xt7f4q7qpt4d https://exploreuk.uky.edu/dips/xt7f4q7qpt4d/data/mets.xml The Frontier Nursing Service, Inc. 1935 bulletins English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins The Quarterly Bulletin of The Frontier Nursing Service, Inc., Vol. XI, No. 1, Summer 1935 text The Quarterly Bulletin of The Frontier Nursing Service, Inc., Vol. XI, No. 1, Summer 1935 1935 2014 true xt7f4q7qpt4d section xt7f4q7qpt4d §’· ·
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THE QUARTERLY BULLETIN OF ,
THE F RONT IER NURSING SERVICE, Inc. i ’
Published quarterly by the Frontier Nursing Service, Lexington, Ky.
SUBSCRIPTION PRICE $1.00 PER YEAR I
VOLUME XI SUMMER, 1935 NUMBER 1
“Ente1·ed as second class matter June 30, 1926, at the Post Office at ·"
Lexington, Ky., under the Act of March 3, 1879.” Q
Copyright 1935 Frontier Nursing Service, Inc. '
I

= HOUSE PROTECTING
l
(Found in a Highland Cottage)
Q God, bless the world and all that is therein,
‘ i God, bless my spouse and my children,
God, bless the eye that is in my head,
And bless, O God, the handling of my hand,
What time I rise in the morning early,
What time I lie down late in bed,
» Bless my rising in the morning early,
And my lying down in bed.
God, protect the house and the household,
God, consecrate the children of the Motherhood,
God, encompass the flocks and the young,
. Be Thou after them and tending them.
What time the flocks ascend the hill and wold,
What time I lie down in peace to sleep.
I —From Carmina Gadelica,
by Carmichael. r
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_ 2 THE QUARTERLY BULLETIN 1
IN MEMORIAM _
*1
WILL ROGERS
"God rest you merry gentleman
Let nothing you clismay."
The death of this dear and distinguished American has
plunged the whole nation into grief. I was going from Kentucky {
to Los Angeles in a ship of the American Airways, whose chief J
pilot, Tom Harding, had often carried Will Rogers over the same 4
route. We landed at the Memphis airport to refuel and word
reached us over the radio that Rogers’ body and Wiley Post’s
had been found in Alaska. The stewardess and I were the only
women on the ship but we weren’t the only people with wet eyes. l.
I never saw a group of men, from Tom Harding on down through l
all the passengers, show more profound evidence of grief. Dur- f
ing the few minutes before we took oft`, we gathered in a little I
group and discussed the incredible news. _1
At Fort Worth, Texas, where we had to wait for some hours
for our night connection for Los Angeles, I went to the moving t
pictures to see Shirley Temple in Curly Top. Just before the `
feature the screen called for two minutes of absolute silence in
Will Rogers’ memory and said that this was being done all over
the United States.
At Phoenix, Arizona, the next morning; at the emergency _
airport of Indio, in the desert; everywhere, the talk was of him, *
but it was talk that immediately lapsed into painful silence.
We have dug out of our files a personal letter from Will V
Rogers, written to me in February, 1933, just before our Belgen-
land Cruise. It was too personal a letter to make public at the
‘ time and, like a number of such letters from high and low, public
I and private people, remained buried for years in our private
` files. We print it now because it is characteristic of him. He *
‘ never did get in to see us although he said more than once that »
he would do it. What he wanted was an airplane landing so as *“
to reduce the long hours of getting in to our Kentucky hills. This ~ l
letter, like everything else he ever said or did, embodies that *
saying of the Master in Matthew, Chapter 5, Verse 48, so well
rendered from the Aramaic idiom by the Torrey edition, "Be all-
including in your good will, even as your Heavenly Father in- ,
cludes all."
€ _ x

i Faoiwina Nuasmo simvrcm s
rl
"Well if it aint Mary Breckinridge:
I have read more about you than I have Mahatma Gandi. .
