CIRCULARS OF INFORMATION 
OK THE 
BUREAU OF EDUCATION. 
No. 5-1881. 
CAUSES OF DEAFNESS AMONG SCHOOL CHILDREN AND ITS INFLUENCES 
ON EDUCATION, WITH REMARKS ON THE INSTRUCTION OF PUPILS 
WITH IMPAIRED HEARING AND ON AURAL HYGIENE IN THE 
SCHOOLS, BY SAMIJ.EL SEXTON, M. D., AURAL SURGEON TO 
T.IE NEW YORK EYE AND EAR INFIRMARY, MEMBER 
OF THE AMERICAN OTOLOGICAL SOCIETY, Ac. 
WASHINGTON: 
GOVERNMENT PRINTING OFFICE. 
18 81. CIRCULARS OF INFORMATION 
OF THE 
BUREAU OF EDUCATION. 
1STo. 5-1881 . 
CAUSES OF DEAFNESS AMONG SCHOOL CHILDREN AND ITS INFLUENCES 
ON EDUCATION, WITH REMARKS ON THE INSTRUCTION OF PUPILS 
WITH IMPAIRED HEARING AND ON AURAL HYGIENE IN THE 
SCHOOLS, BY SAMUEL SEXTON, M. D., AURAL SURGEON TO 
THE NEW YORK EYE AND EAR INFIRMARY, MEMBER 
OF THE AMERICAN OTOLOGICAL SOCIETY, &c. 
WASHINGTON: 
GOVERNMENT PRINTING OFFICE. 
1881. CONTENTS. • 
Page. 
Letter of the Commissioner of Education to the Secretary of the Interior 5 
STRUCTURE OF THE EAR. 
External auditory canal, drum-head, and drum of the ear 8 
Eustachian tube 9 
Sound transmitting mechanism 9 
Ear hones, mastoid cells, and inner ear 10 
Modus operandi of hearing 10 
Noises in the head 11 
Autopliony 11 
CAUSES OF DEAFNESS AMONG SCHOOL CHILDREN. 
Affections of the auricle 12 
Wax in the external auditory canal 12 
Affections of the auditory canal and of the drum 12 
Injuries to the drum from violence 12 
Boxing the ear 12 
Affections of the inner ear 12 
faking cold in the head 13 
Dental irritation 14 
First set of teeth, permanent teeth, and wisdom teeth 15 
Effects of getting water in the ears, surf bathing, and diving and swimming 
underwater 1G 
Nasal douche and sniffing solutions up the nose 16 
Children’s diseases 16 
INCAPACITATING DEAFNESS. 
Normal hearing 17 
Incapacitating deafness 17 
METHOD OF TESTING THE HEARING POWER OF PUPILS. 
9 
Method of examination 18 
Examinations of pupils in the public and parochial schools .• 18 
Earache among school children 19 
ANOMALIES OF HEARING. 
Autophony 1 20 
Noises in the head 21 
IMPERFECTIONS OF SPEECH. 
Feeble-minded children 21 
Acquisition of language 21 
Defects in the vocal organs ' 22 4 
CONTENTS. 
MANAGEMENT OF PUPILS WITH IMPAIRED HEARING. 
Page. 
Separate education of the very deaf, and disposition of deaf pupils 23 
Deaf-mutes - 23 
Dental sound transmission 25 
DEAFNESS AMONG TEACHERS. 
Importance of good heariug 25 
Example of deafness in an applicant for appointment 26 
AURAL HYGIENE IN THE SCHOOLS. 
Structure of school-houses 26 
Temperature of the school room 27 
Insufficient and excessive clothing 27 
TAKING COLD IN THE HEAD. 
Effect of the weather 28 
Exposure to cold 28 
Colds in the head 29 
DENTAL IRRITATION AND THE CARE OF THE TEETH. 
Decay of the teeth 29 
Temporary teeth, six-year molar teeth, and wisdom teeth 30 
Disease of the teeth among school children 31 
Deformity from irregularity of the teeth 34 
OUTDOOR BATHING AND ITS EFFECTS ON THE EAR. 
Bathing in the ocean, rivers, and ponds 35 
Ears of marine animals 35 
Dangers of the public baths ' 35 
MOUTH BREATHING. 
Deafness from mouth breathing 36 
Deformity of the drum-head 36 
g CARE OF THE EARS. 
Effects of violent removal of foreign bodies from the external auditory canal... 36 
Injury from boxing the ear 37 
Discomfort and distraction caused by street noises 37 
Results of the neglect of children’s ears 37 
I CONCLUDING REMARKS. 
Disadvantages of deafness 38 
Apparent dulness of the deaf 38 
Effects of noises in the head and autophony 39 
APPENDIX. 
Tables exhibiting the results of twenty examinations of the hearing power of 
the children in New York public and Roman Catholic parochial schools 41 
Examinations in the colored schools, Tables I to XII, inclusive 42 
Examinations in the Roman Catholic parochial schools, Tables XIII to XVII, 
inclusive 44 
Examinations in New York public schools, Tables XVIII to XX, inclusive 4b LETTER. 
Department of the Interior. 
Bureau of Education, 
Wash inf/ton, September 24, 1881. 
Sir: The causes of deafness among school children are numerous 
and important enough to justify a special investigation of the subject, 
and I have requested Dr. Samuel Sexton, a distinguished aural surgeon 
of New York City, to prepare a paper on the subject. 
The author has collected in the following pages some of the more 
practical conclusions regarding the causes of deafness among school 
children, together with suggestions of a hygienic and prophylactic nature 
drawn from his own observations among a large number of pupils in 
dispensary, hospital, and private practice. 
Before commencing the general discussion of the subject, the writer 
deems it expedient to give a brief description of the structure of the 
ear, together with its physical and physiological functions, including 
the modus operandi of hearing. 
The woodcut illustrating the deeper and invisible portions of the ear, 
it is believed, will materially aid the reader in arriving at a useful knowl- 
edge of the subject. 
The sympathetic relations between the teeth and the ears are also fully 
considered, the influence of diseased states of the former on the acoustic 
organs of youth seeming to demand particular attention. 
I would, therefore, respectfully request its publication as a circular of 
information. 
I have the honor to be, your obedient servant, 
JOHN EATON, 
Commissioner. 
The Hon. the Secretary of the Interior. 
Publication approved. 
S. J. KIRKWOOD, 
Secretary. DEAFNESS AMONG SCHOOL CHILDREN. 
STRUCTURE OF TIIE EAR. 
From a study of Fig. 1 it will be seen that quite a large passage seems 
to traverse the base of the skull from ear to ear; this passage, 
does not extend directly athwart the head in such a manner as to im- 
Fiul'kk 1.— (After liidinger).— Section through the head showing the auditory canal, drum, drum- 
head, and Eustachian tube of each side. 1, cartilage of the external auditory canal: 2, bony portion of 
external auditory canal; !i, 4, drum membrane of the right side; 5, drum cavity; 6, dilator muscle of 
the Eustachian tube; 7, 12, muscles which lift the soft palate ; 8, mucous membrane of the pharyngeal 
orifice of the tube; it, drum membrane of the left side; 10, hammer bone; 11, muscle which renders 
the drum membrane tense; 12, mucous membrane of the Eustachian tube; 14, 15, mucous membrane 
of tlie posterior surface of the pharynx. 
JThe writer desires to acknowledge his indebtedness to Wm, Wood & Co., of New 
York, and Presley Blakiston, of Philadelphia, who have kindly loaned several of the 
cuts made use of in the following pages. 8 
CIRCULARS OF INFORMATION FOR 1881. 
mediately connect the two ears together, tor its connection is broken, 
as it were, in the pharynx, where it 
opens by two separate mouths. 
A description of the passage of one 
side will be sufficient, inasmuch as 
both are alike. From where the pas- 
sage enters the head at the auricle— 
ear, in common parlance—to its'in- 
ner termination in the pharynx, it 
measures about two inches and a 
half. 
The external auditory canal com- 
prises the outer portion of this pas- 
sage; its course is inwards, with 
slight deviations, for about an inch 
and a half, where it is closed by the 
drum-head. It is nearly round, sel- 
dom large enough to admit the end 
of the little linger, and has a lining 
of skin which becomes very delicate 
at its inner end where it is reflected 
over the drum-head. The wax of the 
ear is secreted by numerous small 
glands situated near the centre ol 
the auditory canal. < 
The drum head,1 or membrana tym 
pani (Figures 2 and 3)2, consists of a 
very thin skin, no thicker than tissue 
paper, which is stretched across the 
passage and closes in the drum. It 
is composeel of three layers; the mid 
die or fibrous layer being tough, gives 
it strength. 
The drum cavity, or middle eai 
(tympanum), consists of the middle 
portion of the passage where it goes 
through the base of the skull. The 
drum is for the most part ernly a 
line or two in depth aud about a halt 
an inch in height aud width; its in- 
ner wall, which consists of an irregu 
lar surface of bone, is perforated in 
Figure 2.— Outer surface of the drum head, mag- 
nified about 3£ times. 1, the flaccid part of the drum- 
head ; 2, short process; 3, the back fold of the drum- 
head; 4, the anvil’s long and descending limb shin- 
ing through from behiml the drum membrane; 5, 
5, the true membrane; 6, 6, 6, 6, inner end of bony 
canal forming frame for drum-head; 7, the pyramid 
of light; 8, lower part of the hammer; 9, tlie front 
fold of the drum-head. 
Figure 3.—Inner surface of the drum-head, mag 
nitied about 3J times. 1, short limb of the anvil, 
attached to back part of outer bony wall of drum 
cavity; 2, body of anvil bone; 3, head of hammer 
bone; 4, neck of hammer; 5, 11, chorda tympani 
nerve (this marks also the boundary line of the 
pockets and folds of the drum-head, the latter being 
shown in Fig. 2, at 1 and 5); 6, front part of drum- 
head; 7, 8, bony frame annual drum-head; 9, the 
lower part of the handle of the hammer bone; 10, 
lower part of the long limb of anvil bone; to the 
point 10 the head of the stirrup bone is attached. 
1 Tlie drum-head is liable to be incorrectly spoken of as the drum itself. As in the 
musical instrument known .as the drum, the ear drum lias a membranous cover (drum 
skin) which covers a hollow cavity (drum) containing air. The drum of the ear con- 
tains not only air but also the ear bones. 
* From Hearing, and How to Keep It, by Charles H. Burnett, M. n. DEAFNESS AMONG SCHOOL CHILDREN. 
9 
two places, the openings leading into the labyrinth but closed by mem- 
brane; one of these openings receives the stirrup bone. The drum’s 
dense bony case and its deep situation afford protection to the sound 
transmitting mechanism which it contains, and its unyielding walls 
allow' of precision in the movements of the mechanism. 
The drum head veils the drum cavity outwardly, but owing to its 
translucency a glimpse is afforded of some of the structures within. The 
brain lies above the drum and is separated from it by a very thin plate 
of bone. 
The Eustachian tube.—The inner portion of the passage which extends 
from the ear to the throat takes a somewhat downward course from the 
drum to its inner termination; this portion of the passage is a little 
more than an inch in length and is known as the Eustachian tube. The 
tube is very small where it leaves the drum, but it becomes gradually 
larger, and finally expands at its termination into quite a large trumpet- 
shaped mouth. The pharynx, which receives the inner extremity of the 
tube, is the superior termination of the air passages, and by means of this 
tube the air is conveyed upwards to the drum of the ear. The Eusta- 
chian tube is lined with mucous membrane. The mucus secreted in the 
drum cavity and along the tube passes into the throat. The drum cavity 
requires a constant supply of air from the throat in order to counteract 
the air pressure upon the drum membrane from without; this is accom- 
plished by the act of breathing, every bel 
lows-like movement of the lungs forcing 
little jets of air up through the Eustachian 
tube to the ear. Sound probably travels- 
from the mouth to the ear through tlib 
tube, but we are unconscious of the fad 
unless the ear is diseased. The tube b 
liable to closure from colds, chronic nasa 
catarrh, and other causes, in consequence 
of which mucus is confined in the ear and 
the normal air supply is cut off’. These 
disorders impair the hearing. 
The sound transmitting mechanism.— 
That portion of the acoustic organ whicl 
sound waves set in motion is lodged in tin 
drum cavity, w hose deeply seated bon> 
case affords it protection, besides provid 
ing the unyielding attachment which b 
necessary for the performance of its func 
tions. Besides the drum-head, or drum skin, as it is sometimes called, 
there are three ear bones concerned in this mechanism for the trans- 
mission of sound, namely: (1) The hammer bone, or malleus, which is 
joined to the top of the drum cavity; its handle comes down between 
Figure 4.— Ear bones, or ossicles of the 
ear, in mutual connection, seen from the front 
and from the right side of the head, turned 
a little to the right round a vertical axis. 
