Discovering "Blind Tom," The Slave Turned Civil War-Era Pop Star

By Jeffery Renard Allen, 9-10-14

Several years ago I encountered the story of Thomas Greene Wiggins in the pages of Oliver Sacks’ wonderful study of unusual neurological case studies, An Anthropologist on Mars. Born a slave in Georgia in 1849, Wiggins was one of the first African-American classical performers and composers, a well-known and widely celebrated cultural phenomenon from 1858 when he first began giving stage recitals on the piano, through the 1870s and 1880s when his popularity waned. Under the stage name “Blind Tom,” he gave mind-blowing “exhibitions” where he performed interpretations of pieces by venerated composers such as Mozart, Bach, Chopin, and Liszt, while also engaging in far less conventional musical spectacle. He conjured up imitations on his piano of natural and man-made phenomena such as rainstorms and sewing machines, playing and singing three songs at once in different keys, and inviting members of the audience to test his powers of memory with their own original compositions, newly heard tunes that he would reproduce note for note before venturing off on his own variations and improvisations.

I was especially struck by Sacks’ description of Wiggins’ stage performances, his “exhibition,” as the showmanship, imitations, and other tricks seemed so far ahead of their time, deserving comparison to 20th-century performers like Roland Kirk and Jimi Hendrix, among others. I decided to find out all I could about this forgotten musical pioneer. A good year after reading Sacks, I was lucky enough to be rewarded with a fellowship to the Dorothy and Lewis B. Cullman Center for Scholars and Writers where I could begin to research Wiggins in earnest, having by then decided to use Wiggins as the basis of a novel, which carried the simple working title Tom. (Well, initially I thought Wiggins would be a principal character in a novel with three independent story lines like some of Faulkner’s novels or Caryl Phillips’ The Nature of Blood. Then another fellow at the center told me, “Cut the pretense. Just write about Blind Tom.” It took two years of starts and stops to figure out that she was right.)

A contemporary of fellow virtuosos such as Liszt and Rubinstein, Wiggins was by some accounts the highest-paid pianist of the 19th century, earning more than $100,000 annually during the period of his greatest popularity. In 1860, he performed for President James Buchanan at the White House. At the start of the Civil War, he was such a draw and respected figure that President Abraham Lincoln gave serious consideration to the idea of enlisting him in the service of the Union. And other noted contemporaries had much to say about him. Mark Twain speculated that Wiggins was a kind of “angel” who derived his musical abilities from supernatural forces. Praising the military strategies of Confederate Gen. Nathan Bedford Forrest, Ulysses S. Grant remarked, “Forrest fights the way Blind Tom touches the keys.” Willa Cather reviewed a Blind Tom recital for her college newspaper and was so impressed by his playing that she called him a “human music box.” She would go on to model the character of Blind D’Arnault after Wiggins in her celebrated novel My Antonia. Wiggins remained a public figure even after his retirement from stage, the constant subject of rumor and speculation about his fate and whereabouts. His “death” often made the headlines, with reports of him having been struck down by some affliction or claimed by a catastrophe.

But these were only the historical facts about a performer named “Blind Tom.” Who was the actual person, Thomas Greene Wiggins? This person is far harder to know and understand because the reputed firsthand reports about him are informed by the racial prejudices of the time. Added to this, Wiggins himself had remained largely silent during his life. He gave no interviews. He dictated no letters, essays, or narratives. This silence cost him. His owner and manager arranged for him to give concerts with proceeds going to the Confederacy. Because he either could not or would not speak on his own behalf, a Cincinnati court ruled not long after the close of the Civil War that he was incapable of managing his own affairs and so appointed his “owner,” Gen. Thomas Neil Bethune, a newspaper publisher and propagandist for secession, as his legal guardian. Two decades later, when Wiggins was in his late twenties, Bethune’s daughter-in-law sued for and was awarded custody of him.

How to explain Wiggins’ silence? Was he so completely unaware of his place in the world and incapable of understanding his plight that he had no reason to speak? One writer opines such, suggesting that Wiggins was fortunate because his blindness and mental incapacities saved him from knowing that he was either a Negro or a slave.

Such assumptions about Wiggins’ mental capacities have raised doubts about his musical abilities and deemed him unworthy of serious study by experts in the field. And during those rare instances where music historians choose to write about him, they do so only to hold him up for ridicule and quick dismissal as a serious artist. In his important survey The Great Pianists: From Mozart to the Present, Harold C. Schonberg speaks highly of some of Wiggins’ American contemporaries, calling them “fine and sincere musicians [who] quietly started to raise the standards of piano playing, and of music making in general.” But when he gets to Wiggins, Schoenberg engages in snide and vicious musical scapegoating: “[T]here was one celebrity who for a while attracted more attention than all of them put together—the curious and pathetic Blind Tom.” For Schoenberg, Wiggins was a “mental defective” who “could not do a fiftieth of the things credited to him. As a matter of fact, he could not do anything except play back a few tunes he knew.”

Of course, a “mental defective” would be of interest primarily to medical professionals like Oliver Sacks who specialize in studies of the brain. Sacks views Tom as one of a hundred or so “documented” savants, noting that savants “do not seem to develop as normal talents do. They are fully-fledged from the start. Savant talents, further, have a more autonomous, even automatic quality than normal ones. They do not seem to occupy the mind or attention fully and do not seem to connect, as normal talents do, to the rest of the person. All this is strongly suggestive of a neural mechanism different from that which underlies normal talents.” What this all means ultimately for Sacks is that savants are incapable of imagination and creativity. “Creativity has to do with inner life—with the flow of ideas and strong feelings. Creativity, in this sense, was probably never possible for Blind Tom.”

In deeming Wiggins an abnormal talent, Sacks is not all that far from those 19th-century observers who thought “Blind Tom” was under the control of supernatural forces, “either God or the Devil,” a notion that gave many white people who attended Wiggins’ concerts a palatable explanation for why a black person could play the piano, an instrument requiring skill and refinement, qualities that they believed black people did not possess, proof found in the black person’s penchant for the common “Negro” instruments of violin, drums, and banjo. And the whites in the audience believed that it was these same supernatural forces that enabled Wiggins to play the piano far better than any of them would ever be able to play their parlor piano forte. (Every good middle-class home had one.) Indeed, the supernatural justification was an idea of such lasting credibility that magician Harry Houdini chose to debunk it in his 1924 diatribe titled Houidini: A Magician Among the Spirits as part of his ongoing effort to reveal natural causes for paranormal claims. Wiggins’ ability to reproduce unfamiliar compositions note for note is for Houidini nothing more than an incredible feat of memory. In the end, what interests Houidini is not Blind Tom the musician, but Blind Tom the magician, the charlatan, a creator of musical illusion as opposed to music itself.

With the exception of Eileen Southern’s seminal 1971 study The Music of Black Americans: A History, African-American scholars by and large have shown little interest in Wiggins given their focus on folk idioms like the spirituals, ragtime, and the blues. (Of course, Wiggins’ apparent support of the Confederacy hardly makes him a suitable candidate for celebration and canonization, however much one sympathizes with him as a victim of white racism.) Amiri Baraka is the only noted black writer who has tried to evaluate the compass and range of Wiggins’ talent, using a 1999 recording by John Davis, a white pianist and collector of Blind Tom memorabilia based in Brooklyn, who travels the country giving recitals of Wiggins’ compositions, as the basis for his judgments. In his linear notes to the CD John Davis Plays Blind Tom, Baraka writes, “Listening to Wiggins’ compositions dispels immediately the canard that he is merely imitating. Though the pieces he played reflect the Romantic European concert ‘classics’ of the period, the careful balance of the form, the delicacy and lyric grace of even the most impressionistic passages, the skillful use of arpeggio, crescendo, the movement of the work from the lightest piano to roaring forte, mark Wiggins’ compositions as the thoughtful musings and deliberate organization of sound that can only reflect a humanity and creativity ironically much more developed than the Yahoos who unquestioningly accepted his characterization as ‘less than human.’”

The scholar who has single-handedly done the most to give Wiggins his rightful place in musical history as both a recitalist and composer is the late Geneva Southall, an African-American pianist and musicologist who taught at the University of Minnesota. Southall devoted her academic career to unearthing every scrap of information she could about Wiggins, research that she compiled into a three-volume biography published between 1979 and 1999. It is Southall’s contention that Tom’s owner, Gen. Bethune, and his manager, Perry Oliver, conspired to create the character of Blind Tom the “idiot savant” as a gimmick to draw people to his concerts. Oliver went so far as to engineer the publication of a promotional biography, which depicted Blind Tom as a “natural genius” who had never received any musical instruction and who never needed to study or practice. In painstaking detail, Southall brings to light the true facts about Wiggins the musician. He had extensive musical training in European classical tradition throughout his career, starting with his mistress Mrs. Bethune, a piano teacher. He practiced daily. As well, this supposedly natural and untutored “genius” received endorsements from respected musicians and music instructors. Likewise those who reviewed him in the press were astounded by his performances, notwithstanding the occasional negative review. Wiggins’ ability to reproduce unfamiliar songs on stage went hand in hand with a musical memory encompassing more than seven thousand compositions, an astonishing number far surpassing any other performer in recorded history, including Mozart, who is reported to have had a memory of 5,000 compositions.

To show that Wiggins was more than a mere imitator, Southall points out that he penned hundreds of compositions, several of which were best-sellers. Such is the neglect that these compositions have never been collected, let alone interpreted by others on stage or in recording, with the noted exceptions of Davis and Southall. Southall gave numerous recitals featuring the material and she was first in recording some of them, a recording which has never found general release to the public and is only available on a single tape housed at the University of Minnesota library.

Despite the excellent musicology and unearthing of facts, Southall’s biographies left me no closer in understanding Wiggins the man. This person remained silent to me. How would I tell his story? How would I represent his consciousness, the mode and manner of his thinking? What would he sound like when he spoke? With so much undecided, for the longest time I avoided listening to the Davis and Southall recordings because I feared that their interpretations would too heavily shape the sound of Wiggins’ music I was attempting to construct in my head and on paper. Then too, I had no way of gauging the accuracy of the compositions themselves since parties other than Wiggins had transcribed them. When I finally decided to have a listen, I found the recordings unremarkable and uninteresting. Wiggins’ compositions show the influence of the great European classical composers on the one hand, and on the other those sentimental motifs and conventions that defined American instrumental music at the time. Based on this small sheath of compositions, one would be hard put to make the case for Wiggins as a great composer.

But the listening did make one thing clear. The nature of Wiggins’ genius, the range of his creativity and imagination, was expressed in performance, not in composition. Blind Tom the artist, the maker, found his métier on stage. In the same way that Wiggins’ voice and thoughts were denied to me, ultimately his music was denied, the virtuosity and vitality of his performing self, because all I had about these performances were the words of others.

