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Fig. 1. Horizontal section through brain showing tumor and area of softening.

convulsion. The eyes would be drawn Dercum. This stage of the operation was towards the left. The patient could speak characterized by excessive hemorrhage well and was conscious of what happened. from the diploic veins. The dura was then

From the above date he had daily seizures opened and the interior of the skull exof a similar character, increasing in fre- plored by the finger through a radius of quency until the 31st of October, when he about two inches. No growth was disbecame unable to swallow and did not re- covered, but the brain substance was pale spond to any questions. He was then and showed signs of softening. Protective transferred to the surgical ward for opera- rubber drainage was used and the flap tion.

sutured, the dura remaining open.

[graphic][subsumed]

Fig. 2.
Section from the cervical region of the cord, showing diffuse sclerosis.

November ist—Operation by Dr. Stein- During the evening the patient became bach. The patient was partially anaes- conscious and was able to swallow, althetized and an incision about three inches though with difficulty. long made over the right Rolandic area; The following day he could answer quesexcessive bleeding being noted. The skull tions, protrude his tongue, etc. His temwas next opened with a trephine, making a perature which had been up since the operacircular opening about 4 c. m. in diameter, tion, was now falling; the pulse, however, this operation for surgical reasons being remaining high. From this time on he preferred by Dr. Steinbach to the removal became steadily weaker, dying about noon of a large osteoplastic lap as advised by Dr. the third day after the operation. There

were no convulsions or twitchings of any tinct in Gower's tracts. This peripheral description subsequent to the operation. ring extended to the medulla and was

The pathological findings at autopsy faintly observed in sections cut from the were as follows:

-Edema of lungs; chronic lower levels of this organ. Higher up in adhesive pleurisy; fatty degeneration of the the bulb it entirely disappeared. The greatheart; slight fatty infiltration of the liver; est change was found in the motor tracts, cholelithiasis; tumor of right frontal lobe; especially in the crossed pyramidal bundles. softening of the brain involving the right The columns of Goll were but slightly motor area and part of adjacent frontal affected in the sacral and lumbar regions, convolutions.

distinctly in the thoracic and markedly in Gross examination of the brain:- The the cervical section of the cord. cortical tissue of the center of the right Burdock's columns were affected only in motor area beneath the perforated dura was the cervical region. absent and the surrounding brain substance The cells of the gray matter presented softened for a distance of 2 c. m. anteriorly, slight granular changes, but were otherwise superiorly and inferiorly, and for a distance normal. of 1.5 c. m. posteriorly. Two c. m. above In the medulla, sclerosis was marked in the destroyed brain tissue and 1.5 c. m. an- the pyramids, and was present to a lesser terior to the fissure of Rolando, was a fairly degree in the fasciculus gracilis and Gower's resistant mass, extending to a point 4.5 c. m. tract. from the anterior margin of the hemisphere. That degenerative changes in the posThe mass was fairly circumscribed, ad- terior columns of the spinal cord may be herent to the dura, irregularly oval in shape associated with brain tumor was first oband encapsulated. The tumor measured

served by Mayer in 1894. Since that date 6.2 c. m. by 5.5 c. m.

there have been numerous contributions on MICROSCOPICAL EXAMINATION.

the subject, an excellent article by Batten Tumor:- Sections stained with hema- and Collier appearing in “Brain,” 1899. toxylin and eosin and hematoxylin and Van These authors examined

29 cases

of Geisen. A myxo-sarcoma, one of the forms cerebral tumor with reference to spinal of the sarcoma group infrequently seen. cord changes and found posterior column

Optic Nerves and Chiasm :- Sections degeneration in over half of the series. stained by Weigert and Weigert-Pal Besold in 1896 reported two cases of brain methods. Both nerves and chiasm pre- tumor with degeneration in Gower's tract sented complete degeneration, not a single as well as in the posterior columns, and fibre remaining intact.

since then, other observers have recorded Cord and Medulla : -Sections stained by changes in areas of the cord (chiefly pyrWeigert and Weigert-Pal methods—A "dif- amidal and direct cerebellar tracts) other fuse," rather than a “combined" sclerosis, than the posterior columns. By far the extending throughout the length of the most frequent, however, have been the cord, being most marked in the cervical re- changes limited to the columns of Goll and gion, less in the thoracic and least in the Burdack. The posterior nerve roots have lumbar and sacral. Peripheral degenera- also been found degenerated by several obtion was noted, not intense, but most dis- servers.

