Telling the Redemptive Story of Chinese Female Leprosy Victims in the Late Qing and Early Republican for Western Readers: The Missionaries’ Narrative in Without the Camp

Abstract

Leprosy relief efforts were a key part of the Christian mission of salvation in China. During the Anglo-American Protestant overseas missionary movement in the late 19th and early 20th centuries, many missionaries recorded stories about relief work of Chinese female lepers in Without the Camp: The Journal of The Mission to Lepers in India and the East. First, the missionaries portrayed Chinese female lepers as marginalized figures, symbols of moral suffering and victims in need of salvation, reinforcing their religious mission and humanitarian spirit. Second, through the relief and conversion stories, the missionaries appealed to Anglo-American Christianity to participate in the overseas missionary movement and to fund the leprosy relief cause in China. Finally, the missionaries’ stories of converted Chinese women leprosy victims served as discourses for the spread of the gospel and civilization in China.

1. Introduction

Wellesley C. Bailey, a British medical missionary, found that numerous lepers were in need of relief and could be evangelized during his missionary work in India. With support from philanthropists in the UK, he established the India and Eastern Leprosy Relief Association in 1874 to aid lepers in India, China, and beyond. The organization later set up branches in the United States, Canada, and other countries, and was renamed the “Mission to Lepers.” By the end of the 19th century, it had become one of the most significant charitable and missionary organizations dedicated to international leprosy relief.

In 1893, the Mission to Lepers started publishing its journal, named Mission to Lepers in India and the East, as an annual commemorative publication released once a year from 1893 to 1919, totaling 27 issues. In 1910, the journal was renamed Without the Camp: The Journal of the Mission to Lepers in India and the East, and was changed into to a quarterly publication, with altogether 140 issues. The journal included letters, reports, photographs, and diaries sent by medical missionaries from various regions, documenting their work and experiences in leprosy relief. It served as a platform for sharing stories about leprosy treatment and evangelism, shaping the narrative and perception of leprosy in the late 19th and early 20th centuries, while also reporting on the effectiveness of missionary efforts.

In Asian countries, China was a high-prevalence area for leprosy, with hundreds of thousands of patients, excluding India. In the late 19th and early 20th centuries, medical missionaries in China, funded by the Mission to Lepers, established nearly 10 leprosy sanatoriums or hospitals in Guangdong, Fujian, Zhejiang, Hubei, and other regions. The medical missionaries overseeing this work excerpted or contributed reports and letters to the Without the Camp. Among these, content concerning Chinese women and children affected by leprosy accounted for 12%, with 181 articles specifically addressing the plight of women with leprosy. While existing academic research has touched on the stigma surrounding “female leper” since the Ming and Qing dynasties (Hu 1990, pp. 35–58; Rod 2001, pp. 507–18; You 2021, pp. 100–9; Zhan 2001, pp. 69–74; D. Zhou 2012, pp. 148–54; M. Zhou 2012, pp. 43–44), there is a noticeable gap in studies of the medical missionaries’ treatment of leprosy-affected women, particularly in terms of the portrayal and metaphorical representations of “female leper” in Without the Camp.

This paper examines the letters, lists, essays, and reports published in Without the Camp between 1893 and 1931. The paper explores the construction of the “female leper” image by late Qing and early Republican medical missionaries, the medical relief efforts, and the underlying colonial modernity issues implicit in their activities. This is a religious studies and historical research that explores the narratives of Chinese female leprosy patients by medical missionaries in China during the late Qing and early Republican periods through the lenses of “textual narration” and “discourse construction.”

2. The Construction of Female Lepers’ Image

Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae. Over the past three thousand years, people have feared and even stigmatized leprosy due to the unclear pathology of leprosy caused by limitations in medical knowledge, as well as cultural or social influences. In Without the Camp, missionaries describe the widespread fear of leprosy in China, stating that “Chinese people believe leprosy is both infectious and hereditary.”1 This belief led to the ostracism of leprosy patients, who are, like victims of smallpox, abandoned by society and driven to remote areas. In some coastal regions, leprosy patients were viewed as deeply immoral individuals. People expressed intense fear, disgust, and open hostility toward leprosy patients, and, if forced to interact with them, would cover their mouths and noses, much like medieval Europeans did.2 The stigmatization of leprosy not only deepened the physical pain of the patients but also led to the breakdown of their interpersonal relationships, social isolation, and increased psychological distress. The medical missionaries drew a parallel between the social discrimination against leprosy patients in China and the medieval European practices of isolating patients. This comparison helped Western readers better understand the depth of fear, prejudice, avoidance, and exclusion towards lepers in Chinese society.

2.1. The Tragic Narratives of Stigmatized Lepers

Within the patriarchal traditions of Chinese society, women were historically subordinated and unable to realize their self-worth and legitimate rights fully. As a result, female leprosy patients suffered not only from the same stigmatization as male patients but also from an additional layer of moral stigma. The most representative form of this moral stigma in the Fujian and Guangdong regions involved a superstitious belief that female leprosy patients could cure themselves by infecting the disease to men through sexual intercourse. This belief led to the construction of an image of the “unclean” leprosy woman, shaped and perpetuated by a male-dominated social system. Chinese people believed leprosy to be “impure,” and due to the stigma of “selling leprosy”, Chinese society for a long time did not permit leprosy patients to live alongside healthy people. A small number of them were housed in relief institutions by local governments during the Qingming period, while the vast majority resided in “leprosy villages” outside cities. Before the discovery of the leprosy bacillus in 1873, the Chinese did not understand the cause of leprosy. Medical missionaries could not explain why some children born to leprosy patients were healthy while others contracted the disease. Against this backdrop, healthy children born to leprosy patients also faced discrimination and were confined to leprosy villages.

