8 s. HOLTH AND O. PI I' M \' . M.-N. Kl. 



c) Anna B., Axel's twin sister, born July 28"' 1867, has been under 

 my observation since December i^t 1897; like her brother she did not 

 sufifer from spasm of accomodation or headaches. Right pupil formed a 

 vertical slit V/., X ^U mm., left pupil a nearly horizontal slit ^2 ^~ i nim. 

 (PI. I, Fig. 4). The iris in both eyes was blue slate colour, with a central 

 yellow pcripupillary part; closely stretched and not undulating radial fibres, 

 no circular contraction grooves in the periphery. The right pupil after in- 

 stillation of I per cent atropine thrice a day for four days became nearly 

 round with 2 mm. diameter, while the left pupil became a horizontal oval 

 with diameter 1.5 .X 2 mm.; as shown on PI. I, Fig. 5, both pupils have a 

 somewhat polygonal outh'ne, but by focal light and magnifying lens -H 40 D 

 no posterior synechiae are seen. The addition of cocaine does not dilate 

 the pupils more but it enlari/cs the palpebral /issures (some exophthalmus). 



Under atropine the refraction was the same as before: 



Right eye — 7.0 V = ^ ,5. Left eye — 8.0 V = %. The eyesight in 

 twilight was much improved. Owing to atropine catarrh I continued the 

 mydriasis with 02 per cent scopolamine every morning for 22 years. But 

 when she approached the age of 50 the mydriatic effect decreased. When 

 I saw her on October 6th 191 9, in spite of scopolamine the pupils were 

 of exactly the same size as before the beginning of the treatment (PI. I, 

 Fig. 4), nor did atropine effect any change. The myopia was much in- 

 creased in both eyes, and vision diminished by retinal changes at macula 

 lutea (visible after iridectomy): Right eye — 15.0 V = -^'^q, Left eye — 

 16.0 V = ="/15. Both eyes: tension normal and visual fields with good 

 extent for white objects in daylight; but in twilight very contracted. I made 

 iridectomy upwards first on the right eye, then on left, with the result 

 that she could again see much better by twilight. On March 31th 1920 

 she died suddenly of apoplexia cerebri. — A post-mortem examination of 

 the eyes was allowed on April 3rd. I injected i ccm. of Bouin's fluid 

 (saturated solution of picric acid in water 75 ccm, formole 25 ccm, con- 

 centrated acetic acid 5 ccm) in the vitreous of both collapsed globes till the 

 tension was felt normal, and conserved the enucleated globes in the same 

 fluid; rabbit eyes were used as prothesis. Both globes were oval with 

 staphyloma posticum verum Scarpae; axis antero-posterior in the right eye 

 28 mm., in the left eye 28.5 mm. Prosector O. Berner, M, D., has made 

 an exact microscopical examination of the iris of these eyes. — 



Epicrisis. In the above mentioned cases the pinhole pupils cannot 

 be explained by an abnormally strong contraction of m sphincter only; 

 in this case atropine would have dilated the pupils much more than to 

 about 2 mm. The m. dilatator much be assumed not to act. In textbooks 



