AN EGYPTIAN HOSPITAL.
IT was inevitable that Egypt should be the cradle of the art of medicine, as of most other arts. Long before Joseph's time medicine was studied in Egypt. A chief physician of one of the Kings of the Fifth Dynasty, nearly as old as the Great Pyramid, is buried at Sakkara, and there is no doubt that the art of healing was taught, besides astronomy, mathematics, and law, in the temple schools of Memphis, Heliopolis, and Thebes. The Ebers Medical Papyrus, the oldest treatise on medicine in the world, belongs to the sixteenth century before Christ, but contains much that'
had been handed down from still earlier ages. No doubt the art was in a very elementary stage ; but still it had begun, and when Herodotus visited Egypt he found that doctors had already become specialists in distinct branches of their work. It was at Alexandria that Galen studied before he went to Rome. To the Alexandrian school the East owed much, and it was partly through its influence that the Arabs became the teachers of medicine throughout the countries bordering the Mediterranean during the Middle Ages. These teachers were only occasionally natives of Egypt, but many of them had studied there, and thus the torch which had been lighted in the Pyramid age was carried to Sicily and Salerno by the Arabs of Cairo, Damascus, Baghdad, and Cordova, and spreading through Italy, reached even the barbarous North. We are told that when the University of Tubingen was founded in the fifteenth century there were six Arabic text-books on medicine to three in Greek, and it must never be forgotten that the great medical school of Padua, where Vesalius, Eustachius, and Fallopius taught and where our own Harvey studied, was the direct offspring of the Arab and Jewish school of Salerno.
To the pious Muslim the founding of hospitals was only second to the building of mosques among the acts that lead to paradise. The famous Viceroy, Ibn-Tulun, in the ninth century established a hospital at Fustat, the first Moham medan capital of Egypt, now partly represented by the suburb called " Old Cairo." Saladin founded two hospitals, of which we possess some account by the Spanish Arab, Ibn-Jubeyr. Celebrated doctors, such as Abd-el-Latif of Baghdad and Ibn-Abi-Oseybiya, were then teaching at Cairo, and the effect of these influences was seen in the " Maristan," or hospital, in the Suk-en-Nahhasin, well known to every tourist at the present day. The Mamluk Sultan Kalaun, lying sick of a fever at the great Nury hospital at Damascus founded by the famous Nur-ed-din, King of Syria, vowed that if he recovered he would build a like hospital at Cairo. The result was the Maristan, or, as it is commonly pronounced, Muristan, with its separate wards for distinct classes of disease—wounds, fevers', phthisis, obstetrics, &c.—its salaried doctors and nurses, its library, pharmacy, and lecture theatre. It was open to, all who sought admission, rich and poor, bond and free, and, like education in Egypt, medical treatment was given without fee. The Maristan gradually lost its character as a general hospital, and became a lunatic asylum, and was used as such down to the middle of the nineteenth century. The tomb; of the founder, hard by, however, retains its general therapeutic virtues, and sick people and childless women still touch the robes of Kalaun or lick the pillars of his. chapel in sure and certain hope of a speedy cure.
There is another hospital at Cairo, familiar, at least from the outside, to every visitor, but it was not founded.with any
beneficent object. Kasr-el-Ainy was originally the palace of
the Emir Ahmed ibn el-Airy, Grand Master of the Horse to the Sultan Khushkadam, one of the two Greeks in the line of the Slave Sultans of Egypt. It was built near the Nile bank in 1467. For two centuries and a half its history, like that of the many other Mamluk palaces which have unhappily almost wholly disappeared, is a blank. In the eighteenth century. it became a country house for the Turkish Pasha of Egypt, and a place of entertainment for high officials, and recent excavations during repairs revealed heaps of rabbit and chicken bones, relics of their feasts. With the French occupation it finally became a hospital. Dr. F. M. Sandwith, now its principal physician and Professor of Medicine, has collected every discoverable notice of the hospital in his "History of Kasr-el-Ainy," lately published in the "Records of the Egyptian Government School of Medicine " ; and very curious and interesting are the results of his researches, which are illustrated by photographic reproductions of old drawings.. "In 1802 Desgenettes describes the hospital as being a large and convenient building, very well situated, lofty, and stand- ing almost alone, stretching along the Nile from about two hundred paces north of the aqueduct. He says tlere were no rubbish or dust heaps in the neighbourhood, and it was sur- rounded by pleasant orchards, and open to the north wind. It was here that Larrey studied an epidemic of fever, which broke out in April, 1800, during the siege of Cairo, besides ophthalmia, scorpion stings, and many other diseases." At Kasr-el-Ainy the body of the murdered general, Kleber, rested for a night on its journey to France, and here 'the English, after expelling the French, were filled with' admira- tion at Desgenettes' great hospital. During the 'troubled times that ushered in the accession of Mohammed Aly the hospital became in turn a prison, a barrack, a guest-house, and a slave school, where eight hundred Mamluk cadets' received primary education, probably without much assistance' from the fifteen thousand French and Italian books which still lined the library walls. •