As I see it, on stage Wiggins was fully in line with the changing same of African-American musical expression although he never played “black” music. Black people in America have always taken “European” instruments and made them “sing.” Conversely, we make our voices sound like instruments, machines, and phenomenon from the natural world through the use of grunts, hollers, chants, and moans. And in dance the black body does things bodies are not supposed to be capable of. Little wonder that Wiggins would whirl on the stage, that Monk would do his weird steps at the piano. Perhaps it is not hyperbole when James Monroe Trotter states in his 1881 study Music and Some Highly Musical People that Wiggins was “unquestionably and conspicuously the most wonderful musician the world has ever known.” Here was a blind black slave who could play anything and do anything on stage, who could demonstrate the “infinite plasticity” that Stanley Crouch wisely says characterizes African-American music. Wiggins took the format of the recital and pulled it every which way, making it part dance, oratory, song, all the while playing the piano against the classical grain and making it sound like something other than a piano and making it do what no piano is supposed to do.

One no doubt has to be aware of the historical and cultural particulars that in part made Wiggins who he was as musician and performer, but one can also see him as an artist ahead of his times, a shortcut to modernity tragically trapped in an almost feudal era that had yet to invent an idiom that could allow for the full expression of his genius. Wiggins points ahead not only to great pianists like Art Tatum — interestingly enough, Tatum was born in 1909, one year after Wiggins died — and Oscar Peterson, but also to many other great African-American instrumentalists of the 20th century who would make lasting contributions to musical art by refusing to rigidly categorize their practice, and who would instead, as Miles Davis famously put it, “Play what the day recommends.” That is, Wiggins’ approach to singing and the piano was syncretic, a combining of modes and traditions, a moving beyond what’s there rather than a staying within accepted and set forms and genres. The rigid categories of ethnic and cultural specificity which so often define music — conventional versus experimental, religious versus secular, popular versus art, classical versus jazz, European versus African-American, etc. — reflect the rigid and arbitrary categories that so often categorize people according to pseudo-biological notions of race, especially in the 19th century.

Could it be that Wiggins’ blindness did indeed afford him a barrier from racism since his inability to see color, to see skin, saved him from buying into the false notions and prescriptions of race? On this level at least biology worked in his favor. White people were invisible to him. He had no reason to believe what they said about him, and he had no reason to speak to them or explain himself.
Where nature and fate withheld sight from him, Wiggins himself made the decision to hold his own tongue, to remain silent. Interesting that the few statements attributed to him come in the form of refusals. He turned down requests for hymns by saying, “Tom doesn’t play church music.” On one occasion, his manager took him out to the street to have his shoes blacked by a band of African-American boys, only for Wiggins to walk away, saying, “Tom won’t have his shoes blacked by no niggers.” The greatest refusal of all came in the form of a self-imposed retirement from public performance after he had been giving recitals for more than two decades. Wiggins simply refused to go on stage to play. During his retirement, journalists would come knocking at his residence with inquiries about “Blind Tom.” Wiggins would respond, “Blind Tom doesn’t live here.”

However they appear on the surface these refusals are rife with ambiguity. Wiggins’ unwillingness to play “church music” might be read as a rejection of Christianity hypocrisy and sanctimoniousness. Perhaps he refused to have his shoes blacked by “niggers” in a show of solidarity with fellow African-Americans who were also under the thumbs and boots of white people. He stopped giving concerts because he would no longer allow white people to profit from his body. And during his retirement he refused to recognize and answer to the name “Blind Tom” as this name represented a character that white people had constructed for their own enrichment and comfort.

His protest took the form of these low-keyed refusals. And they took the form of silence. Cut off from his parents and siblings, and dependent on white people for his daily survival, silence was the only means of agency available to him. In place of words he let his hands and feet do the talking and used his voice as an instrument, leaving white people to read these displays of physical and vocal dexterity any way they wanted. He did not seek their recognition or acceptance or praise. What he gave them for a time was performance, a making in the moment that they could not categorize or control. What he refused to give them was the self behind the act.

Wiggins returned to the stage in 1903 during the well-paying vaudeville era. His health quickly declined, his physical woes forcing him into complete retirement in 1905. He died in New York City three years later, in 1908, the same year that the vociferous Jack Johnson became the first black heavyweight, boxing champion of the world. (Wiggins died in June, Johnson won the championship in December.) Johnson’s victory signaled the start of the New Negro era, a political and cultural movement that would reach its peak in the 1920s with the Harlem Renaissance.

Where Johnson had fists (and defiant words and transgressive ways, habits of being) to fight the white world, Wiggins had only himself, a self he could withhold from the public, a mouth that would not speak, a tongue that refused to tell. In the end, Wiggins does not give himself up to any medical professional, biographer, or novelist for that matter. In his refusal to speak, “Blind Tom” remains beyond the purview of all who seek to tell or claim his story.
***
Jeffery Renard Allen is the author of two collections of poetry, Stellar Places (Moyer Bell 2007) and Harbors and Spirits (Moyer Bell 1999); a story collection, Holding Pattern (Graywolf, 2008); and the widely celebrated novel Rails Under My Back (Farrar, Straus and Giroux, 2000), which won the Chicago Tribune’s Heartland Prize for Fiction. His latest novel, Song of the Shank, is in stores now.

From: buzzfeed.com

Read More

Dr. Platt H. Skinner – Early Educator, Advocate, and Abolitionist

By Reid Dunlavey, Feb 2012

Conducting research on forgotten events and people that have impacted disability history can be difficult and at the same time very rewarding. This is the case in regards to a little known educator named Platt H. Skinner. In 1858 Skinner opened his “School for the Instruction of the Colored Deaf, Dumb and Blind” in what is today Niagara Falls, New York near the Suspension Bridge that crossed the border to Canada. How Skinner arrived in Western New York is an interesting story in itself, being chased from his first school in Washington, D.C. as it went up in flames. Some believe his abolitionist views led to his forced migration to the north and to his decision to establish his new school close to a known escape route to freedom for runaway slaves.

Platt H. Skinner’s arrival in Niagara Falls is a benefit for conducting research on the person, his school and activities in the region. While he was here he and his students published a newspaper called The Mute and Blind. The papers have articles on various topic including religion, health and a focus on the abolitionists of his time. Skinner also gives a detailed account of his time in the District of Columbia and his travels north to New York. They are a wealth of information, but using the newspapers can be risky considering the bias of the author. One of the best resources, and the most gratifying, I found while conducting research on Skinner was an 1858 published “Semi-Annual Report.” It was tucked away at the Buffalo and Erie County Historical Society Research Library and was even a surprise to the librarians that it was in their holdings. The report offers details of the founding, financing, and the future of the school. Skinner makes his guidelines for admission clear on the first page; the children must be black and have “deaf ears and a mute tongue, or blind eyes.” This was the case for the nine children at the school by 1858.

In many ways the report is a fundraising tool for Skinner’s school but it is also a ledger for donations to the school in the form of cash and provisions. This ledger will be the next resource for further research on Skinner. He was known for traveling, with students in tow, to raise funds by giving lectures and demonstrating the skills he had taught the children. The ledger lists these demonstrations and lectures, as well as donations, which were given throughout southern Canada from Windsor, Ontario to just outside on Montreal, Quebec. The next step in the research will be to mine the locations visited by Skinner in Canada to try to determine if he recruited any students from these visits and to discover any new information on the educator.

From: museumofdisability.org

Read More

Nutritional Night Blindness during the Crimean War and the U.S. Civil War

By Douglas Lanska, 2-12-13

ABSTRACT

OBJECTIVE: Determine whether night blindness among soldiers in the Crimean War and the U.S. Civil War was due to vitamin A deficiency (VAD) or to malingering as commonly attributed.

BACKGROUND: VAD can result in nutritional night blindness (from impaired phototransduction in retinal rod cells) and corneal epithelial disorders.

DESIGN/METHODS: Review of reports of night blindness and corneal epithelial disorders identified through compilations of the U.S. Surgeon General, electronic databases and search engines, bibliographic compilations, diaries, memoirs, medical journals, and monographs. Quantitative morbidity data were obtained from extensive tabulations of the U.S. Surgeon General from July 1861 through June 1866. Incident cases of night blindness, scurvy, and diarrheal diseases, and mean troop strength among Union troops, were abstracted by month, year, and race.

RESULTS: In both wars, medical officers commonly attributed night blindness to malingering among soldiers. However, a dietary deficiency basis is supported in both wars by: (1) the severely inadequate vitamin A content of military rations; (2) close correspondence of clinical descriptions with the full spectrum of VAD eye disease; (3) occurrence of night blindness in conjunction with other disorders that cannot be readily feigned, and that are now known to result from nutritional deficiencies (keratomalacia and scurvy); and (4) resolution of night blindness with appropriate dietary modification. Also, during the U.S. Civil War marked seasonal variation in night blindness incidence among Union soldiers corresponded closely to seasonal variations in both the availability of foodstuffs and the incidence of scurvy and diarrhea.

CONCLUSIONS: Nutritional night blindness occurred among soldiers forced to subsist on nutritionally inadequate diets during both the Crimean War and the U.S. Civil War. The seasonal pattern during the U.S. Civil War is consistent with seasonal variations in the availability of foodstuffs with high vitamin A content (or provitamin A carotenoid content) superimposed on marginal vitamin A reserves.

Supported by: Department of Veterans Affairs.

Disclosure: Dr. Lanska has received personal compensation from Medlink Neurology for medical publishing and editorial responsibilities.

From: neurology.org

Read More

Vitamin A-Deficiency Eye Disease Among Soldiers in the U.S. Civil War: Spectrum of Clinical Disease.

By Lanska DJ1., July 2015

Abstract
During the U.S. Civil War, nutritional night blindness was a common problem among soldiers forced to subsist of nutritionally inadequate diets, but medical officers typically attributed this complaint to malingering and did not suspect or appreciate a dietary basis. More than 8,000 cases of night blindness were recorded among Union troops, but many cases were not tabulated because of incomplete data for black soldiers and prisoners of war. From 1864 to 1865, during which comparable data were available for both whites and blacks, the average annual cumulative incidence of night blindness was 4.3 per 1,000 troops for whites, compared with 11.0 per 1,000 troops for blacks. Affected patients had dilated pupils that were poorly responsive to candle light. Approximately 30 cases of keratomalacia were also reported among severely malnourished and emaciated soldiers with chronic diarrhea, generally within 2 weeks before death. The reported clinical manifestations are characteristic of the full range of vitamin A deficiency eye disease from night blindness to corneal ulceration and perforation. Although medical officers typically accused affected soldiers of malingering, malingering cannot account for either the observed abnormalities of pupillary reflexes, or the corneal epithelial pathology and mortality recorded in severe cases.

From: ncbi.nlm.nih.gov

Learn more about eye disease and blindness in the Civil War era at www.CivilWarRx.com

Read More

Dr. P.H. Skinner: Controversial Educator of the Deaf, Blind and Mute, and Niagara Falls, New York Abolitionist (Article excerpt)

By Boston, Michael

Many Americans who worked to abolish the institution of slavery are unknown or forgotten. Some of them were "conductors" of the celebrated Underground Railroad. Some supported the abolition movement with financial contributions. Others secretly, and sometimes openly, taught fugitives and free blacks how to read and write, often to the displeasure of their communities. Collectively, they were the force that demanded that their elected representatives end slavery. Without their courage and persistence, slavery might have lasted much longer.

P. H. Skinner (or: Dr. Platt Henry Skinner) was one of those unsung individuals, who was vehemently opposed to slavery and expressed his views vocally and in print. Moreover, evidence indicates he may even have participated in Underground Railroad activities in Niagara Falls, New York, one of the final stations on the journey to freedom. Nonetheless, most sources documenting Skinner's activities underscore his role as an educator and a controversial figure.

