Wide Neighborhoods

A Story of the Frontier Nursing Service

Mary Breckinridge

THE UNIVERSITY PRESS OF KENTUCKY

[excerpts: chapters 9-12]

 

FOREWORD

By Marvin Breckinridge Patterson

Wide Neighborhoods is the story of a woman of vision with sound practical sense. Nothing in Mary Breckinridge's origins or upbringing would have led one to guess that she would become one of the great nurses in history, to follow in the footsteps of Florence Nightingale and Clara Barton. Her great achievements lay in introducing into the United States the concept of the trained nurse-midwife, modeled on those of the British Isles, and in establishing a demonstration project of complete family health care in a remote rural area through the organization which she founded in 1925 and directed until her death in 1965---the Frontier Nursing Service.

I was fortunate enough to know Mary Breckinridge and to work with her in the formative years of the Frontier Nursing Service. She was my father's first cousin, and I remember her staying with my family when I was a school girl, first in France and later in New York. During those visits she told us of her plans to establish a nursing service primarily for mothers and babies in the remote mountains of Eastern Kentucky. When the FNS became a reality, I wanted to help in her work, to live as frontier Americans had lived a century earlier, to share in the adventure, and at the same time to be of service to the public. So in 1928, a year after graduating from Vassar College, I went to Hyden, Kentucky, as the FNS's first girl "courier"---as the volunteers were and are called. I lived mostly at Wendover, the two-story log house which Mrs. Breckinridge had had built with her own money.

My duties at Wendover were mainly in transportation, as they are for today's couriers, but in those days it was all done on horseback, for there were no roads for automobiles. One of Mrs. Breckinridge's duties was to make monthly "rounds," which meant riding half a day to an outpost center, reviewing the records and problems for half a day with the nurses, and then proceeding to the next center. It took almost a week to cover the six centers then open. I vividly remember one such occasion when I accompanied her. It was winter and the weather was bitterly cold, but we were dressed properly---she in her gray-blue riding uniform and I in riding breeches and boots, both of us with yellow slickers over all. The horses . . .

[...]

Chapter 9

I

NORTHERN France was a part of the world where I felt I could be of use to children in 1918, but I could not plan to go until June. Meanwhile, a ruling was passed by the State Department that no one with a brother in the military services could be sent to the war areas. My mother went with me to Washington to see Miss Jane Delano, head of the American Red Cross Nursing Service then. Since she could not send me overseas until "the brothers ruling" was rescinded, she gave her permission for me to accept a three months' contract with the Children's Bureau, under the Child Welfare Department of the Council of National Defense. My work, which took me as far West as Montana, Wyoming and New Mexico, was to gather reports on the nation's children, and to make speeches in their behalf. Miss Julia Lathrop asked me to carry on in California as well but, by the time my contract was up, the ruling in regard to brothers had been repealed. I therefore went East to make my final reports, and to get my loyalty papers and passport cleared for work with the Red Cross Children's Bureau in France, to which I was assigned.

I hit Washington at the height of the 1918 influenza epidemic, when the sick numbered several hundred thousand in that congested city.

The United States Public Health Service had charge of the medical and nursing services, with Miss Mary Lent as chief nurse. From her I learned there were almost no nurses so, with Miss Delano's permission, I volunteered. The District of Columbia had been divided into four medical areas, to one of which I was assigned as assistant nurse in charge. 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 aides for day and night care of the patients with pneumonia in the families where everybody had come down with influenza. Many of these aides were clerks turned over to us for the emergency by the government bureaus, and only a few of them had received training in home care of the sick. They were, however, keen young people who had volunteered for the assignment and had a good will. We issued masks to them and gave them special instruction in the care of their hands. Not many caught the infection. We used the token force of nurses to make rounds of the houses, give hypodermics where ordered, and instruct the aides in regard to other treatments and drugs.

Our physicians were mostly elderly men, who had ceased to practice before the war, and Army and Navy doctors loaned us by the Armed Services. At our headquarters in a schoolhouse we had three telephones, all reporting new cases every minute, while a queue of people stretched out into the street from early morning until around midnight. Cars were put at our disposal so that we could get doctors, nurses and the aides off in the quickest possible time. The filing system was a madness of improvisation in which the vital thing, with thousands of patients, was the correct address of each. Some of the reports the aides dictated, after a day or night on duty, would have been comical had they not been so tragic. One said of a pneumonia who had died, "Patient's condition got pretty bad towards the end." Another, who had been in a government bureau handling food rations, reported on a housewife, "She has twenty pounds of sugar salted away"

One of the most awful things about this Washington nightmare was the condition of the houses in which both our white and colored patients lived. They were riddled with bedbugs. We devised a system of disinfecting the beds, then pulling them out from the walls and putting their legs in tin cans of carbolic. But the bedbugs dropped down on the patients from the ceilings. Years later, when I traveled into Washington on the same train as my cousin, John Mason Brown, I told him about my struggle with the bedbugs. He said, "Yes, I see. You lost the cherry blossom approach."

During the influenza epidemic I hadn't a mind for anything but that. After it was over I found that it would take more than a few days to get my passport and loyalty papers. Upon the advice of Miss Ella Phillips Crandall, I decided to spend the intervening time with the Boston Instructive District Nursing Association for the special training and experience in public health and visiting nursing of which I stood greatly in need. Miss Mary Beard took me in at the house of the Association on Commonwealth Avenue, as a guest. I was put through an abbreviated but intensive course, which included an affiliation with the baby welfare work under Miss Winifred Rand. I was to be grateful a thousand times over, after I got to France, for all that I learned in Boston. My work in the slums lay mainly in the Italian and Irish Sections. I thought the tenements even worse than the New York ones, but nowhere did I find so many bedbugs as in Washington.

The Armistice caused the Red Cross to cancel sailings of its personnel, and I obtained my release from Miss Delano. Through Miss Elizabeth Perkins, a family friend, and my cousin, Mrs. John C. Breckinridge, I was introduced to Miss Anne Morgan and was accepted by her as a volunteer with the American Committee for Devastated France. Miss Morgan was First Vice-President and Chairman of the Executive Committee of this organization, of which Mr. Myron T. Herrick was President. From the first I was enthusiastic about the Committee, and I came to love it more than I have ever loved any group except the Frontier Nursing Service itself.

II

The French name of our organization was Comité Américain pour les Régions Dévastées de la France, called C.A.R.D. for short. We who worked with the Committee were frequently spoken of as the Cards. Our Paris offices and our entrepôt were out on the Boulevard Lannes. I reported, immediately on arrival in Paris, to our Commissioner in France, Mrs. Anne Dike, and was charmed with her. I was to learn in the course of time that she was not only a delightful woman but a brilliant executive. War restrictions were still on, so that I could not go to the war zone until I had a military permit. I had also to get bread and sugar cards, and fill out a lot of forms. One day, as I left the gloomy portals of the Prefecture de Police, by a different way from that in which I had entered, I suddenly found myself face to face with Notre Dame. I caught my breath before this shimmering glory in stone, then I crossed over to the cathedral, and passed through its doors into the hushed darkness. No guides, no noisy clattering, as there would have been in other days--only a few women in black, praying, and some American soldiers as awed as I was.

Eager as I was to get to work among the children, I was enchanted to have a little time in Paris because my sister Lees was there. Since I last saw her she had married Warren Dunn, but my new brother was with the Army elsewhere. Lovely as it was to see something of my sister I was glad when my papers were ready and I could report for duty in the devastated areas at Vic-sur-Aisne. Miss Margaret Parsons was the Director of the unit at Vic. From her, old in years but young in heart, I received the warmest understanding of what I had come to France to do and soon embarked upon my work for children. But in some of our villages there were no children. The clearest way in which I can depict that war-devastated land of France is to quote from one of my first letters to my mother a description of one of our villages:

Tartier, before the war, was a village of 365 inhabitants. Now it has four men and three women---no children---who have returned. It stands on a hill above the valley of the Aisne overlooking a country so lovely that, almost, one could imagine it as it once was. But we drove up through that country on a road broken with shell holes, past fields still massed with barbed wire, and seamed with trenches and dugouts, and past those pathetic roadside graves of soldier; with often a helmet on the cross, and a bayonet stuck in at the foot to mark them, "Soldat inconnu. Août, 1914," or some later date. Tartier is so old that the people don't know when it first began to be, but things like Goths and Gauls are buried in the valley below the village. It was made of the sandstone, of which all these villages of the Aisne of this region are built, and the quarries, used as dugouts by the Germans during their domination, are lived in now by the seven people whose ruined homes are not habitable. Walls of old, old houses still stand, and picturesque wells are labeled "Trinkwasser," just as the Boches left them.

One man and his father, named Dufour, sturdy hardy types, to whom we are sending seeds, showed us around. They pointed out the gardens they were spading, the quarry where they lived underground, and the old tower where the elder Dufour had, before the war, five hundred pigeons, and the ruins of the rabbit hutches where the younger had two hundred rabbits. The younger Dufour had just been demobilized and still wore his old uniform. His wife would soon join him, but they dared not bring the child yet. The hand grenades and unexploded shells lay all about. As we talked, he picked up a hand grenade that lay at our feet and threw it down into the valley, where it burst with a wonderful display of starry lights. Then he took up another and threw it. We saw it drop on the ground below and a moment later it exploded with a reverberating roar that woke the echoes. The younger Dufour was bright and strong and hopeful. He said it was hard to begin over again but it had to be done, and so why not do it? The spirit of the man and his father was as everlasting as the hill they stood on. So was that of the other peasants of the group of seven whom we visited. Coming out of their lonely holes in the rock to greet us they were smiling, every one of them. The spirit of the peasants of France! It explains Verdun. You can't weep with them for you never find them weeping.

