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Topic No. 5

RELATION OF COMMISSION TO OTHER AGENCIES

SURVEY BY R. B. IRWIN
Supervisor of Classes for Conservation of Eyesight, Board of Education, Cleveland, Ohio

January 3, 1917.

SIR FREDERICK FRASER, Chairman.

DEAR SIR FREDERICK:

I visited the Massachusetts Commission office on Thursday morning, November 23, and left Boston Saturday night, December 2. Practically every minute of this time was spent discussing the work of the Commission with the various members of the staff, interviewing heads of organizations having a practical or logical relationship to the Commission for the Blind, and talking With various representative blind people.

The topic of this survey of the work of the Massachusetts Commission for the Blind assigned to me is that having to do with the relationship of the Commission to other social agencies and to organizations of the blind. I was especially asked to consider existing and proposed methods for meeting the need for poor relief to the needy blind. Any one at all familiar with the multiplicity and high degree of specialization of the social agencies of Massachusetts will realize that it would be manifestly impossible in such a short period of time to make anything like a critical study of the entire field in which the Massachusetts Commission for the Blind might conceivably have relations with other social agencies. For this reason, I confined my observations primarily to two lines of endeavor, namely, Prevention of blindness, including conservation of vision; and Relief. These two activities could only be sampled here and there, in order to get the trend of policies and the effectiveness of the efforts put forth.

I wish to express at the outset my appreciation of the absolute frankness and the desire to be of the greatest help in getting at the real situation exhibited by every member of the staff.

COOPERATION WITH VARIOUS RELIEF AGENCIES

Before one can discuss intelligently the relation of the Massachusetts Commission to other social agencies in the State, he should first get some statement of the conception of the proper function of the Commission in that community. The activities of a commission for the blind, in whatever State it may be, are, of course, limited by the powers and duties intrusted to it by the legislature by which it was created. A commission, though, which is directed by persons with broad vision and earnest devotion has a certain ideal toward which it is striving. If its legislative authority is not broad enough, then the General Court should be asked to amend the law creating it. So far as I could make out, the function of the Massachusetts Commission is to study the condition and needs of the blind in the State, and to devise ways and means to meet these needs. So far as possible it is the policy of the Commission to utilize existing agencies which may cooperate in the solution of the various problems arising out of blindness. When no agency can be enlisted in the work, or when existing agencies are inadequate to the task, then only will the Commission undertake to create new machinery for dealing with the special problems. I was much impressed with the ability of the Commission's agents to enlist the cooperation of other organizations. The Commission seems to be upon the most cordial relations with other State and private social agencies, and enjoys the respect of the most advanced social workers in the community. The Commission has shown a willingness to do its special task in the light of its relation to a general program which has won for it the most cordial approbation of those striving to coordinate social effort in the State. This requires patience and forbearance, for there is a danger that an organization working in behalf of a class of people which makes so strong an appeal to public sympathy as do the blind may retard the achievement of certain desired ends by endeavoring to keep step and to work shoulder to shoulder with others in a comprehensive social program. This plan of cooperation, though, wins for the Commission friends who are invaluable in a thorough-going system of case-work.

COOPERATION WITH AGENCIES FOR THE BLIND

The relation of the Commission for the Blind to special agencies organized in behalf of the blind is very close. The Massachusetts Association for the Blind works in such close harmony with the Commission that it is difficult for an outsider to determine the exact line of demarcation between the activities of the Commission and those of the Association. The mechanical connection between these organizations, brought about by the presence of a member of the Commission upon the Board of the Massachusetts Association, is an illustration of the close cooperation of these two agencies, rather than an explanation of it. The close team-work of these two organizations grows out of a singleness of purpose and the unselfish devotion to the cause of the blind actuating both. The value of a private association for the blind in working out a general State program is so manifest as to make one wonder how other State commissions manage to operate without such an auxiliary. The convenience of an association or this kind, unlimited by legislative restrictions or considerations of public policy, makes many undertakings in behalf of the blind possible which might otherwise be left unattempted. Possibly the most valuable assistance which this Association renders in the solution of the problem of the blind is its recreational work. Perhaps the blind need recreation quite as much as employment, but public opinion is not yet clear enough upon this point to make it possible for a State agency to give this side of the work its due attention.

