Kot<>. 
Thanks to anasthesia, asepsis, electric illumination, improved surgical 
instruments, increased knowledge and increased operative skill, aural 
surgery has made great advances in recent years. 
The lecturer’s object has not been to exploit the skill of a few aural 
surgeons to the disadvantage of others, but simply to introduce sufficient 
evidence of progress in this branch of surgery to arouse greater interest 
in the subject, both among laymen and the profession. 
While stapedectomy may be rarely resorted to, the advances made in 
aural surgery, the rapidity and painless nature of middle-ear operations, 
and the great benefit to health, to comfort, and, in many cases, to the hearing, 
resulting from judicious surgery, call for thorough and stated re-examinations of 
the cars of the deaf, including the so-called deaf and dumb, by otologists of re- 
cognized standing. It is estimated that not less than 250,000 young persons 
in the United States need such examination with reference to the amelio- 
ration of deafness by judicious remedial measures. 
For economy’s sake, the lecturer’s explanation of Dr. Frank 
Baker’s series of large charts representing the entire scheme of the 
ear has been omitted, and certain plates from Dr. Harrison 
Allen’s I.ake-George lectures have been inserted in this brochure. The 
lectures, as printed, have been made up from the stenographer’s notes by 
a friendly hand without submission of proof sheets to the speaker for 
revision. 
Particular attention is invited to marked passages jgJFe ‘2rI4ectt»r»». _ 
J. C. G. AMERICAN ASSOCIATION TO PROMOTE THE TEACHING 
OF SPEECH TO THE DEAF. 
Fourth Summer Meeting, 
CHAUTAUQUA, N. Y., JULY, 1894. 
[Proceedings issued in sections.] 
PROGRESS IN THE AMELIORATION OF CERTAIN FORMS 
OF DEAFNESS AND IMPAIRED HEARING 
BY 
DR. J. C. GORDON. 
ROCHESTER: 
Western New York Institution for Deaf-Mutes 
1894. PROGRESS IN THE AMELIORATION OF 
CERTAIN FORMS OF DEAFNESS 
AND IMPAIRED HEARING 
BY 
DR. J. C. GORDON 
OF THE 
N \TIONAL DEAF-MUTE COLLEGE. 
WASHINGTON, D C. Tympanum or Middle Ear, Auditory Ossicles (left) Magnified—A O external auditory meatus: 
M, membrana tympani which is attached to the handle of the malleus n; and near it the short process, 
p; h, head of the malleus; a, incus; fr, its short process with its ligament; l, long process ; 8, orbicular 
ossicle so-called ; S, stapes; Ax, Ax, is the axis of rotation of the ossicles it is shown in perspeftive, 
and must be imagined to penetrate the plane of the paper ; (, line of traftion of the tensor tampani. 
The other curved arrows indicate' the movement of the ossicles when the tensor contrafts; t, grooved 
prominence. 
I. Tympanic membrane and Auditory Ossicles (left)] Seen from Within, i. c., from the tympanic 
cavity. M, manumbrium or handle of the malleus’T,jinsertion of the tensor tympani; h, head; IF, long 
process of the malleus; a, incus, with the short (.KVand the long (i) process; S, plate of the stapes; Ax, 
Ax, is the common axis of rotation of the auditory ossicles; S, the pinion-wheel arrangement between 
the malleus and incus. 
II. and III. The Auditory Ossicles (right).—C. m-lhead; C, neck; Phr, short process; Prl, long 
process; M, handle of the malleus; Cl, body of lncus;’G, articular surface; h, short, and v, long process of 
the incus; O S so-called lenticular or orbicular ossicle: C, 8, head; a, anterior, and p, posterior limb of 
the stapes: P, plate or foot-piece of the stapes. PROGRESS IN THE AMELIORATION OF 
CERTAIN FORMS OF DEAFNESS 
AND IMPAIRED HEARING. 
It seems a little remarkable that those whose life-work is de- 
voted to the amelioration of deficiencies due to deafness, should 
know so little about the organ of hearing as most of us do. And 
it will certainly be entirely inappropriate for me to attempt to 
give an explanation of the ear after the elaborate course of lectures 
on this subjeft bv Dr. Harrison Allen at Lake George. 
In the great majority of the cases we have to deal with, the 
trouble in hearing is chiefly with the curious conducting mechanism 
of the middle ear. The statistics furnished in regard to deafness 
are of very little value indeed, in helping us to render any bene- 
fit to those who are deaf, however interesting they may be in 
other respects. They furnish no clue to treatment by surgeons 
or others. In the great majority of cases of deafness as a re- 
sult of disease, the disease is in the middle ear, and whatever be 
its character, the ultimate result in general, is a thickening or 
partial loss of the tympanum, an ankylosis or closing together 
of the joints of the bortes of the ear; and, worst of all, the plate 
of the stapes becomes utterly unable to work, or move. In a 
number of cases examined it has been found that the play of 
the stapes was absolutely prevented, so that even a mallet and 
chisel could with difficulty detach the adhesions. 
Now, in the medical practice of the present day, great ef- 
forts are made to effeCt the mobilization of the transmitting 
mechanism. Aurists meet with insuperable difficulty in many 
cases owing to intra-tvmpanic adhesions, and science has so far 
not discovered any absolutely certain way of overcoming these 
adhesions bv anv merely medicinal treatment, or system of mas- 
sage without recourse to aural surgery. 
Seventy-two per cent, of deafness from disease is connected 
with the thickening of the tympanum, which renders the trans- 
mitting mechanism in the middle ear utterly useless. This percent- 
age has been obtained from 2,794 cases out of 4,142 examined by 4 
Blake, Burnett and Spenser. About 25 per cent, are connected 
with the outer portion of the ear; and not more than 3 per cent, 
at most aretconneded with the inner ear, the essential organ of 
hearing. The portion of the labyrinth, known as the semi-cir- 
cular canals is now generally admitted not to be an organ of 
hearing, but of balancing, and of direction or co-ordination of 
movement. 
This transmitting mechanism becoming stiffened and com- 
paratively useless, the problem has been what to do with it. 
