The boy of the chapter’s title is Homer Wells, and St. Cloud’s is the name of the orphanage-hospital where he lives. It is also the name of the surrounding town, an impoverished inland community in Maine that was once a logging town. The orphanage-hospital is run by Dr. Wilbur Larch, who is also the presiding physician. He delivers babies at the hospital and occasionally performs abortions. The era is the 1930s, and abortion is illegal in the United States.

Homer Wells is adopted by several local families but always returns to St. Cloud’s. The first family who adopts him, when he is just a baby, finds his silence unnerving and decides that it must be due to a birth defect. The second family abuses him in order to get him to cry. His crying is so loud that it comes to the attention of the neighbors; they tell Dr. Larch, who then retrieves Homer. The third family, a professor and his wife, seem perfect, but Homer comes to find them smug and self-regarding. The professor also turns out to be an alcoholic, and Homer returns to the orphanage when a family cousin attempts to abuse him and then blames the abuse on Homer.