The schema below [Fig. 15], copied from Dr. Seguin, expresses, on the whole, the probable truth about the regions concerned in vision. Not the entire occipital lobes, but the so-called cunei, and the first convolutions, are the cortical parts most intimately concerned. Nothnagel agrees with Seguin in this limitation of the essential tracts.[25]
Fig. 15.—Scheme of the mechanism of vision, after Seguin. The cuneus convolution (Cu) of the right occipital lobe is supposed to be injured, and all the parts which lead to it are darkly shaded to show that they fail to exert their function. F. O. are the intra-hemispheric optical fibres. P. O. C. is the region of the lower optic centres (corpora geniculata and quadrigemina). T. O. D. is the right optic tract; C, the chiasma; F. L. D. are the fibres going to the lateral or temporal half T of the right retina; and F. C. S. are those going to the central or nasal half of the left retina. O. D. is the right, and O. S. the left eyeball. The rightward half of each is therefore blind: in other words, the right nasal field, R. N. F., and the left temporal field L. T. F., have become invisible to the subject with the lesion at Cu.
A most interesting effect of cortical disorder is mental blindness. This consists not so much in insensibility to optical impressions, as in inability to understand them. Psychologically it is interpretable as loss of associations between optical sensations and what they signify; and any interruption of the paths between the optic centres and the centres for other ideas ought to bring it about. Thus, printed letters of the alphabet, or words, signify certain sounds and certain articulatory movements. If the connection between the articulating or auditory centres, on the one hand, and the visual centres on the other, be ruptured we ought a priori to expect that the sight of words would fail to awaken the idea of their sound, or the movement for pronouncing them. We ought, in short, to have alexia, or inability to read: and this is just what we do have in many cases of extensive injury about the fronto-temporal regions, as a complication of aphasic disease. Nothnagel suggests that whilst the cuneus is the seat of optical sensations, the other parts of the occipital lobe may be the field of optical memories and ideas, from the loss of which mental blindness should ensue. In fact, all the medical authors speak of mental blindness as if it must consist in the loss of visual images from the memory. It seems to me, however, that this is a psychological misapprehension. A man whose power of visual imagination has decayed (no unusual phenomenon in its lighter grades) is not mentally blind in the least, for he recognizes perfectly all that he sees. On the other hand, he may be mentally blind, with his optical imagination well preserved; as in the interesting case published by Wilbrand in 1887.[26] In the still more interesting case of mental blindness recently published by Lissauer,[27] though the patient made the most ludicrous mistakes, calling for instance a clothes-brush a pair of spectacles, an umbrella a plant with flowers, an apple a portrait of a lady, etc. etc., he seemed, according to the reporter, to have his mental images fairly well preserved. It is in fact the momentary loss of our non-optical images which makes us mentally blind, just as it is that of our non-auditory images which makes us mentally deaf. I am mentally deaf if, hearing a bell, I can't recall how it looks; and mentally blind if, seeing it, I can't recall its sound or its name. As a matter of fact, I should have to be not merely mentally blind, but stone-blind, if all my visual images were lost. For although I am blind to the right half of the field of view if my left occipital region is injured, and to the left half if my right region is injured, such hemianopsia does not deprive me of visual images, experience seeming to show that the unaffected hemisphere is always sufficient for production of these. To abolish them entirely I should have to be deprived of both occipital lobes, and that would deprive me not only of my inward images of sight, but of my sight altogether.[28] Recent pathological annals seem to offer a few such cases.[29] Meanwhile there are a number of cases of mental blindness, especially for written language, coupled with hemianopsia, usually of the rightward field of view. These are all explicable by the breaking down, through disease, of the connecting tracts between the occipital lobes and other parts of the brain, especially those which go to the centres for speech in the frontal and temporal regions of the left hemisphere. They are to be classed among disturbances of conduction or of association; and nowhere can I find any fact which should force us to believe that optical images need[30] be lost in mental blindness, or that the cerebral centres for such images are locally distinct from those for direct sensations from the eyes.[31]
Where an object fails to be recognized by sight, it often happens that the patient will recognize and name it as soon as he touches it with his hand. This shows in an interesting way how numerous the associative paths are which all end by running out of the brain through the channel of speech. The hand-path is open, though the eye-path be closed. When mental blindness is most complete, neither sight, touch, nor sound avails to steer the patient, and a sort of dementia which has been called asymbolia or apraxia is the result. The commonest articles are not understood. The patient will put his breeches on one shoulder and his hat upon the other, will bite into the soap and lay his shoes on the table, or take his food into his hand and throw it down again, not knowing what to do with it, etc. Such disorder can only come from extensive brain-injury.[32]
The method of degeneration corroborates the other evidence localizing the tracts of vision. In young animals one gets secondary degeneration of the occipital regions from destroying an eyeball, and, vice versâ, degeneration of the optic nerves from destroying the occipital regions. The corpora geniculata, thalami, and subcortical fibres leading to the occipital lobes are also found atrophied in these cases. The phenomena are not uniform, but are indisputable;[33] so that, taking all lines of evidence together, the special connection of vision with the occipital lobes is perfectly made out. It should be added, that the occipital lobes have frequently been found shrunken in cases of inveterate blindness in man.
Hearing.
Hearing is hardly as definitely localized as sight. In the dog, Luciani's diagram will show the regions which directly or indirectly affect it for the worse when injured. As with sight, one-sided lesions produce symptoms on both sides. The mixture of black dots and gray dots in the diagram is meant to represent this mixture of 'crossed' and 'uncrossed' connections, though of course no topographical exactitude is aimed at. Of all the region, the temporal lobe is the most important part; yet permanent absolute deafness did not result in a dog of Luciani's, even from bilateral destruction of both temporal lobes in their entirety.[34]
