SYMHC Classics: Mary Breckinridge

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Speaker 1: Happy Saturday. Mary Breckenrich was born February seventeenth, eighteen eighty one, so we are bringing out our episode on her as Today's Saturday Classic, So enjoy. Welcome to Stuff You Missed in History Class, a production of iHeartRadio. Hello, and welcome to the podcast. I'm Holly Frye and I'm Tracy you Wilson. So today we're going to talk about the topic that a lot of people have requested, the one that I have noted as the most recent requester. So our listener, Amy, I'm a little worried. I'm going to confess because we've talked before in the show about pioneers who advanced the medical field, specifically as it relates to infants. They're usually super uplifting and really great stories. Today's subject definitely adds to that medical improvement for the health of children, but it also has some problemic elements, and I don't know that people who have requested it necessarily know those problematic parts, and they may be disappointed to discover them. I have several things that are on not the specific topic that we're about to talk about, but several things on my episode suggestion list that I know that people who have asked for it are expecting like a one hundred percent affirming, uplifting story, but there's like a bad side to it that. Yeah. Yes, I was describing this story to my husband in the car this morning, as I often do, sort of as a way to make sure I've got bases covered and you know, all the logic flows, and he said, I feel like history is full of this one m Night Shyamalan plot twist where people seem amazing and then they turn out to have like this horrible thing about them. Yeah, usually racism. I was like, Yeah, a really good way to put it, especially this particular time period. Yes, so we're talking about Mary Breckinridge. She is known as the founder of American nurse midwiffery, and she's an iconic figure in Kentucky. But as we have just alluded to their problematic parts of her ideology, here's some udenis we're going to get to you. Yep. So we're gonna talk first about sort of her life and what led her to do this, and then at the end we'll discuss these problematic elements. Yeah, so let's hit it. Mary Breckinridge was born in Memphis, Tennessee on February seventeenth, eighteen eighty one. Her father, Clifton Rhodes Breckinridge, was a congressman from Arkansas, so she spent a lot of her childhood in Washington, d C. Yeah, he's an interesting figure too. There's like a whole scandal, a voting scandal related to his political career, but maybe for another episode. After Washington, the Breckenridges moved eventually across the globe to Saint Petersburg, Russia, when her father was appointed US Minister to Russia. And Mary's education, as you may guess from this life of being in a pretty prominent family, was one of privilege. She attended private schools in the US in Stanford, Connecticut and at the Lausanne, Switzerland, and she had private tutors in Russia as well. Basically everywhere they went she had the best possible education. At the age of eighteen, Mary moved to Arkansas, where she lived until her marriage to Henry Ruffner Morrison, who was a lawyer. In nineteen oh four. Mary was widowed after just two years with her husband when Morrison died because of acute appendicitis. Still sort of dealing with this loss Breckinridge enrolled in school again, this time in New York City at a nursing school at Saint Luke's Hospital. She graduated and became a registered nurse. In nineteen ten, six years after the death of her first husband, Mary got married a second time, this time to the president of a woman's school in Eureka Springs, Arkansas, Richard Ryan Thompson. Mary started to work at the school as a teacher. Her international education lent itself to teaching language, specifically French, and she also taught classes on hygiene. In nineteen fourteen, Mary and Richard had a son, Clifton brick and Ridge Thompson, who they nicknamed Brecky. Two years later, in nineteen sixteen, they had a second child, this time a daughter named Polly, and they were very excited about it, but their joy was abruptly cut short when she died just six hours after her birth. Mary wrote of this loss quote aggrieved for the life she had missed, the splendid work she might have done, the human motherhood she might not know. Two years later, four year old Brecky also died just days after his birthday. He got sick. He underwent surgery to address what doctors thought was an intestinal blockage. It became immediately clear that he had a serious abdominal infection, and he never recovered. This death not only struck her to the core as a grieving parent, but it also really made Mary fear for her work and how it would be perceived by the public. She had been writing for several years about how to raise healthy children, and she had, in the course of two years, lost both of her her own. She was worried that people would think that that meant she didn't know what she was talking about. Throughout the rest of her life, she believed that Becky was ever present in a spiritual sense and that she could communicate with him on the other side. The strain of losing two children also took a toll on her marriage. Mary experienced bouts of depression which continued through her life, and her