Full text of Federal and State Cooperation in Maternal and Child-Welfare Services Under the Social Security Act : Title V, Parts 1, 2, and 3, Maternal and Child-Health Services, Services for Crippled Children, Child-Welfare Services, Maternal and Child-Welfare Bulletin No. 2, Bureau Publication No. 254

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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
FRANCES PERKINS, Secretary

C H I L D R E N ’ S

B U R E A U

KATHARINE F. LENROOT, Chief

VJAAm m x

V iX llr

FE D E R AL AND STATE C O O P E R A T IO N IN
MATERNAL AND CHILD-WELFARE SERVICES
UNDER THE SOCIAL SECURITY ACT
Title V, Parts 1, 2, and 3

Maternal and Child-Health Services
Services for Crippled Children
Child-Welfare Services

Summary for the 5 months ended June 30, 1936
Preliminary summary for the fiscal year 1937
Maternal and Child-Welfare Bulletin No. 2

For sale by the Superintendent of Documents, Washington, D. C.

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CO N TEN TS
Page

Letter o f transmittal____________________________________
Federal administration______________________________
Grants authorized__________________________________
Appropriations for fiscal year 1936_______________________________
Children’s Bureau administrative service______________________
Cooperation with other Federal agencies__________________
Advisory service on policies and procedure_____________________
Conferences o f State officials_______________________________
Allotments to States_________________________________________
Maternal and child-health services______________________ _____
Services for crippled children____________________________
Child-welfare services___________________________________
Submission and approval o f State plans___________________________
Services to special areas and special groups___________________________
The starting point— recommendations o f the Committee on Economic
Security_________________________________________
Maternal and child-health services_______________________________
Children’s Bureau administrative service________________________
Advisory service_________«______________ ____________
Submission and approval o f State plans__________________________
Allotments and payments to States____________________________
Sources o f funds and proposed expenditures___________________________
State divisions o f maternal and child health_________________________
Services o f other divisions o f State health departments________________
Qualifications o f State and local personnel_________________________
Types o f State and local service______________________________
Educational programs in State plans__________________________________
Demonstration services_____________________________
Efforts to protect maternal health___________________________
Medical participation______________________________
The local public-health nurse____________________________
Dental-hygiene service____________________________
Nutrition programs__________________ _____________
Emphasis on work in rural areas_____________________ _______
Public understanding___________________________________
Current statistics and special studies__________________________
Problems and objectives___________________________________
Services for crippled children________________________________
Children’s Bureau administrative service________
Advisory service____________________________
State agencies administering services for crippled children____________
Submission and approval o f State plans__________________________
Allotments and payments to States___________________________
Locating crippled children_________________________________ .
Diagnostic service__________________________ ________
Acceptance for care_________________________________
III

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C on ten ts

Services for crippled children— Continued.
Page
Surgical care and hospitalization---------------------------------------------------- --------48
Convalescent care____________________________________________________________
49
Aftercare services____________________________________________________________
50
Medical service_______________________________________________________________
51
Nursing service_______________________________________________________________
52
Physical therapy------------------------------------------------------------Social service_________________________________________________________________
53
Vocational rehabilitation------------------------------------------------------------------------53
Cooperation with public and private agencies-------------------------------------------53
State research projects----------------------------------------------------------------------------------55
Increased service under 1936 plans--------------------------------------------------------------55
Administrative problems ahead----------------------------------------------------------—
57
Child-welfare services--------------------------------------------------------------------------------------------59
Children’s Bureau administrative service---------------------------------------------------60
5®
Advisory service_______________________________________________________
State public-welfare agencies------------------------------------------------------------------------62
Submission and approval o f State plans-----------------------------------------------------63
Allotments and payments to States-------------------------------------------------------------63
Characteristics o f State plans-----------------------------------------------------------------------64
Emphasis on rural areas---------------------------------------------------------------------------64
Related programs-------------------------------------------------------------------------------------------®5
State and local personnel--------------------------------------------------------------- _---------65
Reports on State activities----------------------------------------------------------------------------66
State progress, February—June 1936------------------------------------------------------------66
Problems and objectives---------------------------------------------------------------------------'0
^
Preliminary summary o f activities in the fiscal year 1937--------------------------------72
Maternal and child-health services--------------------------------------------------------------72
80
Services for crippled children-------------------------------------------------------------------Child-welfare services--------------------------------------------------- -----------------------------Appendix 1.— Text of the sections of the Social Security Act relating to
grants to States for maternal and child welfare---------------------94
Appendix 2.— State agencies administering services under title V , parts 1,
2, and 3, o f the Social Security Act, June 1937----------------100
Appendix 3.— Members o f advisory committees appointed by the Secre
tary o f Labor___________________________________________________
167

TABLES
Table
1. Amounts authorized for annual appropriation by the Social Security
A ct, title V , parts 1 , 2 , 3 , and 5, and appropriations made by Congress
for the fiscal years ending June 30, 1936, 1937, and 1938-------------------2. D ate o f approval b y Chief o f Children’s Bureau o f first State plans
under the Social Security A ct, title V , parts 1, 2, and 3 ---------------------3. Allotments and payments to States for maternal and child-health serv
ices under the Social Security Act, title V , part 1, 5 months ended

3
10

June 30, 1936----------------------------------------- -------------------------------------------------4. Allotments and payments to States for services for crippled children
under the Social Security Act, title V , part 2, 5 months ended June

30, 1936----------- ---------------------------------------------------- -----------------------------------5. Allotments and payments to States for child-welfare services under the
Social Security Act, title V , part 3, 5 months ended June 30, 1936_„

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Con ten ts

6. Federal funds available to States, Federal funds budgeted by States,
and payments to States, for maternal and child-health services under
the Social Security Act, title V , part 1, fiscal year ended June 30
7. Estimated expenditures for maternal and child-health services under
the Social Security Act, title V , part 1, as shown by budgets in
cluded in approved State plans for fiscal year ended June 30, 1937_ _
8. Federal funds available to States, Federal funds budgeted by States"
and payments to States, for services for crippled children under the
Social Security Act, title V , part 2, fiscal year ended June 30, 1937__
9. Estimated expenditure for services for crippled children under the
Social Security A ct, title V , part 2, as shown in budgets included in
approved State plans for the fiscal year ended June 30, 1937_________
10« Federal funds available to States, Federal funds budgeted by States,
and payments to States, for child-welfare services under the Social
Security Act, title V , part 3, fiscal year ended June 30, 1937________

MAPS
Figure 1.

Maternal and child-health services; States receiving Federal
grants as authorized by the Social Security Act, title V , part
1, fiscal years 1936 and 1937__________________________ _____
Services for crippled children; States receiving Federal grants
as authorized by the Social Security Act, title V , part 2,
fiscal years 1936 and 1 9 3 7 _ _ _____________ _________________
’

Figure 3.— Child-welfare services; States receiving Federal grants as
authorized by the Social Security Act, title V , part 3, fiscal
years 1936 and 1937

Figure 2.

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LETTER OF TRAN SM ITTAL

United States Department of labor ,
Children ’s Bureau ,
Washington, December 15, 1937.

MADAM: There is transmitted herewith Maternal and ChildWelfare Bulletin No. 2, Federal and State Cooperation in Maternal
and Child-Welfare Services Under the Social Security Act, title V,
parts 1, 2, and 3, providing for grants to the States for maternal and
child-health services, services for crippled children, and child-welfare
services. This bulletin includes an account of the administration of
these parts o f the act by the Children’s Bureau during the first 17
months that the act was in operation (February 1, 1936, to June 30,
1937); a summary of State and local activities carried on under ap
proved State plans in the 5-month period ended June 30, 1936; and
a preliminary summary of such activities in the fiscal year ended
June 30, 1937.
The members of the Children’s Bureau staff who have been chiefly
responsible for the administration of these programs are Martha M.
Eliot, M. D., Assistant Chief o f the Bureau; Albert McCown, M. D.,
the first Director of the Maternal and Child Health Division, and his
successor, Edwin F. Daily, M. D .; Robert C. Hood, M. D., Director
o f the Crippled Children’s Division; Mary Irene Atkinson, Director
o f the Child Welfare Division; Naomi Deutsch, R. N., Director of
the Public Health Nursing Unit; and William J. Maguire, Director of
the State Audits Unit.
Respectfully submitted.
Katharine f . Lenroot , Chief.

Hon. Frances Perkins ,
Secretary of Labor.
VII

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Federal and State Cooperation in Maternal
and Child-Welfare Services Under the
Social Security Act
A
FEDERAL ADMINISTRATION
Grants Authorized.

The Social Security Act, approved by the President August 14,
1935,1 directed the Children’s Bureau o f the United States Depart
ment o f Labor to administer the sections of the act providing for
grants to the States (including Alaska, Hawaii, and the District of
Columbia) to establish, extend, and improve (1) maternal and childhealth services, (2) services for crippled children, and (3) child-welfare
services. The act authorized the Secretary of Labor to make allot
ments and issue necessary regulations under these provisions.
The Social Security Act authorized annual appropriations for such
grants, as follows:
Maternal and child-health services___________________________ $3, 800, 000
Services for crippled children_________________________________
2, 850, 000
Child-welfare services__________________ _____________ _________
1, 500, 000
T otal--------------------------------------------------------------------------------

8, 150, 000

Appropriations for Fiscal Year 1936.

An act o f Congress, approved February 11, 1936,2 made available
the following appropriations for grants to States under title V, parts
1, 2, and 3, o f the Social Security Act for the fiscal year ended June 30,
1936:
Maternal and child-health services___________________________ $ 1, 580, 000
Services for crippled children________________________ _______ 1, 187, 000
625, 000
Child-welfare services___________________________________ ______
T o ta l____________________________________________________

3, 392, 000

This appropriation act provided that the allotments to the States
for the fiscal year 1936 should be based on five-twelfths of the annual
1 Public, N o. 271, 74th Cong.
2 Public, N o. 440, 74th Cong.

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amounts authorized under the provisions of the Social Security Act
and that no payment should be made to a State for any period prior
to February 1,1936. In other words, the first period of operation under
the Social Security Act was the last 5 months of the fiscal year ended
June 30, 1936.
Children’s Bureau Administrative Service.

Immediately after the passage of the Social Security Act the
Children’s Bureau began to make the preparations necessary for
the administration o f title V, parts 1 ,2 , and 3, of the act, providing
for grants to the States, when funds should become available for this
purpose. For each of the three programs provided for in the act a
division was established in the Children’s Bureau, namely, the M a
ternal and Child Health Division, the Crippled Children’s Division,
and the Child Welfare Division. All appointments in these divisions,
as in all divisions of the Bureau, are made in accordance with civilservice regulations.
The Maternal and Child Health Division and the Crippled Children’s
Division, each of which is directed by a physician, receive general
supervision from the Assistant Chief o f the Children’s Bureau, who is
also a physician. A Public Health Nursing Unit, headed by a publichealth nurse, was established to serve both the Maternal and Child
Health Division and the Crippled Children’s Division. The Child
Welfare Division, with a social worker as director, receives general
supervision from the Chief of the Children’s Bureau. A State Audits
Unit, under an accountant, was set up within the Bureau’s Adminis
trative Section to make the necessary check on budgets submitted as
a part o f State plans, to prepare computations showing Federal pay
ments to be made, and to audit State funds used in matching Federal
funds. Legal service is given by the office of the Solicitor of the
Department o f Labor.
The staffs o f the three social-security divisions of the Children’s
Bureau include consultants in special fields o f basic importance in
each program. The Director o f the Maternal and Child Health
Division is an obstetrician, and the staff o f this division includes
physicians and a nutritionist. Two of the regional medical con
sultants are pediatricians; all have had experience in the maternal
and child-health field and have been trained in public health. The
Director o f the Public Health Nursing Unit gives consultation service
to this division and also to the Crippled Children’s Division. The
Director and Assistant Director o f the Crippled Children’s Division
are pediatricians with experience in work for crippled children, and
the staff o f this division includes a consultant orthopedic surgeon
and medical social workers. In the Child Welfare Division are social
workers experienced in the fields o f State administration and commu
nity organization o f child-welfare services. A statistical consultant

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provides advisory service to these three divisions on the development
o f records and statistical reports o f State and local activities. These
divisions make use also o f the information and advice of the specialists
in the research divisions of the Bureau, especially those in the Division
o f Research in Child Development, the Social Service Division, and
the Delinquency Division.
T o facilitate field service five regions have been marked out, which
include, with some variations, the Northeastern States; the Southeast
ern States; the North Central States; the South Central States; and the
Western States, Alaska, and Hawaii. A regional office was established
in San Francisco in May 1936, and one in New Orleans in September
1936. The other regions are served from the Washington office.
T o give assistance to the State agencies there is assigned to each
region a medical consultant, a public-health-nursing consultant, a
social-work consultant, and an auditor.
The Social Security Act authorized an appropriation of $425,000
for the fiscal year ended June 30, 1936, for the expenses o f the Chil
dren’s Bureau in administering the parts o f the act relating to maternal
and child-health services, services for crippled children, and childwelfare services. The sum so authorized for administrative expenses
was 5.2 percent o f the total amount authorized for Federal grants to
the States for these three types o f service. Under this authorization
$150,000 was appropriated for such administrative expenses for the
last 5 months of the fiscal year ended June 30,1936 (act approved Feb.
11, 1936), with the proviso that this appropriation should be available
to cover administrative expenses paid between August 14, 1935, and
February 11, 1936, in performance o f the duties imposed on the
Children’s Bureau by the Social Security Act. For appropriations
for this purpose for the fiscal years 1936, 1937, and 1938 see table 1.
T A B L E 1 .— A m o u n ts authorized for annual appropriation b y the Social

Security A ct, title V, parts 1, 2, 3, and 5, and appropriations m ade b y
Congress for the fiscal years ending June 30, 1936, 1937, and 1938

Purpose

Grants to States:
For maternal and child-health services_____________
For services for crippled children_______________
.
For child-welfare services__________________ ________
Administrative expenses, Children’s Bureau____ ______

Amounts
authorized
for annual
appropria
tion

Fiscal year
1936 (Feb.
1-June 30)

Fiscal year
1937

Fiscal year
1938

$3, 800,000
2.850.000
1.500.000
(s)

$1,580,000
1,187,000
625,000
< 150,000

3 $2,820,000
3 2,150,000
3 1,200,000
299,000

3 $3, 700,000
3 2, 800,000
3 1,475,000
« 308,000

Appropriations 1

1 These appropriations were made as follows: For the fiscal year 1936, Public, No. 440, 74th Cong.; for the
fiscal year 1937, Public, No. 599, 74th Cong.; for the fiscal year 1938, Public, No. 153, 75th Cong.
3 Tins amount is smaller than the annual amount authorized in the Social Security Act, but the appro
priation act simultaneously authorized allotments to the States on the basis of the total amount authorized in
the Social Security Act.
3 $425,000 was authorized for this purpose for the fiscal year 1936. No amount was specified -or succeeding
years.
3 This appropriation was also available for reimbursement of the Children’s Bureau for administrative
expenses incurred in performance of duties imposed by the Social Security Act between Aug. 14,1935, and
the passage of the appropriation act.
4 In addition, $70,000 has been allotted to the Children’s Bureau for travel expenses from the consolidated
travel fund for the Department of Labor (consolidated in one fund for the year 1938 for the first time).

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Cooperation W ith Other Federal Agencies.

In administering the three maternal and child-welfare programs
the Children’s Bureau proceeds in frequent consultation with other
Federal agencies that are responsible for related programs. Policies
governing the administration of grants for maternal and child-health
services and for services for crippled children are developed by the
Children’s Bureau in the light o f the policies o f the United States
Public Health Service relating to grants-in-aid to the States for
public-health services. In connection with the crippled children’s
program the Children’s Bureau consults as necessary with the Voca
tional Rehabilitation Service o f the Office o f Education, United
States Department of the Interior, which administers Federal grants
to the States for the vocational rehabilitation o f the physically dis
abled. In connection with the program for child-welfare services the
Children’s Bureau works closely with the Bureau of Public Assistance
o f the Social Security Board, which administers grants to States for
aid to dependent children, and cooperates with the social-service staff
o f the Works Progress Administration.
Advisory Service on Policies and Procedure.

A general advisory committee and an advisory committee for each
o f the three special fields o f activity have been appointed by the
Secretary of Labor to advise the Children’s Bureau and the States on
policies to be followed in formulating plans for carrying out the pur
poses o f title V, parts 1, 2, and 3, o f the Social Security Act.
The general advisory committee on maternal and child-welfare
services, with Kenneth D. Blackfan, M. D., as chairman, includes
professional and lay members, a number of them representing national
organizations. The special committees are entirely made up o f pro
fessional members. The chairman of the advisory committees on
the three programs are as follows: advisory committee on maternal
and child-health services, Henry F. Helmholz, M. D .; advisory com
mittee on services for crippled children, Albert H. Freiberg, M. D .;
and advisory committee on community child-welfare services, H. Ida
Curry.
The general committee and the three special committees met on
December 16 and 17, 1935. Each special committee presented recom
mendations on its program, which were accepted and endorsed by the
general committee. These recommendations were invaluable to the
Children’s Bureau and the State agencies in the working out of policies
incorporated in the State plans for the three services under the Social
Security Act.
In anticipation of the development o f plans for the fiscal year 1937
two o f the special committees met again toward the close of the period
of operation o f the State plans for the fiscal year 1936. The advisory

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committee on community child-welfare services held its second meet
ing on June 1, 1936, and amplified the recommendations that it had
made in the previous December. The advisory committee on ma
ternal and child-health services held its second meeting June 5 to
discuss the problems brought to light during the initial period of
operation under the State plans.
As plans progressed prior to the time when funds became available,
the need for a special Children’s Bureau advisory committee on ma
ternal welfare had become evident. A first meeting of a group of
obstetricians was held in March 1936, and as a result a continuing
committee was appointed by the Secretary of Labor, who selected as
its chairman Fred L. Adair, M. D., the chairman of the American
Committee on Maternal Welfare.
A special advisory committee on training and personnel problems
in the field o f child welfare was appointed by the Secretary of
Labor, with Walter Pettit as chairman; and its first meeting was
held October 19, 1936. The same committee serves the Bureau of
Public Assistance of the Social Security Board.
The general advisory committee on maternal and child-welfare
services held its second meeting with the advisory committees for
each of the three programs on April 7 and 8, 1937.
The recommendations made by the advisory committees are dis
cussed in the sections that follow. The committee membership is
given in appendix 3, page 107.
Conferences of State Officials.

The State and Territorial health officers performed a valuable
service to the Children’s Bureau and the States when in June 1935,
in anticipation o f the passage of the Social Security Act, they adopted
an outline or plan for the development o f maternal and child-health
programs, including public-health-nursing and dental programs. The
plan was expanded and somewhat revised at the conference of the
State and Territorial health officers held with the Children’s Bureau
April 15, 1936.
By April 1936 in a considerable number of States the health depart
ment had been designated as the agency to administer the program
for services for crippled children. In other States it was apparent
that the State and local health departments would be called upon to
perform important cooperative services in relation to this program.
At the April 1936 conference, accordingly, the State and Territorial
health officers adopted recommendations on standards and adminis
trative organization o f State programs of services for crippled children.
For a summary o f the recommendations of the State and Territorial
health officers see page 15.
A conference on the administration of child-welfare services was
held at the Children’s Bureau June 1 and 2, 1936. Invitations were

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sent to the directors of public welfare of all the States, and each was
asked to send an official delegate to the meeting, preferably the person
responsible for the direction o f child-welfare services in the State.
The conference was attended by representatives from 43 States, the
District o f Columbia, and Hawaii, and by members o f the advisory
committee on community child-welfare services.
A similar conference o f the directors o f maternal and child-health
divisions in State departments o f health was held at the Children’s
Bureau on June 6 and 7, 1936, to discuss the administration o f mater
nal and child-health services. Forty-one States, the District of
Columbia, Alaska, and Hawaii were represented by maternal and
child-health directors. Four other States were represented by their
State health officers or by other officials from the State department
of health.
Allotments to States.

For the first three parts of title V the Social Security Act specifies
the basis for the allotment o f Federal grants to the States and places
upon the Secretary o f Labor the responsibility for making the actual
allotment to each State.
Maternal and child-health services.— For grants to the States for
maternal and child-health services the Social Security Act authorizes
an annual appropriation o f $3,800,000. It provides (1) that $20,000
shall be allotted to each State (total $1,020,000) and (2) that each
State shall be allotted a part o f $1,800,000 based on the ratio of its
live births to the total number o f live births in the latest calendar
year for which census figures are available. These amounts (total
$2,820,000, designated for administrative purposes as fund A ) are
made available for paying one-half o f State and local expenditures
for maternal and child-health services under State plans approved by
the Chief of the Children’s Bureau. The act provides also that
$980,000 (designated as fund B) shall be allotted to the States accord
ing to the financial need o f each State for assistance in carrying out
its State plan, as determined by the Secretary o f Labor after taking
into consideration the number of live births in the State.
The first appropriation for grants to the States for maternal and
child-health services, made for the last 5 months of the fiscal year
1936, was $1,580,000, approximately five-twelfths of the annual sum
authorized.
Of this appropriation, $1,172,518 (fund A) was available for match
ing State and local expenditures. From this fund the Secretary of
Labor allotted to each State $8,315.69 (about five-twelfths of $20,000)
and in addition a share o f the balance, $748,417.81, in the proportion
that the number o f live births in the State bore to the total number in
the United States in 1934, the latest year for which census figures
were then available.

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Owing to delays in the submission and approval of State plans and,
in some cases, to limited State and local appropriations for maternal
and child-health services, only $952,404.70 was paid to the States by
June 30, 1936, out o f the total o f $1,172,518 available for paying onehalf o f State and local expenditures. The balance, $220,113.30, is
available under the terms of the act for payment to the States until
June 30, 1938. N o payment from the allotment for any fiscal year
may be paid to a State until its allotment for the preceding fiscal year
has been exhausted or has ceased to be available.
The appropriation for the fiscal year 1936 included $407,482 (fund
B), to be allotted according to the financial need o f each State for
assistance in carrying out its State plan. The Secretary o f Labor
made a conditional distribution o f this fund as follows:
1. A uniform apportionment o f $2,078.99 to each State, the
total amount apportioned to the States being $106,028.49.
2. The sum o f $99,791.50, to be divided among the States after
taking into consideration excessive infant mortality and the
number o f live births in each State.
3. The sum o f $99,791.50, to be divided among the States after
taking into consideration excessive maternal mortality and the
number of live births in each State.
4. The sum of $101,870.51, to be divided among the States on
the basis o f the sparsity o f population.
After the conditional allotment for each State was so determined,
the Secretary of Labor compared it with the amount requested by
each State on the basis o f its need for financial assistance in carrying
out its plan. She found it possible to allot to 40 States the full
amount shown by the States to be needed and to make a conditional
allotment to 7 States from which complete detailed information had
not been received. Four States had indicated that they were making
no request for an allotment from this fund (fund B). The final
allotment was made on February 18, 1936.
On account of delays in the submission and approval o f State plans,
State requests amounted to less than the total appropriated for
fund B. The actual payments to the States from this fund for the
fiscal year 1936 totaled $300,031.52. The balance ($107,450.48)
ceased to be available for payment to the States on June 30, 1936.
Services for crippled children.— For grants to States for services
for crippled children, the Social Security Act authorizes an annual appro
priation o f $2,850,000. It provides (1) that $20,000 shall be allotted
to each State (total $1,020,000) and (2) that the remainder ($1,830,000) shall be allotted to the States according to the needs o f each
State as determined by the Secretary o f Labor after taking into con
sideration the number o f crippled children in such State in need of
services and the cost o f furnishing such services to them.

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The first appropriation for grants to the States for services for
crippled children ($1,187,000) for the 5-month period, February 1 to
June 30, 1936, was approximately five-twelfths o f the annual sum
authorized by the act. The Secretary o f Labor allotted $8,329.95 to
each State. The balance of the fund was divided into two parts.
The sum o f $595,506 was apportioned according to the number of
persons under 21 years o f age in each State in proportion to the total
population of the United States under 21. This apportionment was
based on the estimated number of crippled children in the population,
assuming a uniform average of 6 crippled children per 1,000 popula
tion under 21 years of age for the entire country. Of the $166,666.55
remaining $76,154.64 was allotted after the States had sent in reports
showing the number of crippled children not provided for, the need
for care arising out of acute epidemics of poliomyelitis, and increased
costs o f care.
The act provides that the payments to the States for services for
crippled children shall be equal to one-half the total sum expended
for carrying out the State plan. In other words, to receive the full
amount offered a State must have available for services for crippled
children an equal sum from State or from State and local sources.
The States were not all able to submit their plans in time for approval
by June 30, and some were unable to match in full the Federal aid
offered. The total paid to the States to June 30, 1936, was $732,492.33; the balance ($454,507.67) is available for payment to the
States until June 30, 1938.
Child-welfare services.— For grants to the States for child-welfare
services, the Social Security Act authorizes an annual appropriation
of $1,500,000, to be allotted by the Secretary of Labor to the States
on the basis of plans developed jointly by the State agency and the
Children’s Bureau. The Secretary o f Labor is directed to allot
$10,000 to each State and the remainder to each State on the basis
of such plans, not to exceed such part o f the remainder as the rural
population of such State bears to the total rural population of the
United States.
The 1936 appropriation of $625,000 was sufficient to permit the
allotting to each State o f $4,166.67 and a share of $412,499.83 on the
basis o f the ratio of its rural population to the total population o f the
United States. Because of lack of definite administrative organiza
tion for child-welfare services some States could not qualify for the
grant for this purpose by the end of the fiscal year 1936. The sum
of $227,954.12 was paid to the States that qualified by June 30. The
amount available for allotment to the States but remaining unpaid
at the end of the fiscal year 1936 (total $180,865.19) is available for
payment to such States until June 30, 1938.

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Submission and Approval of State Plans.

Soon after the passage of the Social Security Act the Children’s
Bureau began conferring with the States on the preparation o f State
plans for the three programs to be submitted to the Chief of the
Children’s Bureau for approval.
Forms for State plans were provided by the Children’s Bureau for
the use o f the State agencies. The forms for each program called
for a description o f how the State agency proposed to extend and
improve services in accordance with the requirements of the Social
Security Act and a budget showing the estimated expenditures
necessary to carry on the proposed services, including the Federal
funds requested. Forms for certificates of various officials were
also included.
Questions immediately arose in relation to each program in each
State.
The first question was: What State agency had the authority to
submit a State plan and to request the Federal aid offered?
This was readily answered in regard to maternal and child-health
services, as the Social Security Act provided for administration by
the State health agency, and each State and Territory had such an
agency.
With regard to services for crippled children it was necessary for
State officials to determine what State agency was legally authorized
to render such services or for the Governor to issue an executive order
designating the agency authorized to submit a plan.
With regard to the program for child-welfare services the Social
Security Act specified cooperation with State public-welfare agencies.
In a few States either there was no department o f public welfare or
the public-welfare agency had no legal responsibility for services for
children. In such States legislation was necessary before the State
could be in a position to cooperate with the Children’s Bureau in the
preparation of a plan for child-welfare services.
In each case the State agency submitted with its plan copies of the
laws, executive orders, or other documents showing the legal authority
under which it was acting and a certificate of the attorney general
that such laws or orders were valid and in effect.
Another question that arose with regard to the maternal and
child-health and crippled children’s programs was whether the
States and their local governments had for each type of program
appropriations available for matching the Federal funds offered, as
required by the act. As evidence that State appropriations were
available a certificate to that effect from the State treasurer was
submitted. Where local governmental funds were to be used in
matching the Federal funds, it was necessary to make sure that the
local funds were to be used for the services and facilities described in
7424°— 38----- 2

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the State plan under the supervision of the State agency. To safe
guard this the executive officer o f the official State agency was asked
to certify that this was to be done.
For grants for child-welfare services, the Social Security Act does
not require the matching of Federal funds with State and local funds
on a specified basis. It does provide that the Federal grant is to be
expended for the payment o f “ part o f the cost o f district, county, or
other local child-welfare services * * * and for developing
State services for the encouragement * * * o f community childwelfare organization * *
No State expenditure is required
for child-welfare services, and, therefore, it was not necessary to ask
for a State treasurer’s certificate o f State funds available, as was
done for the other two programs. It was sufficient to ask that the
executive officer o f the State public-welfare agency certify that the
budget submitted was based on the availability o f State and local
funds for the services and facilities described in the plan.
An important part o f each State plan is the “ descriptive plan” , in
which the State agency explains the State and local activities already
being carried on and sets forth the plan for extending and improving
existing services and for establishing new services. The descriptive
plan for each type o f service shows how the State proposes to conform
to the requirements o f the Social Security Act, which must be met if
the State is to qualify to receive the Federal grant.
State officials also submit as part of their State plans budgets showing
the estimated expenditures to carry on the proposed services, thus
showing the relation o f the descriptive plan to the request for the
grant o f Federal funds to match or supplement State and local funds.
After a State plan is approved by the Chief o f the Children’s
Bureau, the Secretary o f Labor certifies to the Secretary o f the
Treasury the amount to be paid to the State. Table 2 shows the date
o f approval o f each o f the first State plans.
D ate o f approval b y C hief o f Children's Bureau o f first State
plans under the Social S ecu rity A ct, title V, parts 1, 2, and 3

T A B L E 2.

Date of approval of State plans (1936 unless otherwise
noted)
State 1
Part 1, Maternal
and child-health
services
Alabama___________
Alaska__________
Arizona______________
Arkansas___________
California__________
Colorado_______________
Connecticut. ........... .
Delaware________ _____
District of Columbia___
Florida__________
Georgia_________
1

Part 2, Services for Part 3, Childcrippled children welfare services
M r

Mar. 7
May 21
F e b .17

Apr. 9_____________

Feb. 21.
(a).
May 8.
\ ) ——
—
———————————-- Sept. 4.
June 10.
Aug. 8.
Hi
July 28.
May 8.
Do.
Mar. 25.
Jan. 19, 1987............ Sept. 4.

ter,m “ State” includes Alaska, Hawaii, and the District of Columbia.
JState plan not approved up to June 30, 1937.

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T A B L E 2 .— Date o f approval b y C hief o f Children’s Bureau o f first State
plans under th e Social Secu rity A ct, title V, parts 1 ,2 , and 3 Con.
Date of approval of State plans (1938 unless otherwise
noted)
State1
Part 1, Maternal
and child-health
services
Mar. 10.................... Mar. 14____________
July 2______________
May 20____________
Apr. 8_____________
Feb. 17____________
Mar. 6..................—
Mar. 25____________
Feb. 17—..................

Feb. 17____________
Mar. 5_____________
Feb. 19____________
Mar. 18.................. Mar. 30____________
Mar. 20____________
Mar. 21.................. May 11-.....................
Mar. 18.................. Apr. 25____________
F e b .21.......................
Feb. 17......................
Mar. 14____________
Apr. 7_____________
Nov. 25____________
Mar. 24____________
F e b .17____________
Mar. 24____________
Mar. 30____________
June 30-----------------May 19____________
Apr. 8_____________
Feb. 17.................—

Wyoming-------- ------------------------ -------------------------------

Mar. 7_____________
Mar. 6_____________

Part 2, Services for Part 3, Childcrippled children welfare services

Oct. 20............... .......
Mar. 20____________
Jan. 4, 1937-----------Jan. 12,1937---------Aug. 3.................. —
Apr. 3-------------------Feb. 26.___________
(2) .............................. F e b .26____________
Aug. 1.................. —
June 27—.......... .......
F e b .26____________
Apr. 16____________
June 17____________
Mar. 23................ —
Apr. 6— .......... -June 18___________
(2) .......................... —
May 19............. .......
Apr. 25_________ Apr. 7 ___________ Apr. 3_____________
Apr. 9____________
Nov. 25____________
June 20____________
Mar. 16____________
(2) - ...................... — June 19_____ ______
Mar. 28____________
Mar. 13.............. — Apr. 2 _____________
Mar. 14____________
Mar. 20____________
July 1--------------------Mar. 6 _____________
Apr. 18____________
Apr. 2 _____________
Mar. 11.......... ............
Mar. 17____________
Mar. 6_____________

(2).
Mar. 16.
July 13.
Aug. 11.
Aug. 8.
Mar. 24.
Mar. 9,1937.
June 13.
Mar. 20.
Mar. 24.
June 26.
Apr. 7.
Mar. 16.
(2).
Mar. 20.
Apr. 28.
Apr. 7.
May 18.
Mar. 6.
May 18.
Mar. 18.
May 12, 1937.
Apr. 7.
Oct. 21.
June 18.
May 18.
June 11.
Apr. 7.
(2).
(2).
Mar. 21.
Apr. 23,1937.
Apr. 7.
Mar. 13.
Mar. 9.
Mar. 24.
Mar. 21.
Apr. 7.
Do.
0 .

1 The term “ State,” includes Alaska, Hawaii, and the District of Columbia.
2 State plan not approved up to June 30,1937.

Services to Special Areas and Special Groups.

The Social Security Act directs emphasis on service to special groups
or special areas for the three programs administered by the Children’s
Bureau, as follows:
Maternal and child-health services— “ especially in rural areas
and in areas suffering from severe economic distress,” and “ the
development of demonstration services in needy areas and among
groups in special need.”
Services for crippled children— “ especially in rural areas and
in areas suffering from severe economic distress.”
Child-welfare services—local “ child-welfare services in areas
predominantly rural,” and State services for the “ encourage
ment and assistance o f adequate methods of community childwelfare organization in areas predominantly rural and other areas
of special need.”

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The State health agencies, in making their maternal and childhealth plans, provided first for extending service to rural areas through
county or district health units where organized, or through placing
public-health nurses in counties to work primarily in the rural areas
and the smaller towns. Provision o f such service in all rural areas is
the goal to be approached as more State and local funds become avail
able for this purpose. Areas of economic distress are provided for in
the State plans through the granting o f funds to pay, in whole or in
part, the salaries o f local health workers or through the placing of
State personnel in areas pending the time when the county or the local
subdivision can meet the cost or share it. Groups in special need are
provided for in State plans for the most part through establishing
demonstration services under State direction in areas where the ma
ternal or infant mortality is high and through special services, such
as a mobile tuberculosis unit in New Mexico and a service for migra
tory crop workers in California. Frequently “ groups in special need”
are found in areas o f economic distress.
Crippled children’s services, under the State plans, are extended to
rural areas and areas suffering from severe economic distress through
locating crippled children throughout the State, holding diagnostic
and treatment clinics periodically in centers accessible to crippled
children and arranging for surgical and hospital care and for after
care service.
The Children’s Bureau and the State public-welfare agencies, in
making State plans for child-welfare services, have emphasized
throughout the provision o f service in rural areas. Limited funds
make it necessary in most States for these services to be set up in a
selected area, chosen in part, at least, by reason o f special need, as a
demonstration o f services that might well be available throughout
the State.
Although special attention has been directed in each State toward
observing these requirements o f the act, other areas also will benefit
from the program. The two major benefits that will reach mothers
and children in all parts o f the State are: (1) The stronger State service
that the State administrative agency will be able to render to all areas
and (2) the stimulus and the knowledge tested by experience that will
spread to all communities in the State as they observe the progress of
services and demonstrations in selected areas.
The Starting Point— Recommendations of the Committee on
Economic Security.

