The Recovery of Fields of Vision in Concussion Injuries of the Occipital Cortex

IT is not very frequently that the opportunity has occurred, even during the present war, of making daily examinations of the visual fields of patients with recent occipital injuries during the period of recovery, as it is rarely that there have been the leisure, the inclination, the perimeter, the suitable patient, and convenient surroundings at the same time.It is obvious that cases of concussion must have been seen best in France, or elsewhere, rather than in England, as, by the time a patient has reached the latter, he has either recovered and there is only the history to go upon, or, if the lesion is more persistent, there is probably no accurate record of his visual fields during the earlier stage of recovery.For this reason, very largely, at the last meeting of the Ophthalmological Society, S. A. Kinnier Wilson was only able to report on one case which fulfilled in any way his criterion of a concussion injury of the occipital cortex, viz., a lesion tending to recovery which does not result in a permanent hemianopia in any of its varieties, and excluding all cases of head wounds re&ulting in more or less permanent organic visual defects.And even this single patient seems to have been a very doubtful case, and did not recover in the way one has now come to expect patients with concussion injuries to recover, but, some four or five months after the injury, was left with concentrically contracted fields of vision, showing a well marked helicoid curve of visual fatigue.This patient had had a fracture of the skull in the mid-line by the occipital protuberance and two fragments of bone had been removed by operation, but the dura apparently had not been penetrated, as no mention is made of this, nor of any subdural haemorrhage having been noted.He did not come under the care of Kinnier Wilson until two months after the injury, vwhen anything but a gross lesion or a functional condition should have recovered.It would seem, therefore, to be of general interest to place on record the results I have obtained recently, as during the past few months, in a large Base Hospital Camp in France, I have had the opportunity of watching, during the whole or the greater part of the recovery period, at least five patients, amongst many others with copyright.