The San Juan Islands are a remote, rural archipelago in the Salish Sea of the Pacific Northwest between the Washington mainland and Canada's Vancouver Island. In the late 1930s healthcare for the islands' scattered population was immeasurably improved by the arrival of Elsie Scott to be the San Juan County public health nurse and assist the county's only physician. For several decades Scott was on call for every medical emergency anywhere in the county. She provided health care and training to scores of islanders and their children and inoculated hundreds of youngsters against diphtheria, smallpox, and, in the 1960s, infantile paralysis (polio). She assisted at clinics, provided prenatal care for expectant mothers and post-natal care for them and their new infants. She aided in the diagnosis and treatment of tuberculosis patients and offered personal home care and comfort to many patients far from neighbors or other help. During her long career she became a much-respected member of the island community and was profiled in national publications and on a radio broadcast for her extraordinary and unusually challenging work. Scott is still remembered in the islands with affection and gratitude for her ceaseless, selfless care.
Early Life and Career
Elsie Scott's Irish immigrant parents settled in Good Night, Texas, where she was born in 1898. They returned to Ireland for a few years, but by the time Elsie was 11 years old her family was back in the U.S. and living at a fruit orchard in Wenatchee in Central Washington's Chelan County. Scott graduated from high school in Wenatchee in 1918 and enrolled in the Minor Hospital Nursing School in Seattle. Her studies there were delayed when she contracted typhoid fever, a debilitating bacterial infection with minimal effective treatment in the 1920s. Scott persevered through a long recovery and was able to complete her training and graduate in 1924. Several years of general nursing, both private and in hospital settings, followed, but Scott's interests soon turned to public health nursing with its wider focus on the health of an entire community, not just individual care or a nursing specialty. She returned to school for further training at the University of Washington's Public Health Program and graduated in 1928.
Public health nursing in 1928 was still a relatively new field. The National Organization of Public Health Nurses had been formed little more than a decade before Scott's graduation and the responsibilities and activities of a public health nurse varied depending on the community and needs. One of Scott's first positions was in Clallam County on the Olympic Peninsula, where even the geography turned out to be a major challenge. She frequently had to travel by boat, often piloted by helpful Makah Tribe fishermen, to reach isolated areas such as the Neah Bay community. Traveling muddy county byways in her 1928 Model A Ford was difficult, even where local residents had laid log roads across especially boggy areas. Looking back on her experience in those early years, she remembered "once when her car slid off into the mud, a group of loggers lifted it, with her in it, back up on the road" (Wyborney). By 1934 she had transferred to Chelan County, where she continued to expand her range of nursing services and became active in statewide public health activities as well, serving in administration and program development for the growing Washington State Public Health Association, which had been established a dozen years earlier.
In 1937 Scott accepted a position in Alaska, but within a year she was back in Washington to take up duties as the public health nurse for San Juan County. The county's public health nurse position had been created only a few years earlier under the auspices of federal and state depression-era economic relief programs. Just prior to Scott's arrival in the county, her predecessor reported a busy six months of activities: 600 school examinations; school inspections; home visits to parents; public health talks; communicable disease control with home visits and immunizations; tuberculosis control including chest clinics, the taking of X-rays, arrangement of admittance to sanatoria, identification of new cases, and home visits for suspected cases; home visits to expectant and new mothers; home visits to new infants and preschool children; home visits to bedside cases; and home visits to disabled children. She had attended 45 public meetings and cooperated with the Red Cross and its various nursing and health-related activities. Now Scott was undertaking to serve this widely dispersed community with daunting travel challenges in often-difficult weather, with limited communication capabilities, and with an enormous variety of health-care needs.
First Years in San Juan County
In 1938 San Juan County had approximately 3,100 residents, spread out over more than a dozen of the archipelago's 172 named islands and islets. Only a few of the islands had regularly scheduled ferry service, and air transport would not be available until after World War II. In emergencies and to travel to smaller islands the Coast Guard was called upon. The director of the Coast Guard district covering the San Juans instructed all ports to stand by day or night to assist whenever Scott needed a ship, and when she arrived on a remote island, sometimes in a drenching gale on a beach rather than a dock if conditions demanded, she would be met by residents there who would assist her to get to where she was needed.
