The Deaf. Harry Best
is often some concomitant trouble, and if made notifiable in all cases deafness from it might be checked in no inconsiderable measure. The report of births is also especially needed, and as it becomes obligatory in general, with the consequent detection of physical ailments or disabilities, early cases of deafness may come increasingly to notice, and timely treatment may be availed of. Particular attention is likewise necessary in respect to the medical examination of school children. The proportion of such children with impaired hearing is not slight, even though no great part of them become totally deaf. A committee on defective eyes and ears of school children of the National Educational Association in 1903 found that of 57,072 children examined in seven cities, 2,067, or 3.6 per cent, were extremely defective in hearing.[24] An investigation of the school children in New York City has disclosed the fact that one per cent have seriously defective hearing.[25] Under proper and adequate medical inspection of schools, not only would the need of treatment for adenoids and similar troubles be brought to light, with the result that a number of incipient cases might be stopped in time, but in some instances of deafness already acquired beneficial treatment might be possible.[26]
There is thus a considerable sphere for action towards the prevention of adventitious deafness both by legislation and by education. For the ultimate solution of its problems, however, we have to look mainly to the medical profession. In recent years medical science has won some great triumphs, and in the field of the prevention of deafness no little may be in store to be accomplished in the years to come.[27] Even now, with more particular attention to the diseases of children, and with stronger insistence upon general sanitary measures, the probabilities are that there is less deafness from certain diseases than formerly—a matter which we are soon to consider.
Though as yet there has been little direct action for the prevention of adventitious deafness, there is an increasing concern in the matter, and in this there is promise. By medical bodies in particular is greater attention being given to the subject,[28] and in the widening recognition of their part as guardians of the public health it may be possible for them to do much for the enlightenment of the public. In one state legislative action has been taken expressly for the protection of the hearing of school children. This is Massachusetts, which requires the examination of the eyes and ears of the school children in every town and city, the state board of education furnishing the tests.[29] In some states also general inspection of schools is mandatory by statute, and in others permissive, while in several there are local ordinances with the force of a state law.
In combating adventitious deafness, then, our attack is to be directed in the largest part upon those diseases, especially infantile and infectious diseases, that cause deafness; and it is upon the checking of their spread that our main efforts for the present have to be concentrated. At the same time the better safe-guarding of the general health of the community will insure a proportionate diminution of deafness. Beyond this, we will have to wait upon the developments of medical science, both in the study of the prevention of diseases and of their treatment; and can trust only to what it may offer.[30]
Adventitious Deafness as an Increasing or Decreasing Phenomenon
Our main interest in the problem of adventitious deafness lies in the possible discovery whether or not it is relatively increasing or decreasing among the population, and in what respects signs appear of a diminution. We have just seen the likelihood of a decrease from certain causes; but we are to find what is indicated by statistical evidence.
To be considered first is adventitious deafness as a whole. Respecting it our only statistics are in the returns of the censuses since 1880, the different forms of deafness not being distinguished before this time. The following table will show the number of the adventitiously deaf as reported by the censuses of 1880, 1890 and 1900, with their respective percentages and ratios per million of population.[31]
NUMBER OF THE ADVENTITIOUSLY DEAF IN 1880, 1890 AND 1900
| Total Number | Adventitiously Deaf | Percentage | Ratio per Million of Population | |
| 1880 | 33,878 | 10,187 | 30.1 | 20.3 |
| 1890 | 40,562 | 16,767 | 41.1 | 26.8 |
| 1900 | 37,426 | 18,164 | 48.4 | 23.9 |
From this it appears that adventitious deafness is increasing in relation to total deafness, which is most likely the case, as congenital deafness, as we shall see, is evidently decreasing. Whether or not adventitious deafness is increasing in respect to the general population, the table does not disclose definitely. The statistics probably are not full enough to afford any real indication yet.
Our next inquiry is in respect to the increase or decrease of adventitious deafness from the several diseases individually, which is, upon the whole, the more satisfactory test. Here also, unfortunately, our statistics are very limited, and our findings will have to fall much short of what could be desired.
The following table, based on the returns of the censuses of 1880, 1890 and 1900, so far as the approximate identity of the several diseases can be established, will give the respective percentages found.[32]
CAUSES OF ADVENTITIOUS DEAFNESS IN 1880, 1890 AND 1900
| 1880 | 1890 | 1900 | |
| Scarlet fever | 7.9 | 11.8 | 11.1 |
| Meningitis | 8.4 | 7.8 | 9.6 |
| Catarrh and catarrhal fevers | 0.9 | 3.3 | 3.6[33] |
| Diphtheria | 0.2 | 0.5 | —[34] |
| Abscess and inflammation | 1.0 | 2.5 | —[35] |
| Measles | 1.3 | 2.5 | 2.5 |
| Whooping cough | 0.5 | 0.8 | —[34] |
| Malarial and typhoid fevers | 1.7 | 1.8 | 3.6 |
| Other fevers | 1.1 | — | 2.0 |
In this table the most noticeable thing is perhaps the persistency with which we find most of the diseases to recur, with apparently no great change, while in certain ones, as catarrh and malarial and typhoid fevers, there seems to be rather an increase. It would be best, however, not to place very great confidence in these figures, but, so far as the census reports are concerned, to wait for more precise and uniform statistics.
We have,