xt7gth8bhh51 https://exploreuk.uky.edu/dips/xt7gth8bhh51/data/mets.xml The Frontier Nursing Service, Inc. 1941 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. XVI, No. 4, Spring 1941 text The Quarterly Bulletin of The Frontier Nursing Service, Inc., Vol. XVI, No. 4, Spring 1941 1941 2014 true xt7gth8bhh51 section xt7gth8bhh51 » _. · 3} I .' V' { x, ..V,. pf   V! / f ,· / \.  V ',  I., .
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Proud Father of Ten on April 23, 1941 I
See Article Called "Golden Retriever Puppies"  
Published Quarterly by the Frontier Nursing Service, Lexington, Ky. _' 
"Enter<·d as second class nmtter June 30, 1926, at the Post Ofiicc at Lexington. Ky.,
under Act of March 3, 18T9."
Copyright. 1941 Frontier Nursing Service, Inc.

 T he Lcmd of Memories
4 . REV. A. J. RYAN
A land without ruins is a land without memories~a land without
_ memories is a land without liberty. A land that wears a laurel crown
may be fair to see, but twine a few sad cypress leaves around the brow
of any land, and be that land beautiless and bleak, it becomes lovely in
; its consecrated coronet of sorrow and it wins the sympathy of the heart
. and history. Crowns of roses fade,——crowns_ of thorns endure. Calvaries
and crucinxes take deepest hold of humanity—the triumphs of might are
transient, they pass away and are forg0tten—the sufferings of right are
graven deepest on the chronicles of nations.
  .... give me a land that is blest by the dust,
sr . . .
  And br1ght with the deeds of the down-trodden just.
Q; .... give me the land where the battle’s red blast
    Has flashed on the future the form of the past;
    .... give me a land that hath story and song,
  2 To tell of the strife of the right with the wrong;
  Q .... give me the land with a grave in each spot,
    And names in the graves that shall not be forgot:
.   .... give me the land of the wreck and the tomb,
. There’s a grandeur in graves—there’s a glory in gloom—
_ For out of the gloom future brightness is born,
As after the night looms the sunrise of morn;
And the graves of the dead, with the grass overgrown,
A May yet form the footstool of liberty’s throne,
`   ‘ And each single wreck in the war—path of might,
S . .
Shall yet be a rock in the temple of R1ght.

—— i  
A Courier Becomes a Nurse Neville At/cinsoin. 24
Beyond the Mountains p 73 I 
Field Notes V 81
First Day on Rounds Bcirbcira Brown 21 3
Golden Retriever Puppies 48  
In Memoriam 44  
Old Courier News 49 P
Old Staff News 58  
Pictures From Punch 46-47  
Pupil Midwives Observe Easter Rose Avery _ 39  
Social Service Sketches l Edith Anderson 27  
Stay Put 30 E
"The Land of Memories" Rev. A. J. Ryan. 1  
The Legend of the Dogwood  
(Illustrated) 12 I .
The Organization of the Frontier Q?.
Nursing Service, Inc. 3 j 1
. To Elizabeth Mary Bree/cihridge 31   I
To Tramp Sheila Clair/c 20   `
Trail and Cabin Ethel Broughall 42 l
"Union Now With Britain" A Review 13   *
Urgent Needs 33    
Viney’s Baby Louise Mowbray 57   L_
Bits From Britain Contributecl 26  
From a Billeting Officer in  
Cambridge, England 23 $
From a Friend in Princeton, N. J. 45  
From "Monthly Messages" Byron-Page Printing Co·n1pan;:/ 38 V 
From "The Choir News" 26  
He Who Helps a Child Phillips Brooks 45   ,
If You Are Crossing a Field Pzmch 20 ‘  .
Is It Not Strange? Contributed 41 ; ·
Pro and Con 41  
Shortest Service On Record The Living Church 43  
The Digger The Coimtryiman. 32 , 
We All Could Do More Contributed 80  ‘
Your Receipt 38  

