SURCHON, ROYAL NORTHERN HOSPITALSo much attention has been directed to their fascinating variegated histology and to hypothesizing upon their origin, that practical problems relating to the permanent cure of mixed parotid tumours have been, to my mind, neglected. Obviously there is room for improvement in this direction.All will agree that every potentially malignant tumour should be curable. Even when a mixed parotid tumour has broken its confines, for many months it remains locally malignant only. Surely, one argues, the treatment of a tumour belonging to this category will not show depressing end-results; yet such is the case. Statistical inquiries reveal that the incidence of recurrence is considerable ; in several series it is as high as 30 per cent, and this refers to tumours definitely encapsulated at the time of their removal. Although recurrence can take place after many years, R. Kennon showed that most of them occurred within twelve months.When we examine the position regarding tumours which have recurred or are malignant already, I think there will be few who will disagree with what I have gleaned from first-class clinics up and down this country, viz., such cases are regarded with despondency. Fear of cutting the facial nerve and the bugbear of salivary fistula seem to deter surgical enterprise. Most of the patients are referred to the deep X-ray department, or are subjected to radium therapy. It is my belief that by instituting some radical alterations in teaching and practice, all but a very few parotid tumours can be placed in a category where our conception of surgical pathology tells us they belong-absolute curability. The prognosis should be excellent.ESSENTIAL MODIFICATIONS OF CURRENT TEACHING I. Most Tumours of the Parotid are Radioresistant.--Neoplasms consisting of highly differentiated cells (e.g., teratoma of the testis) do not respond to irradiation. Certainly in those cases of parotid tumour under my observation in which it was employed, deep X-ray therapy has proved futile, if not harmful. The following is a typical example :-Six months previously it had commenced to show signs of malignancy. The surgeon she consulted An Italian woman, aged 41, harboured a mixed parotid tumour for years.

TIIE gifts of embryology to surgery are manifold. The thyroglossal tract. not the least of these, was certaiuly one of the first to be generally appreciated.For this paper it was considered ad1 isable t o adhere strictly t o the surgical aspects of thyroglossal cysts and fiitulz, a i d 11'7 cases have been cdected from the records of the Londoii Hospital for this purpose. Whilst in hospital surgical practicc thyroglossal cysts are frequently encountered, the actual incidence in the general population is probably esccedingly small, for iii 86,000 consecutive patients examined in thc Mayo Clinic only 31 cases of thyroglossal cysts were found (Sistrunk). 111 coninion with affections of the thyroid gland, thyroglossal cysts and fistulz are coiiimoiier in women. Thus, of the 117 cases reviewed, 7 5 occurred in females. THYROGLOSSAL C Y S T S . GENERAL DIAGNOSIS.The diagnosis of thyroglossal cyst is usually simple. Certain difkulties are met with from time to time; the chief of these results from a peculiar liability of these cysts to infection.If' a thyroglossal cyst comes under observation for the first time when thus complicated, its true nature is easily overlooked, and a diagnosis of some inflammatory condition is made, iiotably an abscess ' en bouton de chemise ' connectcd with a tuberculous pretracheal gland.Less frequently. when fluctuation camlot be obtained because the cyst is tense and small, dell y of the accompanying crllnlitis t o &rain, in the middle line a simple enricleatcd. (Sir Hugh Hi!lby's rose.) cpidermoid cyst is a difficult but an unimportant differential diagnosis. I n this connertioii it should be mentioned that a thyroglossal cyst quite frequently moves upwards on fully protruding the tongue, and this sign may sen-e to distinguish it from an epidermoid cyst. The traiislucericy test is worth trying, but as only about

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BRITCSAl study of the marrow is made on sections stained by Maximow's eosin-azure method or by one of the Romanowsky methods. Special stains can, of course, be used; for example we have found Mallory's aniline-blue method of value in the recognition of (Jaucher cells in sternal marrow. Microchemical tests for the presence of iron can be applied. Zefker-formol fixative does not prevent the application of, the prussian-blue method if brief treatment with warm hydrochloric acid is used (Mallory). Excellent histolo9izal preparations of marrow are obtained which show the general architecture, the proportion of fat and cellular tissue, and the relationship of leucopoietic and erythropoietic tissue to one another and to the supporting framework. The number and disposition of the megakaryocytes are readily assessed, and the presence of abnormal elements is more easily detected than in the smear preparations. We have found that unless large numbers of smears are examined a true impression of the marrow may not be obtained, especially in regard to the megakaryocytes, which are not usually evenly dispersed. Abnormal elements, such as myeloma cells, Gaucher cells, and possibly tumour cells, may be recognized in the sections, and confusion due to admixture of blood does not arise. In a case of aplastic anaemia the marrow sections remove all doubt as to whether the lack of haemopoietic elements in smears is due to failure to obtain a true sample of the marrow. These points are illustrated in the accompanying photomicrographs (see Plate).