The UConn School of Nursing’s Dolan Collection was visited recently by the Weinhold family, long-time friends of a 1955 alumna, Barbara Ann Contessa Madgwick, who has donated a handmade crib from her days in Frontier Nursing. The crib was made by a local craftsman, Alonzo Sizemore (Hydon, Essex County, KY) of hickory saplings with woven hickory bark for the bed.

This beautiful and unusual item has been added to the permanent sickroom exhibit in the Widmer Wing atrium.

Madwick and the Weinholds have done the curator’s job for him by providing the following explanation:

Barbara Ann Contessa Madgwick earned her baccalaureate from UConn’s School of Nursing in 1955. Immediately after graduating she joined the Frontier Nursing Service (FNS) in Hydon, Kentucky, as a staff nurse.  Her duties were primarily home visits by horseback or by Jeep to families scattered throughout the hills of southern Appalachia, one of the poorest and most inaccessible areas in the United States.  She assisted at the FNS hospital in her off times or when she was on call.  A clinic was located on the first floor of the old stone hospital.  Maternity services were on the 2^nd floor.  The School of Midwifery was down the path from the hospital. (In the 50’s nurse-midwifery was not yet legal in most states so most of the midwifery students were training for overseas missionary work.) Staff nurses such as Barbara assisted the teachers with deliveries, post-natal care and home visits. The staff nursing team consisted of 4 to 6 young women supervised by a senior British nurse-midwife.

Poverty in that area of Kentucky was endemic. Many homes visited by Barbara and her colleagues were little more than shacks, lacking running water, electricity and indoor plumbing.  The largest medical challenges were chronic respiratory problems among the miners, a huge issue, and general malnutrition.

Toddlers and young children with disabilities were kept in cribs such as this one in order to protect them and keep them safely away them from the “far” (fire), either the open hearth or a potbellied stove.  Barbara remembers being sent into the hills to check on Jeannie, about 8 months old, for “failure to survive.”  Jeannie was kept in a crib like this one. Her family gave her Coke when she was thirsty. Children who were particularly vulnerable or fragile would be kept in the FNS hospital through the winter.  Such was the case with Jeannie.  Parents were comfortable with letting the nursing staff care for the children in this manner. Jeannie slept in a cardboard box while in the hospital and was carried around by the nurses who watched over her. Barbara recalls accompanying Jeannie by ambulance to a hospital in Cincinnati for evaluation and perhaps treatment.

Barbara commissioned this crib from a local craftsman, Alonzo Sizemore. Sizemore was the middle-aged maintenance man/ driver/jack-of-all-trades for the FNS and he made cribs as a side business. The crib is made of hickory saplings and the bottom is lined with hickory bark. This was important because hickory bark is impervious to moisture and thus resistant to decay caused by urine.  Sometimes a crib would be cushioned with a blanket.

The people of the area were very appreciative of the FNS—even if/when they frequently failed to follow medical advice.  In a region known for violent solutions to problems, and the sound of gunfire not unheard, the nurses were never in danger because their service and dedication were highly valued.

The FNS nurses wore uniforms, one for summer, another for winter. At that time the nurses were not encouraged to socialize or participate in local culture but they were always made welcome. They spent their free time cooking and singing hill country songs together.

Following her time with the FNS Barbara went on to be a Peace Corps Volunteer in Malaya (1961-1964), where she served on a yaws control team in rural and jungle areas. Here is where the young Weinholds met her (and each other). The latter part of her career was spent working in an early intervention program for infants in Loudoun Country in Virginia.

Mary Breckinridge established the Frontier Nursing Service in 1926.  Over the years the FSN lowered the maternal and infant mortality rate in southern Appalachia from one of the highest in the country to well below the national average.  Today the FNS still serves southeastern Kentucky, with a new hospital in Hyden, four rural health clinics, a home health agency and the FNS School of Midwifery and Family Nursing.  People have come from around the world to study this model of rural health and social service delivery.

 

Visitors to the UConn School of Nursing’s Widmer Wing atrium cannot avoid observing the Dolan Collection‘s permanent exhibit of an iron lung, a contraption that looks more like a small submarine than a medical device.

Donated by the Veterans Home and Hospital in Rocky Hill, the iron lung is technically known as a negative pressure ventilator (fabricated primarily of steel rather than iron). Weighing about 500 pounds the device was used to help patients with compromised lung function to breathe. The patients lay in the airtight container, with only their heads protruding while pressure inside the tank changed to manipulate the lungs into mimicking the mechanics of breathing, its rubber mechanical diaphragm doing what the patients’ diaphragms could not. Alumna Jean Petrov (Class of 1956) recalls manually operating the lever attached to the diaphragm when the electrical power went out.

Iron lungs were often associated with patients who had contracted polio, and some of our alumni from the 1950s were prepared to oversee the around-the-clock care of patients in iron lungs.

