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American Evangelists and Tuberculosis in Modern Japan$

Elisheva A. Perelman

Print publication date: 2019

Print ISBN-13: 9789888528141

Published to Hong Kong Scholarship Online: September 2020

DOI: 10.5790/hongkong/9789888528141.001.0001

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“The Great Gulf Fixed”

“The Great Gulf Fixed”

Rudolf Teusler and William Vories

(p.156) 8 “The Great Gulf Fixed”
American Evangelists and Tuberculosis in Modern Japan

Elisheva A. Perelman

Hong Kong University Press

Abstract and Keywords

Chapter VIII looks at two examples of individual missionaries who, although originally part of larger foreign, Protestant organizations, sought to pursue their own agenda in Japan. The first, Rudolf Bolling Teusler, successfully ran St. Luke’s Hospital, ministering to the foreign and domestic population of Tokyo alike. In doing so, he was able to provide a service to the urban poor offset by the funds of the wealthier ex-patriot community in the Kantō region. William Merrill Vories, an evangelical teacher originally, branched out in the Kansai region, opening a fruitful architectural firm as well as a pharmaceutical industry. With the money from these endeavors, he opened his Omi Mission and Brotherhood’s sanatorium for the diseased. Both men utilized native assistance, but both successfully prevailed in the moral enterprise by finding a niche that suited the environments, thus not depending solely on the government for continued assistance. Similarly, they were able to transform the question of cui bono to who should benefit?

Keywords:   Rudolf Teusler, William Vories, Medical missionary

Not every foreign evangelist in Japan remained under both the auspices and the control of a larger umbrella organization like the YMCA or the Salvation Army. Yet the men of this small group, and they were invariably male, were not simply itinerant Christians. Where Christians like Uchimura and Kagawa forged their own spiritual paths from the start, not all of their foreign counterparts remained members of the Protestant denomination to which they originally subscribed. Because they were not beholden to organizations like the YMCA and the Salvation Army, the foreign evangelists who forged ahead independently had greater freedom to perform missionary work as they saw fit and in ways that worked with their own talents and strengths. Thus, where such organizations sought to balance evangelizing Japan with monetary solvency, men like Dr. Rudolf Teusler and William Vories concentrated on what the contemporary Presiding Bishop of the Episcopal Church in the United States and Doctor of Divinity, Henry St. George Tucker deemed “not simply to make all the nations of the world Christian, but also so to Christianize their relations one with another that the peoples of the world may become a brotherhood.”1

Both Teusler and Vories, though from different backgrounds, denominations, and professions, dedicated themselves to pursuing their goal of international Christian brotherhood through the medical missionary track. Joseph C. Grew, America’s ambassador to Japan at the opening of the second Sino-Japanese War, lauded the role of medicine not only in the evangelist’s arsenal but also as the embodiment of Christian understanding and values, maintaining that “the departures and developments in science, not only in matters of communication and transit but in a thousand other ways apart from the machinery of war, will constantly and progressively tend to destroy the barriers which today separate the human family.” Grew continued:

And of all the factors of science which must inevitably and increasingly exert their influence in that direction, none can exceed the science of medicine. For medicine best exemplifies the fundamental principles of Christianity: it knows no nationality, no politics, no social boundaries; is unconfined by religious sect or creed. The (p.157) spirit of the Good Samaritan is increasingly alive today, exerting its healing influence, rising above prejudice or partisanship or dogma; soothing, blending, uniting in our strife-ridden world.2

From here, it behooves us to examine each man’s contribution to tuberculosis combat individually, though both sought to fulfill their mission as Grew defined it.

Rudolf Bolling Teusler

Medicine may have known no sect or creed, but that certainly never caused Teusler to question his decision to pursue it. Rudolf Bolling Teusler, a postbellum southerner of German descent who earned his medical doctorate before his twenty-first birthday, studied the boundlessness of medicine at a time when it seemed to become comprehensible and comprehensive. As averred by the so-called “father of modern medicine,” Dr. William Osler, theirs was a medicine that finally “simplified the abstruse and complicated knowledge of the chemical laboratories, … and presented it in a form readily assimilable by the men who have to use it.” One of Teusler’s classmates and friends, Dr. Charles B. Robins, recalled that “the period when Dr. Teusler and I were at the Medical College of Virginia was somewhat a period of metamorphosis in medicine … so that Dr. Teusler’s medical birth was about at the dawn of modern medicine.”3

Though he had a bright future in Virginia and perceived medicine transcending nations Teusler saw fit to pursue his practice in Japan, where he believed that he could heal the body and the soul. From the turn of the twentieth century until his death, thirty-four years later, Teusler, as eulogized by Dr. John W. Wood, secretary of foreign missions for the Episcopal Church,

Worked as a Christian physician to erect barriers against disease, to heal the sick, serve the under-privileged, and to cooperate with his Japanese friends in the application of modern medicine to Japan’s physical ills, though the creation of adequate medical facilities to serve the individual and the community along well tested lines.4

Although he was unaffiliated with the larger Christian evangelical organizations like the YMCA and the Salvation Army and ostensibly worked under the broad auspices of the Episcopal Church of America, Teusler drew on the resources of other missions and, without apology or excuses, pursued relations with Japanese physicians who were unrelated to either foreign evangelical or native Christian (p.158) groups. Upon his arrival in Tokyo, Teusler was housed by the Methodist Mission and contacted “several prominent physicians—Dr. Kitazato—Dr Sezuki (inspector general of the Navy) Dr Tegami and others.” Though he acknowledged to the home office that these physicians were “non believers and one, I know, a professed Buddist, [sic]” he enjoyed their “jenuine [sic] interest in the plans for opening the hospital and dispensary” and offers of assistance, and felt no need to pretend that these relationships would offer any new converts.5

To the home office it soon became obvious that Teusler, though himself a devout Christian and a promising evangelist, was dedicated above all else to his hospital. St. Luke’s Hospital existed before Teusler’s arrival, but it was Teusler with whom it became synonymous. The Tsukiji Hospital, as it was known previously, despite fairly auspicious beginnings in 1874 as the first institution to introduce Lister’s antiseptic system, had since been the victim of repeated unsuccessful attempts at establishing a medical mission, only to be abandoned as a failure. To the head of the Episcopal Church, Bishop McKim, “it seemed to bear a very bad reflection indeed on the work not only of the American Church Mission, but of the American Church at home.”6 Thus, it behooved McKim to allow Teusler his dedication. If nothing else, he could hardly make it worse.

Nevertheless, McKim cautioned Teusler against rushing into a revival of the hospital, a condition to which Teusler, perhaps uncharacteristically agreed, and justified as the opportunity to learn Japanese as well as to continue his relationships with Japanese physicians and his survey of the state of medicine in the relatively recent nation. Like Tsukiji, the facilities he found in Japan were “rather inadequately filled up and run in a ship shod [sic] manner, with a poor regard for cleanliness,” despite over fifty years of both private and state-funded medical education and practice. Nevertheless, his Japanese counterparts proved eager to welcome a presumably well-funded doctor and, as Teusler was pleased to report, had “promised to send me patients.”7

As it turned out, Teusler never needed to plead with other physicians to advertise his services. Within his first four months in Japan, despite agreeing to wait a year to open St. Luke’s and its associated dispensaries, Teusler reported having received 221 patients, including many in June due to an epidemic of tonsillitis. While it is unclear if these men and women were sent by Japanese medical professionals or came by virtue of their own discovery and of their own volition (not to mention whether these men and women themselves were Japanese), it seemed clear to Teusler that the hospital was not merely an evangelical niche but a medical necessity. Thus, it was hardly surprising that Japanese physicians proved eager to welcome Teusler, (p.159) his education, and, perhaps most importantly, his equipment. Teusler brought his surgical tools with him, as well as $150 of the Episcopal Church board’s money, in addition to $300 from his own savings, which he planned to employ in “fitting out the two dispensaries and hospital” he had planned. It was in surgery and prescriptions that Teusler envisioned the funds for the work, and even before opening the hospital, he had performed “a few minor surgical operations,” and founded two dispensaries around the city. He believed these measures would “make the work self supporting” in time.8

With the official opening of St. Luke’s on February 12, 1901, Teusler’s belief proved prescient:

There is a fixed schedule of charges for treatment and medicine, and only in cases of direct poverty are these entirely remitted, therefore, although frequently medicine is dispensed at or below costs, of absolute charity we have very little. As there was no regular foreign drug store in Tokyo and our stock of drugs very good, I decided to keep open the drug department of the dispensary as a regular pharmacy, hoping in this way to hasten the time when the hospital can be self supporting. This has proven quite satisfactory.

In less than six months, nearly three hundred patients filled over 1,500 prescriptions.9

Teusler’s promise of a hospital—if not well-stocked, then certainly partially stocked—and the prospect of a paycheck attracted the attention of some of Japan’s finest physicians:

Dr. J. H. Macdonald, the oldest and last known general practicioner [sic] in Tokyo, kindly consented to be consulting physician to the Det. Of Practice, and Dr. Whitney, the foreign occulist [sic] here, gives his services as consultant to the Dept of the Eye and Ear. I engaged as assistants two Japanese physicians, Dr Kawase, a graduate of the Boston University Medical School, and a member of the English Church, and Dr. Inakita [?], also a Christian, and for seven years Resident physician to Dr. Whitney’s Hospital. To both of these men a very economical salary is paid as they were anxious to connect themselves with a foreign general hospital.10

That physicians would want to align themselves with a foreign and previously poorly performing hospital might have seemed odd. Why, after all, would anyone willingly throw in his/her lot with an untested and, more importantly, private, hospital? Yet, as the vicissitudes of politics had made evident, there was little security in a governmental or government-funded position. The continual changing of the guard effected both foreign and Japanese physicians, but foreign physicians were also subject to dismissal paradoxically for having effectively performed their work. Initially invited as consultants and educators, the physicians who had previously filled (p.160) the upper echelons of their field in Japan were being supplanted by their Japanese students. By the turn of the twentieth century, one correspondent to the American Medical Association noted, though Germans had, decades earlier, comprised the entire medical department of the Imperial University, among the current “medical faculty composed of twenty professors, all the Germans but two, viz., Prof. Erwin Baelz and Prof. Julius Scriba, have been weeded out.” Although fairly well regarded in Japan, Scriba lacked the clout of Baelz, both in Japan and among the foreign community. Indeed, the author of the dispatch to the AMA dismissed Scriba’s medical prowess, belittling his “technic” as “not what one would have expected from a German as far as cleanliness and antisepsis are concerned,” and noting dismissively that Scriba “uses chloroform exclusively as an anesthetic,” when ether was evidently preferable. He then denounced Scriba’s practice of keeping patients “upright when operating on the face and head, because this position, he says, lessens the tendency to hemorrhage, never hinting at the fact that such a position immensely increases the danger of the patient’s dying from the effects of the chloroform.”11

Regardless of his ignorance of anesthesia, Scriba was savvy enough to situate himself successfully in Japanese medicine at the turn of the century. To Teusler’s delight (and, more important, that of the Episcopal Church of America), Scriba required a new opportunity, since he soon fell victim to the government downsizing. For the last few years of his life, Scriba, “the most eminent surgeon in Japan,” agreed to send his patients to St. Luke’s, “operating on them there, and all fees go to the hospital except his own personal charges to patient. He gives his services as Consulting and Operating Surgeon to the dispensary clinic and the fees for this go to the hospital also.” Both his presence and his funds, as well as those of Canadian Methodist Dr. Davidson Macdonald, promised the burgeoning hospital “the confidence of the public, Japanese and foreign.”12

