The Use of Medicine in Espionage, an Old Profession: The Example of Missionary Activities in the Ottoman Empire

Introduction

The Intersection of Healing and Intelligence

Espionage, one of humanity’s oldest professions, has historically relied on the principle of non-official cover, wherein agents operate under guises that provide plausible deniability and facilitate access to target populations. While roles such as diplomat, merchant, and journalist are common covers, the physician’s position is uniquely potent. The medical practitioner’s creed is to heal, a universal imperative that transcends cultural and political divides. This role inherently builds trust, grants intimate access to all strata of society, and lowers the natural suspicion afforded to outsiders, creating ideal conditions for intelligence gathering and influence operations (Akgün, 1988). The physician is invited into the home, privy to family dynamics, and becomes a confidante during times of extreme vulnerability (Hume-Griffith, 1909, p. 56; Strong, 1910, p. 10).

This article argues that the activities of American medical missionaries in the 19th and early 20th century Ottoman Empire, particularly those affiliated with the American Board of Commissioners for Foreign Missions (ABCFM), represent a quintessential case study of this intersection (Strong, 1910, pp. 16-17). What began as a religious and humanitarian enterprise evolved, whether by explicit design or as an emergent property of its structure, into a sophisticated instrument of American soft power, intelligence gathering, and political influence (Salt, 1993; Şahin, 2014; Keskinbora, 2018). This evolution did not occur in a vacuum; it provoked a complex and strategic, though ultimately insufficient, series of countermeasures from the Ottoman State. The analysis will demonstrate that these medical missions, while ostensibly apolitical, became key players in the geopolitical “Great Game” unfolding in the Near East, illustrating how the benevolent act of healing can be inextricably linked to the clandestine art of espionage.

The Vulnerable Patient: The Ottoman Public Health Landscape in the 19th Century

The efficacy of the medical missionary as an instrument of influence depended on the specific conditions of the host environment. The 19th century Ottoman Empire provided fertile ground, not because it was a primitive society devoid of medicine, but because it was a state in the throes of a difficult and incomplete modernization, creating a significant gap between public health aspirations and reality (Yücel, 2015).

1- A System in Transition

The Ottoman state was actively engaged in modernizing its institutions, including its healthcare system. Following the establishment of the Military School of Medicine in 1827 and a civilian counterpart in 1866, the government aimed to train a new cadre of physicians for both the army and the provinces (Altındal, 2008, p. 27; Haytoğlu, 2014, p. 1520). Concurrently, it began to establish a legal framework to standardize the medical profession, creating boundaries between licensed practitioners and traditional healers through regulations such as the 1861 “Regulation on the Practice of Medicine in the Provinces” (Argit and Yildiz, 2024). These reforms were part of a broader state-building project designed to improve the (re)productive capacities of the population and centralize administrative control (Argit and Yildiz, 2024).

2- The “Healthcare Vacuum”

Despite these laudable efforts, a vast “healthcare vacuum” persisted, particularly in the sprawling Anatolian provinces. The output of the new medical schools was critically insufficient to meet the needs of a population of over ten million (Keskinbora, 2017; Akgün, 1988). The few military doctors were concentrated in barracks, leaving the civilian population, especially in tens of thousands of villages, almost entirely without access to modern medical care. The people were left in a “desperate” and “defenseless” position, depending on a patchwork of traditional practitioners, whom missionaries frequently characterized as inexperienced midwives and bonesetters with no understanding of contemporary anatomy, physiology, or hygiene (Çavdar and Karci, 2014). This environment was ripe with disaster. Poor sanitation, contaminated water sources, and a lack of public health infrastructure meant that epidemics of cholera, typhus, typhoid, and dysentery were rampant and deadly (Keskinbora, 2018). Infant mortality rates were exceedingly high, a fact that missionaries attributed directly to the absence of modern hygienic practices.

