The Indian Journal of Social Work, Vol. XXII, No. 3 (December 1961). THE...
The Indian Journal of Social Work, Vol. XXII, No. 3 (December 1961).
THE MODERN APPROACH TO DEAFNESS
C. A. AMESUR., * M . S . (LONDON)
In this article an attempt has been made to deal with the problem of deafness in all
its aspects. We have attempted to show the important causes of deafness, suggest preventive
measures and dispel some misunderstanding about the various types of deafness and the
possibility of cure by medical or surgical treatment.
T h e existing facilities for the education and training of the deaf have been briefly
surveyed. Available information about future plans has been included in the article.
An examination of the present situation seems to indicate that the value of educating
the deaf and placing them in remunerative employment is beginning to be gradually recognized.
There is an imperative need, however, for the rapid expansion of the existing facilities which
are very inadequate. T h e lack of financial resources and the trained personnel are the major
causes of retarded progress in the field.
We hope that with an increasing awareness of the value of rehabilitating the deaf,
it will be possible to generate greater interest in the public at large and in the State and
that this interest will be translated into more educational and training facilities and employ-
ment opportunities for the deaf.
Dr. C. A. Amesur, M.S. ( L o n d o n ) , is a member of National Advisory Council for the
Education of the Handicapped, India and of its Standing Committee; and of the Special
Employment Exchange for the Physically Handicapped, Bombay.
Dr. Amesur has been a member of many committees in drawing up the blue prints of
the E.N.T. and Audiology Departments of various hospitals, both at the National and local levels.
Introduction.—The attitude of society deaf were last enumerated at the 1931 census
towards the physically handicapped,
when the number was put at about 2,30,000.
including the deaf, has passed through three It is believed, however, that the number of
main stages. Ancient society denied to the deaf persons in the country is not less than
handicapped the right to live. The advent about 8 lakhs.
of religion led to the gradual recognition of
During the Second Plan period, the
the right to live. The era of technological Government of India attempted to assess the
progress has, however, revolutionized the size of the handicapped population by
modern concept of disability and has intro-
carrying out random sample surveys in
duced an element of rationale in this as in selected areas. The first such survey was
many other concepts. It is being increasingly carried out in Bombay in 1957.
appreciated now that the loss of hearing
According to this survey, 0.8 per cent. of
does not close the realm of knowledge for the population is deaf. According to the
the victim nor does it deprive anyone of the tentative census figures for 1961, India's
capacity to receive training and engage in population has gone up to 438 million. If
productive work. In fact, the modern con-
however the results of the Bombay are taken
cept of rehabilitation can be summarized as representative, India should have nearly
in the phrase "charity to opportunity".
35 lakh deaf persons. The enormity of the
Incidence.—We have no reliable estimate problem is easily understood at a glance by
of the deaf population in the country. The these figures.
*The author would like to express his grateful thanks to Dr. R. H. Lulla and Shri Lal
Advani for their kind assistance.

174
C. A. A M E S U R , M . S . ( L O N D O N )
A similar survey carried out in Delhi last showed a recessive pattern and that, as a
year t h a t 4 per cent. of the families in the measure of prevention by inference, it would
capital h a d a handicapped member and be much better for the deaf not to m a r r y the
about 12 per cent of these persons were deaf. deaf when there was a genetic factor
Even this reveals t h a t the problem is of very
involved. This theory did not hold good in
considerable size. A sample survey has just a case of a deaf (Secretary of Bombay Deaf
been completed in K a n p u r . It is possible and D u m b Society) who married a deaf but
t h a t this survey might throw more light.
have perfectly normal adult daughter. Such
a case was also reported to me from Kerala
Causes of Deafness.—Deafness is caused by while deliberating at the Deaf Seminar 1955.
a variety of causes. Any serious infection
during pregnancy like German measles,
T h e causes of Kernicterus in this country
typhoid, influenza and the intake of drugs are usually detected in the last m o n t h of
like quinine and streptomycin could lead to pregnancy, when careful examinations are
the impairment of the child's hearing. made for anti-bodies where the mother is
Cerebro-spinal fever during pregnancy is rhesus negative, and it is usually taken t h a t
another potent source of danger.
if the serum bilirubin reaches 20 mgm.s %
that there is a danger of residual problems
Congenital syphilis could destroy the and definite indications for exchange
auditory nerve before birth. Unfortunately, transfusion.
of the auditory nerve is destroyed, no
medical treatment can bring about any
It will pay us dividends to give free
improvement.
Vit. " A " to expectant mothers, and examine
school children for adenoids and infections
Simple conditions like recurrent common of the upper respiratory passages.
colds might lead to deafness by giving rise
to infection of the middle ear. Parents
Types of Deafness.—Two types of deafness
would, therefore, be well advised to consult are commonly observed, (1) conducive or
a doctor if their children suffer from middle ear deafness and (2) perceptive or
prolonged or frequent common colds.
nerve deafness. A combination of both the
types of deafness is also not uncommon.
Summarising, the aetiology of deafness is
concerned in young children the causes are
Conductive is caused by a blockage of the
prematurity, familial deafness, prenatal external auditory canal, infection of the ear
diseases such as anoxia, kernicterus due to drum, eustachian tube and the middle ear.
prematurity, Rhesus incompatibility, or infec-
This type of deafness often yields to medical
tion, meningitis, adenoids and Vit. " A " and surgical treatment. Otosclerosis is now
shortage.
becoming more and more susceptible to
surgical treatment.
From the point of view of prevention
prematurity is always bound up with
Perceptive or nerve deafness involves
antenatal care, social conditions, adequate the inner ear where the sensory cells and
rest etc. for the pregnant mother. T h e r e was auditory nerve fibres are located. Although
an interesting paper by Cheeseman & in young children this type of deafness m a y
Stevenson in the Journal of Humangenetics be called congenital or inherited. It can
1951, on the genetic factors in familian result from meningitis and many other acute
deafness where they showed t h a t if con-
infections, from severe t r a u m a and from
sanguinity was present the inherited factor other causes. P r o m p t treatment m a y salvage

