Diplopia

“ Whether diplopia occur as an early symptom or not, nystagmic oscillation of the eyeballs is commonly found in the developed affection. This nystagmus is usually universal, noted in associated movements in every direction, and aggravated by excitement, by constrained positions, and by any act of innervation of the eye-muscles. It may be looked upon as an intention tremor of the latter, and attributed to sclerotic foci in the cerebral axis, particularly in the tegmental part of the pons varolii. ”

“ The fact that those who squint do not as a rule have diplopia, while squints depending on paralysis of the ocular muscles are combined with diplopia, was difficult to explain as long as the view was adhered to of identical retinal areas founded on anatomical construction. ”

“ The patient complains of many species of disorder; loss of the sense of the third proportion, micropsia, megalopsia, diplopia, erythropsia, diplopia in two colors, inverted image, hemierythropsia, rotatory amblyopia. There is concentrated limitation of visual fields, exaggerated by fatigue and by intense light; reduced in dim light or when the patient is provided with smoked glasses; enlarged upon the instillation of atropin or with convex glasses. As a rule, with unilateral amblyopia, the functional disorders start in binocular vision. ”

“ As squint in myopia usually commences at an age when binocular fusion has already become a fixed habit, diplopia regularly takes place with it, but patients become more easily accustomed to this than in paralysis of the ocular muscles, because the retinal images are indistinct and the double images in the field of vision always keep at about the same distance, while in paralysis of the ocular muscles the distance is constantly changing. ”

“ Hubbell says: “In the diplopia test, the dissociation is effected by changing the visual axis of one eye by means of a prism. The displacement of one image cannot be done without associating with it, more or less, an impulse to some form of ocular effort.... In the obscuration test (Maddox rod) no such effort is invited, no change of innervation takes place.” But in the rod test the light seems nearer to the patient than in the prism test. This may account for much of the difference in results and amount to “an extraneous impulse to muscular contraction.” ”

“ The expression of the countenance is sometimes dull, much more frequently furtive and timid. The repetition of the dose renders it eager and bright. The pupils are commonly contracted, sometimes enlarged, and occasionally unequal. Diminished power of accommodation is common, and diplopia has been occasionally observed. ”

“ There can be no doubt that in most cases the position of the double images does not correspond to the principle of identity, and just as little doubt that one to whom double images are easily made apparent cannot possess the confirmed habit of always suppressing the image of the squinting eye. A certain number of cases remain in which it is impossible to produce diplopia ”

“ Diplopia, and disorders of the power of accommodation, frequently accompanied by increased secretion of the lachrymal glands, show themselves. The patients are overcome by a feeling of weakness and total want of energy, and are thus compelled to lay in bed. ”

“ These may assume the form of a hemiplegia or may involve only certain groups of muscles. Ptosis is often noted. Paralysis of other eye muscles is common, and pupillary rigidity is sometimes a symptom. Hemianopsia and diplopia are often observed: An important feature of the disease is the fact that these conditions are more or less transitory and rarely become [312] permanent. Apoplectiform attacks followed by hemiplegia are results of gummatous growth or may be associated with areas of softening. These are due to vascular disturbances. Aphasia is not an unusual occurrence. ”

“ Surely the truly realistic conception is that the comatose patient does not move any of his limbs from some physical disability—for essentially the same reason that a hemiplegic man does not move his arm and log.
I now go back to my small joke chat punning is a slightly morbid mental state, a "mental diplopia," a caricature of the normal "diplopia" of healthy mentation. From this point I make the assertion that the "physiological insanity" of dreaming is diplopic—a caricature of that of waking mentation. A physician reads in the day of the strained relations of European states ”

“ However, when these conditions result from other imbalances, they must be treated more carefully. For instance, a patient whose right internus is paralysed or congenitally defective on looking to the left, has a cross diplopia which vanishes to the right; as a result, he soon assumes a habit of carrying his head in this position. Ordinarily, this will cause no discomfort; but if the left internus is so weak that it cannot follow the right externus to its position of greatest ease, the visual lines are evidently different and the case must be treated as an exophoria. ”

