1. The early history of midwifery in both England and France is punctuated by the names of outstanding women, particularly those who attended the royal court and the nobility. The old regime in France initiated continue

systematic training for midwives several times, but it was the revolutionary government's 1803 enactment that regularized and expanded instruction at the Paris Maternité. Trained midwives in France held their own against strong pressure from the male medical profession until late in the nineteenth century. In England, the male medical profession generally shunned the lowly manual craft of midwifery until after the Napoleonic Wars, when it became evident that obstetrical practice could be respectable and lucrative. Because men consistently and strongly opposed any instruction and licensing for midwives, untrained women like Dickens's Sairy Gamp continued to dominate the practice during the nineteenth century. Irving S. Cutter and Henry R. Viets, A Short History of Midwifery (Philadelphia and London: W. B. Saunders Co., 1964), 91-95; James Hobson Aveling, M.D., English Midwives, Their History and Prospects (London: Hugh K. Elliot, 1872, rep. 1967); Jean Donnison, Midwives and Medical Men: A History of lnter-Professional Rivalries and Women's Rights (New York: Schocken Books, 1977), 116-133; Shryock, The Rise of Modern Medicine, 50, 77, 83-84.

2. FO/285, Campbell, 24 December 1836.

3. Clot-Bey, Mémoires, 158.

4. Cutter and Viets.

5. See references for the Egyptian School of Medicine in chap. 2.

6. Max Meyerhoff, "Djarrah," in Encyclopedia of Islam, new ed., fasc. 30 (Leyden: E. J. Brill), 481-482; B. Carra de Vaux, "Tibb," ibid., Vol. IV (Leyden: E. J. Brill, 1927), 740-741; both authors point out that, in common Arabic usage, Hakim (Doctor) was the term applied to the scholar versed in the medical classics, while Tibb generally referred to a practicing physician. Government correspondence consistently referred to the women health officer as "hakima" in the nineteenth century.

7. Clot-Bey, Mémoires, 158.

8. Ibid., 159, ENA,

7. Clot-Bey, Mémoires, 158.

8. Ibid., 159, ENA,

9. Clot-Bey, Mémoires, 158; Abdal-Karim, 296.

10. ENA, Ministry of Education, register no. 2027, unn. commun, to the Khedivial Ministry, 17 May 1837.

11. Clot-Bey, Mémoires, 161, 281, 320, 322-333; "Institutions médicales au Caire," Gazette des Hôpitaux XII (1838): 3-4; Abd al-Karim, 303-304.

12. Ibid., 305. ENA, Ministry of Education, register no. 13, pt. 6, 6749: To the School of Medicine, 17 July 1845; register no. 2095, 104, 20 November 1844: Results of the Annual Examination at the School for Hakimas; register no. 2140, 10: Khedivial Order to the Ministry, 1 November 1851; portfolio 49, register no. 46, pt. 4, 1317, no. 298: To the Khedivial Ministry, 13 January 1847; portfolio 50, register no. 108, 147, no. 18: From the Medical Council, 9 October 1849. In the 1830s, the currency equivalents were one pound sterling = 100 piasters; one franc = 30 piasters; one dollar (U.S.) = 20 piasters. break

11. Clot-Bey, Mémoires, 161, 281, 320, 322-333; "Institutions médicales au Caire," Gazette des Hôpitaux XII (1838): 3-4; Abd al-Karim, 303-304.

12. Ibid., 305. ENA, Ministry of Education, register no. 13, pt. 6, 6749: To the School of Medicine, 17 July 1845; register no. 2095, 104, 20 November 1844: Results of the Annual Examination at the School for Hakimas; register no. 2140, 10: Khedivial Order to the Ministry, 1 November 1851; portfolio 49, register no. 46, pt. 4, 1317, no. 298: To the Khedivial Ministry, 13 January 1847; portfolio 50, register no. 108, 147, no. 18: From the Medical Council, 9 October 1849. In the 1830s, the currency equivalents were one pound sterling = 100 piasters; one franc = 30 piasters; one dollar (U.S.) = 20 piasters. break

13. Egyptian Gazette, no. 1, 3 March 1845, 1-2.

14. Abd al-Karim, 305; ENA, Ministry of Education, portfolio 50, register no. 163, 1054, no. 124: From the School of Medicine, 9 April 1851.

