xt73r20rs65g https://exploreuk.uky.edu/dips/xt73r20rs65g/data/mets.xml The Frontier Nursing Service, Inc. 1977 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. 52, No. 3, Winter 1977 text Frontier Nursing Service Quarterly Bulletin, Vol. 52, No. 3, Winter 1977 1977 2014 true xt73r20rs65g section xt73r20rs65g VOLUME 52
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US ISSN 0016-2116 V
. §·
Published at the end of each quarter by the Frontier Nursing Service, Inc.
Wendover, Kentucky 41775 Q
Subscription Price $2.00 a Year ,
Edit0r’s Office, Wendover, Kentucky 41775
Second·class postage paid at Wendover, Ky. 41775 and at additional mailing offices  
Send Form 3579 to Frontier Nursing Service, Wendover, Ky. 41775  
Copyright 1977, Frontier Nursing Service, Inc.  

A New Look Compiled by Peggy Elmore, 3
At The Districts (Illus.) Jim Fulmer and Gabrielle Beasley
 ‘ Photographs by Gabrielle Beasley
 { The Districts Develop 3
~  _ The Horseback Days 5
in A Promise of Growth 10
.   District Clinics in 1977 16
  Conceptual Vignettes of
_ District Family Care 26
 . Care in Community Settings 31
  The Physicians Speak on the
~ , District System 41
,  Our Gals Friday 50 5
  Center Maintenance 52 i
 , Buckhorn and Cutshin Clinics 54 {
 ` Social Service in the Districts 58 `
  The Impact of Legislation on
‘ District Nursing 59
  Beyond the Mountains 77 E
 2. Field Notes 87 `
 t’ Health Care Legislation
__  and Philanthropy Theodore Cooper, M.D. 81
  Old Courier News 65
  Old Staff News 71
  Once Over Lightly W. B. R. Beasley, M.D. 2
 n Urgent Needs 64
 [ Yesterday, Today, Tomorrow Anne A. Wasson, M. D. 69
Brief Bits
 - A Letter From The Assistant
.. ` Surgeon General 68
 ‘T_ A Letter We Appreciate 53
 ° Change Should Breed Change (Verse) William Drummond 63
_ Family Planning 85
{ Mary Breckinridge Hospital
;·  Accredited . . . 76
  "Neither Rain, Nor Sleet . . ." 67
,  N urse—Midwives Listed
ig by MEDLINE . . . 67
  On Building a Center Gladys M. Peacock 62
 N Radio Spots Jim Fulmer 70, 75, 86
i White Elephant 88

This special issue of the Bulletin concentrates on FNS district
nursing. Its philosophy, our past and present record, as well as our
present problems in providing health care to people in their homes
and in district centers are reviewed (page 10). The pattern of
family care has changed from the horseback days to the Jeep and  j
Volkswagen days; the distribution of the centers changed as  ‘
roads made hospital services more accessible and as the  
Buckhorn Dam obliterated two centers. A delightful and infor-  
mative recollection of early district days by Betty Lester, "The Ti
General", appears on page 5. El
The principles of personal family care still dominate our `
district nursing centers but legislation, restrictive in its reim-
bursement mechanism, has wrought some temporary changes in
district services. These restrictions and modifications are
reported in conceptual vignettes, in the physicians’ perception of
the district system, and in Dr. Isaacs’ article on national
legislation. B
The response of FNS committee members to our request for
help has been great. Committee members are seeking support of
their congressmen for expanded national legislation, such as Mr.
Rostenkowski’s H.R. 2504. This and similar bills will enable the
reimbursement of our district nurses for home and clinic visits in
preventive and maintenance care.
We have been assured from our State Capital that the
mechanism for reimbursement for services provided by family
nurses to Medicaid patients will begin in July. *
Rejoice with us that the Mary Breckinridge Hospital has ’
received full accreditation by the Joint Commission on Hospital .
Accreditation (page 76).
We will continue our invitation to President Carter to visit the
Frontier Nursing Service; a letter from the Assistant Surgeon  
General relates to this (page 68). Q
Dr. Theodore Cooper’s speech (page 81) on the vast impor- E
tance of private philanthropy in health care, to be coordinated ,
with basic government support, epitomizes FNS’s position in
providing health services. FNS was brought into existence by gf.
Private Philanthropy, which is, in Mrs. Breckinridge’s words "the
finest flower of free enterprise." We need and must utilize '
government support for the provision of proven services; we need .
the philanthropic donations for the innovations in service and  
education which have not yet received the stamp of approval by  
public monies. `
U/· G . QDRLKY  
—W. B. R. Beasley, M.D. _

