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JAMES J. DAVIS, Secretaiy



Bureau Publication N o . 167

Federal Reserve Bank of St. Louis


Federal Reserve Bank of St. Louis

U. ^




Letter of transmittal. ------------------------------------------------------------------------Introductory summary_____________J------ J»,-— ------------ ---------------------- Purpose and significance of s tu d y -------------- -----------------— —
Conditions found in two States— ------- - --------- ----------------------------Medical and physical data------------------------------------ -— , . - , r —
Social d a ta ______________________________ • ____Tr f — - r-,—
Conclusions______ ________________ _____ _ r -c’--------- - — ---------Maternity homes in M innesota--------------------- ------------------------------------ !7
Licensing and supervision..., — --------- ------ -— - ------------- ? ----------Origin and development— ________
------------------------ 1------ -----Capacity and population------- -----------,--------- ------------- > - ------- - - - r Grounds and buildings------------------- -— -- -------*-—
----------Admin istration -------------------- ------------- -------- ------------ ------------------Boards___________________ — ------------------------------------------ -—
S ta ffs.----------------- ----------------------------------- -,— ------------ - —
Finances_______________ __.______ _______ — ----------- _______——
Rates and fees-------------------------- ---------------------------— •------------Income from work of patients______ !----------- -------------------------Absence o f “ surrender fees” — ___------- — ---------------- ------- - —
Income from board paid for ba b ies..— , — —
--------Records and rep orts-------------------------- ._------- -------------------------------Admission of patients— . _ _ , _ _ _ -----------*______________ ---------S ou rce--------- ---------------------------------------------------------------------- —
Lim itations. ____—
— ~~ —
Diets ________ ___-------------- — _______------------------------------ --------- —
Prenatal care---------------------------------- --------------------------------------------Confinement and postnatal ca re----------------------------------------------------Infant c a r e _______________________________________________________
Observance of public-health measures------------------------------- -------------Vital statistics-------- ---------------------------------------------------- ---------------Routine and regulations--------------------------------------------------------------- Training for future employment---------------------------- — ----------------Recreation__________________ ____________________________________
Special provisions in Minnesota for unmarried mothers and their
children__________________ ______________ _______________________
Responsibility of county child-welfare boards-------------------------Establishment of paternity , --------------------------------- ----------------Placement in foster homes and adoption------- , -----------------------Supervision of children’s institutions, of boarding homes, and of
child-placing agencies--------- ------------------------------------------- Discharge and continued supervision of patients----------------------------Provisions made for babies---------------------------------------------- - -------------General statement-------------------------------------------------------—
Cases studied over period of one y e a r-------------------------------------Descriptions of individual h om es.----------------- ---------------------------- Case stories---------------------- i ----------1---------------- -------------------------------Maternity homes in Pennsylvania----------------------------- — --------------------—
Legal provisions------------------------------s--------------------- -------- -------- -------Origin and development---------------------------------------------------------------Capacity and population— ___ — --------------------- -------------------------Grounds and buildings— ______— ------------------------ ------- --------Administration------------------- ----------- ----------------------------------------------Boards------------------- --------------------------------------------------------------Staffs !--------------------------------------------------- ------------------------- -------
Federal Reserve Bank of St. Louis







Maternity homes in Pennsylvania— Continued.
F in an ces_______________________
Rates and fe e s_____________________________________
Income from work of patients____________ ;____ : I I _ I I I _ I I I I I I
Income from “ surrender fe es” ______________________________ ~
Income from board paid for b a b ie s________
Records and rep o rts__________________________________
Social records________________________________
Medical records_________________________________
Admission of patients____________;_______* ____________
Source________________________________ ______
Lim itations_________________ ____________________
Prenatal c a re __________________ ___________________
Confinement and postnatal care__________________________
Infant c a re _________ ;__________________________ _
Observance of public-health measures____________ _______ H I I
Vital statistics_______ ____________________ _________
Routine and regulations___________________________ _____
Training for future employment_______________________ I I I _ _ I H _ I
R ecreation _________________________________ ||____
Discharge and continued supervision of p a tien ts-____________
Procedure in Pennsylvania relating to placing out, adoption! and
support of children of illegitimate birth_____ ___ _______ _
Provisions made for babies_______________________________
Keeping babies with their mothers__________________ I I I I I I I I H '
Placement in foster homes and adoption_____________ H H H J
Efforts to fix paternity_______________________________
Descriptions of individual homes____ __________ _______ H I - I - H I I T " "
Case stories___________________________________________
A . — Child-welfare standards applicable to maternity homes I I I _ 11II
Medical standards_________ _____________ _ I ___________ H I
Social standards_________ ________ _____________________
B . — Certain State laws and regulations affecting maternity homes
Minnesota___ ____ ______ _______ _______ _______________
Pennsylvania_________ ._________ _______________H I

__________________ _i__ iiiiiin __ ^

Federal Reserve Bank of St. Louis





U n it e d S t a t e s D e p a r t m e n t o f L a b o r ,
C h il d r e n ’ s B u r e a u ,

Washington, March 10, 1926.

Sir : There is transmitted herewith a report on a study of mater­
nity homes in Minnesota and Pennsylvania. This investigation was
made under the direction of the author of the report, Dr. Ethel M.
Watters, then associate director of the maternity and infant-hygiene
division of the Children’s Bureau. The medical data were collected
by Dr. June M. Hull and the social data by Miss A. Madorah
Donahue, both of the staff of the division. The work was made
possible by the cooperation of the State board of health and the
State board of control, of Minnesota, and of the State department of
health and the State department of welfare, of Pennsylvania. The
bureau is indebted to the directors of these agencies and their staffs
for much assistance.
Respectfully submitted.
G r a c e A b b o t t , Chief.
Hon. J a m e s J . D a v i s ,
Secretary o f Labor.
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis


Maternity homes have not been given much attention in the United
States. It has not been the usual procedure here, as it is in England,
to license them or to give them the status of small hospitals. The
term “ maternity hom e” has not been defined in most States, either
in the statutes relating to the protection of maternity and infancy or
by common medical or social usage. The chief purposes for which
many of these institutions were founded were the moral reclamation
of “ unfortunate women’’— prostitutes and those addicted to drugs
or alcohol— and the provision of shelter for indigent women. The
homes provided religious instruction as well as obstetrical service and
care before and after confinement, and some of them also placed
babies soon after birth. They have been known most commonly as
rescue homes, mission homes, asylums, or shelters. In their work the
permanent health and physical well-being of mothers and babies were
not generally considered factors of foremost importance.
With regard to policy the homes could be classified in three groups.
The special policy of one group was to protect the mothers from
publicity; of another, to bring about their moral reclamation; and
of the third, to bring about their reclamation and also to save the
lives of their babies. This difference in the homes’ policies is still
. '
. . ,
In the past practical training or help in economic and social ad­
justment after leaving the home was rarely given the mother, and
little or no effort was made to establish paternal responsibility for
her baby. Neither through their own efforts nor through cooperative
relations with other agencies did the homes attempt constructive
social treatment. Within recent years, however, there has been a
gradual tendency for the homes to limit their intake chiefly to unmar­
ried mothers and to develop their medical and social service to include
prenatal, postnatal, and infant care and the preparation of the mother
for economic, moral, and social adjustment in the community.
A study of the medical and nursing problems involved in maternityhome work and of the results of the various methods of social care and
legal protection developed in relation to it is therefore of interest to
physicians and nurses and to social workers in various fields. The
interdependence of medical, nursing, and social work m any mater­
nity-home undertaking has given to this study a twofold purpose: (1)
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Analysis of work of the homes as agencies in establishing standards of
prenatal, confinement, postnatal, and infant care; (2) evaluation of
the social practices of the homes. In the course of the study the
value of legislation providing for State regulation and supervision
of maternity homes has also been considered.
For the purpose of this study a maternity home is defined as any
institution which cares for women during pregnancy, provides for
their confinement care (whether within the home or at a cooperating
hospital), and after confinement cares for them and their infants for
a varying period of time. This somewhat arbitrary definition was
adopted in order to limit the scope of the study, which was not
intended to include the large maternity hospitals. Many of the
homes included in the study gave confinement care within the home,
but a number sent their patients to local hospitals for this care!
Separate records were kept of the confinement care when it was
given outside the home.
Pennsylvania and Minnesota were chosen for this study because
of the cordial cooperation extended to the bureau b y the Pennsyl­
vania State Department of Welfare and the Minnesota State Board of
Control, and because of the marked contrast in the legal status of
maternity homes in the two States. At the time of the study Penn­
sylvania had no law requiring all such homes to be licensed, but the
State department of welfare was authorized to supervise them as
child-caring institutions. In Minnesota since 1919 legal authority
for licensing and inspecting maternity homes has been vested in the
State board of control.
Thirty-five homes were included in the study— 11 in Minnesota
and 24 in Pennsylvania.
In Minnesota the original list of 22 homes furnished by the State
department of public welfare contained the names and addresses of
individual laywomen in different parts of the State who were open­
ing their homes to the patients of local doctors but were making no
attempt to give prenatal or postnatal care. Although 11 such homes
were visited they were not included in the study because the care
offered was too restricted for them to be classed as maternity homes
as defined for the purpose of this study.
In Pennsylvania a list of institutions was furnished by the State
department of welfare. As there was no centralized registration of
maternity homes at the time of the study except those which were
State aided this list was not complete, and through efforts of the
members of the staff of both the child-health division and the public
health nursing division of the State department of health it was
considerably increased. A preliminary study of these places was
made to eliminate those which did not conform to the definition of
maternity homes already given. Twenty-one were found to be ma­
ternity homes; 74, maternity hospitals; 5,hospitals which cooperated
by giving obstetrical care to the patients of certain maternity homes;
6, institutions which did not care for expectant mothers. Ten were
not found. Fourteen more places were found through the assistance
ot local workers in different parts of the State; of these 3 were ma­
ternity homes, 1 was a cooperating hospital, 6 were maternity hospitals,
and 4 were temporary shelters. The final number of maternity homes
studied in Pennsylvania was 24.
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Two schedules, one for medical data, the other for social, were used
for each institution studied. A physician and a social worker vis­
ited each institution and interviewed superintendents, matrons,
attending and consulting physicians, nurses, and social workers. In
most of the homes the individual records of the patients for the
period of one year (the calendar year 1922, whenever possible) were
studied in order to ascertain the methods of care used, the plans
made for mothers and babies, the status of patients when discharged,
and the amount and kind of supervision after discharge. In many
of the homes the bureau agent came into some contact with the patients
and thus was able to form an opinion of the types of persons admit­
ted and of their reactions to the home. In order to evaluate more
accurately the social methods employed by the homes conferences
were held with representatives of local social agencies, public and pri­
vate, and with members of the governing boards of the homes and
other individuals actively interested in them.
Although widely differing views may be held as to the details of
policy and management which should prevail in maternity-home
work, certain minimum standards of prenatal, confinement, and postnatal care to which every mother and baby are entitled, and of
special care to which the child born out of wedlock has a right, have
been worked out through conferences called by the Children’s Bureau
and are reprinted in the appendix to this report (see p. 87). Two of
the homes studied, one in Minnesota (see p. 33) and one m Pennsyl­
vania (see p. 66), gave care which very nearly measured up to or
approximated these standards.

The maternity homes studied in the two. States had similar origins
and early histories; they were established chiefly from religious
motives, and they admitted not only maternity cases but also almost
any type of woman or girl needing shelter, care, or moral rehabilita­
tion. Certain conditions and policies in the homes also were similar
in the two States at the time of the study, but an analysis of the
various administrative policies of the homes and of their medical and
social practices and results shows considerable variation in the extent
to which the homes measured up to the accepted standards of care
for mothers and babies.
Prenatal care.


Medical examinations and supervision.— In Minnesota every home
except one (and when this one was visited new policies were in process
of adoption) gave the patients at the time of admission complete and

sermann blood test as part of the routine examinations, and only onefourth gave the Wassermann test of placental blood; in more than
one-fourth the examination was so superficial that venereal infections
might easily have escaped detection.
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Seven of the Minnesota homes used the State university laboratory
for their work. The others either had their own laboratory or used
that of a cooperating hospital or clinic. In Pennsylvania two-thirds
of the homes used the laboratory of a State, a borough, or a city health
department, and eight had their own laboratory or the use of that
of a private physician.
Medical supervision of patients during pregnancy, with attention
to individual needs, was “ excellent” or “ good” 1 in the large major­
ity of Minnesota homes, those closely in touch with the medical
school of the University of Minnesota having very satisfactory
practices. Excellent records on medical care were practically uni­
versal in the Minnesota homes, but in the Pennsylvania homes
records were not so well kept, a few homes keeping none. In both
States, however, the prenatal examinations were apparently given at
regular intervals—weekly, semimonthly, or monthly; and individual
instruction was given the mothers in regard to their physical condi­
tion. In 14 of the Pennsylvania homes and in 5 of those in Min­
nesota the prenatal examinations were given in the home; in the
others the patients were taken to clinics, although a few homes
arranged for examinations in the home when pregnancy was far
There is much to be said both for and against all the medical care
being provided in the home. Some persons maintain that it is more
costly for the community to supply proper equipment and service
for physical and obstetrical examinations and also for confinement
care; others, that it is much better to give all the care in the home,
whatever the cost. It is claimed that the unmarried mother especially
is less likely to be a further expense to society if her care is given
entirely under the influence of the home, particularly the bedside
care. According to Dr. Janet Campbell, the pregnant woman should
five in a “ physiological rather than a pathological atmosphere” *2
Just what emergencies can be met in the ordinary delivery room of a
maternity home may be a matter of difference of opinion, but the
prenatal care should be such as to preclude these emergencies as far
as possible.
In the absence of complete facilities for medical care in the home
the home should arrange for obstetrical examinations at a clinic and
for the services of a laboratory and should employ a trained nurse.
If the clinic keeps complete records which are available to the obste­
trician the pregnancy can be properly supervised and safeguarded.
A trained maternity nurse from the chnic or on the staff of the home
can make the proper connecting link between the patients and these
cooperating agencies.
For adequate care of mothers and babies it is very important that
the superintendent of a maternity home should be a trained and
intelligent person who will carry out the directions of the physician.
In some of the homes visited the medical service was found to be
ki&kly standardized; but the maternity-home staff failed to cooperate
with the physicians, so that the results of the home’s work were not
I The terms by which the homes were rated were: Excellent, good, fair, and poor.
°1 I^eat Britain]; Maternity Homes, by Dr. Janet M. Campbell, Senior Medical
Officer, Maternity and Child Welfare. London, 1921.
Federal Reserve Bank of St. Louis



wholly satisfactory. Although the superintendents m nearly all the
homes in both States were kindly and were interested in their charges,
those in Minnesota had had more training and education to fit them
for their work than those in Pennsylvania, more than half of whom
as compared with 3 in the 11 homes studied in Minnesota had only
an elementary education. Five Minnesota and eight Pennsylvania su­
perintendents were college graduates or graduate nurses (of these one
m each State was a physician). In homes which undertook several
tvpes of work the physical care of expectant and nursing mothers
was found to be less satisfactory than in homes which undertook
onlv one. The homes in Minnesota did not give so many kinds of
service as did those in Pennsylvania. Sixteen of the Pennsylvania
homes cared for children other than those of the patients, or for dehnauent girls or for aged or needy women, in addition to giving maS t y - h o m e service, fhereas only one of the Minnesota ^ m e s cared
for children other than those of patients, only one cared for dehn
quents, and none cared for the other types of persons admitted to
i l> fr -&
adhof the expectant mother and the nursing mother
is so important to the well-being of the mother and the child that
an attempt was made to analyze the diet of the patients m the homes.
It is impossible to make a comprehensive study of the efficiency of an
institution’s dietary without careful measurement of the amount of
each food provided and of the amount eaten by individuals, and
since this quantitative study could not be undertaken an analysis
was made of the menus for a series of meals served to the patients.
This gave a qualitative picture of the diet m terms of the use o
different foods. It was assumed that the amount of each food served
at a meal was the equivalent of an average serving. The diets were
graded by finding the average use during the week of each type of
food material and comparing this average daily food
QW1 The
grading sheet which outlined diets of four different grades. The
adequacy of the diets was measured b y the extent to which they
contained satisfactory amounts of the foods containing Dade^ at*
protein,” mineral substances, and vitamins A, B, 0, and D. Many
of the homes reported that an additional amount of food was served
to the nursing mothers; for the most part this was milk in some
form In classifying the diets of the homes, therefore, separate grades
were given for the diets of pregnancy and lactation.
The following daily food plans were used in grading the diets:
Adequate diet
; One pint to 1 quart milk.
One .egg.
One serving leafy vegetable (asparagus, lettuce, greens, cabbage, string beans,
One serving other vegetable.
One serving potato.
. _
_ .v
One serving fruit (citrous fruit at least four .times a week).
One serving whole-grain cereal.
Four or more slices bread (with butter at three meals).
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Probably adequate diet
One cup to 1 pint milk.
One or two servings egg or leafy vegetable.
One serving meat.
One serving other vegetable.
One serving potato.
One serving fruit.
One serving whole-grain cereal.
Bread or other starchy foods, with butter.
Possibly inadequate diet
One-half cup to 1 cup of milk.
One or two servings egg or leafy vegetable.
One serving meat.
One serving potato or other vegetable.
One serving fruit.
Bread or other starchy foods, with some butter.
Probably inadequate diet
Milk in coffee to one-half cup.
One or two servings egg or meat.
One or two servings vegetable or fruit.
One serving potato.
Bread or other starchy foods, with small amount butter or butter substitute.

In both States the diets for expectant mothers fell considerably
short of desirable standards. Only one home in Minnesota was
classed as definitely “ adequate” and none in Pennsylvania. Minne­
sota, however, had a larger proportion of the homes “ probably ade­
quate” in diet than Pennsylvania— 2 out of 11 as compared with 1
out of 21 (the diet of 3 Pennsylvania homes was not rated).
In most of the homes of both States the diets “of the nursing mothers
were not satisfactory. In no Pennsylvania home and in only 2 Min­
nesota homes was the diet classed as definitely adequate. Diets were
graded as “ probably inadequate” or “ possibly inadequate” in more
than half the homes in each State.
It was impossible to determine exactly the average daily consump­
tion of milk by the patients, as the amount purchased by the homes
varied from 2 quarts daily in a home having only 4 persons to 57 quarts
daily in another where there were more than 300. Furthermore,
there was no way to estimate how much the staff consumed, or bottlefed babies, or the other children, and consequently accurate determi­
nation of the amount of milk used by each pregnant woman or nurs­
ing mother was out of the question. Every superintendent claimed
that differentiation from the ordinary diet was made for a patient
when the physician ordered it.
The conclusion was that these diets would be improved if more
eggs, spinach, lettuce, kale, and cheese (especially cottage cheese), as
well as more milk, were used.
Rest and sleep.— In only two homes in Minnesota and three in
Pennsylvania were rest periods provided as part of the regular rou­
tine, but in most of the homes in both States they were arranged for
any mother who seemed to be in special need of them.
For the most part in the homes m both States plenty of sleep in
the open air, another necessity for expectant mothers, was provided
Federal Reserve Bank of St. Louis

In tr o d u c t o r y

sum m ary


through regulations' as to hours of sleep and open windows, hut sonie
homes in each State had overcrowded quarters with insufficient air
SP!Personal hygiene.— Toilet and bathing facilities were provided in
all homes in both States. In all the Minnesota homes the importance
of personal hygiene as part of prenatal care was recognized in the
requirement that patients bathe at least twice a week; in a few Penn­
sylvania homes there were no regulations, the patients bathing when
they pleased.
J ,
Care o f teeth.— Care of the teeth, another item accepted as essen­
tial, was included in the work of four of the Minnesota and six of the
Pennsylvania homes, either in clinics maintained by the home or
through provision for outside dental service.
Exercise and recreation. — Opportunity for outdoor exercise and
recreation was given in all the Minnesota ^homes, as they all had
grounds or gardens; but more than one-third of the Pennsylvania
homes were located in city blocks with only rear yards, so that this
important feature of maternity care was not adequately provided.
Mental hygiene.—A happy, cheerful state of mind and freedom
from worry are among the essentials for an expectant mother s wel­
fare. The majority of maternity-home patients are under economic
and social handicaps which militate against the necessary mental
tranquillity; and therefore the atmosphere and spirit of the home, the
assistance that it gives a mother in overcoming her disadvantages, the
opportunities for recreation, and the assistance that it provides in
working out individual difficulties are factors of great importance.
In both States the atmosphere of most of the homes was pleasant
and homelike, only one or two exceptions being observed. The day s
program usually allowed the patients free time for sewing, reading,
or recreation. The majority of homes had dispensed with hard-and*
fast regulations; and considerable flexibility was noted in regard to
visiting hours, absences from the home, and other matters of daily life,
which tended to bring about a more contented and cheerful frame of
mind than could exist under inflexible routine and rigidly enforced
rules. Well-planned programs of recreation were found, however, m
only about one-third of the Minnesota homes, and only about onesixth of the Pennsylvania homes had either regular or occasional
provisions for recreation other than the evening gatherings of the
patients under the supervision of a staff member. The fact that a
low mothers—-about 6 per cent of the total number cared for during
the year in Pennsylvania and about 9 per cent in Minnesota left
the homes before confinement indicates a certain amount of dissatis­
faction, but other reasons also had a part in their leaving, such as
provision made for their care elsewhere or the fact that they had
venereal disease.
Confinement and postnatal care.

Adequate confinement care was provided for by the large majority
of homes in both States. Half the Pennsylvania homes and about
one-third of the Minnesota homes sent their patients to cooperating
hospitals for delivery. In these hospitals the obstetrical procedure
was “ good” or “ excellent.” Confinement care given within the home
Federal Reserve Bank of St. Louis



was “ poor” in one home in Pennsylvania and in none in Minnesota,
and it was “ fair” in two homes in each State.
The duration of bedside care in the homes averaged 2 weeks in
Minnesota and 14 to 16 days in Pennsylvania. In homes having a
sufficient number of assistants to give bedside care an early return of
the patients from the hospital is not a matter of serious concern, but in
large hospitals with small maternity wards a patient might be sent
out too soon and her future health jeopardized. There was consid­
erable difference in the procedure of the homes in the two States in
the matter of the time which the mothers spent in the homes after the
birth of their babies. In Minnesota practically all remained at least
three months because of the requirement by the State board of con­
trol that babies of illegitimate birth in maternity homes be breast fed
for at least that length of time; but in Pennsylvania wide variations
existed in the periods of aftercare of the different homes. About
one-fifth discharged the patients any time after they had left the hos­
pital, about one-third endeavored to have them remain during the
nursing period, and a little less than half definitely tried to keep
them for this period. The length of time patients remained in some
homes was influenced by the provision made to assist them after
they left, such as hospitalization, rest periods, or continued medical
A plan for further supervision increases the service that a home is
able to give by providing more workers instead of more house accom­
modations. This is well illustrated in the Minnesota policy, under
which the county child-welfare boards assume responsibility for the
mother when she leaves the home and help in her adjustment in her
home county. The difficulties mentioned in the section on prenatal
care (see p. 3), resulting from too wide a program of service, lessened
the adequacy of postnatal care also in certain homes— particularly
those in Pennsylvania.
Infant care.

Care of infants was rated as “ excellent” in 3 Minnesota and in 4
Pennsylvania homes, “ good” in 4 Minnesota and 16 Pennsylvania
homes, “ fair” in 3 Minnesota and 3 Pennsylvania homes, and “ poor”
in 1 Minnesota and 1 Pennsylvania home.
All the homes studied in both States reported that they used a
prophylactic in the eyes of newborn babies, but nevertheless in one
home in Pennsylvania a nursery was visited in which four of the
eight babies had acute ophthalmia.
Breast feeding was recognized in Minnesota as important in the
life and health of babies; and the mothers in the homes visited, with
very few exceptions, nursed their babies for at least three months.
In two homes only were departures from this general practice noted;
in these the weaning of babies began at six weeks.
In Pennsylvania all the superintendents stated that breast feeding
was encouraged, at least for a short time, the periods varying accord­
ing to physicians’ orders.
Tn all the Minnesota homes mothers were given some training in
caring for their babies; in a few this training was only slight. In 17
Pennsylvania homes the mothers were given careful training in inf ant
care; in the other 7 they received little or no instruction.
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General health provisions.

In all but one Minnesota home public-health requirements were
carefully observed; not all the Pennsylvania institutions showed the
same care. The physical equipment of the Minnesota homes gave
them certain advantages over those in Pennsylvania in providing for
the general health of their patients. Three-fourths of these had been
built particularly for maternity-home use. All but one were rated as
in “ excellent” condition. Only three pf the Pennsylvania homes
had been built for maternity-home use. Less than half were rated
as in “ excellent” condition and most of the others were rated as in
“ good ” condition. It is generally recognized that large dormitories
with many beds are not so satisfactory as rooms with only a few pa­
tients in each. An acute infection can be controlled far more readily
in a room of the latter type than in a dormitory . In Minnesota the
proportion of homes having small rooms with single beds was much
higher than in Pennsylvania— 7 of the 11 Minnesota homes studied
as compared with only 1 of the 24 Pennsylvania ones. Several homes
in each State had large dormitories which were crowded; in some of
the Pennsylvania homes the dormitory beds were so close together
that it was hard to pass between them.
In both States the policy of about half the homes was to refuse
admission to patients with any communicable disease and to make
arrangements for their care elsewhere. Several homes which accepted
patients with certain diseases refused to admit those with gonorrhea
or syphilis. In Minnesota all the homes which excluded applicants
with venereal disease gave sufficiently thorough examinations to make
reasonably sure that such cases did not escape detection; some homes
required in addition to their own examination a certificate of freedom
from disease signed by a member of the State board of health. In
Pennsylvania, on the other hand, the inadequate examination might
have permitted applicants with venereal disease to enter several homes
which had the policy of excluding them. In such cases not only
might other patients become infected but the patients with venereal
disease would fail to receive adequate treatment. More than half the
Pennsylvania homes kept patients in isolation until examination
if they could not be examined upon arrival. More than one-fourth
made no attempt to protect from infection patients already in the
home. In the Minnesota homes which admitted patients with ve­
nereal disease there was practically universal practice of public-health
measures, such as the provision of individual towels, separate toilets,
and separate dishes and drinking cups for such patients; but in Penn­
sylvania a few superintendents apparently did not recognize the im­
portance of these measures, and their homes did not practice them.
A policy which provides for adequate examination of all patients
at the time of admission and the treatment of those afflicted with
venereal disease and which assures all other patients security against
infection would seem to be the most reasonable and the most widely
useful policy for maternity homes to adopt.
A number of homes in Minnesota but only one in Pennsylvania
took precautions at the time of admission against other communi­
cable diseases as well as venereal— such as taking throat and nose
h cultures and vaccinating against smallpox. In all the homes in both
' States patients suspected of having an infectious disease, other than
Federal Reserve Bank of St. Louis



venereal, were isolated. Mental defectives were received in all the
homes except two in Pennsylvania and one in Minnesota, unless the
condition of these patients was such as to make them difficult to
manage. Mental defectives were not segregated either in the Penn­
sylvania or the Minnesota homes that admitted them.
Vital statistics.

The mortality of infants during the first three months of life for the
13 Pennsylvania homes for which the information was available was
about twice that which would have been expected both at the rate
prevailing in the State as a whole and at the rate prevailing in the
entire birth-registration area (32 as compared with 16.6 and 15.4,
respectively), whereas the mortality of the group studied in 10 Minne­
sota homes was approximately one and one-half times that which
would have been expected both at the rate prevailing in the State as
a whole and at the rate prevailing in the birth-registration area (28
as compared with 18.8 and 20.8, respectively).

According to the generally accepted standards of child care (see
p. 87), children born out of wedlock are entitled not only to the same
physical care as children of legitimate birth but also to special social
protection which will insure them whenever possible the continued
care of their mother, the support of their father, and home life approx­
imating that of the child in a normal home.
Keeping mothers and babies together.

The proportion of mothers who took their babies with them when
they left tne home was somewhat higher in the Minnesota homes
than in the Pennsylvania ones, and a study of placement of .babies in
free foster or boarding homes from the Minnesota homes and from
some Pennsylvania homes showed that in Pennsylvania the babies so
placed were separated from their mothers at a much earlier age than
in Minnesota. Only three babies under 3 months of age (and they
lacked only a few days of that age) were placed from the Minnesota
homes, but some 12 days to 3 weeks old were placed from the Pennsyl­
vania homes. The influence of the Minnesota three-months regula­
tion is again shown. In both States the records of a number of homes
failed to give adequate information as to what disposition of the
babies was made. In both States it was found that very little social
investigation was made prior to a patient's admission; only one home
in Minnesota and eight m Pennsylvania made any social investigation
through staff workers or other social agencies. Only two Minnesota
homes and six Pennsylvania homes made use of a social-service ex­
change. But in Minnesota care and other assistance for all known
cases of unmarried mothers were provided for through the system of
county child-welfare boards; whereas in Pennsylvania there was no
similar provision, and any assistance or supervision provided for un­
married mothers was dependent upon the interest and ability of the
individual homes or of private social agencies.
Establishing paternal responsibility.

A comparison of concrete results in establishing paternal responsi- (
bility in the two States is difficult because of their different methods '
Federal Reserve Bank of St. Louis



of procedure. In Minnesota the county child-welfare boards were
the recognized agencies through which illegitimacy proceedings were
taken, and the maternity-home superintendents usually left this mat­
ter to agents of these boards, although some superintendents continued
their interest and their efforts to induce fathers to meet their respon­
sibilities even after the mothers had left the home. In Pennsylvania
there was no agency corresponding to the county child-welfare board,
and the policies of the individual homes differed greatly, the majority
giving assistance to patients who wished to take action but not tak­
ing the initiative in the matter. In Minnesota most of the records
of action were filled in by the county child-welfare board, so that the
records in the homes did not give complete data on the cases, and in
most of the Pennsylvania homes the records were too meager to give
conclusive information. However, an intensive study of a limited
number of Minnesota cases and of the records of the six Pennsylva­
nia homes (one-fourth of the number studied) which had information
on this point indicated that paternal responsibility was fixed by the
courts or voluntarily assumed in a much larger proportion of cases
in the Minnesota homes than in those in Pennsylvania. In both States
the large majority of superintendents and governing boards expressed
themselves as not favorable to forced marriages. In only three
homes in the two States was there noted an inclination to encourage
or insist upon marriage for the sake of the child’s name. All others
approved of marriage only if it was desired by both the girl and the
Placement in foster homes and adoption.