We first encounter Skinner in 1856 in Washington, D. C., when he appeared in Washington with five children who were deaf, blind or mute. He had brought these children with him from Canada via New York State. They were the children of fugitive slaves and had been born in Canada. When he came to Washington, Skinner had plans for establishing a school for deaf, blind and mute children. He let his ideas be known, and he attracted the attention of Amos Kendal, a journalist, businessman and Democratic politician, whose wife was deaf. Kendal, who was about seventy when he met Skinner, had been a key member of President Andrew Jackson's cabinet. Kendal helped Skinner to acquire "a house and two acres, helped him set up a board of directors, and introduced a bill in Congress, which rapidly passed, incorporating the Columbian Institution for the Deaf and Dumb and the Blind, and providing an allowance of $150 a year for each local child admitted. To make the public aware of the school, Skinner or Kendal announced in an advertisement in The National Era, a local Washington newspaper, that Friday afternoon of each week would be set apart for the reception of visitors at the Institution. They also invited their friends. Other advertisements to make the public aware of the school were also published from time to time.

A few months after the school opened, a washerwoman of one of Kendal's friends, who had a son in Skinner's school, complained to her employer that her son had been badly cared for and neglected. Her employer informed Kendal, and Kendal and another board member immediately went to the school. The school's door was locked and the children that were there did not know how to unlock it. Kendal and the board member knocked the door down and entered the school. There they observed that the children had indeed been neglected, and two of them lay on a pallet, moaning. The children appeared to have been suffering from heat exhaustion. It is not clear if Skinner was in error, but he appeared to be responsible. Kendal sued in court and obtained custody of the five children Skinner had brought from New York, while the other children were temporarily returned to their parents until Kendal found a new school principal and building.

Skinner, however, protested and put up a strong fight, arguing that his students were not badly cared for or neglected, and that he was being persecuted, not only due to a misunderstanding, but also because he was a northerner and an abolitionist who taught and practiced equality at his school. He allowed black children to eat at his table with him, and he taught black and white mute and blind children together in his school on equal terms.

The fact that Skinner was raising equality issues in Washington should be understood fully in the context of the times. Up until 1850, the domestic slave trade was practiced extensively in Washington, and indeed the city was a major slave-trading center. …

From: questia.com

Read More

Prevalence of Major Eye Diseases Among US Civil War Veterans, 1890–1910 (Abstract)

By Frank A. Sloan, PhD, Daniel W. Belsky, BA, and Idrissa A. Boly, MA

Objectives

To estimate the prevalence of major eye diseases and low vision or blindness in a national sample of male US Union Army veterans from 1890 to 1910 and to compare these prevalence rates with contemporary rates for the same diseases and visual status.

Design

Longitudinal histories of 16 022 white Union Army veterans receiving disability pensions from 1890 to 1910 were developed from pension board examination records. Prevalence rates of trachoma, corneal opacities, cataract, diseases of the retina and optic nerve, and low vision or blindness were calculated in 1895 and 1910. Changes in prevalence by age were examined.

Results

By 1910, 11.9% of veterans had low vision or were blind in both eyes. Prevalence of cataract increased with age, resulting in 13.1% of veterans having had cataract in one or both eyes. Rates of trachoma were 3.2% in 1895 and 4.8% in 1910. Rates of corneal opacity were 3.0% and 5.1%, respectively. Glaucoma was rarely diagnosed from 1890 to 1910, but diseases of the optic nerve were reported in 2.0% of veterans in 1895 and 3.6% in 1910.

Conclusions

This study documents substantial reductions in the prevalence of low vision or blindness and changes in the composition of eye diseases from an era in which there were few effective therapies for eye diseases to the present.

From: ncbi.nlm.nih.gov

Read More

Definite Iindeterminacy: Blindness in the Civil War

By Vanessa Meikle Schulman

"[The wound around his eye] has been constantly open, suppurating and discharging ever since … with loss of strength and increasing blindness in the left eye which is very weak & he is less & less able each year to do any manual labor or care for himself. "

Applying in 1882 for an increase to his Civil War pension, Private James M. Greenleaf, who received his facial wound at the Battle of Fredericksburg in 1862, attempted to convince the government that his eye—unhealed and rapidly losing its sight—was so debilitating as to prevent him from earning a living through gainful employment. To the above statement in his pension application, Greenleaf added an “affidavit signed by 24 acquaintances stating that his wound was worse than the loss of an arm or a leg.” Though Greenleaf also complained of pain in his hip, it was the wound to his face, with its leaking pus, that made him “totally & permanently helpless,” as the government surgeon wrote on examining him in 1907. The claim that Greenleaf’s partial blindness incapacitated him more than the amputation of a limb stands out in a narrative—one of pathos, to be sure, given how frequently his applications were rejected by the government—that was all too common throughout the post-Civil War era. I take Greenleaf’s story not as a representative case of the logistical problems faced by veterans of the Civil War but rather as a signpost to a larger cultural narrative that emerged as a response to war trauma in the years following the conflict: that of blindness.

Two eyewitnesses to the war, author Ambrose Bierce and artist Winslow Homer, used different artistic media to come to terms with the trauma of the war. I argue that instead of being mere “realists,” as they are often described, they used metaphors of blindness or compromised vision in their literary and artistic works. Bierce and Homer deploy these strategies of incomplete representation as a commentary on the futility of using traditional forms of representation to depict the unprecedented horrors of mechanized warfare. Though working in different media, both men questioned how one might begin to represent such a conflict. After examining the ways that both Bierce and Homer developed theories of truth and vision, this essay will examine different modes of “blindness” that they presented in their representations of the war. These modes range from the paradoxical narrowing of vision created by technologies specifically designed to enhance natural sight, the moral and literal blindness of participating in a military engagement, and, finally, the ways that their war experiences caused both Homer and Bierce to question their own self-knowledge and clarity of vision.

The project of representing the Civil War took place in an atmosphere of widespread popular visual culture, manifested primarily in forms that were easy to mass-produce and disseminate. These forms of visuality—most notably popular illustration and photography—emerged in the 1850s in a reproducible form more or less similar to those they took during and just after the war. Displayed in prominent photographic galleries or seen every day in the pages of the illustrated magazines that dominated American news in the 1860s, these images familiarized ordinary viewers with horrific scenes of modern, industrialized warfare. Homer and many of his fellow artists such as Theodore R. Davis, Edwin Forbes, and William and Alfred Waud worked as “special correspondents” during the war, sketching scenes of battle and everyday events of camp life for the most popular illustrated weekly magazines of the nineteenth century, Harper’s Weekly and Frank Leslie’s Illustrated Newspaper. Both publications began circulating in the mid-1850s and both experienced massive increases in their readership during the war years, partly due to their exhaustive and timely visual coverage of the conflict. At the end of the war both magazines maintained competitive circulations, reaching audiences of hundreds of thousands each week.  Advancements in the printing press and technologies of reproduction generally, in addition to increased speeds of communication between reporters on the front lines and their editors in New York, created a visual milieu saturated with war reportage, maps, humorous scenes of military life, and portraits of heroic generals. The “faces and events which the war has made illustrious,” appeared often “tacked and pinned and pasted upon the humblest walls.”

Photography, too, contributed to the ways that nineteenth-century Americans visualized the war. While common soldiers still had their daguerreotypes made before leaving home, the newly-invented wet collodion plate process, with its drastically reduced exposure times and ability for replication using glass negatives, changed both the appearance and functions of photography. The collodion process allowed commercial photographers to take easily reproducible images of the war, though not, crucially, of the action. The photographs that have become famous—shots of bloated corpses on the battlefield at Gettysburg taken by the studio of Alexander Gardner and stark photographic documents of survivors’ ghastly wounds compiled by army surgeon-photographers such as Dr. Reed B. Bontecou—would seem to attest to photography’s supposed objectivity. Of course, despite the indexical nature of the medium, even early photographs were doctored or manipulated. Despite this, the first viewers of Civil War photographs, notable among them the prominent Boston physician Oliver Wendell Holmes, Sr., viewed the images as “terrible mementos” capable of truthfully illustrating “what war is.”

Our perception of photography’s access to the “real,” its status as an impression from a thing that has been, gives it an important role in the reliving of trauma, as Michael S. Roth argues. He notes the apparent ability of photography to bring a “distant real” to the viewer, “making the temporally distant present.” He continues, “Photographic images seem to offer the possibility of reexperiencing the past, or of experiencing a past for the first time without a subjective intermediary.” In this interpretation, the very distinctness of Civil War photographs would seem to be a mechanism for facing—literally—the trauma of the national schism, for seeing it in the most straightforward light possible. It is the direct gaze forced by photography that allows one to deal with trauma; as Roth writes, “traumas seem to urge us not to look away.” In her article on Civil War medical photography cultural historian Kathy Newman reacts to the images of mutilated young men confronting the camera directly, which she characterizes as stark medical documents that “assaulted [her] senses.” As a scholar and a humanist, she claims, one “can neither refuse nor transform their traces of violence.” Newman argues that only through an intimate visual encounter with these images can their pain and discomfort be discharged; a greater disservice is done to the wounded in turning away, in not seeing, than in gazing at their wounds. And yet I argue that Bierce’s and Homer’s suspicion of vision is not a cruel rejection of pain but a legitimate and common response to the trauma of the war. Artists who attempted to depict the war faced obstacles, one of which was the inability of traditional modes of representation to express the political complexities of the war and the deep pain and confusion it caused to those who witnessed it. As Steven Conn records in his study of history paintings of the Civil War, the traditional narratives belonging to that genre—in the American context, most frequently nationalistic and teleological fictions of inevitable progress—were not applicable to this war. It was difficult to accept an overtly nationalistic interpretation of the conflict without mortally offending half the population, and a war in which crucial industrial and transportation infrastructure was damaged on both sides could hardly be said to contribute to progress. There also seemed to be a crippling lack of consensus on the causes and goals of the war—a topic that still bedevils scholars today. The war was, in Conn’s estimation, an event of “narrative trauma,” one that saw the collapse of “traditional representational strategies, the familiar ways of creating order and coherence out of experience.” Uncertainty about the best ways to represent the war stifled the traditional outlets of patriotic battle painting and hagiographic portraits of charismatic generals, leading to a breakdown in visual representation, at least among “high” art circles.

To this uncertainty we may also apply what transcendentalist philosopher Ralph Waldo Emerson termed the “angle of vision,” a moment when “the poles of the eye should coincide with the axis of the world” and the subject reach enlightenment. Throughout his writings, Emerson attempted to make sense of the individual’s capacity for acquiring spiritual knowledge using metaphors of vision, referring to the eye as the “first circle” of the perceived world. According to Emerson, writes literary scholar Sherman Paul, men might reach a “higher” state when “seeing became a unitary act” that combined physical, mental, and spiritual forms of knowledge. Tragically, in the Civil War, such elevated vision revealed itself as an impossible achievement and the “angle of vision” turned out to be oblique. Into this traumatic void stepped artists like Homer and Bierce who, instead of becoming paralyzed by the inability to represent the war through traditional means, adopted stylistic and formal tropes of blindness as metaphors for the dislocating experience of the war itself.

