DEAFNESS IN CHILDREN

34 be of still greater importance. It has been possible to grow human cells in culture for many years, and it may be possible before long to produce a clone from a single fertilised egg. Better still would be the production of a clone from cells of persons of attested ability, which might raise the possibilities of human achievement dramatically. Human genetical make-up may be altered by the deliberate provocation of mutation, and it may also be possible to synthesise new genes and introduce them into human chromosomes. Gene-grafting may make it possible to introduce into human stocks features which would adapt the recipients to extraterrestrial environments. Haldane predicted that in the future there would be much less interest in acquiring material objects, and more and more interest in our own bodies and minds. Investigation of the inner life might reveal one or more objective realities. A new awareness of time, and manydimensional art, may lie ahead. Thus we may expect that the control of physiological processes will be enlarged and the capacity for consciousness enriched. ’*’

’*’

’*’

So in the end this symposium came to the consideration of what is desirable and why. " What is going to happen

Conferences DEAFNESS IN CHILDREN THE first British Academic Conference in Otolaryngology was held in London on June 20 at the Royal College of Surgeons, with Prof. VICTOR LAMBERT in the chair. Sir ALEXANDER EwiNG said that a team project in the Manchester University department of audiology indicated the need for standardised tests of the children’s capacity for speech reception (a) using wearable hearing-aids in ordinary school conditions, and (b) with high-fidelity amplification, controlled acoustics, and expert microphone techniques, aimed at the maximum exploitation of each child’s discriminative auditory ability. Results of speech audiometry and spectrographic analysis were demonstrating serious limitations to the efficiency of contemporary wearable hearing-aids as used in ordinary school conditions; and vocabulary tests of partially hearing children reflected severe deprivation of auditory experience in real-life situations. Recent experiments, he added, suggested an urgent need for much more use of high-fidelity amplification, beginning in infancy; and Lady Ewing had demonstrated that the use of high-fidelity amplification, synchronised with reading and speaking, could be made a means of developing auditory discrimination in very severely deaf children. Mr. GAVIN LIVINGSTONE (Oxford) discussed in general terms the management of the child with a perceptive hearing-loss. The development of speech in normal children, he said, underlined the importance of finding and training the deaf child during the first year of life. After setting out the factors which could predispose babies to congenital abnormalities, he spoke of the possibility of finding all those who had been exposed to such factors-through an " At Risk " register and through greater publicity. Early training was very important. Finally, Mr. Livingstone laid stress on the value of educating deaf children in hearing schools through " partially hearing units ". Miss EDITH WHETNALL (London) (Royal National Throat, Nose, and Ear Hospital) advocated binaural hearing-aids for deaf children. With speech audiograms, she demonstrated that speech scores were much higher with binaural than with monaural aids; and she favoured the use of two separate aids rather than a single aid with a Y-lead. Describing the development and attributes of binaural hearing, Miss Whetnall discussed the advantages conferred through localisation and summation of sounds through both ears.

on what people will think good, and what we would like to happen depends upon what we now think good." Is it true, as Lord Brain suggested, that ultimately " we come down to doing good by’minute particulars’,’, just as we have to change people’s minds, if we can change them at all, individually " ? And is it true, as he also " asked, that there is scope for different sets of symbolic language besides science which are equally important in our relations with things as a whole " ? Does man need some adequate form of symbolisation which adjusts him to things in general, and is associated with emotional satisfaction " ? J. Bronowski, commenting on this, said that science itself is fundamentally an ethical activity and that " our biggest lack at the moment is in our whole understanding of the nature of the process of valuation ". Groups of this kind, said P. B. Medawar, usually end up by agreeing that more education is what is wanted; but how could that view be reconciled with the " incredible diversity of opinion " which had been expressed ? This diversity, he thought, was both the cause and the justification of our being obliged to do good in minute particulars. Lord Brain wound up the proceedings with Blake’s " words, without contraries is no progression ".

depends

"