The provision of foster homes and the process of adoption were
far more carefully planned and supervised in Minnesota than in
Pennsylvania. In Minnesota every foster home had to be approved
by the State board of control, and each baby placed was supervised
after placement by some responsible child-caring agency. No child
could be adopted until after a six-months trial period, and adoption
proceedings were subject to regulation by the State board of control.
Only three Minnesota homes did their own child placing. In Penn­
sylvania the placement and adoption proceedings and policies varied
with the different homes. Several homes referred to child-placing
agencies mothers who wished to place their babies; others placed the
children through newspaper advertising or through persons interested
in the homes.
About one-third of the Pennsylvania homes delegated the super­
vision of placed-out babies to children’s agencies (not all of which
did standardized work). A few did a slight amount of follow-up
work; a few placed babies only on condition of their immediate
adoption, thus eliminating the necessity for supervision. Adoption
proceedings in Pennsylvania did not sufficiently guard the interests
of the child or of the mother, and only a few homes followed the
example of the best child-placing agencies in requiring a period of
residence before adoption. No home of those visited in Minnseota
accepted babies on surrender from their mothers, whereas in four
Pennsylvania homes the “ surrender fees” were one of the sources of
. income.
96892°— 26t---- 2
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The medical and physical care given mothers and babies in mater­
nity homes and the social provisions made for them after leaving the
homes appeared to be much better in Minnesota than in Pennsyl­
vania, although the homes in Minnesota failed to measure up in
certain particulars to the accepted standards of care. The system
of State licensing and supervision of maternity homes and the rela­
tion of the State university’s medical school to them tend toward
standardization of medical practices in the Minnesota institutions.
Through the procedure and policies of the State board of control a
baby of illegitimate birth is practically assured of three months’
nursing by his mother. This board endeavors also to keep such a
baby permanently with his mother, to supervise and help her after
she leaves the maternity home, and to obtain for the baby, if possible,
his father’s interest and support. These efforts by the board are
contributing to improved physical care for both mothers and babies
and a better social policy in dealing with them.
Federal Reserve Bank of St. Louis


The law of Minnesota defines as a maternity hospital any place
operated by an individual, association, or corporation where within
six months more than one woman not related by blood or marriage
to the person operating such place is received for care and treatment
during pregnancy or during delivery or within 10 days after delivery.
The code provides for licensing and inspection of all maternity hos­
pitals by the State board of control. Licenses are issued annually,
stating the name of the person receiving the license and designating
the premises in which the business may be carried on and the number
of patients that may be cared for at any one time. The law also
provides that no person shall offer to dispose of any1child or adver­
tise that he will give children for adoption as an inducement to a
woman to go to any maternity hospital during confinement. The
statute also provides that a record shall be kept by the licensee of
each maternity hospital, to contain the name and residence of every
patient and of the physician or midwife in attendance at the birth
or at an illness of any child at such hospital. It requires a written
report of all such births to be transmitted to the State board of
control and of all deaths therein to the local board of health. The
contents of these records must not be disclosed except in proper legal
proceedings or for the information of the State board of control or
the State board of health or the local board of health. Provision is
made for revocation of the license by the State board of control if
the statute governing maternity homes is violated, or if the hospital
fails to have due regard to sanitation and hygiene or to the health
and well-being of the patients or the infants born to them, or if any
law of the State is violated in a manner disclosing moral turpitude
or unfitness to maintain such a place. Provision is also made for
appeal from the decisions of the board of control.1
The organization of the State board of control provides for a chil­
dren's bureau with a director and three supervisors. The super­
visor of institutions is charged with the supervision of maternity
hospitals, the filing of complaints with the board of control in cases
in which the provisions of the maternity hospital law are not com­
plied with and the offenders are not amenable to persuasion, and the
preparation of such cases for hearing. A certain uniformity in the
matter of minimum standards of care is provided in Minnesota by
the system of licensing and supervision.
Nearly all the homes have either as attending physicians or as
consultants physicians from the medical school of the State univer­
sity, and the State board of health laboratories also are at the serv­
ice of the homes.
l Laws of 1919, extra session, ch. 50.
Federal Reserve Bank of St. Louis



The 11 maternity homes included in the study were located in
four counties. Two of the homes were founded about 50 years ago,
one to provide care for needy prospective mothers, married or unmar­
ried, the other to bring about moral rehabilitation. A third home
was established about 40 years ago, with the purely humanitarian
aim of caring for expectant mothers. Of the other eight, four were
founded between 1900 and 1910 and four since 1913. The motives
actuating the founders of six of these eight were religious or chari­
table in that protection for the indigent mother and her child was pro­
vided; one was founded for purely commercial reasons; and one is
part of a State institution.
The majority of these homes originally admitted all types of women
needing maternity care, but since the opening of the State Home
School for Girls (which cares for delinquents) many homes have
adopted the policy of admitting only young unmarried mothers, con­
sidering them the most hopeful type. In some homes where child
caring was no part of the earlier work it had gradually been added,
and nurseries had been fitted up for the care of younger children.
These homes preferred to limit their work to unmarried mothers.
The licensing of maternity homes by the State board of control
began in 1918, and during that year 10 of the homes studied obtained
their licenses. One was founded in 1922 and licensed in 1923.
The Minnesota homes when visited had the following combinations
of service: Two gave maternity-home service only, caring for the
mother before delivery and for the mother and baby after they left
the hospital (these homes gave no obstetrical service and did not
have a separate child-caring department); three gave maternity-home
service and also obstetrical care in a hospital within the home but
had no child-caring department, except that one cared temporarily
for not more than five children; one gave maternity-home service and
had also a separate department of child care for children up to 2
years of age but gave no obstetrical service; four gave maternity-home
and obstetrical service and also had a department of child care (two
of the four were licensed to place children in free foster homes); and
one provided care for delinquent girls as well as for maternity cases,
using an outside hospital for the obstetrical service. Only one home
accepted children other than those of the mothers cared for, and this
home functioned as a child-caring home for a social agency to which
commitments were made and through which all arrangements were
made for boarding children.
Two homes had discontinued child care and child placing in recent
years and had delegated these services to standardized agencies
equipped for the work. One home had a similar change under con­
In every instance the foster homes were investigated by the State
board of control through the agency of the county child-welfare
boards. If a child was placed by an agency in a home which did
not meet such standards as the board approved the child was removed.
Since the Minnesota law providing for licensing and inspecting
maternity hospitals went into effect 12 hospitals have been closed by
the State board of control. Four of these hospitals had been con­
ducted without a license; four were denied a license on application;
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three which had been conducted as licensed hospitals were denied a
renewal of the license; one withdrew its application immediately
after a visit of investigation by the institution inspector of the State
children’s bureau.
Three maternity hospitals which had been closed in Minnesota
were found to be operating in other States. One of these had been
licensed for three years in succession, but the State inspector was
not satisfied with the condition and management of the place and
finally recommended to the State board of control that the license be
revoked. The owner of the hospital did not appear on the date set
for hearing. On investigation it was learned that she had moved
into another State, where, despite the efforts of the State health offi­
cer, she was granted a license to operate a maternity hospital.

The homes could accommodate from 4 to 63 women and from 5 to
71 children. The total number of women all 11 places could accom­
modate was 379; the total number of children, 420. When visited
the homes had a total population of 249 women and 295 children.
Temporary conditions m 4 homes were to a considerable extent
responsible for the fact that the total number of persons being cared
for was so far below the number that could be accommodated. In 2
homes the number of persons cared for was small because repairs
were in progress. Two other homes were not functioning normally
because of reorganization plans incident to change of management.

All except one of the Minnesota homes visited were in urban or
suburban districts, the one exception being part of a State institution
located on a farm. The other 10 were in entirely detached buildings
with grounds sufficient to provide some outdoor life for the mothers
and babies, these grounds varying from a small suburban lot to a
place of 10 acres. The 8 suburban homes provided space for out­
door exercise or recreation, and the 2 city homes had yards around
them. Ten homes had equipped the grounds for some form of recrea­
tion, and many had vegetable gardens where patients were permitted
to work if they were able. A number of places had attractive, wellkept lawns, shade trees, flowers, and shrubbery. One home was
opposite a large city park. All forms of farm work practicable for
pregnant women and mothers recently confined were arranged for in
one home, which was situated on a large farm. At another home,
where the grounds included 10 acres, efforts had been made to beau­
tify the place. The house had occupied the place only a year, but
already it had a lawn, flower beds, and a vegetable garden from
which the table was supplied.

The buildings themselves, with one exception, were in excellent
Jcondition. The majority were of the congregate type. Two were
* Women other than maternity patients are not considered in this section.
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on the group or cottage plan, these not having been built for the pur­
pose for which they were used. One of these was soon to be replaced
by a building then in process of construction, and another, originally
built for use as an orthopedic hospital, had been excellently adapted
for use as a maternity home. Thus there was only one institution
not well built for its use; this one had no fire protection. The build­
ings were constructed of frame, brick, or stone, and they varied from
two to four stories in height. All were electrically lighted and furnace
heated, and seven had supplementary heating arrangements such as
stoves, fireplaces, and gas burners.
Of the three homes using the cottage plan, one, the State institu­
tion, had five cottages for the maternity group; one had a small cot­
tage adjacent to the main building where girls with venereal disease
lived until medical treatment rendered the disease noninfectious; and
the third, a hospital with maternity-home provision, had separate
buildings for certain -children and a special wing for mothers who
remained after discharge from the hospital proper.
Ten of the kitchens were on the first floor; one home had a basement
kitchen, which was on the ground level in front. All except one
were well lighted and ventilated. All were well screened. The
diningrooms, except one, were on the first floor, and all were well
lighted, ventilated, and screened. Two dining rooms were espe­
cially attractive, and only two were not pleasing.
All serving of meals was done by patients. In three homes the
members of the staff were served in separate dining rooms and had
food different from that served the patients.
As a rule the sleeping quarters were very good. Three homes had
rather large dormitories with crowded floor space, containing 7,19, and
20 beds, respectively. In these dormitories the cubic feet of air space
seemed inadequate even though, as was the custom in all these homes,
the windows were open at night. Another home had rather small
rooms, each containing three single beds. Seven homes had all single
rooms with single beds.
Toilet conveniences were provided in all homes, but it was noted
that in two homes which received patients with venereal infections
no separate toilet arrangements were provided for such patients.
Since the visit of the Children’s Bureau agents one of these homes
has corrected this defect.
Bathing facilities, either tubs or showers, and individual towels
were provided, and the patients were expected to bathe at least
twice a week. Hot and cold water were always on tap. Ten homes
were supplied with water from the city system and one from a
gravity tank at a lake. One had a septic tank for sewage; the other
10 used the city systems. Eight ; had their garbage collected by the
city and three incinerated it. The general impression, was that in
eight institutions the sanitation was “ excellent,” in two “ good,”
and in one “ poor. ”

Four of the 11 homes were controlled by local governing boards,
the membership of which was self-perpetuating. Three had boards
elected by groups interested in the homes. Two had no boards: one
Federal Reserve Bank of St. Louis


of these was controlled by a national organization. One was part of
the State reformatory for girls, which was managed by the State
board of control. No data were obtained for one board which
seemed to be merely an auxiliary to a charity organization responsi­
ble for the home. In all homes having boards the superintendent
met with the board.
Two of the seven boards were composed of men only; three, of
women only; and the other two had both men and women as
members. Four were restricted to their respective religious denomi­
nations— of these, one was composed wholly of clergymen.

Much of the good work accomplished by these homes may be
attributed to the superintendents. Four of the superintendents
were college graduates— one of them a physician. Three were highschool graduates; one was. a graduate nurse; and three had only
experience and common-school education to guide them, although
they could be classed as practical nurses. Their years of work in
institutions varied from less than one year to 17 years. Two (mem­
bers of religious orders) received no salary, and the salaries of the
others ranged from $300 to $2,500 a year, with maintenance.
In three homes the superintendent's assistants were chosen by the
board of managers; in eight, by the superintendent, subject to the
board’s approval. There were 85 assistants on the staffs of the differ­
ent homes, many of whom had had more than an elementary-school
education. Eleven in eight homes were graduate nurses, 33 in four
homes were undergraduate nurses, and 5 in four homes were called
practical nurses. One home employed a social worker.
The number of assistants employed seemed adequate for efficient
management and for supervision of the patients except in two homes.
In one of these the only assistants were two women, former patients,
both of them unmarried mothers who were boarding their babies.
Although these women appeared to be capable of executing the duties
assigned to them, the practice of leaving one of them in charge of the
home during the absences of the superintendent seemed unwise,
especially as these absences were frequent and sometimes prolonged.
In the other home, a commercial one, the proprietor had no regular
assistant but engaged a nurse for a brief period at the time of each
delivery. If the proprietor was absent the establishment was left in
in the care of certain unmarried mothers whom she employed as a
means of assisting them.
In homes where the organization is well planned assistants have
definite responsibility for direction of certain parts of the work—both
in the management and care of the buildings and in the training of
the mothers. With the exception of nurses, physicians, and dietitians,
and of trained social workers who worked chiefly outside the institu­
tions— all of whom were part of the staff in a few homes— the prepa­
ration of the assistants in the homes studied was practically limited
to the experience acquired in working in institutions.
The absence^ of technical training and of experience in modern
methods of social service was, however, less important in the Minnei sota maternity homes than in the Pennsylvania ones, because under
the Minnesota system all unmarried mothers were reported to the
State board of control when admitted to the homes and the county
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child-welfare boards assumed responsibility for plans for the mothers
and babies and provided necessary supervision after discharge from
the homes.
The salaries of the assistants varied from $120 to $1,500 a year,
with maintenance.
V ,
Additional employees such as gardeners and janitors were not listed
as members of the staffs. Every home except one had such help for
work too heavy for the patients. In all the homes some of the house­
work was done by the patients, according to their strength.

One home (part of the State reformatory for girls), which received
minors committed to the reformatory if they were in need of maternityhome care, was wholly supported by the State. No private institu­
tions were given State aid. Boards of county commissioners might
make arrangements for hospital care for persons residing in their
counties. Two of the homes received pay from county boards for
maternity cases on a pro rata basis. One home received a fee of $50
a patient from the city for the care of maternity patients who had a
legal residence in the city and could not pay for their care. One home
received children from an agency which directed its management,
work, and policies. One county paid to this agency as well as other
agencies a pro rata sum to care for committed children. All the other
homes derived their revenue through public appeals for money, unso­
licited donations, fees paid by the patients and their families, or endow­
ment funds. Six accepted money for boarding and caring for children.
Eight of the 10 homes supported privately received their funds
through community chests in their respective cities. The two excep­
tions were: One home, founded in 1922, which at the time visited,
collected its fund independently but which had been admitted to the
community chest for 1924, and one which was a commercial enter­
prise, depending on patients’ fees.
Excluding one institution, a commercial enterprise, the annual ex­
penditures by these institutions varied from $69,000 to a little more
than $4,000. The home connected with the State institution did not
keep a separate expense account.

All the homes except the State institution had a flexible system of
rates which permitted patients to meet all or part of their expenses
if they were financially able to do so. One home had no fixed rate
or fee but accepted compensation commensurate with the patient’s
means, if she could pay any amount at all. Six homes charged fees
varying from $50 to $100. When these fees were collected amounts of
$15 to $35 were sent by the institutions to outside hospitals giving
obstetrical care to the home’s patients. One home charged $47 for
confinement care, plus $12 for use of the delivery room, besides 75
cents a day for the patient’s stay in the house before and after the
period of care in the nospital ward. One home charged $25 a month
for the mother and $5 a month for the baby. Another home charged
$30 for confinement care and $10 a week for board before and arte,
the confinement period; and the physician’s fee was an additional
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These amounts were for the large majority of the unmarried mothers
and for married ones whose cases presented such social problems as
to warrant their inclusion in the service of the maternity homes.
The two hospitals that included maternity-home care in their pro­
grams charged for rooms a maximum of $5.50 per day and additional
amounts for certain services and for physicians’ fees. These serv­
ices were utilized almost entirely by married women. One of the
maternity homes with hospital equipment in the home had a private
room for which $2 a day was charged and which was used sometimes
by married women in the neighborhood* '’

Money was available from the work of the patients in two homes.
In one home the work was limited to art needlework and the entire
proceeds went to the home. Sales were held twice each year. In the
other home there were several courses of training from which revenue
might be realized. There was no hard-and-fast rule about the use of
proceeds, but the girls usually used part of their earnings for some
purpose which furthered the pleasurable interests of their compan­
ions. The summer before the investigation the girls in this home had
24 individual gardens with the privilege of raising what they wished,
and they used the products of their work as they pleased.

The complete absence of the system of accepting babies of illegit­
imate birth on surrender upon payment of a specified fee by their
mothers is noteworthy. To what extent this was due to the attitude
of the people interested in the maternity homes and to what extent
it was due to legislation by the State could not be determined in this
inquiry. The history of the institutions studied—except the com­
mercial institutions—indicated that this system has not at any time
been so extensive in Minnesota as in some other States.

Homes which accepted children for care received a certain amount
of income through board paid for them by relatives or other interested
In some of these institutions the amount of income received for
the care of mothers was not separate from that received for boarding
children, so that it was impossible to measure accurately the extent
to which this latter resource met the actual expense of care for the
mothers. From conferences with superintendents and from a study
of records, however, it would seem that one-half to two-thirds of the
entire number of patients paid all or part of the fees for their care.
In one home it was estimated that about one-fourth of the patients
paid fees.
All b u t one of the homes prepared annual reports, but only three
printed them.
. .

1 The State board of control had furnished a form for registering the
^patients; this was used in all the homes except the maternity depart­
ment of the State reformatory for girls, which had its own special
Federal Reserve Bank of St. Louis



system of record keeping. On this form was provided space for the
name, date of birth, address, religion, nationality, and occupation of
the patient and of the putative father of the child, the date of birth
of the child, the date and cause of death of mother or child, ,the dis­
position of the child, and additional facts which would serve for pur­
poses of identification. Space was also provided for recording any
particularly significant facts in the history of the case. The record
of the birth was to be signed by the physician and the nurse attending
the case.
In addition to the forms provided, four homes used individual his­
tory records, and four others used special record books. For the
most part, medical records were well kept and contained all essential
data, but there was a lack of the complete health data that might
have been recorded under this system. One institution gave an excel­
lent report to the State children’s bureau of all health work done for
the patients in 1923, including a record of treatments for venereal
disease, major and minor operations, dental treatments, the number
of persons fitted with glasses or braces, and psychometric tests. Sev­
eral of the homes had no history of the medical care afforded each
patient. All the institutions weighed and measured the babies and
recorded the results.
No provision was made on the record for data on morbidity after the



Patients were received from social agencies, private and public,
and upon their personal application or that of an individual in their
behalf. Two homes accepted girls through court commitment— the
State institution, and one private home which occasionally accepted
a girl from the juvenile court. The commercial home advertised in
a local daily newspaper that it gave maternity and child care.
Preliminary social investigation by the home was a requirement be­
fore entrance in one home only. A study of the girls after admission
through registration of cases with social-service exchanges was made
in two homes. Such exchanges were available to five other homes, but
they were not used. It was the policy throughout the State for the
county child-welfare board to investigate each patient’s history after
she entered the home. Usually girls ‘ entering the State institution
through court commitment were investigated by the court. The super­
intendents of seven institutions showed no reluctance to transfer cases
to social agencies having an interest in them.

Five of the 11 homes visited made no distinction as to the race of
the patients admitted; three accepted only white patients; two, al­
though they did not refuse women of other races, limited as far as
possible their patients to white women; one accepted patients of
any race but the negro.

In no institution were religious lines drawn, although in one the
management preferred to have only patients of the religious denom-
Federal Reserve Bank of St. Louis



illation under which the place was operated. The policy here was
to refer the application of any person belonging to another denomi­
nation to a home conducted under the auspices of that denomination.
Such patients were accepted in emergency but were transferred when
possible to other homes.


In the home that was part of the State reformatory the maximum
age for commitment was 18. None of the other homes had age limits
or restrictions, although several gave preference to young women.

Although some of the homes tried to restrict their service to per­
sons living in the State, more than half made no restrictions as to
residence. The ruling of three homes was that persons not living in
the State would be admitted only as emergency Cases, and one of
these homes accepted no out-of-State patients unless they were al­
ready in labor. Another home did not accept as free cases patients
living out of the State, but charged them $100.
Marital status.

In- regard to marital status, virtually no lines were drawn except
in one institution. Here the original purpose was moral reclama­
tion, and the managing board still felt that unmarried women needed
their ministrations most. In 5 of the other 10 places there was no
question as to marital status; in 5 the policy was to accept married
women for special reasons only.
Delinquency cases.

Only two maternity homes in Minnesota accepted delinquent girls
who were not maternity patients. One of these was the State re­
formatory home; the other was a private home opened in recent years
for the care of delinquent girls, which received maternity cases to
meet a pressing need in the community.
Pregnancies other than first.

The question whether or not unmarried women in pregnancies
other than the first should be admitted for care had been given
serious consideration by those in charge of many of the homes.
For years the policy in a majority of these institutions was to
limit assistance to unmarried women in the first pregnancy, although
some institutions accepted patients in later pregnancies if they had
not been former patients oi the institution. Some superintendents
and board members have felt that they had exerted every effort
to assist a mother during her first residence at the institution. If
they had failed, or if she had not responded, further effort on their
part, they believed, would avail nothing. Others stated that having
“ repeaters” in the home had a decidedly bad influence on the other
patients, particularly when it was known that the repeaters had been
in the same institution before. However, a tendency was noted not
to have any fixed policy, but to consider each case on its merits.
Three homes received repeaters without question; three received
them unless previously cared for in the same home; two would not
receive them if earlier pregnancies were known but would keep them
1if after admission they were found to have had earlier pregnancies;
two homes made certain exceptions to their policy of not accepting
such cases. The one commercial home which received without
Federal Reserve Bank of St. Louis



charge a few patients in exchange for housework refused to admit
repeaters on this basis, accepting them only as pay patients.
Mental defectives.

Mental defectives were accepted by all but one of the homes,
according to statements of the superintendents, some of whom qualified
their statement by adding “ if they are not too great a. problem.”
They were not segregated.
Communicable disease.

Three homes admitted and isolated patients having any communi­
cable disease, and two others admitted patients having gonorrhea
and had provision for treating them, but consistently refused to admit
persons having any other infectious disease. All the six homes which
refused to admit persons having a communicable disease gave the
patients a physical examination upon entrance or detained them in
isolation until examination was made, Thus it was reasonably certain
that no cases of such disease were admitted. If an infection was found
later arrangements were made for the patients to be cared for else­
where. Four homes required of each patient who entered not only a
physical examination but also a certificate of freedom from communi­
cable disease. The superintendents of three of these homes said that
they required these certificates to be signed by one of the members
of the staff of the State board of health. This procedure was due to
the desire to exclude all cases of venereal disease, despite the fact that
at least two of these homes had excellent provisions for segregation
and treatment of infectious diseases. As a result of this policy these
facilities were not used. The superintendent of another home which
had every necessary provision for isolating contagious disease said she
did not admit patients with either gonorrhea or syphilis; but it was
found that such patients were actually admitted fairly often and were
well treated, every precaution being taken to protect the other persons
in the home from contagion. In most of the homes a marked degree
of flexibility was noted in the rules in regard to admitting patients
having communicable disease.

Menus for a week were obtained from all the homes. The number
of meals served during the day varied from three scant ones in a home
where the diet seemed insufficient to maintain women and girls in
health and where the milk was watered considerably before serving
to five a day in some homes. One superintendent stated that the
patients could go to the kitchen for food whenever they were hungry.
Another was serving water to the nursing mothers because she had
heard that it was “ just as good as milk.” Study of the menus sub­
mitted by the 11 homes showed that their diets belonged in the fol­
lowing grades (see p. 5):
A d e q u a t e _________
Probably adequate
Possibly inadequate .
Probably inadequate








motners on account of the greater amount of milk given the nursing
Federal Reserve Bank of St. Louis



mothers. The addition of the milk raised the content of the diet in
all three of the factors considered in rating them—“ adequate protein,”
mineral substances, and vitamins. In most of these homes two glasses
of whole milk daily should have been added to the diet of every patient.

The majority of these homes were influenced by the medical prin­
ciples taught by the medical school of the University of Minnesota.
In only one home prenatal care was rated as “ poor,” in two it was
“ fair,” and in the remaining eight “ good” or “ excellent.” In the
home in which prenatal care was rated as “ poor” the medical care
was painstaking; but the physician’s advice was not always carried
out by the superintendent* who lacked the training necessary for
thorough understanding of the value of prenatal care. One maternal
death was directly traceable to the lack of an obstetrical examina­
tion. After the death a physician found that the patient had a
badly deformed pelvis. No attention had been given her previous
to the onset of labor, a very protracted and exhausting labor with­
out the attendance of a physician.;
Generally the attending physicians showed keen interest in giving
information as to the details of the patient’s care, and this interest
was further indicated by the almost universal excellence of the med­
ical records kept. A complete physical examination, a Wassermann
test of the blood of every patient either before this examination or
shortly after it, and a vaginal' smear were the customary procedure.
This indicated the effort made to safeguard not only the health of
the expectant mother but also that of the coming baby and to pre­
vent the spread of venereal disease. This practice probably would
have been found in every home had the study been made a little
later, for there was only one exception, a home with a new superin­
tendent who was making valiant efforts to interest local physicians
in her problem. The former superintendent had been uncooperative
and even hostile toward the medical profession.
Two homes required that throat cultures be taken for the detec­
tion of diphtheria bacilli; and because of a previous experience with
an epidemic of smallpox, three institutions required vaccination also
shortly after entrance. One home maintained a dental clinic, and
two others engaged outside dentists for any work necessary. One
employed a dental assistant for regular oral prophylaxis. Mental
examinations of patients were made in only one home.
On the whole, the prenatal care afforded expectant mothers was
good. It was not stereotyped but was suited to each individual.
As an instance of this may he cited the watching of the increase in
weight of the patients during their last six weeks of pregnancy. In
one home a physician did this weighing every other day, and finally
daily, hoping to prevent too great an increase in the size of the
Usually special rest periods were provided for nursing mothers
and others who needed them. In two places definite rest periods
for all patients were provided as part of the routine. All but one
ome made use of a laboratory, eithe“r its own or that of a hospital
or clinic. Seven used the State university laboratory for part or
the whole of their work.
Federal Reserve Bank of St. Louis



The equipment for delivery and the technique, so far as it was
possible to judge, was “ excellent” in four places, “ good ” in five,
and “ fair” in two. One of the last two was in charge of a woman
who had no professional training but who occasionally delivered the
patients herself, and in the other one of the two there was marked
lack of facilities for the sterilization of supplies. The average time
of bedside care was about two weeks. Patients were sent b y four
homes to cooperating hospitals for delivery; in seven they were cared
for in the home. All had the services of graduate nurses, though
two employed these nurses at irregular intervals as they were needed,
All homes provided for examinations by physicians at the end of the
puerperium, though two did not keep records of them.

Special attention has been given the subject of breast feeding in
this State, and the proper technique was employed in the maternity
homes. The statement has been made that with very few exceptions
all mothers can nurse their babies. Nurses whose specialty is instruc­
tion in the technique of breast feeding are available to every mother
in Minneapolis.
• : /'
So generally is breast feeding recognized that a section of a joint
resolution of the State board of health and the State.board of control,
adopted in 1918, governing the policy of illegitimacy proceedings,
provides; “ Because of the very large death rate among children born
out of wedlock, the State board of control has ruled that such children
must be nursed by their mothers for a period of at least three months
and as long thereafter as possible.” (See p. 30.) However, in two
homes weaning was begun at 6 weeks and nursing gradually decreased,
until at 3 months the child was entirely bottle fed. This practice
facilitated the separation of ^mother and baby. With these exceptions
breast feeding was found to be almost universal in the homes, the
rule being carefully observed.
A prophylactic was used in the eyes of all the newborn infants.
There were no nurseries in four homes; in these homes the babies
were kept with their mothers. Other homes had not only nurseries
but also solaria, where the babies were placed during the day. In
all the homes careful, regular weighing of the babies was done, to
note their growth. In two homes for the first two weeks of life all
infants were weighed before and after nursing to determine how much
breast milk they obtained each time.
In an effort to prevent some neonatal deaths the coagulation time
o f the blood of all newborn infants was recorded in two homes, and if
necessary treatment was instituted.
. _
Some training in the care of their infants was given to all the
mothers, but this seemed rather desultory in some homes. Each
institution reported that all births were registered. ;
The care of the infants was rated as ‘¿excellent” an three homes,
“ good” in four, “ fair” in three, and “ poor” in one.
Federal Reserve Bank of St. Louis




All the homes except one carefully observed all public-health re­
quirements. Their attitude of cooperation was doubtless due to the
relation of the State board of health to the child-conservation

During 1922 in the homes studied or in the hospitals cooperating
with them 1,151 live births and 29 stillbirths occurred and 2 maternai
deaths. Among these infants 44 deaths were recorded, i t was not
possible to calculate a rate from these figures in the absence of infor­
mation as to how long the infants stayed in the homes. For 10
homes it was possible to make a comparison between the number of
infants exposed to the risk of dying in the first three months and the
number that died. Comparing the mortality in the homes as calcu­
lated by this means with the mortality in the State and in the birthregistration area it was found that’ the number of deaths in the
homes was; 28 as contrasted with 18.8 that would have been
expected at the rate prevailing in the State as a whole, and with 20.8
that would have been expected at the rate prevailing in the entire
birth-registration area.

The daily routine in most of the homes centered around the work
of the institution, and housekeeping tasks assigned to the patients by
the members of the staff occupied the larger part of the day. Patients
rose between 6 and 7 o’clock in the morning; and the meal hours
were about 7, noon, and half past 5.
Care of the babies was one of the first duties in the order of the
day. Most mothers received training in this and gave most of the
care to their own babies! Generally part of the afternoon was devoted
to sewing. Five homes had arranged classes in hygiene and other
subjects, and these were held in the afternoons or evenings. Three
homes had a well-planned day, and in two of these the daily schedule
was always displayed.
The gradual disappearance of the formidable posted regulations
formerly in general use is encouraging. Not a single instance of these
was found in the 11 homes studied in Minnesota. In several insti­
tutions there were certain specific regulations such as those on
sanitation and hygiene which were found posted in certain parts of
the building, but these were more in the nature of a guide and a help
to the girls than of “ rules. ”
Six oi the homes had a general visiting day; four had flexible rulings
which practically permitted authorized visitors at any time except
during hours which were utterly inconvenient for the home; and one
allowed each girl to select one day a month for her visitors.
The private maternity homes in Minnesota were found in a num­
ber of instances to be permitting their patients all the freedom
which might be granted with due consideration for the well-being of
•he institution and the patients. The management in five of the
Federal Reserve Bank of St. Louis



homes still felt it necessary to provide chaperonage by staff members
for patients at all times. Four homes have had very little restriction;
older patients who have proved trustworthy, as well as volunteer
social workers, were utilized as chaperons. Patients who were believed
reliable were allowed frequently to go alone to their respective churches
for morning services and occasionally to go out on necessary busi­
ness errands. In general these homes planned that when the girls
went out for shopping or recreation a group of them, or at least two,
should go together. In one home the degree of freedom permitted
was so extreme as to be unwise. This was a small place where no
restrictions were imposed except that certain patients who gave
their services in exchange for care and shelter were obliged to com­
plete their work before going out; they were allowed to remain out
until 11 p. m. A local social worker related instances of associations
and conduct on the part of unmarried mothers from this place which
indicated at least the grave danger of abuse to which such a policy is
The almost universal policy of such institutions has been to censor
all incoming and outgoing mail. In this detail, as in other practices,
a gradually crystallizing sentiment was noted in favor of greater
freedom for the individual. In several of the Minnesota homes mail
was not censored, but certain devices were employed to provide some
supervision. In one home the girls were called to the office and
given their mail individually. Almost invariably the girls opened
these letters there, and often they discussed the contents of them
with the social worker.

