"If, therefore, as an economic proposition, it were realized how vitally it concerns the state that not one child shall needlessly become blind, thereby increasing the public financial burden, there is no doubt that early and effective measures would be inst.i.tuted to protect the state from this unnecessary and extravagant expenditure of public funds.

"Eleven states have pa.s.sed legislative enactments requiring that the midwife shall report each case to the proper health authority, and affixing a penalty for the failure to do so. As has been intimated, however, it is not by any means always under the ministration of midwives that these cases occur, and, like all laws behind which is not a strong and well-informed public sentiment, this law is rarely enforced. A more effective method must be devised. Every physician having to do with the parturient woman, every obstetrician, every midwife, must be frequently and constantly advised of the dangers and possibilities of this disease, the necessity of prevention, and the value of early and correct treatment. They must then have placed in their hands, ready for instant use, a safe and efficient preparation, issued by the health authorities as a guarantee as to its quality and efficiency.

"An important step was taken in this direction when a resolution was pa.s.sed by the House of Delegates at the annual meeting of the New York State Medical Society, requesting the various health officers of the state to include _ophthalmia neonatorum_ among contagious diseases which must be reported to the local boards of health.

"The second essential, in order that the cause of infantile ophthalmia be abolished, is that a solution of the necessary silver salt be prepared under the authority of somebody capable of inspiring universal confidence, and that it be distributed by the health department of every state gratuitously to every obstetrician, physician or midwife qualified to care for the parturient woman. The nature of the solution, together with the character of the descriptive card which should accompany it, should be determined by a committee, chosen by the president of the American Medical a.s.sociation, which should have among its members at least one representative ophthalmologist, one obstetrician and one sanitarian. The conclusions of this committee should be reported back to the House of Delegates, so that the preparation and its text should carry with it, on the great authority of this a.s.sociation, the a.s.surance that the solution is entirely safe and necessary, and that its use should invariably be part of the toilet of every new-born child. The solution, probably silver nitrate, could be put up either by the state itself or by some trustworthy pharmacist, at an insignificant cost; its purity and sterility should be vouched for by the board of health of the state.

It should be enclosed in specially prepared receptacles, each containing a special quant.i.ty, and so arranged that it may be used drop by drop. These, properly enclosed, accompanied by a brief lucid explanation of the danger of the disease, the necessity of this germicide, the method of its employment, and the right subsequent care of the eyes, should be sent to the obstetrician on the receipt of each birth certificate.

"I have said that responsibility for the indifference that is annually resulting in such frightful disaster lies primarily with the state, the public and the medical profession.

"The state is already aroused to the necessity of taking effective measures to wipe out this controllable plague. Bills have been introduced in the legislature of Ma.s.sachusetts and of New York, providing for the appointment of commissions for the blind, one of whose duties will be to study the causes of unnecessary blindness and to suggest preventative measures."

Trachoma.

One of the most common diseases of the eye is trachoma, often called "granular lids," because the inner surface of the lid seems to be covered with little granulations. The disease sometimes lasts for years without causing blindness, though it gives rise to great irritation. It is generally attended by a discharge, which is highly contagious, producing the same disease if it gets into other eyes. Want of cleanliness is one of the most important factors in the propagation of trachoma, hence its great prevalence in Oriental countries. Trachoma is very prevalent in Egypt, where those suffering from total or partial blindness are said to amount to 10% of the population. During Napoleon's Egyptian campaign, nearly every soldier, out of an army of 32,000 men, was affected. During the following twenty years the disease spread through almost all European armies. In the Belgian army, there was one trachomatous soldier out of every five, and up to 1834 no less than 4000 soldiers had lost both eyes and 10,000 one eye. It is a disease which is very common in workhouse schools, orphan asylums and similar establishments. Unlike ophthalmia of new-born children, it is difficult to cure, and a total separation of the diseased from the healthy children should be effected.

Sympathetic inflammation.

About one-half of those who are blinded by injuries lose the second eye by sympathetic ophthalmia. It is a constant source of danger to those who retain an eye blinded by injury. Blindness from this cause can be prevented by the removal of the injured eye, but unfortunately the proposal often meets with opposition from the patient.

Glaucoma.

Glaucoma is a disease which almost invariably leads to total blindness; but in most cases it can be arrested by a simple operation if the case is seen sufficiently early.

Short-sight.

