Oral History Interview with Mary W. Duncan

Interviewer: The following is an interview with Mrs. Mary Duncan in her home in Lexington, Kentucky. She was a public health nurse for the Red Cross during World War I. And for one year on a special scholarship in Wayne County, after which she served twenty years as a public health nurse in the health department. [pause] This is an electronic age.

Duncan: Well…

Interviewer: You went there when, Mrs. Duncan?

Duncan: In 1922. And I went from Louisville because the Red, the Red Cross was offering some scholarships. See, it was public health scholarships to nurses who had been, well, I don’t know who they offered those scholarships to, but I was a nurse in World War I. And I was a Red Cross nurse because at that time all of the auxiliary help, nursing help in the army were Red Cross volunteers.

Interviewer: That’s the period when Mary Breckinridge was in the, didn’t she serve in the ambulance service or something?

Duncan: Well, I don’t know her history very well because I’m not a Kentuckian.

Interviewer: I see.

Duncan: I resigned from the army after I returned to the United States from France and Germany after World War I. I was serving in the army at Fort Knox. While there, I decided I didn’t want to spend my life as a military nurse in the United States Army. So I resigned at Fort Knox. Well, Fort Knox is very near Louisville. So in order to get a job, I naturally applied to, I had public health nursing in mind. And although, of course, I was not trained specially for that, I thought I would like it. And so I went to the Visiting Nurses’ Association in Louisville, and got a job as a visiting nurse there. And it was there that they told me about the Red Cross offering these public health scholarships to nurses. Who, it was a year, it was a year of study at the University of Louisville. And I forget now what they paid me. But they paid me enough to maintain myself for that length of time. And, but we had to agree to serve at least a year in the Appalachian Mountains section of Kentucky after we graduated. So when I graduated, I accepted this job in Wayne County as a public health nurse. Well, I think the Red Cross organization down there had some money left over and it was suggested to them that they employ a nurse who would do rural public health. And they could use that leftover money they had collected during the war for more, I guess, some kind of war purposes, I don’t know. Well anyway, I know that they bought a car and I was given, they didn’t give me the car, but I had use of their car. And they paid my salary. And I was provided with an office of some sort, you know. But I had to organize, I was completely on my own about what I was to do. Well, from my public health course in Louisville, we were, I was sort of outlined as to how to proceed. And with the help of the local doctors there, and the people, I, well, let me see what I did. I know I examined school children. That… and of course mainly it was minor, minor things like, you know, scabies and head lice. But, and of course throat. But of course naturally I discovered serious conditions, too. There were crippled children. At that time, at that time, it seems there was no place to get help for these crippled children like there is now. There was no health department there. And there was no health officer or anything. I was completely on my own. And of course I discovered cases of cancer. If they were people who were, could pay for it, they would go to Lexington or Louisville and get some special help. But most of the people couldn’t go anywhere. And of course they just, and there was no place to send them where they could get help. They just simply went on and died. Many, many. And, of course, all of the doctors there did home deliveries. Almost all, since there was no hospital there, all of the babies were delivered at home. But I did not deliver any babies. I was not trained to do it. Since the doctors all would do home deliveries for families who could pay them, I did not feel that, I didn’t branch out into home delivery. Because in addition to the doctors, there were midwives in every, in every area were midwives. Some were, well, none were trained, but some were quite competent. And they understood the importance of cleanliness and so on. And others were not at all. And of course the birth rate was quite high. And, well, to cut a long story short, I stayed there, let me see, I stayed there about a year. And then the money that the local Red Cross chapter had accumulated had run out. And in order to stay longer, we would have had to put on a, you know, a campaign of contributions from everybody and so forth. And I didn’t want to, I didn’t want to become involved in anything like that. So I told the, we had the Red Cross nurse from Louisville who would occasionally, I think she was just in Monticello one time while I was there. But anyway, I told her that when their money ran out, I did not want to stay. And so she, she said they had a, they had a vacancy in Woodford County. And, which was an entirely different environment and so forth. And if I would consider that, she would have me transferred there when my year was up in Wayne County. So she did. so I went to Woodford County. But that was not my sole experience in, I became engaged to this lawyer in the course of this, my year in Wayne County. And of course considered getting married. But it took, it took three years. We finally did, and I went back to Wayne County. Well, there was still no health department there. And I really don’t know what condition the public health was in there. I guess very much like it was when I left. And let me see, I married in ’25. And then my son was born and I decided, well, there was, there was no job, no nursing job in Wayne County at all, until World War II came along. Well then, everybody became very, I don’t know, very health-minded. Or maybe they had some more money. I don’t know. Anyway, they hired a public health doctor, Dr. Roberts. And maybe you’ve met him.

