Table Of ContentSponsoring Committee: Professors Roland H. Spaulding
Brian E* Tomlinson and John G» Rockwell
THE VOCATIONAL REHABILITATION OF THE TUBERCULOUS
A Comparative Analysis and Evaluation
of the Services
Provided by a State Agency
SOL L. WARREN
Submitted in p artial fulfillm ent of the
requirements for the degree of Doctor of
Philosophy in the School of Education of
New York University
L ' O
Thesis acceptaa
OCT 1 '2
I, Sol L« Warren, hereby guarantee that no part of the dissertation
or document which I have submitted for publication has been heretofore
published and (or) oopyrighted in the United States of America,
except in the ease of passages quoted from other published sources;
that I am the sole author and proprietor of said dissertation or
document; that the dissertation or document contains no matter which,
if published, w ill be libelous or otherwise injurious, or infringe
in any way the copyright of any other party; and that I w ill defend,
indemnify and hold harmless hew York University against all suits and
proceedings which may be brought and against a ll claims which may be
made against hew York University by reason of the publication of said
dissertation or doeumento
Signed
TO
MY PARENTS
PREFACE
Following a background in puifcscience, circumstances diverted me
in to so cial service. Sated with scientific method, I entered the field
of re h a b ilita tio n and was soon confronted with a body of practice based
p rim arily on social sanction, legal fia t, and fiscal expediency. Nor>*
e x is te n t was the groundwork of discovery based on research which I had
learn ed to regard as requisite to competence in the practical application
of an exact discipline. True, the convictions of my fellow practitioners
in th e value of their efforts were no less ardent than those of my
s c ie n tis t friends. But, to one accustomed to the test-tube proofs of
the lab o rato ry , i t seemed almost immoral to build his faith in a practical
a rt on a foundation of isolated examples of practice, descriptive surveys,
and ro u tin e collections of data. Yet these were a ll I could find in my
search to construct a rationale.
R ehabilitation was lingering too long in the promotional stage, its
n e c e ssity beyond question, its consequences unexplored; a service too
re a d ily accepted on faith , with only the unsupported assertions of its
pro tag o n ists to ju stify i t . And so, with the zeal of a pioneer, I
determ ined some day to remedy this state of affairs. This was in 1936.
The ensuing decade found me practicing rehabilitation in several
d iffe re n t sitin g s. I had an opportunity to observe at firs t hand and to
r e f le c t upon the very formidable obstacles to basic research met with in
so c ia l service organizations- the lack of funds, staff, and time, the
d isin c lin a tio n of adm inistrators to support non-productive activ ities, the
com plexity of the subject itse lf, the overlapping of disciplines, the
absence of c rite ria , etc. I began to develop a healthier regard for the
differences between the sc ie n tist's laboratory and the counselor's corner,
I no longer minimized the importance of practical examples, descriptive
3urveys, and collections of data. Yet, while the scope of my aspirations
were gradually w hittled down, the yearning to do a "scien tific” piece of
work was never blunted.
The opportunity eventually presented its e lf and, for the satisfaction
of a personal ambition so long nurtured and the fulfillm ent of a pro
fessional need so deeply fe lt, the research here described was undertaken.
That i t has satisfiefl my personal longing is hereby attested . That i t w ill
satisfy the professional need remains to be seen. In any event, I hope
that i t w ill provide an impetus to further investigation in rehabilitation
and related field s in the in terests of both scientific methodology and of
those who stand to benefit by its disclosures.
Many agencies, in stitu tio n s, and individuals have assisted in this
enterprise. I t is a pleasure to acknowledge their contributions 1 /.
As Head of the agency under analysis, Frederic G. Elton was most
directly concerned w ith the outcome of the study. Accepting the risks
involved in exposing his organization's records to c ritic a l evaluation,
he gave unqualified support for an untrammeled inquiiy. He also gave
tangible evidence of his eagerness to advance the study by making available
all necessary personnel, equipment, and supplies, and by providing con
venient and private access to a ll file s.
