The period between 1865 and 1914 witnessed concurrently the transformation of medicine and hospital architecture in Europe and North America and the rise of Protestant medical mission work overseas. Influential in the emergence of the latter was also a shared conviction among many Protestant missionary societies that administrating medicine was the best method for gaining people’s trust, affection and friendship. This shared conviction emerged from a century of mission work marked by failure and frustration. Although the medical missionaries were not alone in talking about gaining local people’s trust and affection, they certainly undertook work on a scale and in places that not only colonial officials but also missionaries themselves could have only dreamed of. By the second decade of the twentieth century, medical missions could be found in large numbers in Asia and Africa. Among the British missionary societies, the CMS took the lead in this regard in Persia and north-western British India, establishing a total of twelve medical missions by 1914.

Through focusing on the issue of gaining trust, affection or friendship, this study has made a case for examining medical mission work under the motto of affecting bodies, saving souls rather than healing bodies, saving souls. In making this interpretive shift, this study has drawn on methodological approaches offered by the field of the history of emotions. In so doing, it has demanded refocusing the attention from medical missions as either sentimental or coercive towards medical missions as emotional setups that served to change the sensory relationship between missionaries and local people. Viewing medical missions in this way has also demanded considering the missionaries, local people, the (built) environment, smell, sound and touch side by side. These points were explored by focusing on five key themes: dispensary and itineration works, the architecture of mission hospitals, hospital visiting and family wards, women’s work and women’s hospitals and the interaction between mission and empire.

I have highlighted that the story of a mission hospital began with itineration tours, dispensaries and local converted buildings that were established before constructing a permanent and purpose-built structure.

In 2011, I visited the Morsalīn hospital in Kerman (southern Persia) for the first time. I intended to work on the revitalisation plan of a historic hospital, and I was advised to focus on this particular hospital – I was told that the Morsalīn hospital was the first contemporary hospital of Kerman. I was born, grew up, and studied architecture in Kerman, yet I was not aware of this hospital, and my advisor had failed to mention that it was established and built by British missionaries. On my first visit, the hospital did not appear to me to be British at all, or foreign for that matter I felt that I was in a familiar place. I only learned that the hospital was built by British missionaries after my third visit; approaching the main entrance of the hospital (which is now closed) I noticed the sign at the top of the entrance, which reads ‘CMS Hospitals’ (Figure I.1). Upon further reading, I realised that the CMS stands for the Church Missionary Society (CMS), which built more than seventy hospitals in Asia and Africa between 1865 and 1939. The first impression that the buildings of the Kerman hospital left with me did not diminish in time, and ultimately it informed the direction of my project – I constantly asked myself how patients felt when visiting the hospitals or, to use Sara Ahmed’s words, how the hospital impressed patients and impressed upon patients.

In 1864 Reverend Robert Clark, a CMS missionary in Punjab, and his wife, Elizabeth Mary Browne, visited Kashmir to find an ‘opening’ for evangelistic work. They were greeted with ‘opposition’ by the officials of the Maharajah and by ‘the masses’ who showed ‘Mr. and Mrs. Clark that neither they nor their religion was welcome in Kashmir’. Despite these obstacles, Mrs Clark opened a dispensary that ‘was largely attended’, and this signified the need for a medical mission. Subsequently, the CMS Committee passed a resolution, and Dr William Jackson Elmslie, a medical graduate of the University of Edinburgh, was appointed to Kashmir to start a medical mission. On 9 May 1865, Elmslie wrote, ‘to-day is memorable in the history of the Kashmir Medical Mission from the fact that I opened my dispensary this morning.’

