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FOR several years we have endeavored to follow the reported cases of the Cushing syndrome. In many instances, by correspondence with the physician, it has been possible to pursue a suspected case to verification, and to obtain sections of the pituitary gland to compare with others in the collection of the Brain Tumor Registry. Prior to this present war we received data from most of the authors of case reports save those who had been dislocated from their practices. The war and other duties have prevented us from completing a full report on this material, yet certain impressions that were gained perhaps deserve to be presented in an informal way at this time. A recently verified case of the Cushing syndrome reported by Paschkis, et al. (26) serves to illustrate the unsolved problem of this disease. The patient, Miss E. R., was a beautiful girl of 17 when the syndrome began to be active, and the first signs were the development of a moon-face, acne, a tendency to baldness, fatigability, and amenorrhea.

It is the purpose of this paper to give the computed mortality percentages for the operations on patients with intracranial tumors in the Peter Bent Brigham Hospital. In order to have information available regarding the number of tumors of different kinds in different locations, special care has been taken for several years to keep track of the patients after they have passed through the clinic. Such detailed statistics as are needed from day to day can hardly be supplied by the record room of the hospital where the clinical histories are officially filed and indexed. The number of cases, as a matter of fact, has become so large that some such system is necessary if the figures are to be kept constantly up to date, because of the frequent changes in diagnosis as new information regarding obscure cases is obtained by secondary operations, here or elsewhere, or by postmortem examinations.

The routine use of the supravital technic in the diagnosis of intracranial tumors has led to greater proficiency in differentiating lesions at the time of operation, and the surgeon has come to depend more and more on its aid. During the period of about four years since the adoption of the method in Dr. Cushing's clinic, increased familiarity with the true microscopic appearances of the various forms of growth has gradually been acquired. The principles of the technic have already been described.1A number of cases reported in more or less detail may best serve to illustrate the further progress made. The following have been selected because of their possible interest, not only to the surgeon, particularly in those instances in which an immediate histologic diagnosis was essential to the conduct of the operation, but to the pathologist because of the peculiar and enlightening appearances of the tumors in

An equally large tumor, to judge by the weight of the fragments that were preserved, was successfully removed three months later from the next case. This tumor also had failed to give neighborhood symptoms beyond those of the syndrome under discussion, though the adiposity and scanty menstruation suggested a nearly hypophysial involvement. Case12.— Failing vision for eighteen months advancing to near blindness. Primary optic atrophy. Bitemporal hemianopsia advancing to unilateral blindness. Normal sella. Correct preoperative diagnosis. Operation. Total piecemeal removal of a 16 Gm. tumor. Recovery with marked improvement in vision in the left eye, stationary after two years. July 8, 1926 : Admission of Mrs. Rose B., 37 years of age, with the sole complaint of loss of vision ; referred by Dr. George de Schweinitz through Dr. Otto Lowy of Newark, N. J. History .—Until December, 1924 , the patient had never consulted a doctor. At about that time she