OF THE

NEBRASKA IW STITUTB

FOR THE

DEAF AND DUMB FOR THE

Years 1893 and 1894.

TO THE

GOVERNOR OF THE STAT4 OF NEBRASKA.

OMAHA, NEBRASIIA.

...................... Hon. Lorenzo Ororrnse ..... :

BOARD OF PUBLIO LANDS AND BUILDINGS. . Hon. A. R. Humphrey,. .. .Corn. of Public Lznds and Buildings

...................... Hon. J. O. Allen.. .Secretary of State ............................ Hon. J. 8. Bartley.. .Treasurer ...................... Hon. Geo. Hastinge. Attorney-General

, OFFICIERS OF THE INSTITUTE.

................. 5. A. Gillespie, A.M. .Principal and steward ............................. T. 3'. Moseley, A M . .Teacher

.............................. R. E. Stewart, A.B .Teaoher ................................ NIX (3. E Clomp. .Teacher

............................... Miss Ella M. Rudd Teacher W. E. Taylor, A.M., Mrs. W. E. Taylor, Miss Helen Mdheane,

Wss Katie B. Regnier, Miss Ellen R. Connett, oral and aural teaohera

........................... Uss May Hurray.. .Art teacher .............................. Xrs. J. A. ailleapie .Matron ............................ J. (3. Denim, M.D.. .Physician

................................... Mr. W, E. Davis Clerk .......... Him Josie Moore.. Nurss end supe~.visor of large boys

........................ Miss Lelia Boote ,tJnprvisor of @la ................ Mies Lillie Babbitt. ..Supervisor of small girle ...................... W s Nora Johnson .Supervisor of b o p

.................... (3. E. bomp.. .Foreman of printing oiEce .................. D. J. Richards.. .Foreman of cmpenter shop

..................... .......... Albert Gladwin.. : Engineer

REPORT . To the Haos.abk the Boc~rd of Public Lands and Buildings :

GENTLEMEN:-I have the honor to hand yon herewith the ninth bien~~ial report of the Institute for the Deaf and Dumb .

The attendance for the biennial period covered by this report has been one hundred and eighty.six . There were admitted dur- ing this time fifty .

Four hundred and twenty-four have been in attendance since the school has been in existence .

These are distributed as to counties. as follows: ........................... ............... Adams ... 9

............................................ Antelope 2 ............................................... Boone 10 ............................................. Buffalo 5

............................................... Burt 8 .............................................. Butler 7

Box Butte ................................. L . ........ 2 ............................................... Boyd 1 ................................................ Cass 10 ............................................... Cedar 4 ............................................... Chase 1 .............................................. Cherry 2

........................................... Cheyenne 9 ................................................. Clay 2

................................................ Colfax 6 ............................................ Cnming 6 .............................................. Cnster 3 ............................................. Dakota 8

.............................................. Dawes 1

.............................................. r

............................................. Greeley 1 I ............................................... I Hall 4 .

........................................... Howard. ............................................ Jefferson 5

........................................ .Tnhnann

......................................... 4

nnn ............................................ 1 ..

INSTITUTE FOR DEAF AND DUMB 355

................................................ Polk 9 .......................................... Red Willow 4 .......................................... Richardson 20

.............................................. Saline 17 Sarpy .............. ..... ...... .. ................... 8

............................................ Sannders 11 .............................................. Seward '6 ........................................... Sheridan 3 ................................ Sherman .... ...... 1 ............................................ Thurfiton 1

.............................................. Thayer 6 .............................................. Valley 6

......................................... Washington 8 .............................................. Wayne 1

............................................ Webster 4 ............................................... Pork 2

The causes of deafness a~ assigned by the parents on thead- mission of the childron are shown by the following table:

.......................................... Congenital 137 ..................................... Spinal meningitis 53

........................................ Rcarlet fever 37 .......................................... Brain fever 27

....................................... Typhoid fever 25 ..................................... Whooping cough I1

.................................. Fever. kind uuknown 13 ............................................. Earache 6 ............................................ Scrofula 6

....................................... Fall in infancy 7 ............................................. Measles 11

............................................... Cold 5 ..................................... Cholera infant urn 3

......................................... ............................................

Lung fever 3 Catarrh 3

Fits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ab~cess in ears. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inflammation of the brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pne~trnonia , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Paralysie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yellow fever.. . . . . . .. . . .. . . . . . . . . .. . . . . . . .. . . . . . . .. . . Worms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Quinsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Intermittent fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dropsy of brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' ~ ~ e e n t e r ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Congestion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bronchitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 57 La grippe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

I n the matter of health I have to say that during the lmt biennial period we have been visited with an epidemic of measles. We had in all a b u t forty cases. While some had other compli- mtiom as well, all recovered.

This fall, on the opening of school, a number of the children were taken down with typhoid fever. We have had in all eleven

08888.

One of these, Miss Ida Boggs, died. The other8 have re- covered or are convalescent Whiie this may or may not be caumd by local oonditions, it would be prudent on the part of thorn whose duty it is, to see that proper provision is made to put s&ool in the most complete sanitary oondition; as no edlncation is d value which is secured at the expense of health, For a fnrther a i d e r a t i o n of this subjeot I would refer to the phy- sician's report

INS1 ITUTE FOR DEAF AND DUNB.

METHODS.

The pupils who come to us are not all totally deaf. A great many have the power of hearing in a limited degree, but not safficiently to gain language through the ear. The degree of deafness in the so-called deaf varies as widely as the degree of bearing in the so-called hearing. In many cases had the same degree of hearing ocourred late in life, the person would only be called "hard of hearing."

Several years ago we undertook to train this dormant hear- ing power, and thus introdurn a new factor in the education of the deaf. The results of our experiments convinced us that we were on the right track, and that incalonlable good would be derived by many of our pupils from this method of instruction.

We then established an aural and oral department, in wnich were placed all who were to be taught speech either with lip-read- ing or with hearing. Since that time about ninety pupils have received auricular instruction in our school. Sixty of these were present during the last biennial period, and fifty are in school at this date, December 1, 1894. Several have gone from us able to make their way by speech and hearing in a hearing world.

Two years ago we began the plan of startilig all new pupils in this department, and in this way we find a greater number of hearers than under the old plan of putting only selected pupils there. This means that -every pupil shall have the chance -to learn to speak and to have his hearing .cultivated, be it ever so slight, and shall be transferred to the manual department only when i t has been clearly demonstrated that he can neither hear nor learn to talk and read the lips. By this process a great many of our pupils will be graduated as hard of hearing people in- stead of deaf mutes.

