speech which I make to Irma in the dream, that above all things I do not want to be to blame for the pains which she still feels. If it is Irma's own fault, it cannot be mine. Should the purpose of the dream be looked for in this quarter?
Irma's complaints; pains in the neck, abdomen, and stomach; she is drawn together. Pains in the stomach belonged to the symptom-complex of my patient, but they were not very prominent; she complained rather of sensations of nausea and disgust. Pains in the neck and abdomen and constriction of the throat hardly played a part in her case. I wonder why I decided upon this choice of symptoms, nor can I for the moment find the reason.
She looks pale and bloated. My patient was always ruddy. I suspect that another person is here being substituted for her.
I am frightened at the thought that I must have overlooked some organic affection. This, as the reader will readily believe, is a constant fear with the specialist, who sees neurotics almost exclusively, and who is accustomed to ascribe so many manifestations, which other physicians treat as organic, to hysteria. On the other hand, I am haunted by a faint doubt—I know not whence it comes—as to whether my fear is altogether honest. If Irma's pains are indeed of organic origin, I am not bound to cure them. My treatment, of course, removes only hysterical pains. It seems to me, in fact, that I wish to find an error in the diagnosis; in that case the reproach of being unsuccessful would be removed.
I take her to the window in order to look into her throat. She resists a little, like a woman who has false teeth. I think she does not need them anyway.
I had never had occasion to inspect Irma's aural cavity. The incident in the dream reminds me of an examination, made some time before, of a governess who at first gave an impression of youthful beauty, but who upon opening her mouth took certain measures for concealing her teeth. Other memories of medical examinations and of little secrets which are discovered by them, unpleasantly for both examiner and examined, connect themselves with this case. "She does not need them anyway," is at first perhaps a compliment for Irma; but I suspect a different meaning. In careful analysis one feels whether or not the "background thoughts" which are to be expected have been exhausted. The way in which Irma stands at the window suddenly reminds me of another experience. Irma possesses an intimate woman friend, of whom I think very highly. One evening on paying her a visit I found her in the position at the window reproduced in the dream, and her physician, the same Dr. M., declared that she had a diphtheritic membrane. The person of Dr. M. and the membrane return in the course of the dream. Now it occurs to me that during the last few months, I have been given every reason to suppose that this lady is also hysterical. Yes, Irma herself has betrayed this to me. But what do I know about her condition? Only the one thing, that like Irma she suffers from hysterical choking in dreams. Thus in the dream I have replaced my patient by her friend. Now I remember that I have often trifled with the expectation that this lady might likewise engage me to relieve her of her symptoms. But even at the time I thought it improbable, for she is of a very shy nature. She resists, as the dream shows. Another explanation might be that she does not need it; in fact, until now she has shown herself strong enough to master her condition without outside help. Now only a few features remain, which I can assign neither to Irma nor to her friend: Pale, bloated, false teeth. The false teeth lead me to the governess; I now feel inclined to be satisfied with bad teeth. Then another person, to whom these features may allude, occurs to me. She is not my patient, and I do not wish her to be my patient, for I have noticed that she is not at her ease with me, and I do not consider her a docile patient. She is generally pale, and once, when she had a particularly good spell, she was bloated.5 I have thus compared my patient Irma with two others, who would likewise resist treatment. What can it mean that I have exchanged her for her friend in the dream? Perhaps that I wish to exchange her; either the other one arouses in me stronger sympathies or I have a higher opinion of her intelligence. For I consider Irma foolish because she does not accept my solution. The other one would be more sensible, and would thus be more likely to yield. The mouth then really opens without difficulty; she would tell more than Irma.6
What I see in the throat; a white spot and scabby nostrils. The white spot recalls diphtheria, and thus Irma's friend, but besides this it recalls the grave illness of my eldest daughter two years before and all the anxiety of that unfortunate time. The scab on the nostrils reminds me of a concern about my own health. At that time I often used cocaine in order to suppress annoying swellings in the nose, and had heard a few days before that a lady patient who did likewise had contracted an extensive necrosis of the nasal mucous membrane. The recommendation of cocaine, which I had made in 1885, had also brought grave reproaches upon me. A dear friend, already dead in 1895, had hastened his end through the misuse of this remedy.
I quickly call Dr. M., who repeats the examination. This would simply correspond to the position which M. occupied among us. But the word "quickly" is striking enough to demand a special explanation. It reminds me of a sad medical experience. By the continued prescription of a remedy (sulfonal) which was still at that time considered harmless, I had once caused the severe intoxication of a woman patient, and I had turned in great haste to an older, more experienced colleague for assistance. The fact that I really had this case in mind is confirmed by an accessory circumstance. The patient, who succumbed to the intoxication, bore the same name as my eldest daughter. I had never thought of this until now; now it seems to me almost like a retribution of fate—as though I ought to continue the replacement of the persons here in another sense; this Matilda for that Matilda; an eye for an eye, a tooth for a tooth. It is as though I were seeking every opportunity to reproach myself with lack of medical conscientiousness.
Dr. M. is pale, without a beard on his chin, and he limps. Of this so much is correct, that his unhealthy appearance often awakens the concern of his friends. The other two characteristics must belong to another person. A brother living abroad occurs to me, who wears his chin clean-shaven, and to whom, if I remember aright, M. of the dream on the whole bears some resemblance. About him the news arrived some days before that he was lame on account of an arthritic disease in the hip. There must be a reason why I fuse the two persons into one in the dream. I remember that in fact I was on bad terms with both of them for similar reasons. Both of them had rejected a certain proposal which I had recently made to them.
My friend Otto is now standing next to the sick woman, and my friend Leopold examines her and calls attention to a dulness on the left below. My friend Leopold is also a physician, a relative of Otto. Since the two practise the same specialty, fate has made them competitors, who are continually being compared with each other. Both of them assisted me for years, while I was still directing a public dispensary for nervous children. Scenes like the one reproduced in the dream have often taken place there. While I was debating with Otto about the diagnosis of a case, Leopold had examined the child anew and had made an unexpected contribution towards the decision. For there was a difference of character between the two similar to that between Inspector Brassig and his friend Charles. The one was distinguished for his brightness, the other was slow, thoughtful, but thorough. If I contrast Otto and the careful Leopold in the dream, I do it, apparently, in order to extol Leopold. It is a comparison similar to the one above between the disobedient patient Irma and her friend who is thought to be more sensible. I now become aware of one of the tracks along which the thought association of the dream progresses; from the sick child to the children's asylum. The dulness to the left, below, recalls a certain case corresponding to it, in every detail in which Leopold astonished me by his thoroughness. Besides this, I have a notion of something like a metastatic affection, but it might rather be a reference to the lady patient whom I should like to have instead of Irma. For this lady, as far as I can gather, resembles a woman suffering from tuberculosis.
An infiltrated portion of skin on the left shoulder. I see at once that this is my own rheumatism of the shoulder, which I always feel when I have remained awake until late at night. The turn of phrase in the dream also sounds ambiguous; something which I feel... in spite of the dress. "Feel on my own body" is intended. Moreover, I am struck with the unusual sound of the term "infiltrated portion of skin." "An infiltration behind on the