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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.

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Public Schools

Conservation of the vision of school children has received much attention at the hands of the Commission during the past two or three years. As a result of studies made in several Massachusetts cities, classes for children with impaired eyesight have been opened in Boston, Cambridge, New Bedford, and Springfield. Similar steps are under contemplation in other cities of the Commonwealth. After the establishment of these classes, no official connection with them is maintained. The nearest approach to this is the regular visits made by a conservation of vision agent of the Commission upon the pupils in one of the Boston classes. By means of these visits, an effort is made to keep the teacher of this class constantly informed as to the eye condition of her charges. As these special conservation of vision classes form but a very minute part of the general school system which maintains them, and as the average public school official knows very little about the problem which these classes are designed to meet, it is to be regretted that there is no scheme by which those in the State most interested and best informed upon this subject can insist upon general principles and standards in their operation. For example, it is to he deplored that, when a city opens classes which depend for their success upon a great deal of individual attention, a minimum enrollment should it he fixed which is so large as to make any amount of individual instruction impossible. I should recommend that some plan be worked out by which cities opening such classes may receive a State subsidy similar to that allowed by the States of Wisconsin and Ohio. The State assistance rendered vocational training schools in Massachusetts would, it seems to me, afford a valuable precedent. With such a subsidy, the State could exercise a supervision which would tend to standardize methods and greatly increase the efficiency of such instruction. This supervision should be removed as little as possible from the State scheme of public instruction. It would be most valuable, however, to give the State Commission for the Blind a certain voice in the direction of these classes which form so important a part of the conservation of vision work of the State. It would seem feasible to establish some joint arrangement between the State Commission for the Blind and the State Board of Education which would give to the direction of these classes the wisdom of the former and the prestige of the latter.

PROBLEM OF BLIND RELIEF.

At best, most of the work for the adult blind must be of a palliative nature. In the mind of the lay public, and to some extent among workers for the blind, there is a lack of definiteness of purpose in dealing with the problems presented by the blind men and women of the community. To a larger extent than in most social work must the individual be considered case by case, rather than as a member of a class. Some one has said that there is no problem of the blind. Each individual blind person is a problem in himself. However true this may be, there are a few rather clearly defined fundamental principles. The needs of those who come to the attention of an organization such as the Massachusetts Commission for the Blind are for the most part education, employment, recreation, or relief.

Any general work for the blind attempts, in a measure, to satisfy these four demands which stand in the way of self-expression. Sometimes these needs have been of so long standing that even the desire for self-expression has largely subsided. Then must the worker for the blind endeavor to stimulate and direct this desire. For the most part, however, one should endeavor to meet these needs and then step aside, so as not to interfere with freedom of expression.

Workshops and Augmentation of Wages

The workshops of the Commission were organized with two fundamental aims. The major consideration is that of employment; the minor object is to pay wages. It is the combination of these two aims, with the emphasis upon the element of employment, which justifies the expenditure of upwards of a dollar or more to pay the blind employee a dollar. The industry has not yet been discovered which can be operated with an unselected group of blind employees in such a way as to pay from the profits' a wage which will enable the less efficient members of the force to support themselves. Many employed blind persons, therefore, are still subjects for relief. It is the policy of some workshops, if not practically all of them, to pay larger wages than is justified by the profits on the enterprise. Up to a certain point this wage in excess of profits is the justifiable cost of meeting the need of employment. There is no agreement among workers for the blind as to just what relation this cost of providing employment should bear to the profit on the industry from which the true wages are paid. This is determined in each shop, either by the limit of the resources available or upon the grounds of policy.

