Say Little, Do Much: Nursing, Nuns, and Hospitals in the Nineteenth Century

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Nearly half a century before Florence Nightingale became a legendary figure for her pioneering work in the nursing trade, nursing nuns made significant but little-known accomplishments in the field. In fact, in the nineteenth century, more than 35 percent of American hospitals were created and run by women with religious vocations. In Say Little, Do Much, Sioban Nelson casts light upon the work of the nineteenth-century women's religious communities. It was they who organized and administered home, hospital, epidemic, and military nursing in America as well as Britain and Australia. According to Nelson, the popular view that nursing invented itself in the second half of the nineteenth century is historically inaccurate and dismissive of the major advances in the care of the sick as a serious and skilled activity, an activity that originated in seventeenth-century France with Vincent de Paul's Daughters of Charity.

In this comparative, contextual, and critical work, Nelson demonstrates how modern nursing developed from the complex interplay of the Catholic emancipation in Britain and Ireland, the resurgence of the Irish Church, the Irish diaspora, and mass migrations of the German, Italian, and Polish Catholic communities to the previously Protestant strongholds of North America and mainland Britain. In particular, Nelson follows the nursing Daughters of Charity through the Revolution and the Second Empire, documenting the relationship that developed between the French nursing orders and the Irish Catholic Church during this period. This relationship, she argues, was to have major significance for the development of nursing in the English-speaking world.

Placing the evolution of the nursing field in the context of a complex array of religious and social conflicts, Say Little, Do Much appropriately counters the tendency of historians to ignore the place of religious institutions in American social history.

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Editorial Reviews

From the Publisher
"A convincing picture."—New York Times

"The most significant contribution to the literature on nursing history in decades."—Journal of Community Nursing

"Required reading for all nurse historians who seek to understand the difficult and complex role of religious women who served nursing prior to our modern era."—Nursing History Review

"Well-researched, scholarly, clearly written, and nicely analyzed, this work makes a significant addition to the historiography of nursing."—Choice

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Product Details

  • ISBN-13: 9780812236149
  • Publisher: University of Pennsylvania Press, Inc.
  • Publication date: 7/30/2001
  • Series: Studies in Health, Illness, and Caregiving
  • Pages: 240
  • Product dimensions: 6.42 (w) x 9.34 (h) x 0.86 (d)

Meet the Author

Sioban Nelson is Senior Lecturer in the School of Postgraduate Nursing at The University of Melbourne.

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Read an Excerpt

Chapter One

"Say Little, Do Much"

Veils of Invisibility—Nursing Nuns

Some years ago at a North American nursing conference I delivered a paper on religious nurses and their impact on the nursing profession and the health care system. When I had finished, a woman stood to make a statement. She told the conference that she was of Boston Irish Catholic stock. She had worked as both a bedside nurse and a senior administrator at a number of Catholic hospitals owned and managed by sisters. Yet when she undertook her MBA and focused her major paper on women in senior health care management, she had found none. The literature told her there were none; she analyzed this deficiency from a feminist perspective and duly received a high grade. After hearing my paper she realized her error — the women were there, she'd even been working for them at the time. Yet, somehow, she had not been able to see them.

    In what follows I focus on this blind spot. I look closely at religious nurses, their work, and its impact, aiming to integrate the history of religious and secular nurses into the story of the emergence of professional nursing. The intention is neither critical nor celebratory. The fact that religious nursing is argued to have been formative of professional nursing in profound and far-reaching ways is not intended to provide a rationale for the "return" to a religious or spiritual basis for nursing practice. It is historical observation. Nor are the religious nurses, with their powerful vocational imperatives, blamed for subsequent dilemmas in the professionalization ofnursing — for its poor pay, its lowly professional status, its gendered character. Again, the vocational origin of respectable nursing is historical observation — it cannot be escaped.

    Neither are nineteenth-century religious nurses argued to be feminist in any way — latent, nascent, or crypto. Religious life was not about individuals but about communities of women. These women did not care for franchise or working conditions. They were on God's mission, and their spiritual training enabled them to turn hardship and adversity into spiritual exercises in obedience and humility. Necessity made them mothers of invention. Moreover, in the United States a good proportion of these women were European. The battles and preoccupations of their Protestant sisters were a world away from their daily lives as immigrant nuns.