T H E MODERN APPROACH TO DEAFNESS
175
the hearing, even when the inner ear is ever, they receive some financial assistance
involved provided no permanent damage from the State Government concerned or
has effected the sensory cells and nerve the Central Social Welfare Board. In the
fibres. However, no type of treatment, recent past the Government of India have
medication, or amplification will restore the also been giving assistance to suitable insti-
hearing of persons whose hearing loss is tutions for implementing developmental
caused by true nerve deafness.
projects. The Government of India have
just decided to liberalize their grant-in-aid
Prevention.—The following are a few policy. In future they will be prepared to
simple measures which could help in contribute 75% of the expenditure on the
reducing the incidence of deafness:—
development schemes of voluntary agencies
(1) Prompt and effective treatment of instead of 70% as in the past. It is hoped
conditions like German measles. that with the liberalization of the grant-in-
Every expectant mother getting an aid rules by the Government of India and
attack of German measles, however the State Governments more and more
mild, specially in the first three schools for the deaf will come up. India
months of pregnancy should be given needs many more schools if the country is
one injection of gamma globulin, to provide education to every deaf child.
which will permanently immunize
Our constitution enjoins on the State to
the foetus.
provide compulsory and free education for
(2) Early treatment of conditions like all children till they reach the age of
syphilis, particularly if it occurs in fourteen years. This provision of the consti-
the last three months of pregnancy. tution applies to all children, including deaf
children. It is, therefore, obligatory on the
(3) Early diagnosis and treatment of State to take all possible steps to fulfil this
conditions like typhoid, colds and requirement of the constitution.
so on.
Education in most schools for the deaf is
(4) Careful use of drugs like quinine and given through the oral method. This means
streptomycin.
that the child is taught to understand the
(5) Measures to insure that the flow of spoken word rather than depend on some
blood in the foetus is not interfered other symbols such as the manual alphabet.
with.
The main medium for understanding the
(6) Avoidance of ex-ray laboratories by spoken word is by watching lip movements
expectant mothers.
—a process technically known as lip-reading.
Some of the schools in the country take
Education.—The first school for the deaf the deaf child up to the primary standard.
was established about seventy-five years ago Since the deaf child cannot easily under-
in Bombay. Since then schools for the deaf stand the spoken word, he usually takes ten
have sprung up in most parts of the years or more to complete primary educa-
country. Today there are about 52 schools tion. The majority of the schools do not
for the deaf with a total enrolment of take the deaf child even up to the primary
about 3,000.
standard. They are content with imparting
The majority of schools for the deaf are to the child a certain degree of linguistic
run by voluntary agencies. As a rule, how-
ability.

