THE DIAGNOSIS OF TUMOURS OF THE CEREBELLUM
596 Among the complications of nose diseases, particularly polypus, none is more common than ctstlima. About every fifth case of chronic nose disease has or has had asthma, continuously or at periods. Frequently this asthma disappears after removal of the polypi, even when they are very small. Some patients were so sensitive to irritation in the nose that they were seized with an attack of asthma when the cavity of the nose was touched by instruments. I have seen the most curious varieties of
... ious varieties of nose disease complicate asthma, even a red thickening of the outer nose, in very abstemious, regularly-living persons in good society. In strong men of active habits the presence of polypi in the nose leads to chronic congestion of the posterior parts of the lungs, for which there is frequently no relief except the complete removal of the nasal polypi. -- The asthma is sometimes relieved by the careful use of ammonic chloride and potassic iodide. But the iodide must not be used when there is bronchitic complication. Here the most useful remedy is the inhalation of the pyrolytic vapours of extract of opium, of belladonna, of Indian hemp, of hemlock, of hyoscyamus, of stramonium. All these remedies have been used for a long time in one form or another, though not in the form here alluded to. Most patients of both sexes who came under my observation had smoked stramonium leaves, or some little rolls of blottingpaper in which a vestige of the solid contents of the tincture of these substance was contained. Some used preparations of vegetals impregnated with nitre and ammonic chloride. These powders are burnt on a tray, and the smoke is inhaled. It contains ammonic carbonate arising from the double decomposition of the potassic carbonate formed from the nitre with the ammonic chloride. These mixtures are called " cures," but seem to me to be destitute of any real alterative or symptom-relieving power. The asthma accompanying nasal polypus may be inherited by the offspring without the polypus, just as polypus alone is sometimes inherited. Of the former I observed a remarkable case some years ago. A strong man following an open-air trade, had been suffering from gout and polypus, and intermittently from asthma for twenty years. I removed the polypus, and by medical treatment much improved the patient's general condition. I was thereupon called to see his two daughters, who both suffered from periodical asthma. In the case of the elder one the attack came on every fortnight or every twenty-eight days, and lasted from one to three days. It was bronchial spasm, causing noisy, heavy inspiration ; the face was livid, and the pulse vacillating between fulness and collapse; the patient could hardly speak a word ; lips and tongue were dry, cracked, and fissured. Strong doses of morphia alone relieved the disorder, and reduced its dimensions and duration, if taken as soon as the premonitions appeared. The asthma was subdued by a long course of quinine and potassic iodide. The younger sister had a spasmodic panting, resembling certain hysterical forms of that neurosis. Its attacks were less regular and shorter than those in the former case, and yielded to the same remedies. I have known polypus affecting three successive generations ; in one instance, seven members of one family, of whom I treated three, were said to be affected by it. Pembroke-gardens. ENLARGEMENT of the head takes place only in children whose cranial bones are not ossified. Their yielding sutures allow the collection of a great deal of fluid, and the attainment of large dimensions by the tumour. Similar enlarge. ment may be produced by voluminous tumours-as hydatio -of the cerebrum. The enlargement is then not always s( symmetrical, and is more frequently associated with hemi plegia. When the various symptoms I have described are presen we may diagnose with confidence-as was done in the threi cases above-tumour of the cerebellum, but it must not be understood that with tumour of the cerebellum these sym ptoms are always present. I have seen cases of cerebellar tumour without these localising symptoms, and in their absence exact diagnosis is impossible. In the present state of our knowledge it is impossible to fix the exact position in the cerebellum occupied by a tumour. A few years ago the same might be said regarding the cerebrum. Detailed reports of post-mortem examinations, and careful clinical records of cases of cerebellar tumour are required, in order that the cerebellum may be mapped out as is being done with the cerebrum. It is as a contribution in this direction that I offer these cases. As regards the nature of tumours of the cerebellum the means at our disposal for its determination are very limited. The cerebellum is a rather favourite seat of tubercular or scrofulous cheesy tumours. Children are most liable to this form of growth, and there is always a strong probability of the tumour being of this character in the young. This pro. bability amounts almost to a certainty when we have, either in the child or the adult, signs of scrofula present. In Case 3 the diagnosis as to the position and nature was complete, and in several other cases it has been equally correct. Almost any kind of tumour may occur-glioma, psammoma from the membranes, &c.,-but syphilomata in this position I believe to be rare. Though my subject is the diagnosis of tumours of the cerebellum, I may be allowed to add a few remarks on the physiological importance and significance of cerebellar lesions. " The functions of the cerebellum form one of the most obscure and disputed questions in cerebral physiology," says one who has done much to clear up the obscurity.' Dr. Ferrier, in his valuable work, has given details regard. ing his own, Flourens', Hitzig's, and other experimenters' investigations into the functions of the cerebellum. Draw. ing attention to the importance of, and at the same time pointing out the difficulties in, distinguishing between the effects of irritative and destructive lesions, he says, "When the cerebellum is divided exactly in the median line in an antero-posterior direction, it is found that the disturbances of equilibrium, if any, are of no marked importance, and there is none of the tendency to reeling or rotation which cha. racterises undefined lesion of the organ. It is also found that when lesions which are as nearly as possible sym metrical on both sides are made, that the disorders of equilibrium are also comparatively slight.