In providing for the three maternal and child-welfare programs
title V o f the Social Security Act embodied in law the recommenda
tions that the President’s Committee on Economic Security made in
January 1935. This committee’s statement in support o f its recom
mendations revealed the need for the new services and defined the

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goals to be sought. It is appropriate to introduce the succeeding
parts of this report, which describe progress made toward those goals,
by quoting the committee’s report to the President:
Local services for the protection and care o f dependent and physically and
mentally handicapped children are generally available in large urban centers,
but in less populous areas they are extremely limited or even nonexistent.
One-fourth o f the States only have made provisions on a State-wide basis for
county child-welfare boards or similar agencies, and in many o f these States
the services are still inadequate. W ith the further depletion o f resources
during the depression there has been much suffering among many children
because the services they need have been curtailed or even stopped. To
counteract this tendency and to stimulate action toward the establishment
o f adequate State or local child-welfare services, a small Federal grant-in-aid,
we believe, would be very effective.
The fact that the maternal mortality rate in this country is much higher
than that o f nearly all other progressive countries suggests the great need for
Federal participation in a Nation-wide maternal and child-health program.
From 1922 to 1929 all but three States participated in the successful operation
o f such a program. Federal funds were then withdrawn, and as a conse
quence State appropriations were materially reduced. Twenty-three States
now either have no special funds for maternal and child health or appropriate
for this purpose $10,000 or less. In the meantime the need has become
increasingly acute.
Crippled children and those suffering from chronic disease such as heart
disease and tuberculosis constitute a regiment o f whose needs the country
became acutely conscious only after the now abandoned child- and maternalhealth program was inaugurated. In more than half the States some State
and local funds are now being devoted to the care o f crippled children. This
care includes diagnostic clinics, hospitalization, and convalescent treatment.
B ut in nearly half the States nothing at all is now being done for these chil
dren, and in many the appropriations are so small as to take care o f a negli
gible number o f children. Since hundreds o f thousands o f children need this
care the situation is not only tragic but dangerous.
W e recommend that the Federal Government through the agency o f the
Children’s Bureau should again assume leadership in a Nation-wide childand maternal-health program. Such a program should provide for an exten
sion o f maternal- and child-health services, especially in rural areas. It
should include: (a ) Education o f parents and professional groups in maternal
and child care; supervision o f the health o f expectant mothers, infants, pre
school and school children, and children leaving school for work; (b ) provision
for transportation, hospitalization, and convalescent care o f crippled children
in areas o f less than 100,000 population. This program should be developed
in the States under the leadership o f the State departments o f health in
cooperation with medical and public-welfare agencies and groups concerned
with these problems. Federal participation is vital to its success. It should
take the form both o f grants-in-aid and o f consultative, educational, and pro
motional work by the Children’s Bureau in cooperation with the State health
departments.8

8 Report to the President o f the Committee on Economic Security, Jan. 15,
1935, pp. 37—38. Washington, 1935.

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MATERNAL AND CHILD-HEALTH SERVICES 1

Part 1 of title V of the Social Security Act authorizes an annual
appropriation o f $3,800,000 for grants to the States to enable each
State to extend and improve, as far as practicable under the conditions
in such State, services for promoting the health o f mothers and chil
dren, especially in rural areas and in areas suffering from severe
economic distress.
The first appropriation for grants to the States for these purposes
was $1,580,000, for the period February 1 to June 30, 1936. (See
p. 1.)
Children’s Bureau Administrative Service.

The Maternal and Child Health Division of the Children’s Bureau,
under the direction o f a physician, was placed in immediate charge of
the administration o f this part o f the Social Security Act. A major
function o f the division is to provide consultation service to the State
public-health agencies in the formulation o f State plans and in the
conduct o f State programs. The director of the division and the
regional medical consultants advise the State health officer and the
State maternal and child-health director with reference to the prepara
tion o f the State plan, and throughout the year confer with them on
the development o f the program and on the administrative and
medical phases o f the service being rendered.
The Director o f the Public Health Nursing Unit and the regional
nursing consultants give advice on the nursing aspects o f maternal
and child-health services to State health officials, including the
public-health nurses in the public-health-nursing bureau of the State
department of health, in States where such a bureau exists, or on the
staff o f the bureau o f maternal and child health.
Similarly the Director o f the Maternal and Child Health Division
gives the State agencies assistance on the maternal-health phases
o f the State program; the consultant in nutrition on the development
o f nutrition service in the program and on the inclusion o f nutrition
in the training given public-health nurses and other health workers;
and the statistical consultant on records and reports.
1 The information in this section is for the fiscal year 1936 (5 months, Feb. 1
to June 30). For preliminary summary o f activities in the fiscal year 1937 see

p. 72.
14

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Advisory Service.

The Children’s Bureau advisory committee on maternal and childhealth services in December 1935 made a series of recommendations
to guide the Children’s Bureau and the States in the development of
these services. One of these recommendations was that State agencies
in making their plans give careful consideration to the recommenda
tions made by the conference of the State and Territorial health officers
relating to local, State, and Federal programs for these services.
The major features of the recommendations o f the State and Ter
ritorial health officers were as follows:
M A T E R N A L A N D C H IL D -H E A L T H P R O G R A M

E m phasis: On the development o f certain minimum health services for mothers
and children who are unable to obtain them otherwise and on State and local
programs for the education o f lay and professional groups in the essentials of
adequate maternal and child care.
LOCAL MATERNAL AND CHILD-HEALTH PROGRAM

1. Maternal, infant, and preschool services.
a. In permanent conferences located in the center or centers o f population
o f the county or district.

b. In regular itinerant conferences reaching out from such centers to rural
areas o f the county or district.
c. In physicians’ or dentists’ offices when this is found to be practicable and
advisable b y health and medical organizations.
2. School health services, including health examinations and health-education
programs— to be provided preferably b y local physicians through local de
partments o f health or o f education, or both, in cooperation with medical
societies in the community.
a . Health examinations (including dental examinations) o f all children on
entering school and at stated intervals thereafter, and o f other chil
dren as indicated.

b. Follow-up for correction o f defects.
3. Health services for children entering employment or at work.
4. Health services for special groups o f children— handicapped, in institutions, on
relief— in cooperation with social-welfare agencies.
5. Public-health-nursing service for mothers and for children o f all ages.
a. As part o f the generalized service o f the official county or district health
units, primarily an educational and demonstration program, includ
ing—
(1 ) Home visiting;
(2 ) Service at prenatal and child-health conferences;
(3 ) Assisting at school health examinations and in securing cor
rection o f defects; and
(4 ) Cooperation with physicians, agencies, and workers in con
nection with health supervision o f individuals, and com
munity organization for improved health services for all
mothers and children.

b. Maternity-nursing service for care o f mothers at delivery and post
partum, bedside nursing service, and an educational program in ma
ternal care for the women o f the county and local community.

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As part of a preventive medical program and in cooperation with local medical
societies and with nursing, welfare, and social-service groups, it should be the
responsibility o f physicians conducting a health service to see that provision for
adequate care for the sick is made, including correction o f remediable defects, by
private physicians or dentists or through appropriate welfare agencies.
A continuing program o f education in the essentials o f adequate maternal and
child care should be developed by local county or community health services in
cooperation with medical organizations, education authorities, nutritionists, and
others. Though such a program o f education is probably carried out most effec
tively in the form o f individual instruction by physicians and nurses, it should
also include health instruction in schools, group instruction o f adults, community
organization for the establishment or improvement o f health services for mothers
and children, and distribution o f printed matter on maternal and child health,
emphasizing preventive measures, health habits, nutrition, and general standards
o f good care. Education in the field o f mental health m ay be developed through
any o f these channels as qualified personnel becomes available for this aspect o f
the health program.
STATE-WIDE MATERNAL AND CHILD-HEALTH PROGRAM—DIVISION OF
MATERNAL AND CHILD HEALTH

S ta tu s: There should be a division o f maternal and child health in each State
and Territorial department o f health, coordinate with all major administrative
divisions and in charge o f a full-time director responsible to the State health
officers. Such a division should provide leadership for the development o f local
health services for mothers and children.
Fun ction s (primarily advisory and educational):
1. T o assist local communities in the development o f maternal and childhealth services through—
a . Consultation with and guidance o f local communities in planning
and developing their services for mothers and children, including
supervision o f methods and technique o f procedures employed.
b . Demonstration o f services in local communities for which personnel
or funds m ay need to be provided.
c . Assistance in the provision o f permanent services in localities in
special need by providing funds or personnel or both.
Where State and Federal funds are available for local purposes the State
health agency through its division o f maternal and child health will assist in
formulating plans and have the power o f approval o f such plans.
2. T o develop, in collaboration with medical organizations and with local
health units, an educational program to reach both lay and professional
groups and organizations through—
a. State-wide planning for the education o f parents and lay groups in
the essentials o f adequate maternal and child care, with emphasis
on the means o f obtaining these essentials through health depart
ments, local physicians, and other agencies.
b. Continuous staff-education program in maternal and child health
for all State and local public-health personnel, including special
postgraduate work in maternal and child health.
c. Cooperation with professional groups and associations (medical,
dental, nursing, social-welfare, education, home-economics, and
others) in the development o f a continuing program o f education
for these groups to bring to them current knowledge in the fields
o f pediatrics and obstetrics and its practical application in the
program o f maternal and child health.

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d. Continued instruction o f midwives, with gradual raising o f stand
ards o f licensing.
e. Cooperation with departments o f public instruction and other edu
cational groups in a program o f education o f students in high
schools, vocational schools, normal schools, or colleges in the
essentials o f maternal and child care.

Personnel:
Medical personnel: Full-time medical director; additional medical staff for
consultation and advisory service, the size o f the staff depending on the
needs o f the State; and part-time regional consultants in the fields of
pediatrics and obstetrics.
Nursing personnel assisting in the maternal and child-health program:
Director o f public-health nursing or chief nurse; educational director;
specialized supervisor; generalized supervisor; staff nurse.
Special staff to be added in the following fields as the program develops:
Dentistry and dental hygiene, nutrition, health education, mental hygiene,
and posture training.
FEDERAL PARTICIPATION W ITH THE STATES

The function o f the Federal administrative bureau (the Children’s Bureau)
with respect to maternal and child-health services under the Social Security Act
is primarily consultative, with the power o f approval o f plans made b y State
departments o f health receiving Federal funds for maternal and child-health
programs. Furthermore, the Children’s Bureau in its relationships with the
States has additional functions as follows:

1. T o provide consultation and advisory service to the State departments of
health with respect to conduct o f the maternal and child-health programs,
administrative procedures, budgeting, and accounting problems.
2. T o assist States in building up well-staffed divisions o f maternal and child
health and public-health nursing and, through such divisions, to improve
services to mothers and children in local communities.
3 . T o cooperate with State health departments and medical organizations in
demonstrations o f special maternal and child-health services and in the
provision o f certain types o f professional education.
4 . To undertake research and conduct investigations or demonstrations that
cannot be conducted by individual States or communities, relating to the
health or mortality o f mothers and children or to improvement in methods
o f care.
5. T o promote joint activities in various phases o f child health and welfare;
for example, community demonstrations in the field o f delinquency and its
relation to mental health and recreation, studies o f the health o f children
entering employment and o f other problems affecting child health and
welfare.

On March 14, 1936, on invitation of the Secretary of Labor and the
Chief o f the Children’s Bureau, the following members of the American
Committee on Maternal Welfare, with Dr. Fred L. Adair as chairman,
met at the Children’s Bureau: Drs. Fred L. Adair, James R. McCord,
Philip F. Williams, Everett D. Plass, Lyle G. McNeile, George W.
Kosmak. Members o f the staff of the Children’s Bureau presented
details of maternal-welfare features of State plans. The following
topics were discussed by the committee: Teaching programs, develop
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ment of special maternity demonstrations, methods of cooperation
between the Children’s Bureau and the State health departments,
and functions of advisory committees. The committee also discussed
the organization o f maternal-welfare committees o f State medical
societies under the auspices of the American Committee on Maternal
Welfare. After this meeting the Secretary of Labor appointed the
special advisory committee on maternal welfare mentioned on
page 5.
Submission and Approval of State Plans.

Each State plan, before it can be approved by the Chief of the
Children’s Bureau, must comply with the conditions specified in
section 503 (a) of the Social Secürity Act. These conditions are as
follows :
1. Financial participation by the State.
2. Administration o f the plan or supervision of administration of
the plan by the State health agency.
3. Such methods of administration (other than those relating to
selection, tenure o f office, and compensation o f personnel) as
are necessary for the efficient operation o f the plan.
4. Provision for such reports by the State health agency in such
form and containing such information as the Secretary of
Labor may from time to time require and for compliance
with such provisions as the Secretary of Labor may from
time to time find necessary to assure the correctness and
verification o f such reports.
5. Provision for extension and improvement of local maternal
and child-health services.
6. Provision for cooperation with medical, nursing, and welfare
groups and organizations.
7. Provision for development of demonstration services in needy
areas and among groups in special need.
In each State plan submitted the “ descriptive plan” explained the
State and local administrative public-health organization for rendering
maternal and child-health services, the proposed administrative
expansion, the existing maternal and child-health activities, the plan
for improving and extending such services, and other data showing
compliance with the conditions specified in the Social Security Act.
The second part o f each plan was the budget, which showed (1) the
State and local funds available and the Federal funds requested and
(2) the estimated expenditures for State and local maternal and childhealth services and indicated whether Federal, State, or local funds
were to be used for each expenditure proposed.
The carrying out of proposals in the State plans for local maternal
and child-health services was necessarily dependent upon the State

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health agency’s obtaining the cooperation of local governing boards
and public-health agencies and of local physicians, whose assistance
is essential to the conduct of such services.
The first legal problem that arose in regard to each State was to
identify “ the State health agency,” which, according to the terms of
the act, was to administer the plan or to supervise its administration.
In most States there was no difficulty, because the State board of
health or the State department of health was clearly the State health
agency vested with authority to render maternal and child-health
services. In a few States legislation was enacted authorizing coopera
tion with the Federal Government under the Social Security Act, in
general terms that cover all parts of the act, and designating one State
agency to administer the cooperative services so authorized. In
States where such a law failed to take cognizance of the fact that the
Social Security Act requires that the grant for maternal and childhealth services should be administered by the State health agency, it
was necessary to call upon the State attorney general to rule upon the
laws involved and to determine whether the authority to proceed with
the program in question was vested in the State department of health.
In reviewing each State plan before approval by the Chief of the
Children’s Bureau, it was determined whether the plan provided for
the extension and improvement of local maternal and child-health
services as required by the act. This point will be of significance each
year, when the States submit their plans, as it will be necessary each
year to show extension and improvement of maternal and child-health
services.
For the 5-month period ended June 30, 1936, the State health
agencies o f all the 48 States, Alaska, Hawaii, and the District of
Columbia submitted plans for maternal and child-health services. Of
the 51 plans submitted, 49 were approved and were in operation as of
June 30,1936; consideration of the other two plans was not completed.
Illinois elected to wait until the beginning of the fiscal year 1937 to
begin operation. In Oregon legal problems arose so that approval of
the plan was delayed.2
Allotm ents and Payments to States.

Table 3 shows the allotments and payments made to the 48 States,
Alaska, Hawaii, and the District of Columbia for maternal and childhealth services for the 5-month period ended June 30, 1936.
2 For the fiscal year 1937 the Illinois plan was approved July 2, 1936; the Oregon
plan N ov. 25, 1936.

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Federal-State M aternal and Child-W elfare Services

T A B L E 3 .— A llotm en ts and p a y m e n ts to States for m aternal and child-

health services under the Social Security A ct, title V, part 1, 5 m on th s
ended June 30, 1936
Allotment

State 1
Total

Paym ent2

FUND A
FUND B
Available for payment
Allotment
of half the total ex
on
basis of
penditures (except
need for
from fund B) under
assistance
approved plans 3
in carrying out
Allotment State plan,
after
num
on basis of
ber of live
ratio of
Uniform
births
is
live births
allotment
in State to taken into
considera
total live
tion
births

Total

FUND A

Total___________ 81,579,968.83 $424,100.19 $748,417.81 $407,450.83 $1,252,436.22 $952,404.70
A lab am a--- ________
Alaska_____________
Arizona.—____ ______
Arkansas____________
California_____ ______
Colorado_____________
Connecticut______ —
Delaware____________
Dist. of Columbia___
Florida______________
Georgia______________
H aw aii..____________
Idaho...... ............. .........
Illinois______________
Indiana______________
Iowa_________________
Kansas______________
Kentucky____________
Louisiana____________
Maine_______________
Maryland___________
Massachusetts______
—
Michigan____ __
Minnesota____ ______
Mississippi__________
Missouri____ _____ _
Montana_____________
Nebraska__________
N e v a d a _____________
N ew Hampshire___
N ew Jersey____ _____
N ew Mexico_________
iJ e w Y o rk __________
North Carolina— ___
North Dakota____ —
Ohio_________________
Oklahoma___________
Oregon______________
Pennsylvania________
Rhode Island________
South Carolina______
South D ak ota_______
Tennessee__________
Texas_________ — - Utah_________________
Vermont— .................
Virginia_____________
Washington____ _____
West Virginia_______
Wisconsin....................
Wyoming_____ ______

45,100. 87
14,992.46
20,924. 85
30,768.94
39, 689.32
27, 581.49
20,139. 85
11,890. 71
14, 574.49
26,324.17
59,638.63
16,938.05
15,752.38
48,880.43
30,443. 80
34,967. 99
37,446.37
36,251.16
31,485.36
19,782.24
19,788. 52
30,246. 56
39,230.74
24,093. 83
51,000.44
28,651.25
15,892.07
24,559.62
24,487.35
18,919. 58
29, 523.26
28.873.41
82,904.16
50,121. 32
18,927. 89
47,698.96
25,869.79
20,176. 80
73, 589. 81
11,871. 53
88,493. 57
16,833. 50
35,448.49
70,333. 82
17,646.91
23,387. 58
84,627.34
23,794.12
27,763.34
29,316. 74
12,862.97

8,315. 69
8,315. 69
8,315. 69
8, 315. 69
8.315. 69
8,315. 69
8,315.69
8,315. 69
8,315. 69
8,315. 69
8,315. 69
8,315.69
8,315. 69
8,315. 69
8,315.69
8, 513.69
8,315.69
8,315.69
8,315.69
8,315. 69
8,315. 69
8,315.69
8.315. 69
8.315. 69
8,315.69
8.315. 69
8,315. 69
8,315.69
8,315.69
8,315.69
8,315. 69
8,315. 69
8,315.69
8,315.69
8,815. 69
8,315. 69
8,315. 69
8,315.69
8,315. 69
8,315.69
8,315. 69
8,315.69
8,315.69
8,315.69
8,315. 69
8,315. 69
8,315. 69
8,315.69
8,315. 69
8,315.69
8, 315.69

21, 816.45
439. 80
2,917. 79
12,889.90
26,919.16
6,132. 80
7,632. 92
1, 370.25
3,483.00
9,179.43
22,217.08
3,193.70
3,220. 50
37, 872.91
17,986. 76
14, 590. 00
11,154.07
20, 582. 61
14,775. 54
5,415.03
9,393. 84
21,930.87
28,836.06
15,778.14
16,445.40
20,335. 56
3,418.40
8,619.03
492. 71
2, 703.73
18,739.92
4,387.34
63,776.06
27,385. 76
4,998. 93
34,393. 69
16,252. 65
4,493.17
55,056. 70
3, 555. 84
15,209.15
4, 526.15
18,001. 88
40.084. 00
4,341. 64
2,265.31
17,995.69
7,744. 59
14,250.18
17,667.22
1, 568. 50

14,968. 73
6,236.97
9,691.37
9. 563.35
4,454.47
13,133.00
4,191.24
1,704.77
2,775. 80
8,829.05
29,105. 86
5,423.66
4,216.19
2,691. 83
4,141.35
12,062.30
17,976. 61
7,352.86
8,394.13
6,051. 52
2,078.99
2,078.99
26,239.35
4,157.98
7,624.90
15,658.95
7,900.16
2,467. 65
16,170.38
10,812.41
14,419. 87
5,613.27
4,989. 58
1,301.45
7,367.94
10,197.42
14,968.73
3,991.66
9,130.92
21,954.13
4,989. 58
12,806. 58
8,315.96
7,738.84
5,197.47
3,333.83
2,978.78

45,100. 68
6,364.06
18,261. 58
30,768.94
39,689.32
7,421. 71
20,139. 85
7,747.00
14, 522. 80
26,324.17
59,638. 63
8,343.33
15,752.38
(<)
20, 573.19
28,224.43
25,260.83
28,898.30
31,485. 36
19,496.95
19,788. 52
28,444. 22
37,995. 54
21,732.00
5i; 000.44
20,875.00
15,338.09
9,400. 00
16,428. 95
11,975.67
13, 566.67
28,873.41
78, 579.19
50,121.82
9,724. 27
22,010.00
18,176.45
(4)
63,371. 66
8,396. 67
84,128. 66
16,833. 50
35,448. 49
42,001.66
10,610. 50
14,250.34
34,627.34
23,794.12
27,763.34
25,982.91
9,183.78

30,132.04
1,366.67
9,001. 58
21,205. 59
35,234.85
7,421.71
15,948.61
6,697.00
11,747.00
17,495.12
30, 532.77
8,343. 33
11, 536.19
(4)
19,083.06
14,162.13
19,469.60
28,898.30
23,091.23
13,445.43
17,709. 53
28,444.22
35,916. 55
21.732.00
24.761.09
20.875.00
11.734.09
5, 541.67
770.00
6,313.00
13, 566. 67
12,703.03
72,091.75
85,701.45
4,111.00
19,010.00
16, 875. 00
(4)
63,371. 66
8,896.67
23,385.03
12, 841.84
26,317. 57
38,765.06
7,610. 50
1,942.67
26, 311.38
16,060.28
22, 565.87
25,982.91
6,205.00

FUND B

$300,031.52
14,968.64
4,997.39
9,260.00
9, 563.35
4,454.47
4,191.24
1,050.00
2,775.80
8, 829.05
29,105. 86
4,216.19
’ (4)
1, 510.13
12,062. 30
5; 791.23
8,394.13
6,051.52
2,078.99
2,078.99
26,239.35
3,604.00
3,858.33
15,658.95
5,662.67
16,170.38
6,487.44
14,419.87
5,613.27
3,000.00
1,301.45
(4)
10,743.63
3,991.66
9; 130.92
3,236.60
3,000.00
12,307.67
8,315.96
7; 733.84
5; 197.47
2,978. 78

1 The term “ State" includes Alaska, Hawaii, and the District of Columbia.
2 In 87 States the operation of the plan was to start Feb. 1, and payment was made on the basis of the full
5-month period. In Minnesota the plan was to start Feb. 16; in Alaska, Arizona, New Hampshire, Rhode
Island, and Texas, Mar. 1; and in Colorado, Delaware, Indiana, North Dakota, Ohio, and Utah, April 1.
3 The amount of this fund allotted to each State with an approved plan remaining unpaid on June 80,1936,
is available for payment to such State until June 30, 1938.
4 Plan not approved.

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Sources of Funds and Proposed Expenditures.

The Social Security Act provides that funds allotted to each State
under section 502 (a) shall be paid to the State quarterly, in an
amount equal to one-half of the total sum to be expended during the
quarter for carrying out the State plan within the total amount
available to the State.3 Accordingly, it was necessary for each State
to show in its budget State and local appropriations for maternal
and child-health services sufficient to equal the amount of Federal
funds requested from fund A. (See p. 6.) The budgets usually
showed all State appropriations for maternal and child-health services
and only enough appropriations by local health agencies to complete
the matching of the Federal sums requested. The inclusion o f local
funds for matching Federal funds made the local maternal and childhealth programs so financed a part of the Federal-State cooperative
program, subject to the supervision of the State health agency.
The proposed expenditure of the funds requested by the State
agency from fund B (see p. 6), for which matching was not required,
was also included in the budget submitted.
The figures given on pages 21-22 are on a 6-month basis. The
State health officers had their budgets for the last 6 months of the
fiscal year 1936 in preparation before it was known that the first
Federal appropriation for grants to the States would cover only the
5-month period, February 1 to June 30, 1936, and the 6-month
figures were included in the State plans submitted. Adjustment to
a 5-month basis was made in the total amount approved, and the
Federal grant to each State was correspondingly adjusted.
The following list shows the sources of the funds for estimated
expenditure for maternal and child-health services under title V,
part 1, of the Social Security Act, as shown in the budgets which were
a part o f the State plans approved for the last 6 months o f the fiscal
year 1936 for 46 States, the District of Columbia, Hawaii, and Alaska.
„

. . . . .

oervices and source o f funds

E stim a ted ex pend iture

Percent
distri
bu tion

T otal___________ _______ _________________________ $3 ,-2 7 7 ,0 3 2 .3 6
State services

1 ,8 9 0 ,0 1 2 .8 2

1 0 0.0

772, 288. 90

State sources______________________________________
Federal grants to States__________________________

1, 117, 723. 92

40. 9
59. 1

Local services-----------------------------------------------------------------

1, 387, 019. 54

100. 0

Local sources______________.1_______________________
State sources__________________________________ '___
Federal grants to S t a te s ..^ ______________________

6 9 6 ,1 9 8 .9 4
248, 515. 60
442, 305. 00

50 .2
17. 9
31. 9

8 Payments at the beginning of the fiscal year are based on estimated expendi
tures, and succeeding payments from quarter to quarter are adjusted in accord
ance with actual sums expended.

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The fact that three-fifths of the funds for State services was to
come from the Federal grants, as shown in these figures, suggests
that appropriations for maternal and child-health services in some
States were decidedly limited and that there was great necessity for
expansion o f such appropriations. The opportunity for future exten
sion of services undoubtedly lies in the local communities, many of
which still lack maternal and child-health services. If the States
can increase their State appropriations, the increase will make possible
the use o f more o f the Federal funds in the local areas, thereby pro
viding for greater assistance in improving and extending local maternal
and child-health services as called for by the Social Security Act.
The following list shows the types of expenditure from Federal,
State, and local sources proposed by the State health officers in the
State plans for the 6 months ended June 30, 1936.
—.

...

T ype o f expenditure

Proposed
expenditure

All types--------------------------------------------------------------$3, 277, 032. 36
Salaries and fees.

2, 259, 244. 78

State division directors and assistant directors. _
Health officers (county or local largely)_________
Physicians--------------------------------------------------------------Public-health nurses______________________________
1,
Dentists and dental hygienists___________________
Nutritionists______________________ ________________
Health educators_____________________________________
Other professional service____________________________
Clerical service____________________________________
Other__________________________________________________
Travel-------------------------------------------------------------------Supplies--------------------------------------------------------------------------Equipment______________________________________________
Communication________________________________________
Printing--------------------------------------------------------------------------Publications for distribution______________________________
Rent__________ __________________________________________
Other________________________________________

101, 913.00
180, 422. 85
309, 356. 33
248, 736. 67
104, 163. 50
1 9 ,3 0 0 .0 0
23,424.59
53,165.52
200, 354. 32
18,408.00
506, 321. 54
179, 625. 56
115, 801. 09
36, 374. 82
38, 443. 83
51,003.00
9 ,2 1 0 .3 3

P ercent
distri bu tion

100. 0

68 . 9
3. 1
5. 5
9. 4
3 8 .1
3. 2

1. 6
6.1

.6
15. 5
5. 5
3. 5

1. 1
1. 2
1. 6
.3
81,007.
2. 5 41

Such a summary of the budgets in the annual State plans will show
each year for what purposes the State health officers consider that
the funds can be used to best advantage. The series of annual sum
maries will show the trend in the distribution of the funds available
between local and State services and the trend in the use of physicians,
nurses, dentists, nutritionists, and others in the program, as well as
in expenditures for purposes other than personal service. Reports
of actual expenditures will reveal how the plans are modified in
operation.

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State Divisions of Maternal and Child Health.

Progress made in the establishment o f divisions of maternal and
child health in the State health departments and in the appointment
of qualified physicians to the staffs o f these divisions may be used as
an initial standard in evaluating progress.
In June 1934, when the President’s Committee on Economic
Security was beginning its work, there were 31 States with a division
of maternal and child health in the State department of health, but
in only 22 of these— less than half of the States—was the director
a physician on a full-time basis.
Each of the 1936 plans approved for 46 States, the District of
Columbia, and 2 Territories, provided for a bureau or division of
maternal and child health and for a physician as its director. All but
four of the directors had been appointed by June 30, 1936. The
great majority of the directors are either pediatricians or obstetricians,
and in a numbei of cases they have also been trained in public-health
administration.
These two features of the plans insure administration of the maternal
and child-health program in the States as a major health service under
full medical direction and supervision, so that it will command the
confidence of the medical profession and o f the public.
Forty-four directors o f divisions of maternal and child health at
tended the June 1936 conference called by the Children’s Bureau.
(See p. 6.) The conference gave an opportunity for general and
individual consultation and exchange of experience on methods of
administration and on maternal and child-health services being
rendered or to be rendered in the States.
Based on the work of these divisions and on the extension of service
in the States reports of progress for the period ended June 30, 1936,
were sent to the Children’s Bureau by the State health officers.
Many o f the statements made in the pages that follow were drawn
from these reports.
Services of Other Divisions of State Health Departments.

An important part of maternal and child-health services is publichealth nursing. Usually the local public-health nurse organizes
and conducts a major portion of the service to mothers and children.
In some States the nursing service o f the State department of health
is part of the division of maternal and child health. In others a
generalized public-health-nursing service is set up as a separate
bureau or division serving all divisions o f the department. In the
latter case the director of public-health nursing advises the director
o f maternal and child health on the nursing phases o f the program.
Public-health nurses who have specialized in maternal and child

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health are frequently employed so that they will be available to give
advisory or supervisory service to nurses who do maternal and childhealth work as part o f a generalized program.
In several State departments of health there is a bureau or division
o f local health work. Usually the major function of sUch a division
is to aid counties or other local subdivisions in establishing and
developing county or local health units or departments. The relation
o f the specialized divisions to such a division of local health work is
cooperative. The maternal and child-health division, for example,
supplies the advisory and supervisory service for the maternal and
child-health activities in the local health units that are established.
Other divisions o f the State health department also perform im
portant services related to child health. Statistics of births, infant
deaths, and maternal deaths are fundamental in planning the maternal
and child-health program. The control of contagious diseases involves
children, and the most effective preventive work for certain diseases
is the immunization of children. Much o f the bacteriological work
is done on behalf o f children. The protection o f the milk supply
benefits children as well as adults. A large part of the educational
publications distributed by the State health department are for the
benefit o f the health o f mothers and children.
Though these indirect services are fundamental to the health of
mothers and children, as are all basic health procedures, the funds
for maternal and child-health services were designated by the State
health officers very largely for direct services for mothers and children
by physicians, public-health nurses, and others.
Qualifications of State and Local Personnel.

T o aid the States in the selection of personnel the State and Terri
torial health officers, meeting in Washington in 1935, adopted a report
suggesting qualifications which they considered adequate for the
medical director o f a State division o f maternal and child health, and
for nursing personnel. For the special staff in nutrition, mouth
hygiene, health education, and mental hygiene, the report recom
mended using the qualifications recognized as adequate by the re
spective national professional organizations.
Some of the State plans provided for scholarships for new appointees
who had basic qualifications for public-health work but who needed
special training for maternal and child-health service. Many States
provided for in-service training for State and local personnel through
conferences and institutes and through observation or participation
in demonstration maternal and child-health services.
Since the program is entirely dependent for success on acceptance
by the public o f the services offered, it is obvious that the personnel

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M aternal and Child-H ealth Services— 1936

giving the service must be sufficiently well qualified to command the
continuing confidence o f the groups to be served.
Types of State and Local Service.

The major portion o f each State plan was concerned with providing
mothers and children with service in the fields of maternal health,
infant health, preschool health, and the health o f the school child!
Maternal-health service consists (1) in reaching the expectant mother
as early as possible during pregnancy to make sure that she is
under continuous medical supervision either by her private physician
or at a prenatal clinic, (2) in providing her with instructions as to her
own care through the advice of a physician, through publications,
and through a nurse’s home visits, and (3) in making sure that she
receives competent medical and nursing care at the time o f delivery
and supervision during the postpartum period.
Infant-health service consists in instruction o f the mother through
the periodic examination of the baby by a physician, with directions
to the mother as to his feeding and care; through nurses’ home visits
to instruct the mother; and through publications. The examination
o f the baby by the physician is done either at a well-baby conference
or, in some cases, by the family physician, when plans for this type of
service have been worked out by the health department in cooperation
with local physicians.
Preschool-health service similarly includes the instruction of the
mother through publications and nurses’ visits to the home, and the
examination o f the child (at less frequent intervals than in infancy)
by the family physician or by the physician at the child-health con
ference, with directions to the mother as to his care and habit training.
Vaccination against smallpox and immunization against diphtheria
are included at this time or in the earlier period. Special effort is
made to have remediable defects corrected before the child enters
school. Dental supervision and the training of the child in the care
of the teeth become increasingly important during this period.
School-health service includes the periodic medical examination of
the child, preferably in the presence o f one or both parents; follow-up
in an effort to have defects corrected; protection against contagious
diseases; and the education of the child in the care o f his own health
and in his responsibility in connection with the health o f the family
and the community. Dental and nutritional supervision and instruc
tion are important throughout the period o f growth. In some States,
as part o f the school-health service, special health examinations are
given to children applying for employment certificates.
The State plans for maternal and child-health services all provided
for the services outlined, with varying emphasis according to the stage
of previous development, the special health needs in the State, the
7424°— 38------ 3

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funds available, and the division of responsibility between the State
health department and other agencies.
Because sufficient funds were not available to provide maternal and
child-health services in all communities and because the Social
Security Act called for extension of services especially in rural areas,
first attention in the State plans was given to such areas. Where
there was an organized county or district health unit, with a health
officer and a public-health nurse on the staff, the maternal and childhealth services were strengthened by the addition of one or more
nurses or by the provision of more health supervisory service by
physicians through part-time service at prenatal and well-child
conferences. Where such units were not yet organized, the expan
sion of service was frequently started with the appointment of a
county public-health nurse, paid in part or in whole by the county,
with medical and nursing supervision provided by the State bureau
of maternal and child health and the division of public-health nursing,
and with local medical service on a part-time basis for prenatal and
child-health conferences. The Federal funds available made it
possible in many States for the State health agency to provide funds
in selected areas for such local services sufficient to pay part, or in
some cases all, of the salaries of one or more employees.
Under the new program each State plan, so far as funds permitted,
provided for the establishment or expansion of the maternal and childhealth division in the State department of health. Medical super
vision of the program was provided by the division director and by
one or more obstetricians or pediatricians employed either as staff
members or as consultants on a part-time basis. Nursing supervision
was provided either by the maternal and child-health division or by
the public-health-nursing division; in some States specialized nurse
supervisors o f maternal and child-health work were added to the staff.
Dentists, dental hygienists, nutritionists, and health educators were
employed in some States.
The major functions of divisions of maternal and child health, as
they appeared in the State plans, included aid in the organization of
local child-health services, improvement of such services through
consultation and supervision, provision for training State and local
public-health personnel in the conduct o f such services, plans for the
postgraduate instruction of physicians and nurses in private practice,
and the conduct of a health-education program through distribution
of publications and by other means. From February to June 1936
the principal advances made were in the formulation of State plans,
in the recruiting of State staff, and in the consultation of various official,
professional, and lay groups. The progress reports for this period,
however, also showed substantial advances in improving and extend
ing local maternal and child-health services.

