The Deaf Their Position in Society and the Provision for Their Education in the United States

The most significant part of the results seems to be found, as before, in respect to whether or not deaf parents are themselves congenitally deaf or have deaf relatives. On the one hand, when one or both of the parents are adventitiously deaf, the percentage of marriages resulting in deaf children is 5.6, and the percentage of deaf children is 4.2; when both parents are so, the percentages are lower: 3.5 and 2.3. The percentages rise when one parent is adventitiously deaf, and the other congenitally: 8.1 and 6.5. In respect to deaf relatives of parents, the percentages are very low when neither has such relatives: 2.3 and 1.2. The lowest percentages of all are in the case where both parents are adventitiously deaf and neither has deaf relatives: 0.7 and 0.3.

On the other hand, we find the proportion of marriages resulting in deaf offspring and the proportion of deaf children much greater when there is congenital deafness in one or both parents, when one or both have deaf relatives, and greatest of all when these influences are combined. When one or both parents are congenitally deaf, the percentage of marriages resulting in deaf offspring is 13.1, and the percentage of deaf children is 12.1; when both parents are so, the percentages are doubled: 24.7 and 25.9. When one parent has deaf relatives and the other has not, the percentages are 6.6 and 6.4; when both have, the percentages are nearly four times as great: 23.5 and 20.9. When both parents are congenitally deaf but neither has deaf relatives, the percentages are 7.1 and 4.1. When both are adventitiously deaf and both have deaf relatives, the percentages are 17.5 and 9.6. When both are congenitally deaf and one has deaf relatives, the percentages are 16.3 and 20.0; and when both have deaf relatives, the percentages are 28.4 and 30.3.

The evidence is very strong, then, with regard to the form of deafness and the presence or absence of deaf relatives. In cases where the parents are not congenitally deaf and have no deaf relatives, the proportion of deaf children is very low. When one or both parents are congenitally deaf or have deaf relatives--when the deafness is inherited or in the family--the likelihood becomes far greater, and greater still when the two influences are in conjunction. In general, in respect to the influences of heredity upon deafness, the main determinants seem to be found in the existence in the parties, whether hearing or deaf, of deaf relatives, and, to a less extent, in the existence in parties who are deaf of congenital deafness.

POSSIBLE ACTION FOR THE PREVENTION OF CONGENITAL DEAFNESS

We come now to the consideration of the question of possible action for the prevention of congenital deafness. This examination naturally centers about the matter of the regulation of marriage, with due attention to the extent that action on the part of the state is to be regarded as desirable or feasible.

We have seen that congenital deafness may, hypothetically, be divided into three distinguishable classes: that in which consanguineous marriages are concerned, that in which there is antecedent deafness in the family, and that in which neither of these conditions occurs; and in our inquiry it has seemed best to take up each of these separately. It may be, however, that there is in fact no very radical difference between these several forms, and that with increased knowledge on the subject a more or less intimate relation will be found to exist.

Of that form of deafness in which neither consanguineous marriages nor antecedent deafness is involved, we are at present, as we have noted, able to say little definitely. In most cases we may be convinced that there exists in the parent some peculiar state of morbidity or other affection, latent or manifest, perhaps to some extent of hereditary influence, which has an effect on the organs of hearing of the offspring. A certain proportion is quite possibly due to recognizable defects both of physical and mental character. Our statistical evidence, however, in respect to this form of congenital deafness is too slight to warrant any positive deductions; and we will have to wait for further investigation to determine its nature fully. None the less, marriage of persons known to be liable to have ill effect on possible offspring is objectionable for not a few reasons, from the standpoint of the interests of society; and in their reduction there will probably be a greater or less diminution of congenital deafness.

With regard to consanguineous marriages and their effect on deafness we are on surer ground, so far as may be indicated by statistical data. This question is found in very great measure to be connected with that of deaf relatives in general. The matter appears to be largely a part of a law of wide application, namely, that in the blood relationship of parents the possibilities are intensified of the perpetuation of a certain strain, which holds true no less with the transmission of deafness. Consanguineous marriages are perhaps not of sufficiently frequent occurrence, so far as concerns the effect on deafness, to require special action; but in the consideration of such marriages in general, their part in the causation of deafness should have due weight; and whatever may be said regarding them in other relations, they are to be avoided if we wish to remove all chances of this kind of deafness resulting.

