[40] Letters of inquiry as to whether or not "total" deafness appeared to be decreasing were sent by the writer to the professors of diseases of the ear of the medical schools of Johns Hopkins University, University of Pennsylvania, Columbia University, Cornell University, Harvard University, University of Chicago, Northwestern University, University of Michigan, and the Jefferson Medical College of Philadelphia. The opinion of four of these is that such deafness is clearly decreasing; of three that little or no decrease is apparent; while by two no opinion can be vouched yet. The greatest encouragement is found in respect to treatment for middle ear affections and infections from fevers. By Dr. S. MacCuen Smith, of the Jefferson Medical College, it is believed that there is a decrease, "largely due to the fact that not only the general medical profession, but the public at large, are recognizing the importance of having the minor aural lesions promptly and properly cared for. This being the case, it is no longer possible for children in the public schools to continue their studies when suffering from diseased tonsils and enlarged adenoid vegetations. From this cause alone, many cases of impairment of hearing which usually occur later in life will be prevented in the future". By Dr. E. A. Crockett, of Harvard University, it is believed that, although there is a larger amount of deafness from measles, there is less, not only from scarlet fever, but also from chronic suppurations, from adenoid and throat troubles in general, and even from meningitis, owing to the use of serums. Regarding his own observations, within a period of twenty-five years "the number of extremely deaf persons and deaf-mutes has very materially diminished". [41] Hereditary deafness is sometimes of a kind that manifests itself some years after birth, often with certain relatives similarly affected. This is especially true of catarrhal and middle ear affections, though their results may more often be partial rather than total deafness. [42] In a part of such deafness, and also in a portion of that occurring shortly after birth, the cause is said to be syphilis. See Proceedings of International Otological Congress, ix., 1913, p. 49; _Volta Review_, xiv., 1912, p. 348; xv., 1913, p. 209. [43] Special Reports, pp. 125, 236. There were 3,341 who failed to answer, and if all had made reply, our percentage would probably be higher yet. [44] P. 108. [45] In the Louisiana School 10 per cent of the pupils are said to have parents who were blood relatives; in the Illinois, 5 per cent; and in the Kansas, from 5 to 5.5 per cent. Report of Louisiana School, 1906, p. 17. See also Transactions of American Medical Association, xi., 1858, pp. 321-425; Proceedings of Conference of Principals, iii., 1876, p. 204; _Annals_, xxii., 1877, p. 242.