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 To Ayden, Ansel, Ashley, and Abigail,
and their teachers—past, present, and future
About the Authors
Shane Templeton is Foundation Professor Emeritus of Literacy
Studies, University of Nevada, Reno. A former classroom
teacher at the primary and secondary levels, he has focused his
research on the development of orthographic and vocabulary
knowledge. He has written several books on the teaching and
learning of reading and language arts and is a member of the
Usage Panel of the American Heritage Dictionary.

Kristin M. Gehsmann is Associate Professor of Education

and Coordinator of the Master’s in Reading Concentration
at Saint Michael’s College in Colchester, Vermont. A former
elementary school teacher and PreK–12 literacy consultant,
she conducts research on narrowing the achievement gap
in high-poverty communities, and bringing research-based
practices to scale through ongoing professional development.
Brief Contents
Chapter 1: The Foundations of Literacy Instruction 1

Chapter 2: Language, Thought, and Literacy Development 32

Chapter 3: Effective Literacy Instruction: Principles and Practices 71

Chapter 4: Prioritizing Student-Centered Assessment and Instruction  112

Chapter 5: Foundations of Language and Literacy Instruction

for English Learners 153

Chapter 6: Emergent Literacy: Engaging the World of Print, Developing

Oral Language, and Vocabulary 173

Chapter 7: Beginning Conventional Reading and Writing 219

Chapter 8: Transitional Reading and Writing 270

Chapter 9: Intermediate Reading and Writing 315

Chapter 10: Skillful Literacy: Developing Critical Engagements

with Texts, Language, and Vocabulary 364

Chapter 11: Response to Instruction: Intervention and Acceleration

for Readers Who Struggle 414

vii
This page intentionally left blank
Contents
Preface xvii
Chapter 1:
The Foundations of Literacy Instruction 1
What Is “Literacy”? 3
The Importance of Print and Digital
Literacy 4
� S trategies for the Classroom: Is There One
“Best Method” for Teaching Reading? 5
The Many Faces of Literacy 5
The Literacy Essentials 6
The Literacy Essentials: The “What” of Effective
Instruction 7
� The Language of Your Instruction: Schema
Theory and Comprehension 8
� Children’s Literature Connection: Historical
Fiction – Al Capone Does My Shirts 12
� The Language of Your Instruction: Standards
and Their Influence 18
The Literacy Essentials from a Developmental
Perspective 18
Stages of Literacy Development 19
The Sociocultural Contexts of Literacy
Learning 24
Learning Cultural Practices 24
Developing a Culture of the Classroom 25
� The Language of Your Instruction: Talking
With, not Just To, Your Students 26
 evels of Support and the Gradual Release
L First Grade) 55
of Responsibility Model 26
Gradual Release of Responsibility Model 27
Differentiating Instruction 27
Chapter Summary 28
Suggested Extension Activities 28
Recommended Professional
Resources 29
Online Resources 29
How to Use This Book 30
Chapter 2:
Language, Thought, and Literacy
Development 32
Characteristics of Oral Language 34
Phonological Knowledge 34
Semantic Knowledge 35
Syntactic Knowledge 37
Pragmatic Knowledge 37
Characteristics of Thought 38
Characteristics of Written Language:
Word Level 40
Correspondences at the Level of Sound: Alphabet
and Pattern 41
Correspondences at the Level of Meaning:
Morphology 43
 haracteristics of Written Language:
C
Text Level 44
What Makes Texts Complex? 46
� T he Language of Your Instruction:
Why the Emphasis on Text Complexity? 47
� C hildren’s and Young Adults’ Literature
Connection: Reading for Boys and Young
Adult Males 49
The Developmental Model of Literacy 49
Understanding the Developmental Continuum 49
Emergent Reading and Writing (Preschool to Early
� S trategies for the Classroom: Scaffolding
Young Children’s Speech Discrimination 57
Beginning Conventional Reading and Writing
(Kindergarten to Early Grade 2) 58
Transitional Reading and Writing (Late Grade
1 to Mid-Grade 4) 60
ix
x Contents

Intermediate Reading and Writing (Grade 3 through Small Group Reading Instruction 87
Grade 8) 62
� A
 ccommodating English Learners: Creating
Skillful Reading and Writing (Grade 6 and Above) 65 an Environment that Supports Risk Taking
Chapter Summary 68 and Collaboration 90
Suggested Extension Activities 69
Independent Reading Time: Time Spent
Recommended Professional Resources 69 Reading 90
Online Resources 70 Managing Small Group Instruction and Independent
Reading across the Week 92
Chapter 3: Wrapping Up the Workshop: Share
Effective Literacy Instruction: Principles Time 93
and Practices 71 Writing Workshop: An Overview 93
Characteristics of Highly Effective Teachers 73 Mentor Texts 94
Mini-Lessons 94
� T he Language of Your Instruction: Building
Independent Writing Practice 95
a Community of Thoughtful Communicators
and Deep Thinkers 74 Small Group Writing Instruction
and Conferring 95
Your Classroom Environment and Students’ Share 97
Motivation to Learn 74
Word Study Instruction: An Overview 97
Organizing Your Classroom Environment 75
Sorting 98
A Print-Rich Environment 75
Student Talk and Reflection 99
Classroom Management and Student
Engagement 77 Different Types of Sorts 99
Conclusion: Your Classroom Environment 77 Sorting Throughout the Week 102
Extension Activities 103
� Reading and Writing in Digital Contexts:
Using Multiple Literacies in Your Classroom 78 Managing Word Study Instruction Across
the Week 107
Your Classroom Library 78 Your Word Study Lesson Plan Sequence 107
Quantity of Books 79 Word Study Assessment 108
Quality and Variety of Books 79 Individual Learning Contracts 108
� S trategies for the Classroom: To Level or Not to Comprehensive Core Reading
Level, That Is the Question 80 Programs 108

Your Daily Literacy Block 81 Chapter Summary 110

Suggested Extension Activities 110
� W
 orking and Collaborating: The Role
of Paraprofessionals in Your Literacy Block 81 Recommended Professional Resources 111
Online Resources 111
Reading Workshop: An Overview 82
Managing Your Time in Reading Workshop 82
Chapter 4:
Shared Reading 82
Prioritizing Student-Centered Assessment
Interactive Read-Aloud 83
and Instruction 112
� C hildren’s Literature Connection: Books A Brief and Recent History of Assessment
to Start the School Year 84 and School Reform 115
Mini-Lessons: Explicit, Whole Class, Standards-Based “A Nation at Risk” 115
Instruction 84 The “Reading Wars” 116

No Child Left Behind and High-Stakes
Testing 117
� T he Language of Your Instruction: Helping
Students Succeed with High-Stakes
Assessment 117
The Misuses and Unintended Consequences
of High-Stakes Assessment 118
A New Era of Reform: Common Core State
Standards 118
� Working and Collaborating: Talking with
Parents and Families about High-Stakes
Assessment 120
Types and Purposes of Assessment 121
Norm-Referenced Assessment 121
Criterion-Referenced Assessment 122
Summative Assessment 123
Formative Assessment 123
� S trategies for the Classroom: Planning
Assessment Before Your Instruction 125
The Qualities of a “Good” Assessment 125
Reliability 125
Validity 126
Instructional Transparency 126
� Accommodating English Learners: Equitable
Literacy Assessment for English Learners 127
A Comprehensive Literacy Assessment
Program 127
Assessing the “Literacy Essentials” 129
Word Structure: Pinpointing Development with Quali-
tative Spelling Inventories 129
Assessing Foundational Skills: Phonological Awareness
Literacy Screening (PALS) 132
Assessing Reading Comprehension 133
� R
 eading and Writing in Digital Contexts:
The Role of Electronic Data Management
Systems 133
Informal Reading Inventories 136
� C hildren’s Literature Connection: Doing Your
Best: Books about Perseverance and Overcoming
Obstacles 136
Assessing Fluency 139
Contents xi
Assessing Vocabulary and Morphological
Knowledge 141
Interest Inventories and Motivation Surveys 143
Special Considerations for Emergent and Beginning
Readers 143
Using Ongoing Formative Assessment
in Your Classroom 144
Conferring 144
Records of Oral Reading 145
Rubrics 145
Student Self-Assessment and Ongoing Feedback 146
Portfolios 150
Chapter Summary 150
Suggested Extension Activities 151
Recommended Professional Resources 151
Online Resources 152
Chapter 5:
Foundations of Language and Literacy
Instruction for English Learners 153
The Foundations of Teaching English Learners 155
Examining Our Dispositions 156
Characteristics of English Learners 158
� W
 orking and Collaborating: Tips for
Effective Home-School Communication 159
Culturally Responsive and Culturally
Inclusive Teaching 159
Effective Instructional Practices 160
Examining Students’ Home Languages and Their
Literacy Experiences 161
� A
 ccommodating English Learners: Speakers
of Variant/Vernacular Dialects 162
Determining Levels of English Learners’
Proficiency in English 164
Literacy Instruction with Your English
Learners 165
� Children’s Literature Connection: Evaluating
Language, Racial, Ethnic, and Culturally Diverse
Aspects of Literature 167
Reading to Your English Learners: Supporting
Language and Literacy Development 168
xii Contents