Interviewer: I’ve interviewed him. Yes, he’s a fine person.

Duncan: You met him. In Wayne County, I did not work under him, but he preceded Dr. Kelsay. Did you−

Interviewer: I interviewed him, too.

Duncan: You interviewed him, too. He preceded Dr. Kelsay. Well, I stayed, I stayed at home and did not practice until, let me see, 1942. And then there was a vacancy in the health department in Wayne County. And they were, they were wanting a nurse very badly and I heard about it and applied. And went back in the public health field. That was after an interim of about seventeen years that I hadn’t practiced. And then we had a health officer. And the health department was under the state health department. We had one nurse and a clerk and the health officer. I think that the staff was comprised of the three of us. And the health officer helped to make out a schedule. Which was visiting all of the schools during the school year and examining them. And giving, giving typhoid and diphtheria and tetanus, typhoid, diphtheria and tetanus shots to all the children who had, who did not have it, and that was practically every child. Because until that time, there had been no program of preventive vaccination in Wayne County. And typhoid was very, very rampant. I mean, every year, they would have many cases of typhoid. And not diphtheria. Although I guess they could have had that epidemic at any time, but I did not encounter it. But we gave diphtheria and tetanus shots anyway. And typhoid. Well, and of course these bad throat conditions that I saw so many of. But there was no, there was no way to help them. We did not have a surgeon who did tonsillectomies. And I suppose some of the children of the wealthier people were taken to Lexington or Louisville for tonsils, I suppose. But I dealt mainly with the more or less indigent families. And during, from 1942 to ’45, we were very much involved in sending soldiers into service. And we did the primary screening. And every week we would, I don’t know, I think there’s two days a week, we would screen just a lot, a lot of, well, I think the health officer worked with the draft board. And they would send all of their draftees to us. And we would look them over first. We would take blood tests of everyone for syphilis. And because those, those who came back positive for syphilis test were not sent. And those who were obviously mentally unfit were not sent. And those who were badly crippled, for instance, were not. And those who were blind or deaf or otherwise, any, anybody without any special, we’d just eliminate them. Well then the other draftees were sent on somewhere. To Louisville, I think. Anyway, they were sent in large numbers on certain days for further more detailed tests by other doctors. And then they were either sent back home or they were taken into the army. So until the end of the war in ’45, we were mainly occupied with that. After that, then we changed our program. And I guess Dr. Kelsay told you about what our programs were at that time.

Interviewer: Yes. Right. That’s a tremendous story. I wish I’d brought my good recorder. One person I’m trying to find out about it − let me see if that recorder’s still on, yeah, it’s on− is Dr. T. Do you remember anything about him? He seemed to have some innovative programs, particularly with the midwives in his tenure.

Duncan: But he didn’t stay there long.

Interviewer: Just a year or two, I think.

Duncan: Yes. He, and what year was he there?

Interviewer: I think he preceded Dr. Roberts. Probably 1931 or ’32.

Duncan: Oh, did he? Oh. Well, that was before I went back into nursing, see. So I knew he was there, but I didn’t know, I don’t know anything about his program. And I know that he soon left. He really wasn’t there long. Did you talk to him?

Interviewer: Oh, no, I wish I could. He’s not living.

Duncan: Oh. He died.

Interviewer: He went on to larger things. I think he went to Johns Hopkins in public medicine and preventative medicine. And then he later, I think, became commissioner of public health in the state, later on.

Duncan: Yes, that’s true.

Interviewer: I’ve gotten the impression that he had a very innovative program, and I’d like to find out more about it.

Duncan: Maybe he did. But I was not the nurse, I was not the nurse at that time. And I don’t know anything about it.

Interviewer: You were nursing, you were nursing your own children. In the home.

Duncan: Yes. Yes. I, I don’t know what they were doing there. But what was he interested in?