15. Ibid., portfolio 49, register no. 2099, 148: From the School of Medicine, 30 May 1844; portfolio 49, register no. 13, pt. 6, 2749, no. 608: To the School of Medicine, 17 July 1845.

14. Abd al-Karim, 305; ENA, Ministry of Education, portfolio 50, register no. 163, 1054, no. 124: From the School of Medicine, 9 April 1851.

15. Ibid., portfolio 49, register no. 2099, 148: From the School of Medicine, 30 May 1844; portfolio 49, register no. 13, pt. 6, 2749, no. 608: To the School of Medicine, 17 July 1845.

16. Abd al-Karim, 306.

17. ENA, Ministry of Education, portfolio 49, register no. 2096, 184: To the School of Medicine, 18 December 1844; register no. 2098, 169: Khedivial Order to the Ministry, 20 January 1845; portfolio 49, register no. 3, pt. 3, 844: To the School of Medicine, 17 January 1845; register no. 4, pt. 4, 2187: To the Medical Council, 1 April 1845; register no. 11, pt. 4, 4032: To the School of Medicine, 15 April 1845; register no. 13, pt. 6, 2799: To the School of Medicine, 1 August 1845.

18. Abd al-Karim, 305.

19. ENA, Ministry of Education, portfolio 49, register no. 27, pt. 2,777: To the School of Medicine, 27 January 1846.

20. Clot-Bey, "Institutions médicales au Caire," 4; Mémoires, 321.

21. Abd al-Karim, 309; ENA, Ministry of Education, portfolio 49, register no. 10, pt. 3, 2028, no. 281: To the School for Hakimas, 10 October 1845; portfolio 50, register no. 143, 772, no. 28: To the School of Medicine, 13 December 1849.

22. Clot-Bey, Mémoires, 160-161.

23. ENA, Ministry of Education, portfolio 49, register no. 2058, 39, 16 February 1837: Results of the Annual Examination at the School for Hakimas; portfolio 49, register no. 2068, 48: To the Khedivial Ministry, 24 December 1840. The first French directress, Suzanne Voilquoin, a member of the St. Simonian group, died in the plague epidemic in 1835. Clot then recruited Palmyre Gault, a graduate of the midwifery program at the Maternité in Paris; Guémard, Les Réformes en Egypte, 233.

24. Ibid., portfolio 49, register no. 2081, 119: To the Chief Tax Collector, 17 January 1843. The results of this initiative apparently left something to be desired, for six months later another government directive ordered that girls brought in from the streets should not be admitted to the school; they were unsuitable, being either too young or not virgins. Ibid., portfolio 49, register no. 2083, 92: To the School of Medicine, 18 July 1843.

23. ENA, Ministry of Education, portfolio 49, register no. 2058, 39, 16 February 1837: Results of the Annual Examination at the School for Hakimas; portfolio 49, register no. 2068, 48: To the Khedivial Ministry, 24 December 1840. The first French directress, Suzanne Voilquoin, a member of the St. Simonian group, died in the plague epidemic in 1835. Clot then recruited Palmyre Gault, a graduate of the midwifery program at the Maternité in Paris; Guémard, Les Réformes en Egypte, 233.

24. Ibid., portfolio 49, register no. 2081, 119: To the Chief Tax Collector, 17 January 1843. The results of this initiative apparently left something to be desired, for six months later another government directive ordered that girls brought in from the streets should not be admitted to the school; they were unsuitable, being either too young or not virgins. Ibid., portfolio 49, register no. 2083, 92: To the School of Medicine, 18 July 1843.

25. Clot-Bey, "Institutions médicales au Caire," 4; Mémoires, 321.

26. ENA, Ministry of Education, portfolio 49, registers no. 2090, 2099, Khedivial Orders to the Ministry, 8 and 9 July 1844; Egyptian Gazette, no. 27, 24 August 1846, 1.

