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In lay language, this means that the definition of blindness includes not only those persons totally blacked out but also those with some remaining vision, which can range from bare light perception to an amount which enables them to see at 20 feet what the person with normal vision can see at 200 feet; and the definition also includes those whose field of vision is so restricted that if they were to grasp a 12-inch victrola record between the thumb and forefinger of each hand and hold it out at arm's length, they could not see their fingers grasping the record. While it is admitted that the loss of one eye is a distinct handicap, the one-eyed person is not considered a blind person in this report.

For the purpose of this hearing today, it seems advisable to highlight certain portions of Dr. Hurlin's report of July 1952 as follows:

Rates of prevalence of blindness in the respective States were determined by the application of a complicated statistical formula arrived at by Dr. Hurlin on the basis of three factors:

1. The composition of the population with respect to age. 2. The composition of the population with respect to race or nonwhite components (Negro, Indian).

3. The public health standards of the State in terms of the infant death rate.

The series of estimated prevalence rates is anchored on a rate for North Carolina computed from an actual count of blind persons within that State made by the State commission for the blind as of the end of June 1952.

The average estimated rate per thousand population in the entire Nation is 1.98.

The lowest rate-1.40 blind persons per thousand population-is that for Utah.

The highest rate—3.42 per thousand population—is that for New Mexico.

The estimated rates of all the States reveal a geographic relationship with 10 of what we might roughly call Southern States and the District of Columbia having a rate higher than 2.4 per thousand; 13 of what we might roughly call border States and the State of Maine have a rate between 2.0 and 2.3 per thousand; while the remaining 25, or Northern States, have a rate less than 2.0 per thousand.

There is no evidence that the racial factor represents a true biological difference. Rather, it is probably a reflection of less education and lower economic standards of the Negro and the Indian which have affected their ability to withstand disease.

The present method of Dr. Hurlin of making estimates of the rates of prevalence of blindness is designed to approximate differences in the rates for States at a given time; it does not serve as well for estimating changes with time.

Because eye diseases—especially cataract and glaucoma--occurring most frequently among older persons accounts for at least two-thirds of existing blindness, and because the proportion of the population aged 65 or over increased by almost 20 percent from 1940 to 1950, it is not unreasonable to assume that the prevalence rate of blindness as well as the number of blind persons will continue to increase. This assumption is additionally augmented by the prevailing incidence of blindness among prematurely born babies. At both extremes of the life span medical science seems to be saving life or prolonging life, but,

ironically, that same science seems not to be able to cope with the serious and negative byproducts of its own efforts.

It is estimated that, unless medical research makes a very real contribution to the prevention of blindness area, there will be at least 60,000 more persons who will lose their sight permanently within the next 10 years.

The American Foundation for the Blind is not medically oriented. We leave to those organizations concerned with the prevention of blindness this very important part of the presentation concerning diseases of the eye and the specific medical research needed to control or eliminate them.

We turn now to the second part of our presentation which concerns the estimated economic burdens placed upon the Nation because some of its citizens happen to be blind. It is generally accepted among workers in our field that about 10 percent of the blind are under 20 years of age and that about 50 percent are over 65 years of age; and also that about 25 percent of all the blind are employable and that about half of the latter can be employed only in sheltered workshops and in home industries, while the other half can be employed in competitive industry and in the professions. Applying these generally accepted percentages to our national estimate of 314,000 blind persons in the United States as of July 1, 1953, we would have 31,400 under 20 years of age; 157,000 over 65 years of age; 36,250 employable in sheltered workshops and in home industries; and 36,250 employable in competitive industry and in the professions.

What do these figures mean to the economy of our Nation? Conservatively speaking, about 20,000 of the blind persons under 20 years of age should be in school. However, according to our best information, only about 7,500 are enrolled at the present time. Figures from the Research and Statistics Standards Section of the United States Office of Education show that it would cost the Nation approximately $2 million per year to educate these 7,500 if they were sighted. However, because they are blind, it is costing the Nation approximately $15 million per year to educate them. Blindness here is adding about $13 million per year to the public education costs of our Nation. However, for the record, we should like to submit that this amount is not nearly sufficient to give the present number of blind children an education equivalent to that which they might have had if they were sighted.

