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Balance indicates a state in which all the voluntary muscular system of the body is under the full control of the central nervous system so that all parts combine to resist gravity or to perform with stability any desired movements. The wonderful development of this faculty, which achieves the most complicated adjustments of hands and eyes, was a main factor in raising man to his position of dominance in the animal world.
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The centre for maintaining equilibrium is in the cerebellum. It receives impressions from three main sources and sends out impulses which control and co-ordinate muscular action.
The executive mechanism which balances the body, whether at rest or in motion, consists of the muscles. Some of the deep muscles of the body are constantly in a state of contraction in order to give sufficient rigidity to the spine and the joints, while the more superficial muscles serve to move the various parts of the body as occasion requires. The muscular actions necessary to ensure stability or balance are controlled by the brain in accordance with information received from every part of the body, but more especially under the influence of three definite groups of nerve messages.
The first group is contributed by the eyes. In ordinary life the position of objects is determined by the sense of sight. The movements of the head and eyes inform us of our relation to objects which we look at. In vertigo or giddiness the subject may appear to himself to be turning round while surrounding objects are stationary, but more often it is the outside things which appear to move. One cannot walk properly while looking through a prism because objects are not correctly localised. If a writing point is attached to the head when standing with eyes closed, it demonstrates that the body sways in a peculiar manner, indicating the successive contraction of differnt series of muscles.
The second group of impulses concerned in balance arrives by the nerves of touch and the nerves of posture-sense which convey stimuli from skin and joints. Contact of the feet with the ground or of the hands with various objects falls in this class. When in going up a staircase one miscalculates the number of stairs a peculiar sensation of lack of equilibrium is aroused through this sense. Our perception of position is so acute" that, without the aid of sight, we can appreciate the movement of wrist or knee through an angle of less than one degree.
Thirdly, there exists a most important; sense-organ for determining the position and direction of movement of the head, and by inference of the whole body. This organ consists of three semicircular canals, full of fluid, situated in the internal part of the ear. These canals are placed in three different planes, and they act much like small spirit levels. Any movement of their liquid contents affects the sentient endings of the auditory nerve, producing a atimulus which is instantly carried to the centre of balance in the lesser brain or cerebullum.
Methods of testing the balancing power are important for certain occupations, such; as that of aeroplane pilot. One test consists in being whirled round in a revolving chair, observation being made as to whether or not this causes giddiness or discomfort or inability to walk straight. Other tests are the balancing of a rod on a flat board, and the ability to stand on one foot for 15 seconds. The power of balance may be impaired or lost in sevoral types of disease.
BALANCE: ROLE OF LESSER BRAIN The lesser brain, or cerebellum, situated in the lower and back part of the skull, co-ordinates all movements maintaining balance. Disease here may cause ataxia.

External or Horizontal . SemicircularCanal
The three semicircular canals in the internal ear contribute largely to the maintenance of balance. They act like spirit levels and are so arranged that movement in any plane is registered and conveyed to the brain. The smaller diagram inset illustrates how the canals are disposed at right angles in planes.
Extensive injurics or wounds may interfere with equilibrium by destruction of muscle, and the use of supporting apparatus of various kinds may become necessary. Some disorders of the brain destroy the power of correctly co-ordinating bodily movements. A patient suffering from cerebellar disease staggers wildly in his walk. Disease of the semicircular canals is often associated with deafness. Its symptoms include dizziness and a feeling of going round or falling. In locomotor ataxia (q.v.) the nerves of muscle and joint sense become deranged, leading to a peculiar unsteady gait and inability to stand with the eyes closed.
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Left, one test of the balancing power of an individual is to rotate him quickly towards either side while he stands with his feet close together and firmty placed on the ground. Right, a similar but more exacting test is to rotate the patient when he is standing on one foot only. To stand steadily on one foot forty seconds is still another form of balancing test.
It is not known precisely how dizziness is caused. Like many another symptom of disease, it probably can be caused many different ways. Everyone who has cell sick or bilious knows that dizziness often comes on before a sickness begins. Many people, again, become dizzy if they smoke much; some people are dizzy on heights, others in open spaces, others again on board ship. Finally, dizziness occurs in some cases of heart disease, in some fevers, and when the are are seriously affected by inflammation.
Dizziness happens when that sixth sense, that of position, is lost or upset in any way. The easiest way to upset that sense is to spin round quickly with the eyes shut. In doing that we seem to interfere with the comfort of the brain in some way, and we are thrown out of gear.
Whatever upsets the brain, shakes it or poisons it, or robs it of its proper amount of blood, will cause dizziness. The ''liver or bilious attack'' is all example of brain poisoning, as is alcohol, and tobacco. The spinning round movement as an example of shaking, the primary disturbance occurring in the semi-circular canals of the inner ear. which subserve the sense of bodily stability. Fear- as for instance when looking down from a great height- is an example of the taking away of blood from the head.
There is a curious sense of thrill inside and then, usually a flush spreads over the face. The dizziness passes off when the flush comes. What happens is that the sight of the precipice puts a slowing effect on the heart-as in the familiar saving “my heart stood still.” All terrible or surprising sights and sounds have that effect. But the body is so made that if soon adjusts itself. The heart which stood still for an instant rushes off again and beats more vigorosly than before. That is when the feeling of flush occurs. In some people, however, this extra action of the heart is delayed. When this occurs the pressure of blood in the arteries is lowered, and the brain gets less blood than it is accustomed to get. Instantly there is dizziness.
Dizziness of the Unfit

