Recovery from Early Blindness

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R L Gregory and J G Wallace

Reproduced from Experimental Psychology Society Monograph No. 2 1963


Appendix

Correspondence on the Case

A correspondence took place between Mr. Hirtenstein, Dr. von Senden (who is still interested in the problem though he has not been active in the field for many years) [Footnote 16.], and ourselves. Since quite a number of points arise in the correspondence we include it here, publishing the letters in full except for small passages of a conventional nature, which would not be of general interest.

First we have a letter from Dr. von Senden to Mr. Hirtenstein, dated 14th May, 1959. This letter has several points of interest. It gives Dr. von Senden's reaction to the newspaper accounts of the case. Since Dr. von Senden quotes the relevant passages we do not give them separately here.

14th May, 1959
Dear Dr. Hirtenstein,
I still have to thank you for your kind lines of the 3rd February. Some days before Miss Schweppe had already sent to me a copy of your letter to her of the 16th January which was especially important, since you had written to her: "He had no difficulty in recognising shapes, faces and objects with which he was tactually familiar whilst blind. This he explains by saying that he had a very accurate mental picture of things he could feel."
If he used the word "picture" it is the question whether he used it like other blinds do without an idea what this word means to the seeing person, or with an at least partially influenced by visual experiences, conception of space and shape.
With regard to the hand movements which he could perceive prior to operation on the last operated eye, he will have perceived them only as a change of more or less light, without a change of "direction". But if you write that he had an accurate light projection on the first operated eye then he must have had to my opinion also a certain idea of a visual "direction", that a light can change this direction independent of his own behaviour. And if you have moved the light beyond the reach of his arm he could get conscious of the fact that visual objects cause sensations to the visual organ without touching it, that they are remote in a "space", this otherwise being unconceivable for the blind. He can have possessed even a certain ability to discern some colour shades, e.g. the difference of the normal eye-lid grey of a closed eye from some more yellow or brown or even red shades.
In this regard I would like to know (a) whether your patient had a nystagmus ante operation, (b) how he had pointed out before operation the different positions of the light, by following it with the whole head or by showing at it with his arm?
When the journalist of the Daily Express interviewed him Mr. B. told him with regard to his wife: "She was just as bonny as I thought she would be. My wife had given me a word picture of what the world was like and I found out that buses I travelled on and cars looked just as I imagined. Lorries seemed very strange." Here the word "picture" seems to have no optical component. Therefore I presume that the "mental picture" as well as the "word picture" means what I have called in my book the tactual schema. Mr. B. had no doubt compared before operation, e.g. his own rather tall figure with that of his wife by feeling. The result of this feeling act could be with regard to his wife "long and thin" or "short and roundish". I find it not so astonishing that the first visual impression which he got of his wife confirmed in his mind anyhow this gross tactual schema; especially if he has had at this moment already a certain experience in the interpretation of visual impressions, if his wife has not been among the very first "objects" presented to his new sense.
In the meantime, Mr. Merrick Winn of the Daily Express has published a series of articles after having spent 10 days with Mr. B., together with Mr. R. L. Gregory and Miss Jean Wallace of the University of Cambridge, two months after his first act of seeing. I have no idea how Mr. Winn has attained his very dissolving pictures which shall adequately show how your patient could really see at this period, according to the physiological status of his eyes. But if he could get indeed no sharper images from the visual things I find therein a confirmation of my standpoint that he could get at the first aspect of his wife no more than confirmation of his tactual schema "long and thin" or "short and round ".
In virtue of my examination of 66 cases of operated blind-born patients described in the literature I had come to the conclusion that a blindborn - by means of his tactual sensations - can neither get an idea of the deep space nor a conception of the shape of things, which one can reasonably design as such; and that he will get post-operation this spatial idea immediately but the comprehension of shape only after a more or less long lasting learn process. On reading the publications about your case one has the impression as if space and shape were (so to say) presented to him without his doing in his first act of vision, in spite of his very distracted vision. If this would be true one could only wonder why Mr. B. should show such an antipathy against any practical use of his new sense; if it comes not from an anxiety for eventual consequences for his economical life (e.g. loss of a pension).
Very significant in the report of Mr. Winn was the matter with a fork: "I'd pick up a fork, feel it and remembering how a fork felt when I was blind I could say: 'This is a fork'. Then I had to learn to remember it the next time I saw it". Without feeling the corresponding visual object before he cannot say what it is. I dare suppose that it was a similar proceeding in your tests with him: a visual aspect, a feeling act for control, say what it is and then impress the visual image upon his mind ("learn to remember it the next time".) You seem to have wondered how quickly this proceeding had a good success with Mr. B. But according to the report of Mr. Winn he must have had still infinite difficulties in this later period of his learning to see.