   Fnomrma Nunsmc smnvrcn 2
I - ofthe
  The Field of Work
3 - The Frontier Nursing Service carries a remotely rural dem-
  onstration in maternity and infancy care, district nursing, public
  health, social service, economic betterment, and in the training
  of graduate nurses in midwifery to serve other frontier areas.
  Its field of work is located in the Appalachian mountains of
  southeastern Kentucky. In remotely rural work, where the
3 people live in little homesteads along the rivers, creeks, and
`L branches, and where travel is by horseback in the main, it is
ji` essential to de-centralize a nursing service in order to reach the
  patients. Therefore, each of the Frontier Nursing Service cen-
  ters is located in the heart of a five mile radius and covers
  approximately seventy-eight square miles. These centers lie
  from nine to twelve miles apart. There are eight of them,
  divided at the present time into twelve nursing districts. Six
ji of the centers are outpost stations; the seventh, at Hyden, is a
.’ z Hospital and the Midwifery Training School as well as a center
if for district work; the eighth, at Wendover, serves as Adminis-
§ trative Headquarters for the whole field of work, as well as a
  center for district work. Hyden and Wendover are only five
  miles apart.
  Five of the centers of the Frontier Nursing Service are on
  the Middle Fork of the Kentucky River, and three are on Red
E  Bird River and its tributaries, and the area covered by the
..  Service is approximately seven hundred square miles in adjacent
t    parts of Leslie, Clay, Perry, and Cwsley Counties. The area
i i ` covered is determined by natural boundaries and not by the
  purely artificial boundaries of county lines, which often run
  through the middle of a neighborhood. Throughout this seven
 ( hundred square mile area the Frontier Nursing Service does a
. complete and intensive piece of work—but many people from

beyond its boundaries attend the clinics and are received in the i
Hospital, to the extent that we have beds. _
g The Appalachian mountain country is rough, rugged, difi-
cult for travel, poor in production of all but forests—and ex-  
tremely beautiful. There is little game left in the woods and l
fish have only begun to come back to the rivers but there are  
innumerable wild flowers, birds, and trees for the nature lover. _
The people are of old American stock, sincere and friendly.
Though most of them are very poor, their hospitality is unsur-
passed. The climate is quite unpredictable. The winters can _
be very cold with snow and a great deal of ice to complicate
travel. The summers are usually so hot that travel in the middle E
of the day, though possible, is quite uncomfortable, but the sum- ;_
mer nights are cool and refreshing. The spring is our rainy J
season. Though we often have sunshiny days, there should QQ
be enough rain to raise the rivers frequently to such height that 94
fording by horseback becomes impossible. As there are only  
two bridges on over two hundred miles of rivers, one must cross  
by a "swinging" foot bridge at such times, or use boats. At the  
peak of the "tides" even these are dangerous.  
Living Conditions of the Staff  
At each of our eight centers the Frontier Nursing Service  
, owns its own buildings, and surrounding land. At Hyden a  
wing of the stone Hospital and an Annex to it serve for the  
present as the nurses’ home. The Medical Director and his fam-  
ily live in a house on the Hospital grounds. Wendover is com-  
posed of a group of buildings, mostly log, in five of which are T
the sleeping quarters and offices of the Service. In the largest ?
building there are a common living-room and a "dog-trot", used i
for meals. The six outpost nursing centers have well-built and i
well-equipped eight-room houses. Two of these rooms are clinic i
and waiting rooms, and the other six serve as the nurses’ home.  
Aside from their living quarters, all of the centers have large l  "
barns, cow sheds, chicken houses, manure bins and plenty of  
room for pastures and gardens. l
Only at the Hospital at Hyden have we electricity. The
rest of the Service depends on kerosene lamps and candles for i
light. All of the centers throughout the Service have running 1

