SwANZY — Note on Magrath's Defective Vision. 527 



retained sight in the nasal side of his left field of vision, and I think 

 we must grant that he did retain this much vision to the end, for had 

 he been quite blind there would probably have been some reference to 

 the fact in the obituary notice of him, which appeared ia two Dublin 

 newspapers of the day. Cases of acromegaly with complete loss of 

 sight in one or both eyes are not uncommon. 



Furthermore, turning to the motor nerves of the eyeballs, it seems 

 to me not improbable that many of them must have suffered in their 

 functions. Both posterior clinoid processes have quite disappeared, 

 along with the grooves at their bases for the sixth nerves. I should 

 think, therefore, that these nerves were destroyed, and that the 

 muscles they supply, the external rectus in each eye, must have been 

 paralysed. Again, the growth of the pituitary body through the 

 right sphenoidal fissure is likely to have pressed severely on the 

 motor nerves of the eyeballs which pass through it, and to have 

 caused complete loss of power of all the muscles of the right eye, 

 so that it became quite immovable, and ptosis of the upper eyelid was 

 caused. The ophthalmic division of the fifth nerve also passes 

 through the sphenoidal fissure, and, if its functions were interfered 

 with, there was loss of sensation of the front of the eyeball, of the 

 eyelids, &c. 



Again, and this point is indicated by Professor Cunningham, 

 it is probable that the growth of the pituitary body into the right orbit 

 through the sphenoidal fissure gave rise to a more or less well-marked 

 proptosis of the right eyeball in a direction downwards and outwards 

 as well as forwards. Protrusion of the eyeball from this cause has 

 been observed in other cases of acromegaly ; and the fact that in 

 Magrath's skull the right orbit is markedly larger than its fellow 

 affords additional evidence in this direction. If the motor nerves of 

 the eyeballs were affected in the manner I have suggested it to be 

 possible that they may have been, and if, as both Professor Cunning- 

 ham and I think, the right eyeball was protruded, Magrath's personal 

 appearance must have been even less that of an Adonis than is described 

 in Professor Cunningham's memoir — the right eye protruded and 

 immovable, and its upper lid hanging down and incapable of being 

 elevated; while, owing to paralysis of the left external rectus, the 

 left eye would have been turned in towards the nose. 



It has been objected to my views that, although the hypertrophied 

 pituitary body gave rise to so much absorption of bone, it does not 

 follow that its pressure on the nerves in its neighbourhood was such 

 as to interfere with their functions. The tumour, it is said, may 



E.I. A, PEOC, SEE. III., VOL. HI. 2 N 



