R L Gregory and J G Wallace

Reproduced from Experimental Psychology Society Monograph No. 2 1963

3. Observations at the Wolverhampton and Midland Counties Eye Infirmary (January 1959)

(1) Introduction to the Case

We first heard of the case of S.B. through a short report in a daily paper, which stated that a man blind from birth, had upon operation immediately recovered his sight. Having read something of earlier cases of recovery from congenital blindness, and being impressed by their significance for contemporary perceptual theory (in particular Hebb’s writing on the subject) we determined to try to investigate this case. We wrote immediately to the Hospital Secretary (the name of the surgeon was not given in the press) and received the following picture of the case, and invitation to investigate it, from the surgeon, Mr. A. Hirtenstein, F.R.C.S.

16th January I959

Dear Mr. Gregory,

Thank you for the letter regarding a patient of mine, who, as you know, underwent a corneal graft operation a month ago.

I have myself been very interested to note how quickly he readjusted himself to the vision he gained after operation. Prior to the operation he only had light perception in the first operated eye; in the other eye he could perceive vague hand movements close to his face. He lost his sight at the age of ten months after smallpox vaccination, and was trained as a blind person from the age of seven to eighteen years, at the Birmingham Blind Institute. I am contacting the Secretary of the Institute to find what records they have of his early years.

After the operation he seemed to have absolutely no difficulty with spatial perception, and he could recognise faces and ordinary objects (i.e. chairs, bed, table, etc.) immediately. He learned the names of colours very quickly, and seemed to have no difficulty in recognising cars, windows, doors, etc. His explanation is that, though he could not see any of these things before, he had a definite and accurate mental image of all things he was able to touch; in the case of a car, for instance, he used to wash his brother-in-law’s car, and thus he had a good idea of its shape. He was working as a boiler-scraper, and although he hasn’t yet seen a boiler, he assures me that he would be able to recognise one immediately, as his mental picture of its shape is very accurate.

As you know I operated on his second eye a fortnight ago, and I hope the visual result will be equally satisfactory for him. His present vision is, of course, not very good yet, but I hope it will improve after further operations, as the first ones were only preparatory ones.

He will probably be staying another week or so in the Wolverhampton Eye Infirmary, and if you would like to see him yourself, and carry out any tests you might wish to do, you would be more than welcome. Do let me know if you are able to come up, as I would very much like to meet you if possible. Thank you very much for enclosing the two interesting articles of yours. I look forward to discussing Mr. B.’s case with you.

Yours sincerely,

Signed: A. Hirtenstein (F.R.C.S.)

We are most grateful to Mr. Hirtenstein, and the Matron and staff of the Wolverhampton a»d Midland Counties Eye Infirmary, who gave us all the facilities we requested, and helped in every way possible. We were given the use of a quiet and well lighted room for our investigations, and were left entirely undisturbed.

It is unfortunate that this case was not examined earlier from the psychological point of view, but it is understandable that it seemed to be of no very special interest to those who were involved in eye operations every working day of their lives. Special investigations take time, and time is obviously a precious commodity in a busy hospital geared to treatment rather than to research. We saw S.B. while still in the hospital, and interviewed members of the staff to obtain details about what had happened before we saw him. These were trained and careful people, and indeed had far more experience in dealing with, and observing, blind people than we had.

S.B. received a corneal graft on his left eye on 9th December, 1958, and on the right eye on 1st January, 1959. We first examined him on 26th January - 48 days after the first operation. The first examination was carried out in a quiet private room in the hospital, lit by winter daylight, and lasted about 3½ hours.

We first saw S.B. walking confidently along a corridor. He guided himself through a door without the use of touch, and he struck us immediately as a cheerful, rather extravert and confident, middle-aged individual. At first impression he seemed like a normally sighted person, though differences soon became obvious. When he sat down he would not look round or scan the room with his eyes; indeed he would generally pay no attention to visual objects unless his attention were called to them, when he would peer at whatever it was with extreme concentration and care, finally making some almost oracular comment. He never said anything silly or hysterical, and answered every question with unusual care. He never evaded a question, and showed an intelligence and sense of curiosity very much higher than a sighted man of his trade would be expected to show. He displayed an unusual dislike of being surprised by anything. He had a matter-of-fact attitude to his situation and his experience, and disliked not knowing things known as a matter of course to sighted people. At no time did he dramatise his situation, or exaggerate his lack of knowledge, as one might have expected if he were trying to impress us with his past blindness. He was proud of his independence as a blind man, and indeed he was unusual in his independence. He would go for long cycle rides, holding the shoulder of a friend, and he was fond of gardening, and making things in his garden shed, provided by the blind school for his trade as a cobbler.

He had no nystagmus. Searching eye movements were minimal, and when they did move over a large amplitude, they did so in larger than normal saccadic jerks which were plainly visible. No records were taken of his eye movements.

