xt7h9w08xm4z https://exploreuk.uky.edu/dips/xt7h9w08xm4z/data/mets.xml The Frontier Nursing Service, Inc. 1986 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 Frontier Nursing Service Quarterly Bulletin, Vol. 61, No. 1, Summer 1986 text Frontier Nursing Service Quarterly Bulletin, Vol. 61, No. 1, Summer 1986 1986 2014 true xt7h9w08xm4z section xt7h9w08xm4z 3 1
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US ISSN 0016-2116 Q
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CONTENTS  
EDITORIAL: “Notwithstanding" —— by Dauid M. Hatfield 1 I .
The Birth of the Hontier Nursing Service — the First l i
Words, the First Steps 3
Introduction (from FNS Quarterly Bulletin, Vol. 1,
No. 1, June 1925) — by Mary Breckinridge 3 `
The Survey (from FNS Quarterly Bulletin, Vol. 1, No. 2, ,
October 1925) —— by Mary Breckinridge 4 é
Miss Ireland’s Report (from FNS Quarterly Bulletin, Vol.   i
No. 2, October 1925) — by Miss Bertram Ireland 5  
Louisville Committee Visits FNS — by Sharon N Hatfield 11
“Health System Clerkship" — FNS and UK Join in a Program
of Field Work for Health Students — by Sharon N
Hatfield 12 l
Beyond the Mountains — by Ron Hallman 14
Honors Presented to Kate Ireland, Ruth Lubic, and David
Hatfield 15 {
Notes from the School — by Ruth Beeman 16 i
FNS Mourns Fred Brashear, Assistant Treasurer and
Long—Time Friend 17 .
Ron Hallman Returns to FNS as Development Director 17 i
In Memoriam 18 .
Memorial Gifts 18
Field Notes 19
FNS Director David M. Hatfield Delivers "State of FNS"
Address at Annual Meeting 21
Courier News Inside Back Cover i
SIXTY-FIRST ANNUAL REPORT OF THE FRONTIER NURSING SERVICE, l
INC., for Fiscal Year May 1, 1985 to April 1986 28-45
Cover: This early photo shows the beautiful but challenging terrain covered by Bertram
Ireland and her assistants in their famous survey of Appalachian health needs in 1925. Miss
lreland’s account of the survey, reprinted from the second issue of the Quarterly Bulletin,
begins on page 5 of this issue. Photo by Caufield and Shook.  
i l
1·'1
and how they will interact and, most importantly, cooperate in moving our ‘
common efforts forward into different or expanded programs will be one of
the most difficult tasks before us over the next few years.
To me, organizations are like humans in that they have a beginning, a  _
lifetime, and an end. But, unlike humans, organizations can live on beyond
our lifetimes by adapting and changing to meet new and ever changing
demands, requirements, and challenges.
The life cycle of the Frontier Nursing Service is still moving ahead. Its · l
past missions and traditions will continue to drive us and require our
adherence to the high purposes established by Mary Breckinridge
throughout the still young history of this most unique and important  l
organization.
And so, FNS must once again sound Mrs. Breckinridge’s heraldic  
"notwithstanding” — but in two senses. "Notwithstanding" its history of
service, it must look for new ways to serve. Yet, "notwithstanding" its new
circumstances, it must never give up its commitment for caring that Mary
Breckinridge proclaimed years ago. It will be a challenge to reconcile these
two objectives — but FNS has made a career of meeting challenges.
— David M. Hatfield, Director
Frontier Nursing Service
A typical Appalachian cabin, much like those
visited by Bertram Ireland in her 1925 survey.
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 QUARTERLY BULLETIN 3
i THE BIRTH OF THE FRONTIER NURSING SERVICE
— THE FIRST WORDS, THE FIRST STEPS
F l For the sixty—first time, the Quarterly Bulletin presents, in this issue, the
annual report of the Frontier Nursing Service. But this report is different.
It is the last one that reflects FNS’ traditional organizational structure. As
FNS Director David M. Hatfield has noted in his editorial, and explained
A · in his "State of FNS" address to the annual meeting, the Service has
decided that, in order to meet the changed needs of the times, it has become
necessary to "restructure" the FNS organization. .
