xt7pc824cp5c https://exploreuk.uky.edu/dips/xt7pc824cp5c/data/mets.xml The Frontier Nursing Service, Inc. 1946 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. 22, No. 2, Autumn 1946 text The Quarterly Bulletin of The Frontier Nursing Service, Inc., Vol. 22, No. 2, Autumn 1946 1946 2014 true xt7pc824cp5c section xt7pc824cp5c Elba ®U&ffBfI? ?§uIIztin
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—P]lOtOgI`d})Il€d by Hans Knopf
Courtesy of Co11i¤er‘s Magazine
Published Quarterly by the Frontier Nursing Service, Lexington, Ky.
Subscription Price $1.00 Per Year
"Entered as second class matter June 30, 1926, at the Post Omce at Lexington, Ky., ` 
under Act of March 3, 1879." V
Copyright 1946 Frontier Nursing Service, Inc. ·

 up ~ -
.,3} `=
   4 INDEX
A Letter We Appreciate Alice Estridge 18 ·
_ Beyond the Mountains 47 -
_  l Christmas (A Poem) George Herbert 2
§, Field Notes 57
  From a Courier’s Letters Home Lillie Middleton 23
   ll l "God Bless the Frontier Nursing
   "— Service" Hallie Maggard 3 ·
  — _ Granny Della Int-Houit 45
   ,3 In Memoriam 19
il  My Christmas Eve Baby Anna May January 36
   'l»   Old Courier News 40
 n Old Staff News 27
  Our Case up Little Flat Creek Virginia Frederic]: 38
The Organization of the Frontier
  Nursing Service, with a Diagram 7
i f _ ’_7z { Igvyl. =   BRIEF BITS
    I Advantages of Drafts British. Medical Journal 39
  ‘‘‘`‘i     An Old Soldier John G. Winant 26
      Approaches (A Poem) George MacDonald 22
 mg-  —»-. Changes The Hazard Herald 37
it   'V__ A Characteristics of Intelligence Contribitted 35
  Christmas Day (A Poem) Charles Kingsley 66
  cum nz E. r. Fowler 46
  Just J okes—Situations The Safer Way 37
  »__:  Q   Leave It to Others People’s Friend, England 56 .
    Louise Fink (A Photograph) 5
l `i °   ‘· Mexican War Period The Two Vanreivels 26 ·
Z    Report from One of Our Patients 17
' Surprise The Countryman, England 18
Ye Canna Mak’ a Soger (Verse) The Pibroclc 18

All aI’rer pIeasures as I ricI one oIay,  
My horse anoI I, bo’rh +ir`oI. boolie and minde.  
\/\/Hh 1°uII crie OT aTIecIIons. quiIe asIray,  
I +ooI< up in Ihe nex+ inne I couIoI TincIe. I
There when I came, whom IounoI I bu+ my cIeare,
My dearesf I.orcI, expechnq IIII Ihe griewc y
OI pIeasures broughf me Io I·Iim, readie Ihere I
To be all passengers` mos+ sweeI reIieI. I
O Thou, Whose gIorious yeI con+racIed light A
Wrapf in I\Iigh+`s man+Ie, s+oIe inIo a manger, `
Since my dark souI and Ioru+ish, is Thy riqh+,
I To man. OT all beas’rs. be no+ Thou a s+ranqer: ‘
I Furnish and deck my souI, +ha+ Thou mays’r have M
A Ioe++er IooIging Ihan a racI< or grave. C

V FRONTIER Nunsmc. smnvicm s A _  
Q by . 
‘ We were deeply moved to receive the following two-part story from
a member of one of our well-known Leslie County families, and to receive
; her permission to print it in our Quarterly Bulletin. With the story came
. the following letter:
  September 6, 1946
  Dear Mrs. Breckinridge,
  I am mailing you a story which I have written for you.
[` I have woven this story around your wonderful work in the
mountains, and have tried to show how all appreciate you and
_ your nurses, even the outlaw in his most degraded state.
Just a kind thought from mountain folks.
Very sincerely, `
° A (Mrs. Jess Maggard)
Owl’s Nest Creek, Kentucky
Far back in the Kentucky hills, Bad Mose, a notorious and
dreaded outlaw; lay in ambush guarding carefully his well-
, hidden moonshine still. Across his lap lay his rifle. By his side
sat, as if motionless, a tousled haired ruffian known as Zeke.
They were watching the trail below them. Their ears were alert
__, _ to every sound. Their eyes were keen and piercing.
  "Quick, draw back behind these bushes," whispered the
  leader. As they peered out from their hiding place they saw for E
i t: a moment, silhouetted against the western sky, the blue-gray
§‘ . uniform of a young woman riding at breakneck speed.
  g "It’s only Scotty," said Bad Mose. "She is going to see a
  patient just over the p’int," and the two men shufiied their giant
  bodies into more open space.
  "Say, Zeke, you are kind of a newcomer and I want to give

