Auricular Training & The Little Deaf Child

I came across a copy of The Little Deaf Child: A Book for Parents, a short book published in 1928 reassuring parents of deaf children that with proper training and education, there was hope for their children. The book was written by John Dutton Wright (1866-1952), the founder and director of the Wright Oral School in New York City, which was established in 1902. The school was originally the Wright-Humason School, founded in 1892 jointly by Wright and Thomas A. Humason on 42 West 77th Street, New York City. The school had a limited enrollment of 25-30 pupils; Helen Keller was one of the pupils, trained to read with her fingers and improve her speech.

John Dutton Wright. The autograph reads: "May this little book bring new courage for old despair."
John Dutton Wright. The autograph reads: “May this little book bring new courage for old despair.”

Wright begins The Little Deaf Child with a simple direction: “Please read the book through from beginning to end before trying to put its suggestions into practical operation in teaching a child. You must educate yourself before you can teach another.” The book follows the earlier slim books written by Wright: Handbook of Speech Training to the Deaf and Handbook of Auricular Training, which were directed to physicians in the hopes of counselling them how to advise parents of deaf children in both medical and educational options. In addition, The Little Deaf Child follows up from Wright’s 1915 publication, What the Mother of a Deaf Child Ought to Know (iTunes podcast also available), an original manuscript during the time offering advice to mothers to master their relationships with a deaf child. According to Wright, “It was not much of a book, but it was the only thing of its kind in print, and has been purchased by people all over the world. It has been translated into Japanese and Mahrati.”

The Little Deaf Child offers guidelines to parents in terms of training and education of young deaf children, for “[v]ery much can be done along these lines at home while the child is yet too young for school and this is where I hope this little volume may be of some service to the perplexed mother, wholly inexperienced in the situation which confronts her” (17). Wright divides the training of the young deaf child in to three periods: (1) For the first two years of life; (2) for the third and fourth years of life; (3) for the fifth year of life. By the time the child reaches age six, it is best to enter the child into one of the special schools for the deaf, or, if preferred, for the parent to employ a specially trained and experienced teacher in the home.

Wright advises parents to begin immediately by evaluating the child’s residual training to begin auricular training. Then, the child is taught to assess his or her other senses, and then, when the child proves to have retained some hearing sufficient to be employed, lip-reading training should begin. Gestures should be minimized and the parent should avoid “spoiling” the child. During the second period, the parent should asses the child’s sight, continue sense training by cultivating the child’s muscular sense, sense of sight, and touch; games of imitation (e.g. piling up blocks), could aid in this training process. Further hearing tests and lip-reading training should continue—moreover, the parent should concentrate on teaching the child to “listen to sounds for the purpose of getting ideas and not merely for the purpose of perceiving sound.” By the third period, the child should learn to read and speak through a variety of exercise that Wright provides in the book.

The book additionally provides a list of special schools for deaf children, with an overview of the common methods used in these schools. Although most schools used a form of the “Combined Method” (speech + speech-reading + auricular training), there were some schools that focused strictly on the “Manual Method” (sign-language), the “Oral Method” (speech + speech-reading + writing), or, as with the Wright Oral School, the “Auricular Method” (speech + hearing + writing), which made use of the hearing of semi-deaf pupils with or without the use of acoustic aids. The auicular method, it should be noted, was largely directed to educating pupils as hard-of-hearing speaking persons, rather than members of the Deaf community.

Wright examining a child (Alexander Graham Bell Association for the Hard and Hearing Collection; Disability History Museum)
Wright examining a child, 1900 (Alexander Graham Bell Association for the Hard and Hearing Collection; Disability History Museum)

Auricular training made use of hearing trumpets, audiphones, conversation tubes, and other types of acoustic aids to increase hearing amplification and make use of hearing as a means of communication. An article in the New York Times from 16 September 1917 explained how Wright brought auricular training to the attention of medical professions. Co-operation with physicians was required in “order that advantage may be taken of unrealized possibilities of educating slight powers of hearing remaining in the cases of many deaf children attending the special schools for the deaf throughout the country.” The “unrealized possibilities” of auricular training could be developed with proper teaching methods. According to Wright, about 35% of pupils at his school had sufficient residual hearing to benefit greatly by the auricular method:

I believe that an adequate examination of all the pupils in our special schools for the deaf would show that fully one-third of them—that is, more than three thousand—are suitable subjects for such training of the brain through the normal channel of approach…It has been my experience that while artificial aids to hearing may sometimes be useful in the earliest stage of awakening attention to sounds, and in the later stage in extending the range of which the hearing can be made of service, throughout the real education process of teaching the brain to associate meaning with sounds and to remember those associations, the use of the unaided voice, applied directly to the ear, produces the best and most rapid results.

