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The frequent association diabetes and cataract should noted. Glaucoma frequently mistaken for neuralgia or some other painful aflfection, and therefore the occurrence severe pain, congested conjunctiva, blurred vision, dilated pupil, and increased intra-ocular tension with nausea and vomiting should call for careful examination the eye a competent specialist.

Certain retinal appearances are great value the internist in the diagnosis particular diseases. A reasonable familiarity with the use the ophthalmoscope should enable him recognize the conditions mentioned, although I have made a rule refer all cases importance an ophthalmologist for more expert Betinal Hemorrhage.

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Red hemorrhagic patches, generally irregular in outline, are common in heart disease, severe anemias and other blood diseases, and in chronic nephritis, especially with degenerated arteries and high blood pressure.

Malignant endocarditis and pyemia lead embolism, with attendant localized blood stasis in Pulsating retinal arteries are seen in aortic regurgitation, and occasionally in neurasthenia and exophthalmic goiter. The rosy optic disc neurasthenia should mentioned. Optic Neuritis. Inflammation the retrobulbar portion the nerve occurs in tobacco and lead poisoning, syphilis, gout, diabetes and other diseases. Papillitis, or inflammation paraphrasing in apa the nerve head, presents a marked swelling, the so-called chgked disc. During the active stage the disc swollen and reddened and the margin blurred. With the proliferation connective tissue which occurs with the subsidence the inflammation, the nerve head shrinks and i need a research paper done becomes pale a secondary optic atrophy.

In tabes, paresis and disseminated sclerosis, after hemorrhages and in certain toxemias a The choked disc especially significant as a sign brain tumor, Retinitis and neuroretinitis are generally anemic, nephritic, leukemic, syphilitic or toxemic origin, and in many cases are easily recognized. The occurrence miliary tubercles in the choroid, obstruction the retinal vessels, and more especially arteriosclerotic changes, may much importance the clinician, but the assistance the specialist should generally obtained.

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The appearances the external ear are discussed elsewhere. Unusually prominent, misplaced or imperfectly developed ears are often found in those mentally or morally defective.

The size and shape the canal should noted, and whether eczema, cerumen, dirt, foreign body, abscess, furuncle, or serous, purulent or bloody discharge present. Practice will enable one manipulate the conical speculum and the auricle with one hand, leaving the other free for further procedure. Serous discharge often seen in fracture the base the skull, and hemorrhage occurs in the same cases. Slight hemorrhage find someone to write my paper may noted in hemophilia and after traumatic rupture the drum. Pus occurs most often from abscess or furuncle the meatus, or otr tis media, but may come from a parotid or other abscess here. The very great frequency otitis media in children even with no especial indications excepting fretfulness and fever should lead a very careful examination the ear in case doubt. If no pus found deep in the ear the reddened and bulging drum membrane may seen if a good light focused upon These are due either the defects in the sound-conducting apparatus or in the nervous mechanism, including the auditory nerve, its nucleus and its cortical center, the latter form being termed nervous deafness. In this type the vibrations the tuning fork or ticking a watch are not heard even upon bony contact, since the perceptive apparatus defective, while in middle-ear deafness the contact with the mastoid enables bone conduction replace the Most cases deafness are the middle-ear type, and due obstruction in the canal or inflammatory conditions in the middle ear, the latter being especially common after the eruptive diseases childhood, help with writing a good thesis statement in tonsilitis, rhinitis, adenoid disease, and nasal obstruction from thesis consulting any cause. Nervous deafness in a majority cases labyrinthine origin, the terminations the auditory nerve in the internal ear being at fault.

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