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A CONSIDERATION OF THE WELFARE OF DEAF 
 
 CHILDREN AND THE DUTY OF THE 
 
 MEDICAL PROFESSION. 
 
 CHARLES SMITH TURNBULL, M. D., PH. D. 
 
 OCULIST AND AURIST TO THE GERMAN HOSPITAL, PHILADELPHIA. ONE OF THB 
 
 TRUSTEES OF THE " HOME FOR THE TRAINING IN SPEECH OF 
 
 DEAF CHILDREN BEFORE THEY ARE OF SCHOOL 
 
 AGE," PHILADELPHIA, PA. 
 
 READ BEFORE 
 
 FIRST INTERNATIONAL CONGRESS IN AMERICA 
 
 ON 
 
 THE WELFARE OF THE CHILD 
 
 WASHINGTON, D. C, MARCH lo TO 17, X«oR 
 
 
w^ 
 
 
A Consideration of the Welfare of Deaf Children 
 AND THE Duty of the Medical Profession. 
 
 BY Charles S. turnbull, m. d. 
 
 Madam President of the National Congress of Mothers and 
 Delegates to the National Congress on the Welfare of the 
 Child: 
 Apart from the honor I feel in addressing such a represen- 
 tative and enthusiastic body as this assembly, I feel it a great 
 pleasure in pleading for the welfare of deaf children. This 
 subject was most near and dear to my father, Laurence 
 Turnbull, M. D., whose hfe work was the practice and teach- 
 ing of Otology. A specialty he, in the old time way, built 
 out of a large general practice. At the commencement of his 
 career he espoused the cause of teaching deaf children the 
 so-called *'oral method," particularly as advocated by the 
 Misses Garrett of Philadelphia. In the first edition of Dr. 
 Tumbull's work entitled, ''Diseases of the Ear," he devoted 
 a chapter to "deaf -mutism," which was a most comprehen- 
 sive resume of this interesting subject. It recorded its his- 
 tory and the results of his large experience, detailed accounts 
 of his visits to the schools of this country and abroad, and 
 concluded with an impartial review of all known methods, 
 as early as the year 1871, and he quoted the following itali- 
 cized paragraph to illustrate Miss Garrett's method:* 
 
 ''Great results have already been gained through the Oral 
 Method, and I have no doubt that greater and better results 
 than any already obtained await us in the future, as the 
 method becomes more widely and more strictly and intelli- 
 gently applied. The oral pupil who has the least amount of 
 intelligible speech and of lip reading compared with his 
 fellow oral pupils, has just that much advantage over the 
 most expert maker of arbitrary signs and the manual alpha- 
 bet, which are sure to be as unintelligible to the general 
 public as our speech is to the sign maker. 
 
 * Directions to Parents of Deaf Children. By Mary S. Garrett. 
 
 180928 
 
''The more perfect we can make the speech of the deaf, and 
 the more skilful we can train them to be in lip reading, and 
 the greater the amoimt of language we can teach them, the 
 happier and more independent they will be." 
 
 As a student I could not help but be impressed with my 
 father's enthusiasm and grow up with a fondness for the 
 subject we have under consideration, and you will, I know,, 
 excuse a pardonable pride and concede my deep interest as 
 justified. My wish is to arouse a universal interest concern- 
 ing the education of deaf c^ldren and ask your co-operation 
 in the welfare of the deaf child whose early training from this 
 time must be in visible speech in but one direction. I cannot 
 help but feel a hesitancy in the simple statement of facts 
 which it seems to me must sound commonplace to some of 
 you, because I feel assured that everybody who has been 
 interested for any length of time in the education and wel- 
 fare of deaf children must already be familiar with the meth- 
 ods about which I want to tell you. 
 
