History of venereal and skin diseases in Egypt from 1825 to 1924, AD

At the end of the 18th century, there was no medical education or medical training in Egypt like the medical education available in many European countries. We hereby shed light on the development of the specialty of Dermatology and Venereology in Egypt and the evolution of Al-Qasr al-Aini from 1825–1924 AD. At the end of the 18th century, there was no medical education or medical training in Egypt like the medical education available in many European countries e.g., France, Austria, etc. [1]. On June 1, 1798, the French military leader Napoleon Bonaparte, accompanied by a few soldiers invaded Egypt. His troops were accompanied also by 150 scholars in all branches of science and art. In 1799, he established a field hospital for his military forces in the Qasr al-Aini area (Manial). In October 1801, Napoleon’s military campaign lefted Egypt after the Egyptian resistance. Despite its short duration, this military campaign had some positives, as it awakened the Egyptians to the reality of their backwardness Mohammed Ali arrived in 1801 to oust the French from Egypt. By 1805, M. Ali (1769–1849) was named the Wali (ruler), the Ottoman Sultan’s viceroy in Egypt, with the rank of ‘Pasha’. M. Ali seized the governorship for four decades. Afterwards, Mohammed Ali troops suffered during his military campaigns in Sudan in 1820–1821 due to infections and diseases that killed his soldiers more than the battles [2]. M. Ali realized the necessity of having a medical corps accompanying his military forces, in terms of military doctors and pharmacists [3]. In 1825, based on the recommendation of the French consul in Egypt, M. Ali invited Dr. Antoine Clot and 20 French doctors to come to Egypt to establish a medical school like those hospitals in France. M. Ali appointed Dr. Clot in 1825 as the chief army physician, and his title was ‘Hakimbashi Al-Jihadiya’ [4]. When Dr. Clot arrived in Egypt in 1825, only 50 European physicians and pharmacists were attached to the 150000-man army. Dr. Clot advised M. Ali about the necessity of introducing the rules followed in the French army to the Egyptian army, the necessity of sending medical missions from the Egyptian students to France, and the necessity of Arabizing medicine and translating of medical books [5]. In 1827, M. Ali built a huge medical edifice in ‘Abu Zaabal’ desert, to be a medical center that included a school and a hospital to serve the nearby ‘Jihad Abad’ camp. Against formidable odds, Dr Clot succeeded in launching Egypt’s first western school of medicine [6]. In November 1832, the first integrated medical delegation consisting of 12 students arrived in France with Dr. Clot. Its members were elected from the students at the medical school in Abu Zaabal. They were examined by the French Medical Association and achieved remarkable success [7]. One of the most famous members of this mission was Dr. Muhammad Al-Baqli. He became head of the medical school in Qasr El Aini from 1863 to 1876 when he was martyred in the Ethiopian War. Dr. Al-Baqli wrote a treatise on purulent conjunctivitis to obtain his baccalaureate degree [8]. A treatise in medicine was among the requirements to obtain a degree in medicine and surgery (baccalaureate) in the French medical school. During the first ten years of the establishment of the medical school, about 420 doctors were graduated to serve in the army [9]. After the significant reduction in the strength of the Egyptian army early in the 1840s, Qasr al-Aini was transformed into a multi-specialty medical center, and its impact extended to aspects of society that went beyond mere army service. Hundreds of doctors were appointed to jobs throughout the country in the ‘health offices‘ which provided free medical care to the poor and needy. The preserved records show the prevailing reasons for people’s dealings with hospitals and health offices that were established in the cities. In most cases, people resorted to hospitals due to very serious diseases, and syphilis was the main disease mentioned, whether for men, women, or prisoners [10]. It must be remembered that the purpose of establishing the entire medical institution was to serve the army. A nursing school was