Classes of various sorts—six-months courses for the training of
nursery maids, instruction in infant care, sewing, cooking, dressy
making, etc.— were held in several homes. Every home provided
some experience in household work or other work under super­
vision for most of the mothers. Two homes had domestic-science
courses. In some homes cooking was not taught. In all the homes
patients were taught how to care for their babies, and they cared for
them during all or part of the time. One home provided excellent
courses of training b y utilizing the resources of public departments
and other agencies. Teachers were supplied by the extension division
of the State university. As a result of a Course in poultry raising
the patients in this home had a plentiful supply of eggs and fowl.
One girl raised 17 chickens. She took these with her when she
returned to her parents’ farm and was able to make a start in the
poultry business. In one home teachers from the State department
of education gave various courses. This home had also a training
class for nursemaids. Three unmarried mothers, cared for in the
home, who had been accepted in this training class were seen at
dinner with the staff. Their acceptance as staff members was very
significant. At one place instruction to a class was given by the Rea
Cross in home hygiene and care of the sick, and a small group of girls
attended an outside business course in preparation for future work.
One unmarried mother, who had been trained as a practical nun
was earning a good salary.
Federal Reserve Bank of St. Louis




The recreation in some of the homes was carefully planned and
supervised, and in others it was not. Organizations such as the Big
Sisters planned entertainment at frequent intervals for patients in
two of the homes. Nearly all the homes had phonographs and pianos.
Musicals, parties, and various entertainments were provided by out­
siders and developed among the patients. The usual time for recrea­
tion was the evening. In homes which gave more than the average
attention to recreation a portion of certain afternoons was also left
free from duties. In one home staff members rotated in taking gen­
eral responsibility for organizing and supervising the recreation.
Four homes had excellent programs, well organized, showing utiliza­
tion of various resources and the cooperation of the Big Sisters and
other volunteers. Picnics, various trips of interest, drives, walks,
parties in the homes of friends of the institution, motion pictures, plays,
and concerts were all part of these programs. Usually a small group
of girls was accompanied by a volunteer worker. In four homes there
was no planned program except group recreation inside of the building.
In one small home the patients were left to their own devices; this
is the place previously referred to which permitted the patient the
entire evening free.
Several homes were equipped with good books, but the use of books
trom a city library was rare.

Tjbie attitude of the State Board of Control of Minnesota, as well
asJiat of the groups who were responsible for the State’s child-wel­
fare legislation ana the resulting system of child care is that the
peculiar danger to which children born out of wedlock have been
subject in most places, the high death rate among them, and the un­
fortunate results of efforts to maintain secrecy about their birth all
constitute reasons for special procedure, special plans for their pro­
tection, and continued supervision.

County child-welfare boards are provided for in the law which de­
fines the functions of the State board of control in regard to the
supervision and care of children. These boards touch closely the
work of maternity homes and community problems related to it.
They are in contact with all known cases of illegitimacy in their
county, either through a member of the board designated by the board
as secretary or through their executive secretary; they supply service
such as relief or temporary case work; they are recognized by the
county attorneys and the courts as the agency through which pro­
ceedings to establish paternity are instituted, and orders for support
usually direct that the money be paid through their office. They
help in the adjustment of the unmarried mother after she leaves the
maternity home and any plan made for her must have their ap­
proval. Preparation for meeting her needs is usually made before
96892°—26t----- 3
Federal Reserve Bank of St. Louis



she leaves the maternity home. Soon after her arrival in the county
where she is to live a representative of the board of the county calls
to see her and her baby. The mother has been prepared for the call,
and understands that through the board’s representative she may be
helped to solve her problems. If the mother remains in the county
where the maternity home in which she received care is located, she
will have already met the representative of the board, because all
patients while in the homes meet the representatives of the boards
of their respective counties. These representatives make investiga­
tions, formulate plans, and give to the mothers the assistance which
prepares the way for them and their children either directly or through
the superintendent or another worker of the home. A report to the
State board of control of all children born out of wedlock is required
and this is an important safeguard against the disappearance of the
children. Provision is made for a permanent file of all cases handled
by the various county child-welfare boards. Duplicates are made
of all case histories in the offices of the county boards. Originals
remain in the county offices; the copies arefowarded to the children’s
bureau of the State board of control and there kept on file. The
State children’s bureau notifies the county child-welfare board of the
removal of a child of illegitimate birth from the county where it was
originally cared for, advising also the board in the county into which
the child is taken. When a child leaves a county the record in the
office of that county board is closed. The State children’s bureau
in reporting the case in the second county passes on to this board
the information with reference to the child and the mother.
Provision for the establishment of these, boards was made in 191rThe directory published by the State board of control in 1923 shf^s
that 67 of the 81 counties of the State had organized boards and tla^
organization or reorganization was pending in 4 other counties. S$vv
enteen of the 67 county boards had executive secretaries. Some of
them gave full-time work and others part time, the part-time workers
being engaged by the Red Cross. In all the counties of the State
there are nurses (and in some, probation officers) whose services are
utilized by the county child-welfare boards.

A Minnesota statute makes it the duty of the State board of control
to see that steps are taken to establish the paternity of children of.
illegitimate birth and that there is secured for such children the
nearest approximation to the care, support, and education that they
would be entitled to if born of lawful marriage.3 Administrative
procedure under the law includes private hearings and affords privacy
to the whole matter, through the functioning of the county child-wel­
fare boards. A warrant is given the representative of the board, who
interviews the putative father and gives him an opportunity to come
into court without arrest. By statutory provisión4 transfer of guard­
ianship of a child under 14 years of age is a matter of court record,
and it may not be informally executed with a mere written surrender.
Thus legal record, which is familiar in all States in regard to the trans­
fer of ownership of property, is required in Minnesota for the transfer.
8Laws of 1917, ch. 194, sec. 2.
<Laws of 1919, extra session, ch. 51, sec. 2.
Federal Reserve Bank of St. Louis



of guardianship of children under 14. Such legal recognition is not
in all States a necessary condition in the acceptance of children by
individuals and institutions for placement away from their relatives.

Whenever a child has to be placed an effort is made by the State
board of control to have him committed to an agency which has been
certified by 'the board as a proper placing agency. This agency,
after investigation, selects a family home, places the child in it, and
reports the placement to the board, which then sends an agent to
visit the home, and if the report is satisfactory approves the place­
ment. By law the placing agency is responsible for supervision of
the child in the foster home until adoption takes place or the child
reaches his majority. Inasmuch as most of the babies and very
young children placed in foster homes are legally adopted, usually
the children need not be supervised for a long time. The law also
requires that the child remain in the home six months before adop­
tion may take place, unless this requirement is waived by the State
board of control or by the court.
Every petition for adoption of a minor child must be reported to
the State board of control by the court in which the petition is
filed. The board must then investigate the child’s history, judge the
fitness of the proposed foster home, and make reports and recom­
mendations to the court.5 Permission of the State board of control
must be obtained in order to place a child outside the State.

The State board of control is authorized by law to license and
supervise all child-placing agencies and institutions and all boarding
homes for children. The law also provides that the board shall have
committed to its guardianship all persons adjudged feeble-minded,
with power to commit such persons to an appropriate institution or
to exercise general supervision over them anywhere in the State outside
an institution.8 This system makes-possible the specialized, individual
treatment of certain cases in family homes, a method which has been
tried successfully in certain places in this country in recent years,
and which has been in use in some European countries with satisfac­
tory results for a number of years.
• The work of supervision and investigation of mentally defective
children placed in family homes is delegated by the State board of
control to the county child-welfare boards.

Inasmuch as the policy of the homes, growing out of a ruling of
the State board of control, influenced the patients to nurse their
babies for three months after birth, the mothers and babies usually
remained at least that length of time in the homes.
Of more than 600 mothers cared for in the 11 homes—that is, the
total number to whom maternity-home service was extended, exclu­
sive of purely obstetrical patients who were all, as far as was known,
6Laws of 1917, ch. 222.
o Laws of 1923, ch. 260.
Federal Reserve Bank of St. Louis



married women— 55 left the institution prior to delivery. The rea­
son given for their leaving was either that provision had been made
to care for them in their own State or county or that they were
venereal-disease patients and had to be cared for elsewhere.
An average period of care of four months and three days was esti­
mated for all the mothers who were cared for in nine of the homes.
Records of individual patients were used to obtain these data. It was
necessary to eliminate the data on two places because in one, a small
home, the date of discharge was invariably omitted from the record,
and in the other, the State institution, all patients had been commit­
ted, and parole was granted to most of them after 18 months.
The supervision of the mothers and babies by the county childwelfare boards after discharge from the homes did not entirely pre­
clude further contact with the institutions and follow-up by them.
One home made an effort to keep in touch with each mother for at
least one year after discharge, but the follow-up by most homes was
rather general; sometimes it was merely an incidental contact. Usu­
ally it depended on relations which had developed between workers
in the homes and their charges. Several homes, however, had organ­
ized associations to foster the tie with the girls. Most of them en­
couraged return visits, one home even providing a bedroom which was
kept in readiness for these visitors.





Omissions in the records of patients, particularly in regard to
provision made for their babies, were noted in several homes. The
records of one home in which only a small number of patients had
been cared for showed no information on the disposition of the babies
born there. In one where 43 patients had been cared for informa­
tion on the disposition of the baby was omitted in 15 cases. Records
of 92 cases in one home showed 30 omissions of this point.
Although the minimum age for separation of babies from their
mothers was usually 3 months on account of the State board of con­
trol’s regulation which insured a start of breast feeding for babies
born out of wedlock, a few instances were found in which earlier
separations had been effected. These had been consented to by the
county child-welfare board, and the records showed reasons for the
action taken. Of 58 babies known to have been placed in boarding
homes 2 lacked a few days of being 3 months old; the age of the
others ranged from 3 months— at which age 37 were boarded out— to
8 months. Of the 37 placed in free foster homes for adoption 1 was
under 3 months of age (2 months and 19 days); 21 were 3 months;
and 15 were 4 months to 10 months of age.

In order to ascertain the extent to which the plans for care of the
babies were influenced by the policy of keeping together unmarried
mothers and their babies, 185 maternity-home cases were selected
at random for study, and their records were studied throughout the
first year of the child’s life. These records were examined in the V
files of the county child-welfare board which originally had super-
Federal Reserve Bank of St. Louis



vision over the child and, if the child had been taken during this
period from one county to another, in the files of the second county s
board. If it was not possible for the investigator to go to the county
into which the child had been removed the records were examined
in the files of the State children’s bureau. This study, although
necessarily small, is an index to the results which may be obtained
by such a centralized State case-working department as is found
in Minnesota.
These records were studied to learn the status of the mother and
baby on discharge from the maternity home, usually when the baby
was 3 months old, and also at the end of the first year of his life, or
at the time of the last information in the record. They were studied
also to learn whether any effort had been made to fix paternity and
what had been the result of tlr s effort.
The records showed the following status of mother and baby at
the time of discharge from the maternity homes:
1. Twenty-two mothers had left the homes before delivery.
2. Eighteen babies had died before their mothers left the home or
were stillborn.
. .
3. Forty-four babies and their mothers were living with relatives.
4. Eleven mothers had married and were keeping their babies with
them. Ten had married the fathers of the babies; one, another man.
5. Twenty-three mothers had obtained domestic positions and were
keeping their babies with them.
6. Six babies and their mothers were living in maternity homes
other than the first home in which they were cared for.
7. Two mothers had been committed to the State reformatory for
girls and were keeping their babies there.
8. Twenty-eight babies were boarded— 26 in family boarding homes
and 2 in institutions. The mothers paid the board or part of it.
9. Eight babies had been placed for adoption.
10. In 23 cases the status was not clear.
The records showed the following status of mother and baby at
the end of the first year of the child’s life or at the time of the last
information in the record:7
1. Fifty-three babies and their mothers were living with relatives.
2. Twenty mothers had married and were keeping their babies
with them (15 had married the fathers of the babies; 5, other men.)
3. Six mothers had obtained domestic positions and were keeping
their babies with them.
. . .
4. Five babies and their mothers were living in maternity homes
other than the homes in which they were first cared for.
5. One mother had been committed to the State reformatory for
girls and was keeping her baby there.
6. Twenty-four babies were boarded away from their mothers—
22 in family homes, 2 in institutions. The mother paid the board
or part of it.
7. Twenty-seven babies had been placed in foster homes, legally
adopted, or committed to placing agencies or institutions.
8. One baby had been committed to a State institution as mentally
i 9. Seventeen babies had returned with their mothers to other

7In 41 of the 186 cases the last information was entered before the child became 1 year old.
Federal Reserve Bank of St. Louis


m a t e r n it y

hom es


M in n e s o t a


Pe n n s y l v a n ia

10. Eleven mothers had disappeared before delivery and had not
been located. Probably they had left the State, as they were residents
of other States.
11. Nine babies had died since discharge from homes.
12. In 11 cases the status was not clear.
The difference in the figures at the time of discharge and at the
end of first year of the child’s life for children who had been placed
out or who were in homes of relatives, for mothers who married dur­
ing that year, and for mothers in domestic positions is of particular
interest. It indicates the advantage of procedure which is not hasty
in planning the permanent disposition of these children. The find­
ings in regard to placements of the mothers who had entered domestic
service and were keeping their babies with them seem to indicate a
certain degree of instability about such an arrangement. It is prob­
able that the reduction from 23 to 6 in the number of mothers in this
occupation between the time of discharge and the time their babies
became 1 year old may be due to the fact that a considerable number
of mothers used this resource through the nursing period and followed
other plans later. The increase from 44 to 53 babies in homes of
relatives may be due to the increased affection for these children
resulting from contact with them, which would not be possible unless
mothers retained custody of them. The increase in the number of
marriages and in the number of placements in foster homes indicates
again the need for looking ahead in making plans for these babies.
Efforts to fix paternity.

Inasmuch as the county child-welfare boards were the agencies
through which all action to establish paternity was taken, the records
of the maternity homes did not always contain the history and results
of these proceedings. Many of the mothers left the homes between
the time when such proceedings were started and the time when the
decision was given by the court. Because final action was determined
by the county child-welfare boards various policies were noted in the
work of the homes in different counties. Some superintendents en­
deavored to reach the putative father and to induce him at least to
see the mother and the baby; they achieved excellent results in cer­
tain instances. Other superintendents preferred to leave the matter
to the agents of the board. In view of the system, it seemed best not
to attempt to interpret the interest and activities of these institutions
in this regard. The description of Home I (see p. 33) shows clearly
the excellent possibilities provided by the Minnesota law. It indi­
cates the general attitude of the courts and it shows what a careful
approach to the problem of the compensation due the child from his
father can accomplish.
Intensive study of the 185 individual case records in the office of
county child-welfare boards and of the State board of control to
ascertain the history of the child through the first year of his life
gave a fairly good idea of the progress in the State of the work of
fixing paternal responsibility. The study showed that in 63 of the
185 cases paternal responsibility was fixed upon the fathers of the
children or assumed by them; that in 39 of the 63 cases paternity
was established in court; that in 10 agreements were reached, 2
of which were approved by a court, the mothers having married
Federal Reserve Bank of St. Louis



other men; and that'in 14 the parents had been married before
action was taken to compel the men to support their children. In
2 of the 39 court cases no orders were entered by the court because
the men had been sentenced on other charges. The orders entered
in 37 cases varied from $10 to $25 per month, besides amounts of $50
to $150 for confinement expenses. Eight of the agreements were
entered into directly by the mother or some of her relatives, contrary
to the usual method in Minnesota. Since these mothers were unwill­
ing to take formal action through the usual method of court proce­
dure, these cases were left in statu quo by the county boards. This
policy has been worked out in accordance with the attitude of pub­
lic officials, from the angle of protecting the interests of the mother
and the baby. Of these agreements 1 was for a monthly payment
of $15 and 9 for settlements of $100 to $1,500. The cases m which
small amounts were paid were those in which only the confinement
expenses of the mother were met. Most of the babies in these cases
had died. In 44 cases reasons were shown why paternity could not be
established and in 78 cases no information was given.



H ome I

This institution was in a good residential section of a city. It had four sep­
arate buildings and its grounds occupied 4 acres. These grounds included lawns,
recreation grounds, and a garden which supplied the home with fresh vegetables.
The four buildings were: A modern maternity hospital with every facility for
medical and surgical care, a cottage which served as a home for unmarried
mothers, a boarding home for well babies, and a small bungalow equipped as a
pediatric building.
The institution was founded more than 35 years ago to meet an imperative
need for care of pregnant women, married and unmarried, which the regular hos­
pitals of the city were not prepared to give. It was incorporated in its threefold
form— mothers and babies’ hospital, home for unmarried mothers, and boarding
home for babies— with control vested in a board of directors made up of women.
The direction of the institution was in the hands of the superintendent, a woman
of training and experience in social work. The members of the resident staff
assisting the superintendent who had to do with unmarried mothers and other
cases requiring social service were: A director of social service, a resident phy­
sician, a superintendent of nurses, a dietitian, a housekeeper, three dormitory
supervisors, and a group of graduate nurses and student nurses. The physician,
who was a young woman experienced in the best practices in obstetrics, and the
other workers in every department not only had been excellently trained but
showed understanding of maternity-home work. An example of the service
given is the fact that the patients might have the house physician see them at
any hour of the day or night.
General supervision of the work was given to this home, as to all such institutions
in Minnesota, by the State board of control. The board granted three licenses
to this institution for the three types of work carried on: A license for a mater­
nity hospital, one for an infant home, and one for a child-placing agency.
Funds for the work were obtained from the money paid by patients, and from
subscriptions raised by the community chest.
The plan of work indicated a desire to render almost any service which might
be required for the well-being of a maternity case. The home provided care for
charity patients and for patients who could pay for private rooms, and between
these two extremes was a large group of patients, both married and unmarried,
who were able to pay a moderate amount and desired to do so, but were unable
to pay usual hospital rates for any length of time. Arrangements as to the
amount to be paid were made through the social-service department of the home.
s Two of the homes visited were in process of reorganization and no description of these has been
Federal Reserve Bank of St. Louis



Private patients paid from $3.50 to $5.50 per day pills $12 for dressings and use
of delivery room. Other patients were charged $47 for hospital care, which was
usually for a 14-day period, and 75 cents a day during the time before and after
the period of hospital care. The actual expense of the prenatal and postnatal
care was estimated at $ 2 a day, so that each patient cared for at the reduced rate
was expected to contribute service to the routine work of the home while phy­
sically able to do so. This was explained in the agreement signed by these pa­
tients on admission.
The total number of beds was 63 for adult patients and 80 for children. The
beds for adults were divided as follows: 37 for hospital care, 10 for expectant
mothers, and 16 for mothers after delivery. Those in the last two groups were
usually used by unmarried mothers, many of whom for social reasons required
shelter and care for varying periods of time both before and after delivery.
Few married women remained for aftercare, as most of them did not need social
All types of maternity patients were accepted except two— those who had a
communicable disease and unmarried women in pregnancies other than the first.
Since the maternity hospital did not receive for prenatal care patients who had
gonorrhea or syphilis, each apjJiicant for admission was obliged either to bring
with her a certificate from the State board of health that she was free from
venereal disease or to be detained in isolation at the hospital until a split Wassermann test was made. If the test showed venereal disease the patient was
transferred to some other institution for treatment. If found free from venereal
disease the patient was then segregated and placed under observation until it was
decided that she was free from all other infectious diseases. No one suffering
from any constitutional disease was admitted to the cottage with the other preg­
nant women.
A thorough physical examination was made with a view to detecting focal in­
fections, dental caries, or any other defect that- could be treated at this time.
Dental service was given at outside clinics. Other corrective work was done if
necessary. The house physician had a small laboratory equipment, and the home
might also have work done at the city laboratory and the State university lab­
During the last six weeks of pregnancy the patient was especially guarded.
She was weighed twice weekly, and the amount of carbohydrates in her diet was
regulated by her variations in weight. Urinalysis was made at the hospital.
Complete records of all examinations were kept.
The house physician delivered the patients, and consulting specialists from
the medical school of the State university gave assistance whenever it was
needed. The hospital chart for each case was made plain for the visit of the
physician by colored graphs which indicated the condition of the patient and
gave also a record of the nursing of the baby. Convalescence was safeguarded
very carefully, the patient remaining in the hospital an indefinite period of time,
according to her condition, and special vigilance was maintained for any evi­
dence of low-grade infections. Isolation with special nursing care was provided
for the patient if abnormal temperature, offensive lochia, or any other symptoms
indicated that it was needed. During the latter part of the hospital period pa­
tients were placed in a solarium where sunshine and fresh air might contribute
to their complete recovery.
Coagulation tests were made of the blood of every newly born infant as a pre­
caution in case of hemorrhagic diseases. Breast feeding was the rule, as in all
other Minnesota institutions, and manual expression of the residue of milk was
taught the mother. Every infant was weighed before and after each of three
feedings daily and the amount of milk taken at each feeding was indicated on
colored graphs. Thus it was determined whether complementary feeding was
necessary. In suitable weather the babies were kept in the open air in baskets
under a canopy with a net over each. After leaving the hospital the patient
might return to it with her baby for any necessary treatment. A pediatrician
visited the hospital nursery three times a week.
Of the 80 beds for children 37 were in the hospital nursery for the babies of
patients; 16 in the department of aftercare; 18 in the boarding home, where
children under 4 years of age might be given temporary care as a means of help
to the mother, and 9 in the pediatric building. Any married woman while a
patient in the Hospital might have a child under 2 years of age cared for in the
boarding home, free or at board as the patient’s circumstances warranted. After
the discharge of the mothers, babies were sometimes retained in the maternity
Federal Reserve Bank of St. Louis



home for a period of time arranged by the social-service director and the super­
intendent of the hospital, either free or at board— a service utilized chiefly by
unmarried mothers. Children under 4 from sources outside of the hospital were
accepted at board, especially medical cases. The boarding home was also the
receiving place for babies who were committed to the maternity hospital. Some
babies born in this maternity home were accepted for placement in foster homes.
The pediatric department was of particular value in relieving the boarding home
of sick babies.
This institution was the only one studied where the diets for both the expect­
ant mothers and the nursing mothers were rated as “ adequate.” In addition to
three meals a day nursing mothers might have two lunches of milk and crackers
if necessary. The physician and the dietitian worked together, and the diets
were varied to suit the needs of the individual mothers.
The menus for a week are given to illustrate the generous use of vegetables—
especially leafy vegetables— and the use of milk, eggs, and cheese in cooking.
All these foods could be used equally well in less elaborate menus.


Menus for one week
Breakfast— Poached eggs, toast, pear sauce, coffee.
Dinner— Ham (baked), corn on cob, escallopedpotatoes, cab­
bage salad, gingerbread with whipped cream.
Supper— Stuffed baked potatoes (meat and potatoes), “ but­
terfly” salad with mayonnaise dressing, frosted cookies, sauce,
Breakfast— Peach sauce, cereal, toast, coffee.
Dinner— Hamburger steak, buttered carrots, mashed potatoes,
beet pickles, tapioca.
Supper— Egg and lettuce salad, bran muffins, pear sauce,
coconut cake, coffee.
Breakfast— French toast, cereal, apple butter, toast, coffee.
Dinner— Roast veal with dressing, riced potatoes, stewed
tomatoes, peach salad with date in center (black-eyed Susan),
apple pie with cheese.
Supper— Welsh rabbit on toast, combination salad (lettuce,
cucumbers, tomatoes), gelatin, drop cookies, coffee.
Breakfast— Scrambled eggs, stewed apricots, toast, coffee.
Dinner— Meat pie, boiled potatoes, head-lettuce salad with
Thousand Island dressing, creamed string beans, prune whip
with custard sauce.
Supper— Sardine-salad sandwiches, radish and lettuce salad,
apple snow, vanilla wafers, coffee.
Breakfast— Pancakes, stewed prunes, toast, coffee.
Dinner— Baked trout, escalloped potatoes, Swiss chard, tomato
and bean salad, chocolate pudding.
Supper— Creamed salmon on toast, cheese salad, Bavarian
cream, chocolate cake.
Breakfast— Milk toast, jam, toast, coffee.
Dinner— Roast beef, browned potatoes, buttered peas, apricot
and coconut salad, caramel custard.
Supper— Spanish rice, cottage-cheese salad, muffins, sherbet
with vanilla wafers, coffee.
Breakfast— One-half orange, cereal, toast, coffee.
Dinner— Chicken, riced potatoes, carrots and peas creamed,
pineapple and tomato salad, raspberry shortcake with
whipped cream.
Supper— Cold sliced meat, potato salad, pickles or relish, cake,
cherry sauce, coffee.

(The patients on a light diet had soup— cream soup, chicken broth, beef broth,
etc.— with the addition of macaroni shells or alphabets, eggs, fish, chicken,
sweetbreads, etc.)
Federal Reserve Bank of St. Louis



The following is an outline which the hospital gave as the daily routine o f
health supervision:
“ All prenatal cases are allowed to work from 7.40 a. m. to 10.30 a. m. and
from 2 p. m. to 4 p. m. unless otherwise ordered by physician in charge. Weekly
examinations are made and close observation of their general health habits.
“ Girls are taken to the hospital proper as soon as labor begins and are kept
there through confinement and two weeks after. Third week after confinement
they are allowed to go to meals but are carefully watched and allowed to do no
work that will necessitate their being on their feet. They may do such work
as making dressings and sewing, but only for short intervals. During this third
week they are also taught the proper care of the child, having complete demonstra­
tions in bathing, weighing, dressing, and the giving of fluids, etc. They are also
taught to take temperatures and the importance of daily bowel movements.
Breast expression is taught them while they are still in the hospital.
“ All babies have a complete physical examination at least once a week, and
any unusual symptoms are brought to the notice of the pediatrician in charge,
who makes at least three calls a week. Graphic charts are kept on all babies,
and the girls are taught the importance of daily gains.”
Cooperation with all public-health regulations is the rule, and insistence is
made upon further measures, such as vaccination, which are not required by
State law. A notable health rule provided that visitors to the nursery must
cover their clothing as a precaution against bringing in germs.
Individual records of patients were kept in the regulation maternity register
prescribed for use in all maternity hospitals by the State board of control, and
additional records for all social-service department cases were in the form of
social histories in narrative form chronologically arranged. These were placed
at the disposal of the Children’s Bureau investigator', and the histories for one
year were studied. Of the 90 new maternity patients known to the social-serv­
ice department 16 were married and 74 unmarried. Nine of the latter left
the home before delivery, leaving 65 patients who needed more or less intensive
social service. A brief summary of the findings in these 65 histories follows.
As part of the institution’s efforts to fix paternity during the year for which
the records were studied action was taken in 38 of the 65 cases, either through court
procedure or by private approach to the man involved, with these results: 7 mar­
riages; 17 court orders and agreements for support, varying from actual expen­
ses paid where the baby had died to an average of $ 2 0 per month; 1 settlement
for $3,000; 1 dismissal by court; 5 decisions pending in court; 7 cases in which
the result was not stated, 6 of these 7 being cases which the county child-wel­
fare board handled without reporting the result to the hospital social-service
The average period of care in the home for these patients was 3 months and
20 days. Twenty-four of the 65 mothers left the hospital without their babies,
3 babies having died and 1 having been stillborn. Of the remaining 20 babies
9 were retained in the boarding home (6 at board and 3 free), and 9 were
accepted for placement in free foster homes. The minimum age at separation,
for any reason, was 3 months, and the maximum age, 8 months.
All ward patients and all patients admitted to the department for expectant
mothers and the department for aftercare were seen by the social-service director,
who utilized community resources in formulating plans for them. Patients whose
needs required the service of the aftercare department were asked to sign a sim­
ple agreement setting forth the mutual obligations of the home and the patient,
providing a promise of three months’ nursing of the baby, if possible, and making
clear what the patient had a right to expect, as well as the rights of the home.
A valuable contribution was the service of volunteer workers who provided recrea­
tion, did follow-up work after discharge, acted as chaperons when such service
was needed, and assisted patients to find suitable employment. The Big Sisters
did much of this valuable service. In the daily routine care was taken to pro­
vide the kind and amount of work suited to the individual patient; rest and re­
creation were provided; a plan of health supervision was posted, together with a
schedule of activities by means of which an orderly routine was maintained, while
at the same time the arrangement was conducive to satisfaction and profit for
the patient.
The schedule of activities was as follows:
6 a. m. Rising hour.
7 a. m. Breakfast (all patients must be fully dressed).
Federal Reserve Bank of St. Louis



A. Laundry workers:
. .
7. 30 a. m. Bathe and weigh babies. (Under supervision of nurse, each
baby is examined daily for rash, sore mouth, or any un­
usual symptoms.)
8 . 30 a. m. Make beds, put rooms in order, and see that babies beds
are in order and have clean linen.
9 .0 0 a.m . Nourishment for mothers.
9. 50 a. m. Nurse babies. (All babies are nursed 20 minutes, unless
mother is otherwise ordered by physician in charge. Ba­
bies are weighed before and after nursing. All mothers
are required to express remaining milk after each nursing
and the breast milk thus obtained is used to complement
the food of babies needing it.)
• .
10. 30 a. m. Babies are placed in baskets and put out of doors if weather
10. 30 a. m. Report for duty in laundry.
12. 00 noon. Dinner.
00 p. m. On duty.
1 . 50 p. m. Nurse babies (same as 9.50 a. m .).
2. 30 p. m. Free for rest or recreation.
3. 00 p. m. Nourishment.
5. 30 p. m. Supper.
6 . 00 p. m. Nurse babies.
7. 00 p. m. Prayers.
9. 00 p. m. Nourishment.
9. 45 p. m. Nurse babies.
10. 15 p. m. Lights out.
2. 30 a. m. Nurse babies (all babies under 2 months).
B. Second cook:
6.30 a. m. On duty.
9.00 a. m. Bathe baby (as in “ A ” ).
9.50 a. m. Nurse baby (as in “ A” ).
10.00 a. m. Nourishment.
10.30 a. m. On duty.
1.00 p. m. Rest.
1.50 p .m . Nurse baby.
2.30 p. m. Free for rest or recreation.
3.00 p. m. Nourishment.
4.00 p. m. On duty.
6.00 p. m. Nurse baby.
Rest of day. Same as in “ A.”
C. Pantry maid:
6.00 a. m. On duty.
8 .0 0 a. m. Bathe baby (as in “ A” ).
9.00 a. m. Nourishment.
9.50 a. m. Nurse baby.
10.30 a. m. Nurse baby.
11.00 a. m. On duty.
12.00 noon. Dinner.
1.50 p. m. Nurse baby.
2.30 p. m. Free for rest or recreation.
3.00 p. m. Nourishment.
4.00 p. m. On duty.
6.00 p. m. Nurse baby.
Rest of day. Same as in “ A.” ,
D . Dish washers and dish wipers:
7.00 a. m. On duty.
9.30 a. m. Bathe babies (as in “ A ” )*
9.50 a. m. Nurse babies (as in “ A ’ ’).
10.30 a. m. Free for rest or recreation.
12.00 noon. Dinner.
1 2 .2 0 p. m. On duty.
1.50 p. m. Nurse babies.
3.00 p. m. Nourishment.
5.50 p. m. On duty.
6.30 p. m. Nurse babies.
Rest of day. Same as in “ A.”
Federal Reserve Bank of St. Louis