Nor is this auricular method confiued to our own school. A great many other schools have seen its advantage, and either

least one special school has been

established practically for this class of our pupils alone, and a

great interest is being aroused i~ the profession in regard to the development of this dormant hewing power.

So great is the interest that our teachers were requested to present t h i ~ subject before the American Association of Teachers of Speeoh to the Deaf, at Chautauqua, N. Y., last July, both by a paper and rt olass from oar sohooL This exemplification of the auricular method has caused a great increase of interest in the subject, and olaases have been started in several schools where before tbey did not exist. An sssociation was formed at this meeting to promote auricular training, thus showing the intarest manifested in this branch of the work.

At this date, December 1, 1894, our aural and oral depart- ment contains eighty-six pupils. Fifty of these are taught as hearers and thirty-six as lip readers. These eighty-six pupils are taught by five teachers, an average of seventeen to a teacher, and some teachers are obliged to have more than one grade. I n come of our best schools an oral cbss is made to consist of six

while the Pennsylvania school at Philadelphia has set ihe number at ten as the highest possible nnmber consistent with the best results, and their school is large enough so that a teacher never has but one grade. Yet our work in speech mprr res not unfavorably with the work of these schools. Yet it is evident that with smaller classes much greater results could be reached.

I n the manual department, the work is carried on by means of the manual alphabet and written language, signs being used

sparingly. In both departments language is taught by what we might designate as a complete thought method: The forms of verna,cular Engliah expression are kept before the eyes of the pupils. They become accustomed to seeing them and using them,

they finally possese a vocabulary of language forms, which they cfin use with a greater degree of accuracy than if the vocabu- lary were of dissociated words. We secure better results by this

INBTITUTE FOR DEAF AND DUHE 359

we have tried. I t s advantages are noticeable in the greater flexibility of language and in the lesser number of mute-isms.

THE OBPIGER8 OP THE BCHOOL

But few changes have occurred in our corps of instructors dur- ing the last two years. Misses Connett and Ragnier, experienced teachers in the public sohoola of the state, have been appointed to succeed Mr. Wentz and Niss McElravy, who left the service of the state, the former in April of the present year to engage in private business, the latter at the close of the term to enter mar- "

ried life. 'LtL'Uq* w - :. rn *- =x,

I t is to the intarest of the work that as few changes as pos- sible be made in the teaching foroe of a school of this kind, ex- a p t , of coarse, for cause. The success of any school depends upon the character and ability of the teachers. It i~ they who are closely aesociated d t h the children day by day, and whose influence over them will make or mar them.

The position of instructor in a school for the deaf is one in which all the skill and ability of the successful public school teaaher is required, and, in addition, the spirit of'the missionary, and the patience of the mother, and the love of justice and firm- new of the judge.

The work is laborious and exl~austing to the mental and hysical forces. This is peculiarly true of the teacher in the uricular and oral departments. No teaching can be more wear-

vata the dormant hearing of the partially deaf.

raraka owes a debt of gratitude which can never be paid in

the labors of the other officers of the scho~l.

The matron, who takes the place of the mother of the household, has duties too varied to enumerate; she is the lady of the house, the presiding genius of the kitchen; the enter- tainer of state's company, and the supervisor of the scrub-girls. It is hers to know that the well are properly fed and the sick cared for; that the ragged are clothed, and the untidy kept neat; to the girls she is an advieor and counselor. It is hers to discipline the refractory, to be the sympathizing friend to those in trouble. She stands in the same relation to the whole school that the mother does to the family.

If this position is that of a sinecure we pity the one who has a difficult position to fill. All others have their responsibili- ties and exacting duties, but none so difficult as this.

To duties well and conscientiously discharged by all we must ascribe the success which the school has attained.

WHY THE STATE BHOULD BUPPOBT A SaHOOL FOB THE DEAF.

Critic!sm is made frequently by public men upon the justice of supporting a school of this kind at state expense, free lo all.

These schools are thus supported throug+out the country, with very few exceptions, if any, free to all, rich and poor, black and white.

The justice in it lies in the fact that, acaording to our prin- ciples of government, every child is entitled to an education at the expense of the state.

Deafness does not debar a child from thia privilege. Be- oanse of this inilrmity he does not receive instruction in his home rnhool as do his brothers and sisters. His condition requires I

that he have individual instruction. The public school-teacher finds that his attention must be devoted to the larger number, & bhe result is that the deaf child is not cared for in the public

0ohooL

INSTITUTE FOR DEAF AND DUMB. 361

To give him the benefit of an education, then, it would be necessary to furnish a special teacher for each deaf child, except in cases where two or three could be brought together. From a financial point of view, this would be found an expensive way to

well, to bring them together into one school, where they can be instructed, where methods are adapted to their condition. This necessitates the addition of maintenance, to which objection is made.

Notwithstanding this added expense, it is economy on the part ofthe state to do this, rather than to supply the educational facilities at their homes.

If this view of the case is correct, schools for the deaf should not be classed as charitable institutions, but as state edu- cational institutions, supported by the atate for the same reasons that the public schools are supported, and the item of mainte- nance added because of the necessities of the case, as being the most economical.

INDUSTItIES.

ABT DEPARTMENT.

Work in this department has been continued on the e rne lines as described in previous reports. Sixty boys and girls have been instructed in free hand drawing; three boys and twenty- eight girls in crayon work; one boy and five girls in oil painting, ansl five girls in water color painting.

In this department twenty-nine girls have been instnoted + in dressmaking, forty-one in plain sewing, and seventeen in fanay work

PRINTING DEPARTMENT.

In this department thirty-four boys have been instructed in

printing. Of these, twelve have learned job work. The job work of the Institute is done in this department, as

letterheads, envelops, report blanks, lessons, books for younger ~lasses, and library books repaired. The Nebraska Mute JOUTL

nul, a semi-monthly publication, is issued from this department; also The Breeze, a tri-weekly for theuse of the younger children.

This department has done work for outside parties for pay, numbering 176 different jobs. While being a school to teach printing, it is also a source of income to the Institute.

OARPENTRY.

During the last two years thirty-three boys have been in- structed in the use of tools in the school of carpentry. Of these, five worked at turning, five at wood carving, one at architectural drawing, two at painting.

