Call the Medical Missionary: Religion and Health Care in Twentieth-Century Britain

If you have ever seen the popular BBC/PBS television program Call the Midwife¹ then you know that the central setting, Nonnatus House, is an Anglican religious order in the East End of London in the 1950s, offering midwifery and medical services to the community. Nonnatus House and Call the Midwife are semi-fictitious creations of author Jennifer Worth, who based them on her experiences as a midwife in East London with the real Community of St. John the Divine (CSJD). Institutions such as CSJD, still in operation in Birmingham today, have existed throughout London and Britain since the mid-nineteenth century. These religion-based medical charities took many forms, from small-scale dispensaries to large-scale hospitals, most offering a specialization. Some were rooted in monastic orders (as with Call the Midwife); some grew out of particular congregational societies; most, though, were established as standalone medical missions, which will be the focus of this post.

Before the establishment of the National Health Service (NHS) in Britain in 1948, medical missions and other religious medical charities constituted the most significant source of health care services for urban Britons. By the mid-twentieth century, dozens of missions were dotted throughout London alone. They first appeared in the mid-nineteenth century as a means of supporting and training medical missionaries departing for the foreign field. Medical missions became more of an end unto themselves by 1900, as they sought to heal the bodies and souls of Britain’s poverty-stricken working classes. These London missions were treating hundreds of thousands of patients each year by the middle of the twentieth century. Though not as common as they were in the twentieth century, medical missions have continued to operate into the twenty-first century, filling gaps not fully covered by the NHS, such as care for the elderly and disabled.

The 1950s, then, was the first full decade of operation for the NHS, yet religious medical charities were still in full force. Medical missions and other institutions (including CSJD, the inspiration for Call the Midwife) were actually operating within a state-run health care system, an overlooked aspect of the social history of medicine. Indeed, most popular conceptions of the history of medicine in Britain assume that the NHS, along with the greater post-war effort to establish a national welfare system, “represented the triumph of scientific … secular medicine over [the] religious.”² How was it that evangelically-based health care survived into the early decades of the NHS?

Between the passing of the National Health Service Act of 1946 and when the NHS came into effect on July 1, 1948, religious health care organizations actively petitioned to retain their evangelical autonomy. Fears were rampant among them that the NHS would be a secularizing force, proscribing overtly Christian features of their operation such as prayers and religious services. Mission workers deeply believed that this aspect of their work was absolutely fundamental and that they could not be impelled to abandon it. They urged their subscribers, those who financially supported the missions, to lend their voices to this campaign.

The Ministry of Health responded to these adjurations with reassurances that the religious characteristics would and “should be continued.”³ Medical missions were granted the autonomy to continue their “religious and social work.”⁴ The NHS simply took over the administrative aspects of running the clinics, hospitals, and nursing homes. Prayers and worship services continued; meetings of devotional Bible study groups continued; jobs continued to be advertised for those in “sympathy” with the Christian aims of medical mission work. Indeed, it was not until the late 1960s and early 1970s that the NHS had effectively weeded out these evangelical practices as it expanded its control over medical missions. Religion, though, has never completely disappeared from the NHS. Chaplaincies are still a regular feature in NHS hospitals and religious charities annually collect and donate millions in contributions to fund the NHS. One primary care center in London retains its nominal connection with this history: Bermondsey and Lansdowne Place Medical Mission. How, then, does this history of medical missions within the NHS relate to popular assumptions that socialized medicine is void of religious practice and belief?

Sociologist Deborah Lupton has recently noted that “Western societies in the early twenty-first century are characterized by people’s increasing disillusionment with scientific medicine. Paradoxically, there is also an increasing dependence upon medicine to provide the answers to social as well as medical problems.”⁵ The prevailing narrative of medicine as a scientific triumph has effectively silenced other important narratives, such as the relationship between religion and medicine throughout the twentieth century. The recent flourishing of interdisciplinary studies, such as medical humanities, seeks to bring new light to the continued connection between theology and medicine. Historically, though, this task has not yet been executed and more work needs to be done, such as investigating what aspects of medical missions allowed their continued existence in the age of socialized medicine in Britain.

An important clue, though, comes from a survey and series of interviews of medical mission patients conducted in 1969. These patients reported various reasons for their choice to attend mission-based practitioners, but one theme in particular stands out: “the common human need for courtesy, audience, understanding and kindness.”⁶ The services rendered by medical missionaries gave patients, both Christians and non-Christians alike, a sense that “there was a ‘something,’ or a ‘somebody’ who cared for them.”⁷ In this historical narrative, care emerges as the most prominent element of religion-based health service that is possibly lacking elsewhere. The name for the NHS provides some credence to this notion: the National Health Service strives for an end (namely, health), whereas a national health care service would arguably focus on both the means (care) as well as the end (health).

Perhaps, then, what we recognize and celebrate in the stories of the Call the Midwife series are relationships of caring and kindness so prized by medical mission patients in 1969. Today, we are beginning to see problems in the narrative of the triumphant scientific progress of medicine. In casting our historical nets, we can retrieve moments from the past through which we may discover more about our “common human needs” and the most beneficial means of resolving them.

Sarah Jane Bodell

Sarah Jane Bodell is a third-year PhD student in the History of Medicine at the University of Warwick. Her research examines evangelical Protestant medical missions to the poor in London, 1900-1960, as a way to investigate the larger history of the transition of health care from Victorian charity to the welfare state.

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