1444

three sections--boys, girls, and infants-having little in

common. He regarded ophthalmia as potent for mischiefin other places equally with Poor-law schools, and didnot regard the disease as by any means a necessarycorollary to the school system. With reference to the

physical condition of the inmates of the schools, he

looked upon the bad record as arising from a natural

selection of the unfittest for these institutions. The degreeof faith to be placed in the much-lauded boarding-outsystem seemed to him to be smaller than is generally feltto be the case, having in view the statistics placed beforethe Committee by those most favourable to it; and, in hisopinion, the standard of excellence in matters educational isquite as high in Poor-law schools as in most of the elementaryschools in the country. Others who spoke felt it to be hardthat no more praise had been accorded to the painstakingwork of the Poor-law guardians and officials to better thesystem as at present existing. The meeting at the end

of this discussion unanimously passed the following reso- ’,lution :-

.

"That in the opinion of this meeting of this associationthe report of the Poor-law schools is unsatisfactory, unjust,and unfair to metropolitan schools generally, which can showvery satisfactory results, as an impartial inquiry must prove ;and this meeting suggests to the National Council that someaction shall be taken in the matter."

THE SURGICAL TREATMENT OF INTRACRANIAL

TUMOURS.

IN a paper in the last number of the American Jo2crnal ofthe Medioal Sciences Dr. Stieglitz, Dr. Gerster, and Dr.

Lilienthal describe three cases in which operation was per-formed for intracranial tumour. In one case the patientrecovered and did well for at least a year after operation ; inthe other two cases death followed operation. The first

patient was a woman aged twenty-five, who, in October,1891, while talking to her husband, suddenly felt the thumband forefinger of her right hand twitch. The spasm graduallyspread up the arm to the shoulder and face, leading to ageneral convulsion, with loss of consciousness. Severalattacks similar in character followed, and in February, 1892,there was definite paresis of the right hand, which graduallybecame more marked in the course of the next few weeks.There was no headache, sickness, or optic neuritis, andanti-syphilitic treatment failed to influence the symptoms.It was concluded that a tumour was probably present in theleft anterior central convolution near the junction of themiddle and lower thirds. Operation was performed onJune 25th, 1892, and a sub-cortical cystic tumour was foundin the position indicated above and an ounce of straw-

coloured fluid escaped. The cyst-wall was perfectly smooth,but it was considered inadvisable to attempt the removal ofthis. The patient made a good recovery and by the end of thefollowing October she was able to write and sew, a markeddifference from her condition before operation, when she hadbeen unable to use the hand at all. In December, how-ever-that is, six months after operation-she had a generalepileptic seizure which began in the right arm, and shecontinued to have twitchings on the right side with

subsequent weakness of the limbs on the affected side. No

other symptoms were superadded until March, 1895, whenshe began to suffer from severe headache, and at this date,for the first time, the optic discs were found to be cloudyand slightly swollen. It was thought that there had beena recurrence, or rather an extension, of the growth in thecyst wall, and at the operation a small maroon-colouredmass was found towards the upper margin of the opening inthe skull. This was found to be conical in shape, with thebase at the surface and the apex deep in the brain substance.It was sarcomatous, and islets of growth were found in the

surrounding brain substance. There was temporary inter-ference with speech after the operation, but this soon passedoff and power began to return in the paralysed limbs.

A year after this second operation the condition of the

patient was very satisfactory. There had been no recurrence

of the severe seizures or even of the slight twitchings, andthere had been considerable return of power in the paralysedarm, the thumb and index finger alone remaining powerless,Cutaneous sensibility is said to have been perfect, but therewas considerable interference with the muscular sense in thehand. The second case was that of a Russian aged thirty-three, who came on account of loss of vision, and was foundto have intense optic neuritis. There were also severe head-

ache, staggering gait with tendency to fall to the right,slight weakness of the right side of the face, and someindefinite limitation of the movements of the righileye. Total deafness on the right side and partialreaction of degeneration in the facial muscles of the rightside were moreover present. Trephining was done in the

right occipital region as it was supposed the tumour wassituated in the ventro-cephalic part of the right cerebellarlobe close to the internal auditory meatus. The intracranial

pressure was found to be enormously increased and thetentorium was pressed up from below. The tumour couldnot be reached, and so enormous was the intracranial

pressure that there was a large hernia cerebri which had tobe removed. The wound subsequently became septic and

, the patient died a fortnight after the operation. At the

necropsy a glio-sarcoma the size of a small apricot wasfound, involving the anterior half of the right cerebellar

hemisphere and indenting the same side of the pons.The third case was that of another Russian fifty years

.

of age who suffered from right-sided fits and subsequently’ from headache and disturbance of speech. There was also

l weakness of the right arm and right side of the face, but no

’ optic neuritis until more than eight months after the first fit,

’ Operation was carried out, but the patient succumbed to the

; shock and loss of blood. A large tumour was found in theleft Rolandic area. These three cases furnish examples of

l the difficulties to be met with in dealing surgically withintracranial tumours. The last two show that trephining

’ alone, even when the tumour is not removed, has certain

dangers. Those arising from the enormously increased intra-

. cranial pressure and consequent protrusion of the cranial

contents after trephining in the case of sub-tentorial tumours’

are strikingly illustrated in the second case.

LONDON DUST.

ONE of the unpleasant effects of the recent spell of dryweather in London has been the unusually large amount ofdust that has been flying about. The irritation of the mucousmembranes of the respiratory tract and conjunctivas whichit produces is no doubt responsible for many of thenasal and bronchial catarrhs which are apt to occur at thisperiod of the year, especially in those who are predisposed tothem, and, besides this simple irritative effect, a large amountof organic matter is naturally inhaled. Dust is chieflymade up of mineral particles to which is added a variableamount of organic matter arising from the decomposition ofanimal and vegetable refuse, and we may feel quitesure that the dust of overcrowded London contains a

large share of the latter. It is impossible to esti-mate with any degree of exactitude what detrimentaleffect on the general health a period of dusty weather mayhave, but we are forced to think it must have some when welook at the disastrous results to health which continuousinhalation of particles causes. So in a minor degree is thedust of the streets injurious, not perhaps to any practicalamount to those who are healthy, but to those alreadysuffering from pulmonary complaints it must necessarily be