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The Practice Of Medical Missions

( Originally Published 1913 )

" The physician's soothing, healing touch is the broad scythe which sweeps a harvest to his feet.... Hospitals become schools, where heavenly lessons seem more easily learned than elsewhere."—A.B.C.F.M.

We come now to a review of the actual ways in which Medical Missions seek to accomplish the various ends for which they have been called into being, and in which they have proved their unique value in the spread of the Gospel. Hardly can there be anything of greater importance in the whole of our subject. For if, as has already been seen, the work of Medical Missions is so urgently and incontrovertibly necessary in the missionary enterprise, then it is of first moment that there should be a clear understanding of the modus operandi adopted by those engaged in the work on the field.

It is now well on towards a century since the first modern medical missionary began his work, and since then the attention directed to this aspect of missions has been increasingly growing in importance. We may therefore safely assume that sufficient experience has been gained to allow of certain definite lines being indicated as those along which the practice of Medical Missions may proceed most usefully, most economically, and with the best result. Manifestly we cannot rightly and adequately appreciate the problems of medical missionaries, nor prayerfully enter into their difficulties unless there is obtained a comprehensive idea of the different aspects of their engrossing work. To a consideration of these we now invite the attention of our readers.

There are five main departments of the practice of Medical Missionaries, and these are : (1) Dispensary work ; (2) Visits to homes ; (3) Itinerating work ; (4) Hospital Work ; (5) Branch Dispensaries. Each of these requires for its best and fullest development the work of the others, but at the same time any one of the first three methods can be carried on apart from the rest. Inasmuch, however, as this latter course is remote from the ideal, and a plan that should be discouraged, we only mention it here in passing. What we propose to do is to sketch what may be described as the natural evolution of a fully equipped Medical Mission, taking each department in the sequence in which it usually appears.

1. Dispensary Work.—This branch of Medical Missions may be compared to the out-patient practice of a hospital in this country, so far as the medical work is concerned. It is almost invariably commenced in some needy mission station, by one of the non-medical missionaries, who has been appealed to for medical help, obtaining a few simple drugs, which he has learned to use, and treating patients, perhaps in a room of his own house. Gradually the work grows, patients come in larger numbers and present cases, which in the scope and severity of their ailments are beyond the skill of untrained help. The need for sending a doctor to the station is then considered, and if it seems that the place possesses the necessary suitability for a medical mission, and the medical missionary is forthcoming, he is attached to the staff and takes over charge of the dispensary.

By this time perhaps a special building has been obtained or assigned for its use ; if not, the doctor quickly finds it necessary to secure and adapt such a one. A stock of the medicines in common use and a few minor surgical instruments is furnished to the doctor, who sets apart definite hours each day for seeing patients. On these days the work commences with an evangelistic service led by the medical missionary, this usually consisting in prayer and a Gospel address. If there is no special waiting room in which this can take place, it is often conducted on the verandah of the dispensary building or in some adjoining courtyard.

The service being over, the doctor goes into his consulting room, and there, one by one, interviews his patients. Whilst he is doing so, those remaining outside are having the Gospel explained to them, by another missionary or by native evangelists, who sell and distribute Gospel literature amongst the patients and their friends. The patients, having been seen by the medical missionary, either have given to them prescriptions to take into the dispensing room, where a trained native assistant makes them up, or are sent into an adjoining surgery, or out on to a verandah for the purpose of having ulcers dressed, abscesses lanced, and other minor surgical work performed. This goes on until all the patients have been attended to, and the work often runs into several hours. Many of the cases are routine and trivial, but many, alas, are severe and beyond all hope of dispensary treatment. An idea of the kind of practice may be gathered from the following account of a series of dispensary patients attending a dispensary in Inland China.

" Who is this that comes in first ? He is a small market gardener who has sold his vegetables and has now come to have his eyes looked at. We look at them. Very red and inflamed they are, and as we look closely, we see that there is what looks like a piece of flesh growing from each corner of his eye towards the pupil. This is a most common disease in China, and thousands suffer from it. Often these fleshy masses grow right across the pupil and completely obscure vision. We explain to him the remedy—removal ; but of this he is rather afraid, so a little ointment is given him to use, and we ask him to come on some other day, when we shall have similar operations, and which he can then see are done quite painlessly ; moreover, we tell him that there are amongst the patients some who have been operated on and from whom he can learn the result. So his courage rises, and he is operated on, getting great benefit, and as a consequence, sending many another patient up to the dispensary, and many of these are accompanied by friends, and as all who come hear of Christ and His love for them, the number of those thus reached by the Gospel is much larger than the number of actual patients.

