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Conclusion By 1922, statistics from the Catholic Hospital Association (CHA) showed that approximately twenty thousand sisters were caring for the sick in the United States and Canada. From the time of their inception, 675 Catholic hospitals, run mainly by nuns, had cared for four million patients.1 Catholic sisters were leaders in the CHA and held the voting power. This book set out to more closely examine how this came about. One of the major themes has been the complex ways in which religious women participated in a market economy. By the late nineteenth century, a more urban and industrial era had come of age. In that context, Catholic sisters entered a capitalistic medical marketplace that had developed as immigration brought diverse cultures and religions across the United States. An entrepreneurial ethos emerged among nuns, influencing them to build their congregations and establish, market, finance, and administer complex hospital networks. In the process, they worked with architects , supply companies, contractors, bankers, industrial owners, physicians , and clergy. Sisters’ efficient administration of hospital corporate structures showed that women could be as successful as men in a growing medical marketplace.The leadership and authority of women such as Sister Lidwina Butler, along with scores of other hospital administrators, defied the stereotype of nuns as passive religious women. Limited endowments meant that Catholic hospitals had to depend on patient fees from the very beginning to carry out their work. Thus, because of economic realities, they were never strictly charity institutions. To maintain financial viability, nuns themselves provided the labor in the early years, although they increasingly transferred nursing care to lay stu186 Wall_Conclusion_2nd.qxd 4/11/2005 3:01 PM Page 186 dent nurses who worked in exchange for their education. Sisters also established bonds with individuals, church leaders, business groups, and local governments. They forged these links because they believed that their nursing and hospitals were integral to the Catholic Church’s ministry . Indeed, institutions had more power to reach people than did individuals . By 1925, all seven hospitals had tremendously expanded their purchasing power. At the same time, questions about hospitals’ reputations , either from the local community or from physicians, could decrease public support, which, considering the competitive medical marketplace, could carry devastating consequences. Indeed, not all sisters’ hospitals were successful. Failures were linked to numerous factors, which included poor planning, unrealistic visions, changing local markets, lack of physicians ’ support, or inadequate governmental and public backing. In the late nineteenth and early twentieth centuries, Catholic hospitals in the Midwest, Texas, and Utah followed much of the standard patterns as those in the East. They expanded in response to social and medical needs, ideas about the germ theory, antiseptic and aseptic surgery, and new technology. In other ways, however, geographic location seems to have accounted for some differences. The Catholic hospitals represented here followed a pattern suggested by Paul Starr.2 Compared to elite eastern voluntary hospitals that preferred closed medical staffs, Catholic hospitals in the Midwest,Texas, and Utah were open to many qualified physicians . Most of these hospitals also had fewer close ties to large university medical schools. They were more likely to admit patients from diverse backgrounds, including those with tuberculosis, alcoholism, and mental disorders. However, while one might easily conclude that frontier conditions in the Midwest and Trans-Mississippi West allowed sisters greater hospital autonomy, Kathleen Joyce found similar situations in eastern hospitals in which sisters exerted unusual authority.3 A second theme of this book has involved the place of gender and religion as frames of reference for understanding sisters’ participation in the hospital marketplace. These were single women who lived in a communal relationship with each other.Through their vow of chastity, they distanced themselves from other women, thereby claiming the respect due them as Roman Catholic sisters. By professing religious vocations, they left behind many of the traditional gender restraints experienced by secular women, and they expanded their activities in the public arena. An important ingredient in their success in dealing with others was their religious image, which included the language they used. When making business proposals or asking for special considerations, they emphasized spiritual aims rather than their own. Even though nuns’ vows called for anonymity, 187 Conclusion Wall_Conclusion_2nd.qxd 4/11/2005 3:01 PM Page 187 they were able to use their religious identities to good advantage as they negotiated within and outside hospital walls. Indeed, their religious mantle afforded them special respect and status, and this implicit authority helped them secure higher...


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