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impression that it consisted of the proper gluten flour as sup-plied by the approved gluten food makers in London.Whatever view of the nature of diabetes is held-and there

is by no means unanimity on the point, -there can be no ques-tion at all as to the desirability of reducing the amount ofcarbohydrate food in the diabetic to the fullest possibleextent. The doctrine, for instance, of faulty action of theliver, that of hyperglycogenesis and the like, is necessarilybound up with the amount of glycogen-forming materialthat finds its way into the portal circulation. Or if, as Dr.

Pavy holds, the essence of the disease is due to defectiveassimilation of the carbo-hydrate element of food, the argu-ment for restriction of diet is even more obvious. for on thisdoctrine the carbo-hydrate principles of food. instead of

passing in their proper direction towards utilisation or con-

sumpt,ion and disappearance in the system, in diabetes,through defect of their chemical transformation, simplyrun--through the influence of ferments with which theycome in contact-into sugar, which, reaching the generalcirculation, will pass off by osmosis into the urine. It doesnot signify in the slightest degree what carbo-hydrate is

given, the result will be the same. In giving carbo-hydratefood in this disease, not only is the food perfectly useless tothe patient because it cannot be properly assimilated, but it

produces an absolutely pernicious effect by reaching thegeneral circulation and inducing at once an abnormal con-dition. In diabetes the blood in the general circulation con-tains sugar quite in proportion to the amount of the carbo-hydrate which has been ingested with the food and as thefood of the general circulation becomes charged with sugar,so in proportion will be the deviation from the normal state,and in proportion to the deviation from the natural state ofthe food, so will be the failure in health and the symptomsof the disease. Of course this is true only up to a certainpoint, for under some conditions the dietetic restrictions areneither well borne nor efficient, and the physician may feelcompelled to remove them in the interest of his patient ; butsuch cases are exceptional.

THE REPORT OF THE PROCEEDINGS OFTHE ASSOCIATION OF FELLOWS OFTHE ROYAL COLLEGE OF SURGEONS

OF ENGLAND.

A FURTHER ACCOUNT of the Proceedings of the Associa-tion nf Fellows of the Royal College of Surgeons of Englandfrom March, 1890, to June, 1892, " has, as we stated last week,been issued and sent to the Fellows of the College. Duringthe period specified the Committee of the Association has beenactively engaged in carrying out the policy approved by theAssociation for advancing the interests of the Fellows of theCollege. ’4 The Committee has held twelve meetings, therehave been three general meetings of the Association,eight or nine meetings of subcommittees appointed forvarious purposes, and a deputation from the Association hasheld ;i conference with a committee of the Council of theColle;. e of Surgeons with very satisfactory results." Themain efforts of the Committee have been concentratedon eii(Itetvouring to secure for the Fellows the privilege ofmeeting within the walls of the College and of being convenedseparately from the Members to deliberate upon the affairs ofthe College. The proposals of the Committee expressed througha deputation were at first met with the statement that thesolicitor of the College had given it as his opinion that underthe existing charters this course of action would be illegal,but in the end the Council of the College submitted thematter to the Attorney-General and Mr. John R. Paget. The

opinion given, which was dated Dec. 22nd, 1890, did notsustain that of the solicitor of the College, the first sentence

affirming that no legal objection exists which prevents theCouncil of the College granting the use of the College pre-mises to either the Fellows or the Members for a meeting forpurely consultative purposes." "In view, however, "of thepending litigation before Air. Justice Stirling, itwas consideredunwise "to permit a meeting of any section of the Collegeexcept in the cases expressly provided by the Charter and By-laws. " In accordance with this opinion, the Council of theCollege resolved not to "take any action in reference to sepa-late meetings of Fellows until the decision of the action Steele

v. Savory." " More than a year elapsed before the action was

settled in favour of the defendants and soon afterwards theCouncil appointed a committee to consider what further

advantages could be extended to the Fellows. The report of £the Committee, which was adopted by the Council, recom-mended that meetings of Fellows apart from the Membersshould be held when the Council deemed it desirable, withor without a requisition from the Fellows and the Fellowshave now been invited to meet the Council at 5 P.M. on the

day of the ensuing election on July 7th. This result is inlarge part due to the Committee of the Association ofFellows. On more than one occasion it has been necessary forthe Committee to formulate and to bring forward at generalmeetings resolutions expressing regret that the Council ofthe College had not consulted the Fellows before takingaction, as, for instance, in regard to the scheme for thereconstitution of the University of London and the schemefor the fulfilment of the five years’ curriculum. The

proposals of the Committee of the Association for simplifyingand improving the method of distribution and reception ofvoting papers resulted, as opinion was equally divided in theCouncil of the College, in the appointment of a committee to

i consider the existing rules. The necessity for altering and, amending the by-laws, in order to effect the object: in view, turned the scale against the proposals, but

probably at no distant date these proposals may be

accepted and the by-laws altered. The request of theCommittee of the Association that the Council would grantto the Fellows a common room in the College has resulted inthe adoption by the Council of a resolution to the effect" That the room adjoining the secretary’s office now forminga part of the library not used by readers be furnished as acommon room for the use of the Fellows and Members of the

