The Deaf Part 2

Without question there is much at the outset that can be accomplished towards the prevention of those diseases that cause deafness. A large part, perhaps fully a third, as we have seen, are due to infectious diseases, and it is probably here that measures are likely to be most efficacious. A considerable portion likewise are the result of diseases affecting the pa.s.sages of the nose and throat, and help should be possible for many of these if taken in hand soon enough. In certain diseases also, as scarlet fever, measles, typhoid fever, diphtheria, and others, there are not a few cases which, so far as deafness as a development is concerned, would prove amenable to skillful and persistent treatment. At the same time due attention to primary ear troubles would in a number of instances keep off permanent deafness.

Indeed, it is possible that some thirty or forty per cent of advent.i.tious deafness is preventable by present known means.[23]

Aside from direct medical treatment for those diseases that cause deafness, there are other measures available in a program for the prevention of deafness. One of the foremost essentials is the report to the health authorities of all serious diseases that are liable to result in deafness. In this way proper medical care may be secured, and due precautions may be taken to isolate infectious cases. Even with meningitis, which is so hard usually to deal with and which is so severe in its ravages, there 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 a.s.sociation 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 advent.i.tious 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 advent.i.tious 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 Ma.s.sachusetts, 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 advent.i.tious 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]

ADVENt.i.tIOUS DEAFNESS AS AN INCREASING OR DECREASING PHENOMENON

Our main interest in the problem of advent.i.tious 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 advent.i.tious 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 advent.i.tiously 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 ADVENt.i.tIOUSLY DEAF IN 1880, 1890 AND 1900

TOTAL ADVENt.i.tIOUSLY PERCENTAGE RATIO NUMBER DEAF 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 advent.i.tious 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 advent.i.tious 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 advent.i.tious 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 ident.i.ty of the several diseases can be established, will give the respective percentages found.[32]

CAUSES OF ADVENt.i.tIOUS 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, further, the statistics published in the reports of certain schools for the deaf. While these are perhaps not of sufficient extent to warrant full conclusions, they may be regarded as quite representative;[36] and though to be taken with something of the caution as the census figures, they may serve to throw some light upon the situation. Comparison of the proportions of pupils deaf from the several diseases at different times may be made in two ways: by finding the respective proportions over a series of successive years from a certain time back down to the present, and by contrasting the proportions in two widely separated periods, one in the present and one in the past. These will be taken up in order.

The following tables give the percentages of cases of deafness in pupils from the important diseases as found in six schools in successive years: in the New York Inst.i.tution in the total annual attendance from 1899 to 1912; in the Michigan School in the total biennial attendance from 1883 to 1912; in the Pennsylvania Inst.i.tution in the number of new pupils admitted quadriennially from 1843 to 1912; in the Western Pennsylvania Inst.i.tution in the number admitted biennially from 1887 to 1912; in the Maryland School in the number admitted biennially from 1884 to 1911; and in the Wisconsin School in the number admitted biennially from 1880 to 1908.

