MAN is endowed with two senses which especially serve him in intercourse with and appreciation of his surroundings, namely, sight and hearing. Of one deprived of either of these it may well be said that "a window of his soul is closed." While it is difficult to determine the true relative value of these senses, it is probably the popular verdict, at least, that blindness is, if not the greatest, one of the greatest physical misfortunes to which flesh is heir. No affliction so quickly appeals to the sympathy of one's fellow beings, and villainy sinks to no lower level than that of imposing on one so afflicted. The progress of a blind man on the street gives at every step evidence of the pity which his condition arouses. Busy men stop to help him on his way, to guide him across crowded thoroughfares, to do all that look, and word and deed can do to make his way easy. The blind receive alms from those who give to no one else. The blind peddler and newsdealer not only sell what the purchaser does not want, but prevail on him to go out of his way to buy. Municipal governments remit their license fees and permit them to establish themselves on highways and in public places, to the dis*Read before Tri-State Med. Assn. (Miss. Ark. & Tenn.) Memphis, Nov. 12, 1902 Vol. 23-9 117 turbance of traffic, but without a protest from any man. The "One low churl, compact of thankless earth, Boring a little auger hole, in fear Peeped, but his eyes before they had their will Were shriveled into darkness in his head And dropped before him. So the powers who wait No imagination is vivid enough to picture in all its details the weight of this infirmity. It is bad enough when it comes to one full of years and surrounded by those who willingly minister to his wants, and with the accumulation of a life's work to provide him with comforts. To the poor it is infinitely worse. Probably the least to be pitied of all this much to be pitied number are those to whom it comes so early in life that they never know what they miss. The genius of Kipling has given us what is to me the most competent description of one so afflicted in The Light that Failed, and so admirable is this description that I take the liberty of quoting it at some length. The story has to do, as you remember, with an artist who loses his sight from optic atrophy, the remote effect of a sabre wound on the head. His companions leave him alone in London, while they go with the army to other fields, and his condition is thus described: "It is hard to live in the dark, confusing the day and night; dropping to sleep through sheer weariness at midday, and rising restless in the chill of the dawn. Dressing was a lengthy business, because ties, collars and the like hid themselves in far corners of the room, and search meant head beatings against chairs and trunks; once dressed, there was nothing whatever to do except to sit and brood till the three daily meals came. Centuries separated breakfast from lunch and lunch from dinner, and though a man prayed for hundreds of years that his mind might be taken from him, God would never hear. Rather the mind was quickened and the revolving thoughts ground against each other as millstones grind when there is no corn between; and yet the brain would not wear out and give him rest. It continued to think at length, with imagery and all manner of reminiscences. It recalled past successes, reckless travels by land and by sea, the glory of doing work and feeling that it was good, and suggested all that might have been done if the eyes had only been faithful to their duty. When thinking ceased through sheer weariness, there poured into his soul tide on tide of overwhelming, purposeless fear, dread of starvation always, terror lest the unseen ceiling should crush down upon him, and fear of fire and a louse's death in red flames, and agonies of fiercer horror that had nothing to do with any fear of death. Then he bowed his head and, clutching the arms of the chair, fought with his sweating self till the tinkle of plates told him that something was being set before him to eat. * * ** * For amusement he might pick up coal, lump by lump, out of the scuttle with the tongs and pile it in a little heap in the fender, keeping count of the lumps, which must be put back again, one by one and very carefully. He may set himself sums if he cares to work them out; he may talk to himself or to the cat, if she wishes to visit him, and if his trade has been that of an artist, he may sketch in the air with his fingers, but that is too much like drawing a pig with his eyes shut. He may go to his bookshelves and count his books, ranging them in order of their size; or to his wardrobe and count his shirts, laying them in piles of two or three on the bed, as they suffer from frayed cuffs or lost buttons. Even this entertainment wearies after a time, and all the times are very, very long." The contemplation of misery and misfortune is always unpleasant, and I hasten to say that my object is not to dwell on the dark side of this subject, but to consider what can be done, and has been and is being done, to lighten the burden of these unfortunates. The causes of blindness might first be briefly considered. The recent and extensive contribution to this subject from our colleague, Dr. J. L. Minor, in the "Reference Handbook of the Medical Sciences," gives a table of the causes of blindness in three groups: (1) Preventable, 41 per cent.; (2) Probably Preventable, 22 per cent., and (3) Unavoidable, 34 per cent. It is to be hoped that the cases coming under the first two headings will continue to be lessened, as they undoubtedly have materially been in the last three or four decades, thanks to the discovery of the ophthalmoscope and the introduction of antiseptic methods of treating diseased conditions of the eye. The success which attends the proper treatment of ophthalmia neonatorum, the operation for cataract, the early recognition and operative treatment of glaucoma, the early recognition and earlier preventive treatment of sympathetic affections, the treatment of progressive myopia, the prevention of the spread of contagious diseases, such as trachoma, and the improved methods of treatment of wounds of the eyes, including the recent methods in magnet operations, have resulted in the rescue of thousands of eyes from blindness and thousands of individuals from pauperism. Since this paper is not strictly a medical essay, it is unnecessary to go more into the details in regard to these matters. As regards the prevalence of blindness, there were in this country in 1890, 50,568 blind persons, or 1 to 1508 of population. In Norway there were 1 to 566, and in Egypt 1 to 97. In the Deutch Med. Wochen., June 9, 1898, Hirschberg speaks of the condition of blindness in Spain. At that time there was no professor of ophthalmology in Spain. Of 300 cases examined by Camuset, all were due to neglect. Hirschberg says he never saw so many shriveled eyeballs, not even in Egypt, and this is especially true of the southern provinces. He saw a street band of nine, all blind. There was no institution for the blind in Spain, all that had been founded having failed. The custodian of the watchtower at Cadiz, famous for its magnificent view, is almost totally blind. His only reply to Hirschberg's questions was, "One must be patient." Time was when blindness carried with it the sentence to idleness and usually indigency. True, some persons who became blind in adult life had already acquired an education and the capacity and inclination for work. Milton became blind from glaucoma, after having achieved fame as a poet, and continued his work by dictation, a fact which accounts for the extremely long and difficult sentences in some of his poems. William Prescott became blind from sympathetic inflammation, in spite of which he became the great historian. General Long wrote his life of Robert E. Lee after he became blind. It is not so much with this class that we have to deal as with those who were born blind or who lose their sight at such an early age that nothing of any moment was learned while seeing. Institutions now abound for the purpose of teaching the blind to read and for teaching them suitable occupations, but these are of comparatively recent date. According to a report of the Tennessee School for the Blind, the first institution for the blind was founded in Bavaria in the middle of the twelfth century, the second in Paris a century later. It is not probable that these were institutions for the purpose of teaching, but rather homes, since no systematic attempt was made to teach them before the eighteenth century. Early in that century, the soil having been prepared by the writings of a Jesuit, Lana Terzi (1670), and the discussions of Locke and others, the first school for the blind was opened in 1784 at Paris by Valentine Hauy, who may be said to be the pioneer in the work of educating the blind. He became interested in their condition by observing the antics of some blind men at the fair of St. Ovid in Paris in 1771. Hauy, being then 26 years of age, made the subject the work of his life, founding the first school, as we have seen, in 1784, and it attracted so much attention as to be taken under governmental control, and Hauy was invited to other continental capitals to establish similar schools. Undoubtedly an enthusiast, and deserving great credit for his work in this untrodden field, he failed to display any executive ability, and largely on this account his |