Ellen G. White and Mission Work in Cities



Many Adventists often quote “Out of the cities, out of the cities!” as though it were Ellen White’s definitive statement on urban ministry.

D. J. B. Trim and A. L. Chism

In December 1952, the sprawling metropolis of London, Europe’s largest city, was brought to a standstill for five days by an extraordinary conjunction of meteorological event and pollution. Winter fogs were a London commonplace, immortalized in 19th- and early 20th-century literary works such as Charles Dickens’s novel Bleak House and Conan Doyle’s Sherlock Holmes stories; but this was the ultimate London fog. For five successive, cold December days, a heavy natural fog, the product of winter weather, combined with sulfurous fumes from vehicle exhaust, the smokestacks of factories and power plants, and millions of chimneys out of which billowed forth the smoke of the coal fires that almost all of London’s citizens relied on for warmth. The result was a dense blanket of toxic smog that reduced visibility to a few feet. Traffic ground to a halt. People who then abandoned buses found that even on foot they struggled to find their way home in the thick, dark miasma. Football matches had to be cancelled because the goalposts could not be seen from the halfway line.

The smog not only blocked the sun, stopped public events, and brought London’s street life to a standstill; it was also a public-health catastrophe. The 1952 fog was the worst air-pollution crisis in European history. Initial reports estimated that about 4,000 died prematurely during and immediately after the five days of fog, mostly from respiratory ailments, but many in traffic accidents. Deaths from bronchitis and pneumonia were more than 700 percent greater than the usual annual average. In London’s East End, an area characterized by slums and industry, the increase in deaths was 900 percent. The detrimental effects lingered, moreover, and mortality rates remained well above normal into the summer of 1953, because of the lasting effects on Londoners’ lungs. The usual death toll given for the Great Smog is now 8,000 lives, but recently experts have estimated that perhaps as many as 12,000 died—victims of mid-20th-century life in big cities.

It is not surprising, then, that in the middle of the 20th century, just six years before London was afflicted by the great smog, that Ellen G. White’s statements on the virtues of rural as opposed to the evils of urban life; compiled in the book, Country Living, proved immensely influential.1 Denis Fortin argues that it is “one of the smallest yet most influential compilations of Ellen White’s writings,” and that it has had a “profound impact upon many aspects of Adventist ethos” encompassing education, home life, and evangelism. The counsels compiled and edited in Country Living were “largely responsible for Adventism’s intrinsic fear of the cities” and may have contributed to the slow growth of present-day urban mission.2

Indeed, Country Living, and its companion volume, From City to Country Living (meant to aid Adventists in their steady flight from the cities), were products of the General Conference’s Commission on Rural Living. The secretary of the commission, Edward A. Sutherland, presented following the carefully chosen and compiled counsel in Country Living as a test of faithfulness to the Spirit of Prophecy. In 1951, he wrote: “Some years ago our denomination gave heed to the message to establish church schools, but it was many years behind time. Likewise we awoke to the importance of the health message after long delay and lack of faith. Now we face another test—the removal of our people from the cities, and the establishment of families on the land where they are to operate as mission centers and rural outposts from which to carry the closing message to the cities.

“Will we be able to meet this test? If we do not, then World War III, with all its attendant troubles, will be upon us, and our people may be like Lot and his family when Sodom and Gomorrah were destroyed. To loiter now is fatal for all of us. The time has come for us to give attention to this neglected work. Many of our people must be gotten out of the great cities and established in country homes. It must be not a stampede or a mass movement but a quiet, steady, progressive movement, as the result of education.”3

Sutherland’s statements here are clearly antithetical to many of Ellen White’s statements about cities. Still, the counsel in Country Living was, or seemed to be, unambiguous, unmistakable, and could probably be quoted by many modern Adventists: “‘Out of the cities; out of the cities!’—this is the message the Lord has been giving me,” wrote Ellen G. White, who then declared: “The earthquakes will come; the floods will come; and we are not to establish ourselves in the wicked cities, where the enemy is served in every way, and where God is so often forgotten.”4 This is from an article that had first appeared in the Review and Herald in July 1906. It was based on a sermon she had given at the dedication of Loma Linda Sanitarium three months before, which included the stirring admonition: “‘Out of the cities! out of the cities!’—this has been my message for years.”5 And indeed, as early as 1882, she had published a testimony encouraging Adventist families to move out of cities; so it had truly been Ellen White’s message for many years.

Yet against that are equally ringing statements, equally unequivocal. Two years after her 1882 testimony, she posed a rhetorical question to church leaders, asking, “Shall the prince of darkness be left in undisputed possession of our great cities because it costs something to sustain missions?” She gave the answer: “Let those who would follow Christ fully come up to the work, even if it be over the heads of ministers and president.”6 And three years after her Loma Linda statements, she declared: “There is no change in the messages that God has sent in the past. The work in the cities is the essential work for this time.”7 Working in cities is the essential work for the endtime. These statements are not exceptions to the rule—far from it.

Ellen White wrote those words in 1909, but a year earlier, in 1908, she had written of “the unworked cities in Europe, Australia, and America, and in the regions beyond” (the latter, in her writings, typically meant Asia, Africa, and the islands of the Pacific). She continued in that letter: “These cities have been neglected for years.”8 In a 1909 letter to the General Conference officers, she firmly admonished them: “As I look over the past testimonies, I see that for years the importance of working the cities has been urged. But . . . excuses have been made, and this great work has been sadly neglected.”9 In 1910, in a testimony dedicated to city ministry, she wrote: “For years the work in the cities has been presented before me and has been urged upon our people. . . . Before this time, every large city should have heard the testing message, and thousands should have been brought to a knowledge of the truth. Wake up the churches, take the light from under the bushel.”10

So, Ellen White’s “message for many years,” from at least 1882 to around 1907, was to get out of the cities. Yet for what she described as years and years, from at least 1884 until at least 1911, she urged Adventists to go into cities to work for those who dwelt in them. On the face of it, and summarized thus, it may seem that Ellen White’s writings on cities support the cynical view that she was not inspired, and so we should not be surprised when she is inconsistent. Is there another way to make sense of these apparently conflicting counsels?


Ellen G. White and Cities

There are two reasons for identifying consistency in the counsel of Ellen White. First, at times in her writings, Ellen White was setting out principles, but at other times, she was addressing a particular set of circumstances. At times, too, she used figures of speech, including moderate exaggeration, and neither intended nor expected to be taken absolutely literally. One must be very careful in applying such statements, but bearing these points in mind helps to clarify her views on cities.

Second, Ellen White was very well-balanced, though that is often not how she appears from the way Adventists quote her. She spent much of her career arguing against the extremists of either side, which helped keep Adventism in the middle of the road and from adopting extreme positions. This was an immensely important service to the Adventist Church. However, as a result, half the time one can sound as though one is from whatever extreme one is arguing against. It is vital to look not at one or two statements from Ellen White’s corpus of writings, but rather to study wholistically what she wrote on a subject, viewing it in the round. If one does this for her writings on cities, then the impression of inconsistency dissolves.


Circumstances Alter Conditions

At times, Ellen White did set out enduring principles, but often she was writing to a particular set of circumstances. Yet subsequent Adventist authors have not always been discriminating in the way they quote and apply her counsel. A few examples of Ellen White’s addressing a specific situation follow.

Two letters demonstrate her writing about a set of circumstances that evolved and where she used overstatement to make a rhetorical point. In April 1900 she wrote from Australia to Stephen N. Haskell, himself a pioneer of city mission. She told Haskell, who had evidently offered advice on where to buy a house in an inner suburb of Sydney: “I have a few words to say in regard to what you say about building a home in Stanmore. This, my brother, will never be. The bubonic plague is in Sydney, and is steadily developing. There are fresh cases every day. From the experience I have recently had, nothing could induce me to locate in Sydney or any of the suburbs.”11 Her fears were not exaggerated. According to historians of medicine: “There were 12 major plague outbreaks in Australia between 1900 and 1925 as ships imported wave after wave of infection” from Asia, where the plague was still common. Cases were recorded in other Australian port cities, such as “Melbourne, Adelaide and Fremantle,” but “Sydney was hit hardest”: 103 people died in the 1900 outbreak, which is notorious in Australian history.12

Just 18 days after writing to Haskell, however, and declaring that nothing could induce her to live even in Sydney’s suburbs, Ellen White wrote a letter to other friends. In it, she praised Wahroonga, where the Sydney sanitarium was to be located, as “the most desirable of all the suburbs of Sydney”!13 To be sure, she explained that part of Wahroonga’s attraction is that it “afford[s] the benefits of country life [while] being sufficiently near Sydney to secure the advantages of connection with the city”; clearly, though, in telling Haskell that “nothing could induce me to locate in Sydney or any of the suburbs,” she was engaging in pardonable exaggeration, motivated by the specific circumstance of plague in Sydney’s port district. But circumstances change; and as Ellen White told church members in California in 1904: “Circumstances alter conditions. Circumstances change the relation of things.” She was moved to make this point, she told them, because “my mind has been greatly stirred in regard to the idea, “Why, Sister White has said so and so, and Sister White has said so and so . . . . God wants us all to have common sense, and He wants us to reason from common sense.”14 Ellen White thus herself warned us that we must be wary about being doctrinaire over specific words or turns of phrase, for she wrote stylish prose and sometimes precision was sacrificed to literary style.