M, hammer, or malleus; J, anvil, or incus 
S, stirrup, or stapes ; Alep, head ; Me, neck 
Ml, long process, or processus gracilis: Aim 
handle, or manubrium, of the hammer; Jc, 
body; Jb, short process; Jl, long process; 
Jlil. orbicular process, or os orbiculare, or 
processus lenticularis, of the anvil; Sep, 
liead, or capitulum, of the stirrup. The 
three ear bonesare shown here enlarged four 
diameters. (Helmholtz.) 10 
CIRCULARS OF INFORMATION FOR 1881. 
the layers of the drum head and is moved to and fro with every vibration 
of the membrane. (2) The upper portion of the hammer is articulated 
to the anvil bone, or incus, to which all of its to and fro movements are 
communicated. (3) The anvil has a slender process projecting down into 
the drum cavity on the end of which is attached the .stirrup bone or stapes* 
The foot plate of the stirrup bone tits like a piston into one of the holes 
that lead from the drum cavity to the inner ear or labyrinth. Thus we 
have a chain of small bonelets extending from the drum membrane to 
the labyrinth; any impulse imparted to the drum membrane is immedi- 
ately transmitted to the stirrup bone, which is driven with a piston-like 
motion into the labyrinth. The mastoid cells are small cavities of irreg- 
ular size, the whole assemblage occupying a space as large as an almond, 
in the mass of bone which may be felt projecting behind the auricle* 
There is a direct communication between them and the drum, and they 
are liable to visitations of an inflammatory nature when it is affected. 
The inner ear or labyrinth.—The affections of the inner ear are influ- 
enced so little by ordinary hygienic measures that I shall not attempt its 
description here. Should the reader feel inclined to acquire a knowledge 
of this part of the ear he will And the subject ably treated in the very 
interesting little book on Hearing, and How to Keep It.1 
The modus operandi of hearing.—The passage that extends from the 
auricle to the throat is mainly an aerial conduit; the currents of air 
entering it at either extremity would intermingle were it not for the 
head of the drum which is stretched across the passage. The thin skin 
composing the drum’s head vibrates freely to all sounds from without 
near enough to disturb the air in contact with it, thus affording the 
motive power that sets the sound transmitting mechanism in motion. 
The aerial vibrations of which sound is composed, entering the ear 
through the external auditory canal, excite responsive movements of the 
drum-head similarly to the impulses of wind that move the sails of a 
windmill; with this difference, however, the sails of the mill receive the 
air impulses obliquely upon a plane surface which causes them to 
revolve, while the drum-head, being immovably attached to the bony 
walls of the auditory canal at its entire circumference and receiving the 
impulses of sound on a slightly concave surface, is simply driven inward 
by each sound-wave, its peculiar construction causing it to instantly 
return to its former position after each inward movement. Now every 
time the drum-head performs a to and fro movement the ear bones ]mis- 
take of the motion, and the stirrup, which tits like a piston into one of 
the orifices between the middle and inner ear, thus imparts an impres- 
sion of each vibration to the nerve of audition. Every sound thus seems 
to cause a particular kind of plunge on the part of the piston. The range 
of the sound transmitting mechanism’s movements is very remarkable \ 
thus it has been determined by scientific experiments that its to and fro 
1 Hearing, and How to Keep It, by Charles H. Burnett, M. i>. Philadelphia, Presley 
Biakistou, 1880. DEAFNESS AMONG SCHOOL CHILDREN. 
11 
movements exceed forty thousand per second in response to the higher 
notes, while shocks of sound requiring no more than sixteen vibrations 
per second may still be appreciated. It will thus be seen that the trans- 
mitting mechanism is capable of such rapid movements that the most 
intricate musical sounds impart their rhythm to the sense of hearing 
without any inharmonious break.1 
It is but fair to state that some authorities hold to the belief that the 
sound transmitting mechanism is incapable of presenting compound 
tones to the perceptive faculties as a whole, but that the function of the 
nerve of audition is to take cognizance of the separate elements of tones. 
Xoises in the head, or tinnitus aurium.—The transmitting mechanism 
in health does not permit sound to be heard through any other channel 
than the auditory canal; confusion naturally results, therefore, when 
unusual sounds are permitted to excite the auditory nerve irrespective 
of the motor of normal hearing. Sounds, therefore, that reach the sense 
of hearing by exciting the piston-like action of the stirrup bone, or other- 
wise, without the aid of the drum-head, interfere with the sounds which 
continue to be perceived as usual; hence vibratory movements arising 
from the circulation of the blood in the head, or from other physiological 
performances which are thus abnormally heard, constitute noises in the 
head. (See pages 21,39.) 
Autophony.2—When the hearing motor, ihe drum head, loses its ten- 
sion, or when any of the ear bones become separated from each other, 
sound in the external auditory canal sometimes fails to cause effectual 
movements of the mechanism; the hearing is then variable, one moment 
the voice and noises in the head are all heard confusedly together, and 
the next moment better hearing is experienced. Autophony and tin- 
nitus aurium are symptoms that confuse the individual very much, 
although he may enjoy quite good hearing when the temporary inter- 
ference is absent. (See pages 20, 39.) 
CAUSES OF DEAFNESS AMONG SCHOOL CHILDREN. 
The sense of hearing is impaired by so many causes to which children 
are exposed, many of them almost unavoidable, that it is unusual to meet 
with a child that has not experienced some aural disease. If we accept 
the statement as approximately correct that of the entire population 
not more than five in every hundred possess unimpaired hearing, some 
idea at least can be formed of the prevalence of this defect in youth. 
The numerous causes of deafness are found to be distributed among 
all the different regions of the ear, and it will, therefore, be most con- 
venient to consider them, as nearly as may be, in connection with the 
1 See Dr. Charles H. Burnett’s interesting researches on this subject, Arch. Opli. and 
Otol., vol. II, No. 2, p. 45. 
2Autoph'ony, from avrbi;, self, and <t>uv?), voice — a symptom in aural affections caus- 
ing the patient when speaking or singing to fancy that his own voice comes from 
within the head, instead of leaving the mouth and going around to the ear as usual. 
The voice of the affected person can, however, be heard by others. 12 
CIRCULARS OF INFORMATION FOR 1881. 
part affected; I shall first allude to local causes, and then to such as are 
remote or general. 
Affections of the auricle.—The auricle is liable to become inflamed from 
blows or when frosted; it may then swell up greatly and close the en- 
trance to the auditory canal, thus causing more or less deafness; a like 
result sometimes follows an attack of eczema, or salt rheum, an affection 
to which some children are subject. Deafness from these causes is not 
very frequent, however. 
Affections of the external auditory canal.— The auditory canal being 
easily inspected under a good light, any object that obstructs it can be 
readily discovered. The foreign bodies that are found in this camil 
usually consist of small objects that children themselves or their com- 
panions have carelessly introduced in play. Although these obstruc- 
tions are usually visible to the eye, their removal is found to be by no 
means an easy task, as will appear further on. 
Wax may collect in the canal and cause deafness by excluding sound, 
or it may become loose in the passage and lodge against the drum mem- 
brane, when intolerable noises in the ear will be experienced. Foreign 
bodies, by exciting the secretion of wax or by preventing its escape in 
the natural way, may give rise to deafness. The canal is also liable to 
be closed by inflammation. (See page 3(1.) 
Affections of the drum [the drum-head, although constituting the hear- 
ing motor, is yet anatomically inseparable from the drum and always 
participates in its affections]. 
Injuries to the drum from violence.—The drum is vulnerable to violence 
from without. Slight blows upon the ear or striking upon it in falling- 
may cause its injury; thus, a slight box on the ear by the hand, suddenly 
compressing the air in the auditory canal, may rupture the membrane. 
Small implements such as are commonly carried about the person are 
sometimes violently thrust into the drum by sudden movements or un- 
expected blows while they are being used in the auditory canal. These 
injuries, which are, fortunately, of rare occurrence, involve to a greater 
or less extent the whole drum, the laceration and concussion being- 
attended by other grave results. (See page 37.) 
Affections of the inner ear, or labyrinth.—The consequences of impair- 
ment of the nerve of hearing are usually very grave. There are a few 
diseases characterized by severe brain symptoms which are singularly 
obnoxious to this region, mainly through the extension of inflammation 
to the auditory nerve and its surroundings; cerebro-spinal meningitis 
is an example of such affections, often leaving complete and incurable 
deafness. The affections of this region are but little influenced by hy- 
gienic measures. 
I. LOCAL CAUSES. 
II. AFFECTIONS OF THE EAR FROM NERVOUS SYMPATHY. 
Affections of the ear from sympathy of the nerves occur more fre- 
quently than from any other cause5 they are characterized by the insid- DEAFNESS AMONG SCHOOL CHILDREN. 
13 
iousness of their approach, serious injury to the organ of hearing often 
taking place without being heralded by any symptom of warning. Gen- 
erally, however, there are appreciable symptoms which attract the 
patient’s attention, although they may not always at first seem to 
threaten the ear. Perhaps the most frequent precursor of these is 
taking cold. 
Taking cold in the head.— In order to understand fully the significance 
of taking cold in the head through sympathy of the nerves, it would be 
well to explain the peculiar character of the. parts involved. 
The cavity of the nose, the region chiefly affected, enjoys an immense 
expanse of mucous surface, far greater in extent than the modest exter- 
nal aspect of the organ would indicate; thus, where the cavity of the nose 
expands into the throat behind, its passages are greatly convoluted and 
an extensive and tortuous cavern is thus constituted. This posterior 
and much expanded portion of the nasal cavity is covered by a highly 
vascular mucous membrane—the Schneiderian membrane—which is 
easily irritated, either by the entrance of particles of dust or by the 
reflex irritation to be described below. At the beginning of a cold in 
the head the blood vessels of this membrane become engorged, when 
the flow of mucus, which is Daturally secreted in moderate quantities, is 
usually very much increased. The phenomena of a nasal catarrh are 
now soon manifest. 
The modus operandi of taking cold in the head through sympathy of 
the nerves should be fully comprehended if we would wish to prevent 
aural disease by means of hygienic measures. In order to clear the way 
to an explanation it may be permitted to draw attention to some familiar 
phenomena which are due to the reflex action of the nerves or nervous 
sympathy; thus, certain individuals are known to be subject to flushing 
from slight causes, in explanation of which it may be said that a shock 
has been experienced from a mental impression which serves to paralyze 
the nerves controlling the blood supply about the head; the face is then 
instantly flushed, and in extreme cases dryness of the throat is experi- 
enced, and the head becomes hot from the sudden rush of blood into 
the arteries. The paralyzing effect is usually of temporary duration, 
the nerves regain their normal power, and the flushing and other 
symptoms are no longer experienced. In the more decided cases, how- 
ever, pallor and dizziness succeed to the rush of blood. Another ex- 
ample suggests itself in the earache of dental irritation; pains in the 
ears are thus experienced in some instances from the cutting of a tooth 
or from dental decay, even without any irritation being felt in the 
mouth. 
A cold in the head may arise from an exposure during which a current 
of cold air is allowed to fall upon the unprotected head and shoulders; 
the local shock from the draught of cold air is usually too mild to be ob- 
served by the person wno has been thus exposed, but the nearest nerve 
centres which are concerned in the reflex action, and which are connected 14 
CIRCULARS OF INFORMATION FOR 1881. 
with the spinal cord, have branches distributed to the exposed regions 
of the head and neck; they also maintain, by other small branches, 
communication with the mucous membrane in the nose and influence the 
blood supply in the latter region. In health the tone of the arteries is 
maintained by these nerves, which are called “sympathetic,” but the shock 
occasioned by the draught of cold air serves to impair their functions 
and they become immediately paralyzed. This temporary paralysis of 
the nerves is promptly followed by an expansion of the'blood vessels in 
the mucous membrane of the nose, when congestion ensues and the mu- 
cous secretion is increased. The result of an exposure to cold draughts 
is not invariably a cold in the head—a “stiff neck” may ensue. 
During the existence of most head colds the ears are exceedingly liable 
to be involved; thus, the Eustachian tubes may be obstructed by the 
swelling of their mucous membranes, when the usual air supply of the 
drum cavity will be cut off; or, the catarrhal inflammation may extend 
from the throat up the Eustachian tubes and thence into the drum 
cavity. Both of these conditions usually coexist and give rise to much 
deafness. 
But the ear may be affected without this catarrhal extension through 
the Eustachian tube. Thus, an independent inflammation may arise in 
the ears through the nervous sympathy existing between them, the 
throat, or nose. 
In a certain number of instances the effect of taking cold may be mani- 
fested in the ear alone, the naso-pharnyx escaping entirely. The aural 
complication is announced by a “ stuffy ” feeling in the ears; there are 
noises and autophony experienced and more or less deafness. (See 
pages 28, 29.) 