The first need for everybody in the devastated areas was for food, clothing, bedding, and a few household utensils, but especially food---what the French called "ravitaillement." 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. Soon after I was sent to our sector, one train a day got through from Paris to Vic and Soissons. But the train could not go where the railroad tracks had not been restored, and most of our villages were not near railroads at all. We supplied them by trucks, or camions as the French call them, huge trucks driven down from Paris by Frenchmen, and small Ford camions driven by our volunteer chauffeurs. Some of our villages had no food but what we took to them, nor could any of them have procured a mattress except from our dépot of supplies---not at any price, because there were no mattresses except those we brought in. As soon as a train could run, our Committee was given a high priority for carload lots of supplies.

Laon, the capital of the Aisne, where we first housed our unit for work in the wrecked canton of Anizy, had been occupied by the Germans until the Armistice and so had escaped destruction. This old-world walled city, rising on a hill beyond the Chemin des Dames, was the birthplace of Père Marquette. The children there, like all who had been under German occupation, those who had not died, were horribly undernourished, but their city had survived, with its cathedral of ageless beauty. Soissons, on the other hand, taken and retaken several times during the war, was terribly damaged by artillery fire, and its cathedral had gaping holes, On my first visit to Laon, I was sent to an office called the Tiers Mandataire, armed with a sheaf of demands for wheat seed from legions of small farmers in our villages. These the Tiers Mandataire took over and gave me in return authorizations called "Bons." Within twenty-four hours we had these "Bons" stamped officially by the village mayors, and had begun to deliver the wheat. Since ours was the only transport service in all that territory, except for a few military cars, it was our girl chauffeurs in their camions who made possible the spring planting.

From Soissons to Laon one crossed the Chemin des Dames. For miles, as far as the eye could see, where for years the two contending armies had fought, the earth was torn apart, broken into ghastly crevices, seamed with jagged openings, thrown over and over, and furrowed with huge craters. Nothing recognizable was left of what had once been a smiling and fertile country, not a weed, not even ruins for long distances. They had been swallowed up by earth so tortured that it billowed like an ocean in a typhoon. The road over which our camion passed had been mended and a military bridge thrown across the little Ailette River. It had lost its banks and wandered through that stricken country, where one hundred and fifty thousand Frenchmen lay buried.

III

The French Government allowed each family losing all a thousand francs to refurnish a household, with two hundred additional francs for each child. Although this was a heavy cost to be borne by a war. bankrupt government, it was little enough, at inflationary rates, for a family to make a new start. The money the Government gave was called an allocation and, when the French peasants got it, they said they had "touched their allocations." At first everything our Committee gave out was provided free, and the clothing from America. the medicines, and the garden seeds, were always given without charge. Later, when the peasants touched their allocations, we furnished things like pine tables and bureaus to the people at wholesale rates, minus transportation which we always paid. We started restocking families with rabbits and chickens even while the ravitaillement was at its peak, and we were busy in the distribution of beds and straw mattresses. We ourselves used the same narrow iron bedsteads and straw mattresses that we gave out to the peasants as they returned to their ravaged homes. just after a shipment had been unloaded, we might have to use boxes to climb on our beds because as many as twelve straw mattresses had been placed on each of them. The next evening when we came in we were lucky to find even one mattress left, so diligent were the chauffeurs in their distribution.

At my Vic unit, we were living that winter in the ruins of two large country houses on a property that ran right down to the river Aisne. Here we had our dispensary, storerooms, dining room and kitchen, and here the members of the unit slept as best they could. The windows were gone and in place of them we had yellow oiled paper so that we couldn't see out and the light inside was rather dim. The water works and the electricity had been completely destroyed. German prisoners brought us our water in hogsheads, and we used oil lamps and candles. Our two houses were full of shell holes which we stuffed with refugee petticoats on the coldest days and nights. For service we depended on the daughters of the neighboring peasant families. We clubbed together to meet our own expenses on a co-operative basis and they came to fifty francs per person per week, not including laundry. The American Committee for Devastated France housed all of its units, some of them in wooden baraques , or huts, that we called barracks. The C.A.R.D. also met the cost of fuel. At that time this was the wood taken out of the trenches, and packing boxes cut up for kindling. We had fires in our rooms in the evenings only. Then we could heat a little water with which to wash.

The American Committee for Devastated France was a masterpiece of 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. Our chief, Miss Anne Morgan, had inherited her father's ability. The conception she had of what needed to be done was matched only by her amazing capacity to put it over. In Mrs. Anne Dike, she had a colleague of ability second only to hers. My admiration for the way we handled our work was profound. During those first weeks that I spent in devastated France, I did not think that trained disaster relief people could have met the conditions better than we met them, volunteers all of us, and inexperienced. We Cards were informal people, casual in our manner, calling each other by our last names or nicknames, but with a strict sense of discipline, and working almost around the clock in that land of stark tragedy. Our uniform, military jacket and skirt, was in the horizon blue of the French Army with their special permission. On the lapels of the jacket we wore metal griffons (gryphons), copied from the arms on the gateway of the ruined old chateau at Blérancourt---the place where the American Committee established its first unit. Of my colleagues among the Cards, many are now members of the Frontier Nursing Service committees. From the chauffeurs, I derived the idea of couriers for the Service.

My letters to my mother are filled that first winter and spring with accounts of people killed and injured by the explosives in the fields they were trying to get ready for the spring planting. I wrote: "A peasant sticks a spade in the ground and is likely enough to strike a and grenade. Our casualties in the past week were three men and two women, of whom only two men survived, one with the loss of both hands."

The family life in provincial France impressed me by its solidarity and beauty. When the French peasant despaired, it was in the injuries, illnesses and deaths of his children. I nursed a five-year-old boy at Vic who died of meningitis. His father had been killed, and he was the last surviving child to his mother. I stood with her as he lay dying. She kept twisting her gnarled peasant hands, muttering under her breath, "What shall I do, what shall I do?" I kept thinking, "What can you do? What use is it to spade your garden when there is no one left to feed but yourself? What will you do?"

The French peasant's love of his own acres and his own house was second only to his love of his children. The French word for home is "foyer" or hearthstone---meaning the very heart of a home. We Americans have prostituted both the word "foyer" and the word "home." We use "foyer" to describe a vast public place, and "home" (funeral) to indicate a place where a corpse rests for a few hours.

As I came to know the French peasant well, his strong family life, his deep-rooted love of home, it seemed to me that Joan of Arc was not an accident but the spiritual outcome of her people and her class. The fragments that have filtered down of Joan's childhood, of the tenderness with which her parents cherished her, the play with her brothers in the forest, the lore of fairies and saints which satisfied her imagination, the simple duties outdoors, and inside around the hearthstone---these things enable us to understand why Joan, her mission ended, begged the king's permission to go back to that family life at her village of Domrémy, which she cherished as the choicest blessing earth could hold.

It was because they loved their own country so much that the French we knew loved ours. You do not love other countries if you are incapable of first loving your own. This was brought home to me on the first American Memorial Day after the Armistice, when we took part in services at two of the cemeteries where American soldiers were buried. One of these cemeteries, at Juvigny, had only a few hundred graves. The peasants in the neighborhood had gathered artillery shells, from the battlefields, to fill with water and put on the graves. Into these they put field flowers. There were many old peasants, and some little children. One woman, who was sobbing, said, "They lie so close together, just like ours." When we thanked them all, as we were leaving, they said over and over, "It will always be so. They will always be to us like our own."

 

Chapter 10

I

ALTHOUGH my first work in the devastated areas in France was to help get food, clothing, supplies and seeds to the villages, and to meet the immediate emergencies, even as I did these things I started to give nursing care to the sick and especially the children. No civilian doctors had returned yet to our sector, but at first there were a few military doctors. To a French military hospital at Compiègne, we carried the people blown up by explosives---those that survived. We took some of our civilian sick to a hospital at Luzancy-sur-Marne, a distance from Vic of about ninety kilometers, maintained by the American Women's Hospital Association. Late in the spring the Association moved it to barracks set up near our unit at Blérancourt. At that time they assigned Dr. Ethel Fraser and one of their nurses, Miss Katherine Smith, to our Vic unit.

With Dr. Fraser's backing and that of Miss Margaret Parsons, I took up with Miss Morgan and Mrs. Dike the problems that lay at my heart. The loss of infants and young children had been, and still was, appalling. I got permission to begin in as many villages as I could tackle single-handed a program for the war-devastated children, with special care to those under six and to pregnant and nursing mothers.

