xt7np55dd50q https://nyx.uky.edu/dips/xt7np55dd50q/data/mets.xml The Frontier Nursing Service, Inc. 1937 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. XII, No. 4, Spring 1937 text The Quarterly Bulletin of The Frontier Nursing Service, Inc., Vol. XII, No. 4, Spring 1937 1937 2014 true xt7np55dd50q section xt7np55dd50q T77 77 ~ if-t—— 77 -7 7 77 77 7 I 7
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{ Reading from left; to right.
Standing: Christine Ekcngrcn, Marion Shousc.
Sittinvz Mar ucrite Woollev Jose hine Rice Louise Mvors.
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Mrs. Paul Magnuson, Jr. (Marianne Stevenson), old ·
Chicago courier and her daughter Alicia, enrolled for
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r
THE QUARTERLY BULLETIN OF J
THE FRONTIER NURSING SERVICE, Inc. In
Published quarterly by the Frontier Nursing Service, Lexington, Ky,  A. A
SUBSCRIPTION PRICE $1.00 PER YEAR  
  I
VOLUME XII SPRING, 1937 NUMBER 4 I
"Entered as second class matter June 30, 1926, at the Post Office at I
Lexington., Ky., under the Act of March 3, 1879." .
Copyright 1937 Frontier Nursing Service, Inc.  

 TO THE FRONTIER NURSING SERVICE
And though the rood shall strike,
} And though it break into a hundred fragments
Spare them, Lord, who, from Thy ceiling’d inspiration, take
A sign, take it and pour it back upon
The staggering multitude.
No peace can find
Its application at the sword’s sharp end,
No sturdy beauty can, unsteady, bind
The ache to ecstasy. You know, my friends,
I Our roadways. Yours a dust-clad, serious path,
l Where you must meet with death at every Pace,
  And meeting, struggle, yielding, giving strength.
i You fortify the fundamental length
  Of life, its agony, its poignant waste.
  I Across the bleeding head of poverty
l   You look with eyes serene, with steady lips,
r   And wipe the wounds from all your little world,
While sailing on a sea of sinking ships.
No solace, no delight for such as I
To bring, a lowly dilettante, to you ·
Upon a firm rock bedding. Yet the sand
Before it slips away and spends itself
. Upon the idle waste may give me time
_ To write a merry rhythm of the land,
r To mist, to air, to sunlight, that shall sway
  Your hearts to happiness some care-filled day.
if  -——MARION SHOUSE, Courier
* Washington, D. C.
l
5

 2 THE QUARTERLY BULLETIN ‘ .
AND NOW THE HILLS ARE GONE ‘
And now the hills are gone, It
Their green, like mist  
‘ I Just risen, fresh from bathing §
In the run j·
I Of Middle Fork, is past. F
Their friendly air ‘ Y
Of loveliness desired and understood z
Becomes a beacon in the mind alone, if
The lonely mind that holds them to its heart. .
Across the smoky valley bottom curves f
Of verdance still unscraped by gaping eyes  
Stretch fingers to the half hid, bubbling west. l
And crumpled rocks that line the man-made veins
Stretch aching scars into a quiet heart
That shuts itself away from human signs.  I
The pools along the river mourn in peace
Their occupants, long gone and long remained, j
And whisper in the clean-cut, blue-eyed dusk ~
Of froth-filled, tinny ripples to the moon. .
Out on the mountain paths the air is clear  .
Like youthful spirits holding high a spear · W
Of peace. No years can rob the inner sight _
Of this one picture cherished with delight. I
-MAR10N SHOUSE. ‘
=l< >l< =l< *
WHY IS IT ?
Why is it when I sit alone beside -
The flame, as spring -comes crying through the air `
In fresh completeness, when the after glare,
Like harassed waves before a running tide, A
Runs through my eyes, that I so often ride S,
Again against the night? That gallant prayer  ,
. Of life hung on a horse’s hoof, that dare _Q
To save against all odds comes to my side.  I
Back of the smoky logs the tired, old hills ,7 
Appear, as laurel scent, so poignant, brings ,
Cost of that finer cost. All April rings i.
This yearly whistle through my alien sills. I
And sitting thus, that picture in the night  
Strengthens worn will with will again to iight.  
—MARION SHOUSE. ¤
l