Dental irritation. — By referring back to the modus operainli of taking 
cold, it will be readily understood how any dental irritation may give 
rise to aural disturbances, for the nervous relationship between the 
teeth and the ears is most intimate. In this manner many affections of 
the ear which were formerly attributed to other influences may now be 
accounted for.1 The reflected neuralgias from dental caries are quite 
familiar to most readers, but it frequently happens that, through the 
nervous influence referred to, a morbid action is set up in the ears, and 
continues almost indefinitely without being attended with any marked 
pain in either the teeth or the ears, and therefore without attracting 
the patient’s attention. But in a great many instances pain, either in 
the teeth or ears or in both, is a prominent symptom. The modus 
operandi of these sympathetic aural troubles is well illustrated in the 
accompanying diagram,2 which shows the nervous connection between 
a carious tooth and the drum-head. The drum-head, it will be seen, is 
in part supplied by a small artery (indicated at 8 in the figure on page 
'See the author’s prize essay ‘‘On affections of the ear arising from diseases of the 
teeth,” Ain. Jour. Med. Sciences, Jan., 1880. 
2Tlie diagram is from Woakes; see his work on deafness, giddiness, and noises in 
the head. Presley Blakiston, Philadelphia, 1880. DEAFNESS AMONG SCHOOL CHILDREN. 
15 
15), which is under the influence of the vaso motor (sympathetic) nerves 
of the carotid plexus, which at this part come largely from the otic gang- 
lion (4). From the source of irritation in the carious tooth a nerve (7) 
also communicates with the same ganglion (4). A line of nerve commu. 
nication is now established, through the otic ganglion, between the teeth 
and vascular supply of the 
drum-head. The effect of irri- 
tation in the teeth or gums will 
be to excite vessel dilatation in 
the arteries supplying the drum- 
head, when hypenemia or even 
inflammation will result. This, 
of course, is only an illustration 
of an injury to a small portion 
of the organ; sometimes the 
drum cavity is thus affected, 
and when the sympathetic influ- 
ence is characterized by chro- 
nicity, trophic changes may go 
slowly on, causing great injury 
to the ear without exciting any attention until hearing is seriously im- 
paired. 
With this brief explanation of the retlex phenomena concerned in 
aural diseases from dental irritation, I shall give some account of the 
dental disturbances that more particularly affect children. 
The first set of teeth, which are all cut before the third year, are liable 
in some children to erupt with difficulty; it is a well known fact that 
with the cutting of nearly every one of these teeth the ears may be 
painful or a discharge may occur. 
The permanent teeth begin to erupt at about the sixth year, and from 
this time on to the twelfth year, when the process is about completed, 
the strength of the child is severely tested; during this period of time 
nature makes an effort to gradually shed the temporary teeth and re- 
place them by the permanent set. When the temporary teeth are shed 
in the natural way the process occasions but little irritation; but the 
crowns of these teeth are extremely liable to decay before being shed, 
when, the nerve being exposed, pains and local irritation are experi- 
enced. 
The wisdom teeth.— These usually erupt about the eighteenth year. 
In many instances, however, their appearance is delayed, and they come 
in with difficulty, causing great aural irritation. 
Among the consequences of dental irritation on the ears may be men- 
tioned the increase of wax secreted, the occurrence of boils in the audi- 
tory canal, and injurious influences on the drum. The importance of 
this subject will demand a more particular account of dental disturb- 
ances further on. 
Figure 5. 16 
CIRCULARS OF INFORMATION FOR 1881. 
THE EFFECTS OF GETTING WATER IN THE EARS. 
When cold water gains admission to the ears the effect is usually 
unpleasant, often injurious. Inflammation of the auditory canal, at its 
delicate inner extremity especially, is a frequent result of getting sea 
water into this passage. But the drum-head, being yet more delicate, 
is more liable to become inflamed from this cause. The inflammation 
seldom is confined to the drum-head, but very soon involves the entire 
drum cavity. 
The force of the waves in surf bathing may send the water into the 
auditory canal with sufficient violence to rupture the drum-head; or, if 
the wave strikes the bather on the face, water may be thus driven 
through the mouth and nose into the Eustachian tubes, by which route 
the drum cavity may be reached. (See Fig. 1, page 7.) 
Diving and swimming under ivater, especially when long continued, 
are even more dangerous than bathing in the surf; the cold and irri- 
tating salt water, when thus long retained in the auditory canal, is very 
liable to cause inflammation; and should strangling occur, water is then 
freely admitted into the mouth and nose, the gasping and sneezing 
efforts to get rid of which are very often sufficiently forcible to send it 
into the drum. The injuriousness of sea water is owing to its com- 
paratively low temperature and the large quantity of salt that it holds 
in solution. Prolonged bathing, however, in the waters of brook or 
pond, is not advisable, neither should the body be exposed to currents 
of air after coming out of the water. Besides being intensely painful 
in most instances, these injuries to the ear always cause temporary 
impairment of hearing; and irreparable deafness, together with chronic 
discharges, is liable to remain as a permanent legacy. (See page 31.) 
The nasal douche.—The use of this apparatus, now unfortunately well 
established in domestic practice, is exceedingly liable to injure the ears 
by the transmission of the fluid used to the drum cavity; its employment, 
therefore, is unadvisable. 
Sniffing ivater or remedies in solution up the nose is not free from the 
same danger that attends the use of the nasal douche; it should never 
be practised, therefore, without the advice of some one competent to 
prescribe the proper mode of procedure. 
OTHER CAUSES OF DEAFNESS. 
Children’s diseases.—Many of the diseases of childhood are well known 
to leave persistent seqnelai in their wake, not the least offensive of 
which are aural discharges. Scarlet fever takes the first place in the 
ranks of these scourges; hut measles, diphtheria, cerebro-spinal menin- 
gitis, whooping cough, and sometimes mumps are likewise inimical to 
the hearing sense, their liability to affect the hearing being somewhat 
in the order of the above enumeration. 
Cutting the hair.—Closely cropping the hair of the head, especially its 
removal from the parts immediately back of the ears, has been observed 17 
DEAFNESS AMONG SCHOOL CHILDREN. 
to be sometimes followed by inti immation of the organ of hearing. Hair 
cutting should not, therefore, be thoughtlessly done. 
INCAPACITATING DEAFNESS. 
Having now given the principal causes of deafness I shall endeavor 
to define the different degrees of aural disability which incapacitate 
the pupil, to a greater or less extent, from receiving instruction in the 
ordinary manner, in order that it may be ascertained what special means 
of instruction might be necessary. Before proceeding further, however, 
it would be well to define what constitutes good hearing, in order that 
we may have some standard from which a departure may be taken. 
Normal hearing may be said, then, to consist in the mental perception 
of sound that has been transmitted through the unimpaired medium of 
both ears. Without binaural hearing the acquisition of knowledge by 
the ordinary methods of instruction becomes difficult proportionately 
to the degree of aural impairment. Hearing with both ears thus enables 
the pupil to quickly determine the direction from which sound proceeds, 
and it also enables him to promptly recognize the finer shading in the 
pronunciation of words. When, therefore, a pupil is observed to be back- 
ward in his studies, the teacher should, before attributing his want of suc- 
cess to mental defects, inquire if lie hears well. It would be by no means 
a wise procedure to classify every departure from the normal standard 
among those who require particular care on account of their defective- 
ness, for a pupil may progress very fairly in his studies when the hear- 
ing of only one ear remains or when he has very considerable defects 
in both ears; yet such pupils will be very much aided by the recognition 
of their disabilities. 
Incapacitating deafness.—All degrees of deafness may be said to impair 
the learning capacity of a pupil, but in establishing a standard of impair- 
ment which shall consign a pupil to exclusion from his better hearing 
fellows for instruction, I would select for special methods those who are 
unable to understand what is said to them in the ordinary tone of voice 
when five feet away from the speaker. Such a rule, however, must nec- 
essarily be applied with discrimination; must be, in other words, a flex- 
ible standard, for some defective, but well advanced, pupils, by reason 
of their natural quickness, will, without being a hindrance, do much bet- 
ter when subjected to the emulative influences of good hearing children. 
The disposition in the school room of those who have been designated 
as likely to make better progress under ordinary methods will be consid- 
ered later on, but for the delicate task of selecting the more defective 
children from these, I shall now venture to lay down some rules which I 
trust will serve to aid the teacher until better ones shall have been devised. 
METHOD OF TESTING TIIE HEARING POWER OF PUPILS. 
It would be well were it a requirement that the pupils of the public 
schools should be examined at the beginning of each session with a 18 
CIRCULARS OF INFORMATION FOR 1881. 
view to ascertain what number were too deaf to receive instruction in 
the ordinary manner and what number, having slight defects, would get 
on better if seated properly in the school room. 
In conducting examinations it will be found that the voice of the per- 
son with which the children are familiar in learning is the best test, and, 
indeed, it is the only sound that need be used; sounds like the ticking 
of a watch, for example, need not be employed, as the ability to hear 
them is not significant as regards the pupil’s hearing power for sounds 
used in teaching.1 
The sentences selected for tests should be intelligible to the under- 
standing of the pupil, and some of the words ought to contain the hiss- 
ing sounds, others the guttural, as “in,” “n,” “g,” as these are heard 
with the greatest difficulty when hearing is impaired. Unless the 
sentences made use of are frequently changed, the pupils may become 
familiar with some of them and thus comprehend their import without 
hearing them distinctly. 
During the examination the pupil should be placed about twelve feet 
from the examiner and should close his eyes; an assistant may then 
stop one of the pupil’s ears by the pressure of his finger while the other 
is being tested. The examiner can now ascertain the hearing power by 
raising or lowering his voice as required. 
In every instance where the sense of hearing is found to be defective, 
some record of the fact would be found serviceable for future use. It 
may be well to remark in this connection that the acoustic qualities of 
the room in which an examination is held should be taken into account— 
whether it be a large or a small room, whether containing many persons, 
-draperies, &c., or comparatively empty, and, finally, whether any open 
•doors or windows admit sounds from without. The age and the mental 
-development of the pupil are also factors of importance, an uncultivated 
mind being slow in comprehension. 
Examinations of the pupils in the public and parochial schools.— The 
writer’s own observations in private and hospital practice having led 
Iiim to believe that a large number of children with impaired hearing 
were in constant attendance at school without due attention being given 
fto the disadvantages under which they were placed, lie concluded to 
institute some examinations of the pupils in the public and parochial 
schools of New York with the view of ascertaining the percentage of 
deafness and the state of aural hygiene among them.2 
1 The difficulties iu the way of establishing a uniform standard for the voice test are 
well nigh insurmountable, inasmuch as no two persons possess voices of equal quality; 
it is thought best, therefore, tor the teacher of each class to examine his own pupils, 
employing for this purpose the tone of voice usual in teaching. 
JThe author gladly acknowledges the courtesy anil kind assistance in his visitations 
of the superintendents and teachers in the Roman Catholic parochial and in the 
colored public schools; his efforts in other departments of the public schools were not 
so successful, and the absence of encouragement iu this direction by those who should be 
interested will serve to account for the small number examined. DEAFNESS AMONG SCHOOL CHILDREN. 
19 
Being aware of the fact that deafness existed in numerous cases where 
an examination only would convince the patient of the fact, the writer 
in conductingthe school examinations first interrogated both the teachers 
and the pupils as to their own knowledge of any deafness ; their replies 
and the subsequent lack of verification are significant. It should be 
stated that these examinations were made under circumstances unfa- 
vorable to the attainment of such results as would be required for an exact 
classification of pupils, for at the visitations the children were found at 
their recitations or when they were on the eve of dismissal. But the 
results obtaine l are thought not to be without value. For his general 
conclusions on this subject, however, the writer has relied on the thor- 
ough examinations made of individual cases which have been brought 
to him for treatment; in these the tests of the hearing power were made 
deliberately, and the statements of parents regarding the cases were also 
obtained. 
Remarks on the examinations of pupils in the public and parochial 
schools.— Five hundred and seventy pupils were examined; they were 
distributed as follows: 
In the colored public schools 2C1 
In the Roman Catholic parochial schools 220 
In the white public schools 83 
570 
An analytical view of the details of these examinations as exhibited 
in the tables1 shows that of the five hundred and seventy pupils exam- 
ined the teachers were previously aware of the existence of one case of 
deafness only, while the pupils themselves were but little better informed, 
only nineteen of the entire number being aware of their aural defects. 
In my own examinations, which were by no means searching and in 
which the teachers usually gave the test questions with the intent of 
compelling the children to hear them, I detected seventy-six cases, or 
about 13 per cent., of greatly diminished hearing in one or both ears. 
Four hundred and eighty-seven of theentire number of thepupils were 
asked if they had ever experienced earaches; one hundred and seventy- 
three of them, or about 3 > per cent., recollected having had this symptom. 
Among the older children but few had any recollection of ever having- 
had pains in the ears, probably because past pains are soon forgotten. 
In all of these instances where earaches had been experienced it may be 
inferred that the aural affection that gave rise to them had also more or 
less permanently damaged the sense of hearing; but such defects would 
not be apparent unless more delicate tests were made. 
There are some peculiarities in hearing experienced when the ears 
have never been diseased which cannot be strictly included in any of 
ANOMALIES OF HEARING. 
