Just off the southeastern coast of Africa, Madagascar is the fourth largest island in the world, with an extraordinary ecosystem: approximately 80 percent of its species are endemic to the island.Footnote 1 By the nineteenth century, Madagascar had established a reputation as a naturalist’s paradise, a land with an amazing array of species found nowhere else in the world, while the Malagasy people were acquiring a reputation of being receptive to Western ideas. This combination attracted the occasional naturalist and traveller, in addition to some traders and merchants, to Madagascar, which was autonomous politically until France colonized the island in 1896.Footnote 2 But it was largely missionaries who crafted this reputation and who were the main Western presence on Madagascar during this period. They were heavily engaged in proselytizing, which involved teaching the Malagasy people the benefits of Western civilization, including not just Christianity, but also science and medicine.
Indeed, across the world missionaries were essential in spreading Western medicine at the local level during this period.Footnote 3 As Megan Reference VaughanVaughan has argued, missionaries sought to convert their patients to demonstrate that moral failings contributed to illness. In doing so, missionaries often fought indigenous healers on their own turf. By saving lives, missionaries thus saved souls and wrested control of both medical and spiritual establishments.Footnote 4 Although missionaries often acted independently and at times even contested the actions of the imperial state in defence of local peoples, their goal of converting people to a modern, civilized life involving Christianity and a scientific education meant that missionaries were also preparing people for imperial rule. Medicine, then, straddled a divide between humanitarian aid and a tool of imperial and missionary propaganda.Footnote 5 This dual purpose of medicine by missionaries has led Michael Reference WorboysWorboys to argue that medicine often went beyond colonial need and carried with it the influence of Christian culture. The existence of, and progress toward, elimination of certain diseases became tests of civilizational progress that influenced the very practice of medicine itself.Footnote 6
The medical mission became a central feature of the missionary enterprise. Although an important limitation to medical missions remained the limited efficacy of medicine and the inability to cure most diseases during the nineteenth century, cures and healing were only part of the process. Instead, missionaries used the entire space of the medical mission, best symbolized by the mission hospital, to preach Christianity and the values of Western civilization, including science and cleanliness, in a controlled environment. While by the start of the twentieth century, the professionalization of medical missionaries and their hospitals began to set them apart from their missionary colleagues,Footnote 7 during the latter half of the nineteenth century the hospital operated as a site for conversion as much as of healing. The mission hospital was central because it clearly identified a Western zone that was separate from a foreign and often hostile environment.
It was this distinction that was in such sharp relief on Madagascar and that magnified the need for the mission hospital and contributed to its success as a missionary tool. Madagascar has often been overlooked, or detached, from the history of Africa, including imperialism and missionary efforts.Footnote 8 The few studies on Protestant missionary efforts on Madagascar have often been cast as a success story. For example, Bonar Gow concluded that nowhere else in Africa did missionary efforts succeed as they did in Madagascar, yet he measures success through Malagasy participation in church attendance and schools.Footnote 9 Studies that focus on Protestant missionary efforts on Madagascar have noted the presence and success of the medical mission, which was a product of collaboration between the London Missionary Society (LMS) and the Friends Foreign Mission Association (FFMA), but have overlooked its centrality to the entire missionary enterprise.Footnote 10 However, Madagascar was at the forefront of Protestant medical missions.
Missionaries extolled the medical mission, explaining that it brought “untold benefits to the Malagasy.”Footnote 11 Medicine provided Western civilization in a controlled setting, allowing missionaries to preach science and Christianity simultaneously. Missionaries established hospitals, dispensaries, and dispensed medicine on their travels to aid conversion. They believed that traditional methods of healing were so superstitious, so ineffective, that Western medicine, with its tangible benefits that patients witnessed first-hand, would convince the Malagasy of the superiority of Western ways.Footnote 12 So as missionaries practiced medicine, they frequently linked it directly to their evangelical cause with prayers, sermons, songs, and Bible readings.
