The Daughters of Charity in the History of Military Health Care and in the History of Nursing
By: Sister María Ángeles Infante, DC
[This article first appeared in Anales, Volume 123, #4 (July-August 2015), p. 327-343 and has been translated and posted on-line with the permission of the author and Anales]
The service of the Daughters of Charity on behalf of the military (soldiers and officers) goes back to the time of their Founders, Vincent de Paul and Louise de Marillac . In 1650, at the request of Queen Anne of Austria, Sisters were sent to care for those who were wounded on the battlefields during the French Wars of the seventeenth century. At that time the Sisters were known as the best health care professionals in France. Since 1634 they had served in the Hotel Dieu or the General Hospital in Paris ; in 1640 they began ministry in the Hôpital-Saint-Jean in Angers where Louise herself had traveled in order to organize their service, present their Rule and sign the contract . The transformation of the institution and the good experiences of the people at the hospital in Angers became known throughout the country. A little later, in 1645, the Sisters began to minister at Saint-Denis Hospital in Paris and the following year, the administrators of the hospital in Nantes requested their service (the Sisters served in Nantes under the same conditions as the Sisters in Angers) .
When the Queen requested the Sisters to serve in the field hospitals they already had an established reputation with regard to good health care, professional competency and accredited service . When Vincent sent the Sisters to engage in this new form of service, he wanted them to understand that their activity was not only a religious activity but that is was also an honor for the Company to be asked to serve in this manner: This is a holy ministry that must be performed to perfection … who are we to be on the mind of the greatest Queen in the world? … So, the fact that the Queen is sending you is rather strong motive, although it is not very weighty compared with the good pleasure of God .
In response to the Queen’s request the Sisters took charge of the field hospitals in Châlons, Saint-Menehould, Sedán, La Fère, Arrás and Calais. Six field hospitals during the time of our Founders! History has shown that the Sisters were prepared for that ministry and, in the words of Saint Vincent, they exercised their ministry as good nurses and as apostles of charity (CCD:X:85).
Having completed this introduction, I will now develop this theme from the perspectives of four aspects which, from an historical perspective, I view as important:  The presence of the Daughters of Charity in military health care since the seventeenth century;  in the school of the Founders: competency, care and comfort;  the presence of the Daughters of Charity in Spanish military health care facilities;  the influence of the Daughters of Charity in the history of nursing.
The presence of the Daughters of Charity in military health care since the seventeenth century
The presence of women on the battlefield was something quite unusual in the seventeenth century. Vincent himself was aware of that fact … he admired God’s action and the strength of the Sisters and he spoke about this to the Missionaries: I also recommend the Daughters of Charity we sent to Calais to nurse the poor wounded soldiers. Of the four we sent there, two of them, the strongest and healthiest among them, have died … Just picture that, Messieurs! Four poor Sisters in the midst of five or six hundred poor sick and wounded soldiers! Please consider for a moment the guidance and goodness of God in raising up such a Company in these days … History makes no mention to us of there ever being such a Company of virgins --- true, there are a few widows among them --- who have given themselves to God in the way those poor Sisters do to nurse the sick and the wounded (CCD:X:34-35).
Let us recall the context in which the Sisters were sent to the battlefields. On October 24th, 1648, the Treaty of Westphalia was signed, thus bringing to an end the Thirty Years War between Catholics and Protestants (1618-1648). This treaty weakened Austria while France obtained some strategic fortifications that enabled her to extend her boundaries. Mazarin then decided to go to war against Spain in order to establish its hegemony in Europe. The people, tired of so many wars, rebelled and the civil war, known as the Fronde, erupted (1648-1652). There were battles, killings, rapes, looting, famine, epidemics and countless deaths . Soup kitchens as well as shelters were established for the refugees in Paris. In the midst of this situation our Founders attempted to respond to the many urgent needs. Châlons was the first field hospital where the Sisters served during this era.
Such was the beginning of the health care services that the Sisters provided in the military hospitals. Their work was dangerous and all encompassing. In order to provide for and heal the wounded the Sisters were scattered in many different villages along the battlefront. Louise wanted to receive news from the Sisters but they had no time to write letters. On a regular basis, the Founder sent letters to the Sisters in order to encourage and support them. We have preserved for us a letter that was sent to Sister Guillemine Chesneau: All our Sisters ask to be remembered to you, and they praise God for the courage his goodness give you to serve these poor afflicted people. Oh what a grace, my dear Sister, to have been chosen for this holy employment! It is true that it is extremely difficult, but it is because of this that the grace of God actin in you is more evident. You have every reason to trust in God and to abandon yourself to his Divine Providence .
