The perseverance of the saints: or, how one of the first American women doctors made medical care into a genuine form of evangelism. Proposed date of commemoration: July 26.
“With only one life to live, why throw it away by going to India?” a friend once asked Anna Sarah Kugler (1856–1930). Deliberately adopting a turn of phrase from her new country, the doctor replied, “It was written on her forehead by the pen of Brahma,” which is to say: she was called to it by God and dared not disobey.
In the late nineteenth-century America, it was uncommon for women to be doctors, much less missionary doctors forsaking their homeland to serve on the other side of the world. But Anna had known that was what she would do ever since as a little girl she first heard a missionary to India speak about the work there.
Anna was born in Ardmore, Pennsylvania, to Harriet Sheaff Kugler and Charles Kugler, the latter of whom served as president of the Lutheran Publication Society for sixteen years and opened the first public school in the county. Education was her father’s passion, and he saw to it that his daughter attended excellent private schools, among them a Friends’ School. She entered the Women’s Medical College in Philadelphia at the age of nineteen and graduated with honors.
Anna’s first assignment established her pattern of doing the unexpected and unprecendented: she took the post of First Assistant Physician at the State Asylum for the Insane in Norristown. Not many years later, a letter arrived from another American Lutheran missionary in India, Pastor A. D. Rowe, whose study Everyday Life in India was intended to humanize and correct the distorted American portrait of Indians as widow-burners and self-torturing religious fanatics, analogous to Bartholomäus Ziegenbalg’s pioneering work as the first Indologist. Rowe described the great need for female doctors and urged Anna to rekindle her childhood dream.
Despite her prestigious position at the Asylum, in 1882 she petitioned the Board of Foreign Missions of the General Synod of the Lutheran Church in America to sponsor her as a medical missionary in India. The response was a “sad disappointment,” in her own words: the Board was not prepared to expand the scope of their mission to include medical work. The most they could do was send her as a teaching missionary. Anna decided to take what she could get and accompanied six others to become the first woman missionary to arrive in Guntur.
She didn’t take the denial of her petition to do medical work lying down, though. In her trunks she had stowed away $100 worth of medical equipment and medicines, purchased in London and financed by a Quaker friend, Rebecca White. In the doctor’s own terse prose, referring to herself in the third person: “Brought up as she had been in the city of Friends, Dr. Kugler was well pleased to have this gift, but she would have been better pleased had she also received encouragement from her own Church.”
Severe monsoons upon their arrival in India meant a delay of a month in Madras (today’s Chennai), followed by a two-week journey in little boats up the canal, but at the end of November 1883 Anna and her companions arrived at last in Guntur. A city of the southeast coastal state of Andhra Pradesh, Guntur had a population of about 18,000, which grew to 50,000 in the course of Anna’s stay. She was welcomed by the four missionaries that had preceded them, themselves following in the footsteps of C. F. Heyer’s pioneering work. Their mission campus had only four residential bungalows and a chapel. It was a shock for the newly arrived doctor to go from the state-of-the-art hospital in Philadelphia to nothing but what she’d brought in her own bag.
As Anna quickly learned, Andhra Pradesh, “the rice bowl of India,” was home to the Telugu people, whose language is the third-most commonly spoken in India to this day. The entire Telugu population at the time reached upwards of twenty million—but as yet there was not one single hospital for women. Male Christian missionaries had already realized that they would never reach the women of India, especially the higher caste ones, sheerly on account of their sex—“the majority of the high caste Hindu and Mohammedan women would rather die than receive medical attention from a man,” as Anna observed—so they began to invite women missionaries who could cross that boundary a little more easily. Women doctors in particular had the ability to bring the gift of healing to isolated local women and in so doing open up new possibilities for evangelical conversation.
That outreach mostly took place in the zenana, or the women’s quarters in a Hindu or Muslim Indian home. In her capacity as teaching missionary, Anna paid zenana visits as well as teaching and, during her second year, opening schools for Hindu girls across the region. But her heart was in the medical treatment that she dispensed from the verandahs of the mission compound. In her first year alone, 276 patients came to see her—often too late, to her intense sorrow—and another 185 she treated in their own homes. The medicines ran out in short order, which deterred further work, but Anna’s colleagues became convinced of the urgency of medical mission as part of the broader task of evangelism and raised enough money to start a basic hospital. By 1885 the church back home changed its mind, too, proclaimed Anna a medical missionary, and found funds to extend her program.