This distinction went further. The mission hospital offered missionaries a controlled space in which to apply Western teachings. Even more, it made Protestant efforts distinctive from those of their Catholic counterparts, which lacked a hospital on Madagascar. The hospital remained one of the few spaces in Madagascar where missionaries could deliberately blend their evangelical identity with their scientific ideals. Even more, the mission hospital was a zone of interaction between Westerner and Malagasy where Western ideals, particularly civilization, could be exhibited in high relief while the Malagasy became a captive audience. Unlike in the forests of Madagascar, where missionaries had to compete with, and often incorporate, Malagasy beliefs and a complex cultural connection with the environment, the hospital clearly established the benefits of Western medicine, and with it Christianity. In the hospital, missionaries could preach science and administer Christianity.
The Itinerant Doctor
The first members of the London Missionary Society (LMS) arrived in Madagascar in 1818. They quickly established a relationship with Radama I, the king of the Merina kingdom that governed much of the interior of Madagascar, which allowed them to preach to and teach the Malagasy. Radama’s death in 1832 interrupted missionary activity until 1861. While the French, particularly through Jesuit missions, maintained a presence on the island, Protestant missionaries successfully competed with them. Significantly, the LMS regained the support of the Merina state, the royal family converted to Protestant Christianity in 1869, and, with missionary reports of Malagasy congregations spilling into the thousands, Madagascar became a success story worthy of further attention.Footnote 13 During the course of the nineteenth century, the LMS would send more than a hundred missionaries to Madagascar, the bulk of them arriving during the 1870s and 1880s, and established churches, schools, and hospitals.Footnote 14 Madagascar’s centrality to the LMS is evident when these numbers are contextualized—from 1838 to 1914, the LMS sent 987 missionaries abroad, meaning Madagascar received more than 10 percent. Further of the eighty-two physicians sent abroad, Madagascar received six official doctors; all of central Africa received only eight.Footnote 15 Madagascar was a priority.
The need for Western medicine was compounded by the vastness of Madagascar. While mountains and plateaus filled the interior of the island, its coastlines straddled a tropical climate composed of thick vegetation, rivers, and pools of water. Disease was rampant, with malaria the most prevalent. Indeed, Radama I once referred to fever as one of the major defenders of his island. In addition to malaria, other diseases, including smallpox and influenza, frequently afflicted the Malagasy.Footnote 16 In the eyes of Western missionaries, the Malagasy clearly needed help.
Medicine was a popular tool of missionaries. They often coupled medical aid with Christian teachings as they made their circuits in Madagascar and were often supremely confident not just in the quality of their medical care, but also the positive reception it would bring. Indeed, missionaries believed that the Malagasy had no effective medical treatments, only harmful superstitions, allowing any Westerner to provide beneficial medical aid in the countryside. James Sibree (1836–1929), one of the leaders of the LMS on Madagascar, a trained engineer and cofounder of the Antananarivo Annual, a natural history magazine that the society published about the island for twenty-five years, explained, “Native medicine consist chiefly of charms, often absurd in themselves, and not unfrequently most harmful to the patient; and the native doctor is mostly a compound of the quack and the knave.”Footnote 17
This lack of competition meant that any Westerner with even a modicum of medical training could dispense medicine and spread Christian civilization. Just as a missionary might be called upon not just to teach the Gospel, but also to help build a church, so he could and should dispense medical assistance. Missionaries firmly believed that the Malagasy would flock to missionary doctors, allowing Westerners to deliver the dual message of Western civilization: science in the form of medical assistance and Christianity.
