarming over him with ecstatic shrieks of “Uncle Sigi,” and even little Dora smiling, whenever he appears. Without doubt Freud’s presence in the household was a good thing; Breuer knew that he himself was too personally distracted to supply the kind of presence his family needed. Yes, Freud filled in for him; and, rather than shame, he, for the most part, felt gratitude to his young friend.

And Breuer knew he could not object to Mathilde’s complaining about her marriage. She had grounds for complaint! Almost every evening, he worked until midnight in his laboratory. He spent Sunday mornings in his office preparing his Sunday-afternoon lectures to the medical students. Several nights a week, he stayed at the café until eight or nine, and he now played tarock twice a week, rather than once. Even the midday dinner, which had always been inviolate family time, was being encroached upon. At least once a week, Josef overscheduled himself and worked through most of the dinner break. And, of course, whenever Max came, they locked the door of the study and played chess for hours.

Giving up on the nap, Breuer went into the kitchen to ask about supper. He knew that Freud loved long hot soaks, but was anxious to get through the meal and still have time for work in the laboratory. He knocked on the bathroom door. “Sig, when you’re finished, come to the study. Mathilde’s agreed to serve us supper there in our shirtsleeves.” Freud quickly dried himself, donned Josef’s underwear, left his soiled linen in the hamper to be washed, and hastened to help Breuer and Mathilde load trays for their evening meal. (The Breuers, like most Viennese, had their main meal at midday and ate a modest evening supper of cold leftovers.) The glass-paneled door to the kitchen dripped with mist. Pushing it open, Freud was assailed by the wonderful, warm fragrance of carrot-and-celery barley soup.

Mathilde, ladle in hand, greeted him. “Sigi, it’s so cold out I’ve made some hot soup. It’s what you both need.”

Freud took the tray from her. “Only two bowls? You’re not eating?”

“When Josef says he wants to eat in the study, that usually means he wants to talk to you alone.”

“Mathilde,” objected Breuer, “I did not say that. Sig will stop coming here if he doesn’t get your company at dinner.”

“No, I’m tired, and you two have had no time alone this week.”

As they went down the long hallway, Freud popped into the children’s bedrooms to kiss them good night; he resisted their entreaties for a story by promising to tell them two stories on his next visit. He joined Breuer in the study, a dark-paneled room with a large central window draped in rich maroon velvet. Stuffed in the lower part of the window, between the inner and the outer panes, were several pillows to serve as insulation Guarding the window was a sturdy dark-walnut desk on which were heaped open books. On the floor was a thick blue-and-ivory-flowered Kashan carpet, and three walls were lined from floor to ceiling with bookcases crammed with books in heavy dark leather bindings. In a far corner of the room, on a Biedermeier card table with thin, tapering black-and-gold spiraled legs, Louis had already set a cold roast chicken, a salad of cabbage, caraway seeds, and sour cream, some Seltstangerl (salt and kemmelseed breadsticks), and Giesshübler (mineral water). Now Mathilde took the soup bowls from the tray Freud was carrying, placed them on the table, and prepared to leave.

Breuer, conscious of Freud’s presence, reached out to touch her arm. “Stay for a while. Sig and I have no secrets from you.”

“I’ve already eaten something with the children. You two can manage without me.”

“Mathilde”—Breuer tried for lightness—“you say you don’t see me enough. Yet here I am, and you desert me.”

But she shook her head. “I’ll stop back in a bit with some strudel.” Breuer threw a look of entreaty toward Freud, as though to say, “What else can I do?” A moment later, just as Mathilde was closing the door behind her, he noticed her glance significantly toward Freud, as if to say, “You see what has become of our life together?” For the first time, Breuer became aware of the awkward and delicate role in which his young friend had been placed: to be a confidant to both members of a disaffected couple!

As the two men ate in silence, Breuer noticed Freud’s eyes scanning the bookshelves.

“Shall I save a shelf for your future books, Sig?”

“How I wish! But not in this decade, Josef. I’ve no time even to think. The only thing a clinical aspirant at the Vienna General Hospital has ever written is a postcard. No, I was thinking, not of writing, but of reading these books. Oh, the endless labor of the intellectual—pouring all this knowledge into the brain through a three-millimeter aperture in the iris.” Breuer smiled. “A wonderful image! Schopenhauer and Spinoza distilled, condensed, and funneled through the pupil, along the optic nerve, and directly into our occipital lobes. I’d love to be able to eat with my eyes—I’m always too tired now for serious reading.” “And your nap?” Freud asked. “What happened to it? I thought you were going to lie down before supper.”

