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ALSO A CONSIDERATION OF THE CONDITIONS DISCLOSED

*Back references, Vol. II, pp. 101, 58; Vol. I, pp.131, 12.

By DR. LOUIS STRICKER
Member of the Commission

Editor's Note. -- The pensions for the blind of Ohio are dispensed by unpaid county commissioners. Each of the eighty-eight commissions is composed of three persons. The care with which some of these boards are beginning their work is admirably shown by the following paper. At the same time that these "Pension Commissions" were created a State Commission for the Blind was established. The County Commissions have the single problem of relief, the State Commission that of finding employment and of ameliorating, in any way possible, the condition of the blind. Dr. Stricker clearly portrays the condition of the blind who have had no friendly organization to which to turn for advice, help, or work. Professor Van Cleve explains what the State School is doing for the juvenile blind. Mr. Charles F. F. Campbell presented a paper at the Ohio Conference of Charities and Correction to the same audience addressed by Dr. Stricker and Professor Van Cleve to show what is possible for the blind along industrial lines. Space does not permit us to print his paper, but our readers can find full information regarding the workshops for the blind in the United States at the end of the July, 1908, Outlook for the Blind, Vol. II, No. 2. In connection with the movement in behalf of the blind which is now developing in Ohio, it is interesting to consider the results of the systematic "field work" conducted by the Massachusetts Commission for the Blind, which is ably set forth in Miss Lucy Wright's paper.

It is clear to every one that the aggregation of the indigent blind throughout the country is a result of the lack of attention in the past. The Ohio pension is an attempt to relieve the needs of this accumulated group of neglected people. One of the chief purposes of the schools, workshops, societies, and state commissions for the blind is to prevent such accumulations in the future.

PERMIT me to thank your honorable president and executive committee for the privilege of addressing your honorable body and I beg to assure you that I am deeply sensible of the high motives which prompt you to endeavor to add to the sum total of happiness, contentment, and uplifting of those whom we designate as the dependent classes.

There is one class of dependents which in all times and all climes has elicited the care and the sympathy of man, namely, the blind. Their infirmity is of such a nature that of necessity it makes them dependent on others. From birth the first impressions of life are conveyed to the mind through the medium of this sense, and throughout life this one sense, more than all the others combined, is the medium through which the mind receives and stores up the impressions of the outer world -- stores up the knowledge derived from that one great factor in human advancement, the printing press. The sense of sight is the predominant influence which directs us, and makes it possible to execute a thousand movements with certainty and dispatch, makes things evident which, if never seen, the mind can hardly grasp, if at all. The lack of this sense, for these reasons, makes the education of the blind such a long and tedious task, and their occupations in life become so restricted and their success the exception rather than the rule.

To them, the aesthetic side of life, the beauties of nature, can only be described, nature as we see it has never existed or has become only a memory. No wonder the poet has said, "The eye is the mirror of the soul." It fairly drinks up the pictures which become mental impressions. 'Tis this lack of mental activity, induced by the never ending stream of images, which accounts for the vacant stare and placid face. Of all the senses, sight is the most precious; that which we value highest we are wont to compare to the apple of the eye.

Observations such as these must be patent to you all, and have from the remotest antiquity caused governments, as well as individuals, to look with favor and extend their support to every effort which has had for its object the amelioration of the deplorable conditions of the blind. The state of Ohio has not been deaf to the appeals of those who have the interests of the blind at heart, and at various times laws have been enacted granting relief and pensions to the blind, which a wise and just supreme court has repeatedly declared unconstitutional on the ground of class legislation. The last Legislature, however, passed a bill, known as House Bill 828, and amended as House Bill 1343, April 2, 1908, which contains a clause which, 'tis said makes this law constitutional, since it grants a pension only to the blind who are needy, and who would otherwise become a charge on the state, or on those who, by law, are not required to support them. It is to be sincerely hoped that this saving clause will rescue this bill from the same fate as its predecessors. Three months of active work under the operation of the new law has convinced me not only of the great charity and benefit which this law confers on a very, worthy class, but of its dire necessity. Even as a physician and oculist, accustomed to contact with the blind and needy, the procession of 287 applicants, each in turn disclosing to me his sightless, often shrunken orbs and empty sockets, relating the details of his afflictions and pressing needs, seemed almost like a chapter taken froth Dante's "Inferno," and cast a state of gloom over me. Fully twenty per cent of these applicants, owing to infirmities incident to old age or disease, were unable to come to me, necessitating a visit to their home; and here the conditions disclosed were even more distressing and appalling, with here and there a ministering angel to assuage the suffering while sharing the burden of want with the afflicted. The truth was brought home to me that, in most instances, the infirmity and misfortune of one have dragged down with them one or more individuals.