I. CAUSES OF DEAFNESS IN NEW YORK INSt.i.tUTION FROM 1899 TO 1912

|1899|1900|1901|1902|1903|1904|1905|1906|1907|1908|1909 +----+----+----+----+----+----+----+----+----+----+---- Total Number | 466| 476| 481| 477| 464| 503| 508| 510| 543| 555| 565 +----+----+----+----+----+----+----+----+----+----+---- Congenital |36.0|27.1|26.8|40.9|36.2|41.1|46.2|31.8|33.3|34.4|34.9 Scarlet Fever |11.4|10.1| 8.9| 7.1| 6.5| 6.9| 6.5| 4.9| 5.3| 5.0| 5.7 Meningitis | 9.5| 9.4| 7.7| 7.9| 7.8| 7.9|11.0|12.2|16.8|18.6|17.7 Brain Trouble |10.1| 9.2| 8.3| 8.1| 7.2| 5.9| 5.9| 7.1| 9.0| 8.3| 8.7 Falls | 9.0| 7.2| 5.4| 4.5| 3.9| 4.2| 3.8| 5.2| 5.9| 6.1| 6.0 Measles | 5.1| 3.8| 3.8| 2.1| 3.9| 4.5| 4.1| 4.1| 4.8| 4.7| 4.4 Typhoid Fever | 3.7| 2.3| 1.6| 1.0| 0.9| 1.2| 1.0| 1.0| 1.3| 1.3| 1.2 Convulsions | 3.2| 4.4| 3.2| 2.9| 2.6| 0.2| 1.8| 1.8| 1.9| 1.5| 1.9 Various Fevers | 2.5| 1.5| 1.4| 1.0| 1.7| 1.6| 1.6| 1.6| 1.5| 1.3| 0.7 Catarrh | 2.3| 2.1| 1.9| 1.8| 1.6| 1.2| 1.0| 2.0| 1.9| 1.9| 1.4 Diphtheria | 1.9| 1.7| 1.9| 1.0| 0.9| 0.4| 0.6| 0.8| 0.9| 0.9| 0.7 Pneumonia | 1.5| 0.8| 0.8| 0.6| 1.1| 0.2| 1.0| 1.1| 1.1| 0.9| 1.1 Whooping Cough | 1.7| -- | 1.6| 1.2| 1.1| 1.0| 0.8| 0.6| 0.9| 0.9| 0.5 Miscellaneous | | | | | | | | | | | and Unknown | 2.1|20.4|26.7|19.8|18.6|23.7|14.7|25.9|15.4|14.2|15.1

1910|1911|1912| ----+----+----+ Total Number 570| 546| 518| ----+----+----+ Congenital 32.8|34.6|36.6| Scarlet Fever 6.1| 5.7| 5.0| Meningitis 17.9|19.0|19.7| Brain Trouble 8.3| 8.0| 8.9| Falls 5.1| 5.5| 5.6| Measles 4.6| 0.2| 0.7| Typhoid Fever 1.1| 0.9| 0.5| Convulsions 1.9| 2.0| 2.1| Various Fevers 0.5| 0.5| 0.7| Catarrh 0.8| 1.0| 0.5| Diphtheria 0.7| 0.7| 0.5| Pneumonia 1.1| 0.7| 0.5| Whooping Cough 0.5| 0.5| 0.2| Miscellaneous | | | and Unknown 18.6|20.7|18.5|

II. CAUSES OF DEAFNESS IN MICHIGAN SCHOOL FROM 1883 TO 1912

|1883|1885|1887|1889|1891|1893|1895|1897|1899|1901|1903 |1884|1886|1888|1890|1892|1894|1896|1898|1900|1902|1904 +----+----+----+----+----+----+----+----+----+----+---- Total Number | 302| 336| 342| 350| 343| 365| 428| 412| 441| 447| 451 +----+----+----+----+----+----+----+----+----+----+---- Congenital | 7.0|18.8|23.1|26.3|24.2|26.3|25.2|30.3|28.8|31.5|32.8 Meningitis |28.8|28.1|23.1|23.1|21.3|15.8|15.6|14.5|10.2| 9.2| 4.6 Scarlet Fever |12.2|11.8|12.3|11.2| 9.0| 9.6| 9.5| 9.7| 9.5| 9.3| 7.6 Brain Fever | 6.2| 6.5| 4.8| 3.7| 5.2| 6.9| 6.6| 6.3| 5.4| 3.8| 3.8 Typhoid Fever | 4.6| 3.6| 4.1| 4.3| 4.7| 1.9| 1.8| 1.4| 2.5| 2.2| 1.3 Measles | 3.6| 4.1| 3.9| 2.9| 2.6| 1.4| 0.8| 1.9| 3.2| 3.1| 2.9 Diphtheria | 0.6| -- | -- | 0.3| 0.3| 0.3| 0.2| 0.2| 0.4| 0.2| 0.4 Catarrh | 0.6| 0.6| 0.9| 0.8| 0.9| 1.1| 1.9| -- | 2.9| 3.5| 3.3 Various Fevers | 2.9| 1.5| 2.0| 2.6| 3.0| 4.4| 4.4| 1.7| 2.9| 2.9| 3.3 Whooping Cough | 1.3| 1.2| 1.5| 1.5| 1.5| 3.0| 3.8| 3.6| 2.7| 2.5| 3.1 Pneumonia | -- | -- | -- | -- | -- | -- | -- | -- | 0.2| 0.2| 0.4 La grippe | -- | -- | -- | -- | -- | -- | -- | -- | 0.9| 1.1| 1.6 Miscellaneous | | | | | | | | | | | and Unknown |32.2|23.8|24.3|23.3|27.3|29.3|30.2|30.4|30.4|31.5|34.9

