CHAPTER V.

THE PRACTICE OF PSYCHO-THERAPY-Continued.

THE PLACE OF SUGGESTION IN ROUTINE PRACTICE.

A physician's experience consists largely of a routine of duties that are made bearable by a sense of suffering mitigated and disorders healed. The doctor goes through the daily grind with a degree of cheerfulness and courage incomprehensible to the lay mind that may see only the melancholy and disagreeable features.

But the physician who loves his work is never satisfied with following exactly the same course and using exactly the same remedies day after day. To him

"Every day is a fresh beginning."

The experience of yesterday must be improved upon. He utilizes the lessons of past failures and gathers all his powers for a new and more promising attack on his obstinate foe. He is continually studying and planning.

Many innovations are suggested; many new remedies are offered. From among them he selects those which to him appear most promising. He finds himself too often worsted to be satisfied with his present equipment.

A means of cure that fits into the grooves of practice, that does not involve cumbersome apparatus and that can be utilized in the office and at the bedside, must be recognized as a desideratum.

This is precisely what suggestion offers.

The purpose of the author is to illustrate the value of suggestion, to show how it can be adapted to practice and made useful under the inconstant phases of morbidity.

USES OF SUGGESTION IN MEDICAL PRACTICE.

Modern practice has a distinct line of demarcation running through it and the two grand divisions are termed (1) Medicine and (2) Surgery.

Demeanor of Physician.

The physician commonly meets his patients either at his own office or at the bedside.

The very courtesy with which the patient is greeted has the power of a suggestion in it. There, of course, should be an intimation of personal poise and power in it which cannot fail to impress the patient and to pave the way for the curative suggestion that may follow. To the patient it also bespeaks interest; and since interest in turn implies sympathy, the sufferer hails it as a prophecy of help.

The Examination.

Means and methods of investigation play an important role that the charlatan has been quick to recognize and utilize. The average patient is impressed by an array of instruments and is mystified by their use in diagnosis. The stethoscope, the speculum, the ophthalmoscope and the microscope have a utility beyond, if not above, that for which they were designed.

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On the other hand, there is a suggestive power in a renunciation of all these, and an examination, the penetration of which appears to make all these helps unnecessary.

We find, upon reflection, that we are daily employing suggestive therapeutics in our routine practice, in most instances without having recognized its true character. In the speech, in the expression of countenance, in the bits of civility, or the lack of them, we are preparing the minds of our patients to receive as truth the more direct assurances that may be given.

Positive Diagnosis.

Then, when we have examined our patient, the manner of making known our conclusions carries much weight. A spirit of uncertainty chills and paralyzes. During the progress of an examination the patient is usually a keen and wistful observer. He realizes that on the conclusions derived from it much of his weal or woe probably depends. It is a wise physician who remembers these truths and who seeks by word and look to disclose the recognition of a chain of symptoms that mean much to the subject's discriminating vision.

At the conclusion of an examination only positive opinions carry much force. To express uncertainty in diagnosis or prognosis is always weakening. It is far better to be positive and err than to be wavering. You can be forgiven if wrong, for your very assurance will have done the patient a certain amount of good, even though it was only for the time. Clear notes are more pleasing than mere noises, for they are musical. It takes courage and confidence to be positive: anybody

can be negative. A positive conclusion, after a careful examination, smacks of skill and ability. Says Dr. Carpenter:

"That the confident expectation of a cure is the most potent means of bringing it about, doing that which no medical treatment can accomplish, may be affirmed as the generalized result of experiences of the most varied kind, extending through a long series of ages."

When succeeding to a case that has been dragging under the care of others until discouragement makes a cure under existing circumstances impossible, the patient must be infused with new courage if one hope to succeed. Without violating any ethical principles it is possible to do this. The chief study should be fixed upon the best manner of compassing one's purpose.

Diagnostic and prognostic conclusions that are jumped to will not be likely to impress; and it may not be wise to venture a positive opinion at the first visit. The lawyer prefers to reserve his opinion until he has had time to examine authorities and reason out a conclusion. If contraindications do not clearly forbid, the effect of withholding one's opinion may have a good effect.

The Prescription.

The prescription should be a finality. All the suggestions ought to lead up to it, so that at the last the patient's mind shall be riveted upon it. Indications of deliberate thought concerning the treatment have a wholesome effect. There is a period of evident uncertainty, during which the physician discloses an effort to differentiate; and then follows the final choice. The patient and friends are impressed by the mental action and interaction of

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the process the play of mental forces-as the physician weighs physical and mental indications. Having chosen the remedy, its action is assured by giving the patient definite indications of what you expect from it. The remedy itself should not be disclosed. The deeper the air of mystery the profounder the effect. It has been a common practice with certain eminently successful physicians to work up their patients' minds to a high degree of expectation and to create a vivid conception of the promised action of the remedy before administering it.

Such a practice is founded on psychic principles and is to be commended. Besides, the effect is far more likely to develop what we seek if the remedy be carefully chosen and the suggestion correspond to the pathogenetic action of the drug.

Do not forget that action is always more easily excited along lines of least resistance.

It is wise to enter into an exegesis to the patient of the expected action of the remedy, and after doing this the effect is intensified by being most explicit concerning the directions for taking it. I have found good effects from having each dose of the drug put into a glass of hot water and slowly sipped. Patients have reported that they formed a real liking for such a draught because of the marked effect observed.

Remedies given in any unusual way, as by hypodermic injection, are more pronounced in their action, as I have demonstrated a thousand times.

Precise directions with respect to the intervals between doses are of much value. I knew an old doctor, now dead, with little knowledge of