xt7jdf6k2047 https://exploreuk.uky.edu/dips/xt7jdf6k2047/data/mets.xml The Frontier Nursing Service, Inc. 1944 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. 19, No. 3, Winter 1944 text The Quarterly Bulletin of The Frontier Nursing Service, Inc., Vol. 19, No. 3, Winter 1944 1944 2014 true xt7jdf6k2047 section xt7jdf6k2047 6 ..lllll'f6’l' y ll 6'fll/I
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il VOLUME 19 WINTER, 1944 NUMBER 3
- W
 
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. THE ROAD TO WENDOVER
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COURIERS
I FANNY McILVAIN JEAN HOLLINS
K A

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El · THE U. S. MAIL AND THE FRONTIER NURSE-MIDWVIFE
  The Nurse On Horseback
, (Abridged)
, A i by
MARY BRECKINRIDGE
l PUBLISHED IN THE WOMANS JOURNALAEEBRUARY I928
ii Nowhere is a more diiiicult scene set for a nursing service
  t0 rural regions of the United States than in Leslie County, Ken-
_— tucky. That is why the Kentucky Committee for Mothers and
1 Babies chose it as the county in which to begin its adventure—
  the adventure of bringing trained nurse-midwives to a country-
; side in which doctors are very rare. The adventure has now
  passed its second birthday, and in that time we have extended
 .; its limits until we cover nearly two hundred and fifty square
  ` miles of rugged highlands through which the Middle Fork of
‘{ `» the Kentucky River cascades picturesquely in country of un-
  surpassed loveliness.
; So remote are we from the turmoil of city life that it takes
.  Uncle Sam’s mail ten hours to travel overland from the railroad
p to Hyden, our county seat, by mule wagon. There the letters
i for our centers farther up the river lie over night and travel to

 L i
i
, i
, 4 THE QUARTERLY BULLETIN  
L us on muleback the next day. So that when a letter from Lex-  
ington, Kentucky, about one hundred and forty miles away,  
reaches us at Wendover or at the Up River center, it has been  
on the road thirty-six to forty hours.  
There is no railroad in our county, no automobile road as , 
yet, and no horse bridge over the river. Foot—bridges are swung J 
by cable about thirty feet above the water-bed, and when the  I
river rises in a few hours fifteen or twenty feet, following a  
heavy rainfall, or the melting of snow, these foot-bridges are  
the only means of getting across to "yon side." During the ¥
. terrible high waters of last winter, when the river almost .,
reached the level of the bridges, the beams holding them up on `
both sides were so badly washed that three out of the five  *
 i bridges fell in and were carried down with the trees and fences  
and other debris of the iioods.  
At the height of the storm, one of the nurse—midwives was  
called out on a delivery and followed the father across the  
swinging bridge at Hyden, with the flood only a few feet below.  
The expression used in the mountains for these freshets is  
"tides"—not so much a left-over from the days, one hundred  
and fifty years ago, when ancestors of the mountaineer lived  
in an island country and watched the ebb and flow of the sea,  
as an Elizabethan form of speech: "There is a tide in the af- ,§
fairs of men." '  
Often, with us in the Kentucky mountains, the river rises ' ¥
only a few feet, and then the nurses, in riding across the fords, g
just above the rapids, find their horses have to swim a "few  .
licks." This is a bit disconcerting for a new nurse, especially if ‘ Q
she is not used to riding and her mount is a frisky creature like  
Lady Jane or Teddy Bear, Silver or Major, Bruna or Dude. QQ
"What makes him go sideways ‘?" she calls out like Dicken’s  
Mr. Snodgrass from the bin, when Mr. Winkle cavorted by at  
the mercy of his "tall quadruped." And it doesn’t reassure her ° ,.
much to have a passing mountaineer reply composedly: "Oh,  {Q
he’s just maneuvrish and feisty." But usually the newcomer  
gets an animal of settled habits like Nellie Gray, to whom a  
river, however high it is rising, is just a wet place between her  
and the barn, to be crossed without one retarding caper.  
» , I
7

