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Rh complete. In 1881 : " We feel bound to point out how very incom- plete are the returns which relate to these afflictions. We have done our best with these unsatisfactory data," etc. In 1891 the report characterized the statistics as " in all probability excessively inac- curate." In 1901 it was pointed out that the machinery of an ordinary census was but imperfectly adapted to furnish the required particu- lars with the degree of accuracy which is essential for statistical purposes; and in 1911 the report stated: " We must submit that statistics of this nature obtained through a general population census are most unsatisfactory, firstly on account of the difficulty of fram- ing a suitable form of inquiry denning the degree of disability, and secondly because the definition has to be applied' by householders with no technical knowledge, who will interpret it in different ways, and many of whom have a natural reluctance to admit that they or their relatives suffer from any defect." But the choice of wording in the 191 1 census schedule was particularly unfortunate and confusing, and might have been avoided if the department had been willing to ask or accept the advice of those bodies, such as the National College of Teachers of the Deaf, and the National Bureau for Pro- moting the General Welfare of the Deaf, which, for educational and social reasons, were anxious to secure reliable statistics relating to deafness and deaf-mutism in the United Kingdom. " Total deafness" is comparatively rare, whether it is congenital or acquired, and even among the so-called " deaf and dumb " it is generally recognized that there are from 15 to 25% with a useful amount of hearing. This fact and the unwillingness mentioned by the commissioners to the return of children who have fairly successfully been taught speech as " dumb " presented difficulties which even experts, such as the responsible heads of institutions for the deaf, founo! it hard to overcome in any attempt to give accurate returns. For instance, if the loo children in a school for the deaf were in the majority of cases neither " totally deaf " nor " deaf and dumb " (i.e. orally taught), what was the headmaster to do ? Leave them out ? or insert them ? and, if the latter, where? Mr. B. St. Johns Ackers, the chairman of the statistics committee of the National College of Teachers of the Deaf, in his address before the Manchester Conference in 1911, laid down a broad principle " statistics, to have their full value, should not only be accurate, full and reliable, but should be on the same plan in all countries. This should apply to census and school statistics," and as the fuller consideration of all forms of defect, not only as to treatment but also as to preventive measures, is now occupying the attention of the newly formed Ministry of Health, it is essential, if State funds are to be spent in collecting informa- tion, that such information should be of real value when obtained.

The difficulty of framing a suitable question or questions relating to so wide a subject as deafness and deaf-mutism, in a short and simple form, in the small space available on a census schedule, caused the department to omit any attempt to secure information of this kind from the 1921 census, and further statistics of this kind will not in future be available until some new machinery has been provided. This may be under- taken through the Ministry of Health, or, if undertaken with the assistance of the various educational and social organizations connected with the deaf and dumb, might secure figures not only relative to the actual existence, but also as to the causes of deafness, which might later prove of inestimable value in pre- ventive measures, and so greatly reduce the number of this afflicted class in the community.

Indeed the medical inspection of school children has already begun to operate in this direction and the discovery of children suffering from causes which may lead to partial or total deafness is part of the ordinary routine of the school medical officers in the counties and county boroughs of the United Kingdom. In 1919 Dr. Hamar, chief medical officer to the London County Council, reported that at the school medical inspections 4,211 children (2-2%) were found to have ear disease, of whom 2,823 (1-4%) were referred for treatment, and the London County Council has now established six centres for the educating of children suffering from impairment of hearing short of " deaf- ness " within the meaning of the 1893 Act. About 25% of the children attending these centres suffer from discharging ears and receive nursing attention under medical supervision.

