By Mike Templeton
A long-standing source of inspiration for Appalachians everywhere, and for the Urban Appalachian Community Coalition in particular, is Appalshop. The education, media, and arts organization produces all manner of film, art, and music centered on Appalachia. They offer both hands-on education and educational materials with the work they produce. You could spend days getting lost in their archive of film, art, and music, and it is nearly impossible to keep up with all that comes out of their many works and project. Their short documentary films have focused on the heroism of the common in the form of people who sustain old ways of living in Appalachia, folks who keep up old Appalachian traditions, and films that shine a light on aspects of Appalachian history that might escape the dramatic stories we see like coal mine wars and feuding mountaineers. A Headwaters/Appalshop Production on the Frontier Nursing Service is one of those historical features that absolutely needed to be brought to light.
A short film produced in 1984 and titled “The Forgotten Frontier,” produced by Headwaters and Appalshop tells the story of Mary Breckinridge who founded the Frontier Nursing Service in Leslie County, Kentucky in 1925. Breckinridge led a team of women who trained as nurse midwives and served the most isolated and remote parts of Eastern Kentucky in the early part of the Twentieth Century. The short film (just over 28 minutes) is really a film within a film as the Appalshop production focuses on a short film produced in 1929 by Mary Breckinridge’s cousin, Mary Marvin Breckinridge Patterson. The elder Breckinridge is in fact the cousin of the younger’s father. As a young woman studying film in New York City, she was invited by her elder cousin to come to Kentucky and produce a short film about the work of the Frontier Nursing Service.
“The Forgotten Frontier” introduces us to Mary Breckinridge Patterson and Betty Lester, one of the first nurse midwives to serve with the FNS. Lester is originally from England. She explains that she first became acquainted with the FNS through a young woman who had come to England to pursue graduate training as a nurse midwife since there were no schools in the U.S. at the time that provided this type of advanced study in midwifery. Lester explains how she saw photos of Eastern Kentucky and fell in love with what she saw. The wildness of Appalachia captivated her, and she decided to come to Kentucky to take on her first professional assignment as a nurse midwife.
The Appalshop film bounces back and forth between contemporary interviews with Patterson and Lester, and segments from the old 1929 film. The older film is completely silent, It utilizes the old type of text cards to explain what was happening and even, at times, to provide dialogue. The 1929 film is unique in many ways as it is a documentary, everyone who appears in the film is in fact a resident of the area who was involved with the FNS. But it is also a dramatic production. Segments were staged using the local people to essentially enact themselves. Patterson explains that the local people were quite natural at appearing in front of the camera. None of them had seen motion pictures before since there was no electricity in the area, and they had not become self-conscious in front of a camera. She provide very little direction, and for the most part, people who appear in the film are simply being themselves.
One thing that did stand out is the way the gaze of the camera lets in more than the primary object under observation. When we shine a light onto something, we illuminate the object we wish to see, but we also illuminate everything around it. The 1929 film does precisely that as we can see the reticence of people and families gathered around the main object of attention. The wildness of the region becomes clear in the ways all signs of life are nearly engulfed in the raw natural world which surrounds it. Even a scene in Hyden, Kentucky reveals a town that has the appearance of something from mid-nineteenth century America rather than 1929. Dirt roads, ankle deep mud, wide rivers with no bridges, and mountainous terrain almost steal every scene. The grainy film and the way the exposure fluctuates the dark and light of a hand-cranked movie camera accentuate the roughhewn nature of everything in the film.
But we are continuously brought back to the subject at hand as the two main narrators recount their time making the film and their time with the Frontier Nursing Service. Betty Lester’s accounts are astonishing. She describes the deeply hands-on approach of the nurse midwives of the FNS who were not simply in hospitals, but were stationed, as it were, in outposts. Men would come to them when there was a woman in need, and the nurse midwives would go to these women on horseback through some of the most rugged terrain in the U.S. They carried all their supplies in saddle bags, and they administered to women in childbirth in their homes. Mary Patterson tells us that by the time the Appalshop film was being made, they had transformed the area from having the highest maternal death rate in the country to a place where they had not lost a woman in childbirth since 1951. All of this because of the way these nurse midwives took care of women before, during, and after childbirth. And they did this in a region that had no electricity, no running water, no roads, not bridges—it was quite literally a frontier in Appalachian Kentucky.