husband, Richard, was not faithful. Mary left Richard in nineteen eighteen while World War One was still playing out, and she applied to work with the American Red Cross as a nurse in Europe, but she had to wait for an assignment. In case you are ever looking at information about her life, we didn't go into it. They will often list her divorce as nineteen twenty, which is when the divorce papers actually happened, but they had been apart for two years by that point. This reason for her delay, though in joining the Red Cross, was due to the rule that no one with a brother actively serving in the military could be sent to areas where the war was taking place. This was in order to preserve the family in the likelihood that the place that the brother was stationed got bombed or rated or attacked in some way, and like a family would not lose multiple children at once. Since Mary had a brother serving at the time, but really felt strongly that she could make an impact on the children of Europe who needed assistance, she and her mother went to visit the head of the American Red Cross Nursing Service, Jane Delano, and sort of plead her case to get around the rule. Delano agreed that Mary would be an asset, but she still couldn't send her because of the brother rule. While Delano worked on Mary's behalf, Breckinridge took on a three month assignment, traveling through the country collecting data on the state of children's health and giving speeches. Yeah, and just to be clear of that country is the US. She went far west and visited a variety of places, and when Mary was finally clear to join the Red Cross Children's Bureau in France, she first went to Washington, d C. To make arrangements and fill out the necessary paperwork. But this actually ended up being quite a detour. So this was happening, you'll recall in nineteen eighteen, and Washington, d C, like many other places, was hit really hard by the influenza epidemic, which we have talked about on the show before. As a nurse, Mary was desperately needed, so she volunteered to help. Almost immediately after seeing how badly overtaxed the medical services in the area were, and after she first asked Jane Delano if she could delay her trip to France a little while longer, this volunteer job almost immediately became more than Mary had anticipated. She later wrote in her autobiography quote, the head nurse of my area fell ill soon after I reported for duty, so that I was plunged into the direction of nursing care for thousands and thousands of stricken people. I don't recall how many patients we had in my district at the peak of the epidemic, but it could not have been less than forty thousand. Nor do I remember how many nurses I had to help me, but I don't think there were more than five. We used hundreds of aids for the day and nightcare of the patients with pneumonia and the families where everybody had come down with influenza. Many of these aids were clerks turned over to us for the emergency by the government bureaus, and only a few of them had received training and home care of the sick. To compound matters, this situation was so chaotic as medical personnel and people who had sort of been requisitioned into being medical personnel to keep up with the ever growing roster of patients, that records were a little bit haphazard, she notes in her autobiography, like some of the reasons clerks tended to write things about the decease that had more to do with their area of knowledge than actually were really relevant to the illness. Like one person worked for the government and they talked about how one of the deceased patients had been sacking away sugar, like she had been kind of hoarding sugar, And it was like this isn't relevant to her medical information at all. Why are you putting this? But it was just the mindset of his or her I don't know the gender. The previous job made them think of things in those terms. Bed Bugs were also a really bad problem in the area that year, so nurses were fighting both influenza and infestation of their patients' homes. When the influenza epidemic had passed, Mary went back to preparing to join the Red Cross, but her passport and loyalty papers had a longer processing time than she'd anticipated. Unwilling to just wait, she filled the time with the Boston Instructive District Nursing Association, where she furthered her education after an abbreviated version of the association association's training courses. She worked in underprivileged neighborhoods and tenements in Boston. She later said of the experience, quote, I was to be grateful a thousand times over after I got to France of all that I learned in Boston. By the time she had her passport, it was after November eleventh, nineteen eighteen, and the war was over, but she still felt compelled to go, and so she made arrangements to be released from her obligation to the Red Cross, which was no longer sending medical personnel to France, and then she did travel to France to work with the American Committee for Devastated France. That was an organization founded by JP Morgan's daughter, Anne Morgan, in which Mary deeply loved, second only to the one that she would later found herself. We're going to talk about Mary's work in France, but first we will pause for a little sponsor break. The loss of her children had really been Breckinridge's inspiration