“I can’t nap anymore. I think I’m too tired to sleep. That same nightmare woke me again in the middle of the night—the one about falling.”

“Tell me again, Josef, exactly how did it go?”

“It’s the same every time.” Breuer downed an entire glass of seltzer, put down his fork, and sat back to allow his food to settle. “And it’s very vivid—I must have had it ten times in the last year. First I feel the earth tremble. I am frightened and go outside to search for. . . ” He deliberated a moment, trying to remember how he had described the dream previously. In it he was always searching for Bertha, but there were limits to what he was willing to reveal to Freud. Not only was he embarrassed by his infatuation with Bertha, but he also saw no reason to complicate Freud’s relationship with Mathilde by telling him things he would be constrained to keep secret from her.

“. . . to search for someone. The ground beneath my feet starts to liquefy, like quicksand. I sink slowly into the earth and fall forty feet—exactly that. Then I come to rest on a large slab. There is writing on the slab. I try to make it out, but I cannot read it.” “Such an enticing dream, Josef. One thing I’m sure of: the key to its meaning is that undecipherable writing on the slab.”

“If, indeed, the dream has any meaning at all.”

“It must, Josef. The same dream, ten times? Surely you wouldn’t allow your sleep to be disturbed by something trivial! The other part that interests me is the forty feet. How did you know it was precisely that?”

“I know it—but don’t know how I know it.”

Freud, who had as usual quickly emptied his plate, quickly swallowed his last mouthful and said, “I’m sure the figure is accurate. After all, you designed the dream! You know, Josef, I’m still collecting dreams, and more and more I believe that precise numbers in dreams always have real significance. I have a new example I don’t think I’ve told you about. Last week we had a dinner for Isaac Schönberg, a friend of my father’s.” “I know him. It’s his son Ignaz, isn’t it, who’s interested in your fiancée’s sister?”

“Yes, that’s the one, and he’s more than ‘interested’ in Minna. Well, it was Isaac’s sixtieth birthday, and he described a dream he’d had the night before. He was walking down a long dark road and had sixty gold pieces in his pocket. Like you, he was entirely certain of that precise figure. He tried to save his coins, but they kept falling out of a hole in his pocket, and it was too dark to find them. Now, I don’t believe it was a coincidence that he dreamed of sixty coins on his sixtieth birthday. I’m certain—how could it be otherwise?—that the sixty coins represent his sixty years.” “And the hole in the pocket?” Breuer asked, picking up a second joint of chicken.

“The dream must be a wish to lose his years and become younger,” replied Freud, as he, too, reached for more chicken.

“Or, Sig, maybe the dream expressed a fear—a fear that his years are running out and that he soon will have none left! Remember, he was on a long dark road and trying to recover something he’d lost.”

“Yes, I suppose so. Perhaps dreams can express either wishes or fears. Or maybe both. But tell me, Josef, when did you first have this dream?”

“Let me see.” Breuer recalled that the first time was shortly after he had began to doubt whether his treatment could help Bertha, and in a discussion with Frau Pappenheim had raised the possibility of Bertha’s being transferred to the Bellevue Sanatorium in Switzerland. That would have been about the beginning of 1882, nearly a year ago, as he told Freud.

“And wasn’t it last January, I came to your fortieth birthday dinner,” asked Freud, “along with the entire Altmann family? So, if you’ve had the dream since then, doesn’t it follow that the forty feet signifies forty years?”

“Well, in a couple of months, I’ll be forty-one. If you’re right, shouldn’t I fall forty-one feet in the dream, beginning next January?”

Freud threw up his arms. “From here on, we need a consultant. I’ve come to the limits of my dream theory. Will a dream once dreamed change to accommodate changes in the dreamer’s life? Fascinating question! Why are years disguised as feet anyhow? Why does the little dream maker residing in our minds go to all that trouble to disguise the truth? My guess is that the dream won’t change to forty-one feet. I think the dream maker would be afraid that changing it one foot as you get one year older would be too transparent, would give away the dream code.” “Sig,” Breuer chuckled, as he wiped his mouth and mustache with his napkin, “here’s where we always part company. When you start talking of another, separate mind, a sentient elf inside of us designing sophisticated dreams and disguising them from our conscious mind—that seems ridiculous.” “I agree, it does seem ridiculous—yet look at the evidence for it, look at all the scientists and mathematicians who have reported solving important problems in dreams! And, Josef, there is no competing explanation. No matter how ridiculous it seems, there must be a separate, unconscious intelligence. I’m sure——” Mathilde entered with a pitcher of coffee and two pieces of her apple-raisin strudel, covered with a mound of Schlag. “What are you so sure of, Sigi?”

