Short Communication

Commentary: the first hospital in Sudan 1826-1959 and the modern

medical health services during the Turco-Egyptian era 1821-1885
Tarik A Elhadd, MD FRCP FACE,

Department of Medicine, Dumfries & Galloway Royal Infirmary, Dumfries, Scotland

Sir, modernise his little kingdom were primarily

We read with interest the historical narrative French. These represented the first
entitled; The First Hospital in Sudan 1826- professionals and technocrats from Europe,
1959 by Professor Siddiq Ibrahim Khalil, we who would flog in big numbers to be
thought to make some comments. With such employed by the Pasha in the army and in his
context in the background, it would be helpful various civil departments. Among them was
to point out to some ironies when looking Antoine-Barthleme Clot, who is famous as
back at the roots of the modern healthcare Clot Bey.
services in the Sudan.
It is true that the modern history of the Sudan
began with the invasion of the Sudanese
hinterlands by the troops led by Ismail Kamil
Pasha, youngest son of Mohamed Ali, the
Egyptian Viceroy, who is credited for creating
the modern Egypt and contributed to laying
the foundations of modern Sudan. The
invading troops had the task of annexation of
the southern frontiers of Egypt, with the main
objectives of exploitation of its resources and
funnelling them into satisfying the imperial
ambitions of the ruling master of Egypt. The
new masters had no intention of laying the
foundation of any modern public services in
the same way Mohamed Ali was keen to
transform his Egyptian Kingdom into a
miniature of Europe. But, some good did
come out of the evil of Mohamed Alis
enterprise in the Sudan. The Pasha, had his
deepest sense of admiration of Napoleon. Clot Bey, above, and top, performing surgery
in Qasr Al-Aini, was the Institutions founder.
Many historians felt that he was his role
Mohamed Ali, right turned Qasr Al-Aini up to
model. No wonder that, the Viceroys 1828 a guesthouse, into a full-fledged hospital.
modern Mecca was Paris and France. Hence,
his first recruits from the Europeans to Clot was born in Grenoble in 1793 and
____________________________ studied medicine at Montpellier and then
Corresponding author started his career as a physician in Marseilles.
Tarik A Elhadd Nobody in France, Clot ascended to fame and
Email: tarikelhadd58@gmail.com fortune in Egypt. Clot was recruited initially
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 Short Communication
Commentary: the first hospital in Sudan Tarik A Elhadd
to help organise the military corps of
Mohamed Ali, and then he was shortly taken
as a private physician to Mohamed Ali
together with an Italian physician, Dr Gaetani.
Clot soon became the favourite of the Pasha
who could see his ingenious potentials. He
went on to establish the first medical school in
Egypt at Abu Zabal near Cairo in 1825. He
subsequently established the Egyptian medical
and veterinary services in 1827. Clot in his
early days in Egypt supervised the hiring of
many European doctors for el-Nizaam al-
Jadeed, and those were mainly French with
some Swiss, Germans and Italians. Many of
them were later transferred to work in the
Sudan. He was also the founding father of the
Egyptian Public Health Council. In 1854 Clot
Bey went on to establish Qasr el-Aini Hospital
which later hosted the old medical school of
Abu Zabal. Clot Bey trained many Egyptian
doctors who served in both Egypt and the
Turco-Egyptian Sudan(1,2,3).
Further it worth mentioning that the bulk of
the European doctors who worked in the early
period after the conquest and beyond were
primarily Italians. It is only intriguing to know
that the lingua franca of both Egypt and the
Turco-Egyptian Sudan for many years was
Italian(4). It is worth noting that the invading
army had many Italian doctors, many of
whom stayed in the Sudan and were running
private clinics. Ismail Kamil Pasha had
several Europeans. Among them were
scientists, geology experts, architects and
doctors. A mention was made of GB Brocchi,
a distinguished Italian scientist who died in
Sennar in 1826(5). Ismail Pasha in his
entourage had his own personal physician, his
protomedicio the Italian D Botzaris, and Dr
Andrea Gentili, an Italian physician and
dispenser, of significant repute in his heyday,
who was present during the earlier campaigns
against the Wahabites in Arabia. Gentili
perished at Merowe around the time of the
skirmishes with the Shaigiyyia and he was
thought to have been poisoned by Botzaris(6).
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The eldest son and regent of Mohamed Ali,
Ibrahim Pasha el-Wali, who later joined his
youngest brother Ismail Kamil in the Sudan,
had his private physician the Italian Antonio
Agostino Scotto, who died in Sennar from
what was described as black water fever(7).
To add a more panoramic historical dimension
to Prof Khalils article, the exact structure and
shape of the health service destined for the
native of the Sudan following the 1820
conquest was not clear. As correctly pointed
out by Professor Khalil, the service was
primarily destined for the troops and the
ruling elite. Even for the military troops the
service was selective and discriminatory. A
blurred picture could be drawn from the