Interviewer: He was interested in public health medicine. He had, I know I’ve seen a photograph of the group of midwives that he was training. I’m trying to find that photograph. I’ve seen it. Dr. Kelsay had it in a little pamphlet. I’d like to find out more about that period. Seems like they may have had a little more money and could exercise a little more programming.

Duncan: Well, maybe so. I was expected to sort of supervise midwives. Well, in a county the size of Wayne County in those days, when the roads were very poor, you know, and there were, I don’t know how many midwives. Do you have an idea of the number of midwives? How many were in that picture with Dr. T?

Interviewer: There was only fifteen or so there. But I have gotten the impression through interviewing people, I’ve been in some of these areas that you went into, among the poor, rural people. And I have just intuitively, I sensed there must have been an enormous number of them there.

Duncan: Well, there was. People couldn’t pay doctors to come, you know, miles and miles over those roads. And they didn’t have the money to pay them, anyway. And midwives just kind of evolved out of mothers and grandmothers and aunts and women who were in the neighborhood. Had perhaps delivered a woman and everything went all right. And then the next woman called her and so on, and pretty soon she was a midwife. There was no, well, my supervising them, I visited them. And saw what they had in their bag. And stressed the importance of cleanliness. Because tetanus was a great hazard, you know. As well as infection of the mother. They did not realize how, why they shouldn’t insert their hands into the vagina and manipulate the baby and things like that. Outside of teaching them that and seeing that they had the very minimum of equipment, like scissors and tape, and teaching them about the necessity for boiling everything they were going to use, and wash their hands, and things like that, that was all my supervision consisted of. And, of course, the birth records. I had, I had to stress the importance of their reporting the births. And what they had to put on that birth, you know, show them the birth record and the things they had to find out at the time and put on there. Showed them how to fill it out and so forth. And if they couldn’t do it themselves, they could find out all the answers and when they came in, someone would help them do it. And so our health department started− did you go into the birth record history?

Interviewer: I have done that. Not yet. I…

Duncan: I don’t know just when that started.

Interviewer: I think they started, I’ve read this out of secondary material, I think that the death records started first. And I think the birth records didn’t start until 1918 or so. 1918, ’19. So it was really close.

Duncan: Maybe it was under Dr. T. Maybe Dr. T started that. Anyway, it was very new when I went there.

Interviewer: Well then that would be prior to Dr. T, though. That would be prior to Dr. T. It started with you is who it started with, really. Must have been. It might have been a little earlier.

Duncan: No, I didn’t go there until ’22. And you see, Dr. Kelsay was already−

Interviewer: You’re getting your time mixed up.

Duncan: I see. [laughs] I guess that’s right. The first time I went there, there was no health department.

Interviewer: That’s right.

Duncan: It was only when I went back. And there still was not any till I went to work in ’42. Well the health department was actually organized and established there. Was T the first health officer?

Interviewer: No. They had a lot of health officers before him. But it was not really a full time job. They were doctors that did this kind of on the side.

Duncan: Already practicing there. Oh, yeah, that’s right. There was a Dr. Young that was doing that when I first went there.

Interviewer: Do you remember him? He’s an interesting character.

Duncan: Yes, I remember Dr. Young. That’s right. I’d forgotten. He did sort of, mainly keeping death and birth records. People would report them to him, but they were very incomplete. That’s right. I’d forgotten. They had that type of health officer. And what he did, actually, I don’t know. He didn’t attempt to help me plan a program when I went there. He was, he had a private practice, country practice. And in addition, he was supposed to be a health officer. But what he did, actually, death and birth reports, they took them to him. But did he keep them in his office? Or in the courthouse?

Interviewer: Probably.

Duncan: Did you ever see any of these old records?

Interviewer: No, but I’m going to. I’ve seen some. Elizabeth had some, and she showed me some. And they’re very interesting, very interesting. And I found out that, it might jog your memory a bit. It seemed that the system was for indigent care in the early years, a doctor would report that this family needed matters, substances, or they needed, whatever they needed. They were put this in the fiscal court. The fiscal court would allot a little money to do that. Or the doctor would do it. And then they would pay them.

Duncan: Oh, I see.

Interviewer: That’s an interesting system, and I want to get into that. I’ve heard that that was the old, traditional, conventional way of doing it. And I hear that the “health officers” earlier, in quotes, that’s sort of the role they played. They kind of were the contact with−

Duncan: They were supposed to take care of the poor and the fiscal court paid them for what they did.

