She did not move and seemed, inwardly, quiet; an unusually attractive little thing, and as strong as a heifer in appearance. But her face was flushed, she was breathing rapidly, and I realized that she had a high fever. She had magnificent blonde hair, in profusion.

As the doctor describes Mathilda, he makes particular note of both her attractiveness and her apparent “strength.” The symptoms of her illness are sandwiched between appreciative remarks regarding her physical appearance, and even the descriptions of her symptoms—“flushed” and “breathing rapidly”—are suggestive of physical exertion. The doctor seems uncomfortably aware of Mathilda’s physicality, and the figuring of the eventual victim of the doctor’s use of force as a beautiful young girl adds a sexual undertone to the story.

After all, I had already fallen in love with the savage brat, the parents were contemptible to me. In the ensuing struggle they grew more and more abject, crushed, exhausted while she surely rose to magnificent heights of insane fury of effort bred of her terror of me.

Over the course of their “struggle,” the doctor imagines himself as having fallen in love with Mathilda, and he seems to exult in her “terror” of him. The “magnificence” of her fury excites him, and he considers her a worthy opponent whom he must dominate. Mathilda’s obvious terror and the doctor’s sadistic enjoyment of the act reinforce the implications of the exam as a sort of rape.

The damned little brat must be protected against her own idiocy, one says to one’s self at such times. Others must be protected against her. It is a social necessity. And all these things are true. But a blind fury, a feeling of adult shame, bred of a longing for muscular release are the operatives.

The doctor, in a bid to recover his own sense of rationality, claims that his forcing of the exam is for Mathilda’s own protection. However, he seems to be attempting to justify this claim even to himself, suggesting that his actions have gone beyond what is considered reasonable. His frustration with Mathilda’s resistance is counterbalanced with his obvious enjoyment of the struggle she puts up. He is no longer acting in the interest of society or Mathilda herself, but is instead in single-minded pursuit of his goal: Mathilda is nothing to him but a clenched jaw that he must release in order to obtain his victory.

In a final unreasoning assault I overpowered the child’s neck and jaws. I forced the heavy silver spoon back of her teeth and down her throat till she gagged.

The reactions of both doctor and patient are stark and visceral. Mathilda, the weaker opponent, resents the superiority of the doctor, her stronger nemesis. The doctor, in turn, is overcome with a sense of shame, and his victory is tainted by the knowledge that he had to sacrifice his professional rationality to obtain it. Their battle is concluded, but at great cost to both parties, calling into question the role of consent in medical settings and the moral and psychological consequences of using force.