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At the congress Dr. Alfred Eicholz, Chief Medical Officer of the Board of Education,
urged the prevention of deafness by attention to one of the most frequent causes of acquired
deafness in children, namely, 'running' ears. Developments in drug therapy have led to
a decrease in the diseases which produce otorrhoea and to fewer chronic cases among those
which still occur. School medical officers are alert to the need for early and effective treatment
for aural sepsis.
Educationalists experimented with various methods of teaching the deaf child to communicate
and the schools changed from finger spelling to lipreading and oralism. It was
recognised, too, that the partially hearing child required different techniques of instruction
from the severely deaf child and the London County Council was the first authority to
initiate special units for these children. The first partially deaf (now called partially hearing)
unit was established by the Council in 1947.
Audiometry—In order to establish a standard test for the routine assessment of schoolchildren's
hearing, the Council introduced gramophone audiometry in 1930. Prior to this,
arbitrary methods of testing were used; for example, the whisper test and the watch tick.
The advantages of the gramophone audiometer were (a) 40 children could be tested at one
time, (b) it was an objective test, (c) it did stress the area of hearing for speech. On the
other hand, it could only be used for children who could write down what they heard, so
that the children had to be of sufficient intelligence and educational attainment, i.e., about
seven years. By 1939 specially trained school nursing staff were carrying out audiometric
testing of all seven year old children in the Council's schools. The children who failed this
initial test were given a further test and the failures of this second test were referred to one
of the Council's otologists.
Pure tone audiometry was first used at County Hall in the 1930's in order to test children
referred to the Council's consultant otologist for consideration for special education.
A wider range of frequencies could be tested and, as the ability to take down dictation was
not involved, children who did not know their letters could be tested. By 1957 pure tone
sweep testing was substituted for gramophone audiometry in all the Council's divisions.
All children of five years were required to be tested and it is now hoped shortly to repeat
this test during the child's period in secondary school. In 1962 a number of light-weight
transistorised portable pure tone audiometers were purchased for the use of school nursing
staff in charge of audiometry in each of the nine divisions.
The numbers of children given' rapid-sweep ' audiometer tests during 1962 are as follows:
Pupils given screening tests 56,249
Pupils failing screening tests given pure tone tests 3,653
Pupils failing pure tone tests referred to otologists 1,501
Pupils found to have impaired hearing 76
Perhaps the most important development in the treatment of child deafness was the
realisation of the urgency of early diagnosis and guidance for mother and infant during the
vital early years when the normal development of speech takes place. After the first three
years of life the acquisition of speech becomes progressively more difficult. Pioneers in
this revolutionary approach were Miss Edith Whetnall, Director of the Audiology Unit,
Royal National Throat, Nose and Ear Hospital, Sir Alexander and Dr. Irene Ewing,
Department of Education, Manchester University and Dr. Mary Sheridan, Medical Officer,
Ministry of Health.
The 'at risk' register—In the maternity and child welfare services of the Council, during
the past few years, the work of clinic doctors and health visitors has been re-orientated
towards the early diagnosis of congenital handicaps. These handicaps, both physical and
mental, can be divided into two groups. Firstly, those which are obvious at birth; secondly,
handicaps which have to be deliberately sought for during the first year of life because the
baby is in the 'at risk' category. The diagnosis of deafness as early as possible is obviously
of major importance.
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