The Contributions of the Service Family to Sustainable Health Care in Sichuan

THE CONTRIBUTIONS OF THE SERVICE FAMILY TO SUSTAINABLE HEALTH CARE IN SICHUAN

Dr. Charles Winfield Service and Mrs. Robina (Morgan) Service were missionaries of the West China Mission located in Sichuan Province from 1902 to 1930. They served with both the Methodist Church of Canada and after church union in 1925, The United Church of Canada. Charlie was a surgeon and an ordained minister graduating from Victoria College in 1895 and Trinity Medical College of the University of Toronto in 1899. Robina received her nursing degree in 1899 from Brockville General Hospital.

Author: Elizabeth Service Researcher: Francie Service (M.A., Global Affairs) (B.A., B.Ed.) Editor: John Service (PhD., Psychology)

This paper expands the research of the Service family narrative beyond its singular linear form to reflect the collective history of the West China Mission. Although the life stories of Charles Winfield Service, a surgeon, and Robina (Morgan) Service, a nurse, are the connecting thread weaving together the narrative, the paper actively links their stories to the collective actions of the numerous individuals and institutions associated with the mission from 1891 to 1952. The narrative is told through the lens of an international development story and focuses on the medical work of the missionary enterprise. One of Canada’s most eminent historians, William Morton, noted that “history is not an academic mystery, it’s what the community thinks about itself, how it sorts out ideas.”1 This paper is an attempt to sort out the ideas of a familial narrative within a larger collective history.

The paper is constructed from an evidence-based approach and relies heavily on primary sources. Scientific biographers Héloïse Dufour and Sean Carroll, in their article Great myths die hard, provide a cautionary note to researchers that if “we are aware of the predisposition to embellish histories, that might discourage us from parroting them without solid evidence.”2 Familial stories can indicate a potential direction of discovery but often these apocryphal family anecdotes can inaccurately depict an individual’s contributions, and sometimes transition into unchallenged historical fact. This reinforces the importance of validating oral history, and the research utilized official church and university documents, period publications, professional journals, newspapers, family letters and photographs. Well-documented secondary sources, written by leading scholars, provided the interdisciplinary analysis to frame the narrative. When an embellished document, contradicting the evidential trail, was discovered on the internet or in print, additional primary sources were sought to ensure historical accuracy.

The West China Mission, based in Sichuan, was the largest missionary operation in the world. It was a complex transnational project, influenced by a cross-sector of individuals and institutions, and each actor reflected their own patterns of social engagement.3 To understand the complexity of the sustainable health care project, the paper utilizes a collaborative partnership framework to recognize the collective impact of the diverse stakeholders committed to social change in clinical medicine and medical education.4 The expansion of the missionary enterprise from its church- based roots to its collective reach within the overall Canadian fabric, including health care, university, business and diplomatic stakeholders, is a relatively unexplored historical narrative. The paper introduces various individuals and institutions but acknowledges that expanded research, across multiple academic disciplines, is required to fully capture this significant period in Canadian and Chinese history. It should also be noted that the research was restricted to English language sources, and the overarching emphasis on Canadian stakeholders has

1 William Lewis Morton in A. Brian McKillop, “William Lewis Morton”, The Canadian Encyclopedia, https://www.thecanadianencyclopedia.ca/en/article/william-lewis-morton. 2 Heloise Dufour and Sean Carroll, “Great myths die hard”, Nature, Vol. 502, No. 7469, (2013), 33. 3 Petra Kuenkel, “Leadership for sustainability: the art of engaging”, The Guardian, April 17, 2012, https://www. theguardian.com/sustainable-business/art-engaging-collaborative-leadership. 4 UN General Assembly, Transforming our world: the 2030 Agenda for Sustainable Development, (#17.16), 21 October 2015, A/RES/70/1, 27; Ronald A. Heifetz, John V. Kania and Mark R. Kramer, “Leading Boldly”, Stanford Social Innovation Review, Vol. 2, No. 3, (Winter 2004), 20-31; John Kania and Mark Kramer, “Collective Impact”, Stanford Social Innovation Review, Vol. 9, No. 1, (Winter 2011), 36-41.

1 contributed to a fundamental weakness in the paper. The inclusion of Chinese archival documents would produce a more balanced cross-cultural context for understanding this transnational relationship in sustainable health care delivery.

ORIGINS OF MEDICAL MISSIONS

Charlie and Robina Service were motivated by the belief that “the promotion of health promises to be the leading ideal of the twentieth century.”5 Their life story, as medical missionaries in China, began in 1902 in a mission station in Wuhu, a commercial river port on the Yangtze River.6 This one year posting focused on language training, and the mission was administered by Dr. Edgerton Hart, a well-known surgeon and the son of the first superintendent of the Canadian Methodist Mission (CMM).7 Superintendent Virgil Hart had managed numerous mission stations in central and western China, for the Board of Foreign Missions of the Methodist Episcopal Church USA, and his experience building a large hospital and envisioning a university-based medical school in Nanjing would influence the direction of the CMM.8

Charlie learned about the work of the Hart family as a young child growing up in Athens, a small agricultural town in eastern Ontario, originally known as Farmersville.9 His father, Rev. William Service, was appointed to the Methodist Episcopal Church from 1877-1880, and Charlie would continue to live in eastern Ontario while attending high school in Athens and at the Ottawa Collegiate Institute, now known as Lisgar Collegiate.10 His final year of high school was spent at Albert College in Belleville, Ontario which was associated with Victoria College at the University of Toronto.11

Athens was also the childhood home of Miss Adeline Gilliland, and after marrying Dr. Virgil Hart in 1865, she spent more than three decades in China. Although her husband would be “remembered as the man who founded the mission in West China,” it was Mrs. Hart who convinced her husband to accept the position of superintendent of the CMM for the period 1891 to 1900.12 Adeline Hart was the first Canadian woman to live in China, and until her death in 1915, she would be an influential voice within missionary circles. Her son, Edgerton, would

5 Charles W. Service, “Public Health in China”, The Canadian Journal of Medicine and Surgery, Vol. 46, No. 5, (1919), 370. 6 C.W. Service, “Departmental Surveys - Medical Work”, in Our West China Mission, ed. F.C. Stephenson, (Toronto: The Missionary Society of the Methodist Church and The Young People’s Forward Movement, 1920), 378. 7 D. MacGillivray, A Century of Protestant Missions in China (1807-1907), (Shanghai: The American Presbyterian Mission Press, 1907), 442. 8 Ibid., 443; Methodist Episcopal Missionary Society, Seventieth Annual Report of the Missionary Society of the Methodist Episcopal Church For the Year 1888, (New York: Methodist Episcopal Missionary Society, 1888), 88. 9 Athens was originally called Farmersville until 1888. 10 “Ministers”, Athens (Farmersville) Episcopal Methodist Church-Yonge Township, Leeds County, Ontario, https://krassoc.wordpress.com/https://www.canadiana.ca/view/oocihm.N_00085_19230726/8?r=0&s=32012/12/01/ athens-methodist-episcopal-church/; “Rev. Chas. W. Service Passed Away in China: Noted Missionary was Former OCI Student”, The Citizen, March 17, 1930, 17. 11 Charles Service graduated gold medalist from Albert College. 12 Neil Semple, The Lord’s Dominion: The History of Canadian Methodism, (Montreal & Kingston: McGill- Queen’s University Press, 1996), 323-326; The Globe, “A Missionary Hero Dies”, February 26, 1904, 8. ProQuest Historical Newspapers: The Globe and Mail.

2 later reflect that “many of the institutions which he [his father] was instrumental in establishing, such as the famous hospital and college in Nanking, owe their first inspiration to her.”13

Another Athens resident, Dr. Leonora Howard King, arrived in China in 1877, and church records credit her with being “one of the first” Western trained doctors to establish “the system of medical missions.”14 Her work was located primarily in Tianjin and over her career, which spanned nearly half a century, she founded a hospital and the first medical school for women in all of China.15 King was the personal physician to Lady Li, the wife of Viceroy Li Hongzhang who was also her main benefactor, and this support legitimized the position of a female doctor.16 In recognition of her treatment of Chinese soldiers, during the 1894 war against Japan, the “young woman from Canada” was awarded the Imperial Order of the Double Dragon which was the first time a Western woman was given such a prestigious honour.17 King’s career was closely followed in Canada and in 1923, while on furlough, the Athens Reporter noted that “since coming here, Mrs. King has received a letter from the Chinese ambassador to the U.S. inviting her to visit his summer home in Massachusetts, and regretting that his official duties will 18 prevent him from making them a visit here in Canada.” King, who was the second foreign female doctor to serve in China, died in 1925 in Beidaihe, and she was recognized as “one of the most widely known and highly respected of lady missionaries in China.”19

The childhood church of Adeline (Gilliland) Hart and Leonora (Howard) King was the Farmersville Methodist Episcopal Church, and it is remarkable that two women, from this small rural community, would be destined to play such effectual roles in disseminating medical knowledge in China. Their pictures were placed in the church sanctuary, and their stories were proudly shared with the local parishioners. And these missionary stories had a profound impact on Charlie, and when he “was a young boy, he formed the decision to come to China.”20 His connection with eastern Ontario would remain throughout his life and just as they were “proud to

13 E.I. Hart, D.D., Virgil C. Hart: Missionary Statesman, Founder of the American and Canadian Missions in Central and West China, (Toronto: McClelland, Goodchild and Stewart, 1917), 25. The spelling of Chinese cities varies due to English transliteration and Nanjing is called Nanking. 14 W.H. Withrow, “Current Topics and Events. Methodist Missions in China”, The Methodist Magazine, Vol. 33, (June 1891), (Toronto: William Briggs Methodist Publishing House, 1891), 624; Jos. C. Thomson, “Medical Missionaries to the Chinese”, The China Medical Missionary Journal, Vol. 4, No. 3, (1890), 233. 15 Margaret Negodaeff, “Howard, Leonora Annetta (King)”, Dictionary of Canadian Biography, Vol. 15, University of Toronto/Université Laval, 2003, http://www.biographi.ca/en/bio/howard_leonora_annetta_15E.html. The conventional form of Tianjin is Tientsin. 16 Maria Cristina Zaccarini, The Sino-American friendship as tradition and challenge: Dr. Ailie Gale in China, 1908-1950, (New Jersey: Associated University Presses, 2001), 61; Athens Reporter, “Athens Distinguished Sons: Rev. H.E. Warren Tells Interesting Story in the Methodist Church”, Vol. 41, No. 9, February 26, 1925, 1. 17 Withrow, “Current Topics and Events”, 624; The Globe, “52 Years as Missionary, Canadian Woman Returns”, July 7, 1923, 3. ProQuest Historical Newspapers: The Globe and Mail; Semple, The Lord’s Dominion, 323; Negodaeff, “Howard, Leonora Annetta (King)”. 18 Athens Reporter, “Local News: Athens and Vicinity”, Vol.38, No. 44, July 26, 1923, 8. 19 MacGillivray, A Century of Protestant Missions in China (1807-1907), 448; The Globe, “One of Pioneer Missionaries Dies at Her Station in China”, July 7, 1925, 11. ProQuest Historical Newspapers: The Globe and Mail; The Globe, “Missionary Returns”, September 22, 1925, 5. ProQuest Historical Newspapers: The Globe and Mail; Negodaeff, “Howard, Leonora Annetta (King)”. The conventional form of Beidaihe is Peitaiho. 20 Rev. George Sparling, “A Friend and Fellow Missionary Laid to Rest”, Funeral Service for Dr. Charles Winfield Service, March 13, 1930, Si Shen Si Church, Chengdu, West China.

3 claim Dr. Service, as a Leeds County boy,” he was honoured that the young people of the Brockville and Matilda District Epworth League raised funds to support his career in China.21

Charlie also interacted with the Harts during his university years, through his position as the secretary of the Student Volunteer Movement for Foreign Missions, and at a dinner in 1897, Charlie presented Superintendent Hart with a memento to officially recognize his contributions to the missionary enterprise.22 Hart, although a clerical missionary, acknowledged that his true “sympathies have been largely with medical missions, and during the later years of service in China much of my energies have been directed in that channel.”23 This medical approach to missions resonated with Charlie, and as a student leader in both university and church-based youth organizations, he was aware of the medical missions established by King in Tianjin, Hart in Nanjing and the CMM in Sichuan. In The Missionary Campaigner, a publication initiated by students of Victoria College, Charlie contributed a study guide to promote the outreach of medical missions. Guided by the precept that “it was the duty of man to care for his fellowman,” Charlie encouraged students to discuss the theological rational encouraging the medical missionary to alleviate “every kind of disease and every kind of sickness among the people.”24 Four health care mechanisms were identified for discussion: itinerating work, hospitals, dispensaries, and the instruction of youth in medical science.25 The study guide was written in 1896, while Charlie was a medical student at the University of Toronto, and six years later, he would be hired by the Methodist Church of Canada to provide sustainable health care in Sichuan.

As a newly appointed medical missionary, Charlie observed the catalytic potential of medicine and education in ameliorating social conditions and accelerating the acceptance of missions. Shortly after arriving in China, Charlie wrote a letter to the church community reinforcing the importance of education and medicine to the overall missionary movement: “What China needs” suggested Charlie was “educational institutions, hospitals, Bible societies, societies for the preparation and diffusion of books of knowledge of every kind.”26 And while travelling in 1903, on the Yangtze River to Sichuan, he sent a message to the youth with the title: NOW is our opportunity for a College in Chengtu.27 Charlie never wavered from his missiological support for the diffusion of knowledge, and as his colleague Dr. George Sparling observed, “from the time that he first came out he constantly urged that there should be a University opened and that in the University there should be a College of Medicine.”28 In subsequent years, Charlie would

21 “Rev. Charles Winfield Service, M.D., C.M.”, Order of Service Wall Street United Church, March 30, 1930; “Names and Post Office Addresses of Missionaries and their Assignment for Support, May, 1920”, Our West China Mission, 468. 22 The Globe, “Forward Movement: A Great Methodist Missionary Awakening”, January 18, 1897, 4. ProQuest Historical Newspapers: The Globe and Mail. 23 The Rev. V.C. Hart, D.D., “Medical Missions. Canadian Methodist Mission in China”, The Methodist Magazine, Vol. 33, (June 1891), 588. 24 Chas. W. Service, “Suggested Programme on Medical Missions”, Missionary Campaigner, Vol. 1, No. 7, (1896), 2; Matthew 4:23, (English Standard Version). 25 Service, “Suggested Programme on Medical Missions”, 2. 26 C.W. Service in Kenneth J. Beaton, Great Living; Rev. Charles W. Service, B.A., M.D., C.M. of Chengtu, West China, (n.l.: The Centenary Committee of the Canadian Churches, n.d.), 18. 27 C.W. Service, “Letter from Rev. C.W. Service M.D., Houseboat on the Yang-tse River, China, December 18, 1903”, The Missionary Bulletin, Vol. 2, No. 1, (1904-1905), 30, The United Church of Canada Archives, Toronto, Ontario, Canada. 28 Sparling, “A Friend and Fellow Missionary Laid to Rest”.

4 join many others to implement this collective vision, and for close to three decades, he would nurture a university “as a missionary statesman furthering medical education.”29

To reach the western province of Sichuan, the Service family navigated the majestic but treacherous Yangtze River. After their one year of language training in Wuhu, they travelled to Shanghai to meet some new recruits, Rev. A.C. and Minnie Hoffman, Miss Dorothy Fox and Dr. James Cox, and they then travelled by steamboat from Shanghai to Yichang.30 This was the deeper and less dangerous stretch of the Yangtze.31 At Yichang, a city set among the hills of Hubei Province, their journey along the more perilous Upper Yangtze commenced, and the group transferred to houseboats to navigate the numerous rapids and gorges, along this 560 km stretch, between Yichang and Sichuan.32 In a letter to the young people of the church, Charlie described the “sights and sounds and experiences that keep eyes, ears and nerves constantly alert,” and he noted that because the “scenery is most diversified and exceedingly beautiful; the mode of travel is totally new; the rapids are numerous and their ascent laborious and exciting,” the travelers were finding “it almost impossible to read, study or write.”33 And with so many boats passing up and down the longest river in Asia, there was also the unfortunate reality that “wrecks are not infrequently seen, with their damaged cargoes arrayed on the shore or mountain side to dry.”34 Their own attempt to traverse one of the largest and most challenging rapids, in the section known as the Three Gorges, was described in detail:

Thus far we have passed many small rapids and two very large ones. Our tow line has twice broken, and we have slowly drifted downstream, but fortunately both times in smaller rapids. About four hours ago we ascended one of the three largest and most dangerous rapids. At the foot of the rapid there were four boats ahead of ours. Of these two broke loose when nearly at the top of the rapid (one of them drawn by three tow lines all of which snapped like a whip-cord), and down they went I know not where. Well, this sight was rather forbidding, I assure you, but our turn came and so we had to start. Each of our boats had two tow lines over a quarter of a mile long, at the end of which about eighty trackers were down on all fours pulling vigorously and shouting vociferously. When about half way up one of the two ropes of our first boat snapped, but the other rope proved true to us, and after a hard half hour pulling this boat anchored securely in a bay, which was a haven of rest indeed. Then followed our second boat, which had identical experience. And so here we are tonight, everything quiet around us, our boatmen asleep and we ourselves about to retire.35

They would not be so lucky further down the Yangtze when they experienced their own boat wreck, but after drying their cargo on the shore, Charlie, Robina, their baby, Winnifred, along with their travelling companions, safely reached Sichuan in 1904. Shortly after arriving, they

29 Board of Foreign Missions, United Church of Canada, “Minutes, Rev. C. W. Service, B.A., M.D.”, (April 1930). 30 Service, “Letter from Rev. C.W. Service M.D., Houseboat on the Yang-tse River, China, December 18, 1903”, 27. 31 The Secretary of the Navy, Sailing Directions for the Coast of China, 4th ed., (Washington: United States Government Printing Office, 1943), 299. 32 Ibid., 305; Service, “Letter from Rev. C.W. Service M.D., Houseboat on the Yang-tse River, China, December 18, 1903”, 30. 33 Service, “Letter from Rev. C.W. Service M.D., Houseboat on the Yang-tse River, China, December 18, 1903”, 31. 34 Ibid. 35 Ibid., 31-32.

5 attended the Mission Council Meeting in Chengdu, which Charlie described as “the wonderful capital of this magnificent province.”36 This visit to the headquarters of the CMM gave Charlie and Robina their “first view of our Chengtu mission property, plant, methods, etc.,” and the opportunity to receive their “first appointment to definite work in West China.”37 After the meeting, they travelled for four nights in a small boat, on the Min River, to the mission station of Leshan where they engaged in clinical health care until 1911.

MEDICAL WORK IN CHENGDU – THE EARLY YEARS

Chengdu was the first mission station opened by the Methodist Church of Canada.38 Prior to the arrival of the Canadians in 1891, other missionary organizations had established medical work in Sichuan: American Episcopal Methodist Mission: Chongqing (1883); China Inland Mission: Chengdu (1884), Chongqing (1885); London Missionary Society: Chongqing (1890).39 One of the medical pioneers was Dr. Harry Crews, of the American Episcopal Methodist Mission, who provided clinical services in Chongqing from 1883 until he was forced to evacuate following the foreign riots of 1886.40 Rev. Virgil Hart, in his previous position as the superintendent for central and western China for the American Methodists, visited Chongqing in 1887 to assess the damages, and he quickly ascertained that although missiological suspicions remained, “there were repeated inquiries by the people about ‘the doctor’ and his return.”41 Historian Xi Gao posits that medical missionaries were “more than just Western doctors; they were the only group of people that had access to every level of Chinese society,” and it was Hart’s belief that “medical men have opened more closed gates in China in the past ten years than all other agents.”42 In the early years, medicine was “an evangelistic strategy aimed at gaining the trust of prospective converts” because as historian Sonya Grypma espouses, “the medical doctor was welcomed where the preacher and teacher were barely tolerated.”43 In subsequent years, the American Episcopal Methodist Mission extended their medical outreach to Chengdu with the appointment of Dr. H.L. Canright in 1891, the building of a medical dispensary in 1892, and the opening of a large hospital in 1907.44

36 Beaton, Great Living, 12. 37 Ibid. 38 The conventional form of Chengdu is Chengtu, Chongqing is Chungking and Leshan is Kiating. 39 Thomson, “Medical Missionaries to the Chinese”, 231-234; Dr. R.B. Ewan, “General Review of Medical Work”, in West China Missionary Conference, ed. A. Grainger, (Chengtu: Canadian Methodist Mission Press, 1908), 235; George Bond, Our Share in China and What We are Doing with It, 2nd ed., (Toronto: The Missionary Society of the Methodist Church, 1911), 150. 40 MacGillivray, A Century of Protestant Missions in China (1807-1907), 445; Grace B. Rape and Edna M. Veals, “Medical Work in Chungking”, The West China Missionary News, (May 1939), 222. 41 E.I. Hart, Virgil C. Hart: Missionary Statesman, 182-183; “Notes from the Wide Field”, The Missionary Herald Containing the Proceedings of the American Board of Commissioners for Foreign Missions, Vol. 83, (Boston: Press of Stanley and Usher, 1887), 157; Hart, “Medical Missions”, 587. 42 Xi Gao, “Chinese Perspectives on Medical Missionaries in the 19th Century: The Chinese Medical Missionary Journal”, Journal of Cultural Interaction in East Asia, Vol. 5, (2014), 117; Hart, “Medical Missions”, 586. 43 Sonya J. Grypma, “James R. Menzies: healing and preaching in early 20th-century China”, Canadian Medical Association Journal, Vol. 170, No. 1, (2004), 84. 44 “List of Registered Delegates”, West China Missionary Conference, 382-386; MacGillivray, A Century of Protestant Missions in China (1807-1907), 446.

Aside from Chongqing, Superintendent Hart toured the regions surrounding Chengdu and Leshan, and when approached by the Methodist Church of Canada, a few years later about a potential site, he suggested opening a mission field in Sichuan. Chengdu was chosen as the headquarters of the mission, and a “plain but well-equipped hospital…able to accommodate one hundred patients” was envisioned, as well as a school to train medical and clerical assistants.45 For those cities and towns within a day’s journey from Chengdu, Hart recommended building a dispensary connected to a chapel, and once Chengdu was established, Leshan was mentioned as a potential mission site.46 Hart’s previous assignment in Nanjing, establishing a substantial hospital which he described as a “plain humane institution” and envisioning a medical school with Chinese as the language of instruction, would provide a working model for the Canadian missionary enterprise.47

Figure 1: Mission stations in Sichuan (Source: John William Foster’s PhD thesis pg. 474/475 Archives and Special Collections, Carleton University Library)

The CMM became operational in 1891 with the appointment of Superintendent Hart and Rev. George Hartwell to church work and Drs. David Stevenson and Omar Kilborn to medical duties.48 A dispensary was opened in November 1892, and “thus, from the beginning of our work,” Charlie later remarked, “our Missionary Society and our Church recognized the place and the value of the medical arm of missionary service.”49 This pioneer group had a strong connection to Athens, Ontario. As mentioned earlier, Mrs. Hart was born in Athens and both Hartwell and Kilborn attended high school in this small Ontario town.50 Included in the missionary group was Miss Amelia Brown, the first representative of the Women’s Missionary Society (WMS), and she would later marry Dr. Stevenson.

The pioneering period of clinical medicine in Chengdu and the initial years of West China Union University are the recurring focus of the recent discourse and evolving narrative about the West

45 Hart, “Medical Missions”, 591. 46 Ibid. 47 Ibid., 590. 48 Ewan, “General Review, of Medical Work”, 235; “List of Registered Delegates”, 382-386. 49 Service, Our West China Mission, 378; C.W. Service, “Letter from Rev. C.W. Service, B.A., M.D., Chengtu, West China, February 27, 1917”, The Missionary Bulletin, Vol. 13, No. 3, (1917), 412, The United Church of Canada Archives, Toronto, Ontario, Canada; Bond, Our Share in China, 61-62. 50 Omar Kilborn, “High School and College Days in Canada”, in The Life of Rev. William James Hall, M.D., ed. Rosetta Sherwood Hall, M.D., (New York: Press of Eaton and Mains, 1897), 37, 44-45.

China Mission. Historian Tim Cook in his book, The Fight for History: 75 Years of Forgetting, Remembering, and Remaking Canada’s Second World War, notes the tendency of future generations to reframe history. He posits that “social memory is the constellation of thoughts, ideas, and key events that people embrace to make sense of their society. Often this involves forging an agreed-upon version of the past that resonates in the present. The past may not change but how we view it does.”51 Although the narrative of the West China Mission is open to differing interpretations, it should be founded on the evidence-based life stories of the individual missionaries and a number of primary sources share their personal observations. To promote the missionary enterprise in Canada, the Methodist Church tasked journalist George Bond with recording the early history in Sichuan. In 1902, Bond was appointed the editor of The Christian Guardian and according to the Canadian Printer and Publisher:52 Mr. Bond is no amateur in journalistic work. He has been for the past nine years editor of The Wesleyan, of Halifax, and prior to that his writing was of such a high order as to merit attention. Mr. Bond is a native of Newfoundland and a brother of Sir Robert Bond, the Premier of that Colony.53 His interest in the church’s overseas missions prompted him to resign from the newspaper, and Bond sailed for Sichuan, in the fall of 1907, to research his book Our Share in China and What We are Doing with It. For eight months, Bond conducted extensive interviews with Canadian missionaries engaged in the medical, educational and evangelical work of the CMM, liaised with personnel attached to other international missions, and met with Chinese officials. His research was conducted during visits to all the central mission stations and most of the out-stations located in Sichuan.54 According to Kilborn, “he took time to become thoroughly acquainted with each missionary, and with each missionary’s work…In ‘Our Share in China,’ Mr. Bond gives us some of these impressions” written in “the breezy, cheery, optimistic, but always carefully accurate language, for which the ex-editor of The Guardian is justly famous.”55 Another foundational book, Our West China Mission, is described as “a somewhat extensive summary by the missionaries on the field of the work during the first twenty-five years of the Canadian Methodist Mission.”56 The book is a compilation of numerous reports including: Kilborn: Historical Sketch; Hartwell: Evangelistic Work; and Service: Medical Work. An

51 Tim Cook quoted in “What do we lose if we forget?”, The Agenda with Steve Paikin, TVO, November 11, 2020, https://www.tvo.org/video/what-do-we-lose-if-we-forget; Tim Cook, The Fight for History: 75 Years of Forgetting, Remembering, and Remaking Canada’s Second World War, (Allen Lane Penguin Canada, 2020). 52 The Christian Guardian, upon amalgamation with the Presbyterians and Congregationalists, was renamed The New Outlook in 1925, The United Church Observer in 1939, and rebranded in 2019 as Broadview. 53 “Journalistic Chit-Chat. The Guardian’s New Editor”, Canadian Printer and Publisher, Vol. 12, No. 1, (1903), 6, https://fishercollections.library.utoronto.ca/islandora/object/cpp%3ACPP190301_0008; “Canadian Printer and Publisher: About the Collection”, Thomas Fisher Rare Book Library, University of Toronto, https:// fishercollections.library.utoronto.ca/cpp_about. 54 The Globe, “Rev. G. Bond Returning”, March 23, 1909, 2. ProQuest Historical Newspapers: The Globe and Mail. George Bond recorded his observations in Sichuan in 1908 and printed the first edition in 1909. His second edition printed in 1911 incorporates up-to-date material. 55 O.L. Kilborn, “Our Latest Book on China for the Laymen’s Missionary Movement: Our Share in China and What We Are Doing About It”, in Our West China Mission: The Departments of Work and their Cost, (Toronto: Missionary Society of the Methodist Church, Young People’s Forward Movement Department, n.d.), 64. 56 Stephenson, Our West China Mission, Inside Cover Page.

8 additional resource is the biography Great Living; Rev. Charles W. Service, B.A., M.D., C.M. of Chengtu, West China. This source was written by Dr. Kenneth J. Beaton who was a member of the Epworth League, the Student Volunteer Movement, a graduate of Victoria College, a missionary in Chengdu from 1914 to 1929, and the editor of The West China Missionary News.57 Beaton was viewed as a “trail-blazer,” and in 1936 he was the founding secretary of the newly formed Committee of Missionary Education, and he was later appointed the director of radio and television for The United Church of Canada.58 In addition to these foundational sources, the missionaries were prolific communicators and liaised with Canadians, through regular letters, speaking tours, articles in magazines, journals and official church reports, as well as published books. Frequent contributions to newspapers, especially The Globe, the predecessor to The Globe and Mail, provided valuable insight into the missionary enterprise and its contextual relationship to the broader social and political environment.59 In the early years of the West China Mission, there was an emphasis on building infrastructure and expanding the number of missionaries. And according to Bond, after the opening of the dispensary, there was a need for a small hospital and “the first hospital buildings were erected by Dr. Stevenson…in 1894.”60 He was an eye, ear, nose and throat specialist, and “Dr. Stevenson reported a successful year” recalled Hartwell and “he had worked up a large practice.”61

Figure 2: The first hospital in West China (Source: Our West China Mission, 37) While Stevenson was constructing the hospital, Kilborn travelled to Shanghai to escort a new group of missionary recruits to Chengdu, and he and his wife, Dr. Retta Kilborn, were then posted to Leshan for one year.62 Stevenson retired from service, after the 1895 riots, but his

57 “The New Editor”, The West China Missionary News, (February 1927), 1; The Globe, “Rev. Kenneth J. Beaton: Used New Media in United Church Mission Work”, October 21, 1957, 2. ProQuest Historical Newspapers: The Globe and Mail. 58 Ibid., The Globe, “Church Sending Pair to Film Life in China to Aid Missions”, January 18, 1947, 11. ProQuest Historical Newspapers: The Globe and Mail. Dr. Beaton, who received his honorary doctorate from Victoria College in 1942, visited China with a film crew for six months in 1947 where he also lectured at WCUU on the topic of visual education. 59 A substantial amount of primary material including books, mission periodicals, university minutes, newspapers and professional journals is digitized to optimize online access. 60 Bond, Our Share in China, 56; Service, Our West China Mission, 378. 61 George E. Hartwell, B.A., B.D., D.D., Granary of Heaven, (Toronto: The United Church of Canada, Wesley Buildings, 1939), 42- 43. 62 Ibid., 43; Bond, Our Share in China, 99, 106; Omar Kilborn, Heal the Sick: An Appeal for Medical Missions in China, (Toronto: The Missionary Society of the Methodist Church, 1910), 233; Yuet-wah Cheung, “The Social Organization of Missionary Medicine: A Study of Two Canadian Protestant Missions in China before 1927”, Ph.D. diss., The University of Toronto, 1982, 93.

9 leadership in opening the first dispensary and building the first hospital would provide a lasting foundation for medical work. And in his book chapter, entitled Medical Missions in West China, Stevenson provided a vision for the future, and he specifically challenged the Methodist community to support 20 doctors “in the next five years, [so] we may start a medical college, and have one doctor for every five great walled cities.”63 The book was published in 1892, to introduce the Methodist community to mission work in China, and Stevenson encouraged Canadians to “ponder over” the notion of educating Chinese medical students.64 Dr. W.E. Smith was appointed to replace Dr. Stevenson in 1896, and with the addition of Dr. R.B. Ewan in 1897, there was now a small group of medical missionaries working in Chengdu.65 An historical overview of the CMM, in The West China Missionary News, noted that “a glance at the mission records of the early days of the century reveals that on several occasions doctors were placed in charge of churches because of the relative dearth of pastoral men.”66 This operational protocol was evident when Kilborn recorded the decision, following the Boxer Rebellion, for “Dr. Ewan to reopen the medical work in Chengtu and myself to reopen the church work in Chengtu” while Dr. Smith was appointed in 1901 to both medical and church activities in Leshan.67 “From 1899 until his furlough year, 1905,” The West China Missionary News noted that “Dr. Ewan had charge of the medical work of the Canadian Methodist Mission in Chengtu.”68 His medical duties during his furlough year were covered by Kilborn and after returning in 1906, “the Council of that year appointed him to the Chengtu hospital, to begin the erection of the large new building.”69 And according to the account in Our West China Mission, the CMM continued to assign doctors to non-medical positions: “The Versatile Medical Missionary - In 1907 there were six medical missionaries, but two of those had to be placed in charge of evangelistic work because of [a] shortage of pastoral workers. These two were, Dr. Kilborn in Chengtu, and Dr. Smith in Junghsien.”70 Although the CMM listed workers as medical missionaries, sociologist Yuet-wah Cheung, in his doctoral thesis The Social Organization of Missionary Medicine, concludes that all doctors were not providing medical care due to scheduled furloughs and the fact “Drs. Kilborn and Smith were engaged more regularly in evangelical rather than medical work. Therefore, the Mission could, at best, place one missionary doctor in every station that was open. This was far from adequate manpower.”71 The medical missionary who served in other capacities was an important asset because with limited workers, it provided the flexibility to fill vacancies in evangelical work, as well as the auxiliary agencies which included the Business Department.72 The various tributes, at Kilborn’s

63 David Stevenson, “Medical Missions in West China”, in China and the Chinese: A Compend of Missionary Information from Various Sources, (Toronto: Methodist Missionary Society, 1892), 30. 64 Ibid. 65 Service, Our West China Mission, 380, 473-474. 66 Leslie Kilborn, “The Medical Services of the Canadian Mission in Szechwan”, The West China Missionary News, (October 1937), 9. 67 Kilborn, Heal the Sick, 241; Service, Our West China Mission, 380. 68 “Rev. R.B. Ewan M.D. D.D.”, The West China Missionary News, (February 1927), 33. 69 Kilborn, Heal the Sick, 246. 70 Service, Our West China Mission, 382; MacGillivray, A Century of Protestant Missions in China (1807-1907), 123. 71 Yuet-wah Cheung, “The Social Organization of Missionary Medicine”, 96-97. 72 Missionary Society of the Methodist Church of Canada, “Sowing and Reaping in West China”, White Unto Harvest: The 101st Annual Report of the Missionary Society of the Methodist Church, Canada 1924-1925, (Toronto:

10 funeral in May 1920, recognized the versatility he exemplified throughout his missionary career.73 His willingness to approach tasks with a “versatile and capable hand” was celebrated by General Secretary James Endicott who represented the General Board of Missions of the Methodist Church of Canada.74 Charlie representing his co-workers eulogized that it was “due to his versatility, adaptability and willingness, [that] he was frequently side tracked from the work for which he originally went to China. For many years the secretary-treasurership engaged the bulk of his time and energies.”75 A headline in The Globe acknowledged that the late Dr. Kilborn Held Unique Position, and he was “one of the leading men of the Union University of West China, and as Secretary-Treasurer of the mission, he was chief administrative officer.”76 By the time the mission entered the 1910s, the hiring process had shifted, and as the workforce expanded, this allowed for greater specialization with the selection of dentists and a pharmacist, and along with the doctors, they expected to serve the mission in their designated career.

