OX THE 
SEVERAL METHODS OF EDUCATING, 
AND ON THE 
SELECTION OF PROPER SCHOOLS FOR, THE 
DEAF AND DUMB. 
ON 
BATHING, SWIMMING, AND HIVING, 
AS 
CAUSES OF AURAL DISEASE. 
BY 
LAURENCE TURNBULL, M.D., 
FELLOW OF THE AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE, AURAL SURGEON 
TO JEFFERSON COLLEGE HOSPITAL, PHYSICIAN TO THE DEPARTMENT OF DISEASES 
OF THE EYE AND EAR, HOWARD HOSPITAL, PHILADELPHIA, 
Extracted from the Transactions of the'" 
INTERNATIONAL MEDICAL CONGRESS, 
Philadelphia, September, 1876. 
VIIIL ADELPHIA: 
1877. PHILADELPHIA: 
COLLINS, PRINTER, 
705 Jayne Street. ON THE SEVERAL METHODS OF EDUCATING, AND ON THE 
SELECTION OF PROPER SCHOOLS FOR, THE 
DEAF AND DUMB. 
The lot of the uneducated and ignorant deaf-mute is sad indeed; cut 
oft' from intercourse with his fellow-man by loss of speech, and unable to 
obtain instruction or amusement from such intercourse, or through books, 
he is left to “ Nature,” and is governed by naught but his animal passions 
and appetites. It is no wonder then that, when these latter are in full 
development, he becomes allied to certain of the brute creation. From 
my own dissections of the brain of the deaf-mute, as from those of many 
careful observers, it is rendered probable that the deaf and dumb are 
capable of receiving and retaining as great an amount of intellectual 
knowledge as their hearing brothers or sisters, provided that adequate 
instruction be made available through the eye. 
As early as the fifteenth century, some effort was made to teach deaf- 
mutes, but it is to the sixteenth century that is due the great honor of 
having been the period of jubilee to the deaf and dumb; and to the Abbe 
de L’Ep£e was given the great gift of teaching deaf-mutes by a symbolic 
language, so that they might know good from evil, have intercourse 
with a select few of their fellow-men, and above all acquire such aspi- 
rations after true knowledge as would fit them for a happy home here, 
and for a better world above. Another devoted man, the Abbe Sicard, 
who took up the clue already furnished by de L’Epde, adopted sign-lan- 
guage, and enlarged, improved, and reduced it to a system. The knowl- 
edge of this valuable method soon crossed the Atlantic, and its advocate, 
the Rev. Thomas H. Gallaudet, D.D., founded the American Asylum at 
Hartford, Conn. (1817), and, soon after (1820), M. Clerc (one of the favor- 
ite pupils of Sicard), who came over with Dr. Gallaudet, organized the 
Pennsylvania Institution for the Instruction of the Deaf and Dumb, in 
Philadelphia. This institution has sent out, since its organization, 1700 
pupils, well educated, and with a careful moral training which has been 
of inestimable advantage to them and to the community at large. Ger- 
many was not long after France in this philanthropic labor, for, in 1760, 
Samuel Heinicke, a Saxon by birth, developed the “ artificial method” 
of instruction for deaf-mutes. The principal aim of this good man was 
to improve the “French system,” and to endeavor to cultivate whatever 
might remain of speech, by developing the latent power which exists in 
all save a very few. In the early stage of this system, artificial signs 
are absolutely necessary; but when these have been acquired, they are to 
be employed only as a ladder to reach the higher department, where the 
finger-alphabet and other artificial signs are no longer required. When 
successfully taught by this system, pupils are enabled to think in the 4 
TURNBULL, 
idioms of the language of their country, to hold audible conversation, 
and so understand much that is spoken to them, being thus rendered 
practically less deaf, and actually less dumb. 
