THE YALE JOURNAL or BIOLOGY AND MEDICINE 48, 251-257 (1975)

Clot-Bey: Founder of Western Medical Practice in Egypt

GERARD N. BURROW

Department of lnternal Medicine, Yale University School 0f Medicine, 333 Cedar Street, New Haven, Connecticut 06510.

Received March 27, 1975

 

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Thomas Wakely provided the only description in English about Antoine-Barthélémy Clot, better known as Clot-Bey, in a Medical Portrait in Lancet in 1833 (1). In his introduction he stated: “If then we are to appreciate the character of Clot-Bey, either by the vastness, the value, or the peculiarity of his labours, we must at once place him in the first rank of the most eminent practioners of medicine of the existing era.” This accolade was especially directed toward his founding an entire system of western medical practice in Egypt over a 7-yr period. During this time he had been able to establish a military medicine service and public health service as well as a medical school at Abou-zabel which had trained over 150 physicians including a native faculty.

Egypt at the time was part of the crumbling Ottoman Empire. However, Napoleon Bonaparte’s incursion had been the basis for a continuing French influence. In 1798 Napoleon’s expedition to Egypt embarked from Toulon with the objective of conquering Egypt, ousting the British from India, and, on the return trip, crushing the power of the Sultan. From a military point of view the foray was a disaster.

However, the expedition directly affected the lives of two obscure individuals, one of whom, Mohammed Ali, was to found the last Egyptian dynasty, and the other, Antoine Clot, was to become a world-renowned physician.

When Napoleon’s intentions to invade Egypt became known, Turkey mobilized  troops from all over its sprawling empire to fight the invaders. Among those mobilized was a Macedonian, Mohammed Ali, who became a colonel in these defending forces (2, 3). Egypt at this time was under the harsh rule of the Mamelukes, mercenary troops, who had been imported by the Arabs in the Tenth Century as slave warriors. From this humble beginning, they gradually grew in power and eventually founded a Mameluke dynasty under the aegis of the Sultan with each Chieftain having the title of Bey. Although Napoleon’s expedition to Egypt did not accomplish his strategic military objectives, he did break the power of the Mamelukes. The downfall of the Mamelukes set the stage for Mohammed Ali to become Viceroy and Pasha of Egypt and founder of a dynasty that ended ingloriously with King Farouk in 1952.

Monsieur Clot, a sergeant major in Napoleon’s army, had left his wife and 5-yr-old son, Antoine, to join the expedition to Egypt at Toulon. However, illness forced him to abandon the expedition and return to his home in Grenoble where the Clots led a very modest existence (4, 5). Young Antoine apparently did not go to primary school but was taught at home by his father and his aunt, a nun who had been forced to leave the convent during the French Revolution.

His father’s health finally forced the family to move from the harsh wintes of Grenoble to the milder climate of Brignoles when Antoine was 15. Monsieur Clot also wished to be near an old army comrade, Monsieur Sapey, a retired military surgeon who directed a convalescent military hospital there. Brignoles was on the road from Nice, and numbers of soldiers returning from the Italian campaign’ had stopped and remained in the town. Monsieur Sapey encouraged the boy and took young Clot with him to visit his patients as well as let him read what was available from his small medical library.

Monsieur Sapey was elderly and palsied, and the boy was trained to perform clinical procedures such as paracentesis under his direction. Clot’s first operation was the removal of a sebaceous cyst which he preserved in alcohol and carried with him as a memento for the next 20 yr. Perhaps a hint that Antoine was not merely a country boy who enjoyed playing doctor could be found in the fact that after Monsieur Sapey retired for the night, Clot had made an arrangement to learn pharmacy from an apothecary.

The elder Clot died in 1810 when Antoine was 16. An only child, Antoine remained in Brignoles with his mother another 3 yr learning the trade of medicine. Finally, in 1813, he decided that there was no future in the small town, and leaving his mother there, set out for Marseille. His possessions for the journey included several medical books, a cheap surgical kit with three or four lancets, a gold watch which was a legacy from his father, and his sebaceous cyst in alcohol.