Early in the century it was recommended to perforate the tym- 
panum and let air into this cavity, hoping that would be of 
some benefit. The eustachian tube, frequently becomes prac- 
tically closed, so that there is a difference of atmospheric pres- 
sure between the outside and inside of the tympanum, causing 
an excessive thrust upon the tympanum and chain of bones, 
and reducing the elasticity of these parts. These perforations 
have been made, producing an equilibrium, and in certain cases 
benefit has been derived from this slight surgical operation,— 
the perforation of the tympanum. The difficulty about it is 
that these perforations heal up rapidly, and need to be opened 
over and over again, and of course the patient objefts to that. 
In the operation as now performed the tympanum is removed 
permanently in many cases. 
Late in this century, surgery has made such progress that 
aural surgeons have undertaken to operate upon these three bones, 
or portions of them, in connexion with the tympanum, effecting 
the removal of the tympanum, sometimes effecting the removal of 
the malleus, and in some cases disarticulating at the first joint, 
and in others removing the incus; but the latest and the most 
startling operation consists in the removal of the stapes, some- 
thing which until recently it was deemed quite impossible to 
accomplish by any legitimate surgical operation. 
Partial excision of the drumhead was recommended by Sir 
Astley Cooper, and others; but the drumhead and malleus were 
not excised until 1872, when Schwartze performed the operation. 
He removed the major part of the tympanum, and removed the 
malleus in 1873. Five years later, in 1878, Kessell of Jena, re- 
ported the removal of the drumhead, the malleus, and the incus, 
and in a short time after that, he performed the operation in five 
other cases. The results were highly favorable to the hearing, 5 
but a growth rapidly formed, the tympanum closed up, and 
there was little benefit from the operation ultimately. 
Kessell’s experiments on the lower animals, on dogs, birds, 
and especially pigeons, in 1871, were very instructive. He re- 
moved from these the stapes and other portions of the appa- 
ratus corresponding to the same in the human ear. In a very 
short time after the operation was performed, and healing oc- 
curred, these animals apparently heard as well as before—quite 
as well perhaps as any animals, and much better than in the case 
of persons whose transmitting mechanism is impaired in any 
way. The experiments upon these animals led Kessell to attempt 
several other experiments of a like character. In 1881, Lucae 
reported the excision of the drumhead and malleus in 23 cases. 
There was no deterioration of hearing in any, and a remarkable 
improvement in hearing in a number of them. In 1883 his 
operations exceeded 40, and still with good results in a majority 
of them; while there was no benefit in a few cases, on the whole 
the results were favorable. In 1885, he published the results of 
S3 operations. In all of them he removed the malleus, and he 
performed the removal of the incus in some cases. In a resume 
of Lucae’s cases, we find that in thirty of them, there was an 
adhesion and thickening, and the ankylosis of these small bones 
was considerable. In 9 cases the hearing improved considerably; 
in 19 cases the hearing improved slightly; in 18 cases the hear- 
ing was no worse; in 7 in which it was bad when he began, 
the deafness was increased. 
Taking this in another way: among Lucae’s cases there were 
28 cases of improvement in which the high tones of the human 
voice were heard better than before; in 21 of these cases the 
opening in the drumhead remained open; in 6 there was an 
entire closure of the drumhead. Stacke of Erfurt reports recently 
ten cases of the removal of the malleus, and all of them showed 
marked improvement of the hearing. A prominent aural sur- 
geon in the city of New York, whom many of you know by 
his works, Dr. Sexton, has been one of the most daring, con- 
sistent with caution, yet most successful in the line of middle- 
ear surgery. His first operation for chronic purulent inflamma- 
tion of the middle ear was in 1886. He could not practically 
operate as he desired, until the great advance of eleCtric science 
enabled him to use the electric light in the illumination of the mid- 
dle ear. In 1888 he reported 29 cases, 13 of which were cured 6 
completely, and 13 improved. Of these cases, in 19 he removed 
the malleus and incus, in 7 he removed the malleus alone, in 
3 he made an incision of the drum. He took out the incus, 
leaving the stapes in place. The hearing indicated a marked im- 
provement in 11 cases. The gain for the human voice was very 
considerable indeed, from 75 to 100 per cent., which made it 
worth while to undergo the operation. 
Now 1 want to say a word in regard to Dr. Sexton’s opera- 
tions. He says that when this operation is indicated, the patient 
need have no fear; the excision of the drumhead, and the removal 
of the malleus and incus, or either one, or both of them, is per- 
formed with very great rapidity, it takes only a few seconds, in- 
volves not more than a dozen tiny drops of blood, the patient does 
not feel it at all, and is usually able to take all his meals, while 
the healing is so perfect, thanks to aseptic surgery, that there is 
no need of any further treatment. Of course the case needs to 
be under the care of the surgeon. But it is all performed very 
rapidly; the healing in cases of good health is rapid and perfect, 
and the operation performed, in these cases at least, led to no 
ill results. 
Dr. Sexton has performed this operation since 1886 with 
universally good results, and in the earliest cases operated upon, 
the hearing that was improved continues to be as good as it was 
at the time of the operation, and much better than it was before. 
It may be of interest to know when the operation is indicated. 
In a general way, in cases of deafness, I should say that the 
friends of persons becoming deaf should consult the highest at- 
tainable recognized authority in aural surgery, at the earliest pos- 
sible moment, and feel perfectly safe in following his advice. But 
it may be of interest to know that Dr. Sexton and other aural sur- 
geons sav that these operations are especially indicated where 
the deafness, from non-suppurative disease of the middle ear, is 
noticed to be progressive, following degeneration of the ear, get- 
ting worse and worse,—then you may know that this operation 
is advisable. 
Suppose the hearing is very bad indeed, and at a stand-still, 
then it will rest with an experienced aural surgeon to decide 
whether an operation should be performed or not; but if the 
hearing is deteriorating, you may know that the operation is ad- 
visable. 7 
Section Showing Organs of Hearing.-—i. Pima or auricle ; 2. Conch with orifices of sebaceous and 
serumenous glands ; 3. Osseous portion of external auditory canal ; 4. External surfaces of the membrana 
tympani; 5. Anterior part of the incus; 6. Head of the malleus; 7. Handle of the malleus lodged be 
tween the internal and middle layers of the membrana tympani ; 8. Tensor tympani with its tendon at 
a right angle to be attached at the inner margin of the base of the handle of the malleus ; 9. Cavity of 
the tympanum; 10. Expanded portion of the Eustachian tubes; 11. Superior semi-circular canal; 12. 
Posterior semi-circular canal; 13. External semi-circular canal; 14. Cochlea; 13. The internal auditory 
*■31131 where the wall has been taken away to show the nerves which its transmits ; 16. Facial nerve ; 17. 
