History Essay

Essay Question: Underlying causes of 1905 revolution in Russia were not political. Whatever else the revolutionaries wanted it was not to overthrow the Tsar. How far do you agree with this claim? I agree that the underlying causes of the 1905 revolution were not only political there were also economic, social and military factors that lead to this revolution. Firstly the social causes of this event. Even though in 1861 the Emancipation of the Serfs had occurred by the early 20th century nothing really had changed for the lower class of Russia society. They were not called Serfs anymore and no longer were a part of a feudal system however the still experienced a low standard of living, had to work long hard hours in menial jobs and poor harvests and famine havocked their lives. The massive gap between the rich and the poor continued to widen as the Tsar and the royal family lived in extravagant luxury and the peasants that made up 85 percent of the people were left to starve and fend for themselves. Another social factor than increased the peasants growing discontent with their ruler was the process of urbanization that led to overcrowding in the cities and horrible living conditions. Overall all these factors and more led to the popular belief among the Russian peasantry that change was needed, that change didn’t need to be the removal of the Tsar. In fact they were happy to work with him to achieve more equality and better living and working conditions for themselves. Next there were the economic causes of this revolution. In the 1900s the world was struck by a recession, Russia in particular was heavily affected. They were so affected because Russia relies so much on its exports especially of grain for its revenue and strength of its economy. So when the worldwide price of grain dropped during the recession mass unemployment results due to the fact that 85% of Russia populations are farmers that grow grain and other foodstuffs. Moreover due the recession the value of the Russia currency (the ruble) drops and therefore Russia exports of grain drops due to farmers not wanting to sell their grain due to an unstable market price. Widespread poverty among the masses grows leading to even more discontent and want for change. This leads on to my next point. The military cause of the revolution is simple and that is the Russo-Japan War. Tsar Nicholas II fearing the growing discontent among the people. So he comes up with an idea of a distraction to make the peasants forget about the horrible situation they are facing. At first his plan works well and the people forget about their troubles and support the war effort. That is until Russia starts losing. This idea needs to be put into context as Russia is the largest country in the world and should simply steamroll a tiny insignificant country like Japan. Defeats on land and at sea shocked the Russian public and if that wasn’t bad enough the war instead of making people forget about their struggles with poverty and starvation causes shortages of fuel and food, high prices and unemployment. As Russia suffered defeat after defeat they were forced to sign a treaty with Japan and became the laughing stock of European powers such as Germany and Great Britain. This shocking defeat also forced the Russia people to consider how incompetent the Tsar and his ruling party were. That they can’t even defeat a tiny island nation like Japan. However there were also political causes to the 1905 revolution such as the harsh Tsarist regime and the three main groups of opposition to the Tsar reign. The Tsar had already shown himself to be weak and indecisive through his actions again the Japanese in the Russo-Japanese war form 1900-1904. He had also made his views clear on the idea of a democratic/constitutional government calling them ‘senseless dreams’ and basically ignoring the pleas of his people for basic reform. The Social Revolutionaries tried to create a peasant revolution based around socialism and were a real ‘party for the youth’ but failed epically. The liberals appealed to the Tsar in a reforming manner but as I previously stated the Tsar refused to back down and give up any of his powers. However political causes amounted a minor role in the 1905 revolution as the other above factors were more important. Overall the underlying causes of the 1905 were not really political and while there was some political influence to the revolution. There were social factors such as urbanization and poor living standards. Furthermore economic factors such as poverty and unemployment ultimately led to dissatisfaction with the ruling class and change was required by the peasants. What the revolutionaries wanted was basic freedom e. g. freedom to form political parties, basic rights as human beings and fundament government reforms. Their main aim was for the people to have an interactive government system that sought the best for Russia. While it was true the peasantry of Russia was tired of autocratic rule they didn’t really want to overthrow the Tsar. All they really desired were some basic reforms to improve their lives.

Introduction of Company

Introduction of Company De Famous Trading Company is a new establishment and located in Klang, Selangor. Our company was founded in July 2011 and established with a fully computerized inventory system to provide more efficient services to all the valued customers. Strict operation process, careful inspection and high quality service with competitive prices enable us to win the long term business relationships from all customers. Our aim is to become a leading supplier of stationery in the international market.We are also working to provide services to companies and be the supplying man power to many renowed universities in Selangor area. We are striving to provide better price and better service to our customers. In terms of nature business, De Famous Trading Company is always stick to the quotes on ‘Going green’ for inspiration and motivation to change. We are one of the companies who supply green stationery and office products. We select products that are environmental ly benign or have environmental advantages over the standard stationery equivalents.We have a unique range of products. Many new Green products are showcased by manufacturers in our Green catalogue before they become available to the normal office supply companies. Our company owners have gained experience in both areas before venturing into the business, including relevant areas such as managing and accounting. Our staff are knowledgeable and willing to give you advice on individual products and their wider impacts.There are five of us in the office, and the hours are flexible, so that staff can lead full lives as artists, campaigners, and occasionally normal people. We all get a say in how the company runs, and working life is generally relaxed, and has the tendency to meander into rambling discussions about deep ecology and the meaning of life. All our customers give positive feedback with our goods and serives since our establisment. We offer the best prices and discounts on eco -friendly stationery and do not charge a premium for green items.We are also a mine of information on the green office and we can untangle most of the competing environmental claims made by manufacturers. Green purchasing is an essential element in reducing the huge amount of waste generated by our disposable consumer culture, endemic in most standard offices. We aim to maintain business practices consistent with the goals of sustaining our fragile environment for future generations, within a culture that respects life and honours its interdependence. Introduction of Company Introduction of Company De Famous Trading Company is a new establishment and located in Klang, Selangor. Our company was founded in July 2011 and established with a fully computerized inventory system to provide more efficient services to all the valued customers. Strict operation process, careful inspection and high quality service with competitive prices enable us to win the long term business relationships from all customers. Our aim is to become a leading supplier of stationery in the international market.We are also working to provide services to companies and be the supplying man power to many renowed universities in Selangor area. We are striving to provide better price and better service to our customers. In terms of nature business, De Famous Trading Company is always stick to the quotes on ‘Going green’ for inspiration and motivation to change. We are one of the companies who supply green stationery and office products. We select products that are environmental ly benign or have environmental advantages over the standard stationery equivalents.We have a unique range of products. Many new Green products are showcased by manufacturers in our Green catalogue before they become available to the normal office supply companies. Our company owners have gained experience in both areas before venturing into the business, including relevant areas such as managing and accounting. Our staff are knowledgeable and willing to give you advice on individual products and their wider impacts.There are five of us in the office, and the hours are flexible, so that staff can lead full lives as artists, campaigners, and occasionally normal people. We all get a say in how the company runs, and working life is generally relaxed, and has the tendency to meander into rambling discussions about deep ecology and the meaning of life. All our customers give positive feedback with our goods and serives since our establisment. We offer the best prices and discounts on eco -friendly stationery and do not charge a premium for green items.We are also a mine of information on the green office and we can untangle most of the competing environmental claims made by manufacturers. Green purchasing is an essential element in reducing the huge amount of waste generated by our disposable consumer culture, endemic in most standard offices. We aim to maintain business practices consistent with the goals of sustaining our fragile environment for future generations, within a culture that respects life and honours its interdependence.

An Analysis of Emily Dickinsons Poem, Because I Could Not Stop for Death

In Emily Dickinson's poem, I can not stop death, treating death as a gentleman, he surprisingly visits Dickinson and takes her to a trip to eternity ( See page 24). Ironically, we all know that death is a gentleman, but we all know that this is the opposite. In the second quarter, they all started a slow and calm journey. We are driving slowly, he does not know how to rush (I.5). You can see the silence of the scene where they are located. Dickinson understands the seriousness of her situation here, she forgot everything. Emily Dickinson's poem I can not stop dying Out of Emily Dickinson's poem Can not stop dying represents a reflection of the speaker against death. This poem focuses on the concept of life after death. The background of this verse reflects the approach of death, death is kind and considerate. Through immortal promises, fear is removed, and death not only becomes acceptable, but also is welcomed. - Analysis of Emily Dickinson's I can not stop dying The poets of the 19 th century have written many themes. The general topic is death. Death theme happens in various ways. Emily Dickinson is one of many poets who uses death as the theme of her poetry. In her poem I can not stop death Death is depicted as a gentleman who makes the talker an eternal journey. Since I can not stop death, I was declared Emily Dickinson's most famous poem. This poem reveals the acceptance of calm death of Emily Dickinson. She portrayed her death as a gentleman and she was surprised at her visit. Emily depicts everyday scenes as life cycles. Her metaphor is exploring death in a fictional way, but her line often contains as much uncertainty as meaning. Life and death are oriented forever and are considered not so important in the eternal framework. - Emily Dickinson, using symbolism, was able to create a theme with the theme I can not stop death. . We travel with the speakers and guide us through life, death and other stages. In this poem the symbol we first encountered is de ath. At their conference, the lecturer is dying as if he is the boss who is at the meeting.

Article Review and Comment Example | Topics and Well Written Essays - 500 words

Review and Comment - Article Example This is letting Republicans take him to task for failing to engage in realistic cost-cutting measures. Republicans are accusing Obama of irresponsible spending. Meanwhile, Democrats are arguing that macro-economic factors like unemployment justify spending even with the deficit. Obama in particular is arguing for long-term investments into workforce and infrastructure to stay competitive. Republicans, as is common, are associating spending cuts with shrinking government. Some Republicans like Scott Walker have even turned down federal government money and associated projects. They are thus clearly rejecting New Deal-style â€Å"pump and prime†, work creation missions. The deficit will impact the 2012 budget intensely. Republicans are hoping to extend spending past March 4th so as to gain more time to debate the issue. Treasury officials predict that by April, the deficit ceiling is likely to be exceeded barring immediate action. The article notes that most initiatives focus on ly on 15% of the budget: Discretionary spending that is non-security oriented. The journal notes that this is deeply flawed: Most of the deficit comes from non-discretionary programs that are much harder to cut such as Social Security (which is a financial obligation and has a separate, non-discretionary fund) and the military which is politically impossible to cut. First, I think that partisan commitments are transparent in this article.