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But justice is likewise blind. The Blind Commission of Hamilton County early in its work recognized the fact that, in order that it might do its work well and in an orderly manner, free from prejudice or favor, protect itself, as well as the state, against impostors, and secure a permanent record open to the citizens of the state, a certain form of procedure was necessary which would disclose the conditions on which our judgment was based in each individual case.

First. A Record Blank was framed, known as Form 1, giving the social and economic factors in the applicant's history, covering briefly the following points (1) : name, age, color, married or single, date of birth, native or foreign, residence, family, person in charge, health, education before blindness, since blindness, blind school attended, earning capacity before and since blindness, occupation before and since blindness, relief and character of.

Second. A Medical Record Blank, known as Form 2, was adopted, being a scientific record of the conditions present in both eyes on which the diagnosis of blindness is based, and such other matter as is important to determining the causation of blindness.

Third. An affidavit embodying the essential factors of the blind pension law necessary to make the applicant eligible for a pension; namely, that he is blind, needy, and a resident of the state and county. These facts to be sworn to before a notary public by a registered physician and a citizen.

Fourth. A certificate of blindness which recites that the cause of the applicant has been duly heard and considered, and that a specified sum (not exceeding $150 per annum, and payable in quarterly installments) has been granted.

Fifth. A voucher ordering the county auditor to issue a warrant on the county treasurer for _____ dollars.

After the conditions of the first two forms had been complied with, agents of the Associated Charities of Cincinnati (of which Pres. C. M. Hubbard is the general secretary) made a personal investigation in order to verify and supplement by further information the statements made by the applicants. In many cases the information was invaluable and has very materially aided us in weighing the merits of the individual applications, and in close cases, or where the information was vague, several visits were made. It has not always been easy to get an exact statement of the family income, but this was always insisted on before the case received favorable recognition. The board recognized that blindness was the prime factor in admitting the applicant to consideration; but, after all, if he was not needy, the pension was not allowed, and twenty-nine blind applicants were rejected because they were found not to be needy.

It also became necessary to define our attitude toward the applicants, and after much thought and discussion the following propositions were formulated and became the by-laws of the commission.

1. Any inmate of the city or county infirmary may be granted a pension on assurance that he will leave the institution as soon as the first quarterly payment is made, and on the further satisfactory assurance that he will not become a mendicant or dependent on charity of a public nature.

2. Any inmate of a permanent home, while he remains in the home, is not eligible for a pension. The commission will exercise the same power of inquiry as to how he proposes to maintain himself, and the same rules will apply as in the case of infirmary inmates.

3. We recognize the obligation of children to support their parents. We recognize the moral obligation which exists between blood relationship.

4. Will not encourage the blind in vicious habits, such as drunkenness, and will exercise the right to enforce assignment of pension to an acceptable trustee.

5. Will do all we can to encourage industry.

As a result, twenty-one were rejected because they were inmates of various charitable institutions of a public and private nature.

A standard defining blindness was also adopted and three degrees of blindness defined.

First. Total or absolute blindness. In which the light sense was totally abolished.

Second. Blindness. Where vision in both eyes, with proper correcting glasses adjusted, is of so low a degree that fingers can no longer be counted at one meter or three feet, but movements of the hand or moving objects may still be discerned.

