faults in the treatment even after such faults have been proven to exist, and it is immeasurably more unfortunate that followers of innovations become partial without cause and when favorably disposed suppress unfavorable evidence, speak lightly of complications and in other ways hold their position upon the subject involved in a manner unbecoming to scientific men. Unfortunate as it is, it is more fortunate that this is an existing tendency and not a growing tendency. It has been remarked by writers for centuries, and grave as is the matter, it has been the subject for the wit of the greatest of literary lights. Keen and unfriendly as has often. been the satire, the medical man of today cannot but be amused and he realizes too often the justice of the wit at the expense of his profession when he sees the attitude of centuries ago manifest among the leaders of today.

When paraffin injections first came to general notice there was the rapid production of a profusion of literature and unfortunately much of the matter offered was from the pens of men of very limited experience. The method. was so distinctly novel and the results. so striking in certain cases that reasoning by analogy and without actual experience a most diverse applicability of the paraffin injection treatment was offered-not prophesied-but offered in generous good faith by scientists of a sanguine if not to say presuming disposition. To illustrate I might cite the instance of an author who had an experience with two cases, one of which I know to have been unsatisfactory. This writer dilated upon the subject of paraffin injections at length and then catalogued an imposing list of pathologic states which might be treated by paraffin injections, yet he had experience with none of the conditions, though he did not admit it in his article.

Many surgeons adopted the technic with an enthusiasm which led them early to disaster, and some of these have

abandoned the method, and it is to them the subject of unqualified disapprobation Others were more fortunate and continued an indiscreet course without serious mishap until they were able to publish claims for the method more promising than deserved.

Champions of the paraffin technic have claimed that this method would revolutionize rhinoplasty. That is true -in a measure-a partial revolution. Rhinoplasty has been the subject for monographs of hundreds of pages, and those monographs, frequently a life's work, are still valuable, for even though the patient has considerably over half of a nose his case may still be beyond correction by the the paraffin syringe alone. Asymmetrical noses are exceedingly common, and it is safe to say that four-fifths of these organs which are not classical in outline are beyond the ken of the paraffin syringe. It is one thing to give symmetry to a nose, and another to improve its appearance.

A

nose may have a comparatively slight lateral deficiency as is illustrated in figure two, yet it is unsuited for paraffin injection as filling out of the deficiency would produce a broadness of the nose which would be less pleasing than the deficiency existing. Comparatively simple as is this defect, to correct the condition it is necessary to reduce the prominent side and then to secure a perfectly pleasing organ it is advisable to attack the alae and secure reduction of them rather than to attempt any filling operation.

The third illustration is that of a nose which has been deviated by a blow. This nose in its present state has a distinctly lowered bridge, yet there is no means of filling along the bridge or any other part of the organ so as to improve the appearance. It is true that the bridge could be raised and symmetry given to the organ, but woe to the patient, for while it might be built out to resemble a great toe or a negro's heel it could never be made into a pleasing

nose. The remedy is either a straightening after loosening the fractured bones or the removal of the deviated bony portion and the subsequent raising of the median line, in which instance the paraffin would find its rightful place. Frequently, mention has been made of the treatment of pock marks by the injection of paraffin, yet the method is unavailable in nearly all instances. Conditions are such as to be particularly unfavorable for the correction of pock marks by the deposit of paraffin beneath the scars and a well marked case such as is illustrated in figure four, is as much a problem today as it was fifteen years ago when these conditions were treated by the use of bichloride lotions of considerable strength or by the cautious applications of croton oil. This young man submitted patiently to the simple injection of paraffin mixtures beneath the skin, to the subcutaneous section of the tissues and injection, to dermal and cicatricial sectionings and injection and to the excision of certain of the larger marks, yet it would not take half an eye, even if astigmatic, myopic or hypermetropic

to realize that he has suffered from small pox, and he still remains a cosmetic problem.

FUSED (HORSESHOE) KIDNEY By Dr. Byron Robinson, 199 State St., Chicago, Ill.

The interest of physicians in fused or horseshoe kidney is manifest since the blooming of ureteral and renal surgery in recent times. Max Nitze's introduction of the cystoscope has called attention to the fact that we can aid patients with vesical, ureteral and renal disease. I selected at random figures 69 and 71 from my 84 illustrations of horseshoe kidney collected during the past dozen years.

Horseshoe kidney presents many factors to study, as the nomenclature,

anatomy, physiology, surgery, clinical diagnosis, pathology, position, form, renal isthmus, renal hilus, renal sinus, renal vessels, symmetry, topography, ureters, relation of horseshoe kidney to the great abdominal vessels, holotopia, syntopia, skeletopia and idiotopia.

The horseshoe kidney must be considered in relation to defaecation, menstruation, gestation, parturition. The physician should always be in a condition of mind to expect the presence of a horseshoe kidney in rectal, vaginal and abdominal examinations, and for the surgeon forewarned is forearmed. The following legends, numbers 69 and 71, will suggest many views to physicians.

FUSED (HORSESHOE) KDINEY.

Fig. 69. Fused (horseshoe) kidneyrenes arcuati distal (i. e., the renal poles fused at the distal end). Presentation. Ventral view. Isthmus renalis, fibro parenchymatous. Dimension,

median. Location, at distal renal poles and ventral to aorta and vena cava, dorsal to ureters. The renal isthmus lies directly between the vasa abdominalia magna (dorsally) and the ureters (ventrally). Both renal isthmus and ureters lie ventral to the great abdominal vessels. Hilus renalis, bilateral hilus unicity and nonsymmetry (as to form, position, dimension). Location on ventral surface of bilateral renal mass. Form, irregular with indefinite boundary. Dimension, excessive. Sinus renalis, diameters, dorso-ventral limited, longitudino-lateral extensive. The sinus renalis-the renal excavation— resembles a shallow wash basin. Ureter proprius bilateral ureteral unicity. Location, on ventral surface of bilateral renal mass. Form, isthmuses and dilatation, normal. Dimension, usual range. Course distorted. Pelvic ureteris, bilateral pelvic unicity, and nonsymmetry (as to form, position, dimension). Location, on ventral surface of the bilateral renal mass. Form, irregular. Dimension, diminutive. Calyces, ureteris,