 Fnomrnzn xwasmo   _g_g
Each nurse saddles and feeds and grooms her own horse,
and no Arab ever loved his any better than we love ours. Not
only the nurse’s own life, on dark winter nights, but those the
stork is bringing, depend on the speed and surefootedness of a
· devoted creature whose
  flying hoofs scatter the -   L_
rocks from the narrow __ 
trails up creek beds and   . ,  
over the gaps of the tall-    
est mountain. No matter     . -
what the weather, if the __,   · _   i'  
man can come for the  A   j A   `
nurse, the nurse can go  —  ·j;2 ” {_ . 
p with him. One of them  2; · _ *‘ T     V
Ii followed a father up ] »   _ _  
  Thousand Sticks Moun- 7 ,_   [_ Ai;° ~ »
  tain one time in a blinding A 7 A   ~?.V,,  
  storm, the last few hun- _    li, [
  dred yards on all fours, he s v g _ g;‘QA}`  
  throwing the saddle bags   L · "iiyi I Q;
  up above them every few   -.~»
gp steps and both climbing    .   E s.  .
  up after.   "  N  "
  At Wendover a nurse   `       ,
  was called out at 4:30   ·  B.; `- _.
~ , . #’*r%;;se—`$?f??s.‘-.:r. _ ¤»— — * · ·. _;
A O Clock On the mommg wrorwmrv runmz AYD BABY
¤ after Christmas for a case A A A A AAAA
on Coon Creek, six miles away. The man who fetched her said
the back water from the river covered the road most of the last
mile and his horse had sometimes to swim. The nurse rode off
with him into the gray dawn. Eight hours later her horse, Nellie
. { Gray, came back dripping wet. saddle bags dangling, and rider-
i l less. If one's hair turned white every time, we should all be
, J - crowned with snow. This time the strain was not for long. Soon
· the missing nurse came down the trail. She had been dragged off
; her horse but was uninjured.
E What is this trained service of ours——the only one within
  these mountaineers’ reach? It is a group of public health
_ nurses who must be trained as midwives, as well as in nursing.

 l.
E
6 THE QUARTERLY BULLETIN   P
‘ to qualify permanently on our 'staff. At the close of our first  
two years we have ten of them. They include American-trained  
nurses who have gone to England at their own expense to take  
the preparation given nurses in midwifery there and pass the  
English Central Midwives Board examinations; and equally ‘ 
splendid English nurses, three of them from the famous Queen’s  T 
Nursing Service, who have come to help us put over in the new  
world the program which has lowered the death rate of mothers 5
and babies in the old.  
Our nurses live in centers, each in the heart of her district,  
in a radius of not more—sometimes less—than five miles in all  
directions. Such an area is approximately seventy-eight square 5
1 miles—a huge territory, and yet the nurse in the heart of such  
¥ a district is not more than five miles on horseback from her · {
farthest patient. _ A
The oldest of these centers is in Hyden, the county seat. i
There We have a loosely-made rented wooden house, with iioors 1
of one thickness of unseasoned wood, much warped, between the ’
planks of which the wind whistles all winter. But there we are  
now building a hospital. It is a charming house of the native  
stone and stands on the slopes of Thousand Sticks Mountain  
above the little county seat, looking up and down the river. The }
site was given by our Chairman, Alexander J. A. Alexander.  
i The central section of the new building is the gift of the  
Mary Parker Gill Estate of Louisville through the United States g
Trust Company, and the right section the gift of Mrs. Thruston i
Ballard of Louisville, in memory of her daughter, Mrs. David 2
Morton. A
' Wendover, our next center following the river, is my home,  
and was built in memory of my two little children. The house, I
which is big enough for administration headquarters and guest Q
house, as well as nursing center, is of logs, as are all the out- J. ‘
buildings, and the whole is so picturesque in its setting of beech it
forest that Little Red Riding Hood and Hop O’ My Thumb would ”
find themselves at home if they chanced by. Many are the S 
children and their mothers who come in for visits of varying  
lengths, to bless the timbers with their presence.  
Our third center, the Jessie Preston Draper Memorial, given l`
by Helen Draper Ayef`, of Boston, in memory of her Kentucky i
E
Q
f

