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ACOUSTIC EXERCISES FOR DEAF-MUTES.

A PAPER, posthumously published, by the lateProf. Victor Urbantschitsch 1 of Vienna, whose deathwe recorded in our issue of July loth, gives aninteresting account of some of the results achieved bythe systematic use of acoustic exercises in a largenumber of deaf-mute pupils at the Israelitic DeafInstitute in Vienna. It has been found on carefulexamination that in a surprisingly high percentage ofcases believed to be totally deaf considerable residualhearing exists ; this may, perhaps, be partly explainedby a confusion between an inability to understandwhat is heard and an inability to hear. The acousticexercises are begun by the repetition of individualvowels, called into the ear, the first vowels used beinggenerally a and o, and the other vowel sounds beingadded by degrees. Words easily understood, such asMama, Papa, Auge, Nase, are spoken slowly and in asustained voice, the pupil, who is told in advancewhich word will be used, having to repeat the practice-word in order that wrong hearing impressions may becorrected. The words have in every case to beacoustically memorised. It is important that in theearliest stages the pupil should be trained by thesame teacher, later on different voices being used.Practice with musical tones (harmonica, piano, windand string instruments) to acquire pitch and to

recognise melody are important. Prof. Urbant-schitsch pointed out that the hearing perception indeaf-mutes is subject to much fluctuation, especiallyin the earlier stages, and perseverance is needed inspite of apparently discouraging results. " Acoustic-fag " is liable to occur and is a warning to limit theexercises, five- to ten-minute periods several times aday usually being enough in view of the intensedegree of concentration needed on the part of thedeaf pupil. Emphasis is laid upon the fact that eventhe acquisition of vowel perception in a pupil whohas never heard is well worth while, this resulting inthe modification of the normal toneless unmodulatedvoice of the deaf-mute.

In a much longer and more elaborate paper 2Dr. Max A. Goldstein develops this theme, payingwarm tribute to the work of the late Prof.Urbantschitsch, whom he describes as

"

perhaps theonly one who has persisted in his training of theprofoundly or totally deaf child by the acousticmethod." After giving a brief review of the literatureof this subject, and a classification of nerve-deafnessinto five groups-each group representing a differentpathological process-Dr. Goldstein describes indetail his own application of the acoustic method,this being divided into passive and active education.Much use is made of sound comparison, which, asthe writer points out, is a logical form of stimulation,awakening a mental differentiation in the brain aswell as a physiological selective differentiation in theorgan of Corti. A brief history of six illustrativecases is given, including instances of congenital deaf-mutism, marked improvement being shown in everycase after two years of training.

JUBILEE OF THE AMERICAN PUBLICHEALTH ASSOCIATION.

THE American Public Health Association will holdits " semi-centennial " celebrations in New Yorkfrom Nov. 8th to 18th. The scientific conven-tion, to be held from the 14th to the 18th, willbe divided into sections of laboratory work, vitalstatistics, public health administration, sanitaryengineering, industrial hygiene, and food and drugs,with special programmes dealing with child hygiene,health education and publicity. Prior to theconvention proper there will be demonstrations ofthe various types of public health activity in NewYork and its environs-the health department bureau,laboratories, health centres, clinics, and hospitals-

1 The Laryngoscope, July, 1921.2 Ibid.

in order that, the health services may be seen in actualoperation, especially those admitting of duplicationin other cities. Dr. Stephen Smith, the founder andfirst president of the Association, is now in his 99thyear ; he will be the guest of honour at a banquetto celebrate his approaching centenary and the jubileeof the Association. At the beginning of October ahistorical jubilee volume entitled " Fifty Years ofPublic Health" " will be published, with an introductorydescription of the earlier beginnings of the science.Detailed announcements and programmes will appearfrom time to time in the American Journal of PublicHeulth and the News Letter of the Association, or maybe had upon addressing the Association at 370,Seventh-avenue, New York city.

SPASM OF THE CENTRAL ARTERY OF

THE RETINA.

Or the various causes of obstruction to the blood-flow in the central artery of the retina, spasm of themuscular wall of the artery is one of the rarest ;indeed, some authorities have doubted whether itactually occurs. Ophthalmoscopic evidence on thepoint must be received with caution, since the appa-rently visible contraction of the artery or one of itsbranches, rapidly changing to a normal appearanceand synchronising with an obscuration of vision inthe affected eye, is a condition which might con-

ceivably be caused by variations in general bloodpressure where the inner lining of the arterial wallis so thickened by disease that the usual pressure ofthe blood from behind is only just sufficient to over-come what amounts to a partial obstruction. Someof the cases of obstruction from spasm which havebeen reported have probably been of this nature,but others, occurring in patients otherwise in goodhealth, will hardly bear any other interpretationthan that of actual spasm. So long ago as 1894 thelate Mr. A. K. Benson, of Dublin, put on record one suchcase where an interruption in the blood column wasobserved repeatedly to move along the inferiortemporal artery towards the periphery of the fundusas far as its bifurcation, and then cease. In 1906R. A. Lundie recorded a case where the contractionoccurred in a single branch, and was stationary untilthe condition of spasm passed off, the apparentcontraction then disappearing. Other cases againhave been reported where all the vessels have beenobserved gradually to diminish in calibre, and aftera time to refill, the condition being in some cases

accompanied by the oedematous retina and cherry-red spot at the macula, typical of embolism or

obstruction of the central artery from any othercause. The most recent case is one reported byA. B. Bruner in the American Journal of Ophthalmo-logy for July. A man of 34 had several attacks ofloss of vision in one eye lasting for a few minutes.He was seen on the day when the attacks firstoccurred. Between them nothing abnormal wasfound ophthalmoscopically, but during them thefundus of the affected (left) eye showed the followingstriking picture :-The nerve and retina decidedly paler than in the right

eye ; the arteries are all markedly contracted, appearingas mere threads ; the veins show entire cessation of blood-

flow, the regular venous pulse ceasing entirely ; the bloodin the veins assumes a granular appearance due to thebreaking up of the normal blood-column ; in from one tothree minutes the flow of blood in the veins recommences, atfirst slowly, then more rapidly, the venous pulse reappears,the arteries assume their normal calibre and appearance,and vision rapidly returns to normal. During the timeof the attack no red spot was seen at the macula.The attacks continued to occur for five days, duringwhich they were observed with no variation of theophthalmoscopic picture. At the end of that timethey ceased spontaneously, and did not recur. Nocause of the onset could be discovered by generalexamination of the patient, unless an alveolar abscessmight be considered such, though, as the affectedtooth was immediately extracted and the attacks