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ing to our experience, are most to be relied upon. We have often found that a few drops of chloroform on cotton wool applied to the ear gives very marked and speedy relief, and it has the negative merit of being perfectly safe in its administration.

III. FOREIGN BODIES IN THE MEATUS AUDITORIUS.

Children not unfrequently contrive to push various foreign substances, such as peas, beads, grains of corn, pieces of slate pencil, of wood, &c., into their ears, and generally they become a good deal alarmed when they have made the discovery that they cannot remove it. In the management of such a case great tact and skill is often required, and though fear will generally be sufficient to induce a child to confess what he has done, the practitioner must not be content with this statement, nor rely too much upon it, but should make a most careful examination to satisfy himself of what is really present, for,it now and then happens that the foreign body drops out again, though the child is ignorant of it. The importance of this examination is seen by the remark that, "for want of this preinspection lives have been destroyed in attempting to extract from the ear imaginary bodies which had never lodged there." If, however, the examination results in the discovery of some foreign material, the sooner it is removed the better. Sometimes the use of a warm water injection will be sufficient for the purpose, provided that a fine mouthpiece be used, so that the stream of water may with some force be thrown behind the foreign body, and thus expel it. If this fails, then a small scoop or curette may be employed, but the utmost care will be necessary in the use of any of these means, to avoid injuring the meatus, and still more the membrana tympani, by forcing the foreign body against it. Cases are recorded in which severe injury and subsequent inflammation have followed these attempts, death even having resulted, and sometimes paralysis of the portio dura nerve. In some cases a pair of small forceps will succeed better than anything else. In any event, if we are not successful at first, it is better to wait awhile, and by warm, soothing, emollient and sedative applications, to subdue as far as possible all irritation and inflammation before resorting to another attempt.

An accumulation of hard, dark brown wax in the auditory passage sometimes acts as an irritant, causing uneasiness, buzzing, and deafness. It may be dislodged by careful syringing with warm water; or if firmly adherent may be lifted away with the curette, all rude force being avoided.

IV. THE DEAF AND DUMB.

Although the subject of deaf-dumbness is not usually treated of in works like the present, yet we trust that the importance and interest which naturally attaches to this most desperate of human calamities, may plead as sufficient excuse for introducing a few remarks on the subject. It can hardly be necessary to observe that the incapacity of speech which exists in such as are designated deaf and dumb, results entirely from the want of the sense of hearing, and not from any physical imperfection in the organs of speech. All who are deaf from birth must be dumb; for how can they use language, the sound of which they have never had the perception of and which they consequently cannot attempt to imitate?

By the census of 1851 in Great Britain, 12,553 persons (6884 males and 5669 females) were returned as deaf and dumb, or one in every 1670 of the inhabitants. According to the most recent returns, the average proportion of the deaf and dumb to the population of Europe generally, is found to be one in every 1593 persons. Deaf-mutism is also found to be more common in agricultural and pastoral districts than in towns.

Causes. In some cases there has been no appreciable organic defect; in others the cause of the deafness has been, either some organic change in the auditory nerves, or some lesion at their origin, an alteration at the base of the brain, or about the medulla oblongata, an effusion into the fourth ventricle, or imperfect development of the ear itself, or disease of the ear occurring during early infancy. The late Mr. Toynbee remarks that "it would be no very violent assumption to suppose that early derangement of the nervous apparatus is at the root of most of the instances of deaf-mutism.' Some authorities also assert that many of the cases of deaf dumbness originate in convulsions occurring during the first dentition.

Of 411 cases observed by Toynbee, 313 were congenital and 98 were the effect of disease acquired subsequent to birth. Of the latter, 36 resulted from scarlet fever, 23 from fever, 4 from measles, and 35 from various other diseases, teething, convulsions, hydrocephalus, &c. Of the total number of cases, in 214 some abnormal appearance was discovered, though in many it was very slight, and 197 were perfectly healthy to all appearance.

Treatment.-Children who are born deaf differ but little from other children during early childhood; and it is not usually until a rather advanced period that the parents will allow themselves to be convinced that there is a positive defect of hearing

in one who is, probably, very engaging and affectionate, and who-from the expressive play of his features and the readiness with which he apprehends the slightest look or gesturehas perhaps been regarded as more than ordinarily intelligent. As regards the actual treatment of the deaf and dumb, one of the first questions to determine is, whether or no there exists any, and if any, what amount of hearing power; for it must not be supposed that all cases are equally deaf; on the contrary, the degrees of hearing vary a good deal. When the deafness is absolute, then nothing whatever can be done to develop it, and the sooner the parents of the child thus afflicted recognize this, and bestir themselves to its education as a mute, the better.