All the repairing done upon the buildings during the last two years has been done by this department.

The pupils, all as soon as old enough, are expected to en- gage in some industry; the girls do general honsework; the bogs do outside work if too young to be employed in any of the shops. All must do something.

Showing'the financial condition of the induetries of the ;[n-

stituh for the Deaf and Dumb.

JOURNAL. ,, - - - . B e d v e d daring the year ending November 50,

I ., 1895 .................................. $316 20

INBTITUTE FOB DFAB AND DUMB.

Received during the year ending November 30, 1894.. ................................. $ 469 81

Expended during the year ending November 30, 1893.. ................................ . $ 05

Expended during the year ending November 30, ................................. 1894.. 93 29

HOUSEHOLD, LIVE STOOK, ETG.

Received during the year ending November 30, 1893 .................................. $ 75 00

Received during the pear ending November 30, 1894 .................................. 205 86

Expended during the year ending Novomber 30, 1893 .................................. $260 63

Expended during tho year ending November 30, 1894 .................................. 586 47

OABPENTEB SHOP.

Reoeivea a u n w the year ending November 30, 1898. ................................. $ 3 00

Received during the year ending November 30, 1894 .:................................

Expended during the year auding November 30, ................................. I89Q .$ 7 68

Expended daring. the year ending November 30, 18% ..................................

Received dn14ng the yam ending November 80, .................................. 1898 $383 93

Beceived during the year ending November 30, 1894 .................................. $ 177 85

Expended during the year ending November 30, ................................ 1893.. .$I79 85

Expended during the year euding November 30, ................................... 1894 2 40

STATISTICS OF THE DEAF.

We obtain the following data in part from the census retwms '

of 1890: &'The average annual attendance upon the public schools for

the deaf was ,501 in the decade 1840-1849, .912 in the decade 1850-1869, 1.563 in the decade 1860-1869, 3.159 in the decade 1870-1879, and 5.910 in the decade 1880-1889, in 1889 there were present in these schools 6.596.

"November 15, 1893, there were present in both public and privata schools 9.542. It will thus be seen that the growth of the schools for the deaf is rapid and constant.

"The average annual per capita expenses of these children, in- cluding buildings and current expenses, was $271 in 1889, and $262 for the decade 1880-1889. The average annual cost for the two previous decades was $256, 1860-1869, and $275 for 1870- 1879.

"The average annual cost for current expenses, excluding buildings, was for 1889 $206, and for the decade 1880-1889 $207."

The average annual cost of this school for the same time and Upon the same basis of calculation was 8'201.91. These figures are obtained by using the number enrolled as the divisor. Using the daily average attendance as a divisor would of course make the per capita expense larger.

The general ratio of the deaf to the whole population is as 1 to 1,600. This holding good in Nebraska, we would have over seven hundred deaf persons in the state. Estimating that one-

TNSTITIITE FOR DEAF AND DUMB 366

half of these are between the ages of five and twenty-five, we would have a, school population of over three hundred and fifty in the state. And judging from a censes recently taken in a neighbor- ing state, I have no doubt but we have approximately that number. Our present accommodations are taxed to their capacity for comfort and health. During the last year we were obliged to take the building erected for hospital purposes to accommodate the small girls for living rooms. Before we can increase our numbers to any appreciable extent, additional room will be required. I here quote from the report of two years ago.

'LOur buildings are full, on the girls' side crowded. The amount of space for girls in the sleeping apartments is 28,875 cubic feet, giving to each girl 465 feet. Health authorities give 800 feet as the minimum which should be allowed to a person. The more space above the figure the better.

The ro6ms now used as school rooms are required for living accommdations, and must be vacated for that purpose, or we must refuse any further increase in our number. Of course, the latter alternative ia not to be considered, hence the necessity of providing new school accommodations. I therefore recommend that an appropriation be made for a separate building to be used wholly for school purposes, and to contain school rooms, assem- bly rooms, library, museum, art moms, eto., with the necessary equipments for such a building.

This building should be erected with reference to the future as we11 as to the present. Aa the population of the state in- creases, the deaf population increases in equal proportion. 80 it ie a matter of wisdom, in building up a permanent institution of this kind, to build beyond present neaessities, and not be obliged to tear down to build larger as numbere inoressa

LAND COMYISBIONPR'S REPORT.

APPROPRIATIONS.

The funds provided by the legislature of 1892-3 for the support of this school, with amounts expended, and balances 011

hand Novcmber 1, are shown by the following table:

APPROPRIATED.

Teachem, ete ....... $ 22,000 00 Living expenses. .... 14,000 00 Fuel and lights. ..... 7,000 00 Employes' wages. .... 6,000 00

..... Superintendent. 4,000 00 Repairs and improve-

ments. ........... 1,000 00 Supplies for industries 500 00

... Hospital building. 500 00 Library ............ 500 00 Telephone .......... 240 00

EXPENDED.

$ 15,907 69 12,335 00 4,001 02 4,610 59 3,000 00

ON HAND.

$ 6,092 31 1,665 00 2,998 98 1,389 41 1,000 00

On account of the financial condition of the state, and the desire upon the part of the taxpayers that expenditures should be reduced, the appropriatious were not a~ liberal aa usual. With the most rigid economy practiced in every department i t is doubtful whether the funds can be made to reach the end of the biennial period. The limited amount provided for repairing the buildings was insufficient to attempt any general improvements. The best we could do was to make suoh repairs only as would prde& the buildings, that they would suffer the minimum of damage. This we have done. The time has come when the work of overhauling and repairing the buildings here cannot be postponed longer without endangering the welfare of the work for which the institute waa organized, and the health of the inmates.

The oldest building, erected in 1871 should be rebuilt. Floors, plaster, stairs, all the wood work should be made new,

WSTITUTE FOR DEAF AND DUMB. 867

and the basement floor ooncreted and tiled. T i e basement floors in all the buildings should be taken up and new ones put down. The girls' wing, the boys' cottage, and the industrial building should be raroofed. To preserve the buildings and beautify them they should be painted inside and outside.

Part of .the plumbing has been in service for many; years. But little of it is of modern make. The city authorities have ex- amined and condemned the whole system as out of date and nn- sanitary. Manx attribute the recent typhoid fever attack to this cause. Whether this be true or not, the fact remains that the

,~lurnbing should be taken out and new put in.

When this is done i t wouid be well to erect an addition at the back entrance of each wing and connect with the same, thie addition to contain the toilets and lavatories of the respeotive wings. This would confine the plumbing largely to these locali- ties, where i t could be more easily kept in repair.

