xt77sq8qd323 https://nyx.uky.edu/dips/xt77sq8qd323/data/mets.xml The Frontier Nursing Service, Inc. 1932 journals  English The Frontier Nursing Service, Inc. Copyright 1925-2010. FNS, Inc. Use and reproduction of this work are permitted for the purposes of research and scholarship if non-commercial. All other rights are reserved to the copyright owner. Federal copyright law prohibits the reproduction, distribution, or public display of copyrighted materials without the express and written permission of the copyright owner, unless fair use or another exemption under copyright law applies. Frontier Nursing Service Quarterly Bulletins The Quarterly Bulletin of The Frontier Nursing Service, Inc., Vol. VIII, No. 1, Summer 1932 text The Quarterly Bulletin of The Frontier Nursing Service, Inc., Vol. VIII, No. 1, Summer 1932 1932 2014 true xt77sq8qd323 section xt77sq8qd323 I"_"“" `) "?'7'7"`"r)77'7 `7)7rAi`— r ""' 
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THE QUARTERLY BULLETIN OF  
TI—IE FRONTIER NURSING SERVICE, Inc. ·
Published quarterly by the Frontier Nursing Service, Lexington, Ky. E li
SUBSCRIPTION PRICE $1.00 PER YEAR ‘ 7
 
VOLUME VIII SUMMER, 1932 NUMBER 1 W
"Entered as second class matter June 30, 1926, at the Post Office at Lex-  
mgton, Ky., under the Act of March 3, 1879." `
Copyright 1932 Frontier Nursing Service, Inc.   I
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   Fizoivrxnn Nunsmc. smavrcn 1
  ANNUAL REPORT
. Contrary to its unbroken custom for the last six years the
. Frontier Nursing Service is not publishing its annual report in
` the summer number of the Bulletin. The reason is, of course,
I . the financial one. We do not like condensed reports, and the
i ~ issuance of a complete report, including the unabridged audit
i and individual acknowledgments of all gifts, is much the most
  expens·ive piece of printing we have to carry in the course of
g , the year.
    We are not, however, going to abandon our custom of mak-
Q ing a complete accounting of all of our affairs for the benefit
i of our subscribers. If times are better next May we intend
[ A printing the report for the two fiscal years in one issue by the
  simple process of a series of double columns headed by 1931-32
{ and 1932-33. This will keep our record unbroken; and it will
' cost very little more to print the two reports in one issue than
to print one report alone.
, For the immediate benefit of our readers we will now give `
a brief summary of the fiscal year which closed May 10, 1932,
both as to funds and as to the work.
FISCAL REPORT
A We received this year, exclusive of $10,000 for the endow-
.; ment of the Hyden Hospital, and borrowed money, $130,98887.
~ V} We had a balance from the close of the previous fiscal year of
$14,301.95, making a total of $145,29082. We spent for run-
 } ning expenses, buildings and equipment, and a repayment of
A borrowed money, a total of $160,72920. It will be seen that
 A this gave us a deficit on the year of $15,438.38. Although this
  is not a large deficit for a large philanthropy to have to shoul-
 = der in a year like this, the resultant debt has been heavily in-
1 creased through the summer months by the lack of a balance
 A for running expenses. As the summer is always our dead .

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2 THE QUARTERLY BULLETIN .`
season, financially, due to the fact that most of our subscrip- ll
tions fall due during the remainder of the year, we have had l
hard sledding. We faced the situation in the following manner.
First, by making a direct cut of about $20,000 in our  
budget. To do this we had to let seven of our nursing and three ‘
of our administrative staff go, thus reducing substantially the  
number of people in the field and putting an added burden on it
those remaining. All those who elected to remain with the l
Service until better times (and they were more than we could  
keep) were given the choice of leaving, fully paid up a month _
in advance, or of remaining on a maintenance basis only for the 5
present. The fact that out of a personnel of thirty-eight a `,
total of twenty-eight remained, and of those ten who went away l
several would have remained, tells the story of the gallantry "
and devotion of our staff better than we could put it in words.  
