I’ve just found this fascinating article on how legendary neurologist Gordon Holmes discovered how the visual cortex represents visual space after studying World War One soldiers who had experienced bullet or shrapnel wounds to the brain.

World War One taught us a great deal about neuropsychology largely due to developments in weapons technology. The German Mauser was an accurate rifle that used small bore ammunition where previous conflicts had largely used single shot rifles mostly designed so a group of soldiers could create a ‘wall of lead’, rather than a carefully aimed shot.

Developments in shell technology also meant that high explosives could be launched with reasonable accuracy into groups of soldiers causing significant shrapnel injuries.

However, both the rifles and shells were at a stage where the velocity of either a bullet or a piece of shrapnel was relatively slow by today’s standards, meaning that the brain was not additionally damaged by shock waves, like with modern munitions.

In other words, they could create small discrete areas of brain damage that left the rest of the brain largely unaffected.

The British Brodie helmet, which sat like a tin bowl on the top of the head, left the lower parts of the head, and hence the brain, exposed. This meant a significant number of injuries were to the visual cortex, at the rear of the brain.

Neurologist Gordon Holmes studied the link between small lesions to this area and which areas of vision had been lost in soldiers coming back from the front.

The diagram on the right is one of his drawings where he demonstrated the link between a very specific shrapnel wound and a crescent-like area of blindness in the visual field. The full diagram is in the article where he also shows how it affected the right eye.

These studies taught us that the visual cortex is ‘retinoptically mapped’, meaning that each part of the cortex corresponds to a specific area of vision. It also taught us that some brain areas can be very specifically localised to certain functions, whereas previously we’d only known of very general connections between function and brain area.

The article, published in opthamology journal Documenta Ophthalmologica, describes Holmes’ wartime experiences, his discoveries and something of his character.

It also contains this curious episode, related by one of his junior doctors, largely notable for the fact that they hid a blonde beauty queen in a bathroom on the hospital ward to boost morale of the medical house officers.

Holmes had no time for neurotics and hysterics, and less … for psychoanalysis … [Once] In the ward there was a blonde bombshell of twenty-one with mild tension headaches. She was as pretty as a picture, plump as a partridge, who the previous year had been the Daily Mirror Bathing Beauty Queen. The first time I took Holmes around, he stopped at the foot of the bed and said ‘Who is this woman?’ I explained, whereupon he jerked his thumb towards the door and said ‘Get rid of her’. Of course, I did nothing of the sort, for she was useful in keeping up the morale of us house officers. A week later he came around and said ‘I thought I told you to get that woman out of here?’ Yet another week passed. On this occasion I got the Sister of the ward to hide the patient in the bathroom during the ward round. Standing at the foot of the empty bed, Holmes paused, then said to me ‘Look here, my boy, either she leaves the hospital or you do – and I don’t care which.

Link to ‘Gordon Holmes, the cortical retina, and the wounds of war’.

Link to DOI for same.