LESHAN ERA (1904-1909)

The CMM assigned Charlie and Robina to the city of Leshan, located close to Mount Omei, one of the most sacred mountains of China. One of their first tasks was to repair and disinfect the hospital, to ensure it met the standards of an aseptic environment, which was medical protocol since the turn of the century.77 This task was a typical assignment, and Charlie would often lament that “valuable time and skill” was wasted, in preparing the infrastructure, instead of engaging in their “real work of ministering to the sick.”78 Ewan encapsulated the numerous tasks restricting effective health care delivery when he argued that the medical worker “must no longer be expected to be a mason, a carpenter, and blacksmith; he must not have to be head cook and chief laundryman, as well as a specialist in every department of his profession.”79 The required repairs were extensive and included all the structures in the overall compound.

In the early years in Leshan, the CMM followed the operational policy of the “versatile medical missionary.”80 This was reflected with the assignment of Dr. W.F. Adams, a trained doctor and dentist, to church activities and Charlie to medical work, and for a few months in 1906, Charlie managed both medical and church needs.81 In the case of Robina, she was assigned to nursing s.n., n.d.), 62; James Endicott, “Memorial Service for Dr. C.W. Service”, (Trinity United Church, Toronto: 23 March 1930). 73 C.W. Service, “A Service of Tribute to the Late Omar Leslie Kilborn, M.D., D.D.”, The Missionary Outlook, Vol. 40, No. 7, 1920, 150, The United Church of Canada Archives, Toronto, Ontario, Canada. 74 The Globe, “Sees in Death of Dr. Kilborn a Heavy Blow”, May 22, 1920, 9. ProQuest Historical Newspapers: The Globe and Mail. 75 Service, “A Service of Tribute to the Late Omar Leslie Kilborn, M.D., D.D.”, 150; Rev. James Neave, “Unoccupied Fields”, Our West China Mission, 129; Bond, Our Share in China, 260; O.L. Kilborn, M.A., M.D.: Corresponding Secretary and Treasurer of West China Mission of the Methodist Church, Canada, West China Mission Handbook, https://ia601602.us.archive.org/14/items/westchinamission00kilb/westchinamission00kilb.pdf. 76 The Globe, “Year at Home Ends in Death of Missionary: Rev. O.L. Kilborn Dies During Furlough From China”, May 19, 1920, 8. ProQuest Historical Newspapers: The Globe and Mail. 77 Bond, Our Share in China, 107; Atul Gawande, “Slow Ideas”, The New Yorker, 29 July 2013, https://www. newyorker.com/magazine/2013/07/29/slow-ideas. 78 Service, Our West China Mission, 384-385. 79 Ewan, “General Review of Medical Work”, West China Missionary Conference, 237. 80 Service, Our West China Mission, 382. 81 Ibid., 383-384.

11 duties and according to Beaton, “Mrs. Service, as she did in those days for all the operations, sterilized the instruments in a steamer over a pot of water in the kitchen, and laid out all the dressings.”82 Even though Robina was providing significant nursing services, her position was classified as volunteer, and this reflected the church’s patriarchal policy toward female mission workers. The CMM expected married women to deliver health care services without official standing and renumeration while single female employees were appointed to salaried positions.83

Figure 3: The 1902 group of missionaries. Back row left to right: Dr. Service, Dr. Adams, Mrs. Bates, Rev. Bates; Front row: Mrs. Service, Rev. Stewart, Mrs. Adams (Source: Vic in China Exhibition. Used by permission Victoria University Library (Toronto). Victoria College and the Student Volunteer Movement, “The Call to Students to the Foreign Field”, Acta Victoriana, 26:4, 298) Once the buildings were operational, the opening of the hospital was further delayed until the fall of 1905.84 Charlie contacted typhus from a woman he discovered lying on the road, and for many months, he would recuperate under Robina’s expert nursing care. The decision to treat this destitute woman reflected the social gospel doctrine of Methodism, and its belief that every church member had an obligation to “bring heaven down to this earth” and to address the “age- long problem of human suffering.”85 And for the medical missionaries, this social justice obligation was fulfilled through the respectful provision of health care to all members of society regardless of their religious beliefs or social status or political affiliation. These humanitarian values placed the Methodist Church in the forefront of societal reform in Canada, and within the Chinese context, after the abolition of the Confucian examination system in 1905, there was a natural alignment of Methodist liberal theology with the education reform movement.86 The introduction of an exogenous health care development model was rooted in the notion of scientific progress, and historian David Luesink posits that at this point in Chinese history: the secular educational interests of Chinese elites and Christian missionaries converged. The rise of a social gospel among most missionaries in the early twentieth century meant

82 Beaton, Great Living, 13-14. 83 Sonya J. Grypma, Healing Henan: Canadian Nurses at the North China Mission, 1888-1947, (Vancouver: UBC Press, 2008), 10. 84 Bond, Our Share in China, 107. 85 S.D. Chown, in Ramsay Cook, The Regenerators: Social Criticism in Late Victorian English Canada, (Toronto: University of Toronto Press, 1985), 230; “Charles Winfield Service”, Through Faith, (Toronto: The United Church Publishing House, 1930), 11, http://library.vicu.utoronto.ca/exhibitions/vic_in_china/sections/missionaries_and _mission_stations/attachments/through_faith_easter_1930.pdf; Neil Semple, The Lord’s Dominion, 307. 86 Semple, The Lord’s Dominion, 329.

that Christianity was becoming more about science and civilization and less about religion. This was far more palatable to the Chinese elites and governments seeking to spread modern education.87

The degree of in-country acceptance to new ideas reflected the regional differences in the country. While the coastal cities had been exposed to scientific-based medical practices for decades and were increasingly influenced by the post-imperialist elites, the city of Leshan, located in the most conservative region of Sichuan, was less receptive to sociocultural change.88 Charlie and Robina, as outsiders arriving from Canada, lacked the trust of their neighbours on a general societal level, and this distrust was professionally amplified because as Charlie noted, their chosen occupation of surgery had “practically been unknown to the Chinese.”89 Systems theorist and public health advocate Atul Gawande articulates that the dissemination of new medical ideas is often a nonlinear process and “to create new norms, you have to understand people’s existing norms and barriers to change…Every change requires effort, and the decision to make that effort is a social process.”90 Because Charlie and Robina firmly believed that surgery was “perhaps, above all else the most tangible” medical intervention for their patients and “the most satisfactory to us of all lines of professional work,” they were determined to offer surgical health care at the Leshan hospital.91 In the early days, as Dr. Stewart Allen would later surmise, “all sorts of ways had to be thought out to entice someone to submit…to surgical treatment,” and one of the best marketing approaches, to secure a “reputation for professional skill and service,” was a visual demonstration of a successfully performed large operation.92 A patient requiring abdominal surgery agreed to a public operation, and the local community was invited to observe through the veranda window the surgeon, Charlie, and the nurse, Robina, removing a bladder stone.93 This evidence-based operation lent itself to building trust, as the observers were able to physically examine the bladder stone and once the patient left the hospital in good health, news of the successful surgery quickly circulated and correlated with an increase in their patient load. Communication theorist Everett Rogers argues that “diffusion is essentially a social process through which people talking to people spread an innovation,” and in Sichuan, the tea shop was often an important public space for the local residents to exchange community news.94 The hospital compound in Leshan was built in 1896 under the supervision of Dr. H.M. Hare, the son-in-law of Superintendent and Mrs. Hart.95 It accommodated 30 patients and consisted of three separate buildings: a women’s ward with 15 beds, a men’s ward with 15 beds, and a third

87 David Luesink, “Dissecting Modernity: Anatomy and Power in the Language of Science in China”, Ph.D. diss., The University of British Columbia, 2012, 61. 88 A.P. Quentin, “Kiating”, Our West China Mission, 192. 89 Service, “Self Support”, West China Missionary Conference, 252. 90 Atul Gawande, “Slow Ideas”, The New Yorker. 91 C. W. Service, “Self Support”, 252. 92 Dr. A. Stewart Allen, “Modern Medicine in China: Its Development and Its Difficulties”, Canadian Medical Association Journal, Vol. 56, No. 2, (1947), 211; C. W. Service, “Self Support”, 247. 93 Beaton, Great Living, 14-15. 94 Everett M. Rogers, “Diffusion of preventive innovations”, Addictive Behaviours, Vol. 27, (2002), 990; Gawande, “Slow Ideas”. 95 Bond, Our Share in China, 106; Directory of Protestant Missionaries in China and Japan: For the Year 1902, (Hong Kong: Daily Press Office, 1902), 8.

13 building with operating, waiting, drug, and dispensary rooms.96 Charlie and Robina were busy treating a large patient load in the dispensary, and although the recommended capacity for the men’s ward was 15 patients, Bond recorded that “there have been as many as twenty-two male patients in at once, which meant very undesirable crowding. Women come to the dispensary in considerable numbers, but the number of female in-patients is much less than that of males, one great difficulty being that of leaving their homes and children.”97 Robina’s role in treating female patients was critical, as a female nurse had immediate access to female patients, whereas a male health care worker faced cultural restrictions within China’s gender segregated society.

Figure 4: Mission buildings in Leshan (Source: Our West China Mission, 97) Dr. Mabel Cassidy, of the Women’s Missionary Society (WMS), was assigned to Leshan, and she was also instrumental in encouraging female patients to seek medical treatment at the hospital compound.98 Cassidy’s background was unique because she did not follow the typical pattern of the early years of the CMM where the initial contact with China occurred as an adult. Instead, her experience began in childhood, and she resided for nine years in central China. Her father, William Cassidy, a medical missionary with the China Inland Mission, died in 1888 from smallpox and her mother Lizzie remarried, and she was an educator with the Christian and Missionary Alliance until her death in Wuhu in 1916.99 In a speech at the Young People’s Summer School in Toronto, Cassidy noted “the great joy it will afford her in the near future to be privileged to return to China.”100 Whereas her appointment as a second-generation missionary was atypical in the early years of the CMM, her resignation from the WMS on the basis of marriage, to an employee of the General Board of Missions, was a typical pattern.101 In 1905, shortly after arriving in Sichuan, she married Rev. W.J. Mortimore and resigned her official position with the WMS, and this meant adhering to General Board regulations that “lady physicians are not appointed by Council to definite work. Nevertheless they render invaluable medical services.”102

96 Bond, Our Share in China, 107. 97 Ibid; Kilborn, Heal the Sick, 242-243. 98 Deborah Shulman, “Prisms of China: Canadian Women Missionaries in China, 1904-1945”, Ph.D. diss., Concordia University, 2008, 37, 88. 99 John Sawin File Project: The Life and Times of A.B. Simpson, Archibald Foundation Library, Regina, 27-28, https://www.cmalliance.org/resources/archives/downloads/simpson/life-and-times-of-ab-simpson-sawin.pdf. 100 The Globe, “Work in New China”, July 25, 1902, 6. ProQuest Historical Newspapers: The Globe and Mail. 101 Semple, The Lord’s Dominion, 326. 102 Service, Our West China Mission, 399.

Aside from medical and church work, Leshan was also the initial location of the Canadian Mission Press. While on furlough in Canada, Superintendent Hart fundraised for the press, and his close friend, Julius Hart, provided a substantial donation.103 Hart purchased two presses in Canada, and then established the printing operations in 1897, and within one year it became a self-supporting business.104 In 1905, the business moved to its permanent location in Chengdu and continued to expand under the guidance of Rev. James Endicott until he relocated, to the church’s headquarters in Toronto, to serve as the secretary general of missionary operations.105 By 1920, the Press Department of the CMM employed about 100 workers, and its annual output reached over 30,000,000 pages printed in four different languages.106 Charlie took a keen interest in the Canadian Mission Press, and as a member of the operations committee, he advocated for the printing of public health pamphlets.

Figure 5: The first printing press - Superintendent Virgil Hart in foreground (Source: Our West China Mission, 412)

The Services returned to Canada in 1909 along with their three young daughters who were born in China: Winnifred (Wuhu: 1903), Margaret (Leshan: 1904), and Frances (Leshan: 1906). During this furlough, Charlie furthered his medical training through postgraduate studies at Johns Hopkins University which was a catalytic centre for institutionalizing large-scale social change in clinical health care methods and medical education.107 MEDICAL OPPORTUNITIES AND CHALLENGES Charlie and Robina’s medical careers spanned an innovative period in the evolution of the surgical profession. The two discoveries of anesthesia and aseptic surgery were made in the mid-1800s, and while anesthesia was immediately adopted, it would take a generation for aseptic surgical techniques to be universally accepted.108 American surgeon Dr. J.M.T. Finney, while a resident at Massachusetts General Hospital, noted that in 1888 attempts to follow “antiseptic

103 Bond, Our Share in China, 78. 104 G. McIntosh, “Mission Presses”, The China Mission Yearbook, (Shanghai: Christian Literature for China, 1910), 356; The Globe, “A Missionary Hero Dies”, 8. 105 S.P. Westaway, “The Mission Press”, Our West China Mission, 412-416; Semple, The Lord’s Dominion, 329; Bond, Our Share in China, 88-89. 106 Service, “A Service of Tribute to the Late Omar Leslie Kilborn, M.D., D.D.”, 150. 107 Beaton, Great Living, 17. 108 Atul Gawande, “Two Hundred Years of Surgery”, The New England Journal of Medicine, Vol. 366, No. 18, (2012), 1719.

15 methods were halting and crude, as witness the wooden handled instruments, the use of sea- sponges, the absence of any effectual method of sterilization of skin, hands, instruments, sponges or dressings, and, as a result…the large percentage of postoperative infections.”109 One decade later, when Charlie and Robina were completing their medical training, they were part of the next generation of health care workers that insisted aseptic surgery was normal protocol. A study in the New England Journal of Medicine, which tracked surgical journal articles from 1812 to 2011, found that the most productive period for surgical innovation was the 60 years following the discovery of anesthesia.110 Charlie and Robina’s medical career took place during this era when “surgery became a dominant force in medical advancement,” and Charlie was determined that his patients would benefit from these surgical breakthroughs.111 He wanted to avoid “chronic fossilization,” a term coined by the president of the Ontario Medical Association, Dr. W.F. Marlow.112 In 1920, Marlow used this term to describe the Ontario system because it permitted doctors to practice medicine from graduation to retirement without upgrading their medical knowledge.113 It was standard practice for Charlie, while on furlough, to take postgraduate training and his interest in the fields of obstetrics and thoracic surgery are discussed later in the paper.

Figure 6: Changes in the proportion of articles on surgery published in The Journal since 1812 (Source: “Two Hundred Years of Surgery”, The New England Journal of Medicine, 366:18, 1721) In 1910, Charlie was reappointed to the mission hospital in Leshan, and he held the position of superintendent until the 1911 Rebellion which overthrew the Qing Dynasty and established the Republic of China. While the missionaries were evacuated to Shanghai, the medical work in Leshan and all other stations, except Chongqing, was shut down due to the absence of trained Chinese doctors, and as Charlie noted, “the Revolution revealed the weakness of our work.”114 International development scholar Adrian Leftwich theorizes that “it is important to recognise the limitations of external interventions” when capacity building initiatives are excluded, and he

109 J.M.T. Finney, “Changing Conditions in Surgery Since the Time of Henry Jacob Bigelow”, The New England Journal of Medicine, Vol. 206, No. 6, (1932), 268. 110 Gawande, “Two Hundred Years of Surgery”, 1720. 111 Ibid. 112 F.W. Marlow in The Globe, “Says doctors must be prevented from being fossilized”, May 27, 1920, 9. ProQuest Historical Newspapers: The Globe and Mail. 113 Ibid. 114 Service, Our West China Mission, 387.

16 recommends “rethinking long-term and sustained support for quality secondary and higher education.”115 Building a locally-trained sustainable health care capacity was a development model the medical missionaries had been discussing for many years. And as Charlie outlined in his report on the history of medical work, their vision was based on the premise that the “missionary doctor is not here merely to cure individuals, but rather to cure conditions,” and to initiate social change on a large scale, there needed to be long-term medical education at a university-level institution.116 Currently, the health care assistants were being individually trained, and this proved to be “altogether inadequate and unsatisfactory” for the delivery of effective sustainable health care.117 In 1904, at the Annual Council Meeting, an official resolution was proposed by Dr. Ewan to open a Medical School, as part of the overall education strategy for a union university.118 The introduction of quality medical education to train Chinese doctors and medical educators, who in turn would train additional doctors, would be the exponential foundation for establishing a sustainable health care system in Sichuan. Charlie was one of many voices throughout China advocating for medical education, and one of the most powerful voices was Dr. Yan Fuqing, a Chinese medical doctor, trained in a mission medical college in Shanghai and at Yale University, and one of the founders of the Yale-in-China Mission in Changsha. Although not a medical missionary, he became the first Chinese member of the Medical Missionary Association of China in 1910.119 In an article in the Journal of the American Medical Association, Dr. Yan challenged foreign medical educators to internalize the notion that “cooperation with the Chinese gives the work more permanency” because “in medical as in other lines, foreigners are merely laying foundations on which the Chinese themselves must build.”120 Charlie firmly believed in this educational approach and according to his colleague Dr. Sparling, “several times I have heard him [Charlie] say that if our work was to be successful it must not depend on the foreigner. Unless we can get Chinese educators educated then our work as foreigners will be a failure.”121 The role of the foreign medical doctor Charlie argued was to train “Chinese leaders who will be able to commence the solution of China’s great physical problem” in health care.122

CANADIAN METHODIST HOSPITAL (1907-1911)

Addressing complex social conditions, such as the introduction of sustainable health care, requires two different delivery models: the building of the physical plant of the hospitals and the designing of the medical delivery mechanism. Leadership theorists Ronald Heifetz, John Kania and Mark Kramer, in their article Leading Boldly, postulate that:

115 Adrian Leftwich, “Beyond Institutions: Rethinking the Role of Leaders, Elites and Coalitions in the Institutional Formation of Developmental States and Strategies”, Forum for Development Studies, Vol. 37, No. 1, (2010), 109. 116 Service, Our West China Mission, 395-396. 117 Ibid., 394-395. 118 “Minutes of the 9th Annual Council Meeting of the Canadian Methodist Mission”, West China Mission Collection (1892-1931), 70, 78.096C, Box 1, The United Church of Canada Archives, Toronto, Ontario, Canada. 119 Xi, Gao, “Chinese Perspectives on Medical Missionaries in the 19th Century”, 114. 120 F.C. Yen, “An Example of Cooperation with the Chinese in Medical Education”, Journal of the American Medical Association, Vol. 64, No. 17, (1915), 1385. Due to English transliteration, Yan Fuqing was also referred to as F.C. Yen. 121 Sparling, “A Friend and Fellow Missionary Laid to Rest”. 122 C.W. Service, “One of China’s Great Problems”, Dominion Dental Journal, Vol. 31, No. 2, (1919), 42.

Some social problems are technical in that the problem is well defined, the answer is known in advance, and one or a few organizations have the ability to implement the solution. Examples include funding college scholarships, building a hospital, or installing inventory controls in a food bank. Adaptive problems, by contrast, are complex, the answer is not known, and even if it were, no single entity has the resources or authority to bring about the necessary change. Reforming public education, restoring wetland environments, and improving community health are all adaptive problems. In these cases, reaching an effective solution requires learning by the stakeholders involved in the problem, who must then change their own behavior in order to create a solution.123 Within the context of the CMM, the building of the Canadian Methodist Hospital or the Medical- Dental College are technical problems and sit within an isolated impact model where funding flows through one source, the Methodist Church of Canada, and one or a few individuals can be assigned direct credit for building the infrastructure. Other initiatives such as the introduction of medical education at West China Union University or the Chengdu collaborative health care system introduced in 1929, and discussed later in the paper, are classified as adaptive problems. These mutually reinforcing initiatives follow a collective impact model where numerous stakeholders must work collaboratively, toward finding a shared vision and a collective plan, in order to address a complex health care situation.124 In these early years, the impact of the CMM was being restrained by its limited outreach in clinical medicine and the Methodist Church of Canada, as a single organization, had the required financial resources, expertise and organizational capacity to solve this technical problem.125 In 1907, the CMM initiated the construction of a large new hospital in Chengdu and Ewan, as the medical superintendent for this mission station, worked alongside the Chinese contractors, masons and carpenters to complete this ambitious project which required a daily workforce of about two hundred labourers.126

Figure 7: Caption written by Dr. Ewan: Clauda and I and our mason, a Daoist Priest. He has become quite a friend. (Source: Ewan Family)

123 Kania and Kramer, “Collective Impact”, 39; Heifetz, Kania and Kramer, “Leading Boldly”, 24-25. 124 Kania and Kramer, “Collective Impact”, 36-37. 125 Heifetz, Kania and Kramer, “Leading Boldly”, 24. 126 Service, Our West China Mission, 382-383; MacGillivray, A Century of Protestant Missions in China (1807- 1907), 123.

Ewan was the only Canadian missionary assigned to medical duties in Chengdu, and as reported in The West China Missionary News, “in addition to the regular hospital and dispensary work was added the very heavy task of erecting the present hospital building.”127 This situation changed temporarily in 1910 when the CMM assigned Dr. W.J. Sheridan, to the American Methodist Episcopal Hospital, to keep it open while the American medical missionary was on a one year furlough, and according to Kilborn, this allowed for Ewan’s time to be “given entirely to the work of finishing building operations on the new hospital.”128 In Our Share in China, Bond reflected about the intended impact of the medical structure: In 1907 the foundations for a splendid new modern hospital were laid. Under the superintendence of Dr. Ewan the work of its erection has so far progressed that it will soon be ready for occupancy. It is a substantial and handsome brick building of four stories, built from plans suggested by Dr. Ewan. It is intended when finished to be as thoroughly modern, commodious, sanitary, and scientific in its equipment as possible, and will undoubtedly be the largest and finest hospital as yet erected in all West China.129

Figure 8: Construction of the Canadian Methodist Hospital, Chengdu Funds raised by the young people of Canada (Source: Ewan Family)

Dr. Ewan would hold the position of superintendent until 1911, when he permanently returned to Canada on account of health problems.130 His 14 years of medical service in Chengdu provided a lasting foundation for the CMM, and in The Missionary Bulletin, a magazine published by the youth wing of the Methodist Church of Canada, Charlie acknowledged that Dr. Ewan was “the originator and promoter of this great Chengtu hospital enterprise” and “before his return to Canada he brought it nearly to completion.”131 And in Our West China Mission, Reverend N.E. Bowles directly credited Ewan’s “efforts while on furlough to secure a modern hospital for West

127 “Rev. R.B. Ewan M.D. D.D.”, The West China Missionary News, (February 1927), 33; Kilborn, Our West China Mission: The departments of work and their cost, 25. 128 Kilborn, Heal the Sick, 248; Service, Our West China Mission, 384. 129 Bond, Our Share in China, 63. 130 Service, Our West China Mission, 389; “Rev. R.B. Ewan, M.D., D.D.”, The West China Missionary News, (February 1927), 33. 131 C.W. Service, “Letter from Rev. C.W. Service M.D., China, July 19, 1913”, The Missionary Bulletin, Vol. 10, No. 1, (1913-1914), 126, The United Church of Canada Archives, Toronto, Ontario, Canada; George Emery, Methodist Church on the Prairies, 1896-1914, (Montreal & Kingston: McGill-Queen’s University Press, 2001), 63.

China” and the fact “he superintended personally the plans, building and equipment…To the faith and hard work of Dr. R.B. Ewan is due in large part the securing of such a splendid building.”132

The construction funds for the Canadian Methodist Hospital were raised by the youth wing of the church, which represented an age group from elementary to university students, and also included young people engaged in the workforce. And as Bond reported:

Under the auspices of the Forward Movement, the young people of our Sunday Schools, Epworth Leagues and Young Men’s Clubs were appealed to in support of the new hospital, and right nobly did they respond. From all over the Dominion, and from Newfoundland, subscriptions for the building fund promptly came in, and it was soon apparent that the young people would furnish enough money to erect and equip a hospital worthy of our Church and of our growing Mission work in the great Chinese city.133

The fundraising campaign itemized the cost of the hospital from an outside brick to an inside hospital bed. And for the younger members of the church, for each one cent contributed, a brick was added to the structure, and through quarterly pictures and letters from the field, published in The Missionary Bulletin, the construction process was closely followed by the young people of Canada.

CANADIAN METHODIST HOSPITAL (1912-1918) In the spring of 1912, following their return from Shanghai, Charlie was named superintendent of the Canadian Methodist Hospital.134 According to James Endicott, general secretary of The United Church of Canada, Charlie “was known to be, perhaps, the outstanding surgeon in our mission in West China, and he had not been in China long before he was placed in our most important hospital - a place not only where the sick were healed but where students secured their clinical training. It is a great and important centre, and in all the developments of our hospital work Dr. Service had a most prominent and vital position.”135 The initial task was to supervise the final stage of construction, and Charlie worked with the building supervisor, Rev. Walter Small, who had completed his language training prior to the 1911 evacuation.136 The appointment of Small, a professional builder, signaled the church’s policy towards increased specialization in the recruitment of mission personnel and with plans to expand the physical plant in medical, educational and evangelical endeavours, throughout Sichuan, the Home Board was implementing a more business-like approach. This decision relieved some of the health care employees from the physically and mentally taxing work of infrastructure building so they could engage in their “real work of ministering to the sick.”137

132 N.E. Bowles, “Station Surveys - Chengtu”, Our West China Mission, 174. 133 Bond, Our Share in China, 63. 134 Ibid; Service, Our West China Mission, 388. 135 Endicott, “Memorial Service for Dr. C.W. Service”. 136 Bond, Our Share in China, 260; Beaton, Great Living, 17. 137 Service, Our West China Mission, 384-385.

Figure 9: Canadian Methodist Hospital, Chengdu: final stage of construction (Source: Service Family) The hospital was officially opened on January 30, 1913, and the CMM was very appreciative that “members of the Szechwan Red Cross Society joined us in acting as hosts, as that Society has done us the honour of choosing ours as the Red Cross Society Hospital.”138 The initial medical staff, assigned by the CMM, consisted of three health care workers: the doctor, Charlie, appointed as superintendent of all hospital operations, the nurse, Barbara McNaughton, designated as lady superintendent in charge of nursing and the training school for nurses, and the pharmacist, Edwin Meuser, assigned to the pharmaceutical department.139 The CMM was able to successfully expand through the collaborative efforts of its mission workers, and as Charlie noted, “Miss McNaughton, Mr. Meuser and Mr. Small have given valuable assistance.”140 The envisioned staffing plan, to manage the increasing workload, included “two doctors, besides a missionary pharmacist and a missionary nurse,” and funds were allocated for a second 141 doctor. This action by the mission board in Canada was welcome d because as Beaton noted: “It seems almost incredible at this stage that the Church at home or the Mission on the field should have expected one doctor, with only one nurse, Miss B.G. McNaughton and with no trained Chinese help, to handle such a medical proposition.”142 In 1914, the staff welcomed Dr. C.B. Kelly, who had recently completed his language studies in Chungchow, and Kelly would provide clinical medical services until he retired in 1926. His speciality was in the field of pathology, and Kelly would lecture at the Medical College of West China Union University, and from 1925-1926, he held the position of dean.143 He was joined by his wife, Marion, who was a trained nurse having graduated from Toronto General Hospital in 1910.

138 Service, “Letter from Rev. C.W. Service M.D., China, July 19, 1913”, 126. 139 Beaton, Great Living, 17; Service, Our West China Mission, 389; Dr. O.L. Kilborn, “Letter from Rev. O.L. Kilborn, M.A., M.D., Chengtu, Szechwan, China, April 13, 1913”, The Missionary Bulletin, Vol. 9, No, 3, (1912- 1913), 494, The United Church of Canada Archives, Toronto, Ontario, Canada. 140 Service, “Letter from Rev. C.W. Service M.D., China, July 19, 1913”, 123. 141 Kilborn, Heal the Sick, 247. 142 Beaton, Great Living, 17. 143 Service, Our West China Mission, 389, 400; C.R. Carscallen, “West China Union University”, Our West China Mission, 368; L.G. Hartwell, “International Hospital Day”, West China Missionary News, Vol. 26, No. 7-8, 22; “University Faculty”, Annual Announcement 1925-1926, West China Union University, 14, http://divinity- adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-278-4398.pdf.

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Figure 10: Staff of the Canadian Methodist Hospital in Chengdu: 1. Miss Barbara McNaughton (nurse); 2. Dr. Charles Service (doctor); 3. Rev. Walter Small (builder); 4. Mr. Edwin Meuser (pharmacist) (Source: Service Family) This well-equipped modern hospital of 150 beds could accommodate a growing patient load, and Charlie would continue to oversee the medical work, until his furlough in 1918. One of his colleagues, Rev. N.E. Bowles, provided some insight into Charlie’s daily hospital routine when he wrote that “Dr. Service performed six operations that morning. During these operations no less than four letters had come in, all marked urgent. He had four dysentery cases to attend… this, besides the regular in-patients, the dispensary, and the one hundred and one things that only a doctor can look after around a hospital.”144 The hospital wards were consistently full, and in terms of the dispensary, Drs. Kelly and Service and Miss McNaughton would treat 175-200 patients three days a week.145 This hospital would eventually be replaced and today Chengdu Hospital Number 2 sits on this former mission site. The Canadian Methodist Hospital also served as a refuge during conflict. In 1911, during the revolution to overthrow the Qing dynasty, missionary families from Canada, the United States and Great Britain were evacuated to Chengdu and stayed on the hospital grounds, until they were transported to Shanghai on British gunboats. In 1917, the hospital compound housed Chengdu citizens escaping the conflict between the Sichuan army, and the invading warlord forces from Yunnan and later Guizhou. Under The Globe headline, Methodist Medical Missionary, in Letter to Toronto, Throws Light on the Stormy Scene, the reporter quoted from a letter Charlie had written to Robina, on May 18, 1917: “We have had a real genuine flare-up in Chengtu, the worst there has been for many scores of years…On the city wall right behind us, in full sight, several hundreds were shot or bayoneted as spies. That was the most unpleasant feature of the whole thing.”146 The wounded soldiers and civilians, caught in the street fighting, were brought to the Canadian Methodist Hospital for medical treatment, and “men, women and children flocked to

144 N.E. Bowles, “Station Surveys - Chengtu”, Our West China Mission, 174-175. 145 Beaton, Great Living, 17. 146 The Globe, “Foreign Devils Power in China: Internal Troubles Bring About Great Change of Feeling. Faction Fights Serious. Methodist Medical Missionary, in Letter to Toronto, Throws Light on the Stormy Scene”, July 4, 1917, 9. ProQuest Historical Newspapers: The Globe and Mail.

22 the Hospital and the Women’s Missionary Society compound for protection.”147 Parts of Chengdu were destroyed in the battle, which lasted from April to August 1917, and with their regular supply lines cut off, “armed parties had to be sent outside of the city to get supplies of coal and rice for the hospital.”148 Clashes between rival warlords would flare-up in Sichuan throughout the warlord era from 1916-1928, and in this particular instance, Charlie reflected that “there has been trouble brewing for a long time. We know that there was an undercurrent of jealousy in Government circles and there would have been an outbreak sooner or later.”149 WEST CHINA UNION UNIVERSITY – THE EARLY YEARS During this period, Charlie was actively involved in medical education, and he was one of the “builders who laid the foundation of West China Union University.”150 Founded in 1910, West China Union University (WCUU) was a synergistic endeavour of different denominations and mission communities from Canada, the United States and Great Britain. Four missions founded WCUU, and these were the General Board of Missions of the Methodist Church of Canada, the Board of Foreign Missions of the Methodist Episcopal Church USA, the American Baptist Foreign Mission Society, and the Friends’ Foreign Mission Association of Great Britain and Ireland. The Church Missionary Society of England joined WCUU in 1918.151 The introduction of university-level education fits within the criteria of an adaptive problem and as Heifetz, Kania and Kramer noted, these are complex situations where “no single entity has the resources or authority to bring about the necessary change.”152 In the case of WCUU, the missions individually mobilized financial and human resources and collectively established a joint governance structure, consisting of both a Senate based in Chengdu and an international Board of Governors, to approve all operational decisions and academic policies. The founding president of WCUU was Dr. J. Beech, of the Board of Foreign Missions of the Methodist Episcopal Church USA, and the founding vice-president was Rev. E.J. Carson, followed by Rev. J.L. Stewart.153 Both men represented the General Board of Missions of the Methodist Church of Canada.154 Stewart had been appointed in 1904, to a full-time position in education, and he co- ordinated with the other missions to develop a middle school system based on the rationale that “as a basis, therefore, for medical work general education must precede.”155 In 1908, the missions began to purchase land, and 120 acres were allotted for the construction of classrooms and student housing. The vision of WCUU, as described by one of the founding educational missionaries Rev. Charles Carscallen, was “to provide courses in Arts, Science, Medicine, Law, Engineering and Agriculture, to become a University in the fullest sense, to

147 Ibid. 148 Ibid. 149 Ibid. 150 H.E. Warren, “Dr. Charles W. Service: A Brief Sketch of his Academic Days”, 2. 151 “The American Context of China’s Christian Colleges”, Yale Divinity Library, http://divinity-adhoc.library. yale.edu/ChinaCollegesProject/descriptions.htm#westchina. 152 Kania and Kramer, “Collective Impact”, 39; Heifetz, Kania and Kramer, “Leading Boldly”, 24-25. 153 Rev. Carson died in June 1910 from typhus. 154 C.R. Carscallen, “West China Union University”, Our West China Mission, 368. 155 J.L. Stewart, “Letter from Rev. J.L. Stewart, B.A., Chengtu, China, Mt. Omei, September 7th, 1904”, The Missionary Bulletin, Vol. 3, No. 3, (1904-1905), 488, The United Church of Canada Archives, Toronto, Ontario, Canada.