3- The Missionary Opportunity

The American Board of Commissioners for Foreign Missions (ABCFM) was the first American Christian missionary organization. It was created in 1810 by recent graduates of Williams College. In the 19th century, it was the largest and most important of American missionary organizations and consisted of participants from Protestant Reformed traditions, such as Presbyterians, Congregationalists, and German Reformed churches. However, due to secessions caused by the issue of slavery and by the fact that New School Presbyterian-affiliated missionaries had begun to support the Presbyterian Board of Foreign Missions, after 1870 the ABCFM became a Congregationalist body (Congregationalism, also Congregational Churches or Congregationalist Churches, is a Reformed Christian (Calvinist) tradition of Protestant Christianity in which churches practice congregational government) (American Board of Commissioners for Foreign Missions archives, 1810-1961).

This systemic weakness created the perfect entry point for American medical missionaries. Their provision of modern, technologically superior medical services was not merely a charitable act but a strategic exploitation of a critical state vulnerability (Yücel, 2015). They offered a service that the state could not consistently provide, making their presence irresistible to a population desperate for healing (Yücel, 2015). The Ottoman state’s own modernization efforts, while intended to strengthen its legitimacy, had an unintended consequence. By introducing Western medical standards and creating new professional categories, the reforms inadvertently established a new benchmark for the populace. When the state, due to chronic shortages of resources and personnel, was unable to meet this criterion, the services of well-funded, well-organized American missionaries became even more effective and attractive (Arikli and Yavuz, 1974, p. 34). The missionaries were not entering a static void, but a dynamic field of competition where the state itself had raised the stakes, and its own shortcomings amplified the appeal of the foreign providers who could fill the gap (Ortayli, 2008, p. 67).

The Scalpel and the Scripture: The Modus Operandi of American Medical Missions

American missionaries understood that medicine was the key to unlocking a society otherwise closed to them. Their methods were systematic, blending genuine medical care with sophisticated psychological and cultural strategies designed to win “hearts and minds” for the ultimate purpose of evangelization (Bartholomew, 1990).

1- Gaining Access and Trust

The primary method was to use medicine to “break down opposition, dissipating prejudice and entering into the hearts and homes of the high and the low, the rich and the poor” (Bass, 2008, p. 202). The first medical missionaries, such as Dr. Asa Dodge, who arrived in Beirut in 1833, were pioneers who used their skills to create a favorable environment for the ABCFM’s broader activities (Yücel, 2015; Bozan, 2014). The work of Dr. Azariah Smith and Dr. Henry Lobdell in Antep exemplified the success of this approach. In a city where American missionaries had been stoned and driven out just years earlier, these two physicians managed to gain the acceptance and respect of the local population in the 1850s solely through their effective medical treatments (Yücel, 2015; Bozan, 2014). This strategy proved so successful that missionary doctors were often welcomed even into the homes of Ottoman officials, granting them remarkable access and influence (Bass, 2008, p. 211).

2- The Doctrine of “Body Politics”

The missionaries’ work, however, went far beyond simple healing. They engaged in a form of “body politics”, a biopolitical strategy where the physical body and its environment were reconceptualized as material representations of religious and moral deficiency that required “civilizing”. They pathologized the local culture, describing native homes as “filthy and unwholesome” and local medical practices as a cure. The “cure” they offered was not just medical but ideological: the adoption of a Western, Protestant way of life. This was most powerfully communicated through the “before-and-after” narrative, often documented with photographs and published in missionary journals, such as the Missionary Herald. These images contrasted the “wretchedness” of the locals before conversion with their “finer”, cleaner, and more “civilized” state afterward, serving as potent propaganda to secure continued funding from supporters in the United States (Grundmann, 2008). They promoted Protestantism as an “antiseptic religion” that could cure both the body of disease and the soul of “heathenism”, even claiming that converted Christians gained “exceptional immunity” during epidemics due to their superior cleanliness and faith (Kim, 2008). The hospital and clinic thus became laboratories for cultural transformation, where the physical body was disciplined and remade in the image of the missionaries’ values. This was a more subtle, yet arguably more pervasive, form of control than direct political or military force.

Maksudyan’s viewpoint is that the American missionary enterprise in the Ottoman Empire was a project of “body politics,” where the physical transformation of the local population served as the primary evidence for the success of their civilizing mission. This approach allowed missionaries to frame their work in tangible, demonstrable terms, justifying their presence and reinforcing a cultural hierarchy that equated Western Protestant values with physical and moral superiority (Maksudyan, 2020, pp. 62-89). These institutions gave them access to the population, allowing them to “make an impression” of what they considered “true Christianity”. Medical care and hygiene became instruments for instilling Protestant values.