Myopia, or "short-sight," makes itself apparent in children between the ages of seven and nine. Neglect of a year or two may do serious mischief. Short-sight, when not inherited, is produced by looking intently and continuously at near objects. Children should be encouraged to describe objects at a distance, with which they are unacquainted, and parents should choose out-door occupations and amus.e.m.e.nts for children who show a tendency to shortsightedness.

A report was issued in 1906, by the school board of Glasgow, as to an investigation by Dr H. Wright Thomas, ophthalmic surgeon, regarding the eyesight of school children, which includes the following pa.s.sage. Dr Wright Thomas states that the teachers tested the visual acuteness of 52,493 children, and found 18,565, or 35%, to be below what is regarded as the normal standard. He examined the 18,565 defectives by retinoscopy, and found that 11,209, or 21% of the whole, had ocular defects. The proportion of these cases was highest in the poor and closely-built districts and in old schools, and was lowest in the better-cla.s.s schools and those near the outskirts of the city. Defective vision, apart from ocular defect, seems to be due partly to want of training of the eyes for distant objects and partly to exhaustion of the eyes, which is easily induced when work is carried on in bad light, or the nutrition of the children is defective from bad feeding and unhealthy surroundings. Regarding training of the eyes for distant objects, much might be done in the infant department by the total abolition of sewing, which is definitely hurtful to such young eyes, and the subst.i.tution of compet.i.tive games involving the recognition of small objects at a distance of 20 ft. or more. An annual testing by the teachers, followed by medical inspection of the children found defective, would soon cause all existing defects to be corrected, and would lead to the detection of those which develop during school life.

HISTORY OF INSt.i.tUTIONS

Although there is a record of a hospital established by St Basil at Caesarea, Cappadocia, in the 4th century, a refuge by the hermit St Lymnee (d. c. 455) at Syr, Syria, in the 5th century, and an inst.i.tution by St Bertrand, bishop of Le Mans, in the 7th century, the first public effort to benefit the blind was the founding of a hospital at Paris, in 1260, by Louis IX., for 300 blind persons. The common legend is that he founded it as an asylum for 300 of his soldiers who had become blinded in the crusade in Egypt, but the statutes of the founder are preserved, and no mention is made of crusaders. This Hospice des Quinze-Vingts, increased by subsequent additions to its funds, still a.s.sists the adult blind of France. The pensioners are divided into two cla.s.ses--those who are inmates of the hospital (300), and those who receive pensions in the form of out-door relief. All appointments to inmates or pensions are vested in the minister of the Interior, and applicants must be of French nationality, totally blind and not less than forty years of age.

From the time of St Louis to the 18th century, there are records of isolated cases of blind persons who were educated, and of efforts to devise tangible apparatus to a.s.sist them.

Girolamo Cardan, the 16th-century Italian physician, conceived the idea that the blind could be taught to read and write by means of touch.

About 1517 Francesco Lucas in Spain, and Rampazetto in Italy, made use of large letters cut in wood for instructing the blind. In 1646 a book, on the condition of the blind, was written by an Italian, and published in Italian and French, under the t.i.tle of _L'Aveugle afflige et console_. In 1670 a book was written on the instruction of the blind by Lana Terzi, the Jesuit. In 1676 Jacques Bernoulli, the Swiss savant, taught a blind girl to read, but the means of her instruction were not made known. In 1749 D. Diderot wrote his _Lettre sur les aveugles a l'usage de ceux qui voient_, to show how far the intellectual and moral nature of man is modified by blindness. Dr S.G. Howe, who many years after translated and printed the "Letter" in embossed type, characterizes it as abounding with errors of fact and inference, but also with beauties and suggestions. The heterodox speculations contained in his "Letter on the Blind" caused Diderot to be imprisoned three months in the Bastille. He was released because his services were required for the forthcoming _Encyclopaedia_. Rousseau visited Diderot in prison, and is reported to have suggested a system of embossed printing. J. Locke, G.W. Leibnitz, Molineau and others discussed the effect of blindness on the human mind. In Germany, Weissembourg had used signs in relief and taught Mlle Paradis.