to doggedly pursue work in children's health, and she never lost that sense of calling. She had been interested in children's health before then, but she really became hyper focused on it after that, and she had been able to focus some of her public health work in Boston and Washington, d C. On the needs of children, and she obviously was working in that area as she toured the country for her reporting assignment with the Children's Bureau. She then carried that focus and passion for the care of children to Europe as well. In her work with the ACDF, she started a program that focused on the needs of pregnant women children and nursing mothers, providing both medical care and vitally needed nutrition. Even though the war was over, there were still heavy restrictions on where she could travel, so she had to once again wait for a military permit to travel into the war zone. Once she finally was approved, she saw immediately that the people of France needed all the basics clothing, bedding, and above all food. She wrote quote in the parts of France occupied by the Germans, it was not a question of the people returning to their shattered homes, because they were already there when the Germans withdrew. But all around them the ground, the bridges, the roads were destroyed so that it was almost impossible to get supplies to them. In some villages in the Nord, people had to be fed by airplane. With such widespread destruction, the problem of transport assumed gigantic proportions. One of the vital parts of rebuilding the country that Mary was directly involved in was acquiring wheat seeds so that rural areas would be able to plant crops. She personally delivered the requests for wheat and as the women chauffeurs in their organization were the only ones who were managing regular transport in the area. They delivered all of the wheat seed that ended up in the ground for that following spring. Even so, getting crops back up and running was actually quite dangerous because the fields were filled with buried explosives, and farmers who accidentally hit them while digging often died or required really extensive medical treatment. The ACDF also helped people re establish their households. In addition to seeing that they got seeds to plant, crops and medical treatment, they also assisted by helping them get low or no cost furnishings and providing small animals to farms like rabbits and chickens. And throughout all of this, the nurses and other personnel working under the umbrella of the American Committee for Devastated France were living in really rough conditions themselves. Public works such as water and electricity services were not restored for quite some time, and the nurses lived in a building that had been severely damaged by bombings. Mary wrote quote the American Committee for Devastated France was a masterpiece of an organization, not only in its handling of direct relief under baffling difficulties, but in later developments that were to be integrated into the very heart of French life. Mary really fell in love with the people of France, and she wrote in one letter to her mother that she saw so many families trying to fight their way back from malnourishment after the war. She wrote, quote, if I could give right now a goat to every family that has a baby, I think we could go far towards saving many that are dying. There is such grip and pneumonia among them that they have no powers of resistance. I wish I had a thousand goats right now. I wish I had fifty. This goat thing is my favorite part of her story. Nine too. Mary's mother passed the letter around friends and family, and soon donations of money for the purchase of goats poured in to the ACDF. Mary would later call this project her goat crusade because she also had to raise funds for feed for the goats for their breeding, and letters back home to each donor to tell them about the family who was benefited from their generosity. Yeah, that was kind of before a lot of the modern charity organizations do things like that. But she was naming goats for families that had bought them and then you know, would keep these correspondences going of like here's how the family that got your goat is doing, which pretty interesting. There's a really great story in her autobiography about the first truck, which I think had twenty nine goats. Like she opens the door and there was one goat that had apparently like destroyed a bunch of their medical supplies had like eaten baby bottles, which was like, I don't even care. I'm so glad the goats are here. And while she was in Europe, she also became acquainted with midwiffery practice in both France and England, and she felt that it should be established in the United States as well. Ever, eager for education, I have to admit that problematic though she is, I admire her constant quest to be educated, Breckinridge decided to formalize her learning on this subject, and she studied midwiffery in several different schools in Great Britain and was certified by the UK's Central Midwife. And we should note this isn't the first time that Mary Beckenridge had been exposed to the concept of a midwife assisted birth, and her family was in Russia, her mother had a midwife in attendance at the birth of Mary's younger brother, and that had made an impact on her. And as we're going to talk more about later, like