her approach to motherhood could not prevent complications during her second pregnancy and on july 8 1916 her daughter paulie was born prematurely and lived only six hours in coping with her grief mary became even more devoted to her son brekkie her son was her hope that was her hope for the future she almost lives vicariously through him he's going to go and do all the things that she as a woman with the limitations of her sphere she can't do those things herself but she can raise a young man who can go and save the world from poverty and all the problems that threaten children especially on january 12th 1918 came brekkie's fourth birthday on the 23rd of january becky died of his swift illness and death i cannot write except to say that he played his part of brave soldier while conscious life remained in him he had taken all the unaccustomed suffering terminating his happy life without questioning why it had come because he believed it was right for a soldier to be brave [Music] he was a well cared for child he had a nurse as a mother he came from a family of means he had every advantage that a child growing up in the 19 teens could have and he still died because death stalked families and they stalked even families like mary breckenridge's this was devastating for her as it would be for anybody but for mary breckenridge it was a big part of her identity to be a mother she wrote a whole book about brekkie and his four years on this earth and she decided at that time that she really needed to do something bigger than what she was doing and she wanted to do something to serve children she really thought that if there was better health care her children may not have died she throws herself into work to also cope with her grief and so right after brekkie's death i think it's 12 days later she's already corresponded with some of her nurse colleagues in the american red cross and she has been granted a commission to go overseas this course during world war one there's a need for nurses and as soon as becky dies she says you know i'm available send me to europe i'll go and work there and so 12 days later they're they're telling her yeah we'll take you we'd love to have someone with your skills she spoke several languages she was a nurse she could be useful and so they were ready to accept her okay um so now we've we've watched that first clip i'm going to hand over to galinis who's going to chair this event um and start everything off uh good afternoon hello um i'd like to welcome everybody to this from wherever you are and um thank you for joining us um i'm glennis meredith windell and i'm the chair of the history of nursing group for london and southeast uh a role that i've only taken up recently so bear with me if i get a bit either carried away one way or the other um and um many of you and again so that's what i do and i'm actually later going to encourage you all to join the history of nursing group goes with the nursing um and because that's part of the royal college of nursing which is um a membership um only um foundation which supports and educates nurses uh all over the uk um next is going to happen i'm going to talk to you about zoom now i hope you're all familiar with zoom um i think over the last couple of years with povid we've all learned to use all these uh things so um and so but a bit of a bit of housekeeping while the talk is on please could you moot um your computers and also stop the video because that would reduce the amount of upsets that often happen with transmissions um there will be generated captions and i'm very i'm reading this everybody so if i look down don't be surprised um and it's just there will be um oh cc button if you want to turn off the automatic generated captions but also just to reassure you that there will be an opportunity to ask questions at the end of the talks um and i'm sure they will generate a lot of questions for everybody and it will be just a question of holding up your hand and then sarah will will talk to you so i'm just saying welcome again and we're we're delighted to get you but again and i'm going to encourage anybody that has an interest in the history of nursing and is a nurse but it's it it's a very um interesting uh group and we have talks four times a year quarterly on the first thursday of the month in every quarter and so and also we don't just have tools we invite all sorts of interesting people but we also sometimes go to visit so it's um and a very interesting amusing uh time is really had by all um but now i'm going to go on to um we've got healthcare and district nursing both from the uk and the united states which is fantastic and you just saw the film about mary brickery which was absolutely fascinating and um now i'm going to introduce you to every speaker that we have and our first speaker is chelsea gorham who's going to talk about uh it's an introduction so over to you chelsea thank you um hello and uh thanks again so much for having me join you all today i'm so grateful for this opportunity and especially for chris holmes um interest in the documentary that kind of brought me brought me to to you all today um so i'm chelsea gorham i am the producer director and writer of angels on horseback midwives in the mountains i work for ket which is kentucky educational television here in lexington kentucky we're a pbs affiliate with in-house production capabilities and have an extremely talented team of folks that work to create various documentaries like this one magazine programs educational programs and public affairs programming and we broadcast and serve the entire commonwealth of kentucky um so angels on