Monday.— 2.30 p. m .: Glee club. 7.30 p. m.: Home and personal hygiene lec­
tures; cooking and dietetics.
Tuesday.— 7.30 p. m .: Big Sisters’ evening.
Wednesday.— Open.
Thursday.— Open.
Friday.— 7.30-9 p. m.: Sewing class.
Saturday.— Club night.
Sunday.— 7.30: Evening service (chapel service each evening).
One afternoon a week small groups were entertained in the homes of friends
of the hospital or taken out for rides around the city. At least one party each
month was held at the home. A musical program was furnished by the school
of music of the State university the first Wednesday of each month during the
school year.
As much freedom as was consistent with the standards of the home and the
welfare of the patients was permitted in the matters of visitors, visiting hours,
and patients going away from the premises for recreation, church, and such neces­
sary business as shopping. For necessary chaperonage the services of volunteers,
as well as of older patients who had proved trustworthy, were utilized with
A hospital library supplied by the city public library was in use.
To prepare the patients for future employment the home had well-planned
courses in home making, including sewing, cooking, home hygiene, personal
hygiene, and care of babies. Not only were the girls taught to do this work
properly but they were given credit for whatever work they did in the hospital
by a system of rating. By this plan of rating patients might repay the home
for their care by doing a definite amount of work, and they sometimes had
a cash credit due them on leaving the department of aftercare, especially patients
whose hospital expenses were paid by the father of the child (as is the usual
procedure when orders are fixed by court) or by relatives. This is perhaps the
most interesting single point in the plans of this home and indeed one of the
most significant points in social service in all the institutions visited in the two
States. Because it points the way to efficiency in managing a maternity home,
because it is an excellent plan for preparing patients for the future during the
period of residence in the home (at the same time making for morale and disci­
pline) , and because of the great advantages to the patient, the entire rating system
■as worked out by the superintendent and the director of social service has been
included in this report.
The rating system was as follows:
Classification of work
Class A workers: Pantry girl, waitress, diet-kitchen worker, cottage cleaner,
office worker.
Class B workers: Dish washer, dish wiper, vegetable cleaner, cleaner of pots
and pans, laundry worker.
Value of work
Class A: Thirty-five and one-fourth hours of work a week (4 ^ days of 8 hours
each) equals $14 or maintenance (no charge is made for maintenance of babies).
Class B: Forty-four hours of work a week (5}/% days of 8 hours each) equals
$14 or maintenance.
Overtime work is paid for at 15 cents an hour.
Credit for ivork
Waitresses work approximately 40)^ hours a week; they receive maintenance
and $3 a month.
Diet-kitchen girls work approximately 40J4 hours a week; they receive
maintenance and $ 8 a month.
Cottage cleaners receive maintenance and $5 a month.
Dish washers, dish driers, vegetable cleaners, etc., work approximately 44
hours a week; they receive maintenance.
Office girls work approximately 35y i hours a week; they receive maintenance.
Pantry girls work approximately 40 hours a week; they receive maintenance.
The hours of laundry work are not long enough to enable girls doing it to
receive maintenance for that work alone. Girls who do both laundry work
(cottage hours) and linen-room work or sewing receive maintenance.
Federal Reserve Bank of St. Louis



Girls who do both linen-room work and dormitory-floor cleaning receive
One of the duties of the director of social service was to arrange assignments of
patients to certain household duties after consultation with other staff members,
considering the condition and needs of the patients rather than the needs of the
house. The reason for this was that the social-service director had to plan for
the patient’s later employment, and she wished to be thoroughly conversant
with her capabilities, preferences, and defects.
After discharging a patient the home made an effort to retain contact with
her for one year if she seemed to need further assistance and supervision in ad­
justing herself anew to her community. This contact was kept by a definitely
worked-out scheme, made possible by the use of volunteer workers, who made
friends with the patients while they were in the home and continued these
friendships so as -to be of real service to the girls afterward.
The members of the board of directors were actively interested in the work
of the hospital. Committees of members worked with the staff on such matters
as the social-service department, education, recreation, religious services, Big
Sister work, adoptions, aftercare, and the general welfare both of married and
of unmarried mothers. With the help of these committees courses in preparation
for the patients’ future employment and in general educational work were
worked out. These activities by the board members fostered interest in
general community problems, in educational propaganda for social service, and
in social legislation. They constituted an important liaison between the com­
munity and the actual work within the institution— a function of paramount
importance to social agencies and institutions.
H ome


This home had been established by a religious group. At the time of the
study it was located in a residential part of the city, but a new building was in
process of construction in a suburb. The place was very homelike, and it was
pervaded by a fine spirit. It was comfortably furnished, and its appearance
indicated general use as though by a family.
Though the superintendent was not highly trained, she was a person of good
fundamental education, a practical nurse. Her only preparation for this work
was years of service in church work, but she had certain valuable qualifications.
She was a kind, motherly woman, with intelligence, and she seemed to have the
ability to understand the girls and to win their confidence. She gave excellent
cooperation to the medical staff. She needed more assistance, for she had the
entire care of the patients in the main building, a practical nurse being in
charge of the isolation cottage.
The medical practice was standardized by the faculty of the State university.
All applicants were isolated until a physical examination had been made by the
attending physician. Those found to have syphilis were transferred elsewhere.
There was a cottage for the segregation of gonorrheal patients. In addition to
the usual physical and obstetrical examinations, nose and throat cultures were
made, and no patient was admitted to the general dining room unless the
results of that examination were known to be favorable. Vaccination against
smallpox had been made obligatory by the home, although it was not a require­
ment of the State law. No dental service was arranged for unless the need was
imperative, as the task of taking the patients to a dental clinic would have been
impossible for the small staff. The temperature of all patients with gonorrhea
was noted daily as a part of the routine observation in order to detect lowgrade infections, both before and after confinement. A study of the morbidity
after confinement of these infected patients was in progress. A physical record
of the patients that lived under observation in the cottage was kept fairly well.
It was written in narrative form by the practical nurse in charge. All obstetri­
cal and laboratory records were kept at the hospital.
There was no delivery room in the home; many of the patients went to the
State university hospital for confinement and a few to other hospitals.
Breast feeding was not always supervised because of the lack of trained help.
A young woman was seen feeding a 5-weeks-old baby from a bottle, and she
said that no measures had been taken to influence her to try to continue breast
feeding. The diet of the home was rated as “ possibly inadequate ” for both
pregnancy and lactation— too little m ilk was used. The nursing mothers were
given two extra lunches daily.
Federal Reserve Bank of St. Louis



Preparation for future employment consisted of training in household wrok
and sewing. Occasionally a girl was given opportunity to prepare for some
other kind of work.
The social records were compiled by a clergyman, a member of the board, from
information which he obtained in part from the girls. This procedure was
inadvisable, and some of the information recorded was unnecessary for the
purpose of these records.
Originally the home did boarding and placing out of babies. In recent years
this work had been transferred to a placing agency having high standards.
H ome


This large institution was housed in a new building combining a maternity
home and a maternity hospital. It was well equipped for medical and surgical
care, but it seemed to lack firm, efficient management and orderly routine.
The atmosphere in the home was difficult to interpret. The patients seemed to
be repressed, though there was evidence of kindness and of a sympathetic rela­
tion between staff members and their charges.
The work was begun 50 years ago by a group of local women engaged in
rescue and missionary efforts. At first various types of women had been
accepted for moral rehabilitation. Later, work with all these except unmarried
mothers was discontinued, chiefly because of the opening of State reformatories
for girls and women.
The home had facilities for the treatment of patients with venereal disease
including an isolation ward of 1 0 beds, with adequate toilets, washbowls, and
bathtubs and a shower bath. However, the management preferred not to
accept such patients and did not inform social agencies that it would accept
The arrangements for receiving new patients were good. Each applicant
was shown into a reception room from which opened a small apartment where
she prepared for physical examination. This apartment included also an ex­
amining room with a table, a medicine closet, and the physician’s laboratory equip­
ment. The patient was kept for a few nights in a single bedroom with toilet
and bath.
The house physician, a young woman, gave each patient a thorough
physical and obstetrical examination, of which a record was kept. The technique
of delivery was very good. The physician and a graduate nurse were prepared
as for a surgical operation. A student nurse was in attendance also. If a
laparotomy was necessary the patient was taken to a general hospital.
The diet kitchen where the babies’ food was prepared seemed to be well
equipped and well conducted. Instruction of the mothers in breast feeding was
given according to the best practice. Every baby was weighed before and after
the daytime feedings, and records were kept of the weights. These records
however, were not used to make a general study of conditions. Breast feeding
was supervised, and dissimulation was practically impossible.
The diet was rated as “ probably adequate” for pregnancy and “ possibly
inadequate for lactation. Butter substitute was used j and although milk was
available in the diet, it was said that not much was used. The proportion of
mothers who nursed their babies adequately could not be obtained. The babies
slept or played on a well-screened sunny porch on the second floor.
Certain excellent arrangements prevailed for teaching the girls, giving them
both fundamental education and special preparation for future employment.
The board of managers were not entirely in sympathy with the policies of the
State board of control. The records were not well kept. Evidences were not
lacking of the home’s desire to find babies for good foster homes, rather than to
keep mothers and babies together.
H ome


This home had been opened by a religious group to provide care for various
types of women— delinquents and others needing care— many of whom were com­
mitted to the home by courts. With the opening of two State reformatories—
one for girls and one for women— the courts discontinued sending delinquents
to private institutions, so that the women in this home began to be limited
practically to unmarried mothers, though occasionally other women were
Federal Reserve Bank of St. Louis



The building was plain, comfortably furnished, and immaculately clean and
sanitary, and the atmosphere in the home was one of content and freedom.
The superintendent was friendly and kind, and she seemed to have the respect
and affection of the girls.
The medical assistance was good, and whether a woman was the private
patient of the house physician or was a recipient of the free prenatal service of a
hospital she was well cared for.
Applicants were supposed to bring a certificate of freedom from venereal infec­
tions, but each one was examined at the home whether she had a certificate or
not. ^No applicant with venereal disease was admitted; but since there was no
isolation or segregation of applicants while waiting, it is conceivable that patients
with such infections might remain in the house for a few days. An effort was
made, however, to have the examination on the day of the patient’s arrival.
Syphilitic or gonorrheal patients were transferred elsewhere for treatment. An
obstetrical examination was made as soon as the hospital for confinement was
decided upon, and thereafter the prenatal care was directed by that hospital.
There was no delivery room in the home. The home cooperated with the hos­
pitals in every way, and good results were obtained. The superintendent
accompanied each patient to the hospital for delivery and brought her back
after the period of hospital care.
A nurse was engaged specially to care for the babies, and she cooperated well
with the physicians. The nurse, the babies, and the nursing mothers all slept
on the same floor, but the babies were not nursed after 10 p. m. Some one was
in charge of the babies all the time.
Special service was rendered by dentists’ assistants, young women who came
to the home to clean the teeth of the patients and advise them about dental
care. All necessary dental work was done at the city hospital, and its prenatal
clinic was vigilant about dental caries and sinus infections.
. The food seemed good and bountiful, though, as judged from the menus fur­
nished, it was rated as “ probably adequate.” The home had a garden plot,
chickens, and two cows. Cottage cheese and cream dressings were in common
use, and the cook was skilled in preparing egg and milk dishes.
The matron assigned a variety of duties to the patients. A fair degree of
freedom was given them in the matter of going out alone to church and on
various errands.
Though licensed only as a maternity hospital the home was permitted by the
State board of control to care for a few children temporarily, so as to assist
mothers with their plans. These children might be boarded or cared for free of
charge. It was noted that this group was not limited to the children of mothers
cared for in the home; also that the number allowed had been exceeded. These
facts show some of the difficulties in regulating maternity homes and holding
them to their own line of work.
This home had the confidence of local agencies and of the State board of con­
trol because of the frankness and the cooperative spirit of the management,
though the workers recognized its limitations.
H ome


This home was of a type of commercial institution particularly dangerous in
any community. The proprietor, who was also superintendent, was a woman
of very limited education, a practical nurse who practiced midwifery. She
advertised in a daily paper both maternity and infant care. Her licenses were
for a maternity hospital and for a boarding home for children.
The house was a frame dwelling; therefore, by requirement of the State board
of control, all the children were kept on the first floor so that they could be carried
out easily in case of fire. The place was comfortably furnished, and when visited
was clean and in order though quite crowded. The crowding increased the
hazard from fire. The kitchen was dark and the bathrooms and plumbing were
The house had no facilities for segregation, though patients with gonorrhea
were received and treated. It was claimed that patients with syphilis were
excluded, but owing to the fact that routine examinations were not made it was
conceivable that these patients might have entered. No records were available
of prenatal or obstetrical examinations, but from the superintendent’s verbal
account of the work it could be assumed that obstetrical examinations were
made. For example, she said that “ a woman was taken to the hospital for
Federal Reserve Bank of St. Louis



Cersarean section.” It seemed that the visiting physician who attended deliv­
eries arranged for emergency work to be done outside the home.
The diet was rated as “ possibly inadequate” for both pregnancy and lacta­
tion. The superintendent claimed to furnish food bountifully, but there was
no special effort to have the patients eat the most suitable food. Milk was not
much used. Upon being qestioned the superintendent said, “ The girls can have
milk if there is any left over.”
No dental service was furnished, nor any special attendance in case of lowgrade infections.
The superintendent was judged to be cooperative with the physician in attend­
ance, but the medical standards of the home were not of the highest.
The maternity register was in bad condition. The record of the disposition
of the baby was omitted in every case; various dates were also omitted. Cer­
tain births which had been recorded as legitimate were found to be illegitimate.
About half the patients were said to be married; but it seems improbable that
married women living in the vicinity would leave their homes and come to
this place weeks in advance of delivery with hospital facilities available elsewhere
in the city. Some of these patients had not consulted a physician, and the
proprietor of the home called one for the delivery from a small group who used
her home.
The owner of this hospital seemed to be a kind, well-meaning, but ignorant
woman. Only one local social worker expressed confidence in her.
H ome


This was the most recently organized of all the institutions studied in Minne­
sota. Primarily it was for the care and training of delinquent girls who might
be helped by a certain amount of freedom rather than by the restraint of a re­
formatory. The addition of work for unmarried mothers had been incidental
to the other work and had been made because of unsatisfactory conditions long
existing in the other two maternity homes in the city.
All the staff members met were women of culture and good preparation for their
work, and they were zealous for the best results. The austerity of some of the
arrangements, especially of the hall in which the patients had their meals, ap peared
unattractive; but there was a very good spirit, and the girls looked happy and
healthy. There seemed to be more unity in the interests of the group than in
some homes where the appointments were more elaborate.
The medical work was carefully done, and records of all examinations were on
file at the hospital, which cooperated understandingly with the staff of the home.
The home had made a complete report to the State board of control of health
work done in the previous year ( dental services, major and minor surgical oper­
ations, glasses and braces fitted, and venereal-disease treatment given ) and of
the results of intelligence tests. The staff closely followed physici ans’ directions.
The cooperating hospital gave unusual service to this home in keeping the
patients for an indefinite time, allowing them to remain throughout any emer­
gencies such as ophthalmia in an infant or evidences of any infection in the mother.
If any condition arose after her return to the home that necessitated bedside care
she might reenter the hospital, and if her baby was breast fed it might go with
her and be cared for in the pediatric ward.
The diet rating was “ probably inadequate” for pregnancy and “ possibly in­
adequate ” for lactation. There was reason to believe, however, that the sample
menus which the staff furnished for this rating did not represent the diet to the
best advantage, as the gardens, cows, chickens, and rabbit hutch all contributed;
and it was found that some simple but important things such as cottage cheese
and skimmed milk had not been considered worth mentioning in the menus, al­
though they were in rather common use.
The training of patients for future employment was varied and efficient and
showed utilization of all available resources. Courses in home nursing were pro­
vided by the Red Cross; teachers were procured from the extension division of
the State universities. A 13-year-old girl (n ot a maternity case) was attending
public school at the time of the study; and four girls, one a mother whose child
had died, were taking business courses at the expense of the home.
Ample provision was made for outdoor life, both work and recreation. About
half the proceeds from certain work done by the girls was used to finance recre­
ational activities; the other half was kept by those who did the work.
Federal Reserve Bank of St. Louis



There was no dining room, a large hall being used in lieu of one. The living
room, opening from this hall, might better have been used temporarily until a
suitable dining room was added. This living room and the sun parlor were simply
but attractively furnished. Good pictures, books, magazines, and other similar
touches added greatly to the good impression.
The home was overcrowded; it seemed that in their zeal to render service the
staff had taken in too large a number of persons.
H ome


This institution was not only a maternity home but also a place of temporary
care for dependent children under 2 years of age. It was of more recent develop­
ment than most of the homes studied, as it was founded less than 2 0 years ago.
At the time of study the superintendent had been in charge less than two years,
and great improvement had been made in that time.
All admissions to this home were made through a certain social agency which
was controlled by a religious denomination. A preliminary social investigation
was made by this agency to help to decide whether the applicant should be
admitted. The agency gave also a physical examination so as to exclude any
applicant with venereal disease. The county child-welfare board assumed com­
plete responsibility for all maternity cases after admission to the home.
The house was well equipped and exceptionally well kept. Only a few defects
were noticed. One of these was- the crowded condition of the dormitory where
both waiting and nursing mothers slept. Another was the lack of a living room
for the girls; it was expected that one would be supplied before long. The
dining room was most attractive, and it was used temporarily as a living room.
Medical care was given to maternity patients at various clinics, and the home
carefully carried out all directions given at the clinics. Dental work was
arranged for if the clinic physicians considered it necessary. Obstetrical
examinations were made at the clinics, but specific information on these was
not sent to the home, and it was not known whether they were thorough.
At the onset of labor each patient was sent to a hospital for delivery. Sev­
eral hospitals were used, and a patient might be sent to one that did not have
the record of her prenatal care. At one hospital it was said that pelvimetry
was done “ if there was time before delivery.” Patients returned to the home
soon after delivery, and there was no provision for bedside care in the home.
The superintendent was very particular about the health and comfort of the
patients, and if any of them felt ill they were sent to a clinic.
The diet was good, being rated as “ probably adequate” for both pregnancy
and lactation. The girls might have all they wanted to eat, including lunches
between meals. The waitresses were instructed to notice timid ones at meals
to see whether they would like second helpings.
The children were well cared for and had the services of a pediatrist. Excel­
lent isolation facilities were provided in case of infection. Trained assistants
carried out the directions of the physicians.
The group of dependent children was entirely under supervision of the social
agency previously mentioned. Every child of illegitimate birth who was
retained in the institution after his mother had left remained under supervision
of the county child-welfare board unless the guardianship was taken from the
mother, in which case the child was committed to the agency for placement.
The social atmosphere of the home was particularly good and the superintend­
ent was sympathetic. The maternity patients were given as much freedom as
was practicable, the home’s nurses and volunteer workers acting as chaperons
when necessary. Training for employment was practically limited to household
work, sewing, and the care of the babies; a few girls received training in dietkitchen work.
The home was constantly occupied to capacity, receiving girls from all parts
of the State. The records were well kept.
H ome


This home was a well-ordered place housed in an attractive building with large
grounds. It had a good, efficient matron and a particularly congenial staff. Every
department seemed busy and happy. It was an outgrowth of missionary work by
a local group of men and women, and it was one of the oldest efforts of its type
in the State. In the early years of the work various types of women needing
96892°— 26f----- 4
Federal Reserve Bank of St. Louis



care were accepted, but at the time of the study the only ones cared for were un­
married mothers. The home was licensed only as a maternity hospital.
The attending physician, a woman, called twice weekly and not only gave good
prenatal and obstetrical care but also instructed the patients in personal hygiene
and the care of their babies. She received good cooperation from the rest of the
staff. A small laboratory equipment was used at the home for urinalyses, and
the city laboratory and the State university laboratories were also available.
Each applicant for admission to the home was detained in isolation until a
physical examination was made, as no patient with a constitutional disease or
an acute infection was kept. The facilities for isolation and segregation were
The diet kitchen, the babies’ bathroom, a delivery room with bath, and a twobed ward were on one side of a corridor, and on the other side a single-bed room,
an examination room which had equipment for special cases, and a labor room.
The delivery suite was especially well arranged and safeguarded.
; The diet was rated as “ probably inadequate ” for pregnancy and as “ possibly
inadequate ” for lactation. Breast feeding was supervised and the babies were
well nourished. They were kept in a nursery under the care of a trained nurse,
and the mothers went there to nurse the babies and sat in low rocking chairs
by the babies’ beds.
The superintendent was a very businesslike person. The home at first gave
the impression that certain human interests were sacrificed to business efficiencv;
but this impression wasdissipated by observation of the girls at work, at meals’
etc. No girl was permitted to leave the home unaccompanied for any purpose.
Groups of girls were accompanied to church, on walks, and on little outings.
There were no other outside activities. Preparation for future employment
was limited to training in household work.
Records were very well kept. For years the management had followed the
policy of keeping mothers and babies together for the moral effect on the mother;
for this reason the records showed, generally, that mother and baby left the
home together. However, these records showed a number of separation plans
made while in the home, and this frankness of the home is to be commended.
The superintendent would not permit any of her staff access to records; nor
would she allow discussion of the “ girls’ stories” with them. She had fixed
ideas as to confidential relations with her charges. The home had not been
running to capacity— a matter of concern to the management.
The idea of religious reformation was uppermost. The superintendent was
making an earnest effort to continue contact with as many girls as possible after
discharge. The cooperation of the county child-welfare board rendered this con­
tact entirely practicable.
H ome


This institution, which gave both maternity-home and maternity-hospital
care, had been built by a philanthropist, and it had every facility for medical
care and treatment which modern scientific methods demand. A suite of rooms
was designed especially for the use of applicants for admission, and segregation
might be maintained there for an indefinite period. On each floor was a solar­
ium and a bathroom. Everything was exquisitely clean. The nursery was
especially attractive.
All the medical care was given within the home and the visiting physicians
kept good records of it. No patient was received unless she had been certified
by the State board of health as free from venereal disease. If a patient had a
vaginal discharge but had been pronounced free from gonorrhea she might re­
main in the home under observation, and the nurse gave her treatment accord­
ing to the physician’s directions. Any baby with ophthalmia was separated
from the others, even though he had been examined and the infection found to
be not of venereal origin. After delivery patients received bedside care in large
airy wards on sun porches. They were not expected to assume any duties un­
til four weeks after confinement.
The diets were too frugal. They seemed entirely inadequate to mantain a woman properly, and they surely did not contain sufficient calcium, phosphorus and
vitamins for women in pregnancy and lactation.
v Tke home had a fine spirit of service and cooperation, although it had certain
limitations. It was licensed only as a maternity hospital, but the State board of
control permitted it to keep a small number of children so as to assist with their
Federal Reserve Bank of St. Louis

Min n e s o t a


plans mothers who had been cared for in the home. The home wished to con­
tinue contact with the mothers for moral influence and therefore encouraged
them to return for visits. At the time of the study about 1 0 0 prls constituted
the group of discharged cases who were still in contact with the home. 1 his
seemed a small number after the home’s years of work, during which approxi­
mately 1 0 0 girls were received annually, but frequent changes in the personnel
of the staff might account for it. The only training given m the home was m
housework and sewing. Some art needlework was taught, and the work was
sold the proceeds going to the home. It would seem that at least part ot tne
money should have been kept by the workers or used for their direct benefit. ^
The superintendent approved marriage of these mothers for the child s name,
even with divorce in mind as a later solution. This is in contrast to the atti­
tude of most social workers, who would give approval and encouragement only to
those marriages which are mutually desired and which give promise of some
Social records were well kept.
In one home an Indian girl was met who was mature in appearance, much
older than her age, 19. One afternoon while the Children’s Bureau representa­
tives were engaged in the home this girl brought in tea. She was dull and phleg­
matic until her child, a beautiful baby, was mentioned. Immediately she showed
„ ,. ,
. .
This girl had been met by a worker of this home m missionary work on an
Indian reservation. Her parents were in almost destitute circumstances and she
had no prospect of suitable care at the time of the birth of her coming child.
At the time of the bureau study she had been in the maternity home for some
months and she had reacted well to the efforts made to assist her. Besides be­
ing given instruction in English and arithmetic by a qualified teacher she was
being taught household work. The assignments of work were graded intelli­
gently and the training was thorough. She was also taking complete care of her
child'having been taught this first of all. Through the joint effort of the home
and the county child-welfare board the father of the baby had been placed under
court order for its support.
, ,, ,
,. ,,
•, ,
The plan for the future was not quite decided. The patient s parents wished
her to return to the reservation with the baby, but she preferred to take a domes­
tic position where she could keep him with her and could make use of what she
had been taught in the home.
A capable, robust girl of 18, approaching delivery, was observed doing some
out-of-doors work at one home. A child, near by in a carriage, began to cry,
and the girl hurried to soothe him. Her eagerness and gentleness m giving the
child attention were noticeable.
, ,
This patient had been referred to the home through her church, and she .was
being provided for by her parents. The plans for her future had been left chiefly
to the county child-welfare board, which was endeavoring to reach the man re­
sponsible for her condition. The girl was doing light housework and sewing
She had been promised a place in the domestic-science class after the birth of
her baby, and she was looking forward to it.

In one home a gentle, timid girl of 17 was seen. She had returned to the
home from the hospital with her baby a few days before and had not yet been
allowed to do any work. Her first assignment would be to give her baby his
morning bath, and later she would participate in the household duties.
This patient was in the third year of high school when she became pregnant,
and she had confided in her mother as soon as she knew it. The young man de­
serted her marrying another girl, but his parents were sympathetic and had
promised to arrange a settlement for the baby’s support. This was to be done
as soon as the girl was strong enough for the necessary interviews with attorneys
and other details of the business. Her parents would then take her and the baby
home to their farm.
Federal Reserve Bank of St. Louis


m a t e r n it y

hom es


M in n e s o t a


Pe n n s y l v a n i a

During the study of one home (a commercial home) a woman who appeared
to be about 35 years old was seen. She was a pay patient in the home and there­
fore did not assist with the work of the house. This patient had been in the
home for more than two weeks and her baby had not yet been born. The pro­
prietor of the home had engaged for this patient a local physician who frequently
attended her patients.
The patient’s story as told to the owner of the home was that she was a mar­
ried woman and had left her husband and two children at their home in another
city to be near this physician. Her husband had not communicated with her.
The patient appeared to have ample funds to meet all expenses, and she might
have entered an excellent hospital in this city or one much nearer to her home.

An attractive, capable-looking girl about 20 years old was on duty as door
maid in a maternity home, and in the course of a day’s work she was seen fre­
quently. This patient gave her baby attention, including the morning bath, and
nursed him at regular intervals but had no further contact with him. He was
2 months old, and the home had a policy of deferring the plans for babies until
the third and last month of the stay of the mothers.
This girl had been reared by an older sister, her mother having died when she
was a small child. The sister and four married brothers were all insisting that
she place her baby in a foster home for legal adoption and return to her former
life with them. This the young mother positively refused to do. She was hop­
ing to be permitted to enter a training class for nursemaids which the home
provided, because that would enable her to live with the baby during the months
of the course and then to take employment which would assure her wages
sufficient to provide adequately for the child in a boarding home.