Colorado Plateau Essay Example | Topics and Well Written Essays - 250 words - 1

Colorado Plateau - Essay Example pictographs, anthropomorphs and Petroglyphs by artists of those times depicted the lifestyle and customs through their drawings of animals, pottery and of the people who lived in the Colorado region during that time. This type of art has evolved over the centuries as peoples lifestyles changed and today we have traditional art as well as Modern art that show us the differences not only in the works of art but also of people’s lifestyles and the changes that evolved over time. Serena Supplee, yet another artist of the Colorado Plateau gained her inspiration from here because she lived in the Colorado region for over 25 years. In her art works she depicts moonlight magic and the transformative forces of river currents. Her watercolor and oil paintings show the intimacy and solace she found in landscape painting. Lynn Jackson, resource advisor, in her literature report of the Colorado Plateau, explains about the changes in Salinity, soils, dust, disturbances, restoration and vegetation that has taken place over time in the Colorado Plateau region. Her literature review was based primarily on the previous information that had been gathered about the Mancos Shale in the Colorado Plateau region. The information gathered about the salinity, sedimentation, erosion, vegetation and disturbances and changes in the region was especially useful to the land managers and other specialists who were involved in the planning with regard to the Mancos landscapes. The current information that was gathered about the Colorado Plateau region showed how the plateau had changed and evolved with regard to the points discussed above and helped them to understand the natural dynamics that contributed towards bringing about this

2 contract law assignments Essay Example | Topics and Well Written Essays - 3750 words

2 contract law assignments - Essay Example However, that right would have arisen by virtue of common law principles rather than statutory law as contained in the Contracts (Rights of Third Parties) Act 1999. Owen Fox explains that ‘for many years, the doctrine of privity of contract was a fundamental feature of English law, meaning that it was only the parties to a contract who could rely upon or enforce the terms of that contract. The consequence of this was that if a third party suffered a loss because the contracting parties failed to fulfil their obligations to each other, then the third party had no recourse under the contract.’2 This is the background against which Sarah Jones Development’s claim for damages against Archibald must be examined. There were and are exceptions to the privity of contract rule. One exception is to be found in circumstances where a collateral contract exists. For example when there is a contract between two parties one of the parties thereto may have a collateral contract with a third party in respect of the same matters contained in the primary contract. Shanklin Pier v Detal Products [1951] 854 provides a good example. In this case the plaintiff hired a contractor for the purpose of painting a pier. The painting contractor was instructed to purchase the paint from the defendants. The defendants informed the plaintiffs that the paint would last for seven years when in fact it only lasted for three months. As a result the plaintiff took the defendants to court despite the absence of a contract between them and defendants. 3 The court ruled that the plaintiffs could sue the defendants for damages on the basis of a collateral contract. The plaintiff had provided consideration in exchange for the defendants’ assurance of the quality of the paint by indorsing a contract with the painting contractor which specifically required that they purchase the defendants’ paint.4 The general tone of judicial findings was that there must be an intention to form a

The income gap between the rich and the poor in China Research Paper

The income gap between the rich and the poor in China - Research Paper Example Over the last decade, China has exceeded the Gini coefficient index threshold by 0.4 close to the warning level given by the United Nations (Cai, 128). This article analyzes the extent of the income disparity in China between the rich and the poor, it cause and effect and the plausible solutions to this problem. Research has shown that income disparity in China between the rich and the poor have continued to increase since 1978 when China opened it boundaries for trade with the rest of the world. According to the China national bureau of statistics, the standard income earning of the 10% richest people in china was 10.9 times higher compared to that of the 10% poorest in the year 2009. In 1985, the figure was just 2. 9 times ((Anon, 148). It can be seen that the gap between the poor has thus increased incredibly. Since 1978 when China opened it door to international trade, per capital income has increased unbelievably. For instance, within the period of 1985 to 2010, the per capital income has increased by 55 times. This has however come from the urban area with the rural area experiencing lesser growth. The earning gap between the rural and city dwellers had reduced from 2.6 to 2.5 times in the 1970 and from 2.3 to 1.9 times in the 80s. However, it widened to 3.3 times in 2009. This is disregarding the fact that there are some social amenities such as good roads, health care house subsidies and other amenities enjoyed by the city dweller which are not available to the rural people further increasing the disparity (Cai, 130). This thus implies that the disparity many even be more than six times larger. The major obstacle in overcoming the income disparity issue is because the affluent have a greater opportunity of increasing their wealth compared to other people. For instance, from 1985 to 2010, the rich recorded a 38 fold increase in their earnings; the people in the middle class register a 21fold increase while the poor only

Electronic Commerce Essay Example | Topics and Well Written Essays - 2500 words

Electronic Commerce - Essay Example Moreover, new sales and distribution channels may appear for Franke thanks to E-commerce. EC can reduce the cycle time to produce Franke’s washroom products. It can also enhance productivity and lessen the time needed to present the products into the market. The supply chain management of Franke will be effective with minimal delays. Moreover, the company can decrease the inventory and so can lower the cost for the inventory. The costs for administrative tasks and sometimes intermediaries in the supply chain are also reduced. The organization’s supply chain may be simplified in which the size of the supply chain is reduced. Franke can work more closely with its smaller group of suppliers in a focused supply chain evolved from applying E-commerce. â€Å"Tight coupling is a method for ensuring that suppliers precisely deliver the ordered parts, at a specific time and particular location.† (Laudon, 2007) It will enhance Franke’s logistical activities which are very important for the company to provide the right products with right quantities to the right locations at the right time. In addition to supply chain improvements, the supply chain management system of the organization can also be upgraded. EC makes SCM systems consistently linked the processes of supply chain such as purchasing, producing and distributing products from suppliers to consumers. Franke can integrate the demands for its equipment and enter them into the order entry system. A Franke worker assembles the equipment, packages them, make them tagged using RFID, etc, and then distributes them to the customer. The delivery process is monitored and tracked by Franke’s SCM system to get the latest information of order status. â€Å"Most B2B E-commerce is an adaption of EDI or is based on EDI principles.† (Deitel, Deitel & Nieto, 2001) EDI stands for electronic data interchange and it can minimize the cost,

Is technology a blessing or a curse Essay Example | Topics and Well Written Essays - 750 words

Is technology a blessing or a curse - Essay Example He describes how and older tool such as a rake can be more efficient and beneficial to the health of the user through the physical exercise he gets when he uses it. In contrast, he states that the leaf blower, although technologically more advanced, is not really that beneficial to the user and even goes as far as to suggest that it may be harmful to him because it makes an awful lot of noise and does not exert the person using it physically meaning that the opportunity for the little exercise he could have gotten from using the rake is lost. Bell uses this example of such a simple task as moving leaves to discuss the greater issues brought about by indiscriminate use of technology. His idea is that we should only use the pieces of technology that we really need and that are beneficial to us both physically and mentally, and that we should discard those that have no real benefit for us (Bell 470-473). One would agree with Bell’s argument that we use technology indiscriminately and that we rarely distinguish between its good uses from its bad ones. We tend to focus more on using the latest technological advancements and not on their benefits to us. There are times when it is better to use the so called old technology such as the rake rather than use new technology like the leaf blower which have little or no benefit to us. We should take every opportunity we have to get some physical exercise and there is no better way to do so than using technology that is physically exerting. The modern world has seriously changed our lifestyles and we are slowly moving from a lifestyle of physical exertion to one of dormancy due to the advancement of technology. However, all technology has its good and its bad sides and it is this in mind that we shall be discussing the following: the automation of industrial and household processes; changes in the modes of transport; reduction of risk to human life; data and information management; and the impact of technology on entertainment and advertising (Bell 470-473). The automation of critical industrial and household processes has reduced the amount of labor that was previously required to perform these processes. It is claimed that electronic gadgets rescue their users from the burden of performing chores. The performance of chores is one of the most basic things that a human being can do and not doing them breeds a culture of laziness among people which results in the growing cases of obesity especially in young people. There is a further claim that a lot of time is saved because these electronic gadgets do work faster. This being the beginning of the age of robotics, machines have been designed which can learn to do things with near human efficiency. Technology has led to a change in the modes of transport from the previously slow modes to the much faster ones that are used today. The creation of the automobile industry and its evolution has enabled the development of faster means of transport unlike in the previous age when animals used to be the only means of transport. If a person from the current world were uprooted and placed in the world of the early twentieth century, he would be surprised at the extremely slow means of transport that existed at that time. The invention of automated aircraft has increased the speed of travel with distances which previously used to be covered in days or even months are now being covered in a matter of minutes or hours. The risk to human life has been reduced by the use of technology and the mundane jobs once done by human workers are now being taken over by machines and this has the effect of making human labor redundant and if this trend is not stopped soon, and with the growing human population, then the