JThe details of these examinations may be consulted in the tables appended at the 
end of the paper. 20 
CIRCULARS OF INFORMATION FOR 1881. 
the subjects previously considered; among- these is the ability of some 
individuals to hear most acutely certain sounds while they hear others 
very badly: thus, a person may hear the low rumbling of the thunder 
attending sheet lightning, a sound quite inaudible to many, while the 
chirping oTa cricket, which is painfully acute to some, he will not hear 
at all. I have no doubt that experiences quite the contrary of this may 
exist, but as yet I have been unable to confirm the opinion by obser- 
vation; in certain diseased conditions of the ear, however, examples are 
not wanting where persons hear the ticking of a watch, which is a 
high sound, quite well, but who hear conversation in a low tone of voice 
with difficulty. On the other hand, the relatively good hearing for low 
sounds of the voice is sometimes a condition in aural affections.1 
Autophony.2—Autophony occurs during the progress of most aural 
diseases. It consists in hearing one’s own voice in the head; it some- 
times amounts to simply this, but there is often heard a reverberation 
of the voice, or an “echo” as it is often styled, and it is then described 
by the sufferer as double hearing. When the patient thus hears his own 
voice he fancies that others cannot hear him talk, for the voice seems 
to go up into the affected ear instead of going out of the mouth. The 
effort of talking becomes very tiresome to him, for no exertion, however 
great, is of any avail; the louder he tries to speak the more disagreeable 
his voice sounds in his own ear. 
The autophonous voice sounds very strange to the patient; it is un- 
like his own voice; it seems as though another person, at a distance, 
were speaking. When the voice is thus heard false by the pupil, he is 
unable to regulate or control it, for at one moment it may sound quite 
naturally, as though in fact it came out of his mouth and went around 
to the ear as usual, while the next moment it seems to fail of utterance 
altogether aud reaches the ear from within the head. 
In false hearing the voice usually appears to be hoarse, the patient 
often calling one’s attention to this with the remark that he must have 
caught cold. Sometimes the voice, however, seems to the sufferer to be 
very high in pitch. When hearing it higher than it should be, the 
patient makes an unsuccessful effort to correct the fault by lowering his 
voice, often to a whisper; when it seems “hoarse” and low the attempt 
to correct the apparent defect results in an unpleasantly loud voice.3 
During the continuance of this trouble confusing noises in the head are 
also experienced; they are but little less annoying than false hearing. 
This symptom is often of brief duration, but in a large number of cases 
it becomes permanent.4 
1 The number of persons who (without aural disease).possess these peculiarities is 
comparatively few, as far as is known, hut as attention is directed to these conditions 
it is probable that the number will be found to be considerable. 
2 See note at the foot of page 11. 
3This will explain why some deaf people shout their words to those whom they know 
to have good hearing. 
4 Allusion has not been made to the effect of false hearing on those who use the sing- 
ing voice; it may be said that while the hearing is thus affected the voice cannot be DEAFNESS AMONG SCHOOL CHILDREN. 
21 
The autophonous voice sounds so alarmingly to children that they 
frequently avoid speaking altogether; when silence is thus maintained 
the child is called “dumb.” It has been my experience to have many 
patients of this kind brought to the infirmary by their parents, and it 
has not infrequently come out at the examination that such patients 
have been severely punished for supposed stupidity. This condition of 
the hearing organ is by no means of infrequent occurrence, and the 
teacher should consider its possible influence on a child’s behavior before 
condemning it as perverse or wilfully disobedient. 
Noises in the head are almost inseparable from all kinds of aural affec- 
tions; they manifest themselves in an infinite variety of phases, almost 
every patient describing his own experience differently; they are thus 
said to resemble ringing of bells, the roar of the sea or of the wind 
among the trees, the buzzing of insects, the escape of steam, &c. To 
some these noises seem so loud that rest cannot be obtained. They must 
be very confusing to children who experience them in some degree with 
almost every cold in the head, and where long neglected running from 
the ear exists the distress from tinnitus must often be very great indeed. 
The above by no means presents in their strongest light the troubles 
that children experience when the sense of hearing is perverted; it may, 
however, serve to show that they are subject to some very distressing 
symptoms without always being able to make their sufferings known, 
such facts, iu my own experience, only being elicited from the uninformed 
and apprehensive patient by the most painstaking examination. 
IMPERFECTIONS IN SPEECH. 
Attention will now be given to another kind of difficulty — in its way 
no less vexatious than the disabling affections already mentioned—an 
ailment existing very often altogether independently of aural disease 
yet having its origin in the same etiological causes: I allude to anomalies 
of vocalization. Although these anomalies usually coexist with defects 
in hearing, their differentiation is important in the management of back- 
ward children, for the subject may otherwise be relegated to the class of 
feeble-minded youth who are considered as but little removed from the 
demented. 
The acquisition of language may be said to consist in correctly hearing 
the words and sentences of which language is composed and in the per- 
sistent repetition of the same until memorized. Children, therefore, re- 
quire good ears and long practice in the imitation of the voice of their 
instructors before they become masters of spoken language. It should 
be kept in mind here that a slight degree of deafness may be sufficient 
to hinder the child in the first steps that he takes in learning to talk — 
and these first steps are, probably, much more immature than they are 
trained to singiujr, nor can the pnpil so affected be taught to perform on musical 
instruments. For au account of false hearing, in this connection, see the author’s 
paper “On false hearing and autophony in singers, speakers, and performers on cer- 
tain musical instruments,” in the New York Medical Record, January 22, 1881. 22 
CIRCULARS OF INFORMATION FOR 1881. 
usually thought to be, as the infant is at first, probably, unconscious of 
most sounds, the perceptive faculties of the ear not being taxed beyond 
the requirements of the mental faculties. 
It is very difficult to discover defectiveness in hearing before the child 
is one year old; owing to this fact the child may be “stone deaf” for a 
considerable time before the discovery is made. Even a slight defect 
in hearing is a detriment to the infant, for his education begins as soon 
as the slightest attention to sound is given. 
The child, in this process of acquiring knowledge, repeats words as they 
are heard; if it hears them incorrectly a faulty enunciation is acquired; 
thus every one has observed in his own experience how unintelligible 
the language of partially deaf children is, how slow they are in learn- 
ing to talk. The flexibility of the voice is naturally very great, and 
uninterrupted practice increases its fluency from day to day; the young 
learner, relying on his imitative faculties rather than his own judgment, 
readily adopts the accent of his teachers and associates, and in this 
manner he acquires the dialect of the locality in which he lives. 
The correct enunciation of words depends very much on a healthy 
condition of the upper vocal organs — the mouth, nose, and pharynx— 
and on the unobstructed passage of air through them during vocaliza- 
tion. Repeated attacks of head colds, resulting in nasal catarrh, en- 
largement of the tonsils, &c., together with irregularities of the teeth, 
are the principal etiological factors in the development of impediments 
that interfere with the physiological functions of these parts. A nasal 
tone of voice is an almost invariable characteristic of these impediments, 
but very often the obstructions in the throat or nose are so great as to 
give a “choked” expression to the voice. Enunciation then is difficult; 
for example, letters which require for their pronunciation the use of 
some of these parts, as “m” and “u,” cannot be correctly enunciated. 
When defects in speech arise from disease in both the ear and throat 
the pupil is placed at a very great disadvantage indeed as regards the 
learning of correct enunciation; he fails to hear certain words and on 
the other hand there are certain others which he is unable to enunciate. 
Thus, the hissing sound of the voice may not be heard at all; the pupil 
is therefore liable to leave it out of his speech entirely; for example, he 
will pronounce sir as “tliir” and sausage as “ thausig,” and so on. 
Should the deafness be very great, the person will omit such sounds 
entirely, not that he is physically unable to make them, but he does not 
know how they sound. Now, should the pupil possess obstructions in 
the nose and throat as well as defective hearing, instruction under ex- 
isting methods will be difficult—in some instances well nigh impos- 
sible. 
The voice, it should be stated in this connection, becomes very much 
modified after the individual ceases to hear well: it loses its flexibility 
and can no longer be modulated. DEAFNESS AMONG SCHOOL CHILDREN. 
23 
MANAGEMENT OF PUPILS WITH IMPAIRED HEARING. 
The separate education of pupils whose impaired sense of hearing- 
debars them from the benefits of education by ordinary methods, from 
the investigation that has been made concerning their capacity to acquire 
knowledge, would seem to be a necessity. The claims of the deaf-jnute 
have been long since recognized, and his wants in great measure pro- 
vided for; it remains now to recommend measures for a neglected class 
of equal numbers whose requirements are no less urgent. 
I shall not, in this connection, essay to suggest any matured scheme 
for the special instruction of those who are not entirely beyond the reach 
of vocal methods, but who are j et too deaf to be taught with good 
hearing pupils without interfering with their instruction: the attempt 
would carry me beyond the scope of this paper. Such a scheme will 
require for its successful development the time and labor of experienced 
teachers, and even under the most favorable circumstances the progress 
of any plan will necessarily be slow. I shall, however, venture to offer 
some suggestions in the matter, hoping that, inasmuch as my views 
have been derived from a very considerable experience in the observa- 
tion of aural defects, the advice given from an otologist’s standpoint 
may not be without value. 
We will suppose that steps have been already taken to ascertain the 
hearing power of the pupils; the next step will be the classification of 
such as have been found to be defective. 
Disposition of deaf pupils. — Any pupil found to hear the ordinary 
voice of the teacher with difficulty should occupy a seat near him. 
When hearing is good in one ear only, the child will hear to the best 
advantage if seated rather to one side, so that the good ear will be 
toward the teacher. 
Pupils whose defective sense of hearing prevents them from receiving 
scarcely any instruction by the usual vocal method should be, if possi- 
ble, separated from the good hearing and taught by special methods. 
As intimated before, children who cannot understand the teacher at the 
distance of five feet, when addressed in the ordinary tone of voice, are 
not only an obstruction to the work of teaching other pupils, but they 
can learn but little themselves. These pupils, in many instances, may 
perhaps remain very deaf only a short time; they may be entirely cured 
by treatment; special instruction would then, in these cases, be re- 
garded as tentative only, for when improvement takes place their ad- 
vancement will be more rapid among pupils whose hearing is good. 
When it is found that children are too deaf to make any progress or 
from an increase of deafness it is unmistakably manifest that they can- 
not be instructed by vocal methods, they may be relegated to a depart- 
ment where deaf unites alone are taught. 
Deaf-mutes.—When the acoustic organs are too greatly impaired for 
vocal instruction to be of any benefit, pupils are generally designated as 
deaf-mutes. This classification, however, is rather an arbitrary one, for 24 
CIRCULARS OF INFORMATION FOR 1881. 
all persons who are unable to understand speech by means of the sense 
of hearing are by no means mutes, nor can all of them be instructed 
equally well. It would be well, therefore, for the purposes of instruc- 
tion, to divide this class of persons into two groups: those who hear 
their own voice and those who do not. 
Of the first named group it may be said that a certain number are con- 
genitally defective, while others become deaf at a later period in child- 
hood. Notwithstanding the profound deafness of these children to out- 
ward sounds, some of them are capable of learning to speak with greater 
or less distinctness, the perceptive functions of hearing having been 
preserved to a goodly extent while the transmitting mechanism has sus- 
tained irreparable impairment. To the greater number of these pupils 
the autophonous voice which remains to them is very far from imparting 
a natural impression of the voice to the mind; their vocalization is 
notable for its “muted” cadence, the words seeming to be uttered in 
imitation of the sounds transmitted to the perverted sense of hearing 
from their own vocal organs. A much better vocal power remains when 
children have previously learned to talk well than when speech has not 
been so acquired. Under no circumstances, however, will the voice 
remain unchanged; it is no longer flexible and pleasautly modulated, 
but soon becomes mechanical and harsh. 
The second group of deaf-mutes includes those in whom there is au 
entire absence of the perceptive function of hearing, either congenitally 
or from the more severe diseases which deprive the auditory nerve of 
its functions. In some of these the transmitting mechanism of the mid- 
dle ear may not be greatly impaired, but the nerve no longer perceives 
sensations of sound from any source, either without or within the head. 
Of these, the congenitally deaf can never, I am inclined to believe, 
practicably be taught to speak very intelligibly, for they cannot hear any 
sound upon which the mind may form an idea as to the character of 
speech. They, however, who have once fairly acquired speech may re- 
tain the use of it in a very satisfactory degree after becoming deaf, if 
well trained. Very young children who have only just learned to talk 
soon lose the faculty, and it is very difficult for them to ever learn to 
speak well again. 
In a certain number of cases of deaf-mutism both the middle and 
inner ear are undoubtedly affected by disease, but in the greater number 
of cases the disability seems to be mainly seated in one of these regions 
only. Where the functions of the nerve of audition have not been ex- 
ercised, in consequence of early impairment of the mechanism on which 
transmission of sound to the inner ear depends, its deterioration will 
probably ensue. Owing to the neglect of a great many of these children 
at home, the difficulties in the way of their education are much increased. 
Although the number of pupils who will be found to hear their own voice 
fairly well is comparatively small, yet it would be well to differentiate 
between these and the pupils who do not, for the former possess capa- DEAFNESS AMONG SCHOOL CHILDREN. 
25 
bilities for learning which the latter do not enjoy; the one may acquire 
articulate speech, while the other may be advantageously taught the 
sign language only. 