I got the book and I can ride those mountains blindfolded. I
can’t be a midwife but I can sure hold the nurse’s horse. Now
’. about this pilgrimage you are making to the West Indies in be-
1 half of better babies in.Kentucky. Thats a kind of a round
" about way to deliver babies, but it sounds mighty sound and
practical. And they say you can live cheaper on one of these
trips than you can at home. Lots of folks are making em just
to dodge their daily mail from creditors.
{ Now I can’t go. You can’t do nothing when you are in the
JI movies but just stay home and make faces at the world.
’° I would sure take you up on the thing, but it would be
mighty slow traveling. I can and have made that same trip be-
tween breakfast and ‘supper.’ But its good for you ‘old folks’
that are in no hurry.
gl The trip I want to make is right out in that virgin baby
» country of yours. I can talkto those people that are breeding
I these babies, but I never could understand a black negro in Ja-
.j maica that spoke English better than Lady Astor.
i Then the next island you go to the negro speaks French like
~ Ann Morgan. So when I get some time off I am heading for this
incubator country of yours. You can’t beat old Kentucky for a
‘ breeding ground. Its the limestone in the soil, and the corn in
l the jug that does it.
What become of the Chinese Breckinridge? There is an-
i other good breeding ground is that China. He had just been
made a ‘General’ when I saw him in Peking. So there is liable
’ to be Breckinridges all through those Mongolian Mountains too.
Well anyhow good luck to you on your trip. I am going
to see if I can’t write something about the trip in a Sunday ar-
ticle drawing folks attention to it and the cause it is for.
* So save me a good mule and a good nurse and I am ready
é to go into the mountains and see ‘How Life Begins}
_ I; Good luck to you and your fine cause." `
(Signed) Wim. Rooms.
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_ 4 THE QUARTERLY BULLETIN l
ANNUAL REPORT
Again we condense our annual report to reduce the costs
of printing. For the immediate benefit of our readers wewill
now give a brief summary of the fiscal year, which closed May ,
10, 1935, both as to funds and as to the work.
FISCAL REPORT 4,
We received this year from all sources, including nursing
and medical fees, investment income, sales of books, revenue “
from Wendover Post Office, refunds, etc., but exclusive of »
$8,000.00 added to the endowment fund of the Hyden Hospital, `
a total of $74,946.50. We sent out our usual Christmas appeal ~
for toys for the children on a post card to reduce postage costs, I
and we also sent out our regular spring "Saddlebag" appeal.
We gained 297 new subscribers during the past fiscal year and
185 people sent $2,376.40 in response to our 10 per cent appeal. l
Obviously, the total sum received, $74,946.50 (exclusive of
endowment fund) did not meet out budget of $80,000.00 and we 4
are approximately $5,000.00 short on last year’s budget. Dur-
ing the current fiscal year, namely, this past summer, we have Q
endeavored to make up this deficit in the following manner. _ A
The members and trustees present at the Tenth Annual
Meeting of the Frontier Nursing Service on May 25, 1935, adopt-
ed the following Resolution:
Resolved, That the members and trustees of the Frontier
Nursing Service, assembled for ·its Annual Meeting at the Coun-
try Club, near Lexington, Kentucky, on May 25th, 1935, do _
hereby, in honor of the Tenth Birthday of the Frontier Nursing
Service, make the following request, to which they also pledge J
themselves, of the two thousand Service Members, scattered all '
over the world, who support the Frontier Nursing Service with ·?
their subscriptions; namely: That each Service Member during g
the current fiscal year endeavor to enlist one other Service Mem-
ber to join the ranks of subscribers to the Frontier Nursing _
Service, in order to widen the interest in this unique piece of T
work, and to broaden the basis of its support.
Y
Fr R .
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l FRONTIER NURSING SERVICE 5
Resolved further, That the members and trustees here pres- _
I ent request the Service Members of the Frontier Nursing Serv-
ice wherever possible, to remember its Endowment Fund in their
Wills, or build up by degrees an Endowment in their lifetimes.
{ Resolved further, That the Director is instructed to send a
copy of this Resolution to each such Service Member with an ‘
, accompanying personal letter.
