North Carolina Nursing History

Goldie Allen was the first professional public health nurse in Avery County.

The below information is reprinted with permission from the American Association for the History of Nursing Bulletin Fall, 1994 pages 4-6. (Available online through UNC Greensboro)

At the turn of the twentieth century gains in knowledge related to the etiology, transmission, treatment, and prevention of many diseases gave rise to new efforts in the field of public health. Women trained in the emerging field of professional public health nursing translated these new scientific findings into action. Even in remote areas of America, nurses were involved in the movement to enhance the quality of life through public health measures (Donahue, 1985). Although much of the early history of public health nursing, especially in southern and Appalachian communities has been forgotten or ignored, the pioneers in public health nursing contributed to their profession and communities in ways worthy of remembrance. This article is an account of the work of the first community health nurse in Avery County, North Carolina.

Avery County, North Carolina Circa 1928

Avery County covers 113,053 acres and in 1928 had a population of 10,335. At that time there were two small hospitals (one with twenty-four beds, the other with six) and nine doctors located in the two towns in the county, Newland and Banner Elk. In this rugged, mountainous environment with long harsh winters and no paved roads or telephone, seeing or even communicating with a physician proved difficult for many rural residents, and there was no county health department (Drummonds, 1924). Grace Hospital in Banner Elk had a nursing school whose graduates were trained in hospital and private duty, but not public health nursing (Pollitt & Moore, 1992). The local health care providers were so busy rendering direct patient care that they did not have time, training, or funding to provide public health services. Disease, malnutrition, and poverty were common (Van Noppen & Van Noppen, 1975). Many Avery County citizens relied on Appalachian folk remedies that often aggravated rather than relieved the problem at hand (Pollitt, 1990).

[Allen's Work with] The American Red Cross Jane Delano Memorial Fund

Jane Delano was the Director of the American Red Cross Department of Nursing from 1909 until her death in 1919 (Kernodle, 1949). In her will, she created the Jane A. Delano Memorial Fund to employ public health nurses to work with rural Red Cross chapters where local resources were too limited to hire a full-time nurse, and no other public health services were available. Local Red Cross chapters contributed a portion of the nurse's salary, a space for her to work, and volunteer time to help with projects initiated by the nurse (Kernodle, 1949). Nurses were hired for a period of three years. Each year they spent four months in three different communities, and then repeated the cycle. They became known as Itinerant Red Cross Nurses (Kernodle, 1949).

The goals of the Itinerant Nursing Service included teaching the art of home nursing of the sick, preventing the spread of disease, holding clinics for immunizations and dental care, and assessing the health needs of school children. The 1922 annual report of the American Red Cross discussed the Delano public health nursing program. It stated:

"Although her stay is short, she inevitably leaves behind her better understanding of health problems, greater self-reliance in health emergencies, and a deeper sense of responsibility to family and neighbors for the maintenance of a healthful community." (pg. 1)

Some farsighted members of the Avery County Red Cross chapter wanted to bring these services to their community. They worked with the national office of the Delano Fund to secure an itinerant nurse for Avery County. Goldie Allen, R.N. began her work in North Carolina in the summer of 1928, the first professional public health nurse to work in the county (Our county nurse, 1928). She began to see patients and initiate programs in line with the national goals of the Itinerant Nursing Service, but with allowances to meet local needs and mores.

It soon became apparent to a local resident that Allen was providing a valuable service. The local newspaper, the Avery Advocate, advised readers to "...listen and cooperate with Miss Allen, and learn as much as they can..." (Our county nurse, 1928). Residents must have heeded this advice, for on June 28, 1928, just two weeks after Allen arrived in Avery County, the Advocate ran a front page story under the headline "County Nurse Busy". The first paragraph reads:

Miss Allen is proving herself an efficient worker in her position as county nurse. She has visited a number of people who need attention and started measures to give them relief and is getting ready to organize classes for the training of our town people for better and more intelligent nursing care" (pg.D.

Allen's report for two weeks between June 15 and 28, 1928, showed 64 home visits for everything from prenatal care to tuberculosis cases, two presentations to civic groups to explain the Itinerant Red Cross Nursing Program, and 22 visits to doctors, dentists, the superintendent of schools, and other public officials to introduce herself and explain the program (County Nurse's Report, 1928).

In addition, Allen started work in the schools. By the end of July she and local Red Cross volunteers had weighted, measured, and inspected all the children in three schools (Avery County Red Cross, 1928). In an article for the Avery Advocate describing the relationship of poor health to academic difficulties, Allen pointed out:

Children with impaired vision, deaf ears, diseased tonsils, adenoids, undernourished bodies or fatigued nervous systems cannot possibly do the work of normal healthy children (Avery County Red Cross, 1928, Pg-D-

Local Red Cross chapter members and other citizens in Avery County joined Allen on several projects; the Women's Club of Crossnore gave a demonstration on the benefits of public health at the Toe River Fair, the Woman's Club of Plumtree donated food and clothing to a widow with many children who was not eligible for Mother's Aid, and the Beech Haven Camp Girls gave a benefit performance to raise money for Allen's work (Avery County Red Cross, 1928).

