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16. History of Dyslexia Part 8: Hinshelwood Ch 4 · Learn Literacy Podcast

• Cheryl Urbanczyk: Hello everyone and welcome to this episode of the Learn Literacy Podcast, where we advocate for language for life by teaching literacy through language and structure. So here we are in another episode of our History of Dyslexia series where we are reading through Dr. James Hinschelwood's congenital word blindness book from 1917. We've gone through the first several chapters. Now we're on to chapter four, which is on diagnosis. So a quick overview in case you're just joining in this episode. We've learned in the book so far about acquired word blindness, which is the loss ⁓ reading ability due to injury ⁓ or So these are people who had the ability to read, but due to illness or injury lost that ability. And then we learned about congenital word blindness, which they believe is due to a difference in brain ⁓ physiology function. ⁓ And made a correlation to people who had acquired brain injury and felt that those who were challenged learning how to read young children so forth were were born with this difference and it must be ⁓ the same brain region. That's affected when people get an injury and lose how to read. And then we looked at how congenital word blindness can have a hereditary factor and runs in families. Okay, so today is diagnosis. So we are going to just jump right into that. chapter four, diagnosis. I saw in an article on the subject of congenital word blindness, the query. Why were these cases which we find so common? Not recognized long before. The answer to that query is very simple. Cases of this defect have existed ever since men began to read by the aid of the twenty two letters of the alphabet invented by Phoenicians nearly 4,000 years ago. But the true nature of this defect could not possibly be recognized until they had become possessed of a knowledge of the facts of acquired word blindness. This knowledge explained the phenomena which must have puzzled so many generations of medical men as something inexplicable and therefore which met little or no attention at their hands. Our knowledge of acquired word blindness is only of about 40 years duration, dating from the days of Cusmel and Broadbent. So the very first episode in the the series The History of Dyslexia is on Kusmal and Broadbent. So if you haven't listened to that, you could go back. For those scientists and learn about them. Back to the chapter. The subject was but little known to the bulk of the medical profession when I published in 1895 my first paper in the columns of the Lancet, ⁓ perusal of which enabled Dr. Morgan to recognize and to record the first case of congenital word blindness. So here Hinschelwood is saying that his articles ⁓ acquired word blindness. allowed Morgan to make that connection to this must be a congenital word blindness or something being born from birth. And in a previous episode we also read Dr. Morgan's paper, so you could go back and find that. Okay, continuing, the papers subsequently published by myself and others during the next few years gradually spread the knowledge of the subject amongst the medical profession until the condition met with general recognition. That this diffusion of knowledge was a very gradual process during the first few years is shown by the fact which Stevenson mentions in his communication published in 1904, eight years after the publication of the first case. That up to that date only 14 cases had been reported. In my first contribution on this subject, I said, I have little doubt that these cases of congenital word blindness are by no means so rare as the absence of recorded cases would lead us to infer. Their rarity is, I think, accounted for by the fact that when they do occur, they are not recognized. That to me just strikes me as a sentence we could hear spoken today by people. That we are still struggling to inform, teach, help people understand about dyslexia, to recognize it properly and to diagnose and provide appropriate intervention. So, you know, there's some misunderstanding maybe about what dyslexia is, how to look for it, how to spot it. And it seems Hinshawood is struggling with the same thing about a hundred years ago. The truth of this forecast became evident from the increase in recorded cases and papers on the subject when once the attention of the profession had been widely directed to the condition. In educational circles, there was even a tendency before long to exaggerate the frequency with which these cases occurred in schools, and I find in an article the statements that these cases of congenital word blindness are a very common occurrence, unquote, and that Quote, one in every thousand of the children in our elementary school at least shows this defect. End quote. Now I am quite sure that these are not cases of congenital word blindness as I understand the term, and hence the great importance of setting forth clearly our principles of diagnosis. Nothing has been more misleading in medicine than the use of statistics. Figures and percentages are worthless unless we know precisely the basis on which they have been drawn up. The value of this statement that congenital word blindness is found in, and he's giving the quote again, in one in every thousand of the children in the elementary schools will depend on what the writer means by the term congenital word blindness. If we label as word blind every case where some difficulty is experienced in teaching the child to read, then no doubt we may find the condition quite as common as is indicated in