Bierce, Vision, and the Devil’s Dictionary

Both Bierce and Homer served on the front lines of the war, though in vastly different capacities. Bierce enlisted in the Union Army’s 9th Indiana Infantry regiment in 1861 and for the following four years served in the army as an infantryman until becoming a military engineer and mapmaker around 1862. Bierce suffered physical and emotional trauma during the war years. He fought in the Battle of Shiloh in 1862 and sustained a major head wound at the Battle of Kennesaw Mountain in 1864, experiences that influenced his later Civil War works profoundly.  After the war, Bierce became known for the acerbic humor and spare realist prose he employed to document his experiences during the conflict. Traditional interpretations of his work, such as journalist and critic H. L. Mencken’s comment in 1927 that Bierce was “the first writer of fiction ever to treat war realistically,” often focus on his evocation of war’s horror through precise details, sparingly and simply told. Yet Bierce’s Civil War stories contain another, more disturbing, theme: that of the impossibility of using vision alone to comprehend the full enormity of the war. Cathy N. Davidson adopts this perspective, arguing that in his stories Bierce consistently structures the narrative “in such a way that the nature of the self, the nature of the world, and the nature of the relationship between the two are called into question.” To Davidson’s interpretation I would add the peculiarly visual nature of Bierce’s writing and its contribution to this exploration of the interplay between inner and outer truths. To his constant focus upon explicit visual details Bierce adds moments when the abilities of sight break down, when epistemological knowledge cannot be gained by mere vision. Bierce intersperses vivid descriptions of the war’s mise-en-scène with ruminations on the instability of sight. His characters withdraw from the visual world in tragic errors of misrecognition or stumble blindly without vital visual information.

Bierce’s contrarian self-presentation in print makes it difficult to assess his attitudes toward the traumatic events he had witnessed as a member of the army. His sarcasm and rejection of sentiment may have functioned as a mechanism for repressing scenes better forgotten, though the grotesque forthrightness of some of his descriptions, such as this one from the short story “Chickamauga,” suggest a willingness to engage in depth with the more horrific elements of the war: “The man … turned upon him a face that lacked a lower jaw—from the upper teeth to the throat was a great red gap fringed with hanging shreds of flesh and splinters of bone.” Bierce’s stories are peppered with such horrific evocations of wartime injuries. However, the larger thematic thrust of his work is taken up with the difficulty of searching for truth amid such chaos. A close examination of entries from Bierce’s Devil’s Dictionary, a collection of humorous definitions of common words that he published serially in American magazines starting in 1875, demonstrates that Bierce took his own role as an interpreter of truths quite seriously. Under the entry for “geographer,” Bierce’s own profession during the war, he quips that he is “a chap who can tell you offhand the difference between the outside of the world and the inside.” Underlying Bierce’s humorous cynicism is the implication of a separation between the external and internal worlds, the sphere of things and that of thoughts, matter and mind. Nineteenth-century American culture was deeply concerned with whether external appearances offered a reliable reflection of the inner life of things and people. An underlying anxiety about the authenticity of images and people pervaded the postwar years as Americans pondered the complexities and contradictions of life in the modern nation. Bierce proposes himself as a guide to the gaps between observed realities and lived experience.

Importantly, Bierce also proposes himself as a figure who sees properly, sees things others cannot. A self-described cynic (the first edition of the Devil’s Dictionary was titled The Cynic’s Word Book), Bierce defined his own vocation thus: “A blackguard whose faulty vision sees things as they are, not as they ought to be. Hence the custom among the Scythians of plucking out a cynic’s eyes to improve his vision.” The emphasis on vision again makes an explicit reference to Bierce’s role as a revelatory figure uncovering truths that others would rather not face. But ironically, this vision is only “faulty” when seen from the point of view of an optimist, the cynic’s foil and bête noire. Bierce excoriates the philosophy of optimism using another visual metaphor: “Being a blind faith, it is inaccessible to the light of disproof—an intellectual disorder, yielding to no treatment but death. It is hereditary, but fortunately not contagious.” The optimist’s blindness causes him to mis-see, to believe “that everything is beautiful, including what is ugly.” The cynic’s “faulty” worldview is, in Bierce’s estimation, far the more truthful. But it is also threatening to the hegemonic establishment of optimists, who visit violent trauma upon the cynic, correcting his “faulty vision” by the extreme expedient of creating a state of total blindness.

Bierce would probably have greatly appreciated—if in an ironical fashion—the disapproving review his 1892 collection of war stories received in the Atlantic Monthly, an apotheosis of the optimist’s rejection of the cynic: “It has never been our fortune to read a collection of tales so uniformly horrible and revolting. Told with some power, and now and then with strokes of wonderfully vivid description, with plots ingenious in their terror and photographic in their sickening details, we must pronounce the book too brutal to be either good art or good literature.”

“I Paint it Exactly as it Appears”

Though he was also a direct witness to major battles as well as to the day-to-day experience of life in camp, Winslow Homer, a visual artist, had a quite different experience of the war. Almost ten years older than Bierce, Homer was already a somewhat well-established professional at the outbreak of the war, having served for the previous four years as a freelance illustrator for various New York-based magazines. Along with a large group of other artists, Homer traveled with the Army of the Potomac on assignment with Harper’s Weekly during 1861-62 and later as a freelancer. After returning from the Peninsular Campaign, he began to experiment with oil painting; his first canvases were of Civil War scenes, some based on the same sketches he translated into wood engravings for Harper’s. Though he was untrained as a “fine” artist, his oils of the war earned acclaim and he was elected a full Academician of the National Academy of Design (NAD) in 1865 at the age of 29, quite young for an artist with very little formal training. From 1863 through the early 1870s, Homer painted at least twenty canvases related to both the home and camp life during the war. His works were considered truthful, straightforward, and honest representations of life on the front and in the wartime domestic sphere; one critic wrote in New Path that Homer was the only American artist “to tell us any truth about the war.”  The London Art Journal concurred: “These works are real: the artist paints what he has seen and known.”  The strong reception of Homer’s war paintings as documents of lived experience seems to contradict my claim that Homer’s war works thematize blindness and trouble the reliability of vision, but I believe that an examination of the spiritual elements within Homer’s art may demonstrate how his indeterminate visions of war suggest a special, privileged kind of vision. The primacy Homer himself placed on the role of the eye, or of vision, as part of a revelatory experience may be seen in his angry response to John W. Beatty, who inquired whether the he “modified” nature in his compositions: “‘Never! Never!’ the artist cried, ‘When I have selected the thing carefully, I paint it exactly as it appears.’”

Homer had a long and successful career in the decades following the war, during which he pursued formal and stylistic experimentation, and it is usually these later paintings that are credited with possessing a sense of indeterminacy, for all their lifelike bodies and violent, crashing waves. Art historians Jules Prown and Charles Colbert interpret Homer’s representations of survival and rescue at sea from the 1880s as manifestations of a battle that is spiritual rather than physical, separating the materiality of his artwork from the ineffable that lies within or beneath.  In these works Homer uses metaphors of rescue and resuscitation to posit a relationship between external, tangible, and observable reality and inner faith. Contemporary reviews focused with startling regularity on Homer’s eye as an organ of both sight and deeper revelations. “This is the picture of a man who has the seeing eye,” wrote Eugene Benson in a review of Homer’s The Bridle Path at the NAD show in 1870, continuing: “We have no figure-painter who … sees the actuality of his subject better; not one who is closer to the objective fact of nature.” Homer’s supposedly direct access to nature was one way for professional art critics to praise him despite his untrained technique. A reluctant admirer of Homer, art critic Mariana van Rensselaer, wrote: “But always, whether it be austerely beautiful or frankly ugly, his work is vital art—not mere painting, not the record of mere artistic seeing, but the record of strong artistic feeling” (emphasis original).  This confluence of sight and emotion, of the outer skin of things somehow invested with an inner life or spirit, this seems in some ways similar to Bierce’s formulation of himself as a privileged figure possessed of uncommon understanding. Learning that Homer possessed a copy of George Chaplin Child’s religious tract The Great Architect, which posits a connection between the technical workings of the eye as an optical apparatus and the inner illumination required for salvation, Colbert reads the painter’s late oeuvre as concerned with the “‘correspondence’ of the material and the spiritual.”34 As previously mentioned, concern with the eye’s ability to perceive a higher “truth” through external observations permeated American culture during this period. But these truths, when it came to making sense of the Civil War, turned out to be fragmentary.

Thus far, both artists have been considered in light of their contemporary reception and self-professed role as figures with access to unique forms of truth. What was this privileged form of sight that both Bierce and Homer shared? Both realized that the real truth of the war was blindness. The contested nature of the war—its multiplied causes and meanings, the still-fractured nation it left behind—was the ultimate truth that Bierce’s and Homer’s direct vision grasped. Both understood that true vision was not purely optical. Concerns and anxiety about the trustworthiness of vision were rampant in these years, and there was a certain horror in the sheer amount of information that threatened to overwhelm the viewer or reader in a torrent of factuality. An odd review of Homer’s art, given by Eugene Benson in a cynical and almost Biercean phraseology, noted that his work usually “falls below the standard of finish and detail which is within the reach of our most childish and mediocre painters, and which misleads many, and deceives painters with the thought that by going from particular to particular, of itself insures a fine result in art.”  While seeming to call Homer worse than mediocre, Benson in fact praises his ability to see only that which is important, removing extraneous detail. The act of a painter moving painstakingly “from particular to particular” sends a creeping horror down the reader’s neck as he imagines a painting—not unlike the Victorian parlor—completely crammed with objects, all rendered in delicate and excruciating detail. Bierce, too, seemed to find the modern obsession with detail a horror vacui; his definition of “telescope” describes an apparatus “enabling distant objects to plague us with a multitude of needless details.”  Homer escapes this fate, van Rensselaer agreed: “He had boldly omitted everything that could not serve his purpose.” Bierce, too, was praised for the stripped-down, often spare forms of his prose. Both Bierce’s and Homer’s narratives, whether textual or visual, deal with the confluence of vision, memory, and trauma by conceptualizing blindness as a narrative strategy for dealing with traumatic events by appealing to non-visual, “inner” truths.

The Blindness of Technologized Vision

Art historians have usually only analyzed one of Homer’s Civil War scenes with explicit attention to vision: the artist’s earliest known oil painting, Sharpshooter of 1863 [Fig. 1]. Since the 1988 publication of an important article by Christopher Kent Wilson, academic discussion of Sharpshooter has tended to hinge on its relation to the new technology of the sniper’s long-range rifle and the intensified looking that the sharpshooter, armed with a highly accurate scope, embodied.  Randall C. Griffin, for example, connects Sharpshooter with “the theme of intense looking” and Homer’s compositional “passion for clarity,” both of which would seem to be diametrically opposed to an interpretation of the work as a figuration of blindness. And yet, two key elements of the composition suggest blindness of different kinds. First, the very close-cropped, intense focus on the body and weapon of the sharpshooter actually serves to obscure the viewer’s larger frame of reference. In addition, the very weapon that enhanced the sharpshooter’s natural vision, the long-range rifle with its high-intensity scope, acts to create a new and fearful moral blindness in the body of the sniper himself.

