THE CASE OF ANNA H.

In January of 1999, I received the following letter, from a woman I will call Anna H.:

Dear Dr. Sacks,, My (very unusual) problem, in one sentence, and in non-medical terms, is:, I can't read. I can't read music, or anything else., In the ophthalmologist's office, I can read the individual letters on the eye chart down to the last line. But I cannot read words, and music gives me the same problem. I have struggled with this for years, have been to the best doctors, and no one has been able to help., I would be ever so happy and grateful if you could find the time to see me., Sincerely yours,, Anna H.

I phoned Mrs. H.--this seemed to be the thing to do, although I normally would have written back--because although she apparently had no difficulty writing a letter, she had said that she could not read at all. I spoke to her and arranged to see her at the neurology clinic at New York University, where I work.

Mrs. H. came to the clinic soon afterward--a charming, vivacious sixty-seven-year-old woman, with a strong Prague accent--and was able to relate her story in much more detail. She was a pianist, she told me, and the first intimation of anything the matter had come during a concert in 1991. She was performing Mozart piano concertos, and there was a last-minute change in the program, from the nineteenth piano concerto to the twenty-first. But when she flipped open the score of the twenty-first she found it, to her bewilderment, completely unintelligible. Although she saw the staves, the lines, the individual notes, sharp and clear, none of it seemed to hang together, to make sense. But, whatever her eye problem--she assumed the difficulty must have something to do with her eyes--she went on to perform the concerto flawlessly, from memory, and the strange incident was dismissed as "one of those things."

Several months later, the problem recurred, and Mrs. H. found that her ability to read musical scores fluctuated. If she was tired, or had a fever (she had had a bad bout of the flu just before the concert), she could hardly read them at all, but when she was fresh her sight-reading was as swift and easy as ever. But, in general, the problem worsened, and though she continued to teach, to give concerts around the world, and to record, she increasingly depended on her musical memory, her extensive repertoire, since it was now becoming impossible to learn new music by sight. "I used to be a fantastic sight reader," she said, "easily able to play a Mozart concerto by sight, and now I couldn't."

Occasionally, at concerts, there were lapses of memory, though Mrs. H., a brilliant improviser, could usually cover these. When she was at ease, with friends or students, her playing seemed as good as ever. And thus, through inertia, or fear, or a sort of adjustment, it was possible for her to overlook her peculiar problems in reading music, for she had no other visual problems, and her memory and ingenuity still allowed her a full musical life.

In 1994, three years or so after she had first noticed problems reading music, Mrs. H. started to have problems with reading words. Here again, there were good days and bad, and even times when her ability to read seemed to change from moment to moment: a sentence would look strange, "like cuneiform or hieroglyphics" at first; then suddenly it would look fine, and she would have no difficulty reading it. (Similar "alexias," sometimes lasting only a few seconds, can occur in the course of a migraine--I have sometimes had these myself.) Her ability to write, however, was quite unaffected, and she continued to maintain a large correspondence with former students and colleagues scattered throughout the world, though she depended increasingly on her husband to read letters she received, and even to reread her own.