Copies of this Resolution were sent out during the summer
i with an accompanying personal letter from the Director, to ap-
J proximately 1800 Service Members, viz., all except those known
il to be traveling abroad or ill, and those who had already increased
! their subscriptions to meet the deficit. Returns to date indicate
·. that 67 Members got 76 new. subscribers who made gifts total-
, ing $758.25, and 81 Members themselves gave extra funds total-
- ing $1,995.00. ·
_ These results are disappointing. They indicate an heroic
I effort on the part of less than 200 people, but unless others are
. willing to work, too, the deficit is not met and the outlook for
I next year’s budget of $80,000.00 is not promising. We call atten-
tion to this situation because when the Frontier Nursing Service
reduced its budget from $120,000.00 to $80,000.00 several years
ago, it effected every possible economy without closing down some
of its nursing stations. The economies were chiefly in cutting
out its outside offices and reducing its promotional costs, which
. has resulted in a lessened income, and in the willingness on the
part of the staff to accept a fraction of their old salaries. The .
chief economy, in fact, lies in that direction and cannot be fur--
ther reduced. If promotional costs are cut out altogether the
income will further decrease. We wish to make this plain to
all of our friends, as we intend to live within a budget and we
are sure they will see that we get the additional money we need,
, namely $10,000.00. We are short $5,000.00 on last year and we
will need $5,000.00 more this year than we received last year to
4 make up this year’s budget of $80,000.00. ,
- )
§ FIELD AND HOSPITAL .
_ The field nurses carried during the year a total of 7,036 I
I people in 1,416 families. Of these 4,324 were children, including
. 1931 babies and toddlers. Bedside nursing care was given to
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6 THE QUARTERLY BULLETIN
286 very sick people, of whom 14 died. The district nurses paid i
17,552 visits and received 20,030 visits at nursing centers. The
emergency hospital at Hyden, Ballard-Gill Memorial, was occu-
pied 4,538 days by 433 patients. There were transported to hos- {
pitals outside the mountains, in Lexington, Louisville, Cincinnati (
and Richmond, 37 patients and their attendants, on passes given
us by the Louisville & Nashville Railroad. I
Under the direction of the State Board of Health, the nurses I
gave 8,092 inoculations and vaccines against typhoid, diphtheria, 4*
smallpox, etc., and sent 159 specimens out for analysis. "»
We held during the year 182 field clinics with an attendance in
of 7,840 people. I
MEDICAL AND SURGICAL 1
Dr. R. L. Collins and Dr. J. E. Hagen, of Hazard, Ken- I
tucky, performed numerous operations during the year, those E
on indigent people as a courtesy to the Service. None of the I
doctors in the various cities, to whom we sent patients, made
any charges for their services. Our regular medical service
was carried by our own medical director, Dr. John H. Kooser;
and various physicians from the nearest towns were called in, r
both for emergencies and at the request of individual patients.
I
MIDWIFERY %
The nurse-midwives delivered 351 women in childbirth of T
349 live babies, 6 stillbirths, and one late miscarriage; and gave
them full prenatal and post-partum care. There was no mater-
nal death. There were 5 sets of twins. There were 374 new f'
l cases admitted and 361 cases closed after post-partum care. Of I
these 16 went to the Hyden Hospital because of some abnormal yl)
condition. Physicians were called to 8 district deliveries and i`
‘ examined 81 prenatals and 7 post-partums.
In addition to our regular cases, the nurse-midwives were ,
called in for six emergency deliveries, where the mother had not |
been registered, or given prenatal care; 11 miscarriages (un-
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l registered cases) ; and they gave post-partum care to 11 unregis-
tered mothers.
I The completion of the graded road into Hyden has necessi-
§ tated a third classification for maternity cases. So far we have
had two classifications only, namely, our own registered cases
which book with us before delivery and for whose care, whether
E delivered by the nurse-midwives or a physician, we are
1 entirely responsible; and, secondly, the emergency cases, either
1 carried by the old midwives, who call us in when they get into •
4 difficulties, or not carried by anybody. Our nurse-midwives al-
ways respond to such cases instantly and at the same time send
C at once for medical assistance. But this group does not come
under the category of our own patients.
