TUMORS OF THE BRAIN AND ITS MEMBRANES. 267 



brum having the same location and equal size, depends partly on 

 whether the tumor has displaced the brain-filaments or has developed 

 at their expense and has substituted them. My colleague, Prof. 

 Schuppel, who has given me some other valuable points on the histol- 

 ogy of cerebral tumors, asserts that the different forms of tumors vary 

 in the above respect. Naturally, tumors, rich in vessels which increase 

 and diminish in size according to then* fulness, are not apt to run their 

 course without symptoms ; but, as a rule, are at least occasionally ac- 

 companied by symptoms of irritation and paralysis. Lastly, I shall 

 mention that tumors running a perfectly latent course are proportion- 

 ately more frequent than those having the symptoms of a severe in- 

 explicable cerebral disease. In abscesses of the brain, just the opposite 

 is true. This difference is probably due to the entire nutrition of the 

 brain being generally more severely impaired by the presence of an 

 abscess than by a tumor. 



Even those tumors of the brain of which we succeed in making a 

 certain diagnosis during the course of the disease, do not always begin 

 with the symptoms which play the most important part in the diagno- 

 sis, that is, with the partial paralysis and anaesthesia, which we have 

 designated as local symptoms (Herdsymptome), and which we have 

 repeatedly and fully described. In many cases the first, and often for 

 a long time the only, symptom indicative of brain-disease, is a severe 

 headache. Although this occurs during the most different brain-dis- 

 eases, and although we may even say there is no disease of the brain 

 which is not, under some circumstances, accompanied by it ; still there 

 is no cerebral disease where continuous, unusually intense, and severe 

 headache is so prominent a symptom, and there is no other disease 

 where it is so often observed as in tumor of the brain. The cases 

 where patients with cerebral tumors do not complain of headache are 

 such rare exceptions, that its absence in a doubtful case rather speaks 

 against a tumor. The fact that headache occurs even in those tumors 

 of the brain which are % located at a distance from the sensitive parts, 

 supports the view we advanced, that in cerebral diseases the pain in 

 the head started from the filaments of the trigeminus supplying the 

 dura mater. We must be very careful about localizing the tumor 

 from the seat of the pain. Only pains constantly confined to the back 

 of the head permit us to conclude that very probably the tentorium is 

 stretched, and that the tumor is probably situated in the posterior 

 cranial fossa. 



In many patients, attacks of dizziness and vomiting accompany the 

 headache, particularly the severe exacerbations which occur, from time 

 to time, with or without perceptible cause. This may facilitate tho 

 correct interpretation of the headache, and show its dependence on 