Other examples of changing circumstances are found in Ellen White’s frequent expostulations about trade unions. In October 1902, for example, she warned Adventist health leaders in southern California: “The turmoil and confusion that fill these cities, the conditions brought about by the labor unions and the strikes, would prove a great hindrance to our work.”15 A few months later, at the 1903 GC Session, Ellen White averred: “The trades unions and confederacies of the world are a snare. Keep out of them, and away from them, brethren. Have nothing to do with them. Because of these unions and confederacies, it will soon be very difficult for our institutions to carry on their work in the cities. My warning is: Keep out of the cities.”16 Nine months later, at the end of 1903, she wrote to John Burden, the founder of Loma Linda: “The forming of these unions is one of Satan's last efforts. God calls upon His people to get out of the cities, isolating themselves from the world.”17 Today, in many Western countries, the power of trade unions is in decline, and there are many Adventists who regard Ellen White’s stance on unions as eccentric. But such an attitude ignores the major importance of unions for much of the 20th century, as well as the fact that, in some nations, trade unions continue to wield considerable power in the 21st century. Moreover, unions’ power has invariably been based in big cities, as this is where large numbers of workers congregate together. Ellen White’s counsel made sense in the America of the early 1900s and still makes sense in some countries today—and will in others in the future.

A final example of how circumstances change, altering conditions and the relation of things (as Ellen White put it) is found in the ways that public-health conditions have evolved, at least in the Western world, over the hundred years and more since Ellen White wrote directly about cities.


Nineteenth- and Early 20th-century Urban Life

Cities were horrible places in the 19th century and indeed up to the middle of the 20th century, as events in London illustrate. In 1858, almost a century before the great smog of 1952, the city suffered “the great stink,” when, in a summer of record heat, the stench from the River Thames, heavily polluted by both household and industrial waste, was so appalling that it even drove members of Parliament from the Palace of Westminster. The contamination of water was by this time a known cause of cholera, which had claimed more than 18,000 lives in three epidemics in London in the preceding 20 years, while the unhealthiness of London life in general was celebrated (if that is the right word) by literary figures including Charles Dickens; but it was the disruption of government business by malodorous miasma that finally set in motion the construction of a massive system of sewers that cleansed the Thames and the city of London’s water supply. While this had considerable beneficial effects (there was an 1866 outbreak of cholera, but it was a minor one and the last in London), air pollution remained a major problem until the post-great-smog Clean Air Act (1956) almost a century later. Meanwhile, although the U.S. city of Philadelphia, too, saw its mortality rates reduced by the construction, in the 1870s, of a sewer system, these two cities were more fortunate than many: Cholera epidemics caused by water pollution affected other large European cities until the 1890s, including the Hamburg epidemic of 1892, which killed nearly 10,000, nearly 14 percent of the population of a city that had a public sewer system, but an imperfect one. Even after cholera became rare in modern Western cities, typhoid was a persistent, endemic urban killer into the early 20th century.

The problem went deeper than periodic outbreaks of infectious diseases. Contaminated air and water were common, as was noise pollution. Even for cities that had sewage and water purification measures in place, awful smells, tainted air, and endless noise were typical. In fact, in 1890, George I. Butler, former General Conference president, depicted the polluted atmosphere of cities for readers of the Review: “The wagons and street and railroad cars, etc., rattling and roaring along the highways, together with whistling, screaming, and tooting, destroy all quiet till a late hour, and break up rest at a very early hour. One fails to get a plenty of calm, refreshing sleep. God’s pure air becomes precious. Tall houses are jammed in close together, with here and there a narrow and often filthy and a back yard strewn with ashes, broken fruit cans, or tumble-down out-houses; and stables hidden away as much as possible from the front street view for appearance’s sake, are in plentiful supply. The odors which come up through the windows of sleeping apartments are often a mixture of coal smoke, decaying vegetation, and mustiness from ill-ventilated rooms.”18 Such pollution was what a city dweller might expect to encounter daily; very little in any city could be seen as conducive to good health. Ellen White had similar experiences in mind.

The results of this pollution were both diminished quality of life and increased chance of death. Even apart from major mortality events, such as cholera and typhoid epidemics, the pollution of both air and water supplies meant life in the big cities tended to be nasty and short. This can be quantified. Historical demographers, using U.S. census data, have shown that in 1830, life expectancy in cities in New England was 46.7 years, whereas in the rest of rural New England it was 52.5 years.19 Things actually got worse as the 19th century wore on, as a result of increasing industrialization. Thus, in 1900, in the United States as a whole, life expectancy for a white man was “44 years in urban areas and 54 years in rural places”; child mortality in cities was 13 percent higher than the national average and 23 percent above the average in the countryside.20 Similar (or worse) patterns occurred in Europe.21

Contemporaries knew there was a difference between city and country and were in no doubt about the reasons why. In 1899, Adna Weber, a pioneering American statistician and economist, observed: “It is almost everywhere true that people die more rapidly in cities than in rural districts. . . . There is no inherent or eternal reason why men should die faster in large communities than in small hamlets. . . . [I]t may be affirmed that the excessive urban mortality is due to lack of pure air, water and sunlight, together with uncleanly habits of life induced thereby. Part cause, part effect, poverty, overcrowding, high rates of mortality, are found together in city tenements.”22

Interestingly, Ellen White independently made an almost identical point the same year Weber wrote: “It is not in [God’s] order that people should be crowded into cities, huddled together in terraces and tenements.”23 In 1900 she returned to this theme, which suggests its importance in her thought; she used the passage, but reshaped it, adding to it, in an appeal for support for the new sanitarium in Sydney; and five years later, she reused this passage in its entirety in The Ministry of Healing. It reads: “It was not God’s purpose that people should be crowded into cities, huddled together in terraces and tenements. . . . The more nearly we come into harmony with God's original plan, the more favorable will be our position to secure health of body, and mind, and soul.”24

The contrast between city and country was central to Ellen White’s concerns. In 1902, Dr. Lauretta Kress wrote to her from Cooranbong, the rural location of Avondale, observing: “Every time I come home from Sydney this place seems like Heaven almost. The air is so pure. There is none of the tobacco smoke & black dust you get in Sydney and it is so quiet. One feels they can rest undisturbed here. I can see more and more why our institutions are better in the country away from the city. There is the quiet, pure air and nothing to contaminate them with the filth of city life. . . . I am sure God saw all this where He instructed when to build sanitariums.”25 Ellen White agreed, without doubt, for she replied to Lauretta and her husband, and Daniel Kress, also a physician: “We have received your good letter. Thank you so much for writing. In regard to our schools and sanitariums being out of the cities, I had . . . written in almost exactly the same language that you used.”26

There is other evidence that the physical conditions of cities and their health implications was one of Ellen White’s reasons for urging Adventists out of cities. In 1905 in The Ministry of Healing she stressed: “The physical surroundings in the cities are often a peril to health. The constant liability to contact with disease, the prevalence of foul air, impure water, impure food, the crowded, dark, unhealthful dwellings, are some of the many evils to be met.”27 In 1906, in another letter to her friends, the doctors Kress, she assured them “that the call is for our people to locate miles away from the large cities. . . . The very atmosphere of the city is polluted.”28 What demographers call the “urban penalty,” in which cities experienced higher child mortality and lower life expectancy, eventually improved in the United States between 1900 and 1910 and improved again in the 1920s. Yet, “As late as 1939, actuaries for the Metropolitan Life Insurance Company reported [that] life expectancy at birth for white males was 64.07 years in rural areas as compared to 61.45 years in urban areas. For white females, the figures were 67.46 and 66.20 years, respectively.”29

What can be concluded? Ellen White was not engaged in fear mongering, nor in nostalgia for the past, nor yet in sentimental yearning for a rural idyll. She was accurately diagnosing the public-health situation in large cities in the 19th century. Nor was the advantage that would accrue from moving out of the cities a minor one, or a largely aesthetic one, of avoiding obnoxious sights, sounds, and smells. It was a major one in terms of lifespan: 10 years in the United States in 1900; as well as in terms of quality of life.