23 make it unnecessary for any student of the Western provinces to go abroad for any course needed to fit him for any phase of life in China.”156 And the union concept according to Bond was “exceedingly simple”:157 It was proposed that the four uniting Missions take their educational work to one central site in Chengtu, where each Mission should erect its own building, own its own grounds, appoint and entirely manage its own staff, and manage its own college as thought best. By the simplest principles of co-operation, however, the four colleges would unite classes in the same subjects, and thus conserve the very highest efficiency with the greatest economy of men and money.158 It was determined by the missionary collective that all subjects would be “taught exclusively in Chinese” because, as Vice-President Carson acknowledged, “it tends less to denationalize the student than the method of giving him his education through the medium of a foreign language.”159 Carson further articulated that it was the definite hope of the founders that the university would ultimately become in “every sense a Chinese institution at such time as it shall be possible to leave it in the hands of Chinese.”160

Figure 11: Fred Rowntree & Sons Architects A Bird’s-Eye View of West China Union University (Source: http://www.guise.me.uk/gallery/rowntree/chengtu/pictures/pages/birdseyeview.htm)

The introduction of medicine was always part of the initial planning, as it was “evident to the small number of medical missionaries that came to West China that the only possible way of caring adequately for the diseased was by the establishing of a Chinese medical profession on a scientific medicine basis,” and the various missions worked together to develop the university curriculum.161 At the interdenominational West China Missionary Conference in 1908, a resolution was passed stating the “importance of founding a Medical School in connection with

156 Carscallen, “West China Union University”, 362-363. 157 Bond, Our Share in China, 77. 158 Ibid. 159 E.J. Carson, “Mission Schools, Colleges, and Universities for Men and Boys: West China”, The China Mission Yearbook, (Shanghai: Christian Literature Society for China, 1910), 93. 160 Ibid., 95. 161 West China Union University, “Medical Education in the West China Union University”, WCUU Radio Broadcast April 13, 1943, 5, http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/ RG011-280-4412.pdf.

24 the proposed Union University,” and it was agreed “that Drs. Wolfendale and Cox be a Committee to prepare a Course of Study for Medical Colleges, and report to the Acting Board of Education of the Union University.”162 Cox was a member of the CMM and Wolfendale was with the London Missionary Society, until he joined the CMM in 1910, after the Canadians were granted operational control of their Chongqing operations which were established in 1887 and after initiating their medical work in 1890, the London Mission Hospital was opened in 1893.163

In these early days, no individual was given the direct credit for introducing the idea of medical education and conceptualizing its implementation. A report, outlining the history of the Medical-Dental College, emphasized this fundamental principle of collective action when it noted that the “college has not been developed in any degree conditioned on the personality, counsel or deeds of any one man. There is no great outstanding figure in our history – every man on the staff has done his utmost for the school and if any merit there be in this college it is to be given to the group alone.”164 This concept of collective responsibility was reinforced by Charlie, in his departmental summary of medical work, published in Our West China Mission: “For many years the idea of a medical college for West China had been in the minds of our doctors, but it was only in 1914 that these ideas fructified. Our mission is now one of several which are united in this young enterprise of training.”165

The collective impact theory published in the Stanford Social Innovation Review, by John Kania, Fay Hanleybrown and Jennifer Splansky Juster, frames the factors driving successful collaborative strategies in social change settings. In the article Essential Mindset Shifts for Collective Impact, the authors postulate that in large-scale endeavours assigning direct credit to one individual or organization is both difficult and counterproductive, and a shared credit leadership approach is the cornerstone for successful collaboration.166 And Petra Kuenkel, co- founder of the Collective Leadership Institute in Germany, theorizes that collaborative change initiatives must be “guided by a leadership paradigm that is inspirational, fosters commitment by various actors and acknowledges the role of collective contributions to decision-making. Leading, here…often begins with a small group of people and aims at profound collective change.”167 The primary sources, written about the early years of West China Union University, reflect an environment where a dynamic and inclusive leadership group was collectively directing the shared tasks within the individual missions and between the multiple missions. The participating churches shared a missiological vision, and collectively they built the necessary foundation of cohesion and trust to nurture this young social enterprise into an established institution of medical training. Inter-mission co-operation was an extension of the decision taken at the Edinburgh World Mission Conference of 1910, which encouraged

162 Grainger, West China Missionary Conference, 364. 163 “Chungking Chronology”, The West China Missionary News, (May 1939), 201. 164 W.R. Morse and A.W. Lindsay, “Introduction”, Dean’s Report: College of Medicine and Dentistry, West China Union University, (Chengtu, Szechwan, West China, 1934), 7-8, http://divinity-adhoc.library.yale.edu/UnitedBoard/ West_China_Union_University/Box%20279/RG011-279-4410.pdf. 165 Service, Our West China Mission, 395. 166 John Kania, Fay Hanleybrown, Jennifer Splansky Juster, “Essential Mindset Shifts for Collective Impact”, Stanford Social Innovation Review, Vol. 12, No. 4, (Fall 2014). 167 Petra Kuenkel, “Leadership for sustainability: the art of engaging”.

Protestant churches with a commonality in liberal theology, to engage in collective social action. Specifically, The Declaration of Principles adopted by the participants affirmed that: We believe that the age of sheer individualism has passed and the age of social responsibility has arrived. All institutions of the higher education should directly prepare young men and women for membership in the social order - in the family, the church, the state, and the community. To this end all teachers should be persons deeply imbued with a sense of social and civic duty…[and] we must now exalt the newer ideals of social justice, social service, social responsibility.168 Churches in Canada, the United States and Great Britain were involved in the collective formation of large social institutions to improve the living conditions of their citizens. The catalyst for collective action was the need to address social concerns rather than reaching a doctrinal consensus to promote religion.169 Universities, as agents of societal reform in Canada, were targeted in the early 1900s, and the Methodist Church of Canada strongly promoted expanding university enrollment to ensure the admission of students from all social classes. Historian Neil Semple posits that their modern liberal curriculums “appeared less concerned with establishing an intimate relationship with Christ and more with developing a proper place in society for the student.”170 This social gospel philosophy, which viewed social interaction from a humanistic rather than eschatological premise, was incorporated into the design of WCUU. The missions developed a curriculum around core subject content to prepare their students for social and civic duty but in the early years of the university, a union in formal religious training was not contemplated.171 Throughout the history of WCUU, the student body was comprised of both Christian and non- Christian students. Unions specifically formed for religious conversion adhered to conservative theology, and during this period, the China Inland Mission and the Church Missionary Society formed a union for religious training.172 The British-based Church Missionary Society, although actively engaged in medical and educational activities, promoted a more orthodox religious theology than the original missions.173 Eight years after the founding of the union university, the Church Missionary Society of England became the fifth member of WCUU.174 The Medical College officially opened in 1914, and there were eight students registered in the program, and five professors were assigned from the various missions including Charlie and Omar Kilborn from the Methodist Church of Canada.175 It was the opinion of Dr. Beaton that

168 “Declaration of Principles Adopted at the Eleventh Convention of the Religious Education Association”, Religious Education, Vol. 9, Issue 2, (1914), 98. 169 Cui Dan, “The Cultural Contribution of British Protestant Missionaries to China’s National Development During the 1920s”, Ph.D. diss., London School of Economics and Political Science, 1996, 24, http://etheses.lse.ac.uk/2413/ 1/U615362.pdf. 170 Semple, The Lord’s Dominion, 392. 171 O.L. Kilborn, “Szechwan”, in The China Mission Yearbook, 1917, ed. E.C. Lobenstine, (Shanghai: The Christian Literature Society for China, 1917), 256, https://archive.org/stream/chinamissionyear08chin/chinamissionyear08 chin_djvu.txt. 172 Ibid. 173 Cui Dan, “The Cultural Contribution of British Protestant Missionaries”, 31. 174 “Board of Governor Minutes”, West China Union University, (25-26 September 1918, #300), http://divinity- adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4326.pdf. 175 Service, Our West China Mission, 397.

“in the year 1910, the West China Union University came into being through the vision of several pioneer missionaries, of whom Dr. O.L. Kilborn and Dr. C.W. Service were prominent members. From the very opening both of them anticipated that Medicine would be taught.”176 Another pioneer medical educator was Dr. H.L. Canright of the American Episcopal Methodist Mission. Dr. Canright had, as he reported, taken “an active interest in all the plans for the advancement of our Union University,” and he was appointed to the position of dean of the Medical College, and he would hold this position until 1919.177 The Americans had already established a university, including a medical college in Nanjing with Chinese as the language of instruction, and their mission brought important expertise to WCUU. As of 1913, there were eight medical schools operating in China, and through such forums as the Medical Missionary Association of China, which was formed in 1886, standards for medical education were discussed and best practices shared to improve the overall quality of education.178

Figure 12: The first medical college, staff and students. Back row left to right: Dr. Service (Methodist Church of Canada), Dr. Irwin (Methodist Episcopal Church USA), Dr. Canright - Dean (Methodist Episcopal Church USA), Dr. Morse (American Baptist Foreign Mission Society), Dr. Kilborn (Methodist Church of Canada) (Source: Our West China Mission, 397) The professors developed a curriculum for a six-year program, and this included clinical training at the Canadian Methodist Hospital where Charlie served as the superintendent. The early years were difficult and during the 1911 Revolution and again in 1914, due to the First World War, education was “very much disturbed, and once or twice the University was unable to admit a new class on account of local wars, etc. But in spite of all difficulties the first [medical] class was graduated in 1920, and consisted of four men.”179 The year 1920 also marked the death of a member of the teaching staff when Kilborn died while on furlough in Toronto.180 “Like other medical men in China,” The Globe reported, “Dr. Kilborn was seized with the great importance of medical education, and took a leading part in the development of the university.”181 Charlie, representing the missionaries at his funeral, noted that “WCUU owes much to him, both in its

176 Beaton, Great Living, 19. 177 H.L. Canright, “Report of Chengtu Medical Work”, 48. 178 Luesink, “Dissecting Modernity: Anatomy and Power in the Language of Science in China”, 142. 179 “Medical Education in the West China Union University”, WCUU Radio Broadcast, 5. 180 The Globe, “Year at Home Ends in Death of Missionary: Rev. O.L. Kilborn Dies During Furlough From China”, 8. 181 The Globe, “Sees in Death of Dr. Kilborn a Heavy Blow”, 9.

27 genesis and its development. From the beginning he was a member of its Senate and of its teaching staff, having taught physiology to the medical and dental students.”182

The missions expected their employees to assume leadership positions at WCUU, and these assignments would rotate to reflect regular furloughs and reassignment to other mission stations throughout Sichuan. Over the years, Charlie would sit as a member of the Senate and serve on committees dealing with operational and academic issues. His responsibilities extended beyond Sichuan and he also represented WCUU on nation-wide educational bodies including the Council of Higher Education based in Shanghai, an organization composed of the representatives of Christian colleges and universities throughout China.183 Charlie’s responsibilities as a professor included teaching courses in surgery, obstetrics, gynecology, pediatrics and public health, and in his position as superintendent of the Canadian Methodist Hospital, he would oversee the clinical training.184 One year he allocated 40 hours per week to the Medical College, and one of his students provided this perspective of his professor’s approach to teaching and medical care:185 As a teacher he was always exceedingly earnest. He was always on time. I have known him to be detained in the operating room till ten minutes to one. I knew he had not eaten his dinner, but he met us in the classroom at one o’clock just the same. His lectures were always thoroughly prepared. He did not enter the classroom and just say what he happened to think about at the moment. His attitude towards the sick was an inspiration. I have known him [to] stay four hours continuously by the bedside of some poor sick Chinese in an effort to save his life. He was a foreigner but he showed such a wonderful spirit of sacrifice and love that he was an example to us, his students. We must keep that spirit alive in our College.186 One area of particular interest for Charlie was the teaching of obstetrics. Charlie and Robina lost their first child during a difficult labour in Canada, and Charlie recognized that a cesarean delivery could have potentially saved his daughter’s life.187 However, it was the turn of the century, and this procedure was rarely performed due to the high maternal mortality rate. A few years after this personal tragedy, cesarean deliveries became more common because of medical advances in both surgical and aseptic techniques.188 This personal loss motivated Charlie to take postgraduate training in obstetrics, and he regularly performed cesarean deliveries in Sichuan. One night an influential family summoned Charlie to their Chengdu home. At this particular time, there were two rival armies vying for control of the provincial capital which was a regular

182 Service, “A Service of Tribute to the Late Omar Leslie Kilborn, M.D., D.D.”, 150. 183 “Senate Minutes”, West China Union University, (3 June 1926, #1965), http://divinity-adhoc.library. yale.edu/UnitedBoard/West_China_Union_University/Box%20275/RG011-275-4363.pdf. 184 “Catalogue 1915-1916”, West China Union University, 7, http://divinity-adhoc.library.yale.edu/UnitedBoard/ West_China_Union_University/RG011-278-4397.pdf; “University Faculty”, Annual Announcement 1925-1926, West China Union University, 16, http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_ University/RG011-278-4398.pdf. 185 Beaton, Great Living, 21. 186 Ibid., 29. 187 Ibid., 9. 188 Wendy Mitchinson, Giving Birth in Canada 1900-1950, (Toronto: University of Toronto Press, 2002), 232, 239- 240.

28 occurrence during the warlord period. As they proceeded through the dimly lit barricades, Charlie was in the lead carrying a lantern, and when questioned at the checkpoints his reply was simple: “missionary doctor on errand of mercy.”189 Once at the home, it was determined that the woman needed a cesarean section, and they then proceeded back through the dangerous checkpoints to the hospital. The delivery was a success, and the return trip a few days later was incident free, as one of the rival armies had retreated and the streets were once again calm. Charlie was the department head in the early years, and he contributed to the development of university-level courses and clinical training in this specialized field.190 One of the doctors trained by the professors was Dr. Yoh Ih-chen. She would graduate in 1932, as the first female medical doctor from WCUU, and she would later take postgraduate training in the United States and England, before being appointed head of obstetrics and gynecology in 1950.191 For Dr. Gladys Cunningham, a long-serving WCUU professor, this appointment signified that “my work is really done” because Dr. Yoh “will then assume Leadership of the Department.”192 Dr. Hsiung Bi-shwang, who graduated from WCUU in 1935 and completed her postgraduate training overseas, was also a member of the faculty, and the staff list for the fall of 1950 stipulated the following positions: Dr. Yoh Ih-chen: professor and head; Dr. Hsiung Bi-shwang: professor; and Dr. G.S. Cunningham: professor.193 Another two Chinese faculty members, according to Cunningham, would be returning to WCUU the following year, and these developments reassured her that “this department is in good shape…I can leave in peace.”194 THE FIRST DENTAL GRADUATE

Dr. Huang Tianqi was the first dental graduate in China.195 Charlie met Huang Tianqi when he was a boy playing outside the hospital in Leshan, and Charlie and Robina were so impressed by his intellect and character that they arranged for him to attend school and to learn English.196 When Huang Tianqi was older, he became interested in health care and under their guidance he trained as a medical assistant.197

189 Beaton, Great Living, 5. 190 E.C. Wilford, “West China Union University: Faculty of Medicine”, China Medical Journal, Vol. 38, No. 9, (1924), 757; West China Union University Annual Announcement 1926-1927, (Chengtu: The University, June 1926), 89, http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-278-4398; “Board of Governors Minutes”, West China Union University, (4 July 1930 # G899), http://divinity-adhoc. library.yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4330.pdf. 191 “WCUU Period 1910-1949”, West China Medical Center Sichuan University, http://202.115.44.126:8080/ wccmsbrief2.htm; “Staff List Spring 1949”, “Staff List Fall 1950”, West China Union University, http://divinity- adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-279-4407.pdf. 192 Gladys Cunningham in Nicole Elizabeth Barnes, Intimate Communities: Wartime Healthcare and the Birth of Modern China, 1937-1945, (Oakland: University of California Press, 2018), 137-138. 193 “Staff List Fall 1950”, West China Union University. 194 Gladys Cunningham in Nicole Elizabeth Barnes, Intimate Communities: Wartime Healthcare and the Birth of Modern China, 1937-1945, 137-138. 195 “Chronicle”, West China School of Stomatology Sichuan University, http://www.hxkq.org/en/js2_en.shtml. 196 Beaton, Great Living, 20-21. 197 The spelling of Dr. Huang Tianqi’s name varies due to changes in English transliteration, and he is also referred to as Dr. T.C. Whang, Dr. Hwang, and Dr. Whang T’ien-chi in official documents.

Figure 13: Dr. Service and a nursing assistant attending to a foot-binding injury; observing is Huang Tianqi (Source: The United Church of Canada Archives, Toronto. 76.001P/5951. Dr. Charles Winfield Service and assistant dressing a patient’s foot, n.d. Francie Service)

His schooling continued in Chengdu where he attended high school, and after the Services went on furlough, he stayed with the Thompson family. Dr. John Thompson was a pioneer dentist, specializing in odontal surgery and crown and bridge prosthetics, and as reported in The Globe, dental outreach was a unique Canadian initiative:

Very little has been written or said about a new type of missionary - the dental missionary. Dr. John E. Thompson, a graduate of the Royal College of Surgeons in this city, who has just returned home from furlough, enjoys the distinction of being the second dental surgeon in the world, as far as is known, to engage in this work. There are only three dental missionaries in all. The first to engage continuously in the work was Dr. A.W. Lindsay of the Canadian Methodist Missionaries in China, with whom Dr. Thompson is associated. The third dental missionary is engaged in the Y.M.C.A. work in South America.198

Dentistry was a six-year program, and in the early years, prospective dental students attended three years of preparatory studies in the medical program followed by three years of dental training. In December 1917, the Senate of WCUU tasked a small committee, composed of President Beech, dental missionary Dr. A.W. Lindsay and Charlie, to recommend a policy to integrate dentistry into the university curriculum.199 The program opened in 1918 and Dr. Huang, after spending three years in the medical program, officially registered as a dental student and in 1921, he was awarded the first dental degree in China.200 Dr. Thompson described this moment with the following words: “When Dr. Whang, the boy I supported graduated it was the proudest day of my life. At that time, I happened to be dean.”201

198 The Globe, “Dental Missionary Home on Furlough”, June 5, 1916, 9. ProQuest Historical Newspapers: The Globe and Mail. 199 “Senate Minutes”, West China Union University, (20 December 1917, # 727), http://divinity-adhoc.library. yale.edu/UnitedBoard/West_China_Union_University/RG011-275-4361.pdf. 200 “Senate Minutes”, West China Union University, (3 June 1920, #1070, #1071; 10 March 1921, #1215; 2 March 1922, #1380), http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-275- 4362.pdf. 201 J.E. Thompson, “Dentistry in West China”, Dominion Dental Journal, Vol. 37, (1925), 228, University of Toronto - Harry R. Abbott Dentistry Library.

Dr. Huang joined the dental faculty of WCUU and at the Senate Committee Meeting in April 1926, he was granted a leave of absence to take postgraduate training at the University of Toronto, so he would be “qualified to render greater service in the future.”202 Thompson arranged the funding during his furlough in 1925, and the Royal College of Dental Surgeons (RCDS) provided Huang’s scholarship, the Methodist Church of Canada covered his transportation, and the Canadian dental community raised the funds for his accommodation costs.203 In 1927, Dr. Huang received the degree of Doctor of Dental Surgery (DDS) and “his ability and application to work won for him whole-hearted commendation of the faculty of the RCDS and his personal qualities were appreciated by all who came in contact with him.”204

Figure 14: Dr. Huang Tianqi University of Toronto graduation picture (Source: Service Family)

Dr. Huang exemplified the philosophy of WCUU, where graduates were encouraged to provide leadership in the public sector rather than operating private dental practices. Upon returning to Chengdu, Huang continued to teach dentistry at WCUU, provided clinical services as superintendent of the Chengdu Dental Hospital, and promoted dental policy throughout China.205 As Thompson noted, he “is doing very fine work in our College…and also working in the hospital.”206 Huang was the connecting link, to effectively disseminate dentistry, because “the advice and practical aid of the Chinese workers is indispensable in adapting such institutions to Chinese requirements” and as Dr. Yan further espoused in his article on medical education, “only a Chinese can fully understand the Chinese point of view.”207 This idea of cross-cultural cooperation was noted in an article in the Dominion Dental Journal when Thompson, reflecting on the importance of the first dental graduate, acknowledged that “I knew he would be a better

202 “Senate Minutes”, West China Union University, (1 April 1926, #1921), http://divinity-adhoc.library.yale.edu/ UnitedBoard/West_China_Union_University/RG011-275-4363.pdf. 203 John Thompson was a graduate of the University of Toronto and he wanted Huang Tianqi to study at his alma mater. His connection to the university was an important part of his life story, and he was especially proud of the fact, he was secretary of the university YMCA when the idea to form Hart House was initially envisioned. 204 “Whang Scholarship Fund”, Dominion Dental Journal, Vol. 41, (1929), 23, University of Toronto - Harry R. Abbott Dentistry Library. 205 “Senate Minutes”, West China Union University, (21 June 1928, # 2236), http://divinity-adhoc.library.yale.edu/ UnitedBoard/West_China_Union_University/RG011-275-4364.pdf. 206 Thompson, “Dentistry in West China”, 228. 207 Yen, “An Example of Cooperation with the Chinese in Medical Education”, 1385.

31 man than I had been…because he is Chinese…[and] he knows how to teach the difficult subjects in the Chinese language.”208

Over the years, Drs. Huang and Thompson would become trusted colleagues, and they worked together to expand the field of odontal surgery.209 After Thompson’s death in 1932, there were three professors assigned to the Departments of Oral Surgical Technology and Oral Laboratory Technology: Dr. Ashley Lindsay (oral surgery), Dr. Harrison Mullet (prosthodontal surgery) and Dr. Huang Tianqi (odontal surgery).210 In the 1933 report of the College of Dentistry, it was announced that Dr. Huang is “carrying the teaching in Odontal Surgery Technology. The students receive a thorough grounding in the techniques of Odontal Surgery” and he has “made an enviable reputation for his specialty and his students are inspired by his enthusiasm for the best type of dentistry for China.”211 The teaching of odontal surgery, by a well-trained Chinese professor, marked the successful diffusion of oral health knowledge and under the leadership of Dr. Huang, the foundation for sustainable dental care was established throughout China.

Figure 15: Drs. Huang and Thompson with patient China Museum of Stomatology, Sichuan University, Chengdu (Source: Service Family)

THE MISSIONARY NURSE After the Service family was posted to Chengdu in 1912, Robina continued to fulfill her nursing obligations to the West China Mission while balancing her expanding familial responsibilities with the birth of her son, William, in 1914. Tracking Robina’s professional contributions requires extensive research, as the General Board of Missions followed a policy where married women were not officially appointed to a position. This patriarchal gender bias is reflected in the official church reports and only very general descriptions, about the contributions of married

208 Thompson, “Dentistry in West China”, 228. 209 “Report of Chengtu Dental Hospital 1931”, Report of the Chengtu Hospitals Board: For the Year 1931, 66, http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/Box%20279/RG011-279- 4410.pdf. 210 “Departments of Oral Surgical Technology and Oral Laboratory Technology”, Dean’s Report: College of Medicine and Dentistry West China Union University, Chengtu, Szechwan West China, (1934), 78, http://divinity- adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/Box%20279/RG011-279-4410.pdf. 211 “Departments of Oral Surgical Technology and Oral Laboratory Technology”, Dean’s Report: College of Medicine and Dentistry, 78; “Biographical Sketches”, Dean’s Report: College of Medicine and Dentistry, 104.

32 nurses to the overall delivery of health care, are recorded in archival material.212 Often there are a few sentences thanking them for their valuable assistance to the mission field, or their name appears, as part of a staff list, in the official publications of the mission hospitals and WCUU.213 In the case of Robina’s involvement, various documents indicated that Robina provided clinical nursing services in Chengdu, and she also taught at the training school for nurses which was located at the Canadian Methodist Hospital. In later years, Robina joined the staff of WCUU as an English instructor in the Faculty of Arts.214 The CMM adhered to Victorian family values, and married women were socialized to take care of the private sphere, reflected in the home, whereas the public sphere of medicine was officially reserved for unmarried women and male missionaries.215 Although Beaton confirms that Robina was providing “efficient nursing” services, and her Identity Card indicates her profession as nurse since 1902, official reports state that the first nurses, appointed by the General Board of Missions, started to arrive towards the end of 1908.216 These nurses were single women officially appointed to a designated full-time paid position, whereas the professional services provided by married nurses like Robina were rendered in a voluntary capacity.217

Figure 16: Robina Service Identity Card (Source: Vic in China Exhibition. Vic. College Missionaries to West China 1891-1949) Aside from nursing-based activities, Robina also contributed to the overall administration of the CMM. And while based in Toronto, for a period of time in the 1920’s to support her children’s education, she routinely passed on correspondence from Charlie or followed-up on matters concerning a variety of activities including administrative matters with the church office,

212 Cory Willmott, “The Paradox of Gender among West China Missionary Collectors, 1920-1950”, Social Sciences and Missions, Vol. 25, (2012), 132-133. 213 Additional research about Robina’s professional life is currently being researched. 214 “The School of Nursing”, Canadian Methodist Mission: West China Reports of Work for the Year 1924, 54, 78.096C, Box 16, The United Church of Canada Archives, Toronto, Ontario, Canada; “Annual Announcement 1925-1926”, West China Union University, 35, http://divinityadhoc.library.Yale.edu/UnitedBoard/West_China_ Union_University/RG011-278-4398.pdf. 215 Helen Woodrow, “Julia Salter Earle: Seeking Social Justice”, in Creating This Place: Women, Family, and Class in St. John’s, 1900-1950, eds. Linda Cullum and Marilyn Porter, (Montreal & Kingston: McGill-Queen’s University Press, 2014), 75. 216 Beaton, Great Living, 12-13; United Church of Canada Archives, “Administrative History of West China Medical Missions”, in General Council Archives Guide to Holdings Related to West China Medical Missions (1800- 1950), Toronto, 7, http://www.united-church.ca/sites/default/files/handbook_research-guide-west-china.pdf. 217 Willmott, “The Paradox of Gender”, 132-133; Grypma, Healing Henan, 10.

33 fundraising activities with the church and health care communities, recruiting initiatives to expand mission personnel, and promotional outreach by forwarding correspondence for publication in newspapers and church documents. Although Robina never held an official position within the church, her overseas work in Sichuan was well-known, and upon her passing in March 1957, The Globe recognized her life story under the headline: Mrs. C.W. Service Spent 25 Years with Mission in West China.218 FURLOUGH: JOHNS HOPKINS UNIVERSITY During their furlough in 1918, Charlie travelled to Johns Hopkins University in Baltimore, Maryland to take postgraduate training. In addition to his clinical exposure in the field of obstetrics and gynecology, Charlie had the opportunity to serve as assistant superintendent of Johns Hopkins Hospital for four months. The reputation of this institution for medical excellence was well known, and when being introduced as a speaker at the Empire Club of Canada in 1919, President R.A. Stapells shared these thoughts: As to the medium, Dr. Service is quiet and modest, but a very able man, who is so anxious to keep abreast of the times in his profession that early in the year he came to Johns Hopkins University to take a post-graduate course in their surgical department, and I am perfectly convinced that if he wanted to stay there they would have made his stay a permanent one.219 Charlie was offered a permanent position on the hospital staff, and even though he chose to return to China, his relationship with Johns Hopkins Hospital remained, and he returned in 1927 to update his medical knowledge.220 While in Baltimore, Charlie also attended courses in the field of public health and preventive medicine. The Senate of WCUU recommended, in December 1917, that Charlie “pay special attention to hygiene and public health while on furlough to enable him to teach these subjects upon his return,” and he was awarded a postgraduate fellowship sponsored by the China Medical Board of the Rockefeller Foundation.221 In recent years, the Rockefeller Foundation was becoming active in China and in 1915, it purchased the Peking Union Medical College, from the London Missionary Society, and introduced a curriculum based on the Johns Hopkins University model and instituted English as the language of instruction.222 A year later in 1916, the

218 The Globe, “Mrs. C.W. Service Spent 25 Years with Mission in West China”, March 15, 1957, 4. ProQuest Historical Newspapers: The Globe and Mail. 219 R. A. Stapells in C. W. Service, “Some of China’s Problems”, Address to the Empire Club of Canada, 30 October 1919, 369-384, http://speeches.empireclub.org/search. 220 Beaton, Great Living, 17. 221 “Senate Minutes”, West China Union University, (6 December 1917, #716), http://divinityadhoc.library.yale.edu/ UnitedBoard/West_China_Union_University/RG011-275-4361.pdf; The Rockefeller Foundation Annual Report for 1919, 299, https://rockefeller.geminiodyssey.org/documents/20181/28210/AnnualReport1919.pdf/16647a33a511 -4f25-8d84-94b0cb8e7a25,299; “Senate Minutes”, West China Union University, (24 January 1918, #734), http:// divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-275-4361.pdf. 222 “Medicine in China”, The Rockefeller Foundation A Digital History, https://rockfound.rockarch.org/china- medical-board.

Rockefellers founded the Johns Hopkins School of Hygiene and Public Health in Baltimore, and it was the pioneer school of public health in the United States.223 This was an exciting time to attend Johns Hopkins University especially in the field of public health, and as Charlie noted, it was important to share the “victories of preventive medicine” with the citizens of Sichuan.224 Charlie recognized that the medical missionary has a “greater responsibility to the Chinese than the mere establishment of hospitals and medical colleges, medical men must be ready and free to preach disease prevention as well as treat ailments,” and in terms of teaching the next generation of Chinese doctors, “missionary medical colleges must place public health in the forefront, so that graduates may be more than mere practitioners. Students must be encouraged to ‘talk shop’ on disease prevention. Popular books and articles must be published.”225 The Canadian Mission Press published public health materials to enable the doctors to “talk shop” and to build greater awareness within the Chinese community. One of the public health policies that caught the attention of the missionaries focused on anti- smoking measures. As early as 1908, this was an agenda item at the interdenominational mission conference held in Chengdu. The introduction of mechanized rolled tobacco, by the Americans in 1881, transformed the consumption of tobacco worldwide and this included China.226 Initially cigarettes were imported from American and British companies, and the local production of cigarettes was introduced in 1905.227 Worried about the health implications, Charlie tabled a motion to recognize “the evils which have been shown to accompany the use of cigarettes, and having had it brought to our notice that an Imperial Edict has recently been issued on the subject,” it was agreed to appoint “a Standing Committee to consider what steps can be taken to bring the evils connected with the importation and use of cigarettes before the Chinese local and central authorities, and before the British and American Governments.”228 Sixty years later Charlie’s son, William known as Bill, would promote an anti-smoking campaign initiated by the Ontario Medical Association and supported by the Canadian Cancer Society, the Tuberculosis and Health Association of Canada, and the Ontario Heart Foundation.229 The campaign analyzed the most effective educational strategy to combat smoking in the general public and school community. Bill was a surgeon practicing in Lindsay, Ontario, and in 1968 “at the urging of Dr. Service, Lindsay was chosen” as the test site for the survey and the education campaign.230 As Bill explained to a Globe and Mail reporter, “I think we have reached the stage in our society where we are just ripe for public reaction against smoking,” and a number of initiatives, including an award-winning CBC documentary, were initiated.231

223 “Public Health at Johns Hopkins”, The Rockefeller Foundation A Digital History, https://rockfound.rockarch.org/ public-health-at-johns-hopkins. 224 Service, “Public Health in China”, 370. 225 Ibid., 373; Charles W. Service, M.D., “How to Promote National Health in China”, The West China Missionary News, (July-August 1924), 32. 226 Lucie Olivova, “Tobacco Smoking in Qing China”, Asia Major, Vol. 18, No. 1, (2005), 230. 227 Ibid. 228 Service in A. Grainger, ed., West China Missionary Conference, 255, 332. 229 Rudy Platiel, “Cigaret addicts in Grade 4, survey shows”, The Globe and Mail, March 18, 1968, 13. ProQuest Historical Newspapers: The Globe and Mail. 230 Ibid. 231 Ibid.

