The Viennese internist Josef Breuer (Fig. 12.1) is widely known as Sigmund Freud’s co-author of Studies in Hysteria (Studien über Hysterie, Franz Deuticke, Leipzig, 1895; English translations by Abraham A. Brill, Nervous and Mental Disease Publishing Company, New York, 1936 and James Strachey, The Hogarth Press, London, 1955). However, his other contributions, which were overshadowed by the profound cultural impact of psychoanalysis, are of equal, if not greater, importance for modern neuroscience. Breuer made seminal discoveries in the pathophysiology of fever, the parasympathetic regulation of respiration, and the function of the vestibular apparatus (Fig. 12.2).

Fig. 12.1
A black and white photograph of Josef Breuer, with his signature at the bottom.

Josef Breuer at 35 years of age, the year he became head of the Department of Neurology and Psychiatry in the Vienna General Polyclinic [12]

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Fig. 12.2
Six title pages of various editions of papers written by Josef Breuer.

Josef Breuer’s landmark contributions: “On the temperature of humans” [3], upper left and middle, a little known paper; “The self-steering of respiration through the vagus nerve” [4], upper right; “The function of the semicircular canals of the ear labyrinth” [7], lower left; “The mental mechanism of hysterical phenomena” [11] and the first English edition of the “Studies in hysteria” by Breuer and Freud, lower middle and right

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Josef Breuer was born in Vienna on 15 January 1842 to Leopold Breuer (1791–1872), a liberal theologian who taught at the Jewish Community of Vienna, and Bertha Breuer (née Semler, 1817–1843), who died at the age of 26 years, 2 months after giving birth to Josef’s younger brother, Adolph Breuer (1843–1874) [1].

Josef entered the Akademisches Gymnasium at the age of 8 years. After passing his Matura exam in 1858, he entered the University of Vienna and for a year attended courses in Greek philosophy, English literature, differential and integral calculus, mathematical physics, and analytical chemistry before enrolling in medical school. The physiology lectures of Ernst Wilhelm von Brücke (1819–1892) had a lasting impact on his scientific formation. In 1862, while a medical student, Breuer went to work as an assistant to Johann von Oppolzer (1808–1871), the chairman of the Second Medical Clinic. He graduated with an M.D. degree in 1867.

Breuer published “On wound fever” [2] with the gynecologist Rudolf Chrobak (1843–1910), who at the time was also an assistant to von Oppolzer. It was an important experimental study on the self-regulatory model of fever. In March 1869, Breuer delivered a lecture on human temperature before the Society for the Dissemination of Scientific Knowledge (Verein zur Verbreitung Naturwissenschaftlicher Kenntnisse) in Vienna [3].

At the Josephinum, the Viennese military medical school, Breuer conducted experiments on the self-regulation of breathing, under the supervision of physiologist Karl Ewald Hering (1834–1918). His paper “Self-steering of respiration through the vagus nerve” [4] was communicated by Hering before the Imperial Academy of Sciences. By demonstrating the role of vagus afferents in the reflex nature of respiration, Breuer provided one of the first examples of a feedback mechanism in the autonomic nervous system. The eponymous “Hering–Breuer reflex” denotes the inhibition of inspiration by lung inflation and the inhibition of expiration by lung deflation, mediated by the vagus. The reflex is sometimes erroneously attributed to Hering’s son, Heinrich Ewald Hering (1866–1948), who was also a physiologist, but was only 2 years old at the time of the discovery [5]. English translations of Hering’s communication and Breuer’s article were published in 1970 [6].

When von Oppolzer died during the typhus epidemic of 1871, Breuer left the Second Medical Clinic and started a private practice in family medicine, which he maintained for the rest of his life. He was highly esteemed and sought after by the wealthy Viennese; he cared for the families of university professors and other prominent intellectuals, including the composer Johannes Brahms (1833–1897) in the final months before his death from hepatocellular carcinoma [1].

