Institutions figure prominently in the historiography of medicine in the Middle East and North Africa. It was medical schools where physicians were trained and in hospitals and clinics where the sick became patients. These institutions figure especially prominently in the history of Egypt where they formed relatively early in comparison to other places in the region and in some cases, as with the hospitals at Qasr al-‘Ayni and ‘Abbasiyya, continue to function. During the British occupation of Egypt, public health outreach was minimal; the relatively small numbers of Egyptians who received allopathic care did so at institutions. The landscape of medicine shifted in the interwar period as a more activist Public Health Department directed interventions in the towns and villages of the countryside, aided by foreign organizations that included the Rockefeller Foundation. During the 1950s and 1960s, public health outreach expanded even further under the populist-authoritarian regime of Jamal ‘Abd al-Nasir and with the formation of a more robust public health international that participated in a wide range of programs based in Egypt. The co-existence of allopathic medicine and public health in Egypt raised a distinct set of questions concerning the roles of doctors and patients and the interactions among these groups. Using documents from the archives of the World Health Organization, publications aimed at Egyptian physicians, and the records of medical research conducted in Egypt, this paper explores the ideas and practices that surrounded the roles of doctor and patient in allopathic medicine and in public health and the tensions among them. It is specifically concerned with evolving notions of what defined “consent,” ideas about patient rights, and the significance of context and scale in shaping both of these concepts. These issues were complicated by class -- the poor were disproportionately represented as patients of institutions as they were objects of public health – as they were by the “field” of public health which was often the very environment in which rural communities lived and worked. While the object of biomedical intervention in the United States and Europe was most often the individual body of the patient, in Egypt, the outsized role occupied by public health blurred the boundaries between individuals, communities, and the environments in which they lived.

This project is situated at an intersection between psychoanalytic theory, psychiatry, disease, capitalism, and the colonial project in British-occupied Egypt. It focuses on pellagra, a condition that today’s medical community understands to be caused by a nutritional deficiency in niacin (Vitamin B3). The sources for my project are Egyptian government records such as the “Annual Lunacy Division Reports,” contemporary scientific and medical journals, and other publications that were produced by both British and Egyptian doctors and psychiatrists. Pellagra afflicted a significant number of patients in Egypt’s state mental asylums. These patients were primarily fellaheen from Lower Egypt who, in the switch to perennial agriculture, shifted to maize cultivation as the staple of their diet. Throughout the British occupation, colonial psychiatrists argued that pellagra, described as a “disease of poverty,” was the leading cause of insanity in Egypt. Additionally, “pellagra insanity” was the most common type of madness that the doctors diagnosed in asylum patients classified as “criminal lunatics.” The European medical community was in an open debate about the exact cause of pellagra. The fellaheen who suffered from the condition also had their own understandings of what was happening to them. Pellagrous patients reported that they were possessed by devils, heard the voices of saints, were victims of sorcery, had poison in put in their stomachs, and other symptoms that Western psychiatry would pathologize as schizoid. My paper takes these accounts seriously, rather than dismissing them as anecdotal, unimportant, or merely bizarre. I approach “pellagra insanity” with a Lacanian psychoanalytic lens, arguing that although subaltern voices cannot be “written-in” to the colonial archive, it is possible for the truth of a situation to be articulated in moments when the consistency of the world is “tripped up” by a failure of language—an encounter with what Lacan calls the real. I read both the doctors’ observations and the patients’ descriptions of their experiences as coeval. That is, they are equal in their contradictions, slips, and gaps and in their potential for revealing something true in these instances of lack. This project asks what is revealed when the fellaheen are taken as literally as their doctors. Such a reading means thinking of pellagra as actually caused by a form of malevolent sorcery: perhaps that of an invasive global capitalism that extracted the lifeforce from Egypt’s fellaheen, changed it into surplus-value, and left them with poison in their stomachs.

In his 1946 book, One Hour of Justice: The Black Book of the Egyptian Hospitals and a Fellaheen Charter, Arthur Cecil Alport decries the corruption with which he sees Egyptian hospitals to be riddled. Alport arrived in Cairo in 1937 to assume his duties as chair of medicine in the Faculty of Medicine at King Fouad I University (now Cairo University) and worked there for six years under the deanship, for the first three years, of Ali Pasha Ibrahim, a pioneer of Egyptian medicine and surgery. The years during which Alport practiced medicine in Egypt witnessed significant political turmoil and important changes in medical structures. Alport saw his book as an intervention on behalf of the “sick-poor” of Egypt. Despite being reportedly discouraged by many elite foreigners living in Egypt who deemed as futile his “crusade” for reforming the healthcare system, Alport butted heads with Egyptian medical elites, including Ali Pasha Ibrahim, and was determined that the way to “make a dent” was to alert “public opinion in the British Empire and America” to the suffering of the poor. Between his idealization of the fellaheen as the authentic Egyptians, his positionality as a colonial physician extolling the virtues of British medicine and Britain’s responsibility for the sick-poor of Egypt in the face of the “incompetent and corrupt” Egyptian elites, and his alternating quotes from Lord Cromer and Hadiths from the Prophet Muḥammad, Alport offers in his book a fascinating window into the complicated world of colonial reformers and the “white man’s burden.” In addition to examining the (semi-)colonial context of Alport’s tome, the paper explores the book’s translation into Arabic in 1951, its subsequent republication in various Arabic editions, and its reception by Egyptian doctors, including many engaged in the movement to reform the healthcare system, especially after 2011. The book’s reception among beleaguered Egyptian doctors poses important questions complicating the postcolonial reading of colonial endeavors in health justice and the social and political roles of doctors and providing an example of the paradoxes of the postcolonial redemption of the colonial. Relying on textual analysis of the book, germane archival sources, as well as interviews with Egyptian doctors involved in the struggle for health and social justice, the paper attempts to critically examine the power dynamics of colonial health reform, the notion of persistence of grievances and how some colonial endeavors reverberate in postcolonial spaces.

This paper addresses the cultural authority of modern psychiatry in the late 1930s Lebanon. It introduces a new reading of the institutionalization of the feminist Nahda literary critic and translator May Ziade at the Lebanon Hospital for Mental Disorders, by exploring the biotechnologies and social lives of her diagnosis: Involutional Melancholia. The paper combines multiple forms of research based on the archival records of the Lebanon Hospital for Mental and Nervous Disorders, as well as research on the psychiatric genealogy of Involutional Melancholia within the history of psychiatry, and primary and secondary sources, including biographies and literary manuscripts. I trace the scientific-making of Involutional Melancholia between Europe and Lebanon, looking at the practices and diagnostics through which certain kinds of women in late 1930s Lebanon could “slip” into psychiatric institutionalization, becoming outside the margins of society. Ziade’s institutionalization led to a raging public debate over women, madness and mental illness, the echo of which still vividly resonates in literary and intellectual circles, among archivists, scholars and feminists today. By engaging the expertise of modern psychiatry with these debates, this paper approaches the clinical encounter as a site of knowledge-making that impacts cultural understandings of gender, mental illness and social pathologies, and delimits the promises of Arab modernity itself.