tentative diabetic law: "It is rare for diabetes to develop in an individual above the age of 20 years who is habitually underweight, and when it does so develop the case will usually be found to be either extremely severe, extremely mild, or associated with a marked hereditary taint or degenerative stigmas."

A particularly valuable part of his article lies in the consideration of obesity as a cause in connection with other factors often deemed of importance in the etiology of the disease. He raises many questions of relative causality in which one must acknowledge preponderance of evidence in favor of frank fatness or overweight as of primary importance.

His experience and studies point out effectively that overweight constitutes a true disposition to diabetes. Accepting this as true, the prevention of diabetes must concern itself with efforts to keep the waistline of the average dimension. Overeating is to be considered as a diabetic hazard, and its importance should be recognized by physicians who, in turn, should emphasize the fact to patients who do not understand that fatness possesses more than mechanical disabilities. A general reduction in the number of overweights in the country would lessen decidedly the incidence of diabetes. A second factor in the prevention of diabetes depends upon the early recognition of sugar in the urine. Frequent or routine urinary examinations are indispensable for the prompt detection of many forms of disease whose early evidence is found primarily in the urine. The accidental discovery of Bright's disease or diabetes, and the frequency and increase of these diseases make it imperative for self-protection that examination of the urine become an annual affair and constitute a part of a routine medical examination.

In the prevention of diabetes, however, especial stress must be placed upon careful eating and drinking with a view to limiting the overweight of the body. For diagnostic purposes the frequent examination of urine is imperative particularly among those who, despite their efforts, roll up and amass superfluous fat. Above the age of forty, overweight, especially over 10 per cent., must be regarded as a distinct liability regardless of its alleged advantages during youth. Every fat person is not a candidate for diabetes, but diabetes finds its victims particularly in the overweight group of the community. The efforts at prevention, therefore, must be particularly centered upon this part of the population, as the most likely potential sufferers from diabetes mellitus.

THE COUNTRY DOCTOR.

You knew him by his muddy shoes,
His clothes of last year's style;
The weary look about him,

The sweetness of his smile.

You knew him when the school let out,
Seeing the children flock

To get his cheery greeting,

And shout their "Hello, Doc!"

You knew him, too, at midnight,
When he rode thru' sleet and rain,
Wading thru' mud and water,
To reach your bed of pain.

You knew in the dawning,

Still sitting by your bed
In damp clothes-Oh, so patient,
His hand upon your head.

He was never in a hurry,

When kindly word could cheer;
The little jokes he saved for you
Are memories, now, dear.

He didn't fall in Flanders Field,
Where crimson poppies grew;
He wore himself out, waiting

On folks like me and you.

He has no cross in Flanders Field,
'Mid poppies' crimson hue;
His cross is in the aching hearts
Of folks like me and you.

-American Journal of Clinical
Medicine, Sept., 1920.

Repopulating France: Production and Salvage. The French Government appears to have learned at last that there are two ways of building up its diminished population, by production and by salvage, by encouraging indiscriminate raising of large families and by a systematic effort to save the lives of those children already born and doomed to die in their infancy thru lack of proper care. Since the Armistice, the French authorities have issued frequent and almost hysterical appeals to the heads of families, have offered prizes and premiums for the greatest number of children, have done everything in their power to increase the population by the encouragement of production. The mischief of this short-sighted policy has been pointed out more than once in these columns. But now some of the more intelligent leaders of the movement have discovered that there is a more fertile field, a more logical course for their efforts, that tho the war made serious inroads on the population, there is a permanent and graver factor that is threatening the country-infant mortality. A high medical authority has come out with the statement that France can add 100,000 to its population annually if infant mortality were cut down. And he adds that the task is not a difficult one. death rate of infants within their first year in France hovers between 15 per cent. and 20 per cent. Among illegitimate children and those abandoned by their parents, the rate is as high as 45 per cent. During the war France lost in all 1,700,000 men, but since 1914 the population of France has been reduced by 4,000,000. The war is, therefore, not the chief factor in depopulation. The high death rate, particularly among children, is responsible for the bulk of the loss. The result is that the more intelligent element among the public is beginning to ask itself why it should raise

The

large families if their lives are not assured by the utmost efforts on the part of the government which demands them.

The Ministry of Health, in response to this new tendency, has opened a large maternity hospital and is providing funds for another. The existing laws giving allowances and special privileges to expectant and convalescent mothers are to be altered so as to give pregnant wives a longer period of preparation and a longer period of rest after childbirth. Efforts are also to be made to surround the new-born infants with every possible protection against disease and death. In short, a very vigorous effort is to be made to increase the population of France thru salvage rather than thru production. Such a course is highly commendable. It is more intelligent than the visionless exhortation to multiply like the sands of the ocean. That was well enough in biblical days, but we are living in a different age and under different conditions today-an age and conditions which call for more far-sighted methods.

