he had been licensed by the Presbytery of Ohio. Happer was admitted in medical school at the University of Pennsylvania in Philadelphia. Upon receiving his M.D., he had been ordained to the Presbyterian ministry on April 23, 1844. Originally he had wanted to travel to India to do missionary work, however after the Opium War and China's opening to the West, he decided he could start his career there. Missionary Service (1844-1891) Happer co-founded one of the first Protestant missions in China through the American Presbyterian Church. The Presbyterian mission was one of the first four American mission agencies in China to carry out missionary work there. The multiple projects and institutions constructed by Happer throughout his forty-seven year career as a missionary represents the evolution of Presbyterian missionary work in China throughout the nineteenth century. He, John G. Kerr (medical administration), and WAP Martin (language) are considered the pioneering Presbyterian missionaries in China. First trip to China (1844–1847), medical missionary work Upon Happer's arrival in Macau on October 23, 1844, the Opium War had previously blocked most forms of western and missionary influence in China. Ability to travel throughout China had been very restricted for foreigners. Although access to Canton was still officially restricted, Happer reached the people through the provision of medical aid and preaching the gospel. Following the Opium War, the Treaty of Nanking opened five ports for foreign trade. As a result, China became open to missionaries. As one of only 31 Protestant missionaries (3 of them Presbyterian, Happer faced numerous challenges and difficulties. Few resources were available, with China as an intimidating location. Foreigners were not allowed to live in Canton so Happer moved to Hong Kong and worked and later led at the Morrison Education Society. Happer returned to Macau in 1845 and opened a boy's boarding school with twenty-seven enrolled students. Although the Opium War treaties had declared that foreigners could access Canton, the Chinese officials refused to let Happer enter the city. He had to move the school to a suburb of Canton. After realizing the responsiveness of the Cantonese people towards education and medicine, Happer opened his first dispensary in 1847. Happer carried out Christian evangelism through the dispensary in various ways, including preaching to his patients and holding chapel services for community residents. Overall, the dispensary treated seven thousand patients annually. This number rose to ten thousand in 1854 after