Of war-devastated children we had three kinds. First, those who had been under German occupation and were two or more years below their age in size and strength. Second, the children in places like Vic, taken twice by the Germans, held briefly, and retaken by the French. They had been frequently under artillery fire. I remember one family where the mother had been killed by a shell in her own garden. Lastly, there were the children who had been evacuated and were now creeping back with their families into the ruined villages. From a letter to my mother written on March 2, 1919, I describe one such family:

The thing I have done most in these last three days has been to help with a pneumonia baby over at Montgobert. Solange Duvauchelle is the name of the little one. Her mother is an intelligent peasant woman reduced almost to despair by vicissitudes of the past. When Solange was three weeks old, they were evacuated and the long forced march completely dried the mother Is milk. From then on it has been slow starvation for Solange who is but the shadow of what she should be at ten months. They returned to their home after the Armistice, the parents and baby and three other children, having lost two others, to find the village in ruins but their own home partly spared so they can get shelter in it. But everything they owned was gone. When they reach this point French peasants always tell about their sheets. One told me she had had fifty-four of linen. Well, the Duvauchelle family had nothing left but the worn clothes they wore. We have given them bedding, clothes, groceries. Then the three-year-old boy, Serge, fell ill with pneumonia and was taken to Luzancy in one of our camions. Now the baby is ill. The five-year-old girl and Serge are pitifully undernourished. The older girl has fainting spells, as does the father. The mother always has toothaches. Why do I write about them? There are thousands of others like them. It is just that I have been so constantly with them.... If I could give right now a goat to every family that has a baby, I think we could go far toward saving many that are dying. There is much grippe and pneumonia among them and they have no powers of resistance. I wish I had a thousand goats right now. I wish I had fifty.

The goat idea struck my mother as feasible. My letters were passed around among members of my family, who all began not only to give goats themselves, but to start goat funds. Soon the money was pouring in, gifts of twenty dollars each, for the goats. Although the valleys of the Aisne had cows before the war, there had been goats in the hill country. Even in the valleys, the goats could serve to tide over the need for milk until the French peasant touched his allocation for a cow and could find one. But war-bankrupt France, with all of the villages to rebuild at government expense, could not give allocations sufficient to cover the replacement of livestock at inflated prices. I asked Miss Morgan to arrange through our Paris office for us to buy the goats. They came in carload lots from the Pyrenees, each car with its own goatherd to feed and milk them on the long trip across France.

The first carload lot of twenty-nine arrived when I was out on my rounds. By this time I had a dispensary at the Vic unit, called "Consultation de Nourrissons." As I opened the door I heard a "Baa, maa, baa," and there stood a white goat. She had gotten her feet in a box of nursing bottles, knocked over the weights of the scales, and chewed various odds and ends, and I hugged her I was so glad. My colleagues explained, ecstatically, that when the train had arrived, everyone on hand had turned out to lead the goats up from the track, with all of Vic in their wake. They told me there probably wouldn't be much lunch because the cook, who was knowing with goats, had spent the morning milking them.

There were gray goats and white ones, and black and gray ones, and brown and white ones, and café-au-lait, and some had horns and some hadn't, and some were so gentle they followed you like dogs and some were wild. To each goat we gave the name of the donor and I wrote back to him or her the history of the children who received them. The distribution of the goats, with the problem of having to choose only twenty-nine families among so many, tore us to pieces. This was only the beginning of my goat crusade, for other carloads were to follow. Later, I asked the goat givers to provide money for beetroots with which to feed the goats their first winter. Meanwhile, the goats had to be bred again. Ambassador Morgenthau came to see us during this crisis and gave me the money for a fine buck, which we named Ambassador.

II

I used to agree wholeheartedly with the late Dr. Truby King of New Zealand that the only reason a woman could not nurse her baby was tuberculosis. I changed my mind that first year in France because I had learned of another reason---starvation. The few babies who came back with their parents to the ruined villages were only partly breastfed, if at all. When we poured malted milk, and chocolate made with condensed milk, into the mothers then the breast milk increased so that the babies had only to be partly bottle-fed. This meant that we were feeding both babies and mothers with our supplies, and with goat milk. The children under six years of age needed lots of feeding and care just to keep them alive. Those in the areas that had been occupied by the Germans were riddled with impetigo and eczema.

In France I felt, as I was to feet later in the Kentucky mountains, that a program for children should begin before the children are born and should place special emphasis on the first six years of life. In France we did not have to worry about childbirth itself because the French midwives took care of that. Some were already in the villages, and others returned with the populations that had been evacuated. Their course of training then was of two years' duration, followed by a diploma to vouch for their qualifications. The course is three years now. My younger brother's birth in Russia, with Madame Kouchnova in attendance, had taught me early the value of a trained midwife. I greeted the French midwives with respect. They were delighted to have special feeding for their expectant mothers. They turned the babies, with their mothers, over to me when they were ten days old.

During that first summer we had a crop of what we called "Armistice babies."

Even before the arrival of the first goats, I had scouted around in various directions for canned milk, liquid or powdered, cocoa, chocolate and other nourishing supplies. The C.A.R.D. were most generous in letting me raid our own stores for enough of these things to get results. The Free Milk for France and the Trait d'Union Franco-Américain gave me a lot of malted milk and condensed milk. The Children's Bureau of the American Red Cross, which closed down its wonderful work not long after the Armistice, was most generous to me in the disposal of its stores. With Dr. Fraser to examine and prescribe for my babies and young children, and both Dr. Fraser and Miss Smith to give the typhoid inoculations and look after the sick adults and accident cases, I had my program just where I wanted it.

Early in May, I had a big windfall. One Monday morning I was told that two military doctors (captains) wanted to see me. They represented the American Committee for Relief in Belgium and France, called C.R.B. for short. They said that the C.R.B. was closing out its work in France and Belgium, and that they had about thirteen million francs of French money which they proposed to use, as long as it lasted, in feeding schoolchildren in the devastated areas. These children were to have a supplementary meal of a cup of chocolate, made with condensed milk, and a biscuit made of flour, sugar and lard, at the close of each school day. The children who were markedly underweight were to get a midday meal of meat, vegetables and bread. They asked me if we would like to be given supplies to start this program in all of our sector, and said that we would have to weigh, measure and examine all of the schoolchildren to determine which ones should have the hot noon meal. The C.R.B. was as good as its word. We secured just the right French people to cook the noon meals, while the teachers gave out the biscuits and chocolate at the end of each school day. Meanwhile, the American Women's Hospital Association Placed women dentists at our units. They were godsends.

III

Early in June of 1919 our Vic unit moved from the battered houses near the river Aisne to other quarters gotten ready for us by the C.A.R.D. The new place lacked some of the points of the old one but had others in its favor. For one thing, it was not full of shell holes. Only one en end of the house had been shattered. This the C.A.R.D. had rebuilt and reroofed. Real glass had been put back in the windows; the breaches in the walls were filled by stones instead of petticoats.

An old stable served as headquarters for the chauffeurs, under Louise Barney, and housed their camions. We had to put up four barracks in the grounds (encircled by a high wall in pretty good repair) to serve as sleeping quarters for some of the unit, and to house our supplies, our dental clinic, my dispensary, and a library. This library, set up like those at all our units by Jessie Carson, whose Card name was Kit, was as frequented as my dispensary by a literate and book-starved people.

The place to which we had moved at Vic was just across the road from the lovely park of an old chateau belonging to the de Reiset family. This chateau was of such historic interest that it had been placed under the Department of the Beaux-Arts to ensure its perpetual preservation. The oldest part of it, the tower, dated back to Charlemagne. The place was terribly damaged by artillery shells, with which the Beaux-Arts had not reckoned, but the Vicomte de Reiset came down in the spring of 1919 and made a part of it habitable so that he could live there with his wife and daughter, Anne. We often had tea with them in the only living room made habitable as a salon.

The Vicomte was a gallant as well as a charming old man. At the time of the last German occupation of Vic, the Germans mined the bridge over the river Aisne so that it could be exploded when they retreated, and delay the allied advance. The Vicomte, with one or two other old men, got down somehow to that troop-guarded bridge and destroyed the connections that would have set off the explosion. The enemy would have made short shrift of him, despite his gray hairs, if he had been caught. Anne de Reiset, a delightful girl, took an immense interest in my work for the little children and often went with me in the camion on my visits to them. She and her mother were greatly beloved in and around Vic. Madame de Reiser put one of the few habitable rooms in the chateau at our disposal for guests. Some of this family dropped in at our place several times a week, or we went to theirs, and we became much attached to them. The French nobility, like the de Reisets, and the modern industrialists in the Aisne had been sorely stricken by the war---their country places and their factories wrecked, or all but wrecked. Yet the concern of most of them was not for themselves but for the peasants who had lost everything. These upper-class families gave us wholehearted co-operation.

Our friends among our neighbors included the schoolteachers, most of them intelligent and well educated, the mayors, the men in the Préfecture, the priests, the large farmers who had been peasants but whose business acumen and thrift had lifted them into the bourgeois class. Not all of our varied friends liked one another, and sometimes they did not even know each other, but they met at our place and worked wholeheartedly with us. We were deeply touched that first September when our Vic unit was decorated by that little to what it had done in the months following the Armistice. We each received a gold medal with "LES HABITANTS DE VIC-SUR-AISNE RECONNAISSANTS " and the year "1919" engraved on it

Innumerable people other than the French themselves were scattered over that devastated land during that first postwar winter. We had Senegalese troops quartered at Vic, little colored men from Africa. We had German prisoners, who lived in barracks behind barbed wires at night but worked on the roads in the daytime. They were humanely treated. I never knew of a single instance of a German prisoner being allowed in the fields to get out the hand grenades which tore so many French citizens to pieces. With the coming of warm weather, hundreds of workmen arrived and camped in barracks to start repairing and rebuilding the shattered villages. We had a lot to do with them because they were always falling off things, or things were falling on them, with gainful results.