the above quotation. But in my opinion, this is an entirely erroneous conception of what the early writers on this subject meant by the term congenital word blindness. And this lack of precision and diagnosis has been responsible for much of the confusion of ideas and inaccuracy which appears in many of the recent accounts of this condition. I will take a sidebar here to mention that this is also a contemporary current concern about dyslexia. how it's defined and how it's diagnosed. If you examine different definitions of dyslexia from different places, they all have the same themes, but may use different wording and different descriptors. And there is ⁓ discussion about how to define it. Especially it's a continuum from mild to moderate to severe. Okay, continuing on, it will be observed that all the cases recorded in this book are marked by two important conditions. First, gravity of the defect, and second, purity of the symptoms. If the reader consults the records of the early cases, he will see that these are all of an exactly similar character. The first case reported by Dr. Morgan is an admirable example and fulfills exactly the two conditions, meaning gravity of the defect and purity of the symptoms. In order to make the principles of the diagnosis perfectly clear, let us examine more carefully the significance of these two conditions, the presence of which I regard as essential, before we can describe a case as one of congenital word blindness. We have seen in our studies on acquired word blindness that although every human being endowed with the sense of sight possesses the visual memory, yet it is possessed in very different degrees by very different individuals. Or by different individuals. Francis Galton, in his interesting work, Inquiries into Human Faculty, made a careful investigation into the powers of visual memory possessed by 100 different individuals and found the most astounding differences. Okay, what he's commenting on ⁓ the natural variation exists ⁓ in human abilities in to ⁓ intelligence and different subjects that some people can do well in math but maybe not in reading. They could do well in reading but maybe not in music. So he's kind of about this natural variation that exists. And so in ⁓ in of what is interesting to us about this paragraph, which I I won't read the rest of is he's just saying that this normal variation is not what can what congenital word blindness is. That there's something else going on there beyond just this natural variation ⁓ strengths we see in students and that ⁓ there there to be more to that. Okay. So picking up, although in every department of study we thus find these great differences in the degrees of aptitude exhibited by the children, we do not give any special name to those cases where some degree of difficulty has been encountered in the teaching of a given subject. We regard them as cases in which the cerebral areas involved have not been well developed. We do not regard them as pathological conditions, but simply as examples of physiological variations in the degree of development of the areas involved. Okay. I have no idea how that relates to like modern brain science, except to say, like I said, that he's trying to get at the normal variation is not included in the definition of congenital word blindness. In a precisely similar manner, when teaching children to read, we find some who learn to read with ease and rapidity, and others attaining the same end but with varying degrees of difficulty, which necessitate correspondingly greater efforts on the part of both teacher and pupil. Such cases as the latter ought not, in my opinion, To be described as suffering from congenital word blindness unless they exhibit such a marked degree of difficulty as renders it impossible for them to be taught by the ordinary school methods. Cases where children simply lag behind somewhat their fellows in acquiring the visual memories of letters and words, but where a little extra time and effort overcomes the difficulty should not be described by this term. If it is thought advisable to describe by any special term such cases where there is evidently some slight defective development of the visual memory center, then in order to avoid confusion with degrees of this defect, let them be described by another term. And he does propose another term. He says, I would suggest for that purpose congenital dyslexia. So Just being honest here, when I'm reading through some of these histories, even other articles and things that I'm thinking about planning to talk about, they they use so many terms for different things, it's kind of challenging to piece it all out. ⁓ Hinshawood is getting at ⁓ have acquired word blindness or what was originally termed dyslexia, and then he's saying congenital word blindness meets those pure conditions. diagnosis and he's introducing the term congenital dyslexia for children let's say who are needing time to learn how to read ⁓ or need more The term dyslexia was introduced by Professor Boleyn, as we shall see later, to describe a special group of cases where the patients experience great difficulty in reading and due to the development of cerebral disease. The prefix congenital, however, would serve to obviate any confusion with these cases of acquired dyslexia described by Professor Boleyn. The term congenital word blindness ought to be strictly reserved for those graver cases of defect where the difficulty in learning to read was so great and so unusual that it could be regarded without any exaggeration as, ⁓ a physiological condition. says abnormal and pathological, just meaning