The stigma of the disease and the stigma of uncleanliness faced by women with leprosy not only caused great psychological and physical stress for the women themselves, but also led to discrimination against their children. Mrs. Bailey, after visiting a leprosy shelter in Kucheng, said that she had initially hoped to find someone willing to take care of the three young children of leprosy patients in the shelter. However, due to the deep-rooted prejudice against lepers in Chinese society, she was unable to find a suitable person and decided to take care of the children herself, for which the children’s mother was very grateful.3 Although these children did not have leprosy, they were nonetheless subjected to verbal abuse, negative attitudes, and rejection due to society’s fear of leprosy.

The missionaries constructed the tragic image of the female lepers or leprosy girl as a socially stigmatized figure in Without the Camp by presenting relevant cases, from the most fundamental stigma of the disease to the gender-specific stigma of uncleanliness specifically associated with women with leprosy, and then to the passive stigma borne by their children. This narrative not only highlighted the physical and psychological suffering of female leprosy patients but also critiqued China’s delayed understanding of infectious diseases, the stubbornness of outdated medical views, and the lack of modernization in healthcare. The missionaries aim to evoke Western sympathy for the plight of China’s women with leprosy and to draw attention to the need to treat such patients in a more humane way, modeling after Western practices. Through the tragic portrayal of female leprosy patients, it inspired Western readers to pay deeper attention to the issue and to contribute to the relief efforts of this marginalized group in China.

2.2. The Helplessness Under Limited Medical Care

Although late Qing missionaries established leprosariums in places like Shantou, Beihai, and Hangchow, none were specifically designated for female patients—revealing a critical gap in gendered healthcare.

In 1893, Duncan Main, superintendent of Hangchow Church Missionary Hospital, and his wife Mrs. Main applied to the Mission to Lepers for funding to establish a specialized hospital for female leprosy patients, aiming to address the current limitation of medical services being exclusively available to male patients.4 Henry Fowler also pointed out the limited treatment received by women with leprosy in China in his letter to The Mission to Lepers. Leprosy asylums were predominantly composed of male patients. Although there were some female leprosy patients in the outpatient clinic, their number was far less than that of male leprosy patients. He observed This disparity, he, was largely attributable to specific social factors within the Chinese context.5

The society not only imposed a dual stigma on women with leprosy based on the disease and gender, but also took extreme measures against them due to limited medical resources. During the late Qing and early Republican periods, while male leprosy patients faced discrimination, most could survive through various means. In contrast, the disregard for the lives of female leprosy patients was deeply entrenched in public consciousness, leading to far more drastic societal responses toward them than toward men. Missionaries documented several typical forms of extreme treatment in Without the Camp.

One method was poisoning women lepers with opium. Without the Camp reported that although the inherent “goodness” or “badness” of men and women was not clearly defined in law in China, acute symptoms of leprosy in women often triggered violent reactions. In many cases, people would take measures to eliminate their presence, such as forcing them to take opium, which was sufficient to cause fatal lethargy.6 Another horrifying practice was burning them or burying them alive. Without the camp recorded that an 18-year-old young woman was burned alive after being isolated from her family and locked in a hut made of branches.7 Additionally, some were smuggled as “pig flowers” (a euphemism for enslaved girls), “The bad practice of selling little girls suspected of being infected with the disease into the colony of Hong Kong is still going on.”8 These accounts underscore not only the severe gender-based discrimination but also the extreme cruelty of society towards women with leprosy.

The secretary of the Hankou Committee of the London Missionary Society explicitly stated: “This class of women with leprosy is not small, yet nothing has been done for them in China thus far.”9 In the context of scarce medical resources, female leprosy patients are portrayed as helpless victims who are forced to endure injustice and suffering. Missionaries used this narrative to critique the contradiction between the advancements in medical technology and the lack of humane care, as well as systemic failures in the distribution of healthcare. Through the construction of this image, they sought to provoke a “savior complex” within Western society, appealing to its moral conscience to drive resource mobilization for the medical relief of China’s female leprosy patients. Their advocacy not only revealed the gendered aspects of leprosy relief, but also positioned Western intervention as a moral obligation.

2.3. The Victims in Times of Turmoil

Although women with leprosy were socially isolated, they still depended on various forms of social assistance.

Missionaries also recorded in Tungkun Lepers and the Revolution, “On my last visit the women told me that several times they had all been weeping together in bed at the thought that the missionaries might have to flee.”10 Due to a lack of food and money, the basic survival of vulnerable groups such as women and children became a significant issue. During times of political change and social unrest, the government’s attitude and measures toward leprosy-affected women determined their survival. Without the Camp records two drastically different approaches the Chinese government: collective massacres and the establishment of leprosy villages.

Regarding the collective massacre of leprosy patients, an article titled “Massacre of Chinese Lepers” highlighted: In 1912, a commander issued a public notice to individuals with leprosy in his jurisdiction, promising distributions of rice and other forms of aid, and instructed them to assemble at a designated rural location. Tragically, when the patients arrived with their children, they were quickly surrounded by soldiers and executed. Their bodies were then thrown into pre-dug pits, doused with kerosene, and burned. A few survivors attempted to flee, but were hunted down in the mountains like wild animals. This commentary is based on three documented leprosy massacres recorded by medical missionaries in Without the Camp, recounting the massacre story where officials lured leprosy patients with food and money to a central location, only to collectively execute and burn them. The missionaries believed that the brutal treatment of leprosy patients by these officials was due to their lack of Christianity. Through these stories, missionaries expected to attract the attention of the Western Christian world, urging them to provide financial and personnel assistance to leprosy relief efforts in China and to spread the gospel.