Interviewer: I don’t know yet. As I interview more people and look at the records, I think that, it’s beginning now, the system is beginning to crystallize. But it’s people like you who can help so much. You have helped so much already.

Duncan: Well, I don’t know. Thinking back, after World War II, of course there was typhoid fever in the county. Just about the way it was when I went there in ’22. And people knew it was contagious. And they knew it came from bad water, too. I mean, they knew it came from contaminated water, I think. But there was no way of that they knew of avoiding it. And of course I didn’t, either. Of course, you could teach, you could go in the home where there was a case of typhoid and you could tell the family, “This is infectious and the rest of you can catch it. And the way you catch it is by putting germs, getting the germs on your hands or on the food that you eat, and putting it in your mouth. And wherever he got it.” And of course they had their own ideas about where he got it. Maybe he got it from another case where he’d been, you know, visiting or something. Or maybe they would attribute it to a spring. Well, all I could tell them was about the hand washing. But all the linen on their bed, the boiling. And keeping all of their dishes separate and things like that in order to prevent the spread to another member of the family, or someone taking care of him. But even so, there were many cases of spread from one person to another. And I presume there were carriers, too, you know. They would suddenly come up with a case, they had no idea of where they got it. Well, they had caught it from a carrier, someone that had carried it for twenty years and spread it around. Well, my main hope, and I knew that it was not in− it’s going to be awfully hot in here if we don’t, if we don’t keep that open. So we concentrated on typhoid immunizations. And I gave thousands and thousands of typhoid immunizations. We gave them free to anybody who came to the health office. And of course all members of all contacts of cases, we’d get them. And all school children got them. The regular three-shot, you know, so they were safe. And typhoid − in my, in my regime there, which was twenty years, I worked from ’42 to ’63 − typhoid disappeared completely from Wayne County. In fact, they were talking then, “Well, it’s not necessary to give typhoid shots because we never see a case anymore.” And that is true. I guess now they don’t give it. And of course the smallpox. I would give smallpox. But I think there was one diagnosed case of smallpox that I saw. They said it was smallpox, and I guess it was. And then there was tuberculosis was another big scourge of the time. And of course it was throughout the state. These big TB hospitals were built around the state. The one nearest us was at London.

Interviewer: One in Glasgow, too, didn’t it? Or London, right?

Duncan: Yes, but London was the near, was the one we were supposed to take our cases to. And everybody that would agree to go, of course they were not, I don’t think they were forced to go. But that was their only hope was to go to these hospitals. And once they went there, they had to stay about three years, you know. It was before, before streptomycin came on, came along. And many of them died anyway, despite the fact they were in the hospital. But there they had the opportunity of complete isolation and complete rest, which they could not get at home. In most cases, they could not get at home. And then, I don’t know, I don’t know when streptomycin came along, but it was after, I think it was after I left−

[35 minutes]

[End Tape 3, Side A. Begin Side B.]

Interviewer: Certainly. You need a little time to think about it.

Duncan: Well, to review work that long ago, [laughs] it’s hard to do.

Interviewer: Sure.

Duncan: But I remember the things, I remember that we had tuberculosis. That was one of our great scourges. And it wasn’t until after streptomycin came along that very much, a very great difference was noticeable.

Interviewer: Scarlet fever seems to have been among, they talk a lot about it being so horrible.

Duncan: We had scarlet, yes, we had scarlet fever. Scarlet, scarlet fever, of course, many children died of scarlet fever. But it was a, it was a childhood disease. Early childhood. The children that I saw that died of scarlet fever were all, even preschool age. But the antibiotics took care of that. Just as soon as antibiotics came, then scarlet fever was whipped. Because the doctors had something they could work with. And they diagnosed it and gave these antibiotic shots. They had that.

Interviewer: How about whooping cough?