, The third classification, which we are opening with the be-
ginning of our third 1,000 cases, is composed of outside people
I who are brought to our hospital because it is the only one in
I this section of the mountains where free care, if the patient
I cannot pay anything, is available for indigent women, or be-
l cause the case is in a bad condition and immediate hospitaliza-
4 tion is desired by the patient’s friends or attendants. We have
had 12 such cases during the last fiscal year, of which one, with
l a critical heart and kidney_condition, sent to our hospital three
; days before delivery by a private physician outside our terri-
l tory, died. The baby also died. Of the other 11 cases, all
l mothers were safely delivered and all babies lived.
l We call attention on page 13 of our Bulletin to the report
l of Dr. Louis I. Dublin, Third Vice-President and Chief Statis-
. tician of the Metropolitan Life Insurance Company, on our sec-
ond 1,000 maternity cases. In his article called "Lost Mothers,"
widely circulated through the press, Dr. Dublin says of our ma-
ternity work: "It is impossible to parallel this success in any
ft other experience that I know of." He sent us, with his report
l on our first 1,000 cases, 22 tables, and with the second 1,000 I
J) cases, 19 such tables. Obviously, without a special grant to
cover the costs, we cannot afford to print them. The summary,
which we do print, will be of profound interest to all supporters
Q of our frontier skirmish on a great battlefield, where more
l American women have died in childbirth in our history as a na-
tion than men in war.
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s THE QUARTERLY BULLETIN *1
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SOCIAL SERVICE DEPARTMENT '
(Alpha Omicron Pi Fund)
Care of dependent and neglected children: 22 children. I
Service to handicapped children: 5 blind or deaf children. j
Court commitments for institutional cases: 2 mentally defective
_ persons. I
· Service to medical-social cases: 50 cases—24 sent to hospitals
outside; 26 given local care. Z
Service to family cases: 21 families. U
Educational assistance: 12 children and young persons.
Advisory service in employment problems: 15 persons. i
Out-of-district inquiries: 9 cases.
Other Service: I
The social service director, Miss Bland Morrow, has, '
throughout the course of the year, given service on the following
committees:
The Leslie County Relief Committee. i
The Area Relief Board.
The Executive Committee of the Kentucky Conference of
Social Work.
She has helped to organize the following projects in the Frontier
Nursing Service:
1. Sewing and knitting classes. Y
2. Christmas celebrations.
3. Circulating libraries.
4. Debating clubs. .
She has also worked on the following programs: A
1. Rehabilitation. {
2. Forestry under National auspices. .5}
3. Protection of fish and game.
4. Dental clinics. I
5. Sanitary toilets. Q
6. School bridges, wells, and county roads. ly
7. School books.

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II FRoN·r1RR iwnsmc snnvicm 9
’ 8. Diversification of farm and garden crops and improved
methods of farming.
I 9. The organization of a local public improvement associa-
tion, and local fish and game clubs.
In conclusion we want to mention the splendid work, short-
I handed and under terrific pressure, by our administrative group,
I the valuable liaison work of our courier service, and the unswerv-
I ing cooperation and loyalty of both our outside and our local
I committees, and of our thousands of patients.
-3 MRs. S. THRUsToN BALLARD, Chairman.
I C. N. MANNING, Treasurer.
I MARY BRECKINRIDGE, Director.
il
| Sayings of the Children _
Alta (badly burned little girl at the Frontier Nursing
Service Hospital at Hyden) , praying out loud before submitting
to a painful dressing: "O, Lord, you know I read your book
nearly plum through."
I A faith healer living at Deal
r Said, "Although pain isn’t real,
I If I sit on a pin and it punctures my skin,
I dislike what I fancy I feel."
5 Our grateful thanks are extended to the Lexington Herald
I A for again giving itself to all eight of our nursing stations dur-
I I ing the past year.
"I am much pleased with the report of your Work and
' congratulate you and your faithful nurses on their accomplish-
I ments."—Dr. J. B. DeLee of Chicago.