" Now another patient comes in and we begin by asking him his name.

" ` What is your honourable name ? '

" ` My unworthy name is Wang.'

" ` What is your exalted age ? '

" ` I am unworthy. I have wasted fifty-two years.' " ` Where do you come from ? '

" ` Your little brother comes from Wang family village,' and so on, in similar language. ` What is his precious ailment ? ' until we find that he has been suffering from very bad dyspepsia, which he dates from a certain day, many years ago, when he ate a bowlful of cold rice, and it upset him ! Another cause which he may assign is the fact that this child committed some fault, and he was angry with him ` just after taking a meal,' and he has had pain ` at the mouth of his heart ever since ' ! We give him medicine, and advice regarding his food, also regarding his temper, too, for could you see a Chinaman ` eating wrath,' as he calls it, you could well understand that he might have indigestion for the rest of his life, no matter how long since his last meal !

" Now, whom have we here ?

" A man comes in carrying an old woman on his back. We soon find that she is his mother. Indeed, if we have been in the country for a while, we should know that at first glance.

" What is the matter ?

" We can tell almost at once, for the poor old lady's breathing is most distressing. She has asthma badly. We cannot cure her. She has had it more years than we are old. She wishes she were dead, she says. We try to cheer her, telling her of a home where there is no sickness and no sorrow, no squalor, no choking smoke permeating every inch of breathing space, where all is peace and rest and joy. She shakes her poor old head sorrowfully, and sadly says, ` Woa pu tung tei ' (I don't understand). Poor soul ! she does not, indeed. She has not known what it is to look forward to a bright and glorious home, and an eternal rest. We give her something to relieve her, and with many thanks from mother and son she passes out. But what a regret lingers in our heart that she did not hear the Gospel when she was younger, and might have understood ! And so we go on. Twenty, forty, sixty, or more cases, just such as this, and a few more acute diseases, together with some more interesting cases amongst them, such as tumours which need removing, abscesses which must be opened, teeth to be extracted, a fractured limb to be set, etc. It does not sound very romantic, does it ? No ! a missionary's life is not always romantic. There is much of the humdrum in it ; but there is the blessed joy of knowing we are where He would have us to be, and doing what He would have us do, and that is all the reward we look for."

The great and splendid work thus accomplished by mission dispensaries will appeal to all, but it will be easy to see that from the point of view of the medical side the work has serious limitations. Large numbers may be treated, but unless there is a hospital in addition to the dispensary, many, very many, of these cannot be cured, or in any sense adequately relieved. The work is extensive, but if it stands by itself alone it lacks the quality of intensiveness. Moreover, medicine that is given to dispensary patients is often taken irregularly, or not at all, until the approval of the " gods " is obtained. Explicit directions as to dose and frequency are forgotten, or hopelessly muddled, so much so that patients who have been given powders to take have been known to swallow the paper wrapper and throw away the powder ! Surgical dressings carefully applied have been removed " to see how the treatment was getting on " and the case spoiled. These and many other grievous drawbacks attach to the medical work of a dispensary, and occasion very frequently not a little disappointment.

Then, too, on the evangelistic side, whilst a wide bearing may be gained for the Gospel, and a most valuable service rendered in the removal of prejudice, and the creation of a favourable feeling, yet the great difficulty is that there is no time for more than a passing impression to be made, and the patients may only come a few times. It is perfectly true that much evangelistic success can be and is attained, but there is the constant want of something additional in the shape of longer and fuller opportunities for " following up " the impressions created. Therein comes the great utility and supreme advantage of a hospital, whereby the initial successes of the dispensary can be conserved, and made to yield the richest fruit. Hence does it come about that from both the medical and evangelistic sides there quickly arises a plea for the addition of a hospital concerning whose work we shall see later.

