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And now we have set our faces resolutely against the storms of another year. The year just past brought many a conflict against disease, with diagnosis as the field-glass and treatment as the weapon. In reviewing it, do you think you have given your patients the advantage of the best light the literature of the profession afforded you? Have you studied enough?

Make out now the line of your work for the new year. Let it be your ambition to become the most thoroughly read physician in your community. This is certainly a worthy ambition, since your patients are to reap the benefit of it as well as yourself. You have perhaps worn your favorite study threadbare. Look around and find that which has always been a dread to you-seemed a little bit beyond you. Take that up and master it. If you do only that which is easy, you will never do much that is worth doing. Do not always stay in

the valley because climbing is difficult. Remember that, if you climb but one hill, you have a more perfect view of all the surrounding

ones.

Suppose you try to make yourself a thorough diagnostician. Purchase all the reliable works you can find on the subject, and study and compare them. If your imagination is not vivid enough to enable you to localize all the symptoms laid down, purchase a manikin, or make a dummy on which you can sketch all outlines. Practice all analyses and examinations of pathological products you can obtain. In one year measure your progress, and you will be surprised.

Suppose you want to achieve some new results in treatment. The field is wide. Nearly the whole science of medicine is in a state of anxious uncertainty, waiting for the mastermind that shall organize order out of the chaos, and crystallize into lines of symmetry the valuable isolated facts that are now floating around. Some time in the future there will be a real science of medicine. See what you can do this year to help it along. Look up that epidemic that you and all your professional neighbors failed on last year. Concentrate yourself on that one thing until you have found its natural therapeutic antagonist.

When you have achieved or discovered something, communicate the fact to your neighbor, or your local medical society; and when by united effort you have verified its truth and value, give it in a joint communication to your favorite medical journal, whatever one that is.

To every one who is trying as best he can to be a True Physician we send a cordial New Year's Greeting.

*

Diabetic Gangrene

The elaborate paper read by Dr. William Hunt in the Philadelphia County Medical Society has revived a considerable interest in this

subject. We think the subject is a valuable one for the consideration of the physician, not so much on account of the number of cases which he is likely to encounter, as from the fact that it furnishes a very fine theme for physiological study and pathological research.

The immediate cause of sugar diabetes has long been a subject of much inquiry. The first and most natural opinion was that it was a disease of the kidneys. But when it was found that other secretions besides the urine, and even the blood itself, of diabetic persons, was charged, with sugar, it was acknowledged that the kidneys constituted only one of the avenues of escape of a pathological substance from the circulation; that instead of causing the disease they are affected by it, as are, indeed, the bladder and urethra, by the constant presence of the irritating substance, sugar. The next citadel of refuge to which theory was driven, and which it now occupies, was that it was the excessive activity of the liver in performing its glycogenic function. The diabetes caused by disease or injury involving the floor of the fourth ventricle of the brain is doubtless due to its stimulation of this glycogenic function of the liver.

What habits predispose to diabetes? Dr. Hunt says that alcohol crazes; that over-eating clogs; that it is the latter, much more than the former, that predisposes to diabetes. We think that in this he has in view only the effects of a "spree," over-looking the effects of a long continued use of moderate quantities of alcohol. Habits which exhaust or depress the nervous system are ranked among the predisposing factors; among which sexual excess is prominent. We question how much of this is cause, and how much coincident. Many facts are elicited from a sick man that would never have been known, if he had not happened to take sick.

What measures are likely to prove curative in diabetes? One by one, as in all incurable diseases, the hosts of specifics have all failed. Martineau's diabetic drink, giving a combination of carbonate of lithium and arseniate of sodium is still on trial. We were once told by an electrical specialist that he could cure diabetes mellitus, but when he began telling us that he

directed his treatment to the kidneys we did not solicit further information. Still, we believe that if electrical treatment be skillfully directed toward the liver and the nervous system, especially the sympathetic nerve, beneficial results would be obtained.

Why should boils, carbuncles and gangrene be associated with diabetes? Probably there are two important factors entering into the cause; the poverty of the starving tissues, rendering them unable to resist the invasion of micro-organisms, and the sugar saturated condition of the blood, forming an excellent culture-fluid for these micro-organisms.