These children, in the larger cities, could in many instances be more 
economically taught if kept under home influences and educated in a 
special department of the public schools. 
In the instruction of the very deaf and of those who hear no external 
sounds but yet hear their own voices, some assistance may be obtained 
by the employment of conversation tubes among the former and of the 
mouth trumpet and otacoustic fan among the latter. The mouth trumpet, 
which consists of a tube for speaking into the mouth, gives the pupil in 
some instances a more correct idea of the natural tone of the voice than 
any other aid to hearing. Dental sound transmission by means of a fan 
can also be made serviceable in certain cases, the speaker being obliged, 
however, in availing himself of its use, to place the pupil within one or two 
feet of his mouth while thus teaching. The use of these appliances, 
moreover, will aid the examiner in determining the pupil’s hearing power 
for lqs (the pupil’s) own voice. 
It is hoped by the writer that what has been said above concerning the 
education of deaf-mutes may not be construed to reflect upon the use- 
fulness of institutions that are more particularly asylums for the physi- 
cal care of this class, and which not oidy provide temporarily a charitable 
home for them, but also give them an education at the same time. 
DEAFNESS AMONG TEACHERS. 
It is not unfair to state that teachers (lo not enjoy greater immuni- 
ties from impairments of the sense of hearing than others in the same 
social position; and, although a certain degree of deafness should not 
exclude a person otherwise competent from the pedagogical profession, 
yet it must be confessed that good hearing is very essential to one who 
has so many experiences to try his temper and who should be able to 
avoid doing an injustice to any pupil from a failure to hear everything 
that is said in his presence. Should an instructor himself be defective 
in his hearing sense and yet be unaware of the fact, it would be easy 
for him to unjustly censure children for incompetency in the course of 
instruction or in examinations for promotion simply because their re- 
sponses were not heard. The writer has known instances where teachers 
when suffering from temporary deafness were almost sure to hear certain 
words incorrectly, and were therefore obliged to ask pupils to repeat their 
replies over and over again before they could assure themselves of their 
correctness. Such experiences are a warning to those having irremedi- 
able defects. 
Persons desirous of acquiring a pedagogical education at the public 
expense should be subjected to an aural examination before they are ac- 
cepted; and in the appointment of teachers in the public schools the 
ability to hear well should be a requisite. If the examinations were al- 26 
CIRCULARS OF INFORMATION FOR 1881. 
ways oral, the applicants being required to hear the questions, they would 
be more satisfactory than if otherwise conducted. I have in mind an illus- 
trative case which is of interest in this connection: A young lady nine- 
teen years old had been, it was supposed, thoroughly prepared for teach- 
ing in an excellent school for young ladies; but, owing principally to 
dental irritation, she gradually became so deaf that when, after gradua- 
tion, she appeared before a Brooklyn board of examiners for appoint- 
ment as a teacher in the public schools, she utterly failed. The questions 
were given out orally, and she was unable to answer them because of her 
inability to hear them correctly. The board of examiners, however, was 
not aware of her aural defect. Had the same attention been given in the 
case of this young lady to the condition of the ears and teeth that was 
devoted to her mental improvement, her success would probably have 
been assured. When I saw her shortly after her failure it was found 
that her mouth was greatly deformed by irregular teeth, and that these, 
together with a great amount of dental caries, had been the principal 
cause of the deafness; the teeth had never received any attention, and 
from the irritation attributable to them and her inability to properly 
masticate her food the general health had also suffered. 
AURAL HYGIENE IN THE SCHOOLS. 
That we have a faulty system of school hygiene no one familiar with 
the facts will deny; and the remark is equally true both as regards the 
construction of our public school-houses and the personal care of school 
children. 
When we are appealed to as humanitarians to provide hospital accom- 
modations for the pauper class, no means are spared in the planning and 
erection of healthful buildings for their use, but when school-houses are 
to be constructed — where both body and mind should be aided in devel- 
opment, prepared, I may say, to enter the struggle for “the survival of 
the fittest”—their erection is, I fear, too often intrusted to the political 
contractor, whose knowledge in building is chiefly confined to “making 
it pay.” 
Let us hope, however, that time will correct these abuses, and in the 
mean time we must discuss what is best to be done with such buildings 
as have been given to us. These are not, perhaps, so faulty but that 
better hygienic regulations could contribute very much to their comfort 
and healthfulness. 
It will, however, be useless to devise plans for the heating and ven- 
tilation of school-houses so long as negligence and apathy prevail on the 
part of those who have such matters in charge; these seem to regard 
the heating of apartments occupied by school children as contributing 
sufficiently to their personal well-being. It is, no doubt, honestly be- 
lieved by many to be more important to maintain a certain established 
temperature in the school room than to protect the individual from inju- 
dicious exposures to draughts or to an undue elevation of temperature, as DEAFNESS AMONG SCHOOL CHILDREN. 
27 
tlie case may be. There has been so much said about the ills that arise 
from breathing foul gas and dust, which are believed to poison the blood 
or irritate the air passages, and so little said about the dangers of 
draughts of air, that the latter are liable to be overlooked in the anxiety 
to avoid the evils attendant on the former. Too much care cannot be 
taken, obviously, to avoid the inhalation of deleterious matters, but cer- 
tainly equal care should be exercised to guard against the injurious 
effects of air draughts to which pupils are so much exposed. It would 
bp of much service in properly ventilating school rooms were open fire- 
places in more general use, and it is to be hoped that architects and 
sanitary engineers will insist on the introduction of these in the future. 
It may be well to say a word here as to the proper temperature of school 
rooms and the clothing of the pupils. 
Temperature of the school room.—The temperature of the school room 
should be kept at about 08° or 70° Fahrenheit, as indicated by the ther- 
mometer; it should not be regulated by the sensitiveness of any indi- 
vidual, such a test being by no means reliable for this purpose. The 
necessity for the renewal of fresh air for ventilating purposes must be 
determined by the season of the year, the size of the room, and the num- 
ber of pupils present; when the doors and windows are thrown open for 
this purpose, the children should be required to leave their seats and 
walk about in order to avoid any ill effects from draughts. Children 
should be protected, if possible, from exposure to currents of air after 
exercising; nor should they stand or sit while “cooling off,” but move 
about quietly and resume any wraps that have been laid aside. The air 
of halls or lecture rooms, especially when illuminated or crowded, soon 
becomes much vitiated, and, by depriving the system of its natural 
powers of resistance, favors the invasion of colds 
Insufficient clothing.—A large number of children present themselves 
at our public schools insufficiently clad, or come during inclement 
weather chilled from exposure; they are often obliged to sit in wet cloth- 
big, especially wet stockings and shoes. The parents of the poorer 
pupils will require their attendance at school under the most unfavor- 
able conditions, that they may be for a time relieved of their care. To 
neglect the physical condition of this class would seem no less a culpa- 
ble oversight than a disregard of intellectual training. 
The excessively clad.—As regards another and entirely opposite class 
to the above, a greatly increased sensibility ensues from the use of too 
much clothing and the neglect of outdoor exercise; thus, children are 
often made exceedingly susceptible to colds by the use of superabundant 
wraps made of furs, which, in our climate, are at best suitable only for 
emergencies arising in exceptionably cold weather. It is a well known 
fact that among the more wealthy the constant use of seal skin sacks 
and all kinds of fur collars, boas, &c., is the cause of unmanageable 
head colds; such colds, when unrelieved, are the means of establishing 
most persistent nasal catarrhs. 28 
CIRCULARS OF INFORMATION FOR 1881. 
From what has been said above, it will be seen that our system of 
school hygienics is by no means perfect, and we may infer that the home 
sanitation of children is also deplorably faulty; when these shall have 
been corrected, much physical suffering will be prevented and many 
of the complaints under consideration avoided. 
We have now to consider the consequences of these neglects on the 
acoustic organs, among the most important of which is taking cold in the 
head; to this is to be attributed a large proportion of children’s aural 
affections, and I shall, therefore, discuss the etiological factors concerned 
somewhat at length. 
TAKING COLD IN THE HEAD. 
Taking cold is an experience usually derived from unguarded expos- 
ures to draughts of cold air. When the weather moderates, colds are 
observed to be especially prevalent; the care ordinarily exercised for the 
body’s protection is then neglected: warm wraps are laid aside, wet 
clothing is permitted to remain upon the person ; and then, too, it is that 
rooms are liable to become overheated, and the dangerous draughts 
which are created by negligently leaving doors and windows open are 
not avoided with sufficient care. It is a well known fact that colds are 
not most prevalent in the coldest weather, but that, on the contrary, the 
persistently low temperature of our northerly climate is most invigorat- 
ing; indeed, while the extreme cold holds on, catarrhs are conspicuous 
by their absence. It is worthy of mention, in confirmation of the above, 
that the inhabitants of our South Atlantic and Gulf States by no means 
enjoy an entire immunity from colds and their consequences. Although 
their winters are exceedingly mild, the thermal vicissitudes are even 
more trying than at the North, and catarrhal troubles are therefore not 
unusual. 
The modus operandi of taking cold having been already explained (see 
pages 13-14), it now remains to account for the prevalence of catarrhal 
affections among school children, in order that hygienic measures may 
be inaugurated for their prevention. It has been asserted above that 
nervous sympathetic action, whereby widely separated parts are brought 
into intimate relationship with each other, is to be dreaded because of 
its insidiousness; thus, following an exposure whereby a cold in the 
head is established, the irritation in the nasal region is not, as may be 
supposed, owing to the cold air inhaled, but to the reflex action of the 
nerves. A supposititious but exceedingly familiar example will serve to 
illustrate this proposition: A current of cold air—it may only be com- 
paratively cold, from the cooling effect it has by hastening evaporation of 
the moisture upon the skin—is wafted in through an open window and 
allowed to fan the head and shoulders of a child who has become heated 
by the exercise of play or in hurrying to school; the exposed parts, the 
head and shoulders in this instance, receive a shock the local effect of 
which is usually slight, but through the agency of the sympathetic DEAFNESS AMONG SCHOOL CHILDREN. 
29 
nerves a more decided impression is made upon the mucous membrane 
of the nose. This may be announced by an attack of sneezing, more or 
less violent. Wet feet and clothing are also prolific sources of colds, 
both in the head and elsewhere. 
Slight colds in the head are even more serious in their consequences 
than the effects of severe attacks with long intervals of immunity. 
When fresh attacks are almost daily experienced, the patient is for the 
most part absolutely indifferent because profoundly ignorant of any 
danger. Frequent recurrences, moreover, seem to eventually establish 
a susceptibility to these invasions, and when, finally, a chronic nasal 
catarrh is established the parents are greatly surprised to learn that, 
although complaints may have been confined to the state of the hearing- 
organs, a most intractable nasal affection has been established. 
catarrh is sometimes an affection of the very earliest period in life, some 
infants, in fact, having evidences of it at birth. The affection is nearly 
always to be recognized by the flow of mucus from the nose, which gives 
rise to constant snuffling, and sometimes excoriates the nostrils and 
the upper lip; in older children attempts are made to hawk the secre 
tion up into the mouth, as it otherwise has a tendency to drop down into 
the throat, where its presence causes irritation. 
The general health of these sufferers is, of course, always more or less 
affected, for no organ of the body can be considered entirely independ- 
ent of the others. Owing to the immediate connection through the 
Eustachian tubes, which are lined with mucous membrane which is con. 
tin nous with that of the nose and pharynx, and also by means of the 
intimate nervous relationship, no organ probably suffers more from the 
consequences of colds in the head than the ear. Although these sufferers 
may have aches and pains in every region of the head, the importance of 
which the writer -would by no means w ish to exclude from due attention, 
yet he believes that the aural aspect of the subject is of sufficient con- 
sequence to justify him in drawing the attention of teachers especially to 
it, and, although they may not entirely prevent the occurrence of the 
colds which thoughtless pupils subject themselves to by exposures, yet 
they can do much in this direction with the means at their command, if 
not unmindful of their share of the responsibilities devolving on all of us 
who assume to aid in the work of bringiug forward the youth of our race. 
(See page 13.) 
DENTAL IRRITATION AND THE CARE OF THE TEETH.1 
The irritation of decayed teetli or inflamed gums is 'not only a fre- 
quent cause of aural disease of an acute nature, but very often it hap- 
pens that when the ear is in a moderate state of irritation from sympa- 
thy with* the teeth a cold or other cause will be much more liable to 
set up acute aural inflammation. From the present writer’s own expe- 
rience for some years he believes that diseases of the ear arising from 
1 The author is indebted to Dr. Frank Abbott, of New York, an authority in dental 
surgery, for valuable suggestions on this subject. 
° V 7 OA1 30 
CIRCULARS OF INFORMATION FOR 1891. 
affections of the teeth are more frequent than has been urged by writers 
on the subject;1 he feels, therefore, that the very considerable space which 
he shall devote to the matter will not be greater than its importance 
demands. 
The teeth of some infants require very early the physician’s and 
dentist’s care, their eruption and development being so unhealthy that 
by much care only can trouble be obviated. 