Wide Reading and Purposeful Writing 168 Other Texts for Emergent Readers 188
Vocabulary Instruction 169 Poetry, Fingerplays, Nursery Rhymes, and Songs 188
Environmental and Functional Print 188
� T he Language of Your Instruction:
Moving Beyond the Literal: Idiomatic � C hildren’s Literature Connection: Favorite
Expressions 170 Books and Resources for Poetry, Nursery
Rhymes, Fingerplays, and Songs 189
Spelling Instruction 170
Concept Books 189
� Strategies for the Classroom: “Modeling”
Academic Language 171 � T he Language of Your Instruction:
Talking with Children about Print in Their
Chapter Summary 171 Environment 190
Suggested Extension Activities 172
Predictable Pattern Books 190
Recommended Professional
Wordless Picture Books 190
Resources 172
Big Books 191
Online Resources 172
Reading to Children: Developing Listening
Comprehension and Vocabulary 191
Chapter 6: Dialogic Read-Alouds 191
Emergent Literacy: Engaging the World
of Print, Developing Oral Language, � C hildren’s Literature Connection: Resources for
Selecting a Good Read-Aloud 192
and Vocabulary 173
An Introduction to the Emergent Stage Text Talk 193
of Development 175 Deciding Which Words to Teach 195
 ral Language Development: The Foundation
O Anchored Vocabulary Instruction 196
of Literacy 176 Developing Conceptual Knowledge 196
Enriching the Language Environment in Your
Classroom 176 � S trategies for the Classroom: Anchored
Vocabulary Instruction 197
Density of Talk 177
Quality of Talk 177 Developing Concepts about Print: Its Forms
and Functions 198
The Role of Syntax 178
Authentic and Sustained Conversation 178 Shared Reading 198
Independent Reading Practice 200
� S trategies for the Classroom: Building
a Tower of Talk 179 � Working and Collaborating: Reading with
Your Child at Home 201
Language and Literacy Development in Meaningful
Contexts 180 Learning the Alphabet and the Role
of Letters 202
� S trategies for the Classroom: Literacy-Rich
Centers 181 � Reading and Writing in Digital Contexts:
Resources for Evaluating Learning
 ngaging the World of Print: The Role
E Applications 203
of Exposure to Written Texts 182
Storybook Reading 182 Alphabet Books 204
Reading Informational Text 184 Beginning Consonant Sounds
and Letters 204
� C hildren’s Literature Connection: Guidelines for Beginning Sound Sorts 205
Choosing High-Quality Informational Text 186
Extensions 206
 Contents xiii

Learning about Units of Print and Units
of Language 206
� A
 ccommodating English Learners:
Predictable Consonant Confusions for English
Learners 207
Phonological Sensitivity and Awareness of Words 207
Awareness of Syllables 208
Rhyming 208
Awareness of Onset-Rime 208
� S trategies for the Classroom: Shared Reading,
Print Referencing, and Rhyme 209
Letter Name–Alphabetic Spellers 233
Vocabulary Development 237
� Strategies for the Classroom: Word Study
in Practice: A Sample Five-Day Lesson Plan 238
Small Group Reading Instruction for Beginning
Readers 241
Guided Reading 242
� The Language of Your Instruction: Prompting
Readers to Be Strategic 246
What Beginning Readers Can Read Themselves 247

� Working and Collaborating: Paired Reading 247

Awareness of Phonemes 209
Phonics 211  eginning Fluency: From Automaticity
B
Phonological Awareness and Language: A Strong to Expressive Reading 252
Foundation 211 Fluency Instruction for Beginning Readers 252
Concept of Word 212 � Reading and Writing in Digital Contexts:
Writing in the Emergent Stage 213 Technology Assisted Repeated Readings 253
Putting All the Pieces Together: The Reading-Writing- Reading To and With Children: Guiding
Language Connection 214 Comprehension Development 254
Chapter Summary 216 Before Reading: Activating Prior Knowledge, Previewing,
Suggested Extension Activities 217 Predicting, and Setting a Purpose 254
Recommended Professional Resources 217 During Reading: Monitoring and Questioning 255
Online Resources 218 After Reading: Retelling 257

� C hildren’s Literature Connection: Texts That

Chapter 7: Stimulate Children to Ask Questions 257
Beginning Conventional Reading
The Beginning of Conventional Writing 260
and Writing 219
Getting Started with Writing Workshop 261
Overview of Beginning Readers, Writers, and Letter
Getting Started with Narrative Writing 262
Name-Alphabetic Spellers 221
Writing to Inform: Procedural “How-To”
Word Knowledge: The Linchpin of Literacy
Writing, “All-About” Texts, and Persuasive
Development 222
“Argument” Writing 263
Alphabet Knowledge 222
The Writing Process 264
Phonological and Phonemic Awareness 224
Chapter Summary 266
Concept of Word in Text 224
Suggested Extension Activities 268
� S trategies for the Classroom: Hearing Recommended Professional Resources 268
and Representing Sounds 225
Online Resources 269
Sight Word Vocabulary 228

� A
 ccommodating English Learners: Building Chapter 8:
Sight Vocabulary 230 Transitional Reading and Writing 270
Word Study: Phonics, Spelling, and Vocabulary 232 Overview of Transitional Readers, Writers, and
Phonics 232 Within Word Pattern Spellers 272
xiv Contents
� W
 ithin Word Pattern Spellers: Moving from
Sound to Pattern 273
Characteristics of Early, Middle, and Late Within Word
Pattern Spellers 274
Studying Vowels in Single-Syllable Words 276
Studying Consonants in Single-Syllable
Words 279
� Accommodating English Learners: Teaching
the Vowel Sounds of English 280
� Working and Collaborating: Talking with Families
about Word Study Instruction 281
 ocabulary Development: Spelling Instruction
V Repeated Reading 303
and Beyond 282
Homophones, Homographs, and Other Features of the
Late Within Word Pattern Stage 282
Shades of Meaning: Synonym and Antonym Lines 283
Generative Vocabulary Instruction: Early
Morphological Awareness 284
� S trategies for the Classroom: Teaching the
Prefix “un–” to Transitional Readers 284
Interactive Read-Alouds: Developing Engaged
Listeners and Deep Thinkers 286
Reader Response Theory in Action: Supporting
Comprehension Development 287
Talking Well, Thinking Well: The Power of Talk in the
Development of Comprehension 289
Supporting Children’s Conversations about Books 289
� C hildren’s Literature Connection: Interactive
Read-Alouds for Developing Critical Thinking
in the Transitional Stage of Development 290
Collaborative Reasoning and Argument Schema 291
� T he Language of Your Instruction: Collaborative
Reasoning in Action 291
From Talking Well to Writing Well: Written
Response to Text 293
Quick Writes 293
� Reading and Writing in Digital Contexts:
Blogging in Response to Text 294
From Quick Writes to Response Essays 294
Books for Transitional Readers: Independent and
Small Group Reading Practice 297
Early Transitional Readers 298
Middle Transitional Readers 298
� T he Language of Your Instruction: Teaching
Children to Infer 299
Late Transitional Readers 300
� C hildren’s Literature Connection: Other Books
for Transitional Readers 302
Developing Transitional Readers’ Fluency
and Comprehension: Research-Based
“Best” Practices 303
Wide Reading 303
Comprehension Routines: Reciprocal Teaching
in Action 304
� T he Language of Your Instruction: Conferring
with Transitional Readers and Writers 305
Reading and Writing Connections: Helping
Transitional Writers Write Well 306
Narrative 307
Research and Reports 309
Persuasive Pieces: The Seeds of Argument 309
Chapter Summary 312
Suggested Extension Activities 313
Recommended Professional Resources 314
Online Resources 314
Chapter 9:
Intermediate Reading and Writing 315
Overview of Intermediate Readers, Writers,
and Syllables and Affixes Spellers 317
Developing Comprehension and Understanding
of Texts 318
Strategies for Approaching Texts: Predicting, Questioning,
Clarifying, Summarizing, Extending 318
Types of Texts and Approaches to Reading 318
� S trategies for the Classroom:
“Reading with a Pencil” 319
Reading Informational Texts 320
� S trategies for the Classroom:
Accountable Talk 322