2. Visits to Homes.—This section of the work of a Medical Mission, as will be 'readily realised, follows most naturally upon the work of the dispensary. Once the doctor has started his medical work, and is seeing patients, there come to him requests that he would visit some who are too sick to leave their homes. Or it may be that patients who have been seen in the dispensary become too ill to attend again, and their only hope lies in the doctor going to them. More especially does this branch of medical work fall to the lot of the lady doctor, though in many lands the male medical missionary is appealed to for help of this nature. And it is work which carries with it many opportunities.

Think for a moment of the openings that visits to homes afford for giving new ideas concerning the care of the sick, and habits of cleanliness and hygiene in general. The Medical Missionary can assume the rôle of health instructor and sanitary reformer. It is true, alas, that the efforts put forth in this direction are apt to be rendered null and void by the superstition of the people and their appalling ignorance, yet, nevertheless, slowly but surely, the influences thus exerted by medical missionaries are destined to accomplish very important results.

Then there is the opportunity that visits to homes present for carrying the Gospel to the inmates, many of whom would otherwise never hear it. Often in this way whole households are brought within the sound of the message, and visiting the bedside of one sick person may open the door for telling an entire family about our Lord. Furthermore this branch of- work again and again proves to be the introduction to people of influence and position, and the means, by so doing, of gaining goodwill and support for the Mission. Time may be hard to find for the visits, but experience has shown that the value of this aspect of Medical Mission practice is both far-reaching and fruitful.

3. Itinerating Work.—By this is meant a tour amongst a series of villages or towns lying at a distance from the Mission dispensary, and here again, as in the case of visits to homes, such work follows in natural sequence to the establishment of a medical centre. Many of the patients who have come to the dispensary represent places situated at a distance, and their coming and return home will have suggested to the doctor the necessity and importance of devoting some time for touring in the district, not only for the sake of following up his old patients, but in order that something may be done, even in a small way, for the large number of sufferers who are yet untreated.

Previous to the tour being undertaken, news is often conveyed to the places which it is intended to visit, so that patients may gather in time to be seen by the medical missionary. The time spent in each place varies—sometimes it is only a day or two, at others a week or more, and it is the longer periods which most abound in result. The kind of medical work under-taken consists in simple operations, the administration of remedies for minor ailments, and the attraction of severer cases to the central hospital. From an evangelistic standpoint this work is distinctly encouraging, and has proved of marked value as an agency for spreading the Gospel. The patients and their friends will often gather round the missionary at the close of the day and, having experienced the blessing of his skill, willingly listen to the words he has to say. Moreover, it is customary before commencing the actual medical work to spend a short time in explaining the Gospel message, so that all may have an opportunity of hearing the Truth.

As an actual description of this branch of work, let us quote the following account of a tour undertaken by a Medical Missionary in North India (Dr Vincent Thomas, of Palwal) :

" It was November, the best month of the year in North-West India for the work of itinerant preaching and healing. We had pitched our camp in a grove of mango trees, about twenty miles from headquarters, and just outside a large village. It was intended to make this the centre for two or three weeks, as there were numbers of villages, large and small, within easy reach, and it was the definite aim to preach in each one before moving on to the next camping place.

The same day that we put up our tents, we were fortunate in securing a small shop just aside from the main bazaar of the village, which we fitted up as a temporary dispensary. This done, we took up a prominent position in the bazaar, started a Hindi hymn, which brought us the desired crowd, and then gave a short Gospel address. Notice was given to all whom it may specially concern, that at nine o'clock on the following morning we should open our dispensary.