While medical doctors were sought after, a formal education was not required for missionaries to dispense medical assistance in the field.Footnote 18 Joseph Pearse (1837–1911) arrived in 1863, part of a concerted push by the LMS to increase its staff on the island, and was one of the first to begin establishing Malagasy congregations away from the capital of Antananarivo. He continued his work through the French occupation of Madagascar until his retirement in 1904.Footnote 19 Despite his lack of formal medical training, Pearse made a point of reading up on medical literature and serving as a doctor to the Malagasy. He created a schedule where two days a week he attended emergency cases and on the others dispensed medicine. Pearse conflated medicine with his Christian message and the superiority of Western science, explaining that he offered the Malagasy only medicine and the truth, and expected only “confidence in him” in return. He believed that because the Malagasy had no knowledge of anatomy, hygiene, or disease, and used only charms and witchcraft to treat maladies, his ability to offer them Western medicine and rational “truth” overcame any lack of the formal training that would have prevented him from administering to Western patients.Footnote 20
Pearse was not an isolated case. Other missionaries practiced medicine in a similar fashion. William Wilson (1857–1909) of the FFMA travelled to Madagascar as a missionary in 1877. As he began his work, he visited various villages teaching the Gospel, but he quickly began to offer medical aid. Starting with dentistry and pulling teeth, Wilson soon compiled a medical chest for his journeys. As he explained to his wife, “I have been preparing my medicine chest. Perhaps you didn’t know I had one, for I have only lately acquired it, and I feel I must seriously take up some medical work even if it is only as a quack! I am firmly convinced that every missionary ought to possess some knowledge of medicine.”Footnote 21 Wilson travelled back to Great Britain and enrolled as medical student, returning to Madagascar after a year’s study to practice medicine, before finishing his medical degree and eventually helping run the mission hospital in 1894. While Wilson turned his enthusiasm into a career, his initial casual adoption of a medical identity to better convert souls reveals how closely entwined medical assistance was with the missionary movement.Footnote 22
Indeed, missionaries often vaccinated villagers as they made their teaching rounds, and it was a common practice in the schools missionaries established.Footnote 23 The missionary Charles Price marvelled at his colleague William Deans Cowan (1844–1923), whom he found one day “vaccinating children by the score” having just received a shipment of vaccine.Footnote 24 In addition to his preaching and educational duties, Cowan, a dedicated naturalist, was placed in charge of a medical dispensary partly funded by the Merina government.Footnote 25 By coupling vaccination and medical aid with their preaching duties, missionaries clearly reinforced that medicine was a Western and Christian practice, hoping to gain converts convinced by the effectiveness of a cure.
Still, traditional remedies and cures were not easily displaced. The Malagasy continued to use their own medical practices as well as Western ones. For example, the Malagasy often used a ritual using the nut of the tangena plant to determine a person’s guilt. When accused of witchcraft or a supernatural crime, the accused often swallowed the nut, often alongside a little rice, three pieces of chicken skin, and some water. If the person vomited up the chicken skin, then he was declared innocent. Western missionaries were shocked by the ritual, arguing that the poisonous nut jeopardized the life of the accused and lacked any scientific merit. Indeed, one missionary doctor even conducted experiments on small animals to prove the deadliness of the nut and to underscore the irrational and superstitious element.Footnote 26
And so, just as missionaries were often dismayed by how their Christian teachings failed to penetrate or persist, so too were they frustrated by how readily the Malagasy combined Western medicine with their own or even failed to accept it. The problem was rooted in perceptions of healing.Footnote 27 In villages, missionaries had to meet the Malagasy on their own terms. The Malagasy had developed a rich relationship with the natural environment that ran from folklore and cultural beliefs to a sophisticated understanding of the fauna and flora.
