A “Dingy Garret-Room in Cowgate”: The Birthplace of the Medical Missionary Movement

At a public meeting held in Edinburgh at the Royal Hotel on 30 November 1841, influential supporters of medical missions came together and founded the Royal Association for Sending Medical Aid for Foreign Countries, renamed the Edinburgh Medical Missionary Society (EMMS) in 1843. Now operating as ‘EMMS International’, the charity is recognised as being the first medical missionary society in the Western hemisphere as well as being the most successful and influential of similar societies. Throughout its history, presidents and fellows of our College have contributed significantly to that success. Some names from the nineteenth century may indeed be familiar to you – Joseph Bell (the real Sherlock Holmes), Benjamin Bell, James Miller and James Syme.

We were delighted to recently acquire the considerable archive of EMMS, making it one of the largest collections now housed in the RCSEd Archive.

The Cowgate Dispensary, Edinburgh

Medical missions proliferated across Britain from the 1870s, yet it was in the slum districts of Edinburgh that the medical missionary movement was truly born, several decades earlier. While local authorities were slow to respond to health problems created by poverty in Edinburgh’s Old Town, individuals associated with EMMS were active participants in attempting to remedy this, most notably Peter Handyside FRCSEd, one of the Society’s founders. His enterprise would be held as a standard for future missions throughout Britain and overseas.

 In 1853, Handyside founded a dispensary in a “dingy garret-room” as the Missionary Dispensary and Hospital for the Irish Poor, serving the city’s Cowgate, West Port and Grassmarket areas, “one of the worst quarters of town”. However, the site proved too small to meet demand, and the surgeon found new premises in 1858 at an old whisky shop at 39 Cowgate, re-opening as the Medical Mission Dispensary and Training Institution. (At this point EMMS was not officially part of Handyside’s enterprise, although the two activities were brought together in 1861).

In its first year of operation, the Dispensary proved so popular that patient numbers increased five-fold and the premises were expanded. After the notable medical missionary David Livingstone died, the name of the Dispensary changed in 1877 to the Livingstone Medical Mission Training Institution.

Philanthropic as well as medical activities underpinned EMMS’ work, through the provision of entertainment, a toddler’s playgroup, and the distribution of clothes, food and linen donations by Dispensary staff.  Of course there was also a spiritual dimension to the work of the doctors and students – or preaching healers – connected with EMMS. Bible classes were offered and evangelistic open-air meetings held, with Dispensary students enlisting attendees by knocking on the door of locals. These meetings were not always appreciated by residents who were known to throw buckets of water over speakers from their tenements!

Other home medical missions

The impact of home medical missions like the above cannot be underestimated, given that its services filled gaps in the existing poor law through the delivery of easily accessible and good quality medical care as well as welfare provision by home visitation. Once EMMS was established, its success sparked a wave of new medical missions such as in Glasgow (1844), Belfast and Liverpool (both 1863). At the first meeting of the Medical Missionary Association in London, it was acknowledged EMMS was their key influence. In 1888 the St. Pancras Medical Mission was founded along similar lines as the Cowgate Dispensary as was the Islington Medical Mission in 1890.

Moreover, many of these societies relied on EMMS to supply them with medical workers, both for home missions and global missions; one of EMMS’ objectives at its inception was “to aid other institutions engaged in the same work”, and this also applied overseas through funds sent to Chinese and Syrian societies.

In the EMMS annual report published in 1893, it was noted that “the medical missionary work carried on from day to day in the Cowgate Dispensary is a model of what goes on in Medical Mission Dispensaries all over the world”.

Nazareth

EMMS’ missionary aims from the outset were international in scope and continue to be to this day. In 1859, with Britain’s imperial expansion in India, several missionary societies called on EMMS to provide medical assistance there and the Society began to fund overseas work. In 1861 two doctors were sent to India and one to Palestine, and by the turn of the century 100 medical missionaries had been sent overseas by EMMS.

In the early twentieth century, it was noted that,

“The Hospital was becoming well known in Galilee and the surrounding country and daily the waiting room was thronged with patients from the deserts and beyond…They came suffering from a variety of diseases and by different means of transport, on horseback, on donkeys, on camels or on foot”.

EMMS’ work in Palestine would have the most significant impact however, with a hospital and clinic service established in Nazareth. This would become known as the ‘EMMS Nazareth Hospital; or ‘Scottish Hospital’ by the local community. In 1861, a Society-trained Armenian doctor Kaloost Vartan left Edinburgh for Nazareth to establish the only dispensary between Jerusalem, Damascus and Beirut, which was initially financially supported by the Syrian Asylum Committee. When this financial support folded Vartan was thereafter funded by EMMS. Now firmly established as a Society ‘mission’, in 1894 a dispensary and clinic was opened in lower Nazareth and in 1912 an even larger hospital opened on land purchased by the Society.

In 1924, the hospital launched the Nazareth School of Nursing and in the 1950s the hospital was expanded further to accommodate more specialised departments including a labour ward and new outpatient department. Maternity facilities continued to grow and the Maternity Department could boast of “the most modern equipment for this important service of childbirth”, recording more than 3000 deliveries over the course of that year. 

