Constance Alexander: Never underestimate a woman with vision, connections, and a good horse

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With slightly less than 100 pages to go in my reading of “Wide Neighborhoods,” the autobiography of Mary Breckinridge, the book is a-flutter with sticky notes to mark memorable and amazing passages. Ms. Breckinridge — an old-world mix of true grit, southern charm, and keen intellect — founded Frontier Nursing Service, advancing the field of midwifery to a model of rural health care delivery in one of America’s poorest and most isolated regions of Appalachia.

Back in the 1900s, when Mary Breckinridge was coming of age, women in rural areas of this country had no access to health care. They ended up giving birth at home, with help from whoever was available. Relatives, neighbors, and untrained midwives often pitched in, but the quality of their assistance varied dramatically. For every 100,000 live births, over 800 resulted in maternal death, and 100 out of 1000 children died before their first birthday.

Mary Breckinridge (Photo provided)

Unlike the disenfranchised, Mary Breckinridge grew up in a prosperous family with ready access to the advantages of her birth. Granddaughter of Vice President John C. Breckinridge, she came of age at the turn of the last century, leading an active social life “filled with romance and adventure,” as she described it in her autobiography. There were parties and travels suited to well-born young ladies who, like herself, were marking time until an acceptable match was made.

Mary married in 1904 but was widowed two years later when her young husband died from a burst appendix. After that, she went to New York City to study nursing at St. Luke’s Hospital. When she finished her degree three years later, she returned to Arkansas to take care of her mother. In 1912 she married Richard Ryan Thompson, a Kentucky native who was president of Crescent College and Conservatory in Eureka Springs.

The path to Hyden, and Mary’s founding of Frontier Nursing Service was paved with loss. In 1916, her newborn daughter Polly barely survived six hours on this earth. Just two years later, Ms. Breckinridge’s beloved little boy, nicknamed Breckie, died of a massive infection at age 4. Stunned by the tragedies, Mary suffered from depression. When the marriage ended in divorce, she took back her maiden name and set out to do something useful with the rest of her life.

Toward the end of World War I, she studied midwifery in England, and went on to France when the war ended to give care to the sick. Stricken with the reality of war-devastated children, she wrote to her mother about one child, Solange Duvauchelle, who suffered slow starvation in the aftermath of the war. In her letter, Mary described the child as “the shadow of what she should be at ten months.”

“There are thousands of others like them,” Mary’s letter explained. “If I could give right now a goat to every family that has a baby, I think we could go forward saving many that are dying…I wish I had a thousand goats right now,” she continued. “I wish I had fifty.”

Mary’s family connections helped, as her mother sought gifts of twenty dollars each from friends and relatives, to purchase goats. The first carload brought twenty-nine and there would be more to come.

“To each goat we gave the name of the donor,” Ms. Breckinridge said in “Wide Neighborhoods.” True to her upbringing, she wrote back to each one, thanking them and providing the history of the children who received them. Thus began one of Mary Breckinridge’s tried-and-true strategies that helped create Frontier Nursing Services: She made connections with people who could help, provided them with information about the needs they could address with their contributions, and made sure that their efforts were recognized.

Despite her privileged background, Mary was fortunate to have grown up riding horses. Midwives could not have done their work in the mountainous region around Hyden, Ky., without that skill. In the early years of Frontier Nursing Service, Mary depended on her faithful horse, Teddy Bear, when making calls around her district.

In “Wide Neighborhoods,” she tells of losing a trail at day’s end, when snow began to fall.

“As night came on,” she wrote, “I decided the only way for us to get home was to start off in what we knew was the direction of Rockhouse Creek and just naturally go there regardless of obstructions. We came to a mountain so steep and so heavily timbered that it was impossible to ride down it. So, Teddy Bear and I just sat down on our haunches and slid. We went over a frozen waterfall and came down off a cliff into an open space. To our joy, we found we were on Rockhouse Creek. It was nothing, then, to follow the creek down to Hyden.”

Since March is Women’s History Month, it is a good time to learn more about this Kentucky woman of courage, and her autobiography is a great place to begin the journey. More information about “Wide Neighborhoods” is available at An article about Mary Breckinridge’s role in the creation Frontier Nursing Service is online at

Constance Alexander is a columnist, award-winning poet and playwright, and President of INTEXCommunications in Murray, Ky. She can be reached at Or visit

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