MEDICAL-DENTAL COLLEGE FUNDRAISING CAMPAIGN A cross-Canada fundraising campaign was initiated in 1918 for a new Medical-Dental College to be built on the campus of West China Union University.232 According to Beaton, Charlie “was filled with a single idea” and he “offered his services to the Board of Missions for the purpose of raising enough money among the doctors, dentists and nurses...to build the sorely-needed Medical-Dental College.”233 Currently, they were allotted space in a number of buildings, and this proposed college would “be an invaluable piece of constructive work” towards providing a permanent home for the anticipated expansion of medical-dental training.234 Motivated by his belief that “the promotion of health promises to be the leading ideal of the twentieth century,” Charlie reached out to medical, dental and nursing audiences through newspaper and journal articles, individual meetings, small group gatherings, annual meetings of professional associations, and large speakers’ forums.235 His fundraising prospectus, Spend Ten Minutes in China, was mailed to every potential donor from the medical, dental and nursing communities throughout Canada.236 In his numerous presentations across Canada, Charlie argued for a global conceptualization of health care and described the health disparity between Canada and China: There is no such thing as a public health bureau…No one knows the birth-rate; no one knows the death-rate. A mere guess would say the death rate is forty per thousand; that is at least double the rate of our own country. We estimate that 2,000,000 Chinese die annually from tuberculosis alone; that anywhere from seventy percent to eighty percent die under one year of age…There is only one way to solve this physical problem of China, and that is by means of medical education…[and] a great effort is being made to outfit dental, medical and nursing institutions.237 This type of fundraising campaign, to cover the costs of a specific infrastructure project, is classified as a technical problem. It addresses a well-defined need and the “solution depends on well-established practices, and, given enough money, a single organization can implement the solution” under the leadership of an individual or a group of individuals.238 In 1918, Charlie approached Dr. R.A. Reeve to organize a fundraising committee in support of the proposed medical-dental building. Reeve had served as dean of the Faculty of Medicine at the University of Toronto (U of T), and as the first president of the Alumni Association, he successfully managed both the fundraising campaign and the construction of Convocation Hall.239 Reeve’s network of contacts was extensive having served as president of the Canadian and Ontario Medical Associations, and the Toronto Academy of Medicine, as well as being only the second

232 “A Great Opportunity”, Dominion Dental Journal, Vol. 31, No. 11, (1919), 410. 233 Beaton, Great Living, 25; Omar Kilborn, “A Quarter of a Century and After”, Our West China Mission, 22. 234 C. W. Service, “Dental and Medical Needs in China”, Dominion Dental Journal, Vol. 31, No. 2, (1919), 39, 41. 235 Service, “Public Health in China”, 370. 236 Drs. Lindsay, Thompson, Mullett and Anderson, “A Message from Canadian Dentists in Szechuan Province, West China to their Colleagues in Canada”, Dominion Dental Journal, Vol. 33, No. 6, (1921), 261. 237 Service, “Some of China’s Problems”, 369-384. 238 Heifetz, Kania and Kramer, “Leading Boldly”, 25. 239 “Officers and Members of the Faculty since its origin”, Faculty of Medicine: Session 1915-1916, (Toronto: University Press, 1915), 25; “U of T Chronology”, Heritage University of Toronto, http://heritage.utoronto.ca/ Chronology.

Canadian to serve as the president of the British Medical Association.240 Reeve also supported the Missionary Society of the Metropolitan Methodist Church in Toronto, and this involvement provided insight into the aspirations of the medical missionaries.241 All of these connections furnished credibility to the fundraising project, and the Medical-Dental Group was formed with Reeve serving as the chair.242 The campaign was designed as an “inter-denominational appeal,” as it was “not related directly to one mission board,” but rather a general appeal targeting individuals engaged in the health care sector.243 This diversification of fundraising, from church- based revenue collection, removed some of the restrictive barriers for the expansion of medical education, as it was sometimes viewed as competition to evangelical mission work. President Beech and Charlie attended the January 1919 meeting, of the Executive Committee of the Board of Governors in New York, to submit the plans for the proposed Medical-Dental College. The Executive Committee “received with great satisfaction a letter from Dr. R.A. Reeve of Toronto, proposing that the surgeons, physicians and dentists of Canada shall co- operate in the development of the Medical School” and in response, the Executive Committee agreed to “aid in the proposed co-operation in every way it may find practicable.”244 For this specific meeting, Charlie “acted as assistant to the secretary,” so he could officially communicate to his colleagues in Toronto “that their suggestions concerning the housing of the Medical Department will be sent to our Architect and the drawings for this building or buildings, when received, will be submitted for their consideration.”245 The Medical-Dental Group liaised with the London-based architect of WCUU, Fred Rowntree, whose vision blended Chinese and western architectural elements.246 Unfortunately, just a few weeks after this meeting, Reeve passed away and at his public funeral, Chancellor Bowles of Victoria College “spoke of Dr. Reeve’s great interest in medical work in China and of his ambition to establish educational institutes in Chengtu, to which he had devoted much of his time and energy.”247 From his estate, an amount of $7,500 had been bequeathed to the missionary fund of the Methodist Church of Canada, and the members of the Medical-Dental Group requested that his donation be designated for the new medical-dental building fund.248 The Methodist Church agreed to this request and Charlie would later reflect that “this was a splendid starter” for the fund.249 An editorial in The Canadian Journal of Medicine and Surgery noted that from this moment “a campaign was then quietly begun in Toronto by the doctors,

240 “Obituary: Richard A. Reeve, B.A., M.D., L.L.D.”, The Canadian Practitioner and Review, Vol. 44, (1919), 54. 241 “Subscriptions and Donations to the Missionary Society of the Methodist Church: Toronto Society”, Sixty- Seventh Annual Report of the Missionary Society of the Methodist Church, (Toronto: Published at the Methodist Mission Rooms, 1891), 1. 242 “Editorial: Medical China”, The Canadian Journal of Medicine and Surgery, Vol. 48, No. 1, (1920), 2. 243 Chas. W. Service, “An Appeal to Nurses on Behalf of a Worthy Enterprise in Chengtu, West China”, The Canadian Nurse and Hospital Review, Vol. 16, No. 3, (1920), 154. 244 “Minutes of the Executive Committee, Board of Governors”, West China Union University, (13 January 1919, #271), http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-273-4338.pdf. 245 Ibid., #272. 246 Yinrui Xie and Paul Walker, “Negotiation Across Cultural Difference: The Creation and Interpretation of a ‘Chinese-style’ Christian Campus”, Proceedings of the Society of Architectural Historians, Australia and New Zealand 36, Distance Looks Back, (2020), 441-54. 247 The Globe, “Great Service for Dr. Reeve: Public Funeral at Convocation Hall of University of Toronto: Fine Tribute Paid”, January 31, 1919, 6. ProQuest Historical Newspapers: The Globe and Mail. 248 “Editorial: Medical China”, 2. 249 Service, “An Appeal to Nurses on Behalf of a Worthy Enterprise in Chengtu, West China”, 153.

37 dentists, and nurses, and is now being carried on all over Canada…to build and equip the two first buildings in which young Chinese will be taught.”250 The decision of the Methodist Church, to redirect Reeve’s contribution, signalled that the church was realizing the potential of the campaign. When Charlie first pitched his fundraising idea, the reaction from the church leadership was mixed. While some individuals immediately supported the initiative, other church personnel believed an expanded role for medical education would diminish the delivery of clinical services in the hospitals and dispensaries. This debate was also taking place at the Board of Governors, and at the annual meeting of September 1917, a resolution was passed requesting that the university members carefully “consider the very important inter-relation between the policy of the University in medical education and the proper development of the general medical work.”251 Another concern raised by the church leadership addressed the global scope of the campaign, and whether the Canadian health care community would identify with the medical needs of Sichuan. However, this initial scepticism soon dissipated when Charlie “actually got in cash from these nurses and doctors, thousands and thousands of dollars. He interested them all and wrote letters to…hundreds” of potential donors while in Canada, and Charlie continued his letter writing campaign upon his return to Sichuan.252 In February 1919, enough donor support was generated for Endicott to officially contact Rowntree and report “the linking up of the Medical and Dental Fraternities in Canada, for the support of the whole of the Medical and Dental work in the University, and more particularly for the erection and equipment of the Medical College at Chengtu.”253 Canadian health care workers were part of an international fraternity of medical professionals committed to enhancing both the health of their own citizens and the overall global community. And as the president of the Medical Missionary Association in China, Dr. H.W. Boone, articulated in 1890, “the International Medical Congresses which hold their meetings every few years are the proof of the common feeling which binds us all into one great band of workers for the common good.”254 To enlist support for the fundraising project, Victoria College hosted a dinner in September 1919, for the members of the Board of Governors who were meeting in Toronto, and leaders in the health care community were also invited to the event.255 Charlie shared the proposal of the Medical-Dental Group “to secure more adequate facilities for training Chinese doctors, dentists and nurses,” and the Canadian Journal of Medicine and Surgery noted that “the meeting was a most encouraging send-off for the new project and it seems certain that the medical, dental and nursing professions of Canada and Newfoundland will rally splendidly to give West China a

250 “Editorial: Medical China”, 2. 251 “Minutes of the Board of Governors”, West China Union University, (12-13 September 1917, #258), http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4326.pdf. 252 Endicott, “Memorial Service for Dr. C.W. Service”. 253 Fred Rowntree, “Architect’s report to be presented to the Board of Governors”, West China Union University, (June 1920, #5,6), http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-296- 4618.pdf. 254 Doctor H.W. Boone, “President’s Address: Medical Education for the Chinese”, China Medical Missionary Journal, Vol. 4, No. 3, (1890), 113-114. 255 The Globe, “Urgent Need in W. China: Governors of Union Christian University Meeting in Toronto for Medical College: Strong Appeal Made to Representative Doctors and Dentists”, September 12, 1919, 5. ProQuest Historical Newspapers: The Globe and Mail.

38 measure of the privileges in skilled men and women and scientific facilities for their work that Canada enjoys so bountifully.”256 Some of the members of the Medical-Dental Group had experience interacting with architects during the construction of the U of T medical building from 1901-1903, and the construction of the Toronto General Hospital (TGH) which was completed in 1913.257 Additionally in 1908, the superintendent of the TGH, Dr. J.N.E. Brown, had studied the construction of hospitals in England and Scotland on behalf of the Government of Ontario, and he also led a subcommittee on hospital construction for the American Hospital Association.258 The Medical-Dental Group proposed a “unit” architectural design similar to the medical building at the University of Toronto.259 Uniformity in room size allowed for “elasticity for the naming and also developing of departments on an uniform basis” and as Rowntree was also designing architectural plans for a biology building, there were discussions about the allocation of departments between these two buildings.260 Rowntree suggested to the Board of Governors in July 1920 that: In view of the fact that Dr. Service tells me he expects to leave Canada for China about the middle of August, might the best course not be to send the plans of both these buildings to him for consultation with his Committee in Canada, and then for him to take them on to China, and discuss them with the Senate, rather than submit them at once direct to the Senate, without them having the value of the knowledge and information which Dr. Service could give to the final consideration of the problem on the Field?261 It was subsequently agreed that “the Architect submits revised plans for the Medical Block, embodying suggestions by the Medical Committee in Toronto and Dr. Service.”262 It was further resolved by the Board of Governors “that we authorize the preparation of the detailed plans and the erection of the building of the Medical Block, subject to the approval of the Senate, and of Dr. Service.”263 Institutional authorization had been secured for the CMM to build a new medical-dental building with funds raised from Canadian health care sources. The response from the nurses exemplified the positive reaction of Canadians towards the fundraising campaign. Charlie spoke about the work of the Toronto nurses led by Miss Kate Mathieson of the Riverdale Isolation Hospital and Miss Jean Gunn of the TGH. Both women held leadership roles in a number of organizations including the Canadian National Association of Trained Nurses and the Graduate Nurses’ Association of Ontario. During this period, the supervisor of the Toronto General Hospital School of Nursing, Jean Gunn, was advocating for

256 “Medical, Dental and Nursing Work in West China”, The Canadian Journal of Medicine and Surgery, Vol. 46, No. 5, (1919), 358. 257 “U of T Chronology”, Heritage University of Toronto, http://heritage.utoronto.ca/Chronology. 258 “Drs. J.N.E. Brown and Bruce Smith Return After Visiting British Hospitals”, The Canadian Journal of Medicine and Surgery, Vol. 24, (1908), 253; “Hospital Construction”, The Canadian Journal of Medicine and Surgery, Vol. 24, (1908), 302-303; Dr. J.N.E. Brown, “Report of Sub-Committee on Hospital Construction”, Transactions of the American Hospital Association: Tenth Annual Conference, Vol. 10, (1908), (Detroit: Published by the Association Office of the Secretary, 1908), 303-319. 259 Rowntree, “Architect’s report to be presented to the Board of Governors”. 260 Ibid. 261 Ibid. 262 “Board of Governors Minutes”, West China Union University, (2 July 1920 # 426), http://divinity-adhoc.library. yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4326.pdf. 263 Ibid.

Toronto-based nursing students to attend U of T for centralized lectures.264 University-based training for nurses was also the position being advocated in Sichuan. A training school for nurses had been established by Barbara McNaughton at the Canadian Methodist Hospital, and Caroline Wellwood, a nurse with the Women’s Missionary Society, founded a training school at the Women’s and Children’s Hospital, and her long-term vision was to establish a baccalaureate program on the campus of WCUU.265 In an article published in The Canadian Nurse and Hospital Review, Charlie summarized the nursing vision, being discussed by nurses throughout China, which incorporated both training at hospitals and on college campuses: Of course, nurse training in China is being carried on in other cities than those in which colleges are located and this work will expand in many centres, as hospitals multiply and missionary nurses increase in number. But particular emphasis must be laid on first-class facilities for training Chinese nurses in college centres, because of the intimate relation between the education of medical students and the work of nurses in well-organized hospitals.266 The Toronto nurses responded to this vision for China, and through the “co-operation of a group of busy nurses working systematically,” they collected close to $3,000 by distributing the prospectus Spend Ten Minutes in China and then canvasing their alumnae and nursing associations. Nurses in other cities and towns joined the campaign, and Charlie highlighted the effort of one hospital nursing superintendent who secured promises from each of her nursing graduates, undergraduates and nurses-in-training, and she also undertook to “canvass every doctor in her county as they come to her hospital for professional duties.”267 Each contribution was classified in the categories of nurse, doctor, dentist, and friend. Prior to departing for Sichuan in the summer of 1920, Charlie met with the five-member organizing committee:

• Nurses: Miss Kate Mathieson, nursing superintendent of the Riverdale Isolation Hospital, vice-president of the Canadian National Association of Trained Nurses • Doctors: Dr. N. A. Powell, professor of medicine U of T, executive of the Ontario Medical Library Association; Dr. J.N.E. Brown, former superintendent of the TGH - the teaching hospital for U of T; general secretary of the campaign • Dentists: Dr. A. E. Webster, dean of the Faculty of Dentistry U of T, editor of the Dominion Dental Journal; Dr. W. E. Willmott, professor of dentistry U of T, secretary of the Ontario Dental Board268

264 Bonnie L. Richardson, “Book Reviews: Jean I. Gunn: Nursing Leader by Natalie Riegler”, Nursing History Review, Vol. 8, (2000), 201. 265 Janet Beaton and Marion McKay, “Profile of a Leader: Caroline Wellwood”, Journal of Nursing Leadership, Vol. 12, No. 4, (1999), 30-33. 266 Service, “An Appeal to Nurses on Behalf of a Worthy Enterprise in Chengtu, West China”, 153. 267 Ibid., 153-154. 268 “News Items: The Chengtu Medico-Dental College Prospect”, The Canadian Practitioner and Review, Vol. 46, (1921), 286; “Rev. C.W. Service, B.A., M.D., and Mrs. Service”, The Missionary Bulletin, Vol. 16, No. 3 (1920), 495-496, The United Church of Canada Archives, Toronto, Ontario, Canada; Alvyn Austin, Saving China: Canadian Missionaries in the Middle Kingdom 1888-1959, (Toronto: University of Toronto Press, 1986), 102.

Willmott was the treasurer of the campaign, and as a member of the Metropolitan Methodist Church and secretary of the Ontario Dental Board, he was well placed to promote the campaign.269 The Willmott name was synonymous with dental education, as Dr. J.B. Willmott, his father, was the founder of dental education in Canada and the first dean of dentistry at the University of Toronto.270 The active participation of the senior leadership, from the dental and medical faculties of U of T and its teaching hospital, placed these institutions at the centre of an evolving transnational partnership with West China Union University. The organizing committee in Toronto continued to fundraise and publish articles in their respective health care publications. The 1921 message in The Canadian Practitioner and Review was simple and direct: “Dr. Service and his friends ask the people of Canada to assist in the building and equipment of this medico-dental college” designed to “teach medicine, dentistry, pharmacy and nursing.”271 The dental missionaries, Drs. Lindsay, Thompson, Mullett and Anderson, wrote a joint appeal to the Dominion Dental Journal requesting their colleagues to contribute to the building fund, so that “this College shall be a distinct contribution to the university from Canada.”272 In a separate appeal by Thompson, he noted that “ours is the only Dental Faculty in all this great land…[and] it is vitally important that we secure Chinese dentists…We covet for every Canadian dentist a share in this great work.”273 The vision of the fundraising committee was to build a transnational health care community, by strengthening people-to-people ties between Canada and China, and the ongoing appeals were successful. While the head office of the Methodist Church had approved the project in 1919, and the architectural plans were completed in the early 1920s, the actual construction of the building was delayed due to furloughed personnel. Construction began in 1925 and continued during the anti-foreign disturbances, even though most missions in 1927 advised all personnel to evacuate.274 The Medical-Dental College was completed in the spring of 1928.275 Sir Joseph Flavelle, the chair of the Board of Governors of WCUU, “congratulated the Board of Missions on its courage in carrying through to completion during the revolutionary period the construction of the medical-dental building for the university.”276 And he especially “commended two Canadian missionaries, Rev. G.W. Sparling, D.D., and Rev. Walter Small who had supervised the building, at the same time bettering the condition of the university’s finances by wise handling of currency problems.”277 Sparling was the acting-president of WCUU, and was part of

269 “Subscriptions and Donations to the Missionary Society of the Methodist Church: Toronto Society”, Sixty- Seventh Annual Report of the Missionary Society of the Methodist Church, 1. 270 Anne Carlyle Dale, “Willmott, James Branston”, Dictionary of Canadian Biography, http://www.biographi.ca/ en/bio/willmott_james_branston_14E.html. 271 “News Items: The Chengtu Medico-Dental College Prospect”, 287. 272 Lindsay, Thompson, Mullett and Anderson, “A Message from Canadian Dentists in Szechuan Province”, 263. 273 Dr. J.E. Thompson, “Dentistry in West China”, Dominion Dental Journal, Vol. 33, No.8, (1921), 318. 274 Beaton, Great Living, 25. 275 West China Union University Annual Announcement 1924-1925, 58, http://chronicles.dickinson.edu/specproj/ dsoninchina/images/wcuu_annual_announcement_1924-1925/wcuuannual1924-1925_058.htm; “Medical Education in the West China Union University”, West China Union University, WCUU Radio Broadcast April 13, 1943, 5, http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-280-4412.pdf. 276 The Globe, “Improvement Seen in Work in China: Missionary Enterprise is Strongly Commended by Sir Joseph Flavelle”, April 30 1929, 17. ProQuest Historical Newspapers: The Globe and Mail. 277 Ibid.

41 a group of five Canadian missionaries remaining in Chengdu which, in addition to Small, included Secretary-Treasurer W.J. Mortimore, Dr. E.C. Wilford and Rev. F. Dickinson. While the Medical-Dental Building was under construction, the Cadbury Education Building was being built by the Friends’ Foreign Mission Association of Great Britain and Ireland.278 In 1914, the Board of Governors had approved a fundraising strategy to identify wealthy individuals “who will assume responsibility for buildings or other important features of the work, and the cooperation of the individual Boards is earnestly sought in securing such friends for the work in their own several constituencies.”279 The construction of the Cadbury Education Building followed this fundraising model as George Cadbury, a prominent British Quaker who had amassed a considerable fortune through his confectionary company, contributed the required finances to the Friends’ Foreign Mission Association.280 The CMM also followed this model and funds provided by Jarius Hart of Halifax, Nova Scotia covered the construction costs of their administration building, Hart Memorial College, named in 1920 to honour both its founding superintendent and donor.281

Figure 17: Medical-Dental College (Source: Service Family) What differentiated the fundraising campaign for the Medical-Dental Building was its broad- based approach designed to engage many Canadians rather than acquiring one large donation. This fundraising strategy was first introduced by Charlie in 1908 when he delivered a paper, highlighting several fundraising principles, for the Sichuan hospitals and dispensaries. Charlie proposed that “it is a mistake to dun a few wealthy officials, gentry and merchants for big sums rather than small sums from the many” for it is “the spirit that goes with the gift that is the part that makes it really worth while.”282 He suggested a similar approach for the fundraising campaign in Canada, and he commented on the importance of the donations from nurses-in- training, which ranged from 50 cents to five dollars, for “the hope is for a wide response from many, rather than a big response from a few.”283 Each donation connected the health care

278 “Campus Items”, The West China Missionary News, (April 1927), 15. 279 “Board of Governor Minutes”, West China Union University, (2 July 1920, #284), http://divinity-adhoc.library. yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4326.pdf. 280 A.G. Gardiner, Life of George Cadbury, (London: Cassell and Company, 1923), 138. Judy (Graham) Cadbury, the granddaughter of Charlie and Robina, married an American Warder Cadbury who was related to the British branch of the Cadbury family supporting WCUU. 281 Semple, The Lord’s Dominion, 330. 282 Service, “Self Support”, 248. 283 Service, “An Appeal to Nurses on Behalf of a Worthy Enterprise in Chengtu, West China”, 154.

42 community in Canada to the medical needs in China, and because the Medical-Dental Group believed that “the health of a nation is one of its greatest assets,” Canadians were encouraged to support sustainable health care through the expansion of medical, dental, and nursing instruction in Sichuan.284 BOARD OF GOVERNORS The Board of Governors of WCUU was composed of 15 members from Canada, the United States and Great Britain. Each of the five uniting organizations appointed three representatives, and annual elections were held to select the leadership positions consisting of one chair, two vice-chairs, two secretaries and one treasurer. The annual meeting of the full Board of Governors rotated between the three host countries, and the smaller Executive Committee met four times a year. Aside from the official representatives, co-opted members from each missionary society were elected and three prominent Canadians, who were active lay workers in the Methodist Church of Canada, were recruited to serve on the Board of Governors: the Hon. Vincent Massey, the Hon. Newton Rowell and Sir Joseph Flavelle.285 Vincent Massey served as a co-opted member for more than 25 years.286 In 1919, the Board of Governors “recommended that Mr. Vincent Massey of Toronto be co-opted as a member of the Board of Governors, to fill the vacancy caused by the resignation of Sir Joseph Flavelle.”287 Massey brought a multifaceted skill set to the Board of Governors including academic credentials from his long association with the University of Toronto, business acumen as president of the Massey-Harris Company, political insight from serving in the cabinet of Prime Minister Mackenzie King, and diplomatic understanding as the first Canadian minister to Washington in 1926, and as the high commissioner to London in 1935.288 After completing his tenure on the Board of Governors of WCUU, Massey would later serve as the first Canadian- born governor general of Canada.289 The Hon. Newton Rowell held the positions of co-opted member, vice-chair and for one year served as the chair of the Board of Governors, after the death of American Dr. John F. Goucher in 1922. Rowell, a prominent Toronto lawyer, was active in both provincial and federal politics, and he served the liberal party, as the leader of the opposition in Ontario from 1911-1917, and he was a cabinet minister, from 1917-1920, in the union government of Prime Minister Robert Borden.290 Rowell was a social gospeller and this was reflected in his political alignment with the social reform movement in Canada. In 1919, as the president of the Privy Council, he was the architect and promoter of the legislation to create a federal Department of Health which he

284 Service, “Dental and Medical Needs in China”, 39. 285 West China Union University Annual Announcement 1926-1927, 2. 286 “Board of Trustees Minutes of Annual Meeting”, West China Union University, (2 November 1944), http:// divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4320.pdf. 287 “Board of Governor Minutes”, West China Union University, (11-12 September 1919, #361), http://divinity- adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4326.pdf. 288 “Vincent Massey”, The Governor General of Canada, https://www.gg.ca/en/governor-general/former-governors- general/vincent-massey. 289 J.L. Granatstein, “Vincent Massey”, The Canadian Encyclopedia, https://www.thecanadianencyclopedia.ca/ en/article/massey-charles-vincent. 290 “Newton Rowell, “Making Medicare: The History of Healthcare in Canada, 1914-2007”, Canadian Museum of History, https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-1k08e.html.

43 noted “was a new departure in the emphasis which it places on the conservation of the health of the public and upon their social welfare.”291 Appointed the first federal minister of health, the minutes of the September 1919 meeting of the Board of Governors noted that “a telegram was read from Hon. N.W. Rowell, K.C., M.P., expressing regret that Parliamentary duties prevented him from being present at the meeting of the Board.”292 Rowell was also an influential leader in the post-war international movement. He represented Canada at the inaugural meeting of the League of Nations, and he was instrumental in the formation of a national volunteer organization in 1921, known as the League of Nations Society in Canada.293 Rowell mobilized public opinion in support of international cooperation and “the ideals of justice, brotherhood, and service.”294 He contended that the missionary enterprise exemplified “the spirit of human brotherhood” through their work in “hospitals for the sick, in orphanages for the children,” and in providing the opportunity for local leadership to receive “their education in the schools and colleges established by missionary organizations.”295 Rowell’s numerous speaking engagements, expounding the benefits of international cooperation, took place during his tenure on the Board of Governors and positively reinforced the fundraising campaign of the Medical-Dental Group. Sir Joseph Flavelle served as both a co-opted member and chair of the Board of Governors. In 1923, he was appointed to replace fellow Canadian Newton Rowell, and he would hold the position of chair until 1935.296 Flavelle was an influential businessman having amassed his fortune through the meat packing firm, the William Davies Company, at that time the largest pork producer in the British Empire.297 His influence extended into the financial community through his involvement with the National Trust Company and the Canadian Bank of Commerce, and also into merchandising through the department store, Simpsons.298 Flavelle had a “passion for careful accounting” and streamlining organizational structures, and he took a proactive approach, as chair of the Board of Governors, by directly engaging with President Beech and the treasurer on financial matters.299 The social gospel doctrine of Canadian Methodism facilitated

291 Ibid. 292 “Board of Governor Minutes”, West China Union University, (11-12 September 1919, Third Session), http:// divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4326.pdf. 293 John D. Meehan, Chasing the Dragon in Shanghai: Canada’s Early Relations with China, 1858-1952, (Vancouver: University of British Columbia Press, 2011), 48; Margaret E. Prang, “Rowell, Newton Wesley”, Dictionary of Canadian Biography, Vol. 17, http://www.biographi.ca/en/bio/rowell_newton_wesley_17E.html. 294 Hon. N.W. Rowell, The British Empire and world peace, 259. 295 Ibid., 222. 296 The Globe, “University in China will have Canadian at Head of Board: Sir Joseph Flavelle is Appointed Head of Unique University”, September 28, 1923, 11. ProQuest Historical Newspapers: The Globe and Mail; Michael Bliss, “Flavelle, Sir Joseph Wesley”, Dictionary of Canadian Biography, Vol. 16, http://www.biographi.ca/en/bio/ flavelle_joseph_wesley_16E.html. 297 Flavelle’s hand-picked successor to manage the William Davies Company was Frederick J. Smale. He had a PhD in chemistry, and Smale represented the next generation of university-trained entrepreneurs. Unfortunately, he suffered a premature death in 1908. Charlie and Robina’s daughter, Margaret, married his son, Frederick E. Smale, in August 1930. 298 Sir Joseph Flavelle, “Sir Joseph Flavelle’s Reply”, The Canadian Bank of Commerce Annual Report For Year Ending 30th November, 1937”, (Toronto, 1938), 35-41; Chancellors’ Circle of Benefactors, “Sir Joseph Flavelle”, University of Toronto, https://www.chancellorscircle.utoronto.ca/members/sir-joseph-flavelle/. 299 Michael Bliss, “Flavelle, Sir Joseph Wesley”.

44 the adoption of the business concepts of influential laypersons within the missionary institutions.300 In 1907, Flavelle and Rowell were founding members of the Canadian Laymen’s Missionary Movement established by the five protestant churches in Canada.301 This organization, modelled after an American initiative, was designed to attract businessmen from across Canada to support various church programs, and in the winter of 1920 a special campaign was promoted to address three specific areas: strengthening Canadian universities to meet the postwar challenges, establishing an adequate pension for retired ministers, and providing increased support to the missionary enterprise.302 In an address to the Empire Club of Canada, to promote the 1920 campaign, J.H. Gundy a prominent member of the financial community and a member of the Metropolitan Methodist Church, challenged businessmen to not only contribute financially but to “put at the service of this campaign the organizing ability of the business people of Canada.”303 Canadian society was struggling with the aftermath of World War 1, and Gundy wanted the business leaders to recognize “the spirit of sacrifice” exhibited by Canadian soldiers, and the best means of honouring their sacrifice was to work towards a global reality where countries can peacefully “co-operate for the advancement of the world.”304 An amount of $14.5 million was raised by May 1920 for the various Canadian and overseas programs of the Methodist, Congregationalist, Presbyterian, Baptist and Anglican churches.305

Figure 18: Sir Joseph Flavelle Chair of the Board of Governors of West China Union University (Source: https://www.thecanadianencyclopedia.ca/en/article/sir-joseph-wesley-flavelle) Flavelle was a member of the Sherbourne Methodist Church and according to his biographer Michael Bliss, “his church-born sense of stewardship underlay a lifetime of public service and philanthropy,” to both religious and secular causes. Sometimes referred to as the Rockefeller of Canada, Bliss suggested that his involvement with WCUU “was mainly a fund-raising

300 David Luesink, “Dissecting Modernity: Anatomy and Power in the Language of Science in China”, 124. 301 Phyllis D. Airhart, Serving the Present Age: Revivalism, Progressivism, and the Methodist Tradition in Canada, (Montreal & Kingston: McGill-Queen’s University Press, 1992), 126. 302 The Globe, “Eyes of World are on Toronto: Other Cities are Following her Missionary Policy”, November 17, 1909, 4. ProQuest Historical Newspapers: The Globe and Mail. 303 J.H. Gundy, “The Forward Movement”, Address to the Empire Club of Canada, 15 January 1920, 20-35. 304 Ibid. 305 Robert Wright, A World Mission: Canadian Protestantism and the Quest for a New International Order, 1918- 1939, (Montreal & Kingston: McGill-Queen’s University Press, 1991), 121.

45 function.”306 In official documents, there are references to his contributions to cover financial shortfalls or additional costs for staff needs or equipment such as: “Sir Joseph Flavelle’s financial guarantee,” “Final settlement with Sir J. Flavelle assisting,” and “Flavelle $10,000 donation.”307 His financial support was sometimes given as matching amounts, and in one case, he indicated to WCUU that if there was “hesitation in carrying the arrangement into effect, I will be personally responsible for the whole amount if, in the many special things for which you have to provide, you find this additional one a burden.”308 This willingness to personally extend a financial guarantee provided WCUU with a certain level of financial security. Flavelle was also uniquely positioned, through his extensive public service in the fields of university governance and health care reform, to navigate the numerous operational challenges of an emerging university in Sichuan. In the early 1900s, post-secondary education in Ontario was the focus of an ongoing debate, and Flavelle was appointed the chair of the provincial Royal Commission on the restructuring of the University of Toronto, more commonly referred to as the Flavelle Commission. Flavelle visited numerous universities in the United States, to study their internal operating structures and funding models, and as one fellow commissioner reported, “I was amazed at [his] grasp of University affairs.”309 Their recommendation in 1906, to distance the university from political control, resulted in the separation of university and state relations, and this principle of institutional autonomy would be incorporated within other provincial jurisdictions.310 The Ontario government subsequently transferred operational control to U of T, and Flavelle would be appointed an inaugural member of the newly independent Board of Governors.311 The involvement of Flavelle, in post-secondary education reform, reflected the growing sentiment within the church community that universities were an important training ground to educate a workforce compatible with the changing economic and social needs of Canada’s growing urban economy. While navigating university reform, Flavelle was also actively involved in the health care sector, and in his position as chair of the Board of Trustees of the TGH, he sat on a committee to discuss the future direction of medical education. Flavelle was a strong supporter of the Flexnerian model of medicine exemplified by the symbiotic union at Johns Hopkins University between its medical school and teaching hospital.312 After an intense debate, a decision was taken to transition from the current U of T model of part-time professors to full-time teaching and research positions, and the TGH was designated as the official teaching hospital. At this time, a

306 Michael Bliss, The Making of Modern Medicine: Turning Points in the Treatment of Disease, (Chicago: University of Chicago Press, 2011), 70; Bliss, “Flavelle, Sir Joseph Wesley”. 307 United Church of Canada Archives, General Council Archives Guide to Holdings Related to West China Medical Missions (1800-1958), 31, 43, 137, http://www.united-church.ca/sites/default/files/handbook_research-guide-westchina.pdf. 308 Sir Joseph Flavelle to Dr. Anderson, 30 November 1928, Board of Governors of the West China Union University, 493, http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-286- 4493.pdf. 309 Reverend Bruce Macdonald in Martin L. Friedland, The University of Toronto: A History, 2nd ed., (Toronto: University of Toronto Press, 2013), 200. 310 Bliss, “Flavelle, Sir Joseph Wesley”. 311 Marianne P. Fedunkiw, Rockefeller Foundation Funding and Medical Education in Toronto, Montreal, and Halifax, (Montreal & Kingston: McGill-Queen’s University Press, 2005), 49. 312 David Olive, “The way to remember Sir Joseph Flavelle”, The Star, 21 December 2014; Thomas P. Duffy, “The Flexner Report - 100 Years Later”, Yale Journal of Biology and Medicine, Vol. 84, No. 3, (2011), 269-276.

