168 OLIVER — BLINDNESS FROM MALFORMATION OF SKULL. [Aprils, 



impulses. The left iris was almost immobile to light-stimulus thrown 

 upon its retina, but responded feebly to forced movement for supposed 

 accommodation, and gave quite prompt consensual reaction to the iris 

 of the less affected organ. Gross downward convergence of the two 

 eyes, by having the patient endeavor to look at his nose tip, rapidly 

 brought the pupillary areas down to one millimeter each in size. 



In spite of a left divergence of about thirty degrees out and slightly 

 down, the exterior muscles of the two organs seemed to enjoy good 

 movement. An almost constant lateral nystagmus that increased upon 

 attempts at near fixation was a prominent symptom. 



The patient's eye-grounds were characteristic of consecutive atrophy, 

 that of the right eye showing evidences of a recent optic neuritis of 

 postocular type. 



Although not hoping for any permanency of result, I gave the patient 

 the benefit of therapeutically driving more blood through the half- 

 starved and degenerating neural tissues of the affected optic nerves. 

 This was done by the internal administration of large and frequently 

 repeated doses of strychnia, resulting in a temporary betterment.^ 



The main disturbances upon the visual apparatus in this case, 

 therefore, which were probably of twofold character — meningitic 

 and mechanical — were mainly exerted upon the optic nerves at the 

 optic foramina. Secondary degeneration changes were only too 

 certain, as later proven by the steady decline of vision in spite of 

 all constitutional treatment that could be conscientiously and judi- 

 ciously directed against any supposed dyscrasia. 



The scaphocephalic type of cranial malformation exhibits a boat- 

 shaped form of deformity of the cranium, with an extremely broad 

 forehead. The deformation is dependent upon a premature union 

 of the sagittal suture between the medial margins of the parietal 

 bones. Here the brunt of the disturbance seems to exert itself 

 upon the median posterior portion of the anterior fossa, the limbus 

 of the lesser wing of the sphenoid bone, and the anterior medial 

 portion of the middle fossa. True optic neuritis with consecutive 

 atrophy; prominent, sightless and divergent eyes; pupils partly 

 dilated, and irides fixed to light-stimulation, are the most prom.inent 

 eye-symptoms in such cases. Intelligence is but fair, convulsive 

 seizures are not infrequent, and a lethal ending from some ordinarily 

 innocuous disease is most frequently an early event. Rapid and 



1 During a portion of my studies of this case the patient attended the public 

 clinic of my friend, Dr. George C, Harlan, at the Pennsylvania Hospital. Dr. 

 Harlan's findings and results of treatment coincided with my own. 