 » FRONTIER Nrmsino smnvxcm s  
‘ HOW THE FRONTIER NURSE SPENDS HER TIME
Q MARY B. WILLEFORD, R. N., Ph. D., Assistant Director F. N. S.
  and
  MARION S. ROSS, M. A., Statistician F. N. S. n
i The district nurse-midwife in the Frontier Nursing Service
1 theoretically works an eight hour day as does the visiting nurse
f _ in a city. Although she is working alone in an isolated area far
`I from an administrative office, she begins her day at eight-thirty
i in the morning, has half an hour off for lunch, and ends it at
  five in the afternoon, provided, of course, that she is not on a
E midwifery call. During such an average working day she spends
26.8% of the time in caring for her horse and in traveling to
 . and from her patients. Twenty-six per cent of her time goes
into midwifery, including prenatal, delivery and postpartum
j care. Public health work of all kinds whether in the home or
1 in the clinic takes 13.6% of her time and sick nursing 3.2%.
‘ Record and office work take, on the average, 16.3% of her time.
 ` Of the remaining 14.1%, she spends 9% in running her center
` and 5.1% in additional unspecified activities.
  The above percentage divisions of time in the hours on
f duty of a Frontier Nursing Service nurse are shown graphically
» in Chart 1. This chart is a composite of all district nurse-
midwives’ working hours during the fiscal year, May 1935 to
 T May 1936, compiled from their daily report sheets.
_ What do the above figures mean in an actual day’s work?
· At eight-thirty in the morning the nurse grooms and saddles
her horse and rides out on her district. All calls, except mid-
H wifery, have reached her before she leaves and so far as is
 S » possible she has planned her work in relation to a certain creek.
  She will do a postpartum and a prenatal, answer a sick call and
 , make such health visits as she can along a given creek. She may
,3  return to her center for lunch or she may eat a sandwich or
i two that she has in her pocket, depending on how far she is
,`· from her center. If she has not returned at lunch time, she
Q will probably cross a hill and work down a second creek on
  her way home, again doing whatever needs to be done on that
. creek. In such a regular day’s work, the nurse makes, on the
l

 . i
I,
4 THE QUARTERLY BULLETIN _.
r
 
!
Midwifery
26.0%
"¤>
Q.
0;%% T
·¤;5’¤.;#z>,I  
§
Other vizjes Publiglgs alth
S; K
CkN"*si¤ ‘
S" 3.39
Office Work °
16.3%
Travel
and
Cure of Horses .
26.8%  
How THE mswmcrr NURSE SPENDS HER TIME `
(Chart 1) »
" 
E
 
e
3

 ¤
E,  Faowrmr. Nunsmo smnvica 5 .
i average, 8 visits. She plans to get back to her center by three-
  thirty or four in the afternoon so that she may put away her
Q horse, have a cup of tea and do her record work before night.
1 Such is an average, regular day’s work for each of the twelve
district nurses and three relief nurses that the Service regularly
_ carries on its staff. Needless to say, it may differ in numerous _
·  ways depending on the endless variations of nursing and mid-
widfery work.
` Each district nurse carries under her immediate super-
vision approximately 100 families, which means about 525 .
people. Of this number she will have about 25 babies, infants
under one year of age, whom she expects to see twice a month.
About 100 will be preschools, children between one and six years
  of age, each one of whom the nurse tries to see once a month.
l Of the remaining 400 people, about 200 will be school children
and 200 will be adults. According to our routine, school children
are seen once in three months and adults once in six months.
This routine of visits is, of course, for well people. Sick people,
Q whether young or old, are seen as often as their condition
warrants.
Of the 525 people mentioned above, from 10 to 20 will
usually be maternity cases, either prenatals or postpartums. If
1 prenatals and normal, they are visited once every two weeks
V until the seventh month of pregnancy and every week thereafter
  until delivery, regardless of the distance they live from the
center. If they are normal postpartums, they are visited every
· day for the first 10 days within a 3-mile limit, every other day
if from 3 to 5 miles away, and on the third, seventh and tenth
= days if over 5 miles distant; thereafter, once a week until one
month after delivery. If either prenatal or postpartum is not
y normal the case is visited as often as the condition requires.
· A nurse-midwife has a definite district limited by well
_ known boundaries. For a single nurse center, it is approxi-
yi  mately a three-mile radius from her center. In a two nurse
* center the radius is five miles, each nurse taking half of the
territory covered. Occasionally there are certain sections farther
than five miles from the center which for various reasons a
nurse may carry for midwifery only. It is because of these
I distances that the routine for postpartum visits varies. One
{K.