46 major fundraising campaign was underway, with Flavelle as the chair, to replace the old TGH building with a modern 670 bed facility, and in 1913 the hospital relocated to a site close to the U of T campus.313 Flavelle understood the challenges of both technical and adaptive leadership, as he had successfully tackled a technical problem with the building of a new hospital, and he addressed the adaptive problems of public education through his leadership on the Flavelle Commission. It was the opinion of Hector Charlesworth, the editor of Saturday Night, that “Sir Joseph touched the life of Canada at more points than any man of his time,” and as a long- serving governor of WCUU, he also touched the life of China.314 CHONGQING ERA (1920-1923) Charlie assumed he would be returning to Chengdu, as the Board of Governors of WCUU had indicated “to Dr. Service our appreciation of fine work that he has done in the interest of the Medical and Dental College and express the hope that he will soon be back at Chengtu to continue his service there in forwarding this work.”315 However, with limited personnel, the CMM needed to temporarily post Charlie to Chongqing to cover the furlough of Dr. W.J. Sheridan. Charlie arrived in Sichuan without his family, in November 1920, and he was assigned to the position of superintendent of the Canadian Methodist Hospital also known as Renji Hospital. Chongqing was a strategic city on the Yangtze River, and in the 1920s, it was the focus of rival warlords vying to expand their sphere of influence. The ongoing unrest on the streets significantly impacted the patient load at the hospital, and in addition to regular medical care, the hospital staff was also tending to both civilian and military casualties.316 Housing for missionary personnel was limited, and Charlie subsequently boarded with various missionary families. This meant that his personal belongings, including his treasured books and violin, remained in Chengdu, and Charlie lamented the fact he did not have access to his personal library. Charlie loved to read, and on his return trip from his regular furloughs, he always packed as many books and journals as he could into his luggage. One time when a shipwreck, in the Yangtze gorges, destroyed some of his possessions, his only complaint was the fact that “with the spoiling of his worldly goods he had lost many of his most valuable books.”317 Another time, when his house was robbed in Chengdu, he was relieved that the thieves showed no interest in what he thought was his most prized possession. Charlie viewed reading as a necessary vehicle, to keep his medical knowledge current, and to ensure his ideas continued to evolve outside of the medical profession. He felt so strongly about this issue that he recommended in 1912, as part of his overall vision for the medical work in Sichuan, a “provision whereby every medical worker shall have at least a brief vacation every year and more time for reading and study.”318 The decision for Robina to remain in Toronto was a typical pattern for mission family life especially when the children reached high school. Another typical pattern was for parents

313 Fedunkiw, Rockefeller Foundation Funding and Medical Education in Toronto, Montreal, and Halifax, 59-60; Bliss, The Making of Modern Medicine, 68-70. 314 Hector Charlesworth in Bliss, “Flavelle, Sir Joseph Wesley”. 315 “Board of Governor Minutes”, West China Union University, (2 July 1920, #400), http://divinity-adhoc.library. yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4326.pdf. 316 Beaton, Great Living, 26. 317 Ibid., 24. 318 Ibid.

47 serving overseas to leave their children with relatives or with other missionary families in Canada. This was the case for the Kilborn family, and during this current period when Robina resided in Toronto, the children of Dr. Retta Kilborn lived with the Service family while their mother worked at the Canadian Methodist Hospital in Chongqing.319 In 1922, a decision was taken for Robina and William to return to Sichuan and the three girls, being of high school and university age, remained in Toronto with Robina’s sister, Jenny (Morgan) Corrigan.320 Charlie was thrilled to have Robina and William with him in Chongqing. His home life was returning to normal and Robina, who had been his health care partner throughout the years, was once again providing nursing services in Sichuan. Robina was also given additional responsibilities by the CMM, and she was appointed to teach at the Canadian School in Chongqing where William was an elementary student.321 The CMM followed the Canadian curriculum and the schools were accredited with the Ontario provincial school system. The main school was in Chengdu and since 1918, it was located on the grounds of WCUU and operated as both a day and boarding school.322 Winnifred would be the first student to take the high school entrance exam, and in June 1916, she passed with honours.323

Figure 19: Chengdu Canadian School 1918. Back Row: fourth from right Margaret, third from right Winnifred; Fourth Row: far left Frances; First Row: far left William (Source: Canadian School in West China, 57) Charlie and Robina found living in the cosmopolitan city of Chongqing very different from life in the interior capital of Chengdu. Located on the Yangtze River, Chongqing was the commercial center for western China and compared with the other mission stations, it was a more diversified cultural contact zone due to the growing presence of western businessmen and diplomats.324 Within this increasingly tense geopolitical landscape, some missionaries began to

319 C.W. Service to Family, (original letter), 21 September 1920; 9 September 1921; 23 October 1921; 25 April 1922. 320 Robina’s sister was Jennie (Morgan) Corrigan. In September 1920, her daughter Beatrice married Joseph Harris of the Harris Abattoir Company which along with the William Davies Company were the two largest meat packing establishments in Canada. In 1927, the companies merged to form Canada Packers Limited, today known as Maple Leaf Foods. 321 Robina Service to Family, (original letter), 11 March 1923; William Service to Family, (original letter), 6 May 1923. 322 C.W.M. Service, “An Address at the Sixtieth Anniversary Reunion, June 22, 1969”, Canadian School in West China, ed. Brockman Brace, (Toronto: The Hunter Rose Company, 1974), 46. 323 Lorenia Edmonds, “The History of the Canadian School 1909-1916”, Canadian School in West China, 42. 324 Marie Louise Pratt in John D. Meehan, Chasing the Dragon in Shanghai, 8.

48 cast an increasingly critical eye on the excessive actions of certain commercial traders and diplomats.325 Historian Michael Barnett posits that “missionaries looked suspiciously on foreign capitalists who seemed willing to do anything to make a profit, who seldom exhibited Christian principles…promoting not righteousness but hedonism.”326 As Charlie’s son, Bill, would later suggest, “it was not our parents’ fault that they took part in the missionary movement during a period of Western imperial expansion…thus modern Missions in China became established in relation to unequal treaties, extraterritorial rights, treaty ports, concessions, wars and indemnities.”327 A strong anti-foreign, anti-Christian sentiment was galvanizing the youth who were reacting to the asymmetrical structure of the treaty port which favoured foreign commercial interests.328 Vice-President Stewart, “one of the leading educationalists” of WCUU, provided this perspective in an article in The Globe:329 It is necessary for one to live in China…in order to appreciate that foreign nations are partly responsible for the present anti-foreign feeling. Young China has travelled abroad, and in doing so has gained an education in the foreign method of doing business, and he, therefore, feels that the foreign nations are taking advantage of China under the present treaty.330 As Charlie internalized the Chongqing dynamic, he began to question his western-centric values, and the reframing of his life story was a natural progression for long-serving Canadian missionaries like Charlie and Vice-President Stewart.331 Historian Jane Hunter argues that “sometimes remaining for years, investing much of their lives in the dilemmas of worlds distant from home-towns, their perspectives evolved in reaction to political, social and economic circumstances they never could have anticipated.”332 Charlie shared his transitioning thoughts in a letter to the church community in Canada.333 Although he “hoped that a better feeling towards foreigners may soon appear,” Charlie acknowledged that “the Chinese have many reasons for disliking foreigners though some of their grievances arise from a misunderstanding of us and our motives. Nevertheless, foreigners, even most missionaries, are to be blamed for the attitude of superiority which most of us unconsciously assume.”334 This attitude of superiority was cultivated by Canadian Methodism, which encouraged its members to take a moral position of superiority against the changing social values affecting

325 Semple, The Lord’s Dominion, 307. 326 Michael Barnett, Empire of Humanity: A History of Humanitarianism, (Ithaca: Cornell University Press, 2011), 68. 327 C.W.M. Service, “An Address at the Sixtieth Anniversary Reunion, June 22, 1969”, 49. 328 Beaton, Great Living, 25-26. 329 The Globe, “Critical situation obtaining in China due to discontent”, July 24, 1925, 10. ProQuest Historical Newspapers: The Globe and Mail. 330 The Globe, “Happenings in China Explained to ‘Lions’ by 25 Year Resident”, April 15, 1927, 11. ProQuest Historical Newspapers: The Globe and Mail. 331 Paul Cohen in Michelle Renshaw, Accommodating the Chinese: The American Hospital in China, 1880-1920, 2nd ed., (London & New York: Routledge Press, 2016), 8. 332 Jane Hunter, “Introduction: Christianity, Gender, and the Language of the World”, Journal of American-East Asian Relations, Vol. 24, (2017), 309. 333 Julie Beck, “Life’s Stories: How you arrange the plot points of your life into a narrative can shape who you are - and is a fundamental part of being human”, The Atlantic, 10 August 2015, https://www.theatlantic.com/health/ archive/2015/08/life-stories-narrative-psychology-redemption-mental-health/400796/. 334 Service in Beaton, Great Living, 26.

Canadian society, as it transitioned from its rural roots to a growing urban economy. The temperance campaign in Canada, which was closely aligned with the suffrage movement and labour reform, was a prominent example of correlating individual moral failure to the decline of the state.335 As religious historian Neil Semple theorizes, “the separation from the corrupt world so long espoused by Methodism now meant moral, as much as spiritual, distinctiveness and superiority.”336 However, a strictly spiritual reaction disengaged from a rational response to social concerns was deemed inappropriate and as Semple notes: Methodism had not been a small body of earnest converts for many decades. It recognized that such a position would only isolate it from contemporary Canadian society, weaken its ability to deal meaningfully with the problems facing the nation, and drive its progressive membership into other denominations…The secret of modern evangelism was to remain as aggressively personal and spiritual as ever but to blend evangelism with a passion for social reform.337 Being well versed in the modern evangelism of social and civic duty, Charlie looked for a positive resolution to the social discord in Chongqing, and it was his expressed wish that “all this unpleasantness may be the school to teach foreigners and Chinese alike to understand and respect each other.”338 And for Charlie, the best means to build a bridge of understanding and respect was to live a life of humble service towards one’s neighbours and as a medical missionary, this meant providing services to his Chinese patients, to visually demonstrate his “all-round interest in mankind.”339 Historian David Hollinger posits that this idea of universal brotherhood was central to the liberal protestant doctrine that promoted “teaching by example” where individual missionaries believed they should “exemplify the Christian life” through humility and respectful actions in social service projects.340 The current environment of distrust towards missionaries was cultivated over many decades, and years earlier, Charlie had argued that it was only natural that Chinese society would express suspicion about their missiological intentions. In a paper delivered at the West China Missionary Conference in 1908, Charlie noted that one approach to reduce “suspicion of our motives” would be to implement a payment system for medical services, where those patients who can pay a medical fee should contribute according to their means:341 Being unable to view our presence here in China, and our expenditure of so much time, money, and effort, from the Christian point of view, many of them cannot but suspect ulterior motives…No doubt not a few think that we have some political mission, that we are connected in some way with our foreign governments, either serving them as emissaries, or drawing pay from them for some mysterious reason. Whereas the payment of a fee will do much to allay such suspicions, and will tend to an enlightened

335 Daniel Malleck, “What alcohol prohibition can teach us about the legalization of cannabis”, The Globe and Mail, (3 August 2018), https://www.theglobeandmail.com/opinion/article-prohibition-then-and-now/. 336 Semple, The Lord’s Dominion, 390. 337 Ibid. 338 Service in Beaton, Great Living, 26. 339 Service, “Public Health in China”, 374. 340 David Hollinger, Video - American Missionaries and the Struggle for Control of Christianity’s Symbolic Capital, The Maxwell Institute, November 13, 2019, https://mi.byu.edu/video-hollinger-lecture/. 341 Service, “Self Support”, 245.

understanding of the real status of the foreign missionary, whether he be doctor, preacher, teacher, or other. I believe such a procedure favorably affects every arm of the missionary enterprise.342 Another contributing factor, for the escalating tensions, was the tendency to view the motives of the multinational missionaries through a singular lens, even though the missiological situation was more nuanced. While conservative theology focused on religious conversion, the liberal theology of the Canadian medical missionaries incorporated the social gospel doctrine of social service. This divide between evangelical conservatives and ecumenical liberals was growing since the start of the 20th century, and Hollinger describes the divide as a “simple salvation narrative pushed by the evangelical missionaries” versus the “Christian life exemplifying mode of religious witness favoured by the ecumenicals.”343 The global mission field where this debate was most pronounced was in China during the 1920’s and 1930’s, and the Methodist missionaries were a leading force framing the liberal theology narrative.344 Charlie according to Beaton was “liberal in his view” and in a letter to one of his daughters, he encouraged her to challenge evangelical conservatism and “not be afraid of truth” because “modern criticism has made parts of the Bible vital with new meaning” and subsequently more relevant to the changing societal needs of humanity.345 The diversity of views within the overseas missionary enterprise was also reflected in geopolitical considerations. Canadian missiological values were sometimes undelineated from the more recognizable motives of the influential global powers. Canada was coming of age as a nation, and due to the larger British and American commercial and political presence, Canada was often a forgotten country. This invisibility extended to Canadian missionaries who were sometimes linked to the larger American and British missions, and their British connection was reinforced by the fact they carried British passports.346 Canadian missionaries had a unique perspective from their British and American colleagues.347 Their Canadian mindset reflected their current colonial status within the British Empire, as well as their North American vulnerability to manifest destiny advocates promoting the assimilation of Canada. During a visit to China in 1909, the then Minister of Labour, William Lyon Mackenzie King, was approached by an American diplomat about the possibility of his country being assimilated by the United States, and King responded that Canada must “cease to think in colonial terms and to act in any way as with colonial status. Let her become a nation or other nations will rob her of this right.”348 These words would foreshadow the growing nationalism when King was the prime minister of Canada, and some historians have theorized that Canadian missionaries were more receptive, to growing Chinese nationalism in the 1920s, because this was a period when Canadians were also forging their own national identity.349 Although they were

342 Ibid. 343 Hollinger, Video - American Missionaries and the Struggle for Control of Christianity’s Symbolic Capital. 344 Ibid. 345 Beaton, Great Living, 15. 346 Austin, Saving China, 85-86. 347 Laura Madokora, “Review by Laura Madokora, Columbia University, Chasing the Dragon in Shanghai: Canada’s Early Relations with China 1858-1952”, H-Diplo Roundtable Review, Vol. 14, No. 38, 2013, 11; Meehan, Chasing the Dragon in Shanghai, 11. 348 William Lyon Mackenzie King in Meehan, Chasing the Dragon in Shanghai, 29. 349 Ibid.

51 still dependant on the British gunboats for protection, Canadian missionaries were becoming important actors and increasingly used their voice to challenge current geopolitical relations. “Influenced by those they served, many championed Chinese nationalism,” historian John D. Meehan claims, “by calling for racial equality, immigration reform, and an end to extraterritoriality.”350 In a speech delivered to the Empire Club of Canada in 1919, an institution founded on the principle “that the highest interests of the Dominion of Canada are identical with the interests of the British Empire,” Charlie challenged the audience to rethink engagement with China because although “there is what is known as extra territoriality,” Charlie was of the opinion “that [it] is an ignominious thing.”351 This argument was echoed by the Hon. Vincent Massey, and as Canada’s leading diplomat, he urged foreign powers to respond “to the legitimate demands of the Chinese for the abolition of the special privileges enjoyed by foreigners.”352 Other advocates included Rowell and while vice-chair of the Board of Governors of WCUU, he delivered a major policy address at U of T where he stated that the modern missionary movement with ‘its hospitals for the care and treatment of the sick, with its schools for the education of the children…and with a Spirit of unselfish altruism…[has] counterbalanced the evil effects of the contact of other phases of our Western civilization.”353 In the immediate aftermath of World War 1, Canadians were questioning their absolute belief in the superiority of Western values, and with the passing of the Victorian era, a new missiological internationalism was emerging to guide their overseas missionary operations. As these members of the Board of Governors were influential Canadian voices in political, diplomatic, financial, academic and church constituencies, their positive messaging, to reform Western policies towards China, were widely circulated throughout Canada. It was Rowell’s contention that “the missionary organization in the Home Land and the returned native missionaries have been the interpreters to the masses at home of the life and spirit and characteristics” of foreign countries, and this circulation of ideas fostered greater global understanding.354 A spirit of isolationism permeated the interwar era in Canada, and the country’s official diplomatic presence was limited to offices in London, Washington, Paris, Geneva and Tokyo.355 In 1929, there were 19 Canadian public servants, designated as foreign service officers and only 12 served abroad, whereas the study Canada’s Share in World Tasks, published in 1920, recorded that Canadian Protestant churches posted 768 missionaries with the Methodists supporting 279 foreign workers in West China and Japan.356 Diplomatic scholar Robert Wright posits that “foreign missionaries were widely, and appropriately, heralded as Canada’s ‘ambassadors’ to the world…All in all it is hardly surprising that visions inside and outside the churches of a new international order rested heavily on the conviction that the foreign-mission enterprise would be a key agency of reconstruction.”357 This concept of soft

350 Ibid., 181. 351 William Clark, “The Empire Club of Canada and Its Ideal of Imperialism”, Address to the Empire Club of Canada, 3 December 1903, 11-14; Service, “Some of China’s Problems”, 369-384. 352 The Globe, “Hope for progress lies within China, declares Massey”, January 19, 1932, 11. ProQuest Historical Newspapers: The Globe and Mail. 353 Rowell, The British Empire and world peace, 220, 227. 354 Ibid., 221. 355 Wright, A World Mission: Canadian Protestantism and the Quest for a New International Order, 1918-1939, 5. 356 Ibid., 5-6. 357 Ibid., 6.

52 diplomacy and the role of non-state actors, in establishing the initial people-to-people links between Canada and China, was echoed in a 2017 headline in The Globe and Mail which stated that China’s history with missionaries forms modern Canada relations.358 THE COSMOPOLITAN MISSIONARY The deepening engagement of the individual missionary, within their foreign work place, changed their own perspective and subsequently changed the trajectory of western nations.359 The impact of the evolving cosmopolitan missionary, can be viewed through the life story of Canadian Methodist missionary, Rev. Robert Cornell Armstrong, who was posted to Japan from 1903 until his death in Tokyo in 1929, and he is linked to the Service family through his marriage to Ketha Service, the youngest sister of Charlie. Known as the “missionary-author,” Armstrong wrote numerous articles and four books about Confucianism and Buddhism while serving as a professor and dean of philosophy and comparative religion at Kwansei Gakuin University, and at the Central Tabernacle in Tokyo.360

Figure 20: Robert Cornell Armstrong Kwansei Gakuin University (Source: https://www.kwansei.ac.jp/r_history/r_history_m_001222/detail/r_history_008330.html) Comparative religion was an emerging field, and in the postwar era, it was gaining prominence especially within liberal protestant ideology. Wright argues that the “thought of Robert Cornell Armstrong, a Canadian Methodist missionary to Japan and one of the leading Western scholars of Japanese Confucianism and Buddhism in the 1920s, evinced this unmistakeable tension between traditional evangelical ideas about the superiority of Christianity and the increasing professionalization of the discipline of comparative religion.”361 And it was Semple’s contention that “Robert Armstrong helped explain Confucianism, Buddhism, and Shintoism to previously

358 Nathan Vanderklippe, “China’s history with missionaries forms modern Canadian relations”, The Globe and Mail, (14 April 2017), http://license.icopyright.net/user/viewFreeUse.act?fuid=MjUyMzE5NjE%3D. 359 Hollinger, Video - American Missionaries and the Struggle for Control of Christianity’s Symbolic Capital. 360 The Globe, “Missionary-Author Succumbs in Japan”, October 30, 1929, 19. ProQuest Historical Newspapers: The Globe and Mail; United Church of Canada Archives, Fonds F3005-Robert Cornell Armstrong fonds, https://www.archeion.ca/robert-cornell-armstrong-fonds; Semple, The Lord’s Dominion, 322. Armstrong’s writings included Light from the East (1914), Progress in the Mikado’s Empire (1920), Buddhism and Buddhists in Japan (1927); and An Introduction to Japanese Buddhist Sects (1950) printed after Armstrong’s death under editor Ketha (Service) Armstrong. 361 Robert Wright, A World Mission: Canadian Protestantism and the Quest for a New International Order, 1918- 1939, 160.

53 skeptical North American audiences. Although such interest demonstrated a natural maturation of missionary experience, it also reflected a certain disillusionment with Western society…in the aftermath of World War 1.”362 Armstrong was a graduate of Victoria College, and through his ongoing research in Japan and postgraduate studies while on furlough, he was awarded his Master’s degree in 1912, and his PhD in 1914 from the University of Toronto.363 His dissertation, later published in book form, and edited by Ketha (Service) Armstrong, was entitled Light from the East, and the research focused on Japanese Confucianism. Mary Evelyn Tucker, founder of the emerging field of religion and ecology at Yale, and a member of the Interfaith Partnership for the Environment at the United Nations Environment Program, recognized Armstrong’s contribution to Japanese Confucian understanding: Japanese Neo-Confucianism has been the subject of significantly polarized interpretations, namely, of fascination with its humanistic aspects and rejection of its apparently rigid hierarchical structure for political control. R.C. Armstrong’s Light from the East (1914), for example, although written over sixty years ago, contains an appreciation for the wisdom and rational humanism of Japanese Confucian thought.364 Armstrong’s pluralistic view was based on the fundamental premise that: The Japanese are our neighbours. It is very important that neighbours should understand each other: that so far as possible suspicion and misrepresentation should be removed and points of contact established. It is very important that we should look at the Japanese from a broad human standpoint and endeavour to discover their real nature. The studies which have made this book possible have led me to feel that, in spite of their differences in custom, the Japanese are essentially the same as we are. They are interested in the same spirit of righteousness and truth; many of them have suffered and even died for their convictions. It is my hope that these studies, which were not primarily made for publication, may lead others to the conviction that East and West are fundamentally one.365 This openness to the study of other religions and stages of spiritual growth led missionary theorists to share their perspective of world religions within the academic and church communities of their native countries.366 And considering “Armstrong’s religious training was virtually identical to that of the men who governed the boards of missions in the mainline Canadian churches,” Wright contends that “some of his ideas were refreshingly progressive.”367 Armstrong challenged the missionary establishment to consider his belief that one “cannot study Eastern thought without sooner or later coming to feel that there are similar movements of

362 Semple, The Lord’s Dominion, 322. 363 United Church of Canada Archives, Fonds F3005-Robert Cornell Armstrong fonds. 364 Mary Evelyn Tucker, “Religious Aspects of Japanese Neo-Confucianism: The Thought of Nakae Toju and Kaibara Ekken”, Japanese Journal of Religious Studies, Vol. 15, No. 1, (1988), 55. 365 Robert Cornell Armstrong, Light from the East: Studies in Japanese Confucianism, (Toronto: University of Toronto Press, 1914), VII. 366 Hollinger, Video - American Missionaries and the Struggle for Control of Christianity’s Symbolic Capital. 367 Robert Wright, A World Mission: Canadian Protestantism and the Quest for a New International Order, 1918- 1939, 160.

54 thought in the West. A sympathetic investigation of things Eastern will convince even the most skeptical that “East is West” and has always been so.”368 His writings were not limited to comparative religion and in another article, written in 1920, Armstrong reflected about the postwar situation in Japan. He concluded that the “influence of the Great World War is making itself felt upon every phase of the national life of Japan” including the “political, economic, social and religious changes [that] are taking place in a manner scarcely possible before the War. Japan has awakened to world consciousness.”369 Historian Kevin Doak, a Japanese scholar at Georgetown University, reflected that Armstrong’s assessment was significant because it was a “contemporary account of the comprehensive impact of the aftermath of the war on Japanese culture, society, and politics,” and it also recorded “how Japan’s awakening to ‘world consciousness’ came, not at the expense of nationalism, but was in fact grounded in ‘national life’.”370 Due to the limited number of Canadian diplomats, the observations of cosmopolitan missionaries, about their overseas countries of work, were sought and considered by political and business elites.371 This was the case when Charlie was invited to give an address at the Empire Club of Canada, which was founded in 1903 as a speakers’ forum, and its membership was composed of the most influential business and political leaders in Canada. Charlie shared his thoughts, in October 1919, after his cross-Canada fundraising tour, and this engagement with Canadian society provided the opportunity, after many years in China, to understand the isolationist tendencies of the business and political leaders sitting in the audience. However, Charlie rather than reinforcing provincialism made a strong pitch for internationalism, and his confidence in China’s future place on the world stage was an underlying theme throughout his address: After a residence of seventeen years in China, I have come to the conclusion that potentially, at least, the Chinese people and the Chinese country are capable of immeasurable expansion. The Chinese people are innately a great commercial and industrious people. I do not believe there is a more highly developed people in the world, with a commercial sense and with commercial aptitude, than the Chinese people…We know that in the course of history civilization has gradually passed from the ancient Nile and the Euphrates across the Mediterranean, and later across the Atlantic, and finally across the great American continent, and it is now beginning to cross the Pacific, and you will find that in the not distant future the Pacific Ocean is to be one of the great regions for the development of commerce.372 He provided numerous examples of China’s enormous potential and he encouraged the audience to consider the opportunity to provide “co-operative…and sympathetic help” in the

368 Robert Cornell Armstrong, Light from the East, 306. 369 Robert Cornell Armstrong, “A General Review of the Year 1920”, The Christian Movement in Japan, Korea, and Formosa: A Year Book of Christian Work, Nineteenth Annual Issue, ed. R.C. Armstrong, (Tokyo: Eibun Tsushinsha, 1921), https://archive.org/stream/japanchristian19unknuoft/japanchristian19unknuoft_djvu.txt. 370 Kevin M. Doak, “The Christian Habitus of Japan’s Interwar Diplomacy”, in Japan and the Great War, eds. Antony Best and Oliviero Frattolillo, (London: Palgrave Macmillan, 2015), 71. 371 Robert Wright, A World Mission: Canadian Protestantism and the Quest for a New International Order, 1918- 1939, 6. 372 Service, “Some of China’s Problems”, 369-384.

55 reconstruction of the “industrial, commercial, financial and other lines in China” and through the missionary enterprise, support education initiatives to address illiteracy and sustainable medical care.373 His extended work experience in China had shifted his perspective, and he shared his internationalist vision that “we are living in a great bundle of nationhood nowadays, and what is the concern of one is the concern of all.”374 And because East Asia was a “diplomatic danger- spot,” fueled by Japan’s aggressive expansion into the Chinese financial and mining sectors, and also fueled by the destabilizing internecine warfare throughout China, he suggested that this was a global concern. The world is not safe Charlie argued “until China herself is made safe for her own peaceful people and for all law-abiding foreigners who live in the country - I think that is an axiom of law.”375 WEST CHINA UNION UNIVERSITY (1923-1927) In the summer of 1923, after their Chongqing posting, Charlie and Robina welcomed their appointment to Chengdu, as they preferred the quieter provincial capital with its university campus. The Senate of WCUU had made an official request for “the return of all those who hitherto have been associated with the University and we would mention in particular the desirability and urgency of appointing Dr. C.W. Service who has been so intimately associated with the publicity work for the Medical School in the homeland.”376 President Beech had experienced first-hand Charlie’s fundraising campaign for the future Medical-Dental College, while attending the Board of Governors meeting in Toronto: I remember very well going to Canada on one occasion some years ago and Dr. Service just dragged me around the city of Toronto…He wanted me to see this doctor and that doctor, and what was it all about. Why, he wanted to get them interested in the University here. He wanted to get the whole of the medical profession in Canada interested in the University. He wanted men to give money for it and he worked tirelessly for it all through his vacation.377 And as medical education expanded, aside from infrastructure needs, another challenge for WCUU was recruiting sufficient staff. A growing student enrolment was encouraging but the university was faced with the situation where “the number of our teaching staff has not kept pace with our student body.”378 Dr. E.C. Wilford, a Canadian medical educator at the Medical-Dental College, provided this perspective: In carrying on our Medical School we have our discouragements, the principle being lack of men and money. On the other hand, we have much to keep us optimistic. We have an unrivalled opportunity here, with plenty of room for expansion as ours is the only Mission College among 1,000,000 people. Our staff, though insufficient in number, is

373 Ibid. 374 Ibid. 375 Ibid. 376 “Senate Minutes - Report of the West China Union University to the Participating Missions”, West China Union University, (6 January 1921, #116411A), http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_ University/RG011-275-4362.pdf. 377 Dr. J. Beech, “A Friend and Fellow Missionary Laid to Rest”, Funeral Service for Dr. Charles Winfield Service, March 13, 1930, Si Shen Si Church, Chengdu, West China. 378 “Senate Minutes”, West China Union University, (6 January 1921, #116411A).

unexcelled in the spirit of harmony and cooperation, and the willingness to shoulder heavy burdens. It is a great pleasure to be permitted to work with this splendid group of men and women.379 The CMM was taking a leading role in medical education with their decision to build a Medical- Dental College, and compared to the other missions, they were also supplying more professors to teach at WCUU and to oversee clinical training at their hospitals. Within the CMM, there continued to be an annual debate about the funding allocation for health care education in Chengdu, and the clinical needs of the hospitals and dispensaries located throughout Sichuan. At Mission Council meetings, when appointments were being allocated, Charlie was known to keep urging his colleagues to “appoint more teachers to teach at the University,” and he frequently wrote letters to the Home Board requesting additional resources for the Medical-Dental College.380 Throughout all these funding debates, it was Endicott’s assessment that “in recent years no one in West China was more keen and more devoted than he to build up a really worthwhile medical and dental school there…[and] he was always, or nearly always, able to carry the majority of the missionaries with him as he pressed forward.”381 One of the issues being discussed was a comprehensive policy for the expansion of medical education. The construction of the new Medical-Dental College was scheduled to start in 1925, and the doctors were strongly advocating that an interdenominational “General Clinical Hospital near the University and easily accessible to the Medical School” should be part of the plans.382 The current inefficient situation where the students took their clinical training at separate hospitals, located far from the university, resulted in a substantial amount of time being lost for travel, and often the senior students were forced to live off campus. Charlie was a member of the Senate Committee tasked to “outline a detailed statement of our ideals for a future medical policy for Chengtu and to suggest a line of procedure for the immediate future.”383 Their report was submitted to the Senate in April 1924, and the governing body approved the recommendation for a centralized medical centre. Specifically, the Senate agreed “that we look forward to the development of a hospital and dispensary for the clinical instruction of the medical students within easy access of the Medical School at the Union University.”384 This large training hospital would eventually be built and was the precursor to the present West China Hospital at Sichuan University. Another significant challenge for the staff was the ongoing shortage of cadavers to teach anatomy to medical students. Although the government had passed a law in 1913 to legalize dissection, the decree required the consent of the patient’s relatives, and there continued to be a strong cultural disconnect to the dissection of the human body after death.385 It was the understanding of the CMM that Chengdu was the “first place in China in which human dissection was legally performed with the full knowledge and assistance of the municipal

379 Wilford, “West China Union University: Faculty of Medicine”, 762. 380 Sparling, “A Friend and Fellow Missionary Laid to Rest”. 381 Endicott, “Memorial Service for Dr. C.W. Service”. 382 “Senate Minutes”, West China Union University, (3 April 1924, #1689), http://divinity-adhoc.library.yale.edu/ UnitedBoard/West_China_Union_University/RG011-275-4363.pdf. 383 Ibid., #1689. 384 Ibid., #1690. 385 Guangqui Xu, American Doctors in Canton: Modernization in China, 1835-1935, (New Brunswick, New Jersey: Transaction Publishers, 2011), 66-67.

57 authorities.”386 The shortage of anatomical material was a familiar situation for the medical educators, as North American medical schools also faced cultural barriers, when promoting the concept of bequeathing bodies to enhance the training of doctors. A common source of cadavers in their home countries were the unclaimed bodies of prisoners in government institutions, and WCUU subsequently made arrangements with local authorities to procure the cadavers of brigands who were being executed for their crimes.387 One of the professors wrote a letter to the governor of Sichuan, General Yang Sen, and suggested an alternative method of capital punishment, to protect the complex nervous system of the brain stem, which was important for teaching crucial life functions in anatomy class.388 In his written response, the governor included an ironic compromise, when he suggested that “since you are not satisfied with my system, I will send the next group of brigands out to you at the University and you dispose of them according to your own method.”389 This was certainly not the anticipated response, and since both sides involved in the negotiation knew that this was not a serious proposition, his biographer Kenneth Beaton observed that “no member of the staff enjoyed the way the humour had been turned on them more than Dr. Service.”390 Charlie had a keen sense of humour, and he was pleased when his knowledge of the Chinese language had progressed to the point where he was able to share his numerous jokes and puns in both English and Chinese. “His lectures and often the suspense of the operating-room” Beaton noted “were enlivened by frequent spontaneous bursts of humour that greatly delighted the students.”391 The education of his students was a primary focus of his life, and when it came time for Charlie to make a personal final decision, just prior to dying in 1930 at the Canadian Methodist Hospital, he requested that his body be given to the Medical-Dental College for anatomical dissection. Although Charlie viewed his body through the detached clinical eyes of a surgeon, and he wanted his corpse to be a teaching tool, neither the staff nor the students would abide by his wishes, and Charlie was buried on the campus of West China Union University. CANADIAN METHODIST HOSPITAL (1923-1927) During the mid-1920s, the CMM was expanding its work in clinical medicine, and the Methodist Church of Canada appointed the largest number of medical missionaries since arriving in Sichuan. This mission was “the largest, single mission field operated by a single church in the world.”392 The statistics for 1923 reinforce the emphasis placed by the CMM on medical work compared to the other seven missionary societies. The CMM controlled 10 of the 24 hospitals, performed 12,000 of the 14,471 operations, and tended to over half of the dispensary patients.393 By 1925, there were more than 30 Canadian doctors and five Chinese doctors supporting a

386 Leslie G. Kilborn, “Dr. William Reginald Morse”, The West China Missionary News, Vol. 40, No. 12, (1939), 471. 387 Mathew Rankin, “Anatomically Incorrect: Bodysnatching in the 19th Century”, Canada’s History, (2017), https:// www.canadashistory.ca/explore/science-technology/anatomically-incorrect-bodysnatching-in-the-19th-century. 388 Beaton, Great Living, 19-20. 389 General Yang Sen in Beaton, Great Living, 20. 390 Beaton, Great Living, 20. 391 Ibid. 392 Austin, Saving China, 48. 393 Charles W. Service, “The Conference and Medical Work”, The West China Missionary News, 1924, 23.