There was only one physician in the islands, and Scott found that in addition to her public nursing responsibilities, she would also serve as the nurse practitioner for Doctor Thomas Judge (ca. 1909-1954) for his private patients. During her first year she quickly plunged into the full array of public health services. She even escorted 12 children to a Bellingham hospital after school examinations revealed the need, the doctor had decided, for tonsillectomies.
While beginning to undertake the massive amount of public health nursing work awaiting her, Scott also took the opportunity to interact with and begin to know the islands' residents -- independent, self-reliant, opinionated, and often questioning of medical recommendations and activities. She made friends and moved into a small cottage near Friday Harbor on San Juan Island that was to be her home for the rest of her life. The cottage, nestled in a grove of cedar trees with a beautiful view of the harbor and neighboring islands, stood on the property of the Kwan Lamah resort, which had been created on land originally homesteaded by island pioneer Edward Warbass (1825-1906). Scott was allowed to rent her cottage on a monthly basis without a lease, and when the property was sold in 1951, the selling owner persuaded the buyer to continue the arrangement. Miss Scott, as she was known throughout the community, welcomed many guests to her home, which became especially popular with the island's children who visited often and found a child-sized table and chairs and toys awaiting them.
Scott had only limited time to enjoy her comfortable cottage, however. A typical week's schedule had her in Friday Harbor on Monday and Tuesday; Wednesday was reserved for clinic duty and special callers; Thursday she would travel to Orcas Island; and Friday she would visit Shaw and Lopez Islands. Saturday mornings were devoted to office appointments. And, of course, she was always on call for emergencies. In those days, when each major island had its own separate telephone system, she made sure to always inform each island operator of her whereabouts and travels so that she could be reached relatively quickly. Her travels were so constant even in her first year that she regularly exceeded her travel expense allotment and the county health officer appealed to the county commissioners for assistance. The commissioners voted unanimously to ask the state Department of Health to provide enough additional monies to raise Scott's travel fund to $45.00 a month so that she could carry on her much-in-demand work.
In addition to her nursing responsibilities, Scott was frequently asked to participate in community groups, and she joined the Business and Professional Women's Club of Friday Harbor and the local PTA (she felt that since the group focused on children and families, their health needs were involved and therefore she should be a part of it). She was a much-sought-out speaker both in the islands and, soon, nationally. She was equally able to offer a convincing, fact-filled presentation at the Lopez Island Grange on community sanitation and to deliver a speech at an American Nurses Association district meeting. She was appointed as advisor to a newly formed local organization focused on fighting infantile paralysis, more commonly known today as polio.
Helping Prevent and Treat Tuberculosis
Widespread use of antibiotics was still decades in the future, and tuberculosis was a major focus of medical attention when Scott began her work in the islands. As late as 1949 tuberculosis was the leading cause of death for those aged 15 to 44. A public health nurse was expected to have a thorough knowledge of the causes, symptoms, treatments, prevention of infection, and psychological aspects of tuberculosis, and often was crucial in identifying contacts and possible sources of local infection. Scott was vigilant as she visited around the county and was able to identify potential tuberculosis sufferers and assist them to get prompt attention. Islanders who had been helped to find good care at a suitable facility wrote to the local newspaper from a sanitorium in Seattle that they wanted "to thank Miss Scott for her watchfulness and urge everyone to cooperate with her to the fullest extent possible in the coming TB program" ("Mr. and Mrs. Willis ...").
An active San Juan County Tuberculosis League met regularly, and Scott worked closely with the organization, promoting its activities as she traveled. She was frequently asked to speak at meetings, including a gathering on Orcas Island at the Waldheim resort attended by members from San Juan, Orcas, Lopez, Decatur, Shaw, Waldron, and Stuart Islands. Scott led a panel discussion and was recorded as having "expressed the desire to make San Juan County famous for its healthy children as well as for its beauty" ("League Holds ..."). The League in turn was supportive of Scott's work, recognized that she needed a secretary to relieve her of the clerical responsibilities that absorbed far too much of her time, contributed $150 for the six months' salary of a part-time stenographer, and began to fundraise and search for a stable source of funding for the position. Articles appeared in the local newspaper recording the growing contributions and urging continued help.