 Pantomime plays no part in the game of "speech imita- 
 tion" we are to champion. Given a deaf child (infant) the 
 first query suggests the all-important question "Is this or 
 that infant deaf ?" No! Emphatically no! Why not give 
 it the benefit of the doubt, keep talking to it straight ahead, 
 frown down anybody who instead of speaking at it, dares to 
 make a sign. Perhaps it may only be "tongue-tied." A 
 rare condition, but popular! Perhaps the child has defective 
 eyesight and does not see well enough to imitate speech. 
 Perhaps the child has congenital occlusion, some foreign 
 substance closes the auditory canals or scar tissue (cica- 
 trices) in its throat. Perhaps the child has a so-called " cold " 
 or influenza or gotten along to dentition time. Perhaps the 
 child has adenoids with or without enlarged tonsils. (At 
 this juncture permit me to pause and say that in the case of 
 '^ mouth breathing children^' our duty is almost as imperative 
 as in the case of the deaf for obvious well known reasons.) 
 Perhaps the child has recently suffered with some exanthema- 
 tous disease. Perchance, it has acquired or inherited some, 
 so-called, scrofulous disease. Many supposed reasons will 
 suffice to make us doubt permanent deafness. Therefore, 
 take it for granted that the child hears more or less and keep 
 on talking to it. The organs of speech are ready and at 
 
your service. Keep up the fight, nothing daunted, because, 
 if you do, the child's education has been started. The child 
 is not necessarily dumb if it should be deaf! A child possess- 
 ed with normal ears and hearing, who has never heard nor 
 seen speech, will just as surely be dumb as the deaf child 
 who has never been trained to see or imitate speech. 
 
 In training a deaf child full faith must always be retained. 
 Deception once practiced is fatal to discipline. When a 
 child once loses faith or has been deceived it will dread strang- 
 ers, especially the doctor, and all influence in the way of 
 discipline will be lost. Firm discipline must always be 
 maintained, not only for the good of the child but for the 
 comfort of the parents or teacher, both in every instance be- 
 ing the undoubted gainers. 
 
 Satisfy yourself that it sees your face in a good light. 
 Children are mimics. Encourage every effort to speak, and 
 after a fair, patient trial always call your physician and if he 
 is imable to assist you in solving the question, "Is the child 
 deaf?'' special counsel must be called to solve the questions 
 I have suggested, and secure intelligent advice. 
 
 All deaf children with good eyesight can, with extremely 
 rare exceptions, and ought to be taught to talk and can learn 
 speech reading, provided their parents, care-takers and 
 teachers know how to guide and instruct them. When 
 parents discover an infant to be deaf, they should continue 
 to talk to it, just as every mother does a hearing baby when it 
 is learning to talk; she does not use motions to it because it 
 has not yet commenced to understand her language, but she 
 repeats over and over again, to it, the pet names she calls 
 it, tells it again and again to "say papa," "say ma-ma," etc., 
 etc., until it learns to understand and then to imitate her 
 words. She is keen to discover, encourage and correct its 
 first attempts at articulation. 
 
 The child should be strictly trained to depend entirely upon 
 speech reading and that alone, and everyone with whom 
 a deaf child comes in contact should talk at it, i. e., to it; 
 and encourage and aid it to articulate. Deaf babies begin to 
 say "ma-ma" just as hearing babies do, but as a rule it is not 
 encouraged. If it were and the child properly guided to 
 further articulation, it would soon talk and evince every 
 sympton of joy and delight. 
 
The Hon. John Hitz, Superintendent of the Volta Bureau, 
 says: ''The fact is well established that defective auditory 
 organs are distinct and as independent from those of speech 
 as they are from those of vision, and if people in general knew 
 that they would more likely disassociate the organs of speech 
 from those of hearing as fully as they generally do the defects 
 of sight from those of speech, and realize that if properly 
 taught the deaf would organically as readily be able to speak 
 a^ are the blind." 
 
 Director Frederick Werner, of Stade, Germany, says: 
 " Develop speech in the deaf child in such a way that his THINK- 
 ING may as soon as possible he based upon his speech sensa- 
 tions." Thus formulated we have a fundamental principle 
 in which is found " the long needed and sought for psychological 
 basis of the oral method." 
 
 For instance, a case on record where a mother, finding her 
 boy of two years old did not talk, and after having been told 
 by a physician that he was totally deaf, talked to him con- 
 stantly, knowing nothing of methods. She treated him and 
 talked to him as a normal child, with the result that he not 
 only has a natural voice, but is also in every other way, 
 except hearing, a natural child. He is now five years and 
 five months of age, and is able to read speech from the lips 
 of strangers. This boy's clever mother stated nothing 
 angered her more than to see any one use motions in talking 
 to her child. 
 
