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These, however, appear to be just those cases which should be kept under
treatment or observation by otologists, to prevent, if possible, progressive impairment
of hearing and deafness in later life. It seems necessary that strong pressure should
be brought to bear upon parents to obtain early and prolonged treatment for all cases
of otorrhœa, and that cases not responding to treatment at the Council's treatment
centres should be referred to otologists without undue delay.
Arising out of the enquiry, the conclusion has been formed that the ordinary
forced whisper test for defective hearing is very unscientific, for it is impossible to
ensure with any degree of accuracy that the conditions are the same for each child
tested. The voice tires, the tone changes and errors of all kinds are apt to creep in.
Moreover, in a school building it is impossible to eliminate external noise, and this
adds to the difficulty of any hearing test.
The use of
the audiometer
in
hearing tests.
The Audiometer.—In view of the unsatisfactory nature of the tests of hearing in
general use, special attention has been given to a scientific instrument for testing
hearing latterly introduced in America, termed the "Audiometer."
The instrument has been studied and brought to further perfection and
standardised for English use by Dr. Crowden at the University of London School of
Hygiene and Tropical Medicine. Dr. Crowden's work has been followed step by step
by one of the Council's officers. The following is quoted from a report recently
made by Dr. Crowden upon an investigation carried out in the elementary schools
of the Borough of Hornsey, where 1,500 children were tested:—
"The 4-a audiometer is essentially a gramophone fitted with a magnetic pick-up which
enables the sound to be transmitted to a number of single headphones instead of through the
ordinary horn. These telephone receivers are made up in sets of eight, and it is possible to join
five of these sets together and so transmit the sound to 40 headphones at once without diminishing
the intensity of the sound heard at any one of them. As many as 40 children can therefore be
tested at the same time. The use of headphones rules out at once one of the objections to the
whisper test—namely, the reflection of sound from the walls of the examination room.
"The record is standardized and the same record is used for each child or group of children,
so the other main objection—namely, the variability in the strength of the whisper—is also ruled
out. In this connection it should be stated that each record may be played 90 to 100 times, after
which it becomes worn in places and must be discarded. Another advantage worthy of note is
that with the gramophone audiometer test there is no possibility of the child reading the lips or
expression of the examiner."
As the result of a report upon the subject the Education Committee gave
authority for the purchase of an audiometer and with assistance kindly given by
Dr. Crowden, experimental tests are now being carried out in the London schools.
Arachnodactyly
or
"Spider
limbs. "
Dr. Maurice
L. Young.
IV.—Arachnodaclyly.—Dr. Maurice L. Young has investigated in the school
children brought before him at medical inspections a not uncommon condition which
has been termed "arachnodactyly," a name taken from one of the most striking
characters shown by the children affected. Dr. Young's paper will be published in
full in the clinical reports, but a brief account of the condition as described by him
is included here on account of its interest to school medical inspectors.
Dr. Young describes three grades of the condition as found by him:—
"In the first the child appears as tall, thin, long-limbed and lanky, he tends to speak in a
slow calculating type of voice, yet is alert and of normal mentality; the face is long and thin,
the mouth small and narrow, the lower jaw is somewhat pointed and projects as does the nose;
the supra-orbital ridges are prominent; the ears always large, especially the lobes, and their
cartilage is often deficient; the whole skull may show some degree of dolichocephaly; the
features tend to be old for the age, this latter point being especially characteristic; the entire
musculature shows some degree, however slight, of flaccidity, ill development and loss of tone,
and in addition, it may be possible to demonstrate a laxity of the ligaments.
"In more pronounced cases there are noticed a high vaulted palate, winging of the scapulae,
deformities of the bony thorax, flaccidity of the musculature, and some increase in length of
hands and feet.
"In a still further grade is found 'arachnodactyly'—a peculiar condition of the hands and
feet in which the metacarpal bones and phalanges are abnormally long, giving a ' spidery'
appearance to the organs, pronounced muscular flaccidity with consequent skeletal deformities
and congenital deformities, especially of the eye, such as dislocation of the lens, small pupils,
nystagmus or persistent pupillary membrane."
In the annual report of the school medical officer for 1913 an account was given
by Dr. Leipoldt of a condition termed by him "asthenia congenita universalis."