Thursday, January 29, 2015

More from the Erie County Poorhouse Hospital

          Well, January is almost over, and my anthropology conference is earlier this year than usual, so it is time to finish the paper to be presented at the American Association of Physical Anthropology conference in St. Louis.  The paper is entitled “Understanding the quality of health care available at the Erie County Hospital, Buffalo, New York, 1880-1910.”  The Erie County Hospital was part of the Erie County Poorhouse complex, which included a poorhouse, insane asylum, and hospital.  As the needs of the poor evolved, so did the hospital, eventually including maternity and tuberculosis wards.  Understanding the quality of care available at this facility seems a straightforward task at first glance, but the city of Buffalo changed dramatically with the building of the Erie Canal in the early decades of the nineteenth century.  Rapid population growth contributed to high rates of infectious diseases and an ever increasing number of people unable to support themselves or their families.  The burden placed on the Erie County Hospital must be examined in the context of a constantly growing subpopulation, namely the poor, and their changing needs.
            To complicate matters further, the Erie County Hospital was not the only hospital in the city.  The Buffalo Hospital of the Sisters of Charity was established in 1848, and Buffalo General Hospital opened its doors in 1858.  These facilities also served the poor.  So the first question one might ask is why would a person go to the poorhouse hospital if there were other options?  The obvious answer is that the poorhouse hospital served the inmates of the poorhouse.  The records indicate that to be true, but they also indicate that a great many other people sought care there as well. 
            Clearly the issue is more complicated than it appears.  One might argue that the poorhouse hospital served only those who could not pay for care at the other hospitals.  That may be true, but we have no definitive evidence indicating that.  Also, in general, during the nineteenth century, most hospitals were considered public and treated patients even if they could not afford to pay.  One of my co-authors suggests that bed space was likely a factor.  One might have gone to the Erie County Hospital if the other hospitals were full.  Another factor was likely the proximity of the hospital to one’s residence and the means one had to travel that distance.  A person might have chosen the poorhouse hospital because it was within walking distance.  It may be hard for us to imagine a sick or injured individual walking several miles, but one of the realities of nineteenth century urban life was that most people lived within walking distance to where they worked because transportation was so expensive.  It would not have been unusual, for example, for a person with tuberculosis to walk themselves to the nearest hospital.

Physician's Report from the Erie County Hospital, 1899
from The Proceedings of the Board of Supervisors of Erie County
Available at the Buffalo and Erie County Public Library

            So in order to truly understand the data obtained from Physician’s Reports for the Erie County Hospital (contained within the Reports of the Erie County Board of Supervisors) it is important to realize that they provide only a small corner of a much larger picture.  Over a 30 year period (1880-1910), 42, 351 people were served by the Erie County Hospital.  Of those, 57% were discharged either cured or improved.  The percentage of people discharged as cured/improved decreased through time from a high of 60% in 1894 to 26% in 1908.  The crude death rate increased through time from a low of 99 per 1000 population in 1882 to 216 deaths per 1000 population in 1907.
            These are very general statistics that summarize a thirty year period of time.  Refining them further is not always possible because many variables are not consistently reported.  For example, many individuals absconded (over 5,000 for the period) and so we don’t know if they were cured, got worse, or died.  Mortality statistics would be better understood if they were broken down by disease category (a process that will soon be underway for the years in which we have those data).  Also, the risk of death would depend on the amount of time spent in the hospital, a variable which is not consistently recorded.  Furthermore, in order for these numbers to be understood, similar statistics from the other hospitals would be needed.
            So, what can be said about the quality of care available at the Erie County Hospital during this period when at most, slightly more than half of the people served were discharged as cured or improved and the crude death rate increased through time?  It might be tempting to say the quality of care was poor, but without comparable statistics from the other area hospitals, the statement would not hold much weight.  Life was difficult during this period of our history.  People worked long hours for meager wages.  They often lived in overcrowded and unsanitary places and had poor quality food available to them.  Infectious diseases were the leading causes of death throughout much of the nineteenth century.  For most of  this period, tuberculosis was the leading cause of death.  Keeping those factors in mind, the statistics presented here may not paint as bleak a picture as we think.

Physician's Report from the Erie County Hospital, 1899
from The Proceedings of the Board of Supervisors of Erie County
Available at the Buffalo and Erie County Public Library

            There are other ways that we might measure the quality of care.  Looking at the detailed inventories of the Erie County Hospital, it appears on the surface that they possessed the proper equipment and medicines of the period to provide adequate care (a closer scrutiny of these items is also under way).  While the average number of patients treated daily was not consistently recorded, for the period between1882-1895 the average number of patients treated daily rose consistently from 96 to 239, but did not come close to the 400 bed capacity of the hospital, suggesting that during that period, the facility was not overcrowded. 
            So this small corner of the larger picture may just suggest that the Erie County Hospital was able to provide adequate care to those who sought treatment there.  Having said that, comparable data from the other area hospitals is welcome!

