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of chronic otorrhoea was comparatively rapid, and indeed remarkable.
Within a period of about two years, practically all the cases of existing
otorrhoea among the school population of the Borough, with the exception
of a small number which required radical mastoid operations—due
to their long-standing chronicity—were healed and 'dry' and as a result,
the hearing in most cases was remarkably improved. This was a great
advance in solving what was, up till then, a most intractable problem.
Further, and an important point, the results, with very few exceptions,
were lasting.
Dr. Friel, realising that the successful treatment of such ear conditions
as otorrhoea, deafness, etc. depended, apart from the local treatment of
the ear itself, also on the recognition and removal of any complicating
factors, frequently present in the nose and throat decided to recommend
enlargement of the scope of the ear clinic by making it a complete unit
for ear, nose and throat affections. The required equipment for this
unit was installed.
Diseased or abnormal conditions in the nose and throat are by far
the most common factors in the causation of ear disease, and consequently
their successful removal is the first and most important step in
the prevention and cure of deafness. To meet this situation, special
methods of treatment, found to be the most successful, many of them
new and quite different from those usually employed, were adopted at
the clinic. These included, in addition to zinc ionization, the new method
of diastolization, a French procedure invented by the late Dr. Gautier
of Paris, and introduced to London by Mr. A. G. Wells, F.R.C.S., Ear,
Nose and Throat Consultant, London County Council, adopted for the
treatment of certain nasal conditions and impaired hearing; aural suction
for acute otorrhoea; Proetz 'sinus displacement' for the diagnosis and
treatment of sinus suppuration; Wells' (New York) nascent iodine vapour
inhalation for infections in the nasopharynx and sinuses; Peters' Tonsilsuction
treatment for diseased tonsils, as well as a number of certain
prescriptions and medicaments found to be of exceptional value.
These methods are still being employed at the clinics, modified, of
course, from time to time, over the years, as experience in their use, and
the discovery of new preparations suggest.
Audiometry
From the beginning, the question of impaired hearing played an
important role in the function of the clniic and the school medical inspections.
Special emphasis was laid on the prevention as well as the cure of
deafness for herein lay the best means and most hopeful prospect of
reducing the incidence of defective hearing both in the school, and later,
adult population.
To deal effectively with the question of deafness in a large population
of school children it is essential to have an exact means of detecting the
hearing loss, from the slightest impairment to the most severe. It is also
necessary that this detection-examination of a very large number of
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