Mikkel Borch-Jacobsen, Ph.D.

Mikkel Borch-Jacobsen Ph.D.

Freud's Patients, A Serial

Mathilde Schleicher (1862-1890)

The tragic poisoning of one of Freud's first patients.

Posted Mar 04, 2012

Mathilde Schleicher, Freud tells us in a case report written in 1889, came "from a distinguished family but prone to nervous illnesses." Her father, Cölestin Schleicher, was a well-known genre painter and she herself was a musician. She had always been very impressionable and suffered from migraines. Her "nervous illness" broke out in February 1886. According to Freud, the triggering event had been the breaking off of their engagement by her fiancé. According to another case report written later by Dr. Hanns Kaan, the fiancé, a "weak character", had instead broken off the engagement after she had become depressed and developed "hysterical facial changes." Whatever the case, she fell into a severe melancholic state which was characterized by self-accusations and delusional ideas.

Freud had just set up private practice as a "nerve doctor" in April 1886 and Mathilde Schleicher was among his very first patients. Presumably it is Breuer who had referred her in his capacity as the Schleicher's family doctor for it is to him that Freud later turned when Mathilde developed the clearly somatic disease that she would die from. The treatment, Freud wrote in his report, had a "changing course" - in other words, ups and downs. What we know is that, at some point, the young nerve doctor began to use hypnosis in the form of direct suggestion. Dr. Kaan, in his report, notes indeed that the patient "worshipped the doctor who had treated her by hypnosis during her melancholic condition." By spring 1889, it seemed that the hypnotic treatment had been successful. Mathilde's depression eased up gradually and in June she offered to her dear doctor-hypnotist a nice history book - Germania. Two Millennia of German Life - with the following inscription: "To the excellent Dr. Freud, with my affectionate memory. As a token of the deepest gratitude and the deepest respect. Mathilde Schleicher, June [1]889".

The respite was short-lived. The following month, the patient developed a full blown mania. She was exuberant, agitated, could not sleep. She spoke constantly of the brilliant concert career to which she was destined and of the millions she was going to earn. She would take over from the Bianchi (Bianca Bianchi, the lead singer of the Vienna Opera). She had grandiose wedding plans. At the slightest provocation, she would fall into violent convulsions that Freud considered "clearly hysterical in nature, which moreover also occurred during the melancholia and multiplied during her recovery from it."

Overwhelmed, Freud committed her on October 29, 1889 to the private clinic of Dr. Wilhelm Svetlin with a diagnosis of "cyclical mood alteration" (what Kraepelin was to call ten years later "manic depressive psychosis"). In his case report, he wrote coyly: "A more serious violation of the limits that her gender and education should assign to her did not occur, although here and there attempts were made". Medical records held at the Svetlin clinic were less prudish. Two days after Mathilde's arrival at the clinic, the attending physician noted: "Nymphomaniac, half naked rolls on the ground while masturbating, calls on Dr. Freud whose slave she wants to be." A week later, it was Dr. Kaan, Svetlin's assistant, who became the object of her "erotic arousal". On November 12, "the manic delirium concerns almost exclusively sexual things: she thinks herself pregnant, every bowel movement is a birth, the faeces are her baby, the ‘jewel of her crown', which she tries to hide from the orderly under a pillow."

Doctors at the clinic seem to have been of the opinion that the worsening state of the patient, notably her convulsions, were due to Dr. Freud's hypnotic treatment (the medical file mentions that she "simulates hysterical convulsions"). For seven months she was given all kinds of hypnotics and sedatives, as was customary at the time with agitated patients: morphine, chloral hydrate, bromide, opium, cannabis, valerian, and so forth. Occasionally she was also given sulfonal, a new hypnotic introduced in 1888 by Alfred Kast and which had been described in medical journals as completely harmless and non-addictive, unlike other products in use. The manic state having abated, she was released on May 25, 1890.

"Healed?" wondered the clinic physician in his file. Obviously not. As might be expected, the melancholic cycle resumed, with depression, apathy and insomnia. Did Freud again use hypnosis (in the meantime, he had moved on to the "cathartic method")? We do not know. What is certain is that he prescribed a treatment alternating chloral hydrate and sulfonal (2 grams per day every other week), presumably to overcome the insomnia. Back from vacation in early September, Freud found Mathilde "anemic". Then there was vomiting, urinary retention and abdominal pain. The urine collected by catheter was strangely red. Neither Freud nor Breuer, whom he had called to the rescue, understood what was going on. On September 24, 1890, Mathilde Schleicher died "fully conscious" in horrible abdominal cramps. She was buried two days later in the Jewish section of Vienna's Central Cemetery.

The enigma of her death was resolved a few weeks later when an article appeared under the signature of Hermann Breslauer (a friend of Breuer's and one of Bertha Pappenheim's doctors) who warned for the first time against the dangers of sulfonal: taken at too high a dose or over a long period, this product might cause acute porphyria, a liver damage signaled by the red color of the urine. But the article came too late. Mathilde Schleicher had died poisoned by the medication prescribed by her doctor.

A couple of months later, Freud reported on her case in the Internationale Klinische Rundschau (December 6, 1891): "During the summer, report of urine retention. Vomiting once, soon over with. Back [home] after 3 months, anemic, otherwise still melancholic. A few days later: vomiting, retention of urine, abdominal pains, no fever. A few days later, urine with catheter, red color. (Examination by Dr. Jolles laboratory.) Never before protein and renal elements. Abdominal pains, anxiety, gloomy, clear consciousness, vomiting, persistent constipation, cyanosis finger tips. After that, weak pulse, racing [pulse], diaphragm paralysis. Death while fully conscious -- complete picture 5-6 days."

(Next post: Fanny Moser)

Sources:

- Freud, Sigmund (1891) Report on the Mathilde Schleicher case written at the request of Adolf E. Jolles, "Über das chemische Verhalten der Harne nach Sulfonal-Intoxikation", Internationale Klinische Rundschau, December 6, 1891, col. 1913-1914.
- Hirschmüller, Albrecht (1989) "Freuds ‘Mathilde': Ein weiterer Tagesrest zum Irma-Traum, Jahrbuch der Psychoanalyse, 24, p. 128-159.
- Hirschmüller, Albrecht (1993) "Freud, Meynert et Mathilde: l'hypnose en question", Revue Internationale d'Histoire de la Psychanalyse, 6, p. 271-285.
- Shorter, Edward (1989) "Women and Jews in a private nervous clinic in late nineteenth-century Vienna", Medical History, 33, p. 149-183.
- Swales, Peter (1986) "Freud, his teacher and the birth of psychoanalysis", Freud: Appraisals and Reappraisals. Contributions to Freud Studies, vol. 1, Paul Stepansky ed., Hillsdale N.J., The Analytic Press, p. 3-82.
- Voswinckel, Peter (1988) "Der Fall Mathilde S...: Bisher unbekannter klinischer Bericht von Sigmund Freud. Zum 100. Geburtstag des Sulfonal-Bayer", Arzt und Krankenhaus, 61, p. 177-184.

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