Louise did not want the Sisters to become overwhelmed by the tremendous amount of work that had to be done which is turn could make them forget the gospel spirit … the Sisters were to serve the sick poor in a spirit of gentleness and great compassion, in imitation of Our Lord who acted this way with the most unfortunate (SWLM:434 [L.383]). The Sisters were also reminded to put into practice the counsel that they had received during their formation: I would ask you to be sure to wash the feet of the sick as they enter, to wash their linens and to treat them with gentleness and charity. Your obligations are to provide the sick their medications and food at the correct times and to see to it that our Sisters are exact in following their Rule (SWLM:291 [L.251]).
Upon their arrival in Châlons, Sister Anne herself was wounded while caring for a wounded soldier. The other Sisters did not become frightened, but continued their service. The soldiers and the officers valued their presence and asked the Queen to send a team of Daughters to the site of each new battle. In July 1654, during the siege of Stenay, four Sisters went to Sedán and in 1656 two other Sisters went to the hospital in La Fère to care for those who were wounded during the battle of Valenciennes. In 1657 the Sisters went to Montmédy and in 1658 we find them in Calis caring for those wounded in the battle of Dunas. In that city there was an epidemic of the plague and four of the Sisters became infected. Two of the Sisters died a few days after their arrival there and the other two Sisters (near death) were moved to the hospital in the city. When Louise was informed about this situation she communicated the news to the other Sisters and compared the death of Sister Françoise Manceau and Sister Marguerite Ménage to that of the martyrs. She stated that they died arms in hand, because God called them while they were serving the poor sick and wounded at Calais (SWLM:608 [L.589]).
Four other Sisters left Paris in order to replace their deceased and infirm companions. Vincent affirmed the fact that the deceased Daughters were martyrs of charity (CCD:X:409, 442-443) and stated that the service that they provided was a form of martyrdom: How happy are they for having lost [their lives] for such a noble reason! The others are very ill … Let us give ourselves wholeheartedly to God always to do his holy will ... So then, Sisters, you are about to make the highest act of the love of God that can be made and you have ever made, for there is no greater act of love than martyrdom. What grounds for humbling yourselves (CCD:X:441, 443). Encouraged by the glorious death of their companions, they wrote to Louise while still traveling to their new mission: We want to arrive there quickly so that we might help the other two Sisters … today we are some twenty-four leagues from Calais. There are so many people who have been abandoned and now they are reclining on straw that has been thrown on the ground … it is most painful to have to see these things .
Upon their arrival in Calais the Sisters immediately began to work. Soon they were overcome by fatigue and three of the Sisters became infirm with the plague. It seemed best to have these Sisters return to Paris on stretchers and thus save their life. Such heroism on the battlefront came to an end when the Treaty of the Pyrenees was signed in 1659, thus bringing to an end the war between France and Spain.
Louise, content and satisfied, communicated the fruits of this service when she wrote to the Sisters: Sister Anne Hardemont and three others went to Sedan to serve the wounded soldiers. They are edified to see them die like good Christians. Pray very hard for the King’s army (SWLM:447 [L.412]).
Having served on the battlefield during the time of their Founders, Vincent and Louise, the Daughters were prepared and willing to return to the battlefront in later centuries.
In the school of the Founders: competency, care and comfort
The Founders sent the Sisters to the battlefront as competent nurses, apostles of charity and instruments of peace. Therefore, before their departure Vincent spoke to them in very moving words as he reminded the Sisters that they were to heal others in the same way that Jesus did, that is, serving with competence and goodness: Now let's see what you have to do so that God may be honored. I think, Sisters, that nothing else is needed than the practice of the virtues that make up your spirit: charity, humility, and simplicity ... you are going to that place to do what Our Lord did on earth ... to imitate him, you will restore life to the souls of those poor wounded men by your instructions, your good example, and the encouragement you will give them to help them either to have a happy death, or to recover well if God is pleased to restore them to health ... What a happiness! (CCD:X:2-3).
That is what the nursing Sisters have done for almost four hundred years. On October 18, 1655, as Vincent explained the Rules to the first Daughters, he told them that their service was based on the aims of the Company and therefore, you must be ready to serve persons who are poor, wherever you're sent: with the army, as you did when called there, with poor criminals and, generally speaking, wherever you can assist poor persons, since that is your purpose (CCD:X:104). After having served on the battlefield of Châlons, Sédan, La Fère, Metz, Arrás and Calais, the Sisters knew that they were prepared to engage in that form of service. Their preparation was not simply the result of their own efforts but was primarily due to the indwelling of the Spirit of God. All of this has unfolded from the time of the Founders and has continued until the present day.
