Ministry and Meaning: A Religious History of Catholic Health Care in the United States (review)

The history of health care in the United States has been so profoundly shaped by Roman Catholic sisters that one wonders why it took so long for such a book to appear. The first university-affiliated infirmary in the United States, at the University of Maryland, was staffed by five Sisters of Charity in 1823. Twenty percent of the nurses in the U.S. Civil War were sisters. Sisters braved smallpox and anti-Catholic prejudice to staff hospitals for settlers, regardless of denomination. Several Catholic institutions developed prepaid health plans in the late nineteenth century. Dominican sisters opened a cancer hospice in New York City in 1899. Forty percent of the nursing schools in the country in 1933 were Catholic. By 1965, there were 13,618 sisters serving in 803 Catholic hospitals throughout the United States.

Kauffman’s history is gracefully and clearly written, well documented, and thoroughly enjoyable. This is not a sugarcoated fairy tale, but a careful chronicle of the struggle of vowed religious women against both ecclesiastical and social obstacles as an immigrant Church tried to find ways to serve its own people, preserve its identity, and find a niche within an emerging pluralistic republic. Some of these struggles persisted until the second half of the twentieth century, when sisters might be administrators of $3 million-a-year operations and yet be forbidden to leave the cloister on weekends to attend meetings.

Kauffman does a good job identifying the underlying spirituality of the sisters. They found in the sick poor the alter Christus, whom they strived to serve with “purity of intention” (p. 6). Kauffman also nicely details how the texture of that spirituality evolved from one of heroic self-sacrifice to one of enlightened Catholic professionalism as the nation, medicine, and the American Catholic experience all changed over the decades. Less careful historians might overlook this, but it impossible to understand the success of these sisters without understanding their spirituality.

Despite the fact that the sisters are the real focus of the book, Kauffman spends a good deal of time describing the priests who were the first presidents of the Catholic Health Association (CHA). This organization was largely one for the sisters and their institutions, but in a Church that was (and still is) dominated by men, they were lucky to find a few male champions. Another irony is that the CHA became a strong force arguing against national health insurance in the 1930s, on the grounds that this would threaten the independence of Catholic hospitals and would depersonalize medicine, thereby interfering with the ability to view sickness and healing in fundamentally religious terms. By the 1980s, it became clear that market forces were the real threats. The CHA has now reversed its position, but perhaps too late.

There are some limitations to the book. For instance, there is no attention to the history of Catholic medical schools in this country. Further, there is undue attention to sisters in the Baltimore-Washington area, and relative neglect of several other major groups. Finally, Kauffman’s treatment of the current situation of Catholic health-care institutions in the United States seriously underplays the effect of declining vocations. But it is probably a form of praise to criticize an author for not having written more. Ministry and Meaning is a major contribution to the historical understanding of health care in the United States.