Saturday, October 25, 2008

Living with Diabetes update

So - here we are in Tampico, Tamaulipas Mexico. Not a place you'd want to be, as it turns out! I've already talked about the difficulties of getting hold of Glucagon and given my views on the underlying reasons. Living with Diabetes (Type 1 anyway) in this part of Mexico continues to get more problematic. Especially if, as my spouse, you follow the tight control regime using the 24 hour ultra-slow acting analog insulin, Lantus, once a day and the ultra-fast acting analog insulin, NovoRapid (or NovoLog in the States), before every meal. Very few, if any, Mexican Type 1 Diabetics can be on this regime. Why do I say this? Well, read below.

As most Type Ones on the tight control regime know, trying to keep blood sugar levels within the normal person's range of 70-100 mg/dl means frequent hypoglycemic episodes of varying degrees of intensity. In the US that fragility means high additional costs occasioned by the need for treatment from Emergency Services or from third party administered Glucagon or, at less extreme times, from self or assisted dosing with glucose jelly or tablets. Therefore, the problem for diabetics in the US is not the unavailability of the treatments - it is their cost. And that can be prohibitive if or when the diabetic is not covered by health insurance. The lack of government controls on drug pricing alone appears to mean that everyone involved in selling the vital products is out to make a fortune. Nevertheless the paramedical services, Glucagon and glucose jelly are available. Not so readily so once you step outside of the first world (not just the USA!), where if products are on shop shelves this week, they may well not be ever afterwards.

So: here in Mexico, there is the Glucagon Problem and its attendant costly Paramedical-Hospital visit Dextrose replacement Set Up difficulty. Avoiding the high expenses entailed in all but compulsory use of the hospital following the administration of Dextrose solution by paramedics necessarily means avoiding hypos altogether; and that means keeping the Blood Glucose levels higher than is good over the long term. No tight control regimen here!

Now you see, now you don't! About a month ago, the locally made glucose tablets that we had discovered disappeared from the pharmacy shelves of two US chain grocery stores in town. It took us a while to find them and they were more expensive and lower in carbohydrate values than their US counterparts - but they had existed. For about two months. As we bought them during our weekly shopping trips, we watched the numbers of their boxed bottles dwindle away to None-at-All.

As for glucose (dextrose) jelly - Ha Ha!! You must be Joking! (I mentioned its never presence in third world countries in an earlier post.)

Now we have just (almost, nearly...) hit another Block in Living with Diabetes in Mexico. The sudden disappearance from pharmacies (here in Tampico, at least) of NovoRapid (Novolog)! My spouse has just enough left for about 12 days! We had bought a box of cartridges three weeks ago from the closest branch of Mexico's largest chain pharmacy: Benavides. Now they no longer stock the insulin - not in either its cartridge or disposable pen form. We already knew that one of the US chain stores here did not stock either it or Lantus. So we took a taxi over to the other to see if their pharmacy stocked it. There was none readily available, and the best that could be offered was that the pharmacist would find out if it could be got for us!

Living without glucose tablets or jelly or even Glucagon can be and is edgy. But without the insulin - that, my friends, cannot be done.

But why not go back to using regular fast-acting insulin? Surely that would be available. Maybe, maybe not. However, long past experience tells us that that course is no option at all without ready access to Glucagon and glucose jelly. Before his doctor put him on these two insulins, my spouse had frequent comas, most of which I dealt with by using the Glucagon. For the equally frequent near comas, I used the jelly. We cannot go back to the dangers inherent in using regular fast-acting at mealtimes in a country where we do not have access to these two items. And living with high blood glucose levels is not an option, either.

So we wait until Monday, when we go again to the Texas chain store pharmacy to find out whether or not the insulin will be available to us.

Living with Diabetes in the third world is riddled with uncertainties and the vagaries of market capitalism. Quite probably the pharmacies here see no profit - literally - in stocking an insulin that has a market of only one. Let him use another! Let him eat cake!

Wednesday, October 8, 2008

What follows is derived from my own trials and tribulations, joys and Eureka! moments as both a student historian and as someone researching their own family history. My hope is that what I have learnt from using historical sources can in some way help others also happily absorbed by the past doings and beings of their families. My posts on this subject will concentrate on the difficulties that we all encounter at some point. For many of us, several "walls" arise to block our forward - or backward - progress, some of which seem absolutely impenetrable. I have at least four such blockages along the main lines of my family. The frustrations are real and derive from really existing problems in the sources and in the ways our ancestors lived their lives.