BY

As pointed out by Batten, the cord tion of symptoms apparently aberrant or changes are not dependent upon either the irrelevent. location or character of the growth, as In the case I have reported, the interestchanges in the cord have accompanied tu- ing points are the size of the tumor, the exmors of varied character and distribution. tent of the cord changes, and the fact that It is true that sarcomata have constituted an osteoplastic flap would have unquestionthe majority of the tumors in the cases re- ably revealed the presence of the tumor ported, but sarcoma is one of the forms which as it was encapsulated and reached of cerebral neoplasm most frequently met the surface superiorly and mesially, could with.

have been enucleated. The chief interest lies in the cause of the The pyramidal tract changes may have spinal degeneration, and many theories have been retrograde, but I believe the peripheral been advanced. Hoche, Pick, Kirschgasser, and sensory degeneration to have resulted Batten and Collier, believe the changes re- from the action of a toxine through the sult from increased intra-cranial pressure blood vessels of the cord. with increased tension in the dural sheath. 1700 Walnut Street. Ursini and Dinkler favor a toxic origin; Besold considers the degeneration due to A SANATORIUM SCHOOL FOR. CON. anemia or cachexia, while Campbell advo

SUMPTIVES.1 cates a retrograde degeneration.

Without repeating the various arguments that have been advanced by these writers,

DAVID L. SOHN, M. D., I will only refer to what I believe to be the

New York City. two most probable theories—viz.: increased This occasion gives me an opportunity of intra-cranial pressure and toxemia.

discussing with you a subject so much deRegarding the former theory, cases have serving of consideration that I look upon it been reported with evidence of extreme as an agreeable duty. I shall endeavor to intra-cranial pressure, yet having no de- take a road on which I hope to find an exit generative cord changes, while other cases out of the labyrinth, a road whose ultimate have been recorded without pressure symp- end goes beyond the immediate visible and toms yet showing distinct cord degenera stated one. A fact presents itself: there

exists a fallen race-victims of the Great The theory of a toxic origin appeals to White Plague, the numerous offspring of me as being the most reasonable, as anal- which grow up to become a plague-sore ogous changes have been found in the cord to society. Instead of a fallen race, we in pernicious anemia, cachexia, lead poison- ought to foster a better and a healthier one. ing, ergotism, pellagra, etc.

The question is: how is this evil to be The possibility of cord changes with a attacked at the root? cerebral growth suggests the advisability More than twenty centuries ago Hipof always including a search for cord symp- pocrates, the father of medicine, spoke of toms in the systematic study of brain tumor Presented before the Bedford Alumnae Assocases, and may sometimes be the explana- ciation at Bedford Sanatorium, July 30th, 1910.

tion.

consumption and recognized it as the great- dollars a year from the incapacity of its est ill that human flesh is heir to and the one consumptives. It would mean a net saving which is responsible for the greatest number to the United States of one hundred and of deaths. We know that ever since con- fifty million dollars a year, if all cases too sumption has been the greatest devastator of poor to afford proper treatment in expensive mankind. It destroys the human race, sanatoria were cared for at the expense of from infancy to old age, furnishing its the state. And this annual gain does not greatest number of victims between the include the enormous saving that would reages of twenty and forty-five, when men sult from the lessened infection occasioned and women should be strong and healthy by the isolating of dangerous consumptives. and able to support their families or their Today with our small number of sanaaged parents. Instead, however, of ful- toria and our great army of consumptives filling their duties to home and state, many it is impossible to combat the disease sucbecome a burden to society and those de- cessfully. It is true that a new era dawned pending upon them must of necessity be when Dr. Koch discovered the cause of taken care of by the charitable organiza- consumption thereby establishing a positive tions.

basis for the extermination of the Great Think of a yearly mortality from con- White Plague. As yet, however, we know sumption of one hundred and forty thou- of no specific cure, wherefor we must resand, and a yearly cost of more than one sort to ISOLATION and EDUCATION. thousand million dollars in the United States Let us isolate those whom we can and alone! These will soon be conditions of the educate those whom we cannot. In order past. The battle has been half won, and I to accomplish the best results under feel certain that if the efforts in which we the present trying circumstances, I advocate are now engaged gather more force as they the establishment of schools for conprogress the disease should, in from twenty- sumptives, in which the patient will in three five to forty years, disappear from all civil- weeks derive the benefit of a practical course ized countries. It will not be very long of instruction at a sanatorium-school debefore tuberculosis will have become as rare voted solely to this purpose. a disease as smallpox is today,

The sanatorium-school I have in mind In studying the report of the National can be built within the city limits or in Association for the Prevention of Tuber- the suburbs. It should be an institution built culosis, we find that the average cost of one and equipped as a modern sanatorium for patient per day in thirty semi-charitable the cure of consumption, suited for open air, sanatoria scattered in all parts of the United rest, hygienic and dietetic treatment and States is about $1.70. Computing that there should be under the supervision of trained are in the United States at least 300,000 physicians and nurses who will carry out the consumptives who are unable to obtain ad- most approved treatment of tuberculosis. mission to any charitable institutions, it is There the patients will not only be kept and estimated that the annual cost for the treat- treated, but they will themselves be inment of these persons would be fifty million structed in the various phases of sanatorium dollars. The lowest figures show that the treatment. There they will be trained country loses at least two hundred million how to take care of themselves after

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