EAR TROUBLE, MALNUTRITION, DEFORMITIES
The presence of adenoids is a frequent cause of both slight and
aggravated deafness. Of 156 deaf mutes examined 59 per cent had
adenoids, while only 6 per cent of the general run of the children in
the neighborhood had this trouble. In mouth breathing, the current of
air entering the mouth draws out some of the air from the Eustachian
tube which ventilates the middle ear and unequalizes the atmospheric
pressure on the eardrum, causing it to sink in and to blunt the
hearing. An examination of the eardrums of school children in New York
who are mouth breathers showed a high percentage of deafness, incipient
or pronounced, accompanying adenoids. For example, of 9 mouth breathers
selected from one class (average age 7-8 years), 6 were well-marked
cases of deafness. Of 8 mouth breathers (average age 8-9 years), and of
5 mouth breathers (average age 5-6 years), all had noticeable defects
of hearing. Many adults that suffer from deafness maintain that they
never had any trouble in childhood. Yet the evidences of nose and
throat trouble in childhood persist and disprove such statements. _The
foundations of deafness in later life are, in most instances, laid in
childhood._ Since the majority of cases of ear trouble occurring in
school children accompany diseased conditions of the nose and throat,
the proper care of nose and throat will, in large measure, balance the
shortcomings of the aural examinations. Since the examination of the
drum itself is not practicable, especial care should be given to the
examination of the nose and throat.
The figures published by New York City's department of health show that
of 274,641 children examined from March, 1905, to January, 1908, 3540,
or 1.2 per cent, gave evidence of defective hearing. Ear specialists
suggest that this small percentage results from employing the whisper
test at twenty feet. The whisper test at sixty feet has been set by
experts as a test of normal hearing. But preciseness with this test is
well-nigh impossible when we consider that the acoustics, the quality
of the examiner's voice, the weather, the vowel or consonant sounds,
all are variable quantities. The watch test is frequently used, but
since a young teacher in her enthusiasm used an alarm clock to make the
test, specialists have decided that the volume of sound differs in
watches to such a degree as to make the watch test unreliable. The
examination of the eye has been reduced to mathematical precision, due
altogether to the anatomy of that organ. As yet there is no instrument
for the ear comparable to the ophthalmoscope. The acoumeter is largely
used by aurists and can be obtained from the optician. This instrument
has an advantage over the whisper or watch tests in that its tick is
uniform.
Each ear should be tested separately. Let the child place his finger
against the flap of one ear while the other is being tested. Then
compare the farthest distance from the ear at which the tick can be
heard with the normal, standard distance. During the test all sound
should be eliminated as far as possible and the eyes should be closed.
At a demonstration of ear testing at Teachers College, one student
stated that she could not hear the tick of the watch at a distance
greater than twenty inches. Then the tester walked noisily toward her,
leaving the watch on the desk, five feet away from the patient. She
heard it now. When the class burst out laughing she opened her eyes,
and, seeing the watch so far away, exclaimed, "Why, I thought I
imagined it." Be careful in testing a child to distinguish between what
he "thinks he imagines" and what he really hears. Because of the
difficulties of this test a doubt should be sufficient to warn the
teacher to send the child to be tested by an expert. Detection of
slight deafness may lead to the discovery of serious defects of nose or
throat. Inflammation from cold or catarrh may cause deafness, which if
neglected may permanently injure the ear. Often deafness is due to an
accumulation of wax. A running ear should receive immediate attention,
as it is an indication of inflammation which may imperil the integrity
of the eardrum, and, if neglected, may eat its way through the thin
partition between the ear and the brain and cause death.
It should never be assumed that deafness is incurable. Stupidity,
inattention, and slowness to grasp a situation accompany difficulty of
hearing and should cause the teacher to examine the ears. No ear
trouble is negligible. Children and parents should be taught that the
normal ear is intended to hear for us, not to divert our attention to
itself. When the ear aches or "runs" or rumbles there is something
wrong, and it should be examined together with the throat and nose.
