stop at the cradle, but will include the new-born child and the expectant mother, although the ministry of health will not call itself the Education Authority then. Hearing is relatively of far more importance to a little child than to an adult. A deaf adult may have to stop or change his business. A little deaf child cannot learn to speak. The ear is the greatest educational gateway. Make a child blind and you may still extend his knowledge by continuing to talk to him. Make him deaf and you must spend some years in training his eye to take the place of his ear, and you never completely succeed. Excluding Syphilis, Meningitis and hereditary deafness, nearly all ear-disease reaches the drum cavity by way of the naso-pharynx. Even in Scarlet Fever and Measles, the naso-pharynx is disturbed before the middle-ear, and although deafness and middle-ear suppuration may occur in these diseases without the intervention of the naso-pharynx, this is not usually so. The naso-pharynx in many children becomes narrowed or almost occluded by the hypertrophy of adenoid tissue which to a small extent is normally present, and breathing by the nose become difficult or impossible. Standing as this swollen and unhealthy tissue does in the great air-way to the lungs, it becomes a harbor for micro-organisms, and either during the course of the exanthemata or without these, the infection is carried by the Eustachian Tube to the ear, the drum cavity suppurates and the membrane breaks down.

When a young child breathes by his mouth or noisily by his nose, the nasopharynx should be examined, cleared if found obstructed and the cavity made aseptic. Should ear-ache and suppuration occur the ear should be treated at once and until the discharge ceases, when the naso-pharynx should also be radically treated. Unless the latter be carried out, the ear will break down again and again or a chronic discharge will be established. Should ear discharge occur during the course of an infectious disease, the ear should be treated until all discharge has ceased even if operation on the mastoid process be necessary, because the ear discharge is infectious and because it is far more difficult to get good results after the

discharge has become chronic. The operations both on the naso-pharynx and the mastoid process should be carried out by specialists, because neither the general surgeon nor the general practitioner has practise enough to become expert at them. Such early treatment, even when operation is done, is truly preventive. It is like the tradesman's visit to a house roof before the winter storms set in. In the case of the child, storms will probably come during the school period. But even during the early school years careful regular treatment by a trained nurse will in most cases save the hearing and dry the ear if at the same time the surgeon put the naso-pharynx right. In Glasgow this plan has given surprisingly good results, although the School Authority does not operate and has to depend on the sometimes unwilling, and nearly always delayed, help of the general and special hospitals. In an experience extending over six or seven years and over several thousands of cases, the writer found that most of the affected ears recover quickly under the care of nurses, and in Dumbartonshire where the Education Authority does operate and does it at once, only two or three out of 350 cases in which the naso-pharynx was cleared, had discharging ears after two or three months treatment, and these exceptional cases were cases of Scarlet Fever which had been dismissed from hospital with discharging ears. At present there is not enough hospital accommodation in this or any country for the work outlined above, and I have no doubt extra accommodation has to be created either by or for the Education Authority.

Such treatment carried out early in life would make major operations on the ear in later life rare, and operations for otitic complications in the brain very rare indeed.

Now these proposals are not brilliant. Common sense proposals seldom are, and if they do away with the brilliant and spectacular in treatment, they tend to the preservation of hearing and life which even operation cannot always save.

Look now for a moment at the three remaining diseases I have mentioned— Meningitis, Syphilis and Hereditary Deafness the last not really a disease.

In a population of from four to five million in Scotland, there are about six hundred deaf-mute children of school age. Probably about 100 are due to Meningitis, 200 to Hereditary Deafness, and not more than 50 due to Syphilis. The remaining 250 are due chiefly to the infectious diseases. But there are nearly half a million school children of whom many thousands are very deaf or hard of hearing, these conditions being due to a neglected naso-pharynx or a neglected running ear. What a field for preventive treatment!

Not that I neglect the three diseases mentioned. They are very important and cause the most profound deafness, especially when they complicate Scarlet Fever. But numerically they are unimportant, and they are less easily brought under control with our present limited knowledge and appliances. Let us look at them individually for a moment.

Take Meningitis. This is not one disease. It is a group of diseases. Sometimes it occurs alone. Sometimes it attends other diseases. It is not always due to the same germ. Every case of Meningitis should be removed to the hospital and there isolated and studied. Neither by the use of a drug nor by an operation can we usually cure it. We do not know enough about it.

