Gender and the Making of Modern Medicine in Colonial Egypt

Hibba Abugideiri

• Publisher: Routledge
• Year: 2016
• eBook ISBN: 9781317130352
• Edition: 1
• Topic: Historia
• Subtopic: Historia del mundo

Gender and the Making of Modern Medicine in Colonial Egypt investigates the use of medicine as a 'tool of empire' to serve the state building process in Egypt by the British colonial administration. It argues that the colonial state effectively transformed Egyptian medical practice and medical knowledge in ways that were decidedly gendered. On the one hand, women medical professionals who had once trained as 'doctresses' (hakimas) were now restricted in their medical training and therefore saw their social status decline despite colonial modernity's promise of progress. On the other hand, the introduction of colonial medicine gendered Egyptian medicine in ways that privileged men and masculinity. Far from being totalized colonial subjects, Egyptian doctors paradoxically reappropriated aspects of Victorian science to forge an anticolonial nationalist discourse premised on the Egyptian woman as mother of the nation. By relegating Egyptian women - whether as midwives or housewives - to maternal roles in the home, colonial medicine was determinative in diminishing what control women formerly exercised over their profession, homes and bodies through its medical dictates to care for others. By interrogating how colonial medicine was constituted, Hibba Abugideiri reveals how the rise of the modern state configured the social formation of native elites in ways directly tied to the formation of modern gender identities, and gender inequalities, in colonial Egypt.

CHAPTER 1

Introduction: Egyptian Gender, Medicine, and Nationalism

In an article entitled “Mother’s Health” published in a popular Egyptian medical journal in 1902, a doctor instructs Egyptians that:

Our world enjoins upon the woman that she becomes a wife, mother, breastfeeder, and childrearer. In addition to these, she has duties that civilization did not make easy for her; in fact, civilization has added hardship to her obligations. Don’t you see that the woman who lives in civilization receives more hardship in delivering her babies than the farmer or tribal woman .... The urban women stay in bed 30 or 40 days after their deliveries, and if they get up before that, they get sick. There is no way the urban women can live like the tribal women because they inherited their weak body constitution from their mothers. But if they exercise more and expose themselves to fresh air while pregnant, this makes the delivery easier, and lessens the hardship of delivery .... The wisdom here is to have a strong body in order to have healthy children.¹

Egyptian medical opinion thus pictured the “modern Egyptian woman” as maternal and domestic certainly, but more interestingly as a pillar of health who should deliver healthy babies, breastfeed, and properly rear her children. This medical discourse was ubiquitous in early twentieth-century Egypt. Notions of civilizational progress assumed new medical significance as Egyptian doctors linked women’s health and bodily functions with Egypt’s societal advancement. In fact, the idealized icon of mothers as modern, urban, and middle-class bespoke a more serious deliberation about woman’s biological role. That Egyptian doctors came to speak about women’s social roles as rooted in a biological destiny was unprecedented. And the fact that this medical discourse of “republican motherhood”² – a scientific discourse that sought to nurture the maternal and domestic instinct in women for the political purpose of modern nation-building – emerged at a time of competing nationalist ideologies was far from coincidental.

This study traces the historical processes through which the trope of the “modern Egyptian woman” was medically constructed by a new kind of Egyptian doctor in the early twentieth century. Seemingly unrelated but very much linked to this emerging discourse of republican motherhood were new medical roles around caretaking assigned to the increasing number of Egyptian women practitioners, especially midwives. The concern here is how a modern gender regime – one based on medically rationalized sex differences – came to characterize relations between Egyptian men and women practitioners, but also native discourses about gender norms. The engine for these unparalleled historical developments was Egypt’s colonial encounter with Great Britain.

The book unfolds its arguments by focusing on the changes brought by British reforms to two pre-colonial Egyptian institutions: the all-male Qasr al-Aini medical school and the all-female School of Midwifery. Under British rule, and mirroring the structure of similar institutions in London, these two previously independent schools were brought into a single hierarchical medical programme in which Qasr al-Aini was given primacy. This meant that Qasr al-Aini dispensed the highest levels of medical training to men while students in the School of Midwifery, who had previously trained as “doctresses” (hakimas), were now restricted to studying the subordinate fields of midwifery and nursing.