Scriba’s exit from public life was actually somewhat controversial, as it remains unclear whether it was volitional. Contemporary sources maintained that he retired from his position as chair of surgery at the university, either of his own accord or at the request of the government. Teusler’s biographers, the Reverends Howard Robbins and George MacNaught, insisted that the sheer strength of Teusler’s invitation was enough to wrench Scriba from his comfortable position with the Japanese government. They reported that presiding bishop of the Evangelical Church and then president of St. Paul’s College in Tokyo Henry St. George Tucker proclaimed that “the greatest stroke Dr. Teusler ever made was when he got Dr. Scriba as head of the surgical service at St. Luke’s. He had a tremendous reputation in Japan, and that was one of the most effective ways to bring St. Luke’s to both the foreign and Japanese attention.” Teusler himself used his good fortune to request more funds from the church board, pointing out that “Dr Screiber [sic] has steadily refused (p.161) several offers to become consulting surgeon to different hospitals stating to me and others that if possible he wishes all of his work done at St. Luke’s.”13

Scriba’s work at the hospital would continue until his death in 1905 and, though Teusler managed a coup of sorts by engaging the talents of Baelz as a consultant, Baelz would provide prestige, but Scriba provided work and funds, as an actual member of St. Luke’s. While the AMA might deride Scriba, while praising Baelz as “a fine teacher of clinical medicine and, as a general practitioner, … at the head of his profession in Japan,” whose success was guaranteed since he served as physician to the imperial family, Scriba remained the more appealing to Teusler. Despite the three decades between them, the two proved good friends. Not only were both avid sportsmen, but, as physicians, both were under no illusions as to the threat of tuberculosis to Japan, despite the fact, as Teusler lamented, that “under the present Law of Japan, the physician is not even allowed to place a patient suffering from one of these (highly infectious) diseases in the buildings (Densenbyo) reserved and designated by law for the segregation and treatment of infectious diseases.” Thus, Teusler confirmed, “it is a fact beyond dispute that the hiatus here in Japan, between Research Medicine as such, and its application to the general public, is the crux of the whole situation.” Tuberculosis was a scourge, but it was a scourge that required at least acknowledgment. In Scriba, therefore, Teusler recognized a kindred spirit. Certainly, Scriba was derided for almost immediately throwing his lot in with tuberculin which, as noted previously, was ineffective. Scriba failed to note any bacteriological indication for his conclusion, while Baelz once again received the higher praise for his more circumspect findings on tuberculin. Nonetheless, Scriba’s optimism meant that he, too, recognized the importance of work on the disease.14

Yet no renown, knowledge, or optimism would matter if Teusler’s institution deviated from its intended purpose—namely, “to make the hospital to them (the patients) a practical application of Christian Charity … to make the teaching of Christianity the prime reason for the existence of the hospital.” As long as Scriba was able to work in a well-furnished hospital, the doctor, though not an evangelist himself, was not averse to St. Luke’s mission, a fact that Teusler touted both as a beneficial attribute of his physician and as a testament to the necessity of funds to continue advancing the condition of the hospital. For Scriba, therefore, the facts that, within mere months of working at St. Luke’s, “already his patients are crowding to him,” and that the hospital needed to “be enlarged so as to accommodate from 80 to 10[0] patients,” were far more significant than the importance of both its medical and moral mission. According to Teusler, “Dr. Scriber [sic] … understands thoroughly that the primal reason for the existance [sic] of St. Luke’s Hospital is that it … teach and bring home to the Japanese Christianity, and he in every way feels (p.162) his aid to this end and has shown interest in the work from this standpoint,” so long as he received his “new addition to the hospital.”15

Scriba, as it turned out, would have little time to appreciate the addition, since the renowned physician would die of tuberculosis in the opening days of 1905, at the age of fifty-six.16 Nevertheless, the fact that Teusler (and his supporters in the Evangelical Church) had been eager to employ and assist such a man, even if only for a short time, was indicative of a willingness not necessarily to ignore the hospital’s stated mission, but to view the achievement of this mission as more important than any of its components in isolation. If Scriba, whose religious beliefs and affiliation, though Christian, remained largely unknown, was nevertheless established as a key figure in the hospital, there was a clear, albeit tacit, acknowledgement that the medical acumen of the staff was at least as important as their moral leanings in attaining the goal of enlightening Japan’s infirmed. While other medical missions tried to maintain a strict denominational bent or clear control within an affiliation, Teusler would continue to employ physicians who, while by no means hostile to his sect, the American Evangelical Church, did not necessarily wholly identify themselves with his denomination or beliefs. Certainly, though the vast majority (if not the entirety) of Teusler’s staff was Christian and, of course, evangelical, they did not need to be Evangelical.

This awareness of the importance of personnel ability, rather than belief, was new and would prove both increasingly useful and economical. Where organizations had required adherence to principles— the Salvation Army more so than the YMCA—Teusler (and, as we shall discover later in this chapter, William Merrell Vories) was free to embrace practitioners outside his denomination. With his employment of and partnership with Dr. Scriba, Teusler had determined that, under his guidance, the institution would remain on the correct evangelical path, even if the denomination of his staff deviated slightly. Through this justification, Teusler would prove able to embrace the assistance of Japanese medical professionals in a way that even the nondenominational organizations could not. Where native Christians had joined the ranks of foreign evangelical organizations, some even reaching the upper echelons of domestic leadership, few were able to occupy similarly responsible positions within the medical missions without the direct oversight of a foreign counterpart, and certainly not so soon after the beginning of the group’s work.

Nevertheless, the transition was far from smooth even within St. Luke’s. Like so many of his counterparts in other missions, Teusler had feared that, without foreign leadership, Japan’s physicians, like its Christians, would be unable to cope, let alone work successfully. Upon learning of Scriba’s death, Teusler wrote a hasty letter to (p.163) Dr. John Wood, secretary of the Board of Missions, to inform him that “as there is no other foreign doctor in charge … things will be largely at a standstill.” It had been a sentiment shared by the Evangelical board as well. When Teusler had first acquired the services of Scriba, the latter had recommended two Japanese physicians who might prove useful to St. Luke’s work, both medically and morally. It remains unclear whether the board embraced these physicians, though the Tokyo bishop certainly seemed dismissive, referring to them as “practitioners,” whose names he was unable to recall.17

Despite his assurances to the contrary, like so many earlier foreign evangelists, the religion Teusler hoped to spread through his work was not Christianity in general, but that of his own sect, the American Evangelical Church. Thus, after Scriba’s death, Teusler continued to press to expand St. Luke’s, and even hoped to do so at the cost of the native congregation adjacent to the hospital’s land. These Japanese religionists, all of whom identified themselves as Christian, were considered by Teusler to be interlopers in his appointed mission and, thus, false Christians, as he believed that they failed to consider moving their church for Teusler’s good. While Teusler urged his home board to grant them sufficient funds to move their place of worship, he lambasted both sides for detaining his work. Although he tried to reach some reasonable compromise, he viewed the neighboring congregants as having had “no legal claim to the land” and he decried the home board for its intention to “have no connection with the matter, beyond paying the money at a specific time.” Teusler railed against his Japanese coreligionists, accusing them and their fellow Japanese subjects, regardless of religion, of continuous “business methods [that] are not honest,” and demanded that St. Luke’s require “a clear title to the land and the Church off the property.” It is hardly surprisingly, therefore, that, as much as American Evangelism, Teusler’s was a religion of pragmatism. He would freely work with those whose belief in the numinous differed from his, so long as their professional skills were up to par, but he had no time for anyone, Christian or not, whom he saw as hindering his immediate progress.18

The relationship between Teusler and the Japanese, including native Christians, might seem complicated, but was evidence of Teusler’s pragmatism. Though willing to work with Japanese as equals, he knew that, in order for St. Luke’s to prove viable as both hospital and herald, the institution needed to appear not merely novel but necessary. Tokyo hardly offered a dearth of medical options by the turn of the century—among those noted by Teusler were “a great many small hospitals, run by individual doctors, which are poorly equipped and indifferently conducted.” So, too, were there “a few large institutions, notably the University and Red Cross hospitals which are doing a good work and are rapidly becoming well appointed.” Of course, for a population rapidly approaching three million, there was still room, Teusler (p.164) believed, for a hospital like St. Luke’s, so long as such a “young foreign hospital must do excellant [sic] work to win the confidence of the people and show itself well equipped and enterprising if it really proposes to become a permanent institution, commanding the patronage of all classes.” Pragmatically, therefore, “it is not enough that a foreign hospital give them as good as they can get else where, from their own native physicians, but we must give them better, or the people as a whole will not patronize the work.” And patronization by the people as a whole was necessary to make the institution self-supporting, the practical goal of evangelical work that supplemented and supported the spiritual goal. Teusler’s greatest fear concerning his work in Japan was that St. Luke’s would be unable to “justly claim to be superior to those around it.” In such a situation, “in place of increasing its usefulness as an adjunct to the work of the Church, it will drag out a few years as a petty dispensary, reaching only some of the poorest classes and depend entirely for its support on the Church at home, finaly [sic] to come to an untimely end and die in obscurity.”19

To combat any slow decline into obscurity, Teusler employed, at least as consultants, the Japanese physicians and surgeons who replaced foreign medical professors like Scriba and Baelz. They included Aoyama Tanemichi, Kitasato’s supposed rival, and Satō Sankichi, who would later amputate Ōkuma Shigenobu’s injured leg. In addition to Japanese practictioners, Teusler continued to court newly arrived foreign physicians, extending “to both of them the privilege of putting their patients in St. Luke’s when in need of hospital accommodation.” Though presumably the foreign unnamed physicians were Christian, of the Japanese physicians Teusler employed or with whom he advertised his consultation, only Aoyama “had a strong affinity for Christianity.” More significantly, both Aoyama and Satō, had significant (though unbeknownst to Teusler) connections to Ōkuma. Satō’s is obvious: having amputated the politician’s shattered leg, he had kept the assassination attempt from being successful. Baelz, who witnessed the aftermath, noted that the leg of the then minister of foreign affairs, resembled little more than a “bag of pebbles,” and, with Satō’s immediate removal of the limb, Ōkuma owed his life to the surgeon.20 Yet Aoyama, too, enjoyed a favorable relationship with the politician. Although it seems doubtful that his machinations ensured that Kitasato’s institute would be transferred to government control under Tokyo University, Aoyama had been a close friend of Ōkuma for many years before the former’s association with St. Luke’s and the latter’s transfer of the institute.21 St. Luke’s ties to such a powerful politician, even through intermediaries, secured the medical mission early attention from Japan’s government. Thus, as with other such hospitals, Teusler had been quick to offer the institution to the Meiji war effort during the year’s conflict between Russia and Japan. (p.165) For this, he was happy to receive the acknowledgement and gratitude of General Terauchi Masatake, the minister of war, who had also utilized the YMCA’s offer to provide army social work during the same campaign.22

Nevertheless, even as he built these professional relationships, Teusler still required outside support for his existence and had to sell his business plan primarily to American investors and philanthropists, few of whom cared about the physical health of a nation so far from their own:

It may be asked why then try to establish Mission hospitals in Japan at all, and the answer to this lies in the counter question:—Do you believe that we as Christians have a responsability [sic] to give to the Japanese Nation Christianity? Is it incumbent upon us as consistent members of the Church and followers of Christ, to support both with our prayers and means Missionary effort amongst these people? If your answer is Yes, then to you the reason for maintaining the furthering Mission Medical work in Japan should become at once clear; for in this we have one of the most, if not the most, efficient means of reaching the people, winning their confidence and leading them to Christ.