not typical, and where the attempts to teach the child to read by the ordinary methods had completely failed. In forwarding me a report about case five, the schoolmaster at the head of a large school board said, I have never seen a case similar to this one in my twenty-five years experience as a teacher. With regard to the family whose history is recorded in chapter three, the headmaster of the large board school at which they were educated said, In his long experience as a teacher, he had never before met with anything like the difficulties encountered in attempting to teach these four boys to read. It is quite evident that the cases referred to in such terms by the headmasters of large schools with long experience must belong to a very different category from those which we are told are exceedingly common and are to be found in one in every thousand children attending our elementary schools. I I think that's kind of interesting. we can think at this period in time and in this period in history, ⁓ people who wealthy went to schools. education ⁓ maybe working ⁓ higher levels of literacy may not have been something everybody did or may not have been available to everybody. So when we see him talk about numbers and things, with our more current modern understanding, let's say from the International Dyslexia Association of 15 to 20 percent ⁓ of the population is the scale of dyslexia. He's has some different numerical values here, but we also know, like I said, we're comparing two completely different periods of time and the the number of people maybe acquiring ⁓ literacy ⁓ or who had options to just leave and work, like we saw the one example of one of the brothers in the family just went to go work in the coal mines. ⁓ urgent need ⁓ literacy in a knowledge-based economy like we have today was not present back then. All right, continuing on. ⁓ Harmon, in an article on congenital word blindness in a recently published work, tells us that the defect as a congenital occurrence is rare. My own opinion is that the condition, as recognized by myself and the earlier writers on this subject, is best described by the term moderately rare. The truth is that this great divergence of opinion as to the frequency of the condition is simply due to the fact that some later writers have extended the term congenital word blindness to include slight degrees of defect in the visual word center, where the earlier writers had reserved it only for those grave cases which could be regarded as pathological. It would simplify matters much if in future the term congenital word blindness was reserved for those grave cases. only such as are described in this book, and applying the term congenital dyslexia to those slighter degrees of defects which are said to be so common in the elementary schools. Very interesting observations by Hinschelwood, and we are seeing current conversation ⁓ some ⁓ of dyslexia with similar ideas where they say that only children on the extreme end of the dyslexia scale should be diagnosed as dyslexia. Others ⁓ maybe not. ⁓ And in mind the diagnosis of something like dyslexia, it's a sliding scale and there how do you determine a cutoff point? It's kind of challenging. So he's seeing these concerns in his day and just trying to figure it out. And what do we call all these things and ⁓ like that? Okay. ⁓ our diagnosis of a case of congenital word blindness, not only must we have regard to the gravity of the defect, but also the purity of the symptoms. So he's saying that it must be extreme, the inability to read, and that. it's the by purity of symptoms he's mean he means it's not caused by other things like vision, ⁓ intellectual concerns or things like that. We restrict this term to the cases of localized defect only where we have one definite cerebral area affected in an otherwise undamaged abnormal brain. Here also I think confusion has arisen by including under the term congenital word blindness cases other than those of pure types of the defect. And so what he goes on to talk about here is children who are struggling to learn all subjects. You know, they struggle in math, they struggle ⁓ schooling in general, and comprehension in general. ⁓ And he's that these ⁓ are cases the term would not apply because they see that pattern of weakness in all subjects where in even in terms of spoken language. We have seen in previous profiles that spoken language, expressive speech, receptive speech was very high amongst what he's calling the purity of the symptoms. ⁓ ⁓ just summarize that paragraph there. ⁓ So for example, he's saying, even the schoolmaster who wrote me regarding case five recognized that such cases belong to quite a different category. There is another boy, he said, in his class, who is quite a poor reader, but this other boy is all around poor, showing no signs ⁓ of of in anything. So you know, that is not a an asset-based phrasing we would use today, but what he's trying to get at is that His learning profile is consistent amongst all the different subjects, right? And then he goes on to say is a true case of congenital word blindness is therefore marked only by the gravity of the difficulty in learning to read, but also by its purity of type, meaning it is uncomplicated by inner other symptoms of cerebral defect. All the children whose cases I have recorded were bright, intelligent children whose powers of observation and reasoning were quite intact, and in many cases the parents said they were in other respects than in learning to read the most intelligent members of the family. If then we limit this name to cases of high degree of defect and of