“The only thing I’m sure of is that we want you to sit down and stay awhile. Josef was just about to describe a patient he saw today.”

“Sigi, I can’t. Johannes is crying, and if I don’t go in to him now, he’ll wake the others.”

As she departed, Freud turned to Breuer. “Now Josef, what about your strange meeting with that medical student’s sister?”

Breuer hesitated, collecting his thoughts. He wanted to discuss Lou Salomé’s proposal with Freud but feared it would lead into too much discussion of his treatment of Bertha.

“Well, her brother told her about my treatment of Bertha Pappenheim. Now she wants me to apply the same treatment to a friend of hers who is emotionally disturbed.”

“How did this medical student, this Jenia Salomé, even know about Bertha Pappenheim? You’ve always been reluctant to talk to me about that case, Josef. I know nothing about it, aside from the fact that you used mesmerism.”

Breuer wondered whether he detected a trace of jealousy in Freud’s voice. “Yes, I haven’t talked much about Bertha, Sig. Her family is too well known in the community. And I’ve especially avoided talking to you ever since I learned that Bertha is such a good friend of your fiancee. But, a few months ago, giving her the pseudonym of Anna O., I briefly described her treatment at a medical student case conference.” Freud leaned eagerly toward him. “I can’t tell you how curious I am about the details of your new treatment, Josef. Can’t you at least tell me what you told the medical students? You know I can keep professional secrets—even from Martha.” Breuer wavered. How much to tell? Of course, there was a great deal Freud knew already. Certainly, Mathilde had for months made no secret of her annoyance about her husband’s spending so much time with Bertha. And Freud had been present in the house on the day Mathilde had finally exploded with anger and forbade Breuer ever again to mention his young patient’s name in her presence.

Luckily Freud had not witnessed the final catastrophic scene of his treatment of Bertha! Breuer would never forget going to her house on that awful day when he found her writhing with the labor pains of a delusional pregnancy and proclaiming for all to hear: “Here comes Doctor Breuer’s baby!” When Mathilde heard about that—such news rapidly making the rounds of Jewish housewives—she demanded that Breuer instantly transfer Bertha’s case to another physician.

Had Mathilde reported all this to Freud? Breuer didn’t want to ask. Not now. Perhaps later, when things had settled down. Accordingly, he chose his words carefully: “Well, you know, of course, Sig, that Bertha had all the typical symptoms of hysteria—sensory and motor disturbances, muscular contractures, deafness, hallucinations, amnesia, aphonia, phobias—and also unusual manifestations as well. For example, she had some bizarre linguistic disturbances, being unable—sometimes for weeks on end—to speak German, especially in the mornings. We held our conversations in English. Even more bizarre was her dual mental life: one part of her lived in the present; the other part of her responded emotionally to events that had occurred exactly one year before—as we discovered by checking her mother’s diary for the preceding year. She also had severe facial neuralgia, which nothing but morphia could control—and, of course, she became addicted.” “And you treated her with mesmerism?” Freud asked.

“That was my original intent. I planned to follow Liebault’s method of removing symptoms by hypnotic suggestion. But, thanks to Bertha—she’s an extraordinarily creative woman—I discovered an entirely new principle of treatment. In the first few weeks, I visited her daily and invariably found her in such an agitated state that little effective work could be done. But then we learned that she could discharge her agitation by describing to me in detail every annoying event of the day.” Breuer stopped and closed his eyes to collect his thoughts. He knew this was important and wanted to include all the significant facts.

“This process took time. Often Bertha required an hour every morning of what she called ‘chimneysweeping’ just to clear her mind of dreams and unpleasant fantasies, and then, when I returned in the afternoon, new irritants had built up requiring further chimneysweeping. Only when we had entirely cleared this daily debris from her mind could we turn to the task of alleviating her more enduring symptoms. And at this point, Sig, we stumbled upon an astounding discovery!” At Breuer’s portentous tone, Freud, who had been lighting a cigar, froze and let the match burn his finger in his eagerness to hear Breuer’s next words. “Ach, mein Gott!” he exclaimed, shaking out the match and sucking his finger. “Go on, Josef, the astounding discovery was——?” “Well, we found that when she went back to the very source of a symptom and described it all to me, then that symptom disappeared on its own—with no need for any hypnotic suggestion——”

“Source?” asked Freud, now so fascinated that he dropped his cigar into the ashtray and left it there, smoldering and forgotten. “What do you mean, Josef, the source of the symptom?”