In this connexion it is interesting to note that in a comparison of the conditions in 1915 and 1919 it was found that in the former year 2-1% of the children examined in London were found to be suffering from ear disease, whilst in the latter year there were only 1-85%. At Glasgow it was found that out of 500 cases of deafness and middle-ear disease, 26% originated in measles, 12% in scarlet fever, 29 % in simple catarrh and 20 % during dentition. Mr. Yearsley, the aurist of the London County Council, found

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that of 177 cases certified by him to be deaf or hard-of-hearing, 37 were congenital, in 119 cases it was acquired, and in 21 doubt- ful. Of the cases of acquired deafness, 61 resulted from suppura- tive and middle-ear disease, 18 followed infectious fevers, n resulted from congenital syphilis and 20 followed meningitis. In the report of Dr. Butterworth (Lanes.) the general conclusions arrived at were that " deafness in school children is largely due to causes which can be removed by simple treatment, but this treatment can only be satisfactorily carried out in a clinic, where the child can attend regularly till it is cured " ; and a further suggestion was made that " the ear, like the eye, must be brought under systematic supervision from infancy upwards."

In the report of the chief medical officer of the Board of Education for 1919 the position with regard to the schools was given as follows:

In Scotland the latest figures available give 12 schools with accommodation for 1,014 children and 714 pupils in attendance; in Ireland 4 schools with accommodation for 580 children and 525 pupils. There was still no law for the compulsory education of the deaf of Ireland.

In the same report for 1019 the chief medical officer of the Board of Education made the following statement: "The regulations of the board cover the educational needs of the child from the age of two years upwards, extending to the age of sixteen. From the age of two to the age of seven attendance is optional and only becomes compulsory at seven. The disadvantages of this statutory provision are considerable, and authorities are not as a rule willing to incur the heavy expense of special education so long as the law does not compel them to do so, and the deaf child is involved in a serious educational loss in consequence. The early beginnings of speech which come more easily to the deaf child are withheld from him to a later age and it may safely be said that the majority of the deaf children never make up for the loss sustained by postponing the beginning of education until seven, or, as often happens, till later."

This illiberal policy of depriving the deaf of the early years of in- struction occasionally takes a more aggravated form when parents or local authorities, from reasons of economy, allow the children to remain away from school even after the statutory age of seven. In a return in 1920 it was found that among the children admitted to schools for the deaf 109 were eight years of age or older, 47 over 8; over 9, 28;' over 10, 13; over II, 10; over 12, 7; over 13, 3; over 14, I. To remedy this evasion of the law a resolution was adopted at the Conference of Teachers of the Deaf at Birmingham in 1920 asking that in cases in which the pupil was admitted later than the legal age the school period should be extended to secure to the child the full period of instruction. This would be in con- formity with the practice in America, where many states provide a school period of from 10 to 12 years for their deaf pupils, irrespective of the age of entry.

The average attendance in England and Wales in the last school year (according to the report for 1919) was 3,325 2,355 in institu- tions and 970 in day schools. In 1920 Mr. Story, chairman of the National College of Teachers for the Deaf, stated that of 2,761 children attending 32 of the schools, 170 were semi-mute (i.e. had become deaf after having acquired normal speech), 390 were partial- hearing cases, 80 were mentally defective as well as deaf, 7 were blind and deaf, whilst 2,114 were ordinary cases of deaf-mutism. Referring to the methods of instruction, he gave the following statement re- lating to the year ended March 31 1920: " The oral method largely predominates in our schools. The day schools are practically entirely oral, as are also several of the residential schools. In the cases of 2,816 children attending 34 schools, 2,494 are orally taught, 289 by finger spelling and 33 by finger and speech combined."

For the same period the returns of American schools, as published by the American Annals, showed that in 169 schools in the United States there were 13,779 pupils, of whom 10,376 were taught wholly or chiefly by the oral method, and a further 862 taught speech in combination with some other method finger-spelling or " signing."

These figures prove the great advance which has been made in the attempt to remove the abnormality of the deaf. The deaf child of tender years is just like his brother or sister, except for his deaf- ness, but as years pass with no auditory impressions and no develop- ment of speech, and the only means of communication open to him that of gesture, his intercourse is narrowed down to those im- mediately around him, and the divergence from the normal becomes