Tuesday, January 20, 2015

A chat with Mike Crowl

One of the best parts of this journey as a writer is the people I have met along the way. Mike Crowl is the author of Grimhilda! and The Mumbersons and the Blood Secret.  I would have never found Mike if not for social media as he is from New Zealand and I am from New York. As a person who grew up before the Internet, I still think that is pretty cool! I thought it would be a nice change of pace to introduce you to him.  We had chatted earlier in the week and I have posted our conversation here.  If you find him as fascinating as I do, you can learn more on Google+ and Goodreads.

Hi Mike, thanks for joining me.  You are a musician, a composer, and occasionally, an actor.  What made you want to write children’s books?

I’ve been a writer for at least as long as I’ve been a musician, so writing is nothing new. It’s just taken me a long time to get to the point of publishing books.

In the past all the books I’ve written (but not necessarily finished) have been for adults, with one exception. However, there have been some children’s short stories in the past, at least a couple of which have been published. The first children’s book I completed (Grimhilda!) was based on a musical a friend and I had written a couple of years earlier. I thought it had some ‘life’ beyond the theatrical version, and that’s proved to be the case.

How do you balance your writing with your other creative pursuits?

It can be a bit of a juggling act, but usually it’s a matter of which creative venture needs priority. A deadline helps, but at the moment I have deadlines in two different areas, one musical and one writing. It’s not unusual for two things to be running along together: they just have to give each other elbow room.

You have referred to The Mumbersons and the Blood Secret as a sequel of sorts to your first children’s book, Grimhilda!.  Please explain what you meant by that.

In terms of the ‘sequel of sorts’ I mean that only two of the characters from the earlier book appear (though Grimhilda is mentioned several times). In other words, it’s a story about a new lot of characters who have some connections to what happened in the previous book.

You mentioned that Grimhilda! was adapted from a musical that you wrote.  What motivated you to write The Mumbersons and the Blood Secret?

I’d had a sequel in mind for Grimhilda! when we produced the musical, partly because some of the cast talked about what happened next and were enthusiastic about me writing another musical. However, the idea I had in mind didn’t seem to work as a musical, or as something that could be done on stage. And I enjoyed the freedom a book version gave me to let things happen that would have been far too complicated to put in a script.

Do you foresee a third book in the Grimhilda! series?

I’ve since written a draft of a third story which will probably be described as a prequel: it’ll take place some twenty years before the events in Grimhilda! and will again only have a couple of characters in common with the first book. But it will (probably) also explain how something that was rather curious in Grimhilda! actually came about.

You have 10 grandchildren and one foster grandchild.  Have they read your books?  If so, what did they think of them?

Strangely I don’t think any of my grandchildren have read the books! They are all readers (at least those who are of an age are) but it’s mostly been their parents who’ve read to them. I think it’s probably not entirely unusual that family members are so close to you they can’t see you as someone separate: a person who writes books. However a number of the grandchildren did come to the musical, and enjoyed it, so I’ll have to do a bit of promotion amongst them in terms of the books… Thanks for the reminder!

What are the challenges unique to writing children’s books in your opinion?

I think everything has to keep moving; you can’t have too much reflection on what’s happening, or too much description of things that aren’t immediately related to the action. On the other hand, someone did comment that The Blood Secret didn’t seem to have any breathing places as the book headed towards its climax. It’s a tricky balance.

I’ve just been reading more of Diana Wynne Jones’ books. She wrote a large number of fantasy stories, with lots of magic and big events. She was a highly successful author of books for children, and yet the books vary enormously in pacing. The one I read most recently had a rather long patch towards the end when things went rather slowly and then suddenly, all of a rush, everything was sorted out and the book was over. Even one of J K Rowling’s books, I think it was the last,  had a long stretch in it where very little seemed to be happening. They tightened this up considerably in the movie. I’m not sure that children worry too much about these things; maybe it’s adult readers who do. (I think adults should read children’s books regularly; I certainly do.)

I have noticed that your blog covers a wide variety of topics, some are about writing, some are religious in nature and some are observations.  What motivates you to write your blog?

As I said earlier, I’ve written since I was young, and it seems part and parcel of my nature to record what I think about things. Before blogging came along I used to do it in exercise books or in diaries or journals on the computer. Blogging just became a way of making these things more public! I wrote a weekly column for a local newspaper back in the 90s, for five years, and in it I was free to write on anything I fancied. I guess the blogging is an extension of that. For me, blogs that keep on hammering away at the same subject week in and week out get a bit uninteresting after a while, just the same as newspaper columns that are focused only on one thing. I like variety!

