Though as yet there has been little direct action for the prevention of adventitious deafness, there is an increasing concern in the matter, and in this there is promise. By medical bodies in particular is greater attention being given to the subject,[28] and in the widening recognition of their part as guardians of the public health it may be possible for them to do much for the enlightenment of the public. In one state legislative action has been taken expressly for the protection of the hearing of school children. This is Massachusetts, which requires the examination of the eyes and ears of the school children in every town and city, the state board of education furnishing the tests.[29] In some states also general inspection of schools is mandatory by statute, and in others permissive, while in several there are local ordinances with the force of a state law. In combating adventitious deafness, then, our attack is to be directed in the largest part upon those diseases, especially infantile and infectious diseases, that cause deafness; and it is upon the checking of their spread that our main efforts for the present have to be concentrated. At the same time the better safe-guarding of the general health of the community will insure a proportionate diminution of deafness. Beyond this, we will have to wait upon the developments of medical science, both in the study of the prevention of diseases and of their treatment; and can trust only to what it may offer.[30] ADVENTITIOUS DEAFNESS AS AN INCREASING OR DECREASING PHENOMENON Our main interest in the problem of adventitious deafness lies in the possible discovery whether or not it is relatively increasing or decreasing among the population, and in what respects signs appear of a diminution. We have just seen the likelihood of a decrease from certain causes; but we are to find what is indicated by statistical evidence. To be considered first is adventitious deafness as a whole. Respecting it our only statistics are in the returns of the censuses since 1880, the different forms of deafness not being distinguished before this time. The following table will show the number of the adventitiously deaf as reported by the censuses of 1880, 1890 and 1900, with their respective percentages and ratios per million of population.[31] NUMBER OF THE ADVENTITIOUSLY DEAF IN 1880, 1890 AND 1900 TOTAL ADVENTITIOUSLY PERCENTAGE RATIO NUMBER DEAF PER MILLION OF POPULATION 1880 33,878 10,187 30.1 20.3 1890 40,562 16,767 41.1 26.8 1900 37,426 18,164 48.4 23.9