Historical essay
Listening to Women Nurses and Caretakers: A Case Study from the Smallpox Epidemic Among North Carolina Moravians

Listening to Women Nurses and Caretakers: A Case Study from the Smallpox Epidemic Among North Carolina Moravians

Savannah Jane Flanagan

As we reflect on how COVID-19 continues to shape society, the centrality of nursing during health care emergencies becomes clear. While many health care professionals were involved in the response to the pandemic, nurses were often on the frontlines of healthcare, directly treating patients and facing exposure to the deadly disease. Women make up the majority of nurses, yet they were often neglected by employers and communities, left to care for others without personal protective equipment or proper pay.

In many ways, the gendered nature of nursing and its broad lack of support is not new. Women nurses who treated soldiers during the Civil War were greatly needed, but not commonly compensated or given supplies. During the 1918 Influenza pandemic, women nurses in small towns worked in unsanitary conditions without proper supplies. As we strive to achieve gender parity in medicine in the wake of the COVID-19 pandemic, however, it would benefit us all to consider one episode from the late 1700s, in which a small religious community empowered women in medicine during the height of a smallpox epidemic.

The Moravians

In the foothills of North Carolina, the small but flourishing town of Salem, made up of German pietists widely known as the Moravians, strove to preserve their separate religious community amid the American Revolution and the first decades of the New Republic. Composed of tradesmen, farmers, and small business owners, the Moravians were bound together by their religious convictions, which valued community, faith, and simple living. During the American Revolution, Moravians managed threats of violence, economic stressors, and diseases, which threatened the future of their little community.[1]


One of the most deadly threats during the Revolutionary period was smallpox. The disease debilitated and even exterminated many communities across the continent.[2] Caused by the variola virus, smallpox was a highly contagious and often fatal disease. It presented with symptoms similar to the flu but also caused one’s body to break out in painful pustules. Beyond the ability to kill, this virus could leave extensive scars and disable the victim.

Smallpox invoked fear in North Carolinians in the 18th century. Their proximity to the Lowcountry, which had many outbreaks, meant that North Carolina communities risked contracting the illness through trade and travel.[3] The start of the American Revolution assisted in the spreading of the virus.

In April of 1779, when soldiers coming from South Carolina stopped in Salem on their way north, a sick soldier introduced smallpox into the community. A few weeks later, the congregation recorded two cases of smallpox, which occurred among an enslaved individual rented by the Salem elders, and an outsider woman hired to work in the tavern. Over the summer, Moravian adults and children began to contract the disease as well. The specter of smallpox loomed over the entire community; especially vulnerable were older members and the youngest generation. Moreover, as the community was situated on the frontier of North Carolina, it was isolated from the networks of medical care that could be found in larger cities. In a society that required everyone’s participation to keep up food production and their economy, this illness threatened their collective future.

With no precise treatment at this time, smallpox quickly spread. The town’s only doctor, Dr. Jacob Bonn, was trained by a German doctor in Pennsylvania and sent to Salem by the church elders to serve the community.[4] However, with only one doctor and no others available to assist them in the surrounding towns, the Moravians were quickly overwhelmed by cases of smallpox.

By the following spring, the situation in Salem had become dire. Smallpox infected entire families, disrupting labor and leaving the ill with no caretakers. At this time, six Moravian women came forward to the elders and proposed a way to assist in the community’s medical care. They would come to be named the Sick Visiting Committee. As the records of the elders noted,

the married Sisters have established Sick Visiting among themselves, with one general sick-nurse, and other Sisters who will serve a week at a time in turn. These Sisters will have a conference, at which Br. Bonn will be present to give them instructions.[5]

The six women who volunteered were all older community members and recognized the need for organized health care, which one doctor alone could not provide. The community listened to these women and supported their efforts by giving them further training and medical tools to serve as nurses for patients. One woman would serve as a permanent nurse, while the others would switch out each week. By creating a committee among themselves that could assign nursing duties while allowing them to take care of responsibilities in their own homes, these women could navigate the complications of illness in their community.

Black and white photograph of an early 19th-century church.
Bethabara Moravian Church, built in 1807 in Winston-Salem, North Carolina. (Courtesy Library of Congress)

The Sick Visiting Committee

The Moravians benefited from the experience and knowledge the women of the Sick Visiting Committee employed. These women wielded a wide breadth of medical knowledge gained from life experiences such as going on missions, serving in the Sisters’ dormitory homes, and taking care of children. Anna Catherina Ernst, for example, had lived in Bethlehem, Pennsylvania, and served as a religious leader for the Moravian women throughout Pennsylvania. She married a doctor in 1758 and assisted with the care of patients. She witnessed death caused by smallpox during her time in the North. In 1759, a Moravian mother who had fallen ill with a fever gave Ernst a six-month-old girl to care for and nurse back to health. This little girl lived to be six years old but then died from a smallpox outbreak.[6] Ernst brought this knowledge and experience with her to Salem. Both Anna and her husband served the medical needs of Salem. When she and the other women noticed the need in their community, they were quick to go to the elders and assert their authority as caretakers.