  We also faced the painful task of disposing of several of our `
old horses. As one of the Victorian novelists says somewhere, -
"This is a penalty we pay for living in one of the least dull
periods of history."
_ We wish to acknowledge with the deepest gratitude the
fact that during the past fiscal year 1929 people contributed to g
‘ the support of the organization——in nearly every case by very  
real personal sacrifice. Although the majority of our sub- I
scribers found it necessary to reduce the size of their gifts, a ,
few of them, by a supreme effort, actually increased their do- l
nations, and 656 of them were new friends. Our various com-
mittees worked for us loyally, and many of them redoubled
their efforts to overcome our added handicap of the director’s _
disabling accident.  
It may be useful in this connection to state the basis upon ·. 
which the Frontier Nursing Service spends money in order to  A
raise money. During the year immediately preceding the de- l
pression (the accepted word and therefore we use it, although  
we dislike the word as much as the condition) the Frontier y
Nursing Service raised a total of $146,680.31 at a total expend-  
iture of less than 4 per cent—a record almost unique in the  
history of a new philanthropy. This was done in normal times  
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` by arranging for meetings through the committees in the houses
A3 of hospitable friends, where the director told the story of what
gi was needed and of what was being done. It has not been pos-
¥ sible to keep to so simple a program since times· became finan-
  cially complex. In order to increase the spread of small sub-
" scribers it became necessary to keep a flood of publicity before
if the public so that it would know about a work of which it was
  otherwise ignorant. We therefore opened three offices, in rep-
* resentative sections of the country (New York, New England
  and Chicago), with the support and consent of the committees
in these areas, to keep the public informed about us and to
1 secure Associated Press and United Press releases for the whole
i_ country. We estimated that with the help of the trained per-
_i sonnel in these offices we could inaugurate plans for earning
‘ money on a broad, national basis. We figured that we could
  carry this additional expenditure at a cost not exceeding ten
_A per cent of our subscriptions, plus funds earned through well-
worked out plans.
Our big feature for the past fiscal year was the West »
Indies cruise of the Britannic. Although we made less than
$6,000 on this cruise, due chiefly to the fact that the rates had
, to be greatly reduced and that, owing to slack Transatlantic
i travel, there was nearly double the usual competition on the
  part of the steamship companies in the West Indian cruise
business, we feel that the cruise was a profitable venture.
A, Even small profits are gratefully received in times like these,
y and the really remarkable publicity given this venture of ours
1 through the courtesy of newspapers over a large part of the
country resulted in the 656 new subscribers to our work who
jg heard of it through this cruise publicity for the first time. This
I, publicity would have been absolutely impossible without the
  three offices and the trained personnel in New York, New Eng-
. ` land and Chicago. Something more than ten per cent (but .
· less than fifteen per cent) of our subscriptions went to the main-
  tenance of these and other agencies to maintain the publicity
{Q necessary both to raise and to earn money for our field work,
 i but we do not think we would have received enough to carry on
{ upon any other basis. As times improve we will raise and earn
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more money at far less proportionate cost. We will not be con-  
tent until we get back to our pre-depression record of raising
our entire budget at a cost of less than four per cent.  
· FIELD REPORT lb
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Now, as to the field work. The record for this last, most 4%
difficult fiscal year, is simply magnificent. We closed the year »}
with 8,289 people in 1,775 families attended by the Service. Of ,
these 5,047 were children, including 2,363 babies and toddlers.  
Bedside nursing care was given to 456 very sick people, of whom  
310 recovered and 31 died. The district nurses paid 26,741 l
visits and received 20,560 visits at nursing centers. Our little ,
hospital at Hyden was occupied 3,120 days by 224 patients. {
There were transported to hospitals outside the mountains, in ,
l Lexington, Louisville, Cincinnati and Richmond, 43 patients  
and their attendants, on passes given us by the Louisville and R
Nashville Railroad. *
Under the direction of the State Board of Health, the nurses  
gave 8,482 inoculations and vaccines against typhoid, diphtheria, .
smallpox, etc., and sent 628 specimens out for analysis. {
There were held during the year 219 field clinics with an at- I
tendance of 7,482 people.  
