(Stye 31fa*rtracjl7il,£? The Modicum of Hearing of Deaf flutes; How to Use It and How to Improve It. Compliments of Reprint: From The Medical Fortnightly, St. Louis, March 2, 1896. The ITodicum of Hearing of Deaf Mutes; How to Use It and How to Improve It. By S. T. Walter, M. A., JACKSONVILLE, ILL., Superintendent of Illinois Institution for the Deaf. The adjective “deaf,” as commonly used, is one of the most flexible terms. Its rhetorical differentiation is nil; its power of scientific definition is value- less; and its promiscuous and general use is misleading. Yet we know of no single terms that will intelligently ex- press the various degrees of deafness, and we are therefore compelled to bring into requisition the awkward and unscientific phrases “hard of hearing,” “semi-deaf,” “partially deaf,” etc., when any attempt toward classifica- tion is made. I yet hope that our sci- entific instruments for measuring hear- ing may develop in excellency beyond the “tick” of a watch, the variable tuning fork or the human voice, so that we shall quickly and easily be able to say of one whose audition is impair- ed, “Your hearing is 20 per cent; yours is 35 per cent,” etc., and have that gra- dation recognized as infallible through- out the profession, and even under- stood in a general way by all. Until some such method is adopted, we shall still be compelled to employ circumlo- cution when any extended classification of the deaf is entered into. The physical act of experiencing sen- sation caused by excitation of the au- ditory nerve is commonly termed “hearing,” and it is this definition that applies to the word as first used in the title of this paper. I recognize, however, that this physical stimulation is but a component part of hearing; that “to hear” in the fullest and broad- est sense comprehends cerebral activ- ity, perception, association, and the re- flex motions arising from normal ex- citation of the auditory nerves. It is this latter and fuller meaning that is referred to in the balance of the title. The ability, then, to experience the physical effect of excitation of the au- ditory apparatus is one thing, and the further power to utilize the effect is another. In the first classification, it has been found by experimentation, belong a respectable proportion of children who are pupils in institutions for the edu- cation of the deaf. In the second class- ification belong a much smaller propor- tion of those pupils, yet it is large enough to have recently commanded the attention of educators and scien- tific men, and ways and means are being devised adaptable to their educa- tional needs. A conviction has long lain in the minds of some who have had charge of institutions for the deaf that a duty in this direction has too long remained unfulfilled. Gradually, however, the most pro- gressive investigators are forcing upon the authorities the imperative neces- sity of provision for the instruction of this percentage of pupils, whatever it may be found to be, by means which I will recite further along in this pa- per. How much actual hearing, through the ear, by the use of tubes and other bone-conduction, exists among pupils refused by public schools and sent to institutions for the deaf? How many have enough hearing to be of benefit in conversation and recitation? These are questions which have been brought most forcibly and interestingly to my attention. Early in the winter of 1893-4 I resolved to make a recorded test of these questions, with the view of hav- ing it as a basis for future operation in the line of educable audition. Through the kind offices of Mr. R. S. Rhodes, of Chicago, the inventor of the “Audiphone,” I obtained one of Prof. D. E. Hughes’ instruments, called a sonometer, or audiometer, for meas- uring the hearing power. This simple instrument may be described for the benefit of those not familiar with it, as one arranged to conduce sound pro- duced by the opening and breaking of an electrical circuit through a receiver 2 to the ear. The sound is a clicking noise, and its intensity is increased or diminished by moving a magnetic disc on a sliding graduated bar towards or away from an electro-magnet, operat- ing by induction. Normal hearing is able by the induction to detect the noise when the disc is at the extreme end of the graduated bar, while one with defective hearing must, in order to hear the noise, have the disc near the coil, the point farthest away from the coil at which the noise is heard de- termining the