midwiffery has been along, as has been around in some way as long as babies have been Yeah, and in Yeah, she isn't like she discovered it now, just kind of how she's sometimes framed in the US. Yeah, we had no idea this was the thing, and it's like no, no, no, no, no, we're talking about more formal eyes midwiffery training and programs. Additionally, she also studied how pre war France had provided for infant care, and she learned that the Public Assistance Office had this program which allowed new parents to bring their babies to a government office, usually like a town hall, where a doctor would be for weighing and for advice on their care, and that there was also a service in some cities of France which provided baby milk stations, but there wasn't much education for parents in how to handle milk and some of the other medical needs their child might have. She saw what she felt was a gap in the system in the lack of parent education, and she decided that a visiting nurse service could fill that gap, so she set up a demonstration version so that it could get some data on its successes. Soon she was asked to expand the program, and she had to really scramble to find properly trained nurses to staff it. Yeah her little experiment, people were like, this is great. Can you widen your area of coverage? And she was like, uh oh. Before long, her nurses were seeing to the general health care needs of the communities in which they worked, and not just prenatal and early childhood care. She was really pleased with her success in this endeavor, but the administrative duties that it required took her away from the hands on nursing that she loved so much, And as her role with the American Committee for Devastated France grew, Breckenridge was offered a car and a chauffeur to drive her as needed, but she opted to actually pool those recals with the other drivers who were already helping to deliver aid. Mary also traveled to Scotland to expand her medical knowledge while she lived in Europe. There she studied a nursing service that cared for a largely rural and decentralized patient base. Yeah, that sort of helped her form a model for her later work. In nineteen twenty one, Mary was ready to return home to be near her parents. They were getting older and she definitely felt a poll to be with them. She also felt that the programs that she had worked to establish in France had reached a point where they could continue without her, and she felt that it was really important that they do so. She was aware that she couldn't stay there and direct all of this forever. She wasn't exactly sure what she would do next, but she wrote in a letter to her mother, quote, I know that the way leads back over the ocean to the country where my own children were born and where they are buried, the country whose development my own people have furthered for nearly two hundred years. Despite this resolve, she actually felt really conflicted about leaving France. There was pressure to stay and develop nursings programs for France, and for her last year she worked tirelessly to fulfill this request, only to have effort after effort fall flat. She felt in some ways as though she had failed, but having friends and associates remark on the incredible improvement of the health of France's children really bolstered her. And next we're going to delve into the project that consumed the rest of Mary Breckinridge's life, in which became her claim to fame. But before that, let's take a little break and have a word for one of our sponsors. Once Mary was back in the United States, she again opted for additional education, and she took classes at Teachers College of Columbia University that focused on public health nursing. In nineteen twenty five, Mary Breckinridge relocated to Leslie County, Kentucky to try to make her idea a reality. She had inherited money from her mother, who had passed away not long after Mary returned to the United States used her inheritance to found in fund the Frontier Nursing Service. Her concentration for the service was on prenatal and early childhood care, which harkened back to her experiences with the families in post war France. She wrote quote in France, I felt, as I was to feel later in the Kentucky Mountains, that a program for children should begin before the children are born and should place emphasis on the first six years of life. So she chose the Appalachian Mountain area for a number of reasons. I know some people like to pronounce it Appalachian. We all do it differently. This one is one where I'm good with what I like. I grew up in North Carolina and spent seven years in western North Carolina, and I say Appalachian. Yeah, I mean I grew I was in Florida when I think I probably learned that word and they I was taught it as Appalachian. But no disrespect to anybody who prefers the other pronunciation. I'm just saying, whichever way we say it, somebody will be chagrined. So she chose this area, as I said, for a number of reasons. First, it was woefully underserved medically, and most of the residents were too poor to travel elsewhere for care. Second, because her family had Southern roots, she believed that she would be able to use their prominence to garner funding for her program. And third, she was kind of thinking long term, and she thought if she could manage to launch a nursing service