1/ The title s and affiliatio n s of the persons named herein, as well as
~ additional inform ation bearing upon th eir specific contributions to
this study, are contained in the section entitled, Persons Involved",
which begins on page 15 ^ .
i v
X am greatly indebted to Dr. I. D. Bobrowitz fo r his inspirational
as well as practical aid. After paving the way for the success of the
in itia l phases of the research by making freely available all the records
and facilities of the sanatorium which he heads, Dr. Bobrowitz subsequently
followed the development of the project with the keenest interest, being
ever ready to accommodate in the solution of day-to-day problems and to
offer encouragement and motivation.
For expending months of assiduous effort in thoroughly reading
voluminous case records in connection with an evaluation procedure, and
for turning in a peerless professional performance in the conduct of that
procedure, I am enormously obligated to Owen Bernstein, Estelle Meeker,
and Irma Minges.
Displaying genuine understanding of the implications of the study,
and with high-minded purpose in ensuring the most favorable climate for
its successful completion, officials of various municipal departments went
far out of their way to cooperate. I wish to convey thanks in this con
nection to Dr. Herbert R, Edwards, Dr. Allen Kane, and Raymond M. H illiard,
a ll of whom so graciously granted the privilege of pursuing the investi
gation through the departments under their adm inistration; and to their
bureau chiefs and other assistants- Henry Rosner, Carl Erhardt, Hazel
O'Connell- a ll of whom pulled the necessary strings to expedite specific
phases of the procedure.
Thanks are extended to Isabel Novell! for enhancing vastly the use
fulness of the Public Health Association's library fac ilitie s; to Hannah M.
Kearney for her readiness in cutting red tape to secure quick clearance of
the case records through the Social Service Exchange; to Dr. Warren Coxe
and Esther Smith for reinforcing immeasurably the sta tistic a l foundation
v
of the study; and to Louis Salzman for nmny tim ely favors.
I am indeed gratefu l to Donald D abelstein and Dr. Thomas B. McKneely
for their active concern throughout the greater part of the inquiry. They
contributed valuably in analyzing and evaluating the methodology and the
results, in pointing out other relevant studies along the way, and in pro
viding copies of publications long out of p rin t and generally unavailable*
Edward Hochhauser and Holland Hudson were exceptionally staunch a llie s.
Both served as storehouses of information in the fie ld covered by the
study and were instrum ental in imparting a proper h isto rical perspective.
For sitting through hours of detailed exposition w ithout exhausting
patience, for offering reassurance and incentive, for contributing so many
suggestions resulting in adjustment of viewpoint and refinem ent of tech
nique, I am deeply beholden to both,
I am extremely cognizant of the expert guidance provided by the
members of my Spo«eoring Committee, and p articu larly by Professor Roland
H. Spaulding, its chairman. Their advice and direction resulted in much
clarification of concept and m aterially strengthened the wrork in many of
its aspects.
I was fortunate indeed in gaining for the p ro ject the specialized
services of such a loyal band of competent and indefatiguable operatives*
Without their combined aid, the huge amount of d etail would have been
impossible of completion even within the extended time lim its occupied by
the investigation. I wish to acknowledge the help of Mary Stein who ren
dered yeoman service during her assignment a t M unicipal Sanatorium; Ruth
Kupersmith who provided bibliographical assistance; and Hargie Rivers who
aided with s ta tis tic a l chores. Harry Devor and Stephen Korein are sympa
thetically remembered for tedious hours spent over calculating machines;
VI
Audrey Johnson for performing so capably on the mimeograph; N ellie Higginson
and Emma Kearse for typing the manuscript through its many revisions; Anna
Klenck and Fay Fried for attending so reliably to multitudinous clerical
and stenographic tasks. To Kean John, for selfless devotion to numberless
duties and for resourcefulness in execution under d ifficu lt conditions,
I feel a keen sense of gratitude.
Thanks are due to those individuals who were kind enough to furnish
original copies of papers and speeches, sometimes the only copies extanfc-
Edgar B. Forter, J. J. Brown, Louis R. Schubert, and C. B. Shroyer,
Similar appreciation is extended to those who manifested by their comments,
suggestions, and continuing correspondence, more than a passing interest
in the research- Dr, Russell I, Pierce, Daniel H arris, Joseph E. Rosner,
and Dean N. Y. Wessell.
I wish to record my appreciation of the efforts of the numerous
physicians, social workers, clerks, and other employees of agencies and
institutions touched by the study; and of the friends, relatives, and
employers of the subjects. All of these, too numerous to mention by name,
labored hard in processing inquiries, fillin g out forms, and otherwise
providing the information without which the project would have fallen far
short of its goal.