 _i;@;1jggjiigsixo snavicu {
mother, we call Up River lt Beech Fork l, as it is our farthest point
up the Middle Fork. It is a white cottage with green shutters, in a
‘ forest above the stream, and has a dispensary, waiting room,
living room, kitchen and two bedrooms, with two verandas and
A0 four guest beds tucked in odd corners. Teams from this center
  take four days to go to the railroad and return.
Possum Bend, the gift of Mrs. Chester Bolton, of Cleveland,
is the last of the four district nursing centers. Situated on the
. lower reaches of the river, thirty miles below Up River, it is a
_ charming house with ample dispensary and living quarters and
* a sleeping porch big enough to serve as a ward for special clinics.
  The money for another center has been given by Mrs. Henry
  Ford.
  Our reason for existence is that America is still a fron-
’  tiersmen’s country for millions of citizens of the old stock, and
  because of that she has the highest death rate of mothers in
  childbirth in the civilized world. Fifteen other nations have a
E lower rate than ours. We lose approximately twenty thousand
$ women every year in childbirth, more than from any other cause
 g except tuberculosis. We have lost more women in childbirth in
E our history as a nation than men in battle. Maternity is, in very
Q truth, the young woman’s battlefield. Childbirth is the one basic
` fact underlying all others. No matter what we plan for the next
  __v'_--     _. —   ,_ B;.  _., N ‘‘‘‘’‘’‘     3    
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    , i     ..   ‘  i      fiil            
moriwAm mo·rm:n Ayn uma CHILDREN
li
  wi

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— §
E
‘ i
s THE ounivrmnry Bu1.1.E·1·1N  
4 . generation, it must first be born. To be born successfully is a  
» prerequisite of any career. To survive the birth of her children  
is the right of an American woman.  
What of the babies themselves for whom so much danger
and suffering is undergone? We lose in America every year .3*
approximately 100,000 infants in the first month of life from _;
causes due to childbirth, with perhaps as many stillbirths over g
and above that. A newborn baby of the old stock in America has _  
less chance of life than a man ninety years old. There is no _ 1
more hazardous occupation than just being born an American g
citizen. ·  
To know these facts should be sufficient to lead us toward fl
. an attempt at changing them in the mountain wilderness so ii
close at our hand. This is what a group of us in Kentucky ?’
thought between two and three years ago when we organized .
this Kentucky Committee for Mothers and Babies, and declared ;
our purpose—"To safeguard the lives and health of mothers  
and young children by providing trained nurse-midwives for il,
rural areaswhere resident physicians are few and far between- ·l
these nurse-midwives to work under supervision; in compliance _ ,)
with the Regulations for Midwives of the State Board of Health,  
and the law governing the Registration of Nurses in Kentucky; i_
and in cooperation with the nearest medical service."  
With stirring resolutions proposed by Mrs. S. C. Henning, of  
Louisville, we formed and later incorporated our association. We  
had found by patient study that the fifteen other nations with  
lower death rates than ours had no better medical or nursing  
services, if as good, in their centers of civilization, but had one * 
and all something which we totally lacked, and that was a skilled Z 
service of trained midwives for every peasant mother in Pyrenees  »
and Alps, Highlands and Apennines. These midwives, trained in  
the centers of civilization by the obstetricians, and supervised,  
are ableito reach the remotely rural mother, who is otherwise i' 
without skilled care. `
_ We found thatthis work, so highly specialized on the con- Q
tinent of Europe, is in Great Britain, especially in isolated posts,  
usually grafted on to the nursing under the Florence Nightingale  
traditions. We have adopted this generalized system, which in- ‘ * V
sures skilled nursing for the sick, and preventive hygiene, as well i
i l

