The rise of medicine in Egypt can be noted as early as the First
Dynasty. Athotis, the second king of the First Dynasty, wrote one
of the earliest works, Practical Medicine and Anatomic Book. The
Edwin Smith papyrus, dating from the 17th century BC, was discovered
in 1862 and is attributed to Imhotop.
The papyrus, dealing with cranial wounds and fractures,
is the world's oldest known surgical treatise. It provided a description
of the brain and noted correlations between cerebral lesions and
loss of movement.
A case of hemiplegia caused by a compound comminuted
cranial fracture was documented. Particular attention was paid to
cranial base fractures associated with bleeding from the nose and
ears. It was noted that fractures of the cervical spine were associated
with limb paralysis, neck rigidity, and conjugate eye deviation.
The treatment for hemiplegia was applied to one-half of the belly
and not to all of the paralyzed side.
In the Ebers papyrus, 12 prescriptions for the treatment
of headaches and migraines were presented. Migraine was called "half
of the head" and was considered to be a special entity, thus
requiring special treatment. Rogers presented two cases of intracranial
meningiomas found in ancient Egyptian skulls.
ancient Egyptian surgical tools Right: Neurosurgical operation
depicted in a drawing from an old Egyptian temple (1500 BC).
Modern Beginning of Neurosurgery in Egypt
The modern history of neurosurgery in Egypt owes
much to its early pioneers; the most prominent were Dr. Ahmed
Abu Zikry, Dr. Osman Sorour, Dr. Samuel Boctor, Major Dr. Ezzat
Tewfik, Dr. Ibrahim Hegazy, and Dr. Ahmed El Banhawy. They played
pivotal roles in the foundation of the modern neurosurgical service
in Egypt. Having graduated from King Fouad University (now Cairo
University) and finding no training facilities in Egypt, they
traveled to the United States and Europe to attain proficiency
in their chosen field. At that time, neurosurgery was not considered
a promising career course, but they nevertheless chose to pursue
The first neurosurgical practice in Egypt was begun
by Dr. Ahmed Abu Zikry, a general surgeon who studied neurosurgery
at the Mayo Clinic for 2 months and the Lahey Clinic for 1 month
in 1949. He then worked in the department of general surgery of
Cairo University, under the chairmanship of Prof. Ibrahim Fahmy
El Miniawy, and cooperated with Profs. Barrada and Guinena, who
were the founders of the department of neurology of Cairo University.
He had a successful career in general surgery; therefore, he chose
to continue as a general surgeon and encouraged his resident,
Dr. Osman Sorour, to specialize in neurosurgery.
Dr. Sorour received his master of surgery degree
in general surgery from Fouad University and joined the general
surgical staff of the medical faculty. He was assisted by Dr.
Ismail Shafie (neurology house officer) in thoracic surgical wards.
After separation of the service, Dr. Shafie became the first neurosurgical
registrar, proceeding to eventually become chairman of the department
Dr. Samuel Boctor treated patients in general surgical
beds, assisted by Dr. Abdel Hamid El Shawarby (surgical resident),
who later became a leader in psychosurgery. In 1956, Dr. Boctor
established a neurosurgical department (the first in Egypt), with
Dr. Gamal Azab as his registrar. This free service served the
northern region of Egypt, with a population of more than 8 million
Egyptians and a steady stream of Libyan patients from the eastern
Major Dr. Ezzat Tewfik joined the medical corps
as a first lieutenant general surgeon, obtained his F.R.C.S. degree
in the United Kingdom, and began neurosurgical training in the
United Kingdom and Karolinska, Sweden, under the leadership of
Dr. Herbert Olivecrona. After returning to Egypt, Major Tewfik
practiced in the general surgical ward of the Kobba Military Hospital,
mainly treating head injuries and performing a few spinal and
Dr. Ibrahim Hegazy worked for the Ministry of Public
Health after obtaining his F.R.C.S. degree in the United Kingdom.
Dr. Hegazy joined the Ibrahim Pasha University (now Ain Shams
University) and was assisted by Dr. Ahmed El Banhawy (M.S.).
Dr. El Banhawy graduated from Cairo University in
1952. After working as a registrar in general surgery, he joined
the anatomy department. In addition to his master of surgery degree,
he obtained a diploma in neurology and psychiatry. He underwent
neurosurgical training in Germany and Oxford, England. In 1964,
he assumed the chairmanship of the military neurosurgical department,
after Major Ezzat Tewfik was involved in a disabling automobile
accident. Dr. El Banhawy was the first Egyptian to document a
case of spinal cord bilharzioma. He later became assistant professor
at Ain Shams University. In the 1970s, he was appointed dean of
the medical school and deputy chairman of the university, before
his premature death.
These early pioneers struggled to establish neurosurgical
departments, because neurosurgery was a division of the department
of general surgery at that time. Furthermore, the general population
was mistrustful of new specialties.
In the middle 1950s, Major Dr. Ezzat Tewfik was uniquely placed
to engineer the founding of the military neurosurgical service.
His international connections allowed him to establish a neurosurgical
department with high standards in the Air Forces Hospital in
1960. After his retirement from the Karolinska Institute in
1961, Prof. Olivecrona traveled to Egypt, with a staff of neurologists,
neuroanesthetists, neurophysiologists, neuroradiologists, and
nurses, to set up training programs for the Egyptian military.
These programs heralded a new era in neurosurgical technology
in Egypt, allowing Egyptian doctors to meet European standards.
Major Dr. Rushdy Diwan, who had been trained by Dr. Hjelm Quist,
practiced modern neuroanesthesia, and intensive care units were
introduced. Captain Dr. Fouad El Nadi, who had been trained
by Dr. Sjogren, practiced the techniques of percutaneous carotid
and vertebral artery angiography, air encephalography, air myelography,
and functional stereotactic surgery. Dr. Kamal Kamel was trained
in neuropathology by Prof. Zulch. He became the dean and later
the rector of Mansoura University. Drs. El Shawarby, Azab, and
Salama of the university hospitals and Drs. Abdel Rahim Galal,
Sayed El Kashashy, and Mokhtar El Mahdy from the medical corps
joined the institutions for various periods.
During this period, Dr. Sayed El Gindi studied for the F.R.C.S.
degree in the United Kingdom and continued his training at Brook
Hospital (London, England), the Radcliffe Infirmary (Oxford,
England) (under Dr. J. Pennybaker), and Oldchurch Hospital (Essex,
England) (under Dr. J. Andrew). After his return to Egypt in
1967, Dr. El Gindi worked in the department of neurosurgery
of the new Maadi Military Hospital. At that time, a system of
collaboration between the universities and the military department
was developed. Young residents recruited for military service
were attached to the Maadi Military Hospital for a period of
1 year, to continue their training. In addition to working in
the military service, Dr. El Gindi was appointed a visiting
professor at Mansoura University, to establish the department
of neurosurgery. In 1968, he became the chairman of the department
of neurosurgery of the Maadi Military Hospital.
In 1959, the Middle East Neurosurgical Society was founded.
Dr. Sorour was one of the founding members and was the president
for 2 consecutive years. Egyptian doctors joined this society
as individuals. It was not until 1967 that the Egyptian Society
of Neurological Surgeons was founded .
Egyptian neurosurgeons had the opportunity to gain wide experience
in treating war injuries. The vast majority of experience in
this field was achieved in the treatment of casualties of the
1973 war. Teams of neurosurgeons from military hospitals and
university clinics, together with doctors of allied specialties,
actively shared in treating these war casualties.
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