1905|1907|1909|1911| 1906|1908|1910|1912| ----+----+----+----+ Total Number 404| 361| 354| 353| ----+----+----+----+ Congenital 36.6|35.7|35.0|31.2| Meningitis 8.6| 9.5| 8.8| 8.2| Scarlet Fever 6.9| 5.8| 3.6| 4.5| Brain Fever 2.7| 2.5| 2.3| 1.0| Typhoid Fever 1.0| 1.4| 1.5| 1.7| Measles 2.9| 4.1| 3.4| 3.1| Diphtheria 0.5| 0.2| 0.3| 0.3| Catarrh 2.8| 1.9| 2.5| 0.8| Various Fevers 2.5| 0.5| 2.0| 1.4| Whooping Cough 3.4| 4.4| 4.8| 5.1| Pneumonia -- | 0.7| 0.6| 0.8| La grippe 1.5| 3.0| 2.3| -- | Miscellaneous | | | | and Unknown 30.6|30.3|32.9|41.9|

III. CAUSES OF DEAFNESS IN PENNSYLVANIA INSt.i.tUTION FROM 1843 TO 1912

|1843|1847|1851|1855|1859|1863|1867|1871|1875|1879|1883 |1846|1850|1854|1858|1862|1866|1870|1874|1878|1882|1886 +----+----+----+----+----+----+----+----+----+----+---- Total Number | 90| 111| 125| 143| 167| 152| 150| 178| 282| 233| 261 +----+----+----+----+----+----+----+----+----+----+---- Congenital |54.4|58.5|56.0|46.8|53.3|48.4|40.0|42.1|31.2|24.4|34.1 Scarlet Fever |13.3|18.0|12.8|16.8| 9.6|19.7|16.0|18.6|18.1|13.7|14.9 Meningitis | -- | -- | 0.8| -- | -- | 2.0| 1.3| 9.6|18.1|25.7|16.4 Measles | 1.1| 2.7| 1.6| 2.8| 2.4| 3.3| 4.0| 1.1| 1.7| 2.6| 1.9 Whooping Cough | 2.2| 0.9| 0.8| 0.7| 1.2| 0.7| 1.3| 0.6| 0.3| 0.8| -- Catarrh | -- | 0.9| -- | -- | -- | -- | 0.7| 0.6| 2.1| -- | -- Brain Fever | -- | -- | 2.8| 2.1| -- | 6.0| 4.7| -- | -- | -- | 0.8 Typhoid Fever | -- | -- | -- | 1.4| 0.6| 0.7| 2.6| 2.7| 2.1| 2.6| 3.4 Diphtheria | -- | -- | -- | -- | -- | -- | 0.7| -- | -- | -- | -- Pneumonia | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- La grippe | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- Mis. and Unknown |29.0|19.2|25.2|29.4|32.9|19.2|28.7|24.7|26.3|30.2|28.5

1887|1891|1895|1899|1903|1907|1911| 1890|1894|1898|1902|1906|1910|1912| ----+----+----+----+----+----+----+ Total Number 207| 248| 250| 239| 240| 282| 152| ----+----+----+----+----+----+----+ Congenital 47.3|46.8|41.6|32.2|35.8|33.7|34.2| Scarlet Fever 14.0|14.1|11.2| 6.3|10.4| 3.9| 5.2| Meningitis 5.8| 5.6| 7.6| 8.4| 7.1|17.4|15.1| Measles 3.9| 3.2| 4.4| 4.6| 4.5| 3.5| 3.9| Whooping Cough 0.5| 0.4| 0.8| 1.7| 0.7| 2.9| 1.3| Catarrh 3.9| 4.8| 6.8| 4.2| 1.2| 2.5| 1.3| Brain Fever 2.9| 5.2| 4.0| 3.4| 1.7| 2.9| 2.6| Typhoid Fever 2.9| 3.6| -- | 2.5| 0.7| 3.9| 1.3| Diphtheria 0.5| 1.6| 2.0| 0.8| 2.5| 1.2| 2.0| Pneumonia 0.5| -- | -- | 0.8| 0.4| 1.2| 4.8| La grippe -- | 0.4| -- | 2.1| 1.2| 0.3| -- | Mis. and Unknown 17.8|14.3|21.6|33.0|33.8|26.6|28.3|

