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Mary Breckinridge: The Frontier Nursing Service and Rural Health in Appalachia
In 1925 Mary Breckinridge (1881-1965) founded the Frontier Nursing Service (FNS), a public health organization in eastern Kentucky providing nurses on horseback to reach families who otherwise would not receive health care. Through this public health organization, she introduced nurse-midwifery to the United States and created a highly successful, cost-effective model for rural health care delivery that has been replicated throughout the world. In this first comprehensive biography of the FNS founder, Melanie Beals Goan provides a revealing look at the challenges Breckinridge faced as she sought reform and the contradictions she embodied. Her experience continues to provide powerful lessons about the possibilities and the limitations of reform.
- GenresNonfictionHistory
359 pages, Kindle Edition
First published June 2, 2008
18 people are currently reading
179 people want to read
About the author
Melanie Beals Goan
2 books3 followersMelanie Beals Goan is an Associate Professor of History at the University of Kentucky. She is originally from Erie, Pennsylvania,. She earned a B. A. in history from Slippery Rock University and a M. A. and Ph. D. from the University of Kentucky. Her research interests and teaching focus include twentieth century U. S. history, Kentucky history, gender, and the history of health care. She lives in Lexington, Kentucky with her husband, Brad, and her three children.
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April 1, 2018
I’m writing a novel based in eastern Kentucky in the 1920s-30s, so I read this book for character and background research. I didn’t expect it to be so compelling.
Breckinridge was a woman to both admire and scorn. On one hand, you can’t but admire Breckinridge’s accomplishments: raising more than $10m for the Frontier Nursing Service (FNS) over the course of her lifetime; caring for 58,000 patients; providing 248k inoculations; safely delivering more than 14.5 babies; and establishing hospitals and medical training programs. She did all of this in a remote region that outsiders (even in the state of Kentucky) would rather forget.
On the other hand, the book portrays Breckinridge as an egotistical control-freak who wrapped these iron-fisted personality traits in the velvet glove of championing for mothers and children. Many of her decisions on behalf of an underserved population were ego-based when alternative solutions would have served patients much better. As the author observed:
While I learned a great deal about Breckinridge and the Frontier Nursing Service that served Leslie County, the America of 100 years ago helps me understand it today: the nationalism, aversion to providing medical care to the “undeserving poor,” the churning gender roles (including homophobia), and the paternalism of saviors who know what’s best for those they claim to serve—all are familiar themes in my 2018 news feed.
Early twentieth century portrayals of Appalachia by social observers and reformers to the larger society largely persists today. The eugenics movement between Reconstruction and WWII celebrated Appalachian residents as a “pure race” that needed to be preserved so that America’s “melting pot...(would not) boil without control.” In this view, Breckinridge said that her patients were “handicapped by geographical conditions and not by native ability,” and likened residents to “modern-day Robinson Crusoes marooned in the mountains.”
Although she blamed isolation for many of their problems, Breckinridge also believed that isolation provided benefits, namely, that it had protected traditional American values at a time when the nation was in transition. She said her patients were “‘unadulterated by foreign infusions, untouched by the jazz-mad world all around them’...holding still to the convictions and beliefs of their forefathers,’ and for ‘speaking a language which (clung) to the idioms and phrases current at the time when Jamestown and Plymouth were settled.’” Sentiments like these are still held and perpetuated today.
Breckinridge walked a razor-thin line in how to portray her patients so that she could raise the funds necessary to serve them. She played to the dreamy romanticism of trained nurse-midwives traveling the hills and hollows on horseback, helping unsophisticates get “proper” medical treatment in their ramshackle mountain cabins—while also aware that citizens in Leslie County would resent this portrayal if it went too far. While she was a successful fundraiser, the problem for patients was that her romantic portrayal of the services she provided to them made their problems seem to be less a national issue in need of true reform than an isolated situation.
Throughout the book I learned how the “business” of American medicine evolved to its current state of chaos and paralysis. Interest groups of competing professions and businesses lobbyied and spread disinformation to the public then, and continue to do it now. Breckinridge was guilty of not calling out the industrialists who both perpetuated Appalachian poverty and profited by it—because they were the primary donors to the FNS. Even though she developed the FNS’ district nurse model on that of Great Britain’s socialized system, yet she resisted all efforts to collaborate with other organizations and governmental programs that would strip her of her authority.
The book is well researched and written. I poured through it in a few enjoyable sittings.
Breckinridge was a woman to both admire and scorn. On one hand, you can’t but admire Breckinridge’s accomplishments: raising more than $10m for the Frontier Nursing Service (FNS) over the course of her lifetime; caring for 58,000 patients; providing 248k inoculations; safely delivering more than 14.5 babies; and establishing hospitals and medical training programs. She did all of this in a remote region that outsiders (even in the state of Kentucky) would rather forget.
On the other hand, the book portrays Breckinridge as an egotistical control-freak who wrapped these iron-fisted personality traits in the velvet glove of championing for mothers and children. Many of her decisions on behalf of an underserved population were ego-based when alternative solutions would have served patients much better. As the author observed:
She was born into a world divided by strict racial, class, and gender hierarchies...Establishinig the FNS afforded Breckinridge a position of power, yet the service’s focus on women and children protected her from appearing self-serving. Professional motherhood proved to be a very flexible ideology, and Breckinridge often privileged one aspect of her role over the other, depending on her audience.”
While I learned a great deal about Breckinridge and the Frontier Nursing Service that served Leslie County, the America of 100 years ago helps me understand it today: the nationalism, aversion to providing medical care to the “undeserving poor,” the churning gender roles (including homophobia), and the paternalism of saviors who know what’s best for those they claim to serve—all are familiar themes in my 2018 news feed.
Early twentieth century portrayals of Appalachia by social observers and reformers to the larger society largely persists today. The eugenics movement between Reconstruction and WWII celebrated Appalachian residents as a “pure race” that needed to be preserved so that America’s “melting pot...(would not) boil without control.” In this view, Breckinridge said that her patients were “handicapped by geographical conditions and not by native ability,” and likened residents to “modern-day Robinson Crusoes marooned in the mountains.”
Although she blamed isolation for many of their problems, Breckinridge also believed that isolation provided benefits, namely, that it had protected traditional American values at a time when the nation was in transition. She said her patients were “‘unadulterated by foreign infusions, untouched by the jazz-mad world all around them’...holding still to the convictions and beliefs of their forefathers,’ and for ‘speaking a language which (clung) to the idioms and phrases current at the time when Jamestown and Plymouth were settled.’” Sentiments like these are still held and perpetuated today.
Breckinridge walked a razor-thin line in how to portray her patients so that she could raise the funds necessary to serve them. She played to the dreamy romanticism of trained nurse-midwives traveling the hills and hollows on horseback, helping unsophisticates get “proper” medical treatment in their ramshackle mountain cabins—while also aware that citizens in Leslie County would resent this portrayal if it went too far. While she was a successful fundraiser, the problem for patients was that her romantic portrayal of the services she provided to them made their problems seem to be less a national issue in need of true reform than an isolated situation.
Throughout the book I learned how the “business” of American medicine evolved to its current state of chaos and paralysis. Interest groups of competing professions and businesses lobbyied and spread disinformation to the public then, and continue to do it now. Breckinridge was guilty of not calling out the industrialists who both perpetuated Appalachian poverty and profited by it—because they were the primary donors to the FNS. Even though she developed the FNS’ district nurse model on that of Great Britain’s socialized system, yet she resisted all efforts to collaborate with other organizations and governmental programs that would strip her of her authority.
The book is well researched and written. I poured through it in a few enjoyable sittings.
Displaying 1 of 1 review