A shared legacy of partnership between Zhejiang and Edinburgh

This year, anniversaries loom large in our part of the University. As Edinburgh Medical School celebrates its tercentenary, I am also mindful that the partnership to deliver the ZJE Institute has now been in place for ten years. 

ZJE is a significant educational and research partnership in Biomedical Sciences between the University of Edinburgh and Zhejiang University in China. From small beginnings, ZJE has grown into a 10,000 m² research facility, home to more than 40 principal investigators and their groups, 600 undergraduates and 300 post-graduates - located on a 200-acre campus.

As we reflect on these anniversaries, it is worth noting that Edinburgh Medical School played an important role in forging much earlier partnerships between Edinburgh and Zhejiang, helping to introduce Western medicine and the formal training of doctors in this region of China. It is one hundred years since Edinburgh University alumnus David Duncan Main, and his wife Florence Nightingale Main, returned home after nearly fifty years dedicated to bringing Western medicine to Hangzhou.

Duncan Main came to China by a circuitous route. He had done well at school in Kirkmichael, where he was both head boy and class medallist. He planned to became an entrepreneur in Glasgow, but a chance encounter with missionaries led him to pivot his career, dedicating his life to God and to medicine. 

With sponsorship from the Edinburgh Medical Missionary Society, Duncan Main was able to study medicine. In1881, he was awarded a Double Licentiateship, a joint qualification of the Royal College of Surgeons of Edinburgh and Edinburgh Medical School. In the same year, he married and was invited by the Church Missionary Society to go to India. Persuaded by the greater need, he agreed instead to go to China. At the age of 25, he was appointed superintendent of a Western hospital in Zhejiang. 

The Guangji Hospital he inherited was, in reality, four rented rooms in a private house, treating around twenty in-patients and 200 out-patients each month. It had initially been established as a place to treat opium addiction. The impact of Duncan Main and his wife was profound. During their tenure, they became prolific fundraisers, medical pioneers, and social reformers. They helped to establish more than thirty institutions and transformed Guangji Hospital into a major centre of care.

Perhaps the most significant part of this legacy was Main’s early and sustained commitment to medical education. From the outset, he sought to train Chinese men and women students establishing Western medical practices alongside Chinese medicine in Hangzhou and laying the foundations for a locally rooted medical profession.

Duncan Main believed strongly in holistic approaches. He combined preaching with practical medical care and was known to refer to God as “the great physician”. Yet his thinking went further than spiritual care alone. In early 1883, Mrs Li arrived at the hospital with a severely ulcerated leg. Main later recalled:

“In the Cowgate of Edinburgh I have come across some very bad legs, but this one was second to none; all those who were sensible of having an olfactory nerve gave the poor lady a wide berth, except my wife, who faithfully dressed her leg every day.”

With the reluctant consent of her husband, the leg was amputated. Main recorded that the stump healed rapidly and that, with a wooden leg made by a local joiner under his direction, Mrs Li was eventually able to walk more than a quarter of a mile to church to give thanks. Under Main’s leadership, the mission also provided training in trades such as masonry, carpentry, tinsmithing, and painting, recognising the importance of livelihoods alongside health.

Duncan Main worked hard to master the Chinese language. He joked that the missionary society had told him it would be no harder than French, adding later that he had “long since taken 25 per cent off that statement”. By 1883, he was proficient enough to preach in Chinese and to make house calls, becoming a familiar figure in his cart moving across Hangzhou.

Around this time, Main described the hospital he had inherited as “deficient in ordinary sanitary conditions, and very far from being worthy of the name it bears”. He committed to demolishing it - using the timber as firewood for the poor - and to building a new hospital worthy of its purpose. With support from wealthy benefactors, the new hospital opened just four years after his arrival.

The rebuilt hospital had 120 beds across four wards, six private wards, and two guest rooms for foreign patients. The ward for opium patients was filled on the first day it opened. Another innovation was the women’s ward, overseen by Florence Main. Education and outreach were also enhanced; they even start to  use a magic lantern show to deliver the gospel. Most notably, a lecture room was established to train thirteen medical students. In 1885, this initiative became the Hangzhou Medical Training College, with Duncan Main as its principal.

Main shared a determination that echoes strongly with our colleagues in ZJE today: to provide students with the best possible training. Writing to the Church Missionary Society, he noted: 

“We are now in possession of a beautiful artificial anatomical subject; it is six feet high, and composed of two thousand pieces… In China, where dissecting rooms are not established, and post-mortem examinations are unknown, it is simply indispensable.”

Even after opening a new training campus, Main wrote in 1907 that he wished he had more resources for teaching. Nevertheless, he was confident in the scope and rigour of the education provided. Students, he explained, were taught both theory and practice, and given clinical experience before being entrusted with responsibility for human life. They were also taught the theory and practice of Christianity. He felt that medical students trained in their local communities gained a more holistic approach than students sent to Japan or elsewhere to train. 

Over time, Duncan Main acquired the sobriquet “Dr Apricot of Heaven Below”. The name draws on a Chinese legend in which a physician asked cured patients to plant apricot trees instead of paying fees, making the apricot a symbol of healing, generosity, and medical virtue. It also resonates with the saying: “In heaven there is paradise; on earth there are Suzhou and Hangzhou.”

Today, the red-brick villa that housed the Songmuchang branch of Guangji Hospital has been fully restored as a museum tracing 150 years of Western and traditional medicine. Curated by the Second Affiliated Hospital of Zhejiang University School of Medicine, it stands as a powerful reminder of a shared medical heritage. 

As we mark the anniversaries of Edinburgh Medical School and the ZJE Institute, Duncan Main’s legacy offers a longer historical perspective on partnership, knowledge exchange, and the shared commitment to education that continues to link Edinburgh and Zhejiang. The challenges and contexts have changed, but the underlying ambition - to train the future leaders and practitioners, advance biomedical science, and work across cultures in the service of health and knowledge - remains strikingly familiar.