176
G. A. AMESUR M.S. (LONDON)
Craft training usually forms an essential
In view of this the importance of detection
part of the curriculum of schools for the and accurate measurement of the loss of
deaf. These schools do not attempt to turn hearing can hardly be over-emphasized. The
out skilled craftsmen. They usually give handicap of a child can be very greatly
good pre-vocational preparation.
minimized if hearing loss is detected at a very
early age and a good hearing aid is used even
Some of the schools for the deaf use group from infancy.
hearing aids. Experience has shown that
many of the deaf children retain a usable
Audiology play an equally important role
degree of residual hearing. With training this in the training and employment of deaf
hearing can be utilised to improve the child's adults. For this reason the author has been
speech and language. It is important there-
advocating the establishment of a comprehen-
fore that more and more schools for the deaf sive audiological centre in the country. The
should begin using hearing aids and should lay Government of India proposed to establish
increasing emphasis on aural training.
such a centre during the Second Plan but
was unable to do so for want of funds. The
As in the case of normal children, the Ministry of Health is however proposing to
education of the deaf child begins in the establish 20 audiological clinics attached to
mother's lap. But it is more important that E.N.T. departments in hospitals during the
the formal training of the deaf child in the Third Plan period. This will be a very great
ability to watch and interpret lip movements step forward in promoting the right type of
should begin at a very early age. To-day even education of the deaf. It will also be desir-
infants can use hearing aids. In this way the able for some of the schools for the deaf to
limitations of deafness can be very sub-
have small audiological units. Some of the
stantially minimized.
good schools like the Lady Noyce School for
The Role of Audiology in the Education the Deaf, New Delhi and the School for the
of the Deaf.-—Audiology is a science of hear-
Deaf, Lucknow, have such units. It is hoped
ing, it is a new integrated concept of human that more and more schools will take to the
communication. For the purpose of this detection of hearing loss and its accurate
article we shall confine ourselves to the detec-
measurement.
tion and measurement of the loss of hearing.
In view of the over-riding importance of
A survey of schools for the deaf in India the subject, the author advocated the
carried out by Mr. John K. Duffy revealed establishment of an audiological centre in
that about 20 per cent of children in these 1952 at Patna, again in 1955 at Mussoorie
schools had an average loss up to 80 D.B. for and New Delhi and at St. Louis in 1957 and
the frequencies, 500; 1,000; and 2,000. in subsequent years with the Union Ministries
Another survey carried out by Mr. A. C. Sen, of Education and Health and the Planning
in 1960, showed that 29 per cent of the Commission. Let us hope that this country
children had an average loss of 80 D.B. This will soon have adequate audiological facilities.
means that at least 30 per cent of the
children in our schools for the deaf should
Training and Employment.—Training is
be reclassified as hard-of-hearing. They an essential prerequisite for employment.
might even be able to receive education in Unless the deaf can engage in remunerative
ordinary schools with the help of powerful work the process of rehabilitation will be
hearing aids.
incomplete.

T H E M O D E R N A P P R O A C H T O D E A F N E S S
177
Unfortunately, there is at present no average wage of Rs. 94 p.m. It is evident
special institution for imparting technical from this t h a t they can hold their own in
training to the adult deaf. T h e Government ordinary industry.
of India are however proposing to start a
Encouraged by the success of this experi-
Training Centre for the Adult Deaf at ment, the Government of India propose to
Hyderabad. This Centre will impart train-
establish at least one special employment
ing to the adult deaf in engineering and non-
office for the physically handicapped in each
engineering trades. Initially the Centre will State in addition to Delhi. The office in
have accommodation for 25 deaf men and Delhi has just been opened. The main task
women, but the accommodation will later be of these office will be to try place physically
increased to 100.
handicapped persons, including the deaf, in
ordinary industry, commerce and the public
As a first step towards the training of the services.
deaf, in 1955, the Government of India
initiated a scheme of scholarships for the
Plans for the Future.—During the T h i r d
deaf. U n d e r this scheme scholarships are Plan period the Government of India are
given to deaf students over sixteen years of proposing to give a larger number of scholar-
age for technical training in addition to ships to the deaf. They have recently
general education. But unfortunately, many liberalized and rationalized the rates of
deaf scholars are unable to take advantage of
scholarship payable to the deaf.
these scholarships because ordinary tech-
nical institutions are usually unwilling to
As pointed out earlier the Central Govern-
admit deaf students. Quite often deaf ment also proposes to establish a Training
students do not satisfy the academic qualifica-
Centre for the Adult Deaf at Hyderabad.
tions prescribed for entry into these institu-
Many of the State Governments propose to,
tions. Again, deaf students cannot always establish additional schools for the deaf.
follow the instruction in ordinary institutions
particularly if the subject has a great deal of
Conclusion.—The value of educating the
theoretical content.
deaf and placing them in employment has
begun to be gradually recognized in this
country. T h e existing facilities are however
In view of these difficulties there is impera-
very inadequate. It is therefore necessary to
tive need for the establishment of special train-
expand these facilities as rapidly as we can
ing institutions for the deaf. T h e Govern-
with the limited h u m a n and material
ment of India have decided to establish one. resources that are available. The training of
We hope that the State Government will personnel should receive top priority because
follow suit.
at present the lack of trained staff is probably
the most serious obstacle to the expansion of
Experience in this country and abroad has educational and training facilities for the
shown that it is possible for the deaf to engage
deaf.
in productive work. T h e special employment
office for the physically handicapped
Public education is of paramount impor-
established by the Government of India at tance. Without the co-operation of the
Bombay in March, 1959, has placed 39 deaf
public at large the total integration of the
persons in employment since its inception. deaf individual into his community will be
These deaf persons are able to earn an impossible of achievement.

C. A. AMESUR, M.S. (LONDON)
R E F E R E N C E S
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2.
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