The old hymn entitled “Little is Much When God is in It” is an accurate summary of the life of Dr. Clara A. Swain. Born on July 18, 1834, in Elmira, New York, Clara A. Swain was only two years old when the family returned to Castile, where they had lived previously. The youngest of John and Clarissa Swain’s ten children, precocious Clara was a challenge for her mother to discipline, but she was also the family’s pet because of her small size and big personality. She spent much time outdoors with her sister, Hattie, and always displayed a tender heart toward animals. Any stray dog or cat was coaxed home with her, and an injured chicken from the hen yard was bandaged and nursed back to health. A good student and eager reader, she began attending the red schoolhouse in the village in 1840, where her siblings and cousins also studied.

The Swain family attended the Methodist-Episcopal Church in Castile, and one of Clara’s older sisters, Ann, joined the church at age 14 in 1843. Because of her sister’s sweet and consistent Christian example, Clara contemplated the state of her own life. She wondered why she wasn’t a Christian yet and wasn’t a good child. Dr. Swain recalled in later years that her sister Ann and her mother’s daily example in the home was the catalyst that prompted her to consider her unruly behavior. After a particularly stirring sermon about a year later, ten-year-old Clara decided that she must become a Christian and, after her conversion, joined the church. She committed herself to seek a “Christian profession,” not knowing what an exciting and exotic future lay waiting.

In 1848, Ann moved to Michigan to teach school and live with an aunt. Clara soon followed her sister. Her first medical experience came when her aunt fell and broke her ankle soon after Clara’s arrival. The teenager took over the care of her Aunt Elizabeth for the next several months until the woman fully recovered. During that time, Ann married, and afterward, Clara decided to return to Castile. Once home, she found employment tutoring younger children and helping mothers with large families.

In 1853 typhoid fever struck the home of Castile’s Presbyterian minister, Rev. Hurlburt. The attending doctor requested Clara’s help with his care. Unfortunately, the Hurlburt children also became seriously ill, and two succumbed to the disease. The pastor lost his battle with typhoid, passing away after his two children. Clara stayed with the bereaved widow and remaining children to help them through the numbing loss over the next several months.

After this intensely emotional and physically draining experience, Clara felt the need for more education and attended school in Pike in 1856. Her father’s aunt, who lived in Canandaigua, then invited Clara to come and live with her in 1857, where she completed her secondary education at the Ontario Female Seminary. After graduation, she began teaching at Canandaigua District School No. 10 in 1858. Still restless and believing there was more for her to do than teach, Clara began to consider a medical career. She had enjoyed the challenges and rewards of caring for her aunt and the Hurlburt family. Surely she had natural gifts for medicine, but needed more training and education.

Medical Training

After approaching Dr. Cordelia Greene at the Castile Sanitarium, Clara was offered a medical internship there in 1865. Under Dr. Greene’s strict but encouraging tutelage, Clara knew she’d finally found her calling. Dr. Greene recommended that the promising intern apply to the Women’s Medical College of Pennsylvania, located in Philadelphia—her own alma mater. Clara’s application was accepted, and she began a term of studies in 1866-1867. Returning to the Castile Sanitarium in 1867, Clara worked another year under Dr. Greene’s supervision. Resuming her coursework in Philadelphia in 1868, Clara graduated with a medical degree on May 11, 1869.

Female doctors were scarce as were medical colleges for women in the 1850s-1870s. Both the Philadelphia medical school and students faced cruel discrimination against them. Housed in rented backrooms of a commercial building, the Women’s Medical College struggled to exist throughout the 1850s. In 1858 the Philadelphia County Medical Society recommended that medical professionals withhold support of the school and its graduates. Many pharmacists wouldn’t fill prescriptions written by women doctors, and in general, women were not considered fit mentally or physically to practice medicine. Cordelia Greene had passed through the same gauntlet years earlier but was now well respected by her male colleagues. Clara was determined to prove herself just as capable and serve God with her medical skills.

Early in 1869, the newly formed Women’s Foreign Missionary Society of the Methodist-Episcopal Church in Boston, Massachusetts contacted the medical school to request a graduate of suitable Christian character and medical abilities. The need for women doctors in India was great, and the Society intended to send at least one doctor that year. Clara’s name was immediately offered, and Mrs. J.T. Gracey of the organization wrote to Clara asking her to consider an appointment as a missionary doctor to India. Astounded at such an opportunity, Dr. Swain asked for three months to pray and consider the position. In August 1869, she agreed to go as the Society’s first woman doctor.

Journey to India

Wrapping up her affairs in Philadelphia and Castile, Dr. Swain took the train to New York City where she sailed for Liverpool, England, on November 3, 1869. Her sailing companion was Isabella Thoburn, another missionary appointee to India. Miss Thoburn was to establish schools for girls which were non-existent at the time.

