Chapter 1: The Past

I.The Evolution of the Medical Missionary

Doctors and nurses have not always been welcome members of the mission family. While interest in missions surged following William Carey's influence in the 1790's, there were only twelve to fifteen physicians in missionary service by 1850. (J. T. Aitken et al, 1984:156). There were a number of reasons for this.

Most importantly, prior to the mid-19th century the medical professions enjoyed only limited success against disease because the science of medicine was still infantile. After this time, the status of medicine improved as professional understanding and ability advanced rapidly. By the turn of the century, there were approximately 650 medical missionaries.

In addition, missions was thought to be the job for preachers and evangelists. The vision in missions was limited to the saving of souls. Therefore, the early missionaries were encouraged only to learn the rudiments of first aid in the hope that they could treat their own medical problems as they circled the globe with the Gospel.

During this stage, some missionaries studied medicine before going to the field just to be better prepared for life in a remote area. David Livingstone, for example, after earning his degree in theology, studied medicine as part of his mission training. In doing so he did not intend to become any special sort of missionary, but just a minister of the Gospel like the traditional missionary. (A. F. Walls 1982:287)

"Hudson Taylor, the founder of the China Inland Mission, and himself a doctor, saw medical missions in similarly strategic terms and consequently advised medical training only for candidates who were too young to go abroad." (C. Peter Williams 1982:275)

The next stage in the evolution of the role of the medical missionary came in the second half of the 19th century. Mission societies began to employ doctors to provide medical care for their own personnel. The main reason for this was the enormous mortality rate among missionaries. The average life expectancy of a missionary in Africa during that century was eight years (James and Marti Hefley 1979:339) Dr. Price in London estimated in 1910 that 61% of 596 deaths among British missionaries were preventable with better medical care. (R. Havelock Charles 1910:872) A silent martyrdom was occurring among missionary women during the late 19th century as they suffered a 5% mortality rate during childbirth on the mission field. The corresponding maternal death rate in Germany at the time was less than one death per 1000 deliveries (Dr. Olpp 1932:159).

Following the stage of employing doctors to treat only missionaries, missions perceived that medical work could be a powerful tool of evangelism, especially in areas resistant to the simple preaching of the Gospel. A resolution to this effect was passed at a missionary convention in Liverpool in 1860. (C. Peter Williams 1982:275)

As a result, missions sent doctors to difficult areas with the express purpose of softening up the people for receiving the Gospel later. The missionary doctor was thought of as artillery, as bait, or as a magnet. His assignments were purely medical, and sometimes he was told that he was not to preach the Gospel himself, nor consider himself as a regular missionary per se. Thus, in 1876, a Dr. Langley was instructed by the Wesleyan Methodist Missionary Society "that his task was to prepare the people by his medical skills for receiving the instruction of Missionaries and therefore he would not be expected to take the duties of any sick Missionary, or take any active public part in the work of direct evangelization.. ." (C. Peter Williams 1982:280)

Later, medical work was recognized as much more than simply a tool for missions, but as a vital part of the overall missions ministry. The care for physical ailments became living demonstration of God's love and concern for hurting people. Instead of being looked upon as inferior to the truly "spiritual" aspects of mission work, medical service became a necessary expression of it in a needy world. Medical missionaries were finally accepted into the mission family as legitimate, first-class members.

II. Early Pioneers In Medical Missions

The first Protestant physician sent out to do missionary work was a Dutchman, Justus Heurnius. His father and two brothers were professors of medicine at Leyden. He served in East India until 1638. (Dr. Olpp 1932:125)

Nearly a century later, in 1730, Kaspar Gottlieb Schiegemuch was sent to India as a medical missionary under joint Danish and German sponsorship. He arrived in Madras, but unfortunately died less than one month later. The third medical missionary, Dr. John Thomas, accompanied William Carey to India in 1793, sponsored by the Baptist Missionary Society in England.

The first American medical missionary was Dr. John Scudder, who went to Ceylon (now Sri Lanka) in 1819, and later to India. (J. T. Aitken et al 1984:125) Dr. Scudder had degrees in both theology and medicine, and was thoroughly committed to serving God through medical missions. Five sons, one daughter, and three grandsons of this great man became medical missionaries.