The great superficial petrosal nerve passing from the geniculate ganglion of the facial toreach its des- 
tination ; 18. Vestibular branch of the auditory nerve. 19. Cochelar branch of the auditory nerve. 
Scheme of the Organ of Hearing.—AG, eternal auditory meatus; T, tympanic membrane; K, 
malleus with its head (h), short process (kf), and handle (m); a, incus, its short process (,r), and its long 
process united to the stapes (n) by means of the os orbiculari so-called (z); P, middle ear; o, fenestra ovalis; 
r, fenestra, rotunda; T, beginning of the lamina spiralis of the cochlea; /if, scala tympani, and Vt, scala 
vestibuli; Vr, vestibuli; N, saccule; U, utricle; II, semi-circular canals; TK, eustachian tube. The long 
arrow indicates the line of traftion ol the tensor tympani; the short curved one, that of the stapedius. 8 
In suppurative disease of the middle ear the operation is 
generally indicated as the only hope of relief. 
I have a letter from Dr. Sexton in which he says that he has 
no doubt whatever from his knowledge of a number of cases of 
pupils in institutions for the deaf and dumb that a great many 
of our children should be operated upon. He thinks that there 
are a great many children whose hearing would be benefitted, and 
whose general health and comfort would be very much improved 
by undergoing this operation. 
Other aural surgeons have gone still further, and have per- 
formed operations involving the removal, or partial removal, of 
the stapes. It is an exceedingly tiny bone, and the whole oper 
ating field is smaller than the end of a lead-pencil; so that it 
is exceedingly delicate to operate upon it. There is not very 
much room; the instrument must be strong as well as sharp, and 
there must be room for light and for the use of the instrument; 
and the bones in some cases have to be extracted from a very 
small passage. Dr. Blake, however, in 1892, attempted with 
success, the removal of the stapes. He holds that the trouble in 
a great majority of cases arises from the condition of the stapes; 
much more so than the condition of either of the other bones. 
It is the key to the situation, according to Dr. Blake. 
Dr. Kessel found in a great many cases that the plate of the 
stapes was firmly attached and he attempted to improve the con- 
dition, not by removing the bone, but by cutting around it. 
Immediately after cutting around it, a system of massage was 
practiced, a modification of Hommell’s method, of which 1 shall 
speak presently. 
I may say that the operation upon the stapes by Dr. Blake, 
of Boston, was performed by him and his assistant in a small 
number of cases with very remarkable effedTs. Shortly after Dr. 
Blake began performing this operation in 1892 he met with an 
accident which temporarily disabled his hand, and his assistant, 
Dr. F. L. Jack, then took up the work and performed a number 
of operations after him. 
Of the cases operated upon, I have a summary of sixteen, 
in which all, or a part of the stapes, was removed. In some 
cases this bone is in a decayed condition, and crushes under the 
most delicate handling. 
In the 1st case on this record, before operation, a moder- 
ately loud voice could be heard at the distance of one foot; after 9 
the operation a moderately loud voice could be heard at the dis- 
tance of two feet. 
In the 2d, an ordinary voice could be heard ten feet away, 
after the opertion, eighteen feet. 
In the 3d case, the whispered voice could be heard eighteen 
inches away; after the operation, eight feet away. The ordinary 
voice in this case, singularly enough, could be heard twenty feet 
away before the operation, and twenty feet away afterward. 
In the 4th case, the loud voice could be heard fifteen feet 
away before the operation, and after it an ordinary voice could 
be heard twenty feet away. The whispered voice could be heard 
eight feet away. 
In the 3th case, the whispered voice could not be heard at 
all; after the removal of the stapes the whispered voice could be 
heard at the distance of two feet. The ordinary voice could 
be heard at the distance of one foot, and after at nine feet. 
In the 6th case, the whispered voice could not be heard at 
all; after the operation, at a distance of two feet; the ordinary 
voice, not at all before, but after the operation, fifteen feet. 
In the 7th case, the ordinary voice could be heard at nine 
feet away; after the operation, thirty feet and more. 
In the 8th case, the whispered voice could be heard four 
feet away before the operation, and fifteen feet away after it. 
In the 9th case, the whispered voice could not be heard at 
all before the operation, but it could be heard one foot away 
after. The ordinary voice could be heard two feet before, and 
twenty-tive feet away afterwards. 
In the 10th case, the whispered voice could be heard at 
the distance of two feet before; and three feet, after. The ordi- 
nary voice could be heard six feet before the operation, and nine 
feet, afterwards. 
In the nth case, the hearing was absolutely gone for all 
sounds except through a conversation tube; after the operation 
a whisper could be heard at a distance of seven feet, an ordinary 
voice ten feet, and a loud voice, twenty feet away. 
In the 12th case, the ordinary voice could be heard one foot 
away before the operation, and a loud voice at ten feet; after 
the operation a loud whisper could be heard ten feet away, and 
the ordinary voice, thirty feet. 
In the 13th case, the whispered voice could be heard two 
feet away before the operation, and the ordinary voice four feet. 10 
After the operation the whisper could be heard five feet; while 
the ordinary voice could be heard at a distance of fifteen feet. 
In the 14th case, the whispered voice could not be heard; 
after the operation, it could be heard at a distance of one foot; 
the ordinary voice was heard at six inches before, and at a dis- 
tance of seven feet, after. The loud voice five feet away before, 
and twenty feet, after. 
In the 15th case, there was a remarkable condition of the 
ear; the stapes and incus could not be found. The malleus was 
removed, and after the operation there was a slight improvement 
in the hearing. 
In the 16th case, a loud voice could be heard at three feet, and 
a whispered voice at six inches. After removal of both stapes 
and incus, the loud voice could be heard at thirty feet and whis- 
pered voice at six feet. 
These are the first sixteen cases reported by Dr. Jack. Since 
that, the operation has been performed, in all, by Dr. Jack, 
in 60 cases; Dr. Blake in 21 cases; Dr. Schwartze in 6 cases; 
Dr. Ludewig in 2 cases, and Dr. Grunnest in 1 case. About 
100 cases in all have been reported, so far, of the removal 
of the stapes. I am very sorry to say that the later cases have 
not been nearly so favorable in their results as the earlier 
ones. The reason of this is unknown to me, but that is the 
fad. At least in two cases, and perhaps in three, the patients, 
after undergoing the operation have suffered a great deal from 
long-continued vertigo. Whether the conditions of the patients 
were very different from those of the earlier patients, I do not 
know; but you can see that stapededomy should not be per- 
formed except upon the advice of the foremost aurists; and I am 
sure that when such authorities as Dr. Blake, or Dr. Jack advise 
that operation, the sooner you have it done the better. 