58 network of 32 hospitals and dispensaries throughout Sichuan.394 With respect to Chengdu, the headquarters of the CMM mission, Charlie concluded that: The Chengtu Men’s Hospital in 1924 probably witnessed the best year in its history, at least as far as amount of work is concerned. And because of a larger staff than ever before it is also probably true that the quality of work done was better than heretofore. Certainly it is true that there was a greater division of work and that along specialized lines. Our plant and equipment have also improved immensely during recent years so that now we feel not only a great satisfaction in doing our work but we also feel our hospital is taking its place among the best in China.395 In 1924, Charlie was asked to prepare an article about his work for the annual report of the CMM. His reflections provided some insight into the life of a medical doctor living in Chengdu, and his words were prefaced with the acknowledgement that “when working in a large teaching hospital with nurses and other doctors, it is a very difficult task to write a report of one’s own work, for it is so intimately linked up with the work of the others.”396

Figure 21: Medical Faculty of West China Union University, October 1923 Far right first row: Dr. John Thompson; far right third row: Dr. Charles Service (Source: The United Church of Canada Archives, Toronto. 1999.001P/3312N. Medical Faculty of W.C.U.U., Oct. 1923. Francie Service)

The Canadian Methodist Hospital was a teaching hospital, and during the nine months of clinical training, this was when Charlie felt “our staff feels the pressure of hard work” for there are “three classes of nurses-in-training…two classes of senior medical students taking clinical work,” and “the teaching of these classes entails a vast amount of preparations as the teaching is chiefly done in the Chinese language.”397 Charlie shared his surgical practice and teaching responsibilities with Dr. E.C. Wilford. He also undertook the didactic teaching in obstetrics and gynecology and he “shared the clinical work in these subjects with Dr. Ada Speers of our W.M.S. Hospital”

394 Semple, The Lord’s Dominion, 331; The Globe, “Chinese Physicians Work for Missions: Are Graduates of Medical College of West China”, April 19, 1924, 18. ProQuest Historical Newspapers: The Globe and Mail. 395 C. W. Service, in Canadian Methodist Mission West China Reports of Work for the Year 1924, 94, 78.096C, Box 16, The United Church of Canada, Toronto, Ontario, Canada. The Canadian Methodist hospital was known under different names including the Chengtu Men’s Hospital, the Hospital for Men and Renji Hospital. 396 Ibid., 94. 397 Ibid., 94-95.

59 where he “also had the pleasure of assisting somewhat in the surgical side of its work.”398 The specialties of obstetrics and gynecology were two of the subjects Charlie studied during his postgraduate fellowship at Johns Hopkins University. In his report, Charlie would refer to his other commitments as the etceteras of a doctor’s life and these included:

• delivering health lectures to the general public • working with the Y.M.C.A. on city-wide campaigns focused on the welfare of babies, opium addiction and home hygiene • writing and distributing public health literature on preventable diseases such as malaria, cholera and tuberculosis • writing a book entitled A System of Case Taking for his senior medical students to standardize the recording of each patient’s history and examination results • acting as the medical editor of The West China Missionary News • working with other health care professionals to conduct physical exams of all the students and missionary families including the promotion of preventive medicine399 The message that “prevention is better than a cure” was strongly promoted within their own schools and the general public because it “brings to the attention of the people the fact that we are sincerely interested in the problem of prevention as well as the problem of cure.”400 The medical community estimated that two-thirds of all deaths in China were the result of plague epidemics and other preventable diseases.401 In an article written for the Canadian Journal for Medicine and Surgery, Charlie reasoned that: preventable diseases are social problems beyond the control of the individual. This means that the remedy is not alone the treatment of the patient by the individual doctor, but rather the broad treatment of the whole social organism by all the constructive forces available. Therefore public health education is the keystone. Without it social conditions cannot be improved, nor can many of the communicable diseases ultimately be stamped out. The rate at which diseases can be wiped out is determined by the amount of regulation which the people will observe. There has to be a specific amount of legislation. But restriction of personal liberty must be understood and supported by the public. It therefore becomes imperative to educate and inform on the modern discoveries regarding disease and to inculcate the idea of the intrinsic as well as the economic value of life.402 The medical staff held regular lectures to share preventive health strategies with the general public. In 1924, a two-day open house was held by the three Chengdu hospitals controlled by the CMM, and over three thousand visitors were welcomed at the Canadian Methodist Hospital

398 Ibid., 95. 399 Service, Canadian Methodist Mission West China Reports of Work, 94-96; “Senate Minutes”, West China Union University, (7 October 1926, #1976), http://divinityadhoc.library.yale.edu/UnitedBoard/West_China_Union_ University/RG011-275-4363.pdf. 400 Service, Canadian Methodist Mission West China Reports of Work, 96. 401 Service, “Public Health in China”, 371. 402 Ibid., 372.

60 for Men, the Women’s and Children’s Hospital and the Dental Hospital. Miss L.G. Hartwell, the superintendent of the Nursing School, provided this account of the evening session: Dr. Service gave the lecture while Drs. Kelly and Best ran the lantern [slides]. A description of the skeleton, the Circulation, the Nervous system, the organs and their functions, were first given. The life of the Fly, and the Mosquito were shown, and the mischief they do. Slides on Gonorrhea, Syphilis, and Tuberculosis were shown. The meeting lasted over an hour.403 This medical outreach was an extension of an interdenominational China-wide program co- ordinated by the Council on Health Education in Shanghai.404 Charlie served as the chair of the West China Council on Health Education and this included heading its Literature Committee to address “the formidable problem of public health” through the regular dissemination of information to their patients and the general public.405 His recent postgraduate training in preventative health at Johns Hopkins University provided the clinical background to promote this emerging field of medicine. And this was an area of medicine that Charlie had been promoting since 1912 when, as part of his document Our Great Vision for Our Medical Work, he had recommended “a doctor to give full time to public health and preventative medicine.”406

FURLOUGH: POSTDOCTORAL TRAINING (1927-1929)

In 1927, due to political unrest against foreign interests, the foreign consulates recommended that all foreigners including missionaries evacuate to Shanghai. The assessment of the United Church was to allow a small group of five missionaries to remain in the field, and Wilford was assigned to the position of dean of the Medical College. However, since Charlie had “remained on duty a year longer than usual, in order to prevent undermanning of the teaching staff in the Medical Faculty at Chengtu,” the Service family was instructed to take their regular furlough.407 Robina and William returned to Toronto, while Charlie spent a term at the London School of Hygiene and Tropical Medicine. This current placement in London, at this globally renowned public health research institution, was illustrative of the ongoing commitment of WCUU to forge multi-institutional collaboration with some of the leading global universities.408 During this furlough, Charlie once again attended Johns Hopkins University, and he also networked with the alma mater of many of the West China medical missionaries, the University of Toronto.

The Canadian members of the Board of Governors and the staff of the United Church were based in Toronto, and this facilitated discussions to further the education agenda of WCUU. In 1926,

403 L.G. Hartwell, “International Hospital Day”, 24. 404 Liping Bu, “Public Health and Modernization: The First Campaigns in China, 1915-1916”, Social History of Medicine, Vol. 22, No. 2, (August 2009), 308. 405 C.W. Service, “One of China’s Great Problems”, 42; “Minutes of the Annual Meeting of the West China Council on Health Education, January 19th, 1926”, The West China Missionary News, (March 1926), 20-22; Beaton, Great Living, 24. 406 Beaton, Great Living, 24. 407 The Globe, “Reassuring Tone in Cable Reports from Mission Field”, October 12, 1926, 13. ProQuest Historical Newspapers: The Globe and Mail. 408 “History: The Building”, London School of Hygiene and Tropical Medicine, https://www.lshtm.ac.uk/Aboutus /introducing/history/building.

WCUU appointed Charlie, President Beech and Mr. S.H. Fong, the principal of the Normal School, “as representatives of the University on the Council of Higher Education” based in Shanghai.409 This organization co-ordinated the activities of the various Christian universities located throughout China and in the later years of the 1920’s, they were advocating for a deepening level of coordination between member institutions. Charlie and fellow missionary E.W. Wallace, the secretary of the China Christian Educational Association, conversed with Flavelle, Rowell, Endicott and other church leaders about the proposal to consolidate regional efforts for “the elimination of any unnecessary duplication” and to put the emphasis on “maintaining quality of work rather than enrolling large number of students.”410 Subsequent to these conversations, at the October 1928 meeting of the Board of Governors in New York, it was “resolved that the Board of Governors finds itself in general agreement with the tentative plan prepared by the Council of Higher Education for the correlation of Christian Higher Education in China.”411

Aside from general church business, Charlie engaged with the staff at the Toronto General Hospital where the breadth of his clinical exposure covered technical skills in general surgery. This included thoracic surgery with two of the pioneers in this field, Drs. Norman Shenstone and Robert Janes.412 Canada was quickly becoming a global leader in thoracic surgical innovation, and in May 1929, Shenstone and Janes successfully performed a one-stage lung lobotomy, utilizing their invention known as the Shenstone-Janes lung tourniquet, on a patient suffering from bronchiectasis.413 This technique would revolutionize lung resection surgery and after publishing their findings, “within a few months, their development became knowledge in every major chest clinic in the world.”414

Montreal was another centre for thoracic surgery, and in 1928 Dr. Norman Bethune, a medical graduate from U of T, was accepted as a thoracic surgical fellow at McGill University, and he trained under Dr. Edward Archibald at the Royal Victoria Hospital.415 Archibald was world- renowned for his contributions to thoracic surgery, in particular extrapleural thoracoplasty, and during his eight-year tenure in Montreal, Bethune would also advance thoracic surgery with the invention of a number of surgical instruments including the rib shears.416 In subsequent years,

409 “Senate Minutes”, West China Union University, (3 June 1926, #1965), http://divinity-adhoc.library. yale.edu/UnitedBoard/West_China_Union_University/Box%20275/RG011-275-4363.pdf. 410 “Correlated Program for Christian Higher Education in China: A Summary of Proposals”, Council of Higher Education in China, (July 1928), 4, http://divinityadhoc.library.yale.edu/UnitedBoard/West_China_ Union_University/Box%20280/RG011-280-4424.pdf; The Globe, “Self-Determination in Chinese Schools, Urges Dr. Wallace”, October 5, 1927, 15. ProQuest Historical Newspapers: The Globe and Mail. 411 “Action taken by the Board of Governors”, West China Union University, (30 October 1928), http:// divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/Box%20280/RG011-280-4424.pdf. 412 “Brief History of Thoracic Surgery in Toronto”, University of Toronto, Department of Surgery, http://thoracic surgery.utoronto.ca/about/history.htm. 413 Norman S. Shenstone and Robert M. Janes, “Experiences in Pulmonary Lobectomy”, The Canadian Medical Association Journal, Vol. 27, No. 2, (1932), 138, 142. 414 Ken W. MacTaggart, The Globe, “Toronto Surgeons’ Find Helped King Recover”, December 12, 1951, 4. ProQuest Historical Newspapers: The Globe and Mail. 415 Shenwen Li, “Bethune, Henry Norman”, Dictionary of Canadian Biography, Vol. 16, University of Toronto/ Université Laval, 2011, http://www.biographi.ca/en/bio/bethune_henry_norman_16E.html. 416 Jean Deslauriers, F. Griffith Pearson and Bill Nelems, “Evolution of thoracic surgery in Canada”, Canadian Respiratory Journal, Vol. 22, No. 2, (2015), e8-e14; Shenwen Li, “Bethune, Henry Norman”.

62 the impact of Bethune would extend beyond the borders of Canada, and his world-wide reach would include his time in China, from 1938-1939, when he joined the 8th Route Army of the communist forces during the Second Sino-Japanese War. Bethune would later be honoured for designing a mobile operating theatre, to tend to wounded soldiers on the front lines, while also providing medical care to rural villagers and training Chinese health care personnel.417

Charlie returned to Chengdu, in the fall of 1929, with new medical textbooks and a thousand pages of clinical and lecture notes which he referred to as “invaluable,” as they have “loaded me up with lots of new ideas for working and for teaching.”418 The opportunity to discuss his most challenging cases with medical educators, and his clinical exposure in thoracic surgery, enabled Charlie to confidently return to China believing that “everything is right up to date.”419 A few months after his return to Chengdu, Charlie wrote a letter to one of the medical professors at U of T, and during a lecture, the students learned about a novel thoracic procedure Charlie performed on a patient in West China, and perhaps the operation was the first performed in all of China.420 The outcome of his operations were also mentioned in his familial correspondence:

I have had several big abdominal operations lately. I have two tomorrow and another on Tuesday in the Women’s hospital when I hope to do an operation that has never been done here in West China. Then I have one of those Thoracoplasty cases to be done soon, probably on Wednesday for an old chronic Empyaema. If I do that it will also be the first operation of its kind ever done up here or perhaps in China, for it is a comparatively new line of chest surgery. So there is nothing like trying. I myself learn more and more by experience and the patients do seem to get well. This is a great life.421

Another region where thoracic surgery was being performed was in northern China through the ongoing collaboration between Peking Union Medical College (PUMC) and Johns Hopkins University.422 The diffusion of thoracic surgery exemplified the commitment of the foreign medical workers to a global health vision based on the free flow of novel ideas and surgical practice. And as a medical professor, Charlie took great pride in knowing that even though his students were studying in an isolated region of China, separated by distance and the natural barriers of treacherous river gorges and mountains, they were exposed to the same medical knowledge as their fellow students sitting in a lecture hall in Toronto, Baltimore or Beijing. A promotional pamphlet for WCUU proudly proclaimed that “science may be said to have permeated the world when it has become an integral part of higher learning in as remote a spot as Chengtu, Sichuan.”423

417 Shenwen Li, “Bethune, Henry Norman”. 418 C.W. Service to Family (original letter), 6 October 1929. 419 C.W. Service to Family (original letter), 22 December 1929; 9 February 1930. 420 Rev. R.O. Jolliffe, “Dr. C.W. Service Memorial Service”, (Trinity United Church, Toronto: 23 March 1930). 421 Service in Beaton, Great Living, 31. 422 Lan Xichun, Gu Kaishi and Wu Yingkai, “History and Present Status of Thoracic and Cardiovascular Surgery in China” in International Practice in Cardiothoracic Surgery, eds. Wu Yingkai and Richard M. Peters, (Boston: Kluwer Academic Publishers, 1986), 23. 423 United Church of Canada, “Science Teaching is Helping to Develop China’s Leaders”, in Barnes, Intimate Communities: Wartime Healthcare and the Birth of Modern China, 1937-1945, 134.

The medical professors of WCUU were also committed to ensuring equal access to a good education, and one of the core values of the West China Mission was the education of female students. When Charlie returned to China in 1929, he was encouraged by the number of women registered in the pre-medical course, and he described these students as a “very bright lot.”424 Charlie would contend that the Chinese “possess an array of qualities which will someday place them in the forefront of nations,” and in an article published in The Globe in 1920, he suggested that one means of achieving this was gender equality in education. “These multi-millions in China” Charlie argued “must and will be educated, among whom not the least important are her women and girls who need equal opportunities with…Chinese men for education and service.”425 WCUU was the first co-educational inland university, and eight women were accepted as full- time university students in 1924.426 Ten years later, this number increased to 108 women and in terms of course selection, 45 percent of the female students were taking classes at the Medical- Dental College with 32 studying medicine and 16 enrolled in dentistry.427 This professional career path for women provided the opportunity, especially for economically disadvantaged women, to achieve a level of self-support and to operate in public spaces previously reserved for male citizens. As historian Nicole Barnes notes:

The authority of science proved to be one of the most useful tools to expand cultural assumptions about what women could and should do. In China’s encounter with western medicine – first as a distinctly foreign import in the early nineteenth century, then as an indigenized system of healing by the mid-twentieth century – scientific medicine…meant greater access to careers outside the home.428

An academic study into the life story of these female health care students, and their impact both on the direction of WCUU and sustainable medical, dental and nursing care, would significantly enrich our understanding of this historical period.

THE YOUNG PEOPLE’S FORWARD MOVEMENT

One of Charlie’s greatest joys was teaching and in November 1929, a decade after his cross- Canada tour to raise funds from Canadian nurses, dentists and doctors, he had the opportunity to be a professor at the newly opened Medical-Dental College. Charlie recognized, while he was an undergraduate student at Victoria College, the importance of fundraising to the overall success of the missionary enterprise. His student years, during the 1890s, was a critical period because even though the church was encouraged that their overseas work was inspiring recent university graduates to choose a missionary career, the institution lacked the financial resources to expand their overseas operations.429 In response to this institutional need, Frederick

424 C. W. Service to Family (original letter), 3 November 1929. 425 Charles W. Service, “The Needs of China; A Warning and a Call”, The Globe, October 23, 1920, 14. ProQuest Historical Newspapers: The Globe and Mail. 426 “WCUU Period 1910-1949”, West China Medical Center Sichuan University, http://202.115.44.126:8080/ wccmsbrief2.htm. 427 B. Louise Foster, “Woman’s College West China Union University 1934-1935”, The West China Missionary News, November 1935, 34. 428 Barnes, Intimate Communities: Wartime Healthcare and the Birth of Modern China, 1937-1945, 121. 429 Frederick C. Stephenson, Pray, Study, Give: Young People’s Forward Movement for Missions as advocated by the Students’ Missionary Campaign, (Toronto: William Briggs, 1897), 24.

Stephenson proposed that a new student organization be formed, and in 1895, Charlie along with Dr. Frederick Stephenson and Rev. Herman Warren founded the Young People’s Forward Movement (YPFM) to engage university students, and eventually the young people of the church, in fundraising activities in support of foreign missions.430

This university movement developed into an official department of the Methodist Church of Canada and while Canadian Methodism initially “demonstrated its great possibilities,” Charlie and the other founding members were encouraged that “several denominations in Canada, several in Great Britain, and at least thirteen in the United States, have now a vigorous Young People’s Forward Movement for Missions.”431 Stephenson would dedicate his life to this organization, and as a result of its fundraising achievements, he would later reflect that “the continued success and expansion of our West China Mission and the growth of the Young People’s Forward Movement have been concurrent.”432 From 1897-1925, the church raised over $3 million through the YPFM, and each decade resulted in a substantial increase in revenue: $482,316 was raised from 1897-1906, this increased to $1,031,322 from 1907-1916, and the period from 1917-1925 saw an additional increase to an amount of $1,594,489.433 This substantial fundraising base was an important revenue source to support individual missionaries, as well as the building fund for the Canadian Methodist Hospital in Chengdu, and other hospitals and schools throughout Sichuan.434

Figure 22: Founding members of the Young People’s Forward Movement Left to right: Rev. H.E. Warren, Dr. F.C. Stephenson, Dr. C.W. Service (Source: Service Family)

The Young People’s Forward Movement was also an important avenue for recruiting missionaries especially with its strong connection to Victoria College. At a large interdenominational meeting in Guiling, in the summer of 1903, Charlie was inspired by the

430 C.W. Service, “The Origin of the Young People’s Forward Movement for Missions”, Acta Victoriana, Vol. 25, No. 8, (1902), http://library.vicu.utoronto.ca/exhibitions/vic_in_china/sections/vics_commitment_to_west_china_ missions/the_young_peoples_forward_movement_for_missions_pray_study_give.html. 431 Ibid. 432 Stephenson, “Forward”, Our West China Mission, 13-14. 433 Stephenson, “The Thirtieth Annual Report of the Young People’s Forward Movement for Missions”, The 101st Annual Report of the Missionary Society of the Methodist Church, Canada 1924-1925, 83. 434 Stephenson, Our West China Mission, 14; Bond, Our Share in China, 62; Austin, Saving China, 97; Semple, The Lord’s Dominion, 328.

65 missiological vision to double the number of missionaries serving in China, and he relayed this message to the YPFM. Subsequently, in January 1904, at the eighth annual Mission Conference of Victoria College, Stephenson conducted a roundtable discussion on “Doubling the Missionary force of the Methodist Church within ten years,” and Charlie’s message was shared with the conference participants: “Here is an invitation, an opportunity, a challenge, to invest life to great advantage.”435 Dr. Hart, now retired as superintendent of the CMM, was one of the keynote speakers, and he also encouraged university graduates to consider a missionary career.436 Through these personal appeals and the strong leadership from the Student Volunteer Movement, the personnel assigned by the General Board of the Methodist Church increased within five years from 12 to 40 families, and the Women’s Missionary Society increased its workforce from eight to 30 single women.437 Among these recruits was Rev. Edward Wallace, the general secretary of the West China Christian Educational Union, and he would later serve as chancellor of Victoria College. Years later, members of the church community, including Chancellor Wallace and Dr. Beaton, would suggest that there was a direct correlation between “that vision which Charlie Service had put before us” and the significant increase in the number of new recruits sent to the mission field.438

One means of circulating missiological messaging, to advance fundraising and recruitment goals, was through the visual mass medium of the lantern show. Lantern slides were photographic images, reproduced or painted onto glass plates, which were individually placed into an image projection device known as a magic lantern, and then animated with narration or music to entertain, instruct and mobilize audiences. Within church circles, visual education was considered to be “the easiest and most natural method of missionary instruction” because as Stephenson noted, “everyone likes a picture whether in papers, books, on the wall, or on the lantern screen.”439 And for researchers, these pictures provide a visual window into an historical period and because they are important evidential documents, archivist Joan Schwartz encourages scholars to investigate “the context or history of the record and the broader functional universe in which it circulates and acts.”440 The societal impact of the lantern performances were often mentioned in the press, and in a 1913 article in The Globe, it was reported that “one of the most astounding features of the lantern department of the Young People’s Forward Movement is the tremendous growth in the interest taken in the lantern displays. Last year 132,000 people attended the missionary lantern lectures given all over the Dominion.”441 Another article in 1919 discussed the use of lantern slides as a fundraising tool, and the reporter documented that the Board of Governors of WCUU were:

435 Beaton, Great Living, 10-11. 436 The Globe, “The Fields are White: Harvesters are needed in Methodist Missions. Annual Conference at Victoria University Discusses Work Done and Outlook for the Future”, January 18, 1904, 7. ProQuest Historical Newspapers: The Globe and Mail. 437 Beaton, Great Living, 11. 438 Chancellor E.W. Wallace, “Dr. C.W. Service Memorial Service”, (Trinity United Church, Toronto: 23 March 1930); Beaton, Great Living, 11-12. 439 Stephenson, “The Thirtieth Annual Report of the Young People’s Forward Movement for Missions”, 74. 440 Joan M. Schwartz, “We make our tools and our tools make us: Lessons from Photographs for the Practice, Politics, and Poetics of Diplomatics”, Archivaria, Vol. 40, (1996), 52. 441 The Globe, “Over 100,000 people saw lantern displays: missionary lectures attract interest in all parts of the country”, December 13, 1913, 17. ProQuest Historical Newspapers: The Globe and Mail.

entertained at dinner last evening by Victoria College, together with a number of the leading doctors and dentists of Toronto interested in the promotion of a medical college in connection with the China institution…Dr. Beech spoke of the progress and development of the University from its small beginning in 1910, and showed lantern slides, which convincingly illustrated his theme. Then Dr. Service of the Canadian Methodist Hospital in Chengtu, immediately addressing the doctors and dentists present, explained the dire need of medical instruction in China.442 The Carleton University Library currently houses 193 hand-painted slides originally managed by Stephenson.443 These slides represent the three missions of The United Church of Canada: the West China Mission, the North Honan Mission and the South China Mission.444 The later two missions were smaller operations and were controlled by the Canadian Presbyterian Church until 70% of their congregations joined with the Methodists and Congregationalists to form The United Church of Canada in 1925.445

Figure 23: Example of a digitized lantern slide in the Carleton University Collection Clock Tower, West China Union University, Miss Lo and Dr. Fu in foreground (Source: John William Foster Fonds, Archives and Research Collections, Carleton University Library) The slides have been scanned and digitized to increase the accessibility of these photographic documents which are described as a “unique resource for researchers who wish to look into the history of the United Church of Canada missions in China. Images of medical work, educational efforts, missionaries, town projects, scenery etc. all help to visually explain this history.”446 To preserve the “multifaced nature of the photographic object,” the Carleton University collection describes the materiality and communicative power of lantern technology, and the university has purchased a Prado 500 projector to complement the online digital format.447

442 The Globe, “Urgent Need in W. China: Governors of Union Christian University Meeting in Toronto for Medical College: Strong Appeal Made to Representative Doctors and Dentists”, 5. 443 “John William Foster Fonds Lantern Slides”, Archives & Special Collections, MacOdrum Library, Carleton University, https://asc.library.carleton.ca/exhibits/john-william-foster-fonds-lantern-slides. 444 Some of the slides in the collection for the West China Mission include the captions: Dr. Charles W. Service and friend; first stones for Medical College at West China Union University; Chengtu Hospital ward in war time. 445 “History of The United Church of Canada”, Community and Faith, The United Church of Canada, https://united- church.ca/community-faith/welcome-united-church-canada/history-united-church-canada. 446 “Conclusion”, John William Foster Fonds Lantern Slides, Archives & Special Collections, MacOdrum Library, Carleton University, https://asc.library.carleton.ca/exhibits/john-william-foster-fonds-lantern-slides/conclusion. 447 Joanna Sassoon, “Photographic Meaning in the Age of Digital Reproduction”, Archives & Social Studies: A Journal of Interdisciplinary Research, Vol. 1, No. 0, (March 2007), 317; Schwartz, “We make our tools and our

Victoria University Library, located at the University of Toronto, has developed an online exhibit entitled Vic in China from scanned photographs furnished by descendant families connected to former missionary graduates. The Vic in China exhibit uses the scanned photographs to share the individual contributions of the former Victoria College students and then links their actions to the overall missionary outreach in health care, education and evangelical work. Supplemental text is garnered, from the missionaries’ memoirs and from period publications, to place the photographs within its historical context. The documents describing the Young People’s Forward Movement include: an official photograph of the three founders, a general article from The Missionary Campaigner, the official publication of the YPFM, and an article by Charlie, describing the origins of the movement, in Acta Victoriana, the student publication of Victoria College.448 Although the photographs “cannot tell the whole story of what life was like for the missionaries,” the curators suggest that the images: provide a flavour of the times, of the endeavors and of the many important accomplishments…If you travel to Chengdu and visit the Hart Memorial College, at the West China Union University, you will see emblazoned on the building in Chinese script the same motto that is inscribed on the Victoria College building, at the University of Toronto, “The Truth Shall Make You Free” - a tangible and enduring reminder of the legacy of the Victoria College missionaries.449 RETURN TO CHENGDU (1929-1930)

The missionaries, after the 1927 evacuation, were returning to a very different health care environment than the one they experienced after the 1911 evacuation when all medical facilities, except in Chongqing, were forced to close their doors.450 Within this 16 year period, WCUU had successfully trained the critical mass of medical graduates required to keep a large hospital like the Canadian Methodist Hospital operational, and these young Chinese doctors worked alongside Wilford, one of the few employees, who had remained in the field.451 Wilford was a skilled surgeon and at his 60th birthday celebration in 1944, after 35 years of service, the Chinese Government initiated a “unique memorial” to recognize his medical contributions to China.452 As reported in The Globe, a subscription was started “for the purchase of radium and [a] deep X- ray unit to supplement the work at the Chengtu university and hospitals, where Dr. Wilford has been at work during most of his missionary career.”453 As early as 1933, at the annual meeting of the United Church’s Board of Foreign Missions, Dr. T.H. Williams had reinforced the tools make us”, 58; “Lantern Slide Projectors”, Archives & Special Collections, MacOdrum Library, Carleton University, https://asc.library.carleton.ca/exhibits/lantern-slide-collection/lantern-slide-projectors. 448 “The Young People’s Forward Movement for Missions: Pray, Study, Give.”, Vic in China, Victoria University Library, http://library.vicu.utoronto.ca/exhibitions/vic_in_china/sections/vics_commitment_to_west_china_ missions/the_young_peoples_forward_movement_for_missions_pray_study_give.html. 449 “Introduction”, Vic in China, Victoria University Library, http://library.vicu.utoronto.ca/exhibitions/vic_in_ china/index.html. 450 Leslie Kilborn, “The Medical Services of the Canadian Mission in Szechwan”, 11. 451 The Globe, “Missionaries start on perilous journey through West China”, January 4, 1927, 14. ProQuest Historical Newspapers: The Globe and Mail. 452 M. Jane Scott, “Gift of Radium Unique Memorial for Canadian-Born Missionary M.D.”, The Globe, July 22, 1944, 7. ProQuest Historical Newspapers: The Globe and Mail. 453 Ibid; Ottawa Journal, “Missionary to China Gets $5,000 for Radium”, January 5, 1946, 4, https://www. newspapers.com/clip/15909347/dr-wilford-ottawa-journal-jan-5-1946/.

68 importance of procuring radium as a “measure against cancer,” and he “alluded to the death of one West China missionary by cancer” the previous year.454 Although the name of the missionary was not mentioned in The Globe article, it was well-known that dental missionary Dr. John Thompson was diagnosed with oral cancer, and within six months after departing China in March 1932, he died in Toronto.455

Charlie was appointed to the vacant surgical position in Chengdu, after Wilford was reassigned to Canada, in the spring of 1929. He arrived in November without his family, as it was decided that Robina would continue to live in Toronto while William attended high school. Their daughters were already settled into their careers and both Winnifred and Frances chose careers in teaching, and Margaret would follow her mother into the nursing profession. Since Charlie had recently undergone two serious operations in Toronto, he was encouraged to postpone his trip but unprepared “to retire from the service he loved,” and according to Dr. Williams, “seeing the need so great he could not remain away even at the advice of physicians and wishes of friends.”456 Charlie was returning “to his work in Chengtu…in connection with the Hospital and Medical College,” and President Beech interpreted his return as “an overwhelming compassion to relieve the suffering people who were sick here in China and to teach the students that they might go on with that work of alleviating the suffering of mankind. It was for that reason that he left his family and came here - a sick man himself - to bring others to health.”457

When Charlie returned to Sichuan, he was appreciative of a donation of $10,000, from Sir Joseph Flavelle, to restock the medical supplies and equipment in the hospitals. Flavelle’s involvement with the Toronto General Hospital made him cognizant of the operating needs of a hospital and while the medical missionaries were in Toronto, there was an opportunity to engage with the chair of the Board of Governors and other Methodist philanthropists such as J.H. Gundy of the Laymen’s Missionary Movement. Gundy had articulated in a speech to the business community a few years earlier that:

We have got some of the cleanest cut, cleverest, best educated men that this country every produced in its colleges over there…[and] if they are prepared to give their lives…the least we can do is to give them the tools with which to work, to give them medical equipment, to give them hospital equipment, to give them educational equipment, so that they can do a first-class job in the work they are undertaking.458

In an October 1929 cable to General Secretary Endicott, Flavelle gave these specific instructions for his donation:

You will be good enough to have a clear understanding that this is an extra amount over the normal appropriation which would be made for improvements and betterments in

454 The Globe, “Supply of Radium for China Sought”, April 8, 1933, 12. ProQuest Historical Newspapers: The Globe and Mail. 455 Kenneth J. Beaton, “Obituary, John E. Thompson D.D.S., L.D.S.”, The New Outlook, (October 1932). 456 T.H. Williams, “Dr. Charles Winfield Service”, The West China Missionary News, (1930), 39. 457 The Globe, “Departing Workers Honored by Church: Dr. Charles and Mrs. Service Guests of Trinity United Congregation”, June 20, 1929, 15. ProQuest Historical Newspapers: The Globe and Mail; Beech, “A Friend and Fellow Missionary Laid to Rest”. 458 J.H. Gundy, “The Forward Movement”, Address to the Empire Club of Canada, 15 January 1920, 20-35.

hospital equipment. The purpose of the subscription is not to take the place of the amounts which would be used from current resources, but as an extra, to help to take up the slack which has occurred over these disturbed, as well as preceding years.459

The slow return of overseas medical personnel meant that Charlie was the only surgeon, obstetrician and gynecologist working in Chengdu, and he found this to be a “very heavy responsibility for so many decisions have to be made alone.”460 This shortage of medical personnel was occasionally raised in his letters where he would suggest the names of potential recruits or he would express that “I only wish my good friends Shenstone or Janes were here to advise and help.”461 Even though his current situation was challenging, Charlie never wavered from his deep respect for the medical profession and the belief that “life goes merrily on, so to speak, with its ups and downs, its lights and shadows; and the life of the doctor and the nurse it is not an easy road to be sure but oh, the many compensations there are in saved lives, and repaired bodies. It is worth it all, is it not?”462

Charlie was continually sharing stories about this rewarding work with potential employees. It was Endicott’s opinion that Charlie had “spoken to more prospective missionary doctors and nurses than any other of our missionaries who have been serving the church in West China,” and through this ongoing engagement, “he was instrumental in sending many missionaries to the foreign field.”463 His recruitment strategies had transitioned through the years to respond to the changing needs of Canadian workers, and the altering political and social landscape. An article in The Globe reported on a 1902 student volunteer meeting in Toronto, to recognize recent student recruits, prior to their departure to the mission field. Charlie, the former secretary of the Student Volunteer Movement and co-founder of the Young People’s Forward Movement, used this opportunity to propose a potential new recruitment strategy to address “the lack in the curricula of the denominational colleges of a thorough course of study in the service of missions, and suggested, if a chair of missions could not be provided, that a collaborated lectureship be provided for the benefit of all students.”464 At the end of his career, as it was becoming increasingly more difficult to recruit permanent personnel, Charlie began to contemplate alternative strategies, to fill the medical gaps particularly when the work of the West China Mission was ‘being tragically restricted for want of finances.”465 In 1930, one of his recruitment ideas was to offer Canadian doctors the opportunity to engage in short-term medical assignments. These were envisioned as volunteer positions with the medical personnel agreeing

459 Sir Joseph Flavelle to Dr. Endicott (cable), 24 October 1929, Board of Governors of the West China Union University, 518, http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/ RG011-286-4493.pdf. 460 C.W. Service to Family (original letter), 25 January 1930. 461 C.W. Service, “Some Letters of Dr. C.W. Service”, 2 March 1930, The West China Missionary News, June 1931, 15. 462 Ibid., 17. 463 Endicott, “Memorial Service for Dr. C.W. Service”; The Globe, “Far from Family, Missionary Passes: Rev. C.W. Service was Outstanding West China Worker”, March 14, 1930, 15. ProQuest Historical Newspapers: The Globe and Mail. 464 The Globe, “Work in New China”, July 25, 1902, 6. ProQuest Historical Newspapers: The Globe and Mail. 465 Endicott, “Memorial Service for Dr. C.W. Service”.