Prof. Dr. H. C. HUlZING (Groningen, Netherlands) spoke of the fundamental aspects of speech development in the normal child, with particular emphasis on the cybernetic functions of the central nervous system (which were indispensable for the mastering of fluent vocalisation) and on the cerebral functions necessary for obtaining skill in auditory discrimination. A basic knowledge of the physiology of speech and language in the normal child was essential, he added, if we were to understand the problem of the deaf child. Mr. J. C. BALLANTYNE (London) issued a warning on the possible traumatic effects of powerful amplification in children with a sensorineural hearing-loss. In his James Yearsley lecture, Air Vice-Marshal E. D. D. Dickson had cited a paper in which Kinney1 of Cleveland, Ohio, reported many cases of perceptive deafness in children in which hearing-loss had progressed after-but only after-they used a wearable hearingaid. In every instance the progress of the deafness was greater in, or confined to, the ear in which the aid was worn. With the powerful aids at our disposal today, Kinney went so far as to suggest that the use of binaural hearing-aids was to be condemned in children with a sensorineural loss. Few of us, said Mr. Ballantyne, would go all the way with him in this: there was too much evidence of their benefits. However, very few of us surely would disagree with another suggestion of Kinney’snamely, that the hearing of children wearing binaural hearingaids should be reassessed regularly; and we should be prepared to change to a monaural aid if hearing-loss was progressing. What had been said so far referred almost entirely to perceptive deafness, but most otologists were confronted much more often with children who had conductive deafness. In most of these cases the cause was treatable, and should be treated. But it must never be forgotten that these children were also handicapped, and they could fall back seriously at school. Many should wear hearing-aids, but very few of them did. Mr. KENNETH HARRISON (Manchester) said that a very common cause of conductive deafness in children was now middle-ear effusion. In this condition the deafness was very variable: it could be very slight or it might be very noticeable. There were usually recognisable changes in the drumheads, and he believed that it was usually of inflammatory origin. Eustachian obstruction led to absorption of air from the middle ear, and this in turn led to exudation. Allergy was not, in his experience, a frequent causative factor, and the effusion was usually sterile. The main task was to restore the function of the eustachian tube. Adenoids were usually responsible for its obstruction and they should be removed. Sinus infection was 1.

Kinney, C.

E. Ann. Otol. Rhinol.

Laryngol. 1961, 70,

828.

35 not a common cause; and, though X-rays might show some loss of translucency in the antra, washout was usually clear and sterile. Patency of the tube was restored by these measures in many cases, but postoperative inflation was often advisable, and paracentesis and aspiration might be necessary. Sometimes this had to be repeated several times. The giants of the past were well aware of this condition, and the otologists of today were again becoming more aware of it. Perhaps it was commoner in the antibiotic era ? However that may be, it remained a formidable problem. Prof. THEODORE WALSH (St. Louis) said that a middle-ear effusion could be fluid or " glue ". In the case of glue ear ", hearing by bone conduction was often greatly depressed; and the condition could easily be confused with perceptive deafness, especially as the tympanic membrane often looked surprisingly near normal. Mr. P. G. APTE said that middle-ear effusion was very common in India. Mr. K. M. MAYALL (Pontefract) disagreed with Mr. Harrison in believing that sinus infection is a much more common cause of middle-ear deafness than adenoids. Mr. A. MARTIN (Uganda) spoke of the problem confronting the otologist in many tropical areas. Its size could be determined only by a survey. But, if the mothers were encouraged to come forward when they suspected deafness in their children, they expected something to be done for their children, and done immediately. In such a population, there were many different tongues, many different dialects. This would mean many teachers of the deaf, who would have to speak these languages. At present there were practically no such teachers; nor were there funds for providing the help needed. "