3- From Healing to Proselytizing

The medical encounter was systematically instrumentalized for religious conversion. The patient’s state of pain, fear, and desperation was seen as a prime opportunity for evangelism (Morrison, 1936). Missionary physicians were instructed to use this vulnerability to introduce Christian teachings. As Morison advised, the goal was to give patients “the principles of our teacher, Jesus, and the knowledge that will save them”. They would read the Bible at the patient’s bedside, attribute the source of healing directly to Jesus Christ, and offer suggestions for conversion. The psychological power of this approach cannot be overstated. As one missionary, Miligan, noted, doctors had the opportunity to say things to Muslims that, if heard from anyone else, “would have been filled with rage and wrath”. This strategy was highly effective, enabling them to approach and influence even the most devout individuals whom it would otherwise be impossible to reach with the Bible (Morrison, 1936). It is possible to understand the breadth of the US plan to control the region through numerous consulates from Figure 1.

Figure 1. The U.S. consular network in 1914 (Consoli, S., 2023)

Mission Creep: From Proselytization to Political Subversion

While the initial impetus for medical missions was evangelistic, their activities gradually expanded, intersecting with the turbulent political currents of the late Ottoman Empire. The missionaries’ success in establishing themselves created a platform from which they began to exert significant political influence, transforming them from simple preachers into agents of political change.

1- Exploiting Legal Reforms

The Ottoman state’s own reform efforts were a critical catalyst for this mission creep. The Tanzimat Edict of 1839 and, more importantly, the Reform Edict (Islahat Fermani) of 1856 were crucial turning points (İnalcık, 2008, pp. 169-190; Şimşir, 1999). By guaranteeing the rights, property, and legal standing of non-Muslim subjects and granting each religious community the freedom to establish its own educational institutions, these reforms gave the ABCFM an unprecedented degree of legal protection and operational freedom. The official recognition of the Protestant millet (a legally protected religious community) in 1850 provided the missionaries with a formal, protected status within the imperial structure. The state’s attempt to create a more equitable society of Ottoman citizens inadvertently created protected enclaves from which missionary activity could flourish with the backing of imperial law (Şimşir, 1999).

2- Targeting Minorities and Fostering Nationalism

After finding little success among Muslims and Jews, the missionaries concentrated their efforts almost exclusively on the nominal Christian communities of the empire, with the Armenians becoming their primary target audience (Çabuk, 2015). The ABCFM systematically organized its presence in Anatolia to maximize its influence over the Armenian population, dividing the region into the “Western, Central, and Eastern Turkey Missions” in 1860. This organizational structure was the foundation for what some have termed an “Armenian Renaissance” (Çabuk, 2015; Kılıç, 2018).

The primary vector for this political transformation was the missionaries’ vast network of schools, which numbered over 450 by 1913 and enrolled nearly 26,000 students. These institutions became a nexus of education and propaganda. Missionaries learned the Armenian language and promoted its use, reviving a language that had been in decline across much of the region (Danacioglu, 2000). Their curriculum emphasized Armenian history, particularly the glories of the ancient independent Armenian kingdom, and introduced a generation of Armenian youth to Western political concepts of nationalism, liberty, and self-determination derived from the French Revolution (Günay, 2021). This educational program directly cultivated a new generation of Armenian intellectuals and activists with a strong national consciousness, which was often overtly hostile to the Ottoman state. Graduates of these schools became, as one source notes, “fanatical... enemies of the Turks” and formed the backbone of revolutionary committee activities (Çabuk, 2015; Haytoğlu, 2014, p. 1531).