you a very important order and I never give one twice. You
saw the nurse who just passed. I saw the gleam in your eye, I
but take orders once and for all. I take my hat off to the Fron-
tier Nurses. My men all do the same."
"Yes, Boss," said Zeke, eager to obey his master.
I Bad Mose talked on in a monotone of voice. "I owe my life
to that nurse," and he nodded in the direction which Scotty
had taken.
"I was in a skirmish once on one of the loneliest trails of
the hills. I crawled into an old deserted cabin to die, I thought,
as I sank into a coma with my back against the log wall. A  
terrible thunder storm came up and drove a wet, bedraggled [T °
little nurse into the same cabin. She flashed a light around and  
when she first saw me she thought she had found a dead man.
Quickly she found her saddlebags and from its contents she
dressed my wound as best she could under the circumstances.
I must have passed out for a short time. I just had a dim recol-
lection that as she was leaving the cabin I heard her say: ‘I’ll ’
send help to you.’ This last sentence brought me to my senses.
I dragged myself outside the cabin. The rain was over. Half
pitching and falling, I stumbled on through the woods, and
sometime the next day I made it back to my den."
’ II L
, A young mother lies on a roughly made bed, smiling between .
_ pains of agony. A white-aproned nurse busily empties her sad-
~ dlebags and arranges all needed articles on a small hewed table. l “
The lamplight is dim and smoky. The nurse finds her flashlight _
very convenient as she goes from the cabin living quarters into I
the dark kitchen which is only a lean-to, built out of boards and  
slats, and fastened on to the side of the cabin. In this kitchen  
sleeping peacefully on the iioor are several small children with iv ` X,
only an old worn quilt underneath them. Q
Sitting outside the cabin, quiet and silent, is the man of  
the house. You only know he is there by the occasional iiash  
of a match as he lights his pipe.  
" The mother smothers back her cry of aches and pains as ii

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she goes downinto the valley and shadow. "I don’t want to
` disturb the children," she whispers to the nurse.
Y All is over. A little bit of humanity is placed in the mother’s
.A arms and, as the nurse takes her leave, the mother gives a wan
· smile and says, "I never got along so well in all my life, thanks I
to you, brave little nurse, and I join in with thousands of other
mothers of the hills as they say, ‘God Bless the Frontier Nurs-
, ing Service} "
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  A. 0. Pi Social Service Secretary of the Frontier Nursing Service
Q   and '
  Paddy, the Collie
  In front of the Garden House at Wendover

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* of the
_ 1946
4 What It Is
" The Frontier Nursing Service is an incorporated, non-profit
  philanthropy. Anyone who contributes two dollars or more to
,1 .’, its work is an honorary member and receives the Quarterly Bul-
" letin published by the Corporation. Voting membership is com-
`i"“ prised of groups of men and women, both professional and lay
persons, organized into committees, in a number of large cities
and eight local communities, to further the work of the Corpora-
tion. Those Committee members who attend the annual meeting
vote for the Board of Trustees and for the officers of the Fron-
tier Nursing Service for the ensuing year. The powers of the
E Board of Trustees, when it is not in session, are vested by the
` Board in an Executive Committee. These bodies approve all
i policies and ventures of the Frontier Nursing Service; the Direc-
F tor of the Service is their oiiicial representative.
T ` The Frontier Nursing Service has two professional advisory °
  groups, the National Medical Council and the National Nursing
lé Council. Those members of the National Medical Council who
? S live in Lexington, Kentucky, comprise the Medical Advisory
i Committee of the Frontier Nursing Service. It is this Committee
‘ which prescribes and authorizes the Medical Routines of the
, Frontier Nursing Service which are the standing orders under
z. which its nurses work.
  Location of Its Work _
R'], The Frontier Nursing Service provides a program of medi-
§ ( cal, nursing, and social service work adapted to the needs of
I   remotely rural areas. The iield chosen for this work is about
”, seven hundred square miles located in the Appalachian Moun-
  tains of southeastern Kentucky, extending into four counties-
  Leslie, Clay, Perry, and Owsley—but covering none of them. All

