Effect of an oral contraceptive immediately post partum on initiation of lactation.

associated initially with loss of unilateral vision and subsequently substantial loss of field in the unaffected eye, relieved by the administration of systemic corticosteroids: the hallucinations were a very temporary effect of cortical ischaemia relieved by prednisolone. In Case 2 the hallucinations occurred after an interval of two months, following severe bilateral loss of visual acuity, with no relief from corticosteroid therapy ; in this particular case it must be assumed that the occlusive process has been permanent. The time of onset of this symptom after ocular involvement is of interest since it corroborates previous descriptions in that the generalized effect of cranial arteritis may follow ocular involvement by an interval of one to six months. The rarity of visual hallucinations in the blind has been noted by Freeman and Williams (1953) and it should be stressed at this stage that the formed hallucinations experienced by these two patients in no way resemble the psychic disturbances of postoperative cataract patients in which the imagery promptly disappears on uncovering the eyes. Walsh (1957) is of the opinion that formed visual hallucinations are due to involvement of the temporal lobe, and cites both experimental and clinical evidence to substantiate this point. A differing view is held by Weinberger and Grant (1940), who believe that no such strict localization exists within the cerebral hemispheres, such hallucinations representing psychological phenomena involving the total integrative activity of the mind, the formed imagery depending on consititutional factors, not on cortical psychic organization. In his summary, Walsh prefers to accept the localization of such phenomena to the temporal lobe, founded on the available experimental and clinical evidence. Both patients whose cases have been described show marked complacency to their respective visual symptoms, and it is postulated that this euphoria may also be connected with the intracranial occlusive episodes of cranial arteritis.