I am sorry that I have no summary of middle-ear operations 
by Dr. Roosa of New York, one of the most successful aural sur- 
geons in the world and well-known to you on account of his 
interest in the deaf and dumb. Dr. C. H. Burnett of Philadelphia, 
has operated upon the bones of the ear, (the incus alone, or incus 
and head and crura of the stapes), in a number of cases. I am 
sorry that I have not the statistics of his operations, for they are 
very interesting. He confines his operations ordinarily to the re- 
moval of the incus, and the head of the stapes, and he says that 11 
he is confident that in a great majority of cases as much improve- 
ment will result as from removal of the entire stapes, and the 
operation is a simple one. 
[A Voice: I should like to ask l)r. Gordon;—In the suc- 
cessful cases, did the tympanum heal again, or remain open ?J 
|Dr. Gordon: In many cases the tympanum healed; while 
in others it has been left entirely open, which is a very desir- 
able condition. It remained open in 21 of Lucae’s cases and 
closed in 6, and the hearing was improved in all. ] 
I have records of persons on whom this operation has been 
performed, in which there is not a trace of this membrane left. 
The middle ear opens up completelv, and it is simply a clean and 
dry passage. The phvsical condition is much preferable to that 
of those whose ears are affected by disease, because they are 
perfectly clean, and give no trouble whatever. An exposure to 
the air, under different atmospheric conditions, seems to occasion 
no inconvenience And I may say that in conversations I had 
with a number of members of the American Society of Otologists 
which met in June, I was told that in many cases even if this 
operation did not result in the improvement of the hearing of 
deaf children it would be highly conducive to the general health 
and comfort of the deaf. All discharges are easily controlled, 
and usually stopped completely. In a great many cases there is 
the disappearance of headaches, and other unpleasant symptoms 
with which some children are affefted. The operation is advised 
by some of these otologists even when there is no prospect of 
hearing, on account of the improvement of the general conditions. 
[A Voice: Is there any form of disorder likely to result from 
leaving an opening in the tympanum?] 
[Dr. Gordon: There is not. It is considered preferable to 
keep this open by some physicians; I cannot say that it is by 
all.] 
| A Voice: Is it possible that the removal of the eardrum may 
occasion inconvenience in swallowing, by leaving an open pas- 
sage from the throat to the external air through the eustachian 
tube ?] 
[Dr. Gordon: In a great many cases the eustachian tube 
has long ceased to perform its functions. By the way, the eus- 
tachian tube is situated so high that I imagine that ordinarily 
the opening could not interfere with swallowing It is placed 12 
much higher than we commonly imagine. Take this pencil here. 
If I push the nares up as far as possible, and push diredly 
back, 1 strike the end of the eustachian tube. ] 
The object of this discussion of middle ear surgery is to 
impress upon the minds of all that the “let alone” policy, 
wisely advised by judicious physicians in the past is not the 
highest wisdom for the present. The advances made in aural 
surgery render it imperative to submit every case of deafness to 
examination from time to time by aural surgeons with reference 
to the advisability of operative interference either for the improve- 
ment of the hearing or the health and comfort of the patient. 
Both auto-massage and massage by mechanical devices for 
the purpose of improving the hearing, through improved con- 
dition of the conducing mechanism, due to enforced exercise, 
have received a great impetus within a few years. 
Hommell’s method is a very interesting one, and it has been 
practiced with very favorable results in certain cases. Dr. Hom- 
mell, of Zurich, is a distinguished aurist, who began to lose his 
hearing a few years ago. He finally hit upon the device named 
after him, Hommell's method for auto-massage of the conducting 
mechanism. The operation is a very simple one, and yet it is 
not advisable to perform it in all cases. He took a finger and 
pressed upon the tragus, slowly at first, increasing these mo- 
tions to an operation of one per second for a minute. In some 
cases the patients will find a peculiar feeling at the end of a min- 
ute, and become dizzy. It increases the circulation of the blood 
in those parts, to say nothing of the mechanical movement of 
the ankylosed bones. And where the adhesion is not very firm, 
it has a tendency to mobilize the transmitting mechanism. Hom- 
mell recommended that his method of finger-aCfion upon the tra- 
gus, be kept up, taking sixty movements per minute for, say a 
week, when the aurist endeavors to increase the speed to 120 
movements per minute. To trace the effect of this, Dr. Hom- 
mell tested the hearing from day to day using the ordinary tests 
employed by physicians and made a chart of the hearing. If 
the hearing, for two or three days, is diminishing, instead of in- 
creasing or holding its own, it is time to stop. But if there is 
an improvement, this treatment is to be continued. In Dr. 
Hommell’s own case the results were very happy indeed. His 
hearing increased considerably, and in the case of a number of 
patients, especially young persons of the ages of eight to fifteen 13 
years, the hearing improved, so that the “ Hommell-method " has 
been introduced as a regular practice of successful physicians 
and aurists both in Hurope and America. I presume that it is 
safer to have I)r. Hommell’s method practiced under the direc- 
tion of a physician than to undertake it yourself, however sim- 
ple it may seem to be. For in some cases it is barely possible 
that you might set up an inflammation in this portion of the 
ear, which might prove somewhat troublesome. 
The question of using the phonograph, or vibrometer, or 
any other instrument for the purpose of improving the transmit- 
ting mechanism was considered by the American Association ot 
Otologists in Washington last month, and the experience of a 
number of physicians and surgeons was given on that occasion. 
They were, in general, disposed to resort to other methods of 
treatment, evidently having little or no confidence in the me- 
chanical massage of the ear for the improvement of the hearing. 
But there are reputable physicians who claim to have effected 
very good results in a number of cases by the use of massage. 
Dr. Houghton, of New York City, claims good results, es- 
pecially in catarrhal cases. There is, first, an increase of circula- 
tion in all these parts. You can feel that these parts are stimulated. 