Over the next few posts I intend to examine some of the problems that beset family historical research, particularly as it relates to English and Welsh records (they are the family records with which I am most familiar). However, the issues I raise are surely not restricted to the historical records of these geographical areas. First I want to take an overview of general historical records as they have related to the majority of the population. Then in this post I'll examine the specific information in BMD certificates and its potential unreliability. Next time I'll look at the Censuses.

Where to begin? Well, when it comes to finding written records about most of our ancestors, the best sources available to us come not, unfortunately, directly from their own pens but from those of the Upper and Upper-Middling Classes. Until the latter half of the 19th century in England and Wales, most amongst the Labouring Classes were illiterate, or, at the very least, could not write. Children of both sexes began their labouring lives as early as eight, even after legislation prohibiting it. (The legislation focussed on factories and mills; small and family workshops where many also children worked were hardly affected.) Moreover, there was no system of publicly funded elementary education; and such schools as existed (dames' schools, for instance) were cheap but not free. Labouring families were in a bind: without the income earning labour of their children they could not afford the cost of the schools. So at best many children had only a few months of schooling in which they may or may not have picked up some reading skills before their life of work began. And at many schools in rural areas the children were learning a "trade" such as strawplaiting rather than the rudiments of reading, writing and arithmetic. In the official records of the day, the signatures of our uneducated or semi-educated ancestors were 'X' followed or suprascripted by the registrar's provision of their names. Even where an ancestor has signed his or her name there is little guarantee that that indicates full literacy. As we shall see, the lack of literacy on the part of those whose births, marriages or deaths were being registered or whose existence was being counted in a census affects the records.

As early as the late eighteenth century in Britain, Gentlemen had been making it their business to test the temperature of the populace at large. The French Revolution and its influences on English Republicanism, the growing disturbances in rural areas and small manufacturing areas (often one and the same place) in the forms of Ludd and of Swing, and later, of Chartism, the evolving industrial revolution with attendant developing gender sensibilities among an emergent manufacturing class, all caused the the few with money, power and in authority to be wary of the unwashed multitudes. The first decades of the nineteenth century saw several Parliamentary enquiries into What the Labourers were Up To and What Could Be Done About Them and Their Behaviour. Consequently, Parliamentary Papers provide rich pickings for historians who seek to know not only about how rural workers in, say, Gloucestershire lived, but also what some of them had to say about their work, living conditions and the labour of others. Of course, these sources are hardly unadulterated or unfiltered, if for no other reason than that the vast majority of the labouring classes accents and dialects would have been unintelligible to the visiting investigators. For the family historian these invaluable sources hold little direct evidence on individual people, unless one of your forebears was among those whose interviews were included in a report. Nevertheless, the reports do provide much background colour and depth for the family historian trying to understand how their ancestors lived and worked. Some reports, for example, contain much collateral information on the living and working conditions of certain groups of workers, particularly in the fields of mining, textiles and agriculture.

Many of these Parliamentary Reports are available in bound volumes, held in places like the National Archives, the British Library and its adjunct institutions in other parts of Britain and possibly in major Public Libraries like the one in central Manchester. It may well be possible to borrow individual volumes through InterLibrary Loan, even through a Public Library. I know that members of universities, students and faculty alike, can gain access to such records via this facility. Other reports are available on microfiche or microfilm; for instance, the 1841 Poor Law Commission: Report of the Special Assistant...on the Employment of women and Children in Agriculture is definitely available in university libraries in the USA on microfiche. If you can get hold of them or copies of them - do. They make for truly fascinating and riveting reading.

Most family historians approach their task by looking for and at familiar records: birth, marriage and death certificates. These public records are the essential building blocks for creating a family history. In England and Wales they only go back to the summer of 1837, when Civil Registration began. Before Civil Registration was initiated the only record of individual life and death events was held in Parish Registers and later in Dissenting sect records. Whether Civil , Parish or Non-Conformist register - the records are incomplete as to content and as to event. And the Parish records only reach back as far as the sixteenth century in a few places, not so far back in most.

Let us deal with Civil Registration first because that is where most of us can and should start. In the first decades of its existence, registration of a Birth was not even compulsory until 1875. Nor was it initially the parents job to report but rather the onus was on the local Registrar to seek out the births. Illness, temperament, lack of communication, poor roads - all could influence any given Registrar's ability to fulfil his duties. As for Marriages, if performed by a minister of the Church of England, were registered automatically because he could and did act as a Registrar. Other denominations' ministers could not. Moreover, among the Labouring Classes unofficial marriages continued to take place; these unions were legitimated by custom and community but not by officialdom. Those who married by common law have left no paper trail of their union, inadvertently denying their descendants a vital piece of the family history jigsaw puzzle. Deaths were supposed to be registered, but not all were. Thus Civil Registration records cannot be completely relied on to provide a full picture of a family's birth, marriage and death history - even when all of the information recorded on those that do exist is accurate.

