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17
of the county in November, 1934, and a second unit in the south-east division in
May, 1935.
A unit consists of one gramophone audiometer ; one full time nurse, who carries
out the testing of the children in the schools, and is present at the clinical examination;
an otologist, who conducts one clinical examination and one treatment session each
week.
The work is under the direction of Mr. A. G. Wells, to whom I am indebted for
the following report:—
The routine procedure is as follows. The nurse attends the school on an appointed day and
proceeds to test all the children, except those in the infants' department. They can be tested at
the rate of 40 a time, each test taking about 20 minutes, so that if there are no difficulties 120
children an hour may be tested. Any children with otorrhœa are cleansed before being tested,
by washing the outer part of the ear with an antiseptic lotion to avoid contaminating the earphones.
When a number of children have had their test, the test papers are corrected by the
nurse from the master sheet, and those children who do not record correctly at the 6 decibel level
or lower are regarded as failures. These children have a second test. It is always found that
some of the children who failed in the first test are successful in the second. If the failures of
the second test are children below the age of 11 years, they are given a third test, for it has been
found, in children up to this age, that a further but smaller number may succeed in this test
though they failed in tests 1 and 2. Children of 11 years and upwards do not require a third test.
The final failures are then submitted to a clinical examination by the otologist, which is carried
out at the school. The object of this clinical examination is to find out whether any pathological
condition is present to account for the child's failure. If such be found, the position is explained
to the parent, who is then asked to acquiesce in obtaining treatment. The case is followed up
and, when treatment is completed, it is the nurse's duty to arrange for a final test to ascertain
and record the result of treatment.
It has already been stated that in children under 11 years of age a third test and sometimes a
fourth is necessary before a decision of pass or failure can be made correctly. There appear to be
various reasons for this, e.g., (1) lack of concentration; (2) backward children, who are slow to
realise what they are asked to do, or in grasping and writing down the digits ; (3) unfamiliarity
with the voice conveyed by telephone ; (4) lack of attention when being told what they have to
do, or not wanting to take the trouble ; (5) nervousness ; (6) arrest of attention due to
other people being in the room or lack of discipline of another child (slowness in recovering a
train of thought after an interruption); (7) factors inherent in the gramophone record. For
the younger children, the pause between the groups of digits at each intensity step is hardly
long enough. Likewise the interval between each individual digit of the various groups is hardly
sufficient, except for the brighter children.
The younger children give the best results when tested in small numbers, so that the nurse
is better able to keep a watchful eye on each child. They appear to feel themselves more in the
nurse's grip and consequently pay greater attention, are not so easily distracted, concentrate
more and show improved discipline. Younger children naturally show mind wandering more
than older children and this is onhanced by environmental fators.