Third. Practical blindness. Where moving objects may still be discerned at three meters, or nine feet, but where the field of vision has become so impaired (either by contraction of the field down to five degrees or less, or where central vision is entirely abolished and a small area of excentric vision remains, or where disseminated scotomata exist, or where only a sector of excentric vision remains) that no useful vision remains and the individual gets about with great difficulty.

Fourth. Only those will be considered as blind who are hopelessly and incurably so.

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This standard is more just and favorable to the blind than that adopted by the states of Massachusetts and New York, where the standard requires reading of fingers at one foot. The third section (admitting the practically blind), so far as I am aware, has never been incorporated in any definition as to what constitutes blindness. I feel that they justly come within the class of the blind.

Under this ruling
117 were found to be totally blind
112 were found to be blind
38 were found to be practically blind
20 were found to be not blind

The rule was strictly adhered to, and though it appeared to visit a hardship on a few isolated cases, in the main it worked with efficiency. There were a few impostors, quite a number in whom vision was of a low degree, but still not low enough to bring them in the fold of the blind. There were quite a number who had undergone operations, in consequence of which conditions existed which made it all but impossible to determine just how much vision they possessed. In all such cases the applicant was given the benefit of the doubt. It should be remembered that the applicants come in a negative state of mind, determined to see as little as possible, not to aid us in getting the highest degree of vision. In one case, taken unawares, the visitor found the blind person playing cards, and in another the applicant, in an unguarded moment, admired the beautiful flowers the visitor was carrying.

A few cases may be here cited to illustrate the manner in which the work was accomplished.

Louis A. Aged 49 years, married, has wife and three children. Medical history shows that his mother had optic atrophy for 30 years previous to her death in her 81st year. He became blind 10 years ago, has optic atrophy, and all the symptoms of locomotor ataxia.

Previous to blindness be was a cigar maker, earning $12 per week. After blindness developed he attended the blind school at Columbus and learned to make brooms, but has never been able to make a living at it. Sells newspapers; his earnings are uncertain, and average about $2 per week. He received the pension of $100 under the old law. The family has been compelled to ask for aid from the Associated Charities, receiving coal and groceries.

He has a sister who earns $1.25 per day scrubbing floors.

A mother-in-law who earns $1.25 per week.

His daughter, 22 years of age, works in a shoe factory, earns $3 per week.

A son 15 years of age is idle.

A daughter 9 years of age is at school.

His wife has an open leg; is unable to add to the family earnings.

The family income is now apparently $5 a week, and seems to be fairly entitled to a full pension of $150.

Mrs. F. 65 years of age, white, widow. Has been blind for 30 years. Chorio retinitis. Has been a resident of the county for 44 years. Has a son and daughter. Both are poor. States that she has the support from her son of $3 per month. Boards with friends who provide care and food. Is unable to care for herself. A visit was made at her home. Talked to her daughter, who states that she takes roomers, making $2 per month over her rent. Her mother has a room in her house, which is paid for by her son. The daughter states that she can only keep her mother by giving her meals, as she is poor herself. Has an insane husband and four children. The husband is not violent, and the doctors at the asylum consented to let him work. He earns $9 per week as a laborer. The son has two children and a mother-in-law to support. Keeps up insurance for his mother. The applicant was awarded $150 pension.

Mr. F. A brewery worker, aged 38 years; became totally blind from the inhalation of wood alcohol while varnishing the interior of a large cask with a shellac varnish, which consisted of one-third Columbian spirits, two-thirds shellac. Blindness followed in thirty-six hours. Complete total atrophy ensued. This man had been earning $16 per week. Was a strong, healthy, honest, and sober man. He has a wife and six children. They had up to this time been living in fairly good circumstances for people in their station in life. His wife was compelled to go out and scrub floors for a living, and must return home at noon and prepare the midday meal, then return to her work. The oldest son, 19 years, is a waiter, earning $6.50 per week, and a second son, 14, earns at times $3; the other children are too young. The family live in two back rooms on the fourth floor in a tenement house. The man's health is broken, and he is still so overpowered by his misfortune that he is unable to help himself in any way. This has become the cause of a celebrated lawsuit, in which he has been awarded $12,000 damages, but the law's delays and trials in upper courts are uncertain. He was granted a full pension, to be revoked when the case is finally decided in his favor.

