This paper describes some of the earlier experiences of parathyroid disease in Birmingham. It goes on to describe the experience of the disease in patients with and without renal failure treated by one surgeon over the past decade. It should be read in conjunction with a previous publication in the Annals (3). A careful neck exploration by a surgeon experienced in parathyroidectomy gives a high (92.3%) cure of all comers with primary hyperparathyroidism. The majority of failures are cases with familial disease. The surgical treatment of secondary hyperparathroidism in renal failure is more controversial. The author's preference for total parathyroidectomy and autotransplantation is explained.