Tumour of the Brain. Tubercular tu mours of the brain are the commonest and syphilitic tumours, but any kind, cancerous among them, may be present. While abscess of the brain has, because of reasons already stated, certain favourite seats, tumour may be present anywhere, and, in the case of tubercle and syphilis, many of varying size may be scattered about. It has been abundantly proved that a tumour or tumours may exist, and give no sign of their presence. But reference to what has been said about certain areas of brain being devoted to certain purposes, and to the figures illustrating this (p. 147), and also reference to Plate XI., will immediately suggest to anyone that if a tumour lay upon, or pressed upon or destroyed any of these areas, the affected area would no longer be able to perform its business, and thus special symptoms would be produced, according to the exact area or areas involved.
Symptoms of tumour are thus of two kinds: (1) general symptoms, such as headache, giddi ness, vomiting, blindness, changes in the pulse, changes in the patient's mental condition, not materially differing from those of abscess of the brain ; and (2) special symptoms, dependent upon the situation of the tumour.
It is the special symptoms which enable one, when they are marked, to form an opinion as to the exact seat of the tumour. For instance, if a small tumour pressed upon the area of the brain shown in Fig. 97 to be concerned with the movements of the fingers of the left hand, if the pressure were only sufficient to irritate this area, then there would be spasms of the fingers, jerking movements of one kind or other. If, on the other hand, the growth pressed sufficiently to destroy the area, then the fingers would be paralysed. Sometimes the irritation due to a
tumour produces convulsions, but if the tumour were situated as supposed, careful observation would show that the convulsion began always in the fingers of the left hand, and from them spread over the body. Thus the special symp toms might include a spasm limited to one muscle or a group of muscles, or a general con vulsion always beginning in the same way, or it might be the paralysis of a muscle or group of muscles, or the whole or part of a limb. It might be a spasm of pain or tingling always in one place, or loss of feeling in a limited part of the body; it might be blindness or partial blindness of one or both eyes, affections of speech, and so on. Such symptoms, when care fully observed and noted, enable the physician or surgeon to conic to a conclusion as to the locality of the tumour, and are, therefore, called localizing symptoms.
Treat m e nt.—A surgeon would always operate on an abscess of the brain, because, if it could be reached at all, the mere passing into it of a probe or a fine knife would permit the escape of the pus; but, in the case of a solid tumour, a surgeon would only undertake an operation if he had some idea that it was possible to get at it sufficiently well to cut it out, and if he had some idea of its nature. Doubtless a surgeon would, for instance, consider himself justified in operating if the special symptoms pointed to a tumour just on the surface of the brain, but not if they pointed to one at the base, where it would practically be out of reach.