A case indicating the injustice of planning for the placement of children
without covering all possible resources for providing care with relatives was
noted in one home. It was the case of a girl less than 18 years old, who looked
several years older and who was capable, dependable, and handsome. This
girl was still nursing her 3-months-old baby, though arrangements were being
made by her parents and the home for placing him in a foster home for legal
While in high school this girl had become pregnant. Since business reasons
made it convenient for the fam ily to move they came into this State from an ad­
joining one. The young mother’s stepfather (her mother had been divorced and
had remarried when the girl was a small child) had visited the home of the
young man responsible for her pregnancy, had seen him and his parents, and had
learned that he was anxious to marry the girl before the baby’s birth but did
not know her address since her family had moved. His parents were anxious
that their son rectify his injustice to the girl and the coming child by marriage,
and they were willing to give the young couple a start in their home until they
could make their own home.
The girl was told nothing of all this. Her mother felt that the young man was
socially inferior, and she wanted her daughter to complete high school and
enter college; so the girl knew nothing of the opportunity to give her child a
legal status nor of the young man’s wish to make what recompense he could to
her. She stated to the bureau worker in a burst of confidence that she was al­
most insane with fear of being found out, because her family had woven a
fabrication of lies to conceal her whereabouts; also that she loved her baby and,
if she would follow her own inclination, would “ walk out with him and work to
support him ” ; but she felt a deep obligation to her stepfather, who had gener­
ously supported her almost all her life, and he wanted her to please her mother.
Fortunately, this case had to be approved by the county child-welfare board
before the baby could be placed. Otherwise, there would have been no chance
for this young couple to marry and give their baby the protection due him and
their affection and care.
The girl’s family and the maternity home had conspired to permit a child to
be born out of wedlock when they might have been instrumental in giving him
the advantage of legal birth.
Federal Reserve Bank of St. Louis


The terms maternity home and maternity hospital were not defined
in the Pennsylvania law until the enactment of the administrative code
by the legislature in 1923. In this code they are defined as any house,
home, or place in which, within a period of six months, any person
receives for care or treatment, during pregnancy or during or imme­
diately after parturition, more than one woman, except women related
to such person by blood or marriage within the second degree. This
code further provides that the department of welfare shall have super­
vision over all maternity homes and hospitals within the State. Until
the enactment of this code there was no centralized registration of ma­
ternity homes except those which received State aid through the
department of welfare.
At the time of the study statutory provision for licensing all
maternity homes and hospitals and child-caring institutions and
agencies had not yet been made in Pennsylvania. However, the
act which created the department of public welfare in 19211 gave
to that department certain supervisory powers over child-caring
institutions and agencies, and maternity homes were considered
as coming within this category. This department, then less than
two years in existence, was operating under the act of 1921 during
the time when the Pennsylvania institutions were visited by Chil­
dren’s Bureau agents. In 1893 an act had been passed by the
legislature providing for permissive licensing of maternity homes and
hospitals by local health boards. Homes and hospitals licensed un­
der this law were to be subject to regulation and inspection by the
local health boards, and their licenses might be revoked by these
boards. The license \Yas to be renewable every two years at a cost
of $5. Record books were to be kept by the proprietor or superin­
tendent showing the name,' the address, the date of admission, and
the date of delivery of each patient and the date of removal of each
child and the address of the place to which such child had been re­
moved. The passing of this statute indicated a realization of
the problem of illegitimacy in the work of maternity homes and
hospitals and of the fact that special care and protection should be
given children born in such institutions. However, the local health
boards’ lack of facilities for investigating applications and for super­
vising licensed homes and the fact that an incorporated institution
could be operated without a license greatly lessened the effectiveness
of this law.
1Acts of the General Assembly, 1921, eh. 426. In 1923 the title of this department was changed to depart­
ment oi welfare, and power to supervise maternity homes was specifically granted. A law passed since the
study was completed (Acts of 1925, ch. 155) provides for compulsory licensing and inspection of all boarding
houses for children except institutions duly incorporated for that purpose.
Federal Reserve Bank of St. Louis



The 24 homes studied were located in eight counties. Three were
established more than half a century ago and one more than 40 years
ago. Ten homes were opened at various times from 1890 to 1897,
more than half of them through the efforts of Mr. Charles Crittenton.
The other 10 were established since 1890.
Twenty were incorporated and hence were not locally licensed, one
was maintained by an incorporated society, two were licensed, and
one was neither incorporated nor licensed.
Thirteen of the 24 homes were established through religious mo­
tives. Two were established for the purpose of providing medical
care for women, and four to provide medical care and social protec­
tion for unmarried pregnant women. Two of the 24 homes were
owned and managed by individuals for personal profit only. What
purpose actuated the founders of one home was not clear; although
this home had been founded probably with charitable intent, its
policy at the time of the study seemed questionable. Two homes
were originally child-caring institutions.
The original policies had been modified in some of the institutions;
six which at first admitted indiscriminately all types of immoral or
needy women had narrowed this policy and were concentrating their
efforts on unmarried mothers, and a few of these homes admitted
only unmarried women pregnant for the first time. In contrast to
this policy, five of the 24 homes studied accepted both unmarried
mothers and other girls needing care. The youngest girl in any of
the homes at the time of the study was about 12 years of age. One
home had greatly departed from its early policy by adding a depart­
ment for the care of aged women. Eleven homes had made no
change in their early policies.
At the time of the study five of the homes accepted practically all
types of women needing moral regeneration. Five had departments
of child care and accepted children for temporary care. Two which
began as child-caring institutions later admitted pregnant women,
adding facilities for their treatment.
The combinations of service given by the Pennsylvania homes at
the time of the study were varied, their programs showing from one
to four types of service. Two homes restricted their work to one
service— that of the maternity home— providing care for women be­
fore and after confinement. Five homes did two kinds of work, as
follows: One provided maternity-home and hospital care; two gave
maternity-home care and accepted children for care; one gave ma­
ternity-home care and had a department for care of aged women;
one gave maternity-home care and accepted various other types of
women, such as those who were unemployed or who for some other
reason needed the temporary shelter of the home. Ten homes did
three kinds of work: Three of them gave maternity-home, hospital,
and child care; three gave maternity-home care and child care and
did child placing; one gave maternity-home care and hospital care
and did child placing; one gave maternity-home care and child care
and accepted women needing temporary shelter; two provided ma­
ternity-home care and child care and accepted delinquent girls.
Seven homes did four types of work; six of these gave maternity-
Federal Reserve Bank of St. Louis



home, hospital, and child care and did child placing; and one gave
maternity-home care, hospital care, and child care and accepted
delinquent girls.2
The women who were not maternity cases—such as homeless and
unemployed women—were few in number in most homes, and the
tendency was to discontinue receiving them. In some homes the
number of babies cared for was small, and little placing in foster
homes by these homes was done. Some homes were tending toward
the policy of referring problems of child placing to children's agencies,
and some had given up child placing. The most varied combinations
of service were found in some of the largest institutions, where the
staffs were able to give fairly satisfactory supervision to the different
types of work, but several combinations were also found in certain
small institutions having only two workers. In an institution run
by one woman with no assistants three types of service were ren­
dered—maternity-home care, child care, and child placing. The
commercial homes visited were among those doing child placing.
One maternity home which did child caring and child placing had as
inmates a small group of chronic invalids of varying ages and types.
Some of the homes having young dependent and delinquent "girls
and other types as well, provided no segregation for the different
types. Although the workers in some of the homes showed a will­
ingness to admit practically any person to whom they might extend
the facilities of their institution, the admission of other than maternity
cases was sometimes the result of the appeal of other agencies for
help. Instances were found of maternity homes accepting school­
girls and homeless and unemployed women at the solicitation of
courts and private agencies.

The total number of individuals cared for during 1922 could be
ascertained with some degree of accuracy for 22 homes, but the con­
dition of the records of two precluded the possibility of using their
figures at all. The records of 22 institutions during the year showed
that 1,573 expectant mothers, 358 mothers with babies, and 1,389
other inmates, including very young children, older girls, aged women,
and women who were chronic invalids, were cared for in these insti­
The total population of all the homes when visited was 464 women
and 787 children. At this time the maternity hospitals in the State
were crowded to capacity, but the maternity homes were not. These
conditions were more marked in some institutions than in others.
The capacity of 23 3 institutions varied from 6 women and 6 children
to 76 women and 375 children (children of the maternity patients and
those in the institution’s child-caring department).
The 23 homes had an aggregate capacity for 599 women— exclusive
of staff members or other employees— and for 1,000 children.
2In the foregoing classification child care refers to the care of children without their mothers—either
surrendered or committed babies of mothers who were cared for in the home or children accepted from
other sources.
8In estimating the capacity of the institutions one very large hospital was omitted because of the diffi­
culty in ascertaining the number of beds available for unmarried mothers.
Federal Reserve Bank of St. Louis



Of the 24 homes in Pennsylvania which were studied 11 were in
suburban districts, 12 in cities, and 1 in a rural section. Nine were
located in city blocks with no provision for outdoor life except the
rear yards. Three of the city homes, as well as all the homes located
outside of the cities, had grounds varying in extent from one-half
acre to 1 3 ^ acres. Several institutions had attractive grounds, pro­
viding healthful and pleasant diversion for the patients and the chil­
dren. Well-kept lawns, trees, flowering plants, and some provision
for outdoor life were almost universal in places where the space
Almost all the homes were housed in one building. The congre­
gate plan was used entirely in 16 homes (only 1 of these had more
than one building), and 8 used a group arrangement which was very
helpful in preventing certain difficulties of general congregate group­
ing. Although most of the homes using the congregate plan were
small and the types of patients received were not diversified, there
were some in which there was great need for separation of different
types of patients.
The buildings were of frame, brick, or stone construction and were
from three to four stories in height. None of them was fireproof,
although many were equipped with fire escapes. Two had a separate
building used as an infirmary or a hospital. All but two were in
good condition. Only three were built for the purpose for which
they were used.
Most of the homes were lighted by electricity; a few by gas. All
but one used coal or gas furnaces, and some also used grates or elec­
tric heaters. It was noted that several had gas stoves with no vents
for noxious gases. One home was heated by grates, gas and kerosene
stoves, and a coal range in the kitchen.
As a rule the kitchens and the dining rooms were on the first floor
and were adequately lighted aod screened. The equipment was very
good in some of these dining rooms, ordinary in others, and in three
might be described as undesirable. The patients served the meals in
all the homes, and they had the same food as the staff members ex­
cept in four homes; in these the staff members had a separate dining
room. In one home the staff had a separate dining room but the
same food.
One home had all single rooms with single beds. Six had no sitigle
rooms; two had double beds in single rooms and in dormitories; one
had two or three single beds in each room but never permitted more
beds no matter how large the room might be; another sometimes had
three single beds in each room ; and others had from five to nine sin­
gle beds in dormitories. The space between the beds varied from 1
Foot to 4 feet. It was said in all the homes that the windows were
opened at night.
Toilet conveniences were provided in every home, and each had
bathing facilities, some both tubs and showers. One had a wellequipped indoor swimming pool for children and adults, and another
had an outside pool. In some institutions the patients might bathe
when they pleased; in others they were required to bathe daily or
weekly. All homes provided individual bath towels, and all but one
provided individual face towels. It was noted that in order to insure
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individual towels for children in one home a clean towel was provided
each time a child was washed. Hot and cold water were furnished
constantly in all but two homes, where the range fire supplied the
One home had a well and the others obtained water from city sup­
plies. Garbage collection and sewage disposal were under city con­
trol, except in two homes where a cesspool and a septic tank were
used and the wet garbage was fed to chickens.
Sanitation in general was rated as “ good” in all the homes.

A large majority of the homes, 20 of the 24, were controlled by
local boards, 7 of these having cooperative relations with national
organizations and 2 with local religious groups. Two were part of
a national organization and were under its general direction. Two
were commercial enterprises and were not controlled by boards.
Six of the local boards were composed entirely of men, and 10 en­
tirely of women; 4 had mixed membership. Several boards were
restricted to persons of a particular religious denomination ; and other
boards required certain other conditions as to the personnel and as
to the territory to be represented.
Most of the boards were self-perpetuating. A group membership
elected the members of four boards. No special requirements for
membership were noted in seven homes save a denominational mem­
bership. Meetings were usually held monthly.

One of the superintendents was a physician; one had a certain
amount of medical training ; five were graduate nurses ; two were college
graduates; three had had some high-school work and some profes­
sional training as teachers. The others had varying degrees of ele­
mentary, high-school, and college work. Three superintendents had
had definite social-work training, and several others had had some
experience in various kinds of social work. Three had a personality
particularly suitable for their work—sympathy and understanding,
together with background and education. Most of the others had
qualifications which were of value; and it seemed that they would
inspire confidence in their charges, nearly all showing kindness and
consideration for them. Their institutional experience varied from
2 to 33 years. The majority of them were resourceful; but some
seemed to lack initiative, and the two superintendents of the com­
mercial homes were apparently interested only in profits.
Most of the superintendents were allowed a marked degree of free­
dom by their boards, and some had unlimited freedom. Some met
with the boards, one having a vote in the executive committee. Sal­
aries varied from $360 to $2,000 a year, with maintenance, although
five superintendents drew no salary, two of these being the proprie­
tors of commercial institutions and three members of religious orders.
In all the homes except one the superintendents had staff assist­
ants—from 1 to 25. In 13 homes the assistants were chosen by the
Federal Reserve Bank of St. Louis



superintendents, and in the other 10 they were appointed by the board
or with its approval.
The institutions having very large staffs were those which had large
departments of child care. The educational qualifications of many
assistants were limited to elementary-school work; of the assistants
listed in 23 homes, only those in 15 homes had more than a commonschool education.
A number of the homes had assistants who were trained nurses,
particularly homes having large child-caring departments. Four of
the homes had resident physicians. Six had dietitians, trained social
workers, or other types of persons who had special professional prepara­
tion for their work. Six persons were designated as social workers for
work outside of the homes—investigation, prosecution of cases to estab­
lish paternity, placing and supervision of babies, and raising money for
the institution. Two of these six workers had had no preparation
for social work. In several of the homes good work was done by the
superintendents or other staff members in making investigations and
in follow-up work with the mothers. Many of the workers had had
years of practical experience in institutional work.
The duties of the assistants were usually assigned by the superin­
tendents, and they consisted in supervising and training the patients
and caring for the children.. In a number of the homes nurses, grad­
uate and undergraduate, were employed to care for the mothers and
babies. In a few instances, however, this was the duty of untrained
practical nurses.
The minimum salary reported was $120 per year and the maximum
$2,500. This latter salary was unusual, being paid to the director
of the social-service department of a large institution.
In all but one home the patients did some or all of the work of the
institution; in eight homes they received compensation for this work.

Methods of financing the homes included State appropriations of
lump sums, pro rata amounts paid by counties, endowments, contri­
butions of money, food, clothing, and other articles from individuals
and groups, appropriations from community chests and federations,
payments by patients for care, “ surrender fees” for babies, and income
from work done by patients.
Twenty-one homes were financed wholly or in part by public appeals
or through contributions from local community chests. Nine of these
received State aid also, and 12 received city or county funds on a per
capita basis. Two were entirely commercial enterprises, and one was
supported through its endowment and by money received from pav
patients. Finances of some of the homes seemed very involved.
The confusion of the financial and personal records indicated great
need for standards to protect not only the patients but the commu­
nities supporting these homes. The expenditures varied from approx­
imately $1,500 to nearly $80,000. The aggregate amount of State
aid for 1922 was reported to be $34,900. Eighteen had accounts
audited by professional accountants, 9 of these 18 being State-aided
institutions where the books were examined by State auditors.
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In 6 homes no accurate data were available on rates and fees paid
by patients; 3 homes had no fixed rates or fees; 15 received all or
part of the expenses of more than half their patients for the year (485
of 859) either fronv the patients or from their counties.
Fees collected from patients or their families varied from $100 to
$140 each for their care; board from $3 to $35 a week was charged.
In some homes the patients did the housework to pay for their hos­
pital care.

Three homes had an income from the work of patients. In one
home patients were permitted to go out to work, usually domestic
work by the day, the proceeds being divided equally between the
patient and the home. In another home which cared not only for
maternity patients but for other cases all the proceeds of the patients’
work went to the home; most of the work was laundry work, and the
maternity patients were rarely assigned to it. In a third home the
profits from art needlework done by the patients were used for recre­
ational purposes for the group of patients.

The policy of institutions accepting babies of illegitimate birth on
payment of a sum of money by their mothers was found to be still in
use in four of the maternity homes in Pennsylvania. Two of these
were commercial homes and two were under direction of church
groups. The babies were accepted in all of them at any time after
the end of the period of hospital care. The fees were $50, $165, and
$250, and one which could not be exactly determined appeared to be
about $165. At the time of the study the institution charging $250
was not accepting many babies on surrender, and those accepted were
placed in families with wet nurses. The fee was estimated to cover
payment for an adequate period of wet nursing. The institution
charging $50 continued its policy of accepting newborn babies, appar­
ently in an earnest belief that this is a truly good plan for the mother
and for the baby.

In some of the homes a somewhat irregular amount of revenue was
derived from board paid for babies.

Just as there has been no central registration of maternity homes
in Pennsylvania, so also there has been no standard requirement in
the matter of records.4 As a result of these conditions thè records
showed great diversity of form and content.

Most of the 24 homes used a record book, in which entries were
made of dates of admission, delivery, and discharge; name, birth
date, residence, occupation, religion, and nationality of the mother;
* A law passed in 1925.requires that footprints or fingerprints be taken of all infants born in hospitals
or maternity homes (Laws of 1925, ch. 209).
p J
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m a t e r n it y

hom es


Min n e s o t a


Pe n n s y l v a n i a

disposition of the baby; certain facts about the putative father; and
the names and addresses of the mother’s parents or of some other
relative or friend. Very few places sought to ascertain as much in­
formation about the putative father as about the mother. These
books varied from well-arranged records giving definite and concise
information to a few lines giving several items.
In some of the homes the superintendent stated that she could not
place such confidential material at the disposal of the Children’s Bur­
eau agent or that the study of the records was unnecessary, as she
could supply any statistics needed. In 16 homes records of individ­
uals were available and were studied by the Children’s Bureau agent.
In the other 8 homes the superintendent furnished information. In
1 of these 8 there was no history of the mother except her name and
address and the dates of her admission, delivery, and discharge; in
another the only record was a sort of log, from which reliable facts
could not be obtained; in a third the superintendent stated that the
record book was lost ; and in the other 5 the agent was permitted to
examine the files to ascertain the type of records and the method of
keeping them. In 4 of these 5 homes the reports on file were suffi­
cient to supply most of the information desired; but the superin­
tendents preferred giving it themselves to having it procured by the
agent directly from the histories; in the fifth a staff member filled
out a blank from each record for the year.

Records were kept of the prenatal, obstetrical, and puerperal
examinations of patients in all but 4 of the 24 institutions studied in
Pennsylvania. Some of these histories were not filed at the homes
themselves but in the cooperating hospitals where the patients were
taken for confinement care.
Very few records were found giving adequate data on the patient’s
history, social or medical, indicating the care of the patient and plans
for her future. Five places kept chronologically arranged social his­
tories, of which two only were entirely acceptable. Several institu­
tions had summary cards which were well kept, though only minimum
information such as a history face sheet contains was found thereon.
Occasional instances were noted where records were easily accessible
to patients. In one home the superintendent was on the second floor
most of the day, while patients, unsupervised for part of the time,
were on the first floor, where case histories were in an unlocked file.
This superintendent remarked that she noticed evidences of the rec­
ords “ having been tampered with by the girls.”
Only 8 of the 24 homes coihpiled reports. Four of these published the
report annually, 1 biennially, and 1 occasionally; 1 issued a type­
written annual report, and 1 issued a monthly bulletin.

In all the homes studied patients were admitted on their own
application or on that of friends or relatives or at the request of pub­
lic and private agencies. In six homes prospective mothers were
received on commitment from juvenile, municipal, and county courts.
Children were received on commitment in 10 homes. The court
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usually retained jurisdiction in these cases since the commitments
were only temporary. The two commercial homes advertised in the
newspapers and circularized physicians.
Social investigations of the patients before admission or after were
made by a qualified staff worker or a standard social agency for only
six homes. In 10 homes there was no attempt to investigate the
patient’s history, and in the rest an interview by the superintendent or a
letter of inquiry was the only effort made in this direction. A few
superintendents thought that any investigation would violate the
confidence of the patient. Only 8 of the 24 homes used the socialservice exchange to identify cases.

Eight homes limited their intake to white women. Two were
homes for colored women, and they rarely had any other patients.
The other 14 accepted both white and colored women, and two had
separate dining and sleeping provision for the two races.

No religious lines were drawn in any institution, although in most
homes all patients who were able to do so were expected to attend
religious services in the home. For this reason one superintendent
endeavored to take only girls of the same faith as that of the religious
group operating the institution.

No homes had fixed minimum or maximum ages for maternity
patients nor for the other types of women admitted. Most homes
caring for children had a limitation as to the ages of those to be
admitted. The maximum age varied from 2 to 6 years. In a few
homes dependent, ‘ ‘problem,” and delinquent girls were admitted as
young as 12 years. The preference of the management of most homes
seemed to be the young woman, unmarried, who was for the first time
pregnant or a mother, as she was believed to be the most hopeful
type for reconstructive effort.
ratients in any stage of pregnancy were admitted to all the homes;
one home preferred them to enter as early as possible and two did
not really wish them to enter before the sixth month.

All the homes accepted patients from throughout the State, though
several gave preference to those living in the vicinity of the home.
Seventeen accepted without restriction patients from other States.
A few endeavored to return girls to their own localities, within the
State, by transferring them to other institutions.
Marital status.

Although the unmarried mothers constituted the major proportion
of patients in all the institutions visited except the large hospitals,
married women were accepted when the services of the home could
help them over some trying period. Only one home preferred not
to accept any married women. These women were never required
to stay through a fixed period of time, as the unmarried mothers
usually were, and little was done for them except to give them phys­
ical care.
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Previous pregnancies.

Six homes refused to care for unmarried women during more than
one confinement, some even limiting their care still further by refus­
ing to admit an unmarried woman pregnant after the first time
whether they had cared for her previously or not. Eighteen homes
accepted women in pregnancies other than the first one. Eleven of
these limited acceptance of such patients to those who had not been
in their institutions before. One home was willing to receive the
same woman in a later pregnancy unless there happened to be in the
home a patient who might know the earlier circumstances.
M ental defectives.

All the homes except two admitted mentally defective girls, unless
their mental condition was such as to create difficult problems in
their care. In several homes women were noticed, undoubtedly
mentally defective, who had remained in the institutions for a period
of years. In one home a woman had remained 18 years. Some su­
perintendents stated that they took these cases only in emergencies
or to accommodate social agencies. They were'not segregated.
Communicable diseases.

Eleven homes accepted ratients having communicable diseases;
two of these did not exclude cases of any such disease, and nine ex­
cluded all cases of communicable disease except syphilis and gonor­
rhea. Of these nine two accepted syphilitic cases, one accepted
cases of gonorrhea, and six accepted both. It was claimed in 10
homes that physical examination and a certificate of freedom from
communicable disease were required for admission. Usually the
examinations were made by a private physician—sometimes by
order of court, if the patient was committed by the court. These
requirements Were not inflexible except in three homes.
Four homes did not receive patients with syphilis and were vigi­
lant about observing this rule. Eight homes claimed that they did
not accept such cases, but on one pretext or another patients with
syphilis had entered, sometimes without the knowledge of the staff,
as the medical examinations on entrance were too cursory to detect
all such cases. Twelve accepted syphilitic patients and treated them
in the home, the municipal hospital, or a shelter prepared to receive
them or had them treated in the State clinic for venereal diseases
until the disease was noninfectious. Most of the homes that took this
precaution were in the eastern part of the State.
Seven homes rigidly maintained a quarantine against patients with
gonorrhea. In six homes it was claimed that patients with gonor­
rhea were excluded, but the examination of patients on entrance was
so superficial that the statement about exclusion of these cases
seemed questionable. Eleven homes received and treated patients
with this disease, keeping them in careful isolation. The 13 homes
which did not treat such patients transferred them to a municipal hos­
pital or shelter for treatment until the disease was noninfectious.
In every home any patient suspected of having an infectious dis­
ease other than venereal disease was isolated until a diagnosis was
made and the case finally disposed of by order of the attending
physician or the local health board.
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Menus were obtained from all the homes except three, and the
diets were rated according to the plan shown on page 5. The diet
situation was similar to that in Minnesota. More milk should have
been used— as a beverage and in cooking—'and more vegetables, eggs,
fruit, and whole-grain cereals. The diets were rated as follows:




pregnancy lactation

A dequate_______________________________________________



Probably adequate____________
Possibly adequate________________________
Probably inadequate_________________





All milk was Pasteurized, and its analysis and the testing of the
cows for tuberculosis were supervised by the local health authorities.
No institution owned cows at the time of the study; one had recently
been obliged to get rid of them, as they had been condemned as a
nuisance because of the flies they drew.

Physical examinations were given by all the homes. If the patient
was not examined on entrance there might be a delay of a few days
until she could be taken to a prenatal clinic or until a visiting phy­
sician could be called. Fourteen homes detained patients in isola­
tion until the first examination had been made; one was not very
particular about this precaution; and nine made no pretense of pro­
tecting the patients already in the home from possible infection.
The examination given was fairly complete; it included pelvic
measurements in 23 homes, urinalysis and blood-pressure reckonings
in all, routine Wassermann blood examination in 11, and Wassermann tests of the placental blood in 6. This was an indication of
the effort made to insure treatment of patients with syphilis.
Seven homes were careless about taking a routine vaginal smear,
with the result that a patient with gonorrhea might be given the
freedom of the home and other patients might be exposed to this
disease. Besides the patient with gonorrhea might thus remain un­
treated, not only to the harm of herself but also of her child at birth.
Seventeen homes were careful about this procedure, reflecting credit
upon their medical advisers.
In one home it was a routine procedure to give each patient a
Schick test and, if the result was positive, to immunize the patient
against diphtheria with toxin-antitoxin injections. It was also the
regular practice to vaccinate against smallpox each patient on entrance.
Five institutions had fully equipped laboratories and three others
had the use of the laboratories of private physicians. The remainder
were dependent upon the public laboratories of the State, borough,
or city health departments.
The superintendents said that the physicians gave advice and rec­
ommendations for the care and treatment of each patient individually.
* three homes definite rest periods for pregnant women were proyvided; in three others most of the afternoon was free for reading,
sewing, or other personal activities; and in another all pregnant
women or nursing mothers were_instructed to report any illness or
indisposition in order that they might be given attention and relieved
Federal Reserve Bank of St. Louis



of work. In one home a patient might go to her room at any time,
and if the work that she was doing had to be done at once she would
report to a staff member to obtain relief from duty.
For the most part examinations were made regularly— weekly,
biweekly, or monthly. Fourteen homes had all examinations made
in the borne itself, eight had the patients attend an outside clinic,
and two sent them to an outside clinic until late in pregnancy and
then had medical attendance in the home.
Three institutions had no record forms for prenatal examinations,
and only by questioning the physician and the nurse could any con­
clusions concerning this important examination be fairly drawn. All
the homes claimed that the prospective mother was given necessary
instruction about her physical condition. Only one home was
found where routine psychometric examinations were made before
entrance, though a number of homes referred patients who gave evi­
dence of mental abnormality to clinics for mental examination.
Two places had fully equipped dental clinics to which dentists
came regularly. Three had arranged for outside dental service.

In 19 homes the physician that made the prenatal examinations
also made the delivery. In 5 these two services were performed by
different physicians; however, except in 2 homes, the obstetrician
was informed of the history of each case, including the results of the
prenatal examinations. From 12 homes patients were sent to hos­
pitals for delivery; in 12 delivery took place at the home. The hos­
pitals used were modern ones and their delivery technique was rated
as “ excellent” or “ good.”
Of the 12 homes where delivery took place the obstetrical procedure
in 9 was “ good,” in 2 “ fair,” and in 1 “ poor.” Twelve had one or
more graduate nurses, and there was an average of 5 patients assigned to
each nurse for care. Two had hospital buildings. In two the delivery
room was “ excellent,” and in 2 it was “ fair.” Two were poorly
equipped for sterilization; but all the other equipment for delivery,
both ordinary and emergency, was rated “ excellent” or “ good.”
Four homes had no medical record forms— prenatal, obstetrical,
or puerperal.
Patients remained in the outside hospitals for an average stay of
13 days, but those of one maternity home returned from the hospital
to the home about three days after delivery. Patients delivered in
the homes received 14 to lb days of bedside care.

The care of the babies varied greatly; it was “ excellent” in 4
homes, “ good ” in 16, “ fair” in 3, and “ poor” in 1. In 20 homes
the babies were kept in nurseries; in 2 they were in nurseries in the
daytime and with their mothers at night; in 2 there was no nursery.
As a prophylactic against ophthalmia neonatorum the physicians in
nearly all the homes used silver nitrate; argyrol was used in two homes.
At the time one home was visited there were in the crowded nursery
8 babies, 4 of whom had acute ophthalmia, and another baby, new­
born, in a private room, had a very severe inflammation of the eyes
which gave indications of being gonorrheal ophthalmia.
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Four homes had no record form for the baby (the same homes which
had no record of the prenatal examination of the mother). Births
were registered by all the homes.
No training in infant care was given the mothers in 3 homes; in 4
they received only a few demonstrations. In 17 they were carefully
taught, and they bathed and dressed their babies every day.
All the superintendents asserted that breast feeding was encouraged,
at least for a short time, 10 days being the minimum and a year the
maximum period for it, according to the physician’s orders. One
institution arranged for wet nursing if it became necessary.
The average technique in bottle feeding was good; only two insti­
tutions were poor in this respect. Infant feeding was done under
the direction of the visiting physician except in 7 institutions where
no bottle feeding was necessary because infants under 1 year old
either were breast fed or were not kept in the home after being weaned.
In most of the homes the children over 1 year of age were fed milk,
soup, vegetables, cereals, eggs, some meat, and bread and butter.
Weighing and measuring of the children in these institutions as a
check upon their growth and development was not regularly done.

Not all the institutions conformed to the ordinary public-health
regulations. This was due probably to the fact that the superintend­
ents lacked special training and did not realize the importance of these
regulations in preserving life and health.

The study included 1,492 livebirths and 35 stillbirths. There were
four maternal deaths— two caused by pneumonia, one by eclampsia,
and one by spinal meningitis.5
Among the infants born in the homes or in hospitals connected
with them or received into the homes after birth 160 deaths occurred
during1 1922. Unfortunately, it was not possible to compute from
these figures any mortality rate as the data for an accurate count of
the numbers exposed to risk at various times in the first year were
not at hand. However, for a limited group in 13 homes a compari­
son was made with the mortality in the State and in the birth-regis­
tration area. During the first three months of life, for which alone
the number exposed to risk was large enough to be significant, the
number of deaths in the homes was found to be 32. This figure con­
trasts with 16.6 that would have been expected at thé rate prevail­
ing in the State as a whole, and with 15.4 that would have been
expected at-the rate prevailing in the birth-registration area.

The daily program in the homes varied. The usual rising hour was
from 6 to 7 a. m. Meals were served at approximately 7 a. m., noon,
and 5.30 p. m., with the day chiefly occupied in cooking, washing, and
sewing, and other ordinary duties of the household. Evenings were
6These figures do not include information on two homes, one of which was the largest studied.

96892°— 26t------5
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spent in group recreation or in religious services, which all patients
were expected to attend if they were able. There were four excep­
tions, the two commercial homes, where religious matters were not
given attention, and two homes in which as a matter of policy pro­
vision was made for sending all patients out to their respective
churches to Sunday morning services. Several other homes permitted
patients to go out to their churches, but only these two made it a
point of general policy. One home made a point of club work and
educational work, such as the teaching of English. In two places
educational talks and lectures were scheduled for both mornings and
afternoons in order to break the monotonous routine.
Formal rules to be observed by persons admitted to maternity
homes for care have become less prevalent in recent years than for­
merly. They were found publicly posted in only 4 of the Pennsylvania
homes; in 3 homes patients were required, on admission, to sign copies
of the rules; in 17 homes there was an entire absence of any formal
rules and regulations. The posted “ regulations” seen on each floor
of one home referred to the patient’s household duties, her responsi­
bility for the care of all the babies in the home, the time which she
would spend away from the home for recreation and other purposes—
arranged regularly once a week— and the responsibility of each pa­
tient to attend her own church.
As in the matter of regulations great changes were apparent in the
freedom allowed patients to be absent from the home. In 14 of the 24
homes patients who were dependable were allowed to go out to
church, and for various other purposes, unaccompanied by officials of
the home.
In almost all the homes a definitely assigned day and hour was
reserved as the regular visiting time, Usually one afternoon each week.
In several places there was but little restriction on visitors; one home
limited the time when visitors might be received to one day a month.
The superintendent of this place objected to the disciplinary problems
created by a general visiting hour and said that it had a disturbing
influence on the girls. In two of the homes each girl selected a vis­
iting time once a week and invited any person she wished to visit
her. All the superintendents were willing to allow the relatives of
patients to see them at times other than the regular visiting hours.
In two hospitals and in the two commercial institutions no super­
vision was exercised over the mail of patients. In most of the other
homes, however, all incoming and outgoing letters were censored or
at least carefully observed. Several superintendents used discrimi­
nation in the matter, not opening the seals on either incoming or out­
going mail.

Only a few homes had definite training courses. Housework was
the subject chiefly emphasized, some homes providing definite train­
ing jn cooking and sewing and other lines of housework. In four
homes patients were assigned to work under direction and were given
training in this way. Six homes had no program for any training or
work under supervision. Some homes had programs of special value,
such as that described on page 68; one had a class for training nurse­
maids, which provided an opportunity for the untrained young mother
to prepare for well-paying work and have a home for herself and her
Federal Reserve Bank of St. Louis



baby during the period of preparation; one home provided a class for
nurses’ aids, to which unmarried mothers were admitted.
In four homes some attention was given to elementary education,
although it was not regular in any of them. Classes provided by
sources outside the homes were rarely used. One home sent patients
to a dressmaking class in a near-by public school.
Instruction in the homes was given by staff members, by teachers
engaged for the purpose, and in a few instances by volunteers.