In the school of the Founders, the Daughters of Charity learned to serve the infirm in the spirit of the gospel (especially as expressed in Matthew 25:40). Vincent stated: when serving persons who are poor, we serve Jesus Christ (CCD:IX:199) … turn the medal and you will see by the light of faith that the Son of God, who willed to be poor, is represented to us by these poor people (CCD:XI:26). Therefore, a Sister will go ten times a day to visit the sick, and ten times a day she will find God there (CCD:IX:199). Vincent then repeated his words and stated that God accepts the services you do for those sick persons and, as you have said, considers them as done to himself (CCD:IX:199).
The Sisters engaged in the ministry of health care as a continuation of the mission of Jesus Christ … they saw Christ in those who were infirm. Therefore, following the advice of the Founders, they were diligent with regard to their human, professional and spiritual formation. In order to provide quality care the Sisters had to know and master nursing techniques and in order to provide comfort the Sisters had to clothe themselves in the sentiments of Jesus Christ. Therefore, all the Sisters were to deepen their practice of the virtues of humility, simplicity and charity which in turn would enable them to act in accord with the Spirit and thus experience themselves as women who share God’s consolation with others: imagine that you are their visible Guardian Angel … weep with them; God has made you to be their consolers (CCD:IX:5).
Louise took charge of providing the Sisters with a holistic formation. In the Rules for the hospital Sisters, Louise was very precise with regard to what the Sisters were to do. Louise emphasized their competency, the care they were to provide and the manner in which they were to comfort the infirm. The Rule was a source of on-going formation and in the Rule we find a detailed description of the health care services of that era. Louise had the prescriptions of Madame Herse copied for the Sisters who worked in pharmacy. The role of the pharmacist was most important and the Rule of the Hospital Saint-Denis stated: The Sister Pharmacist shall take great care to keep the drugs in a good state, making sure that nothing spoils or is lost. She shall see to it that all her utensils are kept clean, that the sick are given their medications at the necessary times, and that the doctor and surgeon are asked to come when necessary. She shall be particularly obliged to inform the Sister Servant of the state of the sick so that, by her order, the sacraments may be given to them. Likewise, she shall carry out her responsibilities only on the orders of the Sister Servant. The Sister Pharmacist or another of the Sisters shall let the blood of the sick (SWLM:752 [A.84]).
The health care services of the Daughters of Charity were inseparable from the care and comfort that the Sisters were to provide to the infirm: The Sisters shall take great care that the infirm who can eat neither bread nor meat are given bouillon and eggs alternately every three hours. They should also be given some sweets according to their needs and tastes, provided it is not detrimental to their health. The Sisters shall see to it that the very sick are washed. Through fear of canker sores, the mouths of the sick should be cleansed frequently. The Sisters must also watch for gangrene … [the Sisters] shall have those sick who certainly will die make frequent confession, preparing them to die well, helping them to detach themselves from the earth and from creatures, and instilling in them the desire for paradise (SWLM:749, 751 [A.84]).
We can state, as did Elisabeth Charpy, that Louise de Marillac, in all her teachings, transmitted to the Sisters that which gave great meaning to her own life, namely, a great love for men and women, a love grounded on the love of the incarnate Christ . Thus we can say that Louise was a true precursor of the nursing profession because she understood how a good professional ought to act. Guided and formed by Louise [a] the Sisters were to provide nursing services to the poor, a public service which should be offered to everyone in need and who have no means to obtain such services; [b] the Sisters had to be aware of the importance of learning proper techniques associated with their profession; [c] the Sisters were to be guided by the norms and regulations that Louise, in consultation with Vincent, had established; [d] the Sisters should always be mindful of the needs of the infirm; [e] the Sisters were to seek a balance in their ministry (caring for the care-giver). These teachings of Louise continue to be relevant today. Yesterday and today the aim of health care is to provide the best care, thus transforming the level of heath by augmenting the well-being of the population.
Presence of the Daughters of Charity in the Spanish military health care facilities
The Daughters of Charity arrived in Spain on May 26th, 1790 and very soon thereafter the French invasion would result in some fierce battles on Spanish soil. At the same time, in 1792, during the Reign of Terror, the Daughters were suppressed in France. Some of the Sisters (now mere citizens) continued to provide health care treatment in the various hospitals. Some year later, in 1800, the needs in the French hospitals became so great that the government issued the following decree: the citizen Delau (former superior of the Daughters of Charity) is hereby authorized to form students who will dedicate themselves to serve in the hospitals . The need to provide health care to the military led to the reestablishment and the restoration of the Company in France. These women first served as lay nurses and, some years later, as women who consecrated themselves to God in order to serve those in need. On December 23rd, 1804 the women were allowed to clothe themselves in their religious habit … this occurred at the time that Pope Pius VII visited the Motherhouse in Paris and as he prepared to participate in the coronation of Napoleon as Emperor .