The sewers of the Institute are not ~onnected with the city ~y&m, but diecharge into a ravine near by. This has become a nnieence to some of our neighbors and complaint has been made. The city authorities expect it to be remedied. To make tbe necessary connections, it will be necessary for the state to put in about a mile of sewer.

I again call attention to the lack of fire irotection to thie Enstitdtion. We are supplied with a number of small Babcock fire extinguishers, located at convenient points throughout the buildings. Shmld a fire be discovered in. its 'incipient stages, i t doubtless could be put out with these.

?The city water mains extend now to within half a mile of the school. These should be extended to the state ground4 a1.d at bast two hydrants located at convenient points to be availab!e iu crtse of fire, also to furnish water for general use in case c f

emergency. Estimates have beensublnitted covering theae rimes-

nary repairs and improvements, which I hope meet your approval.

ESTIMATE OF APPROPRIATIONS

Fon THE YEARS 1895.7 .

Snparjntendent .............................. $ 4. 000 00

............................... Teachers. etc 22. 500 00

OURRENT EXPENSES .

Living expenws and feed .................... $ 16. 000 00 ........................... Employes' wages 6. 600 00

............................. Fuel and lights 8. 000 00

...................... Supplies for industries 600 00 ........................ Bmks and stationery 600 00

Telephone ................................. 240 00 Repairs ................................... 1. 500 00

................................ Incidentals 600 00 ................................. Furniture I. 000 00

BPECIAL APPROPRIATIONB . ................ &werage and city connections

....................... City water conneations Plumbing and connections. and two new buildings

complete ................................ Overhauling old building ....................

............ Brick tunnel to replaoe woodell one Concreting basement ........................

.......................... Painting buildings Front entrances ............................ Resetting three (3) boilers. with Reynolds' smoke

consuming device. and covering steam pipes ...

INSTITUTE FOR DEAF AND DUMB.

DEFICIENCIES OB 1892. . Coutant & Squiree (for coal). ................ $ 956 09

..................... Nebraska Telephone Co. 150 62 ......... George Dickover (for labor plastering) 20 75

GENTLEMEN:--In closing this report, I desire to return to the Board my thanks for their uniform courtesy and assistance in the managenlent of this great charge.

Trusting that the honorable members of the legislature will see to i t that the recommendations contained herein are carried out, and looking forward to the continued care and guidance of the Great Father of us all, this report is submitted.

J. A. GILLESPIE, supm-ntendent

L1rS.T OF PUPILS 1893.94 . w 4 0

NAME . I OAUSE OF DEIPSESS . ADYISSION . I - Arch, Ransom .................... 7 Douglas ............... LR grippe ........................ Septem bsr 26. 1894 Anderson. Jose M ................ 12 Kearney ............... Congenital ...................... December 31. 1890 Blankenship. Lloyd .............. 10 Nemaha .............. Spinal meningitis ............... Septemhera!. 1883 Brown. John ..................... 16 Thayer ................ Scrofula ........................ September 16.1891 Brouhard. Chas .................. LO Fornas ................ Congenital ...................... September 17. 1890 ............... ................ Bingham. Richard ................ 7 Douglw Spinal meningitis LSsptember 16. 1889 Bauman . John .................... 12 Dixon ................. Congenital ...................... October 5 . 1885 s ...................... Boags. I d a ....................... 16 Custer ................. Congenital September 16. 1880 0 Bauman. Bertha .................. 10 Dixon ................. Congenital ...................... October 6, 1835 ...................... Borrows. Nettie .................. 8 Valley ................. Congenital September 21. 1883 [ Bryce. Nellie ..................... 16 Washington ........... Scarlet fever .................... October 1, 1892 m ........................ ................. Connell. 12alph ................... 6 Saline Unknown October 1. 1 8 s ........................ Cbsra. Albert .................... 6 Douglas ............... Unknown 8eptember26. 1894 5 ............... Chase. Freak ..................... 6 Douglas ............... Gathering in head September 16. 1891 3 ...................... Coleman. Hattie J ................ 13 Buffalo ................ Congenital September 17. 1890 Combs. Daisy .................... 11 Douglas ............... Spinal meningitis .............. Januery 15. 1894 5

...................... .............. Davi4 Almer ..................... 7 Saunders Congenital September 12. 1883 S ...................... ................... Dtmker. Chas ..................... 6 Otoe Congenital September 16. 1891

................ ............... Delhoy. Walter ................... 8 Webster Whooping cough September 20. 1893 0 ...................... ................ Donahue. Walter W .............. 11 Dawson Congenital September 17. 1890 3 ............. ........... Dnmke. Fred .................... 10 Laneaster Fever (kind unknown) November 20. 1886

Donnelly. Maria ................. 13 Douglas ............... Scarlet fever .................... September 23. 1888 . ....................... ................... Dinesen, Mary ................... 12 Hall Unknown September 17 1890 ................ ............... Davis. Frances V ................ 6 Douglas Spinal meningitis October 27. 1800 ...................... ............... Duneanson. Clara ................ 6 Douglas Congenital September 16. 1891 .............. ..................... Epps. Thomas .................... 13 Cheyenne Congenital September 26. 1894 .............. ...................... Flood. John ...................... 8 Cheyenne Congenital September 94. 1882 .............. ...................... Flood, Chas ..................... 6 Cheyenne Congenital September 24. 1884 ...................... Fbrrel. Frank .................... 7 Thayer ................ Congenital September 20. 1893 ...................... .............. Forell . Oscar V .................. 9 Thayer Congenital October 18< 1886

Forbes, Estella ................... Li@e .................... ................... - . .a gelma A

Forel, Nellie .................... Fo , Lucy F ..................... Gagrid, Chester A .............. Ul-b, Victoria .................. Oregg, Xyrtle .............. , .... H r q Ferdinand ............... Harris, Thomas 5 ................ HofEstatter, Claude .............. Hulk Usrnerd .................. Has6berget , Dale ................. IIaller, marl ...................... Harrlngton, Wm ................. Hartman, Ches .................. Hall, Mamie ...................... Hant, Belle ...................... Earms, Catharine ................ Johnson, Wilson ................. .............. Jensen, Christian P Jwmq Rlerch A .................. Jenkins, &fmd ................... ............. Eellner, Theodore B &rr. Harry ...................... Kelhierr, Harvey ................. .................. huthold, Chas K bat, John ..................... &ohen+ B ~ J B ................... Korner, Rnby .................... .................. KaufhoM . Itoecl ................... Eiernele, Anna Lee, Harold ...................... Lee, Clarence .................... .................. Lainsw . Leslie .................. Liaey . Alfred L Lockhart, Jane ..................