The temporary teeth, then, will first demand attention. The popular 
belief is that it is of no consequence when these teeth decay or are ex- 
tracted, inasmuch as the permanent set will soon restore the loss. The 
evils resulting from the neglect that is based on this fallacy are very great. 
The temporary teeth, aside from their usefulness in the mastication 
of food, are the necessary pioneers of the second or permanent set; 
they should, therefore, be carefully preserved, not only from the injury 
likely to ensue from biting very hard substances, such as nuts and the 
like, but also from the deleterious influences of uncleanliness. If the 
decay in a temporary tooth is not treated and then filled properly before 
the nerve pulp is destroyed, the roots are not absorbed as they should be 
and hence they are in the way of the coming permanent teeth and divert 
them from their proper course; in most instances there is also much irri- 
tation from the crowding that ensues (see 1, 1, Figure 7, page 32). 
Sometimes these temporary teeth, with their unabsorbed fangs, are 
crowded partly out by the permanent teeth, but remain in the gum by 
the sides of the new teeth; should their fangs be sharp, much irritation 
is caused by wounds of the cheeks or tongue, and their presence in the 
gum is a sufficient source of irritation to set up aural hypenemia. 
The regularity and healthfulness of the permanent teeth depend very 
much on the treatment of the first set; especially is the much too general 
practice of extracting the temporary teeth, because they are believed to 
be of little service, to be deprecated. Just here a word of caution is 
required concerning the appearance of the first teeth of the permanent 
set, namely, the six year molars. 
The sir-year or first molar teeth are four in number. These teeth, on 
account of their imperfect state, are believed to be less able to withstand 
the influences that lead to caries than those of the permanent set which 
are cut later, and they are, therefore, liable to decay early. Even when 
parents find them decayed they are generally neglected, although some- 
times exceedingly painful, for they are usually supposed to be temporary 
teeth, and hence not worth preservation. They should, if possible, be 
preserved. Another dental epoch sometimes has an importance to the 
auriston account of the great amount of irritation that may exist with- 
out the cause being suspected. I allude to the eruption of the third 
molar or wisdom teeth. 
The wisdom teeth.—These teeth should erupt at about the eighteenth 
1 Dr. Charles H. Burnett was among the first to call attention to the nervous con- 
nection between the teeth and the ears. Treatise on the Ear, Philadelphia, 1877. 31 
DEAFNESS AMONG SCHOOL CHILDREN. 
year, but they often come at a much later period and erupt with great 
difficulty. They are especially liable, in the lower jaw, to push against 
the adjacent tooth, and, being urged onward in the process of erupting, 
cause very great irritation. Some of the most intractable affections of 
the ear become established in this manner before the cause has been 
discovered. 
I have long been in the 
habit of examining the teeth 
of children brought to me 
with aural diseases, and it 
happens very often that un- 
suspected dental irritation 
is found to coexist, to which 
the aural irritation is in 
some measure attributable. 
Among the large number ot 
cases of school children who 
attend the aural clinics at the 
infirmary it is rare to find one 
where dental irritation should 
not be considered as a causa- 
tive factor. 
The teeth of children 
should be frequently exam- 
ined at home, and any suspi- 
cious spots should not be lie 
glected. It is a noteworthy 
fact that during the period 
of active dentition the ner- 
vousness of children is 
marked and the susceptibility 
to reflex phenomena is in- 
creased. 
Disease of the teeth in the 
schools.— My attention, as 
above stated, having been 
drawn to the frequency of denial canes m connection wun aural 
affections, I was led to make a thorough examination of the teeth of a 
considerable number of pupils in actual attendance at a public school 
in order to obtain a knowledge of their exact condition.1 The number 
of such pupils examined was eighty; they consisted of such children 
as happened to be present in a number of class rooms, the attendance 
being small, as is usual in midsummer. It was found that scarcely any of 
the children were free from dental irritation, and few of them had teeth 
in a normal condition. In thirty of the number the teeth were in such 
Figure 6.—Lower jaw or interior maxilla, from a specimen 
in the author’s cabinet. The figure shows the horizontal 
position of the lower wisdom teeth, the position which gives 
rise to their difficult eruption. 1. The right wisdom tooth, 
which is wedged in between the ramus, or upright portion 
of the jaw. and the second molar tooth ; it has not, as yet, 
been able to leave its socket and cut through the gum. As 
the tooth is urged onward in the effort to erupt, it is forced 
against the sensitive root of the neighboring tooth, the 
pressure giving rise to much irritation. 2. The fully 
erupted left wisdom tooth; it is inclined toward the first 
molar; the second molar on this side having been lost, 
room was afforded this tooth to cut through the gum. 
The disturbance caused by these teeth is sometimes very 
great; the parts are not only subject to great swelling, 
but the suffering is often of a severe character. When 
mastication is attempted, the gum over the tooth is liable 
to be bruised and thus increase the irritation. Sometimes 
the irritation goes on for years, until nature seems to ex- 
haust her expulsive forces, without completing the proc- 
ess of eruption; pains may or may not be experienced, 
sometimes they seem to shoot from the tooth to the ear. 
Through nervous sympathy the ears are very often af- 
fected. The two upper wisdom teeth usually erupt a short 
interval after the two lower and are cut with less diffi- 
culty. 
1 These children were nearly all of German parentage. 32 
CIRCULARS OF INFORMATION FOR 1881. 
an unhealthy state, from irregularities and decay, that wax impressions 
were taken of them; these have since been mounted up in plaster for 
study. The deplorable neglect of the teeth among these children was 
a surprise to me, although, from previous observations, I had expected 
to find them very bad indeed. It was notable that teachers having 
charge of these pupils never suspected that the teeth ever gave rise to 
any serious trouble, but it was ascertained by questioning the children 
themselves that in nearly 
every instance they had 
experienced pains in the 
teeth or ears, sometimes 
in both. The appearance 
of many of these children 
indicated that the general 
health had not escaped 
the consequences of im- 
perfectly masticated food; 
that some of them also 
suffered from neuralgias 
about the face and head 
“goes without saying.” 
The casts of the upper 
and lower teeth, shown in 
the cut (Fig. 7), represent 
one of the cases seen; it 
is by no means an excep- 
tionally unfavorable ex- 
ample. 
The cast shown in Fig- 
ure 8 represents another 
case. This person always 
had trouble with his teeth; 
they ached severely in 
childhood while he was at 
school, and he has had 
brief periods of immunity 
only since that time. His 
teeth were in so bad a state 
that mastication of food was well nigh impossible, for the pulps were ex- 
posed in nearly every one of them and the pressure of solid food on the 
pulps gave rise to so much pain that the food was bolted down hastily. 
The dental nervous filaments being in a state of constant irritation, not 
only gave rise to neuralgias of the head, but the whole system also sym- 
pathized. The food was retained about the jagged remains ot‘ the teeth, 
and, becoming decomposed, was taken into the stomach along with the 
purulent matter from the diseased gums; thus, contaminated by the 
Figuhe 7.—Casts of the teeth of a school girl twelve years of 
age; from the author's cabinet; the casts are represented as 
being held together by a hinge. 1. 1. The second bicuspid 
teeth of the upper jaw, both of which have been crowded out 
of place as they eiupted by the remains of the fangs of the 
temporary second molar teeth; these fangs, which have been 
too long retained in the gums, are seen in the cut just inside the 
second bicuspids. The retention of the fangs, together with 
the crowded and irregular condition of the permanent teeth 
which have just been cut, gave rise to much irritation. This 
anomalous condition of the teeth is by no means an unusual 
occurrence where the teeth are neglected. 2. The left upper 
six-year molar tooth, which is very carious. 3, 3. The two 
lower six-year molars, both of which have been destroyed by 
caries. The little girl from whose teeth these casts were taken 
suffered from deafness and frequent attacks of pain in both 
ears, and, as she herself expressed it, “the decayed teeth had 
ached very much all around. ” 33 
DEAFNESS AMONG SCHOOL CHILDREN. 
secretions ot the mouth and imperfectly masticated, it caused an aggra 
vated form of dyspepsia before the patient was sixteen years old. This 
person, when he came to the New York Eye and Ear Infirmary, when 
he was first seen, was found to be very deaf in both ears, and the rigid 
one was the seat of a very painful inflammatory affection; he com 
plained of being very weak, and his appearance was that of a persoi 
who had become prematurely old. His face was pale, the cheeks having 
dirty-brown patches, from which the outer coatimr of the skin coulc 
easily be rubbed off. Hi* 
eyes were weak, and a dis 
charge from them had to lx 
constantly wiped away, li 
regard to the teeth in this 
case it may be said that tin 
patient never knew what ii 
was to possess the use o 
them in a normal condition 
for all of the back teeth o 
the second set probably cairn 
into the mouth in an imper 
feet state (deficient i i 
enamel) and were therefore 
easily destroyed by disease 
while the front teeth de 
cayed from neglect to keej 
them clean. 
In Figure 9 are repre 
sented the teeth of a boy 
who was born and broil gin 
up in England, where sucl 
deformities are, I believe 
more frequent than on tlih 
side of the water. This per 
son came to the New York 
Eye and Ear Infirmary ii 
1880 on account of his deaf 
ness, which had been very 
great in both ears ever since 
he was eleven years old; lit 
can hear the voice only when 
spoken in a loud tone, which makes it difficult for him to perform his 
duties as cabin boy on board ship. The ears never ran, but he began 
to acquire his deafness during the period of his schoolboy’ days, at which 
time he experienced much toothache, and he still suffers from the pains 
occasioned by the decay of the second teeth. His tonsils are greatly 
enlarged, which, together with deformity of the teeth, preventing 
Fiuuhk 8.—View of plaster casts ot the upper and lowei 
teeth (Cabinet No. 14) of a youth aged twenty-two yi ars. 34 
closure of the mouth, has been the cause of habitual mouth breathing; 
such breathing prevents the normal development of the ear from taking 
place, and the irritation produced by the crowded and diseased teeth 
gives rise to aural inflammation. 
It will be seen, by referring to the cut, that a very extraordinary de- 
formity exists, namely, the articulation of the teeth is reversed, the 
under teeth shutting outside of the unoer teeth all around the jaw. 
This state of things has been 
caused, it may be surmised, 
by neglect of the temporary 
teeth of the upper jaw and 
their premature removal, 
thus causing contraction of 
the superior maxillary arch. 
When the permanent teeth 
came into the mouth, the up- 
per jaw being too small to 
allow them to take theii 
regular position, they were 
crowded and consequently ir 
regular. When food is re- 
tained about irregular teeth 
their decay is almost inevi- 
table, and in the case before 
us such neglect seems to have 
caused early decay of the first 
permanent molar teeth, which 
were accordingly extracted: 
their loss occasioned a contraction ot me superior maxillary arch to the 
extent of at least one inch. 
The lower teeth not having suffered in a similar manner to the upper, 
the inferior maxillary bone lias gained its normal size, and the lowei 
teeth, in consequence, close outside of the upper (Fig. 9). Of course the 
teeth have caused irritation in this case from a very early period in the 
person’s life, and their condition has likewise interfered with mastica 
tion. The deformity of the face in these cases is very great.1 
Dental inspection.— Neglect of the teeth among the children of the 
poor can only be prevented by some system of inspection. Among the 
well-to-do advice only can be given, but in the public schools arrange 
ments could be made to secure competent assistance from the denta 
departments of some of the charitable institutions. In places where 
such institutions do not exist the services of some competent dentist 
could be obtained. (See page 29.1 
CIRCULARS OF INFORMATION FOR 1881. 
Figure 0.—Front view of plaster casts representing the 
teeth of a boy aged seventeen (Cabinet No. 61). 
'Tlie author desires to acknowledge his indebtedness to J. M. Stebbins, D. D. 8., of 
New York, for bis valuable services in this investigation, and particularly for the im- 
pressions of the teeth. To his skill in the treatment of such cases many of the chil- 
dren were afterwards indebted for relief. DEAFNESS AMONG SCHOOL CHILDREN. 
35 
OUTDOOll BATHING- AND ITS EFFECTS ON TIIE EAR. 
Bathing in the ocean, rivers, an I ponds is a summer pastime to which 
children are very much addicted; it is generally regarded as harmless, 
provided drowning does not take place. If any cautionary measures 
are thought to be worth while they are usually embraced in two sen- 
tences: “ be sure tirst to wet the head” and “Be careful not to get 
drowned.” This advice to immerse the head immediately on entering 
the water is certainly not wise and the other caution may be regarded 
as an unnecessary expenditure of parental concern. Although the ex- 
ercise of swimming and the self reliance learned from taking care of 
one’s self unassisted in the water have their advantages, yet the evils 
arising from a too prolonged stay in the water certainly more than 
counterbalance the possible good that may accrue. From a strictly 
sanitary point of view it may be doubted if, upon the whole, the loss is 
not greater than the gain, for children will not exercise any judgment in 
such matters. Supervision of bathers is not always practicable, but 
parents and teachers may impart some serviceable advice, which, if fol- 
lowed, may be the means of preventing injury to the ear, which is more 
liable to injury from the direct effect of the water in bathing than any 
other organ of the bodj'. Marine animals possessing delicate acoustic 
organs have them protected from the water by the provision of nature; 
they are able, in fact, to close up the passages leading to the ears when 
they are submerged. Man, however, being in no sense a marine animal, 
has not been provided with self protecting ears; he must, therefore, 
guard against the entrance of water by devices of his own, which can 
be at best only partially successful. He may thus in a measure keep 
the water out of the auditory canal by closing it with pellets of wool, 
that obtained from the sheep being preferable to cotton on account of 
its non-absorbent qualities. The excluding of water from the mouth 
and nose in the surf, or when swimming or diving, is not so easily ac- 
complished, depending as it does on an effort of the will. Holding the 
nose or plugging its anterior openings is impracticable in most instances. 