As for what the certificates themselves can tell us, we need to be aware of two categories of error that can and not infrequently do afflict the certificates. The first category of error belongs to the those men (and they were assuredly men and of the middling to upper-middling sorts) who made the original entries and subsequent copies. And the second category derives from the "registrees" themselves: they frequently lied to the registrars about their ages, about their fathers' names and occupations and the addresses they provided were often those of "convenience" (for the purpose of Banns, for instance).

Let's examine the first category. Remember that many of the people registering births and marriages (we'll ignore deaths for the moment) were illiterate or only semi-literate. The registrars and other registry office workers were not; and they were of a higher social class. Their way of speaking - enunciation, accent, dialect - would rarely coincide with that of the local Labouring Classes. Names could be misheard or misunderstood; different officials could hold (and clearly did hold) varying views about how any given name was spelt. The result was a fairly wide variation in name spelling over the years and across the records. The illiterate registrees would have had no idea how their names were spelt; and the registrars would not have consulted them, in any case, assuming that they anyway knew best. This problem only gets compunded for the poor family history researcher! The photocopy of a certificate that we get from the General Register Office is but a copy of a copy of the original registry entry. At each stage the room for error increased. No handwriting is always and to everyone completely legible. And for some names the range of possibilities seems almost infinite: Reeves is one such name! Think about how many ways you could spell it and you'll see what I mean. It has been, and still can be, exceedingly frustrating and at times has led me to yelling robustly at the website I'm using.

The second category is potentially the more serious for the family historian: the lying or misleading that our ancestors engaged in when giving personal information to registrars. Age first, I think. (This problem also plagues the Censuses.) First and foremost, many people did not know exactly when they were born - that literacy thing again! If you were illiterate, you could not even keep a family record in a Bible, if you owned one. Nor could you have read your own birth certificate, should you have had one and should it have survived the travails and shifts of your life. Secondly, during the 19th century our ancestors did not think it a Good Thing when there was a great age difference between a couple. Quite how many years difference constituted a Bad Thing, I don't know, but maybe five or more and certainly ten or above. It really did not seem to matter to our great-grea-grandparents if the woman or man was the older partner; what mattered was how great the age difference. So people raised or lowered their ages to comply with the prevalent social standard. And of course those of minor age marrying without their parents' knowledge raised theirs to avoid legal constraints.

Name and Occupation of fathers only - here was an another opportunity to lie about or improve upon your background. For those who were born out-of-wedlock, and who had no clue about who their fathers were, not infrequently provided him with a name and a death. Others (like one of my great-grandmothers) created for their fathers what was to them a "posher" occupation (for her: "Coachman") than their real ones (in his case: "Iron Foundry Labourer"). I don't know who my great-grandmother was trying to impress, her husband or the registrar, but the result for me was months of futile searching for a Coachman who fitted the other parameters of his existence. Not that she was responsible for my deciding to dig around the back of the family closets!

The Addresses as given on the marriage certificate can also be fairly unreliable, at least as regards actual origins or residence. To be able to marry in a particular church (and in the 19th century that was where most marriages took place and nothing about the belief patterns of our ancestors can or should be construed from this ubiquity of church weddings; most of the lower levels of the English working classes had long been at the very least secular if not actually atheist) meant having to have an address in the church's parish. Some churches, Manchester Cathedral being one, were cheaper places to hold your wedding in than others; but the same rules of "residence" applied. Hence addresses of convenience - a dwelling which could be named as your place of abode for marriage purposes.

Many among the Labouring Classes did not marry by official means, probably for any number of reasons. The commonest reason for most of these marriages was the virtual impossibility of getting divorced. Common Law marriage allowed Labouring couples to engage in serial monogamy without running into legal problems. Not that all official marriages were between two single people - by no means! Bigamous marriages were not unusual in the 19th century, for the same reason that common law marriages were indeed common. Again in my own family, I can point to a (different) great-grandmother, who married three times; the first time officially, the second time unofficially and the third bigamously, her first and only "legal" husband being still alive in another county. (My link to her is through her second, unofficial marriage.)

So - are we to throw up our hands and say: "There is nothing we can trust!" No. For us as family researchers, we must always be wary of accepting at face value what any of the records tell us. But we are not without tools. Here is where learning something of local, social and national history - with all its complexities of gender and hierarchy and ethnicity - will help a lot. Such a broader and deeper understanding of the general histories of our families' pasts will help us to situate our specific ancestors and thus to better comprehend their lives and sometime lies.

Till next time!