On oxycephaly / by H. Morley Fletcher.

  • Fletcher, Herbert Morley, 1864-1950.
Date:
1911
Catalogue details

Licence: In copyright

Credit: On oxycephaly / by H. Morley Fletcher. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    blindness. These may be classed as congenital cases; they are comparatively few in number, and form but a small proportion of the total. In a second group may be placed the cases in which during the first few months of life changes in the shape of the head develop, and the eyes are noticed by the parents to be ‘ large ’. In the course of the first two years these signs become more marked and are attended by gradually increasing impairment of vision. The exophthal- mos and the lofty shape of the head become increasingly evident as growth proceeds. The third group includes those cases which appear to be quite normal for the first few years of life and the earliest signs may not appear before the second to the sixth year. In these cases an increasing visual defect is usually the first symptom. Vision may remain unimpaired till the fifth to sixth year. It is interesting to note that in some cases the onset of the condition appeared to date from a fall, or a blow on the head. Patry records two such cases in which this occurred at the age of four years. (Compare Dr. Hutchison’s case, VII.) A consideration of the recorded cases leads me to agree with Patry that the ocular defect begins in the first five years. The impairment of vision is progressive and sometimes ends in total blindness, but in most cases perception of light or of large objects remains. Fair vision may remain with extreme exophthalmos and very definite optic atrophy as in Case I. As growth proceeds, the lofty shape of the head becomes increasingly evident and exophthalmos develops. Headache is a very common symptom, and may be very severe. In one of my cases it was frontal and vertical. It is often occipital. Vertigo is less frequently met with. Fits have been recoi’ded in a few cases in young children, but it is difficult to be certain as to how far these fits are connected with the cranial condition. Duration. As far as the evidence serves there is nothing to show that oxycephaly shortens life, but it is a noteworthy fact that few, if any, typical cases have been recorded in patients over fifty years of age. Predisposing Causes. Race does not appear to have any influence. In this series of seven cases, four were Hebrews ; this high proportion is probably explained by the fact that the cases were drawn from hospitals in the East End of London attended by large numbers of this race. The recorded cases include most of the European races. Syphilis and Rickets cannot, in the writer’s opinion, be regarded as important factors, though some writers (Meltzer and Potts) consider that rickets plays an essential part in the pathology of oxycephaly. Sex. This may be said to be the only important predisposing factor, as the condition is much more common in males than females. Patry gives a series of sixty-four cases in which only seven were females (this series includes some cases which were not true cases of oxycephaly). Heredity is very rarely a factor, v. Hii schberg records a case whose maternal
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