Ninety-eight thousand five hundred and thirty-six blind people are presently receiving public assistance and some of them are receiving medical care at public expense. According to the Social Security Bulletin of August 1953 and the 1951 annual report of the then Federal Security Agency, an annual amount of about $70 million was spent on public-assistance grants and medical care for blind people, including administrative costs. While we introduce this figure to impress you with the dollar cost of blindness, we must, however, for the record, remind you that the average grant of $54.02 per month is far from adequate and if our Government could possibly afford it, this monthly grant should be materially increased.

In order to make it possible for most of the estimated employable blind of 78,500 to become actually employable, our Federal and State Governments are spending, annually, about $12 million to administer programs of vocational rehabiltation for blind individuals. At the risk of being monotonous, I must comment again, that the amount of money being spent for counseling, training, and placement of blind people is tragically low.

Supplementing the above-mentioned programs of education, public assistance, and vocational rehabilitation, our Federal Government spends about $2,500,000 per year to carry out the programs of the Division of Books for the Blind of the Library of Congress and of the American Printing House for the Blind of the United States Department of Health, Education, and Welfare. This amount represents a worthwhile, yet still inadequate sum. Preferential reduced postage rates necessary to send our present embossed and recorded literature and equipment for the blind through the mails represents another investment of our Government in helping the blind.

Public moneys, then, in the amount of approximately $98 million a year are spent on programs for blind people in our country.

A rough estimate of the combined budgets of the some 250 private agencies for the blind throughout the Nation is about $50 million. I am submitting this Directory of Activities for the Blind in the United States and Canada for the exhibit at this point. The combined total of public and private money spent each year for the blind of our country approximates $148 million. This figure does not include the several million dollars which our Government spends annually on a very special segment of our blind population-the war blinded. And lest you may think that the war blinded should not be included among those who might benefit from medical research, let me hasten to say that not all war blindness is the result of direct enemy action; about 18 percent is the residual of diseases affecting the eyes.

These, then, are the statistics concerning the estimated prevalence of blindness in the United States and the resultant estimated economic burden placed upon the Nation : An average prevalence rate of 1.98 blind persons per every thousand population or 314,000 blind persons in the United States based on the general population figures of July 1, 1953; a total cost to the Nation of approximately $148 million each and every year. Our people are accustomed these days to hearing about large sums so, simply for the sake of effect, you might consider that this means that over the next 10 years, if blindness does not decrease, it will cost the Nation $112 billion, a shocking amount, buteven more shocking—not nearly enough.

But this is the cost in dollars and cents only. If we have a moral obligation to inquire into the dollars-and-cents cost, we can be accused of moral guilt if we do not inquire into another cost which cannot be measured in dollars and cents—a cost which is measured in terms of mental and psychological and physical barriers and in terms of the personal dignity of every blind individual in this country. When we face that intangible cost squarely, how can we sit by and not ask this important question—“What are we doing about it?"

As a government, how do we feel about spending so many millions of dollars each year to ameliorate the condition of blindness and such a very small amount to prevent it? As a government, have we not observed the shameful exploitation of the condition of blindness in order to try to raise private funds to prevent it? As a government, should we not understand that blind people have already given

enough when they have given their sight; that they should not be asked to surrender their individual and collective dignity in addition. Let us think more in terms of public funds for public causes.

As a representative of the American Foundation for the Blind and speaking in behalf of the blind people whom we are serving, I wish to express appreciation to this committee for holding these public inquiries on the causes and control of some of the principal diseases of mankind. I thank the committee for permitting me to appear here today and make this presentation.

The CHAIRMAN. We certainly are very appreciative of the statement which you have just made. It is exceedingly comprehensive and gives us abundant information that can be very helpful to this committee and we thank you.

Are there any questions?

Mr. KLEIN. I want to ask Dr. Johnson a question. I think you said, Dr. Johnson, in your statement, that we spent $400,000 for research

Dr. Johnson. For research in the blinding eye disease.
Mr. KLEIN. Was that directly from the Government ?