successfully in the decentralized communities of the mountains, covering roughly seven hundred square miles, it would be a clear proof of concept that similar programs could work almost anywhere. So to be clear, it wasn't as though Mary Breckenridge was the first person in the United States to think midwiffery should be instituted here. And as we said earlier, there was more informal midwhiffery going back generations. Even in the area of Kentucky where she set up her service, there were lay midwives who delivered babies like that has been a thing pretty much always, but they didn't have actual medical training. Yeah. I think they're referred to in uh I'm not sure if it's her autobiography or another paper that I was reading about her where they're called granny midwives. And it's basically like, you know, an older, experienced woman who has been through childbirth herself and then kind of helps later generations do the same thing. Well. And when a birth goes smoothly, that's often fine, right, That's yes, that's often the care that is needed is that kind of help. But when things don't go smoothly that you want medical training, right, Yeah. And it was of course really hard to get this service up and running. This was a mountain situation spread all over the place, but over time Mary established a home visitation service so that patients could receive care without traveling themselves, as well as a number of district nursing centers and eventually a hospital. Mary's work had obvious results. After her service had been established and she had been providing education to nurse midwives in Kentucky, the region's neonatal and maternal death rates dropped. In nineteen twenty eight, the FNS opened Heiden Hospital, which had twelve beds thanks to money raised through donors. It soon ext banded to offer eighteen beds and eight bacinets, and an expansion in nineteen forty nine increased patient capacity to twenty five beds and twelve bacinets. As a direct result of Mary's work and the success of the Frontier Nursing Service, the American Association of Nurse Midwives was founded in nineteen twenty nine, just four years after Breckinridge had founded her service. In nineteen thirty one, Mary's cousin, Marvin Breckinridge Patterson, directed a film which was called The Forgotten Frontier, and it promoted the importance of the Frontier Nursing Service and the types of care it offered. The film, which is silent, opens with title cards that read, quote, do you know that America is still a frontier country for about fifteen million people with almost no medical, nursing or dental care, and that in our history we have lost more women in childbirth than men in war. According to that documentary, the maternal mortality rate in the Appalachian Mountains was cut by more than two thirds thanks to the Frontier Nursing Service. Scenes in the film are reenactments of previous events played out by the same people who were involved originally and volunteered to recreate moments in there from their interactions with the FNS. Yeah. The film features shots of Wendover, which was the log cabin that served as administrative building and nursing center and guest quarters for the service, and it makes it very clear just how remote the patients being served by this service were. Guests in the film, arriving at the nearest train station had to travel twenty five miles by car and then switch to horses before they could get to that central headquarters because the road ended abruptly and there was nothing but trail after that. One of the visitors to the FNS asked how the nurses managed to get to their patients during the winter, and the reply was, Oh, it's our most important work, so of course we go in any kind of weather. Nurses were shown on horseback crossing icy rivers in winter to deliver babies, and in another scene, a man is carried on a makeshift stretcher for seven hours to get to the hospital after receiving a gunshot wound. You can actually watch this entire documentary online. I will link to it. There's an archival version of it that is available. And this documentary had a really clear purpose. It wasn't just like a hey, this is neat. It was intended to help promote the frontier nursing service and more importantly, drum up donations. This entire enterprise was privately funded from Mary's inheritance as we mentioned before, and from donations, and while the FNS continued its work over the next two decades, that remained how it kept going through donations. It didn't receive any sort of government funding. I don't think until the nineteen sixties no patient was ever turned away if they couldn't pay, but they could offer a trade of goods for care. The nurses were authorized to accept that. But if they could offer nothing, they still got treatment. It seems like that two thirds mortality drop from a promotional documentary might be a little inflated, but still there was an obvious positive impact. Yeah, in the nursing service. Yeah, it's a little tricky. That's one of the things that it would be an easy number to fudge because a lot of the people in those remote areas were not necessarily reporting things like bursts and mortalities regularly to the government, so we don't know how accurate. But I agree it seems a little Yes, that's a big number. Yeah, it is a big number. But like unquestionably, having