" At the appointed time we found a small crowd of about thirty waiting. We expressed our pleasure at having been permitted by God to come there to help them in their need, telling them that we did so because we believed that God had sent us to do what we could for them in their need, and because our religion taught sympathy with the poor and sick. We told them of God's Fatherly compassion on all the children of men who sin and suffer ; of the power of the Lord Jesus Christ to heal and to save ; and of that holiness, the health of the soul, which He alone can impart to those who seek and find Him. Then in a short prayer we asked that our word and work be blessed, that the sick may be healed, and the eyes of the blind opened to see the beauty and truth of the One Saviour of men. The crowd having increased, it became necessary to separate the patients from the mere onlookers, and to then arrange the former in order, names and addresses being first of all carefully registered, so that in days to come we might keep trace of, and in touch with the patients. After this began the work of diagnosing and prescribing, dispensing of medicine, and dressing of ulcers, with a slight operation now and then, such as the lancing of an abscess, or the drawing of a tooth. At such times all is done in full view of the crowd. This has its disadvantages, but in a pioneer work of this kind there is no better way to win the confidence of the people. It teaches them the reasonableness and common sense, the honesty and soundness, of our methods. Moreover (and this is a new thing to most of them), they see that with the doctor there is no ` respect of persons.' He does not allow difference of rank and caste to influence his treatment. He tends the low-caste sweeper's child with as much sympathy and care as he gives to the eldest son of the high-caste Government official. Also they learn the great value we attach to cleanliness. As one dresses these foul ulcers, or lances an abscess, the process is accompanied by a running commentary on each of its steps. It is a clinical lecture on cleanliness as the indispensable condition of healing and of health. From this what could be more natural or more impressive than to draw their attention on from bodily to spiritual cleanliness, pointing out what salvation is to the clean of heart ? Thus do we seek to make plain to them both their need and the divine method of salvation, so that by the time the last of the ulcers has been disposed of, it is not the fault of the " dresser " if patients and by-standers have not had a clear exposition of the essence of the Christian Gospel.

" It was well past midnight when the last patient ` salaamed' and turned homewards, after -which we first prepared the place for the next day, leaving stock medicines, lotions, ointments, and dressings ready for use, and then returned to our camp in the shady mango grove.

" And so the work went on, day by day, wonderfully interesting, often pathetic, always a delight. Frequent opportunities of doing evangelistic work, either along-side of, or as a sequel to, the medical work, showed us more than ever the value of the latter as an auxiliary and a ` path-finder ' for the former. The allotted period of our stay in that centre all too soon drew to an end. There was much ground to be covered on this tour, and it was even as in the days of the Master. They say unto Him, all men are seeking Thee. And He said unto them, Let us go elsewhere, unto the next towns, that I may preach there also ; for to this end came I forth.' "

The value of this form of medical missionary activity may be said, broadly speaking, to depend on the stage to which the work has advanced. At first it may be one of the doctor's main branches of work, and serves a most important function in winning the confidence of the people, and enhancing the success of the central dispensary. Later on, when a hospital is erected medical itineration becomes in certain districts of less imperative necessity, and the time and strength given to it must largely depend firstly upon the presence or absence of a medical colleague, who can take charge of the work at headquarters, and secondly, upon the efficiency of native helpers. Its intrinsic success as an evangelistic instrument is also closely connected with the presence of native assistants to follow up the work and continue the explanation of the truth. Granted that such necessary help is available, then there can be no doubt that medical itineration is calculated to prove of very great worth as an evangelizing agency. Indeed, it may well be regarded as a section of Medical Mission practice which has a distinct place to fill in multiplying the successes of this great work, and in helping to realise its highest aims.

4. Hospital work.—The late Dr Roberts, of Tientsin, wrote on one occasion : " The universal opinion of those in the work seems to be that the value and efficiency of their work is in direct proportion to the presence or absence of a Hospital." And such may be taken to be the practically universal testimony from medical missionaries in all mission fields. We there-fore come now to a consideration of what may be called the very cream of Medical Mission practice. It is not that any one of the other branches of the work is lacking in intrinsic value—all have their place and power as has been seen already—but there are potientalities in mission hospital work which give to it a particularly necessary position in the medical missionary enterprise. As Dr Van Someron Taylor, of China, has said : " From a medical standpoint, medical work without a hospital is almost useless . . . the hospital is the base for work, as well as the workshop of the medical missionary."

Let us think for a moment or two of the medical side of the mission hospital. How does it most frequently evolve ? The doctor, let it be supposed, has settled down at his station, established his dispensary work, paid visits to patients in their homes, and gone out on one or two itinerating tours. He has come into first hand acquaintance with the diseases he has to treat, and the kind of sufferers he has to relieve. What, then, is the necessity that almost invariably compels his attention ? It is the need for a mission hospital into which he can take in patients. How else can he treat successfully a good proportion of the people who claim his aid ? He has come across in his work cases of blindness due to cataract, and only in a hospital can those cataracts be removed. Patients ill with pneumonia, dropsy, and other serious medical diseases have come into his consulting room, and of what use is it for them to have medicine given to them, and then be treated as out-patients ? The doctor knows that there is but one real means of doing anything effective for these patients, and that is to get them under close and constant observation in the wards of a mission hospital.