3- From Consciousness to Rebellion

The missionaries’ activities are directly linked to the rise of Armenian revolutionary committees and subsequent rebellions, such as those in Maraş/Zeytun (1878) and the Sason region (1894-96) (Çabuk, 2015; Öney, 2012). Ottoman officials and later historians accused the missionaries of actively inciting these rebellions. Whether direct instigators or not, they became central figures in a destructive feedback loop. First, their educational and political activities fostered the nationalist sentiment that led to unrest and rebellion. Second, when the Ottoman state implemented security measures, often of a severe nature, missionaries leveraged their extensive communication networks and significant credibility in the West. They proceeded to frame these state actions not as responses, but as unprovoked “atrocities”. This narrative was frequently disseminated using inflammatory, religiously charged language, such as the “massacres of Christians by savage Turks”, thereby decontextualizing the events and mobilizing Western sentiment against the Ottoman government (Öney, 2012). This propaganda, often distorted or exaggerated, was highly effective. It generated outrage and massive fundraising campaigns in the United States and Europe, and it dramatically increased diplomatic pressure on the Ottoman government (Çabuk, 2015; Danacioglu, 2000; Şimşir, 1999). This foreign pressure, in turn, emboldened Armenian nationalist groups, leading to further rebellion and starting the cycle anew. The medical mission, therefore, became the engine of a process that destabilized the region and justified the very foreign intervention it helped to provoke. One of the numerous consequences of this provocation is seen in Figure 2.

Figure 2. Armenian resistance members from the Adapazari Armenian committee (Armenian activities in the archive documents 1914-1918, 1915)

The Physician as an Intelligence Asset: A Comparative Analysis

The American medical missionary represented a uniquely effective model of intelligence operative; one whose capabilities differed significantly from the more conventional espionage methods employed by European powers in the Ottoman Empire during the same period (Erhan, 2000).

1- The Missionary as an Embedded HUMINT Asset

In the language of modern intelligence, the medical missionary was a deeply embedded human intelligence (HUMINT) asset operating under “non-official cover”. A key distinction between missionaries and official state emissaries, such as diplomats and military attachés, lay in their respective degrees of societal embeddedness. Whereas official representatives were largely limited to interactions within capitals and administrative centers, missionaries often resided in local communities for decades. Through their capacity as medical providers, they established direct contact with a wide demographic spectrum, encompassing both rural populations and provincial elites (Haytoğlu, 2014, p. 1532). They possessed fluency in local languages like Turkish and Armenian and a granular cultural understanding that was largely inaccessible to formal intelligence services. This allowed them to gather atmospheric intelligence—the subtle but crucial data on social tensions, political sentiment, economic conditions, and local power structures—that are vital for long-term strategic assessment. The missionaries were, in effect, the “case officers” and “field agents” of a sprawling, non-state intelligence agency operating with the plausible deniability of a humanitarian mission (Salt, 1993, pp. 191-195). This mission was progressing rapidly through marriages between native Ottoman Christians (perhaps Muslims as well) and American citizens, conducted by the consul (Figure 3).

Figure 3. U.S. marriages in 1882 (Consoli, S., 2023)

2- Contrasting with British and Russian Methods

The American approach stands in stark contrast to the intelligence operations of its European rivals. The American expedition occurred in the early years of the modern West’s—at that time mostly British, French, and Russian—penetration into Ottoman lands. Its immediate effect was to draw the East into the rapidly expanding capitalist world economy while curbing the ambitions of rival powers and preparing for the eventual disintegration of the Sublime Porte. This phase of missionary activity represented an extraordinary situation, as the Americans were attempting to impose their own version of Christianity, namely Protestantism, on communities that had been Christian long before the emergence of a Christian American identity (Fildis, 2012).

● Imperial Russia: Russian intelligence efforts were overwhelmingly focused on collecting hard, military-grade intelligence in preparation for conventional warfare with the Ottoman Empire. Their primary method was military-topographic reconnaissance. They deployed trained military officers from specialized corps, often under the guise of scientific or diplomatic missions, to systematically map terrain, transportation routes, mountain passes, and fortifications. Their work was highly technical, state-directed, and geared toward tactical and operational advantage in future campaigns (Simov, 2019).

● Great Britain: British intelligence relied on a more formal and hierarchical network centered on the embassy in Istanbul. The primary sources were the ambassador, a network of consuls spread across the empire, and the dragomen (official interpreters). This structure was adept at gathering political and commercial intelligence through official channels and cultivating contacts. While they also employed covert agents and unofficial negotiators for specific, sensitive tasks, their core structure was diplomatic and designed to inform state policy directly (Yurdusev, 2009).