 Another case well known to Miss Garrett was that of a girl 
 who was about nine years old when she was discovered. She 
 was a so-called "deaf-mute," whose parents had always been 
 wise enough to talk to her (at her) from infancy. She under- 
 stood speech, talked and was able to take part in all ordinary 
 conversation. 
 
 It is unnecessary for me to say how profligate it is of care- 
 takers of the human body to neglect physical developement. 
 In these days of athletics and the strenuous life, it is almost 
 an insult to any intelligent person to suggest that imless a 
 muscle be used and put to work it will waste, atrophy and 
 soon be useless. This is, alas! too frequently and painfully 
 evident in cases of neglected injuries and fractures of the 
 limbs, etc., which have been put up in splints or plaster, and 
 have been allowed to remain without any motion until such 
 
time as the dressings were removed. Many a Umb in such 
 neglected cases hangs stiff and useless for want of proper 
 care, of massage, friction and passive motion — in short, ex- 
 ercise. Why should we not expect the same to occur in the 
 muscles of the organs of speech? Unless developed and put 
 to u^e they degenerate. 
 
 The oculist has no difficulty in convincing the parent of 
 a "cross-eyed child,^' that simple lack of use of the deviating 
 eye is the cause of every case of squint. If one of a pair of 
 eyes is not good enough for associate use with its fellow, 
 " Nature " abandons it, sets it in or out, and keeps it there, out 
 of the way, so that a blurred or indistinct image does not 
 embarrass that of the better fellow-eye. If one of a pair^^of 
 eyes be sightless there is nothing to hold it in place on account 
 of lack of fixation and the stronger of the two muscles pulls 
 it in or out. Nature knows better than to attempt to fuse a 
 blurred or indistinct image with a good one. Correctly fit 
 and adjust spectacles, and the unused weak eye, with its 
 undeveloped muscles, at first refuses to work with its fellow ; 
 although later, when properly corrected, this once poorer 
 eye works equally well. Hence the necessity for putting 
 infants' eyes in order and at work, exercising the muscles at 
 once. 
 
 A further consideration of the welfare of deaf children 
 brings the student to a study of the laws of inheritance, 
 heredity and consanguinity. Here is an awful pause! If 
 such a student be a medical man and the added consideration 
 of the diseases which cause deafness be recognized as another 
 factor which might have aided in the actual foundation of a 
 deaf -variety of the human race, we of the medical profession 
 must be up and doing, lest forgetful of the Hippocratic 
 oath we be charged with neglect of duty. We have the 
 important duty of guiding and instructing parents of deaf 
 infants and children. Pause and reflect a moment when 
 I tell you that one child is deaf out of every fifteen himdred. 
 Dr. Alexander Graham Bell tells us that over fifty per cent, 
 of twenty-two hundred and sixty-two congenital deaf-mutes 
 had deaf-mute relatives and even thirteen per cent, of the 
 deaf from other (accidental) causes had deaf relatives. 
 
 The family physician, autocrat as he doubtless is, can 
 wield a tremendous influence with his adoring families of 
 
8 
 
 patients. It is the duty of the medical profession to prevent, 
 if for hygienic reasons, the segregation, as a class, of any 
 and all children, much more so of deaf children, who must be 
 brought up under the environment of homes or in its home. 
 We must retain normal environment as nearly as possible 
 during the period of education. If children must leave home 
 for special training, let it be at an age when they would ordi- 
 narily commence to talk. There is no sense so variable in 
 its development as speech. Some children begin to talk 
 at twelve to eighteen months, others not until after the 
 second year. Some pronounce distinctly at three years and 
 others not until nine or ten. 
 
 C. G. Pearse, Superintendent of Schools, Milwaukee, Wis., 
 
 "A great hindrance in the teaching of deaf children has 
 been the fact that they began to learn language and speech 
 when they came to school, several years after normal children 
 acquire these accomplishments. For this reason they are 
 likely to master these arts less perfectly, and to be Tater in 
 getting an elementary education than our normal children. 
 For a few years a departure in Pennsylvania, ''The Home 
 for Training Deaf Children in Speech Before They are of 
 School Age," Philadelphia, has attracted marked attention. 
 Into this school deaf children are taken for instruction at 
 age when normal children are learning language and speech 
 at home. Experience here has shown that deaf children 
 may in effect be almost as well grounded in language and 
 speech by the time they reach the usual school age, as are 
 their more fortunate mates who have all their senses. The 
 lessons taught by this school are not unlikely to prove the 
 greatest step forward in the teaching of deaf children that 
 has been taken since oral teaching was established." 
 