It seems a fitting time to look back to the beginnings of the Frontier
_ 4 Nursing Service, and we have chosen to do this by reprinting excerpts from
1 the first two issues of the Quarterly Bulletin. We begin with the very first
V words of the first edition, which was published in 1925. These are from an
~ "Introduction" written by Mary Breckinridge, which presents the rationale
for creating the Frontier Nursing Service in the first place.
We follow that with an account of the famous survey made that same
year by Miss Bertram Ireland (known as "Ireland of Scotland"). Miss
Ireland, assisted at times by others, rode through the "hollers" and over
the mountains of Leslie County and the surrounding area, interviewing
the mountaineers in order to determine their health needs and to provide
information that would guide Mrs. Breckinridge in planning the health
services that would be needed. The article we reprint is Miss lreland’s
report on how that survey was carried out. It was originally published in
the second issue of the Bulletin. We feel it is especially interesting today,
not only because it is an adventure story ofa special kind, but also because
that survey was a remarkable demonstration ofresearch, problemsolving,
and planning, paralleling the kind of research, problem-solving, and
planning that FNS is doing today, in a very different environment, and
with very different means.
Yet both undertakings had the same objective — to determine how best
to serve the health needs of the community. Taken together, they reveal
‘ both the timelessness of the FNS mission and the very natural process by
which organizations, like people and civilizations, perpetuate themselves
through rebirth and renewal. We feel that these two articles, written sixty-
one years ago, provide a valuable perspective on FNS’ mission in
Appalachia, both then and now.
—. From the FNS Quarterly Bulletin, Vol. 1, No. 1, June 1925:
. INTRODUCTION
  [by Mary Breckinridge]
' Notwithstanding the advanced public health work done in many parts
of the United States, which has resulted in the prolongation of human
, life and greatly decreased mortality from preventable disease, statistics
show that our mortality from childbirth is higher than in any other
civilized country. The sixteen other countries that have lower death
rates have no better medical and nursing service than ours, but they all

 4 FRONTIER NURSING SERVICE
have what we conspicuously lack, a large body of qualified midwives, °
trained and supervised. Although we also use midwives for about thirty
per cent of our confinements, we have not brought them abreast of the
times except in one or two of the large cities. So that while we could not
conceive of eighteenth century surgery for our young soldiers, we
continue to supply eighteenth century obstetrics to our young mothers, ~
and have lost more women in childbirth in our history as a nation than
men on the field of battle, and over a hundred thousand of our youngest  A ·
and most defenseless citizens pass annually from one dark cradle to
another with hardly a gap between. `
The same system that has effected such marked reductions in the ? ·
maternal and infant death rate in other countries, viz: that of  `
substituting trained and supervised midwives for untrained ones, 4
could effectively be used in meeting the needs in our isolated rural
areas, especially as carried out in Great Britain with its similar
language and traditions. In England the Queen Victoria’s Jubilee
Institute for Nurses had a maternal death rate in 1923 of only 1.4 per
thousand, in the 54,554 confinements attended by their nurses — who I
are trained as midwives — the lowest rate on such a large scale in the A
world. Splendid work of this character is also being done under the
Scottish Board of Health, in the Highlands and Islands of Scotland.
In many parts of rural Kentucky are to be found pure Anglo-Saxon
folk, living under conditions similar to their kins—people in the British _
Isles, but entirely lacking the trained service described above. 1
Mrs. Breckinridge’s "Introduction" leads, in that first issue ofthe Quarterly
Bulletin, into an account of the first meeting of the Kentucky Committee
for Mothers and Babies — the name under which the Frontier Nursing
Service was originally founded. It is an interesting narrative, and we wish
we had space to reprint it. However, we feel that the report of Miss Ireland’s
survey is of greater interest today, and we reprint it in its entirety,
preceeded by several introductory paragraphs written by Mrs. Breckinridge. ‘
From the FNS Quarterly Bulletin, Vol. 1, No. 2, October 1925: .
THE SURVEY I
[by Mary Breckinridge] 4
This [i.e., the survey] was placed under the direction of Miss Bertram  
Ireland, of Scotland, who has been so highly endorsed by Sir Leslie
Mackenzie for similar work in the Highlands, and was lent to us for the
summer by the Committee on Maternal Health in New York. In all, six
other workers carried on this task under her directions and have just
brought it to a close, after covering every inhabited creek and branch in j

 QUARTERLY BULLETIN 5,
the county, and crossing every inhabited mountain —— visiting every
house and 1,635 families. The data has just been turned over to the
State Board of Health and when Mr. Blackerby and his statisticians
have it tabulated we will know, as accurately as it can humanly be
determined, the birth and death rate for our unit often thousand native
born American mountaineers, and more especially the maternal and
I infant death rate.
