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AN INVESTIGATION OP THE OPERATION AND FINDINGS OP THE LOS ANGELES COUNTY JOINT WORK'TEST PANEL
A Thesis Presented to the Faculty of the Graduate School of Social Work The University of Southern California
In Partial Fulfillment
of the Requirements,for the Degree Master of Social Work
by John Carter Pixley June 1942
UMI Number: EP66179
All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.
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UMI EP66179 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code
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11 ‘n-c. Thesis o f.
T h is thesis, w r it t e n u n d e r the d ir e c t io n o f the c a n d id a te >s F a c u lt y
C o m m itte e a n d a p p r o v e d
by a l l its m em bers, has been presented to a n d accepted by the F a c u lt y o f the G ra d u a te S c h o o l o f S o c ia l W o r k in p a r t i a l f u l f i l m e n t o f the re q u ire m e n ts f o r the degree o f
MASTER OF SOCIAL WORK
D ean Date.
F a c u lty Com m ittee
TABLE OF CONTENTS CHAPTER I.
STATEMENT OF THE PROBLEM AND ORGANIZATION.
. . .
OF THE S T U D Y ...........
The p r o b l e m . ..................................
Significance of the study...................
Sources of i n f o r m a t i o n ...................
Definitions of terms used.....................
Los Angeles Department of Public Assistance.
Los Angeles County Office of the State Relief Administration.
.......... • • • •
General relief ..............................
Organization of the study. . . • • • II.
REVIEW OF SELECTED STUDIES DEALING WITH FACTORS ASSOCIATED WITH UNEMPLOYABILITY...............
Los Angeles Study.......................
. • •
Illinois Study ................................
Chicago Survey • . . •
National Health Survey . . . . . . . . . . . .
S u m m a r y . ......................................
ii CHAPTER III.
THE DEVELOPMENT OP PUBLIC ASSISTANCE PROGRAMS. . IN CALIFORNIA FOR EMPLOYABLE AND UNEMPLOYABLE P E R S O N S . ...............................
Public assistance in California prior to 1931......................................
Institutional care . . .
Non-Institutional care •
The Employable Unemployed...................
Public assistance in California from 1933. . • to 1941......................................
Administration of public assistance in Los . . Angeles County in 1941 . . . . . . IV.
DETERMINATION OF UNEMPLOYABILITY OF PERSONS.
ON RELIEF IN LOS ANGELES COUNTY...............
Early Methods of determining employability • •
Necessity for determining employability. ...
First p r o c e d u r e s ...........................
P r o b l e m s ....................................
The Joint Work Test Panel.
Administration of the Joint Work Test Panel..................................
Sceduling examinations .......................
PAGE Persons to receive work test examinations,
Persons who received examinations.......... •
Procedures of scheduling examinations.
Preliminary procedures .....................
The physical e x amination ...................
Classification of examinees.................
Diagnosis and recommendations.
Statistical summary of a years operation of the Work Test Panel......................... Summary.................. V.
ANALYSIS OP FACTORS RELATED TO THE UNEMPLOY- . . ABILITY OF EXAMINEES OF THE JOINT WORK TEST. . PANEL....................... ..
Methods of collecting d a t a ...................
Activities of Panel for fifty-two weeks.
• . •
compared with one w e e k ............
Distribution by age of e x a m i n e e s .............
Employability classifications of Work Test . • Panel examinees.
. . . . . . .
Sex and racial distribution of Work Test . • . Panel Examinees by sources of referring. agencies.
PAGE Employable for any work.
Racial distribution.......... . . . . * . *
Sex d i s t r i b u t i o n
Employable for light work..................... Referral source.
Sex distribution .
Clients to be . • •
Sex d i s t r i b u t i o n ..........................
Employable with special appliance...........
Sex di s t r i b u t i o n .................
Referral s o u r c e . ...................
• • •
Age distribution of e x a m i n e e s . ..........
PAGE White employables.
. . . . . . . .
White unemployablea# Negro unemployables.
103 105 105
• • • . . • • • • • • •
. . . . . . . . . . . . .
Physical causes of unemployability . . . . . .
Employable for light work.
Temporarily u n e m p l o y a b l e ..................... Employable with special appliance.
• • . • •
110 114 115
Permanently u n e m p l o y a b l e .....................
Summary. • • • • • • • • • •
VI.SUMMARY AND CONCLUSIONS............................. Summary..........................................
Unemployables and employables.................
B I B L I O G R A P H Y .......... ...............................
A P P E N D I X ...............................................
Specific diagnoses included in general classifications.............................
Instructions to examining physicians Lockheed Aircraft Corporation.................
Instructions to examining physicians National Youth Administration..............
CHAPTER APPENDIX D*
Standardization of methods of examination, records, and the classification.
. . . .
. . .
Specific physical defects and disease.
Fitness for e m p l o y m e n t .................
Methods and procedures of conducting pre-
employment examinations........... H.
Standardized medical t e r m i n o l o g y .......
Physical examination p r o c e d u r e ............
167 171 174
vii LIST OP TABLES TABLE I.
PAGE Persons sixteen and over with Disability in Cook County and all other Counties in Illinois and Type of Disability Reported . . ............. 16
Ration of Annual per capita Volume of Disability for Low Income Groups to that in the Highest Income Groups according to Specified Diagnosis Classifications of National Health Survey.
Sex and Employment of Head of Families and per centage Distribution for Heads of Specific Race.............................
Total Number of Examinations given by Work Test Panel for Fifty-two Weeks 1940-41. . . .
Percentage of Work Test Panel Examinees Employable and Unemployable for Fifty-two weeks Compared with One W e e k .................
Per cent of Work Test Panel Examinees Employable or Unemployable by Source of Referral for Fifty-two Weeks and for One Week 1940-41.
Total Number of Persons Examined by Work Test Panel in Five Days - by Age and Sex • . . • •
Total Work Ability Classifications of Joint Work Test Panel Examinees for Five Days . . .
viii TABLE IX.
PAGE Employable Examinees of Joint Work Test Panel shown by Source of R e f e r r a l ............ •
Examinees of Joint Work Test Panel Classified as Employable for Light Work by Source of Referral............
Examinees of Joint Work Test Panel Classified as Temporarily Unemployable Shown by Source of R e f e r r a l .....................
Examinees of Joint Work Test Panel Classified as Employable with Special Appliance shown by Source of R e f e r r a l .......................
Unemployable Examinees of Work Test Panel Shown by Source of R e f e r r a l ......................97
Summary of Referrals to Joint Work Test Panel by Sources of Referral Expressed in per centage of Totals from Each Agency............... 99
Summary of Racial Distribution of Examinees of Joint Work Test Panel Showing Employment Classification and Per cent of Each Racial G r o u p ............................................ 100
Summary of Sex Distribution of Examinees of Joint Work Test Panel Showing Employment Classification and Per cent of Males and Females . . ......................................102
ix TABLE XVII,
PAGE Total number White Employables Examined by Work Test Panel in Five Days, Classified by Age Expressed as Percentage*
. . . . . . .
Total Number Employable Negroes Examined by Work Test Panel in Five Days Classified by Age and Expressed as P e r c e n t a g e .............
Total Number of Whites Examined by Work Test Panel in Five Days Who Were Found to be Unemployable Classified b y A g e ...............
Total Number Negroes Examined by Work Test Panel in Five Days Who Were Found to be Unemployable - Classified by Age.
• • • • • •
Major Diagnoses of Examinees of Work Test
Classified as ^Employable for Light Work11 . • XXII.
Major Diagnoses of Examinees of Work Test Classified as Temporarily Unemployable.
Major Diagnoses of Examinees of Work Test
Panel • . .
Classified as Employable with Special Appliance■.Shown by Race and S e x ............. XXIV.
Major Diagnoses of Examinees of Work Test Classified as Permanently Unemployable.
Panel • •
Comparison of the Incidence of Certain Major Physical Disorders for Persons Placed in Three Work Ability Classifications...........
CHAPTER I STATEMENT OF THE PROBLEM AND ORGANIZATION OF THE STUDY Legislation of recent years dealing with public assis tance has frequently distinguished between two classes of persons in need of general assistance, the ^employables*1 and the “unemployables1*•
Such legislation in the State of Cali
fornia defined only In very general terms the two classifi cations.
Because of inadequate definitions of class limits,
or because the classes may have been too indefinite to permit strict limitation, problems have arisen in administering public assistance to 11employablesw and tfunemployablestt. Where laws require that two such groups be treated as distinct from each other, and where laws fail to define adequately the classes, it becomes the task of persons charged with the administration of public assistance, to define in detail the two classes.
Thus in California public welfare administrators
have had to define specifically who was employable or who was unemployable, first by setting up limits of the two categories, and then by determining into which class each applicant for relief should be placed.
This is no easy task for the admin
istrator since he must meet the legal responsibility placed on him by law, and he must also be concerned with the effects
of the policies of his administration upon those persons served —
the clients. I.
The purposes of this study are to examine a physical examination center which was established in Los Angeles County, to determine which relief recipients were unemploy able because of physical disabilities.
This center is the
Joint Work Test Panel which was first developed by the Los Angeles Department of Public Assistance, and which was later brought into use as a means of determining which of two agencies administering general relief in Los Angeles County, should assume responsibility in individual cases for the provision of relief. Significance of the study.
The Joint Work Test Panel
was an administrative tool used by two large public reliefgiving agencies, the Los Angeles County Department of Public Assistance and the State Relief Administration, to determine which of the two agencies should accept applicants for public
The Los Angeles Department of Public Assistance administers Public Assistance in Los Angeles County. At the time of this Study, (1941) this agency was known as the Bureau of Indigent Relief, and later as the Department of Public Assistance. Department of Public Assistance will be used throughout this study regardless of what name the agency was called at the time data were collected.
This panel might have set a pattern which could he
used throughout all counties of the State of California, to determine agency responsibilities for public assistance.
it should have been adopted on a state-wide basis, and if It proved successful, many confusions growing out of conflicting opinions on legalistic interpretations might have been avoid ed*
Although the panel was designed to help solve an admin
istrative problem, It should be noted that the recipients of public assistance were very much concerned, and that this examination center not only eliminated administrative pro blems, but it also eliminated much uncertainty for the relief clients, who did not themselves know in which category they belonged —
the "employable11 or the "unemployable" —
were frequently shunted from one agency to another.
quate manual of operations definitions were supplemented, and conflicting opinions of physicians were eliminated.
field of social work administration it is Important that de vices which meet problems such as those mentioned above, be studied as to effectiveness; and as a step to further coop erative arrangements between agencies* Any agency set up to meet specific needs may raise additional problems of its own.
It is important to the
agency and to those interested in such problems, that pro cedures be studied, and an analysis made of such problems*
4 If a study such as this is based upon factual material, it may become the basis for certain refinements of procedures* These should lead to an efficiently, or a more efficiently, operated program functioning within the purposes of the agencies as defined by law, and as interpreted in adminis trative procedures* Significant, also, is the fact that through a study of records of physical examinations of the Joint Work Test Panel, it is possible to develop an appraisal of a group of persons who have been receiving relief or who are eligible for such assistance*
Other studies of this group have been
made, although none is known to have adequately.described the physical abilities of members of this group, as they relate to employability* Sources of information*
The bulk of this study is
based upon an analysis of 601 physical examinations conduct ed by the Joint Work Test Panel.
Other sources of informa
tion include administrative manuals of public agencies charged with the responsibility of administering public assistance, annual reports of these agencies, and interviews with persons in administrative positions in the agencies* Additional knowledge was obtained through visitation of the panel and direct observation*
Six full days were spent in
observing the operations of the panel and noting methods of
5 examination. Other sources of information include publications in the fields of Public Welfare and Public Administration, numerous studies having to do with examinations of persons on relief, or of persons in the general population coming under the classification of "low income” .
was obtained from legislation of the Federal, State and Local Governments, as the legislation related to the problem of relief, and particularly to provisions concerned with “employables” and “unemployables.” II.
DEFINITIONS OF TERMS USED
Los Angeles Department of Public Assistance.
Angeles Department of Public Assistance (DPA) is a department of the county government of Los Angeles County which admin isters all types of public assistance that are provided through public auspices.
This includes general unemployment
relief, which is financed wholly from County funds; aid to dependent children, old age assistance, and aid to the blind which are financed jointly from federal, state, and county funds.
At the time the data for this study were collected,
the DPA administered general unemployment relief only for those persons considered to be unemployable.
6 Los Angeles County Office of the State Relief Admin istration,
The Los Angeles County State Relief Administra
tion was the local office of the State Relief Administration^ in Los Angeles County,
The SRA was a state tax-supported,
public assistance agency.
It gave general unemployment
relief to persons who were in need of such assistance !,due to and caused by unemployment1*.
This need was interpreted
to include only persons who were "employable” .
The SRA was
created in 1933 and was discontinued July 1, 1941. Employable.
An employable person as used in this
study is any person who was eligible for assistance from SRA. To be eligible a person could not be totally incapacitated for gainful employment, and he must be willing and able physically and mentally to perform gainful employment; he must be available for such employment; and he could not be . prevented from accepting such employment as a result of family responsibilities.
He must be over eighteen years of
age. Public Assistance.
Public assistance is any type of
indoor or outdoor relief administered by public tax-supported
^ The State Relief Administration will hereafter be referred to as SRA.
7 agencies and financed by taxation. General relief.
General relief is any type of public
assistance which is not covered by categorical limitations. It may also be known as general assistance, general unemploy ment relief, or general aid. persons.
It is relief given to all needy
Usually, it will not be given to persons who are
entitled to receive other types of assistance.
relief is differentiated from categorical assistance which provides assistance for special and defined classes of needy persons such as dependent children, blind, and the aged.
DPA administered general relief, along with the categorical aids, while the SRA gave categorical assistance* The terms which have just been defined will be dis cussed throughout this study.
Their use will be clarified
as they are related to actual happenings.
In each case, the
definition is a practical definition, that is, it describes the term as it has been necessary to use it in this study. Thus an employable person as used herein would not be a satisfactory definition in other situations. III.
ORGANIZATION OF THE STUDY
The remainder of this study consists of five chapters. Chapter II discusses studies which have been conducted in several cities.
Although the objectives of these studies
8 are different from those of this thesis, they are concerned with some aspects of unemployability and health factors that relate:, to unemployability and are therefore relevant.
of the studies discussed is a thesis which treats certain aspects of determining unemployability in Los Angeles County* A resume of the development of public assistance pro grams in California is developed briefly in the third chapter. This development traces the two broad types of public assis tance programs set up for the two classes: and the unemp1oyab1e s .
In this chapter special considera
tion is given to the development of relief programs in Los Angeles County. Chapter IV describes the methods used to determine unemployability in Los Angeles County.
The methods discussed
here are those used to determine agency responsibility for individual persons.
Detailed discussion-is developed on the
operation of the Joint Work Test Panel.
cedures of the panel are presented and analyzed. Health factors which have been found to be related to employability status are discussed in Chapter V.
factors are based on an analysis of 601 records of physical examinations conducted by the Joint Work Test Panel. Efforts have been made to show causal relationships between specific health problems or diagnoses and unemployability.
relationships were based on diagnoses of examining physicians* The highlights of this study are summarized in the last chapter*
Certain conclusions are drawn as to the opera
tion of the Joint Work Test Panel and some suggestions are made as to possible methods of improving services of the papiel*
These suggestions would keep in mind the purposes
for which the panel was established and the limits within which it functions*
CHAPTER II REVIEW OP SELECTED STUDIES DEALING WITH FACTORS ASSOCIATED WITH UNEMPLOYABILITY Many studies have been made which have dealt with physical disfunctions which accompany unemployment.
studies should be reviewed at this point although their pur poses are in most cases different from those of this study. They do bring information, however, concerning disabilities found among classes of the unemployed which surely have some bearing upon the unemployment of individuals afflicted with them. Los Angeles Study.
In a Master’s thesis written in
1939, Estelle Davis Brenner made an analysis of fifty case histories of recipients of public assistance in Los Angeles County.^
The persons discussed in this study had been
classified or needed to be classified as employable or unem ployable before they could be definitely accepted by either of the two public relief-giving agencies operating in Los
* **• Estelle Davis Brenner, ”Factors in the Determination of Employability With Special Reference to Public Relief Administration in Los Angeles County,” (unpublished Master’s thesis, The University of Southern California, Los Angeles, 1939), 130 pp.
11 Angeles County.^
Each of the cases considered had been
disputed by the two agencies, the Bureau of Indigent R e l i e f , 3 and the Los Angeles County Office of the State Relief Ad~ ministration.
The fifty cases had been brought before a
disputed case committee of the two a g e n c i e s . ^ The cases discussed by individually,
Mrs. Brenner were considered
and the factors that
enteredinto the final
decisions of employability were analyzed.-
No attempt was
made to classify and tabulate the factors which entered into final decisions of the committee. individually. histories and
Each case was treated
Social factors brought to light in case case summaries, such
as work histories, economic
and income factors, alcoholism, children in the home and so forth, were the determining factors.
