DR. MACLEOD YEARSLEY'S PAPER 443 



we could prevent it, and by preventing it we could 

 prevent the deafness which it often causes. 



Lastly, there is the deafness caused by primary 

 ear disease. This is, in almost all cases, the result 

 of adenoids, either immediately or remotely. We 

 otologists see daily patients who are hopelessly deaf 

 from this cause ; we can do little or nothing for them, 

 they are handicapped severely in social and in civic 

 life, but they could have been prevented from becom- 

 ing deaf. When they become deaf during school 

 life, they require active treatment, to be carried out 

 in school clinics or treatment centres. In this regard, 

 I wish to emphasize the fact that, to be efficient, this 

 treatment must be in the hands of specialists. Otology 

 has grown to be a very special branch of surgery, 

 requiring special skill, training and experience ; hence 

 the National Bureau insists that all aural school clinics 

 and treatment centres should be under specialists or 

 at the very least under specialist supervision. 



There is, however, another point. I have said 

 that in the great majority of these cases the primary 

 cause is adenoids. What we have to do is to prevent 

 adenoids. What are the factors in operation to cause 

 this hypertrophy of the lymphoid tissue in the naso- 

 pharynx ? It is due to bacterial infection, either by 

 a common cold or by some specific fever. Much 

 could be done to prevent this infection by improve- 

 ments in the hygiene, in the feeding, and in the 

 housing of infants and, no doubt, much has been done. 

 The better the infant is nourished, clothed, and cleansed, 

 the better able it is to resist bacterial invasion. I 

 believe that overcrowding, especially in cases where 

 the whole family has to live and sleep in one, perhaps 

 not overclean, apartment, is a potent factor. Barraud, 

 of Lausanne, has pointed out that the improper artificial 

 feeding of infants is an important cause of adenoids, 

 and I am sure that that most pernicious accompani- 

 ment of infancy, the misnamed " comforter," has 