The Districts Develop
I , . "The Frontier Nursing Service has come into existance in order to
7 provide a district nursing, midwifery and child hygiene service for the
  inaccessible, difficult areas, mostly in the mountain ranges. Its
T4 boundaries are topographical and not artiiicial. It works on a regional
gl and not a county basis, and divides its nursing areas into districts, every
·= part of which is accessible to its own nursing center. The rural sections
need visiting nursing, on a district family basis, much more than cities
need it, because they have less of everything else."
—Mary Breckinridge `
Quarterly Bulletin of The Frontier
Nursing Service, Inc., Vol. IV, ,
No. 4, March 1929 {
The work of the Frontier Nursing Service began in the summer l
of 1925 from a small house in Hyden which combined an
outpatient clinic with living quarters for the first two nurses,
Edna Rockstroh and Freda Cafiin. Patients came to the clinic and
the nurses went into the homes of the patients, thus establishing  
the pattern of care which has continued for nearly fifty-two years. %
In 1925, Mrs. Breckinridge built her own home (the Big House
I at Wendover) in Leslie County. Inside there was a bedroom for the I
’ district nurse-midwife and a small outpatient clinic. The six
* outpost nursing centers followed shortly thereafter. "In building
our outpost centers," Mrs. Breckinridge noted in her
j autobiography, "we located them from nine to twelve miles apart
  so that where one district nurse-midwife’s territory ended another
  district nurse-midwife took over .... In developing the area
_ coverd by the FNS, we followed the waterways, the natural
, · arteries of travel and trade in our part of the world."1
ilk These district centers had many things in common. No center
, was begun without an invitation from leading citizens of the area
_ who offered land, labor, timber and stone for the construction.
Q  They were located near the center of the area to be served and were
  comfortable buildings with plumbing and central heating, a large
I  living room with an attractive stone fire place, a kitchen and three
_ or four bedrooms for the staff, and a clinic and waiting room for
 . the patients. And, with one exception, their construction and
T development was supervised by that indefatiguable pair of nurse-
. midwives, Peacock and Willeford!

 4 FRoNT1ER Nunsmo smzvics
"Gladys Peacock and Mary B. Willeford had been with us
about two months, in 1926, when I told them to go up to Beech Fork
to open up the district there and build the nursing center. They
said that they knew nothing whatever about building. I replied
that neither had I known anything about it when I built F 
Wendover. If I could learn by doing, so could they. Peacock and iz “
Texas rode off with the light hearts of those whose ignorance is y
That first center, Beech Fork, was an experiment—it was a rm
ready-built house (in pieces) complete with plumbing and instruc-
tions. It took twenty-four mule-drawn wagon trips four to five
days each to make the sixty-four mile round-trip from Beech Fork
to Pineville to unload two freight carloads of house. Even though
there were three pieces left over, the center still stands—but that
was the last time that FNS ever tried that kind of construction!
The other centers were built with local materials, by local
While nursemidwife Ellen Halsall was supervising the open-
ing of the center at Confluence*, Peacock and Willeford went first
to start the Center at Red Bird, then at Flat Creek and, finally,
built the centers at Brutus and Bowlingtown*, eleven miles apart,
simultaneously, in the summer of 1930. Not only did the nurses
cope with construction but, at the same time, they organized the
district committees, gave bedside nursing care to the sick, and
delivered babies.
—-Peggy G. Elmore
’Wide Neighborhoods by Mary Breckinridge, Harper & Row, Publishers, page 229
Zlbid, page 231 Q
*When the Buckhorn Dam was complete in the late 1950’s, the Margaret Durbin
Harper Memorial Nursing Center at Bowlington, the gift of Mrs. Hiram Sibley of '
Rochester, New York, in memory of her Kentucky-bom mother, and the Con- ,
fluence Center, the gift of Mrs. Frances Payne Bolton of Cleveland, had to be  
closed. The Bowlington Center was relocated on Wolf Creek in Leslie County and Q
the money from the sale of Confluence Center to the govemment purchased Bolton °
House on Hospital Hill in Hyden as a residence for an FNS physician. The Wolf ‘· 
Creek and Wendover District Clinics were closed in October 1976.  
"To me, I really admire FNS because of the long-standing
tradition it has and the reason it was developed—for mother and
child. Something like that is really needed in this area. It is really
useful." _
—A District Secretary “