Without the Camp also provided an account of the Chinese government’s and local society’s management of leprosy villages. Without the Camp emphasized that while there was some funding for leprosy villages from the government and local societies, it was insufficient and unsustainable. To some extent, these leprosy villages received recognition from local governments. In certain cases, local authorities provided subsidies to support individuals with leprosy; however, only a small portion of patients were able to benefit from such assistance.11 After going through various administrative channels, government subsidies were significantly reduced, making it difficult for leprosy patients to maintain their basic living.12 To survive, some able-bodied leprosy-affected women earned a living by making straw sandals, braiding hair, and so on, but their income was insufficient to meet their living needs. Thus, the majority of leprosy-affected women survived by begging. In China, the government did not impose strict measures of isolation or control over individuals with leprosy. Women with leprosy often left the leprosariums and begged freely, holding out their festering hands to seek alms at store counters.13 Among them, the blind, those without limbs, or elderly leprosy women with no ability to work had no choice but to wait for death.14 Maintaining a living through work was already difficult, and raising children added more pressure on leprosy-affected women. Children in leprosy villages rarely received social support and had no independent source of income. These children were weak and sick, malnourished, and lack education.15 The pressure to survive has led many young women with leprosy to even resort to prostitution.

Through documenting these atrocities and the leprosy villages’ hardships, in Without the Camp, missionaries revealed the brutal violence and indifference of some local Chinese governments, who, in their eagerness to “eradicate” leprosy, resorted to massacring leprosy patients, thus portraying Chinese leprosy women as victims of social upheaval. This documentation aimed not only to reinforce the Western moral stance based on racism but also to highlight the religious responsibility and “purification” duty of Christian organizations towards vulnerable groups in foreign, heathen lands.

This subjective and emotionally charged narrative by medical missionaries shaped the image of “women with leprosy” as tragic, stigmatized figures—helpless sufferers under limited medical conditions and victims of social upheaval. Through the portrayal of their plight, these missionaries criticized the Chinese government’s inaction on public health issues. By reading Without the Camp, Western society became aware of the Chinese government’s neglect and the suffering of leprosy-affected women, naturally prompting them to provide aid for the relief of these women in China.

3. Charity and Evangelizing for the Female Lepers

Between 1893 and 1931, with the financial support of the Mission to Lepers, dedicated leprosy hospitals for women were established in several regions of China, including Beihai, Hangchow, and Tenghsien. As a form of charitable endeavor, the relief work for women with leprosy shifted from a passive model of custodial care to a more proactive combination of education and rehabilitation. These mission-run institutions not only provided basic necessities such as clothing, food, shelter, and medical treatment but also established schools to teach literacy and vocational skills, aimed at fulfilling both evangelical purposes and self-sufficiency.

3.1. Charity and Relief

In 1930, a survey conducted at the Tenghsien leprosy home revealed that less than 7% of the women with leprosy were literate.16 To enhance the women lepers’ ability to receive and retain the teachings of the Gospel, missionaries established girls’ schools with the specific aim of improving their capacity to comprehend and memorize the Bible. James Taylor, the medical missionary responsible for leprosy patients in Canton, stayed in the leper village outside the city even during the outbreak of revolution. In his correspondence, he reported on the progress of leprosy relief efforts in Kwangtung in 1911, which included the establishment of a school for women with leprosy. The teachers in this school were Christian women lepers themselves, and the curriculum primarily comprised hymn singing, prayer, and Bible study. An average of 41 women per month participated in these classes.17 The outcomes of the “Leprosy Women’s School” were generally positive; after a period of instruction, most participants were able to read newspapers and write.18 Van Someren Taylor, who herself contracted leprosy due to her selfless dedication to these women, also undertook efforts to provide basic education for young girls in the village. She wrote that she established a small school for several young girls in the village, with six girls attending lessons each day. Christian women led them in singing a hymn, followed by a Bible lesson, and then sewing instruction. Once they completed their sewing projects, the girls were allowed to take their work home.19 In addition to this elementary education for young girls, prayer meetings were specifically organized for adult women lepers. These gatherings were held every Friday afternoon and were typically attended by ten to fifteen women.

Women leprosy patients learned to engage in activities such as lace-making, basket weaving, sericulture, and beekeeping. These forms of labor not only fostered their capacity for independent livelihood but also helped maintain their muscular function and physical condition. Moreover, participation in such work provided a psychological benefit: it enabled them to divert attention away from their physical impairments and reduced the tendency to fall into cycles of self-pity and introspection.

By establishing educational programs for women within leprosy hospitals, medical missionaries emphasized a dual approach of instruction and care, thereby advancing the right of women leprosy patients to receive an independent education. Although the curriculum remained confined to Christian doctrine and was primarily aimed at “point them to the Saviour who can heal their immortal souls”20, the missionaries nevertheless provided shelter and care. In doing so, they protected these women from being “hunted like wild beasts”21 and helped transform their self-perception, shifting them from socially marginalized and abandoned individuals to subjects worthy of dignity and compassion.

As a charitable undertaking, the relief efforts for women with leprosy relied fundamentally on a stable and continuous source of funding. The number of women afflicted with leprosy and their healthy children requiring assistance far exceeds the capacity of church-run leprosariums or leprosy clinics to accommodate them. So, the collective efforts of female missionaries, missionary wives, and medical missionaries, though commendable, were clearly insufficient to fully address the practical needs of these women. Therefore, there was an urgent need for support from all sectors of society in terms of extensive financial backing and material assistance.