Or again, his skill has been sought for cases requiring important surgical operations, and if there be no hospital, how dare he attempt such measures ? On all hands, consequently, the doctor finds the call for a hospital, and so he starts this line of work by making room in his dispensary building for one or two beds, or gets a native dwelling and adapts it for this purpose. Soon this becomes too small, and it is found necessary to erect a properly built hospital, which is the next stage in the equipment of the Medical Mission. Here the medical missionary can undertake the successful treatment of that numerous class of cases for which dispensary work, etc., is of no avail, and make his work in every sense of the word more efficient, and more worthy of the cause.

It has, however, to be stipulated that no hospital can do what should be expected of it unless there is an adequate staff. To this we shall refer more especially in a later chapter, and only content ourselves here by stating that as a general rule every hospital should have at least two medical missionaries in charge, and be equipped with a proper stock of drugs and surgical apparatus.

Coming now to the missionary side of the work, it is easy to realise how greatly a hospital contributes to the successful prosecution of the evangelistic efforts of the Medical Mission. Many patients are under Christian influence for weeks or months, and during that time have every facility for seeing and knowing what a Christ like life should be. Frequent ward services are held for the patients, and as far as he can the doctor gets into touch with the individuals. His work in this direction is followed up by native evangelists, and thus hearts are opened, personal difficulties met, and time is given for the truth to make a permanent impression.

Clearly the opportunities of a mission hospital for a direct furtherance of the Gospel are many and great, and of a such character as should encourage to the fullest extent the provision of many more such additions to the work of Medical Missions.

In order that an adequate appreciation may be gained of the kind of spiritual work carried on in a mission hospital, we quote the following extracts, from an account of the evangelistic work of one hospital in North China, written by Mrs Broomhall of Tai Yuan Fu :

" Sunday morning dawns in Tai Yuan Fu to find the Chinese assistants with clean shaven heads, and clean blue gowns preparing for morning prayers. These prayers are held each morning—and all who are able of the staff and convalescent patients are expected to be present—the evangelists and students, who are Christian men and boys, leading in turn. At 11, when the weekly service is held in the large mission church in the city, two of the students are left in charge to receive accidents, which, if serious, they would report to the doctor, or which they care for until his return, while the rest of the staff go to church.

" At 3.30 in the afternoon is a service in the out-patients' waiting-room for any who wish to attend : evangelists, students, nurses, gate-keepers, coolies, any patients who can hobble in, and most joyfully welcomed old patients, are then gathered together, when a short service, only lasting one hour, is conducted by the doctor, a visitor missionary, perhaps, or one of the students.

" When the sun has set behind the western hills, which, like the hills round about Jerusalem, keep guard over the city, the old bell rings for prayers—early in the winter, but in the cool of evening after the hot summer days. This is the best time of all, when, like a family, the whole of the hospital inmates gather, or are expected to do so, if possible, round the Word of God, one week in the eastern ward of the new hospital block, and one week in the western, so that men confined to their beds can, at least, have the benefit of half the services each fortnight. The work is carefully mapped out, so that the doctor, evangelist, and Christians, each know and take their turn in leading this simple worship. It only consists of the singing of one or two hymns—reading from God's Word, and a short address and prayer, yet it is always hoped that the bread cast upon the waters will return in due time, and the silent listeners be influenced by the quiet services. Each Monday night a Bible class is held for students and Christians, the point being that, by unitedly searching the Scriptures and seeking to know more of the things of God, the doctors and fellow-workers may be drawn closer together in their service for Him, and keener in their desire to win those around them to know the only true God and Jesus Christ whom He has sent.

" On Tuesday mornings, as on Fridays, service is held at 10 A.M., for all the out-patients who have been collecting from the by-ways of the city and from the villages around—a quaint crowd of all sorts and conditions of men who, after a short prayer, are told very simply of the love of God and of His great gift for us. To many this is a strange proceeding—and it is often not until a man has paid several visits to the hospital that he grasps the meaning of this hither-to unknown service to the invisible God. Doctors, students, evangelists, and sometimes friends, lead this service, which is held in the out-patient waiting-room, after having been commended to God in prayer by the inner circle of Christians in the consulting-room.