It was very soon apparent that his vision was far. from rudimentary: he could name almost any object in the room. Much to our surprise, he could even tell the time by means of a large clock on the wall. We were so surprised at this that we did not at first believe that he could have been in any sense blind before the operation. However he proceeded to show us a large hunter watch with no glass, and he demonstrated his ability to tell the time very quickly and accurately by touching the hands. It appears that he always used this method of telling the time before the operation.

We were even more surprised when he named correctly a magazine we had with us. It was in fact Everybody’s (for January 17th, 1959), and had a large picture of two musicians dressed in striped pullovers. Although he named the magazine correctly, he could make nothing of the picture. We at once asked him how he knew which magazine it was, and he said that although he could not read the name, he could recognize the first two letters, though not the rest, and he guessed that the Ev belonged to Everybody’s. Further questioning revealed that he could recognise any letter in upper case, though not in lower case, and it so happens that the title of the magazine was written with only the first two letters in upper case, thus:

He then told us that he had learned capital letters by touch, these being inscribed on blocks and taught at the blind school. Lower case letters were not taught.[ Footnote 8.] This was particularly interesting, for it suggested direct transfer from touch experience. It also showed how he could guess correctly from comparatively little evidence. We were, after this early experience, continuously on our guard for intelligent guessing covering up perceptual abnormality.

His colour naming was not at that time by any means perfect. He told us that his only visual memories were of red, white and black. He could name these correctly, and apparently could do so very shortly after the operation. When we saw him he was uncertain about yellow, complaining of the large number of kinds of yellow. Latta’s patient responded with great displeasure to yellow. S.B. did not show dislike for any colour, but seemed to prefer greens and blues, for example when seen in kodachrome projections, even when he could not name the objects. He liked bright colours, and later often expressed disappointment when things were "dingy".

When we established that he could distinguish upper case letters, cars from lorries as seen in the distance through the window, and name such objects as trees and tables, we realised that more sophisticated tests were called for. Fortunately we had brought everything we could think of in the time available, including the tests to be described.

(2) First Visual Experiences after Operation

S.B.’s first visual experience, when the bandages were removed, was of the surgeon’s face. He described the experience as follows: - He heard a voice coming from in front of him and to one side: he turned to the source of the sound, and saw a "blur". He realised that this must be a face. Upon careful questioning, he seemed to think that he would not have known that this was a face if he had not previously heard the voice and known that voices came from faces.

At the time we first saw him, he did not find faces "easy" objects. He did not look at a speaker’s face, and made nothing of facial expressions. On the other hand, he very rapidly (apparently within a couple of days) distinguished between passing lorries and cars, and would get up at six each morning to look at them some way off. He "collected" different types of lorry, and took much pleasure recognising vans, articulated lorries, and so on. His particular interest in cars and lorries may have been in part that they made familiar sounds, which helped in identification; that they could only be driven by sighted people, and so held out particular promise to him. He had spent many hours trying to visualise the shape of cars while washing them, particularly his brother-in-law’s car, which he frequently washed down.

He told us that he did not suffer particularly from giddiness when he first opened his eyes.

As in previous cases (Latta, 1904), he experienced marked scale distortion when looking down from a high window. In the famous Cheselden case, objects were at first reported to be touching the eye [ Footnote 9. ] ; this was not true for S.B. but he found that when looking down from a high window (about 30 - 40 feet above the ground) he thought he could safely lower himself down by his hands. When later he saw the same window from outside, he realised that this would be impossible.

On the whole, his early estimates of the size of objects seem to have been quite accurate providing they were objects already familiar to him by touch. Thus buses seemed to him to be too high but the right length. This may well have been because he was used to walking their length but not feeling their height, adding the separate tactile sensations of the height of each step and adding enough above the stair-case would be a comparatively difficult and unfamiliar task. In drawings of buses, to be given later, he emphasised the features familiar to touch but ignored the bonnet, which would not normally have been touched by him.

He may well have made many mistakes of identification of objects which we did not hear about, but from the beginning he was proud of his ability to name objects correctly, and took no pleasure in allowing others to find out that he made mistakes.

It was very soon obvious (as we had to some extent anticipated) that merely to ask questions about what he saw would not give us much information about his visual capacity. In fact the only example of a curious and interesting mistake was described to us by the Matron, who said that about three days after the operation he saw the moon for the first time. At first he thought it a reflection in the window, but when he realised, or was told, it was the moon, he expressed surprise at its crescent shape, expecting a "quarter moon" to look like a quarter piece of cake! It is noteworthy that this is the only clear instance of an expression of surprise, or of a clear error of this sort. That it should occur with an object he could not have touched is perhaps significant. It also shows - when it is remembered that the full moon only subtends 0.5° - that his visual acuity must have been reasonably good at that time, a few days after the first operation.

It is also worth noting that reflections fascinated him and continued to do so for at least a year after the operation.

continues with Section 3.2 Observations at the infirmary: Perceptual Tests