Complete dental care, over a period of two months, in af- l
filiation with the Kentucky State Dental Association, was given I
to 247 children and expectant mothers.
Dr. Scott Breckinridge, of Lexington, Kentucky, held his •,’
annual gynecological clinic at the Hyden Hospital; and Dr. R. U!
L. Collins, of Hazard, Kentucky, performed numerous opera- j
tions during the year, those on indigent people as a courtesy to
the Service. None of the 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 direc-
tor, Dr. John H. Kooser, and various physicians from the near-  .,
est towns were called in, both for emergencies and at the request  
of individual patients.  '1
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ll MIDWIFERY
i The nurse-midwives delivered 404 women in childbirth of
§ 396 live babies, 11 still-births, and 1 late abortion; and gave
l them full prenatal and postpartum care. Doctors were called
, in 14 times for abnormal conditions. There was no maternal
  death on the district. One mother died of mitral stenosis at
ig the hospital, under medical care, 18 days after delivery. There
f were 493 midwifery cases closed during the year, and 501 new
} cas·es admitted. In addition to our regular cases, the nurse-
li midwives were called in for 9 emergency deliveries where the
l mother had not been registered and given prenatal care; 20
5 early abortions (unregistered cases) ; and they gave postpartum
care, only, to 19 unregistered mothers.
{ The greatest triumph of the year, and indeed of all the
¤ seven years since our inception, was the publication, by Dr.
  Louis I. Dublin, Vice-President and Statistician of the Metro-
el politan Life Insurance Company and President of the American
_' Public Health Association, of a summary of his tabulations of
I our first thousand midwifery cases. Dr. Dublin’s summary and
  covering letter are printed in full at the end of this report.
{ We gratefully acknowledge the most unswerving coopera-
E tion on the part of the State Health Officer, Dr. Arthur T. Mc-
` Cormack; the support of our central records system by the
  Carnegie Corporation; and the adoption as their project by the V
i Alpha Omicron Pi Sorority of our Social Service Director, Miss
Bland Morrow, and her budget. We also acknowledge with
deepest thanks the support of our local committees and thou-
= sands of mountain friends in carrying forward our program
  throughout an area where financial strain is as heavy as in any
j part of the United States; and, also, the really marvelous spirit
in which our friends and committees on the outside have coupled
 . the needs· of this national .piece of work with the strain of the
unemployment problems in their several cities. Likewise, to
our couriers we express gratitude for the courage and devotion
 » they have shown in covering our difficult trails at all seasons
CI and acting as liason officers among our widely scattered cen-
 ! ters. Lastly, but none the less deeply felt, in the name of the
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trustees of this organization, we render thanks to the staff, II
nurses and secretaries alike, now carrying on with added bur- II
dens and with almost no financial remuneration. In common  
with the whole world we look and pray for better times ahead, I
but we honestly believe that we are stronger as individuals and I
as a group because of the strain through which we have carried ,
on together. I
I
 
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In lieu of the annual report we are using this issue of the
Bulletin for a summary, in question and answer form, of the I
purpose and program of the Frontier Nursing Service and of I
what has been accomplished to date. We receive so many hun- I
dreds of inquiries that we thought it wise to put them, and the I
answers to them, in booklet form. —By having this printed with Q
I the Bulletin we can have extra copies struck off at very little -I
additional cost, and our friends may secure them on application —
to give to interested persons. `
Signed: Mas. S. THRUSTON BALLARD, Chairman
MR. C. N. ll/IANNING,-T1’€3.SLl1`€I` {
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Mas. MARY BRECKINRIDGE, Director. I
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{ Fnoivrma NURSING smzvrca  
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{ METROPOLITAN LIFE INSURANCE COMPANY
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{ NE\V YORK CITY
  M 7 4, 19"2
I 1.oms 1. DUBLIN as Q
Third Vice-President
I and Statistician
All Mrs. Mary Breckinridge
i‘{ Cosmopolitan Club
{ 133 East 40th Street
{ New York, N. Y.