Reading Literature: Narrative Fiction 324
Reading Literature: Poetry 325
� Strategies for the Classroom: Book Clubs 327
� Young Adult Literature Connection: For Middle
School Students at the Intermediate Stage 330
Developmental Word Knowledge 330
Spelling: Exploring Syllable Patterns
and Morphology 330
� T he Language of Your Instruction: Spelling
Features at the Intermediate Stage 331
Vocabulary Development 336
� S trategies for the Classroom: Teaching
Morphology at the Intermediate Level with
Root Words and Affixes 339
Applying What They Are Learning: Decoding and
Learning Longer Words in Reading 341
� S trategies for the Classroom: Teaching
Morphology at the Intermediate Level with
Greek and Latin Roots 342
Systematic Instruction in General Academic and
Domain-Specific Vocabulary 346
Fluency: The Bridge to Comprehension 349
� Accommodating English Learners: Awareness
and Understanding of Cognates 351
Modeling Fluent Reading 352
Bridging from Read-Alouds to Students’ Reading
of Anchor Texts 352
Writing 352
The Writing Process in the Intermediate
Stage 354
� T he Language of Your Instruction:
Writing Traits 356
The Traits of Writing 356
Getting Under Way with Informational Writing: RAFT
Papers 358
� S trategies for the Classroom: Author’s
Craft Lessons 360
� Reading and Writing in Digital Contexts:
Connecting Content Learning and
Technological Literacy 360
Chapter Summary 362
Contents xv
Suggested Extension Activities 363
Recommended Professional Resources 363
Online Resources 363
Chapter 10:
Skillful Literacy: Developing Critical
­Engagements with Texts, Language, and
Vocabulary 364
Overview of Skillful Readers, Writers,
and Derivational Relations Spellers 367
Characteristics of Texts for Skillful
Readers 367
� Young Adult Literature Connection: The Uses
of Mythology 369
Developing Comprehension and Understanding: In-
Depth Critical Engagements with More
Complex Texts 371
Literature 371
� The Language of Instruction: Provoking
a Persuasive Stance 372
Independent Reading: Motivating and Engaging
Readers with Self-Selected Reading 378
� Y
 oung Adult Literature Connection: Literature
for LGBTQI Students 379
Informational Texts and Academic Language 381
Developmental Spelling Knowledge: Derivational
Relationships 384
� Reading and Writing in Digital Contexts: Critical
Literacy in Action on the Web 388
Vocabulary Development 394
� Strategies for the Classroom: Skillful Readers
with “Spelling Issues” 395
Advanced Generative Vocabulary Instruction 395
The Role of Etymological Knowledge in Growing and
Deepening Vocabulary Knowledge 398
Systematic Instruction in General Academic and
Domain-Specific Vocabulary 400
� S trategies for the Classroom: Reading
Workshop Mini-Lesson: Author’s Craft 404
Writing in the Skillful Stage 405
Analyzing Narrative 405
Analyzing and Constructing an Argument 407
Chapter Summary 412 Accommodating Students Experiencing
Suggested Extension Activities 412 Difficulty with Literacy 425

Recommended Professional Resources 412 Supporting the Development of All Students:

Research-Based Best Practices 426
Online Resources 413
� W
 orking and Collaborating: Helping Students
with Learning Disabilities Be ­Successful with
Chapter 11: Homework 427
Response to Instruction: Intervention
and Acceleration for Readers Who Word Sorts: Varying the Complexity 428
Struggle 414 � Children’s Literature Connection: Great
What Is Response to Instruction? 416 Books about Children and Adolescents with
Learning Difficulties 428
� T he Language of Your Instruction:
Student-First Language 419 Building Background Knowledge and Using Graphic
Organizers 429
Tiered Instruction 419 Increase “High-Success” Reading Practice 431
The Role of Assessment in Response to Instruction 420
� S trategies for the Classroom: Tips for
� Accommodating English Learners: Determining the Teaching Comprehension Strategies 431
Presence of a Learning Disability in an English
Learner 420 Morphological Analysis: Helping Students “Unlock” the
Meaning of Words 432
Profiles of Students Experiencing Difficulty in
Attend to Motivation and Engagement 433
Learning to Read 421
Chapter Summary 434
Automatic Word Callers: Readers with Strong
Word Recognition, Weak Vocabulary and Suggested Extension Activities 434
Comprehension 422 Recommended Professional Resources 435
Word Stumblers: Readers with Strong Vocabulary Online Resources 435
and Comprehension, Weaker Word Recognition
and Fluency 423
Struggling Word Callers: Readers Experiencing
Difficulty with Word Recognition and Glossary 436
Comprehension 423
References 442
Slow and Steady Comprehenders: Readers with Strong
Comprehension and Word Recognition and Weaker
References for Children’s and Young Adult
Fluency 424
Literature 461
Slow Word Callers: Readers with Strong Word Recogni-
tion and Weak Fluency and Comprehension 424 Index 466
Students with Specific Learning Disabilities
in Reading 424 Photo and Text Credits 478
� Reading and Writing in Digital Contexts:
Assistive Technology in the Literacy
Classroom 425
Preface
Today’s teachers face many challenges, including teaching all students, teaching them well,
and teaching them in the context of rising expectations and high-stakes assessment. Today’s
students come from increasingly diverse socioeconomic, cultural, linguistic, racial, and ethnic
backgrounds. Because of your dedication to these children, you embrace the challenges and
opportunities of teaching in today’s dynamic and diverse classroom environments. In this book
we provide the foundation for meeting the challenges of teaching literacy in these contexts,
providing you with the knowledge and tools necessary to teach literacy in a developmentally
responsive and integrated way.

Purpose
Understanding developmentally responsive instruction allows you to teach in students’ instruc-
tional zones, accelerating their literacy learning and development. We have written Teaching
Reading and Writing: The Developmental Approach (PreK to Grade 8) to provide you with the
knowledge and strategies for this type of teaching, including up-to-date research on literacy
development, instruction, assessment, and intervention. In this book, we address three goals:
1. Provide foundational knowledge in the nature and progression of literacy development,
identifying what learners are able to understand about the essential elements of literacy
at different developmental stages, and when and how are they able to apply those under-
standings with your help as well as independently.
2. Provide an understanding of the essential elements of literacy and how related instruc-
tional strategies support deep and meaningful engagements with texts.
3. Provide an understanding of the foundations and nature of culturally responsive literacy
instruction.

Using This Book

Intended for preservice and experienced teachers alike, this book provides a wealth of con-
tent and does so in a conversational, approachable style that connects theory to practice by
including:
• Vignettes and sample lessons from real classrooms
• Authentic student work samples
• Ways to use and integrate print-based and digital texts across the curriculum
• Tools for organizing and managing a comprehensive, developmentally responsive
literacy program

Whether you’re preparing to teach or have a classroom of your own, Teaching Reading and
Writing: The Developmental Approach promises to provide you with the tools and knowledge

xvii
xviii Preface

necessary to confidently and competently meet the diverse needs of students in today’s class-
rooms. It is designed to help you teach in a student-centered, research-based way. Beginning
with assessment, you’ll learn to identify students’ stages of development as a means for
determining not only what to teach, but how to teach it. Most methods texts dedicate sepa-
rate chapters to the essential elements of literacy—word analysis skills, fluency, vocabulary,
comprehension, writing, and motivation—but our chapters reflect an integrated model of
literacy instruction that is based on the understanding that reading and writing are devel-
opmental processes. As such, you will see these components of literacy addressed in every
chapter.

