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THE DEAF

THEIR POSITION IN SOCIETY AND THE PROVISION FOR THEIR EDUCATION IN THE UNITED STATES

BY HARRY BEST



NEW YORK THOMAS Y. CROWELL COMPANY PUBLISHERS



COPYRIGHT, 1914, BY HARRY BEST.

Published April, 1914.



Transcriber's Note:

Minor typographical errors have been corrected without note. Significant corrections have been listed at the end of the text. The oe ligature has been transcribed as [oe].



TO

THE DEAF OF THE LAND

AND TO THOSE WHO LOVE THEM



FOREWORD

The aim of the present study is to ascertain as far as possible the standing of the deaf, or, as they are so often called, the "deaf and dumb," in society in America, and to examine the treatment that has been accorded to them—to present an account of an element of the population of whom little is generally known. In this effort regard is had not only to the interests of the deaf themselves, but also, with the growing concern in social problems, to the fixing of a status for them in the domain of the social sciences. In other words, the design may be said to be to set forth respecting the deaf something of what the social economist terms a "survey," or, as it may more popularly be described, to tell "the story of 'the deaf and dumb.'"

The material employed in the preparation of the work has been collected from various documents, and from not a little personal correspondence: from the reports and other publications of schools for the deaf, of organizations interested in the deaf, of state charities, education or other departments, of the United States bureaus of education and of the census; from the proceedings of bodies interested in the education of the deaf, of organizations composed of the deaf, of state and national conferences of charities and corrections; from the statutes of the several states; and from similar publications. From the American Annals of the Deaf the writer has drawn unsparingly, and to it a very considerable debt is owed. Valuable assistance has also been obtained from the Volta Review, formerly the Association Review, and from papers published by the deaf or in schools for the deaf. Other sources of information used will be noted from time to time in the work itself.

For all that has been set down the writer is alone responsible. He is, however, keenly mindful of all the co-operation that has been given him, and it would be most pleasant if it were possible to relate by name those who have been of aid. Mere words of thanks could but very little express the sense of obligation that is felt towards all of these. Indeed, one of the most delightful features connected with the work has been the response which as a rule has been elicited by the writer's inquiries; and in some cases so courteous and gracious have been the correspondents and informants that one might at times think that a favor were being done them in the making of the request. To certain ones the writer cannot escape mentioning his appreciation: to Dr. E. A. Fay, editor of the American Annals of the Deaf, and vice-president of Gallaudet College; Dr. J. R. Dobyns, of the Mississippi School, and secretary of the Convention of American Instructors of the Deaf; Mr. Fred Deland, of the Volta Bureau; Mr. E. A. Hodgson, editor of the Deaf-Mutes' Journal; Mr. E. H. Currier, of the New York Institution, and Dr. T. F. Fox and Mr. Ignatius Bjorlee, also of this institution; Dr. Joseph A. Hill, of the Census Bureau; Mr. Alexander Johnson, formerly secretary of the National Conference of Charities and Corrections; Dr. H. H. Hart, of the Russell Sage Foundation; Professor S. M. Lindsay and Dr. E. S. Whitin, of Columbia University; and to the officials of the Library of Congress, of the New York Public Library, of the New York State Library, of the New York School of Philanthropy Library, of the New York Academy of Medicine, of the Columbia University Library, of the Volta Bureau, and of the Gallaudet College Library.



CONTENTS

PAGE

INTRODUCTION xiii

PART I

POSITION OF THE DEAF IN SOCIETY

CHAPTER

I. THE DEAF IN THE UNITED STATES 3

Meaning of Term "Deaf" in the Present Study—Number of the Deaf in the United States—Age when Deafness Occurred—Ability of the Deaf to Speak—Means of Communication Employed by the Deaf.

II. THE DEAF AS A PERMANENT ELEMENT OF THE POPULATION 13

Increase in the Number of the Deaf in Relation to the Increase in the General Population—The Adventitiously Deaf and the Congenitally Deaf—Adventitious Deafness and its Causes—Possible Action for the Prevention of Adventitious Deafness—Adventitious Deafness as an Increasing or Decreasing Phenomenon—The Congenitally Deaf—The Offspring of Consanguineous Marriages—The Deaf Having Deaf Relatives—The Offspring of Deaf Parents—Possible Action for the Prevention of Congenital Deafness—Congenital Deafness as an Increasing or Decreasing Phenomenon—Conclusions with Respect to the Elimination or Prevention of Deafness.

III. TREATMENT OF THE DEAF BY THE STATE 63

General Attitude of the Law towards the Deaf—Legislation Discriminatory respecting the Deaf—Legislation in Protection of the Deaf—Legislation in Aid of the Deaf—Tenor of Court Decisions Affecting the Deaf—Present Trend of the Law in Respect to the Deaf.

IV. ECONOMIC CONDITION OF THE DEAF 75

The Extent to which the Deaf are a Wage-earning and Self-supporting Element of the Population—Views of the Deaf as to their Economic Standing—The Deaf as Alms-seekers—Homes for the Deaf—Conclusions with Respect to the Economic Position of the Deaf.

V. SOCIAL ORGANIZATION OF THE DEAF 91

Social Cleavage from the General Population—Desirability of Organizations Composed of the Deaf—Purposes, Activities, and Extent of Such Organizations—Newspapers of the Deaf.

VI. POPULAR CONCEPTIONS CONCERNING THE DEAF 99

Viewed as a Strange Class—Viewed as a Defective Class—Viewed as an Unhappy Class—Viewed as a Dependent Class—Need of a Changed Regard for the Deaf.

VII. PRIVATE ORGANIZATIONS INTERESTED IN THE DEAF 107

General Societies Interested in the Deaf—The Volta Bureau—Parents' Associations for the Deaf—Church Missions to the Deaf—Organizations Interested in the Education of the Deaf—Publications Devoted to the Interests of the Deaf.

PART II

PROVISION FOR THE EDUCATION OF THE DEAF

VIII. THE EDUCATION OF THE DEAF PRIOR TO ITS INTRODUCTION INTO THE UNITED STATES 119

IX. HISTORY OF EDUCATION OF THE DEAF IN THE UNITED STATES 129

Early Attempts at Instruction—Beginning of the First Schools—Early Ideas concerning the Schools for the Deaf—Aims of the Founders—Extension of the Means of Instruction over the Country.

X. ORGANIZATION OF THE INSTITUTIONS AND GENERAL PROVISIONS 171

Arrangements in the Different States—Semi-Public Institutions—"Dual Schools"—Provision for the Deaf-Blind—Provision for the Feeble-minded Deaf—Government of the Different Institutions—Procedure in States without Institutions.

XI. THE DAY SCHOOL FOR THE DEAF 187

Inception and Growth of the Day School—Design and Scope of Day Schools—Extent and Organization of Day Schools—Arguments for the Day School—Arguments against the Day School—Evening Schools for Adults.

XII. DENOMINATIONAL AND PRIVATE SCHOOLS 202

Denominational Schools—Private Schools.

XIII. THE NATIONAL COLLEGE 206

XIV. PROVISION FOR EDUCATION BY STATES 209

XV. CONSTITUTIONAL PROVISIONS FOR SCHOOLS 242

Extent of Constitutional Provisions—Language and Forms of Provisions.

XVI. QUESTION OF THE CHARITY CONNECTION OF SCHOOLS 248

Institutions Sometimes Regarded as Educational: Sometimes as Charitable—Charity in Connection with Schools for the Deaf—Arguments for the Connection with Boards of Charities—Arguments in Opposition to the Connection—-Conclusions in Respect to the Charity Connection of Schools for the Deaf.

XVII. PROVISIONS CONCERNING ADMISSION OF PUPILS INTO SCHOOLS 262

Rules as to the Payment of Fees—Provision for the Collateral Support of Pupils—Age Limits of Attendance.

XVIII. ATTENDANCE UPON THE SCHOOLS 268

The Proportion of the Deaf in the Schools—The Need of Compulsory Education Laws for the Deaf—Present Extent of Compulsory Education Laws.

XIX. METHODS OF INSTRUCTION IN SCHOOLS 277

The Use of Signs as a Means of Communication—Rise and Growth of the Oral Movement—Present Methods of Instruction—Courses of Study and Gradations of Pupils—Industrial Training in the Schools.

XX. COST TO THE STATE FOR EDUCATION 293

Value of the Property Used for the Education of the Deaf—Cost of the Maintenance of the Schools—Form of Public Appropriations—Cost to the State for Each Pupil.

XXI. PUBLIC DONATIONS OF LAND TO SCHOOLS 299

Grants by the National Government—Grants by the States—Grants by Cities or Citizens.

XXII. PRIVATE BENEFACTIONS TO SCHOOLS 303

Donations of Money—Gifts for Pupils—Present Tendencies of Private Benefactions.

XXIII. CONCLUSIONS WITH RESPECT TO THE WORK FOR THE DEAF IN AMERICA 309

APPENDIX A 325

TABLE WITH RESPECT TO HOMES FOR THE DEAF IN AMERICA.

APPENDIX B 326

TABLES WITH RESPECT TO SCHOOLS FOR THE DEAF IN AMERICA.

I. PUBLIC INSTITUTIONS 326 II. PUBLIC DAY SCHOOLS 329 III. DENOMINATIONAL AND PRIVATE SCHOOLS 331

INDEX 333



INTRODUCTION

Society as a whole knows little of the deaf, or the so-called deaf and dumb. They do not form a large part of the population, and many people seldom come in contact with them. Their affliction to a great extent removes them from the usual avenues of intercourse with men and debars them from many of the social activities of life, all tending to make the deaf more or less a class apart in the community. They would seem, then, to have received separate treatment, as a section not wholly absorbed and lost in the general population, but in a measure standing out and differentiated from the rest of their kind. Thus it comes that society has to take notice of them. By reason of their condition certain duties are called forth respecting them, and certain provision has to be made for them.

The object of the present study of the deaf is to consider primarily the attitude of society or the state in America towards them, the duties it has recognized in respect to them, the status it has created for them, and the extent and forms, as well as the adequacy and correctness, of this treatment. Hence in our study of the problems of the deaf, the approach is not to be by the way of medicine, or of law, or of education, though all these aspects will be necessarily touched upon. Nor is our study to deal with this class as a problem of psychology or of mental or physical abnormality, though more or less consideration will have to be given to these points. Nor yet again are we to concern ourselves principally with what is known as the "human interest" question, though we should be much disappointed if there were not found an abundance of human interest in what we shall have to consider. Rather, then, we are to regard the deaf as certain components of the state who demand classification and attention in its machinery of organization. Our attitude is thus that of the social economist, and the object of our treatment is a part or section of the community in its relation to the greater and more solidified body of society.

