Latest / Learn Literacy Podcast / 8. History of Dyslexia Part 4: Hinshelwood Ch 1
Transcript
- Cheryl Urbanczyk: Hello everyone and welcome to this episode of the Learn Literacy Podcast, where we champion the cause of language for life by teaching literacy through language and structure. I'm your host, Cheryl Erbanzik, and I'm excited for another History of Dyslexia episode. We're doing some wandering through history in terms of understanding where dyslexia came from and some early documentation. ⁓ Through sources really starting in the late 1800s, and now we're moving up to about 1917. ⁓ if you listen to previous episodes, we talked about how acquired dyslexia was noticed and how they made that connection between acquired dyslexia ⁓ students not being able to read and thinking that whatever situation those children have must be like those adults with acquired dyslexia. So James Hinchelwood was a Scottish ophthalmologist that lived, at the turn of the century. ⁓ And he had a lot cases of acquired dyslexia and those ⁓ people who were born with ⁓ So we're going to review book together ⁓ and just start at the and go through the chapters ⁓ one by one and and see what they thought about. congenital word blindness at the time and how it might inform our understanding of that today. Alright, so let's dive in. Okay, so I have a copy of his book. It is in the public sphere, so I think we are good with copyright and sharing and things like that, because I did find it online. ⁓ So word blindness ⁓ and it written by James Hinchelwood. ⁓ It he's A late surgeon to the Glasgow Eye Infirmary and a lecturer on ophthalmology in the Glasgow Western Medical School. And the date of the book is 1917. So if we go through and read the preface together, we'll get an understanding of what Hinschelwood was thinking. Okay, congenital word blindness is a subject which has been gradually obtaining a greater amount of attention from the medical profession and more especially from that. Part of it engaged in educational work. It is now generally recognized as one of the congenital defects of childhood and as a subject of considerable interest and importance, particularly in its educational aspects. I have therefore thought it advisable to gather together in book form my studies and observations on the subject, which are to be found scattered in contributions to various medical journals during the last 20 years. And a list of which is given at the end of this book. It will be observed that I have devoted considerable space to the subject of acquired word blindness without an adequate knowledge of which, in my opinion, congenital word blindness cannot be properly understood. My aim has been first to furnish the reader with the chief facts regarding acquired word blindness, and then to employ this knowledge in the interpretation and explanation of the various phenomena of congenital word blindness. Seventeen years ago, I published a small volume on acquired word blindness, and I hope that this complimentary volume on the congenital form will will help still further to diffuse a more precise knowledge regarding these interesting subjects. So his preface was written in January 1917. So it seems to me he's collected a bunch of his work from his career and put it together in this book. ⁓ And The various studies that he puts in the index are referenced throughout. Okay. After the preface, we have the table of contents. There's not too many chapters. Chapter one is on acquired word blindness. We'll talk about that in this episode. Chapter two is on congenital word blindness. Chapter three, hereditary congenital word blindness. Chapter four, diagnosis. And chapter five, which is the final chapter, prognosis and treatment. There are some illustrations that he's referencing here, and they are in the appendix or the addendum to chapter one, and they are illustrations of the brain ⁓ ⁓ think from autopsies and ⁓ various studies that he's done ⁓ brains of of people who did have acquired dyslexia. Okay, ⁓ so just dive into chapter one, Chapter one is on acquired word blindness. And he's referencing some people we already studied and talked about. ⁓ It was Kusmal in 1877 who first clearly pointed out that blindness words is capable of being met with clinically as an isolated condition and that it represents the pathological condition of a special faculty. Sir William Broadbent, five years previously, had already called attention to cases where patients were unable to read printed and written words, but in these cases had the inability to read was accompanied by speech disturbances such as verbal aphasia or amnesia in a greater or lesser degree. Tecusmal, therefore, must be given the credit of first recognizing the possibility of this inability being met with as an isolated symptom. So he's what the symptom he's referring to is the inability to read when you have other mental faculties available to you. So Kusmal's exact words are: a complete text blindness may exist, although the power of sight, the intellect, and the powers of speech are intact. He invented the term word blindness for this condition, in which the patient, though not blind, is unable to read words. Sir William Broadbent, in a criticism on my first paper in The Lancet on this subject, remarked that in his judgment, the employment of the term word blindness has been misleading and unfortunate. Now I quite agree that the word has frequently been used by writers loosely with different meanings attached to it, and therefore it may have frequently been misleading. The fault, however, lies not in the word, but in the fact that those who use it have not