ROYAL NORTHERN HOSPITAL" A DISEASE of the terminal ileum, affecting young adults, characterized by a subacute or chronic necrotizing and cicatrizing inflammation, ulceration of the mucosa and excessive connective tissue formation through the wall, leading to stenosis and fistula formation ". In these words Crohn,l in 1932, described a localized disease of the ileum of a granulomatous nature, and gave it the name "regional ileitis".Since that time it has become evident that other parts of the intestinal tract may become involved in such a process. Harris, Bell, and BrunnY2 in 1933, recorded the involvement of the jejunum only, and in 1934 C01p3 described the first example in which large and small bowel were together affected. Many other cases have recently been described, some being earlier examples of obscure intestinal granulomata reviewed in the light of Crohn's researches, and others being recent types conforming to the entity which he described. Thus Koster, Kasman, and SheinfeldY4 and J. SproullY5 each reviewed in 1936 a large number of recorded cases, the former 126 and the latter 132, including not only the more recent and carefully observed examples, but also the older and less certain forms of granuloma. In these papers it is claimed that Crohn's disease may be found anywhere from the jejunum to the sigmoid colon, involving either long or short segments, and often several sections of intestine separated from each other by normal bowel. The record of T. K. DalzieP is quoted, who, in 1913, gave two instances in which almost the entire small and large bowel were affected. He called it ccchronic interstitial enteritis ".It is uncertain that these conform to the granuloma described by Crohn, and it is in our view desirable that only recent authenticated cases be included in this category. Jackson', in a recent communication, refers to 219 such instances reported in America since Crohn first gave his classical description in 1932. Jackmans, in 1934, H. SchwabacherlO in 1936, and Colbeck, Hurst and Lintott in 1 9 3 9~~~ have recorded the incidence of the condition in this country.It is our view that this is a new disease ; we do not believe that a pathological condition of such a definite nature, and so unlike any of the known diseases of the intestine, can have remained for long unrecognized in this keen and critical surgical age. When operating upon the first of the cases which form the basis of this paper, we were hardly aware of Crohn's description, and yet the pathological appearance, disclosed at operation, left us in no doubt that here was something which we had never seen before, something that was not tuberculosis, malignant disease, or ulcerative colitis, and something which for its cure required radical treatment. The picture was very striking and unforgettable ; the thick, solid loop of intestine with fat standing out predominantly ; even more, the heavy infiltrated mesentery, red and edematous, with swollen glands massed within its thickened substance.

SURGICAL REGISTRAR, ROYAL NORTHERN HOSPITALTHE uncommon features presented by a solid tumour removed from the lateral aspect of the neck are believed to be of sufficient interest to warrant the placing of the following case on record.The patient was a man, aged 62 years, who came to the hospital complaining of a swelling behind the angle of his lower jaw. He first noticed it five years previously ; it was painless and was gradually increasing in size.A movable tumour was present, in size a little smaller than a hen's egg. It was firm in consistency, non-fluctuant, and there was no evident fixation to adjacent structures. Under general anaesthesia the tumour was exposed through a transverse incision. It lay beneath the deep cervical fascia, projecting forward from under cover of the sternomastoid, and extending upwards as far as the lower pole of the parotid gland. (No definite attachment, however, to the latter was demonstrated.) It was easily enucleated from its surrounding capsule. The specimen obtained was ovoid in form, and covered by a thin membrane in which a number of bloodvessels were to be seen. Its cut surface was greyish-yellow in colour, with one or two small areas of softening. Microscopically (Figs. 149, 150) there were evident a large number of alveoli, most of them small in size, but a few almost reached the size of small cysts. Each was lined by a well-marked epithelium of very uniform type throughout the section. This was constituted by a double layer of cells, the inner being columnar in form, and the outer cuboidal. Here and there the epithelium projected into the alveoli, forming processes which occasionally showed branching. The cells were non-ciliated. Surrounding these alveoli and extending between them was lymphoid tissue, densely packed and with germinal centres, and around the whole a fibrous capsule was evident. No muscle or cartilage was found in the sections, and no sebaceous gland, hair follicle, or Hassal formations were seen. In 1898, Neissel described the inclusion of parotid tubules in lymphatic glands. The developing salivary buds are at an early stage surrounded by a diffuse mass of lymphoid tissue which gradually becomes collected into nodes, and around these, capsules are eventually formed. During this process certain salivary epithelial tubules may become separated and included within the lymphatic gland. These formations were demonstrated by Neisse in many newly-born infants, and they have also been shown in association with the submaxillary salivary gland. It is from these remnants that a tumour is believed occasionally to arise.During the past twenty-five years there have been described a number of cases bearing a close resemblance to each other. Two cases were described by Albrecht and ArtzY2 who pointed out the striking resemblance of the included epithelium to that of salivary duct. This view is endorsed by G. W. Nich~lson,~ who presents two more examples. Ten cases are reviewed by M~a t t i ,~ and this writer points

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