Douglas ............... b d a ~ s ................. .................. Polk Thayer ................ Clay .................. Johnson ............... Douglas ............... Lanoaster ............. Hares ................. Thurston .............. Douglas ............... Cheyenne ............. Colfax ................ sheridan .............. Cass ................... bawson ............... Pierce ................. Dakota ................ .................. Gage .................. h r p y .............. Hamilton Hamilton ............. ................ Dakota ............... Madison ................ Perkins .............. Madison ............... Doughs ................. Saline ................. Boone Richardson . , .......... ............... Douglas ................. Dawes ................. Saline ................. Saline .............. Hamilton ............... Douglas Boone .................

8 10 13 7 U 7

15 10 12 12

7 11 7 7 6

10 7 7

14 6

10 8 11 5

11 5 9

10 11 12 5 6 8 6

11 6

10

Bronchitis ....................... Earache ............. : ........... ....................... Unknown Congenital ...................... Diphtheri~ ....................... Congenitat ...................... Congenital ...................... Whooping oough ................ Typhoid fever ................... Congeni'al ...................... La grippe ........................ Brain tever ...................... Bcarlet fever .................... Catarrhal fever .................. Congenital ...................... ...................... Lung fever Whooping cough ................ Quinsy .......................... ..................... Spinal fever ............... Spinal meningitis ...................... Congenital Congenital ...................... ............... Gpinal meningitis ............................. Cold ...................... Congenital

....................... Unknown ......................... Mensles ....................... Unknown .................... l'yphoid.fever

Unknown ....................... ...................... Congenital ...................... Congenital ............................. Fall ...................... Congenital ...................... Congenital ........... Fever (kind unknown) Congenital ......................

Beptember 30. 1882 Beptember 13 l81R February I , 1890 October 18, 1886 September 20, 1893 November 7, 1890 September 26, 1894 November 1, 1892 January 23, 1887 September 17, 1890 October 7, 189'2 September 20, 1893 January 17, 1894 Ootober 15, 1892 September23, 1887 September 17. 1890 September 12, 1884 October I, 1885 January 2', 1889 September 26, 1894 Bepternber 17, 1884 September 20, 18% September 17, 1890 September 26. 1894 January 21, 1889 October 10, 1802 September 26, 1894 September 16, 1892 Maroh 9, l a 9 SeptemberU.1899 September 26.1884 September 26. 1894 September 16, 1891 September 20, 1893 September 14. 1892 Oc.ober 17, 1894 November 30, 1885

LIST OF PUPIL8 1893.94-Continued . :1: 4 N

NAME lAaE/ couNTy . -1 CAUSE OF DEbFIiEaa . I ADMITTEu .

Lloyd. &he1 C ................... Luhn. Emma . C .................. Meidl. Frederick .................

..................... Macek. Chas May. Otto F ..................... Mbtnep. James ................... Miller. Alexan.ler ................ McFadden. Henry ................ Mchdden. John ................. MoManos. Thos .................. McFadden. Ethel ................. McManus. Maggie ................ Marsball. Rebecca ................ Marshall. Julia .................. Wrshall, Edith A ................ Marshall Maud D ............... Moose. Emma G ................. Marek. J d l a A ................... Marttn. Sarah J .................. O'Brien . John .................... Oelke. Christopher .............. Opfer. John ...................... Osmun. Ziba ...................... Oliver. Helen .................... Phillips. John .................... Parker. Pearl .................... Palike. Martin. jr ................. .................. PickeriY John Pravanc a, Merrick .............. Porter. Charles ...................

Douglas ............... E~chal.dson ............ Cherry ................ Buffalo ................ Seward ................ Burt .................. Madison ............... Boone ................. Boone .................

............... Nemaha Red Willow ........... Nemaha ............... Lancaster .............

............. Lancaster ................... York

............. Lancaster ................. Eoone ................. Dodge ................ Lincoln ................. Otoe

.................. Otoe ................. Gage :

York .................. Lancaster ............. Cheyenne .............. ................ , Thayer ................ Colfax

............... Dawsos Cedar .................

, Pawnee ................

Cold ........................... ...................... Hrain fever ...................... Congenital

Congenital ...................... ...................... Congenital .......................... Malaria

.......... Fever (Bind unknown) ...................... Congenital ..................... Brain fever

....................... Unknown ....................... Unknown Congenital ...................... Congenital ..................... ...................... Congenital

................ Whooping cough ...................... Congenital .......................... Measles ...................... Brain fever .......................... Measles ...................... Brain fever ...................... Brain fever ..................... Brain fever

La grippe ....................... Whooping cough ................ Congenital ...................... ....................... Unknown ....................... Unknown ..................... Scarlet fever Unknown ....................... Congenital ......... ; .............

September 23, 1887 October 2. 1892 October --. 18% May -. 1893 September 14. 1892 September 19. 1888 September 26, 1894 September 26. 1894 September 20. 1893 September 16. 1891 September 20. 1893 October 1. 1885 October 1. 1885 September 17. 1886 September 20. 1893 September 20. 1893 October 1. 1892 September 16. 1891 September 20. 1892 October 1. 1886 September 12.1883 aeptember 14. 1892 September 14. 1892 September 14. 1892 September 17.1884 September 23, 1857 September 16. 8891 September 15. 1879 September 26. 1894 September 19. 1888

................

Sabin, Willie .....................

Btodoh, John.. ................. Brnith, Anna C .................. Emrh, Mary.. .................. Bpencer, J o h m a ............... Boanlan, Mabel.. ................

eaker, Lillie E.. .............. ............. ahn, Nhrgareta

LIST OF PUPILS 1893-94-Co~zcEzideed. 4 w - - - I+

I I I I ' 1 NAME. OOUNTY. CAUSE Ol? DBAFSEBS. ADMIsSIO~.

Red Willow ........... Douglas .............. Richardson ........... Dakota.. .............. Otoe .................. Boyd .................. Douglas ............... Douglas ............... Doughs ............... A d ~ m s ................ Hall.. .................