Until the introduction of the Salk vaccine in 1957, polio had reached fearsome epidemic status, with children particularly vulnerable (thus it was often called infantile paralysis). As alumna Phyllis Foley (Class of 1962) recalls, “I was a kid during the polio epidemics, and I do remember my mom (a nurse) warning and worrying about all of us, especially in the summer when we would go to the beaches in New York.”

Alumna Peg Hevel (Class of 1956) recalls: “Polio, a word during those years that created body shivers when spoken out loud. The words iron lung sent feelings of dread to the ears of family and friends. Emotions rippled that all was lost.”

For Mary-Lou Faubel Waite Simpson (Class of 1959), simulating the role of an iron lung patient during her nursing education provided her not only with skill but more important with empathy: “I will never forget the day we were required to be the ‘patient’ as our classmates transferred me from a gurney into the iron lung and locked it shut with only my head outside of the unit. Then they turned it on, under our instructor’s supervision, and I vividly remember the panic of not being able to breathe until I finally relaxed and let the ‘lung’ breathe for me. Each time I inadvertently fought the lung, it was very scary; I could not breathe! Eventually I learned to ‘go with the flow’ as the pressure the machine exerted was impossible to overcome. Along with that was the anxiety of not being able to escape the confines of the entrapment; I was locked in and totally dependent on my fellow classmates and instructor to get me out, which gave me absolute empathy for my future patients, mostly polio victims.”

Polio patients were not alone in requiring respiratory assistance, and Lou also recalls a “. . . young Yale student who attempted suicide by overdose. His respirations were so compromised and/or non-existent that he was ‘our’ iron lung patient for 6 weeks. We worked in pairs, one on each side, turning him every two hours, bathing him and providing skin care to prevent breakdown, exercising his limbs within the lung, and feeding him. The iron lung was one of the most memorable learning experiences of my life.”

Joann Griswold (Class of 1954) vividly recalls three patients in iron lungs for whom she cared. One was a four-year-old child: “We accessed her bedding and body through elasticized portholes, and this as I recall intrigued her; she would try to grab our hands. I realized that human contact was exceptionally important with a baby or child, and she certainly showed a positive response to holding my hand, and or my gently rubbing her forehead, and bathing her. Although rest was important, once her fever had subsided, she was able to do gentle exercises within the respirator to retain the musculoskeletal function she had. We had to closely monitor her breathing, because people with this type of polio mainly affecting the respiratory system could die suddenly, and because of her age, there was always a nurse or a student nurse with her. She enjoyed being read to, and with the respirator mirror we could show her pictures, which she also enjoyed. It was important to keep her calm so that her weakened respiratory system would not be further compromised by her crying, shouting, etc. We sang to her, talked, read, drew pictures, told stories.”

Joann also recalls caring for a nurse in her mid-20s: “As a nurse, she knew what was going on, and what her condition meant, that she would never again walk, use her arms, be able to do the things she loved, and very likely thinking about the change in the course her life would take. . . . Her care required one person on each side of the iron lung working through the portholes, freshening her, positioning her frequently to preserve her skin, caring for her IV. Her condition was so serious that we could not pull out her bed to change the sheets; we had to do that through the portholes. To lift an adult or turn one to change a sheet was very difficult, and of course we always worried that we might be adding more discomfort. . . . One day during a storm, the power went out and we had to pump the respirator to keep it functioning until power returned.”

The third patient was a young mother whose positive attitude seemed indefatigable: “She talked and laughed. Every morning she wanted her hair combed just so, and she would indicate which ribbon she wanted in it. Her makeup was applied to her satisfaction as she watched the proceedings in a mirror. Her name was Joan, and she would read because there was a way to position a book, and by holding a straw in her mouth she could use it to turn the pages. Joan spoke happily about her children and delighted in having many pictures of them around her.”

Peg Hevel vividly recalls and wrote a poem about one child for whom she cared:

“During my pediatrics rotation, I took care of a young girl with polio. She spent 24 hours each day in an iron lung. . . . I don’t recall the girl’s name. Memory’s picture is hazy, but I still can see her wan face, brown hair in two braids— one to each side of her face—on a small embroidered pillow from her grandmother. For me, the best way to tell you what I experienced being with this seven year old girl is through a poem.”

 

Child in an Iron-Lung

Fear with a disease unknown resides

In body darkness it creeps to paralyze

To a child’s question of seven

Mom says, It’s called polio.

Your new bed is an iron-lung, don’t be scared

Strangled crying erupts

Mother’s soft lips kiss forehead, eyes, nose and lips

Hush now,

I’ll always be here.

Questions swirl through this child’s mind

Slowly in halting speech to find

Why am I in this thing?

When do we go home?

Why does it make that swooshing sound?

My voice sounds funny to my ears– why?

Will you hold me now?

Tears slide down this child’s cheek

Hush now,

I’ll always be near.

A mother’s heart skips a beat as she says,

While you’re sick this machine will breathe for you.

Will I be alone when you go to sleep?

No dear,

someone will always be near.

That someone else was a student nurse,

me.

For the rest of my story, I will call this

young child “Amy.”

