My friend Otto is now standing next to the patient, and my friend Leopold examines her and calls attention to a dulness low down on the left side. My friend Leopold also is a physician, and a relative of Otto's. Since the two practice the same specialty, fate has made them competitors, so that they are constantly being compared with one another. Both of them assisted me for years, while I was still directing a public clinic for neurotic children. There, scenes like that reproduced in my dream had often taken place. While I would be discussing the diagnosis of a case with Otto, Leopold would examine the child anew and make an unexpected contribution towards our decision. There was a difference of character between the two men like that between Inspector Brasig and his friend Karl. Otto was remarkably prompt and alert; Leopold was slow and thoughtful, but thorough. If I contrast Otto and the cautious Leopold in the dream I do so, apparently, in order to extol Leopold. The comparison is like that made above between the disobedient patient Irma and her friend, who was believed to be more sensible. I now become aware of one of the tracks along which the association of ideas in the dream proceeds: from the sick child to the children's clinic. Concerning the dulness low on the left side, I have the impression that it corresponds with a certain case of which all the details were similar, a case in which Leopold impressed me by his thoroughness. I thought vaguely, too, of something like a metastatic affection, but it might also be a reference to the patient whom I should have liked to have in Irma's place. For this lady, as far as I can gather, exhibited symptoms which imitated tuberculosis.

An infiltrated portion of skin on the left shoulder. I know at once that this is my own rheumatism of the shoulder, which I always feel if I lie awake long at night. The very phrasing of the dream sounds ambiguous: Something which I can feel, as he does, in spite of the dress. "Feel on my own body" is intended. Further, it occurs to me how unusual the phrase infiltrated portion of skin sounds. We are accustomed to the phrase: "an infiltration of the upper posterior left"; this would refer to the lungs, and thus, once more, to tuberculosis.

In spite of the dress. This, to be sure, is only an interpolation. At the clinic the children were, of course, examined undressed; here we have some contrast to the manner in which adult female patients have to be examined. The story used to be told of an eminent physician that he always examined his patients through their clothes. The rest is obscure to me; I have, frankly, no inclination to follow the matter further.

Dr. M says: "It's an infection, but it doesn't matter; dysentery will follow, and the poison will be eliminated." This, at first, seems to me ridiculous; nevertheless, like everything else, it must be carefully analysed; more closely observed it seems after all to have a sort of meaning. What I had found in the patient was a local diphtheritis. I remember the discussion about diphtheritis and diphtheria at the time of my daughter's illness. Diphtheria is the general infection which proceeds from local diphtheritis. Leopold demonstrates the existence of such a general infection by the dulness, which also suggests a metastatic focus. I believe, however, that just this kind of metastasis does not occur in the case of diphtheria. It reminds me rather of pyaemia.

It doesn't matter is a consolation. I believe it fits in as follows: The last part of the dream has yielded a content to the effect that the patient's sufferings are the result of a serious organic affection. I begin to suspect that by this I am only trying to shift the blame from myself. Psychic treatment cannot be held responsible for the continued presence of a diphtheritic affection. Now, indeed, I am distressed by the thought of having invented such a serious illness for Irma, for the sole purpose of exculpating myself. It seems so cruel. Accordingly, I need the assurance that the outcome will be benign, and it seems to me that I made a good choice when I put the words that consoled me into the mouth of Dr. M. But here I am placing myself in a position of superiority to the dream; a fact which needs explanation.

But why is this consolation so nonsensical?

Dysentery. Some sort of far-fetched theoretical notion that the toxins of disease might be eliminated through the intestines. Am I thereby trying to make fun of Dr. M's remarkable store of far- fetched explanations, his habit of conceiving curious pathological relations? Dysentery suggests something else. A few months ago I had in my care a young man who was suffering from remarkable intestinal troubles; a case which had been treated by other colleagues as one of "anaemia with malnutrition." I realized that it was a case