GENERAL REPORT OF AN EXAMINATION OF 
415 YOUNG DEAF-MUTES, IN REGARD TO 
THE NASAL CHAMBERS, EARS, AND 
ORGANS OF PHONATION. 
BY 
ARTHUR AMES BLISS, M.D., 
OF PHILADELPHIA. 
FROM 
THE MEDICAL NEWS, 
November 19, 1892. [ Reprinted from The Medical News, November 19, 1892.] 
GENERAL REPORT OF AN EXAMINATION 
OF 415 YOUNG DEAF-MUTES, IN REGARD 
TO THE NASAL CHAMBERS, EARS, 
AND ORGANS OF PHONATION. 
By ARTHUR AMES BLISS, M.D., 
LARYNGOLOGIST TO THE GERMAN HOSPITAL; SURGEON TO THE THROAT, 
NOSE, AND EAR DEPARTMENT OP ST, CLEMENT’S HOSPITAL, 
PHILADELPHIA. 
During the past year I made a careful examina- 
tion of the aural, throat, and nasal conditions of 415 
deaf-mute children, inmates of the Pennsylvania In- 
stitution for the Education of the Deaf and Dumb. 
The cases thus examined may be divided into 
three groups, the first being the pupils of the sign 
department, whose education has been conducted 
entirely by means of the “sign language,” and with 
whom there has been no attempt made at oral train- 
ing. Of the 415 pupils examined, 303 belong 
to this group of “signers.” Group 2 is com- 
posed of pupils of the oral department, whose train- 
ing is strictly oral, the aim being to enable the 
pupil to use and understand verbal language. Of 
the total number examined, 91 pupils belong to 
this group of “orals.” Group 3 is made up of 
pupils who have been given a trial in the oral 
department, but, failing to succeed in this system, 
have been sent to the sign department, the attempt 
at oral training being abandoned. Of the 415 
pupils 2i'belong'to this group of oral failures. 2 
Group 
i. 
Group 
2. 
Group 
3 
Total. 
Nares. 
Deformities, consisting of deviated 
septa, exostoses, hypertrophied tur- 
binals, causing partial or complete 
occlusion of one or both nares . . 
65 
14 
4 
83 
Posterior hypertrophies of turbinals 
21 
I 
2 
24 
Impactions of middle turbinals 
against the septum 
14 
3 
O 
17 
Synechial bands between the sep- 
tum and lower turbinals .... 
2 
2 
O 
4 
Sclerosis of mucous membrane in 
the anterior nares 
35 
7 
5 
47 
Sclerosis in posterior nares . . . 
13 
8 
O 
21 
Atrophy of nasal mucous membrane 
20 
2 
O 
22 
General catarrhal condition due to 
vasomotor paresis without de- 
formities 
13 
3 
O 
l6 
Adenoids in vault of pharynx, caus- 
ing partial occlusion of this space 
or pressure upon the Eustachian 
openings 
57 
14 
84 
79 
Tongue. 
The frenum was abnormally short . 
24 
O 
I 
25 
Hypertrophy of the lingual tonsil 
worthy of note 
I21 
X 
O 
13 
Palate. 
Abnormally high, narrow, and 
gothic-arched 
8 
0 
2 
IO 
Deflection of raphe from median 
line, most frequently to left side . 
6 
0 
0 
6 
Double uvula 
2 
0 
O 
2 
Relaxed and pendulous soft palate 
2 
0 
O 
2 
Tonsils. 
Large tonsils which filled the spaces 
between the faucial pillars of their 
own sides of the throat, but were 
not adherent to these bands, or did 
not cause serious occlusion or pres- 
sure upon surrounding parts . 
32 
16 
I 
49 
1 Six of these were in pupils between 14 and 22 years old ; the 
other six in pupils under fourteen years of age. 3 
Group 
i. 
Group 
2. 
Group 
3- 
Total. 
Tonsils. 
Tonsils greatly hypertrophied, dis- 
eased, and causing pressure upon 
palate or tongue, and greatly oc- 
cluding the faucial space . . . 
18 
5 
4 
27 
Adhesion between tonsil and faucial 
pillars, the tonsil being encapsu- 
lated 
30 
6 
5 
41 
Narrowing of fauces by broad pos- 
terior pillars with high attachment 
to the pharyngeal walls . . . . 