Duncan: Well, whooping cough, of course, was rampant. And they had the, they had the whooping cough antitoxin, too, I think, then. So I didn’t see any deaths from whooping cough. And whooping cough is not considered a fatal disease. It was something like measles. It was a bad thing to have, but it wouldn’t kill you, you know. Occasionally, I guess, it went into pneumonia or something, but it was not considered fatal. It was more of a nuisance disease considering the others down there that they had to contend with. Then polio came along. Well, all the time during my training years, I never saw polio. I’d heard of it. But I thought it was such a rare thing. But suddenly, in Wayne County, every, every spring and summer, there were cases of polio. They didn’t, the doctors didn’t know what to do about it. And they didn’t know where it came from. And they were rather helpless about it. But every year, we’d have a crop of crippled children. And of course, more or less crippled. Sometimes just an arm, sometimes very badly. Both legs, you know. That was the age where you could see children in braces and crutches, things like that, all over the place. And then, Salk came along with his Salk vaccine, you know, for polio. Well, I thought that was a godsend. Because I dreaded to see spring and summer come. I knew we were going to have many children with polio. And polio, then the paralysis, that was a lifelong disability. And so I welcomed the Salk vaccine. And we put on a very thorough and comprehensive program of immunizing everybody. Not only children from six months on, but adults. Everybody got it.

Interviewer: How did you do that? Did you work through those local schools? Or bring them into the town?

Duncan: Well, we, we put on a campaign and went into every locality, it was usually a school. And we invited everybody in that locality to come. And of course the Salk vaccine was very− you know at first, we had these, you had to give shots, you know. And when we gave shots, I think it was, it was confined just to the children. But when they dropped, the Salk vaccine came along and they dropped, where you just dropped two or three drops on the tongue, that was so easy, everybody volunteered for it. And that just wiped out polio completely out of Wayne County. There was no polio. That was like a magic wand. I tell you, whoever, whoever this Dr. Salk certainly deserves a lot of credit. Well, those things happened during my regime there. We got rid of typhoid, we got rid of, and then, of course, tuberculosis. And we got of polio. And then the antibiotics got rid of these venereal diseases. We had two special days a week that we set aside for venereal cases to come to the health office for treatment. And before antibiotics came along, it was a long, tedious, you know, syphilis, for instance, was a very long, tedious process. And very uncertain as to its results, too. And the same way with gonorrhea. But the antibiotics simply took care of that beautifully. And until, well, I think even when I left there, however, the health officer was prepared to treat venereal diseases who were indigent and came to him. He could give…

Interviewer: Excuse me, Mrs. Duncan. I’m supposed to have already picked up my wife from the university. I’m going to be in trouble. I really came over thinking I could make an appointment with you. And I didn’t realize, you have been so helpful. There are some other questions I’d like, I’d like to know, for instance, what staff you had to do all this work. Like in the polio campaign. That campaign you did, did you have a little larger staff?

Duncan: No. I had some volunteer help. You know, to keep the books. And then the health officer and myself. And our clerk. That was, that’s all the staff we had.

Interviewer: Good grief.

Duncan: We did a lot of work. And it was very effective as to.

Interviewer: Let me see. [pause]

Duncan: Oh, I see.

Interviewer: This is the stop. It says stop. You just push that. Push that. [pause]