70 to take a temporary leave of absence, from their Canadian medical practice for up to one year, to fill overseas openings in the health care system.

IMPACT OF THE MEDICAL GRADUATES

Due to the recent disturbances by nationalist forces, against the extraterritoriality rights of foreign missions, Charlie expressed some apprehension about his return to Sichuan. In an August 1929 report to the Board of Governors, Beech observed that although “West China was not in the main path of these forces, they have touched us in spots with destructive force,” and the returning missionaries would have been advised of the potential for cross-cultural discord.466 However, once Charlie arrived his apprehension soon dissipated, and he was very appreciative that the “people, students and Chinese staff in the university all seem very friendly and willing to co-operate, and the eagerness and efficiency of several of our Chinese doctors working with us are splendid and marks a new era in our work.”467 The West China Mission had to adjust to this new era, as they began to integrate these recent medical graduates, and one area that required a missiological shift was the salary levels of the Chinese doctors. In recognition of the fact these graduates “are very well trained…and are invaluable” to the health care system, Charlie argued that the salaries of the Chinese doctors, especially those with additional training, should be increased to reflect their position as valued colleagues.468 The training opportunities for medical personnel were expanding, and the new Medical-Dental College accounted for nearly half of the student body at WCUU by the early 1930s.469 Some of the medical graduates were also enhancing their knowledge in overseas universities through postgraduate courses in Canada, the United States and Great Britain.

The medical missionaries were also reacting to a new dynamic where the WCUU graduates were being offered outside medical positions, at higher salaries, and the West China Mission being critically understaffed could not afford to lose any more doctors. They wanted to retain the most promising graduates, to reduce the workload of the foreign doctors, and to expand their medical outreach in the Chinese community. As foreign medical workers were returning very slowly to Sichuan, this provided the current opportunity for a more rapid devolution of authority. Presently, their dispensary work was being effectively managed by one of their recent graduates, and there were plans to combine dispensary work with the WMS. This would enable, as Charlie noted in a letter to his family, the “combined staff to see 1,500 outpatients a week and so care in a more adequate way for the very poor.”470 The dispensary was targeted to open in early 1930 and “that desire was about to materialize when Dr. Service was taken from our midst. Because of the dearth of surgeons, it was deemed best to wait awhile” and the Union Dispensary opened

466 Dr. Beech, “Report of the West China Union University to the Board of Governors”, West China Union University, (Chengdu, 1 August 1929), http://chronicles.dickinson.edu/specproj/dsoninchina/wcuu.htm#. 467 C.W. Service to Family (original letter), 3 November 1929. 468 Ibid., 13 October 1929. 469 “The American Context of China’s Christian College and Schools, West China Union University”, Yale Divinity Library, http://divinity-adhoc.library.yale.edu/ChinaCollegesProject/descriptions.htm#westchina; “Students 1910-1939”, The West China Missionary News, (April 1939), 182. 470 Service in Beaton, Great Living, 22.

71 in October 1930.471 From January 1931 to January 1932, a total of 19,543 patients received medical treatment and this represented 8,856 women and 10,687 men.472

Figure 24: Members of the Graduate Association of WCUU 1929 (medical and dental) Dr. Service front row, third from right; Dr. Huang back row, third from left (Source: Service Family)

During this period, China was also moving towards educational sovereignty, to address the “besetting dread of the Chinese of foreign aggression in educational work,” and a new chapter was unfolding where WCUU started to transition from a university under missionary jurisdiction to an institution governed by the new educational policies of the Nationalist Government.473 The concurrent processes of rising Chinese nationalism and the expanding base of WCUU graduates provided the foundation for devolution, and certain responsibilities were transferred to satisfy the new government regulation that “a majority of the governing body of the university should be Chinese.”474 In 1927, the Senate was composed of 14 Chinese and 13 foreign representatives, and as reported in The Globe, “reorganization has been affected along lines agreeable to Chinese national aspirations…by adding Chinese professors, alumni and clergy to the Senate until these form a majority.”475

The devolution of responsibilities from the Canadian, American and British foreign workers to Chinese educators was a complicated process involving multiple stakeholders, and decision- making extended beyond the educators on the campus of WCUU, to include the national government in China and the foreign missionary organizations in their home countries. Even though it was the vision of the founding organizations that WCUU would ultimately become in “every sense a Chinese institution at such time as it shall be possible to leave it in the hands of Chinese,” agreeing to hand over all senior academic positions to Chinese educators proved to be a challenging and eventually elusive adaptive problem.476 It was not until 1952, after all the

471 “Report of the Union Dispensary”, Report of the Chengtu Hospitals Board: For the Year 1931, Chengtu, 23. 472 Ibid. 473 Yen, “An Example of Cooperation with the Chinese in Medical Education”, 1385. 474 G.W. Sparling, “University Registration”, The West China Missionary News, (February 1928), 22. 475 “Campus Items”, The West China Missionary News, (April 1927), 16; The Globe, “Chengtu Situation is Reported Quiet: Increased Enrollment in West China University Noted in Letter”, May 26, 1927, 16. ProQuest Historical Newspapers: The Globe and Mail. 476 Carson, “Mission Schools, Colleges, and Universities for Men and Boys: West China”, 95.

72 foreign workers departed and the Chinese government took over WCUU, that the complete devolution of power was achieved. CONSOLIDATION OF HEALTH SERVICES IN CHENGDU

The effective delivery of sustainable health care services requires a multifaceted approach, as many situations have both technical and adaptive components.477 The interdenominational missions had individually addressed the technical elements when they built the hospitals and dispensaries. However, due to the overlapping of services, an adaptive collective solution was required to ease the bottleneck hindering the delivery of efficient patient care and the clinical training of university students. This concern was manifested in 1929 because of the staff shortages following the recent evacuation, and this provided a level of urgency to push for corrective action.478

One of the joint mission projects under discussion was the consolidation of health care services in Chengdu. For large-scale social change to succeed, Petra Kuenkel and Kristiane Schaefer, in their paper Shifting the way we Co-Create, theorize that “when people work innovatively on a jointly agreed deliverable while tending to the quality of relationships through respect, trust and genuine listening” this is the time in the relationship when collective action is possible.479 Change often begins with a small group committed to a “leadership paradigm that is inspirational” and the Medical-Dental College appointed a special committee, to work on a new health care delivery mechanism, composed of President Beech and medical representatives from the five international missions.480 To successfully implement this operational change, each health care worker, drawn from different countries and denominations, needed to undergo a significant shift in both behaviour and outlook and in Beech’s assessment:

We all know that in conducting a medical school our hospitals are not located as they ought to be for the medical school. We ought to have them together. They ought to be co-operating together as one unit. But we are separated by distance and separated in many other ways. Recently we had been trying to get together. It is rather hard to move institutions. It is rather hard to move people after their ideals are set. But Dr. Service among us has always been ready when the going was the hardest just to say the right thing and to throw all his influence toward that ideal.481

This proposed union would improve the efficiency of their work, and it affected not only the individual doctors, dentists and nurses, but also their institutions including the hospitals, the dispensaries, and the Medical-Dental College. Charlie was encouraged by this development because, as he reflected in a letter to his family, “it is a dream that I have had for many years and

477 Heifetz, Kania and Kramer, “Leading Boldly”, 25. 478 Ibid. 479 Petra Kuenkel and Kristiane Schaefer, Shifting the way we Co-Create: How we can turn the Challenges of Sustainability into Opportunities, (2013), 17, https://www.researchgate.net/publication/313295059_Shifting_ The_Way_We_Co-Create_How_We_Can_Turn_The_Challenges_Of_Sustainability_Into_Opportunities. 480 Petra Kuenkel, “Leadership for sustainability: the art of engaging”, The Guardian, April 17, 2012; C. W. Service to Family (original letter), 3 November 1929. 481 Beech, “A Friend and Fellow Missionary Laid to Rest”.

73 it is now beginning to be realized.”482 Shortly after being appointed, the superintendent of the Canadian Methodist Hospital, Charlie wrote a document entitled Our Great Vision for Our Medical Work which envisioned moving beyond an isolated impact model and toward a collective health care delivery system. The document, written in 1912, outlined the need for adequate staff, up-to-date equipment including laboratory and X-ray facilities, a training school for nurses, a medical college, a doctor to give full time to public health and preventive medicine, and the “unification of the management and direction of all the hospitals in Chengtu.”483 All the other recommendations had been addressed, and the remaining piece of the vision was now being seriously discussed by the individual missions.

Once the missions agreed to proceed, it took only a few meetings to finalize their collective vision for integrated health care delivery. Author Stephen Covey posits a theory that social change happens at “the speed of trust,” and because this interdenominational group was able to reach an operational consensus, within one month, this reflected the foundation of trust developed over decades of respectful collaboration.484 The committee members were able to build from their previous union initiatives, where mission activities intersected through professional partnerships and personal connections.485 One insightful reflection on inter-mission collaboration was described, as early as 1910, when Rev. John W. Yost, of the Methodist Episcopal Church USA, reported on the early days of the educational union of the high schools:

While there have been necessarily differences of opinion, these differences have been adjusted amicably and I think without any doubt that all the representatives of the three missions who united are closer and warmer friends and fellow workers than they were a year ago…One characteristic of our committee meetings for the year which seems to be worth mentioning here has been that when any one or two members seriously objected to some method of procedure which a majority seemed ready to adopt, the majority when possible would frequently rule that the matter be delayed for a time till further light might be had. Sometimes it happened that by the next meeting we were able to agree unanimously.486

The committee reached a consensus for the individual missions to pool all of their resources related to medical work, including personnel, finances, equipment and drugs, and to replace their individual control with a joint hospital board. This new Chengdu Hospitals Board would have the authority to allocate all resources and to appoint all medical, dental and nursing staff associated with the seven participating hospitals and dispensaries.487 These institutions were currently managed under separate missionary societies:

482 C. W. Service to Family (original letter), 10 November 1929. 483 Beaton, Great Living, 17-22. 484 Stephen M.R. Covey in Kania, Hanleybrown and Splansky Juster, “Essential Mindset Shifts for Collective Impact”, https://ssir.org/articles/entry/essential_mindset_shifts_for_collective_impact. 485 “Build the collaborative governance structure”, Collaboration for Impact, http://www.collaborationforimpact. com/the-how-to-guide/phase-3-organise-for-impact/build-the-collaborative-governance-structure/. 486 Rev. John W. Yost, “Report of Union High School, Chengtu”, Minutes of the Third Annual Session of the West China Mission Council of the Methodist Episcopal Church: Chengtu January 19-24, 1910, (Shanghai: Methodist Publishing House, 1910), 45. 487 C.W. Service to Family (original letter), 10 November 1929.

• Hospital for Men (previously Canadian Methodist Hospital) - United Church of Canada Mission (General Board) • Women’s and Children’s Hospital - United Church of Canada Mission (Women’s Missionary Society - WMS) • Dental Hospital - United Church of Canada Mission (General Board) • Chengtu Eye, Ear, and Throat Hospital - Board of Foreign Missions of the Methodist Episcopal Church USA • Union Dispensary - United Church of Canada Mission (General Board and WMS) • University Dental Infirmary - West China Union University (Department of Clinical Dentistry of the College of Medicine and Dentistry) • Student Dispensary - West China Union University (United Church of Canada Mission - General Board and WMS; Board of Foreign Missions of the Methodist Episcopal Church USA; American Baptist Foreign Mission Society; Church Missionary Society of England)

The staff would be drawn from four countries: China, Canada, the United States and Great Britain.488 It was also agreed that the new Hospitals Board would continue to work towards the construction of a union teaching hospital close to the Medical-Dental Building. This idea was first introduced in 1924, and its purpose was to “make it the outstanding training hospital in this part of the world” through the consolidation of all the medical and dental work in Chengdu.489

The shift from an isolated impact to a collective impact model involves a systemic approach, and to reflect the changing vision of the collaborating organizations, a new non-profit structure was created.490 This organizational change decreased the oversight from the exogenous offices, located in the home countries, and transferred greater decision-making powers to the endogenous collective in Chengdu. And in order to create their envisioned management model, the next step was to convince their Home Boards that this missiological shift would significantly improve the impact and efficiency of medical services in Chengdu and enhance the clinical training of their students. A simultaneous gathering of key personnel, from the home offices of each of the missionary societies, was scheduled for January 1930 in Sichuan, and this provided the opportunity to pitch their collaborative model. Rev. J.H. Arnup, one of the Board of Foreign Missions’ secretaries, attended the meeting of the Canadian Mission Council, and “the scheme for co-ordination of all hospitals in Chengtu under one Board met with sympathetic and favourable consideration and it was resolved to adopt in general the scheme as presented.”491

Although Charlie was unable to work under this new unification structure, as he passed away a few months later, his fellow interdenominational committee members were successful in convincing their Home Boards to approve the consolidation of health care services.492 In the 1931 report of the Chengdu Hospitals Board, it was noted that this new collaborative health care

488 “Report of Hospital for Men”, Hospitals’ Board Chengtu: Report 1932, 4, http://divinity-adhoc.library.yale.edu/ UnitedBoard/West_China_Union_University/Box%20279/RG011-279-4410.pdf. 489 “Forward”, Report of the Chengtu Hospitals Board: For the Year 1931, 1. 490 Kania and Kramer, “Collective Impact”, 39. 491 “The United Church of Canada Mission Church Conference Mission Council”, The West China Missionary News, (March 1930), 22. 492 Beaton, Great Living, 22.

75 structure has provided “a much greater degree of co-operation and unity of direction, permitted a more satisfactory allocation of our staff members to their respective specialities, thus improving clinical instruction and contributing to a larger hospital service.”493 The Hospital for Men, previously controlled by The United Church of Canada, was now “composed of people belonging to 5 different missions and 4 nationalities,” and it was reported that “considering their various viewpoints, education etc. we get along very harmoniously. There is a good esprit de corps.”494 This shift towards collective action required the collaboration of Chinese health practitioners and foreign nationals drawn from three countries, and through this expanding global partnership in clinical health care, Charlie noted that “another milestone” was reached in the history of the West China Mission.495

THE FINAL DAYS

Charlie died on March 10, 1930, after suffering post-operative complications, following emergency abdominal surgery. As Charlie was the only surgeon in Chengdu, a local anesthetic was administered, and he directed the operation until the circumstances necessitated a general anesthesia.496 Charlie subsequently succumbed to peritonitis and in one of the newspaper articles in The Globe, it was reported that:

the death of Rev. Charles Winfield Service, pioneer medical missionary and founder of the medical college in connection with the West China University was announced by a cable message received yesterday from Chengtu, West China, by the United Church Foreign Mission Board. His death, which occurred on Monday, was due to ‘unavoidable complications following an operation - which was successfully performed.’497

Another article in The Globe reflected that the “leaders of the United Church of Canada and missionaries on furlough were shocked” to learn of his death, as they had just received a letter from him the day before asking for new personnel to be sent to the field. The newspaper article went on to say that “letters received this week bespeak the good health he was enjoying a month ago and operations which he himself was performing.”498 The chair of the Board of Governors, Sir Joseph Flavelle, being “deeply grieved to hear sad news of Dr. C.W. Service,” took a decision, along with the Board of Foreign Missions of The United Church of Canada, to bury Charlie on the campus of WCUU, the place where:499

During the last sixteen years in addition to his regular duties as a hospital surgeon he devoted all his time to teaching in the West China Union Medical College, and to working for the development of that institution. From the beginning of a project for a

493 “Chengtu Hospitals Board”, The West China Missionary News, (September 1932), 13. 494 “Report of Hospital for Men”, Hospitals’ Board Chengtu: Report 1932, 4. 495 C.W. Service to Family (original letter), 10 November 1929. 496 Beaton, Great Living, 33. 497 The Globe, “Pioneer Missionary Dies in West China: Rev. Charles Service Founded Medical College at Chengtu”, March 14, 1930, 4. ProQuest Historical Newspapers: The Globe and Mail. 498 The Globe, “Far from Family, Missionary Passes: Rev. C.W. Service was Outstanding West China Worker”, 15. 499 “Senate Minutes”, West China Union University, (3 April 1930, Correspondence), http://divinity-adhoc.library. yale.edu/UnitedBoard/West_China_Union_University/RG011-275-4365.pdf.

Medical College in West China, Dr. Service has borne an increasingly heavy share for adapting that growing institution to the complex situation in which it finds itself.500 At the time of his death, Charlie was the head of the departments of surgery, obstetrics and gynecology, and the Board of Governors recorded “the great loss that has come to the University…and its appreciation of his sterling qualities and the fine service he rendered medical education and suffering humanity as a Medical Missionary.”501 At the meeting of the West China Mission Council in Sichuan, the missionaries of The United Church of Canada discussed the commemoration of their colleague, and the following resolution was passed: “Resolved to recommend to the Home Board that the name of the completed Medical-Dental Building be the ‘Service Memorial College’ and that a brass plate be prepared and sent out to be placed in the completed building.”502 Dr. James Endicott, current general secretary of the Board of Foreign Missions and former moderator of The United Church of Canada, introduced the resolution at the Executive Committee Meeting of the Board of Governors, in New York in May 1931, where “it was agreed to commend the…resolution of the Mission Council, to the Board of Governors of the West China Union University for sympathetic consideration.”503 A commemorative plate was subsequently placed at WCUU in recognition of Charlie’s commitment to educate future generations of Chinese doctors, dentists and nurses. The Central Government of the People’s Republic of China nationalized WCUU in 1951, and the Medical-Dental College continued to transition until it was incorporated into the West China Medical Centre of Sichuan University, currently one of the top medical schools in the country.504 In describing the history of the West China Medical Centre, Sichuan University states that: the predecessor of the Centre…is West China Union University (WCUU), which was jointly founded in Chengdu by five Western Christian Missions from the United States, the United Kingdom, and Canada in 1910…Today, in the place where the Center originated, there stands a comprehensive medical institution with full range of medical disciplines, strong teaching faculty, excellent medical techniques, advanced diagnosis and treatment equipments, and powerful scientific research capacity.505 The continued commitment of Sichuan University to deliver “medical excellence” and to “create doctors who can provide that excellence for generations to come” was the same commitment affirmed by the medical missionaries over a century ago, and Charlie had such confidence in the

500 “Minutes, Rev. C.W. Service, B.A., M.D.”, Board of Foreign Missions, United Church of Canada, (April 1930). 501 “Board of Governors Minutes”, West China Union University, (4 July 1930 # G899), http://divinity-adhoc. library.yale.edu/UnitedBoard/West_China_Union_University/RG011-272-4330.pdf; “Minutes of the Executive Committee, Board of Governors”, West China Union University, (Toronto, 8 May 1930, #E865), http://divinity- adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-274-4343.pdf. 502 “Board of Governors Minutes”, West China Union University, (4 July 1930 # G899); United Church of Canada, General Council Archives Guide to Holdings Related to West China Medical Missions (1800-1950), 31; “Minutes of the Executive Committee, Board of Governors”, West China Union University, (14 May 1931, #E965), http://divinity-adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/ RG011-274-4343.pdf. 503 “Minutes of the Executive Committee, Board of Governors”, West China Union University, (14 May 1931, #E965). 504 Nathan Vanderklippe, “China’s history with missionaries forms modern Canadian relations”; West China School of Medicine / West China Hospital of Sichuan University, “About Us”, http://eng.cd120.com/a/aboutus/. 505 “About Us”, West China Medical Center Sichuan University, http://wcums.scu.edu.cn/about_en.asp.

77 ability of his students to provide quality health care.506 One of his final tasks was marking his student’s examination papers, and in a letter to his family, he indicated his delight that “the only girl in the clinical years of medicine…beat the boys” and received the top marks in third year.507 This student, Dr. Yoh Ih-chen, would be recognized as the first female medical graduate from WCUU, and she would later be appointed professor and eventually head of obstetrics and gynecology.508 Another student in fourth year was characterized to his family as “perhaps the best all-round and cleverest student we have ever had,” and Charlie had “an eye on him to train for surgery,” and he was also thinking of recommending him for postdoctoral studies at the University of Toronto.509 The positive impact of the recent medical graduates was also very encouraging, and he described the “splendid spirit prevailing…between the Chinese doctors, nurses and foreigners. Moreover the presence of several very efficient Chinese doctors…does ease the very heavy load for us all.”510 Charlie was clearly inspired by his students, and this provided some comfort in his final days, knowing that his responsibilities were being transferred to this next generation of capable Chinese health care professionals.

Figure 25: Chinese doctor and nurse in a ward located at the Canadian Mission Hospital in Chongqing (Source: The United Church of Canada Archives, Toronto. 2000.017P/120N. Nicole Barnes, Intimate Communities: Wartime Healthcare and the Birth of Modern China, 1937-1945,125) THE SERVICE FUND A special fund was established in Chengdu to honour Charlie’s commitment to disadvantaged patients identified in the dispensary for surgery. According to Dr. Williams, Charlie “was constantly pleading with the hospital management for financial consideration of patients who had appealed to his great heart. Indeed this was the real beginning of our appeal for the Samaritan Fund for he deposited money of his own to be used for operation fees for poor patients and we

506 “About Us”, West China School of Medicine / West China Hospital of Sichuan University. 507 C.W. Service to Family (original letter), 9 February 1930. 508 United Church of Canada Archives, “Administrative History of West China Medical Missions”, in General Council Archives Guide to Holdings Related to West China Medical Missions (1800-1950), Toronto, 7; “WCUU Period 1910-1949”, West China Medical Center Sichuan University, http://202.115.44.126:8080/wccmsbrief2.htm; “Staff List Spring 1949, College of Medicine and Dentistry”, West China Union University, 19, http://divinity- adhoc.library.yale.edu/UnitedBoard/West_China_Union_University/RG011-279-4407.pdf. 509 C.W. Service to Family (original letter), 9 February 1930. 510 C.W. Service to Family (original letter), 3 November 1929.

78 but enlarged the plan and appeal.”511 As a memorial to Charlie, the name of the Good Samaritan Fund was changed to the Service Fund, as “it has been given by the Chengtu community in memory of Dr. Service.”512 Official church policy towards hospital funding was shifting from its early days, when it was predominately a granting agency, to the current situation where the hospitals were encouraged to be self-supporting.513 Charlie agreed with the principle of striving for self-support and about two decades earlier, he had reasoned that “complete self-support may be far from possible for most of us involved in medical work, but I firmly believe that it should be an aim toward which we should steadily strive” and “those who can pay should pay according to means.”514 However, while their middle and upper-class patients could afford hospital care and contributed to the self- supporting status of the hospitals, the front-line medical workers were concerned about the ethical issues of accessibility and fairness because their poorer patients were finding it difficult to pay for medical treatment. This policy went against their social gospel principles and “support of this Fund helps the hospitals to care for the needy and distressed who look to hospitals for healing.”515 The medical community initiated an annual appeal recognizing that “with falling appropriations and increasing cost of drugs and equipment, we need your help that we may carry on the tradition that none worthy of help need be turned away.”516 Donations were received from the Chinese and foreign communities, and the targeted Chengdu institutions were the Canadian Methodist Hospital, the Women’s and Children’s Hospital, the Dental Hospital, and the Eye, Ear, Nose and Throat Hospital.517 Some of the rules for administering the funds included:

• that the name shall be the Service Fund • that the use of the money be reported in the West China News • the Orphanage children and Blind School students are legitimate claimants • chronic cases whose funds are exhausted may be helped • student cases are to be considered on the merits of each case518 In the May 1932 edition of The West China Missionary News, it was noted that $2,054 was raised in the previous fiscal year and distributed between the four hospitals.519 The Service Fund covered a variety of hospital fees including the surgical treatment of tuberculosis cases, cataract operations, the setting of broken legs, diphtheria antitoxin for children, dental care for gangrenous infections, mastoidectomy cases and tracheotomy procedures.520 The 1931 Report of the Hospitals Board provided this overview about the work at the Chengdu Dental Hospital:

511 T.H. Williams, “Dr. Charles Winfield Service”, The West China Missionary News, (April 1930), 39. 512 “Report of the Service Fund for the Past Year”, The West China Missionary News, (May 1932), 11. 513 Leslie Kilborn, “The Medical Services of the Canadian Mission in Szechwan”, 12. 514 C. W. Service, “Self Support”, 245, 247. 515 “Report of the Service Fund for the Past Year”, 14. 516 Ibid. 517 Ibid., 13-14. 518 Ibid., 13. 519 Ibid. 520 Ibid., 12.

The Hospital continues to draw patients from long distances, even from other provinces, necessitating as many as twenty days travel to reach Chengtu. The Chinese patients come from all classes of society. The better classes are able to pay the usual fees asked, but a considerable proportion of our patients receive treatments at reduced rates; whereas a number of poor patients are scarcely able to pay anything. This class are usually those most in need of treatment, since their treatment has been long neglected. It is in these cases, that the money from the Service Memorial Fund serves a worthy purpose.521 After Charlie passed away, Robina continued the family tradition of supporting hospital costs for deserving patients through contributions to the Service Fund. Although her direct involvement with the West China Mission ended in 1930, Robina continued to support the missionary enterprise through her association with the Women’s Missionary Society of Trinity United Church in Toronto, and she was also active in the Women’s Canadian Club and the Victoria College Women’s Association.522 In her final years, Robina lived with her daughter Margaret Smale until her death in March 1957.523 Although the missionary enterprise was a focal point in her life story, another lasting legacy from Robina’s life was her interest in art. Robina began to draw in her teenage years, and her art collection depicted a range of expressive charcoal drawings, including visually striking portraits and detailed animal artworks.

Figure 26: Charcoal drawing - Robina Service (Source: Service Family) THE NEXT GENERATION The opportunity for the next generation to work in China occurred when Bill Service approached the Canadian military in 1942, about serving overseas during the Second World War, and it was determined that he could consider his posting as a medical missionary to China, an allied country, as his contribution to the war effort. Bill was a medical graduate from U of T, and he had recently completed three years of postgraduate training at Toronto Western Hospital, the Toronto General Hospital, and the Hospital for Sick Children. After a journey by ship following the Atlantic route around the Cape of Good Hope, The Globe and Mail posted a notice indicating

521 “Report of Chengtu Dental Hospital 1931”, Report of the Chengtu Hospitals Board: For the Year 1931, 69; “Report of Hospital for Men”, Hospitals’ Board Chengtu: Report 1932, 4. 522 The Globe, “Mrs. C.W. Service: Spent 25 Years with Mission in West China”, 4. 523 Ibid.

80 that “Dr. Charles (Bill) Service, prominent Toronto medical missionary, and son of the late Dr. Charles W. Service, has arrived in Chungking.”524 Bill was initially assigned to Chengdu for short-term language training, and he also worked part- time at WCUU. While in Chengdu, Bill had the opportunity to attend the opening ceremony of the West China Hospital, and this would have been a special occasion for him, as this was the central teaching hospital envisioned by his father and his interdenominational colleagues in 1924.525 Today this hospital is known as West China Hospital of Sichuan University, and is also referred to as Huaxi Hospital or the International Hospital of Sichuan Province, and it is ranked as one of the largest single-site hospitals in the world.526 His main assignment was in Chongqing, the wartime capital for the Nationalist Government during the Second Sino-Japanese War. Bill was appointed chief surgeon and superintendent of the Canadian Methodist Hospital, and he also served as the chairperson of the International Relief Committee for the seven western provinces. This committee worked with the Canadian Red Cross, hospitals, schools, and universities to distribute medical aid to Chinese citizens affected by the war. Aerial bombings were frequent in Chongqing, and the hospital staff were treating injured citizens and soldiers, and the delivery of effective health care was further complicated because the hospitals were targeted in the air raids. The population had dramatically increased with the relocation of the national government to Chongqing and the city accepted a steady influx of refugees and soldiers. The Chinese doctors and nurses, trained over the past twenty-five years, were the predominate health care workers during this period. A report in The West China Missionary News recorded that in 1939, when Dr. Stewart Allen was the superintendent and the only Canadian doctor assigned to the hospital, “working with him [were] ten Chinese physicians, graduates of our West China Union University and other Colleges in China.”527 A veteran Canadian nurse, Irene Harris who had founded a Chongqing nursing school with Barbara McNaughton in 1925, described the expanding professionalism of the Chongqing nurses in her 1943 Work Report. After returning from furlough in 1943, she noted that “I have filled a more or less nonentity position, the Chinese nurses have risen to the place where they can be heads of departments, Superintendent of Nurses, Principal, Dean of School of Nursing, etc., etc., and …I have simply filled in, acting in an advisory capacity, standing behind them, making suggestions but letting them carry through.”528 Tang Chi Yuan was hired as the first Chinese superintendent of nurses at the Canadian Mission Hospital in 1937, and the statistics for 1939 indicated that she was supervising twenty graduates and seventy-three student nurses.529

524 The Globe and Mail, “Dr. Service in China”, February 19, 1943, 7. ProQuest Historical Newspapers: The Globe and Mail. 525 “Senate Minutes”, West China Union University, (3 April 1924, #1689), http://divinity-adhoc.library.yale.edu/ UnitedBoard/West_China_Union_University/RG011-275-4363.pdf. 526 “Outline”, West China School of Medicine / West China Hospital of Sichuan University, http://www.wchscu.cn/ details/50464.html. 527 Grace B. Rape and Edna M. Veals, “Medical Work in Chungking”, 221-222. 528 Irene Harris in Barnes, Intimate Communities: Wartime Healthcare and the Birth of Modern China, 1937-1945, 136-137. 529 Barnes, Intimate Communities: Wartime Healthcare and the Birth of Modern China, 1937-1945, 137; Rape and Veals, “Medical Work in Chungking”, 222.

Figure 27: Bill Service and Chinese colleagues, Canadian Mission Hospital, Chongqing (Source: Service Family) One of the medical missionaries previously stationed in Chongqing was Dr. Cecil Hoffman, and he and his wife Marie, a trained nurse, provided health care services in Sichuan from 1932-1947. Dr. Hoffman was from a second-generation missionary family, and his parents, Rev. A.C. and Minnie Hoffman, were involved with the West China Mission for 42 years and served in Renshou and Zigong.530 Rev. Hoffman was primarily assigned to evangelical duties, but he was also an accomplished builder, and he supervised a number of construction sites in Renshou, and he was one of the CMM employees overseeing the building of the Zigong Hospital. The construction of this medical facility was unique, as it was jointly financed from funds raised through Methodist sources in Canada and wealthy Zigong families connected to the salt mines.531 The hospital was completed in 1918, and a quarter of a century later, after their posting in Chongqing, Cecil and Marie Hoffman were assigned to the large 150 bed hospital where they provided medical services from 1943 to 1947. When reflecting on the history of the West China Mission, the strong connections between families stands out, and it was in 1903 that the Service and Hoffman families commenced a life-time of familial friendship, when Rev. A.C. and Minnie Hoffman travelled with the Service family up the Yangtze River to Sichuan.532 Fifty years later, these long-serving missionary families would be officially united through the marriage of their grandchildren, Ted (Service) Smale and Dorothea (Hoffman) Smale. The Service family would also be united with another missionary family in 1945 when Bill married Norma Thompson, the daughter of John and Ena Thompson. The West China Mission recognized Ena’s skills as “an expert designer” and under the industrial education program of the CMM, she organized an industrial group to augment the income of disadvantaged and marginalized women living in Chengdu.533 The CMM viewed these outreach programs as “development along the lines of self-help,” and this community enterprise produced clothing and household linens which incorporated the traditional blue-and-white embroidery known

530 G.E. Hartwell, “Evangelistic Work”, Our West China Mission, 278. The conventional form of Renshou is Jenshow and Zigong is Tzeliutsing. 531 R.B. McAmmond, “Jenshow”, Our West China Mission, 179; R.O. Jolliffe, “Tzeliutsing”, Our West China Mission, 208; Service, Our West China Mission, 392. 532 Service, “Letter from Rev. C.W. Service M.D., Houseboat on the Yang-tse River, China, December 18, 1903”, 27. 533 “Industrial Education”, Our West China Mission, 337.