More particularly, our purpose is twofold. We first consider the deaf, who they are, and their place in society, and then examine the one great form of treatment which the state gives, namely, the making of provision for their education. This we have attempted to do in two parts, Part I treating of the position of the deaf in society, and Part II of the provisions made for their education. As we shall find, the special care of the state for the deaf to-day has assumed practically this one form. Means of education are extended to all the state's deaf children, and with this its attention for the most part ceases. It has come to be seen that after they have received an education, they deserve or require little further aid or concern. But it has not always been the policy of the state to allow to the deaf the realization that they form in its citizenship an element able to look out for themselves, and demanding little of its special oversight. They have a story full of interest to tell, for the way of the deaf to the attainment of this position has been long and tortuous, being first looked upon as wards, and then by slow gradations coming to the full rights and responsibilities of citizenship. In this final stage, where the state provides education for the deaf only as it provides it for all others, and attempts little beyond, the deaf find themselves on a level with citizens in general in the state's regard.

In Part I, after we have ascertained who are meant by the "deaf," and how many of them there are, we are to find ourselves confronted by a question which is of the foremost concern to society; namely, whether the deaf are to be considered a permanent part of the population, or whether society may have means at hand to eliminate or prevent deafness. After this, our discussion will revolve about the deaf from different points of view, regarding them in the several aspects in which they appear to society. We shall examine the treatment which the state in general accords the deaf, how they are looked upon in the law, and what changes have been brought about in its attitude towards them. This may be said to be the view of the publicist or legalist. Next, we shall attempt to see how far the deaf are really a class apart in the life of the community. This will involve an examination, on the one hand, as to whether their infirmity is a bar to their independent self-support, that is, whether they are potentially economic factors in the world of industry, how far their status is due to what they themselves have done, and to what extent this result has modified the regard and treatment of society; and, on the other, how far their want of hearing stands in the way of their mingling in the social life of the community in which they live, whether the effect of this will tend to force the deaf to associate more with themselves than with the rest of the people, and what forms their associations take. These will be the views respectively of the economist and the sociologist. Then we shall consider the regard in which the deaf are popularly held, the view of "the man in the street," and whether this regard is the proper and just one. Lastly, we shall note what movements have been undertaken in the interests of the deaf by private organizations, and to what extent these have been carried.

In Part II we shall consider the provision that has been made for the instruction of deaf children. First we shall review the attempts at instruction in the Old World, and then carefully follow the development of instruction in America, considering the early efforts in this direction, the founding of the first schools, and the spread of the work over the land; and noting how it was first taken up by private initiative, in time to be seconded or taken over by the state, and how far the state has seen and performed its duty in this respect. Public institutions have been created in nearly all the states, and we shall examine the organizations of these institutions and the general arrangements in the different states. The development of the work also includes a system of day schools, a certain number of private schools and a national college, all of which we shall consider, devoting especial attention to the day schools and their significance. Following this, we shall consider how each state individually has been found to provide for the instruction of the deaf, observing also the extent to which the states have made provision in their constitutions, and the extent to which the schools are regarded as purely educational. Next, we shall proceed to inquire into the terms of admission of pupils into the schools; and we shall particularly concern ourselves with the investigation of the question of how far the means provided for education by the state are actually availed of by the deaf. The great technical problems involved in the education of the deaf will be outside the province of this work, but we shall indicate, so far as public action may be concerned, the present methods of instruction. This done, we shall mark what is the cost to the state of all this activity for the education of its deaf children, noting also how far the state has been assisted in the work by private benevolence. In the final chapter of our study we shall set down the conclusions which we have found in respect to the work for the deaf on the whole in the United States.



PART I

POSITION OF THE DEAF IN SOCIETY



CHAPTER I

THE DEAF IN THE UNITED STATES

MEANING OF TERM "DEAF" IN THE PRESENT STUDY

By the "deaf" in the present study is meant that element of the population in which the sense of hearing is either wholly absent or is so slight as to be of no practical value; or in which there is inability to hear and understand spoken language; or in which there exists no real sound perception. In other words, those persons are meant who may be regarded as either totally deaf or practically totally deaf.[1] With such deafness there is not infrequently associated an inability to speak, or to use vocal language. Hence our attention may be said to be directed to that part of the community which, by the want of the sense of hearing and oftentimes also of the power of speech, forms a special and distinct class; and is known, more or less inaccurately, as the "deaf and dumb" or "deaf-mutes" or "mutes."

In our discussion it is with deafness that we are primarily concerned. Deafness and dumbness are, physically, two essentially different things. There is no anatomical connection between the organs of hearing and those of speech; and the structure and functioning of each are such as to preclude any direct pathological relation. The number of the so-called deaf and dumb, moreover, who are really dumb is very small—so small actually as to be negligible. Almost all who are spoken of as deaf and dumb have organs of speech that are quite intact, and are, indeed, constructively perfect. It comes about, however, that dumbness—considered as the want of normal and usual locution—though organically separate from deafness, is a natural consequence of it; and does, as a matter of fact, in most cases to a greater or less extent, accompany or co-exist with it. The reason of this is that the deaf, particularly those who have always been so, being unable to hear, do not know how to use their organs of speech, and especially are unable to modulate their speech by the ear, as the hearing do. If the deaf could regain their hearing, they would have back their speech in short order. The character of the human voice depends thus on the ear to an unrealized degree.

NUMBER OF THE DEAF IN THE UNITED STATES

According to the census of 1900 there were 37,426 persons in the United States enumerated as totally deaf;[2] and according to that of 1910 there were 43,812 enumerated as "deaf and dumb."[3] Hence we may assume that there are between forty and fifty thousand deaf persons in the United States forming a special class.[4]

The following table will give the number of the deaf in the several states and the number per million of population, according to the census of 1910.[5]

NUMBER OF THE DEAF IN THE SEVERAL STATES

NO. PER NO. PER MILLION OF MILLION OF NO. POPULATION NO. POPULATION

United States 43,812 476 Montana 117 311 Alabama 807 377 Nebraska 636 531 Arizona 53 259 Nevada 23 281 Arkansas 729 464 New Hampshire 191 443 California 784 329 New Jersey 667 263 Colorado 243 304 New Mexico 177 540 Connecticut 332 297 New York 4,760 522 Delaware 59 291 North Carolina 1,421 644 District of Columbia 114 344 North Dakota 239 414 Florida 216 286 Ohio 2,582 539 Georgia 956 366 Oklahoma 826 491 Idaho 114 349 Oregon 241 359 Illinois 2,641 468 Pennsylvania 3,656 477 Indiana 1,672 619 Rhode Island 208 383 Iowa 950 427 South Carolina 735 485 Kansas 934 552 South Dakota 315 539 Kentucky 1,581 690 Tennessee 1,231 563 Louisiana 774 468 Texas 1,864 478 Maine 340 458 Utah 232 621 Maryland 746 576 Vermont 126 354 Massachusetts 1,092 324 Virginia 1,120 543 Michigan 1,315 468 Washington 368 323 Minnesota 1,077 519 West Virginia 713 584 Mississippi 737 410 Wisconsin 1,251 537 Missouri 1,823 553 Wyoming 24 159

From this table the largest proportions of the deaf appear to be found in the states rather toward the central part of the country, and the smallest in the states in the far west and the extreme east. The highest proportions occur in Kentucky, North Carolina, Utah, Indiana, West Virginia, Maryland, Tennessee, Missouri, Kansas, Virginia, New Mexico, Ohio, South Dakota, Wisconsin, Nebraska, New York, and Minnesota, all these states having over 500 per million of population. The lowest proportions are found in Wyoming, Arizona, New Jersey, Nevada, Florida, Delaware, Connecticut, Colorado, Montana, Washington, Massachusetts, California, District of Columbia, Idaho, Vermont, Oregon, Alabama, and Rhode Island, in none of these states the number being over 400 per million. Why there should be these differences in the respective proportions of the deaf in the population of the several states, we cannot say; and we are generally unable to determine to what the variations are to be ascribed—whether they are to be set down to particular conditions of morbidity, the intensity of congenital deafness, or other influences operating in different sections; or, perhaps in some measure, to the greater thoroughness with which the census was taken in some places than in others.

AGE WHEN DEAFNESS OCCURRED

The vast majority of the deaf lost their hearing in early life, and most of them in the tender years of infancy and childhood. More than ninety per cent (90.6, according to the returns of the census) became deaf before the twentieth year; nearly three-fourths (73.7 per cent) under five; over half (52.4 per cent) under two; and over a third (35.5 per cent) were born deaf. Deafness thus occurs in a strongly diminishing ratio with advancing years.[6] These facts may be indicated by the following table,[7] which shows the percentages of those who became deaf at different ages.

THE DEAF ACCORDING TO AGE OF OCCURRENCE OF DEAFNESS

At birth 35.5 After birth and under two 16.9

Under two years 52.4 2 and under 4 17.1 4 and under 6 7.3 6 and under 8 4.5 8 and under 10 2.8 10 and under 12 1.8 12 and under 14 1.6 14 and under 16 1.3 16 and under 18 1.0 18 and under 20 0.8

Under five 73.7 5 and under 10 10.5 10 and under 15 4.0 15 and under 20 2.4

Under 20 90.6 20 and under 40 5.7 40 and under 60 2.4 60 and under 80 1.1 80 and over 0.2

ABILITY OF THE DEAF TO SPEAK

We have just seen that "dumbness" frequently follows upon deafness, or that it is usually believed to be an effect of deafness. It is true that with the majority of the deaf phonetic speech is not employed to any large extent; but there is at the same time a fair number who can, and do, use vocal language. This speech varies to a wide degree, in some approximating normal speech, and in others being harsh and understood with difficulty; and it depends in the main upon three conditions: 1. the age at which deafness occurred, this being the most important factor; 2. the extent to which the voice is cultivated; and 3. the remaining power of the ear (which is found but seldom).[8]

Of the deaf persons enumerated in the census,[9] 21.5 per cent were reported able to speak well; 15.8 per cent imperfectly; and 62.7 per cent not at all. In other words, somewhat over a third of the deaf can speak more or less, one-fifth being able to speak well, and one-sixth imperfectly, while over three-fifths do not speak at all. The dependence of the ability to speak upon the age of becoming deaf is clearly in evidence here, the proportion of those not able to speak showing a great decrease with the rise of this age. Thus, of those born deaf, 83.5 per cent cannot speak at all; of those becoming deaf after birth and under five, 74.6 per cent; of those becoming deaf after five and under twenty, 26.5 per cent; and of those becoming deaf after twenty, 3.4 per cent.