Prior to the 18th century, blind beggars existed in such numbers that they struggled for standing room in positions favourable for asking alms. Their very affliction led to their being used as spectacles for the amus.e.m.e.nt of the populace. The degraded state of the ma.s.ses of the blind in France attracted the attention of Valentin Hauy. In 1771, at the annual fair of St Ovid, in Paris, an innkeeper had a group of blind men attired in a ridiculous manner, decorated with peac.o.c.k tails, a.s.ses'

ears, and pasteboard spectacles without gla.s.ses, in which condition they gave a burlesque concert, for the profit of their employer. This sad scene was repeated day after day, and greeted with loud laughter by the gaping crowds. Among those who gazed at this outrage to humanity was the philanthropist Valentin Hauy, who left the disgraceful scene full of sorrow. "Yes," he said to himself, "I will subst.i.tute truth for this mocking parody. I will make the blind to read, and they shall be enabled to execute harmonious music." Hauy collected all the information he could gain respecting the blind, and began teaching a blind boy who had gained his living by begging at a church door. Encouraged by the success of his pupil, Hauy collected other blind persons, and in 1785 founded in Paris the first school for the blind (the Inst.i.tution Nationale des Jeunes Aveugles), and commenced the first printing in raised characters. In 1786, before Louis XVI. and his court at Versailles, he exhibited the attainments of his pupils in reading, writing, arithmetic, geography and music, and in the same year published an account of his methods, ent.i.tled _Essai sur l'education des aveugles_. As the novelty wore off, contributions almost came to an end, and the Blind School must have ceased to exist, had it not been taken, in 1791, under the protection of the state.

The emperor of Russia, and later the dowager empress, having learned of Hauy's work, invited him to visit St Petersburg for the purpose of establishing a similar inst.i.tution in the Russian capital. On his journey Hauy was invited by the king of Prussia to Charlottenburg. He took part in the deliberations of the Academy of Sciences in Berlin, and as a result a school was founded there.

Edward Rushton, a blind man, was the projector of the first inst.i.tution for the blind in England--the School for the Indigent Blind, Liverpool.

In 1790 Rushton suggested to the literary and philosophical society of which he was a member, the establishment of a benefit club for the indigent blind. The idea was communicated to his friend, J. Christie, a blind musician, and the latter thought the scheme should also include the instruction of young blind persons. They circulated letters amongst individuals who would be likely to give their a.s.sistance, and the Rev.

Henry Dannett warmly advocated the undertaking. It was mainly due to his co-operation and zeal that Messrs Rushton and Christie's plan was carried out, and the Liverpool asylum was opened in 1791. Thomas Blacklock of Edinburgh, a blind poet and scholar, translated Hauy's work on the _Education of the Blind_. He interested Mr David Millar, a blind gentleman, the Rev. David Johnston and others in the subject, and after Blacklock's death the Edinburgh Asylum for the Relief of the Indigent and Industrious Blind was established (1793). Inst.i.tutions were established in the United Kingdom in the following order:--

School for the Indigent Blind, Liverpool 1791 Royal Blind Asylum, Edinburgh 1793 Bristol Asylum 1793 School for the Indigent Blind Southwark (now removed to Leatherhead) 1799 Norwich Asylum and School 1805 Richmond Asylum, Dublin 1810 Aberdeen Asylum 1812 Molyneux Asylum, Dublin 1815 Glasgow Asylum and School 1827 Belfast School 1831 Wilberforce School, York 1833 Limerick Asylum 1834 London Society for Teaching the Blind to Read, St John's Wood, N. 1838 Royal Victoria School for the Blind, Newcastle-on-Tyne 1838 West of England Inst.i.tute for the Blind, Exeter 1838 Henshaw's Blind Asylum, Manchester 1839 County and City of Cork Asylum 1840 Catholic Asylum, Liverpool 1841 Brighton Asylum 1842 Midland Inst.i.tute for the Blind, Nottingham 1843 General Inst.i.tute for the Blind, Birmingham 1848 Macan Asylum, Armagh 1854 St Joseph's Asylum, Dublin 1858 St Mary's Asylum, Dublin 1858 Inst.i.tute for the Blind, Devonport 1860 South Devon and Cornwall Inst.i.tute for the Blind, Plymouth 1860 School for the Blind, Southsea 1864 Inst.i.tute for the Blind, Dundee 1865 South Wales Inst.i.tute for the Blind, Swansea 1865 School for the Blind, Leeds 1866 College for the Sons of Gentlemen, Worcester 1866 Northern Counties Inst.i.tute for the Blind, Inverness 1866 Royal Normal College and Academy of Music for the Blind, Upper Norwood 1872 School for the Blind, Sheffield 1879 Barclay Home and School for Blind Girls, Brighton 1893 Homes for Blind Children, Preston 1895 North Stafford School, Stoke-on-Trent 1897

Many of the early inst.i.tutions were asylums, and to the present day schools for the blind are regarded by the public as asylums rather than as educational establishments. With nearly all these schools workshops were connected. In 1856 Miss Gilbert, the blind daughter of the bishop of Chichester, established a workshop in Berners Street, London, and since that date workshops have been started in many of the provincial towns.