When my mother wrote me that my descriptions reminded her of Lewis Carroll's Wonderland and Looking Glass books, I replied that we were often reminded of them because

This whole country is such stuff as dreams are made of. Consider, here in one fragment of a shattered land are a Napoleonic duchess, and a royalist family who keep a whole page in their visitors' book free because Sixtus de Bourbon wrote on it, and big modern industrial magnates, and Républicains and peasants, and secularized nuns and curés, and German prisoners who sleep behind barbed wire, and colored troops from Madagascar, and hand grenades in the fields which blow people up, and in Coeuvres the mayor is the Comte de Berthier and in Dommiers the village blacksmith, and workmen from all over the world are coming in to rebuild, under the Administration, among them English-speaking Negroes from Barbados, who know no word of French but came because they heard there was work to do, and brought wives and babies with them. Lastly, an American Committee of women tear around in camions, and are still the sole source of the food supply to many villages. All of this is jumbled in together like a loose pack of cards, and someday we will wake up and not be here any more.

 

Chapter 11

I

WHEN I started my special work for children in the communes (village groups) covered by the Vic unit, I began to gather information about what the French had done for children before the war, and what they wanted to do now. I subscribed for two Paris magazines, the Nourrisson and the Presse Médicale, which carried articles by leading pediatricians. I bought a number of books by French authorities, and I made inquiries of all the local people capable of giving me information. I found that the French, under a public department known as the Assistance Publique, had paid a physician to examine all babies brought to the mairie, or town hall, and to weigh the babies once in two weeks and give free advice. I also learned about the organization known as the Gouttes de Lait, started as a private philanthropy by a man named Boudin, which operated baby milk stations in the larger places only. There had been one at Soissons. Through the Gouttes de Lait, modified milk was supplied at cost to bottle-fed babies, but no instructions went with it and the mothers were never taught to handle the milk themselves. In other words, there was no follow-up work because there was no visiting nurse service. I resolved that I would organize a visiting nurse service, as good as the one in Boston, to cover the sector of devastated country assigned to the C.A.R.D. My plan for this work was to link it with all that was good that the French had done and add to it something France had never had, a visiting nurse service with a staff of trained nurses, qualified also for district and public health work. We would keep such careful records of our demonstration, and get such good results, so I reasoned and wrote at the time, that the French would want to copy it elsewhere even if they had to revolutionize their antiquated nursing system to do it.

I was profoundly impressed by the quality of my peasant children. Of course we had some low-grade children, for the feeble-minded are not confined to the United States. But in France, as well as in America, they are a small minority. I never forgot that Pasteur had been a peasant child and what his life had meant, not just for France, but for the world. I wrote my mother, "I believe that the best asset I bring to my work here is not my training and experience, although I couldn't do the work without them, but the fact that I can and do appreciate the appeal of the people themselves, that I love and admire them and realize they are worth saving. The world needs France."

As soon as my work at Vic was well under way, it was inspected by the French authorities as well as by the heads of our other units. Mrs. Dike then asked me to extend it to cover the rest of our sector. That was all very well, and what I wanted to do, but my experience with partly trained, and therefore poorly trained, nurses had been such that I knew I could not expand my program without fully trained nurses. The Florence Nightingale School, organized years before by Dr. Anna Hamilton, and attached to the Maison de Santé Protestante at Bordeaux, was the only hospital school in all France, except the one at the American Hospital at Neuilly near Paris.

In my need for trained nurses I wrote Dr. Hamilton to ask her if she could let me have some of hers. She promised me two to begin with, and more to come later. In September, 1919, the first one, Mlle Harrioo, joined me. I kept her a week at Vic and then spent several days with her at our Blérancourt unit in the canton (county) of Coucy, to get her work started there. In October, Mlle Mertillo came and I followed the same course with her. When the third Bordeaux nurse, Mlle Monod, came in November I gave her my beloved county of Vic with the little town and the many villages where my work had begun. It was an awful wrench to give it up, but a joy to have it taken over by so gifted a woman as Marcelle Monod. Meanwhile Dr. Hamilton had made us a visit of inspection which brought about an even closer collaboration. We took on the wrecked villages of the Soissons unit. At the turn of the year, with four more of the Bordeaux trained nurses, my service was established throughout the C.A.R.D. sector of devastated France.

As I got the nursing situation under way throughout our sector, the medical situation became acute. In August of 1919, Dr. Fraser and Miss Smith left Vic to return to America, to be followed by other members of the American Women's Hospital Association. There was an appalling scarcity of physicians in our sector, although the French Government offered them special compensation to locate in the devastated areas. I suggested to Miss Morgan and Mrs. Dike that the American Committee supplement the government grants, with a proviso that only physicians be chosen who knew something of pediatrics. To this they agreed, with the result that we persuaded three competent men to locate in our territory.

Meanwhile my nursing work had become a fully generalized service. We gave bedside care to the sick of all ages and both sexes and did a vast amount of public health at the same time. The C.A.R.D. kept the barrack hospital at B1érancourt open---a godsend for our patients. We kept our emphasis on the care and rehabilitation of babies and children, the expectant and nursing mothers. My friends at home, bless them, continued to send money for more goats, and the circle of goat givers widened. It was wonderful to see the transformation of the children, bowed little figures with large pathetic eyes, after only a few weeks of four glasses of some kind of milk a day.

When I sent my mother a copy of my ten-page quarterly report for the last three months of 1919, I wrote her:

So much of my work now is taken up with writing, going over reports, talking, that sometimes I am a wee bit sad about it. Of course it is a sign of growth but I love the contact with the peasants best and now I have small time for that. Instead, I am having interviews with the Mayor of Soissons, the head of the Service de Santé of the Department (like our State Boards of Health), the people in the health part of the Ministère des Régions Libérées, in Paris.... I can hardly believe that only last summer I was alone in my loved villages.

From among the official people I met, I formed a lasting friendship with one man and his family. Dr. René Lemarchal. was the President of the Medical Syndicate of the Department, a position the equivalent in America of president of one of our state medical societies. I had to see him frequently about the incoming doctors. He lived in one of the old Laon houses, opposite the cathedral, with a walled garden at the back, from which came the laughter of children.

In the middle of February, 1920, I took with me to Soissons my cousin, Katherine Carson (in France at that time, and spending two days with me) to see the city decorated by Poincaré with the Legion of Honor. I wrote:

The ceremony took place at the lovely old Hôtel de Ville against which Lombard had a grudge, because it was not near enough to the cathedral for you to enjoy both at once, until Lummie suggested that perhaps it was the cathedral's fault. Katherine and I were curious as to how one decorated a city, whether the ribbon was pinned on the walls of the Hôtel de Ville or the lapel of the Mayor's coat. In case you have a similar unsatisfied curiosity, I will hasten to say that the city receives the decoration on a cushion, which in this case was held out by a lovely young girl in black. Poincaré made a speech and the Mayor another, which those who were close enough to hear said were good. There were lots of military, and a band which played the Marseillaise, of course, and I wanted to wave and shout like any schoolchild. Then a man sang the Marseillaise, then the children of Soissons sang it. That moved me most of all. Poor babies What a hell of a five years! God send they may never have it to live through again.

At about this time, the Mayor of Soissons told me that the city meant to re-establish its baby milk station, the Gouttes de Lait. He wanted to know if the C.A.R.D. would provide a visiting nurse service to follow up on the babies and their mothers in their homes. It was agreed that we provide such a service for all the people then living in that shattered city, including bedside nursing of the sick, school nursing, and the control of communicable diseases. This meant a larger nursing unit at Soissons than we now had for the work among the villages in the county. It also meant the engagement of a first-class supervisor to direct the Soissons unit. I consulted Dr. Hamilton, remembering a visit to Bordeaux where I saw something of the splendid visiting nurse service that Miss Evelyn Walker had organized there, under the American Red Cross. The upshot was that Miss Walker arrived in Soissons in March of 1920 to become my Associate Director of the Child Hygiene and Visiting Nurse Service, with headquarters at Soissons.

At about the time we accepted the invitation of the Mayor of Soissons, the Rockefeller Foundation established one of their dispensaries for the treatment and care of tuberculosis at the Soissons Hospital. Nothing could have afforded more of a contrast than this modern dispensary in that hospital, which I considered a very good one for the thirteenth century. The Rockefeller put a trained French-speaking English nurse in charge of their work, with an assistant who was not a nurse but one of their newly trained Visiteuses d'Hygiène. When the nurse lunched with me at our Soissons unit, we worked out a plan of co-operation. Our people were riddled with tuberculosis. It meant a lot to us to have the Rockefeller establish a dispensary at Soissons, and one at Laon.