I
l 10 THE QUARTERLY BULLETIN I ’
l
LETTER OF TRANSMITTAL OF ANNUAL AUDIT REPORT I
I
From i <
W. A. HIFNER, Jr. F
Certified Public Accountant E
si,}
City Bank Building g
Lexington, Ky.
` May 24th, 1935. {
Mr. C. N. Manning, Treasurer, l ii
Frontier Nursing Service,
Lexington, Kentucky.
My dear Mr. Manning :— i
A short time ago a friend, a man who is nationally known I
, as being at the very top of his profession, made the statement
to me that he did not see how I could Work with figures all the I
time, as the mere thought of figures, especially tabulated state-
ments, almost gave him nervous prostration. Q
It was a revelation to me that anyone could entertain such
an attitude in regard to figures. I had never before realized that
to some persons an annual report or financial statement is just .
another form of the multiplication tables. _
To the accountant, figures are merely the tools with which I
i i to work. Just as the sculptor makes use of his hammer and
K chisel to bring forth out of the rough marble his conception of
a Venus de Milo, so, also, does the accountant make use of figures
to convey his conception of facts and events that have occurred. ,
The accountant’s sole function is to assemble the figures in such
a manner as to present a true picture of the facts, and his suc- ,
cess is measured by the extent to which his assembly is most *
y readily understood. Q
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I ’ Fizoiwrima NURSING smavicm 11
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` In transmitting to you, Mr. Treasurer, the annual audit re-
1 port of the Frontier Nursing Service for the fiscal year just
‘ ended, I wish I had the ability to convey to you the succession of
i exquisitely beautiful pictures these annual reports have visual- l
{ j ized to me.
I shall never forget the first audit we made for the Service.
Y “ The Director walked into our office, a total stranger; dumped
I on the floor an old rusty pair of saddlebags, and calmly an-
i nounced that she wanted her accounts straightened out. You
{ti will please note that I say "accounts" and not "books", as the
Service survived the first several years of its existence without
I the aid or impediment—according to one’s point of view—of
`, books of any kind.
I do not know how familiar you may be with saddlebags,
but that was my first introduction to the species, and I am still
amazed at the enormous mass of papers that first pair of saddle-
l bags disgorged. They reminded me of nothing else quite so
j much as an old rag bag my grandmother kept hanging on the
inside of her closet door as a receptacle for the most varied as-
l sortment of cloth, of every hue and texture, it has ever been my
l lot to inventory in any department store.
, And, just as the contents of that humble old rag bag, under
T the deft fingers of my grandmother with the aid of her looms
* and frames, were gradually transmuted into some of the most
S beautiful quilts, rugs and carpets it is possible to describe, so
Q also, did the simple contents of that first visitation of saddle-
1 bags, and its annual successors, when assorted and assembled,
I depict the realization of hope and the futility of despair; the
, glory of tasks well done and the satisfaction of service rendered.
I I shall not attempt to describe to you all the beautiful scenes
these animal reports have brought to my mind, as they are too
many and too varied. Their predominating motif, constantly
j. recurring, seems to be the spirit of an intrepid adventurer and
r pioneer, wearing a girdle of courage, a mantle of faith and hope,
l a banner of mercy, and a shield of duty; a spirit imbued with
I an overwhelming and intense love for little children.
l . In the collaboration of these reports I have been accorded
l the privilege of witnessing history in its making; where the

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` 12 THE QUARTERLY BULLETIN ]
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I warp and woof of a better civilization, in an area larger than
many principalities, has been fabricated thru the piecing to-
gether and skillful application of an infinitude of small contri- Lg
` butions from the four corners of the globe, to the end that gen-
erations yet unborn will be endowed with better minds and Y
hearts by reason of a natural heritage of better bodies. ll
Other pioneers and adventurers have been memorialized in P
bronze and stone, granite and marble, but to live, both contem- ,
poraneously and thruout future generations, in the minds and i ,
hearts of men is the high honor justly earned by the Director it
of the Frontier Nursing Service. *
Sincerely yours, 1
(Signed) W. A. HIFNER, JR.