. . It would be hard to exaggerate the difficulties of this survey. Often
_ those making it slept wherever darkness overtook them in rooms  
  crowded with other people, but in homes too hospitable to turn them off l
 , . after nightfall. Because of the drought and failure of crops there was
  not the usual variety of food — corn bread and apples being actually the
A only fare in one cabin — and horses’ feed so scarce that in one part of
the county we had to have it hauled twenty—five miles from the railroad
in advance of our survey. The horses met with many mischances. One
worker hitched her horse, Sandy, above a precipice to the only tree and
continued an ascent she judged too steep for him, only to turn and see
‘ Sandy and the tree disappearing over the mountain together. Another,
  dismounting at a rough gap, stepped on a long snake, who, liking the
contact as little as she, they quickly parted. To her horror she stepped
on him again, and then a third time in her hurried retreat, so that, in her
own words, she "danced a jubilee on that old snake all the way down
  the mountain."
MISS IRELAND’S REPORT
[by Miss Bertram Ireland]
The mountain county selected to be surveyed (Leslie) measures about
» 376 square miles, and comprises about 10,000 inhabitants; but the only
_ sure way of understanding the distribution of the population and the
. nature of the country is by scrutinizing the detailed map issued by the
 _ ·· Geological Survey Department a few years ago. On it is marked, with a
· high degree of accuracy, every contour, river, fork, creek, branch and
house. There is no large community in Leslie County, the chief being
i 300 inhabitants in Hyden (the county seat) and the next being 100 at
Ev Wooton, which means that the bulk of the population is scattered up
» and down the valleys and on the hillsides. The only means of transport
is by horse or muleback riding, mule wagon, or by walking, as roads,
bridges, and railways are unknown in the county.
Largely because of such conditions, complete registration of births
and deaths has never been achieved, and it was in order to supplement

 6 FRONTIER NURSING SERVICE J
the information obtained during the last fifteen years that the present  i
survey was undertaken. Then on its completion, with the cooperation of I
the State Board of Health, the data desired by your Committee with ,
regard to the number and causes of deaths among mothers and babies I
will be available.
As we found, it was quite impossible to estimate with any degree of
accuracy, just how long it would take to survey the county. Skilled city  .4
census takers, judging largely by the number of families to be seen, ·
thought that it could be done within two months, while the local _
residents consulted said, either pessimistically, "It is no work for a
woman; it is a lifetime job you’ve got" or optimistically, "Oh, it won’t  , ¤
take too long." Very quickly it was realized that, there, the unexpected - 
happens so frequently as to be almost monotonous. It was an unusual _
day that did not present a special problem, and the heart-easing
philosophy and self·protecting humour of the mountaineer were not to
be attained by us all at once. We had not learned to say with those who
live under the soothing influence of the eternal hills "I’m in no hurry
today" and it was only after many such incidents as finding that
someone had mistakenly gone off with our horse blankets or even our ci
horses, that the mail wagon had not been able to make room for our
anxiously expected equipment, that rain very quickly made our chosen
route impassable, or that our and the local ideas of distance were not .
compatible, that we began to acquire the requisite placidity and
balance of spirit. In my first week, there was a "tide" due to flooding, ’
and while it was a highly welcome opportunity for the loggers to get -
their timber down to market before prices fell during the summer, it
confined me on a small island for four days and allowed of not more I
than half a dozen families being visited. Later owing to shortage of
oats, my horse was given a "green feed" which, together with his being »
out in a severe hail storm the same day, gave him colic so badly that he
could not be ridden for two days. At other times, new horses reckoned ‘
on for immediate work, turned up "barefoot," which involved waiting i
until the soreness had gone before they could be ridden. And it was `·¥
wonderful how the horses’ feet always seemed to need some special
attention just where blacksmiths were not. I had been warned that ,
although it was not dangerous were a hind foot shoe to become loose, it  Mi
was highly dangerous if a front shoe lost any of its nails, as the hind i
foot might catch in the loose front shoe, so you can imagine my feelings  i
while at work one morning, when on hearing a strange noise, I saw half
of Rick’s right front shoe swinging from his hoof. His feet had been
overlooked the day before; it was a very wet morning, the nearest
blacksmith was "away to the railroad", and there were two mountains

  l QUARTERLY BULLETIN 7
 ’ to be crossed before dark. But back we turned, down the stony creek,
‘ until a man was found who mended matters with his pocket·knife,
= some nails and a hammer, using the emergency shoe always carried in
‘  the saddle bags.