Twenty-first Century Urban and Rural Life

It is true that in the 21st century that public health in the large cities of most of Latin America, sub-Saharan Africa, Southern Asia, Southeast Asia, East Asia, and Eastern Europe still can be characterized by industry, overcrowding, and pollution. Large urban areas are still innately unhealthy. Yet in the Western world (much of Western Europe, North America, North Asia, and Australasia), however, cities are far healthier because of the reduction of pollution, a result both of stringent regulations and the rise of cleaner energy sources, such as solar and wind power, though even London can still have “bad air” days in summer, when there is no breeze. It is reasonable to suppose that many of Ellen White’s concerns about big cities would not be expressed today, or, at least, would be less urgent. Some tourists to London today are disappointed not to find thicker fogs, but the legislation prompted by the great smog of 1952, which included the banning of coal fires, means that story could not be repeated today.

In contrast, in some cases, rural areas at the time Ellen White wrote now suffer from pollution. For example, in the autumn of 1902 she wrote: “Southern California is world-renowned as a health resort.”30 If air pollution is not now as bad as it was in the 1960s and 1970s, before lead-free fuel was introduced, even so, southern California is thickly populated and heavily congested, its skies in late spring and summer almost invariably a dirty brown color with smog. Its reputation now is not as a health resort but rather for traffic jams and poor air quality. Again, as circumstances change, there is sometimes need to change how Ellen G. White’s prophetic counsel should be applied in our circumstances.

In addition to the various factors leading to physical contamination, Ellen White was concerned about moral contamination. She warned that “cities are. . . hotbeds of vice,” with “the sights and sounds of evil” evident.31 She wrote of “the contaminating influences of modern city life”32 and elsewhere of “the cities that are fast becoming as Sodom and Gomorrah. . . God desires us to leave the sin-polluted atmosphere of the cities.”33 Yet in the era of high-speed Internet and the rampant availability of online pornography, with sexual addiction added to the traditional tobacco and alcohol addictions, farming areas and small towns are today no longer as free of moral pollution as they once were thought to be. In North America, rural areas also are suffering an epidemic of opioid addiction. Furthermore, where once living in the city had a mortality penalty, today the opposite is true. Metropolises are better served by public-health infrastructure than rural areas. Among the consequences are that infant mortality is worse in the country, while in “most of the world’s nations, living in a city now extends life expectancy.”34

There is, to be sure, significant availability of drugs, alcohol, and monetized sex in inner cities, but in general they are not as bad for public health or morals as they used to be; while at the same time, many small towns are not as wholesome as they once were. If the potential for temptation is still greater in cities, there is also far greater potential for witnessing; and this was a major issue from Ellen White’s perspective.


Missional Implications

What, then, may be said about Ellen White’s prophetic counsel about urban areas? In light of the points made in the preceding section, it seems clear that today she would be less negative and that, in consequence, we should have far fewer inhibitions about engaging in mission to cities. Yet it is hard not to conclude that there would also be some continuity—that today she would still have considerable reservations about big cities.

But this prompts two questions: first, about what, in particular, would she have had reservations? And second, what are the missional implications of this example of continuity? As noted earlier, in her testimonies, Ellen White often was seeking to counteract extremist views; in order for us to understand her, it is necessary to develop a rounded, fully contextual sense of her thought. This cannot be done by simple quotation of a few choice passages. In going through her writings about cities, this is striking: There truly is no contradiction in her testimonies. The essence of her writings on this topic is threefold: first, institutions ought not be created in cities; second, to the best of their abilities, individuals should not live in places detrimental to their health, but rather in places that foster health. Yet she understood that this would not be practicable for all Adventists, and indeed there were exceptions to the second principle she did not merely accept, but actually desired; for, third, she wanted Seventh-day Adventists to work in cities—especially evangelistic and medical-missionary work.

When she urged departure from the cities, she typically was discouraging the creation of colleges, schools, sanitariums, and hospitals in cities—because the young and the sick are the most susceptible to the negative influences (physical and spiritual) typical of big cities, now as well as when she wrote. One example of this is a manuscript called “The Southern California Sanitarium”; in it, she wrote, “A city is no place for a sanitarium. . . . For three nights the need of establishing our sanitariums outside the cities has been presented to me. I have written out the instruction given me on this subject, and I hope my brethren will be able to see its importance.” This, and other similarly strong statements regarding other institutions, can be found in her writings.35

In response, church leaders often moved more than just schools and sanitariums out of the cities—or, at least, appeared to do so. A report on the removal of Southern Publishing Association from the city by George I. Butler, then president of the publishing house, was published in the pages of the December 14, 1905, issue of The Advent Review and Sabbath Herald. The press’s old premises, located at 1025 Jefferson Street, 1.1 miles north from the Tennessee State Capitol, had been sold, Butler said. “It is well known that much has been said within a few years past among our people about the advisability of getting our institutions out of the great cities,” Butler wrote. “There has been general agreement among us that this was light from the Lord. It is certainly good common sense.”36 Yet the new address of the Southern Publishing Association was 24th Avenue North, almost two miles northeast of the original premises, was still considered a city address in the postal office’s eyes. It was on the outskirts of Nashville and thus possessed some of the benefits of a rural location, while still retaining some of the “advantages in being in the center of these cities, such as easy access to most of the people and within ready reach of post and express offices, banks, freight depots, and the other desirable things” that Butler and the other leaders saw in Nashville.”37 However, compared to the move that the Nashville Sanitarium would make near the same time, this move was not so momentous as Butler’s nearly four columns of text would imply.

Ellen White wrote to ordinary church members, encouraging them to live where they would be free of air and water pollution and where they could have contact with the soil, ideally growing their own fruit and vegetables. In 1910, she declared, “As much as possible, let the homes of our people be out of the cities, that the children may have ground to cultivate”38; this was so that their children would learn about the creation of proper habits. Writing in 1902 to Daniel and Lauretta Kress about the location of a school in California, she stated, “How much better this retired place is than a location in the city. How much better for the students to have the advantages of country life than to be crowded into a city, where their ears are constantly wearied with the noise of street cars and trains, and where there is little but houses to be seen.”39

The general trend of her counsel for church members, as opposed to institutions, is clear. Yet today, the implications of her principles might result in different practice. Across the Americas, Europe, Australasia, and in parts of Asia, finding a quiet place with space for a garden can be done in many suburbs, and certainly in “exurbs,” rather than only in fully rural areas. It is a significant point that suburban houses with reasonably large blocks of land became common and affordable for ordinary people only after Ellen White’s death in 1915. Here is another case in which circumstances have changed.

Bearing in mind the interpretative principles outlined earlier, and considering the principles that she adumbrated, it is clear that Ellen White today would not urge the complete abandonment of metropolitan areas, since most of the goals she had for church members in leaving cities could be achieved today by people living in suburbs. Indeed, she herself warmly approved of establishing Sydney Sanitarium in one of the city’s outer suburbs.

In any case, though it may not be certain whether Ellen White would today advocate church members moving to farms or just to suburbs or exurbs, it is clear that she always wanted some Seventh-day Adventists to stay in cities. This is the final reason there is no inconsistency in the many passages she wrote on cities. Just as Ellen White did not believe that all Adventists needed to serve as foreign missionaries, but still actively encouraged as many as possible to go overseas, so, too, she wanted an active body of enthusiastic workers to go as missionaries into cities, even if the great mass of the membership got out of the cities. As she put it to John Burden, at Loma Linda: “I write you this that in a guarded but decided way you may advise our people to keep out of the cities. But the cities must be worked; yes, and our people have been asleep.”40


Outpost Centers

But how to work the cities? In some of Ellen White’s writings, she advanced a unique idea about how city missionaries can evangelize the cities: the “outpost center.” This is a concept that developed relatively late in her ministry, probably reflecting the fact that in the 1880s and 1890s, Adventists had many effective city missions, but that in the 1900s, the number of these missions diminished and their ministry circumscribed, meaning that prophetic guidance became more important. The first time Ellen White referred to an outpost center was in a 1902 letter to church medical leaders, when it was set out as a principle for city ministry: “We are to remember the cities that have been neglected and that must now be worked. The people in these cities must have the light of truth. . . . We are to be wise in securing advantages already provided that the Lord desires us to have. We are to be as wise as serpents and as harmless as doves in our efforts to secure country properties at a low figure, and from these outpost centers we are to work the cities.”41

The principle, then, is that the church should secure country properties, which will become what Ellen White termed “outpost centers,” from which “we are to work the cities.” If the principle is clear, however, the proposed praxis is not. What is unclear is just how cities are to be worked from outpost centers.

Some have assumed that the point of outpost centers is for city missionaries to live in them, commuting in and out of the city each day. But an alternative interpretation is that Ellen White meant for city mission workers to live in the cities, with the outpost center a place for periodic rest, recreation, and recuperation. In these places of respite, city workers could be refreshed from the daily grind of city life, and then from the outpost center return to the mission field in which they made their home. This would be consistent with the distances in some cases. Some insight is afforded by considering her counsel about specific cities and the institutions situated nearby; and by considering the practicalities of travel. Some Adventist institutions were well placed for workers to commute daily into city centers, but others, including ones praised by Ellen White, decidedly were not.