NERVOUSNESS
In New York City one child in ninety-one already examined has had the
form of nervous disease known as St. Vitus's Dance, or chorea. So prone
are we to overlook moderate evils and moderate needs that the child
with aggravated St. Vitus's Dance is apt to be cured sooner than the
child who is just "nervous." Teachers cannot know whether twitching
eyes, emotional storms, constant motion of the fingers or feet are due
to chorea, to malnutrition, to eye strain, or to habits acquired in
babyhood or early childhood and continued for the advantage that
accrues when discipline impends. Many a child treasures as his chief
asset in time of trouble the ability to lose his temper, to have a
"fit," to exhibit nervousness that frightens parent, teacher, or
playmate, incites their pity, and wards off punishment. The school
examination will settle once for all whether the trouble can be cured.
The family physician will explain what steps to take.
TESTS OF MALNUTRITION
We Americans were first interested in the physical examination of
school children by exaggerated estimates of the number of children who
are underfed. As fast as figures were obtained for eye defects,
breathing defects, bad teeth, some one was ready to declare that these
were results of underfeeding. Hence the conclusion: give children at
least one meal a day at school. Scientific men began to set us straight
and to give undernourishment a technical meaning,--soft bones, flabby
tissue, under size, anæmia. While too little food might cause this
condition, it was also explained that too much food of the wrong sort,
or even food of the right sort eaten irregularly or hurriedly or
poisoned by bad teeth, might also cause undernourishment, including the
extreme type known as malnutrition. In extreme instances the symptoms
enable an observant teacher who has learned to distinguish between the
pretty hair ribbon and clean collar and the sunken, pale, or hectic
cheek and lusterless eyes to detect the cause. But as with eyes and
nose, an unhealthy condition of nourishment may exist long before
outward symptoms are noticeable. Therefore the value of the periodic
searching examination by the school physician.
[Illustration: SAME AGE, SAME SCHOOL, DIFFERENT NUTRITION]
BONE TUBERCULOSIS; ORTHOPEDIC TESTS
Only recently have we laymen learned that knee trouble, clubfoot, ankle
sores, spine and hip troubles, scrofula, running sores at joints, etc.,
are not hereditary and inevitable, but are rather the direct result of
carelessness on the part of adult consumptives. These conditions in
school are indices of homes and houses where tuberculosis is or has
been active, and of health boards that are or have been inactive in
checking the white plague. Early examination may disclose the small
lump on the child's spine,--which one mother diagnosed as inherited
"round shoulders,"--and save a child from being a humpback for life.
Moreover, the examination of the crippled child's brothers and sisters
will often show the beginnings of pulmonary tuberculosis.
[Illustration: A GRIEVOUS PENALTY FOR NEGLECT BY ADULT
CONSUMPTIVES]
ENLARGED GLANDS--TUBERCULOSIS
In almost every class are one or more children who are proud of small
or big lumps under one or more jaws. Only physicians can find very
small lumps. Many family doctors will say, "Oh, he will outgrow those,"
or "Those lumps will be absorbed." Like most other evils that we
"outgrow" or that pass away, these lumps shriek not to be neglected.
They mean interference with nourishment and prevent proper action of
the lymphatic system, as adenoids prevent free breathing. Even when not
actually infected with tubercle bacilli, they are fertile soil for the
production of these germs. If detected early, they point to home
conditions and personal habits that can be easily corrected. In New
York one child in four has these enlarged glands. If the same
proportion prevails in other parts of the United States, there are
5,400,000 children whose strength is being needlessly drained, many of
whom, if neglected, will need repeated operations.
[Illustration: MODEL OF AMERICA'S FIRST HOSPITAL FOR SEASHORE
FRESH-AIR TREATMENT OF NONPULMONARY TUBERCULOSIS IN CHILDREN
To be erected at Rockaway Beach, New York City]