Before the end of March of 1920 I returned home on my first leave of absence. I did not get back to France until June. The welcome everyone extended to me, not only my colleagues in the C.A.R.D. everyone and my Bordeaux nurses, but the French from the poorest on up to those of high degree---this welcome went right to my heart. I was allowed by my chiefs in Paris to continue to make my headquarters at Vic. Months before, when I began to create a generalized nursing service in all the centers and Mrs. Dike made me a Director, she offered me a car and chauffeur. I pooled them with the camions of the Vic unit. When Barney became chief of the whole motor service of the CA.R.D., I continued to pool my car and chauffeur with the rest. The nursing work mattered as much to Barney as it did to me, and she never let us down. It was something for me and my nurses to feel that we must match the enthusiasm and efficiency of Barney and her chauffeurs, because they could not have been surpassed.

Although I made my headquarters at Vic, I now had to spend days at a time not only with other units in our field of work but in other parts of France. During the war the C.A.R.D. had established a children's colony far back behind the lines in a chateau called Boullay-Thierry. Now that the children, who had been evacuated, could be returned to their homes it was decided to close down the colony. We persuaded Mrs. Dike to keep it open a few months longer as a convalescent home for nearly one hundred of our children, who made no progress despite all the feeding and care we gave them.

Our next opportunity arose at Reims. Back in 1919 I had made the acquaintance of a Comité Britannique, attached to the French Red Cross and stationed not far from the military hospital at Compiègne. The director of this British Committee was a Miss Celia du Sautoy, an Englishwoman with a distinguished nursing career, who had been matron (superintendent) of a British nursing unit attached to the French during the war. Her associate, Lady Hermione Blackwood, was the daughter of the famous English statesman, Lord Dufferin. The friendship I formed with them leads directly to the nurse-midwife of the Frontier Nursing Service because in them I first knew women who were both nurses and midwives.

After the unit of the Comité Britannique had moved to Reims I went down there to see them. Although the glorious cathedral was not destroyed, only terribly damaged, most of the city even up to the cathedral walls was a shambles. Since the main purpose of the British Committee had been direct relief, and its funds were giving out, it had begun to close down its work. Word went out that the Reims unit would have to withdraw. But in Reims, the British Committee had French-speaking English nurses as well as relief personnel. The condition of the children, everywhere crowded into ruins and wooden huts, and the sickness among the people were such that the city of Reims held a meeting and commissioned Monsieur Guichard to offer, on behalf of Reims, free quarters, heating, lighting, water, and telephones if the British Committee would leave its nurses and continue to provide them with maintenance. To this the British Committee replied that funds were exhausted.

That was the situation when I went to Reims. I got a budget from Miss du Sautoy and ran back to Paris to see Miss Morgan and Mrs. Dike. I laid the whole thing before them, they saw it the way I did, and agreed to have the American Committee for Devastated France take over the Reims unit. I wrote my mother, "And thereby hundreds of little lives are saved. Sometimes when the longing for my own babies gets most unbearable, it does help me to remember that I can do for others what I could not do for my own." From that time on, the Reims nursing unit became an integral part of the C.A.R.D. I asked to have Miss du Sautoy made a co-director with me and left in complete control of the eight Reims nurses. These were placed in pairs in wooden barracks, given by the city, in the four sections of Courcy, St. Brice, Chalet and St. Nicaise. I asked to have Miss Walker made a third co-director. I wound up my requests with one for scholarships to send two of my English-speaking Bordeaux nurses (one of them Marcelle Monod) to the United States for study in American methods of public health nursing, and for travel and observation. All of this was granted me by Anne Morgan, the most wonderful chief that anyone ever had.

Early that autumn, Lady Hermione Blackwood went back to London to be near her family until after Christmas. She invited me to spend a week with her in November at her quaint little house in Chelsea, where she saw that I had a steaming tub of water to bathe in every night. She also introduced me to many of the leaders of the nursing world in London, midwives all of them, and magnificent women. Lady Hermione and I spent every day going through great hospitals like St. Thomas', poorhouses, district nursing centers, infant welfare centers, all of profound interest to us both. In the evenings, Lad Hermione's family were most kind to me. Her mother, Lady Dufferin, had me to dinner. To Lady Dufferin's beauty, charm of manner, keen mind, and courtesy, she added a quality I can only describe by saying she was gallant. It was a special joy to me to meet Lady Hermione's sister, Lady Victoria Braithewaite, who before the death of her first husband, Lord Plunket, had gone to New Zealand with him when he was governor-general. There she established the Plunket Nurses of whose work I had known for years. Lady Victoria took us to the place of all others that interested me most, the Mothercraft Training Center. It was Lady Victoria, as Lady Plunket, who had interested the famous Dr. Truby King in coming to London, with his two best nurses, to start this wonderful place where the Truby King methods of breast feeding babies were developed and taught.

In October of 1920 1 told Miss Morgan that I had to go back to America for good in the fall of 1921. About this I wrote my mother:

She and Mrs. Dike won't hear of my planning to have this my last year in France, which is kind, but I am sure my work will be on a firm basis. I would never leave things at loose ends, but I do want to be getting home after another year. Much as I love France I can't turn into a sort of Franco-American. My home is in America and so that is where I belong in the end. It isn't only that I get home longing very often, although I do, and that my place is nearer you and father as you get older, although it is, but when in the course of events I have fulfilled my purpose in France and rounded out my work and trained people to carry it on, then carry it on without me they should, and something else is mine to do back in my own land. I don't know what yet, but I dream dreams and see visions and tens of thousands of children, mostly very little ones, are dancing always across the visions and the dreams. 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. After all, two hundred years would count for something even in Europe and it has made me very much of an American. I love France like a friend, a dear friend, who has been cruelly beset and is brightly courageous, but the time will come when her need for friends becomes less acute, and then, thank God, America is home. Her I love as I love my dead.

III

It seemed odd to me that in France where the training of midwives was excellent, and constantly improving, the training of nurses should be neglected. In the United States it is the other way around. Over here one has to push the need for midwifery. In France, the push needed was for nursing. The word "infirmière," as commonly used in France, did not stand for a trained nurse. An infirmière might be a lady who during the war took a course on how to put on a bandage or and give a piqûre (hypodermic injection), or she might be a poor drudge under the Assistance Publique. Sometimes she was a health visitor without a nurse's training.

The patients in the great Paris hospitals, like the Charité and the Pitié, with their thousands of beds, were cared for by male and female attendants called garçons de service and filles de service. At night the wards were shut up like pianos. The patients who could stagger out of bed had to wait on those who were desperately ill. A French physician told me that lack of care at night in the military hospitals had led to the loss of many soldiers from secondary hemorrhages. How the French, with their intelligent minds and their brilliant physicians, could tolerate the lack of nursing care in their hospitals never ceased to puzzle me. I came to the conclusion that the reason lay in the immense political power of the employees, under the Assistance Publique who held the public hospital jobs. My first inkling of this came when I made my first visit to a Paris hospital.

The Salpêtrière accommodated four thousand patients, including insane, epileptic, feeble-minded, aged, and acute cases of all sorts. Within its walls are some of the old cottages which once formed a part of the village of Salpêtrière, now in the heart of Paris. The library of Charcot, one of the world's biggest men in research on the nervous system, is kept just as he left it, as is his laboratory with jars of brains preserved in alcohol. Some years before I made my visit, the Assistance Publique of Paris decided to found a modern school of nursing at the Salpêtrière. They built a beautiful house with single rooms, baths, a drawing room, and tennis courts. They outlined a good course of study and got, so I was told, a desirable group of applicants. They were about to open the school when the attendants of all the Paris hospitals struck. They said they would all go out at once if the school was opened. Their opposition was so vehement, and their political power so great, that the plan was abandoned. In place of it, a school of sorts was started for applicants who needed only to read and write and do a little arithmetic to be accepted. They obligated themselves to stay two years, during which they worked in the wards and received some instruction. I attended one of their classes. For this instruction they engaged themselves to work five subsequent years in the hospitals of Paris. But even if they failed in their lessons and had to leave the school, they might become attendants (filles de service) and carry on with the care of the sick poor. To this kind of school, which fed their own ranks, the employees of the Assistance Publique had no objection.

It was as obvious to Miss Morgan and Mrs. Dike as to me that the success of the Child Hygiene and Visiting Nurse Service that we had created in the Aisne was due to the quality of our Bordeaux nurses, whose basic training had been as good as that of the best nurses of England and America. When they spoke of it as a demonstration they realized as well as I did that it could not be widely copied in France unless modern schools of nursing could be established in the great public hospitals. Miss Morgan asked me to undertake, during my last winter and spring in France, an exhaustive study of the Paris hospitals and come up with a plan to establish a school of nursing in one of them. She, on her side, undertook to raise the money for such a school. Mrs. Dike introduced me to Madame Gervais Courtellemont, Surintendante des Infirmières du Ministère des Régions Libérées (Superintendent of Nurses under the Ministry of the Liberated Regions). Mme Courtellemont, a public-spirited French woman, but not a nurse, was convinced that neither the care of the sick poor nor the training of nurses to use later for district and public health work could be accomplished until we had a foothold in at least one of the Paris hospitals.

