Maisie Holt Gallery

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Occupants of "Hollydene" 1920 - 2003

• 1920  Thomas Henry and Lucy Holt. 1922 Thomas Henry and Lucy Holt
• 1929  Lucy Holt
• 1933  Lucy Holt and Phoebe Fisher
• 1938  Electoral roll George and Nora Earle. 1943 Maisie Holt inherits Hollydene
• 1946  Lucy Holt [Maisie mother] died, buried at St Edmunds. 1947 Electoral Roll Charlie and Elizabeth Taylor
• 1947  Valerie Cowie
• 1948  W.J. Roberts
• 1966  Mary Taylor
• 1970  Maisie Holt
• 1972  Mr. Ffrench
• 1973  Neville Place
• 1974  Ivy Marsden
• 1975  Ronald and Winifred Fellows
• 1976  Julia and Christopher Mew
• 1977 - 2003  Maisie Holt

Unpublished Research Notes

Dyslexia - A Historical Account with Special Reference to England: Date Unknown

Courtesy of St. Bartholomew's Hospital Archives

Awareness and treatment of Word-blindness or dyslexia has had a very checkered history, especially in England. Over eighty years ago an Eye-surgeon in Glasgow, James Hinchelwood, wrote an article in the December copy of the Lancet 1805 on visual memory and. word.-blindness, and stressed the importance of differentiating difficulties due to congenital word blindness, from defects in reading due to other causes.

The following years Dr. Pringle Morgan, a general medical practitioner at Seaford, who had extensive experience of school children, was much impressed by Hinchelwood's work, and published an account of one of his own patients in The British Medical Journal, under the Title " A Case of Congenital Word-Blindness". He described a 14 year old boy of normal intelligence who had great difficulty in reading and spelling, he would write for example scone for song and wichout for without, though he had no difficulty in arithmetic. The examples of strange spelling quoted by Morgan are identical with those found among dyslexics today. In the same year 1396 Dr James Kerr of School Hygine fame, and Medical Officer of Health for the City of Bradford discussed in his Harvard Medical Essay, "exceptions: children" who though otherwise normally intelligent had extreme difficulty with reading and spelling and whose agraphia - or difficulty in dealing with the written word - was often quite unintelligble to their teachers. These papers occasioned much interest and discussion at the time concerning the cause of such abnormalities and Hinchelwood opined that such cases were not as uncommon as might be supposed, but were simply not recognised, the child being thought dull or defective.

Unfortunately interest then seemed to lapse in this country for well over a decade. Around the beginning of the 20th Century, however, interest was aroused in Holland and Germany, while in Denmark a very intelligent and charming little girl, Edith Norrie, the daughter of a doctor had the misfortune to suffer from the disability. She, however, managed to turn it to the Advantage of many others similarly affected, as with great persistence she taught herself to read by means of a specially arranged alphabet - later called the compositing box - I have once had a patient who achieved a somewhat similar attainment - In both cases, however, writing words, or spelling was the practically inseperable difficulty, and up to the time of her death Edith Norrie was unable to really write a letter. In 1939 she had, however, published "Om Ordblinded Kebenhaven" - based on her own experience and her work with small groups of children she had helped at her own flat in Copenhagen. From this work the present Word Blind Institute grew and further development under the Direction of Knud Hermann M.D. Chief Neurologist at the University Hospital of Copenhagen. Hermann was much interested in the publication by H.B.Skygaard in 1942 of some geneological tables showing the incidence of dyslexia in families. Morgan in 1896 had earlier hinted at the possibility of congenital maldevelopment of the gynus angularies in the brain, and in 1950 Dr. Hallgren carried out a study of 20 pairs of twins, when he found the word-blind syndrome to be present 100% in uniovular or monozygotic twins and only 33% in binovulat or dizygotic twins which he took to demonstrate the establishment of genetic transmission. A further genetic survey of 276 cases supported his previous data which he concluded indicated heredity as the decisive factor. From this he estimated the incidence in the normal population to be about 10% and also to be on the increase.

