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!