For months I spent a part of every week in Paris. I went through miles of wards, talking with attendants and the patients. Sometimes Madame Courtellemont was with me and sometimes I went alone. I wanted all the facts I could gather before I came up with a plan. Meanwhile Madame Courtellemont introduced me to the great physicians and surgeons of Paris. To sponsor our undertaking, we formed a committee of nationally known physicians. M. le Professeur Calmette, one of the directors of the Pasteur Institute, consented to take the chairmanship of our committee which we called Comité pour le Perfectionnement des Infirmières Françaises. Other distinguished medical names were those of Bezançon, Couvelaire, Delille, Guinard, Letulle, Nobécourt, Rist, Tuffier, Léon Bernard. We saw Madame Curie and asked her if she would come on our committee. She said no, because it would be her name only since she had no wards to give us, but she promised to give lectures in the school when we had it set up. I wrote my mother: "She was an interesting person to meet, just stepping out of her laboratory in a stained black and white apron, with her hair drawn back from her face and her hands trembling, as it is said the hands do of those who engage in radium research."

The surgeons and physicians on our committee suggested to us that instead of trying to get one of the vast hospitals we take over their own surgical, medical and pediatric wards scattered in several of them. They promised the fullest co-operation if we would provide decent day and night nursing under supervision. We all thought this a good idea and that the school building could be located at a central point. Monsieur le Docteur Marfan invited me to attend one of his open lectures and to visit his wards for sick babies. The hospital auditorium was crowded with physicians from all parts of Europe. Dr. Marfan had a number of sick babies brought to him, for demonstrations, while he talked. He handled them with great tenderness. When I went into his first ward where the babies were breast-fed, I thought it not too bad. Each baby had its own mother with it to take care of it. Then I passed into a ward with between thirty and forty bottle-fed sick babies. They were all being fed at once and the system was this. Two filles de service walked from crib to crib handing each baby a bottle or propping it against the baby's neck. Some of the babies were strong enough to hold their bottles, but it seemed to me that at least a third of them either made no effort to do it or let them fall. The nipples had large holes and the milk went down the babies' necks. Some of them swallowed the milk too fast and choked on it. So there lay the babies Monsieur le Docteur Marfan had diagnosed so well and handled so tenderly, starving to death. I knew what he meant when he told me how glad he would be to give his wards to our nursing school.

IV

When Madame Courtellemont and I had completed our study of the Paris hospitals and formed our committee, we sought an interview with a top authority, whose name I shall not give. We told him that physicians and surgeons on our committee said we could have their surgical and pediatric wards, of not less than six hundred beds, that Miss Morgan would finance a modern school of nursing, that all we asked was his permission to take over the nursing in the designated wards and be responsible for it day and night. He told us he would like to give his consent but that he did not dare. The male and female employees under the Assistance Publique, who were the attendants for the hospitals, were so numerous and so powerful politically that he could not risk their opposition., We pointed out that we would only displace a few of them, but the authority said they would know very well that when the camel's head got in the tent, the camel would follow. So that was off.

We were disheartened and discouraged because we knew a successful school could be established if only we had the hospital beds. I knew that the Bordeaux nurses, and a few French-speaking English and American nurses, experienced in hospital administration, could run it. I had also met in Paris a charming French gentlewoman, Mademoiselle de Joannis, who had taken a nurse's training and then established a small nursing school in the Rue Amyot. Unfortunately, it was not at that time a hospital school but Mlle de Joannis had succeeded in teaching her students the principles of nursing. She seemed to me just the person to direct the school we wanted.

Madame Courtellemont and I had failed in the first plan we put before Miss Morgan, for the same reason the Salpêtrière school had failed long before. We came up with the second plan. I was convinced from my conversations not only with the great physicians of Paris, but with many lay people, that a climate of public opinion could be formed powerful enough, even on the political level, to overcome the resistance of the employees of the Assistance Publique. Our medical committee agreed to co-operate with us towards that end.

The longing of the French to save the lives of their children was immense, and to me incredibly appealing. In their trained midwives the French had a competent body of skilled women for the care of the unborn and the young infant. They realized they had nobody to carry on where the midwives left off. The hastily formed groups of health visitors, with no grounding in real nursing, were the result of their efforts to reach the children in the towns and villages. The French did not see that the crux of the matter lay in their public general hospitals, even though it was in their public maternity hospitals that the student midwives received the best of training. Until the general hospitals had modern schools of nursing as good as the midwifery schools, not only would the care of the sick poor be shameful, but the nurses that might become the backbone of a public health nursing system could not be trained. In our Aisne and Reims demonstrations we had all the facts anybody needed to prove that the use of trained nurses in a visiting nurse service would save the lives of children. A gifted public speaker, who was a nurse, could bring all of this home in talks to groups of French men and women, through the press, through articles in the magazines, and in many other ways. Like all educational things, like everything that grows, this plan would take time but would come right in the end. When I put it up to Miss Morgan and Mrs. Dike, concurred but said that I was the one to do it. This led to the only disagreements I had with them. Not only was I not willing to stay beyond the time I had set for leaving, but I knew that the job could done far better by a Frenchwoman, and I knew exactly the Frenchwoman to do it. Marcelle Monod, so brilliant, so fine a public speaker, could take over when she came back from America and give her full time to the work even if it took years. I thought I had that lined up before I left France, but it fell through after I had gone home. The committee of distinguished physicians we had formed was allowed to lapse. Not long after, Madame Courtellemont died---my failure was entire, complete.

That winter, so much of it spent in Paris, was more exhausting than my first winter in the devastated areas. On the sixth of March I wrote my mother that I had just finished my long report for the annual meeting of the American Committee for Devastated France in New York, in April, and that I had to write another long report for the Director of the hospitals of Paris. I said, "I think I have walked through miles and miles of hospitals lately, such dreary, sad hospitals, with such unspeakable nursing. I am so tired, not in my body but in my head, which doesn't seem to be my head but somebody else's which I am carrying, around on a platter-like the daughter of Herodias."

There were pleasant interludes during this Paris experience which helped to make it bearable. Nearly every evening at six o'clock, I dropped in at the apartment of Admiral and Mrs. Magruder, warm family friends. My cousins, John and Isabella Breckinridge, spent a short time in Paris. With them, and with such of my colleagues as turned up, I often went to the theater. The de Reisets were always glad to see me. Mrs. Dike had me to dinner more than once to enjoy the society of distinguished Frenchmen as well as Americans. The French are so quick at repartee that you have to be on your toes to keep up with them. I saw something of old General de Maud'huy, who had a profound admiration for General Lee. He called him the modern Bayard, and was writing a small book about him. Since he did not own General Lee's signature, I sent home for one to give him. André Tardieu I met often. He presented me with a copy of his book, La Paix, with a message inscribed in it. Colonel Winship of the Reparation Commission, a Kentuckian, and Surgeon-General Blue of the United States Public Health Service had Mrs. Dike and me to lunch at an apartment where they were keeping house together. We teased General Blue about letting some lice slip by him, get to New York and kill a man with typhus. He protested that only eight lice got through, and they were on stowaways. He had a staff of men at every port just to keep out the lice and rats.

V

No dinners and luncheons with the French and with the Americans, no matter how delightful, could make up to me for the exhaustion brought about by my study of the Paris hospitals. When my Breckinridge cousins went Town to Cannes they invited me to join them for a bit of a holiday. I got a permission (vacation) of three weeks and spent it with them at the Villa Allegria, a place they had taken on the Route de Fréjus. My young cousin, Mary Marvin, was in her early teens, as I had been when I had spent my Christmas holidays at Cannes. I wrote my mother that nothing seemed changed on the Riviera after an absence of twenty-five years:

There are the same monks (or they look the same!) on the Isle St. Honorat, the same gorgeous hotels, semitropical foliage, the same little Scottish church, and the same curious creatures in the sea. There are even Breckinridge children playing on the beach---but it is the next generation, preparing to lift our work when we drop it and carry on after us.... Isabella and John have taken me in as one of their own household. Already the tiredness is falling away from me like a dark veil (I never liked veils, you know) and the restoring sun is giving me back my enthusiasms.

In another letter I wrote fully of the pressure brought to bear upon me to stay in Europe, to take on the vast task of creating a climate of opinion that would enable our French Committee to effect an opening for a nursing school in the Paris hospitals. I said:

Well, darling Mother, a decision has come to me and not of myself. Call it what you will---I feel it definitely and will follow it with the assurance that I am doing what is right. Sometimes we are blest with a clear decision. A reform of nursing in the Paris hospitals and through them in all France is not my job---not even the organization for it. I am fortified by this knowledge to resist all the pressure in Paris. I am to work directly for little children now and always---because that is the work I can do best, in which my health and enthusiasm and happiness do not fail. Some very special thing is waiting for me on the other side of the ocean (although I don't know what it is). I am absolutely sure that I am not the person for this larger work in France. It is an inexpressible comfort and relief to know this---know it as I know that I know it. I shall be home for good within the year.

 

Chapter 12

I

My letters from Cannes, in which I really let myself go, troubled my people more than I had realized they would. A shower of letters came back, urging me to come to The Brackens in Canada for a summer holiday. In reply, I wrote that "the director of a department of child hygiene in a great international committee can't jump in and out of Europe like a tennis ball." I reminded my loved ones at home that I had sent two of my best nurses to America on scholarships, and that they would not be back until the end of the summer. I told them that Miss Walker needed a vacation and that, in June, I was letting her go to New York to visit her mother. I could not leave until all three had returned.