The Malagasy relied upon plants for their remedies. Many cures included ingesting plants through drinking or inhaling the steam of a ground concoction.Footnote 28 George W. Parker, one of the few trained LMS physicians on the island, and for a time personal physician to the Merina royal family, dismissed the Malagasy healer as an “herbalist” and compiled an account of Malagasy plants used for remedies to support his conclusion, noting that for a sprain a Malagasy would place the scrapings of a tree into a drink, or sarcastically commentating in the case of a “useless” Malagasy water-vapour treatment to treat smallpox that “of course you must not be vaccinated!”Footnote 29 Yet, Parker was forced to admit that there were successful exceptionsFootnote 30 and Sibree noted that many Malagasy plants had “real curative properties” while bemoaning that the Malagasy people often combined this with “charms which is the groundwork of their idolatrous worship,” and thus forsook using Western medicine.Footnote 31
This was the crux of the problem. It was not that Malagasy medicine was practiced by mere “herbalists,” or mostly ineffective in the eyes of missionaries, but rather that it was “witchcraft.”Footnote 32 Malagasy culture involves a rich tapestry of folklore that helps to explain events, people, and nature, as well as involving cultural taboos, known as fady, that regulate daily life. Omens and spirits are intimately connected to a person’s well-being, and healing often involved a spiritual component.Footnote 33 The complicated relationship with cultural beliefs created an unacceptable situation for medical missionaries. The Malagasy medicine man possessed considerable influence in the local community, offering not just medical help, but also spiritual. The lack of spiritual or cultural connections often led Malagasy patients to refuse Western treatment.Footnote 34 So while missionaries would often decry how the Malagasy relied upon “chance” for a cure with no idea how their remedies worked, it was the superstition surrounding the cure that was the most troubling.Footnote 35 It was clear that no matter how many patients a medical missionary might successfully treat, from the missionary’s vantage, the space had been corrupted by the overwhelming presence of a Malagasy environment. To combat this, missionaries highlighted the benefits of the mission hospital.
The Mission Hospital
The missionary hospital was at the core of the medical establishment on Madagascar. Within its walls, the London Missionary Society offered the Malagasy people a professional doctor in a controlled and civilized setting. In 1862, the LMS began its medical mission under Dr Andrew Davidson (1836–1918) who provided medical aid to the royal family and ordinary people. His service as a personal physician to the royal court helped Davidson find Malagasy government support to open a medical dispensary, followed by the first hospital, which opened in 1865.Footnote 36 Davidson’s tenure on Madagascar was marked by his commitment to science and medicine alongside his evangelical faith. His missionary ideals not only led him into disagreements with the Malagasy prime minister, but also coloured his attitude toward disease, and served as a prominent, though common example, of how missionaries intertwined faith and medicine.
In 1863, Davidson reported on a new disease sweeping through the countryside and that had arrived in Antananarivo. The epidemic was composed of dancing and singing that affected mostly lower-class young women between the ages of fourteen and twenty-five. Patients complained of pain and stiffness of the neck, and Davidson recorded that patients often became uncontrollable and danced frenetically for hours, accompanied by singing. Davidson labeled the disease choreomania and he linked it to a disease seen in Europe during the Middle Ages. For him, the disease represented an anti-Christian, anti-progress affliction. He noted that “very few, indeed scarcely any, Christians came under the influence.” The reason for Davidson was simple: Christians possessed a “superior education, mental and moral.” Davidson diagnosed his patients as suffering from a psychological disease brought on by a refusal to accept the progress of Christianity.Footnote 37
This link between disease and anti-Christian behaviour was not unusual. The Madagascar Times noted a resurgence of “dancing Mania” twenty years later in 1884, nothing that “if they had known the love of Christ, no such diabolical disease would have come upon them. It is very remarkable that no Christians ever have any such disease.”Footnote 38 Elsewhere in the world, the continuation of tuberculosis and leprosy were also seen as evidence of the rejection of Christian values.Footnote 39 This attitude reflected the idea that Christianity kept diseases at bay because of its emphasis on a rational belief that embraced civilization.
Health, civilization, and proper behaviour were all linked, and the missionary doctor offered a way to impart to converts and patients both Christian teachings with evidence of the superiority of Western science. Indeed, medicine offered a tangible way for Westerners to prove the truth of their convictions in a way that no other scientific endeavour could so readily or powerfully match. Missionaries believed that curing patients from an illness, pain, or injury was not only a Christian duty but also supplied ample proof to the entire community of the validity of Western ways.