• Each chapter begins with real-life scenarios that illustrate the theory in practice. This will
help you immediately see the relevance and application of theory.
• Student work samples are included in each chapter to help you actually see the kind
of work students at each stage of development create so you will know what to expect
from learners across the developmental continuum. We also help you learn how to
analyze student work to identify your student’s stages of development and instruction-
al needs.
• Sample lessons not only make the text engaging and accessible but they also make the
text come to life. These samples help you put the theory and research into practice with
real students in real classrooms. Each lesson is aligned with the Common Core State
Standards for English Language Arts.
• Literature for children and young adults is integrated throughout the text. In each
instructional chapter you’ll find a list of titles appropriate for that stage of development;
in other chapters you will find titles appropriate for the various topics that are addressed.
With the Common Core’s emphasis on text complexity, these lists are timely and extremely
helpful for teachers who are planning Common Core-aligned lessons each day.
• An illustrative companion text, Newbury Honor Award-winning Al Capone Does My Shirts
by Gennifer Choldenko (2004), is available.
• Each chapter ends with a comprehensive chapter summary, suggested extension activi-
ties, recommended professional resources, and additional online resources.

The first two foundational chapters of Teaching Reading and Writing: The Developmental
Approach address the nature of development and interaction of thought, language, and literacy.
They introduce you to the developmental model, the literacy essentials, historical trends in the
field, as well as the current policy environment in which the Common Core State Standards and
Response to Intervention (RTI) figure prominently. By giving you an overview of these topics
early on, we’re able to build on this knowledge in each of the subsequent chapters.
The third foundational chapter addresses the principles and practices of effective, develop-
mentally responsive literacy instruction, and the fourth grounds your understanding of develop-
ment and instruction in effective assessment.
Chapters 6 through 10 are dedicated, respectively, to each stage of literacy development:
emergent, beginning, transitional, intermediate, and skillful. Within each chapter, you’ll learn how
to differentiate instruction for students within each stage, meet the expectations of the new
Common Core State Standards for English Language Arts, accommodate English learners,
collaborate with other professionals, integrate print and digital literacies, and build
 xix
Preface

home–school connections. The literacy essentials are addressed in each of these chapters with
a special focus on the unique needs of learners at each specific stage of development. You will
learn what to teach, when to teach it, and how to teach it.
In addition to a special feature titled “Accommodating English Learners” in each chapter,
the fifth chapter of this book is dedicated to the special needs of English learners. The chapter
addresses specific accommodations English learners may need in the literacy classroom, as well
as the importance of culturally relevant pedagogy. A specific chapter on teaching readers who
struggle provides an overview of Response to Intervention as well as profiles of readers who
struggle. For each profile, you will learn about research-based methods proven to accelerate the
achievement of these readers. General suggestions for accelerating the achievement of all learn-
ers are included at the end of the chapter.
At the end of Chapter 1 you will find the section “How to Use This Book,” which provides
much more specific information and advice on the purpose and application of the organization
of the book and the features of each chapter. These features include Strategies for the Classroom,
The Language of Your Instruction, Accommodating English Learners, Reading and Writing in Digital
Contexts, Children’s Literature Connection, and Working and Collaborating.
We hope you’ll find Teaching Reading and Writing: The Developmental Approach to be the
foundation and guide for your literacy instruction that we have intended it to be. It will support
your dedication, excitement, and commitment to the very best of literacy instruction—a guide to
helping your students move toward reading and comprehending literary and informational texts
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xx Preface

Acknowledgments
A project as intensive and extensive as this book could not have been undertaken, much less
completed, without support and ideas from so many dear friends and professional colleagues. Space
does not allow the inclusion of all of their names here, but we wish to acknowledge those who
have impacted this project most specifically.
Aurora Martínez, who realized, sustained, and supported the vision; Erin Grelak, who was
there in the beginning and throughout most of the journey, and who believed and invested in so
many ways; Kathryn Boice, who took over the reigns and skillfully and considerately guided us to
a successful conclusion; Beth Jacobson, extraordinary developmental editor, who attended this
project, nurtured, and provided feedback as if it were the only book on which she was working,
but we of course knew better; Karen Mason, project manager and mastermind of permissions,
production, and so much more; Tania Zamora, who negotiated the intricacies and challenges
of permissions with expediency and good humor; Michelle Hochberg, logistics planner ex-
traordinaire; Libby Bonesteel, who graciously and with all due dispatch took on the Herculean
project of writing the Instructor’s Resource Manual and Test Bank, and of preparing the chapter
PowerPointTM slides. We could easily write a page of gratitude for each of the following individu-
als: Donald Bear, Marcia Invernizzi, Francine Johnston, Kevin Flanigan, Tisha Hayes, Darrell
Morris, Tamara Baren, Carol Caserta-Henry, Sandy Madura, Kara Moloney, Shari Dunn, Brenda
Sabey, Dianna Townsend, Diane Barone, Cindy Brock, Julie Pennington, Pete and Stephanie
Cobin, David and Regina Smith, Karen Carpenter, Janet Bellavance, Matthew Hajdun, Lynda
Siegel, Suzy Tenenbaum, David Mendenhall, Karen Jeffrey, Nicole Doner, Alexis Scott, Jessica
Pepin, and Allison Drake.
We also gratefully acknowledge the reviewers, whose time, commitment, and feedback during
the development of this book were extraordinary and invaluable. Because of their efforts, we
believe this book is a much stronger resource: Bruce F. Brodney, St. Petersburg College; Melissa
Caraway, University of Dallas; Ann Crutchfield, Pfeiffer University; Annette M. Dobrasz, Niagara
University, D’Youville College, Niagara Community College; Meadow Sherrill Graham, West
Virginia University; Ellen Jampole, Coastal Carolina University; Robert Timothy Rush, University
of Wyoming; and Kim S. Truesdell, Buffalo State College.
Thank you, too, to those elementary and middle school students who generously shared their
work with us and with you, and to the undergraduate and graduate students of Saint Michael’s
College who read and responded to early drafts of the manuscript. We are most grateful for their
suggestions and encouragement. And finally, we are especially grateful to our families, who have
been more than supportive and understanding of the countless hours we’ve invested in this
project.
 1

Chapter Outline

The Foundations » What Is Literacy?

» The Importance of Print and Digital Literacy

of Literacy » The Many Faces of Literacy

» The Literacy Essentials

Instruction » The Literacy Essentials from a Developmental

Perspective
» The Sociocultural Contexts of Literacy Learning
» Levels of Support and the Gradual Release of
Responsibility Model

1
 1 Focus Questions
1. How are “print literacy” and “digital literacy” alike? How are they different?
2. Why is each of the following essential to the development of proficient reading and writing:
Comprehension, Writing, Vocabulary, Word Structure, Fluency, Motivation?
3. What is the importance of understanding the developmental nature of literacy across the
five stages: Emergent, Beginning, Transitional, Intermediate, Skillful?
4. Describe the sociocultural contexts of literacy learning and how they may impact your teach-
ing of literacy.
5. Why is the “Gradual Release of Responsibility” model for instruction such a powerful frame-
work for teaching literacy?

