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The causes of blindness are such as to suggest much of this disability in children as
a matter for prevention. Prominent causes are accident, syphilis, purulent conjunctivitis,
congenital defects, and ophthalmia neonatorum. Half of the blindness due to purulent
conjunctivitis is deemed avoidable, at least two-thirds of the syphilis, and almost all the
ophthalmia neonatorum. It is considered that only one child in five is born in a clean home
in England, hence purulent conjunctivitis, but feeding may have influence in this
matter. As regards gonococcal infection of the eyes, this can be nearly obviated by proper
attention to the child at birth. Syphilis can be largely prevented according to the use
made by the syphilitic pregnant woman of the facilities for cure of her disease. A syphilitic
pregnant person, treated from the early months of pregnancy, will bear a normal child.
Children born syphilitic, with persistent treatment from early birth, are rendered normal.
It, therefore, appears that gonococcal and syphilitic blindness should be reduced under
systems of ante-natal and post-natal care in properly arranged clinics. Congenital syphilis,
untreated, shows itself in the eyes at any time between the ages of 2 and 35, and 2 to 10
years of treatment is then necessary before even a quiescent stage in the disease is reached.
There remain many diseases of the eye which are truly hereditary in nature, and which
are handed on inevitably from generation to generation in more or less well-known mendelian
ways; these can be but registered, prevention in them is a matter of eugenics. The
country, however, is turning over in its sleep on this subject.
The Memorandum of the Advisory Committee recognises the difficulty of determining
whether a child under the school age is a blind person within the meaning of the Blind Persons
Act, and that it requires discretion on the part of the registering body to determine whether
a child is suitable for registration; but where there is doubt, it is deemed preferable to
register a child under the school age as blind, in order to keep it under observation, rather
than run risk of the lapse of a number of years before steps are taken to provide the
special education it may require.
The close liason now established with St. Bartholomew's Hospital in the matters of
infant welfare and the treatment of venereal disease is an agency well calculated to do a large
preventive work and to make early note of the cases which arise.
Circular 1353 of the Ministry of Health on the certification of blindness draws attention
to the following points:—
(1) A person should not be registered as blind until satisfactory medical evidence
of blindness is produced.
(2) Local Authorities should consider the desirability of the examination and
certifying of a blind person by a medical practitioner with special experience in ophthalmology—i.e.,
a medical practitioner in charge of the ophthalmic department of a General
Hospital, or one holding a recognised diploma in ophthalmology, or one who, by reason
of special experience in the practice of ophthalmology, is fully competent to secure a correct
and just certification.
(3) A form of certification designed to be at once a certificate and a record for
compilation of statistics of scientific value, which should be used in every case of blindness
placed upon the register.
The Minister and Board of Education have authorised the Prevention of Blindness
Committee to collate and tabulate the statistics for the use of local authorities.
An appendix to the circular gives intimate technical directions for the use of the certifying
ophthalmologist and a definition of blindness for the purposes of the Blind Persons Act,
1020. For registration the person must be "so blind as to be unable to perform any
work for which eyesight is essential"—i.e., not his ordinary or any particular work, but any
work. It is recognised in this stringency, however, that a person with recent defect is less
able to adapt himself to his environment than a person whose defect in acuity of vision
is of long standing; and an old person with recent failure of sight, so readily as a young
person with equal defect.
The Metropolitan Society for the Blind, who are the agents for the Corporation, report
for the year 1932-33 that the City of London blind number only 15, of whom in seven
blindness occurred below the age of 50, in four below 30, and in two below 20. No one of
the City blind is now below age 30.
The services of an ophthalmologist have been obtained through the medium of St.
Bartholomew's Hospital, at a fee of two guineas for examination and certification.
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