I have seen many cases of severe aural disease among children—the 
milder ones are probably neglected — from the use of the New York 
public baths. Owing to the negligence of some of the superintendents 
of these establishments, aural disease is frequently contracted by the 
bathers. Although children are not permitted to remain more than a 
few minutes in the w ater, yet they manage, by making the most of the 
time at their disposal, by diving and struggling in the cold salt water, 
get enough of it in their ears to injure the organ more or less. 
Those who bathe very much are liable to suffer from slight injuries to 
the ears from time to time, and, inasmuch as pains are not always pres- 
ent, no trouble is suspected until very considerable impairment of hearing 
occurs. The exposure of the body on coming out of the water to the 
gradual drying influences of the wind is, of course, to be avoided. (See 
page 10.) 36 
CIRCULARS OF INFORMATION FOR 1881. 
MOUTH BREATHING. 
A noticeable practice among some school children is that of habit- 
ually breathing through the open mouth, a custom that has been re- 
garded as a consequence of defective hearing; but the reverse of this 
is true; such breathing arises from obstructions of the nasal passages, 
irregular teeth, enlarged tonsils, &c., and in many instances the habit 
is acquired where no physical cause is known to exist. Habitual mouth 
breathing prevents the normal renewal of air in the drum from taking 
place. 
Deformity of the drum-head is a consequence of the absence of the 
proper amount of air in the drum during the period of its development. 
The sound transmitting mechanism is crippled by this deformity, and 
the sense of hearing is correspondingly impaired. 
When no physical necessity for this practice exists, its continuance 
should be discouraged; breathing should take place through the nose, 
nature having provided this organ with warming cavernous departments 
which temper the air before it enters the lungs. The great influence that 
irregularities of the teeth have on mouth breathing is believed to be of 
sufficient importance to Warrant the introduction of a cut (Figure 9, 
page 34) which represents the case of a lad who became exceedingly 
deaf from this cause. Every one must have observed the hideous facial 
expression of persons whose ill developed jaws, irregular and projecting 
teeth, prevent closure of the mouth. 
WHAT TO DO WHEN FOREIGN BODIES GET INTO THE EXTERNAL 
AUDITORY CANAL. 
Foreign bodies in the external auditory canal are not always an incon- 
venience, nor do they always cause deafness, but when their presence in 
this situation is discovered efforts for their removal are usually under- 
taken with an energy proportionate to the alarm of the child’s friends, 
and, when their own efforts have been unavailing, the assistance of some 
convenient druggist or barber is obtained ; these only too often succeed 
in pushing the offending substance farther in, and then the unskilful 
work may be carried still further by some bungling pretender, who soon 
causes irreparable injury to the hearing organ by his more ambitious at- 
tempts. Such treatment by incompetent persons at best only results 
in pushing the foreign body farther into the passage, where its presence 
against the drum-head may do much harm. Even death is reported to 
have followed the fruitless probing and tearing of a child’s ear, when no 
foreign body was present. It is a safe rule, therefore, to let foreign 
bodies alone unless competent aid can be obtained. (See page 12.) 
Live insects sometimes gain an entrance into the auditory canal, where 
their movements give rise to much distress, especially if the drum-head 
is reached by them; their expulsion can be secured by filling the upturned 
ear with warm water. 37 
DEAFNESS AMONG SCHOOL CHILDREN. 
Happily the coarse and cruel practice of boxing and pulling the ears 
as a means of corporal punishment in the schools is nowadays seldom 
heard of; a few instances only have come to my knowledge through the 
reports of hospital patients; among common people, however, it is not 
unusual to find the drnin-head ruptured by a blow inflicted by the hand 
of an enraged parent, and, as there is reason to believe that injuries of 
this kind are not always reported, we probably see only the severer cases. 
Death has resulted from a blow upon the ear; in any case the drum-head 
is liable to be ruptured and hearing permanently impaired. 
Punishment cannot be safely inflicted by boxing the ears, and pulling 
the auricle even is not only very painful, but is sometimes followed by 
injury to the deeper seated parts. 
BOXING THE EARS. 
Some of the school-houses of cities are necessarily erected in the noisy 
districts, for they must be near to the Jiomes of the pupils. The unre- 
mitting din of street noises is undoubtedly distracting, especially when 
the doors and windows have to be kept open; such sounds fatigue the 
mind, however familiar they may be. The discomfort from this cause 
should be considered in selecting the site for a building, and the con- 
struction of pavements which allow of the noiseless passage of vehicles 
in the immediate neighborhood would be advisable. 
STREET NOISES. 
The question of the aecountability of the public schools for the phys- 
ical as well as intellectual improvement of children is, to some extent, 
a debatable one; it is a matter that seems to depend, in many in- 
stances, on the sense of duty that inspires the management of particular 
schools, inasmuch as the recommendations for the guidance of teach- 
ers concerning hygienics are entirely inadequate. The writer believes 
that, as regards the more unfortunate children of the very poor—the un- 
washed of both body and raiment—no inconsiderable number of them 
would be more benefited by personal hygiene than by mental training; 
at least the two should go hand in hand in every instance, for Mens 
sana in corpore sano. 
The chief object of the public school system being the elevation of the 
entire population, thus placing them beyond the boundary of charitable 
support, their bodily well being must be assured by influences brought 
to bear during the formative period of life. 
Children whose hearing has been impaired by scarlet fever, measles, 
or other diseases of youth, are very often neglected by parents who 
have neither the knowledge nor the time to give them proper care; or 
their ears have been purposely “let alone” by the physician’s advice; 
these, when sent to school, greatly annoy the teacher by the vexatious 
delays which their instruction occasions and by the hindrance they are 
to others. Notwithstanding the fact that the neglect of parents and 
THE PHYSICAL WELL BEING OF PUPILS. 38 
CIRCULARS OF INFORMATION FOR 1881. 
physicians throws increased labor on the teacher, he must take some 
action respecting this class; for, besides being deaf, many of them suffer 
from offensive discharges, which are not only an evidence of the progress 
of aural disease, but are very objectionable to cleanly children who are 
obliged to sit near them. In numerous instances the teacher may find 
that his pupils are exceedingly deaf without being aware of the defect 
themselves; the present writer has known children who could not under- 
stand a word spoken to them to remain in school for years without any 
efforts being made to better their condition; they were regarded as 
defective in intellect. 
Whatever rules may be established to meet the exigencies arising out 
of deafness in the schools, the teacher may do much to ameliorate the con- 
dition of these unfortunate people by making himself conversant with 
their wants and by prudent and considerate treatment of them while 
under his charge; and by the enforcement of hygienic regulations a 
great deal may be accomplished in-the way of prevention. 
CONCLUDING REMARKS. 
The enumeration of all the influences which fire liable to affect the 
sense of hearing in children would be difficult in a paper like this; in- 
deed, when it is seen that no one unhealthy organ can fail to have a 
deleterious effect on some other organ or on the whole system, there 
must be a limit to the discussion of the consequences thereof on the ear; 
enough has been said, the writer trusts, to impress on those concerned 
the importance of care, combined with a certain degree of solicitude, in 
the management of the class under consideration; otherwise great injus- 
tice may be done them. 
In their examinations, deaf children, notwithstanding their defects, 
may come forward well prepared; but if examined in a hasty or impatient 
manner, the teacher’s questions are liable not to be heard well enough 
to elicit correct answers, and they are thus unable to secure a promo- 
tion which their preparation has justly entitled them to receive. 
The surroundings of these children are in everyway discouraging; 
they are disheartened both at home and at school, subjected, as they 
are, to the jeers, ridicule, and mockery of their companions and to the 
punishment of parents and teachers for seeming inattention and dulness. 
Their inability to hear much of what is said to them, the difficulty 
they experience in the correct enunciation of words when the vocal 
organs are deficient, and the dismay occasioned by autoplionous hear- 
ing and noises in the head, either singly or combined, are sufficient to 
entirely discourage these sufferers. That they become distrustful, de- 
ceitful, and vicious in character is to be expected. 
Seeming inattention and dulness arise from the inability to hear, and 
when proper training has been wanting both at home and at school, in 
many instances the child will naturally accept the situation and cease 
to be attentive; it is important, therefore, to maintain the child’s inter- DEAFNESS AMONG SCHOOL CHILDREN. 
39 
est ill instruction by special methods, which shall not permit any slur- 
ring work to be done by either teacher or pupil. 
Dumbness, so called, proceeds from the indescribable sensation expe- 
rienced by the child in hearing its own voice within the head or as the 
voice of a person at a distance; these phenomena of the voice very often 
confound even the most intelligent person, so difficult is it to under- 
stand why such seeming strange alterations in the voice should occur. 
When the child experiences autophonous voice, it fancies that it has 
.been deprived of the ability to speak, for, to it, the voice seems to fail of 
utterance;1 it now becomes convinced that it is “dumb,” and with the 
feeling comes the peculiar “dumb” expression. But this is by no means 
always the entire experience of the sufferer, for the voice, which has been 
said to seem to fail of utterance, seems to ascend into the head, where its 
unusual reverberations give rise to the belief that the head is “hollow” or 
“empty.” These are alarming symptoms, and, inasmuch as they recur 
with every attempt at speech, the child fears to make an effort which 
is attended by such disagreeable symptoms. 
Noises in the head are seldom absent when autophony exists. The 
character of the noise depends very much on the imagination of the 
patient, and may, therefore, be said to be variable; but it is also in- 
fluenced greatly by changes in the transmitting mechanism. In the 
worst cases the patient hears the rushing of a railway train in the head 
or the raging of a storm; these noises are attended by sounds of ringing 
bells, pattering hail or rain, &c. When the patient has an interval of 
relief the noises are more bearable; they may then be likened to the 
gentle sighing of the wind among the trees, the play of the surf on the 
sandy beach, the singing of the tea kettle, the buzzing of insects, &c. 
Patients usually describe these noises as resembling some familiarly re- 
membered sound; thus the distant roar of a waterfall occurs to one or 
the pattering rain to another whose memory goes back to the days when 
he slept just beneath the roof. But very often the imagination foils to 
aid in the description, and with children the difficulties in the way of 
finding out their feeling are almost insurmountable. 
When we come to consider what effect these various experiences 
must have on the minds of children,2 our sympathies should be enlisted 
in their behalf to the last degree and our patience should be without 
limit; in a word, when no apparent cause for a child’s dulness of action 
is known to exist, let there be made a thorough investigation into the 
condition of the acoustic organs before necessarily regarding it as a dunce 
or feeble-minded. 
1 The reader will please remember that, although persons with autophonous voice 
fancy that they are dumb, or at least dumb in some degree, yet their voice is in reality 
plainly heard by others. 
2 The hearing of the greater number of children who have these autophonous ex- 
periences remains pretty good as regards what is said to them most of the time; but 
when suffering from an aggravation of the trouble the noises in the head cause tem- 
porary interference, and then greater deafness is experienced. APPENDIX- 
Tlie following tables exhibit the results of twenty examinations made by the author 
in the New York public and Roman Catholic parochial schools, with the view of as- 
certaining the hearing power of the pupils. 
Tables I to XII, inclusive, show the number of children examined in the colored 
public schools. 
Tables XIII to XVII, inclusive, show the number examined in the Roman Catholic 
parochial schools. 
Tables XVIII to XX, inclusive, show the number examined in the white public 
schools. 
These examinations are not ottered as complete, but rather as pioneering efforts 
which were made by the writer under difficulties. 
Differences in the examiner’s toue of voice and in the acoustic properties of the 
rooms prevented uniform results from being obtained. It is a noteworthy fact, how- 
ever, that about the same ratio of earaches previously experienced was found in all 
the classes where inquiries on that point were made. From this the inference may be 
drawn that the etiological factors were similar and that about the average amount of 
i njury to the ear had, therefore, occurred in every class. No attempt was made in these 
examinations to record the lesser aural defects, which when present are by no means 
unimportant. 
It will be observed that in all the examinations the teachers and pupils were seldom 
aware that any deafness existed. 42 
CIRCULARS OF INFORMATION FOR 1881. 
Vwkirtf VHMlier 
Table. classes j cla88. 
examined. 
Sex of 
claM. 
Average age 
of class. 
Nauie of school. 
Date of ex- 
amination. 
Degree of impairment of hearing for the voice. 
