272 DISEASES OF THE BRAIN. 



characteristic but not a constant symptom for the tumor to move with 

 respiration; occasionally it may be replaced. Attempts to do this, 

 which suddenly contract the space in the skull and prevent the en- 

 trance of arterial blood to the brain, usually induce loss of conscious- 

 ness and convulsions. 



The nutrition, general condition, and the functions of the body in- 

 dependent of the brain, often show no anomaly for a long time. In 

 other cases it seems as if the organic processes went on with a certain 

 sluggishness : the heart and pulse beat slowly, respirations are rare, 

 the bowels constipated, secretion of urine scanty, and, perhaps as a 

 consequence of this, the body often increases remarkably in size. In 

 other cases, on the contrary, marasmus occurs early, the patients ema- 

 ciate, the skin becomes dry and scaly, the mucous membranes, espe- 

 cially the conjunctiva, are affected with blennorrhcea. Lastly, there 

 are bed-sores and dropsy of the feet. 



The course of cerebral tumors shows many variations which we 

 shall not discuss in detail. At first, there are generally exacerbations 

 and remissions of the symptoms, which subsequently become constant 

 and steadily grow worse. 



In carcinomatous tumors the disease usually lasts only a few 

 months, but occasionally a year or more. Non-carcinomatous tumors 

 often run on for several years. 



The most usual, and perhaps the only, termination is death. If it 

 be not induced early by complications or intercurrent disease, the 

 symptoms of general limitations of the space in the skull become more 

 and more marked. The patients fall into deep coma, followed by 

 death. 



It is rarely possible to recognize the seat and size of a tumor ex- 

 actly ; but it may often be approximately decided in what part it is 

 located, whether in the cerebrum, medulla oblongata, or in the cerebel- 

 lum, at the base or at the convexity. The "brilliant diagnoses," 

 where the precise localization of a tumor is fully confirmed by autopsy, 

 are not usually due to acumen of the observer, but are cases of lucky 

 diagnosis. If a basilar tumor destroys the function of several cerebral 

 nerves, one after the other and in regular sequence, while it spares 

 neighboring nerves, any one, having a knowledge of only the coarse 

 anatomy of the brain, can decide the seat and extent of the tumor 

 with almost absolute certainty. However, such cases, which are pub- 

 ashed with much self-satisfaction, are exceptions, as said before. 



It would occupy too much time to speak fully of all the factors, be- 

 sides the participation of the different cerebral nerves, which are to be 

 considered when deciding the location of the tumors. We must limit 

 ourselves to the following short hints. The presence of hemiplegia 