 Fi>.oN·rmR NURSING smnvica 5
, water and bathrooms. The older buildings at Wendover are
heated only by open fires, but our Hospital and the outpost cen-
i ters have central heating, with open tires in the living-rooms.
I The staff of the Frontier Nursing Service makes its own
1* housekeeping arrangements. In the outpost centers the nurses
T have a maid who milks the cow, feeds the horses when the
Y nurses are too busy, cans, cleans, keeps fires going, and prepares
‘ the food the nurses order and the people bring. At Hyden and
Wendover each member of the staff pays for her own board.
The Service pays the costs of patients and guests. Although
c domestic service in the mountains is not skilled, there are always
, many people eager to carry this important part of our work,
if either to support their families or to send younger brothers and
Y sisters off to school.
ii All of the centers are comfortably furnished by the Service
  and are insured and kept in repair. The Service also pays for
  cleaning of barns and for all transport, including the care, re-
  placement and feeding of horses. The Service pays for all sad-
  dlebag and clinic supplies and clinic laundry. The Service sup-
NQ plies each nursing center with a cow, and there are several cows
  at both Hyden and Wendover.
  The Nursing Work
gx  The Frontier Nursing Service staff works under the guid-
  ance of the Director of the Service who is herself a graduate,
  registered nurse and a graduate midwife holding the certificate
  of the Central Midwives Board of England. She has three grad-
  uate nurse—midwives as assistants, each with her own field of
Y supervision. One is the Hospital Superintendent, one is In-
  structor of the Frontier Graduate School of Midwifery, and one
  is Supervisor of the district work.
The Hyden Hospital is a general hospital of eighteen beds
j taking in all types of cases except those with chronic, communi-
  cable or mental disease. It is the only hospital within many
l  " miles of our territory. The Hospital Superintendent has five
  * full-time graduate nurses under her: one, a nurse-midwife; four,
’ non-midwife nurses. The nurse-midwife has charge of all mid-
wifery patients in the Hospital and supervises the pupil mid-
i wives in their hospital deliveries. Each non-midwife nurse takes
i her turn in rotation for a period of three weeks at each of the

. •
four types of Hospital assignments. As ward nurse she cares  
for all non—midwifery patients; as surgical nurse she has charge 4 J
of treatments, medicine, dressings, and sterilization; as obstet-  
rical nurse she assists the Hospital nurse-midwife; and as night  
nurse she has complete care of all Hospital patients from 7:30 L`
p. m. until 7 :30 a. m., except that the nurse-midwife is on call a
for maternity cases in labor. The night nurse is the only one on  
twelve-hour duty. To compensate her for this she has four days S
off after each period of night duty before beginning work in the  
daytime. In the other three rotating posts we have an- eight- fj
hour service, with twenty-four hours off duty weekly. i
Often specialists from the cities offer their services for spe-  
cial clinics. Two such clinics (one for gynecology, one for tonsil-  
lectomies) have become regular annual events. Except in the it
case of special clinics, our surgery usually falls under the head-  
ing of emergency. The regular Hospital nurses help in the oper-  
ating room. The visiting surgeon for the Hospital lives in a  
mining town twenty-four miles away. As this town is on the  
state road and has a telephone connection with the Hospital,  
there is little delay in getting him, and his promptness in re- 1§
sponding to our calls is only equaled by his kindness and skill.  
The Medical Director of the Frontier Nursing Service holds  
a clinic at our Hospital at Hyden three times a week. Patients y 
, from all over our territory and even from beyond it come to these  
clinics. The Medical Director has a non—midwife clinic nurse to  
_ help at these, and to send reports on their patients back to the  
district nurses. She also helps with the laboratory and X-ray  
work and keeps the doctor’s medical and obstetrical saddlebags  
in order.  
Although at each center the district nurses hold a clinic one i
morning of each week, and sometimes a second clinic at our  
small outlying dispensaries, most of their work is done in the  
homes of the people. Theirs is a generalized program and each  
nurse is responsible for the health of everyone living in her dis- ,.
trict. The first fundamental of our work is bedside care—bedside   ’
care for the sick, for the woman in labor and for the young baby  
and his mother. Only in chronic cases does the nurse leave the  
actual nursing in less skilled hands—and then only after enough I
demonstrations have been given to convince her that the care

 l Fnoiwrrmn Nunsmc snnvicm 7
  will be adequate. After that the nurse makes follow-up visits .
,] to assure herself that all is going well. Having demontrated our
? value in bedside care we go on to include a broad public health
p, program; inoculations, wormings, instruction concerning sani-
i“ tary privies, a pure water supply, and as adequate a diet as
a possible. The only instance where a district nurse does not
il carry this whole program is on a double district at Hyden, Here
Q a non-midwife carries everything except midwifery. This is
  reserved for teaching material for the Frontier Graduate School
‘g of Midwifery.
 y Although a state road now passes through Hyden, and WPA
  roads made it possible to reach most of the centers by car or
  truck in dry weather, the nurses must still follow poorly defined
  trails leading along rough creek beds, over steep mountains,
  through fenced cornfields to visit their patients. In only a small
  part of two districts has a car proved useful in the district work.
  For the rest the nurse travels by horseback, her supplies in sad-
  dlebags, at an average speed of four miles an hour. She often
  is unable to get back to the center for lunch but carries sand-
  wiches with her. She does, however, try to get back in time to
¤§ Write up the records and do her time sheet at the end of the
gi  day’s work. Each nurse keeps a full record for each individual
2% in her district. These are kept in a family folder in files at the
li center. Her daily time sheets and any records of patients
  she has closed out are sent in each week to the record ofiice at
i  Wendover. The statisticians from the record omce make rounds
  periodically of all the centers to check the nurses’ count and to
  help the nurses meet any difficulties connected with the keeping
  of records. They are always available and eager, by telephone
;§ or special courier messenger service, to help the district nurses
  with their record work.
Q The district nurse-midwives are subject to midwifery and
  other emergency calls at night and sometimes they have patients
, who must be seen on Sundays. To compensate them for these
  ’ extra calls in their normal rest periods two weeks extra holiday
Q, is added annually to their four weeks vacation. Thus they get
  six weeks holiday annually and this may be taken at one time
I or in two periods, to suit the convenience of the Service and the i
wishes of the individual nurses.