perfect purity of type, then I think it will be found that such cases are by no means common, but still occur with sufficient frequency as to be of the greatest importance to all who who are engaged in the training and education of the young. Hinchelwood seriously is in so many ways ahead of his time, because We are still struggling with this today, that getting knowledge to general classroom teachers about what dyslexia is, how to recognize it, how to support students, that kind of thing. So maybe general classroom teachers aren't doing the remediation or tier three or the intensive intervention, but they should know how to support students, how to ⁓ notice signs and and symptoms for referral. And I think this is a corollary that we see today. This is a large number of cases to come under the observation of an ophthalmic surgeon in such a period of time, but my opportunity for seeing these cases was an exceptionally favorable one. Having always been greatly interested in the cerebral disorders of vision from the very beginning of my career as a teacher of ophthalmophthalmology and with large classes of students, I had delivered special lectures every year on this subject, which included word blindness. Both acquired and congenital. My students, being thus especially instructed, were able to recognize these cases when they met with them later in their practices. A large proportion of the cases seen by me were thus sent by formal pupils from all parts of the country, and these 31 cases came therefore from a very wide area. Okay. What what he does in the upcoming portion of the chapter here is discuss How children with congenital word blindness relate to other aspects of things that they assess, ⁓ music, math, and compares that to reading and he summarizes cases and things like that. ⁓ Not only are the general intelligence, powers of observation, and reasoning unaffected in true cases of congenital word blindness, but the auditory memory is intact and in many cases is exceptionally good. This is very well exemplified by the fact that out of the twelve recorded in this book, four of them are For a time concealed their defect by learning their reading book by heart, so that when it came time to their turn, they could from memory repeat their lesson, although they could not recognize the words by sight. They had therefore no difficulty in all the subjects which could be imparted to them orally. They all learned to spell well, they had no difficulty in committing to memory passages of poetry, etc., and made quite satisfactory progress in all subjects which they could acquire. By oral instruction. In case two, the boy made good progress in music, and his teacher expressed great satisfaction with his progress in his musical studies. These children, therefore, though manifesting the greatest difficulty in learning to read words and letters, may experience none in the reading of music. When such a difference is observed, it should help to the correct diagnosis of the true nature of the difficulty in learning to read print. We have seen that out of the twelve recorded cases, the difficulty in reading extended to figures in three cases only, so that in nine cases the children experienced no difficulties in reading figures or in learning their arithmetic. And so we're able to keep abreast of the other children in this subject. In two of these 12 cases, the children actually excelled in arithmetic. Now, when this marked difference is present in the ability to read words and figures respectively, it is of the greatest value in diagnosis. When a child experiences difficulty in learning to read, the first cause which naturally suggests itself is that the difficulty may be due to some defective vision, either to an error of refraction or to some diseased condition of the eye. When the difficulty, however, is found to be confined to learning to read words and letters and does not extend to figures, it is at once made evident to the examiner that the difficulty is due not to an optical but to a cerebral defect. Hence, in every suspected case, the child must be carefully examined as to its power of reading figures as well as words and letters. I think that's just so cool how they really tried to use their reasoning and piece all these things together, right? Too much importance, however, in the diagnosis must not be attached to this point. Although experience teaches that in the great majority of cases of congenital word blindness, the defect extends to words and letters only, still genuine cases are met with, as in cases 1, 4, and 11, where the difficulty extends to both words and figures. Nor is this to be wondered at when we consider that distinct cerebral areas are utilized for the storage of visual memory. Of figures, words, and letters, and that the cerebral areas involved are close together and probably contiguous. Whilst the retention of the power to read figures is most helpful in the diagnosis by making it at once clear that the inability to learn to read is due to a cerebral and not to an optical cause. Yet it is to be remembered that the extension of the defect to the reading of figures does not exclude the diagnosis of congenital word blindness. In such cases where the defect extends both to words and figures, careful consideration of the other symptoms will lead us to the correct diagnosis. We have found that in all our cases the children had no difficulty in learning to write and were able to copy. So by learning to write, he means handwriting. And they could copy things well. Some of them were good at drawing. They also had no difficulty in recognizing and