XII. THE BLIND CHILD1 By DOCTOR F. PARK LEWIS, Buffalo, N. Y. Fundamental Needs. In the training of the blind child, three things must be emphasized: 1. The necessity of recognizing the fact that the child is blind or has defective sight, at the earliest age possible. 2. The manner in which the brain is developed through the training of the remaining special senses in the absence of sight. 3. The existence of that unusual condition, more highly developed in the blind than those who see, and what is sometimes termed the sixth sense, touch at distance, but which consists in the recognition of the nearness of any material body having a sufficiently large surface area by the perception of its approach through some other than that of conscious sight, hearing, or personal contact. Early Recognition. If there is reason to suspect that the sight is imperfect it is of great importance that the existence of marked refractive errors be discovered as soon as possible. In a very large number of markedly hypermetropic eyes, or farsighted eyes, or those in which the two eyes are focally different, and more especially when one eye converges and there is a permanent squint, the brain area corresponding to the sight centre of the inturned eye ceases to function, and, following the law of nature, those functions which are not used cease to have the power of use. There has developed, therefore, an amblyopia, or dull sight, which, if uncorrected, becomes permanent, and a semiblindness of the inturned eye, lasting through life, is the consequence. If, on the other hand, the proper refractive correction is made early enough, and the neurons, or nerve-endings in the brain corresponding to the sight centres, are made to function, the sight may be permanently preserved. It is a matter of first importance that in cases of squint the child be sent to an oculist as soon as the defect is discovered. I have, myself, used with great satisfaction strong correcting glasses upon a baby as young as five and one-half months old. 1 This contribution is a compilation from several of Doctor Lewis's papers, made with the author's special authorization. Sometimes the presence of congenital myopia, or near sight, in very high degree gives the child a vague blind look which may lead to a mistaken diagnosis of idiocy. I have seen such an instance in the case of a 5-year-old child whose eyes were myopic to the extent of ten diopters. To such a child all objects beyond five or six inches would have the appearance of being shrouded in mist, and the educative value of the visual pictures that are constantly being presented to the seeing child was thereby lost to him. The correction of the refraction gave the child such a degree of improved mental control as would hardly be thought possible. As all young babies roll their eyes aimlessly during the first weeks of life it is difficult to determine, from observation merely, the absence of sight. This difficulty is increased if, as more commonly happens, blindness is not complete, but objects are imperfectly seen. If, however, the pupils are widely dilated and unresponsive to light; if the eyes continue to move aimlessly from side to side without attempt to fix them on any object; and more particularly when nystagmus, or spasmodic twitching of the eyeballs is present, associated with an unwillingness or an inability on the part of the child to follow a light with his eyes when it is moved before him, there would be strong presumptive evidence after the sixth month that the vision was so imperfect as to warrant an ophthalmoscopic examination by a capable oculist by which a conclusion can be reached with much greater certainty. Early Impressions. However rapid may be the development of the child after he has reached school age, the period of greatest plasticity and quickest responsiveness is during the months of babyhood and the early years immediately following, and it is through the sense of sight that impressions, carried to the cortex, or surface of the brain, exercise the most profound influence upon the brain development. With the visual images every other sense impression is correlated. The object which the child sees, in order that he may realize its position in space, must be verified by the sense of touch. All of those sensory nuclei, therefore, which have been energized by the touch of the fingers, if the object is held in the hand, of the feet as they touch the floor, of the arms and limbs as they move through the air-every one of these millions of neurons is brought into direct relationship with the corresponding number of other neurons in the sight centre, so that every motion is sending a flood of nervous energy surging through the brain of the child. In that way he becomes conscious of his position in space, and he develops what is known as the stereognostic sense or the consciousness of solid objects. Cut off as the blind child is from the primary energizing influence of the visual impressions, he is intellectually hampered and limited unless every possible supplemental effort is employed to replace, as far as may be, the advantages which, in comparison with the seeing child, he is obliged to sacrifice. The blind baby, not seeing the objects around him, is not, as is the seeing child, unconsciously or persistently being educated as to their form, their size, their importance, their meaning, in a word: their value. He lives in the dark, and every motion or every step which he attempts to make is an experiment and an adventure. The next step may precipitate him he knows not where. It may be from the top of a stairway. He can have no means of knowing. He is living in a world separate and distinct from that of his seeing associates. This fact should be early recognized and constantly borne in mind. The blind baby must be