After the beginning of the 19th century, inst.i.tutions for the blind were established in various parts of Europe. The inst.i.tution at Vienna was founded in 1804 by Dr W. Klein, a blind man, and he remained at its head for fifty years. That of Berlin was established in 1806, Amsterdam, Prague and Dresden in 1808, Copenhagen in 1811. There are more than 150 on the European continent, most of them receiving aid from the government, and being under government supervision.

The first school for the blind in the United States was founded in Boston, Ma.s.s., chiefly through the efforts of Dr John D. Fisher, a young physician who visited the French school. It was incorporated in 1829, and in honour of T.H. Perkins (1764-1854) who gave his mansion to the inst.i.tution was named the Perkins Inst.i.tution and Ma.s.sachusetts Asylum (now School) for the Blind. Aid was granted by the state from the beginning. In 1831 Dr Samuel G. Howe (q.v.) was appointed director, and held that position for nearly forty-four years; being succeeded by his son-in-law Michael Anagnos (d. 1906), who established a kindergarten for the blind at Jamaica Plain, in connexion with the Perkins Inst.i.tution. Dr Howe was interested in many charitable and sociological movements, but his life-work was on behalf of the blind. One of his most notable achievements was the education of Laura Bridgman (q.v.) who was deaf, dumb and blind, and this has since led to the education of Helen Keller and other blind deaf-mutes. The New York Inst.i.tution was incorporated in 1831, and the Pennsylvania Inst.i.tution was founded at Philadelphia by the Society of Friends in 1833. The Ohio was founded at Columbus in 1837, Virginia at Staunton in 1839, Kentucky at Louisville in 1842, Tennessee at Nashville in 1844, and now every state in the Union makes provision for the education of the blind.

STATISTICS

England and Wales.

In England and Wales the total number of persons returned in 1901 as afflicted with blindness was 25,317, being in the proportion of 778 per million living, or 1 blind person in every 1285 of the population. The following table shows that the proportion of blind persons to population has diminished at each successive enumeration since 1851, in which year particulars of those afflicted in this manner were ascertained for the first time. It will, however, be noted that, although the decrease in the proportion of blind in the latest intercensal period was still considerable, yet the rate of decrease which had obtained between 1871 and 1891 was not maintained.--

+------+-----------+-------------------+-------------------+

Year.

Number of

Blind per Million

Persons Living to

Blind.

of the Population

one Blind Person.

+------+-----------+-------------------+-------------------+

1851

18,306

1021

979

1861

19,352

964

1037

1871

21,590

951

1052

1881

22,832

879

1138

1891

23,467

809

1236

1901

25,317

778

1285

+------+-----------+-------------------+-------------------+

The following table, which gives the proportions of blind per million living at the earlier age-groups, shows that in the decennium 1891-1901, as also in recent previous intercensal periods, there was a decrease in the proportion of blind children in England and Wales generally; it thus lends support to the contention, in the _General Report_ for 1891, that the decrease was due either to the lesser prevalence, or to the more efficient treatment, of purulent ophthalmia and other infantile maladies which may result in blindness.

+----------------+------+------+------+------+------+------+

Age-Period.

1851

1861

1871

1881

1891

1901

+----------------+------+------+------+------+------+------+

Under 5 years

198

196

185

166

155

129

5-10

297

256

259

288

188

192

10-15

365

366

359

"

290

323

15-20

416

415

404

388

370

239

20-25

481

443

451

422

385

359

+----------------+------+------+------+------+------+------+

Total under 25

339

322

317

298

269

261

+----------------+------+------+------+------+------+------+

In 1886 a royal commission on the blind, deaf and dumb was appointed by the government, and, after taking much valuable evidence, issued an exhaustive and instructive report. Following on the practical recommendations submitted by this commission, the Elementary Education (Blind and Deaf Children) Act 1893, was pa.s.sed, under which the education of the blind became for the first time compulsory. In terms of this statute, the school authorities were made responsible for the provision of suitable elementary education for blind children up to sixteen years of age, and grants of 3, 3s. for elementary subjects, and of 2, 2s. for industrial training, were contributed by the state towards the cost of educating children in schools certified as efficient within the meaning of the Elementary Education Act 1876. The princ.i.p.al aim of the Education Act of 1893 was to supply education in some useful profession or trade which will enable the blind to earn their livelihood and to become useful citizens; but the weak spot was that no provision was made therein for the completion of their education and industrial training after the age of sixteen.