Yet Teusler was a pragmatist, as well as a true believer, which permitted him a deft hand as a moral entrepreneur, and continued thus:

There is also an answer from the business standpoint:—St. Luke’s has fully demonstrated after three years of work, by actual results obtained, that if a Mission hospital is properly equipped and run in Tokyo, it at once becomes much more than self-supporting. Our Church therefore can, by meeting the present demand for extension, establish an institution which will adequately exemplify the philan-thropical and charitable side of Christian Missions, and that at no cost, so far as running expenses are concerned, to the Church at home. From the time of Christ until today, preaching the Gospel and tending the sick and suffering have gone hand in hand, and because for Mission Medical work to succeed in Japan there are certain conditions required, shall we hesitate or doubt its need. If the opportunity now ours in Tokyo is taken full advantage of, we can establish at once and pay its own way from the start. If the opening is allowed to pass it will be very difficult if not impossible for us, because of our inadequate size and equipment, to hold the position we have won.

There still remains to be considered our duty to the native Christians to establish a Church hospital, and the service which the work is daily rendering the large body of Mission workers and other foreigners in Japan. Affording them a hospital near at hand in time of sickness and need, instead of, as has been the case several times already, their having to take long and expensive trips to America in search of treatment at the hands of foreign physicians in foreign institutions. St. Luke’s is the only Mission hospital in the whole of the Tokyo Diocese and our doors are open to all, rich or poor, Christian or heathen, irrespective of creed or belief.23

(p.166) The hospital depended upon foreign funds, both from America and from foreign dignitaries and missionaries residing in Japan. Thus, Teusler continuously pointed out the merits of maintaining a “well-appointed hospital” at exactly St. Luke’s location to render medical assistance to “our own Missionaries and the large body of foreigners in the East,” noting that “Tokyo offers a better climates [sic] for hospital and surgical work than the cities further south and in China and the Philippines.”24

But the evangelist doctor feared that all his connections would come to naught economically in the face of what he deemed the lack of philanthropy in Japan. After all, he noted, there was “no board of well-to-do men in Japan who without compensation give their time, money and best endeavors to build up this or that hospital or institution for the general good.” Moreover, “when a rich Japanese dies he does not leave his money to charity…. Endowment funds are unknown…. Charity in Japan begins at home, and up to the present has remained there. A man helps his relatives but goes no further.”25 Yet the institution had, according to Teusler, also served to assist “several members of the Japanese nobility, and men of the highest influence, both in the army and civic life.”26 It was, therefore, his hope that these Japanese notables would ensure that the hospital could not only become self-supporting, but could become truly charitable—assisting those subjects who, up to now, having “little or no money and limited judgement,” were forced to visit “Machi Isha,” or street doctors, who “have only a very limited medical education and practically no equipment or resources,” and whose treatment proves “thoroughly inefficient and in case after case which has come under our observation, the time thus lost has proven the cause of the death of the patent [sic].”27 At the mercy of quacks and chicaners, the vast majority of Japan’s ill threatened the health of the nation, both figuratively and literally. With a disease as virulent as tuberculosis, Teusler, who had secretly faced “the possibility of a tubercular infection,” and had returned to America to recuperate in 1907, knew that, still without a cure, immediate isolation could save hundreds. However, even as he obtained funds to enlarge his hospital, Teusler still lacked the staff necessary to ensure compliance. To this end, the doctor turned his eye toward the creation of a nursing school for the purposes of supplying the hospital with a constant curative presence, and one that would teach its students to be “comforted in mind as well as body” through knowledge of “the great Physician of Souls.”28 In addition, he requested an assistant, who would be not only a doctor but a Christian and who, Teusler believed, would be “a special kind of man … somewhat difficult to find.” While the nurses, both the students and their teachers, could be Japanese and, of course, female, Teusler’s assistant could not. Although (p.167) he claimed that this bias was not his own, but was strictly a necessity when dealing with Teusler’s foreign-born patients, Bishop McKim had noted that the American Evangelical Church had had poor luck when permitting Japanese subjects in “positions of responsibility,” as “one of our prominent Japanese Christians, a physician of some years standing and a graduate of the Medical College of the Imperial University” had been made interim superintendent of St. Luke’s before Teusler’s arrival. The result was “a dead failure. The administration was bad, the place was dirty and always looked down at the heels.”29 Thus, Teusler hoped to find the man he was seeking in America, where “in addition to the usial [sic] requirements in regard to character and Christian training,” Teusler believed he could obtain “a gentleman in the more restricted sense of the term and a man of some address and bearing. It is better for him to have had hospital training and he must have had a thorough medical education. He must be a man of good judgement and weight…. He must not seem too young or immature.”

Though since his arrival in Japan Teusler had employed and entrusted a doctor and nurse couple, Dr. Kubo and Mrs. Araki, both of whom had trained abroad and could communicate in English, Teusler was pleased to have found an American, one Dr. Trinder to serve as his assistant. Almost immediately, however, Trinder have proved an overwhelming failure, and had left without a word. As Teusler angrily reported to Wood:

I was astonished yesterday when I received the cable stating that Trinder had withdrawn. I can find no explanation for his behavior and his method of doing business has upset all of my plans and caused me the greatest amount of annoyance and chagrin. It is now four months since Dr. Trinder applied for Japan and nearly two months since his appointment. All of this time in which I could have gotten some other man he has waisted [sic] and I am about where I was last summer. Added to this he has disarranged all of my plans and thrown out of order much of the work in the hospital. I have told all of my patients here in Tokyo that he would be out by February and had even made definite engagements for his two cases. After I received the cable on Dec. 11th advising me of his appointment it never occurred to me that he would develop into a quitter.

Trinder’s betrayal smarted, not least because he had not offered to “return the fifty dollars that have been wasted in the cables,” and because Teusler was also forced to “countermand an order for his sign which I was having made to be hung up promptly.” Yet, despite the added offense of the money and the nameplate, Teusler still could not be convinced to abandon his presumed need for a foreign assistant, even in the short term. Nevertheless, as he would claim, American physicians proved too selfish and too greedy for Teusler’s work. After a day of interviewing potential and oft-recommended assistants, Teusler relayed his concerns: “One of the first questions which every one of them asked me was, ‘What is there in it for (p.168) me?’ I told them that if that was what they were looking for I didn’t want them. There is no place in our work for any man who is looking to see what he can get out of it for himself.” Bishop McKim, who had found a Japanese medical missionary so irresponsible and irredeemable as to question the point of employing native Christian physicians in their own country, had, by Trinder’s resignation, advised Teusler to continue his vacation as previously planned, “turning over … work to Kubo,” rather than the now-absent Trinder. Teusler, however, refused.30

Dr. Kubo Tokutarō had joined St. Luke’s staff six months after Scriba had done so, making him the longest-serving physician working solely at the institution. Beholden to the hospital not merely for his livelihood, Kubo had also met his wife at St. Luke’s. Araki Iyo, Kubo’s wife, had worked with Teusler longer than her husband had—since before St. Luke’s founding. Soon after Teusler’s arrival, Araki, a graduate of Kobe’s Canadian Church Training School who was working as a private nurse for a patient of Teusler’s, became the medical missionary’s entire staff. In her short memoir, “The Life Story of a Japanese Nurse,” Araki recalled that early on “we had no internes [sic], so I worked both day and night and helped Dr. Teusler all I could.” For his part, Teusler acknowledged that Araki was “very efficient” and “seems to be very intelligent and to love her work from the purest motives.”31 Quickly, Teusler came to trust Araki with his work, medical, spiritual, and educational. Thus, she was entrusted with the administration as well of Teusler’s nursing college, “a training-school for native nurses.” While the Japanese Red Cross, which had previously stood at the helm of Japan’s recent nursing education, was assisted, Araki recognized, by “the fact that they are under Government control,” nevertheless that “nursing throughout Japan, until recently, has been looked upon as a menial occupation rather than a profession.” Under Teusler and Araki’s administration, and using “standards … [that] have been based upon the practice here in the United States,” St. Luke’s Hospital was to be “the only one in Japan requiring its applicants to be high school graduates and insisting upon a minimum of a three-year undergraduate course.” Though in 1918 the position of principal was separated from that of superintendent of nurses, the former going to a female American medical missionary, Araki by then had served as both for sixteen years, since the institution’s founding in 1902.32 Thus, Araki, and not her husband, Dr. Kubo or his physician colleagues, would prove to be the first Japanese medical professional given equal consideration by Teusler.

Araki and Teusler also enjoyed a shared commitment to Christianity in nursing, though neither begrudged those students who chose to pursue other spiritual avenues within the institution. The school emphasized Christianity in nursing (p.169) education, and, in addition to the fundamentals of medicine, “Bible instruction forms a regular part of the training.” Thus, as the medical missionaries reported proudly, “though several [of the nursing students] on entering were not baptized, all have now become Christians.”33

It would make sense for graduates of Araki’s school to be guaranteed placement at St. Luke’s, but, in fact, neither Araki nor Teusler envisioned the institution as a finishing school for St. Luke’s medical missionaries. Both medical professionals entertained the hope that, by sending well educated, Christian nurses throughout the country, both the religion and a dedication to medical charity would permeate Japan and Japanese beliefs. This was a more important task than merely creating a self-supporting institution, at least in terms of personnel. Thus, Araki maintained, her students would be “taught rather than trained and that the institution is really a college of nursing and not a training school for nursing to serve the interests of the hospital itself.” By the end of their education, some three to four years later, the newly certified nurses would “exert a splendid influence in a practical way for Christianity.”34

The spread of medical charity was important to Teusler and his staff, including Araki and Kubo, since it was this concept that Teusler believed to be key to Christianity and, more important, an idea that was foreign to Japan as well. What he did not count on was that, in addition to being purportedly foreign to Japan, it also seemed somewhat foreign to his countrymen. In order to serve as an example of Christian charity in Japan, Teusler determined that his hospital would provide care for those for whom care had been lacking, including those who had fallen through the cracks of previous medical missionary work in Japan. To the displeasure of much of his Board of Missions, he noted that “with our present equipment we are able to do practically nothing for the children, though out here the little ones, particularly among the poor, probably suffer more than many others.” Overlooked by both native hospitals and medical missionary institutions, these children were “sent from one dispensary to another, plastered here, poulticed there, and carelessly treated throughout.” In aiming to provide impoverished children with the care to which Teusler maintained they were entitled, he would have to argue with his home board by exacting payment for medical services from his fellow evangelists. When the hospital cared for the wife and child of a missionary in the Philippines, the Reverend Robb White, both the home board and the local board in the Philippines protested the costs, claiming that “since St. Luke’s is a mission hospital and since Mr. and Mrs. White are our missionaries, the hospital may not reasonably be expected to render this service without cost.” To John Wood, who was representing the home board, Teusler responded:

(p.170) You asked “whether the main charge of ¥72.00 (for Mr. White’s account for hospital services whoever and whatever that is) might not reasonably be considered as fully covered by appropriation made by the Boards.” To my mind undoubtedly no.

The hospital is an institution doing a large charity work and with heavy running expenses. There is no endowment and it has to depend almost entirely on its own earnings to meet these expenses. During the year 1907 the total expenses of the hospital were a little under $16,000.00, (gold). Of this amount the Board paid $1,800.00 and the rest we had to earn.

One of the chief ways we have of earning money is by taking in foreign patients. In 1907 the receipts from this Department amounted to $6,095.00. The regular charge for a private room is $3.00 a day. In a talk with the Bishop several years ago on this subject of the proper charge to be made [to] members of our own Mission, we decided it would be fair to charge the Mission the actual cost of taking care of the patient. In this way the hospital would suffer no loss and the Mission would get the hospital service at actual cost. This is the plan we have worked on for five years. When Miss Clarke of the Hankow District was in the hospital her account was rendered and paid according to this ruling.