The revival of Kasr-el-Ainy as a hospital and medical, school was the work of another eminent Frenchman. Clot Bey came to Egypt in 1825 as chief physician and snrgeon to the Pasha's new army, followed by more than a hundred 4.ncl. fifty French and Italian surgeons and apothecaries,, and .he soon established a medical school and military hospital in connection with the camp near Abbasiya to the north of Cairo. There were drawbacks in the hospital arrangements, for there was an insanitary cemetery close by, and "the patients were kept awake at- night by the hyenas fighting over the un- earthed corpses." Nevertheless Clot Bey and his able, assistants, who included Pruner and Peron, persevered, and enjoyed the triumph of conducting "twelve picked Egyptian students, wearing turbans and flowing robes," to Paris in 1832, where they were examined for the medical degree by .4f leaders of the faculty. In 1837 this successful medical s was transferred to Kaar-el-Ainy, where it still subsists. There were then sixty-four wards of forty beds each, with chemical laboratory, pharmacy, museum, baths, and other necessary appliances :- "The medical course was at this time five years ; the pupils, who varied in age from 20 to 25 years, consisted of three coin• panies of 100 each ; they wore a military uniform, and were fed, dressed, and lodged at the expense of the government. They also received pocket-money, beginning at 40 piastres a month. The professors, who were all Europeans, provided with native assistants, included Figari, ,who taught botany and materia,
medics, Pruner, who taught ophthalmology, and Gaetani, a well- known surgeon. Some of the original prejudices which had to be overcome in inducing the Musulmans to dissect dead bodies were immense, and the dissecting-room had to be surrounded by guards, who were kept ignorant of what they were guarding. Clot Bey bsgan by dissecting a dog, not even a Muslim's dog, but a Jew's dog or a Christian's dog.' Later he got permission to use Christian subjects and black slaves, and he was allowed to bring skulls and bones from disused cemeteries to his lecture-room, though the 1Jlema had begun by decreeing that the dissection of a human body was against the tenets of the Musulman faith. Eventually steady perseverance overcame all difficulties, and the students became so interested that they would take home portions of the body to study.' "
His resolute support of Clot Bey was not the least of Mohammed Aly's services to Egypt. He encouraged no fewer than four hundred European and native doctors to practise in Egypt, who were supplied with medicines from Kasr-el- Ainy, and the introduction of vaccination by Clot Bey notably reduced the mortality, especially among children. He trained two thousand five hundred barbers for this work ; all slaves from the Sudan arriving in the market were im- mediately vaccinated, and every year fifteen thousand children in Cairo were protected from smallpox. It was done in the face of every opposition, except the great Pasha's. As Dr. Sandwith says, "in spite of public opinion, court intrigues, and the passive resistance to novelty which is the outcome of generations of blind ignorance, it is wonderful how much Clot Bey succeeded in accomplishing." The death of the Viceroy and the reaction that ensued compelled the great doctor's retirement to France, but after Kasr-el-Ainy had suffered manifold vicissitudes under German and Italian management, not unskilled, but ill-supported by the new Pasha, Clot Bey returned to reopen his old school in 1856, and for two years presided over the institution he had created. After his final retirement, in the hands of native teachers the school declined, and it was not till Dr. Sandwith took charge of the new Sanitary Department of Egypt in 1884 that a reform was attempted. We draw a veil over the state of the hospital as be then found it. In point of sanita- tion it was horrible beyond words, and the public of Cairo, not without reason, " firmly believed that the hospital was merely a prelude to the cemetery." The class of patients was naturally the lowest possible, and some of the wards were pandemoniums. " No respectable woman ever applied to the hospital for advice, and no parent ever left his child in the wards for treatment." The story of the English doctors' fight with this Augean condition of things, as told modestly and dispassionately by Dr. Sandwith, is an example of the kind of work that has been doing in Egypt during the past twenty years. With Mr. Milton as resident medical director, Kasr-el- Ainy began to take a new character : " his work is not the least of the many triumphs of England in Egypt." But the victory was not won without daily struggle, and want of money at first checked the efforts of the reformers. Step by step the wards were ventilated,—iron bedsteads took the place of trestle planks, the diet was remodelled, a new kitchen built (the old one was over an open cesspool), and s3ptic rules enforced, native nurses and midwives trained to some extent, the abominable drainage (after several lessons of typhoid) entirely reconstructed, operating theatres and a post-mortem room built, and a house for the English nursing sisters erected in the botanical garden ; in short, " during the first years of Mr. Milton's directorate workmen were never absent from the building," which was in such bad repair that students bad a way of suddenly disappearing through the floor in the midst of a professor's address. The medical school in 1884 was as bad as the hospital: typhus prevailed, a servant was chief demonstrator, and there were no micro- scopes, no laboratories, no pathology, no practical work. The only European professor had resided fifty-two years in Egypt without being able to master Arabic. Thanks to the en- lightened Under-Secretary of Public Instruction, Yakoub Artin Pasha, the school was taken in hand, and the course of instruction was remodelled on sound lines. Bacterio- logical, histological, and physiological laboratories began to rise up, where original research is now eagerly carried on, and in 1897 the hospital and . school were placed under the sole direction of Dr. Keatinge, with five new English surgeons and physicians on the staff. The results have been most satisfactory. The laboratories and museums have been enlarged and improved, electric light introduced, a students' club-room opened, and the lectures are now given in English to a large body of students, in whom there is observed " a marked improvement in intelligence, healthy bearing, and social standing." Clot Bey's good seed has brought forth fruit an hundredfold, and the old palace, guest-house, prison, barrack, and military school of Kasr-el-Ainy has become a medical institution of which any country might be proud.
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