Indian Reservations Study
We have made during the summer, through Miss Mary B. .
Willeford and Miss Bland Morrow, a study of the nursing, i
medical and social aspects of certain Indian Reservations in
the Southwest. This was financed by the Guggenheim Founda-
tion, The Sibyl Carter Memorial Fund, and an interested private
individual; and was carried out at the request of the U. S. Indian 4
, Bureau. The two Indian nurses now with us, Adeline Clark
V and Virginia Miller, will be placed by the Indian Bureau under ,
Commissioner Collier and Miss Gregg, who asked us if we would
§ _ help them to determine the places where they could work most
{ effectively. A further mention of this will come in a later
k Bulletin.
r—‘—* . . li
We had fourteen tides on the Middle Fork and Red Bird {
Rivers in the late winter and all through the spring, and many ll
landslides. One of our nurses, Miss Grogan, was nearly killed,
together with her horse, when a landslide came down on both i
of them. Some men who were near dashed up and dug them l
I out, but it was a close call. ·`
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Q Fnonrinn NURSING smnvicm ia
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ii METROPOLITAN LIFE INSURANCE COMPANY
New York City
·: May 22, 1935.
_· Mrs. Mary Breckinridge,
» Frontier Nursing Service,
t Wendover, Kentucky.
~ My dear Mrs. Breckinridge:
ii I am sending you a report on the second thousand cases
i which you were good enough to make available to us for study.
= I think you will find very much for gratification in the results.
° I have gone over the work of Miss Steele who prepared the tabu-
lation and summary and take full responsibility for the accuracy
of her results. It seems to me that she has covered all of the
Q important points and you should not hesitate to utilize any of
` this material in any of your publications. The tables cover the
same material as in the first study and comparisons can be made
between the first and second thousand. Altogether, I congratu-
late you on the excellence of your results which present an un-
l approachable standard for most other maternity services.
If there are any questions or any comments on this statisti-
cal report, I do hope you will not hesitate to write to me at once.
We are very happy to be able to cooperate with you.
i Sincerely yours,
7 (Signed) Louis I. DUBLIN,
Third Vice President and Statistician.
l
* Dr. Dublin
é In re: Summary of Second 1000 Midwifery
U Records of Frontier Nursing Service.
E The record of the Frontier Nursing Service is indeed an
enviable one. The nurses of that organization have delivered
their second thousand of mothers without a single maternal
i death. Since this would be an exceptional record under the most
1 favorable circumstances, its accomplishment under the difficult
·` conditions obtaining in frontier homes is noteworthy. In 1930,
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14 THE QUARTERLY BULLETIN t
I the last year for which figures are available, the rural white {
population of the United States recorded a maternal death rate .
of 5.2 per 1,000 live births and Kentucky a rate of 5.0 per 1,000 ·
live births. In a recent study of maternal mortality in New
York City, 1930-1932, the puerperal death rate for women de- 2
livered by a midwife was 1.6 per 1,000 live births. When the
cases were added, in which the midwife had contacted the patient
without responsibility for the delivery, the rate was 2.9 per l
1,000. The nature of the contact varied from the cases in which ‘,
the midwife saw the patient only once and immediately called ";
a physician or sent her to the hospital, to the cases in which she 5
remained with the patient while in labor and only called assist- $*
ance when some disquieting symptom became evident.
Although the group of women served by the Frontier nurses .
varied in age from the early teens to the late forties, they were,
on the whole, from the age standpoint, a favorable group as
16.6 percent were under twenty years of age, and an additional
31.3 percent were between the ages of 20 and 25 years. That
is, almost a half of the women were less than 25 years of age. `V
In spite of the young average age of the mothers (26.3 l
years) the minority of the women were primigravidae. Only
203 of the 1,000 were in their first pregnancy. On the other _
hand, over 175 were of gravida eight or more.
If we consider the recommendations of the Federal Chil-
dren’s Bureau as a fair criterion, the women in the group were
rather late in registering with the Frontier Nursing Service.
