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162
Annual Report of the London County Council, 1910.
Speaking generally, these statistics conform to those given in the Annual Report for 1909, p. 76,
the number of congenital cases is, however, less. Last year in 500 cases, there was no instance of the
occurrence of cerebro-spinal meningitis as a cause of deaf-mutism, a cause which is very common in
the United States' statistics. This year one case was met with. The history was undoubted.
The long continued prevalence of a very mild type of scarlet fever, and the absence of any
serious epidemic during the last decennium is showing in the deafness returns. Measles continues to
give rise to nearly twice as many cases of deafness as scarlatina, 8.2 per cent. as compared with 3.4
per cent., which is the reverse of proportions found in older records. In the 115 cases here analysed, the
percentage of those due to congenital syphilis was 6.25, as against 7.5 per cent. in last year's
analysis of 500 cases; the latter is a much higher percentage than occurs in other places, Kerr Love
giving that for Glasgow as 1.8 per cent. and Castex for Paris as 2.5 per cent. Last year the percentage
of this cause among the acquired cases was 7.5 per cent., so that it is seen that its occurrence among
the additional cases this year is practically the same.
Hard of Hearing.—One of the most important innovations of the year was the hard of hearing
class at Ackmar-road which was started on September 12th, 1910, with six cases, others being added,
so that at the end of 1910 the class numbered 17. Of these 17 cases, 7 were boys and 10 were girls.
Nature of the cases.—The children who would be fit for a hard of hearing class will not be found
among the congenital partially deaf cases nor among those semi-deaf who have acquired their defect
from such causes as meningitis, mumps, or injuries affecting the internal ear. Such cases have not
usually sufficient hearing for any form of education but that provided in the deaf centres. It is essentially
the middle ear cases which are suited to the hard of hearing classes, in whom deafness is due to
suppuration or catarrh, especially those in whom it has been induced by the presence of adenoids.
A few may show a limited amount of secondary involvement of the internal ear. Those are the
children who are distinctly unfit for a deaf school and the necessary association there with deaf mutes.
At the same time they are unable to obtain any benefit at an ordinary hearing school. An analysis
of the 17 children gives the causation of the deafness as follows:—
Middle ear catarrh 5 Secondary internal ear involvement in 1
„ „ suppuration. 9 „ „ „ „ 1
, , ,, and catarrh 3 ,, ,, ,, 1
Total 17 „ „ „ „ 3
The primary cause was adenoids in 12 cases (4 catarrhal, 6 suppurative, 2 suppurative and
catarrhal), or 75.8 per cent. a high percentage, but, when the enormous potency which these hypertrophies
possess for causing ear disease in children is taken into consideration, not higher than is to
be expected. Taking the 5 catarrhal cases, 4 were undoubtedly due to adenoids and one was
doubtfully so. One showed moderate secondary internal ear involvement. Of the 9 suppurative
cases, 6 were undoubtedly due to adenoids. Of the remaining three one was caused by scarlet fever
the other two giving no history. One showed secondary internal ear involvement. It will also be
noted that several of these cases were in need of active treatment. Three cases showed a combination
of the two conditions, suppurative and catarrhal; in two of these the right and in one the left ear was
suppurating. The radical mastoid operation had been performed in three cases, in one case,
on both sides.
The question of the hearing of these children is a very interesting one. In an experimental
class of this kind it is a little difficult to fix at first the amount of hearing which should qualify for
admission. Two of the cases who showed a hearing acuity, one for six inches for the voice and one
for the raised voice only, at the initial examination at the Head Office, subsequently were found to
hear 48 in. and 120 ins. in the one, and 8 ins. and 84 ins. in the other, and were transferred to the
front row of an elementary school. A third, who appeared to hear the raised voice at 24 ins., it has
been found necessary to transfer to a deaf school. There are several factors which come into play in
estimating accurately the fitness of a given case for the various forms of deaf education. Such are
shyness, individual variations in mentality, and the listlessness engendered by a sojourn in a large hearing
class where the inability to hear has resulted in what may be termed chronic inattention. Deducting
the three cases mentioned above and taking the amount of hearing in the remaining 14, it will be
found that they average a hearing distance of about 16.3 ins. in the right and 14.5 ins. in the left ear
or for both ears 15.4 ins. This would, in dealing with such small numbers, be a very fallacious
figure upon which to base any conclusions and it would probably be best to fix the amount of hearing
which should qualify for a hard of hearing class at about 4 feet. This is, of course, an entirely
empirical estimate. The amount of hearing which decides the question whether a given child is to
be classified as fit for hearing class, hearing class in the front row, hard of hearing class, or deaf
school can only be arrived at after prolonged observation and experiment. Careful examination by a
skilled otologist is needed in every case. Probably given normal mentality, a comparatively small
amount of hearing is sufficient to enable a child with acquired deafness to be instructed in a hard of
hearing class. Speech was defective in two cases, one was the child subsequently transferred to a deaf
centre, in whom it was doubtful whether there was any defect of mentality or mere backwardness.
The other was a boy with pronounced deafness and speech defect was but slight. In the remaining
fourteen cases, speech was natural. In almost every instance, however, unless educational measures
had been taken to obviate it, speech would have tended to become defective.
Results.—Of the seventeen scholars forming the class at the end of December, 1910, one left
with sufficient facility in lip reading to obviate her defective sense of hearing in after life, two were