334

was the cause of much heart-searching among the IChurch, and Alexander spent the night previous to the dayfor which the reception had been fixed in the greatChurch of Alexandria praying, and the words of his prayerwere, ’’ Either me or Arius, 0, Lord I " On the followingday, as Arius was proceeding to the church in procession forhis reception, he was suddenly taken ill and died withinabout half an hour. "M. C.," however, is much less fair-minded than the Bishop of Alexandria, who was quitewilling to pit his own life against that of Arius. Theother classical instance of praying to death-but this prayerwas made to a different deity-is to be found in that

delightful romance " Sidonia the Sorceress." Sidonia, aseverybody knows, prayed various people to death. Amongothers were the porter of the convent of which Sidonia wasgovernor, and perhaps it will profit M. C." to learn whatappearances the body presented, as they were said to be

significant of having been prayed to death. The appear-ances were these: "1. The face brown, green, and yellow,particularly about the mU8rmli frontales et ternporales. 2. The

rmlsauli pectorale8 so swelled, and the cartilago ensiformis sosingularly raised, that the chest of the corpse touched themouth. 3. From the patella of the left leg o the ’malleolu8.cxtrn,zcs of the foot, all brown, green, and yellow, blendedtogether. And on examination of the said corpse, Dr. Kukuckof Stargard affirmed and was ready to swear that no one tittleof the signature of Satan was wanting thereupon." "M.C." "

might inquire whether these appearances were present inthe case of the distinguished scientist who dropped." It

would be interesting to know whether M. C." has previouslytried other ways of getting rid of people of whom he dis-approves ; for instance, there is the Icelandic method of

the "sending," or the primitive and wideworld process ofthe wax image put down to melt slowly before the fire, or

the image can be made of clay and placed in a runningstream ; but, on the whole, we think it kinder to assume

that M. C." is a lunatic. But as he may possibly proceedfrom mental methods of murder to those in which suchcarnal and earthly weapons as knife or revolver play a part,his friends should keep a careful eye on him.

THE FEAR OF EARTHQUAKES.

WE imagine that there are few serious" seismophobes" "

in this country, for history even a long way back does not- record the occurrence of earth disturbances of any magnitudein the British Isles. Evidence, however, is not wanting thatparts of the world are passing through a period of greatinternal activity and disturbance, and the continual recordsof such by the seismograph have produced in the minds of.some people a certain feeling of alarm. It may be well to

reflect, therefore, that although these islands may visiblyshake as the result of a disturbance yet the centre of

activity of that disturbance is usually remote and its

effects here are, comparatively speaking, without harm.

In this connexion it is interesting to recall thenature of the earth tremors experienced in this countryin 1884 according to a description which appeared in

THE LANCET of April 26th, 1884, p. 764. The earthquake, Iaccording to this account, occurred on April 22nd and wasmost distinctly felt in the metropolis in Cheapside, Fleet-street, and the Strand. So distinctly was the vibration feltin THE LANCET offices that "the compositors left their

work in a body under the impression that the building wasabout to fall." The " cases " throughout the composingroom shook, ’’ causing each compositor to suppose that hisneighbour was playing a practical joke; the gas-burnersvibrated and the floor was felt distinctly to oscillate." This

sudden motion produced in some a feeling of slight nauseaand giddiness," but no further disturbance occurred and

the men speedily returned to their work." There was noloss of life reported and the greatest damage to propertyoccurred at Birmingham and Malden, but more particularly atColchester. A similar shock was experienced about a hundredyears before this date. With this record in front of us we maystill reasonably hope to enjoy an immunity from earth con.vulsions having at any rate the awful intensity which gaverise to the appalling consequences recently experienced at

Messina. -

THE MEDICAL FACTOR IN OUR TENURE OFINDIA.