Again, the Appalshop production reinforces all of this by splicing in text cards from the 1929 film with the narration by Patterson and Lester. While Patterson cites the vast store of medical data they acquired and archived, we see the very moments when this information was unfolding not as data but as very real moments in the lives of the people who lived it. We see nurse midwives embedded in the families and communities in these rural areas. They built life-long relationships, and this is directly tied to the ways people’s health and lives were transformed by the FNS. In addition to administering to births, the nurse midwives brought inoculations to the region at time when they were still being ravaged by epidemics of typhoid and small pox. They became such a part of these peoples’ lives that they children themselves reminded the nurses about booster shots. The presence of the nurse midwives became so ever-present that it became common for very young children to believe that babies came from the midwives’ saddlebags. No need of the stork mythology.
Appalshop’s film within a film accomplishes something quite rare by creating historical continuity with the splicing of a film from 1929 into a contemporary documentary, and by revealing the thread of community that persists into the present day. A young boy who appears in the 1929 film volunteering for his inoculation is revealed by Patterson to be a physician in Western Kentucky today. The communities of Hazard and Hyden are at the center of everything, and we are constantly reminded of how the growth of these towns is tied to the work of groups like the Frontier Nursing Service. Of course, at the center of both films is the living memory of Mary Breckinridge Patterson and Betty Lester. It is Betty Lester who tells us that the motto for the nurse midwives was, “If a man could come to the nurse, the nurse could get to the woman.” This was the official motto, but toward the end of the film, Lester reminisces on how things were done in those days and in that part of the world and says: “Everybody helped everybody else.” I would venture to say there is much to be learned from this unofficial motto. As we head into uncertain and potentially difficult times today, we might need to return to simple ways of doing things that are maybe not quite as simple as the down-home language would imply. Becoming actively engaged and involved in small communities was the guiding principle of the Frontier Nursing Service. It may well become the means toward a meaningful co-existence in our near and palpable future.
The historical and cultural preservation work done by Appalshop helps sustain similar work by the Urban Appalachian Community Coalition. The network of historical documents maintained in UACC’s own library is fed by things like this film, and UACC works to help feed this kind of work. “The Forgotten Frontier” provides such a singular window into Appalachian history, and it reveals the ways women built Appalachia, in this case, literally from birth. One may wonder if we are all looking up toward the big stars of history, when we would find the most important heroes of our history in people like Mary Breckinridge and Betty Lester. Saving women’s lives, bringing children into the world, and caring for people all their lives, these are the people to hold up as paragons of who we can be. Unfortunately, the Frontier Nursing Service chose to leave Hyden and Leslie County in 2018 to continue in the form of Frontier Nursing University in the Bluegrass community of Versailles, Kentucky. FNU still trains nurse midwives, and they still maintain community engagement as a central feature of their training programs.
“The Forgotten Frontier” can be viewed on the Appalshop YouTube channel at this link: https://www.youtube.com/watch?v=9oruiiHh4kU.
More about Appalshop can be found at this link: https://appalshop.org/.
Michael Templeton is a writer, and independent scholar. He is the author of The Chief of Birds: A Memoir published with Erratum Press and Impossible to Believe, published by Iff Books. He is also the author of Collected Apoems, forthcoming from LJMcD Communications and the awaiting of awaiting: a novella, with Nut Hole Publishing. Check out his profile in UACC’s Cultural Directory. He has published numerous articles and essays on contemporary culture and works of creative non-fiction as well as experimental works and poetry. He lives in West Milton, Ohio with his wife who is an artist.