A CONTRIBUTION TO THE PATHOLOGY OF 
HEMIANOPSIA OF CENTRAL ORIGIN 
(CORTEX-HEMIANOPSIA) 
BY 
E. C. SEGUIN, M.D. 
CLINICAL PROFESSOR OF DISEASES OF THE AND NERVOUS SYSTEM IN THE COLLEGE 
OF PHYSICIANS AND SURGEONS, NEW YORK ; CORRESPONDING MEMBER OF THE 
VEREIN FUR INNERE MEDICIN OF BERLIN, AND OF THE 
- SOCIETE DE BIOLOGIE OF PARIS, ETC. 
Reprinted from the Journal oe Nervous and Mental Disease, Vol. xiii., 
No. I, January, 1886 A CONTRIBUTION TO THE PATHOLOGY OF 
HEMIANOPSIA OF CENTRAL ORIGIN (COR- 
TEX-HEMIANOPSIA). 
E. C. SEGUIN, M.D. 
THE importance of hemianopsia with reference to the 
recently developed doctrine of the localization of 
functions in the cerebral'cortex is so great as to merit the 
closest study on the part of the physiologist and the prac- 
tical neurologist. Few subjects -of such apparently small 
intrinsic importance have attained to such a magnitude as 
this one, rendering quite impossible to treat of it fully in a 
paper for an ordinary Society meeting. Only one or two of 
its phases can be considered within the time allotted me, 
and I shall therefore limit my remarks to the relation of the 
symptom hemianopsia to certain central or cerebral lesions, 
and endeavor to show its value for purposes of diagnosis in 
actual practice, rather than develop its significance for the 
solution of physio-psychical problems. 
My apology for presenting the subject is that during the 
past winter it was my fortune to observe a typical case of 
lateral hemianopsia, stationary till the patient's death many 
months afterward, and almost unaccompanied by other cere- 
bral symptoms. The topographical diagnosis made during 
life was verified by the post-mortem examination, so that, 
Reprinted from the Journal of Nervous and Mental Disease, Vol. xiii, 
No. i, January, 1886. 2 
E. C. SEGUIN. 
apart from its scientific interest, I may venture to submit 
the case as an encouragement to the making of positive 
diagnoses intra witam, in the light of the rapidly growing 
laws of so-called cerebral localization. 
Before relating the case and presenting the specimen I 
should make a few remarks upon the scope of the paper, 
and briefly state certain data relative to parts of the subject 
which I cannot treat in full. 
First, then, as to the scope and plan of the paper. I 
shall consider only the recorded cases of hemianopsia in 
which the autopsy revealed a lesion in some part of the 
brain inclusive of the optic thalami. Since the publication 
of Dr. Starr's valuable resume of cases of hemianopsia in 
January, 1884, their number has somewhat increased, and I 
am able to tabulate forty. I should add that I have endeav- 
ored to obtain the original essay in each case, and have care- 
fully prepared the abstracts myself: only one, No. o, by 
Prevost of Geneva, has been impossible to obtain, and I 
quote it upon Westphal's authority, but exclude it from my 
tables. This labor I was induced to perform in order to 
avoid errors which otherwise easily occur in quoting cases, 
and also to be able to group these cases and more fully 
appreciate and present their pathological and diagnostic 
value. It is far from me to claim that my collection is 
absolutely perfect, but it is, I believe, almost cqmplete and 
reliable in its critical arrangement. Let me repeat that I 
am anxious to present this relatively very rich and singularly 
harmonious collection of cases in such a way that it shall 
prove of most use to the practising physician for diagnostic 
purposes. 
Second, as to the subject of hemianopsia in general. 
The fact that a person might temporarily or permanently 
see only one half of objects placed directly in front of him 
has been known to physicians more than one hundred years. 
In 1723 Vater and Heinecke described three cases under 
the name of wisus dimidiatus. 
The same phenomenon was designated as hemiopia at the 
close of the last century, probably first by A. G. Richter, a 
term which prevailed and is still employed though in a dif- HEMIANOPSIA. 
3 
ferent sense since the introduction of hemianopia by F. 
Monoyer in 1865, and of hemianopsia by J. Hirschberg in 
1877. The latter is the preferable and preferred form. 
As the terms are now accepted, hemiopia signifies loss 
of perceptive power in one lateral (or vertical) half of the 
retina, while hemianopsia means obscuration of one lateral 
(or vertical) half of the visual field. As rays of light cross 
within the eye before reaching the retina, it follows that, for 
example, right hemiopia is equivalent to left hemianopsia ; 
or, in other words, that nasal hemiopia corresponds to 
and causes temporal hemianopsia. 
In describing cases at the present time, it is customary 
and preferable to omit all mention of the retinal condition, 
or hemiopia, and to describe the hemianopsia, or the state 
of the visual field as determined by the perimeter or by 
ruder though sufficient tests. 
Several varieties of hemianopsia are recognized. 
1. Horizontal, superior, or inferior hemianopsia, almost 
always due to defects within the eye, and of relatively small 
interest to the neurologist. 
2. Vertical hemianopsia, almost always due to lesions of 
the retro-ocular nervous visual tract, and hence of great im- 
portance in neuro-pathology. Quite a number of terms have 
been employed to designate the varieties of vertical hemi- 
anopsia. Of these we recognize and adopt : 
(at) Temporal hemianopsia. 
(Z>) Nasal hemianopsia. 
(f) Lateral hemianopsia, often designated as homonymous 
hemianopsia. 
The first two varieties are exclusively caused, as far as our 
present knowledge goes, by lesion of the optic chiasm, of its 
lateral, or of its frontal or caudal borders. 
The last variety, lateral hemianopsia, is always produced, 
as far as our present knowledge goes, by lesions of one optic 
tract, or of the more central parts of the optic apparatus as 
far caudad as the cortical centre for vision in one hemi- 
sphere. 
The object of this paper is to study the recorded cases of 
lateral hemianopsia, with autopsies, due to lesions situated 4 
E. C. SEGUIN. 
in the more caudal parts of the optic apparatus, its central 
portions, from the primary optic centres (lobi optici, cor- 
pora geniculata lateralia) to the cortical visual centres, of 
areas. 
With reference to all three forms of hemianopsia, I shall 
assume the following propositions as established : 
1. The fact of a semi-decussation in the optic chiasm or 
man has been proven chiefly by the researches of von Gud- 
den. According to these recent views (which are in part 
a return to the ancient theoretical statements of Newton, 
Wollaston, Muller, Hannover, and von Graefe) the optic 
fasciculi are disposed as follows : The fibres of each tractus 
opticus at the chiasm divide into two parts : A larger one 
which decussates with its homologue and enters into the 
composition of the opposite optic nerve, supplying the 
nasal half of the retina. This is the fasciculus cruciatus. 
The other, smaller set of optic-tract fibres does not decus- 
sate but passes on directly to form a part of the optic nerve 
of the same side, supplying the temporal half of the retina. 
This is the fasciculus lateralis. Thus each retina receives 
nerve fibres from both optic tracts, or, in other words, each 
optic tract contains fibres destined for both retinae. 
The inter-retinal fasciculus of Hannover is purely imagin- 
ary ; there are no such fibres. The posterior loop of 
Hannover is now known, since the experiments of von Gud- 
den, to be composed of non-optic fibres ; it is the inferior 
cerebral commissure. 
2. The connection of the optic tracts with the corpora 
geniculata lateralia and the lobi optici (anterior corpora 
quadrigemina) is an intimate one, but probably (in man) 
more for trophic and reflex purposes than for vision. 
Whether mere perception of light (as an excitant) may 
take place in these bodies after removal of the hemi- 
spheres, is still an open question. Certainly sight, in the 
ordinary meaning of the term, is impossible under such 
conditions. 
3. A total lesion of one tractus opticus fatally produces 
lateral hemianopsia of the fields opposite the lesion. 
4. A lesion acting upon one side of a tractus opticus so as HEMIANOPSIA. 
5 
to compress only some of its fibres will produce one-sided 
nasal hemianopsia. 
5. A lesion acting simultaneously on the sides of the 
optic chiasm will, by injuring both fasciculi laterales, pro- 
duce nasal hemianopsia in both eyes. 
6. A lesion compressing the optic chiasm in its frontal or 
caudal borders will produce bilateral temporal hemianopsia 
by injury to both fasciculi cruciati. 
7. All such lesions are apt to be accompanied by pupil- 
lary irregularity or immobility, by optic neuritis or atrophy ; ' 
and their diagnosis is further facilitated by finding signs of 
paralysis of other basal nerves, or of crossed hemiplegia. 
8. It must be borne in mind that a lesion of the hemi- 
sphere may be so situated as to press downward upon one 
tractus opticus, and thus produce hemianopsia of the pe- 
ripheral type (see case of Hirschberg, No. 5). 
9. Lesions of the lobi optici in man have been rarely ob- 
served, and when observed have been bilateral in their 
effects, so that nothing can be said at present of hemi- 
anopsia due to disease of these parts. 
With this brief introduction I now pass on to the consid- 
eration of the clinical and pathological aspects of the sub- 
ject of my paper as exemplified in forty cases with autop- 
sies, and five traumatic cases without autopsies, which I 
have been able to collect. 
After a careful analysis I have grouped these forty-five 
cases into six categories. 
1. Cases which are indefinite or useless for the study of 
localization, four in number. 
2. Cases of lesions of parts which we have good reason to 
believe unconnected with the central optic apparatus, and 
which produced hemianopsia by pressing upon the optic 
tracts or the chiasm, three in number. 
3. Cases in which the hemianopsia was due to a lesion of 
the corpus geniculatum laterale or the thalamus opticus, or 
both, six in number. 
4. Cases of hemianopsia due to lesion of the white sub- 
stance of the occipital lobe, eleven in number. 
5. Cases of traumatic hemianopsia, due to injuries of the 6 
E. C. SEGUIN. 
occipital region of the skull and lesion of the subjacent 
brain, five in number. 
6. Cases of hemianopsia due to lesions of the cortex of the 
brain, cortex only, or also of the subjacent white substance, 
sixteen in number. In this class I have included my own 
case. Among these sixteen cases there are four (Nos. 28, 
29, 41, 45) in which the lesion was circumscribed, and 
where it occupied so nearly the same spot in the cortex 
cerebri as to afford us, in my opinion, a solution of the 
problem of the location of the cortical visual centre in 
man. 
In order to shorten this essay for publication I have tabu- 
lated the cases according to the above grouping of the 
cases. 
The four conclusive cases I shall, however, offer in full 
abstract illustrated with diagrams in order to enable the 
reader to more fully appreciate their value. But first I shall 
give the details of a traumatic case which is of extreme 
interest, from the facts that hemianopsia has existed as the 
sole symptom for twenty-three years, and that the cicatrix 
in the head is so distinct as to allow of study at present. 
Case 3.-Keen and Thomson. P. H., a soldier, aged twenty- 
three, was wounded in the head by a minid ball, during the battle 
of Antietam, in September, 1862. The missile entered the skull 
in the median line, 1% inches above the external occipital pro- 
tuberance, and made its exit at a point 2 inches distant from the 
median line, and 3 inches distant from the point of entrance. 
There was no immediate loss of consciousness. In the next few 
days the patient complained of impaired vision. Ten days after 
the injury, loss of consciousness, with right-sided hemiplegia, 
occurred. Paralysis and imperfect memory lasted for two or 
three months. Apparently no aphasia. 
When seen by the authors, in 1870, there was no paralysis, and 
the mental functions were unimpaired. The patient complained 
that the vision of his right eye was deficient. The pupils, ocular 
muscles, and fundus were normal. The left cornea bore an old 
opacity. Central vision on right side, = 1 ; on left side, The 
fault complained of by the patient was found to be a complete 
right lateral hemianopsia, with a vertical division line. 