Some of the deaf are able to read the lips of the speaker, or as it is better expressed, to read speech, or to understand what is being said by watching the motions of the mouth. This in reality is a distinct art from the ability to speak, though popularly they are often thought to be co-ordinate or complementary one to the other. Like the ability to speak, it varies in wide degree, from the ability to understand simple and easy expressions only, to the ability to follow protracted discourse; and like the ability to speak, it is found in increasing frequency with the rise of the age of becoming deaf. According to the census,[10] 38.6 per cent of the deaf are able to read the lips. Of those born deaf, 28.0 per cent have this ability; of those becoming deaf after birth and under five, 37.1 per cent; of those becoming deaf after five and under twenty, 64.3 per cent; and of those becoming deaf after twenty, 43.6 per cent.[11]

MEANS OF COMMUNICATION EMPLOYED BY THE DEAF

If the larger number of the deaf do not use the speech which is used by those who can hear, how is it that their communication is carried on? The chief method is a certain silent tongue peculiar to the deaf, known as the "sign language,"[12] a part of which may be said to be the manual alphabet, or the system of finger-spelling,[13] the two usually going hand in hand. In this way most of the deaf are enabled to communicate with each other readily and fluently. But this language, or at least the greater part of it, not being known to people generally, the deaf frequently have to fall back on writing to convey their ideas in communicating with hearing persons. This, while slow and cumbersome, is the surest and most reliable method of all. In addition, as we have seen, a certain number of the deaf are able to use speech, which of course has manifold advantages. These are the several methods, then, of communication employed by the deaf; but they are not usually employed singly, as most of the deaf are able to use two or more. According to the census,[14] the sign language alone or in combination with other methods is employed by 68.2 per cent, or over two-thirds of the deaf; finger-spelling by 52.6 per cent, or over one-half; writing by almost the same proportion—51.9 per cent; and speech by 39.8 per cent, or some two-fifths. It is probable, however, that the proportions employing the sign language, finger-spelling and writing, either singly or with other methods, are really somewhat larger. In this case, likewise, we find that the lower the age of becoming deaf, the smaller is the proportion of the deaf with speech, which shows again the connection of the ability to speak with the age of the occurrence of deafness. Of those born deaf, speech alone or in combination with other methods is used by 18.2 per cent; of those becoming deaf after birth and under five, by 27.4 per cent; of those becoming deaf after five and under twenty, by 75.3 per cent; and of those becoming deaf after twenty, by 97.7 per cent.

FOOTNOTES:

[1] There are no sharply dividing lines between the different degrees of deafness, but it is only those described that really constitute a special class. Persons whose hearing is such as to be of use even in some slight degree are rather to be distinguished as "hard of hearing."

[2] By this census both the partially deaf and the totally deaf were enumerated, or 89,287 in all. The former should not have been enumerated, the enumerators being instructed not to include those able to hear loud conversation.

[3] For the census returns for 1900, see "Special Reports of the Census Office. The Blind and the Deaf," 1906. This report was under the special direction of Dr. Alexander Graham Bell, who has long been interested in the deaf. The returns of the census for 1910 are yet to be revised, while at the same time additional data are to be secured to be published as a special report like that of 1906. As yet the census office has for 1910 only the actual enumeration of the deaf and dumb in the various states, and the returns with respect to other particulars regarding them are yet to be completed. See Volta Review, xiii., 1911, p. 399. Hence in our discussions we shall, except for the number by states, deal with the census of 1900. For a review of this census, see American Annals of the Deaf, Sept., 1906, to May, 1907 (li., lii.). In a number of states certain county officers are required from time to time to enumerate the deaf. For a census in one state, see Bulletin of Labor of Massachusetts, July-Aug., 1907.

[4] Included in the census of 1900 were 491 deaf-blind persons (totally deaf), and in that of 1910, 584.

[5] From statistics kindly furnished by the Census Bureau.

[6] This is just the opposite of the case with the blind.

[7] Special Reports, 1906, p. 79. Some 2,000 cases were thrown out for indefinite replies, leaving 35,479, upon which our percentages are based.

[8] A somewhat frequent classification of the deaf in respect to their power to speak is to regard them roughly as falling into three great divisions: 1. "Deaf-mutes," who come nearest to being deaf and dumb. They have always been deaf, and have never had natural speech. What speech they may possess has come from special instruction, with the result that it is more or less artificial. 2. "Semi-mutes," who are deaf, but who have once had hearing as well as speech; and this speech they are able to use to a greater or less degree, though in time it is likely to become more and more astray. 3. "Semi-deaf" persons, who are only partly deaf, and possess a little hearing, though it is too slight to be of real practical use; and who have voices most nearly approaching the normal. They belong somewhere between the really deaf and the hard of hearing.

[9] Special Reports, pp. 82, 240.

[10] Ibid., pp. 87, 240. For 8,966 no returns were made.

[11] On the subject of lip-reading, see especially E. B. Nitchie, "Lip-Reading: its Principles and Practice", 1912.

[12] This "sign language" is referred to at somewhat more length in Chapter XIX.

[13] Sometimes called "the deaf and dumb alphabet".

[14] Special Reports, pp. 89, 240. For 2,365 no returns were made.



CHAPTER II

THE DEAF AS A PERMANENT ELEMENT OF THE POPULATION

INCREASE IN THE NUMBER OF THE DEAF IN RELATION TO THE INCREASE IN THE GENERAL POPULATION

Are the deaf to be a permanent element in the constitution of the population? Are they always to be reckoned with in the life of the state and the regard of society? Would it not be well to inquire whether or not deafness may be eliminated, or at least reduced to an appreciable degree? These are questions that present themselves at the outset in a consideration of the relation of the deaf to society, and to them we now devote our attention.

Our first inquiry in the matter is directed to the question whether deafness as a whole is increasing, decreasing or remaining stationary, in relation to the general population. To determine this, we have recourse to the census returns of the deaf in connection with those of the general population. Unfortunately, however, comparisons of the different censuses respecting the deaf are not altogether to be depended upon, for the reason that they have not always been taken on the same basis, and conclusions from them consequently have to be accepted with qualifications. Special census returns of the deaf have been made since 1830; but the censuses of 1830-1870 purport to be of the deaf and dumb; the census of 1880, of the deaf who became deaf under sixteen years of age; that of 1890, of the deaf and dumb; that of 1900, of the totally deaf; and that of 1910, of the deaf and dumb. The results thus obtained are in the main analogous, but there are a certain number of cases included on one basis that would be excluded on another, and vice versa.[15]

Taking the statistics as they are, we have the following table,[16] which gives the number of the deaf as found in the several censuses, according to the bases upon which they were made, together with the ratio per million of population.

NUMBER OF THE DEAF ACCORDING TO THE CENSUSES OF 1830-1910

NO. PER MILLION OF YEAR NUMBER POPULATION

1830 (the deaf and dumb) 6,106 475 1840 (the deaf and dumb) 7,665 449 1850 (the deaf and dumb) 9,803 423 1860 (the deaf and dumb) 12,821 408 1870 (the deaf and dumb) 16,205 420 1880 (deafness occurring under sixteen) 33,878 675 1890 (the deaf and dumb) 40,592 648 1900 (the totally deaf) 37,426 492 1910 (the deaf and dumb) 43,812 476

From this table there appears to be a steady decrease in the number of the deaf in relation to the general population from 1830 to 1860, this latter year seeming to be the low water mark. From 1860 to 1870 there is a slight increase, and from 1870 to 1880 a very large one, due to some extent to the method of taking the census. From 1880 to 1890 there is a certain decrease, though the proportion is still very high. From 1890 to 1900 there is a very considerable decrease, probably indicating a return to true conditions; and a not negligible decrease from 1900 to 1910.

On the whole, with respect to these statistics, probably the most that we can safely say is that deafness is at least not on the increase relatively among the population, while there is a possibility that at present it is decreasing. For further determinations, we shall have to seek other means of inquiry.

THE ADVENTITIOUSLY DEAF AND THE CONGENITALLY DEAF

We may perhaps best approach the problem of deafness as an increasing or decreasing phenomenon in the population, if we think of the deaf as composed of two great classes: those adventitiously deaf, that is, those who have lost their hearing by some disease or accident occurring after birth, and those congenitally deaf, that is, those who have never had hearing.[17] In regard to the former class, it follows that we are largely interested in the consideration of those diseases, especially those of childhood, which may affect the hearing, and in their prevention or diminution we can endeavor to ascertain how far there are possibilities of reducing the number of the deaf of this class. In the latter case we are called upon to examine some of the great problems involved in the study of heredity, especially in respect to the extent that the offspring is affected by defects or abnormalities of the parent, and to see what, if any, means are at hand to alter conditions that bring about this form of deafness. We shall first discuss the causes of adventitious deafness, together with the possibilities of its prevention and the likelihood of its diminution, and then consider the questions involved in congenital deafness.

ADVENTITIOUS DEAFNESS AND ITS CAUSES

From three-fifths to two-thirds of the cases of deafness are caused adventitiously—by accident or disease. To accidents, however, only a very small part are due, probably less than one-fiftieth of the entire number.[18] Nearly all adventitious deafness results from some disease, either as a primary disease of the auditory organs, or as a sequence or product of some disease of the system, often one of infectious character, the deafness thus constituting a secondary malady or ailment. The larger portion is of the latter type, probably less than a fourth resulting from original ear troubles.[19] In either case deafness occurs usually in infancy or childhood, and does its harm by attacking the middle or internal ear.

From diseases of the middle ear results over one-fourth (27.2 per cent, according to the census) of all deafness, and from diseases of the internal ear, one-fifth (20.7 per cent), very little (0.6 per cent) being caused by disorders of the outer ear. Of the classified cases of deafness, according to the census, 56.3 per cent are due to diseases affecting the middle ear, and 42.7 per cent to diseases affecting the internal. Of diseases of the middle ear, 72 per cent are of suppurative character, often with inflammation or abscess, and 28 per cent non-suppurative, or rather catarrhal in character. Of diseases of the internal ear, 89 per cent are affections of the nerve, and 10 per cent of the labyrinth. It is to be noted that when the affection is of the internal ear, the result is usually total deafness.

By specified diseases, the leading causes of deafness are scarlet fever (11.1 per cent), meningitis (9.6), brain fever (4.7), catarrh (3.6), "disease of middle ear" (3.6), measles (2.5), typhoid fever (2.4), colds (1.6), malarial fever (1.2), influenza (0.7), with smaller proportions from diphtheria, pneumonia, whooping cough, la grippe, and other diseases. A large part of deafness is seen to be due to infectious diseases, the probabilities being that fully one-third is to be so ascribed, with one-fifth from infectious fevers alone.

After birth and under two years of age, the chief causes of deafness are meningitis, scarlet fever, disease of middle ear, brain fever, and measles. From two to five scarlet fever and meningitis are far in the lead, with many cases also from brain fever, disease of middle ear, measles, and typhoid fever. From five to ten scarlet fever alone outdistances all other diseases, followed in order by meningitis, brain fever and typhoid fever. From ten to fifteen the main causes are meningitis, scarlet fever, brain fever, and catarrh; from fifteen to twenty catarrh and meningitis; from twenty to forty catarrh, colds and typhoid fever; and from forty on, catarrh.

The following table[20] will show in detail the several causes of deafness and their respective percentages.

