. Physical diagnosis . (c) Nystagmus is a rapid, usually horizontal oscillation of botheyeballs. It may be the result of albinism or of various local eyetroubles, but is an important member of the symptom group char-acteristic of multiple sclerosis. It may, however, occur in manyother brain lesions. Rarely the oscillation is vertical. THE HEAD AND FACE 17 The Retina. The lesions which are of greatest interest in general medicineare: Retinal hemorrhage, optic neuritis, and optic atrophy. (a) Retinal hemorrhages, with or without other retinal changes,are important signs of nephritis, grave anaem
. Physical diagnosis . (c) Nystagmus is a rapid, usually horizontal oscillation of botheyeballs. It may be the result of albinism or of various local eyetroubles, but is an important member of the symptom group char-acteristic of multiple sclerosis. It may, however, occur in manyother brain lesions. Rarely the oscillation is vertical. THE HEAD AND FACE 17 The Retina. The lesions which are of greatest interest in general medicineare: Retinal hemorrhage, optic neuritis, and optic atrophy. (a) Retinal hemorrhages, with or without other retinal changes,are important signs of nephritis, grave anaemias, and diabetes. * (6) Optic neuritis (usually bilateral) is of great value in thediagnosis of brain tumors, tuberculous meningitis, and brain also forms part of the lesions in many cases of nephritis and diabetes. (c) Optic atrophy may be the end result of any of the types ofoptic neuritis just mentioned, or in a primary form is importantevidence of tabes dorsalis. Many cases occur without any Fig. —Syphilitic Depression of the Nasal Bones. VI. The Nose. i. Size and Shape.—The enlargement of all the tissues of the noseoccurring in acromegaly has already been mentioned. In myxcedemathe nostrils are sometimes thickened and the whole nose loses itsdelicacy of shape. A red nose is popularly and correctly associated 18 PHYSICAL DIAGNOSIS with alcoholism, but in many cases identical appearances are producedby acne rosacea or by lupus erythematosus, as well as by circulatoryanomalies without any other disease. Falling in of the bridge of the nose may be due to syphilis of thenasal bones, especially when there are scars over the sunken portion,but is sometimes present without any disease. See Fig. 16. The small, narrow nose associated with adenoid growths has alreadybeen mentioned. 2. The nostrils move visibly in many conditions involving dyspnoea(diseases of the heart and lungs, acute infections, etc.), and this is
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