Recently I traced this soldier, through, the Pension Bureau at 
Washington and the office at Philadelphia, to his home in that 
city. He has consented to come here this evening, in order to 
make the report more exact. By the courtesy of Drs. Keen HEMIANOPSIA. 
7 
TABLE I. 
Cases of Hemianopsia in which the Relation between the Lesion and the Optic Defect was not Evident ; Indefinite and Insufficiently 
Reported Cases.-Four in Number. 
No. 
Observer. 
Sex. 
Age. 
Fundus and 
Pupils. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
12 
Charcot 
and Pitres, 
1877. 
F. 
52 
(?) 
Left lateral 
H. (De Wecker 
and Landolt.) 
(?) 
Localized epileptiform 
attacks in 1. face, neck, 
and arm. Left hemi- 
plegia with flaccid mus- 
cles. 
Various old patches 
of softening in different 
gyri. Recent red soften- 
ing of cerebellum. 
State of occip- 
ital lobes, optic 
tracts, and chi- 
asm not men- 
tioned. 
21 
Linnell, 
1881. 
M. 
63 
At first exam, 
fundus normal; 
at second, right 
side of left disk 
pale. V. = Jg or 
J8- 
Left lateral H. 
Sclerosis (?) of right 
optic tract. Softening 
of corp.quad.etgenic.(?) 
Attacks of neuralgia 
in head and limbs for 8- 
q years. For 4 years 
paralysis agitans " 
right side, with numb- 
ness and tingling. Sud- 
den blindness after se- 
vere headache : im- 
provement in V. Blind- 
ness again, general tre- 
mor, halluc. of V. 
Death. 
Large recent clot in 
right hemisphere ant. to 
its centre, and wholly 
in white substance. 
Left hemisphere nor- 
mal. Tubercula quad, 
in state of white soften- 
ing, as also the corp, 
genic, and ventral part 
of thalamus, more on 
left side. Right optic 
tract firmer than left, 
chiasm and nerves nor- 
mal. 
»5 
Petrina, 
1881. 
M. 
53 
Normal fun- 
dus and papil- 
lae. V. not 
measured: no 
mention of re- 
fraction or ac- 
commodation, 
or pupils. 
No hemianop- 
sia. Amblyop- 
ia of left eye : 
after using this 
eye alone a few 
minutes every 
thing becomes 
confused and 
gray. 
Fissure in right lamb- 
doid suture. Pachy- 
meningitis, meningeal 
hemorrhage,and soften- 
ing or degeneration of 
cortex of occipital gyri, 
especially the 2d ana 3d, 
from sulcus tempor- 
alis sup. anteriorly to 
fissura calcarina be- 
hind. (?) 
Fall backward on oc- 
ciput with loss of C.; 
vomiting, headache, and 
vertigo. Failing sight. 
No motor or sensory 
symptoms. All special 
senses normal except 
sight. Died of pneu- 
monia. 
Apparently no 
oculist saw the 
case. If report 
is correct there 
was probably 
paralysis of ac- 
commodation in 
1. eye. The le- 
sion may not 
have involved 
the cuneus. 
4° 
Wiethe, 
1884. 
M. 
54 
Fundus nor- 
mal. Pupilsand 
V. not mention- 
ed. Binocular 
V. preserved. 
Superior la- 
teral hemianop- 
sia. 
Lesion-of left thala- 
mus opticus. (?) 
Fall upon occiput; 
unconscious, and bleed- 
ing from nose, mouth, 
and ears. Violent head- 
aches, impaired mental 
action ; no paralysis. In 
a few weeks apoplectic 
attack with left hemi- 
plegia: recovery. Later, 
complete (?) blindness 
developed in i| hours : 
partial recovery. Death 
from hernia. 
Atheromatous cere- 
bral arteries. Old hem- 
orrhagic foci in r. 
temporal lobe, lenti- 
form nucleus, medul- 
lary subst. of frontal 
lobe and gyrus olfact. 
Also in left parietal 
lobe and left thalamus. 
Chronic pachymenin- 
gitis. 
Extent of le- 
sions not well 
given. No spe- 
cial mention of 
occip. lobe and 
optic tracts. 8 
E. C. SEGUIN. 
TABLE II. 
Cases of Hemianopsia from Lesions Unrelated to the Cortical Centre for Sight ; Cases from Pressure Transmitted to Optic Tracts, etc.- 
Three Cases. 
No. 
Observer. 
Sex. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
5 
Hirschberg, 
1875- 
M. 
4° 
Fundus nor- 
mal. Central 
vision normal. 
Right lateral 
H. with sharply 
defined vertical 
line passing 
close to point of 
fixation. 
Left tractus opticus 
smaller than right. 
For four years severe 
left-sided, intermittent 
headache. Imperfect V. 
to right. Right hemi- 
plegia. Aphasia. 
Glio-sarcoma, size of 
an apple, in left frontal 
lobe. 
Tumor may 
have pressed on 
tractus. State 
of occipital lobe 
not mentioned. 
8 
Huguenin, 
1876. 
F. 
46 
(?) 
Right lateral 
H. with a not 
well defined 
vertical line. 
(?) 
Attack of uncon- 
sciousness ; right hemi- 
plegia with partial an- 
aesthesia, aphasia, alex- 
ia, and word-deafness. 
Embolism of 1. mid- 
dle cerebral artery; sof- 
tening of Broca's gyrus, 
gyrus precentralis, et 
postcentralis, in their 
lower parts ; insula, ex- 
ternal capsule, claus- 
trum, and external di- 
vision of N. lentiformis. 
State of oc- 
cipital lobe not 
mentioned. 
16 
Pfliiger, 
.1878. 
M. 
62 
(?) 
Left lateral H. 
Injury of inferior part 
of thalamus by clot, 
with pressure on trac- 
tus. (?) 
Attack of cerebral 
hemorrhage. 
In right lateral ven- 
trical much semi-fluid 
blood. Hemorrhage in 
corpus striatum, and 
inferior part of thala- 
mus. 
State of oc- 
cipital lobe not 
mentioned. HEMIANOPSIA. 
9 
No. 
Observer. 
Sex. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
6 
H. Jackson 
and W. R. 
Gowers, 
1875. 
M. 
65 
(?) 
Left lateral H. 
Softening of caudal 
half of right thalamus: 
pulvinar disintegrated. 
Left hemiplegia and 
hemianaesthesia. Death 
from a non-cerebral 
disease. 
9 
Pooley, 
1877. 
M. 
55 
V. normal 
when first seen. 
Later, choked 
disk in left eye, 
normal fundus 
in right eye. 
Fields normal 
when first seen. 
Sudden right 
lateral H., pass- 
ing away, but 
returning in a 
few days. 
Complete softening 
of left thalamus and 
surrounding white sub- 
stance. 
For 6 years epilepti- 
form seizures, halluc. 
of sight, maniacal at- 
tacks. Right hemipare- 
sis, reduced sensibility, 
aphasic symptoms, 
weak memory. 
In left occipital lobe 
there was a " gummy 
tumor" 12X30 mm., ad- 
herent to pia. Right 
lateral ventricle much 
dilated. 
Syphilitic ar- 
teritis and tu- 
mors. 
'9 
Dreschfeld, 
Case I.. 1880 
F. 
(?) 
Left lateral H. 
A tuberculous tumor 
almost replaced the 
right thalamus, and ex- 
tended laterad through 
int. capsule to nucleus 
lentiformis. Right 
tractus opticus reduced 
to a thin band. 
Paroxysms of head- 
ache and weakness of 
left leg for 7 years. 
Apoplectic attack and 
left hemiplegia, con- 
vulsions, coma. 
The tumor extended 
in a ventral direction 
almost to the surface of 
the brain. 
3° 
Dreschfeld, 
Case IL, 
1882. 
M. 
4° 
Fundus nor- 
mal. Central V. 
good. 
Left lateral H. 
Cysto - sarcoma in 
place of lateral part of 
right thalamus ; lobus 
opticus, internal cap- 
sule and part of nucleus 
lentifoimis involved. 
Right optic tract flat- 
tened. 
Headache, giddiness, 
diplopia, left-sided par- 
esis and tremor for 18 
mos.Three convulsions. 
Left hemianaesthesia, 
and hemiplegia. 
No syphilis. 
3i 
Dreschfeld, 
Case III., 
1882. 
F. 
52 
Pupils equal 
and react well. 
Central V. fairly 
good. 
Left lateral 
H., with a verti- 
cal line not 
quite reaching 
point of fixa- 
tion. 
A clot, ovoid and 6X8 
mm., in the upper and 
post, extremity of right 
thalamus (pulvinar). 
Optic tracts, lobus 
opticus, and corp, 
genic., normal. 
Bright's disease and 
mitral stenosis. Apo- 
plectic attack, followed 
by* left hemiplegia and 
transient aphasia. Also 
diminution of sensi- 
bility on left side of 
body. Special senses 
normal except V. 
Several clots within 
the r. brain: two cor- 
responding to fasciculi 
from precentral gyrus, 
and one under the 
parietal gyri. 
36 
Rosenbach, 
1883. 
F. 
34 
(?) 
Right lateral H. 
Softening of external 
part of left thalamus ; 
tumors in post, seg- 
ments of both lobi 
optici ; atrophy of left 
tractus opticus and of 
right optic nerve. 
Right hemiplegia, 
right amblyopia. Epi- 
leptoid convulsions. 
Amnesic aphasia. Im- 
pairment of mental 
activity. Symptoms of 
pressure. 
Softening of corpus 
striatum and internal 
capsule. 
TABLE III, 
Cases of Hemianopsia from Lesions of the Thalamus Opticus and Corpora Geniculata.-Six Cases. 10 
E. Q SEGUIN. 
No. 
Observer. 
Sex. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
2 
Levick, 
1866. 
M. 
4° 
(?) 
H., of which 
side not stated, 
when first seen, 
Feb'y 9, 1866. 
Abscess in posterior 
lobe of right hemi- 
sphere, ij inches in di- 
ameter (Pepper). 
In May and June, 
1865, slight (?) injuries 
to head, by falling ob- 
jects. In July and Au- 
gust, headaches and ex- 
treme drowsiness ; ver- 
tigo, sense of feeling 
drunk. No convulsions 
or paralysis. Death in 
coma eight months af- 
ter injury. 
Opacities in arachnoid. 
Various structures at 
base of brain softened 
and discolored. Small 
abscess in anterior lobe 
of left hemisphere. Lat- 
eral ventricles lined by 
consistent whitish-yel- 
low inflam, lymph. 
Hosch, 
1878. 
M. 
54 
V. R. Jg, V. 
L. Jg. Slight 
redness and 
veiling of pa- 
pillae, and a few 
streaks of hem- 
orrhage in ret- 
inae. 
Left lateral 
H. with verti- 
cal line a little 
to 1. of point of 
fixation. 
Large hemorrhagic 
cyst, almost destroying 
right occipital lobe to 
cortex. 
Slight apoplectic at- 
tack and weakness of 
left side of body, with 
darkening of I. fields of 
V. Complete left hemi- 
plegia after a third apo- 
plectic attack. In fourth 
attack, right side par- 
alyzed ; death. 
Large pigmented cic- 
atrix in right corpus 
striatum, extending into 
thalamus. N. caud. et 
lentif. atrophied. Last 
attack due to a large 
fresh hemorrhage in 
3d vent., causing exten- 
sive laceration. 
*3 
Baumgar- 
ten, 1878. 
M. 
(?) 
Central V. 
normal. 
Left lateral 
H. suddenly- 
developed and 
persistent. 
In the substance of 
the right occipital lobe 
was an old hemorrhagic 
cyst as large as a wal- 
nut, and the various 
convol. of the occipital 
lobe were softened, 
though recognizable. 
None (?). 
Death in several 
months, from paralysis 
of the heart. 