 l
6 Tm: QUARTERLY BULLETIN  
day a week the nurse-midwife does not go out on her district l
except for a midwifery or sick call. She stays in her center for  
clinic visits and sees the people who come to her. Much of her E
A l health work and many of her prenatals are taken care of in
this way. Many babies and preschools are brought to her for
_ - weights and measurements, for advice in regard to their diet
and general health. School children are often brought by the _
teacher in a group for inspection, general health check-up and
personal hygiene. Many prenatals are seen on clinic days. Thus
is the nurse’s travel time cut down and some part of the regular
l visits is carried by district people.
Now that we have a general idea of a nurse’s district, her ,
families and her daily program let us analyze certain aspects 3
of her work. We note from Chart 1 that the actual nursing
work divides itself into three types, i.e., midwifery, public
health and sick nursing. If we compare these three kinds of
nursing work in regard to visits paid and hours on duty for
visits paid on a percentage basis, we get what is shown in
Charts 2 and 3. When the visits paid of all the district nurses I
for the fiscal year 1935-1936 are thrown together, we find, as A
shown in Chart 2, that 46.3% of the visits has to do with mid-
wifery, including prenatal, delivery and postpartum, that 44.7% S
is health and 9% sickness. Now looking at Chart 3, we find V
that, when the hours on duty for visits paid of all the district
nurses for 1935-1936 are thrown together and then subdivided
into a percentage distribution, midwifery accounts for 67.3% x
of the time. In other words, nearly half of the visits paid are
to obstetrical cases and two-thirds of the hours on duty for ‘
visits paid are spent with midwifery patients. One can easily
see the enormous amount of time proportionately that goes into 7
a midwifery service. Comparing Charts 2 and 3 for health (as p,.
we did above for midwifery) we find that it takes only 23.4% i
of the hours on duty for 44.7% of the visits paid. And likewise `
for sickness, we find that 9.3% of the hours on duty is sufficient  
. to care for 9% of the visits paid. ’
Now let us look further into this midwifery care by in-
specting Charts 4 and 5. As Charts 2 and 3 select midwifery,
health and sickness for the purpose of comparing visits paid
with hours on duty for visits paid, so Charts 4 and 5 take mid-

 Q .
  FRONTIER NURSING SERVICE 7
Health
44.770
I Sickness
9.0%
Midwifery
46.3%
VISITS PAID IN HEALTH, IVIIDVVIFERY AND SICKNESS
Fiscal Year 1935-36
_ (Chart 2) ·
'Health
2::.4%
_ Midwifery
Sxckness 57,3%
9.3%
iq.
wi
HOURS ON DUTY FOR VISITS PAID IN HEALTH,
IVHDWIFERY AND SICKNESS
Fiscal Year 1935-36 "
(Chart 3)

 é
I1
8 THE QUARTERLY BULLETIN  
' 1
  1
_§:'gq>  
. q ‘°  »
Prenatal L
_ . 29% .
`4
zi
5
Postpartum 1
65.1%
_ VISITS PAID IN MIDWIFERY  w
Fiscal Year 1935-36 4 · 1
  (Chart 4)  
i
1
 4%
.  ·S
Q
Prenatal  
16.9% 5
I
Delivery
49.9% `
Postpartum I
‘ 33.2%
 ~.
1.
HOURS ON DUTY FOR MIDWIFERY VISITS PAID I
· Fiscal Year 1935-36
(Chart 5) ,

