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pupils should be carried out within a reasonable time without sacrificing
accuracy. The ordinary routine methods of clinical testing such as
'conversational voice', watch, tuning forks, etc. would be unsuitable and
unreliable as regards the time involved and accuracy. The invention of
the audiometer in America in 1927 was the answer to the large and
growing demand for a suitable method of detecting quickly and accurately
any defect in hearing among large numbers, such as in schools, industrial
works, etc.
The audiometers, there are two types—the 'Speech' and the 'Pure
Tone'—are very highly developed scientific, electrical instruments and
so sensitive that they can detect and measure accurately in "units of
hearing loss" the slightest to the most severe impairment over the whole
hearing range.
From 1927 onwards the hearing of thousands of children has been
investigated in various cities in U.S.A. The first similar investigation of
hearing loss, on a large scale among school children in this country—
an audiometric survey—was conducted in the Tottenham schools in
1930 by Professor G. P. Crowden of the London School of Hygiene
when he completed a survey of 2,000 children (Proc. Roy. Soc. Med.
27.-1934) and in Hornsey, do, in 1931. (Annual Report of M.O.H. 1930).
From then onwards regular routine audiometer testing has been carried
out in Tottenham schools with the exception of an unavoidable interruption
during the war years. Those children who "failed to pass" the
tests were referred to the ear clinic where a detailed enquiry and clinical
examination was made in each case as to the 'history', cause, duration,
complications, any treatment already received, etc. and a course of
special treatment was carried out. The results of the special treatments
given at the clinics are very interesting. The following account taken
from "Children with Defective Hearing", Board of Education Publication,
1938 and 1950 is an example. "Between 1932 and 1936, 10,171 individual
children were tested as a routine by gramophone audiometer in Tottenham.
Of these children, 8.8% 'failed to pass' in either or both ears. Yet after
treatment had been given where necessary only one child (0.1 per thousand)
had to be sent to a special school as Grade II,B, and 19 children (1.9
per thousand) were found to require favourable position in class".
The Pre-school Child
The primary object of the clinic from its beginning to the present time
has been to emphasise the importance of prevention as well as the treatment
of diseased conditions. Many of the defects, including deafness,
found in the ear, nose and throat in school children originated before the
child attended school, and many such as otitis media, during early
infancy. Prevention is the most important of all the problems connected
with defective hearing and it is during early pre-school age that prevention
can play its important part. The advisability, therefore, of including
pre-school children in the clinic scheme becomes obvious and was recognised
by the Ministry of Health in its issue of Circular 1337(a), in the
early thirties. This urged local authorities to arrange for co-operation
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