In centre of right 
thalamus was a so- 
called apoplectic cica- 
trix, half size of a lentil. 
Tractus optici and op- 
tic nerves normal. 
Fatty heart and con- 
tracted kidneys. 
>5 
Dmitrow- 
sky and 
Lebeden, 
1879. 
F. 
22 
Papillae con- 
gested, obscure 
limits, veins en- 
larged. 
Right lateral 
H. 
In the left cerebral 
hemisphere, a clot 
which involved the 
greater part of the cor- 
ona radiata, and pene- 
trating the temporal 
lobe almost to the cor- 
tex. 
Headache, drowsi- 
ness, and difficulty in 
speaking. Aphasia. 
? 
TABLE IV. 
Cases of Hemianopsia from Lesions Situated Chiefly in the White Substance of the Occipital Lobe.-Eleven Cases. HEMIANOPSIA. 
11 
No. 
Observer. 
Sex. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
w 
Related Lesions. 
Other Symptoms. 
Other Lesions. 
Remarks. 
22 
Westphal, 
Case I., 
1881. 
M. 
42 
Slight optic 
neuritis in 1. 
eye. 
Left lateral 
H. Vertical 
line passing 
through point 
of fixation. 
Old focus of soften- 
ing in white subst. of 
parietal and occip. 
lobes, as low as 2d 
temp, gyrus. Gyri of 
parietal and occip. lobes 
smaller and softer than 
those of left side. Vol- 
ume of caudal end of 
right hem. much less 
than that of left hem. 
Left-si<led convul- 
sions, followed by 1. 
hemiplegia. Clonic 
spasms in paroxysms, 
lasting days or hours, 
often without loss of 
C. At end, some con- 
tracture of 1. arm. Very 
slight anaesthesia ; tran- 
sient. 
Basal optic apparatus 
and thalami normal. 
24 
Senator, 
1881. 
M. 
69 
(?) 
Left lateral 
H. 
Clot occupying great- 
er part of white subst. 
of right temporal lobe 
outside inf. horn of 
ventricle. Dorsally 
lesion destroys a large 
part of white subst. of 
inf. parietal lobule ; 
mesad it extends to 
the lateral part of thala- 
mus ; complete inter- 
ruption of post, part of 
internal capsule ; occip. 
and temporal radiations 
cut through. 
Left hemiparesis; 
contracture ; conjugate 
deviation to right ; 
speech normal. Sen- 
sibility to pain preser- 
ved. Later, movements 
of right arm ataxic; 
r. leg paralyzed. 
Thalamus normal ; 
right corp, genic, lat. 
flattened and yellowish- 
red. The clot also ex- 
tended frontad through 
ext. capsule and outer 
segment of n. lent., as 
far as insula. Rest of 
brain normal. 
• 
3* 
Stenger, 
Case VII., 
i88z. 
M. 
32 
At close of 
life, for two 
months, blind- 
ness and hal- 
luc. of V. 
Left lateral 
H. Verified by 
repeated tests. 
In white substance 
bordering right post, 
horn, is a distinct, rather 
broad furrow, extend- 
ing from post, border 
of thalamus caudo- 
laterad. 
Symptoms of demen- 
tia paralytica ; excite- 
ment, tremors, thick 
speech. Attack of 1. 
hemispasm and hemi- 
plegia. Later, attacks 
of left-sided spasm. 
Decortication over 
left parietal lobe and 
whole of both occip. 
lobes, which are short- 
ened and shrunken. 
Post, horns much di- 
lated ; the right more. 
Both thalami, especially 
in post, thirds, are col- 
lapsed and softer. Op- 
tic tracts equal and nor- 
mal. 
♦ 
TABLE IV.-Continued. 12 
E. C. SEGUIN. 
No. 
Observer. 
Sex. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
34 
Wernicke 
and 
Hahn, 
1882. 
M. 
45 
No lesion in 
fundus. 
Right lateral 
H. Vertical line 
passing a little 
to right of point 
of fixation. 
Abscess in white 
subst. of 1. hemi- 
sphere, latero-dorsad of 
post, horn of V. At its 
frontal end the vent, 
was opened. The caudal 
end of abscfess almost 
reached the apex of 
occip. lobe ; mesad the 
abscess was limited by 
the ependyma. De- 
struction of white 
subst. of sup. and inf. 
parietal lobules. 
Chronic phthisis. Pain 
in 1. frontal and occi- 
pital regions ; a cloud 
before right eye. Mind 
dull ; right arm and leg 
awkward. Paresis of 
r. arm and leg ; loss of 
muscular sense in r. 
arm. Later, complete 
paralysis. Trephining 
in upper post, quadrant 
of 1. parietal bone ; 
abscess in brain evacu- 
ated by deep incision. 
Relief to motor sym- 
ptoms, etc. On 6th day, 
stupor, paralysis, and 
death. 
Ventricle perforated 
and containing pus. No 
meningitis. 
The diagnosis 
of abscess of 
occip. lobe was 
made intra 
vitam and con- 
firmed. Sur- 
gically the case 
is most encour- 
aging. 
35 
Jany, 
1883. 
F. 
21 
V. much re- 
duced. R. -|- 
A, S. " 
L. fingers 
counted at S'. 
Neuro - retinitis 
passing into 
atrophy, more 
in r. eye. 
Right lateral 
H. In r. eye 
vertical line a 
little outside 
point of fixa- 
tion. In 1. eye 
outer field con- 
tracted. 
Cysto-sarcoma occu- 
pying nearly whole of 
1. occip. lobe. Solid 
tumor lies at apex of 
occip. and mesad, as far 
as occipito - parietal 
sulcus. 
Severe headache, 
most in 1. occip. region. 
Vertigo. Paraesthesia 
and analgesia of r. hand 
and face. Stammering. 
Later, no objective 
symptoms, except in 
eyes ; occip. pain, vom- 
iting, convulsions ; 
death. 
Cystic part of tumor, 
of orange size, involves 
white subst. about post, 
horn of V.; and under 
inferior parietal gyri. 
38 
Richter, 
,883, 
Case I. 
M. 
54 
Pupils equal, 
normal in size 
and action. Op- 
tic nerves pale ; 
vessels smaller. 
Left lateral 
H. Vertical di- 
vision line. 
Clot of a certain age 
in r. occip. lobe in 
white subst., just la- 
terad of post, horn of 
V., separated from it 
by ependyma. Cortex 
uninjured. 
Hallucinatory para- 
noia. Left eye weak, 
and left hand numb. 
Left hemiplegia. Death 
in apoplectic attack. 
Most ancient clot in 
r. temporal lobe. 
Third and fresh clot 
had disorganized the 
crura, filled third and 
fourth ventricles. 
3? 
Schmaltz. 
Cited by 
Vetter, 
i883. 
F. 
69 
Pupils and 
ocular muscles 
normal. 
Right lateral 
H. 
Yellow softening in 
left hemisphere, most 
destructive in occipital 
lobe. Caudal part of 
thalamus softened. 
Apoplectic attack, 
followed by r. hemiple- 
gia. Complete r. hemi- 
anaesthesia. Muscular 
sense lost. Left arm 
with choreiform move 
ments. State of smell 
and taste uncertain. 
Yellowish softening 
of various gyri in 1. 
brain : pre- and post- 
central. parietal, and 
occip. gyn. 
TABLE IV.-Continued.  
Prevost, in 
M. 
75 
Fundus normal} 
L. lateral 
Yellow patch in right 
'Attack sudden but 
Old thrombus of right 
46 
Bulletin de 
l.i socifitfi 
m6d de la 
Suisse 
Romande, 
1878. 
(Haltenhoflf). 
H. 
occipital lobe, from its 
mesal gyri inward into 
white substance along 
the post. horn of 
ventricle as far frontad 
as corp, genic, lat. and 
thalamus. Lobus opti- 
cus normal. 
without loss of c. Slight 
left hemiplegia. Partial 
left hemiantesthesia 
( hearing, taste, and 
smell uncertain because 
of stupidity). 
posterior cerebral ar- 
tery. Recent thrombo- 
sis of basilar. External 
gyri of brain and in- 
sula normal. 
ADDITIONAL CASh HEMIANOPSIA. 
13 
No. 
Observer . 
Sex. 
Age. 
Fundus, Pu- 
pils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
3 
W. W. 
Keen and 
W. H. 
Thomson, 
1871. 
M. 
32 
V. R. = 1. V. 
L. Opacities 
ant. cornea. 
Pupils, ocular 
muscles, and 
fundus normal. 
Right lateral 
H. Vertical di- 
vision. 
In Sept., 1862, re- 
ceived a gunshot 
wound of post, end of 
cranium on left side. 
Entrance in median 
line inches (31 mm.) 
above the external occi- 
pital protuberance. 
Exit 2 inches (50 mm.) 
from median line, and 3 
in. (75 mm.) from en- 
trance. 
No immediate loss of 
consciousness. Im- 
paired V. soon noticed. 
Ten days later loss of 
consciousness followed 
by r. hemiplegia. No 
aphasia. Paralysis and 
imperfect memory last- 
ed for 2-3 months. No 
paralysis in 1870. 
Hemianopsia 
caused by in- 
jury to optic 
fasciculus. Oc- 
cipital gyri un- 
injured. 
* 
Idem. 
Observed 
by E. C. 
Seguin, 
in 1885. 
M. 
46 
Pupils nor- 
mal. Eye mus- 
cles normal. 
Fundus: blood- 
vessels normal, 
outer temporal 
quadrant of 
both disks 
whiter than nor- 
mal ; left a lit- 
tle whiter than 
right. V. R. = 
fg with - 71- ; 
ax. 90. -V. L. 
- jg with - 7'5 ; 
ax. 90. R. reads 
No. 14 J. at 12' 
with -|- 72 S. 
No. 1 at 8". L. 
reads No. 14 J. 
at 12' with 4- 
72 S. ; No. 6 at 
8'. (Dr. Hale, 
House Sur- 
geon, Manhat- 
tan Eye and 
Ear Hospital ) 
Right lateral 
H. Division line 
not quite reach- 
ing point of fix- 
ation. 
Entrance cicatrix 
barely noticeable. Exit 
is a large cup-shaped 
depression 5 X 6.5 
cent, and 1.5 cent, 
deep. Bridge of bone 
between entrance and 
exit only 3 cent. Bot- 
tom of depression is 
firm but not osseous. 
Injury imitated on the 
cadaver shows an in- 
jury of parietal lobe, 
dorsad of angular 
gyrus. Occipital gyri 
uninjured. White sub- 
stance deeply lacer- 
ated. 
One epileptiform at- 
tack 6 years ago (1879). 
Right side a little 
weaker ; more easily 
affected by alcohol. 
Uses left hand habitu- 
ally. Mental action 
good. 
TABLE V. 
Cases of Hemianopsia due to Injuries to the Cranium and Brain ; Lesion mostly Cortical.-Five Cases. 14 
E. C. SEGUIN. 
No. 
Observer. 
Sex. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
4 
Hughes, 
M. 
38 
Eyes normal 
Right 
lateral 
Injured by fall of a 
Coma relieved by 
1873. 
except hernia- 
H. unchanged 
large iron vessel on 
operation. 
nopsia. (Prof. 
at time 
of dis- 
back part of head. 
Wilson, Drs. 
charge 
from 
Compound depressed 
Jacob and 
hospital. 
fracture of occipital and 
Swansy, of 
parietal bones. Several 
Dublin.) 
pieces of bone removed 
and coma relieved at 
once. Complete recov- 
ery in 3 mon. except im- 
Schmidt- 
pairment of V. 
20 
M. 
(?) 
? 
