easily confused with ae.  Then ee (e with macron).  If, after a time, a distance and a degree of loudness are found that enable him to recognize these sounds with unfailing accuracy, or at least 90 per cent. of the time, then other sounds can be added, such as aw (a with diaresis below), (a with breve) (as in hat), (i with macron) (as in ice), oo (as in cool), ow (as in owl).  Using these sounds at different pitches, and with different intensities and distances, a sufficiently accurate estimate can be formed of the degree of his hearing power so far as his present needs are concerned.

IX

THE DEVELOPMENT OF RESIDUAL HEARING

If any ability to perceive sounds is found, every effort should be made to lead the child to use it, and as the most essential use of hearing is in the comprehension of spoken language, the principal effort should be made along that line.

Take three objects, the names of which are short, with the principal vowels quite easily distinguished.  A little toy street car, a cap, and a toy sheep, would do nicely to begin with, as the three words, “car,” “cap,” and “sheep,” are not easily confused.  Place two of the objects before him, the car and the sheep, and speak the name of one of them, “car,” we will say, loudly and distinctly close to his ear, but in such a way that he cannot see your mouth.  Then show him the car.  Repeat it with “sheep” and show him the sheep.  Repeat “car,” and take his little hand, put it on the car.  Then “sheep,” and make him put his hand on the sheep.  Continue this process until he will indicate to you the object you name.  When he makes only occasional mistakes with two objects, add the cap.  When he can get the right one about 90 per cent. of the time, then take three new words, returning occasionally to the first three.  Very soon his own name and those of others, with photographs to enable him to indicate which, will prove of interest to him.  When he has successfully learned to distinguish a few single words, a beginning can be made on short sentences.  Commands that he can execute are convenient.  “Shut your eyes,” “Open your mouth,” “Clap your hands,” can follow drill on the three words, “eyes,” “mouth,” “hands.”  “Open the window,” “Shut the window,” “Open the book,” “Shut the book,” “Open the door,” etc.  “Stand up,” “Sit down.”  When this beginning has been made, the road is open to the gradual increase in a hearing vocabulary, but do not attempt so much at once as to confuse and discourage the child.

The suggestions already made should be studiously followed throughout his whole childhood.  If his hearing is not too seriously impaired, he will begin to attempt to imitate spoken sounds by the time he is twenty-four to thirty months old.  But his ability to imitate sounds is not an accurate measure of his ability to hear.  He may perceive the sounds much better than he is able to reproduce them.