Catholic sisters were a powerful force in the making of the U.S. healthcare industry. But until an influential group of mostly women historians began to write about the contributions of Catholic sisters at the end of the twentieth century, few scholarly accounts extolled their significance. Standard textbooks and journal articles proclaimed the role of doctors, philanthropists, politicians, businessmen, and reformers while largely neglecting the sisters'' Importance. Yet it was Catholic sisters--not doctors, priests, or bishops--who founded and established the vast majority of Catholic hospitals which in 2020 comprised over fifteen percent of all U.S. hospitals.

How did they do this? How did Catholic sisters forge a vast network of hospitals across the country in the nineteenth and twentieth centuries while facing societal constraints and ecclesiastical restrictions on them? How did they contribute to the formation, growth, and development of the U.S. healthcare industry? For several reasons, this book focuses on one group of Catholic sisters, the Daughters of Charity (the "Daughters"), to answer these questions. While several Catholic communities deserve consideration for their contributions to nursing and hospital administration (and some have received it), few can match the scale and scope of the Daughters'' undertaking. The Daughters began their healthcare ministry in 1823 at the Baltimore Infirmary (today''s University of Maryland Hospital), and in 1828, they founded the nation''s first hospital west of the Mississippi River, known as "Mullanphy" (later DePaul Hospital). Both events preceded by years and decades the arrival of other nursing sisterhoods. Donning their large white-winged cornettes, the Daughters mended the wounds of soldiers in the Civil, Spanish-American, and First World Wars. They provided food, clothing, and care to poor immigrants who came to the U.

S. from Ireland, Germany, and other countries. And they served America''s sick poor during severe epidemics, including cholera, typhus, typhoid, and yellow fever. Before the end of the nineteenth century, the Daughters'' geographic reach extended from Boston to Los Angeles, from Buffalo to New Orleans, and from Baltimore to St. Louis. In 1986, the Daughters formed the largest private, nonprofit hospital chain in the country, the Daughters of Charity National Health System, consisting of forty hospitals and three nursing homes in seventeen states and the District of Columbia. Throughout their two-hundred year history, the Daughters operated at the cutting edge of U.S.

healthcare delivery. They contributed to the development of nursing as a profession through uniform preparation, supervised training, and a written code of conduct which stressed the fair and ethical treatment of all patients. They pioneered health administration by stressing order, discipline, accountability, efficiency, and sanitation. They extended healthcare services beyond the inpatient setting through outpatient clinics, community health centers, and alliances with local and regional public health facilities. And they honed hospital finance and delivery, the integration of hospitals and related institutions, and the creation of specialized facilities for the elderly, the mentally ill, and women and children. Founded in France in the early 1600s by Vincent de Paul (canonized as a saint in 1737) and Louise de Marillac (canonized as a saint in 1934), the Daughters represented a "new form of religious life"-- "active" and "uncloistered"--which meant that they did not live in convents apart from secular society. Instead, they lived and worked among the persons they taught or cared for, in schools, hospitals, homes, and apartments. After overcoming early opposition from the French clergy to their "active spirituality," the Daughters attained substantial geographic reach and mobility during the seventeenth and eighteenth centuries.

From their motherhouse in Paris, their central location for administration, oversight, and formation for service, the Daughters established missions throughout the world in countries such as Spain, Italy, Mexico, Turkey, Poland, and China. Their work inspired other groups of Catholic women, among them the Sisters of Charity of St. Joseph''s (the "Sisters"), which Elizabeth Ann Seton (canonized as a saint in 1975) founded in 1809. In 1812, the Sisters adopted the Daughters'' rules and regulations, their form of governance, individual behavior and decorum, spiritual practices, and daily regimen. Still, the Sisters were a separate community until they officially joined the Daughters in 1850. In 1850, the Sisters (now Daughters) became a province (the "U.S. Province") of the International Company of Daughters, and changed their attire to the Daughters'' white-winged cornette and blue-gray habit.

While the French Daughters'' rules and constitution provided a strong foundation, the American Daughters'' trajectory differed from that of their French sisters largely because the U.S. was different--socially, politically, and economically. Unlike the French Daughters, the American Daughters could own hospitals, giving them important economic and political advantages in a nation that was in its early stages of development. There was no dominant infrastructure in the U.S. as in France or other European countries, no established traditions, laws, governments, or institutions to deter their activities. Though prejudice against Catholics and normative constraints on women impeded their efforts, hospital ownership mitigated these barriers.

In their dealings with bishops, doctors, and government officials, ownership provided significant leverage. The question was not whether the Daughters could participate in the struggle to shape and define healthcare delivery in America. Rather, the question was how and to what extent they would do so. (Excerpted from Introduction).