always. Had a clear conception of what kusmel meant by it. By the term word blindness is meant a condition in which normal vision and therefore seeing the letters and words distinctly, an individual is no longer able to interpret written or printed language. With a clear understanding of this definition, there is nothing misleading about the term, which I think has now become permanently fixed in our medical vocabulary. Okay? So he's kind of clarifying the term and and how it should be used. So we will kind of hop, skip, and jump around the chapter. he quite a few cases and and ⁓ intellectual wanderings ⁓ in the chapter, and maybe not all of them are particularly relevant. So We'll skip over a case that he describes of a 58-year-old man with acquired word blindness, ⁓ and he devotes several to this case study. So we'll scroll through those. ⁓ It is interesting, but necessarily pertinent to exactly what we want to be talking about. Okay. ⁓ Then he talks at bottom of page seven here. He, talks about losing the inability to read and he's always trying to connect that to brain structure and function. ⁓ And so he the member of this group which concerns us is the visual memory, meaning, what brain functions involved here. There is in the visual memory center situated in the angular and supramarginal convolutions, a storehouse of past visual impressions. These can be called into the sphere of consciousness at will when we form what we call a mental picture, or according to the French nomenclature, a visual image. And so he devotes some time to talking about, this visual memory and what it is. I'm not an expert on brain structure and function and what all the parts do, ⁓ but he's saying, sweep away all the visual memories or images from the brain, and you have the condition com commonly known by the term mind blindness. So he's introducing another concept. But what's important to us is what he states here on page nine. The clinical experience clearly demonstrates that the visual memories for words and letters, for numbers, and for musical notes have a functional independence of each other. So if we stop for a minute and we think about what The Morgan studied with Percy, how he tested his ability with letters and numbers ⁓ what they called figures at the time. And then in Hinschelwood's response to Morgan, Hinschelwood mentioned, Did you test the ability to read musical notes? So he's mentioning these various types of reading here and stating that ⁓ have functional independence of each other. Each group of visual memories may be entirely lost while the others remain intact and unaffected by the slightest degree. Hence, we are led to infer that they must possess an anatomical independence. We can as yet only localize the visual memory of words and letters, but from the frequency with which these three groups of visual images are simultaneously lost, we can infer that the regions affected, though not identical, are probably close together. So he's had this intellectual curiosity of where these ⁓ pieces in the brain and exactly what's happening with them. So he then goes on to talk a lot about the different types of visual memory ⁓ and what's happening ⁓ And ⁓ because is historical treatise that's, easily a hundred years old, I'm not quite sure how it connects to the modern corollary. And again, that's not really the my purpose in wanting to go through all this, ⁓ but I'll highlight a couple things. He does talk about the angular gyrus, the a lesion in one side of the brain in the vast majority of cases in the left angular gyrus will completely obliterate the visual word memories and make the individual world word blind. As is well exemplified in the present case. And so he's referencing brain regions that we know today that are involved in the literacy process. And so they found this out through autopsies and other things like that, and from those with acquired blindness, that if this part was injured in acquired blindness that led to the inability to read, that must be the part affected in congenital word blindness. So, we also talked about ⁓ how Morgan mentioned this area, this angular gyrus as being important in reading. ⁓ So a recurring theme, even in in some of these historical works, that they were onto ⁓ the brain regions. Okay. So then what he does is he refers back to that case that he talked about at the beginning ⁓ and that person. made progress or lack thereof and trying to learn how to read again. So he has ⁓ a really interesting statement here about another loss of visual memory. It says another very interesting form of loss of visual memory is that of the loss of visual memory for musical notes or note blindness. So I think that term is cool because he's taking the concept of word blindness ⁓ and ⁓ using different, facets of loss to talk about it. ⁓ Note maybe there's number blindness, so forth and so on. So I thought that was kind of neat. ⁓ And he goes on to say Professor Edgren of Stockholm has published a most interesting paper in which he gives 52 cases collected from various sources in which the power of musical expression was partly lost and which he is ⁓ and he has designated by the term a musia. ⁓ So from a historical perspective, they are trying to think about reading from a variety of aspects, numbers, musical notes, words. So it's interesting ⁓ thinking about how visual processing for those things, brain regions, and how all this stuff ties together, and the coining of these very interesting and neat words like note blindness, amusia, so forth and so on to describe all that. And he goes on to say that in my own experience, I have met with two