In parallel, Breuer conducted experiments on fish, amphibians, reptiles, and birds at his home. He studied the morphology and functions of the vestibular apparatus in the inner ear. One of the most important functions of the semicircular canals is to cause the eyes to move in an opposite direction to the rotation through the anatomical connections with the ocular muscles when the head moves. The net effect of this reflex is to hold the visual world steady.

In 1873, Breuer and the physicist and philosopher Ernst Mach (1838–1916) in Prague independently discovered how the sense of balance operates.

The structure of the labyrinth was originally described in 1830 by Pierre Flourens (1794–1867), who erroneously concluded that the labyrinth was involved in the motor control of head movements. In 1870, Friedrich Goltz (1834–1902) also incorrectly suggested that the semicircular canals were the specific sense organs for the spatial position of the head.

In his study, “On the function of the semicircular canals of the ear labyrinth” [7], Breuer recognized that nystagmus, or ocular oscillations, resulted from a streaming of the endolymph within the semicircular canals and that the ampullary nerve of a single canal could perceive angular acceleration by sensing endolymph flow in all directions through the stimulation of nerve terminals at the base of the canal [8]. Mach arrived at similar conclusions. The “Mach–Breuer theory” of the function of the semicircular canals and the otolith is still valid and is the basis of modern neuro-otological and oculomotor research. Breuer provided clues to the perception of position and equilibrium, the tonic and postural reflexes, eye and head movements, and changes in the visual field in response to labyrinthine stimulation, spatial perception, and orientation as dependent on the vestibular apparatus, vertigo, and the function of the otolith apparatus [9].

In 1875, Breuer earned his habilitation in internal medicine and therapeutics from the University of Vienna and taught as a Privatdocent (lecturer) for 10 years. In 1877, he succeeded Moriz Rosenthal (1833–1889) as chairman of the Department of Neurology and Psychiatry at the Vienna General Polyclinic (Allgemeine Poliklinik Wien), but only stayed there for a year. Breuer’s successors were Lothar von Frankl-Hochwart, Johann Paul Karplus, Otto Kauders and Hans Hoff from 1913 to 1938, and Viktor Frankl from 1946 to 1970 [10].

In 1885, Breuer resigned from his teaching post at the university owing to the demands of his private practice and because his relationships with other academics had become tense. Theodor Billroth (1829–1894) offered to propose to the Chairmen’s Electoral College a faculty position for Breuer at the associate professor level, but Breuer declined.

Problems in vestibular research were further dealt with by Breuer in his studies “On the function of the otolith apparatus” (1891), “On the semicircular canals and the sense of space” (1897), and “On the vestibular apparatus” (1903). With his pupil, physiologist Alois Kreidl (1864–1928), Breuer wrote “On the apparent rotation of the visual field during the action of a centrifugal force” (1898). Between 1902 and 1905, with the support of the otologist Viktor Urbantschitsch (1847–1921), Breuer carried out experiments on galvanotropism (galvanotaxis) in fish.

Although Breuer had not formally trained in psychiatry, his neurophysiological expertise contributed to deeper psychological insights [9]. He met Freud in 1877, while the latter was probing, as a medical student, the neuromorphology of brook lampreys and river crayfish at von Brücke’s Physiological Institute. They developed a friendship which played a vital role in Freud’s early career. Freud dedicated his neurological classic, Zur Auffassung der Aphasien: Eine kritische Studie (Franz Deuticke, Leipzig, 1891), to Breuer “in friendly devotion” (Herrn Dr. Josef Breuer in freundschaftlicher Verehrung gewidmet).

