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OXFORD
Contents vii
(ID CHAPTER 2 I Perceiving Self in Relation to Others 35

Introd uction 36
Nature of Our Self Concept 37
Self-Image: The Role of Internal Voice 38
Creating Our Life Scrip ts 39
Validating Our Life Scripts 40
Revising Our Life Scripts 41
Looking-Glass Self: The Role of External Voices 42
Family 44
Romantic Partners 45
Peers 46
Teachers and Coaches 47
Caregivers and Health Care Providers 49
Workplace Colleagues and Supervisors 50
Ideal Self: The Role of the Media 52
Interaction of Children and Adolescents with Media Images 52
Shifts in Media Depictions of Women over Time 52
Media Influence on Body Satisfaction 55
Variations across Cultures 58
Real Self: Challenges in Discovering the In ner Self 59
Ch allenges in Measuring Self-Concept across Cu ltures 60
Tips for Accepting and Moving beyond Self in Com munication 61
Summary 63
Review Questions 63
Suggested Ac tivities 63
(ID CHAPTER 3 I Perception of Others 67

Introduction 68
Nature and Characteristics of Perception 69
Perception Is Learned and Backward Looking 70
Perception Is Culture Bound and Racially Biased 72
Perception Is Selective and Self-Serving 76
Perception Is Spontaneous, Largely Unconscious, and Value Driven
Perception Is Relative and Context Bound 80
Perception Is Mood Dependent 83
Perception Is Completion Seeking 84
viii Cont ents
Strategies, Tools, and Tips for Gaining Awareness and Controlling

Perception Biases 91
Adopting Strategies to Control for Bias and Improve Communication 91
Using Perception Checking to Minimize Er ror 93
Using the Comm unication Predicament of Aging (CPA) Model to Improve Interactions
with Older People 94
Summary 95
Review Questions 96
Suggested Activities 96
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Understanding, Navigating, and Managing
Our Identities 99
Introduction 100
Navigating Mult iple Identities w ith Collective Dimensions 102
Navigating Gender Iden tities 104
Navigating Ethn ic and Racial Identities 104
Navigating Religious Identities 106
Navigating Linguistic and Cultural Identities 107
Navigating Regional and National Identities 108
Experimenting with Our Identities 111
Validating Our Identities 114
Managing Our Identities 115
Managing Impressions in Different Contexts 117
Common Impression-Management Strategies 120
Managing Impressions in Online Environments 123
Tips for Navigating and Managing Id entities 127
Summary 128
Review Questions 128
CID CHAPTER 5 I Listening 131

Introduction 132
The Nature of Listening 133
Hearing and Listening: Not the Same 134
The Listening Process 134
The Importance of Listen ing 137
Barr iers to Effective Listening 140
Information Overload and Multi-Tasking 140
Contents Ix
Difference between Thought Rate and Speech Rate 142

Listening from Your Own Perspective 143
Taking Away from the Other Person's Perspective 143
Getting the Most out of Listening 146
Listening to Learn 146
Listening to Sustain or Improve Relationships 150
Tips for Effective Listen ing 155
Summary 156
(ID CHAPTER 6 I Communicating Verbal ly 159

Introduction 160
The Cha racter istics of Language 162
Language Is Symbolic 162
Language Is Ru le Bound 165
Language Is Culture Bound 167
Language Is Dynamic 169
Social Functions of Language 171
Language Allows Us to Construct and Name Our World 172
Language Brings Us Together or Separates Us 173
Language Conveys Credibility to the User 174
Barriers to Effective Verbal Communication 176
Bafflegab 1n
Equivocality 178
Euphemisms and Doublespeak 179
Language Misuse 180
Static Evaluation 181
Politically Incorrect Language 182
Tips for Effective Verbal Communication 183
Summary 185
(ID CHAPTER 7 I Communicating Nonverbally 189

Introduction 190
Differentiating between Verbal and Nonverbal Communication 191
Pr imary Functions of Nonverbal Communication 193
x Contents
Replacing or Substituting for Verbal Messages (Emblems) 193

Complementing, Repeating, and Accen ting Verbal Messages (Illustrators) 194
Regulating Interaction (Regulators) 194
Relieving Tension and Satisfying Bodily Needs (Adaptors) 195
Conveying Emotion (Affect Displays) 196
Secondary Functions of Nonverbal Communicat ion 196
Making First Impressions and Violating Expectations 196
Making Connections through Immediacy 199
Building and Maintaining Relationships 201
Nonverbal Communication Channels or Media 202
Facial Expressions, Eye Contact, and Gaze 203
Vocal Cues and Silence 204
Body Movement, Posture, Stance, and Gestures 205
Touch 206
Clothing and Personal Artifacts 209
Colour 211
How Space, Time, and Physical Settings Com municate 213
Personal Space 213
Territoriality 213
Ch ronemics 214
Buildings and Spatial Arrangemen ts 214
Questioning t he Work of Pioneers in the Field of Nonverbal Com munication 216
Tips for Improving Nonverbal Communicat ion Skills 217
Summary 218
(ID CHAPTER 8 I Building and Maintaining Relationships 221

Introd uction 222
The Value of Relationships 223
Reasons for Forming Relationships 225
Needs Theory 225
Social Exchange Theory 230
Types of Relationships 231
Relationsh ips of Circumstance 231
Relationships of Choice 232
Relat ionsh ip Contexts 233
Family 233
Fr iends 234
Work Colleagues 237
Romantic Partners 240
Stages of Roman tic Relat ionsh ips 241
Coming Together 242
Coming Apart 243
Predicting Relationship Failure by Analyzing Communication Patterns 245
Bu ilding Trust and Intimacy through Self-Disclosure 247
Contents xi
Social Penetration Theory 247

Johari Window 247
The Internal Drive to Self-Disclose 248
The Dangers of Self-Disclosure 249
Tips for Building and Maintain ing Relationships 250
Summary 252
Review Questio ns 252
(ID CHAPTER 9 I Managing Conflict and Practising Civility 255

In troduction 256
Sources of Conflict 258
Differences in Beliefs, Attitudes, and Values 258
Personality Differences 258
Incompatible and Conflicting Goals or Roles 259
Interdependencies 259
Insufficient or Different Information 260
Poor Communication 260
Scarce and Non-distributable Resources and Power Struggles 261
Stressful Situations 262
Types of Con fl ict 262
Overt Conflict 262
Covert Conflict 263
Stages o f Conflict 264
Ro le of Power in Co nflic t 266
Coping Styles 269
Com peting 269
Accommodating 269
Avoiding 270
Com prom ising 271
Collaborating 271
Finding the Right Coping Style 272
Outcomes of Co nflic t 272
Dysfunctional Conflicts 272
Functional Conflicts 274
Develo ping a Civil Wor kplace 274
Behaviours Associated with Incivility 275
Costs of an Uncivil Workplace 276
Creating a Civil Work Climate 277
Using the Aware ness W heel to Manage O ur Conflicts 280
Tips for Manag ing Con fl ict 281
Summary 283
Review Questio ns 283
xii Contents
(ID CHAPTER 10 I Group Decision-Making: Leadership and Process 287