Most people are much more apt to he dizzy when they are unfit. If a man is convalescing from an illness, he will not be able to keep his balance in awkward places so easily as at times of ordinary health. When he is well, however, adjustments are made so quickly that he has not time to notice any discomfort.
There is no cure for the inborn types of the symptom. But the coming on of dizziness in people, who have not felt it before is always a sign that something is amiss. In the vast majority of cases that something will be found in connexion with the digestive organs. Constipation will induce dizziness by the poisoning it causes in the bowels with toxins circulating in the blood and brain. In all such cases it is of great importance to keep the bowels free. It is also most important to cut down the food supply to simple articles of diet for a few days, like fresh fruits and vegetables. Especially in such cases should excess of tobacco and alcohol be avoided. The cause of the trouble may also be poisoning from bad teeth. septic tonsils or even chronic appendicitis.
Giddiness, or vertigo, is a loss of the sense of balance. The loss may be for a few seconds only, or it may be more or less permanent, or the giddiness may come on from time to timc in definite attacks following prolonged intervals. Sometimes giddiness is the only thing complained of. In other cases the giddiness is accompanied by the distressing symptoms of subjective noises or ringing in the ears, and by nausea or even vomiting, and severe headache.
The causes of giddiness may be best considered as (1) causes acting in the auditory labyrinth, and (2) causes acting outside the labyrinth. By far the commonest cause is labyrinthine disease, which may be trivial or serious, temporary or permanent.
Of direct labyrinthine causes of vertigo, one of the most important is Meniere's disease (q.v. ), in which sudden attacks of severe giddiness arc apt to appear at intervals without obvious caus, usually accompanied by nausea, and tinnitus. The exact nature of the labyrinthine affection is not fully understood.
Another such cause is the condition known as otosclerosis (q.a;.), a form of hereditary deafness in which pathological bony changes take place in the structure of the labyrinth.
Any sudden disease, infection or inflammation of the labyrinth alwavs causes giddiness Such a condition is well seen in syphilis,
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either congenital or acquired, when it attacks the ear. Giddiness is one of the first symptoms to appear. In later stages the affected ear becomes, as a rule, hopelessly deaf. Giddiness and noises may, however, survive the loss of hearing. Spotted fever, or cerebro-spinal fever, is another somewhat similar cause. Giddiness appears when. the labyrinth becomes invaded be the disease, cwhich progresses, as a rule, to total functional destruction of the organ of balance and hearing. Finally, any inflammation of the labyrinth (Iabyrinthitis), however produced, is an invariable cause of giddiness in greater or less degree.
Causes which originate outside the labyrinth may be divided into (1) those acting in the middle ear and (2 ) those causes acting generally. Of the first class by far the connnonest is middle-ear catarrh. Here secondary cause, in the bony casing of the labyrinth commonly produce giddiness, and the disease is ant to progress towards a nerve-deafness.
Chronic middle-ear suppuration is a prolific cause of giddiness. There is, no doubt, a certain degree of giddiness with every discharing ear, but it does not become a noticeable feature of the disease unless one or other of certain conditions are present. One of these is cholesteatoma, a somewhat obscure tumour formation in the middle ear, which sometimes develops when a discharge from the ear becomes well established. Erosion of the bone of the inner tympanic vall, as the result of long-continued suppuration, and caries or decay of bone from similar causes are very frequent sourcea of vertigo.
Simple and Serious Causes of Giddiness

Another important cause of vertigo, acting outside the labyrinth is closure, temporary or permanent, of the Eustachian tube. If the tube can he again opened up, the giddiness at once ceases.
Any affection of the outer passage of the ear, especially the impaction of hard wax or a foreign body, is a likely cause of vertigo.
Any gross lesion of the brain, for instance a brain tumour, or a tumour of the auditory, nerve along its course between car and brain, may cause severe giddiness as one of the symptoms produced. Giddiness is often, experienced as one of the introductory symptoms at the onset of the acute specific fevers or in the early stage of influenza. Any condition or disease which tends to raise the blood pressure, chronic kidney disease, or . arterio-sclerosis, may act as a cause.
Biliousness, constipation and general malaise are frequently accompanied by a certain degree of giddiness. It may occur from eye trouble or in epilepsy. Finally, drugs may be a potent cause in the production of vertigo, e.g. alcohol, morphia, quinine and arsenic.
Broadly speaking, it may be said that the essential change which leads to giddiness takes place within the labyrinth, and that it is a physical change. That is to say, an alteration with regard to the normal tension and pressure of the fluids circulating within the labyrinth takes place.
In the matter of diagnosis, for every case, except those which are obviously trivial in nature, skilled opinion should be sought. The vast majority of cases are trivial and due to one or other of the simple causes already enumerated. Serions cases are those in which there is chronic middle-ear suppuration with local complication. Grave cases which, in a varying degree, always become a menace to life are vertigo due to abscess of the brain or brain tumour and vertigo due to any form of infective labyrinthitis.