horseback is the documentary you just saw a brief clip and we'll be seeing a few more uh throughout this and i'm so happy to share it with you all um and of course you can also stream the entire program at ket.org angels and i'll throw that in the chat uh once i once i wrap up here and we go on to the next thing um so i hope that you're able to stream it um from wherever you are um so angels on horseback of course is the excuse me the documentary and it covers uh the founding years of the frontier nursing service which is in leslie county uh kentucky which is in the heart of the appalachian mountains uh so the organization was started in 1925 by mary breckenridge as a demonstration to show the possibilities of rural health care for the entire united states um she and her nurses were able to lower the infant and mature maternal mortality rates uh to be among the lowest in the nation at that time and they lost just two mothers in the first 12 years of operation so very successful for their their efforts um in the mountains and um so the program follows breckenridge's life experiences and motivations that led her to create the service as well as her training abroad and the recruitment of the nurse midwives who came to help bring everything to fruition um as well as frontier nursing services once they got it established the first decade of operation uh right up until about the start of world war ii which is um you know the event that drew the majority of her english nurse midwives back back home back overseas um and they had to start a whole new whole new chapter with a graduate um nursing education program um so mary uh was 44 years old whenever she established frontier nursing um in kentucky so she had a lot of life experiences experiences that culminated into this demonstration she was a part of a very prominent political family and spent a lot of her youth traveling with her parents and siblings between like washington dc and new york and arkansas and canada and russia and switzerland and so that childhood kind of instilled that sense of adventure you know that she applied in the mountains and afforded her you know pretty good education for the time especially for a female of the time and as well as the social connections with being um you know kind of a social life of her time um so um all that kind of helped her to to realize the frontier nursing service but we just watched uh a short clip about how grief was a major uh driver for breckenridge uh what wasn't in it um prior uh to the loss of her children she had lost her first husband uh pretty early in their marriage and that drove her to become a nurse um and that's where she got her nursing training but then in coping with the deaths of her two children from her second marriage that's when she was kind of pushed overseas um and helping a relief organization in post-world war one france um and it was there that she came to realize that the solution to the lack of rural health care in the united states was the combination of district nursing and midwifery as kind of this public health care program to treat the whole family um and so um of course she applied what she's uh witnessed in scotland and the hebrides there and i know chris will talk a little more about that uh in a bit but she chose to german chose to demonstrate in the uh eastern kentucky mountains because of their remoteness and you know the difficulty of life there you know they're riding horseback for everything in those early years um and she did that she chose that to prove that if her system could work there it could feasibly be applied anywhere in the nation and kind of solve um you know some of our our health care issues which may or may not be still happening today but um so that's kind of a brief um you know overview of um you know who uh who i am and and what the documentary is about and kind of what um has brought me here to you today so okay um we're now going to play another short clip of the documentary to to introduce the next talk so this will be about the the links with uh district nursing in uk right within the first six years it's amazing to look at it because from 1925 to 1931 she built six rural health clinics and in 1928 built the hospital the structure of the frontier nursing service it was designed to be decentralized and very much patterned off of british district nursing concepts you had a central hospital and then you had outpost centers spread around the county and it wasn't just leslie county they weren't looking so much at county lines when determining their territory but where people were that needed to be served in their proximity to the hospital see that that was really interesting sarah again morton's and we're we're moving on now to professor barry grenon who's going to talk about the um uk district nursing community nursing um up from the 19th century up to the the um 1920s and she's got a vast amount of experience which will tell you about so over to you barry thank you thank you everybody i'm really pleased to be here i'm trying to cover a large amount of history in a very short amount of time um so i'm going to read from a script so that i stick to time i'm going to start off by talking about what i see is quite a tangled story that's not linear not easy to describe and intertwined because i'm going to sketch a history for you i know some of you will be really unsatisfied some of you will have questions and you'll think i'm missing things out so i'm really happy to answer questions or hear further information or talk with others later so to start my story i've got to take you back to the mid-19th century and set the contextual