If a young child is seen first towards the close of the disease when the symptoms have become complicated with those of basilar meningitis, we must inquire carefully as to the previous course of the illness and the progression of the symptoms. If we find a history of chronic disease in which headache, sickness, and local paralysis, such as squinting, ptosis, or distortion of the face,, have occurred some months previously ; if any loss of 'power observed has been persistent ; and especially if we can discover that the child is the subject of optic neuritis, or that his sight has been failing, we may give a positive opinion that a tumour is present in the brain. Even the anomalous course of a tubercular meningitis is suspicious of a cerebral growth, and the sudden appearance of symptoms character istic of the third stage of this disease (convulsions, stupor, squinting, un equal pupils, paralysis, or rigidity of joints), preceded by signs of chronic nervous disturbance, are very suggestive of tubercle of the brain.
In older children the combination of headache, vomiting, and optic neuritis is very significant if Bright's disease can be excluded. Severe headache alone is of no value, for migraine is a not uncommon complaint in young persons. The disease does not, however, always begin with pain in the head. When this symptom is absent, tremors or muscular spasms occurring repeatedly in the same limb or the same region of the body are suspicious. If after a time they become more severe and general, and are complicated with other signs of nervous disturbance, such as paralysis, especially of a cerebral nerve, and impairment of sight, the disease is in all probability tumour of the brain.
The actual position of the new formation can seldom be more than suspected. In the case of a cerebellar growth, the symptoms to which this gives rise have been already described. When the tumour occupies the base of the brain, paralysis of some special cerebral nerves may reveal the seat of pressure. In other parts of the brain the symptoms are so often contradictory, and are so liable to be altered and confused by dis turbing causes, that the situation of the tumour can seldom be predicted with anything approaching to certainty.
If epileptiform attacks form part of the symptoms, these are distin guished from genuine epilepsy by remarking that between the attacks the patient is not well, but still continues to exhibit signs of cerebral irritation.
With regard to the nature of the growth : A tumour of the brain is in childhood so generally tubercular that we may conclude it to be so unless there be signs to make us suspect the contrary. If, however, the child be well nourished and of sturdy build, if there be no history of phthisis in the family, and if the other organs appear to be healthy, we should hesi tate to class the growth as a tubercular one. Children with tubercle of
the brain are not necessarily wasted, nor have they always a tubercular or phthisical history ; but they are usually pale and flabby, and generally show in their physical conformation signs of diathetic influence. No argument can be founded upon the age of the child, for although the disease is said to be rare under the age of two years, I cannot agree with this statement. Indeed, in the preceding pages I have referred to two cases—one a little girl of twelve months and another aged six months, both patients of my own in the East London Children's Hospital—in each of whom tubercular misses were found after death connected with the brain.
Prognosis.—The disease is so fatal a one that when we are satisfied of the existence of a tumour of the brain, we can have little expectation of the child's recovery. In very rare cases shrinking and calcification of a tuberculous tumour have been known to occur ; but if the growth has produced symptoms of pressure and irritation, little hope can be enter tained of a favourable ending to the illness. Even in cases where the symptoms, although distinct, are of a mild character, we must not allow ourselves to anticipate necessarily a lengthened course to the disease, for however chronic may have been the earlier symptoms, the diseaSe may at any time take on a more acute course and run rapidly to a close.
Treatment.—In the treatment of these cases we must attend to the con stitutional condition of the child and correct any derangement which may be present to interfere with the nutritive processes. We must remedy any digestive disturbance and regulate the bowels. By improving the general health of ,the patient we may perhaps help to arrest the extension of the mass, and may possibly promote the calcification of the tumour. The child should live, if possible, in a dry bracing air ; should be warmly clothed, judiciously fed, properly exercised, and be treated generally ac cording to the rules laid down for the management of the scrofulous dia thesis. Cod-liver oil and iodide of iron are useful aids to this treatment. If any history of syphilis can be obtained, mercurial treatment must be adopted without loss of time, and a long course of perchloride of mercury should be entered upon. Distressing symptoms must be treated as they arise. Vomiting can be often allayed by keeping the child perfectly quiet in a recumbent position, and by applying an ice-bag to the head. Cold applications will also relieve the headache when this becomes severe, and a good aperient of calomel and jalap is useful. If necessary, morphia can be given with the same object.