 "The public schools should stand anxious to increase the 
 scope of their usefulness, and become so far as they may, to 
 all the children of the state, the door of opportunity, as they 
 now are to all the normal children of the State. That we 
 should so order our system of public education that we may 
 care not only for the normal, but the great majority of those 
 who depart from the normal type, either through lack of 
 some bodily power or sense, such as sight, or hearing, or 
 through some intellectual lack, where that lack is not such 
 
9 
 
 as to render them incapable of leading self-directed lives. 
 That our search in this direction should not cease until we 
 have brought within the magic circle of our people's schools 
 all the classes of defective or attypical children, except those 
 unfitted by their misfortune to lead self-controlled, self- 
 directed and self-supporting lives; and have made it possible, 
 in these schools, for them to receive the special care and 
 special edueational facilities which they require, while at 
 the same time remaining in their homes in the care of father 
 and mother, in the companionship of brothers and sisters, 
 approaching more and more nearly, as their educational 
 years pass by, to the normal type of the society in which 
 they must take their places, tending less and less to become 
 members of a class apart, unseeking and unsought by their 
 normal fellow man." 
 
 Mr. William Nelson, Headmaster of the Royal Schools for 
 the Deaf and Dumb, Old Trafford, Manchester, England, on a 
 visit of inquiry to schools for the Deaf in the United States 
 of America, writes at length of ''The Home for the Training 
 in Speech of Deaf Children Before They are of School Age." 
 He says: "This is the school which has excited my interest 
 for some years, as its aims and methods were so entirely new, 
 that I believe very few teachers in England credited the 
 accounts that had been given of it. 
 
 It is composed of two detached villa residences, and stands 
 in the middle of the fine park just outside of Philadelphia. 
 
 Its object is described in the following words by the Princi- 
 pal, Miss Garrett: ''The fact that all deaf children, after 
 leaving school, must live their Hves and earn their living 
 among hearing people, and that heretofore so little has been 
 done toward training them until they were of school age, had 
 induced us to try teaching them to talk as nearly as possible 
 at the natural age, and then sending them to be educated 
 with hearing people, among whom, as before said, they must 
 Hve their later lives." 
 
 The children are received at the age of two and up to eight 
 years old, but the earlier the better after they have reached 
 the age of two years. Their attention is constantly directed 
 to the Ups of everybody who comes in contact with them, 
 from the lowest servant in the place to the head of the school, 
 and whatever they are doing, all through the day, becomes a 
 
10 
 
 constant lesson in speech and language and lip-reading. 
 Absolutely no signing is allowed. All this is done under the 
 most happy and delightful conditions. Although the child^ 
 ren, many of them, come from the very poorest homes^ 
 they are dressed and fed and treated from the first like 
 little ladies and gentlemen, and they play about^ in these two 
 beautiful little villas, as happy and well cared-for children 
 do in our best EngUsh homes. The whole feeling of the place 
 is delightfully nice and simple, and directed towards the 
 object they have in view, namely, the humanizing and edu- 
 cating of these little children. 
 
 My first introduction to them was at dinner, and this I 
 want to describe fully. The children were seated in groups, 
 aroimd small tables for eight or ten, with a couple of teachers 
 or more at each table, and a constant chatter was kept up 
 during the whole meal, in the most natural way possible. 
 This was really school in disguise, education around a centre 
 of interest, which could not fail to produce attention and 
 good results. I was asked by quite small children, if I would 
 Uke any bread, or any salt, or a glass of water, and where I 
 came from and whether I liked America. They told me that 
 Miss Garrett had been in England last year, and numerous 
 other things, such as might be said by ordinary hearing 
 children at the table. The whole thing surprised me very 
 much, as I had quite expected to find that the accounts of 
 this method of instruction had been exaggerated. 
 