I t is shortly after 9:00 a.m. on a Tuesday morning

in September. Ms. Arlene Robinson, principal of
Compello Elementary School, has invited you
to accompany her as she visits each classroom
during literacy block. The primary grades have a two-
hour block; intermediate grades meet for an hour and a
half. Arlene visits the classrooms every day; her previous
school, she mentions, was simply too large to be able to
do that—so she worked out a rotation. And she doesn’t
always visit the classrooms at Compello Elementary in the
mornings; quite often, she does her “walkabout,” as she
calls it, in the afternoons. Like most effective elementary
principals, Arlene makes it a point to know the names of
every student well before the holiday break in December.
As you’re walking down the kindergarten/first-grade
wing, you can’t help but notice the lively voices pouring
out into the hallway from every classroom; all doors are
propped open. Arlene chuckles. “You know,” she says,
“when I began teaching, my principal told all of the
new teachers that when he walked down our hallway
he wanted our kids to be so quiet that he’d be able to
hear a pin drop! Needless to say, I crossed some swords
with that gentleman!” Arlene went on to share how
every teacher at Compello understood that learning is
a social phenomenon, and that students have to be able
to talk with one another in order to learn. “Most of the
time,” she winks, “they’re using their indoor voices!”
2
When we enter Karleen Echevarria’s first-grade
classroom, several of the children move quickly across
the room to give Arlene a hug, which she receives with
smiles, hugs them in return, but then gently eases them
back toward what they had been engaged in doing.
These particular children had been working at their
desks on their science unit, sorting pictures into dif-
ferent categories: creatures that live on land, in water,
or both on land and in water. The children resumed a
spirited debate about whether one particular creature
could be placed in the “both land and water” category,
then agreed to put it in an “oddball” category—they’d
check on it later with Ms. Echevarria. Karleen was in
the reading corner, meeting with another group of
seven children. They were earnestly discussing why the
animals who Henny Penny told “the sky is falling” all
went along with her without asking her how she knew
this! Karleen followed up by asking them if there’d ever
been a time when they had followed along with a group
without asking why.
A bit later, as you and Principal Robinson turn into
the fourth/fifth-grade wing, Arlene shares that the dis-
trict adopted a new reading program the previous year.
The state had mandated that schools adopt a program.
“Now, I know I’ve got several experienced teachers at
Compello who are excellent teachers of reading and
writing. I’m pretty certain they don’t need a program
Another random document with
no related content on Scribd:
Franklinic or Static Electricity.—This form of electricity is now being
much used, especially abroad, in the treatment of nervous affections,
but does not appear to have been employed in the different
copodyscinesiæ, as but few reports of such treatment have found
their way into current literature. Romain Vigouroux111 states that he
has cured one case by statical electricity. Another case is reported
by Arthuis112 as rapidly cured by this treatment after many other
means, carried on during a period of five years, had failed; but his
brochure contains too many reports of cures of hitherto incurable
diseases to be relied upon.
111 Le Progrès médical, Jan. 21, 1882.

112 A. Arthuis, Traitement des Maladies nerveuses, etc., Paris, 1880, 3me ed.

Gymnastics and Massage.—As those suffering from copodyscinesia

are generally compelled by their vocation to be more or less
sedentary, exercise in the open air is indicated, inasmuch as it tends
to counteract the evil effects of their mode of life; but the use of
dumb-bells or Indian clubs, riding, rowing, and similar exercises do
not ward off the neuroses in question or diminish them when they
are present.

Such is not the case when rhythmical exercises and systematic

massage of all the affected muscles are employed, as marked
benefit has followed this method of treatment. The method employed
by J. Wolff, a teacher of penmanship at Frankfort-on-the-Main, which
consists of a peculiar combination of exercise and massage,
appears to have been wonderfully successful, judging from his own
statements and editorial testimonials of such eminent men as
Bamberger, Bardenleben, Benedikt, Billroth, Charcot, Erb, Esmarch,
Hertz, Stein, Stellwag, Vigouroux, Von Nussbaum, Wagner, and De
Watteville. The method is described by Romain Vigouroux113 and Th.
Schott,114 the latter claiming priority for himself and his brother, who
employed this method as early as 1878 or 1879. Wolff,115 however,
states that he had successfully treated this disease by his method as
early as 1875. Theodor Stein,116 having had personal experience in
Wolff's treatment, also describes and extols it: 277 cases of
muscular spasms of the upper extremities were treated; of these,
157 were cured, 22 improved, while 98 remained unimproved; these
comprised cases of writers', pianists', telegraphers', and knitters'
cramp.
113 Le Progrès médical, 1882, No. 13.

114 “Zur Behandlung des Schreibe- und Klavierkrampfes,” Deutsche Medizinal

Zeitung, 2 März, 1882, No. 9, Berlin; also “Du Traitement de la Crampe des Écrivains,
reclamation de Priorité, Details de Procedes, par le Dr. Th. Schott,” Le Progrès
médical, 1re Avril, 1882.

115 “Treatment of Writers' Cramp and Allied Muscular Affections by Massage and
Gymnastics,” N. Y. Med. Record, Feb. 23, 1884, pp. 204, 205.

116 “Die Behandlung des Schreibekrampfes,” Berliner klinische Wochenschrift, No.

34, 1882, pp. 527-529.

It must be borne in mind that Wolff, not being a physician, can refuse
to treat a case if he thinks it incurable; and in fact he does so, as he
has personally stated to the writer, so that his statistics probably
show a larger percentage of cures than otherwise would be the case.

His method may be described as follows: It consists of a combined

employment of gymnastics and massage; the gymnastics are of two
kinds: 1st, active, in which the patient moves the fingers, hands,
forearms, and arms in all the directions possible, each muscle being
made to contract from six to twelve times with considerable force,
and with a pause after each movement, the whole exercise not
exceeding thirty minutes and repeated two or three times daily; 2d,
passive, in which the same movements are made as in the former,
except that each one is arrested by another person in a steady and
regular manner; this may be repeated as often as the active
exercise. Massage is practised daily for about twenty minutes,
beginning at the periphery; percussion of the muscles is considered
an essential part of the massage. Combined with this are peculiar
lessons in pen-prehension and writing.
The rationale of this treatment is not easy, but any method which
even relieves these neuroses should be hailed with pleasure, as they
heretofore have been considered almost incurable.

The method employed by Poore, as mentioned under Electricity, of

rhythmical exercise of the muscles during the application of the
galvanic current, is worthy of further trial, as it combines the two
forms of treatment hitherto found most successful.

Internal and External Medication.—Generally speaking, drugs are of

comparatively little value in the treatment of these affections. This
statement does not apply to those cases where the symptoms are
produced by some constitutional disorder, or where there is some
other well-recognized affection present which does not stand in
relation to these neuroses as cause and effect.

In any case where an accompanying disorder can be discovered

which is sufficient in itself to depress the health, the treatment
applicable to that affection should be instituted, in the hope, however
unlikely it is to be fulfilled, that with returning health there will be a
decrease of the copodyscinesia. In the majority of cases no
constitutional disease can be detected, and it is in these that internal
medication has particularly failed.

The following are some of the remedies that have been employed:
Cod-liver oil, iron, quinine, strychnia, arsenic, ergot, iodoform, iodide
and bromide of potassium, nitrate of silver, phosphorus,
physostigma, gelsemium, conium, and some others.

Hypodermic Medication.—Atropia hypodermically, as first suggested

by Mitchell, Morehouse, and Keen117 in the treatment of spasmodic
affections following nerve-injury, has been used with good effect in
those cases where there is a tendency to tonic contraction; it should
be thrown into the body of the muscle. Vance118 speaks very
favorably of one-sixtieth of a grain of atropia used in this manner
three times a week. Morphia, duboisia, and arsenic in the form of
Fowler's solution have been used hypodermically with but little effect.
Rossander119 reports a cure in one month of a case of two years'
duration by the hypodermic use of strychnia. Onimus and Legros120
used curare in one case without effect.
117 Gunshot Wounds and Other Injuries to Nerves, Philada., 1864.

118 Reuben A. Vance, M.D., “Writers' Cramp or Scriveners' Palsy,” Brit. Med. and
Surg. Journal, vol. lxxxvii. pp. 261-285.

119 J. C. Rossander, Irish Hosp. Gazette, Oct. 1, 1873.

120 Loc. cit.

Local Applications.—The apparent benefit following the local

application of lotions, etc. to the arms in some cases appears to be
as much due to the generous kneading and frictions that accompany
them as to the lotions themselves. Onimus and Legros, believing the
lesion to be an excitability of the sensitive nerves at the periphery,
employed opiated embrocations, but report amelioration in one case
only.

When there are symptoms of congestion of the nerves or of neuritis,

then the proper treatment will be the application of flying blisters, or
the actual cautery very superficially applied to the points of
tenderness from time to time, so as to keep up a continual counter-
irritation. This treatment may be alternated with the application of the
galvanic current (descending, stabile, as previously mentioned) or
combined with it. As these conditions are often found in nervous
women, care should be taken lest this treatment be too vigorously
carried out.

Considerable relief has been reported from the use of alternate hot
and cold douches to the affected part—a procedure which is well
known to do good in some cases of undoubted spinal disease; the
application peripherally applied altering in some way, by the
impression conveyed to the centres, the nutrition of the spinal cord.