Few of the persons
discussed in this thesis were disputed on the basis of physical findings, although the importance of defining physical ability in individual cases is discussed. Mrs* Brenner pointed out the need for some consistent method of determining employability if it were to continue to
2 See Chapter III. 3 Now the Department of Public Assistance. ^ The disputed case committee is discussed in Chapter IV•
12: be the basis for determining agency responsibility.
mentioned that the Joint Work Test Panel which had just been established, might eliminate some of the difficulties which beset clients who sought relief in Los Angeles County.
applicants were very often referred back and forth between the two agencies before final acceptance* Illinois Study*
In 1935 a study was made of persons
receiving assistance from the Illinois Emergency Relief Com« mission.
This research project was undertaken by the Works
Progress Administration under the supervision of Elizabeth A. H u g h e s *5
The purpose of the project was to 11gather essen*
tial information” which would help in gauging public assis tance needs in Illinois.
An important part of this analysis
was the tabulation of physical disorders reported among the 1,177,206 persons covered by the project.®
the tabulations was obtained through the analysis of case records in local public assistance offices throughout the State of Illinois together with follow-up interviews.
of this method of obtaining data of physical disorders, there is considerable question that the data presented in the study
® Elizabeth A. Hughes, WPA Project Superintendent, Illinois Persons on Relief in 1955, Chicago 1937. 6 Ibid*, p. xiii and xiv.
While schedules used in the study set forth de
tailed criteria for determining diagnoses, it is doubtful that case records or persons interviewed gave diagnoses that had actually been made by physicians.
Even in eases where
physicians had diagnoses disorders, there is question that the diagnoses have statistical significance unless rigidly defined classifications have been established prior to exam** inations.
Regardless of these questions, the study repre
sents a tremendous work, which covered nearly fifteen per cent of the Illinois State population of 1935,^ and included 342,930 heads of families. February 28, 1935.
All data obtained related to
Some of the findings of this project are
presented here. Information as to employability of family heads was available for 272,285 families.
Physical or mental disability
was reported as affecting the employability of 95,364 family heads.
Only permanent disabilities which were serious enough
to handicap in securing or holding a job were recorded.
all family heads with serious disabilities were considered incapacitated for work and consequently adjudged unemployable. In fact, 6,312 heads of families or 6.6 per cent of all those with disabilities reported that they had work on February 28, 1935.
About 55 per cent or 52,108 heads of families were
14 employable but were out of work*
Of the total number of
persons considered, only 36,823 or 38*6 per cent were found to be totally unemployable# Foreign born whites showed the highest proportion of disabilities with 38.7 per cent of the total group reported with such afflictions.
Negroes showed 34.9 per cent with
/ disabilities and native born whites showed 33#4 per cent with disorders.
The Mexicans showed the lowest proportion
of disabilities with 16.8 per cent of the total.8 Of all the persons interviewed and reported In this study, disabilities serious enough to be a handicap in getting and holding a job were reported for 218,988 of the 730,802 persons of employable ages.
However, only 32.8 per cent of
the 114,569 men with disabilities were judged completely un employable, while 83.6 per cent of the women were unemploy« able.
Disabilities did totally incapacitate 69,687 or
approximately 10 per cent of all persons of employable ages covered by the survey. Table I shows the types of disabilities discovered by the survey, for Cook County and for the other 101 counties of the state.
Percentages for Cook County run higher than
those for the remainder of the state.
® Ibid., p. xxvii*
It is pointed out in
15 the study that in Cook County medical facilities and examina tions were more readily available than in the rural parts of the state.
Data derived from examinations were more accurate
than those obtained through interviews alone. This study shows the incidence of some disorders among relief recipients, and it relates these disorders to the em ployability of these persons.
It is of value in giving a
picture of the relief client of Illinois in 1935* showing his physical disabilities and their relationships to employability* This information is in addition to other data which are in cluded in this comprehensive research and statistical project. Chicago Survey. A study was made of unemployable relief recipients in Chicago in 1937.
Included in the study were
only those persons who were considered unemployable on the day May 15, 1937*^
Case records of relief recipients were
used as sources of the basic information.
were classified by age, sex, color, birthplace, and the pri mary causes of unemployability.
Eighteen disability classi
fications were used to describe these causes.
^ Clara Paul Paige, "Chicago’s UnemployablesM , Survey, 73:373-5, December, 1937*
TABLE I PERSONS SIXTEEN AND OVER WITH DISABILITY IN COOK COUNTY AND ALL OTHER COUNTIES IN ILLINOIS AND TYPE OP DISABILITY REPORTED* Cook County Type of Disability Number 11$,110
Per cent Di stribution
to • —1
All Other Counties
Senility Heart, blood, and circulatory Orthopedic Rheumatism, neuralgia, neuritis Hernia Respiratory, including tuberculosis Diseases of Stomach and Abdomen Genito-Urinary Eye Mental and Nervous Ear Cancer and Tumors Diabetes Goiter Venereal All Other
Per cent Distribution
6,374 6,836 7,298 5,676 2,518 1,872 1,530 1,250 1,564 3,924
5.4 5.7 6.1 4.8 2.1 1.6 1.3 1.0 1.3 3.3
6,379 5,851 5,198 5,585 2,237 1,379 896 1,075 296 1,723
6.4 5.9 5.2 5.6 2.2 1.4 0.9 1.1 0.3 1.7
!tIllinois Persons on Relief in 1955” , p. xxxv.
17 This study, described by Clara Paul Paige showed that slightly more than 18 per cent of the unemployables had some injury which was the major factor in unemployability.
teen per. cent had heart disease, 10.2 per cent were suffering from disabling nervous or mental conditions, and of the total number of persons reported upon, only 48.2 per cent were re ceiving medical care.
Approximately 40 per cent of the un
employables were considered to be permanently unemployable* Here as in the Illinois Study previously discussed, the source of information concerning the employability status of individual cases Is questionable, unless all diagnoses were made by physicians who were aware of the specific limits of the classes of persons to be known as "unemployables*11 Minnesota Study*
Dr. Harold S. Diehl has developed a .
study, in which he discusses the physical findings of the Employment Stabilization Research Institute of the University of M i n nes o t a * ^
p or a period of three years this agency
conducted physical, psychological, and sociological examin ations of both employed and unemployed persons In Minneapolis, Saint Paul, and Duluth*
Harold S* Diehl, "Physical Condition and Unemploy ment", Reprint No* 1716 from the Public Health Reports, United States Government Printing Office, 1936*
In a report of his findings, Dr. Diehl has attempted to relate physical handicaps to unemployment.
aminations of four broad occupational- groups were studied: (1) professional and business officials; (2) clerical workers (3) skilled workers;
(4) semi-skilled workers.
Each of the
classes was further broken down by the following sub-group ings:
(1) early depression unemployed;
(2) late depression
unemployed; and (3) unemployed at the time of the examination Each physical examination was classified on the basis of the following groupings: reduce efficiency;
(1) physical defects likely to
(2) physical defects which might impair
efficiency; and (3) no physical defects, or handicaps likely to offset efficiency. Prom the findings of this study, it was found that the occurrence of physical handicaps or defects is greater among the unemployed than the employed groups of each occu pational class, and that they occur more frequently among the early depression unemployed than among the late depression unemployed.
It is pointed out that physical conditions are
probably not considered as of major importance when men are laid off from their jobs, although their presence in larger per centages of the unemployed, might easily lead to the con clusions that efficiency was impaired as a result of the handicaps*
19 Dr, Diehl believes that the data of the examinations seem to justify the following conclusions: Individuals who are in good health and who keep themselves as free as possible from physical handi caps are less likely to suffer unemployment than individuals who are handicapped by physical defects; and that employers could expect greater efficiency from their employed if provisions were made to dis cover and correct their physical handicaps and to keep them in better health.,,H National Health Survey,
As part of the Nation-wide
Health Survey of 1955-1936 conducted by the National Institute of Health, a study was made of the relationship of causes of physical disability to status in classified economic groups. One of the economic groupings considered was that of persons on relief.
Additional analysis was made of age g r o u p s , ^
The study showed the days of disability for each age group and the number of cases of disabling illness by sole or pri mary d i a g n o s i s , 13
^he findings were analyzed statistically,
with rate discussed under age classifications, which were adjusted to a standard age distribution,
11 Ibid., p. 9. National Health Survey 1935-1936, Preliminary Report Sickness and Medical Case Series Bulletin, "Disability From Specific Causes In Relation to Economic Status” , National Institute of Health, United States Public Health Service, Washington, 1938, Ibid., pp. 12-13. Ibid., pp. 2, 12-13.
In collecting the data for the survey, several measures of illness were used for each person: person from work, of the canvass;
(a) illness keeping a
school, or other usual activity on the day
(to) illness which had disabled a person in
the above sense continously for seven days or more during the 12 months preceding the date of the canvass;
disease present, whether or not it had caused disability; (d) gross physical impairment, including lost and impaired legs, feet, arms, fingers, etc*, and total or partial blind ness and deafnes s. Reports of the National Health Survey show that for all types of disabilities considered, the incidence of dis ability was highest in every age classification for persons on relief.
Persons on relief rolls or of low Income groups
experienced more frequent illness during the year of study, and the duration of each illness is longer than for other income groups.
The annual per capita volume of disability
from diseases, accidents and impairments for persons on re lief was 17.4 days per year, for non-relief persons under $1,000 annual Income, it was 10.9 days per year, while for other income groups it ranged from 6.5 days for the income groups over $5,000 to 7.9 of groups receiving annual incomes from $ 1,000 to $ 1 ,500.16
Report based on white persons only.
In summarizing disabilities in relation to economic status, the National Health Survey has this to say, 11. • there has been shown a definite relation between economic status and volume of disability.,f16 Summary.
(See Table II)
The studies and surveys discussed in this
chapter have with one exception, been either entirely or in part devoted to discovering physical disabilities of unemploy ed persons or persons on relief rolls.
None of these studies
has attempted to show the effects of specific physical dis abilities on the employability of the people about whom data were gathered.
However, they do present information on the
types of disabilities and the frequencies of occurrence to be found among low income groups. The high incidence of disabilities among relief appli cants shown by findings of studies herein discussed , , .. indicates there is much more likelihood of persons on relief being unemployable because of disability.
These studies do
not answer the question of whether the unemployable person on relief is there because of his disability, or whether his low income status is responsible for his disability, in that the medical care, or nutrition requirements necessary .
National Health Survey,, Op. cit., p. 9.
to maintain adequate health have been lacking*
do show that there is a broad relationship between unemploy ment and unemployability caused by physical disabilities. They also show the types of disability most frequently found among persons receiving relief. If it continues to be necessary to distinguish between the relief applicant who is lfphysically employable” and the relief applicant who is ”physically unemployable” there should be certain descriptive classifications which adequately describe such persons*
Such classifications would ease an
administrative problem caused by the use of these terms with out definite detailed decisions as to what persons will com prise the class.
The writer makes this statement, well aware
that two persons with the same disfunction in the same degree will not be unemployable in the same degree.
23 TABLE II RATIO OP ANNUAL PER CAPITA VOLUME OP DISABILITY FOR LOW INCOME GROUPS TO THAT IN THE HIGHEST INCOME GROUPS ACCORDING TO SPECIFIED DIAGNOSIS CLASSIFICATIONS OF NATIONAL HEALTH SURVEY*
Income Status of Family Diagnosis
Under ,#1000 to . #5000 #1500 and #100 per yr* per yr. over
Orthopedic Impair ments
Diagnoses not grouped elsewhere
'‘Based on rates adjusted to the age composition of the Health Survey total white population* Source: National Institute of Health, United States Public Health Service, d i s a b i l i t y From Specific Causes in Rela tion to Economic Status” , Preliminary Reports, Bulletin No. 9, Sickness and Medical Care Series* Washington, 1938, p. 9.
ILLINOIS PERSONS ON RELIEF IN 1935 TABLE III SEX AND EMPLOYMENT OF HEAD OF FAMILIES AND PERCENTAGE DISTRIBUTION FOR HEADS OF SPECIFIC RACE* Total Sex and Employability . Total Employed Employable but out of work Unemployable Male Employed Employable (not working) Unemployable Female Employed Employable - out of work Unemployable
Per cent Dist.
Foreign Born White
196,064 51,657 225,445a
71.8 18.9 100.0
72.3 10.8 100.0
70.0 ■23.2 J.00.0
71.8 21.7 100.0
76.4 14.6 100.0
47,770a 2,468 16.037 29,265
a *- Employability was unknown for 1,678 heads, 1,490 men and 188 women. * - Source:
Illinois Persons on Relief#
CHAPTER III THE DEVELOPMENT OP PUBLIC ASSISTANCE PROGRAMS IN CALIFORNIA FOR EMPLOYABLE AND UNEMPLOYABLE PERSONS The pattern followed In the development of public assistance programs in the State of California resembles that of most of the other states of the United States.
depression of 1929, the public responsibility for the care of the poor was primarily that of local
responsibility for the care of the poor was defined by law as belonging to the counties and ”poor relief” was admin istered by the county supervisor s. 2
Although the ”Indigent
Act11 was not passed until 1901, there was f,local responsibility11 defined by statute and carried out by operations of local governments as early as 1855, for the 11indigent sick11♦3 Through the years following these early definitions of res ponsibility, it was the accepted policy that the local governments would be charged with the care of those who were unable to work.
Even though ”local responsibility” was later
The exception was state aid for children and aged who were in the care of private agencies or counties. ^ Constitution of California (1879) Article IV, Section 22. 3 California Statutes 1855, Chapter LVII, Sections 1, 2, 6.
26 “broadened by definition to Include all of the poor having residence in the several counties, practice continued the earlier policies.4 Thus in the early days of public relief In California, a distinction was made between the "employable” and the ”unemployable” relief client.
This distinction became more
pronounced in the 1930*s, after the federal and state govern ments began to assist local governments in providing assis tance for certain categories of persons.
The unemployed as
a relief category were not included in the federal programs. Consequently, when the State of California undertook the responsibility of caring for the employable unemployed, the local governments were left with the responsibility for giving assistance to the unemployable unemployed.
responsibility thus came to be defined in terms of caring for "unemployables.”
This made it necessary for state and
local relief administrators to define the classes of persons who would be aided as the employable unemployed and the unemployable unemployed.
It is the problem of defining these
two groups and how the- problem was met in Los Angeles County with which this study is concerned.
4 California Statutes (1901), Chapter CCX.
PUBLIC ASSISTANCE IN CALIFORNIA PRIOR TO 1931.
the Gold Rush with its sudden increase of population, Cali fornia was faced with an emergency situation brought on by problems of destitution and sickness.
These resulted from
the hardships of migration and the difficult living conditions found by early immigrants to C a l i f o r n i a . ^
in 1855 the Cali
fornia poor law was enacted making county boards of super visors responsible for the needy sick.
Most care for the
poor in these early days was institutional and was given through county hospitals and local almshouses, although state hospitals took care of many persons who could not be accom modated in inadequate county hospitals.^
The limited pro
vision resulted in some counties, in the extension of the definition of “sick" to include infirm, aged and other help less persons. Certain state funds were made available to counties following legislation in 1855, for the purposes of caring for the indigent sick.
However, hospital developments follow
ing this were not uniform throughout the state.
5 Cahn and Bary, p. 137. 6 Ibid., p. 140.
institutions which were established for the care of the un employable or indigent sick were variously know as "almshouses, *7
and "County Hospital,” and these terms have generally lasted. Care given by these early hospitals was inadequate and in many instances was provided only for men. with no provisions for women and children. In 1860 the State legislature enacted statutes which permitted the establishment of county Infirmaries, "when in the opinion of county supervisors such a. measure would be advantageous*1 and defined those eligible for care t!as every person who Is blind, lame, old, sick, or decrepit, or in any other way disabled so as to be unable by his or her work to maintain themselves.*1®
Funds for the establishment of these
institutions were to be raised through an ad valorem tax not to exceed one quarter of one per cent on all real and per sonal property.
In Los Angeles and two other counties, the
issuance of long term county bonds for the construction of such hospitals was authorized.
Besides state appropriations
for institutions, the state began in 1869 to give funds to local Benevolent Societies.
Such procedures were made illegal
by the Constitutions of 1879, and were discontinued.
^ Cahn and Bary, 0£. c i t ., p. 142. 8 California Statutes (1860), Ch. 247, Series 1, 12.
The number of almshouses during the decade following 1860 increased considerably.
By 1870 there were 24 county
hospitals and almshouses in California, three times the number that had existed in 1860.9
in 1883 the State legis
lature authorized reimbursements of $100 a year for all persons over 60 years of age who were being cared for in county hospitals providing certain State requirements were met.