‘ From my twice having mentioned rain storms, you may think it was
y a wet season, with rivers and fords running high. On the contrary, it `
._  was said to be the dryest, hottest summer experienced by living
‘ mountaineers, and water for drinking and washing became scarcer i
  every day. Most of the branches and creeks and wells were empty by the `
time I "came out of" the mountains, and, on my last ride of sixteen i
' miles to the railroad, my horse scorned the stagnant, green water of the
 { Middle Fork. One of the saddest features of the drought, apart from
burned up corn and stunted fruit, was the insufficiency of water for the
canning of winter supplies. And at the mission center which exchanged
clothing for vegetables and fruit (used in its Dormitory) it was feared
that the "traders" families might go cold during the winter as they felt
they had so little to exchange and were apt, therefore, to discontinue
I trading.
A This feeling of fairness, or nothing for nothing, impressed us as we
e went about the county. When it became known that there was the
I probability of an increase in the number of nurses in the county, we
  were almost embarrassed with offers of land and timber and workers if
  only we would establish a nursing center "right here on this creek."
i True enough, it was needed "right here", almost everywhere, but all we
could say was "eventually, there will be a center for each neighborhood.
Meantime will you give us the information that will help to make our
Y plans a success?" And in return for that, we tried to give satisfaction to
those who were sufficiently interested to remark "I don’t think I’m
acquainted with you, I guess you are a stranger in this country?"
, "Where do you stay?" or "You don’t look like you were married?" or
. "Mebbe you get $100 a month for doing this"; or "Did you ever have to
 _ hoe corn?" or "I’ll bet you never carried wood on your back?" Yes, we
i carried wood, drew water from the well, saddled and groomed our
. horses and took stones from their shoes, all under the critical eyes of the
. 4 practised mountaineer, but never quite up to his way of thinking, I
=, imagine!
{ At this point, it should probably be explained that after about three
weeks’ work, it was obvious that I could not complete the survey in the
two months at first thought ample. In the first week, the "tide" was
accountable for a certain amount of delay, next week the heat made
progress slow, and the third week Rick’s colic held me up, but we were

  ‘
  I
learning that similar happenings would have to be reckoned with in .
the future. It seemed advisable, therefore, to seek help if the survey were ·
to be finished during the summer and we were indeed fortunate to meet  
Miss Zilpha Roberts, a mountain teacher, born in Leslie County, who A
gladly gave us two months of her time. Miss Roberts has an intimate A
knowledge of the more remote parts of the county, and is a quick
worker, so gave inestimable assistance; but even she, after a few weeks’ I 4
continued surveying, practised rider as she is, said that "the next }
census should be taken by aeroplane and parachute!" But I do not {
know, with a little experience of both, whether aeroplaning would be
any less rough than riding up and down the creeks and branches of 3
Leslie.
"It’s a rough country this, and we’re a poor people, but there ain’t a  T
cleverer on the face of the earth" was a phrase we heard almost daily,  ·
and heartily endorsed. With regard to the first part of the phrase, there  5
was no denying it, so far as the travelling was concerned; but, `
frequently, in conversation, I compared the good fortune of the » 
mountaineers in having such abundance of timber, coal, fruit and V
sunshine, etc., with that of the Scotch Island Highlanders, whose  _
existence depends so largely on the season’s supply of fish. That drew  .
forth not a few expressions of envy, such as that voiced by a thin, tired,  Q
hungry-looking mother who had lost two sets of twins and had a living  
family of seven, "Oh, I should like that, I haven’t had a mess o’ fish in  
years." These mountain people seemed to enjoy hearing of mountain- ·
eers of another country and other ways, and I believe I convinced some .
