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turned back at this point. But the author/dreamer does not . He
dramatizes himself as the anxious but undaunted hero who
perseveres in his quest. His scientific odyssey is a higher mission
even than curing the patient.
The dreamer's anxiety about not having taken his patient more
seriously (placing his scientific ambition before Irma's welfare)
opens onto a concern about his medical responsibility generally.
Irma's symptoms remind him of other cases in which he made the
wrong diagnosis or prescribed inappropriate medicines. He had
brought patients into unnecessary danger and even hastened the
death of several, including a personal friend. Freud observed, "It
seemed as if [in the dream] I had been collecting all the occasions
which I could bring up against myself as evidence of lack of medical
conscientiousness." The several occasions on which his patients had
died involved the use of inappropriate dosages of drugs, particularly
cocaine. This reminds him of his having been the first to recommend
the use of cocaine in eye surgery, and the fact that this recommenda–
tion had "brought serious reproaches down upon me." These, of
course, were the reproaches of his fellow physicians .
The dream provides many other details, however, that Freud
interprets as expressions of a compensatory desire to place his physi–
cian colleagues in embarrassing positions . According to Freud's
reading , the dream-text makes Otto responsible for Irma's enduring
symptoms. He had apparently given her an inappropriate injection
with an unclean syringe and thus caused the infection from which
she now suffered. This not only serves to assign responsibility to
Otto, but (Freud does not note this explicitly) also locates the incep–
tion of her infection in the period of her vacation, that is, after her
last visit to Freud-effectively exculpating Freud even from the
responsibility of failing to notice the organic basis of the symptoms.
Dr. M.-the enior colleague to whom the dreamer appeals in
the dream (and for whom Freud wrote out Irma's case history the
night before the dream)-is also ridiculed. In the dream Dr. M.
opines that Irma does in fact have an infection; according to the
dream interpretation, he thus excuses Freud and his method of treat–
ment. But Dr. M.' s statement that the infection did not matter,
since dysentery would supervene and eliminate the toxin, is nonsen–
sical. This, apparently, was an expression of the dreamer's wish to
mock Dr. M ., by depicting him as a fool.
Freud concludes his interpretation of the nonsensical utterance
of Dr. M. with the suggestion that the dreamer was deriding his