 Miss Garrett does not teach abstract articulation, but 
 commences at once to teach speech, and in the lowest class, 
 with quite baby children of four years of age, such questions 
 as " Who cut your hair?" and " What did the barber do?" and 
 so on were asked and answered quite readily in amazingly - 
 natural speech. All through the school this method of in- 
 stiUing the language of early childhood is followed; the great- 
 est possible freedom is allowed, and no series of set lessons 
 or time tables is adhered to. I spent two days in examining 
 and looking into the working of this delightful school, and 
 the impression I got was that it was on the right lines un- 
 doubtedly, if the aim of deaf-mute education is to give speech 
 and lip-reading in such a natural way as will readily be ac- 
 cepted and understood by the general public. Miss Garrett, 
 in order that I might follow up her idea, that after the Ian- 
 
11 
 
 guage difficulty had been solved for the deaf, and natural' 
 everyday speech given, that they should be transferred to 
 ordinary schools for the purposes of education proper, very 
 kindly invited a number of her old pupils to meet me at 
 supper next evening. The boy who sat next to me was at a 
 grammar school, and he told me he was intending to be an 
 engineer. They were all doing exceedingly well at school, as 
 their reports plainly showed, and as I could readily imderstand 
 from their fluency and accuracy in the use of everyday speech. 
 I had the pleasure of giving them a short lesson after supper 
 on some birds' eggs, which some of them had brought. They 
 were easy to teach, and, what is very unusual with many 
 of the orally-taught deaf, the work could proceed quite rapid^ 
 
 One of the secrets of this success is no doubt due to the 
 fact that the children never go home for holidays during the 
 first six years of instruction, which means that the continuity 
 of speech training is unbroken. I have no doubt the ad- 
 vantage of that is quite clear to all teachers, who have experi- 
 enced the disastrous results of a long holiday away from 
 school, often in a wretched home, where the influences are 
 entirely opposed to all that goes on in school. This is one 
 of Miss Garrett's strong points, and it shows with what per- 
 tinacity she has carried out her ideas and fought the question 
 through in order to secure her ends, both in legislation, with 
 the parents, and, unfortunately, with teachers. 
 
 I believe that the influence of this one school in America 
 will count for much in the future. It is already beginning to 
 tell, and there are signs in many of the larger schools that 
 fresh ideas and new thoughts are in the air in regard to the 
 teaching of the deaf. What strikes me, is that with the 
 present attitude of the " powers that be " in our own country,, 
 it would be impossible to drop a lump of leaven like this into 
 our midst at the expense of the State. This elasticity applies 
 not only to Miss Garrett's school in America, but to all 
 schools that I saw. Freedom to teach is given to the school 
 by the State, and freedom to invent, and adopt, and try new 
 methods, is given to the teachers in the schools. Mistakes 
 are made, but the general gain is greater than the loss, and 
 the deaf schools in America in this respect honestly reflect the 
 general national spirit which allows the apprentice at the 
 
12 
 
 bench to "have his say," and to use his mind in everything 
 that touches his work. Fault-finding is not one of the signs 
 of State control in America. The money is freely given and 
 freely expended in order that the utmost may be done for 
 the children it is intended to benefit. 
 
 The general attitude of the Inspectors and the State de- 
 partment is one of sympathetic encouragement, and the 
 teachers on the visit of the Inspectors, go on with their work 
 with confidence. The rise of such splendid work as Miss 
 Garrett's is the outcome of this remarkable sympathy on 
 the part of the State." 
 
 When considering consanguinity, Dr. Alexander Graham 
 Bell* says, in his more than interesting and valuable article 
 on Eugenics: ''If there are any conditions under which con- 
 sanguineous unions would be a benefit to man they^ should 
 be made known so as to enable us to understand certainly 
 what conditions are beneficial and what harmful to the end 
 that public opinion may be rightly guided in its treatment 
 of this important subject. We have statistics which indi- 
 cate very clearly that consanguineous unions should not be 
 contracted by defective persons, and the results obtained 
 by Dr. E. A. Fay are specially significant in this connection. 
 He shows that there is a considerable liability to the produc- 
 tion of deaf offspring where a deaf mute marries a blood 
 relative even in cases where the original deafness was' not 
 congenital. The statistics of the twelfth census of the United 
 States show that at least 4.5 per cent, of the deaf of the 
 country and 4.5 per cent, of the blind are offspring of con- 
 sanguineous marriages, but we do not know conclusively 
 whether consanguinity in the parents produces the defective 
 condition or whether it simply intensifies a pre-existing 
 tendency in the family. The largest percentage of children of 
 cousins marriages are found among the deaf who have deaf 
 relatives (8.8 per cent.) and among the blind (9.5 per cent.) 
 who have blind relatives." 
 