If I adopted the plan your Committee suggests the hospital would loose [sic] in actual money at least a thousand dollars a year and many questions would arise which it would be difficult to settle and out of which abuses would probably spring. Every body in the Tokyo and Kyoto Dioceses would have to be granted the same privilege of free board in the hospital whenever they have any ailment. This would also extend to all of our Missionaries passing through Japan. In addition to this as there is no regular arrangement in our other Mission hospitals for taking care of foreigners it would not be long before they would be sending their Missionaries from China and the Philippines up here for free board and lodging.

The rest of Teusler’s missive is decidedly more pointed and even more vituperative:

Putting all this aside I still fail to see what right your Committee has to think that an appropriation made to help out a Mission hospital amounting to about 1/8 of its total running expenses, is sufficient to fully cover a charge made for actual cost of food and lodging for two of the members of the Mission. We have another Department of the hospital for earning our money:— Exporting surgical instruments, etc., to China. We might be urged to sell these instruments to Dr. Jeffereys in Shanghai at cost, but it would hardly be fair to ask us to give them to him, would it? The proposition is exactly parallel. Our rooms for foreigners are merely a means of earning money for the hospital. The standard required for a hospital in Japan is much higher than in China and to meet the necessary additional expenses I have to resort to every way in my power to earn the money….

If we had sufficient endowment, of [sic] the Board gave us enough money to fully support such a large work I think we might take care of our Missionaries free of charge, though I question the wisdom of such an arrangement.35

(p.171) The fight for funds continued for months, with Teusler tenaciously refusing to permit a redefinition of “charity,” which, while angering some of his counterparts elsewhere, allowed St. Luke’s to grow “so steadily in the good will of the public that I am especially anxious just now for it to have no set back.” Though headstrong, Teusler knew that he could not be so unyielding as to antagonize his compatriots and tried to appease them by appealing to their sense of superiority, noting that “a mission hospital in Japan certainly seems to require different handling from mission hospitals any where else, like every thing else in this ‘Flowery Kingdom’ which to our mind seems upside down.” Moreover, though McKim informed Teusler that the Japanese government had “practically decided to give land for our hospital near the Red Cross hospital [sic], provided we only take in Japanese charity cases,” this, too, Teusler refused, since—though “it show(s) there is something doing”—the condition “would cut us out of much of our income, limit our field of usefulness and in some ways injure our work.”36

Teusler desired to maintain his charity work, particularly with the impoverished and young of Japan, as provided by the funds generated from caring for the wealthy, be they Japanese or foreign. To that end, despite the continued support and succor of Dr. Kubo and Ms. Araki, Teusler once again hired an American assistant, Dr. Theodore Bliss, a Cornell graduate, who, Teusler was pleased to discover, was as hard a worker as his Japanese staff and “well liked.” Dr. Kubo continued to perform his job without the full accolades he deserved, though Teusler noted that the physician was “also very popular,” and determined that he, the hospital, and the mission were “fortunate in having two such men.” Indeed, after the fiasco that was Dr. Tinder, Teusler, the Hospital, and the mission were fortunate to have Dr. Bliss, the “steady hard worker” from Cornell, but Dr. Kubo had been a consistent and competent physician, able to weather the storms of a busy medical mission and a busy medical missionary boss, who finally had no choice but to acknowledge that Kubo “has earned golden opinions as to his ability and his character.” Teusler considered Kubo “one of the finest Japanese I have ever known.” Yet Teusler was lucky, as he knew that Dr. Kubo “will remain definately [sic] connected with the hospital, presumable [sic] for life, and will devote all of his time to our work alone.” Similarly, Teusler was fortunate that Kubo was as dedicated an employee as he was a physician, since, “from the first of the year the hospital will pay him Yen 250 per month and all money he makes will be turned into the hospital, except some received for work he is doing for a life insurance company.” It is hardly surprising that Dr. Kubo’s salary at St. Luke’s, regardless of whether he returned it to the hospital, was still less than the salaries of American employees. In 1910 St. Luke’s newly arrived pharmacist made 1,500 dollars for the year, which was at least six dollars more than Dr. Kubo made that same year. Although this difference may seem scant, even taking into account inflation, the fact that an employee who had been with the hospital (p.172) essentially from its beginnings and whose position was more esteemed was making less than a recent hire in a less prestigious position is rather glaring. Yet because of his nationality, Dr. Kubo was regarded as the lesser of the two, at least in economic value.37

His wife also experienced similar relegation. Once chief nurse and principal of St. Luke’s Nursing School, she soon was replaced by the American Alice C. St. John as principal of the school. St. John was well connected to the American Red Cross, and was seen as an asset to ensuring continued American instruction and philanthropic assistance, despite Araki’s ability to ensure the school had acquired Japanese governmental recognition, and who, too, had endeavored rather successfully to acquire eleemosynary assistance.38

Araki, in addition to providing “able management” of the nursing school and enabling it to enter the Taishō period in “a flourishing condition,” also ensured that both it and the hospital proper remembered the importance of the charity that Teusler fought so hard to maintain. Like her supervisor, Araki was committed to serving those whose livelihoods and neighborhoods meant that theirs was a life in Tokyo’s slums—indeed, in the very environs of St. Luke’s. Here, some of Japan’s great epidemics preyed on the populace, claiming many in their youth. Along the banks of the Sumida River mortalities exhibiting symptoms of cholera and tuberculosis often surpassed other causes of death well past World War I.39 It was the latter that troubled Araki the most. As she reported to the Sixth International Congress on Tuberculosis in Washington, DC, the disease, in all its myriad forms, was rampant in her country, and its prevalence was “much greater pro rata to the population than in America or Europe.” Though the Japanese government calculated that among the lower class the number afflicted ranged “from 25 to 40 per cent,” Araki noted that, in Japan, “among factory workers, milling hands, and those leading a laborious and exposed life, such as ‘rickshaw pullers,’ street peddlers, etc.”—namely those living in the slums near her workplace—“the figures range from 55 to 70 per cent.”40 One of the participants of the international congress was more than aware of Araki’s findings. Kitasato Shibasaburō, an honored speaker at the congress, noted that the mortality rate from pulmonary tuberculosis in Japan, increasing steadily since before the Sino-Japanese War, had reached 18 percent per 10,000 inhabitants throughout the country and across the economic spectrum. Though still considered a lower-class affliction, tuberculosis was beginning to cut swaths across Japan’s military, and had (p.173) not gone unnoticed by the nation’s burgeoning life insurance companies: “Although the public conscience is well aroused as to the dangers of tuberculosis, no adequate instruction is given as to the proper modern measures for prevention and cure.” Indeed, Araki noted, “The general poverty of the people prevents adequate curative measures from being taken by the individuals infected.”41 For so many of Japan’s afflicted, government assistance—medical, educational, and social—was unknown.

Under the guidance of Teusler, Kubo, and Araki, St. Luke’s became one of the few institutions to offer assistance to those suffering from tuberculosis, and to do so at little to no cost to the patients or their families. Not surprisingly, many government officials were grateful for the philanthropy. However, originally, the role of Christianity within the hospital was somewhat troubling to the same officials. In offering the affiliation of the government’s Department of Communications, some ten thousand workers, and the necessary bureaucratic assistance and permission to build a hospital to serve them on condition that St. Luke’s renounce its Christian affiliation, Prime Minister Katsura Tarō had hoped to employ Teusler’s knowledge and assistance without his presumed religious association. Teusler, however, refused. Yet the wariness of Japan’s government toward Christianity was actually shared by the American physician. As with his earlier spat with the native Christian church next door to the hospital, Teusler’s relations with Japanese Christians, save for those in his employ, were rather strained. Even Sakai Tokutarō, known to his American friends and peers as Barnabas Tokutarō Sakai, a high-level Japanese government official, graduate of Hobart College and Harvard University, and a devout Christian, was considered unworthy of representing Christians. As Teusler sniffed to Wood, “It would be a waste of money to send Sakai to Edenburgh [sic] as a representative of the Church in Japan. He has never really been actively engaged in Mission work, is not a Priest and for the past several years has devoted himself almost entirely to Goverment [sic] and political work.”42 In dismissing Sakai, a highly placed government official, who could certainly prove a boon to the evangelization of Japan, Teusler made his prejudices clear. Teusler’s distrust included not merely many Japanese Christians but also government officials, and a number of his fellow evangelists both in Japan and elsewhere. Though a devout Protestant, Teusler bristled at how his Mission failed to realize, as he did, that St. Luke’s transcended mere missionary work. Indeed, neither McKim nor Wood, both considerable allies of Teusler and admirers of his work, saw the hospital as anything more than another aspect of the Episcopal Church’s evangelical efforts. As McKim noted to Wood, when Teusler (p.174) failed to cooperate with the home board, “I think that the doctor should be more generous and consider the evangelistic work as being equally important with that of St. Luke’s.” Wood concurred, and politely reminded Teusler “how easily some people get the impression that St. Luke’s work is something apart from the Mission. I know you want to head off any such misapprehensions as that. Perhaps one of the best ways to do it is to be ready to give and take with the rest of the Mission when needs arise.”43

Teusler’s defensiveness might seem disparate and even odd, but, in truth, all his suspicion was cast upon those he feared would or could co-opt his work for their own—Japan’s native Christians, Japan’s government, and those within the Episcopal Church who believed that they should benefit from Teusler’s charity. Teusler knew his worth, even if those around him did not. More important, he knew the worth of his work.

By the end of the Taishō period, however, Teusler would become more open to assistance by outsiders, and would begin to differentiate cooperation from co-opta-tion, yet the Japanese government, it seemed, would have to make the first move. By 1914, the government had recognized how convenient St. Luke’s was to the capital city, and, under Ōkuma, some of Japan’s bureaucratic and intellectual elite forced a council with an eye towards granting “official recognition of the plan to build a new St. Luke’s and [determining] the most satisfactory way in which assistance might be given by the Japanese.” Assisted by Gotō Shinpei, Sakatani Yoshio, and Shibusawa Eiichi, the four men aimed to raise (though not necessarily personally donate) 200,000 yen (the equivalent of $100,000) for the hospital, since, as Ōkuma pointed out, “the past work of St. Luke’s Hospital has already proven invaluable to our own people as well as to foreigners.” Ōkuma claimed to be “pleading for your assistance in this great cause for suffering humanity, and for the advancement of medical science and learning both in the Occident and the Orient.” The Taishō emperor answered his call with a gift of 50,000 yen. The commendation’s worth was more than just financial, to both Teusler and Ōkuma. To the former, as recorded in the Mission bulletin, The Spirit of Missions, the gift “attracted attention throughout the length and breadth of Japan and will draw at once to St. Luke’s the best of Japan’s medical student and nurses. Any work or institution upon which the Emperor puts his stamp of approval secures the allegiance of the people.” To Ōkuma, though his charitable interests certainly benefited in the same right, it once again meant he need not reduce his personal coffers.44

The coalition of government officials and Teusler also proved a boon to Japan’s foreign policy. Like his colleagues in the YMCA, Teusler volunteered to assist Japan’s mission in Siberia following World War I, but, more important, he also began to view St. Luke’s as a true alliance of nations, even more so as the relations between Japan and America began to founder, the victim of fears of the Yellow Peril on the side of (p.175) Americans and the reaction to that fear on the side of the Japanese. Nevertheless, regardless of racism and distrust on both sides, with the abnegation of the 1907 Gentleman’s Agreement, limiting Japanese immigration to the United States, Teusler persevered in maintaining work and relations of benefit to both nations. When representatives of the Rockefeller Foundation, including John D. Rockefeller Jr. himself, stopped in Tokyo en route to Beijing in 1921, Teusler invited them to tour his hospital, and accepted passage for himself and Dr. Kubo the following year to visit the Rockefeller-funded Peking Union Medical College, in order to “profit by innumerable suggestions for the plans of the new St. Luke’s Hospital.” Not satisfied to learn by example, Teusler bombarded Dr. George E. Vincent, then president of the foundation, with requests for assistance in founding Tokyo’s public health program. Vincent, no friend of Japan or the Japanese government, was unmoved by the request to assist the nation and, as Gotō (then mayor of the city) claimed, “attract the attention of nearly 200 million people to a generous act of cooperation between Japanese and American citizens.”45

Vincent’s reticence was challenged by the Great Kantō earthquake of 1923. Though relations between the two nations often remained tense, the aftermath of the tragedy saw the Rockefeller Foundation reluctantly comply with Teusler’s wishes, though, as medical historian John Farley claimed, even after the devastation wrought by the earthquake and the fires that ravaged the eastern seaboard immediately after it, “the Japanese seemed perfectly capable of organizing their own affairs…. One gains the impression that the Health Board was being taken for a very long ride.”46 What Farley failed to consider, however, was that, while Japanese science was, indeed, highly advanced, the nation still struggled against epidemics in the face of a government unwilling to invest fully in national public health. The issue, however, would remain moot for a few more years while the divisions between Kitasato’s institute and that of the Japanese government continued.

