Freud - Complete Works (103 page)

  
My friend Otto was now
standing beside the patient and my friend Leopold was examining her
and indicated that there was a dull area low down on the left
.
My friend Leopold was also a physician and a relative of
Otto’s. Since they both specialized in the same branch of
medicine, it was their fate to be in competition with each other,
and comparisons were constantly being drawn between them. Both of
them acted as my assistants for years while I was still in charge
of the neurological out-patients’ department of a
children’s hospital. Scenes such as the one represented in
the dream used often to occur there. While I was discussing the
diagnosis of a case with Otto, Leopold would be examining the child
once more and would make an unexpected contribution to our
decision. The difference between their characters was like that
between the bailiff Bräsig and his friend Karl: one was
distinguished for his quickness, while the other was slow but sure.
If in the dream I was contrasting Otto with the prudent Leopold, I
was evidently doing so to the advantage of the latter. The
comparison was similar to the one between my disobedient patient
Irma and the, friend whom I regarded as wiser than she was. I now
perceived another of the lines along which the chain of thought in
the dream branched off: from the sick child to the children’s
hospital. -
The dull area low down on the left
seemed to me
to agree in every detail with one particular case in which Leopold
had struck me by his thoroughness. I also had a vague notion of
something in the nature of a metastatic affection; but this may
also have been a reference to the patient whom I should have liked
to have in the place of Irma. So far as I had been able to judge,
she had produced an imitation of a tuberculosis.

The Interpretation Of Dreams

613

  
A portion of the skin on the
left shoulder was infiltrated
. I saw at once that this was the
rheumatism in my own shoulder, which I invariably notice if I sit
up late into the night. Moreover the wording in the dream was most
ambiguous: ‘
I noticed this, just as he
did . . .
.’ I noticed it in my own body,
that is. I was struck, too, by the unusual phrasing: ‘a
portion of the skin was infiltrated.’ We are in the habit of
speaking of ‘a left upper posterior infiltration’, and
this would refer to the lung and so once more to tuberculosis.

  
In spite of her dress
.
This was in any case only an interpolation. We naturally used to
examine the children in the hospital undressed: and this would be a
contrast to the manner in which adult female patients have to be
examined. I remembered that it was said of a celebrated clinician
that he never made a physical examination of his patients except
through their clothes. Further than this I could not see. Frankly,
I had no desire to penetrate more deeply at this point.

  
Dr. M. said: ‘Its an
infection, but no matter. Dysentery will supervene and the toxin
will be eliminated.
’ At first this struck me as
ridiculous. But nevertheless, like all the rest, it had to be
carefully analysed. When I came to look at it more closely it
seemed to have some sort of meaning all the same. What I discovered
in the patient was a local diphtheritis. I remembered from the time
of my daughter’s illness a discussion on diphtheritis and
diphtheria, the latter being the general infection that arises from
the local diphtheritis. Leopold indicated the presence of a general
infection of this kind from the existence of a dull area, which
might thus be regarded as a metastatic focus. I seemed to think, it
is true, that metastases like this do not in fact occur with
diphtheria: it made me think rather of pyaemia.

The Interpretation Of Dreams

614

  
No matter
. This was
intended as a consolation. It seemed to fit into the context as
follows. The content of the preceding part of the dream had been
that my patient’s pains were due to a severe organic
affection. I had a feeling that I was only trying in that way to
shift the blame from myself. Psychological treatment could not be
held responsible for the persistence of diphtheritic pains.
Nevertheless I had a sense of awkwardness at having invented such a
severe illness for Irma simply in order to clear myself. It looked
so cruel. Thus I was in need of an assurance that all would be well
in the end, and it seemed to me that to have put the consolation
into the mouth precisely of Dr. M. had not been a bad choice. But
here I was taking up a superior attitude towards the dream, and
this itself required explanation.

   And why was the consolation so
nonsensical?