Davidson envisioned his hospital precisely as a blend of Western medicine and Christian teaching. Writing home, he argued that funding would enable him to train some Malagasy “in medicine and in the faith of Christ, and send them out as pioneers of the clerical missionary.” A hospital was essential for this purpose, and Davidson underscored this was not a whim, but a “sober and practical” plan for which he required only some assistants and the funds for a building. With these in place, Davidson began construction of the first hospital at Analakely, a district within the capital city of Antananarivo, concluding triumphantly that it was a “testimony to our humanity, our science, our Christianity.”Footnote 40
In this way, the importance of the hospital transcended the number of patients it treated. The LMS reported large numbers of patients. From 1881–1885, the LMS hospital averaged hundreds of patients a year, tallying a total of 1467 patients, of whom 793 were declared cured, 405 whose symptoms were relieved, 84 who showed no improvement, and 157 deaths.Footnote 41 By the late 1880s, the hospital was dealing with nearly 500 patients a year, in addition to the hundreds of house calls the LMS doctors made. Such numbers overwhelmed the resources of the LMS. The numbers of Malagasy patients, however, were less significant than maintaining the hospital as a space of Western civilization, a zone that had to be maintained on several fronts, any of which could threaten the mission.
The hospital had become indispensable to the LMS effort on Madagascar. It not only provided medical aid, but its popularity, coupled with an explicit Christian message, had created an important symbol. The reason went beyond the medical services. The hospital had become a key focal point in the missionary movement, which combined all the elements that missionaries professed to bring to the island: civilization through the knowledge of Christianity and science. Once admitted as a patient to the hospital, a Malagasy entered a controlled setting. It was to be a place, as one LMS report stressed, where the “prejudices of the natives began perceptibly to be broken down.”Footnote 42 Inside, the patient entered a European world of science and rationality, one where cleanliness and order replaced the dirtiness and irrationality of daily life. Patients were not just treated for illness. Through removal from their home environment, they were introduced to the trappings of civilization. By dispensing medicine away from traditional remedies and superstition, missionaries believed that the Malagasy would associate their improved health with European, and Christian, methods.
Inside the hospital, Christian teaching was essential. It was here that patients and those who came to visit were subject to Christian teachings. Patients were often taught how to read the Bible. Hymns were sung. And in the ward patients participated in a “short” Church service “before they are seen and prescribed for,” directly, and compulsorily, correlating physical and spiritual health.Footnote 43 The hospital provided a controlled setting where medicine was combined with Christian teaching, and missionaries often preached to patients and their families before and after administering medicine or treatment.
As such, more hospitals and dispensaries were essential to spreading the Christian faith and became central to the LMS mission on Madagascar: “We feel very strongly that this country work is just what is needed in the present state of the Christian development and civilization about the capital. It is astonishing how tenaciously the old witchcraft and superstitions seek to hold their ground, and how slow even professing Christians are to abandon their faith in the old charms.” This LMS report clearly saw the hospital as a main battleground “In the struggle of Truth, Enlightenment and Good against Superstition, Darkness and Evil.”Footnote 44 And since patients were potential converts, and essential to the LMS cause, more dispensaries and hospitals were needed.
The Domestic Sphere
Beyond directly linking Christian teaching with medical practice, the hospital operated as a zone of Western space because it was intended to sharply contrast with the Malagasy environment. The hospital represented not just a hygienic area, but crucially a place where everything operated according to Western norms of behaviour. It was a masculine, controlled, and clean space, as important to the success of the mission hospital as the blend of medical aid and Christian teaching. Indeed, without the creation of a Western domestic sphere within the hospital, the entire endeavour could fail.
Yet since this space was an ideal, it remained fragile, threatened by limitations and scant resources. The most acute crisis was the loss of a supervising doctor for the mission hospital. The LMS viewed every doctor’s departure as crippling to their entire movement and feverishly attempted to recruit replacements. Davidson’s departure in 1876 created a vacuum until 1879, when Drs Parker and Mackie took over with the assistance of Norwegian Protestant missionaries.Footnote 45 Seven years later the mission hospital faced the same crisis as it struggled to hold on with only a Western-trained Malagasy left in charge until two LMS doctors arrived in 1889.Footnote 46 In the field, a missionary could adequately stand in place of a proper medical doctor and dispense rudimentary medicines and vaccines, but the hospital could not function without the presence of a Western medical doctor. In part, this was because hospitals were expected to house a professionally trained doctor, which was more important still in the urbanized capital, where the hospital was on display not only to the Malagasy people and government, but also to other Westerners. The mission hospital was a symbol of Western civilization and needed to operate according to those standards.