“ It is much safer to reflect the periosteum further outwards and downwards from the lower border of the Killian bridge. In doing this the pulley of the superior oblique is detached with it; any diplopia, most noticeable on looking downwards and outwards, is generally temporary; and as a rule it will disappear when the swelling subsides and the periosteum gets back to its anchorage (Fig. 342) .
It is this part of the operation which is the most delicate, tedious, and important. It is very common to meet with irregularities. ”

“ Next, taking these miniature and transient cases of insanity, and other cases commonly called insanity, I should try to show that the comparison of mentation with vision is of direct value. In the symptomatology of a patient who has paralysis of an ocular muscle there are many elements. There is morbid visual diplopia; in insanity there is morbid mental diplopia. ”

“ When the eyes turn out the opposite should be the case. But often the position of the images is reversed, the image of the right eye in convergent squint being seen to the left and that of the left eye to the right, while in divergent squint the opposite is the case. This condition is known as paradoxical diplopia.. Furthermore, persons with almost normal vision and both eyes perfectly straight may have both kinds of double vision. ”

“ At the same time, marked symptoms of the motor nerves of the face are present, the patient’s sight is disturbed, he sees colours or sparks before his eyes; in a few cases there has been transitory blindness, in others diplopia. The pupil in nearly all the cases has been dilated, also in exceptional instances it has been contracted. The levator palpebrae superioris is paralysed, and the resulting ptosis completes the picture. Consciousness remains intact almost to death, there is excessive weakness of the muscles, perhaps from a general paresis. ”

“ In this hot gloom the diplodocus trailed itself about, eating, eating; living a century or so; loving, as far as a brain the size of a pigeon's egg can love, and no doubt with a maternal tenderness for its loathly offspring. It had but few foes, though, in the course of endless generations, there sprang up a carnivorous race of creatures which seem to have found the diplodocus tender eating. The particular diplodocus of which I speak probably died of old age in the act of drinking, and was engulfed in a pool of the great curdling, reedy river that ran lazily through the forest. ”

“ The chief exciting cause of this affection is unquestionably diphtheria. It is, in fact, a sequel of diphtheria. It will hardly be necessary to repeat here what the reader will find fully discussed in the sections devoted to diphtheritic inflammation of the fauces and adjacent parts: we are mainly concerned with the phenomena. Just how this morbid process produces paralysis is not known. It is believed by some observers that the disease is produced by the alteration of the nutrition of the parts during the progress of the diphtheria. ”

“ II. The immediate cause of dropsy is the paralysis of some other branches of the absorbent system, which are called lymphatics, and which open into the larger cavities of the body, or into the cells of the cellular membrane; whence those cavities or cells become distended with the fluid, which is hourly secreted into them for the purpose of lubricating their surfaces. ”

“ The mouth is overhung by a large labrum or upper lip and the integument of the dorsal surface of the body forms a more or less definite dorsal shield. The paired eyes are as yet wanting, but the median eye is large and conspicuous.
The large labrum or hypostoma, the biramous character of the appendages, especially of the antennæ, the functional gnathobases on the second and third appendages, and the oval unsegmented shield are all characteristics of the trilobites, and it is interesting to note that all nauplii have the free-swimming habit. ”

“ When the patient cannot bear to be raised up in bed without great uneasiness, it is a bad symptom. So I believe is deafness, which is commonly mistaken for stupor. See Class I. 2. 5. 6. And when the dilatation of the pupil of either eye, or the squinting is very apparent, or the pupils of both eyes much dilated, it is generally fatal. As by stimulating one branch of lymphatics into inverted motion, another branch is liable to absorb its fluid more hastily ”

“ In the males of the Diplopoda, the legs belonging either to one of the anterior or of the posterior segments of the body are modified into prehensile hooks which serve to secure the female. In some species of Iulus the tarsi of the male are furnished with membranous suckers for the same purpose. As we shall see when we treat of Insects, it is a much more unusual circumstance, that it is the female in Lithobius, which is furnished with prehensile appendages at the extremity of her body for holding the male. ”