It is not a bit like an English hospital.’ This was the reaction that the architecture of the CMS hospital for women in Isfahan, Persia, elicited from the newly arrived missionaries in the early twentieth century. The hospital had inpatient, outpatient, isolation and private blocks familiar to the missionaries but the specific design and arrangement of the buildings and the mode of occupation they engender appeared very different. Planned with almost no reference to the prevailing hospital design principles in Britain, the buildings were arranged to form an enclosed compound and were designed to facilitate free movement between the different parts of the hospital (Figure 2.1). Not only the Isfahan hospital but also some of the hospitals in north-western British India were judged in this way: ‘at first one feels “How different to an English hospital”,’ wrote Miss D. Mellowes in 1919 about her first impressions of work in the Multan hospital. Likewise, Miss F. M. Clarke referred to the Peshawar hospital in 1922 as ‘this most un-English hospital’. Not all mission hospitals planned differently from conventional models of the period in Britain. In contrast to the Isfahan, Peshawar and Multan hospitals, the hospital of the London Society for Promoting Christianity Amongst the Jews in Safed, for example, was described as ‘English-Like’. But they functioned, and some were designed, to gain the trust of the local communities.

This chapter is the first among the three that focus on hospital buildings. They examine various architectural configurations the CMS medical missionaries developed to obtain trust and friendship while showing that mission hospitals could not impress upon patients (and visitors) in any simple way. The focus of this chapter is mainly on the design characteristics of the master plan of the hospitals and the general wards, and the following two chapters examine specialised buildings constructed for a whole family and female patients. Meanwhile, they go beyond a mere focus on the layout and appearance to consider smell, taste, touch and sound.

These three chapters also raise questions concerning the internationalisation of hospital architectural forms in the late nineteenth and early twentieth centuries.

This statement, made by Dr Arthur Lankester of the Peshawar medical mission in 1900, suggests that medical missions were established in a step-by-step manner. First, the missionaries opened outpatient dispensaries, after which they started inpatient departments. Dr Urania Latham (Mrs Napier Malcolm) of the Yazd medical mission echoed this statement in her book, Children of Persia, in 1911; she asserted, ‘[a]s a rule a dispensary is started first, to which out-patients can come to get medicine and have their hurts attended to. Later a hospital is opened.’ Lankester and Latham’s statements are comparable to John Barton’s, the CMS’s secretary in British India, in 1874:

The CMS advocated modesty in architecture throughout the nineteenth century. But Lankester and Latham’s use of the term ‘as a rule’ was more complex than it might seem at first sight. They did not necessarily refer to the CMS’s principles; rather, they pointed to the specificities of medical mission work, particularly in British India, China and the Middle East. Not only the CMS medical missions, but also medical missions of the ABCFM, the London Missionary Society (LMS), the SPG, the Christian Missions in Many Lands (CMML) and the German-based Sudan Pionier Mission (SPM), to name but a few, were started as small outpatient dispensaries, followed by an inpatient department in rented buildings and, after several years, a purposebuilt structure.

From the design of the Kashmir, Dera Ismail Khan and Bannu hospitals to the Peshawar, Multan, Islamabad, Isfahan, Kerman and Yazd hospitals, there were continuities, varieties, differences, as well as innovations. As I explained, these varieties and innovations mean that we need to expand our understanding of British hospital architecture in the nineteenth and early twentieth centuries. Besides, what do these variations and innovations tell us about the relationship between missionary medicine and empire? More specifically, could missionaries’ agenda to gain trust overlap with the interests of ‘the state’? This chapter addresses this question. A statement by Lord Frederick Roberts, which was made probably sometime in the 1900s, regarding Dr Theodore Pennell would be a good starting point: ‘Dr Pennell is worth a couple of regiments to the British on that frontier any day’. This statement interested missionaries; they referred to it in their reports, extending it at times to include all the medical missionaries who worked in north-western British India. Lord Roberts was one of the most successful British military commanders, famous for his service in both British India and South Africa. Concerning north-western British India, he is known for his standpoint and actions regarding Anglo-Russian rivalry that lasted intermittently from approximately 1807 until 1914. In using the word ‘regiments’, Roberts associated or even equated the missionaries with his troops in the struggle against Russia. The missionaries’ interest in this declaration suggests that they presented (if not partly perceived) their work as an essential component of the British Indian defence.

