Stewart grew up with both his mother and father, but his mother died while he was a teenager and his father remarried. His mother was part of the Dudgeon sept of the Noresmen. His mother was thought to be a major influence in Stewart’s life from whom he received his love and appreciation for beauty. He was a cab proprietor and later ran a farm called Pictstonhill. He was a very religious man and influenced Stewart towards missionary work. Stewart had a desire from a young age to go to Africa. He told his cousin, “I shall never be satisfied till I am in Africa with a Bible in my pocket, and a rifle on my shoulder to supply my wants.” From a very young age, James Stewart knew what he wanted to do with his life: be a missionary in Africa.
Stewart was educated at the Royal High School, Edingburgh as well as Perth Academy. He graduated from the University of Glasgow in 1866 and began his study of medicine in Edinburgh. This education was interrupted when he traveled to central Africa for missionary work. There he learned about African medicine. He then resumed his studies at Glasgow and graduated from there in 1866. He earned an M.B. and C.M. and graduated with distinctions in surgery, material medical, and forensic medicine.
On August 13, 1861, James Stewart traveled to Cape Town with Livingstone's wife. On his first journey there, he became ill with a fever. When he arrived in Africa he teamed up with David Livingstone, a Scottish missionary who was a national hero in Britain for his medical work. Stewart soon returned to Europe to complete his education, then returned to Lovedale in South Africa in 1867 after marrying his wife, Mina Stephen.
Stewart thought that Africa was lagging behind other nations. When he first traveled in Africa, he observed that magic and medicine were intertwined, which he felt made African medicine inferior to European medicine. He felt that medicine in Africa had a very large presence, but he also felt that it had many malignant effects. He learned some of the natives’ medicine, but thought that European medicine should take precedence over native medicine.
He also had many negative views about the African natives. He felt there were no moral forces present in the African natives' lives. He warned people who went there of "descent into mere animalism and fixed and hopeless barbarism," showing how he viewed the lives of the Africans as inferior to his life. He was also worried about their moral degradation because of polygamy and witchcraft. Stewart thought that this degradation process was reversible through mission help. He aimed at fixing their decline through his missionary work in Africa. Stewart also implicitly suggested that Africans were racially inferior to Europeans, both physically and biologically. Even though at first James Stewart had many negative views on Africans, he did not treat them as inferiors and did everything he could to help them.
In 1864 Stewart was selected to work at Lovedale, which was a mission and a school 700 miles north-east of Cape Town and 80 miles away from the Indian Ocean. He took charge in 1866 and was asked to be principal in 1867. Jane Elizabeth Waterston was employed to create an institution for girls. Lovedale was supported financially by the Free Church of Scotland. At the time Stewart arrived Lovedale had a staff of more than twenty-four Europeans. Stewart became the principal of Lovedale in 1867 and maintained this position for 40 years; as a result, he was given the name Stewart of Lovedale. He made Lovedale the best school in Africa by adopting the school to the natives’ needs. For example, instead of teaching them Latin and Greek, he taught them English, which was a much more useful language for them. Stewart also had many different goals for Lovedale which he described in his book Dawn in the Dark Continent:
- To take young men of intellectual and spiritual qualifications and train them to be preachers.
- To train young men and women as teachers for native mission schools.
- To give education in various industrial arts, such as carpentering, waggon-making, blacksmithing, printing, bookbinding, telegraphy, and agricultural work of various kinds, to natives, that they may become industrious and useful citizens."
- To give a general education of an elementary kind to all whose course in life has not been definitely determined"
Through these goals Stewart aimed at providing a complete education, which also prepared the students for the workforce. During Stewart's time at Lovedale, he also erected a small hospital.
In 1875, Stewart founded Livingstonia in honor of the well-known Scottish doctor, David Livingstone. Stewart did this because he wanted to continue the work of Dr. Livingstone. He wanted Livingstonia to be on the shores of Lake Malawi, and received financial backing from a group of Glasgow businessmen. He wanted it independent from the Free Church Foreign Mission authorities. The mission was located at the south end of the lake at Cape Maclear and opened in October 1875. The mission focused on improving (or providing) housing and diet (or food) as a way to promote health. Livingstonia became the most important mission in the region, until the first World War.
During Stewart’s time in Africa he learned a lot of valuable information about Africa and the natives' ways, for example, information about the medical properties of different plants. He also observed many medicine men. Stewart decided that the best way to treat Africans was by combining Western medicine with their own practices, such as those of the medicine men. None of the missionaries who preceded James Stewart in South Africa, such as Dr. Venderkemp and Dr. Livingtsone, had focused on the medical aspect of missionary work. Stewart, however, felt that it was equally important.
While Stewart was working in South Africa he was one of only five legal medical missionaries there. Stewart was the first of them to found a hospital in South Africa. He also instructed native nurses and hospital assistants and laid a foundation for a medical school. Stewart also made many house calls. People described Stewart as "the beloved physician in many a home" and that he "gave both ungrudgingly, and no home was too far [for him], no road too difficult, no night too stormy, to hinder the great missionary in his errands of mercy". One person described how one night Stewart was called for because a little boy had been bitten by one of the most dangerous serpents, the puff-adder. Stewart sucked the venom out of every one of the boy’s wounds, risking his own life to save the young boy. This example is very accurate depiction of how much Dr. Stewart cared for his patients.
Stewart had many goals. Stewart had sole medical charge of all the boys and girls at Lovedale, but he also wanted to create a hospital there. His first attempt did not work, however with the help of the Colonial Government he opened the Victoria hospital. He gained the respect of natives by charging a small amount for the medicine and treatment he gave them. This made them value his care more. The hospital was opened in 1898 and after a few obstacles had an annual attendance of five thousand. Stewart also wanted to create a medical college, and planned to eventually expand the hospital at Lovedale into a medical school. He wanted the people of Ethiopia to have access to a full medical education.
Stewart also had a family life. He was married to Mina Stephan and had one son and eight daughters. During Stewart's later life he made many trips between Africa and Europe. He traveled to Lovedale in 1899, then came back to Scotland in 1900. He again visited Lovedale in 1901, and returned to Edinburgh in 1902. He then visited America in 1903, and went from there to Lovedale in 1904, then went to Cape Town in 1905. Looking back on his experience in Africa, Dr. Stewart realized that "but of all that the African continent contains which the civilized nations prize and want, it still remains true that the most valuable asset in Africa is the African himself. We cannot do without him, and, if he is wise, he will admit that he cannot do without us." Stewart learned to respect the African's and realized that the natives had as much to offer to him as he has to them. Stewart died on December 21, 1905, in Lovedale.