Angels on Horseback

This is another character that really inspired me. I learned of her through the writing of Janet Skeslien Charles in her book, “Miss Morgan’s Book Brigade.” I wrote about Anne Morgan, the lead character of the book, two weeks ago. There were other really notable, yet unknown, women in that work of historical fiction. Today let me introduce you to Mary Carson Breckinridge. 

Mary was born in Memphis, Tennessee on February 17, 1881, the second of four children, the daughter of Katherine Carson and Clifton Rhodes Breckinridge, a distinguished diplomat. She was the granddaughter of Vice President John C. Breckinridge, who served with President James Buchanan. Her father was a congressman and diplomat and she grew up in Washington, D.C. When he served as the U.S. minister to Russia, the family moved to St. Petersburg. Private schools in Lausanne, Switzerland and Stamford, Connecticut, provided Mary with her education. Clearly, her early life was one of privilege. 

The world in which Mary lived considered the primary role of women as those of a devoted wife and mother. When she was 23, Mary married Henry Ruffner Morrison, a lawyer from Hot Springs, Arkansas. He died just two years later of complication from appendicitis. They had no children. In 1906, Mary entered St. Luke’s Hospital School of Nursing in New York City, graduating in 1910 with an R.N.

In 1912, Mary married Richard Ryan Thompson, who hailed from Kentucky and was the president of Crescent College and Conservatory in Eureka Springs, Arkansas. Mary taught French and hygiene classes at the Conservatory. This experience led to a position serving in France after the war. 

Mary and Richard had two children; a daughter Polly born in 1916 but only lived a few hours, and a son, Clifton, “Breckie” who died just two years after the death of their daughter at four. (Interesting that in the book that was her nickname while working in France) 

The experience of losing one husband and two children was devastating. Mary’s focus now became clear to her. Using her nursing degree, she became committed to “raise the status of childhood everywhere.” She believed that the nurse-midwife would significantly aid families in rural America. She and Richard had grown apart, and the marriage was no longer a happy one. They divorced, and it became final in 1920, upon which she resumed using her maiden name. 

Mary’s work in health care began in the slums of Washington, D.C., where she supervised nurses during the influenza epidemic. She was driven and always eager to learn more to better serve children. This may have been a lifelong feeling that her brothers received a better education than she did as a girl. It always bothered her that her education was not as important as that of her brothers. She completed an intensive course in baby welfare work at the Boston Instructive District Nursing Association. Upon completion, Mary worked with families in the tenements in the slums of Boston. 

Mary worked for three years with the American Committee for Devastated France. While working overseas, which was rich with experiences, she developed a plan that she could bring back to rural areas in the States. Nurse-midwives were the backbone of this plan. Her work with a group of others provided direct relief to families. They restored supply chains for food, seed and much needed medicine. Her focus was mainly on children under six, and pregnant and nursing mothers. The group was caring for malnourished children who had developmental delays, families who had been under frequent attack during the war and evacuated families. They treated patients with pneumonia, impetigo, eczema, scarlet fever, and diphtheria, to name a few of the illnesses plaguing this area.  

When Mary arrived back in the U.S. she designed a series of advanced courses in public health nursing at Columbia University that included statistics, child psychology, metal health, and biology. 

During her first summer at home in 1923, Mary spent her time riding on horseback. She rode through the hills and valleys of rural Kentucky. She rode over 650 miles conduction surveys with midwives who were working in the area. What she found was disturbing. Most were untrained “grannies”, with an average age of 60, who were operating at a very low level of care and under filthy conditions. This was understandable as there were not midwifery courses offered in the United States, understandable but not acceptable. Mary returned to England that fall to receive four months of intensive training. This time it was at the British Hospital for Mothers and Babies. She earned a midwifery certificate, but that was not the end for Mary. In 1924, she traveled to the Hebrides in Scotland to view their models of health service in rural areas and took a comprehensive tour of Scotland’s entire public health system. When she returned home, she used the Highlands and Islands and Medical and Nursing Service in Scotland as her model to design a new public health system in the U.S. 

Private and public grants funded Mary’s system and was a decentralized and coordinated system. All the nurses underwent thorough training in public health, district nursing, and midwifery. Mary monitored her nurses and paid great attention to their training and their own living conditions. 

However, Mary still had more to learn. She returned to London to the Post Certificate School as a post-graduate student of midwifery to enrich her knowledge and abilities. At the Queen’s Institute of District Nursing in London, the maternal death rate was below 2%.

Mary returned to Kentucky with rich practical experience, further formal education and the administrative connections to create the Frontier Nursing Service (FNS) in 1928. Mary supported the service entirely with her personal funds for a few years. There were few reliable roads, limited transportation, mostly horses, that reached very remote areas in all kinds of weather. Within the first five years, FNS reached over 1,000 families in an area that was greater than 700 square miles. Eventually, the FNS morphed into the Association of Nurse Midwives and they trained hundreds of nurse midwives.

The FNS delivered their first baby in September 1925. Mary worked closely with Anne McKinnon and together they set up the Kentucky State Association of Midwifes in 1930. They had proven that they could reduce the mortality rates of mothers and babies. They established The Frontier School of Midwifery and Family Nursing was a first in the U.S. Much of this was because of Mary’s generous financial support. A life of privilege led her to a life of extreme service and devotion to children and family welfare. 

Mary worked tirelessly and was delighted with the results. Shortly before her death, she said, “The glorious thing about it is that it has worked!” Upon her death, FNS had treated nearly 58K patients and delivered over 14,500 babies, with only 11 maternal deaths.