Mr. S. Visited at his home. Aged 61 years; has been totally blind for 11 years. American born. Sits in a wheeling chair; paralyzed from waist down; has no control over his sphincters; locomotor ataxia. Total optic atrophy. Was in the poultry business, and earned from $15 per week upward for years, until finally overcome by disease, which he attributes to exposure to cold, standing in market, and lifting heavy barrels, etc. Has three sons -- one 20 years of age, a cripple, having received an injury to his hip in a street car accident. A second son, 19, recently lost his left leg and lost entire use of his left arm, having been injured in a railroad accident nine months ago. A third son, 17 years, is weak-minded. The entire surroundings indicated extreme poverty, and the only income was from the wife, who takes in washing, earning $3 per week. A full pension of $150 per year was granted.

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Mrs. H. 71 years, decrepit and old, is totally blind; has never had an education; worked for 20 years on a farm. Her only income is a soldier's pension of $8 per month. The son, who is 48 years of age, feels that he must stay at home with his mother. The home was visited. The son states that he feels that he cannot accept regular employment because his mother needs some one to care for her. She is very helpless. It is difficult for him to state his earnings, as he only does an occasional day's work; states that last month he earned $3.45. They are living out of this and the pension of $8 per month which the woman receives.

The report was not satisfactory, and he was visited a second time. He insists that he can give no definite idea as to what he earns. Last week he earned $1.25. Usually depends on $1 or $2 per week of his own earnings. He insists he cannot work more because his mother requires his attention.

The commission felt than -sic- an able-bodied man could earn a great deal more than $1 or $2 per week, and if he did so he could keep a young girl to attend his mother. The pension would not have aided her in the least, but given him a little more money to spend. This was told him and the pension refused.

Mrs. O. 44 years of age; married. Has been totally blind for past 11 years. Husband and six children living. She has attended the blind school, but has never been able to do anything but housework and washing. The oldest daughter works in a shoe factory and earns $5 per week. Cannot live at home, owing to the quarrelsome disposition of her father. The family have frequently been compelled to call on the Associated Charities and the city for coal and groceries. The husband is a carpenter by trade, but refuses to work under a boss, and does such jobs as he can get. He gives her $6 to $7 per week. He could earn more, but is unsteady, owing to drink. Spends more for beer than he ought to -- 20 to 40 cents per day.

This case was under consideration no less than four times. An agent called and explained to the woman that the commission was anxious to give her the pension, but feared it would only help him to spend more money for beer, work a little less, and do her no good -- in all probability make conditions worse for her. She was asked to have her husband call and have a talk with the board, which she feared she could not manage. She was asked if she had ever considered leaving her husband. Would not consent to this because she feared that even with her daughter's earnings and the pension there might not be sufficient to keep the family together.

Another visit was made at the noon hour, and the man found at home. He refused to call and have a talk with the commission. He was told that regardless of the Blind Relief Commission, the Associated Charities would see that he did support his family. The man looked dissipated and ill-tempered, and began quarreling with his wife the moment the agent closed the door.

Another visit was made, conditions found as before. An offer was made to the husband to get him work through the Associated Charities, which he refused.

The commission felt that a pension would give him the opportunity to make a little less and spend more money for beer, and the pension was refused on the ground that the husband should support.

The Hamilton County Blind Relief Commission was appointed May 18, 1908, and in the short period of ninety days received and investigated, with all the details as given above in view, 287 applications; of these 163 were males and 124 females. Of this number but 30 were colored. Two hundred and twelve were granted the pension, one died shortly after making application, and 74 were rejected for various causes, as follows:

Exercising the right of discretion as provided for in the law, we granted:

for the first quarter.