cases of word blindness where the patients preserve quite intact the power of reading musical notes. One of these was a case where the patient retained his power of reading Greek whilst he was partially word blind to English, French, and Latin. The other was that of a girl of 15 years of age who had been completely wordblind from cerebral disease. She could not read a single word of a song, but could read the music. And so being a good musician and not being able to read books, she spent a large part of her time at the piano playing page after page out of music. It is evident then that the visual memory for musical notes is quite distinct from the visual memory of words, since the one form of visual memory may be entirely lost, while the other is not changed or modified in any way. And just as in the case of figures or numbers, this complete functional independence entitles us to infer a corresponding Anatomical independence. So, he ⁓ he all of these ideas, and ⁓ and quite interesting having a window into his thought process and how all this stuff is reasoned out. And, ⁓ these just his observations from all the collected case studies and the different various publications that he looked at and he found and kind of piecing all these things together. Okay. And then he goes on to detail a case where patient retained the power of reading Greek but lost other languages. And then so he does detail some other cases of people who knew more than one language using more than one type of alphabet. for example, Greek has a different alphabet than the the Romance languages, and talking about how the loss of one language may occurred but not another, which is really interesting to think about because you would think that they're all words or all visual symbols representing something. So how with acquired word blindness could you retain some aspects of one language but not aspects of another language? So interesting, he's documented all this kind of stuff, which is really neat. Okay. And then he goes on to say, thus of the four languages which he could read of the person whose case study he's detailing, the word blindness extended only to three, and the degree of word blindness was very different in each of the three languages affected, being greatest in English, less in French, and least in Latin. The Greek language had entirely escaped, and no trace of word blindness was manifest so far as it was concerned. He read numbers also with fluency and correctness, both individually and in the most complex combinations. And he read musical notes as fluently and correctly as he ever did without manifesting the slightest hesitation. ⁓ phenomena, which at first may seem strange and inexplicable, are in perfect harmony with our knowledge of the brain and afford further clinical proof of the correctness of the views expounded and developed in my book on letter, word, and mind blindness. The varieties of worn blindness met with in clinical experience can be intelligibly explained by regarding them as disorders of the visual memory ⁓ produced lesions affecting more or less completely definite areas of the cerebral cortex in which are preserved these past visual impressions arranged in definite and ordered groups. ⁓ ⁓ again, at the time and in terms of how these memories are stored with our current contemporary knowledge. I'm not sure if that ⁓ is and upheld, ⁓ but has this interest of trying to figure out what happens with various types of reading. Words, figures, musical notes, where are they in the brain and what's happening? Okay. He then goes on to highlight a bunch of other cases in terms of, if they lose musical notes, the ability to read it, can they hear music? all the various combinations he talked about. Can they read numbers? Can they read musical notes? Can they read words? And presents a bunch of different cases and things like that. He also has some anatomical conjecture ⁓ on what. Is the parts of the brain involved in these things and their potential function? And so, he spends some time giving his ideas about that. ⁓ the angular the occipital lobe comes up again. These are brain regions that we know are involved with ⁓ learning to read and the reading process. And in people with dyslexia, they are underdeveloped. Okay. ⁓ So then he starts to about. prognosis and remediation of people with acquired word blindness. So he says cases of word blindness may be divided into two great classes. First, those which recover more or less completely, and secondly, those in which the condition is permanent. And then he goes on to say, it depends on how much damage there was ⁓ and how severe the ⁓ Then he gives some ⁓ of people where he try remediation and wanted to support remediation to see what would happen. And these are interesting. ⁓ In our first case we have seen the patient after a period of six month cerebral rest, meaning after the initial visit and the initial injury to the brain, they had a rest on my advice ⁓ and started the process of re-education. And this is the 58-year-old man that was profiled at the beginning of the chapter. He got a child's primer and began again to learn the letters of the alphabet. After six months' daily practice, he learned again to recognize all the letters of the alphabet and slowly and laboriously to spell out the words letter by letter like a child. He was never able to reacquire the visual memory of words, except only a very few of the short familiar ones, such as the of. On, to, etc. He therefore could only read by spelling each word out loud and thus appealing to his auditory memory, but he never got beyond this stage. After laboring at this for