Yet while Rockefeller Foundation funding foundered amid the divisions within the scientific and political bureaucracy, Teusler continued to work as a bastion of Japanese and American assistance—a fine alternative to pure American philanthropy, like the American Red Cross, to which many Japanese politicians and their constituents were increasingly averse to be beholden.47 While grateful for the assistance, a large portion of the Japanese populace desired that Japan be considered capable of assisting itself, such that, once rebuilt, the nation could progress without interference. While at first glance this preference might seem “antiforeign,” it began to make sense to Teusler, as it had to a handful of other foreign evangelists within larger organizations, though not necessarily to those leading the organizations themselves. “I cannot blame them very much,” Teusler informed Wood. This (p.176) sense of self-sufficiency was important to a nation. Teusler’s rejection of Western condescension is also apparent in his account of a dinner with a well-placed British resident of Yokohama who described the nature of the Japanese staff at the International Hospital in Kobe:

He explained they had four British nurses and five Japanese women helpers, three of them trained nurses, and also explained, with characteristic British detachment and aloofness that ‘of course we cannot permit the native nurses to give drugs or anything more than bathing the patient and serving them their food, … one can’t put much confidence in these native nurses, can one?’ I laughed, and replied that he had come to the wrong man, inasmuch as St. Luke’s had about one hundred and twenty-five Japanese nurses, and only some four American nurses, not one of whom, so far as I knew, ever gave a dose of medicine from year’s end to year’s end….

My point is that the seven foreign doctors on the Staff of the International Hospital, together with the foreigners treated in the Hospital, and the nurses controlling it, almost without exception assume an air of superiority and conduct themselves in a way inimical to real friendship and understanding with the Japanese. The Hospital, with all of its services, is an exotic and will remain so, so long as they continue such a policy…. I believe, however, it should be run on lines more friendly to the Japanese, and more cooperative.48

In the wake of the earthquake, St. Luke’s had become a symbol of Japanese resilience, and one that the government was far more willing to encourage. Gotō issued an official communication “as Home Minister and President of the Board of Reconstruction” in which he stated that he eagerly anticipated the hospital’s restoration as well as that “of its service to the people of Japan. The needs of our suffering people are very great and the sooner you open your doors to receive them the greater will be their gratitude.”49 Though once again ravaged by fire in 1925, St. Luke’s continued to serve the suffering people of Japan, be they victims of natural disasters or of diseases. And though gratitude continued and Japanese government support, even if usually only by means of lip service, remained firm, Teusler was willing to question his patrons in Japan for their continued disregard of the plight of the nation’s infirm.50

(p.177) Though his commitment specifically to Japan’s tubercular might seem more tenuous than that of his fellow medical missionaries in larger evangelical organizations like the YMCA or the Army, Teusler (and thus, St. Luke’s) must nonetheless be credited for eventually realizing the necessity of employing Japanese medical professionals in positions of authority. As a moral entrepreneur, Teusler proved fairly successful at utilizing Japanese medical personnel, without facing such stricture from the Japanese government. Indeed, such men and women as Kubo and Araki were both fully capable of the work and were well aware of the conditions in their native land. Teusler’s commitment to the health of Japan might not have been fixed solely on a single epidemic, but nor was it as self-serving as that of his compatriots. In contrast, William Merrell Vories melded Teusler’s cooperation with Japanese medical professionals with an attempt to concentrate solely on one disease, and thus proved to surpass Teusler’s work, and to do so outside Japan’s capital.

William Merrell Vories

Unlike Teusler, Vories had not intended to become a medical missionary in Japan. In 1886, when he was seven years old, Vories’ family had moved from Kansas to Arizona to facilitate his recovery from intestinal tuberculosis. Ten years later, and presumably cured of his disease, the family landed in Colorado, where Vories attended high school, eager to pursue architecture at Colorado College. An intelligent and confident youth, Vories joined his school’s YMCA chapter, quickly becoming treasurer. Yet it was not until halfway through his education at Colorado College that his intended path shifted significantly. At the 1902 International Students Evangelical Movement Convention in Toronto, Vories was transfixed upon hearing Dr. John Mott speak of the importance of foreign evangelical work, a sentiment echoed by Mary Geraldine Taylor (née Guinness), the wife of Frederick Howard Taylor, a medical missionary based in China during the tumultuous Boxer Rebellion. Moved by their messages, Vories forsook his intended major and dedicated himself to philosophy, with the hope of becoming an evangelist in Asia.51

His faith was complemented by his devotion to the arts; in addition to the painting and drawing that led him to architecture originally, Vories was a gifted musician and composer, and an eager, though not particularly talented, poet. Now emboldened with a mission, the desire to fulfill it, and the gifts to do so, Vories believed that he had uncovered a universal truth:

  • (p.178) One time a fool
  • Was sent to school
  • To learn some sense
  • And clear the dense
  • Delusion from
  • His cranium;
  • This is no lie:
  • That fool was I.52

No longer a fool, though still not much of a poet, Vories graduated in 1904, and within the next year the twenty-four-year-old was on his way to Japan to work as a high school English teacher under the auspices of the Young Men’s Christian Association in Hachiman, a rural, small former castle town on the shores of Lake Biwa, once famous for its traveling merchants and its connection to Toyotomi Hidetsugu, the nephew and one-time heir of Toyotomi Hideyoshi, one of Japan’s great unifiers.53 Since the Meiji Restoration, however, the Ōmihachiman region had become somewhat more quiescent. Some three hundred miles from Tokyo, the town was closer to Kyoto, yet still far enough over land and water from even that city to feel a sense of isolation. Vories noted that his placement letter described “a Japanese government academy in an interior town, at the heart of a whole province in which no missionary yet resided.” So desperately eager were the local government officials to remedy their isolation, both national and international, that Vories reported that the bureaucrats “would concede him (the English teacher) permission to teach Bible classes in his leisure time, so long as he refrained from mentioning religion in the class rooms.” This suited Vories, since it meant that he “might earn [his] living by teaching, and at the same time inaugurate mission work in virgin soil.” Unlike many of his colleagues in the association, Vories recognized that his situation was precarious, not merely because his position was at the mercy of the town government but because, even that late in the Meiji period, few men could survive as evangelists without a supplemental income source.54

To Vories, however, Hachiman seemed less than the sum of its parts, parts that were located far off the beaten path, seventeen hours by train from Tokyo: “At last—and a very long last it seemed—the train drew up at a desolate little station … Nothing of the town was in sight except a dozen or so shabby buildings clustered near by…. It seemed incredible that this could really be Hachiman—the Hachiman of my quest.” Somewhat sobered by the discovery, Vories admitted that his arrival was inauspicious. “Here I was at last in the place of my dreams—and rather badly shaken in my enthusiasm for the great venture.”55

(p.179) Confused, scared, and quite a bit homesick, Vories resolved not to give in to the “night-marish feeling of insufficiency, of foretasted defeat” that ate at him, and to continue on in his dream of “establishing … an ideal community on Christian principles,” though, as he was warned by “Tokyo Americans,” and as he imagined it, he was located “in the heart of the last determined stand of Buddhism, in its least enlightened manifestation.” Yet perhaps the region was not so unenlightened as Vories had feared. After all, the school at which Vories was to teach had been established almost two years earlier, the brainchild of prefectural governor Nakai Hiroshi, a colleague of the pioneering Meiji minister of education Mori Arinori, in the hopes of promoting the same level of “wealth and power” that Nakai had observed when he visited England as both a student and a politician.56 Nevertheless, to Vories in the first days after his arrival, it did, indeed, appear, as he had been warned, a desolate area, “cut off from surrounding parts by a girdle of mountains, isolated from foreign contact, conservative to a degree.” Moreover, he had been advised that, though much of his new flock would remain strongly held in the grip of Buddhism, “the students and teachers of your school … being educated out of the superstitious forms of Buddhism,—which are all they have known,—will be either indifferently agnostic or openly opposed to all religion.” Thus, even acknowledging the presumably progressive influence of the Meiji leadership meant only that those with whom Vories would have initial contact would be as intolerant of forms of Buddhism as they were of Christianity, preferring the nationalist value of Shinto. For foreign evangelists, the denial of all religion was far more difficult to counter than the embrace of a competing faith. The latter, presumably, required only education to correct ignorance; the former, however, demanded a method to overcome disbelief entirely.57

The town’s greeting of Vories’ February arrival seemed as cold as the weather, yet, as Vories would soon discover, a number of residents of Ōmihachiman would show themselves to be very pleased to engage the new teacher. At his encouragement, students arrived to interact with him, since “it was no small attraction that a real live American could be inspected at close range.” Drawing upon his novelty, Vories offered the boys a chance to indulge the natural curiosity of youth, offering to show them “delectable foreign games—new and glamorous there (altho [sic] almost prehistoric at home)—such as Dominoes, Flinch, Ping Pong, and the like,” as well as all of his “American furnishings and trinkets and a large and varied collection of views and picture post cards that gave intimate glimpses of that Promised Land of Japanese youth—America.” Although he hoped to introduce the inquisitive students to another promised land, both Vories’ loneliness and his intuition led him to realize that his task was to introduce America before he could heaven. Indeed, Vories was savvy. As historian Gregory Vanderbilt noted, in inviting the boys to his home, Vories would, by terms of his contract, be able to conduct religious study (p.180) unimpeded, so long as the work was neither during school hours nor on school grounds. It also permitted the teacher to observe the students under more relaxed standards, and thus to conclude which students, regardless of their persona within the classroom, were the true leaders of the group. It was, therefore, to these students first that Vories put forth an invitation to pursue Bible study, his first foray into missionizing, before he turned to the sanatorium.58

Despite the ease by which Vories might have acquired disciples had he promoted his extracurricular group as one of English education, he determined that this could prove both misleading and difficult, particularly since his Japanese was nearly nonexistent and many of his students’ knowledge of English was still basic. This was a distinction that few of his fellow association teachers made, often employing both language training and, eventually, physical activity and games as an (often unsuccessful) subterfuge by which to evangelize. Thus, with the assistance of a young Japanese Christian, Miyamoto Bunjirō, a graduate of the high school and now one of the instructors, Vories planned his first group as a slow progression of explanations of Bible passages, first in English by Vories, and then translated in Japanese by Miyamoto.59 Although the head of the English department at the school demanded that he act as Vories’ interpreter, the meeting went on unhindered by this slight change. As the number of attendants grew, Miyamoto, too, was allowed to act as interpreter when the original group became too numerous, and subgroups formed. Within eight months, the Bible study groups were attracting well over one hundred students, not counting the two-hundred-some students who attended Vories’ groups at the two other institutions in which Vories taught weekly.60

