Disturbances of respiration were observed in a number of cases in various stages. Cheyne-Stokes breathing was usually a late symptom. In a case of tubercular meningitis with a tubercular granulation springing from the left side of the fourth ventricle (Case 82) it was present. Extraordinary slowing of respiration occurred in a tumor of the right middle cerebellar peduncle and cerebellar hemisphere which caused irritation and softening of the floor of the fourth ventricle. The respirations ran as low as four and five per minute two weeks before death.

Persistent epistaxis and a tendency to hemorrhage from the mucous membranes were interesting vaso-motor phenomena in a case situated in the upper left quarter of the pons (Case 84). Profuse perspiration, more marked on one side, was observed in a case of tumor in front of the optic chiasm. Polyphagia was observed in two cases, one a growth of the cerebellum and the other on the floor of the skull. Polyuria was a very marked symptom in Case 95, a tumor at the base of the brain at a spot corresponding to the sella turcica, and diabetes was present in a case of frontal tumor. Albuminuria was recorded twice—once in the same case in which diabetes was present, and again in a case of multiple tumor of the supramarginal convolution of one side and the angular gyrus of the other. Somnolence was occasionally observed.

Constipation or torpor of the bowels occurs somewhat frequently in the early stages of the brain tumor, giving place in the terminal periods to involuntary evacuations. The conditions of the bladder are practically the same. It is either not involved or suffers from torpor or paresis of the muscular walls early in the disorder, and later, and especially very late, incontinence from paralysis of the sphincter results.

DURATION, COURSE, AND TERMINATION.—The duration of cases of intracranial tumor is very uncertain. In many of the reported cases no definite information is given as to the exact length of time from the initial symptoms until the fatal termination. The few cases in which the time was recorded showed a duration of from three months to as many years.

In a few cases, even in some which are not syphilitic in character, a remission of all the symptoms and what appears to be an approximate cure sometimes take place, the general symptoms, such as headache, vertigo, vomiting, spasms, etc., disappearing for a time. Even the condition of the eyes and the paralysis in rare instances make marked improvement. In these cases, in all probability, the progress of the growth of the tumor is arrested either by the remedies employed or spontaneously, and the acute or subacute phenomena of congestion, œdema, etc. around the tumor subside. These patients may remain for a long period or until cut off by some other disease without any change for the worse; but the sword constantly hangs above their heads, and any excitement, traumatism, the abuse of alcohol or other narcotics, an attack of fever, or some other special exciting cause, may again light up the intracranial disorder, to then progress more or less rapidly to a fatal termination.

This fatal termination may occur in various ways. Sometimes a sudden apoplectic attack occurs. This may be an intercurrent hemorrhagic apoplexy, although our personal experience would not lead us to believe this mode of termination is common. In a few cases the enormous irritation of the cerebral growth suddenly or gradually inhibits the heart's action through the impression made on the pneumogastric. Apoplectic attacks which may or may not terminate fatally sometimes are the result of a sudden giving way of necrosed brain-tissue, the necrosis having resulted from the obliteration of numerous blood-vessels by the advancing growth. Blood-poisoning occasionally takes place from abscesses in proximity to the tumor. In some cases the patients slowly but surely emaciate, or are exhausted and worn out by the agonizing pain and incessant vomiting which they are called upon to endure. Occasionally a more or less diffused and violent meningitis hastens the fatal issue.

COMPLICATIONS AND SEQUELÆ.—Tumors of the brain may be complicated with other affections due to the same cause. Thus, for example, in a case of gumma other evidences of syphilis may be present in the form of nodes, eruptions, etc. A sarcoma or carcinoma of the brain may be associated with similar disease in other organs. Such affections as cystitis, pyelitis, keratitis, etc., which have been discussed under Symptomatology, are secondary complications of cases of tumor. As intracranial tumors almost invariably terminate fatally, strictly speaking we have no sequelæ.

PATHOLOGY.—We present in tabular form the various classes of tumors found in the one hundred cases of brain tumor in the table appended to this article:

Carcinoma7 Glio-sarcoma1
Cholesteotoma1 Gumma13
Cyst2 Lipoma1
Echinococcus2 Myxo-sarcoma1
Enchondroma1 Myxo-glioma2
Endothelioma1 Osteoma2
Fibro-glioma2 Sarcoma15
Fibroma4 Tubercle13
Glioma16 Unclassified16

The histology of tumors of the brain does not in the main differ from that of the same growths as found in other parts of the body, so that a detailed description of their structures, even though founded upon original research, could not offer many novel facts in a field which has been so thoroughly cultivated. Such a description would probably repeat facts which have already been presented in other parts of this work, and which are better and more appropriately put forth in special treatises devoted to the science of pathology. It is proper, however, for the sake of convenience and thoroughness, to make brief mention of the structure of brain tumors, and especially to dwell upon certain features of these morbid growths which may be considered characteristic of their encephalic location, and hence have not only pathological but also clinical interest. It is hardly worth while to refer to speculations which aim to elucidate the very foundations of the science, except that in a few of these theories we gain an additional insight into both the structure and conduct of some very characteristic brain tumors.