IV. CAUSES OF DEAFNESS IN WESTERN PENNSYLVANIA INSt.i.tUTION FROM 1887 TO 1912

|1887|1889|1891|1893|1895|1897|1899|1901|1903|1905|1907 |1888|1890|1892|1894|1896|1898|1900|1902|1904|1906|1908 +----+----+----+----+----+----+----+----+----+----+---- Total Number | 61| 56| 58| 58| 49| 40| 50| 41| 110| 59| 73 +----+----+----+----+----+----+----+----+----+----+---- Congenital |24.6|14.3|20.7|32.8|46.9|40.6|40.0|31.9|38.2|25.4|30.1 Scarlet Fever | 9.8|21.4| 8.6|10.4|10.2| 5.0| 6.0|12.2| 8.3|11.8| 8.2 Meningitis |16.5|14.5|13.8|10.4|10.2|20.0|14.0|17.1| 7.2|10.2|13.7 Measles | 4.9| 1.9| 5.2|10.4| 4.0| -- | 2.0| 2.4| 7.2| 1.9| 8.2 Catarrh | 3.2| -- | 7.6| 1.9| 2.0| 5.0| 2.0| 9.6| 2.7| 3.8| 4.1 Brain Fever | 6.5| 5.4| 1.9| 1.9| -- | 2.5| -- | 4.8| 2.7| 5.1| 2.8 Typhoid Fever | -- | 1.9| 5.2| -- | 6.0| 2.5| -- | -- | 1.8| 1.9| 4.1 Whooping Cough | 1.6| -- | 1.9| -- | 2.0| -- | 6.0| 2.4| 1.8| 1.9| 2.8 Diphtheria | 1.6| -- | 1.9| -- | -- | -- | 4.0| 2.4| 1.8| -- | 1.4 La grippe | -- | -- | -- | -- | 2.0| -- | 2.0| -- | -- | 1.9| -- Pneumonia | -- | -- | -- | -- | -- | 2.5| 2.0| -- | -- | 1.9| 1.4 Miscellaneous | | | | | | | | | | | and Unknown |31.3|30.6|33.2|32.2|16.7|22.5|22.0|17.2|28.3|34.2|23.2

1909|1911| 1910|1912| ----+----+ Total Number 71| 73| ----+----+ Congenital 40.9|36.5| Scarlet Fever 11.3|12.7| Meningitis 14.1| 9.6| Measles 2.8| 6.8| Catarrh 2.8| 1.8| Brain Fever 1.4| 4.1| Typhoid Fever 2.8| -- | Whooping Cough -- | 1.8| Diphtheria 1.4| 1.8| La grippe -- | -- | Pneumonia -- | -- | Miscellaneous | | and Unknown 22.5|24.9|