Dr. JOHNSON. Through the Institute of Neurological Diseases and Blindness.

Mr. KLEIN. Was that a grant from the Government to the Institute?

Dr. Johnson. $400,000 was the total amount; yes, sir. Is that right, Dr. Bailey?

Dr. BAILEY. Dr. Stone, can you verify that?

Dr. STONE. Yes, sir. We awarded through the research grant program $392,186 out of fiscal 1954 funds and the previous fiscal allocation was $251,000.

Mr. KLEIN. This is the most you have ever received ?
Dr. JOHNSON. Yes, sir.
Mr. HELLER. Are there any private contributions?

Dr. JOHNSON. We will come to that in another paper, sir. May we defer your question until later?

Mr. HELLER. Yes.
The CHAIRMAN. Are there any further questions?
You may proceed, Dr. Johnson.

Dr. Johnson. The next presentation will be from the National Society for the Prevention of Blindness and Dr. Franklin Foote will make that presentation.


NATIONAL SOCIETY FOR THE PREVENTION OF BLINDNESS Mr. FOOTE. I am Dr. Franklin M. Foote and I am a physician. I come from North Salem, N. Y., in Westchester County. I am executive director of the National Society for the Prevention of Blindness, with headquarters in New York City. We work throughout the United States.

My background is in the field of preventive medicine and public health, in which I have worked in the States of Connecticut, Tennessee, and as assistant professor of preventive medicine at Cornell Medical College. In December 1942 I went into active duty in the Army.

I have been associated with the national society since I got out of the Army in 1946, and what I have to say is based, in part at least, on statistical studies-biochemical and epidemiological studies, which the national society has made for 25 to 30 years, and is also based on observations which I have made in the last several years as I traveled around the United States, visiting between 30 and 40 of the medical schools, laboratories doing research in this field, as well as State health welfare and education agencies for the blind and others working in the field of prevention of blindness and the improvement of vision and sight restoration.

I would like to comment a moment on some of the figures that Miss Gruber gave you.

The study which is reported by Dr. Hurlin on behalf of a committee supported by both of our organizations indicates that if you got all of the blind men and women and children together in one spot in one city, gentlemen, we would have a city the size of Miami, Fla.; larger than Akron, Ohio, or Providence, R. I., or Omaha, Nebr., in which every man, woman, and child is blind.

If you could think of it in those terms, I think you can visualize the extent of the problem today.

Again, basing it on Dr. Hurlin's figures, and if we take the average life expectancy of the people now alive, including ourselves, I believe as a fairly conservative estimate, that three-quarters of a million of those Americans alive today will be blind before they die. So, the problem is a little larger than simply the 314,000 figure which was mentioned.

There are about 1 million in this country with glaucoma-one of the blinding eye diseases which creates pressure within the eyeballwho do not know they have it and who will face blindness unless proper treatment is given at the proper time.

Then, we get divisions in the causes of blindness and there are a great many diseases that cause blindness. In addition to that we have the injuries which occur to the eye. Injuries cause roughly 9 to 10 percent of the blindness. I am now quoting from a paper which Dr. Walter Lancaster, of Boston, and I presented before the American Medical Association at a scientific meeting in 1950, a study based on observation of 50,000 blind men, women, and children.

This study was made in cooperation with schools for the blind throughout the United States, in cooperation with agencies for the blind, welfare departments, and others serving the blind, all of whom in order to carry on their activity had the actual diagnosis of the cause of blindness by the ophthalmologist who examined the patient. However, of the total 90 percent of the blindness due to diseases of the eye, we can break that down still further. We know that about 43 percent of the causes of blindness are due to causes in which we know the nature of the underlying conditions. For example, 22 percent of all those now blind are due to infectious causes--to germs-producing conditions within the eyeball. We have seen a tremendous improvement made in this cause of blindness because of efforts made in many different directions, particularly by local public health units.

Some of that has been done through grants given them by the Public Health Service under the provisions of the Social Security Act passed in 1935.

Infectious causes of blindness is the principal cause of blindness among children and it has decreased 50 percent in the last several years.

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