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“If you give not of yourself, you have given nothing”

Samia Ayad

22 Jul 2015 11:07 pm

Naguib Mikhail Mahfouz (1882 – 1974) 
The month of July brings with it the memory of a man who became a pillar of modern Egyptian medicine: Naguib Pasha Mahfouz. Professor Mahfouz was born on 5 January 1882 and died on 25 July 1974. Watani commemorates the great man
The name Naguib Mahfouz might bring to mind the Egyptian novelist who lived from 1911 to 2006 and, in 1988, won the Nobel Prize in Literature. Yet long before that, in 1882, Egypt gave birth to another legend who first bore the name Naguib Mahfouz.
Not everyone knows the story behind the name of these two honourable Egyptians. The older Naguib Mahfouz was a renowned obstetrician, the first in Egypt where, until the early 20th century, babies were born at the hands of midwives or in extreme cases surgeons. On a bitterly cold night in December 1911, a father knocked on the door of the famous obstetrician and asked him to come to the rescue of his wife who was having a very difficult delivery that threatened her life. Dr Mahfouz immediately went with him; they boarded a horse-drawn carriage and arrived at the middle-class neighbourhood of Gamaliya at midnight. The dawn hours saw a happy, healthy mother holding her baby in her arms. The elated father named the newborn baby after the doctor, and that was the boy who grew up to be the Nobel Laureate Naguib Mahfouz.
Early life
Watani talked to Dr Mahfouz’s grandson Dr Samir Simaika who followed in his grandfather’s footsteps and became a prominent obstetrician and gynaecologist in his own right. Dr Simaika has fond memories of his grandfather.
“Naguib Mahfouz was born on 5 January 1882 to a well-off Coptic family in the Delta town of Mansoura. He had a precarious start to life, with everyone believing he was stillborn. The midwife took him for dead until, half an hour later, his aunt noticed that the baby was breathing feebly every few minutes. The midwife wrapped him up and did what she could to resuscitate him.” 
The young Mahfouz attended the American Mission School in Mansoura, then the government elementary school where his teachers noticed how brilliant he was and gave him special attention. Later on, with his brother Farid, he moved to Cairo where he joined the Tawfiqiya Secondary School and obtained the baccalaureate certificate after three years of study instead of the customary five. His name was at first announced ranking him 19th among the top students in the country but, owing to an unexpected error which prompted a recalculation of the students’ marks, it was found that Mahfouz had scored the highest grades, making him the topmost ranking student nationwide.
“In 1898 Mahfouz joined the Qasr al-Aini Medical School in Cairo, and in 1904 he was appointed supervisor of surgical anaesthetics at Qasr al-Aini Hospital,” Dr Simaika says. “In 1902, an outbreak of cholera in the village of Mousha in Assiut, Upper Egypt, led him to volunteer to help combat the growing epidemic. He drew a map of the village and was able to trace the cholera outbreak to an infected well in a farmer’s house. The well was filled in and that was the end of cholera in Mousha.” 
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Career change
What, then, made Dr Mahfouz change his career from anaesthetist to gynaecologist? Watani asked.
In 1902 in Alexandria, a fellow doctor asked Dr Mahfouz to administer anaesthesia to a woman in very difficult labour.” In his autobiography, (The Life of an Egyptian Doctor, Livingstone, 1966) Dr Mahfouz describes the shattering experience: “One day … Dr Shoukry … asked me to help him in a difficult case of labour. I went with him to his clinic and there found on the operating table a woman whom they had tried, unsuccessfully, to deliver with forceps without anaesthesia. For two hours Dr Shoukry tried, unsuccessfully, to deliver the head with forceps but it would not come down … Dr Shoukry tried to pull down a foot and it took him a whole hour before he succeeded. He and his assistant were able to deliver the body of the foetus up to the shoulders only but the head would not come down. They went on pulling the shoulders until the body of the foetus was severed from the head. I suggested taking the patient to the public hospital or calling an obstetric surgeon into consultation. They replied that among all the Egyptian and foreign surgeons, none was specialised in obstetrics… The patient died during the night with the baby’s head still in her uterus. … It was then that I resolved to do everything in my power to study obstetrics and gynaecology and dedicate my life to help women suffering from difficult labour.”
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Founding the department
“At the time there was no department for obstetrics and gynaecology in medical school in Egypt,” Dr Simaika says. “The surgeon and the midwife used to do the job, and no one at Qasr al-Aini had thought of founding such a department. It was Dr Mahfouz who made the suggestion to his mentor Dr Milton, who was a surgeon, to establish a department for obstetrics and gynaecology at Qasr al-Aini. Dr Milton talked to Dr Keating, the dean of Qasr al-Aini, who allowed Dr Mahfouz to use the outpatient clinic for this purpose for one month. A month later the clinic proved its success as a growing number of women visited it. This was the nucleus of the gynaecology and obstetrics department. 