Let us look at what happened in Spain. For eighteen years the Sisters had provided services in the area of health care, education and emergency assistance. At the time of the French invasion the Sisters began to care for the soldiers who were wounded in Lérida, Reus, Pamplona, Madrid, Palma de Mallorca and Cádiz. In the Hospital of Santa Maria de Lérida, Sister Esperanza Blanc was distinguished because of the fact that she had been formed in Paris and was a specialist in caring for military personnel. During her eight years of formation in Paris, Sister was engaged in service at the Military Hospital Gros-Caillou where she cared for the officers and the soldiers of the Royal Army. In the hospital there were twenty-four wards and in each ward there were twenty patients (a total of four hundred eighty patients). There was a doctor, six surgeons, four pharmacists and many highly specialized nurses. It was there that Sister Esperanza Blanc learned the best nursing techniques of that era . This Sister became a pioneer of military health care in Spain. She cared for both the wounded French and the Spanish soldiers in the Hospital of Lérida (1808-1814) and also provided care for the victims of the yellow fever epidemic (1821, Cataluña). It was there that she became infected with the disease, was transferred to Madrid and died the following month. Before her death she had communicated her knowledge and her experience to the other younger Sisters.
Sister Vicenta Molner y Segimon also cared for the wounded French and Spanish soldiers in the Hospital San Juan Bautista de Reus. This Sister was distinguished for her dedication to the wounded soldiers during the War of Independence . She cared for the soldiers with such respect, dedication and courage that one of the French soldiers, whose life she saved, dedicated one of his paintings to her . After the war this soldier returned to the General Hospital in Madrid (where Sister Vicenta was superior) and thanked her.
In 1817, at the request of the Archbishop, the Sisters took charge of the administration of the General Hospital in Valencia. Nearby there was also a military hospital. When the military government became aware of the competency of the Sisters, a ward was created in the General Hospital for the military personnel and immediately all the soldiers were transferred to that ward. The following year D. Joaquín Villarroya stated: I saw the military provided for with great care and this was due primarily to the Daughters of Charity who, with great zeal, cared for the infirm with much competency. Their moral and religious methods are clear examples of their loving service .
During the Carlist Wars of the nineteenth century, the Daughters of Charity were called to care for the wounded soldiers in the various military hospitals on the battle front and to also provide care for these soldiers on the ships that transported the wounded. Anales of the Company has preserved letters and reports from that era. Everyone seemed to speak about the competency, the courage and the dedication of the Daughters in the various hospitals during the campaigns of 1835-1839. These wars were especially fierce in Northern Spain … at the conclusion of these wars those hospitals disappeared . These events would be repeated during the second and third Carlist Wars (their dedication to the infirm is memorialized in etchings and engravings from that era). The work and service of the Daughters of Charity during the era of the civil wars of the nineteenth century are highlighted in the text and the drawings of the book, Aventuras de un gentleman en la tercera Guerra carlista (The adventures of a gentleman during the Third Carlist War) .
The first military hospital in Spain that was administered by the Daughters of Charity was Santa Isabel in Madrid. Dr. Rafael Michelena, quartermaster of the army, made a written request to Sister Bonifacia Espoz (superior at the hospital) in which he asked her to provide Sisters to care for the victims of the cholera epidemic who were in hospitals that the army has set up in Vallecas. Sister Francisca Palmer and Sister Nicolosa Ramírez left on the afternoon of July 1st, 1834 for Vallecas. They traveled with the Duke of Gor and his secretary and went to assist those afflicted with cholera . The documents that have been preserved from that era not only reveal the good relationship that existed between the directors of military health care and the superior of the Daughters of Charity in Spain but also point out the protection that the Sisters experienced during their travels, a protection that was provided by the army.
In the Guia del Estado Eclesiástico de España para el año 1868, [Guide with regard to the Ecclesiastical State in Spain for 1868] published by the Ministry of Grace and Justice, there is a picture of the military ward in the Hospital de la Princesa and some other military hospitals that were created as such and administered by the Daughters of Charity (hospitals in Spain as well as in the overseas colonies). At that time the Sisters were caring for soldiers and their officers in some sixty-eight hospitals (some were strictly military hospitals while others were civilian hospitals which had wards dedicated to the care of the military).