scene of the first country to industrialize with rapid mass migration to the towns and cities here living and working conditions for the labouring classes of all ages were appalling as documented amongst other in edwin chadwick's blue books for the poor law commission so who helped at times of sickness confinement and death well for the rich we have those services they could employ as listed here and at this time in the mid 19th century the early schools in nursing were being set up in the voluntary hospitals on the nightingale model and they were training nurses not just to work in hospital but training them for private employment via the hospital and the income from these nurses employment was used to fund the schools of nursing so what about our less well-off people the class the the poor as i've just described well for those who could afford to pay these turn to older women in their communities known as the handy women or howdies in scotland who could turn their hand to care in a number of situations delivering babies looking after the sick laying out the dead helping in the house for those that would destitute they were the provisions of the poor law and from 1834 there was indoor relief i.e you became resident within a workhouse although we know that the poor lord guardians paid the handy women in some areas to provide outdoor relief in homes at times of epidemic so what propels the development of organized visiting nurses for the poor and i'd argue there are three main movements and you may wish to add more so the first is the sanitary and public health movement which found momentum from the repeated epidemics such as cholera from the documentation of mortality and morbidity statistics and from the scientific discoveries the bacteria were the agents of this specific disease rather than foul air miasma all of which eventually resulted in a series of new public health acts from 1848 onwards the second movement influential to this is the growth of the philanthropic and charitable organizations which were seen as acceptable activities for middle and upper class women linked often to religious organizations and though some were not non-denominational and finally the movement to ensure that nurses and midwives were trained as championed by florence nightingale so against this backdrop we start to see the experiments in providing home care nursing with sanitary education for the poor through philanthropic endeavors and the first documented examples are instigated by the great victorian reformer elizabeth frye he was short-lived but others followed and the most notable of these was in liverpool in which um brings together strands of philanthropy the sanitary movement and the movement to train nurses in particular home visiting nurses so in 1859 william rathbone a wealthy merchant philanthropist and later member of parliament set up a philanthropic experiment for training home nurses for the poor with the advice of florence nightingale at the same time creating a scheme in the city in which it was divided up into districts each under the direction of a lady superintendent and her committee they were responsible for finding the funds to employ and provision the nurses to care for the sick who were poor and to teach sanitary principles for domestic hygiene and we can see in their statistics in the first year's reports that infectious diseases were common and that the nurses also attended child births the experiment was deemed so successful that similar district nursing associations were set up in the coming years in many other cities such as london manchester bristol newcastle and spread to towns as the century progresses so does the movement to train nurses and in the history of home nursing this is manifest in the prestigious establishment of the queen victoria jubilee institute for nurses in 1889 with a grant of 70 000 pounds from the queen's jubilee fund secured by william rathbone with others it's the nucleus of a new national charity to coordinate standards of district nursing training and organization and it has offices in london edinburgh and dublin while this organization was nationally recognized not all district nursing associations wanted to be controlled or affiliated with it and there were many other groups providing home visiting nursing for the poor such as the jewish welfare organizations in manchester and london there were also parish nurses and rural and country nurses so a vast array a patchwork across the country at the same time as william rathbone starts his liverpool experiment we see other experiments that lead to the group of another organized home visiting community nurse known as the health visitors their development comes from the synergy between the philanthropic and sanitary and public health movements in 1866 the manchester and sulfur branch of the ladies sanitary association first employed a working class woman to visit the homes of the poor primarily to teach about sanitary measures as outlined here on my slide by the leeds branch established in the same year they the manchester branch organized on the same district principles as the liverpool district nursing association with lady superintendents with committees responsible for fundraising and directing the work of in this case working class women and these became known as health missioners and lady health visitors so this model attracts the attention of many others and in particular the medical offices of health employed by councils in this by this time and boroughs with a remit for public health and beginning concerns about maternal and child health and we see experiments in health visitors