far I could form no sure judgement about the degree of thwarting of libido, or other factors determining this wish. Analysis elucidated this too, when the patient had described in detail his attacks of pain, and included many new particulars.
Already twenty-four hours before these began, great restlessness set in. Ordinary incidents, usually without effect on him, now excited him. He became silent and irritable, especially at home where he treated his wife curtly; the more imminent the approach of the attack, the less could he tolerate her proximity or ultimately even her presence. He accounted for this strange behaviour, most important for the resolution of the neurosis, by the significant parallel that when at hospital, every assistance rendered by a woman had irritated him. Particularly had he refused to let one give him an enema; this operation seemed an impossibility for a woman. A sense of shame will not completely explain this behaviour; I discern here too a passive-homosexual factor. He regarded his illness jealously as an exclusively personal affair. If he happened to be asked how he was, he might become furious and flare up; of this I had opportunity of satisfying myself during analysis. Together with his transformation of mood, he suffered from constipation that was not amenable to any drug. Regularly following such prodromal indications, the pain in the side occurred on the next day, and increased for some hours until the patient could neither stand nor sit. Even lying down he could maintain one position only for few minutes. As soon as the pains reached a climax, he became weak and limp. He then had to lie down on his left side, and it eased him to stuff a small bolster under him. Sometimes he would fall asleep in this position after a short while. The attacks which were accompanied by loss of consciousness, were preceded by buzzing in the head, and seeing black before the eyes. Afterwards he felt pricking in all his limbs, and was temporarily dazed. First he passed wind, and finally the constipation too ceased.
This description which was taken almost word for word from the patient, together with an impressive demonstration of his behaviour during an attack which he reproduced in my presence, drove me at length to the idea, which had formerly passed through my mind but was always suppressed as ridiculous, that if this were all true, the attack could represent nothing but a childbirth; moreover the constipation must be a conversion symptom