On April 12th, 1896, the Daughters of Charity arrived at the Military Hospital in Carabanchel and at the same time it was decided that contracts for providing care at the military hospitals would be given only to the Daughters of Charity. In 1898 the Daughters became the administrators at the Military Hospital in Barcelona and “The General Rule Governing the Daughters of Charity in their Service at the Military Hospitals” was approved. In 1922 that Rule was modified and updated. The Sisters who were to serve in the military hospitals would take a course at the Military Hospital in Carabanchel  and those Sisters who were to serve in the hospitals in Morocco would take a course in the Military Hospital in Sevilla. During the civil war of the twentieth century (1936-1939) the Sisters served in three hundred twenty-five field hospitals .
In 1945 the historian Pedro Vargas Sáez listed eighty-three military hospitals in Spain where the Sisters were providing services on a regular basis (that list did not include the overseas hospitals). In addition to providing services in the military hospitals, the Sisters also cared for the soldiers in the hospitals of the Red Cross and in the military wards that had been set up in the civilian hospitals. During the nineteenth and twentieth centuries the Daughters of Charity in Spain served in some three hundred seventy-six field hospitals and there was an average of 3,800 Sisters involved in this ministry . In 1952 all the military hospitals in Spain were administered by the Daughters … thus the Sisters gave new life to Vincent’s words: [you are] to run to the spiritual needs of [your] neighbor as if we were running to a fire (CCD:XI:25). In 1953 the Daughters organized a School of Nursing in Madrid; the first director was Dr. D. Manuel Gómez Durán, a military medical doctor. Many professors at that hospital would become medical military doctors at the Hospital Militar Gómez Ulla.
We should be mindful of the fact that the presence of the Daughters of Charity in the Spanish military hospitals was not seen as something extraordinary, but was viewed as one of the normal ways in which the members of the Company engaged in ministry. In 1850 the French soldiers landed in Algeria. A few years later, in 1836, after the disaster at the first assault of Constantine and at the request of Cornel Lamoriciére, six Daughters were sent to the Hospital de Bon to take charge of caring for the wounded and the infirm. Later, they would take responsibility for the administration of four military hospitals.
During the Crimean War England and France declared war against Russia (March 23, 1854). Russian-Turkish hostilities became worse and the Sisters, who had arrived in Turkey in 1839, began to provide services in the various field hospitals. The one hundred fifty Sisters, who resided in Constantinople and the surrounding area, closed their schools and cared for the wounded. Father Doumerq, CM, stated: the nurses there, decimated by the cholera epidemic, were very hesitant to approach the infirm … but when they saw the Sisters arrive and go directly to the hospital, everyone felt strengthened. This same reaction was experienced in many other places. As soon as Sister Lesueur (the coordinator of the effort) was told of the arrival of a ship, she sent two of the Sisters there with provisions that would enable them to administer first aid to the infirm and wounded (this was done because removing all the wounded from the ship involved many hours of work) .
Similar commitments and witness was given in Mexico during the 1847 civil war and the 1858 revolution. Anales stated: Night and day the Daughters were beside the infirm providing them with the care that was required, assisting in amputations, and caring for the soldiers during their final moments . The same gestures were repeated during the Piedmont War and in the war that the French waged against Austria (1850-1860). At that time some forty Sisters were sent from the Motherhouse to the battlefront. The same occurred during the war the ended with the unification of Italy (1860-1861), during the civil war in the United States (1861-1865), the two world wars during the twentieth century and the Spanish civil war that also took place during the twentieth century.
Influence of the Daughters of Charity in the history of nursing
In the seventeenth century there was almost no understanding of the causes of disease or of the manner in which such diseases were transmitted or of the incubation period of these diseases. Care of the infirm was focused on treating the symptoms. Therefore observation of patients was very important in order to cure them of their illness. The practice of nursing was based on four principles: care, good administration of resources, teaching others to heal and care for the infirm, and looking for the best methods and medicines in order to heal the infirm (investigation). In the nineteenth century nursing would be systematized and organized as a science. Florence Nightingale was the first individual to develop nursing in some systematic manner. As a result, new methods came into existence and each model was based on a philosophy and a specific manner of understanding nursing and caring for the infirm.
The nursing journal, Cultura de los Cuidados, has recently published an interesting article: “The Daughters of Charity and the Professionalization of Nursing in Lleida”. In the conclusion of that article we read: the establishment of the Daughters of Charity meant better health care for the infirm and better health care institutions . Also stated in the conclusion is the fact that it was the presence of the Daughters of Charity that enables one to speak about the professionalization of nursing in Spain around the end of the eighteenth century. Lorena Tejero, the author of this article, highlights the invaluable contributions of the Sisters to the history of nursing, contributions that resulted from their knowledge, their health care practices, their witness and the medical manuals which they brought from France: Manual para el servicio de los enfermos  (Manual for the Service of the Infirm) and Instrucciones para los enfermeros y vigilantes de manicomios  (Instructions for nurses and those who care for the mentally insane).
