0. H. Usher 
49 
made was epilepsy, meningiti.s, and mitral incompetence. Her thyroid was de- 
finitely enlarged ; knee jerks plus ; plantar reflexes not elicited; no ankle clonus; 
difficulty in articulation suggestive of a bulbar lesion ; reported ditticulty in 
swallowing; patient now cannot walk. On November 18th had incontinence of 
urine and faeces. On November 20th lumbar puncture was made. The fluid 
was clear and under slight pressiu'e. Pi-ofessor Shennan's report of the cerebro- 
spinal fluid states that " Few gram-negative cocci which did not grow in culture 
medium were found present." The temperature gradually rose from normal on 
November 17th to 105" on November 22nd, when she died. 
On November 18th I noted that the optic discs were normal. The choroidal 
vessels were markedly exposed except at the macular I'egion. Each fundus was 
albinotic. No red reflex was visible in the pupils. The iris was blue, and no 
pigment could be detected in the stroma, even when it was viewed through a 
loupe. There was constant lateral nystagmus in each eye. The skin was blond, 
and the hair was pale yellow in artificial light. When seen again three days later, 
in good day-light, she was semi-conscious, and at first the eyeballs were motionless, 
but on being roused a little, the nystagmus commenced again though the move- 
ments were slow. In this light the hair was tow colour. When attending the 
Ophthalmic Department of the Infirmary on October 5th, 1911, the refraction 
of the eyes was estimated after the use of atropine. The right eye had 1"5 D. of 
hypermetropia in an oblique meridian and 3 D. of myopia in the opposite meridian ; 
acuteness of vision with correction was y"^. The left eye had 1*5 D. of hyper- 
metropia in one meridian, and 2'25 D. of myopia in the opposite meritlian ; 
acuteness of vision with correction was -^\r. At the same date the pupils looked 
black, though occasionally a port-wine colour was visible. A description of this 
case, by Dr W. C. Souter, and the pedigree, is published in Albinisvi in Man, 
Pt. IV. No. t)46. At this date, 1909, the hair was white and contained no granules 
and no diffused pigment. The eyes were less myopic and the pupils were red. 
No general post-mortem examination was obtained. The left eye was excised 
17 hours after death and placed in Zenker's fluid. The eye was opened equa- 
torially, embedded in celloidin and then sectioned. 
Macroscopicully the ciliary body was well pigmented, and definite brown 
pigmentation of the fundus was visible. A horizontal fold of retina passed 
outwards from the optic disc through the macula, and a smaller fold passed nasal- 
wards from the optic disc. (Folds of the retina at the macula are of common 
occurrence in eyes removed after death.) No fovea was discernible. The retina 
at the macular region was of a pale yellow colour, such as is seen in the normal 
eye. A complete series of consecutive sections, cut horizontally, was made through 
the macula. No section was lost. The anterioi' portion of the eyeball was cut 
antero-posteriorly. 
Microscopical Examination. The iris contains no stroma pigment. Sections 
both stained and unstained were searched for pigment with an oil immersion lens. 
The two epiblastic layers at the back of the iris are pigmented, but not so deeply 
Biometrika xiii 4 
