166 OLIVER — BLINDNESS FROM MALFORMATION OF SKULL. [April 5, 



same, that he had more than once pushed his right eye out between the 

 lids. Five years before I saw him he accidentally discovered that he 

 could not see with the left eye. Two and a half years after this the 

 sight of the right eye began to gradually fail, until at the time of exam- 

 ination it was found that vision with it was reduced to a faint doubtful 

 perception of light in an inferior temporal field. The left eye was blind. 

 The superficial areas of the two orbits were immense. The lids were 

 large and the palpebral fissures were broad and long. When the posi- 

 tion of the left eye was gauged so as to have its supposed visual axis 

 directed straight ahead, the right eye projected two and a quarter milli- 

 meters forward beyond the superior and the inferior margins of the 

 orbit, and diverged some thirty degrees out and three degrees down. 

 When the right eye was placed in the same relative position, the left eye 

 was found to be almost as greatly diverged and was directed somewhat 

 more downward.^ Curiously, extraocular motion was very little if at 

 all disturbed, although palpation showed that the eyeballs were situated 

 in extremely shallow, almost saiicer-like orbits, the shallowest portions 

 of the cavities being situated toward the median line. The corneal 

 epithelium was thickened and the deeper structures of the membrane 

 were opaque in a couple of places. The pupils were large and the irides 

 seemed disproportionately sluggish in their various reactions to the 

 amount of local disturbance. Both lenses presented evidences of dense 

 secondary degeneration, that of the left eye being so opaque that the 

 fundus of the organ was invisible. A faint red glare, with the appear- 

 ance of a few retinal vessels — best seen with a minus spherical lens of 

 twenty diopters' strength — made it probable that portions of the sec- 

 ondary ocular lesions were due to a high-grade myopia. Intraocular 

 tension in each eye was normal. The anterior scleral vessels were not 

 engorged, and there was not any ciliary tenderness. 



The conformation of the skull was typical. The lower jaw, which 

 was increased in size, was mesognathous, if not prognathous in shape. 

 The condition of the hands, as seen crossed upon the body, discredited the 

 belief of any disease of the pituitary body. The bitemporal diameter 

 of the skull was but thirteen and a half centimeters, and the biparietal 

 was but one and a quarter centimeters wider. The occipito-frontal diam- 

 eter equaled eighteen and a half centimeters, while the occipito-mental 

 was somewhat in excess of twenty-six centimeters. The trachelo-breg- 

 matic diameter was twenty-three and a half centimeters in length.^ 



1 The exophthalmus and divergence can be easily differentiated by examina- 

 tion of the reproduction of the photograph of the case. 



2 I am under obligations to Dr. Clarence Van Epps, one of my Residents in 

 both institutions, for presentation of the copy of the photograph of the first 

 subject taken by Mr. James F. Wood, of Philadelphia; to Dr. Frederick C. 

 Krause, one of my former assistants, and now Assistant Ophthalmic Surgeon to 