Though interest was high, conversion was not. At first, the work seemed to many students a novelty. But Vories had the enthusiasm of youth, and his joy seemed infectious. As one man reported to him, some fifteen years after a chance encounter when the former was a college student who happened upon a YMCA conference at a rented Buddhist temple, “I could not understand much of what you said, but the way you talked to me made me feel that you had something which I did not have; and I was never afterward satisfied until I had found it.” It was a sentiment shared by many of Vories’ actual students. There was something terribly engaging about the man. Indeed, so eager was the teacher to convey his lessons that Vories opened (p.181) his house to a few students, in addition to Miyamoto, as a proto-YMCA dormitory in the town.61

Emboldened by his success, Vories began to engage a disciple of Rev. Joseph Neesima, one of Japan’s most famous converts, and together the two men established both an official YMCA building and a small church, using only the gentleman’s charity for their foundation. Within this presumed bastion of Buddhism, Vories and his colleagues had begun to establish a small wellspring of Christianity. It was, he recorded in his diary, “a great privilege … But it costs much, much! No other teachers know of these … doings, or of the bright side, either. It costs blood and gray hairs; but it is life worth living!” Though Vories mentioned that the cost of the work was blood and aging, he failed to point out that the work cost him nothing economically, or, at least, it had not yet done. Nor (and more important) did it cost the home office anything. He proudly stated in 1925, “Not a cent for building, salary, or current expenses” of the little church in the town “has been given them from America.”62

Evidence of the Buddhist animosity about which Vories had been forewarned seemed at first happily absent, and Vories’ belief that “human nature is identical in Orient and Occident; that the recently acquired characteristics of races and nations are, like war paint and feathers and other clothing, only outward show” remained firmly intact. Yet, when, as Galen Fisher maintained, “the number of student converts aroused opposition,” rumblings began in the local community. According to Vories, there were “two unfortunate elements” that led to conflict with this community:

First, I was undoubtedly enthusiastic and active, and the Bible classes became unexpectedly popular and successful. This caused surprise and then consternation among the easy-going country priests of our community who feared loss of adherents and whose head temples in Kyoto began to fear loss of revenue. The local priests were incited to resistance and assisted in it by their superiors from Kyoto. Second, reports from my new friends, and then observations of my own, revealed a scandalously low standard of personal living and of community service on the part of the unfortunately low-grade priests who headed the local temples. Either directly or indirectly I was bound to condemn the local priesthood—even if I praised the ideals of their religions.

Indeed, Vories assured his readers, the first Buddhist officials with whom he had come into contact, a young priest and the head priest of his sect, were “men of good character and ability,” and, he quickly noted, “they were not local men.” While the superior priest differed philosophically from him, Vories nevertheless claimed that their character and ability was laudable as the younger priest was “well educated and fluent in English” and, more important, had informed Vories that “he felt (p.182) Buddhism to be decaying and inadequate to modern Japan, and that he personally hoped Christianity would become the standard of his Nation.”63

However, no matter how positively Vories paints his consideration of his community (and of those people who did not subscribe to his beliefs), the work was disrupting some social relations. From his own varying accounts, Vories blames “a small group of the unruly element” among his students “whose chief enjoyment seemed to be to fight or to break discipline,” as well as Buddhist priests who “did not come from the school” and who “instituted various forms of obstruction” (which then led to student unruliness) and who instigated “newspaper attacks … upon the character and motives of the new American teacher. Finally politicians were induced to make an issue of the school’s appropriations from the provincial government being used to support a ‘foreign’ religious propagandist.” Whoever was to blame originally, Vories claimed, the student bullies nevertheless perpetrated a “systematic and resourceful campaign of abuse and persecution, such as, I believe, the annals of modern missions in Japan have seldom, if ever, paralleled.” Yet, even these students were reformed, and some so far as to become, like Watanabe, as described by one photo caption, a “Sunday School Superintendent and pillar of the church in his native town.” Thus, it was the adults who continued persecuting Vories, culminating in the forced lapse of his contract with the school, since, as the principal admitted, the town “expected you to teach the Bible, but they did not expect anyone to believe.” His first successes having come to ruin, Vories left his position in 1907 knowing that the town would remain closed to him, yet determined (albeit somewhat demoralized) to remain with his young flock.64

In hindsight, Vories’ next move, to support his work through architecture, seems both wise and immediate. Both Galen M. Fisher, of the YMCA, and John T. Faris, of the Presbyterian Board, address the career change rather flippantly, as if it seemed to Vories the next obvious choice.65 In truth, Vories’ self-support faltered briefly, as did his faith, though only in himself. Instead of immediately searching for a new position, Vories benefited from the kindness of friends and strangers, both Japanese and American. After two years of self-support, and evidence that his evangelical work could be both self-supporting and expanding, was Vories able to earn and utilize philanthropy from America. Yet these foreign funds came, not from the association under which he had worked, but from men like one American businessman who, without visiting the town and without revealing his name for over two years, donated twenty-five dollars a month. Similarly, funds came from subscribers to Vories’ newsletter, Omi Mustard-Seed, a self-published magazine that apprised foreign readers of the growth of Vories’ independent Omi Mission, unconnected to (p.183) the various publications of either umbrella organizations like the association and the Army, or of entire religious sects.66

Once assured of continued subvention, Vories was free to explore options for continued organizational self-support, including the architecture he had previously abandoned. In fact, the necessity of further self-support had struck Vories a year earlier, suspecting that his teaching job could not last indefinitely. Either for sustenance or growth, he recorded in March 1906, “some lucrative side-issue for getting funds” was necessary “to be accumulating toward the eventual Mission to Omi.” He had earlier abandoned architecture not merely because philosophy seemed more utilitarian for an evangelist but also because, as Vories later recalled, it was too easy to deny his call to serve abroad as an architect. As a future architect, Vories “had sought for excuses to stay at home,” instead of attending his Colorado high school. He struggled against his inclination, and his planned career offered him the perfect excuse: “I determined that I would become an architect in America, make a large fortune, and send out half a dozen missionaries. That would be so much better for the Cause; and, more particularly, it would excuse me from going out!”67

Now architecture had to be rehabilitated. No longer an excuse, the occupation needed to become a more direct support of evangelical activity in the field. As Vories soon realized, architecture would support not only evangelical activity among his flock but also those throughout Japan. While providing funds for his work, Vories believed that his inchoate architectural firm could improve the nation’s evangelical buildings, since, as he noted, “a good deal of uneconomical building had been done by various missions, and that some rather inconvenient buildings had cost over much, where the builders were at the mercy of native contractors.” Thus, architecture would allow Vories to “serve other missions while earning support” for his own.68

Despite the education he lacked in both architecture and business, Vories proved a savvy businessman, in addition to being a natural architect. With the assistance of a former student, Yoshida Etsuzō, and young American architect Lester G. Chapin, Vories founded W. M. Vories and Company, Architects, an architectural firm with a solid basis in evangelical work, originally building mission offices and churches, and later including secular buildings both in town and across the nation.69

The architectural firm was far from the only business Vories would establish. Soon after the architectural firm received commissions, Vories realized that various equipment need not be imported from abroad, and began to build relationships with local suppliers, to the benefit of both groups. Within six years, Vories had established a network for building materials and interior goods. Yet, Vories’ commercial successes were not merely pragmatic. Not surprising for a philosopher, (p.184) Vories also based his business decisions on principles. As he admitted in one of his many memoirs of the growth of his evangelical community, “an additional stimulus was urging us to attempt a business venture.” Vories’ business savvy was meant to counter “the cynical attitude of our neighbors, who professed to believe that the principles of Christ which we were advocating, altho ideal in theory, were impossible to apply in a successful modern business.”70

Even more than his architectural firm, Vories is often associated with another branch of his businesses, namely the Omi Sales Company, Ltd., which introduced and distributed Vories’ so-called “healing cream,” that very “well-known household remedy for little ills, like bruises, burns, and any inflammation—Mentholatum.”71 An 1893 invention of Wichita businessman Albert A. Hyde, Mentholatum, a combination of petroleum jelly, camphor, and menthol crystals, the “simple and really effective remedy for a score of little ills of the skin and mucous membrane” became popular in America soon after Hyde began selling it from his Yucca Company of soaps and shaving creams. By 1906, it became Hyde’s sole product, making him a fortune, much of which he was inclined to tithe to various Protestant evangelical organizations, including the association and the Army.

Hyde was also given to assisting such organizations in more direct ways. Soon after meeting Hyde in Wichita, Vories convinced the businessman to give Omi Mission the exclusive rights to sell Mentholatum in Japan. By 1920, Mentholatum was distributed in Japan by the Omi Sales Company, Ltd., of the Omi Mission and would fund the work to which not only Vories but his entire organization dedicated their lives.72

One should not, of course, discount Vories’ architectural firm, which funded the mission for some thirteen years before the commercial success of Mentholatum. Whereas the balm had already proved fiscally sound in America, there was no precedent for Vories’ architectural success. After all, he was a self-professed “lone amateur” who could only count somewhat “more than ten years’ study of architecture as a personal hobby” as his qualification. Nonetheless, in less than twenty years, his firm, having grown to thirty men, primarily Japanese, many of whom “trained wholly or chiefly in our offices” (although some also possessed degrees from Japanese and American universities), would be consistently commissioned by Japanese bureaucrats to build secular buildings in Japan. It was primarily this work that funded Vories’ evangelization of the rural area across Lake Biwa, to the west, through literature and periodicals, railroad workers’ YMCA branches, and, uniquely, his motorboat mission, Galilee Maru, whose sailors preached along the (p.185) shores of the large lake.73 What Vories realized, as Teusler had eventually, was that, just as these works were for Japanese villagers, so, too, should they be primarily conducted by Japanese villagers. It was something that Galen Fisher discussed, even as the association had continued to reject it:

Many a foreign missionary has insisted too long upon disbursing all funds granted for evangelism by his home board. No rule can be laid down as to just when he should let go of them, but some men have wasted their own strength and impaired their finer influence by failing to entrust funds more fully to Japanese colleagues. To be sure, some of the dollars might possibly appear to go further if the missionary were handling them, but it is very doubtful if they would carry so much of the love and power of Christ with them. I do not doubt that scores of Japanese [of] the largest caliber have been repelled from Christian service by the domineering spirit and close financial control of a few missionaries whose reputations have hurt the entire missionary body.74

Vories also recognized what many others, including Teusler, had not—namely, that the evangelization of Japan would be unsuccessful without equal emphasis on the nation’s rural population as on its urban one. And, more important, he recognized that the evangelization of Japan had to be more important to the population of Japan than it was to Christians worldwide, but often was not. To Vories, this lacuna was “the weakest point in the missionary campaign in the Empire.” It was a lacuna that Dr. Wilhelm Gundert, evangelist turned Japanese religious scholar, had attributed solely to “the great gulf fixed between the missionary worker and those whom he ought to serve.”75

By 1915, when Vories published his treatise, this gulf had come to include the spread of tuberculosis throughout the rural communities. As the early phase of industrialization ended, the nation’s young, primarily female textile workers returned home, ill or as silent carriers, and spread the disease through a population that lacked resistance to what had previously been, as historian Mikiso Hane deemed it, “a relatively rare disease.” Though Vories noted the “depredations of the ‘white plague” soon after his arrival, and was particularly shocked by “the neglect of its victims in an avowed belief that it was ‘as hopeless as leprosy’—then held absolutely incurable,” his attempts to promote the need for medical mission assistance had remained unfulfilled.76