In most of the homes recreation was limited to group recreation in
the evenings, when patients gathered in the living room under super­
vision of a staff member. All the homes had musical instruments—
most of them pianos—and two had radio receiving sets. Two homes
that had child-caring departments showed good motion pictures.
All the homes planned some outings during the summer months, but
only a few had developed any other recreational activities outside of
the institutions. Two had well-defined programs which provided for
regular attendance at theaters, motion pictures, and concerts for all
patients whose condition permitted it, and one other home arranged
for patients to go occasionally to the theater. Staff members chap­
eroned patients at all outside recreation except in one home, where
chaperonage was trusted to patients who had been made “ trust
officers.” Meetings of Y. 'W. C. A. clubs were attended by the
patients of two homes. Volunteers planned parties and other rec­
reation in several homes; in one of them a club of the girls gave an
entertainment each month. One institution made use of a circu­
lating library. The superintendent of another had a “ reading hour,”
at which standard literature was read and discussed. Many homes,
however, had no good books.

Ten homes endeavored to retain mothers for periods of care rang­
ing from two to six months after the babies’ birth, largely to promote
breast-feeding; five discharged the patients any time after they left
the hospital; nine had no set time for discharge, but theoretically at
least preferred to have mothers remain through the nursing period.
Thirteen superintendents were willing to transfer cases to agencies
interested in them; one held the patient for its required period of
stay before transfer— that is, two months after the birth of the baby:
one allowed patients over 16 years of age to decide whether thé
assistance of an outside agency was desired; three settled each case
in conference ; and two settled each one in accordance with the patient’s
wishes. Information on the other four was not available.
Discharge was influenced by financial considerations in three homes;
two of these homes accepted but did not insist upon six months’ serv­
ice from a mother in lieu of payment for obstetrical care; the other
required three months’ service from every mother for whom the home
placed a baby.
Of the total number of mothers (1,862) accepted during the year
-108 left the home before delivery. The chief reasons given for leaving
:were that the patients were venereal-disease cases and had to be cared
for elsewhere, that suitable plans had been made for their transfer to
other places for care, or that the patients were dissatisfied with the
Federal Reserve Bank of St. Louis



home. Dissatisfaction seemed particularly in evidence in one home,
where an exceptionally high proportion of patients— 14 out of 57—
left before delivery.
The homes where the average stay of the patients was shortest
kept them for an average of 4 weeks. One home kept its patients
for an average of 18 weeks— the longest average stay for the 24
homes studied.
In 17 homes there was an understanding that the mother might
return for advice for herself or her child, and several of the hospitals
would receive the mother or the baby again if need arose due to con­
ditions resulting from the birth. Two homes had no interest in the
physical welfare of the mother or baby after they left the institution.
Thirteen homes tried to retain an informal contact by such means as
correspondence, return visits of patients, and personal association.
Six used local social agencies, but only one of the six had a definite
system of referring all discharged patients who were unmarried to a
social agency. Three homes included on their staffs workers for this
follow-up. One depended on volunteers. In seven homes no effort
was made to keep in touch with discharged patients.
On the basis of cooperation with local and State agencies the
homes may be rated as follows: Sixteen good, 3 fair, and 1 poor; 4
were too little used by any agency to be rated. Only two of the
superintendents seemed to appreciate the relation of their work to
the community at large. Most of them thought only of the individ­
ual girl and her baby as persons to be assisted by kind treatment,
by religious reclamation, and by the observance of a more or less
regular orderly routine of household duties. Few homes took active
interest in helping to form public opinion or to obtain needed legis­
lation and its enforcement.

In the State department of welfare responsibility for all child-welfare
work is delegated to the bureau of children. The director of this
bureau has a corps of workers who visit institutions, including mater­
nity homes. Regional conferences are held which bring together
groups of institutional workers for discussion of their common prob­
lems and their varying methods of work. Local child-welfare com­
mittees, which are unofficial, have been organized throughout the
State to act in an advisory capacity to the State bureau of children.
The Pennsylvania law does not require the formality of commit­
ment with a permanent record for transfer of guardianship for chil­
dren, nor is there any statutory provision governing supervision of
placed-out children by private agencies. Under the adoption stat­
ute the entire proceeding of legal adoption of children rests with the
courts, the petitioner, and the child’s parent or guardian. No defi­
nite period of residence in the petitioner’s home is required, nor
investigation into its fitness, nor of the suitableness of the child for
The law providing for support of children born out of wedlock pro­
vides that the complaint be filed by the mother of the child.
6By Act No. 93, Laws of 1925, the court hearing the adoption petition is given power to make an inves­
tigation (or to cause some specifically designated person or agency to do so) to verify the statements of
the petition and collect such other information as will give the court full knowledge as to the desirability
of the proposed adoption.
Federal Reserve Bank of St. Louis




Four homes accepted babies on surrender from their mothers for
fees varying from $50 to $250. Three discharged all babies with
their mothers, one of these referring to a social agency any mother
who wished to dispose of her baby and two insisting that the mother
must retain her baby through the nursing period before any other
plan was considered. These two homes endeavored to keep in touch
with their cases after discharge, particularly those in which there was
any question as to the advisability of the baby’s remaining with the
mother, sometimes, after a period of observation, agreeing to relieve
her of the child. In these two homes the nursing period covered at
least six months, and the period of observation was such that babies
under 1 year of age were practically never accepted on surrender.
Eight homes which had a policy of insisting on breast feeding for
varying periods of time accepted babies on surrender after the nursing
period if the mothers felt that they could not keep them. Six homes
had no definite policy relative to acceptance of babies on surrender,
leaving matters to be worked out in each individual case by the
superintendent or the board; four of these homes rarely accepted a
In cases of legal adoption seven homes required that surrender be
made directly to them; nine homes had policies of having mothers
surrender the babies to placing agencies; and four homes required
that the baby be surrendered directly by the mother to the foster
parent. In one of the last group— a commercial maternity hospi­
tal— a singularly indirect method was used. The surrender was
signed by the mother before she left the home and the space for the
name of the person to whom the baby was to be surrendered was
left blank. The names of the prospective foster parents were filled
in later when they made application to adopt the baby. The child
was thus legally adopted without execution of the mother’s surrender
of her baby by affidavit before a notary, even this safeguard appar­
ently being waived in some of the courts of record in Pennsylvania.
Of the 1,862 mothers cared for in 22 maternity homes during the
year for which figures were obtained 312 were discharged without
their babies. Fifty-nine babies were stillborn or had died before
their mothers left; 253 were placed in foster homes or boarding homes
or were retained in the maternity homes. The number retained in
the maternity homes was 146, of whom 120 were surrendered to 12
institutions and 26 were kept temporarily, free or at board, for the
mothers. The records of four homes indicated that no babies were
kept after the discharge of their mothers and that two of these homes
gave as the reason for discharging mothers without their babies the
mental defectiveness of the mother. Two instances of this sort
occurred in one home, where the babies remained in the institution
after the mothers left, and one in another home, where the baby was
taken by relatives.

Twelve maternity homes placed 128 children in free foster homes;
8 placed 43 children in family boarding homes. 'Seventy-four chil­
dren were adopted from 7 maternity homes; 36 of them were from
Federal Reserve Bank of St. Louis



one home with a child-caring department not limited to children born
in the home. The following tables give the ages of children when
placed in free foster homes and in boarding homes:
Ages at which children were placed from maternity homes in free foster homes
Children placed in free foster homes
Age at time of placement

3. ____


8........ .


12 ........


17 days—9 months.
3—6 months.
One at 2 months; ages of three not in records.
14 days to 5 months.
20 days to 3 months.
2^—10 months.
Ages not given (it was stated that children were usually about 1 month old when
2—7 months.
1 month—4 years.1
12—16 days.
Four under 1 year and eight over 1 year.
Under 4 years.1

1 No differentiation was made as to children of maternity patients and those in department of child
8 A general hospital.

Ages at which children were placed from maternity homes in hoarding homes
Children placed in boarding homes
Age at time of placement

B_.......... .
C i............
F ______

4}^ months.
24 days.
12 days and 22 days.
2 months.
8 months.
Age not in records.
17 under 1 month—wet nursed; 12 between 1 month and 1 year, all boarded after
nursing period.
5 2—3 weeks.


i A maternity hospital.

8A general hospital.

The methods used by the institutions to find foster homes varied
only slightly. Eight relied solely on personal contacts with friends
of the institution; four advertised in newspapers, as well as finding
some homes through personal contacts; three referred every mother
who wished to place ner baby to a children’s agency, which dealt
with both mother and child. The management of six homes after
approving the separation referred the mother to a placing agency or
transferred the baby to it.
Fourteen homes placed babies— either directly or through placing
agencies— only with persons living within the State. Seven homes
had no restrictions as to the State, although five of them used only
homes which were accessible for visit (unless the homes were
known to be unusually good ones, with favorable prospects of legal
Three homes placed babies only on the condition that they be
immediately adopted, thus eliminating the necessity for any super-,
vision. Four homes did follow-up work, which was, however, so
vague and indefinite that it could be of little, if any, value. Eight
Federal Reserve Bank of St. Louis



homes delegated the work of supervision to children’s agencies, five
of which did standardized work. One of these agencies, which did
the placing and supervision of placed-out babies for two of the homes
visited, had all this work done by volunteers— board members,
whose services rotated, new members being appointed monthly—so
that the children, quite conceivably, might not have had the same
visitor for any two visits. No records were kept; these volunteers
reported orally to. their headquarters, where there was a full-time
One home made a practice of removing from a family any child
who had not been legally adopted after a placement of one year.
One home having a department of child care continued supervision
of children until they were legally adopted or had reached the age
of 4 years, when the custody was transferred to a children’s
agency. One of the hospitals doing child placing had on its staff a
nurse with no training in social work, who made all investigations of
prospective foster homes, decided with the mothers when babies
were to be accepted for placement in boarding homes or in foster
homes (without making any effort to develop any other resources
for the children), and supervised the placed-out children. She
stated that the longest period of time she had ever had to supervise
a placed-out baby, before legal adoption, was four months. One
institution used volunteers, under direction, for investigation of foster­
home applications and for supervision of the placed-out children.
Oral, reports were made by these volunteers to the secretary of the
institution, who added these reports, in her own wording, to the
records of the children.
Since there is no requirement in the Pennsylvania law that persons
wishing to adopt a child should care for that child in their home for
a definite period prior to filing a petition for legal adoption, diversi­
fied policies have developed throughout the State. Many of the
children’s agencies which do conscientious and careful work have
developed a policy of requiring a residence of one year in the home
before legal adoption will be agreed to, except in unusual cases. A
few superintendents of homes followed this policy, believing that it
was a statutory requirement.

The records in the homes gave, on the whole, meager information
on establishing paternity. In 3 homes the statement given as to the
policy followed was that nothing was done to reach the fathers of the
babies; in 1, that mothers were advised of the law and its provisions;
in 8, that mothers who wished to take action were assisted by being
taken to court; in 10, that such mothers were referred to a social
agency; in 1 home the information given was so vague that the policy
could not be determined; in 1 home each case was settled on its
merits. A study of the records of 16 homes in which- the records
were available for study showed that the records of 6 homes included
no information on paternal responsibility, either voluntarily or legally
determined; the records of 1 contained certain notations which were
too vague to be of any use; and the records of 6 had available data
on this point. These 6 homes had cared for 344 unmarried mothers
during one year.
Federal Reserve Bank of St. Louis



In 259 of these cases no efforts were made by the home, either
through court action or through private agreement, to establish
paternity. An analysis of the action taken in the other 85 cases
shows that marriages or agreements of some sort—such as cash
settlements— were arranged through private efforts of the home in
16 cases, that court action was taken in 45, and that in 24 some
action was taken, the exact nature and result of which were not given
on the records. Of the 45 cases* brought before the court 22 were
still pending at the time the records were studied. What action was
taken in regard to 26 was not stated. Orders for support, varying
from $1 to $7 a week, had been entered in 10 cases; settlements of
$300 in 5 cases and of $500 in 1 had been made; marriages had taken
place in 2 cases; in 2 cases the men involved had been sentenced;
and 1 case had been dismissed.
These figures are taken from records, but for several reasons they
do not present a complete report on the outcome of the efforts to
establish paternal responsibility. In some homes which referred the
establishment of paternity to outside agencies the action taken and
its results were not entered in the records; in other homes the action
was entered, but not the result, because the patient had left the home
before a decision was reached. It is quite probable, also, that a
certain number of the putative fathers, either directly or through the
mother or her family, paid hospital expenses, although the mother
had been accepted as a private patient, or, in some of the maternity
homes, the regular rate. It is possible that some men paid the
surrender fees in homes in which babies were accepted under this


H om e I

This home was well located in a beautiful suburban section of a city. The
main building, formerly a handsome residence, had been equipped for maternityhome use without regard to expense. There were two smaller buildings. One
of these had been converted into an infirmary, and it had provision for necessary
isolation. It was modernly and even elaborately equipped, so that it might be
operated with a minimum of workers. The glass-walled ward and cubicles made
it possible for the trained nurse to supervise the entire corridor. The wellarranged facilities, such as sterilizer and utility room, baths, and laundry, made
it easy to manage the routine. The steam-laundry equipment included a small
vat for antiseptic solution. The sleeping apartments were in suites with baths
in each. There were never more than three persons in one room and never fewer
than two (except in isolation rooms), so that sleeping quarters were not crowded
and bathing facilities were adequate. Minor operations were performed in the
infirmary, as it had facilities for emergencies. There was no delivery room, the
patients going to a modern hospital, where the best confinement care is given.
They were brought back from the hospital in a few days and were cared for in the
infirmary during convalescence. The other building was a small cottage in which
a group of older children lived with their mothers.
7Besides the homes studied an institution was visited which, although not really a maternity home, met
a distinct need in the field of maternity-home service. Other provisions in the Community for prenatal
care madeit unnecessary for this institution to accept any appreciable number of “ waitingmothers,” but
it rendered real service to new mothers, many of whom needed convalescent care, which is not supplied
in most maternity homes and which is inadequately provided for in nearly all communities. Ideal
physical equipment, occupational therapy, provision for teaching the care of babies and some branches of
household work, all made for the satisfaction and gain of the patients. A routine was arranged for each
patient individually according to her strength. The presence of a special “ mothers’ building ” in this insti­
tution, with unmarried mothers accepted on the same basis as married mothers—that of patients need­
ing convalescent care—constitutes a valuable asset in this field of work.
Federal Reserve Bank of St. Louis



•The grounds were most attractive. They were well equipped for recreation
for mothers as well as children. A vegetable garden was provided, as well as
flower beds, trees, and shrubbery, and small individual or group flower gardens
for which children made themselves responsible. The products of the children’s
gardens were always their own.
Originally the home was a child-caring institution housed in a down-town
section of the city. Among the children admitted for care then were babies
of illegitimate birth who had been early separated from their mothers. The
superintendent in charge at the time of the study had formulated plans for re­
ceiving the mothers with the babies. Her reason was twofold: To help meet
the mother’s need for assistance in the trying experience of illegitimate mother­
hood and to conserve for the child the invaluable asset of nurture and care
by his mother. Accordingly, the board of directors decided in 1916 on this
addition to the work. At the time of the study the home had two departments
of work— the maternity home and the department of child care. The latter
was not limited to care of children of the mothers in the home, but was a
general child-caring home.
The home was part of a local federation of charities but had a separate board
of directors. Besides the superintendent, the staff included an assistant super­
intendent, five graduate nurses, a dietitian, and a house mother. Funds were
raised by the federation of charities. A pro rata sum was paid by the county for
committed children. No rates or fees were charged the maternity patients
though any mother whose circumstances permitted might make a contribution
to the.home.
Admission restrictions were very few. Only white women were admitted, and
none with any communicable disease. Most applicants were received through
cooperating social agencies, and they had had an examination showing that
they were free from infectious disease. However, isolation facilities were main­
tained, and a complete examination was given by the attending physician.
Girls in pregnancies other than the first who had been cared for elsewhere or even
in this home previously were admitted if there were no girls in the home who
knew them. No distinction was made between married and unmarried women,
although few married women applied for admission.
Prospective mothers were admitted at any time. The superintendent preferred
having them enter early in pregnancy. Mothers with young babies were also
admitted from hospitals. Preliminary social investigations were not always
made, though case investigations were part of the routine. These investigations
included visits to relatives if they were living in accessible places. On admission
patients were asked to remain for one month after delivery (except the few
committed girls, who understood that they were obliged to remain longer).
At the expiration of that time, or just before, plans for further stay were made
by the superintendent with the girls.
Though the capacity was 35 mothers and their babies, the total number of
mothers cared for the year before the study was 56, A number of cases were
noted in which girls who could not adjust themselves to other institutions were
sent to this home by courts and from private sources. This group included a
few delinquent girls with sex experience.
Thorough physical examinations led to the correction of many defects, and the
best possible preparation was made in each case for the unborn child. If a
patient became toxic, she was sent to the infirmary and was placed under special
care by a physician.
Dental attention was given whenever necessary, and an ophthalmologist gave
part of the specialized care which the patients received. Psychometric examin­
ations were included in the routine, and the service of a psychiatrist was obtained
if needed. If it became necessary to have after-puerperium care the mother
and nurSing baby might return to the infirmary.
Breast feeding was the rule. There were several factors contributing to its
success, including a pleasant, healthful rural environment and hygienic prepara­
tion for confinement. The fact that the length of stay in the home was determined
entirely by consideration of the future welfare of the mother and the child was
a determining element in the mother’s mental attitude.
The diet of this home was classed as “ possibly inadequate” (seep. 6) for
both pregnancy and lactation and was regarded as probably the poorest phase
of the work. In an effort to insure contentment and cooperation the girls were
allowed to eat the food to which they had been accustomed in their homes.
For example, no citrous fruits were served at breakfast because the girls did not
Federal Reserve Bank of St. Louis



care for them. The menu for at least one meal a day was chosen by the girls.
Though such a practice might help to make them contented, it is, nevertheless, not a
practice that would lead them to eat properly for pregnancy and lactation. As
the children had no such inclinations to overcome, they were fed according to
good judgment. A garden on the premises furnished fresh vegetables in abun­
dance during the summer.
The best understanding of public-health measures was shown here of all the
places visited in Pennsylvania. The members of the staff not onlj7 observed
ordinary prophylaxis but seemed to know why they were doing so.
Physicians gave lectures to the household regularly upon different subjects—
emergencies, personal hygiene, and general rules of health, as well as some tech­
nical lessons in first aid— to instruct those who probably had never had any traming in physiology and. hygiene. At the close of the lecture there was often a
demonstration and a quiz. The superintendent believed that such instruction,
the subjects of which were chosen to meet the needs of pregnant women and
nursing mothers, had a greater weight when given by the visiting physician
than when given by herself and the trained nurse.
The policy of the home was to foster the mother’s responsibility with a view
to procuring for the child permanent care by his relatives and also for the moral
influence on the mother. Among the 43 cases disch arged the year before the
study there were only 2 separations of babies from their mothers. In. both
cases of separation the mothers were mentally defective and were committed to
institutions. These babies were retained in the home, on surrender by their
mothers, to be cared for until their mentality could be studied and permanent
plans for them decided.
Effort was made to fix paternal responsibility. The superintendent endeav­
ored to see the fathers and have them come to the home to see their babies.
She stated that in about one-third of the cases the fathers either voluntarily
assumed responsibility for support of the baby or were compelled through court
action to do so.
. . , '
The daily routine practically covered the day from the rising hour (b a. m.)
until 7 p. m. Besides the meal hours a break of two hours was provided in the
morning and again in the afternoon. These periods were used for varied pur­
poses— rest, lectures and conferences, recreation, or personal pursuits.
Assignments to the work of the home were correlated with plans for training the
mothers for future employment. This home had unusual provision fpr this pre­
paration. There were seven distinct lines of training: Care of babies; care of
older children; housework and sewing, including operation of power sewing
machines, cooking, and laundry work; industrial art; and special types of prep­
aration selected by the girls with the help of the superintendent.
The courses of training were given under direction of the staff. Care of babies
was taught by nurses; housework, sewing, and operation of the power sewing
machines by the house mother; cooking by the dietitian; the course in training asi a
child’s nurse was given by-doctors and nurses; industrial art was taught by the
superintendent; laundry work by an employee who was in charge of that work
under supervision of a staff member. The course in the care of babies was the
only one which all patients were obliged to take. Any of the others were chosen
in conference with the superintendent, according to each girl’s aptitudes and in­
clinations. An instance of special preparation for future employment is that
given three girls living in the home with their babies at the time the study was
made. They were attending a preparatory school to complete high-school work,
which was required for positions which they expected to fill later.
Instruction was provided for girls who had not had even rudimentary school­
ing. At the time of the study the services of a volunteer teacher were utilized,
while the management was endeavoring to procure assistance from the State de­
partment of education. When the home was located in the city girls had attended
night classes in the public schools.
The average period of stay in the home was about 18 months, so that most oi
the girls had ample opportunity to complete several of the courses.
All the girls in the home were urged to become members of a club that had as
its purpose self-government and recreation. The club planned and carried out
entertainments in the home and arranged for outside recreation. The members
were instructed by the staff in principles of social organization and management.
Much freedom was permitted. Recreation was well planned, the program in­
cluding entertainments within the home and also attendance at concerts, plays,
and motion-picture shows. A great deal of time was spent out of doors, both in
work and in recreation. Although patients were permitted to go out alone for
Federal Reserve Bank of St. Louis



certain purposes, the recreational activities outside of the home were usually ar
ranged for groups accompained by a staff member. The home had a very liberal
policy of arranging for attendance at religious services; any clergyman might
come to the home by appointment for conference with one or several of the pa­
tients of his religious group. Girls went usually unaccompanied to their respec­
tive churches. The staff appointments were made with a view to having on the
staff Catholic, Protestant, and Jewish officers for contacts with girls of their own
faith. This deference to religious practices is a most significant departure in
maternity-home work.
, ,
No formal regulations were posted. No general visiting day was set, but pa­
tients selected one afternoon each week and invited their friends to call at that
time. This obviated certain difficulties resulting from bringing together relatives
and friends of different girls and protected the privacy of each one with her own
^Particular attention was given to mentally defective patients. An effort was
made to make their families realize the need for close supervision or for institu­
tional care when that seemed suitable. The management of the home was keenly
interested in all methods of devising the best care for its charges. The staff and
the board members also manifested intelligent interest and cooperation in com­
munity plans, social legislation, and general social service. _
The record system was very efficient. Narrative histories were used, chrono­
logically arranged. Those which were examined— records for about half the
patients for a year— were succinct and informational. At the beginning of the historv was placed the “ mother’s statement.” This is a unique addition to social his­
tories. It was made up by the superintendent after she had gained the confidence of
the patient, usually after a residence of some months. All those read by the Chil­
dren’s Bureau agent contained simple, definite statements and seemed to be
valuable contributions to the records.
H om e II

A residence building in a crowded city block was used for this home, and these
housing conditions brought about some difficulties in management. The build­
ing was in fair condition, but it needed some repairs. The furnace was not al­
ways adequate for cold, windy days, and it was supplemented by a kerosene
stove with no vent for noxious gases.
, . _, , .
, , , ,,
The staff was small, and the members of it were not highly trained, but they
were sympathetic and kind to the patients and cooperative with the physicians
in attendance on them.
............... .
. , ,.
Patients with venereal disease were not admitted if the infection was known,
but as the physical examination was not given until a few days after entrance
such patients might have been admitted and might b&ve lived in the home for a
while before the infection was detected. Isolation facilities were poor, the only
provision being a small room containing two beds, one for a child and one for an
adult. No separate toilet or bath was provided for patients with venereal dis­
ease. The only precaution against the spread ot infection was scrupulous
^Soon* after entering the home each patient was given a physical examination
at the cooperating hospital, and she then began attending the hospital s prenatal
clinic. The suggestions made at the clinic were carefully carried out at the
home. The same hospital received the patients for confinement, giving them
careful attention and using the most approved technique. Six weeks after deliv­
ery each patient returned to the hospital for final examination.
The babies were given painstaking care, but it was hardly up to modern stand­
ards. For example, unless a baby was noticeably ill or required special feeding
directions he might not be seen by a physician for months.
The diet was rated as “ probably inadequate” for pregnancy and probably
adequate” for lactation. Breast feeding was encouraged and supervised.
All babies were discharged with their mothers. For this home this procedure
did not seem best, because the home had no trained social workers to keep con­
tact with certain types of mothers who needed supervision after discharge.
Local agencies found the home willing to cooperate with them— perhaps too
willing for younger girls who were not maternity cases were sometimes accepted,
at the request of the agencies. The home had no provision for segregating
different types of women, and its policy of placing inexperienced girls or even
certain types of problem girls with unmarried mothers seemed unwise, the
Federal Reserve Bank of St. Louis



home was a member of a local federation of social agencies and received funds
from it. This membership was a good feature of the work, as it indicated that
the home took part in community activities.
The superintendent exercised common sense in dealing with the patients,
allowing them to attend their own churches and to have recreation outside the
home. She also allowed those who did commercial work to keep part of their
H om e III
A building which was formerly a private residence had been enlarged and
otherwise adapted for this home. It was on a crowded city street, but this
disadvantage was partly offset by the fact that it was near a good prenatal clinic
and well-baby station. The living rooms, dining room, and kitchen were light
and pleasant. The sleeping quarters were crowded and probably were the poor­
est feature of the house.
A lack of isolation facilities placed the patients rather at a disadvantage, as
a newcomer might remain several days before a physical examination was made.
Either at the near-by clinic or at one of the many excellent hospitals in the
city the expectant mothers were given suggestions on prenatal care. The
superintendent was not enthusiastic about carrying out these suggestions, as
she had not been trained to value scientific help. The home had no graduate
nurse or other highly trained person on the staff, and some of the medical policies
were obsolete. The diets for both pregnancy and lactation were rated as “ prob­
ably inadequate.”
The cooperating hospital sent an ambulance to the home for each patient at
the onset of labor, and the confinement and puerperal care were excellent. The
patient returned to the home 12 to 16 days after delivery and received special
care there for at least two weeks longer. If a toxic patient did not improve
promptly in the home under the regimen prescribed she might return to the
hospital for an indefinite period.
The children in the home were under the supervision of a nurse and a doctor
at the hospital’s health center, and suggestions for infant care were sent to the
home. An outline of diets for an infant under 1 year was furnished by the
center, but, as in the case of prenatal care, the cooperation at the home was
The house was fairly homelike. The “ parlor” was used by the patients only
for religious services, group singing (usually part of a semireligious meeting),
and similar purposes. The living room was small and was inconveniently sit­
uated near the rear on the second floor.
The social policies were poor. Most of the babies were separated from their
mothers soon after birth. Of a group of 11 mothers cared for during the year of
the study the babies of 7 were taken for placement at ages varying from 14 days
to 5 months, the maximum age in all but two cases being 2 months. The place­
ment of these babies was delegated to an agency with no conception of modern
standards of work, though there were at least three agencies in the city doing
good work in child placing. This was an example of the general social policies
of the home.
One of the members of the board of managers stated that they believed they
had evolved “ the best possible method of caring for these girls and their
Agencies doing standardized work used this home rarely, and only for tempo­
rary care for brief periods.
H om e IV
This home, which was much larger than most of the others studied, included
a maternity home, a maternity hospital, and a department for the care of depen­
dent children. The building had been planned especially for its work, and it
was well arranged in all three departments. The dining rooms, kitchen, laundry,
bakery, and refrigerating plant were well equipped. The baths, toilets, and
washbasins had excellent plumbing and were adequate in number for the large
Large dormitories were used for both waiting and nursing mothers. They
did not seem crowded, as the beds were far apart and the ceilings were high.
The isolation suite consisted of four single bedrooms, with bathing and toilet
facilities for four patients awaiting examination. Patients with venereal dis­
ease were not accepted except in emergency. A number of such patients, on
the verge of labor, had been received and had been kept as long as was necessary.
Federal Reserve Bank of St. Louis




The superintendent was a graduate nurse and was a person of ability, pro­
gressiveness, and charm. Two other graduate nurses were on the staff. The
administration of the institution showed good teamwork. One of the best hos­
pitals in the city had arranged for rotating service by resident physicians. A
dentist was employed and complete dental equipment was provided.
Pregnant women had a prescribed rest period every day. The prenatal record
was carefully kept by the resident physician, and any unusual condition was
brought to the attention of the chief of staff. Minor operations only were per­
formed in the institution; laparotomy was done at an outside hospital.
The babies and older children were weighed and measured regularly and the
results recorded and kept. A trained nurse had charge of this work under the
direction of a pediatrist. The diet in the maternity home was rated as “ possibly
inadequate ” for pregnancy and “ probably adequate ” for lactation. Diets were
differentiated according to physicians’ orders. Every toxic patient was put in
the infirmary and was kept on a strict dietary regimen. In the puerperium in
case of a rise of temperature or offensive lochia the patient was isolated at once
and a special nurse was placed in charge of her.
Appreciation of the advantages of employing modern technique had led to the
opening of a social-service department. Visitors were permitted to call any after­
noon and at certain other times, so that undesirable mingling of visitors and the
peculiar atmosphere incident to general visiting were avoided.
Certain points in the social policies were not commendable, such as the large
group system of care which resulted in contacts between younger girls and those
older in years and experience; the practice of retaining some mothers for long
periods of care, although the home offered no preparation for future employment
save domestic work and plain sewing; and inadequate follow-up work. Devel­
opment of social service should improve some of these conditions.
The records were carefully kept, though they did not include as much infor­
mation as the modern case history. The staff appeared to be well prepared for
their work. They were active in continuing formal studies— working for degrees,
and attending local, State, and national meetings of social workers.
Local agencies found the home very cooperative.
H om e V 8


It was difficult to judge this home according to the usual standards for mater­
nity-home work. Its purpose was to care for colored unmarried mothers and
their children, and its founding was apparently an expression of racial responsi­
bility for these women and children. It did not seem to fill a great need, for
the number of persons cared for was very small. At the time of the study only
three women (one a boarder employed all day) and eight children were being
cared for in the home. As the other child-caring institutions of the city accepted
children without question of race, it would seem as though the child-caring
department of this home was not greatly needed.
The equipment was poor and the surroundings unhygienic. The superin­
tendent was untrained and her resources were very inadequate.
The patients were given prenatal care at health stations or at hospital clinics.
A practical nurse, available on call, gave volunteer service. Several good hospi­
tals received the patients and gave them the best of care. Upon their return
to the home the superintendent allowed ample time for their return to normal
The diet was rated as “ probably inadequate ” for pregnancy, but the effort that
was made for the mothers and their children is shown in the rating for the diet
for lactation— “ probably adequate.”
No home records with which to check up the work done or the results obtained
were available, and the medical records at the hospital were merged with too
many others to be studied.
Local agencies, though realizing the limitations of the work, used this home in
emergencies as a detention place, having confidence in the integrity of the super­
intendent’s motives. The home’s refusal to accept “ innocent girls ” because of
the dangers of subjecting them to contact with the others was commendable.
Poor methods of discipline and absence of records were among the more serious
defects Qf the home’s work. The superintendent did not know the number of
placed-out children supposedly under her supervision at the time of the study,
admitting that she “ loses track of some.”
‘This home is no longer in existence, as its charter has heen revoked by the State.
Federal Reserve Bank of St. Louis