Take Syphilis as a cause of deafness. We know a great deal about the germ and its conduct. But we do not treat it like other diseases. It raises moral and social problems. Now the germ of Syphilis is neither moral nor immoral-it is merely un-moral like any other germ, and it will yield to none but physical measures such as human ingenuity has found successful in preventing other infectious diseases. At present if I find a deaf syphilitic child I have no authority to treat the mother or the baby at her breast, or even the child about to come to school. Until the health authority takes the mother, the father and the whole family under its care, either deaf children or dead children will follow the syphilitic child.

Then take hereditary deafness. We do not know much about it, but it is Mendelian in incidence, and we can breed it out in two or three generations whenever we like. But have we tried to explain to the

deaf whom they should marry, and should we expect to begin this outbreeding without the help of the deaf themselves? The hereditary deaf are honest, intelligent men and women who do not want deaf children, but who go on marrying each other because more hearing children than deaf are born to them, and who hope for the best. Let them put precision instead of slackness into their marrying and the rate of deafness will soon lessen and ultimately disappear. There is room for propagandist work here, and the deaf in the long run would welcome it.

I have said nothing about Tuberculosis of the Ear in children. It usually attacks the middle ear and spreads to mastoid process and petrous process of the temporal bone, involving of course the internal ear. In this way it often reaches the brain and causes death by Meningitis. As a rule too, the abdomen and chest are involved in these young children, and the aurist finds he is dealing with a condition in which the ear infection is the least serious element. Tuberculosis of the ear appears during the first or second years of life, and the most of the children die before school age, so that the disfiguring paralysis which is common is seldom seen in the classroom.

The amount of individual and national loss originating in the deafness and ear disease of early childhood is incalculable. Think of the time and devotion-never mind the money-spent by teachers in bringing the deaf child up to the plane of the hearing child, and remember that the teacher never wholly succeeds. Watch

the deaf adult fight shy of society, because morose and dull, or seek companionship amongst his fellow unfortunates. I am glad that in both America and Britain efforts are being made to give all the deaf lip-reading lessons and most of the dumb speech. But in spite of fine architecture, in spite of the devotion of splendid teachers, in spite of charity running over, an institution for the deaf is an appalling thing. And why? Because nearly all the deafness can be prevented. Is there nobler service which one generation can offer to that which is to follow it, than the prevention of deafness?

In order to deal with the increasing number of men discharged from the Army and Navy on account of deafness and ear disease, the Special Aural Board in London was organized in August, 1917, with Major Dundas Grant as President, while in other parts of the United Kingdom Aural Boards were established, where required. On all the boards a specialist on Lip-reading is associated with the aural surgeon and they decide as to the degree of disablement and the necessity of lip-reading instruction or treatment, or both.

The work in London was at first carried on at the town residence of Lord Lamington, who generously placed it at the disposal of the Ministry until it was removed to the roomy Official Headquarters at 28 Park Crescent, the scene of the activities of the Aural Board, the Lip-Reading School, the special evening Aural Clinic and the Club (feeding and recreation) for the pupils.

The Secretary (Captain Ingram) and his staff include among other duties the finding of work for those in want of it and the supplementing of pensions and allowances by private contribution in cases of special need for such assistance.

Up to the present about 10,000 men have been discharged from Military or Naval Service on account of deafness or disease of the ear. A considerable number of these have useful hearing and a smaller number are classified as very deaf. Of the latter a large proportion have been recommended for instruction in lip-reading. Fortunately, up to the present even a high degree of deafness

has not prevented a man from doing useful work. (This is shown by the returns of the Special Aural Board for Lancashire, Cheshire and Westmoreland, for which we are indebted to Mr. Nelson, Principal of the Royal Schools for the Deaf, Old Trafford, Manchester).

It is reported that up to June 30, 1919, out of 1,985 men discharged on account of deafness or ear diseases, 1,598 (84. 3%) were at work and only 297 (15.7%) out of work. There is every probability, however, that in time men with defective hearing will find themselves handicapped in the fight for work in spite of all artificial expedients on the part of a beneficent. government and in view of the regulations enforced by the trades unions. The best hope for them lies in the acquisition of the faculty of lip-reading for purposes of verbal communication, and still more in such improvement in hearing-power as patient and skilful treatment can afford them.