Tenotomy.—Tenotomy has been but little practised for the cure of

these affections. Stromeyer121 cut the short flexors of the thumb in a
case of writers' cramp without any benefit, but in a second case,
where he cut the long flexor of the thumb, the result was a cure.
Langenbeck122 quotes Dieffenbach as having performed the
operation twice without success, and states that there has been but
one observation of complete success, and that was the one of
Stromeyer. Aug. Tuppert123 has also performed this operation, and
Haupt124 advises it as a last resource.
121 “Crampe des Écrivains,” Arch. gén. de Méd., t. xiii., 1842, 3d Series, p. 97.

122 Ibid., t. xiv., 1842, 3d Series.

123 Quoted by Poore, loc. cit.

124 “Der Schreibekrampf,” rev. in Schmidt's Jahrbuch, Bd. cxv., p. 136, 1862.

Very few would be willing to repeat the experiment in a true case of

copodyscinesia after the failures above enumerated, for the
temporary rest given the muscle does not prove of any more service
than rest without tenotomy, which has failed in all the more advanced
cases, which are the only ones where tenotomy would be thought of.

Nerve-Stretching.—It is curious that no cases have been reported (at

least I have not been able to discover them) of nerve-stretching for
aggravated cases of copodyscinesia, as the operation has been
performed in several cases of local spasm of the upper extremity
following injuries to the nerves.

Von Nussbaum125 alone mentions the operation, and states that it

has been of no avail, but gives no references; he previously126
stretched the ulnar nerve at the elbow and the whole of the brachial
plexus for spasm of the left pectoral region and of the whole arm,
following a blow upon the nape of the neck; the patient made a good
recovery.
125 Aerztliches Intelligenzblatt, Munich, Sept. 26, 1882, No. 39, p. 35.

126 London Lancet, vol. ii., 1872, p. 783.

This operation, according to an editorial in the American Journal of
Neurology,127 has been performed seven times for spastic affections
of the arm with the following results: 2 cures (1 doubtful), 3 great
improvement, and 2 slight relief.
127 Am. Journ. of Neurology and Psychiatry, 1882.

This procedure would seem to be indicated in those cases of

copodyscinesia where spasms are present which have a tendency to
become tonic in their character, where other means of treatment
have failed. One such case has fallen under the writer's notice,
which, on account of its singularity and the rarity of the operation,
seems worthy of record. The patient is a physician in large practice,
and his account, fortunately, is more exact than it otherwise would
be:

—— ——, æt. 36. Paternal uncle had a somewhat similar trouble in

right arm, father died of paralysis agitans, and one brother has
writers' cramp. From nine to twelve years of age he was considered
an expert penman, and was employed almost constantly, during
school-hours, writing copies for the scholars. At the age of eleven he
began to feel a sense of tire in right forearm and hand when writing;
soon after this the flexors of right wrist and hand began to contract
involuntarily and become rigid only when writing. He remembers
being able to play marbles well for two years after the onset of the
first symptoms. The trouble gradually increased until every motion of
the forearm became involved. At the age of nineteen he became a
bookkeeper, using his left hand, but at the end of one year this
became affected also. Since then both arms have been growing
gradually worse, and at one time exhaustion would bring on pain at
the third dorsal vertebra. At the age of thirty a period of
sleeplessness and involuntary contractions of all the muscles of the
body came on, accompanied by difficulty in articulation from
muscular inco-ordination. After persistent use of the cold douche to
spine these symptoms ameliorated, but the general muscular
twitching sometimes occurs yet, and overwork brings on spasm of
the extensors of the feet. The condition of his arms in December,
1882, was as follows: At rest the right forearm is pronated, the wrist
completely flexed and bent toward the ulnar side, the thumb is
slightly adducted, and the fingers, although slightly flexed, are
comparatively free, enabling him to use the scalpel with dexterity.
This contraction can be overcome by forcibly extending the fingers
and wrist and supinating forearm, but if the arm be now placed in
supination the following curious series of contractions occur,
occupying from one to two minutes from their commencement to
their completion: gradually the little finger partially flexes, then the
ring, middle, and fore finger follow in succession; the wrist then
slowly begins to flex and to turn toward the ulnar side, and finally the
arm pronates, in which position it will remain unless disturbed. The
contraction is accompanied by a tense feeling in the muscles, but is
painless. The left arm behaves in a somewhat similar manner, and if
this is placed in supination a gradual pronation of the arm begins;
then follows the flexion of the fingers, commencing with the little
finger and ending with the thumb; the wrist also flexes, but not as
much as the right, although the flexion of the fingers is more marked.
There is no pain on pressure over muscles or nerves. The extensor
muscles of both arms, although weaker than normal, are not
paralyzed, those of the right responding more readily to both faradic
and galvanic currents than do the left. There is no reaction of
degeneration. The flexors respond too readily, the right showing the
greatest quantitative increase.

In 1879, while abroad, his condition being essentially as above

described, he consulted Spence of Edinburgh, who as an experiment
stretched the left ulnar nerve at the elbow; immediately after the
operation the muscles were paralyzed and the arm remained quiet;
in twenty-four hours the nerve became intensely painful, and
remained so, day and night, for three weeks; this gradually subsided,
and ceased with the healing of the wound two weeks later. Forty-
eight hours after the operation the spasm of the muscles returned,
and in a short time became as bad as ever, proving the operation to
have been a failure.
An interesting point to decide in this case is whether the symptoms
point to an abnormal condition of the nerve-centres, first manifesting
itself in difficulty of writing, or whether the constant writing induced a
superexcitability (for want of a better term) of the spinal cord in a
patient markedly predisposed to nervous troubles. This last
hypothesis I believe to be the correct one.

It might be considered at first sight that the symptoms presented by

this patient were due to a paralytic condition of the extensors, and
not a spasm of the flexors, or at least that the latter was secondary
to the former. While the extensors are somewhat weaker than
normal from want of use, a careful study of the mode of onset of this
affection and the symptoms presented later prove this idea to be
erroneous.

In regard to the operation and its results, it seems that a fairer test of
the efficacy of nerve-stretching in this case would have been made if
the median and not the ulnar nerve had been stretched, as the latter
only supplies in the forearm the flexor carpi ulnaris and the inner part
of the flexor profundus digitorum, while the former supplies the two
pronators and the remainder of the flexor muscles.

Of the mode of action of this operation we are still much in the dark,
but it would seem to be indicated in any case where the contractions
are very marked and tonic in their nature—not, however, until other
means have failed to relieve.

In the ordinary forms of copodyscinesia, it is needless to say, the

operation would be unjustifiable.

Mechanical Appliances.—Most of the prothetic appliances have

been devised for the relief of writers' cramp, the other forms of
copodyscinesia having received little if any attention in this direction.
The relief obtained by their use is usually but temporary, especially if
the patient attempts to perform his usual amount of work, which is
generally the case.
These instruments are of undoubted benefit when used judiciously in
conjunction with other treatment, as by them temporary rest may be
obtained, or in some cases the weakened antagonists of cramped
muscles may be exercised and strengthened. They all, without
exception, operate by throwing the work upon another set of
muscles, and failure is almost sure to follow their use if they alone
are trusted in, as the new set of muscles sooner or later becomes
implicated in the same way that the left hand is apt to do if the whole
amount of work is thrown upon it.

To accurately describe these instruments is out of place in this

article: those wishing to study this branch of the subject more fully
are referred to the article by Debout,128 where drawings and
descriptions of the most important appliances are given.
128 “Sur les Appareils prothetiques, etc.,” Bull. de Thérap., 1860, pp. 327-377.

Their mode of action may be considered under the following heads:

I. Advantage is taken of muscles as yet unaffected, which are made

to act as splints (so to speak) to those affected, greater stability
being thus given and cramp controlled when present.

Under this head may be mentioned the simple plan of placing a

rubber band around the wrist, wearing a tight-fitting glove, or
applying Esmarch's rubber bandage with moderate firmness to the
forearm. Large cork pen-holders, by distributing the points of
resistance over a larger surface, are thus much easier to hold than
small, hard pen-holders.