A Missionary Who Transformed a Nation Essay Example for Free

A Missionary Who Transformed a Nation Essay When Englishman William Carey (1761–1834) arrived in India in 1793, it marked a major milestone in the history of Christian missions and in the history of India. Carey established the Serampore Mission—the first modern Protestant mission in the non-English-speaking world—near Calcutta on January 10, 1800.1 From this base, he labored for nearly a quarter century to spread the gospel throughout the land. In the end his triumph was spectacular. Through his unfailing love for the people of India and his relentless campaign against â€Å"the spiritual forces of evil† (Eph. 6:12), India was literally transformed. Asian historian Hugh Tinker summarizes Carey’s impact on India this way: â€Å"And so in Serampore, on the banks of the river Hooghly, the principal elements of modern South Asia—the press, the university, social consciousness—all came to light.† 2 Who was William Carey? He was exactly the kind of man that the Lord seems to delight in using to accomplish great things; in other words, the kind of person that most of us would least expect. He was raised in a small, rural English town where he received almost no formal education. His chief source of income came through his work as a cobbler (a shoemaker). He had an awkward, homely appearance, having lost almost all his hair in childhood. Upon his arrival in India and throughout his years there, he was harassed by British colonists, deserted by his mission-sending agency, and opposed by younger missionary recruits who were sent to help him. Despite these setbacks, he became perhaps the most influential person in the largest outpost of the British Empire.3 Carey didn’t go to India merely to start new churches or set up medical clinics for the poor. He was driven by a more comprehensive vision—a vision for discipling the nation. â€Å"Carey saw India not as a foreign country to be exploited, but as his heavenly Father’s land to be loved and served, a society where truth, not ignorance, needed to rule.†4 He looked outward across the land and asked himself, â€Å"If Jesus were the Lord of India, what would it look like? What would be different?† This question set his agenda and led to his involvement in a remarkable variety of activities aimed at glorifying God and advancing His kingdom. Following are highlights of Carey’s work described in Vishal and Ruth Mangalwadi’s outstanding book The Legacy of William Carey: A Model for the Transformation of a Culture.5 Carey was horrified that India, one of the most fertile countries in the world, had been allowed to become an uncultivated jungle abandoned to wild beasts and serpents. Therefore he carried out a systematic survey of agriculture and campaigned for agriculture reform. He introduced the Linnaean system of plant organizations and published the first science texts in India. He did this because he believed that nature is declared â€Å"good† by its Creator; it is not Maya (illusion) to be shunned, as Hindus believe, but a subject worthy of human study. Carey introduced the idea of savings banks to India to fight the all-pervasive social evil of usury (the lending of money at excessive interest). He believed that God, being righteous, hated this practice which made investment, industry, commerce, and economic development impossible. He was the first to campaign for humane treatment of India’s leprosy victims because he believed that Jesus’ love extends to leprosy patie nts, so they should be cared for. Before then, lepers were often buried or burned alive because of the belief that a violent death purified the body on its way to reincarnation into a new healthy existence. He established the first newspaper ever printed in any Oriental language, because he believed that â€Å"above all forms of truth and faith, Christianity seeks free discussion.† His English-language journal, Friend of India, was the force that gave birth to the social-reform movement in India in the first half of the nineteenth century. He translated the Bible into over 40 different Indian languages. He transformed the Bengali language, previously considered â€Å"fit for only demons and women,† into the foremost literary language of India. He wrote gospel ballads in Bengali to bring the Hindu love of music to the service of his Lord. He began dozens of schools for Indian children of all castes and launched the first college in Asia. He desired to develop the Indian mind and liberate it from darkness and superstition. He was the first man to stand against the ruthless murders and widespread oppression of women. Women in India were being crushed through polygamy, female infanticide, child marriage, widow burning, euthanasia, and forced illiteracy—all sanctioned by religion. Carey opened schools for girls. When widows converted to Christianity, he arranged marriages for them. It was his persistent, 25-year battle against widow burning (known as sati) that finally led to the formal banning of this horrible religious practice. William Carey was a pioneer of the modern Christian missionary movement, a movement that has since reached every corner of the world. Although a man of simple origins, he used his God-given genius and every available means to serve his Creator and illumine the dark corners of India with the light of the truth. William Carey’s ministry in India can be described as wholistic. For something to be wholistic, it must have multiple parts that contribute to a greater whole. What is the â€Å"whole† to which all Christian ministry activities contribute? Through an examination of Christ’s earthly ministry, we see that the â€Å"whole† is glorifying God and advancing His kingdom through the discipling of the nations (Matt. 24:14; 28:18–20). This is God’s â€Å"big agenda†Ã¢â‚¬â€the principal task that he works through His church to accomplish. If this is the whole, then what are the parts? Matthew 4:23, highlights three parts: preaching, teaching, and healing. Because each part is essential to the whole, let’s look at each one more carefully. Preaching includes proclaiming the gospel—God’s gracious invitation for people everywhere to live in His Kingdom, have their sins forgiven, be spiritually reborn, and become children of God through faith in Christ. Proclaiming the gospel is essential to wholistic ministry, for unless lost and broken people are spiritually reborn into a living relationship with God—unless they become â€Å"a new creation† (2 Cor. 5:17)—all efforts to bring hope, healing, and transformation are doomed to fail. People everywhere need their relationship with God restored, yet preaching is only one part of wholistic ministry. Teaching entails instructing people in the foundational truths of Scripture. It is associated with discipleship—helping people to live in obedience to God and His Word in every area of life. In Matthew 28:20 Jesus tells His disciples to â€Å"teach [the nations] to obey everything I have commanded you.† Unless believers are taught to obey Christ’s commands, their growth may be hindered. Colossians 3:16 says, â€Å"Let the word of Christ dwell in you richly as you teach and admonish one another with all wisdom.† Healing involves the tangible demonstrations of the present reality of the Kingdom in the midst of our hurting and broken world. When Jesus came, He demonstrated the present reality of God’s Kingdom by healing people. â€Å"The blind receive sight, the lame walk, those who have leprosy are cured, the deaf hear, the dead are rais ed, and the good news is preached to the poor,† was Jesus’ report to His cousin John the Baptist in Matthew 11:4–5. Jesus didn’t just preach the good news; He demonstrated it by healing all forms of brokenness. Unless ministry to people’s physical needs accompanies evangelism and discipleship, our message will be empty, weak, and irrelevant. This is particularly true where physical poverty is rampant. The apostle John admonishes, â€Å"If anyone has material possessions and sees his brother in need but has no pity on him, how can the love of God be in him? Dear children, let us not love with words or tongue but with actions and in truth† (1 John 3:17–18). Here’s a picture of the basic elements of a biblically balanced, wholistic ministry: First, there are multiple parts—preaching, teaching and healing. These parts have distinct functions, yet they are inseparable. All are essential in contributing to the whole, which is glorifying God and advancing His Kingdom. Lastly, each part rests on the solid foundation of the biblical worldview. In other words, each is understood and implemented through the basic presuppositions of Scripture. In summary, preaching, teaching and healing are three indispensable parts of wholistic ministry, whose purpose is to advance God’s kingdom â€Å"on earth as it is in heaven† (Matt. 6:10). Without these parts working together seamlessly, our ministry is less than what Christ intends, and will lack power to transform lives and nations. To comprehend the nature and purpose of wholistic ministry, two concepts must be understood. First is the comprehensive impact of humanity’s spiritual rebellion. Second is that our loving, compassionate God is presently unfolding His plan to redeem and restore all things broken through the Fall. When Adam and Eve turned their backs on God in the Garden of Eden (Gen. 3:1–6), the consequences of their sin were devastating and far-reaching; they affected the very order of the universe. At least four relationships were broken through the Fall. First, Adam and Eve’s intimate relationship with God was broken (Gen. 3:8–9). This was the primary relationship for which they had been created, the most important aspect of their lives. When their relationship with God was broken, their other relationships were damaged too: their relationship with themselves as individuals (Gen. 3:7, 10), with each other as fellow human beings (Gen. 3:7, 12, 16), and with the rest of creation (Gen. 3:17–19). The universe is intricately designed and interwoven. It is wholistic, composed of multiple parts, each of which depends on the proper functioning of the others. All parts are governed by laws established by God. When the primary relationship between God and humanity was severed, every part of the original harmony of God’s creation was affected. The results of this comprehensive brokenness have plagued humanity ever since. War, hatred, violence, environmental degradation, injustice, corruption, idolatry, poverty and fa mine all spring from sin. Thus, when God set out to restore His creation from the all-encompassing effects of man’s rebellion, His redemptive plan could not be small or narrow, focusing on a single area of brokenness. His plan is not limited to saving human souls or teaching or even healing. Rather, it combines all three with the goal of restoring everything, including each of the four broken relationships described above. Colossians 1:19–20 provides a picture of God’s wholistic redemptive plan: For God was pleased to have all his fullness dwell in [Christ], and through him to reconcile to himself all things, whether things on earth or things in heaven, by making peace through his blood, shed on the cross. (Emphasis added) God is redeeming all things. Through Christ’s blood our sins are forgiven and our fellowship with God is renewed. And not only that—we also can experience substantial healing within ourselves, with others, and with the environment. The gospel is not only good news for after we die; it is good news here and now! The task of the church is to join God in His big agenda of restoring all things. We are â€Å"Christ’s ambassadors,† called to t he â€Å"ministry of reconciliation† (see 2 Cor. 5:18–20). In the words of Christian apologist Francis Schaeffer, we should be working â€Å"on the basis of the finished work of Christ . . . [for] substantial healing now in every area where there are divisions because of the Fall.