 i
§
  4
i
  1¤i>.om·1ER NURSING smnvicn 9
  as maternal and infant care. We use the Scotch Highland method
  in local formations. We select a District Nursing Committee
Q from among the leading mountaineers in the area covered by
ly each nursing center. This committee meets monthly at the cen-
  ter to hear the nurses’ report and advise with them. They have
  stood between us and many mistakes. They help in other ways.
{ Boyd Campbell, the chairman of the Possum Bend Committee, at
? Confluence, raised over $500 in supplies and labor and cash from
_` i seventy-six neighbors to help build the nursing center there.
g In fees we follow the Scotch Highland method of a small
  yearly charge which insures nursing care for a family, and we
gl charge a $5.00 midwifery fee, which is often paid in fodder for
  the horses or by the 1iusband’s labor. Sometimes we carry an .
  account which is afterward repaid us-—for instance: One of our
, Hyden Committee, a very responsible man, had a grown son
. needing hospital care in Lexington. We paid the bill for him at
V} St. J oseph’s for six weeks in the spring. It came to over $60.00.
  The following October the father repaid us every penny in cane
.l hay delivered in our barns. St. J oseph’s Hospital didn’t need the
Y hay. We did. By carrying the account until the hay was gath-
* ered we got the boy under treatment in time to restore him, and
s preserved the father’s sense of personal integrity.
I Due to the appalling scarcity of medical service in our coun-
Q try districts, we have been asked by the State Board of Health of
  Kentucky, whose chief, Dr. Arthur McCormack, has been our big
  friend from the beginning and is one of our trustees, to give
  hookworm treatment and inoculate against typhoid and diph-
*  theria. Because we render our neighbors essential services in
E  hours of pain and danger,_and because their leaders are on our
 » district committees, theypooperate with us in this preventive
  work. Such has been their response that during thesfirst two
  years since our nursing began we have given 6,360 inoculations
i'  against typhoid andtdiphtheria alone, and have practically elim-
` inated these two preventable diseases from the area we cover.
%· Through the generosity of the Louisville `and Nashville Railroad,
  which furnishes passes for our patients and their nurses, and of
  our leading Louisville and Lexington doctors, who give their
i V services, we are enabled to take special cases down out of the
l mountains for treatment in the city hospitals.
1
•

 3
L
10 THE QUARTERLY BULLETIN  
is
` Enough has perhaps been written to show that we are ren-  
dering an essential service, not only to maternity and infancy,  
which are our primary objectives, but to a whole population of  
the most sterling people in America today. The thing we want gg
our friends to understand is that we get great fun doing it. When  
they struggle in to see us they are struck with the happy, eager
faces of our nurses. Just at the moment of writing, one of these  Q
has been moving from the one-room log cabin she has occupied  
in the Possum- Bend District, since July, into permanent quarters  
which are not yet complete. She reports: , 
"Yes, we are in, among the shavings, but in. The rains and Q 
wind beat in the cabin last night so badly we were almost floating ,f·
_ into the river. So Van and I decided, at 3 A. M., to race a tide __
V and cart our belongings into the center. So here we are, at least  
dry, and our horses under shelter. I wish you could have seen us  
` loading our ‘plunder’ and wondering if we could make another i°;_
load before the river rose too high. We managed to get in three  
loads, leaving one for when the river went down. Lady Jane and ,
I finally made our way swimming, but nevertheless we made it. Q
The new house is the most beautiful ever built."  
The nurse had never ridden in her life when she came in 1
twenty months ago. Her horse had to be led for her the first few
miles after leaving the railroad. Now she takes quite casually I
swimming away from one home to another in November at three "
in the morning on our friskiest animal, the redoubtable Lady  
Jane. Such is the personnel of the Kentucky Committee for _Q
Mothers and Babies. The governing body of the Committee is  
convinced that no iiner group of women than these nurses were  J
p ever assembled, and one of Uncle Sam’s officers, who has twice  pr
been up to see us, calls them the "Marines." fi
There is everything in the goal one sets out to reach.  _
"He whom a dream hath possessed,  
treads the impalpable marches,  X
From the dust of the day's long road,
he leaps to a laughing star."  
' I
l
I