“ The ancient writers who treat systematically of dropsy generally describe four varieties of it, namely, dropsy from disease of the liver, from disease of the spleen, from fever, and from a sudden draught of cold water. See De Morbis, and Paulus Ægineta, B. III., 48, Sydenham Society’s edition.
[476] On this variety I have remarked in the Comment. on Paulus Ægineta: “Hippocrates refers one species of dropsy to disease of the parts situated in the loins, by which Galen and Stephanus agree that he means the jejunum, mesaraic veins, and kidneys.” (Paulus Ægineta, l. c.) ”

“ The antennæ are formed according to the type of the Diplopoda, with seven joints. The body is composed of numerous segments. The scuta may be prolonged laterally into laminæ, but afford protection only to the back and flanks; the central part of the abdomen is not covered by a firm, resistant shell. The feet are hidden beneath the broad body. The male genitalia are placed in the seventh segment. In the classification of the families and genera I have followed Mr. Brandt, [26] his arrangement, as far as the two species I have seen enable me to judge, being founded on natural characters. ”

“ The Diplodocus, a harmless placid beast, was over eighty feet from the tip of his snout to the end of his enormous tail. It has been calculated that impulses travel along the nerves to the brain at the rate of about twelve yards a second. ”

“ Each grasps the dorsal papilla of the other by its own ventral sucker, thus undergoing a certain amount of torsion. Where the two bodies touch, complete fusion occurs, and, as shown in Fig. 28, the united Diporpa (or Diplozoon, as the product is now called) decussate, each forming one limb of the X-shaped Diplozoon, within which the two sets of complex genitalia develop (Fig. 28) .
IV. Gyrodactylidae.—Gyrodactylus (Fig. 29) , the structure of which is in many ways peculiar, produces one large egg at a time. ”

“ The Diplopods depend upon the vegetable kingdom for their sustenance. The body is much more rigid than in the Chilopods, from the close conjunction, or often imbrication, of the segments, and the inflexibility of the segments themselves, caused by the density and thickness of the scuta aud sterna and the absence of lateral membranes. For this reason the Diplopoda possess but little or none of that power of raising and twisting the body, which is so annoying to the collector of tropical Scolopendra. ”

“ Nyctalopia is most apt to attack young persons, either males or females, and to pass off spontaneously on the fortieth day or in seven months, and in some cases it endures for a whole year. Its duration may be estimated from the strength of the disease and the age of the patient. They are relieved by deposits which determine downwards, but these rarely occur in youth. Married women and virgins that have the menstrual discharge regular are not subject to the complaint. ”

“ When a bacteriological examination is impossible, or when the clinical features do not coincide with the results obtained, the patient should always be treated on the assumption that he suffers from diphtheria. So much doubt exists as to the real nature of membranous croup and its relationship to true diphtheria, that when the diagnosis between the two is uncertain the safest plan is to treat the case as one of diphtheria. ”

“ This is continuous with the uterus (ut) of Diporpa I; uto, ventral opening of uterus; vag, vagina, with vd, vas deferens, permanently inserted into it through the genital pore; yd, yolk-ducts; yg, yolk-glands.
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Diplozoon paradoxum.—The life-history of Diplozoon is unique. For whereas the larvae of most animals grow up, each into a single adult, in Diplozoon, of the few larvae that survive the dangers of their free-swimming existence, only those become mature which conjugate permanently with another individual. ”

“ Diploconida the forty aspinal pores are present which we found in all Hexalaspida, Belonaspida, and Diporaspida, so that these four families of Acanthophracta represent one continuous phylogenetical series; Phractaspis among the Diporaspida is at the beginning, and Diplocolpus among the Diploconida at the end of this remarkably transformed morphological series.
The twenty radial spines in all Diploconida are probably united very firmly (or even perfectly grown together) in the centre of the small thick-walled lattice-shell, the inner space of which is extremely reduced. ”