By focusing his composition so intently on the isolated sharpshooter, high in his treetop vantage point, Homer excludes us from any engagement either with the man depicted or with the greater context of battle going on around him. Despite art historian Julian Grossman’s praise of “the sharpness of the soldier’s eye,” Homer paints that eagle eye as an obscured smudge under the shadow of the marksman’s cap. We are completely cut off from the consciousness of this soldier and from what he actually sees through the scope of his rifle. Bierce might give some hint. In “One of the Missing,” he composes the inner monologue of just such a reconnaissance man, Jerome Searing:

After a keen reconnaissance from the safe seclusion of a clump of young pines Searing ran lightly across a field and through an orchard to a small structure which stood apart from the other farm buildings, on a slight elevation. This he thought would enable him to overlook a large scope of the country … Searing looked across the open ground between his point of view and a spur of Kennesaw Mountain, a half-mile away. A road leading up and across this spur was crowded with troops—the rear-guard of the retiring enemy, their gun-barrels gleaming in the morning sunlight.

Bierce encapsulates the extremely long range of Searing’s view and the precision with which his “searing” vision appreciates his surroundings, elements intentionally excluded from the composition of Sharpshooter. Technological advancements in riflery, as Wilson notes, greatly increased the speed and accuracy of long-range marksmen; Civil War sharpshooters were feared because they could bring instant and unseen death, as one Confederate lieutenant later reported: “I’ve seen them pick a man off who was a mile away. They could hit you so far you couldn’t hear the report of the gun. You wouldn’t have any idea anybody was in sight of you.”  However, the viewer can only speculate as to what Homer’s sharpshooter sees. Homer’s deceptively simple composition cleverly blinds the viewer to the larger context of the sharpshooter’s situation.

The emphasis on his role as a highly-trained marksman, in combination with the importance to the war of sharpshooters’ technologized vision, leads to the second blindness represented by this painting: that of the moral blindness of the sharpshooters and of the war itself. As Wilson argues, the technological developments in marksmanship were crucial to Northern successes, but they were also connected in the contemporary mind with a troubling new phenomenon: that of the machine-like killer, uncaring of human life, who, rather than using his newly-accurate weapon as a tool, was himself becoming a dispassionate extension of that weapon. In a much-quoted letter, Homer later wrote that he regarded sharpshooting “as near murder as anything I ever could think of in connection with the army.”  Bierce was no fan of these marksmen, either, having been severely wounded by one at the Battle of Kennesaw Mountain. In his 1888 essay “Modern Warfare,” he complained that humankind was “taking a deal of pains to invent offensive weapons that will wield themselves … A modern battle is a quarrel of skulkers trying to have all the killing done a long way from their persons.”  His evocation of the interior life of the Union sharpshooter in “One of the Missing” is less snide but far more chilling: “Jerome Searing drew back the hammer of his rifle and with his eyes upon the distant Confederates considered where he could plant his shot with the best hope of making a widow or an orphan or a childless mother,—perhaps all three, for Private Searing, although he had repeatedly refused promotion, was not without a certain kind of ambition.”  Fears about these marksmen’s distance from the sites of the deaths they caused gave many civilians a complicated reaction to their skills. Though they look with exceptionally sharp eyes, they are blind to the suffering they cause. They were represented in the press, indeed, as terrifyingly calm and dispassionate.  A soldier should do his duty in wartime, true, but a kind of moral panic indicted sharpshooters for suspected ethical blindness and even, most fearfully, an enjoyment of killing like that of Bierce’s Searing.

Bierce addressed the impersonality of technologized vision in “The Coupe de Grâce,” a story in which Captain Downing Madwell performs a mercy killing on his childhood friend Sergeant Caffal Halcrow, whom he finds lying on the ground partially eaten by roving pigs but still, painfully, alive. Both Halcrow and Madwell exhibit a kind of temporary blindness; Halcrow, half-conscious “stared blankly into the face of his friend,” while above him Madwell’s “tears splashed upon the livid face beneath his own and blinded himself.” Recognizing that the kindest gesture would be to kill his old companion, Madwell finds himself unable to do so and departs. Seeing a wounded horse nearby, he shoots it quickly and then noting how its “sharp, clean-cut profile took on a look of profound peace and rest” after its agonized death throes, he changes his mind and returns to where Halcrow lies wounded. “Apparently lost to all sense of his surroundings,” Madwell takes the pistol he has just used to execute the horse, holds it to his friend’s head, “and turning away his eyes pulled the trigger.”  The sharp irony of the story comes from the fact that his gun is empty; he has used his last bullet to put the dying animal out of its misery. Determined, however, to complete the deed, Madwell next takes out his sword and plunges it into his friend’s chest. “This time he did not withdraw his eyes,” Bierce records, despite the gruesomeness of the death.  It seems telling in this atmosphere of technologized warfare and heightened vision that Madwell cannot bring himself to watch Halcrow’s death by pistol—surely the more humane, if not the more human, method—but looks directly at his friend as he skewers him with a saber. Guns, by which the killing of men had become no different than the killing of animals, had rendered slaughter impersonal and thus terrible to witness, while Madwell’s final execution of the wounded man becomes a deeply personal and thus moral act from which he need not look away.

To return to the figure of the sharpshooter, a final example from Bierce’s “The Mocking-bird” depicts the cruel impersonality of shooting at distant enemies. Posted on picket duty, Union Private William Grayrock spends his night “staring at the darkness in his front and trying to recognize known objects.” Upon hearing the approach of someone he cannot see, Grayrock shoots blindly into the night and is certain he has hit a man in the darkness. For, as Bierce informs us, “he had a marksman’s intuitive sense of having hit; for he was one of those born experts who shoot without aim by an instinctive sense of direction, and are nearly as dangerous by night as by day.”  Grayrock is an even more terrifying version of Homer’s Sharpshooter, because not only is the reader blind to the enemy he shoots at, but Grayrock himself shoots blindly and still manages to execute his man. The danger of this blind shooting becomes apparent the next day when Grayrock searches for the enemy soldier he is certain he has wounded and finds the dead body of his own twin brother John, a Confederate soldier. Shooting blindly at invisible enemies was not particular to the marksman’s routine, however. It was woven into both the symbolic meaning and the lived experience of Civil War battles.

“A Battle Which No Man Saw”

The Battle of the Wilderness, a fight Homer probably witnessed firsthand, was described in 1888 by participant Robert Stoddard Robertson as “the strangest and most indescribable battle in history.” Robertson added that as it was fought in an impenetrable forest at close hand, “the lines of battle were invisible to their commanders … the enemy was also invisible.”  Homer famously rendered this obscurity in his only oil painting of a Civil War battle in progress, Skirmish in the Wilderness, which shows indeterminate clusters of men lost in a dark thicket of trees, puffs of smoke from rifles providing the only clues to the action. It was indeed, as another eyewitness, William Swinton, described it, “a region of gloom and the shadow of death.” But such opacity of battle was not specific to the Wilderness action; Bierce also utilized the theme of visual impenetrability in the autobiographical essay “What I Saw of Shiloh.” Throughout the piece, Bierce and his men experience the bewildering attacks of unseen enemies as they fight through dense, gloomy forests. “What I Saw of Shiloh” may, indeed, be titled ironically, as much of the piece chronicles the difficulty of viewing what is going on around the narrator. First, as Bierce and his men wait to be ferried across the Tennessee River to relieve embattled troops, he records the confused impressions of the battle going on nearby, “obscured … by blue sheets of low-lying smoke.” Bierce continues: “The farther edge of the water could not be seen; the boats came out of the obscurity, took on their passengers and vanished in the darkness.” The air is lit with “blinding flashes” and the soldiers on the opposite bank are seen only as “moving black figures.”

Bierce’s description of the scene at Shiloh matches Homer’s evocation of the Battle of the Wilderness, a small and obscure canvas showing a tangled cluster of soldiers taking cover from enemy fire behind a tree. The viewer sees the scene from a vantage point a little behind them, facing the ongoing action. Homer outlines their figures against a haze of white smoke from the discharge of their weapons. The color of the men’s uniforms—whether a grey darkened by the gloom of the forest, or a blue made grey by the sickly yellow light filtering through the leafy canopy of the woods—is indistinguishable. From the right, a column of Union soldiers marches into the scene; in the space between the central grouping and this more orderly formation, an undulating mass in the green-black murkiness of the background may herald approaching enemies or may merely be tangled vegetation. The “blinding” flashes of gunfire do not serve to elaborate the positions of either friendly or unfriendly troops.  Grossman writes of Wilderness that it “gives some idea of the difficult terrain, in which dense thickets broke up battle lines and the enemy, more often than not, remained unseen … in the tangled woods.”  Homer’s indistinct topography contrasts with Bierce’s own visual renderings of the war: the maps he produced as personal cartographer to General W. B. Hazen were “meticulous” with “never an erasure, never a smudge.”  Their sharp black lines differ starkly from the chaotic, indeterminate milieu of Homer’s Wilderness.

And yet Bierce’s exquisite maps are explicitly dissimilar from his descriptions of the confusing sights that greeted him and his men when they eventually reached the scene of battle at Shiloh. Sensory deprivation strikes both the eyes and the ears of his unit as he notes: “A few audible commands from an invisible leader had placed us in order of battle. But where was the enemy? Where, too, were the riddled regiments we had come to save? … What protected our right? Who lay upon our left? Was there really anything in our front?”  Bierce’s litany of questions speaks to the confusion of this contentious battle—considered a failure of strategy on the part of Ulysses S. Grant, despite the Union’s eventual victory on the second day of fighting—but also to an epistemological instability inherent in the condition of battle more generally. Throughout the piece, Bierce speaks of troops—enemy and ally alike—that are “screened from view,” woods “impervious to sight,” men directed “we knew not whither.”  Homer’s visual articulation of the confusion of battle suggests the contingency and confusion of modern warfare and, through its sketchy and episodic character, the failure of traditional narratives of heroism. Conn’s theory of “narrative trauma” comes again to mind. A fragmented, indistinct canvas reflects the unpleasant realities of this fragmented, indistinct war in a way that no traditionally composed history painting could. In Skirmish in the Wilderness, Homer uses visual confusion, limited sight range, and intentional obscurity of figures in relation to the landscape and to one another to represent the actual conditions of this 1864 clash, but he employs them in support of a larger argument that the Civil War proved to be “impossible to paint” because it “stood as the great, glaring, and unarguable challenge to any facile notion of American progress.”  Bierce’s writings, Sharon Talley asserts, “reflect not only his own psychic conflict but also the related national crisis in sensibilities, marking the transition between concepts of the heroic.”  Likewise, as both Conn and Nicolai Cikovsky, Jr., argue, Homer succeeded as a painter of the Civil War precisely because he turned away from the traditional narrative conventions of wartime representation.  But the turn from battle painting to the domestic side of war—what art historian Elizabeth Johns terms “American males in social relationship with each other as men”—had its areas of blindness as well.  The homosocial camaraderie and ersatz domesticity created by wartime conditions enabled observers to contrast soldiers’ lived realities with their idealized visions of prewar household life.