 ‘ 8.- ..-.-... ----- ___.T!@nQUARTE.¥°;&LEU&FLFIN .... __; A
its boundaries are determined by natural barriers, not by arti- .
ficial county lines which often run through the middle of a 1
neighborhood. Hyden Hospital, Midwives Quarters (building V
for the Frontier Graduate School of Midwifery), and Joy House ;
(home of the medical director) are in Hyden, the county seat H
_ of Leslie County on the Middle Fork of the Kentucky River.
About iive miles from Hyden is Wendover, administrative head-  
quarters and the home of the Director. Besides these, there are Y
six outpost centers, nine to twelve miles apart; three on the .
Middle Fork, two on Red Bird River, and one on Bullskin Creek  
which flows into Red Bird River.  
Living Conditions . 5/
At each of its eight centers the Frontier Nursing Service `
owns its own land and buildings. At Hyden part of the stone
hospital and an annex to it serve as living accommodations for
the nurses. Joy House and Midwives’ Quarters are on the hos-
pital grounds. Wendover is composed of a group of buildings, -
in several of which are bedrooms for nurses and secretaries.
All Service personnel have rooms to themselves. Wendover and j_
Hyden each have a large living room and a dining room while
, Midvvives’ Quarters has a combination living-and-dining room. Q
, The six outpost centers have well-built and well—equipped eight-  
  room houses. Two of these rooms are clinic and waiting rooms,  
i and the other six serve as homes for the nurses——at three centers  
for one nurse each, at three for two nurses. All centers have  
large barns, cow sheds, chicken houses and acreage for pastures ? .
and gardens. ’
Hyden and one of the outpost centers have electricity. The ,
rest of the Service depends on kerosene lamps and candles for
light. All centers have running water and bathrooms. Except
for three of Wendover’s older buildings (heated by individual   '
open fires), all have central heating, with open fires in the  
living rooms as well. _; » ,
It is the policy of the Frontier Nursing Service to stabilize J I
the cost of living for its staff. At Hyden and Wendover everyone i
i pays a fixed rate for room, board, and laundry, the details of ,
which are managed by specified members of the administrative  
staff. In the outpost centers the nurses make their own house- ,1

— Faonrma Nunsme snnvicm `s g
A keeping arrangements, but the Service provides furnished living
, _ quarters, keeps them in repair, and pays board for all patients
  and guests of the Service. The Service also provides a cow for
V each center and feeds it. In times of high prices the Service
Y makes other adjustments to keep down the living expenses for l
its staff without sacrificing quality. Each center is expected to
  keep a maid to do the housekeeping, milking, and cooking
; although the lack of skilled domestic help in the mountains
  makes necessary a varying degree of supervision on the part
{ of the nurses.
iq The regular working week has forty-four hours. For all
 ,__ but the hospital nurses this is made up of eight-hour days with
  Sundays and Saturday afternoons off duty. In the case of hos-
YJ pital nurses the usual working day is seven and a half hours
S with six hours on duty Sundays and one day off each week. The
schedule is so made up that each nurse has last hours before
I her day off and has forty-eight hours free before going on night
duty. Because there are times when over-time work is necessary,
` a vacation of six weeks with full pay is allowed each year.
" The Nursing Work
  In order to cover the territory where travel is diflicult
  and time-consuming, the nursing work has been organized on a
  decentralized basis with Wendover as administrative headquar-.
  ters and Hyden as medical headquarters. The entire staff works
  under the guidance of the Director of the Service who is a regis-
.i tered nurse with graduate public health training and who is
  a graduate midwife holding the certificate of the Central Mid-
Q wives Board of England. The Director has two assistants who
— are graduate registered nurse-midwives. The first assistant is
g · a college graduate and holds a master’s degree in Public Health
  and is responsible for the field work and educational programs, .
EQ including that of the Midwifery School of which she is dean,
  l The second assistant helps the Director in her contact work
z and helps in field supervision. Under the Director, too, are the
_. superintendent of the hospital and the instructor in the Frontier
it Graduate School of Midwifery. This latter is a college graduate
Q and holds a master’s degree.
` I