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The State reports that gave information by districts, counties, or
towns showed that new work had been started in 20 health districts,
204 counties, and 73 towns, and that existing services had been
expanded in 26 districts, 215 counties, and 50 towns. Preliminary
work to start or expand services was reported in many more areas.
Educational Programs in State Plans.

The major objective of the whole program, furthered by a large part
of the State and local activities, is the education of the mother in the
care o f herself and her children. The education of the father as to his
responsibility for family health is also important in order that he may
intelligently cooperate with his wife in establishing family health
practices. He also should appreciate the need o f obtaining adequate
medical care and supervision for every member of the family. Insofar
as high standards of care of the health o f mother and children are
absorbed into family custom and practice fundamental and lasting
protection is given to the health o f the family and of the community.
Preparation for working toward this major objective was made in
the State plans through provision for the postgraduate training of
professional groups, for the in-service training of health workers, and
for health-education service for the schools and for the public.
Many of the plans made provision for staff training for physicians
and nurses through conferences or institutes, through participation in
county demonstration services, and, to some extent, through scholar
ships for advanced training in maternal and child health at schools
of public-health administration or schools of public-health nursing.
Such training will be of continuing importance in improving the
quality of service rendered by State and local employees.
Educational services for local physicians were provided for in a
majority of the State plans through institutes and postgraduate
courses to keep physicians in touch with the latest medical develop
ments in obstetrics and pediatrics. (See p. 78.)
The State plans, assuming that the child receives his first health
education at home, provided, with varying emphasis, for the educa
tion of children in school, first in habits o f personal hygiene and, as
they grow older, with regard to their future responsibilities for mater
nal and child care. In some States the health education of children
is entirely a school function, with the health department serving only
in an advisory capacity. The majority of the States in their 1936
plans contemplated programs for the health of the school child but
postponed development of such programs to a later period. The
Indiana, Iowa, Kentucky, Massachusetts, Ohio, and Virginia plans
for the health education o f school children were particularly extensive.
Several States are employing as health educators physicians with

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recognized teaching ability or other individuals especially trained in
health education. These health educators act in liaison with State
departments of public instruction in outlining the content of schoolhealth programs, in conducting health institutes for teachers in normal
schools, and in integrating generally the health teaching o f the school
with the activities o f the State health department. Obviously the
success o f such educational programs will depend on the professional
ability, personality, and adaptability of the physicians and other
professional workers appointed.
The Indiana plan for 1936 included a health-education program
worked out with special care. A physician experienced in health
education was placed on the staff of the bureau of maternal and
child health of the State health department to cooperate with the
State department o f public instruction. His first work was to
arrange for and supervise talks on child health and maternal welfare,
to be given at State colleges, normal schools, and high schools, for
students who were to become teachers. Activities proposed in the
Indiana plan included expanding such services in the high schools and
extending them into the grade schools, supervising material for text
books, and cooperating with such organizations as parent-teacher
associations. The chief emphasis was to be placed at first on the
dissemination of health knowledge to teachers.
Demonstration Services.

The Social Security Act prescribes that each State plan shall provide
for the development of demonstration services in needy areas and
among groups in special need. This requirement made it possible
for each State health agency to use a part of its Federal funds to
develop one or more demonstrations under State direction, providing,
for example, either a well-rounded maternal and child-health service
in a selected area or a project designed to meet the special need o f a
particular area or group. The demonstration services so undertaken
serve as testing grounds for methods and procedures in attacking
maternal and child-health problems. As the methods and the
results attained are studied and reported they will be o f value in
guiding the program in other areas within the State and in other
States. Twenty-four demonstration services were reported to be
under way on June 30, 1936, or ready to start soon after. Others
were in the preliminary stages of development.
The demonstration services started can be classified roughly as
follows:
County or local maternal and child-health demonstrations in
areas with high maternal or infant mortality— Alabama, Alaska,

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Georgia, Missouri, Ohio, Oklahoma, South Carolina, South
Dakota, and Tennessee.
County training centers for public-health personnel— Arkansas
and West Virginia.
Maternal-care demonstrations— Connecticut, Iowa, Maine,
Maryland, Michigan, New Hampshire, New Jersey, Tennessee,
Washington, and Wisconsin.
Special services— Delaware, nutrition demonstration in Kent
County; Indiana, dental demonstration; Rhode Island, dentalhygiene demonstration in Bristol County.
The following descriptions of demonstrations under way on June 30,
1936, illustrate the types of work undertaken:
Alabama expanded the maternal and child-health services in Jefferson County
to make such services available in rural areas and more accessible in needy city
areas. B y June 30, 5 new health centers were in operation (12 were planned).
Mothers visit the centers for prenatal and postnatal examinations and advice
given by a local practicing physician with a nurse in attendance. A consulting
obstetrician attends from time to time to instruct attending physicians a t the
same time that service is being given to the patients. Similarly, children are
examined by a local physician, and a pediatrician attends periodically to instruct
the physicians as service is given the mothers and children. Three centers have
dentists in attendance to make dental examinations and to do temporary or
emergency dental work. The dentist and the nurse give instruction in oral hygiene.
Eight nurses and a social worker were added to the staff during the first 5-month
period.
others and children from families in the low-income group receive the
services described.

Iowa has undertaken a maternal-care program in Washington County with
the cooperation o f all the local physicians. Tw o afternoons a week physicians,
who are paid by the State health department, give without cost to the family
prenatal care and supervision in their private offices to any expectant mother
residing in the county who is otherwise unable for economic or other reasons to
get such care. The mother receives a complete obstetric examination, including
a Wassermann test for syphilis; regular subsequent check-ups, including bloodpressure readings and urinalyses, during the period o f pregnancy; and a final
postpartum examination. A nurse is assigned to make instructional home visits
to the mothers thus cared for and to organize and conduct classes in maternal
hygiene. County nurses assist private physicians with the delivery o f indigent
mothers in the home and give postpartum nursing care to those mothers. Sterile
obstetric kits are supplied to physicians for use in connection with home deliveries.

In M aine an area including several towns was chosen in which to carry on a
complete, intensive demonstration o f maternity-nursing service, including pre
natal, natal, and postnatal care. In this area about 200 births occur a year.
M any o f the families have small incomes. Medical facilities and hospitals are
adequate. Three public-health nurses— one a supervisor— were to be employed.
Nursing assistance at the time o f delivery was to be given on the request o f the
attending physician to any woman who had been under his supervision during

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the prenatal period. B y June 30, 1936, the nursing supervisor had been engaged,
report forms and instructions for nurses had been prepared, and contact had been
made with the medical societies and with individual physicians to explain the
demonstration.

Field service was to start in July.

Maryland has placed two nurse-midwives in Wicomico and Charles Counties,
where 50 percent o f the births are attended by midwives. The nurses, who have
obstetric training, are to give delivery nursing service and raise standards of
midwifery in cooperation with physicians.

In Oklahoma a five-county demonstration is being conducted by the Okla
homa State Department o f Public Health, the United States Public Health Service,
the United States Office o f Indian Affairs, and the United States Children’s
Bureau. The counties selected (Cherokee, Adair, Delaware, M ayes, and Sequo
yah) have an Indian population o f 23 percent; the incidence o f typhoid fever,
diphtheria, tuberculosis, and malaria was high; maternal and infant mortality
rates were high; and 35 percent o f the people were on relief. The maternal and
child-health staff includes a pediatrician as director, a supervisor o f nurses, and
five field nurses who do maternal and child-health work as part o f a generalized
program.
As a result o f a recent survey to inquire into the causes o f high infant mortality
in Memphis,4 Tennessee selected for one demonstration service the carrying out
o f the recommendations o f the survey. W ith State aid the staff o f the Memphis
Health Department was strengthened and its maternal and child-hygiene services
were expanded and improved. The city government appropriated funds for a
maternity center to be located in an outlying section, from which the general
hospital clinics draw most o f their patients.

On June 7, 1936, W ashington began a maternal-care demonstration in an
area comprising approximately 150 square miles (centering in Everett, Snohomish
C ounty) after consultation with the county medical society and with physicians,
nurses, and lay groups. Two-hour classes every 2 weeks are provided for expectant
mothers within the area and for all women who care to come. These classes are
held with an obstetrician and a nurse alternately as instructors. Nutritionists
and dentists assist in the teaching program. Hom e visits by a nurse to give in
struction and advice are made in prenatal cases within the area. Registered
nurses in private practice are also trained in the demonstration area. They are
given a 3-m onth course in home-delivery service for which they receive a certifi
cate. Public-health nurses are given training in the same course, with the expec
tation that they will set up similar courses for nurses in their own localities.

W est Virginia has established a demonstration service in Fayette, Raleigh,
and W yom ing Counties, with headquarters at the county seat o f Raleigh County.
Quarters and some furnishings were provided by the county board o f education

4 See

Infant M ortality in Memphis (U . S. Children’s Bureau Publication N o.

233, Washington, 1936).

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and the county court. The unit is being used as a training center where health
officers, public-health nurses, and sanitary engineers may get field experience.
Its staff includes a physician who is the director, a chief nurse, and a sanitary
engineer, who supervise the corresponding officials in the three counties. Classes
are conducted covering all phases o f maternal and child hygiene, as'well as other
phases o f public-health work. Demonstration clinics are held to show how the
various clinics and conferences should be conducted. Supervision and instruction
o f midwives are also part o f the training program.

Efforts to Protect Maternal Health.

The unnecessarily high maternal death rate in the United States
has caused health officials and medical societies to direct their atten
tion toward means o f safeguarding the lives and health o f mothers.
The 1936 State plans for maternal and child-health services clearly
reflected this emphasis. Postgraduate courses in obstetrics for physi
cians and the further promotion o f prenatal conferences were the two
outstanding methods of attack. Ten States had maternal-care
demonstrations under way by July 1, 1936— Connecticut, Iowa,
Maine, Maryland, Michigan, New Hampshire, New Jersey, Tennes
see, Washington, and Wisconsin. Several others had done prelim
inary work on such demonstrations. The demonstrations varied in
tyPe> including prenatal nursing service, delivery nursing service,
maternal-hygiene service organized by nurse-midwives who give
training to midwives, and maternal-care training programs combining
the giving o f service with the training o f physicians and nurses for
public-health work and for better service to the women in their
communities.
Midwives attend a large proportion o f the births in certain States,
and many are inadequately trained or entirely untrained. More than
a third o f the States included in their 1936 State plans supervision and
training o f midwives. In many States deliveries are made without
medical attention because the doctors are far away or too few to
serve the population, because the families cannot afford medical
service, or because family tradition does not call for the services o f a
physician at childbirth. From the public standpoint the problem at
present calls for careful licensing and supervision o f midwives.
Usually instruction is given midwives in classes conducted by the
local public-health nurse. In some States the State advisory nurse
supervises midwives in counties without public-health organization.
In Kentucky two public-health nurses o f long experience in maternal
and child-health work took courses in midwifery for the purpose of
returning to conduct a demonstration in bedside training o f rural
midwives.
Other States have appointed as State midwife supervisors nursemidwives trained at the school for midwives, who are equipped to help
teach midwives the fundamentals of good practice.

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Medical Participation.

Every State plan showed cooperation with the medical profession.
Frequently the State medical society was consulted and gave advice
on the formulation of the State plan. Thirty-five States reported the
inclusion of a representative of the State medical society on the State
advisory committee for the maternal and child-health programs. In
several States a representative of the State school of medicine was
also on the committee. Seven additional States reported medical
representation on various special advisory committees. Pediatricians
and obstetricians, as individuals or as representatives of State soci
eties, were frequently included on the general advisory committee or
on technical advisory committees. Committees on maternal welfare
of State and county medical societies were often mentioned as par
ticipants in planning the activities to be undertaken.
Local physicians are employed in many of the States for the con
duct of prenatal, postnatal, infant, and preschool clinics and confer
ences. In a few States where the physical examination of school
children is under the supervision of the State health agency, the State
plan provides for the employment of local physicians for this purpose.
Although the funds for local medical service are limited, most States
have budgeted for the payment o f local physicians.
The new program affords opportunity for postgraduate instruction
in pediatrics and obstetrics for physicians in private practice. The
opportunity has been eagerly welcomed by medical groups. The
lecture courses described in State plans are given in cooperation with
State and local medical societies.
Thirty States in their 1936 plans budgeted sums of money to be
used for such postgraduate education o f physicians, and 15 actually
had such programs in progress by June 30. Because o f the short time
between the receipt of Federal funds and the expiration o f the fiscal
year 1936, many o f the States deferred any postgraduate education
until a later date.6 Two of the early reports received gave the fol
lowing information:
Kansas reported a “ refresher” course for physicians in obstetrics
and pediatrics, starting June 22, covering 31 counties in the western
part o f the State. Six towns were visited weekly for 4 consecutive
weeks. Of the 199 licensed physicians in the area covered 119
attended; in 6 counties every practicing physician registered.
In seven towns in North Carolina, in May and June 1936, 1-week
lecture courses in obstetrics were held. Each course consisted of
five afternoon lectures. Motion-picture films were used for illustra
tive purposes. About 600 physicians from about 275 places in the
5Forty-one States carried on such programs during the fiscal year ended June
30. 1937.

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M aternal and Child-H ealth Services— 1936

State attended one or more of the lectures. The attendance included
one-third of the active general practitioners who include obstetrics
in their practice.
On June 30, 1936, four States had on their staffs full-time obstetri
cians or pediatricians carrying out State-wide postgraduate teaching
and consultation. This type of postgraduate teaching has proved
especially valuable, and more States were planning to make such
appointments during the fiscal year 1937.
The Local Public-Health Nurse.

More than one-third of the Federal, State, and local funds for ma
ternal and child health budgeted in State plans for the fiscal year
1936 were designated for the employment of public-health nurses in
local areas. These local public-health nurses, functioning in organized
district or county health units under the direction of the local health
officer and in other areas under the immediate direction o f the State
department of health, carry an important share of the responsibility
for the local health program.
The public-health nurse, through her various nursing services in
the home, gains the confidence of the family, showing them the
importance of health supervision of mothers and children by their own
physicians or through prenatal and child-health conferences. The
public-health nurse helps arrange for such conferences, assists the
physician with his examination of mothers and children, and helps
interpret his instructions to them. She also teaches individuals and
groups o f mothers verbally and by demonstration at the time of the
health conference.
Through visits to the families in their own homes she teaches by
demonstration and through actual nursing care the application of
scientific knowledge and procedure to everyday living, adapting her
teaching to the conditions in various homes. She frequently extends
her public-health-nursing services to the school, so as to give continuity
to the services throughout the school period. Here she assists the
physician with health examinations and with measures for controlling
communicable disease. She helps teachers as well as parents to under
stand the health needs of children and to know about the health
services that the community makes available.
Public-health-nursing services to individuals and families are supplemented and reinforced through group educational activities such as
classes and conferences, as well as through the distribution and inter
pretation of health publications.
The State advisory or supervisory nurse plans the nursing program
with the director of the State division o f maternal and child health
and assists the local nursing staff to establish and maintain a general
ized nursing service in which the maternal and child-health activities

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are given sufficient emphasis to meet the health needs of the families
in the community.
The State plans and progress reports for the fiscal year 1936 showed
provision by various means for an increase in the number of local
public-health nurses. Where the health services are centrally ad
ministered, public-health nurses were employed directly by the State
health department for work in local areas. In some States a sum to
pay part o f the nurse’s salary was offered to the county or district on
condition that the appointee should meet standard qualifications set
by the State. In other cases State nurses were lent to the counties
with the expectation that the county would later appropriate funds
for employing nurses.
State progress reports showed that the usual heavy service demands
on the rural public-health nurses were in some cases appreciably
reduced by the augmented personnel made possible by Federal mater
nal and child-health funds. Where more nurses were employed a
better quality o f service to mothers and children was made possible,
and the nurses were able to develop added activities such as group
instruction at prenatal clinics and well-baby conferences. However,
in many States the added nursing personnel was employed in rural
areas that previously had had no public-health-nursing service. It
still remains true, therefore, that many a county nurse is serving too
large a district and population to be able to give adequate service.
Many State plans made provision for the in-service training of
public-health nurses as a means of attaining higher standards of
maternal and child-health nursing service. The progress reports
showed that stipends had been provided to enable a considerable
number of nurses to attend special courses in maternal and childhealth nursing or public-health nursing. State advisory nurses and
educational supervisors plan systematic staff-education programs,
including institutes and meetings, as well as manuals of the objectives
and procedures in the nursing service.
The following illustrations from the progress reports show the
various ways in which the States are extending and improving the
nursing service in the maternal and child-health program:
In Arkansas, Georgia, Iowa, Massachusetts, Minnesota, New
Mexico, North Carolina, South Carolina, and Tennessee, State super
visory nurses have been added to the staff. South Carolina as
signed four supervisory nurses for the organizing of prenatal and
well-baby clinics throughout the State. Georgia, Louisiana, Mary
land, and Oklahoma have increased the supervisory service directed
toward improving the quality of midwifery.
The State supervisory nurses in Georgia and Mississippi are stimu
lating the promotion of full-time public-health-nursing services in
areas having no health service. In Wisconsin 10 counties established

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public-health-nursing services during the first half of 1936 under a
1935 State law authorizing a grant of $1,000 to each county employing
a public-health nurse. Michigan reported the loan o f State nursing
staff to seven localities.
Minnesota, North Carolina, and West Virginia reported the estab
lishment of rural training centers where new staff nurses are to receive
intensively supervised field practice.
Dental-Hygiene Service.

State and local dental societies are actively participating in the
program. They are represented on State advisory committees in
most of the States.
Many State plans for maternal and child-health services include
provision for dentists and dental hygienists. In many States full
time dentists, appointed upon recommendation of the State dental
society, act as coordinators o f dental education in the State and assist
county dental societies in the development o f dental clinics for educa
tional and corrective services.
Thirty States included dental-hygiene programs in their 1936 State
plans. Some o f the dentists and dental hygienists employed for this
work were in the division of maternal and child health and others were
in the dental-hygiene division. In Kansas a unified program had
been adopted in 23 counties by June 30, involving the cooperation of
dentists, teachers, and public-health nurses in a program including
examinations, teaching, and follow-up. In Minnesota as a demonstra
tion service the State health department started a study, in coopera
tion with the university medical school and the Mayo Foundation,
on the relation jsf fluorine in water to dental caries and dental defects.
North Carolina, through its oral-hygiene division, conducts a State
wide dental service for school children and planned to add dentists to
the staff for work with expectant mothers and preschool children at
health centers. In Rhode Island under the direction o f a part-time
dentist on the State staff a dental-hygiene demonstration was under
taken in Bristol County, including dental clinical work for expectant
mothers and preschool children and lectures and demonstrations of
prophylaxis for children and adults.
The chief demonstration service started in Indiana was a dental
service for children in Owen and Greene Counties. The demonstra
tion was to start July 30 after preliminary organization, which included
placing a county health nurse in the area, obtaining the cooperation
of local dentists and welfare groups, and ordering dental equipment
and supplies. A mobile dental office was constructed for the purpose.
The program is in charge of dental officers in the State maternal and
child-health bureau, one a field director to be in charge of the educa
tional work and the other a dental operator to take charge of the mobile

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dental office. The mobile dental unit was to be equipped entirely for
children’s dentistry. It was proposed that dental attention be given
to children in families unable to pay for it, as a means of improving
the general health o f the children of the community selected. Before
the appearance o f the mobile unit in any community, an educational
program was to be carried on in the public schools, bringing to the
attention of all school children the importance and necessity of
adequate dental care.
Nutrition Programs.

Of the 49 States for which plans had been approved before July 1,
1936, 9 had made provision in the budget for a staff nutritionist ; 4
o f these had appointed one or more workers. Three additional States
reported plans for securing the full-time or part-time services of a
nutritionist connected with the agricultural-extension service or some
other State agency. Nutritionists are participating in educational
plans for training workers who will come into contact with mothers
and children; that is, public-health nurses, dental hygienists, and
health-education workers. They also share in the planning and con
duct o f demonstration services. Their activities include: (1) Collecting
and preparing literature and exhibits, (2) consulting with nurses and
other workers on typical or problem cases, (3) conducting study groups
or demonstration classes for staff workers and student teachers, (4)
enlisting the support and effective cooperation of local agencies dealing
with nutrition and child health, (5) organizing and supervising classes
for mothers, and (6) teaching nutrition to mothers and children at
prenatal and well-child conferences.
The 1936 plan for Massachusetts, where nutrition service has been
offered in the department of public health for more than 10 years,
stated:
W e have used the nutritionists in our department to supplement the
work done by our physicians and nurses, and we are convinced that there
is a definite place in a public-health program for such service, either on
a State-wide basis or a local basis. There is a particular need in the wellchild conference * * * and in the community as a whole to give service
not only to organizations but to individuals.

Emphasis on Work in Rural Areas.

The Social Security Act calls for the improvement o f maternal and
child-health services especially in rural areas. This provision was
made in recognition o f the fact that urban areas on the whole have
been better served than rural areas.
In the 1936 plans (except that of the District of Columbia— an
urban region) the State health officers directed their attention first to
the provision o f maternal and child-health services in rural districts.
So far as possible the expanded service is financed, at least in part, by

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the county or other local subdivision. In cases where the State
planned to start local service with workers to be paid from State funds,
the State health officers stated their intention of encouraging the
assumption of financial responsibility by the local subdivision.
Increasing allocations of State or local funds to maternal and
child-health services in local areas will be needed if the State health
officers are to be able to show each year extension and improvement
of local maternal and child-health services when they request Federal
grants.
Public Understanding.

The maternal and child-health program is dependent on public
understanding for its acceptance, support, and expansion.
The program must be responsive to the needs and the desires of
parents and particularly of mothers who come for instruction and
accept and practice what they learn. If the best results are to be
obtained, the initial stages of the program in any community should
be planned with representatives of the groups to be served, and the
plans so made should be widely explained in the community. Ex
pansion o f the local program to meet fully the needs of the community
will come as a result of widespread understanding of the work being
done.
As one means of promoting such public understanding the State
health officers have included on the advisory committees for maternal
and child-health services representatives of citizens’ groups concerned
with maternal and child welfare. As reported on June 30, 1936, State
parent-teacher associations, State federations of women’s clubs, and
State departments of the American Legion were the organizations
most commonly represented on State advisory committees. Other
organizations included were the American Association of University
Women, the League of Women Voters, the Federation of Business
and Professional Women’s Clubs, Rotarians, Kiwanians, Lions, and
many others. In two States the Chamber o f Commerce and in one
the State Federation o f Labor was represented, and five States had
representatives of men’s or women’s farm organizations on such
committees.
Georgia and Washington, as well as other States, are using such a
method to promote local understanding of the program. County
public-health councils or advisory committees are appointed for this
purpose. In Minnesota, under a State law, county advisory nursing
committees are appointed to work with the county public-health
nurse.

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Current Statistics and Special Studies.

Maternal and child-health programs in operation in all the States
make possible the gathering o f current statistics on health services
rendered to mothers and children and special studies o f service
needed and o f administrative procedure developed to meet State
and local needs.
In April 1936 the conference of the State and Territorial health
officers approved a report of its committee on records and reports
presenting a plan for the tabulation o f health-department services,
and recommended the use o f this plan as a basis for State reports of
activities to be sent to the Children’s Bureau and to the United States
Public Health Service. The plan was accepted by the Children’s
Bureau as the basis for reports of maternal and child-health services.
The State health agencies were asked to begin July 1, 1936, the
collection o f data for quarterly reports on maternal and child-health
services administered directly by the State health agency and those
under local administration in counties or districts in which the local
program is financed in whole or in part from Federal grants under
title V, part 1, o f the Social Security Act. In order that information
might be available on the total volume of maternal and child-health
services in every State, each State agency was requested to forward
as a supplementary report available data on other maternal and childhealth services rendered under public or private auspices. The
quarterly report on maternal and child-health activities provides for
entry o f detail on medical, nursing, dental, and other services in the
fields o f maternal, infant, preschool, and school hygiene.
The Children’s Bureau is directed by the Social Security Act to
make studies and investigations to promote the efficient administra
tion o f this part o f the act. Reports on such studies, together with
similar reports made by State agencies, will make possible an exchange
o f experience between the States on methods o f discovering and meet
ing the health needs o f mothers and children.
,
Problems and Objectives.

During the 5-month period ended June 30, 1936, the State health
agencies formulated and started operation under plans for the mater
nal and child-health services made possible by Federal grants to the
States under the Social Security Act. State staffs, including pedia
tricians, obstetricians, public-health nurses, nutritionists, dentists,
and health educators were assembled. General and technical ad
visory committees were appointed to assist State and local staffs in
rendering health service to mothers and children.
Any evaluation o f the program from the results obtained by June
30, 1936, would be premature. However, the spirit o f cooperation
shown by the State health officers, their eagerness to find and appoint

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qualified personnel, and the response of professional and lay groups has
already justified belief in the far-reaching and lasting value of the
services to be rendered to mothers and children.
The first full year o f operation under the new program, beginning
July 1, 1936, offered to each State health department and its division
o f maternal and child health the opportunity to strengthen the State
advisory and supervisory service to local health agencies and to
develop a State-wide educational program for public-health workers,
for professional groups, and for mothers and children.
It is apparent that the problem in local communities is twofold.
Where a program is under way the problem is how to reach more
mothers and children and how to provide more complete and adequate
service. For the community that has no local maternal and childhealth service, the problem is how to get a start.
Although a great number o f public officials, physicians, dentists,
nurses, and representatives o f health and social agencies and o f citi
zens’ organizations participated in the formulation and launching of
the program in each State, nevertheless the program for some time to
come will be too new to be well understood throughout the State. It
needs careful and continuous presentation to the groups directly con
cerned and to the general public both as a State-wide program and
as a program to meet local community needs. The discussion in
volved in this process should help to keep the program in each State
sound in its objectives and methods of procedure, should obtain for
it cooperative services, and should insure its steady development.
The new demonstration services initiated under the State plans will
be subject to observation as they develop. These special projects,
together with other experience in rendering maternal and childhealth services, should reveal the extent and nature of the need for
services and the successful methods of procedure in providing for
such need. Particularly in the fields of maternal care, protection of
the newborn child, nutrition, dental hygiene, the hygiene o f the school
child, and health education, the work is in the experimental stage.
What should be done for mothers and children in these fields and how
it should be done will be under continuous review.
The dissemination o f information on the scientific aspects o f ma
ternal and child health and on administrative procedures will be
developed increasingly by the Children’s Bureau through conferences
of technical' and administrative groups, reports on studies o f admin
istrative practices, and staff consultation service to the States.

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SERVICES FOR CRIPPLED CHILDREN 1

Part 2 of title V of the Social Security Act authorizes an annual
appropriation of $2,850,000 for grants to the States to extend and
improve (especially in rural areas and in areas suffering from severe
economic distress) services for locating crippled children and for pro
viding medical, surgical, corrective, and other services and care, and
facilities for diagnosis, hospitalization, and aftercare for children who
are crippled or who are suffering from conditions which lead to crip
pling.
The first appropriation for grants to the States for these purposes
was $1,187,000, for the period February 1 to June 30, 1936.
Children’s Bureau Administrative Service.

The Crippled Children’s Division of the Children’s Bureau, with a
physician as director, was placed in immediate charge o f the adminis
tration o f this part of the Social Security Act.
The Crippled Children’s Division maintains close working relation
ships with the Maternal and Child Health Division, the Child Welfare
Division, and the Social Service Division o f the Children’s Bureau;
the United States Public Health Service; the Vocational Rehabilitation
Service of the Office o f Education and the Office of Indian Affairs,
both in the United States Department of the Interior; and the Amer
ican Red Cross.
The regional medical consultants o f the Children’s Bureau give
consultation service to State agencies on the preparation o f State
plans and budgets for services for crippled children and on the devel
opment o f programs. At first the consultants were asked to explain
the terms o f the part o f the Social Security Act relating to crippled
children. In several States aid was asked in formulating a new State
program, and in others, in planning for the extension o f an existing
program. Among the subjects that State officials have discussed
with the consultants are the organization o f the State agency, pro
cedures for locating crippled children, arrangements for diagnosis and
for surgical and hospital care and for aftercare, provision for coopera
tive relationships, and the budgeting of funds available to cover the
services planned. Frequently the consultants are asked to meet
with advisory committees and with other groups whose understanding
r * T !?a m f° f mation in this section is for the fiscal year 1936 (5 months Feb. 1 to
June 30). For preliminary summary o f activities in the fiscal year 1937 see p 72

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Services for Crippled Children— 1936

of the State plan is essential and to attend conferences called to arrange
for cooperative services by various State agencies. They are also
asked to furnish information as to how other States are dealing with
various phases of service. By June 30, 1936, each of the States
(not including Alaska and Hawaii) had been visited at least once by
the medical consultants.
The regional nursing consultants confer with the State agencies
regarding problems of nursing services associated with services for
crippled children, including the locating of crippled children, the
conducting of diagnostic and treatment clinics, and the provision of
aftercare services by public-health nurses and orthopedic nurses.
Eleven States had been visited by the nursing consultants by June
30, 1936.
The consultant orthopedic surgeon, by June 30, had visited Mary
land, Pennsylvania, Virginia, North Carolina, South Carolina, and
Georgia to confer with the State agencies on technical problems and
on professional relationships.
Specialized consultation service to the State agencies was to be
given by medical social workers in the fiscal year 1937.
A brief report on progress for the fiscal year 1936 was requested of
the State agencies. Plans were made for more complete reports of
activities under the State plans for the fiscal year 1937, to be sent in
on forms provided by the Children’s Bureau. The statistical con
sultant on the Bureau staff gives advice to the State agencies with
regard to records and reports. Using these reports and other infor
mation received from the States, the Children’s Bureau is able to
serve the States as a clearinghouse for experience.
Advisory Service.

At its first meeting, held December 16 and 17, 1935, the advisory
committee on services for crippled children considered various phases
of the program and made recommendations looking toward its satis
factory development. Recognition was given to the principle that
qualified personnel is essential for the efficient operation of State
programs. Attention was drawn to the assistance that might be
rendered by national organizations in the formulation of acceptable
standards for professional personnel in their respective fields. Plans
were made to work out continuing programs o f professional education
and to encourage the progressive training o f personnel. Much stress
was laid on the importance of the selection of hospitals in accordance
with standards that would safeguard the quality o f care. It was the
consensus of opinion that physicians should be remunerated for
services on the basis of policies to be established by the State agency
in conjunction with State and local medical societies and the Children’s
Bureau.
7424°— 38----- 4

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It was suggested that during the initial stages of the program the
various State definitions of a crippled child should be accepted pend
ing further study and possible adjustments. Because o f the many
problems presented by children with cerebral palsy, it was recom
mended that special consideration be given to projects designed to
care for this group o f children. Emphasis was placed on the impor
tance o f the cooperation o f the groups specified in the law. Attention
was drawn to the valuable assistance in program planning to be ob
tained through the use o f advisory committees with professional
representation from the various fields of medicine, nursing, physical
therapy, and social work.
The State and Territorial health officers (Apr. 16, 1936) adopted a
committee report that included recommendations relating to the pro
cedure to be followed when the State health department administers
services for crippled children. The report also recommended that in
the States where the health department does not administer these
services it should be prepared to advise the administrative agency on
the points covered in the report. The major recommendations were
as follows:
That the program should be directed by a physician, preferably
one experienced in the care of crippled children.
That a separate division or bureau under qualified personnel should
be established.
That a general advisory committee and technical advisory commit
tees on medical, surgical, and hospital procedures should be appointed.
Other recommendations related to the promotion of a uniform
record system; an educational program for personnel; participation of
local health personnel; provision for. reporting injuries of the newborn
and congenital malformations; a program for the prevention of crip
pling conditions; publication of educational material; establishment
of consultation services and special laboratory services for use during
epidemics; establishment of standards for qualifications of personnel,
based on requirements of nationally recognized organizations; and
establishment o f standards for hospital care, based on the require
ments o f national hospital organizations.
State Agencies Administering Services for Crippled Children.

The type o f State agency administering crippled children’s services
varies. State plans approved for the fiscal year 1936 were adminis
tered in 15 States by the department of health, in 10 by the depart
ment o f public welfare, in 8 by a crippled children’s commission, in 3
by the department o f education, in 1 by an interdepartmental com
mittee, and in 1 by a State university hospital.

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Services for Crippled Children— 1936

Submission and Approval of State Plans.