On one hand, missionaries sought the support of Chinese officials and members of the local gentry, positioning themselves as intermediaries for Sino-Western cooperative relief. They appealed to the Chinese government and influential elites for donations and land allocations. Without the Camp frequently documented collaborations between missionaries and Chinese society in regions such as Shantung, Kwangtung, and Wuchow. For instance, in Tenghsien, missionary Dodds utilized Western donations, land provided by local gentry or government, and public subsidies to construct a new leprosy hospital. With the accumulation of experience and resources, she proceeded to establish a separate convalescent facility exclusively for women.22 In Tungkun, Kwangtung, a missionary used a $3500 donation from Mrs. King in the United States to purchase a private island and build new facilities, thereby providing a dedicated and improved environment for Christian women lepers. This missionary sought to prevent their placement in government shelters, which were often of significantly lower quality.23 Medical missionaries also engaged in negotiations with local authorities, advocating for the official recognition of leprosy patients and the establishment of gender-specific isolation regulations. They proposed building designated shelters on suitable islands to ensure safety and promote self-sufficiency among patients. Furthermore, they urged the segregation of uninfected children and the dismantling of existing unsanitary leprosy villages, envisioning a series of reforms conducive to the survival and development of leprosy sufferers.24

As practitioners of charitable work, medical missionaries viewed their responsibilities as extending beyond medical treatment and the alleviation of physical suffering. They sought to address the deeper social roots of that suffering by combating the stigma associated with women lepers.

The dissemination of the Christian Gospel was at the very heart of both the publicity and financial mobilization surrounding the relief work for women leprosy patients. The more frequently Without the Camp reported successful cases of evangelism among leprosy sufferers, the more donations missionaries were able to secure from Western supporters. For instance, in the process of confirming the baptismal eligibility of nine male leprosy patients and three women lepers, Reverend Parsons mentioned that most of the individuals, due to their inability to read and the burdens of their illness, could not fully grasp the doctrines. However, because of their condition, they were likely to have passed away by the time the bishop next visited to confirm their eligibility for baptism. As a result, they earnestly requested to be baptized.25 Illness often intensified women lepers’ spiritual longing and piety, making their desire to embrace Christianity even more urgent than that of healthy individuals. For them, receiving the Gospel represented not only the promise of salvation and a sense of belonging for their souls, but also a source of spiritual comfort and hope for peace after death. The high conversion rate among women lepers motivated Christian communities across the globe to actively contribute financially to support the success of missionary efforts. These donations enabled missionaries in China to “stand on the frontlines of the mission field”26 on behalf of their sponsors.

Without the Camp sought to construct and project the dual identity of missionaries as both evangelists and humanitarians through narrative and textual representation. By documenting activities such as the provision of medical services, the dissemination of the Gospel, and collaboration with various sectors of Chinese society, the journal aimed to enhance Western respect for missionaries and elevate the public image of the religious organizations they represented. This, in turn, facilitated the acquisition of financial and institutional support from individuals, governments, and international agencies, thereby expanding the missionaries’ influence and operational capacity. Simultaneously, the writings in Without the Camp broadened Western awareness of Chinese women leprosy patients, portraying them as marginalized figures, symbols of moral and social degradation, and sufferers in need of rescue. These portrayals served the dual purpose of mobilizing compassion and justifying missionary fundraising efforts from both charitable and evangelical standpoints.

3.2. Save Souls: The Relief of Women Leprosy Patients as a Missionary Endeavor

In Without the Camp, missionaries frequently referred to themselves as “Christ’s servants”27 positioning their work among leprosy patients as a sacred and indispensable expression of Christian compassion. Given the incurable nature of leprosy and its often debilitating consequences, missionaries regarded the act of serving leprosy sufferers particularly women as a profound embodiment of the Christian principles of loving God above all and loving one’s neighbor as oneself. For them, offering both physical and spiritual aid to these marginalized individuals was among the most meaningful forms of missionary labor.

They made it explicitly clear that their aim was not merely to offer charitable support to women leprosy patients as a gesture of goodwill, but rather to “win souls for Christ,”28 rather than simply provide charity that would elicit gratitude toward foreigners. Their goal was to integrate Christian doctrine and the teachings of Jesus into the very structure of leprosy relief, thereby offering these women a life and social environment aligned with Christian values and ideals.

Missionaries utilized the leprosy hospital as a place of concentrated isolation and enclosed living conditions as a strategic platform for evangelization. Within this space, they combined physical care with spiritual ministry, embedding the act of evangelism within the framework of charitable relief. Through this fusion of “mission” and “mercy” leprosy hospitals became sites where women lepers not only received medical treatment but were also introduced to Christian teachings. Despite the severity of their illness, these women experienced tangible improvements in their daily lives, and, more significantly, they were enveloped in a community of compassion and care. As missionaries described it, their “radiant faces” not only signaled physical recovery but also symbolized the blossoming of God’s love among the so-called heathens.29 Thus, women with leprosy long abandoned by both society and family and burdened by inner suffering were reimagined as fixed and receptive subjects of missionary work. Through the promise of improved living conditions, missionaries created an opportunity to transform the spiritual lives of these women and guide them toward a Christian faith.

In the process of missionary work, missionaries first employed the church-a symbolic structure of Christianity to cultivate an environment conducive to preaching from a spatial and architectural perspective. The “little chapel”30 was a prominent feature noted in Without the Camp, described as a common and essential structure in every leprosy village established with missionary support. Within these villages, the chapel served as a central space for evangelism, education, and celebration, functioning as the primary means through which villagers came to know God.31 In Hangchow, a solemn St. John’s Chapel was specifically constructed between the male and female leprosy hospitals for the exclusive use of leprosy patients.32 Within these sacred spaces, missionaries organized daily prayer sessions; during weekdays, the chapel served as a classroom for women leprosy patients, while on Sundays it hosted worship services, and on religious holidays it became a venue for communal celebrations.