Vories’ metaphor was not merely medical; the reference to leprosy also brought with it allusions to the New Testament, and to the belief that the faith of the patient together with both the tenderness and the faith of the physician could be curative. Certainly, Vories was not ignorant of the importance of medical science, but, in lieu of a scientific cure and, perhaps more important, in lieu of a sense of caring from the (p.186) larger populace, the government, and even much of the Christian community, this was a rural need that he felt he could well fill. “For years,” he noted, the Omi Mission marked its concern over “the terrific toll of tuberculosis in Japan,” and had debated the merits of the establishment of “such fresh-air cures as we had seen in Colorado.” (Though it is undeniable that Vories had seen such environments in Colorado, whether the majority of the Omi Mission had actually experienced this was doubtful. Still, that Vories spoke inclusively of his Mission and those who assisted him was certainly part of his personal success as an evangelist and as a leader.) Though late to the medical missionary world, Vories noted that, by the start of World War I, so few such missions had pursued this work, even after the passage and presumed enforcement of factory legislation, it was decided among Omi’s leadership to undertake this new enterprise.77

There was a pragmatic need for tuberculosis care in Japan, but Vories was not a physician. Nor was he a dedicated amateur, as he might claim to be in architecture; indeed, he could not even be described as a medical dilettante. Thus, in his writings, particularly over time, Vories seemed to believe that he needed something more than his own credentials to justify his entrance into the medical mission sphere. In his 1925 memoir, he noted that his decision to undertake the work was assisted by the death of a young convert. By his next memoir, eleven years later, the incident had expanded from a sentence to a “rather romantic story” consisting of five pages in addition to a full-page portrait of the unfortunate young man. This young Buddhist priest, frustrated by the behavior of his superiors in his faith, turned to Vories, eventually embracing the Christianity that he witnessed his peers espousing happily. When he fell visibly ill with the scourge, he was moved into a little cabin on the mission’s small plot of farmland, there to partake in the presumed curative powers of fresh air. Endō Kanryu, the infirm convert, had improved to the point that “he, and all of us, had thought him cured,” only to have “over-exerted himself in the winter (which would not have occurred had we had a resident doctor and a real sanatorium) and a sudden cold had developed into pneumonia and brought on his death.” In a very real sense, young Endō became a martyr to the mission’s necessity for medical work. Before his death, Vories memorialized, Endō had “urged us to push forward our plan for the tuberculosis sanatorium, that others might share the joy he had found in Christ.” For Endō, the sanatorium would first provide the mental health that his acceptance of Christianity and the Mission’s continued acceptance of him had accorded to the former Buddhist priest. Even in his death, the work performed to assist Endō in recovering his physical health had proved a spiritual and mental salve. “No matter, he declared,” recalled Vories, “whether we should be able to cure their bodies, if only they could have the peace and confidence which he had felt in the hour of death.”78

(p.187) Vories knew that he could assist Japan’s infirm in understanding the peace and confidence that he believed his faith could provide, but, though the importance of physical health had been minimized by Endō, and the lack of a cure for the disease remained disconcertingly obvious, a sanatorium and a medical mission nonetheless required a physician. Rather than seek out a foreign physician, whose acclimation and dedication to Japan could not be insured, Vories sought his medical professionals far closer to home. When the Omi Sanatorium opened in 1918, three years after Endō’s death, it was staffed by Japanese professionals, all members of the growing Omi Mission. An image of the facilities’ staff and volunteers in 1925, including physicians and nurses, pharmacists and laborers, revealed that all thirty-one men and women pictured were Japanese.79

Vories did, however, acquire from foreign sources the funds to establish the sanatorium and to care for its grounds. The main building, the Anna Danforth Tooker Building, was a memorial to the mother of the wife of a wealthy New York lawyer, while the cottages surrounding it, housing patients and other services, commemorated the lives of men and women half a world away. Yet, even with the considerable generosity of these individuals, the institution remained relatively small. Indeed, it did not aim to be a large home, whether hospital or hospice. In 1925, Vories proclaimed that, in addition to the dispensary, it “aims to provide only fifty beds for in-patients.” It was not merely that the funds for further development were lacking; rather, Vories had no desire to build a larger institution. By 1936, in fact, the sanatorium had only gained another ten beds for inpatients. Yet, according to Vories, it remained “the first in Japan to have modern equipment and methods, and its effectiveness has been not alone in a very fine record of cures, but especially in influencing the Government in a widespread effort to combat the disease throughout the Empire.” Certainly, in opening the year before the 1919 Tuberculosis Prevention Law, which mandated government construction of sanatoria at the local level, Omi Sanatorium had proved a trailblazer. Moreover, as long as local efforts to build similar institutions stalled in the face of bureaucratic and popular dissent, the sanatoriums at Omi remained uncommon As Vories (now Hitotsuyanagi, having adopted his wife’s surname) proclaimed, Omi Sanatorium “has been practicing the most progressive methods of treatment with a strong emphasis on mental and spiritual health.” Since its inception, it was “primarily interested in rendering a Christian service to those in need.” Yet the “cure” of the Omi Sanatorium continued to be primarily based on “open-air” therapy, even after the introduction of bacillus Calmette-Guérin, the first, moderately successful antibiotic against TB, in Japan in 1925.80

(p.188) Nevertheless, it was something where so often there had previously been nothing. And it did assist in the fulfillment of the platform of the Mission, specifically sections III, VI, and VII:

  1. I. To preach the Gospel of Christ in the Province of Omi, Japan, without reference to denominations. There being no “Omi Mission Church,” converts to be organized into self-supporting congregations of the denomination of their own choice.

  2. II. To practise the complete unifying of the work and fellowship of Japanese and foreign workers.

  3. III. To evangelize communities unoccupied by any Protestant Mission, and under no circumstances to overlap with the work of such Missions.

  4. IV. To evangelize Rural communities, as the most conservative element of the nation, and the most probable source of leadership.

  5. V. To seek, enlist, and train leaders and workers.

  6. VI. To work for social reforms, including temperance, social purity, marriage customs, physical and sanitary betterment, and definite efforts for the neglected.

  7. VII. To study and experiment with new methods of evangelization.

By working with a physically and psychologically isolated community, namely, the rural tubercular, the Omi Mission utilized new methods of evangelization through medical missionary work without overlapping with any preexisting foreign evangelical organizations. Given its success, it was no wonder that, of all of the mission’s branches and departments—of which, in 1925, Vories counted seventeen— only the architectural department possessed a larger staff than the Omi Sanatorium. With an average staff of 6.5 people per department, the sanatorium required nearly three times that many. And, unlike the architectural department, “the Sanatorium is conducted on a non-profit basis.” Staff gladly eked out a living primarily from donations, as the “patients pay only actual cost of their living.”81

Their lives in the sanatorium involved “regular pastoral visitation and … frequent (religious) meetings,” both as an evangelizing effort and for psychologically curative effect. Indeed, Vories intended to promote easy garden and farm labor as “a sort of ‘graduate’ institution” for “patients nearly cured, or quite ‘cured’ but not yet strong enough for full time work”—a rehabilitative effort to allow patients a return to normal working life. More importantly, however, these activities would serve as a response to what Vories’ deemed the “Sanatorium Mondai,” or problem of the sanatorium—the question of how the work could fail. Only by creating an “ideal Sanatorium” could the Sanatorium Mondai be solved. As Vories determined, the ideal sanatorium would be a “School of Health in which every pupil-patient has a full program of activities, made out of conference of the Staff, supervised, and adjusted periodically to suit the progress of each case.” In spite of the (p.189) hospital-setting, Vories insisted that, ideally, the institution “be kept Homelike, by a woman officer (or Superintendant) [sic] who knows and cares for each case as a personality.” Notwithstanding the gendered dichotomy that designates feminine role to be that of a nurturer, Vories and his compatriots in the Omi Mission (later the Omi Brotherhood) could also conceive of a guiding role for women within the work of the sanatorium. Certainly, there was both a perception of woman as caretaker of the facility as a home, and caregiver of the patient as a child, thus lending the institution a sense of itself as a hospice, more than merely a hospital. And, indeed, it was an ideal, but the world of the Omi Mission was one of the most equitable of its time, allowing both Japanese Christians and women not only to rise in its ranks but also to serve within those ranks throughout the departments.82

That said, Omi Sanatorium remained somewhat infantilizing to its patients, as Vories also insisted that the motherly figure in charge limit the size of the institution to allow her only as many patients as she could “easily know in detail.” She would explain “the entire system” to patients at the start, earning their trust. Finally, in addition to knowing about her wards, she would provide “proper food, sleep, rest periods, and exercise under supervision,” as well as “some forms of occupations,” like the farm, “to take patients’ minds off themselves and provide interest.” In the ideal institution, as in reality, to Vories, the insitution’s “profit is less important.” Yet the farm could also supplement the Mission’s funds by acting as an “Independent Food Supply,” which Vories had deemed “essential: not only to assure sufficient and proper food, but also to get it without exorbitant cost.” The regulation of food was important in the Omi Sanatorium, which was both teetotalling and, obviously, wholly controlled.83

Although not necessarily Vories’ ideal, the Omi Sanatorium was considered Japan’s ideal institution by many who encountered it. According to Galen Fisher, the sanatorium was, in 1923, “recently declared, by the head of the largest government pulmonary hospital, to be the best in Japan.” In the 1930 presentation of an honorary doctorate to Vories, Colorado College, in making note of all his accomplishments, singled out his sanatorium “which is the Japanese empire’s standard for the treatment of tuberculosis.” In 1957 Hitotsuyanagi proclaimed that in the thirty-nine years since its founding “the Sanatorium has grown in size and usefulness, and has won the favor of the public and the Imperial Household.”84

Vories did in fact, earn the approbation of the emperor, but the circumstances surrounding the meeting and the reason for it were rather more complex. Vories was not granted an audience with the Shōwa emperor for his work with the sanatorium but rather because of his unique circumstances. After all, as a foreign national, he wed a Bryn Mawr–educated Christian woman, Hitotsuyanagi Makiko, the daughter of a viscount and member of the Japanese House of Peers. Lauded in (p.190) the foreign evangelical press as “a striking example of the superiority to race, rank, and worldly advantage which true Christian faith engenders and for which Omi Mission stands,” the marriage would prove more controversial twenty years later. In 1941 Vories renounced his American citizenship and his status in Japan as a foreign national to naturalize as a Japanese citizen, taking the name Hitotsuyanagi Mereru. Unlike his native-born wife, Vories could and did become a citizen of his adopted homeland. During World War II, life proved difficult for the Vories family, as it had for their neighbors, though the persecution by the Japanese military police was lessened when the emperor’s brother visited Vories’ mission in Omi. Recruited by MacArthur to assist the Americans during the Occupation, Hitotsuyanagi met his emperor postwar as a loyal Japanese citizen, but also one whose position had proved highly unique.85

It is interesting, therefore, that, following the 1920 marriage, Japan’s government did not assist or claim to assist the Omi Sanatorium. Though her parents had not approved of her choice of partner, Mrs. Vories was still a woman of means and influence. Nevertheless, both she and her husband preferred to continue their work and their fund-raising as far removed from Tokyo as was their dwelling. Vories noted in 1925, “The patronage of the Sanatorium is interesting.” And it was. Though not his ideal, it was successful. “From all parts of Japan patients come. The reputation of the institution is nation-wide.” As an evangelical method, it had not failed, as “not a few who came without a knowledge of Christ are baptized here and go back earnest advocates of the Gospel.” Furthermore, without other foreign evangelists, without the Japanese government, in the quiet town of Omi, William Merrell Vories was succeeding in the battle against tuberculosis. A true moral entrepreneur, through his work, “finally the idea of the cure of tuberculosis by rational methods is gradually supplanting the old feeling of hopelessness toward this dread disease that is so prevalent in Japan.”86 Lacking a medical panacea, Vories had nonetheless found a spiritual one.

