1902.1 OLIVER — BLINDNESS FROM MALF0R:\[ATI0N OF SKULL. 165 



It is not, however, with these minor and relatively undisturbing 

 types that this communication deals. It is with the grosser forms 

 of cranial malformation ; those that particularly involve the basil- 

 ary fossa and their many fissures and foramina ; types which sooner 

 or later give expression to blindness as one of their most prominent 

 and characteristic symptoms. 



The gross configuration of the skull and the condition of the 

 various portions of the visual apparatus are so strictly in accord with 

 one another, that certain forms of cranial asymmetry can, with 

 almost definite precision, be associated with certain kinds of blind- 

 ness. Five coarse clinical types of cranial deformation — the well- 

 known oxycephalic, the scaphocephalic, the leptocephalic, the 

 trigonocephalic, and what I have elsewhere described as the occipi- 

 tal or occipito-parietal — may be cited. 



The oxycephalic or even the gross hypsicephalic type is char- 

 acterized by the so called steeple-shaped or dome-like head. It is 

 dependent upon an improper union of the parietal bones with the 

 occipital bone, the temporal bones and the sphenoid bone, produc- 

 ing compensatory over-developments along the sagittal suture and 

 in the position of the anterior fontanelle. The pterion region with 

 its anterior lateral fontanelle and later Wormian bone, and the 

 region of the lambda marking the situation of the posterior fonta- 

 nelle, with its intervening sutures and angular articulation, are all 

 too early united and ankylosed, giving rise to corresponding rela- 

 tive disturbances in the calval portion of the cranium, particularly 

 along the sutural lines and in the most nearly related fontanelles. 



In this type, which may be very slight or of the grossest charac- 

 ter, as shown in the accompanying reproductions of two undeniable 

 cases occurring in my public practice at the Philadelphia and Wills' 

 Hospitals (Plate XX, Figs, i and 2), the visual signs of the disease 

 vary from the veriest eye symptom to the coarsest ocular expres- 

 sion, and may first appear at any time during early or middle life. 



Case I. — The gross example shown in Fig. i was that of a sixty-two- 

 year- old negro, who, with a history of an acute attack of convulsive 

 seizures from fright, occasioned, he asserted, by a fall ^ at one year of 

 age, had three years later the expression of "pop-eyed" epithetically 

 applied to him, this pseudonym having since persisted throughout life. 

 The patient stated, and I one day had a clinical demonstration of the 



^ The postnatal fall as a causative factor for the cranial malformation must be 

 rejected when the congenital stigmata are considered. 