    But despite the eradication of self through total obedience striven for by religious women, despite their spiritual practices performed to achieve Christian perfection through this erasure, and finally, despite their obedience to clergy and the narrow confines of religious life, these women constituted a powerful social movement. They were singleminded missionaries whose faith in God's will and belief in the miraculous enabled them to achieve far more than any group of individual women could ever have accomplished. They were the means to the creation of a Catholic world in the New World, and the foundations they laid for the work of all women in the pastoral domain has never been subject to the scholarly scrutiny it deserves.

    I approach this subject matter as a nursing historian of Irish Catholic background, a background that I believe equipped me to recognize traces of Catholic culture, even when removed from its doctrinal context. As a student nurse (armed with a history degree) in a public secular hospital, I was often struck by the religiosity of nursing training. The weighty moral framework and conventual model of practice under which so many programs operated were, in my view, unpleasant reminders of my convent schooling. But I was even more struck by a general lack of recognition of this legacy, even as we registered nurses in Australia in the 1980s were still called "sister" and in some hospitals expected to wear veils.

    Furthermore, my Irish sensibilities were offended by the ostensible Englishness of nursing history. How did the story of modern nursing and hospital reform become an English one? In Australia the old nursing schools all proudly laid claim to their Nightingale heritage, and the Imperial flag-waving that once upon a time accompanied this allegiance included the exclusion of Irish Catholic girls. Catholic girls had their own hospitals — St. Vincent's or Mater Misericordia — hospitals seldom mentioned in the nursing histories. But it seemed to me that at least in these hospitals the title "sister" and the veils made sense — their heritage openly acknowledged, not bizarrely rescripted as an English secular invention.

    Unlike the triumphant Nightingale nurses whose story obscures them, religious nurses, Catholic nuns, Anglican sisters, and deaconesses are difficult to see and discuss — particularly in a collective sense. To overcome some of the difficulties entailed in crossing the confessional boundaries (the divisions between Christian religious sects or groups that define them as Roman Catholic, Methodist, Lutheran, and so forth) that still dictate our understanding of these women, I adopted the generic term "vowed women." This notion allows us to speak collectively about those women who separated themselves from the rest of the world to live in a community according to a set of religious precepts. Technically the deaconesses did not take vows — though they were consecrated and "set apart." Anglican sisterhoods were not supposed to take vows, but they did. Catholic women were all vowed. The "active" communities, however, whose work took them beyond the convent walls, took what was termed "simple" vows; lifelong solemn vows belonged only to women bound to the cloister and "dead" to the world.

    The term vowed women emphasizes the fact that these were simply women who took a voluntary vow. Second, vowed women produced vowed labor. It was the vowed labor of these women that built so much of the health care system that we take for granted today. Their labor was a phenomenal resource for Christian churches, most notably the Roman Catholic Church — it created Catholic institutions and shaped Catholic life in the New World.

    The story of nursing addressed in this book concentrates on the English-speaking world of North America, Britain, and Australia. This awkward categorization represents the best educated and best paid nurses in the world today. These were all ostensibly Protestant countries which, until the Catholic diaspora of the nineteenth century, were dominated by Protestant values and anti-Catholic sentiment. They thus provided a consistent and particular milieu for the work of the Catholic sisterhoods. It was a milieu that expressed strong reservations over the entry of Protestant women into the world and into professional life. It was a world that was fraught with anxiety over the rising profile of Catholicism and the large numbers of immigrant Catholics. It was a world where social reform movements occupied the intellectual energies of many. And finally it was a world that held romantic notions of Sisters of Charity and Gothic fantasies about Rome, convents, and nuns.

    For its part the Catholic Church had to build its institutions and minister to its immigrant millions in an English-speaking world — an alien world for the church when only a tiny proportion of its nineteenth-century followers even spoke English. The nursing nuns who built a Catholic empire in the English-speaking world were largely immigrant women. They were part of a vocational wave of European women who were building institutions and creating services for the poor. They were doing all this long before the emergence of the modern hospital and scientific medicine. But when these trends did appear the sisters were already old hands at a new game.

