Bernadette McCauley, Who Shall Take Care of Our Sick? : Roman Catholic Sisters and the Development of Catholic Hospitals in New York City, John Hopkins University Press, Baltimore, Maryland, USA, 2005, ISBN 0-8018-8216-8 (hardcover), pp. xiii + 146.
Reviewed by Joos van Vugt, Radboud University, Nijmegen, the Netherlands
Bernadette McCauley, associate professor of history at Hunter College, City University of New York, describes the founding and development of Catholic hospitals in New York City and, more specifically, the key role of women religious in this development. She does so in a concise book which, contrary to many congregational histories, does not dwell on the peculiarities of individual institutions but on the essentials of an important social development. Also, although her book is based on hands-on examination of archives, her narrative does not stick closely to the records. By avoiding needless detail she produces an efficient and readable account.
McCauley’s story begins in the 1840s and ends in the 1930s when Catholic hospitals, staffed and managed by sisters, had become an important segment of health care in New York (and in the United States as a whole). Starting with the founding of St. Vincent’s in 1849, several congregations of sisters embarked on the creation of a separate Catholic health care system in New York, which for many decades received immigrants, mainly German and Irish, many of them destitute. For these congregations, hospitals were a means of caring for the poor and the sick, which was part of their raison d’être, but also a means of contributing to the separate social environment for American Catholics which came into being in the late nineteenth century. Their hospitals did not offer any specific Catholic approach to medicine – there never has been any ‘Catholic medicine’ – but an ambience of common sense care, order and discipline, mainstream medical treatment, and a thoroughly religious atmosphere (which was considered an integral part of good health care). Exemplary dedication to their patients’ well-being and remarkable networking and fundraising skills have made the deployment of sisters in hospital care a big success. It was the sisters’ dedication which raised the reputation of all hospitals from dubious institutions of poor relief to places of good care and cure for all citizens. I especially appreciated the author’s assertion that the success of the sisters was the result of their tireless dedication and not of the inexpensiveness of their services. Sisters were by no means second choice!
McCauley seeks to answer questions such as: what was distinctive about Catholic hospitals? Or about sisters as nursing and managing personnel? What role did Catholic hospitals play in the whole of New York health care? How did Catholicism influence the care the sisters offered to their patients? Etc. Most of these questions she answers convincingly. However, now and then, on some points in her narrative her generalist approach backfires. McCauley stresses that the sister congregations founded hospitals on their own initiative, just as she stresses the entrepreneurship, pragmatism and fundraising skills of the sisters throughout her book. However, based on European experience, I suspect that in the United States too the founding of hospitals was the outcome of complicated financial and political maneuverings between sister congregations (willing to do the job), clergy (eager to have a hospital but jealous of their parish kingdom), well-to-do citizens (aiming at improving the health care for themselves or for their poorer fellow citizens) and bishops (insisting on proper hierarchical relations, and worrying about money). Only historical detail can bring to light if this was so. The same goes for the issue of professionalization. McCauley asserts that sisters were willing, even eager, to go along with hospital reforms and with the professionalization of their nursing activities. Again, I wonder if it was so simple. In Europe, for many congregations professionalization in education or health care proved difficult, because of some innate conservatism, the restrictions imposed upon them by religious life, or the lack of competent internal management. Perhaps in the United States these difficulties were less formidable – American sisters were certainly of a more enterprising and pioneering disposition than many of their European colleagues – but one wonders nevertheless. Did the American congregations really take change in their stride as McCauley seems to suggest? Another question: McCauley writes very little about the relationship between sisters and male doctors, either in management or on the shop floor. I can’t imagine that this relationship was always trouble free. If there were problems, it would be interesting to know the bone of contention, both from the viewpoint of the history of health care and from the viewpoint of women’s history. After all, most Catholic hospitals in Europe and the United States eventually came under male management, ending the unique role of sisters as autonomous managers of large health care establishments. A very intriguing development!
Finally, McCauley writes briefly about the way the sister congregations slowly left the hospital scene. Of course, this development took place after 1930 – I would guess from the 1950s onward – and is thus outside the chronological scope of McCauley’s fine work. Consequently, she only gives one or two examples. A more extensive and detailed account would perhaps shed light on the reason why their presence came to be seen as less urgent in the second half of the twentieth century. One observation of the author seems to me very important: the presence of sisters in hospitals (and education, I may add) became problematic years before the congregations were confronted with any shortage of personnel. Very true. That their withdrawal has had something to do with slow cultural and religious developments within the Catholic community is evident. Even so, the why of the rise and fall of the wide-ranging social deployment of women religious remains a bit of a mystery. All these questions do not detract from the quality of McCauley’s book. If anything, it is a compliment that her book offers many insights and inspires many questions too.