· l
Hyden Hospital _  
The Hyden Hospital is a general hospital of twenty beds
and six bassinets taking in all types of cases except those with
chronic, mental, or (except in rare instances) communicable
_ diseases. It is the only hospital within many miles of our terri-
tory and many people from outside the area seek admission- '
more than the hospital can accommodate. The hospital super- {
intendent has six full-time graduate nurses under her: one a i
nurse-midwife, four non-midwife nurses for iioor duty, and one
graduate nurse for the large out-patient department. The nurse-  
midwife has charge of all midwifery patients in the hospital IQ
and supervises the hospital work of the midwifery students. The  
floor nurses get experience in each of four types of hospital  
assignments. As ward nurse each cares for non-midwifery ,
patients; as surgical nurse she has charge of treatments, medi- Q;
cines, dressings, and sterilization; as obstetrical nurse she assists  
the nurse-midwife; and as night nurse she has complete care  
of all hospital patients except maternity cases in labor.  
Often specialists from the cities offer their services for  
special clinics. Two such clinics (one for general surgery, one  
for tonsillectomies) have become regular annual events. Except  
A in the case of special clinics, only emergency surgery is done at ;
  Hyden Hospital.- The regular hospital nurses help in the oper-  
l ating room. The visiting surgeon for the hospital lives in a E
` 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  
responding to our calls is only equaled by his kindness and skill.  
The medical director holds a clinic in the outpatient unit  
of the hospital three times a week. Patients from all over the E
territory and from beyond it come to these clinics. The medical l
director has a non-midwife nurse and a secretary to help her pj 
with these and to send reports back to the nurses from whose V
districts the various patients come. The nurse helps with the   `
laboratory and X-ray work and keeps the doctor’s medical and ’;
~ obstetrical saddlebags in order. She is in charge of the clinic  #
on non-clinic days, to care for emergencies and for those who ¤._  
` must return for treatment.  

i Fnowrimn Nugsgigg sianvxcm n ’
  District Nursing
District nursing is carried on by all centers of the Frontier `
Nursing Service. At Hyden there are two nursing districts; at _
Wendover, one; and of the outpost centers, three are divided ‘
_ into two districts and three are single district centers. At each
l center the district nurses hold a clinic one morning of each
X week, and sometimes a second clinic at small outlying dispen-
, saries, but 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 district.
,5, The first fundamental of the work is bedside care—bedside care
  for the sick, for the woman in labor, and for the young baby
Y'? and his mother. Only in chronic cases does the nurse leave the
, actual nursing in less skilled hands—and then only after a suffi-
  cient number of demonstrations have been given to convince
  her that the home care will be adequate. After that the nurse
  makes follow-up visits to assure herself that all is well. Having
  demonstrated her value in bedside care, the nurse goes on to
  include a broad public health program; inoculations, wormings,
  and instructions concerning sanitary privies, a pure water
  supply, and a diet as nearly adequate as possible. The only
  instance where a district nurse-midwife does not carry this
  whole program is on the double district at Hyden. Here a non-
  midwife nurse carries everything except midwifery. This is
? cared for by the Frontier Graduate School of Midwifery.
  Although a state road now passes through Hyden, and
  WPA roads make it possible to reach most of the centers by
  jeep or truck in dry weather; the nurses must still follow poorly
  defined trails leading along rough creek beds, over steep moun-
l tains, and through fenced corniields to visit their patients. Only
* in parts of three districts has a car proved useful in the dis-
,,.‘  trict work. For the rest the nurse travels by horseback, her .
, supplies in saddlebags, at an average speed of four miles an
  ` S hour. She often is unable to get back to the center for lunch
li but carries sandwiches with her. She does try to get back in
·· time to write up the records and do her time sheet at the end
  of the day’s work. Each nurse keeps a full record for each
  individual in her district. Records are kept in family folders in

