206 AROUND THE WORLD VIA INDIA. 



ion. due to the chewing of 'bete].' a common habit in 

 this country, and indulged in, I believe, by almost all 

 classes of natives. 'Betel.' as used in the Madras presi- 

 dency, is said to be made up of the following parts: 

 (a) The essential constituents, viz.. 'betel' leaf, areca 

 nut, and caustic lime (chunam). (b) Condiments, 

 such as cloves, nutmeg, cardamons, cubebs. Dry pow- 

 dered cocoanut and oil are also sometimes added. The 

 above components are mixed in varying proportions, 

 rolled up in a betel leaf, and placed in the mouth. They 

 are then chewed and' rolled about by the tongue and 

 cheek for a period varying from in to 30 minutes and 

 then spat out." 



I can testify from observation to the universal use of 

 betel both in India and Ceylon. Carcinoma of other 

 parts of the body appears to be more rare than in our 

 country. The tables of Capt. Niblock show, for in- 

 stance, that 513 cases of carcinoma of the mouth were 

 admitted to the General Hospital during 10 years, 

 1892-1901, and only 44 cases of carcinoma of the breast 

 and 19 of the lip. Concerning the latter he says: 

 "Epithelioma of the lip, it will be noted, is com- 

 paratively rare, and, so far as my experience goes, af- 

 fects both lips with equal frequency. The rarity of 

 carcinoma in this situation is no doubt explainable by 

 the fact that smoking from a pipe (or at any rate a 

 clay pipe) is not indulged in by the natives of this coun- 

 try." The comparative frequency of carcinoma of the 

 upper lip referred to by Capt, Niblock stands almost 

 isolated as a clinical ob-ervation and constitutes a very 

 important contribution to the topography of carcinoma 

 as it i> observed in India. Hundreds of cases of carci- 

 noma of the lower lip have come under my observation 

 and only a single case of carcinoma of tin' upper lip. 



ABSCESS OF THE LIVER. 



In visiting any of the large hospitals in India one is 

 sure to find a few cases of abscess ( >f the liver, and yet 