    Care of the sick as a serious and skilled activity is argued to have emerged in seventeenth-century France with Vincent de Paul's Daughters of Charity. The opening up of the pastoral domain as the site of expertise and government has been well examined by scholars in the fields of poor law, psychiatry, and prison reform. However, the role of pious women in this government of the poor has received little attention. The achievements of these women in France were of direct relevance to the subsequent development of nursing in the English-speaking world. In particular, the connection between these French events and the Irish Catholic Church is argued to be of major significance. The Irish diaspora brought a flood of women to the New World as novices and nuns, and also produced the first and second generation of convent entrants. This is a complex story involving Catholic emancipation in Britain and Ireland; the resurgence of the Irish Church; the Irish diaspora and mass migrations of German, Italian, and Polish Catholic communities to the previously Protestant strongholds of North America, Australia, and mainland Britain (the United Kingdom minus Ireland); and political turmoil, such as the Nativist movement in the United States. The care of the sick occurred in the context of these religious and social conflicts, and the work of the nursing nuns was part of, and significant to, the broader goals of the Catholic apostolic mission.

    Of course the first women to be nursing and building hospitals in the New World were the women of New France — Jeanne Mance and Marguerite D'Youville, founders of the Hôtel de Ville in Montreal and the Grey Nuns respectively. The contribution of these Canadian religious nurses to the development of the nursing sisterhoods in Canada and the United States is immense. But the story in Canada is truly distinctive when it comes to the notion of the English-speaking Protestant world — because Canada was two countries, one Catholic and one Protestant. The tensions and dynamism that characterized the work of Catholic women in the Protestant English-speaking worlds of Australia and the United States were very different from the tensions between Catholic French Canadians and English-speaking Canadians — tensions much complicated by issues of sovereignty and national identity. For this reason the Canadian situation warrants special investigation and has not been covered in the current research. I do, however, deal in depth with one group of French Canadian women, the Daughters of Providence, missionaries in the Northwest of the United States.

    In the nineteenth-century social landscape of Australia and North America, Ireland, and Britain, Catholic nuns were everywhere — abroad in the world like no other women. They ran corporations, dealt with national governments, journeyed on fact-finding missions — crossing the country, indeed the world, in search of recruits, funds, and ideas. They dealt with banks and businessmen with a lawyer's mind, mastered the tendering process for private and state contracts with a mixture of faith and business acumen, dealt with boards of notaries and hostile bishops as a matter of course. These women did nott speak from platforms at temperance meetings, they did not write memoirs, they did not express a political or sexual critique of contemporary society. Importantly, neither did these women seek the path of individual progress and personal development, but embraced anonymity. They mobilized the ancient techniques of the cloister to "eradicate" self and become the mere expression of their holy rule. They were institution builders, workers for the poor and for their church. As St. Vincent de Paul had admonished them, they said little and did much. They were, as we will see, "Marthas" — hardworking, resourceful, and indefatigable.

    The aim of this work is not to claim territory for religious women but to eradicate the divide that separates these women from their non-vowed sisters, and to resituate the emergence of modern nursing within the religious and pastoral domains of nineteenth-century society. In reality, the nineteenth-century nursing innovators were all religious women. The very notion of "secular" meant something quite different in the nineteenth-century context. It meant "nonsectarian" — not formally affiliated with a religious sect, not "without religion." The distance between Catholic, Protestant, and secular women was writ large in the nineteenth century. This religious and social distance discursively situated secular nurses as the "new wave" of nursing reformers — a positioning that was of major importance in the Nightingale story. At the same time as the work of the vowed nurses was ignored or trivialized, always depicted as a preparatory stage to real nursing, the religious and vocational ethos of the Protestant reformers was erroneously endowed with a purely secular basis.

    However, the historiographical problem confronting the study of religious nurses has been not just with the issue of religion, but with the usual focus on secularization (as the starting point of nursing). I would argue that this focus on secularization has obscured the mechanisms activated by nineteenth-century women to colonize new territory — territory that was to become gendered professional territory. Also obscured is the relationship between vocational ethos and the emergence of a role for women as part of a professional work force. One of the barriers to making visible and rethinking the nursing nuns has been the idea that these women were "pre-professional." Professions cannot include vowed women — the nuns are not independent, they are obedient and follow whatever path is decreed for them by their superiors. Doctors and lawyers are professional. Nursing may or may not be a profession, depending on the definition used. However, a religious woman — even if she runs the largest public institution in a city of five million, holds higher degrees, and plays a leading role in professional associations — is never professional. The barrier in essence is the tacitly accepted view that there is a division between the world of religion and the world of work. Almost by definition, then, secularization becomes the only means to professionalization. By contrast, what is proposed here is that nursing emerged as a hybrid religious and professional practice. Its continuing ambiguous and ambivalent fit with models of professions is a legacy of those origins.