“The original irritant, the experience that gave rise to it.”

“Please!” Freud demanded. “An example!”

“I’ll tell you about her hydrophobia. Bertha had been unable or unwilling to drink water for several weeks. She had great thirst, but when she picked up a glass of water, she couldn’t bring herself to drink and was forced to quench her thirst with melons and other fruits. Then one day in a trance—she was a self-mesmerizer and automatically entered a trance every session—she recalled how, weeks before, she had entered her nurse’s room and witnessed her dog lap water from her drinking glass. No sooner did she describe this memory to me, along with discharging her considerable anger and disgust, than she requested a glass of water and drank it with no difficulty. The symptom never returned.” “Remarkable, remarkable!” Freud exclaimed. “And then?”

“Soon we were approaching every other symptom in this same systematic manner. Several symptoms—for example, her arm paralysis and her visual hallucinations of human skulls and snakes—were rooted in the shock of her father’s death. When she described all the details and the emotions of that scene—to stimulate her recall, I even asked her to rearrange the furniture in the same way it was at the time of his death—then all these symptoms dissolved at once.” “It’s beautiful!” Freud had risen and was pacing in his excitement. “The theoretical implications are breathtaking. And entirely compatible with Helmholtzian theory! Once the excess cerebral electrical charge responsible for symptoms is discharged through emotional catharsis, then the symptoms behave properly and promptly vanish! But you seem so calm, Josef. This is a major discovery. You must publish this case.” Breuer sighed deeply. “Perhaps, some day. But now is not the time. There are too many personal complications. I have Mathilde’s feelings to consider. Perhaps now that I’ve described my treatment procedure, you can appreciate how much time I had to invest in Bertha’s treatment. Well, Mathilde simply couldn’t, or wouldn’t, appreciate the scientific importance of the case. As you know, she grew to resent the hours I spent with Bertha—and, in fact, still is so angry she refuses to talk about it with me.

“And also,” Breuer continued, “I cannot publish a case that ended so badly, Sig. At Mathilde’s insistence, I removed myself from the case and transferred Bertha to Binswanger’s sanatorium at Kreuzlingen last July. She is still undergoing treatment there. It’s been hard to withdraw her from the morphia, and apparently some of her symptoms, like her inability to speak German, have returned.” “Even so”—Freud took care to avoid the topic of Mathilde’s anger—“the case breaks new ground, Josef. It could open up a whole new treatment approach. Will you go over it with me when we have more time? I’d like to hear every detail.” “Gladly, Sig. In my office I have a copy of the summary I sent to Binswanger—about thirty pages. You can start by reading that.”

Freud took out his watch. “Ach! It’s late, and I still haven’t heard the story of this medical student’s sister. Her friend—the one she wants you to treat with your new talking cure—she’s a hysteric? With symptoms like Bertha’s?”

“No, Sig, that’s where the story gets interesting. There is no hysteria, and the patient’s not a ‘she.’ The friend is a man, who is, or was, in love with her. He fell into a suicidal love-sickness when she dropped him for another man, a former friend of his! Obviously she feels guilty, and she doesn’t want his blood on her conscience.” “But, Josef”—Freud seemed shocked—“love-sickness! This is not a medical case.”

“That was my first reaction as well. Exactly what I said to her. But wait until you hear the rest. The story gets better. Her friend, who is, incidentally, an accomplished philosopher and a close personal friend of Richard Wagner, doesn’t want help, or at least is too proud to ask for it. She asks me to be a magician. Under the guise of consulting with him about his medical condition, she wants me to sneak in a cure for his psychological distress.” “That’s impossible! Surely, Josef, you’re not going to attempt this?”

“I’m afraid I have already agreed.”

“Why?” Freud picked up his cigar again and leaned forward, frowning in his concern for his friend.

“I’m not sure myself, Sig. Since the Pappenheim case ended, I’ve felt restless and stagnant. Perhaps I need a distraction, a challenge like this. But there is another reason I took this case! The real reason! This medical student’s sister is uncannily persuasive. You cannot say no to her. What a missionary she would make! I think she could convert a horse into a chicken. She is extraordinary, I can’t describe to you just how. Perhaps one day you’ll meet her. Then you’ll see.” Freud rose, stretched, walked over to the window, and opened wide the velvet drapes. Unable to see through the vapor on the glass, he used his handkerchief to wipe a small section dry.