Each State plan for services for crippled children, before it can be
approved by the Chief o f the Children’s Bureau, must meet the con
ditions specified in section 513 o f the Social Security Act. These
conditions are as follows:
1. Financial participation by the State.
2. Administration or supervision of administration of the plan by
a State agency.
3. Methods o f administration (other than those relating to selec
tion, tenure o f office, and compensation o f personnel) necessary for
the efficient operation o f the plan.
4. Provision for furnishing reports to the Secretary of Labor.
5. Provision for medical, surgical, corrective, and other services and
care, and facilities for diagnosis, hospitalization, and aftercare, for
children who are crippled or suffering from conditions leading to
crippling.
6. Provision for cooperation with medical, health, nursing, and
welfare groups and organizations, and with any State agency admin
istering laws providing for vocational rehabilitation.
*'— A11° ta ' f n *8 a n d p a y m e n ts to States for services for crippled
June 30, 1936"
Security A ct, title V, part 2, 5 m o n th s ended

T^ / S

Allotment available for payment of half the total
expenditure under approved State plans 2

State 1

Total.
Alabama___________
Alaska. ____________
Arizona____________
Arkansas___________
California__________
Colorado____________
Connecticut________
Delaware___________
District of Columbia
Florida_____________
Georgia_____________
Hawaii_____________
Idaho_______________
Illinois______________
Indiana_____________

Allotment on basis
of need after
number of crip
pled children in
need of care and
costs of service
are taken into
consideration

Paym ent3

Total

Uniform
allotment

$1,187,000.00

8424,827.45

* 8762,172. 55

8732, 492.33

23.778.14
8,606.14
10,608. 86
18,878.95
29,908.35
13.237.15
15,723.11
9,396.31
10,060. 69
15,495.67
25,112.37
10,419.32
10, 689. 85
41, 525. 89
23,035. 84

8,329.95
8,329.95
8,329. 95
8,329.95
8,329. 95
8,329.95
8,329.95
8,329. 95
8,329.95
8,329.95
8,329. 95
8,329. 95
8,329. 95
8,329.95
8,329.95

15,448.19
276.19
2,278. 91
10,549.00
21, 578. 40
4,907.20
7,393.16
1,066. 36
1,730. 74
7,165. 72
16,782.42
2,089.37
2,359. 90
33,195.94
14,705. 89

17,846.21
1,250.00
10, 608.00
(6)
13, 758.00
9, 500.00
(5)

(6)

5, 586. 68
15,495.00
(s)

(5)
8 000.00
(s)

2 Tvif I61” 1 “ ?ta,t? ” inJc!udes Alaska, Hawaii, and the District of Columbia
State^ntif^une 30J1938.*°
* * * remainin« unPaid
30, 1936, is available for payment to such
5-month period.^InT f Spates ^ th ^ p ro T O ^ n Y a n s the d a t e s ^ ^ paym?nt was “ ade on the basis of the full
Idaho, Kansas. Texas• Mar lfl M . t S ! . ? Ians the dates of beginning operation were as follows: Mar. 1,

E"ln c lu les89e0W5 n e9 fCO’ OWo.’ Vennsylvailia,1aA d W h ?M aJ l 6f C oloild” aSSaChUSettS’ * * * » « * & .New
fund^ecause^matcMngfunds^w^renotavISiabie^r
W
sts, for aU°‘ ™ nts from this

T:^ pK

o
T

^ S 8 f/ ndwas:”

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Federal-State M aternal and C hild-W elfare Services

T A B L E 4 .— A llotm en ts and p a y m e n ts to States for services for crippled

children under th e Social Security A ct, title V, part 2, 5 m o n th s ended
June 30, 1936— Continued
Allotment available for payment of half the total
expenditure under approved State plans

State
Total

Iowa___________________ _____ _______________
K a n sa s................................. ......... ................. ..
Kentucky------ ------------------------ ------------------Louisiana____________________ _____________
- Maine--------------------------------------------- Maryland_________________ _____ ___________
Massachusetts
. ----------------------- . . . . .
Michigan__________________________________
Minnesota___________________ ____________
Mississippi_______________________ ________
Missouri------------------------ -------------- . . . -------Montana-------- --------- -----------------------------------Nebraska________________________ - ------Nevada--------------------------- -------------- . . .
N ew Hampshire------------------ ----------------------N ew Jersey . . ____________ _______ _
..
N ew Mexico____ __________________________
N ew York_________ _____ — -----------------------North Carolina -----------------------------------------North Dakota----------------- --------------------------Ohio____________ _____ _________ __
______
Oklahoma________________ ________ ________
Oregon.. . . . ---------------- -------------------------Pennsylvania. . --------------------------------------Rhode Island----------------------- --- ----------------South Carolina----------------------------------------- South Dakota------------ ---------------- -----------------Tennessee_______________________ ________
Texas________ . . . --------- -------------- -------------Utah . . . ---------------------------------------------------Vermont----------------------- ------------------ ---------Virginia--------------------- -------------------------------Washington_____________________ _______ _
West Virginia----- -------- -------------------------------Wisconsin-................ ......................... .................
Wyoming___________________________________

$19,814.03
17,266.88
27, 520.10
19,837.01
12,057.36
15,883. 53
26,935. 75
37,000.00
20, 542.01
19,974.29
24, 598.00
10,936.63
25,000. 00
8,690.18
10,368.19
44,803.00
10,786.25
64, 537.00
32,709.00
12,170. 59
44,650.00
21, 529.23
12,286.62
55,639.03
11,499. 70
19,278.29
12,010.74
25,593.00
49,999.92
11,226.52
9,986.63
21,672.65
14,915.00
26,268.27
22,258.63
9,772.92

Uniform
allotment

$8,329.95
8,329.95
8,329.95
8,329. 95
8,329. 95
8,329. 95
8,329. 95
8,329. 95
8,329.95
8,829.95
8,329.95
8,329.95
8,329. 95
8,329. 95
8,329.95
8,329.95
8,329. 95
8,829. 95
8,329.95
8,329.95
8,329. 95
8,329. 95
8,329. 95
8,329.95
8,329.95
8,329. 95
8,329. 95
8,329.95
8,329.95
8,329.95
8, 329.95
8,329.95
8,329.95
8,329.95
8,329.95
8,329.95

Allotment on basis
of need after
number of crip
pled children in
need of care and
costs of service
are taken into
consideration

11,484.08
8,936.43
19,190.15
11,507.06
3,727.41
7, 553. 58
18,605. 80
28,670.05
12,212.06
11, 644.34
16,268.05
2,606.68
16,670.05
360. 23
2,038.24
36,473.05
2,456.30
56,207.05
24,379.05
3,840. 64
36,320.05
13,199.28
3,956,67
47,309.08
8,169.75
10,943.34
3,680.79
17,263.05
41,689.97
2,896. 57
1,656.68
13,342.70
6, 585.05
17,938.32
13,928.68
1,442.97

Payment

(s)
$9,726.64
26, 520.10
(*)
12,057.36
(')
21,233.00
87,000.00
14,379.00
2,487.08
24,598.00
7,900.00
25,000.00
(5)
1, 500.00
37,494.88
7,500.00
61,213.00
32,086.00
(')
44,650.00
21, 508.33
(6)
55,639.00
3,000.00
8,300.00
12,010.74
25, 593.00
49,999.92
7, 500.00
6,665.00
21,672. 57
14,915.00
26,268.27
22,258.63
9,772.92

5 Plan not approved.

Every State plan that was submitted provided for the development
of State-wide services. In States where services were already in
existence they were extended and improved so as to meet the require
ments o f the Social Security Act.
Since this was an entirely new program involving Federal and State
cooperation, legislative or administrative action was necessary in a
number o f States before they could participate. Difficulties involved
in such arrangements in some States caused delay in submission and
approval o f plans. No plan for the fiscal year 1936 was received from
Arkansas, Delaware, Hawaii, Illinois, Louisiana, Nevada, or North
Dakota. Plans for 1936 were submitted by Connecticut, Georgia,
Indiana, Maryland, Iowa, and Oregon, but there were legal or adminis
trative difficulties which prevented approval of these plans before the
end of the fiscal year.

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Services for Crippled Children— 1936

Between February 11 and June 30, 1936, 36 States, Alaska, and the
District o f Columbia submitted plans for services for crippled children
which conformed to the requirements of the Social Security Act and
were approved by the Chief of the Children’s Bureau.
Allotm ents and Payments to States.

Table 4 shows the allotments and payments made to the States for
the 5-month period ended June 30, 1936.
The amount of State, local, and private funds included in the State
budgets for services for crippled children for the fiscal year 1936
exceeded the amount of Federal funds requested. The plans as
approved showed $1,133,500 of State and local funds and requests for
$747,484 from Federal funds. The State agencies were encouraged
to include in their budgets all public funds used for services for
crippled children, even though the total exceeded the amount needed
to match the Federal funds requested. However, this was not done
in all cases.
Of the amounts included in the budgets as approved, $911,130 was
from State funds, $206,350 from local funds, and $16,020 from private
funds made fully available for expenditure as public money. Although
the amount of State and local funds available for matching exceeded
the amount o f Federal funds requested in a number of States (Florida,
Kansas, Minnesota, New York, Ohio, Oklahoma, and Wisconsin),
appropriations in several other States were relatively small, and these
States were unable to request the total amount of Federal funds
available for allotment to them.
Locating Crippled Children.

Although surveys to locate crippled children had not been made in
all States, in most of them there were sufficient cases on record
reported from public and private sources to enable the State agency
to initiate extensive plans for diagnostic clinics and hospital care.
The school census in some States provides for a separate enumeration
of crippled children. This has not always included children o f pre
school age, but efforts are being made to have this group included.
In Maine a partial survey was conducted by the department o f health,
through the local health officers, during the early part of 1936. In
Utah, where the program was new, questionnaires were filled in by
county public-health nurses and social workers who obtained the
information from physicians, schools, hospitals, and other organiza
tions and agencies. In Montana, Idaho, and other States with new
programs special efforts were made to collect reports o f cases through
both official and unofficial agencies. Incomplete returns from a
survey in Cleveland o f all persons who had had infantile paralysis as

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Federal-State M aternal and Child-W elfare Services

children indicated that a large number had never received any
treatment.
The reporting on birth certificates of congenital malformations and
injuries o f the newborn makes early diagnosis and treatment possible.
In New Jersey such reporting is required by State law. Through the
courtesy o f the State agency in New Jersey copies o f the New Jersey
law and report forms were forwarded to agencies in all other States.
An additional method o f locating crippled children is through reports
by public and private welfare or health agencies and by organizations
such as the Shriners, the Elks, the American Legion, men’s “ service
clubs,” women’s organizations, and interested individuals. Complete
registration o f all crippled children is not available in any of the States,
but through the cooperation of the various groups registration records
are being brought up to date.
Through the epidemiological reports of the State health depart
ments the State crippled children’s agencies are informed of cases of
poliomyelitis.
Diagnostic Service.

Examination of crippled children is provided in the States through
itinerant or permanent diagnostic clinics conducted by orthopedic
surgeons in cooperation with local physicians and assisted by nurses,
social workers, and volunteers. Clinics are held at intervals, the
frequency depending on the locality and the number o f children to be
examined.
The State programs were often a continuance o f programs already
under way. For example, the Oklahoma Society for Crippled Children
and the State vocational-rehabilitation division had conducted crippled
children’s clinics over a period o f 10 years. Every county in the State
had been reached and a total o f 269 clinics had been held. Permanent
orthopedic and plastic clinics had been established in two counties.
The Oklahoma Commission for Crippled Children, created in 1935,
is continuing these activities.
New York State has been divided into five districts (exclusive of
New York City), and clinics have been so arranged and scheduled in
each district that clinical services have been provided throughout these
districts. A part-time district orthopedic sur geon is in charge o f each
o f four districts, and the other district is served by surgeons from the
central office.
Before Federal funds became available clinics in some States were
usually held in hospitals; and transportation expense made it impos
sible to bring children from all over the State to such centers. Under
the present plans itinerant clinics to serve even remote areas in these
States are being arranged by the State agencies.

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Services for Crippled Children— 1936

In many States clinics have been organized for providing treatment
as well as diagnosis. This practice has proved to be o f great value in
reducing the length of hospital stay and in providing treatment for
great numbers o f crippled children who have been on waiting lists for
prolonged periods. In South Carolina some o f the combined diag
nostic and treatment clinics are held at weekly intervals. In this
State many cases o f clubfoot have been successfully treated on the
weekly clinic days without hospitalization, thus enabling the surgeons
to take care o f a greater number o f patients with the funds available.
In a number o f other States similar treatment clinics are in operation
but are held at less frequent intervals. Services given include mas
sage, muscle manipulation, measurements for and fitting o f braces
and artificial limbs, and instructions regarding further treatment in
the home.
Six States in which the services were new reported that clinics had
been held between February 1 and June 30, 1936, as follows: 3 in
Colorado, 9 in Idaho, 12 in New Mexico, 6 in Rhode Island, 2 in
South Dakota, 1 in Utah, and 1 in Washington. Alabama, Kentucky,
Minnesota, Missouri, North Carolina, Ohio, South Carolina, Tennes
see, Texas, Vermont, Virginia, West Virginia, and Wisconsin reported
that clinic service was increased and in some cases was extended to
remote areas not previously reached. A total of 529 children were
examined in the 9 clinics held in Idaho, and 186 of these children were
recommended for hospitalization. In New Mexico 482 children were
examined in the 12 clinics, 320 were recommended for hospitalization,
and 68 o f these were hospitalized. In North Carolina the State
clinics provided examination, reexamination, and treatment (for the
less severe types of crippling) for 556 children, and 57 children were
admitted to selected general hospitals for treatment.2
A number of States that did not get their clinic programs under
way by June 30 devoted time to organization work, selecting clinic
centers and surgeons, and obtaining cooperation of local groups, so
that they were ready to go ahead during the fiscal year 1937.
Acceptance for Care.

The methods by which applications are submitted to the State
crippled children’s agencies and acted upon differ.
In Ohio the application for care is made to the juvenile court by a
parent, guardian, or other interested person. The social history is
prepared by a juvenile-court worker, a local child-welfare worker, or
a public-health nurse. If the parent or guardian is financially unable
2This does not include children who attended clinics conducted by the North
Carolina Orthopedic Hospital, nor by Duke Hospital, nor children admitted to
the North Carolina Orthopedic Hospital for treatment.

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to care for a crippled child who is in need of treatment and if the State
agency is able to accept the child for care, the court commits him to
the agency for a year. At the expiration o f the commitment the
State agency makes a report to the juvenile court recommending
renewal or termination of the commitment.
In Indiana, under a public-welfare law passed in 1936, a county
board may recommend to the State board of public welfare that a
crippled child whose parents are unable to provide treatment be ad
mitted to the State hospital or to any public or private hospital for
treatment. The county board acts upon the recommendation of a
physician or surgeon and secures the consent in writing o f the parent
or guardian of the child. Upon receiving the recommendation from
the county board, the State agency may apply to the State hospital
for admittance o f the child, or place him in any other public or private
hospital with which it has contracted for care.
The decision with regard to the acceptance of responsibility for
the care o f a crippled child rests with the State agency. The agencies
are trying to establish sound procedures leading to such a decision,
such as considering the family’s ability to pay for the medical treat
ment needed and making sure that the child is not under medical
care when accepted.
In emergency the agencies make a special effort to speed the pro
cedure so that medical care can be begun at once.
Surgical Care and Hospitalization.

After accepting a crippled child the State agency provides surgical
and hospital care insofar as funds and facilities are available. Since
public funds are to be used in paying for medical care, the State agency
is responsible for the selection o f surgeons with satisfactory profes
sional qualifications. For hospital care the State agency must set
standards for the approval of hospitals to which children may be sent
and for the kind o f care to be given. In establishing professional and
hospital standards the State agencies have been using the require
ments set by nationally recognized groups, including the American
Board o f Orthopedic Surgery, the American College of Surgeons, the
American Medical Association, and the American Hospital Association.
In some cases only State-owned and State-operated hospitals have
been used in the past. The new plans in a large number of States in
clude the use, on an individual-case basis, o f all public or private
hospitals adequately equipped to give orthopedic care. This decen
tralization o f hospital facilities makes it possible to hospitalize in
creased numbers o f children and to give hospital service nearer the
children’s homes.
The Pennsylvania and Minnesota plans showed that local hospitals
were to be used for short-term cases and that beds at the State hos
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Services for Crippled Children— 1936

pitals were to be reserved for cases needing long-time care or specialized
services. In Missouri, in the past, children were placed in the State
university hospital. Under the new plan in this State agreements
were drawn up with other approved hospitals, the State was divided
into three districts based on ease of transportation, and in general
children will be referred to the hospital most easily accessible. Other
States are following similar procedures by treating children in local
hospitals where facilities are available or by transporting them to
other hospital centers for treatment of special types of crippling con
ditions.
The use of additional hospitals will reduce the waiting lists for
hospitalization, which are distressingly long in many States. Since
State registers were incomplete when the plans for the fiscal year 1936
were submitted and many children had not yet been examined in
clinics, data on the number of children awaiting hospitalization as
given in the plans were not comparable, State by State. Alabama
reported an estimate of 9,000 crippled children in the State, including
900 children whose records, carried in the active files, showed need of
hospitalization and treatment. Kansas estimated the number of
crippled children in need o f care at 2,000. The Michigan estimate
showed 1,000 children who had never had hospital care, and 4,000
who had had some hospital care but needed further hospitalization.
Nebraska reported a total of 1,979 children under 16 years o f age
eligible for care for whom records were on file, with an estimate of
6,500 such children in the entire State. New Hampshire reported
460 crippled children under 16 years of age, of whom 84 children
were under treatment. North Carolina reported 1,200 children
who had been examined and who were waiting for hospitalization at
the end of the fiscal year. Reports from other States also indicated
large numbers of children in need of hospitalization or other treatment.
The number of cases that can be given care is influenced by the
average length of time children are kept in the hospital. The average
length of stay, reported by only a few States, ranged from 15 days up
to 9 months. Information on length of stay in the hospital was too
incomplete to permit any definite conclusion, but it was evident that
in a number of States the time might be reduced by the use of care
fully selected convalescent homes and boarding homes.
Convalescent Care.

Plans for convalescent care for crippled children following hos
pitalization differ from State to State. On the whole, the 1936 plans
showed that the State agencies in many cases were not yet ready to
develop this phase of service to meet the recognized need.
Convalescent homes under public or private auspices are used in a
number of States. In Birmingham and Mobile, Ala., for example,

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Federal-State M aternal and Child-W elfare Services

certain citizens are providing buildings for convalescent care for
crippled children. In Ohio there are six convalescent homes in the
State, and two hospitals give a “ convalescent rate” after 21 days’ care.
Each o f these convalescent institutions has a pediatrician on the staff
and, with one exception, a complete physical-therapy department.
In Massachusetts a State sanatorium and a State hospital school are
used for convalescent care. In New York 15 convalescent homes are
used.
In Wisconsin, through the combined efforts of the interdepart
mental committee for crippled children’s services and the State
department of education, two additional orthopedic schools were
established, in connection with which treatment and education are
combined. For children who live at a distance from such schools
board is paid in homes located near the schools, so that they are
enabled to receive medical and nursing care, physical training, and
schooling. These children do not lose contact with their own families
as in most cases arrangements are made for them to spend week ends
at home.
Aftercare Services.

For cases that do not need the intensive care given in convalescent
institutions, aftercare is given in the child’s own home, wherever
possible, or in a well-selected foster home.
The State agency arranges for the child’s return home and for the
transmitting of the physician’s instructions to the local public-health
nurse or other local worker who is to advise and instruct the parents
on how to care for the child. Physical therapy may be provided by
a local physical therapist, or a physical therapist from the State staff
may instruct the local public-health nurse and the mother on the
care to be given. Medical and surgical supervision are provided
through return visits to the operating surgeon or by bringing the
child to the State clinic when it is held in thé neighborhood of the
child’s home. The local child-welfare worker may be called upon to
arrange for the child’s return to school and for his participation in
normal neighborhood activities.
As the program in many States had been in operation for a relatively
short time by June 30, 1936, plans for follow-up services had not been
completely developed. A number of States, however, reported that
provision for follow-up services, through use of Federal funds, had
met one of the great needs in their programs.
In New Mexico the official agency is responsible for obtaining
written instructions from the orthopedic surgeon and seeing that they
are forwarded to the local public-health nurse who is responsible for
aftercare. The field representatives of the State child-welfare agency
prepare social-history summaries for the public-health nurses.

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In Massachusetts physical therapy is given through the out-patient
departments of State hospitals.
In Kansas six field districts were created, and b y June 30, 1936, five
nurses had been employed for these districts. The nurses are respon
sible for locating crippled children and for work with the orthopedic
surgeon in the aftercare of cases under his supervision. Such nursing
service was new in the State. The State agency soon became aware
of increased interest in crippled children in the districts in which the
nurses were working.
In Ohio visits to the children’s homes are made by four orthopedic
nurses working in the four districts into which the State is divided.
For foster-home care only homes licensed and investigated by the
State department of public welfare are used. In Minnesota aftercare
in the homes is done by a field staff of public-health nurses, some o f
whom have had physical-therapy training. Whenever the State
agency administering service for crippled children finds that care in a
foster home is needed, the State children’s bureau cooperates by
investigating and recommending foster homes.
Medical Service.

The program for services for crippled children is a medical-care
program involving many social problems. In addition to performing
professional services, members of the medical profession are asso
ciated with the program as administrators and members of advisory
committees.
In about one-half o f the States with approved plans the program
was directed by a physician. In bther States where administrative
direction was given by nurses, social workers, or other executives,
there was close cooperation with the State health departments and the
medical profession.
By June 30, 1936, general advisory committees, including repre
sentatives of the medical profession in their membership, had been
appointed in most of the States. Technical advisory committees
composed of medical members had been appointed in about twothirds of the States.
Problems in connection with standards for selection of surgeons,
pediatricians, and physicians to whom children are to be referred for
care are referred by the State agency to the general advisory committee
or to a technical advisory committee. In most instances, the qualifi
cations recommended by such committees as a basis for selecting
surgeons and pediatricians are those recommended by the Children’s
Bureau advisory committee on services for crippled children and by
the State and Territorial health officers. (See pp. 41-42.)

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Physicians and surgeons providing service are paid on a part-time
salary basis or on a fee basis. In a few States medical services are
given without compensation.
Nursing Service.

In most of the States public-health nurses have been appointed to
the staff o f the State crippled children’s agency. They function in a
liaison capacity between the State agency and the local public-health
nurses throughout the State, offering consultation service on the ortho
pedic aspects o f public-health nursing.
Trained to recognize deviations from the normal in children,
the public-health nurse, through her home and school visits, has
an opportunity to recognize early symptoms that may lead to
serious crippling and to bring such children to diagnostic and treatment
clinics. The local public-health nurse frequently assists in organizing
and conducting clinics for crippled children, and in arranging with the
parents and the State agency for sending the child to the hospital,
where surgical care can be given. The local public-health nurse also
plays an important part in the aftercare program, which includes
explaining to the parents the kind o f care the child needs and arranging
for the child’s further supervision by the orthopedic surgeon.
The supervising nurses and the district nurses employed by the
State agency teach the public-health nurses the orthopedic phases of
their work and supplement the local nursing service where necessary.
In an effort to get well-qualified public-health nurses for the State
positions, emphasis is being placed on orthopedic-nursing courses
and experience in addition to the public-health-nursing courses and
experience prescribed in the standards o f the National Organization
for Public Health Nursing. Study of orthopedic nursing, either as
part o f the nurse’s basic preparation or in postgraduate courses, or
supervised experience in orthopedic nursing in a public-health-nursing
agency, is now considered an important qualification o f candidates
for appointment on the staff o f a State crippled children’s agency.
If the nurse is to give physical-therapy service, approved courses in
this type of care are also needed. In some States stipends are being
given to nurses to enable them to obtain additional training for
orthopedic nursing.
Physical Therapy.

Physical therapy has heretofore been available in connection with
hospitals, convalescent homes, and crippled children’s schools, but
such service has seldom been available to children in small towns and
rural•communities. By the close o f the fiscal year 1936 a few crippled
children’s agencies had placed physical-therapy technicians on their
State staff, in some States to give service to children and in others to

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teach mothers and local public-health nurses how to give physical
therapy to convalescent children. There probably will be steady
development in the provision of this type of service by the State
agencies.
Social Service.

Plans for 16 States showed social workers on the State crippled
children’s staff; in six of these States the program was directed by
a social worker. Social workers employed in the field assisted in
locating crippled children, in planning for clinics, and in working out
arrangements with State and local welfare organizations for social
case-work services. There has been a growing interest in the use of
medical social workers who are especially trained to study the family
situation of a child in relation to his illness and to work out correlated
plans to meet the social problems connected with medical care. In
order to make medical care and the necessary supplementary serv ies
equally available to all crippled children— in remote areas as wellcas
in cities— medical social workers are assisting in the development of
programs and policies with regard to effective procedures for serving
the individual child.
In selecting medical social workers, standards formulated by the
American Association of Medical Social Workers are used in many
States.
Vocational Rehabilitation.

The Social Security Act requires that the State crippled children’s
agency cooperate with the State vocational-rehabilitation service.
In Alabama, Mississippi, and Texas the State crippled children’s
service and the vocational-rehabilitation service are both under the
State department of education, and they exchange information in an
effort to provide well-planned vocational training for physically re
stored children. In other States referral of cases from one service
to the other is arranged for and other cooperative activities are
planned.
Cooperation W ith Public and Private Agencies.

The general State advisory committees previously mentioned, which
include representatives o f medical, health, welfare, nursing, and educa
tional groups, have been appointed in a majority of the States, and
technical advisory committees representing the medical profession
have also been appointed in many cases. For example, in California
a professional advisory committee, with a northern and a southern
group of members, has been appointed, and also a lay advisory
committee.

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A distinctive feature o f most o f the State plans is the coordination
o f the work of public and private agencies concerned with services
for crippled children.
Cooperation with State health departments has been described.
(See p. 42.)
State departments o f education and local school authorities provide
special educational facilities for crippled children in a number of
States through the use o f special schools and through bedside teach
ing. In certain States arrangements have been made for mental
testing in the schools.
The State departments o f public welfare, through State field workers
or through county units, cooperate in locating crippled children, in
operation o f clinics, in making social case studies when needed, and in
arranging for aftercare services.
The assistance given by private groups in funds, transportation,
and personal interest has enabled State agencies to extend the facilities
for hospitalization and other essential services. In many States
organizations, such as the Shriners and the Elks, maintain hospitals
where crippled children are treated free o f charge or on the payment
of a nominal sum by the official agency. The Junior League in
Tennessee and in Oklahoma operates convalescent homes and in
West Virginia assists at clinics. State societies for crippled children,
the American Legion, women’s organizations, men’s “ service clubs,”
and other groups assist at clinics, provide transportation for children,
and make other contributions which broaden the range o f services
and conserve the funds of the official agency. In some States special
rates are given by railroads and busses for transportation of children
to clinic or hospital centers.
In Seattle, Wash., an orthopedic hospital supported by private
funds has been the principal organization in the State giving services
for crippled children from birth to 14 years o f age. By agreement
with this hospital, the State examines all children from birth to 21
years o f age in diagnostic clinics, and provides hospitalization for
children from 14 to 21 years of age. The private hospital provides
treatment for children under 14, and the State agency accepts the
responsibility for aftercare o f children o f both groups.
In New Jersey the Elks have been active in the past in providing
services for crippled children, and arrangements have been made for
correlation o f their work with that of the official agency. The Shriners
cooperate in paying for hospitalization and in providing maintenance
while the child is away from home to get vocational training; the
Rotary and Kiwanis d u b s take an interest in children who are re
ceiving vocational training and endeavor to get employment for them
afterwards. These organizations supplement the work of the State

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agency, and they frequently provide services that are outside the
scope of the public program.
State Research Projects.

In States where programs are well established and the waiting list
for hospitalization is small, an intensive study is being made o f the
methods o f locating crippled children and o f the results o f treatment.
The New Jersey plan included a special project for the study and care
of cases o f cerebral palsy. The Michigan Crippled Children’s Com
mission is making a study of the results o f the care given children,
especially in rural areas, over the last 10 years.
Increased Service Under 1936 Plans.

Before the plans for services for crippled children under the Social
Security Act were developed, in a number o f States no State agency
was provided for such services. In others public funds were available
for only one type of service, such as hospitalization. All the State plans
for the fiscal year 1936 showed, as required by the act, the develop
ment o f additional services and the extension of services to rural areas
or to areas showing special need.
Progress in the States under the Social Security Act can be measured
in part by the extent to which the State administrative staff has been
strengthened and the extent to which services have been provided
throughout the State. A total o f 122 staff members were added in
33 States.3 These included 33 nurses, 10 physical therapists, and
17 social workers. A large proportion of these new members of
the State staffs were employed to do field work throughout the
State. The plans as made provided for appointment of additional
personnel, particularly field workers, but the short time the plans were
in operation made it impossible for the State agencies to select qualified
persons for all the positions planned for.
Fifteen physicians or surgeons were added as regular staff members,
and a large number o f orthopedic surgeons and other physicians were
to be used in the programs for diagnostic and operative services on a
part-time basis.
By June 30, 1936, the State plans had been in operation only 5
months or less. The following information from State reports shows
the progress already made by the States:
In Florida the number of cases hospitalized during the 5-month
period covered by the 1936 plan increased about 50 percent as com
pared with the same period in 1935. The scope o f the work was
broadened to include cases of harelip and of cleft palate. One ortho3This does not include orthopedic surgeons or physicians engaged on a parttime basis for diagnostic or operative services.

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pedic surgeon was added to the staff, and, during the succeeding
fiscal year, two more surgeons and three nurses were to provide more
adequate treatment and follow-up.
Kentucky reported an increase in the number of children given treat
ment from February through June as compared with the corresponding
period in 1935. One clinic was held in a rural community where no
previous clinic had been held. Children stricken with poliomyelitis
in 1935 had been given a total of 259 physical-therapy treatments.
Additional field staff provided more adequate follow-up service.
In Michigan a new field district had been created, with a nurse in
charge; this permitted closer supervision and better follow-up service.
Through the addition to the staff of a statistical clerk more frequent
evaluations of the work will be possible.
Until 1936 the crippled children’s program in Minnesota had been
almost entirely one of surgical care in the State hospitals and of
itinerant clinics. There had been no field follow-up work and no
provision for convalescent care or aftercare. The expanded program
includes decentralization of hospital services by the planned use of
various private hospitals and the development of case-finding serv
ices, convalescent-care facilities, and follow-up services by the field
staff. The program will extend services over the State. A depart
ment o f field nursing service was organized, clinics were held, and,
in addition to children placed in the State hospital, 30 were placed
in private hospitals during the time the 1936 plan was in operation.
The situation in Missouri was similar to that in Minnesota. Good
but quantitatively inadequate services had been provided by the
State university hospital. The use of other hospitals to serve the
eastern and the western sections of the State and the development of
diagnostic and follow-up services will insure a State-wide program
and more adequate services. Two field nurses were employed and
the field staff was to be increased during 1937.
In South Dakota funds had been limited, and therefore work for
crippled children had been sporadic. The new program was slow in
starting, but during the 2 months of operation under the 1936 plan
38 children were given care, as compared with 68 during the 2-year
period ended June 30, 1934.
In South Carolina the number of orthopedic centers was increased
from 1 to 4, the number o f hospitals from 1 to 6, and the number of
diagnostic and operative clinics held monthly was increased from 4
to 10. The services of a physical therapist were used for the first
time in the State program. As in a number of other States, the
training o f staff was included in the program.
The grant of Federal funds to Texas made possible better care of
convalescents through the addition of three nurses to the State staff,
reported by the State to be a pressing need. The volume of work

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had been doubled and the service had improved. Additional social
workers, nurses, and a physical therapist were placed on the staff.
In New Jersey a program for care of crippled children has been in
operation for a number of years. A special effort was started under
the new program to recheck all cases of crippled children in the State.
The director of the program met with a special committee o f the
board o f each political subdivision so that cooperation could be
arranged in order to have all cases cleared through the crippled chil
dren’s commission. A recheck of cases by the nurse in charge had
been undertaken in each jurisdiction.
The program in Arizona was entirely new, and the time during the
first 3 months of operation was devoted to locating crippled children,
appointing advisory committees, and providing for certification of
orthopedic surgeons and hospitals in preparation for future work.
A few emergency cases were given care.
In Colorado also the program was new. The State child-welfare
bureau had made a survey of crippled children in 1933-34. The
new program administered by the division of public health was built
in part on the survey findings. A general advisory committee was
appointed and a physician and two medical social workers were placed
on the staff. Three diagnostic clinics were held in June 1936.
Administrative Problems Ahead.

There are a number of administrative problems to be worked out.
Some of these problems have been discussed with the Children’s
Bureau advisory committees and will receive further attention at
future meetings of these committees. Among the subjects that
require special consideration are the following:
1. Types of crippling conditions found in different parts of
the country, the number of each type, and the kind and extent
of care which should be provided under the joint Federal-State
program.
2. Duration of hospital care required, development of con
valescent facilities, not only to shorten hospitalization but to
make the transition from the hospital to the home easier for the
child, and extension of aftercare to make medical treatment
more effective, through the services of nurses and medical
social workers.
3. Costs o f medical care, including professional fees, hospital
charges, and cost of appliances.
4. Standards for hospitals and convalescent homes.
5. Qualifications of professional personnel, including the
extent to which standards developed by national professional
organizations are being followed in State programs.
7424°— 38-------5

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6. Reporting systems that will indicate accurately the numbers
of crippled children in need of care, the types of crippling condi
tions found, and services being provided.
7. Functions of the general advisory committees and of medical
committees acting in an advisory capacity to the State agency.
8. Use of medical social workers in an effort to provide the
family service needed in connection with locating crippled chil
dren and arranging for medical care, convalescent care, and after
care and to coordinate health and welfare services in State and
local programs.
9. Policies and procedures with regard to acceptance by the
State agency of crippled children for care.
10. Provision in hospitals and convalescent homes for dis
charge procedures based on consideration o f the family situation
o f the child and of the resources available in his community.
11. Working relationships between vocational-rehabilitation,
public-health, and crippled children’ s services.
12. Provision for diagnosis and treatment o f children suffering
from cerebral palsy resulting from birth injuries, and results of
treatment o f such children.
13. Development of popular material concerning the causes
and prevention of crippling conditions.
14. Methods of providing immediate care for children suffering
from poliomyelitis.

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CHILD-W ELFARE SERVICES 1
Part 3 of title V of the Social Security Act authorizes an annual
appropriation o f $1,500,000 for Federal grants to the States to enable
the United States, through the Children’s Bureau, to cooperate with
State public-welfare agencies in establishing, extending, and strength
ening, especially in predominantly rural areas, child-welfare services
for the protection and care o f homeless, dependent, and neglected
children and children in danger o f becoming delinquent. The funds
are to be used for payment of part o f the cost o f district, county, or
other local child-welfare services and for developing State services for
the encouragement and assistance of adequate methods of community
child-welfare organization in areas predominantly rural and in areas
o f special need.
The first appropriation for grants to the States for these purposes
was $625,000 for the 5-month period ended June 30, 1936.
The provisions of the Social Security Act relating to child-welfare
services vary in several particulars from those relating to maternal
and child-health services and services for crippled children. The act
provides that the amounts allotted by the Secretary o f Labor to the
States for child-welfare services shall be for use by cooperating State
public-welfare agencies on the basis of plans developed jointly by the
State agency and the Children’s Bureau.
The act defines only in general terms the requirements which the
States are to meet in submitting State plans when they request
Federal aid for child-welfare services. The State’s share of the
Federal appropriation is to be expended for payment of part of the
cost o f local child-welfare services and for developing State services
as specified, but the act does not require dollar-for-dollar matching of
any part o f the funds.
The emphasis on providing services in rural areas is stronger in this
portion o f the act than in the other two. The distribution o f the
larger part o f the fund for grants for child-welfare services is on the
basis o f rural population, and the funds to be used for local services
are to be expended primarily for child-welfare services in predomi
nantly rural areas.
1 The information in this section is for the fiscal year 1936 (5 months, Feb. 1
to June 30). For preliminary summary of activities in the fiscal year 1937
see p. 72.
59

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Children’s Bureau Administrative Service.

