The creation of a medical profession in Egypt, 1800–1922

AMIRA EL-AZHARY SONBOL, The creation of a medical profession in Egypt, 1800-1922, Syracuse University Press, 1991, pp. xii, 177, $34.95 (0-8156-2541-3). In this study Amira Sonbol uses the history of the rise of a modern medical profession in Egypt as a vehicle for examining the question of social change and the impact of westernization in a Middle Eastern country. The book ranges over numerous problems and issues, but devotes special attention to the founding (1827) and subsequent history of the Qasr al-'Aynl School of Medicine. The reforms of Muhammad 'All Pasha (r. 1805-48) are the obvious starting point, and, in tracing the early history of Qasr al-'Ayni, Sonbol offers new and enlightening insights into the viceroy's programmes and objectives. Religious scholars, the only teachers in pre-reform Egypt, quite rightly saw the teaching of modern medical science as a threat on several fronts, and the Egyptian people at first found it difficult to accept the loss of their sons' labour (most medical students were of peasant origin) for the sake of training in which no immediate benefit could be perceived. The development of the medical school thus proceeded haltingly for a time, its progress dictated by the cautious pragmatism of Muhammad 'Alr and shaped by the expert guidance of Clot Bey. Rejecting the usual view that medical reform was pursued for the sake of protecting the Egyptian army, Sonbol argues convincingly that from the start Muhammad 'All and Clot Bey aimed to improve the lot of the population at large. Civilians were treated at the Abu Zabal site of the first hospital, the veterinary school (est. 1827) was founded in response to a general epizootic that devastated the country's animal population and so represented a serious threat to the economy, and the maternity school (est. 1831 to train female doctors, the hakimas, to treat women's disorders and conditions) was obviously irrelevant to the concerns of the army. The affiliation of the school with the army was a tactic to give the institution greater status in the eyes of the people, as also was the practice of awarding military titles to graduates. Clot Bey himself saw military costs as an impediment to modernization in other areas. The pursuit of modern medical education at first required simultaneous translation into Arabic of lectures delivered by foreign professors in either French or Italian; but former students later became teachers themselves, European textbooks were translated at a rapid pace, and committees of scholars and interpreters laboured over the establishment of modern medical terminology in Arabic. By 1876 the school was an efficient and well-organized institution with 195 students, an excellent hospital, a well-staffed library, and its own natural history collection. Over 3000 students had graduated; and while the traditional and folkloric healers had not been eliminated (this was not a goal in any case), there was a growing public awareness of the dramatic differences between these practitioners and the modern physicians. The differentiation was increased and highlighted by the favourable pay, ranks, promotions, and pensions the regulars received from the government, and "by the 1870s doctors were recognized by the population as being the members of a corporate structure, the medical profession" (p. 97). It has been argued that Egyptian medical reforms, impressive on paper, were in reality modelled on the distinctly urban institution of the Western hospital and so were irrelevant to the needs of most Egyptians, 85 per cent of whom were peasants living in the agrarian hinterlands far from the major cities. Here Sonbol's work is particularly important, for she argues that Muhammad 'Ari's reforms were indeed relevant to the peasantry. Medical personnel, sometimes husband and wife teams, were sent out to the villages and were often based in local primary schools; village barbers were trained to perform such minor surgery as opening abscesses and suturing wounds; and the hakimas were a common and welcome sight in rural areas. That a serious urban/rural gap eventually did develop is not doubted by Sonbol, but she views this within a context of general decline caused by measures taken under British rule after 1882. New laws made it possible for incompetent foreign physicians to practise in Egypt, while Egyptian physicians and medical students were faced with an increasingly difficult array of obstacles: a refusal to allow students to specialize, the adoption of English as the language of instruction, the imposition of discriminatory examination requirements, and the introduction