82 throughout China for its striking colour and design.534 Later, Ena would serve as matron of Llewellyn Hall in Oshawa, Ontario, where she looked after the children of missionary families while their parents served in overseas missions. And as mentioned earlier in the paper, Norma’s father was “one of the pioneer dentists of the Mission,” and he also served as “one of the founders of the Dental Faculty of the West China Union University.”535

Figure 28: Bill and Norma Service with Irene Harris and nursing staff and graduates, Chongqing, 1948 (Source: United Church of Canada Archives, United Church Observer, Feb. 1, 1949, 7) Norma and Bill knew each other from their childhood days, as they were both born in Chengdu and were classmates at the Canadian School. After graduating from Ontario Ladies’ College, Norma attended U of T where she obtained a degree in social work. Her professional career focussed on children, and she was hired by the Children’s Aid Society of Toronto, as a child protection worker and was later appointed head of the Adoption Department. This experience in social work intervention was recognized by U of T, and Norma was recruited as a part-time sessional faculty member in the School of Social Work.536 Her trip to China took six months due to war time conditions, and in 1944 Norma sailed from New York to Europe, where she stayed for several months, until she was able to secure passage on a British troop ship to Egypt, where she again was delayed until passage was secured through the Suez Canal to Mumbai, India, and the final leg of her journey was by airplane over “The Hump,” the nickname given by allied pilots, for the dangerous supply route over the Himalayan Mountains to China. Their son, John, was born in 1946 and according to Bill, the family received excellent care from the Chinese doctors and nurses on the hospital staff. While living in Chongqing, a focus of her volunteer interests was working with the Canadian Red Cross and Norma’s interest in non-profit organizations, dedicated to improving the social situation of vulnerable people, would continue throughout her life.537 After returning to Canada, Norma was

534 Ibid., Ka Bo Tsang, Touched by Indigo: Chinese Blue-and-White Textiles and Embroidery, (Toronto: Royal Ontario Museum, 2005), 49; Catherine Pagani, “From Woodblock to Textile: Imagery of Elite Culture in the Blue- and-White Embroideries of Sichuan”, Canadian Art Review, Vol. 24, No. 1, (1997), 28. 535 “Minutes, Dr. and Mrs. C.W. McD. Service”, Board of Overseas Missions, United Church of Canada, (1952); “Minutes, Dr. John E. Thompson”, Board of Foreign Missions, (April 1933). 536 University of Toronto, University of Toronto Report of the Board of Governors for the Year Ended 30th June 1944, (Toronto: T.E. Bowman, 1945), 137, https://archive.org/stream/uoftreportgov1944univ/Uoftreportgov1944 univ_djvu.txt. 537 Her contributions to the non-profit sector were recognized by the town of Lindsay, Ontario when Norma Service was named Citizen of the Year. Additional details of her life will be included in the upcoming paper about the Thompson family.

83 also connected with the for-profit sector, and she was the first Canadian woman to sit on the board of directors of a financial institution. She was appointed in 1976 as a director of Victoria and Grey Trust Company, which was founded by the Flavelle family in Lindsay, Ontario.538 In 1948, the Services left Chongqing for their regular furlough in Toronto, where Bill pursued postgraduate training and obtained his FRCS (Fellow of the Royal College of Surgeons). They were to return, as part of the staff of WCUU, and their return was classified as pending in December 1949 with travel plans arranged for February 1950.539 However, the United Church was unable to secure entry visas for their personnel, and in June 1950 the church considered “Service a test case” but all attempts to obtain an entry visa were denied, and Bill officially requested a leave of absence and then permanently resigned.540 The timing of his resignation was directly tied to the closing of all operations of The United Church of Canada in China and the subsequent departure of all missionaries in March 1952.541 MISSIOLOGICAL TRANSITION The United Church of Canada was in a period of transition and it was the former missionaries, after decades of overseas engagement, who ultimately pushed for significant change in the church’s global vision. This was evident in the life story of Bill Service and he was a member of the Board of Overseas Missions when it transitioned, in 1962, into the Board of World Mission (BWM). This new structure shifted the church’s operations from a few mission fields to a general world response. From 1962-1972, Bill served, as a member and the first non-ordained chair of the BWM, during a period when the church was struggling to remain relevant to both a domestic and foreign community.542 While the global sphere was reacting to the restructuring of the international system following the decolonization of the overseas empires and the rapid formation of new nation-states, domestically Canadian society was also undergoing rapid change. “Challenged by the cultural upheavals of the 1960’s,” historian Don Schweitzer postulates that the United Church “did not cling defensively to its past and retreat into a sectarian posture. Instead, it remained open to Canadian society and active in it.”543

538 “Annual Report: Victoria and Grey Trust Company”, The Globe and Mail, February 6, 1976, B4. ProQuest Historical Newspapers: The Globe and Mail; “The Scotiabank Story”, Inside Scotiabank, https://www.scotiabank. com/ca/en/0,,476,00.html. Victoria and Grey Trust Company amalgamated with the National Trust Company, and was later purchased by the Bank of Nova Scotia. Sir Joseph Flavelle was the founding president of the National Trust Company and Henry Newton Rowell Jackman, the grandson of the Hon. Newton Rowell, was the chair of the board of National Trust, at the time of amalgamation, and he would later serve as the lieutenant governor of Ontario. 539 “Minutes, Dr. and Mrs. C.W. McD. Service”, Board of Overseas Missions, United Church of Canada, (1952); United Church of Canada Archives, General Council Archives Guide to Holdings Related to West China Medical Missions (1800-1958), 128-129, http://www.united-church.ca/sites/default/files/handbook_research-guide-westchina.pdf. 540 United Church of Canada Archives, General Council Archives Guide to Holdings Related to West China Medical Missions (1800-1958), 128-130. 541 The Globe and Mail, “Last Missionaries of United Church Leave Red China”, March 22,1952, 1. ProQuest Historical Newspapers: The Globe and Mail. 542 Rev. Donald Ray, “Letter to Dr. Service from the Deputy Secretary of the General Council”, United Church of Canada, May 1972. 543 Don Schweitzer, “The Changing Social Imaginary of The United Church of Canada”, in The United Church of Canada: A History, ed. Don Schweitzer, (Waterloo: Wilford Laurier University Press, 2011), 292.

At the time of the founding of the BWM, in 1962, an independent study was commissioned to provide a roadmap for the new organizational structure, and The Report of the Commission on World Mission was tabled in 1966.544 A second-generation West China missionary, Katharine Hockin, who was the dean of studies of the Ecumenical Institute of Canada, served on the commission and contributed the section on Revolutionary Changes in the 20th Century: Challenging Traditional Approaches to Missions.545 A key recommendation was for the church leadership to initiate “dialogue with people of other faiths” which was a natural maturation process from when cosmopolitan missionaries, like Robert Cornell Armstrong, had encouraged “a sympathetic investigation of things Eastern” because “of the similar movements of thought in the West.”546 Other recommendations included forming global partnerships with both faith- based and secular organizations engaged in sustainable development, contributing to humanitarian aid and disaster relief, and replacing missionary personnel with technical advisors. And after careful deliberation, this recalibrated mission was adopted enabling the United Church to transition into a responsive organization supporting national organizations, humanitarian relief operations, and long-term “strategic and catalytic” development projects initiated and managed by their global partners.547 The BWM reached out to a variety of potential partners and this included continuing to work in former mission countries. During the mid-1960s, India was the largest recipient of aid and Bill, on behalf of the BWM, toured India to meet with current and potential partner organizations, and he also liaised with the diplomatic corps while staying in the home of Canadian Ambassador Roland Michener.548 As India was a former mission field, the BWM was reassessing its previous relationships, and decisions were taken to continue with some groups and discontinue working with other organizations. For personnel like Dr. Robert McClure, a former second-generation medical missionary from the North Honan Mission in China, and a church medical worker in India since 1954, he continued to work in India until he permanently returned to Canada, to serve as the first non-ordained moderator of the United Church.549 His position, as the leader of the executive branch of the church from 1968-1971, provided a platform to disseminate to Canadian society the changing landscape of global mission. During this new era, the BWM initiated new relationships and implemented different delivery mechanisms. In 1964, the church supported a short-term humanitarian relief initiative of the World Council of Churches and $196,000 was donated, to this inter-church coalition of 250 member churches, to distribute aid to India in response to the Pakistan refugee crisis.550 The United Church also reached out to non-governmental organizations (NGOs), and a partnership

544 Ruth Compton Brouwer, “When Missions Became Development: Ironies of ‘NGOization’ in Mainstream Canadian Churches in the 1960s”, in Protestant Missions and Local Encounters in the Nineteenth and Twentieth Centuries, eds. Hilde Nielssen, Inger Marie Okkenhaug and Karina Hestad Skeie, (Leiden, The Netherlands: Koninklijke Brill NV, 2011), 265. 545 Vicki Obedkoff, “Katherine Hockin Lane: Companions on the Way”, Centre for Christian Studies, http://ccsonline.ca/2013/10/katharine-hockin-lane/#pope. 546 Robert Cornell Armstrong, Light from the East, 306. 547 C.W.M. Service, “An Address at the Sixtieth Anniversary Reunion, June 22, 1969”, 51-53. 548 Brouwer, “When Missions Became Development”, 267. 549 Neil Semple, “Robert Baird McClure”, The Canadian Encyclopedia, https://www.thecanadianencyclopedia.ca/ en/article/robert-baird-mcclure. 550 The Globe and Mail, “United Church Assists Needy in India, Africa”, December 31, 1964, 5. ProQuest Historical Newspapers: The Globe and Mail.

85 was developed with Action for Food Production (AFPRO), which was founded in 1966, as a technical response to the ongoing Indian droughts of the 1960s and “without consideration for race, caste, creed, or religion.”551 The five founding organizations were secular and faith-based groups including the National Christian Council of the Protestant Churches of India and OXFAM.552 The United Church was a founding donor in 1966, and from these beginnings, AFPRO evolved into a national development organization specializing in the delivery of water projects and biogas technology.553 Another relationship developed in 1968, when the Canadian Government replaced the External Aid Office with the Canadian International Development Agency (CIDA), now known as Global Affairs Canada. One of its first projects was with the United Church and the Malwa Economic Development Society (MEDS) in India.554 MEDS was founded in 1963 to deliver drinking water projects and in 1968, CIDA contributed $100,000 for portable drill rigs, and the church contributed a technical advisor.555 The United Church had been partnering with MEDS for a number of years, and a headline in The Globe and Mail stated that an Expert well-driller new-type missionary sent by United Church, and the article went on to report that “an experienced driller” was needed in 1966: in the central area of a country that has been plagued by a water shortage. He is to remain in Indore for about six months teaching Indians modern drilling techniques, then will return home…The church has sent an auto mechanic to Nepal; a chicken farmer and an agronomist to Brazil; a business administrator to a Zambian hospital, and a ceramic expert to India.556 Rev. James Ormiston, the personnel director of the BWM, expressed that “increasingly there is a place for the layman on the frontiers of missionary service.”557 These new types of relationships signified the transformation within the BWM but as the leadership of the church moved forward, there was a growing disconnect with the general membership. Historian Ruth Compton Brouwer talks about this communication challenge through the experience of Bill Service, in his position as chair of the BWM:

551 Raymond M. Myles and Anil Dhussa, AFPRO’s Field Guide to Biogas Technology, 3, https://www.ircwash.org/ sites/default/files/352.1-87AF-3568.pdf; “History”, Action for Food Production, http://www.afpro.org/aboutus/history/; Brouwer, “When Missions Became Development”, 268. 552 “History”, Action for Food Production, http://www.afpro.org/about-us/history/. 553 Myles and Dhussa, AFPRO’s Field Guide to Biogas Technology, 4; “Water and Sanitation”, Action for Food Production, http://www.afpro.org/water-sanitation/; “Renewable Energy”, Action for Food Production, http://www.afpro.org/renewable-energy/; Soma Dutta, Ibrahim H. Rehman, Preeti Malhotra, and Venkata Ramana, Biogas, The Indian NGO Experience: AFPRO-CHF Network Programme, (New Delhi: Tata Energy Research Institute, 1997), xiii. In the 1980’s, Elizabeth Service managed a biogas project implemented by AFPRO and financed by CIDA, the Canadian Hunger Foundation and Indian State Governments. A network of multisectoral partners utilized a collective impact strategy to disperse Deenbandhu biogas technology throughout India. 554 United Church of Canada Archives, Series 8–Records Relating to India, Board of World Mission, https://catalogue.unitedchurcharchives.ca/records-relating-to-india; Clyde Sanger, Half a Loaf: Canada’s Semi-Role Among Developing Countries, (Toronto: The Ryerson Press, 1969), 129; Brouwer, “When Missions Became Development”, 268. 555 Brouwer, “When Missions Became Development”, 269. 556 The Globe and Mail, “Expert well-driller new-type missionary sent by United Church”, March 19, 1966, 20. ProQuest Historical Newspapers: The Globe and Mail. 557 Ibid.

Throughout the 1960s, the BWM had struggled to tutor its Canadian constituency into a new understanding of mission. Yet as it entered the new decade, Board spokesmen experienced a sense of frustration that their message was not being heard. As Board chairman in 1971, C.W.M. Service, a practising surgeon in Lindsay, Ontario, and a former China medical missionary, gave an address on ‘The Changing Face of Mission.’ In it he declared that ‘the man in the pew’ was ‘still generally living with a Nineteenth Century concept of Mission.’ Even the clergy seemed unaware of ‘what this Board is doing and what it stands for in the 70’s. The communication gap is colossal.’ To illustrate his message, Service presented a ‘Then’ and ‘Now’ list: a list of the ways that missionaries, and understandings of mission, had changed in the course of a century.558 As part of their strategy to communicate “the changing face of mission” emerging at the church’s head office in Toronto, the United Church restructured its overseas delivery mechanism for the second time in a decade. In 1972, the Division of World Outreach was established, and the word mission was removed from the name to reflect the concept of reaching out and working with a variety of global partners. The Executive of the General Council appointed Bill the founding chair because “with your experience as Chairman of the Board of World Mission,” the church leadership contended it would “be possible right from the beginning of the life and work of the Division of World Outreach to have the wisdom and guidance in the affairs of the Division fulfilled in your very capable way.”559 The United Church periodically reassesses its relationships with its global partners to ensure it remains relevant within a dynamic world context because the global realities of “our world and the way we engage in it is, after all, continually changing.”560 The church initiated its last review in 2008, to evaluate the principles and practices of its “partnership model,” and placed the engagement of the West China Mission and other mission fields within the following context: The United Church of Canada has been involved in global mission through its founding churches since late in the 19th century. While the church inherited traditional understandings of the missionary gospel imperative, the turn of the century brought to the foreground of the new Canadian church the message of the social gospel and the desire to serve the physical and social well-being of people throughout the world. The early expressions of mission therefore involved Canadian missionaries serving the social, medical, and educational as well as religious needs of people in foreign lands. As the growing Christian communities became larger national churches, and as medical and educational institutions developed local indigenous leadership, missionaries stepped aside from direct leadership roles in overseas communities.561 This review produced a document entitled Statement and Affirmations on Global Partnership, and affirmed that because the United Church has “been involved in global partnerships, through

558 Brouwer, “When Missions Became Development”, 279; C.W.M. Service, “An Address at the Sixtieth Anniversary Reunion, June 22, 1969”, 51-53. 559 Rev. Donald Ray, “Letter to Dr. Service from the Deputy Secretary of the General Council”, United Church of Canada, May 1972. 560 “Introduction”, Renewing Partnership in the Context of Empire, (Toronto: The United Church of Canada, 2009), 5. 561 “The United Church of Canada and Global Partnership - A Short History”, Renewing Partnership in the Context of Empire, 8.

87 our antecedent denominations, since before church union in 1925,” our “partnerships grow from our history and experience of collaboration with others. We are one partner among many, journeying together in humility toward relationships that are just, honest, respectful, and life- giving.”562 This document currently guides the global engagement of The United Church of Canada. IMPACT ON CANADIAN SOCIETY While the global mission of the United Church was being recalibrated by Bill Service, Katharine Hockin and Bob McClure, other former missionary personnel were providing leadership in a myriad of organizations. The emergence of Canada, as an influential middle power, was significantly shaped by the sons and daughters born in China to missionary parents. These individuals “had the opportunity to travel widely,” and Bill Service would contend that since “our school was set in the midst of an old and great culture…this contact with another great people and their thought was of inestimable value.”563 The offspring of missionaries according to historian Jane Hunter “combined both a deep commitment to Asia, born of their own early experiences and identifications, and a kind of cultural fluency, an ability to see the world conditioned by the receptive brains of children first noticing the larger world around them.”564 The missionary enterprise left a traceable footprint both in China and Canada, as these individuals eventually became internationalists in reverse within Canadian society.565 Their parents had set sail as idealistic university graduates and in the case of the medical missionaries, it was to disseminate medical care and education. Along their journey, they transitioned into international citizens who became advocates of global interdependence encouraging Canadians to realize that “we are living in a great bundle of nationhood nowadays” and as Charlie Service suggested, “what is the concern of one is the concern of all.”566 This global humanitarian vision influenced their bicultural children and historian David Hardiman argues that it was this “strong belief in social duty, social reform, and sympathy for the weak and powerless” that may be the most enduring contribution of medical missionaries as “today such a spirit lives on in the work of dedicated non-governmental workers – Christian and non-Christian alike – throughout the world,” and a reflection of this spirit is evident in non-governmental organizations such as Doctors Without Borders.567 Hollinger refers to this as the boomerang effect where Protestant “missionaries tried to change the world” but they were themselves transformed after living abroad, and they subsequently “challenged many of the Home Truths dear to the folks who had remained at home. During the middle decades of the twentieth century, missionary-connected individuals and groups broadened the perspectives of the American public,” and Hollinger traces the career path of

562 “Global Partners”, The United Church of Canada, https://united-church.ca/community-and-faith/welcome- united-church-canada/partners-mission/global-partners. 563 C.W.M. Service, “An Address at the Sixtieth Anniversary Reunion, June 22, 1969”, 47-49. 564 Hunter, “Introduction: Christianity, Gender, and the Language of the World”, 315. 565 Terrill B. Lautz, “The SVM and Transformation of the Protestant Mission to China”, in China’s Christian Colleges: Cross-Cultural Connections 1900-1950, eds. Daniel H. Bays and Ellen Widmer, (Stanford: Stanford University Press, 2009), 19. 566 Service, “Some of China’s Problems”, 369-384. 567 David Hardiman, “Introduction”, in Healing Bodies, Saving Souls: Medical Missions in Asia and Africa, ed. David Hardiman, (Amsterdam: Editions Rodopi B.V., 2006), 49.

88 second-generation Protestant missionaries in the foreign service, universities, the civil rights movement, journalism, and the arts.568 Within the Canadian context, there was also a boomerang effect and some missionary-connected individuals returned to university campuses, as professors and administrators, establishing East Asian programs and encouraging educational exchanges.569 Others inspired the 1960s movement towards secular international development causes with home offices based in Canada and within the international structure of the United Nations.570 And a number of individuals joined the Department of External Affairs, currently referred to as Global Affairs Canada, and while the former China-based missionaries working at the American State Department were purged during the anti-communist McCarthy era, the Canadians, known as the China mish kids or old China hands, became persuasive champions guiding the process of engagement with China. This was in sharp contrast to the American policy of isolation and containment.571 During this period, the United Church continued to lobby the Canadian government to recognize the People’s Republic of China. Their positive messaging was evident in 1969, as the topic for their annual congregational study was Understanding China and the Chinese People. “Surely this is significant” Bill Service would suggest “of a large desire on the part of the United Church to bring about a greater degree of appreciation and understanding.”572 Canada normalized relations with the People’s Republic of China on October 13, 1970. This decision was influenced by Prime Minister Pierre Elliott Trudeau’s position that China would become “one of the two or three most influential countries in the world. For that reason, it must not be allowed to assume that it is without friends.”573 The bilateral negotiations were held in Stockholm over a 20 month period, and the chief Canadian negotiator was an old China hand from the West China Mission, Robert Edmunds.574 After numerous rounds of negotiations, a joint communique between Canada and China was signed, and 30 countries would later use the same wording, referred to as the “Canadian formula,” in their own bilateral agreements.575 The distinguished Chinese diplomat Huang Hua was the first Chinese ambassador to Canada and in his memoirs, he noted that Canada “played a positive role in promoting the establishment of diplomatic relations between the overwhelming majority of Western countries and China, thus ushering in the third tide of China's establishment of diplomatic relations with foreign countries.”576 Subsequent to normalizing relations, Canada appointed Ralph Collins, John Small

568 David A. Hollinger, Protestants Abroad: How Missionaries Tried to Change the World but Changed America, (New Jersey: Princeton University Press, 2017), xi. 569 Alvyn Austin, “Missionaries, Scholars, and Diplomats: China Missions and Canadian Public Life”, in Religion and Public Life in China: Historical and Comparative Perspectives, ed. Marguerite Van Die, (Toronto: Toronto University Press, 2001), 145-146. 570 Brouwer, “When Missions Became Development”, 281. 571 Paul M. Evans, Engaging China: Myth, Aspiration, and Strategy in Canadian Policy from Trudeau to Harper, (Toronto: University of Toronto Press, 2014), 11; Aileen McCabe, “Decision to recognize China a watershed movement for Canada and the People’s Republic”, Postmedia News, October 9, 2010, http://www.canada.com/ life/Decision+recognize+China+watershed+moment+Canada+People+Republic/3647075/story.html; B. Michael Frolic, “Canada and China at 40”, Asia Colloquia Papers, Vol. 1, No. 1, (Toronto: York Centre for Asian Research), 10, https://ycar.apps01.yorku.ca/wpcontent/uploads/2013/09/Asia_Colloquia_Papers_Frolic.pdf; Austin, “Missionaries, Scholars, and Diplomats”, 144. 572 C.W.M. Service, “An Address at the Sixtieth Anniversary Reunion, June 22, 1969”, 51. 573 Pierre Elliot Trudeau in Evans, Engaging China, 25. 574 Robert Edmonds, “Negotiations For Canadian Recognition of the People’s Republic of China”, Canadian School in West China, 286-287. 575 McCabe, “Decision to recognize China a watershed movement”. 576 Huang Hua in McCabe, “Decision to recognize China a watershed movement”.

89 and Arthur Menzies, all born in China to missionary parents, as the first three Canadian ambassadors from 1971 to 1980.577 Following in their ambassadorial footsteps was David Mulroney, and during his posting, the Canadian Embassy and the Old China Photo Project organized in 2012 receptions in Beijing and Chengdu, to showcase a photo exhibition of missionary activities in Sichuan. This included the opening of the China Museum of Stomatology located on the campus of Sichuan University and representatives from missionary families attended these events.578 Revisiting their Chinese roots has created an interesting dynamic where bicultural memories of residing in China have been juxtaposed against the current reality of being observers of modern China. In May 1978, the Service family followed this typical pattern when Bill organized a tour on behalf of Fleming College.579 Three years earlier, Fleming College had awarded a Fellowship in Applied Education to Bill noting that his life “extended the normal bounds of the Hippocratic oath…to the benefit of the local, national and international community.”580 It was 30 years since Bill and Norma had been to China, and just five months after their tour, Bill passed away in October 1978.581 “In recognition for his admiration and affection for China and her people,” the tour participants raised funds for the donation of medical books to the library of Chongqing Hospital Number 5.582 This was the hospital where both Bill and his father had served as superintendent, and historian Alvyn Austin would suggest that “sometimes brilliant parents begat a missionary dynasty…Dr. Charles Winfield Service, who died at his post after thirty years of service, fathered Dr. Charles William Service, known as Bill; both were remembered as gentle souls who made the world a better place by having passed through it.”583

Figure 29: Bill Service visiting a hospital (1978) Figure 30: Donation to Hospital Number 5, Chongqing (Source: Service Family)

577 Austin, “Missionaries, Scholars, and Diplomats”, 145. 578 Bill and Norma’s daughter Francie was part of this tour organized by the Old China Photo Project and the Canadian Embassy in Beijing. 579 Fleming College was originally known as Sir Sanford Fleming College. The main campus is in Peterborough, Ontario with several satellite campuses, one of which is in Lindsay, Ontario, Canada. 580 Elizabeth Clarkson, Chairman, Board of Governors, “Citation: Dr. Charles William McDonald Service Fellowship in Applied Education”, Sir Sanford Fleming College, Lindsay Convocation, May 10, 1975. 581 Bill and Norma’s daughter Elizabeth was one of the participants on the 1978 tour to China. 582 The dedication in the medical textbooks donated to Chongqing Hospital Number 5. Mr. Bill Small, Vice- President of York University, contacted the Dean of the Medical Faculty of the University of Toronto and the Chinese Embassy in Ottawa for their assistance. Bill Small was born in China and posted to Chengdu in 1941 and worked at WCUU for ten years. 583 Austin, Saving China, 170-171.

RENEWED INTEREST IN THE MEDICAL LEGACY The 21st century has seen a renewed interest in the medical legacy of the missionary enterprise and the narrative potential of photography through the opening of museums, the publishing of books, the production of documentaries, the creation of online exhibits and the touring of physical photo exhibitions. The photographic images, which were inactive for more than half a century within the formal institutional archives of The United Church of Canada and the in- formal private family collections, are currently re-entering the public sphere. Photographs are embedded in story-telling and British archivist Elizabeth Edwards posits that photographs “literally unlock memories and emerge in multiple soundscapes…thus enabling knowledge to be passed down, validated, absorbed and refigured in the present.”584 The current circulation of photographic documents, within the context of the West China Mission, is unlocking memories of the transnational health care partnership developed over a century ago.

And as the photographs leave the private domain and enter into the public sphere, they are transitioning from apocryphal family story-telling into historical photographic objects. Rather than viewing the photograph as the passive visual confirmation of an action, Australian archivist Johanna Sassoon suggests that photographs are active “historical documents that have accumulated a range of meanings over their lives from the interactions between their content, the contexts in which they have been placed and used, and their photographic or published formats.”585 A single original photograph can become multiple prints, and as Canadian archivist Joan Schwartz articulates: Identical prints, each a complete original, can be made at different times for different purposes to circulate in different discourses – commercial, scientific, political, economic, journalistic, aesthetic – and may even serve diametrically opposed functions. Each time a negative is printed, each time a print is used, the photographic image is transformed into a photographic document created by an author with a purpose to convey a message to an audience.586 The captioning of the image, and its placement in the written text or museum setting, reflects the distinct vision of each author, and as Sassoon posits “simply re-writing captions is one demonstration of how different contexts can frame the meanings of multiple originals of the same photograph.”587 Within the context of the West China Mission, a number of photographs can be classified as historical documents because of their extensive social biography, accumulated from multiple uses in print and digital formats, and the framing of the different photographic messages can be traced for over a century. Each time these historical photographs of the West China Mission are reproduced, the “range of meanings” of the photographs are extended through books, photo

584 Elizabeth Edwards, “Photographs and the Sound of History”, Visual Anthropology Review, Vol. 21, Numbers 1 and 2, (2005), 39. 585 Joanna Sassoon in Emma Hamilton-Hobbs, “Joanna Sassoon, Agents of Empire: How E.I. Mitchell’s Photographs Shaped Australia”, Archivaria, Vol. 85, (2018), 196. 586 Schwartz, “We make our tools and our tools make us”, 51-52. 587 Joanna Sassoon, “Becoming anthropological: a cultural biography of EL Mitchell’s photographs of Aboriginal people”, Aboriginal History, Vol. 28, (2014), 71.

91 exhibits, and museum displays, and the different messaging reflects the views of those organizations currently writing the photographic captions and controlling the story-telling narrative.588 Whereas previously the photographic archives and messaging of photo images were controlled by the Methodist Church of Canada and then The United Church of Canada, the current messaging is scripted by a myriad of individuals, organizations and institutions located in Canada and China. Deciding “what the future will know of the past” is not a passive neutral exercise because as Joan Schwartz and Terry Cooke note, each time a narrative is created it reflects the views of those with “the power to privilege and to marginalize…the story-telling narratives that give cohesion and meaning to individuals, groups, and societies.”589 Assigning fictional achievements to one individual marginalizes the factual life story of another, and the more often an embellished story is viewed, this increases the possibility of it morphing into myth.590 It is for this reason that science biographers Héloïse Dufour and Sean Carroll, in their article Great myths die hard, propound that “storytellers – journalists, authors, film-makers, scientists and educators – need to be vigilant when it comes to their sources” to ensure the circulation of historically accurate stories.591 And with more of the archival documents being digitized for online access, this increases the opportunity for the verification of facts and facilitates the discovery of new historical evidence. While the factual contributions of individual missionaries to the overall collective of the West China Mission does not change, the interpretation of this evidential trail does and the sorting out of ideas, within a contemporary context, influences the evolving narrative of historical understanding.592 FUTURE RESEARCH This paper could be significantly strengthened with the inclusion of Chinese archival information located at Sichuan University and the hospitals in Chengdu, in particular, Chengdu Hospital Number 2. One area that would benefit from additional China-based facts is the captioning of the photographic images. These photographs are included in the paper to provide visual context to the structures of the West China Mission and to identify key individuals included in the narrative. Some of these photographs reflect an extensive social biography and are important historical documents. These include the depiction of the Canadian Methodist Hospital and its staff in Figures 9 and 10, and the first staff and students of the Medical College at WCUU in Figure 12. However, the Canadian-centric captioning of Figure 10 identifies the four Canadian employees but does not identify the Chinese personnel standing on the steps. This bias is also reflected in the captioning of Figure 12 which provides the names of the five North American members of the teaching staff of the Medical College but the seven Chinese medical students, who were part of the pioneering class, remain nameless. As noted in the introduction, the overarching emphasis on Canadian contributions is a weakness of this paper, and hopefully additional information, to identify these Chinese individuals and their contributions to

588 Sassoon, in Emma Hamilton-Hobbs, “Joanna Sassoon, Agents of Empire”, 196. 589 Joan Schwartz and Terry Cooke, “Archives, Records, and Power: The Making of Modern Memory”, Archival Science, Vol. 2, (2002), 13. 590 Heloise Dufour and Sean Carroll, “Great myths die hard”, Nature, Vol. 502, No. 7469, (2013), 33. 591 Ibid. 592 Tim Cook quoted in “What do we lose if we forget?”, The Agenda with Steve Paikin, TVO, November 11, 2020; William Lewis Morton in A. Brian McKillop, “William Lewis Morton”, The Canadian Encyclopedia.

92 sustainable health care, is available in the institutional archives in China and can supplement the information in this paper. A forthcoming paper expands the section discussing the dissemination of dentistry. This was a unique initiative between Canada and China, and the paper begins with a discussion of the social gospel principles guiding the introduction of public health dentistry in both countries. Downtown Toronto was the site of North America’s first free dental hospital in 1872, and this Methodist humanitarian initiative would provide a conceptual framework, for the global dental missionaries disseminating dental public health in China. And four decades later, the trailblazing spirit of Canadian dentists was once again reflected with the opening of China’s first dental hospital. Although clinical dentistry was the initial focus of the CMM, the dental missionaries were very cognizant that the connecting link, to sustainable dental care, was the education of well-trained Chinese leaders. The collective impact from China’s first university-level dental program is examined from its initial vision to serve the regional needs of western China, to its national reach through the training of students from different regions of China, who then instituted university-level education at a network of universities, and finally to its global outlook through the training of international students. Throughout the narrative, the Thompson family and Dr. Huang Tianqi, the first Chinese dental graduate, are the connecting thread weaving together this unique dental relationship between Canada and China. However, to fully understand the relationship, especially the impactful life story of Dr. Huang Tianqi, additional Chinese documents, to augment the limited English language sources, are required from the archives of the Dental College and the Dental Hospital in Chengdu. Additionally, analyzing the career paths of the dental graduates working throughout China, and the global impact of the international students, would provide a more comprehensive understanding of this unique transnational initiative. Finally, as the introduction of sustainable medical care was a complex initiative with multiple stakeholders and components, certain issues and individuals were briefly introduced in this paper, to provide some explanatory context for the reader, and these topics could be expanded into future research projects. This was an important period in Canadian and Chinese relations, and to fully capture this historical period, Canadian and Chinese scholars from multiple disciplines will need to engage in both independent and collaborative analysis. There are an infinite number of potential topics and the following three research areas are identified, as examples, to reinforce the collective international reach of this complex transnational relationship:

• For Chinese scholars, the transforming capacity of medical knowledge could be further analyzed through the lens of the initial classes of medical students. Foreign medical personnel laid the framework for sustainable health care, and the medical graduates expanded its exponential outreach in clinical medical care, formal medical instruction and public policy advocacy. Their life stories provide important historical context and the accessibility of this analysis, to an English-speaking readership, would ensure a more balanced understanding of this health care relationship. • For Canadian scholars, a largely unexplored area is the deepening engagement of multiple sectors of Canadian society in the West China Mission. This topic could generate a number of academic papers, and one fascinating Canada-China interface is the expanding role and influence of the Canadian members on the Board of Governors of

West China Union University. The overall contributions of these prominent Canadians are documented in historical papers and books but their connection to China, especially West China Union University, remains largely untouched by scholars. • A collaborative research initiative could analyze the strengthening relationship between Canadian and Chinese health care professionals. One potential research project could investigate the free flow of novel knowledge, from thoracic surgeons at the University of Toronto and the Toronto General Hospital, to surgeons performing operations at the hospitals in Chengdu. An examination of China-wide surgical data could provide greater clarity with respect to the historical place of Chengdu in the overall evolution of thoracic surgery in China.

This period of history is often a forgotten chapter in Canada-China relations or is studied through the prism of religious history but as this paper has demonstrated, the relationship is multifaceted and the people-to-people connections, developed a century ago, provides a foundation for scholars to analyze this evolving transnational relationship in the 21st century.