These grants were discontinued in 1895 when economy
measures were adopted by the state. The Indigent or Pauper Act was enacted by the State legislature in 1901.
This Act made the counties responsible
for the care of the indigent sick, the aged, the blind, and those who were otherwise physically disabled.
The law de
fined residence of persons eligible for assistance.
ponsibility of relatives for the care of the abovementioned was defined by the Act.10 The State Board of Charities and Corrections was established in 1903, bringing all of the county hospitals under its supervision, in order that standards of 11social policy" might be established.^
By July 1, 1904, there were
59 county hospitals in California with a total of 4,168
9 Cahn and Bary, Og. cit., p. 144. 10 California Statutes (1901), Ch. CCX, Sections 1-7. 11 Ibid., (1903), Ch. CCCLXIII, Sections 1 and 3.
Most of them served the double purpose of
hospitals for the indigent sick and
a l m s h o u s e s .
three counties, including Los Angeles, these functions were separated and two separate institutions were maintained. In 1925 the State Department of Public Welfare took the place of the Board of Charities and Corrections, and took over the functions of supervision of county hospitals. In turn the State Department of Public Welfare was succeeded by the State Department of Social Welfare in 1927.
supervisory agencies of the State government developed con trols, the administration of local hospitals was affected and higher standards of operation prevailed.
With the de
velopment of higher standards in the county hospitals, these hospitals became almost entirely medical hospitals for the indigent sick, losing all identity as almshouses.
during this same period, programs of non-institutional relief began to be developed, replacing institutions which had lost the functions of almshouses. The Unemployables.
Cahn and Bar.y, 0£. cit., pp.' 146-7.
13 California State Board of Charities and Corrections, First Biennial Report 1903-4, pp. 78-97, 100-08.
3£L passed by the State legislature in 1855, which provided for the care of the indigent sick by the counties of California, also made county supervisors responsible for the granting of outdoor
r e l i e f . 14
provisions were made for such grants to
persons besides the sick, until they were included in the Constitution of 1879.
The Constitution stipulated that when
ever any county, city, or town should provide support for in digents, the same pro rata appropriation should be given as was given to indigents cared for in i n s t i t u t i o n s . 15
County Government Act of 1883 broadened the powers and res ponsibilities of the counties and the county boards of super visors in addition to caring for the indigent sick were empowered to relieve 11the otherwise dependent poor of the county.ff
Following this enactment, the counties began to
extend outdoor relief to the needy aged as part of a system of state aid to the aged which had been adopted at the same t i m e . 15
a.id to the aged, subsidized by the state government,
was eliminated in 1895 when it was felt by the legislature to be a prohibitive charge against the state treasury.
14 California Statutes (1855), Ch. LVII, Sections 1, 2, 6* 15 Constitution of California (1879), Article IV, Section 22* 16 California Statutes (1883), Ch. LXXV, Section 2565.
the withdrawal of state aid, the giving of relief was thrust upon the counties where it remained for the next thirty-four years as a full responsibility,^ except for special assis tance programs for the aged and children. In 1901 the Indigent or Pauper Act was enacted by the State legislature, placing upon counties the responsibilities of caring for the poor and defining the responsibilities of relatives.
Although the State Board of Charities and Cor
rections was created in 1903 it had no supervisory jurisdic tion over outdoor relief until 1911.
In 1916 the State Board
of Charities and Corrections made a study of outdoor relief in California.^-®
It was found that the giving of outdoor re
lief was established In all but two counties.
In most cases
the practice was to give small amounts of assistance, most commonly In the form of groceries, but in some cases advanced in the form of cash grants ranging from $5 to $30.
grants were made to persons on the County Indigent Lists, whose names were placed there by the supervisors representing the districts in which the applicants for relief lived.
study showed four general types of organization in the
Cahn and Bary, 0£. cit., p. 172;.
**-® California State Board of Charities and Corrections, "County Outdoor Relief in California", 1916.
counties which administered assistances
(1) the County
Charities Office (4 counties -- one of which was Los Angeles) (2) private agencies acting as paid agents of the county (2 counties);
(3) County Agents (11 counties);
administration by the county supervisors (39 counties)# counties gave no out-right relief#
In Los Angeles County
outdoor relief was supervised by a director of a department under the County Superintendent of Charities, who was res ponsible to the county supervisors.
The total amount of
outdoor relief given by all counties in 1916 was $902,195.58# Of this total, 29 per cent was distributed by County Chari ties Offices, 11 per cent by the counties using private agencies, 22 per cent by the counties using a county agent, and 38 per cent by the counties where assistance was admin istered directly-by the County Supervisors# In 1917, the Indigent Act was amended making it manda~ tory upon the local boards of supervisors, "to provide for the maintenance and support . . • of indigent incompetent and incapacitated persons, other than persons adjudged insane and confined within the state hospitals."
It also required
investigation of persons who sought relief in the various counties. As a result of the investigation of 1916 and of the 1917 legislation, uniform methods of reporting were developed "leading to a more constructive handling of indiyidual
This pointed toward local programs of rehabilita
tion of persons in need of help, in addition to the giving of relief. The study of the State Board of Charities and Correc tions recommended that the counties organize County Welfare Departments.
The study also recommended that local staffs
should be trained and selected on a merit basis.
of these recommendations, by 1924 outdoor relief was being handled under eight different
s y s t e m s .
the counties, however, relief was handled directly by the county supervisors, or by a welfare department. About this time throughout the United States old age assistance began to be considered of great importance.
1925 an old age pension act was passed by the California legislature but was vetoed by the governor.
study authorized by the State Department of Social Welfare a bill was passed by the state legislature in 1929, based upon county and state joint financing.
This law became effective
the first of January, 1930, to be administered by a division under the State Department of Social Welfare.
Cahn and Bary, Op. cit., p. 177.
20 Loc. cit.
35 The Employable Unemployed*
Throughout the years in
which California has been a state, legislation which would provide for the person who is out of work but who is able to work has been emergency legislation.
The care of such per
sons has been different from that of persons considered to be permanently unemployable for whatever reason*
blem of taking care of these persons has from the first been considered to be a problem with which the fflocal respon sibility” defined by statutes could not cope, although local governments did develop concurrent legislation with the state government to deal with the problems.
ployment has been deemed a statewide problem, no state pro visions were made for the granting of general relief to the unemployed until the advent of a federal program of assis tance to the states. Early state legislation was of a nature designed to eliminate evils which were thought to be the causes of unem ployment.
Consequently, until federal participation, "local
responsibility” was the only source of funds for taking care of unemployed employable, even though the problem of unem ployment might not necessarily be a local problem. The first real depression in California came in the 1870*s.
It followed the opening of new mines In California
and in Nevada, where unemployment had failed to be much of a
36 problem since man power had been at a premium*
Any man who
was able to work, could find employment in the mines or on the farms*
A large migration had taken place, however, and
between 1870 and 1880, local organizations were hard pressed to find adequate sums to provide for the care of persons who were unemployed*
Due to the peculiar type of migration to
California, the problem of the unemployed was largely that of unemployed and unattached men.
To help the local benevolent
societies which were trying to meet the problem, the State government made grants to them.
These grants were discon
tinued in 1879 with the adoption of the State Constitution.21 Early measures adopted by the State of California to meet unemployment were designed to eliminate competition on the part of Chinese laborers*
Considerable agitation was
raised in the larger centers of the State where it was felt that the rapid influx of Chinese was interfering with the work or employment possibilities of native born Americans. Most of the measures against the Chinese consisted of special taxes, which soon began to make up a major part of the State revenues.
Later legislation was enacted which refused the
Chinese admission to the State, but several years after
^ Constitution of California, 1879, Article IV, Section 22.
37 enactment, this legislation was declared unconstitutional by the Supreme Court of the United States*22 The panic of 1893, starting in the East, soon spread to California creating once again a severe problem of unem ployment*
In some local communities, this problem was met
by city funds which were used to provide free lodgings and meals for the unemployed men.
The worst local problem of
California was in San Francisco where most of the unemployed men located*
Certain public works programs were begun by
the City of San Francisco, but these were inadequate to meet the problem.
The State Bureau of Labor and Statistics which
was first organized in 1883, and reorganized in 1895, directed its efforts toward the placement of unemployed men in industry. The unemployment crisis felt throughout the United States as a result of the panic of 1907 was considerably eased in the San Francisco and Bay areas by the necessity for rebuilding after the earthquake and fire.
California the problem of Mexican agricultural workers became quite severe about this time and the problem of their winter unemployment was forcibly brought to the attention of local officials as a result of a housing situation which received
22 Cahn and Bary, Op. cit., p. 200.
38 its first major notice in the winter of 1907-1908*
the City of Los Angeles set up a Housing Commission which acted under the supervision of the City Health Department, to look into the matter of housing of unemployed Mexicans during the winter months* A serious depression hit the State of California dur ing the winter of 1913-1914*
Local relief agencies were
swamped and were unable to meet the problem with funds which they had available*
The City of San Francisco undertook a
program of work relief whereby $3*00 was paid for eight hours of work.
This type of work relief was publicized and soon
brought thousands of men to the City of San Francisco so that a tremendous problem resulted.
The operation of the work
relief program was turned over to a Citizens’ Council which in order to care for the increasing number of unemployed, with the funds available, reduced payment for work relief to 20^ an hour.
Winter unemployment in Southern California
continued as a problem and was brought out by hearings of the United States Industrial Commission in 1914, held in San Francisco and Los Angeles.
As a result of the hearings and
some additional study, a coordinated effort was made to de velop a state employment program aimed toward this unemploy ment situation among casual workers.
In the program the
Federal government and the State and local government were
39 to cooperate in concerted efforts to meet the problem of u n e m p l o y m e n t T h r o u g h this cooperation, the unemployment situation of 1914-1915 was met through the following effort: **(1) The Federal agencies assisted in discouraging the migration to California of unemployed persons from other States, checking the usual winter migration. (2) The State and also local Public Works Departments enlarged on highway and other public works to increase the amount of employment. (3) Each locality under took to meet its own problem without passing the unem ployed along to the next locality. (4) Resident des titute families were cared for by local charities, mainly County agencies, and by County funds. (5) Home less men were provided for by cities, each city pro viding a shelter with food and lodging, in return for which men were to give a certain amount of labor on streets and in clean up jobs on public buildings. Homeless men arrested for vagrancy were given suspended sentences and sent to the municipal shelters for work instead of the usual practice of f l o a t i n g ’ them along. (6) An inter-city exchange of information was establish ed under a State clearing h o u s e . w 2 4 This cooperative program was continued throughout the next winter of 1915-1916.
In the spring of 1916 war industries
began to develop which considerably reduced the problem of unemployment. After the war the problem which faced the entire country and California was one of placing men discharged from the Army in industry. of national,
Despite concerted efforts on the part
state, and local governments and citizens* coun«
i b i d . ,
24 Loc. cit.
2 0 5 .
40 cils to get the men back in industry, unemployment began to increase early in 1919.
Local and national efforts to coun«
teract unemployment increases were ineffective. A serious depression occurred in the winter of 19211922.
The California Legislature meeting in January, 1921,
enacted 11A measure to alleviate Conditions In Times Of Spe cial Unemployment Caused by Depression” .25
paw adopted at
that time provided that a Board of Control should obtain from all State Boards and Departments ”tentative long range plans” with a view to the extention of public works during periods of unemployment.
The Board of Control was authorized to use
emergency funds for public work and in addition was authoriz ed to conduct the registration of all applicants for jobs and to allot work on the basis of ”residence and need” . Here a pattern was set up which carried on into the depression beginning with the market crash of 1929, with the State enacting emergency legislation to take care of a pro blem of •unemployment.
At this time (1921) the efforts of the
State were not sufficient, and consequently counties found it necessary to contribute large amounts of relief through out the winter of 1921 and 1922.
It is reported that nearly
$400,000 more was spent for outdoor relief in the year 1922
25 California Bureau of Labor Statistics, ”Twentieth Biennial Report” , 1921-22, p. 246-7.
41 than in the previous year 1921.
This depression lasted to
the spring of 1922. From 1926 on there were certain indications of the impending depression which was to begin in 1929 with such serious consequences.
Work opportunities provided by public
employment offices began to decline up to 1928.
In the State
of California placements dropped 33 per cent in October of 1929.
Following the crash of the Stock Market the President
appointed an emergency committee for employment, to find jobs for the unemployed.
In California the Governor appoint
ed the California State Unemployment Commission in November of 1930 with the Director of Industrial Relations as chair man. 26
This Committee operated with branches in the northern
and in the southern parts of the State and was, in effect, two separate committees. In the year 1931, a State Unemployment Commission of five members was appointed by the governor. commendations it made the following:
Among other re
"That the State provide
$20,000,000 for emergency unemployment relief to be used for loans to counties and municipalities.1*
It further recommend
ed that "the expenditures of these funds be supervised by
Cahn and Bary, Op. Cit., p. 208.
the State Department of Social W e l f a r e ” .27
jn August, 1931,
the P r e s i d e n t s organization on unemployment relief met with representatives of the various States* The year 1933 ushered in the first efforts of the Federal government to assist the States in the field of giv ing aid to persons who were unemployed.
At the same time the
state of California began more extensive participation in the provision of funds for the unemployed.
Out of these
programs of public assistance came the confusion of deter mining which persons were the employable unemployed and thus the State or Federal government’s responsibility, and which persons were the unemployable unemployed and thus the res ponsibility of local communities and local County Boards of Supervisors. II.
PUBLIC ASSISTANCE IN CALIFORNIA FROM 1933 TO 1941 At the time of the depression of 1929 public assis
tance in the State of California continued to be a local res ponsibility.
Local private agencies were supplementing
grants made by public local agencies, but when the employment problem became so great, the public and private agencies
California State Unemployment Commission, “Report of Recommendations” , November, 1932. pp. 54-55.
43 operating locally were unable to meet it in any substantial terms.
This was true even though community chest gifts
reached a new high at that period.
Unemployment in California
increased from 288,000 in April 1930 to 700,000 in June, 1932. Neither state nor local governments were able to cope ade quately with this problem.
Some assistance was given to
California through federal loans under the Emergency Relief and Construction Act of 1932, administered by the Reconstruc tion Finance Corporation.
The loans were to be retired
against annual allotments for highway construction. were later cancelled.
With the passage of the Federal Emer
gency Relief Act in May 1933, the Federal Emergency Relief Administration made grants to California for relief.^8
June, 1933, a State bond issue of $20,000,000 was issued and the money received therefrom was loaned to the Counties to make relief payments to the unemployed. In March, 1933, the State Emergency Relief Administra tion was established by constitutional amendment, but in accordance with the pattern adopted by most states; viz., a commission of citizens and a state director.
Review of Activities of the State Relief Adminis tration of California 1955-5, (San Francisco: S.R.A. of California), April, 1936, pp. 22-23.
44 unlike many states, however, never integrated emergency re lief administration with county organization, but maintained direct state administration through branch offices in coun ties.
This agency assumed responsibility for all distribu
tion of State and Federal money.
The general policies of
such distribution, however, were determined by the Federal Emergency Relief Administration and were accepted by the State Relief Commission. From November 1933 to March 1934, the Civil Works Administration financed through Federal grants as a federal works program was in operation in the state of California. This agency provided work for all persons who were unemployed whether or not they had been, certified by local offices for relief.
In March 1934 it could no longer meet the financial
obligations thus entailed and ceased operation. Following Civil Works Administration an emergency work program was set up as part of the Federal-State emergency relief program.
Work was assigned to relief clients only;
but a type of employment for "unemployed employables1* only was a reality at last.
The Federal Emergency Relief Adminis
tration made its last grant to California in December, 1935. Thereafter the State Relief Administration which had been set up to handle Federal and State grants continued as a direct relief agency for the unemployed, caring for 101,000 families and single persons with State funds.
this agency (S.R.A.) gave aid to per
sons who were employable physically and unemployed only be cause they were unable to find work.
It also gave aid to
persons who were not displaced' workers, hut who were "employable on the basis of certain standards11.
Because of the
fact that eligibility for relief or assistance from the State Relief Administration was based on employability,
veloped a problem in the counties of determining who were the employables who were out of work.
It was difficult in many
cases to determine administrative responsibility.
to serious difficulties in local relief offices where it became necessary for County Boards of Supervisors and local public assistance agencies to assume responsibility for all those who were rejected by the State Relief Administration. The Budget Bureau for the State Relief Administration of 1935 stated: "State monies made available to the Relief Administreation are to be expended for the relief of hardship and destitution due to and caused by unemployment."
that County Supervisors and their relief agencies were to assume responsibility for all those not cared for by the State Relief Administration since by statute "every County and every City and County may relieve or support all incom petent poor indigent persons and those incapacitated by age, disease, or accident lawfully resident therein, when such persons are not supported and relieved by their relatives
or friends or by their own means or by State Hospitals or other State or private institutions.”