The ages of the applicants ranged from 2 1/2 years up to 90 years. It will be observed that but 16 were under 20 years of age, 106 between 20 to 50 years. The majority, 165, had passed the 50th year, and of these 65 had passed the 70th year. The word adult or citizen does not appear in the bill, hence it was held that every needy blind person was entitled to relief under bill; 16 cases under the age of 21 years applied, but in these cases a full pension was not allowed, and only then where the parents were very poor and after the age when the child could reasonably, under normal circumstances, have been expected to help himself, or add to the family income.

As regards nativity, 194 were native-born Americans, and of these 120 were born in Ohio; but 93 were of foreign extraction. All but two have lived the requisite length of time in the state and county.

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Their meager educational advantages before blindness give us a reasonable explanation for their utter helplessness, and in many cases for their inability to take advantage of any opportunity offered to better their social and economic conditions. There are unquestionably many more blind in Hamilton County in the higher walks of life, living in affluence and following business and professional careers, contented and happy and able to care for themselves, who did not come under our observation, and these must be left out of consideration in looking at this somber picture. Those who are born blind, or become so shortly thereafter, attend school and are apt pupils, but those who become afflicted later in life are so overpowered by their misfortune that they lose hope and ambition and often refuse to be comforted, and this is especially true after middle life.

62 had become blind prior to the 10th year
24 between the 10th and 20th year,

making a total of 86 becoming blind during the years when the mind and senses are most pliable and the pupil most apt to learn.

51 became blind between the 20th and 40th year, whereas
50 became blind between the 40th and 50th year.
100 became blind subsequent to the 50th year.

Inquiry among the 287 applicants disclosed that 66 had no education whatever before blindness set in, and never could read or write.

Two hundred and nineteen had had a common school education, which in many cases did not mean very much.

Two had had a high school education.

Since the occurrence of blindness, but 77 had attended a school for the blind:

Of these 77, but 40 had learned a trade at the blind school which was of any value to them in making themselves self-sustaining, and in but a few instances can they do more than earn one or two dollars per week.

There are

Inquiry develops that but two of the broom makers can make a living, and they only because they receive institutional aid in buying and disposing of their product. All the remainder say they can only do occasional work, and cannot support themselves. Piano tuners are not trusted, and except here and there blind musicians are only engaged as curiosities or as a charity which is not often aroused.

Could one ask for a more convincing argument as to the necessity of workshops in the larger centers of population in the state, where these people could be assembled under one roof during the daytime, and under proper supervision and aid follow the various occupations which they had been taught? (The plan could even be extended to teaching the blind at these workshops.) In this way the materials they work with could be bought cheaper, and by disposing of the product for them in large quantities better prices could be obtained, and the blind receive a living wage for their services. It has been told me repeatedly that until they buy their material and afterwards go from door to door trying to dispose of their finished ware they find that they lose money. In the meantime they also lose heart and become mendicant.

The practical results as here shown do not speak well for the institutions for the blind. There is a defect somewhere. Could they not be taught something more remunerative than making brooms or baskets?

Of the 77 blind who have learned to use the raised letters,

Before blindness, of the 153 males, 39 had never had an occupation; the remaining 114 were engaged in a variety of 39 occupations and trades. Subsequent to blindness, we find 95 with nothing to do because "they cannot" or are too old or infirm, with 5 attending school; the remaining 58 are engaged in but 15 occupations.

Among the women, before blindness 29 had no occupations, 85 engaged in 13 occupations; subsequent to blindness, 90 had no occupation and 24 had a variety of 4 occupations. Observe how their usefulness to the community and their ability to help themselves have become restricted.

Is it a wonder that they become destitute and objects of public charity?

Forty families had at various times been forced to ask for outdoor relief of groceries, coal, etc., from various charities, and many others have suffered in silence want and privation, too proud to ask for aid. Sixteen applicants have no family connections whatever; 12 are living alone, earning from $1 to $6 per week; 4 with friends, and have no income whatever.

Just a few words regarding blindness and its causes, for it must be evident to every one that just in proportion as we eliminate the causes will the number of the blind and the entire train of misfortunes which follow in its wake disappear.

The frightful ravages of accident and disease had disfigured the features of many of these unfortunates, and it cannot be denied that the appearance of even a blind individual has much to do with human prejudice and in giving them employment.