established in 1832 and a school for midwives was established in 1837 in the Qasr Al-Aini area. All men and women were subjected to strict military discipline and had military ranks. Patients were also subject to strict military discipline. A rare description in one of the writings of the French writer ‘Gustave Flaubert’ [11] who visited the ‘Syphilis’ ward in Qasr Al-Aini in the year 1849; ‘Qasr Al-Aini’ hospital is in excellent condition, the achievement of Clot Bey − his hand can still see beautiful cases of syphilis. Many were infected with it in their buttocks and when a signal comes from the doctor, they all stand on their beds and open their anuses with their fingers, revealing their genital ulcers, and huge cavities [12]. In 1861, (Godard) a French doctor described Al-Qasr Al-Aini as the only hospital in Cairo. He described the women’s ward, which was divided into three wards [13]: (a) Surgery ward, capacity for 47 patients. (b) Franchise diseases (venereal) ward, capacity for 26 patients. (c) Internal diseases ward, capacity for 15 patients. At the beginning of the 19th century, the population of Egypt was estimated to be about 2.5 million people and became 6.5 million by the end of the same century. A growing number of European residents in Egypt, estimated to be 5000 foreigners in 1840. Influx continued to 68000 by 1878. The number continued to grow due to the prosperity and peace in Egypt during the 1st and 2nd world wars with the influx of a huge number of immigrants, refugees, prostitutes, etc. during the first half of the 20th century. Four medical topics were the main concern of the work of the medical establishment throughout the country and ports [14]: (a) Hospitals. (b) Quarantine (Karantina). (c) Vaccination against smallpox. (d) Medical examination and body autopsies. Rare statistics indicate the extent of some diseases in Cairo (Tables 1 and 2) showing that venereal diseases were a common ailment at that time. Table 1 - Diseases prevalent in municipal outpatient clinics in Cairo from 1845 to 1847 Number Diseases 198 Emergency 327 Scorpion sting 456 Infectious diseases 534 Trauma 607 Smallpox 766 Scabies 958 Venereal diseases 1227 Internal ailments 3111 Fractures Table 2 - Classification of cases treated in Kasr Al-Aini Military Hospital from 1847 to 1848 [15] Number of Deaths Discharged Number of Cases Diagnosis 357 5592 5949 Internal Ailments – 1846 1846 Eye diseases 37 2350 2387 Surgery – 5136 5136 Venereal diseases 394 14924 15318 Total Herein a review of some of the venereologists and dermatologists whose names were mentioned in the 19th and first quarter of the 20th century: (1) Mustafa Al-Waty Bey. (2) Abd al-Rahman al-Hawari Bey. (3) Hassan Mahmoud Shaltut Pasha. (4) Mohammad Salem Bey. (5) Mohammad Radouan Effindi. (6) Prof. Dr Portocalis. (7) Dr. Fakhry Mikhaïl Farag. Mustafa Al-Waty Bey (Died 1864) Born in Al-Wat village, Menouf District, Menoufia. In the year 1842, he was the head of one of the translation departments, established by M. Ali Pasha under the supervision of Rifa’a Bey Al-Tahtawi. Al-Tahtawi sent M. Al-Waty to study medicine in France in 1845 for two years, then he completed his studies at the Al-Qasr Al-Aini School of Medicine. He was graduated with the rank of Yüzbaşi, later on the Hakimbaşi of the “Department of the Franchise diseases” (syphilis) and physiology. Later, he took over the responsibilities of treating scabies and tineas among soldiers in Al-Qasr Al-Aini hospital [16]. Abd al-Rahman al-Hawari Bey (Died 1906) Studied at Qasr al-Aini School of Medicine. After completing his medical studies, he traveled to France in 1847 and returned in 1855. Upon his return, he was appointed professor of physiology and skin diseases at the school and became the school’s vice dean in 1880 [17]. After the death of M. Ali, missions continued during the reign of Khedive Abbas I (1848–1854) to various countries such as Italy and Austria based on the advice of the British Consul!! The School of Medicine was closed during his reign and then reopened with the return of Clot Bey (1855–1856) for a very short period. During the reign of Khedive Saïd Pasha (1854–1863), the ‘second medical mission’ was sent to Austria in 1862, and its destination was changed from Austria to