The sense of smell in many cases is intensified and its power 
temporarily increased; and in some cases there is an increase in 
the flow of saliva, proving that there is a stimulating process go- 
ing on, and the result of the exercise is a better nourishment of 
the diseased parts due to the nerve-stimulation and better cir- 
culation of the blood. The theory is that the vibrations tend 
to promote the normal condition, and to draw off the effete de- 
posits that exist in many cases; there is, not infrequently, a re- 
moval of such deposits, and an increase of the mobility of the 
parts. But when the adhesion of the plate of the stapes, or of 
the chain of bones, is as firm as it is in a great many cases we 
have to deal with, no mobilizing of these parts is possible. 
Dr. Bissell. of Rochester, attaches a great deal of impor- 
tance to sound as a therapeutic agent. He uses vibrating strings 
for this purpose, and has devised an instrument which he uses 
in his practice. The strings are conneded with a sounding 
board, and the vibrations are transmitted to the ear by tubes 
from the board. He claims to have achieved good results in a 
large percentage of cases, but I am not able to give the figures. 14 
You know that Charcot, the great specialist in Paris, made 
use of vibratory massage from a stringed instrument in the treat- 
ment of nervous disorders. He attached great importance in- 
deed to the vibratory treatment of certain diseased conditions of 
the brain, and of the nerves. 
The instrument with which 1 have experimented a little my- 
self is one that is manufactured in Baltimore,—the vibrometer. 
It is essentially a banjo. It has the form of the banjo, the banjo- 
heads are made of wood and of metal, and there is an air-cham- 
ber between these two heads. The heads are set in motion 
mechanically by devices impelled by an eleCtric motor; and 
these devices are so adjusted that you can give graduated vibra- 
tions, in great variety. These vibrations are transmitted through 
rubber tubes to the ear. 1 have not been able to use the vibrom- 
eter in many cases, but I have diagrams interesting as far as 
they go. I have not only used the vibrometer to mobilize the 
conducting mechanism, but from time to time I measured the 
’degree of hearing for a certain kind of sound, as measured by the 
audiometer made by Professor Bell and Mr. Clarke. And the 
results of these measurements I have charted. 
I will take the case of a gentleman 84 years old, though 
I did not advise him to use the vibrometer nor did I discour- 
age his trying it. He used it a short time beginning January 
15th. At that time the audiometer reading was one centimeter; 
the 20th of January the audiometer reading was 2 centimeters; 
the 23d it was still 2. About that time he took a severe cold, 
and his hearing dropped. The 2 sth of January the record was 
above 1 centimeter. He could barely hear. He resumed the 
practice, and a day or so later it ran up to 2>4 centimeters. And 
then he took another cold, and down dropped his hearing again. 
Then we had long spell of delightful weather; he took his “ med- 
icine ” every day, and worked right along, and his hearing im- 
proved until the experiment terminated on the 15th of February. 
He could then hear at the distance of 3>4 centimeters. 
Another case was still more defined. This was a young 
man who had been in Mr. Gillespie’s aural class, but after he 
came to College his hearing deterioiated. He took the exercise 
on the vibrometer; and I took the audiometer measurements. 
First it went up, then he took a cold and it went down; then it 
went up, then was stationary, and then up, and down again. 
This was at a time when he was working very hard. Then we 15 
had fine weather, and he kept up the exercise, and his hearing 
improved. Then it dropped a little; and then improved again, 
the final record indicating considerable improvement in one ear 
and very slight gain in the other. 
[A Voice: Hearing by the audiometer; how about the hear- 
ing as tested by the voice?| 
[Dr. Gordon: The’hearing for the voice became better from 
time to time; but we. cannot always tell from the audiometer. 
I may say that when this young man began he was not able to 
hear the ticking of the clock in his room. Afterward he heard 
his clock constantly. In another case, a young man came to me 
one day in a state of excitement, and said that at four o’clock he 
was out on the common, and felt a shock in his ears. This came 
four times. He happened to look at the tower-clock and it was 
four o’clock ! At five o'clock he felt or heard it strike five times, 
and ever since that he has been getting a little enjoyment from 
noticing the strokes of the tower-clock.] 
I should like very much to have spoken of improvement in 
hearing in cases originally, apparently, beyond hope, through 
patient and persistent drill with the human voice as practiced bv 
Mr. Gillespie, of Nebraska, for the last ten years or more. The 
following statement shows what has been accomplished in one 
school in Germany within the last year under Dr. UrbantschjLsch. 
There were sixty cases in all. When he began there were six of 
them who could hear words; 22, vowels only, and 33, were 
totally deaf. This was last Odober. In April, 12 could hear 
sentences; 16, words; 21, vowels, and 11, were not improved. 
The method of treatment is precisely that originated and practiced 
by Mr. Gillespie, and still followed by his assistants, Mr. and Mrs. 
Taylor. 
Before 1 leave the floor, 1 will take this opportunity to com- 
municate to the profession, through this Association, the adion 
of the American Otological Association at its recent meeting held 
in Washington, a resolution presented by Dr. Blake of Boston, 
and discussed by Dr. Blake. Dr. Knapp of New York, Dr. Randall 
of Philadelphia, and by a number of other prominent otologists :— 
“ Resolved, That it is the sense of this Association that at each 
institution for the deaf, there should be an experienced aurist to 
make careful examinations of the condition of the ears of the 
pupils.” 16 
Dr. Blake’s motion was seconded and unanimously adopted. 
The discussion was brought on by the presentation of copies 
of very interesting examinations made by Dr. Bliss in the Phila- 
delphia Institution. The report is a wonderfully complete one. 
And when the Association of Aurists recommended that every 
school or institution for the deaf and dumb should have on its 
staff a competent specialist to examine the organs of hearing and 
speech, they really meant that they should have on their staff such 
a man as Dr. Bliss with full power to ad. (Applause.) 
LECTURE 11. 
Let me call your attention, in the first place, and briefly, to 
a lesson from one of the most fruitful branches of science, that of 
psychophysics, which is based upon the study of the anatomy 
and physiology of the human organs, connected with the devel- 
opment of mind. If there is anything that should be interesting 
to us, it is the question of mind-building, for mind-building is 
very closely related to brain-building which in turn is dependent 
upon the right exercise of brain functions. It is the habit now- 
a-days in speaking of articulation teaching, to base its import- 
ance, chiefly on the utility of speech and lip-reading,—a very 
important use,—as a means of communication. But I think 
that there is a greater utility underlying it. 1 do not wish to 
be understood for a moment as undervaluing speech and lip- 
reading as a means of communication; but if lip-reading were 
much worse than it is; even if the speech were a great deal 
worse than it is, I hold it is so important to the cultivation of 
the structure of the brain itself, and the development of the 
mind itself, that for these ends alone it would be worth while 
to spend all the time and effort spent upon articulation teach- 
ing. (Applause.) 