These activities were carried out by Presbyterians on behalf of the British. They opened schools, monasteries, and similar institutions in Suwaydiye in 1846, Antioch (Antakya), and Iskenderun in 1876. However, their main area of interest was the area around Baghdad and Mosul. The British missionary army in the region, consisting of 141 missionaries, 183 local helpers, 111 informants, 75 schools, and 4,600 students, worked according to the motto “a drop of blood, a drop of oil”. Dr. Lespiyes, on behalf of the German missionaries, and the Americans, on behalf of the Italians, from 1860 onwards, knew exactly what to do (Tozlu, 1991, pp. 20-26).

The American model, leveraging the vast and decentralized network of the ABCFM, offered a distinct advantage. While the British ambassador relied on his dragoman for news from the Sublime Porte, an American missionary could report on the mood in a remote Anatolian village after treating a cholera outbreak (Keskinbora, 2018). This “grassroots” intelligence was invaluable for understanding the internal fragilities of the Empire and for shaping long-term political strategy. The missionaries provided a depth and texture of information that the more structured European services could not easily replicate (Hülagü, 2001).

The missionary efforts of the American, British, and Russian groups are systematically organized in Table 1 to permit a synchronous comparison. This data visualization tool is offered as an accessible reference for a summary review of their activities.

The Imperial Response: Ottoman Counterintelligence and Statecraft

The Ottoman government was neither a passive nor a naive victim of these activities. Archival evidence reveals a growing awareness of the threat posed by the missionaries and the development of a sophisticated, multi-pronged counterstrategy designed to contain their influence and reassert state sovereignty (Şahin, 2014, pp. 16-18).

Documents and details regarding the Ottoman Empire’s perception and reaction to Armenian militant activities and rebellions, according to archive records, are shown in Table 2.

The American Board of Commissioners for Foreign Missions (ABCFM) Archives, housed at the Houghton Library at Harvard University (and available on microfilm), are the key source for the missionary perspective. These documents would contain the detailed observations and communications that could be interpreted as “intelligence gathering” or “hostile sentiments.” ABCFM Records are shown in Table 3.

The missionary may describe treating wounded Armenians involved in a conflict (thus having direct access to intelligence), while simultaneously criticizing their use of violence, but ultimately framing the insurrection as a response to Ottoman oppression. This highlights the “dual role” of missionaries.

1- Awareness of the Threat

From an early stage, Ottoman officials were suspicious of missionary motives, complaining about their “destructive” activities as early as 1841 (Segev, 2024). By the time of the reign of Sultan Abdülhamid II (1876-1909), this suspicion had hardened into a clear policy position (Keskinbora, 2017). The government explicitly viewed the missionary enterprise as a threat to state security, with provincial governors continuously sending reports to Istanbul accusing the missionaries of spreading “sedition” (fesâd hareket) and inciting rebellion among Christian minorities (Şahin, 2014; Altintas, 2018). Missionaries were charged with supporting Armenian rebels in Bitlis and with severe patient misconduct in Kayseri, leading to arrests and the closure of their facilities (Öney, 2014; Şahin, 2014, pp. 34-36). The Ottoman state saw the missionaries not as benevolent healers but as agents of subversion.

2- A Multi-pronged Counterstrategy

Alongside the large number of missionaries whose primary goal was to convert Ottoman Christians of other denominations to Protestantism, another large group of missionaries was also active, attempting to convert them to Catholicism. These missionaries also attempted to convert the Muslim population by propagating Christianity at opportune times (Sönmez, 2021). While the Sublime Porte remained indifferent to missionary activities among its subjects in the first years of Ottoman-American encounters, the official attitude gradually changed and became more negative in the following years, parallel to the increase in the number of complaints from non-Muslim clergy, Muslims, and government officials (Erhan, 2000). Recognizing this, the Ottoman administration began implementing various administrative and police measures. In addition, reform efforts and decrees were issued to address deficiencies in education and healthcare. The Ottoman response was not one of simple repression but a complex application of modern statecraft.

A. Legal and Administrative Control

The state used its own burgeoning legal and bureaucratic apparatus to try to contain the missionaries. This included instituting strict regulations on the opening of new schools and hospitals, which now require official permits from the Ministry of Public Instruction. Officials conducted inspections of curricula and textbooks, censoring any content deemed politically or morally harmful (Şahin, 2018). In the early 20th century, they also implemented new tax and property laws designed to limit the physical and financial expansion of the tax-exempt missionary establishments, a clear attempt to curb their growth using economic leverage (Öney, 2014).