Home Sweet Home

For the first time during the Civil War, army doctors treated homesickness as a deleterious illness that affected the troops as they camped far from their loved ones.66 Homesickness can in many ways be defined as visual, and the thought of one day seeing far away people rings out in soldiers’ letters. Aides-memoires such as daguerreotypes or tintypes kept soldiers’ visual memories alive in their homes, while those on the front might have carries likenesses of wives, sweethearts, or mothers with them. But despite its underlying visual qualities, homesickness is, at base, about the absence of persons and scenes one most desires to see. Homesickness is based on a kind of interrupted vision, a blankness on the retina, filled in with snatched glances at a tintype in its protective case or re-imagined with the eyes closed. It is in light of this visually impenetrable homesickness that I reinterpret Homer’s 1863 painting Home, Sweet Home, which one reviewer described as possessing a “hearty, homely actuality.”

Home, Sweet Home, Homer’s first exhibition picture, appears to be a sentimental scene of camp life in which Union soldiers listen to a band play the popular sentimental melody “Home, Sweet Home.”  This supposed focal point is located in the far background of the scene, barely discernable as a cluster of blue-clad men listening to music. Homer instead focuses on the ersatz home of two weary soldiers: a meager fire of twigs, a boiling can of broth or coffee, discarded items of equipment placed on makeshift coat and boot racks. The two central figures seem intensely quiet, contemplative, their faces highlighted with broad strokes of the brush that make out sketchy lineaments rather than identifiable physiognomies. In her recent evaluation of the relationship between “inner” life and observed reality in Homer’s work, Elizabeth Johns interprets Home, Sweet Home as part of Homer’s maturation as an artist. She suggests that this canvas demonstrates the artist’s increased interest in psychological realism rather than the drama of battles, for it “probed other aspects of male psychology in war … [such as] homesickness.”  Julian Grossman agrees that Homer did experience a shift at some point during the war: “like other sensitive artists, he turned away from the face of death, away from the front, to scenes in camp, concentrating on the camaraderie formed during trials suffered together.”  In its rendering of a stand-in for the family hearth, Home, Sweet Home accessed both a generalized mid-century sentimentalization of family life and the fact of homesickness as a particular problem rampant among troops of both armies. In an 1862 letter to his wife, Union soldier John Henry Jenks specifically references the touchstone of the home’s hearth, here abandoned and cold “among all the desolations of war, the sundering of family ties, the deserted hearthstones, the vacant chairs, the intense solicitude for absent freinds [sic].”

The problem of homesickness is not merely the subject matter of the painting. Through numerous lacunae in the viewer’s apprehension of the scene, Homer constructs a quietly powerful narrative of homesickness that imagines “home” as an unknown territory: a blind spot. The first such blind spot is the immediate “home” of the camp as it is shown. The two-man tents that compositionally bookend the men and act as their temporary homes—mobile and ever-shifting sites where they merely rest themselves occasionally—are drawn as blanks: triangular, black gaping holes surrounding the central figures. In the crooks of their arms and the opening of the man on the right’s jacket to reveal a blood-red shirt beneath, the triangular forms of the tent flaps are mirrored in their bodies, physically tying them to these dim openings leading to unseen interior spaces. Barely emerging out of the left hand tent is the sole of a boot, catching a glint of light on its curvature, suggesting the body of a comrade within.

These darkened spots in the composition contrast directly with the beige canvas of the tents’ exteriors and, most dramatically, with the large and tattered piece of canvas hanging behind the standing man like a theatrical backdrop. Literary historian Martin Griffin uses the metaphor of the tableau vivant when discussing Bierce’s manipulation of time and memory in his Civil War stories. In the practice of tableaux vivants, a popular parlor game of the nineteenth century, human actors would recreate famous works of art or, dressed in elaborate costume and standing perfectly still, present a narrative in a series of posed scenes. Griffin argues that Bierce’s war stories may be read as tableaux, series of carefully framed narrative moments, complete with the gaps in memory, the temporal breaks, and the discontinuity this art form necessarily possesses. He writes: “Each tableau in the story is individually loaded with meaning, but exists only in its own context of realization.” It is an art form that is structured around the concept of a narrativity that is by necessity incomplete. Homer’s Civil War paintings, too, particularly the scenes of daily incidents in camp life including Home, Sweet Home, Playing Old Soldier, Pitching Quoits, The Last Goose at Yorktown, Sutler’s Tent, The Brierwood Pipe, and A Rainy Day in Camp, may be interpreted as a series of tableaux played out against sceneries as artificial as painted backdrops. This becomes even more striking when we note that five of these seven canvases feature similar backdrops of hanging or blank fabric.

But, particularly in Home, Sweet Home, which contains the largest and most prominent usage of this feature, these canvas curtains evoke not merely tableaux but also veils that block access to what lies behind, creating sites of indeterminacy. The representation of painted fabric curtains in the Western artistic tradition goes back to Pliny the Elder, and it has become a shorthand for epistemological uncertainty.  In a contest between Zeuxis and Parrhasius to paint the most convincing illusion, the latter wins by producing a painted curtain so lifelike that his competitor attempted to lift it to see the painting underneath. American artists and audiences were familiar with this story, most famously articulated by Raphaelle Peale in his painting Venus Rising from the Sea: A Deception.  Oddly for Homer, who was known and often mocked by contemporaries for his somewhat clumsy modeling and large, flat planes of color, the effects of light bouncing off the folds in the large swath of canvas in Home, Sweet Home are rendered in precise and almost illusionistic detail. The care lavished on this expanse of fabric—the largest single section of the painting other than the sky—suggests its importance in Homer’s composition. It serves here less as Parrhasius’s actual curtain than as a test for the viewer’s eye. Instead it cuts off the “home” of the painting from that larger home beyond. As Grossman writes, “Perhaps because home was around the corner, just up the road but still agonizingly far away, the longing was greater.”  As soldiers’ letters suggest, the true home ceased to feel real after a certain length of time in the “home” given by the army. One unknown young man wrote back to his mother in 1862: “What a day it was,—and a Sunday too! … I think of you all at rest, with the sound of church-bells in your ears, with a strange, distant feeling.”  Many wrote of home as a place they could only dream of, as Josiah B. Corban told his wife in a letter of 1863: “I dreamed of being at home how I wish it might come to pass. I wish George and Julia [their children] would write often they cant think how much I want to see them they seem very dear to me all the time.”  In Bierce’s story “The Mocking-bird,” which, as we have seen, ends with the tragic murder of John Grayrock by his twin, the main character “dreamed … himself a boy, living in a far, fair land by the border of a great river.”   Bierce slowly reveals this vivid dream as an actual memory of his happy home life before the war. The heartrending juxtaposition of the two homes—family home and army home, with neither feeling entirely real—the knowledge that home may be just beyond the curtain (but, then again, it may not), is what creates the claustrophobic homesickness of Homer’s scene.

A final void appears in the foreground: a sheaf of white papers on the knee of the seated man. He rests his hand on the paper, not clutching it to him, but not careless enough that it could fly away. What can be seen of the paper is merely blank whiteness. But it is easy enough to guess that here is yet another reference to Homer’s title: a letter home, perhaps unfinished. Homer does not pay special attention to these papers, except that, folded in the shape of a rough triangle, they are the only place where he has used a large quantity of true white in the painting. Homer had received the English translation of the French chemist M. E. Chevreul’s The principles of harmony and contrast of colours from his older brother Charles in 1860. He referred to the book as “my bible” and carefully studied Chevreul’s analysis of the relationship between visual perception, artistic communication, and use of color.  On the relationship between dark and light, he later told John W. Beatty, “It is wonderful how much depends upon the relationship of black and white. … The construction, the balancing of parts is everything.”  In Home, Sweet Home’s small patch of paper, Homer utilizes such a contrast for great effect. He surrounds this flash of white with darker hues—the black of the tent openings, the deep blue of the uniforms—to highlight its importance but also its emptiness. Soldiers sometimes emphasized that they did not know what to say to their loved ones, or how to say it. In 1863 Harrison Clarke wrote a friend that “I have frequently made the attempt [to write you] and as often failed.”  The page in Home, Sweet Home trumpets its blankness. There was no good way to describe the sights of war in a letter. But more importantly, home was a blind spot in the soldier’s mind, no matter how faithfully he attempted to conjure it in his imagination.

The Perils of Self-Recognition

Though Homer and Bierce shared a sensibility in their representations of war, they seem almost diametrically opposed when it comes to depicting themselves in their art. Homer never painted a self-portrait; Bierce seems constantly to be re-articulating his own traumatic experiences of the war in his fiction by writing about the battles he fought. And yet, we may consider both of them in terms of a kind of faulty or flawed self-recognition that is expressed through their art and the record of their experiences in the war. Several scholars have commented on and evaluated how traumatic events in the war may have affected Bierce and Homer, based upon the form and content of their works surrounding the conflict. Bierce seemed to cling more tenaciously to the memory of the war than Homer, seeing in the war the experience of a sort of fracturing of the self, from which he retreated with a carefully-cultivated reputation for ironical misanthropy. The prominent twentieth-century leftist intellectual Carey McWilliams wrote of Bierce: “The war was a troubling memory. It never left him; he mused and puzzled about it all his life. … one is impressed with the frequency of his references to war, the constant presence in his mind of its images, and the color that it gave his thinking and even his vocabulary.”  Martin Griffin reminds us of “the persistence of traumatic memory of combat experience within the psyche of the individual veteran,” describing Bierce’s literary output as a post-traumatic symptom characterized by “a merciless, almost nihilistic representation of contingency, violence, and unresolved conflicts of character and environment.”  Similarly, art historian Peter Wood notes that Homer left little record of how the war affected him and that it is probable that “shadows of combat remained a lasting part of Homer’s life.”  If these assessments of trauma seem presumptive or based on a sketchy foundation, we should recall that it was not until Bierce and Homer were both deceased that trauma related to wartime experiences became recognized as a medical condition rather than a constitutional weakness. The nature of historical trauma is complex, as Michael S. Roth reminds us. There is, on one hand, “the part that is repressed, or at least insufficiently attended to,” which can perhaps be seen in Homer’s apparent rejection of or lack of interest in the war later in his career. However, Roth continues, “the problem is not that the past event has been forgotten … but that the event has not been left behind successfully. It continues to have effects in the present.”  It is impossible, of course, to gauge with any accuracy what the actual psychological effects of the war may have been, and whether they led to cases of lingering trauma in these two men. However, as multiple scholars have made clear, we must consider the possibility that the shattering effects of the war inflected their later artistic and literary outputs.