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I was not able to ascertain that the Commission had any uniform policy in this connection which might be said to apply to all of the industrial departments. The shops outside of Cambridge have worked out an ingenious system of augmenting the wages of the less efficient blind persons in a way well calculated to bring the workmen's income more nearly to a point upon which he can exist without discouraging the more efficient and more energetic operatives. This augmentation of wages may or may not be considered relief. It depends upon its object. If the object is simply to give the blind man funds sufficient to enable him to live without depending upon others, then it is relief. But if the object is to encourage him to greater efforts, especially while he is attaining greater skill, then it should be regarded as the cost of training or the cost of employment. If the latter view be taken, the system of augmenting wages should be continued in some form until his wage reaches a point upon which he can maintain a more decent subsistence. If this be considered the cost of training, it should be continued only so long as the apprentice shows progress. If the management considers this augmentation a relief, it should be carefully separated from wages in the minds of the employees. Without attaching a stigma to its reception, there should be stimulated an earnest desire among the workmen receiving it to reach the point where his wages will no longer need this augmentation.

Payment of Board of Apprentices

Another form in which the Commission dispenses money for the direct assistance of individual blind persons is the payment of board of apprentices. At first thought, this might seem to be relief. But since this policy was adopted in lieu of a residential trade school for adults, I think that it should be charged to educational activity.

Industrial Aid Fund and Homes for the Blind

Two forms of relief have been considered by the Commission -- first, the Occupational Colony, and second, the Industrial Aid Fund. That which has attracted the most local attention in Massachusetts is the Occupational Colony -- in its later form, the Industrial Home. Many blind people of the state have condemned this as a "blind man's poorhouse." In spite of all the efforts which might be made to keep this institution from assuming the tone of an almshouse, I feel confident that a weak administration would sooner or later come which would justify the appellation of its opponents. An institution which endeavors to be a temporary abode for men learning a trade, and at the same time a permanent residence for workmen unfit for one reason or another to hold their own in the community, must be confronted with innumerable problems. I am convinced that the only way to operate successfully such an undertaking would be to separate carefully, both in place and management, the industrial school from the permanent home. Otherwise, there will be constant dissatisfaction on the part of certain apprentices who are forced to resume life in a normal community, while those compelled by circumstances to remain at the home will complain bitterly at not being given another chance in the day shops. The question whether or not Massachusetts is in need of an industrial training school with boarding facilities in connection is a question which does not fall within the purview of my examination. As to the need of an employment home for the blind, I must confess that I was not convinced by the agents of the Commission that the peculiar character of the blind population of Massachusetts justifies one in disregarding the general considerations against such an establishment. Any plan for the segregation of persons, on the basis of a common infirmity removing them from intercourse with ordinary society, is out of keeping with twentieth century social work. Workers for the blind in Massachusetts during the past three-fourths of a century have done more than any others to persuade the world that a permanent employment home for the blind is unwise and unnatural. Any step toward the creation of such a home in the face of the Massachusetts tradition upon this subject should be most carefully weighed before it is entered upon.

Industrial Aid Fund

There remains one more form in which it has been proposed that the Commission dispense funds directly to blind persons. This is the Industrial Aid Fund. This comes as near the payment of actual relief money as, in my opinion, the Commission should approach. If wisely and fearlessly administered, it will enable the Commission to assist a group of blind members of the community in a truly constructive way. This aid may sometimes be actual relief. In other cases it may be cost of employment; in still other cases it may be in a sense chargeable to educational work. So far as it is actual relief, the Commission should make its payment a temporary arrangement until some other agency can be found which will take over this expense under the supervision of the Commission. In cases where it is the cost of employment, it is quite as legitimate a permanent undertaking as the operation of the workshop.

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Aid from Relief Agencies

For more than a quarter of a century the blind people of Massachusetts have urged the General Court from time to time to grant a "pension" to the needy blind residents of the Commonwealth. This claim is based upon the conviction that there is a large amount of poverty which may be traced directly to the handicap of blindness. Since this poverty resulting directly from blindness is due to no fault of the individual himself, the blind people, feel that it should be relieved in some direct way which will carry with it no social stigma. Furthermore, it should be associated with none of the indignity which so frequently accompanies a searching social investigation. Not being social workers, and not being trained in the modern principles of organized philanthropy, an easily obtained flat rate "pension" to all needy blind persons seems to them the simplest and most effective solution of the situation. It is admitted by the advocates of the "pension" that it may result in a certain amount of fraud. But the sums of money received by fraudulent means, it is contended, will not be likely to exceed the cost of a thoroughgoing system of investigation. It is further contended that the unsophisticated needy blind persons are no more likely to make incorrect statements of their condition than are the "high-salaried" investigators who feel that it is incumbent upon them to make findings which will justify their employment.

