Effects of Ill Health on the Service of Scottish Presbyterian Missionaries 1867-1929 Jonathan H. Cossar and Derek A. Dow Background: The experience of Scottish Presbyterian missionaries serving overseas between 1867 and 1929 was analyzed. Method: Data were compiled during a 4-year postgraduate research program from such sources as the General Assembly Re- ports of the Foreign Mission Committees of the Church of Scotland, numerous missionary magazines, school records, medical directories, and newspaper and medical journal obituaries. Results: Data show that the year of appointment, the mission station and continent location, and medical knowledge were all influencing factors on the length of missionary service, early retirement on account of ill health, death in service, and age at death. Conclusions: This method of comparative, historical study may have further useful applications in looking at the health experi- Downloaded from https://academic.oup.com/jtm/article/1/1/16/1819259 by guest on 30 September 2021 ence of other groups who lived and worked abroad at the turn of the century, such as civil servants, the military, or other comparable missionary groups. (J Travel Med 1:16-29, 1994) In 1612 Francis Bacon observed “Travel in the However, recognition of the importation of in- younger sort, is a part of education; in the older, a fection by travelers is not new. In response to out- part of experience.”’ breaks of plague during the Middle Ages, following He would have needed remarkable foresight to the arrival of ships from the East, measures were taken anticipate that the opportunity afforded by travel for to protect communities from these epidemics; Venice education and widening of experience would give rise and Rhodes introducing the first regulations in the to 341 million international tourists by 1986.2It was twelfth century.24 Ships arriving at these European then impossible to predict the medical problems asso- ports were kept at a distance and travelers detained in ciated with contemporary travel abroad, problems isolation for 40 days (quaranta giorni) before they were which are compounded by the widespread destina- allowed to proceed to their final de~tination.~~First tions, and the speed and frequency of this travel. In imposed in 1377 by the Venetian Republic, this was the last decade alone over 20 different infections have the origin of the concept of quarantine. Other cities been imported into the United Kingdom (typh~id,~ and countries followed this example until some form he pa ti ti^,^ p~liomyelitis,~leptospirosis,6 schistoso- of sanitary regulation became general in many coun- miasis,’ amoebiasis,* ~holera,~rabies,’O giardiasis,” tries during the next five centuries. salmonellosis,12 shigell~sis,~~dysentery,I4 leishma- Scotland’s difficult terrain (75% uninhabitable niasis,” lassa fever,I6 trypanosomiasis,” legionnaires’ hilVmountainous country),26inhospitable climate, im- disease,18 di~htheria,’~cytomegalovirus infection,20 poverished domestic economy, agricultural insuffi- malaria:’ acquired immunodeficiency syndrome,22and ciency, and political oppression all combined to en- sexually transmitted diseases23). courage the Scots to travel abroad. Allied to natural enterprise in the fields of exploration, commerce, and the acquisition and dissemination of knowledge, many examples of this Scottish translocation can be found during different episodes of colonization, in military Jonathan H. Cossar, MD, Ch B: General Practitioner and records, and in educated Scottish pioneers whose glo- Research Associate Communicable Diseases (Scotland) Unit, bal exploits earned them international recognition. It Ruchill Hospital, Glasgow, Scotland. Derek A. Dow, MA, Dip has been stated that in the three decades from 1871 to Ed, PhD: Formerly, Archivist to Greater Glasgow Health 1901,483,000 Scots emigrated, perhaps the nation’s Board, University of Glasgow, Glasgow, Scotland. Currently, Honorary Research Fellow, Department of General Practice, greatest world export.27 School of Medicine, University of Auckland, Auckland, New In sharp contrast to the current problem of im- Zealand. ported infections associated with rapid air transit, pre- Reprint requests: Jonathan H. Cossar, MD, CbB, Research vious generations of travelers were exposed to a wide Associate, Communicable Diseases (Scotland) Unit, Ruchill range of health hazards while abroad. The best known Hospital, Glasgow, G20 9NB United Kingdom of these episodes occurred during the ill-fated Darien Cossar and Dow, Ill Health and Scottish Missionaries 17 Expedition of the 1690s, when some 2000 Scots died coded information was punched in at the University as a result of appalling local conditions in which ma- of Glasgow Department of Computing Science and laria and