II 
O 
O 
II 
Pharynx. 
Simple hypertrophy of mucous fol- 
licles 
23 
3 
2 
28 
Sclerosis of mucous membrane with 
follicular hypertrophy . . . . 
9 
6 
O 
15 
Simple sclerosis of mucous mem- 
brane 
55 
20 
5 
80 
Atrophy of mucous membrane . . 
8 
I 
1 
IO 
Venous engorgement worthy of 
note 
22 
2 
3 
27 
Larynx. 
Epiglottis abnormally depressed 
“ Infantile ” epiglottis 
142 
2 
0 
l6 
23 
O 
O 
2 
Vocal Bands. 
Apparently normal in color and or- 
dinary movement 
83 
63 
12 
158 
In considering the general results of examina- 
tions, only decided pathologic conditions will be 
considered in this paper. The detailed account 
of each case will be prepared and published at a 
2 Only four being in pupils under fourteen years of age. 
8 Both being in pupils over fourteen years of age. 
* These eight cases all occurred in subjects between twelve and 
nineteen years old. 4 
later date. The mere enumeration of lesions is of 
general interest, but, to estimate the importance of 
such lesions in their influence on the training and 
education of the pupil, the reader must know what 
relations these bear to all the parts involved in 
phonation. In short, the report of conditions found 
in the nose, post-nares, pharynx, tongue, palate, 
tonsils, larynx, and ears, in each individual pupil, 
must be tabulated and put in form for easy refer- 
ence. This will be done at a future date. 
Most of the pupils of group i presented voca- 
bands of a dull-gray color, bowing or wavy at their 
free margins, or so thin and narrow as to be un- 
usually obscured by the ventricular bands. Efforts 
at phonation showed the adducting muscles to be 
weak and inefficient. 
EARS. 
The limits of this paper will not permit of more 
than a general enumeration of gross lesions. The 
majority of pupils presented drum-heads that were 
retracted, dull in color, and feebly movable. These 
will not be noted here, but only such cases of plastic 
otitis media as displayed adhesion of the drum-head, 
in whole or in part, or other destructive process. It 
is left for the detailed report to give the aural con- 
dition in each individual pupil. 5 
Group 
i. 
Group 
2. 
Group 
3- 
Total 
Plastic otitis media, limited as al- 
ready explained 
75 
20 
l6 
III 
Adherent and immovable drum- 
heads 
94 
28 
3 
125 
Very feebly movable drum-heads . 
43 
12 
4 
59 
Atrophic drum-heads 
2 
0 
O 
2 
Engorgement of manubrial vessels 
and pinkish tint of drum-head 
6 
3 
I 
IO 
Calcareous deposits in drum-head . 
14 
2 
O 
l6 
Double perforations with otorrhea 
9 
5 
3 
17 
Single perforations with otorrhea . 
IO 
5 
I 
l6 
Cicatrized perforations, many of 
them covered with new membrane 
32 
13 
3 
48 
Double impactions of cerumen . . 
14 
5 
O 
19 
Single impactions of cerumen . . 
i5 
7 
2 
24 
Atresia of external auditory mea- 
tus 
2 
0 
O 
2 
Undeveloped auricles with absence 
of auditory meatus 
i 
0 
O 
I 
Foreign bodies 
61 
0 
O 
6 
Desquamative otitis externa . . . 
4 
0 
O 
4 
Hearing. 
A slight trace of hearing . . . . 
6 
17 
2 
25 
On contact only 
62 
6 
IO 
78 
Fair hearing 
O 
2 
0 
2 
Personal and Family History. 
Origin of Deaf-mutism. 
Group 
i. 
Group 
2. 
Group 
3- 
Total. 
(a) From birth 
105 
22 
IO 
>37 
(6) Acquired 
178 
6S 
II 
254 
(c) Uncertain 
20 
4 
O 
24 
1 Consisted of cotton, stick of wood, paper, and a piece of tin, 
all showing evidence of having been in the ears for a long time. 6 
Causes of deaf-mutism given without the division 
in separate groups: 
Spotted fever 
Cases. 