or lady sanitary inspectors being employed to teach the women of the poor classes about sanitary measures in the home and how to look after their children glasgow and worcestershire were amongst the first councils in which they employed health visitors with this remit i.e using public funds taxes to do this north buckinghamshire council was the first to provide specific health visitor training as advised by florence nightingale we also see that ladies health committees as described here in this commit in this slide were established and they begin to employ health visitors so aside from our medical offices of health and i'd just like to point out for you in my where my blue arrow is that while the health visitors are being instructed to give hints on feeding and clothing their children for example and sanitary ways of looking after their homes they're also instructed to look after sick people if they find them so you can see the crossovers in between these types of experiments and visiting groups and the health visitors had to either be registered uh sorry not registered had to be trained nurses or trained sanitary inspectors and or with midwifery training so now we turn to the 20th century it's a period when there's a new liberal government and they were elected on the landslide majority and they brought in sweeping reforms such as the introduction of the old age pension in 1908 and the national insurance act in 1911. so i want to draw your attention to the thread of state agency in the development of the uk home visiting nursing and midwifery services supporting the development and quality assurance of some access aspects of these services but not others and while the public health measures of the 19th century had improved mortality rates the infant mortality rates are seen in my slide here remain unchanged this together with the reports on the physical deficiencies of recruits to the army for the bowel wall was reframed in terms of the jeopardy opposed to having enough fit british people to help control and defend the british empire as derek fraser social policy historian commented in the bizarre way again and again we see imperialism was linked to social reform and the maternal and infant welfare philanthropic and public health movements gained momentum at the turn of the century before the first world war and during the first world war so if we look at our midwives the passing of the 1902 midwives act and its subsequent iterations ensures only those with recognized training can legally assist in births and by 1918 local authorities had the responsibility to supervise midwives ensure and ensure there are adequate services in many rural areas they chose to do this through payments to district nursing associations the permissive notification of birth act changed in 1915 and all births had to be notified to medical officers of health within 36 hours to enable prompt visiting by trained local authority employed health visitors who could then advise on care and health of both mother and infants and promote health as well as higher levels of survival if we turn to our health visitors we find 600 were employed by local authorities in 1914 but by 1918 there are over 3 000 employed one change had been made in 1914 in that the board of education and local government board grant gave grants for maternity and child welfare facilities to local authorities but also to charitable organizations the 1918 maternal and child welfare act made it mandatory for local authorities to employ health visitors their policy concern continued to be about having sufficient people of the right caliber to control and defend the british empire and this meant their attention also turned to the health of school-aged children similar to the history of district nursing and health visiting school nursing starts with experiments to provide hygiene knowledge to identify those children with lice and other conditions that might be contagious the 1907 education act introduces school medical inspections for the first time accompanied in many local authorities by employment of school nurses to assist help and provide treatment for minor illness local authorities in the main use their health visitors to provide these services or in rural areas paid for the district nurse to provide it and lastly to our district nursing associations seemingly reducing not in numbers through the first world war and certainly didn't cover the whole country as you can see here reported by mary stocks in her 100 years of history of the district nurse or district nursing but she's here mainly reporting those queens nurses i.e those who've had training through the queen's nursing institute a major issue um was that those that were trained through the first world war just as we saw with uh with mary in the clip a first clip was that they were drawn out into the military services and provision of red cross uh and other hospitals for example so the financial issue i've mentioned already that local authorities were paying the district nursing associations for the provision of some type of work to the poor and we know by 1920 a thousand district nurses were providing health visiting services in the rural areas as recorded by the minister of health newly set up many district nursing associations used provident used provident or membership schemes and this is what were being set up uh pre and during and after the first world war and so you can see in this slide an advertisement in a newspaper for the public to pay into a district nursing local association providence scheme and it's not until 1929 the local government act that local authorities