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Introduction In 1877, Sister Lidwina Butler sat in the dimly lit steerage compartment of a trans-Atlantic sailing vessel, her thoughts no doubt shifting between the Ireland she left behind and the New World she would soon embrace. Few in this last great wave of Irish emigrants could have foreseen that this youthful nun would one day become the administrator of a major Catholic hospital. And certainly most American citizens, many of whom viewed the Irish as the dregs of society, would not have imagined her ascension to such a challenging and respected position. Although Sister Lidwina’s personal story was in no way unique—many other Europeanand American-born women were equally as successful—it is used now to personify the personal, spiritual, and business journeys of Catholic women who helped to establish the modern hospital system in the United States. Sister Lidwina was one of the ubiquitous Irish nuns whom religious orders entrusted with hospital administration.1 Born Annette Butler in County Kilkenny in 1850, she received her education from the Sisters of Loreto in Rathfarnum, where girls from upper- and middle-class families received a high-quality education. After her mother died when she was a girl, Annette had to manage the large household. In 1876, she joined the Congregation of the Sisters of the Holy Cross. When she made her final profession of vows in 1879, she was given the name Sister M. Lidwina. Her household management skills were early training for the executive tasks she would later undertake in two different hospitals in the United States. Following assignments in the infirmary and dormitory at the motherhouse in Notre Dame, Indiana, she became superior of St. Lawrence Hospital in Ogden, Utah, and later served in this same capacity for eighteen years at Holy Cross Hospital in Salt Lake 1 Wall_Intro_3rd.qxd 4/11/2005 2:46 PM Page 1 City.2 The hospital underwent tremendous growth under her direction. She set admission policies, protected the hospitals’ assets, and promoted it to the press and general public. She controlled equipment purchases, nursing assignments, and billing procedures. Sister Lidwina was known as a straightforward woman who could be quite formidable, and she often would exercise those personal traits in her role of approving all medical staff admissions and dismissals. This illustration shows an important aspect of a woman’s religious vocation: the entrepreneurial task of building an enormous health-care empire. Sister Lidwina built a large institution and controlled not only its personnel but also its finances. Another aspect of a religious vocation for Catholic women included the service-oriented role, although initially it was not clear what each nun’s specific work would be. Sisters were frontline nurses during wartime and in hospitals across the United States.They provided care for physical sustenance, but equally important, they also tended the dying, giving spiritual care and saving souls. In this book, the hospital activities of three orders of Catholic nuns are explored. Each has a long history in health care, and each was chosen because of different geographic locations and historical missions. The examination centers on the Sisters of St. Joseph of Carondelet from St. Paul, Minnesota; the Sisters of Charity of the Incarnate Word from San Antonio, Texas; and the Sisters of the Holy Cross from Notre Dame, Indiana. Each group embodied the issues of gender, religion, and ethnicity that animated the move westward. The book details sisters’ establishment of hospitals during a key transitional period: from 1865, when Catholic hospitals first experienced significant growth as communitybased , religious institutions, to 1925, when they transformed to expensive, modern hospitals of science and technology. Much of hospital history tends to focus on large eastern institutions in New York, Boston, and Philadelphia, but this book centers on the more numerous smaller hospitals in the Midwest and Trans-Mississippi West where gender roles, religion , economics, and local political independence and power were contested issues with distinct histories from eastern hospitals. Seven representative hospitals in Indiana, Texas, Minnesota, Utah, and Illinois have been chosen for study, with references to other hospitals and women’s religious orders for comparison purposes. Significantly, in these areas nuns strengthened their influence among a growing, diverse population . Between 1865 and 1925, the three congregations operated and owned more than forty hospitals in the Midwest and Trans-Mississippi West. They included general hospitals as well as facilities for mining, marine, 2 Introduction Wall_Intro_3rd.qxd 4/11/2005 2:46 PM Page 2 and railroad patients who did not...


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