†6 To do this, we must first believe that such healing can be a reality here and now, in every area, on the basis of the finished work of Christ. This healing will not be perfect or complete on this side of Christ’s return, yet it can be real, evident, and substantial. Preaching, teaching, and substantial healing in every area where brokenness exists as a result of the Fall—in essence, wholistic ministry—is the vision that Christ had and modeled for us on earth. It was the vision that set the agenda for William Carey in India. It is the vision that should set the agenda for our ministry as well. When Jesus sent out His disciples on their first missionary journey, â€Å"He sent them out to preach the kingdom of God and to heal the sickâ⠂¬  (Luke 9:2). Yet today it’s common for Christian ministries to separate the twin ministry components. Some focus exclusively on preaching, evangelism, or church planting, while others focus on meeting the physical needs of the broken or impoverished. Typically these two groups have little interaction. This division is not what Christ intended. By focusing on one to the exclusion of the other, ministries are limited and ineffective in bringing about true, lasting transformation. The Bible provides a model of ministry where preaching, teaching, and healing are, in the words of Dr. Tetsunao Yamamori, â€Å"functionally separate, yet relationally inseparable.†7 Each part is distinct and deserves special attention and focus. Yet the parts must function together. Together they form a wholistic ministry that is both powerful and effective—a ministry able to transform lives and entire nations. The work of William Carey in India gives historical testimony to this fact. According to theologian David Wells, preaching, teaching, and healing must be â€Å"inextricably related to each other, the former being the foundation and the latter being the evidence of the working of the former.† There is a story told about the subject of the following sketch which may be repeated here by way of introduction. It is said that long after he had attained to fame and eminence in India, being Professor of oriental languages in the college of Fort William, honoured with letters and medals from royal hands, and able to write F.L.S., F.G S., F.A.S., and other symbols of distinction after his name, he was dining one day with a select company at the Governor-Generals, when one of the guests, with more than questionable taste, asked an aide-de-camp present, in a whisper loud enough to be heard by the professor, whether Dr. Carey had not once been a shoemaker. No, sir, immediately answered the doctor, only a cobbler! Whether he was proud of it, we cannot say; that he had no need to be ashamed of it, we are sure. He had out-lived the day when Edinburgh reviewers tried to heap contempt on consecrated cobblers, and he had established his right to be enrolled amongst the aristocracy of learning and philanthropy. Some fifty years before this incident took place, a visitor might have seen over a small shop in a Northamptonshire village a sign-board with the following inscription: Second-hand Shoes Bought and Sold.WILLIAM CAREY.| The owner of this humble shop was the son of a poor schoolmaster, who inherited a taste for learning; and though he was consigned to the drudgery of mending boots and shoes, and was even then a sickly, care-worn man, in poverty and distress, with a delicate and unsympathizing wife, he lost no opportunity of acquiring information both in languages and natural history and taught himself drawing and painting. He always worked with lexicons and classics open upon his bench; so that Scott, the commentator, to whom it is said that he owed his earliest religious impressions, used to call that shop Mr. Careys college. His tastes — we ought rather to say Gods providence — soon led him to open a village school; and as he belonged to the Baptist community, he combined with the office of schoolmaster that of a preacher in their little chapel at Moulton, with the scanty salary of  £16 a year. Strange to say, it was whilst giving his daily lessons in geography that the flame of mis sionary zeal was kindled in his bosom. As he looked upon the vast regions depicted on the map of the world, he began to ponder on the spiritual darkness that brooded over so many of them, and this led him to collect and collate information on the subject, until his whole mind was occupied with the absorbing theme. It so happened that a gathering of Baptist ministers at Northampton invited a subject for discussion, and Carey, who was present, at once proposed The duty of Christians to attempt the spread of the Gospel amongst heathen nations. The proposal fell amongst them like a bombshell, and the young man was almost shouted down by those who thought such a scheme impracticable and wild. Even Andrew Fuller, who eventually became his great supporter, confessed that he found himself ready to exclaim, If the Lord would make windows in heaven, might this thing be? But Careys zeal was not to be quenched. He brought forward the topic again and again; he wrote a pamphlet on the subject; and on his removal to a more important pos t of duty at Leicester, he won over several influential persons to his views. It was at this time (1792) he preached his famous sermon from Isaiah 54:2,3, and summed up its teaching in these two important statements: (1) Expect great things from God, and (2) Attempt great things for God. This led to the formation of the Baptist Missionary Society; and Carey, at the age of thirty-three, proved his sincerity by volunteering to be its first messenger to the heathen. Andrew Fuller had said, There is a gold mine in India; but it seems as deep as the centre of the earth; who will venture to explore it? I will go down, responded William Carey, in words never to be forgotten, but remember that you must hold the rope. The funds of the Society amounted at the time to  £13 2s 6d. But the chief difficulties did not arise out of questions of finance. The East India Company, sharing the jealousy against missionary effort, which, alas! at that time was to be found amongst the chief statesmen of the realm, and amongst prelates of the Established Church as well as amongst No nconformist ministers, were opposed to all such efforts, and no one could set his foot upon the Companys territory without a special license. The missionary party and their baggage were on board the Earl of Oxford and the ship was just ready to sail, when an information was laid against the captain for taking a person on board without an order from the Company, and forthwith the passengers and their goods were hastily put on shore, and the vessel weighed anchor for Calcutta, leaving them behind, disappointed and disheartened. They returned to London. Mr. Thomas, who was Careys companion and brother missionary, went to a coffee-house, when, to use his own language, to the great joy of a bruised heart, the waiter put a card into my hand, whereon were written these life-giving words: A Danish East Indiaman, No. 10, Cannon Street. No more tears that night. Our courage revived; we fled to No. 10, Cannon Street, and found it was the office of Smith and Co., agents, and that Mr. Smith was a brother of the captains; that this ship had sailed, as he supposed, from Copenhagen; was hourly expected in Dover roads; would make no stay t here; and the terms were  £100 for each passenger,  £50 for a child, and  £25 for an attendant. This of course brought up the financial difficulty in a new and aggravated form; but the generosity of the agent and owner of the ship soon overcame it, and within twenty-four hours of their return to London, Mr. Carey and his party embarked for Dover; and on the 13th June, 1793, they found themselves on board the Kron Princessa Maria, where they were treated with the utmost kindness by the captain, who admitted them to his own table, and provided them with special cabins. The delay, singularly enough, removed one of Careys chief difficulties and regrets. His wife who was physically feeble, and whose deficiency in respect to moral intrepidity was afterwards painfully accounted for by twelve years of insanity in India, had positively refused to accompany him, and he had consequently made up his mind to go out alone. She was not with him when he and his party were suddenly expelled from the English ship; but she was so wrought upon by all that had occurred, as well as by renewed entreaties, that with her sister and her five children she set sail with him for Calcutta. Difficulties of various kinds surrounded them upon their arrival in India. Poverty, fevers, bereavement, the sad illness of his wife, the jealousy of the Government, all combined to render it necessary that for a while Carey should betake himself to an employment in the Sunderbunds, where he had often to use his gun to supply the wants of his family; and eventually he went to an indigo factory at Mudnabully, where he hoped to earn a livelihood. But he kept the grand project of his life distinctly in view; he set himself to the acquisition of the language, he erected schools, he made missionary tours, he began to translate the New Testament, and above all he worked at his printing press, which was set up in one corner of the factory and was looked upon by the natives as his god. Careys feelings at this time with regard to his work will be best expressed in the following passage from a letter to his sisters: I know not what to say about the mission. I feel as a farmer does about his crop; sometimes I think the seed is springing, and then I hope; a little time blasts all, and my hopes are gone like a cloud. I preach every day to the natives, and twice on the Lords Day constantly, besides other itinerant labours; and I try to