naming pictorial representations of objects independently of the size of the pictures. These facts themselves would show that the difficulty in learning to read words and figures was not due to defective vision, as otherwise the difficulty would have extended to their learning to write, to copying, to drawing, and to the recognition of the pictures. The first cause of we as we have seen, which parents and teachers naturally think of when they observe the difficulties of the child in learning to read is defective vision. And that is why I saw most of my early cases at the Glasgow Eye Infirmary. A careful consideration of the history of the case will, as a rule, have made us conclude that the difficulty is cerebral and not optical, even before we examine the child's vision. In all cases, however, we must satisfy ourselves by careful examination that the eye is healthy and the visual acuity good before we can pronounce with complete confidence the diagnosis of congenital word blindness. The presence of some ocular defect due either to disease or refractive error does not, however, exclude the possibility of congenital word blindness. There is no reason why these conditions should not coexist with word blindness. But the presence of ocular defect and diminished visual acuity would impart some uncertainty as to the relative importance of these different factors in contributing to the difficulty experienced by the child in learning to read. This uncertainty would of course be cleared up in course of time after the ocular defect had been remedied by appropriate treatment or any refractive error corrected by the prescription of suitable glasses. So what what a fascinating study here about ⁓ when we think about even today, ⁓ one the things ⁓ we is to rule out something. So ⁓ when do have trouble learning to read, a lot of common advice is to get an eye test. And that happened with me, with my daughter. What you know, people said we'll get an eye test, she's not learning how to read. So we did the eye test. And of course it rules ⁓ something out. rules out that vision is fine and it has to be something else then. So it's just fascinating here. Hearing his description of this and how they work through this at that period in time. The diagnosis must, however, in the final resort, be based upon the fact that the difficulty in learning to read is manifestly that of storing up letters and retaining the visual memories of words and letters. In the examination of these children, this deficiency becomes most evident in the contrast afforded between their visual memory for words and letters and their auditory memory for the same. Which we have seen is preserved intact. In cases one and eleven, where the children recognized by sight only a few letters of the alphabet, they could, by appeal to their auditory memory, repeat them all correctly in sequence. In the other cases where they knew the letters, they could all read if allowed to spell aloud the words letter by letter and thus make appeal to their auditory memory, but when they were asked to recognize them by the sense of sight alone, Their defect became manifest and their recognition by sight alone was confined to a few common monosyllabic words. Some could even read, some could read even if allowed to spell silently with the lips, or copy the letters with their hand on the table, thus appealing to the glossokinesthetic and writing centers respectfully. So again, mention of the multimodal approach, multi-sensory approach. of understanding even at this time of that multisensory input from motor movement of the hand, articulation features of the mouth, maybe voicing in the voice box, things like that. So it's just amazing that ⁓ there's roots of ideas, these germs of ideas here. Hence the importance in the examination of these children that no appeal be allowed to the other forms of memory than the visual, because in this way alone is the true character of the defect made manifest. My usual routine in the examination of the child is as follows. And this is cool. He talks about how he examines a child ⁓ does his assessment. I use an ordinary first reading book for this purpose, which of course has only small monosyllabic words and has a few pictures. I first point to a picture, say of a cat, and ask the child what it is. I then ask the child to spell the word, which he probably does quite correctly. This shows me that he has a concrete knowledge of the object and that he has the word registered in his auditory memory. I then take him to the alphabet and I see that he is able to recognize the individual letters, C A T, although I do not ask them in that order as he would then recognize the word from his auditory memory. When I've thus satisfied myself that he knows how to spell the word and also that he recognizes the individual individual letters of which is the word is composed, I then ask him to look at the page and pick out the word by the aid of sight alone. I explained to him that he must not spell it out either aloud or even silently by moving his lips and that he must not move his hands. In this way, no appeal can be made to any other form of memory than the visual. It is here that he breaks down. When restricted to this appeal to the visual center alone, it is found that he knows very few or perhaps none of the words which he can spell correctly, and even recognize when allowed to spell them out letter by letter, and thus appeal to his auditory memory. I I'm wondering spell correctly if he's thinking here, like spell them correctly, like out loud and name the letters. I'm because if he could spell the word, we know