Duncan: I was employed by the Kentucky state health department as public, as county public health nurse of Wayne County from the years 1942 to 1963, a period of twenty-one years. In that, our staff consisted of a, of a doctor who was public health officer of three counties, and spent only two days in Wayne County. Sometimes three, depending on the load of our work. In the course of that twenty-one years, we moved from two rooms over the drugstore on Main Street to a more elaborate layout in the new courthouse. And later, to our own county public health building on the south edge of town where we had ample parking space and room for expansion. In addition to myself, the public health officer, the clerk, and a clerk, two sanitarians, in time, were added to our staff. They had a regional supervisor who visited occasionally. [pause] We had annual public health, state public health department meetings in Louisville where all of the counties that had public health departments met. We were not, we were not first to attend these meetings. But we were urged to. The public health officer always did. And I did. And the clerk. Usually. There, we made reports and we were briefed on the new laws that had been passed by the legislature, or perhaps in Washington, affecting our program. For instance, in 1952, when the Supreme Court abolished the equal but separate act, segregating the colored children, that had a tremendous effect upon my program in the schools of Wayne County. I remember it well because one teacher of a little isolated country school had a family of colored children in her area, in her district, who were furnished books by the school superintendents. And the mother attempted to teach these children as best she could. Because they were so isolated there was no possible colored school near them they could attend. And it so happened, and it so happened, that just as soon as the Supreme Court published the abolishment of this separate but equal act, she invited these children to come to her school. And it so added, and it also so happened that she did that entirely on her own, without asking any, without asking the county superintendent. She knew it was right. She knew she was right. She knew she was right. She did not wait for precedence. She simply invited those children to come. And it so happened that all unprepared I wandered into that school a few days later, and there they were. These little black faces, fuzzy hair, short, fuzzy hair. Or little braids, little tight braids, sticking out from the heads with ribbons on them. Sitting there and very neat and clean and well behaved. And studying very earnestly. And the other children not paying any attention at all to them. They took them as (a natural?), took them in their stride. But I remember, but I never will forget the shock the sight of those children in that, sitting there in those seats, gave me. I looked at the teacher. And she told me that she did not wait. That she implemented the Supreme Court, Supreme Court action concerning these children at once. And all on her own. I congratulated her. I did not know that this national magazine, Look, would come down and take pictures. And she would have the honor of being the first one to include colored children into her school entirely on her own. She’s living, she’s living there. She’s living there in Wayne County now. And one son, maybe two, are dentists there. Of course I worked, I worked largely through the schools. And one Ira Bell for the entire period of my employment, over twenty-one years, was county superintendent of public schools. And very, very, a very, a graduate of Eastern state college. A very able, very able, very political-minded. Just as soon as the FDR social acts went into effect, he seized on as many as he possibly could for the benefit of our county. WPA, WPA, WPA, I remember particularly, because he built the high school with WPA labor. He made no, and built roads, and did away entirely with toll roads. And toll roads were done away with entirely. And good public and good roads, good graded, not blacktop, but at least rocks. Good roads. Good graded, and rocks roads were built, to, and all sections, to the principal sections of the county. Radiating out from Monticello. Then, then the seventy-two small one-room schools in the county that existed when I first went to work were quickly consolidated. The roads made that possible. And busing came into existence. Soon the schools were reduced to about thirty. I think there was probably thirty schools and only one high school where there had been at least three in the county before. And of course, Medicaid, the first Medicaid made it possible to establish a social service department. Whereas I had been doing what social service work was done in the county, which included, included in my program. How glad I was, how glad I was. But still, at that time, the state health department was divided into divisions. Each with a head. Actually, I don’t know what the structure. I never knew. And the structure changed so frequently that I couldn’t keep up with it. But I know that there was a department of public, there was a department of tuberculosis that a specialist, TB specialist at the head, there was a mental health division. Which looked after all of the mental health hospitals in the state. The retarded and then the drugs. The sedatives and mental, the drugs came into existence. Treating mental, the mentally ill. And they were kept to hospital a short time, and then sent home. As they came home, they were referred to me, to us, to follow them. And to report, make reports on them. Which I did. The load, of course, the load for one public health nurse in Wayne County was tremendous. We worked six days a week from eight to four. All the time. All the, the new hours, five days a week, thirty-nine hours, five days a week, or thirty-nine hours, five days a week, came later. When I, when I left, when I left in ’63 to retire, the wife, another, another trained nurse in Monticello, the wife of the local paper, the Outlook, Mrs. Simpson, took my place. And I believe she is still there. [pause] One of the sanitarians also retired, Paris Bowles, is also living there and he could fill you out much along the lines of public sanitation. As it grew and as it grew in Wayne County, it very big, a very big, it was a very big subject. And we had two sanitarians. A very big subject because Lake Cumberland. They had springs for being used. Sometimes by the schools. Even our city water established sometime during that period. We had a town spring. And everybody else that did not carry water from the town spring had individual wells in their yard. They also, we had no, we had no sewer system, of course. Water from those wells was always suspect. [pause] The clerk, the clerk, Ruby Barrington, who worked with me for the greater part of the time during this twenty-one year period, at least the last fifteen years, at least the last fifteen years, was a very important, she knew, person. Of course she kept the records, made reports. Wrote the letters for the public health officer, for myself. She knew, kept the birth and death records up to date. She knew better than most of us what was going on. Because she was a clerk for the sanitarians as well as myself and the health officer. She kept visiting days, kept a record of visitors, what they came for, and so forth. A very important person. After my retirement, I have lived, since my retirement, I have lived on social security and on pensions established for employees, state employees pensions.

[180 minutes]

[End Tape 3, Side B.]