Al-Ahram Weekly Online
28 Feb. - 6 March 2002
Issue No.575
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A Diwan of contemporary life (431)

Dr YunanQasr Al-Aini, the Arab world's oldest and most famed medical school, marked its first 100 years with ceremonies befitting the Egyptian institution's status. Leading up to the occasion in 1928, a slew of scholars and contributors wrote in Al-Ahram about the establishment, exploring its history and profiling its founder and the emir after whom the school was named. The articles also covered Qasr Al-Aini while it was under British control and the reforms introduced by the 1919 Revolution. As described by Professor Yunan Labib Rizk*, Qasr Al-Aini was and remains a medical marvel

A time-honoured institution

In 1928, Egypt marked the 100th anniversary of the oldest medical school in the Arab world and possibly in the East: Qasr Al-Aini.

It was an occasion worth celebrating. Egyptians had every right to be proud that theirs was an Oriental country in which modern medical education could flourish and pass the century mark. Indeed, they could also boast that many families from other Arab and Islamic countries sent their sons to Cairo to receive medical training and, indeed, preferred Cairo as the place for their children's higher education to European capitals where temptations would be too great to resist.

For several decades, Qasr Al-Aini operated as one of Egypt's few higher institutes of learning. However, when Egypt's first university was transformed into the nation's first public university, the famous medical school was merged into this institution to form one of its first four colleges.

Egypt celebrated Qasr Al-Aini's centennial "in its own way," meaning that the commemoration took many forms. First, the Egyptian press teemed with articles on the history and role of the venerable institution. Second, the occasion gave rise to the idea of hosting an international medical conference in the Egyptian capital. Third, it occasioned a review of the law governing the practice of medicine in Egypt "to protect the graduates of this college from impostors and parasites," as Al-Ahram put it. Finally, the government moved to approve allocations for the construction of a new building for the faculty of medicine.

Many Egyptian scholars delved into the history of Qasr Al-Aini; indeed the history of medicine in general. One was the "distinguished professor," as this contributor to Al-Ahram signed his article, who wrote on the origins of modern medicine. Appearing in Al-Ahram of 18 December 1928, the article hailed Ibn Sina, Ibn Rushd and Abu Bakr El-Razi as "the beacons for all who strove to acquire medical knowledge in the Middle Ages." "Did not the principles they established form the basis of the science of medicine in those centuries until the era of Pope Paul XI?" the medical historian asked. He added that scientists in the West, French physicians foremost among them, acknowledged their debt to the Arabs "who were so far advanced and who through the modest means at their disposal produced astounding results. Through distillation, for example, they succeeded in analysing poisons and from this discovery they formulated accurate theoretical principles."

Moving from the general to the specific, Al-Ahram then featured articles on Clot Bek, the founder of Qasr Al-Aini, and the history of the institution. The first, taken from the British magazine Nature, relates the following story:

"One day, as Mohamed Ali was on his way to his palace in Shobra, he ordered his driver to stop to call over a well-dressed Frenchman who was walking down the street in which the wali's (ruler's) carriage was passing. Mohamed Ali told the Frenchman that he wanted to establish a school of medicine in Cairo. Although Clot Bek, as the Frenchman came to be known, knew nothing about medicine, he was a most capable man, and fulfilled the task to which he was assigned to perfection. In recognition of this deed, the University of Paris later conferred upon him the title of 'professeur'."

Disturbed both by the naiveté and inaccuracy of the story, an Al- Ahram reader submitted a letter to the newspaper addressed to Nature. Mohamed Ali did not happen across the Frenchman in the streets of Shobra. Rather, he said, in 1825, the Egyptian ruler invited Clot, who was then a forensic physician in Paris, to come to Egypt in order to institute a health system for the Egyptian army. Mohamed Ali then assembled an enormous team -- some say as many as 154 members -- of European physicians and pharmacists. Two years later, Clot, later dubbed Clot Bek, set up the school of medicine.

Nature was obliged to print an apology although the writer of the article was quick to find excuses. The story he related, he wrote, had found so much currency that it had started to be taken for fact. Moreover, many of his sources had spoken with such certainty that he had no reason to doubt them. True, among the British staff in that college there were individuals who were fond of spinning tales, but he had no documents or other evidence to disprove them.

It is interesting to note here that the British magazine's story and the Al-Ahram reader's rebuttal can be seen in the context of the rivalry between the influences of British and French culture in Egypt, a rivalry which intensified in 1925 after the establishment of the Egyptian University. Whereas French culture continued to prevail in the colleges of law and literature, British influence gained a foothold in the faculty of medicine.

