In Daughters of Charity: Women, Religious Mission, and Hospital Care in Los Angeles, 1856–1927, Kristine Ashton Gunnell analyzes the prominent role of Catholic sisters in the development of a Catholic hospital presence in Los Angeles beginning in 1856 when the Daughters of Charity from Emmitsburg, Maryland, first began caring for the sick in southern California. The book effectively details the sisters' charitable and business activities as they established an official hospital in 1858, incorporated it as a business in 1869, and led the hospital to become the modern St. Vincent's medical establishment by 1927. Throughout this time, the hospital admitted both Catholic and non-Catholic patients. Gunnell maintains that the Daughters of Charity were intermediaries between local patients of various cultures and classes and the business, religious, and government leaders of region. To enhance her thesis, she provides a thorough textual analysis of primary source documents such as letters, hospital admission books, Rules and Constitutions of the Daughters of Charity, images, biographical information, county records, pamphlets, and minutes of meetings. She also compares her findings to secondary sources of other historians' interpretations.

The author contextualizes the Daughters of Charity's activities within the large migration to California after the Mexican-American War ended in 1848. Significantly, the first six Daughters of Charity who came to Los Angeles included three Spanish and three American-born sisters. These sisters were familiar with American social welfare policies, and they also represented a bilingual community that facilitated support among the Spanish-Mexican leaders of the city as well as the multicultural community members who utilized the sisters' services. In a trajectory that differed from religious communities in the East, the Daughters of Charity also included Californian and Mexican sisters who held leadership positions with the American sisters on the boards of their hospitals and other institutions.

Chapters one through four detail the establishment and workings of the Los Angeles Infirmary. The author provides evidence of her thesis that sisters were intermediaries by showing how they first worked among the indigent, supported by the Los Angeles County Board of Supervisors. Indeed, Gunnell weaves together a fascinating story of the sisters' partnership with city officials to help finance the hospital while they also maintained their distinct religious values and commitment to the poor. A shared religious identity also fostered a “spirit of community” (53) among the sisters and the local residents. The author details the training that the Daughters of Charity brought with them in terms of leadership and administrative skills, mentoring, nursing, and teaching through her analysis of their Common Rules dating back to their founding in France in 1633. She also relies on a very important early text on nursing, Matilda Coskery's Advices Concerning the Sick, written in the 1840s, to show how these sisters had actual training in nursing long before American nurse training schools began to proliferate in the late nineteenth century.

As Los Angeles's economic prosperity grew, working conditions deteriorated, and health care costs skyrocketed, the Daughters of Charity eventually received some state funding even as they faced increased competition from free dispensaries run by physicians. To obtain income, like sisters in other parts of the West, the Daughters of Charity expanded their hospitals to include private rooms for paying patients, which involved partnering with the Los Angeles County Medical Association. Yet when the economic boom collapsed in the late 1870s, the sisters and the county ended their partnership over several issues. The author discusses this entangled relationship in chapter 4 by including press releases that accused sisters of “negligence, poor food, and total disregard for a patient's comfort” (120), descriptions of a Grand Jury investigation, accusations that the sisters overcharged the county for their services, and evidence that sisters were providing too much care to the poor, which did not sit well with county officials. Contextualized within the discourse of scientific charity that was popular at that time, the author describes county leaders' and local boosters' creation of a new hospital farm that distanced the poor and needy from the growing white urban population. This separated the Catholic and Mexican past in favor of modernization as leaders attempted to segregate “foreign” elements of the population. Unfortunately, none of sisters' records exist to chart their response, and the author is left with speculations based on the Daughters of Charity's work in other hospitals. What is known is that the sisters lost most of their clientele in the Lost Angeles Infirmary.

Chapters five and six describe how the sisters adapted to the medical marketplace that expanded in the 1880s and 1890s. Deprived of the opportunity to care for the indigent, the sisters had to find new ways to continue their mission. Although they had accepted private patients as early as 1859, they increased this practice over time. The sisters also collaborated with railroad executives to care for their working-class laborers, and they even leased some of their land to an oil company and received royalties. The income from these sources and their private patients helped subsidize their care of the poor. The sisters continued their charitable work by making home visits and operating outpatient clinics for the poor. As they admitted more patients, bought x-ray equipment, and modernized their operating rooms, they had to deal with the need for an expanded workforce. Thus, like most hospitals at that time, the Daughters of Charity established a nurse training school for Catholics and non-Catholics. In doing so, they carved a specific conception of nursing onto secular society in California.

Daughters of Charity builds on other scholarship of Catholic sisters as the major architects of hospitals in the United States. It is unique, however, in that it provides an in-depth study on Catholic hospital and charitable work in southern California. Significantly, the chapters reveal close collaborations, from the beginning, between church, state, and businesses. As such, the book is a story of religious women who had to adapt to a country that was growing in industry and agriculture while also maintaining a distinct Catholic identity. According to the author, the sisters succeeded.

The book is well written and well researched. It is interesting that the author combined historical, qualitative, and quantitative methodologies. This combination of approaches often is not used in historical research unless to generate theory. Nevertheless, the book enhances our understanding of the genre of the New Western History by integrating religion, gender, nursing, medicine, and work in the social history of the American West.