Mr Winn describes your patient as a cheerful, very good-natured and courteous man - which is confirmed by the picture of Mr. B. in the Daily Express - who likes to do any favour to his fellow-creatures if he can. Since you - and probably some other surgeons - had made all imaginable efforts with him and had to surmount so many obstacles for about 3 years he felt a deep gratitude for you and had the best will not to undeceive you. Therefore he showed during your tests full interest and full energy to support your efforts by his own efforts "to learn to remember as soon as possible the visual images, and tried to declare to you his success in his regard by his 'mental pictures'." When Mr. Winn spared no pains with him and was rather disappointed at the end Mr. B. was in the same crisis which is reported in nearly all cases and which can be surmounted only by full moral energy of the patient.
After all I have not the impression that it has been really of visual cognising of a former tactually gained "mental picture" or "word picture", but a confirmation of a tactual schema after feeling control of the respective visual object.
The first visual object he caught sight of was your face of which he could not have a "mental picture". In this regard he has told Mr. Winn "I saw a dark shape with a bump sticking out and heard a voice, so I felt my nose and guessed the bump was a nose. Then I knew if this was a nose I was seeing a face". I find this description very exact and conclusive. Above all it has been his consciousness of the situation which led him, which generally is highly developed in all blind persons. He knew your voice already before operation i when he heard it post-operational close to him the situation was quite clear for him. If you use perhaps a well-scented hairwater this would have been a further confirmation for him. The first visual impression which excited his reflection (probably as being the nearest and the lightest object) was the "bump" in the middle of a darker surface which he called "shape" as he knew this word pre-operatively from a seeing person. He knew that a nose is "in the middle of a face", asked himself whether this bump could be a nose, controlled his doubt by feeling his own nose. But even then he felt not quite sure but "guessed" that it was indeed a nose, and concluded that the whole surface (if his guessing was right) must be your face. Thus the seeing of the "bump" was not a recognising of a "mental picture" "nose" but partially a knowledge of the situation, partially a real seeing act, partially a controlling tactual proceeding and for the rest a mental conclusion.
Now Miss Schweppe and the publisher of the English translation mean that there is an essential contrast between the declaration of your patient with regard to the "mental picture" and the conclusion in my book that a man born blind cannot get any kind of a shape-conception. Therefore she has suggested to me that I should (1) ask Mr. B. himself by letter, (2) declare in the Preface of the English edition of my book for which reason the result of your investigations is such a contrast to my own conclusions.
(Ad 1) I cannot imagine that Mr. B. would be delighted to receive a letter from an unknown foreigner or could be encouraged thereby in his efforts to improve his vision. I am afraid indeed to increase by my questions his feeling of embarrassment and misery. And if he would be inclined to reply then I must doubt whether his declarations will have a greater value, since he scarcely can understand the special point of my questions. In this respect it would be a more promising way if you - having his full confidence - would try to elucidate this contrast, if you believe that this would be possible, and if you have the time for it.
(Ad 2) I have only tried to evaluate in my book the reports of those who have executed such an operation on a man born blind without having myself an occasion to occupy myself with such a blindborn, neither before nor after an operation. Therefore I feel myself not competent enough to express an opinion with regard to your case of which I know too little, and would do it only if you mean that it would be favourable to mention your case in the Preface.
Nevertheless you will understand that it is my personal interest to clear up this seeming contrast resp. to hear your opinion about it. This is the principal purpose of my letter. Therefore I beg your pardon if I have still some more questions:
(1) How long have you occupied yourself with Mr. B. before the first operation? Have you had an opportunity to examine whether he has had more than a mere knowledge about space and shape, as communicated to the blind by seeing persons?
(2) What has happened in the 3 weeks between the first and the second operation with regard to the training of his seeing? It is mentioned somewhere that your patient has visited other patients within the hospital and has walked about in the hospital garden in this period. Has he made his experiences under control or without it?
(3) In your letter to me you write that the psychological aspect following the operation (the second op.?) was investigated by Mr. R. L. Gregory of Cambridge University. In this respect I would like to know how long after the operation Mr. Gregory has seen your patient the first time. Had you given him information before the operation or was he induced only by the first notice in the Daily Telegraph? Was it possible in your opinion to reconstruct at that moment truly the whole development of his learning to see? I have the impression that Mr. Gregory cannot say out much more than Mr. Winn in his press articles.
I am regretting, dear Mr. Hirtenstein that this letter has become so long and that I waste your time immoderately. But I would be very obliged to you for a reply which can be so much shorter. If you want to read the conclusions of my book in English please ask Miss Schweppe to send them to you. For I believe that the contrast is only in the words but not in the real state of your case, as I have tried to explain above.
With kindest regards,
Yours sincerely,
Signed M. von Senden.