27. ENA, Ministry of Education, portfolio 49, register no. 2098, 106. From the School of Medicine, 18 November 1844.

28. Egyptian Gazette, no. 1, 3 March 1845, 1-2.

29. Ibid., no. 46, 5 January 1847, 1-2. break

28. Egyptian Gazette, no. 1, 3 March 1845, 1-2.

29. Ibid., no. 46, 5 January 1847, 1-2. break

30. Duc de Raguse, Voyage de Maréchal Duc de Raguse (Paris: Chez l'Avocat, 1837), 307-309.

31. Herman von Puckler-Muscau, Egypt under Muhammad Ali, 2 vols. (London: Henry Coburn, 1845), 1, 232-233.

32. Yates, I, 509.

33. Schoelcher, 44-45.

34. ENA, Ministry of Education, portfolio 50, register no. 108, 147, no. 25: From the Medical Council, 3 December 1848; register no. 144, 821, no. 27: To the Chief of Police, 22 December 1849.

35. Antoine B. Clot-Bey, Introduction de la vaccination en Egypte en 1827 (Paris: Victor Masson et Fils, n.d.), 22-23.

36. Egyptian Gazette, no. 619, 13 July 1840, 3; nos. 101, 109, 113, 119, 123, 128; 21 February, 21 March, 21 April, 19 June, 18 July, 21 August, 1848, 1.

37. ENA, Ministry of Education, portfolio 49, register no. 2083, 18, 19: From the Medical Council, 26 February, 19 March 1843.

38. Egyptian Gazette, no. 84, 29 September 1847, 1.

39. ENA, Ministry of Education, portfolio 49, register no. 11, pt. 4, 3017, no. 348: To the School for Hakimas, 9 March 1845; portfolio 49, register no. 11, pt. 4, 3050, 3083, nos. 372, 390: To the School of Medicine, 21 and 31 March 1845; portfolio 49, register no. 94, pt. 2, 749, nos. 120, 122: To the School of Medicine, 17 and 18 November 1847; portfolio 50, register no. 163, 1054, no. 124: From the School of Medicine, 9 April 1851.

40. Godard, 17-21; "Modern Medical Schools," JEMA (1928), 356D and E; Hassan Effendi Mahmoud, "L'Ecole de Médecine d'Egypte," 399-400. According to Umar Tusin's study of Egyptians who studied abroad (p. 500), Tamurham married a pharmacist, Saleh Ali al-Hakim, who had completed undergraduate training at the School of Medicine in Cairo. Their daughter, Galila, also was educated at the school for hakimas and published a students' manual, A Guide to Obstetrics, in 1869.

41. See chap. 6, "The Conquest of Smallpox."

42. Said Abdou, "Preventive Medicine," in Health and Human Relations (Cairo: Ministry of Public Health, 1952), 9-18.

43. Karl B. Klunzinger, Upper Egypt, Its People and Its Products (London: Blackie and Son, 1878), 81.

44. V. Edouard Dor, L'instruction publique en Egypte (Paris: A. Lacroix, Verboeckhouen et Cie., 1872), 226.

45. Florence Nightingale failed to act on her good intentions to raise the professional status of midwifery as she had for nursing. Trained midwives then had no patron with sufficient social standing and political influence to challenge the medical establishment's implacable opposition to any reform in midwifery practice. Dr. James Aveling, one of the few nineteenth-century male advocates of improvement in midwifery, wrote in 1872 that, during continue

the 325 years since the first attempt in 1547, the Royal College of Physicians had defeated twenty organized efforts to license, regulate, and instruct midwives. Both on the continent and in the British Isles, midwives were disadvantaged by the fact that the professional class of general practitioners emerging in the nineteenth century continued to invoke medieval guild regulations that restricted the use of instruments to surgeons, and they were able to enjoin midwives from using forceps. British midwives faced the additional handicap that the upper classes promoted the snobbish fashion of patronizing male "accoucheurs," preferably French, like male coiffeurs, as a superior class of practitioner. The Colleges of Physicians and Surgeons responded to this competition by abolishing the membership bar against manmidwives when these practitioners adopted the title of "obstetrician" in the 1850s; Donnison, 57, 62, passim.