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4 “An Institution for the Community and Not Narrowly Sectarian”: CATHOLIC HOSPITALS, 1880–1925 The parade was one that did credit to the event that was being celebrated and it was watched with much interest by the throngs that lined its course. The societies that took part represented many different interests, showing an appreciation of the fact that St. Joseph’s Hospital was to be an institution for the community and not narrowly sectarian to any degree.1 South Bend Times, April 21, 1903 Under a rare warm sun in April 1903, Catholic officials placed the cornerstone for a new addition to St. Joseph’s Hospital in South Bend, Indiana. It involved an impressive ceremony that started at St. Patrick’s Church and included a parade of civic and religious societies, posts from the Grand Army of the Republic, and an imposing procession led by Bishop Herman J. Alderling. Thousands thronged the parade line. This auspicious ceremony reflected the broad base of support that sisters and the Catholic Church actively sought. The links nuns forged to make hospital building possible are important elements in the story of the medical marketplace after 1880.2 Although hospital growth had clearly begun before 1880, changing social and economic conditions led to an aggressive expansion of hospitals in the last quarter of the nineteenth century and the first quarter of the twentieth. During this time, institutions became increasingly tech74 Wall_CH4_3rd.qxd 4/11/2005 2:53 PM Page 74 nological and market-based.3 Catholic sisters continued to carve out their own niche: in a 1910 government census, Catholic hospitals accounted for one-fifth of all the hospitals responding, and most were under nuns’ direction .4 In recruiting patients, sisters had to negotiate in a society in which gender, race, class, religion, and ethnicity were important variables. Entrepreneurship is a central characteristic of the actors in this chapter . Sisters took responsibility for building construction and the risks that accompanied large capital improvements, sought patients, and provided them with specific services. In addition, nuns gave doctors a site for certain forms of medical practice, providing them opportunities to practice private medicine without having to invest their own money.5 Sectarian rivalries within local and regional communities pressured sisters to improve their medical and nursing facilities so that they could remain competitive. In addition, the needs of local and regional communities for hospital treatment grew. Mainly, however, sisters believed their presence would create a beneficial environment for anyone facing a health crisis, and they especially wanted to provide quick spiritual care to any Catholic in need. During this period, sisters had to compete not only with voluntary and public hospitals but also with institutions founded on different principles . Physicians had responded to competition by establishing proprietary hospitals, which operated to supplement the wealth and income of owners. By contrast, not-for-profit voluntary and religious hospitals took no share of hospital income to enhance owners’ personal wealth. Physicians also had developed specialties such as ophthalmology and obstetrics and had opened their own institutions for this new kind of practice. All of these institutions experienced increased financial pressures and competition. One of the defining characteristics of hospitals during this period was the way the power of science increasingly affected hospital decisions. By 1925, the American hospital had become an institution with recovery and cure the goals to be achieved by professional personnel and increasing medical technology. Like secular hospitals, Catholic hospitals functioned with the advantages of x-rays, laboratories, and aseptic surgery, making hospital operating rooms, with all their technical equipment and specialized personnel, the safest and most convenient places to perform surgery.6 Reflecting these transformations, the physical layouts of hospitals grew considerably. Expansions were consistent, although the sequence depended on when the sisters established the hospitals, what funds were available, and the degree of denominational competition in the area. In 75 “An Institution for the Community” Wall_CH4_3rd.qxd 4/11/2005 2:53 PM Page 75 the details of the hospitals’ programs of growth, one can obtain a view of the importance of local markets, religious and ethnic influences, and scientific imperatives. As hospitals grew in number and complexity, members of the lower classes and the working poor, such as laborers, domestics, factory workers , and small craftsmen, entered them, as did larger numbers of the middle classes. Scientific medicine, surgery, the professionalization of medicine and nursing, and an emphasis on efficiency and order changed the character of hospitals. Growing deficits led administrators away from charity...


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