Supplemental Schedule 5: Blind

The object of this Supplemental Schedule is to furnish material not only for a complete enumeration of the blind, but for an account of their condition. It is important that every inquiry respecting each case be answered as fully as possible. Enumerators will, therefore, after making the proper entries upon the Population Schedule (No. 1), transfer the name (with Schedule paper and number) of every blind person found, from Schedule No. 1 to this Special Schedule, and proceed to ask the additional questions indicated in the headings of the several columns. In this enumeration will be included not only the totally blind, but also the semi-blind. No person will be carried on this Schedule, however, who can see sufficiently well to read. For the distinction between the totally blind and the semi-blind see Note E; it is of the greatest importance to note this distinction with care, by making the proper entry in columns 10 or 11.

Number taken from Schedule No. 1
01 Number of Page
02 Number of Line
03 Name
Residence when at home. -(See note A.)
04 City or Town
05 County (if in same State), or State (if in some other State)
06 Is he (or she) self-supporting, or partly so? (See Note B.)
07 Age at which blindness occurred. (See Note C.)
08 Form of blindness. (See note D.)
09 Supposed cause of blindness, if know.
See Note F.
10 Is this person totally blind? (See Note E.)
11 Is this person semi-blind? (See Note E.)
Institution Life
12 Has this person ever been an inmate of an institution for the blind? If yes, give the name of such institution.
13 What has been the total length of time spent by him (or her) in any such institution?
14 Date of his (or her) discharge. (Year only.)
See Note F.
15 Is this person also insane?
16 Is he (or she) also idiotic?
17 Is he (or she) also deaf-mute?

NOTE A – A blind person may be found either at his own home or away from it in some educational institution, asylum, or poor-house. In the latter case, his residence when at home must be stated, in order that he may be accredited to the State or county to which he properly belongs, and that the county in which the institution is situated may not be charged with more that its due proportion of the blind.
NOTE B – If self-supporting, say “yes;” if partly self-supporting, say “partly;” if not, say “no.” Indicate all inmates of institutions who are maintained or treated at their personal expense (not at the expense of any town, county, or State, nor of the institution) by the word “Pay.”
NOTE C – If a blind from birth, say “B;” if not, state the age at which blindness occurred. Special pains should be taken to indicate all the blind from birth.
NOTE D – Where practicable, get a statement from attending physician.
NOTE E – The totally blind are unable to distinguish forms of colors; the partially blind can distinguish forms or colors, but cannot see to read, or at least not without such effort as to make reading practically impossible.
NOTE F – In making entries in columns 10, 11, 15, 16, and 17, an affirmative mark only will be used, thus /.