The granting of relief by moderns organizations is an effort to relieve poverty not on the basis of pity, but on the basis of justice. If this be true, it is a reflection on the efficiency of this machinery that there should be connected with the reception of such relief a stigma which tends to degrade the individual who is so placed that he must continue to receive the alms and bear the disgrace. Perhaps nowhere in the country is the reluctance to become a "pauper" stronger than in New England. This, of course, has its beneficial effects in restraining persons who might otherwise endeavor to impose upon charitable agencies, but there can be no question that it works a hardship upon certain persons, some of whom are without sight, who are compelled to sell their respect in this connection in order to obtain the necessities of life. It is the half-conscious conviction of the public of the injustice of this situation which made the authors of the Mothers' Aid Law declare the recipients not to be "paupers," while at the same time prohibiting such mothers from obtaining settlement in any town while receiving this public aid. This is why we have "pensions for the blind" instead of "blind relief." It is an effort to attach to the reception of blind relief that sense of just due which has grown up in the public mind around the soldier's pension. This, however, is a subterfuge which carries with it dangers of a fundamental nature. It is an effort to relieve certain classes from the effect of a certain error in the administration of charity without attacking the error.

Whether or not Massachusetts is in need of a special blind relief law is a question upon which I, in my short visit, was not able entirely to satisfy myself. I feel certain that unless those most competent to solve these problems work out some general plan for the relief of the needy blind in a way carrying with it no stigma, the lay friends of the blind are going to take matters into their own hands. Special "blind pensions" and "blind relief laws" seem to be the order of the day throughout the country. They have been hastily drawn by persons who have made no thoroughgoing investigation into the operation of similar laws in other States. Blindness makes its own strong appeal, and, if I mistake not, the people of Massachusetts, in the long run, are not unlike those in our States farther West.

An effort is being made by the Massachusetts Commission to let the real facts regarding the granting of relief to blind persons by the various towns of the State. The information available at the time of my visit, indicated that in a few districts overseers of the poor had taken into acccount the special needs of the blind in fixing the amount of relief granted, but in most cases the sums allowed to the blind applicants are the conventional amount doled out to paupers of the community.

It cannot be denied that the handicap of blindness forces the most efficient sightless person down far nearer the poverty border line than he would otherwise be. Consider, for example, the case of a man with a modicum of vision, which enables him to take his place in the community in some inferior position. He may have intelligence and energy slightly superior to his associates, and by the exercise of ingenuity and unflagging industry is able to earn a wage amounting to possibly two-thirds of what the average man with sight would be able to command. The limitation in his wage means self-denial amounting in many cases to inadequate food, clothing, and medical attention. He cannot select occupations which will be healthful, and must many times work under unsanitary conditions. He cannot save against the "rainy days" which are bound to come to him sooner than to other men. The first sign of breaking throws him upon the public. Such a man should not be forced into an almshouse, nor should he be compelled to submit to the disgrace usually associated with town relief.

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Again, take the case of an old woman who has lost her sight in later life. She goes to the home of the relative upon whom she has the greatest legal and moral claim. If she could see, she would do many little things about the house that would go far toward making her welcome there. As she is blind, though -- and blind after the age of ready adaptation -- she is not a help in any way, but a great care to the family. In appealing for relief to the overseers, it would appear from the Commission's investigations that she is usually treated upon exactly the same basis as is an elderly woman with sight.

Again, take the case of a young woman who has attended a school for the blind, or who has had a good education before losing her sight, with all the refining influence and raised standards of living which go with such an early training. It is obvious that a larger percentage of such women are likely to become more or less charges upon the public than those enjoying eyesight. Her high standard of living resulting from her early education makes her feel the sting of poverty much more keenly than does the typical recipient of relief. Those best acquainted with the blind realize that the poverty line for her is much higher up in the scale of weekly income than for those who have not had her early advantages.