 oumrmzry BULLETIN 5
The Horseback Days
Excerpts from an Interview with Miss Betty Lester
K , p Question: How did you hear about the FNS?
  Answer: When I first heard about the FNS, it was still being
  called the Kentucky Committee for Mothers and Babies. I was
_s» taking my midwifery training—well, or course, all the people in
I midwifery knew about Mrs. Breckinridge because she sent all of
her nurses to be trained in England. She had offered to pay the
expenses of any British midwife who would come and stay for two
Question: What made you interested in going to Kentucky to be a ,
midwife? l
Answer: Well, when I was taking my training, this American
nurse came and, ofcourse, all us Britishers were talking about her.
She had brought a big album of photographs with pictures of all ’
the horses and dogs and people. I got very interested because I’m {
from the country and don’t like cities very much. So Italked to the l
American nurse and said I would be interested. She told me to
write Mrs. Breckinridge who replied by sending me application
blanks to fill out when I received my diploma.
Then, of course, the story went around the hospital thatI was
going to Kentucky. Well, there was a furor. I was called into the
Sister’s office and she said, "Nurse, you think you are going to
‘ Kentucky?" So I said, "Yes, Sister."
Q "Well, do you know what you are doing? You’ve got me on day
_ duty, you’ve got the Night Sister on night duty, and you’ve got a
doctor within iive minutes of you. When you go out there, you’ve
{Qi got nobody to back you up. What are you going to do? Have you
,P thought about it?!
 , I said, "No, I haven’t really." I wanted to go and I thought that
  was it. Then when the Matron called me in and said the same
if thing to me, I really began to think I was crazy.
E So, then they put their heads together. I had only just Hnished
my training and had my 20 deliveries and all the theory, but really
was a raw recruit. Well, they knew what I was going to, because
Mrs. Breckinridge had told them. They decided I should stay for
‘ six more months and do post-graduate work. It really was a help so

 6 Fnomisa Nunsmo smwxcs
when I came, I was all right. ——I wasn’t all right, but I knew what I
was talking about! So that was that.
Question: Were you sent out on district when you arrived?
Answer: For your first delivery you always had to go out with  _
an older nurse, because we wouldn’t know what to do. Miss Marsh X; ,.
took me out on my first delivery and I was shown around. I had I  
about a week, I think, with another nurse; then she went to  
England to get her midwifery. I was just left lamenting on my  
district! I had a map and I knew some of the branches. Of course,
everybody showed me where to go. You know, people in this
country are very proud. They are also very hard working.
Question: Was it hard—getting to know the people and to work
with them at first?
Answer: They knew me because I wore a uniform with FNS on
the sleeve and had a horse—so they knew I was one of Mrs.
Breckinridge’s nurses.
Question: Did you ever just stop and visit when you weren’t
Answer: Oh, yes. I would sit on the porch with them. They
would let me go on talking and I wouldn’t think I was getting any
response at all. At the end of about a month, I was getting a bit
frantic because I didn’t seem to be getting anywhere. I told the
head of the hospital and she said, "They probably like you very
much, but they aren’t going to make an awful fuss of it ‘til they’re ‘
sure of you." Well, that didn’t help me very much! However, one
day one of the patients from my district was over at the hospital ,
and someone asked how he liked the new nurse. ?
"We like her fine, but she sure is the talkingest woman I ever .
heard." i I
So I got my reputation. I’ve been talking ever since!  
Question: What kind of records did you have to keep? "
Answer: Each family had its own folder with the name on the .- 
front and the address. We had to put down all the immunizations _
and all the visits. And, of course, everyones’ weight and
measurements, how many children, and so on. We kept very
careful track.
Question: Did you take those folders on your visit?
Answer: No, no. We had our notebooks with us. Every night,

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- i   ·
when we came in, we would have a cup of tea and begin writing on
the records. Oh, how I hated records! But they had to be done and
we had to be very careful.
Question: You were the district supervisor for a period, I
;. understand. What did that job entail?
  Answer: Well, I used to do a "round" every month. That meant
* you rode around to all the districts to see how things were going, or
I M if there were any problems I could help with. And, ofcourse, just to
l listen to their troubles and the nice things that happened. In the
p ‘l summer we would sit out on the porch and in the winter, we would
V  sit in front of the fire. If anybody needed a second pair of hands to
help with a case, or if a nurse were sick, or if the doctor needed to be
` called, I was the one responsible. Usually, I would stay the night
at a center, then ride on to the next one the next day.
Question: How long did that usually take?
Answer: Well, you can’t really visualize it now, but the centers
were about 12 miles apart. So I would do one center a day. First, I

would ride from Wendover up the river to Beech Fork, then from
Beech Fork I’d go over the mountains to Flat Creek—then from
Flat Creek to Red Bird and back to Hyden. I would see what work ·
had to be done there—answering mai1—because that was where , .
my office was, then back to Wendover, as that was a district also. ~
The second part of the rounds would cover the lower districts- '"
Confluence, Bowlingtown and Brutus. To go from one center to Q
Hyden and back again would have meant riding 24 miles in one .
day. That was too much to do frequently, so the nurses didn’t get to li `
come in to town very often. In the winter, especially, the districts  ’
were very isolated, so it was important that I got out every month `
to see what the needs were. »
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Miss Betty Lester