The problem of deaf relatives and their connection with congenital deafness is a very large one. Attention however, has mostly been focused upon it in relation to the intermarriage of the deaf and its effect upon their offspring. Indeed, in such unions there has already been more or less concern, and there has even been question whether it is a wise or unwise policy to allow the deaf to marry other deaf persons. The deaf, as we shall discover, not only find their companions for social intercourse among similar deaf persons, but a fortiori very often seek such persons for their partners in marriage--in fact, more often than they do hearing partners, nearly three-fourths of the married deaf being married to deaf partners.[56] Not only has it been feared that the offspring of such marriages might likewise be deaf, but there has also been apprehension lest in their encouragement there might result a deaf species of the race.[57]

From our discussion, however, we have found that in most of the marriages of the deaf we have but small reason for disquiet. If deafness in the parent is really adventitious, there is little possibility of its passing on to the offspring. When the deafness in the parent is itself congenital, the situation becomes more serious. If in such case there is no added risk from the existence of deaf relatives, the likelihood of transmitting deafness need not always be a matter of deep concern, though the hazard is materially larger than for adventitious deafness. When there are deaf relatives involved, the peril, made stronger if coupled with congenital deafness, is most pronounced; and, indeed, the existence of collateral deafness seems a more certain sign of warning than direct heredity itself. Finally, even in the marriage of the deaf with the hearing, the dangers are not in fact lessened if conditions otherwise unchanged are attendant.

What action should be taken in respect to that part of the deaf who may marry under conditions favorable to the production of deaf offspring is not at present clear. Legislation would not appear on the whole to be advisable;[58] and the exertion of moral suasion, so far as possible, in the individual cases concerned would seem a more acceptable course. The matter, however, really belongs in the province of eugenics, and we will probably do best to await the authoritative pronouncement of its decrees before full procedure is resolved upon.

CONGENITAL DEAFNESS AS AN INCREASING OR DECREASING PHENOMENON

The final matter to be ascertained in respect to congenital deafness is whether it is relatively increasing or decreasing. The following table will show the number of the congenitally deaf in the censuses of 1880, 1890, and 1900, with their respective percentages and the ratios per million of population.[59]

NUMBER OF THE CONGENITALLY DEAF IN 1880, 1890, AND 1900

RATIO PER TOTAL CONGENITALLY PER MILLION OF NUMBER DEAF CENT POPULATION

1880 33,878 12,155 35.6 242 1890 40,562 16,866 41.2 269 1900 37,426 12,609 33.7 166

From this it appears that congenital deafness is decreasing both in relation to all deafness, and to the general population.

For further statistics, we may revert to our tables under adventitious deafness. In the tables relating to periods of successive recent years we find in respect to three schools, the New York and Western Pennsylvania institutions and the Maryland School, with certain fluctuations, no great change on the whole, though the last named school shows still a very high proportion. In two schools, the Michigan and Wisconsin, rather an increase is observed. In the Pennsylvania Institution, which covers a period of seventy years, there is a decrease from over 50 per cent to less than 40.

A better test perhaps lies in the comparison of the proportions found for congenital deafness in the tables relating to periods widely separated in time. In these an increase is seen in the single case of the Ohio School; while a decrease is apparent in three, namely, the American and Iowa schools and the New York Institution. These decreases in percentages are respectively from 44.8 and 50.1 to 35.2; from 37.2 to 26.9; and from 42.9 to 38.0.[60]

From the evidence that we have, then, taken together, it seems reasonable to conclude that congenital deafness is, though slowly, becoming less in the course of the years.

CONCLUSIONS WITH RESPECT TO THE ELIMINATION OR PREVENTION OF DEAFNESS

Most of what has been said in this chapter with respect to the elimination or prevention of deafness may be summed up as follows:

1. There are two kinds of deafness--adventitious and congenital. Of the total number of cases adventitious deafness comprises nearly two-thirds, and congenital deafness a little over one-third.

2. Nearly all adventitious deafness is caused by some disease of infancy or childhood attacking the middle or internal ear, a large part being of infectious character. The two chief diseases causing such deafness are scarlet fever and meningitis, with a less amount from brain fever, typhoid fever, measles, catarrh, diphtheria, whooping cough, etc.

3. A considerable part of this deafness is preventable under enlightened action. Medical science is principally in control of the situation, but there is also much that can be done in general measures for the protection of the health. In attacking the problem, the most immediate practical program lies in the arrest of those diseases, especially infantile and infectious diseases, that cause deafness.

4. Our evidence is incomplete to determine definitely whether adventitious deafness is increasing or decreasing relatively among the population; but it is hardly other than likely that it is decreasing. Although certain diseases producing deafness fail to show any extensive signs of abatement, there are other diseases from which there can be little doubt that deafness is decreasing.