CAUSES OF DEAFNESS

Total classified 48.5 External ear 0.6 Impacted cerumen 0.2 Foreign bodies 0.1 Miscellaneous 0.3 Middle ear 27.2 Suppurative 19.6 Scarlet fever 11.1 Disease of ear 3.6 Measles 2.5 Influenza 0.7 Other causes 1.7 Non-suppurative 7.6 Catarrh 3.6 Colds 1.6 Other causes 2.4 Internal ear 20.7 Labyrinth 1.8 Malarial fever 1.2 Other causes 0.6 Nerves 18.5 Meningitis 9.6 Brain fever 4.7 Typhoid fever 2.4 Other causes 1.8 Brain center 0.3 Miscellaneous 0.1 Unclassified 45.3 Congenital 33.7 Old age 0.3 Military service 1.0 Falls and blows 2.8 Sickness 2.7 Fever 2.0 Hereditary 0.3 Miscellaneous 2.5 Unknown 6.2

In fairly approximate agreement with the returns of the census, are the records of the special schools for the deaf in respect to the causes of deafness in their pupils, with information also as to the amount from the minor diseases. The following table will give the causes by specific diseases, as found in one school, the Pennsylvania Institution, for two years:[21]

CAUSES OF DEAFNESS OF PUPILS IN PENNSYLVANIA INSTITUTION

1906 1907 PER CENT PER CENT

Total number 510 100.0 500 100.0 Born deaf 213 41.8 206 41.2 Scarlet fever 43 8.2 47 9.4 Meningitis 36 7.1 40 8.0 Falls 24 4.7 25 5.0 Diseases of ear and throat 13 2.6 23 4.6 Catarrh and colds 13 2.6 — — Measles 18 3.5 18 3.6 Brain fever 17 3.3 16 3.2 Convulsions 14 2.8 13 2.6 Abscesses 10 2.0 12 2.4 La grippe 10 2.0 7 1.4 Accidents (not stated) 9 1.8 7 1.4 Whooping cough 7 1.4 7 1.4 Typhoid fever 7 1.4 6 1.2 Diphtheria 6 1.2 6 1.2 Mumps 5 1.0 5 1.0 Paralysis 5 1.0 4 0.8 Marasmus 2 0.4 4 0.8 Pneumonia 4 0.8 2 0.4 Dentition — — 2 0.4 Dropsy of blood 2 0.4 — — Chicken pox 1 0.2 1 0.2 Poisoning 1 0.2 1 0.2 Intermittent fever 1 0.2 1 0.2 Blood clotting on brain 1 0.2 — — Cholera infantum 1 0.2 — — Gastric fever — — 1 0.2 Sickness (not stated) 10 2.0 8 1.6 Unknown 37 7.3 38 7.6

POSSIBLE ACTION FOR THE PREVENTION OF ADVENTITIOUS DEAFNESS

In respect to present activities for the prevention of adventitious deafness, we find the situation very much like that of marking time. Deafness, since the beginning of time, has largely been accepted as the portion of a certain fraction of the race, and any serious and determined efforts for its eradication have been considered for the most part as of little hope.[22] With the auditory organs so securely hidden away in the head, entrenched within the protecting temporal bone, and with their structure so delicate and complicated, the problem may well have been regarded a baffling one even for the best labor of medicine and surgery. Hence it is that after deafness has once effected lodgment in the system, a cure has not usually been regarded as within reach, though for certain individual cases there may be medical examination and treatment, with attempts made at relief. For deafness in general, it has been felt that there has been little that could be done in the way of prevention or cure beyond the preservation of the general health and the warding off of diseases that might cause loss of hearing.

As a matter of fact, however, altogether too little attention has been given hitherto to the possibilities of the prevention of deafness. Without question there is much at the outset that can be accomplished towards the prevention of those diseases that cause deafness. A large part, perhaps fully a third, as we have seen, are due to infectious diseases, and it is probably here that measures are likely to be most efficacious. A considerable portion likewise are the result of diseases affecting the passages of the nose and throat, and help should be possible for many of these if taken in hand soon enough. In certain diseases also, as scarlet fever, measles, typhoid fever, diphtheria, and others, there are not a few cases which, so far as deafness as a development is concerned, would prove amenable to skillful and persistent treatment. At the same time due attention to primary ear troubles would in a number of instances keep off permanent deafness. Indeed, it is possible that some thirty or forty per cent of adventitious deafness is preventable by present known means.[23]

Aside from direct medical treatment for those diseases that cause deafness, there are other measures available in a program for the prevention of deafness. One of the foremost essentials is the report to the health authorities of all serious diseases that are liable to result in deafness. In this way proper medical care may be secured, and due precautions may be taken to isolate infectious cases. Even with meningitis, which is so hard usually to deal with and which is so severe in its ravages, there is often some concomitant trouble, and if made notifiable in all cases deafness from it might be checked in no inconsiderable measure. The report of births is also especially needed, and as it becomes obligatory in general, with the consequent detection of physical ailments or disabilities, early cases of deafness may come increasingly to notice, and timely treatment may be availed of. Particular attention is likewise necessary in respect to the medical examination of school children. The proportion of such children with impaired hearing is not slight, even though no great part of them become totally deaf. A committee on defective eyes and ears of school children of the National Educational Association in 1903 found that of 57,072 children examined in seven cities, 2,067, or 3.6 per cent, were extremely defective in hearing.[24] An investigation of the school children in New York City has disclosed the fact that one per cent have seriously defective hearing.[25] Under proper and adequate medical inspection of schools, not only would the need of treatment for adenoids and similar troubles be brought to light, with the result that a number of incipient cases might be stopped in time, but in some instances of deafness already acquired beneficial treatment might be possible.[26]

There is thus a considerable sphere for action towards the prevention of adventitious deafness both by legislation and by education. For the ultimate solution of its problems, however, we have to look mainly to the medical profession. In recent years medical science has won some great triumphs, and in the field of the prevention of deafness no little may be in store to be accomplished in the years to come.[27] Even now, with more particular attention to the diseases of children, and with stronger insistence upon general sanitary measures, the probabilities are that there is less deafness from certain diseases than formerly—a matter which we are soon to consider.

Though as yet there has been little direct action for the prevention of adventitious deafness, there is an increasing concern in the matter, and in this there is promise. By medical bodies in particular is greater attention being given to the subject,[28] and in the widening recognition of their part as guardians of the public health it may be possible for them to do much for the enlightenment of the public. In one state legislative action has been taken expressly for the protection of the hearing of school children. This is Massachusetts, which requires the examination of the eyes and ears of the school children in every town and city, the state board of education furnishing the tests.[29] In some states also general inspection of schools is mandatory by statute, and in others permissive, while in several there are local ordinances with the force of a state law.

In combating adventitious deafness, then, our attack is to be directed in the largest part upon those diseases, especially infantile and infectious diseases, that cause deafness; and it is upon the checking of their spread that our main efforts for the present have to be concentrated. At the same time the better safe-guarding of the general health of the community will insure a proportionate diminution of deafness. Beyond this, we will have to wait upon the developments of medical science, both in the study of the prevention of diseases and of their treatment; and can trust only to what it may offer.[30]

ADVENTITIOUS DEAFNESS AS AN INCREASING OR DECREASING PHENOMENON

Our main interest in the problem of adventitious deafness lies in the possible discovery whether or not it is relatively increasing or decreasing among the population, and in what respects signs appear of a diminution. We have just seen the likelihood of a decrease from certain causes; but we are to find what is indicated by statistical evidence.

To be considered first is adventitious deafness as a whole. Respecting it our only statistics are in the returns of the censuses since 1880, the different forms of deafness not being distinguished before this time. The following table will show the number of the adventitiously deaf as reported by the censuses of 1880, 1890 and 1900, with their respective percentages and ratios per million of population.[31]

NUMBER OF THE ADVENTITIOUSLY DEAF IN 1880, 1890 AND 1900

TOTAL ADVENTITIOUSLY PERCENTAGE RATIO NUMBER DEAF PER MILLION OF POPULATION

1880 33,878 10,187 30.1 20.3 1890 40,562 16,767 41.1 26.8 1900 37,426 18,164 48.4 23.9

From this it appears that adventitious deafness is increasing in relation to total deafness, which is most likely the case, as congenital deafness, as we shall see, is evidently decreasing. Whether or not adventitious deafness is increasing in respect to the general population, the table does not disclose definitely. The statistics probably are not full enough to afford any real indication yet.

Our next inquiry is in respect to the increase or decrease of adventitious deafness from the several diseases individually, which is, upon the whole, the more satisfactory test. Here also, unfortunately, our statistics are very limited, and our findings will have to fall much short of what could be desired.

The following table, based on the returns of the censuses of 1880, 1890 and 1900, so far as the approximate identity of the several diseases can be established, will give the respective percentages found.[32]

CAUSES OF ADVENTITIOUS DEAFNESS IN 1880, 1890 AND 1900

1880 1890 1900

Scarlet fever 7.9 11.8 11.1 Meningitis 8.4 7.8 9.6 Catarrh and catarrhal fevers 0.9 3.3 3.6[33] Diphtheria 0.2 0.5 —[34] Abscess and inflammation 1.0 2.5 —[35] Measles 1.3 2.5 2.5 Whooping cough 0.5 0.8 —[34] Malarial and typhoid fevers 1.7 1.8 3.6 Other fevers 1.1 — 2.0

In this table the most noticeable thing is perhaps the persistency with which we find most of the diseases to recur, with apparently no great change, while in certain ones, as catarrh and malarial and typhoid fevers, there seems to be rather an increase. It would be best, however, not to place very great confidence in these figures, but, so far as the census reports are concerned, to wait for more precise and uniform statistics.

We have, further, the statistics published in the reports of certain schools for the deaf. While these are perhaps not of sufficient extent to warrant full conclusions, they may be regarded as quite representative;[36] and though to be taken with something of the caution as the census figures, they may serve to throw some light upon the situation. Comparison of the proportions of pupils deaf from the several diseases at different times may be made in two ways: by finding the respective proportions over a series of successive years from a certain time back down to the present, and by contrasting the proportions in two widely separated periods, one in the present and one in the past. These will be taken up in order.

The following tables give the percentages of cases of deafness in pupils from the important diseases as found in six schools in successive years: in the New York Institution in the total annual attendance from 1899 to 1912; in the Michigan School in the total biennial attendance from 1883 to 1912; in the Pennsylvania Institution in the number of new pupils admitted quadriennially from 1843 to 1912; in the Western Pennsylvania Institution in the number admitted biennially from 1887 to 1912; in the Maryland School in the number admitted biennially from 1884 to 1911; and in the Wisconsin School in the number admitted biennially from 1880 to 1908.