B. Surveillance and Law Enforcement

The government conducted close surveillance of missionaries, intercepted their mail during wartime, and rigorously censored their publications to prevent the dissemination of “seditious” materials (Altintas, 2018). When missionaries were caught in activities deemed illegal—such as the missionary in Bitlis accused of supporting rebels—the authorities took direct action. They arrested or deported the individuals involved and pointedly refused American diplomatic interference, asserting that these were internal matters of imperial law enforcement (Altintas, 2018).

C. Competitive State-Building

Perhaps the most sophisticated element of the Ottoman response was not just to suppress missionary institutions, but to out-compete them. Recognizing that the missionaries thrived by filling a void, the Hamidian government launched a major state-led initiative to build its own network of modern public schools (mekatib-i iptidaiye). These schools offered an Ottoman-Islamic curriculum in the Turkish language, providing a direct alternative to the Christian-centric, English-language missionary schools (Altintas, 2018; Keskinbora, 2018). This was a direct countermove in the battle for the “hearts and minds” of the next generation, a clear example of using the tools of modern governance to fight a soft power threat.

This state response reveals a fundamental paradox of late Ottoman history. To counter the threat posed by modern, Western missionary organizations, the state had to adopt the very tools of modernity itself—centralized bureaucracy, public education, legal codification, and modern medicine. This attempt to strengthen the empire against foreign encroachment required it to become more like the West (Ümit, 2014). However, this very process of modernization, including the Tanzimat and Islahat reforms, often made the empire more vulnerable to the type of soft power penetration the missionaries represented. By creating a legal and social framework based on Western norms, the state gave the missionaries, who were masters of that framework, new avenues to exploit (Sönmez, 2021; Ümit, 2014). The very act of self-defense accelerated a transformation that ultimately contributed to the weakening of the traditional structures that had once held the multi-ethnic empire together.

Discussion

The introduction of missionary activity into the empire, the resolution of the Eastern Question, the re-Christianization of Anatolia, the domination of the Middle East and therefore the Islamic world, Istanbul’s centuries-long obstacle to Christian expansion, and its role as the capital of Islamic politics in this regard—all these fundamental ideals necessitated the selection of Istanbul as the center of missionary work. All of these also served as the reasons why the empire became a significant area of activity. Therefore, the first sentence of the 1880 Bartlett Report, which summarizes the activities of the ABCFM, is as follows: “From the perspective of missionary activities, Turkey is the key to Asia” (Kocabasoglu, 1989, p. 29).

This idea was adopted by American missionaries as well as other missionaries. Their presidents also sided with the missionaries. John Hay, Secretary of State in President McKinley’s (1897-1901) administration, was the cousin of George Washburn, the renowned principal of Robert College. Howard Bliss, the renowned principal of the Syrian Protestant College, was a childhood friend of President Theodore Roosevelt (1901-1909). The renowned missionary and founder of Robert College, Cyrus Hamlin, instigated aggressive “gunboat diplomacy”, advising President Cleveland (1885-89 and 1893-97) to send warships into Ottoman territorial waters. And T. Roosevelt, elected president in 1901, declared as early as 1898: “The two powers in the world I want to crush before anyone else are Spain and Turkey (Ottoman Empire)” (Taken from the minutes of the annual (1906) meeting of the ABCFM) (Kocabaşoğlu, 1989, pp. 41-43).

Missionaries do not hesitate to be extremely harsh and harsh in protecting themselves, their values, and their religion. They punish families who convert to Islam most horrifically. The missionaries smuggled twelve families who had converted to Islam from the island of Naxos to Malta and tortured them to death. No one ever dared to convert to Islam again (Refik, 1924).

Situated within the nascent stages of modern European encroachment upon Ottoman lands—a process led chiefly by Great Britain, France, and Russia—the American expedition had significant geopolitical and economic ramifications. It served to enmesh the Ottoman economy within the expanding capitalist world-system while simultaneously functioning as a strategic check on the aspirations of competing empires, thereby hastening the decline of the Ottoman state (Tozlu, 1999, pp.329-339). “We know that by the last quarter of the 19th century, ABCFM was publishing in 23 languages worldwide. It is also noteworthy that nearly half of these were published within the borders of the Ottoman Empire” (Kocabaşoğlu, 1989, p. 74).