Left 
lateral 
Vertical compound 
No paralysis. Re- 
R i m p 1 e r, 
H. 
fracture of right occipi- 
covered with complete 
1880. 
tai and parietal bones 
deafness of r. ear, left 
by a fall. A handful of 
lat. H., and occasional 
bony splintersand some 
dizziness with loud tin- 
brain substance were 
extracted. 
nitus in r. ear. 
23 
Heuse, 
M. 
(?) 
Slight opaci- 
Right 
lateral 
Fall upon head caus- 
1881. 
ties of cornea, 
reducing V. and 
H. Right tern- 
inga depressed fracture 
poral and left 
of cranium. Enormous 
rendering oph- 
nasal half-fields 
cicatricial depression of 
thalmo s c 0 p i c 
were not abso- 
the bones on the left 
( 
exam, unsatis- 
lutely dark but 
side of the occipital end 
factory. 
dim or very ob- 
of the skull ; a strong 
Nieden, 
scure. 
ridge-like depression 
extended from left pa- 
rietal into the occipital 
bone. 
37 
F. 
22 
During sec- 
After 
opera- 
Fall down steps, 
Paralysis with partial 
This case was 
1883. 
ond paralytic 
seizure before 
tion monocular 
striking occiput repeat- 
anaesthesia of right side 
probably one 
H. temporal 
edly on succeeding 
of body. Mental action 
of hysterical na- 
operation : Eye 
field of right eye 
steps. Unconscious- 
normal. Great recov- 
ture. 
and even 
muscles and 
and in part of its 
ness, vomiting, pain in 
1. occipital region. 
ery in six months. 
the optic svmp- 
pupils normal. 
superior 
inner 
Seven months after in- 
toms 
may have 
fields normal. 
(nasal) 
quad- 
At operation, 9 months 
jury severe headache, 
been 
of same 
Slight venous 
rant. Field of 
later, no lesion found, 
vertigo, semi - uncon- 
sort. 
hyperaemia of 
left eye 
limited 
but the dura mater (and 
sciousness. Right hemi- 
papillae and 
in its upper and 
brain) was injured by 
plegia ; face not in- 
retinae. Ninth 
nasal areas. 
trephine to left of me- 
volved. Also right 
day after op- 
dian line. After opera- 
hemianaesthesia. At- 
eration V. L. 
tion, complained of im- 
tacks of headache with 
= Jg. Field 
paired vision. 
loss of C.; jerks of left 
normal. V. R. 
side muscles, face, 
= 50, temporal 
and limbs. Trephined 
field wanting to 
in left upper quadrant 
median line. 
of occip. bone. All 
symptoms passed away 
and, 13 months after 
original injury, she re- 
turned to her work. 
TABLE V.-Continued. HEMIANOPSIA. 
15 
TABLE VI. 
Cases in which Lateral Hemianopsia was due to Lesions of the Cortex of the Brain and Subjacent White Matter (mostly Cortical 
Lesions).-Sixteen Cases (Arranged in the Order of their Value for Studying the Localization of the Visual Centre). 
No. 
Author. 
Sex. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
I 
Chaillou, 
1863. 
F. 
69 
(?) 
Lateral H. 
Side not stated ; 
most probably 
on left side, 
corresponding 
with hemianaes- 
thesia observed 
Atrophy of gyri at 
the end of left (?) fiss. 
of Sylvius and of inner 
face of occipital lobe ; 
white matter of occip. 
lobe much atrophied. 
Disorder of speech 
followed by coma. Re- 
covery with imperfect 
V. and weakness of r. 
arm. Previous to ad- 
mission patient had had 
a similar " congestive " 
attack, leaving left 
hemianaesthesia. Hemi- 
anopsia older still. 
Death in a third attack. 
Small patches of soft- 
ening in left (?) thala- 
mus. Inferior part of 
left corpus striatum 
contained a cavity 2 x 
5 cent. Right hem. of 
cerebellum in inf. as- 
pect contained a cavity 
(old patch of softening) 
3x1 cent. Oldest lesion 
was that in occip. lobe. 
Sides of brain 
probably rever- 
sed in autopsy. 
Lesion of occip. 
lobe and thala- 
mus must have 
been in right 
hemisphere. 
26 
Westphal, 
Case II., 
1882. 
M. 
38 
Central V. nor- 
mal. R. pupil 
trifle wider. 
Eye - muscles 
not stated. No 
lesion to oph- 
thalmoscope. 
R. Lateral 
H. discovered 
June, 1880. 
Nearly vertical 
line passes a 
little to left (?) 
of point of fixa- 
tion. 
Softening of gyrus 
angularis, of occipital 
lobe (much adhesion 
over cuneus and pre- 
cuneus). Optic nerves 
and chiasm normal. 
In June, 1879, alco- 
holic (?) convulsions, 
followed by delirium 
and imperfect speech. 
In august, awoke with 
r. hemiplegia (arm 
most) and complete 
loss of speech ; word- 
deafness and amnesic 
aphasia. Later, repeat- 
ed convulsions (clonic) 
on r. side. Slight r. 
sided anaesthesia and 
paresis ; great loss of 
muscular sense. 
Left hemisphere 
showed an extensive 
cortical softening, in- 
volving post - central 
as far as supra-marg. 
gyrus, the whole of 
parietal lobe, gyrus an- 
gularis, and nearly the 
whole of occipital lobe. 
Slight softening of cor- 
tex at junction of 2d 
and 3d temp. gyri. No 
central lesion. 
3a 
Stenger, 
Case VIII., 
1882. 
M. 
5a 
Special senses 
normal on ad- 
mission. 
L. lateral hemi- 
anopsia after 
left hemipare- 
sis. Persistent. 
Softening of white 
subst. of r. par. lobe 
interrupting fasciculus 
of Gratiolet. 
Admitted with de- 
ni e n t i a paralytica. 
Shortly after, convul- 
sions in left side of 
body, followed by 1. 
hemiparesis with numb- 
ness of 1. hand. Mus- 
cular sense much im- 
paired in 1. hand. Va- 
rying 1. hemiparesis. 
Death in general con- 
vulsions. 
Int. and ext. hydro- 
cephalus. Cortical soft- 
ening over right parie- 
tal and occipital lobes ; 
subjacent white subst., 
yellowish, and much 
atrophied. Right thala- 
mus smaller and softer 
than left. Int. aspect 
of occip. lobe not men- 
tioned. Right post, 
horn much distended. 
Degeneration 
from visual cor- 
tex along optic 
fasciculus to 
thalamus. 16 
E. C. SEGUIN. 
No. 
Author. 
Srx. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
7 
Forster 
M. 
- 
(?) 
At first, temp. 
The area of softening 
Repeated paralytic 
Embolus in left Syl- 
This case 
has 
and 
field of right 
caudad of the fissure of 
attacks on right side; 
vian artery ; softened 
been sometimes 
V ernicke, 
eve obscured 
Sylvius, including the 
inf. parietal lobule and 
aphasia. 
patch in cortex, includ- 
cited twice 
as 
1876. 
vertically al- 
ing inf. parietal lobule. 
separate 
ac- 
most to point of 
gyrus angularis, pene- 
gyrus angularis, and 
counts were 
fixation; the na- 
trated to the lateral 
frontal part of occip. 
published 
by 
sal field of left 
ventricle, probably in- 
lobe ; numerous small 
W. and F. 
was darkened 
terrupting the optic 
necrotic foci in I. nu- 
also almost to 
fasciculus. 
deus lenticularis, nu- 
point of fixa- 
cleus caudatus, thala- 
tion. The left 
mus, and external cap- 
temp, field was 
sule. Insula, chiasma, 
also slightly 
and optic nerves 
contracted. 
normal. 
Later, a degree 
of left lateral 
hemianopsia 
was found, but 
the original lim- 
its of the right 
hemianopsia re- 
mained un 
changed. 
xo 
Jastrorvitz, 
M. 
(?) 
Transient pa- 
Right lateral 
Soft sarcoma of left 
Vertigo ; loss of mem- 
Thalami, lobi optici, 
Case I., 
ralysis of R. 
hemianopsia 
occipital lobe, involv- 
ory, of energy ; general 
tractus, chiasma, and 
1877. 
N.VI. Papillae 
normal ; V. re- 
latively good ; 
(Hirschberg). 
ing occip. gyri and 
weakness ; amnesic and 
nervi optici presented 
precuneus. It extended 
ataxic aphasia, alexia, 
no alterations. 
in conical form toward 
and agraphia. Right 
fixation pos- 
the post, horn of lateral 
hemiplegia appeared 
sible. 
ventricle as far laterad 
as Gratiolet's fasciculus 
later ; paralysis of vari- 
able intensity. 
which presented a 
slight discoloration and 
punctate hemorrhages 
as far as the thalamus. 
18 
Cursch- 
M. 
50 
(?) 
Left lateral 
Large focus of soft- 
Drank sulphuric acid 
Usual lesions of aeso- 
mann, 
H., which per- 
sisted from 10th 
ening in right occipital 
with usual local effects. 
phagus, etc. An ex- 
'879. 
lobe, extending to the 
There occurred, on 10th 
tension of inflam, to 
to ifith day 
surface,especially on its 
day, embolism of right 
inner coat of aorta. 
(death). 
caudal and mesal parts. 
brachial artery. A few 
days later, patient com- 
plained that he could 
Complete embolism of 
right brachial artery. 
not see well with his 
left eye. No other 
symptom of local dis- 
ease in brain. Death, 
of inanition, on i6tb 
day. 
TABLE VI.-Continued. HEMIANOPSIA. 
17 
No. 
Author. 
Sex. 
Age. 
F UNDUS, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
ii 
Jastrowitz, 
Case IL, 
1877- 
(?) 
(?) 
(?) 
Limitation of 
visual fields to 
the right. 
Large patch of soft- 
ening in left occipital 
lobe. 
Aphasia. 
Partial embolism of 
left internal carotid 
artery. 
'7 
Nothnagel, 
1879. 
M. 
51 
(?) 
Partial right 
lateral H. ; 
shortly before 
death, total 
blindness. 
In left hemisphere 
(besides several small 
lesions) there was a yel- 
lowish-red softening of 
the entire occipital 
lobe. Chiasma, optic 
tracts, and nerves nor- 
mal. 
Patient awoke with 
paralysis of left arm 
and obscurity of vision. 
There was monoplegia 
of left arm ; no anaes- 
thesia. Death by in- 
anition. 
Carcinoma of pan- 
creas, with various sec- 
ondary deposits. En- 
docarditis aortica ver- 
rucosa. Numerous 
spots of embolic soften- 
ing in brain. In r. 
hem. a patch in middle 
of precentral and post- 
central gyri, softening 
of caudal extremity of 
sup. parietal lobule, 
with extension into in- 
terparietal fissure, and 
into white substance 
to ventricle. Small 
patches in r. occipital 
lobe. 
'7 
Marchand, 
1882. 
Richter, 
Case II., 
1885. 
M. 
M. 
72 
70 
(?) 
After H. there 
occurred con- 
junctivitis, ker- 
atitis, cataract ; 
phthisis of left 
eye. 
Left lateral H. 
- " complete." 
(Dr. Pepmtiller) 
Complete left 
lateral H. De- 
fect persisted in 
right eye. 
Patch of softening 
in right occipital lobe ; 
pia adherent; apex of 
occip. lobe occupied by 
a necrotic patch as large 
as a hazel-nut, separat- 
ed from deeper parts of 
brain by a softened yel- 
lowish zone about .5 
cent, thick. 
Patch of softening in 
right occipital lobe. 
Sudden left hemiple- 
gia. Death in a few 
months. No details as 
to motor and sensory 
symptoms. 
Senile dementia. 
Gyri adjacent to oc- 
cipital in same condition 
of yellowish softening. 
Arteries tortuous and 
thickened. 
43 
Richter 
Case III., 
1885. 
M. 
48 
L. pupil re- 
acts well; right 
very slightly. 
Left 
normal; right, 
atrophied. 