Allen's work with children increased in August with the resumption of school. She inaugurated the "Progressive Program for Better Health" in which the school with the most children following eight rules for better health would receive a silver cup. The eight rules were: 1) A full bath more than once a week, 2) Brushing the teeth at least once a day, 3) Sleeping long hours with windows open, 4) Drinking as much milk as possible, but no coffee or tea, 5) Eating green vegetables or fruit every day, 6) Drinking at least four glasses of water a day, 7) Playing a part of each day outdoors, and 8) A bowel movement every morning. This program was endorsed by local doctors, dentists, and school board representatives, and appears to have been successful in inculcating better health habits in children (Avery County Red Cross, 1928). Before she left for Mothers County, Virginia, in October 1928, Allen found time to teach two classes of Home Hygiene and Care of the Sick, coordinate a typhoid immunization clinic, and persuade the county commissioners to pay for a county resident with an advanced case of tuberculosis to go to a sanatorium (Avery County Red Cross, 1928).

Allen's activities for 1929 are not well documented. An article in the September 5, 1929 Avery Advocate describes her teaching classes in home nursing, placing one child at the North Carolina School for the Deaf in Morganton, securing a special nurse to come to the county to hold classes for midwives and others, and coordinating a pediatric orthopedic clinic in Banner Elk (Nurse reports progress, 1929).

Another busy year for Allen was 1930. In July she organized inoculation clinics for diphtheria and typhoid fever through the county (Clinics set for county, 1930). In August she coordinated the first free clinic to detect tuberculosis held in Avery County (Lung clinic to be held, 1930), and in September she taught a class in home nursing to the girls of Newland High School (Home hygiene class planned, 1930).

In November 1930, Allen summarized her three years work in Avery County in a final report to the National Red Cross office. She had taught five classes of Home Care for the Sick with a total attendance of 71, and coordinated screening clinics for tonsils and adenoids (95 people treated), orthopedics (41 treated), dental (503 treated), tuberculosis (180 screened), and typhoid and diphtheria immunizations (2896 given). She had gotten new water supplies for Newland and Cranberry schools, worked on a county wide fly eradication campaign, sent three children to a tuberculosis sanatorium, one to an epileptic colony, two to the school for the blind, and five to the school for the deaf and dumb (Report made, 1930).

After three years with the Red Cross Itinerant Nursing Service, Allen married and moved to St. Louis, Missouri. Her acceptance by Avery county residents was apparent when local women honored Allen with a combined going away party and wedding shower (Miss Goldie Allen, 1930).

Her work had demonstrated the value of public health nursing to the community. The local Red Cross chapter arranged for another Itinerant Red Cross nurse, Bess Dalton, to continue Allen's work for three years. Then, in 1935, the U. S. Congress passed the Social Security Act. Portions of the Act provided funds for state and local governments for programs involving maternal-child health, crippled children, and services for the disabled and elderly (Donahue, 1985). Community health efforts by voluntary agencies such as the Red Cross became secondary to the larger and better funded program sponsored by the federal government. The scope and model of public health nursing used by the Itinerant Red Cross Nursing Service in Avery County served as a basis for the work of the new county health department nurse.

While public health nursing would have arrived in Avery County with the passage of the Social Security Act, the earlier efforts of the Itinerant Red Cross nurses relieved suffering and improved the health of many people. The local chapter of the Red Cross was farsighted in seeing the benefits of a community health program, and resourceful in bringing the benefits of prenatal care, screening clinics, school health programs, home health nursing and health education to the people of Avery County. The contributions of these public health pioneers should not be forgotten.

Reference List

• Avery County Red Cross Chapter: (July, 1928). The Avery Advocate, pg. 1.
• Avery County Red Cross Chapter: (August, 1928). The Avery Advocate, pg. 1.
• Clinics set for county: (July, 1930). The Avery Advocate, pg. 1.
• County nurse busy: (June, 1928). The Avery Advocate, pg. 1.
• County nurses report: (July, 1928). The Avery Advocate, pg. 1.
• Donahue, M. P. (1985). Nursing: The Finest Art, St. Louis, Mosby.
• Drummond, A.Y. (1924). Drummond's Pictorial Atlas of North Carolina, Charlotte, NC, no publisher information given.
• Home hygiene class planned: (September, 1930). The Avery Advocate, Pg. 1.
• Kemodle, P. (1949). The Red Cross Nurse in Action, 1882-1948 New York: Harper.
• Lung clinic to be held: (August, 1930). The Avery Advocate, Pg-1.
• Miss Goldie Allen: (November, 1930). The Avery Advocate, Pg. 1.
• Nurse reports progress: (September, 1929). The Avery Advocate, Pg. 1.
• Our county nurse: (June, 1928). The Avery Advocate, Pg. 1.
• Pollitt, P. (1991). Lydia Holman: Community Health Pioneer. Nursing Outlook, Vol. 39(5), pgs. 230-232 ,
• Pollitt, P. & Moore, K. (1992). Appalachian Health Care: The Grace Hospital School of Nursing, American Presbyterian, Vol. 70(4) pgs. 239-246.
• Report made on nursing service here: November, 1930). The Avery Advocate, Pg. 1.
• Van Noppen, I. W. & Van Noppen, J. J. (1973. Western North Carolina since the Civil War. Boone, NC: Appalachian Consortium Press.