Caring for the Young
Inoculating youngsters to prevent, especially, diphtheria (still a devastating childhood ailment then) and smallpox, was an annual undertaking. At the beginning of each school year the island PTAs sponsored clinics held at the local elementary schools for preschoolers as well as children just starting their education. Dr. Judge and Miss Scott offered basic physical exams for all children as well as the inoculations. A fee of 50 cents was charged for each service. In later years hearing tests were conducted too. Scott was creative in her approach to services that she knew might be frightening for children. Fifth graders were organized to act as receptionists and help manage each clinic. One of the boys met each mother and child or children at the car, greeted them, and escorted them into the building. A girl hostess took brief histories. Other youngsters then escorted the child to a dressing area. Trauma was kept to a minimum because, as Scott noted, "Small children will go to other children where they would be afraid of strange adults" ("Lady Robinson Crusoe"). The fifth graders (with adult supervision and verification) took preschoolers' temperatures. When it came time for a vaccination, Scott produced a wind-up, four-piece Mickey Mouse orchestra that so diverted a child that the prick of the needle was barely noted.
Local schools benefited in other ways from Scott's services. She fostered a community project to equip five schools with basic first-aid and health supplies. Teachers, parents, and students were enlisted to create an attractive, efficiently organized room in each school to house the supplies and provide a comfortable setting for administering aid and health assistance. She often taught first-aid and home-nursing classes, one year offering a one-and-a-half-hour-credit class on home nursing each week for an entire year to junior high school students. Her teaching enabled better control of communicable disease epidemics because the children she visited and befriended on her rounds reported new cases to her. Her approach was practical and involved providing the children with motivation and activities appropriate to their ages. In one instance she gave young children suffering from impetigo (a highly contagious bacterial skin infection that causes itchy red sores, often on the face or arms) paper towels and told them that when the bandages came off the sores, they should be wrapped in the towels and burned. Miss Scott asked the children, "Do you know why?" The prompt answer, in unison, was, "So other children won't get it" ("Lady Robinson Crusoe"). Generations of school children quickly learned of her kindness and skillful help. She so inspired the students of one graduating high school class that all six of the girls in that class enrolled in nurses' training.
A Growing Reputation
The year 1947 didn't get off to a good start for Elsie Scott. Driving home on January 1st from a holiday visit with friends in Port Angeles, she lost control of her car on the icy road and overturned. It was some time before the wreck was discovered by young travelers in a passing car who treated her for shock and called an ambulance. She was taken to a hospital in Port Townsend and found to have suffered serious bruises and a severe bump to the head but no broken bones. Dr. Judge and his wife immediately flew to Port Townsend and word came to the community that Miss Scott would be hospitalized for at least two weeks. The whole county was concerned. The Friday Harbor Journal, the local newspaper and chief source of news for islanders, had reported her accident on the front page. Two weeks later it followed up with another front-page story announcing that Miss Scott was then in Seattle continuing her recovery at the home of friends but in need of a six-week leave. She had called the Journal office and particularly wanted the community to know how much she appreciated all the flowers, cards, and letters (more than 200!) she had received and was especially touched by the collective note from the school children. Her Seattle address was published in the paper, so that the island community could stay in touch. The outpouring of support and concern was clear evidence of the respect and regard that she had garnered throughout the islands.
And word of her work was spreading well beyond San Juan County. The nursing profession's national publication for registered nurses, R.N., included a biographical sketch of Scott and a description of her work in the San Juans in its March 1946 issue. The story was titled "Lady Robinson Crusoe." In April 1947, Beatrice Cook (1901-1990), a summer resident of Orcas Island who was heavily involved with the Seattle Visiting Nurse Association and National Board of Public Health, chose her friend Elsie Scott to be the subject of an article intended to focus on the contributions "of public nursing upon the public mind and to bring attention to the importance of the Public Health Nursing movement" ("Public Health Nursing ...").
Cook's article was featured in The Seattle Times Sunday magazine section but was destined to have a much wider impact as the basis for a script, written by William Kendall Clark for a CBS national radio broadcast on April 23, titled "Lantern in the Dark." Scott's work in the islands was dramatized as a trip to a storm-battered island and the challenge of bringing improved medical service to an isolated, rural community. The broadcast was directed by Albert Ward; Dorothy McGuire (1916-2001) played the role of Elsie Scott. The crisis featured in the original script was typhoid fever, but Scott insisted it be changed to diphtheria so that tourists wouldn't be discouraged from coming to the islands by the thought of possible infection. The Friday Harbor Journal reported that the broadcast "was well-received by all who were fortunate enough to hear the program" ("Public Health Program ..."), but the Orcas Islander was not as pleased. A reminiscence of Scott written more than a decade later reported the publication grumbling that the radio program offered too primitive a picture of the islands and islanders with a script suggesting that Scott "instituted measures in the face of provincial suspicion and antagonism" (untitled typescript, ca. 1963).