Another advance which has been made in the further improvement of 
the mode of instruction of the deaf-mute, comes from England, in the 
system known as “Bell’s Method of Visible Speech,” which, having re- 
ceived but little attention in the country of its origin, was brought by its 
author to the United States, where it has been received and adopted in 
seven of our forty-eight institutions, and with the most gratifying re- 
sults. Ido not find fault with what has been done under the old me- 
thods, but rather rejoice that so many thousands of deaf-mutes have 
received the advantages of an education by means of the sign language, 
and of articulation taught by the German method. I would also state 
that the United States have a “ National College” at Washing-ton, where 
O C' 7 
more advanced studies can be pursued, and where young deaf-mutes are 
graduated with a standing and scholarship not inferior to that achieved 
by the graduates of ordinary colleges. This institution bears to others 
for the deaf and dumb, the same relation that colleges bear to schools 
and academies. Many of the graduates of this college have received 
appointments as teachers, while others are editors, authors, and writers, 
or are found in the various government offices, in the exercise of duties 
which they are quite capable of performing in an entirely satisfactory 
manner. In our Centennial Exhibition will be found some admirable 
pictures executed by deaf-mutes, as well as other products of their pencils 
and pens. They are also capable handicraftsmen, and are to be found in 
our shops and factories, as well as in the Industrial Homes founded in 
this city for their special benefit. 
Bell’s method or system of visible speech gives the pupil, by means of 
drawings, etc., a knowledge of the concealed parts of the month and 
throat, which are used in articulation, as also of the movements of the 
various parts, so that the pupil is thus better able to gain conscious con- 
trol over them. This method of writing any sounds that the pupils may 
utter, serves to interest them in the practice of the elements and com- 
binations, thus giving them great power over their organs of speech, and 
obviating the necessity of informing them that a sound is wrong if it is 
not the one which the teacher wishes to obtain. It is the practice of 
those who teach this system to write all sounds in the visible speech- 
symbols, and especially those that are essential in English speech. The 
symbolizing of odd sounds also leads the pupil to think and study about 
the parts of the mouth that produce them. 
I shall now discuss the following questions; (1) What is the best me- 
thod of classifying deaf children, and is it advisable to place them in 
ordinary, or in special, schools? and (2) How many deaf-mutes are ca- 
pable of receiving Bell’s method of instruction, and should the attempt 
be made to instruct all deaf-mutes by articulation, or by the sign language 
only ? Not having heard Hr. Blake’s paper, I shall attempt to answer 
these questions from my own personal observations. 
If a child can hear sufficiently well to understand the teacher when 
near him, the ordinary school is, for him, decidedly better than a special 
school. Children sometimes become deaf after having learned to talk 
and read; such children may profitably attend an ordinary school, pro- 
vided that the parents or teacher take time to explain the lessons; but 
if this be not done, the child will often recite in a parrot-like manner, 
without understanding what he has learned, and will go over a great deal EDUCATION OF DEAF AND DUMB. 
5 
of ground with very little profit. This has been the experience of 
teachers of deaf-mutes, even when the pupil has learned to read quite 
well by observing the lips of the speaker. Congenital deaf-mutes, at- 
tending an ordinary school, may learn to write, or rather to copy, and 
may perhaps get some idea of numbers; but the teachers of such schools 
do not know how to reach their pupils’ minds, even if they have the time 
to teach them. As a rule, such children might as well be at play, except 
that school occupies their time and their thoughts. Another advantage, 
however, which is gained for the deaf-mute children, is in their mingling 
as much as possible with those who hear. 
If a child cannot profit by the instruction given in an ordinary school, 
let him if possible have a private teacher, but not necessarily in his own 
house, as he is not always subject to the best government there. If he 
needs stimulating, it may be well to place him in a class with four or 
five others of a suitable degree of advancement; and if this cannot be 
done, he may be placed in a school or institution where the instruction 
is especially adapted to the deaf. 
If children are too deaf to profit by the common school, and yet have 
sufficient hearing to have acquired speech through the ear, instructors of 
the deaf are near!}7 or quite unanimous in the opinion that they should 
be taught by articulation and lip-reading. The experience of the teachers 
would lead them to say, “ Let the attempt be made, if possible, to teach 
every deaf child in this way,” Of 116 pupils in the “ Clark Institution 
for Deaf-Mutes,” three have been dismissed as incapable of learning arti- 
culation and lip-reading, and one because she required more individual 
instruction than could be given her. The latter, however, has since been 
taught, so that speech and lip-reading are her means of communication 
in her own home. Some of the remaining number of pupils (congenital 
mutes) speak imperfectly, but in every instance well enough to be under- 
stood in their own homes, while some of the indifferent speakers are 
fairly successful in lip-reading, an acquisition as valuable as that of 
speaking. Many congenital mutes speak so as to be understood by 
strangers, and will probably be able to make speech and lip-reading a 
successful means of communication throughout the world. Of the 116 
pupils at the above-named institution, one-third are semi-mutes or semi- 
deaf, although some of*, those so classed have not had hearing enough to 
learn to talk. 