" On Wednesday afternoon is the service which, though perhaps the smallest, is the one which needs more patience, more grace, more hope, and more prayer, in him who leads, than any other. It is a gathering of those who know absolutely nothing of Christianity or the Bible, men who have followed the plough, hawked their quaint goods on the street, joined the rough army, or been coolies all their days, and who, through ill luck, or the untimely visitation of an evil spirit, have found themselves sick, and have been persuaded by report or their friends to entrust their bodies to the unknown foreigners. Among these men the evangelist has been doing his quiet work all through the week, teaching the most elementary truths of Christianity, reciting a hymn, or dictating a simple prayer to the sick men, and on Wednesday afternoon the doctor goes through a simple form of questioning to prove that the evangelist has done his work well, and that the patients are gradually taking in the teachings."

The foregoing description will sufficiently indicate the splendid utility of mission hospitals as evangelistic agencies, and convey, we think, to all our readers how magnificent are the possibilities attendant upon such a work. Can any one question the importance of the contention that no Medical Mission should stop short of a fully equipped hospital ?

5. Branch Dispensaries.—The establishment of a ring of branch dispensaries is the natural and necessary complement to the work of the central hospital and dispensary. It is, moreover, in an almost equal way the normal outcome of the itinerating tours conducted by a medical missionary. The importance of this addition to the work of most Medical Missions may be gathered from the following Resolution which was brought forward by Dr W. J. Wanless, on behalf of the Indian Medical Missionary Association, at the Medical Missionary Conference held in Edinburgh 1910 :

" That branch dispensaries are a valuable extension of hospital work, and are especially so in districts where Christians are scattered amongst the villages. Only trained and experienced assistants should be placed in charge of branches, the connection with the central hospital should be close, and the supervision thorough."

There are two reasons which make the establishment of branch dispensaries a wise and valuable development of the work of a hospital centre. In the first place, such branches will enable the needs of village districts to be in some measure met, when otherwise the people living in those areas must be left to depend upon the occasional itinerating visit of a medical missionary. In the second place, branch dispensaries are a most important means of keeping a central hospital in touch with a district which it is supposed to serve.

It does not need much explanation to show that there must be many districts which present conditions of great physical need, though they are in themselves unsuitable for the erection of a fully equipped hospital. It may be that the population is a scattered one, or too far removed from lines of communication, and too much out of contact with popular areas to render the establishment of a hospital an advisable course. Yet at the same time, there may exist an urgent need for something in the way of medical missionary effort, which will bring to the people living in such districts the blessing of the two-fold healing for which Medical Missions stand. Thus arises the place and utility of branch dispensaries.

Without a lot of expensive plant, with a minimum of difficulty, these excellent additions to the work of a Medical Mission can be brought into being, and prove a veritable Godsend to many a needy place. A small building can either be rented or erected, and a supply of the commoner medicines, etc. supplied to the native medical assistant in charge. If the latter be sufficiently competent, there may be included provision for a couple or so of in-patients, so that the dispensary may attain to the utmost degree of beneficial service. But whether that is done or not, it will be invariably found that branch dispensaries can make a most effectual contribution to the healing of large numbers in the districts where they are established. Specially to the Christians who may be living in villages around a mission centre these dispensaries are calculated to be of very great help.

Then there is this further value of branch dispensaries, that by means of their institution, a central hospital can keep in intimate touch with the population of a considerable area. Patients who come to any of these dispensaries are at once brought within the radius of the influence of the Medical Mission. In the person of the trained assistant who is in charge, they see a representative of the medical missionaries who are working at the hospital. Should their ailments require more in the way of treatment than the branch dispensary can undertake, they can be induced to go to the hospital, and the way be opened up for them to become in-patients. In other words the branch dispensaries can not only discharge their own special service to the people of their immediate districts, but they can provide what is frequently a most necessary and invaluable link between the various parts of a wide village area, and the mission hospital at the centre.

