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simpler treatments are carried out. Those needing more active
treatment are referred to the specialist school aural clinics where
emphasis is laid upon prompt early treatment.
The nature of the work at these clinics is mostly of a conservative
nature.
Supplementary tonics such as cod liver oil are available free
of charge, and if necessary the child may be referred to convalescence
or placed in an Open Air School.
Any child who has an infective condition of his ear, nose, or
throat such as otorrhoea and tonsillitis is rigidly excluded from
school.
Infectious diseases comprise the other great group of causes of
acquired deafness. It is therefore important to try to reduce their
incidence among school children. This can only be done by a very
close surveillance of both school and home by the school nurse and
health visitor during an epidemic. Here detection and exclusion
of all cases and of contacts is essential. The help of teachers at this
stage is invaluable. They refer every child, who presents the least
symptom either to the minor ai!ment clinic or to their own doctor
before he is allowed to remain in school.
A great deal of minor degrees of deafness may go unrecognised
in schools unless the acuity of hearing is tested. The group method
for testing is employed in the form of a gramophone audiometer.
This instrument can examine as many as twenty-four at a time.
It has a number of headphones, and speaks a series of numbers in a
measured gradation of intensity or loudness. The children write
down the numbers they can hear on a special form. From this it
can easily be deduced whether the child has a normal range of
hearing.
If deafness cannot be improved, and is of such a degree that the
child is unable to profit by education in a normal class, then he is
referred to special classes or schools for the partially deaf, where
special methods of teaching are used, or, if necessary, for the use of
electrical hearing aids.
DEFECTIVE VISION.
Approximately 9 per cent. of school children show some defect
of vision. For the efficient functioning of a preventive ophthalmic
scheme, the earliest possible ascertainment of children needing that
service is essential. The examination of children below school age
is the responsibility of the Maternity and Child Welfare Authorities,
and it is important that any found having defective vision are