I. CAUSES OF DEAFNESS IN NEW YORK INSTITUTION FROM 1899 TO 1912

1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 + Total Number 466 476 481 477 464 503 508 510 543 555 565 + Congenital 36.0 27.1 26.8 40.9 36.2 41.1 46.2 31.8 33.3 34.4 34.9 Scarlet Fever 11.4 10.1 8.9 7.1 6.5 6.9 6.5 4.9 5.3 5.0 5.7 Meningitis 9.5 9.4 7.7 7.9 7.8 7.9 11.0 12.2 16.8 18.6 17.7 Brain Trouble 10.1 9.2 8.3 8.1 7.2 5.9 5.9 7.1 9.0 8.3 8.7 Falls 9.0 7.2 5.4 4.5 3.9 4.2 3.8 5.2 5.9 6.1 6.0 Measles 5.1 3.8 3.8 2.1 3.9 4.5 4.1 4.1 4.8 4.7 4.4 Typhoid Fever 3.7 2.3 1.6 1.0 0.9 1.2 1.0 1.0 1.3 1.3 1.2 Convulsions 3.2 4.4 3.2 2.9 2.6 0.2 1.8 1.8 1.9 1.5 1.9 Various Fevers 2.5 1.5 1.4 1.0 1.7 1.6 1.6 1.6 1.5 1.3 0.7 Catarrh 2.3 2.1 1.9 1.8 1.6 1.2 1.0 2.0 1.9 1.9 1.4 Diphtheria 1.9 1.7 1.9 1.0 0.9 0.4 0.6 0.8 0.9 0.9 0.7 Pneumonia 1.5 0.8 0.8 0.6 1.1 0.2 1.0 1.1 1.1 0.9 1.1 Whooping Cough 1.7 1.6 1.2 1.1 1.0 0.8 0.6 0.9 0.9 0.5 Miscellaneous and Unknown 2.1 20.4 26.7 19.8 18.6 23.7 14.7 25.9 15.4 14.2 15.1

1910 1911 1912 + Total Number 570 546 518 + Congenital 32.8 34.6 36.6 Scarlet Fever 6.1 5.7 5.0 Meningitis 17.9 19.0 19.7 Brain Trouble 8.3 8.0 8.9 Falls 5.1 5.5 5.6 Measles 4.6 0.2 0.7 Typhoid Fever 1.1 0.9 0.5 Convulsions 1.9 2.0 2.1 Various Fevers 0.5 0.5 0.7 Catarrh 0.8 1.0 0.5 Diphtheria 0.7 0.7 0.5 Pneumonia 1.1 0.7 0.5 Whooping Cough 0.5 0.5 0.2 Miscellaneous and Unknown 18.6 20.7 18.5

II. CAUSES OF DEAFNESS IN MICHIGAN SCHOOL FROM 1883 TO 1912

1883 1885 1887 1889 1891 1893 1895 1897 1899 1901 1903 1884 1886 1888 1890 1892 1894 1896 1898 1900 1902 1904 + Total Number 302 336 342 350 343 365 428 412 441 447 451 + Congenital 7.0 18.8 23.1 26.3 24.2 26.3 25.2 30.3 28.8 31.5 32.8 Meningitis 28.8 28.1 23.1 23.1 21.3 15.8 15.6 14.5 10.2 9.2 4.6 Scarlet Fever 12.2 11.8 12.3 11.2 9.0 9.6 9.5 9.7 9.5 9.3 7.6 Brain Fever 6.2 6.5 4.8 3.7 5.2 6.9 6.6 6.3 5.4 3.8 3.8 Typhoid Fever 4.6 3.6 4.1 4.3 4.7 1.9 1.8 1.4 2.5 2.2 1.3 Measles 3.6 4.1 3.9 2.9 2.6 1.4 0.8 1.9 3.2 3.1 2.9 Diphtheria 0.6 0.3 0.3 0.3 0.2 0.2 0.4 0.2 0.4 Catarrh 0.6 0.6 0.9 0.8 0.9 1.1 1.9 2.9 3.5 3.3 Various Fevers 2.9 1.5 2.0 2.6 3.0 4.4 4.4 1.7 2.9 2.9 3.3 Whooping Cough 1.3 1.2 1.5 1.5 1.5 3.0 3.8 3.6 2.7 2.5 3.1 Pneumonia 0.2 0.2 0.4 La grippe 0.9 1.1 1.6 Miscellaneous and Unknown 32.2 23.8 24.3 23.3 27.3 29.3 30.2 30.4 30.4 31.5 34.9

1905 1907 1909 1911 1906 1908 1910 1912 Total Number 404 361 354 353 Congenital 36.6 35.7 35.0 31.2 Meningitis 8.6 9.5 8.8 8.2 Scarlet Fever 6.9 5.8 3.6 4.5 Brain Fever 2.7 2.5 2.3 1.0 Typhoid Fever 1.0 1.4 1.5 1.7 Measles 2.9 4.1 3.4 3.1 Diphtheria 0.5 0.2 0.3 0.3 Catarrh 2.8 1.9 2.5 0.8 Various Fevers 2.5 0.5 2.0 1.4 Whooping Cough 3.4 4.4 4.8 5.1 Pneumonia 0.7 0.6 0.8 La grippe 1.5 3.0 2.3 Miscellaneous and Unknown 30.6 30.3 32.9 41.9

III. CAUSES OF DEAFNESS IN PENNSYLVANIA INSTITUTION FROM 1843 TO 1912

1843 1847 1851 1855 1859 1863 1867 1871 1875 1879 1883 1846 1850 1854 1858 1862 1866 1870 1874 1878 1882 1886 + Total Number 90 111 125 143 167 152 150 178 282 233 261 + Congenital 54.4 58.5 56.0 46.8 53.3 48.4 40.0 42.1 31.2 24.4 34.1 Scarlet Fever 13.3 18.0 12.8 16.8 9.6 19.7 16.0 18.6 18.1 13.7 14.9 Meningitis 0.8 2.0 1.3 9.6 18.1 25.7 16.4 Measles 1.1 2.7 1.6 2.8 2.4 3.3 4.0 1.1 1.7 2.6 1.9 Whooping Cough 2.2 0.9 0.8 0.7 1.2 0.7 1.3 0.6 0.3 0.8 Catarrh 0.9 0.7 0.6 2.1 Brain Fever 2.8 2.1 6.0 4.7 0.8 Typhoid Fever 1.4 0.6 0.7 2.6 2.7 2.1 2.6 3.4 Diphtheria 0.7 Pneumonia La grippe Mis. and Unknown 29.0 19.2 25.2 29.4 32.9 19.2 28.7 24.7 26.3 30.2 28.5

1887 1891 1895 1899 1903 1907 1911 1890 1894 1898 1902 1906 1910 1912 + Total Number 207 248 250 239 240 282 152 + Congenital 47.3 46.8 41.6 32.2 35.8 33.7 34.2 Scarlet Fever 14.0 14.1 11.2 6.3 10.4 3.9 5.2 Meningitis 5.8 5.6 7.6 8.4 7.1 17.4 15.1 Measles 3.9 3.2 4.4 4.6 4.5 3.5 3.9 Whooping Cough 0.5 0.4 0.8 1.7 0.7 2.9 1.3 Catarrh 3.9 4.8 6.8 4.2 1.2 2.5 1.3 Brain Fever 2.9 5.2 4.0 3.4 1.7 2.9 2.6 Typhoid Fever 2.9 3.6 2.5 0.7 3.9 1.3 Diphtheria 0.5 1.6 2.0 0.8 2.5 1.2 2.0 Pneumonia 0.5 0.8 0.4 1.2 4.8 La grippe 0.4 2.1 1.2 0.3 Mis. and Unknown 17.8 14.3 21.6 33.0 33.8 26.6 28.3

IV. CAUSES OF DEAFNESS IN WESTERN PENNSYLVANIA INSTITUTION FROM 1887 TO 1912

1887 1889 1891 1893 1895 1897 1899 1901 1903 1905 1907 1888 1890 1892 1894 1896 1898 1900 1902 1904 1906 1908 + Total Number 61 56 58 58 49 40 50 41 110 59 73 + Congenital 24.6 14.3 20.7 32.8 46.9 40.6 40.0 31.9 38.2 25.4 30.1 Scarlet Fever 9.8 21.4 8.6 10.4 10.2 5.0 6.0 12.2 8.3 11.8 8.2 Meningitis 16.5 14.5 13.8 10.4 10.2 20.0 14.0 17.1 7.2 10.2 13.7 Measles 4.9 1.9 5.2 10.4 4.0 2.0 2.4 7.2 1.9 8.2 Catarrh 3.2 7.6 1.9 2.0 5.0 2.0 9.6 2.7 3.8 4.1 Brain Fever 6.5 5.4 1.9 1.9 2.5 4.8 2.7 5.1 2.8 Typhoid Fever 1.9 5.2 6.0 2.5 1.8 1.9 4.1 Whooping Cough 1.6 1.9 2.0 6.0 2.4 1.8 1.9 2.8 Diphtheria 1.6 1.9 4.0 2.4 1.8 1.4 La grippe 2.0 2.0 1.9 Pneumonia 2.5 2.0 1.9 1.4 Miscellaneous and Unknown 31.3 30.6 33.2 32.2 16.7 22.5 22.0 17.2 28.3 34.2 23.2

1909 1911 1910 1912 Total Number 71 73 Congenital 40.9 36.5 Scarlet Fever 11.3 12.7 Meningitis 14.1 9.6 Measles 2.8 6.8 Catarrh 2.8 1.8 Brain Fever 1.4 4.1 Typhoid Fever 2.8 Whooping Cough 1.8 Diphtheria 1.4 1.8 La grippe Pneumonia Miscellaneous and Unknown 22.5 24.9

V. CAUSES OF DEAFNESS IN MARYLAND SCHOOL FROM 1884 TO 1911

1884 1886 1888 1890 1892 1894 1896 1898 1900 1902 1904 1885 1887 1889 1891 1893 1895 1897 1899 1901 1903 1905 + Total Number 28 27 25 25 29 30 30 39 29 30 28 + Congenital 46.4 62.9 44.4 36.0 37.9 43.3 43.3 61.5 44.8 43.3 57.1 Meningitis 10.7 11.1 8.0 12.0 10.3 10.6 6.7 2.6 14.0 3.3 3.6 Scarlet Fever 10.7 7.4 12.0 16.0 6.7 5.2 3.5 10.0 7.2 Measles 3.6 3.5 3.3 6.7 3.5 3.3 Diphtheria 3.5 3.3 3.3 2.6 3.3 3.6 Catarrh 3.5 3.3 3.3 5.2 3.5 Typhoid Fever 4.0 6.7 Whooping Cough 3.6 3.5 Pneumonia 3.6 7.0 3.6 Brain Fever 7.2 4.0 8.0 3.5 3.3 7.0 3.3 Various Fevers 4.0 8.0 3.5 2.6 3.3 3.6 Miscellaneous and Unknown 14.2 18.6 23.6 20.0 34.3 32.9 28.1 22.0 16.7 23.5 21.3