Wright’s work at the school secured his reputation as a pioneer in education of the deaf with the use of acoustic aids and auricular training. He was also one of the first directors to include sound amplifiers in schools. He published several journal articles, especially in the Volta Review, the publication of the Volta Bureau (est. 1887, now the Alexander Graham Bell Association for the Deaf and Hard of Hearing). The Volta Bureau advised all mothers of deaf children to read The Little Deaf Child.

Active in civic affairs throughout his life, in 1920 Wright traveled the world with his wife and two children, occasionally visiting schools for the deaf. He was particularly influential in the creation of Japan’s first oral school for the deaf. A collection of Wright’s travel photographs can be viewed at the Dutton Wright Photographic Collection at the University of Washington, some of which I’ve included below.

John Dutton Wright, his wife Ysabel Wright, and their children John Jr. and Anna seated on an elephant, with a car in the background, ca. 1921
John Dutton Wright, his wife Ysabel Wright, and their children John Jr. and Anna seated on an elephant, c.1921 (University of Washington Libraries)
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One of Wright’s photographs in India, 1921 (University of Washington Libraries)
Wright's photograph: Boy and woman with babies on their backs, Japan, ca. 1921 (University of Washington Libraries).
Wright’s photograph: Boy and woman with babies on their backs, Japan, ca. 1921 (University of Washington Libraries).
Wright's Photo: Group of boys with bamboo instruments called angklung, Java, ca. 1921 (University of Washington Libraries).
Wright’s Photo: Group of boys with bamboo instruments called angklung, Java, ca. 1921 (University of Washington Libraries).

 

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Surgeons & Surgical Kits

There’s always a scene in any movie or television show depicting a surgical operation: a nurse or assistant clad in scrubs, enters the room pushing a cart. On the cart lies several delicate instruments, their hard steel glistening under the harsh lights of the theatre. None of the instruments touch each other, and they are placed in a carefully organized order.

Then we see the scene after the operation: the once pristine instruments stained with the bright red of blood, and discarded into a bowl. They have fulfilled their purposes, the dangers embodied in their construction has diminished and they are to retire until they are called for again.

I love those scenes. The instruments play as much of a role in surgical operations as the nurse, the lights, the antiseptics anesthetics and of course, the surgeon. But without the instruments there really is no operation. Without the instruments is a surgeon even a surgeon?

The 10th century Arabic scholar and physician, Abu al-Quasim ibn al-Abbas al-Zahrawi (936-1013) introduced many notable surgical instruments in his eponymous Kitab al-Tasrif ( Method of Medicine), a thirty volume encyclopedia on the anatomy and practise of medicine. Al-Zahrawi, also known by his Latinized name Albucasis, details over 200 instruments, many of which he devised himself, combining ideas from ancient Greek and Roman physicians with his own observations and experiences as a surgeon.

A replica of Roman surgical instruments in a cloth roll, AD50. 13 instruments made of brass and steel. (The Old Operating Theatre Museum)
A replica of Roman surgical instruments in a cloth roll, AD50. 13 instruments made of brass and steel. (The Old Operating Theatre Museum)

Al-Zahrawi stressed a skilled surgeon would not only know the uses and benefits of numerous types of instruments, but will apply the knowledge to make sure an instrument was used properly and carefully to prevent excessive pain to the patient. Other medieval surgeons also stressed the importance of instruments–the surgeon’s kit–as an essential part of the surgeon’s practice.

Before the operating theatre had instruments nicely laid out on a cart, surgeons often carried their own instruments in a box or bag, taking with them as they attended to patients. Some were of simple designs, while others were more elaborate, with ivory, gold, or silver detailing.

