In late eighteenth- and nineteenth-century Pennsylvania, women were the primary caretakers of the dying and dead. Watchers tended to the physical, spiritual, and social needs of the dying. Layers out of the dead washed, groomed, fxed, and dressed dead bodies. Watchers and layers included female relatives and neighbors and women who offered their services for pay. By the second half of the nineteenth century, most Pennsylvania women did not participate in these activities; the care of the dying and dead became the responsibility of formally trained and licensed professionals. The Civil War, industrial tragedies, the rise of undertaking and embalming as professions, and the increasing dependence on medical institutions such as hospitals and homes for the incurable contributed to the changes in the care of the dying and dead.