1906 1908 1910 1907 1909 1911 -+ Total Number 41 32 135[37] + - Congenital 53.7 34.4 51.8 Meningitis 2.4 12.2 8.1 Scarlet Fever 9.6 3.1 1.4 Measles 3.3 2.2 Diphtheria 0.7 Catarrh Typhoid Fever 2.4 3.1 2.2 Whooping Cough 3.1 1.4 Pneumonia 2.4 3.1 2.2 Brain Fever 4.8 2.9 Various Fevers 4.8 2.2 Miscellaneous and Unknown 19.9 37.7 24.1

VI. CAUSES OF DEAFNESS IN WISCONSIN SCHOOL FROM 1879 TO 1908

1879 1881 1883 1885 1887 1889 1891 1893 1895 1897 1880 1882 1884 1886 1888 1890 1892 1894 1896 1898 - Total Number 36 66 231[37] 56 67 50 44 72 64 72 - Congenital 14.3 31.8 35.1 35.7 49.3 38.0 50.0 40.3 53.1 52.7 Meningitis 27.7 33.3 37.7 33.9 28.3 32.0 15.9 12.5 31.2 19.4 Scarlet Fever 14.3 6.0 12.5 8.9 12.0 20.4 11.1 4.7 6.9 Measles 12.8 3.0 1.5 2.9 2.3 4.1 3.1 Typhoid Fever 6.0 7.4 1.8 2.0 2.3 1.6 Whooping Cough 1.3 1.8 1.5 1.4 Diphtheria 2.0 4.6 1.4 Catarrh 1.3 1.6 5.5 Brain Fever 2.9 11.1 Miscellaneous and Unknown 30.9 19.9 3.2 26.8 6.2 14.0 4.5 20.9 4.7 12.7

1899 1901 1903 1905 1907 1900 1902 1904 1906 1908 + Total Number 62 33 33 63 70 + Congenital 64.3 33.3 48.4 34.9 40.0 Meningitis 16.1 9.1 3.0 6.3 5.7 Scarlet Fever 4.7 6.1 9.5 8.6 Measles 3.0 3.6 1.6 4.3 Typhoid Fever 3.2 6.1 3.2 1.4 Whooping Cough 1.6 2.8 Diphtheria 1.6 3.2 1.4 Catarrh 1.6 3.0 9.1 3.2 2.8 Brain Fever 6.1 3.6 4.8 4.3 Miscellaneous and Unknown 8.5 33.3 31.3 31.7 28.7

We may take these tables together to see how the proportions of deafness from the leading diseases have changed in the course of the several periods indicated, proper allowance being made for the shorter length of time covered in some schools than in others. In respect to scarlet fever, one of the two foremost causes, we find in the New York Institution, the Michigan School and the Maryland School, a distinct and steady decline; in the Pennsylvania Institution a decline of late years, which is especially significant in view of the extended period covered by it; and in the Western Pennsylvania and the Wisconsin School little change, though in the latter there is less than at the beginning. In meningitis, on the other hand, the second of the two most important causes, a marked increase is seen in the Pennsylvania Institution for the entire period, while in the New York a sharp increase is found in the time designated, this being all the more noticeable because of the large proportion already attributed here to convulsions, often a trouble of kindred origin. In the Western Pennsylvania Institution and the Maryland School little change is observed, though in the latter some decline is apparent in the later years. In the Wisconsin and Michigan schools a very strong decline is seen. On somewhat the same order as meningitis is brain fever. It, however, shows little change on the whole, though in the Michigan and Maryland schools and the New York Institution some decline is evident. Of the remaining diseases none plays singly a large part in the causation of deafness, and in most of them the results are similar. Measles, typhoid fever, diphtheria, pneumonia, and whooping cough show, with some fluctuations at times, little change on the whole, beyond certain local differences. In the New York Institution a decline is reported in nearly all. In the Pennsylvania Institution a rather larger proportion for measles is seen in later than in earlier years. In the Michigan School an increase seems to be the case with whooping cough, but a decrease with typhoid fever. In catarrh the results are not so uniform. In the New York and Pennsylvania institutions a decline is manifest, though in the latter a larger proportion is reported than at the beginning. In the Michigan and Wisconsin schools rather an increase is noted. La grippe is only reported occasionally of late years, and its real effects cannot yet be ascertained. With respect to general fevers, their classification is found to be so varying that little can be determined.

We now proceed to make comparison of the proportions of deafness from the principal diseases in a series of years some time past with similar proportions in recent years. The following tables give the several proportions in the American School (Connecticut) in the entire attendance from 1817 to 1844 and from 1817 to 1857, and in the new admissions from 1901 to 1913; in the Ohio School in the entire attendance from 1829 to 1872, and in the average annual attendance in 1904, 1905, 1906, and 1911; in the Iowa School in the entire attendance from 1855 to 1870 and from 1855 to 1912; and in the New York Institution in the entire attendance from 1818 to 1853 and in the average annual attendance from 1899 to 1912.[38]

I. CAUSES OF DEAFNESS IN AMERICAN SCHOOL FROM 1817 TO 1844, FROM 1817 TO 1857, AND FROM 1901 TO 1913.

PERIOD TOTAL NUMBER CONGENITAL SCARLET FEVER MENINGITIS TYPHOID FEVER MEASLES WHOOPING COUGH GENERAL FEVERS BRAIN FEVER PNEUMONIA DIPHTHERIA CATARRH UNKNOWN AND MIS. -+ + + + -+ -+ -+ -+ -+ -+ -+ -+ -+ 1817-1844 761 44.8 5.7 6.1 1.6 1.6 6.7 33.5 1817-1857 1081 50.1 9.2 4.6 1.8 1.3 5.3 27.7 1901-1913 310 35.2 7.7 11.3 3.2 1.3 1.3 1.9 5.8 0.6 1.3 1.0 29.4

II. CAUSES OF DEAFNESS IN OHIO SCHOOL FROM 1829 TO 1872 AND FROM 1904 TO 1911.

PERIOD TOTAL NUMBER CONGENITAL SCARLET FEVER MENINGITIS TYPHOID FEVER MEASLES WHOOPING COUGH GENERAL FEVERS BRAIN FEVER PNEUMONIA DIPHTHERIA CATARRH UNKNOWN AND MIS. -+ + + + -+ -+ -+ -+ -+ -+ -+ -+ -+ 1829-1872 1252 33.8 10.3 3.0 1.8 3.2 1.7 4.6 5.7 0.3 35.6 1904-1911 38.9 5.0 9.2 1.4 2.8 1.7 1.1 5.3 0.5 0.5 3.5 30.1

III. CAUSES OF DEAFNESS IN IOWA SCHOOL FROM 1855 TO 1870 AND FROM 1855 TO 1912.

PERIOD TOTAL NUMBER CONGENITAL SCARLET FEVER MENINGITIS TYPHOID FEVER MEASLES WHOOPING COUGH GENERAL FEVERS BRAIN FEVER PNEUMONIA DIPHTHERIA CATARRH UNKNOWN AND MIS. -+ + + + -+ -+ -+ -+ -+ -+ -+ -+ -+ 1855-1870 245 87.2 13.4 3.3 1.6 2.0 1.3 6.1 1.3 33.8 1855-1912 1672 26.9 10.3 14.9 1.7 2.2 1.7 0.1 7.0 0.3 0.8 1.7 32.4

IV. CAUSES OF DEAFNESS IN NEW YORK INSTITUTION FROM 1818 TO 1853 AND FROM 1899 TO 1912.

PERIOD TOTAL NUMBER CONGENITAL SCARLET FEVER MENINGITIS TYPHOID FEVER MEASLES WHOOPING COUGH GENERAL FEVERS BRAIN FEVER PNEUMONIA DIPHTHERIA CATARRH UNKNOWN AND MIS. -+ + + + + -+ -+ -+ -+ -+ -+ -+ -+ 1818-1853 1148 42.9 7.2 [39] 1.9 0.7 1.6 45.7 1899-1912 38.0 6.8 13.1 1.3 3.4 0.8 1.3 8.1 0.9 0.9 1.7 23.7

Taking these tables also collectively, we find in respect to scarlet fever a decline in all the schools, this being especially pronounced in the case of the Ohio. In meningitis, however, there is an increase so heavy as to call in question the accuracy of the earlier records; and it is possible that it failed to be entirely recognized then. In most of the other diseases, as in the previous case, no very great change is perceptible. In general fevers a decline is apparent in all, in most being considerable; and probably several diseases were formerly included which are now listed separately. In measles rather a decline is found in the American and Ohio schools, but a slight increase in the Iowa, and a somewhat larger one in the New York Institution. In typhoid fever there is a slight increase also in the Iowa School, but a decrease in the Ohio. In brain fever a considerable increase is observed in the Iowa School, but a slight decrease likewise in the Ohio. In whooping cough there is an increase in the New York Institution and the Iowa School, but a decrease in the American. Such diseases as pneumonia, diphtheria and catarrh seem not usually to have been separately classified in the past, though in the Ohio School we find diphtheria noted, and with somewhat smaller proportions than in later years; while in several of the schools we find "colds" given in former times, which may have been in part really catarrh.

Combining now the results of our two groups of tables, we may be able to reach some conclusions with respect to the increase or decrease of deafness from certain diseases, though on the whole far less definite than we could wish. In the first place, it seems safe to affirm that deafness from scarlet fever is becoming relatively less with the years; and it is possible that if it continues its present rate of decline, it will in time cease to be one of the main causes of deafness. On the other hand, meningitis, its great companion in evil, shows a striking increase in comparison with past years, as a cause of adventitious deafness; while its accretion may be traced as well in a series of recent years in certain schools, though not in others. But how far there is an absolute increase in meningitis over the past, and whether it is tending at present actually to increase, may be a matter for question. In view of the possibility that the disease was not sufficiently accounted for in the past, and in the absence of any knowledge to indicate a reason for its less prevalence in earlier years, at least not to the extent indicated by the statistics, it may be that its increase is, after all, more apparent than real. The fact, moreover, that in the series of recent years a marked increase is found in some schools, but a marked decline in others, may perhaps be taken to mean that at present meningitis may be on the increase only in certain sections, depending possibly on local conditions. With the greater medical skill of to-day, and with a larger proportion of children in the schools, it may be open to considerable doubt if the movement of this disease is really one of increase, though it seems that we are on the whole making no great headway against it.

