This dissertation presents a nineteenth-century history of midwestern general hospitals. It examines how the region's dependence upon navigable water spawned pioneer general hospitals and continued to influence their development throughout the century. In major river cities, early hospitals operated as "bulwarks against a human tide" of maritime transients who traveled the region's waterways. The dissertation also demonstrates the continuing significance of the federal government to the region's hospitals. The federal Marine Hospital Fund, created in 1798, established a precedent for government-sponsored hospital care for mariners. In the 1830s, after intense political pressure from western states, this federal program was expanded to cover the region's mariners. The tens of thousands of mariners covered by the program provided a critical core of paying patients for the region's pioneer hospitals.;Historians have noted the high numbers of mariners that entered early American hospitals, but they have dismissed their significance to these institutions. They have also ignored the federal program that provided for their care. This dissertation argues, through case studies of Buffalo, New York, and Milwaukee, Wisconsin, that midwestern hospitals, especially Catholic hospitals, valued marine patients, and demonstrates the considerable lengths they went to secure the federal marine hospital contracts. These cases also illustrate the larger regional pattern of Catholic leadership in developing midwestern hospitals.;Using patient records and government sources, this dissertation presents a quantitative and qualitative analysis of patients at St. Mary's Hospital in Milwaukee. Mariners, this study shows, accounted for the majority of St. Mary's patients during most years between 1859 to 1900. Patient records, for the period between 1871 and 1877, reveal that several distinct types of patients entered the hospital and that mariners were the least sick among them. Transient by profession, mariners were especially vulnerable when ill or injured and had a greater need for hospital care. Covered under the federal marine hospital program, an estimated 5 to 10 percent of the American maritime workforce entered hospitals each year during the 1870s. Overall, during the nineteenth century, the federal government provided good quality medical relief to mariners and helped thousands to avoid medically-caused indigence. In preventing medical indigence among a large and vulnerable group, the federal marine hospital program also protected the welfare resources of maritime cities.
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