 l
A
 
 E Faomrma NURSING srravxcm 9
 { wifery alone to compare on`the same basis. Chart 4 shows that,
. when the visits paid in midwifery by all the district nurses
 A. for 1935-1936 are thrown together and subdivided into prenatal,
  delivery and postpartum, 29% of the total visits paid in mid-
`  wifery are to prenatals, 5.9% to deliveries and 65.1% to post-
9  partums. Comparing these same midwifery divisions·with hours
A on duty for visits paid in midwifery as shown in Chart 5, we
find that it takes only 16.9% of the hours for 29% of the mid- l
wifery visits when those visits are paid to prenatals and only
l 33.2% of the hours for 65.1% of the midwifery visits when the
visits are paid to postpartums, but that it takes 49.9% of the
hours spent in midwifery to cover 5.9% of the visits in midwifery
when those visits have to do with deliveries. Nothing could show
more clearly the time consuming element of a delivery service.
At least one reason should be mentioned to explain why
both the prenatal visits and time are markedly less than the
 “ postpartum visits and time. It was mentioned above that many
 2 prenatals come to clinic for their routine visits and all of the
 u last four charts are based on visits paid, both as regards hours
  on duty and number of visits and in no way consider either
{ clinic hours or visits.
 3 In looking again at the last four charts and seeing the high
  percentage of time and visits that go into the midwifery work,
4 is it apparent what this means in terms of a nurse’s daily work?
  She may have her work planned for the day and have all of
S it cancelled by a midwifery call. She may have done a full day’s
1 work and only just returned to her center and be immedi-
i ately called out again to a woman in labor. She is on call for
deliveries twenty-four hours every day, seven days every week,
regardless of tide or drought, heat or cold, snow or ice. A
S primipara may keep a nurse from her center for twenty-four
I hours or longer; a prenatal with an abnormality may require
. endless work and worry to get her into the hospital for neces-
 x sary care under the Medical Director; a postpartum who makes
g a poor recovery may require a daily visit for weeks. It is true
 v that the Service allows a six weeks yearly vacation to compen-
  sate to some extent for overtime, but the nurse’s real compen-
` sation comes from results such as those given below.
2 The results obtained by the nurses after they have spent

 a
  Q
10 THE QUARTERLY BULLETIN
their time as indicated above might be evaluated in many ways. i
They might be given in total visits paid and received for a year
and total number of hours on duty for the same period. Again  
· the number of families visited, women delivered or sick people ` 
nursed might be indicative. In addition, one might mention
the thousands of inoculations given, the wells chlorinated and S
the baby cribs built. It is true that any or all of these are ways E
of measuring results and would undoubtedly show progress.
However, as the above has shown the emphasis that is placed K
on midwifery in the Frontier Nursing Service, it is by means
of such statistics that the results in the present instance should
be given. Chart 6 shows a comparison of figures for the United
States and Kentucky for 1934 with the Frontier Nursing Service
from the beginning of the Service in May 1925, to the end of the
fiscal year May 1935 based on 2,254 live births. It will be noted
that the maternal mortality rate is so much lower for the Service '
than for the United States and Kentucky, that the figures are l
scarcely comparable. It will also be noted that the stillbirth rate I
and neo-natal mortality rate for the Service are both less than (
for the United States and for Kentucky. Could there be any i
better indication of the results obtained by the Frontier nurse
who spends so much of her time in maternity work?
;;[
A Comparison of Statistics of the United States (1934) and Kentucky  
(1934) with the Frontier Nursing Service (from May 1925 to  
May 1935, Based on 2,254 Live Births) `
  ]
Frontier ?
United Statest Kentuckyt Nursing Service P
1934 1934 May *25-May ’35 .
 
Maternal mortality rate . . . 5.9 5.4 .8  
(per 1000 live births) V
 
Stillbirth rate ........ 3.6 3.4 2.4  
(per 100 live births) ’
_Neo-Natal mortality rate . . 34.1 32.6 28.4 I
(per 1000 live births) » (
*Figures from the United States Department of Commerce, Bureau of  
the Census.
· (Chart 6) `