HISTOCHEMISTRY AND CYTOCHEMISTRY

dehydrogenase, A.T.P.-ase, alkaline and acid phosphatase, nonspecific esterase, and leucine-amino-peptidase in the tissues surrounding synthetic vascular prostheses for times up to one year after implantation in dogs. He found that the new vascular channel formed around the porous artificial substitute was not a " simple granulation-tissue tube but consisted of coats " of cells that differed distinctly in functional enzyme differentiation. A year after implantation, when the granulation process seems to be morphologically complete, there were enzyme reactions which suggested the presence of immature mesenchymal cells. He also found that with practice many of the enzyme histochemical methods were less laborious than routine histological methods. Another outstanding paper was that of Dr. R. G. J. WILLIGHAGEN, of the pathology laboratory, Rijksuniversitet, Leiden, who had been investigating the activity of 6-hydrolytic and 5-dehydrogenating enzymes in 1600 human tumours. His methods had proved valuable in differentiating anaplastic carcinoma from reticulum-cell sarcoma and adenocarcinoma of the lung from metastatic carcinoid adenoma. He also found that the method for amino-peptidase could be used at operation to decide the limits to which malignant cells had extended in linitis plastica. He noted a relation between the non-specific esterase activity of squamous carcinomas of the lung and the survival time of the patient.

For someone working in the West, one of the most interesting points from this well-organised meeting was the rapid use that has been made of these methods, mainly Western in origin, by the Eastern investigators in following up their particular line of study. They seem to be much more progressive and uninhibited in the use of the methods

than

we are.

FROM A CORRESPONDENT

THE first International Symposium of Histochemistry and Cytochemistry, held in Warsaw on April 13-16, was organised to give Eastern European scientists with interests in these subjects an opportunity to meet their colleagues from Western Europe. Of the 350 participants, about 50 came from the West, so the purpose of the meeting was well served. The general topic of the meeting was cellular proliferation, and this was subdivided into sections on functional organisation of cells, functional differentiation of proliferation of normal tissues, organogenesis and histogenesis, and pathological growth and proliferation of tissues.

Histochemistry is still often looked upon as an extension of histological technique, wherein the topographical

conventional

distribution of staining reactions is correlated with structural changes in tissues and cells. Many papers at this meeting reflected this attitude, but some were of particular value in showing how much information about variation in function of apparently identical and adjacent cells, or groups of cells, can be obtained by this means. Dr. V. V. PORTUGALOV, of the Laboratories of Biochemistry and Histochemistry of the Brain Institute in Moscow, described biochemical and histochemical studies of the distribution of oxidative enzymes in cells of different phylogenetic age in different parts of the brains of different species. This work showed that in the phylogenetically older cells these enzymes were mainly in the cell bodies, whereas in the younger cells the enzymes were in the dendrites as well. He also showed that reduction of enzyme activity occurred in neurones of motor and visual analysing areas in animals of higher neural organisation compared with those of lower organisation. These decreases were, however, associated with increases in respiratory and phosphorylative activity, which he interpreted as demonstrating increased efficiency of the enzyme mechanism. Another paper of considerable interest was that of Dr. S.

SZENDZIKOWSKI, of the department of pathology, Lodz, who histological distribution of D.P.N.H.-tetrazolium reductase, succinate, lactate, and alpha-glycerophosphate described the

Medicine and the Law Cruelty and Insanity A HUSBAND who in 1954 began to " hear voices " was admitted to a mental hospital as a certified paranoid schizophrenic. He was regraded as a voluntary patient in 1958 and returned home; but his conduct and, in particular, his persistent accusations of adultery against his wife damaged her health; and she presenteda petition for divorce on the ground of cruelty. Medical evidence at the trial showed that the husband knew what he was doing when he accused his wife but that he did not know that his accusations were wrong. The Commissioner and a majority of the Court of Appeal held themselves bound by authority (Palmer v. Palmer (1955) P. 4) to hold that both limbs of the McNaughten rules applied in matrimonial causes, so that the fact that the husband did not know that he was doing wrong in accusing his wife of adultery was a good defence to her petition based on cruelty. The wife appealed to the House of Lords. Lord REID said that this

the first reported case in which get relief on some ground against a spouse who was insane, and it called for a decision of the question whether an insane person could be held to have treated his, or her, spouse with cruelty. In some of the old law, stress had been laid on certification as an adequate protection to the other spouse; but this case showed that because of modern methods of treatment certification was not now always an adequate protection. His Lordship was clearly of opinion that it would be wrong to take the McNaughten rules as a test. Not only had the rules been criticised for nearly a hundred years but their strict application would lead to capricious results. It was the general opinion of medical men, who had at least a better understanding of insanity than lawyers, that there were types of insanity not within the rules which deprived the insane man of choice or responsibility just as a

petitioner had failed

to

was