When she was 27, she went to Freud seeking treatment for vague symptoms including stomach ailments and slight depression related to menstruation. Freud diagnosed Eckstein as suffering from trauma, secondary to childhood sexual abuse. Freud suspected, in addition, a "nasal reflex neurosis," a condition popularized by Fliess, an ear, nose and throat specialist. Fliess had been treating the nasal reflex neurosis in his own patients with local anesthesia, specifically cocaine, and found that the treatment yielded positive results, in that his patients became less depressed. Fliess conjectured that if temporary cauterization was temporarily useful, perhaps surgery would yield more permanent results. He began operating on the noses of patients he diagnosed with the disorder, including Eckstein and even Freud himself.
Eckstein's surgery was a disaster. She suffered from terrible infections for some time, and profuse bleeding. Freud called in a specialist who removed a mass of surgical gauze that Fliess had not removed. Eckstein's nasal passages were so damaged that she was left permanently disfigured. Freud initially attributed this damage to the surgery, but later, as an attempt to reassure his friend that he shouldn't blame himself, Freud reiterated his belief that the initial nasal symptoms had been due to hysteria. The incident provided source material for Freud's dream of "Irma's injection".