    Finally, it needs to be made clear that, while this particular story of nursing has European origins, it took on a distinctive gloss in the New World. For the Catholic sisterhoods, Protestant hostility and the impoverished state of the Catholic Church, combined with the wider community's desperate need for the skills and expertise of the sisters, worked to produce a new variation of the nursing religious sister. This was not the Catholic nursing sister of Europe — the sister-nurse of the New World was a new creature. To live by her wits in the New World she had to be professional and accountable; she had to be innovative and entrepreneurial; finally, she had to understand the politics and economics of her domain to be self-funding. She, in turn, had a major impact on the way nursing in North America and Australia came to achieve a high level of professionalism in the twentieth century. O'Connell points out that at the time of the Second Vatican Council (1962), the American church had 950 hospitals with 156,000 beds and admitted 16,000,000 patients per year. This was the result of the efforts of these nineteenth-century women.

    The series of five case studies presented here does not constitute the basis for a comparative analysis of religious nursing over the course of a century, in three continents and from four confessions (Roman Catholic, Anglican, Lutheran, and Methodist). Rather, this collection of essays is designed to convey the sense that nursing and hospital foundation was part of a gendered international movement — a movement that to a great extent was neither English nor Protestant.

    Chapter 2 examines the way nursing history, the history of women, and nineteenth-century religious history have dealt with the religious communities of women. It argues that these women have fallen through the gaps in contemporary scholarship. Religious women are dealt with seriously only by "insider" histories. They have not received serious consideration in the histories of women and philanthropy, they are seldom included in professional nursing histories, and their "professional" contribution to English-speaking nineteenth-century society is generally of only tangential interest to historians of religion. Concepts such as the women's sphere and secularization are revisited to explore what is argued to be a set of discursive evolutionary assumptions that set the basis and the limits of nursing history. The Vincent de Paul Daughters of Charity are discussed, and their impact on the subsequent rise of the nineteenth-century religious nursing — Catholic and Protestant — examined.

    In Chapter 3 the American "take" on this Vincentien Daughter of Charity is explored. Of importance to this discussion were the extremes of response the nursing nuns were capable of evoking. As one of the most visible symbols of Catholicism and foreign power (Rome), the "un-American" identity of the nuns caused them a great deal of difficulty. However, episodes such as the cholera epidemics, when they volunteered to nurse the sick, and later their heroism during the Civil War made them complex and unstable figures in the American psyche — vilified and romanticized. But despite the social and political difficulties faced by the communities of nursing women in the United States, Catholic vowed women managed to found an extraordinary number of hospitals right across the country. The work of Mother Seton of course features here. Her Sisters of Charity were founded in 1809, the earliest non-French version of the Vincentien vision.

    The Old World of London and the New World of the northeast American cities were not such different universes by the end of the nineteenth century as they had been when the century began. Over the course of the century rural America had been filled with cities, choked with industry, and swamped by immigrants. The Catholic Church, filled with immigrant congregations, took enthusiastically to its role of unsettling Protestant certainties. In New York, Toronto, and London the defenders of the Reformation found themselves in a pluralistic world of Catholics, Jews, and liberals. In England, the passage of the Catholic Emancipation Act in 1829 signaled the beginning of decades of debate, riot, and confusion over the role of the established church (Anglicanism), the rise of secularism, and the colonial designs of the Catholic Church for the souls of England.

    Chapter 4 takes up this story through the Sisters of Mercy at Bermondsey in the East End of London. This community played a significant role in nineteenth-century nursing history, providing a team of nurses to accompany Florence Nightingale to the Crimea. Mother Mary Clare Moore, the mother superior of the Bermondsey convent, went on to become a confidante of Nightingale. But it is the period prior to the Crimean events that is the focus of the chapter. Founded in 1838, this convent was the first to be established in England since the Reformation. The work of the sisters involved home visitation and epidemic nursing. It was not until after the Crimean War that their public standing was so boosted that they were able to open a hospital — the first Catholic hospital in England since the Reformation. So this community of women were very much in the front line of the reestablishment of Catholicism in a very hostile Britain. They were also well established in Britain prior to the great famines in Ireland and served the burgeoning and increasingly desperate Irish poor. By the second half of the nineteenth century the Catholic nursing orders began to share the stage with communities of Protestant women, some vowed, others not, who too had answered a call from God to nurse the sick poor. This chapter looks at the commonalities between religious nurses — their vocational imperative, their strong commitment to an "active" life, and their powerful sense of the need that they were meeting. It argues the importance of the religious sisterhoods in establishing the groundwork to the Nightingale reforms.