V. CAUSES OF DEAFNESS IN MARYLAND SCHOOL FROM 1884 TO 1911

|1884|1886|1888|1890|1892|1894|1896|1898|1900|1902|1904 |1885|1887|1889|1891|1893|1895|1897|1899|1901|1903|1905 +----+----+----+----+----+----+----+----+----+----+---- Total Number | 28| 27| 25| 25| 29| 30| 30| 39| 29| 30| 28 +----+----+----+----+----+----+----+----+----+----+---- Congenital |46.4|62.9|44.4|36.0|37.9|43.3|43.3|61.5|44.8|43.3|57.1 Meningitis |10.7|11.1| 8.0|12.0|10.3|10.6| 6.7| 2.6|14.0| 3.3| 3.6 Scarlet Fever |10.7| 7.4|12.0|16.0| -- | -- | 6.7| 5.2| 3.5|10.0| 7.2 Measles | 3.6| -- | -- | -- | 3.5| 3.3| 6.7| -- | 3.5| 3.3| -- Diphtheria | -- | -- | -- | -- | 3.5| 3.3| 3.3| 2.6| -- | 3.3| 3.6 Catarrh | -- | -- | -- | -- | 3.5| 3.3| 3.3| 5.2| 3.5| -- | -- Typhoid Fever | -- | -- | 4.0| -- | -- | -- | -- | -- | -- | 6.7| -- Whooping Cough | 3.6| -- | -- | -- | -- | -- | -- | -- | 3.5| -- | -- Pneumonia | 3.6| -- | -- | -- | -- | -- | -- | -- | 7.0| -- | 3.6 Brain Fever | 7.2| -- | 4.0| 8.0| 3.5| 3.3| -- | -- | 7.0| 3.3| -- Various Fevers | -- | -- | 4.0| 8.0| 3.5| -- | -- | 2.6| -- | 3.3| 3.6 Miscellaneous | | | | | | | | | | | and Unknown |14.2|18.6|23.6|20.0|34.3|32.9|28.1|22.0|16.7|23.5|21.3

1906|1908| 1910| 1907|1909| 1911| ----+----+-------+ Total Number 41| 32|135[37]| ----+----+-------+ Congenital 53.7|34.4| 51.8| Meningitis 2.4|12.2| 8.1| Scarlet Fever 9.6| 3.1| 1.4| Measles -- | 3.3| 2.2| Diphtheria -- | -- | 0.7| Catarrh -- | -- | -- | Typhoid Fever 2.4| 3.1| 2.2| Whooping Cough -- | 3.1| 1.4| Pneumonia 2.4| 3.1| 2.2| Brain Fever 4.8| -- | 2.9| Various Fevers 4.8| -- | 2.2| Miscellaneous | | | and Unknown 19.9|37.7| 24.1|

VI. CAUSES OF DEAFNESS IN WISCONSIN SCHOOL FROM 1879 TO 1908

|1879|1881| 1883 |1885|1887|1889|1891|1893|1895|1897 |1880|1882| 1884 |1886|1888|1890|1892|1894|1896|1898 +----+----+-------+----+----+----+----+----+----+---- Total Number | 36| 66|231[37]| 56| 67| 50| 44| 72| 64| 72 +----+----+-------+----+----+----+----+----+----+---- Congenital |14.3|31.8| 35.1|35.7|49.3|38.0|50.0|40.3|53.1|52.7 Meningitis |27.7|33.3| 37.7|33.9|28.3|32.0|15.9|12.5|31.2|19.4 Scarlet Fever |14.3| 6.0| 12.5| -- | 8.9|12.0|20.4|11.1| 4.7| 6.9 Measles |12.8| 3.0| 1.5| -- | 2.9| -- | 2.3| 4.1| 3.1| -- Typhoid Fever | -- | 6.0| 7.4| 1.8| -- | 2.0| 2.3| -- | 1.6| -- Whooping Cough | -- | -- | 1.3| 1.8| 1.5| -- | -- | -- | -- | 1.4 Diphtheria | -- | -- | -- | -- | -- | 2.0| 4.6| -- | -- | 1.4 Catarrh | -- | -- | 1.3| -- | -- | -- | -- | -- | 1.6| 5.5 Brain Fever | -- | -- | -- | -- | 2.9| -- | -- |11.1| -- | -- Miscellaneous | | | | | | | | | | and Unknown |30.9|19.9| 3.2|26.8| 6.2|14.0| 4.5|20.9| 4.7|12.7

1899|1901|1903|1905|1907| 1900|1902|1904|1906|1908| ----+----+----+----+----+ Total Number 62| 33| 33| 63| 70| ----+----+----+----+----+ Congenital 64.3|33.3|48.4|34.9|40.0| Meningitis 16.1| 9.1| 3.0| 6.3| 5.7| Scarlet Fever 4.7| 6.1| -- | 9.5| 8.6| Measles -- | 3.0| 3.6| 1.6| 4.3| Typhoid Fever 3.2| 6.1| -- | 3.2| 1.4| Whooping Cough -- | -- | -- | 1.6| 2.8| Diphtheria 1.6| -- | -- | 3.2| 1.4| Catarrh 1.6| 3.0| 9.1| 3.2| 2.8| Brain Fever -- | 6.1| 3.6| 4.8| 4.3| Miscellaneous | | | | | and Unknown 8.5|33.3|31.3|31.7|28.7|