Marseille was a bustling port city in the early l800s, and not knowing anyone, Clot wandered around the city looking for work. He quickly ran out of money and was forced to sell the gold watch, but finally solved his financial problems by going to work for a barber—surgeon. Shortly afterward, he had the good fortune to meet a childhood friend from Grenoble who was then a medical student in Marseille. The friend was very helpful and lent him medical books; more importantly, he gave him an introduction to the Hotel Dieu, the city hospital. Clot did well in the entrance examinations, and at the age of 22, was admitted as a student externe which provided him with room and board. He was considered to be the best student of the group and was appointed in succession, Assistant Chief Surgical Interne, Chief of Anatomy, and Aide in the Dispensary. Despite this success and advancement, he was unable to support his mother on his small salary, and finally made the decision to become a health oflicer in some rural village. He took the examination on September 30, 1817, and performed so well that the senior examining physician encouraged him to continue and take the degree of Doctor of Medicine. Despite his mother and his penurious circumstances, he apparently needed little urging. The chaplain of the Hotel Dieu tutored him in Latin and on May 2, 1819, he went to the University of Aix en Provence and returned with the necessary medical school prerequisite degree of Bachelor of Letters.

With these qualifications he was accepted at the Faculty of Medicine at Montpellier, one of the most prestigious schools in Europe. With the title of health officer and his previous hospital service, he was allowed to skip 3 yr of medical school studies. Some evidence of his motivation to obtain the medical degree may begathered from the fact that he walked on foot between Montpellier and Marseille on four different occasions that year, a distance of about 100 miles each way. However, this perseverance was rewarded and on July 24, 1820, he successfully defended his thesis “Research and Observations on Spinitis or Inflammation of the Spinal Cord made by me at the Hospital at Marseille.” With this degree in hand, he was made assistant surgeon at the Hotel Dieu in Marseille. However, not content with an M.D. degree, he continued his education and on February 23, 1823, he returned to Montpellier to present his thesis for Doctor of Surgery. This successful thesis was entitled Dangers of the Instrumental Manipulation in Obstetrical Delivery.”

From the background of an unschooled soldier’s son, Antoine Clot had risen to hold the twin degrees of Doctor of Medicine and Doctor of Surgery, a remarkable occurrence in 1823. At this point, his brilliant career became clouded. Euziere has suggested that because of his success and his vigor in defending his views he was dropped from the Academic Society of Medicine of Marseille and was forbidden to give lessons in the hospital (4). There seems to be little question from his later behavior that he was egotistical, obsessive, and intolerant.

At this nadir in his career, Clot made a decision that was to subsequently bring him world fame. Mohammed Ali, now viceroy of Egypt, was determined to keep his army in good health for military reasons and to this end sent emissaries to France to recruit physicians. Clot was intrigued by the ofler, perhaps largely because there appeared to be no future in Marseille. On January 25, 1825, he left for Cairo on the ship “Bonne Emilie” accompanied by 20 young European physicians who were to assist him. Clot arrived in Egypt with the title of Surgeon-in-Chief of the Armies.

There was no medical care system in Egypt at that time and he began by instituting French Army regulations for the Egyptian army camps. Gastrointestinal illnesses, particularly dysentery, were common as were eye diseases. Tuberculosis was rare, but venereal disease was common. Smallpox epidemics occurred intermittently and were brought from the interior of Africa across the Sahara.

In order to keep the army healthy, he convinced Mohammed Ali that it was necessary to raise the health standards for the general population, and he made smallpox vaccination mandatory for the civilian population. However, these medical reforms were not popular with the Ulemas, or religious leaders. With a finesse that may well have been Mohammed Ali’s, he created a council of health on which he placed both the opposition and his friends. With the council behind him, he reorganized the hospitals to make them consonant with Western medicine ofthe day.