Boston. One city that Ellen White specifically singled out as needing to be “worked” is Boston, a city which she had known in her youth, but which had already grown considerably in size by the time she singled it out. But the personal connection may explain why she writes in 1905: “I feel a deep anxiety that Boston shall hear the word of the Lord and the reasons of our faith.”42 In addition, she specified New England Sanitarium as potentially having a key role in mission to Boston. The sanitarium was located near Melrose, a city eight miles north of Boston and today part of its metropolitan area; for this reason, it was often simply called Melrose Sanitarium (later renamed New England Memorial Hospital, and finally, before it closed, Boston Regional Medical Center). Melrose is, moreover, one of the few places mentioned in connection with outpost centers.

Ellen White seems to have seen the rebuilding and redevelopment of the sanitarium, consequent on a fire that destroyed much of it on January 1, 1905, as an opportunity to establish an outpost center for working Boston. In 1906 she wrote to Dr. Charles C. Nicola, superintendent of the New England Sanitarium: “It was a wonderful providence that brought us into possession of the Melrose sanitarium property. . . . It is to be an important outpost-center, from which to work the city of Boston. You, my brother, understand the instruction that the Lord has given regarding this matter.”43 Apparently Ellen White had discussed with Nicola the details of the inspired instruction and thus felt no need to elaborate. It is necessary to deduce from context what she might have intended. The very terminology outpost implied that such a center was not to be directly in a city, but the fact that it was to be used for reaching the city implied it had to be relatively close to the heavily populated urban core. Further insight is afforded by counsel Ellen White gave to the president of the Central New England Conference, Albert E. Place, written barely two weeks after the fire: “Ask the Lord to raise up laborers to enter the field. Ask Him to raise up laborers who can gain access to the people of Boston. The message must be sounding forth. There are thousands in Boston craving for the simple truth as it is in Jesus.”44 Outpost centers were meant to be near enough to allow easy access to the people being evangelized.

That this was Ellen White’s intent is evident in the fact that, by 1907, church workers in Boston operated a health-food restaurant and health-food store on Boylston Street, mere blocks from Boston Common. This meant they were in the heart of downtown Boston. It is not known where the staff of the restaurant and store lived, but the emphasis of these institutions on healthful living implies a connection with Melrose. Indeed, the same year, Ellen White wrote: “Boston has been pointed out to me as a place that must be faithfully worked. . . . This Sanitarium is one of the greatest facilities that can be employed to reach Boston with the truth.”45 She thus explicitly identified the sanitarium as involved in the Boston mission. She also wrote, in a telling passage: “The light must shine in the outskirts and in the inmost parts. . . . The city and its suburbs must hear the last message of mercy to be given to our world.”46 This is noteworthy for the emphasis that the city missionary must not evangelize either in the city center or in the suburbs, but in both. The whole city was to be reached. Counsel and practice coincided: The health-food store and restaurant were in Boston’s “inmost parts,” while New England Sanitarium was on what was then the outskirts of Boston—a location also consistent with Ellen White’s advice about situating institutions outside city centers.

What does the location of New England Sanitarium imply about the nature of an outpost center? Melrose had a station on one of the main train lines into Boston and had commuter-train services from the late 19th century. With 15 miles of track and seven stations between Melrose and Boston, it would not have taken very long, even on a slow commuter service. It would have been practical, therefore, for workers in the center of Boston to be commuting daily from the sanitarium. No evidence has yet been found that would verify or falsify this possibility; but it must be acknowledged as practicable.

Washington, D.C. and environs. Takoma Park, Maryland, had a station for the Baltimore & Ohio Railroad; an 1890 map shows the rail line skirting past the then-thinly-populated and rural area. Once Adventists moved there, they often gave their address in Yearbooks as “Takoma Station.” Today, Takoma Park is an inner suburb, while towns much further north of it, once distinct from the city of Washington, have become part of the larger metropolitan area.

While the main building of the Washington Sanitarium was being built in Takoma Park, Maryland, a branch sanitarium was begun in the city, operated out of Nos. 1 and 2, Iowa Circle, Washington, D.C. Since renamed Logan Circle, this was a location five miles south of Takoma Park and one-and-a-half miles north of the White House, and, if not in Washington city center, then very close to it. Writing to Dr. Patience Bourdeau in June 1905, Ellen White implored her to come to Washington, D.C. and work at the “Iowa Circle Sanitarium”: “An expensive building has been rented in Iowa Circle, Washington. It is a beautiful location for a sanitarium, and has been fitted up for the giving of treatment, but it needs a house physician and a manager. We need you. We believe that you can help us in Washington. You can give the nurses instruction that they need, and can also give lectures in the parlor to the patients. Will you receive this invitation as prompted by the Lord; for I have an assurance that you can do the work essential. Brother Hare is an excellent physician, but not a manager. We need someone who can plan and manage. You can help us out of our difficulty. Washington is a most important place, and a right representation of our work must be given by the sanitarium.”47 Dr. Bourdeau did go to Washington; she is listed in the 1906 Yearbook as the Iowa Circle Sanitarium’s “Lady Physician.”48

When the Washington Sanitarium neared completion, the question arose about closing the branch sanitarium, even though it was apparently paying for itself. It might be thought that Ellen White would be supportive of having just one health-care institution, in what was then still the semi-rural area of Takoma Park. But the opposite was true. Writing to her old friend Marion Crawford in the spring of 1907 she expressed herself strongly: “The question whether the sanitarium we have in Iowa Circle in Washington shall be given up is now being considered. For a time this institution was an expense to the cause, but now it is paying its way. . . . It has been thought that when we have the institution at Takoma Park ready for occupancy, the sanitarium at Iowa Circle could be given up. My answer to this proposition is, No, no; the institution at Washington must stand to represent the work and cause of God there, the closing work for this earth. . . . To give up this institution would be a mistake, for Washington is an important place. Our work and faith must be represented there in the best possible way.”49

What does the case of Washington, D.C., with its branch sanitarium inside the city and the main sanitarium in the suburbs of Maryland, indicate? First, Ellen White emphasized that the entirety of a city should be worked. When church leaders looked to close the branch sanitarium, she emphatically argued against it. Second, like Melrose and Boston, it would have been possible for an inner-city institution to be staffed by commuters living at or around the suburban institution, given Takoma Park’s rail and tram connections to the city center. Again, there is no evidence for or against this possibility; indeed, Iowa Circle had housing around it, so workers could just as easily have lived nearby. But the potential to commute from Takoma Park certainly existed.

Sydney, Australia. Ellen White’s emphasis on reaching both suburb and city can be seen in a letter written to John A. Burden and his wife, Eleanor, in 1903 as they were about to embark in medical-missionary work in Wahroonga, then an outer suburb of Sydney, Australia, connected with the creation of what Ellen White called the ‘Wahroonga Sanitarium.’ “Brother Burden, your work and Brother and Sister Starr’s work has been presented to me,” Ellen Write wrote, continuing: “It does not lie entirely in the institution. You are to get out among the people of Sydney and its suburbs, doing all in your power to win men and women to the truth, watching for souls as they that must give an account. You are to carry the truth to the homes of the people.”50

Although Ellen White did not describe Sydney Sanitarium as an outpost center, she thus certainly saw it as having an important part to play in mission to the large city of Sydney. Her experiences with Sydney may have led to the advice later given to Boston. Certainly her counsel to Place and to Burden manifests the same passion for close involvement in the lives of a city’s people.

Adventists, moreover, at this time did have a city work in the center of Sydney. In 1903, the Sanitarium Health Food Company was located at 228 Clarence Street, a four-minute walk from the vegetarian restaurant Adventists operated at 283 Pitt Street, which also contained the premises of the Australian Good Health magazine. The offices of the Australasian Union Conference and New South Wales Conference, however, were at 56 George Street, West, putting them not even two miles from the food company and restaurant and yet still providing them with access to arriving ships. The next year, however, the offices of the union conference are listed as being at 32 Royal Chambers, Castlereagh Street, still a major thoroughfare in Sydney’s business district, whereas the New South Wales Conference’s premises were located at 80 Hunter Street, deep in the heart of Sydney’s downtown. In the yearbooks for 1904 through 1906, which give this snapshot of the Sydney work, every minister in each edition listed has the conference headquarters address as his own (except for the union president, who from 1904 has the Castlereagh Street address). Probably, just as Adventists in Takoma Park stated their address to be Takoma Station, a number of the pastors did not actually live on George Street or Hunter Street, but just received their mail there. But it stretches credulity to think that none lived close at hand.