The crisis created by the loss of a Western doctor went beyond jeopardizing missionary medical standards because the absence of a male authority figure involved a threat to the domestic space of the mission hospital. Often hospitals and dispensaries continued to treat patients without a Western doctor through the use of Western female nurses or local assistants. Even in the best of times, hospitals employed local boys to keep the records, dispense medicine, and even vaccinate patients.Footnote 47 Further, local Malagasy were trained as doctors and carried out rounds, and a medical academy was established in 1886 to deepen this training among a larger number of Malagasy. The LMS even sent several Malagasy to the University of Edinburgh to be trained as doctors. Davidson argued in 1864 that he could convert the whole island with the assistance of medically-trained Christian Malagasy assistants.Footnote 48 However, for all their potential, the Malagasy remained a race in the process of civilizing and developing, but one that still clearly fell short of a Western standard. As such, no local assistance was a satisfactory replacement for the mission doctor- his loss imperilled more than patient care, particularly since patient care often continued.Footnote 49 Instead, the absence of a masculine authority figure represented a loss of the command of the medical and Western sphere.
Beyond the mission doctor, the hospital removed the Malagasy from their own environment. For missionaries, this was an essential step. Western missionaries were frequently appalled by the living conditions in Malagasy homes. Western descriptions of Malagasy houses commonly referred to them as dark, dirty huts filled with filth.Footnote 50 One missionary expressed this common complaint by summing up a Malagasy home as a “dreadful, evil smelling hole.”Footnote 51 Such dwellings were clear evidence of the primitive and backward quality of the Malagasy.Footnote 52 Further, missionaries often blamed illness on Malagasy living conditions.Footnote 53 Indeed, one doctor estimated that over 10,000 Malagasy had died during an influenza outbreak due to the combination of superstition, local remedies, and living conditions.Footnote 54 How could missionaries hope to succeed, particularly in providing medical aid, to a people who lived in abject squalor? And yet, how could missionaries prove the superiority of the Western domestic sphere if the Malagasy continued to dwell in such conditions?
One solution was the mission hospital. If a patient was removed from such a space with its dank grime and placed into a sterile atmosphere filled with light, clean blankets, then the patient’s health would improve. And with the return of health, word would spread of the medical mission’s success. Even without a full recovery, it was hoped that visiting relatives would be impressed by the superiority of Western hygiene. As with medical missions elsewhere, the formula was simple: remaining at home with traditional remedies exacerbated sickness, but a clean, well-lit, and Christian environment combined with Western medicine provided a cure. The condemnation of Malagasy living conditions, and the elevation of a sterile Western medical space, reflected a concern with championing the Western domestic sphere.
The domestic sphere was integral to the missionary movements in Madagascar as elsewhere. Imperial attitudes were deeply interwoven with ideas of proper masculine and feminine models of behaviour. As Reference McClintockMcClintock has argued, “As domestic space became racialized, colonial space became domesticated.”Footnote 55 Further, cleanliness became a defining feature of the domestic sphere, symbolizing Western attempts to civilize other peoples.Footnote 56 As such, attempts to sharply distinguish between the dirty, primitive quality of Malagasy homes versus the sanitary, ordered realm of the mission hospital spoke to the core of the Western mission to civilize not just behaviour but the Malagasy race itself.
