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suggest the propriety of endeavouring to infect dogswith the human virus, if this has not been adequatelytested.

I would add that I welcome Mr. Pugh’s paper andconsider that there is much to be gained from thejoint discussion by veterinarians and medical men ofallied problems in epidemiology.

I am, Sir, yours faithfully,C. O. STALLYBRASS, M.D., D.P.H.

PARAFFIN IN PLASTIC SURGERY OF THENOSE.

To the Editor of THE LANCET.SIR,—In your issue of March 27th you were good

enough to review my book, " Plastic Surgery of the

Nose," in terms very gratifying to an author pardonably interested in the reception of his first work.I trust you will not hold me in any way lackingin the appreciation due for this courtesy if I findmyself in active disagreement with your reviewerconcerning one of his expressions of individual opinionin which he traverses the position I took up in regardto the use of paraffin in naso-facial repair. My viewis that the use of paraffin should be condemned.His view is that " the common small depression atthe nasal bridge is best corrected by the injectionof a small quantity of paraffin wax," and that " theresult is quite permanent."The question is : When may the result be pro-

nounced " quite permanent " ? Practically all casesdemanding surgical interference to get rid of theinjurious effects of injected paraffin had gone forseveral years before there was occasion to doubt thepermanence of the repair, and most of them for severalyears more before the condition became so menacingthat it was no longer possible to defer consultationfor relief. That is the characteristic of injectedparaffin ; there may be

"

permanence " for ten years

and then paraffinoma in the eleventh or twelfth.The injuries produced are peculiar to the material.

The tissues are intolerant of any foreign bodyinserted among them, and there is persistent effortdirected towards its expulsion. With most of themthe expulsion is early and violent. With paraffin itis slower, but not less certain. There is a tendencyfor the particles to disseminate even without pressure,this being due to the nature of the substance ; butwhere, as in the case mentioned, the material isemployed to give a support, pressure is inevitable, andthe process of dissemination, with its sequence ofinfiltration and inflammation, is hastened. When itis known beyond peradventure that these things dohappen, how can anyone possibly proceed upon theassumption that in a given instance they will not ?For those who believed, and those who still believe,

in the efficacy of paraffin, the nose has always beena favourite field. That is why the majority of casescalling for relief are nose cases. Anyone who seesa few of them will want no more to do with paraffinfor any correction. It may be encapsulated andtumescent, or it may travel into the tissues of thecheek, lip, philtrum, ala, tip or columella, andwherever it is or has been there are tumours, varyingin kind and degree. The only recourse is completeextirpation, something not always possible. It doeshappen that there is hardly enough healthy tissueleft upon which to base a repair. This, surely, is asufficient deterrent against its use, without goinginto the case-histories of a more startling nature,with their record of blindness, of embolism, and ofmalignancy. Nor is there much consolation fromreflecting that in many cases the material was

injected in the belief that the repair was the best andwould be permanent.

Moreover, in the case cited, there is no need toresort to the use of paraffin, for if correction cannotbe effected by a readjustment of the tissues them-selves, it can be nicely and easily done by trans-ferring a small bit of ear cartilage.

I am, Sir, yours faithfully,J. EASTMAN-SHEEHAN.

ASHAMED TO BEG.To the Editor of THE LANCET.

SIR,—I also have had occasion to see consultantson my own behalf and that of members of my familyand have had the same difficulties. Consultants-and they have unfortunately been many-have oneand all been indefatigable in their kindness andgenerous of their skill but, though I am engagedwholly in laboratory work and almost divorced frompatients, they all refuse fees. I recently asked a

medical colleague to tell me what he would regardas a reasonable fee for one in my financial positionfor what he had done for me, and allow me to senda cheque to either Epsom College or the RoyalMedical Benevolent Fund. We both welcomed it asa happy way out.

I am, Sir, yours faithfully,MEDICO II.

To the Editor of THE LANCET.SIR,—Your correspondent who describes himself

in the issue of Nov. 6th as " ashamed to beg," hascreated for himself an entirely imaginary difficulty.He need not, as he puts it,

" hesitate " to ask the helpof any colleague, consultant, specialist or other. Oneis only proud that one’s services or advice are sought,and happy that one can place them at the disposalof a colleague. His fear that a present will not bevalued, or that the consultant will not be pleased, ismorbid, and he should recognise it as such. Atleast a third of the men on the Register are in thesame position, unable to send private cases toconsultants. If the matter of a fee is really felt,a plan I have found acceptable might help. In suchcases, where a fee is pressed, I ask the patient tobecome a subscriber to the Royal Medical BenevolentFund, or to increase his subscription if he is onealready. This avoids any question of indebtedness ;I have accepted the fee, but on behalf of other andeven less fortunate colleagues, and in the knowledgethat the debt the patient feels he owes to hisprofessional brethren he is paying to his professionalbrethren. I am, Sir, yours faithfully,

Nov. 8th, 1926. CH.M.

To the Editor of THE LANCET.SIR,—In reply to Medico’s letter " Ashamed to

Beg," our friend overlooks the broader and trueraspect.

All " consultants and specialists " have had helpgiven them in their hours of need by their colleagues.As they are unable to repay the aid individually,they welcome the opportunity of helping the professionin general. This assistance is their only means ofexpressing their deep sense of gratitude.

I am, Sir, yours faithfully,G. LENTHAL CHEATLE.

Harley-street, W., Nov. 9th, 1926.

HALOGEN ERUPTIONS WITH LESIONS ONTHE TONGUE.

To the Editor of THE LANCET.SIR,—In THE LANCET of Nov. 6th (p. 952) Prof.

A. J. Hall records the case of a nephritic young woman,who, as a result of taking potassium iodide (only12 gr. in all) developed a severe iodide eruption, oneof the lesions being situated on the tongue. Aboutthree weeks later she developed pericarditis and died.He writes : " This occurrence of a lesion on the tongue,similar to those on the face, has, so far as I am aware,not been previously observed." In my paper on theMycotic Type of Bromodermia and Iododermia inthe British Journal of Derm.atology and Syphilis(1923, xxxv., 169-180) Case 5 was that of a girl,aged 14 years, with granulomatous nodules on thetongue as well as lesions on the face and one leg,apparently due to iodides that she had been taking.In the hospital there was bronchitis, with evidenceof nephritis, and pyrexia. She died and the necropsyshowed (not very old) pericardial adhesion, muchbronchitis, and " large white kidneys." She had