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Preface This book analyzes Catholic sisters as entrepreneurs in hospital development in the late nineteenth and early twentieth centuries, in the full context of the social, cultural, economic, and medical history of the time. Historical argument is used to highlight the fundamental thesis that sisters created hospitals where a specific, socially beneficial type of care could be provided and purchased. This approach constructs and interprets the history of Catholic health-care institutions, the sisters who founded them, and the complex forces involved as they attempted to negotiate in the medical marketplace in the late nineteenth and early twentieth centuries. The book shows the interaction between women’s religious roles and broader economic roles of creating viable health-care institutions by exploring how boundaries and norms about health care are created in a market-oriented society. When immigrant nuns came to the United States in the late nineteenth century, they encountered a market economy that structured the way they developed their hospitals. Sisters enthusiastically engaged in this market as “entrepreneurs,” but they used a set of tools and understandings that were counter to the market. Their entrepreneurship was not to expand earnings but rather to advance Catholic spirituality. The sisters’ story is important for several reasons. First, it illuminates the interplay between religious and secular institutions and the place of that interplay in American social history. Second, the history of nuns’ work in health care in the United States illustrates the fundamentally gendered story of hospital foundations and what was to become the nursing profession. Third, it deepens understanding of the evolutionary development of consumerism by demonstrating how seemingly opposite topics xii Wall_FM_3rd.qxd 4/11/2005 2:46 PM Page xii such as commercialized exchange and spirituality can be interwoven. Last, the economic milieu in which the sisters found themselves, and the way they seized opportunities offered by the market economy to build healthcare institutions and services, is a vital and thus far missing element in the history of the American health-care system. The book comes at a crucial time in contemporary health-care debates. Hospitals were and still are places where both curing and death occur, and hence, places of important work.1 In 2003, spending for health care in the United States reached $1.7 trillion, or 15.3 percent of the gross domestic product. Hospital care expenditures totaled $515.9 billion, representing one-third of total national health spending.2 Furthermore, although the Catholic Church is one of the country’s largest private suppliers of health services, sisters’ attendance has been markedly diminished. As a result, Catholic hospitals barely resemble their predecessors of the late nineteenth and early twentieth centuries when the nuns’ presence dominated. Healthcare institutions that nuns have continued to manage have become increasingly bureaucratized and professionalized. What has been gained with these evolutionary changes? What has been lost? In the modern healthcare climate, with the influences of national corporations, federal laws, spiraling costs, managed care, and medical practices that rely increasingly less on human judgments and increasingly more on technological innovations, the “modern” hospital setting reflects a dim memory of the institutions of the past. What issues will influence how government officials, managedcare providers, and other health-care planners respond to these changes? Who will provide hospital care as the sisters depart, and how will costs be met? Who will receive care, and who will be denied quality health services? This historical research informs these debates. My background as a trained historian and nurse will enrich historical perspective. The methodology has involved seeking and evaluating evidence in primary sources that are located in sisters’ archives, many of which have not been made public before. These include nuns’ constitutions; official community records called “annals”; in-house circular letters; correspondence among sisters, clergy, and medical authorities; hospital chronicles and ledgers; prayer books, spiritual formation guides; sermons; and religious retreat records. While much of sisters’ in-house correspondence reveals important aspects of their work, they often were written with a need to explain accomplishments to superiors. While attemping to present the sisters in as favorable a light as possible, they do not show evidence of any neglect in duties, which in all probability occurred. However, when viewed within the larger body of available evidence, indications of resistance sometimes show through. Other primary sources include minutes of xiii Preface Wall_FM_3rd.qxd 4/11/2005 2:46 PM Page xiii nurses’ and physicians’ meetings; annual reports; account books; census reports; secular, diocesan, and ethnic newspapers; photographs; early city...


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