excellent accounts by the Austrian Bohemian
trader Ignatius Pallme, who spent some time
trading in Kordofan in 1838. In his writings,
Pallme described el-Obeid as an
amalgamation of several villages similar in
appearance to each other(8). Those included
Wady Naghele and el-Orta (also called the
town of the Turks) and few others. In the
former, mainly resided the native traders,
principally the Danaqla and other Riverain
Sudanese, and El-Orta later harboured various
government buildings, military barracks, the
officers quarter and a hospital. He described
the hospital buildings as well various diseases
and health services as he saw them, and you
could sense that he was quite passionate about
what he witnessed. Describing the buildings
and amenities of the hospital at el-Obeid he
wrote The hospital consists of a few hovels
of clay covered with a straw roofing; they are
ill-ventilated, and, in the wet season, the rain
beats in upon the sick soldiers through the
narrow windows, as they are not furnished
with glass; the cold nights, moreover, proves
very severe trials, especially to those who are
suffering from smallpox. The invalid lies on
an angareb, and is left to his fate(8).
According to Pallme, the army medical
personnel were allowed to open private
clinics, where they even employ their
 Short Communication
Commentary: the first hospital in Sudan Tarik A Elhadd
subordinates, to boost their income. So the
health service destined for the natives was
delivered by proxy rather than by a dedicated
service per se provided by the ruling regime.
It is true that since the early period of the
Turco-Egyptian rule the French played a
major role in the health services, not only
through the earlier influence of Clot Bey. The
French Cult Saint-Simonian, which was a
religio-sociological cult, founded by Claude
Henri Comte de Saint-Simon, played a crucial
role in the technical administration and the
civil services of Egypt and the Turco-Egyptian
Sudan. Bartheleme Prosper Enfantin, who was
a leading figure of the Sect came to Egypt to
join the services of the Pasha and through him
many other members were recruited. Several
French physicians from the cult worked in the
military hospitals established in various parts
of the Turco-Egyptian Sudan. Many of them
were mentioned in the journal of Reboul, a
French trader and a Saint-Simonian. Reboul
first came to Sudan as a Clerk with Georges
Thibaut, a well versed French merchant in the
early years of the Turco-Egyptian Sudan.
Thibaut was also a live game hunter who once
procured Giraffs to London Zoo from
Kordofan. Reboul joined Thibaut during that
venture in 1834, and he wrote a journal which
was translated later by Santi & Hill (1980)
(Santi & Hill op. cit.)(4). In that journal,
several European doctors were mentioned to
have been in the employment of the Egyptian
military service in the Sudan. Dr M Gallina,
an Italian doctor, who worked in Kordofan. It
is interesting that he was mentioned by Pallme
as to have been lost on travel between
Dongola and el-Obeid and he could only
survive after he resorted to drinking the urine
of his camel (Hill 1951 op.cit.). Dr Gallina
was reported to have died eventually in
Galabat near Gedaref on the Abyssinian
border in 1838. Others included Dr M
Drouart, a French who was the military
medical officer stationed at Dongola, Saint-
Andr a military pharmacist who
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Sudan Med J 2014 August;50(2)
accompanied the French traveller Edmund
Combes to Dongola in 1833, and Dr M
Landini, the senior medical officer at El-
Obeid military hospital. Also in the same
journal there was a mention of Mr Lascari, a
Greek who was senior pharmacist, and Mr
Tiran, a French pharmacist at the same
hospital.
At the beginning of the reign of Ismail Pasha
in the early 1860, and during the Governor
Generalship of Gaafar Mazhar Pasha (r. 1863-
1866), the health service would reach a
climax. There was a hospital in each
Mudieriyya of the Turco-Egyptian Sudan.
These included Dongola, Berber, Khartoum,
Sennar, Kordofan, Taka (Kassala), Suakin.
The hospitals had a total capacity of 438 beds.
These were divided as follows; Dongola
Hospital 15 beds, Kassala 38, Berber 20,
Kordofan 35, Khartoum 270 and Sennar 60(9).
In 1862 the first Egyptian physician to be
appointed to a senior medical post in the
Sudan was Dr Hassan Bey Hashim (1825-
1879). Dr Hashim, who initially studied
pharmacy in the Pharmaceutical School at
Cairo, was sent to France in 1847 for further
studies in pharmacy, but instead he took
studies in medicine and went on to specialise
in obstetrics. On his return to Egypt in 1862,
he took up the post of Assistant Director of
the Egyptian School of Medicine. He was sent
on several missions to the Sudan, and in 1863
he was appointed Chief Medical Officer at
Khartoum during the tenure of the Sudanese
notable, Sheikh Ahmed Bey Awad Alkariem
Abu Sinn, Governor of Khartoum and Sennar.
As another interesting note, Gaafar Mazhar
Pasha, was likely to be the first advocate of
training of Sudanese in medicine during that
era. He was reported to have recruited twenty
Sudanese elementary school pupils to learn
the rudiments of medicine and dispensing
under the guidance of the Principal Medical
