Paul Theerman, Associate Director, Center for the History of Medicine and Public Health
“Dr. Livingstone, I presume?”
One of the great phrases of the 19th century and the butt of many jokes, the words were apparently first spoken when journalist Henry Morton Stanley came to an African village in 1871 on a quest for the elusive Scottish missionary, Dr. David Livingstone, not seen for many years, whose birthday we celebrate today, March 19.
It seems such a non sequitur: one white man enters a village in the middle of Africa—it was Ujiji, on the shores of Lake Tanganyika, near the town of Kigoma, Tanzania—walks over to the only other white person for hundreds of miles, and either feigns uncertainty about his identity, or approaches him with mock humility. Stanley recorded the scene in his book, How I Found Livingstone, and attributed the phrase to shyness:
I would have run towards him, only I was a coward in the presence of such a mob [of onlookers]—would have embraced him, only he being an Englishman, I didn’t know how he would receive me, so I did what cowardice and false pride suggested what was the best thing—walked deliberately to him, took off my hat, and said, “Dr. Livingstone, I presume?”
“Yes,” said he, with a kind smile, lifting his cap slightly.
I replaced my hat on my head, and he puts on his cap, and we both grasp hands, and then I say aloud: “I thank God, Doctor, I have been permitted to see you.”
He answered, “I feel thankful I am here to welcome you.” 1
How did Livingstone get to Africa, and why was there such a fuss about finding him?
Medicine was one part of the path—Christianity was the other. As a young child growing up in Blantyre, Scotland, Livingstone (1813–1873) became entranced by the missionary movement. In this he was influenced by his father, Neil, a traveling tea salesman and fervent churchman. The younger Livingstone coupled his Christianity with a love of science and the outdoors, and, prompted by the church circles in which he moved, developed a desire to serve as a missionary. Of very poor means and a mill worker from his early teens, bright and ambitious, Livingstone set out to achieve his goal. In his mid-20s, he undertook two years of courses of medical lectures at Anderson’s University Glasgow, 1836–1838. Accepted provisionally as a missionary by the London Missionary Society—a more vigorous and evangelical group than that in the established church—he took further medical training in London, 1839–1840, including at Charing Cross Hospital—as well as theological study. He obtained a license to practice, then started out. His first choice, China, was closed to him due to the Opium Wars, and at the end of 1840 he instead left for South Africa.2
The term “medical missionary” is a freighted one. Consider that at the time Livingstone trained, the germ theory of disease had not yet been established; neither had antiseptic procedures. The causes, even the identities, of the major tropical diseases had not yet been worked out. Antibiotics and antifungal medications were decades off; rehydration therapy for cholera and similar diseases had not yet been determined. For a venture into Africa, about the only specifically useful item in Livingstone’s arsenal was quinine, to battle the symptoms of malaria, part of Western therapeutics since the 17th century. Most of what he could do was palliative care—dressing wounds and providing beds to make room for healing.
Once in South Africa, Livingstone traveled first to Kuruman, a missionary outpost set up by fellow Scot Robert Moffat. After marrying Moffat’s daughter, Mary, Livingstone and his wife established Kolobeng mission in Botswana in 1847. At this time, they intended to live among Africans in order to convert them, to provide for their medical needs, and to compete with African religious leaders and healers. In the book that made his reputation, Missionary Travels and Researches in South Africa (1857), Livingstone imaginatively plays out a dialogue between a Western “medical doctor” and an African “rain doctor.”3 The worldviews were mutually incomprehensible and the competition fierce, especially after conversion stopped one of the village leaders from his rainmaking work. In the ensuing three-year drought, Christianity itself was on trial. The drought did not end, there were raids by Boers (Dutch settlers), and the Africans left. In 1852, Livingstone closed his mission and sent his wife and children to England.4
In his years in southern Africa, Livingstone found that his true calling did not lie in the work of the solitary missionary:
Sending the Gospel to the heathen must . . . include much more that is implied in the usual picture of a missionary, namely, a man going about with a Bible under his arms. The promotion of commerce ought to be specially attended to, as this, more speedily that anything else, demolishes that sense of isolation which heathenism engenders . . . . My observations on this subject make me extremely desirous to promote the preparation of the raw materials of European manufactures in Africa, for by that means we may not only put a stop to the slave-trade, but introduce the negro family into the body corporate of nations, no one member of which can suffer without the others suffering with it. . . . [F]or neither civilization nor Christianity can be promoted alone. In fact, they are inseparable.5
He eventually captured his new vision with the phrase, “Christianity, Commerce, and Civilization.”6 Medicine was part of it all: supporting healing as part of the compassion that Christianity enjoined; providing health in support of commerce, maintaining both healthy places and healthy people; and being an integral part of Western civilization, and by example, persuading others of that civilization’s value and truth. This was all caught up in his new mission: through Christianity, Western civilization, and commerce to bring slavery to an end.