In 1852 Florence Nightingale, with her book, Notes on Nursing, provided a foundation for the nursing profession. She attempted to define the specific contribution of nurses as they cared for the infirm. She had studied nursing in a place other than her country of origin and she had also spent time at the Institute for Protestant Deaconesses in Kaisrswerth, Germany and with the Daughters of Charity in Paris . There she visited various hospitals that were administered by the Daughters, observed the manner in which they functioned and adapted their best practices. When the Crimean War began she went to Renkioi Hospital in Turkey (she went there in response to the request of the English). She was most gracious in accepting the difficult task that had been entrusted to her. She was then in London where she was involved in various Anglican beneficent works. In October 1854 she gathered together thirty-eight nurses (older women and young Anglican deaconesses) who then departed for the East. As they traveled to Marseilles (their point of departure) they passed through Paris and there Florence Nightingale decided to take advantage of this opportunity to obtain a better understanding of the nursing procedures of the Daughters of Charity. With a letter from Queen Victoria and a recommendation from the British ambassador to France, Florence visited Father Jean-Batiste Etienne, superior general of the Congregation of the Mission and requested his permission to spend some time with the Sisters in one of their hospitals in Paris (she asked for this permission for herself and for the other women who were traveling with her). Father Etienne did not judge this as appropriate but he brought Nightingale to the Motherhouse of the Daughters of Charity. There she was allowed to read the Rules of the Hospital Sisters, visit different offices and examine everything as she desired. She visited an orphanage on rue du Oudinot, as well the Necker Hospital and the Reuilly Hospice. The Sisters assisted Florence and provided her with the information that she wanted. When those visits were concluded she once again visited Father Etienne, thanked him and in fact, had a lengthy conversation with him .
With her group of Anglican deaconesses Florence took up residence at the British army base in Scutari and remained there until it closed. Sister Lesueur, foundress of the mission in Constantinople and coordinator of services during the Crimean campaign, maintained cordial relations with Florence … they engaged in an on-going correspondence. Their relationship was one of mutual trust and esteem, in fact, when Nightingale returned to her country, she gave Sister Lesueur the many supplies that were at her disposition because she knew that they were now in good hands and that they would be used in order to serve the poor. In the biography of Sister Joáquina Bisqueyburn there is reference to this Sister’s relationship with Florence Nightingale (1855). Sister arrived in Constantinople in 1855 and was in charge of some forty Sisters who had traveled there with her. The commitment of these women was admired by Nightingale who visited the hospital and other centers where the Sisters cared for the infirm . She wanted to learn from the Sisters and took detailed notes.
At the close of the Crimean War, Florence once again visited the superior general and thanked him for the opportunity to experience the kind and generous hospitality of the Sisters. She felt that she was now prepared to copy the administration and manner in which the Sisters served in the hospitals. Father Etienne warned her: Madame, you have taken notes as if you were trying to build a machine and therefore, you might now be able to build a model similar to the one you have seen with your own eyes … not a single bolt will be missing, but it will not function. Yes, you will have a machine, but what will be the motor of that machine? … you see the motor here is charity, humility, self-sacrifice, obedience and all the other virtues that are the soul of religious life … and this is only found in the Catholic Church .
In the second half of the nineteenth century, technological and scientific advances allowed for every more complicated interventions. Nursing became more technical and specialized. In 1864 the Red Cross was founded. Joseph Lester began to use phenol as a disinfectant and obtained good results. For the first time surgical gloves were used to protect the skin from the corrosive effects of phenol. The syringe was invented in order to inject the infirm with morphine. Pasteur made important advances in microbiology and in the area of vaccinations. Pasteur and his wife discovered radioactivity. Concepción Arenal, in his proposals with regard to prison reform and the reform of the health care system, urged the creation of nursing schools … the first of which was begun in 1895. That school was organized and administered by Doctor Federico Rubio y Gali, a surgeon who worked in London with William Fergusson. The school was dedicated to Saint Elizabeth of Hungry and was located in Madrid, in the Hospital de la Princesa (Princess Hospital) which was administered by the Daughters of Charity. The Sisters played an important role in the pharmacy and in the transmission of their knowledge and their health care practices.
In addition to their relationship with Florence Nightingale, the influence of the Daughters of Charity in the history of nursing is seen [a] in the practices and the knowledge that they transmitted to others, [b] in their witness with regard to good hospital administration, [c] in the nursing manuals imported from France that were utilized in these schools, [d] in the formation of nurses during the second half of the twentieth century which was done in many nursing schools directed by the Daughters.
