Gender and the Making of Modern Medicine in Colonial Egypt (review)

Western medicine was long associated with state building in Egypt. As Hibba Abugideiri persuasively shows, this linkage shaped not only the social production of medical professionals but also their authority in society. The relationship was symbiotic and pragmatic, but by no means unchanging. Seeking to integrate Egypt into wider circuits of world trade and enhance its autonomy within the Ottoman Empire, Muhammad Ali in 1825 invited French officer Antoine Bartelemy Clot to organize the Egyptian medical system. The military was prioritized, but Ali’s mercantilist vision soon embraced the aspiration of a healthy population. A growing number of urban hospitals and rural clinics served this vision. The only medical school—initially at Abu Zabal and later at Qasr al-Aini—would play a major role in the indigenous production of Western-trained medical practitioners. Abugideiri lucidly shows that the modern coexisted with the traditional at Qasr al-Aini to achieve a pragmatic purpose: the recruitment and training of doctors for the state.

Until the establishment of the secular primary and secondary educational system, medical students came from traditional institutions, such as the kittab and madrasa. Even as French became compulsory, Arabic remained important in lectures and clinical settings, not to mention in translated Western medical texts. Students were drawn from non-elite social origins, which accounts for an array of subsidies and incentives for their recruitment and retention. There is perhaps no better illustration of the state’s pragmatic approach to mass medicine than the complementary relationship of hakimas, or midwives, to doctors. Due to their reach within the community and the limited impact of doctors in society, hakimas functioned as “mediating agents” (130). Trained in a separate school founded by Clot, they were licensed to give vaccinations, perform deliveries, and treat women and children at no cost. By 1848, however, male doctors enjoyed growing authority in and outside Qasr al-Aini as the shift from military to mass medicine continued fitfully under Ali’s successors.

With the coming of British rule in 1884, the position of Egyptian doctors changed. Abugideiri demonstrates the rise of the modern profession within the structures of colonial medicine over a four-decade period. The process of anglicization at Qasr al-Aini restructured the social production of doctors in ways that would profoundly shape their self-image and place in society. Henry Keatinge, who was appointed director in 1893, implemented far-reaching reforms articulated in the 1898 report by Guy’s Hospital superintendent E. Cooper Perry. Keatinge consolidated power at the medical school and affiliated hospital both administratively and structurally. British doctors strictly regulated access to medical knowledge. Keatinge appointed them to key professorial positions and to the hospital medical staff, while Egyptian faculty members were limited to positions of lower status and pay. English replaced French, and the curriculum shifted to a clinical focus. Increasingly specialized knowledge, as exemplified by gynaecology, rendered knowledge far less accessible while privileging medical intervention by doctors as the preferred solution for managing difficult births and gynaecological disease. By the turn of the century, Western medicine had become far more exclusive and male-dominated. Entry criteria became steeper, limiting the profession to the privileged few. An explicit gender hierarchy defined the relationship between doctors and midwives, who were trained with nurses, expected to serve at the direction of doctors, and had sharply circumscribed access to the female body. Colonial regulation facilitated the formal masculinization of medical knowledge and skill by endowing licensed doctors with exclusive rights to perform high-risk procedures and use specialized instruments such as forceps.

Even as Egyptian doctors were disadvantaged by anglicization, they were active agents who harnessed modern medicine as a tool in self-interested ways. As licensed practitioners, they both enjoyed and enforced the state’s mandate to define and treat illness and disease. They benefited from state-sponsored immunization campaigns, which exhibited the curative power of modern medicine. The gender division of labor privileged the...