{ Dear Mrs. Breckinridge
{ I am sending you herewith a brief statement cover-
{ ing in summary form the chief results of our study
l just closed of your first thousand records. I am also
{ attaching the main tables which give the details of our
. study.
l . It was a pleasure to have the opportunity to pre-
V — s·ent these facts before the splendid group at Miss
Morgan’s house yesterday, and I hope that you will be
able to prepare a statement for the press which will
; have a wide appeal.
{ Sincerely yours
{ Louis I. DUBLIN
_ Third Vice President
{ Enclosures and Statistician
l
This study covers the tabulation of the first one thousand
midwifery cases of the Frontier Nursing Service. All of these
N women registered with the service during pregnancy and were
"  cared for during delivery and were followed up for one month
v i after delivery.
The patients cared for were, for the most part, young wom-
{ en. Seventeen per cent. were under age 20 and 28 per cent.
{ between 20 and 25 years. A total of 45 per cent. were regis-
{ tered under age 25.
 { Eighteen per cent. of the cases receiving care were primi-
{ paras, that is, were bearing their first children. Among the
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167 women under age 20, 109 were in their first pregnancy.  
Two hundred eighty-seven women, or 29 per cent., developed II
one or more puerperal abnormalities during pregnancy and in  
130 cases, the services of a doctor was called for. This propor- I
tion of abnormalities is lower than is usually found in the gen- L
eral population and is lower than in other series where excel-
lent care in pregnancy has been available. Only two of the  
thousand cases developed eclampsia, although there were 172 {I
cases with toxic symptoms which might have developed serious- ·  
ly without the care which the nurses rendered. Delivery com-  
plications occurred among 366 women, of which the common-
est were hemorrhage, prolonged labor, and laceration. The I
number of these cases, however, is much less than usually oc-  
curs. In only 52 cases was it necessary to obtain the service of .
a physician during labor. Forceps were used 9 times. I
  The most important single result of this work is that not
  one of the women died as the direct result of either pregnancy ·.
or labor. There were two deaths in the series; but in one of
I these, the cause of death was chronic heart and kidney disease »
I and in the other, it was chronic heart disease. Neither of these I
two cases could properly be ascribed to the maternal state. They
would probably have occurred under ordinary conditions. é
Another important result is the small number of stillbirths.
. There was a total of 26 stillbirths among the 1,015 babies. · This
figure is one-third less than occurs usually in the general popu- ‘
lation of the United States. Another end result is the number `
of babies that die within one month after birth. There were I
25 such deaths out of 989 babies born alive. In the general  
white population of Kentucky, there occurs 36 such infant deaths
in 1,000 livebirths, which represents a saving of one-third from -·
that in the general population. {I 
Finally, it is important to note that the mothers and babies °' Y
were discharged at the end of the month in good health. Out
of the thousand women who were visited up to within four weeks
after delivery, 96 per cent. were reported by the nurse as in  .
satisfactory condition.  Yi
The study shows conclusively what has in fact been demon-  ~I
strated before, that the type of service rendered by the Frontier ·
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iii Nurses safeguards the life of mother and babe. If such service
Q, were available to the women of the country generally, there
  would be a saving of 10,000 mothers’ lives a year in the United
V States, there would be 30,000 les·s stillbirths and 30,000 more
{L children alive at the end of the first month of life.
  The study demonstrates that the first need today is to train
Q a large body of nurse midwives, competent to carry out the
  routines which have been established both in the Frontier
s Nursing Service and in other places where good obstetrical
care is available. _
§ May 9, 1932.
E
ANNOUNCEMENTS
Ai Miss Gladys M. Peacock, Assistant Director of the Frontier
l Nursing Service, returned to her field duties this summer after
, a furlough spent at Teachers College, Columbia University,
l where she obtained the B. S. degree.
  Miss Mary B. Willeford, Assistant Director, completed her
’ work at Teachers College, Columbia University, in June, and
_, received a doctorate of philosophy in Educatnmal Research.
  Mention is made of her thesis, "Income and Health in Remote
 S Rural Regions," on page 21 of this issue.
