frequently in children and
adolescents, and other signs of tuberculosis are usually present. The
cerebellum is a common seat of these tumours, and they are often
multiple. Their growth may be rapid at first, and then become arrested
for a time. Spasmodic growth of a tumour strongly suggests its
tuberculous nature, and superadded signs of basal meningitis confirm
the diagnosis.

_Endothelioma_ grows from the dura mater, and in so far as it is a
well-defined and non-infiltrating growth it lends itself to removal by
operation. Unfortunately, however, it is usually located at the base
of the brain and is not readily accessible.

_Glioma_ is usually met with in the young; it tends to grow slowly at
first, but may take on a rapid growth at any time, and haemorrhage is
liable to occur into the substance of the tumour, causing a sudden
aggravation of the symptoms.

_Sarcoma_ occurs between puberty and middle life; it grows slowly, and
compresses rather than destroys the brain tissue. It is sharply
defined from the surrounding cerebral tissue, and is therefore more
favourable for operation than glioma.

The _prognosis_ is grave in all forms of brain tumour. Even in
syphilitic growths, although the more urgent symptoms may be
ameliorated by the use of drugs, recurrence is liable to occur, and
the structural changes induced in the cerebral tissue, and the
contraction of the cicatrix which results, may permanently interfere
with the functions of the brain, or may induce Jacksonian epilepsy.
Tuberculous tumours also may become arrested, and may cease for a time
to cause symptoms, but permanent cure is extremely rare. We have known
a sarcoma to recur as late as five years after removal. Death
sometimes occurs suddenly from haemorrhage, from acute oedema, or from
implication of vital centres.

_Treatment._--It is to be borne in mind that gummatous growths in the
brain are seldom influenced to any extent by anti-syphilitic remedies,
and time should not be wasted in trying this form of treatment.

The question of removal by operation arises in cases in which there is
reason to believe that the tumour is situated near the surface of the
brain and that it is circumscribed and of moderate size. Unfortunately
it is only in a small proportion of cases that these conditions are
present and can be recognised before opening the skull.

In many cases in which there is no hope of being able to remove the
tumour, it is advisable to reliev