were permitted to provide or pay for home nursing services for the sick who were poor as the advert shows here the district nurse is also a midwife and it illustrates the interconnected way these home visiting nursing services developed particularly in rural areas although candy island which can be ireland is so what i hope i've done in this brief time is sketched for you the development to the period of our kentucky frontier services that we we're focused on i've omitted the element about the high london island services chris is going to talk about that what i hope i've managed to persuade you though is over the interconnections for the development of community nursing between the sanitary movement the public health movement the actions of the state the philanthropic movements and the movement for trained nurses and midwives thank you for your attention here are some of my sources i'm more than happy to answer any questions later on or talk to people separately thanks so much thank you very much very that that was so interesting and we feel that we're need to go back to this revisit these things at the moment in terms of community care um next we're going to have another clip about training in scotland so um sarah is going to oh and by the way chelsea i'm so sorry i did thank you after your talk i was on moot if you didn't hear it and likewise to sarah so i'll pay more attention thank you so much though both of you it's just fascinating once she decides that she's going to create a nurse midwifery organization she has to be a nurse midwife and she had the nursing training so she goes for several months to britain and enrolls to become a certified midwife she went to london she took her middle free training at the british hospital from motherson bay then she went up to scotland and there she met sir leslie mckenzie in edinburgh and he was the head of the scotch nurses and he suggested that she should go up to the highlands and the islands of the hebrides and see what the nurses were doing up there she went to scotland and she spent about 10 months over there touring midwifery services and public health nursing services scotland had the same nurse midwife model and she got a lot of her ideas for frontier nursing service from her time in scotland and she made a lot of good friends there too early in 1925 i came back kentucky right i'm it's me again and i'm just in a very timely way we don't just make it up you see so now we like i'd like to introduce chris holm who's actually going to talk about this scottish highlands um services so over to you chris we can see you chris excellent and hear you excellent forgiving i'm just technologies oh we all understand that chris don't you worry so yes uh thanks very much and thanks to vari that was for 15 minutes you nailed it and thanks also to uh chelsea uh i i i thought her film was absolutely terrific a brilliant brilliant documentary anyway hello and howdy everybody on both sides of the atlantic it didn't click with me until yesterday that howdy is also the old scots word for midwife so hello hello howdy howdy so what was the highlands and islands medical service it was a unique social experiment uh long before the nhs providing state-funded comprehensive care to more than 300 000 people on half the landmass of scotland it was set up in 1913 with a treasury annual grant of 42 000 pounds in the wake of a report by sir john dewer medical services were either poor or non-existent in many areas within the crofting counties they weren't covered by the 1911 national insurance act which flores mentioned that was for insured workers mainly men or mostly men in the rest of britain jurors committee started taking evidence in june 1912 submitted its final report by christmas idea and by august 1913 the service came into being financed were distributed from edinburgh to local nursing associations to hire nurses paid gps a basic salary and to local authorities for other initiatives state resources were directed to basic needs providing a house telephone car or motorcycle which were essential to get around in such remote uh areas like this queen's nurse uh who's elizabeth mcphee this was taken in 1926 or a rather a big motorcycle there and elizabeth uh worked uh well you can guess where she worked from the castle of elaine uh ellen dunham uh in the background there fees were set at minimal levels but inability to pay did not prevent people from getting treatment by 1929 there were 175 nurses and 160 doctors in 150 practices this is flora ferguson the first motorized nurse in the highlands but who were these nurses breckenridge more accurately referred to it as the highlands and ireland's medical and nursing service that's because queen's nurses were the bedrock and the lifeblood of the service they are also supremely well qualified thanks to sherlock holmes well uh surgeon joe bell the inspiration for conan doyle's celebrated detective worked closely with florence nightingale to establish nursing at edinburgh royal infirmary but later as president as vice president rebecca and chair of the executive committee of the queen's nursing institute in scotland he insisted that recruits had three years general hospital experience before undertaking the six months queen's training for district work and four months for midwifery anyway these were the nurses that mary breckenridge came to see in august 1924 at the suggestion of sir leslie mckenzie scotland's chief medical officer and a leading member of john dewey's committee breckenridge developed the concept of the nurse midwife from her experience in france and england what she needed was to see how these