  
Dysentery
. There seemed to
be some remote theoretical notion that morbid matter can be
eliminated through the bowels. Could it be that I was trying to
make fun of Dr. M.’s fertility in producing far-fetched
explanations and making unexpected pathological connections?
Something else now occurred to me in relation to dysentery. A few
months earlier I had taken on the case of a young man with
remarkable difficulties associated with defaecating, who had been
treated by other physicians as a case of ‘anaemia accompanied
by malnutrition’. I had recognized it as a hysteria, but had
been unwilling to try him with my psychotherapeutic treatment and
had sent him on a sea voyage. Some days before, I had had a
despairing letter from him from Egypt, saying that he had had a
fresh attack there which a doctor had declared was dysentery. I
suspected that the diagnosis was an error on the part of an
ignorant practitioner who had allowed himself to be taken in by the
hysteria. But I could not help reproaching myself for having put my
patient in a situation in which he might have contracted some
organic trouble on top of his hysterical intestinal disorder.
Moreover, ‘dysentery’ sounds not unlike
‘diphtheria’ - a word of ill omen which did not occur
in the dream.

The Interpretation Of Dreams

615

   Yes, I thought to myself, I must
have been making fun of Dr. M. with the consoling prognosis
‘Dysentery will supervene’, etc.: for it came back to
me that, years before, he himself had told an amusing story of a
similar kind about another doctor. Dr. M. had been called in by him
for consultation over a patient who was seriously ill, and had felt
obliged to point out, in view of the very optimistic view taken by
his colleague, that he had found albumen in the patient’s
urine. The other, however, was not in the least put out:
‘
No matter
’, he had said, ‘the albumen
will soon be eliminated!’ - I could no longer feel any doubt,
therefore, that this part of the dream was expressing derision at
physicians who are ignorant of hysteria. And, as though to confirm
this, a further idea crossed my mind: ‘Does Dr. M. realize
that the symptoms in his patient (Irma’s friend) which give
grounds for fearing tuberculosis also have a hysterical basis? Has
he spotted this hysteria? or has he been taken in by it?’

   But what could be my motive for
treating this friend of mine so badly? That was a very simple
matter. Dr. M. was just as little in agreement with my
‘solution’ as Irma herself. So I had already revenged
myself in this dream on two people: on Irma with the words
‘If you still get pains, it’s your own fault’,
and on Dr. M. by the wording of the nonsensical consolation that I
put into his mouth.

  
We were directly aware of the
origin of the infection
. This direct knowledge in the dream was
remarkable. Only just before we had had no knowledge of it, for the
infection was only revealed by Leopold.

  
When she was feeling unwell,
my friend Otto had given her an injection
. Otto had in fact
told me that during his short stay with Irma’s family he had
been called in to a neighbouring hotel to give an injection to
someone who had suddenly felt unwell. These injections reminded me
once more of my unfortunate friend who had poisoned himself with
cocaine. I had advised him to use the drug internally only, while
morphia was being withdrawn; but he had at once given himself
cocaine
injections
.

The Interpretation Of Dreams

616

  
A preparation of
propyl . . . propyls . . . propionic
acid
. How could I have come to think of this? During the
previous evening, before I wrote out the case history and had the
dream, my wife had opened a bottle of liqueur, on which the word
‘Ananas’¹ appeared and which was a gift from our
friend Otto: for he has a habit of making presents on every
possible occasion. It was to be hoped, I thought to myself, that
some day he would find a wife to cure him of the habit. This
liqueur gave off such a strong smell of fusel oil that I refused to
touch it. My wife suggested our giving the bottle to the servants,
but I - with even greater prudence - vetoed the suggestion, adding
in a philanthropic spirit that there was no need for
them
to
be poisoned either. The smell of fusel oil (amyl . . .) evidently
stirred up in my mind a recollection of the whole series - propyl,
methyl, and so on - and this accounted for the propyl preparation
in the dream. It is true that I carried out a substitution in the
process: I dreamt of propyl after having smelt amyl. But
substitutions of this kind are perhaps legitimate in organic
chemistry.

