Muhammad Ali of Egypt
Hakimas and the school of medicine for women

In 1832, Muhammad Ali allowed Antoine Clot, known as "Clot Bey" in Egypt, to establish a School of Medicine for women. Clot-Bey had been invited in 1827 by Muhammad Ali to found the Qasral-‘Ayni School of Medicine at the Army hospital of Abou Zabel which later transferred to Cairo. The Army Medical School had a difficult beginning with religious officials against dissection of corpses for anatomy lessons.

The medical school for women would produce hakimas, "doctoress", to treat women and children. French women adherents of the Saint-Simonian social reform movement were living in Egypt during 1833–36 and studied or provided medical care under Clot Bey's direction. French sage-femme (midwife) Suzanne Voilquin writes of assisting during the cholera epidemic of 1834. Several of the French women contracted cholera and died.

Ali's military and economic goals required a healthy army and population from which young boys could be conscripted. Venereal diseases, especially syphilis, were common among soldiers and smallpox outbreaks led to high childhood mortality rates. Clot Bey argued that female-provided health care for women and children was crucial to maintain a healthy population. He believed that the untrained local dayas (midwives) were unable to provide appropriate care and under Egyptian law, male doctors could not treat women. Clot Bey's solution was a school to train female doctors.

The school of medicine for women followed a French model. The first two years of training provided Arabic literacy in order to communicate with patients. The following four included training in: obstetrics, pre- and post-natal care, dressing wounds, cauterization, vaccination, scarification, cupping, application of leeches, identification/preparation of common medicines. Students were provided housing, food, clothes and a monthly allowance from the state.

Graduates served at the Civil Hospital in Cairo or at health centres throughout Egypt. Some stayed at the school to serve as instructors. Marriages were arranged by the state to male doctors. Once married, hakimas were given the title of Effendi, the rank of second lieutenant, and a monthly salary of 250 piasters.

Licensed hakimas treated women and children, providing vaccinations and delivering children. They served a fundamental role in reducing the incidence of smallpox during the 19th century by vaccinating approximately 600 children a month in the Civil Hospital. They checked and treated women, mainly prostitutes, for venereal diseases. Another important task was the "forensic examination" of women. In this respect, hakimas operated in a legal setting. Their examination was used as evidence in cases involving unnatural death, suspected premarital loss of virginity, or miscarriage.

Although one task of the hakimas was overseeing childbirth, the majority of the population continued to use the dayas. Hakimas performed almost no deliveries and often were only called upon during difficult deliveries. However, dayas were required to have a certificate to perform deliveries, which could only be obtained from hakimas. They were also expected to report statistics on births to the hakimas.

A significant issue was recruitment of students. Egyptian culture at the time opposed the education of women. Therefore, the first students at the medical school were young slave girls. Slaves continued to be recruited through slave auctions as well as orphans from hospices. Despite the modest success of the school and its graduates, increasing enrolment remained a consistent problem, though the limit of 60 students was reached in 1846.

Contemporary and modern historians have viewed the creation of a school of medicine for women and the position of hakima as an example of modernization and reform for women under Muhammad Ali. Khaled Fahmy argues against this view. Fahmy states that, because the reasons for the creation of the school are primarily for the maintenance of a healthy army, the school was not a sign of reform but Ali furthering his military goals. For example, their treatment of venereal diseases was intended to curb its incidence among soldiers and smallpox vaccinations increased the pool of potential soldiers by reducing childhood mortality rate. Furthermore, the hakimas allowed for increased state control over social life. This is observed in the use of hakimas to collect statistics on childbirth, either personally or through dayas, as well as in the cases where a hakima was used to examine a woman.
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