Finding permission and funds for her work were only the very beginning of the challenges that awaited her. The biggest barrier was cultural. The great numbers of poor women who turned to her were illiterate and couldn’t read directions for their prescriptions, so Anna had to devise ingenious ways to convey the dosage. Extensive purity taboos hedged the lives of higher caste Indian women, making them reluctant to seek and accept treatment. As Anna put it herself, “It did not take long for the doctor to learn that she was ceremonially unclean and that every object touched by her in the high caste Hindu home was defiled… She very soon became an adept in placing the medicine bottle on the floor, for she knew that it had been defiled by her touch and that nothing but the earth could make it fit to be handled by the ceremonially clean hand of a Brahmin… The doctor learned, too, that love was stronger than caste. When, as the results of her services, the life of a mother or little one had been saved, there often was established a friendship with inmates of the Hindu home that made them less strict in their observance of caste rules.”
Anna quickly learned the delicate art of respecting caste enough to reach out to the people she was sent to serve while at the same time gently contributing to its breakdown. “Those missionaries who do not unnecessarily offend caste are most successful, not alone in a Maternity Ward but in all dealings with the people. The sooner the new missionary learns that some of the customs of India are really superior to those of the West, the sooner will he be fitted for his work.” She had a pump installed so that Brahmins could use its clean and untouched water without lugging their own containers of water from home. She also invited school groups from across the religious spectrum for tours of the mission, where curiosity about the work overrode caste considerations.
Step by step the long dreamt-of hospital came into being. In 1886 Anna rented a house in the Muslim quarter of Guntur. By 1887, two dispensaries were up and running in Guntur and Mangalgiri. During a three-year furlough, Anna studied hospital administration in the U.S. By the time she returned to India in 1891, a plot of land had been bought in Guntur for the hospital site. The cornerstone was laid the following year during a prayer service, and the first Dispensary opened in 1893. That same year Anna spend ten weeks in America again, among other things to represent Lutheran women in India at the first-ever Parliament of the World’s Religions held during the famous World’s Fair in Chicago.
The doors of the hospital were finally opened in June 1897, and upon her return from a convalescing furlough in 1899 Anna took charge as supervising doctor. She had waited sixteen years for this moment. Posted all over the hospital were the medical mission’s principles:
Our Motto: Ourselves your servants for Jesus’ sake. II Corinthians 4:5
Our Rule: Whatsoever ye would that men should do to you, do ye even so to them. Matthew 7:12
Our Goal: Study to show thyself approved unto God, a workman that needeth not to be ashamed. II Timothy 2:15
In time a children’s ward and a maternity ward, plus a chapel and a residence for nurses, were all added on, built of the same gray stone and financed by American women donors.
Not only was the hospital funded and headed by women: most of Anna’s staff were women too. Other American doctors joined her, chief among them Mary Baer and Ida Scudder, as well as Elsie Mitchell, Eleanor Wolf Stewart, and Mary Fleming. Katherine Fahs, a nurse, set up a nurses’ training program at the hospital. Over time these colleagues moved out into other areas and set up new dispensaries, as well as forming partnerships with other Christian medical missions. These collegial relationships meant the world to Anna: at first she had been very much on her own, and in her first five years in India she met with only three other women doctors for a few short hours total.
Anna’s most important colleague, though, was her well-loved friend Dr. P. Paru from Cannanore. She worked side by side with Anna at Guntur from 1911 to 1923 until she opened up a clinic in her hometown on the Malabar coast. After being educated at the Madras Medical School she joined the hospital staff in 1911 and within months she was baptized. In time she became a skilled surgeon and obstetrician and wrote a Telugu textbook on obstetrics. In Anna’s admiring words: “It is fitting to write at length of this member of the staff, to whom the Guntur Hospital owes so much, for but for her devotion and faithful service the work at that time could not have gone on. Twelve years of work, which often taxed her strength to the utmost, is the gift that Dr. Paru gave to Guntur. Her reward—what has it been? A place among the leading women of South India. Is that all? The love of those for whom she labored. That is very great. But best of all is the knowledge that she was been true to her convictions of what is right, and that God has given her the courage to carry them out.”