Although we had a staff of twenty-nine nurses I could not spare even one that summer to act as supervisor for the Aisne area; I had to stay in France and run it myself. But my rest at Cannes, and the certainty that I need never tramp the wards of Paris hospitals again, had cured my exhaustion. I felt clearheaded once more and eager--this was just as well because a lot of threads had to be woven into a final pattern before my work in France was done.

In late May, I spent eight successive nights in: Vic, Laon, Reims, Paris, Rouen, Paris, Vic, Paris. A part of this time spent running around Robin Hood's barn was great fun. My cousins John and Isabella Breckinridge had turned up again in Paris. They asked me to drive with them on a visit to our Aisne units, spending a night at Laon, and then driving to Reims for twenty-four hours there. At that time we had a Hostess House at Laon. Here we found two of the C.A.R.D. Directors from America. It warmed my heart to hear their praise of our nursing service. "What have you done to the children?" they asked. "A year ago they were so pale and listless still, and now we never saw such hearty children. It strikes us the same in every village where we go." So the work of rebuilding France, not in monuments of stone but in the temples of the bodies of her little ones, had gotten far enough along to be visible to eyes which had seen the early ruins upon which we had to build.

The second night we spent at Reims, not in the little lodging house where I always put up but at a restored hotel, which included the rare luxury of baths. Reims was so horribly smashed that few buildings stood up. We invited Lady Hermione and Miss du Sautoy, who were living in the Hospice (an eleventh-century poorhouse), to come early to dinner and bathe first. They took us at our word and arrived armed with bath towels and soap.

My trip to Rouen was made with Madame Gervais Courtellemont, whose brother was the Préfet for the Seine Inférieure. His was a position somewhat similar to that of the Governor of Kentucky. Other large cities in his Department were Boulogne and Dieppe. I was eager to learn ever more and more about the things the French were doing to conserve their depleted population, and Mme Courtellemont was as eager to further my education. Among the places I visited with her in her brother's Department were excellent tuberculosis sanatoria (one for women, one for men), a preventorium for children, a home for abandoned children, a maternal canteen, a visiting nurse service at Rouen that had a real nurse at its head, Mlle Hervey, one of the best of the Bordeaux nurses. I also went over the old-world hospital of Rouen, where the nursing seemed not to have been bettered in four centuries. It was always in the public hospitals that one found the Achilles' heel of France. Although my twenty-four -four hours in Rouen were busy enough, I did take time to visit the lovely old church of St. Ouen and to dwell on memories of Joan of Arc, the sweetest and most gallant girl in all history.

In order to further Mme Courtellemont's education (we took turnabouts working on each other), I invited her to go with me to Bordeaux to attend the ceremony of the laying of the cornerstone of the American Nurses' Memorial building---given to the Florence Nightingale School of Nursing. This took place on Sunday, the fifth of June, 1920. The Maison de Santé Protestante, to which the school is attached, had given medical and nursing care to sailors for a generation, including hundreds of American sailors during the war. I suggested to Dr. Hamilton that her Board invite Admiral Magruder, the American Naval Attaché at Paris, to take part in the ceremony. This was done. When I had a quiet word with him, he said that not only would he go himself but be would send a destroyer to represent the Navy, and have five officers and fifty seamen attend with him. The ceremony of the laying of the cornerstone was deeply moving. When the names of our sister nurses, who died in the war, were placed by Miss Helen S. Hay in the stone, and an American bugler sounded taps, not many of us---French or American---had dry eyes.

II

I spent the three months following my trip to Bordeaux almost entirely in my beloved Aisne sector, where I had to run my nursing service without the help of even one supervisor. I moved to Soissons, where there was now a daily express to Paris, so that when I had to go there it would not take as long as from Vic. Aside from that reason for the move, our nurses in the canton and town of Soissons were our largest group and I was nearer Laon, the capital of the Department of the Aisne. I maintained the closest relationships with Dr. Lemarchal, and with Dr. Cavaillon, Chief of the Service de Santé (Board of Health). I had borrowed Miss Morgan's limousine and chauffeur the preceding summer to take both these men on a complete tour of inspection of our nursing work at all the C.A.R.D. units. I respected Miss Morgan's limousine. Whenever she made rounds in it, she picked up anything and anybody needing transportation. As she herself said, her limousine had carried everything but a cow.

It was an awful wrench to leave Vic, my home for more than two years. "Dear Vic," I wrote, "the nicest little town in Europe! It has given me so much more, so terribly much more, than I ever gave in return, even when my work lay mostly here." I returned to Vic for an occasional weekend before I went home in September, but I never lived there again.

When I moved to Soissons, Mrs. Dike gave me a personal bilingual secretary. Until then I had to write my long reports, and all of my correspondence in French and English, with such help as the Paris office and the secretaries at the units could give me. My French correspondence was so heavy that I really needed someone to whom I could say, "Please write such and such to so and so, and I will sign it." I had not asked for this luxury until now because I tried to run my nursing service as economically as possible. I had so much respect for the money people sent us from America that I wanted to be sure that every dollar of my part went into the nursing service itself, with the records of its work, and into the hungry mouths of our thousands of children. There has never been anything for which I have had more respect than the money given by charitable people. I know from experience that what you give, you go without.

It was my privilege that last summer to organize one more big thing for our French children. We were approached by a group of philanthropic Swiss people at Geneva who said that they would like to form a Swiss Section of the C.A.R.D. to aid the children of France The President of the group was a distinguished woman, Mlle M. Moulin. The Swiss made arrangements to receive our children at Geneva, as soon as their Section was formed. I got the first twenty off in July. Each child had to have a passport, birth certificate, medical certificate, vaccination certificate, a paper giving parental consent, Swiss permit de séjour and one or two other documents. The French railroads gave free passes to the children and the nurse who attended them. The Swiss met the children at the border and took over their entire care afterward. They placed them first in the Geneva hospitals for a real medical going over, treatments, and surgery if needed. After that the children went to Swiss homes all around Lake Geneva, where they were well fed and kept much in the open air. None of the services of the Swiss Section cost the American Committee for Devastated France anything, and some of the children were kept in Switzerland from six months to several years. In all, the Swiss Section cared for thirty-two hundred of our French children---a tender, charitable gesture from a small group of people to the children of a foreign country.

We had had a lot of scarlet fever and diphtheria in our villages during the winter. The diphtheria persisted into the summer. Just as I was finishing dinner one evening in late June, I got word there was a critical case of diphtheria over at Coucy. The nurse I had there, filling in for a vacation, was young and new to our work, so I went over at once---taking with me another nurse to relieve the one on duty. Twin babies of eleven months , a boy and a girl, had suddenly fallen ill but the parents did not send for the nurse until the morning. She went at once to find the boy just dead, and the girl battling for breath with the membrane covering her throat. Our young nurse and the nearest doctor-in the next county-took her to the hospital for a tracheotomy. They would not keep the baby at the hospital so the nurse brought it back to its home, with an oxygen tank and an order for stimulants. That was the situation when I got there. I took over the nursing of the baby (the oxygen, stimulation, and keeping the tube clean), while Mlle Laget gave serum to the other seven members of the family. We did all we could for our little one but towards eleven o'clock that night she gave up the unequal fight. When we had bathed and dressed her, we put her beside her brother. I wrote my mother:

There lay those babies, the day before in perfect health, struck as by lightning, and a broken mother who could not understand.... Always when I lose a baby, always while the fight for it is on, I seem conscious of another child in the room. The pale flicker of the lamp flame the other night seemed to shine like a halo above his yellow hair. When the baby died, I said, "Here, Breckie, take this little child. We have done all we could, now she goes to you." Nor do I doubt the welcome on the other side, for Breckie and I have a sort of partnership about babies.

The Municipal Council of the village of Coucy-la-Ville sent a most moving address of thanks to the C.A.R.D., in which they outlined all that we had done to re-establish agriculture, including the tractors we had given; our work in forming groups of boy scouts; our rehabilitation with food, clothing, beds---all the multifarious activities in which we had engaged. The last paragraph of this address of thanks I translate as follows

Finally, and this is the most fruitful work and the most worthy of praise, the C.A.R.D. has, through its nurses, its devoted, courageous and indefatigable nurses, fought disease and death which otherwise, under our conditions here, would have caused a large part of our population to disappear.

The summer of 1921 will be remembered in Europe as one of the hottest on record. This added heavily to the burden of our nursing work. There were lots of flies and the country had practically no sanitary arrangements of even the most rudimentary sort, as they were the last to be reconstructed. We bought mosquito netting to protect our babies, and encouraged people to put their food in garde-mangers (screened containers). I drew up a special report:

On the Mortality Rate of the Babies and Young Children
under the Care of the Nurses of the American Committee,
in Reims and in 103 Villages of the Aisne and the Town of Soissons,
for the Months of July and August, 1921
(during the heat wave)

Of babies under two years we had lost twelve per thousand babies. Of children between the ages of two and six we had lost three per thousand. It was hard.