On the history of this institution and its premises, Al-Ahram featured the contribution of another of its readers, Mohamed Ramzi, from Heliopolis, who informs us that the palace which became Qasr Al-Aini took its name from Shihabeddin Ahmed Ben Zeineddin Al-Aini El-Qahiri El-Hanifi, born in 1444. The grandson of a chief magistrate of Egypt, Al-Aini had a smooth road to advancement in government service and "moved up through various positions until he became an emir over several administrative sectors." Ramzi continues: "Like other sons of royalty, he lived in the Citadel and even after he became emir he continued to rise in the ranks until he commanded a legion, after which the Mameluke sultan appointed him emir ul-hajj (leader of the pilgrimage), thus elevating him further in prestige and power."

In 1466, the emir had a grand palace built overlooking the Nile. Unfortunately, he was unable to enjoy it for long, having become embroiled in the notorious Mameluke struggles over the throne, in the course of which he was deprived of most of his wealth. Ramzi writes: "When El-Malek El-Ashraf became sultan, he arrested a group of individuals, among whom was Ahmed Al-Aini, and imprisoned them in the Citadel. Al-Aini was only released after he paid 140,000 dinars to the sultan's treasury."

Perhaps to avoid further risk at El-Malek El-Ashraf's hands, Ahmed Al-Aini went on the hajj in 1494, "with great pomp and splendour." Then, shortly after he returned to Cairo, he decided to leave again for Mecca "where he attended and contributed to the renovation of the military school in Al-Haram Al-Sharif. However, during a time of strife in Mecca, his house was plundered, forcing him to migrate to Madina where he died in 1502."

Ramzi then writes that when the government determined that Al- Aini had stopped living in the palace he built overlooking the Nile, it confiscated it and turned it into a guesthouse for visiting dignitaries. Throughout the following centuries, it continued to be used alternately as a guesthouse or a private princely residence, until 1828, when Mohamed Ali transformed it into a hospital. By that time, of course, most of the original structure built by Al-Aini had changed. As Ramzi writes, "Whenever portions of the palace fell into disrepair they would be replaced by new construction, designed according to the circumstances of the times and the purpose for which it was intended, although the palace continued to retain the name of its original founder: Ahmed Al-Aini."

Another reader supplied Al-Ahram with an account of the history of the famous medical school. According to Michel Zeidan of Al- Mehalla Al-Kubra, the school, founded in 1828, was originally located in Abu Zaabal and was intended to train physicians for the army. Clot Bek was its first director. At first, the language of instruction was a problem. But in 1832, Mohamed Ali sent the first medical study mission, composed of 12 students, to France, after which similar missions were sent every year thereafter.

Five years after its foundation, the school relocated to Cairo -- to Qasr Al-Aini. By that time, the student body had reached 300. "Students resided in the palace at the government's expense and they were also accorded a small personal allowance. The period of study was five years. Eventually the school administration opened a veterinary department and an obstetrics department."

Following the death of Mohamed Ali, some of his advisers were dismissed, among them Clot Bek. Although a number of physicians assumed the management of the school following Clot Bek's departure, among whom was Theodore Bilharz, the first to identify the parasite that causes schistosomiasis, the school began a steep decline. Indeed, so desperate was its straits that Khedive Said Pasha closed it down for a short period (1854-1856). Nevertheless, the ruler subsequently determined that the country needed a facility like this and, therefore, called Clot Bek back to Egypt to revive it. Although Clot Bek returned, he only managed to serve for two years, after which his health deteriorated and he was forced to return to France.

Following Clot's departure, a number of French physicians assumed control of the school. When Ismail took the throne in 1863 he appointed its first Egyptian director: Mohamed Ali El-Baqali Pasha, who remained in the post for more than 18 years. By the time of the British occupation in 1882, the school was thriving and applicants had become so numerous that the British authorities imposed tuition fees. Then, in 1887, after the secondary school system was established, this certificate also became an entrance requirement.

Of the directors who assumed the management of Qasr Al- Aini in the first decades of the British occupation, the most important was Ibrahim Hassan Pasha whom the British dismissed in 1898 in their bid to extend their control over the school. Hassan was replaced by Qasr Al-Aini's first British director who, in turn, engaged a number of British instructors.