H om e VI

This home, established in recent years for the care of dependent children, in
a rural community already well provided with such institutions, had later
undertaken also the care of unmarried mothers and of other women. On account
of the limited capacity of the building, it would seem wise for the home to have
concentrated on one kind of work instead of attempting three.
The rooms were crowded but were all in good order and scrupulously clean.
There was only one bathroom, and its toilet, washbowl, and bathtub were used
by the entire household, which at the time of the study consisted of 10 adults
and 21 children.
. .
, ,
. .
The staff was composed of persons who in the opinion of local social workers
were utterly unsuited for the work which they were doing by reason of person­
ality point of view, and lack of education and of training. One member whose
tim e’ was divided between collecting money and visiting prospective foster
homes and the persons given as their references was called the social worker.
The staff members were not highly trained for their medical work but were
very cooperative with the attending physicians. Undergraduate nurses were
employed. A physician, who came upon call, safeguarded the health of the
patients very well. Those with venereal disease were detained at a hospital
until the disease was rendered noninfectiOus. The physician did not intend
patients with such infections to be received at the home; but they were some­
times received from other agencies and the physical examination was made
afterwards. There were no facilities for isolation, but partial segregation was
obtained by putting an extra bed in the matron’s room.
Prenatal oversight was exercised by a good, modern hospital, where the
deliveries were made in accordance with the best procedure. The patients were
kept at the hospital throughout convalescence, so that bedside care at the home
was not necessary. Breast feeding was required for at least two weeks, but it
was not always supervised, and dissimulation would have been very easy. The
diet was rated as possibly inadequate” for both pregnancy and lactation. If
a pediatrist was needed the child was taken to a health center, as there was no
special service of that kind at the home. All the health records that were kept'
were at the hospjtal; none were available at the home.
The business organization promised extensive development. Support, moral
and financial, was being developed in many quarters. But the home’s uncoop­
erativeness with all local social agencies, its lack of confidence in them, its atti­
tude toward official supervision, and the staff’ s ignorance of modern methods of
social treatment, all gave the impression of a home of questionable character.
H om e V II®

An entirely commercial enterprise, this home represents a type of institution
different from most of the others studied. In at least one detail it conformed
with recognized standards, as it was one of the few homes in the State which
were found to be licensed. It provided hospital care and maternity-home
care, boarded children, and placed them in foster homes, accepting the custody
of babies for placement on the payment of a certain sum by the mother.
The proprietor, who was also superintendent, was a practical nurse, and she
was assisted by undergraduate nurses; no graduate nurse was on the staff at the
time of the study. The proprietor’s personality did not seem to recommend
her for work requiring character, dignity, skill, and sympathetic understanding,
such as maternity-home work. The babies were in charge of a colored maid.
Toilet and bathing facilities were inadequate for the number of patients, as
there was only one bathroom, with one tub, one washbowl, and one toilet, for
the whole household, which at the time of the study included 24 adults.
Prenatal care was directed by a physician whe called at regular intervals.
Deliveries were made at the home in a poorly equipped room without proper
facilities for sterilization of supplies. There was but scant equipment to meet
emergencies and no surgical equipment except that for lacerations. No record
of physical or obstetrical examinations was kept. A labor record and a clinical
sheet, kept by the nurse, were the only medical records seen by the bureau
»Since the time of the study the work of this institution has been gradually changing and general-hos­
pital work has been largely substituted for maternity-home work and child caring.
Federal Reserve Bank of St. Louis



No isolation facilities were provided for cases of infectious disease. Of a total
of eight babies in the nursery four had acute ophthalmia; another baby in a
private room had it also. No apparent precautions were taken to protect babies
not infected.
Patients with venereal disease were not treated, the claim being made that
they were excluded. There was no evidence that such infections were detected,
and no precautions were taken to prevent their spread. •
The mothers slept in the dormitory on the third floor and took their babies
to bed with them at night. There was no supervision of the nursing of the
babies. The majority were artificially fed. Sample menus were not obtained,
but the superintendent said that private patients paid for proper, adequate
food, and that the entire household was supplied alike.
The proprietor claimed that the primary function of this institution was to
give hospital care, chiefly to married women, but by its advertisements in news­
papers and by other means it called attention to the protection it gave unmar­
ried mothers and to its acceptance of the care of infants. No effort was made
to do constructive work with the unmarried mothers. A recognized social
agency in the city occasionally used this home, and the superintendent made
the most of this connection to improve the home’s reputation.
H om e V III

This home was part of a national organization, and the policies were formu­
lated at national headquarters and in the general conference of workers, leaving
the management of the home freedom and responsibility in matters pertaining
to individual work as far as was consistent with these general policies. Origi­
nally planned for the work of “ rescuing girls,” this home has also developed a
department of child care. None of the staff had given any thought to the
origin of the latter work, and they were unable to state when or why it had
been begun. The home also gave maternity-hospital care. The various records
were regularly kept, though social case histories were inadequate in content,
showing that insufficient work had been done in investigation.
The building was a converted residence in a suburban section, well adapted
for the types of work done by the home.
All the medical care was given in the home by a physician who lived nearby
and came on call. Besides this physician a pediatrician was on the staff. The
superintendent, her assistant (a graduate nurse), and other trained employees
cooperated well with the physicians.
At the discretion of the nurse, new patients were isolated until they had been
examined by the physician. Isolation was maintained on the second floor by
means of separate toilet, bath, and sleeping facilities. The physician’s exami­
nation was usually given within 24 hours. The Schick test was given to new
patients because the home had once admitted a patient with diphtheria without
knowing it. It was claimed that the home did not receive patients with syphilis,
but the Wassermann test was not made until the placental blood was obtained.
Gonorrheal patients were kept and treated.
Records of the prenatal, obstetrical, and puerperal examinations were kept.
The physician or the nurse, who was a midwife, delivered the patients. Com­
plicated cases involving surgical interference were sent to an excellent outside
hospital. The nurse performed urinalysis weekly.
The patients were cared for in the home throughout convalescence after
delivery, great care being taken in case of a low-grade infection or other retar­
dation of recovery. The diet was rated “ probably adequate” for both preg­
nancy and lactation. After leaving the home the girls might return at any
time for help, advice, or rest.
The staff had the usual kindly characteristics of workers in the organization
which operated this home, and they manifested a spirit of service which was
perhaps responsible for the home’s being filled to capacity— a condition rare
among the homes studied. This institution also served the immediate com­
munity well, as the nurse was accustomed to go out to help local physicians in
emergencies when no other nursing help was available.
The home was not extensively used by local social agencies. One objection
was that the patients received hospital care within the home, most workers pre­
ferring to use homes that sent their patients to general hospitals. Virtually no
efforts were made to fix paternity. Babies were placed by an agency doing
very poor work, and under these circumstances the home’s policy of accepting
babies readily on surrender was questionable.
Federal Reserve Bank of St. Louis


H o m e IX

This home represented a work of long standing for the moral rehabilitation
of women. It presented an unusual combination— the care of unmarried mothers
and the care of aged women. Care of the aged had been developed in recent
years, and for this work a wing had been added to the building.
The house was not particularly well arranged for a home of this kind, as its
dormitory and bath for both waiting and nursing mothers was on the third
floor. The bathroom had one tub, one toilet, and four washbowls. Individual
, bath towels were provided, but not individual face towels. The dormitory was
crowded, with barely space to pass between the beds.There was no provision for segregation, and the superintendent claimed
that she did not admit any patient that had venereal disease.
There was no highly trained person on the staff, and the medical care seemed
haphazard. Only if a girl “ looked delicate” was she excluded from the work
of the dining room or the kitchen. A physician, who came upon call, made a
physical examination, but no record of it was kept. The obstetrical examination
was made at one of the various clinics and hospitals used by the home— often
at the hospital where the patients were delivered.
During convalescence every mother was well cared for, and she was prepared
to nurse her baby and take all responsibility for his care. The practice of hav­
ing the babies sleep with their mothers in the dormitory was a poor one.
The diet was rated as “ possibly inadequate” for both pregnancy and lactation;
but it may be that there should be a shading toward “ probably adequate,” as
the amount of milk used was not accurately computed. Apparently breast feed­
ing was usual, though no records of the care of the infants were kept.
The fact that the home did not require the mothers to stay a fixed period indi­
cated a flexibility in procedure which was perhaps offset by the requirement that
each woman sign a set of formal rules before admission to the maternity-home
A certain amount of training in domestic work was given. Practically no effort
was made to fix paternal responsibility. Any mother who objected to keeping
her baby after discharge had to leave the home with the baby, as the home
would not make any provisions for them. Financial conditions did not enter
into the procedure.
Though the limitations of the work were recognized by local agencies, the
home had their confidence, and it was used by them because of its cooperative
H om e X
Housed in a modest building, plainly (though comfortably) furnished, with a
superintendent of only elementary education and no training for her work, this
home, nevertheless, was outstanding in its fine spirit and its appreciation and
use of modern methods and resources.
The place was an illustration of good work without great expenditure. The
house was being improved as to heating and other modern conveniences. It
provided bedrooms with two single beds in each for the waiting and nursing
mothers. The health and safety of the inmates were well safeguarded. All
patients on entrance were examined and segregated for three weeks in order that
the mothers and babies already in the house might not be exposed to infection.
The home cooperated with a number of hospitals, and all examinations, even
urinalysis, were made at outside clinics or hospitals. Recommendations made
at the clinics were carefully followed at the home. Two of the hospitals some­
times sent a nurse to the home to report on the condition of a patient late in
pregnancy, if it was too great a task for her to go to the hospital. If a patient
was toxic she was placed in the medical ward at a hospital and remained there
until all symptoms subsided. She was then kept on a strict regimen in the
home. Upon return after labor the patients had good care and were not expected
to resume their regular duties for four weeks after delivery.
The care of the babies in the nursery was noteworthy. The superintendent
slept in a room opening from the nursery and called the mothers in the night to
nurse their babies. The babies were soon trained not to be nursed between 10
p. m. and 5 a. m. The diet of the mothers was rated as “ possibly*inadequate”
for pregnancy and lactation.
Though the mothers in this institution were usually there for a short time
only, the wholesome atmosphere, good medical standards, and close association
with the superintendent and her assistant must have been a valuable training
Federal Reserve Bank of St. Louis



for the patients. It was recognized that the patients were under considerable
and unusual strain, and allowances were made in every way possible> Through­
out the study board members and other persons connected with the home
manifested a fine humility, in contrast to the complacency noted among persons
connected with some other institutions. The combination found here of the
appeal of emotional religion with modern social piocedure is very rare.
Early in the history of this home the board and other interested persons were
divided in opinion as to whether the babies should be cared for by their mothers
or placed in foster homes. Feeling was intense on both sides; the decision was
to keep the babies with their mothers.
The social-service exchange was used; in the main, cases were referred to
social agencies for investigation, efforts to fix paternal responsibility, and follow­
up. Training for future employment was practically limited to domestic work,
but this training was fairly thorough. The patients were employed to some
extent at commercial work, all the income from which went to the home. Not
a great deal of such work was done in this home, but the practice of the home’s
keeping all the money earned by patients is undesirable. At least part of this
money should go to the patients.
H om e X I

The first impression on visiting this home was of a very happy place. The
superintendent had a unique personality. She had a background of education
and natural refinement, a gift of imagination which was a distinct asset in dis­
cipline, and a cooperative attitude toward all community agencies, but with
these she combined a certain sentimentality. She also combined religious zeal
with the modern nurse’s good technique and cooperation with medical service.
The house, a converted residence, was well adapted for the work of a mater­
nity home and hospital. The rooms were all pleasant, comfortably furnished,
and clean, making the impression of a very pleasant home. There were two
bathrooms, one in the delivery suite for the use of the staff and the other for the
patients. There were modern appliances for the work of the household in base­
ment and kitchen. Low gas pressure was a great trouble, especially in the
sterilization of supplies for the delivery room.
The home did not keep any patient with any communicable disease, and
every applicant was supposed to bring a clean bill of health with her. A phy­
sician, who came upon call, made a physical examination as soon as possible;
and if gonorrhea or syphilis was found the patient Was transferred for treat­
ment until the disease was rendered noninfectious, when she might return to the
home. The physician made the obstetrical examination, and the prenatal care
was definitely outlined, with the home cooperating. If a patient became toxic
she was sent to a hospital, as she would be for any illness requiring bedside care.
Delivery was made in a room adapted for that purpose. The patient remained
in the bed used for delivery through the puerperium and then was placed in one
of the rooms on the second floor, to remain until the baby no longer needed to
be nursed at night. Waiting mothers slept in a dormitory on the third floor.
The bedside care after delivery was one of the important factors in the man­
agement of the home. Every effort was made to restore the patient physically
and to teach her to realize her social responsibilities. Most painstaking care was
given the babies, though no record was kept of it. No health records of any
kind were available.
An eye, ear, nose, and throat specialist was on the staff and did the work
referred to him by the attending physician.
The diet was rated as “ possibly inadequate ” for both pregnancy and lactation.
More modification than was shown in the menus may have been made in the
diet for nursing mothers.
In the main, modern social methods and policies were followed; still there
was an unwillingness to use the confidential exchange of information, as “ it
exposes families.” The girls were fairly well trained in cooking and housework;
they were taught the care of their babies, and some educational work was done,
particularly in English. Their appearance was neat and attractive. Evidence
of daintiness in the home was striking, especially at meal times. The quiet,
pleasant, apparently unrestrained conversation would impress a visitor favorably.
Recreation was given due attention.
96892°— 26f------6
Federal Reserve Bank of St. Louis



Though this was one of the few homes filled nearly to capacity when visited,
the total number of girls cared for during the previous year was smaller than
would be expected.
Shortly before the study the chronologically arranged, narrative social history
had been introduced. These histories were found to be very poorly kept.
The home had the confidence of the local agencies. Workers, though real­
izing certain defects and limitations, used it with very satisfactory results.
H om e X II

This home was a purely commercial institution, operated by a man with no
medical nor social training who seemed utterly unfit for such work by reason of
his personality and characteristics. Patronage was obtained chiefly by circu­
larizing physicians. The circulars were alluring in their promise of “ seclusion
and privacy for unfortunate girls.” As would be expected, the babies were an
important factor in the commercial transactions. They were taken at any age—
at birth, if it was requested, the mother never seeing her child. Babies were
placed out and legally adopted, as rapidly as possible. An attorney was em­
ployed to see that the home did not violate the law.
This institution was a branch of a much older one under the same manage­
ment in another State. A conditional license had been granted the older home
by the State, but the year of the study this license had been withheld. The
proprietor had, therefore, established another home in a State which placed
fewer safeguards about mothers and babies. All the information gained about
this place was disparaging to it from the point of view of sound social procedure
and policy.
The building was not well adapted to the work, though improvements were
being made in the sleeping quarters. It conformed to certain city health regu­
lations. The house staff had only one trained member, a graduate nurse. A
contract physician came on call. No precautions were taken against admitting
patients with venereal disease, although the management claimed not to receive
anyone with any “ obnoxious disease.” No effort was made to ascertain whether
kitchen or dining-room help were free from infections.
The prenatal care was outlined by the physician, and brief records of obstet­
rical history and labor procedure were kept. A chart of the puerperium was
kept by the nurse.
Delivery was made in the home in a fairly well-equipped delivery room. No
record was kept of the infants except date of birth, weight, and general appear­
ance. The babies were nursed one week; the mothers usually left the home two
weeks after confinement. The diet was rated as “ possibly inadequate ” for both
pregnancy and lactation.
H om e X III
A certain apathy marked this home. It was manifest in the listless attitude of
the mothers as well as of the staff and in the general atmosphere. In a city of
more than 100,000 population this was the only institution for the reception of
older girls and women needing temporary care, and it might have been filling
its function extensively and efficiently. But this was impossible while the ac­
tivities were directed by the managing board in charge at 'the time of study.
Although the home could accommodate 9 adults, only 17 were cared for during
the year preceding the study. In an attempt to stop the continuous dwindling
of the number of patients the required period of stay had been shortened and
provision had been made for the care of types of women not previously admitted.
Maternity cases from a State school for girls were received.
A residence in a pleasant street, near a good hospital, was used for this home,
and the building was well adapted for the work.
No highly trained person was on the staff, but a physician came on call and
had given good service for years. The superintendent, who was also the house­
keeper, was overworked; and she was worried about the danger of admitting
patients with venereal disease, for she had not the training nor experience to
cope with that problem. She seemed glad to leave to the hospital all matters
pertaining to the patients’ health.
Each applicant was detained in isolation until a complete physical examina­
tion was made, and an obstetrical examination was made at the hospital as soon
as convenient. There were no records available of examinations or prenatal
Federal Reserve Bank of St. Louis



history. The patients were delivered at the hospital. Though no records were
kept, any abnormality was brought to the attention of the chief of the obstetri­
cal staff by the hospital’s resident physician.
The patients usually returned to the home 14 days after delivery. If need arose
for any patient to return to the hospital she might take her baby with her.
Breast feeding was encouraged, but it was not insisted upon. The diet was
rated as “ probably inadequate” for both pregnancy and lactation. The amount
of dairy products used was very low.
The patients were given mental tests at a clinic in the city, and the superin­
tendent relied a great deal on the results of these tests in dealing with the
Apparently no social poli'cies had ever been formulated. Provision for rec­
reation was meager; patients were given no training for future employment;
and little effort was made to fix paternal responsibility. The formal rules of
the home, a copy of which was given to each patient on admission, were not such
as would inspire confidence in the home or develop a desirable mental attitude
in the patients.
Relations with a good case-working agency had recently been established.
The superintendent was in advance of her board in utilizing resources, made
available through this agency, for improving individual treatment and for
developing standards and policies of work.
H om e X IV

An unusual combination of conditions existed here. Parts of the house were
attractive, and parts unattractive. The superintendent, whose preparation was
limited to practical experience in institutions, had certain excellent qualities.
A pleasant spirit was manifest, all the patients calling the superintendent
“ mother” of. their own accord. However, her assistant, a practical nurse, did
not cooperate well with the physicians in attendance, and better work should
have been done for the babies.
The house was only fairly well adapted for the work. Double beds in the dor­
mitories were used. The patients had only one bathroom, and it was on the third
floor. The staff had one on the second floor, the toilet in which was often used by
the patients. The patients had a separate dining room, which was less attrac­
tive than the one for the staff. The same food was served in the two dining
Every girl committed to this home by a court had had a complete physical
and mental examination. Other patients were kept in isolation until a physi­
cian came to the house and made an examination. A Wassermann test was not
given, but if there was evidence of a venereal disease the patient was sent away
for treatment until the disease was rendered noninfectious. In case of acute
infection isolation might be improvised at the home and a special nurse ar­
ranged for.
The obstetrical examination and the prenatal care were given at the hospital
clinic, which the patient attended according to the orders of the physician there.
Recommendations made at the clinic were not always carried out at the home.
The patient was delivered at an excellent modern hospital, and the puerperium
was well safeguarded. If the patient had not attended the clinic at the hospital
regularly she entered for confinement as an emergency case, for the attending physi­
cian at the home was not a member of the obstetrical staff of the hospital. No
health records were available at the home for either mothers or children.
The diet was rated as “ possibly inadequate” for both pregnancy and lacta­
tion. The superintendent intended that nursing mothers should nourish their
babies adequately, but the feeding was not always supervised.
Through the cooperation of a local agency, two departures of significance had
recently been made: A day nursery operated by the home was closed after a
careful study had been made to ascertain the reason for a steady decline in its
use, and the funds formerly used for "the day nursery were used to pay the
salary of a trained worker who was added to the staff to make social investiga­
tions and to formulate plans for mothers. For several years the policy had been
to refer to a social agency all babies to be placed.
Several points in the management of the home were notable. Outside
recreation was provided, each patient going at least one evening each month
to a concert, a play, or a motion picture, accompanied by the superintendent or
some other suitable person. Patients were expected to attend services at their
Federal Reserve Bank of St. Louis



own churches; this requirement was included in the posted rules, which, unlike
the usual regulations, simply referred to the mother’s responsibility for her child
and to the home. Religious services or group prayers were never held in the
home, but occasionally a brief reading or a selection from the Scriptures was
substituted for the grace before meals.
H om e X V

Originally intended for delinquent girls and women, this home was caring for
three distinct groups at the time of the study: Unmarried mothers; problem
girls, not necessarily sex offenders; and children. As the unmarried mothers
were only a small proportion of the persons assisted, the policies in the main
were formulated on the basis of service to the other two groups. The manage­
ment was considering using the home as a reception place and clearing house
for various types of girls 12 years of age and older.
The home was housed in a suitable building erected especially for its use, and
it was in a good location. Single sleeping rooms, large sunny windows, a sleep­
ing porch, and a pleasant yard all added to its attractiveness.
Patients entering the home were kept in a special isolation suite until the
results of tlie rncdic&l ex&miniitioiis were known. A physician, who citme upon
cal1, had been interested for years in this place and had given faithful service.
At his laboratory chemical analyses were made and results of Wassermann tests
and vaginal smears determined. After six months of pregnancy each patient
went to the prenatal clinic at the hospital, and the clinic’s recommendations
were carefully carried out at the home. Delivery was made at a good hospital,
and each patient was kept there as long as necessary. If she needed to return
later for any cause relating to her •confinement she might do so and take her
baby with her. The hospital kept all records of prenatal and confinement care
and also a record for each infant. At the home the babies were seen bv the
house physician and by a pediatrist who was on the consulting staff. ‘ The
well-tramed, understanding superintendent cooperated well with the physicians.
The nurse gave particular attention to the pregnant women. Each one’s
room was changed from the third floor to the second when she neared confine­
ment, and the nurse then gave her individual care. After returning from the
hospital the mothers slept on the second floor near the nursery.
was, rated as “ possibly inadequate” for both pregnancy and lactation;
but the household was large, and differentiation for various inmates was not
easy to carry out.
Probably the poorest phase of the medical work was that too many types
were dealt with, so that the superintendent could not know enough about each
patient s care in pregnancy and lactation. She had had some very serious *
handicaps to overcome and was doing well. The board of managers formerly
had not been in favor of any special prenatal care, permitting the “ natural
process” to be unguided.
The superintendent was well prepared for social-service work with unmarried
mothers, as she had a certain educational background as well as experience. She
appreciated modern procedure and was identified with the social work of the com­
munity. Though unable to make complete case investigations, she visited the
homes of most of her charges and. made efforts to fix paternal responsibility.
Babies were occasionally accepted on surrender, but never until after the nurs­
ing period and usually only if the mother proved to be mentally or morally unfit
to assume maternal responsibility.
Mothers had the care of babies, and did housework, cooking, and laundry
work, though there was no definite training except for housework. The home
did commercial laundry work, but mothers were seldom assigned to that
A departure from the stereotyped recreation found in many homes was the
use of a circulating library. Recreation outside of the home was limited to an
annual picnic.
Local social workers found the home cooperative and helpful.
H om e X V I

This large institution was well appointed in almost every detail. Its build­
ing had been planned for its work. It had plenty of baths and toilets, including
separate ones for patients in isolation.
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The medical work had been wholly changed since the return of its physicians
from clinics in foreign countries, and many excellent reforms had been instituted.
Some of the best medical work in the State was now done here. The prenatal
care was excellent. A fully equipped dental clinic contributed to the success
of the program. The home received patients with venereal infections and had
excellent facilities for their segregation.
From birth all children were under the care of a pediatrist. At the time of
the investigation he was studying the prevention of congenital syphilis and
of ophthalmia neonatorum. The problems of infant feeding were also receiving
intelligent consideration. The diet was “ probably adequate” for pregnancy and
lactation, and the amount of milk used was “ adequate” for lactation. However,
the babies might not be breast fed very long, as separation of the mother and
her child might occur early.
The outstanding feature in the social work was the motive of protection of
the mother. Methods and policies appeared to be formulated primarily with
this end in view, as will be noted in the ready acceptance of babies and the use
of assumed names. Babies were accepted, on surrender, for a financial consid­
eration. Training the mothers for future employment was not recognized as
part of the responsibility of the home, probably because the average period of
stay was very short. This was one of the few homes giving care, without ques­
tion, to unmarried mothers in pregnancies other than the first. It was also one
of the few accepting women with any communicable disease and providing
Some of the board members were interested in promoting social service with
a view to*developing modern policies of investigation, fixing paternal responsi­
bility, and improving the work of placing out children. The fact that the home
was a member of the community chest showed that it participated in commu­
nity work and that it was taking advantage of opportunities for progress.
Local agencies found the home cooperative and used it to a considerable extent.
H om e X V II

A lovely old residence, surrounded by beautiful grounds, the building housing
this home was ideal for maternity-home work, and the home should have served
the community in a far larger measure than its administrative, social, and med­
ical policies permitted. The home had good equipment— excellent sleeping
quarters, toilets, baths (including showers), and a pool on the grounds for sum­
mer bathing. Garden and fruit cultivation and the raising of chickens were
outstanding features of the home’s efforts for the health of the inmates.
If a girl had been referred to the home through an agency in the city she
usually brought a record of a physical examination and was supposed to have a
clean bill of health as regards venereal disease. The home claimed to refuse
patients with venereal disease, but such patients were admitted and were treated
either at the cooperating hospital or at the home.
The prenatal care was haphazard. The hospital where patients went for
examination and advice was at a distance, and they did not go regularly.
Delivery took place at the same hospital; the obstetrician gave the patients
skilled service. The patient returned to the home in about 12 days, and
though no further bedside care was necessary she was not expected to do her
usual work for several weeks. There was usually a trained nurse on the staff,
who under the supervision of a pediatrist took good care of the babies and also
taught the mothers how to care for them. Every mother in the home was
required to nurse her baby, and the nursing was done under supervision. The
diet was not so good as conditions warranted, being rated as “ probably inade­
quate” for both pregnancy and lactation.
This was one of the few homes studied which admitted unmarried women for
pregnancies other than the first. This breadth, however, was not typical of the
general policies. Analysis of case records revealed serious defects in discipline and
management. Though the home was conceived in zeal for the moral rehabilita­
tion of girls and women, the methods of care seemed to reflect quite different
motives. Many cases were noted in which disciplinary problems were created
by lack of understanding on the part of the staff, Too much emphasis was
placed on the ability of mothers to do the routine work of the house. Almost
half the expectant mothers who entered during the year before the study left
before delivery— an indication of poor work in adjusting newcomers, who were
naturally in an abnormal frame of mind. Theoretically babies were to be kept
with their mothers for three months and breast fed if possible; actually, although
Federal Reserve Bank of St. Louis



only a comparatively small number of separations of mothers and babies occurred,
there seemed to be no fixed policy relative to separating them and accepting the
babies for placement. No training was given mothers except in the care of
their babies. Assignments to household duties were regulated according to the
needs of the institution and not according to the need of the girls for training.
Few of the local workers who had used the home spoke favorably of it.
Under different management this home could have held a place of real leader­
ship in its field of work.
H o m e X V III
The pleasant, homelike house and surroundings of this place were conducive to
composure and health; but it was somewhat behind the times in certain medical
details and social work was lacking.
The staff was not highly trained, and the practical nurse took considerable
responsibility, especially about feeding the babies under 1 year of age, which
would seem to require supervision by a physician.
All the medical care was given within the home. The physician’s orders
were followed as to prenatal care. Delivery took place in a room not well
equipped for the purpose, and there was no standardized technique. Postnatal
care was good. Patients were placed in separate rooms with single beds during
this period and were kept there until convalescence was well established.' Seg­
regation for patients with communicable disease was provided as to sleeping
quarters but not as to baths and toilets.
The diet was rated as “ possibly inadequate’’ for pregnancy and was not
rated for lactation, as the majority of the mothers did not nurse their babies, and
it was said at the home that they were unable to. This condition seemed to be
partly the result of the mental attitude of the girls, as influenced by the home.
A commendable point in the routine was that the patients might retire to their
rooms when fatigued or indisposed without any formality.
A large refrigerator on the third floor was a good feature in connection with
caring for the babies’ milk. The nurse attended to all the details of the care
of bottles and the preparation of food according to formulas.
The superintendent claimed that she did not accept patients with venereal
disease, but these might have been admitted without detection, as no Wassermann
test was made and no vaginal smear taken. It had occurred twice in recent
years that the presence of syphilitic infection in the mother was disclosed only
at the birth of the baby.
No records of any health work were available at the home.
Xhe home was a haven to the girl in distress, a shelter affording to the unmar­
ried mother care before and after delivery, but it gave no other social service.
Such privacy as an institution of this type afforded, efforts to make patients com­
fortable, and genuinely kind treatment constituted the sum total of care given.
The superintendent, a woman well past middle age, of the motherly-housekeeper
type, seemed to have no conception of the possibilities in her work.
This home required patients to remain an arbitrary length of time after delivery.
This was unlike the practice in most of the homes studied, for the rules were
generally flexible in this respect. Even when cases were known to be under the
care of social agencies the patients had to complete the required period of stay
before transfer would be considered. The required period of stay had been
reduced twice, and at the time of the study it was two months. Although the
mothers were required to remain in the home a certain length of time, no train­
ing was given them in preparation for future employment. They gained some
experience in domestic work, but this work was assigned them according to the
needs of the home and not according to their need of training.
Policies in relation to separation of mothers and babies were indefinite.
Theoretically the policy was to encourage maternal responsibility; actually any
mother unwilling to keep her child was assisted in placing it in a foster home
for legal adoption. It seemed that the superintendent of the home felt impelled
to place babies when excellent homes were offered. Nothing was done to fix
paternal responsibility. The home was seldom used by social agencies.
H om e X IX

With a private hospital on the grounds, this home was well equipped for the
physical care of maternity patients. There was every facility for good, modern
practice as to examinations and for some treatments.
Federal Reserve Bank of St. Louis