An ivory surgical presentation set, c.1868. It contains  a full complement of scalpels, bistouries, needle threaders and tenaculum hooks.  The lid compartment contains two scissors, one pair of scissor handled and two hand forceps. The lower tray contains a crosshatched ivory metacarpal saw, a director, two silver tracheotomy tubes, a crosshatched ivory and silver trocar and a pair of bone forceps. This was the Governor's Prize at Middlesex Hospital and awarded to Mr. Robert Harry Lords. (Phisick Medical Antiques)
An ivory surgical presentation set, c.1868. It contains a full complement of scalpels, bistouries, needle threaders and tenaculum hooks. The lid compartment contains two scissors, one pair of scissor handled and two hand forceps. The lower tray contains a crosshatched ivory metacarpal saw, a director, two silver tracheotomy tubes, a crosshatched ivory and silver trocar and a pair of bone forceps.
This was the Governor’s Prize at Middlesex Hospital and awarded to Mr. Robert Harry Lords. (Phisick Medical Antiques)

These kits consisted of knives, razors, and lancet for making incisions; cattery irons grasping tools, probes, suture scissors, saws, needles, cannulae, pads, bandages, and in some instances, even tools for trepanation. Some kits also contained analgesics such as opium or hashish as pain relievers, or plasters for treating wounds.

A 19th century 14-piece surgical instrument kit (Barcelona)
A 19th century 14-piece surgical instrument kit (Barcelona)
A 19th century French surgical leather kit with knife and needle, artery forceps, curved scissors, curette, trocar, director, blunt needle, thermometer, caustic stick holder,  toothed forceps and two plain forceps. (Phisick Medical Antiques)
A 19th century French surgical leather kit with knife and needle, artery forceps, curved scissors, curette, trocar, director, blunt needle, thermometer, caustic stick holder, toothed forceps and two plain forceps. (Phisick Medical Antiques)

Pre-anesthetic surgery was crude, gruesome, and horrifying. Operations were limited to amputations, suturing, and bone-setting. And because it was preferable patients remained awake during the operation (as it was easier to deduct whether there was serious danger), speed was a crucial factor for ensuring a higher degree of success. Instruments were used over and over, frequently without being cleaned, and without being disinfected–antiseptics wouldn’t arrive until the second half of the nineteenth century.

Five surgeons participating in the amputation of a man's leg while another oversees them.  Coloured Aquatint by Thomas Rowlandson, 1793.
Five surgeons participating in the amputation of a man’s leg while another oversees them.
Coloured Aquatint by Thomas Rowlandson, 1793.

Galvanism & Deafness

Galvanism is a medical treatment that involves the application of electric currents to body tissues in order to stimulate the contraction of muscles. First experimented in the late eighteenth-century by Luigi Galvani (1737-1798) who investigated frog legs twitching once sparked by an electric current, galvanism was believed to be a miraculous application of scientific prowess and capable of curing all sorts of medical disorders. It even had the capacity for animating a corpse, as narrated in Mary Shelly’s Frankenstein!

Aurists certainly saw the benefits of galvanism in cases of deafness they diagnosed as caused by paralysis of the auditory nerves. The paralysis prevented sound vibrations from being transmitted properly through the tympanic membrane (eardrum). Several nineteenth-century treatises on aural surgery discussed how galvanism could cure deafness by stimulating muscular action necessary for restoring the auditory nerves to function in the transmission of sound.

In his Elements of Galvanism, in Theory and Practice (1804), Charles Henry Wilkson outlined an apparatus for safely applying an electric current to cure deafness.

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Regarding his apparatus, Wikson wrote:

When it is ascertained hat the deafness is of that particular nature, in which galvanism may be usefully employed, p…two conducting wires, A & B, at end of each which is a small plate of ivory, about one inch & half in diameter. Through center of the plates is passed a silver wire, with a small ball at its extremity. To be insulated, silver wires are about an inch in length, enclosed, with each of them in an ivory tube. Inside of right ear moistened with water, and ball is introduced the ear, with the ivory plate preventing the wire from penetrating too far. Similar procedure on left ear. Once inserted, completion of the circuit is conducted by bringing the end of the conducting wires into occasional contact with the trough (the plates between A and B).

He warned that great care should be taken when using the apparatus for the first time on a patient. The physician should use gentle power through a small number of plates, and not exceed seven or eight plates. Power can be increased by adding plates, but it depended on the sensations experienced by the patient: “Some persons scarcely feel the power of twenty plates; while others experience from such a proportion of the fluid a very distressing giddiness.”

