||The purpose of this ethnohistorical research was to study the first fifteen years of the Frontier Nursing Service in Hyden, Kentucky, the years 1925 to 1940. This time span was chosen for several reasons. First, the founding of the Kentucky Committee for Mothers and Babies (the name was changed to Frontier Nursing Service in 1928) occurred in 1925. Second, by 1940, the agency had met the challenges posed by three major events: the devastation of the economy caused by the depression and drought of the thirties, the return of the British nurse-midwives to their homeland and the closure of nurse-midwifery educational programs to foreign nurses upon that nation's entrance into the Second World War, and finally, the opening of the Graduate School of Midwifery at Frontier Nursing Service. This study began with several basic questions. What caused the founder of the Frontier Nursing Service, Mary Breckinridge, to initiate a health care agency? For what reasons did nurse-midwives go to work at Frontier Nursing Service? What were the early work experiences encountered at Frontier Nursing Service? What were the responses of public agencies to the establishment of a philanthropic work to deliver health care? Perhaps, most significantly, what was the status of health care at the time, and specifically, what role did establishment of a philanthropic nursing service play in the broader issue of health care delivery? This research examined these aspects and integrated these findings with the data available from other studies and sources and synthesized this material into an ethnohistorical framework. The findings may be used to analyze, plan for or implement health care delivery systems. The study demonstrated the significance of economic, social and political factors upon the health care delivery system and had as its goal contributing nursing knowledge in the specific area of health care delivery.