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V V SOMI·: OF TIIIC STAFF OF Tru-} FRONTIER NYRSING sI·:R\’IC1·1 IN A TYPICAL
 _ A- » SOUTIIIGRN )IOI‘NTAIN SETTING
 I Nurses On Horseback
A (Abridged)
.V  by
f  EDITH REEVES SOLENBERGER ·
 I PUBLISHED IN I-IY@EIA—JULY I93I
I . ,
E The Frontier Nursing Service has set out·to provide nursing,
f .A public health service and midwifery under medical direction, and
  also dentistry, for the remotest sections of the southern moun-
II tains. Its work began iive and a half years ago with two nurse#
L; midwives in a remote Kentucky country in which in an area 50
 AV  miles square [over 2,000 square miles] there was no resident
 I physician for a population of 10,000 people. The Service now
  has twenty—eight nurse-midwives, its own physician, in coopera-
{ tion with the state health authorities, and an affiliation with an-
I
I
I

 T i
 
12 THE QUARTERLY Bunnmiu  
· other doctor maintained by a medical mission. For six months  
of the year it has a dentist, in cooperation with the state health  
authorities. i
The country is a veritable frontier—no railroads, no automo-  
bile roads, no bridges over its rivers and creeks. It is difficult for  
outsiders to realize how utterly remote are some of the farther  l
pockets in this region of many streams and narrow valleys be- Z
tween steep, wooded hills. One would be put to it to lay out a  
golf course or even a croquet set within the 375 square miles of  
Leslie County, where the service began, and would find it only a  
little less difficult in most parts of the adjoining counties of Clay  
and Perry into which the service has expanded to cover a total Q
of nearly 1,000 square miles. Land usable for farming is so scant l
R that the people are very poor. Timber, white oak and black wal- 'E
nut, is the cash crop and is floated out in rafts on the "tides"  ‘
which come to the rivers with the melting snows in the spring.  
The mountaineers for whom the doctor and nurses work,  
and among whom they live as neighbors, are all of old American
stock; their ancestors came south from the older colonies long Q
before the American Revolution. Most of them were of English, ‘
Highland Scotch or Scotch-Irish descent, with a sprinkling of ,q
French Huguenots. They have been long immured from contact .~
with the industrial development and varied immigration that -
have transformed other sections of the United States. Their con-  
tinued use of old English words and phrases and the preserva-  
tion of folklore and ballads forgotten in England itself have fas-  
cinated many friendly observers like the Americans, Dr. and  
Mrs. John C. Campbell, and Cecil J. Sharp of England, who col-  '
lected a thousand old British ballads still sung -in the southern 1 
mountains.  »
The mountaineers present a definite physical type+tall, lean, ‘  
of great endurance, in temperament self-reliant, highly individ— ’_ 
ualized, scorning charity, deeply religious and as closely inter-  
ested in discussion of theological points as any native Scot. They it
have a real dignity, which includes friendliness toward those vis-  
itors who do not adopt a patronizing air. The men are almost in-  .`
variably skilled marksmen; in all American wars they have been  
notable soldiers; that is, notable as "dead shots" and for courage it
and initiative, but sometimes worrisome to superior officers be- 5
· é

 F
1
I
Y Fnonrma Nuasme smavicm is
  cause they disliked routine drill and were homesick for mountain
t air and water.
* The Frontier Nursing Service was started in 1925 by Mrs.
  Mary Breckinridge whose family background and experience
?  gave her an easy approach to the people she wished to help.
  She prepared for the work by general nurses’ training at St.
 ' Luke’s Hospital in New York and later