of them that theirs was not the poor country they felt it to be. To the
phrase in regard to their "cleverness" we had nothing but assent. It  .
was apparent that locally the term "clever" retains its old meaning of __ 
generous, hospitable, or ready to help, and as I look back on the number  I
of questions we asked (many of them necessarily bringing back sad I
memories) and on the number of people interrogated, I cannot recall  ‘
one instance of anything but consideration, patience and helpfulness. —=
(True, I retired hastily from a house where a man approached me while  
drawing out his huge pocket knife, but, on looking back, I saw him I
attacking — a cabbage!) To recall dates — days and months and years  
— of events covering a period of 15 years is no easy task for anyone, but  
especially difficult where calendars and diaries and marriage lines and _
birth certificates and burial permits and newspapers and vacations I
and even clocks are sufficiently uncommon as to be of little help in ;
marking the passage of time. Where the births and marriages and i
deaths had been "sot down" in the family Bible (not the one that "had L

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A  Although Marvin Patterson did not record this scene until several years after the Ireland
 I survey, it is doubtful that it is much different from what the surveyors encountered in their
 I travels throughout Leslie County and the surrounding area.
 . not been used for 10 years") our interviews went along quickly enough,
 I even though each page had to be scrutinized in case of a stray entry; but
{ where some loose sheet of paper or an old notebook or even a store
 ’ catalog had to be hunted up from a certain old box kept in the depths of
U a trunk, or when memories had to be relied upon and consultations with
  the whole assembled family were necessary, we had to try to forget our
l fear of not getting over the next mountain in daylight. The memory of
tales of dark nights when wild cats cast themselves on the heads of
, tired travelers, or of snakes seen to be slithering along the bridle paths,
. always plagued me on such occasions! But sooner or later, the details
T wanted were forthcoming and the forms supplied by the State Board of
Health were duly filled, and the interview invariably closed with the
 ’ invitation "don’t be in no hurry, I’ll fix you a bit o’ dinner and then
gi: you’ll make the night with us." Many a time, the invitation was gladly
  accepted, and, on other occasions, the non-acceptance was excused
ly only on our explaining that the more speed we made, the sooner the
( county would have its new nurse-midwives. I shall never forget the
  quiet spontaneity and cordiality with which I was treated, especially
on one occasion. I had attempted to cross a mountain by a path
 l unmarked on the map and known only to those living near. After
I repeated directions I missed the path twice, once in time to return to get
 2 renewed instructions, but the second time, several miles from any
. habitation. Fallen trees were everywhere, the mountain was steep and

 10 FRONTIER NURSING SERVICE J
stony, and a snake fence seemed to surround me. The branches were so V
low and so thick that I had to dismount, and lead the horse, and, oh! the L
spiders’ webs and hissing in the grass! On and on we wandered until,  _
most reluctantly, I decided to try to retrace my steps so as to gain the
valley path; but that was easier said than done, and, to add to my i
feeling of fallen pride, I let a branch swing back very hard hitting the I
horse in the eyes. Poor Rick, however, took that blow as patiently as he
took all my other amateur handling, and soon after we turned to go ·
back, the path in the right direction became apparent. So down we
went, until we came to a house where I was only too glad to comply with
the hospitable greeting "git down, come in and git ye a char, I’ll hitch <
your nag". Then followed much kindly conversation. I was given a
hearty meal and the horse had food and his eyes bathed — all of which I
cheered and refreshed us and made us entirely fit to “carry on."
Towards the end of July, Miss Caffin and Miss Rockstroh, the _
Committee’s first nurses who are to be stationed in Leslie County,
joined us and at once consented to help with the survey before
beginning their own particular work. Unfortunately, it was necessary
to ask this of them; but the statistics sought were required partly as a .
basis for their activities, and partly as a basis for their location, as, by
means of the survey, it was possible to judge of the most necessitous
districts, ofthe most appropriate sites for the first nursing centers, and ‘
of the existing disease and death conditions. Numbers of families I
within a certain area, facilities for reaching these, distance from l
railroad, availability of good water, all were noted and considered, and
will weigh with the Committee in its decisions. By this time, the whole
county was interested in the proposed scheme and everyone was eager
to give assistance. One of the most immediately valuable offers came
from Miss McCord, Head ofthe Presbyterian Board for Home Missions