Deafness as a Public Health Issue in the 1920s & 1930s (Part 1 of 2)

Today we have part one of a guest post written by Dr. Jaipreet Virdi-Dhesi, the 2016 Klemperer Fellow in the History of Medicine at the New York Academy of Medicine and a SSHRC Postdoctoral Fellow in the Department of History at Brock University in St. Catharines, Ontario. She is working on her first book, Hearing Happiness: Fakes, Fads, and Frauds in Deafness Cures, which examines the medical history of hearing loss and “quack cures” for deafness. Some of these cures are explored on her blog, From the Hands of Quacks. You can find her on twitter as @jaivirdi.

In 1935, physician Francis L. Rogers of Long Beach read a paper addressing the worrisome statistics of deafness. One study discovered nearly thirty-five thousand Americans were deaf. Another found that out of a million people tested for their hearing, 6% had significant hearing impairment. Yet another study reported three million people had some kind of hearing impairment. This “problem of deafness,” Rogers emphasized, “is primarily of public health and public welfare.” Not only were there too many people failing to adequately care for their hearing, but many cities, schools, and governments lacked the proper infrastructure to educate the public on the importance of hearing preservation. Indeed, as Rogers stressed: “Today the three great public health problems confronting the world are heart disease, cancer, and deafness.”[1]

Image 1

A window display in Detroit (Hearing News, June 1942)

The notion of deafness being statistically worrying as a public health issue actually dates to the late nineteenth century, especially to the work of otologist James Kerr Love of Glasgow. Love conducted several statistical studies of the ears of deaf schoolchildren, discovering that the majority of them were not completely deaf, but had some level of “residual” hearing. With proper medical treatment, the hearing could be intensified enough to warrant a “cure.” For other cases, children could be taught to make use of that residual hearing through invasive training using acoustic aids and other kinds of hearing technologies.

Love’s research concluded that many deafness cases could actually be relieved if the ears of children were examined early and frequently—that is, deafness could be prevented. His “prevention of deafness” concept was influential for the new generation of otologists in America, especially those who were members of the New York Academy of Medicine’s Section of Otology during the first three decades of the twentieth century.

To raise awareness on the necessity of proper medical examinations and frequent hearing tests, these otologists collaborated with social organizations such as the New York League for the Hard of Hearing, which was established in 1910. The League was a progressive group catering to the needs of hard of hearing or deafened persons who were raised in a hearing society rather than in a D/deaf community and communicated primarily with speech and lip-reading rather than sign language. Composed mostly of white, middle-class, and educated members who lost their hearing from illness, injury, or progressive deafness, the League strove to construct hearing impairment as a medical issue. They argued hearing impairment was not an issue of education or communication, but rather a handicap.

Image 2

An otologist examining a young patient’s ear (Hygeia, June 1923)

The collaboration between New York otologists and the League eventually created a national network of experts, social services, teachers, physicians, and volunteers who banded together to address the so-called “problem of deafness.” That is, the problem of how to best integrate the hard of hearing, the deafened, and to some extent, even the deaf-mutes, into society. One key achievement of the League was the establishment of hearing clinics to properly assess hearing impairment, especially in children, to ensure medical care could be provided before it was too late. This project was primarily spearheaded by Harold M. Hays (1880-1940), who was recruited as president of the League in 1913, becoming the first active otologist collaborating with the League. After the First World War, Hays set up a clinic for treating hearing loss in children at the Manhattan Eye, Ear, and Throat Hospital.

Image 3

Group hearing tests of schoolchildren, using an audiometer. Headphones are used first on the right ear, then the left. (Hygeia, February 1928)

Hays claimed that hearing impairment might be a handicap, but “the sad part of it is that 90 percent of all hearing troubles could be corrected if they were treated at the proper time.” With regular hearing tests, this was possible. Yet, as Hays argued, regular hearing tests were not considered on par with other hygienic measures under public health services:

We are saving the child’s eyes! We are saving the child’s teeth! Is it not worth while to save the child’s ears?”[2]

During the 1920s, Hays’ activism for regular hearing tests was so instrumental that in 1922, the League’s newsletter, The Chronicle, told its readers “we believe that the League would justify its existence if it did no other work than to prevent as much deafness as possible.”  To achieve this mandate, the League launched a large public campaign to raise awareness on the importance of medical care. Indeed, in one report for the League, Hays remarked that with the increased publicity, there were 10,000 calls to the League in 1918 alone inquiring about aural examinations. A steady increase in patients would follow: 17 clinic patients in 1924, 326 in 1926, and then 1,531 in 1934.

Another publicity campaign spearheaded by the League was the establishment of “Better Hearing Week” in 1926, a week-long awareness program (later renamed “National Hearing Week”). Held in October, the campaign included symposium discussions on the “Problems of the Hard of Hearing,” including topics on the relationship between the physician and his deafened patient, how the deafened could build their lives, and even on newest technological developments in hearing aids. October issues of The Bulletin (the renamed League newsletter) and the Hearing News, the newsletter of the American Society for the Hard of Hearing (ASHH) included reprints of letters from prominent leaders supporting the mandates of “Better Hearing Week,” including letters from President Roosevelt and New York Mayor LaGuardia.