The Children’s Bureau recommends that the first visit to a clinic i
. or physician be made at or before the fifth calendar month of I
I gestation. In this study, only 21.4 percent registered before
i , the sixth month, 20.5 percent registered during the sixth month,
26.2 percent during the seventh month, 21.3 percent during the
eighth month, and 10.6 percent in the ninth month. The primi- . l
gravidae registered little if any earlier than the multigravidae.
However, the experience in this series is in line with many other H
studies, as generally speaking less than one-fourth of all the
cases reported in`such studies are registered before the fifth or j
sixth month. Twenty-eight percent of the 4,726 women studied ’
, by the Maternity Center of New York came under observation 2

l
. FRONTIER NURSING snnvrcm 15
{ before the fifth month. In the 6,117 cases that received prenatal
. care from the CommunityHealth Association of Boston, only 30
· percent of the patients were booked in the first six months of
pregnancy. Among the Frontier women, the time of registration
1 varied little in the different age groups. The numberof visits
for prenatal care, which naturally varies directly with the month
of registration is shown in Table VI.
l As the Nursing Service covers three periods, pregnancy,
`, labor and puerperium, we have considered the results for each
Fi period separately.
il I. Period of Pregnancy
l Approximately 317 of the women developed one or more
_ abnormalities during pregnancy. One hundred ninety-three of V
the women recorded puerperal complications, the most common
_ being the toxic conditions and the varicosities, while 163 women
reported non-puerperal complications. This latter covered a
wide range, the most frequent being simple goiter, diarrhea and
`V enteritis and infiuenza.
' The prenatal care given by the Frontier nurses was success-
ful, on the whole, for those women with toxic conditions of preg-
nancy, as in only three cases out of a possible 78 did the condi-
A tion interfere with the birth of a live baby. In all but nine
I cases the condition was eliminated by the time of confinement.
Altogether, the doctor examined 265 women during preg-
nancy, 71 being primigravidae and 194 multigravidae. That is,
» the doctor examined 35 percent of the primigravidae and 24
· percent of the multigravidae, included in the group. Altogether
he examined three-fifths of the women reporting toxic condi-
tions.
The incidence of the complicating conditions of pregnancy
p 1 are shown in Tables VII and VIII.
· II. Period of Labor
The great majority of the women in the present series of
- cases were confined in their own homes, although 66 women
E were taken to the hospital at Hyden, or to one of the other cen-
; ters for delivery. The doctor was called in on both home and

16 THE QUARTERLY BULLETIN
hospital cases only 61 times (in four cases he was called after
delivery). In seven cases, he failed to arrive before the baby
was delivered. In about one-half of the cases he was reported
as making deliveries. In the remaining cases, he assisted at one
or more stages of the delivery, repaired the perineum or exam-
ined the newborn. Caesarean operations were necessary in only
two cases, an episiotomy in one case and forceps were used in
only four others. To appreciate these figures it may be well to
recall that in New York, where most cases are attended by doc-
tors, it is estimated that 20 percent of all deliveries are opera- 5
tive and that almost one-half of the operations are Caesarean
sections. 5
The length of labor reported by the nurse in attendance is
an estimate and no doubt in many cases a rough estimate, since
many of the homes lack time pieces. Labor was reported as
lasting from less than one hour up to 70 hours. In three-fourths
of the cases of multiparae the labor was of a duration of less
C than 12 hours, while among the primiparae only one-third re-
ported labor of so short a duration.
Puerperal complications of labor were reported for 277
women, 71 of whom had experienced some abnormality of preg-
nancy of a puerperal nature. The most common puerperal com-
plication of labor was bleeding of some amount. There were
two cases of placenta previa marginalis, two cases of cervical
bleeding, 41 cases of persistent trickle and 123 cases of hemor-
1 rhage—the loss of 20 ounces or more of blood being considered
y a hemorrhage as well as those cases so marked. In an addi-
Q tional 76 cases, the amount of blood lost was estimated by the
g nurse at 15 ounces or more, although the case was not character-
{ ized as hemorrhage. The next most common condition was lacer- _
I ation or rupture of the perineum—the tear being of second §
‘ degree, however, before the condition wa