Introduction 288
Guid ing the Group through the Process: A Leadership Perspective 290
Six Steps in Problem Solving 292
Step 1: Defining and Analyzing the Problem 293
Step 2: Establishing Criteria for Solutions 294
Step 3: Identifying Possible Solutions 294
Step 4: Choosing the Best Solution 310
Step 5: Implementing the Decision 313
Step 6: Evaluating What Worked 313
Tips for Improving Group Decision-Making 314
Summary 315
Appendix I Making a Team Presentation 317

Glossary 341
Notes 348
Index 387
FROM THE PUBLISHER
Communication in Everyday Life: Personal and Professional Contexts i s desi gned to

improve readers' conununication skills i n both their person al an d p rofessi onal lives. To
that en d, this nev, and excitin g introduction to i n t erpersonal communication i ncl ud es
the follo\ving key features:
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From the Publisher xvii
'"
Managing lmpreuions in Online Environments
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xviii From the Publisher
® SUPPLEMENTS
Communication in Everyday Life: Personal and Professional Contexts is supported by
an outstanding array of teaching and learning tools for both instructors and students.
For Instructors
• A co1nprehensive instructor's n1anu al includes detailed lecture outlines,
questions to encourage class discussion and debate, a v,realth of suggested
assignments, and links to websites and online videos.
• An extensive test bank provides instructors with hundreds of questions in multiple-
choice, short·anS\ver, and true/ false fonnats.
• Hundreds of editable Po,verPoint slides sum1narize key points from each
chapter and incorporate visuals dra\vn from the text.
For Students
• A s tudent study guide features detailed chapter summaries, self-grading quizzes,
suggested topics for oral presentations and writing projects, and more.
About the Book
TNs compr~ nslve .,~ exapdon•Uv

ac:c.culblo Introduction to lntcrPt-rSONI
commvnlcetton UMS eng-vlng nerrat1ve:s •nd Pte:.;,se contact your locel
ex.mple, from • r•nge of dlsclpllnu to
provide e well•rounded tru tm~nt ol the Information.
c:onupa, theories, and appUc.tions ol
commun!catton In everyoa.,. tire.
Student RoaourCff
Sample Material
Qrdlooa1otggntttqn
Coritact ft CommtnU Get Adobe POF reader ( ~ I W:t J
www.oupcanada.com/Ferguson
From the Publisher xix
CD ACKNOWLEDGEMENTS
We would like to thank the follo,ving manuscript reviev;ers, as well as those who
chose to remain anonymous, for their insightful comments and suggestions during
the development of Communication in Everyday Life: Personal and Professional Contexts:
Diane Demers, Concordia University
Laura Doan, Thompson Rivers University
Dawn Fleming, Saskatchewan Institute of Applied Science and Technology
Victoria O'Connor, Algonquin College
Barbara Rice, Conestoga College
Joanne Spence, Humber College
FROM THE AUTHORS
In 2010, Oxford University Press confirmed their decision to publish this book; and
Jenepher and I began our journey to address gaps we had uncovered during more than
a half century of collective experience teaching introductory courses in interpersonal
and organizational con1111unication.
I first taught the interpersonal and organizational communication course at the University
ofWmdsor in the early 1970s and later co-authored or edited (v.rith Stewart Ferguson) t:1,vo
of the first books in organizational co111munication.Jenepher's entry into teaching began at
the State University of New York (SUNY) at Buffalo in the late 1980s, where she taught inter-
personal communication. As a professor at the University of Otta\va, her work continued
to include the teaching of courses in interpersonal and organizational communication, for
which she has \Von 111any av.rards. Her focus in research and teaching has always been on
maximizing the student experience. I am proud to say that Jenepher \¥as one of my earliest
students; and while I carmot claim credit for her acco1nplishments, I am pleased to have her
as a colleague and co-author on this book. In short, the woofus bring a large store of experi-
ence and commitment to researching and teaching introductory courses in interpersonal
and organizational communication.
Vvhile the theories presented in this book focus predo111inantly on the interper-
sonal, their applications include an equal emphasis on organizational and professional
contexts. Fro111 its beginnings, organizational com111unication included a significant
interpersonal component because, after all, communication in organizations involves
interactions beween people w ho use a variety of media to express themselves. 1hose
media may include air \Vaves (in the case of face-to-face con1munication), postal ser-
vices, cellular telephones or land lines, co111puters, video links, or other. We interact in
dyads (groups ofwo}, small groups (three or 111ore), and large groups.
In addition, \'l'e carry our private lives, our self-concepts, and our identities into
organizations. Our personalities detennine our preferences in managerial and leader-
ship styles, and emotional intelligence (EQ) counts as 111uch or more than experience
and general intelligence (tQ) \¥hen it comes to succeeding in organizations. Our identi-
ties also influence how we behave in organizations and how others react to us. In an
increasingly multicultural and global world, identity management becomes a critical
ele111ent in navigating business and corporate environments. So to separate what hap-
pens in our personal and \Vork lives makes little sense. That is the premise on \Vhich \Ve
designed this book, \,vhich includes both personal and professional contexts-in other
words, co111munication in our everyday lives.
In a greater sense, it is no\,v extremely difficult to separate con1munication into discrete
fields of study such as media, organizational, interpersonal, and health communication.
Courses in 111edia include a focus on how people use media for social gratification, how
perception of risks influences behaviours, and how social media change the\vaywe interact
with each other in interpersonal contexts. Courses in organizational co111munication talk
about how people interact in small groups, exercise leadership, and respond to cultural
From t he Auth o rs xxi
influences. Courses in interpersonal communication describe the behaviours of people in

virtual space (e.g., Second Life and multi-player games}, explore how people 111anage their
online identities, and examine the psychology of perception. Courses in health conununica-
tion talk about doctor- patient interactions and how health organizations use video links to
connect \~rith, diagnose, and prescribe treatment for clients in re111ote geographic areas. In
other words, a M de variety of courses in the social and health sciences now bring together
insights from 1,vhat used to be separate fields of inquiry.
Despite the fact that health, policing. social work, and other professional progra111s
include interpersonal conununication courses in their curricula, none of the other intro-
ductory textbooks in our field have focussed so strongly on meeting their needs. We
have also included an important and necessary e111phasis on diversity in our exa111ples,
theories, and text boxes; and we have tried to recognize the importance of the Aboriginal
heritage in Canada.
We wan ted to 1,vrite a book that was highly readable and student friendly-that con-
tained interesting and current examples of how we com111unicate Mth family, friends,
ro111antic partners, 1,vork colleagues, and super\risors. In line Mth this idea, 1,ve wrote a
nu1nber of original narratives and stories to illustrate points. We wanted the students
to enjoy the experience of reading this book.
In terms of research, v,e \¥anted to include the classical studies that have defined the
field, alongMth major developing areas of research. However, we did not 1,vant to include
a myriad of relatively isolated studies that have not yet achieved a high level of visibility.
\Ive also 1,vanted students to understand hoi,v the concepts in this book apply to their
everyday lives. So \'l'e have featured a large nu111ber of text boxes that ask students to put
theories into practice. We have also concluded each chapter 1,vith tips for conununicat-
ing 111ore effectively. We wanted students to be able to see the p ractical implications of
what they are learning-how they can i111prove their fa111ily, social, and work relation-
ships by applying the principles they acquire in this book.
\Ive have 111ade some original contributions in areas such as defining the differences
between self-concept and identity-tenns that appear in many different and confusing
guises in the literature. In the sa111e way, 1,ve tried to look at the relationship between
personal and collective identities-relationships that are ill-defined in the literature. vVe
devoted an entire chapter to identity management, another novel feature of this book.
\Ive hope that you will enj oy reading this book as m uch as we enj oyed researching
and 1,vriting it!
Acknowledgements
All books are a journey. As they progress, so do our lives progress. \Ive are never in the
same place at the end as at the beginning of any project. When I began 111y journey \'l'ith
this book, I was grieving the loss of111y husband of37 years. I a111 noi,v grieving the loss
of a daughter who \,vas Mth 111e for 38 years. So ackno\,vledging both the professional
and the personal is important to 111e as this journey draws to a close.
Jenepher and I would like to thank Rukhsana Ahmed and Peruve111baJaya, associ-
ate professors in the Department of Communication at the University of Ottawa, for
contributing some interesting examples, theoretical insights, and text boxes in areas
such as diversity, health, and impression 111anagement.
\Ive would like to ackno\,vledge the representatives at Oxford Un iversity Press in
Toronto, w ho sho\,ved an early enthusiasm for the project. Stephen Kotowych \,vas the
xxii From t he A ut hors
acquisitions editor at the time we proposed this book. We thank both Stephen and
managing editor Phyllis Wilson for their interest in-and support for-the project. In
addition, we thank Janice Evans, senior editor, for her conscientious efforts with get-
ting this book ready for publication. We have never worked ,vith a 1nore competent or
dedicated editor. She is special!
Finally, but not least i1nportant, vie thank Mark Thompson, develop1nental editor at
our, for his dedication and professionalis111. Mark never failed to respond to a question,
to offer expert advice, or to suggest positive directions for change. This book v,ould be
a different and inferior product ,vithout his input. On a personal level, I would also like
to thank Mark for holding my hand in virtual space at times when I was not sure that I
could finish what I had begun. His encourage1nent and flexibility 1nade all the difference.
I ,vould also like to ackno,vledge the people in my life \¥ho have held a candle for me
in my darkest moments. My daughter Ca1neron and her children (Solan and Harper),
my son Eric and his children (Erica, En'lilie, Vvillia111, and Morgan), and my daughter
Ali's little girls (Ella and Sasha) continue to be light bearers for me. I love all of them very
much, and they help to remind 1ne of the continuity of life-that ,ve are placeholders for
the next generation. I particularly want to ackno\¥ledge Ca1neron at this time, because
she has sho,vn great strength in this past year. As much as her grief has threatened to
overwhelm her at times, she has been a constant support for me; and I a111 very proud of
the \¥01nan that she has become. I also \¥ant to recognize, \~rith affection, Bruno Lepage,
who joined our fa1nily many years ago. I thank Eric for coming to help me \¥hen he was
himself exhausted and not well after a trip abroad.
I \¥ould also like to ackno\¥ledge 1ny sisters Desiree, Claire, and Barbara, \¥ho occupy
special places in 1ny heart and life. Ali \¥ould be happy to kno,v that her husband, Patrick
Hendriks, and I have worked closely together since her death to support the emotional
needs of their children. The sharing has been important to 1ne, and I thank hi111 for
continuing to include me in the lives of his girls.
I thank my neighbour Jocelyn Burgess for her al\¥ays cheerful and generous com-
pany-especially the Sunday night dinners and evenings at the National Arts Centre. I
a111 grateful to 1ny childhood friend Bobbie Giltner for con1ing to Canada in 2012 to offer
prayers and e1notional support to 1ny fanu ly. Her presence was co1nforting to my daugh-
ter and to 1ne. I have also appreciated the emotional support offered by psychologist
Marie-Sylvie Roy, ,vho has helped me to accept that nothing is ever lost, only changed.
Last summer's journey to the sacred valleys and mountains of Peru was ,vonderful and
healing; for that, I owe a debt ofgratitude to Pete Bernard, Algonquin medicine 1nan and
shaman. I thank reno\~rned mediu111 and author Janet Mayer for the constancy of her
friendship. What began as a professional relationship became a personal connection .
And last, but certainly not least, I want to acknowledge the support and valued friend-
ship of esteemed scientist and researcher Dr Henry Lai (Seattle Magazine's Person of the
Year in 2011 and recently retired professor from the University ofWashington). Despite
his o,vn heavy research agenda, he shared medical research and ad.rice with me on a
daily basis during the period of my daughter's illness. I have never known a more ethical
or caring person, and I ~rill never cease to be grateful to him.
Sherry Devereaux Ferguson

September 2013
From t he Auth o rs xxiii
I 1,vould like to acknowledge my friend and colleague Dr Lynne A. Texter, professor at La

Salle University in Philadelphia. As office and house 111ates throughout graduate school
at the State University of New York in Buffalo, Lynne and I spent hours talking about
teaching, learn ing, and education. It was in Buffalo that I began 111y teaching career,
putting in to practice the theories about communication and teaching that Lynne and
I explored together. I v.rould also like to thank my students, thousands of the111 over the
past tv.ro and a half decades, for their 1,villingness to let me test teaching techniques,
try out innovative forms of evaluation, and introduce all kinds of 111ulti111edia and tech-
nology in the classroom. Their feedback and enthusiasm has made 111y teaching and
research so much more 111eaningful.
My teaching and research assistants over the years have also provided 111uch support
and guidance- as \¥ell as a lot of fun and youthful energy. I a111 especially indebted to
Victoria Aceti, Genevieve Brisson, Jessica Daoust, Samantha DeLenardo, Dominique
Leonard, Vidya Nair, and Jerie Shai,v for their collaboration. I 111ust also thank Dr Sherry
Ferguson, my co-author, for her feedback on every word I 1,vrote in this book, her com-
mit111ent to excellence in writing, and her sound leadership on this writing journey.
My parents, Richard and Katharine Lennox, encouraged 111e to love learning, to be
unafraid of change and adventure, and to pursue \¥hatever directions I wanted to. 1heir
belief in me has contributed to everything I have done. I would like to acknowledge the
love and support of my children, Jack, Richard, and Katie. So many of the exa1nples I
generated in this book ca111e from observing the111 and their friends and reflecting on
the kinds of challenges that young people face in their relationships 1,vith fa111ily, peers,
and members of their co111munity. Finally, I 111ust acknoi,vledge the partnership I have
enjoyed with 111y husband, best friend, and soul 111ate, Kevin Terrian, for 25 years. \Ive
have learned and grown together in so 111any ways, and it is to hiln that I turn every day
for guidance, affirmation, and love.
Jenepher Lennox Terrian

September 2013
ABOUT THE AUTHORS
Dr Sh erry Devereaux Ferguson (Ph.D., Indiana University; MA, University of Houston;

BA, Louisiana State University) is a senior professor and former department chair and
director of graduate studies for the Depart1nent ofCom1nunication at the University of
Ottav.ra. She has acted on the editorial boards of numerous journals and yearbooks, includ-
ing the Journal ofCommunication, the Communication Yearbook, Communication Studies,
the International Journal ofStrategic Communication, and Communication, Culture, and
Critique. She chaired the Public Relations Division of the International Communication
Association (ICA) and held the position of executive board me1nber-at-large for the
Americas. She also chaired the Internationalization Conunittee for that organization.
Vvhile acting as chair of the PR division, she established the Global Task Force, a research
initiative involving scholars from 1nany countries. She is an honorary board member
for the Systems Theory and Complexity book series (Aracne Publishing, Rome}, in col-
laboration with the World Co1nplexity Science Academy (~vCSA).
Publications include three books on organizational com1nunication, tv,o on public opin-
ion and strategic planning in com1nunication, ti,vo on public speaking, one on civic dis-
course and cultural politics in Canada, and one on interpersonal com1nunication. Publishers
include Oxford University Press (New York and Toronto), Sage, Green\vood, Transaction, and
others. One of her books has recently been translated into Chinese. Ferguson has published
30 articles in refereed journals and made 45 conference presentations.
Clients in an extensive consulting career have included, in Canada, the Department
of Foreign Affairs, the Department of Justice, Transport Canada, Health Canada, the
Canadian Space Agency, the National Research Council, the Office of the Auditor
General, the Canadian International Development Agency, the Canadian Institute of
Management, Petro-Canada, and others. She served on ti,vo major federal advisory
boards, v,hich oversaw the \vriting of a vision state1nent and the defining of curriculum
needs for govern1nent co1nmunicators. She trained more than a thousand govern1nent
communication officers in public opinion analysis and strategic planning techniques,
initially at the request of the assistant secretary of communications to Cabinet. She also
did professional speech writing for a fonn er prime minister, government ministers, and
top-level bureaucrats.
Dr Jeneph er Lennox Terrion is an associate professor in the Depart1nent of

Co1nmunication at the University of Otta\va. She received her Ph..D. in communication
fro111 Concordia University.
Dr Lennox Terrion is the winner of1nany teaching awards, including the University of
Ottawa's Award for Excellence in Education, Distinguished Teaching Av,ard, and Capital
Educators' Award. She is passionate about teaching and has de1nonstrated creativity in
the design and delivery of both undergraduate and graduate communication courses
over the past tv,ro decades.
Another random document with
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of lesion causing this symptom, some of which have been
reproduced in our table. We will not go into any details as to the
character of this symptom, referring the reader to the sources
indicated. In the first case given in our table (Case 10) the
hemianopsia was produced by a tumor in front of, and impinging
upon, the optic chiasm; in the other four cases (Cases 40, 41, 42,
and 43) the tumor was situated in the occipital lobe, and was
surrounded by an area of destroyed tissue. Hemianopsia is not,
strictly speaking, a symptom of brain tumor, but is likely to be present
in cases occurring in certain regions of the brain. Starr's conclusions
with reference to lateral homonymous hemianopsia when it is not
produced by a lesion of one optic tract are that it may result from a
lesion situated either (1) in the pulvinar of one optic thalamus; (2) in
the posterior part of one interior capsule or its radiation backward
toward the occipital lobe; (3) in the medullary portion of the occipital
lobe; or (4) in the cortex of one occipital lobe. The conclusions of
Seguin are only different in so far as they more closely limit the
position of the lesion.
25 Vol. IV.
26 Pp. 84, 85 of present Volume.
27 Amer. Journ. Med. Sci., N. S., vol. lxxxvii., January, 1884, p. 65.
Phosphenes, or subjective sensations of light, occur in various forms

—simply flashes or sheets of light, scintillations, balls of fire, etc.
They are not very common as isolated phenomena, and probably
are dependent in most cases upon irritation of the nerve and retina in
some of the stages of neuro-retinitis. Even visual hallucinations are
occasionally present, as in one of Bennett's cases of tumor of the
Rolandic region.
Conjugate deviation of the eyes, with rotation of the head, a

symptom of the early stages of apoplectic attacks, is also sometimes
observed in brain tumor. The patient is found with both eyes turned
to one side and slightly upward, as if looking over one or the other
shoulder, the head and neck being usually rotated in the same
direction. Sometimes the deviation is slight, sometimes it is marked.
Frequently the muscles of the neck on one side are rigid. The eyes
are commonly motionless, but occasionally exhibit oscillations. This
sign, well known to neurologists, usually disappears in cases of
apoplexy in a few hours or days, although it occasionally persists for
a long time. It will be more fully considered under Local Diagnosis.
Diminution or loss of hearing, tinnitus, and hyperæsthesia of hearing

are all occasionally observed. The most decided disturbances of this
sense are those which are found in connection with tumors of the
base or of the cerebellum in such a position as to involve the
auditory nerve or auditory tracts. Tinnitus, acoustic hyperæsthesia,
with complete or partial deafness, accompanying facial paralysis,
with or without paresis of the limbs of the opposite side, indicate
clearly a tumor of the base so situated as to involve the superficial
origin or intracranial course of the auditory and facial nerves.
The sense of smell is affected, of course, when the olfactory bulbs

are involved in the growth, either directly or by pressure, as in certain
tumors of the antero-frontal region (Cases 4 and 8). Disturbances in
the power of consciously perceiving odors, or abnormal perceptions
of odors or hallucinations of smell, are sometimes present in cerebral
tumors involving certain convolutions. The lower postero-parietal
region or the temporo-sphenoidal region of the base would seem,
from the few reported cases, to be implicated when this sense is
centrally affected. Smell was lost or impaired in two cases of tumors
of the postero-parietal region, in one limited to the supramarginal
convolutions. In a case reported by Allan McLane Hamilton (Case
47), an induration of the lower part of the right temporo-sphenoidal
lobe involving the uncinate gyrus, the patient, preceding light
epileptic attacks, always had an olfactory aura of a peculiar
character—a disagreeable odor, sometimes of smoke and
sometimes of a fetid character. In this case the olfactory nerves were
examined and found to be healthy.
Taste may be involved in several ways. In the first place, subjective

sensations of taste, particularly the so-called metallic taste, may be
present when the growths involve the cranial nerves in such a way
as to cause irritation to be conveyed to the nucleus of the
hypoglossal. When it is remembered that a mild galvanic current
applied to the nape of the neck or face will often cause this metallic
taste, it can be seen that the irritation of a tumor situated at almost
any point of the base might lead to abnormal taste-phenomena.
Neoplasms involving the trunk of the portio dura may of course
cause diminution or loss of taste on the anterior extremity of the
tongue by the involvement of the chorda tympani nerve. In the very
few cases in which the hypoglossal trunk may be involved
disturbances of taste posteriorly may occur. In two cases (Cases 33
and 36) some possible indications as to the cortical areas of taste
are given. One was a tumor so situated as to cause pressure on the
orbital, and possibly anterior, portion of the temporo-sphenoidal lobe;
the other was a lesion closely localized to the supramarginal lobule.
Trophic disturbances of decided character are sometimes present in

cases of brain tumor. Their presence, character, and extent depend
upon the position of the tumor and the cranial nerves involved.
Trophic disorders of the eye have been noted in cases of tumor of
the antero-frontal region, and also of various positions at the base,
especially those so situated as to involve the trigeminal nerve. In a
fibroma of the superior antero-frontal region (Case 1) conjunctivitis
and corneitis of the left eye, with anæsthesia of the conjunctiva, were
present, and were very marked symptoms. This patient, who was
under the care of one of us at the Philadelphia Hospital, was
examined by O. E. Shakespeare, ophthalmologist to the hospital. At
his first examination the bulbar conjunctivæ were slightly injected
and the cornea clear. The sensibility of the cornea was possibly a
little lowered. Ten days later, at a second examination, the central
corneal epithelium of the left eye was found to be hazy and the
whole bulbar conjuntivæ much congested. “This condition soon
developed into a severe superficial corneitis, which was mainly
limited to a central area of an extent about equal to three-fourths of
the diameter of the cornea, which threatened to slough, a narrow
peripheral ring of the cornea being comparative unaffected. At the
same time the engorgement of the bulbar conjunctiva increased. The
sclera, the iris, and the deeper parts were apparently not involved in
the inflammatory process.”
Disturbances of respiration were observed in a number of cases in

various stages. Cheyne-Stokes breathing was usually a late
symptom. In a case of tubercular meningitis with a tubercular
granulation springing from the left side of the fourth ventricle (Case
82) it was present. Extraordinary slowing of respiration occurred in a
tumor of the right middle cerebellar peduncle and cerebellar
hemisphere which caused irritation and softening of the floor of the
fourth ventricle. The respirations ran as low as four and five per
minute two weeks before death.
Persistent epistaxis and a tendency to hemorrhage from the mucous

membranes were interesting vaso-motor phenomena in a case
situated in the upper left quarter of the pons (Case 84). Profuse
perspiration, more marked on one side, was observed in a case of
tumor in front of the optic chiasm. Polyphagia was observed in two
cases, one a growth of the cerebellum and the other on the floor of
the skull. Polyuria was a very marked symptom in Case 95, a tumor
at the base of the brain at a spot corresponding to the sella turcica,
and diabetes was present in a case of frontal tumor. Albuminuria was
recorded twice—once in the same case in which diabetes was
present, and again in a case of multiple tumor of the supramarginal
convolution of one side and the angular gyrus of the other.
Somnolence was occasionally observed.
Constipation or torpor of the bowels occurs somewhat frequently in

the early stages of the brain tumor, giving place in the terminal
periods to involuntary evacuations. The conditions of the bladder are
practically the same. It is either not involved or suffers from torpor or
paresis of the muscular walls early in the disorder, and later, and
especially very late, incontinence from paralysis of the sphincter
results.
DURATION, COURSE, AND TERMINATION.—The duration of cases of

intracranial tumor is very uncertain. In many of the reported cases no
definite information is given as to the exact length of time from the
initial symptoms until the fatal termination. The few cases in which
the time was recorded showed a duration of from three months to as
many years.
In a few cases, even in some which are not syphilitic in character, a

remission of all the symptoms and what appears to be an
approximate cure sometimes take place, the general symptoms,
such as headache, vertigo, vomiting, spasms, etc., disappearing for
a time. Even the condition of the eyes and the paralysis in rare
instances make marked improvement. In these cases, in all
probability, the progress of the growth of the tumor is arrested either
by the remedies employed or spontaneously, and the acute or
subacute phenomena of congestion, œdema, etc. around the tumor
subside. These patients may remain for a long period or until cut off
by some other disease without any change for the worse; but the
sword constantly hangs above their heads, and any excitement,
traumatism, the abuse of alcohol or other narcotics, an attack of
fever, or some other special exciting cause, may again light up the
intracranial disorder, to then progress more or less rapidly to a fatal
termination.
This fatal termination may occur in various ways. Sometimes a

sudden apoplectic attack occurs. This may be an intercurrent
hemorrhagic apoplexy, although our personal experience would not
lead us to believe this mode of termination is common. In a few
cases the enormous irritation of the cerebral growth suddenly or
gradually inhibits the heart's action through the impression made on
the pneumogastric. Apoplectic attacks which may or may not
terminate fatally sometimes are the result of a sudden giving way of
necrosed brain-tissue, the necrosis having resulted from the
obliteration of numerous blood-vessels by the advancing growth.
Blood-poisoning occasionally takes place from abscesses in
proximity to the tumor. In some cases the patients slowly but surely
emaciate, or are exhausted and worn out by the agonizing pain and
incessant vomiting which they are called upon to endure.
Occasionally a more or less diffused and violent meningitis hastens
the fatal issue.
COMPLICATIONS AND SEQUELÆ.—Tumors of the brain may be
complicated with other affections due to the same cause. Thus, for
example, in a case of gumma other evidences of syphilis may be
present in the form of nodes, eruptions, etc. A sarcoma or carcinoma
of the brain may be associated with similar disease in other organs.
Such affections as cystitis, pyelitis, keratitis, etc., which have been
discussed under Symptomatology, are secondary complications of
cases of tumor. As intracranial tumors almost invariably terminate
fatally, strictly speaking we have no sequelæ.
PATHOLOGY.—We present in tabular form the various classes of

tumors found in the one hundred cases of brain tumor in the table
appended to this article:
Carcinoma 7 Glio-sarcoma 1
Cholesteotoma 1 Gumma 13
Cyst 2 Lipoma 1
Echinococcus 2 Myxo-sarcoma 1
Enchondroma 1 Myxo-glioma 2
Endothelioma 1 Osteoma 2
Fibro-glioma 2 Sarcoma 15
Fibroma 4 Tubercle 13
Glioma 16 Unclassified 16
The histology of tumors of the brain does not in the main differ from
that of the same growths as found in other parts of the body, so that
a detailed description of their structures, even though founded upon
original research, could not offer many novel facts in a field which
has been so thoroughly cultivated. Such a description would
probably repeat facts which have already been presented in other
parts of this work, and which are better and more appropriately put
forth in special treatises devoted to the science of pathology. It is
proper, however, for the sake of convenience and thoroughness, to
make brief mention of the structure of brain tumors, and especially to
dwell upon certain features of these morbid growths which may be
considered characteristic of their encephalic location, and hence
have not only pathological but also clinical interest. It is hardly worth
while to refer to speculations which aim to elucidate the very
foundations of the science, except that in a few of these theories we
gain an additional insight into both the structure and conduct of some
very characteristic brain tumors.
Cohnheim's theory was that tumors are formed from foci of

embryonal tissue which had been non-utilized or left over in the intra-
uterine development of the body. Many have not accepted this idea,
but have rather considered that in tumors we witness a reversion of
tissue to lower or embryonic types.28 Whether we accept either or
neither of these propositions, the idea sought to be conveyed is that
in all these morbid structures we have a tissue of low or degraded
character, springing in most instances from a connective or non-
differentiated tissue. This fact is brought out very clearly in many of
these intracranial growths. Virchow29 has said that tumors originate
in the cells of the connective tissue, although his law has been
condemned as not of sufficient breadth, since it seems to ignore the
epithelial and myomatous tumors. Dermoid cysts, of which an
example is given in the table of spinal tumors,30 are said to illustrate
the embryonic function revived—i.e. the tendency of lower tissues to
spontaneously differentiate into higher and more complex ones.
28 Article “Pathology” in Brit. Encyc., by C. Creighton.
29 Quoted by Cornil and Ranvier.
30 Page 1107.
The gliomata are among the most common and characteristic tumors
of the cerebro-spinal axis, to which system and its prolongation into
the retina they are confined. They invariably spring from the
neuroglia or connective tissue of the nerve-centres, and reproduce
this tissue in an embryonal state. They greatly resemble the brain-
substance to naked-eye inspection, but have, histologically, several
varieties of structure. These variations depend upon the relations of
the cell-elements to the fibres or felted matrix of the neoplasm. In the
hard variety the well-packed fibrous tissue preponderates over the
cell-elements, and we have a tumor resembling not a little the
fibromata (Obernier). The second variety, or soft gliomata, show a
marked increase of cells of varied shapes and sizes, with a rich
vascular supply which allies these growths to the sarcomata. The
elements of gliomata sometimes assume a mucoid character, which
allies them, again, to the myxomata.
FIG. 43.
Flat Glioma-cell with its Fibrillar Connections (Osler).
FIG. 44.
(1) Homogeneous translucent fibre-cell; (2) cells like unipolar ganglion-
cells; (3) giant cell (Osler).
W. Osler has recently described31 to the Philadelphia Neurological

Society the structure of certain of these tumors, from which we
abstract the following facts: One point referred to is that gliomata
sometimes contain larger cells and coarser fibres than are usually
shown. The structures are (1) The “spinnen” or spider-cells
(characteristic of glioma), which present variations in size; (2) large
spindle-shaped cells with single large nuclei (some of the largest
cells met with in tumors); (3) cells like the ganglion-cells of nerve-
centres, with large nuclei and one or more processes: some are
balloon-shaped with single processes; they are larger than the
spider-cells; (4) translucent band-like fibres, tapering at each end,
without nucleus or granular protoplasm, regarded as a vitreous or
hyaline transformation of the large spindle-cells. Klebs (quoted by
Osler) holds that the ganglion-like cells are derived from the nerve-
cells of the gray matter, “and that in the development of this variety
all elements of the nerve-tissue participate.” Osler examined the
advancing region of the tumor, and was not able to satisfy himself
that the nerve-cells were in process of proliferation. He thinks they
are connective-tissue elements. He has seen but two out of five
cerebral gliomata which were of small-celled type.
31 “Structure of Certain Gliomas,” Philada. Med. News, Feb. 20, 1886.
The gliomata are subject to fatty degeneration, which usually occurs

in the central (older) portions of the mass. The more vascular forms
are also peculiarly liable to hemorrhage, which is probably caused in
some instances by this process of retrograde metamorphosis. These
hemorrhages resemble apoplexies, not only in their clinical features,
but also on gross examination. Great care is therefore often
necessary at the autopsy to distinguish such a hemorrhage,
occurring as it does in a brain-like neoplasm, from one caused by the
rupture of a diseased artery. The hypertrophy of the pineal gland,
sometimes noted, is caused by the formation of gliomatous tissue.
Under the microscope it is necessary carefully to distinguish some
forms of inflammatory new formations from the gliomata. We have
recently seen, by the courtesy of E. N. Brush of the Pennsylvania
Hospital for the Insane, photographs of microscopic sections from
the ependyma of the lateral ventricles in a case of general paresis,
which showed the structure of this degenerated tissue to be a
compound of fibres and cells of marked resemblance to gliomatous
tissue.32
32 These micro-photographs were prepared in the laboratory of the State Lunatic
Asylum, Utica, New York, by Theodore Deecke.
Sarcomata of the brain are common, as our table shows. In them the
cell-elements predominate, both in the large- and small-celled
variety. They are malignant and grow rapidly. The form known as
alveolar sarcoma, which has a distinct stroma, is to be distinguished
from the cancers; which has probably not always been done.
Tubercle, according to Ross, is the most common of all forms of

brain tumor. Our table shows 13 cases out of 100, the gliomata and
sarcomata being in larger number. Its favorite seat is in the cortex of
both the cerebrum and cerebellum: some observations appear to
show that it is more common in the cerebellum and mid-brain region
than in the fore-brain, and in children than in adults; some of which
points distinguish it from the gummata, which are more common in
adults and occur anywhere. Tubercle is another form of development
from the connective tissues, usually dependent upon a constitutional
taint or predisposition: in it the cell-elements have generally
undergone a degeneration into an amorphous cheesy mass. It is apt
to be multiple and accompanied by a similar deposit in other organs
of the body.
True neuromata are probably very rare growths, and it is likely that
some tumors which have been described as such are really
connective-tissue tumors of a gliomatous nature, in which some of
the cell-elements have been mistaken for the ganglion-cells.
Obernier33 says that these tumors are small and grow from the gray
matter on the surface, also on the ventricular surfaces. They are also
found in the white matter. He says they are only found in persons
having some congenital or acquired aberration; by which is probably
meant some other well-marked neurosis or psychosis. The one
hundred tabulated cases afforded no examples of neuromata.
33 Op. cit.
Myxomata are not, histologically, to be distinguished from the

gliomatous tissues by anything but the peculiar mucoid changes
which their structures have undergone. They are more rare in the
brain, as our tables show, than in the spinal cord.
Lipomata are very rare in the brain, according to most observers.
The table shows but one example. These tumors, as their name
signifies, are made of fat-bearing tissues—another of the connective-
tissue class.
The angiomata, somewhat rarely found within the skull, are noted for
their abnormal development of the vascular tissues: they are
composed mainly of blood-vessels and the connective tissue, which
supports them in closely-packed masses. They also present
cavernous enlargements. They are of especial interest in cerebral
pathology, because the lesion known as pachymeningitis
hæmorrhagica, often found in dementia paralytica, is considered by
some to be angiomatous; although by far the most generally
accepted view of this latter condition is that it is due to arterial
degeneration, and in part is an inflammatory exudate.
Syphilitic tumors, or gummata, are, like tubercle, a special

development with degeneration from the connective tissue, due to a
constitutional taint. This new growth is sometimes single, sometimes
multiple. The corpuscles of the neuroglia are the apparent points of
origin of the tumor, the substance of which is the firm, peculiarly
gummy, and non-juicy material from which the name is derived. It
would be impossible in our allowed space to trace this neoplasm
through the successive stages of its development. It has especial
clinical interest, inasmuch as it and its damage are probably
amenable to specific treatment when it has not progressed to too
great a destruction of brain-tissue.
The true cancers, or epithelial neoplasms, are not a common form of

tumor of either the brain or spinal cord. They present, as in other
parts of the body, a stroma forming alveolar spaces in which are
contained the nests of epithelial cells. These tumors thus present
characteristic differences in their histology from the connective-tissue
or mesoblastic groups, but clinically no very special interest attaches
to them. Their location, the rapidity of their growth, and their fatal
import are points which they share with most other new growths of
the cranial cavity.
The cholesteotomata, or pearl cancers, consist of hardened
epithelial cells which have undergone a sort of fatty degeneration.
The psammomata are loosely described as tumors containing sand-

like bodies, which bodies are normal about the pineal gland. These
sand-like bodies are found in tumors of some histological diversity,
and do not appear to have much identity of their own. They occur in
sarcomata and carcinomata, and are probably not to be
distinguished from mere calcareous infiltration and degeneration.
They are most common in sarcomata, as this is one of the most
common of cerebral tumors.
True osteomata—i.e. tumors with the structure of true bone—are

probably rare in the brain, although more common on the inner table
of the cranium; but the deposition of calcareous salts has been
recorded in a variety of conditions. F. X. Dercum, in a recent paper
read before the Philadelphia Pathological Society,34 has recorded the
autopsy of a paretic dement in which case calcareous deposits were
scattered throughout both hemispheres and the cerebellum. He
believes that “the areas in which the concretions were found were
probably foci of encephalitis of greater intensity than elsewhere. In
these foci inflammatory changes in the walls of the vessels became
pronounced; besides which the vessels increased enormously in
size and number; so marked is this increase that these foci could,
with perfect propriety, be called angiomata.” This is followed by
proliferation of the neuroglia, compression and destruction of nerve-
tissue, and deposit of the calcareous salts especially about and upon
the coats of the vessels. This case illustrates in the simplest manner
the formation of both vascular and sand tumors.
34 The Medical News, April 24, 1886, p. 460.
Pacchionian bodies are very common in the brain, and are really
small fibromata. They may form true tumors (Cornil and Ranvier)
capable of wearing away the bones of the cranium. In fact, even
when small they may have corresponding indentations in the skull.
They are not to be mistaken for tubercle. Clouston35 has described
excrescences from the white matter of the brain, growing through the
convolutions, projecting through the dura mater, and indenting the
inner table of the skull; which new growths he calls hernia of the
brain through the dura. We have not seen such a condition
described elsewhere, and think that we have here probably
Pacchionian bodies growing from the pia mater. They were found in
a case of tumor of the cerebellum.
35 Journ. Ment. Sci., xviii. p. 153.
A cystic formation, constituting a veritable tumor, not unfrequently

occurs in the pituitary body and mounts into the third and lateral
ventricles. Echinococci and hydatids also occur, and have the same
natural history as these parasitic offspring have when found in other
parts of the human body.
Obernier refers to an enchondrosis of the basilar process. Our table

presents one case of enchondroma.
Some of the gross appearances found on autopsies of tumors of the

brain are worthy of note. Often an area of congestion or
inflammation, especially of the membranes, is seen about the new
growth, and the brain-substance in its immediate vicinity is much
more frequently softened. The cerebro-spinal fluid is increased, and,
especially when direct pressure has been exerted upon the veins of
Galen, are found distended lateral ventricles. When a tumor does not
approach the surface, but has attained some size, the hemisphere in
which it is located often has a bulging appearance, crowding over
upon its neighbor, and the convolutions are flattened by the
pressure. The cranial nerve-trunks are occasionally involved in or
stretched by the tumor, and also occasionally the bones of the vault
or base of the cranium are extensively eroded. This happens
especially in cancer and osteo-sarcoma.
A few remarks should be made about the methods of making post-

mortem examinations and the gross appearances and conditions
likely to be found in brain-tumor cases. As not a few intracranial
tumors are connected with the bone or with the dura mater, the latter
being adherent to the skull-cap in some positions because of
inflammation arising from the seat of the growth, especial care
should be taken in removing the calvarium. Examination of the
external surface of the dura mater will sometimes reveal the
presence of a growth beneath or incorporated with this membrane.
The dura mater should not be roughly dragged from the surface of
the brain, but should be carefully removed by a process of partial
dissection. During this process a meningeal growth will sometimes
be found growing apparently from the fused membrane. In such
cases it is usually better to so proceed as not to entirely separate the
outer membrane from the growth. Indeed, this cannot be done
sometimes without injury directly to the specimen, and especially to
its cerebral surroundings. The dura mater having been removed, a
marked opacity, sometimes a dirty-brown hue shading off into a
lighter color, will indicate to the eye the probable presence of a tumor
beneath and growing from the pia mater of the cortex. In such a
case, and even when no such appearance is present, but a tumor is
suspected, the fingers passed carefully over the cerebral surface will
feel a hard, and it may be nodulated, mass at some position. A
growth, having been located in this way, should not be roughly
handled or at once examined by section. An effort should be made to
accurately localize it, not only with reference to lobes, but also with
reference to convolutions and fissures, and even special portions of
these. This is best done, after a thorough examination has been
made of the pia mater, by carefully stripping the pia mater from the
brain, beginning at points some distance from the growth and
gradually approaching it, and leaving the pia mater for a short
distance around the growth connected with it. The location having
been fixed and other portions of the brain having been examined, if it
is not possible or desirable to retain the entire brain as a specimen, a
block should be removed embracing a considerable portion of
healthy brain-tissue on all sides of the tumor. In order to study the
gross internal appearance of the tumor, it is a good plan to make a
clean section through the middle of the tumor. From each side of this
cut fragments can be taken for microscopical examination without
deranging appreciably the size and appearance of the tumor.
When the tumor is not meningeal or cortical, or not situated at the
base or floor of the skull, its presence may be revealed, when it is in
centrum ovale and of considerable size, by either hardness or
fluctuation of the hemisphere in which it is located, this fluctuation
not being due to the tumor itself so much as to the breakdown of
tissue around it. Large sections in known positions with reference to
convolutions and ganglia should be made when examined for tumors
deeply situated. If possible, sections close to and just before and
behind the growth should be made, so as to assist in the accurate
localization.
Small tumors are not infrequently overlooked by careless observers,

and even growths of considerable size have escaped discovery by
one examiner to be found by another. Tumors in certain special
localities, as between the temporo-occipital lobe and the superior
surface of the cerebellum in the great longitudinal fissure, or small
growths in the substance of the cerebellum or deep in the Sylvian
fissure, are more likely than others to be passed by, although this, of
course, is not likely to occur when the examination is made by a
competent or careful physician.
DIAGNOSIS.—The diagnosis of the existence of an intracranial tumor,

as a rule, is not difficult. It can be made with greater certainty than
that of almost any other serious encephalic disease.
It is sometimes important to decide as to the nature of an intracranial

neoplasm, particularly whether or not it is syphilitic. Little is to be
gained by following the plan adopted by some physicians, of treating
all cases as if they were due to syphilis, on the principle that these
are the only forms of tumor which can be reached by treatment. The
pitiable condition of such patients is sometimes thus made worse. In
every case careful and persistent efforts should be made to obtain
an authentic previous history from the patient. Whenever possible
the physician should search directly for the physical evidences of the
former existence of syphilis—for cicatrices on the genitals and
elsewhere, for nodes and depressions, for post-cervical and other
swellings, etc. A history of previous disease of the throat and of
pains in bones and nerves, of epileptiform attacks, of headache, and
eye symptoms which have disappeared under treatment, should be
sought out. It is not well to give too much credence to the stories of
patients, who are not always willing to admit their past lapses from
virtue; but, on the other hand, the plan of suspecting everybody who
presents advanced cerebral symptoms is often a grievous wrong.
Not infrequently external cranial nodes are present in cases of
intracranial syphilis.
Carcinomata and sarcomata, particularly the former, are

comparatively rapid in their progress. They sometimes involve the
bones of the skull, even to the extent of perforation.
The existence of an inherited tendency and of tuberculosis in other

