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In considering the relationship of the Commission to the Nursery for Blind Babies, I feel that it is very wise that the General Superintendent should serve on the advisory board of the Nursery. In few phases of philanthropic work is there more need for wisdom than in the training of little blind children. The presence of a trained social worker on the Board of this Nursery has had, I believe, a very salutary effect upon the management and aims of the institution. The broad policy of the Nursery in opening its doors to the phlyctenular keratitis cases, brought to the attention of the Commission in its work in conjunction with the hospitals, is most fortunate. This practice goes far toward making the results of the prevention of blindness activity of the Commission permanent, so far as this class of case-work is concerned. I was much interested in the statement of the matron of the Nursery regarding the influence of these little temporary sojourners upon the more permanent population. Entering as they do, they bring with them a little of the outside normal environment. The matron says that she has noted a marked change in the other children since these temporary inmates have been received. The presence of three or four children coming from normal homes has given a spontaneity and leaven to the entire group. The advent of these little convalescents has broken up old habits of speech and little set games, and has introduced a new life, new ideas, and new standards.

The membership of the Director of the Perkins Institution upon the Commission insures cooperation between the Commission and this School. Without knowing the difficulties in the way of such a move, it occurred to me that this connection between the Perkins Institution and the Commission might well be developed in such a way that some of the Perkins plant could be utilized by the Commission during the long summer vacations for the purpose of instructing blind adults. How far this might be carried out, and just how far such cooperation might be practicable, remains with the management of the two organizations to determine.

The relation of the Commission to organizations of the blind seems, with the exception of one organization, to be more cordial than is often found in other States. The one organization to which I refer is the Blind Welfare Union. The difficulty in this particular case grows, in a measure, out of a difference of opinion between the management of the Commission for the Blind and the leaders of the Welfare Union regarding blind pensions. The leaders of the Union feel convinced that the most satisfactory solution of the problems of the blind is a general flat county pension of $150 per annum for all blind persons having an income of less than $300 a year. In the opinion of these persons, this pension should be distributed with the use of as little machinery as possible. The attitude of the Commission upon this question is a desire to make every effort to utilize other existing relief agencies to meet the needs of the indigent blind persons before special machinery and special public relief funds are provided for them. Until a satisfactory solution of the blind relief problem is put into operation, I see no hope for bringing about more harmonious relations between these two organizations.

CONSERVATION OF VISION AND PREVENTION OF BLINDNESS

Hospitals and Boards of Health

Prevention of blindness and conservation of vision work conducted by the Massachusetts Commission for the Blind is at one with the general policy of the Commission. This has consisted primarily of the collection of data and the distribution of information in every way that the limited funds appropriated for this work will permit. All classes of agencies which obviously should take an interest in the prevention of blindness, and some whose responsibility in this respect is not so obvious, have been urged by the Commission to take all necessary measures to eliminate unnecessary blindness. Hospitals have been urged to develop follow-up work in this direction. By means of periodical inquiries into the thoroughness of this follow-up work, and by stimulating the interest of the medical profession in the local communities in this activity, the Commission had acted as the State-appointed representative of that class of patients with whom the hospitals must concern themselves if insidious eye affections are not to result in complete loss or permanent impairment of vision. The Commission has also stood as the champion of children who have a right to be protected against the ravages of ophthalmia neonatorum, by keeping the medical profession, boards of health, and societies interested in the protection of children awake to the need of a rigid enforcement of laws against eye neglect. Some interesting studies are now being made upon the results of treatment for glaucoma afforded by certain Boston hospitals. This may shed much light upon the comparative efficiency of the general follow-up nurse plan, as contrasted with that of the special eye nurse.