College. "

Legal opinion was adverse to the appropriationof a room in the College for the exclusive use of a section ofthe Members of the College. Into the other subjects dealtwith in the report it is not necessary to enter. The cardinalfact remains that owing, we may hope, to our own repeatedrepresentations and to the perseverance of the Committeeof the Association steps have been taken by the Councilof the College to establish more satisfactory and inti-mate relations between the Fellows of the College and theCouncil. A new departure has been made and it rests withthe Fellows of the College generally to improve their posi-tion by united action at the meetings of Fellows which willsoon be inaugurated. A large accession of numbers to theranks of the Association and the success of its candidates atthe election at the College would speedily be followed byfurther concessions, which would place the Fellows of theRoyal College of Surgeons in a similar position to that en.joyed by the Fellows in the other professional colleges irthe United Kingdom.

IMPROVED FACILITIES FOR CONTINENTAL.TRAVELLING.

THE DTEPPE ROUTE.

THE increasing number of travellers between England and,the Continent renders any improvement that can be effected)in the Channel service a question of considerable importance.Progress has been achieved by leaps and bounds. For in-

stance, if we take the three main routes-Dover and Calais,Boulogne and Folkestone, Newhaven and Dieppe-we find<,

that the number of passengers between England and theContinent by these three routes amounted to 347,923 in 1884.During the year of the great Paris Exhibition the number of’passengers was nearly double and attained the extraordinaryhigh figure of 642,465 for the three routes. In 180 there-were 450,779 and in 1891454,538 passengers. These passengers-travelled during the Exhibition year in the proportion of53’90 per cent. by the Calais route, 17’42 per cent. by the-Boulogne route and 28’68 per cent. by the Dieppe route.This latter route found special favour during the Exhibitionyear and its percentage rose much above the normal. In the-previous year (1888) only 17’54 per cent. of passengers wentby Dieppe. Those who, for special and temporary reasons,.went by Dieppe during the Exhibition year were evidently-favourablyimpressed, for thepercentage of passengers goingby-that route has steadily increased ever since. Thus the percen--tage of passengers by Dieppe was equal to 21-55 in 1890 and)

46

23 ’03 in 1891. The statistics of continental travel clearly estab-lish that the Calais and Dieppe routes are becoming more andmore appreciated every year. The Calais route will always,enjoy the largest patronage because, apart from all other con-.siderations, it involves the shortest sea journey. The newsteamers have now crossed from the Calais pier head to theDover pier head in one hour and ten minutes. Formerly thepassage from Newhaven to Dieppe took as long as seven hoursin crossing and has sometimes occupied nine hours. The

ships were small and narrow and those passengers who were;subject to sea-sickness suffered terribly. The route thereforeacquired the reputation of being only suited to good sailorsand certainly invalids would scarcely venture upon such ajourney. Nor were the ports of Newhaven and Dieppe allthat could be desired. Consequently in very bad weatherthere were delays in the departure of ships. Now, however,both ports have been considerably improved ; a magnificentbreakwater has been built at Newhaven which effectuallyshelters the entrance to the port from south-westerly winds’while the cliffs close by, at Seaford, break the force of

’easterly winds. At Dieppe dredging operations, carried outon an extensive scale, render the entrance easy even at lowtide.

Of more importance than this consideration is the greatimprovement effected in the character of the ships nowemployed on the service. In 1882 two new ships were puton the line. These were called the Brittany and

sl’ormandy. They measure in length 231 feet and their

registered tonnage is 240, which is equal to about 520,gross tonnage. These ships have a shallow draft, 7 ft. 6 in.,and can carry 578 passengers. In 1888 two ships of a largermodel were added to the fleet. These are the Paris andthe -Ro2ten. Their length is 250 feet, their draft 8ft. 2in. ;their registered tonnage is 326, which is equal to about’700 gross tonnage and they can carry 706 passengers. All-these four ships are fitted up in a luxurious manner. Theyhave deck cabins and an upper deck which constitutes a veryfavourite lounge for passengers. But what is of greater’value than all such qualities is the fact that these

;ships effect the passage in four hours. Indeed, whenthe season is favourable, and more particularly in themonths of July, August, and September, the passage isoften accomplished in three hours and a half. Another

;ship was added to the line last year. This was the

.Seine, and she differed from the other ships inasmuch,-as she possessed double screw propellers instead of paddlewheels. The Seine has effected the passage in three hours:and eleven minutes. But nevertheless the venture cannotbe spoken of as a success. The speed is unequalled, butin consequence of the shallow harbours the draught is slight tand is insufficient to secure steadiness. Therefore there havebeen so many complaints that the Seine was sent into.dock for structural alterations with a view of preventing theexcessive rolling of the vessel. These new ships have been.constructed in such a manner as to secure notable sanitary.advantages. Care has been taken to warm and to ventilatethe cabins. Under the seats and all round each of the- cabins there is a copper coil which during cold weatherseceives the steam from the engine. Underneath the cabin,table are openings through which air, brought down from the.deck, enters. All round the ceiling of the cabin, close underthe deck, is an exhaust shaft which communicates with thefunnel of the steamer. Openings about two inches long and,a quarter of an inch wide at a distance of about a quarter ofAn inch from each other are made by perforating the metallicrsides of the exhaust shaft. Thus, all round the cabin the.air finds a natural exit which is stimulated by the suctionproduced in the funnels of the steamer. We noted with

pleasure that no difference whatever is made, in respect towarming and ventilation, between the first class and second"class cabins. In like manner the closets and the lavatoriesare the same for both classes. The constructors of these