The development of pulmonary degeneration in the course of diabetes seems to admit of the same explanation.

Reading With a Preceptor.

We fear that this excellent, old-fashioned custom is destined to become unpopular, since Prof. Flint's statement that those students who spend the extra year attending lectures pass

the best examination. But the examination is not the grand end and aim of all medical study, and a sensible, clear-headed preceptor can do much to start a young man on the right course towards successful medical practice.

Where can he learn so well the practical professional duties of the sick room? Where can he be so thoroughly initiated into the mysteries of diagnosis? Where, in fact, can he see so well the practical side of a physician's life as while riding with a preceptor, whether much reading be done or not? We hope never to see this custom given up. However, we should prefer to see it follow rather than precede a course of college study. It is an excellent way of employing the vacation between terms, and we should like to see young men come out of college with their diploma modest enough to feel that they need a year or two of apprenticeship to some experienced practitioner.

Preliminary Training.

Did it ever occur to you as forcibly as it does now, when you are reviewing your own past life, how important it is that the boy who is destined to the study of medicine should begin his scientific training as young as possible. We hardly have time to become really skillful till we are called upon to hand in our commission to the Great Healer. What a pity that a really good physician cannot become immortal, or transfer his skill to his successor !

Let us see. Before one begins his own practice, he should have had one or two years' practice with an older physician; but before that he should have taken a thorough medical college course. Before he entered medical college, he should have been well trained in zoology, biology and comparative anatomy. This, of course, was preceded by physics, chemistry and botany. So, you see, the boy must begin young, so that these sciences, with their facts and valuable mental training, can lead him from one step to another, until he becomes the scientific, trained physician.

Now we hear some one remind us that we have left out the dead languages. Yes, and we wish we could leave them out altogether in the necessary preliminary training for a physician; but, unfortunately, we cannot. They are necessary to enable the student to crack the useless shells of petrified pedantry that have been deposited around the kernels of truth. We heartily wish that the whole science of medicine had not a single Latin or Greek word in it. True science would be better off for it.

In a short summary of the treatment of gonorrhea last month, we neglected to mention the benefit derived from the application of ointment of cocaine, morphine and atropine, with lanoline as a base, under the prepuce. Any one who will try this will be pleased with it as an aid in the treatment of these cases.

The excruciating pain of uterine cancer is sometimes wonderfully relieved by the administration of quinine. This was asserted by Verneuil many years ago, and has since been rerepeatedly confirmed.

Organic Headache.

Intense persistent headache and pain at one fixed point or at one side of the head; repeated cerebral vomiting; convulsive movements with or without paralysis; affections of the sight and other organs of sense; and disturbance of intellect, without very appreciable deterioration of the general bodily health; these symptoms, combined, point almost conclusively to the existence of a tumor on or in the brain. Organic headaches are distinguished from the less serious varieties by the continuance of the pain, and its localization, with occasional paroxysms of agony, caused by incroachment of an increasing tumor on adjacent sensory nerves. Functional headaches are less persistent and severe. When the pain is referred to the forehead, it is frequently due to abdominal affections; when at the top of the head, the brain is probably disturbed; and pain at the back part is often, too, attributable to circulating disorder and anemia. The free administration of iodide of potassium or sodium is frequently very beneficial in ogranic headache, whether it be of syhpilitic origin or not, and iodides seem especially useful in cerebral tumors, and in meningitis. Subcutaneous injections of morphia relieve the agonizing pain, but should not be pushed to the point of insensibility. Great caution is always necessary. Rheumatic, neuralgic, congestive, uremic, and other headaches are more easily diagnosed, and are much more amenable to prompt and suitable remedies.

Yawning.

Usually, when we yawn or gape, it is because we are sleepy or weary. The nervous impulses that govern our movements of respiration are enfeebled; there is a lull in our pulmonary circulation; we get tired of breathing, and hand the business over to the involuntary nervous system (for breathing is a voluntary as well as an involuntary act). The involuntary nerves at once mechanically set to work to fill up the gap caused by our involuntary pause; a long, deep inspiration and expiration ensue; the respiratory muscles of the face join in; the mouth is opened wide, under the directions of