might be transition how this might be translated uh into the harsh and unforgiving challenges she faced in the sparsely populated appalachian mountains breckenridge arrived at the institute's headquarters where she was given a given a list of nurses and officials for a trip north and what she went by her own account her six weeks in the highlands and islands was a joyous epiphany please forgive my terrible american accent when i try to quote her north us had four nurse midwives and a doctor it's unlikely that she met at least one of these these are north u.s midwives in 1926 two years later but it's likely that she met one if not all of them i don't know about the wee lad on the far right i'm sure his mum must have loved him she described louis as like no other part in the planet where she was greeted with unending kindness by families living in traditional black houses the only housing by the way she thought it was the warmest housing she'd ever experienced in the united kingdom erasure had no doctor but a splendid queen's nurse midwife miss martin in whose work i was keenly interested her nearest physician on southwest could reach her on call only when the seas were not too high at target she met miss mclean who served 18 scattered villages working with dr ross against the elements the winds were so terrible that bicycles were almost useless and they had to walk miles over the moors to reach their patients returning to london she did further studies in district nursing at the general lying in hospital in york road just around the corner from thomas's this is also where betty lester who features in chelsea's wonderful film was trained it's now a premier league so you know where to go next time uh you're in london if you can forgive them for demolishing the nurses home to build the new bit it promises you you will sleep like a baby back in kentucky uh breckenridge firmed up her plans she needed she needed basic demographic data for the population of leslie county to demonstrate the impact a new service might have mackenzie obliged by recommending this lady miss bertram island or miss william ina bertram ireland who had conducted similar studies studies for him in the outer hebrides this is the only photograph i can trace of miss island she looks a really cheery soul and this was a piece done in uh an american newspaper when she got the obe from the current queen in the current queen's first but the honors list in 1953 uh miss island as well as her research experience had two further essential qualities she could ride a horse and take a nickname ireland from scotland became the first of many annie mckinnon from sky arrived soon after inevitably she was given the name mack uh she was awarded the quad aguer for continuing to care for the sick and wounded under enemy fire in 1918. uh for information the other quadriga awarded that day went to an entire british army regiment ali and betty proved mainstays to the frontier service both came home in 1939 to serve on the war betty narrowly escaped death when a bomb destroyed a nurse's home in the london hospital she was working and killed several of her colleagues annie was severely injured when her casualty evacuation train was blown up at new market she spent two years recovering in hospital from a broken back but both came back to the fns their home was now kentucky in both services nurses were the lead providers largely dictated by the necessity of geography they were embedded in the communities they served and enjoyed far more professional autonomy than their colleagues elsewhere that brought responsibility and huge pressure of being on call 24 hours a day this is the verdict on the big sister the combination of doctor and nurse is extraordinarily impressive many of the doctors say the practicing narratives would be impossible without the services of the nurses and everywhere we are told that cooperation between doctor and nurse leaves nothing to be desired and the little sister this is uh irvin lowden's comment uh from his book definite childbirth irvin uh is i think the leading scholar of international uh mortality maternal mortality rates and i'll just read it i regard this as one of the most remarkable episodes in the history of maternal and child care in the united states there are only a few occasions when an individual established a technique or a service which had a profoundly beneficial effect on maternal care we end uh with this uh one of the i think one of the most iconic photographs of the nurse ever taken it's of uh queensland's katrina mccaskill in 1961 it was taken in loch maddie north eust and katrina is one of 20 queen's nurses interviewed by nurse catherine morrison for her her book based on her manchester university phd phd this thesis called hybridian heroines which i heartily commend here the photographer i actually knew the photographer oh i know the photographer that was dennis thrawn he and reporter russell galbraith had gone up to loch maddie in north eust to interview dr alex mccloud the gp who did his rounds on horseback uh the world health organization in geneva saw the article in the scotsman weekly and was sufficiently gobsmacked to commission russell dennis to go to africa for a month to provide more of the same thank you thank you chris that that was absolutely fascinating um to hear that and also the interesting thing is that um there's the similarities that we still have with potter's commun community on all the islands still you know no hospitals no doctors and some of them and helicoptering and so it's interesting how everything first first started so that was good now we're going to have