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the case when dealing with younger children. The nurse is also able to use her professional
judgment, as hearing may be affected by the child's general health, e.g., wax in the
ears, and to assist the otologists professionally at the audiology centres. All work in
connection with the children's hearing is thus centred on the same school nursing
sister. Technicians would not be qualified to perform the functions of a ' clinic sister '
in this way.
Audiology
centres
Towards the end of 1953 it was considered desirable to carry out field trials in
London of the rapid pure tone sweep method of testing school entrants aged 5+ years.
As it was essential to arrive at an estimate of the number of staff required if this method
were to be adopted, it was decided to conduct an experiment in two divisions, and
pilot schemes began in 1955 after the purchase of two Amplivox Model 70 portable
audiometers. Before the field trials commenced, a medical officer and school nursing
sister from each of the two divisions received training at the Royal National Throat,
Nose and Ear Hospital.
The pilot schemes were visualised as a modification of the existing London procedure
only in the substitution of a rapid sweep test in school for the gramophone test in
school. The reference of school test failures' to a full pure tone test, and of full pure
tone test failures to the otologist, remained as before. Similarly, in these pilot schemes,
the school nursing sister remains responsible for making all ancillary arrangements as
before.

Training of
very young
deaf children
There are nine audiology clinics equipped with a pure tone audiometer and other
special equipment and staffed by part-time otologists serving the nine health divisions
of the county.
Whenever there is any question of suspected hearing defect, children are referred
to these clinics by school doctors from routine or special medical inspections, by school
nursing sisters after group gramophone tests in school, by teachers, speech therapists,
etc.
The eventual disposal of these children depends upon the medical and educational
recommendations made by the otologist at the audiology centre. The majority of the
children are found by this specialist either not to be deaf, or to be only temporarily
' hard of hearing ' due to a ' cold ', wax in the ears, or to some condition, such as septic
tonsils, which requires treatment. Minor treatments are carried out at the audiology
centre. Children whose condition is more serious are referred to an ear, nose and throat
clinic at a hospital, where any necessary treatment (including the supply of hearing aids,
and operations, such as tonsillectomy or mastoidectomy) is carried out. During
1955, 292 audiology sessions were held, at which there were 3,299 attendances, including
1,164 new cases.
A small residual number of children, who may require special educational treatment
after ascertainment as handicapped pupils, are referred to the County Hall for examination
by the Council's consultant otologist. In general, it is seldom that a pupil requiring
special educational treatment is found by routine audiometer, or other tests in school.
The needs of the majority of these children are noticed before they reach the age of
five years.
Pure tone
sweep testing
Training in speech and understanding should begin at the age when a child normally
beings to speak, i.e., at about 10 months, and should be given continuously at home by
the parent. The parent therefore needs to receive instruction from the teacher so that
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