Bierce’s psychological state has been the focus of much scholarship, for the war evidently consumed him until the end of his life. Homer, on the other hand, had a long and prolific career—continuing unabated for almost fifty years after the end of the war—filled with works that seem to have little bearing on the conflict. And yet numerous art historians have focused on Homer’s seeming obsession with the fragility of man in the face of violent and uncontrollable forces, usually the forces of nature such as sea squalls or snowstorms. Jules Prown interprets this thematic fixation as an unresolved quest for spiritual salvation, while Sarah Burns has read it as a response to the late-nineteenth-century cult of rugged masculinity.  But both interpretations may also be applied to the lingering effects of the war, which historians link both to a newly modern atmosphere of spiritual uncertainty around the turn of the century and to a crisis in masculinity brought on by the losses of the war, which was offset by increased focus upon manliness during the same years.  Merely because Homer completed all of his important Civil War paintings within two years of the peace at Appomattox does not mean that he worked through his trauma and got over it. He constantly returned to the theme of conflict in his later paintings of fishermen struggling against violent natural forces; art historian Paul Staiti describes nature in Homer’s late work as “a cold and amoral environment of chance and brutality, devoid of justice.”  Such an inexorable and pitiless conception of fate could almost have come from the pen of Bierce in his descriptions of muddled and terrifying Civil War battles. So also did Homer’s later work reflect continued interest in themes indirectly associated with the war, and can be seen in his dealings with postwar African American life and his focus on farm labor, a theme he began exploring during the war with The Brush Harrow, Haymaking, and On Guard, which portray children taking on grown men’s roles. Regardless of how we interpret the seriousness of the war’s traumatic resonance with Homer, it is clear that it had a lasting impression on the way he looked at and represented the world. The war changed both men greatly, and not only their minds were affected.

These men’s experiences of the war caused physical changes as well, leading to situations in which the authors’ very bodies became unrecognizable. Homer’s mother wrote to his younger brother that after being starved while traveling with the army on the Peninsular Campaign, her son was “so changed that his best friends did not know him.”  We may interpret this as a mental change, perhaps, but as she comments on the hardships he faced on the front, it seems likely to have been a physical change as well. Homer’s lack of recognition by his friends is nothing to the lack of self-recognition faced by Bierce when, around forty years after the end of the war, he embarked on a tour of the battlefields. This trip seems to have underwhelmed but also disturbed him as he attempted to understand and recapture some of the feelings of his own youth. He described the tour in a letter to poet Herman Scheffauer as a meeting between his present and former selves:

"twelve miles from here, my age and my youth met—the latter a trifle wan, ghostly, and absent-minded, inhospitable to questioning. What I mean is that I was in Oakland (Md.) forty-odd years ago, as a young soldier … This country has been Dreamland to me ever since. I know I should not have sought it again, to dispel the illusions, but I just had to; and I mean to go over all my old campaigning routes and battle grounds…"

The event of finding old familiar places to be strange and of finding the self irrevocably and unaccountably changed is chillingly recounted in the short story “A Resumed Identity,” which Bierce composed after he had taken his trip around those now unfamiliar battlegrounds. When the tale opens, the unnamed character is walking on a moonlit road during summer. Bierce describes how “the man looked curiously about him on all sides, as one who among familiar surroundings is unable to determine his exact place and part in the scheme of things.”  During the night he sees a procession of soldiers moving, as he believes, to take Nashville. Meeting a doctor on the road the next morning, he informs the doctor that he is a lieutenant in the regiment of General Hazen (as was Bierce) and inquires about the troops. Learning that the doctor “met no troops” he stumbles further along the road in confusion.  Finally coming upon a monument “brown with age, weather-worn at the angles, spotted with moss and lichen,” he reads that it commemorates the troops of Hazen’s brigade lost at the Battle of Stone River in 1862. Still a sense of recognition does not seem to occur in the man, until he is finally granted direct access to his reflection in “a pool of clear water” just adjacent to the monument. “He uttered a terrible cry” upon recognizing his own elderly face; “he fell, face downward into the pool and yielded up the life that had spanned another life.”  In the beginning of the story the soldier fails to recognize what should be familiar places, accounting his difficulty to a head wound he believes he has recently sustained in action; even the explicit signs of age appearing upon the monument do not seem to allow him to recognize his predicament. It is only the sight of his own time-ravaged countenance—his inner and most inviolate “home,” which he has consistently failed to recognize or know for sure throughout the story—that removes the veil of forty years and, ironically, is the cause of his ultimate death.

Homer offered no such haunting coda to his own wartime experiences, other than in the moody oil sketch Trooper Meditating Beside a Grave of c. 1865.  This quiet work was never exhibited during Homer’s lifetime. Though Homer never painted a self portrait, what the viewer can see of the man’s downcast face bears some resemblance to his own, at least in superficial features such as the “great waving moustache” and “red, or nearly red, hair” noted by Harrison Morris in an amusing description of Homer’s appearance. Covering his downcast eyes, the brim of the trooper’s cap blocks our access to his thoughts. The opening paragraph of Bierce’s “The Mocking-bird” finds Private Grayrock similarly with “his cap downward over his eyes, almost concealing them.”  Homer repeated this strategic marker of blindness in many Civil War scenes, including Sharpshooter, A Rainy Day in Camp, Home, Sweet Home, Sutler’s Tent, and even his supposed masterpiece of psychological insight, Prisoners from the Front. As one critic wrote of Homer, “There is nothing personal, or rather, subjective in his work. … He must give the essential nature of what he sees. He gives the true import … and leaves you there, saying nothing of the effect of the scene upon himself.”  While Bierce might give us too much of himself without ever coming to a resolution about the true identity of his war-shattered self, Homer holds back in indeterminacy, refusing to meet our gaze. Both display a lack of self-recognition. Bruised by the war, seeming to work through the catastrophe in different ways, Homer and Bierce show us continually, through the piercing power of their own ability to observe, that we cannot trust what we see, that we are always blind to the true story of the Civil War.

Image: Winslow Homer (American, 1836-1910), Trooper Meditating Beside a Grave, c. 1865, oil on canvas, 16 x 8 inches. Joslyn Museum, Omaha, Nebraska. Gift of Dr. Harold Gifford and Ann Gifford Forbes, 1960.298

From: ivc.lib.rochester.edu

Read More

Prevalence of Major Eye Diseases Among US Civil War Veterans, 1890-1910

 By Frank A. Sloan, PhD; Daniel W. Belsky, BA; Idrissa A. Boly, MA

ABSTRACT
Objectives:  To estimate the prevalence of major eye diseases and low vision or blindness in a national sample of male US Union Army veterans from 1890 to 1910 and to compare these prevalence rates with contemporary rates for the same diseases and visual status.

Design:  Longitudinal histories of 16 022 white Union Army veterans receiving disability pensions from 1890 to 1910 were developed from pension board examination records. Prevalence rates of trachoma, corneal opacities, cataract, diseases of the retina and optic nerve, and low vision or blindness were calculated in 1895 and 1910. Changes in prevalence by age were examined.

Results:  By 1910, 11.9% of veterans had low vision or were blind in both eyes. Prevalence of cataract increased with age, resulting in 13.1% of veterans having had cataract in one or both eyes. Rates of trachoma were 3.2% in 1895 and 4.8% in 1910. Rates of corneal opacity were 3.0% and 5.1%, respectively. Glaucoma was rarely diagnosed from 1890 to 1910, but diseases of the optic nerve were reported in 2.0% of veterans in 1895 and 3.6% in 1910.

Conclusions:  This study documents substantial reductions in the prevalence of low vision or blindness and changes in the composition of eye diseases from an era in which there were few effective therapies for eye diseases to the present.

The 20th century experienced great changes in the treatment of major eye diseases. However, longevity also increased substantially. The US population aged older than 65 years increased from 4.1% in 1900 to 12.4% in 2000, eye disease prevalence often increases with age. Thus, though innovations in treatment should have decreased prevalence, increases in population age may have, at least in part, offset these decreases. Nationally representative historical data documenting trends in prevalence of major eye diseases and low vision and blindness across several decades have been lacking.

Recently, data from a federal program that began in 1862 and paid pensions to Union Army veterans of the US Civil War (1861-1865) became available in machine-readable form. To obtain a pension, veterans had to be examined by a 3-physician panel, which determined whether their illnesses or injuries qualified for compensation. Prior to 1890, only service-connected disabilities were compensated. In 1890, the program was amended to include compensation for non–service-related conditions, which led to a major increase in veterans having examinations to obtain pensions. In 1907, the program was further amended to include old age as an eligibility criterion. Although old age was not recognized by statute as a basis for receiving a pension until 1907, a minimum pension was granted to all those aged 65 years or older from 1890 to 1907, unless the veteran was unusually vigorous.

This was the first major national pension program in the United States to which a large portion of federal expenditures was allocated in the late 19th century. The program covered 85% of Union Army veterans who were alive in 1900 and more than 90% of veterans who were alive in 1910. Only Union Army veterans were eligible.

METHODS
The data were produced by the Center for Population Economics at the University of Chicago. A 1-stage cluster sample of 331 Union Army companies was randomly selected by the Center for Population Economics from more than 20 000 company records stored at the National Archives in Washington, DC. These companies yielded a sample of 39 616 veterans.

The surgeons' certificates data consist of medical records used by the US Bureau of Pensions to evaluate pension applications. Each record contains physical examination findings. Veterans could apply for a pension more than once (they could claim > 1 disability at each application); therefore there were multiple medical records for some veterans. Surgeons' certificates data were classified by the Center for Population Economics into 21 (primarily) organ system–based health screenings.

The total surgeons' certificates sample includes 87 224 examinations of 17 721 veterans. The veterans sample was reduced to 16 022 because of missing information on birth or death dates. Once a veteran's condition was diagnosed, we assumed that the veteran had that condition until death. In any year, the number of veterans in the sample was well below 16 022, because either the veteran had not yet been examined or had died by then. Our analysis focused on 1895 and 1910. The year 1895 was long enough after the statutory change of 1890 that allowed many veterans with non–service-related disabilities to be examined and added to the pension roles. By 1910, 3 years had passed since the statutory change of 1907, an eligibility expansion that classified old age (≥ 62 years) as a disability. Also, by 1910, most surviving veterans were aged 65 years or older. The death rate was high enough that sample sizes were too small to calculate reliable estimates of prevalence a decade or a decade and a half later.

We identified veterans with a visual disability who had diagnosed amblyopia or blindness in both eyes. We examined 5 categories of eye disease: trachoma, corneal opacity, cataract, disease of the retina, and disease of the optic nerve. Trachoma, corneal opacity, and cataract were all easily identified then by basic visual inspection. All were well-known causes of blindness and were considered when determining cause of impairment. Diseases of the retina and of the optic nerve, rather than being specific diagnoses, refer to findings from an examination with an ophthalmoscope. Ophthalmoscopes were reasonably well distributed by the 1890s.

Trachoma was identified by searching responses for trachomawithin a category dealing with the conjunctiva. We identified cases of corneal opacity by searching for items pertaining to the cornea. Cataract was identified from variables for cataract and cataract extraction and was indicated as specific to the left, right, or both eyes. Diseases of the retina and optic nerve were identified by codes for infection or inflammation of the eye.

Few cases were explicitly classified as glaucoma, but glaucoma was also plausibly included in a separate category, diseases of the optic nerve. We included both in the category disease of the optic nerve.

RESULTS
The sample increased by 50% between 1890 and 1895 (Table 1), reflecting the increase in veterans obtaining examinations after the statutory change in pension law in 1890. In 1895, of the 12 144 veterans in the sample, 84.8% were aged younger than 65 years. By 1910, of the 7782 remaining veterans in the sample, only 17.8% were aged younger than 65 years. Most veterans were aged 65 through 74 years in 1910 (66.2%).