Question: Were there many doctors around then?
Answer: No, not here. There was Dr. Collins in Hazard who
  helped us quite a bit, but he had a six hour trip on a horse. If we had
  a real emergency it could be pretty bad. But, you see, we had to be
in able to recognize our abnormalities as soon as possible. We did not
V  A "diagnose"—because nurses did not make diagnoses in those
.   days. We made "a tentative diagnosis"! We did have rules about
wl what we could give a patient and what we couldn’t. In those days
   W we did not have all the wonder drugs, such as penicillin. We just
 - had aspirin and tonic and cough medicine and sedatives.
Question: Were most of the deliveries done at home?
_ Answer: Oh, yes. But if we thought that anything was abnor-
» mal, we would bring the patient into the hospital and call Dr.
Collins. We watched the mothers very carefully. You know how
J few maternal deaths we’ve had. We are proud of ourselves!
a If it were a normal home delivery, we would go out as soon as
  the man called us. The patient was not left until one and a half to
? two hours after delivery to make sure everything was all right. I
.j mean we couldn’t go floating around anywhere we wanted while Y
y the patient was in labor. If we kept bobbing up and down to the
_ home on our horses, the poor creatures would be dead. So we
g· stayed, sometimes 24 or 30 hours, at the home. The second stage
i . might go on a long time, so we would stay and pray and eventually
  get the baby. If the delivery was in the night, we always had to
  have breakfast before we left. No one would ever dream of letting
.  ui (go without eating, so we usually stayed until the first gray light
gr o awn.
Question: What happened if you were called out at night?
'” Answer: We were never allowed to ride alone at night. If Mrs.
l _,( Breckinridge ever found out that one of the nurses had gone out or
  l come home by herself at night, there would be war! You see, if your
'T horse stumbled and you fell off and were hurt, you could lie there
 ~ for hours because no one would know where you were. You always
A left a note to say where you were going but no one would come to
  look for you at night because it was known that one waited until
dawn to start back home. There weren’t many telephones so the
husband or a neighbor always came for the nurse.

 10 mzonmm Nunsmo SERVICE
The story of Family Nursing at FNS, spanning 5 decades, is
punctuated with the personalities of individuals who have helped
to shape into reality the dream of a woman whose foresight  j
spawned and nurtured an extraordinary promise of growth.  
The people of these Kentucky Mountains have participated in Q
the unfolding of the unique health care system which is the  
Frontier Nursing Service. They live on the Cumberland Plateau,  
the western fringe of the oldest mountain range on the continent
of North America, the Appalachians. Their homes are situated on
the edges of streams which wind through the troughs ofthe steep, A
saw-tooth terrain. Others are nestled in remote wooded hollows.
These people, most of whom came from independent, self- =
sufficient English and Scottish stock, purposely chose the isola-
tion provided by the narrow valleys of southeastern Kentucky.
Central to their way of life has always been the family and central .
to the inception and growth of the FNS has been its focus on
family care.
The long line of nurses who have come to the mountains began
with two American NurseMidwives who followed Mary Breckinr-
dige to Leslie County in 1925. Both Freda Caffin and Edna r
Rockstroh were experienced Public Health Nurses who completed
their Midwifery training just before coming to Kentucky. The
District Nursing System was launched when these two hardy
women opened the first clinic in Hyden. Since those early r
beginnings District Nursing has provided care to mountain 3
children and their families. Both patient and nurse have been  ·
participants in changing health care patterns on the one hand, ·
and on the other, both have experienced the feeling of rootedness 'A
provided by tenets which underscore changeless dedication to the 4
care of the person within his family circle. `
The people have relinquished a good deal of their chosen i
isolation to the inroads of education, improved tranportation,  ‘
financial assistance, and telephone, radio, and T. V. communica- ’
tion. New ideas have at times been ·resisted, at other times
tolerated, and often welcomed. Nursing methods, legal re-
quirements, and sources of financial support have become more
sophisticated but certain themes have continued with minimal
interruption since our story of district nursing began.

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Miss Ruth B|evins—Fami|y Nurse Midwife

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