This influence is recognized by all the historians who deal with the development of nursing … the majority of these writers refer to the Daughters of Charity as the pioneers of modern nursing .
 Massons, José Maria, Historia de la Sanidad Militar Española, [The Hisrtory of Spanish Military Health Care], Ed. Pomares-Corredor, Barcelona, 1994, 4 volumes, volume III, p. 167.
 Baunard, Luis (Rector of the University of Lille and Domestic Prelate to the Pope), Vida de la V. Luisa de Marillac [Life of the Venerable Louise de Marillac] (Biography that was utilized during the process of Louise’s beatification), translated from the original French and published in Paris, 1898, Ed. Imprenta San Francisco de Sales, Madrid, 1904, pp. 141-174.
 Martínez Betanzos, Benito, Empeñada en un paraíso para los pobres, Ed. CEME, Salamanca, 1995, pp. 113-115; Cf, Baunard, op.cit., pp. 242-253; Dirvin, Joseph, Louise de Marillac, Farrar, Straus and Giroux, New York, 1970. pp. 180-189.
 Baunard, op.cit., pp. 325-344.
 Hernández Martín, Francisca, DC, “La Hijas de la Caridad en la profesionalización de la enfermería” [The Daughters of Charity and the professionalization of nursing” in Cultura de los Cuidados [the Culture of Caring], Second Quarter, 2006, Year X, #20, p. 39.
 Vincent de Paul, Correspondence, Conferences, Documents, translators: Helen Marie Law, DC (Vol. 1), Marie Poole, DC (Vol. 1-14), James King, CM (Vol. 1-2), Francis Germovnik, CM (Vol. 1-8, 13a-13b [Latin]), Esther Cavanagh, DC (Vol. 2), Ann Mary Dougherty, DC (Vol. 12); Evelyne Franc, DC (Vol. 13a-13b), Thomas Davitt, CM (Vol. 13a-13b [Latin]), Glennon E. Figge, CM (Vol. 13a-13b [Latin]), John G. Nugent, CM (Vol. 13a-13b [Latin]), Andrew Spellman, CM (Vol. 13a-13b [Latin]); edited: Jacqueline Kilar, DC (Vol. 1-2), Marie Poole, DC (Vol. 2-14), Julia Denton, DC [editor-in-chief] (Vol. 3-10, 13a-13b), Paule Freeburg, DC (Vol. 3), Mirian Hamway, DC (Vol. 3), Elinor Hartman, DC (Vol. 4-10, 13a-13b), Ellen Van Zandt, DC (Vol. 9-13b), Ann Mary Dougherty (Vol. 11, 12 and 14); annotated: John W. Carven, CM (Vol. 1-14); New City Press, Brooklyn and Hyde Park, 1985-2014; volume XI, p. 1-2; future references to this work will be inserted into the text using the initials [CCD] followed by the volume number, followed by the page number, for example, CCD:IX:1-2.
 CCD:IV:199-201 – the town magistrates in Bethel described the situation to Vincent.
 Louise de Marillac, Spiritual Writings of Louise de Marillac, Edited and Translated from the French by Sister Louise Sullivan, DC, New City Press, Brooklyn, New York, 1991, p. 354, L. 347 --- in this letter reference is made to the four Sisters who had gone to Châlons. Future references to this work will be inserted into the text using the initials [SWLM] followed by the page number, followed by the number of the letter or the number of the writing and/or manuscript , for example, SWLM:354 [L.347].
 La Compañia de las Hijas de la Caridad en los origenes [The Company of the Daughters of Charity at the time of its establishment], Ed. CEME, Salamanca 2001, Doc. 832, p. 841.
 Charpy, Elisabeth, DC, Vida de Santa Luisa de Marillac (Life of Saint Louise de Marillac), Ediciones Paulinas, Madrid, 1992, p. 23.
 HH.C., Genesis de la Compañía de las Hijas de la Caridad [Origin of the Company of the Daughters of Charity], Motherhouse in Paris, 1968, p. 44.
 Anonymous, Viaje del sumo pontífice Pio VII a Francia, [The Journey of His Holiness, Pius VII to France]. The original was written in French and then translated into Spanish by D.L. de N. This manuscript was published by Imprenta de Gamarra y Compañia, Madrid, 1811.
 Hernández Zapatel, María del Carmen, DC, Las Hijas de la Caridad en España (1782-1856), Documentos [The Daughters of Charity in Spain,(1782-1856), Documents], Ed. CEME, Salamanca, 1988, p. 21.