For this purpose, Livingstone began to explore the great unknown territories of Africa. His first expedition lasted from 1852 to 1856, running across Africa from Angola to Mozambique. He was the first westerner to see Victoria Falls, the world’s largest waterfall, and was regaled by the London press and the Royal Geographical Society on his return. He resigned from the London Missionary Society and went back to Africa as head of the government-sponsored Zambezi Expedition, 1858–1864, to explore the commercial possibilities of the Zambezi River valley. It failed—Livingstone had great ideas but little skill in leading others. After two years in England, he returned to Africa alone in order to seek find the source of the Nile. From 1866 until his death in 1873, he wandered, chiefly in the Congo and along Lake Tanganyika.
Only the barest of notes came out, requesting supplies and medicines. Livingstone was often in a desperate state, ill, hungry, and without help. Stanley’s visit reinvigorated him, though he would not accompany the journalist back to the coast. Within 18 months, Livingstone was dead, at the age of 60. His African servants removed his internal organs, salted the body, dried it in the sun, and took it to the coast for transport to England. In a grand funeral, the body was buried in Westminster Abbey in April 1874.
When Stanley came out of the forest to greet Livingstone, it was not just the brash American finding the kindly medical missionary. It was rather the shrewd journalist coming to face to face with the embodiment of an idea: that exploration would lead to commerce, commerce to civilization, both to the triumph of Christianity, and all to end slavery. Strength of will was all that was needed for success, and medicine was bound up deeply in it. In Livingstone’s case, will was not enough, and his efforts gave out. The link of commerce, Christianity, and civilization continued into the next century, but would eventually falter as well. Medical missions continue, some religious and some not, but Livingstone’s grand vision is now greatly tempered.
1. Henry Morton Stanley, How I Found Livingstone: Travels, Adventures, and Discoveries in Central Africa, including Four Months Residence with Dr. Livingstone (London: Sampson, Low, Marston, Low, and Searle, 1872), p. 412, quoted in Daniel Liebowitz, The Physician and the Slave Trade: John Kirk, the Livingstone Expeditions, and the Crusade Against Slavery in East Africa (New York: W. H. Freeman and Co., 1999), p. 156.
2. For the particulars on Livingstone’s life, and detail about his medical training, see “Livingstone Online: Exploring the Manuscripts of David Livingstone” (accessed March 18, 2015), and particularly “David Livingstone’s Life” and “David Livingstone’s Medical Education.”
3. David Livingstone, Missionary Travels and Researches in South Africa: Including a Sketch of Sixteen Years’ Residence in the Interior of Africa, and a Journey from the Cape of Good Hope to Loanda on the West Coast; Thence across the Continent, down the River Zambesi, to the Eastern Ocean (London: John Murray, Albemarle Street, 1857), with the dialogue on pages 23–25.
4. Livingstone, Missionary Travels, p. 92.
5. Livingstone, Missionary Travels, p. 28.
6. The phrase comes from evangelist Thomas Foxell Buxton, whom Livingstone heard present in London in the summer of 1840, in his last year of preparation. “David Livingstone, 1813–1873,” as part of Princeton University Library’s online exhibition, “To the Mountains of the Moon: Mapping African Exploration, 1541–1880” (2007) (accessed March 18, 2015).
7. Liebowitz, The Physician and the Slave Trade, pp. 164–66.
Kathleen O’Donnell MBA, MPH, MA
Senior Vice President
The New York Academy of Medicine
1216 Fifth Avenue
New York, New York 10029
Thanks for this brief history. I had no idea Livingstone was so accomplished. He must have had a solid constitution to live to age sixty, given the stresses and strains he endured.