October i8, i< 



•] 



SCIENCE. 



269 



rapidly as did the population, and during the last five years of that 

 decade it increased 13.7 times as rapidly. 



It may be interesting also to glance at the distribution of blind 

 throughout the State of New York. The tenth United States cen- 

 sus gives for the first time the number of these imfortunates in the 

 different counties of each State. These statistics are in process of 

 publication ; but, as that portion of the report was not complete 

 when this one was being prepared, application was made to the 

 State Board of Charities, where there is deposited a copy of the 

 official returns relating to the bliud. The assistant secretary of the 

 board, Mr. James O. Fanning, has kindly furnished the coinmittee 

 with the number of blind in each county, having ascertained that 

 by adding the lists of more than five thousand names on record. 

 The different counties have been arranged in four groups. The 

 first includes those which contain less than .005 of one per cent ; 

 the second, those which contain from .005 to .01 of one per cent ; 

 the third, those which contain from .01 of one per cent to 5 per 

 cent ; the fourth, those which contain more than .0521 of one per 

 cent. 



In view of these rather startling assertions in regard to the in- 

 crease of blindness, it is natural that we should question the cor- 

 rectness of the data which lead to any such conclusions ; in other 

 words, to suspect that the apparently rapid increase was due to the 

 difference in the manner in which the statistics were collected in 

 1S70 as compared with 1880. In the compendium of the " Tenth 

 Census " it is stated by Mr. Wines, who has charge of that depart- 

 ment, that the plan was essentially the same ; but, in order to sat- 

 isfy ourselves more thoroughly, a letter was addressed to the sec- 

 retary of the interior, asking for any additional facts in regard to 

 this point, and we were informed that the same outline was fol- 

 lowed in one case as in the other, simply a special blank for the 

 blind being filled out in 1880. Of course, these examinations were 

 by no means as accurate as would be desired from the ophthalmo- 

 logical point of view, for the numerators were often ignorant and 

 careless men ; but the fact remains that the errors were probably 

 almost as great in 1870 as in 1880. Moreover, in order to verify 

 the accuracy of some of the figures in the last census, we made ap- 

 plication for the returns regarding the city of Buffalo ; and while 

 a number of changes of residence were mads, and it was difficult 

 to verify the reports in detail, still the information obtained, as far 

 as it went, showed that at least that part of the report was quite as 

 reliable as could be expected. 



Let us consider next the causes which tend to make this appar- 

 ent increase of blindness. In doing so, it is natural that we in- 

 quire, first of all, what were the causes which have produced that 

 condition among those who are already blind. To determine this, 

 it seemed advisable to undertake the examination of a considerable 

 number of these unfortunates, and, of course, that could be done 

 most conveniently in asylums, almshouses, where they were col- 

 lected together. Accordingly a list of questions was prepared, be- 

 ing mainly a copy of that which was used by Hugo Magnus, a 

 specimen of which is here appended ; the name of the blind-asylum, 

 location, date of the examination, and name of the examining phy- 

 sician, heading the list. I. Name of the blind person, residence ; 

 name of father or guardian, residence. 2. Sex. 3. Age. 4. Religion. 

 5. Nationality. 6. For adults, occupation before blindness ; for 

 children, occupation of the parents. 7. Color of the hair. 8. 

 Color of the iris, if possible. 9. Degree of blindness : A. Couftt 

 fingers at ^ of a metre ; B. Quantitative perception of light ; C. Ab- 

 solute amaurosis. 10. Cause of the blindness of the right eye. ii. 

 Cause of the blindness of the left eye. 12. Condition of the right 

 eye. 13. Condition of the left eye. 14. Age at which right was 

 lost. 15. Age at which left was lost. 16. Can the blindness be 

 referred to scrofula ? 17. Can it be referred to syphilis.? 18. Is 

 the blmdness the result of any disease of the general system .•' 19. 

 Are there any other bodily infirmities ? (For those who have had 

 small-pox) 20. Was the blindness before vaccination ? and 21. Was 

 the vaccination effectual .' 22. Did the blindness occur when in a 

 town, or when in the country } 23. Were the parents related to 

 each other? 24. Did the parents have normal vision? 25. Were 

 any of the relatives blind ? 26. Were there any other circum- 

 stances which might be important in connection with the 

 case ? 