access to basic medical care that wasn't there before would have made a big difference. World War Two impacted the way in which the nurses for the FNS were trained. Before nineteen thirty nine, many of the nurses were sent to Great Britain to train as midwives, just as Mary herself had done, but the tensions in Europe surrounding the war made that unsustainable, and it was then that Breckenridge founded the Frontier Graduate School of Midwiffery. The school continues today under the name Frontier Nursing University. Yeah, obviously it has changed and involved and modernized, but it is still the thing that has grown out of that core entity. In nineteen fifty two, Mary published her autobiography, which was titled Wide Neighborhoods The Story of the Frontier Nursing Service. Once again, this was at least in part, a way to make money for or the FNS. The proceeds from the sale of the book went right back into keeping the people of rural Kentucky care for and educated about their health. Breckinridge died on May sixteenth, nineteen sixty five, in Hyde in Kentucky. She worked right up until the end. I mean she literally she had fallen off a horse at one point and had to wear a brace, but she still had to keep riding the horses to get to her patients. She was working basically until the day she died, which is all pretty inspirational, But we got to talk about the problematic parts. Now. While Breckenridge's contributions to medicine are undeniable, she had some deeply problematic views. First, she was a fan of eugenics. From early on in her career. She wrote articles for publications such as Southern Women's magazine, in which she encouraged women to carefully select their mates as only people of quote good blood should be having children. Eugenics was by the nineteen teens gaining popularity in the United States as a way to eradicate disease infirmity. As if you haven't listened to our podcast about the Calikacs and the eugenicists, like, we talk a lot about how this wasn't just something that was a fringe element in society. It was like a mainstream taught in standard high school biology textbooks kind of thing. So it is absolutely easy to see why someone interested in nursing might have been into eugenics. But the way most eugenicists in the United States envisioned these improvements was specifically through keeping the bloodlines pure without integration of immigrants into families. Breckenridge believed that women in the US were duty bound to have healthy babies to keep the country strong, and that to do so, those babies had to be white, ideally white blood from Anglo Saxon roots. Yeah, she definitely had like a hierarchy of even people that would all be sort of umbrella under white of which ones were the best kind of went Anglo Saxon Nordic and then kind of went down from there, Like she really very clearly had no problems comparing people and deciding which ones she thought were the good ones and which ones were lesser. She also thought that women couldn't be creative like men because their creativity expressed itself biologically through making children. And while an official stance on birth control wasn't included any literature of the Frontier Nursing Service, Mary Breckinridge believed that contraceptives weren't as good a remedy for rural Kentucky's problems as education would be. She had to personally approve any tubal ligations performed by the service, and even then she would only do it if there was a medical reason or for women who already had at least five children. Yeah, she didn't seem to really get super involved in any of the politics surrounding other aspects of healthcare outside of like maternal and children. And she even wrote that she thought like birth control was in staying in that you know, that was that was good for some people, but not for her patients, which is a little again, she's problematic. Five years after Mary's death, ground was broken for a new hospital to be built and named for her, and the Mery Breckenridge Hospital was dedicated in nineteen seventy five. So it took a while to build and it assumed the general care duties that had been handled previously at the Heiden Hospital, and then the Heiden facility was converted into a teaching center, the Frontier School of Midwiffery and Family Nursing. In nineteen eighty two, Mary Breckinridge was posthumously inducted into the American the American Nurses Association Hall of Fame. As of twenty fifteen, there were thirty nine accredited graduate midwiffery programs in the United States and more than eleven thousand certified midwives and certified nurse midwives. So while she is considered the the sort of mother of midwiffery in the United States, it really grew very quickly and clearly. I mean it was address seeing a need that was there already, and other people were super interested in really more than midwiffrey. I feel like she should be maybe lauded as a person who introduced medical like formalized medical training in general. Uh with us. Mary Breckenridge. Thanks so much for joining us on this Saturday. Since this episode is out of the archive, if you heard an email address or a Facebook RL or something similar over the course of the show, that could be obsolete now. Our current email address is History Podcast at iHeartRadio dot com. 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