 a
l
FRoN1*1ER Nuasms smnvicn 11
o THE HORSE EPIDEMICS
`  By
MARY S. GORDON, Pittsburgh Courier
I Epidemics is the word, because from March 5th ’til the
5 end of April the Wendover stables were besieged by horse-
influenza, distemper (abscesses) and one lone and tragic case
i of pharyngitis-laryngitis. Our epidemic started and spread as
ripples will from a stone cast into a pool——the stone in our case
being a lovable animal, one "Puck," new from Lexington, who
arrived late on the afternoon of March 2nd. Jean and I met
him at the Head of Hurricane with "Lady Ellen" and "Bobby."
"Lady Ellen" uncivilly kicked at him when Jean tried to lead
him from her, so I led "Puck" from "Bobby": one hour’s ride
' down Hurricane with "Puck" coughing slightly and "Lady
I Ellen" in the lead. - _
I The next morning "Lady Ellen" was sent to Brutus and
( "Puck’s" cough seemed all right. This was simply the lull before
1 the storm. On Friday, March 5th, Lois called from Brutus,
saying that "Lady Ellen" was coughing badly. No runny nose,
simply a fairly severe cough. Monday, March 8th, saw Jean on
ll her way to Brutus to see "Lady Ellen" and "Pinafore," both
  of whom were coughing and having slight nasal discharges.
  Jean was there two weeks. She, alone, took care of a neighbour-
i horse, of "Bobby" (the horse she rode over), and "Lady Ellen"
l and "Pinafore," the two nurses’ horses. They had horse-inf1u-
t enza. Jean by herself carried buckets, wiped noses, took tem-
? peratures, groomed and fed four horses daily—a man-sized job
i for anyone.
yi Things at Wendover were getting no better fast. One
I courier was ill in bed for two weeks, while the other two fol-
. lowed Dr. Hagyard’s medical routine. Without Dr. Hagyard’s‘
, advice telephoned and written from Lexington, we should have
I been desperate. In swift succession "Rex," "Llan," "F1int,"
  "Sunny," "Tramp," "Bruna" and “Gloria" developed coughs,
then runny noses. “Puck" was our problem child. His flu ran
into distemper with abscess.
, While the Service functioned on "Lassie" the invincible and

 J
1
—  I
12 THE QUARTERLY BULLETIN  
"Gabriel" the hardy mule, we carried buckets of water with H
Glauber’s salts, wiped noses clean from runny yellow discharges, J
. syringed quarts of thick pink cough medicine down throats,  j
fixed bran mashes and prayed for the recovery of our horses.  
This was routine and was applicable to the general group.  i'
"Puck" had special doses of tonic and sweet spirits of nitre
from time to time. Also, temperatures were taken morning and ‘
afternoon. On March 27th our first crisis came with "Puck."   _
He had developed a large abscess in his throat, which was .
slowly choking him. No food or water could get down. He was ;
weak as a kitten and breathing in terrible gasps. A hurry call
to Lexington brought Dr. Holmes of Dr. Hagyard’s staff on
Easter Sunday. He made the whole trip (160 miles each way)
as a courtesy. He said "Puck’s" condition was serious, but not
if the abscess would break. The others were improving nicely
and could be ridden when their noses stopped running. "Rex" _
was the most seriously affected with laryngitis and pharyngitis
(a paralysis of the throat making eating and drinking difficult,  i
if not impossible). Following Dr. Holmes’ advice, we kept hot  t
compresses on "Puck’s" abscess for two weeks. It opened in two
days and drained until the 16th of April. His temperature came _
down slowly as the poison left his system, until on April 16th I
it was 99° all day, he was eating and drinking normally, and
actually bouncing about. This last a marvelous sight for every- `
body on the place. He is a darling and a lamb. So much for him.
"Rex," after two weeks of inadequate eating and drinking
in spite of every effort to tempt him with various foods, suffered ·
an apparent breakdown of his digestive tract and organs of
elimination. On the next to his last day, several doses of nitre
failed to relieve him. He was given a hypodermic to relieve his .
pain and after a night and day of plunging and suffering, we  .
gave up all hope and he was put away; a fine animal and a I
heartfelt loss to the Service.
To jump back again—which is necessary as I can’t seem ‘,`
to bring the horses and their ailments along in an orderly '
progression—on Saturday, April 10th, "Tramp" developed a
throat abscess after ten days on duty seemingly well and healthy.
, As I write, on April 17th, the abscess is coming to a head nicely
and when it breaks, will drain the poison out. With the going
· ~ ~ 71** r~f7W.- a..,..i,—,,.H I