The S.R.A. and the local relief agencies continued side by side, one taking care of the employables and the other assisting the unemployables until July 1, 1941, at which time the State Relief Administration became inactive due to the failure of the State Legislature to make appro priations for its continuance. III.
ADMINISTRATION OP PUBLIC ASSISTANCE IN LOS ANGELES COUNTY
Before 1915 small relief programs had been established in the various cities within Los Angeles County.
the size of these programs was small there had already been developments which pointed toward future confusion and over lapping.
Various civic organizations became concerned with
so that when the Los Angeles County Charter of
1913 was adopted, it provided thatt
29 Welfare and Institutions Code 1937, State of California, Section 2400. 30
Hurt, Elsey, C a l i f o r n i a State Government, An Outline of Its Administrative Organization, Vol. 2M , The Independent Agencies 1850-1939, California State Print ing Office, Sacramento.
47 The Superintendent of Charities shall be under the direction of the Board of Supervisors, and shall exer cise general supervision and enforce rules and regula tions for the conduct and government of the charitable institutions of the County. He shall perform such other duties as shall be prescribed by the Board of Supervisors or by l a w s . 31 On February 1, 1915,
the Department of Charities be
came a part of the county government by action of the super visors, assuming responsibility for the giving of outdoor relief, the County Hospital, the county farm, and the county cemetery,
A division of outdoor relief was established.
the same time the relief activities of the City of Los Angeles were transferred to the County by an informal agreement which was later approved by the County Board of Supervisors on July 10, 1 9 1 5 . ^
Similar agreements were soon made with
other municipalities which had been administering relief so that by 1929 most of the assistance given in the county was under the direction of the County Board of Supervisors. From the period beginning with the centralization of relief activities in the County government in 1915 to the beginning of the depression of 1929, grants of assistance
31 **Los Angeles County Government", Part II, p r o t e c tion of Life, Health, Property” , Published by the Office of the County Superintendent of Schools, 1940. ^ Ronald M. Ketchum, Intergovernmental Cooperation in the Los Angeles Area, Bureau of Governmental Research, U.C.L.A. Studies in Government, No. 4.
made by the county were very small, frequently taking the form of grocery orders*
During this same period, the pri
vate welfare agencies played a significant part in the grant* ing of assistance.
Caseloads were low, however, and the
total number of persons receiving assistance from private and public sources was low in comparison with the numbers who were .to be aided during the height of the depression.
out this period, the basic assumption underlying the granting of public assistance seemed to be that only persons unable to work because of physical reasons actually needed public assistance.
Consequently, with the severe unemployment pro
blems starting with the "crash” of 1929, the private agencies of Los Angeles County and the Department of Charities were unable to take care of the great numbers of persons who needed assistance• During the first days of the administering of federal and state grants to the counties, the Los Angeles Department of Charities: assumed the responsibility for giving aid to persons in need because of unemployment.
This was done under
the supervision of the State Department of Social Welfare*
In 1933, the State Emergency Relief Administration assumed total responsibility for the distribution of state and federal funds, but in Los Angeles County the Department of Public Assistance
of Los Angeles County administered the
funds, under supervision of the State Emergency Relief A d ministration,
In May 1934, with the establishment of the
State Relief Administration, local offices of the state administration were set up to administer unemployment relief in Los Angeles County.
These local offices also became the
certifying agencies for the federal works programs* When the State Relief Administration established local offices to distribute unemployment relief funds, there imme diately arose problems over the question of what persons would receive aid from the state and what persons would re ceive aid from the local Los Angeles county agency.
latter was considered responsible for the care of all per sons in need, who were not cared for by some other state agency.
By definition of the appropriations for relief in
the state of California, the State Relief Administration was 35 responsible for the unemployed employables* Consequently,
34 Then the Bureau of Indigent Relief. 35 California Statutes, 1935, Chapter 675.
so much confusion arose locally over what persons would he cared for by what agency.
This confusion existed not only among
persons who needed aid but also among persons who were ad ministering the local relief programs.^®
Mo definite physic
cal standards were ever established in the determination of eligibility on a state-wide basis.
Therefore, it became
necessary in Los Angeles County for representatives of the State Relief Administration and the Department of Public Assistance to work out together methods of establishing eligibility requirements for each of the two agencies,
is, to determine which persons were Employable" and which persons were "unemployable11*
M. H. Lewis, 0£* cit*
CHAPTER IV DETERMINATION OP UNEMPLOYABILITY OP PERSONS ON RELIEF IN LOS ANGELES COUNTY I.
EARLY METHODS OP DETERMINING EMPLOYABILITY
Necessity For Determining Employability*
the establishment of local offices of the State Relief Ad ministration in Los Angeles County, local administrators of the then Bureau of Indigent Relief and the Los Angeles County State Relief Administration, were faced with the problem of determining the categorical limits of the two classes— the “employables” and the ^unemployables” , as a result of state legislation and limitations of the appropriation acts.
of course, was not a problem peculiar to Los Angeles County, but was one causing much confusion throughout the State.^ Expert legal advice was sought to define the limitations to appropriations of State Relief Administration funds, to the end that local departments of public welfare would be able to define their responsibilities —
to provide for those
persons in need who were not to be cared for by any state agency.^ an(-* ^
It was on the basis of these legal interpre-
1 Lewis, 0£. cit. 2 1
L o c . cit.
3 See Chapter III.
tations that it was determined that persons who could be aided by the State Relief Administration from funds for "relief of hardship and destitution due to and caused.by unemployment" were persons who were employable * public assistance programs developed,
As the two
the actual criteria
and methods used in the determination of employability became the responsibility of local relief agencies and the local offices of the State Relief Administration.
In Los Angeles,
the State Relief Administration and the Department of Public Assistance early came to agreement upon two types of "unem ployability":
(1) unemployability resulting from social
(2) unemployability resulting from physical
disabilities. It became necessary to establish methods of determin ing specifically employability or unemployability on such bases, or which agency would accept any one person who sought relief. First Procedures.
The determination of unemployability,
in the early days of the State Relief Administration, was determined through (1) definitions of manuals of operations of both of the above agencies,
(2) a panel of physicians of
the State Relief Administration;
(3) examining physicians of
the Department of Public Assistance, who operated the Work Test Clinic;
(4) a Disputed Case Committee made up of repre-
53 sentatlves of the State Relief Administration and the Depart ment of Public Assistance, who met to consider cases which were disputed by the two agencies. Problems.
Despite efforts to define specifically per
sons who would be considered employable, many disputes arose as to which agency would accept individual applicants for assistance.
A great number of borderline cases were found
which could not be classified on the basis of manual defini tions.
Examining physicians of the State Relief Administra
tion frequently found persons unemployable who were consider ed to be employable by examining physicians of the Department of Public Assistance.
The result of these differences of
opinion was that applicants were often required to go back and forth between the two agencies several times before final decision was made, and in many instances were required to be examined by physicians of both agencies.
This proved to be
a hardship, both to the applicants and to., the administrations of the two agencies.
The Disputed Case Committee which was
organized to review only a small number of cases, began to .■ handle large numbers of eases, many of which were disputed on the basis of physical examinations of the two agencies1 physicians.^
As a result of these disputes arising over
4 Cf. Brenner, op. cit.
54 agency responsibility in administering public assistance in Los Angeles County, a need was clearly evident for some method of determining physical employability, or unemploy ability, and one which would be consistent and final*
method which was developed was the Joint Work Test Panel. This was a cooperative enterprise of the Los Angeles Depart*ment of Public Assistance and the Los Angeles State Relief Administration.
The remainder of this study will be concern
ed with the operation of this panel, and the “causes11 of un employability as determined by physical examinations con ducted by its staff of physicians. II.
THE JOINT WORK TEST PANEL
In April 1939 it was announced that beginning April 10 a “Joint Work Test Panel comprising medical examiners from the State Relief Administration and the B.I.R.“ 5 was inaug urated .6
From that date forward all examinations to “deter
mine employability of applicants or clients of the S.R.A. or the B.I.R.“ were to be referred to this panel for examination and report.
The decisions of this panel were to be consider-
^ Bureau of Indigent Relief - since 1941, the Depart ment of Public Assistance. 6 See Appendix
55 ed to be final for both agencies, although requests could be made at any time for re-examination or for reconsideration of findings.
Prom its beginning to the termination of the State
July 1, 1941, 68,368 examinations were
conducted by the physicians.of the' Joint Work Test Panel, and relief applicants were classified as “employable” or “unem ployable” in the several categories coming under each classi fication**^ Administration of the Joint Work Test Panel*
Joint Work Test Panel was made up of examining physicians who were employed by the Los Angeles County Department of Public Assistance, and by the State Relief Administration* Physicians were paid directly by the agency which employed them.
A director of the panel was employed by the Depart
ment of Public Assistance.
He was in charge of the panel, and
was responsible for the administration of the panel and for medical supervision of physicians of both agencies.
decisions on classifications of clients were his responsi bility, and each examination form completed by physicians bore*' his signature.
In addition to the Director, the De
partment of Public Assistance also provided an examining
Figures taken from weekly reports of the Director of the Work Test Panel.
56 physician on a half-time'basis until December 1, 1940•
July 1, 1939 a full-time psychiatrist was added to the staff of the Work Test Panel paid through funds of the Department of Public Assistance. The State Relief Administration from the establish ment of the joint panel,
to June 1, 1941 employed physicians
who were assigned to the panel for a total of 120 hours weekly.
Until December 1940, six half-time physicians were
assigned to the panel, and from that time four part-time and one full-time physician were assigned. In March 1941, the one half-time physician of the Department of Public Assistance left and was not replaced, and in June the State Relief Administration reduced its staff by the time of a half-time physician. As has been mentioned, supervision of the director.
all physicians were under the No restrictions were placed
upon the amount of time which examiners of the Department of Public Assistance might give to individual examinations, other than limitations of staff and the number of examina tions scheduled.
Physicians assigned by the State Relief
Administration, however, were required to complete twelve
® Thirty hours weekly.
57 examinations each hour, or one examination each five minutes. On the face of these statements, it might be considered that the time allotted was inadequate to complete an examination satisfactorily.
However, other factors which'will be dis
cussed later, would seem to show that the time was sufficient to carry out the purposes of the examinations, namely, to determine employability;^ In addition to the physicians, each of the agencies provided clerical assistants for filing and scheduling of examinations and hospital attendants who.rassisted in the examinations.
All employees were responsible to the director
The Joint Work Test Panel was
located in the basement of a building on the grounds of the Los Angeles County Hospital.
From February 21, 1938, the
Work Test Clinic of the Los Angeles Department of Public Assistance had been housed in these quarters.
ed of a reception room with seats for approximately 50 per sons, and an examination room for men and one for women. There was also an office for the director.
At one end of the
reception room was located the desks of the clerks and the files.
® See Appendix D.
Persons To Receive Work Test Examinations.
of Operations of the S.R.A. and the D.P.A. defined certain classes of employables or unemployables who could be accepted for relief without referral to the Work Test Panel.
specific definitions were worked out jointly by the State Relief Administration and the Department of Public Assistance. Persons falling under one of the several definitions did not have to have examinations, so that it follows that persons not included in these definitions must have examinations to deter mine employability status. By agreement of the two public assistance agencies an ffemployable person” was defined as ”one who is ablebodied and fit.”^
It was also agreed that a person should be con
sidered employable if it could be shown that he ”was regularly employed while in his present condition of physical handicap and the type of work at which he was employed was not special or unique, but is still commonly performed; or if he is per forming worthwhile work (to the extent required by his family
'L0 Los Angeles County Department of Public Assistance, Manual of Operations. Item 016, Revised, September 29, 1937.
59 budget) on a work project of general public benefit sponsor ed by the County in accordance with rules and regulations of the State Relief Administration.1* 11 an
Employable for light work
Employable with special appliance
Unemployable - probably permanently
Tables IX - XIII Inclusive.
TABLE XV SUMMARY OF RACIAL DISTRIBUTION OF EXAMINEES OF JOINT WORK TEST PANEL SHOWING- EMPLOYMENT CLASSIFICATION AND PER CENT OF EACH RACIAL GROUP#
Per cent Negro
j____________ i.... ... ...
Per cent Oriental
00 H •
Per cent White
Temporarily unem ployable
Employable with special appliance
Unemployable - pro bably permanently
Employable for light work
Tables IX - XIII inclusive.
##.includes only one person.
appliance” the distribution of whites and Negroes so closely follows that of all persons, to be insignificant.
It is in
teresting but probably not important that 85 per cent of persons "employable with special appliance” are whites, as compared with 81.7 per cent of all persons classified. Distribution by sex may be found in Table XVI.
pressed as a per cent of all persons classified, males made up 48.3 per cent and females 51.7 per cent of the total. There is greater variance between these classifications than in racial distribution.
Most significant is the large pro
portion of males "employable with special appliance” which is 65 per cent of the total.
This is understandable since
males would be most likely to engage in types of work which would lead to hernia, which makes up the largest number of diagnoses placing persons in this classification.
teresting to note is the relatively smaller proportion of males considered to be unemployable, and the relatively larger proportion of women placed in this class. also understandable,
since It may be that women with certain
physical disfunctions might be considered less employable than men with the same disfunctions.
This difference in
diagnosis in which sex might play an important part is not considered to be unduly great, however, as a result of the control of the director of the Joint Work Test Panel.
it is not necessarily important, even if it should be a fact,
TABLE XVI SUMMARY OP SEX DISTRIBUTION OP EXAMINEES OP JOINT WORK TEST PANEL SHOWING EMPLOYMENT CLASSIFICATION AND PER CENT OP MALES AND FEMALES*
Total per cent ►
Sex Male per cent
Female per cent
Employable for light work
Employable with special appliance
Unemployable - probably permanently
Tables IX - XIII.
105 since sex undoubtedly would be considered in all potential employment opportunities for women, and for men as well. III.
AGE DISTRIBUTION OF EXAMINEES
The following section discusses the age distribution of white and Negro examinees placed in the five employability status classifications.
Pertinent data are included in
Tables XVII to XX, where the total numbers of persons placed in each classification are presented numerically and also as percentages of the total. White Employables,
Table XVII shows the age distri
bution of white examinees placed in the two classifications considered to be employable.
Ninety-one persons were employ
able for light work, with a total of 295.
It is of most
significance that 29.4 per cent of persons employable for light work were over 55 while only 7.6 per cent of those “employable for any work** were in this age group.
ployable for light work” percentages increase for each age classification, while those of the other group increase to the 56 to 45 group and then decline.
We might justifiably
expect that employability would decrease with age, thus accounting for this distribution, and on the other hand, it might further be expected that the distribution of employable persons would be a more nearly normal distribution, as it is.
104 TABLE XVII TOTAL NUMBER WHITE EMPLOYABLES EXAMINED BY WORK TEST PANEL IN FIVE DAYS, CLASSIFIED BY AGE EXPRESSED AS PERCENTAGE
Employment Classification 1.
Total A. Per cent
Employable for any work A. Per cent
Employable for light work A. Per cent
Age Total 18-25 295
26-35 , 36-45 ,46-55
56 and i over
105 Negro Employables*
The distribution found in the case
of employable whites does not hold for negroes classified as employable.
There were no negroes of this classification
over the age of 55.
Nearly half of them were between the
ages of 26 and 35, and over one fourth from 18 to 25 years of age.
(See Table XVIII)
It is difficult to explain this
distribution, except on the basis of the inadequacy of the sample, which included 59 cases.
It should be mentioned
that the greatest number of those employable for any work are under 35, 73.7 per cent, and that the majority of those employable for light work are over 35, 82.5 per cent.
both of these employable groups indicate the importance of age in the classification E m p l o y a b l e for light work” . White Unemployables.
The age factor assumes even more
importance in the instance of white persons classified as “permanently unemployable” than for other employability and o racial groups.0 Seventy-four and four tenths per cent of this group were over the age of 55, while 89.8 per cent were over the age of 45.
In the class of the “temporarily unem
ployable” , while 84.3 per cent of all were over 36, there
2 See Table XIX
106 TABLE XVIII TOTAL NUMBER EMPLOYABLE NEGROES EXAMINED BY WORK TEST PANEL IN PIVE DAYS CLASSIFIED BY AGE AND EXPRESSED AS PERCENTAGE
Age Employment Classification
Total Per cent
Employable for Any work Per cent
Employable for Light work Per cent
56 and over 6 10.2
106-A TABLE XIX TOTAL NUMBER OP WHITES EXAMINED BY WORK TEST PANEL .IN FIVE DAYS WHO WERE FOUND TO BE UNEMPLOYABLE CLASSIFIED BY AGE
2• a. 3.
