388 ALCOHOLISM IN SCHOOL CHILDREN.

means and Mr. Bayliss and Dr. Starling have taken

opportunity of the control thus acquired to investigate theexact character of the changes induced in the pancreasunder this physiological stimulus. Apparently, secretinhas no specific influence on any one constituent of the

pancreatic juice. When injected it causes secretion of ajuice which is normal in that it resembles the juice secretedon entry of food into the duodenum, and contains a precursorof trypsin, amylopsin, and steapsin. Secretin, in fact,appears to cause the pancreatic cells to turn out the wholeof the mesostates which they have accumulated during rest inpreparation for the act of secretion. If secretin be injectedat repeated intervals until the gland will no longer respondto the injection it is found on microscopic examination thatthe cells have discharged the whole of their granules.Under healthy conditions it is probable that the activity ofthe pancreas is two-fold in character and that the normalstimulus of secretin excites not only a breaking down of theprotoplasm and a discharge of granules but also a buildingup of the protoplasm and a new formation of granules. So

marked, in fact, is this power of self-restitution that it is

often advisable to diminish the resistance of the animal bybleeding or other means if it is desired to obtain a speci-men of exhausted gland. So far the writers have dealt onlywith the correlation of the activities of the cells lining theintestinal tube with those forming the masses of the

pancreas and liver, from which it will be seen that a very

large part of this correlation is played by a chemical sub-stance which acts, so to speak, as a chemical messengerbetween these various organs. A striking feature, however,of the pancreas is its alleged power of adapting its secre-tion to the nature of the food taken in by the animal.A study of the mechanism by which the pancreas can adaptitself to the nature of the food has been carried out and

completed by Dr. F. A. Bainbridge in an interesting seriesof physiological experiments. It was found that as the

result of injecting lactose some substance which may becalled x is produced in the mucous membrane of the smallintestine. This substance is carried by the blood to the

pancreas and there slowly gives rise to the formationof lactase which is turned out in the juice whensecretion is excited by the entry of acid chyme intothe duodenum. As yet the nature of this substancex is not known. All that can be said is that itis destroyed at a boiling temperature, since boiledextracts of the mucous membrane of milk-fed dogs donot, when subcutaneously injected, cause the appear-ance of any lactase in the pancreatic juice of biscuit-feddogs.

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ALCOHOLISM IN SCHOOL CHILDREN.

OUR Berlin correspondent writes : ’’ Dr. Goldfeld, medicalofficer to the public schools at Schoneberg, a suburb of

Berlin, has recently carried out an investigation on the

spread of alcoholism in school children. The investiga-tion included a boys’ school of 470 and a girls’ schoolof 497 children (a total of 967 children), the result beingthat not less than 496, or 51’3 per cent., of the childrenwere accustomed to indulge daily in the drinking of beer,whilst 299, or 30’9 per cent., casually took spirits also.

The quantity of beer consumed was from one to two

glasses of a quarter of a litre a day. Malt beer was

preferred by the majority, whilst some drank lagerbeer, or the so-called white beer, a special Berlin

beverage containing a great quantity of carbonic acidand a relatively small quantity of alcohol. As to the

other liquors Dr. Goldfeld states that rum, kummel,cognac, or even a combination of several spirits was taken.As a rule the father on going to a public-house invitedhis children to go with him, where he allowed them tohave a drink. Children of publicans were especially liable

to indulge in spirits. It was not only the boys. but alsothe girls who liked to drink beer, but they preferred thesweeter liquors to the sharper ones. The teachers in-formed Dr. Goldfeld that children accustomed to the use of £

spirits were especially lazy, absent-minded, and inclined,to tell lies. Dr. Goldfeld undertook to warn the children

against the danger of alcoholism but without any success,,the children continuing to drink. Although his endeavour,was supported by the teachers the parents were not to,

be persuaded and the influence exerted by the schooL was;checked by that of the parents. Dr. Goldfeld proposes that

eventually addresses should be read on the subject before-a meeting of parents of children attending individual schoolsand that, moreover, they should be provided on behalf of’the school authorities with a short essay dealing with the:dangers of alcoholism." The tables given in Dr. Goldfeld’s.paper show that of 470 boys 264, or 56’ 2 per cent., daily drankbeer and 139, or 30 per cent., were casual drinkers. Inone of the classes 96’ 2 per cent. were regular drinkers andin another only 33t per cent. Spirits were taken by from.17 7 to 60 4 per cent. The figures relating to girls, thoughsufficiently serious, showed a less prevalent consumption ofalcohol.

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THE OPERATIVE TREATMENT OF RETROFLEXIONOF THE UTERUS WITH ADHESIONS.

THE treatment of cases of retroflexion of the uterus’with prolapse of the ovaries and adhesions preventing thereposition of the displaced organs is often a source of greattrouble to the practitioner. The distress caused to the

patient by such a condition is frequently extreme and

yet ordinary methods of treatment may quite fail to give-any relief. That most cases of retroflexion giving rise to-

symptoms where the uterus is moveable and can be replacedshould be treated by the introduction of a pessary there canbe no question. It cannot be justifiable in such cases topractise any operation if relief can be obtained by a pessary,unless indeed the patient refuses to wear such a support.In cases, however, where a pessary gives no relief and wherethe patient, as not infrequently happens, is made a chronic-invalid by the conditions, the question of operative treatmentmust be considered, and it is precisely in this class of-case that so much difference of opinion exists as to whatoperation should be performed. Shall the patient be-

treated by Alexander-Adam’s operation, shall the round’

ligaments be shortened intraperitoneally, or shall the fundusuteri be fixed to the abdominal wall by one or other of the’methods of ventrofixation ? If adhesions are present thenthe view taken by most operators is that they can be dealtwith most safely and most certainly after opening the-abdomen. In such circumstances, then, either ventrofixationor intraperitoneal shortening of the round ligaments must be’carried out. Which of these two operations is most likelyto be followed by permanent results and lead to no sub-

sequent disability? The question is one that does notadmit of a ready answer. That ventrofixation has in some-instances given rise to trouble in subsequent confinementsthere can be no question. But if the lower part of the-

uterus alone be fixed to the abdominal wall such fixation.would not appear at all likely to cause subsequent trouble.On the other hand, the intraperitoneal method of shortening-the round ligaments is quite safe from the point of view ofany trouble being" caused in a future pregnancy, but the’permanency of the result is on the whole less certain. Our own’feeling in the matter is that while intraperitoneal shorteningof the round ligaments is not at all likely to be attendedby any subsequent trouble, yet the permanent result of ven-trofixation is much more certain. The method of prac-tising it in which the lower uterine segment alone is fastened

to the abdominal wall reduces the risk of any trouble at a

; subsequent pregnancy to so small a factor that this should