Now administered through the ‘EMMS Nazareth Trust’, the Nazareth Hospital is currently the second largest employer in the region serving a catchment area of 264,000 people, having always treated people of all faiths.

Women as medical missionaries

It is argued that the opportunities afforded by medical missionary work acted as a significant driver for women’s entry to medicine. Victorian women’s attempts to secure a public role are well known, and from the early years of EMMS’ history women contributed significantly; as donation givers, fundraisers, educators, voluntary spiritual providers and administrators, including arranging parcels of toys and clothes to send overseas. Women would also increasingly seek roles in the field of medicine. Yet this could only be negotiated with access to a full medical education leading to qualification by training and examination, before they could be deployed in the missionary field. Therefore, it was the 1890s before women were able to make substantial advances in the field of missionary work as doctors.

Although attempts were made earlier by EMMS to encourage women to be trained medically through funding grants, in 1891 the Directors adopted a scheme “for the education and training of women as fully qualified Medical Missionaries”. They claimed that “women’s work is now happily recognised as one of the most blessed and important developments of the modern missionary enterprise…none are more urgently needed in the foreign field”. The first woman to become an EMMS trained medical missionary, Eleanor Montgomery, qualified in 1895, and she took up an appointment in India shortly afterwards. Montgomery was part of a cohort of 8 women, all of whom went to work as medical missionaries overseas after qualifying. EMMS also encouraged women to follow new branches of medicine such as pharmacy, and from 1906 a female chemist worked at the Cowgate Dispensary, not only responsible for preparing medicines but also for the education of medical students, both male and female.

Even when women were able to qualify in medicine, continuing prejudice against female medical practitioners in this country made overseas mission work an attractive option. This is borne out by the numbers of women who had joined medical missions in India by the turn of the century; over a quarter of women who qualified in medicine in Britain. 

It was in the field of nursing that women especially found an important medical missionary role. In 1945, Dr Ruth Young wrote from Dehli:

“I think that sometimes when we think of medical missions, we tend to dwell too much on the work of doctors and forget the all-important work which nurses have to play.”

In Nazareth, the opportunity to be trained in nursing was particularly liberating for a large number of women as one of the Society noted at the turn of the century: “There are many domestic problems before an Arab girl will leave her home and family for a profession”. In 1911, a British nurse published an article in the EMMS Quarterly Papers recounting the early obstacles of nursing recruitment in Nazareth,

…it is a recognised fact that the male relatives, whose duty it is to get the girls married, have great difficulties in doing so if it is known that she has been nursing or serving…if these difficulties are to be overcome it must be done by making them feel that nursing is something worth doing, and that it is as good as, if not better than, teaching.

By 1919, the School of Nursing established in Nazareth was recognised under the British government as one of 13 hospitals for training nurses.

Throughout the twentieth century, female medical missionaries not only grew in number dramatically (making up over 1/3 of missionary doctors) but also in prominence, and they were often at the forefront of arguments advocating for greater professional standards and raising the status of medical missionary work.

We are grateful to EMMS International for the donation of their archive.

The EMMS Archive

The EMMS archive collection is substantial.

Please note the basic summary finding aid below is not definitive. The collection is currently being catalogued to item level, which, once complete, will be made available on our online catalogue. There are a substantial number of photographs in the collection, and we will be digitising sections of the collection to make available as on online gallery on our Digital Collections website.

The collection comprises:  

  • Annual Reports, 1841-c.2003
  • EMMS Minute Books, 1841-2011
  • Legal papers
  • Medical Missionary Journal, 1865-1870
  • Quarterly Papers, 1871-1966

This complete run of bound volumes provide a “continuous record of the work not only of the Society…but of the medical missionary enterprise all over the world”. Each publication comprises letters from missionaries and supporters from across the globe, reprinted for popular consumption; reports of society business, obituaries and other general information.

  • The Healing Hand 1966-2012
  • EMMS Correspondence, 1956-77
  • Financial papers, cash books and ledgers
  • Dr Tester’s papers
  • Cowgate Dispensary (Edinburgh) Minute Books, 1893-1950 and other papers relating to the Cowgate Medical Mission
  • Western Dispensary (Edinburgh) papers, 1870-1901
  • Livingstone College Hospital, Leyton
  • Victoria Hospital patient ledgers and papers/photographs relating to other medical missions in England, late 19th-early 20thc
  • Medical Missionary Association papers including photographs, Monthly Periodical ‘Medical Missions at Home and Abroad’, 1887-1923 and ‘Conquest by Healing’, 1924-1961
  • Minutes of Women’s United Missionary Movement, Liverpool, 1911-52
  • EMMS Committee Meetings
  • Notebooks of various committee meeting minutes
  • Minutes of Foreign Missions
  • Papers relating to Nazareth

This is a substantial section of the archive and includes: financial papers, case books, correspondence; architectural plans; photographs, tape recordings, lantern slides; annual reports;

  • Papers relating to Damascus
  • Papers relating to David Livingstone
  • Application Papers, 1878-1961
  • Papers relating to EMMS staff
  • Papers relating to EMMS students
  • Photographs, photograph albums, scrapbooks and other visual material
  • Ephemera
  • Diaries, plans and ledgers
  • Books, booklets and pamphlets

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