speak of Jesus Christ and Him crucified and of Him alone; but my soul is often dejected to see no fruit. And then he goes on to speak of that department of his labour in which his greatest achievements were ultimately to be won: The work of translation is going on, and I hope the whole New Testament and the five books of Moses may be completed before this reaches you. It is a pleasant work and a rich reward, and I trust, whenever it is published, it will soon prevail, and put down all the Shastras of the Hindus. The translation of the Scriptures I look upon to be one of the greatest desiderata in the world, and it has accordingly occupied a considerable part of my time and attention. Five or six years of patient unrequited toil passed by, and then four additional labourers were sent out by the Society to Careys help. Two of them will never be forgotten, and the names of Carey, Marshman, and Ward will ever be inseparably linked in the history of Indian missions. Ward had been a printer; and it was a saying of Careys, addressed to him in England, that led him to adopt a missionarys life: We shall want you, said he, in a few years, to print the Bible; you must come after us. Marshman had been an assistant in a London book-shop, but soon found that his business there was not to his taste, as he wished to know more about the contents of books than about their covers; so he set up a school at Bristol, mastered Greek and Latin, Hebrew and Syriac, and became prosperous in the world; but he gave up all to join Carey in his noble enterprise, and moreover, brought out with him, as a helper in the mission, a young man whom he himself had been the means of converting from inf idelity. Marshmans wife was a cultivated woman, and her boarding school in India brought in a good revenue to the mission treasury. His daughter married Henry Havelock, who made for himself as great a name in the military annals of his country as his illustrious father-in-law had won for himself in the missionary history of the world. The jealous and unchristian policy of the East India Company would not allow the newly arrived missionaries to join their brethren, and they were compelled to seek shelter under a foreign flag. Fortunately for the cause of missions, a settlement had been secured by the Danes at Serampore, some sixteen miles up the river from Calcutta, and it now proved a city of refuge to Englishmen who had been driven from territory which owned the British sway. The governor of the colony, Colonel Bie, was a grand specimen of his race; he had been in early days a pupil of Schwartz, and he rejoiced in knowing that the kings of Denmark had been the first Protestant princes that ever encouraged missions amongst the heathen. He gave the exiled missionaries a generous welcome and again and again gallant ly resisted all attempts to deprive them of his protection, declaring that if the British Government still refused to sanction their continuance in India, they should have the shield of Denmark thrown over them if they would remain at Serampore. Carey determined, though it was accompanied with personal loss to himself, to join his brethren at Serampore, and the mission soon was organized in that place, which became, so to speak, the cradle of Indian missions. It possessed many advantages: it was only sixty miles from Nuddea, and was within a hundred of the Mahratta country; here the missionaries could preach the Gospel and work their printing press without fear, and from this place they could pass under Danish passports to any part of India. There was a special providence in their coming to Serampore at the time they did; for in 1801 it passed over to English rule without the firing of a shot. They were soon at work, both in their schools and on their preaching tours. Living on homely fare and working for their bread, they went forth betimes in pairs to preach the word of the living God, now in the streets or in the bazaars, now in the midst of heathen temples, attracting crowds to hear them by the sweet hymns which Carey ha d composed in the native tongue, and inviting inquirers to the mission-house for further instruction. The first convert was baptized in the same year on the day after Christmas. His name was Krishnu. He had been brought to the mission-house for medical relief, and was so influenced by what he saw and heard, that he resolved to become a Christian. On breaking caste by eating with the missionaries, he was seized by an enraged mob and dragged before the magistrate, but to their dismay he was released from their hands. Carey had the pleasure of performing the ceremony of baptism with his own hands, in presence of the governor and a crowd of natives and Europeans. It was his first recompense after seven years of toil, and it soon led the way to other conversions. Amongst the rest, a high-caste Brahmin divested himself of his sacred thread, joined the Christian ranks, and preached the faith which he once destroyed. Krishnu became an efficient helper and built at his own expense the first place of worship for native Christians in Bengal. Writing about him twelve years after his baptism, Car ey says, He is now a steady, zealous, well-informed, and I may add eloquent minister of the Gospel, and preaches on an average twelve or fourteen times every week in Calcutta and its neighborhood. But we must turn from the other laborers and the general work of the mission to dwell upon the special work for which Careys tastes and qualifications so admirably fitted him. We have seen that his heart was set on the translation and printing of the Scriptures and to this from the outset he sedulously devoted himself. On the 17th March, 1800 the first sheet of the Bengali New Testament was ready for the press, and in the next year Carey was able to say, I have lived to see the Bible translated into Bengali, and the whole New Testament printed. But this was far from being the end of Careys enterprise. In 1806, the Serampore missionaries contemplated and issued proposals for rendering the Holy Scriptures into fifteen oriental languages, viz., Sanskrit, Bengali, Hindustani, Persian, Mahratta, Guzarathi, Oriya, Kurnata, Telinga, Burman, Assam, Boutan, Thibetan, Malay, and Chinese. Professor Wilson, the Boden Professor of Sanscrit at Oxford, has told us how this proposal was more than ac complished: They published, he says, in the course of about five-and-twenty years, translations of portions of the Old and New Testament, more or less considerable, in forty different dialects. It is not pretended that they were conversant with all these forms of speech, but they employed competent natives, and as they themselves were masters of Sanscrit and several vernacular dialects, they were able to guide and superintend them. In all this work Dr. Carey (for the degree of Doctor of Divinity had been bestowed on him by a learned university) took a leading part. Possessed of at least six different dialects, a thorough master of the Sanscrit, which is the parent of the whole family, and gifted besides with a rare genius for philological investigation, he carried the project, says the professor, to as successful an issue as could have been expected from the bounded faculties of man. And when it is remembered that he began his work at a time when there were no helps or appliances for his studies; when grammars and dictionaries of these dialects were unknown, and had to be constructed by himself; when even manuscripts of them were scarce, and printing was utterly unknown to the natives of Bengal, the work which he not only set before him, but accomplished, must be admitted to have been Herculean. Frequently did he weary out three pundits in the day, and to the last hour of his life he never intermitted his labours. The following apology for not engaging more extensively in correspondence will be read with interest, and allowed to be a sufficient one:— I translate from Bengali and from Sanscrit into English. Every proof-sheet of the Bengali and Mahratta Scriptures must go three times at least through my hands. A dictionary of the Sanscrit goes once at least through my hands. I have written and printed a second edition of the Bengali grammar and collected materials for a Mahratta dictionary. Besides this, I preach twice a week, frequently thrice, and attend upon my collegiate duties. I do not mention this because I think my work a burden — it is a real pleasure — but to show that my not writing many letters is not because I neglect my brethren, or wish them to cease writing to me. Carey was by no means a man of brilliant genius, still less was he a man of warm enthusiasm; he had nothing of the sentimental, or speculative, or imaginative in his disposition; but he was a man of untiring energy and indomitable perseverance. Difficulties seemed only to develop the one and to increase the other. These difficulties arose from various quarters, sometimes from the opposition of the heathen, sometimes from the antagonism of the British Government, sometimes, and more painfully, from the misapprehensions or injudiciousness of the Society at home; but he never was dismayed. On the contrary, he gathered arguments for progress from the opposition that was made to it. There is, he writes a very considerable difference in the appearance of the mission, which to me is encouraging. The Brahmins are now most inveterate in their opposition; they oppose the Gospel with the utmost virulence, and the very name of Jesus Christ seems abominable in their ears. And all this is the more remarkable, when we remember that he was by nature indolent. He says of himself, No man ever living felt inertia to so great a degree as I do. He was in all respects a man of principle and not of impulse. Kind and gentle, he was yet firm and unwavering. Disliking compliments and commendations for himself, it was not his habit to bestow them upon others. Indeed, he tells us that the only attempt which he ever made to pay a compliment met with such discouragement, that he never had any inclination to renew the attempt. A nephew of the celebrated President Edwards called upon him with a letter of introduction, and Carey congratulated him on his relationship to so great a personage; but the young man dryly replied, True, sir, but every tub must stand on its own bottom. From his childhood he had been in earnest in respect to anything he undertook. He once tried to climb a tree and reach a nest, but failed, and soon came to the ground; yet, though he had to limp home bruised and wounded, the first thing he did when able again to leave the house was to climb that same tree and take that identical nest. This habit of perseverance followed him through life. One evening, just before the missionaries retired to rest, the printing office was di scovered to be on fire, and in a short time it was totally destroyed. Buildings, types, paper, proofs, and, worse