Only the practical aspects of this subject remain to be considered. A physician in general practice must not only treat his patient, but be in absolute control of the environing influence brought to bear upon him as well, in order to secure the best results.

The sick-room, especially in the small towns and rural districts, is often the meeting place for gossipers, who unconsciously exercise a great influence upon the patient, frequently preventing recovery in an otherwise curable disease.

To say nothing of the value of quiet, rest, and sleep, which are hindered by this procedure, the discussion of other cases of a similar kind that have terminated unfavorably and which had come within the experience of the visitor, or remarks relating to the procedures of another physician whose methods are different from your own, all exercise an unconscious influence that makes the patient nervous, excites fear, and proves destructive to that confidential relation which should exist between patient and physician.

The physician who is timid and allows this state of affairs to exist, to the detriment of his patient, is jeopardizing his professional reputation.

A loud-mouthed, self-assertive woman, who is the unconscious drummer for a competitor, is to be found in every locality. Seeing the harmful influence of such an individual upon a patient with a continued illness, the simple instruction to "admit no visitors" is usually sufficient; but the madam in question is not always repulsed so easily, as she unduly exaggerates the importance of her presence to the welfare of the sufferer, and enforces her entrance in spite of your injunction, which she considers does not apply to her.

My own custom has been, under such conditions, to give my patient or his family the choice between my services and those of this unfriendly visitor.

Useless antagonism, however, never pays upon any occasion, but, where the welfare of your patient is at stake, people will appreciate any stand that you take in his behalf. "Do what's right, come what may," is a safe rule under any and all circumstances, and the self-respecting physician should exercise the courage and self-assertiveness to face these problems and leave no stone unturned that might retard the recovery of his patients. The successful men in the medical profession are those who have the stamina to stand by their convictions and allow no intervening meddler to poison the environment of the sick-room.

In a large class of cases it is absolutely impossible to obtain successful results in private practice on account of our inability to secure the right environment, and here is where sanatorium and hospital facilities give the physician a wonderful advantage. In such places the environment is absolutely under his control and direction.

We should, however, as far as possible, overrule any factor in private practice that will in any way set up an undesirable mental attitude on the part of the patient in regard to his own condition, or that will create mental states that are injurious; for mental states influence metabolism, and encourage or retard all the normal physiological processes, and wonderfully help or woefully hinder the recovery of your patient.

In all classes of professional work there is a fine art in adapting one's self to whatever environment one may be thrown into, and in maintaining that prestige which the successful physician must never surrender. When to be dictatorial, when to coerce, when to be lenient and kind, and when even to soothe and palliate by your presence, and at the same time be in absolute control of the situation, are all important considerations in the successful practice of medicine.

People sometimes need to be aroused and lifted out of mental states which prove to be adverse to their recovery, and new ones substituted in their place; and this applies not only to the patient, but to every one coming into his or her presence. It is our duty, as physicians, to create an environment wherever our patients are to be found that will help to make them get well.

To illustrate, here is a patient sick with pneumonia, a disease that frightens the majority of people. On my second visit I find the family and others in attendance depressed and down-hearted, which, of course, renders the patient morbidly conscious of his condition. It is evident to me that I must alter that environment and re-establish hope in my patient, or the outlook is very grave. Do I send for a consultant? Not unless it is a baby less than two years old. What I do is to look every member of that family squarely in the face, and kindly but positively tell them, and also the patient, that he is going to get well. I have frequently emphasized that suggestion, and assured the patient that I had seen a hundred people ten times sicker than he with pneumonia, and every one of them recovered.

Then, getting close to him, with my hand on his head, I quietly and calmly assure him that I have never treated a pneumonia patient above two years old who did not get well, with the single exception of one old man who had a bilateral pleuropneumonia, with an enormous effusion, and I tell the truth.

I leave that home with a newly created helpful environment as a therapeutic resource, and under such conditions my patient is enabled to relax and to proceed with a consciousness that gives rise to mental states favorable to his recovery.

Do I depend alone upon the psychologic factors thus set in operation? No, I give my patient the benefit of every other possible therapeutic adjunct, from the application of a brick - heated to a red heat and placed in boiling water, and allowed to remain therein until all simmering ceases, wrapped in a woolen cloth, and the moist heat confined by a blanket - to the diseased lung, or a cornmeal and mustard poultice, renewed and applied hot every hour or two, or an ieebag in their stead, to the use of all other measures, medicinal, dietetic, and hygienic.

The hot brick, taken out of boiling water, has a weighty psychological significance aside from being an excellent vehicle to retain heat and moisture, which it gradually liberates to the great comfort of the sufferer. I do not hesitate to tell both my patient and his family that this hot brick relieves the pain, relaxes the patient all over, and causes the blood to circulate more freely to the periphery, and thus relieves the lung of its congestion and inflammation, reduces his temperature, enables him to sleep, and helps to make him a well man. I tell him in perfect candor and truthfulness that I have never known a patient who has used the hot brick heated to a white heat, and then taken out of boiling water and applied as indicated, to fail to recover.

Is the point clear! I am using that hot brick as a means of suggestion. Aside from the therapeutic value of heat and moisture, this harmless palliative resource is used to substitute sense impressions that are pleasant and comfortable in the place of existing ones that are distressing. This enables my oral suggestion, strongly and emphatically driven in upon his consciousness, to call myriads of living cells in his organism into helpful, useful, and active service.

In a crisis like this the entire picture of the disease is changed by the personality of the physician.