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 dullness, 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 see,s 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 realised that it was a case of hysteria; I was unwilling to use my psychotherapy on him, and sent him off on a sea-voyage. Now a few days previously I had received a despairing letter from him; he wrote from Egypt, saying that he had had a fresh attack, which the doctor had declared to be dysentery. I suspect that the diagnosis is merely an error on the part of an ignorant colleague, who is allowing himself to be fooled by the hysteria; yet I cannot help reproaching myself for putting the invalid in a position where he might contract some organic affection of the bowels in addition to his hysteria. Furthermore, dysentery sounds not unlike diphtheria, a word which does not occur in the dream. To be continued...