Sigmund Freud

The Collected Works of Sigmund Freud


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with the consoling prognosis: "Dysentery will develop, &c.," I am making fun of Dr. M., for I recollect that years ago he once jokingly told a very similar story of another colleague. He had been called to consult with this colleague in the case of a woman who was very seriously ill and had felt obliged to confront the other physician, who seemed very hopeful, with the fact that he found albumen in the patient's urine. The colleague, however, did not let this worry him, but answered calmly: "That does not matter, doctor; the albumen will without doubt be excreted." Thus I can no longer doubt that derision for those colleagues who are ignorant of hysteria is contained in this part of the dream. As though in confirmation, this question now arises in my mind: "Does Dr. M. know that the symptoms of his patient, of our friend Irma, which give cause for fearing tuberculosis, are also based on hysteria? Has he recognised this hysteria, or has he stupidly ignored it?"

      But what can be my motive in treating this friend so badly? This is very simple: Dr. M. agrees with my solution as little as Irma herself. I have thus already in this dream taken revenge on two persons, on Irma in the words, "If you still have pains, it is your own fault," and on Dr. M. in the wording of the nonsensical consolation which has been put into his mouth.

       We have immediate knowledge of the origin of the infection. This immediate knowledge in the dream is very remarkable. Just before we did not know it, since the infection was first demonstrated by Leopold.

       My friend Otto has recently given her an injection when she felt ill. Otto had actually related that in the short time of his visit to Irma's family, he had been called to a neighbouring hotel in order to give an injection to some one who fell suddenly ill. Injections again recall the unfortunate friend who has poisoned himself with cocaine. I had recommended the remedy to him merely for internal use during the withdrawal of morphine, but he once gave himself injections of cocaine.

      Trimethylamin. I see the chemical formula of this substance in the dream, a fact which probably gives evidence of a great effort on the part of my memory, and, moreover, the formula is printed in heavy type, as if to lay special stress upon something of particular importance, as distinguished from the context. To what does this trimethylamin lead, which has been so forcibly called to my attention? It leads to a conversation with another friend who for years has known all my germinating activities, as I have his. At that time he had just informed me of some of his ideas about sexual chemistry, and had mentioned, among others, that he thought he recognised in trimethylamin one of the products of sexual metabolism. This substance thus leads me to sexuality, to that factor which I credit with the greatest significance for the origin of the nervous affections which I attempt to cure. My patient Irma is a young widow; if I am anxious to excuse the failure of her cure, I suppose I shall best do so by referring to this condition, which her admirers would be glad to change. How remarkably, too, such a dream is fashioned! The other woman, whom I take as my patient in the dream instead of Irma, is also a young widow. I suspect why the formula of trimethylamin has made itself so prominent in the dream. So many important things are gathered up in this one word: Trimethylamin is not only an allusion to the overpowering factor of sexuality, but also to a person whose sympathy I remember with satisfaction when I feel myself forsaken in my opinions. Should not this friend, who plays such a large part in my life, occur again in the chain of thoughts of the dream? Of course, he must; he is particularly acquainted with the results which proceed from affections of the nose and its adjacent cavities, and has revealed to science several highly remarkable relations of the turbinated bones to the female sexual organs (the three curly formations in Irma's throat). I have had Irma examined by him to see whether the pains in her stomach might be of nasal origin. But he himself suffers from suppurative rhinitis, which worries him, and to this perhaps there is an allusion in pyæmia, which hovers before me in the metastases of the dream.

      Such injections are not made so rashly. Here the reproach of carelessness is hurled directly at my friend Otto. I am under the impression that I had some thought of this sort in the afternoon, when he seemed to indicate his siding against me by word and look. It was perhaps: "How easily he can be influenced; how carelessly he pronounces judgment." Furthermore, the above sentence again points to my deceased friend, who so lightly took refuge in cocaine injections. As I have said, I had not intended injections of the remedy at all. I see that in reproaching Otto I again touch upon the story of the unfortunate Matilda, from which arises the same reproach against me. Obviously I am here collecting examples of my own conscientiousness, but also of the opposite.

      Probably also the syringe was not clean. Another reproach directed at Otto, but originating elsewhere. The day before I happened to meet the son of a lady eighty-two years of age whom I am obliged to give daily two injections of morphine. At present she is in the country, and I have heard that she is suffering from an inflammation of the veins. I immediately thought that it was a case of infection due to contamination from the syringe. It is my pride that in two years I have not given her a single infection; I am constantly concerned, of course, to see that the syringe is perfectly clean. For I am conscientious. From the inflammation of the veins, I return to my wife, who had suffered from emboli during a period of pregnancy, and now three related situations come to the surface in my memory, involving my wife, Irma, and the deceased Matilda, the identity of which three persons plainly justifies my putting them in one another's place.

      This much is apparent at first sight. But many things in the details of the dream become intelligible when regarded from the point of view of wish-fulfilment. I take revenge on Otto, not only for hastily taking part against me, in that I accuse him of a careless medical operation (the injection), but I am also avenged on him for the bad cordial which smells like fusel oil, and I find an expression in the dream which unites both reproaches; the injection with a preparation of propyl. Still I am not satisfied, but continue my revenge by comparing him to his more reliable competitor. I seem to say by this: "I like him better than you." But Otto is not the only one who must feel the force of my anger. I take revenge on the disobedient patient by exchanging her for a more sensible, more docile one. Nor do I leave the contradiction of Dr. M. unnoticed, but express my opinion of him in an obvious allusion, to the effect that his relation to the question is that of an ignoramus ("dysentery will develop," &c.).

      It seems to me, indeed, as though I were appealing from him to some one better informed (my friend, who has told me about trimethylamin); just as I have turned