Missionaries place extraordinary importance on education. Their most fundamental work is carried out through this medium. Education is the medium through which ideals are imparted and instilled, and cultural transformation is carried out gradually. This is also how the public is influenced. This is how the youth are reached. Furthermore, through education, it is possible to continue Christianization efforts without arousing hostility among the Turks (Trask, 1965, pp. 66-76).

Another active area for missionary service was healthcare. The Ottoman Empire’s weakness in providing healthcare services significantly influenced missionaries’ efforts, particularly in the field of health. These missionaries, who had begun their work with mobile healthcare services, later continued with dispensaries and hospitals. The Anatolian people, deprived of healthcare, showed tolerance and sympathy to the missionaries for the care and treatment they received while seeking healing. Thus, the missionaries, who had a comfortable working environment, campaigned, particularly among Armenians, then Bulgarians and Greeks, to secede from the Ottoman Empire and provided significant support to nationalization efforts (Keskinbora, 2018).

Significant literature indicates that American Evangelical missionaries working in the Ottoman Empire during the 19th century directly contributed to the rise of Armenian nationalism and the uprising against the Ottoman State. It is acknowledged that missionaries had an impact on Armenian nationalism. The impact of missionaries proved far more unforeseen than commonly assumed, stemming primarily from Armenian reactions to their growing influence. Using new data on the biographies of Armenian nationalist leaders and comparative-historical methods, researchers present evidence that missionary influence led to a response within Armenian society that intensified pre-existing local initiatives, increased investment in widespread education in the provinces, and modernized the school system. All these initiatives popularized and strengthened Armenian nationalism far more than anticipated (Amasyali, 2021, pp. 523-532).

This is quoting verbatim the researcher’s own statement in her Master of Arts thesis, “Al-Tabib: Medical Knowledge Production and Exchange in the 19th Century Levant”, submitted by Dana N. Nabulsi in 2022: “Furthermore, the successful education and practice of the graduates acted as a testament to the superiority of missionary education. Moreover, native physicians joined missionary clinics and hospitals across the Levant and Egypt; they were well-suited for this role as natives who were fluent in Arabic and familiar with modern medicine. Several graduates, some even inadvertently, assisted in the promotion of imperial interests and colonial expansion, as several graduates joined the British and American armies. ……. This thesis aimed to illustrate some of the changes that happened during this period in the medical profession and practice. However, many questions remain unanswered” (Nabulsi, 2022).

Conclusion

The use of medicine by American missionaries in the 19th century Ottoman Empire was far from a simple act of humanitarianism. It was a complex, multi-layered operation where the practice of medicine served as the entry vector for a broader mission of religious, cultural, and ultimately political transformation. The healthcare vacuum in the Empire provided the opportunity; the doctrine of “body politics” provided the method; and the political context of a declining empire and rising nationalisms provided the fuel. The scalpel and the scripture worked in tandem, one healing the body while the other sought to capture the soul and, with it, political loyalty.

The medical missionary network, with its deep community embedding and humanitarian cover, functioned as a highly effective, if unconventional, intelligence and influence operation. It gathered crucial atmospheric intelligence that was largely unavailable to its European counterparts and played a direct role in fostering the nationalist movements that contributed to the Empire’s dissolution. The Ottoman state, for its part, recognized this threat and responded with a sophisticated, modernizing counterstrategy of legal containment, surveillance, and competitive state-building, highlighting a dynamic and consequential geopolitical struggle fought not on the battlefield, but in clinics, schools, and printing houses.

The case of the medical missionaries in the Ottoman Empire serves as a critical historical lesson on the nature of soft power and the use of non-traditional covers in intelligence and strategy. It illustrates that the lines between aid, religion, and political influence are often deliberately blurred, and that the most effective forms of penetration can come not from the spy in the shadows, but from the trusted physician in the light. This historical precedent remains deeply relevant in understanding contemporary geopolitical conflicts where humanitarian and non-governmental organizations operate in fragile and contested states, reminding us that the motives behind benevolent actions can be as complex and strategic as any military maneuver.

Funding

None.

Conflict of Interest

None.

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