Thus, a new profile of the modern Egyptian doctor emerged based on the male monopoly of medical knowledge about women’s bodies and, by implication, their social behaviours. By contrast, a modern medical ethos of caretaking became associated with Egyptian midwifery and housewifery so that women’s work, whether professional or domestic, was now scientifically predicated on female nurturance and health care. Medical professionalization, then, scored the indelible effect of creating a medical division of labour based on modern scientific notions of sexual difference.

Explaining how and why these “modern” Egyptian gender roles emerged within a colonial context by the early twentieth century raises the more complex question of how medicine was constituted by British reforms seeking to modernize the state. While colonial reforms were certainly imposed without Egyptian consent and with British interests in mind, native doctors nevertheless found in imperial medicine the authority to forge an indigenous variant of medicine that, on the one hand, took its cues from Victorian science, yet on the other, found its raison d’être within Egyptian anti-colonial nationalism. Britain’s colonization of Egyptian state medicine, then, set into motion a struggle between the colonizer and the colonized over how medicine, as an instrument of secular progress and modernity, should determine Egyptian social organization. By interrogating why imperial medicine played such an instrumental role in Egypt’s state formation process, Gender and the Making of Modern Medicine in Colonial Egypt argues that British colonial reforms determined the social formation of native elites like doctors in ways that were inextricably tied to the construction and formation of new gender identities, and gender inequalities, in Anglo-Egypt. As such, this study locates itself at the axis of gender, medicine, and nationalism. However, their interconnections only become intelligible in the context of the rise of the modern state.

At the broadest level, this study interrogates the impact that the rise of the modern state had on gender formation in ways that were decidedly interconnected. It situates itself squarely within an expanding body of literature in Middle East women’s and gender studies that problematizes the multifaceted ways that gender identity formation was shaped by modern state-building. I share with this body of scholarship the viewpoint that women of the region should be studied, not ahistorically in terms of Islam and Islamic culture, but alternatively by highlighting the reproduction of gender inequalities through various dimensions of state policy, specifically through “gendered” constructions of citizenship and the dynamics of incorporation of national and ethnic collectivities into modern states.³

To approach a study of Egyptian gender in this way is ultimately an attack on modernization theory, which has affected the field of Middle East women’s studies in particular. Modernization narratives make the axiomatic assumption that counter to “traditional Islamic” societies that suffer from an inevitable Islam-inspired gender inequality, newly Westernized or modernized societies – whether indigenously inspired or imposed from the outside by colonization – produce new sources of openness.⁴ As Mervat Hatem has suggested: “Nowhere in this narrative is there any skepticism about the presumed progressiveness of the outcome. There is theoretical blindness to the mechanisms of gender, class, and ethnic subordination internal to modernization as a system of new power relations.”⁵ Alternatively, this study looks more critically at state modernization projects and their impact on female emancipation.⁶ Like Lila Abu-Lughod’s volume that critically explores the turn-of-the-century “projects of remaking women” in the region, I too ask “how modernity – as a condition – might not be what it purports to be or tells itself, in the language of enlightenment and progress, it is”.⁷

Such an epistemological critique of modernity is central to framing this gender foray. In fact, by arguing that the colonial state and the new medical male elite that it produced ultimately relegated Egyptian midwives and housewives to nurturing roles in the domicile in the name of modernity and female liberation, Gender and the Making of Modern Medicine in Colonial Egypt exposes what Abu-Lughod calls the “politics of modernity” – namely, those new ideas and practices considered “modern” and progressive implanted in Europe’s colonies or simply taken up by emerging local elites that ushered in not only forms of emancipation, but new forms of social control and coercive norms.⁸ By exploring medical programmes intended to make women modern in ways different from men, I join other scholars in a growing scholarly trend that rethinks the implications of modernity for women as necessarily progressive and emancipatory.