talked to more than the child who sees. He must be allowed, carefully, to touch the objects about him, in order that in that way he may learn what he can about them. He must not be startled by being touched suddenly and without warning. He must not be allowed to be frightened by taking a misstep. A nervous impression of that kind may leave its results for months, if not for years, upon that sensitive organism. When he is old enough to creep he should be allowed the freedom of a room from which all objects against which he might hurt himself have been removed. The floor should be of one level so that there may be no pitfalls for him. He must be allowed all manner of harmless things to handle, and he must always be spoken to when one comes near him that he may not be startled. Large motor and sensory areas may be trained by allowing him to feel, to touch, and to handle things varying in degrees of hardness, and smoothness, and of different shapes and forms. He will in that way be getting such approximate impressions as he can, limited as those are compared to the possibilities of the seeing child. At a very early age, too, auditory areas may be actuated by singing simple melodies to the child, not in a vague and meaningless way, but carefully and in tune where it is possible for the mother to do so. The attention in that way can be directed and a recognition of different tones will begin at a much earlier age than is ordinarily supposed. Let it constantly be remembered that all of the moving pictures that pass before our eyes are blotted out for the blind baby. There is nothing but darkness before his unseeing eyes, and this monotony must be varied by greater attention to details that will interest him than would be necessary with a seeing child. At a very early age any other existing corrigible physical defects should, if possible, be removed. It is bad enough for the child to be blind. He should not be still further handicapped by the presence of large tonsils, by adenoids, and the consequent otitis and deafness, or any other defects of the body. The training of the voice to make it as musical and sympathetic as possible will be a great advantage to the child, and a quiet, self-possessed manner instead of a nervous and jerky one will not only make him more agreeable, but will give him balance of mind as he has poise of manner. In a word, before the child can be placed under the systematic and special training provided for the sightless, much can be done by the intelligent mother, under the advice of the physician, to so aid the child's development as to make life easier and simpler when the systematic training of the school com mences. School Training.-The time in which the blind child should be placed under the instruction of those specially qualified to train him in a school for the blind is the earliest period at which children are admitted, and that is the kindergarten age. Very often mothers do great injustice to their children by failing to realize this important fact. The mistake is often made in keeping him at home through mistaken sympathy, when he should be under definite and systematic training. It is not at all unusual to find that blind children are denied the privileges of training until they are 13 or 14 years old, and are then reluctantly sent to the special schools and find themselves utterly handicapped by their inability to do the simple things that other blind children easily do, because of the mistaken kindness of parents and friends. They are unable to put on their own clothes, to button their shoes, or to use their hands and fingers in the simplest mechanical effort. The handicap which they suffer is so great that it can never be completely overcome. If the blind receive suitable training at a sufficiently early age to develop in them that strength of body, of intellect, and of character that is the prerequisite of any successful life, their possibilities, strange as it may seem, are not greatly lessened by their loss of sight. This has been demonstrated in the lives of a multitude of successful blind men and women. England's ablest postmaster-general, Mr. Faucett, was blind. He rode horseback, skated, and did many things that are supposed to require eyesight. The most wonderful and exact observations on the life history of the bee were made by a blind man, who directed the eyes of his servant. Blind musicians have written and played, and Mount Blanc has been scaled by blind men. It is the mind and the spirit which control, and when these are great they dominate and rise superior to mere physical deficiencies. The inspiration of great ideals must be held out to the blind, even more than to the seeing from the beginning. Need of Normal Companionship.-At as early a period as possible in the child's life, he should be given an opportunity to play with other children of his own age. With a little supervision, he can be taught to enter into all of their games, and to do a great many things that are done by seeing children. It is as true of the blind as it is of those who see that the most important elements in their education come not from teachers but from their associates. The effect of having a blind child among a group of seeing children is mutually helpful. If the children are properly taught, they will soon learn to supplement the lack of sight in their companion by giving him a little help when necessary. They will learn to tell him of things that are about him and describe the things as they see them, and in consequence they will learn how to observe and express their thoughts, while he will quickly begin to form mental images, as far as he can form them, from his surroundings. Special teachers for blind children are exceedingly difficult to obtain, and they are rarely necessary. It is not usually desir |