The Child Welfare Division of the Children’s Bureau, including a
Director, an Associate Director, and five regional social-work con
sultants, was established to work with the State public-welfare
agencies in formulating the State plans to be submitted for the ap
proval o f the Chief o f the Children’s Bureau and to give consultation
service to the States in the conduct of the plans as approved.
By March 31, 1936, contact had been established between the
Child Welfare Division and each of the 48 States and the District of
Columbia, either through visits to the States by members of the staff
or through interviews in the Washington office. By June 30, 1936,
every State had been visited at least once and a considerable number
more than once, by a field consultant or by the Director or the
Assistant Director of the Child Welfare Division. There had also
been correspondence between the Chief of the Children s Bureau
and the Governors of Alaska and Hawaii, but no plans for childwelfare services had been received from these Territories up to June
30, 1936, because neither had a Territorial public-welfare agency.
The method followed by the Children’s Bureau and each State
public-welfare agency in developing jointly plans for child-welfare
services was to determine the existing situation in each State and to
formulate a plan conforming to the provisions of the act and pro
viding for maximum service to the children to be served. No effort
was made to outline a uniform plan to which all the States would be
expected to conform.
An effort was made by the State agencies and the Children’s Bureau
to set up objectives for a long-range child-welfare program and to
include in each State plan such portions of this program as appeared
to be possible of accomplishment during the period for which the
plan was made.
Advisory Service.

The advisory committee on community child-welfare services made
two reports outlining objectives and organization for child-welfare
services, which were valuable to the Children’s Bureau and to the
State public-welfare agencies in formulating plans and procedures for
carrying out plans.
At its first meeting, December 16 and 17, 1935, the advisory com
mittee listed as child-welfare services needed in rural communities
the following types o f service, which are needed in any locality:
1. Arranging for foster-home care or institutional care for children who
need care away from their own homes.
2. Protecting neglected children and those suffering from mistreatment or
exploitation.
3. Finding, and securing the necessary attention for, children handicapped
by physical defects.

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4. Finding the mentally defective children who are in need of custodial
care or training, safeguarding those in the community when necessary, and
supervising those on parole from schools.
5. Safeguarding children o f illegitimate birth.

6. Providing investigation and case-work services for courts handling cases
o f neglect, transfer o f custody, and adoptions.
7. Assisting courts without full-time probation service by investigating
complaints and supervising children on probation.
#
Cooperating with State children’s institutions with reference to admis
sions and aftercare service.
Providing case-work services for mental-hygiene clinics.
10. Assisting schools in dealing with attendance and conduct problems.
11. Organizing or cooperating in community activities for the prevention
o f juvenile delinquency.
12. Arranging for care in appropriate institutions or foster homes for de
pendent or defective children found in institutions not equipped for such care.

Xhe committee emphasized the importance of including in State
plans adequate provision for both State and local services. It was
the opinion of the committee that since funds available would not in
most cases permit development of uniform local programs in all parts
of the State, emphasis might be placed on the development of services
in certain areas on a demonstration basis, looking forward to the com
plete assumption o f responsibility by the State or by local units as
soon as possible, thus making funds available for services in other
areas. Xhe committee placed particular emphasis on the importance
of a basic general public-welfare program in which the child-welfare
program would have its proper place.
With reference to State services, the committee agreed that one or
more o f the following activities might be included in State plans,
depending on the situation in the State, the financial resources avail
able, and the services already provided:
# 1* Assistance in developing community child-welfare activities in counties,
districts, or other areas.

2. Consultant service to local units or areas on special problems of child

care.
3 . Local demonstrations o f methods o f conducting child-welfare services
and developing sound relationships between such services and other socialwelfare activities.
4. Cooperation with child-health services, in connection with clinics for
promoting physical and mental health and providing child-guidance facilities.
Conferences and institutes, local or regional.

6. Assistance in developing and promoting professional training for childwelfare work.
7. Special studies and research, such as studies o f population and intake
of institutions and child-placing agencies in relation to community childwelfare services available.

8 . Statistical services affording current information on
problems in relation to community child-welfare programs.

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The advisory committee on community child-welfare services
agreed that, depending on State and local conditions, plans for local
service in rural areas might include (1) sharing in paying for salaries
and travel of welfare workers (in a general public-welfare program)
who devote part-time to child-welfare service, (2) employment of
specialized child-welfare workers to serve as part of a unit having
general social-welfare functions, and (3) provision for specialized
local child-welfare services where no provision for family social service
exists, pending development of a unified welfare program.
At its second meeting, held in June 1936, the advisory committee
included in its report a statement o f basic principles for the develop
ment o f child-welfare services which constitutes a significant contri
bution to the philosophy of programs for services to dependent and
neglected children.
State Public-Welfare Agencies.

The Social Security Act requires the Children’s Bureau to cooperate
with State public-welfare agencies in administering the program for
child-welfare services.
Prior to the date when the first Federal appropriation for this
purpose became available (Feb. 11, 1936), the Children’s Bureau,
through its Child Welfare Division, conferred with State officials in
each State to determine which State agency would be the one to cooper
ate in the administration of child-welfare services.
Some States had a department of public welfare that was clearly
responsible for services to children. In some States the only organiza
tion that could be termed a State public-welfare agency was the relief
administration. When direct Federal relief was terminated, this
agency became the nucleus for the further development of a State
public-welfare agency. In some States a special session of the legis
lature was called for the purpose of enacting laws to enable the State
to cooperate with the Federal Government in the administration of
the social-security program. In other States, pending legislative
action, the Governor by executive order authorized such cooperation
between the State relief authority and the Federal Government. In
a few States no agency had been authorized by June 30, 1936, to
carry on the cooperative child-welfare-service program.
On June 30, 1936, there were, broadly speaking, four types of State
agencies with which the Children’s Bureau was cooperating in the
administration of child-welfare services. These were as follows: (1)
State departments or boards of public welfare in which there had
been no recent changes of function; (2) State departments or boards
of public welfare reorganized to include relief functions; (3) newly
organized State departments o f public welfare having relief functions;
and (4) State relief administrations, authorized by executive order

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or by special legislation to cooperate with the Federal Government in
carrying out the purposes of the Social Security Act.
Submission and Approval of State Plans.

By June 30, 1936, the plans presented by 33 States and the District
of Columbia had been approved by the Chief of the Children’s
Bureau, and Federal payments had been made to these States.
Allotm ents and Payments to States.

Table 5 shows the allotments and payments made to 33 States and
the District of Columbia for child-welfare services for the 5-month
period ended June 30, 1936.
Of the 17 States and Territories that did not receive grants for
child-welfare services for the fiscal year 1936, all but 6 received grants
for the fiscal year 1937 (see table 10, p. 91). The amounts available
annually for grants for child-welfare services to the States which did
not participate in the program for child-welfare services during the
fiscal years 1936 and 1937 are shown on page 89.
T A B L E 5 .— A llotm en ts and p a y m e n ts to States for child-welfare services

under the Social Security Act, title V, part 3, 5 m on th s ended June
30, 1936
Allotm ent 1
State i
Total

Total.
Alabama___________
Arizona_____________
California__________
Delaware___________
District of Columbia.
Florida______ _______
Idaho_______________
Kansas______________
Louisiana______ - ___
Maine...... ......... ......... .
Maryland___________
Massachusetts______
Michigan___________
Minnesota__________
Missouri____________
Montana____________
Nebraska___________
Nevada_____________
N ew Hampshire____
N ew Jersey_________
N ew Mexico___ . ___
North Carolina______
Ohio________ _____
Oklahoma___________
Oregon______________
Pennsylvania_______
South Dakota________
Texas________________
Utah_________________
Vermont______ ______
Virginia-—. . . ..............
Washington_________
West Virginia_______
Wisconsin___________

$408, 819.31
18.684.34
6,347. 53
15, 743.21
5,046. 24
4,166. 67
9, 574410
6, 575.05
12,953.44
13,845. 70
7,799. 31
9,178. 89
7,358. 67
15,923. 31
14,137.86
17,678. 87
6,888. 34
10,974.15
4, 598. 64
5, 633. 83
9, 525. 68
6, 582. 50
22.183. 69
20,496.02
16.183. 66
7,708. 65
27,812.30
8,455. 94
30,388. 63

6, 010. 66
6,005.02
16, 656. 56
9.348.34
13,613. 97
14,739. 54

Uniform
allotment

$141, 666. 78

4. 166. 67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166.67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166.67
4. 166.67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166.67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166.67
4. 166. 67
4. 166. 67
4. 166. 67.
4. 166.67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166. 67
4. 166.67
4. 166.67
4. 166.67

Allotment on
basis of ratio of
rural population
in State to total
rural population

Payment

$267,152. 53

$227, 954.12

14, 517. 67
2,180. 86
11, 576. 54
879.57

18, 684.34
6, 300.00
1,883. 00
1,790. 00
1, 666. 30
6,255. 07
4,348. 61
12, 953. 40
4,153.71
1,881.63
7,336. 00
3,250. 00
10,102. 50
11.300. 00
9,225. 00
2,062. 50
8, 572. 84
842. 57
4,971. 68
1, 896. 67
6, 582. 00
12,126. 89
6.983.00
2,260.20
964.44
5,440. 00
5.040.00
27,349. 74
3.450.00
3,372.46
8,930. 00
9.300. 00
11,079.00
6, 600. 57

5,407.43
2,408. 38
8,786. 77
9,679. 03
3,622. 64
5,012.22
3.192.00
11,756. 64
9,971.19
13, 512. 20
2,721. 67
6,807.48
431.97
1,487.16
5.359.01
2,415. 83
18,017. 02
16,329.35
12,016.99
3, 541. 98
23,645. 63
4,289. 27
26,221. 96
1,843. 99
1,838.35
12,489.89
5,181.67
9,447.30
10, 572. 87

1 The term “ State” includes Alaska, District of Columbia, and Hawaii.
. * The amount of funds allotted to each State with an approved plan remaining unpaid on June 30. 1936
is available for payment to such State until June 30, 1938.

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Characteristics of State Plans.

In the development of State plans, differing conditions in the several
States were taken into consideration in order that the funds available
might be used, within the limitations of the law, for purposes that would
contribute most to the development of the child-welfare program
in each State. Although every plan provided for the extension and
strengthening of State services, for the encouragement and assistance
of community child-welfare organization, and for the development of
additional local facilities, there were marked variations within ,this
general framework, due to the differences in existing child-welfare
programs. The outstanding features of the plans may be summarized
as follows:
Extending and strengthening existing State field services in prder that
local units m ay be aided in providing more adequate social resources for the
care and treatment o f children.
Organizing county or district units which might include a demonstration
o f intensive case work with children.
Making provision for in-service training o f staff through methods best
suited to the needs in each State and encouraging selected staff members
who have had at least a beginning in basic training in social work to obtain
additional professional training, specializing in child-welfare work.
Coordinating child-welfare services with other phases o f public-welfare
services for which county welfare departments are responsible.
Stimulating interpretation o f the need for child-welfare services through
enlisting the interest o f public officials, lay groups, individuals, and repre
sentatives o f other social agencies in securing more adequate resources for
the care o f children. This activity included planning for county and regional
conferences designed to stimulate interest in community participation in the
child-welfare program.
P l a n n i n g for special consideration o f the needs o f Negro children either
by the addition o f a Negro worker to the staff o f the State department or of
a demonstration unit or by including in the plan provision for adding such
service later.
Developing State and local committees with both professional and lay
members to advise on the program.

Emphasis on Rural Areas.

The Social Security Act in providing for child-welfare services, as
previously indicated, specifically states that the funds are to be used
for furthering the development o f services in areas predominantly
rural. The members o f the President’s Committee on Economic
Security had data showing that numbers o f children living in rural
communities throughout the country have been consistently neglected
because facilities for health and social services were lacking in their
communities. Thus, in the drafting o f the bill which became the
Social Security Act, emphasis was placed upon the development of
such services near the child’s home. For this reason the Children’s
Bureau, in planning with States for the administration o f child-welfare
services, has placed emphasis upon need for (1) a local unit o f welfare

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administration and (2) unified service within that unit in order that
services for children might not be too widely separated from other
phases of public-welfare service.
Related Programs.

In initiating the new program the Children’s Bureau has made
every effort to correlate the services for which it is responsible with
the services administered by the Social Security Board, the Public
Health Service, the Works Progress Administration, the Office of
Indian Affairs, the Rural Resettlement Administration, and other
Federal agencies, and with the services of private national agencies
such as the Child Welfare League of America and the American
Public Welfare Association.
Special emphasis was placed upon coordinating the program for
child-welfare services with the programs for maternal and child-health
services and services for crippled children, which are also administered
by the Children’s Bureau. In one State, for example, the children’s
case workers employed in the program for child-welfare services are
giving special attention to the social needs of crippled children coming
to the attention of the health department and the department of
education. In another State, in which the State department o f health
has set up a child-health demonstration in a rural county, the State
welfare department has assigned to the same county a children’s case
worker, whose salary is paid out of child-welfare-service funds.
The policy o f making the field consultants on the staff of the Child
Welfare Division available to the Crippled Children’s Division for
consultation service on the social aspects o f programs for crippled
children has been in operation since the inception of the two divisions
within the Children’s Bureau.
State and Local Personnel.

During the first months when the Children’s Bureau began making
payments to States for child-welfare services, various problems
emerged. One o f these had to do with securing properly qualified
personnel. It seems obvious that there is little point in investing
money for services for children unless that money is used to purchase
service that is sufficiently skillful to produce constructive results.
There is considerable feeling in some o f the States against the importa
tion o f out-of-State persons, and, at the same time, there is a dearth
o f local workers who are qualified. For this reason many o f the plans
presented included provision for further training o f workers already
on the jo b and for encouraging workers to secure additional profes
sional training. Through the use of advisory committees for both
State and local programs, it is hoped that there will come an increasing
appreciation o f the importance o f entrusting a child-welfare program

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only to persons who have the kind o f training and experience which
warrants their participation in a program shaping the lives o f children
who are unable to speak for themselves. The following statement
from the report of the Children’s Bureau advisory committee on
community child-welfare services is pertinent at this point:
* * * It is essential that personnel be secured which will be capable
o f organizing programs, o f introducing and developing standards, o f recog
nizing the needs o f children, and o f resourcefully developing remedies. The
benefits to be derived from the program o f child-welfare services now being
set up by the various States in cooperation with the Federal Children’s
Bureau will accrue in exact proportion to the extent to which its administra
tion is entrusted to persons selected solely because they are capable of
securing the results which are sought.

Reports on State Activities.

During the experimental and developmental stages of the childwelfare-service program the Children’s Bureau did not ask the States
for detailed statistical reports on activities. Simple financial reports,
showing expenditures and balances for the 5-month period, and a
general statement regarding progress made in carrying out the original
plans approved were all that the States were requested to furnish.
The importance o f relating statistical reporting and research to the
social objectives o f the child-welfare program and o f correlating its
reporting system with those for aid to dependent children, for relief,
and for other social-welfare activities under the local administrative
unit became increasingly clear as the Social Security Act began to be
translated into action. Data that will be of benefit to the local unit
are o f primary importance; second in importance are data from local
units that will help the State welfare departments to understand social
conditions in the State and to plan constructive methods o f dealing
with problems discovered ; and third in importance are data that should
be obtained by a Federal agency from all States for purposes of
summary and comparison.
In relation to child-welfare services under the act, the Children’s
Bureau for the present will continue to request general reports, in
such form as seems desirable to each State, on important projects
undertaken and on progress made.
State Progress, February-June 1936.

The major effort and accomplishment of the first 5-month period of
the program o f Federal aid to the States for child-welfare services were
the formulation and initiation of State plans. Each o f the cooperating
States, after the plan was approved, had to find additional childwelfare workers for the State staff, and the ground work had to be
laid for the local projects.

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C h ild-W elfare Services— 1936

The reports from the State agencies for the period ended June 30,
1936, showed substantial progress in putting the plans into effect,
especially in establishing child-welfare services in local communities.
A summary made shortly after June 30, 1936, showed that in 308
counties or districts (in 4 States the districts are composed o f several
towns) child-welfare services had been put into operation with the
use o f Federal funds supplemented by local funds. Workers attached
to the State welfare departments were providing general child-welfare
services and some case work for individual children in 192 additional
counties in order to demonstrate the necessity for more extensive local
work.
Local staff paid in full or in part from Federal funds included 271
social workers. Full-time service was being given by 133 workers
and part-time service by 96 workers employed by State welfare depart
ments for assisting local units and organizing State-wide activities.
The following excerpts from progress reports submitted by the State
agencies, covering the initial period o f development of child-welfare
services under the act, illustrate more clearly the mode o f procedure
and the type of advances made under the program:
In order to intensify the field service for children’s work, three children’s
case consultants * * * have been attached to the field staff. One of
these consultants accompanies the field representative, who is responsible
for advising the county public-welfare units on all phases o f their program,
on the regular routine visit to the county. The consultant remains in the
county for a week or 10 days following the visit o f the field representative.
In this way routine supervision o f children’s work is facilitated because basic
and fundamental policies are being interpreted more carefully than the field
representative has had the time to do. The needs o f the county staffs have
been illuminated for the State staff by this consultation service.
For demonstration purposes our plan includes four special areas, each
area consisting o f four counties. In each area there has been placed a
community worker, whose responsibility lies in the field o f further develop
ment o f community resources for child welfare. There was no pattern for
the development o f a plan o f community organization, since this State has
done very little in this specific field. The workers have had a major interest
in the development o f recreational facilities and in encouraging volunteer
leadership. They have made library facilities available to children in remote
hamlets. They have worked out cooperative arrangements with other
agencies and have established wholesome community relationships. They
have been received enthusiastically in the rural areas, and there is evidently
a field o f service here. The time has come, after the several months that
the plan has been in progress, when we realize that we must define relation
ships with other agencies more clearly and stake out in greater detail the
next steps in the development o f this service.

The counties, in general, are eagerly taking advantage o f the State-wide
program. The larger counties are starting special training programs for
their staffs in child welfare, conducted either by the county case supervisor
or by a specially designated member o f the social-service staff. One o f the

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objectives o f the State welfare program is the setting up o f a permanent
integrated service of public-welfare and child-welfare services. The State
and district staff workers * * * have all been working to this end. The
response from the counties, in general, is good. The county staffs are inter
ested in endeavoring to develop public-welfare activities on a modern basis,
including special stress on child-welfare services. The State welfare agency
is giving financial aid to the counties to enable them to keep social-work
staffs qualified to carry on not only relief activities but child-welfare services
also. It is requiring the counties to have staffs which meet the personnel
standards outlined by the State, to conduct their case work on an acceptable
level, and to give full consideration to child-welfare problems and needs.

Each o f the 64 parish welfare units was told o f the proposed plan for childwelfare services, and they were asked to submit cases which they felt should
be carried by a child-welfare worker. They were also asked to designate all
children not living in their own homes, on the schedules sent to the State
office, as a basis for the study o f cases eligible for aid to dependent children.

After considerable discussion among members o f the State staff, with
county workers and board members, with members o f the board o f State aid
and charities, individual social workers in State social agencies interested in
the State program, with institutional workers, child-placing workers, juvenilecourt judges, and so forth, a bulletin in regard to child-welfare services was
sent out to all county welfare boards in the State. In response to the bul
letin, various county welfare boards have discussed preliminary plans with
the division o f county organization and field supervision after careful study
and discussion with local community agencies in regard to potential develop
ments. As a result o f this local activity, the State office went through the
process o f preliminary planning for the final setting up o f child-welfare
services.

On July 1, 1936, there were 10 district case workers, responsible for childwelfare cases, assigned to districts throughout the State. This includes 2
case workers assigned to handle child-welfare cases in one o f the larger cities.
Tw o counties have been selected as “ demonstration counties” under the pro
gram for child-welfare services. A case worker was assigned to one o f these
counties, to begin work on the demonstration June 25, 1936.

From April 20 to June 30 some progress was made in establishing local
child-welfare services, strengthening existing State services, securing local
cooperation, and developing relationships with agencies in allied fields. N o
separate local child-welfare advisory committees were formed, on account of
the fact that it is planned to utilize the advisory committee on crippled chil
dren’s services in each county as an advisory committee on child-welfare
services also. On June 1 there were employed and in the field five district
supervisors.

In one county the county judge considered the children’s case worker
chiefly as a probation officer and tended to swamp her with problem cases.
* * * He volunteered the statement that such cases as he had been

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Child-W elfare Services— 1936

sending would take time and that progress would be gradual. He also
pointed out that under some circumstances the case would probably show
little response to treatment and that the community should be made to real
ize this. Increasingly he has been able to visualize the possibilities o f a
broad, county-wide, children’s program. He * * * is planning with the
worker as to how the county may give adequate and continued financial
assistance in the child-welfare program.

In the counties without a local worker the field worker acquainted the
county welfare office with the service now available through child-welfare
services and gave advice and assistance on cases involving child-welfare
problems. County judges were interviewed, as they handle mothers’ pension
cases and juvenile delinquency and are members of the county child-welfare
boards under the State child-welfare commission.
* * * Facts were
gathered as to number o f mothers receiving a “ mothers’ pension,” the lowest
and highest amount given in each county, and the basis on which the aid is
given, whether according to a set schedule baëed on the number in the family
or on the fam ily’s individual need. Even these meager facts showed a need
for better administration if the State receives funds under the Social Security
Act for aid to dependent children. The field worker found no paucity of
cases, as every county welfare office had from 3 or 4 to 15 or 20 cases needing
immediate attention.

The plan o f this State for carrying out the provisions o f the Social Security
Act concerning child-welfare services is a training program, the objective of
which is to provide workers in rural areas with an opportunity for training
and supervision while handling actual child-welfare cases. * * * The
present training program began April 1 o f this year (1936). Eight workers
were released from eight different counties and brought to the State capital
for training. In addition, one field supervisor joined the group.
* * *
The original program o f training was set up to include a discussion o f general
principles of child-welfare work and the use and development o f community
resources plus actual experience in children’s case work. However, since
none of the students had had any professional training, the plan was altered
to include a short period of intensive discussion, covering the nature and
scope of the whole field of social work and the principles of social case work.
Each student carried from five to seven cases. The cases were selected
because o f the particular children’s problems involved. Three agencies were
used as a source for case material; namely, the county department of public
welfare, the juvenile court, and the department o f education.

A demonstration of the need of general child-welfare services was started
March 15 (1936) under the direction o f a trained social-service worker. I f
there was any doubt o f the need o f child-welfare services in her vicinity, it
has already vanished. The worker has been successful in fostering the
interest of local groups, including officials and lay persons who can be de
pended upon to develop an intelligent public opinion leading to coordination
o f local effort. She has been given office space in the county courthouse and
is being called for conferences with the judge and the State’s attorney on
juvenile cases. She finds the Works Progress Administration nursing service
invaluable, and one community has a fund for the medical care o f its children.*"
She has had contact with 46 families, 2 of which live where they cannot be

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Federal-State M aternal and Child-W elfare Services
reached by car, even in good weather, while 10 live back in the hills on roads
which are extremely rough but still passable during the summer months.

Problems and Objectives.

Since the program for child-welfare services centers around pro
viding funds for additional personnel for States and local communities
which will enable them to give more adequate service to individual
children, it is clear that this program will not be worth the investment
in it unless properly qualified persons are employed.
In the field o f public health there is complete acceptance of the
necessity for employing physicians and public-health nurses for medical
and nursing service. Acceptance of the professional status of social
work is not as yet general. Therefore, it is difficult to explain to
public officials and to citizens’ groups why interest in children and
good intentions are not the only qualifications necessary for a childwelfare worker. Sometimes it is difficult to make people see that train
ing for social work is necessary because only through the employment
of qualified personnel can a standard of service be maintained which
safeguards the personality of the individual coming to an agency for
help.
One of the problems which must be faced in the immediate future
is that of securing competent personnel. It will be necessary for
some time to carry on in-service training projects and to provide for
“ educational leave” in order that workers having basic qualifications
may attend professional schools of social work. Even though the
Children’s Bureau is now cooperating with most of the States for the
purpose o f providing services for children in rural communities, this
does not mean that all the personnel problems have been solved. As
new plans are developed in each State, the importance of selecting
efficient persons for child-welfare services must be continually stressed
in order that the purpose of the act may not be defeated by crude and
ignorant treatment of children.
The child-welfare-service program is of necessity a demonstration
program in selected areas. Its value lies not only in the direct service
which will be rendered to children in the areas selected for demonstra
tion but also in the stimulation given to children’s services in other
areas. To be successful, therefore, the program for child-welfare
services must be accompanied by a continuous analysis of the value
of various methods and procedures used in dealing with children’s
problems and by presentation of such experience to the communities
concerned and to other communities. Such a presentation will un
doubtedly lead other counties and local districts to set up or to
strengthen their own programs for child-welfare services.
As the local child-welfare demonstrations operated with Federal and
State aid prove their worth, the county or other local area benefited

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C hild-W elfare Services— 1936

should assume increasing financial responsibility for such child-welfare
services. The available Federal and State funds thus released can
then be used to aid other communities in establishing adequate childwelfare programs.
Government structure and administration in the child-welfare
program are important only as they unloose forces that will make it
possible for more children to have a satisfactory family life and
greater opportunities for the development of their capacities. The
Children’s Bureau and the State child-welfare agencies have a responsi
bility for helping all workers participating in the program to focus their
attention upon what is happening to children rather than to permit
themselves to become absorbed in the machinery that they are
operating.

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PRELIM INARY SUM M ARY OF ACTIVITIES IN THE
FISCAL YEAR 1937

The State plans submitted and approved for each of the three
social-security programs administered by the Children s Bureau for
the fiscal year ended June 30, 1937, were for the most part a contin
uance and an extension of the 1936 plans. While a full report cannot
be made on the activities carried on under the 1937 plans until reports
for the fiscal year are in, significant developments are already apparent.
Maternal and Child-Health Services.

For the fiscal year 1937 State plans for maternal and child-health
services were approved and were in operation for all the 48 States,
Alaska, Hawaii, and the District of Columbia. (For States receiving
grants, see fig. 1 and table 6.)
In every State a division of maternal and child health is functioning
as a major unit of the State health department. In 45 States a
physician is the full-time director of the division and in 3 States the
part-time director. Three States budgeted for a full-time medical
director, but the positions had not been filled by the end of the fiscal
year (June 30, 1937).
In the plans submitted by the States for the fiscal year 1937 an
average o f only 37 percent of the total expenditures for State maternal
and child-health programs was budgeted from State funds; 63 percent
was budgeted from Federal funds. For local maternal and childhealth programs 18 percent was budgeted from State funds, 48 percent
from local funds, and 34 percent from Federal funds. (See table 7.)
72

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Preliminary S u m m a ry— 1937

Figure 1 .— M aternal and child-health services; States receiving Federal

grants as authorized b y the Social Security A ct, title V, part 1, fiscal
years 1936 and 1937
Fiscal year ended June 30, 1936

Fiscal year ended June 30, 1937

7424°— 38----- 6

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T A B L E 6.

Federal fu n d s available to S tates, Federal fu n d s bu d g eted b y States, and p a y m e n ts to States, for m atern al and
child-health services under the Social Security A c t, title V, pa rt 1, fiscal yea r ended June 30, 1937
Federal funds available

Payment

FUND A
FUND B
State 1
Total

Balance of
Fund A
available
from allot
ment for
fiscal year
1936^

Available for payment of
half the total expend
itures (except from fund
B) under approved State
plans 3
Total

Uniform
allotment

Total.
Alabama..............................................__

Alaska.
Arizona___________
Arkansas_________
California....... .........
Cobrado__________
Connecticut_______
Delaware_________
District of Columbia.
Fbrida____________
Georgia___________
Hawaii____________
Idaho_____________
Illinois____________
Indiana___________
Iowa______________
Kansas___________
Kentucky_________
Louisiana_________
Maine____________
Maryland.............

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$4,379, 849.40

$584,450. 51

103,217.66
45,387.91
52,558.28
80,155.39
121,658.24
72,620.81
46,328.23
33, 282.31
35,104.41
75,239.17
144, 565.39
43,669.49
47, 941.05
157,276. 73
82,448.16
75, 880. 96
68, 884. 00
92,826. 70
93,028.22
55, 610.10
53, 807.64

.10

7.743.16
2,231.90
6, 985. 78
34,015.31
13,933.41
2,970.48
4,211. 60
51.69
4,289. 79
3.896.16
4,070. 77
5,389. 51
46,188.60
19,188.67
11,368. 96
13,037.65
5,300.29
3,731.39
5,074. 56

, 795,398. 89
103, 217. 58
37, 594. 75
50,326.38
73,169.61
87,642. 93
58.687.40
48, 357.75
29, 070. 71
35,052. 72
70,949. 38
140, 669. 23
39, 598. 72
42, 551. 54
111,087.13
63,259.49
64, 512.00
55,846. 35
87.526.41
89,296. 83
50, 535. 54
53, 807.64

Allotment on
basis of
' ratio of
live births
in State to
total live
births

$1,020,000 $1, 800,000.00
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20, 000
20,000
20,000
20,000
20,000
20,000
20,000

52,470.16
1,057. 75
7,017.52
31,001.15
64, 742. 54
14, 749.83
18,357.75
3,295. 55
8,876.88
22,077.22
53,433. 72
7,681.09
7,745. 54
91,087.13
43,259.49
35,090.03
26, 826.35
49, 502. 68
35, 536.27
13,023. 54
22, 592. 88

Allotment on Federal funds
basis of
budgeted in
need for
State plans
assistance
as approved
in carrying
out State
plan after
number of
live births
is taken
into con
sideration

Total

FUND A

FUND B

< $975,398.89

, 736,104. 23

, 989,014.72

191,001.70

$798,013.02

30, 747.40
18,537.00
23,308. 86
22,168.46
2,900.39
23,937.67
5,000.00
5, 775.18
6, 675.84
28, 872.16
67,235. 51
11, 917.63
14,806.00

103, 217. 56

102,446.14
15,945.22
51,735.02
70,071.78
51, 599.79
60, 788.70
41, 634.86
32,059.65
32,328.61
65,978.07
132,076. 81
42,630.93
39, 518.90
70,144. 50
47,845.42
42, 728.06
28,702.16
87,170. 59
88, 924.43
36, 999.27
53,239.74

72,470.16
3,885.33
29,249.42
50,345.81
50,049.40
36, 851.13
37,422.90
26,284.49
28,428. 57
42,077.22
73,433. 72
30,847.15
26,646.07
70,144. 50
47, 845.42
37,936. 92
25,063. 24
69,146. 86
55,176. 94
24,425.88
42, 592. 88

29,975.98
12,059. 89
22,485.60
19,725.97
1, 550.39
23,937. 57
4,231.96
6,775.16
3,900.04
23,900. 85
58,643.09
11,783.78
12, 872.83

9,421.97
9,020.00
18,023.73
33, 760. 56
17, 512. 00
11,214. 76

21,100. 00

52, 558.28
80,155.39
87,867. 54
71,093.24
46,328.23
33.282.31
35,104.41
75,239.17
144, 565.39
43.669.49
47,941.05
86.232.50
69,818. 50
61.752.31
61, 526.00
92.470.88
92.668.89
54,357.00
53, 807.64

4,791.14
3, 638. 92
18,028. 73
33,747.49
12, 578. 39
10,646. 88

Federal-State Maternal and Child-Welfare Services

Allotment for fiscal year 1937

Massachusetts......................................
Michigan_____________ ___________
Minnesota........... .................. ...............
M ississip p i______________________
Montana____________ - _______ - _

. . . . ..
Rhode Island___ _____
South Carolina.. . ....................... .
South Dakota . ___ ________ ___ .
Texas__________________ ________ .
Utah__________
. . . _______ ______
.
. . ._
Vermont_________ .
Virginia_______________ . . . _______
Washington____ __ . _____________
West Virginia______ . . . . . _____
Wisconsin_____________ . .
. ._
W yom ing...____ ___________________

6,186.47
16, 597. 57
2,361. 83
8,732. 50
14,791. 62
2,340.80
16,934.72
8,449. 90
7,012.44
18,915.61
8, 510. 51
57,422.48
8, 550.04
11,272. 74
29,430.44
9,603. 64
12, 808. 86
63,372.39
5,447. 52
139.81
8, 804.49
29,183.20
12,090.41
9,391.75
1,747.68
1,137.33
3,713.24
6,094. 91
9, 725.83

77,372. 87
99,294.36
69,434. 60
104, 696.66
78, 908. 52
45,153. 52
40,729.41
60,347. 29
86,077.68
71,005.61
61,957.45
182,018.45
137,852.22
48,051.41
115,136. 34
79,086. 23
38,312.65
176, 940. 35
34,265.07
100, 876.19
50, 772. 55
95, 875. 85
190, 590. 86
46,045.04
41, 782. 68
90,220.45
53, 549. 87
70,133.09
70, 508. 88
40,642. 67

20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000
20,000

52, 745.35
69,352.85
37,947.60
39, 552.41
48, 908. 52
8,221. 52
20,729.41
1,185. 01
6, 502. 68
45,070. 88
10, 551.87
153,386.10
65,864.75
12,022.81
82,719. 84
39,088. 82
10,806.41
132,415.40
8, 552.07
36, 579.13
10,885.73
43,295. 85
96,356. 86
10,441.98
5,448.24
43,280. 96
18, 626.31
84,272. 74
42,490. 96
3, 772.37

4,627.52
9,941. 51
11,487.00
45,144.25
10,000.00
16,932.00
39,162.28
9, 576.00
5,934.73
31,405. 58
8,632.35
51,987.47
16, 028.60
12,417.00
19,997.41
7, 506. 24
24, 524.95
5,713.00
44,297.06
19,886. 82
32, 580.00
74,234.00
15,603.06
16,334.44
26,939.49
14, 923. 56
15,860.35
8,017.92
16, 870.30

83, 559.34
114,901.51
69,434.00
113,428. 75
51,591.06
47,494.32
22,330.00
40,372.28
32, 575.00
80,934. 73
70,467.96
211,181. 57
137,852.22
36,931.10
96,378.00
68,272.41
27,441.25
156,100.00
83,783.00
101,016.00
36, 564.30
95,875. 85
190, 590.00
53,088. 61
30,834.44
91,968.13
54,687. 20
73, 846.33
76, 603. 79
31, 245. 30

79,175.21
84,440. 68
67, 508.15
104, 696. 25
43,467.27
42, 599. 52
1,997.05
28, 557.03
27,022. 79
75,481.94
61,003.47
78,655. 04
116,362. 25
28,974.34
83,456.11
64,333.78
27,441.25
50,813.96
31,409.34
98,994.68
27,021.32
92,295.27
129, 543. 93
43,045.03
23,312. 53
76, 718. 57
47,895.91
68,616. 78
64, 878. 61
24, 710. 03

74, 547.69
75,303.41
57,947.00
59, 552. 00
33,467.27
28,221. 52
1,997.05
798. 50
20,693. 98
69, 573.33
30, 551.87
75, 553. 58
70,202.18
17,621.81
79,308.94
45,439.11
19,950.00
50,813.96
26,097.34
56,718.94
7, 802.49
63,295.85
78,034. 20
30,441. 97
13,746. 58
63,280. 96
38,626.31
54,272. 74
58,642.45
8,174. 66

4,627. 52
9; 137.27
9, 559.15
45,144. 25
10, 000.00
14,378. 00
27, 758. 53
6,328. 81
5, 908. 61
30,451.60
3,101.46
46,160.07
11,352. 53
4,147.17
18,894.65
7,491.25
5,312.00
42,275. 74
19,218. 83
28,999.42
51, 509. 73
12,603.06
9, 565.95
13,437. 61
9,269.60
14, 344. C4
6, 236.16
16, 535. 37

1 The term “ State” includes Alaska, Hawaii, and the District of Columbia.
2 Includes remainder of 1936 allotment in the Treasury of the United States and unexpended balance of Federal funds in State treasury June 30, 1936.
2 The amount of this fund allotted to any State remaining unpaid at the end of each fiscal year is available for payment to such State until the end of the second succeeding
fiscal year.
* Of the $980,000.00 authorized for allotment, $4,601.11 was not allotted.

