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WITH the advances in our knowledge of the location and functions of the different cell groups and fibre tracts in the spinal cord, there has come a better understanding of the symptoms and signs of slowly increasing cord pressure, and the possibility of a finer differentiation between the disturbances caused by spinal cord tumors and those which result from intrinsic disease of the cord. Manometric studies of the pressure of the spinal fluid and the investigation of the physical, histological and chemical changes which occur in the fluid when the subarachnoid space has become blocked by an expanding new growth have added much to our knowledge, advances which are due especially to the studies of Froin,1 Mestrezat,2 and Sicard and Foix 3 in France, of Raven 4 and Queckenstedt 5 in Germany, and of Ayer s and his co-workers, of Stookey 7in our clinic, and of others in this country. Much progress has also been made in our understanding of the mechanical effects of tumors within the spinal canal and of the manner in which nerve roots and fibre tracts are involved by a slowly increasing pressure. From the progression of the symptoms and the objective signs of disturbed function, we are now able, in many instances, to say with certainty that an individual has a spinal cord tumor, and it is possible to diagnosticate not only the level at which the spinal cord is compressed, but also the side of the cordwhether anterior, posterior or lateral-upon which the expanding lesion is exerting its pressure. Rarely, however, does the patient first seek out the neurological expert on account of his symptoms; more often he consults the general practitioner. and not so rarely the general surgeon on account of pain in one or other part of the body. Paini in Spinal Cord Tuntors.--Pain referred to the back, to the chest, to the abdomen or the extremities is very frequent in spinal cord tumors occurring in my series of II5 cases in about two-thirds of the patients with extramedullary and extradural growths, and in less than one-sixth of the patients with growths within the substance of the cord. In high cervical tumors, the pain may be felt in the suboccipital region or in the nape of the neck, on one or the other side. The pain in the neck from a tumor which compresses the cervical spinal cord may be very severe, and' may be so much

SOME ASPECTS OF THE DIAGNOSIS AND SURGICAL TREATMENT OF TUMORS OF THE SPINAL CORD WITH A STUDY OF THE END RESULTS IN A SERIES OF 119 OPERATIONS