Beyond condoning the formation of the Sick Visiting Committee, the community elders supported these women by allowing them to receive further training from Dr. Bonn, who instructed them in utilizing the plants grown in his medicine garden to treat patients. The elders also supplied the committee with medical tools from syringes for enemas to specially-made chairs that could be adjusted while treating the ill.[7] With their previous knowledge and new information and materials, women such as Ernst went to their neighbors’ houses to provide health care, which included giving medicines, staying up with patients, and preserving their spirits with prayer. These efforts provided much-needed medical intervention and allowed family members to resume chores and jobs.[8]

After a long spring and summer of assisting the entire community of Salem, the Moravians celebrated on September 29th, when there were no longer any active cases of smallpox within their borders. Forty-one adults and children had caught the disease during the outbreak, but only three died.[9] In a community of only around a hundred individuals at this time, smallpox was a real threat to their survival, yet the Committee’s intervention ensured the Salem Moravians’ immediate survival.

The Sick Visiting Committee became an integral part of the Moravian health care system in Salem and the surrounding communities. When the second wave of smallpox entered the town (likely a result of an influx of wounded soldiers from the war in 1781), Dr. Bonn found himself completely overwhelmed with smallpox patients and war victims. He asked for the Sick Visiting Committee, which had continued to address the needs of their community after the first wave of smallpox, to expand its numbers and assist him with the ill and the wounded. Moreover, with an increase in pregnancies due to the growing population of Moravian congregants, the need for maternal care likely added additional pressure for Dr. Bonn and the Committee.[10] During this second outbreak, the community decided to partake in smallpox inoculations (the predecessor to vaccines). This procedure involved giving a patient a mild case of cowpox by introducing the virus into the bloodstream, providing them with some immunity from smallpox. Dr. Bonn inoculated many Moravians during this time, decreasing cases and outbreaks. Although it is unclear whether any of the women of the Sick Visiting Committee gave inoculations, records indicate that they helped families manage the side effects while in quarantine after receiving the treatment. Many of these nurses also alleviated other medical burdens, serving as midwives and nurses to injured soldiers.

With a damper put on smallpox in Salem, the Sick Visiting Committee began to serve surrounding towns, providing health care beyond the borders of their community, and expanding healthcare into the frontier to help neighboring communities who were greatly suffering from the disease.[11] Despite the larger trends of male doctors pushing women out of medicine, the Sick Visiting Committee influenced the development of healthcare in Salem and beyond by providing nursing, caretaking, and midwifery. The Committee continued to train women in these practices, serving the area and receiving support from the community throughout the first half of the 19th century until the Salem congregation relinquished control of the town in 1857.

Legacies of Caregiving

The healthcare system that developed in Salem in the late 1700s reveals the dual importance of women nurses to the historical narrative of healthcare during disease outbreaks, while also emphasizing the importance of supporting women who have insight into the specific needs of their communities while in crisis. In the 21st century, COVID-19 overwhelmed healthcare systems throughout the world and left many communities scrambling to manage the spread and care for the ill. Women nurses reacted to the needs at home and in healthcare spaces and provided care that ultimately sustained their communities during the crisis. However, these women often lacked support from their communities and employers. As we continue to reflect on the impact of the COVID-19 and seek to address nurses’ needs (support, adequate pay, and protection), we would do well to learn from the support the Sick Visiting Committee received from Salem’s elders, male doctor, and community, ultimately allowing the Moravians to survive their own pandemic.


  1. Elisabeth W Sommer, Serving Two Masters: Moravian Unity in Germany and North America, (Lexington: University Press of Kentucky, 2000).
  2. Elizabeth A. Fenn, Pox Americana: The Great Smallpox Epidemic of 1775-82 (New York: Hill and Wang, 2001), 9.
  3. Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry (Cambridge; Cambridge University Press, 2011), 8.
  4. Mary Lou Moore,“Bright Spot in the 18th Century,” The American Journal of Nursing, (1969)
  5. Minutes of the Grosse Helfner Conferenz May 8th, 1772, Moravian Archives, Winston-Salem, NC.
  6. Anna Catharina Ernst, 1816, Moravian Archives, Winston-Salem, NC.
  7. Die Aeltesten Conferenz March 8th, 1781, Moravian Archives, Winston-Salem, NC.
  8. Mary Lou Moore,“Bright Spot in the 18th Century,” The American Journal of Nursing, (1969); R. D. Siewers, and C. M. Siewers, “The Dear Brother Kalberlahn: A Glimpse at Medicine In Colonial North Carolina,” North Carolina Medical Journal (Durham, N.C., 1964).
  9. Salem Diary September 29th, 1779, Moravian Archives, Winston-Salem, NC.
  10. Salem Diary July 2nd, 1781, Moravian Archives, Winston-Salem, NC.
  11. Die Aeltesten Conferenz March 28th, 1781, Moravian Archives, Winston-Salem, NC.

Featured image caption: St Pancras Smallpox Hospital, London. Watercolour by F. Collins, 1881. (Courtesy Wellcome Collection)

Savannah Flanagan is a History Ph.D. student at Baylor University. She is currently studying religious communal groups and the implications of gender, medicine, and belief.

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