France in 1863 during the reign of Khedive Ismaïl Pasha (1863–1879). In this mission, two students (H. Mahmoud and M. Salem), took over the specialty of syphilitic and skin diseases [18]. Hassan Mahmoud Shaltut Pasha (1841–1906) Born in Talbieh (Giza). He completed his medical studies, at “Saint Louis” Hospital in Paris in 1869, and presented his thesis about ‘Monographie du Pemphigus’ under the supervision of Dr. Hardy (Fig. 1). He obtained a baccalaureate degree in medicine, which is equivalent in Egypt to a bachelor’s degree. He published many books and articles, including: (a) Treatise on pemphigus. (b) Modern exploration of the Egyptian abscess 1873. (c) Medical benefits in skin diseases, published in 1875. (d) Body healing in the Helwan Baths, published in 1877. He published more than 25 articles eg., on pus, hemorrhoids, dengue fever, and cholera, in Al-Muqtaf magazine, which denote that he was interested in health problems and had a message to enlighten doctors, medical field personnel, and citizens.Figure 1: Front page of M. Hassan thesis, ‘Monographie du Pemphigus’.The Egyptian Gazette issue No. 832 of October 19, 1879, mentioned him: ‘The appointment of Dr. Hassan Bey Mahmoud, Egyptian Health Inspector, A.H., took over the management of the Health Council and the Karantina administration in Alexandria ‘. As such, Dr. H. Mahmoud saved Egypt from the plague epidemic in 1881. Later, he was appointed head of the School of Medicine (1889–1891) and obtained the rank of Pasha. He was a member in two medical societies, eg., the Brazilian Medical Academy and he remained in touch with them even after his return to Egypt. He was assigned to several medical conferences as well. Dr. Hassan Mahmoud Pasha was self-taught since his birth [18]. Mohammed Salem Bey (1843–1894) Son of the late Salem Bey Ali, the health inspector of Upper Egypt, during the reign of Khedive Saïd Pasha. He completed his medical studies at the University of Paris in 1870 and wrote his medical thesis under the supervision of Dr. Fournier. Its title was about chancres: “Syphilitic chancre versus simple chancre” (Fig. 2). His training took place in ‘Lourcine’ and ‘Midi’ hospitals in Paris. Both hospitals were venereal disease hospitals, for women, men, and nanies. After his return in 1870, he was appointed to the General Canal Hospital in the Suez Canal region, then to Upper Egypt. He participated in the war with the Egyptian army in Darfur, Sudan in 1875, Ethiopian war in 1876, and alongside the Ottoman army in the war against Russia in the year 1877. The Egyptian Gazette Issue No. 763 dated June 2, 1878, mentioned that he obtained the Medal of Honor; fourth class; as at 4 G Bayada, in the first division. He was the army’s first doctor until the Orabi revolution, then a teacher at Al-Qasr Al-Aini School, and his treatise about chancres, was taught as part of Al-Qasr Al-Aini curriculum [19].Figure 2: Front page of M. Salem thesis, ‘Étude Comparative des Chancres; chancre simple et chancre syphlitique.Mohammad Radouan (1845–1920) In 1865, the Governor of Egypt, Khedive Ismail Pasha, approved the mission of M. Radouan based on the recommendation of the ‘Hajj princes’, as he worked faithfully with the pilgrims’ caravans to avoid the transmission of the cholera epidemic from Mecca to Egypt. He traveled to France and studied medicine from 1867 to 1870 [20]. He decided to complete his studies to obtain a doctorate in the field of dermatology from the year 1870 to 1875. The title of his thesis was ‘Étude Théorique et Pratique sur L’Éczema’ (Fig. 3). Dr. Hardy was the supervisor of his thesis. His studies took place at Saint Louis Hospital in Paris, one of the most famous teaching hospitals in France and the world at that time. Later, Prof. Dr. Hardy held the first international conference on dermatology in August 1989. This was in the hall of the Dermatology Wax Museum in “Saint Louis”.Figure 3: Front page of M. Radouan thesis ‘Étude Théorique et Pratique sur L’Éczema’Upon his return in 1875, Dr. M. Radouan worked and teach in Al-Qasr Al-Aini Clinic, in addition to the Khedive clinics in Cairo. In 1882, the British colonized Egypt. They tightened their control over the medical school, which led to a decrease in the number of students, and