In order for this reorganization to be meaningful, he accomplished the truly remarkable feat of founding a medical school for 300 students at the 1500 bed military hospital of Abou-zabel which was located just outside of Cairo. He patterned the medical school after the military hospital in France and imported French, German, and Italian professors to teach. These instructors knew no Arabic and the students knew no French. Clot solved this communications gap by finding interpreters and making them medical students and eventually instructors. Religious objections, however, were a more difficult problem. Moslem law demanded respect for the dead and forbade mutilation; as a consequence, anatomical dissection was forbidden. The opening of the school of Abou-zabel was the high point of the indignation of the Moslem fanatics. One day in the middle of an anatomy demonstration, a fanatic student stabbed Clot, but the knife glanced ofl his ribs and he was not seriously wounded. Probably with the help of the Viceroy, he appealed to the Ulemas themselves, and was able to convince them that they could augment their own influence by learning this new medical science. Several Ulemas did become medical students and later assistants at the medical school. One of them, Seid Ahmet-er-Rachidi, composed an Egyptian medical vocabulary of 6000 words. Clot helped to assuage the religious difficulties by making concessions to the Moslem religion. Ramadan, the Moslem holy month, was made a l-mo holiday for the medical school. Moslem law forbade a wife to be seen by a man other than her husband. This made it impossible for men to practice obstetrics and gynecology, but Clot solved  the problem by recruiting black and Abyssinian female slaves whom he taught in a separate school of midwifery.

The medical school at Abou-zabel was divided into four different sections with different curricula. The first section was for physicians and the courses included:

Anatomy and Physiology

Hygiene and Medical Jurisprudence

Pathology and In-Patient Care

Pathology and Out-Patient Care

Surgery and Obstetrics.

The second section was a veterinary school. The third, a school of pharmacy, had courses in:

Physics or Natural Philosophy

Astronomy and Meteorology

Chemistry and Pharmacy

Botany and Zoology.

The fourth section was the school of midwifery.

Clot periodically published a series of monographs outlining the accomplishments of the school. In 1830 he published the first, in which he summarized the accomplishments of the school which was then in the third year of operation (6). Clot brought an outside examiner from Europe to give the students an oral examination in public and then a written test. Three hundred questions were asked in the course of the examination, and all of the students passed. Doctor Pariset, who was the chief outside examiner, later wrote the Viceroy that European students would not have done better in the examinations. If this indeed were true, Clot in the span of 3 yr had been able to found a Western-style medical school and produce Egyptian students that were the equal of their European counterparts.

During this period, Clot entertained Alexandre Dumas who was visiting Egypt. Dumas wrote of his visit with Clot in a monograph entitled Quinze Jours Au Sinai (7). The visit took place on April 22, I830, and Dumas and his company were taken on camels to visit the medical school at Abou-zabel. Dumas wrote that there were diseases like leprosy and elephantiasis that were not found outside of the Bible and that the entire book of Job could be found in the hospital. The company returned to Clot’s magnificent mansion in Cairo for dinner where each of the guests lay on a couch attended by his own servant. The guests were bored by the Egyptian music, but this was followed by four dancing girls and finally, a very attractive dancer who gradually shed all her clothes. Dumas was impressed by the expense of the evening and estimated that one could buy six or eight slaves for the same amount.

In 1831 a major cholera epidemic broke out in Egypt, and the older medical students were pressed into active service with great success. Partly because of this success and probably also because of his warm relation with the Viceroy, Clot was given the rank of colonel and later appointed general. He also became the first Roman Catholic to receive the title “Bey,” and hence forth was known as Clot-Bey, the title of Mameluke chieftains. Clot-Bey’s relationship with Mohammed Ali was an interesting one. Although the Viceroy theoretically ruled Egypt in the name of the Ottoman Empire, he was in fact an absolute ruler as Turkey was too weak and too far away to interfere.

In an anti-slavery monograph entitled Egypt and Mohammed Ali published in London in 1841, Dr. R. R. Madden described the Viceroy as a harsh, but at times fair, and impartial ruler (8). This description occurred despite the fact that Madden, with justification, thought Mohammed Ali was in favor of slavery and estimated that as many as 4000 slaves a year were brought to Cairo. Madden in the same book condemmed Clot-Bey for stating that the formation ofa regular army in Egypt had general benefits to the country in terms of health care. (This was unquestionably true because Mohammed Ali was primarily interested in his army and only secondarily in the health of the people.) However, Madden did state that Clot-Bey had done an excellent job in organizing the medical service and public hospitals in Egypt. Clot-Bey was apparently able to overlook the less desirable aspects of Mohammed Ali and staunchly defended him.