Each day began with attending to her physical needs

I prayed the touch of my hands would give her comfort

During her routine care, Amy would make up rhymes

like a favorite Dr. Seuss book.

I concentrated on her mental health with

reading books such as: Princess and the Pea, Velveteen Rabbit, Goodnight Moon

and Harold and the Purple Crayon.

I developed a game using crayons to draw circles, lines and dots on paper

Amy directed my drawing by saying,

top of page; center, dot, move right, circle

bottom, line to left— and so on.

When finished, the fun began by saying what our picture was;

sometimes we made up stories.

Her eyes lit up; mouth smiled wide

her musical giggles warmed my heart.

And so, monthly calendar pages fluttered by until

a new month where

Amy went home wearing a leg brace.

Tears of sadness and joy mingled as we all said goodbye.

I watched them walk down the hospital hallway.

Mom, Amy and Dad— hands entwined.

I murmured— Love.

Thank you, Amy, for teaching me that each life has its unique rhythm!

In addition to the vaccine’s eradication of the polio epidemic in the United States, the later development of the positive pressure ventilator that delivers air directly into the respiratory airway came to make the iron lung obsolete. However, nursing care continues to employ both high tech and high touch. The latest sophisticated health technologies still require humane, empathic nursing care.

For more information, see G. Chapman (2015, July 6), From iron lung to independence, O Say Can You See?: Stories from the National Museum of American History, (Washington, DC: Smithsonian Institution), http://americanhistory.si.edu/blog/iron-lung-independence

Santa Claus was good to the Dolan Collection in the person of his deputized elf, alumna Jane K. Dickinson, RN (PhD, 2000), who donated to the collection what she had received as a gift, the first English edition of Florence Nightingale’s Notes on Nursing: What It Is and What It Is Not, published in London in 1859. You can read more about this copy’s history and how Dickinson was given the book here: http://nursemanifest.com/2016/01/17/nursing-history-and-a-book/

The slender volume shows wear, but that wear signifies the many hands and the frequent use of its many owners over the past 156 years. Notes on Nursing is the generative text of nursing practice and research, distilling Nightingale’s experiences in a variety of settings and establishing the foundational principles for nursing education.

Nightingale’s book is still in print, as well as in a variety of digital versions, including Google Books, a Gnosis library version, a digital version provided by the University of Pennsylvania, and a Project Gutenberg version.

So why does a hard-copy material version still matter?

Paratexts

A book is more than the words supplied by the author; it has a material reality that surrounds and conveys the author’s text, including the typography and book design selected by the publisher, and, in the case of nineteenth-century books, the advertisements for the publisher’s other books situating this book within a discursive field. These supplementary materials are known as paratexts. Paratexts gave the readers at the time of publication a set of interpretive tools (for example, is the book to be read for entertainment, edification, education, or some combination of the three?), giving modern readers and scholars hermeneutic tools.

For example, the Nightingale first edition’s publisher (Harrison) featured advertising for a variety of topics, including heraldry and travel narratives, as well as medical works.

Marginalia

Throughout history, book readers have actively engaged in conversation with the books, highlighting and commenting on the words on the page, rather than just passively consuming them. Often found on the margins of pages, these marginalia provide us a window into the minds of previous readers of a particular book, pointing to what they found valuable or controversial in their reading.

For example, in our first edition a cryptic note has been slipped in between pages 6 and 7 on a scrap of paper: “[indecipherable] 1859-60.”

Provenance and Association

Related to paratexts and marginalia are the documentary evidence of previous owners (provenance) and previous owners of significance or renown (association). At its best, provenance documents a “chain of ownership” used to authenticate the object; sometimes the object is associated with a significant owner.

In our new acquisition, one owner has inscribed it: “Annie Bromley | March 26th 1880.” An Annie Bromley in Coburg, England, was married and having children at that time (The Bromley brothers, 2015). More distantly, Bromley (1911) identifies several Annie Bromleys in the United States, associated with Connecticut and Rhode Island.

Sales receipt documentation included also shows that the book was sold by book seller Donald A. Berry (“Specialist in Books on Economics, History, Science, Medicine and Periodicals) in London in August 1959.

The UConn School of Nursing has a personal connection to Nightingale. Our founding dean’s maternal grandfather, Cyrus Hamlin, was a Congregationalist missionary to the Turkish Ottoman Empire in the mid-nineteenth century whose bakery provided bread to Nightingale and her hospital patients in Scutari.

We are grateful to Jane Dickinson for this generous gift to a nursing history collection that began with the generosity of Josephine Dolan and has benefited from the thoughtful donations of many other alumni in subsequent years.

References

Bromley, V. (1911). The Bromley genealogy. New York: Frederick Hitchcock. https://archive.org/details/bromleygenealog00bromgoog

The Bromley brothers of Munro Street, Coburg. (2015, August 13). Fighting the Kaiser: Coburg and the First World War. http://fightingthekaiser.blogspot.com/2015/08/the-bromley-brothers-of-munro-street.html