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driacal ideas which later are much more difficult if not incapable of removal. Treatment from the very first should be a psychical one, and should be per- sisted in as long as or longer than the false ideas pre- vail. The anticipation of a trial with the hope of re- ward for supposed or real injuries received, must inevitably be a serious hindrance to the therapeutic measures undertaken. During the time of suspense it is more than likely that an attitude of mind maybe viagra 25mg generic established which no effort, however painstaking, can later alter. Hence the perfectly well-established fact that the bestowal of damages does not usually cure the disease, as the radical simulationists would have us believe. Striimpell's conclusions in the articles to which allusion has already been made are so moderate and fair that we give them in substance here: (1) The name "traumatic neurosis" in its common acceptation should no longer be used as the expression for a de- finite and special disease. (2) It is probable that a true " traumatic neurosis" exists in viagra 80 mg the sense of a chronic organic change resulting from a severe com- motio cerebri or commotio spinalis. Such cases are, however, rare. (3) The so-called objective symptoms of accident neuroses do not properly deserve the name. All such symptoms are dependent upon the psychical state of the patient. 14) The distinction between simulation, purposive exaggeration, and a true neurosis is easy theoretically. Practically the dif- ficulties in diagnosis are often great. The changing character of certain symptoms does not necessarily imply simulation. viagra 25mg generic (5) It is of the utmost practical importance, whenever possible, to prevent the onset of the neurosis. Palliation has a much more brilliant outcome than treatment when the condition is estab- lished. (6) In all cases it is the duty of the physician to bring it about that the patient shall again gradually accustom himself to work. Medical Record A Weekly Journal of Medicine and Surgery Vol. 49, No. 21. Whole No. 1333. New York, M AY 2 0> 1896. $5.00 Per Annum. Single Copies, 10c. (Original Articles. HOPEFUL OUTLOOK CONCERNING THE TREATMENT OF TRUE (GRAVE) OR PAN- CREATIC DIABETES. By TALBOT JONES, M.D., ST. FAUL, MINN., *!NG PHYSICIAN TO THE CITV AND COUNTY, ST. LUKE'S, AND BETHESDA HOSPITALS, ETC. After a prolonged and painstaking investigation of diabetes mellitus, viewed from various standpoints clinical, chemical, physiological one is apt to arise from the study with three impressions so strong as to overshadow all others: (1) That diabetes is not a univocal malady. The term or designation serves to viagra 80 mg express divers morbid forms, i.e., the cerebral, the dietetic, the hepatic, the hereditary, and the pancreatic; and many of these types are so dissimilar in etiology, symptomatology, and prognosis as to scarcely possess anything in com- mon except the presence of sugar in the urine. (2) That " lean" (grave J or true diabetes viagra 25mg generic mellitus is due, in a large percentage of cases, to degenerative or destructive lesions of the pancreas (sclerosis, atrophy, cysts, etc.), which prevent this gland from elaborating the glycolytic ferment, the presence of which in the blood determines the destruction of viagra 25mg generic sugar. (3) That in " grave" or true diabetes mellitus, where destructive lesions of the pancreas render it impossi- ble for that gland to further elaborate the glycolytic ferment whose presence in the blood determines the destruction of sugar, the recent experiments of Le'pine, Torup, Battistini, and others, in which they employed in the treatment of diabetes artificial ferments made from malt by Le'pine, viagra 80 mg made from the pancreas by To- rup and Battistini, are so promising that one is justified in hoping that agents have been found which will ameliorate the condition if not actually cure diabetes, in the same way that the enzyme or ferment elaborated by the thyroid viagra 25mg generic gland now cures myxcedema. With the first proposition, that the term or designa- tion diabetes viagra 25mg generic expresses divers morbid forms or types of the malady, there can be no serious differences of opinion; so viagra 80 mg this phase of the subject is viagra 25mg generic instantly dis- missed. The second proposition, that degenerative or destruc- tive lesions of the pancreas ab initio stand in a viagra 80 mg causal relation to " lean" (grave) or true diabetes mellitus in a large percentage of all cases, will not perhaps be readily accepted in the absence of incontrovertible evi- dence; and the burden of proof, of course, devolves on