Mary Breckinridge: The Frontier Nursing Service and Rural Health in Appalachia

In 1925 Mary Breckinridge (1881–1965) founded the Frontier Nursing Service (FNS), a public health organization in eastern Kentucky providing nurses on horseback to reach families who otherwise would not receive health care. Through this public health organization, she introduced nurse-midwifery to the United States and created a highly successful, cost-effective model for rural health care delivery that has been replicated throughout the world.

In this first comprehensive biography of the FNS founder, Melanie Beals Goan provides a revealing look at the challenges Breckinridge faced as she sought reform and the contradictions she embodied. Goan explores Breckinridge’s perspective on gender roles, her charisma, her sense of obligation to live a life of service, her eccentricity, her religiosity, and her application of professionalized, science-based health care ideas. Highly intelligent and creative, Breckinridge also suffered from depression, was by modern standards racist, and fought progress as she aged — sometimes to the detriment of those she served.

Breckinridge optimistically believed that she could change the world by providing health care to women and children. She ultimately changed just one corner of the world, but her experience continues to provide powerful lessons about the possibilities and the limitations of reform.

Melanie Beals Goan teaches history at the University of Kentucky.