Over the next four generations of Scudders, 42 served over 1100 years of missionary service. The granddaughter of Dr. John, Dr. Ida S. Scudder, was the founder of Vellore Christian Medical College and Hospital in India in 1900. In 1971, it had a staff of 262 full-time doctors and 292 graduate students. (James C. Hefley 1971:10)

Early medical missionaries went to other places besides India. In 1834, Dr. Peter Parker sailed for China. He was both a doctor and a Presbyterian minister. He arrived in Canton and met another Christian surgeon, Dr. Colledge. Dr. Colledge was employed by the East India Company and had already established a small eye hospital in 1827. (J. Kammerer 1932:16) A Christian physician working abroad in a secular organization for the purpose of witnessing for Christ, Dr. Colledge is the first "modern" example of a tentmaking medical missionary.

By 1845, Parker and Colledge were teaching five full-time Chinese medical students, thus establishing the first modern medical education program in China. These two physicians established the Medical Society of China in order to, in Parker's own words, "open China for the Gospel with the lancet." (J. Kammerer 1932:17)

Dr. Parker was the first doctor to use an anaesthetic agent during surgery in China. "He played an important role in encouraging the teaching of Chinese physicians and surgeons to care for their own people." (Charles G. Roland and Jack D. Key 1978:127) He also stimulated colleagues in Britain, Scotland, and the United States to become supportive of medical mission work. He was instrumental in founding the Edinburgh Medical Missionary Society.

London was the base for much medical mission activity in the 19th century. The prime mover for medical missions in London at this time was Dr. James L. Maxwell. He was led to Christ by a praying patient in 1859, and went to the Dutch island of Formosa as a missionary doctor in 1868. After working there for 17 years, he returned because of ill health. He became the first director of the London Medical Missionary Association and, along with his wife, had a ministry of encouraging medical students in London to consider the call to medical missions. By 1900 they had helped 84 students to become medical missionaries, 25 of them to China. Among the 25 were two sons of the Maxwells. One son became president of the Medical Missionaries to China Association, which had 499 members (381 male and 118 female) in 1900. The other son was a gynecologist in the Union Medical College at Peking. (Dr. Olpp 1932:128)

Following the well-publicized death of David Livingstone in 1873, several committed their lives to medical missionary service. One such person was Robert Laws of Aberdeen, Scotland. He had trained in theology and medicine. In 1875, he went to Nyasaland (now Malawi) under the Free Church of Scotland. In 1876 he used chloroform for the first time in Africa to remove a cystic tumor from an eye. His ministry combined evangelism, medical work, and the teaching of various building trades. He established the Overtoun Institute to teach trade skills and built thirteen hospitals. From 1912 to 1916, he was an unofficial member of the Nyasaland Legislative Assembly. (J. T. Aitken et al 1984:165)

The first woman medical missionary from the United States was Dr. Clara Swain, who arrived in Bareilly, India, in 1870. Miss E. M. McKechnie was the first missionary nurse. She began work in Shanghai, China, in 1884, and established a hospital there. (James C. Hefley 1971: 11)

Both Ludhiana (started by a British woman, Dr. Edith Brown) and Vellore (started by an American woman, Dr. Ida Scudder) Christian medical colleges in India were founded to train female physicians. The need for female doctors was created by the fact that culturally it was unacceptable for an Indian woman to be examined by a male physician.

These few highlights from medical mission history illustrate some of the breakthroughs for missionaries who were health care professionals. We can go on to give examples of medical missionaries opening up closed doors for other missionaries and making scientific discoveries which have benefited all mankind.

The first missionary to Korea came oft the passenger ship in 1869 and was "bludgeoned to death 15 minutes after stepping on shore. It took a Christian physician, Dr. Horace Allen, to establish the necessary beachhead which permitted the first Presbyterian, Horace Underwood, and the first Methodist, Henry Appenzeller, to enter Korea in 1884 and stay. " (Kenneth M. Scott 1983:10) Dr. Allen was able to save the life of the nephew of the king when the local physicians could not stop the bleeding from a deep wound. After the treatment, the prince claimed that Dr. Allen could not have come from America, but straight from heaven. (Dr. Olpp 1932:156) The laws were changed to allow Koreans to become Christians, and today South Korea has one of the strongest Christian communities in the world. Dr. Allen later served as the first American ambassador to Korea. (James C. Hefley 1971:11)