The women were abysmal sailors and spent most of the time in their room crossing the Atlantic. Upon arrival in London, Dr. Swain had to explain herself to the customs official, who discovered a skeleton in one of her trunks. The man turned pale and looked to the smiling woman, who explained she was a doctor and needed the skeleton to teach medical classes. The man quickly closed the trunk and allowed the women to pass through. When they reached Egypt on the next ship, the women enjoyed the exotic culture and thrilling sights in the ancient land of the pharaohs. They crossed the country by train, purchasing passage on a ship docked in Suez. The Suez Canal had just opened on November 17^th, a week before their arrival.

Clara and Isabella boarded the steamship Krishna on Christmas Day, 1869. They arrived in Bareilly, India, their final destination, on January 20, 1870. The voyage had taken them to Bombay where they took a northbound train, then found transport by bullock train and then, horse and carriage. It was an arduous and frightening journey. Clara wrote that she and Isabella prayed together in the carriage when their escorts left them alone in the jungle to secure fresh horses one evening. The men warned them not to wander away because of tigers in the area. The strangeness and dangers of India brought troubling doubts to the women’s minds, but both were committed to accomplish the work waiting for them.

Arrival in Bareilly

Once in Bareilly, Clara and Isabella experienced extreme culture shock settling into life at the Methodist mission with fellow missionaries. Besides the language barrier, exotic new food, and tropical climate, the religious restrictions for both Hindu and Muslim women were complex. There was much to learn. In a letter to her sister on January 25, 1870, Clara wrote: “Life seems different to me already, and I appreciate more than ever everything that is good and noble. The words of love and good wishes and the many assurances in my letters that I am faithfully remembered in prayer are of great comfort to me, and now that I have been brought in safety to India where I am to work for the Master, I feel the need of the prayers of my friends more than ever. As I begin to realize what is before me and the expectations of the people concerning my work, my faith and courage almost fail me.”

In another letter, she wrote about those early struggles: “Calls for medical attention increase in number daily and nearly every day I go into the city morning and evening. I visit regularly in 15 different zananas (women’s apartments within a house). It is a trial to me not to be able to talk with the women instead of speaking through an interpreter. I suppose, in a way, this year will be my hardest year in India. I have to study the diseases peculiar to the climate and country and their treatment keeping in mind the mode of life of the people, which is not always favorable to the recovery of a patient.”

By the end of the first year, she had treated more than 1,300 patients and was training a class of 17 women to become doctors. At the outset of her work in Bareilly, it was evident that a larger facility was needed to provide adequate medical care for the many women who sought treatment. So, in September 1871, she decided to approach the Nawab of Nampore, a Muslim prince who owned property adjoining the mission. She sought the help of the Commissioner of Bareilly to arrange an audience with the prince to request an acre of the estate for a dispensary and hospital. It was an impossible request, being informed that no prince would sell land that was part of his inheritance. But the diminutive Dr. Swain believed the mission must try.

Hospital Plans

With the prime minister’s help, the palace extended an invitation for an audience with the prince in early October. A missionary couple, Mr. and Mrs. Thomas, and a native Christian convert knowledgeable about royal etiquette, along with Clara set off in a fine coach to meet the Nawab. The lavish estate included beautiful gardens, royal elephants, and the prince’s elegant palace. The prime minister met them at the palace and formally presented the missionaries’ request to the prince while the group waited anxiously in a separate room. They were overjoyed when he agreed to talk to them.

Mr. Thomas explained the need for the acre of land from the royal property and the benefit to the women and children of Bareilly. Before the nervous missionary finished his speech, the prince responded, “Take it! Take it! I give it with pleasure for such a purpose.”

In fact, the Nawab donated the entire 40-acre estate to the mission. The astonished group struggled to comprehend the generous gift that had come so easily. Their prayers were answered! In January 1872, the Women’s Foreign Missionary Society was called upon to fund the project, and they responded generously with $10,000. The house on the property was repaired as a residence for single missionary women and their assistants. At the same time, a six-room dispensary was planned to accommodate the needs of women who adhered to strict rules of seclusion even when receiving medical care. Dr. Swain carefully thought out every detail to ensure women were at ease and husbands had no concerns about another man seeing his wife. Rooms also had to be large enough to accommodate several family members accompanying the patient.

Dr. Swain and Fanny Sparkes, Director of Education for the mission’s orphanage, moved into the repaired estate house in January 1872 while construction of the six-room dispensary commenced. It opened on May 10, 1873, and besides patient and treatment rooms, the dispensary also contained an operating room. Hospital construction soon followed, and the facility opened on January 1, 1874. Its doors were open to all: Bengalis, Muslims, Hindus, and Christians.