Two of the instruments devised by Cazenave—one, consisting of two

rings joined together in the same plane (to which the pen-holder is
attached), and through which the index and middle fingers are thrust
as far as the distal joints; and another consisting of two rings of hard
rubber, one above the other, sufficiently large to receive the thumb,
fore and middle fingers, which are thus held rigidly in the writing
position—act in this manner, and are used when the cramp affects
the thumb or fore finger.
II. The cramp of one set of muscles is made use of to hold the
instrument, the patient writing entirely with the arm movement.

The simple plan of grasping the pen-holder in the closed hand, as

previously described, or of thrusting a short pen-holder into a small
apple or potato, which is grasped in the closed hand, occasionally
affords relief and acts in this way. The instruments of Mathieu,
Velpeau, Charrière, and one by Cazenave are based upon this
principle. The first consists of two rings rigidly joined together about
one inch apart, one above the other, through which the fore finger is
thrust, and of a semicircle against which the tip of the thumb is
pressed; the pen-holder is attached to a bar adjoining the semicircle
and rings. Velpeau's apparatus consists of an oval ball of hard
rubber carrying at one extremity the pen-holder at an angle of 45°;
the ball is grasped in the closed hand, and the pen-holder allowed to
pass between the fore and middle fingers. Charrière's instrument is a
modification of the last, having in addition to the ball a number of
rings and rests for the fixation of the fingers. The latter has also
devised an instrument consisting of a large oval ball of hard rubber;
this is grasped in the outstretched palm, which it fills, and is allowed
to glide over the paper; the pen-holder is attached to one side.
Cazenave's instrument is simply a large pen-holder with rest and
rings to fix the fingers.

III. The instrument prevents the spasm of the muscles used in

poising the hand from interfering with those used in forming the
letters.

One of the instruments devised by Cazenave acts in this way: it

consists of a small board, moving upon rollers, upon which the hand
is placed; lateral pads prevent the oscillations of the arm due to
spasmodic action of the supinators. The pen-holder is held in the
ordinary manner.

IV. The antagonistic muscles to those affected by cramp are made to

hold the instrument, while the cramped muscles are left entirely free.
But one instrument acts in this manner—viz. the bracelet invented by
Von Nussbaum,129 which consists of an oval band of hard rubber to
which the pen-holder is attached. The bracelet is held by placing the
thumb and the first three fingers within it and strongly extending
them.
129 Aerztliches Intelligenzblatt, Munich, 1883, No. 39.

The inventor claims great success by its use alone, as the weakened
muscles are exercised and strengthened and the cramped muscles
given absolute rest.

Résumé of Treatment.—In the complicated cases of copodyscinesia

rest of the affected parts, as far as the disabling occupation is
concerned, must be insisted upon: this should be conjoined with the
use of the galvanic descending stabile current, combined with
rhythmical exercise of the affected muscles and of their antagonists,
and massage. Where there is evidence of a peripheral local
congestion or inflammation, this must be attended to; for instance, if
there is congestion of the nerves, or neuritis, flying blisters or the
actual cautery should be applied over the painful spots, followed by
the galvanic current. Where there is paralysis of one or more
muscles, with evidence of interference of nerve-supply, the faradic
current may be used with advantage.

Evidences of constitutional disease should lead to the employment

of the treatment suitable for those affections.
 RÉSUMÉ OF 43 CASES OF TELEGRAPHERS' CRAMP.

Age at time of onset:

Under 20 years 7
Between 20 and 30 25
Between 30 and 40 7
Doubtful 4—43

Average age 23.94 years.

Average age of males 24.22 years.
Average age of females 20.66 years.

Average length of time before the disease appeared after the

commencement of telegraphing was—
In males 7.27 years.
In females 4 years.
The shortest period being 6 months.
The longest period being 20 years.

Left arm implicated in 21

(Not counting case with amputation of right arm) 1
Never used left arm 8
Left arm not affected, although used 12
Doubtful 1—43

Percentage with left arm implicated 63.63

No. of cases with difficulty in telegraphing only 9

No. of cases with difficulty in writing only 0
No. of cases with difficulty in telegraphing most 22
No. of cases with difficulty in writing most 11
No. of cases with difficulty in both alike 1—43
Use of tobacco or alcohol:
No effect in 14
Bad effect in 16
Good effect (in moderation) in 3
Don't use either 10—43

Flushings in arm or face during work in 22

Brittleness of nails in 5
Emotional factor present in 29
Sympathetic movements in other parts in 9
Pain in back during work in 18
Trouble in performance of other acts in 19
Pain on pressure over nerve or muscle in 13

Cramp of flexor group of muscles:

In writing only 0
In writing most 3
In telegraphing only 1
In telegraphing most 5— 9
Cramp of extensor group of muscles:
In writing only 0
In writing most 0
In telegraphing only 4
In telegraphing most 7—11
Doubtful as to character of cramp 11
No cramp 12—43

Manner of telegraphing:
Arm resting on table 22
Arm raised from table 12
Alternating one with the other 7
Doubtful 2—43

Manner of writing:
 Arm movement 13
Finger movement 6
Combination of the two 24—43

TETANUS.

BY P. S. CONNER, M.D.

Tetanus (τεινω, to stretch) is a morbid condition characterized by

tonic contraction of the voluntary muscles, local or general, with
clonic exacerbations, occurring usually in connection with a wound.
Cases of it may be classified according to cause (traumatic or
idiopathic); to age (of the new-born and of those older); to severity
(grave and mild); or to course (acute and chronic), this latter
classification being the one of greatest value.

Though known from the earliest times, it is in the civil practice of

temperate regions of comparatively rare occurrence, and even in
military surgery has in recent periods only exceptionally attacked any
considerable proportion of the wounded.
Occurring in individuals of all ages, the great majority of the subjects
of it are children and young adults. Women seem to be decidedly
less liable to it than men. That this is due to sexual peculiarity may
well be doubted, since the traumatic cases are by far the most
numerous, and females are much less often wounded than males.
The traumatisms of childbed are occasionally followed by it
(puerperal tetanus).

That race has a predisposing influence would appear to be well

established; the darker the color, the greater the proportion of
tetanics. Negroes are especially likely to be attacked with either the
traumatic or idiopathic form.

Atmospheric and climatic conditions, beyond question, act powerfully

in, if not producing at least favoring, the development of tetanus.
Places and seasons in which there is great difference between the
midday and the midnight temperature, the winds are strong, and the
air is moist, are those in which the disease is most prevalent; and it
is because of these conditions that the late spring and early autumn
are the periods of the year when cases are most often seen.1
1 In his account of the Austrian campaign of 1809, Larrey wrote: “The wounded who
were most exposed to the cold, damp air of the chilly spring nights, after having been
subjected to the quite considerable heat of the day, were almost all attacked with
tetanus, which prevailed only at the time when the Reaumur thermometer varied
almost constantly between the day and the night by the half of its rise and fall; so that
we would have it in the day at 19°, 20°, 21°, and 23° above zero (75°–84° F.), while
the mercury would fall to 13°, 12°, 10°, 9°, and 8° during the night (50°–61° F.). I had
noticed the same thing in Egypt.”

Cold has, from the time of Hippocrates, been regarded as a great

predisposing if not exciting cause, and the non-traumatic cases have
been classed together as those a frigore. It is not, however, the
exposure to simply a low temperature that is followed by the disease,
but to cold combined with dampness, and quickly succeeding to a
temperature decidedly higher, as in the cool nights coming on after
hot days in tropical regions, or in the spring and fall seasons of
temperate latitudes, or in the cold air blowing over or cold water
dashed upon a wound or the heated skin. That such cold, thus
operating, does most usually precede the attack of tetanus is
unquestionable; and it has by many been held that without it no
traumatism will be followed by the disease. Observers generally are
agreed, with Sir Thomas Watson, that “there is good reason for
thinking that in many instances one of these causes (wound and
cold) alone would fail to produce it, while both together call it forth.”

In the low lands of hot countries (as the East and West Indies) the
disease is very frequently met with, at times prevailing almost
epidemically; and, on the other hand, it is rare in dry elevated
regions and in high northern latitudes, as in Russia, where during a
long military and civil experience Pirogoff met with but eight cases.
Trismus nascentium would seem to be an exception to the general
rule of the non-prevalence of tetanus in places far north, since, e.g.,
it has been at different periods very common in the Hebrides and the
small islands off the southern coast of Iceland. But these localities,
from their peculiar position, are not extremely cold, and their climate
is damp and variable; so that, even if the lockjaw of infants be
accepted as a variety of true tetanus, the geographical exception
indicated is but an apparent one.