a year, he abandoned the attempt partly because he was making such slow progress, but more especially because the intense mental effort involved in this daily task caused such a great feeling of mental exhaustion. It took too much out of him, as he himself expressed it. As this patient was now 59 years of age, I did not insist on his further continuance with a task which seemed to produce such great cerebral exhaustion. And so it's to see this because I I think about, the students I've worked with with very severe dyslexia, the the mental exhaustion is real for them. it's a lot of work. And so, the the challenge with these children is though they they don't have the luxury ⁓ of not Okay. Then he goes on to say, this case, however, was so far encouraging as the patient reacquired the visual memories of the letters of the alphabet ⁓ and of few familiar and short words. This showed the possibility of re-education to some extent at least, and encouraged me to try the same method in the next case, which came under my notice. This patient was a woman aged thirty four years who'd been completely word blind for a period of fourteen months before I saw her. So complete was the word blindness that she could not recognize a single letter of the alphabet. I recommended that she could learn to read again, beginning with the letters of the alphabet and then the short words and sentences in a child's primer. This case was much more favorable as the patient was 24 years younger. Fortunately, also she lived with her brother, who, being a schoolmaster, was naturally greatly interested in this process of re-education and undertook the supervision of it. I asked her brother to give me some account of his experience in teaching her to read. And I quote the following from his notes, which he kindly sent to me. On July 19, 1900, my sister became paralyzed on the right side and also became completely word-blind, both for printing and writing, but to a considerable extent could recognize figures. So again, that testing of various things that they considered to be reading. By September 1900, she had recovered the power of her right arm and leg and improved in her general health. But her inability to read remained just as before. Her medical attendant advised that Dr. Hinschelwood should be consulted regarding her word blindness, and in September 1901, Dr. Hinselwood, after seeing her, advised that an attempt should be made to re-educate her. Ordinary school primers were recommended, the print being big and the lessons graduated. Generally speaking, the task of relearning was found to be twice as difficult as the learning of words and letters for the first time, but as the auditory memory was unimpaired, the task was to some extent easier, for she could spell words when she could neither recognize them nor even the letters of which they were composed. She could not study at first for more than 10 minutes at a time, as the exhaustion soon came on and she had to stop. Slowly and with great perseverance, she succeeded in learning the alphabet and little words. The first primer, Words of Four Letters, was mastered in about 10 weeks, greatly by the help of auditory memory, and by July 1902, she was reading simple Bible texts, but spelling most of the words letter by letter. Since then, her progress has been steady but slow. In common narrative, a large proportion of the words are now spelt at all. And those of which she requires to spell few have now to be spelt aloud. She often stumbles yet at small words and gets easily over big words, the appearance of the latter being even more characteristic. So, interesting how we see themes related to children who have dyslexia. The challenge in learning, the great effort that it's taking, the slow pace, the puzzling thinking about interacting with the text, forgetting some little words, maybe reading other words okay. ⁓ And so ⁓ It seems when these brain regions are affected either, by being born that way or through injury, the the process of reading is really challenging. And whether you're relearning after an injury or starting learning, it's it's an effort, a real effort. Okay, so Hinschelwood goes on to talk a little bit more about this patient. In 1911, after an interval of more than 10 years, I had an opportunity of again examining this patient and hearing her read. She read to me an article from a newspaper very fluently, but occasionally stopped and spelt out a word before she was able to read it. This occurred only very rarely so that she had practically recovered her power of reading by sight. She now, as her brother informed me, reads newspapers and books for pleasure, just as she used to do. Okay, the third case of remediation or retraining ⁓ brain injury is ⁓ a younger person. So we have a 58-year-old, ⁓ 30-ish year old, and now a girl of 14. So in April 1905, a girl of 14 years of age was brought to me with the history that 18 months ago she became paralyzed on the right side with loss of speech. She gradually recovered from her condition, but it was then found she was unable to read and had remained in that condition ever since. Before her illness, she was in the fourth standard at school and could read very well. When I examined her, I found that she was completely word blind, not being able to recognize a single letter or word. Her auditory memory was unaffected and she still retained the power of spelling. I therefore advised that she should be re-educated, beginning with the alphabet ⁓ and then the child's primer. After learning the alphabet she was allowed to spell out the words letter by letter ⁓ and thus to her auditory memory Which