From the nose to the uterus? What the nasogenital reflex theory teaches us about science and error

Introduction: When medical errors make history

Have you ever heard that menstrual pain was treated with surgery on the nose? What seems grotesque today was a seriously advocated medical procedure in Vienna around 1900 – propagated not by outsiders, but by leading figures such as Wilhelm Fliess and supported by none other than Sigmund Freud.

This episode in medical history is not only astonishing – it reveals how strongly medical thinking is influenced by cultural, social and scientific trends. Why did highly educated doctors assume that a mucous membrane in the nasal septum was responsible for uterine cramps? And why was this idea not immediately rejected?

The answer takes us deep into the history of medical ideas at the turn of the century – and provides important insights for today's approach to scientific hypotheses, medical authority and therapeutic practice.

What it's all about:

• What exactly the nasogenital reflex theory was – and why it became so influential

• How scientific assumptions change over time – and why mistakes are part of the process

• What lessons can be learned from this episode for modern medicine and science?

What was the nasogenital reflex theory?

The so-called nasogenital reflex theory emerged in the late 19th century and was based on the widespread belief at the time that the human body functioned through an extensive system of neural reflexes. The idea was that if two areas of the body are connected via the nervous system, a disturbance in one area can trigger symptoms in the other – or vice versa: by stimulating one area in a targeted manner, the other could be influenced therapeutically.

Wilhelm Fliess, a Berlin ear, nose and throat doctor and close confidant of Sigmund Freud, formulated the theory of a ‘nasogenital reflex arc’: certain zones in the nose – in particular the so-called ‘genital points’ on the nasal septum – are directly linked to the sexual organs. Irritation or pathological changes in these areas of the nose could thus cause gynaecological complaints such as menstrual pain, infertility, chronic fatigue or hysteria.

Fliess assumed that these complaints could be alleviated or cured by local interventions on the nose. Common procedures included:

• cauterisation (destruction) of the ‘genital points’ using chemical or thermal means

• surgical removal of the turbinates

• electric current treatments using galvanic devices for nerve stimulation

• in some cases even the surgical removal of parts of the mucous membrane

Sigmund Freud supported these approaches – not least because they seemed compatible with his own theories about psychosomatic complaints and sexuality. Probably the best-known patient in this collaboration was Emma Eckstein, a young woman who suffered from menstrual cramps and psychological symptoms. On Freud's recommendation, she underwent surgery performed by Fliess – with dramatic and painful consequences.

Why was this theory so influential?

The medical landscape at the turn of the century was marked by upheaval: advances in anatomy, physiology and psychiatry merged with speculative concepts from neurology. In this atmosphere, a veritable reflex theory boomemerged. Everything seemed to be connected: toothache could cause stomach problems, appendicitis could cause headaches, and nasal irritation could cause menstrual cramps.

The nasogenital theory was also attractive because it offered a modern, ‘scientifically based’ explanatory model for female complaints – at a time when psychological symptoms in women were often dismissed as hysteria. Instead of pointing to moral or character flaws, it was now possible to refer to a seemingly objective physical correlate: the nose.

Added to this was a certain therapeutic need for innovation. Nineteenth-century medicine was desperately searching for causal and technically treatable causes for ailments that could not be explained by medication or purely psychological interpretations. The nasogenital theory promised both: a concrete diagnosis and a physical-surgical solution.

Historical context: a mixture of progress and fantasy

From today's perspective, the idea that menstrual problems could be influenced by the nasal mucosa seems completely absurd. But within the medical logic of its time, it was by no means irrational. The theory combined advances in the anatomy of the nervous system with a holistic understanding of the body. It offered doctors a course of action – and patients hope.

The history of the nasogenital theory is a prime example of how the boundaries between evidence-based science, clinical intuition and speculative construction can become blurred. Medicine is never just technology – it is always an expression of historical, cultural and social patterns of interpretation.

Lesson 1: When strange theories emerge from serious science

The nasogenital theory did not arise in a vacuum. It was not an obscure individual opinion, but a product of its time – embedded in a medical worldview that understood the body as a reflex machine. In the late 19th century, so-called reflex pathology was booming: numerous clinical pictures were explained by malfunctions in supposedly interconnected regions of the body.

Observations such as nosebleeds during pregnancy or puberty, cyclical changes in the mucous membranes or simultaneous complaints in the nose and abdomen were considered evidence of a functional link. In an age characterised by organic explanatory models, it seemed plausible that stimulus transmission via the nervous system enabled direct therapeutic influence.