Cataract was by far the most common of the study diseases, with prevalence ranging from 4.5% for those younger than 55 years to 15.6% for those aged 75 years and older in 1895 (Table 2). In 1910, prevalence of cataract among those aged 75 years and older had risen to 17.1%. For those aged 65 through 74 years, prevalence of cataract was 8.4% in 1895 and 13.0% in 1910. Corneal opacity affected 3.8% and 4.8% of this age group in 1895 and 1910, respectively. Prevalence of trachoma was similar; that for diseases of the retina and optic nerve was much lower, ranging from just under 1% to 2% in 1895.

Prevalence of diseases of the retina increased between 1895 and 1910, even on an age-adjusted basis, possibly reflecting better detection in the latter year. However, in data for either year, rates of documented retinal disease did not increase with age, as is now typical in elderly populations. Prevalence of disease of the optic nerve did not change appreciably between 1895 and 1910 on an age-adjusted basis, and the patterns of prevalence rates with respect to age are irregular in both years.

In 1895 and 1910, respectively, 7.1% and 11.9% of the white male veteran population had low vision or blindness. The prevalence of low vision/blindness increased substantially with age. In 1895, 6.0% of veterans younger than 55 years and 11.0% aged 75 years or older had this diagnosis. In 1910, 14.1% of veterans aged 75 years or older were recorded as having low vision or being blind in both eyes.

Of those veterans with low vision or blindness, most had diagnosed cataract (Table 3). Corneal opacity and trachoma were present in one-quarter or more of these individuals. Diseases of the retina and optic nerve were documented in 13% to 15% and 8% to 10% of these cases, respectively.

COMMENT
Several major eye diseases and low vision/blindness were highly prevalent at the turn of the 20th century. Prevalence of some major eye diseases, especially cataract, increased substantially with age.

Owing to increased longevity and improved medical knowledge and diagnostic techniques, reported prevalence increased for many eye diseases. Current rates of cataract surgery, a reasonable proxy for cataract prevalence in high-income countries, are well above those for cataract and cataract surgery combined in the Union Army data, especially for populations aged 70 years or older. Data from populations aged 65 years or older in the 1990s indicate a prevalence rate of about 5% for age-related macular degeneration, about 7% for diabetic retinopathy, and close to 8% for glaucoma. The combined rates of 5% and 7% for the retinal diseases are far above the corresponding rates in the Union Army data (considering joint prevalence of both diseases), even allowing for a somewhat higher mean age of the more recent population. Diabetes prevalence among white veterans in 1895 was about 2% and was about 4% in 1910. Judging from recent data, far fewer than half of veterans with diagnosed diabetes would have had retinal disease (< 1% in 1895 and < 2% in 1910). Urinalysis was used during this period to diagnose diabetes. Recent prevalence of glaucoma is also much higher than the rates diagnosed in the Union Army veteran population, even accounting for some differences in age between the comparison and Union Army data.

However, trachoma, which was highly prevalent in the United States around 1900, is now virtually nonexistent in the developed world, which is largely a result of better sanitation, improved personal hygiene, and antibiotics. The disease now exists almost exclusively in low-income countries, where prevalence is similar to that found in our study, though it was sometimes higher depending on the region.

In contrast to increases in reported prevalence of major eye diseases, visual outcomes in the United States have improved dramatically since about 1900. Data from the World Health Organization from indicate that blindness prevalence (defined as visual acuity < 20/400 OU) among those aged 50 years or older in the United States was 0.4%. The Eye Disease Prevalence Research Group (EDPRG) reported a combined prevalence of blindness (defined as best-corrected visual acuity < 20/200 OU) and low vision (defined as best-corrected visual acuity < 20/40 OU) for those aged 40 years or older of less than 3%. Rates for other high-income countries are similar.

Eye disease prevalence in the Union Army veterans data are more similar to reported prevalence in low-income countries, where sanitation and hygiene may be more like that of the United States in the early 20th century. According to the World Health Organization, prevalence of blindness in Africa among individuals aged 50 years or older was 9% in 2002. In Southeast Asia, including Indonesia, Malaysia, the Philippines, and Thailand, prevalence in 2002 was 6.3%. Combined prevalence of blindness and low vision (best-corrected visual acuity < 20/60 OU and > 20/200 OU) among adults in Pakistan and Bangladesh is around 10%. Rates for persons aged 60 to 69 years have been reported at 13% in Malaysia and 8% in Nepal.

Access to affordable, safe, and effective cataract surgery is of primary importance in decreasing prevalence of blindness in the developed world. Cataract is the leading cause of blindness globally, accounting for 47.8% of adult-onset blindness. The EDPRG estimated that among white Americans, cataract caused less than 9% of blindness, even though the US population is proportionally much older than the world as a whole; 7.4% of the global population is aged 65 years or older compared with more than 12% of the US population.

Causes of low vision or blindness cannot be ascertained from the Union Army data; however, prevalence of eye diseases among those with low vision or blindness provide an approximation. These data assign a major role to cataract as causing low vision or blindness. Even with better technology, contemporary estimates of the causes of the 2 conditions in the United States differ appreciably. According to EDPRG's meta-analysis, cataract, for example, accounts for 59.9% of low vision and only 8.7% of blindness among white Americans. Rates are 3.3% and 6.4% for glaucoma and 22.9% and 54.4% for age-related macular degeneration among white individuals with low vision and blindness, respectively. Age-related macular degeneration's prominence in the EDPRG meta-analysis relative to that in the Union Army data (even considering that some diabetic retinopathy would have also been included in diseases of the retina) primarily reflects current knowledge compared with that of a century ago as well as the higher fraction of younger elderly in the veterans' analysis.

Unlike cataract, age-related macular degeneration, and glaucoma, corneal opacities were much more common among those with low vision or blindness in the Union Army sample compared with contemporary populations in both the United States or low-income countries. Corneal opacities accounted for 3% of blindness in the United States and 8% to 12% of blindness in Africa in 2002. Higher prevalence of trachoma, the most important infectious cause of corneal opacity, cannot fully explain this effect. While rates of trachoma in Africa (6%-8%24) are higher than those in our data, the reported effect of corneal opacity on vision is substantially lower. Corneal scarring from war-related trauma is the likeliest explanation for the high rates of corneal opacity among those with visual impairments in the veterans' sample. This explanation is supported by the decline in the prevalence of corneal opacity among those with serious visual impairment as the sample aged and other eye diseases become more common.

A strength of the veterans data is that they are fairly representative of middle-aged and elderly white men who were alive around 1900. About half of adult white men in the North fought in the Civil War. Many men whose poor health precluded fighting in the Civil War, owing to, eg, congenital heart disease, probably did not survive to 1895. The pension program covered 85% of all Union Army veterans by 1900 and more than 90% by 1910. Because of the relaxation of regulations in 1890 that allowed pensions to be granted to almost all veterans older than 65 years and the formalization of this policy in 1907, there was a substantial incentive for even veterans without disabilities to apply for pensions. Fogel conducted analyses comparing the examined soldiers with other men of this period, concluding that the veterans sample was representative of the Northern white male population according to geographic distribution, wealth, and cause of death.

We acknowledge several study limitations. Our data only pertain to adult white men and exclude men in states not held by the Union Army until the end of the Civil War. Second, methods of diagnosing and classifying disease and depth of understanding of disease processes differed substantially between the beginning and the end of the 20th century. Diagnostic techniques around 1900 were very limited, the field of ophthalmology was comparatively young, and the physicians performing the examinations were not likely to be familiar with any ocular pathologies besides the very most common. Consequently, misdiagnosis and underdiagnosis were likely to have been more common relative to more recent data. For example, around 1900, the presence of cataracts was typically based on observing a “white pupil” rather than by methods used more recently. Vision loss at the time of cataract surgery today is comparatively mild. Thus, using contemporary criteria, prevalence of cataract in 1895 and 1910 reported in our study is likely to be understated.

However, visual and functional status was observable. Graeff, in his book Das Menschliche Augepublished in 1933, urged those rating severe visual impairment and blindness to classify them based on the conditions' effects on patients' ability to function in their usual activities.

Classification, terminology, and knowledge of disease processes also differed. For example, the 1898 English edition of Fuchs' Text-Book of Ophthalmology, a widely respected reference at the time, defines amblyopia as weak sight or low vision that cannot be corrected by eyeglasses. Similar definitions are found in Alt's 1884 A Treatise on Ophthalmology for the General Practitioner and Higgens' 1888 Ophthalmic Practice. Complete blindness is referred to in these 3 texts as amaurosis. Our analysis considered a diagnosis of amblyopia in both eyes as functional blindness.

There is good support for supposing that a diagnosis of amblyopia, as the term was used then, was associated with severe functional impairment. Wood, writing on the army pension program, stated that “No pension is given for a partial loss of sight or for the partial or complete loss of the field of vision or the muscular functions of the eyes.” Graeff, writing more than 3 decades after Fuchs, Alt, and Higgens, characterized amblyopiaas a historical scientific term for severe visual impairment. He argued that if the criterion of amaurosis had been strictly applied as a basis for admission, 80% to 90% of all residents of institutions for the blind would have been there inappropriately.

Glaucoma provides an example of the lack of understanding of disease processes in the early 20th century. The term glaucoma appeared in ophthalmologic reference books of the period, and it was one of the listed diagnoses the board of surgeons could apply following their examinations of pension applicants; but the consequences of glaucoma were not understood then. There are 2 chief reasons for the rarity of reported glaucoma: (1) The disease was thought to be very uncommon and (2) the relationship between glaucoma and the optic nerve was not well understood. Fuchs wrote in 1898 that glaucoma accounted for less than 1% of all eye diseases. In 1900, Deyl and Sattler’s chapter “Diseases of the Optic Nerve” in Norris and Oliver's System of Diseases of the Eyemade no reference to glaucoma, though some connection with the optic disc was mentioned in Smith’s chapter on glaucoma in the same volume. Fuchs identified excavation of the optic nerve as the cause of blindness in advanced glaucoma but went no further. Both Alt and Higgens discussed glaucoma and the optic nerve separately. However, by the time Graeff’s text was published in 1933, examination of the optic nerve was used to diagnose glaucoma. Although tonometers existed in the late 1800s, in our data, there were more findings of disease of the optic nerve than there were of diagnoses labeled glaucoma. Thus, in our analysis, the latter was combined with the former group.

This study documents substantial reductions in the prevalence of low vision/blindness and changes in the composition of eye diseases from an era in which there were few effective therapies for eye diseases to the present. Comparisons of major eye diseases over the course of 100 years reveal substantial improvements in visual function. The appreciable reductions in the prevalence of low vision/blindness reflect such technological changes as innovations in the treatment of cataract and glaucoma and economic growth, which provided funds for developing capacity and financing provision of services. Other improvements, such as a reduction in the prevalence of trachoma, reflect improvements in environmental and public health, which is largely a byproduct of a country's level of economic development.

The burden of chronic eye disease is substantial and is reflected by (1) the resources devoted to its diagnosis and treatment and (2) the losses in productivity and quality of life it can cause. Both are important components of the total burden. Around 1900, when therapeutic options were limited, the burden of such disease and disability was largely borne outside the health care system. But nevertheless, particularly as reflected in high rates of low vision/blindness, this burden was substantial and much greater than it is now.

From: archopht.jamanetwork.com

Read More