It is a biography of the woman to whom the contract was given for the care of the poor of Lincoln County from 1923 until 1934.

On-line reviews of the book describe it as follows: "Award-winning author, Nellie Snyder Yost, weaves recollections, interviews, newspaper accounts and court documents into a horrifying but readable story of farm wife Annie Cook's part in "the little Chicago of the west" era of North Platte, Nebraska, history."

The book is a real "page-turner"...except for one thing. My revulsion at the sadistic abuse and neglect which is so excruciatingly detailed frequently reached the point that I had to put it away in disgust.

Unfortunately, it is absolutely necessary to acknowledge that such abuse happened; and it happened in many other communities around the country. Perhaps only the degree of the neurotic and sadistic behavior was remarkable in this case. While these horrors were not the rule ... the poorhouse system itself was an invitation to graft. In many areas, poorhouses were inadequately inspected and/or audited. Nepotism was extremely common and fraud by the greedy often exploited the poorly managed system.

And, lest we become complacent in our assumption that ... "It couldn't happen here or now." ... we need to realize that any system which contracts with people to provide services to people who are poor, elderly, vulnerable because of youth or sickness on the basis of a fixed flat cost-per-person and which implicitly allows the withholding of services as a way to make a better profit for the owner of the contract ... we have a potential for abuse.

[Note: By profession I am a health care provider. Today's managed health care programs are subject to the same temptations. When contracts are offered to the lowest bidder, we need patient advocacy to make sure that patients rights to the services they need are respected by those who tend to profit more if services are minimal. Remember that the next time you get upset that your doctor "won't take (your) insurance plan" ... s/he may be refusing to do so for moral or ethical reasons rather than because of any greedy desire to make more money than the plan allows. And the cheapest plan (in terms of the price of premiums -- or in the Annie Cook story, lower taxes .. may be very costly in terms of the suffering that a lack of adequate services can produce. Of course, an Annie Cook would have no qualms about accepting a contract that allowed only very low reimbursement for each person in her care -- she could deny food, heat, adequate hygiene, etc. and still make a tidy profit!]

I feel sorry not only for those who suffered directly at that time, but also for those folks who may discover that their ancestors may have been "cared for" by the likes of Annie Cook. The book is bound to be extremely upsetting to them. But it is true that a knowledge of failures in the history of how we delegate the care of those less fortunate may be the only thing that helps us guard against such abuses now and in the future.

PHL