than all, the Sanscrit and other translations perished in the flames. Ten thousand pounds worth of property was destroyed that night, no portion of which was covered by insurance; but under the master mind of Carey the disaster was soon retrieved. A portion of the metal was recovered from the wreck, and as the punches and matrices had been saved, the types were speedily recast. Within two months the printers were again at their work; within two more the sum required to repair the premises had been collected; and within seven the Scriptures had been re-translated into the Sanscrit language. Carey preached on the next Lords-day after the conflagration, from the text, Be still, and know that I am God, and set before his hearers two thoughts: (1) God has a sovereign right to dispose of us as He pleases; (2) we ought to acquiesce in all that God does with us and to us. Writing to a friend at this time, he calmly remarks that traveling a road the second time, however painful it may be, is usually done with greater ease and certainty than when we travel it for the first time. To such a man success was already assured, and by such a man success was well deserved. And it came. When the Government looked round for a suitable man to fill the chair of oriental languages in their college at Fort William, their choice fell, almost as a necessity, upon the greatest scholar in India, and so the persecuted missionary became the honoured Professor of Sanscrit, Bengali, and Mahratta, at one thousand rupees a month. He stipulated, however, that he would accept the office only on the condition that his position as a missionary should be recognized; and he took a noble revenge upon those who had so long opposed his work, by devoting the whole of his newly-acquired salary to its further extension. His new position served to call attention to missionary work; and by degrees a better feeling sprang up towards it both at home and abroad. Carey and his companions were at length able to preach in the bazaars of Calcutta. Fresh labourers had come to India. Corrie, Browne, Mart yn, and Buchanan were stirring the depths of Christian sympathy by their work and by their appeals. Grant, Wilberforce, and Macaulay were rousing the British nation to some faint sense of duty; so that when the charter of the East India Company came to be renewed in 1813, the restrictive regulations were defeated in the House of Commons by a majority of more than two to one. In the very next year the foundations of the Indian Episcopate were laid; and in the following year Dr. Middleton, the first Metropolitan of India (having Ceylon for one archdeaconry, and Australia for another) was visiting the Serampore missionaries, in company with the Governor-General, and expressing his admiration and astonishment at their work. Distinctions crowded fast upon the Northamptonshire cobbler. Learned societies thought themselves honoured by admitting him to membership. He had proved himself a useful citizen as well as a devoted missionary. He had established a botanic garden, and edited The Flora Indica; he had founded an agricultural society, and was elected its president; he suggested a plantation committee for India and was its most active member; he collected a splendid museum of natural history which he bequeathed to his college; he was an early associate of the Asiatic Society, and contributed largely to its researches; he had translated the Ramayana, the most ancient poem in the Sanscrit language, into three volumes; he was a constant writer in the Friend of India; he founded a college of his own, and obtained for it a royal charter from the King of Denmark; and in these and other ways he helped forward the moral and political reforms which have done so much for Hindustan. He was one of the first to memorialize the Government against the horrid infanticides at Sangor, and he lived to see them put down. He was early in the field to denounce the murderous abominations of the Suttee [sati], and to oppose to them th e authority even of the Hindu Vedas, and he had the satisfaction of seeing them abolished by Lord William Bentinck. He protested all along against the pilgrim tax, and the support afforded by the Bengal Government to the worship of juggernaut, and he did not die until he saw the subject taken up by others who carried it to a triumphant issue. What would have been his devout gratitude, had he lived to see the last links of connection between the Government and the idol temples severed in 1840, and Hindu and Mohammedan laws, which inflicted forfeiture of all civil rights on those who became Christians, abrogated by the Lex Loci Act of 1850! What would have been the joy of Carey, of Martyn, or of Corrie, could they have heard the testimony borne to the character and success of missions in India by Sir Richard Temple, the late Governor of Madras, at a public meeting held last year in Birmingham! He said, I have governed a hundred and five millions of the inhabitants of India, and I have been concerned with eighty-five millions more in my official capacity. I have thus had acquaintance with, or been au thentically informed regarding, nearly all the missionaries of all the societies labouring in India within the last forty years. And what is my testimony concerning these men? They are most efficient as pastors of their native flocks, and as evangelists in preaching in cities and villages from one end of India to the other. In the work of converting the heathen to the knowledge and practice of the Christian religion, they show great learning in all that relates to the native religion and to the caste system. They are, too, the active and energetic friends of the natives in all times of danger and emergency. So far as to the character of the missionaries. Speaking of their success, he said, It has sometimes been stated in the public prints, which speak with authority, that their progress has been arrested. Now, is this really the case? Remember that missionary work in India began in the year 1813, or sixty-seven years ago. There are in the present year not less than 350,000 native Christians, besides 150,000 scholars, who, though not all Christians, are receiving Christian instruction; that is, 500,000 people, or half a million, brought under the influence of Christianity. And the annual rate of increase in the number of native Christians has progressed with advancing years. At first it was reckoned by hundreds yearly, then by thousands, and further on by tens of thousands. But it will be asked, what is the character of these Christian converts in India? what practically is their conduct as Christians? Now, I am not about to claim for them any extreme degree of Christian perfection. But speaking of them as a class, I venture to affirm that the Christian religion has exercised a dominant influence over their lives and has made a decided mark on their conduct. They adhere to their faith under social difficulties. Large sacrifices have to be made by them. The number of apostates may almost be counted on the fingers. There is no such thing as decay in religion, nor any retrogression towards heathenism. On the contrary, they exhibit a laudable desire for the self-support and government of their Church. I believe that if hereafter, during any revolution, any attempts were to be made by secular violence to drive the native Christians back from their religion, many of them would attest their faith by martyrdom. Carey was not the man to wish or to expect that Government should step out of its sphere in order to enforce Christianity upon the natives. Do you not think, Dr. Carey, asked a Governor-General, that it would be wrong to force the Hindus to be Christians? My Lord, was the reply, the thing is impossible; we may, indeed, force men to be hypocrites, but no power on earth can force men to become Christians. Carey, however, was too clear-headed not to see, and too honest not to say, that it was one thing to profess neutrality, and anothe r to sanction idolatry; that it was one thing to abstain from using earthly power to propagate truth, and quite another to thwart rational and scriptural methods of diffusing it. And he was too much of a statesman, as well as too much of a missionary, not to see that in respect to some tenets of the Hindu system it would be impossible for the Government eventually to remain neutral, inasmuch as they subverted the very foundations upon which all government is based. Such was the man who in the sequel won deserved honour even from hostile critics, and earned high encomiums from even prejudiced judges. Well might Lord Wellesley, who was, perhaps, the greatest of Indian statesmen, say concerning him, after listening to the first Sanscrit speech ever delivered in India by an European, and hearing that in it Carey had recognized his noble efforts for the good of India, I esteem such a testimony from such a man a greater honour than the applause of courts and parliaments. Still, amidst all his labours and all his honours, he kept the missionary enterprise distinctly in view, and during the forty years of his residence in India he gave it the foremost place. Several opportunities and no small inducements for returning to his native land were presented to him, but he declined them all. I account this my own country, he said, and have not the least inclination to leave it; and he never did. To the last his translations of the Scriptures and his printing press were his chief care and his chief delight. He counted it so sacred a work that he believed that a portion of the Lords-day could not be better employed than in correcting his proof-sheets. In his seventy-third year, when weak from illness and old age, and drawing near to death, he writes, I am now only able to sit and to lie upon my couch, and now and then to read a proof-sheet of the Scriptures; but I am too weak to walk more than across the house, nor can I stand even a few minutes without support. His last work was to revise his Bengali Bible, and on completing it he says, There is scarcely anything for which I desired to live a little longer so much as for that. He went back to Serampore to die; and he died in the presence of all his brethren. It must have been a touching sight to see Dr. Wilson, the Metropolitan of India, standing by the death-bed of the dying Baptist, and asking for his blessing. It bore witness to the large-heartedness both of the prelate and of the missionary, and was a scene that did honour alike to the living and to the dying. Carey in his will directed that his funeral should be as plain as possible; that he should be laid in the same grave with his second wife, the accomplished Charlotte Rumohr, who had been a real helper to him in his work; and that on the simple stone which marked his grave there should be placed this inscription, and no more.