By 1905, the health-food company had been relocated to Cooranbong, but the health-food restaurant—Pure Food Vegetarian Café—had moved further into the city’s heart, finding a place at 45 Hunter Street, only a minute’s walk from the conference offices and a six-minute walk to the Customs House, just across from the Sydney Harbour’s quays. Of its move from Pitt Street to Hunter Street, it was reported that such a move made the café “now quite centrally located, being within two minutes’ walk of the General Post Office.” Moving deeper into the city was a strategic decision taken with an eye to evangelism—it was hoped that the new location would bring “a much larger patronage” to the restaurant.51 The “Vegetarian Café Committee” stressed that the new location “in the midst of the business portion of the city, yet in a quiet place” would “better represent [their] principles and would allow growth.”52 Essentially, the new location in the heart of Sydney was seen as advantageous. In Good Health magazine, whose target audience was the population at large, the café’s potential patrons were assured that the restaurant’s “much more desirable and convenient location” would serve its aim to “always . . . serve the purest and best foods in the most attractive, palatable, and healthful manner.” To further underscore the restaurant’s connection with the Sydney Sanitarium, the Café Committee also let their readers know that Dr. Daniel Kress would be available for consultations for an hour two days a week at the café, though in practice it seems to have been Daniel Kress on one day, and Lauretta Kress on the other.53

It should be noted that vegetarian restaurants represented a significant Adventist commitment to Australasian cities. The Pure Food Vegetarian Café (called the “Sanitarium Health Food Café” in the 1908 Yearbook of the Seventh-day Adventist Denomination) was soon joined by similar restaurants in the Australian cities of Melbourne and Hobart, and in Wellington, New Zealand. By 1908, more health-food restaurants had been opened in Adelaide, South Australia, and in Christchurch and Auckland, New Zealand. These Australasian health-food restaurants overseen and likely staffed by Adventists lasted far longer than similar efforts in the United States or brief efforts in Europe; indeed, some of these restaurants, supplied and equipped by the efforts of those working in the health-food factory in Cooranbong, continued operation into the 1980s. Seventh-day Adventists did not soon give up on work located in city centers.

But where did the church members who staffed these restaurants live? There is no information about the cafés in other cities, but Sydney, of course, was also the home of Wahroonga Sanitarium. If it indeed was fulfilling the role of an outpost center, what does it suggest about the nature of such centers? Thornleigh Station, in the northern Sydney suburb of Thornleigh, opened as part of the city’s Main North Line in 1886. Wahroonga Station, originally named Pearce’s Corner, was opened as part of the North Shore Line in 1890. Both are roughly a mile and a half from Sydney Sanitarium (though in opposite directions). Essentially, when the institution was established in 1904, it was placed comfortably between both of these stations, the railway allowing access to downtown Sydney. The railway certainly allowed commutability for the early Adventists based in Wahroonga and still allows for relatively easy access to travel today. Adventists in Australia would certainly have been aware of the locations of these stations when planning their institutions. The case of the Doctors Kress, who were working a day a week each in the city center, but by that time were living in Wahroonga (having moved from Cooranbong), demonstrates that the sanitarium was, at least to some extent, functioning as a suburban base for inner-urban medical-missionary work. But ministerial mailing addresses imply that some workers in the city core were not commuters. Again, it is possible that those working the restaurant in Sydney’s center and doing evangelistic work in its many suburbs were commuting from Wahroonga, which was plainly feasible; but again, this remains in part an inference based on distances and rail services.

Nashville, Tennessee. The last time Ellen White used the phrase “outpost center” was in relation to the city of Nashville in 1912. In counsel given about the Southern work in the United States, she wrote of “the advantages to be gained by the maintenance of a suitable outpost-center from which a strong medical-evangelistic campaign can be carried forward in Nashville,” which indicates that the outpost center must be close to the city being worked.54 But in practice, a close investigation of how Adventist institutions in Nashville were located and functioned adds complexity to understanding what an outpost center was meant to be, especially as attitudes related to race complicated how the work in Nashville functioned.

Ellen White did not specify that the Nashville outpost center was to be in a sanitarium, but her reference to “a strong medical-evangelistic campaign” implied that this is what she had in mind. In 1912, when Ellen White wrote those words, however, there was more than one sanitarium in Nashville, making it hard to interpret what she meant, because of their different locations and clienteles. Rock City Sanitarium (1909–1914), operated by Dr. Lottie Isbell Blake for African-Americans, was located just east from the city center across the Cumberland River, at 316 Foster Street. It was thus an institution in the city rather than in a suburb. The Nashville Sanitarium, which was open between 1903 and 1914, was originally located at 624 Church Street, two blocks from the Tennessee State Capitol, a structure that had been in place since 1859. It soon moved to the corner of Church and Vine, and then to 140 Seventh Avenue, only a block or two south of the original location. In 1911, however, church leaders moved the Nashville Sanitarium east outside the city to a spot along what is now Murfreesboro Road; its address was listed as “Station No. 5” on the Nashville, Chattanooga, and St. Louis Railway. A pamphlet published by Nashville Sanitarium gives its location as “Located on the Murfreesboro Road, three miles from Nashville, five minutes’ walk from the N.C. & St. L. suburban station, Easton.” The location was definitely regarded as rural, as the United States Postal Office considered it to be a part of Rural Free Delivery Route No. 7 in Nashville. Clearly, the Nashville Sanitarium was rural yet commutable, using the nearby railway line.

Thus, when Ellen White wrote of the need for an outpost center from which a medical-evangelistic campaign could be mounted in Nashville, implying a role for an Adventist sanitarium, there was one inside the city and one outside. Which of these she thought of as an outpost center, it is impossible to say. By 1913, Foster Street was one of the many streets in Nashville containing an electric car line. Yet despite that fact, and despite the fact that Blake’s Rock City Sanitarium was smaller, it is virtually certain that its staff would not have been living near Nashville Sanitarium and commuting in, because Rock City was black and Nashville was white—and at that point, never the twain would have met.

Nashville Sanitarium seems to have been moved away from the center of Nashville to a rural location, in response to Ellen White’s earlier counsel about locating medical institutions away from cities. It would have been possible for workers from Nashville Sanitarium to have commuted into the city center, to take part in “medical-evangelistic” projects. Yet at the same time, there was an institution in the city center, whose workers almost certainly lived close by, rather than commuting in from outside the city. So, while the examples of Boston, Washington, and Sydney could be interpreted as supporting one view of what it meant to “work cities from outpost centers,” the example of Nashville could well support the other view. What can be concluded with confidence from the case of Nashville is that the two institutions further illustrate Ellen White’s strong desire that the city center and the suburbs all be reached. Yet the history of Adventist institutions in Nashville also illustrates the tendency of early 20th-century Adventists to abandon inner cities in the 1910s and 1920s. Not only did Nashville Sanitarium move out of the downtown area; not only did Rock City close in 1914; in addition, when a second sanitarium was built near the Tennessee capital in 1927, Riverside Sanitarium and Hospital was located north of the city and the Cumberland River, and had its main building at 770 Youngs Lane. A pamphlet about Riverside Sanitarium declares its location as “within a few minutes ride from the city of Nashville [but] away from the noise and bustle of the cities.”55


Lack of Commutability

Commutability was not characteristic of all Adventist sanitariums, however, nor does it appear to have been a requirement for institutions built in rural areas. This becomes clear with a look at sanitariums known to have supported urban missions.

San Francisco and St. Helena. St. Helena Sanitarium was never described by Ellen White as an “outpost center,” but it was an institution in which she had a close personal interest that dated back years before she took up residence within view of what had initially been called the Rural Health Retreat. At the same time, Ellen White was keenly interested in city mission in nearby San Francisco and Oakland, and commended the cluster of mission activities being conducted in these large urban centers. Furthermore, the medical-missionary work that was being conducted on several sites in San Francisco all came under the aegis of the California Medical Missionary and Benevolent Association (CMMBA), the principal institution of which was St. Helena Sanitarium. Ellen White attended meetings of the Rural Health Retreat board in 1892. After she and her son, W. C. White, returned from Australia and took up residence at Elmshaven in 1901, Willie was one of the directors of the CMMBA. Thus, there can be no doubt of the interconnectedness of St. Helena Sanitarium and the San Francisco city mission, even apart from Ellen White’s deep personal interest in both.

In 1906, Ellen White related a dream from about 1876, wherein she saw two beehives representing the cities of San Francisco and Oakland; the latter was an active hive of activity, but the former was not as promising. When she looked at that beehive again, it had undergone “an entire change” and “[g]reat activity was seen among the bees.” The interpretation of this was that “in San Francisco there was a great work to be done,” and steps were taken to begin that work. All this was context to the commendation Ellen White gave to the work in San Francisco: “During the past few years, the ‘beehive’ in San Francisco has been indeed a busy one. Many lines of Christian effort have been carried forward by our brethren and sisters there. These included visiting the sick and destitute, finding homes for orphans, and work for the unemployed; nursing the sick, and teaching the truth from house to house; the distribution of literature, and the conducting of classes on healthful living and the care of the sick. A school for the children has been conducted in the basement of the Laguna Street meeting-house. For a time a working men’s home and medical mission was maintained. On Market Street, near the city hall, there were treatment rooms, operated as a branch of the St. Helena Sanitarium. In the same locality was a health food store. Nearer the center of the city, not far from the Call building, was conducted a vegetarian café, which was open six days in the week and entirely closed on the Sabbath. Along the water front, ship mission work was carried on. At various times our ministers conducted meetings in large halls in the city. Thus the warning message was given by many.”56

Where did the busy worker bees of the San Francisco beehive work and live? Indeed, the health-food store Ellen White mentioned was at 1482 Market Street, not too far from the Branch Sanitarium, and the vegetarian café was at 755 Market Street (now the location of a Four Seasons Hotel). The San Francisco Branch Sanitarium was located at 1436 Market Street, an address mere blocks from the city’s docks, and the Hydriatic Dispensary was at 916 Laguna Street, close to the Laguna Street Seventh-day Adventist Church at 914 Laguna and less than a mile from the Branch Sanitarium.