Total Per cent
Unemployable Per cent Temporarily Unemployable Per cent
46-55 56 and over i
Employable with special appliance 34 Per cent
107 TABLE XX TOTAL NUMBER NEGROES EXAMINED BY WORK TEST PANEL IN FIVE DAYS WHO WERE FOUND TO BE UNEMPLOYABLE - CLASSIFIED BY’AGE
Employment Classifications 1.
Per cent Unemployable
Per cent Temporarily Unemployable
Per cent Employable witi special appli ance
Per cent .
56 and over
108 were only 16.6 per cent over the age of 55*
Of those "em
ployable with special appliance" 44,1 per cent were within the age classification 46 to 55, and 29.4 per cent were over 55.
Of all persons classified as unemployable,
cent were over 55 years of age and 86.5 per cent were over the age of 35 years. Negro Unemployables. classified as unemployable,
A total of 46 negroes were in the several classifications.
Of the permanently unemployable 50.0 per cent were over the age of 55 and 87.5 per cent were over the age of 46 years. Sixty-seven and four tenths per cent of all unemployable negroes were over 45 years of age, and none wasi between 18 and 25. Summary.
All of the data presented in this section
strongly emphasizes the importance of age in the employ ability status of the examinees.
In none of the diagnoses
of examining physicians was age given as the cause of "un employability". case.
Some specific diagnosis was given in each
Furthermore, an age limit is given in the manual of
operations of each referring agency which defines arbitrarily the age above which persons may be considered unemployable. It is, of course, recognized by the writer and by persons administering general assistance in Los Angeles County that some persons of any given age are more employable than others,
109 even discounting physical disorders.
it has been
deemed advisable in the interest of "operations” to place this age limit on employability.
It must be assumed that
examining- physicians did take age into account in their diagnoses, and that two persons with the same disorder In the same degree of severity, but one person younger would have been given different employment classifications.
physician*s decision as to the effect of age on any one per son Is not infallible, and examining physicians would be the first to recognize this.
controlled situation such as exists In the Work Test Panel is more likely to be able to take age into account, than the case worker at intake or in the field.
The ideal situation,
however, would be one in which the physician has the benefits of the advice of the case worker and access to adequate in terpretation of the case history which would bring to light information on the work history of the client, and bring out some of the social and emotional factors which might affect employability.
In such manner the true effect of the client’s
age on his work ability might be determined with increased accuracy. IV.
PHYSICAL CAUSES OF UNEMPLOYABILITY
This section deals with physical factors which were considered by examining physicians to be the causes of "unem~
As an aid in presenting a summary, all exam
inations which were included in each of the employability classifications were tabulated on the basis of major and minor diagnoses.
The major diagnoses were considered to be
causes of unemployability.
In most cases,
did not occur alone, but were accompanied by other disorders. This was particularly true where persons were placed in the classification nEmployable for Light Work” , which was essen tially an employable group.
In some instances,
ficult to determine any one disability as major.
it was dif In all
such cases the advice of the director of the Work Test Panel was followed in defining causes.
In most cases some one dis
function was obviously the major cause of unemployability. Other physical factors,
of course, contributed to the classi
fications and are thought to be important.
sistent with the purposes of this study, this section will attempt to answer in some respects the question, "What are the major physical causes of unemployability?*11 Later In this chapter consideration will be given to the total Incidence of the disorders which have occurred with most frequency, regardless of whether it was considered major or minor and regardless of any work status classification. Employable For Light W o r k .
The major physical find
ings of persons classified as f,employable for light work51 are
I l l
presented in Table XXI.
The specific disorders included in
each one of the major classifications will be found in the appendix. By far the largest number of diagnoses in this classi fication come under cardio-vascular disfunctions.
persons out of a total of 244 were diagnosed as having such disorders.
At this point it is important to remember that
persons in this category are considered employable,
none of the cases diagnosed as having cardio-vascular dis orders wase considered sufficiently severe to prevent the person suffering, from working.
It should be recognized
also that while these disorders were not disabling to any degree at the time of examination, each one of the 44 per sons was potentially an unemployable person. The 44 persons made up 16.4 per cent of the total number of persons in this classification.
Table XXI shows
also that 18 of a total of 97 white males and 15 of 107 white females had disorders of the heart and circulatory systems. For Negroes, 31.3 per cent of all males in this classifica tion were found to have such disorders, and females 8.3 per cent.
Thus both white and Negro males were found to have
heart and circulatory disorders more frequently than females of either racial group. Second in importance among persons in this classi fication were orthopedic defects.
A total of 27 persons
112 TABLE XXI MAJOR DIAGNOSES OP EXAMINEES OF WORK TEST PANEL CLASSIFIED AS tfEMPLOYABLE FOR LIGHT Y/ORKir
O O £3
2* 3. 4. 5. 6# 7. 8. 9* 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22.
Cardio vascular Dental Dermatology Diabetes Ear, Nose, Throat Ey© Gastro intestinal Genito urinary Gynecological Hemorrhoids Hernia Nervous and Mental Obe se Obstetrics Orthopedics Respiratory Rheumatism Tuberculosis (Pul.) Underweight Venereal Disease No defects Other
40 16 2 4
18 0 1 33
15 11 1 1
5 3 0 0
2 2 0 0
5 126 11
3 0 0 8
11 4 0 27 12 10
0 0 0 0
2 9 5 2
0 0 0 1
0 3 1 0
0 0 0 0
0 0 0 0
3 0 0 16 8 7
7 4 0 7 4 2
1 0 0 2 0 0
0 0 0 2 0 1
0 0 0 0 0 0
0 0 0 0 0 0
12 17 9
1 2 0
6 11 6
1 0 2
4 4 1
0 0 0
0 0 0
0 0 0
113 or 11.1 per cent of all were found to have such conditions, although none were sufficiently disabling to keep the per son from working at some occupation.
It should be mentioned
that at the time of this study, the loss of an arm or leg, was not considered sufficiently disabling to keep him from being referred to S.R.A. Next in importance were dental defects, which while not disabling undoubtedly have some effect on the work abiliity of the client.
Fifteen of the total persons in this
group had visual defects for which correction was needed. Twelve persons had disorders in each of the following cate gories:
gynecological, respiratory, and venereal disease.
Eleven persons were classified as having hernia, but not of sufficient size to interfere with ordinary types of work. Another eleven persons were diagnosed as having nervous and mental disorders and 11 others as having possible pulmonary tuberculosis.
Since persons with recent diagnosis of pul
monary tuberculosis were routinely classified as unemployable, it is quite significant that such a large number should have been so diagnosed. Of the total group of 244 persons only 17 were found to have f,no defects11.
Since this is an employable classi
fication it might reasonably be expected that the nuinber of persons with no diagnosis might be larger.
114 these persons with some diagnosis, while not having disfunc tions of enough severity to cause them to be unemployable in the examining physician*s opinion at the time of examina tion, must all be considered to be potentially unemployable unless adequate courses of treatment should be instituted. Temporarily Unemployable.
The major diagnoses of per
sons who were classified as temporarily unemployable are pre sented in TableXXII.
A total of 159 cases are reported in
this table. Of the total number of persons in this classification, 38 or 23,2 per cent had a major diagnosis of heart or cir culatory disorders.
This is a proportionately larger number
of such cases than were found among those employable for light w o r k .
Twenty-two persons were diagnosed as having
This group comprised 13.7 per cent of total
A relatively large number of persons were diag
nosed as having nervous and mental disorders.
It should be
noted that this diagnostic classification includes alcoholics and persons diagnosed as senile.
It is significant, however,
that 10.5 per cent of persons temporarily not employable should be so classified on the basis of mental and nervous disorders. Sixteen and six tenths per cent of the persons in this classification had gynecological disorders.
115 sidered only as a disorder of the women examined, 20*0 per cent of all women were found to be unemployable because of such disabilities. A comparison of the incidence of some of the major diagnoses in each work ability classification will be made later.
It should be pointed out at this point, however,
that a large number of persons shown in Table XXII do have disorders which may ordinarily be expected to increase in severity despite any treatment which might be given and undergone• Many of the diagnoses that were shown in Table XXI are not included in Table XXII.
This does not indicate that
these disorders were not present among persons who were placed in this classification, but that they were not con sidered the major physical cause of unemployability.
cluded among such diagnoses was dental pathology. All of the persons in this work ability classification were subject to re-examination within periods ranging from three months to six months.
Possibly a large proportion of
those diagnosed were only tentatively placed in this group until further physical examination might be made verifying present findings. Employable With Special Appliance.
Table XXIII pre
sents the diagnoses of persons who were classified as being
116 TABLE XXII MAJOR DIAGNOSES OP EXAMINEES OP WORK TEST PANEL CLASSIFIED AS TEMPORARILY UNEMPLOYABLE
Race Major Diagnoses
Total 1* 2. 3. 4. 5. 6* 7. 8. 9* 10. 11. 12. 13. 14. 15. 16. 17. 18.. 19.
Cardio vascular Dermatology Diabetes Ear, Nose, Throat Eye Gastro intestinal Genito urinary Gynecology Hemorrhoids Hernia Nervous and Mental Obstetrics Orthopedics Respiratory Infection Rheumatism Tuberculosis (Pulmonary) Venereal Disease Other Deferred Diagnosis
17 1 1
9 0 0
5 0 0
7 0 0
0 0 0
0 0 0
2 17 1 3
0 0 0 3
2 13 0 0
0 0 0 0
0 3 1 0
0 0 0 0
0 1 0 0
16 3 12
11 0 3
5 3 4
0 0 4
0 0 1
0 0 0
0 0 0
38 1 1
117 employable with a special appliance, the appliances in all cases being glasses or trusses.
It should be mentioned
again that this is an unemployable classification, with persons in it considered unemployable until the special appliance is provided. A total of 40 persons were placed in this classifica tion of whom 16 had visual defects and 24 had hernias.
might be expected of persons most likely to do heavy work requiring lifting, most of the hernia diagnoses were for men. A much larger proportion of the total number of examined might have been expected to have visual defects of enough severity to limit employability unless glasses were provided. However, only 16 of the total 601 persons were unemployable because they needed glasses, or 2.8 per cent of all those examined. Permanently Unemployable.
The major diagnoses of
those persons found to be permanently unemployable are shown in Table XXIV.
The total number of different diagnoses are
much less in number than for either the employable for light work or the temporarily unemployable.
By far the most sign-
fleant cause of unemployability among the classification are diseases of the heart and circulatory system.
represent 47.9 per cent of the total diagnoses of the 48 per sons in this classification, and must be considered the most
TABLE XXIII MAJOR DIAGNOSES OF EXAMINEES OF WORK TEST PANEL CLASSIFIED AS EMPLOYABLE WITH SPECIAL APPLIANCE SHOVtfN BY RACE AND SEX
Whites ) M 40
w .'!».. —„
One person In need of both, truss and glasses. One person in need of both truss and glasses*
119 outstanding problem of this group* age of most examinees,
Considering the advanced
this would not he unexpected, hut it
is enough of a problem that it should he given special con sideration in the operation of the Work Test Panel* Six' persons were unemployable from nervous and mental disorders, 4 had impaired vision, 3 had asthma which was disabling, and 3 had rheumatism* diabetes, cystitis, arthritis,
Other diagnoses included
syphilis, cancer, paralysis,
and tuberculosis. Summary.
Analysis of the tables in this section shows
that the Joint Work Test Panel diagnosed heart and circula tory disorders in more cases than any other disorder. sequently,
if the findings presented here may be taken as
a true picture of the health of most relief clients in Los Angeles,
the prospects of employability of large sections of
such groups are bound to be -restricted since the type of disorders found are most likely to continue over long periods of time.
The fact that this study cannot be considered in
all respects a true picture of all relief clients has been discussed in the presentation of data.
However, the pro
blems brought to light are not invalidated for the thousands of relief clients who have been examined by the Work Test Panel from the beginning of its operations.
Nor can other
disfunctions be passed over lightly, even though their fre-
120 TABLE XXIV MAJOR DIAGNOSES OP EXAMINEES OF WORK TEST PANEL CLASSIFIED AS "PERMANENTLY UNEMPLOYABLE
i Total Classified
White s M
1 p 2
1# 2. 3. 4. 5# 6* 7. 8. 9. 10. 11. 12.
Cardio-vascular Impaired vision Diabetes Cystitis Nervous and Mental Asthma Rheumatism Arthritis Syphillis Cancer Tuberculosis Paralysis
23 4 1 1 6 3 3 1 1 2 1 2
8 1 0 0 2 0 0 1 0 1 0 2
8 2 1 1 4 3 3 0 1 1 0 0
1 0 0 0 0 0 0 0 0 0 1 0
5 1 0 0 0 0 0 0 0 0 0 0
1 0 0 0 0 0 0 0 0 0 0 0
.... 1 0 0 0 0 0 0 0 0 0 0 0 0
quency is too small to be considered of statistical signi ficance.
suffering from isolated dis
functions must be treated and cured if they are to become employable, even though they be single cases in a hundred. Table XXV compares the percentage of cases having been diagnosed as certain disorders in three of the work test classifications.
It is interesting to note the increase
in importance of cardio-vascular disorders from 16.4 per cent of all cases of those employable for light work to 24.9 per cent of the temporarily unemployable and to 47.9 per cent of the permanently unemp1oyab1e .
On the other hand the presence
of orthopedic conditions as major factors in affecting em ployability decreases as does the proportion of possible tuberculosis.
Nervous and mental disorders increase propor
tionately. No significant difference has been noted in the types of disfunctions which cause unemployability in each of the various categories, with the exception,
of course, of those
classified as 11employable with special a p p l i a n c e *
group of disfunctions which were significantly absent were orthopedic defects, and it should be expected that they were not entirely missing, but that persons who were so afflicted were obviously unemployable to the case workers responsible for their cases, and were consequently not referred for exam ination.
Minor orthopedic impairments would not be so easy
TABLE XXV COMPARISON OF THE INCIDENCE OF CERTAIN MAJOR PHYSICAL DISORDERS FOR PERSONS PLACED IN THREE WORK ABILITY CLASSIFICATIONS#
Diagnosis Work Ability Classification
Cardio-vascular Per cent
Possible Orthopedic Tuberculo 'Nervous and Mental Per Cent Per Cent sis Per Ct.
Employable for Light Work
** All percentages based on figures of Tables XXI, XXII, and XXIV.
123 to perceive.
In the case of tuberculosis, persons who would
be unemployable because of it might be more likely to know of the presence of the disease as a result of a diagnosis of tuberculosis by one of the city or county clinics which pro vide such diagnostic services.
of tuberculosis made by the Panel were on the basis of “ sus picions11 which were not substantiated by chest x-rays, and were stated “rule out tuberculosis11, on the examination re cords.
Consequently, the conclusion is drawn that the funda
mental difference: between diagnoses of persons placed in the work ability classifications is in the degree of dis ability which a disfunction produces in the individual per sons.
Since no specific instructions have been given to
examining physicians as to what degree of any disability should be considered disabling, it is impossible to know the degree or how advanced any disfunction may be when it causes a person to be classified as employable or unemployable. Thus,
there arises some question as to consistency of classi
As has been pointed out before, any consistency
in such classifications will be the responsibility of the director of the Joint Work Test Panel who has the responsi bility of reviewing each examination record.
Also as has
been pointed out earlier, it is not necessarily sound that sharp classification limits should be defined,
since it must
be recognized that factors outside the field of medical
124 diagnosis undoubtedly enter into classifications.
in the interest of good administration, and in the interests of the relief recipients who are to be examined and classi fied, it is deemed that the total factors of such classifica tion should be carefully analyzed, and that they should be determined in each case in a manner consistent with the best practices of professional persons who administer the program and make the classifications, namely,
the physicians who at
the time of this study made the classifications, and the case workers who should have the best knowledge of social and emotional factors which should be taken into consideration at the time of classification.
CHAPTER VI SUMMARY AND CONCLUSIONS I.
Unemployables and Employables*
The problem that has
been discussed in this study has been one of a local solution to an administrative difficulty in the administration of public assistance.
The problem in administration came as the
result of legislation which defined in general terms which persons in need of relief would be accepted as the responsi bility of the State Relief Administration.
By legal inter
pretation the persons who could be so accepted by the S.R.A. became a class or category to be known as ” employables11• The problem of caring for all unemployable persons became the charge of local departments of public welfare, and in Los Angeles County, the responsibility of the Department of Pub lic Assistance. From the time the S.R.A. first began to administer a program of relief for employables in Los Angeles County,
became apparent that it was very difficult to draw a definite line between persons who were employable and those who were not.
Thus categories set up through legislation and legal
definition did not actually exist in fact.
Many factors en
tered into the final determination of whether or not a person
126 was actually employable.
Even in the field of medical science,
where diagnoses are more objective and amenable to exact des cription than other fields of study, there was much disagree ment over individual cases by physicians who made physical examinations.