Professor Morrill-Gates has been engaged for the last fifteen 
years in original researches in psychophysics. His experiments 
have not been confined to the human brain, but he has exper- 
imented upon the brains of animals, and his experiments have 
been very instrudive. For instance, as related by him in a re- 
cent ledure, he has experimented upon young puppies. He took 
three puppies of the same litter. Number One was permitted to 
lead the normal life of a young dog; Number Two had his eyes 17 
completely bandaged and lived in absolute darkness. Number 
Three was allowed all the privileges good for puppies, and in 
addition much time was given to the training of its sense of 
sight. The animal thus trained could distinguish many differ- 
ent shades of color, not recognized by dogs usually. After some 
months the three dogs were killed and examined. The parts 
of the brain which had to do with the fundion of sight were 
wholly undeveloped in the puppy that had been blinded. In the 
educated puppy they were twentv-five times better developed 
than in the ordinary dog, being almost equal to the same por- 
tions of the human brain. The developed portions of the brain- 
substance were more dense, supplied by more blood-vessels, had 
more cells, and more highly developed cells, than the cor- 
responding structure of the normal dog. Like results were ob- 
tained with other animals. Similar experiments upon the ears 
led to similar results upon the hearing-centers in the brain. In 
the course of these experiments, he found that wherever any 
physical link for transmitting impressions was restrained or dis- 
used, be it what it might, there was a corresponding lack of 
development in the brain. Now therein lies an important les- 
son for us. If our deaf children are not taught to speak, and 
to use all the organs of speech as normal children do, there are 
many cells and nerves not properly used. And if we had the 
scientific eye, we could see in the atrophied brain of such chil- 
dren U)e effect of the lack of symmetrical or normal develop-> 
ment. 
To 
I wish to make a few observations uporr articulation t&acli< 
ing in the College. The Congress of the United States, in i8qi, 
by a special appropriation for the purpose of affording instruc- 
tion to the students of the National College, enabled the author- 
ities of the Institution to take a step long contemplated; and 
the continued liberality of the Government has made it possible 
to keep up the Department of Articulation to the present day. 
Some may think we have been a little slow at Washington, but 
you must remember that we live quite far South; and though 
we move slowly, I have no doubt that we move surely, and 
we hope not to make any serious mistakes. We shall try to 
keep somewhere in the procession. 
In the prosecution of the work of this department, a per- 
sistent effort has been made by brief special lessons given daily, 18 
to preserve and improve the speech of all the students in the Col- 
lege who came to us with these powers, and we have also carried 
to the point of success an experiment of which 1 shall speak at 
length later on. 
At Chicago, last summer, all persons specially interested in 
our work had, in lieu of-a “living exhibit,” an opportunity to 
examine the records of the ordinary practice in lip-reading from 
the lips of the teachers by every student in the College for an 
entire term, as recorded by the lip-readers themselves. 
1 may say that the first two terms of each year in this Depart- 
ment, are occupied mainly in instruction and drill and practice 
in articulation, in speech, with incidental lip-reading. The third 
term the emphasis is thrown upon lip-reading, and for various 
reasons 1 find it desirable to insist upon their recording nearly 
everything that they read during the short time allotted to this 
exercise. That enables us to have a record, of lip-reading actually 
performed by each student under the instructors of this Depart- 
ment for a Single term in the year. 
1 have spoken of “lip-reading.” And 1 may say that I 
used to be something of a reformer; and held very strongly to 
“speech-reading” as the proper and most expressive term, 
coming nearest to the idea we wish to convey. But 1 am in- 
clined to abandon that term, for the newspapers gave accounts 
of how we were teaching deaf-mutes to speak, and said we made 
orators of them; that they became great “speech-readers.” And 
in general 1 think it is a hazardous experiment to undertake to 
force new meanings into old words; and as lip-reading has the 
authority of the dictionaries, 1 think we are safe in using “lip- 
reading ” as more likely to be generally understood. 
To give some idea of the lip-reading by different students, 
1 take great pleasure in submitting these “echoes” from the 
classrooms in the form of books, containing the entire record of 
lip-reading in the College for the term just closed. 1 may say 
that each “book” contains the record of lip-reading of various 
persons with the personal history of each case. 
Perhaps this would be a good time to introduce another 
matter. 1 may say that among semi-mutes, the greatest diffi- 
culty that 1 have found in the lip-reading and speech, arises 
largely from their imperfeCt knowledge of phonetics, of the mech- 
anism of speech. 1 agree thoroughly with everything said in 
Mrs. Bell’s paper; but at the same time 1 think that if one is 19 
to become a fair musician, and he has not a great genius for 
music, the more scale-praftice you give him the better, in the 
end. And 1 have not been able to find any better method of 
drill than the method based upon that admirable analysis of 
speech given in ‘‘Visible Speech.” 
I have made a study of as many cases of proficiency in lip- 
reading by semi-mutes, as possible; 1 know many of them per- 
sonally; I have corresponded with many, and 1 find in general 
that semi-mutes, no matter how well they speak, are not very 
familiar with anv form of phonetic analysis. Systematic drill in 
phonetic analysis tends to help the eye, to fix the skeleton forms 
of words, and to fix forever their pronunciation as well as ap- 
pearance. Mv own best results have been obtained (and 1 refer 
to work done years ago, for 1 am not engaged in the practice 
of this art now), by drill, first, on a limited number of ele- 
ments, reading them from the lips, speaking them as uttered, 
and also writing them in definite and plain symbols. 1 have 
here with me a simple outline of the drill which 1 used in 1870, 
1 think, and in 1871 and 1872, with excellent results. 
I will not stop to give you that now. In the first series 
it was confined to exercises upon lip-reading,—all the permuta- 
tions of “p,” “t,”*or “b,” “t,” “v.” After they were mas- 
tered, I permitted mv scholars to advance to the second series. 