The 1905 Yearbook of the Seventh-day Adventist Denomination lists Dr. Henrietta E. Brighouse as the physician at the San Francisco Branch Sanitarium and the San Francisco Hydriatic Dispensary and gives her address as the Branch Sanitarium. References to Dr. Brighouse in Ellen White’s letters and manuscripts mention nothing about the location of the San Francisco Branch Sanitarium; in fact, the only mention of the “S. F. Dispensary” in her writings is in relation to recommending to the California Conference that they employ Dr. Brighouse “in medical missionary work around the Bay.”57 Another physician, Robert Buchanan, who was the first medical missionary in San Francisco, also listed 1436 Market Street as his address. The only references to him in Ellen White’s manuscripts and letters are in relation to his initial employment with the Branch Sanitarium. Emmet J. Hibbard, pastor of the Laguna Street church, listed his address as 528 Fell Street, less than a mile from both the Branch Sanitarium and the church. (Presumably, Hibbard’s wife, Flora, and at least some of their five children also lived at the Fell Street location.) They soon moved to a place on Pearl Street, which was a little farther from the church, but still very much within the city. Elmer and Amanda Parlin lived in Room 203 in the Parrott Building in San Francisco, located near Chinatown; Elmer operated the Pacific Press Publishing Association’s branch office from the room, and Amanda did Bible work in both San Francisco and its suburbs. That year, Phoebe Press lived at 1049-A Market Street, one of many addresses she would hold in San Francisco; she was a literature evangelist, covering the city in such a dedicated manner that the writer of her obituary mentioned it: “[S]he began the stupendous task of placing the ‘Signs of the Times’ in every home in the great city of San Francisco. She completed this labor for the Master.”58

When Ellen White praised the San Francisco Mission (“the beehive”), in other words, she was praising a mission whose staff were largely based in the city itself. Indeed, even after the removal of many of the church’s Californian institutions to Mountain View and St. Helena, the city of San Francisco was not entirely abandoned. The 1908 Yearbook of the Seventh-day Adventist Denomination gives a snapshot of who and what was left of the beehive in San Francisco after the 1906 earthquake. Hibbard, the Parlins, and Press all stayed in San Francisco. Hibbard, the pastor of the Laguna Street church and listed as living at 916 Laguna, lived and worked in San Francisco until his health broke and he removed to the state of Oregon for rest and recuperation; it is uncertain if this was due to age, city dwelling, or typical Adventist overwork (or a combination of all three). The Parlins lived at 909 Steiner Street; Elmer worked as an attorney, and Amanda continued to do Bible work; both were “very active in the work in San Francisco and Oakland.”59 Although Phoebe Press listed her address in 1907 as 916 Laguna Street, by 1908 she resided at 663 Fillmore Street, listing her occupation in the City Directory simply as “missionary.”60

What support could these city missionaries on the bay receive from the substantial Adventist medical institution in the Napa Valley? St. Helena Sanitarium was not commutable. In Ellen White’s writings, whenever St. Helena is mentioned in relation to the larger cities of Oakland and San Francisco, it is usually in context of her or her family’s extensive travels. While Sanitarium, California, was close to Calistoga, which from 1869 was served by a railway, daily commuting to Oakland and San Francisco was not feasible as there were only two trains a day from Calistoga to Vallejo, from whence, moreover, the traveler had to take a ferry across the Carquinez Straits, wait for a train to Oakland, then take a second ferry to San Francisco (before repeating the whole process on the way back). In 1902, Ellen White recorded how she and Willie with her staff had “left St. Helena” “early this morning” in order to connect with a 7 p.m. train from San Francisco to Los Angeles; in effect, then, it was a day’s journey each way.61 From July 1905 an electric railway connected Napa to Vallejo, which now had several ferry services directly to and from San Francisco daily. Not until January 1908, though, did this railway extend from Napa to St. Helena. Thereafter, with seven services a day, it was theoretically possible to commute from the north end of the Napa Valley to San Francisco, but in practice it would have been extremely unlikely, because it would have taken three-and-a-half hours each way between St. Helena station and San Francisco, plus the journey between the station and the sanitarium. The fact remains, however, that the San Francisco Branch Sanitarium’s “root” was St. Helena Sanitarium. In light of the realities of travel and of the fact that the San Francisco Branch Sanitarium was staffed by people living in the city itself, clearly it cannot be concluded that branch sanitariums were solely staffed by personnel commuting from the parent institution; this has obvious implications for Washington, D.C., and perhaps for Nashville.

Colorado and Illinois. In this same time period, Ellen White singled out Boulder Sanitarium as a foundation for mission. Boulder is adjacent to Denver, Colorado, the largest city in the area. While train tracks connected Boulder and Denver, Ellen White never explicitly spoke of working Denver from Boulder Sanitarium. The closest she ever got to doing so comes from a talk about Boulder Sanitarium given in Takoma Park: “There certainly is a work to be done by the Boulder Sanitarium and a broad work to be done in the vicinity of this sanitarium. Laborers should be working all through that section of the country. There are souls there to be brought to a knowledge of the truth.”62 Urging “a broad work . . . in the vicinity” of Boulder Sanitarium included Denver, but White did not specifically single Denver out as a focus of mission work nor Boulder Sanitarium as a particular place from which to work Denver.

Yet another institution, Hinsdale Sanitarium, was located close to a city; it was about 17 miles outside of Chicago, Illinois, and supported the city mission work in the city. But its work could be seen as a hybrid: an institution that both supplied commuting workers and supported workers dwelling in the city. While the town of Hinsdale is now a heavily populated suburb of Chicago, in the early 1900s it was a decidedly rural location and a pointed choice for a new Adventist sanitarium, when it was founded in 1904. There had been a substantial Adventist presence in inner Chicago since the 1880s, but work in the city had been closely directed by Dr. John H. Kellogg, and his disputes with church leaders had led to the Chicago Mission becoming estranged from the church. It would have been easy, in the circumstances, for Adventists to abandon the city of Chicago. Instead, Hinsdale was founded by Dr. David Paulson, who had been a protégé of Kellogg’s but remained faithful to the church; the location of Hinsdale, not in Chicago (tainted by association with Kellogg, who was finally disfellowshipped in 1907), but close to Chicago, seems deliberate and strategic.

Under Paulson’s leadership, experienced nurses from Hinsdale were permanently based in Chicago, and supplemented by students and junior nurses who traveled in and out of Chicago on a daily basis by train. In 1914 Paulson wrote to Irwin H. Evans, General Conference vice president for the North American Division, regarding the city work being conducted by the Hinsdale workers, particularly in training the nurses: “The plan we are working after is to have one of our trained nurses work hand in hand with two of these inexperienced workers. Their substantial training will make a good combination with the enthusiasm and zeal of these new untrained workers. One will balance the other. We have decided to have them come back every evening to their quiet, beautiful home down there in the woods; in other words, working the city from Hinsdale as an outpost center. That means a little over sixty dollars railroad carfare every month for these ten workers. . . . We do not feel that it would be wisdom to have these inexperienced workers camp overnight in Chicago as our most experienced nurses have been doing in building up centers there.”63

This is the only specific contemporary reference to how an “outpost center” functioned. It is written neither by nor to Ellen White, but it has to be taken seriously, because its author had insights into her thinking.

Paulson had regularly written to Ellen and W. C. White, since the early 1900s, with updates about the work being done for and in Chicago. He and his team had established a restaurant near the University of Chicago, serving 500 to 600 meals a day in the summer of 1902, and the “Medical Missionary center [was] already becoming a strong influence for good in the community.”64 This center, listed as the American Medical Missionary College Dispensary, in the 1906 Yearbook of the Seventh-day Adventist Denomination was located at 3558 Halsted Street, now North Halsted Street. In early 1903, Paulson wrote to W. C. White: “From what I have studied of your mother’s writings with reference to how these opportunities are to be followed up with other points of truth, and from my personal conversation with her on the subject, I am in most hearty accord.”[65 Later that year, Paulson was writing of the transition to the Hinsdale campus; over the years he consistently supplied the Whites and other correspondents with details of Hinsdale’s Chicago mission.