It is very important, however, that the points referred to in the Resolution quoted above should be consistently remembered. Branch dispensaries should only be placed under the charge of properly trained and earnest Christian medical assistants, and they should be visited at regular and frequent intervals by a medical missionary from the central hospital. To establish a branch dispensary, and then leave it to an assistant who is inefficient, or upon whose earnestness and conscientiousness sufficient reliance cannot be placed, is a course which is greatly to be deprecated. Branch dispensaries, unless efficiently conducted in the true missionary spirit, may prove a weakness, rather than a strength. In view, however, of the training work to which allusion has already been made, there is, we venture to think, every reason to believe that the necessary number of native assistants possessing consecrated efficiency for the work of these dispensaries will not be lacking in coming days. Given then, that frequent visits are paid by the medical missionary who exercises super-vision, it can be confidently anticipated that branch dispensaries will prove a most serviceable and successful department of the practice of Medical Missions.

We must now bring to a close this hasty sketch of the main elements that enter into the practice of Medical Missions. Before doing so, however, it is necessary to draw attention to two other directions from which important demands are made upon the time and strength of medical missionaries. We refer to the work of training, and that of hospital administration.

In regard to the first of these, it will be readily recognised how indispensable is the necessity to raise up a staff of native helpers for the due and efficient discharge of all the duties pertaining to a Medical Mission. This is indeed a vital part of the work of every medical missionary. We do not, of course, refer in this connection to the education of fully qualified students—that can only be properly undertaken in specially equipped and staffed medical colleges—but simply to the training of ordinary helpers for the routine tasks that enter into the day by day practice of medical missionary work. For instance, there are the dispensing of medicines, the dressing of wounds, the performance of ward work, the preparation of patients for operations, the nursing of those in bed, and many other essential duties which must be provided for, and which, at the same time, no medical missionary can ever hope to satisfactorily accomplish, unaided. Obviously it becomes a manifest necessity, right from the start, to look out for suitable helpers who can be trained to undertake the foregoing pieces of work ; and happy is the medical missionary who is successful in his task of selection. At first this department of his work claims a large share of the daily round, and it requires, all through, infinite patience and grace. Again and again it may bring much disappointment, and possibly it may seem as if the time and toil expended were hardly worth the return. Yet in the end it is rarely found that there is not considerable recompense in the diligent and devoted help of a band of native assistants. And beyond all such considerations affecting directly the work of the Medical Mission, there is the joy of knowing that something more has been accomplished in diffusing a knowledge of healing amongst the people of the land.

Then in regard to the work of hospital administration. This is a task which gives to the medical missionary in charge of a hospital much labour and thought ; and strangely enough, it is one of which many of those who go out as medical missionaries possess little or no knowledge. Here we have to do, not with purely professional or evangelistic duties, but with all those business and financial relations which concern a public institution. The medical missionary has to keep the hospital books, administer the general life and work of the hospital, engage, and pay the native staff, frame annual estimates of the receipts and expenditure, and attend to all the many questions that concern the maintenance of such an establishment. He has to bring into play powers or organisation, and be prepared to be many things in turn. Now and then he may have to doff the rôle of the physician, and don that of the architect and builder. Occasionally he may have to spend hours considering matters which lie as far apart as the poles from his professional work, and yet upon whose efficient conduct may hinge much of the success of the Medical Mission. It is, of course, perfectly true that this administrative work can never rank pari passu in importance with the other departments of a medical missionary's work, but that does not minimise the large share that it is bound to take in the daily routine of a medical station. There is not a medical missionary of experience who will not endorse the truth of this fact. No review of the practice of a Medical Mission would there-fore be complete without some reference to this aspect of its work, and in directing attention to it, we would ex-press the hope that as far as may be possible all intending medical missionaries would secure, before departure for the field, some acquaintance with hospital administration.

Medical Missions will thus be seen to cover a wide field in their beneficient ministry, and we venture to think that it will be felt by all who are students of missionary methods that medical missionaries have certainly adopted sound and fruitful lines in practising their great and two-fold calling. Bright with the richest promise as well as with the record of notable success, the work of our Medical Missions stands be-fore the Christian Church to-day, and appeals for its sympathy and liberality. Here in its practice are embodied some of the finest types of Christian service, and visions of some of the most glorious ideals. Whether these will be realised speedily, or in the dim future, depends on the measure of devoted giving, both in life and treasure, that the churches display towards this work. The issues lies with them, or rather with the individuals composing their member-ship. Shall it be half-hearted support, or generous practical sympathy ?



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