“Still raining, Sig?” Breuer asked. “Shall we fetch Fischmann?”

“No, it’s almost stopped. I’ll walk. But I have more questions about this new patient. When are you seeing him?”

“I’ve not heard from him yet. That’s another problem. Fräulein Salomé and he are on bad terms now. Indeed, she showed me some of his enraged letters. Still, she assures me that she’ll ‘arrange’ for him to consult me for his medical problems. And I have no doubt that, in this as in all things, she will do exactly what she sets out to do.” “And does the nature of this man’s medical problems warrant a medical consultation?”

“Definitely. He is extremely ill and has already stumped two dozen physicians, many with excellent reputations. She described to me a long list of his symptoms—severe headaches, partial blindness, nausea, insomnia, vomiting, severe indigestion, equilibrium problems, weakness.” Seeing Freud shake his head in perplexity, Breuer added, “If you want to be a consultant, you’ve got to get used to such bewildering clinical pictures. Patients who are polysymptomatic and hop from one physician to another are an everyday part of my practice. You know, Sig, this might be a good teaching case for you. I’ll keep you abreast.” Breuer reflected for a moment. “In fact, let’s have a quick one-minute quiz now. So far, just on the basis of these symptoms, what’s your differential diagnosis?” “I don’t know, Josef, they don’t fit together.”

“Don’t be so cautious. Just guess. Think out loud.”

Freud flushed. However thirsty he was for knowledge, he hated to display ignorance. “Perhaps multiple sclerosis or an occipital brain tumor. Lead poisoning? I just don’t know.”

Breuer added, “Don’t forget hemicrania. How about delusional hypochondriasis?”

“The problem,” Freud said, “is that none of these diagnoses explains all the symptoms.”

“Sig,” said Breuer, rising and speaking in a confidential tone, “I’m going to give you a trade secret. One day it’ll be your bread and butter as a consultant. I learned it from Oppolzer, who once said to me: ‘Dogs can have fleas and lice, too.’ ” “Meaning that the patient can———”

“Yes,” Breuer said, putting his arm around Freud’s shoulders. The two men began to walk down the long hallway. “The patient can have two diseases. If fact, those patients who reach a consultant generally do.”

“But let’s go back to the psychological problem, Josef. Your Fraulein says this man won’t acknowledge his psychological distress. If he won’t even admit he is suicidal, how will you proceed?”

“That shouldn’t pose a problem,” Breuer said confidently. “When I take a medical history, I can always find opportunities to glide into the psychological realm. When I inquire about insomnia, for example, I often ask about the type of thoughts that keep the patient awake. Or after the patient has recited the entire litany of his symptoms, I often sympathize and inquire, off-handedly, whether he feels discouraged by his illness, or feels like giving up, or doesn’t want to live anymore. That rarely fails to persuade the patient to tell me everything.” At the front door, Breuer helped Freud on with his coat. “No, Sig, that’s not the problem. I assure you I’ll have no difficulty gaining our philosopher’s confidence and getting him to confess everything. The problem is what to do with what I learn.” “Yes, what will you do if he’s suicidal?”

“If I become convinced that he means to kill himself, I’ll have him locked up immediately—either in the lunatic asylum at Brünnlfeld or perhaps in a private sanatorium like Breslauer’s at Inzerdorf. But, Sig, that’s not going to be the problem. Think about it—if he were truly suicidal, would he bother to consult with me?” “Yes, of course!” Freud, looking flustered, tapped himself on the side of his head for his slowness of wit.

Breuer continued, “No, the real problem will be what to do with him if he is not suicidal, if he is simply suffering greatly.”

“Yes,” Freud said, “what then?”

“In that case, I’ll have to persuade him to see a priest. Or perhaps to take a long cure at Marienbad. Or invent a way to treat him myself!”

“Invent a way to treat him? What do you mean, Josef? What kind of way?”

“Later, Sig. We shall talk later. Now, off with you! Don’t stay in this heated room with that heavy coat on.”

As Freud stepped out the door, he turned his head. “What did you say this philosopher’s name is? Anyone I’ve heard of?”

Breuer hesitated. Remembering Lou Salomé’s injunction for secrecy, on the spur of the moment he made up for Friedrich Nietzsche a name according to the code whereby he had devised Anna O. to represent Bertha Pappenheim. “No, he’s an unknown. The name is Müller, Eckart Müller.”