This series gave us the largest rounded mouth-opening vowel 
in “ah,” and the tiny rounded opening in “00,” and the broad- 
ening of the lips in the very visible long “e,” “ah,” “00.” These 
anv one but a blind man can read; the idea was to seleft those 
elements most visible and most differentiated, and we practiced the 
permutations upon this series. Then we combined the first series 
with the second, and then we passed to the third series,—“th” 
“1," “aw" (J), and then, after my class had mastered these, I 
passed backwards again and combined them with the other series, 
and so on. 
Then we had a syllabic drill; I preferred to take a single 
vowel and begin with a consonant, and then to take another 
set of exercises beginning with a vowel and ending with a con- 
sonant. Then for another exercise, the same syllables were to 
be repeated, as mamma, lala, duhduh, buhbuh. Then we ad- 
vanced to one consonant between two like vowels. Then one 
consonant between two different vowels. And then we ad- 
vanced to two syllables. Here we took different consonants 20 
with the same vowels, and vice-versa, and then advanced to 
two syllables in which all the elements were different. 
And about this time 1 introduced some simple, easily visi- 
ble words used by many teachers successfully. 
[Here the speaker gave quite an extensive list.] 
Then 1 felt 1 was ready to begin simple narrative, and I 
was always anxious to find whether the pupil had committed 
anything to memory, rhymes or jingles, names of the States,—no 
matter what, and 1 would try to get them to repeat them from 
my lips. If they had forgotten half, so much the better for the 
lip-reading,—knowing the general run of the thing, and not the 
precise words. They would seemingly make considerable pro- 
gress, with such verbal exercises; in reality, the progress was not 
great, but it encouraged them very much. Thus we proceeded 
from the known to the unknown, every once in a while work- 
ing in these phonetic drills or rather lip-reading drills in review. 
1 will digress once more to say that there is a lady pres- 
ent, from New York City, Miss Keeler, who has had a number 
of adult pupils sent to her who had speech, but not lip-reading. 
Rev. Dr. Gallaudet, knowing her work, has recommended her in 
a number of cases, and many adults have taken lessons of her. 
She has a system which is probably a great deal better than 
mine,—though any method is better than none, and therefore 1 
praise my own. But hers is the result of a great deal of study. 
She has not only worked out a general scheme, but the exaCt 
exercises which she will use from lesson to lesson, from day to- 
day, so that not a moment is lost in thinking of what she shall 
say to her pupils. She can go through with such exercises 
with great ease and rapidity, and 1 hope the opportunity may 
be afforded her to give us a precise account of her method. It 
may eventually be published, so that all may have the benefit 
of the exercises. 
1 may say that 1 used my series of exercises with one of my 
normal classes, and endeavored to have it used with some classes 
in the college; but there was considerable friction. A great many 
students did not exactly see the necessity of anything so dry, 
and promising so little immediate result; they could talk very 
well without that. And it did not seem advisable to insist upon 
their following a dry routine where they did not fully com- 
prehend what the outcome might be, and where it might not 
meet my own expectations. But in the case of my own pupils 21 
in years gone by the results were very happy indeed. It was 
designed to meet the needs of intelligent students, who would 
persevere in practice. Secondarily the exercises cultivated the 
voice, and improved the distinctness of speech. 
Among these exercises, 1 have two volumes made up of 
the lip-reading for the term which just closed, by grown-up 
pupils, beginners who came to us unable to utter the simplest 
sentence. That is, the adult-beginners in speech,—41 in all,— 
of whom 14 were between 18 and 21 years of age; and 27 
were between 21 and 28 years of age; 33 were men, and 8 were 
women. Of these, 15 were born deaf, or became deaf in early 
childhood; 7, at one year; 8, at 2 years; 3, at 3 years; and 
6, at 3 years; making 41 in all. One of these adults came from 
New England; 13 from the Middle States; 8 from the Southern 
States; 18 from the Western States, and 1 from Canada. The 
first year there were 28 beginners, the second year 8, and the 
third year 3. 
I meant to say somewhere that this experiment was an 
unique one. This experiment of teaching these grown-up deaf- 
' mutes to speak and read the lips is without .recorded parallel 
in the history of deaf-mute instruction. I have not been able 
to find a record of anything like it in the whole history of our 
work. So it possesses that one interest, if no other. 
Now of these 41, 8 left college, 6 dropped articulation at 
their own earnest request, and 18 are still under instruction. 
And the records 1 have with me are the records of these 18. 
1 may say that a peculiarity which was noticed in regard 
to these 41 adult beginners in speech is that their lung capacity 
is “short.” And it is an interesting faCt, for though it may 
not have a direCt bearing upon their speech, it may have an 
important bearing upon methods, means and appliances in edu- 
cation. The average lung capacity of the males is 243 cubic 
inches. That compares favorably with the average of the public 
at iarge where a large number of persons is taken into account. 
But it is ten cubic inches less than that of a university class, 
and 88 cubic inches less than that of the same number of uni- 
versitv men of the same height, presumably devoting the same 
attention to athletic exercises. A remarkable difference. Eighty- 
eight cubic inches in young men devoted to athletic pursuits. 
The breathing habits are defective. They should have been care- 
fully trained in their cHUdhood. ~~ 22 
The laryngeal development in a number of cases was in- 
complete. I regret that the notes of the laryngoscope exami- 
nations have been mislaid, so that 1 cannot use them. The 
speech acquired is generally slow and labored; the voices are 
usually weak, but with few exceptions not at all unpleasant. 
Every hour one spends in a crowded city, you will hear voices 
that are unpleasant, and many voices as difficult to understand. 
The intelligibility of the speech varies considerably. In certain 
cases, on certain occasions, where the speakers were embarrassed 
or fatigued, the speech was unintelligible, as a whole to me. 
The teachers did not seem to tyive difficulty in understanding 
them, but the speech was not intelligible to me, although 1 
think 1 have always been able to understand some words in 
every sentence. 1 am inclined to think, however, that every 
case would pass muster according to the sensible diftum laid 
down by Dr. Williams, of Hartford; “Any pupil who has mas- 
tered speech and lip-reading so far as to be able to carry on 
conversation in regard to the ordinary affairs of life in speech 
so plain as to be readily understood by persons of his own 
family, even though others fail to understand him, should be 
accounted as a successful articulator and lip-reader.” (Applause.) 
The degree of proficiency attained is such that with a fixed 
determination to use speech, it would be possible for at least 30 
of the whole number to depend upon it. There were 41 cases 
in all. Eight dropped out after one year. Of the remainder, 30 
of them. 1 think, could make use of speech freely with their im- 
mediate friends, and 20 could use speech if they so chose in all 
the ordinary business of life. 