Finally, I wish to acknowledge my heartfelt homage to the two-hundred-
odd subjects who formed the basis of this investigation. Sharing the
conviction and anticipation of the investigator that th eir cooperative
participation would yield fruitful and constructive findings, they gave
liberally of themselves to produce the storehouse of data which, i t is
hoped, w ill constitute their enduring memorial.
TABLE OF CONTENTS
Page
T itle page
D edication
Preface i i i
Table of Contents v iii
L ist of Tables xvi
Chapter I . The Problem 1
A. The Purpose of the Study 1
B. Problems Involved 1
C. D efinition of Terms 2
D. D elim itations U
E. Summary 9
Chapter II. The Need for the Study 11
A. V ocational R ehabilitation in Tuberculosis Control 11
B. Magnitude of the Vocational R ehabilitation Program 12
C. Promotion of Anti-Tubercxilosis E fforts 13
D. V ocational R ehabilitation and Relapse Experience 13
E. The Need fo r Concrete Data 15
F. The Absence of Basic Research 16
G. Shortcomings of Previous Studies 15
H. Organized A ssistance Versus Self-Adjustment 25
I. The Future of Vocational R ehabilitation 26
J. Summary 27
Chapter III. Basic Assumptions 25
A. Com parability of Experimental and Control Groups 25
P. S elf-S election of Service 30
C. Sample Bias 31;
1. Bias Due to Non-Reporting 31;
2. Bias Due to the U nreliability of Responses h0
D. Determining the Need for Vocational R ehabilitation U3
E. Sine of the Sample U3
F. Length of the Follow-up Interval U6
G. Use of tho B ell Adjustment Inventory us
H. G eneralizations Based on the Study 51
I. Summary 53
Chapter IV. H isto rical Background and Related L iterature 55
A. O rigin of the R ehabilitation Concept 55
B. Development of R ehabilitation E fforts 58
C. Extent of the problem of D isability 60
. 1. D isab ility in General 60
2. Tuberculosis 62
D* Development of R ehabilitation F a c ilitie s for
the Tuberculous 65
1* In-Sanatorium Programs 66
2. Tuberculosis Colonies 69
3* S heltered Workshops 70
U* Night Sanatoria 73
Contents Page
Chapter TV* 5* industrial Programs 74
(Cont'd) 6* Rehabilitation Centers 76
7m Official Programs 78
(a) History 79
(b) Federal Participation 83
(o) Looal Participation 85
E« Research in Tuberculosis Rehabilitation 89
1* Follow-up Studies of Discharged Patients 91
2* Determination of Rehabilitation Needs 97
3* Evaluation of Established Programs 104
(a) In-Sanatorium Programs 104
(b) Tuberculosis Colonies 107
(o) Sheltered Workshops 107
(d) Night Sanatoria 109
(e) Industrial Programs 110
(f) Rehabilitation Centers 111
(g) Official Programs 113
(1) Looal Studies 114
(2) Federal StudieB 125
($( Other Studies 129
Evaluative Criteria 129
Case Histories 130
Administration of the Program 131
The Counselor's Role 133
4. Miscellaneous Studies 133
(a) Employment of the Tuberculous in Sanatoria 134
(b) Work Performance of the Ex-Tuberoulous 135
(o) Medical Aspects of Tuberculosis 136
(d) Psychological Aspeots of Tuberoulosis 138
(e) Socio-Economic Aspeots of Tuberculosis 140
(f) General 141
5« Studies in Progress 142
F* Summary 145
Chapter V* Plan of the Research 146
A* Nature of the Study 146
B. The Data 146
C. Materials Involved 147
D. Places involved 148
1* Municipal Sanatorium 148
2. Division of Vocational Rehabilitation 149
3« Tuberculosis Clinics 150
4. Private Medical Sources 150
5* Sanatoria, Hospitals, Convalescent Homes 151
6. Places of Interview 151
7, Department of Welfare 151
8* Social Servioe Exchange 152
E* Persons Involved 152
1* Agency Administrators 152
2. Other Agency Executives 153
30 Consultants and Advisors 154
4* Task Forces 154
IX