    The complexity of work, gender, and religion as it was played out in Victorian England permeated to the boundaries of the empire. In Chapter 5 I turn to the story of professional nursing in colonial New South Wales. In 1868 a team of Nightingale-trained nurses arrived in the colony. But long before the Nightingale sisters disembarked at Sydney Cove, a group of French-trained Irish Sisters of Charity had been nursing the sick in their homes, and in 1857 they established a widely supported hospital, St. Vincent's. This juxtaposition, in a small remote colony, of English Nightingales and Irish nursing nuns in the city's only two hospitals continues the story of Catholic Emancipation, Irish politics, Anglican tensions, and women's work. The Sisters of Charity and the Nightingale nurses were both victims of sectarian bigotry as each "community" of women overstepped the bounds of female authority while struggling to establish an independent domain— a hospital run by women. This chapter, then, provides a case study of issues of competence, professionalism, religion, sectarianism, and colonial politics.

    That strange bedfellows are born of the exigencies of frontier life is nowhere better illustrated than in the complex arrangements of Irish, French, and Québecois women that are featured in Chapter 6. To some extent the story of the frontier sisterhood is the story of all the sisterhoods writ large. The poverty, the oppression, and the inventiveness that characterize successful communities of religious women, particularly nursing communities, are in evidence whether one looks in New York City or Dawson City. That said, there was something distinctive about this experienced group of women with a firm identity and confidence in their rule and life, taking on the enormous challenge of working, not among communities of immigrant poor, but in the male world of mining towns, logging camps, railroad camps, forts, and mission settlements. It was a world impenetrable to ladies without protection of veil and vow.

    Commercialism and business acumen were the skills developed by the successful sisterhoods in the sink or swim world of the North American west. The northwest and the southwest provide counterpoints for our examination of the phenomenon of vowed women in the wilds. Quite different women, very different religious communities, and different social and political contexts reveal remarkable consistencies in mode of adaptation and successful establishment.

    Between the wilds of the west and the factories of the east lies the midwest. This episode of American settlement is distinctive. It does not have clear parallels with settler societies in Australia or with industrial Europe. It is an American story of cultural pluralism, ethnicity, and settlement. For despite the great dominance of Irish in the American Catholic Church, they were only the first wave, the English-speaking wave, and the group well practiced in tribal politics. The next largest group of Catholic immigrants to the United States in the nineteenth century was German. It was a German community in exile from persecution. Its goal was continuity of community and tradition, continuity of liturgy and prayer, and continuity of language. These imperatives were in stark contrast to those of the Irish Church which had been in expansionist mode throughout the century. The German-American story of nursing sisterhoods is also distinctive in that it introduced to North America a successful Protestant sisterhood of nurses — the deaconesses. Chapter 7 sets out to examine these women, connected by culture and language rather than religion, and explores their impact on the American health care system.


Excerpted from Say Little, Do Much by Sioban Nelson. Copyright © 2001 by University of Pennsylvania Press. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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Table of Contents

Ch. 1 "Say Little, Do Much": Veils of Invisibility - Nursing Nuns 1
Ch. 2 Martha's Turn: Vowed Women and Virtuous Work 11
Ch. 3 Free Enterprise and Resourcefulness: An American Success Story - The Daughters of Charity in the Northeast 32
Ch. 4 Behind Enemy Lines: Religious Nursing in England - Conflicts and Solutions 56
Ch. 5 At the Margins of the Empire: Religious Wars in the Hospital Wards of Colonial Sydney 80
Ch. 6 Frontier: "The Means to Begin Are None" 100
Ch. 7 Crossing the Confessional Divide: German Catholic and Protestant Nurses 126
Ch. 8 The Twentieth Century: "Every Day Life Got Smaller" 151
Abbreviations 165
Notes 167
Bibliography 213
Index 227
Acknowledgments 235
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