The devotion, skill and enthusiasm in teaching shown by 
Miss Gordon, our senior teacher, and Miss Fish, who has had 
charge of nearly all of 'this section, and to whom the develop- 
ment of speech is due, have been met by unusual difficulties. 
It should not be forgotten, that the mere age of the stu- 
dent was not the chief barrier in the way of success; in many 
cases there was so complete a degree of satisfaction with their 
fixed habits of communication that but a languid, temporary, or 
perfunCtory interest, could be aroused. In a few cases there was 
a positive prejudice, which it was exceedingly difficult, if not im- 
possible to overcome. There was too little time available for the 
best results. Our College program is almost as crowded as Chau- 
tauqua’s. 23 
| A Voice : How much time have the students had in their 
speech-work?] 
[I)r. Gordon: These beginners are arranged as nearly as 
possible in small classes, not exceeding six in a class, and the 
time devoted for a single exercise is half an hour, and the indi- 
vidual instruction never exceeds fifteen minutes at the most. 
The results are remarkable when everything is considered. In 
all cases there is too little time for the best results. Then, too, 
if a working system is employed at all, the students in speech 
need the stimulus of recorded work. In the speaker's opinion 
the work in articulation should be included hereafter in the reg- 
ular curriculum of the College. 1 think perhaps the time has 
not come yet, but I think it is approaching when so many wiil 
come to us with speech and lip-reading already acquired that 
it will be well just to take it as a matter of course, that they 
should go right on with their constant usage of speech and lip- 
reading.] 
In conclusion, I may sav that it is exceedingly difficult to 
form the “speech-habit ” in adult life; and for this reason it is bet- 
ter for the pupils to begin when they are young.. The intelligence, 
and knowledge of language, which these grown-up beginners 
brought to bear upon their work enabled them to accomplish as 
much in speech in one year as might be expected of young chil- 
dren in two or even three years. But this great advantage does 
not balance the influence of the acquired and inveterate habit of 
silent methods and the complete degree of satisfaction with these 
methods of communication, nor is it possible to secure in adult 
life the full development of the sound-producing organs. It should 
be borne in mind that every one of these fortv-one adults came 
to the College dumb, from schools in which an effort was made 
to teach all promising pupils speech and lip-reading. Practically 
they were all rejected cases without trial or with little trial, with the 
exception of one young woman who had had five vears of in- 
struction in the early part of her course, and was then dropped 
as an unpromising subjeCt. 
i am, from my own observation, convinced that every one 
of them was a suitable subject for oral instruction. 
The final lesson is this:— 
Let us not be too easily discouraged with unpromising 
cases. I cannot do better in closing than to refer to one ot 24 
these: Among the beginners in the first year the most dis- 
couraging was that of a man born deaf, 21 years of age, with- 
out a vestige of hearing. An observer wrote of him as follows: 
“After three weeks of instruction, Z is a problem. He 
has very little power of imitation, and still less of memory, and, 
to make matters worse, he is very slow to understand what 
you mean. His lack of memory of positions, probably, has the 
most effect, for even when he gets an element right, he cannot 
remember the position in order to repeat it. His improvement 
is almost imperceptible.” Three weeks later the observer says: 
“Z has made considerable progress. The sentence 1 gave 
to him was given back to me, and repeated very well.” 
A week later: “Z has improved considerably, but it 
is slowly, step by step.” At the June examinations at the close 
of his first year, this unpromising student read from his teach- 
er’s lips 695 words with 9 failures, and spoke 688 words with 
46 failures. 
Now I know as little about what he has read from the lips 
as you do. 1 see here he has the names of all the faculty. 
That was February 1st. These are the daily lessons, you under- 
stand. 
March 12, he records: “It is a beautiful day. I met a 
pretty girl. Did you go to the market ? Prof. Porter went to 
.see it. Did you see Miss Taylor? She returned to Philadelphia 
yesterday. She will go to Portland, Maine, next week. Prof. 
Porter is much better. He will come down.” 
April 16: “When did you hear from home? What day 
of the month is this ? What month is this ?” 
May 7: “How did you enjoy the ball? Please tell me 
about it. 1 came home at 12 o’clock.” 
This is lip-reading from this unpromising student; he is not 
a good lip-reader, and would not be pronounced a promising 
case, but he has accomplished a good deal under the circum- 
stances. 
1 will turn to Miss Kershner’s case. It is an interesting one. 
She has a number of deaf-mute relatives, and was born deaf. She 
entered the Philadelphia school, and attended it nine years. She 
entered the College in 1892 and began then to learn to speak and 
to read the lips. 
[Reading records from January 19 to May 25.] 
[Dr. Bell: How are these records made?] 25 
[Dr. Gordon: The teacher sits before the class, talks to the 
class, tells stories, and asks questions. They sit with their little 
books open and write, and are expected to speak all that the 
teacher says. I prefer that they should both speak and write 
what they see upon the lips. It is a record of their lip-reading. 
In some cases they have not given every word, or have made 
mistakes which have been underscored. They are not always 
required to get the word the first time, but their time is limited. 
Some words might have been repeated two or three times. It 
is taken from the lips. “Do you think it is very cold for the 
first day of summer?” (Reading June First.) That was read in 
one exercise from the teacher’s lips in Miss Kershner’s second 
year.] 
|A voice: Sentence by sentence?] 
[Dr. Gordon: Generally sentence by sentence, sometimes 
word by word, and sometimes right ahead. Of course this 
could not have been given right off. ] 
[June 8. Reading from the MSS.J 
This is from Emma Kershner's exercises. If time permitted 
I should like to run over some other lip-reading by some who 
have had more practice and knowledge of speech than she. 
[Dr. Bell: I understand that these you have read are ?] 
[Dr. Gordon: Grown-up deaf-mutes without previous in- 
struction in speech and lip-reading.] 
Let me call your attention to something I failed to present 
yesterday. I had the promise from Dr. Lucien Howe of Buffalo 
of a collection of ear-bones. But he disappointed me, and sent 
me photographs instead. I suppose he knew the reputation of 
Chautauqua, and was afraid to trust those valuables on these 
grounds. Here are photographs of the ear-bones of man, the 
whale, the elephant, etc., which you can examine at your lei- 
sure, and return to me if you please. I am obliged to you. 
(Applause).