The whole problem of the care of lepers in Japan is very large, and the Government should be spurred to do better things for the lepers, and protect the rest of the community against them. I have talked with Professor Nagayo, the head of the Government Institute for Infectious Diseases, and one of the leading authorities on leprosy in Japan. He is an advocate of segregating the lepers on some island off the coast of Japan and already two or three such places have been tentatively selected. Sooner or later the Japanese Government will wake up, and do something about the miserable situation which now exists. Later if the opportunity comes our way to help in propaganda of this kind, or if it seems advisable later to try and develop in Kusatsu a small modern hospital to facilitate scientific treatment of lepers, and exemplify their proper hospital care, I will gladly do anything I can.

(AEC: Letter to Wood from Teusler. Jan. 13, 1927, p. 2)


(3.) Osler, xxix; Robbins and MacNaught, 11. Teusler was actually the cousin of Edith Bolling Galt Wilson, the wife of Woodrow Wilson. Unfortunately, the family tie does not appear to have assisted Teusler in his work, save for a handful of lunch invitations. Nor, it turns out, did the rest of his ancestry, which was purported to have included Pocahontas and the Plantagenets (“Obituary,” 496).

(5.) AEC: “Letter to Mr. John Wood.” Mar. 11, 1900.

(6.) Whitney, 347; Robbins and MacNaught, 29. Dr. Henry Faulds, the first doctor at the Tsukiji Hospital, and the last successful one before the arrival of Teusler, was also notable as the man who introduced fingerprinting as a form of identification to Japan, if not the world (Herschel, 77).

(7.) AEC: “Letter to Rev. Arthur S. Lloyd.” June 30, 1900; Whitney, 347.

(8.) The Spirit of Missions, 1; AEC: “Letter to Rev. Arthur S. Lloyd.” June 30, 1900.

(9.) AEC: “Report of Rudolf B. Teusler, M.D./Residence Tokyo, for the year ending June 30–1901.” July 1, 1901.

(12.) Nakamura, 17–18; AEC: “An Appeal for St. Luke’s Hospital, Tokyo.” R. B. Teusler, MD. July 3, 1902. p. 2.

(13.) Bowers, 126; Robbins and MacNaught, 71–72; AEC: Teusler to Lloyd, July 3, 1902.

(15.) AEC: Report of Rudolf B. Teusler, M.D./Residence Tokyo, for the year ending June 30—1901. To the Rt. Rev. John McKim. July 1, 1901; AEC: Letter from Lloyd to Bishop McKim. July 3, 1902; AEC: Letter to Wood from Teusler. Oct. 17, 1902.

(17.) Robbins & MacNaught, 64; AEC: Letter to Wood. Jan. 5, 1905; AEC: Letter from Lloyd to Bishop (McKim). July 3, 1902.

(18.) AEC: Letter to Wood. June 8, 1905; AEC: Private Letter to Wood. Aug. 11, 1906.

(19.) AEC: “A Tokyo Hospital—Being some description of our Medical Mission Work in Japan’s Capital: Its growth and development during the past three years.” Rudolf Bolling Teusler, MD. p. 1.

(20.) Bowers, 128; AEC: “St. Luke’s Hospital Report: From June 31st, 1904 to July 1st, 1905.” Aug. 10, 1905. From Teusler to McKim. p. 3; Mitamura, 165; Bartholomew 2011, 52; Baelz, 92; Bowers, 128.

(23.) AEC: “A Tokyo Hospital—Being some description of our Medical Mission Work in Japan’s Capital: Its growth and development during the past three years.” Teusler, 1–2.

(24.) AEC: “A statement of the needs of St. Luke’s Hospital, Tokyo.” R. B. Teusler, MD. Tokyo, Apr. 2, 1907. p. 4.

(26.) CUB: “A church in the capital of Japan: Being some account of the successful work of St. Luke’s Hospital in the city of Tokyo.” Rudolf Bolling Teusler. The Spirit of Missions. Dec. 1904. p. 2.

(27.) AEC: “A statement of the needs of St. Luke’s Hospital, Tokyo.” R. B. Teusler, MD. Tokyo, Apr. 2, 1907. p. 2.

(28.) Robbins & MacNaught, 57; AEC: Letter from McKim to Rev. H. R. Hulse in New York City. Apr. 6, 1907.

(29.) AEC: Letter from Teusler to Wood. Aug. 22, 1908; AEC: Letter from McKim to Hulse. Apr. 6, 1907.

(30.) AEC: Letter from Teusler to Wood. Aug. 22, 1908; Robbins and MacNaught, 59; AEC: Letter from Teusler to Wood. Jan. 27, 1909.

(31.) Robbins & MacNaught, 36, 33–34; AEC: Letter from Teusler to M. Mood. Aug. 7, 1902.

(32.) Azuma, 118; CUB: “A church in the capital of Japan: Being some account of the successful work of St. Luke’s Hospital in the city of Tokyo.” Rudolf Bolling Teusler. The Spirit of Missions. Dec. 1904. p. 1; Araki 1928, 1004; Tokiwa, 42.

(33.) CUB: “A church in the capital of Japan: Being some account of the successful work of St. Luke’s Hospital in the city of Tokyo.” Rudolf Bolling Teusler. The Spirit of Missions. Dec. 1904. p. 1.

(34.) Araki 1928, 1006; AEC: Letter from Teusler to Wood. Oct. 3, 1908.

(35.) Brent, 88; AEC: Letter from unknown author to Home Board. Jan. 16, 1909; AEC: Letter from Teusler to Wood. Feb. 15, 1909. Emphasis in original.

(36.) AEC: Letter from Teusler to Wood. May 8, 1909; AEC: Letter from Teusler to Wood. Mar. 2, 1910.

(37.) “Wants to Enlarge American Hospital”; AEC: Letter from Teusler to Kimber. Nov. 8, 1910; AEC: Letter from Teusler to Wood. Dec. 12, 1910; Langland, 179. The yen, in 1910, was valued at .498 of the dollar. Thus, Kubo made a total of $1,494 per annum from his work at St. Luke’s.

(39.) AEC: Report of St. Luke’s Hospital to McKim. Aug., 1912, p. 4; Ishizuka 1981, 172; Ishizuka 1983, 8. These symptoms included diarrhea, enteritis, and nephritis in the case of cholera, and pulmonary and broncho-pneumonia symptoms in the case of tuberculosis. Although not pulmonary, other mortality causes common to tuberculosis and prevalent among the neighborhoods bordering the Sumida River included meningitis and various deformities, including those of the spine.

(41.) Kitasato 1908, 2–3; Araki 1908, 573. As Anna C. Jammé, superintendent of nurses at St. Mary’s Hospital Rochester, Minnesota, noted, Japan’s Red Cross Hospital—purportedly independent, but actually connected to the government and presided over by director of nursing and colleague and friend of Princess Nashimotonomiya Itsuko, Hagiwara Take (whose name Jammé mistakenly reported as “Hagewara”)—still used outmoded equipment in the tuberculosis ward as late as 1923: “All utensils, as basins and receptacles, instead of being white enamel, as we are accustomed to see, were of brass and highly polished” (Takahashi, 119; Jammé, 771).

(42.) Robbins and MacNaught, 75; AEC: Letter from Teusler to Wood. Mar. 2, 1910; AEC: Letter from Teusler to Wood. Apr. 13, 1910.

(43.) AEC: Letter from McKim to Wood. Apr. 20, 1920; AEC: Letter from Wood to Teusler. June 21, 1920.

(45.) Robbins and MacNaught, 116–17; SSC: In Memoriam: Rudolf Bolling Teusler. His Excellency, Prince Iyesato Tokugawa; Stoddard, 293; Farley, 245–46.

(47.) AEC: Letter from Teusler to Wood. Feb. 16, 1924.

(48.) AEC: Letter to Wood from Teusler. Jan. 18, 1927, pp. 2–3.

(49.) CUB: “Why St. Luke’s Hospital Should Be Rebuilt.” Dr. Rudolf B. Teusler.

(50.) As Teusler wrote to Wood:

(51.) OKS: “Omi Brotherhood and William Merrell Vories: Footsteps of the Omi Brotherhood Groups,” pp. 1–2; Okumura, 14. Historian William H. Lyon claimed that Vories intestinal tuberculosis was both a misdiagnosis and undiscovered until soon after the turn of the twentieth century. He posits, instead, that the ailment continued to trouble him until the removal of his appendix, although, as he acknowledges, the likelihood of the disease being simple appendicitis was highly unlikely since the progress of appendicitis is far more rapid than Vories’ case manifested (Lyon, 39).

(54.) OKD: “Vuo-rizu kinenkan goannai”; Fisher, 189; Vories 1925, 3.

(58.) Vories 1925, 8–9; Vanderbilt, 27. Actually, Flinch, a card game, was younger than Vories’ new acquaintances, having been invented not long after the turn of the twentieth century. Ping-pong, now more associated with Asian schoolchildren than American, was slightly older. While dominoes were considerably older than both games, the game existed in Asia in its current form over a decade before Vories’ presumed introduction of it (Elliot Avedon, “Flinch” and “Dominoes”; Culin, 102).

(60.) Okumura, 4; Fisher 1914, 330; Vories 1925, 12. It was, of course, proper that the head of the English department act as interpreter, and to persist with Miyamoto as sole assistant would have been extremely rude. However, it is unclear for how long the department chair insisted on interpreting. He is not mentioned again in this regard in any of the sources I have encountered. I suspect that he gave up, eventually. Certainly, it is doubtful that he ever became a Christian.

(62.) Vories 1925, 20, 23; Vories 1936, 27. Emphasis in original.

(67.) Vories 1936, 66 (italics in original); Vories 1925, 45.

(69.) OKS: Vories’ Architectural Works; Vories 1936, 73; Lewis, 402.

(72.) Richmond et al., 255–56; Suzuki, 527; OKS: “Omi Brotherhood and William Merrell Vories.” Suzuki points out that Mentholatum, though less expensive than a similar ointment (Tako no Suidashi, or Octopus Cupping Balm, invented by Machida Shin’osuke of the Meiji School of Pharmacy), was preferred by wealthier customers, whom Suzuki suspects were attracted by the presumed association of the former with America (Suzuki, 528).

(73.) OKS: “Omi Bortherhood and William Merrell Vories”; Vories 1925, 81; Okumura, 31.

(75.) Vories 1915, 1, 7 (italics in original); Gundert, 86.

(79.) Vanderbilt, 283; Yoshida, 124; Vories 1925, photograph between 80–81.

(80.) VKB: “Utsukushiku gogatsu” (5/25/1918). Vuo-rizukinenbyōin 60nen tenbyō, p. 7; “Heylman—Tooker”; Vories 1925, 77; Vories 1936, 98; VKB: “History.” Omi Sanatorium. February, 1957; Johnston, 269, 259. Admittedly, BCG remained relatively unused in Japan until after 1940 (Johnston, 259).

(82.) VKB: “Sanatorium Mondai.” Vuo-rizukinenbyōin 60nen tenbyō, p. 11 Emphasis in original.

(83.) Ibid. Emphasis in original.

(84.) Fisher 1923, 189; Vories 1931, 3; VKB: “A Message from the Founder.” Omi Sanatorium. Feb., 1957.