American Aid Saves 6,000,000 Children. -It is interesting to add that the principle of salvage, in preference to production, was very early recognized by America. When the history of Europe during the past two years comes to be written, it will be seen that America contributed more to the repopulation of Europe than the individual countries themselves. It was stated recently that the work of the American Red Cross and the American Relief Administration in Europe saved the lives of 6,000000 children. Their relief efforts alone were almost sufficient to balance the entire loss of life during the war. While the European countries, like France, were making hysterical appeals to their nationals to

produce larger and larger families, the Americans were acting on the principle that saving the life of a child already born was a more definite and certain contribution to the population than exposing a new being to the hazards of existence. The inconsistency of an appeal by governments for more children in the same breath as an appeal for food for starving infants was pointed out here before. There is not enough food in Europe to supply the needs of the children already born, and were it not for American aid the fatalities among these would be appalling.

Fortunately, the Americans acted on a more far-sighted principle: increasing the population by restoring the balance of births over deaths, not by increasing births, but by cutting down deaths. The high infant mortality was the most vulnerable point in Europe's defense against continued depopulation. Feeding stations were opened in the most stricken areas in Europe, millions of children being fed there. In Vienna alone, the American Red Cross has more than fifty such stations. Children's clinics were also established and the health of the youngsters was carefully nursed. Sanitary methods were introduced in homes and in schools and instructors were sent to teach mothers how to care for their young. In Czecho-Slovakia the Junior Red Cross has introduced a "Health Game" which is being played by more than 70,000 school children in four of the largest cities in the young republic. The "toys" employed in this game are soap, tooth brushes, tooth paste and sanitary articles of a similar na

The laws of hygiene are being taught by play methods and parents as well as children have been won to a régime which has resulted in better health and in many cases even an increase in weight in the undernourished youngsters. Beginning with the year 1921, it is the purpose of the American Red Cross to concentrate almost exclusively on the needs of the children of Europe, on the theory that after two years of assistance the adults ought to be in a position to look after themselves. Thus, if any of the European countries show an increase in population in the near future. they will have to thank not themselves, but American appreciation of the value of human salvage as the most effective means of repopulation.

Tributes to Sir Wm. Osler

The First Anniversary of Sir William Osler's Death.-To those who knew Sir William Osler intimately, it seems almost impossible to realize that he is dead, and that a whole year has passed since he was taken away. This is due to the remarkable personality possessed by Sir William Osler, and few men in our day have been able to impress themselves on their friends and acquaintances as this great physician did. While this sense of the unreality of his death is perhaps to be expected on the part of those in this country and Canada, who were not in daily personal contact with Sir William Osler, we learn that even those in England who enjoyed actual association with him every day, and had this association suddenly cut off by his death, still have the feeling that he is about to join themthat he still lives.

And so a year after his death, we believe that the medical world has not yet come to realize the loss that it has sustained. Gradually the actual fact will become evident, and then, but not until then, will the medical profession begin to grasp and fully appreciate the greatness of Osler. Today our thoughts are too full of the lovable qualities of the man, and the pleasures of his friendship. But tomorrow we will recognize the imprint he has made on modern medicine. Then will we understand the debt we owe to Osler, the foremost clinician and medical teacher of his day. Then will we know that Osler can never die!

It gives us great pleasure to print the splendid, comprehensive article by Dr. S. Adolphus Knopf in this issue, together with the following brief tributes by a few others who also knew Sir William Osler intimately. We consider it a privilege to thus help in commemorating the first anniversary of his death, and trust that this issue will serve in some degree not only to honor a great physician but to carry to the American medical profession the inspiration of Sir William Osler's life and work.

Impressions of Osler After a Year.

After all that has been written about Osler, this remains, no man in our generation has had so large an influence, and this is mostly due not to laboratories, research methods or to discoveries, but to personal qualities. Osler was ever an idealist in his work, far above all mere material standards.

His gifts as a teacher were so unusual that every student and even the casual visitor, who has seen him at the bedside carries a vivid picture as tho he stood by him but yesterday, and saw him half-inclined towards the patient and quizzically half-turning towards his hearers and summing up the situation in a few explosive, terse, epigrammatic sentences destined to remain indelibly fixed in the memories of his hearers. Such surely is the supreme quality of a great teacher.

Osler's life was poured out in the interests of medicine and all his other activities were tributary to this end. In advancing scientific medicine with a few chosen spirits of the age he overthrew the age-long superstition of polypharmacy which opposed progress like a Chinese wall.

High spiritual qualities governed his relations to students and to friends, and to each he gave some real bit of himself which gripped everyone who came into close contact with him; an invaluable adjuvant was his remarkable memory of men and their

names.

Great energy, supreme devotion to a great cause, and unremitting toil for the highest ideals in a humane profession, embodied in a bizarre personality saturated with a love of his fellows produced unparalleled results. These Oslerian qualities are in some measure attainable by all who seek the highest standards in our profession, and without them there can be no true success.

HOWARD A. KELLY.

"Always An Optimist."

A little more than a year has passed since the death of Sir William Osler and still tributes to his memory continue to be written and his various wise sayings quoted.