The merits of galvanism were discussed by aurists in numerous publicatons, assessing the benefits of the procedure, or criticizing its miraculous applications. The aurist John P. Pennefather, for instance, wrote in his Deafness and Diseases of the Ear (1873):

I allude to this vaunted remedy from the specious character it presents, and the conquest frequency with which persons suffering from deafness are tempted to give it a trial, in many cases a prolonged one, to find themselves in the end but disappointed dupes. The error which the majority of people fall into with regard to the cause of their deafness is, that some defect exists in the nerve of audition, and therefore galvanism cannot fail to cure, and this popular error is taken advantage of by quacks to cry up its application as a specific for all cases of deafness.

Galvanic current, Pennefather asserted, “cannot have the slightest remedial influence; on the contrary, is more likely to exercise an injurious tendency.” He further explained that he was not decrying the valuable agency of medical galvanism, nor contending that it was not beneficial for particular cases of deafness. Rather, he warned its application should only be ascertained by a proper diagnosis and undertaken by skilled and trained aurists. It was not, nor should be, a catch-all cure for all sorts of deafness.

Webster’s Otaphone

I wrote a new entry over at Nineteenth-Century Disability: A Digital Reader:

UK patent #7033, dated 17 March 1836, is the earliest British patent for a hearing aid device, granted to the aurist (19th century term for ear specialist) Alphonso William Webster, for his “curious” invention, the Otaphone (sometimes spelled “Otophone”). In his publication, A New and Familiar Treatise on the Structure of the Ear, and On Deafness (London: published by the author, sold by Simpkin & Marshall, 1836), Webster outlines he was first devised his invention by observing the common practice of cupping the hand to the back of the ear to enhance hearing. He wondered whether the practice could be obtained by “means less troublesome and unsightly” (132).

Continue Reading…

Medieval Surgery: Abulcasis

I was watching World Without End and came across this scene in which a female medical practitioner explains the value and beauty of a surgical textbook she purchased:

WWE

I don’t recognize the book–does anyone know what it is?

On the left page, there’s a man fighting Death. The right page is the Zodiac Man, an explanation of how the signs of the zodiac govern different aspects of the body–it was often used by medieval physicians to decide when bloodletting was more favorable and what body parts to avoid for surgery in conjunction to the alignment of the stars.

Medieval surgery is interesting in that it is the one medical occupation besides physician’s medicine that was taught at the university, particularly in southern Italy. However, most surgeons would not have been university educated, since they would have learned primarily through apprenticeships. They dealt primarily with every day injuries such as broken limbs, sprains, dislocations burns, and so on. At the fringes of the surgeon’s trade were those practitioners (often unlicensed) who specialized in particular operations like bone-setting, tooth-pulling, couching cataracts and so forth.

However, it did bring to mind the how Arabic treatises were adopted and translated into Latin. Between the 6th-11th centuries, medical handbooks had little or nothing to say about surgery and for the most part, surgery was not separated from medical practice. After 12th century, books on surgery began to emerge and evolve as a distinct form of medical writing. As with physicians’ medicine, much was learnt through Arab texts, particularly the work of Abu al-Qasim ibn al-Abbas Al-Zahrawi (936–1013), known by his Latanized name Abulcasis.

220px-Albucasis

Considered the greatest medieval surgeon from the Arab-Islamic world, he has even been named the father of modern surgery. His greatest work is the Kitab al-Tasrif [Method of Medicine], 30-volume encyclopedia that described pioneering surgical procedures and instruments—over 200 hundred instruments are detailed in the book! Not only did Abulcasis devise many of these instruments himself, but many are still in use today.

220px-Zahrawi1

The impact of Abulcasis’ book was enormous once it was translated into Western Latin by Gerard of Cremona in 12th century Spain, who also illustrated the book. The al-Tasrif became a standard reference for both doctors and surgeons as it was translated into Latin five times.

Two pages from an incunabulum of the 30th section of Al-Tasrif as translated to Latin in the 12th century by Gerard of Cremona.
Two pages from an incunabulum of the 30th section of Al-Tasrif as translated to Latin in the 12th century by Gerard of Cremona.

With works like the al-Tasrif, there soon existed a body of specialized knowledge that was preserved in learned sources—in authoritative textbooks; surgery becomes a literate discipline. Eminent surgeons then insisted that learned medicine, as well as a good eye, a steady hand, and a sharp blade could make an excellent surgeon