In England and Wales, in 1907, there were twenty-four resident schools and forty-three workshops for the blind. In many of the large towns, day cla.s.ses for the education of blind children have been established by local education authorities. There are forty-six home teaching societies, who send teachers to visit the blind in their homes, to teach adults who wish to learn to read, to act as colporteurs, to lend and exchange useful books, and to act as Scripture readers to those who are aged and infirm. All the home teaching societies for the blind and many public libraries lend embossed books. The public library at Oxford has nearly 400 volumes of cla.s.sical works for the use of university students.

A society was inst.i.tuted in 1847 by Dr W. Moon for stereotyping and embossing the Scriptures and other books in "Moon" type. The type has been adapted to over 400 languages and dialects. After Dr Moon's death in 1884 the work was carried on by his daughter, Miss Adelaide Moon, and the books are much used by the adult blind.

In 1868 Dr T.R. Armitage, being aware of the great improvements which had been made in the education of the blind in other countries, founded the British and Foreign Blind a.s.sociation. This a.s.sociation was formed for the purpose of promoting the education and employment of the blind, by ascertaining what had been done in these respects in various countries, by endeavouring to supply deficiencies where these were found to exist, and by attempting to bring about greater harmony of action between the different existing schools and inst.i.tutions. It gave a new impetus to the education and training of the blind in the United Kingdom. At that time their education was in a state of chaos. The Bible, or a great part of it, had been printed in five different systems. The founders took as an axiom that the relative merits of the various methods of education through the sense of touch should be decided by those and those only who have to rely on this sense. The council, who were all totally or partially blind, spent two years in comparing the different systems of embossed print. In 1869 and 1870 Dr Armitage corresponded with Dr J.R. Russ in regard to the New York Point.

No trouble was spared to arrive at a right conclusion. The Braille system was finally adopted, and the a.s.sociation at once became a centre for supplying frames for writing Braille, printed books, maps, music and other educational apparatus for the blind. All books printed by the a.s.sociation are printed from stereotyped plates embossed by blind copyists. About 3000 separate works, varying in length from 1 to 12 volumes, have been copied by hand to meet the requirements of public libraries and individuals. About 700 ladies, who give their services, make the first Braille copy of these books, and they are recopied by blind scribes, chiefly women and girls, who are paid for their work.

The National Lending library, London, was founded in 1882. It has over 5500 volumes in Braille and other types. Books are forwarded to all parts of the United Kingdom.

There are fourteen magazines published in embossed type in the United Kingdom.

There are thirty-six pension societies--the princ.i.p.al are Hetherington's, Day's, the Clothworkers', the Cordwainers', the National Blind Relief Society, Royal Blind Pension Society and Indigent Blind Visiting Society.

The Gardner Trust administers the income of 300,000 left by Henry Gardner in 1879. The income is used for instructing the blind in the profession of music, in suitable trades, handicrafts and professions other than music, for pensions, and free grants to inst.i.tutions and individuals for special purposes.

Scotland.

According to the census of 1901, Scotland had 3253 (or 727 per million) blind persons, as against 2797 in 1891, but in a paper read at the conference in Edinburgh, 1906, the superintendent of the Glasgow Mission to the Out-door Blind stated that there were 758 employed or being educated in inst.i.tutions, and 3238 known as "out-door blind," making a total of 3996. There are in Scotland ten missions, so distributed as to cover the whole country, and regular visits are made as far north as the Orkney and Shetland Islands. In carrying on the work, there are twenty-four paid missionaries or teachers and a large number of voluntary helpers. These societies originated in a desire to teach the blind to read in their own homes, and to provide them with the Scriptures and other religious books, but the social, intellectual and temporal needs of the blind also receive a large share of attention. These teachers afford the best means of circulating embossed literature, therefore the library committee of the Glasgow corporation has agreed to purchase books and place them in the mission library instead of in the public library. As the inst.i.tutions provide for only a small number of the blind, strenuous efforts are made by the committee and teachers of missions to find some employment for the many adults who come under their care.

In Glasgow, a ladies' auxiliary furnishes work for 150 knitters, and takes the responsibility of disposing of their work. In Scotland there are five schools for the young blind, and in connexion with each is a workshop for adults. In Edinburgh the school is at West Craigmillar, and the workshop in the city, but both are under the same board of directors.