The Hakima, Clot-Bey, and Women’s Health

November 2, 2018 by Caroline Warfield

It may surprise you to know that a medical school for women opened in Cairo in 1832. Can you imagine such a thing in the United States or Great Britain at that time?

To put it in perspective, Elizabeth Blackwell, the first woman licensed as a physician in the U.S. got her license in 1849 having been rejected by several medical schools earlier. Elizabeth Garrett Anderson passed her medical exams in Britain on 28 September 1865 relying primarily on private tutoring due to rejection from formal schools. In one case, male students petitioned that she not be admitted. Florence Nightingale didn’t establish her school for professional nursing until 1860. So Cairo? Who knew?

Cairo street scene by Jean Achard, 1835

Before we draw too much from that, however, we need to clarify some terms. The women’s school has been variously called a medical school, a woman’s medical institution, and a school of midwifery. Its graduates were called “hakima,” derived from the Arabic word for wise or even holy. It would be a mistake, however, to draw one to one equality between the hakima and either doctors of medicine or nurses or midwives, as we know those terms today. The range of medical titles between nurse, nurse practitioner, midwife, nurse-midwife physician’s assistant, and physician or surgeon with all their variants in education or licensing did not exist. But the women trained at the school were trained to provide women and children with the benefits of modern medicine; that much is certain.

Antoine Clot

Antoine Bathelemy Clot, the founder of the Kasr El Aini Hospital and school, was one of several French physicians recruited by Muhammad Ali Pasha to improve military medicine and care for his army. The Pasha welcomed Members of the French Saint-Simonian social reform movement into Egypt during this period; it is unclear if Clot was one of them, but he had admirers and associates among them. He was by far the most ambitious. He arrived in Egypt in 1825 with the title Surgeon-in-chief and immediately began applying French army regulations in the Egyptian army camps.

An indicator of both Clot’s force of personality and Muhammad Ali’s determination to modernize is that Clot convinced the Pasha that the only way to ensure the health of the army was to improve the health of the general population. Between them they created a council of medicine and set about reforming hospitals to meet European standards. In order to complete that goal, he established a medical school attached to the army hospital at Abu Zaba’al in 1827.

Never a man to think small, Clot recruited three hundred students and imported instructors from Italy, France, and Germany. He hired interpreters to handle the language difference, and then added some interpreters as students, eventually training home-grown instructors. Three years later he imported a European examiner to give both written and oral tests. The man pronounced the students the equal of any in Europe. That’s a remarkable accomplishment, but it has been noted that Clot was also a bit of a self-promoter, and he certainly published frequent reports of his success and research. Genius though he probably was, his statements sometimes engender skepticism.

Anatomy Lesson at Abu Zaba’al 1829

Clot encountered no small resistance from religious leaders. While he refused to back down on the issue of dissection of cadavers for anatomy classes, he worked to win the support of religious leaders. The school scheduled a full month holiday for Ramadan, for example, and religious leaders were invited to serve on the medical council. One part of Muslim law was absolutely clear: no man but a woman’s husband could see her. None could see unmarried ones either. Clearly, men could not practice obstetrics and gynecology in Clot’s expanding health system.

In his own words the necessity of training for the care of women was “strongly felt.” Classes were offered at Abu Zaba’al for a small group of women, taught by “a European female teacher; and a professor to whom the art is entrusted.” When the medical school moved to Cairo as the Kasr El Aini Hospital, the women’s institution moved with it. A women’s hospital opened and students were taught what he called “simple medical subjects,” including the preparation of pharmaceuticals, bleeding, vaccination, surgical dressings, and of course childbirth and delivery. The women’s school was overseen by a woman recruited from La Maternité de Paris, a lying-in hospital for poor women in Paris.

Müller, Egyptian Girl, 1892

Clot believed he had created “an educated class of midwives,” who are capable of “treating the secret diseases to which females are subjected, and for which they are prevented by false modesty from applying to physicians.” In other words they the hakima were intended to be midwifes, yes, and also pediatric and general practitioners. Clot appears to have been respected by some early feminist members of the Saint-Simonian movement, and had an early interest in women’s health. His dissertation was on “Dangers of the Instrumental Manipulation in Obstetrical Delivery.”

Initially the hakima were recruited from among African women, including Abyssinian women from what is now called Ethiopia. It is unclear the extent to which these women were slaves. Clot also mentions they recruited the orphaned daughters of dead soldiers and claimed “they will receive rewards in the same manner as students of the school of medicine.” Equal pay? For women of color and probable slaves? We’ll hold on to our judgment.

The hakima appear to have never replaced the traditional midwives entirely, but played a vital role and held positions of respect nonetheless. Interestingly they were often based at police stations where they not only intervened in complicated births, but also served as forensic experts in criminal cases involving women victims. They were conscripted for state run public health projects such as vaccination campaigns.

Clot Bey

As to Antoine Clot, he received the honorary title of bey without being required to convert to Islam in 1832; he styled himself Clot-Bey thereafter. In 1836 he was given the rank of general (which one suspects meant more to Muhammad Ali), and appointed head of medical administration for the entire country. He returned to France in 1849, but returned to Egypt repeatedly. He died in France in 1868.

When Muhammad Ali’s grandson, Khedive Ismail, planned the modernization of Cairo into a city he hoped would rival the great European capitals in 1875, he named Clot Bey street in the man’s honor. He hoped it would be a center for the trade in grains, fruits and vegetables. British troops occupied Egypt in 1882 and retained it as a “protectorate” until 1949. During the British occupation, Clot Bey Street degenerated into a strip of bars and brothels, the center of prostitution that served the British army, a sad irony.

For more information check out:

Burrow, Gerard N., “Clot-Bey, Founder of Western Medical Practice in Egypt,” in Yale Journal of Biology and Medicine, July 1975, pp 251-257. Viewed on U.S National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2595236/ Accessed on October 26, 2018

Clot, Antoine B., “On the Medical Institutions of Cairo,” in The British and Foreign Medical Review, Quarterly Journal, October 1838, pp. 592-593. Viewed on U.S National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590249/ Accessed on October 26, 2018

Kozma, Liat. “Medicine, Law, and the Female Body,” in Policing Egyptian Women, Syracuse University Press, 2012. Excerpt viewed on Project Muse, https://muse.jhu.edu/chapter/390837 Accessed on October 26, 2018

O’Neil, Peat, “Footsteps of the Saint-Simonians in Cairo,” 1/6/2017, https://peatoneil.com/tag/dr-a-b-clot-bey/ Accessed on October 26, 2018

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Caroline Warfield is a writer of Regency and Victorian stories who sits in an office surrounded by windows and occasionally travels to fire her imagination. She is currently envisioning a romance involving the hakima, an Englishman, and the conflicts between Egypt and the Ottoman Empire in the late 1938-1841. You can find her here:

https://www.carolinewarfield.com/

 

 

 

 

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