Because of disagreements and confusion which
handicapped the administration of assistance and which also proved confusing to clients,
the two local relief agencies
of Los Angeles County cooperated in the establishment of the Joint Work Test Panel.
This panel composed of medical ex
aminers of both relief agencies had the final decision as to whether a person was employable as determined by a physical examination.
The primary purpose of this agency was to de
cide which agency should administer assistance to any one person who was receiving relief,
to eliminate jurisdictional
disputes between the two agencies, and to do away with the confusion that was passed on to the recipients of relief. Thus the Joint Work Test Panel conducted physical examina tions of persons for whom case workers of the two agencies were unable to decide the employability status with the in formation available. Throughout the operation of the Panel three or four hundred persons were examined each week.
A large number of
those referred by the S.R.A. Were found to be employable even though case workers referring them for examination had reason able doubts as to employability.
On the other hand
127 numbers of the persons referred for examination by the D.P.A# were found to be unemployable, even though case workers scheduling the examinations had some reasons for believing that these persons were employable. Examination Procedures#
Examinations conducted by the
Joint Work Test Panel were recorded on an examination form particularly designed for the use of the Panel.
tions were brief, although the availability and use of hos pital records for 70 per cent of all examinees, added con siderably to the validity of the examinations.
examined was placed in one of five classifications pertaining to employability.
The results of the examinations, when re
lated as major factors in classifications,
show that there
was no significant difference^ between the types of disfunc tions brought to light by diagnoses of physicians.
orders which proved to be most prevalent in all classifica tions were those associated with the heart and the circula tory system.
This would not be considered unusual in view
of the age distribution found among the persons examined. Age as a determining factor in employability classifications did not appear on any examination records.
However, it was
surely taken into consideration by physicians in making all classifications•
Leaders in the field of public welfare believe that programs of public assistance based on classes or categories are undesirable.
One of the reasons for this belief is the
difficulty of establishing limits to the classifications or categories.
This difficulty has been apparent throughout
this study, even where classifications have been made on the basis of physical examinations, and where diagnoses are more accurate than in other fields where diagnoses may not be so accurately defined. The administration of programs of relief for classes of persons Is not new and dates from early days of the Eng lish Poor Laws, where efforts were made to eliminate from the poor rolls persons who were “unworthy,M the in-effect "employables11.
This attitude toward classes of persons in
need of assistance has continued and became most evident within the past ten years, first with the establishment of federal aid for persons who normally had work but who had lost employment at the time of the depression.^
popular opinion and In legislative action there was a dif-
^ This pattern of categorical assistance was continued under the Social Security Act with Aid to the Blind, Aid to Dependent Children and Old Age Assistance.
129 ference between the classes of persons in need of assistance. Basically it was assumed that the unemployables had normally been the responsibility of the local community and that it was only the newly unemployed who were able to work.
seems to have been inaccurately assumed that the only persons receiving relief prior to the depression were the unemploy ables,
Whatever the assumption, emergency appropriations.for
relief were largely for those able to work.
care of unemployab1es remained the responsibility of local governments, the counties. Whether or not categorical assistance should be the pattern followed, after legislation was passed which pro vided for categorical assistance it was necessary for methods to be developed which would determine the limits of each category.
The problem was met in Los Angeles County through
the operation of the Joint Work Test Panel. As an administrative help, the Joint Work Test Panel adequately served its purpose which was definitely to make a decision as to the employability of individual persons.
addition to this, it took much of the uncertainty from indi vidual persons as to what agency might give# them assistance. As it operated, the Joint Work Test Panel provided examina tions under qualified medical examiners.
Also, since copies
of the examination record were returned to the case worker to become a part of the permanent case record, case workers did
130 receive valuable information which they could, use in their treatment of the clients who had been examined. It should be remembered that the panel dealt almost entirely with persons who were not obviously employable or not obviously unemployable, but were borderline.
that incomplete medical information was augmented by the ex aminations of the panel.
The values of such an agency as
the Joint Work Test Panel should be considered not only from the standpoint of administrative purposes, but also from the standpoint of the part it plays in the total program of pub lic relief agencies, including more than just the health and medical aspects* The examinations of individuals receiving relief are of great value to case workers who must work with the clients in planning for the future.
It might often be helpful to a
client to understand the full significance of his physical condition, and it may be that the client and case worker will be in a position to obtain specialized advice both on inter pretation of findings and future planning. The findings of such an agency as the Work Test Panel should be tabulated frequently.
It is useful to a community
to have knowledge of the health of its citizens as it plans for the general welfare.
Such knowledge is also necessary
in the planning of medical care programs for persons on the relief rolls.
For example, if detailed dental examinations
131 were made of all relief recipients,
the dental needs of the
needy unemployed might he determined and a dental program established which was based on detailed knowledge* The tabulations of physical disability among clients of public welfare agencies would indicate types of vocation al rehabilitation training courses which should be establish ed.
Nutritional needs of large groups would also be shown
by these examinations. It should be remembered,
that the health examination
findings of an individual client are only a part of the total picture of the person examined.
It would be very easy to
look upon the physical examination program as the only indi cation of the client1s ability to get along and to hold a job.
On the other hand it would be very easy to disregard
the health factors of individuals.if health examinations have not been given. As the Work Test Panel functioned,
it did become a
part of the larger program of Public Welfare, and its find ings became a part of the equipment of the case worker who had the final responsibility for working with the individual person and making use of the information provided by the examination. The examination procedures of the Work Test Panel are similar to those of pre-employment examinations of private industry and of the federal, state, and local government
132 civil service commissions, although the exact purposes of each are different.
Without disputing the value of the panel
as it was operating at the time of this study, it is believed that the best procedures known to medical science should be used in its operations.
It is believed that the best pro
cedures known to the social work profession should be used throughout any part of the work of a department of public welfare.
The most valuable physical examination on this
basis would be the most complete examination available, m a k ing use of most sound diagnostic procedures and laboratory procedures known to medical science.2
The experiences of
medical and health divisions of industrial plants would be of value in planning the operations of the Work Test Panel in the future.
This is particularly true of the classifica
tions having to do with work ability.
It might be
to relate them more specifically to types of activity in which examinees could effectively carry on.^ The ability of any one person to work is not determin ed by physical examination alone.
This is recognized by the
Manual of Operations of the Los Angeles Department of Public
2 See Appendices of adequate programs of ^ See Appendix B*
B, C, D, E, F, G, H, I for health examinations.
133 Assistance, and in policies having to do with intake proce dures.
the Joint Work Test Panel should he in a
position to take all of these factors into consideration in determining employability.
Through the addition of psycho
logists and social workers to the panel staff, and with the help of the psychiatrist who is now a member of the staff, a much better final classification of work ability might be made.
The additional information provided by the extra staff
members should prove valuable to case workers, ment of the social problems of the clients.
in their treat
such a program, the Joint Work Test Panel should make a unique contribution to public welfare agencies throughout the country.
Alden, Percy and Edward E. Hayward, The Unemployable and Employable. London: Headley Brothers, 1908. 159 pp. Anderson, Nels, The Right To W o r k . Books, 1938. 15S pp.
Armstrong, LowLse V., W© Too Are The People. Brown, and Company, 1938. Bakke, Edward Wight, The Unemployed M a n . Dutton and Company, 1934. 308 pp-
Modern Age Boston:
Little, E. P.
Bergen, Garret Lawrence, Ten Thousand Clients of the Adjust** ment Service. American Association for Adult Education, 1935. 164 pp. Brenner, Estelle Davis, Factors in the Determination of Employability with Special Reference to Public Relief Administration for Los Angeles County. June, 1939. 130 p p . (Unpublished)• Calkins, Clinch, Some Bruce and Company,
Folks Won* t W o r k . 1930. 202 pp.
New York: Harcourt,
Fuller, Norma, The Health of S t . Louis Y o u t h . (St. Louis Youth Commission")^ St. Louis, Missouri, June, 1940. Survey Report T w o , 100 pp. Gilboy, Mrs. Elizabeth (Waterman), Applicants for Work Relief: A Study of Massachusetts Families under the F.E.R.A. and W.P.A. Harvard University Press, 1940. 273 pp. Hall, Olivier Milton, 1934. 65 pp.
Attitudes and Unemployment. New ■
Heiser, Victor G., M.D., Industrial Health Practices. Nation** y _al Association of Manufacturers, New York. New York. May, 1941. 76 pp. Hurt, Elsey, California State Government - An Outline of Its Administrative Organizations. Volume 2, "The Administra tion Agencies 1850-1939"• California State Printing Office, Sacramento, California. 166 pp.
136 Kahn, Dorothy C . , Unemployment and Its Treatment in the United States, New York, American Association of Social Workers, 1937. 105 pp. Kurtz, Russell Harold, The Public Assistance W o r k e r . York: Russell Sage Foundation, 1938. 224 pp. _____ , Social Work Year B ook, 1941. Sage Foundation, 1941,
Paterson, Donald Gildersleeve, M e n , Women and Jobs. University of Minnesota Press, 1936. 145 pp. Seipp, Emma, A Study of 100 Clients of the Adjustment Ser vice, American Association for Adult Education, 1935* 30 pp. Young, Erie Fiske, The Case W o r k e r 1s Desk Manual. "Social Work Technique11. Los Angeles, California. 1939. B.
Adams, K. E., ffCommunity Revises Relief: -Santa Ana, Cali fornia", Nation1s Business, 27:29-30, September, 1939. Amidon, B., "Always With Us! What is happening to Unemploy ables?", Survey Graphic. 25:107-10, February, 1936. Anderson, Nels,. "Are the Unemployed a Catastrophe?", Survey Graphic, 24:345-47, July, 1935. Chopin, F. S., and John, J. A., "Advantages of Work Relief Over Direct Relief in St. Paul", American Journal of Social Workers, 46:13-22, July, 1940. Cohn, M. M., "Defence of Chislers", Forum, 16:18919, " 1936.
Glover, Mayor G. C., "Iron Rule for Relief", Business W e e k , Page 26, March 9, 1940. High, S., "Jobs Preferred! Cineinnatti1s Four Point Program" Saturday Evening Post, 210-23, June 24, 1937. Hopkins, H. L., "They*d Rather Work", Collier *s, 96:7-9, November 16, 1935.
137 Kelly, P. C., “Shall We Drown the Unemployed?11, American Mercury, 46:438-40* April, 1939* Kelly, Tom P., “Happy Unemployables“ , Review of Reviews, 93:68, June, 1936* Laird, Donald A., “Tail That Wags the Nation” , Review of Reviews, 92:44-5, November, 1935* Livingston, H* E., “Deeters: the Psychological Effects of Unemployment” , Scribnerfs Monthly, 103:57-60, January, 1938* McMurray, “Unemployables“ , Atlantic Monthly, 167*72-78* January, 1938. Paige, Clara Paul, “Chicago1s Unemployables” , Survey Graphic, 73:3 3-5, December, 1937. Prentis, H. W . , Jr., “Employer Looks at Unemployment” , Vital Speeches, 6:663-7, August 15, 1940. Shedd, Fred F., “Pennsylvania Studies Its Relief Rolls” , Review of Reviews, 93:32, May, 1936. Spengler, J. J., “Popular Movements and Economic Equilibrium in the United States” , Journal Political Economics, 48:152-3, April, 1940. Stocking, Ruth E., “Certification of Disability in Social Insurance” , Social Security Bulletin, June, 1941. Federal Security Agency, Social Security Board, Washington, D.C., p. 3. Teaf, H. M., Jr., “Work Relief and the Workers” , Survey Graphic, 4:199-201, June, 1938. Titus, E. K., “Eight Ways to Cut Relief Costs” , North American, 243:383-94, June, 1937. Ward, P. W., “It Pays to Stay on Relief” , Nation, 143*439, October 17, 1936. New Republic, "Those Laxy Unemployed” 86:302, April 22, 1936* _____ , “Skinflint Relief” , 102:8-9, January 1, 1940. Monthly Labor Review, "California Re-employment Commission Recommendations” , 50:329-34, February, 1940.
LAWS, ADMINISTRATIVE ORDERS, AND SPECIAL REPORTS
American City, "Municipal Employees at Regular Wages Replace Relief Labor11, 55:79, October, 1940, American College of Surgeons, Medical Service in Industry and Workmen1s Compensation L a w s , 1938. Ciiicago. 70 pp. Baines, George W . , "Public Relief Administration in Los Angeles County", Los Angeles Bureau of Governmental Research, U.C.L.A., 1938. 109 pp. Bloodworth, Jessie, "Social Consequences of Prolonged Unem ployment - Analysis of 500 cases", August, 1933. Chicago University, "Unemployment and Relief Documents", 1934. Illinois Persons on Relief in 1955, Report of a Project sponsored by the Illinois Emergency Relief Commission, Hughes, Elizabeth A. Jeter, Helen R., "The Administration of Funds for Unemploy ment Relief by the Los Angeles County Department of Charities Prior to November 24, 1933." A report sub mitted to the sub-committee on relief standards and pro cedures of the Los Angeles County Emergency Relief Com mittee, Los Angeles, California, December 5, 1933. 139 pp. Manual of Operations of Los Angeles County Department of Charities, Los Angeles, Los Angeles County Department of Charities. Ordinances of the County of Los Angeles, State of California, Los Angeles Board of Supervisors of Los Angeles County, 1930. Social Service Division Manual, State Relief Administration of California, San Francisco, State Relief Administration, 1938. State Relief Administration of California, State Relief Administration Manual, Revised January 13, 1941, 900 items. Welfare and Institutions Code, State of California. Sacramento, Supervisor of Documents of the State of California.
159 Young, Erie Plske, "A Manual of Family Case Work11, Educational Service, Los Angeles, 1926* D.
PARTS OF SERIES
Burns, Evalina M., "Appraisal of Services for the Unemployed*1 American Annals of the Academy of Social Sciences, 202:45-52, March, 1939. Diehl, Harold S., Physical Condition and Unemployment, Re print No, 1716 from the Public Health Reports, United States Government Printing Office: 1936, pamphlet, 8 pp. Hansen, Alvin, Marion R. Trabius, and Harold S. Diehl, "The Duluth Casual Labor Croup", No. 3. Pennell, Elliott H. and Hazel 0*Hara, The Validity of Health Service Data Gathered by the Family Survey Method, Re print No. 19lS"^ from the Public Health Reports, United States Government Printing Office, Washington, 1938. National Health Survey, "Color, Sex and Age of the Population Enumerated", Preliminary Reports, National Health Survey, Population Series, Bulletin No. #. National Health Survey, 1935-6, Preliminary Reports, "Sick ness and Medical Care Series Bulletin and Disability From Specific Causes in Relation to Economic Status", National Institute of Health, United States Public Health Service, Washington, 1938, pamphlet, 13 pp. Stegenson, Russell Alger, "The Minnesota Unemployment R e search Project", November, 1931, Employment Stabilization Research Institute, University of Minnesota.
APPENDIX A SPECIFIC DIAGNOSES INCLUDED IN GENERAL CLASSIFICATIONS 1* Cardio-vascular defects: Includes all diagnosed dis orders of heart and circulatory systems such as hypertension* varicose veins, cardiac irritability, tachycardia,‘arterio sclerosis, myocardial weakness, angina pectoris, mytral stenosis, aortic stenosis, and cardiac hypertrophy. 2. Dental defects: Includes dental caries when severe enough to he noted by examining physicians, and diagnoses of pyorrhea and gingivitis. 3. foot. 4.
Dermatological defects: Diabetes:
Includes dermatitis, athletef
Includes diabetes mellitus.
5. E a r , nose, and throat defects: Include impaired hearing, sinusitis, diseased tonsils, otitis media. 6. Eye defects: Includes impaired vision where they hamper employability and physicians consider refractions to be necessary. 7. Gastro-intestinal disorders: Include bowel adhe sions, colitis, peptic ulcers, gastritis, cholecystitis. 8. Genito-urinary disorders? Include diagnoses of cystitis, nephrosis, variocele, prostatis, urinary patholocy, cystocele. 9. Gynecological disorders: Include diagnoses of chronic pelvic inflammatory disease (P.I.D.), menopausal syndrome, amenorrhea, cervicitis, and dysmenorrhea. 10.
Includes any diagnosis of hemorrhoids.
Includes diagnoses inguinal and ventral
hernia. 12. Nervous and Mental Disorders? Include diagnoses of neuroses, impediments of speech, senility, alcoholism, psy chosis, neurasthenic stigmata, constitutional psychopathic inferior, psychoneuroses, tabes dorsalis, epilepsy, drug addiction, central nervous system lues, mental deterioration, and mentally dull.
142 13. Obesity: Includes cases where obesity is suffi ciently marked that it impairs work ability. 14.
Includes any pregnancy.