To this end, this study employs medicine as an analytical lens to interpret how Egyptian cultural formations like gender were impacted by the modern state-building process under colonial rule. The choice of medicine reflects an attempt to broaden approaches to Middle East history writing by showing how a medical history of Egypt uncovers new dimensions of state and gender formation that help explain the emergence of modern gender inequalities. Medicine, as a field of historical inquiry, has witnessed a slow growth within Middle East studies, in contrast to Western European history, which, since Patterson and Hartwig’s classic 1978 volume, Disease in African History, began exploring the medical traditions of colonies under imperial rule – what has come to be called colonial medicine.⁹ Its historiographical appeal rested in the challenge to the imperialist belief that medicine was a prime exemplar of the constructive and beneficial effects of European rule, and thus, to the imperial mind, one of its most indisputable claims to legitimacy.¹⁰

Indeed, revisionist medical historians have sought to rethink and problematize the Western dissemination of medicine into colonies by identifying disease and medicine as a site of contact, conflict, and possible eventual convergence between Western rulers and indigenous peoples. By identifying the centrality of medicine and disease to the ideological and political framework of empire, such works insist on the centrality of notions of health, body, and medical practices to the very identity of colonial regimes.¹¹ After all, medicine rendered colonialism possible, not only by allowing colonial expansion into equatorial climates and protecting colonists from the pathogens of the new territory, but more notably by facilitating provision and maintenance of healthy workforces and drawing colonized populations into colonial institutions.¹² Like steamers, quinine prophylaxis, quick-firing rifles, cables, and railroads, medicine too can be counted as one of Britain’s most powerful “tools of empire” – namely, that arsenal of nineteenth-century technologies that allowed the British to establish, but also maintain, imperial rule in Africa and Asia.¹³

More than this, medicine was part of colonial ideologies, and thus used to balance out the coercive features of colonial rule, and of establishing a wider imperial hegemony than could be derived from conquest alone.¹⁴ As such, Western medicine can be viewed “as one of the most powerful and penetrative parts of the entire colonizing process, one of the most enduring and, indeed, destructive or distorting legacies of colonial rule”.¹⁵

Scholars, especially in the last two decades, have increasingly employed medicine as an innovative and creative approach to examine modern state formation in Egypt.¹⁶ Laverne Kuhnke’s pioneering Lives at Risk was one of the first studies to take on the question of medicine and modern state politics. In demonstrating the historical complexities of public health under Ottoman-Egyptian rule in the early nineteenth century, she argues that issues of health, in light of successive epidemics, were enmeshed in the politics of economic trade and European encroachment. Kuhnke established an epistemological framework of the entanglements of modern medicine within the Egyptian state-building enterprise which others, including Amira Sonbol, Khaled Fahmy, and Nancy Gallagher, have since used to frame their own narratives.¹⁷ There has been less attention, however, to the dynamics of medicine and state-building in colonial Egypt.

To date, there are no studies which have examined in any comprehensive way the systematic impact of British colonialism on Egyptian medicine. Admittedly, Sonbol’s work does treat the colonial period, but as the product of a broader examination of the nineteenth century. Colonial medicine, as a topic of historical study, has yet to make any real scholarly impact on the larger discipline of Middle East studies. Yet such an inquiry makes three notable contributions to the wider discipline in general, and to modern Egyptian history and Middle East gender studies in particular.

First, rather than framing medicine as a by-product of, or reaction to, state politics, as does much of the scholarship mentioned above, a colonial medical history of Egypt presents medicine as an active agent in creating and expanding British imperial hegemony, as an intrinsic part of how the colonial state maintained and legitimized itself as a foreign-imposed political apparatus. Medicine allows us to interrogate the nature of colonial rule by asking how modern technology was made intrinsic to producing, extending, and justifying British empire-building in Egypt, and what effects such “tools of empire” had on seemingly unrelated social formati...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Acknowledgements
• Series Editors’ Foreword
• List of Abbreviations and Note on Transliteration
• 1 Introduction: Egyptian Gender, Medicine, and Nationalism
• 2 Muhammad Ali’s Egypt: The Rise of Modern Medicine
• 3 Colonizing Egyptian Education: Creating an Anglo-Egyptian Civil Service
• 4 Anglicizing State Medicine: The Rebirth of Qasr al-Aini
• 5 Hakimas, Dayas, and the State: Displacing Women in the Name of Modern Medicine
• 6 A Modern Medical Profession at Last: The Rise of the Egyptian Doctor
• 7 Egyptian Doctors and Domestic Medicine: The Forging of Republican Motherhood
• 8 Conclusion: Egyptian Nationalism, Medicine, and the Scientization of Culture
• Bibliography
• Index