Dr. Swain worked tirelessly, treating thousands of patients with a host of maladies over the next several years. Higher-caste women lived solitary lives in zananas within huge mansions, rarely leaving their homes. Hindu and Muslim women were also forbidden to learn to read. As a result, women’s physical and mental health was often negatively affected. They led lives without much social interaction, purpose, or outside interests. Clara slowly and respectfully approached husbands and the women themselves with new ideas of learning to read, instruction in needlework, exercise, and homemaking skills to improve overall health. Dr. Swain had the satisfaction of seeing many women she treated in this holistic way regain their strength and become more involved in managing their own lives.

Her first medical training class proved successful, and 13 of the 17 women passed India’s Civil Service 4^th Grade Doctor’s examination. These women immediately went to work in different areas around Bareilly to provide desperately needed medical care. One of the graduates and her husband left for a leper colony to serve this most shunned population.

By late 1875, Clara was exhausted, and her own health was failing. Although she was hesitant to ask for a rest from the mission, they were made aware of her condition and sent out a replacement in January 1876. Clara sailed for home that May, confident the new doctor could handle the work. Her time in the States was rarely idle, however. Clara spoke at churches that supported the work in India and attended lectures at Boston University School of Medicine. By September 1879, she packed once again for India, resuming the work at Bareilly in January 1880.

The Work in Khetri

The Rajah of Khetri summoned the doctor to treat his wife, the Rani, in May 1885. The long journey of around 300 miles was by train, then by a four-camel chariot, then on horseback, switching to elephants, and finally, a conveyance called a rath pulled by two white oxen. Dr. Swain was in awe of the luxurious palace and the warm hospitality offered by the Rajah and his wife. The Rani quickly improved under Dr. Swain’s care, and the Rajah was so pleased he offered Clara a paid position there.

She prayed about the opportunity, concerned over leaving the mission and the hospital work in Bareilly. Clara wrote to a friend in the States: “The more I prayed, the more I saw the Lord in it all, and I accepted the position on the condition that the young lady who had accompanied me be allowed to remain with me, and that we both be allowed to work among the people as Christian women.”

The Rajah had no objection, and for the next three years, Clara worked diligently to treat women and children with great success. She also obtained permission to open a school for girls. The Rajah supported the idea, even providing a pound of flour each day to every girl who attended, along with a set of new clothes. In addition, Dr. Swain and Miss Pannell, her secretary and companion, taught hymns and shared the Scriptures with those who were interested without any prohibition from the Rajah. He highly commended her work in official reports and was pleased the women in his region were being helped.

Dr. Swain left Khetri for the States in March 1888 to care for her sister Hattie, who was seriously ill. She returned to Khetri to resume her duties in late 1889. Her relationship with the Rajah and Rani was an affectionate one, so when in 1896, Clara told them she needed to return to America for her health, the Rajah wanted her to promise to come back after a year. The sixty-two-year-old replied, “I’m getting old enough to go to heaven before many years;” a gentle attempt to tell him she didn’t plan to return. The Rajah answered, “But India is just as near heaven as America. You can go to heaven from here.”

Going Home

Despite the Rajah’s pleas, Dr. Swain returned home in March 1896, leaving India for what she believed was the last time. She settled into a quiet life in Castile, renewing her friendship with Dr. Cordelia Greene and many others. Encouraged by family and friends, she began organizing her correspondence and writing of her experiences until another opportunity to visit India came in 1906. The Methodist-Episcopal Mission started in 1856, was celebrating 50 years of service in Bareilly. The hospital she had founded in 1874 had continued to expand, staffed now by several women doctors. She couldn’t miss the grand celebration and eagerly sailed for Bareilly with a party of fellow missionaries.

Clara was overcome by the progress of the hospital and its far-reaching work. The hospital and the staff were integral parts of the community; its reputation was held in high esteem by officials and patients. There were now several thousand converts to Christianity and thriving churches as well. When she left Bombay in March 1908, she knew this surely was her final visit to India. Clara returned to Brookside in Castile, which had been Dr. Cordelia Greene’s residence and was now Dr. Mary Greene’s home. There she finished the manuscript for A Glimpse of India, a compilation of her letters throughout her time in India. Unfortunately, her fragile health further deteriorated, and Dr. Clara Swain passed away peacefully on Christmas Day in 1910 at age 76.

The impact of Clara Swain’s life and faith continued to be celebrated for many years following her death, not only in Castile but throughout the United States by the Methodist-Episcopal Women’s Foreign Missionary Society. Today, the Clara Swain Hospital is a modern facility, still providing medical care for the men, women, and children of Bareilly after 148 years. It is certainly an amazing legacy for the precocious little girl from Castile.

Resources: Castile Historical House, A Glimpse of India, Palace of Healing, M-E Women’s Foreign Missionary Pamphlet, Clara Swain Hospital website.