files at the center. Daily time sheets and closed out records are ,
sent twice a month to the record ofiice at Wendover. f
In all her work the district nurse follows the Medical and  
Record Routines. If the Medical Routine proves inadequate, she
gets help from the medical director. When she needs assistance F
· or advice with her nursing work she gets both from the field  
supervisor. The executive secretary, the social worker, the -
record office personnel, and the couriers act as her advisors and ‘
assistants in their various departments. Drugs and clinic sup-
plies she orders monthly from the hospital superintendent and
couriers deliver them to her when they bring the Service’s if
blacksmith to the center to shoe the horses.  
New nurses are introduced to the district work by senior a
members of the staff who act as teaching supervisors. For  
about six weeks the new nurse assumes little responsibility. She U
is under the direct supervision of the senior nurse who plans  
each day’s work 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 d
nurse, going wherever the need is greatest. In this way she J
becomes familiar with all the nursing centers and often with f
the hospital as well. Later she becomes a junior nurse at a i
center and finally is given charge of one. I,
T Senior Cadet Ajffiliation  
The Frontier Nursing Service began its cadet program in  
the Spring of 1944. According to this program a limited number  
of senior cadets are given experience for not less than four Q
months and preferably for six months in the generalized nurs-  
ing work of the Service. Before being accepted the student .
must have had a minimum of six weeks’ visiting nurse experi-
ence, or some other form of public health, and must be recom- '·
mended by the director of her nursing school as being suitable G. 
for this type of work. It is not necessary that she ride horse- _
back, though she should not be unduly frightened of horses. , 
The first few days with the Service, the cadet spends at  
’ Wendover where the resident courier, or an able senior courier, Q
checks on her riding ability and her knowledge of saddling her  
own horse and caring for him. If she does not know these  

 i Faourina Nnnsmc smavicm is i
  things before coming to the Service the couriers teach her.
E - After she feels at ease with her horse, she is put directly under
  ` one of the district nurses chosen because of her teaching ability.
* This nurse-midwife gives her demonstrations and teaches her _
. the routines of the Service. After the student is allowed to go ”
t out alone, she discusses her cases with the nurse-midwife each
Q night and at intervals the nurse-midwife makes supervisory
, visits with her.
The work of the cadet includes home visiting in sickness,
public health, and maternity nursing; clinic work in these fields;
'F and, usually, a limited amount of work (not over one month)
  in the Hyden Hospital. Cadet experience does not include instruc-
l tion in delivery technique, but the cadet does assist the nurse-
Ti midwife in her deliveries. Before leaving, each cadet makes an
 , inspection tour of all eight centers of the Frontier Nursing
  Service. S
There is no formal class work. Occasionally the student
J may be asked to attend a special lecture, but for the most part
is instruction is given in individual conferences and by clinical
‘ teaching. The cadet is expected to write up one case study or
· a paper on some phase of her work. She keeps an experience
A sheet which she sends in each month to the central office, and
  each nurse-midwife under whom she works sends in an evalua-
  tion of the ability the student has shown in various phases of
  her work, thus enabling the field supervisors to see just how
  each student is progressing. At the end of her stay with the
QL Frontier Nursing Service a summary of her experience sheets
i and a report on her abilities is sent to the home school.
` Frontier Graduate School of Midwifery
In November, 1939, the Frontier Nursing Service started
'· the Frontier Graduate School of Midwifery at Hyden. This
G.  school gives graduate nurses a thorough training in midwifery .
1 and frontier technique. The course is of six months’ duration
,  and the School is equipped to take six pupils at a time. Class-
, room and living quarters are at Midwives’ Quarters, an attrac-
  tive building on the hospital grounds. The instructor and dis-
  trict supervisor have their meals with the students, but their
  bedrooms are in the annex of the hospital.

The curriculum meets the requirements laid down by the
British Central Midwives Boards including prenatal, delivery,  
and postpartum care. The pupil is taught to care for the normal;  
to recognize the abnormal and to give emergency treatment when L9
necessary. Class instruction by a graduate registered nurse-  
_ midwife and lectures by the medical director are given; demon- ,¤
stration and practice on a manikin, actual prenatal and post- I
partum work in the homes and clinics and hospital, and deliveries  
both in the homes and the hospital are included in the course.  
Tests and discussions are frequent. The Iinal examination is l
given by physicians from the Kentucky State Board of Health Y
and includes written, oral, and practical work. _,,.
Upon completion of the course and passing the Kentucky r
State examinations, the nurse-midwife is given the diploma of A
the school. She also receives a certificate from the State Board _
of Health entitling her to practice midwifery in the State of K
Kentucky and authorization from the Board to use the letters {
C. M. (certified midwife) after her name. The course is one for  
which Teachers College of Columbia University in New York
will allow credits toward a B. S. degree.  
; l
Auxiliary Work  
Administration C i
l Since the administrative headquarters of the Service are  
at Wendover, the administration of the work is an integral part   E
of the work, itself, and the expense of renting outside city oiiices   S
is saved. The Director of the Service makes her home at Wend-   t
over where she acts as general consultant and with the help of  
her secretary, takes care of a vast correspondence from all over   1
the world. The executive secretary lives at Wendover and car- i
ries the responsibility for all construction, repairs, upkeep, insur-  
ance, and orders