Where, on the other hand, some hearing power, however slight, exists, attempts should be made by the use of hearing trumpets to develop it, sounds being of a nature of stimulants to the auditory nerve. And though we have had no experience with galvanism in these cases, it seems quite reasonable to suppose that some good might result from a very moderate and gentle use of it. Moreover, something may also be done for cases where deafness has occurred subsequent to birth. Thus, Toynbee remarked,-"In cases where by disease subsequent to birth, either the membrana tympani, or the mucous membrane lining the tympanum, has been thickened, counter-irritation over the mastoid process will aid the use of trumpets; and in those where the membrana tympani has been partially or wholly destroyed by ulceration, and where there is a constant discharge of mucus from the surface of the tympanic mucous membrane, it is desirable for the ears to be syringed occasionally with a weak astringent, so as to prevent the membrane becoming ulcerated, and the bone which it covers carious. The artificial drum may also be resorted to."

Further experience having shown the complete impossibility of curing the great majority of these cases of deafness, it becomes a matter of the utmost importance to commence the education of the other senses as early as possible; so that the hapless being who is debarred from the chief avenue to knowledge at the most critical period of his intellectual growth may, nevertheless, not remain altogether uneducated. The system of instruction for deaf mutes consists of:-1. Pantomime, which may be divided into the employment of such natural, imitative, or descriptive signs or expressions of thought by gesture and pantomime as all mute persons acquire; or those arbitrary and conventional signs used by teachers and others in the habit of communicating with the deaf and dumb. The former are com

mon to all mutes, and vary but little; the latter are generally founded upon some special plan, the method of one teacher differing from that of another-all of which shows the necessity of adopting some universal system by which the mutes of countries speaking different languages may communicate their ideas. The use of pictures, models, and similar illustrations may be classed under this head. 2. Dactylology, or fingerwriting by either the double or single-hand alphabet; the former being that chiefly taught in this country; the latter that used on the Continent, in America, &c. 3. Writing and Reading. 4. Lip-reading, by which a mute understands what is said by merely watching the motions of the lips of a speaker; those, however, who acquire this faculty being generally such as heard and spoke originally, but who, by accident or disease, have become totally deaf and subsequently mute. 5. Articulation, or the pronunciation of words and sentences. To what extent

the true congenital deaf person can ever be taught to speak is still undetermined-only a few of the most intelligent and anxious are at all capable of such teaching, and even in these, the effort at vocalization is, from want of hearing, harsh and inharmonious, and seldom turned to much account in their intercourse in life. In most of the schools of this country, this system has been abandoned; the teachers conceiving that the time spent in acquiring this mechanical form of speech may be more usefully employed in other descriptions of education.

As regards the industrial education of deaf mutes, it is only necessary to say that they are probably as capable of acquiring a practical knowledge of the mechanical and industrial arts, as hearing and speaking persons in their own rank of life.

Note. The system of instruction given above is taken almost verbatim from the Appendix to Mr. Wilde's treatise.

PART IV.

ACCIDENTS, INJURIES, AND DEFORMITIES.

CHAPTER I.

ACCIDENTS AND DISEASES CONNECTED WITH BIRTH.

I. STILL-BORN CHILDREN-APNEA NEONATORUM.

INFANTS are occasionally born in a state of apnoea, or of apparent death; to recover them from which very prompt and skillful attention on the part of the accoucheur is necessary. The term apnoea (from a, priv., and πνεω, spiro) is a great improvement over that of asphyxia (from a, priv., and couw, pulso). The one signifies want of respiration, and almost suggests artificial respiration as the remedy; while the other means want of pulse, and teaches nothing, or, if anything, that the circulation has ceased, and consequently that attempts to excite respiration will be useless.

Causes. This condition may result from many causes; the most common are the following: (1) a natural feebleness of constitution which exists to such a degree that the infant is incapable of making the muscular exertion necessary for the commencement of respiration: (2) the existence of some obstruction to the flow of blood, through the umbilical cord during labour; as when the cord is twisted round the neck of the infant or some other part of its body, or when, from prolapsus, it is subjected to pressure between the head of the child and the walls of the pelvis: (3) the premature separation of the placenta―i. e., before the birth of the child: (4) too great or too long continued compression of the head, either by the forceps or by an obstacle in the pelvis: (5) the presence of a collection of viscid mucus in the mouth and fauces preventing the entrance of air into the bronchial tubes and pulmonary air-cells (6) and lastly, M. Velpeau suggested, as another cause of apnoea, a cessation, from some unexplained cause, of the proper functions of the placenta shortly before birth, by which, through the impeded depuration of the blood, the nervous system is deprived of its necessary stimulus.

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