In 1832 Clot-Bey departed for Paris with 12 of his brightest students. This was to be a tremendously successful trip, and he received accolades wherever he went. It was during this trip that Clot-Bey went to London and visited Thomas Wakely. He traveled in his full uniform which he had designed himself, complete with turban and scimitar (fig 1)

clot-bey founder of wetern medical practice in egypt.jpg
Clot-Bey : FIG 1

He visited his mother in Marseille and her great concern was whether he had become a Moslem during his stay in Egypt. He was very sensitive about this religious issue and went to great pains to show that he was a true Christian. During his stay in Paris in I831, he had an audience with King Louis Phillipe and asked permission to wear the cross of Saint Sepulcre on his uniform. He felt that wearing the cross and the crescent simultaneously was one way to show that he had remained a Christian. Pope Pius IX subsequently made him a count of the Holy Roman Empire.

In 1835 plague broke out in Egypt and during a 3-mo period, 31,000 people died in Cairo. Although quarantine was practiced in Egypt, Clot-Bey believed that plague was not contagious, and that quarantine was useless. Controversy swirled around him over this position and in 1840 he published De La Peste Observée en Egypte (9). The book was divided into five chapters: (1) Description, (2) Origin, (3) Etiology, (4) Contagion vs Noncontagion, and (5) Prophylaxis. Apparently, the day after his arrival in Egypt in 1825, Clot-Bey had examined a French sailor in Alexandria with Plague. No one else subsequently became ill, and he began to wonder about the contagiousness of the disease. He therefore decided to do some experiments on the contagion theory of plague. During the epidemic in Cairo he innoculated dogs with blood and pus from plague victims without any of the animals developing disease. Clot-Bey also performed experiments on five condemned Egyptian prisoners. One prisoner who wore the shirt of a plague victim and stayed in his bed, developed plague 4 days later and died. Three others developed buboes but recovered; the fifth prisoner remained asymptomatic.

Clot-Bey made a statement that in Egypt of the 1830s, and perhaps even today in the era of clinical investigation committees, seems remarkable: “To justify what we had dared to do to others, M. Bulard and I thought we should run similar experiments on ourselves” (9). Monsieur Bulard wore the shirt of a plague victim without any harmful effects. Clot-Bey innoculated himself with the blood from a plague patient and several days later with the pus from a bubo. Following the innoculations of the pus, Clot-Bey had malaise for several days but no symptoms of plague; why he and the others did not develop plague is not clear. However his experiments confirmed his belief about the lack of contagiousness of the disease, and he continued to preach against the contagion theory.

After several emotional entanglements, he eventually married Mademoiselle Gavoty at the age of 47. The Clots had a daughter who was born in Egypt; his mother who came to visit him in Egypt, died there, and was interred in the Christian cemetery in Cairo. Mohammed Ali died in I849 and his successor Abbas-Pasha discharged Clot-Bey who returned to Marseille. Clot-Bey died there on August 28, 1868, a commander of the Legion of Honor, with numerous Egyptian and European decorations, and membership in most of the prestigious medical societies of Europe.

 

ACKNOWLEDGMENTS

 

Much of the information on Clot’s early life was obtained from a series of articles by Jules Euziere. I would also like to thank Mademoiselle Tricart, Assistant Librarian of the Faculty of Medicine of Marseille and Mademoiselle Bourlard-Collin, Curator for the Museums of Archeology in Marseille, for their assistance.

 

REFERENCES

 

  1. Lancet. Lancet Gallery of Medical Portraits, pp. 88-91, April 3, 1833.
  2. Sabry, M. “L’Empire Egyptien Sous Mohammed-Ali et la Question D’Orient.” l8ll—l859. Paris,1930.
  3. Dodwell, Henry. “The Founder of Modern Egypt.“ Cambridge, 1931.
  4. Euziere, Jules, Clot-Bey, Docteur de Montpellier, Fondateur de la Faculte de Médecine du Caire. Mon speliensis Hippocrates: 5, 7, September, I959.
  5. Jahier, H. and Ducassou, J. Un Urologue Marseillais Meconnu: Antoine Clot. J. Urol. Nephrol. (Paris I 73, 343-345 (1967).
  6. Clot, A. “Compte Rendu des Travauz de I’Ecole de Medicine d‘Abou-zabel.“ Marseille, I830.
  7. Dumas, Alexandre. “Nouvelles Impressions de Voyage. Quinze Jours Au Sinai.” Paris, 1839.
  8. Madden, R. R. “Egypt and Mohammed Ali. » London, l84l.
  9. Clot, A. B. « De La Peste Observée en Egypte.” Paris, I840

 

 

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