A visit to Scotland is often enjoyable. Sometimes it can be life-changing. In September 1924, an American nurse, Mary Breckinridge, arrived at the Edinburgh headquarters of Queen's Nursing Institute Scotland (QNIS). She was given a list of names of nurses and off she went to see how the Highlands and Islands Medical Service (HIMS) might prove a model for a nurse midwife service she was planning in the mountains of eastern Kentucky.
HIMS was a unique social experiment set up in 1913 to meet the needs of crofting communities where services were poor or non-existent. They had been excluded from the 1911 National Insurance Act which covered regularly paid workers. State funding for HIMS (£42,000 a year) was distributed to local authorities and nursing associations to pay for basics like a telephone, house, or motorcycles.
Breckinridge chronicled her six-week trek in her memoirs. She described Lewis as 'like no other part of the planet', where she was greeted with unending kindness by families living in the traditional black houses – people sharing the same roof as hens and cows. 'But I will say this for the black houses – they were the only warm ones I found in Great Britain,' she remarked.
Eriskay had no doctor 'but a splendid Queen's Nurse-midwife, Miss Martin, in whose work I was keenly interested. Her nearest physician, on South Uist, could reach her on call when the seas were not too high'.
Benbecula had its hazards: 'The nurses… visited some of their patients on bits of islets, fordable at low tide only. They tried to make their crossings then, to save boat hire, and often ran into danger from the incoming tides and from the quicksand. Their work was heroic'.
Barra, with all its beauty, had one road which had never seen a motor car. The doctor got round on a horse.
On South Uist, she did not heed an old woman's advice and went on to climb Ben Kenneth, became caught in the mist and got lost. The old woman went to her rescue and brought her in for tea, a scone and a warm fire. Conversation was limited – the old lady only had Gaelic. She then hitched a ride on a cart northward to meet the resident nurse midwives: 'North Uist had four of these wonderful women and a doctor – all under the Highlands and Islands Grant and with keen local committees'.
At Tarbert, she met Miss Maclean who served 18 scattered villages working with Dr Ross against the elements: 'The winds were so terrible that bicycles were almost useless, and they had to walk miles over the moors to reach their patients'. The visit was a true epiphany. Breckinridge did not witness examples of extreme poverty apart from children on Eriskay lacking warm clothing. Back in Edinburgh she blitzed the shops in Princes Street to buy them woolly jumpers. She became good friends with Scotland's chief medical officer, Sir Leslie Mackenzie, and his wife Helen. He had been a leading light in establishing HIMS.
Back in Kentucky, Breckinridge set up the Frontier Nursing Service (FNS) based on its Scottish big sister. Both were highly unusual for that time: organised and staffed by women, serving women and children in remote communities, based around highly qualified Queen's Nurses who, by necessity, had to demonstrate considerable professional autonomy.
One bloke did have a key role: Sherlock Holmes. Or, more precisely, the Edinburgh surgeon Joe Bell who provided the model for Conan Doyle's detective. As QNIS vice president, Bell had insisted on three years' hospital experience before nurses could train for district work, midwifery, and health visiting.
Also unusual at that time was that the FNS was built on a firm evidence base. This was provided by Miss Bertram Ireland, a researcher recommended by the Mackenzies for similar work she had previously conducted in the Western Isles.
There was just one flaw – America had no training schools for midwives. Instead, British and Americans who had trained as nurse midwives in the UK were brought in – lured by Breckinridge's advert promising adventure: 'Your own horse, your own dog, and 1,000 miles of Kentucky mountains. Join my nurse brigade and help save children's lives'.
The Mackenzies came over a special guests to open the first FNS hospital at Hyden – greeted by Ann Mackinnon from Skye, one of the first British nurses. Breckinridge's family originally came from Angus. She and Sir Leslie waxed lyrical about the bonds of kinship uniting Scotland and Kentucky.
Lest the spectacles become too rose-tinted, this was an all-white world. Breckinridge's views on race were exactly those you would expect from the granddaughter of a Confederate general. Scotland also had a questionable role in the American Civil War, possibly prolonging it by at least a year through Clyde shipowners providing blockade runners that kept the Confederacy going.
Later nursing links were not all one way. On holiday in the USA in 1913, Elsie Inglis found her model maternity hospital in Muskegon, Michigan. War intervened and set out a different course for her with the Scottish Women's Hospitals. In 1946, Elsie Stephenson gained a scholarship to study at the University of Toronto, a pioneer in nursing degrees and put this into practice later as the first director of nursing studies at the University of Edinburgh.
The FNS thrives today as the Frontier Nursing University as does the QNIS in training Queen's Nurse leaders. They can be found leading change at the sharp end of care all over Scotland: supporting refugee mothers, victims of domestic abuse, those struggling with addiction.
The nursing pioneers were also captured by the first female film makers. Mary's cousin, Marvin, made The Forgotten Frontier
in 1931 to promote the FNS, and Kay Mander produced Highland Doctor
in 1943 on the HIMS. Newly released is Chelsea Gorham's documentary Angels on Horseback – Midwives in the Mountains
which you can watch here
Chris Holme is a former
Herald reporter and Reuters Foundation fellow in medical journalism. He now runs the History Company