This chapter will shed some light on how the missionaries presented their efforts to gain trust in the context of Anglo-Russian rivalry. Eighteen years after Jeffrey Cox warned against ‘the marginality of missionaries in narratives of the imperial enterprise’, missionaries are now one of the main preoccupations in the ‘mainstream imperial history and literature’. However, the same cannot be said about the narratives of Anglo-Russian rivalry, where the missionaries are still marginalised or ignored altogether, in favour of those judged to be central to the rivalry: scholars, military officers, imperial administrators and travellers. This makes defining a point of view from which to tell the story challenging, and this chapter by no means claims to provide an all-inclusive examination.

When I examined the architecture of the Peshawar hospital in the previous chapter, I mentioned that it consisted of a caravanserai for traveller patients – patients who travelled from other cities – and their family and friends. This chapter, the focus of which is on hospital visiting, returns to this architectural configuration. A focus on visitors and visiting is beneficial to understanding the distinct nature of mission hospitals, as it can reveal much about the relationship between the institutions and the communities they served. In their edited collection on hospital visiting, Graham Mooney and Jonathan Reinarz assert that ‘visiting involved the comings and goings not only of relatives and friends, but also of administrators, managers, philanthropists, lay care-givers, priests and ministers, entertainers, and tourists’. Mission hospitals also received visitors from various groups. This chapter identifies these groups, focusing ultimately on patients’ visitors, namely family and friends. Protestant missionaries of various denominations allowed family and friends to visit and even live in the hospitals in Persia, British India, China, the Persian Gulf region, Uganda and Nigeria. The chapter examines who family and friends were, what they did and discusses the reasons that counted for their presence. Additionally, it demonstrates that the presence of family members had an architectural manifestation; that is, the missionaries developed a specific building to host a ‘whole family’ in a hospital. In so doing, the chapter identifies a new hospital type developed at the beginning of the twentieth century.

Mooney and Reinarz find it surprising ‘how little has been revealed about the historical evolution of this seemingly universal practice’. Reinarz further states that ‘the history of hospital visiting has been a strangely neglected theme in the history of medicine’. More than ten years after the publication of their volume, hospital visiting is still a relatively marginalised topic. There is an even greater shortage of research on hospital visiting beyond the European and North American contexts. Only a few scholars have explored the specificities of the boundaries between asylums (or hospitals for the insane) and the extra-institutional world in Australasian Colonial World and South Asia.

I started the Introduction with the story of the Kashmir medical mission. To recall: it tells that Reverend Robert Clark and his wife, Elizabeth Mary Browne, visited Kashmir to find an ‘opening’ for evangelistic work in 1864. They were greeted with ‘opposition’, yet Mrs Clark opened a dispensary which ‘was largely attended’, and this signified the need for a medical mission. This story demonstrates the centrality of Mrs Clark to the foundation of the Kashmir hospital and the history of medical mission work more generally. In 1904, Robert Clark even acknowledged that his wife’s dispensary ‘was the commencement of the present Kashmir Medical Mission’. However, missionary publications credited Dr William Jackson Elmslie as the founder of the Kashmir hospital. Some thirty years later, Dr Henry White of the Yazd medical mission recognised Dr George Dodson as the sole designer of the Kerman hospital, disregarding the involvement of Dr Winifred Westlake completely. While the work of female missionaries like Mrs Clark and Westlake was acknowledged in mission accounts, the history of missions was written in a way as though male missionaries were the solo actors. These cases recall Jeffrey Cox’s statement that ‘interpreting missionary records requires constant attention to the multiple levels of exclusion in the narratives’.

This chapter builds on works of feminist scholars and historians of missionary women. It highlights some of the different ways female missionaries were active agents in Persia and British India. It provides information about several female missionaries whose names and activities have remained unknown in scholarship. Moreover, it demonstrates that there was more to female missionary work than most scholarship has recognised. More specifically, it argues that women’s work in mission should include their involvement in the construction of the hospitals (and mission buildings more generally). Female missionaries were not only educators, doctors, nurses, traveller writers and collectors but were also ‘amateur’ architects. It also shows that scholarship on women and architecture in the late nineteenth and early twentieth centuries should include women who set sail for different countries across the British Empire.