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156
Annual Report of the London County Council, 1911.
Acute infectious diseases account for one-third of the acquired cases.
Epidemic cerebro-spinal meningitis, which is the most prevalent cause in America, is here only
represented by one case. The older work of Mygind gave percentages as follows for statistics from
various countries: Norway, 23.5 to 12.0; Pomerania, 26.8; Baden, 14.0; Denmark, 1.9; Mecklenburg,
1.5; Saxony, 1.1
Scarlet fever accounted for 39 cases, together with one where it was complicated with typhoid.
Of these 40 cases (8.8 per cent.) in 35 there was suppuration, 3 had middle ear catarrh, and 2 internal
ear disease. Scarlet fever used to be a very large factor in English statistics of deafness, but during the
present generation the mildness of the disease has materially lessened the aural sequelæ.
Measles figures as follows, measles 61, measles and scarlatina 1, measles with meningitis 3, measles
with pneumonia 6—a total of 71, or 15.6 per cent. Suppuration had resulted in 38 of these cases, whilst
catarrhal disease 6 and internal ear disease 24, account for the rest. The diminished seriousness of scarlatina
as a factor of deafness partly due to increased attention paid to it by public health authorities, and
partly to reduced prevalence of serious forms shows up well when measles and scarlatina are compared
as factors of acquired deafness. Here measles is twice as important as scarlatina, but in the older statistics
of Mygind the opposite was always the case. He gives :—
Ireland. Germany. Denmark.
(Wilde) (Hartmann)
Scarlet fever 7.0 11.3 20.8
Measles 1.4 3.6 5.3
Diphtheria is given as the only cause in 10 cases, and in 4 as the cause combined with scarlet
fever or measles. This makes 14, or 3.1 per cent. Suppuration had resulted in 11 of the cases.
Pneumonia, now classed as an acute specific disease, is said to have been the cause in 13, or 2.9
per cent., 8 of which were due to suppuration and the rest to internal ear troubles.
Other acute diseases figuring in the history as a cause were typhoid 2, influenza 3, whooping cough
5, mumps 1, and rheumatic fever 1 case. The majority of these last cases were due to nerve deafness.
The constitutional diseases tubercle and syphilis are extremely prevalent in the community,
but apart from the case of recovered tuberculous meningitis, which is a rarity, there was only one case in
which tubercle could be assigned definitely as the cause. This was a case of old middle ear tuberculosis
which had undergone more than a dozen operations. Considering the frequency of tubercle as an aural
disease in very young children its absence in the deaf schools is remarkable and can only be due to its
fatality. Our figures are borne out by other statistics which assign less than one per cent. to this cause.
Congenital syphilis is responsible for an appreciable number of severe cases of acquired deafness in
children. In addition there are a considerable number of cases which become affected in the last year or
two of school life, and which, though too deaf for ordinary life, yet are not wholly deaf; these do not come
into the deaf schools. All kinds of causes are assigned, " paralysis, nerves, run over, unknown, improper
medical treatment" and so on. It is only by careful enquiry that a number of these cases are known,
Castex, in Paris, publishes (1908) 18 out of 719, or 2.5 per cent.; Yearsley (1909) noted 17 of 225, or 7.5
per cent. There are 37 cases here assigned to this cause; that is, 8.03 per cent. of the cases requiring
education as deaf are definitely assigned to congenital syphilis. This alone is an argument for the
sanitary control of this most serious disorder, which is so prevalent.
Primary ear disease is disease of the ear not due to infectious fevers, constitutional or brain
disease. The cases under this head may be classified as—
(i.) Suppurative disease, not caused by the fevers. To render a child educationally deaf
it must have considerable destruction of the middle ears or secondary implication of the internal
ears. These cases numbered 51, or 11.25 per cent. The majority were due to naso-pharyngeal
conditions, chiefly adenoids, and most were avoidable.
(ii.) Middle ear catarrh numbered 41 cases, and of these 40, or 98 percent., were due to
adenoids. This shows the necessity of attention to preventative measures, as every one of these
cases should have been avoided.
(iii.) Otosclerosis is a remoter consequence which does not usually show before adult life,
but which was the cause of deafness in a girl of eleven years of age.
Other influences.—Undoubted causes were fright or shock 9, injuries such as blows or falls 66,
where the deafness is directly caused 45, or secondarily through concussion of the brain 5, or meningitis
16. Three cases were assigned to the problematical cause burns. Other improbable causes were teething
8, four of which were probably due to congenital causes, meningitis, scarlatina, and catarrhal middle
ear disease respectively. One case ascribed to diarrhoea was probably the result ot adenoids, and
associated mucous disease.
Doubtful cases were 41, nearly 5 per cent. of all the children, and they were provisionally
assigned as follows:—
Probably congenital 23
„ congenital aphasia 1
„ middle ear suppuration 2
„ „ „ catarrh 14 ;
Fever (nature not ascertained) 1
41
Causes were quite unknown in 15.