Left Lateral 
H. 
Patch of softening in 
right occipital lobe. 
Syphilis in 1865. Since 
1880, repeated apoplec- 
tic attacks, accompa- 
nied by temporary r. 
hemiplegia and aphasia. 
In 1882, 1. hemiplegia 
and hemianopsia. De- 
mentia. 
Small psammoma in 
r. optic nerve. Patch 
of softening in 1. island 
of Reil. 
* % 
TABLE VI.-Continued. 18 
£. C. SEGUIN. 
No. 
Author. 
Sex. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
44 
Richter, 
Case IV., 
1885. 
M. 
4° 
Pupils react 
well. Fundus 
normal. Mus- 
cles normal. 
Shortly before 
death, no oph- 
thalm 0 s c 0 p i c 
changes. 
Left lateral H. 
suddenly de- 
veloped in hos- 
pital. Limit to 
left of fixation 
point. 
Firm adhesion of pia 
to occipital gyri, also 
over cuneus, and lower 
temporal gyri. Tip of 
occip. lobe least injured. 
Granular bodies found 
in white substance of 
occip. lobe, from cu- 
neus and gyrus hippo- 
campi, and from in- 
ferior temporal gyri, 
along outer wall of 
ventricle, in a tract 
which can be followed 
to atrophied pulvinar. 
No atrophy of tractus 
or optic nerves. 
Syphilis in 1861. Epi- 
leptiform attack, men- 
tal failure, staggering 
gait, weak legs, tongue 
tremulous, speech 
thick. Hallucination of 
V. Death from epilep- 
toid seizures. 
Basal nerves normal. 
In various places, opa- 
city and thickening of 
pia. 
45 
Seguin, 
1885. 
M. 
46 
Pupils and 
fundus normal. 
Central vision 
good with glas- 
ses for presby- 
opia (Dr. C. R. 
Agnew). 
Sudden attack 
of left lateral H. 
persisting till 
death. Vertical 
line passing a 
little to left of 
point of fixa- 
tion. Was able 
to read and 
write. Always 
complained 
that his left eye 
alone was af- 
fected. 
Patch of old soften- 
ing involving almost 
the whole of the right 
cuneus, not quite reach- 
ing apex of lobe, in- 
cluding a part of the 
gyrus hippocampi, the 
fifth temporal, and en- 
croaching on the fourth 
temporal gyrus. No 
other lesion. (?) 
Mitral regurgitation, 
enlargement of the 
heart, various peripher- 
al embolisms, pseudo- 
intermittent fever. No 
hemiplegia or anaes- 
thesia. Slight ataxia of 
left hand. Death six 
months after hemian- 
opsia appeared. 
Verrucose disease of 
mitral valve, tissue 
containing balls of mi- 
crococci. Large in- 
farcts in kidneys and 
spleen. No other im- 
portant superficial les- 
ions on surface of brain. 
Chiasm, tracts, and 
nerves normal. 
The absence 
of hemiplegia, 
distinct anaes- 
thesia, and con- 
vulsions makes 
it almost certain 
that there were 
no gross lesions 
within the 
brain. Location 
of lesion cor- 
rectly diagnos- 
ticated during 
life. 
21 
Haab, 
1882. 
M. 
68 
Central vision 
= 1. Optic 
nerves present- 
ed " a senile 
grayish color." 
Left lateral H. 
Complaint of 
left eye only. 
Vertical line 
reaching quite 
(?) up to point 
of fixation. H. 
persisted till 
death. 
Caudal end of right 
hemisphere .5 cent, 
shorter than its fellow. 
Patch of softening 
(cavity and debris] 
mostly on mesal aspect 
of occip. lobe, includ- 
ing apex. It involves 
the cuneus in its inferior 
half, the fifth temporal 
gyrus, and fissura hip- 
pocampi. White sub- 
stance destroyed as far 
as ventricle. 
Endo- and peri-cardi- 
tis, sudden attack of 
left hemiparesis rapid- 
ly passing away almost 
wholly. No hemianaes- 
thesia. Death in two 
years. 
No other cerebral 
lesion. Optic nerves, 
chiasm, and tracts nor- 
mal (microscopic ex- 
amination). 
D iagno sis 
during life ; 
embolism of 
artery supply- 
ing hinder part 
of right thala- 
mus. 
TABLE VI.-Continued. HEMIANOPSIA. 
19 
No. 
Author. 
Sex. 
Age. 
Fundus, 
Pupils, etc. 
Hemianopsia. 
Related Lesion. 
Other Symptoms. 
Other Lesions. 
Remarks. 
4i 
F6r6, 
1885. 
F. 
52 
Ophthalmo- 
scope showed 
no lesions. Pu- 
pils not men- 
tioned. 
Right lateral 
H. Vertical 
line passing 
through point 
of fixation. 
Yellow patch destroy- 
ing the greater part 
of the left cuneus, and 
encroaching somewhat 
on fifth temporal gyrus. 
No secondary degen- 
eration. 
Nov. 2, 1883, slight 
and transient attack of 
right hemiplegia. On 
admission to Salpfi- 
tridre, no motor symp- 
toms, but slight r. hemi- 
anaesthesia to pain and 
cold. Hearing, taste, 
and smell normal. 
No other cerebral 
lesions. 
Lobi optici, 
tractus, chiasm, 
and nerves nor- 
mal. 
*9 
Huguenin, 
1882. 
F. 
8 
At first visit, 
April 16th, vi- 
sion and hear- 
ing'good. Op- 
tic nerves nor- 
mal. On 27th, 
slight optic 
neuritis. 
Left lateral H. 
discovered on 
May 20th. 
A caseous tumor. 3 
x 3 x 2.5 cent, lay on the 
mesal aspect of the 
right occipital lobe; 
partly embedded in the 
brain, firmly adherent 
to pia. It was over the 
fissura hippocampi, ex- 
tending above and be- 
low it, and into the 
cuneus. 
Pertussis followed by 
slow mental action and 
ill-health ; a few months 
later, headache in par- 
oxysms, vomiting ; re- 
curring convulsions ; 
increasing dementia. 
Death of broncho- 
pneumonia ; never 
localized paralysis, or 
anaesthesia. 
A small tumor on the 
the apex of the right 
frontal lobe. Epen- 
dyma of ventricles 
granular ; pia over 
chiasm, and in both 
fossae Sylvii, slightly 
thickened. 
TABLE VI.-Continued. 20 
E. C. SEGUIN. 
and Thomson, I have the additional information that a few days 
ago the hemianopsia was found unchanged, twenty-three years 
after the reception of the injury. I made an examination of the 
patient, Hughes, this morning, with the following results : 
He presents no distinct paralysis or anaesthesia, or aphasic 
symptoms. His tongue deviates a trifle to the right, and the grasp 
of the right hand is a little less than that of the left. Dynamome- 
ter test : L, 38, 34 ; R, 35, 34. The knee-jerk is abnormally 
great on both sides, but equally so. 
Tests reveal no anaesthesia, but the patient thinks that his tactile 
sensibility is very slightly dull on the right side of head and in 
right hand. The muscular sense, tested by knowledge of passive 
movements of fingers, and by different weights laid in both hands, 
while the patient's eyes are closed, is normal. 
He habitually uses the left hand more than the right, but this is 
on account of his loss of vision on the right. 
He adds that when under the influence of liquor his right leg 
and arm feel the effects first and most. 
Only one epileptiform seizure is known to have occurred, viz.: 
an attack in the night, about six years ago. He claims that his 
memory is now good. It was formerly weak, but he never, ap- 
parently, had amnesia of words. 
The scalp presents two cicatrices ; that of entrance very small, 
that of exit of the ball enormous and greatly depressed. The 
following are some topographic measurements with the head 
placed so as to have the skull resting on the alveolo-condyloid 
plane of Broca. 
The entrance wound is in the median line, about 3.5 cent, above 
the external occipital protuberance. From the bregma along the 
median line to this cicatrix is 15.5 cent. 
The exit scar is a large cup-shaped depression situated dorso- 
laterad of the other, near the parietal eminence. Its frontal 
edge is 6.5 cent, from the bregma ; its mesal edge nearly at the 
median line (.5 cent, distant) ; and its fronto-lateral edge is 12.75 
cent, from the left tragus. Its transverse diameter is 5 cent., its 
longitudinal diameter 6.5 cent. Its depth is 1.5 cent. The bridge 
of bone between the two scars is only 3 cent, broad. 
The bottom of the exit scar is very firm though not bony, and 
the patient is not affected by reasonable manipulation. 
A rough test with a small white object at 18 inches shows right 
lateral hemianopsia, with line passing outside of point of fixation ; 
there is besides a darkened area in the left upper temporal quad- 
rant. 
Dr. G. W. Hale, House Surgeon of the Manhattan Eye 
and Ear Hospital, has very kindly made an examination of 
H.'s eyes, and made diagrams of his visual fields. He finds 
the following: HEMIANOPSIA. 
21 
R = H : -H w. - ; ax. 90° : 
L = 2V<r: 7$ w- - > ax- 9°° : 
R reads No. 14 J at 12" w. -|- No. 1 J at 8" : 
L reads No. 14 J at 12" w. Noz 6 J at 8" : 
Pupillary reaction, normal. 
Eye muscles : no insufficiency either at 20' or 1'. 
Fundus : blood-vessels of normal size ; outer temporal quad- 
rant of either disk whiter than normal, left a little whiter than 
right. No other lesions. 
Fig. i.-The probable course of the minie ball through the brain in case 3 
(Keen and Thomson) is indicated by the club-shaped shaded figure in the occi- 
pital part of the head, extending across lines 2 and B. 
By the kindness of Drs. Peabody and Ferguson 1 have 
had the opportunity of repeating the injury upon the 
cadaver at the New York Hospital. Trephine openings 
were made in the cranium of a male subject at points cor- 
responding with the author's measurement of H.'s cicatrices, 
and an iron rod pushed through, followed by a large seton 
of jute. The hemisphere was placed in alcohol for harden- 22 
E. C. SEGUIN. 
ing. It was then found that the track of the ball was entirely 
dorsad of the occipital, through the parietal lobe almost to 
the confines of the postcentral gyrus. Its penetration was 
such, however, that it must have injured the optic fasciculus 
on its way to the cuneus. See fig. 1. 
Case 28.-Haab : male, set sixty-eight years. In Feb., 1878, 
while under treatment for endo- and peri-carditis, experienced an 
attack of paresis of the left extremities. This rapidly passed away, 
leaving a certain degree of disability, for after working with the 
left hand patient experienced pain in the left arm, and palpita- 
tion. 
When seen by Haab in July the patient complained that he 
Fig. 2.-Mesal aspect of right hemisphere (Ecker) showing patch of soften- 
ing in case 28 (Haab). 
could not see to his left with his left eye-thought his right eye 
was normal. Examination showed only a trace of paresis 
or awkwardness in left extremities; no anaesthesia. Intel- 
ligence normal. Hearing good. Central vision = i (H. 2). 
There was left homonymous hemianopsia, the limit reaching 
quite (?) up to the fixation point. In right fields color-percep- 
tion good. 
Optic nerves present a "senile grayish color." 
During the year several re-examinations gave the same results. 
The patient insisted that there was a veil or cloud over the left 
eye. Death in July, 1879. HEMIANOPSIA. 
23 
Autopsy.-The caudal end of the right hemisphere was .5 
mm. shorter than its fellow. There was a depression in right# 
occipital lobe, the pia hanging loosely over a cavity containing 
clear fluid. The patch was mostly upon the mesal aspect of 
the hemisphere (including apex). It occupied the site of the 
fissura hippocampi, and extended beyond it above and below. 
The frontal end of the cyst was at six cent, from the apex of 
the lobe. The white substance was but slightly injured, and 
there was no communication between the cyst and the poste- 
rior horn of the ventricle. The vertical height of the 
patch was 2-3 cent. 