My object in writing this brief paper has been : (1) To excite a greater 
degree of interest, in physicians, for the deaf-mute, with an endeavor on 
their part to prevent deafness, and so diminish the number of deaf-mutes ; 
(2) To induce a more conscientious study and treatment, by physicians, 
of the ears of their patients, when the latter are attacked by scarlet or 
typhoid fever, cerebro-spinal meningitis, or obstruction of the Eustachian 
tubes as the result of measles, diphtheria, tonsillitis, or syphilis; (3) To 
lead physicians to give the systems of instruction pursued in our various 
institutions for the deaf and dumb, a certain amount of study, so as to be 
able to recommend intelligently to patients, their relatives, or friends, the 
best method for each individual case; and (4) To induce physicians to 
recommend that there should be appointed by the governor of each State, 
a commissioner, to collect, examine, and classify the deaf and dumb, so 
that all who are found to possess any degree of hearing, or any remnant 
of speech, may be taught articulation by the method of Bell, and that 
those who are unable to profit by this system, may be taught the lan- 
guage of signs, natural or acquired. 6 
TURNBULL, EDUCATION OF DEAF AND DUMB. 
To aid them in their arduous work, I have recommended to some of 
our teachers of deaf-mutes, that their pupils should use mechanical appli- 
ances for improving the hearing power. By speaking or singing differ- 
ent vowels into one of these aids to hearing (tubes or trumpets), we can 
determine how much hearing the pupil possesses, and, if he be able to 
distinguish one vowel from another, a continued use of this mechanical 
aid may ultimately enable him to utilize audition as an auxiliary to 
vision. I have known very deaf persons, by the aid of this means alone, 
to have had their hearing so much improved that they could distinguish 
all ordinary sounds, and, by some effort, enter into conversation. An- 
other important mechanical aid to persons who are deaf from diseases 
in which the tympanic membrane is lost, in part or in whole, but in which 
the inner small bone (the stapes) still remains, or in whose ears the bones 
have become stiff or anchylosed, is the pellet of cotton, moistened and 
applied near to the bones, or against the stapes,-so as to bring the parts 
in closer contact with external vibrations, and thus cause the sounds to 
be transmitted to the auditory nerve. 
In conclusion, I have added, chiefly from German authorities, the most 
recent views on the subject of phonation, knowing how much interest 
this subject is exciting in the minds of both physicians'and teachers of 
the deaf and dumb, at the present day. Some writers have endeavored 
to prove that the brain molecules of the deaf and dumb differ from those 
of persons who hear; but, as I have already stated, the brain is rarely 
affected in those that' are deaf, while, on the other hand, in many 
instances of extensive disease of the brain, not involving the auditory 
nerve, deafness has not resulted. Occasionally the spine is diseased, or 
the nerves which, coming from that great centre, give power to the 
tongue and larynx, thus rendering the deaf-mute unable to articulate, no 
matter how much instruction he may receive. Section of the spinal 
accessory, or of the inferior laryngeal nerve, entirely destroys the voice, 
so that these may be termed the true vocal nerves. If, therefore, the 
centre of phonation is situated in the spinal cord, it is plain that it can- 
not be found in the brain; anencephalous children have been known 
to scream under the influence of external excitation or internal pain. 
The centre of the memory for words, appears to reside in the brain, and 
attempts have been made to fix its seat in the anterior lobes, but the 
observations made on this subject are as yet contradictory. Each centre 
is independent of the other, for a cry may be easily uttered when articu- 
lation is very difficult. Amnesia, or the loss of memory for words, there- 
fore, must be distinguished from aphasia, or the loss of power to pronounce 
them ; the patient suffering from aphasia can still write his thoughts, 
while in amnesia he can only express himself by drawing a representa- 
tion of the object to which he wishes to refer. ON BATHING, SWIMMING, AND DIVING, AS CAUSES 
OF AURAL DISEASE. 