another click now on nursing days it's slightly longer than the others just over two minutes and then chelsea's gonna rejoin us we had this bag in which we carried all supplies that we should need for delivery and those bags were sacrosanct we weren't allowed to use them for anything but just the delivery itself and accounts by midwives of their practice do show them spending a whole weekend three days even sometimes waiting for a child to be born and not resenting it because it's part of the profession women they appreciate someone coming into the home and being with them for a period of time the nurse midwives are able to really see recognize and get the kind of help that makes all the difference in the world if you were one of their prenatal cases they would visit you on a regular basis long before the baby was born and they were checking blood pressure they were doing urine samples they were they were doing everything that a woman today visiting their doctor for prenatal visit would get and this was not the standard of care in most places at the time and then they'd provide care after the baby was born every day for 10 days they were visiting they wanted to make sure these children grew up to be healthy adults and so they kept very good tabs on all of their patients and the reason why she was able to have as lower infant mortality rates that she had is that she stressed good maternal environments for your baby and then you will have a healthy baby and if you have a healthy term baby they're not likely to die in the first years of life and her infant mortality rate was competitive with the best in the country for the nurses it was a very busy lifestyle they would get up every morning they would saddle their horses and get ready they would do rounds all day long and come back they talk about very long days because even when they got back there were records to keep that was that was actually interesting and i just thought something that might amuse you between 1984 and 88 i worked in lesotho which is southern africa and uh our tertiary referral hospital um the patients used to come to us on horseback and often it would take them three days because they had to get across the mountains but that's that's by the way now i'd like to invite chelsea back who's going to talk about the frontier nursing system more of her documentary which i can't wait to hear so over to you chelsea thank you thanks um yeah i'm going to i'll just kind of expand on uh a little bit of the documentary and um you know how it came to yeah to be what it is uh but then also the lives of the nurses and kind of their role in helping to to build it up but i'm so grateful for the expansions of you know both the british and scottish uh nursing and midwifery uh backgrounds i wish that i could have expanded more in the documentary so i've just learned so much from you both um with with this talk so thank you for that um but what breckenridge uh spearheaded with uh frontier nursing service would not have been possible without the adventuresome and hearty nurses and women who came to kentucky kind of for that adventure um betty lester um whose voice you know you've heard she remarked um about you know whenever she was doing her training um you know she kind of said hey i want to go to kentucky and they're like well do you know what you're doing there she's like well i just want a horse and a dog you know so whatever drew them there um you know they made a huge difference um once once they came and really helped to um you know build frontier um and of course in chris mentioned nicknames of you know with ireland of scotland but i'd like to point out how you know that kind of speaks to breckenridge's uh she had a wicked sense of humor and it was just a great storyteller and an excellent orator all which helped to to bring everything to fruition um but because frontier nursing service was a demonstration um and and because breckenridge had the means um everything was very well documented and archived uh which was uh is a documentarian's dream when it comes to everything that we had access to you know there were hundreds and hundreds of professional photographs um where she hired photographers including her cousin marvin uh breckenridge who also produced a silent film uh called the forgotten frontier in 1931 and and that really you know expanded on what the the mission and goal of frontier uh nursing was but another um you know side effect from not having government funding was uh needing to promote and um and a way that breckenridge would appeal to donors was by releasing quarterly bulletins and and i'll throw a link in the chat too because those are fascinating to read through and that's where you really get um you know a snapshot of the nurses lives and you know what they went through you know the adventures and um in you know the harrowing and heartbreaking tales and everything um you know riding horseback and being frozen to saddles and um you know just the various things that they came across in appalachia and so those stories you know it really helps to to see what these women were up against uh but it also helped to to you know pull on those heartstrings of of the donors uh to give and to help you know support and continue the health care um and and so these nurses who came you know from from england and scotland and new zealand and and everywhere in between um you know they they came and they provided care uh to over 10 000 people covering um over 700 square miles of all you know all mountainous trains so um as i mentioned they were on horseback in all those early years they didn't switch over to jeeps until i think