 ''If it be true that 'the proper study of man is man' no 
 higher or nobler subject of research can be found. The 
 improvement of the human race depends largely upon two 
 great factors, heredity and environment: and we deal chiefly 
 with the question of heredity. 
 
 •A Few Thoughts Concerning: Eugenics. The National Geographic Magazine, 
 February, 1908. 
 
13 
 
 ''The institution of marriage not only provides for the pro- 
 duction of offspring but for the production of morahty in the 
 community at large. This is a powerful reason why we 
 should not interfere with it any more than possibly can be 
 helped. There are other reasons, however, arising from a 
 consideration of the rights possessed by individuals in a free 
 community." 
 
 I wish in this connection to draw your attention to the 
 marked effects of voice culture in throat troubles and deaf- 
 ness. In the latter case pronounced benefit seems almost 
 invariable by means of vocal vibration of the parts through 
 specially evolved exercises, for the chest, posterior portion 
 of the throat, tongue and lips. Every child is receiving a 
 certain amount of voice culture at Miss Garrett's Home. 
 The advanced classes already show marked improvement, 
 not only in their voices but in their manner of speaking^ 
 promptness of response being particularly noticeable. 
 
 Miss M. S. Zane, who is devoting particular attention to 
 this special branch, tells me: In a comparatively short time 
 she found not only a marked improvement in articulation, 
 but that the child even showed an appreciation of the fact 
 that they had found another source of relief. Even in the 
 classes of very young children, as all classes are receiving 
 this training, they are eager for this exercise, which is another 
 proof that it is quite natural for deaf children to use their 
 voices and that they do appreciate every effort that tends 
 toward making them like other children. It is an understood 
 fact that all organs and members of the body should be put 
 in their normal condition, performing their natural functions; 
 and only when this is accomplished are we the happier. Then 
 why, because the child has been deprived of one faculty,, 
 should we permit it to be deprived of the use of others. 
 
 Industrial Training: In our endeavor to follow the lines 
 endorsed by leading educators, we have, with several back- 
 ward boys in the Home, given them the special training for 
 learning speech and language, and then advised industrial 
 training among the hearing, instead of sending them to 
 ordinary schools, which is our general custom. The in- 
 dustrial results have been as successful as with the children 
 who are not mentally backward and the pupils' mental de- 
 ficiencies have been lessened. We train the hands of all the 
 
14 
 
 children, however, young, in accuracy, beginning with folding 
 their table bibs evenly, etc. As soon as they are at all old 
 enough they go to the sloyd room and lay, under a male 
 teacher, foundations for their later industrial training. In 
 their lessons there we seek to discover and encourage the 
 natural bent of each individual child. 
 
 Physical Training: Neither the Sloyd Teacher nor the 
 Teacher of Physical Training at the Home have had any 
 special training for teaching the deaf, but teach just as they 
 do hearing classes in schools. 
 
 Sir William Wilde, whose work on "Aural Surgery," reads 
 more like a novel than a text-book, pays a touching tribute 
 to teachers of the deaf children. In his forcible style, he 
 ^ays: 
 
 *'For wealth, men have risked their salvation; for fame, 
 men have periled their existence; for religion or enthusiasm, 
 men have died at the stake ; — the miser or the murderer saw, 
 however, the golden glare of riches beyond the gulf of crime; 
 the warrior felt already the laurel on his brow, and heard the 
 shout of his welcoming country-men as he sought the thickest 
 of the fray; — but to me it has always appeared that the 
 patient instructor of the deaf deserved a reward which noth- 
 ing earthly could bestow. And the energy, perseverance, and 
 philanthropy of those good women and men who have from 
 time to time undertaken in different countries that herculean 
 task of teaching the eye to hear, have only been equalled by 
 the eloquence of those who have advocated the claims which 
 the deaf have upon all to whom the Creator has afforded the 
 blessing of speech and hearing." — (Wildes' Aural Surgery, 
 Am. Edition, Addinell Hewson, 1853.) 
 
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{ 80928