La grippe ....................... Unknown ....................... Bpinal fever.. ................... Typhoid fever. .................. Earache.. ....................... Fall.. ........................... Congenital ...................... ...................... Congenital

................. Typhoid fever.. ....................... Unknown

Spinal meningitis ...............

Trissell, Myrtle G.. ............. Vaughn, John.. .................. Wittwer, Isaac.. ................. Whited, Ernest.. ................ Willman. Hesler. ................ Wfight, (3hloe €3. ................ Welch, Anna M.. ................ Williams, May.. ................. Zaclins, John .................... Zeilier. Jaoob ................... Zweifel, Maud E.. ...............

September 26,1&4 January 2!!,1&88 September 16, 1891 September 19,140 September 27,1890 September20, 1893 u September 26, 18% Jannam -, 1894 December 3,1886 2 September26,1894 September 30.1890 $

6 17 7

13 8

10 6 5

14 8 8

INSTITUTE FOR DEAF AKD DUMB.

PHYSICIAN S REPORT.

To the HonorabZe the Borird of Public Lands ulzd Buildings:

GENTLEMEN:-AS physician to the Deaf and Dumb Institute, 1 have the honor to submit the follcwing report for the two suc- cessive years, ending November 30, 1894.

The aggregate number treated in the hospital was 161. A tabulated statement of the diseases, and results is herewith ap- pended I n addition to these there were the usual temporary ail- ments, and accidents requiring attention from the nurses and at- tendants and occasional advice from the physician, but of which there is no record

The institution was uuusuillly free from sicknese durrng the school year of 1692-93. The increase commenced the last part of the calendar year 1893, manifested chiefly by various forms oE catarrhal troubles, and ending the school year with an epidemic of measles. The first case of measles was admitted the 28th day of

February, 1894, and the last on the 27th of March. During this time forty-five cases were treated, taxing the hospital to its full capacity. All recovered without any after bad effects.

The two mses of scarlet fever were isolated in the old frame building standing some distanea from the other buildings, and no others occurred.

October 19, 1894, four cases of typhoid fever were sent to the hospital, and afterward, up to November 22, seven more, making a total of eleven cases. None since that date. Of these, one d i d , two remain in hospital, one of whom was the first case admitted, but now convalescent, and the other, the last one ad- mitted, will donbtless recover. I t is not difficult to trace the origin of this disease. The school opened the 26th of September. Many of the victims were ill at that time, and not till the full devel.

878 LAND COXM~SIOREB'S BEFORT.

brain and baffled all treatment. In several instances we know the disease was in the communitiee during vacation. Besides, it is a notorious fact that typhoid fever has been more prevalent than usual throughout the state. I speak of this to correct any impression that may have gone out, through newspapers orother- wise, that this disease had a local origin. I n regard to the needs of the Institution, I heartily concur in the recommendations of the Superinteudent. Owing to the faulty construction of the old buiIdings there are some.things that cannot be remedied. I t is unwise to ventilate large public: buildings, particularly school- rooms and dormitories, through open windows, as thereby draughts are created, and " colds," so called, are " caught. " I am satisfied that many of the cases of "sore throat" and inflam- mation of the tonsils, so common, have had their origin in this wrsy. So far as possible the old buildings should be remodeled, and in the con~truction of new ones special attention should be directed to this matter.

The water supply and sewerage are also of im~nense impor- tanoe. The number of pupils is increasing year by year, very rapidly, from natural causes, and increased conveniences for their care must necessarily be provided. Not only must they be taken care of, but the state must provide for all contingencies of siok- ness, accident by fire, etc., that are liable to arise in even the best regulated institution.

The question of inadequate or unwholesome water supply

, and unsanitary sewerage would not be raised were tihe water fur- nished by the city and the sewerage connected with the oity sys- tem. The present faoilities for extinguishing fires are insuillcient, I might say useless, and one stands appalled in theoontmplatiw of such a possible catasirophy.

I t is well known that the sign language bas been the method mostly in ufie -to cops-ey ideas to the deaf in our institution. I n the experience of oar able superiatendent, a limited namber of 1

INSTITUTE FOB DEAF AND DUMB. 377

children were found with a limited amount of hearing remaining. This was utilized by teaching them aurally, with such gratifying results that this method is now employed in all suitable cases.

The question as to which individual subjects were the pro- per ones to put into the hearing and speaking classes could not be determined by the superintendent alone, so at his request my partner, Dr. F. T. Owen, who is an expert specialist in such lines, undertook thq examination of the 135 pupils, with the result that several children were found unsuspected, who were proper subjects, and have since been instructed in this way with remark- able success. This tedious, painstaking, and di5cult labor was accomplished without cost to the state. This examination revealed another important fact, via : That many children had diseased

of the ears, nose, and throat, that could be removed, or at least greatly ameliorated by proper treatment, which would often add to their receptive faculty of acquiring knowledge, and increase their ability to articulate, and thus make practical use of their knowledge. The great advantage to the individual and the state, both in a productive, and socialistic sense of view, cannot be over-estimated. This has been demonstrated in a few instances where the parents or friends were able to meet the expense of treatment, but it is well known that such cases are rare, and if anything is done for the larger number it must be done by the

I append herewith Dr. Owen's report, as part of my own, if it meets the approbation of the board, believing that the facts therein will be interesting, and profitable to the parents, the pub- '

lie at large, and physicians, and others connected with like in- stitution~. From a study of tables in this report, it would seem that there are something like 60 to 100 cases in each cIass of ear, nosla, and throat subjects, which should be looked after in the manner above indicated.

The experience of the last year has demonstracted the fact - that a spwial fund should be appropriated for the purchase of

medicinee and hospital supplies. Owing to the deficiency of the general fund the hospital has been embarrassed for immediate supplies. This would not occur under the plan I suggest, except in an extraordinary orisis.

I therefore recommend a special fund for medicines and hospital suppLies of 8160, per m u m , and physician's salary of $500 per amum.

INB'IITUTE TOR DEAF AND DUMB.

TABULATED STATEMENT

OF PATIENTS TREATED IN THE HOSPITAL OF THE! DEAF AI?D

INBTITUTE, FOB TWO SCHOOL YEABS ENDING NOV. 33, 1894, O M ~ H A .

NAME OF DISEISE. WHOLE NO. DEATHS. OURED. REMAINING.

