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Problems of the Deaf and Hard of Hearing 3g to be solved by abstract applications of genetic principles, but re- quire the cooperative work of physicists, physiologists, sociologists, psychologists, and medical men. The Conference believes that the results of the research recorx~mended in this report will contribute much toward the solution of these genetic problems. VIII. RESEARCH PERSONNEL AND RESEARCH PROVISIONS It is apparent to the Conference that personnel adequate to the under- taking of the galaxy of investigations which have been outlined under headings I to VI is not now available, and that the development of in- vestigators competent to conduct many of the details will require time, and will depend upon efforts intelligently directed toward such de- velopment. On the other hand, it is obvious that while certain features of the program cart be commenced as soon as funds and personnel are avail- able, other features will require a longer planning; and some will neces- sarily await the completion of others upon which they will depend for data and orientation. It should be possible, therefore, to carry out the actual research coordinately with the effective development of research personnel. The sources of personnel will obviously be varied. A certain number of investigators may be drawn from institutions for the deaf, these requiring in most cases further training in scientific directions. Others will be drawn from universities, and from the medical profession. These, too, will, in general, need intensive supplemental training to adapt them to the needs of the research. Certain portions of the program may effectively be undertaken by organizations now active in fields to which these problems pertain. Cer- tain others may well be undertaken by university departments which are adequately equipped and which are in efficient working relations with Other departments cognate to the work, and with institutions for the deaf. The problems of palmesthetic stimulation and of the use of visible phonograms are illustrations of this type. For other groups of problems, specific working units must be set up under proper control and administration. The surveys of teaching and supervisory personnel and the survey of curricula for example, may be coordinately conducted by a single investigator with a small staff, per- haps under the administration of the organization which should conduct the population surveys. The development of methods for the rating of portable microphone sets may well be carried out by a single investi- gator under the direction of the Bureau of Standards. The legal and

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40 Pro blends of the Deaf and Hard of Hearing economic surveys may well be taken under the wings of existing in- stitutes for research in those subjects. The establishment of the nursery school is believed to be one of the most important of the major recommendations of the Conference, war- ranting the establishment of a special commission for its further plan- ning. The adjustmental work with older children may perhaps in large measure await the development of the nursery school, and develop in cooperation with it. The production of measures of capacity and achievement should be accelerated as much as possible in the hands of a unit giving the maximal proportion of their time to this work, since the attack on many of the educational and other problems awaits the making available of these measures. A. PROVISIONS FOR THE TRAINING OF PERSONNEL The Conference recommends: I. That provision be made by which a limited number of capable persons, sufficiently versed in the problems of the care and train- ing of the deaf and hard of hearing from the institutional and public school points of view, may be enabled to receive in uni- versities one or two years of scientific training in lines appro- priate to investigations which these persons will later undertake. That a limited number of post-doctoral fellowships be made available for persons trained in appropriate scientific lines, for work in connection with favorable institutions for the deaf under suitable scientific direction. That steps be taken to acquaint various scientific departments throughout the United States and Canada with the research pro- gram herein presented, with the need of drawing highly capable persons into this work, and with the existence of problems sup- plementary to this program which may well receive the attention of graduate students planning doctoral research. B. A NATIONAL ADVISORY COMMITTEE The Conference recomwlends that the National Research Council be requested to establish in the Division of Anthropology and Psy- chology a small advisory committee with continuing personnel, which shall, for a period of five years, endeavor to forward in all ways the carrying out of the Conference's recommendations, and which shall serve as a centre of coordination for the various organizations, institutions, groups and individuals which may engage in the work. NOTE ~ The terminology of the field of auditory disability is at present some- what awkward. In this program, the word deaf is used to indicate the

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Pro bleats of the Deaf and Hard of Hearing 4~ condition in which the auditory capacity is so low as to be virtually use- less. This is in agreement with technical usage, although opposed to popular usage. For the total absence of auditory capacity, anacousia (with the adjective anacousic) should be employed. For the condition in which the hearing ability is of some value, the technical term hypa- cousia is employed (with the adjective hypaco?~sic); and hypacousic individuals may be referred to as hypaconsics. These are the individuals who are commonly described as " hard of hearing." Both deafness and hypacousia are properly described as auditory de- ficiency, and the deaf and hypacousic may be conveniently classed as auditorily deficient. The loss of normal hearing, once possessed by the individual, is prop- erly described as auditory impairment, and individuals whose hearing has been significantly impaired are described as deafened. Instruments for measuring auditory capacity and deficiency have long been known by the standardized name of acoumeters. The hybrid term " audiometer " has also been applied to a number of instruments of the same types to which the name acoumeter is applied, but in the United States at present is generally tolled as referring to the improved acou- meters developed in the Bell Telephone Laboratories. NOTE 2 GENERATE PRINCIPLES GOVERNING POPULATION SURVEYS, WITH ESPECIAL REFERENCE TO SURVEYS OF AUDITORY DEFICIENCY I. Three major problems must be recognized in undertaking any scientific survey, namely: a. That of defining the purposes of the surveys. b. That of securing objectivity and standardization in observ- ing and recording auditory deficiency of different types for sufficiently large samples of the population. c. That of scope and methodology in attaining the purposes which surveys are to serve. 2. The major objectives of surveys of auditory deficiency appear to be three in number, all of which are closely related, and under each of which may be classified a variety of specific objectives. These three objectives are: a. The prevalence of different types and degrees of auditory deficiency in the population. b. The association of auditory deficiency of different types and degrees with various conditions and factors for the purpose of determining causal relationships. c. The efficacy of preventive, adaptive and curative measures.