Preliminary S u m m ary— 1937

Nevada___ ____ _______ ______ __ . _
N ew Hampshire_________ . . .
N ew Jersey____ . . . ________ ______
New Mexico___________ _______ . .
New York_____ - ___
. ...
North Carolina____
North Dakota.............. .. .
... ..
Ohio______________ . ___________
...
Oklahoma_____________
Oregon___________ . ....................

83, 559.34
115, 891. 93
71, 796.43
113,499.16
93,700.14
47,494.32
57,664.13
68, 797.19
43,090.12
89, 921.22
70,467.96
239,440.93
146,402.26
59,324.15
144, 566. 78
88,689.87
51,121. 51
240,312.74
39,712. 59
101,016.00
59, 577.04
95,875.85
219,774.06
58,135.45
51,174.43
91,968.13
54,687.20
73, 846.33
76,603. 79
50,368. 50

C/i

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

T A B L E 7.

Estim ated expenditures for m aternal and child-health services under the Social S ecu rity A ct, title V, part 1
as sh ow n b y budgets included in approved State plans for fiscal yea r ended June 30, 1937
[Supplements and complete revisions included; amendments since approval not included]
Expenditures for State purposes
Expenditures for
State purposes

From State funds

Amount

Total.

A la b a m a Alaska____
Arizona___
Arkansas...
California..
Colorado___
Connecticut.
Delaware...
District of Columbia___
Florida________
Georgia________
Hawaii________
Idaho_________
Illinois..______
Indiana_______
Iowa__________
Kansas________
Kentucky______
Louisiana______
Maine_________
Maryland______
Massachusetts. .
Michigan______
Minnesota_____
Mississippi____
Missouri_______
Montana_______
Nebraska______
Nevada______ '..
New Hampshire
New Jersey____
New Mexico___
New York.

«7, 507,565.01

$4,367,157.48

222,065.36
25,663.00
88, 723. 06
145,908.46
230,416. 59
118,248.91
89, 720.00
93,149. 50
102,360. 25
157,968. 80
289,463.62
100,448.44
83,837.30
172,465.00
161,156.47
94,082. 65
114,467. 54
166, 649.00
151,656.17
91,202. 00
180, 680. 39
170, 829.00
219, 861. 51
200, 700.00
184,980. 75
94, 156.06
84, 724.00
44, 660. 00
41,082.28
55, 575.00
384,452.73
112,921. 71
414,092. 75

30, 574.40
14, 700. 00
39,704.06
53, 308. 46
75,697. 54
52,293.91
89,720. 00
31,067. 95
102,360. 25
99,321.80
178,173.62
100,448. 44
54,132. 30
157, 602. 50
102,934. 50
64,062. 31
87,925.79
60, 725. 00
59,859. 67
46,042.00
SO, 196. 39
170,829. 00
163, 611. 51
67,034.00
127,380. 75
65,731. 06
29,184. 00
44, 660. 00
19,932.28
65, 575.00
126,434. 73
46,692.96
309, 688.40

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Per
cent

Amount

58 $3,140,407. 53
14
57
45
37
33
44
100
33
100
63
62
100
65
91
64
68
77
36
39
50
17
100
74
33
69
70
34
100
49
100
33
41
75

Expenditures for local purposes

Expenditures for
local purposes

Per
cent

Amount

$1,610, 514.84

191,490.96
10,963.00
49,019.00
92,600. 00
154,719.05
65,955.00

86
43
55
63
67
56

62,081.65

58, 647. 00
111,290.00

37
38

29,705. 00
14,862. 50
58,221.97
30,020. 34
26, 541. 75
105,924. 00
92,296. 50
45,160. 00
150, 484.00

35
9
36
32
23
64
61
50
83

56,250.00
133,666.00
57, 600.00
28,425.00
55, 540.00

26
67
31
80
66

21,150.00

258,018.00
66,228. 75
104,404. 35

67
59
25

6,932. 84
2,000.00
7,200. 00
14,765. 00
8, 680. 00
22,015. 67
42,360.00
9,330. 84
61,087.77
41,100.00
48,000. 00
53, 551. 71
19,765. 65
71,370.00
33,116.00
12,310.00
81,064. 79
23, 262. 50
4,490. 78
11,111.00
15,280.00
86,700. 00
48,710. 00
23,400.00
42,752.00
22,090.00
8,054. 00
22,330.00
960. 00
23,000. 00
59,900.00
4,225.00
107,740. 00

Per
cent

From Federal funds From State funds

Amount

37 $2,756,642.64
23
14
18
28
11
42
*7
30
60
41
27
53
37
45
32
19
35
38
8
24
51
51
30
35
34
34
28
50
5
41
47
9
35

23,641. 56
12,700.00
82,504.06
38, 543.46
67,017. 54
30,278.24
47,360.00
21,737.11
41,272.48
58,221.80
130,173. 62
4 ^ 896. 73
34,366. 65
86,232. 50
69, 818. 50
51, 752. 31
56, 861. 00
87,462. 50
54, 868. 89
34,931. 00
14, 916. 39
84,129. 00
114,901. 51
43, 634.00
84, 628. 75
43,641. 06
21,130. 00
22,330. 00
18,972.28
32, 575. 00
66, 584. 73
42,467. 96
201,948.40

Per
cent

63
77
86
82
72
89
58
53
70
40
59
73
47
63
55
68
81
65
62
92
76
49
49
70
65
66
66
72
50
95
59
53
91
65 1

Amount

$552,398.99
21,407.62
2, 563.00
9,290. 00
16, 775. 00

Per
cent

From local funds

Amount

Per
cent

From Federal funds

Amount

Per
cent

18 $1, 522,055. 76

48 $1,065,952. 78

11
23
19
18

90, 507.34

17,829. 00
34,125.00
133,869.05

36
37
87

42
77
45
45

25,140.00

79, 576.00
8,400.00
21,900.00
4i; 700. 00
20 850 00
4Ö; 815! ÖÖ

48,536.00

13, 545.55

3,480.00

27,250.00
33,360.00

46
30

14, 750.00

18, 315. 00
22,496. 00
54, 298.00

20
50
36

56,250.00
4, 750.00
9, 600.00

100
4
17

4, 548.00

38, 899.00
150.00
47,886. 00

15
P)
46

27,917.00
77,930.00

48
70

14,955.00
14,862.50
58,' 221.97
SOI 020. 34
21, 876. 75
51,255.62
3S; 181. 50
3,238.00
54,436.00

100
100
100
82
48
39
7
36

4 665 00
54 668. 88
37,800. 00
19,426. 00
41, 750. 00

41
43
28

103,116.00
19, 200. 00
20,475.00
2i; 852.00

77
33
72
39

25, 800.00
28,800. 00
7) 950 00
29,140.00

21,150.00

100

14,400. 00
28; 000.00
8, 632. 35

6
42
8

204, 719.00
38,078.75
47, 886.00

79
58
46

19
50

Federal-State M aternal and Child-W elfare Services

State

Total esti
mated ex
penditures

223, 716.97
57,833. 60
181,418.00
116,547.41
50,054.41
334,928.00
61, 853.00
163,254.00
49,331. 62
197, 654. 50
308,071.00
90, 574.16
45, 334. 44
241,684. 63
116, 897. 03
173, 679.85
149,290. 38
57,078. 71

202,116. 97
36, 203.35
74,998.00
78,897.41
14, 764.16
334,928.00
60,853.00
128,222. 00
40, 586. 82
31,722. 50
154,022.00
40, 584.16
25,817.17
123,068.13
42,157. 79
53,472.85
141,290. 38
26, 348. 71

90
63
41
68
29
100
98
79
82
16
50
45
57
51
36
31
95
46

21,600.00
21,630.25
106,420.00
37,650. 00
35,290.25

10
37
59
32
71

1,000.00
35,032.00
8, 744. 80
165,932.00
154,049.00
49,990.00
19, 517.27
118,616. 50
74,739.24
120,207. 50
8,000.00
30,725. 00

2
21
18
84
50
55
43
49
64
69
5
54

1Less than 1 percent.

85.861. 75
5.050.00
12.990.00
39.750.00
5,026. 66
178,828.00
27.070.00
25,000.00
12.270.00
9,412. 50
27.032.00
13,690. 55
13.800.00
71.690.00
5.886.00
10.095.00
70,781. 50
7,623.33

42
14
17
50
34
53
44
19
30
30
18
34
53
58
14
19
50
29.

116,252.22
31,153. 35
62,008.00
39,147.41
9,737. 50
156,100. 00
38, 783.00
103,222.00
28,316. 82
22,310.00
126,990.00
26,893. 61
12,017.17
51,378.13
36,272.79
43,377. 35
70, 508. 88
18, 725. 38

58
86
83
50
66
47
56
81
70
70
82
66
47
42
86
81
50
71

150.00
8, 913.00
8, 525.00

1
9
23

2,452.4Ó
34,780.00
21, 638.00
23,795.00
700.00
34, 560. 30

28
21
14
48
4
29

11,050.00

6,751.67

56-month budget.

15, 702. 50
63,187.00

72
59

17, 586. 50

1,000.00
35,032.00

100
100

56,942.00
68,811.00

34
45

43,466.20
50,379.24
62| 402. 50

87
67
52

21, 600. 00
5i 777.75
34,370.00
29,125.00
17,703. 75

100
27
32
77
50

6, 292.40
74,260.00
63, 600.00
26,195.00
18; 817.27
40; 590. 00
24 360 00
4e; 75 5 .0 0
8,000 00
23; 9 7 3 .3 3

72
45
41
52
96
34
33
39
100
78

Preliminary S u m m ary — .

North Carolina.
North Dakota..
Ohio_________
Oklahoma____
Oregon2______
Pennsylvania..
Rhode Islan d..
South Carolina.
South Dakota...
Tennessee____
Texas________
Utah_________
Vermont______
Virginia______
Washington___
West Virginia..
Wisconsin____
Wyoming_____

'o
u>

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Federal-State M aternal and Child-W elfare Services

Thirty-five State health agencies included in their 1937 budgets
funds for the payment of local practicing physicians on a part-time
basis for conducting prenatal or child-health conferences. This has
meant during the current year a considerable extension of these
conference services into towns and rural areas where they did not
exist before and has insured the participation of a large number of
physicians in the maternal and child-health program. Many States
and communities now recognize that the payment of physicians for
this type of service is as important in rural areas as it is in cities,
where this plan has long been followed.
In 28 States a total of 54 dentists were employed on the State staff,
as well as 38 dental hygienists and 4 dental-health instructors. There
is a growing tendency toward the employment of dentists on the
staff of the State health agency, either in the division of maternal
and child health or in a coordinate dental-hygiene division.
The State health officers again recognized in the 1937 State plans
the basic importance o f the service rendered by the public-health
nurse in the maternal and child-health program. The State agencies
are encouraging the employment of public-health nurses, usually
with the county or the local governmental unit bearing a considerable
proportion of the cost. Nursing service at time of delivery was
planned in 21 States. Nurses participating in such service have
special training and experience in obstetric nursing. Maternity
nursing institutes have been held in four States. Many nurses have
been awarded stipends enabling them to study public-health nursing
and also maternity nursing. Plans are being made to develop further
facilities for courses in maternity nursing, combining experience in
hospital- and home-delivery service. Effort is being directed toward
the inclusion o f preparation for service to infants during the neonatal
period. Continuous supervisory service through the preschool period
is being encouraged, so that upon entering school the child’s physical
defects will have been corrected. The content of school nursing
service is receiving attention in many of the States.
There has been a distinct advance in the employment o f nutrition
ists by State health agencies. Under the 1937 State plans 12 State
health agencies employed a total of 23 nutritionists, of whom 20 are
attached to maternal and child-health divisions.
Seven State health agencies employed health educators— a total
of 11.
Forty-one States conducted postgraduate courses in obstetrics or
pediatrics for local physicians during the fiscal year ended June
30, 1937. As instructors for such courses, the State agencies are
taking great care to obtain obstetricians and pediatricians who are
qualified to teach local general practitioners and to discuss their
problems. Eight States had a total of 12 such instructors as full-time

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employees on the staff of the maternal and child-health division; 14
States engaged lecturers residing in their own State only; 13 States
engaged out-of-State lecturers only; 6 States engaged both local and
out-of-State lecturers. Such instructors are available at the request
of local medical societies for consultation and demonstration clinics.
The State agencies are receiving many requests for the extension and
improvement o f the program for postgraduate instruction o f physicians.
Reporting to the Children’s Bureau by the State agencies o f current
statistics o f maternal and child-health activities began with the
quarter July 1 to October 31,1936. (See p. 38.) Some State agencies
could not send in complete reports at the start because it was necessary
to readjust the local reporting systems in order to obtain data in the
form requested. It was expected that by July 1, 1937, every State
would be in a position to assemble and send in comparable data
on maternal and child-health activities.
For the first year State reports were requested only from areas where
Federal maternal and child-health funds were being expended. For
the fiscal year beginning July 1, 1937, reports are to be requested
covering all local areas, with the intention o f securing as soon as
possible complete reports of maternal and child-health activities for
each State. Separate entries will be requested for the areas in which
the State health agency is conducting maternal and child-health
demonstration services.
In January 1937 a 2-day conference was held at the Children’s
Bureau, with representatives of State health agencies present, to
discuss medical and nursing record forms for maternal and child-health
services. Subsequently the Children’s Bureau prepared tentative
forms for maternity-service records and for infant and preschool-serv
ice records. These were sent to the State agencies for comment.
When the final form for each record is agreed upon copies will be
printed for optional use in the States.
One outstanding fact revealed by the experience of the first year of
operation o f the maternal and child-health program is that although
there has been marked extension o f child-health and prenatal services,
the State agencies have not been able with the funds available to pro
vide to any extent for better care of the mother and infant at the time
of birth. A number of State agencies have inquired as to the feasi
bility of including in their State plans provision for paying local
physicians, on a case basis, to provide obstetric and pediatric care or
consultation service for patients otherwise unable to obtain such serv
ice. The costs of such service and the funds so far available for the
whole program have made it apparent that such expenditure can be
undertaken only in a few small areas. The year’s experience has made
it increasingly evident, however, that there is urgent need in many
areas for the provision of more adequate maternal care, including pre
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natal, natal, and postnatal care and care of newborn infants, byqualified local physicians, assisted by public-health nurses with special
training. Inability to obtain such care is due to many factors, among
them low economic status of the family, distance from physicians and
hospitals, poor transportation facilities, and the inadequate under
graduate and graduate obstetric training of many practicing physicians.
In recognition of this need the general advisory committee on ma
ternal and child-welfare services (Apr. 7 and 8, 1937) made recom
mendations to the Chief of the Children’s Bureau and the Secretary of
Labor proposing the extension of the maternal and child-health pro
gram under the Social Security Act by the provision of public funds
to make available (1) increased and improved maternity care and care
of the newborn and (2) training in these fields for physicians and nurses.
The recommendations proposed provision of resources for: (1) Ma
ternal care, to be given locally by qualified general practitioners and
public-health nurses to women who could not otherwise obtain such
care, (2) expert obstetric and pediatric consultation service to aid
general practitioners in areas where such service is not otherwise
available, and (3) delivery care in hospitals for women who because of
medical, social, or economic reasons should be so cared for. In the
development of such an extended program the committee recognized
the right of the patient to select her own physician. The recommenda
tions proposed also the establishment of centers of postgraduate edu
cation to teach urban and rural physicians and nurses the principles
of complete maternal and infant care.
Similar recommendations were approved by the conference of State
and Territorial health officers April 9, 1937, in adopting a joint report
of its committee on maternal and child health and the child-hygiene
committee o f the Conference of State and Provincial Health Authori
ties of North America. This report also included a recommendation
that the Children’s Bureau send a questionnaire to the States on
present facilities and resources for maternal and child health.
Services for Crippled Children.

For the fiscal year ended June 30, 1937, State plans for services for
crippled children were approved for 42 States, Alaska, Hawaii, and
the District of Columbia. (For States receiving grants see fig. 2 and
table 8.)
Every State has designated an official agency for administering
these services. The question o f what State agency was best equipped
to conduct them was considered by 1937 legislatures in many States,
and in some the services were transferred from one agency to another.
In Maryland the responsibility for the services was transferred from
the board of State aid and charities to the State department of health,

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T A B L E 8.— Federal Junds available to States, Federal funds budgeted b y

States, and p a y m e n ts to States, for services for crippled children under
the Social Security A ct, title V, part 2, fiscal year ended June 30, 1937
Federal funds available for payment of half the total expend
itures under approved State plans

Allotment for fiscal year 1937 3

Siate i
Total

Balance
available
from allot
ment for
fiscal year
19361

Total

Total______ ... 83,627,675.98 $678,615.47 1$2,849,060.51
Alabama_________
Alaska___________
Arizona__________
Arkansas_________
California_________
Colorado__________
Connecticut_______
Delaware_________
District of Columbia
Florida___________
Georgia___________
Hawaii________, __
Idabo_____________
Illinois____________
Indiana__________
Iowa_____________
Kansas___________
Kentucky_________
Louisiana_________
Maine____________
Maryland_________
Massachusetts____
Michigan_________
Minnesota________
Missippi..________
Missouri__________
Montana__________
Nebraska_________
Nevada___________
N ew Hampshire___
New Jersey_______
New Mexico_______
New York_________
North Carolina_____
North Dakota_____
Ohio______________
Oklahoma________
Oregon___________
Pennsylvania_____
Rhode Island______
South Carolina_____
South Dakota______
Tennessee________
Texas_____________
Utah______________
Vermont__________
Virginia___________
Washington____ __
West Virginia_____
Wisconsin________
Wyomihg_________

70,676.57
28,915. 51
35.328.18
64.210.46
100,799.08
61.698.04
53.476.46
31,956.98
34.216.74
57.500.00
85,412.32
35,436. 56
34,642.70
141,239.94
78.349. 38
67,390.97
48,998.96
83,620.26
67,469.13
40,000.00
54,022. 09
84.676.00
100,284.49
95.161.00
65.997.05
67,970.44
32,735.95
59,355. 55
29, 555.22
35,262.65
115,715. 35
33.244.00
180,160. 50
98.118.00
41.393.19
164,120. 80
61.825.00
41,787. 84
189,243.24
37,703.91
57.251.74
40,005.28
76,026. 55
152,730. 02
37,720. 81
31.082.46
77, 550.00
67.196.47
83.672.00
62.350. 65
32,419. 99

13, 580. 53
8,252.28
9,855. 78
18,878.95
28,982.46
12.435.19
15, 723.11
9,396. 31
10,060.69

6.01
25,112.37
10,419.32
8,975.82
41, 525.89
23,035.84
19.814.03
7, 539.74
1,309.39
19,837.01
6,295. 86
15,883. 53
15,953. 47
284.49
6,163. Cl
18,035. 27
8.684.17
6,476.47
23.191.63
8.690.18
10.368.19
21, 210.11
6, 530.45
33,104.00
18, 554.72
12,170. 59
5,419.04
20. 90
12,286. 62
55.639.03
10,092. 32
10,973.29
11.229.20
21.772.63
10,764. 72
7,104. 23
4,252. 75
12,123. 98
1,924.03
8,903.45
9, 772.92

57.096.04
20.663.23
25,472.40
45,331. 51
71,816.62
49,262.85
37,753.35
22, 560. 67
24.156.05
57,493.99
60,299.95
25.017.24
25,666. 88
99.714.05
55,313. 54
47, 576.94
41.459.22
82,310.87
47,632.12
33,704. 64
38,138. 56
68,722. 53

100,000. 00
88,997. 99
47,961. 78
59,286.27
26.259.48
36,163.92
20,865.04
24,894.46
94, 505.24
26,713. 55
147,056. 50
79, 563.28
29,222. 60
158,701.76
61,804.10
29, 501.22
183,604.21
27,611. 59
46,278.45
28,776.08
54,253. 92
152,730.02
26,955. 59
23.978.23
73.297.25
55.072.49
81,747. 97
53,447.20
22,647.07

Allotment
on basis of
need after
number of
crippled
Uniform children in
allotment need of care
and costs of
service are
taken into
considera
tion

$1,020,000 $1,829,060.51
20,000

20,000

20,000
20,000
20,000
20,000
20,000
20,000

20,000

20,000
20,000
20,000
20,000

37.096.04
663.23
5,472.40
25,331. 51
51,816. 62
29,262. 85
17,753. 35
2, 560. 67
4,156.05
37.493.99
40,299.95
5,017.24
5,666.88
79.714.05
35,313. 54
27, 576.94
21,459.22
62,310. 87
27,632.12
13,704. 64
18,138. 56
48,722. 53
80,000.00
68.997.99
27,961. 78
39,286.27
6,259.48
16,163. 92
865. 04
4,894.46
74.505.24
6,713. 55
127,056. 50
59, 563.28
9,222. 60
138,701. 76
41,804.10
9, 501. 22
113,604. 21
7,611. 59
26,278.45
8,776.08
84,253.92
132, 730. 02
6,955. 59
3,978.23
53.297.25
35,072.49
61,747.97
33,447.20
2,647.07

Federal
funds
budgeted
in State
plans as
approved

Payment

2,681,350.92 $2,011,606.04
45,091.21
3, 500.00
34,461.00

37,442. 61
2,115. 62
21,662. 74

88,920. 57
61, 500.00

33,731. 23
48, 794. 60

25,000.00
57, 500,00
4,993. 75
19, 724.16
30,124. 84
112, 880.00
68, 500.00
58,776.94
36,810.00
83,310.87

663. 32
57,494. 66
4,993'. 75
15, 816.03
18,216. 52
4,900.00
26,411.65
58,778. 94
36,810. 00
82,267.04

40.000.
39.000.
84.676.00
100,284.48
95.161.00
15,246.89
62.314.00
22,309. 77
46,163.92

0025,465. 72
0036,033. 56
61, 591. 71
99,999. 99
95,161. 00
12,606.40
53,629. 83
18,869.93
16, 552. 38

4,000.00
115, 715.35
33.244.00
103,942.72
93.118.00
11,728.44
164,120. 80
61.825.00

2, 500.00
86, 711. 66
27,089.28
74,162.72
72,789. 71
11,728.44
158,701. 76
61,825.00

189,243.21
6, 592. 62
37.863.00
40,005.28
63,104.42
152,730.02
87,038.19
16,000.00
77, 550.00
67,196.47
83.672.00
58.412.00
23,000. 00

106,609.05
5,000.00
37,863. 00
26, 551.77
21,947. 75
152,717.75
29,999.99
12.217.40
73,297.33
43.923.40
80,330.10
49, 508. 55
6,124.15

1 The term “ State” includes Alaska, Hawaii, and the District of Columbia.
a Includes remainder of 1936 allotment in the Treasury of the United States and unexpended balance of
Federal funds in State treasury June 30, 1936.
3 T1\e amount allotted to any State remaining unpaid at the end of each fiscal year is available for payment
to such State until the end of the second succeeding fiscal year.
* Of $2,850,000 authorized for allotment, $939.49 was not allotted.

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Federal-Stat& IMiaternal and Child-W elfare Services

Figure 2.— Services for crippled children; States receiving Federal grants

as authorized b y the Social S ecu rity A ct, title V, part 2, fiscal years 1936
and 1937
Fiscal year ended June 30, 1936

Fiscal year ended June 3 0 , 1937

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and in Tennessee the State commission for crippled children’s service
was placed under the supervision of the State department of public
health. In Arizona, Washington, and West Virginia new depart
ments of public welfare, public assistance, or social security were
created, which took over the functions o f the old departments of
welfare, including services for crippled children. Summary o f State
plans in operation June 1, 1937, showed the program administered in
19 States by the department of health; in 13, by the department of
welfare; in 7, by a crippled children’s commission; in 4, by the depart
ment o f education; in 1, by a university hospital; and in 1, by an
interdepartmental committee.1
Of the total amount of funds for services for crippled children
budgeted in the State plans, 44 percent were State public funds, 15
percent were local public funds, 1 percent was private funds made
fully available for public use, and 40 percent were Federal funds
(see table 9).
In several States laws passed in 1937 defined more clearly the
responsibilities o f the State agency for services for crippled children.
Thirty-six States have sent in preliminary reports showing the number
of crippled children on the State register, and the number of crippled
children thus registered totaled nearly 100,000 on June 30, 1937.
Other States planned to report after the names on their registers had
been compared with names on other records. The Children’s Bureau
has prepared an outline for recording the types of crippling conditions,
based on the Standard Classified Nomenclature of Disease.2 The
use of this outline by the State agencies should contribute to the
obtaining of more definite and comparable information on the incidence
o f the various types of crippling conditions. A form for use in the
State registration of crippled children is being prepared and will be
issued for optional use in the States.
The State plans for the fiscal year 1937 and preliminary reports
show an increase in the total number o f diagnostic clinics held and in
the number of such clinics held in areas not previously served, and
1 Laws have been enacted, which will be in effect by July 1, 1937, authorizing
transfer o f the responsibility for services for crippled children as follows: Georgia,
responsibility transferred from State department o f public health to State depart
ment of public welfare; M ontana, State orthopedic commission abolished and
responsibility transferred to State department o f public welfare; South Dakota,
responsibility transferred from State public-welfare commission to State board
o f health.
In the six States whose plans had not been approved by June 1, 1937, the crip
pled children’s agency has been designated as follows: Connecticut, Delaware,
Louisiana, Nevada, State department o f health; Arkansas and Oregon, State
department o f public welfare.
2 Standard Classified Nomenclature of Disease.
Commonwealth Fund, New York, 1935. 870 pp.

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Edited by H . B . Logie, M . D .

T A B L E 9.

E stim ated expenditure for services for crippled children under the Social S ecu rity A ct, title V, part 2, as show n
in budgets included in approved State plans for the fiscal year ended June 30, 1937

State and local funds
Federal funds

Total estimated
expenditures

Total

Amount

Total________

$3,954,376.15

90,182.42
7,000.00
68,923.00
171.292.14
123.000.
00
50.000. 00
140.000. 00
9,987. 50
39,448.33
60,443. 59
225.760.00
150.349.15
146, 274.23
313,310. 76
166,621.74
80.000. 00
78.000. 00
169, 588.00
200, 568. 96
298.456.00
29,250. 00
119,628. 00
46,919. 57
93,038. 72

8,000.00

Percent

Amount

Percent

.Amount

Percent

Amount

Percent

$2,908,420.45

$988, 477.22

$57,478.48

$2,642,910. 53

50
50
50
50
50
50
64
50
50
50
50
54
60
88
50
50
50
50
50
70
50
50
52
50
50
51
50
73
53
50

19,774.90
3, 500. 00
34,462. 00
9,266. 07
61, 500. 00
25,000. 00
90,000. 00
993. 75
19,724.17
30,318. 75
112, 880. 00
8,000. 00
87,497. 29
5,000. 00
83,310. 87
40,000. 00
39,000.00
84,912. 00
100, 284. 48
208, 295. 00
5,000. 00
59, 814.00
24,609. 80
46, 874. 80
4,000. 00
20,000. 00
80,000. 00
284, 720. 00
103, 732.00
11, 728. 44

22
50
50
5
50
50
64
10
50
50
50
5
60
2
50
50
50
50
50
70
17
50
52
50
50
8
50
73
52
50

1,250.00

24,066.31

76,380.00

4, 000. 00

9,625.00

45,091.21
3, 500. 00
34,461. 00
85, 646. 07
61, 500. 00
25,000. 00
50,000. 00
4,993. 75
19, 724.16
30,124. 84
112, 880. 00
68, 500. 00
58, 776. 94
36, 810. 00
83,310. 87
40,000. 00
39,000. 00
84,676. 00
100, 284. 48
90,161. 00
14,625.00
59, 814. 00
22, 309. 77
46,163. 92
4, 000. 00
115,715. 35
30,000. 00
103, 942. 72
95,118. 00
11,728.44

50
50
50
50
50
50
36
50
50
50
50
46
40
12
50
50
50
50
50
30
50
50
48
50
50
49
50
27
47
50

73, 849.15

271, 500. 76

97, 550.00
2,005. 00

41
1

C
G

287, 705. 85
60.000. 00
388, 662. 72
200, 855.00
23,456. 88

45,091.21
3, 500.00
34,462. 00
85,646.07
61, 500.00
25,000.00
90,000. 00
4,993. 75
19,724.17
30,318.75
112,880. 00
81,849.15
87,497.29
276, 500.76
83,310.87
40,000.00
39,000.00
84,912.00
100,284. 48
208,295.00
14,625.00
59,814.00
24,609. 80
46,874. 80
4,000.00
121,990.00
30,000. 00
284,720.00
105,737.00
11,728.44

Amount

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$6, 597,236.68

Percent

Private funds in public
treasury

Local public

Alabama__________
Alaska____________
Arizona___________
California_________
Colorado___ ____ _
District of Columbia.
Florida____________
Georgia2__________
Hawaii____________
Idaho_____________
Illinois____________
Indiana___________
Iowa______________
Kansas____________
Kentucky_________
Maine______ ______
Maryland........ .........
Massachusetts_____
Michigan__________
Minnesota_________
Mississippi________
Missouri__________
Montana___________
Nebraska_________
New Hampshire___
New Jersey________
New Mexico_______
New York_________
North Carolina_____
North Dakota3 ____

State public

Federal-State M aternal and Child-W elfare

State i

<J>

•'S

740, 894. 80
200.825.00
424,043.21
13,185.24
75,726.00
80,118.08
126,208.84
305,460.12
74,076.39
32.000. 00
148, 500.00
134,392. 94
170.742.00
228.392.00
46.000.

581.774.00
144.000. 00
234.800.00
6,592.62
37.863.00
40,112. 80
63,104.42
152,730.10
37,038.20
16,000. 00
74.250.00
67,196.47
87,070. 00
169,980. 00
23.000. 00

1 The term “ State,” includes Alaska, Hawaii, and the District of Columbia.

224,100. 00
144.000. 00
234,800.00
6, 592.62

20.000.00

89,365.63
31,099.11
152,730.10
37,038.20
16,000.00
64,250.00
67,196.47
87,070. 00
106,980. 00
23,000.00

357,074. 00

600.00

13, 863.00

4,000.00
747.17

5
1

32,005.31

10,000.00

63,000.00

s Estimate for 3 months.

3 Estimate for 9 months.

159,120. 80
56, 825.00
189,243.21
6, 592. 62
37,863.00
40,005. 28
6 3 ,1C4.42
152,730. 02
37,038. 19
16,000.00
74,250. 00
67,196.47
83, 672.00
58,412. 00
23,000.00

4 Less than 1 percent.

Preliminary S u m m ary— 1937

Ohio__________
Oklahoma____
Pennsylvania..
Rhode Island..
South Carolina
South Dakota..
Tennessee____
Texas_________
Utah__________
Vermont.........
Virginia_______
Washington___
West Virginia..
Wisconsin____
Wyoming_____

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indicate effort to provide services on a State-wide basis. There is a
tendency for clinics to be used not only for diagnostic service but also
for reexamination o f children needing continued medical supervision
and for certain treatments such as physical therapy, application of
casts, and adjustment of braces.
Additional State, Federal, and private funds were made available in
Tennessee, Mississippi, Virginia, and Alabama, in the summer and
fall o f 1936, by means o f which immediate examination and treatment
could be given to children who were stricken during the poliomyelitis
epidemic. These special projects were organized to provide as quickly
as possible special diagnostic services, physical therapy, and nursing
care for these children. Orthopedic surgeons examined the children,
and public-health nurses with physical-therapy training visited them
in their own homes to carry out the instructions o f the surgeon.
Hospitalization was provided for special cases that could not be treated
in the child’s own home. Appliances were provided by the official State
agency. These projects demonstrate the value of immediate diagnosis
and treatment in the prevention o f crippling following poliomyelitis.
During the epidemic the United States Public Health Service
conducted a demonstration o f preventive measures in these areas.
Current reports continue to show that the majority of children
accepted for care by the State agencies are those needing orthopedic
or plastic surgery or physical therapy. More complete figures on
the number of children affected by each type o f crippling condition
are needed before policies can be formulated in regard to increase or
decrease in services.
The recommendations of the advisory committee on services for
crippled children and of the State and Territorial health officers have
been of great value to the State agencies in establishing and main
taining adequate standards for medical and hospital care. During
the year there has been a decided increase in the number of hospitals
approved by official agencies, with a resulting decentralization of
hospital care. The approval of hospitals located in different parts of
the State makes it possible to provide hospital service nearer the child’s
own home.
Hospital charges have been under continuous review by the State
agencies during the year, and revisions in charges have been made in
the light of experience. It has been possible in many instances to
arrange, in a manner acceptable to the professional groups involved,
for payment on a flat-rate basis, to cover the cost of all hospital
services except surgeons’ fees and the cost of appliances. Further
revisions will undoubtedly be made as longer experience shows more
clearly the factors involved, such as the types of cases referred for
treatment, the actual cost of ward care, and the financial responsi
bility assumed by the hospital.