“Dr Mahfouz then asked officials at Qasr al-Aini to bring over a specialised physician from abroad to head the new department and teach Mahfouz himself what he needed to learn about gynaecology and obstetrics. Dr Roy Dobbin was appointed to the Qasr al-Aini Hospital, and he brought with him the enthusiasm and state-of-the-art methods of the Dublin school of obstetrics and gynaecology. Within a year Dr Mahfouz had examined 850 patients, but the number doubled during the following year and the cases that needed hospitalisation swelled to more than the number of beds the department could hold. Dr Mahfouz thus resorted to treating hundreds of patients in their homes free of charge.
“The Health Bureau used to call on Dr Mahfouz’s expertise in hard deliveries. He would instantly oblige at all hours, wait patiently, and never ask for any fees.”
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Challenges, challenges
Dr Simaika spoke of the challenges his grandfather had to cope with. “During the early years of the department of gynaecology and obstetrics there were no relevant textbooks available in the Arabic language,” Dr Simaika explained. “Nor was it possible for students of obstetrics to gain the practical experience they needed, meaning that they were in dire need of a good textbook they could easily understand. Dr Mahfouz bore the brunt, compiling a book on obstetrics and another on gynaecology and printing them at his own expense.”
Dr Simaika explained that, prior to the 1919 nationalist revolution against the British occupiers, Egyptian physicians were looked down on and their efficiency doubted. It was only foreign physicians who had good names in the field of medicine: patients would willingly seek their advice no matter how hefty their fees or how far they had to travel. “The prestige of Egyptian physicians was at stake,” Dr Simaika noted.
A bitter struggle ensued in the medical community involving physicians, pharmacists and nursing school graduates, all of whom wanted to promote respect for Egyptian physicians by highlighting their efficiency and making the public aware of their contribution to the world of medicine and medical research. They ensured their valuable scientific research was published in Egyptian and foreign scientific periodicals.
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Kings and president
“My grandfather’s remarkable reputation reached Egypt’s monarch, King Fuad, who asked him to attend his wife, Queen Nazli, when she gave birth,” Dr Simaika said. In 1935, King Fuad asked Dr Mahfouz to write a book on medicine in Egypt and to complete it within six months. Dr Mahfouz obliged and wrote The History of Medical Education in Egypt, which is still a treasured reference. 
“King Fuad’s son, King Farouk, also valued Dr Mahfouz and appointed him the Royal Family’s obstetrician. The three royal princesses, daughters of King Farouk and Queen Farida, were all born at the hands of Dr Mahfouz. After the monarchy was abolished in 1953 and Gamal Abdel-Nasser became Egypt’s second president in 1954, he also chose Dr Mahfouz as his family’s obstetrician and gynaecologist.”
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Honours
Dr Simaika spoke to Watani with pride about the honours his grandfather received during his lifetime. “Dr Mahfouz was venerated and honoured by Egypt’s successive kings and presidents,” Dr Simaika remembered. “In 1919 he was granted the Order of the Nile. In 1930 King Fuad bestowed on him the honorary title of ‘Bek’, then in 1937 he was granted the more prestigious title of ‘Pasha’, the highest honour bestowed on a civilian in Egypt.”
In 1935 Dr Mahfouz was elected an Honorary Fellow of the Royal College of Obstetricians and Gynaecologists of England, an honour only bestowed on five eminent doctors at any one time.
In 1937 he became a Fellow of each of the Royal College of Physicians of England and of the Academy of Medicine of the USA. In 1943, the Royal College of Surgeons of England elected Sir Winston Churchill, Mrs Chiang Kai-Shek and Professor Naguib Mahfouz as Honorary Fellows of the College, the highest honour the Royal College could bestow. As Naguib Mahfouz could not make it to London because of lack of transport during World War II, the Royal College Council took the unusual step of conferring the degree on him in Cairo.
On 1 July 1947, the Royal Society of Medicine of England bestowed its Honorary Fellowship upon Professor Naguib Mahfouz, an honour also awarded that year to Sir Alexander Fleming, the discoverer of penicillin. In the same year Dr Mahfouz was granted an Honorary Fellowship of the Royal Society of Gynaecology and Obstetrics of Edinburgh. 
In 1950 Professor Ibrahim Shawky, president of Cairo University, established the ‘Naguib Mahfouz Scientific Prize’ to encourage research in the field of gynaecology and obstetrics.
Naguib Mahfouz was granted the Medal of Education as well as the King Farouk Prize for Medical Sciences in 1951. 
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Like no one else
In 1956, The Royal College of Obstetricians and Gynaecologists invited Dr Mahfouz to deliver the Fletcher Shaw Memorial Lecture, an honour only conferred on Fellows of the College “whose research would have contributed to noticeable progress in obstetrics and gynaecology”. So many applications to attend came in that the venue of the lecture had to be moved from the College’s lecture hall to the Royal Society of Medicine in London. 
In 1960, President Gamal Abdel Nasser granted Dr Mahfouz the First Class Order of Merit and the State Prize of Distinction for Science. 
“After Dr Mahfouz gave a series of lectures at London University’s Graduate School of Obstetrics and Gynaecology, the school’s dean said, ‘I do not think that there is one physician in the world who has the expertise that Mahfouz acquired’,” Dr Simaika said. “I am sure that no other person could make use of his experience and communicate it to the medical world in the way that Mahfouz did.”