relative degree of hear- ing or deafness. Out of 523 pupils comprising the en- rollment of the Illinois Institution for the Deaf (at Jacksonville), I found it practicable to secure what appeared to be intelligent answers from 381. Fre- quent false tests were made in cases where it was suspected that the child was ignorant of what was desired to be known, or where, being deaf abso- lutely, wrong answers were given un- intentionally, and such cases were thrown out of the count. Great care was taken to have the test as nearly perfect as the instrument used and the intelligence of the child would ad- mit, and I feel confidence in the re- sult. The scale on the audiometer was re- duced to 100; R. signifies the right ear; L. signifies the left ear; 100 equals normal hearing; 0 equals total deaf- ness; the percentage in all cases indi- cates the degree of hearing. In the first table I will give the ten pupils who possessed the greatest percentage of hearing, and for the sake of future reference I will give records of both ears, age at date of test, supposed cause of deafness, and age at which deafness occurred: Percentage of Hearing. Age. Supposed Cause of Deafness. T H R. 70— L. 80 18 years J \v R. 80—L. 0 23 “ R. F R. 0—L. 78 19 “ Ij. V R. 75—L. 20 12 “ A T R. 0—L. 75 14 “ J w R. 65—L. 70 19 N M R. 70- L. 50 9 “ H J R. 35—L. 65 19 “ w. S R. 65—L. 20 12 “ N. M R. 50—L. 60 17 “ Out of 381 I found results indicated in the table below. This classification gives the “best” ear, without reference to the percentage of hearing in the other. It also gives the average of each group: Percentage Groups Per cent of Hearing. Per cent of whole Number Tested. Average Pres- ent Age. 60 had record of various degrees to... 10 15.7 15 years 65 had record of various degrees between 10 and 20 9 2 17 “ 47 had record of various degrees between 20 and 30 12.0 19 “ 18 had record of various degrees between 30 and 40 4.7 16 “ 7 had record of various degrees between 40 and 50 2.0 17 “ 16 had record of various degrees between 50 and over 4.2 17 “ 40 had record of zero in right ear 10.0 17 “ 46 had record of zero in left ear 12.0 16 “ 198 had record of zero in both ears 52.0 15 “ There seems to have been quite a variation between the degree of hear- ing in right and left ears of individual cases, as out of the total number ex- amined only twenty-six had an equal degree of hearing in both ears. The 3 average in the aggregate of the per- centage of the right, however, and that of the left ear is very nearly the same, a very interesting fact, going to prove, though not by any means fully estab- lishing the fact, that one ear is not more susceptible to influences causing deafness than the other. The average percentage of hearing of all those who heard in any degree is 19 per cent in the right ear and 20 per cent plus in the left ear—'practically the same. By reference 'to the percentage col- umns of the last table it will be seen that nearly 11 per cent of all examined recorded an audiometric hearing power of 30 per cent and over of normal hear- ing. At that rate, there should be in the Illinois Institution for the Deaf nearly sixty pupils who have 30 per cent and over of hearing. The impor- tance of this disclosure would seem to be augmented, taken with the state- ment of Mr. Rhodes that he himself has only about 7 per cent in one ear and nothing in the other, and that of the late Prof. George Wing, who claim- ed it as his belief (though not verified by tests) that fully 20 per cent of all pupils in institutions for the deaf were more sensitive to sound than he him- self was. Mr. Rhodes, it may be said, carries on a large business and tran- sacts his affairs by speech and hear- ing, using the audiphone and experi- encing little or no trouble. Mr. Wing used a trumpet or flexible hearing tube with as little inconvenience. Were J to let this statement stand without further comment, the natural conclusion would be: If the gentlemen referred to, having each less hearing that each of sixty pupils in one insti- tution for the deaf, can successfully use that modicum of hearing, the duty is plain and neglect is culpable. But there is a very important fact to note, and that is, children partially deaf do not, and, I may say, will not, except- ing in rare instances, put forth the ex- ertion needful to utilize and educate the modicum of hearing they possess. On the other hand, adults, who sensi- bly appreciate the annoyance arising from deafness, will put forth the .ut- most exertion, wholly or