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Preliminary S u m m ary— 1937

The Children s Bureau has started a study of the admission proce
dures and discharge policies of hospitals and institutions where
crippled children are given convalescent care, which will provide
information to be used in later studies.
Charges involving payments for professional services are also under
going continuous study and revision by the State agencies in consul
tation with technical advisory groups. In adjusting such charges
consideration is given on the one hand to the types o f cases referred
for treatment, the responsibility involved, and the requirements as
to professional certification, and on the other hand to the State’s
responsibility for the efficient administration o f limited public funds
intended to provide care for large numbers of crippled children whose
parents cannot afford to pay for needed services.
The recommendations of the advisory committee on services for
crippled children and of the State and Territorial health officers have
also been o f great value in the organization o f the State agencies and
in tbe selection of qualified staff. The necessity for medical direction
is increasingly recognized as indispensable for the development o f a
well-balanced program and for the safeguarding of the quality of
service to be given. When the State agency is not directed by a
physician, the need for providing active medical assistance on the
technical phases o f the program is evident.
Administrative officials realize that the conduct of these services
requires technically qualified persons— the physician, the orthopedic
surgeon, the nurse, the medical social worker, and the physical thera
pist. With a wide variety of administrative agencies, it has been
interesting to see the methods by which effective working relationsre established among the different types of workers in the
program. As the State plans have been put into practice during the
year and as services have been extended, the role o f each type of
worker in the program has become more clearly defined.
The year s experience has also clarified the relationship of the socialsecurity program to the programs of other agencies and organiza
tions engaged in services for crippled children.
State agencies are recognizing that local services are extended most
satisfactorily through a system by which maximum advantage is
taken o f the services of local public-health nurses and local social
workers. The State crippled children’s agencies are offering such
local workers consultation service and staff education through State
and district workers with special orthopedic training. The local
workers throughout the State thereby become better equipped to give
service to crippled children before and after surgical and hospital care.
A system of reporting the services rendered to crippled children,
the number o f such children on State registers was put into
operation for the quarter July 1 to September 30, 1930, (See p. 4L)

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Federal-State M aternal and Child-W elfare Services

The fact that some States had had no central reporting system and
that the program of services was being rapidly extended made it
difficult to get complete data at the start. Reports so far sent in
indicate that there will be available in the near future more reliable
information concerning the numbers of crippled children and the
services being provided for their care than has ever previously been
assembled in the United States.
In certain States the State agency was able to report during this
period only on the services for crippled children for which it was ad
ministratively responsible. If services provided in close relationship
with the State program but not administered by the State agency had
been included (as is being done to an increasing extent through coop
erative reporting arrangements) a much larger volume of service would
have been shown than in these first reports from the States.
The Children’s Bureau advisory committee on services for crippled
children held its second meeting with the Children’s Bureau October
9 and 10, 1936.
This committee recommended that children whose chief disability
is incurable blindness, deafness, or mental defect or whose abnormali
ties require permanent custodial care should be considered beyond the
scope o f the program.
With regard to administration the committee recommended (1)
that the program should be extended to all persons up to 21 years
of age who are found to be in need of such service and who are unable
to obtain it otherwise (where statutory provision to include all crippled
children up to 21 years of age is necessary, the committee urged that
action be taken), (2) that after the first year of operation each official
State agency should have on its staff at least a full-time administrator
with proper clerical assistance, and (3) that agreements should be
worked out between States to insure the use of public funds for the
care of crippled children regardless of the duration of their residence
in a State.
With regard to professional standards the committee recommended
(1) that State agencies should use orthopedic surgeons and other
specialists certified by the national boards conducting examinations
for certification in the respective specialties, (2) that standards recom
mended for physical therapists and medical social workers by their
respective national organizations should be used, and (3) that the Na
tional Organization for Public Health Nursing should be requested
to submit recommendations for qualifications for nurses taking part
in the program.
The committee submitted minimum standards for hospital care of
crippled children and suggested that the State agencies endeavor to
obtain from each hospital a flat rate to include all necessary services
with the exception of surgeons’ fees and appliances,

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Preliminary S u m m ary— 1937

At its third meeting, April 7, 1937, the advisory committee on
services for crippled children reaffirmed and amplified its previous
recommendations concerning the qualifications o f surgeons and other
trained personnel, recognizing at the same time the difficulties that
confront State agencies in obtaining competent personnel for sparsely
settled areas. The committee recommended that the State agencies
in reporting crippling conditions use the classification o f types of
crippling prepared by the Children’s Bureau (see p. 83). The
committee reviewed and approved the preliminary studies made by
the Children’s Bureau concerning fee schedules, hospital rates, and
other charges, and made suggestions as to future studies.
Child-Welfare Services.

For the fiscal year ended June 30, 1937, State plans for child-welfare
services were approved for 44 States and the District o f Columbia.
(For States receiving grants see fig. 3 and table 10.)3
Progress reports received from the States as o f December 31, 1936,
showed that Federal funds for child-welfare services were providing all
or part o f the salaries o f 170 professional and 47 clerical workers on
State welfare department staffs and of 242 social workers and 9
clerical workers assigned to local demonstration units or to districts
in which some case-work service was being given under direct State
supervision.
One hundred and twenty-two counties in 21 States had 124 childwelfare workers working directly under local boards or welfare officials.
In 11 other States 67 workers under State supervision had been assigned
to 106 counties. In 3 New England States, 7 workers had been
placed in 6 rural areas including 111 towns. In areas where local work
was in process o f organization, 44 State workers were doing some case
work in 370 counties as a part o f the process o f developing local childwelfare programs.
As a result o f the Federal-State program, therefore, services were
being rendered to children in 598 counties and in 6 rural New England
areas, or in approximately one-fifth o f the counties o f the United
States. The areas selected were all predominantly rural.
„ I * * States and Territories did not receive Federal grants for child-welfare services in either 199«nrlMr
S? flal Secui'lty -fct th? following amounts are available annually to these States when State pipns
for child-welfare services have been developed and approved.
P S

State or Territory
Alaska_____
Hawaii_________
Mississippi________
Rhode Island__ _
South Carolina_____
Wyoming_______

7424°— 38------ 7

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Total

$10,942.31
13,121. 55
40,610. 62
10,953. 84
35,054. 71
12, 848. 03

Uniform allot
ment
$10,000
10,000
10,000
10,000
10,000
10,000

Allotment on
basis of ratio
of rural popu
lation of State
to total rural
$942.31
3,121. 55
30,610.62
953.84
25,054.71
2,848. 03

Federal-State M aternal and Child-W elfare Services

F igu re 3.— Child-welfare s e r v ic e s ; States receiving Federal grants as au

thorized b y the Social Security A ct, title V, part 3, fiscal years 1936
^

Fiscal year ended June 30, 1936

Fiscal year ended June 30, 1937

|alaska|
¡HAWAII |

J | m

STATES RECEIVING FEDERAL GRANTS

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Preliminary S u m m a ry— 1937

T A B L E 1 0 .— Federal funds available to States, Federal funds bu d geted

b y States, and p a y m e n ts to S tates, for child-welfare services under
the Social Security A ct, title V, part 3, fiscal yea r ended June 30, 1937
Federal funds available for payment of part of cost of local
services and for development of State services
Allotment for fiscal year 1937 3
State1
Total

Total_________
Alabama__________
Arizona___________
Arkansas________ ...
California__________
Colorado___________
Connecticut_____ __
Delaware____ ;_____
Dist. of Columbia___
Florida____________
Georgia____________
Idaho_____________
Illinois____________
Indiana___________
Iowa______________
Kansas____________
Kentucky__________
Louisiana__________
Maine_____________
Maryland____ _____
Massachusetts_____
Michigan__________
Minnesota_________
M issouri-.__________

Montana___________
Nebraska___________

Nevada___ ________
New Hampshire.....
New Jersey____ ___
New Mexico_______
New York_________
North Carolina_____
North Dakota______
Ohio___ *»_________
Oklahoma_________
Oregon____________
Pennsylvania______
South Dakota______
Tennessee_________
Texas_____________
Utah________________

Vermont___________
Virginia___________
Washington________
West Virginia______
Wisconsin_________

Balance
available
from al
lotment
for fiscal
year 19369

Total

Federal
funds bud
geted in
Allotment State
plans
on basis
as apof ratio of
proved
Uniform rural popallotment lation in
State to
total rural
population

Payment

,699,485.82 $323,028.86 *$1,376,456.86 $450,000.00 $926,456.96 $1,534,780.15 $969, 827.23
55,526. 94
19,905. 83
36.958.41
53,526.91
19,450.97
18,703. 99
16.817.22
14,166.67
81,873. 60
46,876. 53
18,644. 37
46, 545.00
36,427.29
87,325. 57
39,243. 84
43.259.42
46.233.77
25,883.13
30,479.06
24,299.46
51,235.70
44,128.45
55,638.93
23,055. 83
36.612.12
15, 592.39
15.280.13
32,082.31
16.407.77
47,849.27
72,122.96
20,385.00
69.572.22
54,079.99
26,187.88
93.404.03
26,424.39
41, 509.13
98,462. 80
17,406.76
18,963.16
52,608.10
23.747.04
39,926. 54
44,654. 94

10,684.53
4,871.76
15,743.21
4,706.24
4,166.67
8,895.77
2,884.24

8,155.57
13,004.08
7,164.77
8,449. 72
6,638.65
13,019.76
10,197. 68
13,209.64
6, 523. 80
10,274.15
4,555.64
1,758.95
9,220.68
609.77
18,882.11
20,381.77
15,239.00
7,687.11
26,654. 52
6,130.14
25,530.09
2,981.18
4, 551.11
12,632.36
1.311.02
7.253.02
9,280.05

44.842.41
15,234.07
36.958.41
37.783.70
19.450.97
18,703.99
12.110.98
10,000.00
22,977. 83
46,876. 63
15,780.13
46, 545.00
86.427.29
37,325. 57
31.088.27
43.259.42
33,229.69
18,718.36
22,029.34
17,660. 81
38,215. 94
33,930. 87
42.429.29
16, 532.03
26,337.97
11,036. 75
13, 521.18
22,861. 63
15,798.00
47.849.27
53,240. 85
20,385. 00
49,190.45
38,840. 79
18,500. 77
66,749. 51
20,294.25
41, 509.13
72.932.71
14,425.58
14,412.05
89,975.74
22,436.02
32,673. 52
35,374.89

10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000. 00
10, 000.00
10, 000. 00
10, 000. 00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000. 00
10, 000.00
10, 000.00
10, 000. 00
10, 000.00
10, 000.00
10, 000. 00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00
10, 000.00

34.842.41
5,234.07
26.958.41
27,783. 70
9.450.97
8,703.99
2.110.98
12,977.83
36,876.53
5,780.13
36, 545.00
26.427.29
27,325. 57
21.088.27
33,259.42
23,229.69
8,718.36
12,029.34
7,660. 81
28,215.94
23,930. 87
32.429.29
6,532.03
16,337.97
1,036.75
3,521.18
12,861. 63
5,798.00
37.849.27
43,240.85
10,385.00
39,190.45
28,840. 79
8,500.77
56,749. 51
10,294.25
31,509.13
62,932.71
5,425. 58
4,412.05
29,975.74
12,436.02
22,673. 52
25,374. 89

55.490.00 41,850.32
5,404. 82
18.789.28
9,311.64
36.958.41
43.520.00 18.140.41
19.450.97 12,974.46
18,703. 99 10.291.26
8, 720. 85
12.110.98
10,000.00
5, 582.26
30.620.00 17,857.15
46,876. 53 33.569.94
18,023.14 15,884.96
46, 545.00 21.620.26
36.427.29 21,192. 36
37,325. 57 23,293.86
39,243.80 28,251.02
43.259.42 30.270.92
46.233.77 35,840.19
20.072.00 13,719. 56
22.940.00 16,333.17
20.320.30 10,174. 55
45.325.00 23,950.99
42, 592.00 29.489.92
55,638.93 43,301.64
23,055.83 16.072.95
33,490. 82 17.216.41
15.200.00 13,131.44
15,280.13 13,868. 59
26.620.00 15.622.41
16.407.77 13,243.62
8,790. 58
8,790. 58
62,681.00 39, 597.04
20.385.00 15,963. 62
54, 560.00 23,643. 52
50,937.49 24,398. 76
26,187. 88 13.716.41
92.690.03 35,162. 64
23.040.00 20,325.80
28,438. 75 28,438. 75
90,758.45 42,438.21
17,197. 50 14,665.36
18.850.00 15,305. 42
43,338. 50 82, 566. 67
23.747.04 22,484. 36
38.805.00 28,437.24
37.852.00 87.710.92

1The term “ State” includes Alaska, Hawaii, and the District of Columbia.
3Includes remainder of 1936 allotment in the Treasury of the United States and unexpended balance of
Federal funds in State treasury June 30,1936.
3 The amount allotted to any State remaining unpaid at the end of each fiscal year is available for payment
to such State until the end of the second succeeding fiscal year.
* Of $1,500,000 available for allotment, $123,543.04 was not allotted.

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Federal-State M aternal and Child-W elfare Services

The State plans for child-welfare services for the fiscal year ending
June 30, 1937, included, on the whole, the objectives set up in the
first set o f State plans for the fiscal year 1936. Based on the situation
in each State, these plans, which were formulated by the Children’s
Bureau and the State public-welfare agencies, were directed toward
better standards of service to children.
Although it was not possible to obtain enough State and local
workers with special training and experience in the child-welfare field
to fill all the new positions created, the State agencies in the majority
o f cases were able to employ persons who had had either training
or experience or both in some phase of social work. Frequent
popular insistence on the employment of legal residents of the
State restricted the selection o f workers on the basis of qualifica
tions. The limited training and experience o f the workers employed
in the child-welfare field made apparent the need for budgeting some
o f the Federal funds for training purposes. Provision for training
under the State plans includes: (1) Educational leave to enable
qualified personnel to attend schools of social work, (2) training on the
jo b through intensive supervision, (3) a few training centers where
students work under a supervisor, and (4) institutes to orient workers
in child welfare.
The scope of the child-welfare services made available has been
appreciably broadened in the local areas where the demonstration
units have been located. The following excerpt from a progress
report gives an account of typical services provided:
In one district, o f 150 children referred for attention during a 6-month
period, family adjustments were made for 32 children; health care was ar
ranged for 28; material assistance was obtained for 3 0 ; the aid o f relatives
was enlisted for 11; 6 were placed in local foster homes; 2 were placed in a
children’s home; and plans are still in process for 54 children.
O f 327 children referred in another district, family and school adjustments
were worked out for 195 children; health care arranged for 28; material
assistance obtained for 115; aid o f relatives enlisted for 24; 6 were placed
in local foster homes; and 106 children remain under continuing supervision.
In a third district, o f 40 children referred, family adjustments were made
for 7 children; 10 were given health care; material assistance was obtained for
6; care b y relatives was arranged for 8 ; 1 was placed in a local foster home;
and 6 were placed in a children’s home. Plans for 22 children were still in
process o f development at the time o f reporting.

There is a definite trend toward a generalized service by publicwelfare workers, State and local, which has affected plans for childwelfare services. In some States a portion of the Federal funds for
child-welfare services is used to pay part o f the salaries o f field staff
workers doing general public-welfare work as well as child-welfare work.
Reports from the State agencies show that the local child-welfare
workers are utilizing all available social resources, public and private.

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Preliminary S u m m a ry— 1937

One of the first tasks of a worker going into a rural community is to
determine the availability of resources. In many places services
offered by organizations in metropolitan centers never reach rural
communities, even though the program of the organization is supposed
to include nonurban regions.
Some of the first cases reported to local workers are those involving
feeble-minded children. The depression years shifted attention and
funds away from the care of the feeble-minded. As services for children
become available in rural communities, there should be renewed inter
est in securing facilities for the care of the feeble-minded. * The
reports clearly indicate the many demands for medical care and cor
rective treatment. In spite of efforts of the child-welfare workers to
search out all resources, many of these needs cannot be met at present.
Many of the States include in their plans for rural child-welfare
services some provision for psychologic and psychiatric services.
In some instances it has been made evident that without basic social
services these more specialized skills cannot be used effectively.
Demonstration services for Negro children were included in the
original plans submitted by North Carolina and Alabama, and these
have been continued. In the Florida training center there is a Negro
worker. The Kentucky State Home for Colored Children is included
in the special institution project incorporated in the Kentucky plan.
A Negro worker has been added to the Delaware staff.
No State submitted an official plan involving the use of Federal
funds for services which had formerly been financed by the State
itself. The Children’s Bureau has consistently held to the principle
that the Federal funds granted to a State are for services which other
wise would not be provided and that in no case are they to be used
in order to enable a State to conserve its own funds. In a number
o f States, however, the amount of Federal funds for child-welfare
services is in excess of the amount of State funds thus far appropriated
for child-welfare work.

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A p p e n d i x 1.— T e x t o f the Sections o f the S o c i a l
Security Act Relating to Grants to States
for Maternal and Child Welfare
Title V.— G RAN TS TO STATES FOR M A TER N AL AN D CH ILD
W ELFARE
Part 1.— M A T E R N A L A N D C H IL D H E A L T H S E R V IC E S
APPROPRIATION

Section 501. For the purpose o f enabling each State to extend and improve,
as far as practicable under the conditions in such State, services for promoting
the health o f mothers and children, especially in rural areas and in areas suffering
from severe economic distress, there is hereby authorized to be appropriated for
each fiscal year, beginning with the fiscal year ending June 30, 1936, the sum o f
$3,800,000. The sums made available under this section shall be used for making
payments to States which have submitted, and had approved by the Chief o f the
Children’s Bureau, State plans for such services.
ALLOTMENTS TO STATES

Sec. 502. (a ) Out o f the sums appropriated pursuant to section 501 for each
fiscal year the Secretary o f Labor shall allot to each State $20,000, and such part
o f $1,800,000 as he finds that the number o f live births in such State bore to the
total number o f live births in the United States, in the latest calendar year for
which the Bureau o f the Census has available statistics.
(b ) Out o f the sums appropriated pursuant to section 501 for each fiscal year
thje Secretary o f Labor shall allot to the States $980,000 (in addition to the allot
ments made under subsection (a )) according to the financial need o f each State
for assistance in carrying out its State plan, as determined by him after taking into
consideration the number o f live births in such State.
(c ) The amount o f any allotment to a State under subsection (a ) for any
fiscal year remaining unpaid to such State at the end o f such fiscal year shall be
available for payment to such State under section 504 until the end o f the second
succeeding fiscal year. N o payment to a State under section 504 shall be made out
o f its allotment for any fiscal year until its allotment for the preceding fiscal year
has been exhausted or has ceased to be available.
APPROVAL OF STATE PLANS

Sec. 503. (a ) A State plan for maternal and child-health services must (1>
provide for financial participation by the State; (2 ) provide for the adminis
tration o f the plan by the State health agency or the supervision o f the administra
tion o f the plan by the State health agency; (3 ) provide such methods o f adminis
tration (other than those relating to selection, tenure o f office, and compensation
o f personnel) as are necessary for the efficient operation o f the plan; (4 ) provide
that the State health agency will make such reports, in such form and containing
such information, as the Secretary o f Labor m ay from time to time require, and
comply with such provisions as he m ay from time to time find necessary to assure
the correctness and verification o f such reports; (5 ) provide for the extension and

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Sections o f Social Security A c t ( Text )

improvement of local maternal and child-health services administered by local
child-health units; (6 ) provide for cooperation with medical, nursing, and welfare
groups and organizations; and (7 ) provide for the development o f demonstration
services in needy areas and among groups in special need.
( b ) The Chief o f the Children’s Bureau shall approve any plan which fulfills
the conditions specified in subsection (a ) and shall thereupon notify the Secretary
of Labor and the State health agency o f his approval.
PAYM ENT TO STATES

Sec. 504. (a ) From the sums appropriated therefor and the allotments available
under section 502 (a ), the Secretary o f the Treasury shall pay to each State
which has an approved plan for maternal and child-health services, for each quar
ter, beginning with the quarter commencing July 1, 1935, an amount, which shall
be used exclusively for carrying out the State plan, equal to one-half o f the total
sum expended during such quarter for carrying out such plan.
(b) The method o f computing and paying such amounts shall be as follows:
(1 ) The Secretary o f Labor shall, prior to the beginning o f each quarter
estimate the amount to be paid to the State for such quarter under the
provisions o f subsection (a ), such estimate to be based on (A) a report filed
by the State containing its estimate o f the total sum to be expended in such
quarter in accordance with the provisions o f such subsection and stating
the amount appropriated or made available by the State and its political
subdivisions for such expenditures in such quarter, and if such amount is
less than one-half o f the total sum o f such estimated expenditures, the
source or sources from which the difference is expected to be derived, and
(B) such investigation as he m ay find necessary.
(2) The Secretary o f Labor shall then certify the amount so estimated by
him to the Secretary o f the Treasury, reduced or increased, as the case m ay
be, by any sum by which the Secretary o f Labor finds that his estimate for
any prior quarter was greater or less than the amount which should have
been paid to the State for such quarter, except to the extent that such sum
has been applied to make the amount certified for any prior quarter greater or
less than the amount estimated by the Secretary o f Labor for such prior
quarter.
(3) The Secretary o f the Treasury shall thereupon, through the Division
o f Disbursement o f the Treasury Department and prior to audit or settle
ment by the General Accounting Office, pay to the State, at the time or times
fixed by the Secretary o f Labor, the amount so certified.
(c ) The Secretary o f Labor shall from time to time certify to the Secretary of
the Treasury the amounts to be paid to the States from the allotments available
under section 502 ( b ), and the Secretary o f the Treasury shall, through the
Division o f Disbursement o f the Treasury Department and prior to audit or
settlement by the General Accounting Office, make payments o f such amounts
from such allotments at the time or times specified by the Secretary o f Labor.
OPERATION OF STATE PLANS

Sec. 505. In the case o f any State plan for maternal and child-health services
which has been approved by the Chief o f the Children’s Bureau, if the Secretary
of Labor, after reasonable notice and opportunity for hearing to the State agency
administering or supervising the administration o f such plan, finds that in the
administration o f the plan there is a failure to comply substantially with any
provision required by section 503 to be included in the plan, he shall notify such
State agency that further payments will not be made to the State until he is

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Federal-State M aternal and Child-W elfare Services

satisfied that there is no longer any such failure to comply. Until he is so satisfied
he shall make no further certification to the Secretary o f the Treasury with respect
to such State.
Part 2.— S E R V IC E S F O R C R IP P L E D C H IL D R E N
APPROPRIATION

Sec. 511. For the purpose o f enabling each State to extend and improve (espe
cially in rural areas and in areas suffering from severe economic distress), as far
as practicable under the conditions in such State, services for locating crippled
children, and for providing medical, surgical, corrective, and other services and
care, and facilities for diagnosis, hospitalization, and aftercare, for children who
are crippled or who are suffering from conditions which lead to crippling, there is
hereby authorized to be appropriated for each fiscal year, beginning with the
fiscal year ending June 30, 1936, the sum o f $2,850,000. The sums made available
under this section shall be used for making payments to States which have sub
mitted, and had approved by the Chief o f the Children’s Bureau, State plans for
such services.
ALLOTMENTS TO STATES

Sec. 512. (a ) Out o f the sums appropriated pursuant to section 511 for each
fiscal year the Secretary o f Labor shall allot to each State $20,000, and the re
mainder to the States according to the need o f each State as determined by him
after taking into consideration the number o f crippled children in such State in
need o f the services referred to in section 511 and the cost o f furnishing such
services to them.
( 6 ) The amount o f any allotment to a State under subsection (a ) for any fiscal
year remaining unpaid to such State at the end o f such fiscal year shall be avail
able for payment to such State under section 514 until the end o f the second suc
ceeding fiscal year. N o payment to a State under section 514 shall be made out
o f its allotment for any fiscal year until its allotment for the preceding fiscal year
has been exhausted or has ceased to be available.
APPROVAL OF STATE PLANS

Sec. 513. (a ) A State plan for services for crippled children must (1) provide
for financial participation by the State; (2 ) provide for the administration o f the
plan by a State agency or the supervision o f the administration o f the plan by a
State agency; (3 ) provide such methods o f administration (other than those relat
ing to selection, tenure o f office, and compensation o f personnel) as are necessary
for the efficient operation o f the plan; (4 ) provide that the State agency will make
such reports, in such form and containing such information, as the Secretary o f
Labor m ay from time to time require, and comply with such provisions as he
m ay from time to time find necessary to assure the correctness and verification of
such reports; (5 ) provide for carrying out the purposes specified in section 511;
and (6 ) provide for cooperation with medical, health, nursing, and welfare groups
and organizations and with any agency in such State charged with administering
State laws providing for vocational rehabilitation o f physically handicapped
children.
( h) The Chief o f the Children’s Bureau shall approve any plan which fulfills
the conditions specified in subsection (a ) and shall thereupon notify the Secretary
o f Labor and the State agency o f his approval.

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Sections o f Social S ecu rity A c t {Text)

PAYM ENT TO STATES

Sec. 514. (a ) From the sums appropriated therefor and the allotments avail
able under section 512, the Secretary o f the Treasury shall pay to each State
which has an approved plan for services for crippled children, for each quarter,
beginning with the quarter commencing July 1, 1935, an amount, which shall be
used exclusively for carrying out the State plan, equal to one-half o f the total
sum expended during such quarter for carrying out such plan.
( b ) The method o f computing and paying such amounts shall be as follows:
(1 ) The Secretary o f Labor shall, prior to the beginning o f each quarter,
estimate the amount to be paid to the State for such quarter under the
provisions o f subsection (a ), such estimate to be based on (A) a report filed
b y the State containing its estimate of the total sum to be expended in such
quarter in accordance with the provisions of such subsection and stating
the amount appropriated or made available by the State and its political
subdivisions for such expenditures in such quarter, and if such amount is
less than one-half o f the total sum o f such estimated expenditures, the source
or sources from which the difference is expected to be derived, and (B) such
investigation as he m ay find necessary.
(2 ) The Secretary o f Labor shall then certify the amount so estimated
b y him to the Secretary o f the Treasury, reduced or increased, as the case
m ay be, by any sum by which the Secretary of Labor finds that his estimate
for any prior quarter was greater or less than the amount which should have
been paid to the State for such quarter, except to the extent that such sum
has been applied to make the amount certified for any prior quarter greater
or less than the amount estimated by the Secretary o f Labor for such prior
quarter.
(3 ) The Secretary o f the Treasury shall thereupon, through the Division
o f Disbursement o f the Treasury Department and prior to audit or settle
ment by the General Accounting Office, pay to the State, at the time or
times fixed by the Secretary o f Labor, the amount so certified.
OPERATION OF STATE PLANS

Sec. 515. In the case o f any State plan for services for crippled children which
has been approved by the Chief o f the Children’s Bureau, if the Secretary of
Labor, after reasonable notice and opportunity for hearing to the State agency
administering or supervising the administration o f such plan, finds that in the
administration o f the plan there is a failure to comply substantially with any
provision required by section 513 to be included in the plan, he shall notify such
State agency that further payments will not be made to the State until he is
satisfied that there is no longer any such failure to comply. Until he is so satis
fied he shall make no further certification to the Secretary o f the Treasury with
respect to such State.
Part 3.— C H IL D -W E L F A R E S E R V IC E S
Sec. 521. (a ) For the purpose o f enabling the United States, through the
Children’s Bureau, to cooperate with State public-welfare agencies in establishing,
extending, and strengthening, especially in predominantly rural areas, publicwelfare services (hereinafter in this section referred to as “ child-welfare services” )
for the protection and care o f homeless, dependent, and neglected children,
and children in danger o f becoming delinquent, there is hereby authorized to be
appropriated for each fiscal year, beginning with the fiscal year ending June 30,
1936, the sum o f $1,500,000. Such amount shall be allotted by the Secretary of
Labor for use by cooperating State public-welfare agencies on the basis o f plans

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Federal-State M aternal and Child-W elfare Services

developed jointly by the State agency and the Children’s Bureau, to each State,
$10,000, and the remainder to each State on the basis o f such plans, not to exceed
such part o f the remainder as the rural population o f such State bears to the
total rural population o f the United States. The amount so allotted shall be
expended for. payment o f part o f the cost o f district, county, or other local childwelfare services in areas predominantly rural, and for developing State services
for the encouragement and assistance o f adequate methods o f community childwelfare organization in areas predominantly rural and other areas o f special need.
The amount o f any allotment to a State under this section for any fiscal year
remaining unpaid to such State at the end o f such fiscal year shall be available
for payment to such State under this section until the end o f the second succeeding
fiscal year. N o payment to a State under this section shall be made out o f its
allotment for any fiscal year until its allotment for the preceding fiscal year has
been exhausted or has ceased to be available.
(b) From the sums appropriated therefor and the allotments available under
subsection (a ) the Secretary o f Labor shall from time to time certify to the
Secretary o f the Treasury the amounts to be paid to the States, and the Secretary
o f the Treasury shall, through the Division o f Disbursement o f the Treasury
Department and prior to audit or settlement by the General Accounting Office,
make payments o f such amounts from such allotments at the time or times
specified by the Secretary o f Labor.
*

♦

Part 5.— A D M IN IS T R A T IO N
Sec. 541. (a ) There is hereby authorized to be appropriated for the fiscal year
ending June 30, 1936, the sum o f $425,000, for all necessary expenses o f the
Children’s Bureau in administering the provisions o f this title, except section 531.
( b ) The Children’s Bureau shall make such studies and investigations as will
promote the efficient administration o f this title, except section 531.
(c ) The Secretary o f Labor shall include in his annual report to Congress a
full account o f the administration o f this title, except section 531.
*

Title X I.— GEN ERAL PROVISIONS
D E F IN IT IO N S
Section 1101. (a ) W hen used in this Act—
(1) The term “ State” (except when used in section 531) includes Alaska,
Hawaii, and the District o f Columbia.
(2 ) The term “ United States” when used in a geographical sense means the
States, Alaska, Hawaii, and the District o f Columbia.

(d) Nothing in this A ct shall be construed as authorizing any Federal official,
agent, or representative, in carrying out any o f the provisions o f this A ct, to take
charge o f any child over the objection o f either o f the parents o f such child, or
o f the person standing in loco parentis to such child.
R U L E S A N D R E G U L A T IO N S
Sec. 1102. The Secretary o f the Treasury, the Secretary o f Labor, and the
Social Security Board, respectively, shall make and publish such rules and
regulations, not inconsistent with this Act, as may be necessary to the efficient
administration o f the functions with which each is charged under this Act.

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--------------------------------------------------------------------------- n - i---------------------------

S E P A R A B IL IT Y

'] | >( /, f ;

Sec. 1103. I f any provision of this A ct, or the application thereof to any
person or circumstance, is held invalid, the remainder of the A ct, and the applica
tion o f such provision to other persons or circumstances shall not be affected
thereby.
R E S E R V A T IO N OF P O W E R
Sec. 1104. The right to alter, amend, or repeal any provision of this Act is
hereby reserved to the Congress.
S H O R T T IT L E
Sec. 1105. This Act may be cited as the “ Social Security A ct.1

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ALABAM A.

ALASKA.

Maternal and Child-Health Services
Title V, Part 1
S tate

D ep artm en t

oí

Public

Health,

James N . Baker, M . D .f State Health
Officer.
Bureau of Hygiene and Nursing, B. F. Aus
tin, M . D ., Director.

Child-Welfare Services
Title V, Part 3

S ta te D ep a rtm en t o f Education, J. A.

State D ep a rtm en t o f Public W elfare,

Keller, Superintendent.
Division of Vocational Education, J. B.
Hobdy, Director.

A. H. Collins, Commissioner. Mrs. Harry
Simon, Administrative Assistant.
Bureau of Child Welfare, Mrs. Judith Hall
Gresham, Director.

Territorial D ep artm en t o f H ealth , W . W . Council, M . D ., Commissioner.

Division for Maternal and Child Health and
Crippled Children, Sonia Cheifetz, M . D .,
Director.

ARIZONA.

S tate Board o f H ealth, Coit Hughes, M . D.

ARKANSAS.

S tate Board o f H ealth, W . B. Grayson,

CALIFORNIA.

Services for Crippled Children
Title V, Part 2

Division of Maternal and Child Health, Jack
B. Eason, M . D ., Director.

Division for Maternal and Child Health and
Crippled Children, Sonia Cheifetz, M . D .,
Director.
State Board o f Social Security and Public W elfare, Lee Garrett, Commissioner.

Division for Crippled Children, Ruth E.
Wendell, Director.

State D ep a rtm en t o f Public W elfare,

Gussie Haynie, Commissioner. _ Mrs. Ruth
Moore Cline, Acting Supervisor, ChildWelfare Services.

M . D ., State Health Officer.
Maternal and Child Health Division, W .
Myers Smith, M . D ., Director.
S tate D ep artm en t o f Public Health, W . M . Dickie, M . D ., Director.

Bureau of Child Hygiene, Ellen S. Stadtmuller, M . D ., Chief.

Ann M . Bracken, Director of Social Service.

_
Bureau of Administration, W . M . Dickie,
M . D ., Director.

State

D ep a rtm en t

o f Social W elfare,

Mrs. Florence L. Turner, Director. Social
Security Program, O. C. Wyman, Ad
ministrator.
Division of Child-Welfare Services, Miley
M . Pope.

COLORADO.

S tate Division o f Public Health, R. L. Cleere, M . D ., Secretary and Executive Officer.
Division of Maternal and Child Health, Vera Division of Crippled Children, Vera H. Jones,
M . D ., Director.
H. Jones, M . D ., Director.

S ta te D ep a rtm en t o f Public W elfare,

CONNECTICUT.

S tate D ep a rtm en t o f H ealth, Stanley H.

State Public W elfare Council, F. C.
Walcott, Commissioner.
Bureau of Child Welfare, Grace M . Hough
ton, Director of Child Care. Mrs. Mary
Buckley, Supervisor, Child-Welfare Serv-

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Osborn, M . D ., Commissioner of Health.
Bureau of Child Hygiene, Martha L. Clifford,
M . D ., Director.

Earl M . Kouns, Director.
Child Welfare Division, Marie C. Smith,
Director.

Federal-Statie M aternal and C hild-W elfare Services

STATE

100

Appendix 2.— State Agencies Administering Services Under Title V, Parts 1, 2, and 3, of
the Social Security Act, June 1937

DELAW ARE.

