existence of such general infection by means of the dulness, which thus suggests a metastatic lesion. I believe, however, that just this kind of metastasis does not occur in the case of diphtheria. It rather recalls pyæmia.
It does not 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 pains of the patient are the result of a serious organic affection. I begin to suspect that with this I am only trying to shift the blame from myself. Psychic treatment cannot be held responsible for the continued presence of diphtheritic affection. But now, in turn, I am disturbed at inventing such serious suffering for Irma for the sole purpose of exculpating myself. It seems cruel. I need (accordingly) the assurance that the result will be happy, and it does not seem ill-advised that I should put the words of consolation into the mouth of Dr. M. But here I consider myself superior to the dream, a fact which needs explanation.
But why is this consolation so nonsensical?
Dysentery:
Some sort of far-fetched theoretical notion that pathological material may be removed through the intestines. Am I in this way trying to make fun of Dr. M.'s great store of far-fetched explanations, his habit of finding curious pathological relationships? Dysentery suggests something else. A few months ago I had in charge a young man suffering from remarkable pains during evacuation of the bowels, a case which colleagues had treated as "anæmia with malnutrition." I realised that it was a question of hysteria; I was unwilling to use my psychotherapy on him, and sent him off on a sea voyage. Now a few days before I had received a despairing letter from him from Egypt, saying that while there he had suffered a new attack, which the physician had declared to be dysentery. I suspect, indeed, that the diagnosis was only an error of my ignorant colleague, who allows hysteria to make a fool of him; but still I cannot avoid reproaching myself for putting the invalid in a position where he might contract an organic affection of the bowels in addition to his hysteria. Furthermore, dysentery sounds like diphtheria, a word which does not occur in the dream.
Indeed it must be that, with the consoling prognosis:
