A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
History
A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
Medicine -- Practice
Contraction of the pupil is observed in inflammation of the retina or
of the brain, narcotism from opium (until near death) or eserine, or
apoplectic effusion near the pons varolii. Dilatation of the pupil is
seen in most cases of hydrocephalus and of apoplexy; in
nerve-blindness (amaurosis), glaucoma, cataract, and narcotism from
atropia, duboisia, or hydrocyanic acid. Inactivity of the pupil
(Argyll Robertson) under changes of light and darkness is common in
locomotor ataxia. Different states of the two pupils under the same
light show disorder, either ophthalmic or cerebral in site, or may
indicate pressure on the cervical sympathetic ganglia, as from aortic
aneurism.
In elderly persons we ought always to look for the arcus senilis,
which is a sign of a tendency to fatty degeneration. It is a ring, or
part of a ring, with ill-defined edges, best seen by lifting or
depressing an eyelid, at the junction of the cornea and sclerotic coat
of the eye. In some quite healthy old persons there may be seen at the
same junction a clearly-defined circular line of calcareous nature.
This must be distinguished from the true fatty arcus senilis.
Of the face we may also notice the pinched nose, hollow eyes, and
falling jaw of the facies Hippocratica, presaging death; the square
forehead of the rickety child (not common in this country); ulcers on
the forehead, scars at the mouth-corners, or copper-colored eruptions
in syphilis; the full, flabby lips of scrofula. In peritonitis or
gastritis the mouth is apt to be drawn up with a peculiar expression
of suffering and nausea. Very striking is the characteristic one-sided
appearance in facial palsy, from lesion of the seventh nerve. There
may be a smile, a frown, or other expression on the sound side of the
face, while the paralyzed side is quite immovable. As the seventh
nerve (portio dura) supplies the orbicularis muscles, its paralysis
(so often temporary) may cause inability to close the eye upon the
affected side. Ptosis, or inability to open the eye, involving the
levator palpebræ, which is innervated by the third nerve (motor oculi)
is more significant of cerebral lesion.
Even the ears may have language, as when their lobes are full and
glistening red in the gouty diathesis, or wrinkled in prolonged
cachexiæ, or when they are running with discharges in the struma
(scrofula) of childhood. The hair becomes dry and lustreless in
phthisis, and falls out during convalescence from many acute diseases.
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