yellow fever were rife.28a. By the nineteenth thereafter analyzed using the SPSSx statistical program. century the continent of Africa posed the greatest There was sufficient information on 141 6 individuals threat. Mungo Park, David Livingstone, and Mary to permit a meaningful analysis. Slessor, who succumbed respectively to trauma From studying the information on the original (&owned while under attack by hostile natives), dys- cards there were obvious limitations on the impartial- entery with internal hemorrhage, and “exhaustion,” ity of the final analyses. For example, the missionar- were three of the most heroically tragic figures in Scot- ies were preselected by religious faith (Protestant)and tish history. country of origin (predominantly Scotland). The study Livingstone and Slessor both journeyed to the period was limited to 1867-1929, and the quality of Dark Continent as Protestant missionaries, a form of data was dependent upon the availability and com- Downloaded from https://academic.oup.com/jtm/article/1/1/16/1819259 by guest on 30 September 2021 service in which Scotland played a disproportionate pleteness of the original missionary records. Statisti- part considering the size of its population, supplying cally the missionaries are an extremely nonrandom more recruits in absolute terms than any other Euro- sample of all Britons working abroad at the specified pean It was therefore deemed appropri- time due to vocational motivation, the selection pro- ate to use this group to provide a historical compari- cedures which they underwent, and the selectivity of son with the health hazards experienced by contem- the data collected on them. However, this was com- porary Scottish mon to the group as a whole, and therefore compari- sons within this population are valid. Where relevant, statistical analyses have been carried out using the chi- squared (x2)test of independence in a two-way table. The raw data used in this exercise were compiled Occasionally when dealing with tests for trend or during a 4-year postgraduate research program lead- three-way tables, it was necessary to use more com- ing to the completion of a PhD thesis in 1977.41The plicated methods, namely log-linear and logistic mod- sources included General Assembly Reports of the els. Foreign Mission Committees of the Church of Scot- Due to the nature of retrospective collection of land, the Free Church of Scotland and the United Free information from historical records, the details for Church of Scotland, Synod Reports of the United Pres- some individuals were incomplete thereby precluding byterian Church, Life and Work, Free Church Monthly identical totals in all the analyses for the different Record, Home and Foreign Missionary Record, and groups. other similar missionary magazines, university ma- triculation and graduation records, Medical Directo- Results ries, and newspaper and medical journal obituaries. A summary card index was completed for each mis- The mission fields of 1409 Presbyterian mission- sionary identified in the course of this work. These aries serving abroad between 1867 and 1929, divided data were subsequently recompiled with a view to into subgroups and subtotals, were identified (Table conducting a comparative analysis of different mis- 1). Similar numbers served in India and Africa (594 sionary subgroups, by assessing such factors as (1) and 612 respectively) accounting for the major pro- retiral from missionary service due to personal or fam- portion (85Y0)of the total. One hundred and forty- ily ill health; (2) death while in service; (3)the cause two (10%)served in China, and the remaining 61 (4%) and age at death; (4)the length of service at different were equally divided between Jamaica and other ar- mission stations, and (5) areas, countries, and conti- eas (Arabia, New Hebrides, Japan). nents during different periods of appointment. Male missionaries (739: 52%) and female mis- Information coding was carried out for gender sionaries (639:45%)were the largest subtotals; 3% and occupational grouping, mission fields, year of could not be classified by gender (where only an ini- birth, age at death, year of appointment, years of serv- tial or a nongender-specific first name was available). ice, reason for retirement, and specified cause of death. Females who were neither trained in health care nor The missionaries were subdivided into groups-or- ordained comprised the largest subgroup (441: 31 YO), dained males, nonordained males, male doctors, or- followed by ordained males (384: 27%), and those dained male doctors, female nurses, female doctors, trained in health care (343; 24%).The remaining five other females, and into subtotals-males, females, and subgroups (3, 5, 7, 9, and 15% of the total) range those with