Secondly, in light of the traditional Chinese cultural norm of gender segregation summarized by the adage “men and women should not interact freely”, missionaries established the role of the Christian women, a position specifically designed to leverage gender affinity as a strategic medium for disseminating Christian teachings among women leprosy patients. Christian women were assigned to reside within the small chapels and were responsible for interpreting the Bible to female leprosy sufferers. As noted in Without the Camp, “Christian women played a significant role” in educating and guiding women lepers in their spiritual formation.33 Within the community of women leprosy patients, the Christian women held unquestioned authority. Yet her manner of communication was consistently maternal and nurturing, making her not only a spiritual instructor but also “a comforter, teacher, counselor, and friend to them all.”34 In addition to the Christian women, catechists, pastors, and physicians regularly visited the women leprosy patients each week, offering holistic care that addressed both physical ailments and spiritual needs.35 Students from the Bible school also actively participated in missionary outreach, visiting leprosy villages weekly to evangelize and teach patients how to sing hymns, thereby extending the reach of Christian compassion and doctrine within the community.36

Moreover, in Christian doctrine, baptism is regarded as a profound spiritual act symbolizing the convert’s repentance of sin and affirmation of faith in Christian beliefs. Missionaries strategically employed the ritualistic significance of baptism to foster religious conviction among women leprosy patients. In Without the Camp, missionaries documented numerous instances of baptisms among men, women lepers, and children between 1893 and 1937 in regions such as Wuchow in Guangxi, Hangchow in Zhejiang, Canton and Tungkun in Guangdong, and Siao Kan in Hubei. From the perspective of medical missionaries, “the state of a leprosy patient’s soul was clearly more pitiable than their afflicted physical condition”, and they believed that through baptism, “a complete relationship was established between the soul and the Savior who heals the spirit.” In that moment, the women leprosy patients not only received care and redemption but also became vessels through which “the power of faith and love was manifested.”37

3.3. Soul Salvation

In describing the spiritual transformation of women leprosy patients following baptism, missionaries portrayed them as having changed from beings who were once “like wild animals hunted everywhere” to individuals displaying “gentle and peaceful expressions.”38 They emphasized that Christ could sustain them during the most painful and sorrowful moments of their lives, and that the Gospel could bring comfort and hope. Furthermore, missionaries observed that women leprosy patients, in comparison to their male counterparts, were more “willing to accept the doctrine and become Christians”39 and were often “eager to express gratitude to God and to the missionaries.”40

Nevertheless, it is undeniable that the evangelistic efforts within the centralized setting of leprosy hospitals proved significantly more effective than traditional street preaching. The enclosed and stable environment allowed for deeper spiritual engagement and more consistent religious instruction. For example, Mrs. Main, the wife of the founder of Church Missionary Hospital in Hangchow, wrote to the Mission to Lepers about the successful conversion of a woman leprosy patient named Salome. Salome’s responses to the doctrines were very sincere. After being baptized on September 22, she transformed from a sorrowful girl into a joyful one, believing that the Christian Gospel could bring her love and happiness 41. Similarly, in Kien-ning, a woman leprosy patient who had lost all her fingers and was nearly blind experienced a profound change after baptism, her once irritable temper gave way to radiant smiles and a calm acceptance of death.42 Within just one week, ten women lepers at the Kien-ning leprosy hospital received baptism.43 In their own words, “No one can accept the visible church as joyfully as we do.”44 Even when their faces were disfigured and their bodies impaired, they remained joyful because “Jesus had saved them from sin.”45 Women leprosy patients in relatively better physical condition were also willing to take on missionary responsibilities. They expressed a readiness to “submit to God’s will and carry out Christian work for other leprous girls,” thereby actively participating in the continuation of missionary outreach.46

3.4. The Interweaving of Charity and Evangelism

In Without the Camp, missionaries articulated a clear perspective on the intersection of charity and evangelism. They believed that the positive impression formed by charitable work in China, whether for the elderly, children, or leprosy patients had a profound and beneficial impact on various missionary activities. These acts of charity perhaps more vividly embodied the true spirit of Christian love than any other form, effectively recommending the doctrines of Christianity to those around them. The missionaries acknowledged the importance of charitable work, but at the same time, they firmly believed that only within Christianity could leprosy patients find true hope. While missionaries could use all available scientific means through medication, physical therapy, and psychological treatment to assist leprosy patients, they argued that such efforts would be of no use unless the light of hope continued to shine in the hearts of those seeking help.47 In this conception, Christian doctrine itself was understood to be the “light of hope”. For women and children with leprosy individuals doubly abandoned by both family and society, the spread of the Gospel thus offered, at least in part, a form of solace for both physical and psychological suffering. In the eyes of missionaries, it was this spiritual hope that could meaningfully sustain them through affliction.