  
Trimethylamin
. I saw the
chemical formula of this substance in my dream, which bears witness
to a great effort on the part of my memory. Moreover, the formula
was printed in heavy type, as though there had been a desire to lay
emphasis on some part of the context as being of quite special
importance. What was it, then, to which my attention was to be
directed in this way by trimethylamin? It was to a conversation
with another friend who had for many years been familiar with all
my writings during the period of their gestation, just as I had
been with his. He had at that time confided some ideas to me on the
subject of the chemistry of the sexual processes, and had mentioned
among other things that he believed that one of the products of
sexual metabolism was trimethylamin. Thus this substance led me to
sexuality, the factor to which I attributed the greatest importance
in the origin of the nervous disorders which it was my aim to cure.
My patient Irma was a young widow; if I wanted to find an excuse
for the failure of my treatment in her case, what I could best
appeal to would no doubt be this fact of her widowhood, which her
friends would be so glad to see changed. And how strangely, I
thought to myself, a dream like this is put together! The other
woman, whom I had as a patient in the dream instead of Irma, was
also a young widow.

  
¹
I must add that the sound of the word
‘Ananas’ bears a remarkable resemblance to that of my
patient Irma’s family name.

The Interpretation Of Dreams

617

   I began to guess why the formula
for trimethylamin had been so prominent in the dream. So many
important subjects converged upon that one word. Trimethylamin was
an allusion not only to the immensely powerful factor of sexuality,
but also to a person whose agreement I recalled with satisfaction
whenever I felt isolated in my opinions. Surely this friend who
played so great a part in my life must appear again elsewhere in
these trains of thought. Yes. For he had a special knowledge of the
consequences of affections of the nose and its accessory cavities;
and he had drawn scientific attention to some very remarkable
connections between the turbinal bones and the female organs of
sex. (Cf. the three curly structures in Irma’s throat.) I had
had Irma examined by him to see whether her gastric pains might be
of nasal origin. But he suffered himself from suppurative rhinitis,
which caused me anxiety; and no doubt there was an allusion to this
in the pyaemia which vaguely came into my mind in connection with
the metastases in the dream.

  
Injections of that sort ought
not to be made so thoughtlessly
. Here an accusation of
thoughtlessness was being made directly against my friend Otto. I
seemed to remember thinking something of the same kind that
afternoon when his words and looks had appeared to show that he was
siding against me. It had been some such notion as: ‘How
easily his thoughts are influenced! How thoughtlessly he jumps to
conclusions!’ -Apart from this, this sentence in the dream
reminded me once more of my dead friend who had so hastily resorted
to cocaine injections. As I have said, I had never contemplated the
drug being given by injection. I noticed too that in accusing Otto
of thoughtlessness in handling chemical substances I was once more
touching upon the story of the unfortunate Mathilde, which gave
grounds for the same accusation against myself. Here I was
evidently collecting instances of my conscientiousness, but also of
the reverse.

The Interpretation Of Dreams

618

  
And probably the syringe had
not been clean
. This was yet another accusation against Otto,
but derived from a different source. I had happened the day before
to meet the son of an old lady of eighty-two, to whom I had to give
an injection of morphia twice a day. At the moment she was in the
country and he told me that she was suffering from phlebitis. I had
at once thought it must be an infiltration caused by a dirty
syringe. I was proud of the fact that in two years I had not caused
a single infiltration; I took constant pains to be sure that the
syringe was clean. In short, I was conscientious. The phlebitis
brought me back once more to my wife, who had suffered from
thrombosis during one of her pregnancies; and now three similar
situations came to my recollection involving my wife, Irma and the
dead Mathilde. The identity of these situations had evidently
enabled me to substitute the three figures for one another in the
dream.