partially, to retrieve the lost sense. This explana- tion of the reason why greater success in this direction may not be attained is, without doubt, the valid one, and the fact is a most serious block in the way of carrying out a most pleasing theory. Only one ray of hope for the removal of the difficulty appears, and that is in more persistent and individ- ual instruction in much smaller classes than it has yet been found practicable to form. Audiometric tests of hearing power were made also in the New York In- stitution for the Deaf by Prof. F. D. Clarke, 341 pupils being tested. The re- sult of this test was as shown in the following table: Number Cases Audiometer. Percentage of Cases Tested. 70 0 20.52 9 0 and under 5 2.63 30 5 and under 10 8.79 112 10 and under 15 32.96 03 15 and under 20 18.47 25 20 and under 25.. .. 7.33 10 25 and under 30 2.93 5 30 and under 35 1.46 4 35 and under 40. .. 1.17 2 40 and under 45 0.58 4 45 and under 50 1.17 2 50 and under 55 0.58 8 55 and upwards 2.34 From the experiments made, the au- thorities in the New York Institution concluded that about sixty of the whole number tested (341) possibly heard enough to eventually be instructed through the ear ,but finally decided to begin with but thirty-two . This was eleven years ago. The latest report is that nineteen only receive instruc- tion through the medium of the ear. In the Nebraska Institution fifty- four, or about 34 per cent of the whole number receive instruction through the ear. That institution is the pioneer in the classification and instruction of the semi-deaf, and I am sorry that no data are at hand with reference to the re- corded degrees of deafness which the number who receive instruction through the ear possessed when such instruction was commenced, for much of the value of such experimentation results from comparisons made from time to time, The first permanently organized class of semi-deaf pupils in the Illinois Institution was formed in October, 1894. The members of the class were taken from the other classes, where they had been receiving instruction such as is given to deaf mutes who do not hear or speak. From that time to the present these pupils, who have various degrees of hearing, have been compelled to depend upon the ear for their instruction and required to com- municate by vocal speech during the five hours each day they are reciting. The experiment has been most grat- ifying. While the work is exceedingly taxing to the teacher, who must mate- rially increase the volume of vocal speech so as to meet the requirements of the deafest member of the class, yet this great strain will, I trust be lessen- ed by means of assistance from the graphophone. Experiments to that end are now being prosecuted. The aim, it must be understood, in classifying the semi-deaf together is to secure for them such instruction as they would receive in the ordinary schools, were they able to receive it in public school classes. In addition to this, their defective articulation and breathing, which almost invariably ac- companies defective hearing, are cor- rected and much improved by exercises designed by the teacher to fit such cases. Not only is the practical utility of their remnant of hearing thus made a prominent feature of instruction by its continued exercise toward practical ends, but the esthetic cultivation and use of the semi-dormant sense is un- dertaken also by a short daily musical program sometimes given by the teach- er rendering piano and vocal selec- tions, or by the graphophone. Consid- ered psychologically, this exercise is of no small importance. It is conceded by students of psychology that sound affects the psycho-accoustic and the emotional centers of the brain very perceptibly, and to an extent that may soothe and palliate nervous disorders or excite to serious nervous affections. The effect upon the totally deaf of the absence of sound in the formation of character, as well as the therapeutic value of harmony, is a subject that is well worth investigation. As a means of laryngeal exercise, the class is also made to go through with a daily drill, very much the same as singers, usually accompanied by the piano, but limited, of course, to rudi- mental exercises designed for especial purposes, such as “opening the throat,” “abdominal breathing,” and the “plac- ing” of abnormal voice. Aids to hearing are resorted to where it is difficult to secure comprehension normally, and the various tubes and trumpets, as well as the audiphone, are