For example, in the realm of charitable work, children often the symbolic center of humanitarian concern-became a primary focus for missionaries. In order to protect the uninfected children of leprosy patients and prevent them from repeating their parents’ tragic fate, missionaries established dedicated children’s homes. These institutions not only safeguarded the children’s physical well-being but also provided them with a sense of spiritual belonging amidst widespread social discrimination, thereby facilitating the spread of the Gospel. The intertwining of charity and evangelism in the relief work for women and children with leprosy is exemplified in the case of Van Kyin-dang, a child born into a leprosy-affected family. Raised in a children’s home under the care of Mrs. Main, he received an education alongside other children with similar backgrounds. Eventually, he grew into a committed evangelist. In the small hospital chapel, Van Kyin-dang used the rhetorical eloquence typical of the Chinese to explain that China, in its deeply sinful state, could not attain “redemption,” and that only through the “healing” of Jesus Christ could true salvation be achieved.48 For this young man raised in a missionary-established children’s home, belief in Christ was deeply personal and unwavering. He was convinced that Jesus had once saved him, and thus, if other young people gave their hearts fully to Christ, He would likewise offer salvation to all who came before Him. Van Kyin-dang’s story exemplifies how charitable relief efforts by missionaries cultivated deep trust, first in the missionaries themselves, and subsequently in the teachings they imparted. Religious faith, woven through the fabric of his upbringing, naturally became a guiding force in his life, a “light of hope” that accompanied his journey and solidified his enduring belief in Christ.

In conclusion, the relief efforts for women and children with leprosy, as part of missionary activities, contain charitable elements. Missionaries demonstrate care through the provision of material support, medical assistance, and education, thereby attracting women lepers to convert to Christianity. At the same time, these charitable efforts provide an effective platform for evangelism, allowing missionaries and leprosy-affected women and children to establish trust and facilitate the spread of faith. In practice, evangelism and charity often intertwine, with religious belief not merely serving as a tool for proselytization, but becoming the core value of charitable work.

4. Missionaries’ Identity and Female Chinese Leper Relief

Missionaries traveled from afar to provide relief for women lepers, often employing a strategy of constructing an “other” identity to reinforce their own sense of self. In Without the Camp, women lepers are essentially portrayed as the “other” in opposition to the missionaries. They are depicted as stigmatized tragic figures, helpless under limited medical care, and as victims of societal upheaval. Additionally, they are framed as individuals with “sin”, further reinforcing the missionaries’ narrative of moral and spiritual redemption.

4.1. The Internalization of Religious Mission

To emphasize the religious nature of their mission and highlight the spread of the Gospel, missionaries were eager to associate women lepers with the concept of “sin” within Christianity. They framed behaviors that they sought to avoid, such as inhumanity, a lack of charity, or antisocial actions as manifestations of “sin”, thus clearly demarcating the boundary between themselves and the “other”. So, what is “sin”?

The Christian concept of sin is a fundamental doctrine within the Christian faith. According to the Apostle Paul, sin constitutes an act of transgression against the law, such as fornication, impurity, licentiousness, idolatry, sorcery, and so forth. In Without the Camp, the missionaries’ understanding of “sin” can be divided into two categories. One category pertains to the “sin” of the women lepers themselves. The missionaries in Without the Camp described these massacres as the “slaughter of helpless victims, whose only crime was contracting the disease”,49 and they emphasized the contrast between Confucianism and Christianity. They argued, in areas where Christianity is prevalent, these suffering patients are welcomed and redeemed, whereas in Confucian regions, the situation is quite the opposite.50 Therefore, the atonement for the women lepers’ “sin” was framed as “praying for God to lead us to confess our sins”51 and repenting with sincere and fervent hearts, so that the “Kingdom of God” could be realized. The other category of “sin” pertains to the actions of other social groups in their treatment of women lepers. Without the Camp includes numerous accounts of the discrimination, trafficking, and massacres that women lepers endured, describing these as injustices and “sins” committed by other social groups, who violated the principles of human goodness.

The “other” is sinful; therefore, in order for missionaries to achieve their goal of constructing the “missionary self”, they must “redeem” this “sin”, that is, they must provide both physical and spiritual relief to women lepers. This sense of identity among the missionaries is rooted in this very purpose. In the three Gospels of the New Testament, there are records of Jesus engaging with and speaking to leprosy patients, expressing a desire for all Christians to work together to heal those suffering from leprosy. As a role model, Jesus served as the example that missionaries sought to emulate and follow. They firmly believed that “Christians are those to whom Jesus Christ has entrusted all of humanity.”52 Therefore, these “women lepers” were precisely the individuals they felt called to care for.

The missionaries wrote in Without the Camp: “Our work is not merely about charitable assistance; it is aimed at saving the lives and future of leprosy patients. It is seen as one of the means through which Christ Himself has appointed the dissemination of His love, intended to spread this message of love across the world. Our work is also viewed as a key step in helping China move from darkness to light, to have a Christian government, and to become a Christian nation. The care for leprosy patients has been incorporated into our divine mission, with the goal of eradicating leprosy from China.”53 In Without the Camp, missionaries frequently mention their mission to preach Christ’s “redeeming love” and the successful examples of evangelizing women lepers. They describe the task of saving women lepers and spreading the Gospel as “a great endeavor.” They believed that providing donations, ensuring the supply of materials, and alleviating the suffering of women lepers were challenges to faith and to God’s love. God, seeing these people, would surely be moved with compassion.54 In summary, the missionaries used the concept of women lepers as “sinners” or “suffering from sin” to legitimize their relief efforts, positioning it as a religious mission in their work with leprosy patients in China. This strategy reflects the complexity of the intersection between religion and charity, while also revealing how societal prejudices were utilized for specific purposes.

4.2. The Externalization of Humanitarianism

In Without the Camp, missionaries describe women lepers as an extremely vulnerable, helpless, and suffering group. They used their suffering and vulnerability to enhance the humanitarian appeal of their work, thereby constructing their “humanitarian self” identity.

