Nancy Dammann

Date of Conferral





Roy P. Fairfield


The purpose of this dissertation was to analyze the influence of the Frontier Nursing Service (FNS) on the area in which it operated. Mary Breckinridge founded the FNS in 1925 to demonstrate a method of delivering health care in an isolated rural area. She selected Leslie County in southeast Kentucky for its locale because of its isolation; there were no roads in the county and no licensed physicians.

The FNS program centered on nurse-midwives who provided health care from decentralized district clinics so situated that no family was more than an hour's horseback or jeep ride away. A hospital and physician backstopped the district midwives.

Apparently FNS did an excellent job of delivering health care. There have been no maternal deaths since 1952 and its infant mortality and communicable disease rates have been low. Presumably because of its emphasis on home health care, typical hospital stays have been shorter than the national average.

FNS appears to have had little impact outside of the immediate field of health. The nurses were well accepted and their advice followed on such matters as child care. But they were unable to persuade their patients to build latrines or otherwise improve sanitation. Government programs and improved communications seem to have been the chief stimuli for change in the field s of economics, education and sanitation.

Breckinridge urged her nurses to avoid discussing and becoming involved in politics, religion or moonshining. FNS was, accordingly, no threat to the local power structure which may be one reason it was so well accepted. It also may explain why FNS had so little impact outside of the field of health.