Early in August we had a shocking blow in the form of an epidemic of dysentery in the commune of Blérancourt, including three adjacent villages, caused by the bacillus of Shiga. I find from my four-page official report that there was a difference of opinion as to the cause of the epidemic. The physician at Blérancourt, Dr. Fournier, thought that its origin came from an old graveyard where the Germans had buried victims of a similar epidemic in 1918. The bodies had recently been disinterred. On the other hand, the Departmental Director of Hygiene, our constant friend Dr. Cavaillon, who personally studied the ground, thought that while it was not possible to locate the origin of the first cases, the fact that one of the first had been the baker would explain the subsequent spread of the disease. The water was not contaminated. Our two chief difficulties in handling the epidemic lay in the disposal of excreta and in getting enough serum. The first problem we met by having a hole, a meter in depth, dug behind each house where there was a case of dysentery, lined with lime, and covered with a specially constructed cover made in our own workshop. We did this for the first twenty families affected, and then Dr. Cavaillon sent two men to take the job over and co-operate with us.

To get the serum was a graver problem because it lay beyond our power to remedy. Dr. Cavaillon said that the surest way to break up the epidemic was to give preventive doses of the serum to all exposed people. Not only could we not get enough serum for that, but often we could not get enough to give the maximum curative dose to the sick. None died who had the maximum dose within the first twenty-four hours. Those who did not get it were gravely ill for weeks, with subsequent prostration. We had 128 cases with 9 deaths, of which 7 were children. The reason for the scarcity of serum, as reported to us by the Pasteur Institute, in Paris, to whom we sent people direct time and again, was the unusual demand for it that hot summer all over France. Only a proportion of orders could be filled.

The work of our Bordeaux nurses at Blérancourt received the highest praise from Dr. Cavaillon. Mlle Dumon was the senior nurse; Mlle Eldin was her assistant. The third nurse I sent them for several days was Mlle Coste, one of our best, who knew the Blérancourt district. The nurses gave the patients sterile, normal saline solutions by hypodermoclysis. They worked far into the long summer evenings, until the light had gone, and into the night when need be, with a selflessness beyond all praise. One amusing touch should be reported before I close the account of this period of terrible strain. The village authorities wanted to be of some help, so they fumigated the library!

III

I took on only one trip during the summer. Early in July, before we got involved with epidemics, I went as a delegate to the English-Speaking Conference on Infant Welfare in London. Since my absence from France had to be of the briefest, I went by plane from Paris to London on a French air line called the Messageries, and returned from London to Paris on an English plane of the Instone Air Line. Kit, who had taken her vacations with Racky or Lummie in places like Venice, decided that she would fly with me to make a lark of it. She wanted to check up on the London libraries in preparation for her popular library in Paris. Commercial air lines were in their infancy then. The pilots had been war aces and were superb but the planes, with their inside wickerwork, looked like governess carts. The French one had room for only four passengers. The other two were a famous jockey and an English tailor, who carried a robe for an Eastern potentate to wear the next day at Buckingham Palace. The flight reminded me of the trip Alice made in a train, after she had gone through the Looking Glass, when she found herself sitting near a gentleman in white paper and a horse.

I thought the Conference worth the time and the money I had spent in going there. The London Observer of Sunday, July 10, 1921, called it "A Great Congress." They concluded a long article by their Medical Correspondent with words that seem as applicable today as they were then:

We are mammals, and therefore the mother is the natural saviour of the baby. There is not---never was, nor ever will be---anything that can replace the mother in the home.... Our mottoes for the future should be Back to the Home and Back to the Breast. It is an ancient and perdurable ordinance of Nature that for these there shall be no substitute.

IV

I had intended to return to America early in September on a Canadian boat, to meet my mother at The Brackens and to go South with her. Although this plan was close to her heart and mine, I gave it up when Miss Morgan asked me to go back with her on the Paris, sailing September 24, in order to discuss the hospital-training school plans. As things turned out, I needed the extra weeks in France. When Miss Walker and Miles Monod and Peiron returned to the Aisne, and I turned the direction of that nursing field over to Miss Walker, I had one last fling with Mme Courtellemont.

We had been working up a Comité d'Action Franco-Américain, to supplement the work of our distinguished medical committee. To serve on the new committee, we invited representatives from the nursing services of the International Red Cross and the Rockefeller Foundation, as well as from our own C.A.R.D. Miss Morgan and Mrs. Dike consented to hold high office, which was altogether right, as the C.A.R.D. was to put up the money. Mme Gervais Courtellemont took the hardest post, that of volunteer secretary. As a committee for the purpose we had in mind, it had points. To keep out of the political factions into which France was as split then as she is now, we chose people whose appointments were of a more or less permanent character. The top people rose and fell with dizzy rapidity. A committee on which they served would have had to be reconstituted every few months. Among ourselves we called our group "A Committee on Nursing Propaganda in France." I wrote my mother that the committee would arrange to give a series of conferences this coming winter (with Monod speaking), write articles, talk to people individually and persuade distinguished French men and women, planning trips to the United States, to arrange to visit some of our leading hospitals. "Out of this committee will grow the grain I have sown but cannot harvest. As a matter of fact, there have been many of us in the sowing, and others ahead of us whose footsteps we follow only." Such were my hopes then.

On my last fling with Mme Courtellemont, I made a visit to Camier, near Etaples, on the Picardy coast. The English built a hospital of wooden barracks there during the war. These the French took over and turned into a camp large enough to accommodate between five and six thousand children. The camp had two seasons of two months each; the first for girls from seven to twelve, the second for boys. Our visit fell in the boy season. Thousands of these children, all undersized and debilitated, had come from the great cities of the north---Lille, Roubaix, Arras. In squads of forty-five, they played on the sands under the direction of their school teachers. A corps of doctors and infirmières looked after their health. The food was excellent. With Mme Courtellemont I stayed overnight at the camp. My French hosts were exquisite in their courtesy as well as in their hospitality. The American flag flew over the Administration Barrack in my honor.

To my mother I wrote:

Rarely have I been more moved in a land where so much is moving than on the second afternoon at Camier, when we passed around the dunes and came onto miles of shining sand and glimmering water---a seashore like Tagore's, "of endless worlds where the children meet with shouts and dances." Scattered all over the beach they were, digging, gathering shells, listening to fairy tales, chasing one another, playing in the pools left by the outgoing tide. It was a shore for children ---no fashionable promenade, no ugly buildings---nothing but a glory of sun and sea and sand, and one German wreck that had washed ashore in 1914 and still bleaches there.

My last days in France had to be spent in Paris "on final work with Mme Courtellemont for our nursing propaganda committee and inducting my Monod into its bypaths," so I wrote in my last letter before sailing. On my good-by visit to Reims, I stayed in the poorhouse with my English friends. We talked far into the night. My last rounds of the nursing centers in the Aisne, my last visits to old friends near them, were to say adieu. My work in them and for them had ended. I made farewell ceremonial visits to the officials at Laon, among them my friends, Dr. Lemarchal and Dr. Cavaillon. "As we sped back over the familiar road from Laon to Soissons, across the Chemin des Dames toward the setting sun, the early autumn lay in the bits of yellow here and there in the living trees. But soon we were in the dead ones, which know no season, and mournfully stretch their sapless arms out to those of us who never will forget."

The Vic unit of the C.A.R.D. had a good-by party for me with toasts and songs. The songs harked back to the early days when I gave personal care to babies and children, before I got drawn into the net of administrative work in which I lost touch with the peasants. My good-by party at Soissons was a dinner given me by our nurses. They invited a number of my C.A.R.D. colleagues to attend, and Miss Morgan and Mrs. Dike honored us by coming down from Paris. Marcelle Monod had been chosen to make the farewell speech. She handed me the last part of it, written out like a citation, and signed by all the nurses. Because I treasure this more than any citation, I translate a few lines:

You cherished all our French children. You dreamed of the day when all of them, in country and in city, in mountains and on seashore, would be placed under the guidance of nurses . . . and we, your little army of nurses, we shall remember you as we carry out our daily tasks, forcing ourselves to follow in your footsteps, having learned from you that the most precious qualities are those of the heart.

The reason why I have covered my years in France so fully---the devastation where we of the C.A.R.D. went to work; the people of all classes with whom we mingled; the beginning of my nursing service for children and its growth; our search for a solution to the nursing problem of France---is not for old affection's sake, although that would be reason enough to me. But in this part of my book I try to tell of the things which prepared me for the work that lay ahead in the Frontier Nursing Service. Nothing better prepared me for this than my years in France. I learned then that it is wise to begin small, take root, and then grow. I also formed a habit, indispensable in new undertakings, of learning all I could about native customs so that new things could be grafted on the old. Finally, I gained a respect for facts---old and new---with the knowledge that change is not brought about by theories.

V

Early in October, I was with my mother, my gallant mother. With a heart at one with theirs, she had seen her four children volunteer for war. The youngest was still with the Army of Occupation in Germany when I went home. No matter to what parts of the world her children scattered they knew that she went with them, that distance was no barrier to love and faith like hers. To me, whose life had twice been shattered, she transmuted the sustaining power of her courage and her tenderness. After my long absence from home we had much to tell each other. We had long, quiet hours for a deep exchange of thought before she left me, in less than a month after I had gone back to her from France. On November 2 she passed "to where beyond these voices there is peace."