was unaffected. I saw her again four months afterward, and I found that she had made considerable progress in that time. She could recognize by sight all the letters of the alphabet and could pick out by sight a large number of small words such as to, up, the, of, and so forth. Larger words she could read by spelling them out letter by letter and so appealing to her auditory memory. I learned later from her medical attendant that her progress in relearning to read has been continuous. Her education was undertaken by her father, who spent a great deal of time in teaching her, and in two years after I saw her, she was able to read just as well as ever. The comparative ease and rapidity with which this child relearned to read was very striking as compared with our previous experience in the cases of the two adults. It is evident then that age is a very important factor in determining the prognosis as regards to reeducation in any case of word blindness, and that the younger the patient, the less will be the difficulty experienced in teaching him to read again. So I think that's just fascinating because that is so on point when we think about remediation efforts today for children with learning disabilities, dyslexia, other things that. We know remediation can always happen and teaching can always happen, but the the the quicker we can get into support, the faster we can intervene, the better it it is. And maybe there's some brain neuroplasticity also involved, but it was exciting to see this case and the student ⁓ supported in learning to read again. So Okay, after talking about these cases of retraining or re-education, he goes through some wanderings about which side of the brain is involved. If you have an injury on one side, does the other side of the brain overcompensate and take on, things like that? Okay, and then we get to the conclusion of the chapter. ⁓ That a very interesting final paragraph of the chapter. It is worthy of note that in these three cases of worn blindness in which re-education was accomplished, the auditory center was unaffected, and hence these patients retained the power of spelling words even when they could no longer recognize them by sight. So by spelling words, he means saying the letter names out loud. This made the process of re-education much easier as it enabled the patient after acquiring the visual memory of letters or learning the letter names. To read words by spelling out aloud each word letter by letter and so appealing to the auditory memory. All the cerebral centers concerned in language are intimately connected with one another, and experience teaches that the impressions made on one cerebral center are deepened and strengthened by being associated with the impressions made on other centers. Hence the simultaneous appeal made both to auditory and visual centers. Strengthens the impression made on the new visual memory center and enables it to attain more rapidly to the permanent retention of the visual memories, such as will enable the patient to regain the power of reading. I think that's really cool. My take on what he's talking about here is multimodal or multi-sensory learning. That if you have a visual aspect and an auditory aspect, you have these mutually reinforcing things. And we know, Orton Gillingham has the multisensory component of the visual, auditory, kinesthetic tactile, structured literacy, ⁓ uses term multimodal, but the idea is the same that you're including multiple senses for multiple input to get those strong connections in the brain between the various facets of the thing you're learning. ⁓ So it's of neat how he hints at this here that If you have the visual and auditory, the learning is strengthened together over just visual. And so that's how he concludes this first chapter. So the the appendix to chapter one ⁓ is autopsy reports. I'm not going to spend time going over that. And those of you may be interested in brain anatomy and physiology might get a kick out of that. ⁓ But ⁓ In the first chapter, he tries to set the stage for what comes next. He talks about various cases of acquired word blindness and their various forms. Is word reading lost? Is figure reading lost? Is music reading lost? And can you have some or none? Or do they exist in various combinations? Then he talks about some ways ⁓ understanding this in brain structure and function. And he talks about re-education or what he's calling prognosis with the three different cases ⁓ that ⁓ reeducation available to two ⁓ of the but not the third one. ⁓ And ⁓ interesting he notes in the re-education process things we see as parallels to when children with dyslexia learn how to read. It's hard. It takes time. It takes a lot of mental energy. It's slow. ⁓ having to work with areas of the brain that need a lot of practice and reinforcement to ⁓ support the there. ⁓ And then, ends with this very interesting comment about connecting these multi-sensory pieces together, which is interesting. So, when we're thinking ahead to what's coming next in our next episode of Hinchelwood, we're going to look at the next chapter and talk about congenital word Okay. ⁓ So thank you very much for tuning this episode of Learn Literacy, podcast and thinking about history of dyslexia. If you're interested in learn literacy, please go to the website learnliteracy.com and you can learn about upcoming trainings for Orton Gillingham and Structured Literacy. You can find out more information on social media at Learn Literacy One. And again for your interest and supporting the cause of Language for Life and teaching literacy through language and structure. Thank you.