Swimming and diving in cold water seem to me to be important and 
frequent causes of disease of the external auditory canal and anterior 
surface of the merabrana tympani, as also of the middle ear, though bath- 
ing in river or sea water is, when wisely and properly regulated, both 
healthful and pleasant. The evils attending bathing and swimming in 
cold water are the entrance of this cold fluid, not only into the external 
meatus, but as far as the membrana tympani, causing inflammation of 
the lower portion of the auditory canal, and-of the anterior surface of the 
tympanic membrane. But a still greater evil is from sudden deglutition, 
during diving or swimming, by which—the mouth, nose, and pharynx 
being tilled with cold water, and the mouths of the Eustachian tubes 
open—a portion of the water passes into the middle ear. This result 
rarely occurs in expert swimmers or divers, hut is most common in begin- 
ners, who suddenly, from cold, or the shock of the contact of the water, 
breathe or swallow in a sobbing manner. I have, however, known it to 
occur in old and experienced swimmers while plunging headforemost, 
owing to the intense coldness of the water—the act of deglutition being 
entirely involuntary. 
If the water is not removed by placing the head to one side, and draw- 
ing the external ear forcibly outwards, shaking the head at the same 
time and opening the mouth, it is apt to cause inflammation, with the 
formation of pus, followed by perforation of the membrana tympani; or 
the inflammation, if neglected, may pass, inwards to the cochlea and 
labyrinth, and, implicating,the brain, may terminate in death. 
It is a well-recognized maxim among those who devote special atten- 
tion to diseases of the ear, that no cold fluid should be allowed to enter 
even the external auditory canal; still this important fact is not suffi- 
ciently recognized by the profession at large. The entrance of warm water 
into the ear is less objectionable, but even this is not quite free from dan- 
ger, and has its disadvantages; and the water should in all cases contain 
a few grains of a saline ingredient, like borax, soda, or common salt, when 
employed in washing out the ear. The symptoms of water in the mid- 
dle ear are, in the first stage, an uncomfortable sensation, followed by 
earache or pain, which after a time becomes agonizing, and is accompa- 
nied with great tenderness behind the auricle. In proof that water in 
the ears is injurious, and causes deafness, I might cite a number of in- 
stances, and it is a well-known fact that dogs which are thrown into 
ivater become deaf. 
Many cases of this form of disease, in its chronic stage, come under 
treatment during all seasons, but acute cases, from swimming and diving, 
occur during the summer months, and chiefly in boys from eight to six- o 
o 
TURNBULL, BATHING, ETC., AS CAUSES OF AURAL DISEASE. 
teen years of age ; a ranch smaller number occurring in the fall and win- 
ter. If the acute form is promptly treated, entire recovery takes place; 
but should the case not be seen until after the chill, it is always followed 
by a discharge of shorter or longer duration. In cases not recognized, 
the symptoms of violent headache, furious delirium, and coma, give the 
physician the impression that disease of the brain is present, and the case 
thus improperly treated terminates in death. The morbid condition in the 
first stage consists in acute inflammation of the extremely delicate raucous 
membrane lining the middle ear. This inflammation is followed by effu- 
sion of fluid, and, after twenty-four hours, by the formation of pus ; it is 
in every instance attended by fever, with swelling and inflammation of 
the nasopharyngeal space, and great pain. If this fluid or pus be removed 
by incision into the membrana tympani, followed by the use of the air 
douche, and injections of hot saline water, the patient recovers, and the 
ear is saved. The patient is apt to remain deaf for several weeks, and 
the local application of tincture of iodine, with or without some anodyne, 
brushed around the back of the auricle, facilitates the removal of the in- 
flammatory thickening. To diminish the discharge of pus, should it 
continue, we may employ a powder of salicylic acid and starch, blown 
into the meatus and after a time washed out, and reapplied twice a day, 
until the discharge shall have ceased and the perforation have become 
closed.