No other cerebral lesion. The optic nerves, chiasm, and 
tractus were normal to a microscopic examination. Haab's 
diagnosis during life was embolism of an artery supplying 
the hinder part of right thalamus opticus. 
Case 29.-Huguenin. A girl, aet. eight years. In autumn of 
1878 whooping-cough, followed by ill-health and sluggish mental 
action. In January, 1879, headache in paroxysms ; later, frequent 
vomiting, sleep broken ; no motor or ocular symptoms. At end 
of March severe convulsions, which have frequently recurred, con- 
stituting the principal phenomenon. Increasing dementia. Seen 
by Huguenin, 16th April, 1879. Child demented ; understands 
what is said, and, according to parents, replies well ; memory 
feeble ; general muscular weakness, but no localized paralysis. 
Vision and hearing good. Seems sensitive to pinching, etc. 
Optic nerves normal. 
Temporary improvement under Ki. and syr. ferri iodidi. 
April 27th, second ophthal. exam. Slight neuritis with some 
swelling (no " stauung ") Headaches. In middle of May it was 
noticed that patient held her head obliquely to the left. Exam, 
on 20th revealed left homonymous hemianopsia. This symptom 
was the only one indicating a focal lesion of the brain, and it 
persisted. Death in June, of broncho-pneumonia. 
Autopsy.-Two tumors were found in the brain ; one at 
the apex of the left frontal lobe, the other near the apex 
of the right occipital lobe. Ependyma of ventricles granu- 
lar; slight thickening of pia over chiasma and in both fossae 
Sylvii. 
The second tumor lay in the mesal aspect of the right oc- 
cipital lobe, projecting a few mm. above the level of the 
brain, firmly adherent to the pia and only slightly to the 24 
E. C. SEGUIN. 
dura. Its length was 3 cent., height 3 cent., thickness 2.5 
cent.-mostly buried in brain substance. It lay directly 
over the sulcus hippocampi, extending to either side of 
it. Basis of occip. lobe not involved. Tumors caseous. 
Fig. 3.-A. Tumor in mesal aspect of right occipital lobe : left lateral 
hemianopsia. B. Diagram of horizontal section, showing the slight penetration 
of the tumor. Case 29 (Huguenin). 
Case 41.-F6re. Female, aet. fifty-two. In November, 188?, 
sudden apoplectic attack followed by transient right hemiplegia. 
On admission to the Salpetriere, no motor symptoms. Partial and 
slight right hemianaesthesia to cold and pain. Hearing, taste, and 
smell normal. Typical right lateral hemianopsia, vertical line HEMIANOPSIA. 
25 
passing through point of fixation. No ophthalmoscopic lesions ; 
state of pupils not mentioned. 
Death Dec. 24, 1884. Autopsy showed only a yellow patch de- 
stroying the greater part of the left cuneus and encroaching 
somewhat on the adjacent second temporal gyrus (gyr.- temp. 5 of 
Ecker). No secondary degeneration. Corpora geniculata, lobi 
optici, tractus, chiasm, and optic nerves normal. Gray commis- 
sure of 3d V. absent. 
Fig. 4.-Mesal aspect of left hemisphere (Ecker). Patch of softening caus- 
ing right lateral hemianopsia. Case 41 (Fere). 
Case 45.-Seguin. Mr. J. W. D., set. 46, consulted me on Janu- 
ary 18, 1884, for insomnia and dyspepsia. Wakefulness was most 
marked in early morning. Has grown paler, weaker, and thinner 
of late. Denies dyspnoea. Examination showed general anaemia, 
feeble, slow pulse (63 to 66 beats per minute). Heart feeble, with 
a distinct, harsh, mitral regurgitant murmur. There were pulsations 
in the external jugular veins. Urine normal, though of high spe- 
cific gravity. 
Under digitalis, cannabis indica, nux vomica, and arsenic, in 
various combinations, and a much more nutritious diet, with a 
glass of rich claret at his meals, a good recovery was obtained in 
about six weeks. Sleep was sound ; the patient had regained 
weight and color. 
November 26, 1884, I was sent for to visit him at his home. I 
learned that in the spring he had travelled south as far as Havana, 
and returned in excellent health, to all appearances. He was then, 
and for the succeeding three or four months, much overworked, 
and especially worried about his business, which was far from 26 
E. C. SEGUIN. 
prosperous. He had given up his claret, and, most unfortunately, 
purchased and used quite actively a rather strong home-gymna- 
sium. His house was situated at the top of one of our hilliest 
streets, and this he climbed rapidly every day. 
I found him suffering apparently from regular intermittent fever; 
severe chills followed by high fever and sweating. He had been 
severely purged, and was quite weak. His heart was larger than 
when first seen, and the mitral murmur was much louder and 
more diffused. He was given quinine and nutritious food. 
A few days thereafter, about December 5th, I was sent for in 
haste, because of an attack of a nervous nature. I found Mr. D. 
considerably alarmed, but rational, and free from serious symptoms. 
He complained of numbness in the whole left side, cheek, arm, 
leg, and trunk ; most marked in the hand and foot. There was 
no distinct hemiplegia, and no anaesthesia to ordinary tests ; he 
thought, however, that tactile sensibility, as tested by passing his 
fingers over objects, was somewhat duller. He was most con- 
cerned, however, about another symptom, which he stated as a 
■" blindness of the left eye." He could not, he said, see objects on 
his left without turning his head and eyes. Testing by means of 
a small bright object in the usual way, revealed typical left lateral 
hemianopsia, with a vertical division line not including the points 
of fixation. Central vision was as good as ever, as tested by 
newspaper type. Dr. C. R. Agnew was asked to see the patient 
the next day, and the following is a copy of his report of the con- 
dition of the patient's eyes : 
" My dear Doctor : I have examined Mr. D.'s eyes. He has 
left hemiopia, as you say. He has opaque nerve fibres in nasal 
half of left optic disk, extending off a little distance into the fun- 
dus, which is physiological. He has a few punctate changes in 
the pigment layer of retina in both eyes, chiefly the left. I do not 
'think that these things have any thing to do with the eye trouble- 
that is central, as you say. I agree with you in all you say, and 
have nothing to suggest in the way of topical treatment. 
" Yours faithfully, C. R. Agnew." 
My diagnosis at the time was embolism of a branch of the pos- 
terior central artery supplying the meso-caudal part of the right 
occipital lobe. 
Mr. D.'s illness lasted, with most remarkable symptoms and ex- 
traordinary remissions, until May 17, 1885, when he died. 
The chief features of this long sickness may be summarized as 
follows : 
In December he had a violent attack of acute hallucinatory 
mania (both aural and visual hallucinations), due probably to cere- 
bral anaemia. Under large doses of chloral, digitalis, and most 
persistent feeding with large quantities of milk and eggs, this 
subsided. 
In February Mr. D. was able to go to Nassau, N. P. While 
-there the severe chills, high fever, and sweats returned, and HEMIANOPSIA. 
27 
proved rebellious to large doses of quinine. These chills fol- 
lowed no distinct type of periodicity ; they occurred twice a day, 
every second day or daily. 
He returned to New York April 5th, and to the last, recurring 
febrile paroxysms usually clearly intermittent, were prominent fea- 
tures of the case. His general condition was better, but the heart 
was larger and presented an extremely loud and diffused mitral 
regurgitant murmur. During the month several attacks of visceral 
and peripheral embolism occurred, characterized by haematuria, 
splenic pain, and enlargement, a few discolored patches under 
the skin. 
[In the preceding November, shortly after the hemianopsia, he 
one day complained of pain and swelling of the right palm, fol- 
lowed by a turgid condition of the whole hand for several days ; 
probably embolism of a part of the palmar arch.] 
These embolisms were all recognized at the time as dependent 
upon the mitral disease, and it finally occurred to me that the in- 
tractable, irregular intermittent fever might also be of cardiac 
origin, each attack due to the detachment of microscopic particles 
of the diseased valves. 
Dr. William H. Draper was called in consultation May 8th, and 
made the formal diagnosis of ulcerative or malignant endocarditis. 
Previous to death, for a period of about a fortnight, the patient's 
speech was sometimes difficult to understand ; his articulation 
was defective, partly from extreme general debility, but also 
from some want of power in the buccal muscles. The hands both 
showed disorders of movements, choreiform tremors, and in the 
left hand slight ataxia in larger motions. 
Often Mr. D. complained of numbness and coldness of the left 
hand. 
At no time was there distinct hemiplegia or monoplegia, and 
repeated tests of sensibility showed it to be nearly if not quite 
normal, so that I was of the opinion that no emboli of any size 
had reached the brain since the attack in November. Several 
tests were made of the hemianopsia, one a few days before death. 
It persisted to the last unchanged, as judged by rough measure- 
ment, and vision remained good. The patient always insisted that 
his left eye was weak (a statement made by other hemianopsic 
patients). He was able to read and write easily until a few weeks 
before death, when increasing debility confined him to his bed. 
The autopsy was made with the assistance of Dr. W. R. Bird- 
sall, on the evening of the fatal issue, May 17th. The spleen and 
kidneys contained several infarcts of various ages, some very 
large, and looking like hemorrhagic foci. 
The heart was much enlarged ; the mitral valves deformed and 
bearing enormous rough vegetations, one almost polypoid. Sections 
through some of these vegetations, stained by Gram's method, 
showed under the microscope globular nests of micrococci and 
separate colonies of bacteria. The aortic valves and aorta were 
normal. 28 
E. C. SEGUIN. 
The brain was generally anaemic. The basal vessels and middle 
cerebral arteries free from emboli and thrombi. The vbasal 
nerves, the optic tracts, and the chiasm were most carefully exam- 
ined and found normal. On the right lateral aspect of the pons, 
caudad of the IVth nerve, a small branch of the basilar artery con- 
tained a firm thrombus of dark red color about 4 mm. in length ; 
the vessel supplied the velum medullare anteiius. The left 
hemisphere presented a small area of extreme congestion and 
ecchymosis over the folds of the second frontal gyrus ; there was- 
another patch at the foot of this gyrus extending toward the 
orbital gyri. 
The right hemisphere had a similar superficial recent lesion 
(ecchymosis) at the vertex, extending over the dorsal extremity 
of the fissure of Rolando. 
Fig. 5.-Mesal aspect of right hemisphere (Ecker). Patch of softening 
causing left lateral hemianopsia. Case 45 (Seguin). 
Viewing the brain from above, the occipital extremity of the 
right hemisphere appears thinner than its homologue. This is 
found to be due to the destruction of the mesal surface of the 
right occipital lobe by a large focus of yellow softening, evidently 
an old patch. The lesion involves the basal part of the cuneus,, 
the fourth and fifth temporal gyri (Ecker), and a part of the gyrus 
hippocampi. The destruction does not quite attain the tip of the 
occipital lobe. 
The remaining gyri of both hemispheres were normal. 
I would add that the above records of the appearance of the 
brain were made at the time of examination by our President, Dr. 
Birdsall, and me. HEMIANOPSIA. 
29 
Most unfortunately, the brain was not cut at once. The left 
hemisphere was separated, leaving the " stamm " attached to the 
right hemisphere, and these were placed in bichromate of potassium, 
with the intention of making a series of sections after'complete 
hardening. 
Through mishaps the process of hardening was not very suc- 
cessful, and the right hemisphere particularly suffered from too 
prolonged pressure upon its temporal lobe, which disintegrated. 
The result is that I can only show you to-night the occipital half 
of the right hemisphere with the patch, which I consider the 
essential and truly causal lesion of the hemianopsia. The 
destruction of tissue extends only a few mm. into the subjacent 
white substance. The state of the internal capsule, thalami, 
etc., remains unknown, owing to the misfortune in preserving the 
specimens. From the history of the case, however, judging from 
the absence of hemiplegia and marked anaesthesia, it may be safely 
assumed, in the light of our present pathological knowledge, that 
there were no lesions, or at least no tangible lesions, in the cen- 
tral parts of the brain. 