To the president of each county medical society we then for- 

 warded as many of these blanks as there were blind inmates of his 

 county almshouse, and the request was made that the blanks be 

 filled and returned to the chairman of this committee. Responses 

 were returned in only nineteen instances, although letters with 

 blanks were sent to all. Unfortunately, also, the answers to some 

 of the questions were so indefinite that it was necessary to omit 

 the cases from the classification. 



A second set of examinations which the committee have to ac- 

 knowledge was made by Dr. W. H. Bates of New York, acting 

 under the supervision of Dr. H. D. Noyes. This list includes one 

 hundred and sixty-eight cases seen at the New York State Insti- 

 tution for the Blind in New York. The third list contains the re- 

 sults of an examination of one hundred and twenty-eight inmates 

 of the New York State Institution for the Blind at Batavia. These 

 examinations were made by the chairman, assisted by Dr. Elmer 

 Starr of Buffalo. 



In spite of this plan of inquiry, it is difficult to determine exactly 

 some of the causes of the blindness, even when the greatest care 

 was exercised ; but it was evident from even the most casual ex- 

 amination that a very large percentage of the cases were due to 

 some form of contagious disease of the eye. It must be admitted 

 that in the case of blind-asylums this representation, however 

 truthful in itself, has a tendency to exaggerate the importance of 

 the contagious disease of the eye as a cause of blindness. We do 

 not find at such an institution those who have become blind by 

 accident to adult life, or by those diseases which are more common 

 in old age. A table of percentages is given by Magnus in his ad- 

 mirable work on blindness, in which he brought together the re- 

 sults of examinations by different investigators, which covered a 

 total of 2,528 cases of blindness. In this table it may be seen at 

 a glance how very great is the influence of those diseases which 

 are distinctly of a contagious kind as compared with any other, 

 over 20 per cent of those of all ages being due to contagion. In 

 the "Annual Report of the Manhattan Eye and Ear Infirmary for 

 the Year 1886 " is given a summary of 48,509 cases, of which it 

 was shown that 26 per cent were due to conjunctival diseases, and 

 25.5 per cent to corneal diseases ; but one of those who made this 

 report, when speaking of them, mentions " over 50 per cent as 

 being communicable, or closely related to communicable diseases." 

 In summmg up, therefore, this portion of the question as to what 

 are the causes which have produced blindness, it is fair, we think, 

 to reply that contagion exercises by far the most important in- 

 fluence. 



There is another aspect of this part of the subject which it is 

 necessary to mention : we have reference to the influence which 

 immigration has upon the increase and spread of contagious dis- 

 eases of the eye, directly and indirectly. A considerable number 

 of facts might be presented to illustrate this phase of the subject. 

 We need only select as an example the influence exerted by one 

 class of immigrants in relation to spreading one disease of the eye. 

 It is generally conceded that trachoma is essentially contagious, 

 and also is of frequent occurrence among the lower class of the 

 Irish population. Now, the report of the Treasury Department 

 for 1886 shows that from 1 87 1 to 1880 there were nearly half a 

 million of Irish immigrants in this country, — more exactly, 444,- 

 5S9, — and during these years the Irish formed 15.1 per cent of all 

 the immigrants who arrived in the United States. It should be 

 borne in mind that by far the greater part of these immigrants — 

 at least four-fifths of them — land at Castle Garden. In order, 

 therefore, to ascertain what care was exercised in isolating any 

 such contagious cases which might enter there, a letter was ad- 

 dressed to the physician in charge of the State Emigrant Refuge 

 and Hospital at Ward's Island, New York, inquiring as to this 

 point; and his replies, although frankly given, were by no means 

 such as to impress one with the care which the authorities exercise 

 as to the disposition of such cases. 



Few persons appreciate how great is the cost to the community 

 of the maintenance of a number of persons in their midst who are 

 not only non-producers, but who must also be fed and clothed. It 

 is possible to make an estimate of the annual cost to the State for 

 the maintenance of the blind. Supposing they were all provided 

 for in an economical manner, such as can be done in large institu- 