Fliess even believed in a female cycle system that also influenced the mucous membranes of the nose at 28-day intervals. This idea linked biological rhythms to specific anatomical structures that could be treated – a connection that was considered innovative and holistic in the medical discourse of the time.

This shows that medical theories do not have to be ‘crazy’ or ‘irrational’ to be considered erroneous in retrospect. They are usually the expression of serious scientific endeavour – formulated within the framework of available concepts, methods and cultural assumptions. What seems strange today was coherent thinking at the time.

Lesson 2: Science evolves – also through mistakes

Initially, the nasogenital reflex theory was not rejected in medical circles, but was seriously discussed. Fliess published his ideas in specialist circles and gained supporters – including Freud, who initially supported the project with enthusiasm. Both believed that physical interventions on the nose could alleviate not only somatic but also psychological symptoms.

The fact that the theory later proved unsuccessful was not due to a lack of commitment on the part of those involved, but to growing scientific scepticism. Over time, it became apparent that the surgical successes could not be replicated, the foundations of the theory were neurologically untenable – and the risks of the procedures were considerable.

The operation on Emma Eckstein marked a turning point: after the procedure, Fliess forgot a piece of gauze inside her nose. This led to severe inflammation and permanent complications. Freud initially interpreted the subsequent problems psychodynamically, but later distanced himself increasingly from Fliess's theories.

Scientific errors are not a sign of stupidity, but part of the scientific process. They show that knowledge is always subject to reservation. Belief in absolute certainties prevents learning – willingness to revise, on the other hand, is a sign of scientific maturity.

Lesson 3: Behind theories lie human destinies

The history of the nasogenital theory is not just a curiosity in the history of ideas, but also a story about patient fates, medical hubrisand cross-border friendships. Emma Eckstein was not just any patient – she was also a confidante of Freud, a journalist herself and involved in psychoanalytic circles.

Her suffering after the operation was not taken seriously at first. Freud saw the causes of the complications as lying in ‘inner conflicts’ rather than surgical failure. It was only later that it emerged that the bandage had been left inside her body – and Freud never publicly acknowledged this as medical malpractice.

This story shows how medical errors not only have intellectual consequences, but also cause physical and emotional stress for real people – especially for women, whose complaints have historically often been psychologised and devalued.

Scientific theories do not exist in a vacuum. They unfold their effectiveness in clinical practice, in relationships of trust, in life stories. Medicine is also about relationships – and theories influence how doctors treat patients. The ethical weight of medical errors in reasoning should not be underestimated.

Lesson 4: Science needs critical thinking and modesty

The fact that the nasogenital reflex theory is now considered disproved is not simply due to progress per se, but to the introduction of systematic testing mechanisms, methodological standards and critical discourse in medicine. The ability to be self-critical and to question established narratives is one of the cornerstones of scientific work.

Fliess, however, was hardly willing to revise his thinking. He interpreted criticism as misunderstanding or personal hostility. Freud, on the other hand, showed ambivalence: he wavered between loyalty to his friend and growing doubts about his theories. This episode exemplifies how difficult it is to question one's own models of thinking, especially in close relationships.

Without critical thinking, science degenerates into ideology. Without modesty, even brilliant minds can end up in dogmatic dead ends. Those who work scientifically should not regard error as a disgrace, but as a driver of knowledge.

Lesson 5: Learning from mistakes – why historical missteps remain relevant for modern medicine

Today, evidence-based criteria apply in medicine: treatments must prove themselves in controlled studies, side effects must be documented, and mechanisms of action must be comprehensible. But even today, media hype, premature promises of therapy and pseudoscientific narratives arise – for example in the wellness sector, in self-optimisation or in biomedical trends.

The history of the nasogenital theory therefore acts as a mirror: it shows how urgently medical practice remains dependent on sound research, but also on ethical reflection. It reminds us that even current certainties are only as strong as the methods used to arrive at them.

Medical history is not merely a look back – it is a critical tool for diagnosing the present. Those who are aware of past mistakes can more quickly recognise the pitfalls in today's healthcare system. Scientific humility protects against ideological blindness.

Conclusion: Science as a learning process

From today's perspective, the nasogenital reflex theory seems absurd – and yet it was the result of serious medical conviction, embedded in the medical logic of its time. It shows how science works: tentative, hypothesis-based, prone to error – and precisely because of this, capable of learning.