Tatsuji Inouye's pioneering mapping of the cortical visual area by the effect of gunshot wounds

Division of Clinical Neurosciences, The Center for Applied Research in Head Injuries, Rambam (Maimonides) Medical Center, B. Rappaport Faculty of Medicine, The Technion-Israel Institute of technology, Haifa, Israel

At the end of the 19th century and by the turn of the 20th century, investigators, were engaged in a running controversy regarding the location and organization of the primary vision center in the brain.

Tatsuji Inouye (1880-1976), a young medical officer in the Japanese Imperial Army during the 1904-1905 Russo-Japanese war, devised a novel three-dimensional model of the human head and could locate the calcarine cortex in its coordinates, constructing a prototype of modern stereotaxis instrumentation. By using entrance and exit wounds he calculated the destroyed region of the primary visual center or its afferent fibers. Inouye studied, single handed, with a creative pioneering approach, the visual field defects in the brain-injured soldiers in relation to the injured cortex, being among the firsts to use war wounds for the mapping of brain centers. The analysis of accurate case reports enabled him to study the dynamics of recovery and was among the firsts to recognize the clinical evidence for the budding concept of diaschisis. He addressed fundamental questions about the cortical representation of central and peripheral vision and the areas devoted to each. Inouye established that the periphery of the visual field is represented anteriorly and the fovea posteriorly. His maps also show that there is a disproportionately larger of cortex devoted to central vs. peripheral vision. Inouye's work "Die Sehstörungen bei Scüßverletzungen der kortikalen Sehsphäre Nach Beobachtungen an Verwundeten der letzten japanischer Kriege" (Leipzig 1909) is a model of outstanding innovating clinical research; undertaken alone, with amazing skill and deep insight into the problems to be addressed. His studies preceded those of Holmes, who, assisted by the use of X-rays could study a larger number of isolated missile wounds of the brain after World War I. Holmes' map, the basis of our modern interpretation of visual fields, has been recently modified by Horton and Hoyt who showed, using MRI studies, as Inouye predicted, that the magnification of the central retinal projection onto the cerebral cortex to be even larger than was previously thought.

Session VI -- Anatomical and Physiological Models and Techniques
Monday, 3 June 2002, 2:30 pm

Seventh Annual Meeting of the International Society for the History of the Neurosciences (ISHN)

Los Angeles, California, USA