Mrs. Taylor (Van Someren Taylor) offers a typical description of the suffering and helplessness of women lepers: “She had no home nor friend sand as she could not remain in the school, her only refuge was the Leper Village. She cannot use her hands much, but she keeps her room very clean and tidy, using her mouth, instead of her hands, to hold her clothes. Many of them are such nice, refined women, and so patient and cheerful under their sad conditions; I often wonder how they can be.”55 In the missionaries’ accounts, women lepers are portrayed as resilient, actively loving life despite their hardships. Even though they suffer from severe illness and physical deformities, they are still depicted as perfect victims who are eager to help others. This portrayal reflects the nature of charitable endeavors, which often depend on whether the sufferers are perceived as “worthy” or “unworthy” of assistance. Suffering, in contrast to other circumstances, is more likely to attract Western support. As a result, Without the Camp frequently uses terms like “pain”, “misery” and “horrible” to describe the tragic conditions of women lepers, presenting these helpless and vulnerable individuals as the most deserving of aid in the eyes of donors.

From the Western perspective in Without the Camp, who possesses the willingness and ability to act as humanitarians and save these helpless women lepers in China?

The first group to show willingness to help the women leper population in China were the female missionaries and the wives of missionaries. Due to gender-based empathy and resonance, female missionaries and missionary wives were more likely to focus on and be inclined to assist women lepers. According to Without the Camp, between 1893 and 1931, eleven leprosy hospitals run by missionaries in Hangchow, Shaohing, Foochow, Siao Kan, Kien-Ning, Futsing, Tungkun, Sheklung, Tenghsien, and Wuchow explicitly treated both male and female leprosy patients. Although in places like Foochow, there was already a trend of separating male and female patients, in a broader context, the lack of specialized women’s leprosy hospitals limited the number of women lepers who could be treated in these regions. In 1920, in Tenghsien, Shantung, Miss Dodds encountered three women lepers seeking treatment. They said they were not afraid of the suffering of the injections, but Dodds had not the least place for her. She had just to send her back home.56 In her reports, Dodds repeatedly mentioned the urgent need for specialized accommodation for women lepers in certain areas of Shantung. Over thirty individuals had already sought information from her on this matter, leading her to believe that the actual demand could be even greater.57 Dodds believed that the majority of these women were strongly eager to find a stable place where they could receive more adequate care and no longer suffer from hunger and cold.58 In order to help more women lepers, after two years of preparation, the “Home for Women Lepers” in Tenghsien, Shantung, officially began operations at the end of 1923. By 1931, it had treated 31 women lepers.59 The specialized leprosy hospital set up by Dodds in Tenghsien also became a core and exemplary institution for women leper relief.60 Although the number of patients was small and the scale was limited, it served as a model for the entire women leper population. Not only did it provide effective treatment for women lepers, but it also became a channel for communication between Western nations and China, a country still in a relatively underdeveloped state, allowing China greater access to modern medicine.

Dr. Arthur T. Kember, in reflecting on the work of the Guangji Leprosy Hospital in Hangzhou in 1914, mentioned that by the end of the year, a blind leprosy patient, before his death, requested Mrs. May to take his son, as a healthy child, into the children’s home. Mrs. May granted this request, and the child is now attending school and performing well.61 Mrs. Main, as the wife of missionary Main in Hangchow, founded the children’s home based on the Christian principles of love and compassion, her sense of social responsibility as a missionary’s wife, and her personal empathy. Through this initiative, she provided essential help and support to leprosy patients.

However, not every region had such compassionate female missionaries and missionary wives. Therefore, the intervention of medical missionaries, as the practical agents of humanitarian work, was especially significant.

“Out-patient treatment does nothing to ameliorate such essentials in raising the resistance of the individual as food, fresh air, exercise, bodily cleanliness, freedom from financial anxiety.”62 Therefore, a clean environment is of critical importance in the treatment and care of women affected by leprosy. Medical missionaries believed that “Until we can provide sanitary well-equipped Asylums in place of these dreadful leper villages and effect a literal cleansing of the lepers in them, we are not doing our whole duty.”63 In places such as Siao Kan and Hangchow, facilities were established that met these standards, including dedicated shelters for women lepers, where gender segregation was strictly enforced. In Hangchow, the new Lepers’ Refuge is significantly cooler and nicer, and healthier than the City Hospital.64 In Siao kan, Women’s wards, in particular, were thoroughly cleaned on schedule. Each ward had a designated person responsible for cleanliness, discipline, and prayer, and the best-performing wards were even rewarded with cash prizes.65 Well-maintained grounds, sound infrastructure, surprisingly clean wards, complete facilities, and orderly management played a crucial role in improving the health of women leprosy patients. These efforts also served a broader evangelical purpose demonstrating to the Chinese public and authorities that Christian organizations genuinely cared for leprosy sufferers. Through such examples, missionaries hoped to inspire local governments and churches to follow suit in taking the initiative for the welfare of leprosy patients.66

“Besides the routine medical treatment, we lay stress on the development of atrophied muscles, and physical exercise in general.”67 At the Tsinan Leprosy Hospital, looms were utilized as tools to help exercise the hand and leg muscles of women lepers, and “the cloth produced by these machines could be used by the hospital to make bandages.”68 Each patient was assigned specific tasks, such as cleaning the wards, washing windows, and working in the dining hall. During the summer and autumn, they were also given tasks such as weeding.69