In 1924 an Austrian neuroologist Josef Gerstmann was investigating a peculiar difficulty experienced by some of his patients in distinguishing right and left thus in discriminating between the two sides of their body, or of naming fingers, which he termed finger agnosia, or defective-recognition of fingers by name or number.

These patients also exhibited confusion when attempting to write, such as reversals of the letters d,b; gpq, n.m.v. and also of words, writing t.a.r for rat, and g.r.i.t. for girl etc. They also very often had difficulty in carrying out calculations and in reading music notation. This condition occurred in patients who suffered from a disease in the lobe of parietal hemisphere of the brain but this nevertheless corresponded so closely with the difficulties experienced by word-blind children who are not brain damaged that Hermann, writing in Psychiatric Neurological 1958 asks "Is Congenital Word-Blindness Type of Gerstmans Syndrome" and suggests that both conditions stem from the same basic disturbance.

This premise, together with an account of many actual cases together treated at the Institute in Copenhagen, are discussed at length by Hermann in his book "Reading Disabilities, a Medical Study of Word-Blindness and Related Handicaps " published in 1959.

Work had also been going on in America and Samuel Torry Orton, who later became Professor of Neurology in the University of Colombia and who had previously worked with word-blind children in Iowa, received a Rockfeller 2year grant to organisea full-scale research on the condition.

He studied a specific characteristic or reading impairment which these children exhibited namely the instability in recognition, recall and orientation of letters and the order of letters in words, to which he gave the name "strephosymbolic" which means twisted symbols. This to him was of extreme importance as it suggested an intrinsic difficulty of a special nature in the association processes of the brain. He also sought to explain it on the basis of analegy with work on his brain-damaged patients who had suffered loss of, or difficulty in language through disease or injury to the dominent hemisphere. This is usually the opposite to the master hand. Hence in right handed people the association processes are on the left side, where as in left handed people the dominent hemisphere would be the right side of the brain.

These patients also exhibited a tendency to reverse letters and words, produce bizarre spelling and mirror writing (this occurs when a word appears as looked at through a mirror, for example y.a.w. could be written for may). He consulted with Sir Henry Head in England, who was the leading authority at this time on the brain and its functions. He came to the conclusion that a "physiological state of ambiguous occipital dominence was largely responsible, and that a faulty patterning of brain function in varying grades of severity occurred". This could be also partly due to late maturation of the parts involved.

Orton's work in this field is therefore chiefly known for his theory of lateral dominence, and in certain variations of a condition of crossed laterality, as when a person is, for example, left eyed, right handed and mixed footed and any other combinations.

He worked closely with two gifted teachers, Anna Gillingham and Bessie Stillman to evolve a method suitable for helping these children.

During this period few people in England seemed aware of what was going on in this field in either Denmark or America. Perhaps this is not so astonishing as many people in America were totally unaware of the work being carried out in their own country, also Sweden had little knowledge of the work in Denmark.

In fact, one might almost say that in England Dr. McDonald-Critchley Consultant-neurologist to King's College Hospital and the National Hospital Queens Square, London, was a lone voice crying in the wilderness. He both recognised and diagnosed this difficulty, and wrote and lectured on it trying to make as many people aware of it as possible. He must have rescued many children from being deemed M.D. and relogated to Mental Institutions, or punished (often with great severity) by teachers and parents for laziness and inattention. He was a brilliant and convincing speaker and I recall one occasion when he had addressed a large hall full of teachers and had completely carried them with him, the meeting practically rose up as one body and said "Tell us what we must do doctor", "Do", replied Critchley, "Do?, you can't do anything". The audience fell the back somewhat stunned and much deflated. The truth was the actual attempt to teach reading never comes within the neurologists province anymore than neurologic diagnosis comes within that of the teacher. The gap between research and methods of putting it into practice has always been the most difficult to bridge. Apart from Terry Orton who worked with teachers and enlisted the help of their teaching skills.