As to the minor diseases causing deafness, our statistics do not indicate just to what extent and in what direction deafness from them is being affected, and no precise conclusions can at present be set down. It is probable, however, that with the increased attention to children's diseases, as we have noted, there is really less deafness from most of them than formerly.[40]

THE CONGENITALLY DEAF

When we come to consider the question of congenital deafness, which comprises a little over a third of the total amount of deafness, we have an even more difficult problem on our hands, for here we are to deal with some of the great questions of heredity—though hereditary deafness and congenital deafness are not altogether one and the same thing.[41] For the purposes of our inquiry, let us think of the congenitally deaf as divided into three great classes in respect to their family relations: 1. the offspring of parents who were cousins; 2. the offspring of parents who were themselves deaf or members of families in which there are other deaf relatives; and 3. the product of families without either consanguinity or antecedent deafness. Of these three classes the first two only will engage our attention. Of the last, comprising, according to the census, nine-twentieths, or 44.4 per cent, of the congenitally deaf, there is not much that we can say. For a great part of it there no doubt exists in the parent, or perhaps in a more remote ancestor, some abnormal strain, physical or mental, in the nature of disease or other defect. But in respect to such deafness we have too little in the way of statistical data to help us arrive at any real determination; and for it as a whole we shall have to wait till we have greater knowledge of eugenics and the laws of heredity.[42]

THE OFFSPRING OF CONSANGUINEOUS MARRIAGES

Not all the deaf born of consanguineous marriages are congenitally deaf, but as the majority are so, and as the fact of the parents being blood relatives is assumed to have at least a contributing influence in the result, we may consider the matter in this place. It is in fact closely connected with the question of deaf relatives in general.

In the census investigations,[43] of the number who answered on this point, 2,525, or 7.4 per cent, have parents who were cousins. Of these cases, deafness occurred in 87 per cent before the fifth year of age, and in 60 per cent at birth. Of all the deaf born without hearing, 13.5 per cent are the offspring of consanguineous marriages. The proportion of those born deaf is thus nearly twice as great when the parents are cousins as it is among the whole class of the congenitally deaf; and the proportion is also nearly twice as great of the offspring of consanguineous marriages among the congenitally deaf as the proportion of the deaf from such marriages among the total number of the deaf. Moreover, 55.0 per cent of the offspring of cousin-marriages have deaf relatives of some kind, and of the congenitally deaf from cousin-marriages, 65.6 per cent have deaf relatives; while the respective proportions when the parents are not cousins are 25.5 per cent and 40.7 per cent—in the one case less than half, and in the other two-thirds, as great.

Further statistics bear out the findings of the census. Dr. E. A. Fay in his "Marriages of the Deaf"[44]—a work we are soon to notice—finds that, though consanguineous marriages form only about one per cent of the total number considered, 30.0 per cent of the children of deaf parents who are cousins are deaf, and that 45.1 per cent of such marriages result in deaf offspring; but that when the parents are not cousins, the respective proportions are 8.3 per cent and 9.3 per cent—only about a fourth and a fifth as great. In the Colorado School, out of 567 pupils in attendance from the beginning to 1912, in 17, or 3 per cent, the parents were related before marriage. In the Kentucky School, out of 83 pupils admitted in 1910 and 1911, 18, or 19.3 per cent, and out of 42 admitted in 1912 and 1913, 8, or 19 per cent, were the offspring of parents who were cousins. In the Iowa School, out of 62 admissions in 1911 and 1912, 4, or 6.5 per cent, and in the Maryland School, out of a total attendance in 1911 of 135, 13, or 9.2 per cent, had parents who were cousins.[45]

Consanguineous marriages, so far as the effect on deafness is concerned, are not of relatively frequent occurrence. But where they do take place, there is found a decided connection between them and deafness, the increased tendency thus to transmit a physical abnormality being plain. How far, however, if at all, such deafness is to be directly ascribed to consanguineous marriages, is a matter for question. The main consideration seems to be that in such marriages the chances are at least doubled of the offspring acquiring the characteristics of the parents; and that in them the liability is thus proportionately enhanced of transmitting deafness.[46]

THE DEAF HAVING DEAF RELATIVES

We are now to examine what traces there may be of deafness in a family by noting what proportion of the deaf have deaf relatives, and are to attempt to see what may be its bearings upon the question of heredity. In the census investigations,[47] we find that out of 34,780 deaf persons who answered, there are 10,033, or 28.8 per cent, who have deaf relatives of some kind, direct or collateral, 8,170, or 23.5 per cent, having deaf brothers, sisters or ancestors. In all of these we can without difficulty discover the influence of heredity. In the congenitally deaf the trace of a physical defect is even more clearly indicated. Of these 40.1 per cent have deaf brothers, sisters or ancestors, and 46.2 per cent have also deaf uncles, cousins, etc.[48]

It is thus evident that there are certain families in society deeply tinged with deafness, that it sometimes passes from parent to child, from generation to generation, and that like a cloud it hangs over a section of the race.

THE OFFSPRING OF DEAF PARENTS

All this argument leads up to one most pertinent question: Are the statistics which we have indicative that this deafness which passes so remorselessly in certain families will be found all the stronger in the children of deaf parents? Have we ground to believe or fear that this deafness will crop out far more surely than in the children of parents not deaf? And can we determine to what extent possibilities are increased of the offspring of deaf parents being likewise deaf?

Let us now consider the statistics which we have in this matter, first examining the results of the census investigation.[49] Of the 8,022 married deaf persons for whom statements are made, we find that there are 190 who have deaf offspring, or 2.4 per cent. Of the 4,116 deaf persons who are married to deaf persons, 137 have deaf children, or 3.3 per cent; and of the 3,906 deaf persons married to hearing persons, 53 have deaf children, or 1.4 per cent. Of the married deaf having deaf children, 52.5 per cent have deaf relatives of some kind, and 54.7 per cent are congenitally deaf, the proportion of those having deaf relatives who are also congenitally deaf being 66.7 per cent. Of the deaf married to hearing partners, who have deaf children, 26.4 per cent are congenitally deaf, while 50.9 per cent of the partners in such marriages have deaf relatives of some kind.

From the census statistics, then, it appears that the married deaf as a class do not have a large proportion of deaf children, and that this proportion is only a little more than twice as great when the deaf are married to the deaf as when they are married to the hearing. It appears also, however, that when there are deaf relatives involved in either kind of marriages, or when there is congenital deafness in the deaf parent, the effect is quite marked in the offspring.

Besides the census returns, we have the statistics presented in the reports of certain schools, which are found to point, as far as they go, to the same conclusions. In the Kentucky School, out of 83 pupils admitted in 1910 and 1911, there were none the children of deaf parents, though 35, or 30.1 per cent, had deaf relatives; and out of 42 admitted in 1912 and 1913, there were 2, or 4.8 per cent, the children of deaf parents, and 12, or 28.8 per cent, with deaf relatives. In the Iowa School, out of 62 admissions in 1911 and 1912, 4, or 6.5 per cent, had deaf parents, and 21, or 33.9 per cent, "defective" relatives. In the Michigan School, with an annual enrollment of some three hundred, there were from 1903 to 1908 but three children of deaf parents.[50] In the Colorado School, out of a total attendance since its founding to 1912 of 567, 3, or 0.57 per cent, were the children of deaf parents, though 83, or 14.6 per cent, had deaf relatives. In the Missouri School, out of a similar attendance to 1912 of 2,174 there were 52, or 2.4 per cent, with deaf parents, though there were 235, or 10.8 per cent, with deaf relatives.[51]

The most exhaustive study of the question of the liability of the deaf to deaf offspring is that of Dr. E. A. Fay in his "Marriages of the Deaf"—covering the majority of the marriages of the deaf in America at the time it was made (1898).[52] Statistical information is presented for 7,227 deaf persons and for 3,078 marriages with either deaf or hearing partners.[53] In the following table are summarized the results of this investigation.[54]

MARRIAGES OF DEAF PERSONS

NUMBER OF NUMBER OF MARRIAGES CHILDREN - - - - Partners in Marriage Total Resulting Per Total Deaf Per in deaf cent cent children - - - - One or both deaf 3,078 300 9.7 6,782 588 8.6 Both deaf 2,377 220 9.2 5,072 429 8.4 One deaf, other hearing 599 75 12.5 1,532 151 9.8 One or both congenitally deaf 1,477 194 13.1 3,401 413 12.1 One or both adventitiously deaf 2,212 124 5.6 4,701 199 4.2 Both congenitally deaf 335 83 24.7 779 202 25.9 One congenitally, other adventitiously deaf 814 66 8.1 1,820 119 6.5 Both adventitiously deaf 845 30 3.5 1,720 40 2.3 One congenitally deaf, other hearing 191 28 14.6 528 63 11.9 One adventitiously deaf, other hearing 310 10 3.2 713 16 2.2 Both had deaf relatives 437 103 23.5 1,060 222 20.9 One had deaf relatives, other not 541 36 6.6 1,210 78 6.4 Neither had deaf relatives 471 11 2.3 1,044 13 1.2 Both congenitally deaf Both had deaf relatives 172 49 28.4 429 130 30.3 One had deaf relatives, other not 49 8 16.3 105 21 20.0 Neither had deaf relatives 14 1 7.1 24 1 4.1 Both adventitiously deaf Both had deaf relatives 57 10 17.5 114 11 9.6 One had deaf relatives, other not 167 7 4.1 357 10 2.8 Neither had deaf relatives 284 2 0.7 550 2 0.3 Partners consanguineous 31 14 45.1 100 30 30.0

It is thus seen that 9.7 per cent of the marriages of the deaf result in deaf offspring, and that 8.6 per cent of the children born of them are deaf—proportions far greater than for the the population generally.[55] A striking fact to be noted, however, is that these proportions are greater when one parent is deaf and the other hearing than when both are deaf. The percentage of marriages resulting in deaf offspring when only one parent is deaf is 12.5, and when both are deaf, 9.2; while the percentage of deaf children born of them when only one parent is deaf is 9.8, and when both are deaf, 8.4. This is apparently a very strange result, though it probably may be accounted for in some part on the theory that it is not so much deafness itself that is inherited, but rather an abnormality of the auditory organs, or a tendency to disease, of which deafness is a result or symptom, and that with different pathological conditions in the parent there is less likelihood of deafness resulting.

The most significant part of the results seems to be found, as before, in respect to whether or not deaf parents are themselves congenitally deaf or have deaf relatives. On the one hand, when one or both of the parents are adventitiously deaf, the percentage of marriages resulting in deaf children is 5.6, and the percentage of deaf children is 4.2; when both parents are so, the percentages are lower: 3.5 and 2.3. The percentages rise when one parent is adventitiously deaf, and the other congenitally: 8.1 and 6.5. In respect to deaf relatives of parents, the percentages are very low when neither has such relatives: 2.3 and 1.2. The lowest percentages of all are in the case where both parents are adventitiously deaf and neither has deaf relatives: 0.7 and 0.3.