Do you find social media to be more useful in marketing or in helping you to learn more about the self publishing universe?

I don’t know that I’ve made a distinction like that between them. I tend to read anything and everything that’s going when I’m first learning about something. Social media’s certainly been helpful in discerning what’s useful in terms of marketing though you have to sift between what are often opposing viewpoints. Equally there’s a heap of information about self-publishing out there: some of it is excellent, some rubbish, some marginally informative and so on. It’s the nature of the Internet. But it often points you to books that are of value: I’ve discovered several books about self-publishing/marketing, and these have probably been more helpful because they’re more focused. Deb Vanasse’s book What Every Author Should Know is one I’ve read recently that I found very good all round.

If you could ask any question on social media about self publishing and get an honest answer, what would it be?

“How can I guarantee that my books will sell very well?” I’m sure I’d get plenty of honest answers, but I don’t think I’ll get one that will guarantee sales! 

I would ask "How many books have you sold?"  There are so many of us out there and I think it would help to have a better understanding of the goals (in terms of sales) that other authors set for themselves and the timeline they set for achieving them.

With e-books by relatively unknown authors, the secret seems to be perseverance: keep on reminding people about the books through social media. But don’t do it in a way that makes it sound like you’re insisting on a sale, or like you’re advertising. Make it part of the overall conversation. Encourage people to help your books to sell by word of mouth. An endorsement from someone who’s enjoyed your books to one or more of their friends is still one of the best ways of getting the books known, even better than good reviews.

I was pleased this morning to find a tweet from a friend saying: My daughter is again reading Grimhilda, by @mcrowl. She thinks it’s ‘awesome’.  That sort of publicity is invaluable, because it’s sincere.

Well, judging by your reviews on Amazon, others find Grimhilda! awesome as well!  I really enjoyed The Mumbersons and the Blood Secret and I look forward to reading Grimhilda! (I agree with you that adults should read children’s books, and I do!).  Mike, thanks again for taking the time to share your thoughts with me.  I wish you success in all of your endeavors!

Wednesday, January 7, 2015

Some remarkable new characters

Part of the Museum of disABILITY History's Abandoned History Series

         Among the many treasures in the city of Buffalo, New York, is the Museum of disABILITY History (  This is a museum entirely devoted to advancing the understanding, acceptance and independence of people with disabilities.  In the early nineteenth century, county poorhouses were places of refuge for people with disabilities resulting from injury, illness or old age.  I think there is a place in book three of the Orphans and Inmates series for one or more characters with disabilities.  Because the story thus far focuses on the plight of children living in poverty, it makes sense that at least one of these characters should be a child.
          Looking to my friends at the Museum of disABILITY History for inspiration, I came across a book called Dr. Skinner’s Remarkable School for “Colored Deaf, Dumb, and Blind Children” 1857-1860 by James M. Boles and Michael Boston (part of the Museum’s Abandoned History Series). Dr. Skinner, himself a blind man, established his school first in Washington, D.C. and then in Suspension Bridge, New York (now known as Niagara Falls, New York) “for the purpose of ameliorating the condition of one of the most unfortunate class of children the world contains.” 

            Dr. Skinner's school provided much needed care, concern and education to disabled students of color.  There were only three criteria for admission:

1.      A dark face
2.      Deaf ears and a mute tongue or blind eyes
3.      The state or country in which they lived had not provided for             their education                  

            The school received nine pupils the first term and hoped to have the funds to enroll twenty the following semester (although they had identified fifty children in need of their help).  A newspaper called The Mute and the Blind, which was entirely run by the students, was produced to help support the school.  Dr. Skinner’s abolitionist leanings became a problem in terms of maintaining support for the school and he ultimately moved it to Trenton, New Jersey just before the Civil War.

            Dr. Skinner’s school got me thinking about what options were available to orphaned children with disabilities earlier in Buffalo’s history.  What might have been the fate of a blind or deaf child who lost her parents (say in a cholera outbreak)?  Le Couteulx St. Mary's Benevolent Society for the Deaf and Dumb was established in 1853 (just a short time after the year in which book three takes place).  It’s time to see what relationship, if any, existed between the orphanages and St. Mary’s.  The school that would become St. Mary’s School for the Deaf was established with the help of Bishop Timon, and was run by the Sisters of St. Joseph, so it will be interesting to understand its place among the predominantly protestant charitable institutions.  It looks like I will be spending some time in the library at the Museum of disABILITY History.  Stay tuned…