15. Orthopedic defects: Include diagnoses of scoliosis, disabling head Injuries, lost parts, deformities of parts, ‘’painful** flat feet, disabilities due to injuries, osteo myelitis, and paralyzed parts, and back sprains. 16. Respiratory defects: Include diagnoses of bronchi tis, bronchial asthma, upper respiratory infections, f,pulmonary pathology*1 and influenza. 17. Rheumatism: Includes diagnoses of arthritis, rheu matism, and neuritis. 18. Tuberculosis: Includes diagnoses or suspected diagnoses of pulmonary tuberculosis. 19. Underweight: Includes those cases where clients were markedly underweight• 20. Venereal diseases: and gonorrhea.
Included all cases of syphillis
Lockheed Aircraft Corporation INSTRUCTIONS TO EXAMINING- PHYSICIANS .Physical Examination
;i A. Routine of Examination: Personal history of past illnesses is recorded on the Physical Examination Record by the stenographer and signed by the applicant, who then gives a urine specimen to medical assistant, and is shown to a booth where he strips to shorts and socks. Routine examina tion including T.P.R., blood pressure, height and weight, examination of head, neck, teeth, eyes, chest, abdomen, hernia, extremities, etc., is then completed and recorded, and the applicant apprised of any defects that may exist. The applicant dresses and if acceptable for employment, a blood sample is taken by the medical attendant for Wasserman examination. A correlation of the history given by the ap plicant with the physical findings and the requirements of the job for which he is being selected will be considered by the examiner in rating the applicant as excellent, good, fair, or poor. Anyone rated poor should be rejected. 1. Weight - If marked obesity or marked underweight exists such as to make one a poor health risk or to inter fere with his ability to do the work assigned, reject. Strict adherence to a 10$ leeway from the average heightweight scale is not required. 2. Blood Pressure. - Definite cases of malignant hypertension should be rejected. Pressures up to 170 or 180 may be acceptable at times if the rest of the physical find ings is entirely normal. 3. Skin - Cases with eczematoid dermatitis or history of allergic dermatitis should be kept out of sheet metal, paint, and assembly departments because of the probability of occupational dermatitis from contact with the zinc chro ma te paint used on the sheet metal. 4. Vision - (a) Color blindness should be cause for rejection for truck drivers and for those doing drilling in assembly where colored markings have to be followed. (b) Depth Perception - loss of depth perception should be cause for rejection in any of the hazardous occupations with power machinery, such as saws, routers, riveters, etc., but will
145 be allowable in non-hazardous or clerical work. (c) Visual Acuity - Uncorrected errors must be properly corrected. 5. Ears, Nose, and Throat.- Acute sinus or throat infections or chronic ear infections will be cause for re jection until the infection has been cleared up. Deafness should be corrected by a hearing aid. 6. Teeth - Advanced dental caries with pyorrhea and obvious, advanced infection will be cause for rejection u n til cleared up. Heart - Organic heart disease, as rheumatic, luetic, or hypertensive heart disease with any evidence of decompensation or history of decompensation in the past will be cause for rejection. If the disease is in an early stage, selected cases may be accepted for sedentary or clerical work, if an E.K.G-. provided by the applicant does not show evidence of myocardial impairment. ^
Lungs - Any evidence of pulmonary tuberculosis or bronchiectasis will be cause for rejection. Acute or chronic bronchitis will also be cause for rejection until cured. 9. Abdomen - Abdominal tumor masses will be cause for rejection unless positively diagnosed as being benign and symptomle ss• 10. Hernia - All cases will be rejected until repaired, treated by the injection method properly and adequately, or adequately supported by a truss as the examiner may deem necessary and in keeping with the type of work to be done by the employee. A truss or the Injection treatment will be acceptable only in clerical workers. 11. Varicocele or Hydrocele - will not be cause for rejection unless they cause some disability. 12. Venereal Disease - in active stage, as acute G.C., urethritis, or primary or secondary lues, will be cause for rejection until cured or in the non-contagious stage. 13. Anus - Prolapsed or bleeding hemorrhoids will be cause for rejection until properly treated. 14. Joints, Spine, Extremities - Deformities that pro duce limitation of motion or marked deformity will be cause for rejection in any occupation where agility and dexterity
are essential* Occasional exceptions may "be made for nondisabling deformities where the occupation is more or less sedentary. Large varicose veins of both legs will be cause for rejection in factory j*obs, especially where considerable standing, walking, or operating machinery is involved* 15. .Laboratory - (a) Urinalysis - SUGAR - known or proven diabetics will be excluded from factory jobs where the hazard of cuts and scratches is prevalent, but will be permitted to do clerical work if they remain on adequate diabetic treatment. ALBUMINURIA - If persistent will be cause for rejection unless proven to be orthostatic or not associated with lowered kidney function. B.
Classification after examination:
Class !,A fl - unlimited - acceptable for any type of work in any department. Class “B 11 - limited - Because of some physical defect, an applicant may be acceptable for certain selected classes of work, but a poor risk or actual hazard in other types of work. For example, a person blind in one eye has no depth perception and should not be allowed to work with machinery in the machine shop, wood shop, final assembly, riveting, etc., but will be able to do all types of clerical work, drawing, checking, etc., without hazard. A person with an artificial limb would be safer sitting behind a desk than climbing around jigs. Any person placed in Class !,Bn should not be transferred to another job or type of work without the approval of the medical examiner. The medical classification should be placed on the card in the personnel file so that the medical limitation will be evident to Employment Division whenever occasion arises to review his classification. Class ”C tf - Rejection - Causes for unqualified rejec tion are listed below. However, on occasion an applicant who will be rejected for the type of work for which he is being hired may be accepted as Class ltBfl for some other type of work. If this possibility exists, the interviewer who handled the case will be notified of this fact by the medical examiner so that the a p p l i c a n t s qualifications may be r e viewed with the view of offering him some other type of work. Some who otherwise would be rejected might in this way be properly placed on a job for which they are physically suit ed and become valuable employees. The medical examiner must
147 be sufficiently familiar with the physical requirements of the various types of factory jobs to be able to judge whether, or not a man with a given handicap will be able to do the job without danger to himself or to his fellow employees# C. Causes for rejection: It is evident that an applicant should be rejected for: 1# Any condition which will endanger those with whom he associates, such as active Infectious or contagious diseases, tuberculosis, active venereal disease, etc# 2. Any condition which will render the employee un fit for work, as serious heart disease, kidney disease, sen ility, high blood pressure, epilepsy, psychoses, or marked deformity of spine or extremities. 3. Any combination of conditions 'which would make an applicant a very poor health risk, as marked under-weight with anemia, bronchitis, sinusitis, etc. 4. Any condition which might be made worse by employ' ment and constitute an industrial hazard, as hernia, large varicose veins, or grossly defective vision.
APPENDIX C INSTRUCTIONS TO EXAMINING PHYSICIANS NATIONAL YOUTH ADMINISTRATION Federal Security Agency NATIONAL YOUTH ADMINISTRATION INSTRUCTIONS TO EXAMINING PHYSICIANS FOR COMPLETING HEALTH EXAMINATION RECORD, NYA Form 120, and HEALTH RECOMMENDATIONS NYA Form 121 For each youth examined, a HEALTH EXAMINATION RECORD, NYA Form 120 shall be completed and mailed promptly to the State Youth Administrator, attention: State Health Consult ant. In addition, HEALTH RECOMMENDATIONS, NYA Form 121, shall be prepared and mailed promptly to the Area Division of Youth Personnel. The forms should be prepared in ink or indelible pencil. Instructions for their completion are given below. I.
HEALTH EXAMINATION RECORD, NYA Form 120
Past Medical History. Fill in each of the spaces in the manner indicated, showing youth* s best judgment as to the number of years since his last visit to physician, last time hospitalized, and last regular visit to dentist; under last regular visit to dentist include only visits made for routine dental check-up. Immunity Status. Specify location of vaccination scar (e.g. upper left arm); if no scar enter 11Q 11'. Color of vaccination scar to be entered as "pink" (scar not fully contracted; blood vessels not completely absorbed) or "Q" (white or natural skin color of the examinee). Unless there is a history of a smallpox vaccination having been performed within the past year and a pink scar is present, the youth is to be vaccinated or re-vaccinated against smallpox. In the area south of and including the States of Texas, Oklahoma, Arkansas, Tennessee, and Virginia, unless there is a history of typhoid immunization within the past year the youth is to be immunized or re-immunized against typhoid. If vaccination or re-vaccination of the youth is not indicated enter "X" under "Date vaccinated b y " (December 3, 1940)
150 Appearance. Circle the term which most nearly des cribes youth*s appearance or specify in the space provided. Measurements. Height without shoes. Weight without clothes; thin covering garment may be worn. In order to avoid, as much as possible, inclusion of muscle development in the chest measurement, the circumference is to be measured below the nipple line, as specified in the NYA Form 120 it self. E y e s . Use Snellen chart at a distance of 20 feet and artificially and evenly illuminated to an intensity of 80 to 100 foot candles. Record the smallest type read, using 20 as the numerator of the fraction. If un-assisted vision is not as good as 20/30 in the better eye, retest with the aid of: (1) the youth*s own glasses; (2) a pinhole punched through black cardboard; and/or (3) trial lenses. Record the most favorable set of readings and specify which type of aid pro duced such result. (In case a pinhole or trial lens test produces a considerably more favorable result than the youth*s own glasses a refraction should be recommended in the space provided on the back of the examination form.) For testing color sense use colored yarns or Ishihara plates and indicate which test produced result recorded. B a r s . In recording hearing, consider 20 feet as nor mal distance for conversational voice and record deviation from normal as fraction with 20 as denominator and actual distance at which ordinary conversation is understood as numerator. Otoscope must be used for the examination of the ear drum. Throat. Do not record deviated septum unless it offers marked obstruction. Mouth. Record the condition of each tooth separately, using the symbols specified on the form. For the purposes of this examination the following definitions are set up: (December 3, 1940)
151 Normal - present in the mouth and is not and has never been carious. Repaired - filled, capped or crowned. Extracted - extracted and not yet replaced. Replaced - extracted and replaced prosthetically. Lungs. Inspection, palpation, percussion, ausculta tion and.the auscultatory cough are to be used. If at all possible a provisional diagnosis is to be made if any abnor malities are noted. The question, X-ray indicated?" is findings themselves, tices as to X-ray in
"Because of physical findings is chest to be answered on the basis of your and without regard to the NYA* s prac your area.
If youth is to be X-rayed at this time the roentgen ologist will record and classify his findings in the space provided and sign the record form before it is sent to the NYA State Office. In case there is not sufficient room on the form for the full roentgenologic report, a separate sheet should be attached and such fact recorded under "Other findings". Circulatory system. Additional findings may be re corded under "Remarks" or on a separate report. If you consider it advisable, any particular youth may omit the specified exercise, in which case record your reasons under "Remarks"• Orthopedic Impairments. Do not record flat foot un less it is of such a nature as to incapacitate, to become aggravated by work or to be alleged later to have been caused by accident or occupation. Impairment of function is the point to be noted. Small insignificant abnormalities may be ignored. Laboratory. A blood serologic test for syphillis and a urine test for sugar and albumin is required. In the area south of and including the 'States of Texas, Oklahoma, Ark ansas, Tennessee, and Virginia a stool examination for in testinal parasites is required. Whenever such examination is not made enter "X” under "Fecal". Various other labora tory procedures may be indicated in individual cases. Re sults of tests should be entered by examining physician be fore form is mailed* (December 3, 1940)
152 Remarks. Record here any findings for which adequate space has not been provided elsewhere on the form. It is desired that all abnormal findings be recorded and that each carry as much description as is medically significant. While the form as designed is adequate for normal or almost normal cases, it is recognized that there will be exception requiring somewhat detailed descriptions. Therefore, attach additional pages for a continuation of "Remarks” is necessary, in which case record here the number of such additional pages. In particular, a full report of every chest X-ray should be made, here or on a separate page. Recommendations. Indicate with (or with if urgent) any procedures recommended for this youth. If special diet, additional diagnostic procedures or study by a specialist are recommended, give details in the space provided. Health Status Classification. Every youth examined must be classified in one of the six categories listed on the form. To assist the examining physician in making such classification it is suggested that youths with one defect only be classified somewhat as follows: (These examples are not exhaustive and must be taken as suggestions only; actual classification of individual youths is the sole responsibility of the examining physician). Class I.
Pit for any work or athletic activity, having no defects, or only very slight defects, such as: 1. 2. 3.
Slightly underweight. Systolic blood pressure not over 140 or under 105. Unassisted vision not less than 20/40 in the worse eye and having glasses which bring vision up to 20/20 in each eye. One ring or one little finger, or one minor toe missing. Missing teeth, provided the masticating area is not seriously effected or has been replaced. No dental pathology present. (December 3, 1940)
153 Class II.
Pit for any work or athletic activity, ab normal conditions present can be corrected by proper measures, medical, dental, ex ercise, diet. 1. 2.
3. 4. 5. 6. 7. Class III.
Pit for almost any kind of employment or recreational activity; minor defects not thought to be amenable to correction but not severely handicapping. Physician to indicate on Form 121 type of work to be avoided or whether conference with Youth Personnel Division regarding work assign ment is desirable. 1. 2. 3. 4. 5. 6.
Physically underdeveloped; considerably underweight• Unassisted vision not less than 20/40 in the worse eye and improvable to 20/20 in each eye through the use of glasses. Dental pathology, (caries, gingivitis, etc • ) Hernia. Diseased tonsils. Hemorrhoids. Slight maladjustment.
Systolic blood pressure not over 150. Slight heart lesion fully compensated. Assisted vision 20/30 to 20/50 in better eye. Moderate hearing loss - hearing acuity at least 10/20 in better ear. Loss of fingers not seriously impair ing function of hand. Trace of sugar or albumin.
Pit only for certain kinds of employment; physician to approve assignment, and to state whether medical supervision of the youth during employment is necessary. 1. 2. 3. 4.
Systolic blood pressure over 150.. Moderate heart lesion, compensated. Assisted vision 20/70 or worse in better eye. Hearing acuity of less than 10/20 in better ear. (December 3, 1940)
154 5. 6, Class V.
Classification here implies subsequent re classification to Class I, II, III or IV, Youth may not undertake NYA employment un til after reclassification, (Form 120 is not to be delayed pending such reclassifi cation. ) 1* - 2. 3. 4.
Loss or paralysis of members, Convalescing from tuberculosis.
Any communicable disease. Severe infestation of intestinal para sites. Mental abnormalities with favorable prognosis. Marked orthopedic impairments if pro curement of appliances would permit employment.
Not now employable and prognosis unfavorable 1. 2. 3.
Mental abnormalities. Marked orthopedic impairments. Severe heart lesions.
Youths with more than one defect should be classified according to the physicianTs best judgment. Youths with two or more defects, any one of which would indicate Class II or Class III, need not be placed in a higher numbered class. However, if each of two defects present in any youth would place him in Class IV, It might well be that the combination would be sufficient to warrant Class VI. In every case it must be kept in mind that youth, not defects, are being classified, and that the purpose of the examination is not to exclude from employment but rather to; 1. 2. 3. II.
Discover defects so that they may be remedied; Assist In the proper work assignment of NYA youth; Assist in the development of health and physical development activities.
HEALTH RECOMMENDATIONS, NYA Form 121.
NYA Form 121 is in the form of a letter to the NYA area Office, Division of Youth Personnel Office. It contains space for indicating the health status classification given also on (December 3, 1940)
155 NYA Form 120, and for recommendations concerning activities to be avoided, follow-up procedures to be undertaken, etc. Please discuss the results of the Health Examination and any necessary advice or remedial procedures with the youth examined before filling out the form. In the case of group examinations, the physician in charge should summarize the results with the youth and fill out .the form. Prompt mailing in a franked envelope is requested to insure proper placement of the youth in the National Youth Administration program.
(December 3, 1940)
APPENDIX D STANDARDIZATION OF METHODS OF EXAMINATION, RECORDS, AND THE CLASSIFICATION# The thoroughness of physical examinations varies from mere Inspection to complete health audits.
When large num
bers of persons are to be examined in a short time, it is ob vious that only a few minutes can be devoted to each examin ation.
tfWhen only three to five minutes are allowed for an
examination, the procedure, in reality, becomes only an in spection, and an examination for gross defects, regardless of the speed or the ability of the examiner.
Studies have been
made by the National Industrial Conference Board in regard to the length of time required by an examination of new em ployees.
Such studies showed an average of eight minutes in
1920, ten to fifteen minutes in 1924, while in 1930, the largest number of companies which reported used thirty minu tes., or more.
At the present time, one of the large indus
trial concerns, which has an excellent medical service, de votes an average of forty-five minutes per examination.
trend everywhere is to allot sufficient time to make physical examinations of practical value.f,l
1 American College of Surgeons, Medical Service in Industry and Workmen1s Compensation Laws, 1938. Chicago. 70 pp., page 15.