   ‘<
 
 !
»  l .
  ' Fizourimz Nunsmo smwxcm is
 S of the pus, down will come his temperature and he will go on
p duty after a period of rest, we hope. This glib statement is
wg what should happen and what we hope will happen.
All At the same time of "Tramp’s" relapse, "Bobby" and "Llan"
i re-developed runny noses and temperatures. Also, "Gabriel."
 ‘ He surprised us all, because he had gone for some six weeks
‘ through the entire contagion perfectly well. He is now almost
 l _ cured and needs only rest and bran mashes.
On reading this over, it seems pretty much of a jumble.
It should be clear that the Wendover stable for the past seven
weeks has been horse-bound, and that is equivalent to a taxi
_ garage being full of cars with one spark plug. This has meant
countless trips on foot up and down Hurricane creek and no
I trips with "unclean" horses to the "clean horse" centers. At
 1 the moment, we are almost out of the woods-—"Tramp" being
i our one patient and a very gay one.
=; In conclusion, I’d like to apologize to any doctor or medical
Q person who reads this for the lack of correct medical termin-
ology, etc. We knew what we were doing, but medicines were
‘ designated as "pink," "brown," "sticky," and "smelly" by us
. and were given accordingly.
` An Apology
 l This year’s Winter Bulletin was dated 1936 whereas it
should have been dated 1937. The editor oHers her apology for
_ this slip—up which was entirely her own fault.
`gi  Overheard in Washington
g "The Frontier Nursing Service? They are the ones that
- have babies on horseback."
I

 I
‘ l
14 THE QUARTERLY BULLETIN l
"MANAGEMENT OF OBSTETRIC DIFFICULTIES"  f
. - By .  
PAUL TITUS, M. D., Obstetrician and Gynecologist to the St. Margaret  
Memorial Hospital, Pittsburgh; Consulting Obstetrician and Gynecologist ’
to the Pittsburgh City Homes and Hospital, Mayview, and to the Home- ’
stead Hospital, Homestead, Pa.; Secretary of the American Board of
Obstetrics and Gynecology. (879 pages with 314 illustrations. Published
by the C. V. Mosby Company, St. Louis, 1937). ‘
The outstanding contribution that the "Management of
Obstetric Diificulties" will make to obstetric literature is that
it will prove of enormous aid to the general practitioner who
meets with an abnormality. It will serve also as an excellent
reference for the obstetric specialist. Although in the true sense ’
of the word it is not a textbook, it will probably serve that I
purpose to some extent for the advanced student and for the ,
hospital resident. As the title indicates, the book treats of the |
abnormal and not the normal in obstetrics. Techniques for  I
handling obstetric difficulties are given concisely and lucidly
with numerous well-titled illustrations which make the pre-
sentation particularly graphic.
Dr. Titus devotes the first section of his book to sterility g,
with particular reference to causes and treatment. Following
that section is one on the difficulties involved in the diagnosis
of pregnancy, giving in detail some of the newer tests for ”
pregnancy. Sections III, IV and VI take up respectively the ;
complications of pregnancy, labor and the puerperium, the 5
intervening section V having to do with obstetric operations.
Section VII treats of the newborn and the final Section VIII is
devoted to general procedures such as preparation for operation,. _ 
anesthesia, intravenous injections, etc., with particular reference
to the obstetrical patient.
Although Dr. Titus is concerned primarily with the man- `. .
agement of obstetric complications, nevertheless he indicates A
the importance of prevention and the measures that can be
taken both by the patient and her physician to prevent many
of the complications that may arise during pregnancy. In his
T introduction he points out that the recent surveys of the causes
L