4 STRENGTHEN, reinforce the medical arm," is the nowunanimous recommendation of those directly interested inthat great instrument of conciliation between the governingBriton and the subject Hindoo represented by medico-missionary enterprise. We have recently quoted the opinionbequeathed to his successors in office by one of India’smost sagacious Viceroys, Lord Lawrence, when, referringto the humanely inspired work of an able physicianin the above-named service, he said, " Our Eastern

Empire owes more to such men than to its regularofficials "-men, to wit, whose intelligent solicitude for

the health and material happiness of the poor amongwhom they lived and laboured did more to soften and to

sweeten their lot and to convince them as to who were thebest custodians of their interests than all the surveillance,departmental or municipal, traditionally practised by officials,however exemplary. "Immediate care for the body," par-ticularly in special illness or epidemic diseases, is the best,as it is the first, mode of access to the sympathies and affec-tion of the natives, insomuch that, as was powerfully put inevidence in the Missions Section of the Pan-Anglican Con-gress, Christianising effort made progress precisely in the

degree in which that care had in the first instance been

most effectively applied. When we read of the medico-

missioner not only relieving pain, working cures, and

arresting contagious or infective disease, but even

mitigating the horrors of visitations like flood or

famine, pressing into the humanitarian service the dis-

pensary, the hospital, the convalescent home, in reinforce-ment of the orphanage, the school, and the workshop, webegin to realise what a potent factor towards conciliating thenatives, what a mighty " first step

" towards getting at theheads and hearts of the people is within the resources ofGovernment. Striking illustration of the task to be thus facedand fulfilled was given in a lecture delivered in Edinburghon Jan. 12th by Sir Thomas Raleigh, legal adviser to theViceroy. With ’’ The Mind of India" for his theme, heshowed that by the lines hitherto followed we had

failed to reach that "mind," mainly from an unsym-

pathetic mode of addressing it, and from an imperfectrealisation of where its interests, intellectual, moral,and religious, reposed. The day is long past when,with well-meaning but surely mistaken zeal, a missionarymight be seen chastising a Hindoo boy for ignorance of

" Paley’s Evidences," but we are still far from appreciatingor making practical allowance for the beliefs in which theindigenous population live and toil and die. To force theHindoo mind into European moulds has hitherto succeededonly in creating suspicion and in alienating sympathy, whilethe problem still awaits solution of how to make the said minddevelop on lines of its own under the complex conditionsof the twentieth century. It is not enough that, for the

Hindoo, the British Government stands for "justice, security,and peace." Something else is needed to penetrate the innermind and to conciliate the sympathies and the affections.Education, hitherto open to the native shopkeeper or trader,

1 THE LANCET, Dec. 19th, 1908, p. 1826.

335

while denied to the labouring poor, has had its turn but on awrong system, which has created difficulties of. its own.

Approached through the English language and not throughhis vernacular the Indian youth took on an artificial cultureunder which he ceased to be a Hindoo and did not

become a Christian. Quoting from Lord Curzon, Sir

Thomas Raleigh indicated the check given to teaching inthe vernacular "when the withering blight of Macaulay’srhetoric passed over the field ’of education in India "-a

blight difficult to countervail, inasmuch as English is thepassport to official preferment or employment, while thevernacular condemns the aspiring youth to a humbler andless lucrative career. Add to this the too great facilitiesopen to such youth for professional qualification and we’can account for the increasing army of the" educated

unemployed" (what has been :called the "academic pro-letariat") which promotes such. noxious growths as

political agitation and revolutionary journalism. Another

of Sir Thomas Raleigh’s remarks had reference to the

comparative failure of Christianising effort-failure due tothe Western accretions" gathering round the Christianityinculcated. Christianity, oriental in its origin, has thus ceasedto be oriental in form if not in substance, and, as presentedby the average missionary, evokes but a partially sympathetic.response. Christianity, according to Sir Thomas Raleigh,must be "orientalised again" if it is to find real and

abiding converts in the East, and that can only be done by.a special education on the missionary’s part hitherto ignoredor neglected. "The Founder of Christianity," said LordMorley in his late speech in the House of Lords, arose inan oriental country "-to which we may add that He

appeared in the capacity, above all things, of the Healer,accompanying, oftener prefacing, His teaching by the pre-vention or cure of disease. It is by a reinforcement of thepractice of the Great Exemplar, by the care for the body inits affliction and in its suffering, that the Christianising pro-paganda has hitherto achieved such success as has hithertobeen vouchsafed it. Only by recognition of this, and bystill further action on the same lines, will a higher measureof success be reached-success making for the consolidationand the permanence of our tenure of India, towards whichlying ready to our hand we have few such potent instrumentsas the medical factor.

--

ENLARGEMENT OF CERVICAL GLANDS THESOLE SIGN OF CANCER OF THE

ŒSOPHAGUS.