State

State Board o f H ealth, A. C. Jost, M . D .,

DISTRICT OF COLUMBIA. H ealth D ep artm en t o f the District o f
Colum bia, George C. Ruhland, M . D .,
Health Officer.
Bureau of Maternal and Child Welfare, Ella
Oppenheimer, M . D ., Director.

Charities,

Elsie

Charles a L.
Lee Spring,

Board o f Public W elfare, Elwood Street, Director.

Division of Care for Crippled Children, Paul
L. Kirby, Chief, i

Division of Child Welfare, A. Patricia
Morss, Director. A. Madorah Donahue,
in charge of Child-Welfare Services.

Crippled Children’s C o m m ission , O. G.

S ta te Board o f Social W elfare, Conrad

S tate Board o f H ealth, W . A. McPhaul,

GEORGIA.

State D ep artm ent o f Public H ealth, T . F.

H AW AII.

Territorial Board o f Health, F. E. Trotter, M . D ., Territorial Commissioner of Public
Health.
Bureau of Maternal and Infant Hygiene, Division of Services to Crippled 'Children,
Bureau of Maternal and Infant Hygiene,
Fred K . Lam, M . D ., Director.
Fred K . Lam, M . D ., Director.

IDAHO.

State D ep artm ent o f Public Welfare, the Hon. Barzilla W . Clark, Governor of the State,
Commissioner of Public Welfare ex officio.
James W . Hawkins, M . D ., Director of James W . Hawkins, M . D ., Director of Divi
sion of Public Health.
Division of Public Health.
Bureau of Maternal and Child Health and Bureau of Maternal and Child Health and
Crippled Children, G. D .
Crippled Children.

Kendrick, M . D ., Chairman.

Van Hyning, Commissioner.
Department of Child Welfare, Mrs. Ruth
W . Atkinson, Director. Louise K . Carr,
Technical Consultant, Child-Welfare Serv-

State D ep a rtm en t o f Public W elfare, Lamar Murdaugh, Director.

Abercombie, M . D ., Director.
Division of Child Hygiene, Joe P. Bowdoin,
M . D ., Chief.

Division of Child Welfare, Frances Steele,
Director. Loretto _Chappell, Supervisor,
Child-Welfare Services.

S ta te D ep a rtm en t o f Public Assistance.

Peter H. Cohn, Director, Louise Cuddy,
Child-Welfare Supervisor.

S ta te D ep a rtm en t o f Public W elfa re, A. L. Bowen, Director.
D ep artm en t o f Public Health,
Crippled Children’s Envision, Paul H . Har Division of Child Welfare, Edna Zimmer
Frank J. Jirka, M . D ., Director.
man, Superintendent of Child Welfare.
mon, Director.
Division of Child Hygiene and PublicRuth M . Bartlett, Supervisor, ChildHealth Nursing, Grace S. Wightman, M .
Welfare Services.
D ., Chief.
1Responsibility for administering services for crippled children was transferred to the Health Department of the District of Columbia July 1, 1937.
1Responsibility for administering child-welfare services was transferred to the State welfare board July X ,1937.

ILLINOIS.

S ta te

State Adm inistrative Agencies

FLORIDA.

M . D ., State Health Officer.
Bureau of Maternal and Child Health (Di
rector to be appointed).

Board o f

Candee, President.
Associate Secretary.

Executive Secretary.
Division of Maternal and Child _ Health,
Woodbridge E. Morris, M . D ., Director.

101

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Federal Reserve Bank of St. Louis

2.— State

Agencies Adm inistering Services Under Title V, Parts 1 , 2 , and 3, o f the Social S ecu rity A ct,
June 1937— Continued
Child-Welfare Services
Title V, Part 3

Services for Crippled Children
Title V, Part 2

INDIANA.

S tate Board o f H ealth, Verne K . Harvey,
M . D ., Director.
Bureau of Maternal and Child Health,
Howard B. Mettel, M . D ., Director.

_î
a
/"I !
1.J
Services
to Crippled
Children, Oliver WJ
W,
Greer, M . D ., Director

V
T
iu n c in n
lMildred
^ iW r p /1
A i^ i a i h
Children’s
Division,
Arnold,
Di
rector. Louise Griffin, Supervisor, ChildWelfare Services.

IOWA

S tate D ep a rtm en t o f Health, Walter L.

S ta te Board o f Education, W . M . Cobb,

Bierring, M . D ., Commissioner of Health.
Division of Child Health and Health Edu
cation, J. H. Kinnaman, M . D ., Director.

Comptroller. Iowa City.
State University of Iowa, E. M . MacEwen,
M . D ., Dean College of Medicine, Iowa
City.

State Board Social Welfare, W . F. Miller,
Chairman.
Bureau of Child Welfare, Frank T. Walton,
Superintendent. Anneda Slavins, Super
visor, Child-Welfare Services.

KANSAS.

State Board o f Health, Earle G. Brown,

Crippled Children C om m ission , R. A.

Kansas E m ergen cy R elief C o m m ittee,

KENTUCKY.

S tate D ep a rtm en t o f H ealth, A. T . Mc

Crippled Children C o m m ission , Marian

LOUISIANA

State Board o f H ealth, J. A. O’Hara,

MAINE.

M ARYLAND

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M . D ., Secretary and Executive Officer.
Division of Child Hygiene, H. R. Ross,
M . D ., Director.

Cormack, M . D ., State Health Commis
sioner.
Bureau of Maternal and Child Health. (Di
rector to be appointed.)

State D ep a rtm en t o f Public Welfare, Thurman A. Gottschalk, Administrator.

Raymond, Secretary.

Williamson, Director.

Jerry E. Driscoll, Executive Director.
Esther E. Twente, Superintendent of
Relief. Emily W . Dinwiddie, Supervisor,
Child-Welfare Services. 8

State D ep a rtm ent o f Welfare, Frederick
A. Wallis, Commissioner.
Division of Child Welfare, Mrs. Mabel B.
Marks, Director.
State D ep a rtm en t o f Public W elfare,

A. R. Johnson, Commissioner.
Bureau of Child Welfare, Mrs. Irene Famham Conrad, Director.

M . D ., President.
Division of Maternal and Child Health, L. A.
Masterson, M . D ., Director.

State D ep a rtm ent o f Health and W elfare, George W . Leadbetter, Commissioner.

Bureau of Health, George H. Coombs, M . D .,
Director.
Division of Maternal and Child Health and
Crippled Children, Herbert R. Kobes,
M . D ., Director.

State D ep artm ent o f Health, R . H . Riley, M . D ., Director

Bureau of Child Hygiene, J. H. Mason Knox,
M . D ., Chief.

Services for Crippled Children, C. H. Holli
day, M . D ., Director.

Bureau of Social Welfare, Norman W .
MacDonald, Director. Lena Parrott,
Consultant, Child-Welfare Services.

Board o f S ta te A id and Charities, J.
Milton Patterson, Executive^ Secretary.
Social Work Department, Anita J. Faatz,
Director.
Child Welfare Division, Mrs. Isabelle K .
Carter, Director.

Federal-State M aternal and Child-W elfare Services

Maternal and Child-Health Services
Title V, Part 1

STATE

102

A P P E N D IX

MASSACHUSETTS.

State D ep artm en t o f Public H ealth, Henry D. Chadwick, M . D ., Commissioner of Health.

M ICH IGAN.

S ta te D ep a rtm en t o f Public W elfa re,

Walter V. McCarthy, Commissioner.
Division of Child Guardianship, Winifred
A. Keneran, Director. Lillian A. Foss,
Supervisor, Child-Welfare Services.

Division of Child Hygiene, M . Luise Diez,
M . D ., Director.

Division of Administration, Public Health
Administration, Orthopedic Unit, Edward
G. Huber, M . D ., Director.

S tate

D ep a rtm en t o f H ealth, C. C.
Slemons, M. D ., Commissioner of Health.
Bureau of Child Hygiene and Public Health
Nursing, Lillian R. Smith, M . D ., Director.

Crippled Children C om m ission , Harry

M INNESOTA.

S tate D ep artm en t o f Health, A. J. Ches-

ley, M . D ., Secretary and Executive Officer.
Division of Child Hygiene, E. C. Hartley,
M . D ., Director.

S ta te Board o f Control, E. C. Carlgren, Chairman.
Division of Services for Crippled Children, Children’s Bureau, Charles F. Hall, Direc
H. E. Hilleboe, M . D ., Director.
tor. Jean Johnson, Supervisor, ChildWelfare Services.

MISSISSIPPI.

S tate Board o f Health, Felix J. Under

S ta te Board fo r Vocational Education,

MISSOURI.

S tate Board o f Health,

H. S. Parker,
M . D ., State Health Commissioner.
Division of Child Hygiene, James Chapman,
M . D ., Director.

J. S. Vandiver, Chairman and Executive
Officer. F. J. Hubbard, State Director of
Vocational Education.
University o f M issouri, Leslie Cowan,
Secretary.
State Crippled Children’s Service, William
J. Stewart, M . D ., Director.

S tate Board o f Health, W . F. Cogswell,

M on ta n a O rthopedic C om m ission , Mrs.

NEBRASKA.

M . D ., Secretary.
Child Welfare Division, Jessie M . Bierman,
M . D ., Director.
S tate D ep artm en t o f Health, P. H. Bar

tholomew, M . D ., Acting Director of
Health.
Division of Maternal and Child Health, J.
Warren Bell, M . D ., Director.

NEVAD A.

State Board o f Health, John E. Worden,
M . D ., State Health Officer,
Maternal and Child-Health Division, H.
Earl Belnap, M . D ., Director.

P. J. Brophy, Chairman.
ler, Executive Secretary.5

Freda E. Mil

W elfare D ep a rtm ent, James G .
Bryant, Director. Lansing.
Michigan Children’s Institute, C. F. Ram
say, Superintendent, Helen F. Geddes,
Supervisor, Child-Welfare Services.

S ta te

S ta te Board o f M anagers o f E leem os
y n a ry In stitu tion s, W . Ed Jameson,

President.4
State Children’s Bureau, Carrollton. Mrs.
W . W . Henderson, Executive Director.
Mary Lois Pyles, Supervisor, Child-Wel
fare Services.
S ta te D ep a rtm en t o f Public Welfare,

I. M . Brandjord, State Administrator.
Mrs. Maggie Smith Hathaway, Secre
tary, State Bureau of Child Protection,
Supervisor of Child-Welfare Services.

State Board o f Control, N . C. Vandemoer, Director.

Child Welfare Division, Harry
Acting Director.

Becker,

Child Welfare Division, Harry Becker, Acting Director.

State Adm inistrative Agencies

M ONTANA.

wood, M . D ., Executive Officer.

H. Howett, Secretary-Treasurer.

S ta te Board o f R elief, W ork Planning
and P ension Control, Gilbert C. Ross,

Secretary. Cecilia Carey, Director, ChildWelfare Services.

3 Responsibility for administering child-welfare services was transferred to the State board of social welfare July 1, 1937.
4 Responsibility for administering child-welfare services was transferred to the State social-security commission June 23, 1937.
3 Responsibility for administering services for crippled children was transferred to the State department of public welfare July 1, 1937.

103

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STATE

Maternal and Child-Health Services
Title V, Part 1

Child-Welfare Services
Title V, Part 3

Services for Crippled Children
Title V, Part 2

S tate Board o f H ealth, Travis P. Burroughs, M . D ., Secretary,
Division of Maternity, Infancy, and Child Division of Maternity, Infancy, and Child
Hygiene, Byron H. Farrall, M . D ., Direc
Hygiene, Byron H. Farrall, M . D ., Direc
tor.
tor.

S ta te Board o f W elfare and R elief, Divi

NEW JERSEY.

State D epartm on t o f H ealth, J. Lynn
Mahaffey, M . D ., Director of Health.
Bureau of Child Hygiene, Julius Levy, M . D .,
Consultant.

Crippled Children’s C om m ission , Joseph

State D ep a rtm en t o f In stitu tio n s and
Agencies, William J. Ellis, Commis

NEW M EXICO .

S tate D ep a rtm en t o f Public H ealth, E.

S ta te D ep a rtm en t o f Public Welfare, Fay Guthrie, Director. Mrs. Laura Waggoner,
Director of Social Service.
Crippled Children’s Division________________ Child Welfare Division.

NEW YOR K -

S tate D ep artm en t o f H ealth, Edward S. Godfrey, M . D ., State Commissioner of Health
Division of Maternity, Infancy, and Child I Division of Orthopedics, Walter J. Craig,
Hygiene, Elizabeth M . Gardiner, M . D .,
M . D ., Director.
Director.
I

S ta te

NORTH CAROLINA.

S tate Board o f Health, Carl V. Reynolds, M . D ., State Health Officer.
Maternal and Child Health Services, G. M . Division for Crippled Children, G. M . Cooper,
M . D ., Medical Director.
Cooper, M . D ., Director.

S ta te Board o f Charities and Public
W elfare, Mrs. W . T . Bost, Commissioner.

B. Godfrey, M . D ., Director.
Division of Maternal and Child Health,
Hester Curtis, M . D ., Director.

NORTH DAKOTA.

D ep a rtm en t o f Public H ealth, Maysil M .

OHIO.

S tate D ep a rtm en t o f H ealth, Walter H.

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Williams, M . D ., State Health Officer.
Maternal and Child Health Division, August
Orr, M . D ., Director.
Hartung, M . D ., Director of Health.
Bureau of Child Hygiene, P. L. Harris, M . D .,
Acting Chief.

sion of Welfare, Jay H. Corliss, Director.
Charlotte Leeper, Supervisor, Social
Security Services.

sioner.
Board of Children’s Guardians, Joseph E.
Alloway, Executive, Director. Minnie
Kuhfuss, Supervisor, Child-Welfare Serv
ices.

D ep a rtm en t

o f Social W elfare.

David C. Adie, Commissioner.
Bureau of Child Welfare, Grace A. Reeder,
Director.

Division of Child Welfare, Lily E. Mitchell,
Director. Virginia Denton, _ Assistant
Director for Child-Welfare Services.

Public W elfare Board o f N orth Dakota, E. A. Willson, Executive Director.
Children’s Bureau, Theodora Allen, Super- I Child Welfare Division, Theodora Allen,
visor.
I Supervisor.
S ta te D ep a rtm en t o f Public W elfare

Division of Charities, Gertrude Fortune,
Superintendent. Crippled Children’s Bu
reau, Mabel E. Smith, Chief.

Division of Charities, Gertrude Fortune,
Superintendent. Helen Mawer, Super
visor, Child-Welfare Services.

Federal-State M aternal and Child-W elfare Services

NEW H A M P SH IR E -

G. Buch, Chairman-Director.

104

A P P E N D I X 2. -S tate Agencies A dm inistering Services Under Title V, Parts 1, 2, and 3, o f th e Social S ecu rity A ct,
June 1937— Continued

OKLAH OM A.

State

D ep a rtm en t

Public

H ea lth,

7424

Charles M . Pearce, M . D ., State Health
Commissioner.
Division of Maternal and Child Health, Paul
J. Collopy, M . D ., Director.

OREGON .

PE N N SYLVA N IA .

C om m ission for Crippled Children, Joe

N. Hamilton, Executive Secretary.

W elfare,

S ta te R elief C o m m ittee, Elmer R. Goudy,

State D ep a rtm en t o f H ealth, Edith MacBride-Dexter, M . D ., Secretary of Health.
Bureau of Maternal and Child Health, Wayne Crippled Children’s Service, John S. Donald
S. Ramsey, M . D ., Director.
son, M . D ., Director. State Hospital for
Crippled Children.

S ta te D ep a rtm en t o f W elfare, John D.

Administrator. Loa Howard, Social Work
Director. Norris E. Class, Supervisor,
Child-Welfare Services.

SOUTH C A ROLIN A_______

State Board o f H ealth, James A. Hayne, M . D ., State Health Officer.
Division of Maternal and Child Health, Division of Crippled Children, Mrs. Eunice
R. W . Ball, M . D ., Director.
H. Leonard, Director.

SOUTH D A K O T A .

State Board o f Health, P. B. Jenkins,

M . D ., Superintendent of Health.
Division of Maternal and Child Health, Viola
Russell, M . D ., Director.

Pennington, Secretary of Welfare.
Division of Community Work, Rosemary
Reinhold, Chief. Marguerite E. Brown,
Supervisor of Rural Extension Unit.

S ta te D ep a rtm en t o f Public W elfare, Alvin Waggoner, Director.

P. B; Jenkins, M . D ., Assistant Welfare Com
missioner (Superintendent of Health).
Division of Crippled Children, G. J. Van
Heuvelen, M . D ., Director.6

Mrs. Ruth Deets, Technical Assistant, ChildWelfare Services.
Mrs. _ Mary Bryan, Executive Secretary,
Child Welfare Commission, Supervisor o f
Child-Welfare Services.7

State D ep artm en t o f Public Health, W . C. Williams, M . D ., Commissioner o f Public
Health.
Division of Maternal and Child Health, John Commission for Crippled Children’s Service,
M . Saunders, M . D ., Director.
T. Graham Hall, Chairman. W . J. Breed
ing, M . D ., Medical Director and Super
visor.

State D ep a rtm en t o f In stitu tio n s and
Public W elfare. George H. Cate, Com

State D ep artm en t o f Health, George W .
Cox, M . D ., State Health Officer.

S ta te Board o f Control, Claude D. Teer,

Division of Maternal and Child Health, J. W .
E. H. Beck, M . D ., Director.

S ta te D ep a rtm en t o f Education, Crippled

Children’s Division, J. J. Brown, Director,
James L. Tenney, Chief.

missioner. Vallie Smith Supervisor, ChildWelfare Services.

State Adm inistrative Agencies

State D ep a rtm en t o f Public Health, Edward A. McLaughlin, M . D ., Director
Bureau of Child Hygiene, Marion A. Glea- I Crippled Children’s Division, William A.
son, M . D ., Chief.
| Horan, M . D ., Director.

TEXAS.

D ep a rtm en t o f Public

Harve L.
Melton, Director. Grace
Browning, _ Assistant Director. Laura
Dester, Director, Child-Welfare Services.

S tate Board o f Health, Frederick D.
Strieker, M . D ., State Health Officer.
Maternal and Child Health Division, G. D.
Carlyle, M . D ., Director.

RH ODE ISL A N D .

TENNESSEE.

S ta te

Chairman.
Division of Child Welfare, Mrs. Violet S.
Greenhill, Chief. Mrs. Norma Rankin,
Director, Child-Welfare Services.

6 Responsibility for administering services for crippled children was transferred to the State board of health July 1, 1937.
7 Responsibility for administering child-welfare services was transferred to the State department of social security July i , 1937.

105

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106

A P P E N D IX 2 .— State Agencies A dm in istering Services Under Title V, Parts 1, 2, and 3, o f the Social Security A ct,
June 1937 — Continued
STATE

Maternal and Child-Health Services
Title V, Part 1

Services for Crippled Children
Title V, Part 2

Child-Welfare Services
Tide V, Part 3

S tate Board o f Health, J. L. Jones, M . D ., State Health Commissioner.
Bureau of Maternal and Child Health, Mil- I Crippled Children’s Service, Marcella M clndred Nelson, M . D ., Director.
| nerny, R. N ., Director.

State D ep a rtm en t o f Public

VERM ONT.

S tate D ep a rtm en t o f Public Health, Charles F. Dalton, M . D ., Secretary and Executive

State D ep a rtm en t o f Public W elfare,

VIR G IN IA.

State D ep artm en t o f H ealth, I. C. Riggin, M . D ., State Health Commissioner.
Bureau of Child Health, B. B. Bagby, M . D ., Crippled Children’s Bureau, E. C. Harper,
Director.
M . D ., Director.

State D ep a rtm en t o f

W ASHINGTON.

S tate

WEST VIRGINIA.

State D ep a rtm en t o f Health, Arthur E.

WISCONSIN.

W YOMING.

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Officer
Maternal and Child Health Division, Paul D . I Crippled Children’s Division, Lillian E. Kron,
Clark, M . D ., Director.
| R. N ., Director.

D ep artm en t o f Health, Donald
Evans, M . D ., Director of Health.
Division of Maternal and Child Hygiene,
John D. Fuller, M . D ., Director.

W elfare,

Darrell J. Greenwell, Director. Social
Service Division, Mrs. V. M . Parmelee,
Director.
Timothy C. Dale, Commissioner. Mrs.
Omeron H. Coolidge, Deputy Commis
sioner.
Public

Welfare,

Arthur W . James, Commissioner. Chil
dren’s Bureau, W . L. Painter, Director.
Harriet L. Tynes, Supervisor, Child-Wel
fare Services.

S ta te D ep a rtm ent o f Social Security•, Charles F. Ernst, Director.
Division for Children, Mrs. Helen C. Swift, I Division for Children, Mrs. Helen C. Swift,
Supervisor.
| Supervisor.
State Depart m e n t o f Public Assistance, A. W . Garnett, Director.

McClue, M . D ., State Health Commis
sioner.
Division of Child Hygiene, Thomas H. Blake,
M . D ., Director.

Children’s Bureau, Francis W . Turner, Chief.
Division of Crippled Children (Supervisor
to be appointed.)

Children’s Bureau, Francis W . Turner, Chief.
Division of Child-Welfare Services, Ruth C.
Schad, Supervisor.

State Board o f H ealth, C. A. Harper,

Interd ep a rtm en ta l C o m m ittee for Crip
p led Children’s Services, R. C. Buerki,

State Board o f Control, John J. Hannan,

M . D ., State Health Officer.
Bureau of Maternal and Child Health, Amy
Louise Hunter, M . D ., Chief.

M . D ., Chairman.
Crippled Children’s Division, State Depart
ment of Public Instruction, Mrs. Mar
guerite Lison Ingram, Director.

State Board o f Health, G. M . Anderson, M . D ., State Health Officer.
Division of Maternal and Child Health, I Division for Crippled Children, Margaret
Margaret H. Jones, M . D ., Director.
H. Jones, M . D ., Director.

President.
Juvenile Department,
Director.

Elizabeth

Yerxa,

Federal-State M aternal and Child-W elfare Services

UTAH .

Appendix 3.— Members1 of Advisory Committees Ap
pointed by the Secretary of Labor to Advise With
the Children’ s Bureau Concerning the Devel
opment of General Policies Affecting
the Administration of Title V,
Parts 1, 2, and 3 of the Social
Security Act
GENERAL ADVISORY CO M M ITTEE ON M ATERN AL AND
CHILD-W ELFARE SERVICES
[Appointed 1935]
[Meetings held: Dec. 16 and 17, 1935; Apr. 7 and 8, 1937]

Chairman , Kenneth D . Blackfan, M . D ., Professor of Pediatrics, Harvard
University School o f Medicine, Boston, Mass.
Grace Abbott, Professor o f Public Welfare, School o f Social Service Administra
tion, University o f Chicago, Chicago, 111.
Fred L . Adair, M . D ., Professor o f Obstetrics and Gynecology, University of
Chicago School o f Medicine, Chicago, 111.
W . W . Bauer, M . D ., Director, Bureau o f Health and Public Instruction, Amer
ican Medical Association, Chicago, 111.
M . O. Bousfield, M . D ., Director, Negro Health Service, Julius Rosenwald Fund,
Chicago, 111.
C. C. Carstens, Executive Director, Child Welfare League o f America, New
York, N . Y .
John A Ferrell, M . D ., Chairman, Executive Board, American Public Health
Association, New York, N . Y .
F . H . Fljozdal, President, Brotherhood o f Maintenance o f W a y Employees,
Detroit, Mich.
Homer Folks, Secretary, State Charities Aid Association, New York, N . Y .
Amelia H . Grant, R . N ., President, National Organization for Public Health
Nursing, New York, N . Y .
Clifford G . Grulee, M . D ., Secretary and Treasurer, American Academy o f
Pediatrics; Editor, American Journal o f Diseases o f Children; Clinical Professor
o f Pediatrics, Rush Medical College, University o f Chicago, Chicago, 111.
T . Arnold Hill, Director, Department o f Industrial Relations, National Urban
League, New York, N . Y .
Fred K . Hoehler, Director, American Public Welfare Association, Chicago, 111.
Arlien Johnson, Director, Graduate School o f Social W ork, University o f W ash
ington, Seattle, Wash.
Paul H . King, President, International Society for Crippled Children, Detroit,
Mich.
Blanche L . LaD u , Member, Executive Committee, American Public Welfare
Association, Chicago, 111.

1 Each member o f these advisory committees was appointed for a 2-year term.
2 Thomas Parran, Jr., M . D ., was appointed as the representative of the
American Public Health Association in 1935.
successor in 1937.

D r. Ferrell was appointed as his
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108

Federal-State M aternal and Child-W elfare Services

M rs. S. Blair Luckie, General Federation o f W om en’s Clubs, Chester, Pa.
The Reverend Bryan J. M cEntegart, Director, Division o f Children, Catholic
Charities, New York, N . Y .
M rs. George B . Mangold, National League o f W om en Voters, Los Angeles, Calif.
M ary E . M urphy, Director, Elizabeth McCormick Memorial Fund; National
Chairman, Committee on Child Hygiene, National Congress o f Parents and
Teachers, Chicago, 111.
Robert B . Osgood, M . D ., Emeritus Professor o f Orthopedic Surgery, Harvard
University Medical School, Boston, Mass.
Abbie C . Sargent, President, The Associated Women o f the American Farm
Bureau Federation, Bedford, N . H .
Dora H . Stockman, National Grange, East Lansing, Mich.
M rs. N athan Straus, National Council o f Jewish W om en, New York, N . Y .
Linton B . Swift, General Director, Family Welfare Association o f America,
New York, N . Y .
Douglas A . Thom , M . D ., Director, Division o f M ental Hygiene, Massachusetts
State Department o f M ental Diseases; Professor o f Psychiatry, Tufts College
Medical School, Boston, M ass.

AD VISORY

CO M M ITTEE ON M ATERN AL
HEALTH SERVICES

AN D

CHILD-

[Appointed 1935]
[Meetings held: Dec. 16 and 17, 1935; June 5, 1936; Apr. 7 and 8, 1937]

Chairman, Henry F . Helmholz, M . D ., Professor o f Pediatrics, M ayo Founda
tion, University o f Minnesota Medical School, Rochester, Minn.
Thomas F. Abercrombie, M . D ., Director o f Public Health, Georgia State Board
o f Health, Atlanta, Ga.
S. Josephine Baker, M . D ., Princeton, N . J.
Ernest A . Branch, D . D . S., Director, Division o f Oral Hygiene, State Board of
Health, Raleigh, N . C.
Hazel Corbin, R . N ., General Director, Maternity Center Association, New York,
N. Y.
Robert L . DeNormandie, M . D ., Boston, Mass.
George W . Kosmak, M . D ., Editor, American Journal o f Obstetrics and Gyne
cology, New York, N . Y .
Elmer V . M cCollum , Sc. D ., Professor o f Biochemistry, School o f Hygiene and
Public Health, Johns Hopkins University, Baltimore, M d .
Grover F . Powers, M . D ., Professor o f Pediatrics, Yale University School o f
Medicine, New Haven, Conn.
Oscar Reiss, M . D ., Associate Clinical Professor o f Medicine (Pediatrics), Uni
versity o f Southern California School o f Medicine, Los Angeles, Calif.
Lillian R . Smith, M . D ., Director, Bureau o f Child Hygiene and Public Health
Nursing, Michigan Department o f Health, Lansing, Mich.
Elnora E . Thomson, R . N ., Director o f Nursing Education, University o f Oregon
Medical School, Portland, Oreg.
Felix J. Underwood, M . D ., Secretary and Executive Officer, Mississippi State
Board o f H ealth; Chairman o f Child-Hygiene Committee o f Conference of
State and Provincial Health Authorities o f North America, Jackson, Miss.

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Advisory C o m m ittees

109

ADVISORY CO M M ITTEE ON M ATERN AL WELFARE
[Appointed 1936]
[Meeting held M ar. 22, 1937]

Chairman, Fred L . Adair, M . D ., Professor o f Obstetrics and Gynecology,
University o f Chicago School o f Medicine, Chicago, 111.
H azel Corbin, R . N ., General Director, Maternity Center Association, New York,
N. Y.
Robert L . DeNormandie, M . D ., Boston, Mass.
George W . Kosmak, M . D ., Editor, American Journal o f Obstetrics and Gyne
cology, New York, N . Y .
James R . M cCord, M . D ., Professor o f Obstetrics and Gynecology, Emory
University School o f Medicine, Atlanta, Ga.
Lyle G . M cN eile, M . D ., Professor o f Obstetrics and Gynecology, University o f
California School o f Medicine, Los Angeles, Calif.
Alice N . Pickett, M . D ., Associate Professor o f Obstetrics, University of Louis
ville School o f Medicine, Louisville, K y .
E . D . Plass, M . D ., Professor o f Obstetrics and Gynecology, State University o f
Iowa College o f Medicine, Iowa C ity, Iowa.
Philip F . Williams, M . D ., Assistant Professor o f Obstetrics, University o f Penn
sylvania School o f Medicine, Philadelphia, Pa.

AD VISO RY CO M M ITTEE ON SERVICES FOR CRIPPLED
CHILDREN
[Appointed 1935]
[Meetings held: Dec. 16 and 17, 1935; Oct. 9 and 10, 1936; Apr. 7 and 8, 1937]

Chairman, Albert H . Freiberg, M . D ., Professor o f Orthopedic Surgery, Univer
sity o f Cincinnati College o f Medicine, Cincinnati, Ohio.
George E . Bennett, M . D ., Associate Professor o f Orthopedic Surgery, Johns
Hopkins University School o f Medicine, Baltimore, M d .
R . C . Buerki, M . D ., Superintendent, State o f Wisconsin General Hospital,
Madison, W is.
M . Antoinette Cannon, Medical Social Service Department, New York School
o f Social Work, New York, N . Y .
Bronson Crothers, M . D ., Assistant Professor o f Pediatrics, Harvard University
Medical School, Boston, Mass.
Mildred Elson, Editor, Physiotherapy Review, Chicago, 111.
Ralph K . Ghormley, M . D ., Associate Professor o f Orthopedic Surgery, Univer
sity o f Minnesota Graduate School o f Medicine, Rochester, Minn.
Harry H . Howett, Secretary-Treasurer, Michigan Crippled Children’s Commis
sion, Lansing, Mich.
Bess R . Johnson, Principal, Smouse Opportunity School, Des Moines, Iowa.
T . Duckett Jones, M . D ., Research Director, House o f the Good Samaritan,
Boston, M ass.
J. Albert K ey, M . D ., Professor o f Clinical Orthopedic Surgery, Washington
University School o f Medicine, St. Louis, M o.
O. L. Miller, M . D ., Consulting Surgeon, North Carolina Orthopedic Hospital,
Charlotte, N . C.
Marian Williamson, R . N ., Director, Kentucky Crippled Children Commission,
Louisville, K y .

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Federal-State M aternal and Child-W elfare Services

110

Edith Baker, formerly Director, Social Service Department, Washington Uni
versity Clinics and Allied Hospitals, St. Louis, M o ., served as a member o f the
committee until her appointment to the staff o f the Children’s Bureau, July
27, 1936.

ADVISORY CO M M ITTEE ON CO M M U N ITY CHILDW ELFARE SERVICES
[Appointed 1935]
[Meetings held: Dec. 16 and 17, 1935; June 1 and 2, 1936; April 7 and 8,
1937]

Chairman, H . Ida Curry, Superintendent, County Children’s Agencies, State
Charities Aid Association, New York, N . Y .
C . W . Areson, Chief Probation Officer, Domestic Relations Court, City of New
York, New York, N . Y .
Sophonisba P . Breckinridge, Professor o f Public Welfare Administration, School
o f Social Service Administration, University o f Chicago, Chicago, 111.
Violet S. Greenhill, Chief, Division o f Child Welfare, Texas State Board o f Con
trol, Austin, Tex.
A . T . Jamison, Superintendent and Treasurer, Connie Maxwell Orphanage,
Greenwood, S. C.
Cheney C . Jones, Superintendent, New

England Home for Little Wanderers,

Boston, M ass.
#
Rose J. M cH ugh, Chief, Administrative Surveys Division, Bureau o f Public
Assistance, Social Security Board, Washington, D . C.
James S. Plant, M . D ., Director, Essex County Juvenile Clinic, Newark, N . J.
Em m a C. Puschner, Director, National Child Welfare Division, The American
Legion, National Headquarters, Indianapolis, Ind.
Alice Leahy Shea, Department o f Sociology and Social W ork, University o f
Minnesota, Minneapolis, Minn.
G ay B . Shepperson, Administrator, Works Progress Administration, Atlanta, G a.
Edwin D . Solenberger, General Secretary, Children’s Aid Society o f Pennsylvania,
Philadelphia, P a .; President, Child Welfare League o f America, Inc., New
Y ork, N . Y .
Ruth Taylor, Commissioner o f Public Welfare of Westchester County, W hite
Plains, N . Y .
_
. . .
The R t. R ev. Monsignor R . Marcellus Wagner, Director of Catholic Charities,
Cincinnati, Ohio.

J. Prentice M urphy, Executive Secretary, Children’s Bureau o f Philadelphia,
served as a member o f the committee until his death, February 1, 1936.
C . V . W illiam s, Superintendent, Illinois Children’s Hom e and Aid Society,
Chicago, 111., served as a member o f the committee until his death, October 9,
1937.

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Advisory C o m m ittee

111

ADVISORY COMMITTEE ON TRAINING AND PERSONNEL
IN THE FIELD OF CHILD WELFARE1
[Appointed 1936]

[Meetings held:

Oct. 19, 1936; M a y 23, 1937]

Chairman, Walter W . Pettit, Assistant Director, New York School o f Social
W ork, New York, N . Y .
Edith A bbott, Dean, Graduate School o f Social Service Administration, Univer
sity o f Chicago, Chicago, 111.
William W . Burke, Associate Professor and Director o f Child Welfare, School of
Business and Public Administration, Washington University, St. Louis, M o .
M . Antoinette Cannon, Medical Social Service Department, New York School
o f Social W ork, New York, N . Y .
E . N . Clopper, in Charge o f Graduate Training for Public Service, University of
Cincinnati, Cincinnati, Ohio.
Arthur Dunham , Professor o f Community Organization, Institute o f Health and
Social Science, University o f Michigan, Detroit, Mich.
Gordon Hamilton, Instructor in Family Case W ork, New York School o f Social
W ork, New York, N . Y .
Kenneth Pray, Director, Pennsylvania School o f Social and Health W ork, Phila
delphia, Pa.
Christine C . Robb, Assistant Executive Secretary, American Association of Social
Workers, New York, N . Y .
Alice Leahy Shea, Department o f Sociology and Social W ork, University of
Minnesota, Minneapolis, Minn.

1This

committee also serves the Social Security Board.

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