Osler was a great personality and impressed his mark on every community and country in which he labored. I first knew him in 1870 when he came as a student from Toronto to McGill. At that time he was an enthusiastic, energetic and forceful young man. Lectures and note-taking he rather despised and spent most of his time in the wards of the hospital and the post-mortem room. At that time he was one of the few students who possessed a microscope and he used it continually.

Altho Osler did not take a very high degree, his thesis on pathologic anatomy was specially commended and some of the specimens with which it was illustrated are still in the Medical Museum of McGill University.

After two years abroad he was appointed Professor of the Institutes of Medicine at his Alma Mater at the age of 25. He soon became a power in the Medical Faculty, introduced reforms, new methods of teaching and new men. He took charge of the smallpox hospital and performed all the post mortems, both public and private. In 1878 he was elected Physician to the Montreal General Hospital and he, with the late Professor George Ross, introduced the methods of clinical teaching by which he became so famous while at Johns Hopkins.

He revived the Medico-Chirurgical Society of the city, which was very decrepit, and brought opposing factions together so that they worked amicably; founded the Students Medical Society and held weekly demonstrations on morbid anatomy, which all the younger medical practitioners attended. He also started a laboratory of practical physiology and edited Volume 1 of the Montreal General Hospital Reports.

At the end of ten years he left us for Philadelphia where he remained five years and was as much a leader at the University of Pennsylvania as at McGill.

In 1889 he went to Johns Hopkins Hospital and with Welch and Kelly and Halsted organized the New Medical School.

As a clinical teacher, with a sound training in Practical Pathology, Osler made a great reputation and sent his students thruout the United States to carry on his methods of instruction. There is no doubt he was chiefly instrumental in reforming or rather establishing better methods of clinical teaching in the United States.

In 1905 Osler was called to Oxford as Regius Professor of Medicine and remained there until his death in 1919. In Oxford, and in England also Osler soon became power for good. He reformed the Medical School of Oxford and soon became prominent in medical affairs thruout Great Britain. He was active in making the Bodelein library a useful institution and was an active member of the College of Physicians.

Osler had a great capacity for making friends and altho he made many new ones he never forgot his old ones. He was also a very stimulating and suggestive teacher and colleague and had the power of evoking the love of his students and fellow-workers. Osler was a man of wide reading as any one can see who reads his essays. He has written much and written well. Aequinimitas and The Alabama Student and other Biographical Essays should be in the hands. of every literary and medical man. He had high ideals and at the dinner given him at the Waldorf in New York by the profession, said: "I have three personal ideals, one, to do the day's work and not bother about tomorrow; the second ideal has been to act the Golden Rule as far as in me lay, towards my professional brethren and towards the patients committed to my care; and the third has been to cultivate such a spirit of equanimity as would enable me to bear success with humility, the affection of my friends with pride and to be ready when the day of sorrow and grief comes to meet it with courage befitting a man."

Sir William Osler received many honors, was a Fellow of the Royal Society of London, Fellow of the Royal College of Physicians, London, had any number of LL.D.'s and D.C.L.'s and was in 1911 made a Baronet by the King. He never forgot his Alma Mater and was always interested in its welfare. He gave much to it while living and bequeathed to the Medical Faculty of McGill his wonderful library of old medical works and also directed that his ashes should repose in a suitable place near his beloved books. Osler had a keen sense of humor and was fond of practical jokes, was a cheering and stimulating companion and was always an optimist.

FRANCIS J. SHEPHERD.

A Genius for Friendship.

Of course everyone who came in contact with Osler was made to feel that Osler had a special interest in him. No one that I have ever met impressed me so much with his power to give such special attention to every one of his acquaintances as made him. feel that he was a particular friend. Nearly twenty years ago I asked to be allowed to dedicate my book Makers of Modern Medicine to him, and he was as gracious about it as if I had been one of his students, or a life-long friend. The article in it on the Irish School of Medicine was practically due to him. He was very much interested in Graves and Stokes and Corrigan, and so one summer when I was going over to Ireland he gave me a sheaf of introductions to men prominent in the profession in Dublin, and so I had the opportunity to see the conditions under which the Irish School of Medicine had accomplished its great work. As he handed the bundle of letters to me he said, "Of course this means that you must come down and read a paper on this subject at the Medical History Club of the Johns Hopkins Hospital" and of course I said I would, just as pleased as I could be over the invitation.

I wondered, when he went over to England, whether he would not find it rather difficult to keep up this wonderful attitude. toward all the world. I feared that the proverbial coldness of our British cousins would prove glacializing even for Osler's geniality. It did not. I have heard British doctors, who had never met him until he went to England, ardent in his praise.

While others talk about his magnificent clinical powers of observation, his ability as a teacher, and his magnificent intellectual talents and broad interests, I feel that the one thing above all for which Osler should be remembered was his veritable genius for friendliness. He accomplished an endless amount of good by it, giving incentive to younger men to accomplish good work, but above all to be broad in their interests, forward looking in their work as young men, postponing material success for a little while in order that, as older men, they might reap ever so much more satisfaction from life and often secure even better material results than would be the case if they hastened into money making at once.