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57
year old children and 4.5 of the twelve.year olds. The importance of paying attention to these defects
is great because deafness is much more frequent in children with throat troubles, imperfect development
of the chest and general physique is associated with them, and dullness of intellect with backwardness
in school is also an accompanying feature.
4,211 children (2.2 per cent.) were found to have ear disease, of whom 2,823 (1.4 per cent.) were
referred for treatment. Many of the larger number who were not referred for treatment represented
cases in which there was an accumulation of wax. 1,921 children (1.0 per cent.) were found hard of
hearing; this is a slight improvement upon the previous vear.
Ear disease
and deafness
In last year s report the possibility was discussed of hardness of hearing in children passing
undetected in school for a long period of time. During 1919 considerable attention was paid to this
point. Mr. McLeod Yearsley pointed out that a certain percentage of the children classified as hard
of hearing or deaf had been suffering from diseases of the ear for some time before their condition was
recognised, that this period is not seldom a considerable one, and this means that in such cases there has
been serious loss of time before any machinery for ensuring treatment could be put in motion. He
suggested that a regular system of testing the hearing by the teachers might be put into force. A conference
of head teachers in schools for the deaf brought to the notice of the Special Schools Sub.Committee the
necessity for children who have become deaf being admitted at the earliest possible moment to specia1
schools, adding that it appeared that this was not always done. The conference also suggested a comprehensive
system of testing of all children.
In order to gain experience Dr. Higgs, the Divisional Medical Officer, undertook to arrange a
comprehensive test in a typical large school in the South.Eastern Division with the co.operation of the
head teacher. The test was carried out at Woods.road School (Peckham) under the supervision of
Dr. H. R. Kidner.
A hearing
best.
After the correct method of applying the "forced whisper" test was explained, the teachers
tested each boy in the playground. Each ear was tested separately. Dr. Kidner checked the results of
the teachers' tests in all boys found not to hear the whisper at 10 metres, and also some of the others,
and obtained improved response in several cases. The following is a summary of the results of the
test:—
Results of tests of 121 boys from 7—11 years old—Number hearing the forced whisper at 20.
metres with each ear, 100; number failing at 20 metres (teachers' test), 21; number failing at 20 metres
when checked by Dr. Kidner, 18. Of the last.mentioned 18 boys, 4 were subnormal in both ears and 14
subnormal in one ear only. Of the former group 3 had already been noted at routine medical inspection
(R.5m.—L.10m.; R.5m.—L.10m.; R.5m.—L.5m.), the fourth case was R.15m.—L.15m. and had not
been noted previously. Of the 14 boys subnormal in one ear only none had been noted previously,
but all except one heard the forced whisper at 15 metres, the remaining one hearing R. 20m.—L. 10m.
It will be noted that no case of auditory acuity of less than 15 metres in both ears was missed
at routine inspection; and only one case of monaural deafness, hearing the forced whisper at less than
15 metres, was missed, and in that case wax was present and the deafness was probably not present at
previous routine examination.
With regard to the possibility and advisability of the forced whisper test being carried out as
a routine, the following points arise:—
1. The only places where the test could be carried out at 20 metres are : (a) the hall, and
(b) the playground. In a considerable proportion of the schools the playground is noisy, and
in practically all there is always some noise in the hall.
2. If the environment were suitable, the extra time taken if the doctor performed the
test would be considerable and could result in only 20 cases being seen per session instead of
25. The carrying out of the test for 20—25 children (both ears) consecutively would be very
fatiguing.
3. There are considerable difficulties in the way of asking teachers to perform the initial
test. Even if instructions were issued that teachers were to carry it out, it would not be done
efficiently unless the particular teacher in each case were interested in the test, and the
results would therefore be of doubtful value.
4. If the experience described above is sufficiently wide to form an opinion upon, it would
appear that the extra time and trouble expended in carrying out the test as a routine would
not be justified.
Dr. Higgs' view as the result of the experiment in this typical school, was that the routine forced
whisper test, as it could be carried out in the schools, would not give results to justify the extra time
involved, but that the special attention of teachers might be drawn to the necessity of observing cases
of suspected slight deafness and of reporting them for special examination by the school doctor. Teachers
might be asked to use the whisper occasionally in class to assist them in finding out the slightly
deaf children.
It is most desirable that, when once a child is found to have subnormal hearing, arrangements
should be made whereby the child should be re.examined at regular intervals.
As a result of the discussion of the question, a special notice was placed in the Council Gazette
drawing the attention of head teachers to the possibility that the backwardness of certain pupils may
be in a large measure due to deafness. The head teachers were requested to take particular notice of
any case where backwardness is accompanied by any hardness of hearing, even when apparently slight,
and to bring such children specially to the notice of the school doctor, and in suitable cases to
take steps for the nomination of the children for consideration for admission to special classes.
A total number of 14,844 children (11.9 per cent.) was referred tor treatment tor detective vision.
The proportion of children at twelve years referred for vision is much greater than that at eight years
Vision.
55680 H