The Order of Saint Elizabeth was founded by Countess Palatine Elisabeth Auguste of Sulzbach, the first spouse of Charles Theodore, Elector of the Palatinate, in honor of Saint Elizabeth of Hungary and as a charitable institution for the poor on 18 October 1766.

The nomination took place either on Easter or on Saint Elizabeth’s Day (19 November), the entrance fee was four ducats.

Additionally, the Grand Mistress was enabled to appoint Honorary Dames, i. e. princesses consort, who were dispensed from the fee.

The badge was a white enameled cross, representing on one side Saint Elizabeth dispensing charity to the poor, and on the other E A, the initials of the founder.

It was worn on the left breast by a blue ribbon with a red border, with inverted colours for Honorary Dames.