An early start in the teaching of lipreading was made in Edinburgh where the Edinburgh Lip-reading Association established a class on May 1, 1917 under the tuition of Miss M. E. B. Stormouth (now Mrs. Mann), of the Edinburgh School-Board. The teaching was excellent and the results, according to Mr. Sibley Haycock's report, were most satisfactory. The activity of this centre increased when it received the State recognition and support to which it had established its claim.

The first lip-reading class in London for Deafened Soldiers and Sailors under the Ministry of Pensions was opened in the autumn of 1917. The teachers were drawn from the teaching staff of the National Association for the Oral Teaching of the Deaf, the organization and technical direction being in the hands of the principal, Mr. Sibley Haycock. At a later period teachers were also supplied by the London County Council under B. P. Jones, the Superintendent of the Council's Schools and Training Classes for the Deaf and Blind.

At present three classes are held in the day time, consisting of upwards of fortyfive pupils; these classes are primarily intended for men with such a high degree of deafness that lip-reading is for them

not merely desirable but actually indispensable.

The results have been classified by Dr. Eichholz as follows:

1. Entirely satisfactory. These include cases whose lip-reading attainments place them practically on the level of hearing people; that is to say they lipread a stranger as though they were practically in full possession of ordinary hearing power.

2. Satisfactory. This category included cases possessing a useful acquirement of lip-reading, and who respond either (a) after not more than a single repetition or, (b) after they have repeated the question as lip-read in order to make certain that they have understood rightly.

3. Fair. These cases respond to simple sentences only, and require questions to be repeated from three to five times before they apprehend rightly.

4. Unsatisfactory. These cases respond merely to single words after frequent repitition. They are apt to suffer also from neuro-muscular changes, resulting in flattened or rough voice.

Out of 157 men who have attended or are attending the day classes at Park Crescent 109 passed out and the results were as follows:

Day classes are also held at Margate, Doncaster, Brighton and Edinburgh.

For those whose deafness is not so extreme as to prevent them from following their occupations there are evening classes in London, the larger number of which are established under the London Council in various populous districts, in addition to one held at Park Crescent.

Evening classes are also held at Carlisle, Stockton-on-Tees, Newcastle-onTyne, Liverpool, Edinburgh, Dublin, Exeter, Birmingham, Stoke-on-Trent, Cardiff, Derby, Leicester, Nottingham, Glasgow, Hamilton, Paisley, Aberdeen,

Doncaster, Hull, Bradford, Halifax, Leeds, Middlesborough, Sheffield, Manchester, Bolton, Burnley, Rochdale, Oldham, Chester, Grimsby and Plymouth.

Good work has been accomplished in all, but, from the nature of things the attendances have not been all that could be desired, and this is from various causes, the chief of which may be that the men are too tired after their day's work to concentrate their minds on lipreading. The existence of these classes has been made known by the Ministry by circularization of the men, by personal visitation and by advertisement in the papers so that as far as practicable they are at the disposal of every man within the district.

In view of the monotony and nervous strain involved in the concentration necessary for learning lip-reading it is absolutely essential that the men in the intervals of instruction be afforded means of recreation. For this purpose a Club is conducted at Park Crescent by Mrs. Dundas Grant, wife of the President of the Board, consisting of dining-room, billiard rooms, recreation rooms and reading rooms, the benefits of which are much appreciated by the students.

The hours of instruction are from 10 to 12 and from 2 to 4, varied by breaks of 15 minutes twice each session. At 12.15 a good hot dinner is served in the dining-room at a charge much below the actual cost of the provisions, and tea is given at 3.15. The men are made to feel absolutely at home, and being so treated, there has never been any need for the exercise of disciplinary measures.

The health of the men attending these classes is held to be the first consideration and Dr. Grant makes a special visit to the school each Monday and Friday to give aural treatment to all who need it, and at any other time when notified that a man "is under the weather."

It has been said that the army is a great leveler, but nowhere is this more emphasized than at Park Crescent, where we have officers and men mingling together, at work and play, in perfect harmony and good fellowship. When a man comes to us, it is unusual to find him otherwise than despondent, irritable and almost without hope of ever bettering his