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Advertisement for Western Electric Hearing Aid, the “Audiophone.” These before-and-after shots were powerful for demonstrating the effects of “normal” hearing, sending the message that outward signs of deafness, such as the “confused face,” could easily disappear once being fitted properly with a hearing aid. (Hearing News, December 1936)

The 1920s publicity campaigns were primarily focused on fostering ties between otologists and the League, in cooperation with hospitals and schools. In 1927, the League purchased audiometers and offered invitations to conduct hearing tests in schools across New York, so children with hearing impairment could be assessed accordingly. Two years later, the League worked with Bell Laboratories to further substantiate the conviction that deafness was a serious problem amongst schoolchildren and that something needed to be done.

At the same time otologists across America established joint ventures between organizations like the America Medical Association and the American Otological Society. They formed committees to write reports to the White House on the national importance of addressing the “prevention of deafness.” Wendell C. Phillips (1857-1934), another president of the League and the founder of ASHH, particularly emphasized the need to address the “psychologic conditions and mental reactions” of the deafened patient, for the tragedy of acquired deafness meant it is a “disability without outward signs, for the deafened person uses no crutch, no black goggles, no tapping staff.”[3] It was an invisible handicap that needed to be made visible if it was to be prevented, if not cured.

References

[1] The Federation News, August 1935.

[2] Harold M. Hays, “Do Your Ears Hear?” Hygeia (April 1925).

[3] Wendell C. Phillips, “Reminiscences of an Otologist,” Hygeia (October 1930).

“A Passionate Statistician”: Florence Nightingale and the Numbers Game

In conjunction with its exhibit, “Extraordinary Women in Science & Medicine: Four Centuries of Achievement,” the Grolier Club is holding a symposium on October 26, 2013, to which all are welcome. The exhibition and symposium explore the contributions of 32 women, one being Florence Nightingale, to science and medicine. The exhibition features NYAM’s copy of one of Nightingale’s statistical charts. In today’s blog post, Natasha McEnroe, director of London’s Florence Nightingale Museum, explains their significance.

Florence Nightingale. Reproduced by courtesy of the Florence Nightingale Museum.

Florence Nightingale. Reproduced by courtesy of the Florence Nightingale Museum.

The Victorians loved nothing better than to measure and classify, trying to discover natural laws through the data they recorded, and Florence Nightingale (1820-1910) was no exception in sharing this general enthusiasm. Having gained celebrity status from her nursing work at the infamous Barracks Hospital at Scutari, the British base hospital in the Crimean War (1853-1856), Nightingale returned to England with her health permanently broken down. Determined that the appalling treatment of the soldiers during the war should not be repeated, she spent the rest of her life conducting a political campaign for health reform from her bedroom. One of the ways her campaigning was groundbreaking was in the use of statistics.

Reproduced by courtesy of the Florence Nightingale Museum.

St Thomas’ Hospital, London, home of the Nightingale Training School for nurses. Reproduced courtesy of the Florence Nightingale Museum.

Nightingale’s love of mathematics was apparent from an early age and was an interest  encouraged by her father, who took the responsibility of educating his daughters into his own hands. Her parents’ social circle brought the young Nightingale into contact with many of the most brilliant minds of the age, including Charles Babbage, whose own passion for numbers (and not a little pedantry) is shown in a letter to Alfred Tennyson in response to the poem The Vision of Sin:

‘In your otherwise beautiful poem, one verse reads,
Every moment dies a man,
Every moment one is born.

…If this were true, the population of the world would be at a standstill. In truth, the rate of birth is slightly in excess of that of death. I would suggest that the next version of your poem should read:
Every moment dies a man,
Every moment 1 1/16 is born.
Strictly speaking, the actual figure is so long I cannot get it into a line, but I believe the figure 1 1/16 will be sufficiently accurate for poetry.’

Just weeks after her return from the Crimean War in 1856, Nightingale secured a Royal Commission from Queen Victoria investigating the health of the British Army. Nightingale herself was involved in every step of the Commission’s investigations, working with the statistician William Farr to illustrate graphically that more British troops died of disease during the war than in battle. Farr encouraged Nightingale to compare statistics on mortality rates of civilians with that of soldiers, showing that whether at war or at home, soldiers demonstrated a higher mortality rate.  He wrote to Nightingale, “This I know…Numbers teach us whether the world is ill or well governed.”  Nightingale pioneered what is now called evidence-based healthcare and in 1858 she was the first woman elected to the Royal Statistical Society.

Chart from Florence Nightingale’s A contribution to the sanitary history of the British army during the late war with Russia (London, 1859)

Chart from NYAM’s copy of Florence Nightingale’s A contribution to the sanitary history of the British army during the late war with Russia (London, 1859).

A devout woman, Nightingale saw statistics as having a spiritual aspect as well as being the most important science, and believed statistics helped us to understand God’s word. Influenced by the ethos of Victorian vital statistics, her greatest legacy can be seen in improved public health, reformed nursing education, and in her innovative polar area graphs and other work in statistics. In Nightingale, this most eminent of Victorians, we can see the combination of the two great passions of her age—a compulsion to classify and a desire to improve by reform. What made Nightingale remarkable were the personal qualities of fierce intelligence and energy that enabled her to pursue these passions with the immense determination for which she was famed.