kept at hand. The principle govern- ing the class is “the greatest amount of audition that is possible, together with activity of the vocal and articula- tory organs.” It will readily be under- stood that the attedant labor is great, owing to the amount of individual at- tention required. The graphophone is, I think, going to prove a valuable as- sistant to the teacher in this respect. The principal way in which it can be used is by the teacher recording upon a blank cylinder such lessons, exer- cises or recitations as she may desire most frequently to fall upon the ears of her pupils. These cylinders then can at her pleasure be placed in the ma- chine and as many as eleven pupils can, by using the multiple hearing at- tachment, hear over and over the rec- ord of the cylinder. Thus much time as well as lung power can be saved and a vastly greater quantity of vocal utterance into the ears of the pupils can be secured. To what limit the use of the graphophone can be bene- ficially serviceable is yet to be discov- ered. Tests are now being made with other pupils whose hearing is much less in degree than those we term the semi-deaf, ranging down to zero. One hundred and ninety have already been tested. The graphophone, it must be understood, has much greater volume than the phonograph, and the person making the record can secure a re- production that may be heard by nor- mal hearing in any part of quite a large room. The cylinders used in the test were: First, a musical selection by an orchestra (a march), in which was introduced the ringing of a bell; sec- ond, a cylinder the record of which was made here, representing, first, loud speech, (hen the imitation of a bird, 5 followed by an imitation of the squeal- ing of a pig. The graphophone was taken to the various class-rooms and the pupils told to listen (using the ordinary tubes us- ually connected to the phonograph) and write down as good a description of the sound or sensation produced as they could. It is safe to presume that the answers which I reproduce below are for the most part “honest” ones, though doubtless the imagination was drawn upon in some instances. It must be remembered, too, that the greatest majority of those tested probably never very distinctly heard many sounds of any kind, and that, therefore, any sound-impression might be defined, not as relating to any special similarity in quality to another, but as causing a sensation similar to that caused by most any accidental sound-impression which had at some previous time been experienced. Others seem very closely to have recognized some of the sounds produced. As a matter of comparison, I have re- verted to my former audiometric tests and have followed the definition of the sound-impression as given by the deaf pupil with the percentage of hearing found to exist in each case at that time. The columns on the right indi- cate the right and left ear percentage of hearing as shown by audiometer: Graphophone Test—190 Deaf Children. R. L. A., C.—Birds singing. Cats mewing. 0 0 A. N.—Like Music. Whistle 16 16 B. J.—Little like a band 0 0 B., S.—Music J 10 0 B. H.—Whistle. Baby crying. Man said words 20 22 C. E.—Heard words and noise of locomotive 27 20 C., M.—Like the blowing of a horn. Laugh and whistle 25 10 C„ W.— Birds singing. Dog bark 4 4 C. R.—Piano and singing. Train coming 10 25 D. —Dog bark 0 0 D., G.—Whistle. Cow 0 0 D. A.—Little sound like a horn and band 0 0 E. L.—Music 0 0 F. G.—Bird’s voice. Music 0 0 F. J.—Dog bark. Birds singing 0 0 G. B.—Like an organ. Dog bark- ing 0 0 G., P.—Croaking of window in wind- storm. Voice like screaming G. E.—Bird 3 0 H. J.—Whistle. Bark, Music...,,. 20 22 H., Li.—Singing of animals 0 0 H., C.—Noise like a lamb and a cat. 0 0 H„ G.—Whistle 0 0 H., H.—Whistle. Bark H., M.—Dog barking 0 0 K., P.—Band. Music. Man holding hog that squealed 0 22 K. E.—Bird 0 0 L. K.—Dog bark. Birds singing 0 0 M. A.—Bands and songs 35 32 McC., T.—Music like in opera house. 5 0 M., N.—Negroes singing. Birds sing- ing 50 60 McF., B.—Music. Noise like some animal. Loud talking. Sensibly- affected and auditory nerves caus- ing shock 10 0 M., O.—Very sensibly and acutely affected auditory nerves and caus- ed shock McD., M.—Bird 0 0 M., J.—Like a boy going up steps... 10 6 M.,. C.—Ungreased wheels. Dog barking ; 0 0 M., N.—Whistling. Rumbling of wheels M. K.—Baby crying. Band. Car- riage 60 0 N. A.—Cow and dog 0 0 O. E.—Cat mewing. Dog bark. Hen singing 12 0 O. W.—Band 3 0 P. B.—Whistle 0 0 P., D.