On the other hand, we find the proportion of marriages resulting in deaf offspring and the proportion of deaf children much greater when there is congenital deafness in one or both parents, when one or both have deaf relatives, and greatest of all when these influences are combined. When one or both parents are congenitally deaf, the percentage of marriages resulting in deaf offspring is 13.1, and the percentage of deaf children is 12.1; when both parents are so, the percentages are doubled: 24.7 and 25.9. When one parent has deaf relatives and the other has not, the percentages are 6.6 and 6.4; when both have, the percentages are nearly four times as great: 23.5 and 20.9. When both parents are congenitally deaf but neither has deaf relatives, the percentages are 7.1 and 4.1. When both are adventitiously deaf and both have deaf relatives, the percentages are 17.5 and 9.6. When both are congenitally deaf and one has deaf relatives, the percentages are 16.3 and 20.0; and when both have deaf relatives, the percentages are 28.4 and 30.3.

The evidence is very strong, then, with regard to the form of deafness and the presence or absence of deaf relatives. In cases where the parents are not congenitally deaf and have no deaf relatives, the proportion of deaf children is very low. When one or both parents are congenitally deaf or have deaf relatives—when the deafness is inherited or in the family—the likelihood becomes far greater, and greater still when the two influences are in conjunction. In general, in respect to the influences of heredity upon deafness, the main determinants seem to be found in the existence in the parties, whether hearing or deaf, of deaf relatives, and, to a less extent, in the existence in parties who are deaf of congenital deafness.

POSSIBLE ACTION FOR THE PREVENTION OF CONGENITAL DEAFNESS

We come now to the consideration of the question of possible action for the prevention of congenital deafness. This examination naturally centers about the matter of the regulation of marriage, with due attention to the extent that action on the part of the state is to be regarded as desirable or feasible.

We have seen that congenital deafness may, hypothetically, be divided into three distinguishable classes: that in which consanguineous marriages are concerned, that in which there is antecedent deafness in the family, and that in which neither of these conditions occurs; and in our inquiry it has seemed best to take up each of these separately. It may be, however, that there is in fact no very radical difference between these several forms, and that with increased knowledge on the subject a more or less intimate relation will be found to exist.

Of that form of deafness in which neither consanguineous marriages nor antecedent deafness is involved, we are at present, as we have noted, able to say little definitely. In most cases we may be convinced that there exists in the parent some peculiar state of morbidity or other affection, latent or manifest, perhaps to some extent of hereditary influence, which has an effect on the organs of hearing of the offspring. A certain proportion is quite possibly due to recognizable defects both of physical and mental character. Our statistical evidence, however, in respect to this form of congenital deafness is too slight to warrant any positive deductions; and we will have to wait for further investigation to determine its nature fully. None the less, marriage of persons known to be liable to have ill effect on possible offspring is objectionable for not a few reasons, from the standpoint of the interests of society; and in their reduction there will probably be a greater or less diminution of congenital deafness.

With regard to consanguineous marriages and their effect on deafness we are on surer ground, so far as may be indicated by statistical data. This question is found in very great measure to be connected with that of deaf relatives in general. The matter appears to be largely a part of a law of wide application, namely, that in the blood relationship of parents the possibilities are intensified of the perpetuation of a certain strain, which holds true no less with the transmission of deafness. Consanguineous marriages are perhaps not of sufficiently frequent occurrence, so far as concerns the effect on deafness, to require special action; but in the consideration of such marriages in general, their part in the causation of deafness should have due weight; and whatever may be said regarding them in other relations, they are to be avoided if we wish to remove all chances of this kind of deafness resulting.

The problem of deaf relatives and their connection with congenital deafness is a very large one. Attention however, has mostly been focused upon it in relation to the intermarriage of the deaf and its effect upon their offspring. Indeed, in such unions there has already been more or less concern, and there has even been question whether it is a wise or unwise policy to allow the deaf to marry other deaf persons. The deaf, as we shall discover, not only find their companions for social intercourse among similar deaf persons, but a fortiori very often seek such persons for their partners in marriage—in fact, more often than they do hearing partners, nearly three-fourths of the married deaf being married to deaf partners.[56] Not only has it been feared that the offspring of such marriages might likewise be deaf, but there has also been apprehension lest in their encouragement there might result a deaf species of the race.[57]

From our discussion, however, we have found that in most of the marriages of the deaf we have but small reason for disquiet. If deafness in the parent is really adventitious, there is little possibility of its passing on to the offspring. When the deafness in the parent is itself congenital, the situation becomes more serious. If in such case there is no added risk from the existence of deaf relatives, the likelihood of transmitting deafness need not always be a matter of deep concern, though the hazard is materially larger than for adventitious deafness. When there are deaf relatives involved, the peril, made stronger if coupled with congenital deafness, is most pronounced; and, indeed, the existence of collateral deafness seems a more certain sign of warning than direct heredity itself. Finally, even in the marriage of the deaf with the hearing, the dangers are not in fact lessened if conditions otherwise unchanged are attendant.

What action should be taken in respect to that part of the deaf who may marry under conditions favorable to the production of deaf offspring is not at present clear. Legislation would not appear on the whole to be advisable;[58] and the exertion of moral suasion, so far as possible, in the individual cases concerned would seem a more acceptable course. The matter, however, really belongs in the province of eugenics, and we will probably do best to await the authoritative pronouncement of its decrees before full procedure is resolved upon.

CONGENITAL DEAFNESS AS AN INCREASING OR DECREASING PHENOMENON

The final matter to be ascertained in respect to congenital deafness is whether it is relatively increasing or decreasing. The following table will show the number of the congenitally deaf in the censuses of 1880, 1890, and 1900, with their respective percentages and the ratios per million of population.[59]

NUMBER OF THE CONGENITALLY DEAF IN 1880, 1890, AND 1900

RATIO PER TOTAL CONGENITALLY PER MILLION OF NUMBER DEAF CENT POPULATION

1880 33,878 12,155 35.6 242 1890 40,562 16,866 41.2 269 1900 37,426 12,609 33.7 166

From this it appears that congenital deafness is decreasing both in relation to all deafness, and to the general population.

For further statistics, we may revert to our tables under adventitious deafness. In the tables relating to periods of successive recent years we find in respect to three schools, the New York and Western Pennsylvania institutions and the Maryland School, with certain fluctuations, no great change on the whole, though the last named school shows still a very high proportion. In two schools, the Michigan and Wisconsin, rather an increase is observed. In the Pennsylvania Institution, which covers a period of seventy years, there is a decrease from over 50 per cent to less than 40.

A better test perhaps lies in the comparison of the proportions found for congenital deafness in the tables relating to periods widely separated in time. In these an increase is seen in the single case of the Ohio School; while a decrease is apparent in three, namely, the American and Iowa schools and the New York Institution. These decreases in percentages are respectively from 44.8 and 50.1 to 35.2; from 37.2 to 26.9; and from 42.9 to 38.0.[60]

From the evidence that we have, then, taken together, it seems reasonable to conclude that congenital deafness is, though slowly, becoming less in the course of the years.

CONCLUSIONS WITH RESPECT TO THE ELIMINATION OR PREVENTION OF DEAFNESS

Most of what has been said in this chapter with respect to the elimination or prevention of deafness may be summed up as follows:

1. There are two kinds of deafness—adventitious and congenital. Of the total number of cases adventitious deafness comprises nearly two-thirds, and congenital deafness a little over one-third.

2. Nearly all adventitious deafness is caused by some disease of infancy or childhood attacking the middle or internal ear, a large part being of infectious character. The two chief diseases causing such deafness are scarlet fever and meningitis, with a less amount from brain fever, typhoid fever, measles, catarrh, diphtheria, whooping cough, etc.

3. A considerable part of this deafness is preventable under enlightened action. Medical science is principally in control of the situation, but there is also much that can be done in general measures for the protection of the health. In attacking the problem, the most immediate practical program lies in the arrest of those diseases, especially infantile and infectious diseases, that cause deafness.

4. Our evidence is incomplete to determine definitely whether adventitious deafness is increasing or decreasing relatively among the population; but it is hardly other than likely that it is decreasing. Although certain diseases producing deafness fail to show any extensive signs of abatement, there are other diseases from which there can be little doubt that deafness is decreasing.

5. In the outlook there is, on the whole, promise, both in respect to the treatment of deafness itself and of the diseases that lead to deafness, though it cannot be said in any sense that any large or general relief is at present in sight.

6. Of congenital deafness nearly half occurs in families often without any positively known strain to indicate a predisposition to deafness. Though concerning this deafness little in the present state of our knowledge can be predicated, it is likely that with measures to secure a race sound in all particulars there will be a reduction to a greater or less extent of such deafness.

7. Consanguineous marriages do not take place, so far as deafness as an effect is concerned, to any great extent; though where they do the consequences are very marked. Their relation to deafness consists apparently for the greatest part in the fact that the chances of its transmission are thereby intensified, there being also a very strong connection with the question of deaf relatives in general.

8. There are a certain number of families in society deeply tainted with deafness, in evidence both lineally and collaterally, and this deafness may be transmitted from parent to offspring.

9. Children of deaf parents are far more likely to be deaf than children of hearing parents.

10. The great majority of the children of deaf parents, however, are able to hear, the proportion of those who are not being small.

11. The likelihood of deaf offspring is not necessarily greater when both parents are deaf than when one is deaf and the other hearing.

12. The liability to deaf offspring depends in the greatest degree upon the presence or absence in the parents, deaf or hearing, of deaf relatives, and, to a less extent, upon whether or not the existing deafness is congenital—being especially great under a combination of these two conditions.

13. Action in respect to marriages of the deaf likely to result in deaf offspring seems for the present rather to be limited to moral forces.

14. Congenital deafness appears, from all the evidence, to be decreasing relatively among the population, though probably only at a very slow rate.

15. Finally, with respect to our original inquiry, it is to be said that there are no indications that deafness will disappear from the human race within any time which we can measure; and hence that the deaf are to be in society not only for a season, but for a period apparently as yet indefinite. Nevertheless the situation is not without encouragement. From the data in our possession regarding deafness as a whole, it seems certain that deafness is not on the increase relatively among the population. From our knowledge concerning adventitious deafness, the probabilities are that, if anything, it is decreasing; while the evidence as to congenital deafness is that it is decreasing. It is likely, then, that deafness in general is tending to decrease; and we are thus justified in believing that the number of the deaf will in time become less.

FOOTNOTES:

[15] Moreover, later censuses are probably taken more thoroughly than former, with a consequent discovery of a larger number of the deaf; while at the same time greater care is employed in preparing the later censuses, with the more rigorous elimination of doubtful cases, all in some measure, however, tending to even up the differences. On the difficulty of making comparisons of the censuses of the deaf, see Special Reports, pp. 66-69; Annals, li., 1906, p. 487.

[16] Ibid.

[17] Deafness has also been divided into three classes: adventitious deafness, congenital or hereditary deafness, and infantile or sporadic congenital deafness, the last class including many cases where there are other antecedent defects, mental or physical, or where the deafness occurred shortly after birth with the exact cause not definitely determined. See Proceedings of International Otological Congress, ix., 1913, p. 49; Volta Review, xiv., 1912, p. 348; xv., 1913, p. 209.

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