These are but three typical cases. One could multiply them indefinitely. The fact is, in my judgment, that blindness should be taken into consideration as a large contributing factor in making persons fit subjects for outdoor relief. The flat pension without investigation, without adjustment to other incomes, and without corresponding demand for some sort of return from the individual, is not the true solution. Blindness in itself seldom carries with it any claim upon the public, but blindness in itself does tend to convert otherwise self-supporting persons into dependents. It is not fair to the blind, whose road is already hard enough, to subject them either to the pangs of keen want because their special need is not realized; nor is it fair to subject them to the stigma accompanying the reception of outdoor relief when they are forced to this situation by no fault of their own. Blindness makes a stronger appeal to public sympathy than does almost' any other handicap. Let us not delay special provision for this class simply because other handicapped persons should be included in the social program of which special blind relief is a part. Those most enlightened concerning the problems of the blind, and those upon whose interest the blind have the greatest claim, should endeavor rather to blaze the way for handicapped classes. If, in so doing, we can formulate a plan for special aid that will dovetail into any general social program to be completed later, then so much the better.

My study of the Massachusetts situation convinced me that there were two steps which may be taken for adequately meeting the needs of the blind for relief. Perhaps the wiser plan will be to try to take one step and, should if prove inadequate, then to try the other. The first step, it seems to me, is one which the Commission can properly take without disrupting its machinery. This is the appointment of agents to act as special advocates of the blind wherever persons without sight are making a just appeal to the overseers for relief. It may be that these special advocates will in time be able to so educate the overseers and the public that justice will be done to the blind without a special relief law. This must, of course, take years to accomplish, and the patience of the blind and their friends will be tried many times before anything approaching a satisfactory condition will be obtained. Should this prove inadequate or impracticable, a special blind relief law in some form is hound to come. In formulating such a law, it appears to me that there is a valuable suggestion contained in the Mothers' Aid Law. In brief, the Mothers' Aid Law authorizes boards of overseers of towns to provide adequate relief to needy mothers of dependent children. One-third of the money thus paid is refunded to the town by the State on condition that the overseers administer the relief in a way improved by the State Board of Charities. In this way the Board of Charities is able to supervise and standardize the administration of this aid.

I would suggest that some such plan be followed in respect to the blind. The supervision, however, should be shared jointly by the Commission for the Blind and the State Board of Charities. The State Board of Charities should have the bulk of the responsibility. This would insure an administration of the blind relief in accordance with approved principles of granting relief laid down by the State Board of Charities, and at the same time the Commission for the Blind could see to it that the peculiar angle growing out of blindness is not disregarded.

One of the grounds of dissatisfaction with the State Commission for the Mind voiced by the Welfare Union is the lack of a representative blind person upon this Board. The contention is that some blind person who is taking a success in life under the handicap of blindness should be appointed. Such a person, they feel, would be, in a sense, their special representative, to whom they could appeal with a confidence of sympathy and comprehension.

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This criticism contains a certain element of truth. Should the Governor at some future time see fit to comply with this demand, much care should be exercised in the selection of the blind person. Without the presence on the Board of a representative blind man who has won his way in spite of his handicap, every member of the Commission feels it incumbent upon him to strive to see for himself the blind man's point of view. With such a practical blind person upon the Board, the other members will be likely to shift upon him the responsibility for calling to their attention the special viewpoint of the blind. Should this "practical blind man" he incapable of properly presenting this aspect at all times, the net result might be greater neglect of the special wishes of the blind than grows out of the present composition of the Board.

There is one way in which the Commission might come closer to some of the blind people than it now does. In a large measure the public knowledge of the Commission for the Blind throughout the Commonwealth emanates from the blind people themselves. An effort should, therefore, be made to inform this group of people in some definite way as to just what the Commission is doing. A special Braille edition of an annual report not exceeding 10,000 words might be sent to a few hundred sightless readers. This would involve an initial expenditure of twenty or thirty dollars for plates, and perhaps fifty cents a copy for the report.

Respectfully submitted,
R.B. Irwin