The bone disorders

The bone disorders Introduction There are many different types of bone disorders and these can have vast implications on a patient suffering from any particular one of these bone disorder. There 7 main categories of bone disorders listed below, each of which will be discussed in detail. Genetic (inherited) disorders, i.e. Achondroplasia, Osteogenesis imperfecta. Nutritional disorders, i.e. Rickets, Osteomalacia. Autoimmune disorders, i.e. Rheumotid Arthritis Degenerative disorders, i.e. Osteoarthritis. Bone tumours, i.e. Primary Bone Cancer, Secondary Bone Cancer. Hormonal disorders, i.e. Osteoporosis. Pagets disease. Genetic (inherited) disorders. Achondroplasia. Achondroplasia is genetic disorder and is the main type of short-limbed dwarfism that takes place in humans, occurring amongst 1 in 15,000 and 40,000 live births. It has been estimated that about 90% of cases of achondroplasia are sporadic, and on average, there is a rise of paternal age at the moment of conception of affected individuals (Vajo et al., 2000). The literal meaning of achondroplasia is without the formation of cartilage, and sufferers have difficulty with bone growth. Achondroplasia affects mainly long bones e.g. legs and arms. It is an Autosomal Dominant Gene Defect (ADGI), and leads to the conversion of cartilage into bone. It occurs when one of the 22 non-sex genes is mutated, and this mutated gene has now been identified to be located on chromosome 4, which is known to be the Fibroblast Growth Factor Receptor 3 (FGFR3). Symptoms; Achondroplasia is typically distinguished by the formation of a long, narrow trunk and short limbs. Some other usual symptoms of achondroplasia include hyperextensibilty of joints in particular at the knees and hands, however the rotation of the elbow is limited as well being unable to fully extend. Sufferers of Achondroplasia normally have a large head, short broad hands, and suffer from hypertonia (poor muscle tone). Spinal cord compression at the cervicalmedullary junction is another typical feature of achondroplasia patients (Horton et al., 2007). The location of the mutated gene associated with achondroplasia was mapped to chromosome 4p16.3 in 1994, and this was followed soon after by the identification of the heterozygous mutations of FGFR3 (Rousseau et al., 1994). It has been further discovered that children that have FGFR3 mutations, they parents generally do not have the FGFR3 mutation, and there has also been a strong association between advanced paternal age, in particular over 35 years of age. Diagnosis; Because the symptoms of achondroplasia are very distinguishable, the diagnosis at birth should not be a problem. However, it has been estimated that about 20% of individuals are not diagnosed with achondroplasia at birth (Trotter et al., 2005). A common method that has been employed and widely used for the diagnosis of achondroplasia is prenatal ultrasound. This method detects effected foetuses in the third trimester of pregnancy. The diagnosis of Achondroplasia can be carried out via CVS (Chronic Villus Sampling), followed by molecular gene tests. CVS is a test that is carried out before birth, in which cells are inspected. Molecular genetic testing is carried out in order to identify possible mutations. Treatment; There is no clear treatment for achondroplasia, and there are many tests that are ongoing in order to do find one. The use of human growth hormone has been proposed as a possible method of treatment. Tests have shown that there was an initial increase in growth rate of subjects with achondroplasia, nevertheless, the long-term benefits of such treatment have not been made clear, and many experts do not recommend it (Horton et al., 1992). In order to increase the stature of achondroplasia patients, surgical limb lengthening is another proposed method to help achondroplasia patients. The typical method compromises of different bones being broken, i.e. femur, tibiae, and humeri, after which orthopaedic appliances are used in order to carry out slow stretching during the healing process. Although this method increases the standing height of the patient, this method is also not recommended due to the many complications arising from it. These complications include, the need of repeated surgeries, wound infections and problems arising from the stretching of skeletal tissue such as blood vessels. Osteogenesis Imperfecta. Osteogenesis imperfecta is a bone disorder causing imperfect bone formation. It effects roughly 1/5,000 to 1/10,000 individuals (Sillence et al., 1979). It occurs as a result of a poor quality of collagen or a lack of collagen production, and can lead to fragile bones that are easily broken and have a low bone mass. Another distinguishable characteristic of osteogenesis imperfecta patients is an s-shaped spine that can eventually break. Osteogenesis imperfecta occurs as a result of mutations in the genes that encode the chains of type I collagen. Type I collagen is the main protein found in bone. Genetically inherited cases of osteogenesis imperfecta normally show very mild symptoms. However, spontaneous cases are often more severe. Symptoms; The symptoms of osteogenesis Imperfecta range in severity, from intrauterine fractures and perinatal lethality, to very mild fractures. Diagnosis; The diagnosis of osteogenesis imperfecta in individuals with a family history of the disease is rather simple, but more difficult in those that do not have a family history. Generally osteogenesis imperfecta is diagnosed clinically, and based on the physical symptoms associated with the disease Osteogenesis imperfecta can be diagnosed via a collagen biopsy test, which is a new method. This test is known to identify 90% of osteogenesis imperfecta cases. Ultrasound is another method that can be used for diagnosis, and can detect more severe types of Osteogenesis imperfecta, even at the foetus phase and also 16 weeks into pregnancy. Test such as those that include culturing cells, and observing the collagen produced can also be carried out, as well as using blood samples to examine mutations of the collagen manufacturing genes. Although these types of tests can be useful in the diagnosis of osteogenesis imperfecta to some extent, they are generally no more than 85% accurate. Treatment; Currently there is no known cure for osteogenesis imperfecta. However particular emphasis has been placed on prevention on injury and maintaining healthy bones particularly in younger children. Supplements of calcium and phosphorus help increase bone density. Also Biophosphates are used, and these are drugs that help decrease the rate of bone resorption. Biophosphates have been clearly shown to prevent bone fractures from occurring and also increasing the bone strength and density. Growth hormones has been previously proposed as a possible treatment for osteogenesis imperfecta (Kruse and Kuhlencordt, 1975). However this has been later dismissed, and although the use of growth hormone in combination with Biophosphates may be a useful treatment, this has not yet been tested. Metal bone plates are also used for patients with more severe fractures, and helps to strengthen and reduce fractures of the affected bones, mainly long bones e.g. arms and legs. Nutritional disorders. Rickets and Osteomalacia. Rickets is a nutritional bone disorder which is found in children. It is known to affect about 1 in 1000 children in the UK alone. A very similar disorder takes place amongst adults and this is known as osteomalacia. Both these disorders occur as a result of abnormal mineralisation (calcification) of bone and cartilage. The body transfers calcium and vitamins from the bone into the blood due to vitamin deficiency i.e. deficiency in Vitamin D and calcium. This demineralisation subsequently leads to bone deformity, and thus the bones become soft and very vulnerable to fractures. There are many reasons that cause vitamin deficiency that subsequently leads to rickets and osteomalacia. Some of which include nutritional deficiency (poor diet), poor lifestyle (lack of exercise), insufficient sunlight exposure (remaining indoors for long periods of time) and abnormal metabolism (liver and kidney disease, chronic renal failure etc) (de Menezes Filho et al., 2006). Another main cause of rickets in children is due to the baby receiving a lack of vitamin D in the womb from the mother who may also be deficient in vitamin D. Symptoms; Symptoms of rickets and osteomalacia include; Growth retardation. Deformities in the upper and lower limbs. Insufficient weight gain in children. High vulnerability to bone fractures. Bone pain. Muscle weakness. Pelvic flattening. Bowing legs. Defects in structure of teeth. Diagnosis; A physical examination will firstly help to identify bone deformities and multiple fractures. A medical history check can also help to identify a possible genetic link. The levels of parathyroid hormone and alkaline phosphate will increase in the blood as a result of deficiency in vitamin D and calcium. These hormones are responsible for the transfer of minerals and vitamins from the blood to the bone. This rise in the bloodstream is a major sign of rickets and osteomalacia, and blood tests carried out to see this elevated rise of these hormones is a good method for diagnosis. X-rays can also show the demineralisation of the bone and reveal any abnormal bone structures. Treatment; Replacing vitamin D, calcium, and other necessary minerals in patients with rickets and osteomalacia is very important, and is the main method of treatment. Babies that received a lack of vitamin D whilst in the womb of their mother, or a shortage from their mothers milk should be given vitamin drops, e.g. Abidec, to help increase their levels of vitamin D. Food rich in Vitamin D and calcium are highly advised, and offer a replacement for their deficiency. These types of food include oily fish (tuna, salmon herrings, mackerels), dairy products (milk, yoghurt), liver, Vitamin supplements can also be prescribed from a doctor. An injection of vitamin D (calciferol) is also available and can last up to a year before another injection is needed. Adequate exposure to sunlight is also highly recommended. Autoimmune disorders. Rheumatoid arthritis (RA). It has been estimated that at least 1 in 100 people suffer from RA, and that in the UK alone there are about 400,000- 500,000 sufferers. It is a chronic inflammatory disease mainly affecting synovial membrane, cartilage and bone. This then can lead to joint destruction, which is typically distinguished by gradual bone erosion, and is the main cause of disability in RA. RA causes the immune system to start producing antibodies, which attack the lining of joints (synovium), and tissues (tendons), and so thus resulting in inflammation and swelling. In response to this, the body releases a special synovium thickening chemical which causes the joint to wear away and loose its shape, and eventually the joint is completely destroyed. RA is also systemic and can spread to other tissues and other parts of the body causing more problems mainly in the hands, feet and spine. In very severe cases the disease can spread to organs and this can be very critical. RA does not occur at a particular age group, and the disorder can develop at any age in sufferers lifetime. However, more commonly RA occurs in patients that are between the ages of 30 to 60 years old. The causes of RA are still relatively unknown, however that have been several theories involving possible genes that can cause RA (Barton and Worthington, 2009). RA may also occur as a result of pollution (bacteria, fungi, viruses). Symptoms; Symptoms of RA include; Swelling of joints. Stiffness, particularly early in the morning. Inflammation. Formation of rheumatoid nodules, which appear on hands, feet and elbows. Flu like symptoms such as fever. Weight loss. Diagnosis; The diagnosis of RA is rather difficult, due to the fact that the main symptoms of RA inflammation and joint stiffness/swelling, and these symptoms can be commonly associated with other diseases/disorders. A full family history is looked at first in order to establish any hereditary traits of RA in the patient. Imaging techniques such as X-rays, CT scans and ultrasound can used to look at rheumatic erosion (the disappearance of bones/joints). However, it can be difficult to diagnose RA in the early stages of the disorder, as there may not be any physical changes during these stages. The cytokines TNF (tumour necrosis factor) and IL-1 (Interlukin-1) are responsible for further inflammation which occurs in people that suffer from RA. Both of these cytokines are present in the joint of people with RA, and checking for the presence of these cytokines at joints is a method used to diagnose RA. ESR (erythrocyte sedimentation rate) is also another blood test that can be used to diagnose RA. It is a measure of the rate in which red blood precipitate in a period of 1 hour, and is a non specific measure of inflammation. The CRP test (C-reactive protein test) is the second most popular diagnosis test for RA. In response to inflammation of tendon/ligaments, the liver produces C-reactive proteins, and this test is used to detect the presence of these proteins in the blood. The antibody RF (Rheumatoid factor) is present in the blood of sufferers of RA. Therefore blood tests to identify the presence of this antibody in the blood, 8 out of 10 times will diagnose a person that is suffering from RA. Treatment; Currently there is no clear treatment for RA, however there a few drugs available that either help relieve some of the symptoms, or to help modify the disorder. Pain killers such as paracetamol and ibuprofen can help relieve some of the symptoms of RA. NSAIDs (non-steroidal anti-inflammatory drugs) are also a set of pain killers e.g. diclofenac, ibuprofen and naproxen, and help to control joint pain and stiffness. Although these drugs help with the symptoms of RA they do not directly impede the development of RA. Furthermore, there are many common side effects associated with NSAIDs including diarrhoea, nausea, increased risk of myocardial infarction