These were only the first examples of national interest in the story of Elsie Scott and public health nursing in the islands. In the following year the Seattle Post-Intelligencer featured her in an article titled "Florence Nightingale of the San Juans," which was chosen by the national Public Health Association as the outstanding story to be featured during Public Health Week. It was subsequently republished in American Weekly Magazine, a Sunday supplement included in all Hearst newspapers, prompting letters from interested readers around the country.
In 1950 Scott and her work were the subjects of a lengthy article in the popular magazine Today's Health. Wanting local color, the author followed Scott on her rounds. While traveling from call to call, they discussed the important role of the county nurse in a rural environment. The resulting article was a good portrait of Elsie Scott's personality, her approach to her responsibilities, and the unique circumstances of her work in the islands. It was enlivened with some of Scott's many anecdotes: one, of the time she was called to bury a dog, the beloved pet of a distressed elderly woman living alone in an isolated house, and another, of a call that, upon her arrival, turned out to be an appeal for her to treat a cow belonging to a man who had, for years, resisted her urgings to have his children vaccinated for diphtheria. It seemed that the farmer knew her but not a veterinarian. She called the county agent for the cow and waited with the farmer until the agent arrived, using the time to convince the man of the need for the inoculations. Another article appeared in the March 1950 issue of American Magazine, a monthly publication that included human-interest stories, fiction, and contributions on social issues from notable writers. The article was featured in the "Interesting People" section and included a picture of Scott climbing onto the deck of a Coast Guard cutter. As reported in the Friday Harbor Journal, it noted that "She is the first line of defense against illness and accident for 3000, more or less, islanders, and her duties are seldom simple, often dangerous" ("Elsie Scott Subject ...").
Long Years of Service
For almost 15 more years Elsie Scott continued to minister to the needs of San Juan County residents. As the population grew, so did the demands for public health assistance. Multiple calls in a day were not unusual. On one memorable occasion Scott had almost simultaneous calls to an auto accident on Lopez Island, a man on Orcas who had mistakenly drunk canned heat, and two visitors who were engaged in a knife fight on the San Juan Island dock. Scott always kept two medical bags and a traveling package ready. One medical bag was only for communicable disease work, so that she could keep her usual instruments and supplies as clean and uncontaminated as possible. The traveling package, kept at the office, included in later years emergency supplies for plane trips including a nightgown, bathrobe, wool blankets, and a zipper case for a bedpan, so that no time would be lost collecting essential items when an emergency call came in.
As was noted in the article in Today's Health, while islanders might not have known what public health nursing was supposed to entail, they did "know that Elsie Scott is there and will come when they call her. They are grateful that she is an ideal to many of their daughters who have followed her into the nursing profession. They love her as a friend who will sit through an all night watch by a sickbed, and, in the morning, rig up a Punch and Judy show to allay their children's fears in a clinic" ("Island Nurse"). One acquaintance said that she was "just the kind of person you'd like to tell your troubles to" ("Island Nurse").
When Scott retired there was an outpouring of respect and affectionate remembrances of friendships forged and crises shared, of humorous encounters and compassionate care. It wasn't just the physical care that she administered that was so exceptional but how she worked to ferret out the causes of psychological and emotional struggles and her empathetic approach to each situation, individual, or family. And she took time to nurture friendships and enjoyed entertaining; on just one occasion she hosted an elaborate steak barbecue for more than 30 invited guests from the San Juans and Seattle.
Elsie Scott passed away on September 27, 1983, at the age of 84. In an obituary, colleagues described her as "a completely selfless, yet dynamic personality whose only goal was to be of service to those who were hurting" ("Elsie Hope Scott ..."). She was unendingly generous, often using her own money to meet a need when other funds were not available or too slow in arriving. At her memorial service, Roy Franklin (1924-2011), the San Juan Island pilot who began regular air service to the islands and had flown her to many emergency calls around the county, talked about her roaring around in her car to patients on San Juan Island. Dr. Malcom Heath (1913-1989), who had succeeded Judge as county medical officer, reflected that although in that role he was nominally her supervisor, Elsie Scott largely seemed to run her own family practice, not just treating but adopting the families that she cared for. It is this legacy of compassion and skill, friendship and caring that has lasted in islanders' memories for so many years.