IN the Boston Nedioal and Surgical Journal of Dec. 31st,1908, Dr. 0. Mitchell has reported the following case whichhows the importance of enlargement of lymphatic glands asa sign of cancer in the absence of other signs. A farmer,.aged 38 years, was admitted into hospital on Sept. 24th,1907. He had suffered from scrofula in childhood but noglands suppurated. He had been losing flesh, though hisappetite remained good. On examination his colour was

good. Along the left sterno-mastoid muscle were markednodular enlargements and on the right side were smaller

enlargements. The patient first noticed them on May 1st. Hecomplained of pain in them which radiated to the top of thehead. The skin over them was moveable but congested.Inspection of the mouth, nose, and throat revealed nothingabnormal. Cervical adenitis was diagnosed and he wasdischarged unimproved. On Dec. 4th he was readmitted.He said that when he swallowed a lump seemed to comeup his oesophagus. Examination of the throat and nosewas negative. The percussion note in the upper partof the back on - the right side was dull and on

deep inspiration moist râles were heard. In the upper

,part of the back on the left side fine rales were heard. The

front of the chest was clear. A systolic murmur was heardover the heart. The urine contained a trace of albumin anda few granular casts and epithelial cells. The patient com-plained of pain in the nodules which had considerablyenlarged since his discharge and felt elastic, as though puswas present in the deeper portions. The following diagnoseswere entertained :-1. Syphilis. There was no history or

other signs of this disease. 2. Hodgkin’s disease. This was

negatived because of the inflammation and absence of

enlarged lymphatic glands in other parts. 3. Cancer.

There was no sore or other lesion on the skin or in the throator mouth nor history pointing to a growth in the stomach oroesophagus. 4. Tuberculosis. This was diagnosed in co’n-

sequence of the slow growth of the nodules, the history ofscrofula, the pulmonary signs, a temperature higher in theafternoon than in the morning, the wasting, and the patient’sstatement that the nodules had decreased. A 5-inchincision was made over the posterior border of the sterno-mastoid muscle and the skin and fascia were divided. A

number of nodules were removed and on microscopicexamination showed typical carcinoma. Carcinoma of

the oesophagus was then diagnosed. The patientwas discharged in a fortnight improved as regards

! pain and local symptoms but with the wound unhealed.He became cachectic, and about 2 months later began tovomit blood and had difficulty in swallowing. Other nodules

developed in the cervical region and on the right side of thechest about the level of the tenth rib. Death occurred on

August lltb, 1908. A necropsy could not be obtained, but thelater symptoms showed that the primary growth must havebeen in the oesophagus, or possibly in the stomach. In hisbook on pathology Kaufmann states that in many cases ofcancer of the oesophagus the cervical glands and connectivetissue may be infiltrated, producing severe stenosis of the

upper part of the oesophagus long before any manifestationof stenosis attributable to the primary growth occurs. He

reports the case of a woman, aged 21 years, who had a

tumour on the left side of the neck adherent to the vesselswhich was excised and on microscopic examination wasfound to be cancer. At the necropsy the primary growthwas found to be a flat ulcerating growth, scarcely observable,in the upper part of the oesophagus. These cases show that

when the cervical lymphatic glands are enlarged in adultscancer should be suspected, as the primary growth may bediscoverable only after death.

CHILDBIRTH CUSTOMS.

ACCORDING to an ancient Jewish tradition, quoted by SirJohn Pettus in his Volatiles from the History of Adam andEve " (1674), our first parents had 30 sons and 30 daughters.Old theologians were often at a loss to explain how the first-born of these was successfully brought into the world, seeingthat neither father nor mother had any experience of mid-wifery. Astruc, the famous medical writer, in an "answerto a casuistical letter on the conduct of Adam and Eve at thebirth of their first child," accuses his adversary of irreverencein wishing to know what was done with Cain’s umbilicalcord. Doubtless, according to Astruc, the knowledge of

midwifery came by inspiration. A modern writer on a

similar subject, Dr. De Vere Stacpoole, in his brilliant book’’ The Blue Lagoon," supposes that instinct comes to theaid of the entirely ignorant mother. Folklore, how-

ever, is constantly showing that all knowledge, such

as that of the obstetric art or that of cookery, has

arisen by an infinitely gradual process. All mammals have

doubtless always severed the navel-string for the simplereason that the newly born must be freed from the placentaor that the mother must be freed from the child before the