Secondly, we have Mr. Hirtenstein's reply to the letter quoted above, dated 24th November, 1959. This letter gives several details concerning both the eyes and also S.B.'s visual ability as observed by Mr. Hirtenstein.

24th Nov., 1959
Dear Dr. von Senden,
I apologise for not having written to you sooner, but your letter dated 14th May never reached me, and I have just received a copy of it from Miss Schweppe. [ Footnote 17. ]
As to your questions: -
(1) S.B. had no nystagmus before or after the operation.
(2) The light projection before the operation was tested by a pencil-light, and the patient indicated with his hand from which direction the source of light came. This was quite accurate in his case, with both eyes. Moreover, trans-scleral retinal stimulation produced a clear pattern of retinal vessels subjectively, and this was the main reason that I decided to operate on him.
(3) S.B. was referred to me by a fellow-ophthalmologist, and I knew the patient for a few weeks prior to his first operation. I had no means of testing him about space and shape of objects before the operation.
(4) As soon as the operated eye was uncovered after the first operation, the patient's ability to assimilate new visual sensations was truly remarkable. He was able to learn colours quickly and recognise simple objects with which he was familiar through tactile sensation, (chairs, tables, doors, etc.). He walked through the Hospital corridors without difficulty, and avoided objects and subjects in his path. It is interesting that his visual re-education still continues; every time I see him in my Out-patient Department he seems to be more confident in his walking and ability to "get around" generally. He now travels a considerable distance by train and bus to visit me at the Hospital from his home.
(5) Mr. Gregory saw the patient only after the second operation; he learnt about the case from the daily newspapers, and I invited him to examine SB. whilst still in the hospital. He spent a considerable time with the patient, and he is just about to publish his findings. I think it would be perhaps worthwhile for you to get in touch with him, as he would, I'm sure, give you all the information you require about this case.
Yours sincerely,
Signed: A. Hirtenstein.

Thirdly, we give extracts from a letter written by one of us to Dr. von Senden. We include it here because it gives an account of our general impression of S.B. at that time (November, 1959) before later events had a chance to change and perhaps dull our impressions. (This letter was written before we had read Dr. von Senden's book, though we knew of his work and had read accounts of it.)

