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operation is a serious economic drawback to a patient. Usually,
in the chronic cases, the hearing becomes very defective after
operation; whilst if the discharge is not cured, disability is still
greater. It is the practice in this Clinic not to send a patient for
operation unless the disease is acute, or unless it is reasonably
certain that the child will be much better after the operation than
he was before. Not merely is the condition in the ear taken into
account, but the financial condition of the family is also considered.
It is not to be expected that a mother whose husband is out of work
at intervals and who has several young children, can bring a patient
regularly to hospital to have the ear dressed for some months after
the operation has been performed. As long as there are no acute
symptoms such a child is, therefore, allowed to remain as he is.
It is an easy thing to have a mastoid operation performed, but it
is a difficult thing to ensure a dry ear and moderate hearing.
These conditions which need a mastoid operation often attend the
Clinic for years, and they reappear in the Tables in successive
years.
' 'Every ear in which discharge comes from the mastoid does
need operation. Those cases in which the discharge is mucoid
usually recover with treatment at the Clinic, but those in which
the discharge is purulent very seldom do so.
"Children are frequently brought to the Clinic suffering from
deafness. Sometimes the deafness is slight, but more usually it
is of moderate or even of considerable degree. When it is slight
and recent, a great deal can be done and the patient can often leave
school without any handicapping deafness.
' 'When the deafness is of greater degree, complete recovery is
rare. In these cases, the deafness has usually lasted a considerable
time. It may be asked, why did they not come for treatment when
the deafness was recent and slight? The answer is that they were
not detected. It is only quite recently that in this country it has
been possible to measure accurately the hearing of children. An
American instrument called the Audiometer has been introduced
into this country by Dr. Crowden, of the London School of Hygiene
and Tropical Medicine. This instrument is really a gramophone in
which the horn is replaced by a large number of earphones.
Twenty-four or more children can be readily tested at one time.
A single earphone is given to each child, who puts it over one ear
and writes on a piece of paper what he hears. The gramophone
speaks a series of groups of numbers thus, 846, 327, 591 form a
group. Each group is spoken at a different degree of loudness,
and the groups which he cannot write down wholly or in part give
a measure of his defect of hearing. Some thousands of children
have been tested in schools in North London, and it has been found