As part and parcel of their duties, Anna insisted that all her medical staff actively participate in the evangelistic work, displaying that their love of Christ motivated their healing ministry. But the chief responsibility lay with the Bible women—a church office that no mission has ever succeeded without. These indigenous evangelists were accorded equal respect and responsibility in the mission’s outreach: among them P. Evangeline, K. Rangamma, Enoch Susan, M. Parvatamma, K. Mary Ann, Philip Sarah, Esther, Krupamma, Narasimma, Soubhayamma, and M. Harriet. Many of them had first arrived at the hospital as patients: disabled, blind, orphaned, suffering from disfiguring diseases. Their embrace of the Christian faith gave them a new calling in life, to share the gospel with others suffering pain and disease. They intuitively knew how to share the good news of Jesus Christ in a way their compatriots could understand. Two Indian preachers, Chegudi Joshua and Murari David, also joined the evangelistic team and alternated in leading daily prayer alongside the doctors and Bible women.
There was never any end to the need or the work. A mere five years after the hospital opened its fifty beds were insufficient to meet the demand. Only those who could afford to pay were charged fees, though it was often difficult to extract them. By contrast, the impoverished women who were treated free of charge always tried to leave a gift in return, even something as simple as a piece of fruit. Anna reports, “A poor Mohammedan woman for whom an abdominal operation had been successfully performed gave one rupee, and as she climbed into her cart and bent low over our hands we felt how genuine was her gratitude. We have always considered that fee as one of the largest that we have ever received.”
One one of her last trips back to the U.S., a women’s mission convention presented Anna with a wristwatch. She responded with some embarrassment, “I don’t know why you did this for me; I haven’t done anything much. The Lord did it all; I only helped.” The British colonial authorities insisted on recognizing her as well: she received the Kaiser-i-Hind Medal twice, in 1905 and 1917.
Anna served a total of forty-seven years and expressed disappointment in her final illness not to have reached fifty. During that period several hundred thousand patients were treated under her supervision. Upon her death in 1930, Dr. Scudder remembered her as one of “those noble pioneering women who made it easy for us who follow in their trail,” adding that “a star of great magnitude has fallen from the galaxy in our medical missionary firmament.” Despite spending some of her final years in America trying to recover from her health problems, in the end Anna died in India, as she had hoped, in the very hospital she had built. At her funeral, Hindu friends willingly incurred ritual defilement in order to carry her coffin and lower her body into the earth.
The Guntur Mission Hospital was renamed the Kugler Hospital shortly after its namesake’s death and continued to operate into the twenty-first century.
One of the most stirring testimonies to Anna’s ministry came from a Hindu friend, the Rajah M. Bhujanga Rao. He was a Sanskrit scholar and a poet in the Telugu language, as well as a devotee of Shiva. Though exposed to the gospel as a student at another mission’s school, he never took it seriously until his wife’s severe illness meant hours and days spent at the hospital in Guntur. In time he began to translate the Gospels into Telugu, which went on to sell nine thousand copies, and after ten years’ labor he published a complete New Testament in Telugu.
According to his own testimony: “Before our first visit to this hospital my wife and children never heard the name of the Good Shepherd—no, not even once. After their acquaintance with this hospital, though we are not converts in the strict sense of the term, my family regularly pray every morning and evening in the name of the Lord, read their Telugu Bible and meditate on some passage or other. We do not now feel ashamed if people call us Christians to mock at us. It is needless to say that this change in my family is mainly due to the saintly character of the most able physicians in charge of the hospital.”
For Further Reading
Margaret R. Seebach’s Indian Goddess: The Story of Anna Kugler (1942) is a seven-page account of Kugler’s ministry.
Maina Cawla Singh in “Women, Mission, and Medicine: Clara Swain, Anna Kugler, and Early Medical Endeavors in Colonial India,” International Bulletin of Missionary Research 29/3 (2005): 128–33 puts Kugler’s story in a broader context.
Peter Vethanayagamony gives an overview of her whole life and ministry in “St. Anna Sarah Kugler,” Lutheran Forum 44/4 (2010): 40–50.
Kugler’s own account of her work can be found in Guntur Mission Hospital (Women’s Missionary Society of the ULCA, 1928), written during a convalescence three years before her death.
A. D. Rowe’s sympathetic study of the Telugus, Everyday Life in India, can easily be found for free online.