• 43 
Scarlet fever 
66 
Measles 
17 
Meningitis 
29 
Typhoid fever . 
S 
Pneumonia 
2 
Diphtheria 
2 
Malaria 
2 
Smallpox . 
1 
“ Colds ” . 
13 
Convulsions 
10 
Black fever 
3 
Traumatism 
9 
Spinal meningitis 
S 
Inflammation of bowels 
Cholera infantum 
2 
1 
Shock 
Mumps . . . 
1 
1 
Bronchitis . 
1 
Catarrhal fever . 
1 
Sunstroke . 
1 
Otitis media 
9 
Whooping-cough 
2 
Teething . 
3 
Croup 
1 
Eczema 
1 
Unknown (exclusive of 137 pupils credited 
being deaf-mutes from birth) 
as 
49 
The parents were relatives in 24 cases; deaf-mutes 
in 7. Pupils possessing other deaf-mute relatives, 94. 
I would again call the reader’s attention to the 
numbers composing each group: Group 1 (the 
sign-language pupils) being 303, Group 2 (the 
oral pupils) being 91, and Group 3 (the oral 
failures) being 21 in number. 
HEREDITY. 7 
Especial attention is called to these oralfailures, 
and by glancing at the figures it will be observed 
that,in abnormalities of the post-nasal space,pharynx, 
and tonsils, this group is particularly rich. The 
difficulties for a deaf-mute, under the best circum- 
stances, to acquire verbal language are sufficiently 
great to make a successful result seem almost like a 
miracle. With a post-nasal space stuffed by enlarged 
adenoids, the choanae further occluded by posterior 
enlargement of the lower turbinated bodies, the 
tonsils so hypertrophied as to press upon the soft 
palate and tongue, and to greatly lessen the caliber 
of the fauces, it is not surprising that the would be 
deaf-mute speaker should become one of the army 
of “oral failures.” I think that if these statistics 
show nothing else, they indicate the need for 
careful inspection of the entire vocal apparatus in 
all deaf-mutes entering upon oral training. They 
also show the necessity for such judicious treatment 
as will place the vocal apparatus of the pupil in the 
best condition for the various parts to perform their 
functions. I believe that many deaf-mute children 
have failed as oral pupils, or have not attained a 
satisfactory degree of ability in phonation, not be- 
cause of mental inaptitude, or of neglect upon the 
part of their teachers, but purely because of ana- 
tomic defects that might have been corrected. 
The large number of pupils showing the existence 
of plastic otitis media, but still having some sense of 
hearing by bone-conduction, suggests the possibility 
of benefit from modern operative methods. 
The same suggestion would apply to cases of 
acquired deaf-mutism, in which bone-conduction 
was fairly good, and the lesion distinctly a sclerosis 8 
of the middle ear or a necrotic process. These 
procedures would consist of excision of the useless 
drum head with the malleus, now acting as obstruc- 
tors to instead of conductors of vibrations, or of 
Urbantschitsch’s or Miot’s method of mobilization. 
Certainly, in a limited number of cases, it would be 
quite justifiable to perform the preliminary opera- 
tion of making an ample perforation in the drum- 
head, and then be guided in regard to farther pro- 
cedures by the results thus obtained. 
The reader must not be misled into exaggerating 
the importance of certain data given in this report. 
I would refer, in this connection, chiefly to the sub- 
ject of sclerosis of the phar) ngeal mucous mem- 
brane. This appears as a very common condition 
in normal subjects, who are never conscious of any in- 
convenience therefrom. It is the degree of sclerosis 
in which the process borders upon true atrophy that 
renders it worthy of notice. However, it indicates 
the result of inflammation or malnutrition, and 
appears to me to be more advanced among the cases 
reported here than among normal children of the 
same age. 
This report may serve as a partial answer to the 
question so often asked, why certain deaf mutes, of 
average mental capacity, either fail completely as 
speakers, or make sounds almost unintelligible, ex- 
cept to those long associated with them. In many 
instances, the causes may lie hidden deeply in some 
atrophied cerebral center, but it should certainly 
encourage the oral teacher to know that, in other 
cases—and, perhaps, a large proportion, too—the 
causes of failure are mechanical and within easy 
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