after world war ii whenever you know vehicles were more uh readily available but um up until then everything you know operated out of their saddle bags they had you know special bags for uh for doing that betty lester talks a little bit about that um as well um but you know in their daily lives you know they're saddling and maintaining the horses and so the courier program was started a few years into the service um in which they brought young young girls in to to have an adventure in the mountains themselves and that really helped to alleviate you know what the nurses had to do on a daily basis but you know they're riding up and down the creek beds nonetheless and you know and ridges and everything to get to to the patients but then they had to do like very diligent record keeping um to continue to show um the demonstration and that it was successful um but the nurses were extremely professional and well-trained of course um and they're they have these uniforms and everything that kind of brought them that respect but the community ultimately the community respected them and they respected the community which i think was also a big um part of it um it wasn't just coming in as a you know helper it was kind of that of that era where socialites would hey i wanna i wanna do this or that and they'd pop in and they'd pop back out but what breckenridge and her nurses did you know really established something in the mountains they weren't just doing it for show um and but they were able to also keep up their british customs um with tea time at a window where they had every uh every afternoon at 4 pm everyone who was who was close enough would gather and do tea time um and hear stories from breckenridge or any guests uh that she had in the house so i thought that was a fun you know she brought a lot you know from britain and scotland and everything that she learned there but also kept up the customs uh to keep the nurses um happy and and perhaps more comfortable um more home-like um but you know they the nurses they had two uh two nurse midwives stationed per clinic slash outpost you know i was in the middle of uh middle of nowhere basically and they had regular clinic days and also went out to visit homes and but they gave care of course under the orders of a doctor and followed medical routines and they you know they kind of talk about that a little bit in the documentary as well and um just kind of the conditions of uh of the appalachians they were dealing with snake bites and worms and gastrointestinal issues and gunshot wounds and broken bones and and everything um so so it was a slew of of things on top of you know kind of having this frontier lifestyle um and and another thing you know that i'm i was so grateful for was the uh oral history project that happened in about 1978 uh 77 to 78 a um a oral history uh fella from uh university of kentucky was able to go and capture these early nurses voices and so i'm i was so um so happy to be able to draw on those and hear you know the actual experiences from nurses like edna rockstroe um who was one of the early ones and she was actually american and kind of followed the same path uh that that breckenridge did and you know going to france post world war one and then training as a midwife um in britain and um and so she was one of the earlier ones and so her experiences were a little a little tougher um but then on the other hand you have betty lester who came in 1928 and stayed until she passed away and you know interrupted you know her service was interrupted by world war ii um but you know she was you know she loved loved uh loved kentucky and wanted to stay and while i have not confirmed via census uh records or anything but a conversation that i had with uh one of the the folks along the way kind of revealed that many children in the area were you know took her namesake there were a lot of little girls named betty and a lot of little boys named lester so uh so they were inspiring to uh to the community in that way as well um but you know they were so successful because and i think that um one of the interviews in the past clip which will bring us to our next clip um it talks about how they provided this you know education on basic hygiene how to keep people healthy the preventative health care and and they gave you know thousands of inoculations i think it was 90 000 inoculations over the first you know dozen years and so um you know that was kind of the ground work that they were also laying and so they they really improved um the health of that you know population that otherwise would not have had any health care you know the um the hospital was the closest one was probably in lexington and you know of course a lot of patients had to had to go there um you know even with frontier nursing service but um but frontier um yeah it was life-changing for for that area and she could not have done it without the the foreign nurses that that that came to serve and to help um so i think yeah i'll toss it or you know to the next clip i guess um that i think is about educating the women um right thanks again chelsea that was good yes it is educating women and suck it very close to my heart in every sense of the words so here now i'm not sure how long this one is but i don't think it's it's only about a minute there we are she taught them how to work with the whole community the importance of painting the importance of sealing up the houses and windows and you know the importance of what we call now the social determinants of health they educated the women and that saved a lot of children and a lot of illnesses because they knew what to do