Michel Zeidan writes that under British management enrolment plummeted so dramatically that at one point the school had no more than 15 students. British authorities were, thus, compelled to take urgent measures, towards which end they brought in the director of a British hospital as a consultant to study the conditions of Qasr Al-Aini. He submitted several recommendations, among which was that the administration of both the medical school and the hospital be placed in the hands of a single director, that the period of study be reduced from six to four years and that English be made the language of instruction.

British management remained firmly ensconced in Qasr Al- Aini until the 1919 Revolution, following which attempts were made to Egyptianise the administrative and teaching staff. Zeidan writes, "Soon there was the same number of Egyptian and British professors on the staff and Egyptians also became members of the board of administration. Also, so as to equip Egyptians replacing departing British staff, the government increased the period of study in the university from four to five years and increased the number of medical study missions to Europe."

The reforms proved so effective, according to Zeidan, that the school of medicine was now "one of the finest in the world and its hospitals are fully equipped to train its students to become highly competent physicians." He continues, "It is a great pleasure to see that medicine has been accorded such prominence in Egypt. It is not surprising that 4,000 years ago Egyptians led the world in the medical sciences. They practised medicine with superior skill and for every ailment they had a remedy. The scientists of today were able to discover the secrets of the medicines they invented and used only after exhaustive research."

Although Qasr Al-Aini's centennial was to be marked by an international medical conference in Cairo, this was not the first such conference to be hosted in the Egyptian capital. The first took place in 1902. However, there was a striking difference between the two events. In the 1902 conference, most of the physicians representing Egypt were foreigners, whereas a quarter of a century later the majority were Egyptians.

Naturally, Al-Ahram dispatched a correspondent to cover the opening ceremony of the 1928 international medical conference in Cairo. Forty-one nations were represented and the Royal Opera House, where the inaugural ceremony took place, was decked out with the flags of these countries. Participants arrived sporting formal attire. Inside, at centre stage, stood the chairman's podium. To its right were university professors and to its left the members of the conference steering committee.

At 11.00am, King Fouad entered the hall. Then, wrote the Al- Ahramcorrespondent, "Shahin Pasha, an eminent physician and the deputy minister of interior for health affairs, rose to deliver the opening speech, after which he walked over to the royal box to request that his majesty kindly accept the commemorative medal of the conference. The king graciously accepted."

The conference lasted eight days, with its main sessions held at the faculty of medicine. Other seminars were held in various hospitals and medical societies. Participants presented papers in eight categories: internal medicine, surgery, malaria, pathology and bacteriology, health and hygiene, pediatric medicine, ophthalmia and bilharzia. Unlike its predecessor, the conference also featured a medical fair held on the grounds of the Royal Agricultural Society in Gezira. The exhibition, commented the Al-Ahram correspondent, "is performing the feat of a 20th century hero in combating superstition and old wives tales. It is launching a sweeping campaign against the use of amulets and incantations, against all the medical myths that have remained entrenched in ordinary women's minds, that are so harmful to public health that hurt the human conscience."

Among the manifestations of such superstitions which the correspondent saw at the fair was a large charm consisting of a dog's skull and part of the face of a donkey. "Women believe that this charm will guarantee their children a long life and protect them from illness," he scoffs. Another amulet consisted of a piece of solid sulphur, enclosed in a pouch, said to cure whooping cough. A dead scorpion enclosed in a small tin box, which is then placed in a pouch, was believed to guard against, or cure, convulsions. As for abu galambu, a type of crab, when placed in a pouch and plastered to one's side, functions as an anaesthetic as powerful as morphine. All these concoctions, the correspondent charged, were no more than hoaxes and trickery invented by charlatans whose sole aim was to rob the ignorant of their money.

Al-Ahram was not alone in its interest in the new medical practice ordinance. The Telegraph correspondent in Cairo observed that the new law sought to avoid the bitter criticisms that had been levelled at its predecessors, thus differing from them in at least two respects. Under the old ordinance, unqualified individuals could still practice medicine. The new law, therefore, targeted specifically those who were unable to obtain a diploma from Qasr Al-Aini and yet succeeded in obtaining certificates from foreign institutions. It stipulated that such individuals would not be granted licenses to practice medicine unless they passed the equivalency exam at Qasr Al-Aini.