... Boils ........................ 3 ... 3

... Bums ...................... 2 ... 2

... Congestion of liver.. ......... 1 ... 1 Corea ....................... 2 ... 2

... Croup ..................... 2 ... 2

... Debility.. .................. 10 ... 10

... Ear ache. ................... 3 ... 3

... Fracture of tibia.. ............ 1 ... 1

... Fracture of fore a m . ......... 1 ... 1

... Hoemorrhage ................ 1 ... 1

... Inflammation of bowlcs. ....... 1 ... 1

... Inflammation of tomila, acute. .. 12 ... 12

... Iuflammationof tonsils,ulcerative 29 ... 29

... Inflammation of mouth.. ...... 1 ... 1

... ............. Incised wound.. 2 . 2

. . . Indigestion .................. 2 ... 2

... Makria ..................... 11 ... 11

... Measler, ..................... 40 ... 40

... Neuralgia ................... 1 ... 1

... Pneumonia, croupous. ......... 3 1 2 Scrofula .................... 4 ... 4 . .

... Scarlet fever.. ............... 2 ... 2 Typhoid fever.. .............. 11 1 8 2

... Ulcers ...................... 1 ... 1 - - - - Totals.. .............. 161. 2 157 2

Respeotfnlly submitted, J. C. DENISZ,

Physi0ian.b Deaf and ~ i m b Instif&.

380 LAND ~ 0 1 1 1 6 1 ~ ~ 1 0 ~ ~ ~ ' ~ I1EPORT.

DEAF-MUTISM AND PREVENTABLE DEAFNESS.

KNOWLEDGE GAINED BY AN EXAMINATION OF THE EARS AND m p ~ ~

AIR PASSAGES OF ONE HUNDRED AND THIRTY-FIVE DEAF-MUTES, BY F. 8. OWEN, M.D., OMAHA, INSTRUUTOR I N OLINIOAL RHINOL-

Om AND LARYNGOLOGY, OMAHA MEDICAL UOLLEGE ; LARYNGOLO-

GIST TO PRESBYTERIAN HOSPITAL, OMAHA,

Speaking generally, m u t i m is the direct result of partial or complete loss of hearing; one is the natural sequence of the other. Yet the defects of the auditory apparatus cause no change, except indirectly, in the organ of speeoh,. as anatomical changes are not found more frequently in the larynx of the deaf mute thau, in the larynx of the person possessed of good hearing and speech, except those that naturally result from disuse of the

organ. Whether the deaf-mutism is congenital or acquired, we have

abundant evidence to prove that it is the direct result, in the majority of cases, of middle ear disease; or, speaking by way of oomparison, we find approximately the same proportion of middle ear diseases to labyrinth diseases in the deaf mute that we End in impairment of hearing at a latter age.*

Pursuant to a request of Prof. J. A. Gillespie, and to a de- sire on my own part for the data I would obtain, I htwe care- fully examined in the past six months the ears and upper air

I passages of the 136 deaf-mutes, pupils of the State School far the Deaf and Dumb, located at Omaha.

The hearing power and pathological changes of membirrse Qmpana are shown in the following general table, in acoord with the supposed causes assigned for their loss of hearing.

1 especially call your attention to the so-called congenitally deaf. It is in this class of cases that an abnormality of the labyrinth, the'auditory nerve, or brain, bas been often assumed to

* st. John Roov's Treatise on Diseases of the Ear, p, 687. 7

XRBTITUTE FOR DEAB AND DUMB.

be the most frequent cause of the deafness; but a careful study of the figures of this column will r e v e ~ l the fact that the lesion at least began in the middle ear in a large percentage of the oases, which is evidenced by the large number(34 out of 6O)who have perception of the sound of the tuning fork through bone and aerial condaction, and by the richness of the pathological ohenges in the membranm tympana. .

Although it has been stated by Schwartm* that in two out of every five new born children the tympana will be filled with pus, and by other investigatorsf that otitis media occurs with astonish- ing frequency in the new born, yet this doee not aocount for all those wmmonly ~luppoaed to be congenitally deaf. I t requires no proof to show that many commonly placed in this category, when found to be deaf s t the end of one or two years of age without a recugnized cause, are not of the truly congenital class. I am mnvind, after a careful study of these oases, judging on the one hand by the strong predisposition to disease of the middle ear existing at this age and the peculiar difficulty attending the rec- ognition of the same, and on the other by the present active na- ture of the disease and relative pathological changes and amount of hearing power, that at least in a small contingent the inception of the disease is to be dated some time afterbirth.

The gross lesions of the drum-head in those deaf from scar- let fever show that in the great majority of cases the disease first menifested itself in the middle ear and the internal became af- Eeoted secondarily; so also we have a similar picture in those deaf from oerebro-spinal meningitis, though the percentage of niiddle ear disease is not so great; yet the pathological changes in the drum-head and relative hearing power show that in a large percentage of the cams fhe disease had its starting point in the tympanum

*Troeltsoh's Diseases of the Ear in Children, p. 40. tHartman'a Diseases of the Ear, p. 156. C

INSTITUTE BOB DEAF AND DUMB 383

Space mill not permit me i n this paper to draw deductions from the figures under each heading of this table in detail, but a cursory glance will show that the anatomical changes in the mem- brancs tympana and relative hearing power evince the truth of the statement that in the great majority of the cases the defects in the auditory apparatus either exist or started in the middle ear.

Below I append a table representing the pathological changes . . .

- 71 33 31 135

PATHOLOGILldL OHANQES IN ANTERIOR NASAL CAVITIBS. - - - - Inflamed and tumefied inferior turbinated worthy of note 11 6 9 26 Inflamed and tumefied inferior turbinated with incipient

hypertrophy, causing partial or complete occlusion of thecavity ............................................ 10 3 8 21

Hypertrophic and aedematous inferior turbinated, anter- ior portion.. .......................................... 10 1 3 14

Posterior hypertrophies of turbinated.. ................. 7 .... 3 10 Hyperplasia of middle turbinated with impaction of the

same against the septum.. ............................ 5 3 3 11 Atrophy of the nasal mucous membrane ................ 3 6 .... 9 Deformities, consisting of deflections, spurs, etc., of septa 15 .... 11 26 *Ehinolitieu ............................................ 1 1 .... 2

PATHOWCtIUAL CHANGES I N POST-NASAL CAVITIES. Adenoids, causing more or less occlusion of the cavity. .. 15 10 5 .10 Membrane inflamed and hypertrophic.. ................. 14 8 12 32