I Although our district nurse-midwives work many miles from  
J a doctor, they always work under doctors’ orders. The section  
of the National Medical Council known as the Medical Advisory i
I Committee, composed of physicians and surgeons in Lexington,
` one hundred and forty-five miles away, have authorized a Medi- ,
cal Routine for the Service,——the standing orders under which
our nurses work. In individual cases who must have treatment  
not covered by the Routine, the Medical Director must be con-  
sulted. He gives the orders to be followed, or, when necessary,  
visits the patient in her home.  
New nurses are introduced to the district work by senior ,,
members of the staff who act as teaching supervisors. For  
about six weeks the new nurse assumes little responsibility.  
She is under the direct supervision of the senior nurse who  
plans each day’s work for her and helps her with the riding,  
the trails, the records, and the routines. Even then the new  
_ nurse is not usually given a district. For a varying length of  
time she acts as a relief nurse, going wherever the need is great-  
est. In this way she becomes familiar with all the nursing 5, 
centers and often with the Hospital as well. Later she becomes  
a junior nurse at a center and finally is given charge of one.  
Auxiliary Work  
So far we have dealt chiefly with the medical, nursing, and  
i Hospital aspects of the work of the Frontier Nursing Service.  
We have explained the system under which the district nursing _  
, is decentralized, so as to put the district nurse-midwives in reach  
of their patients. We have also said that Medical Headquarters  
and the Hospital (available for our whole area and even beyond  
it) are located at Hyden.  
The Administrative Headquarters of the Service are located 4
at Wendover, on the Middle Fork of the Kentucky River above  
the Hospital at Hyden. Thus the administration of the work is  
an integral part of the work itself, and we are saved the expense f,
of renting outside city ofiices. The Director of the Service l
makes her home at Wendover, and the Assistant Director, in  
charge of field work and all nursing correspondence, headquar— ig
ters there. The Executive Secretary and her assistant also live  
at Wendover and carry responsibility for construction, repairs, z
upkeep, insurance, and orders for a wide variety of supplies  

   Fnowrma Nunsmc smzvicm sa
1 ranging from carload lots of hay for horses to parts needed
SE on deep well engines.
} Since no organization can ask for public support unless it
keeps an accurate accounting of its affairs, the Service has book-
. keepers and statisticians at Wendover who meet the high stand-
if ards required by our treasurer and auditors and by the Metro-
`, politan Life Insurance Company in New York, which does the
  final tabulations on our maternity and early infancy statistics.
  Wendover is a Federal institutional Post Office and this means
é? post oflice assistants. Also living at Wendover is the Director’s
  secretary who, with assistance, takes care of a vast correspond-
  ence from all over the world.
  At Wendover the Social Service worker has her headquar- A
  ters, although she functions in all our territory. The Social
 f Service worker visits and carries social service cases reported
  to her by the Medical Director and the nurses on the various
fi  districts; she is responsible for the welfare of the dependent
F  and semi-dependent children of the Frontier Nursing Service;
1,  for the transport to the Free Children Hospitals in Cincinnati
  and Louisville (on passes furnished by the L. & N. Railroad
}=  Company) of such children as our Medical Director wants to
  receive specialized pediatric care; for the transport of crippled
i`  children to the Kentucky Crippled Children Commission; and '
  for the blind and the deaf to the State Institutions. The Social
  Service Secretary is also responsible for such delinquent children
 _- as are turned over to us by the courts; for the children we are
it  educating; for the orphans we have placed out in neighborhood
  families; and for special help to families where there is tubercu-
if losis or other condition causing acute financial strain. The social
  worker also handles the work of the Frontier Nursing Service
  Cooperative Handknitters and carries as much constructive and
  recreational work as her time permits.
  The Social Service worker is assisted in these projects by
  the volunteer courier service, and this brings us to a description
in of this service, which also has headquarters at Wendover. The
  couriers are all young women, nineteen years old or over, who
  are experienced horsewomen and are first recommended to us
  by friends of the Frontier Nursing Service. Three or four
i couriers are scheduled to come at the same time, and each re-