Dr. McDonald Critchley's position on this subject is clearly set out in "Developmental. Dyslexia 1954 pub by Will;Heinmann Medical Books and the Dyslexic Child" 1969, where he affirms dyslexia to be an entity, nosologically apart from other factors governing types of reading difficulties. It may be said "to rest on four premises
1) Persistence into Adulthood (if not treated).
2) The peculiar and specific nature of the errors in the reading and writing.
3) The familiar incidence.
4) The frequent association with other symbol defects".

The term word-blind and dyslexia have been used interchangable in this discussion, as the original term was Word-blind, whereas the accepted term at the moment seems to be dyslexia.

This is due to the fear held by some, that the word 'blind' may mislead people into thinking it is a condition of faulty eye-sight. Dyslexia really means imperfectly developed reading (and spelling) skills, but not total absence of ability to deal with words as in a brain lesions.

A further impetus in England occurred in this field, especially on the practical side of remedial work with children, though the interest of Dr. E.B. Strauss, who in 1938 was appointed Head of the Department of Psychological Medicine at St. Bartholomews Hospital, London. He had had considerable experience on the continent and worked closely with Sir Henry Head. He was also much influenced by Ernst Knetchmer's work in Austria on physiological bodily types. At this time he was also unaware of the ignorance and lapse of interest in this condition in England, but recognised that certain patients who were referred to him for a variety of reasons were also suffering from word blindness. He saw this condition as stated in his book "Psychiatry in the Modern World" 1958 as "a congenital brain anomaly which for the most part depends on the inability to retain the image of the word. Each time a word is seen, it is as though it were viewed for the first time many attempts have been made to obtain a satisfactory definition and Dr. McDonald Critchley was largely instrumental in helping to formulate one acceptable to the World Federation of Neurological Research Group which met in 1973.

They suggested.:-
1) Specific Developmental Dyslexia
A disorder manifested by difficulties in learning to read despite conventional learning instruction, adequate intelligence, and socio-cultural opportunity. It is dependent upon fundamental cognitive disabilities which were frequently of constitutional origin.
2) Dyslexia
A disorder in children, who, despite conventional classroom experience, failto attain the language skills of reading, writing and spelling commensurable with their intellectual abilities.

In 1949 I was appointed Medical Psychologist to the department of Pyschological Medicine at Barts, an one day Dr. Strauss brought along a 12 year old boy, who was on probation to him for truancy. The implication of this is obvious he felt that school was too difficult and wretched for him to face any longer. Strauss said to his somewhat startled psychologist "This boy is word-blind, what can we do for him?".

I was aware that such a condition existed. nevertheless I had not thought much about it, considering like so many other people that it did not no come within my province, and gave a reply somewhat similar to that of Dr. Critchley "I would not think we could do anything --- well--- I would need to be seen once a day at least --- there were not that many clinics --- I only come once a week --- Strauss could not have agreed more, then he gave one of his most charming smiles (of which one learnt to beware ) and said "Well, just see if there is anything you can do for this patient", and departed. The boy was reassured and given an appointment for the following week.

It so happened that the writer had had a very varied background, having researched on the neurological side with Professor Sir Grafton Elliot-Smith at University College London University and with Professor Sir Frederick Bartlett on visual perception at Cambridge University, and had also worked in the Educational field teaching children and lecturing to students in Education and psychology. Hence with Strauss's challenge thrown at she went thoughtfully into an empty treatment room, trying to draw on what knew, and to formulate for herself what I understood by word blindness. It seemed necessary try and decide what it was that needed treatment, before starting trying to do so. I sat there for a long time, and finally realised it had become dark, so I then went home pulled various books out, looking up all kinds of references. I finally came to the conclusion that the condition was some form of Aphasia - a view I still hold. Speaking very broadly, aphasia means loss of, or something missing, or (with the same practial effect) something not functioning.

aking an anologous concrete example, if there is a river barring ones path, or a chasm, one has either to throw a bridge across, or find a way around. I asked myself what sort of bridge could be built for these children? What way around could be found for them?

