One

In light of Freud's letter to Fliess concerning the unsuccessful nasal surgery of Emma Eckstein, additional interpretation can be offered to Freud's dream of "Irma's Injection" concerning various sexual issues and the issue of pregnancy. The theme of misdiagnosed infection in "Irma's Injection" has already been discussed, citing Emma's surgery and Martha's undesired pregnancy ("pale and puffy") as evidence of this. Throughout Freud's letter to Fliess four months earlier, the imagery of the discharge, bleeding, and irrigation all can be related to a woman's period. It is the discontinuation of the bleeding that represents Martha's pregnant state. It also seems as though the idea of abortion comes into play. Upon the removal fo the gauze, blood flow is restored, and the pulse has deadened. When a woman's period is restored, no fetus can live. Freud becomes sick at the sight of the patient---feelings of remorse. However, he drinks water in an attempt to regain his composure. Water is a sign of life which also surrounds and nurtures a baby. Thus, the preoccupation of Martha's pregnancy prevails in Freud's mind.

The concept of reproach interpreted by Freud in his dream is also reinforced in his letter to Fliess. Freud slightly reproaches Rosanes for not having recognized the blockage and consequences of removing it. However, the person truly responsible, Fliess, is consoled by Freud, partly because Freud is responsible for recommending the surgery. Freud is attempting to transfer the blame onto someone other than himself, evident in his dream of "Irma's Injection" where his colleagues become sources of ridicule and blame.

Two

Freud's famous dream of "Irma's Injection" is rich with meaning from what Freud was dealing with at the time of the dream. At the time of the dream Freud was struggling to convince himself that Wilhelm Fliess was a legitimate doctor, for Fliess was Freud's friend and confidante. Approximately four months prior to the dream, Freud witnessed a half a meter of gauze pulled from Emma Eckstein, a patient of Freud's. The gauze had been left there by Fliess when Fliess operated on her nose in order to try to cure her hysteria. The dream of "Irma's Injection" is filled with Freud's concerns for Fliess's legitimacy. The character of Irma represents Emma Eckstein, for Irma is described as "pale and puffy." In Freud's letter to Fliess he describes Emma as "pale" and "swollen." In the dream Freud then says to Irma "If you still get pains, its really only your fault." He is trying to place the blame on Emma for getting the infection in order to take the blame away from Fliess. This is a wish fulfillment for Freud. Next, Irma says that she is choking which is linked to breathing which is linked to the nose. When Freud looks down her throat, Irma resists as if she has artificial dentures. She is resisting as if something artificial or fake is in her,for Freud is concerned that Fleiss has performed fake surgery and left the gauze in her nose. Irma's throat then changes into a nose. The nose is infected with a big white patch which represents the gauze and scabs which represent the blood. A Dr. M enters the dream and undoubtedly represents Fliess and Freud's anxieties about his legitimacy. Freud says that Dr. M represents Dr. Breuer who Freud has lost his affection for. By linking Fliess to Breuer he is displaying his unconscious loss of respect for Fliess as a physician. Dr. M gives absurd advice at the end of the dream as to how to cure the infection which further undercuts Fliess. The dream, is an anxiety dream, for Freud is struggling with convincing himself that Fliess is a legitimate physician while unconsciously he knows that Fliess is not respectable.

Three

I feel that perhaps I have not been entirely honest in my interpretation up to this point. Upon further analysis, it is clear that much of the latent content of the dream points to thoughts of my dear friend Fleiss, and the terribly unfortunate case of Emma Eckstein. Indeed, from the very start of the dream there is the image of Irma's mouth as nasal cavity, thereby calling to mind Fleiss and his theory of the nose and female genitalia. I am furthermore prompted to think of the nature of the surgery he performed on Emma, and the gauze that remained in her nasal passage; as Irma said to me in the dream, "if you only knew what pains I've got now in my throat and stomach and abdomen--it's choking me." Her throat and the choking sensation she complained of in the dream I now relate to Emma, and the blockage of her nostril. As M. said, "there is no doubt of the infection;" this I also associate, (as well as Irma's pale and puffy appearance) in part with Emma's state of affairs, as the delayed removal of the gauze would certainly be cause for infection.

The connection to my friend Fleiss continues with the image of trimethylamin, as I have previously discussed. Yet I feel that Otto serves as a possible composite character for Fleiss as well. The necessary leap here is from the "injection" that Otto gave Irma, to the surgery Fleiss performed. I find it important to note my sentiments that reveal themselves regarding this surgery. As I noted in my dream, "injections of that sort ought not to be made so thoughtlessly." Thus I am at once criticizing Fleiss and the careless nature of his mistake, and yet exculpating both Fleiss and myself when I reproached Irma by saying if you still get pains, it's really only your fault.

Four

"She looked pale and puffy."
-This seems to be an act of substitution regarding my past patients. The most most striking resembalance seems, however relates the palid demeanor of one patient of my colligue and friend Wilhelm Fliess, by name Matilda.

"What I saw in her throat: a white patch and turbinal bones with scabs on them."
-The examination of turbinal bones relates not to any recent examination of my own patients, but, again, that of Matilda, Fliess's own. I can connect this image only with the aforementioned infection of the nasal passages in Matilda, brought on by Fliess's faulty removal of the idoform gauze used to treat her. The "white patches" suggest the prescence of the growing infection; the scabs can only be from the previous opperation. It seems as though I were trying, in examining the patient before her infection reached an advanced state, to avert the blow to my dear friend's reputation through this mishap.

"I at once called in Dr. M and he repeated the examination."
-Since I had been critical of M on previous occasions, this appeal presented here may reflect my own desire to shift the blame from Fliess to him. It is as though I were attempting to connect him, by implication of his examination, to the future state of the patient (known only to me).

"I was alarmed that I had missed an organic illness."
-This, as well as the previous statement within my dream, attest to my own sense of responsibility taken in the case of Matilda, and my desire to avoid it and preserve my reputation. This situation, too represents my sentiments regardind the Matilda case, of being beyond my psychoanalytic skill (freeing me from personal blame), and, being and accident of chance, bayond the responsibility of Fliess.

"Dr. M said, "It's only an infection, but no matter. Dysentary will supervene and the toxin will be eliminated.""
-The guilt aroused at having missed the organic illness seems to resolve itself, again, through transferal to the responsibility of M. "No matter" seems to be, paradoxically, a consolation, trying to alleviate the enormity of the situation, but also a statement attesting to the futility of Matilda's situation; "No matter" can be thought of as meaning "nothing to be done." The nonsensical nature of the response reveals my own contempt for Dr. M's judgement of my practice; I discredit him through his apparently erronious conclusions. The focus on elimination may have arise out of the anxiety of the realization that the gauze remained within Matilda's nasal cavaties for far too long; my wish for removal certainly springs from this frustration.

Actualy, Mathilde was Freud's daughter (named for Breuer's wife), of whose life-threatening diptheria the dream reminded him.