Miss Bland Morrow, B. A., has just finished her two years
 I work at the New York School of Social Work and has taken
I over her duties·, as Social Service Director for the Frontier
j  Nursing Service, under the advisory council of the Alpha
" Omicron Pi Sorority, and supported by their grant.
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‘ FRONTIER NURSING SERVICE PRIMER §#
° FOREWORD .  
The economic and social rehabilitation of the rural area is I
our central problem today. The farm has long suffered under  
serious handicaps. Since 1929, its status has become steadily =f
worse, as a result of differential price-levels and the return home ` {
of sons and brothers thrown out of industrial employment. Our ;,
social order can be re-established on a really sound basis only ;
by ensuring reasonable security and opportunity to the farm
dweller. _
One of the gravest handicaps under which the rural area  
I , has suffered has been the lack of elementary facilities for health *
protection. Doctors, dentists, nurses, hospitals and health de- I
partments are almost non-existent over large areas; and lowered
y vitality spells economic backwardness. Our American pride in A
. equality of opportunity remains, in so far, an empty boast.
The Frontier Nursing Service has shown us how this need . .
can be met. I have studied Mrs. Brecl 
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 14 THE QUARTERLY BULLETIN ~”v
WHAT HAS IT ACCOMPLISHED?
"1000 deliveries without a single maternal death as
the direct result of either pregnancy or labor."
"l-3 less stillbirths than occur usually in the gen- x
eral population of the United States."
"1-3 less infant deaths within one month after birth  
than occur in the general white population of Kentucky."
LOUIS I. DUBLIN. V
More than 46,000 inoculations and vaccines given
against typhoid, diphtheria, smallpox, etc., with the au-
thorization of the State Board of Health.
10,000 people given intensive home care.
Wells chlorinated.
Hookworm studied and combatted with the help of
the United States and State Health authorities, the
Rockefeller Foundation, Johns Hopkins and Vanderbilt
Universities, and the American Child Health Associa-
tion. ’
Hundreds of people sent to physicians and hospitals
in distant cities.
Travelling clinics arranged in the mountains for vis-
iting specialists in trachoma, obstetrics, orthopedics, .
pediatrics, eye, ear, nose and throat, and helminthology. i
Full time dentist for children and expectant mothers. _]
maintained every summer in cooperation with the Ken- il
tucky State Dental Association.
Model record system supported by a grant from the
Carnegie Corporation. _
Nurse-midwives prepared for other organizations
interested in similar problems in other parts of the
United States.
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 - *.___FE‘2E’E*`E5 NURSING SETESF H
WHY WERE THE KENTUCKY MOUNTAINS CHOSEN
FOR THIS DEMONSTRATION?
Because nowhere in the United States are the diffi-
t culties facing rural health administration more acute.
y Because the people of this region are American
qi stock, handicapped by geographical conditions and not
by lack of native ability.
HOW HAVE THE PEOPLE SHOWN THEIR COOPERATION?
The Fathers—By petitioning for Centers, and offer-
ing both land and labor prior to the extension of the work
in any neW area.
The Mothers———By registering with the nurses in in-
creasingly large numbers for their confinements, and re-
sponding to new methods of child care.
The Pe0ple—By asking for inoculations amounting
in all to over 46,000, and otherwise cooperating with the
public health program.
'I .
ll SAYINGS OF THE CHILDREN ‘
Three year old girl, poking her head in the cabin where the Frontier
Nurse is dressing a dirty wound with lysol solution, “I smell a nurse."
Four year old boy, inquiriugly, of a slim, short—hai`red nurse astride
her horse, “Ai·r you d boy or a girl?"
_ Nurse, with a smile, "A boy."
Four year old boy, “I knowed you was ci boy, but I thought you was-
a girl."

 is THE oumpmany BULLETIN  
’WHAT IS THE NATIONAL VALUE OF THIS _ l
D EMONSTRATION ?
"Until the methods, here proved to be practicable, ‘
are widely adopted in rural America, we cannot hold up
our heads among enlightened countries." Z;
HAVEN EMERSON, M. D.,  
College of Physicians and Surgeons, Columbia University. .