organs, with the special phenomena of general tuberculosis, assists
in the diagnosis of tubercular tumors.
The frequent occurrence of gliomata in early life, and the

comparatively frequent absence of severe irritative symptoms, with
the well-preserved general nutrition of the patient, speak for these
growths.
Cerebral abscess is, on the whole, more difficult to diagnosticate

from intracranial tumor than any other affection. Abscess, however,
more frequently than tumor, can be traced directly to a traumatism. It
is often associated with disease of the internal ear. Obernier speaks
of the headache of cerebral abscess as slight, but this does not
correspond with usual experience. Headache, on the whole, may be
oftener absent or less agonizing in abscess than in tumor, but it is
frequently present, and sometimes of great severity. Its greater
mildness in a few cases is to be explained by the fact that abscess
does not produce so much pressure within the intracranial cavity,
and does not so frequently cause irritation of the branches of the
trigeminus in the dura. Undoubtedly, the symptoms of abscess often
remain for a long time comparatively latent, with then a sudden
outburst of violent symptoms. The course of brain tumor is more
uniformly and steadily progressive, and febrile phenomena, the
results of pyæmia, are of more frequent occurrence in abscess than
in tumor.
In old cases of tumor it is sometimes necessary to differentiate

between it and the results of various forms of apoplexy, such as
hemorrhage, thrombosis, and embolism. Cerebral hemorrhage,
embolism, or thrombosis leaves a condition of paralysis, sometimes
with, but usually without, accompanying spasm or convulsion, which
simulates closely the paralysis and other permanent conditions of
cases of tumor occurring in the same cerebral locality. In these
cases, in the first place, the history of the disease will throw
considerable light upon the diagnosis. In both hemorrhage and
embolism the history is usually one of a sudden attack without
special premonitory symptoms. Hemorrhage gives usually a
precedent history of diseased kidneys, hypertrophied heart, or
atheromatous blood-vessels, and occurs generally in advanced life;
embolism, a history of rheumatism and valvular disease of the heart,
occurring at any period of life, early or late. In brain tumor the
previous history is usually one of traumatism, of constitutional
infection, or of a special predisposing diathesis. Blows and falls upon
the head are common antecedents, or a history of syphilis,
tuberculosis, scrofula, or cancer is present. Tumor, like embolism
and unlike hemorrhage, may occur at any time of life. While slight or
dull headache, with more or less vertigo, may be present in cases of
hemorrhage and thrombosis, the severe and often agonizing
headache, with vomiting and serious vertiginous attacks, which
precedes the paralytic or other phenomena of tumor, is a much more
conclusive symptom in the latter cases than in the former. Choked
discs and optic neuritis are much more likely to occur in tumor than
in the other affections.
Brain tumor must sometimes be diagnosticated from the head

symptoms of some form of Bright's disease. A case not long since
presented itself to one of us with a history of having suffered at
frequent intervals for two years with headache of gradually
increasing severity. Dimness of vision and slight temporary œdema
of the feet, circumscribed and painful swellings along the lymphatics
of the thighs and legs, with some mental irritability, were other
marked symptoms. The patient had been attended by several
physicians of prominence, one of whom had diagnosticated tumor of
the brain. The violent, apparently agonizing headache, with the
diminution of vision, and the absence of marked symptoms indicating
other organic disease, made the diagnosis of a growth in some non-
excitable region of the cerebrum most probable. Examination of the
urine showed no albumen. Careful examination of the eye-ground
with the ophthalmoscope, however, revealed the appearances of
retinitis albuminurica. Under a treatment directed to the relief of
chronic nephritis the patient's headache and other symptoms
improved.
It must not be forgotten just here, however, that, on the one hand,
ophthalmoscopic appearances very similar to those of albuminuric
retinitis are sometimes present in rare cases of brain tumor, and also
in other constitutional disorders, such as leukæmia; and, on the
other hand, that, as stated by Norris,36 exceptional forms of
albuminuric retinitis have been reported where the only change seen
in the fundus oculi was pronounced choking of the disc.
36 Op. cit.
Intracranial tumors must be diagnosticated from meningitis in its

various forms. In children tubercular meningitis sometimes closely
simulates brain tumor. Tumors of the brain are comparatively rare in
children, but, as has already been shown, gliomata and other tumors
do sometimes occur in early life. The course of tubercular meningitis,
whether in children or in adults, differs from that of brain tumor. It is
more irregular in its method of advance, or if it shows the regularity
which is sometimes present, and which has led authors to subdivide
it into three more or less completely separable stages, the symptoms
of these stages do not correspond with any closeness to those of the
initial, middle, and terminal periods of brain tumor, as already given.
Headache is usually present in both affections, although the absence
of headache in some cases of gliomata in children must be here
borne in mind. When headache is present in tubercular meningitis, it

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(eBook PDF) Communication in

Everyday Life Personal and

(ID CHAPTER 2 I Perceiving Self in Relation to Others 35

(ID CHAPTER 3 I Perception of Others 67

Strategies, Tools, and Tips for Gaining Awareness and Controlling

,t• .,., ; '

CID CHAPTER 5 I Listening 131

Difference between Thought Rate and Speech Rate 142

(ID CHAPTER 6 I Communicating Verbal ly 159

(ID CHAPTER 7 I Communicating Nonverbally 189

Replacing or Substituting for Verbal Messages (Emblems) 193

(ID CHAPTER 8 I Building and Maintaining Relationships 221

Social Penetration Theory 247

(ID CHAPTER 9 I Managing Conflict and Practising Civility 255

(ID CHAPTER 10 I Group Decision-Making: Leadership and Process 287

Appendix I Making a Team Presentation 317

Communication in Everyday Life: Personal and Professional Contexts i s desi gned to

cation skills. Throughout, clear writing and accessible ~l/<ll.ff::#.\.i,..... ~"1,\'"Ml'tlnJa'.Altd.&i11""""*rf~llau1

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About the Book

TNs compr~ nslve .,~ exapdon•Uv

influences. Courses in interpersonal communication describe the behaviours of people in

Sherry Devereaux Ferguson

I 1,vould like to acknowledge my friend and colleague Dr Lynne A. Texter, professor at La

Jenepher Lennox Terrian

Dr Sh erry Devereaux Ferguson (Ph.D., Indiana University; MA, University of Houston;

Dr Jeneph er Lennox Terrion is an associate professor in the Depart1nent of

26 Pp. 84, 85 of present Volume.

Phosphenes, or subjective sensations of light, occur in various forms

Conjugate deviation of the eyes, with rotation of the head, a

Diminution or loss of hearing, tinnitus, and hyperæsthesia of hearing

The sense of smell is affected, of course, when the olfactory bulbs

Taste may be involved in several ways. In the first place, subjective

Trophic disturbances of decided character are sometimes present in

Disturbances of respiration were observed in a number of cases in

Persistent epistaxis and a tendency to hemorrhage from the mucous

Constipation or torpor of the bowels occurs somewhat frequently in

DURATION, COURSE, AND TERMINATION.—The duration of cases of

In a few cases, even in some which are not syphilitic in character, a

This fatal termination may occur in various ways. Sometimes a

PATHOLOGY.—We present in tabular form the various classes of