—Birds singing. Dog bark. Baby crying 8 8 P., E.—Cow. Dog. Whistle R., F.—Dog bark. Noise of machine. Shout of man R.,V.—Dog bark. Cat mewing. Cow. 0 0 R., C.—Cow o 0 R., M.—Piano. Hand organ. Dog.. 20 32 R., D.—Like a cat 0 0 R., H.—Band o 0 R., M.—Music 2 0 R., S.—Music 0 0 R. M.—Singing o 30 S. G.—Preaching. Pig squealing... 30 20 S., J.—Train o 0 S., F.—Music. Whistle 0 0 S., L.—Music. Whistle 0 0 S., M.—Whistle. Birds singing 10 0 S. H.—Birds singing 15 20 T. A.—Piano. Dog bark 0 0 T. F.—Noise like a cat. Boys playing 0 0 U. T.—Preaching. Pig squealing... 30 20 V. F.—Rooster crowing 6 5 V., J.—Whistle o 5 V. L.—Cat. Church bell. Train 15 15 W. M.—Street car. Whistle. Train 0 0 W., O.—Bell o 0 W.f M.—Whistle. Boy’s scream. Birds singing Z., R.—Birds singing. Dog bark 0 0 C., A.—Dog bark 22 20 To utilize and improve the hearing and to educate sound-perception in those -whose hearing has never differ- entiated sounds to an extent that would render their physical hearing a practical agent for conversational uses, requires still more complex and patient treatment. Should a person born deaf miraculously and suddenly receive hearing, he would be utterly unable to successfully associate the sounds he would hear uttered as vocal speech. He would be as a foreigner in a strange land, and the words of his own mother would be meaningless. His hearing power, so far as its utility in conver- sation is concerned, would be nil. His auditory cerebral center would have to be educated with as much detail as that of a babe. Frequent repetition of the verbal sound of common objects would be necessary, together with as- sociation of the sound with the visual object. A regular course would have to be pursued with him, beginning with the very simplest elements of lan- guage, and this, too, in the face of the fact that his previous education may have been carried to a high de- gree of perfection and he may be able to comprehend by visual means the most abstruse statements. In this hypothetical case we have the exact condition of one whose hearing, always dormant or never having been utilized, is sought to be improved by any means that may be employed. The degree of physical sound-sensation reaching the autditory nerve, whether greater or less, does not enter into the problem so much as does the past history of the practical use of that degree. In other words, a person born with as high as 60 per cent of hearing, be he of phlegmatic temperament, slow of perception, indolent, and mentally dull, may, if no interference super- venes, live a long life without, ever ut- tering a word or comprehending a word spoken to him. On the other hand, one born with a much less de- gree of hearing, but of active tempera- ment and an inquiring mind, is open to impressions, faint though they may be, through the auditory nerve. His very keenness to know of cause and effect will frequently lead him to a knowledge and perception of the genius of speech. To what extent these phleg- matics with a comparatively large per- centage of hearing power, and these others with active and inquiring minds, though possessing relatively a less de- gree of hearing power, may be brought to a practical hearing perception, is a question that the future only can an- swer. Some experiments are now be- ing made in that direction. Sugges- tions have been made towards massage of the sound-conducting apparatus by means of vibratory impressions grad- uated so as to meet the requirements of various cases, and to give variety of pitch and quality. This is done by an instrument termed a vibrometer used by Dr. Henry F. Garey of Bal- timore. Dr. Garey claims that in the loss of elasticity of the membrana tym- pani, and adhesions caused by secre- tions of a gluey nature in the tympanic cavity, curtailing the movements of the ossicula auditus, a systematic mas- sage of the vibrometer will restore these parts to activity. Some eminent members of the iprofession do not agree with this view, though Dr. Garey cites cases where the treatment has been successful. Whether the theory is ipractical or not, there certainly is reason enough in it to induce experiment along that line, though I am constrained to be- lieve that more may be accomplished by professional surgical interference in case of diseases such as Dr. Garey describes. In the foregoing I have shown, I think, in what manner the modicum of hearing possessed by some of the deaf is, and how in others, it may be util- ized in their education and later, in af- fairs of life. How far