158 Such items as visual acuity, blood pressure, urin alysis, and the serological test should be included in a routine physical examination.
In an examination program
undertaken by the National Youth Administration during the fiscal year 1940-41,
the tests just mentioned were included,
and in addition, as a routine part of the examination, each youth was vaccinated,
if he had not been vaccinated within
the twelve months immediately preceding examination. The most recent large-scale examination program in this country has been carried on under the Selective Service Act.
These examinations are carried on in great detail, in
cluding an urinalysis, neurology, chest x-rays in almost every case, and a brief psychiatric examination. The Lockheed Aircraft Corporation, of Burbank, Cali fornia, in its pre-employment examination, includes a physi cal examination which is quite complete, and at the same time includes an intelligence test, a personality inventory, and certain aptitude tests.
One of the tests included in the
physical examination is used to gauge depth perception, which is considered important in many types of work in the shops. There is becoming more evident a trend on the part of industry, in examinations,
to relate the physical findings
of any one person directly to the type of work which could be performed.
Recent studies by the American Association of
159 Manufacturers shows that very few persons have been rejected from employment on the basis of physical examinations *
ever, the examinations have been used to determine the type of employment the examinee carries on.
American College of Surgeons, Medical Service In Industry and Workmen’s Compensation Laws, 1938. Chicago, 70 pp.
APPENDIX E SPECIFIC PHYSICAL DEFECTS AND DISEASES* 1.
Underweight, 10 per cent or. more.
Overweight, 20 per cent or more.
Visual defects, total (20/30 or worse in one or both eyes uncorrected or corrected to) 4. (Visual defects as indicated by the Snellen test. If the subject uses glasses, they were worn during test.)
Visual defects, high grade (20/40 or worse in one or both eyes uncorrected or corrected to.) 4. (Visual de defects as indicated by the Snellen test. If the subject uses glasses, they were worn during test.)
Color blindness. 5. (Partial and complete as indicated by the Ishihara test cards.)
Hearing loss, total (16 per cent or more in one or both ears) 6. (Some examinations were done with the 3A W e s tern Electric audiometer; others with the watch test.)
Hearing loss, high grade (20 per cent or more in one ear, 10 per cent or more in other ear.) 6. (Some exam inations were done with 3A Western Electric audiometer; others with the watch test.)
Dental caries, total (8. Examinations of teeth were made only by physicians; hence the prevalence of caries re ported is lower than actually exists. Differences b e tween groups, however, are dependable.)
Dental caries of advanced grade. (8. Examinations of teeth were made only by physicians; hence the prevalence of caries reported is lower than actually exists. Dif ferences between groups, however, are dependable.)
*These classifications were used by Dr. Harold S. Diehl in Physical Condition and Unemployment, C f . Chapter II.
Gingivitis and pyorrhea.
Nasal obstruction (9. Indicates partial or complete nasal obstruction caused by deviated septa, septal spurs, hypertrophied turbinates, etc.)
Upper respiratory tract diseases. (10. Includes dia gnoses of sinusitis, nasal polyps, septic tonsils, hypertrophied tonsils, tonsil tags, chronic rhinitis, hay fever, etc.)
Lower respiratory tract diseases. (11. Tuberculosis and suspected tuberculosis not included.)
Suspicious chest findings or tuberculosis. (12. Includes definite diagnoses of tuberculosis and cases in which the physical findings or physical findings and the his tory together were sufficiently suggestive of tubercu losis for the examining physician to advise an X-ray of the chest.)
Cardiac abnormalities (13. Includes endocarditis, arrythmias, chronic myocarditis, etc.) Pulse rates 90 or more.
2 1 . Pulse rates less than 60. 2 2 . Blood pressure 140-159 m.iru 23.
Blood pressure 160 mm or more.
Blood vessels, abnormalities of (14. Includes varicose veins, hemorrhoids,' and arteriosclerosis.)
Abdominal disorders. (15. Includes gastric distress, gastric ulcer, duodenal ulcer, cholecystitis, chronic appendicitis, chronic constipation, possible cancer, etc •)
Genito-urinary system, diseases of.
Menstrual function, disorders of (16. Includes dysmenorr hea, amenorrhea, metorrhagia, and menorrhagia.)
Albuminuria or nephritis.
Glycosuria or diabetes.
Syphillis. (17. Diagnosis based upon a positive Wasserman test, or history with physical findings of syphillis or upon both.)
Mental or nervous conditions. (18. Includes nervousness, tics, delusions, tremors, strokes, post-encephalitis, paresis, epilepsy, migraine, nervous fatigue, hypochon^ driasis, hysteria, insomnia, high-strung nervous type, speech difficulties, etc.)
Locomotor system, abnormalities of*
APPENDIX P FITNESS FOR EMPLOYMENT A Suggested Scheme of Medical Ratings* In the administration of relief programs it may be ne cessary to classify clients in terms of their employability as determined by age and physical fitness when given a medi cal examination. The following classes represent a simple minimum scheme. QUALIFIED FOR WORK: ltA ,,«-ibhe individual of from eighteen to forty-five years who is organically sound. (Apparently capable of physical effort without restriction as far as physical condition is concerned.) Should be able to pass on Industrial Accident Examination in private Industry. — the individual of from forty-six to sixty-five who is organically sound and is apparently capable of performing 120 hours of physical effort per month. (Lighter labor than that referred to in is implied in this rating.) The worker has some physical defect which would cause him to fail to pass Industrial Accident Examination. «C,!--the individual of from eighteen to sixty-five years of age who is capable of performing 120 hours of work per month at either very light labor or clerical work. (The basis of this classification frequently involves physical conditions which do limit the physical capacity of the per son so handicapped, but do not prohibit his carrying on some physical activity of less strenuous character.) He is unable to do heavy manual work but able to do non-manual or light manual work without injury to himself or danger to others. DISQUALIFIED FOR WORK: 11D M ^Borderline*1— the individual who has some determined physical impairment or handicap preventing him from perform ing 120 hours of work per month on a regular day-in-and-dayout assignment, but still would permit of his carrying on part-time work of light labor or clerical or house-work type.
166 t e m p o r a r y Disability"--the person who is unable to carry on work to his normal capacity because of illness or injury of a nature that will require rest or treatment over a temporary period with recovery expected to occur* with in a period of sixty days. Hptt “permanent Disability"--the individual whose physi cal status, because of advanced pathology, prohibits his per forming any "gainful or productive work* "Organically" is interpreted as including both "mentally" and "emotionally". "Advanced pathology refers to medical findings of a character indicating extensive abnormalities, with poor probability of recovery of the normal state. Prognosis, the prediction of the duration and outcome of an illness or injury, is difficult, not infrequently, for the physician, and should be so recognized and so respected by the social worker, including the medical social worker. Under the groups disqualified for work, it will be noted that such persons present a definite industrial hazard and have medical conditions of a borderline nature, which under stress would hasten physical breakdown even under the slight est of laboring conditions. It cannot be emphasized too frequently, that all rules, regulations, ordinances, statutes, even instruments of govern ment, require interpretation. And, so it is with the points referred to in this outline of standards of medical work ratings as practiced in San Francisco.
^ Young, Erie Fiske, The Case Worker1s Desk Manual. "Social Work Technique". Los Angeles, California, 1939.
APPENDIX G METHODS AND PROCEDURES OF CONDUCTING PRE-EMPLOYMENT EXAMINATIONS A Method for Making Routine Physical Examinations of Female Applicants for Employment in Industry New England Conference of Industrial Physicians. When deemed expedient■the value of such to the applicant and to the industry may be briefly explained* 1. 2*
Height and weight in ordinary clothing. (a) Examination of eyes for color blindness. (b) Examination by Snellen Charts for vision, both without and with correction. Note: Numbers 1 and 2 can be done before the following by a nurse* 3. Applicants remove coats, shawls, or wraps. 4. General inspection with applicant standing. Romberg tried* 5* Applicant sits facing examiner who is standing and hear ing tested with Ingersoll watch. Hair and scalp inspect ed* . 6* Examiner sits: Right ear, right eye, left eye, left ear, nose, mouth, and throat examined in this order with head mirror* 7. Neck inspected and palpated. 8. Chest inspected while comparing and counting pulse. 9* Apex and upper portion of chest percussed and auscultated* 10* Simple movements of the extremities will show joint move ment and involvement. Applicant removes shoes and feet are examined. 11* Blood pressure taken if indicated, or on applicants over 40 years of age* 12* Any other laboratory tests indicated. History: Questions as to previous accidents, illness, operations.
Date last visited physician, and cause for such visit* The details under each of the above suggested steps may be amplified to suit the particular industry*
Ordinarily such an examination can he made in 5 minutes
Conference Board of Physicians in Industry*
170 A Method for Making Routine Physical Examination of Male Applicants for Employment in Industry New England Conference of Industrial Physicians. When deemed expedient the value of such to the applicant and to the industry may be briefly explained. 1. 2*
3. 4. 5. 6. 7. 8. 9. 10. 11# 12. 13. 14. 15. 16. 17. 18. 19.
Height and weight in ordinary clothing. (a) Examination of eyes for color blindness.*. (b) Examination by Snellen Charts of vision, both without and with correction. Note: Numbers 1 -and 2 can be done before the following and by a nurse. Male applicants stripped to the waist and with both feet bare • General inspection with applicant standing. Romberg tried. Applicant sits facing examiner who is standing and hear ing tested with Ingersoll watch. Hair and scalp inspected^ Examiner sits: Right ear, right eye, left eye, left ear, nose, mouth, and throat examined in this order with head mirror• Neck inspected and palpated. Chest inspected while comparing pulses. Precordium pal pated while'counting pulse beat. Completion of chest examination. Test knee jerks. Applicant stands and drops clothing to ankles. Liver and spleen palpated. Genitalia and inguinal canal inspected and palpated. Applicant faces about and bends forward. Spinal and anal inspection and palpation. Legs inspected. Applicant pulls up clothing and feet are examined. Simple movements of extremities will show any joint involvement. Blood pressure taken if indicated or on applicant over 40 years of age. Any other laboratory test indicated.
History: Questions as to previous accidents, operations.
The details under each of the above suggested steps may be amplified to suit the particular industry. Ordinarily such an examination can be made in five minutes.
APPENDIX H STANDARDIZED MEDICAL TERMINOLOGY Conference Board of Physicians in Industry The Conference Board of Physicians in Industry has recom mended the standardization of terminology used to describe defects found upon the physical examination of applicants and employees. Among the conditions found the following occur with the greatest degree of frequency: Heart:
Valvular Tachycardia Arrhthmia Lung s: Tuberculosis Emphysema Asthma Bronchitis. Hernia: Inquinal Umbilical Femoral• Limbs: Contractures. Enlargement s Flat feet Atrophies Varicosities • Vessels: Arteriosclerosis Varicose veins.
Orchitis. Epididymitis. Variococele• General: Rheumatism. Nephritis. Alcoholism. Syphillis Diabetes. All eye, ear, skin and other diseases Spinal: Tabes Multiple sclerosis Multiple neuritis. Deformities: Atrophies. Hypertrophies. C ontrac ture s . Curvatures.
The following are the recommended limitations of de grees of defect for the conditions indicated: Hernia Degrees: 1st degree: External ring admits tip of little finger, impulse felt. 2nd degree: External ring admits thumb, protrusion. 3rd degree: External ring patulous; bubonocele. 4th degree: Mass reaches external ring level. 5th degree: Mass scrotal. Varicosity Degrees: 1st degree: Venous mottlings on one or both lower extremities.
173 2nd degree: 3rd degree:
Venous cords visible on one or both lower extremities* Venous cords visible and palpable on one or both lower extremities.
Flat Feet Degrees? 1 3 1 degree: One or both arches sagging. 2nd degree: One or both arches touch floor. 3rd degree: One or both arches touch floor with eversion deformity. Varicocele Degrees? 1st degree: Thickening of cord. 2nd degree: Thickening of cord with dangling testicle and scrotum with laxity. Vision Defective Degrees? 1st degree equal to 20/20 in one eye; 20/40 in other. 2nd degree equal to 20/40 in one eye; 20/70 in other. 3rd degree equal to 20/70 in one eye; 20/100 in other. 4th degree equal to 20/100 in one eye; 20/200 in other. Hearing Defective Degrees: 1st degree equal spoken voice at 20 feet; Ingersoll $1.00 watch at 36 inches; one or both ears. 2nd degree equal spoken voice at 10 feet; Ingersoll $3jC0 watch at 18 inches; one or both ears. 3rd degree equal spoken voice at 5 feet; Ingersoll $1.00 watch at 9 inches; one or both ears. 4th degree equal spoken voice at 2 feet; Ingersoll $1.00 watch at 4-J- inches; one or both ears. Persons examined showing defects of the following severity should be classed as substandard: Hernia, 2nd degree or more. Varicosities, 2nd degree or more. Flat Feet, 2nd degree or more. Varicocele, 2nd degree or more. Hearing, 2nd degree or more. Vision, 2nd degree or more. Also the following: Arteriosclerosis. Endocarditis. Tuberculosis— Active Bronchitis--Chronic
Emphysema— Chronic Asthma--Chronic
APPENDIX I PHYSICAL EXAMINATION PROCEDURE Conference Board of Physicians in Industry An outline of the principal points to be kept in mind when making a physical examination of applicants or employees It is understood, however, that in many cases and for many purposes a partial examination.only will be necessary, and that, barring special cases, the examination would consume an average of from 6 to 10 minutes per person. It is also understood that the procedure may be added to or subtracted from as the peculiar requirements of each industry may make advisable in the judgment of the examining physician* SPECIAL SENSES (a )
Eye s : Visual Acuity: Right Eye:..... Left Eye:...* Visual acuity of 20/40 or less in both eyes indicates specified employment. Class III, and further investigation. Visual acuity of less than 20/30 in one eye and less than 20/200 in the other with suit able correction indicates specified employe ment. Class III A greater disparity in vision of the two eyes indicates need for further investiga tion. Reading Test: Right Eye:..... Left E ye:.... ........... .Size of T y p e ..... .............. Distance........ Field of Vision: Right E ye:.......Left Eye?... ...........Normal or Limited Loss of more than one third of field of vision of both eyes, or loss of two thirds of field of either eye, indicates specified employment. Class III. Color Sense: Ability to match colors and call them correctly. Pupils: Reaction. Puffiness' of Lids.
176 (b )
Ear s : Drums
Right Ear:*........ Left E a r : ......... ...... Appearance............ ...... Hearing Power......... ...... By watch............... Use Ingersoll $1.00 watch at 36tf as normal. Any variation from normal to he indicated.by the fraction 36, denominator being distance at which watch can be heard. Deafness to be indicated by the word ^contact” . Hearing power of less than one half normal indicates specified employment. Class III. Nose: Septum. Turbinates. Obstruction. Mouth and Throat: Condition of teeth. Condition of gums . Condition of tonsils Tby»oid enlargement t
CHEST EXAMINATION: (a)
Heart: 1. Myocardial test. Effort syndrome--Pulse reading before and after exercise. 2. Blood pressure taken on all cases over 40 years of age; others as indicated. 3. Valvular disease--compensated or uncom pensated. 4. Arrhythmia. 5. Tachycardia. Lungs: 1. Inspection— lagging, apical retractions. 2. Auscultation--Eight points to examine closely as follows? Front: Apex of lung— right and left. Infraclavicular space--right and left. Back: Suprascapular space--right and left. Base of Lung--right and left.
ABDOMEN: Inspection--abdominal tumors. Hernia: Inquinal--complete, incomplete, oblique, direct. Size of external ring.
177 Impulse, present or absent. Femoral hernia. Ventral hernia. Umbilical hernia. Post-operative. Abdominal wall. SPINE: Curvature Mobility. ANUS: Examined for hermorrhoids, fissures, fistulae, protru sions . GENITALS: Examined for varicocele and hydrocele. EXTREMITIES: (a) Lower: Varicose veins. Joint motility. Loss of member Deep reflexes. Foot strain. (b) Upper: Joint motility. Loss of member. Loss of digits. Tremors. GENERAL: Gait. Romberg. Skin. „ HEIGHT, WEIGHT, and AGE to be recorded. All deformities and contagious conditions should be noted in the proper place. Applicants should be rejected on physical grounds only when their employment would make them a menace to themselves, to others, or to property. Following questions will give a good background for obtaining important family history information:
178 1. 2
3. 4* 5. 6. 1
When did you last consult a physician? Have you ever been In hospital or sanitarium? Have you ever had heart trouble, lung trouble, or tuberculosis? Have you ever had tonsillitis? Have you had fits or fainting spells? Are you well and strong? Have you any relatives who have had tuberculosis? Have, you ever had accidents, operations, or injuries? Have you weak lungs or heart trouble?