from our, you know, current understanding that if the child can spell a word, they can read it. But it seems like he's using some different definition of what spelling correctly is here, because The children are not able to read the word. So I'm not sure what he means here, maybe announcing letter by letter. It is this startling contrast between the efficiency of the auditory memory and the poverty of the visual, thus made evident, which shows that the essential point in this child's case is the difficulty it experiences in registering in its brain the visual memories of words. As has been already pointed out, the receptivity of this visual memory center. And that of all the sensory centers varies a great deal in different individuals owing to different degrees of development of the cerebral areas involved. Hence, it is found at school that the rapidity and ease with which children learn to read by sight vary a great deal. No doubt it is a comparatively common thing to find some who lag behind. Who lag considerably behind their fellows because of their slowness and difficulty in acquiring their visual word memories, but I regard these slight defects as only physiological variations and not to be regarded as pathological conditions, meaning that it's so great that there's a very severe impact and the children aren't learning to read by normal methods, as he stated before. It becomes a source of confusion to apply to such cases as has been done of late the term congenital word blindness, which should be reserved for the really grave degrees of this defect, which manifestly are the result of a pathological condition of the visual memory center, and which should prove refractory to all the ordinary methods of school instruction. Meaning children are learning to read by other by typical instruction, but children with congenital word blindness are not. In the 12 cases recorded in this book, the children had been at school for periods ranging from three to ten years and had yet acquired practically no visual word memories when tested strictly in the manner I have described. In such cases, the defect is so striking as to mark out the affected children as suffering from a pathological condition, meaning from birth, and one that severely affects their learning, and hence to justify us in describing their defect by the special term congenital word blindness. With the possession of a knowledge of the symptoms, there's little difficulty in the diagnosis of congenital word blindness when the cases are met with, since the general picture of the condition stands out as clear-cut and distinct as that of any pathological condition in the whole range of medicine. So he's making a case for himself here that the pure symptoms ⁓ the the clear-cut case is there. This is very well exemplified by the history of the discovery of case three. The father of this child informed me that one of my papers on congenital word blindness having accidentally come into his hands and having read it, he, although without any medical knowledge whatsoever, at once concluded that his child's case belonged to this category. He accordingly sent the child to see me and I confirmed his diagnosis. This was the third case which had come under my observation, and on Reporting it then, I remarked, and he has a quote here, this incident alone shows the importance of a diffusion of knowledge regarding this subject which has hitherto practically received little or no attention. And that's just an amazing note that ⁓ is, probably from his notebooks or something like that that he says because ⁓ fast forward a years we are still working on ⁓ The dissemination of information and having people understand what dyslexia is, its cause, and how to support students. So it's fascinating that this case was brought to him because the father read that study. So if we're thinking about some highlights of this little chapter, we find corollaries between ⁓ historical observations and comments. To parallels that are happening today, right? That dyslexia is not recognized. There's differences ⁓ diagnosing and defining. how do you ⁓ rate or people or adults ⁓ on scale of reading challenge from severe to moderate to mild? Where are they? Called dyslexic, where are they just maybe people who need some extra support and help, right? And do we need terms for each area on that sliding scale? ⁓ he has assessment methods, he had a way to figure out what was going on. ⁓ And, really he relied a lot on spreading And he talked about including in his lectures about congenital word blindness to the students he was teaching at that time to spread the word so people could be aware so they could notice it and look for it. And then, obviously when you can diagnose, you can provide treatment. And prognosis and treatment is indeed the next chapter that we'll read together. It it is the last chapter of the book. So thank you very much for being here for chapter four, listening about diagnosis and keep championing the cause of language for life and teaching literacy through language and structure. Please go to learnliteracy.com if you're interested in what I do. I will have ⁓ OG trainings, structured literacy trainings coming up. I have various cycles of trainings throughout the year and have a bunch of other resources on the website. Thank you very much and see you in the next episode. And please like, share, comment, repost, all that kind of thing, because you sharing this information about dyslexia is helping to fulfill my cause and is helping to fulfill Hinchelwood's cause ⁓ trying to disseminate information about this to everybody. Thank you.