Two medical missionary brothers, Drs. Jack and Albert Cook, founded the Mengo Hospital near Kampala, Uganda, in 1897. To reach Kampala, they had walked nearly 850 miles from Mombasa, Kenya. In 1901, they first noted the relationship between the trypanosome parasites and sleeping sickness. In 1917, they began teaching medical assistants, a program which was later handed over to the government. This expanded to become the University of Makerere Medical School. They kept careful scientific records throughout their careers and made many valuable contributions both as Christians and as physicians. Both were knighted in 1932. (A. T. Aitken et al 1984:164)

One of the best known medical missionaries, Dr. Albert Schweitzer, established a hospital at Lambarene, Gabon, French West Africa, in 1913. Having earned advanced degrees in four major disciplines (music, philosophy, theology and medicine), he captivated the world by dedicating himself to serving poor and needy people from the time he was 30 until his death in 1965 at the age of 90. His example and writings have stimulated many others to similar work. In 1952, he was awarded the Nobel Peace Prize.

Another medical missionary who has contributed greatly to the advancement of medical science is Dr. Denis Burkitt. Trained as a surgeon in Britain, he became curious about the cause of a frequent jaw tumor in East African children. He did elegant epidemiologic work which eventually led to a greatly improved understanding of the etiology and treatment of this childhood cancer now known as Burkitt's lymphoma. Later, while working for the Medical Research Council in London, Dr. Burkitt popularized the importance of fiber in the diet of man, thereby changing the eating patterns of millions of health conscious people around the world. (Brian Kellock 1985)

III. Statistical Summary of Medical Missions

Medical missions is a relatively recent phenomenon. As has already been mentioned, by 1850 there were only twelve to fifteen medical missionaries. However, by 1900 there were approximately 650 medical missionaries, 128 of whom were British. Between 1850 and 1950, more than 1,500 British medical missionaries served in developing countries. (J. T. Aitken et al 1984:158)

The World Missionary Atlas, published in 1925, gave the total number of missionary doctors from Europe and America as 1,157. In addition, there were 614 national physicians serving in mission hospitals. Most of these were trained at one of the 19 Christian medical colleges offering a full medical course. There were 914 students enrolled in these schools in 1925. This does not include the 1,932 nursing students enrolled in the 66 nursing schools run by missions in 1925.

The breakdown of where the 1,157 missionary doctors and 1,007 missionary nurses were working in 1925 is as follows:

The percentage of missionaries on each continent who were health care professionals in 1925 were as follows:

In 1932, there were 1,307 medical missionaries, with 89 from Europe, 518 from Great Britain, and approximately 700 from the United States. ( Dr. Olpp 1932:148

The Directory of Protestant Church-Related Hospitals, published in 1963, lists 1,231 mission hospitals. These were staffed by 828 missionary doctors and 1,317 national doctors. At these hospitals were 1,321 missionary nurses and 6,928 national nurses. (J. T. Aitken et al 1932:167)

James C. McGilvray estimated in 1969 that the budgets of the more than 1,200 Protestant medical institutions in the Two-Thirds World exceeded $100 million annually, and that the 2,000 Roman Catholic medical institutions cost twice that amount.

James D. Hefley reported in 1971 that churches and missions spent $100 million annually to support 1,239 mission hospitals located in 81 countries. This does not include the four medical colleges, nine schools for physicians' assistants, and the 412 professional schools for nurses run by missions. (James D. Hefley 1971:12)

The magazine Medical World News ran an article on "Medicine with a Mission" in December, 1979. With admittedly incomplete data from a telephone survey, they listed 59 church or parachurch bodies from North America having a total of 1,021 missionary doctors serving abroad. (R. Herschberger and L. Wingerson 1979:29) The largest single group of missionary doctors was 438 from the Seventh Day Adventist Church, while the Southern Baptist Foreign Missions Board was second with 136.

The stress laid by the Seventh Day Adventist Church on medical missions is further shown by the fact that in 1979 they spent more money on health work in developing countries than 33 other Protestant missions combined. (S. Rasmussen et al 1980:7)

Conclusion

The subject of medical missions is vast, and no one has yet attempted to write its history in a comprehensive way. There are many individual biographies and autobiographies of medical missionaries, and probably a lot of archival material in the vaults of the various mission boards and associations. This chapter has simply touched some representative highlights of the past.

The history of medical missions is exciting because it is the story of God's work, a work of healing and restoration among the peoples of the world. A better understanding of this heritage is also helpful in analyzing present conditions and planning more creatively for our future.

After this brief look at the past, the next chapter turns to our present situation.

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