etc. Disease modifying anti-arthritic/antirhumatic drugs (DMARDS) are drugs that function by blocking the affect of certain chemicals i.e. TNF following the damage of bone, joints, tendons and ligaments. These drugs not only ease the pain and stiffness related to RA, but also slow the progression of the condition. Maintaining a healthy lifestyle for an individual suffering from RA is also vital as it reduces the chances of further complications arising from the disease. There are also many therapies e.g. acupuncture, hydrotherapy, and also arthroplasty which can significantly help with the pain and joint stiffness linked to the disorder. Degenerative disorders. Osteoarthritis (OA). Osteoarthritis is an age-related disease that ultimately has an effect on each individual, who live onto they senior years (Wong and Carter, 2003). The pain associated with osteoarthritis typically emerges from the degeneration of the cartilage between the joints, as a result of primary osteoarthritis, or from trauma bringing about the loss of cartilage (Temenoff and Mikos, 2000). Given that cartilage demonstrates a poor ability to self-repair, these injuries are sustained for years and can ultimately bring about further degeneration (secondary osteoarthritis) (ODriscoll, 1998). The degeneration of cartilage causes bone ends to become exposed, and the deposition of new osseous tissue on the bone ends. This also reduces the space in the joint cavity and limits movement (Gerard J. Tortora, 2007). The underlying bone also forms osteophytes (spikes) which grow outwards due to the bone compensating for the loss of cartilage, and this hinders joint movement and causes pain. It has been estimated that roughly 36 million Americans are diagnosed with this form of arthritis (Temenoff and Mikos, 2000). Osteoarthritis is also the main reaso n as to why many individuals undergo hip and knee replacement surgery (Wilson et al., 2005), and is also the main cause of mobility impairment in elder individuals (Buckwalter, 1997). Symptoms; Acute pain causing stiffness and lack of joint movement is the main symptom of OA. The capsule surrounding joints become bigger due to inflammation and this reduces mobility, and thus muscles at the joint become weaker. Other symptoms include spasm and contractions in the tendons; accumulation of fluid at joints, muscle weakness, and hardy bone enlargements in small joints i.e. fingers and toes. Diagnosis; There is no single test used to diagnose OA. A physical examination can show a lack of mobility, joint weakness and swelling. X-rays can show the loss of joint space and in extreme cases the presence of osteophytes. Treatment; There is advanced research going into ways to engineer cartilage to help patients suffering from OA, although a major breakthrough has yet been developed. Instead a healthy lifestyle i.e. loss of weight and exercise is highly advised Sufferers are advised to exercise the affected area as this will enable better support for affected joints and strengthen the muscles surrounding the joint. This also helps in increasing the mobility of the joints, balance and posture. Drugs such as NSAIDs (non-steroidal anti-inflammatory drugs) i.e. ibuprofen can help in relieving pain and reducing inflammation. However the long term use of these types of drugs can cause many adverse reactions. Bone tumours. A Bone tumour is the neoplastic growth of tissue in bone i.e. cells in tissue continually dividing resulting in the formation of the tumour, and can be benign or malignant. This tumour can further spread throughout the body via the lymph system. The lymph system contains lymphocytes and phagocytes, and a further function of the lymph system is to remove worn out red blood cells. There are two main categories of bone tumours, primary bone tumours and secondary bone tumours. Primary bone tumours can be localised or can spread (malignant), and these bone tumours derive from within the tissue. Primary tumours can be further divided into benign tumours and cancer. Secondary bone tumours derive from other tumours from a different part of the body and spread to the tissue via the blood. The mutation of the P53 gene which suppresses bone tumour is thought to responsible for the formation of bone tumours; however the exact cause is still not fully known. There are many different types of bone tumours, of which the most common are listed below, including symptoms, diagnosis and treatments. Osteosarcoma- This is the most common type of bone tumour, and as well as Ewings syndrome (see below), is the most aggressive type of bone tumour. It affects people at an early age (5-25years), and is rare in people of above the age of 30. Osteosarcoma is a malignant tumour and eventually will spread throughout the body. It is also known to start in the cavities within the bone, and is it affects long bones mainly the knee. Osteosarcoma is diagnosed via examination and imaging techniques such as MRI or CT scan. Osteosarcoma if usually treated by surgery and chemotherapy before and after the surgery. Ewings Sarcoma- Just like Osteosarcoma, Ewings sarcoma affects people at a young age (5-15 years), and also the survival rate up to 3 years is a 60% chance. Ewings sarcoma in mainly found in the lower extremity, than the upper extremity (Eggli et al., 1993) Some of the symptoms of Ewings disorder include pain and swelling, warmth of the local area, and the appearance of onion skin. Ewings disorder can be diagnosed via MRI and CT scans. Treatments of Ewings disorder include surgery, radiation and multi-drug chemotherapy (Eggli et al., 1993). Chondrosarcoma- This bone tumour affects the chondrocytes of cartilage tissue and subsequently, the tissue eventually becomes cancerous. Chondrosarcoma can occur at any age, and this tumour grows slowly and normally without any pain. Lymphoma- Lymphoma is cancer of lymphatic cells, and usually begins in the lymph node, but can also form in the bones. Multiple Myeloma- This bone tumour occurs as a result of bone marrow cells becoming cancerous and can cause osteolytic bone damage. It usually occurs in people above the age of fifty five, and men are twice more likely to get it than women. The main symptom of multiple myeloma is pain, as well as normochromic anemia, spinal cord compression and renal insufficiency. Multiple myeloma can be diagnosed via MRI and CT scans. Chemotherapy, bone marrow transplant as well as Bisphosphonate drugs are some of the main treatments for multiple myeloma. Osteroid Osteoma- This tumour occurs as a result of the matrix of bone becoming cancerous. It normally occurs twice as often in males than females. It more commonly takes place in the proximal femur, then mainly in the tibia, followed by posterior elements of the spine and the humerus (Bloem and Kroon, 1993). Common symptoms include dull pain which gets worse during the night, an increase in skin temperature, increased sweating and abnormal growth. Radiological scans and CT scans are common methods for diagnosis. Non-steroidal anti-inflammatory drugs are given as part of the treatment for osteroid osteoma as well surgical removal. Osteoblastoma- Osteoblastoma is a benign tumour in bone tissue and occurs when osteoblast cells become cancerous. It is mainly common in children and young adults. Pain and bone mass reduction are the main symptoms of osteoblastoma. Method of diagnosis for osteoblastoma includes x-rays, microscopic examination of osteoblast cells and a biopsy. Surgical removal of the tumour is a common treat for this bone tumour as well as cryosurgery, radiation and chemotherapy. Hormonal disorders. Osteoporosis. Osteoporosis results in bones becoming porous and these pores become bigger (2 times bigger) in cancellous cortical bone. It occurs as a result of a reduction in bone mineral density (bone mineralisation). It is a direct disease of the bone as compared to some of the other bone disorders mentioned above. During osteoporosis the rate of bone renewal is slower than bone breakdown and it commonly affects the hip, wrists and spine. It is estimated that over 3 million people in the UK alone suffer from osteoporosis. There are two main types of osteoporosis (Type I and Type II). Type I osteoporosis occurs mainly in females following menopause. Following menopause there is a deficiency in oestrogen and testosterone and this disorder is known as postmenopausal osteoporosis. Type II is mainly caused by a poor lifestyle i.e. excess smoking and drinking. This leads to a deficiency of calcium and vitamin D as a result of disorders of the intestine. The deficiency may also arise from kidney disorders caused by a poor diet (too much fast foods and fizzy drinks) and excess alcohol consumption. Also people continuously taking drugs mainly corticosteroid drugs will have a loss of bone density. Symptoms; Osteoporosis does not have any specific symptoms; however its main outcome is an increased risk of bone fractures and breaks, and also an increased risk of falling due to fractures of the wrist, spine and hip. Diagnosis Bone mineral density (BMD) test to measure bone mineral density was the first test used to diagnose osteoporosis. There are many different types of BMD tests, the most common being quantitative ultrasound. This is a very good method for diagnosis and is also a much safer approach than x-rays and radiography, which can also be used to diagnose osteoporosis. Blood tests to identify deficiencies in calcium and vitamin D are a further method for diagnosis. Treatments; HRT (Hormone Replacement Therapy) was initially used to treat postmenopausal osteoporosis, however its used was later stopped due to its many side effects e.g. breast cancer, blood clotting, stroke etc. Bisphosphonates can be used to treat osteoporosis and it functions by slowing down the breakdown of bone, in order for the body to cope with bone renewal. Bisphosphonate intolerancy was then later discovered in 20 % of people. Calcitonin drugs are another type of drug used to treat osteoporosis. Calcitonin is produced naturally in the thyroid gland, and calcitonin drugs work by directly inhibiting osteoclast activity. Calcitonin is also found naturally in salmon. Strontium Renelate is another drug that can be used and helps to promote bone renewal. Calcium and vitamin D supplements also help to slow down osteoporosis. Exercise is also highly advised for osteoporosis sufferers and has been shown to maintain or increase bone mineral density especially in postmenopausal women. Pagets disease. Pagets disease is a bone disorder associated with a disorder in bone remodelling, and affects 10% of elderly people (Barker et al., 1980). Furthermore it is more prominent in males than females. In Pagets disease there is an increase in bone remodelling which is also disorganised, and this caused by a primary abnormality of osteoclast cells (Hosking et al., 1996). The bone turnover is increased by 40%, and in addition, bone is grown in areas where bone is not needed and removed from areas where bone is required. Pagets disease is now referred to as osteoclast pagetic disease. In the disorder, the osteoclasts which are bone cells responsible for the removal of bone are targeted. Over a period of time osteoblast activity subsequently increases in response to osteoclast activity, and helps in forming new bone. However, the new bone that is formed is a lot larger and thicker because of the very fast remodelling process, but critically the interior parts of the bone are porous, and a lot more fragile and tender. This therefore makes the bone more venerable to fractures and breaks. Below is an illustration of a particular deformity associated with Pagets disease sufferers (see Figure 2.) Symptoms/complications; Joint pain and bone paint are common symptoms associated with Pagets disease. As the disease progresses the swelling and expansion of the bone leads to the expanding bone becoming weaker. Also the initial symptoms of Pagets disease are not clear but do become clearer over time as the disorder develops. Fractures of long bones e.g. tibia, femur, pelvis, spine, skull are common symptoms of Pagets disease as well as skeletal deformity. Arthritis is a common complication which arises from Pagets disease and occurs mainly in the proximal ends of long bones. A further complication of Pagets disease is Gout. Gout arises from the excessive production of uric acid and salts leading to gouting arthritis, which is a disease of uric acid metabolism. The build up of uric acid and salts in the bloodstream leads to accumulation at the bone joints/cartilage which then causes kidney stones. Bone tumours, and in particular cancellous bone tumour can arise as a result of gout. The dysregulation of bone can also cause an increase in blood circulation and can consequently bring about heart failure. Compression of nerves is also seen in sufferers of Pagets disease and is caused by bone expansion and this brings about complications in movement. Also nerve compression in the skull brings about a loss of hearing and vision. Diagnosis; X-rays is a very clear method to help detect bone expansion, bone loss and bone deformity. Alkaline phosphate which is a by-product of any type of bone disease/disorder is present in the bloodstream, and so blood test can help to identify the presence of these. Treatment; Bisphosphonates and calcitonin are common drugs used to treat Pagets disease. These drugs bind to osteoclast cells and increase their activity, thus reducing their breakdown, and reabsorption of bone into the bloodstream. Pain killers can also be taken to help ease bone pain and neuralgic pain. It is also advised that Pagets disease sufferers should receive adequate sunshine, adequate amounts of vitamin D, and maintain a healthy lifestyle i.e. healthy diet and regular exercise. References Barker, D.J., Chamberlain, A.T., Guyer, P.B., and Gardner, M.J. (1980). Pagets disease of bone: the Lancashire focus. Br Med J 280, 1105-1107. Barton, A., and Worthington, J. (2009). Genetic susceptibility to rheumatoid arthritis: an emerging picture. Arthritis Rheum 61, 1441-1446. Bloem, J.L., and Kroon, H.M. (1993). 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