That the destruction of the right cuneus and fifth temporal 
gyrus was the cause of the left lateral hemianopsia during life, 
I have not a shadow of a doubt. 
The softening was produced by embolism of the third branch 
of the posterior cerebral artery, the occipital artery of Duret. 
The objections which may be presented against the value 
of my case, in consequence of its imperfect anatomical in- 
vestigation, are greatly reduced in force by the considera- 
tion that the case is one in harmony with many others. 
Were it a contradictory or anomalous case, it would certainly 
possess much less value. 
Now, gentlemen, what conclusion may reasonably be 
drawn from all these cases? 
1. That lesions in the mesal aspect of the temporal lobes, 
or even in other basal districts of the hemispheres, may 
give rise to hemianopsia indirectly by pressing upon the 
primary optic centres or upon the tractus optici and chiasm. 
2. That lesions of the corpus geniculatum laterale, pul- 
vinar, and latero-caudal parts of the thalamus may cause 
hemianopsia; usually in association with hemianaesthesia and 
hemiplegia, or hemianaesthesia alone. 
3. That a lesion of the white substance of the occipital 
lobe, in the caudal radiations of the internal capsule, may 
•cause hemianopsia alone, or with hemianaesthesia. 30 
E. C. SEGUIN. 
4. That lesions of the supra-marginal gyrus, angular 
gyrus, and inferior parietal lobule with the subjacent white 
substance may cause hemianopsia-with or without other 
symptoms (hemiplegia, loss of muscular sense, word-deaf- 
ness, etc.). ? 
5. That a lesion of greater extent, involving the speech 
centre, the motor convolutions, and the parts enumerated 
above (4), due usually to embolism or thrombosis of the 
entire Sylvian artery, will, when existing on the left side, 
produce aphasia, alexia, hemianopsia, and hemiplegia. 
6. That lesions of the occipital lobe, cortex, and subjacent 
white matter produce blindness when bilateral, and hemi- 
anopsia when unilateral. This conclusion is in accord with 
Exner's (1881). 
7. That a lesion of the cuneus and adjacent 5th temporal 
gyrus (Ecker) on one side produces lateral hemianopsia of the 
opposite side. 
In support of this last conclusion I would again invite 
your attention to the cases 28, 29, 41, and 45. 
I have endeavored to fuse the diagrams of the sixteen 
cases with occipital lesions (exclusive of the traumatic ones) 
on one chart, by the successive application of layers of 
India ink. The larger lesions were first indicated on the out- 
line diagram, and the most limited lesions washed last. I 
was somewhat hindered by the " running " of the black in the 
lines indicating gyri, yet I think that the maximum color 
due to the superposition of the greatest number of layers is 
over the cuneus, and next to the occipital apex, as a whole. 
This is a simplification of one of Exner's methods, and I 
think may, with some improvements, be made serviceable 
for clinical teaching. [The diagram was shown at the time 
of reading the paper.] 
Let us now turn to the physiological and theoretical as- 
pect of our subject. My time is limited, and I can only treat 
this highly important matter in a most summary way. 
What do the most modern physiological researches teach 
us upon this question of the location of the cortical visual 
centre and its white connecting fasciculi? 
The views of Munk and Ferrier are the authoritative ones.. HEMIANOPSIA. 
31 
The former physiologist has persistently taught that the 
visual areas, or centres for psychic vision, are in the occipi- 
tal lobes, and that each visual area has connections with both 
retinae. He invariably produced hemianopsia in dogs by 
destruction of one occipital lobe. These experimental re- 
sults have been verified by Ganser, von Gudden's assistant, 
upon kittens. 
Ferrier's theory, supported, as he believed, by experi- 
ments upon monkeys, has received an apparent verification 
at the hands of Prof. John C. Dalton.1 Ferrier thought 
that the visual centre was in the angular gyrus. The fol- 
lowing are his most recent conclusions, as presented to the 
Royal Society, and published in its Proceedings, xxxv., p. 
229, and abstracted in Brain, April, 1884. 
1. Lesions of the occipito-angular region (occipital lobes 
and angular gyrus) cause affections of vision without affec- 
tion of the other sensory faculties or motor powers. 
2. The only lesion which causes complete and permanent 
loss of vision in both eyes is total destruction of the occipi- 
tal lobes and angular gyri on both sides. 
3. Complete extirpation of both angular gyri causes for a 
time total blindness, succeeded by lasting visual defect in 
both eyes. 
4. Unilateral destruction of the cortex of the angular 
gyrus causes temporary abolition or impairment of vision in 
the opposite eye-not of a hemiopic character. 
5. Deep incisions may be made in both occipital lobes at 
the same time, or the greater portion of one or both occipi- 
tal lobes at the same time may be removed without any 
appreciable impairment of vision. 
6. Destruction of the occipital lobe and angular gyrus on* 
one side causes temporary amblyopia of the opposite eye 
and homonymous hemianopia of both eyes toward the side 
opposite the lesion. 
7. As in none of the cases recorded, either of partial uni- 
lateral or bilateral destruction of the occipito-angular region, 
were the amblyopic or hemianopic symptoms permanent, 
it is concluded that vision is possible with both eyes if only 
portions of the visual centres remain intact on both sides. 
1 John C. Dalton, in New York Medical Record, Oct. 26, 1881. 32 
E. C. SEGUIN. 
It will be seen that the results of our pathological analysis 
are seemingly favorable to both the theories of Munk and of 
Ferrier. But, on the one hand, the most conclusive cases, 
i. e., those with the most limited cortical lesions, are wholly 
opposed to Ferrier's views and in favor of Munk's; and, on 
the other hand, a peculiarity in the anatomy of the occipital 
extremity of the brain goes to explain Ferrier's results with- 
out assuming the existence of a cortical visual centre in the 
angular gyrus. It is this : that the optic fasciculus of Gra- 
tiolet and Wernicke, on its way from the caudo-lateral as- 
pects of the thalamus, in the internal capsule, passing out 
caudad, lies latero-dorsad of the posterior horn of the 
lateral venticle, and close under the inferior parietal lobule 
and the angular gyrus, on its way to the occipital lobe 
(cuneus chiefly). A lesion of the angular gyrus, the supra- 
marginal gyrus, and even of the inferior parietal lobule, is 
almost certain to involve this optic fasciculus, and thus cut 
the communication between the visual centre and the eyes. 
I pass around a specimen in which, on a horizontal longi- 
tudinal section of the human brain hardened in bichromate 
of potassium, the optic fasciculus is plainly visible as a homo- 
geneous whitish band. It is evident that lesions in the an- 
gular gyrus and supra-marginal gyrus could easily penetrate 
deeply enough to injure this fasciculus. 
It seems to me that with this anatomical knowledge the 
discrepancies between Ferrier and Munk's results disappear 
in part, and that some of the cases of my sixth category 
(cases 26, 32) are reconciled with the others. 
Next, as to the various purely hypothetical or clinical theo- 
ries of the course of the optic paths. Of these the best known 
is that of Prof. Charcot. His well-known diagram of the 
course of the optic fibres from the retina to the visual centres 
represents a second decussation of the fasciculi laterales 
through the corpora quadrigemina (lobi optici) on their way 
to the internal capsule, so that finally each internal capsule 
contains all the fibres for the opposite eye. This diagram 
was made to explain and support Charcot's theory of the 
production of amblyopia of one eye by lesion of the occipital 
lobe and the internal capsule of the opposite side. He HEMIANOPSIA. 
33 
thought that he had observed that amblyopia of one eye, 
and not hemianopsia, was the companion of hemianaesthesia 
produced by lesion of the internal capsule. 
I regret to say that my illustrious master's theory has not 
been supported by either clinical observations or by post- 
mortem results. I know of but one case with a post-mortem 
examination which is in favor of Charcot's view,1 while the 
sixteen cases I have read to you speak emphatically against 
it. Indeed, there is reason to believe that Prof. Charcot has 
never attached much value to his diagram, and I under- 
stand that he has already abandoned it, yielding, as he is 
ever ready to do, any theoretical views of his own to oppos- 
ing pathological facts. 
Grasset has recently (1883) offered a modification of 
Charcot's diagram, which is extravagant. He would have 
still a third decussation (counting the chiasmic as the first) 
somewhere in the callosal fibres, so that after the fibres for 
one whole retina, according to Charcot's schema, have passed 
a certain distance in the internal capsule, the fibres of the 
fasciculus lateralis again cross the median line, so that the 
visual centre receives fibres from both retinae. This far- 
fetched attempt to reconcile Charcot's opinion as to the 
effect of lesion of one internal capsule in its caudal division, 
with the well-established results of lesions of the occipital 
lobes, is hardly deserving of serious criticism ; but it may be 
as well to state that more recent (1884)' experiments by W. 
Bechterew show that in dogs at least section of the posterior 
part of the internal capsule produces lateral hemianopsia- 
a result in full harmony with some of our human cases. 
From his latest pathological observations von Monakow ' 
draws the following conclusions as to the course of the 
central optic fasciculi in man : 
" The collective optical bundle forms a- solid tractus in 
the sagittal white substance of the occipital part of the 
brain, which passes alongside of the corpus callosum fibres 
or tapetum, and ends in the cortex of the occipital gyri, 
1 Petrina, in Prager Zeitsch. f. Heilk., II., p. 595, case viii. Vide Table I. 
9 W. Bechterew: Ueber die nach Durchschneidung der Sehnervenfasem im 
innere der Grosshirnhemispharen, etc. Neurol. Centralbl., 1884, No. I. 
* Westphal's Archiv f. Psychiatric, xvi., 352, 34 
E. C. SEGUIN. 
more especially in that of the cuneus, lobus lingualis, and 
gyrus descendens." 
The diagram of optic paths which I offer you is, I believe, 
in agreement with Munk's view of the physiology of the 
visual centre, with what we know of the anatomy of the optic 
tracts by dissection and by secondary degeneration (Mon- 
akow), and lastly, best of all, with the results of now numer- 
ous post-mortem examinations. 
From the above data, pathological, anatomical, and ex- 
perimental, are we now in a position to induce diagnostic 
laws with reference to the symptom hemianopsia ? I think 
we are, and I would propose the following as a preliminary 
set of rules. 
1. Lateral hemianopsia always indicates an intra-cranial 
lesion on the opposite side from the dark fields. 
2. Lateral hemianopsia with pupillary immobility, optic 
neuritis or atrophy, especially if joined with symptoms of 
basal disease, is due to lesion of one optic tract, or of the 
primary optic centres on one side. 
This diagnosis may be further strengthened and rendered 
quite certain by seeking for and finding one-sided pupillary 
reaction, as recently suggested by Wernicke.1 He ingeni- 
ously predicts that only one lateral half of each iris will be 
found to contract by the reflex effect of light when one 
optic tract has been interrupted. He designates this as 
" hemiopic pupillary reaction." 
3. Lateral hemianopsia, or sector-like defects of the same 
geometric order, with hemianaesthesia and choreiform or 
ataxic movements of one half of the body without marked 
hemiplegia, is probably due to lesion of the caudo-lateral 
part of the thalamus, or of the caudal division of the internal 
capsule. 
4. Lateral hemianopsia, with complete hemiplegia (spastic 
after a few weeks) and hemianaesthesia, is probably caused 
by an extensive lesion of the internal capsule in its knee 
and caudal part. 
5. Lateral hemianopsia, with typical hemiplegia (spastic 
1 Wernicke : Ueber hemiopische Pupillenreaction. Fortschritte der Medicin, 
1883, i., 49-53, L r. r 
R. M._ F 
eV. O. S. 
r. c.s 
Al. 0. D 
F. L.D 
iT.O.D 
C G.L- 
P. O.C, 
R 0. 