 Hijos ilustres de Reus [Distinguished Persons in Reus], p. 2,831ff. Cf. also Mas, Nicolás, CM, Fundación de las Hijas de la Caridad en España [Establishment of the Daughters of Charity in Spain], Madrid 1978, pp. 85-89.
 Cf. the engraving that served as a model for the picture in the book, Compendio de la historia de San Vicente de Paúl y de las Hijas de la Caridad (Compendium of the History of Saint Vincent de Paul and the Daughters of Charity] by Ramón Sanz, Madrid, Omaña, 1844, 212 pages with numerous engravings.
 Doc. AHN [Translator’s Note: I have been unable to find the meaning of AHN].
 Vargas Sáez, Pedro, Historía de las Hijas de la Caridad en España [History of the Daughters of Charity in Spain], Ed. Restringida, Madrid, 1996, p. 303.
 Campistegui, Francisco Javier; Larraz, Pablo and Ansorena, Joaquín, Aventuras de un gentleman en la tercera guerra carlista [The adventures of a gentleman during the Third Carlist War], Publicacines del Gobierno de Navarra, Historia #121, Pamplona, 2007, pp. 123 and 130.
 Documents relative to the Carlist wars of the XIX centruy, Archives of the Daughters of Charity, Madrid-San Vicente, Year 1834.
 Massons, José María, op.cit., volume IV, p. 169.
 Escribano, Eugenio, Por Jesucristo y por España. Las Hijas de la Caridad de la Provincia española en 325 Hospitales de sangre [For Jesus Christ and for Spain. The Daughters of Charity of the Spanish Province in 325 field hospitals], Gráf. Uguina, Madrid, 1941-1942, volume 3, pp. 365, 426, 440.
Data taken from the catalogues of Pedro Vargas Sáez in his work, Historia de las Hijas de la Caridad de la Provincia Española [History of the Daughters of Charity in the Spanish Province].
Lelandais, Renée, “Les Filles de la Charité sur les champs de bataille, 1847-1864” in Préludes et pionniers. Les précurseurs de la Crois-Rouge, 1840-1860, Société Henry Dunant, Genève, 1991, pp. 299-319.
 The French edition of Anales of the Congregation of the Mission, 1858.
 Tejero Vidal, Lorena Lourdes and Torres Penella, Carmen, “La profesionalización de la enfermería en Lleida a partir de las Hijas de la Caridad” in the Journal of Nursing and the Humanities Cultura de los Cuidados, Year XV, #3 (third quarter, 2011), ISSN 1138-1728, pp. 64-68.
 Carrere, Joseph-Barthélemy-François (1740-1802), Manual para el servicio de los enfermos, Paris, 1787. Translated into Spanish by De. Francisco Salvá (1796, Barcelona).
 Anonymous … it is believed that this work was translated into Spanish in Barcelona soon after the arrival of the Sisters.
 González, F., Navarro, A., and Sánchez M.A., Los hospitales a través de la historia y del arte, [Hospitals in history and art], Ed. Ars Medica, Barcelona, 2005, p. 50.
 Renée Lelandais, DC., “Las Hijas de la Caridad en los campos de batalla (1836-1863)” [The Daughters of Charity on the Battlefield (1836-1863)] in Ecos de la Compañía de las HH.C., Motherhouse, Paris, 1989.
 Mott, Marie-Eduard, CM, Le scapulair vert et ses prodigies [The Green Scapular and its wonders], Ed. Hijas de la Caridad, Paris, 1923. This work includes the biography of Sister Joaquina Bisqueyburu and her relationship with Florence Nightingale, pp. 6-7.
 Ibid., p.7.
 Hernández Martín, Francisca, DC, in Historia de la Enfermeria [The History of Nursing], Ed. Sintesis,, Madrid, 1996; an article entitled: “De las Hijas de la Caridad sanitarias” [the Daughters of Charity as health care providers], Anales de la CM and de las HHC, Madrid, 1995, p. 428-436; Martínez Martín, María Luisa and Chamorro Rebollo, Elena, Historia de la enfermería [History of Nursing], Ed. Elsevier, Barcelona, 2011; Molina, Teresa, Historia de la enfermería [History of Nursing], Ed. Interamericana, Buenos Aires, 1973; Patricia Donahue M., Historia de la enfermería, [History of Nursing], Ed. Doyma, Barcelona, 1988; Castro Vizoso, Josefina, DC, Técnica del cuidado de los enfermos [Techniques in caring for the infirm], Ed. Escuela de AYS femenina, Facultad de Medicina de Granada, 1974; Laín Entralgo, Pedro, Historia Universal de la Medicina [Universal History of Medicine], Volume VI, Salvat Editores, Barcelona, 1976.
Translated: Charles T. Plock