Although the hospital was a symbol of European progress, it often failed to live up to these expectations. Just as the loss of the mission doctor undermined the missionary endeavour, so, too, did the eroding quality of the physical condition of the hospital itself. Understaffed, with chronic supply shortages, and cramped and unsanitary conditions, the hospital was at the centre of a debate about funds for the missions. The unhealthy nature of the hospital was of paramount concern. Medically, concerns arose over how the hospital had been used for years in such an unsanitary way that “wounds will not heal in the way that they should.” Indeed, with walls made of mud and damp floors, the chances of a “fatal epidemic” increased each year. Furthermore, the site of the hospital was undermined by “both impure and deficient” air because the hospital sat in a valley close to native buildings and next to a weekly market and slaughtering ground.Footnote 57 Such a state undermined missionary attempts to demonstrate the effectiveness of Western science and cut at the core of their mission.
A new, larger hospital was needed. This building would not only provide better medical facilities and assistance, but it would also once again be a beacon of Western civilization. In 1885, the hospital “barely h[e]ld 40 inpatients.” Indeed, it was the only one in all of Madagascar and the need for a larger one was exceeded only by the need for more across the countryside.Footnote 58 A newer hospital would provide for more patients, and do so in an improved setting. The need for a new hospital arose not just to match patient needs, but also out of a desire to create a space that more closely approximated the ideal. Indeed, the entire medical endeavour, and hence the ability of missionaries to convert, was jeopardized by a substandard hospital.
By 1891, the LMS had its new hospital, and it was one clearly devoted to the missionary cause. Beyond the mixture of faith and medicine, the entire LMS medical establishment had become a zone to advance its mission. While Drs Fenn and Moss hailed the progress of the new hospital in bringing in new patients and helping them train new Malagasy students, with over twenty men receiving a medical degree, fifty more in training, and forty women trained as nurses, the mission hospital remained a Christian, and Protestant, space.Footnote 59 The LMS denied a request from the French Roman Catholic Bishop on Madagascar to admit a Catholic Malagasy to their medical college because “our medical school is essentially missionary and Protestant.”Footnote 60 Indeed, this attitude spilled over to the acceptance of Malagasy students in general when, in 1893, the LMS confidently stated “it is felt that the time has now come to be more careful as to the Christian character of the men we accept” and thereby raised the standards of the medical exam.Footnote 61 Five Malagasy girls applying to be nurses were praised not just for their intelligence and work ethic but also for their knowledge of scripture.Footnote 62 As the missionary doctor James Mackay concluded, a new hospital would help eradicate superstition by providing treatment “based on the knowledge of Him Who is Physician both of soul and body.”Footnote 63 Medical aid remained directly related to the London Missionary Society’s goals of converting Malagasy to their specific faith.
Conclusion
The society’s medical mission officially ended with the French colonization of Madagascar in 1896. For a time, LMS missionaries remained on the island, but the French soon began to remove the LMS, with its British connections, from Madagascar. It took possession of the LMS hospital in 1896 because it was both a valuable piece of infrastructure and a symbol of the Protestant and, in the eyes of the French colonial government, British presence on Madagascar.Footnote 64 Indeed, medicine was a key component of early French colonization, in part because of the perceived success of British missionaries.Footnote 65
The medical mission of the LMS on Madagascar reveals how missionaries envisioned science as an efficient and necessary component in promoting Western civilization alongside Christianity. On Madagascar, missionaries did not often use nature to promote the glory of God as they did in other areas of the world,Footnote 66 but they directly connected what happened in their hospitals and doctor visits to their faith. This occurred because the Malagasy were a captive audience in one of the few Western spaces on Madagascar. They received both medical treatment and Christian messages. Further, medical benefits were often tangible and often occurred in the presence of missionaries. They preached the Gospel alongside the benefits of medical aid, confident that the Malagasy would interpret their results positively and associate healing with Christianity.
The mission hospital was a choreographed Western sphere, one designed to promote scientific and Christian ideals. Failure to do so not only jeopardized the health of patients, but also threatened the very success of missionary efforts at converting the Malagasy to civilization. On Madagascar, medicine, particularly the mission hospital, offered missionaries an isolated Western space in which to champion Western civilization.
