Library Collections: Document: Full Text

The relatives or friends of the blind who may be sent to the institution are requested to furnish information in answer to the following questions:

1. What is the name and age of the applicant?
2. Where born?
3. Was he born blind? If not, at what age was his sight impaired?
4. Is the blindness total or partial?
5. What is the supposed cause of the blindness?
6. Has he ever been subject to fits?
7. Is he now in good health, and free from eruptions and contagious diseases of the skin?
8. Has he ever been to school? If yes, where?
9. What is the general moral character of the applicant?
10 Of what country was the father of the applicant a native?
11. What was the general bodily condition and health of the father, --was he vigorous and healthy, or the contrary?
12. Was the father of the applicant ever subject to fits or to scrofula?
13. Were all his senses perfect?
14. Was he always a temperate man?
15. About how old was he when the applicant was born?
16. Was there any known peculiarity in the family of the father of the applicant; that is, were any of the grandparents, parents, uncles, aunts, brothers, sisters, or cousins, blind, deaf, or insane, or afflicted with any infirmity of body or mind?
17. If dead, at what age did the father die, and of what disorder?
18. Where was the mother of the applicant born?
What was the general bodily condition of the mother of the applicant, --strong and healthy, or the contrary?
20. Was she ever subject to scrofula or to fits?
21. Were all her senses perfect?
22. Was she always a temperate woman?
23. About how old was she when the applicant was born?
24. How many children had she before the applicant was born?
25. Was she related by blood to her husband? If so, in what degree, -- first, second, or third cousins?
26. If dead, at what age did she die, and of what disorder?
27. Was there any known peculiarity in her family; that is, were any of her grandparents, parents, uncles, aunts, sisters, brothers, children, or cousins, either blind, or deaf, or insane, or afflicted with any infirmity of body or mind?
28. What are the pecuniary means of the parents or immediate relatives of the applicant?
29. How much can they afford to pay towards the support and education of the applicants?

For further particulars, address M. ANAGNOS, DIRECTOR OF THE INSTITUTION FOR THE BLIND, South Boston, Mass.