Psychological Laboratory,
Downing Place,
Cambridge.
30th November, 1959.
Dear Professor von Senden,
We found that S.B. has a strong personality, and is not suggestible.
He had difficulty in naming some colours, in particular yellow, but could name most objects and judge distances accurately. He made very little from pictures, or large clear colour photographs projected on a screen.
We gave him a large number of perceptual tests, including reversible figures (the Necker cube for example) and we also gave him the Ishihara colour test. This produced a most interesting result, for he was able to read correctly every one of the numbers represented by the coloured dots seen by normal observers. What struck us was not so much that his colour discrimination was normal on this test, as that he was able to recognise block letters and figures tactually, and it is quite clear that this knowledge had transferred to sight without special learning being required. This was the most definite and the most striking finding of our examination.
He did not seem to get any depth from perspective drawings, or to get reversals of Necker cubes, although his visual acuity was probably adequate. (It is worth pointing out that one can get reversals of Necker cubes when the retinal image is degenerated, by viewing through highly astigmatic lenses).
The patient showed no nystagmus at any time I examined him. His eye movements were far from normal, however, for his "searching" or "scanning" movements were infrequent. He did not look round to the source of a noise anything like as often as normal, and he did not look at people's faces. He could however recognise people by the way they moved and from their clothes, or so he informed me.
As for the "psychological" reason why he became upset after the operation, my own opinion is that while blind he had managed exceptionally well. He went for bicycle rides with companions; he tended his garden and was something of a craftsman. Once he regained his sight, he felt, I think, up against the competition of sighted people. Further, he had throughout his life been treated with special consideration by his family and friends. After the operation this became modified. To his workmates he became something extraordinary and they would play small jokes on him. He must feel that by being blind for more than 50 years he has lost a great deal, not only sensory experience, but perhaps more important the chance of holding an interesting and well paid job. One must remember that he is an intelligent man with a strong personality. He would undoubtedly have risen above the social position into which he was born if he had not been handicapped, and he must realise this. I should add that this last point was not made explicitly by him; I give it as a reasonable inference from the evidence which is available to me.
With regard to his first "perception" of the surgeon: he told me that the newspaper account was wrong. His account is that he heard Mr. Hirtenstein's face and looking toward him (by Sound) "saw" a confusion of colours, and knew that this must be Mr. Hirtenstein's face. (He may, of course, have been wearing a mask). He was able, within hours, to name many objects correctly, and would get up early in the morning to watch cars passing on the street below.
He tended to misjudge the size of objects he had not been able to touch or walk along. For example, a bus looked too high but the right length.
Yours sincerely,
Signed: R. L. Gregory.

Before replying to this letter, Dr. von Senden wrote to the Editor responsible for the English translation of his book "Space and Sight" commenting on a report of our case appearing in the Daily Express.