We may take these tables together to see how the proportions of deafness from the leading diseases have changed in the course of the several periods indicated, proper allowance being made for the shorter length of time covered in some schools than in others. In respect to scarlet fever, one of the two foremost causes, we find in the New York Inst.i.tution, the Michigan School and the Maryland School, a distinct and steady decline; in the Pennsylvania Inst.i.tution a decline of late years, which is especially significant in view of the extended period covered by it; and in the Western Pennsylvania and the Wisconsin School little change, though in the latter there is less than at the beginning. In meningitis, on the other hand, the second of the two most important causes, a marked increase is seen in the Pennsylvania Inst.i.tution for the entire period, while in the New York a sharp increase is found in the time designated, this being all the more noticeable because of the large proportion already attributed here to convulsions, often a trouble of kindred origin. In the Western Pennsylvania Inst.i.tution and the Maryland School little change is observed, though in the latter some decline is apparent in the later years. In the Wisconsin and Michigan schools a very strong decline is seen. On somewhat the same order as meningitis is brain fever. It, however, shows little change on the whole, though in the Michigan and Maryland schools and the New York Inst.i.tution some decline is evident. Of the remaining diseases none plays singly a large part in the causation of deafness, and in most of them the results are similar. Measles, typhoid fever, diphtheria, pneumonia, and whooping cough show, with some fluctuations at times, little change on the whole, beyond certain local differences. In the New York Inst.i.tution a decline is reported in nearly all. In the Pennsylvania Inst.i.tution a rather larger proportion for measles is seen in later than in earlier years. In the Michigan School an increase seems to be the case with whooping cough, but a decrease with typhoid fever.

In catarrh the results are not so uniform. In the New York and Pennsylvania inst.i.tutions a decline is manifest, though in the latter a larger proportion is reported than at the beginning. In the Michigan and Wisconsin schools rather an increase is noted. La grippe is only reported occasionally of late years, and its real effects cannot yet be ascertained. With respect to general fevers, their cla.s.sification is found to be so varying that little can be determined.

We now proceed to make comparison of the proportions of deafness from the princ.i.p.al diseases in a series of years some time past with similar proportions in recent years. The following tables give the several proportions in the American School (Connecticut) in the entire attendance from 1817 to 1844 and from 1817 to 1857, and in the new admissions from 1901 to 1913; in the Ohio School in the entire attendance from 1829 to 1872, and in the average annual attendance in 1904, 1905, 1906, and 1911; in the Iowa School in the entire attendance from 1855 to 1870 and from 1855 to 1912; and in the New York Inst.i.tution in the entire attendance from 1818 to 1853 and in the average annual attendance from 1899 to 1912.[38]

I. CAUSES OF DEAFNESS IN AMERICAN SCHOOL FROM 1817 TO 1844, FROM 1817 TO 1857, AND FROM 1901 TO 1913.

PERIOD |TOTAL NUMBER | |CONGENITAL | | |SCARLET FEVER | | | |MENINGITIS | | | | |TYPHOID FEVER | | | | | |MEASLES | | | | | | |WHOOPING COUGH | | | | | | | |GENERAL FEVERS | | | | | | | | |BRAIN FEVER | | | | | | | | | |PNEUMONIA | | | | | | | | | | |DIPHTHERIA | | | | | | | | | | | |CATARRH | | | | | | | | | | | | |UNKNOWN | | | | | | | | | | | | |AND MIS.

---------+----+----+----+-----+---+---+---+---+---+---+---+---+-------- 1817-1844| 761|44.8| 5.7| 6.1| --|1.6|1.6|6.7| --| --| --| --| 33.5 1817-1857|1081|50.1| 9.2| 4.6| --|1.8|1.3|5.3| --| --| --| --| 27.7 1901-1913| 310|35.2| 7.7| 11.3|3.2|1.3|1.3|1.9|5.8|0.6|1.3|1.0| 29.4