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7 had had both eyeballs removed
30 had had one eyeball removed
32 had one shrunken eyeball
39 had both eyeballs shrunken

Two cases (0.75 per cent of the 267 cases admitted as blind) were due to consanguinity (i.e., marriages between first cousins). Twenty-five cases were due to congenital disease, and the vast majority of these are undoubtedly syphilitic. Add to this number 42 cases of acquired syphilis, making a total of 67 cases, and we find that this one cause alone is responsible for 25.09 per cent of all the cases of blindness. Fourteen cases were due to ophthalmia neonatorum (gonorrhoea) in the newborn, equal to 5.24 per cent, which is an entirely preventable cause of blindness. There is a law on the statute books making it a misdemeanor, punishable by fine and imprisonment, where a midwife or nurse does not at once call in an oculist where purulent inflammation develops in an infant's eyes within the first few days after birth. The law is honored more in its breach than in its enforcement. Ignorance and neglect exist among the poor, and I feel that if an offender was now and then made to feel the full force of the law, it would arouse the conscience of others. As has been well said, blindness from this cause is a crime against civilization.

Blindness due to the infectious diseases sum up a total of 53 cases = 19.86 per cent; due to scarlet fever, measles, mumps, cerebro-spinal meningitis, typhoid, smallpox, trachoma. School inspection is the greatest safeguard against all of these. No civilized community ought to expose its school children to the ravages of the infections, when regular and systematic examination of all children at school by competent physicians will lead to the early detection of a contagious disease in a child. Where isolation of a case of scarlet fever or measles follows at once, where all the other children in that family, or even living under the same roof, are isolated and not allowed to return to school until the danger of contagion is past, where fumigation of the schoolroom follows every time infection is detected, just to that degree are the dangers of an epidemic averted; and we know only too well that in a certain percentage of serious cases of infectious disease, when death does not ensue, blindness does. Five cases of blindness were due to this cause. Smallpox is entirely preventable by vaccination. Trachoma, a most virulent and practically incurable disease, leads to blindness, and is transmitted by using the same handkerchiefs and towels. Roller towels in schoolrooms or institutions are an abomination. One child with granulated eyelids can infect a whole school, even a community, and spread disaster.

Eleven cases (4.11 per cent) were due to nearsightedness, high degrees of myopia. This condition can likewise be ameliorated by the proper lighting of schoolrooms, seeing that the light falls from the proper direction; the character of the type used in school books, and the proper adjustment of desks and chairs.

Methyl or wood alcohol has been the cause of blindness in three (possibly four cases), as the result of inhalation. Hundreds have died from drinking it. Its sale should be made a felony, since denatured alcohol (which contains but two per cent of wood alcohol) can be used for everything for which wood alcohol is now used, and the dangers are greatly minimized. Lead poison caused four cases of blindness. These two causes are responsible for 2.62 per cent of cases of blindness.

In a total of 154 cases, equal to 57.67 per cent, the causes can justly be considered as preventable. In detail, the preventable causes appear as follows:

The causes put down as not preventable are:

Accidents are placed in the list of non-preventable diseases, and still a study of the causes will disclose many where a little care or forethought could have prevented these frightful results. Man's brutality has not been wanting in at least two cases. The elements, heat, cold, and lightning, are responsible for seven.

In the most liberal sense, fully forty to fifty per cent of all cases of blindness are due to venereal disease, infection poisons, and accident, and ought to be preventable in a very large proportion of cases.

The work demonstrates:
1. That the pension is of inestimable benefit to a large dependent class.
2. That the conditions of the blind, as a whole, are deplorable.
3. That more than half of them are too old to help themselves, or to accommodate themselves to their surroundings.
4. The teaching at the blind school has benefited but few, and of these but a small proportion become self-supporting.
5. That there is need of workshops for the blind in all the large cities in the state.
6. That strict supervision of midwives, some method still to be determined by which the general public may become better informed as regards the dangers of venereal diseases and the part they play in the production of blindness, school inspection -- all will aid greatly in diminishing the number of the blind.