mains with us for a period of six weeks to two months. These  
young women not only assist the social service worker and the  
nurses, but have as their direct responsibility the thirty to forty  
horses of the Service and all stable equipment, such as saddles, i
bridles, saddle blankets, etc. This equipment must be kept in .
perfect repair and replaced when necessary through the order »
department under the Executive Secretary. Sick or lame horses ;
‘ must be nursed by the couriers, and tired horses replaced by  
fresh horses at the outlying centers. The extra horses, includ- Q
ing the tired ones and the remounts, are kept at Wendover and T
on the pastures at The Clearing,-—an extensive acreage with a ,
caretaker which adjoins the Wendover properties. Although the  
couriers’ headquarters are at Wendover they are constantly in . .
the field, not only on their duties connected with the horses I
but to act as messengers between the centers and as escorts  
for guests, patients, and new members of the staff. To give Z  
continuity to this vital branch of the Service, it is under the ,=
direct supervision of a resident courier, who has had training in §_
veterinary work. When she is away on holiday, she is relieved  g
by one of the older and seasoned couriers of the Service. . 
. In November 1939 we started the Frontier Graduate School  
of Midwifery at Hyden. This school gives graduate nurses a  
thorough training in midwifery and frontier technique, similar ii
to that obtained by the old Frontier Nursing Service staff (Brit-  
ish and American alike) under the Central Midwives Boards of  
Great Britain. The course is now one of six months’ duration, fi
and we are equipped to take three pupil midwives at a time. ;
At present the School is housed in the Hyden Hospital but we i
q have the money to construct a separate building for it near the j
Hospital this summer. E
The curriculum follows the requirements laid down by the A
British Central Midwives Boards including prenatal, delivery, _
and postpartum care. The pupil is taught to care for the nor-  
mal; to recognize the abnormal and give first aid treatment when i
necessary. Class instruction by a graduate, registered nurse- ,
midwife, lectures by the Medical Director, demonstration and  

   _ Fnoivrinn Nunsmc snnvicn 11
ii practice on a manikin, actual prenatal and postpartum work in
  the homes and the Hyden clinics, and deliveries both in the
  homes and in the Hospital areincluded in the course, as re-
Z quired by the English and Scotch Central Midwives Boards.
, Tests and class discussions are frequent. The course is followed
. by an examination given by the Kentucky State Board of Health.
{ This examination includes written, oral and practical work.
  Upon the completion of the course and the passing of the
  examination, the nurse-midwife is given the diploma of the
Y School. She also receives a certificate of registration from the ·
  State Board of Health entitling her to practice midwifery in the
  State of Kentucky. The course is one for which Teachers Col-
4 lege of Columbia University in New York will allow nursing
Q credits towards a B. S. degree.
,   Financial Basis
  The Frontier Nursing Service is an incorporated philan-
i  thropy, under a voluntary Board of Trustees. It is financed
  (except for an income from endowments which we are building
  up) chiefly by the private contributions of over three thousand
°  members, and an annual grant from the Alpha Omicron Pi Na-
  tional Sorority for social service. In nineteen cities we have
{  committees of friends who are interested in the Service and who
g,  are instrumental in helping us raise funds. We charge fees for
  our services but these meet only a small part of our budget- A
  last fiscal year only six per cent. Our midwifery fee is five dol-
5, lars, which includes prenatal, delivery, and postpartum care.
if  There is also an annual fee of one dollar from each family, which
3 gives them public health and sick nursing. Dressings and medi-
{i cine are charged for at cost. The Hospital makes no charge
¥ for children under sixteen years of age and no additional charge
; to its five dollar fee for midwifery cases. For other adults the
i charge is one dollar a day. Payment in work and produce is
i always accepted, and fees are modihed or remitted to meet in-
,1 dividual needs. Never is service ma