"If such service were available to the Women of the  
country generally, there would be a saving of 10,000 ‘
mothers’ lives a year in the United States, there would .
be 30,000 less stillbirths and 30,000 more children alive  
rr at the end of the first month of life." ·
LOUIS I. DUBLIN, Ph. D.,  
Third Vice President and Statistician, Metropolitan  
Life Insurance Company, New York City.  
   
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"SEEN IN THE APPALACHIANS ON A TWO WEEKS ,0
VACATION IN SEPTEMBER"  
“A one-legged girl on a mule, her crutches strapped to her saddle, i
traveling to town, a distance of twenty-five miles.”  
"A family of eleven sitting down to a breakfast of corn bread and  
potatoes. The same family sitting down to a dinner of corn bread and  
potatoes. The same family sitting down to a supper of corn bread and ._
potatoes?  
“‘WeZl’s Outline of Hist0ry’ on the shelf above the fire in a cabin i
inhabited by a so—called ‘ignorant’ mountaineer and his family/’ ’
“A little girl eating her first dish of ice cream in the hospital at ,
Hyden.” l
—Excerpts from an article by Caroline Gardner. ’

   FRONTIER NURSING SERVICE 17
` HOW IS IT FINANCED?
Chiefly by voluntary contributions, which have
V always been the means of blazing trails in pioneer work.
A small state subsidy.
§, Small fees from patients.
  An appropriation from the Alpha Omicron Pi Soror-
L ity to finance the Social Service department which is
; under the direction of their Advisory Council.
  A grant from the Carnegie Corporation to maintain
2 a central record system.
g WHAT IS THE BUDGET FOR THE CURRENT FISCAL YEAR?
  $125,000.
  HOW IS THIS MONEY SPENT?
  Let the record on a family over a period of one year,
  from September to September, point the answer:
  Wiley and Sudie Davis are raising their brood up on
  Lonesome Fork. The year started with five children,
  and ended with six. The first event was on September
  15th, when ten-year—old Bessie, the eldest of the lot, had
  her tonsils removed at the Frontier Nursing Service
  clinic. September 30th saw Sudie and four children at
§ the Dental clinic. October was typhoid-inoculation
  month for the little Davises, all five of them. In No-
i vember, Bessie, Tad and Edwin, the three old enough
  for school, fortified themselves against the winter by
_ having Influenza—Pneumonia vaccine. Through the
J winter months Sudie, under the care of the Service, pre-

 ` 18 THE QUARTERLY BULLETIN ~
pared for the event on March Ist, when the Frontier ;
‘ nurse-midwife saw Doris into the world. The new baby
succeeded to the screened crib, first made for Edwin A
and repainted in her honor. Wiley paid the five dollar »
F. N. S. fee in corn for the nurse’s horse.
In June, Sudie’s step-brother arrived very ill, after . 
walking twenty-five miles from the railroad. The " 
Service doctor and nurse looked after him, but he died ] 
p within a few days of pneumonia following upon measles. f 
T Then three of the Davis children had measles and the  
. Service nursed them through without complications. In ‘
July, live of the children were examined by a visiting  _j
child specialist at a pediatric clinic arranged by the
T Service. Shortly afterwards the three youngest had 5 
their T. A. T. shots and so completed the protection of  
. the whole half-dozen against diphtheria. On August  
7th Sudie had an operation at the F. N. S. hospital at  if
Hyden, remained there two weeks, and then had the E
I necessary aftercare following her return home. - 
WAITING AT A DELIVERY
“We settled down to the evening. As we talked we kept turning in _ 
our chairs like meat on a spit roasting one side at a time. The snowflakes . 
blew in and tickled my face. I pulled my beret on tighter, gloves still on,  
and thought of the song, ‘O.Wert Thou In the Cauld, Cauld Bla.<:t.’ Once  
` I nearly stepped on a brooding hen. Dougall ( the nurse) was kept busy· ‘c
throwing a cat and two kittens out of the window only to se