Traumatic cases are greatly more numerous than idiopathic, and no

class of wounds is free from the possibility of the supervention of
tetanus. Incised wounds are much less likely to be thus complicated
than either of the other varieties, though operation-wounds of all
sorts, minor and major, have been followed by this affection. So
frequently has it been associated with comparatively trivial injuries
that it has become a common belief that the slighter the traumatism
the greater the danger of tetanus. That this is not true the records of
military surgery abundantly show. Wounds of the lower extremity are
much graver in this respect than those of the upper. Injuries of the
hand and feet, especially roughly punctured wounds of the palmar
and plantar fasciæ (as, e.g., those made by rusty nails), have long
been regarded as peculiarly liable to develop the disease, and
accidents of this nature always give rise to the fear of lockjaw.
Though there can be no question but that more than one-half of the
cases of tetanus in civil life are associated with wounds of these
localities, yet the number of such injuries is so much greater than of
those of other parts of the body that the special liability of the
subjects of them to become tetanic may well be questioned. In this
connection it is a significant fact that during our late war of perhaps
12,000 or 13,000 wounds of the hand, only 37 were followed by
tetanus, and of 16,000 of the foot, but 57. A few years ago numerous
cases of tetanus were observed in our larger cities complicating
hand-wounds produced by the toy pistol—injuries that were often
associated with considerable laceration of the soft parts, and
generally with lodgment of the wad.

Not even the complete cicatrization of a wound altogether protects

against the occurrence of the disease, the exciting cause of which,
under such circumstances, is probably to be found in retained
foreign bodies or pent-up fluids.

ETIOLOGY.—Almost universally regarded as an affection of the central

nervous system, inducing a heightened state of the reflex irritability,
though some have maintained that the reflex excitability of the
medulla and the cord is actually lessened, how such affection is
produced is unknown; and it is an unsettled question whether it is
through the medium of the nerves or the vessels, whether by
ascending inflammation, by reflected irritation, or by the presence of
a septic element or a special micro-organism in the blood.

That the disease is due to ascending neuritis finds support in the

congested and inflamed state of the nerves leading up from the
place of injury (affecting them in whole or in part, it may be in but a
few of their fibres), and in the inflammatory changes discoverable in
the cord and its vessels. But time and again thorough and careful
investigation by experienced observers has altogether failed to
detect any alterations in the nerves or pathological changes in the
cord, other than those that might properly be attributed to the
spasms, the temperature, or the drugs administered. The symptoms
of acute neuritis and myelitis (pain, paralyses, and later trophic
changes) are not those which are present in cases of tetanus. The
evidences of inflammation of the cord are most apparent, not in that
portion of it into which the nerves from the wounded part enter, but,
as shown by Michaud, so far as the cellular changes in the gray
matter are concerned, always in the lumbar region, no matter where
the wound may be located.

The much more generally accepted theory of reflex neurosis is

based upon the association of the disease with “all forms of nerve-
irritation, mechanical, thermal, chemical, and pathological;” upon the
direct relation existing between the likelihood of its occurrence and
the degree of sensibility of the wounded nerve;2 in the, at times, very
short interval between the receipt of the injury and the
commencement of the tetanic symptoms; in the local spasms
unquestionably developed by nerve-pressure and injury; in the
primary affection of muscles at a distance from the damaged part; in
the already-referred-to absence of the structural lesions of
inflammation; and in the relief at times afforded by the removal of
irritating foreign bodies, the temporary cutting off of the nerve-
connection with the central organs, or the amputation of the injured
limb. But that something more than irritation of peripheral nerves is
necessary to the production of tetanus would seem to be proved by
the frequency of such irritation and the rarity of the disease; by the
not infrequent prolonged yet harmless lodgment of foreign bodies,
even sharp and angular ones, against or in nerves of high
sensibility;3 by the primary affection of the muscles about the jaws,
and not those in the neighborhood of the wound; by the almost
universal failure to produce the affection experimentally, either by
mechanical injuries or by electrical excitations; by certain well-
attested instances of its repeated outbreak in connection with a
definite locality, a single ship of a squadron, a particular ward in a
hospital, or even bed in a ward; by the usual absence of that pain
which is the ordinary effect of nerve-irritation; and by the small
measure of success which has attended operations, even when
early performed, permitting the taking away of foreign bodies
pressing upon or resting in a nerve, interrupting the connection with
the cord, or altogether removing the wound and its surroundings.
Even in the idiopathic cases—many of which, it would at first sight
appear, can be due only to reflected irritation—another explanation
of the mode of their production may, as we will see, be offered.
2 According to Gubler, the danger is greatest in wounds of parts containing numerous
Pacinian corpuscles.

3 Heller has reported a case in which a piece of lead was lodged in the sheath of the
sciatic nerve. Though chronic neuritis resulted, the wound healed perfectly. Two years
later, after exposure while drilling, the man was seized with tetanus and died of it.

The so-called humoral theory would find the exciting cause of the
disease in a special morbific agent developed in the secretions of the
unbroken skin or the damaged tissues of the wound, or introduced
from without and carried by the blood-stream to the medulla and the
cord, there to produce such cell-changes as give rise to the tetanic
movements. It finds support in the unsatisfactory character of the
neural theories; in the strong analogy in many respects of the
symptoms of the disease to the increased irritability and muscular
contractions of hydrophobia and strychnia-poisoning, or those
produced by experimental injections of certain vegetable alkaloids; in
the recent discoveries in physiological fluids, as urine and saliva, of
chemical compounds,4 and in decomposing organic matter of
ptomaïnes capable of tetanizing animals when injected into them; in
the rapidly-enlarging number of diseases known to be, or with good
reason believed to be, consequent upon the presence of peculiar
microbes; in the more easy explanation by it than upon other
theories of the ordinary irregularity and infrequency of its occurrence,
its occasional restriction within narrow limits, and its almost endemic
prevalence in certain buildings and even beds; in the extreme gravity
of acute cases and the protracted convalescence of those who
recover from the subacute and chronic forms; in the very frequent
failure of all varieties of operative treatment; and in the success of
therapeutic measures just in proportion to their power to quiet and
sustain the patient during the period of apparent elimination of a
poison or development and death of an organism.
4 Paschkie in some recent experiments found that the sulphocyanide of sodium
applied in small quantities caused a tetanic state more lasting than that caused by
 strychnia.

This theory is as yet unsupported by any positive facts. Neither

septic element nor peculiar microbe has been discovered.5 Failure
has attended all efforts to produce the disease in animals by
injecting into them the blood of tetanics. There is no testimony
worthy of acceptance of the direct transmission of the disease to
those, either healthy or wounded, coming in contact with the tetanic
patient; nor can much weight be attached to such reports as that of
Betoli of individuals being attacked with it who had eaten the flesh of
an animal dead of it.
5 Curtiss of Chicago thought that he had found a special organism, but further
investigation showed that it was present in the blood of healthy members of the family
and in the water of a neighboring pond.

The ordinary absence of fever has been thought to prove the

incorrectness of this theory, but increased body-heat is not a
symptom of rabies or strychnia-poisoning, of the tetanic state
following the injection of ptomaïnes, or of cholera—a disease very
probably dependent upon the presence and action of a bacillus.
Martin de Pedro, regarding the affection as rheumatic in character,
located it in the muscles themselves, there being produced, through
poisoning of the venous blood, a muscular asphyxia.

MORBID ANATOMY.—The pathological conditions observed upon

autopsy in the wound, the nerves, the central organs, and the
muscles, have been so various and inconstant that post-mortem
examinations have afforded little or no definite information respecting
the morbid anatomy of the disease. Many of the reported lesions
have unquestionably been dependent upon cadaveric changes or
defective preparation for microscopic study. The wound itself has
been found on the one hand healthy and in due course of
cicatrization,6 on the other showing complete arrest of the reparative
process (“the sores are dry in tetanus,” wrote Aretæus),7 or even
gangrenous, with pus-collections, larger or smaller, in its immediate
vicinity, usually in connection with retained foreign bodies.