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Inability to speak is in a large majority of cases the result of deafness. A person who cannot hear either the voices of others or his own has no inducements to utter words, and thus becomes dumb. It is naturally during childhood that this is specially shown. A child who has become deaf, as the result of disease, speedily loses the power to use language of which he had not yet obtained any mastery. A grown-up person, to whom the use of lan guage has become a matter of habit, would not so lose the power of it, though he might lapse into silence, more or less complete.

Children may be born deaf, and thus never become able to utter the sounds of articulate speech. In a large number of cases, however, the deafness is the result of disease arising in the course of childhood.

The causes of the congenital form of deaf mutism, that is of the form dating from birth, cannot be stated with certainty. It is impor tant, nevertheless, to observe that intermarriage, the marriage of blood relations, is held to play a very serious part in the production of the defect. For example, it has been estimated that 10 per cent of the deaf in the United States of America are the offspring of parents nearly related. It is not necessary that the children of deaf-mute parents should also be deaf-mute, but the risk is considerable that they will be so, especially if both parents are deaf. This applies, however, only in those cases where the deafness of the parents arose before birth, and not where it has been the accidental result of some disease of childhood. The causes of deaf ness arising after birth are numerous. Scarlet fever is one of the commonest, because of the disease of the ear so rarely absent from this fever (pp. 490, 520). Next in order of frequency as a cause is disease of the brain, some form of meningitis (p. 154), or water in the head (p. 155), measles, typhoid fever, whooping-cough, mumps, scrofula, inflammation of the lungs, diphtheria, and accidents of various kinds.

Treatment.—It is sometimes the case that a child, apparently deaf, possesses some slight degree of hearing; and, in a few cases where the deafness is the result of sonic acquired disease, something may be done to improve the hearing. It is, therefore, of great consequence that parents should early detect defects of hearing in their children and promptly seek skilled advice. Where the degree of hearing is slight, parents are too apt to conclude that it is useless to attempt to train the child in the 1 ordinary way, and to allow it to grow up as if it were absolutely deaf, teaching it by signs only. When the child can be made to hear by loud distinct speaking, close to its ear, the parents ought to take the utmost pains to teach it in this way, and ought to make use of signs as little as possible in order to enable it to acquire a knowledge of words.

There are two methods of teaching deaf mutes, one by means of signs and by the manual or finger alphabet, called the French system; and the other by lip-reading and artic ulate speech, or the German system. In lip reading and speech the deaf-mute is taught to put his vocal organs into the positions by which the various sounds are produced, and to under stand what is said to him by seeing the position of the lips, mouth, &c., of the person speaking to him. This method has been attended with very considerable success, so that on leaving school the deaf-mute is able to converse with his teachers and intimate friends on ordinary subjects. In are cases the deaf-mute is able to converse freely with strangers. The time required to attain moderate proficiency in lip reading and speech is ten or twelve years, and the child should begin to receive instruction early, at the seventh year of age if possible.

A system of signs for instruction in lip-read ing and speech has been designed by Prof. A. M. Bell of England, and extended and developed by his son Prof. Graham Bell of New York, the inventor of the telephone.

The modern system of caring for and edu cating deaf-mutes has shown that deaf-mutism is not necessarily associated with any degree of mental or moral defect. In some cases the defect is undoubtedly associated with feeble mindedness, and is only one evidence of impaired development, but it is not necessarily so. With deafness one great avenue of the mind is closed up, and, if no effort is made to supply its place, the intelligence must suffer from want of devel opment. If pains are taken to open up other avenues, education becomes as effective as if supplied through the channels of hearing.

Of recent years it has been clearly shown that a very large proportion of children, classed as deaf-mutes, have a remnant of hearing quite capable of being developed and extended. But each child requires individual instruction of the most patient and persistent kind. The cost of such training is considerable, as it is impossible in an institution with a large number of chil dren, and requires a specially trained teacher devoted to the child in its own home.

Much work has been done in this department by Manage, of Paris, where also Marcel Natier and the Abbe Rousseau have founded an in stitute for the study of these conditions, and in Vienna, where Urbanntschitsch has specially devoted his attention to the training of the deaf-mute to hear as well as to speak.