The work that Fred Schonell - later Professor of Psychology in Australia - and I had carried out, trying to spot difficulties and help backward children, before he wrote his book "Backwardness in Basic Subjects" also came to mind especially his book "Diagnosis of individual Difficulties in Arithmetic" 1937. The salient point in this was the carefully graded step by step approach for all the four rules

1+1=2 0+0=0 2+2=4
1+2=3 2+3=5 etc.

When the child reached the point where he made a mistake, it indicated his type of difficulty and level of achievement in that series.

Hence it seemed to me that a similar type of approach was needed in the reading sphere to bridge the gap of whatever type was there, and not only that but one where no steps were left out, but one that needed constant reinforcement by means of much repetition, due as Strauss had pointed out, to the very short visual memory these children had for this type of material.

As St. Bartholomews is a General Hospital, all the original patients seen for this kind of help were referred for any treason other than a school difficulty with reading and spelling. They were referred for all kinds of emotional and physical difficulties such as night terrors, stamma, asthma, vomiting, diarrhoea, ennuresis, encopresis alopecia etc.

Many of them were found to be also dyslexic and when treated for this disability the referring symptom was found to be secondary, simply manifesting in this way, but having its roots in a state of anxiety, frustration, anger or despair. As treatment for the dyslexic condition, with resultant success progressed and the children gradually became confident, assured and happy and able to take their proper place in school work with the others in their class, the referring symptoms disappeared, nor did they reappear again. The great need, therefore, was to make this more widely known and recognised and to back up what we were doing in England by comparing work in other countries where special Institutions for treatment of the difficulty and training of students had been set up. To this end a Conference was finally organised at Barts Hospital This was made possible by the interest and Head of the Childrens Department Dr. White Franklin many of whose patients had been treated at the hospital. He was also the Chairman of a Charity, The Childrens Aid Association and he managed to interest the Committee in such a project and funds were subscribed for travelling expenses accommodation and fees for lectures from Denmark, America and France. It was hoped that this would stimulate interest and convince the public of the existence and possibility of treatment for those conditinns. Without this help such a project was impossible due to the difficulty of obtaining money for something which had not recognised organisation and which few people knew anything about.

Invitations were sent out to those likely to be interested such as Medical Officers of Health, Directors of Education, Lecturers in Training Colleges, Heads of Schools some teachers, and parents to attend the 2-day symposium. The lectures and discussions were all recorded on tanoy after which the material was edited to form a Report entitled "Word Blindness or Specific Developmental Dyslexia" published 1962. It unfortunately went out of print fairly quickly and it [is] no longer obtainable.

The Conference was well pressed, and articles in various papers on the subject have appeared intermittently ever since.. Also demands for lectures and discussion on the Radio and T.V. helped to spread information. Besides arousing Much interest an unbelieveable storm of abuse and opposition was also aroused, chiefly from teachers and Educational Psychologists who seemed to feel that their ability in their own particular field was being critisised or attacked. Such is the conservatism of the English.

On the other hand the Hospital now began to be beseiged with enquiries and requests for treatment and lectures.

As there was only one person to deal with all this, the waiting list was at one two and a half years long. Many children were now referred directly to the Hospital by their doctor for suspected word blindness. They came from all over the country, as far afield as Lancashire, Wales, the North of England, Devon and Cornwall and even from foreign countries. They travelled to the Hospital once a week, for as long as was necessary, for one period of 45 minutes treatment. This was usually for 18 months to 2 years.

I now concentrated on this work only in,the hospital and had six clinics a week, also in 1969 two students were taken on as trainees. They were qualified sspeech therapists and one had a degree in Education.

Gradually various centres and attempts by different people to help these children have sprung up, together with a number of parent associations, and pressure groups.

The greatest difficulty has always been to procure trained specialists.