The new law also called for the creation of a higher medical board to receive complaints regarding malpractice and ethical matters such as physicians using their access to drugs for personal profit. The provision had many members of the medical profession up in arms. They feared that the new board would seek to prove itself "by giving credence to all the trivial and malicious complaints it receives, particularly those pertaining to the trade in illicit drugs. Consequently, no physician would feel secure in his job." The critics added that this provision could bring more harm than good, "especially in the event of an emergency situation on the streets in which there would be an urgent need for morphine," Al-Ahram wrote.

In the opinion of Al-Ahram, however, the proposed composition of the higher medical board, which would consist of such prominent figures as Shahin Pasha and Dr Madden, dean of the faculty of medicine, should allay fears about the soundness of the board's judgment with regard to the complaints it received.

The new law also brought into being a board of medical ethics. An Egyptian physician, Abdel-Meguid El-Boulaqi, wrote to Al-Ahram saying how pleased he was at the move and drawing attention to the fact that there was no provision for disciplinary action against the practice of some qualified physicians to rent out "in exchange for a set fee or for a percentage of the profits," their names and lengthy accreditation to individuals who would otherwise be barred from practising medicine. Evidently, this practice was not unusual, for El- Boulaqi adds that there were physicians who owned several clinics, "on each of which is a plaque with their names and qualifications, a ruse used to deceive and swindle the public, because, in fact, these physicians visit their clinics rarely, and then in order to claim their share of the profits." El-Boulaqi, who may also have felt pressured by unfair competition, demanded that the new ordinance should contain a provision prohibiting physicians from operating out of more than one clinic. This, he said, would help "to cleanse the profession from alien elements" and "remove dishonourable competition from the path of medical academy graduates."

Finally, Al-Ahram, along with the rest of the national press, rejoiced at the news of a new premises for the university's medical faculty, towards which the cabinet allocated LE25,000. To mark the occasion, Al-Ahram of 5 May 1928 featured an in-depth report on the developments of this project, which had actually begun nine years earlier when, in 1919, a committee was formed to choose a suitable location for the medical faculty and the university hospital. The site the committee settled upon was on the bank of the Nile in Manial Al-Rowda. The committee initiated a competition for the best design for the new building. The firm of Nicolas and Dickson won and the construction costs of their project were estimated at LE60,000. All that remained was for the government to approve the necessary funding and this was forthcoming in the year of Qasr Al-Aini's centennial.

The foundation stone for the new faculty building and hospital was laid on 16 December 1928. The ceremony proceeded according to plan. Al-Ahram reports that the director of the Construction Authority presented King Fouad I with a ledger "in which was written the date of that day and the fact that the cornerstone was laid during the reign of Fouad I. The king signed the ledger, after which he went to the site where the cornerstone was laid."

Following the ceremony, Minister of Education Lutfi El-Sayed delivered a speech that revealed much about the shape the building would take. In addition to an outpatients clinic, a dentistry department, a medical school, autopsy rooms, wards for the patients and administration facilities, the building, situated on 44 feddans, would be surrounded by gardens and have several small outbuildings; in short, "everything needed" for the operation of the college and hospital. Also, according to El-Sayed, the hospital and its educational facilities had become essential due to the urgent need for more doctors to attend to public health matters after the population increase. In addition, it was important to cater to the growing number of students aspiring to study medicine. Ten years earlier, he said, the college had a student body of 236. In 1928, this had climbed to 629, not counting the dentistry and pharmaceutical departments. As a result, "laboratory facilities are overcrowded and there are not enough beds for the patients." The new hospital, which would be called Fouad I Hospital to distinguish it from Qasr Al-Aini, would house 1,500 beds, El-Sayed said.

The 100th anniversary of Qasr Al-Aini was not about to pass without some tribute to prominent practitioners in the field of medicine. Foremost among these was Ali Ibrahim Bek, who became a fellow, a title awarded by the British Royal College of Surgeons. Commenting on the award, the London-based Near East wrote: "It is no exaggeration to say that Dr Ali Bek is among the most outstanding physicians even in Europe." Similar praise was showered on the Egyptian physician by African World, which added, "The Egyptians have taken an important step towards the advancement of their illustrious medical school. They have also furnished incontrovertible proof of their great talent in the science of medicine and medical treatment." Such was the esteem expressed by prominent European medical educational institutions for their counterpart in Egypt during the first quarter of the 20th century. That such esteem diminished greatly towards the end of the century should provide additional incentive towards reviving the prestige of Qasr Al-Aini as it goes through its latest stage of development.

* The author is a professor of history and head of Al-Ahram History Studies Centre.

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