Hamburg, 12th December, 1959
According to the first short report of the Daily Express of the 7th January, 1959, Mr. B. had told his interviewer that his wife "was just as bonny as I thought she would be. My wife had given me a word picture of what the world was like and I found out that buses I travelled on and cars looked just as I imagined" . . . "When the doctor removed the pad I could see his black hair and his face."
People who read those lines were glad that learning to see apparently was a rather simple affair. But those who knew my book were surprised, having the impression that these assertions of Mr. B. were contradictory to the conclusions which I had drawn from my studying all comparable cases reported in the literature.
The question is how the words of Mr. B. must be interpreted, whether the circumstances he tried to express with these words corresponded with the signification which seeing people adjudge to them. A person born blind learns all words of his language from seeing persons but cannot know which sensual or mental content they have for a seeing person. He uses all these words indeed, but as a seeing person cannot explain to a blind one much about things, a blind person cannot explain exactly (by means of the words of the seeing world) to a seeing person what occurs to him in his daily life. The same words have a different sense for these two categories of human creatures.
As Mr. Hirtenstein - who has executed the two operations on him - wrote to me he has "had no means of testing him about space and shape of objects before the operation". According to him the patient had a very poor vision but could indicate before the operation accurately the direction of a little pencil light with his hand! This fact indicates that Mr. B. has had already before operation a certain idea of a visual "direction"; he had been aware that a light can change this direction independent of his own behaviour, how it is when a light "moves". Thus he must (or at least could) have become conscious pre-operatively of the fact that visual objects cause sensations to the visual organ without any participation of the sense of touch, and could conclude that they are remote in a deep "space". Therefore we may say that "space" was nothing fundamentally new to him before operation. As I have shown in my book every operated blindborn has the space immediately post-operatively without any education for this purpose, but B. has had it already earlier.
When Mr. Gregory - as he wrote to me the other day - asked him later how it really has been when he used his new sight for the first time after the operation he has answered that the newspaper account was wrong! His own account is that he "heard Mr. Hirtenstein's voice, and looking toward him (by sound) 'saw' a confusion of colours, and knew that this must be Mr. Hirtenstein's face" (who may, of course, have been wearing a mask in this moment). This description is quite analogous to all other descriptions in the literature, as mentioned in my book.
This report of Mr. Gregory is very interesting indeed also in many other points. But as he intends to publish something about this case I don't want to anticipate him. But as he has accompanied Mr. Winn and Mr. B. for several days during their stay in London I like to allude to the remark in the very fine report in the Daily Express (two months after the operation) where Mr. Winn says: "S.B. was still basically a blind man. He could see but did not care. All this time he had been 'seeing' largely not to let us down"; and on another spot: "He never knew my face properly in all these 10 days we were together but he knew me instantly by my voice, clothes, walk, even breathing". Therefore I agree with Mr. Hirtenstein and do not wonder if he writes that B. "was able to learn colours quickly and recognise simple objects with which he was familiar through tactile sensation (chairs, tables, doors, etc.)". But I am sure that in these acts of "recognising" sight was participating only a very little. A hospital room contains only a small number of furniture objects. An intelligent blind man like Mr. B. has no difficulty in building up for his own use the tactual schema of the room within the first 24 hours. He can exactly indicate then where the different objects are, which name they have, etc. And if "he walked through the Hospital corridors without difficulty and avoided objects and subjects in his path" there is nothing extraordinary in this, especially if we remember that during the 3 weeks between the two operations he could attain any kind of visual experiences without a scientific control, that he walked alone in the garden and had passed the Christmas days in his own home.
With regard to his assertion that his wife was "as bonny as I thought she would be" I may remark that this word "bonny" to my opinion has no component of space or shape. It merely signifies that the aspect as well as the tactile feeling causes agreeable sensations. B. himself declared to Mr. Winn: "I always felt in my own way that women were lovely, but now I can see them I think they're ugly". Also for this "lovely feeling" we have parallels in some other cases.
Concerning the bus I can imagine that he has had indeed a certain conception of it preoperatively. When he awaited (very very often in his long life) on the halting-place of his bus he could hear the typical rolling noise of the arriving vehicle and that this noise ceased together with the stopping of the bus; he could see that the diffused brightness surrounding his eyes before the arrival of the bus was darkened when it is quite near to him and that the brightness eventually reappeared when the bus had passed his place; and he could number how long the light was darkened by the outrolling bus. Having got these three different dates and correlating them to each other he could have got to a certain degree the idea what it means what seeing people call the "movement" of a vehicle, what seeing people call the "length" of an object, and that one can measure "breadth" and "height" on a similar way. Thus he could imagine already pre-operatively a "mental picture" of a bus. But it is quite clear that in the forming of this or other "mental pictures" the visual sense has participated a great deal.
Therefore I am sure that this case is not fundamentally different from the other known cases, and that this case does not alter the conclusions in my book.
Signed: M. von Senden.

The relevant parts of Dr. von Senden's reply were as follows : -

Hamburg-Othmarschen,
Schwindstr, 13.
14th December, 1959
Dear Mr. Gregory,
What has equally struck me as yourself is your test with the block letters and numbers. Had anybody punched out them for his personal use in wood or some other material? Block letters and numbers have indeed a very pregnant form and are easily distinguishable from each other. Also in this regard it would be very interesting to ask him anew how he has proceeded to transfer from touch to vision. Have you observed perhaps that he has made some movements with his finger-tips as if he followed out mentally (perhaps with closed eyes) the outlines of the block letters which he saw and recognised their name by controlling the well known tactual sequence of the resp. letter?
Very interesting also are his drawings. What order had he got when he made these drawings? Was he to draw for instance a table out of memory as a proof for the "word picture" which he had affirmed to possess from touch? Or was he drawing an object he could see in this moment? [ Footnote 18.]
In any case I may assure you that I shall be very pleased to read some day your publication about this case, don't forget it please!
With kindest regards,
Yours sincerely,
Signed: M. von Senden

We have presented all the evidence available at this time, and it is now unlikely that more will ever be learned. We hope that the material has been presented in a form which makes it possible for the reader to form his own opinions as to what, if anything, this and other cases can contribute to our understanding of human perception and its development.

We feel privileged to have had the opportunity of studying this case, and feel grateful to all those - including poor S.B. - who made it possible.


 

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