He was adamant about the importance of this city mission to the sanitarium’s work, with those who wanted to attend courses at Hinsdale. In February 1915, for example, five months before Ellen White’s death, Paulson wrote to Kate Christenson, a young woman who had applied to work at Hinsdale Sanitarium: “We firmly believe that one of the principal reasons God had in mind in the establishment of the Hinsdale [S]anitarium was that it might be an aggressive medical missionary outpost from which to work Chicago.”66 In fact, one of Paulson’s selling points in 1905 for the nurses’ training school at Hinsdale was that it was “only seventeen miles from the heart of Chicago” and allowed students “full access to the vast city missionary opportunities that it affords.”67 But as is plain from his letter to Evans, it was only the inexperienced who would take advantage of the short distance and commute from rural Hinsdale; others would be living among the people, in Chicago itself.

Clearly, Paulson, eager to implement medical-evangelistic work, did not see Ellen White’s counsel as barring him from having workers living both inside and outside a city. Indeed, in 1914, the same year he wrote to Evans, Paulson wrote to Asa T. Robinson, W. C. White’s son-in-law and president of the Colorado Conference, about Boulder Sanitarium and its relation to city work in Denver, Colorado: “I believe you people could find a consecrated graduate nurse and put her right down in Denver to do house-to-house work among the common people, and then have your nurses who are in training spend each a month with her there. It would mean that twelve of your nurses would have most splendid city missionary experiences each year. You would have to support the graduate nurse and perhaps pay the room rent for the nurses in training.”68

This suggestion was in addition to those of Boulder Sanitarium staff conducting regular Bible work and canvassing efforts when they were not engaged in medical work. Plainly Paulson expected that some, at least, of the staff of various city missions would live, long term, among the people they were trying to reach; and that even other workers would be spending a month at a time, not going in and out daily.

From his practice in Chicago and his advice about Denver, Paulson did not advocate a strict either-or approach. Some have assumed that Ellen White’s counsels mean that we should have a work in the city, performed by workers living outside the city. Paulson’s example, based on his close familiarity with Ellen and W. C. White and the inspired counsels on city work, shows otherwise.

It appears that the implementation of the outpost- center concept partly depended on the circumstances in a particular location. What worked in Boston and Sydney, where the evidence does suggest the sanitarium was home for workers who commuted into the city, would not necessarily work in Nashville or Washington, D.C., where the evidence is inconclusive; or in San Francisco, which could not have been staffed by commuters; or in Chicago or Denver, where there was a mix of locally based and commuting staff. Again, circumstances alter conditions. But again, too, what is very clear is that Ellen White wanted all the citizens of large urban areas to be ministered to, and that this entailed some city missionaries living in the cities.


Cities as a Home Mission Field

In the summer of 1906, Ellen White penned a more general testimony in the introductory section to which she declared: “More and more, as wickedness increases in the great cities, we shall have to work these places from outpost centers.” A little later she continued, significantly: “Soon we shall have to leave the cities. For years we have been instructed that our people, and especially families with children, should plan to leave the cities as soon as the way opens before them to do so. But until it is possible for them to leave, they should be most active in doing missionary work, however limited their sphere of influence may be. As they yield their talents and their all to God to be used as He may direct; as they live out their consecration by engaging in practical missionary work wherever opportunity affords, God will bless them.”69

Here Ellen White was explicit: Not everyone would move out of the cities right away. But also, one of the most powerful forms of missionary work is the living out of consecrated lives as members of communities. This is similar to an oft-repeated statement: “Wherever the people of God are placed, in the crowded cities, . . . or among the country by-ways, there is a home mission field.”70 This occurred in an article published in 1888, much of which (including these words) she republished in 1901, and then she used the same sentence to articulate inspired thoughts in a testimony (in a rather different context) in 1907. In other words, consistently Ellen White took for granted that there would be people of God living in the crowded cities, since this is a home mission field.

This aligns, too, with counsel Ellen White gave to Allen Moon, one of the veteran leaders of city mission. Addressing the 1910 Annual Council, Moon “spoke of an interview in which Sister White said that it was not so much by public evangelists that the work [in cities] was to be done as by seeking out the people one by one through Bible work and canvassing effort, and medical missionary work.”71 Bible work and canvassing effort meant door-to-door efforts; this could only be done effectively and people sought out (as she counseled), if the workers were actually living in the cities.

This is also consistent with a number of testimonies Ellen White wrote about vegetarian restaurants, urging that they be maintained in inner-city areas and that treatment rooms be opened alongside them, since she affirmed that the two forms of ministry would complement each other. But from the way she described this linked outreach, and from how it appears to have happened in practice, Ellen White clearly envisaged a labor-intensive approach. Moreover, where possible, she counseled that “a Bible school” be held, as part of a “well-balanced work,” in which those attending the school would receive “daily instruction,” while lectures would also be offered to patrons of the vegetarian restaurants “on the science of health and Christian temperance.” The buildings in which restaurants and treatment rooms were combined were to include lecture rooms, and Ellen White urged that daily meetings should be held in those rooms, in which, she wrote, there should be “prayer and singing and talks, not only on health and temperance topics, but also on other appropriate Bible subjects.”72 In theory, the workers responsible for this intensive range of activities could commute in and out daily from a sanitarium or other center of influence on the city outskirts, especially with convenient mass transportation; but the sheer level of activity that Ellen White envisaged made this highly improbable, as it would be simply impracticable (especially today with the size of modern cities). Her ideal curriculum presupposed that the workers would be living in the city.

Finally, this is of course what Stephen Haskell, Ellen White’s dear friend and pioneer of city mission did in New York City. Haskell and his wife, Hetty, lived in the city—in fact, only a few blocks from Central Park—from 1901 to 1903. In 1901, indeed, having recently moved there, Haskell reported briefly on where he and his wife were living, and concluded, “Do not let our brethren forget to pray for us. Do not forget the address. It is 400 West 57th, New York City.”73 This is in the area of the city known colloquially at the time and since as “Hell’s Kitchen.” The Haskells were literally doing mission in the most hellish part of the city. They received encouragement, as well as chastisement, in the mail from the prophetess. Ellen White wrote in the fall of 1901 to encourage the Haskells’ work in New York City: “Be of good courage. God’s providence will certainly open your way and give you precious victories. It is our duty to place ourselves where God has signified we should be. He was in your going to New York City, working just as you have been working for those not of our faith.”74

The fact that the Haskells lived in the city—in Hell’s Kitchen but God’s outpost—affords a key insight into what Ellen White intended to be understood by her frequent references to the need for Seventh-day Adventists to be in the cities. What did “in the city” mean? All the evidence suggests it meant not that city workers should be mere day trippers in and out from the outpost centers, but that they should live among the people they were trying to reach: mingling with them, showing them sympathy, meeting their needs, and then bidding them to follow Jesus (to adapt the counsel of Ellen White about “Christ’s method”75 of ministry and mission).



What, then, was the purpose of outpost centers? How did they permit cities “to be worked” in Ellen White’s phrase? In a letter written in 1910, Ellen White articulated her gratitude to God “that so many of our sanitariums are established in pleasing country locations, and yet within easy reach of important centers of population.”76 Here, “easy reach” could mean commutable—where transportation links made this practicable, which was not everywhere. But it might also mean a day’s journey as at St. Helena: a journey into the city, to work for its people, or out of it, into fresh air. Ellen White’s words about “easy reach” thus could actually mean workers living in the downtown rather than in suburbs or the rural fringes of cities.

If city missionaries were living in urban centers, however, then just what was the role of the rural sanitariums from which the cities should be worked? What function did Ellen White envisage them fulfilling?

Regardless of whether staff commuted or spent blocks of time living in the center of cities, all these sanitariums—from St. Helena to Melrose to Hinsdale—could contribute to city work in two ways. First, these institutions could all provide medical resources and lecturers on health and temperance to the treatment rooms and hygienic restaurants in the city centers. Second, however, each sanitarium (Nashville is a partial exception) was, to use St. Helena’s original title, a rural health retreat. The need for such retreats was underscored by Ellen White’s frequently repeated references to the contaminated air and water of cities, and the temptations that were offered in them; and to the need for Adventists to have contact with the soil and fresh food harvested from it, and with the fresh air and water that loom so large in Ellen White’s concept of the ministry of healing. There is a plain inference of the evidence from San Francisco, Washington, D.C., and Nashville, one made explicit in the statements by Paulson about Chicago and Denver: that an important part of the purpose of an outpost center was to provide periodic respites for weary city workers, worn down by the morally and physically polluted environment. This role could also have been played by sanitariums that were a commutable distance from cities, such as Melrose and Wahroonga.

Indeed, in counsel written in 1902, Ellen White affirmed the need for city missionaries to get out of the cities to attend camp meetings, and she explicitly counseled: “our workers are not to think that they must remain in the cities to attend to business matters connected with various lines of city work; nor are they to hurry . . . [back] in order to do this kind of work.”77 Here, again, residence in the city was taken for granted; but it was not, in Ellen White’s thinking, to be uninterrupted residence. Rest and refreshment were—and still are—necessary if “the essential work for this time” is to be pushed forward successfully.

