1902.] OLIVER — BLINDNESS FROM MALFORMATION OF SKULL. 167 



The second example of the type, in a German, an excellent 

 illustration of possibly an extreme hypsicephalic skull with a pre- 

 ternaturally elongated bregmato -mental diameter, is not quite so 

 rare, I having the opportunity to systematically study four or five 

 such patients in a total number of some sixty to seventy thousand 

 cases of ophthalmic disease that I have seen in the combined public 

 and private practice of myself and others.^ 



The reproduction of the photograph of the case shown in Plate 

 XX, Fig. 2 gives a good idea of the general appearances of the head 

 in profile. In this case the suboccipito-bregmatic circumference 

 equaled twenty inches, the occipito-frontal circumference was 

 nineteen and a half inches, and the occipito-mental circumference 

 equaled twenty-six and a half inches. 



Case IT. — The patient, who was born in Germany, was a thirty-five- 

 year-old farmer. He stated that he had always had a curiously shaped 

 skull. He had been free from all disease until he was ten years old, at 

 which time he had had a series of spasms. These convulsions were 

 associated with a permanent divergence of the eyes and a persistent in- 

 different vision which was more pronounced in the left eye. Three 

 weeks before I saw him, he noticed that the sight of his good eye began 

 to fail, this failure being associated at times with deeply seated orbital 

 pains on the same side. His habits, he said, were good, and there were 

 not any signs of gross hereditary or acquired disease. No other mem- 

 bers of his family "for three generations back had gone blind." His 

 parents were not blood relations. 



Vision with the right eye was reduced to an incorrectible one-eighth 

 of normal in an excentrically placed field, with its fixation-point situ- 

 ated far up and in. Color perception for green, red, blue and yellow 

 was lost. Vision with the left eye was almost gone, there being but one 

 small area of doubtful at times light-perception situated in an extreme 

 temporal field as the last remnant of sensory functioning. Intraocular 

 tension in each eye was normal. The pupil of the left eye, which was 

 round, was about two millimeters larger than the similarly shaped one 

 of the right eye. The right iris responded fairly well to light-stimulus 

 and accommodative efforts, giving rise to rather prompt consensual 

 reactions of the iris of the almost blind left eye during both of these 



St. Christopher's Hospital, in Philadelphia, lor photographing the second case ; 

 to Dr. William L. Zuill, one of the Assistant Surgeons at Wills' Hospital, for the 

 craniometric measurements of the second case ; and to Dr. Frank R. Harrison, 

 of East Liverpool, Ohio, for securing the photograph of the third case. 



1 Individuals from two races have been purposely used in the elucidation of 

 this phase of the subject in order to obtain exceptionally broad standpoints of 

 observation. 