1. 1 29 
M & F. 
About 10 
Grammar department of Colored 
Grammar School No. 3. 
Apr. 23,1880 
Case 1. Female. Hears loud voice only in the right ear ; ordinary 
voice in the left ear. 
Case 2. Male. Hears loud voice only in the left ear ; ordinary voice 
in the right ear. 
Remarks.—The teacher who examined this class had a low and soft but distinct voice, and asked the children familiar questions only ; they were not required to repeat 
any test questions that would tax the memory. A very considerable number of them had the sentences repeated several times before they were understood. The teacher said 
that she had never before observed any deafness in the'class. The children were mostly mulattoes ; thirteen of the number recollected having had earaches, and it is probable 
that but few of these possessed normal hearing. 
IT. 
1 
18 
M. &F. 
About 13 Grammar department of Colored 
Apr. 23,1880 Case 1. Hears loud voice only in the left ear ; ordinary voice in the 
Grammar School No. 3. 
right ear. 
III. 
9 
25 
About 11 Primary department of Colored Apr. 23,1880 Case 1. Hears loudest voice only in each ear: occupies a front seat. 
Grammar School No. 3. 
IV. 
2 
38 
Primary department of Colored 
Grammar School No. 3. 
Apr. 23.1880 
Case 1. Hears loud voice only in tlic left ear; ordinary in the right 
ear. 
Remarks. The teachers, when first asked, were unaware of any deafness in these classes, but afterward recalled the above case. Twelve of these children recollected 
having experienced earaches. These were among the youngest children in the school, and I was unable to determine in doubtful cases whether the failure to reply correctly 
was owing to want of intelligence or to impairment of hearing. 
V. 
1 
15 
11 
Grammar departin' nt of Colored 
Grammar School No. 3. 
Apr. 27,1880 
Case 1. Many years deaf. Hears only loudest voice in the right ear, 
and loud voice only in the left ear. 
Remarks. Tin; teacher was awaie of this one case; he was, she said, a *• little deaf,” and being a mischievous boy he was required to occupy a back seat. Four of these 
pupils stated that they had suffered with earaches. 
Remarks.—The teacher was not aware that any of the pupils were hard of hearing. Thirteen of this class stated that they had previously experienced earaches. 
Tables showing the remit a of examinations as to the hearing power of school pupils. 
Remarks. —Fifteen of the children composing these two classes had experienced earaches. DEAFNESS AMONG SCHOOL CHILDREN. 
43 
VI. 
1 
21 
About 12 Grammar department of Colored Apr. 27,188c 
None of the pupils of this class were found to havo any marked im- 
Grammar School No. 3. 
pairment of beai in}; for the voice. 
VII. 
2 
23 
15 
Grammar department of Colored 
Grammar School Mo. 3. 
Apr.*27,1880 Caae 1. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
| Case 2. Hears loud voice only in the left ear ; ordinary voice in the 
right ear. 
Remarks.— These two deaf pupils were mulaltoes. The teachers were not aware before the examination of the presence of any deaf pupils in these classes. None of 
the pupils themselves were aware that they had any aural defects, nor did any of them remember having experienced earaches. Some of the pupils were over eighteen years 
of age, and seem to have forgotten these very common experiences of youth. 
VIII. 
2 
63 
M. & F. 
7 to 12 
Primary department of Colored 
Apr. 27, 1880 
Case 1. Hears loud voice only in the left ear; ordinary voice in the 
Grammar School Xo. 3. 
right ear. 
Case 2. Hears load voice only in both of the ears. 
Case 3. Hears kmd voice only in the right ear; ordinary voice in the 
left ear. 
Case 4. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 5. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 6. Hears loud voice only in the left ear ; ordinary voice in the 
right ear. 
Case 7. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 8. Hears loud voice only in the left ear ; ordinary voice in the 
right ear. 
Case 9. Hears loud voice only in the left ear ; ordinary voice in the 
right ear. 
Case 10. Hears loud voice only in both of the ears. 
Remarks.— Six of these pupils were mulatfoes, one of them was quite dark, and the color of the other three was not noted. The teachers had been unaware of any case 
of deafness these pupils, and but two of the pupils themselves were aware that they were hard of hearing. Eighteen of the number had experienced earaches. 
IX. 
1 
14 
14 
Grammar department of Colored 
Grammar School No. 3. 
May 19,1880 
Case 1. Hears shouted voice only in the right ear; loud voice only 
in the left ear. 
Case 2. Hears loud voice only in both of the ears. 
Remarks—One of these pupils was a mulatto, the other was dark colored. Neither the teacher nor any of the pupils knew of any deafness in the class before the 
examination. 
Remarks.— Twelve of these pupils stated that they had experienced earaches. 44 
CIRCULARS OF INFORMATION FOR 1881. 
Table. 
Number of 
classes 
examined. 
Number 
in class. 
Sex of Average age 
class. of class. 
Name of school. 
Date of ex- 
amination. 
Degree of impairment of hearing for the voice. 
X. 
1 
33 
12 
Grammar department of Colored 
Grammar School N o. 3. 
May 19,1880 
Case 1. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Remarks.—This pupil was a mulatto. The teacher of this class once had a pupil who was temporarily deaf, hut she knew of no deafness in the class at the time of the 
examination. The pupils themselves were not aware of any case of hardness of hearing in the class; nine of them, however, had experienced earaches previous to this 
examination. 
XI. 
1 
28 
6 to 10 
Grammar department of Colored May 19,1880 None of these pupils were found to have impaired hearing for the 
Grammar School No. 3. voice. 
Kemauks.— Neither the teacher nor any of the children themselves knew of any case of deafness in this class. Fifteen of the pupils stated that they had experienced 
earaches. 
XII. 
1 
23 
6 to 9 
Primary department of Colored 
Grammar School No. 3. 
May 19,1880 
Case 1. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 2. Hears loud voice only in the right.ear; ordinary voice in the 
left. ear. 
Case 3. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 4. Hears shouted voice only in the right ear; ordinary voice in 
the left ear. 
Remarks.— Two of these pupils were mulattoes, one was dark, and the color of the other was not noted. The teacher knew of no cases of impairment of hearing before 
the examination was made; one of the pupils only was aware of his own deafness. Ten of tlrs class stated that they had previously experienced earaches. 
XIII. 
1 
35 
F. 
8 to 12 
Roman Catholic parochial school 
of the Church of the Assump- 
tion. 
May 18,1880 
Case 1. Hears loud voice only in the left ear ; ordinary voice in the 
right ear. 
Case 2. Hears loud voice only in both of the ears. 
Case 3. Hears loud voice only in the left ear; ordinary voice in the 
light ear. 
Case 4. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Remarks.— The teacher was not previously aware that any of the pupils ha 1 imperfect hearing nor were the pupils themselves. Sixteen of them remembered having 
hail earaches. 
TahLs showing the results of examinations as to the hearing power of school pupils — Cum i..ueil. 45 
DEAFNESS AMONG SCHOOL CHILDREN. 
XIV. 
] 
40 F. 
9 to 13 
Homan Catholic parochial school 
May 18, 1880 
Case 1. Hears loud voice only in the right ear; ordinary voice in the 
ol the Church of the Asiump- 
left ear. 
tion. 
Case 2. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Remarks.— Neither the teacher n >r the pupils themselves were aware of any impairment of hearing iu the class. Five of the pupils stated that they had suffered with 
earaches. 
XV. 
1 
48 M. 9 to 13 Roman Catholic parochial school 
May 18,1880 
Case 1. Hears loud voice only in the right ear; ordinary voice in the 
of the Church of the Assump- 
left ear. 
tion. 
Case 2. Hears loud voice only in the right ear; ordinary voice in the 
XVI. 
1 
48 
M. & F. 
8 to 12 
Roman Catholic parochial school 
of the Church of the Assump- 
tion. 
May 21,1880 
Case 1. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 2. Heais loud voice only in the left ear ; ordinary voice in the 
right ear. 
Case 3. Hears loud voice oidy in the left ear ; ordinary voice in the 
right ear. 
Case 4. Hears loud voice only in the right ear ; shouted voice in the 
left ear. * 
Case 5. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 0. Hears loud voice only in both of the ears. 
Case 7. Hears loud voice only in both of the ears; does not hear any 
sentence completely. 
Case, 8. Hears loud voice only in both of the ears. 
Case 9. Hears loud voice only in both of the ears. 
Case 10. Heais loud voice only in the right ear; shouted voice only 
in the left ear. 
Case 11. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 12. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 13. Hears loud voice only in the left ear ; ordinary voice in the 
right ear. 
Remarks. -- The teacher w::s not previously aware that any of the pupils were (leaf. Five of the pupils stated that they were previously aware of haviug defects in hearing 
Remarks.— Neither the teacher nor the pupils themselves were aware that any deafness existed in the class. Thirteen of the pupils had had earaches. 46 
CIRCULARS OF INFORMATION FOR 1881. 
Table. 
Number of 
classes 
examined. 
Number 
in rlass. 
Sex of 
class. 
Average age 
of class. 
Name of school. 
Date of ex- 
amination. 
Degree of impairment of hearing for the voice. 
XVII. 
1 
55 
M. & F. 
6 to 11 
Roman Catholic parochial school 
of the Church of the Assump- 
tion. 
May 21,1880 
Case 1. ITears loud voice only in the right ear; ordinary voice in 
the left ear. 
Case 2. Hears loud voice only in the left ear; ordinary voice in the 
right ear. 
Case 8. Uears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 4. Hears loud voice only in the left ear; ordinary voice in the 
right ear. 
Case 5. Hears loud voice only in both of the ears. 
Case 6. Hears shouted voice only in the left ear; ordinary voice in 
tli • right ear. 
Case 7. Hears loud voice only in both of the ears. 
Case 8. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 9. Hears shouted voice only in the right ear ; loud voice in the 
left ear. 
Case 10. .Hears shouted voice only in the left ear ; loud voice only 
in the right ear. 
Case 11. Hears shouted voice only in both of the ears. 
Case 12. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 13. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 14. Hears loud voice only in both of the ears. 
Case 15. Hears shouted voice only in the left ear ; ordinary voice in 
the right ear. 
XVIII. 
1 
27 
M. 
11 to 15 
Grammar School No. 35, New 
Mar. 5,1880 
Case 1. He: rs loud voice oulv iu the right ear ; ordinary voice in the 
York Public Schools. 
left ear. 
Case 2. Hears shouted voice only in the right ear; ordinary voice 
in the left ear. 
Remarks.— The teacher was not aware of any deafness in the class previous to the examination. This class of boys is particularly bright: it is recruited from the well- 
to-do class of citizens. Mr. Henry E. Pellew, a commissioner of education, who kindly accompanied the author, inquired of these boys if any of them were hard of hearing; 
eleven of them said they were. This apparent discrepancy between the recorded result of the examination and the replies given to Mr. 1’ellew's inquiry is accounted for by 
the fact that the teacher’s voice was loud and distinct and he had endeavored to put the questions plainly. 
Tables showint\ Ike results of examinations as to the hearing power of school pupils—Continued. 
Remarks.— The teacher never regarded any of the class as hard of hearing. Eighteen of the pupils had experienced earaches. DEAFNESS AMONG SCHOOL CHILDREN. 
47 
XIX. 
1 
27 
M. 
11 to 15 Grammar School No. 35, New 
Mar. 5,1880 
Case 1. Hears loud voice only in the right ear; ordinary voice in tlio 
York Public Schools. 
left ear. 
Case 2. No heal ing remains in the right ear; hears shouted voice 
only in the left ear. 
Remarks.—Neither the teacher nor the pupils themselves were aware that any case of deafness existed in the class. The examination of this class took place in the 
presence of Mr. Henry E. 1‘ellew, one of the commissioners of education. Cases of slight impairment were not noted. 
XX. 
1 
29 
M. 
10 to 13 
Grammar School No. 21, Ne Feb. —,1880 Case 1. Hears loud voice only in the right ear; ordinary voice in the 
York Public Schools. left ear. 
Case 2. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 3. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 4. Hears shouted voice only in the left ear; ordinary voice in 
the right ear.1 
Case 5. Hears loud voice only in the right ear; ordinary voice in the 
left ear. 
Case 6. Hears loud voice only iu the left ear ; ordinary voice in the 
right ear. 
Case 7. Hears loud voice only in the left ear ; ordinary voice in the 
right ear. 
Case 8. Hears shouted voice only in the left ear ; ordinary voice in 
the right ear. 
Case 9. Hears loud voice only in the right ear ; ordinary voice in the 
left ear. 
Case 10. Subject to colds in the head, when he cannot hear loud voice 
in the right e r. 
Case 11. nears loud voice only in the left ear ; ordinary voice in the 
right ear. 
•Case 4 was suffering with a severe cold in the head at the time of the examination. 
Remarks.— The hearing of this class was tested by the teacher, who gave the pupils short sentences to repeat from a newspaper. He ascribed some of the failures to 
repeat the sentences to their length. One of the boys found to be deaf had always been regarded as a dull pupil; his seat was on the fourth row from the front.