BLINDNESS

blindness, the condition of being blind (a common teutonic word), i.e. devoid of sight (see also vision; and eye: _diseases_). the data furnished in various countries by the census of 1901 showed generally a decrease in blindness, due to the progress in medical science, use of antiseptics, better sanitation, control of infectious diseases, and better protection in shops and factories. blindness is much more common in hot countries than in temperate and cold regions, but finland and iceland are exceptions to the general rule.[1] in hot countries the eyes are affected by the glaring sunlight, the dust and the dryness of the air. from statistics in italy, france and belgium, localities on the coast seem to have more blind persons than those at a distance from the sea. the following table gives the number of blind persons as reported in the census of each country. unless otherwise stated, it refers to the statistics of 1900. +----------------------------------+--------+----------------+ | | total | number | | country. | number.| per million | | | | of population. | +----------------------------------+--------+----------------+ | austria | 14,582 | 540 | | belgium | 3448 | 487 | | canada | 3279 | 610 | | denmark | 1047 | 427 | | england | 25,317 | 778 | | france | 27,174 | 698 | | finland[2] | 3229 | 1191 | | germany | 34,334 | 609 | | hungary | 19,377 | 1006 | | ireland | 4263 | 954 | | italy | 38,160 | 1175 | | holland (1890) | 2114 | 414 | | norway | 1879 | 838 | | portugal | 5650 | 1040 | | sweden | 3413 | 664 | | switzerland (1895) | 2107 | 722 | | scotland | 3253 | 727 | | spain (1877) | 24,608 | 1006 | | russia | . . | about 2000 | | united states (corrected census) | 85,662 | 1125 | +----------------------------------+--------+----------------+ causes and prevention there are many cases of complete or partial blindness which might have been prevented, and a knowledge of the best methods of prevention and cure should be spread as widely as possible. magnus, bremer, steffen and rossler are of opinion that 40% of the cases of blindness might have been prevented. hayes gives 33.35% as positively avoidable, 38.75% possibly avoidable, and 46.27% as a conservative estimate. cohn regards blindness as certainly preventable in 33%, as probably preventable in 43%, and as quite unpreventable in only 24%. if we take the lowest of these figures, and assume that 400 out of every 1000 blind persons might have been saved from such a calamity, we realize the importance of preventative measures. for the physiology and pathology of the eye generally, see vision and eye. ophthalmia. the great majority of these cases are due to infantile purulent ophthalmia. this arises from inoculation of the eyes with hurtful material at time of birth. if the contagious discharges are allowed to remain, violent inflammation is set up which usually ends in the loss of sight. it depends on the presence of a microbe, and the effective application of a weak solution of nitrate of silver is curative, if made in a proper manner at an early period of the case. in germany, midwives are expressly prohibited by law from treating any affection of the eyes or eyelids of infants, however slight. on the appearance of the first symptoms, they are required to represent to the parents, or others in charge, that medical assistance is urgently needed, or, if necessary, they are themselves to report to the local authorities and the district doctor. neglect of these regulations entails liability to punishment. eleven of the united states of america have enacted laws requiring that, if one or both eyes of an infant should become inflamed, swollen or reddened at any time within two weeks of its birth, it shall be the duty of the midwife or nurse having charge of such infant to report in writing within six hours, to the health officer or some legally qualified physician, the fact that such inflammation, swelling or redness exists. the penalty for failure to comply is fine or imprisonment. the following weighty words, from a paper prepared by dr park lewis, of buffalo, n.y., for the american medical association, show that laws are not sufficient to prevent evil, unless supported by strong public sentiment:-- "when an enlightened, civilized and progressive nation quietly and passively, year after year, permits a multitude of its people unnecessarily to become blind, and more especially when one-quarter of these are infants, the reason for such a startling condition of affairs demands explanation. that such is the fact, practically all reliable ophthalmologists agree. "from a summary of carefully tabulated statistics it has been demonstrated that at least four-tenths of all existing blindness might have been avoided had proper preventative or curative measures been employed, while one-quarter of this, or one-tenth of the whole, is due to _ophthalmia neonatorum_, an infectious, preventable and almost absolutely curable disease. perhaps this statement will take on a new meaning when it is added that there are in the state of new york alone more than 6000, and in the united states more than 50,000 blind people; of these 600 in the one state, and 5000 in the country, would have been saved from lives of darkness and unhappiness, in having lost all the joys that come through sight, and of more or less complete dependence--for no individual can be as self-sufficient without as with eyes--if a simple, safe and easily applied precautionary measure had been taken at the right time and in the right way to prevent this affliction. the following three vital facts are not questioned, but are universally accepted by those qualified to know:-- "1. the ophthalmia of infancy is an infectious germ disease. "2. by the instillation of a silver salt in the eyes of a new-born infant the disease is prevented from developing in all but an exceedingly small number of the cases in which it would otherwise have appeared. "3. in practically all those few exceptional cases the disease is absolutely curable, if like treatment is employed at a sufficiently early period. "since these facts are no longer subjects of discussion, but are universally accepted by all educated medical men, the natural inquiry follows: why, as a common-sense proposition, are not these simple, harmless, preventive measures invariably employed, and why, in consequence of this neglect, does a nation sit quietly and indifferently by, making no attempt to prevent this enormous and needless waste of human eyes? "the reasons are three-fold, and lie--first, with the medical profession; second, with the lay public; third, with the state. "for the education of its blind children annually new york alone pays _per capita_ at least $350, and a yearly gross sum amounting to much more than $100,000. if, as sometimes happens, the blind citizen is a dependent throughout a long life, the cost of maintenance is not less than $10,000, and the mere cost in money will be multiplied many times in that a productive factor, by reason of blindness, has been removed from the community. "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 instituted to protect the state from this unnecessary and extravagant expenditure of public funds. "eleven states have passed 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 passed 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 association, 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 association, the assurance 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 quantity, 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 massachusetts 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 amusements 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 passage. 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-class 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 substitution of competitive 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 institutions 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 institution 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 assists the adult blind of france. the pensioners are divided into two classes--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 assist 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 title 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 amusement of the populace. the degraded state of the masses 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 peacock tails, asses' ears, and pasteboard spectacles without glasses, 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 substitute 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 institution 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, entitled _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 institution 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 institution 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 assistance, 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). institutions 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 institute 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 institute for the blind, nottingham 1843 general institute for the blind, birmingham 1848 macan asylum, armagh 1854 st joseph's asylum, dublin 1858 st mary's asylum, dublin 1858 institute for the blind, devonport 1860 south devon and cornwall institute for the blind, plymouth 1860 school for the blind, southsea 1864 institute for the blind, dundee 1865 south wales institute for the blind, swansea 1865 school for the blind, leeds 1866 college for the sons of gentlemen, worcester 1866 northern counties institute 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 institutions 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, institutions for the blind were established in various parts of europe. the institution 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, mass., 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 institution was named the perkins institution and massachusetts 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 institution. 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 institution was incorporated in 1831, and the pennsylvania institution 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.