they taught medicine in the English language. They imposed annual tuition fees after free education, which led to a rapid deterioration in the conditions of the medical school, a decrease in the number of Egyptian doctors, and the restriction of entry to the medical school and medical professions to a selected handful who were skilled in English. The British colonial regime always relied on this policy to tighten its control over countries in all fields. Professor Dr. Portocalis Bey (20th century) There is no information except what he mentioned about himself. Former professor at the Sultan High College in Asetana (Istanbul). He launched a private clinic at 4 Al Mahdi Street in downtown Cairo, which is a stone’s throw from ‘Clot Bek’ Street, the red zone in Cairo, which was famous for the presence of national prostitutes and brothel houses. ‘ Clot Bek’ st. was next to the lodgment of foreign prostitutes in the ‘Azbakeya’ wealthy neighborhood district. Prof Dr. Portocalis Bey advertised himself and his clinic on daily basis in ‘Al-Ahram’ newspaper, one of the major and most widespread newspapers at the time (Fig. 4).Figure 4: Advertisement for Prof. Dr. Portocalis in Al-Ahram Newspaper.He published seven books, only one them is available at the National Egyptian libraries entitled: ‘Prostitution or the Danger of Fornication in the Egyptian Country’. Translated into Arabic by ‘Daoud Bey Barakat’ in 1907 [21]. Perhaps, Portocalis private clinic was the first private venereology clinic in Egypt. The emergence of private clinics took place from two clinics in 1925 to 39 clinics in 1949. Dr. Fakhry Mikhaïl Farag (20th century) He mentioned that his private clinic is located at 81 Abbas Street (Ramses Street) in Cairo, near the Red Zone and downtown Cairo. He studied venereology in Berlin around 1917 [22]. He published two books on venereal diseases [23], to be in the curriculum of teaching at Fouad I University (Al-Qasr Al-Aini) for many academic years starting from 1921. Prof. Dr. Abdel Moneim Al-Mufti was one of his students (personal communication). Dr. Fakhry also published a 155-page report in 1924 that he submitted to “King Fouad” I and to the Egyptian government entitled: ‘The spread of prostitution and venereal diseases in the Egyptian country and some methods that can be followed to combat them’ [24], Dr. Fakhry proposed the following: (a) The necessity of abolishing the official prostitution system, which is required by the Islamic religion, the country’s official religion. (b) The necessity of learning medicine in the Arabic language and he published his books in Arabic, except for medical terminology in Latin and Greek words. (c) The necessity of establishing a private hospital for venereal diseases in Egypt, like what exists in European countries, based on what he witnessed and experienced during his studies in Berlin. Dr. Fakhri inspected three venereal diseases office belonging to the Public Health Authority, in 1921: (a) Darb Al-Nubi office (b) Abbasiya Office. (c) Sayeda Zeinab’s office. Dr. Fakhry accurately described how antagonistic the relationship between doctors and prostitutes was. Doctors did not provide care nor time for prostitutes, Negligence was the predominant feature, and the bottom line is that there is no benefit from this medical supervision. On the contrary, he described the venereal diseases clinic in Berlin in detail. He described the examination chairs, microscopes, and the workforce. Venereal disease clinics in Berlin provided service during the morning and evening period. Thirty VD clinics existed in Berlin in 1917. Syphilis was endemic in Egypt, as such, the number of public venereal clinics and hospitals reached about 40 and perhaps more in 1949. It is worth mentioning that the books used in the curriculum of venereal and skin diseases in the 19th century at A-Qasr Al-Aini Medical School [25]: (a) Maladies de la peau ‘Rayer et Cazenave’ traduit par Ahmed Raschidi, 4 volumes. (b) Manuel des maladies Vénériennes par Philippe Ricord (1800–1889), traduit par Mustafa El Ouati, 1 volume. (c) Salem. M, Étude comparative des chancres: chancre simple et chancre syphilitique. Thesis for the doctorate in Medicine, Paris, 1870. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.