In addition to maintaining a clean environment and promoting appropriate physical labor, the most essential aspect of the relief process for women leprosy patients was the treatment of the disease itself. Accordingly, Without the Camp documents the efforts of medical missionaries to continuously learn and introduce advanced Western methods for the diagnosis and treatment of leprosy, aiming to meet the health needs of women afflicted with the disease. During the late Qing and early Republican periods, there were no known specific cures for leprosy. Western drugs such as “Anlailu” were introduced to China, while Chaulmoogra oil, a traditional Chinese remedy historically used to treat skin ulcers, became one of the main therapeutic components for leprosy. After being introduced by missionaries, these drugs were further tested in clinical applications within China. For instance, leprosy hospitals in Canton were staffed with at least one resident physician, and the pharmacy facilities were well-equipped with the necessary tools, instruments, and medications required for treatment.70 Medical missionaries working in the dispensary regularly visited bedridden patients (typically every other day) and administered newly adopted injections three times per week to 47 female patients. These injections consisted of guaiacol or nastin, which yielded significantly better results than earlier methods.71 In Hangchow, the leprosy hospital went even further in exploring new therapies. They reported that “We are still working away with the chaulmoogra oil, camphor, and resorcin hypodermic injection treatment, but the results have not come up to our expectation.”72 So they were eager to try Sir Leonard Roger’s gynocardate of sodium treatment, which from his experience in India and the experience of others in China and other countries is significantly better than the chaulmoogra oil treatment; unfortunately, the drug cannot be procured in China at present, but we hope to obtain it from home or from India very shortly. Moreover, these imported medications were exceedingly expensive, and as a result, medical missionaries could only administer them on a trial basis to patients in the early stages of leprosy. By the end of 1930, all patients in the Hangchow leper hospital were receiving oral anti-leprosy medications. Of these, “five patients had stabilized but were left with deformities; 34 showed signs of improvement; 17 had no improvement; and six had deteriorated.”73 Overall, the efficacy of treatment had significantly improved.

The image of the leprous woman as “the Other” constructed by medical missionaries and other agents of Western civilization within the context of Eastern or Chinese civilization. The term “the Other” here does not refer to the universal concept of “the Other” as distinct from ordinary people, but rather to the more stigmatized “the Other” within the leprosy patient community. Through their portrayal of women lepers as helpless and suffering “others” who nevertheless faced life with dignity and perseverance, missionaries constructed a powerful contrast with their own actions the establishment of dedicated hospitals for women lepers, the founding of children’s homes, the emphasis on hygienic living environments, and the adoption of up-to-date treatment methods. These humanitarian efforts served to reinforce the missionaries’ self-image as moral agents and humanitarian warriors, committed to compassion and medical progress in the face of profound suffering.

5. Conclusions

Medical missionaries used Without the Camp as a platform to report on the conditions of women and children suffering from leprosy in China to the Western world. Through their writing, they aimed to foster public awareness and prevent society from descending into a cycle of familiarity, indifference, and eventual neglect. The journal served to raise consciousness about the severity of leprosy prevention and control, to advocate for the dignity and equality of women leprosy patients, and to accurately reflect their real needs. In doing so, it sought to establish a sustainable survival mechanism for women lepers one rooted in respect, understanding, and humanitarian care.

This also reflects the humanitarian orientation of missionaries in their relief work for women affected by leprosy. As a significant public health and social issue, the missionary response provided crucial support through multiple avenues. Through the establishment of leprosy hospitals, missionaries enabled some women lepers to access basic medical care and pharmaceutical treatment. Through girls’ schools, they combined education with care, helping women lepers learn appropriate survival skills. Equipping them with basic literacy and knowledge-empowered women who were already in a subordinate position in traditional society to pursue self-worth and legitimate rights more confidently. By raising public awareness of leprosy, they sought to dispel misinformation and fear, thereby reducing the stigma attached to women with the disease. In addition, by soliciting donations from Western society, they drew upon international resources and financial support to sustain these efforts.

The writing and narrative framework of Without the Camp reflect a deep sense of compassion for human suffering and a strong sense of responsibility to alleviate disease. However, both the missionaries’ relief efforts and the journal’s frequent emphasis on religious rites such as baptism point to the fundamental goal of Christian evangelism in their work with women lepers during the late Qing and early Republican periods. In this process, charitable aid was employed as a vehicle for religious conversion, and the missionaries, through their acts of service, fashioned themselves as savior figures earning the trust and respect of women lepers, many of whom had been psychologically numbed by a life of hardship. The ultimate aim was to guide them toward conversion to Christianity. Thus, while the relief of women lepers under the dual objectives of charity and evangelism reveals an impure motivation for using medical assistance as a means of expanding religious influence it also underscores a historical reality: without the driving force of missionary zeal, neither the missionaries, religious organizations, nor the broader Western public might have turned their attention to the plight of women lepers, much less provided the humanitarian aid they received. Their fate might have been even more tragic. The interweaving of charity and evangelism reflects the specific sociocultural context of the time and offers valuable insight into contemporary practices in medical humanities.

From the perspective of contemporary medical humanities, society’s attention to patients particularly those in vulnerable groups has become more holistic. It no longer focuses solely on biomedical treatment or the healing of the body (“healing the physical”), but increasingly emphasizes psychological well-being and the influence of social and environmental factors which may be termed “healing the soul”. In the absence of religious intervention, both healthcare providers and charitable organizations are called upon to offer greater emotional support, assist patients in maintaining social connections, and provide appropriate forms of spiritual and psychological comfort. Through practical approaches such as psychological counseling, social work, and community support networks, more humane and compassionate models of care can be developed that transcend religious and cultural boundaries. These models aim to offer respect and empathy to all patients, regardless of background. Ultimately, this reflects a deeper aspiration: to strike a meaningful balance between medicine and the humanities, thereby achieving genuine progress in healthcare that is guided not only by scientific advancement, but also by humanistic concern.