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4 ~Problems of the Deaf and Hard of Hearing 3. Taking up these objectives in the order given above, some of the detailed considerations that have been discussed may be men- tioned briefly: a. On the prevalence of auditory deficiency, certain possible fac tors ordinarily connoted by the term " demographic " should be taken into' account, viz: (~) Sex and age (~) Race and nativity (3) Urban and rural environment (4) Economic status (5) Scholastic or educational attainments (6) Intelligence These factors to be determined for normal as well as affected persons in any group surveyed. b. In attempting to ascertain correlations of auditory deficiency with possible causative and influencing factors, certain specific objectives suggest themselves, viz: The past incidence or present existence of those diseases and defects which might be suspected of significance; history of accidents. (2) The eRect of environmental conditions, particularly those involved in occupation, such as dust, noise. etc. (3) The extent to which inheritance of physiological and anatomical conditions is a factor. c. In surveying the general extent of adaptation and adaptive methods, account ought to be taken of natural adjustment of the auditorily deficient to their environment, as well as of measures that have been devised and put into operation. Among these specific objectives may be mentioned: (~) The extent to which the "hard of hearing" (by type and degree) realize their own impairment. (2) The incidence of auditory deficiencies (by type and degree) among persons in different kinds of occupations. (3) The economic or earning ability of persons of varying types arid degrees of auditory deficiency. (4) The comparison of trained and untrained auditorily deficient individuals of a given degree and type with degree, among persons in different kinds of occupations. (5) The attitude of employers and other employees to per- sons affected.

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Problems of the Deaf and Hard of Hearing 43 4. Objectivity and standardization of observation. a. A preliminary experimental survey is regarded as highly desirable for the purposes of (~) Perfecting the use of acoumetric instruments in such surveys, particularly with regard to method of dealing with the elements of interest and intelligence on the part of the subject and of outside interference. (~) Ascertaining the best ways of collecting data on the various factors involved. (3) Agreement upon, and standardization of, terms and statistical units. (4) The training of a group of investigators to direct the larger surveys as well as the more specific studies. b. In the use of acoumetric measurement, at least for the pre- liminary surveys, it is regarded as desirable to select a random sampling of the population by house-to-house investigation, obtaining data along the lines discussed above, and by measur- ing the hearing of the subject. In the measurement of the hearing of the subject, it would be desirable to measure by both bone conduction and air conduction through the audibility range. This would involve a tremendous amount of work, however, and it seems to place obstacles in the way of such a survey being under- taken. As an alternative it is suggested that the following method be used: The hearing of the subject by air conduction should be measured at a low frequency, an intermediate frequency, and a high frequency. A person who could hear a standard in- tensity at each of these points would be passed as of " normal " hearing. A person who failed at any point would be considered as a subject to' be referred to some central investigation point. The central investigation point should be equipped with complete apparatus to measure hearing, and a determination of the hearing by air and bone conduction should be made. This should be supplemented by a careful orological examination. Since only a small percentage of the people in the community would be referred to this central investigation point, this phase of the plan seems feasible. For the test to be conducted in the home at the three pitch points, for example, loo cycles, loon cycles and 6000 cycles, a small portable " audiometer " could be provided.

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44 Problems of the Deaf and Harc! of Hearing 5. Methods and scope of surveys. Certain basic postulates have been considered, as follows: a. It is clearly necessary, in making surveys for these purposes, and in analyzing the results, that many of the possible factors suggested above should be observed not only for persons with normal hearing, but also for persons with defective hearing. b. In determining the degree of association between any one possible factor and the existence of defective hearing, sev- eral other factors must be held constant, and provision should be made for the necessary observations and records for this purpose. c. Although the possible causal and adaptive relationships may be studied for a specific population group, i. e., limited by selection as to sex, age, race or nativity, and intelligence, it is assumed that to ascertain the magnitude of the problem is a major objective, and that actual conditions in a con- siderable sample of the population should be observed. At the same time, it appears feasible to extend the inquiry, in certain of its phases, to a considerable sample or series of samples, and to restrict the study of other phases to smaller groups.