Despite Ellen White’s explicit counsel that the inner cities as well as suburbs must be reached, within a few years of her writing those words, the few remaining Adventist city missions were deliberately avoiding what Ellen White called the “inmost parts” of cities and instead were focusing on the suburbs. But this was contrary to what she had written and what she wanted.

Many Adventists often quote “Out of the cities, out of the cities!” as though it were Ellen White’s definitive statement on urban ministry. But what is certain is that it was not her last word on the topic of city mission. In the summer of 1909, in retirement at Elmshaven, she wrote a testimony entitled “Reaching the Cities,” in which she made the following remarkable statement: “If God gives me strength now, at nearly eighty-two years old, I shall be in the cities.”78 In her ninth decade, Ellen G. White was not thinking of rest but of getting into the polluted, iniquitous cities, because they were full of people who needed to hear good news. She continued the testimony with a rhetorical question: “Now where are the people that will be ready to go out into the city?” For in her own case, though the spirit was enthusiastic, the body was by this time too weak. Her question is still there, posed to her readers today: Where are the people? Where are the people who will say, “If God gives me strength, then I shall be in the cities”?


D. J. B. Trim, PhD. is Director of the Office of Archives, Statistics, and Research for the General Conference of Seventh-day Adventists in Silver Spring, Maryland, U.S.A.


A. L. Chism, MSI, is Research Center Manager of the Office of Archives, Statistics, and Research at the General Conference of Seventh-day Adventists.



1. Ellen G. White (hereafter abbreviated EGW), Country Living: An Aid to Moral and Social Security (Washington, D.C.: Review and Herald, 1946).

2. Denis Fortin, “Country Living,The Ellen G. White Encyclopedia, Denis Fortin and Jerry Moon, eds. (Hagerstown, Md.: Review and Herald, 2013), 743.

3. E. A. Sutherland, “The Commission on Rural Living,” The Advent Review and Sabbath Herald 128:1 (January 4, 1951): 19.

4. Country Living, 31.

5. __________, “Notes of Travel—No. 2: Dedication of the Loma Linda Sanitarium,” The Advent Review and Sabbath Herald 83:25 (June 21, 1906): 7.

6. Testimonies for the Church, 5:369.

7. Medical Ministry, 304.

8. Evangelism, 428.

9. Letter 47, 1909.

10. Medical Ministry, 302, 303.

11. EGW to S. N. Haskell, April 9, 1900, Letter 57, 1900.

12. “Bubonic Plague Comes to Sydney in 1900,” University of Sydney Medical School, Online Museum & Archive: https://sydney.edu.au/medicine/museum/mwmuseum/index.php/Bubonic_Plague_comes_to_Sydney_in_1900.

13. EGW to Mr. and Mrs. George O. Wellman, April 27, 1900, Letter 212, 1900.

14. EGW, “Report of an Interview,” January 14, 1904, St. Helena, Calif., Ms. 7, 1904.

15. Country Living, 11.

16. Ibid., p. 10.

17. Manuscript Releases, 3:43.

18. George I. Butler, “Rural Versus City Life,” The Advent Review and Sabbath Herald 67:1 (January 7, 1890): 9, 10.

19. Louis Cain and Sok Chul Hong. “Survival in 19th-century Cities,” Explorations in Economic History 46 (Oct. 2009): 450–463.

20. Michael R. Haines, The Urban Mortality Transition in the United States, 1800–1940, Historical Paper 134 (Cambridge, Mass.: National Bureau of Economic Research, 2001), 2.

21. Samuel H. Preston and Etienne van de Walle, “Urban French Mortality in the Nineteenth Century,” Population Studies 32 (1978): 275–297.

22. Adna Weber, The Growth of Cities in the 19th Century (1899), 343, 348, quoted in Haines, Urban Mortality Transition, 3.

23. EGW, Manuscript Releases 10:241.

24. The Ministry of Healing, 365.

25. L. Kress to EGW, September 4, 1902, Ellen G. White Estate Incoming Correspondence Files (transcription by Ashlee Chism).

26. EGW to Brother and Sister D. H. Kress, October 15, 1902, Letter 161, 1902.

27. The Ministry of Healing, 365.

28. EGW to Brother and Sister D. H. Kress, May 10, 1906, Letter 158, 1906.

29. Cain and Hong, “Survival.”

30. EGW, Miscellaneous Collections, “Loma Linda Messages,” 43.

31. The Ministry of Healing, 363.

32. __________, “Behold, What Manner of Love!” The Advent Review and Sabbath Herald 83:39 (September 27, 1906): 9.

33. Manuscript Releases, 6:408.

34. Steven Johnson, The Ghost Map: The Story of London’s Most Terrifying Epidemic (New York: Riverhead Books, 2006), 232.

35. EGW, “The Southern California Sanitarium,” Ms. 43, 1902.

36. George I. Butler, “The Removal of the Nashville Publishing House,” The Advent Review and Sabbath Herald 82:50 (December 14, 1905), 19.

37. Ibid.

38. Ellen G. White, “The Family as an Educational Agency,” Pacific Union Recorder 10:3 (August 18, 1910), 4.

39. EGW to Brother and Sister D. H. Kress, October 15, 1902, Letter 161, 1902.

40. EGW to Brother and Sister J. A. Burden, December 10, 1903, Letter 26, 1903.

41. Manuscript Releases, 4:282.

42. Ibid., 1:135.

43. EGW to Dr. and Sister C. C. Nicola, May 15, 1906, Letter 150, 1906.

44. Manuscript Releases, 1:135, italics supplied.

45. Ibid., 1:134.

46. Ibid.

47. Ibid., 7:335.

48. 1906 Yearbook of the Seventh-day Adventist Denomination, 120.

49. EGW to Marion Stowell-Crawford, April 3, 1907, Letter 126, 1907.

50. EGW to Brother and Sister J. A. Burden, August 4, 1903, Letter 171, 1903.

51. “Notes and Personals,” Union Conference Record 8:4 (February 15, 1904): 7.

52. “Pure Food Vegetarian Café,” ibid., 8:5 (March 1, 1904), 7.

53. “Pure Food (Vegetarian) Café,” Good Health (Australia), 7:3 (March 1, 1904): 355; “Notice,” Good Health (Australia), 8:8 (August 1, 1905): 168.

54. EGW, “Be Not Discouraged!” Ms. 3, 1912.

55. “Riverside Sanitarium and Hospital” brochure, February 16, 1937, W. E. B. Du Bois Papers (Ms. 312), Special Collections and University Archives, University of Massachusetts Amherst Libraries.

56. EGW, “Notes of Travel—No. 3, The Judgments of God on Our Cities,” The Advent Review and Sabbath Herald 83:27 (July 5, 1906): 8.

57. Ms. 194, 1903.

58. M. C. Wilcox, “Obituaries: Press,” Pacific Union Recorder 24:31 (March 12, 1925): 6.

59. 1908 Year Book of the Seventh-day Adventist Denomination, 68.

60. Ibid., 69.

61. EGW to Brother and Sister Haskell, September 11, 1902, Letter 140, 1902.

62. “The Boulder Sanitarium,” May 29, 1905, Ms. 72, 1905.

63. David Paulson to Irwin H. Evans, July 21, 1914, White Estate Incoming Correspondence, Ellen G. White Estate [hereafter EGWE], Record 38163.

64. Paulson to EGW, July 20, 1902, EGWE, Record 17583.

65. Paulson to W. C. White, Nov. 23, 1903, EGWE, Record 17605.

66. Paulson to Kate Christenson, February 22, 1915, EGWE, Record 38177.

67. Paulson to “Friend,” 1905, EGWE, Record 20012.

68. Paulson to Asa T. Robinson, August 28, 1914, EGWE, Record 38164.

69.  EGW, Ms. 107, 1906.

70. __________, “Missionary Work in the Neighborhood,” The Advent Review and Sabbath Herald 65:21 (May 22, 1888): 321, 322.

71. General Conference Executive Committee, meeting of April 12, 1910, “S.D.A. General Conference Committee Proceedings,” viii:199, in General Conference Archives, RG 1, Box No. 13738.

72. Testimonies for the Church, 7:115.

73. Stephen N. Haskell, “New England Camp-Meeting,” The Advent Review and Sabbath Herald 78:28 (July 9, 1901): 445.

74. EGW to Brother and Sister Haskell, October 7, 1901, Letter 132, 1901.

75. Gospel Workers, 363.

76. EGW to H. W. Cottrell, January 27, 1910, Letter 12a, 1910.

77. Testimonies for the Church, 7:253.

78. “Reaching the Cities,” sermon given at Three Rivers, Michigan, Ms. 127, 1909.