.ships have evidently recognised that it is as necessary toobserve the laws of health for the poor as for the rich and asmuch pains are taken to give a plentiful supply of air to thesecond class as to the first class passengers.

The Dieppe route is now able to offer accommodation as’commodious as can be found on anv channel steamer. Ofthe three principal routes to the Continent, the Dieppe hasthe longest sea and the shortest railway journey. Thejourney from London to Newhaven is effected under twohours and that from Dieppe to Paris under four hours.The scenery on both sides is undoubtedly the prettiest thatexists on any of the routes from London to Paris. On the

English side the passenger, by the payment of one shillingover and above the first class fare, can enjoy the luxury oftravelling in a Pulman car. The railway officials are preparedto tender every assistance and facility to invalids travellingby this line. A sort of hammock has been made which canbe affixed to the roof of the railway carriage in such amanner that a patient may be carried in his bed from Londonto the steamer. Finally we should not omit to mentionthat the ladies’ cabins, both in the first and the second class,are of much larger dimensions than were considered necessaryin the older steamers. Indeed the ladies’ cabin used to be sosmall and so badly ventilated that many and bitter com-plaints were made. It is satisfactory to note that thegrievances and the hardships attending the Channel passageare rapidly disappearing. Delicate persons need no

longer entertain the fears that in the past were quitejustifiable. The journey can now be accomplished with somuch ease, comfort and rapidity that the apprehensionsformerly entertained, when patients were recommended to goabroad, do not apply to the present improved services.

THE TWENTY-FIRST GERMAN SURGICALCONGRESS.

EARLY on June 9th the members of the Surgical Con-

gress inspected the hospital at Moabit under the guidance ofProfessor Sonnenburg. At ten the second meeting of theCongress began in the Langenbeck House. Dr. Giiterbockof Berlin showed a case of Empyema. The patient was aman in the prime of life. In the right side of the breast,from the armpit to the girdle, a deep depression was visible,with the operation wound, not yet quite healed, in themiddle. The loss of ribs and of a large portion of the

lung and the adjacent parts, however, had not in the

least impaired the state of the patient’s nutrition or the useof the right arm and his appearance was that of a man inexcellent health. A considerable number of cases of theremoval of tumours from the brain were then discussed andCzerny of Heidelberg expressed the opinion that trephininghas a great future as a means of regulating iitercranialpressure in mental disease. Pfeilschneider of Schonebeckshowed several persons treated by him for fracture or com-minution by suture, but this method was condemned byBergmann and others and only partly defended by Trendelen-burg. Euster of Marburg showed a boy in whom a ureterhad been successfully resected for stenosis. Schlange ofBerlin exhibited several persons who had been cured ofactinomycosis. Eyselsberg of Vienna reported a case ofthis disease which had been cured by injecting tuberculin.Grawitz of Greifswald spoke on the changes of tissues ininflammation and their biological ignificance and K&ouml;nig onthe treatment of tuberculosis of the bones and joints, on

which subject he is about to publish a book. In the courseof the same sitting K&ouml;nig proposed the erection in the

Langenbeck House of a marble bust of Gustav Simon, whomay be regarded as the real originator of the German SurgicalSociety, for it was he who persuaded the reluctant Langen-beck to found it. After the sitting the members of theCongress dined together in the Central Hotel.On the 10th some of the members inspected the municipal

Hospital am Urban under the guidance of Dr. Iiorte, others theEmperor and Empress Frederick Hospital under the guidanceof Dr. Baginsky and Prof. Gluck, while others were present ata series of demonstrations with the projection microscope givenby Dr. Barth of Marburg and Dr. Arthur Hartmann of Berlin.Hartmann’s demonstrations had reference to the structure ofthe skull and attracted great attention. The Congress metat ten. Thiem of Kottbus showed a woman in whom thetemporarily applied artificial anus had been reclosed afterthe healing of a syphilitic ulceration and stricture of therectum. Trendelenburg followed with a case of flat-footcured by straightening the foot after chiselling the bones ofthe leg just above the ankle. On the fact observed by him,that flat feet sweat excessively, Trendelenburg bases the theorythat the morbid secretion of sweat is due to a condition ofnervous irritation and that perhaps in flat-footthere is abnormalpressure on the nervus plantaris. Professor Albert K&ouml;hlershowed a young woman who had suffered from stenosis of the

pylorus. Before the operation she weighed less than 54 lib