The museum
The Gynaecology and Obstetrics Museum founded by Dr Mahfouz has a story behind it. “My grandfather used to import special glass jars from France for specimens that he collected in his private clinic,” Dr Simaika said. “He would take these specimens to the medical school for his students to study. In 1929, the dean of the school decided to allocate a place for these specimens, and hence the Naguib Mahfouz Museum of Obstetrics and Gynaecology Museum was born. By 1932, Dr Mahfouz had collected some 3,000 of the rarest specimens in obstetrics and gynaecology obtained from his operations and offered them to the museum. A contemporary issue of the British Gynaecology and Obstetrics Magazine reads: ‘The Egyptian School of Medicine is to be envied for this great museum established by Dr Naguib Mahfouz, Professor of Gynaecology and Obstetrics, together with the Egyptian University.’
“Dr Mahfouz has more than 30 books and scientific researches to his name. One of his greatest achievements is the Atlas of Mahfouz, which was published in three volumes and several languages and is still an invaluable reference. He also wrote The Scientific Encyclopaedia in Gynaecology and Obstetrics in 1,350 pages. Sir Eardley Holland, Dean of the Gynaecology and Obstetrics School in the UK, described the encyclopaedia as ‘no doubt the best book that has appeared in obstetrics and gynaecology, and far surpasses any book that has appeared in Britain, Germany or America.’ Other books include the acclaimed History of Medical Education in Egypt and Principles of Gynaecology and the Art of Obstetrics, both in Arabic. In a letter that Lord Alfred Webb-Johnson, the then President of the Royal College of Surgeons, sent to Dr Mahfouz, he described his works as ‘pieces of art’’.”
Reaching out to the women
Dr Mahfouz also established a nursing and midwifery school. At the time, poor people would not accept the idea of giving birth in hospital; they were used to giving birth at home, and there was a general belief that only cases where the lives of mother or baby were threatened went to hospital. It was thus a bad omen for women to deliver in hospital. This attitude irked Dr Mahfouz and preoccupied his thoughts. He finally decided to reach out to such women by establishing a department for out-of-hospital labour in order to ensure the eradication of puerperal fever.
He introduced the first antenatal clinics in Egypt to offer care for pregnant women, and also established a child welfare section at Qasr al-Aini Hospital, the first of its kind in Egypt. He founded the Egyptian Childbirth and Gynaecology Society which contributed much towards scientific research in the field, and compiled video recordings of the surgeries he had invented to treat cases previously considered hopeless. He wrote two books in Arabic on birth care, The Art of Nursing and The Art of Midwifery. 
Mrs Mahfouz
“My grandfather also wrote poetry and prose, something not many people know about,” Dr Simaika said. “Ever since his elementary school days he excelled in writing, and after he graduated from medical school he wrote a colloquial poem depicting the dire situation of the people during WWI.”
Dr Simaika also talked about his grandmother Fayka Mahfouz, Dr Mahfouz’s wife. “The roots of her family extend back to the Mamluk era. My grandparents were married in 1911. My grandmother had a passion for serving the poor, needy, and underprivileged, and dedicated her life to that cause. In 1939 she founded the Friends of the Bible Society for charity. She established schools for boys and girls whose parents were not capable of caring for them. After she died in 1952, her husband said that he had never known anything about her charity work. She obviously lived by the Bible’s teaching that, when you do charity work, your left hand should not know what your right hand is doing. 
“My grandparents had a son and four daughters, but they lost their son to a tragic accident.”
But while Dr Simaika’s talk mainly focused on his maternal grandparents, the topic of the interview, he did not mention that his paternal grandfather is also a prominent Copt who made a lasting contribution to Egypt. Marcus Simaika, who married Dr Mahfouz’s daughter, was the founder of the Coptic Museum in Cairo. [Watani International, 26 December 2010; ]
Unforgettable grandfather
“But what made you choose to venture into the very field in which your grandfather so excelled?” Watani asked Dr Simaika. In fact, he replied, joining the gynaecology and obstetrics department was not his original intention. I always had a passion for history,” he said. “It was my father who insisted that I do so, and I obliged. But then I fell in love with the profession and invested my time and effort in it, carrying on with the mission of my grandfather. My only son Youssef insisted on following the same path, too.” At this point Dr Youssef Simaika, who was present during the interview with his father, spoke up in agreement. “I was eager to follow in my father’s footsteps, so I joined the department of gynaecology and obstetrics and was able to prove myself. I cannot describe the ever novel joy of bringing new life into the world and seeing parents delighted with their newborns.”
“Respecting the patient, being punctual and not focusing on profit are all values that Dr Mahfouz instilled in me,” the senior Dr Simaika said proudly. “He was an extremely self-effacing person, pious and peaceful, even towards those who bore him ill-will. As his grandson, I am happy to feel that I can fill for my grandparents the painful void left by the death of their son.” 
My visit to the senior and junior Drs Simaika came to an end. As I left, a line written by Dr Mahfouz in his The Life of an Egyptian Doctor lingered in my mind: “If you give not of yourself, you have given nothing.” I could not help thinking: How apt, and how true!
Watani International
22 July 2015


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