Officer of the Sudan the Egyptian Dr Hassan
Bey Hashim. However, and intriguingly
enough, the Viceroy forbade the training of
 Short Communication
Commentary: the first hospital in Sudan Tarik A Elhadd
Sudanese assistant doctors in Khartoum,
which prompted Mazhar Pasha to request
more doctors from Cairo. This gave rise to
exchange of correspondence between the
centre and the periphery, and Mazhar Pasha
was demanded to justify his claims. Here we
quote Richard Hill; in a sobering report,
pointed out the drastic limitation of the
country, with only one senior doctor at each
province headquarter there could be neither
general vaccination nor registration of births
and deaths(10). The 1873 official report of the
Governor General at Khartoum stated that
there was a hospital in Dongola, Berber,
Khartoum, Fung, Kordofoan, Taka and
Suakin. In that same year two more hospitals
were opened in the southern part of the
country at Fashoda and Lado in Equatoria(11).
Dr Khalils mentioned that the missionary
doctor and explorer, William Felkin, who
spent sometime in the Sudan during the first
tenure of Gordon Pasha made favourable
comments about the public health of
Khartoum which were contradictory to that of
the Italian doctor and explorer Dr. Pellegrino
Matteucci who described the situation there
as horrible(12). Gordon soon after he assumed
office tried to make reforms and improvement
in health and education. However, he was
preoccupied by other political matters, which
were his prime tasks, and into which he put
most of his energies(13). In his efforts to re-
organise the service, he appointed the Greek
physician Gheorgios Demitrios Doulglou as
the chief inspector of public health with a
mandate to improve health and sanitation of
the country(14). As Douloghlou achieved little,
Gordon next turn to his British native Dr
David Lowe, who was at the time in Cairo. He
persuaded Lowe to take the post of the chief
medical officer for the army in Sudan which
he accepted in 1879. Dr Lowe first began his
service in Sudan in the Egyptian Government
service and was commissioned as a medical
officer during the initial phase of building a
railway line at Wadi Halfa in 1875. That
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railway line was planned to link Al-Dabba to
el-Fashir. In 1876 he was appointed by Ismail
Pasha Ayyub, then Governor General of the
Sudan to the post of the Chief Medical Officer
of the Sudan, then left back to Egypt.
However, Lowe spent most of his time touring
the provinces and he suffered from prolonged
ill health which forced him eventually to
resign and left back to Egypt in 1880(15).
During the reign of Charles Gordon the
hospital in Khartoum witnessed the first
European nurses, the Verona Sisters, the
Catholic nuns who were attached to the
Catholic Mission in Khartoum. Indeed,
Charles Gordon requested Daniel Comboni to
help to staff the other hospitals in the
provinces with more nuns to be recruited from
Italy(16). Such request was passed by Comboni
to his superiors in Rome, however, the Verona
Sisters already in Sudan suffered chronic ill
health and the dream to staff more hospitals
with nuns remained unfulfilled(17).
The early 1880s witnessed the beginning of
the Mahdists revol, so little attention was
paid to make any further reforms in the health
services. The large Egyptian hospital in
Khartoum, which was staffed by several
doctors, their senior member during the final
chapter of the crumbling state was Dr Nessib
Salim who was assisted by Dr Hassan Effendi
Zaki. Zaki was to play an important role in the
medical history of the Sudan in years to come.
Dr Nessib Salim was renowned during his
time there as physician and surgeon of repute,
operating on bladder stones, Madura foot,
abscesses and wounds. Chloroform was
available as anaesthetic. During the siege of
Khartoum by the Mahdi, it was recorded that
Gordon would visit the hospital daily
bestowing materials and morals on the
inmates Syphilis, dysentery, trachoma and
bilharziasis were the main scourge. Measles
was particularly fatal among children with
mortality of about 10% (Bloss & Cruickshank,
op cit).
Certainly the first hospital in the Sudan went
 Short Communication
Commentary: the first hospital in Sudan Tarik A Elhadd
in disrepute following the Mahdiyya, but its
resurrection after the Reconquest gave a new
prime move which helped to set up a strong
platform of what went on to be a model health
services in the world by the 1940s and 1950s.
Such high reputation led many British doctors
from leading institutions like Cambridge and
Oxford to flog to the Sudan seeking a fortune
and career furthering (K Owen, Sudan
Interlude 2008 & Bill MacGowan, personal
communication)(18). A final point to make is
the amazing relationship between the River
Hospital, its mother hospital and tuberculosis.
When the military hospital was re-built in
1901 its senior medical officer was Bimbashi
Steven Lyle Cummins, a distinguished
Irishman from Cork. Lyle Cummins was a
member of the RAMC who was involved with
the Nile Campaigns from its outset and was
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Sudan Med J 2014 August;50(2)
present during the Battle of Omdurman
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