In his practice, Breuer attracted several so-called “neurasthenic” patients. One of them was a social pioneer and founder of the Jewish Women’s Association (Jüdischer Frauenbund), Bertha Pappenheim (1859–1936). An intelligent young woman, she suffered a host of mental symptoms, most likely from dissociative identity disorder, when her father, Sigmund Pappenheim (1824–1881), died. Breuer began treating her and realized that he could relieve symptoms of hysteria after inducing her to recall, under hypnosis, past unpleasant experiences. He concluded that neurotic symptoms emanating from unconscious processes would disappear when such underlying processes became conscious.

Breuer described the case of Bertha (or “Miss Anna O.” as she became known) to Freud and introduced him to the “cathartic method” or talking cure, which Freud adopted to treat his own mentally ill patients. Freud persuaded Breuer to present the “Anna O.” case before the Vienna Medical Club, and he did so in January 1893 in a preliminary communication “On the mental mechanism of hysterical phenomena” [11]. Two years later, Breuer and Freud published the “Studies in hysteria” (Fig. 12.2), the work that marked the beginning of psychoanalysis [10, 12].

A disagreement on basic theoretical tenets brought the collaboration between the two men to an end. Breuer was cautious and rather unenthusiastic about Freud’s overemphasis on the significance of sexuality, fantasy, and repression in the etiology of the neuroses; disenchantment set in because he could not follow Freud’s ability to tell stories convincingly: “With their air of private fantasies promoted to scientific status… the theories were stories, held together by power of imagination rather than weight of evidence” [12].

Freud departed from Breuer’s emphasis on trauma, real experiences, and dissociation, which are largely still valid, but articulated concepts of the unconscious, dream analysis, and aggression that impacted twentieth-century psychology in an unprecedented way. Breuer is often acknowledged as the main forerunner of psychoanalysis, having provided some of the determining concepts and intellectual breakthroughs for the theory that Freud later formulated as psychoanalytic [13].

Breuer published 35 works over four decades [1]. He wrote on migraine, dysentery, sciatica, alcohol intoxication, hydrophobia, jaundice, and mastitis. In 1894, he was accepted as a corresponding member into the Imperial Academy of Sciences of Vienna after being nominated by Hering, Mach, and Siegmund von Exner-Ewarten (1846–1926) [10]. Breuer was well-read in the sciences and the humanities. In May 1902, he was invited to lecture before the Vienna Philosophical Society on “The crisis of Darwinism and teleology” (Die Krisis des Darwinismus und die Teleologie, Johann Ambrosius Barth, Leipzig, 1902).

Josef Breuer died in Vienna on 20 June 1925 at the age of 83 years. He was cremated per his wish. A family gravesite is located at the Döblinger Friedhof. Memorials were written by Freud, Kreidl [14], and Hans Horst Meyer (1853–1939), chairman of the Pharmacological Institute of the University of Vienna [15].

Breuer’s legacy in the history of science does not rest principally on his studies in hysteria. His pioneering work in the neurophysiology of respiration control and labyrinth function is the reason for his lasting fame. “When psychoanalysts speak of Breuer, there is often a note of ambivalence, apparently dictated by his abandonment of psychoanalysis; when other medical men speak of Breuer, it is in consistent tones of the deepest respect” [9].

Breuer married Mathilde Breuer (née Altmann, 1846–1931) in 1868. They had two sons and three daughters. Robert Breuer (1869–1936) studied music with the composer Hugo Wolf (1860–1903) and became a physician; Johannes Breuer (1876–1926) became an attorney at law. The Breuers’ eldest daughter, Bertha Hammerschlag (née Breuer, 1870–1962), married Paul Hammerschlag (1860–1933), brother-in-law of the neurologist and aphasiologist Ludwig Lichtheim (1845–1928). The Breuers’ second daughter, Margarethe Schiff (née Breuer, 1872–1942), who had married the internist Arthur Schiff (1871–1939), died in the Theresienstadt ghetto, and her daughter Hanna Schiff (1902–1942) died in Auschwitz. The Breuers’ youngest daughter Dorothea Breuer (1882–1942) committed suicide in Vienna when the Gestapo went to arrest her for deportation.