Each patient was detained in isolation until complete examinations were
made and the results reported. If a patient was syphilitic she was allowed to
enter the home but was treated at another institution, being taken there as
often as the physician ordered. Supplementary treatment was carried out in the
home. Patients with gonorrhea were treated at the home under the direction of a
venereal-disease clinic. Segregation facilities could be improved when needed.
Single rooms, adequate baths and toilet facilities, and a solarium were part of
the equipment.
The prenatal care was good, and records of all examinations were kept. Each
patient went to the hospital department some days before her confinement and
remained there after confinement for weeks, or even months. The superintend­
ent was a trained midwife, and the obstetrical nurse was taking a course in
midwifery. When specialists were needed for either the mothers or the children
the superintendent called outside consultants.
Some of the most modern practices of obstetrics and pediatrics were not
observed, the medical staff being opposed to them. For example, the infants
were breast fed at night till they were 9 months old, and no supplementary
feeding was given them until they were 1 year old. The diets for both preg­
nancy and lactation were rated “ possibly inadequate.” Only a small amount
of dairy products was used.
The spirit of the place was beautiful, and the combination of a well-equipped,
modern hospital and a homelike place to live presented rare possibilities for
good work. A very good feature was the supervision over the health of the
mother and her child, which was maintained after they left the home. Any
patient might return for medical care or advice at any time after discharge-.
This was one of the few maternity homes in the State which was licensed.
Both white and colored girls were admitted, separate bedrooms being provided.
Emphasis was placed on permanent maternal responsibility by the attitude and
influence of the home and by intensive follow-up. Confidential relations
between the patients and the home were deemed of paramount importance.
The home even would not make social investigations, and it refused to allow any
person other than the members of the staff to see the records.
The social policies, though not modern in some respects, were to be com­
mended on certain points: Aftercare of mothers, refusal to place out children
(which is not the function of a maternity home), absence of financial consider­
ations from the procedure relative to disposing of the baby and discharging the
mother from the home. On the other hand, the practice of discharging practi­
cally all mothers with their babies seemed questionable; a certain proportion
of the unmarried mothers treated here must have been unfit to assume such
responsibility. It seemed, too, that the work done to fix paternal responsibility
was inadequate.
Training for future employment, though not diversified, was thorough.
The impression made by the home was of efficient work, a sympathetic atti­
tude, and an earnest desire for the moral reclamation of the girls. The atmos­
phere of the home as well as the attitude of girls who were interviewed confirmed
these impressions. The home was much used by local workers because of the
personality of the superintendent, the consideration shown the mother, the
excellent spirit in the home, and the results accomplished.
H om e X X

This hospital represented the expression of the effort of a group of colored
people to develop racial responsibility for unmarried mothers. Admirably
located, surrounded by several acres of land, it was an ideal place for maternityhome care. It was fully equipped for nearly every variety of service pertaining
to prenatal, confinement, and postnatal care. It did not have a dental clinic,
but arrangements were made for this service elsewhere. Consultants in other
departments not maintained regularly at the hospital were also available.
One noteworthy feature was the stressing of the use of certain foods for expect­
ant mothers, the mothers being taught not only the caloric value of the food
but the nutritive as well. This was taken up from the points of view of health
and economy. Good educational work was done in prenatal care. The hospital
was dealing with the problems of the colored race very efficiently.
Although the great freedom given the patients was excellent in some respects,
the lack of supervision presented certain dangers.
Federal Reserve Bank of St. Louis



The social-service department consisted of one worker, a nurse whose training
and experience did not fit her for social service. It is significant that unmarried
mothers requiring follow-up, aid in obtaining employment, or other assistance
were referred to agencies equipped to render the service needed, except when
the assistance needed had to do with relieving a mother of her baby. The
worker would accept any baby after it was 2 weeks old for placement in a board­
ing home or free foster home without any effort to develop other resources. She
did all the investigation and supervision of the foster homes. This work was
not well done, and the worker’s lack of social training and experience was prob­
ably responsible.
In the main the social policies of this institution had the confidence of local
social agencies.
H om e X X I
An unmodern building, located in one of the older residential sections, noisy
and crowded, placed this home under certain handicaps. Most of the patients
admitted were received from local social agencies. Both married and unmarried
women were accepted, though intensive social work was limited to the unmarried.
Applicants with venereal disease were transferred elsewhere for treatment.
All the examinations and health work, up to the time of confinement, were
done in the home by a physician, who called daily. A well-trained staff, con­
sisting of the superintendent and one trained nurse, carried out all public-health
measures and gave complete cooperation to the attending physician. The
trained nurse worked with the girls in the sewing room and gave advice on
preparation for motherhood. Prenatal care had not been very good but was
being improved at the time of the study. The diets both for pregnancy and
lactation were rated as “ probably inadequate,” but this feature also was being
improved. The mothers were under the care of the physician after delivery,
and the feeding of the babies was directed by him. All records of medical
attention were kept at the hospital.
One bedroom for waiting mothers was somewhat crowded, but the rooms for
the mothers who had returned from the hospital with their babies were very
well arranged. For colored mothers the home reserved one bedroom containing
three beds, and one table in the dining room.
In the superintendent’s talks to the patients she stressed the mother’s respon­
sibility for whatever physical advantage she could give her child and reminded
her that this was especially his due because of his social handicaps. The poli­
cies and standards of the home, at the time it was studied, were going through
a transitional period. Recent affiliation with a case-working agency had resulted
in the appointment of a superintendent whose qualifications promised complete
reorganization and standardization of the social work. The statistics and data
gathered reflected, in the main, the work of the earlier régime. The social poli­
cies reflected an appreciation of modern methods. This was shown in the pro­
visions for follow-up work, in the practice of individual case work, in the exercise
of judgment in regard to maternal responsibility, and in the absence of financial
considerations. These policies, however, had not always been satisfactorily
carried out up to the time of the study, because the personnel, in the main, had
been untrained and had lacked the fundamental qualifications for social work.
Analysis of records revealed a large proportion of unmarried mothers whose stay
was brief either because they were dissatisfied or because they gave dissatisfac­
tion. Reports from local social agencies indicated notable improvement under
the new administration.
H om e X X II
Founded about 50 years ago as a shelter for unmarried mothers, to whom at
that time little provision was open except almshouses, this home had not
changed its main policies, except to admit also married women. This depar­
ture was said to have been made because only a few patients were making use
of the home. But at the time of the study, even though both married and
unmarried women were admitted (two-thirds of the patients the year before the
study were married), the accommodations were little used. Only one-third of
the beds were occupied by patients at the time the home was visited, and the
total-number of patients the year before was but four times the number of beds.
The medical equipment was that of a good hospital. Daily visits of physi­
cians and the constant attention of trained nurses and midwives obviated the
necessity for going out to clinics. A strict regimen of daily bathing, proper
dressing, and plain food was followed.
Federal Reserve Bank of St. Louis



Although expectant mothers were admitted at any time during pregnancy and
were kept for a short time after the period of hospital care in order to allow
time for formulation of plans, the home did no social service, referring patients
in need of such assistance to agencies equipped to render the help needed. In
the absence of a social-service department this seemed a wise policy.
The home was little used by local social agencies, as they believed that better
hospital care was afforded in other places. The superintendent was very
cooperative in the matter of any cases placed by the agencies. On the whole
the small number of patients served raised the question whether there was anv
need for this home*
H om e X X II I
One of the oldest of the institutions studied, this large home had its beginin£\ a. foundling asylum. The motive of protection of the unmarried mother
which influenced its early history, was apparent throughout the latter develop­
ment of its work, which included addition of a maternity home and a maternity
hospital, and, later, extension of the hospital work into general service for mothers and children. The fact that the married women delivered during the year of
^ outnumbered the unmarried was significant j no longer might any woman
in this institution be assumed to be an unmarried mother. The institution had a
large building with facilities for isolation and segregation, which were well adapted
lor use in detecting and treating venereal disease. There was an especiallv
good laboratory with a pathologist in charge who, besides giving the usual tests
safeguarded the household by analyzing the milk.
The health work for the patients was all done in the home, and strict stand­
ards were maintained. A physician was available every day, and pediatrists
were called in consultation. Confinement took place in the home, and the deliv­
ery room was well equipped for emergencies. A staff of three obstetricians were
on rotating service. Records of all the health work were available.
The diet was not formally rated, but a large amount of dairy products was
used— an indication that the dietary regimen was probably satisfactory. Breast
feeding was required. It was supervised and "no dissimulation was possible
small honorarium was given each week to the mother whose baby had made the
greatest gain. The babies were weighed and measured and careful records were
Ux i an<^ n®Jea. ^ res ° f the home’s social policies were the training of mothers
with the aim of giving them some definite preparation for life and the employ­
ment of a housem other” and of a social worker with some training. The
superintendent’s methods of dealing with the girls indicated an understanding
of the psychology of the work.
The one really serious defect in the social policy was the presumable discrim­
ination in favor of girls whose financial condition made it possible for them to
escape assuming responsibility for the nurture and care of their babies by sur­
rendering them upon payment of a fee. Though the patients in the home all
appeared to be satisfied and unrepressed, the discrimination must have had a
bad influence on certain girls, who had not money enough to take advantage of
the opportunity to surrender their babies. Efforts of the superintendent to
improve this condition and her success in correcting other defects in policy during the short period of her administration rendered the situation less discourag­
ing than it otherwise would be.
H om e X X IV

By reason of a policy that no woman in need of obstetrical care might be
rejected, this institution was a general receiving place from near-by parts of the
otate for pregnant women with venereal disease. It was a modern hospital
equipped for prenatal, confinement, and postnatal care; it provided for dental
service elsewhere.
It had a “ waiting ward,” and it had for years assisted unmarried mothers
with plans for themselves and their babies. Some time before the study a considerable amount of child placing had been done directly from the hospital. But
at the time of the study the work was under the direction of a recently provided
social-service department, and analysis of social histories revealed remarkable
improvement m procedure. The periods of care of patients before and after
actual hospital care were being shortened by the use of family-home and other
community resources, so that the institutions could give service to a greater
number of patients.
Federal Reserve Bank of St. Louis



The daily routine showed that attention was paid to the physical comfort of
pregnant women; definite rest periods were provided, regardless of the work to
which the patients might be assigned, an unusual feature in the maternity homes
studied. Introduction of occupational therapy was under consideration.
The social-service department was.rendering some services which seemed to
be beyond its scope. Although it was the policy of the department to refer to
other agencies all cases not yielding readily to adjustment, instances were noted
of double activity— by this department and another agency. Such duplication
must have led to confusion and must have militated against the efficiency of
both agencies.
Physical conditions were admirable, with the exception of lack of recreational
facilities for unmarried women whose stay was long. This condition was being
remedied by the utilization of outside resources.

A frank attractive girl of 20 had made her home with relatives since her infancy,
when her mother had died. Her ties with these relatives were not strong and
when she found she was pregnant she sought advice outside the family, consulting
a local social worker, who brought her to the maternity home. The father of her
coming child had disappeared when she told him of her pregnancy. After sev­
eral months he returned and married her and then went west to go into business.
He sent her money several times at the home. Later, when his business plans
had matured and the girl was able to travel, he again returned and brought her
and the child back with him to the West. During the interval the maternity
home afforded the mother and the baby shelter and care.

An intelligent young woman, a high-grade factory operator, was admitted
to the home through the assistance of her family physician. An attorney
obtained from parents of the baby’s father a private settlement of $400, out of
which he declined to take any fee.
Complying with a regulation of the home, the mother nursed her baby for
three months. After that she returned to her parents’ home and left the baby
in the maternity home, paying his board. When the child was 1 year old he
was taken by his mother’s parents, ostensibly an adopted child.

In a home which requires each patient to remain for three months after deliv­
ery the child of a 17-year-old girl had been placed in a foster home at the age of
3 weeks and immediately adopted. While the mother and baby were in the hospi­
tal an applicant for a baby had been taken to see them by the superintendent of the
home, and soon the adoption was agreed to. The putative father of the child
had not been communicated with, and the mother thought that he had no knowl­
edge of her pregnancy. The one concern of the girl’s family had been for se­
crecy, and the management of the home had fully cooperated with them. The
girl chafed at the restraint imposed by the required stay, but this the manage­
ment insisted on to give them opportunity for their work of moral reclamation.

A pretty, refined girl of 20, whose financial assistance in her home was needed
because her mother was a widow, had come from a small town in an adjoining
State to conceal her pregnancy. When the pregnancy was so advanced as to
compel the girl to seek a temporary shelter she registered in the obstetrical clinic
of a hospital. She was frightened at the thought of entering any “ home” ; she
had heard that “ they were all dreadful places.”
She was persuaded by the
hospital social worker to enter this home. The worker chose wisely, for the at­
mosphere here was such as to disarm suspicion and win the confidence of patients.
The girl’s expression of her appreciation of what the institution had done for her
constituted a real tribute to the management.
Although relatives urged the girl to give up her baby, she steadfastly refused
to do so. While in the hospital the chief resident physician had urged her to
place the child with friends of his who wanted to adopt a baby.
Federal Reserve Bank of St. Louis



The superintendent of the maternity home had developed relations with a local
agency by which she was able to refer the patient to it, so that necessary guid­
ance and assistance could be given to her.

In one home a timid, appealing little foreigner was met, who seemed helpless
about managing her affairs. She was doing fairly heavy and responsible house­
hold work in the home. Her baby had been placed in a free foster home when
it was 15 days old. Before the baby’s birth a relative of the father had brought
the mother $100 and a message that he had gone to his home in a foreign coun­
try, that she was to take good care of the baby, and that he would return in a
year and marry her. Despite these facts, the superintendent of the home decided
that the mother could not care for the baby. The mother was very emphatic
in saying that she had not given up her baby and that she would see that it had
good care.
As this home insisted on legal adoption of all placed-out children, the superin­
tendent was asked about her plans for this baby. She replied that she would
not allow legal adoption during the year and that she would permit the mother
to visit the baby. The superintendent required three months’ service from the
mother to compensate for this placement— certainly a questionable action. There
could be no indebtedness, for delivery had occurred in a hospital outside of the
home and the mother had worked all through the prenatal period.

During the study of one maternity home a certain expectant mother was re­
peatedly met. She was 24 years old, was dependable and capable, and had filled
a well-paid domestic position for several years. One day this patient produced
the clothes which ishe was making for the coming baby. They were inexpensive
but tastefully and well made. 'This led to mention of her plans for the baby.
With real gri4f-she said that she would have to give him up for adoption because
his father was disabled— a veteran of the World War— and her own help was
needed in her home. The possibility of some other plan was intimated to the
superintendent, who was present; she announced in an arbitrary manner that
adoption of the baby was the only solution. Yet this was in a large city where
many resources are available for- mothers of this type.

A girl living in a small town concealed her pregnancy until near the end of it.
When it was discovered by her parents the young man responsible could not be
found. The family physician promised to arrange for sending the expectant
mother to a city some distance away. Premature birth of the baby at home
created consternation in the household. On the advice of a worker in a near-by
institution, the mother and baby were taken by train a distance of 20 miles, one
* week after the child’s birth, to an institution where it was understood that both
would be accepted for emergency care, that the mother would return to her home
soon, and that the institution would accept permanent custody of the baby. On
their arrival the mother, as might be expected, was in a state of collapse. First
aid was immediately rendered, and she and the baby were sent to a hospital.
Here they were seen the following week, the mother critically ill.
Several months later this patient was again met in a maternity home to
which she and her baby had gone from the hospital. On account of her changed
appearance, due to excellent care, the bureau agent did not recognize her un­
til she recalled the earlier meeting in the hospital The weeks of nursing and
care of the baby had changed the attitude of the girl’s family and they were now
awaiting developments instead of continuing with hasty and ill-considered plans
for the disposal of the baby.
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis

Standards especially for maternity homes have not been formulated, but such
portions of the Minimum Standards for Child Welfare formulated by the Child­
ren’s Bureau Conference on Child Welfare Standards in 1919 as would apply to
mothers and babies in these institutions may be stated as follows: 1

1. Complete physical examination by physician as early in pregnancy as possi­
ble, including pelvic measurements, examination of heart, lungs, abdomen
and urine, and the taking of blood pressure; internal examination before
seventh month in primipara; examination of urine every four weeks dur­
ing early months, at least every two weeks after sixth month, and more
frequently if indicated; Wassermann test whenever possible, especially
when indicated by symptons.
2. Instruction in hygienfe of maternity and supervision throughout pregnancy
through at least monthly visits to a maternity center [clinic or physician]
until end of sixth month, and every two weeks thereafter.
3. Instruction of expectant mothers in hygiene of pregnancy and early infancy.
4. Confinement by a physician or a properly trained and qualified attendant.
5. Nursing service at the time of confinement and during the lying-in period,
or hospital care.
6. Daily visits by physician or nurse for five days, and at least two visits dur­
ing second week.
7. At least 10 days’ rest in bed after a normal delivery.
8. Examination by physician six weeks after delivery.
9. Cooperation with clinics, such as dental clinics and venereal clinics, for
needed treatment during pregnancy.
.10. Registration of all births.
11. Prevention of infantile blindness by treatment of eyes of every infant at
12. Instruction under medical supervision to mothers in breast feeding and in
care and feeding of children. This instruction should include:
(а) Value of breast feeding.
(б) Technique of breast feeding.
(c) Technique of bath, sleep, clothing, ventilation, and general care of
the baby, with demonstrations.
(d) Preparation and technique of artificial feeding.
(e) Dietary essentials and selection of food for infants and for older
(/) Prevention of disease in children.
13. Hospital care, or provision for medical and nursing care at the home, suffi­
cient to care for all sick infants and young children.
14. State licensing and supervision of all maternity, homes.
15. General educational work in prevention of communicable disease and in hy­
giene and feeding of infants and young children.

The child born out of wedlock constitutes a very serious problem, and for this
reason special safeguards should be provided.
The treatment of the unmarried mother and her child should include the best
medical supervision, and should be so directed as to afford the widest opportunity
for wholesome, normal life.
1These are intended only as minimum standards and are not intended to limit in any way the degree of
protection that a progressive State might desire to give its children. See Minimum Standards for Child
Welfare Adopted by the Washington and Regional Conferences on Child Welfare, 1919 (U. S. Chil­
dren’s Bureau Publication No. 62, Washington, 1920).

Federal Reserve Bank of St. Louis



Care of the child by his mother is highly desirable, particularly during the
nursing months.
No parent of a child born out of wedlock should be permitted to surrender the
child outside his own family, save with the consent of a properly designated State
department or a court of proper jurisdiction.
Each State should make suitable provision of a humane character for estab­
lishing paternity and guaranteeing to children born out of wedlock thé rights
naturally belonging to children born in wedlock. The fathers of such children
should be under the same financial responsibilities and the same legal liabilities
toward their children as other fathers. The administration of the court with re­
ference to such cases should be so regulated as not only to protect the legal
rights of the mother and child, but also to avoid unnecessary publicity and
Save for unusual reasons both parents should be held responsible for the child
during his minority, and especially should the responsibility of the father be
Federal Reserve Bank of St. Louis

[Session Laws, extra session 1919, ch. 50]
An Act Defining and regulating maternity hospitals

Be it enacted by the Legislature of the State of Minnesota: S e c t io n 1. Maternity
hospital defined.— Any person who receives for care and treatment during preg­
nancy or during delivery or within ten days after delivery, more than one woman
within a period of six months, except women related to him or her by blood or
marriage, shall be deemed to maintain a maternity hospital. The word “ person”
where used in this act shall include individuals, partnerships, voluntary associ­
ations and corporations; Provided, however, That this act shall not be construed
to relate to any institution under the management of the State board of control
or its officers or agents.
S ec . 2 . Licensed by board of control.— The State board of control is hereby
empowered to grant a license for one year for the conduct of any maternity hos­
pital that is for the public good and that is conducted by a reputable and respon­
sible person; and it shall be the duty of the board of control to prescribe such
general regulations and rules for the conduct of all such hospitals as shall be
necessary to effect the purposes of this act and all other laws of the State relat­
ing to children as far as the same are applicable and to safeguard the well-being
of all infants born therein, and the health, morality and best interest of the
parties who are inmates thereof. No maternity hospital shall receive a woman
for care therein without first obtaining a license to conduct such hospital from
said board of control. No such license shall be issued unless the premises are
in fit sanitary condition. The license shall state the name of the licensee, des­
ignate the premises in which the business may be carried on, and the number
of women that may be properly treated or cared for therein at any one time.
Such license shall be kept posted in a conspicuous place on the licensed premises.
No_ greater number of women shall be kept at any one time on the premises for
which the license is issued than is authorized by the license and no woman shall
be kept in a building or place not designated in the license. A record of the
license so issued shall be kept by the board of control, which shall forthwith
give notice to the State board of health and to the local board of health of the
city, village, or town in which the licensee resides of the granting of such license
and the conditions thereof. The license shall be valid for one year from the date
of the issuance thereof. The State board of control may, after due notice and
hearing revoke the license in case the person to whom the same is issued violates
any of the provisions of this chapter, or when, in the opinion of said board, such
maternity hospital is maintained without due regard to sanitation and hygiene,
or to health, comfort or well-being of the inmates or infants born to such inmates
or in case of violation of any law of the State in a manner disclosing moral turpi­
tude or unfitness to maintain such hospital or that any such hospital is con­
ducted by a person of ill repute or bad moral character.
Written charges against the licensee shall be served upon him at least three
days before hearing shall be had thereon and a written copy of the findings and
decision of the board upon hearing shall be served upon the licensee in the man­
ner prescribed for the service of -summons in civil actions.
Any licensee feeling himself aggrieved by any decision of the board may
appeal to the district court by filing with the clerk thereof in the county where
his^ hospital is situated within ten days after written notice of such decision, a
written notice of appeal specifying the grounds upon which the appeal was
The appeal may be brought on for hearing in a summary manner by an order
to show cause why the decision of the board should not be confirmed, amended,
or set aside. The written notices and decisions shall be treated as the pleadings
in the case and may be amended in the discretion of the court. The issues shall
be tried anew by the court and findings shall be made upon the issues tried.

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Either party may appeal to the supreme court from the determination of the
district court within five days after notice of filing the decision, in the manner
provided for appeals in civil action.
No revocation of license shall become effective until any appeal made shall
have been determined. In case of revocation of a license, the board shall make
a notation thereof upon its records and give written notice of such revocation to
the licensee, or leaving a copy thereof with a person of suitable age and discretion
living upon the premises. In case of revocation the board of control shall also
notify the State board of health and the local board of health of the city, vil­
lage, or town in which the hospital is situated.
S ec . 3. Disposition of children.— No person, as an inducement to a woman to
go to any maternity hospital during confinement, shall in any way offer to dis­
pose of any child or advertise that he will give children for adoption or hold Him­
self out as being able to dispose of children in any manner.
S ec . 4 . Board of control to prescribe forms.— The State board of control may pre­
scribe forms for the registration and record of persons cared for -in any such
hospital, and the licensee shall be entitled to receive gratuitously from the board
of control a book of forms for such registration and record. Each book shall
contain a printed copy of this chapter. The licensee of a maternity hospital
shall keep a record in the form to be prescribed by said board, wherein shall be
entered the true name of every patient, together with all her places of residence
during the year preceding admission to said hospital, the name and address of
the physician or midwife who attended at each birth taking place at such hos­
pital, or who attended any sick infant therein, and the name and address of the
mother of such child; the name and age of each child who is given out, adopted,
or taken away to or by any person, together with the name and residence of the
person so adopting or taking away such child, and such other information as
will be within the knowledge of the licensee and as the board shall prescribe.
S ec . 5. Physician or midwife to make report.— Every birth occurring in a
maternity hospital shall be attended by a legally qualified physician or midwife.
The licensee owning or conducting such hospital shall within twenty-four hours
after a birth occurs therein, make a written report thereof to the State board of con­
trol giving the name of the mother, the sex of the child, and such additional informa­
tion as shall be within the knowledge of the licensee and as may be required by
the board. The licensee owning or conducting any such hospital shall immedi­
ately after the death in a maternity hospital of a woman, or an infant born
therein or brought thereto, cause notice thereof to be given to the local board
of health of the city, village, or town in which such hospital is located.
S ec . 6 . Inspection of hospitals.— The officers and authorized agents of the
State board of control, and of the State board of health and the local board of
health of the city, village, or town in which a licensed maternity hospital is located,
may inspect such hospital at any time and examine every part thereof. The
officers and agents of the State board of control may call for and examine the
records which are required to be kept by the provisions of this act and inquire
into all matters concerning such hospital and patients and infants therein; and
the said officers and authorized agents of the State board of control shall visit and
inspect such hospitals at least once every six months and shall preserve^ reports
of the conditions found therein. The licensee shall give all reasonable informa­
tion to such inspectors and afford them every reasonable facility for viewing the
premises and seeing the patients therein.
S ec . 7. Information as to legitimacy of child.— Whenever a woman, who within
ten days after delivery of a child, or a woman who is pregnant, is received for
care in a maternity hospital, the licensee of such maternity hospital or the offi­
cer in charge of such other hospital, shall use due diligence to ascertain
whether such child is legitimate and if there is reason to believe that such child
is illegitimate, or will be when born illegitimate, such licensee shall report to the
State board of control forthwith the presence of such woman together with such
other information as shall be within the knowledge of the licensee and as the
board mav require.
.. . ,,
Sec . 8. Disclosure of contents.— No officer or authorized agent of the State
board of control, State board of health, or the local boards of health of the city,
village, or town where such licensed hospital is located, or the licensee of such
a hospital, or any of its agents, or any person, shall directly or indirectly dis­
close the contents of the records herein provided for, or the particulars entered
therein, or facts learned about such hospital, or the inmates thereof, except
upon inquiry before a court of law, at a coroner’s inquest or before some other
tribunal, or for the information of the State board of control, State board of
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health or the local board of health of the village, city, or town in which said
hospital is located: Provided, however, That nothing herein shall prohibit the
board of control, with the consent of any patient in such hospital, disclosing
such facts to such proper persons as may be in the interest of such patient or
the infant born to her.
S e c . 9. Burden of proof.— In a prosecution under the provisions of this act
or any penal law relating thereto a defendant who relies for defense upon the
relationship of any woman or infant to himself shall have the burden of proof.
S e c . 10. Violation a gross misdemeanor.— Every person who violates any of
the provisions of this act shall upon conviction of the first offense be guilty of
a misdemeanor. The second or subsequent offense shall be a gross misdemeanor.
S e c . 11. This act shall take effect and be in force from and after its passage.
Sec . 12. All acts and parts of acts inconsistent herewith are hereby repealed.
Approved September 22, 1919.
An Act To amend sections 4651, 4652, 4656, 4657, 4660, and 4661, General Statutes 1913, as amended by
chapter 220, Session Laws 1917, and to repeal section 3 oi chapter 220 oi General Laws 1917, all of said
sections relating to the record of births and deaths







S e c t io n 4. That section 4657 of the General Statutes of 1913 be, and the same

is hereby, amended so as to read as follows:







“ S e c . 4657. All superintendents, managers, or persons in charge of lying-in

or other hospitals, almshouses, charitable or other institutions, public or private, to
which persons resort for confinement, treatment of disease, care, or are committed
by process of law, shall, at once, make and preserve a record of all the personal and
statistical particulars relative to the inmates now in, or hereafter admitted to
their institutions, that are required to be stated in the certificate of birth and
death provided for by this act, and on or before the tenth of each month shall
file with the State board of health, on a blank provided by such board for the
purpose, a report of all births and deaths, or stillbirths, occurring in such institu­
tions during the previous month. If admitted for medical treatment of disease
the physician in charge shall specify, in the record, the nature of the disease and
where it was contracted. ”
Approved April 14, 1921.
[Regulations of State board of health, edition of November 1,1919]







R e g u l a t io n 13.

All lying-in houses shall be licensed and the local health
officer shall inspect those within his jurisdiction and satisfy himself that they
are properly licensed or conducted.
R e g u l a t io n 14. No maternity hospital shall be granted a licence unless same
is constructed and maintained with such regard for sanitation and for protection
of health of inmates as shall meet with approval of State board of health.
[Laws of 1893, Act No. 19; Stat. 1920, secs. 14504-14506]
An Act To provide for the licensing and regulation of lying-in hospitals
S e c t io n 1. Be it enacted etc., That it shall be lawful for the board of health of

any locality to license any person or persons, other than an institution duly
incorporated for such purpose, to establish and keep a lying-in hospital, ward,
or other private place for the reception, care, and treatment of women in labor,
upon written application filed with the said board, accompanied by the endorse­
ment of six or more reputable persons, citizens of the county where such hos­
pital may be situated, who shall certify to the respectability of the applicant
and that the hospital, hospital ward, or other private pïace, shall only be used
for legitimate, mural, and charitable purposes] and if, after due inquiry of such
board of health, R is believed that the applicant is a proper person and the prem­
ises are suitable and properly arranged for such purpose, the said board of health
shall grant a license for the purpose above mentioned upon the payment of a
fee of five dollars. Such license shall continue in force for a period of two years
subject, however, to be revoked by the board of health granting the same upon
the violation of the rules and regulations enacted by the said board of health
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for the government of said hospitals, hospital wards, or other private places.
The proprietor of every such hospital, hospital ward, or other private place kept
for lying-in purposes shall keep a record in a book for that purpose, containing
the full name and address of each person admitted, the date of admission, the
date of birth of every child, the date of its removal, and the place to which such
child shall be removed. Such hospital, hospital ward, or other private place
shall be subject to the visitation or inspection at any time by the board of health­
granting the said license, or any special officer that may be appointed for that
purpose by the court of common pleas, upon the petition of any society for
the prevention of cruelty to children of the proper county.
Sec . 2. The proprietor of every hospital, hospital ward, or other private place
for lying-in purposes to which a license has been granted according to section
one of this act shall, within five days after the birth of any child, report to
the said board of health the date and place of such birth, the name, sex, and
color of the child.
Sec. 3. Whoever shall violate the provisions of section one of this act by
keeping a hospital, hospital ward, or other private place for lying-in purposes
for hire or reward, without license, shall be guilty of a misdemeanor, and for the
first offense, upon conviction thereof, shall be punished by a fine not exceeding
one hundred dollars, and for the second offense, upon conviction thereof, shall
be punished by a fine not exceeding two hundred dollars and imprisonment of
not more than one year, or either or both, at the discretion of the court.
Sec. 4. All acts or parts of acts inconsistent herewith are hereby repealed.
Approved the 26th day of April, A. D. 1893.
[Administrative Code, 1923]
An Act Providing for and reorganizing the conduct of the executive and administrative work of th.e
Commonwealth by the executive department thereof and certain existing and certain new administra­
tive departments, boards, commissions, and officers; abolishing, combining, changing the names of,
reorganizing, or authorizing the reorganization of certain administrative departments, boards, com­
missions, bureaus, divisions, offices, and agencies; defining the powers and duties of the governor and
other executive and administrative officers, and of the several administrative departments-. ,boards,
and commissions; fixing the salaries of the governor, lieutenant governor, and certain executive and
administrative officers; providing for the appointment of certain administrative officers and of all
deputies and other assistants and employees in certain departments, boards, and commissions; and
prescribing the manner in which the number and compensation of the deputies and all other assist­
ants and employees of certain departments, boards, and commissions shall be determined.



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A r t . X X . — P o w e r s a n d D u t ie s of t h e D e p a r t m e n t of W e l f a r e an d I ts
D e p a r t m e n t a l A d m in is t r a t iv e a n d A d v is o r y B o a r d s a n d C o m m is sio n s
S e c t io n 2001. Powers and duties in general.— The department of welfare shall,
subject to any inconsistent provisions in this act contained, continue to exercise
the powers and perform the duties by law vested in and imposed upon the depart­
ment of public welfare and the commissioner of public welfare. It shall also
exercise such additional powers and perform such additional duties as are imposed
upon it by this act.
Sec. 2002. Definitions.— * * * (d) “ Maternity home and hospital ” shall
mean any house, home, or place in which, within a period of six months, any
person receives for care or treatment, during pregnancy or during or immediately
after parturition, more than one woman, except women related to such person
by blood or marriage within the second degree;
Sec. 2003. Supervisory powers.— * * * (d) All maternity homes and hos­
pitals within this Commonwealth.

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