172 OLIVER— BLINDNESS FROM MALFORMATION OF SKULL, [April 5, 



situations more markedly than they do the visual apparatus. Such 

 cases always present mental inefficiencies and disturbances from 

 either gross organic change or deficient development and growth in 

 the intracranially placed tissues. Circulation of but small quanti- 

 ties of blood and lymph of poorly nourishing quality through the 

 distorted and ofttimes inflamed and even contracted tissues, is seen 

 in so many cases of this coarse type of disease, that it seems no 

 wonder that cerebral development and growth soon become affected. 

 Many such subjects are fortunately early victims of convulsive 

 seizure, mental hebetude, general wasting from ectogenous infection, 

 and death. 



The cerebral alterations in these types are many. Should the case 

 exhibit mental deficiency, the convolutions are generally gross, 

 narrow and uncomplicated, while the related gyri are small and 

 badly developed. Fissural confluences may be present, and not 

 infrequently the occipital lobes do not extend over the usually too 

 large cerebellum. These conditions are probably also found in 

 other forms of genetous idiocy with and without eye lesions. 



Some cases of that rare condition, microcephales, from too early 

 ossification of the cranial sutures with and without idiocy, may 

 have true microphthalmus as a jmrt of the products of the same 

 morbid cause ; though functioning power, particularly that for 

 color-perception, as far as can be scientifically determined, may, 

 even in minor cases, remain practically undisturbed. As a rule, 

 the eyeballs of such subjects are relatively well placed, and exterior 

 ocular muscle action seems good. 



In hydrocephales, on the contrary, there are frequent disturbances 

 of muscle action in and around the eyeball, particularly during 

 attempted movements of coordination, and when the parts are 

 brought into association with the related ocular reflexes. 



An extremely broad interpupillary distance with a broadening of 

 the zygomatic arches forms one of the characteristic ophthalmic 

 features of congenital cretins, whether they be endemic or sporadic 

 in origin. In this peculiar type of cases sight is generally undis- 

 turbed, the sensory part of the visual apparatus usually being good* 

 The visual organs, however, are somewhat differently sized. In 

 such cases disturbances with the motor portions of the visual appa- 

 ratus are quite common. The affected individuals are frequently 

 deficient in hearing and are often unable to enunciate. The size 

 of the orbits in these cases is unequal. The osseous irregularities. 