FAUCES. Hypertrophied tonsils on one or both sides, encroaohing more or less uppn this space ........................... 16 9 5 30

Hypertrophy of lingual tonsil.. ......................... 1 3 1 5 Bifurcated uvula ....................................... 1 ........ 1 Mycosis tonsilaris.. ..................................... 1 1 .... 2 Hypertrophy of follicles of pharynx.. ................... 13 10 7 30 Atrophy of mucous membrane of pharynx.. ............ 1 1 .... 2 Lingual varix.. ........................................ 3 ........ 3

LARYNX. Overhsngingepiglottis.. ................................ 3 1 2 6 Other abnormalties of the larynx, consisting of paresis

of mllscles, thickened and irregular or attenuated vocal bauds,eto ............................................. 15 1 5 21

Uncertain ............................................... 16 3 1 2 21 * The nucleus of one consisted of a wild plum pit; that of the other was

a pieoe of shell of a nut.

found in the upper air passages, the totals of which are placed under the separate headings representing the various methods taught. The pupils of the manual class are instructed by means

of the manual alphabet, pantomime and the sign language. Those of tho oral elms are taught by speeoh, the pupils taking i t from the lips of their teacher. Those of the aural class are instructed by much the same method as in the oral class, except that lan- guage is addressed to the ear instead of the eye; ear trumpets are used when necessary.

I t is interesting to note the prevalence of hypertrophy of the -

lymphoid structures of the fauces and naso-pharynx, especially that of the naso-pharynx as characterized by adenoid vegetations. At first sigbt this seems like an astonishing number, but it ap- pears to be less exagerated when we remember that adenoids are a frequent sequel* of the exanthameta to which many of these children owe their deafness, and that they are the predisposing cause of the deafness in many instances in which a "cold," an ~6eara~hel" an exanthem, or whatever disease is supposed to be tlie direct cause.

I n the light of these facts, and Bosworth'sf statement that sixty to seventy per cent of all catarrh in children is due to adenoids, and Meyer's$ statement that seventy-four per cent of those having adenoids are hard of hearing, and 8winburn3s§ re. port that forty cases in 176 case8 of deafness are due to adenoids, it is not surprising, therefore, that so great a perdentage of young deaf-mutes should have adenoid growths; and the influence they may have exerted, either directly or indirectly as a causative factor of deaf-mutism, can be fully appreciated,

That so large a percentage of those abnormalities should 00-

cur in the oral clasa may seem inconsistent, but i t will be ob- served that the vocal organs of this class, with one exception, are normal; and then it must be remembered that every child who

Pritchmd's Diseases of the Elm, p. 40, 1. Medical Mirror, January, 1693, p. 36. $ Buck'sManud of Diseases of the Ear, p 171. g Medical Wiror, January, 1893, p. 36.

INSTITIJTE FOR DEAF AND DUMB. 386

shows the lead capability of artiaulating speech is placed in this

class, and so important to the child are the advantages of this

method, and so persistently is the oral method taught; that he is re-

tained in this class in spite of the defective speech and slow progress

g r w that these obstructions would necessarily occasion; and other

things being equal, his progress in acquiring speech is propor-

tional to his freedom from these growths, and other abnormalities

of the now and fauces that go to obstruct these resonant cham-

bers.

It is scarcely necessary in this connection to suggest the im- portance of clearing these parts from their various obstructions. Since the importance to the person blessed with good hearing to have these chambers that have to do with the quality of the voice, and the acquisition of good speech, freed from marked ob- structions, cannot be gainsaid; how much greater then is the im- portance to the person who cannot hear, and at the best acquires spseoh under the greatest disadvantage, to have these orgalls placed in the best possible condition.

Much good can be done along this line for these unfor- tunates, and intelligent treatment will enable the majority 'of those, to whom the sign lsnguage alone is otherwise possible, to learn articulate speech, and the gulf that would inevitably sep- arate the mute from his fellow man will thus be bridged over.

In this state there are about 500 deaf-mutes, or about one to every- 1,500 of the population; 310 of these have at some time been pupils at the state school. Practically speaking, these 1% from whom these tables are made will represent fairly well the entire number ae to the relative defmte of the auditory apparatus, and the diseases causing the same, though from the whole nnm- ber there would perhaps be a slight inorease in the percentage of those deaf from some brain affectioa

38 6 LAND UOYYIEU~IONER'* REPORT.

That so small a percentage (7 out of 135) should be found deaf from so common a disease as scarlet fever, where Caiger* tells us 12.9 per cent of the cases have dtitis media, and that none should result from diphthera, where Herman Wendt.1. tells us 20 per cent of the cases have the middle ear affected by the specific process, reflects great ctredif upon the methods of treatment em- ployed in these diseases by the profession.

A marked contrast, however, to the small percentage of the above named diseases as a cause of the deafness is seen in the large percentage of those deaf from cerebro-spinal meningitis. Since the pathological process affecting the middle ear in this disease does not differ essentially from that occurring as a corn- plicrltion of other diseases, the largest per centage is perhaps at least in part due rather to the difficulty of recognizing the com- plication of aural diseases than to the ineficiency of treatment. That proportionally so many cases should be found under the ar~signed cause of " earache," " a cold, " " scrofula," etc., is to be acaounted for by the lack of appreciation by the laity of the great import of a suppurating ear, an " earache " and the slighter evi- dencea of disease of the aural apparatus. Too frequently, in the light of to-day, a slight or marked deafness in a child goes un- treated through the false notion of t t e parents br aunts that the child will 'boutgrow it," and an acute otis media is treated by the mogt crude and barbarous means to subdue the pain, and when suppuration and perforation follow, is allowed to run ite destruc- tive course unchecked through the false notion that " it is dang- erous to meddle with it." The ignorance of the laity of all things pertaining to the ear, more especial!^ of the importance of early treatment, is scarcely less profound than during the dark ages, and too many deaf mutes and other unfortunates who swell the great army of the deaf are its victims. The physician who is at

*London Lanwt, June 6,1892. tTroeltsch, p. 46.

INSTITUTE FOR DEAF AND DUMB. 387

at1 times on the alert for aural disease in the very young, and guards and watches the ear in those diseases in which experience has shown it is liable to occur, as carefully and systematically as he does the temperature or pulse, and when this organ becoms affected, however slight i t may be, treats i t as diligently and judi- ciously as he would any other affection, still fails to perform his full duty if he does not at every opportunity try to instruct the laity and impress upon it the importanoe of timely treatment.