C.P. 
F.O. 
G.A 
L.O.S 
L O.D 
Fig. 6.-Diagram of Visual Paths ; designed to illustrate specially Left Lateral 
Hemianopsia from any lesion. L. T. F., left temporal half-field. R. N. F., 
right nasal half-field. O. S., oculus sin. O. D., oculus dexter. N. T., nasal 
and temporal halves of retinae. N. O. S., nervus opticus sin. N. O. D., nervus 
opticus dext. F. C. S., fasciculus cruciatus sin. F. L. D., fasciculus lateralis 
dext. C., chiasma, or decussation of fasciculi cruciati. T. O. D., tractus op- 
ticus dext. C. G. L., corpus geniculatum laterale. L. O., lobi optici (corpus 
quad.). P. O. C., primary optic centres, including lobus opticus corp, genic, 
lat., and pulvinar of one side. F. O., fasciculus opticus (Gratiolet) in the in- 
ternalcapsule. C. P., cornu posterior. G. A., region of gyrus angularis. L. 
O. S., lobus occip. sin. L. O. D., lobus occip. dext. Cu., cuneus and sub- 
jacent gyri constituting the cortical visual centre in man. The heavy or shaded 
lines represent parts connected with the right halves of both retina. The reader 
may place the lesion as he pleases. 
35 36 
E. C. SEGUIN. 
after a few weeks), aphasia if the right side be paralyzed, 
and with little or no anaesthesia, is quite certainly due to an 
extensive superficial lesion in the area supplied by the 
middle cerebral artery ; we would expect to find (as in case 
26, by Westphal) softening of the motor zone and of the 
gyri lying at the extremity of the fissure of Sylvius, viz.: the 
inferior parietal lobule, the supra-marginal gyrus, and the gy- 
rus angularis. Embolism or thrombosis of the Sylvian artery 
would be the most likely pathological cause of the softening. 
6. Lateral hemianopsia with moderate loss of power in 
one half of the body, especially if associated with impair- 
ment of muscular sense, would probably be due to a lesion 
of the inferior parietal lobule and gyrus angularis, with their 
subjacent white substance, penetrating deeply enough to 
sever or compress the optic fasciculus on its way caudad to 
the visual centre. 
7. Lateral hemianopsia without motor, or common sensory 
symptoms, this symptom alone, is due, I believe, from the 
convincing evidence afforded by Cases 28, 29, 41, and 45, to 
lesion of the cuneus only, or of it and the gray matter im- 
mediately surrounding it on the mesal surface of the occipi- 
tal lobe, in the hemisphere opposite to the dark half-fields. 
Most surgical cases come at once, or after convalescence, 
within this rule or in No 6 (Case 3.) 
In all cases coming under rules 3 to 7 inclusive, the pupils 
react normally; and rarely does the ophthalmoscope show 
any lesion of the optic nerve, except, of course, in some 
tumor cases, when neuro-retinitis may be expected. 
A LIST OF CASES OF HEMIANOPSIA OF CENTRAL ORIGIN, 
WITH AUTOPSY, AND OF TRAUMATIC HEMIANOPSIA, 
TO OCTOBER 30, 1885, ARRANGED IN CHRONOLOGICAL 
ORDER. 
1, 1863. Chaillou. Societe anatomique, Feb., 1863. Bull, de la Sac. 
Anat., 1863, p. 71. 
2, 1866. Levick. Case of abscess of the brain. Trans, of the College of 
Physicians of Phila., March 7,1866. Am. Journal Med. Science, 1866, ii., p. 413. 
3, 1871. W. W. Keen and Wm. Thomson. Gunshot wound of the brain, 
followed by fungus cerebri, and recovery with hemiopia. Trans. Am. Oph- 
thal. Soc., 1871, p. 122. Also in " Medical and Surgical History of the War 
of the Rebellion," i., p. 206. HEMIANOPSIA. 
37 
4, i873- Hughes, J. S. Case of compound depressed fracture of the skull. 
Irish Hospital Gazette, July I, 1873 (abst. in Nagel's Jahresbericht uber Oph- 
thal., 1874, p. 440). ' , 
5, 1875. Hirschberg, J. Zur Semidecussation der Sehnervenfasern in 
Chiasma des Menschen. Virchow's Archiv, Ixv., p. 116. 
6, 1875. Jackson, J. H., and Gowers, W. R. I. A case of hemiopia, with 
hemianaesthesia and hemiplegia, by Dr. Jackson. Lancet, 1874. ii., 306. 
II. Autopsy on a case of hemiopia, etc., by Dr. Gowers. Lancet, 1875, i., 722. 
7, 1876. FSrster and Wernicke. Fbrster in " Graefe-Saemisch Hand- 
buch der gesammten Augenheilkunde," Bd. vii, p. 118. Also in Wernicke's 
" Die aphasische Symptomcomplex," p. 47. Berlin. 
8, 1876. Huguenin. Article " Chronic Abscess of the Brain," in Am. 
ed. of Ziemsseris Cyclop., xii., 796. 
9, 1877. Pooley, T. R. Right-sided binocular hemiopia, depending upon 
a gummy tumor in the left posterior lobe of the brain. Knapp's Archives of 
Ophthal., v., p. 148 ; ix., p. 83. 
10, 1877. Jastrowitz, M. Tumor im linken Hinterlappen, Aphasie, 
rechtsseitige Hemianopsie. Hirschbergs Centralbl. f. pract. Augenheilkunde, 
1877, p. 254. 
11, 1877. Jastrowitz. Case referred to briefly in his paper in Hirschberg's 
Centralbl. f. pract. Augenheilk., i., p. 256. 
12, 1877. Charcot et Pitres. Contributions a 1'etude des localizations 
dans L'ecorce des hemispheres cerebraux. Revue mensuelle de mid. et de chir., 
i., p. 372, obs. xxxiv. (1877). 
13, 1878. Baumgarten, Paul. Hemiopie nach Erkrankung der occipitalen 
Hirnrinde. Centralbl. f. Med. Wissensch., 1878, No. 21. 
14, 1878. Hosch, Fr. Zur Lehre von der Sehnervenkreuzung. Zehender's 
Monatsblatter f. Augenheilk., 1878, p. 281. 
15, 1879. Dmitrowsky and Lebeden. Hemianopsia dextra. Monoplegia 
facialis dextra. Haemorrhagia und Erweichung in der linken Hirnhalbkugel. 
Medicin. Bote, 1879, No. 46. (Abst. in Hirschberg's Centralbl., 1880, p. 84.) 
16, 1879. PflOger. Augenklinik in Bern. Bericht uber das Jahr 1878, 
P- 57- 
17,1879. Nothnagel. Topische Diagnostik der Gehirnkrankheiten. Ber- 
lin, 1879, p. 389. 
18, 1879. Curschmann. In Berliner Gesellschaft f. Psych, und Nerven- 
krankheiten, Juni g, 1879. Westphal's Archiv, xi., 822. 
19, 1880. Dreschfeld. Pathologische-anatomische Beitrage zur Lehre von 
der Semidecussation der Sehnervenfasern. Case ii. Hirschberg's Centralbl. f. 
pract. Augenheilkunde, 1880, p. 35. 
20, 1880. Schmidt-Rimpler. Sitzb. der arztl. Verein zu Marburg, Juni 
9, 1880 (abst. in Hirschberg's Centralbl., 1881, p. 358). 
21, 1881. Linnell, E. H. A case of left-sided binocular hemianopsia, with 
report of autopsy and microscopical examination. Knapp's Archives of Oph- 
thal., x. (1881), 4, p. 446. 
22, 1881. Westphal, C. Zur Frage von der Localization der unilaterale 
Convulsionen und Hemianopsie. Charitl-Annalen, vi., 1881, p. 342. 
23, 1881. Heuse. Hemianopsie bei Schadelverletzung. Case ii, Hirsch- 
berg's Centralbl. f. pract. Heilkunde, 1881, p. 205. 38 
E. C. SEGUIN. 
24, i88i. Senator, H., in Wernicke's Lehrbuch der Gehirnkrank- 
heiten, ii., p. 70, 1881. 
25, 1881. Petrina. Ueber Sensibilitatsstbrungen bei Hirnrindenlesionen. 
Case viii. Zeitschr. f. Heilkunde, Prag, 1881, ii., 375. 
26, 1882. Westphal, C. Zur Localization der Hemianopsie und des Mus- 
kelgeftthls beim Menschen. Charitl-Annalen, Bd. vii., 1882, p. 466. 
27, 1882. Marchand. Beitrag zu Kenntniss der homonymen bilateralen 
Hemianopsie, und der Faserkreuzung in Chiasma opticum. Archiv f. Ophthal., 
xxviii., 2, 63. Case iii. 
28, 1882. Haab, O. Ueber Cortex-Hemiopie. Klinische Monatsblatter f. 
Augenheilkunde, xx., 141, 1882. 
29, 1882. Huguenin. Case in Haab's article. 
30, 1882. Dreschfeld, J. Pathological contributions to the course of the 
optic nerve fibres in the brain. Brain, iv., p. 543, Jan., 1882. Case i. 
31, 1882. Idem. In idem. Case ii. 
32, 1882. Stenger, C. Die cerebralen Sehstbrungen der Paralytiker. 
Arch. f. Psych., xiii., p. 242. Case vii. 
33, 1882. Idem. In idem, p. 246. Case viii. 
34, 1882. Wernicke and Hahn. Idiopathischer Abscess des Occipital- 
lappens, durch Trepanation entleert. Virchotv's Archiv, Ixxxvii., 335. 
35, 1883. Jany, L. Ein Fall von rechtsseitiges Hemianopsie und Neu- 
ro-retinitis in Folge eines Gliosarcoms im linken occipitallappen. Knapp's 
Archiv f. Ophthal., xii., p. 327. 
36,1883. Rosenbach, P. Zur Casuistik der Hemianopsie. St. Petersburg 
Med. Wochenschr., 1883, No. 12. Neurolog. Centralbl., 1883, p. 442. 
37, 1883. Nieden, A. Ein Fall von einseitger temporaler Hemianopsie 
des rechten Auges nach Trepanation des linken Hinterhauptbeins. Archiv f. 
Ophthal., xxix., iii., p. 143. 
38, 1883. Richter. Fall von dreimaliger Blutung in ein Gehirn. Gesell. 
f. Psych, u. Nervenkrankheiten, 11 Juni, 1883. Neurolog. Centralbl., 1883, 
P- 307- 
39, 1883. Schmaltz. Case given by A. Vetter; Ueber die sensorielle 
Function des Grosshirns, etc. Deutsch. Archiv f. kl. Medicin, xxxii., p. 469, 
1883. 
40, 1884. Wiethe, Th. A case of superior homonymous hemianopia. 
Knapp's Archives of Ophthal., xiii., 3, 301. 
41, 1885. FIsre, Ch. Trois autopsies pour servir i la localisation cerebrale 
des troubles de la vision. Case iii (from Charcot's service). Archives de 
Neurologic, Mars, 1883, p. 229. 
42, 1885. Richter, A. Zur Frage der optischen Leitungsbahnen des 
menschlichen Gehirns. Archiv f. Psych, und Nervenkrankheiten, xvi., p. 641. 
43, 1885. Idem. Ueber die optischen Leitungsbahnen des menschlichen 
Gehirns. Fall ii. Allg. Zeitschr. f. Psych., xli., 1885, p 637. 
44, 1885. Idem. In idem. Fall iii., p. 638. 
45, 1885. Seguin, E. C. A contribution to the pathology of hemianopsia 
of central origin. Case with specimen. Read before the New York Neurological 
Society, October 6, 1885. g. p. putnam's sons, printers 
NEW YORK