 l
l
{ FRoN·r1E1>. Nuasmc smavicm 15
of our high maternal mortality do not prove that which is often
! suggested, i.e., "That a universally poor quality of obstetric
_ ability pervades the entire medical profession of this country",
i but three other facts. "The first of these is that a surprising
? number of pregnant women in this country . . . fail entirely
{ to seek prenatal care .... Second, it has been shown . . . that
' there is a tendency on the part of many physicians to under-
take obstetric maneuvers and operations of which they are
entirely incapable. Third, (the) surveys have shown also that
some men who have had even special training in obstetrics have
, developed the radical tendency of interfering or operating for
the slightest complication."
The last two points mentioned above lead naturally to an-
g other important factor in obstetrics which Dr. Titus emphasizes,
l i.e., conservatism. As long as both mother and baby remain in
  good condition and the difficulty is such that the physician can
{ safely wait, Dr. Titus outlines a program of rest, sedatives and
l conservation of Nature’s forces with the result that often inter-
l ference is not necessary. A policy of "cool conservatism" isthe
l one that Dr. Titus recommends to obtain the best outcome for
patients.
I The Frontier Nursing Service feels extremely honored that
F it is mentioned in Dr. Titus’ book. He points out that the
l Service reports notably low maternal mortality rates among
i the mountaineers, ". . . chiefly because they are given skilled
l care with especial attention to prenatal supervision, including
E anticipation of as many as possible obstetric complications?
Dr. Paul Titus is a member of the National Medical Council
i of the Frontier Nursing Service. He has presented us with a
copy of his book and we are most grateful for it.
"  MARY B. Winnnrono, R. N., Ph. D.
i · Vivat Rex! Vivat Regina!
- The Frontier Nursing Service extends its congratulations
to the British Empire on the coronation of the Empire’s ad-
mirable new King and Emperor and the Empire’s charming
new Empress and Queen.

 I
16 THE QUARTERLY BULLETIN {
A WORD OF EXPLANATION y
- """ l
Occasionally we receive a subscription with a request i
"Please do not trouble to acknowledge as the canceled check is
my 1·eceipt". We know that this request is meant to save us =
trouble but we cannot comply with it because our auditors re- {
quire us to send a numbered receipt for each subscription and i
to keep the duplicate in our files for the annual audit. Thus if ·
you receive receipt No. 967, a duplicate No. 967 (with your 1
name and address and the amount you gave thereon) remains *
in our files and goes to the auditor at the close of the fiscal year
with the bank statements, the bookkeeper’s books, etc. It is a
double check which our auditors put into operation a number T
of years ago and consider the most satisfactory way of account- I
ing for public funds. Every gift, therefore, is not only traced
through the bank statements to the books but checked by these  p
duplicate receipts, and finally appears in the audit, although i
there it is anonymous if requested. l
We have been rather put to it to decide about the mailing ,
of these receipt cards. First, we sent them out in an envelope  i
with first class postage. Then the postage jumped to 3c and, as
we receive over two thousand contributions during each fiscal _
year and, as the treasurer insisted on paying personally all the
postage, the Executive Committee felt that it wasn’t fair to .
allow him to pay three cents for each receipt card and we began l
sending them out as postal cards for a penny each. This, how-
ever, has not proved satisfactory either because some of our
subscribers do not like to have an acknowledgment of their
gift in the open mail. This coming fiscal year which begins May _
1st, we are trying another way. We are going to mail the
receipt cards out enclosed in unsealed envelopes at one and a  
half cents each. We hope this will be acceptable to our sub-
scribers, and, if anyone’s receipt fails to be forwarded to them
when they are away from home, they can always get a duplicate l
sent them by writing down to us. ,
Gifts to the Frontier Nursing Service, Inc., are deductible
' from the income tax. -
1
l

 i
l V FRONTIER NURSING SERVICE 17
I IN MEMORIAM
   
I MRS. LEONARD HANNA, of Cleveland
MRS. JOHN MARKOE, of Philadelphia
‘_ MRS. J. H. STRONGMAN, of New York
l MRS. A. E. DUNCAN, of Baltimore
F JUDGE J. M. MUNCY, of Hyden, Kentucky
l "It may be in the evening
, When the work of the day is done,
And you have time to sit in the twilight
And watch the setting sun,
While the long bright day dies slowly
Over the sea,
j And the hour grows quiet and holy
I With thoughts of Me;
While you hear the village children
Passing along the street,
. Among those thronging footsteps
E May come the sound of My Feet.
* Therefore, I tell you, watch
I By the light of the evening star
` V When the room is growing dusky
, As the clouds afar:
I Let th