Overview

	Apart from contemporary anthropologists and other interested scholars alluded to earlier in this book, many other Europeans, Americans and Arabs have visited the Sudan in the last two centuries as travellers, explorers, missionaries, historians, archaeologists, geographers, naturalists, botanists and as part of the ruling administration.
	They have recorded useful information about the country, its people and prevalent customs and practices. They have contributed their fare share in studying or describing the healing methods of the people they came across and described the state of health, hygiene, sanitation and medical practices in the early times. These sources remain our main repositories of the past of man’s health in the Sudan.
	Most travellers (and sojourners) did not see in the Sudanese ways of life anything more than a collection of strange and barbaric customs, and some even created several myths and stereotypes about which present day researchers are still trying to separate fact from fiction, as Tigani Al-Mahi noted.[1] Others made sweeping generalizations about the people—their physical characteristics, vices and virtues, the way they behaved and the beliefs they held. Nonetheless, there is much to learn from the accounts they left behind, which are, in most cases, extremely engaging. Of interest to us here is what they wrote on the health of the country and its peoples, and how health and disease were managed. The documentaries left back by these early writers frequently proved to be of the utmost importance in tracing several medical practices. For example, much has been learnt about zar and tumbura from the writings of Frobenius,[2] Hurgronje,[3] Plowden,[4] Junker,[5] and others; female circumcision from the writings of Browne,[6] Burton,[7] and Bruce.[8]
	Cursory comments could be found in several books of travelogue. The British administrator, traveller and sportsman, Samuel White Baker (1821-1893), wrote many books on the Sudan but they contain little information on health. He was in the Sudan in the years 1861-65, and travelled all over the country. He mentioned the occurrence of a bad smallpox epidemic alluded to in page 279. In 1866, he mentioned a plague that broke out in Khartoum, but he did not accurately identify the disease.[1]
	The Sudanese historian Abbas Ibrahim Muhammad Ali reviewed critically the literary works that described some of the Sudanese ways of life and customs in the last two centuries, in a booklet entitled The Anglo-Saxon Teutonic Images of the People of the Sudan.[9] Many of his thoughts are echoed here.
	The Sudanese psychiatrist and bibliophile Tigani Al-Mahi[2] has, with great scholarship, called into question the quality of the ethnographic literature produced by the European travellers who visited the Sudan before the First World War. Tigani Al-Mahi thought it is fair to admit that those writers were the faithful offspring of their times, and that the judgements they expressed, have more to do with the values of nineteenth-century Europe than those of the Sudan of that or any other time, where certain historical factors had contributed to their orientation, and the realities and stamp of the time had influenced and shaped the pattern of values affecting human relations and attitudes. The methodology, thus, of those writers in particular, leaves much to be desired. He said:
	“The review of the literature until the First World War, for example, and in this respect I shall have to be very frank, reveals a quality which, to say the least, is fictitious and grossly incorrect; half belief and half make-believe. Many authors were curiosity-hunters rather than academics, and their predilections were obtrusively for the strange and whimsical. Their writings created more enigma than they solved. The gulf between the observer and the observed was seemingly immense.”[10]
	Abbas Ibrahim Muhammad Ali identified some examples of bias and partiality in his above-mentioned review. He could see the predilection of those early writers for describing strange customs, on which they did not hesitate to pass moral judgements. None of them had the scholarship or deep imagination to view those customs in the social and cultural context of the society in which those customs were dominant. He quoted a few interesting examples.
	A custom they viewed with distaste was the Negro custom of breaking off the lower two front teeth; a custom the majority of the tribes of the southern Sudan practise. An American observer, Bayard Taylor, described the practice as giving “their faces a wolfish expression.”[11] We alluded earlier in this chapter to the comments of Schweinfurth, who confessed that the object of this hideous mutilation is hard to determine.[12]
	This section is not intended to be exhaustive, and does not review the work of all those who had interest in the Sudan and wrote about, rather it highlights the importance of the contribution of these writers by giving some examples. Future researchers should give this field its due attention and study it more thoroughly and systematically.

Muhammad Ibn Umar Al-Tunisi

Most notable of the latest travellers in the Sudan was Al-Tunisi who reported in an organized fashion on several aspects of the land and people of Darfur of the 18th century. Of interest to us here were his comments on health, related customs and traditions, methods of treatment of disease, and medicinal recipes used then.[13] His comments were alluded to in their respective chapters of this book: magical roots (page 324), castration (page 182), magic (page 107), cataract operation (page 188), divination (page 126), fevers (page 289) etc.

Naom Shuqair

Naom Shuqair compiled a massive treatise on the history and geography of the 19th century Sudan with sizable sections on prevalent health customs and diseases and their treatment in different parts of the Sudan.[14]

Theodor Krump

	One of the earliest missionaries who recorded some ethnographic notes on the Sudan, was Theodor Krump.[3] Except for plague and smallpox, which were dreaded by the locals, Krump wrote, no other diseases were prevalent, except abostem, ulcer, coughing and ophtomalia; but il mal francese (that is syphilis) was common. He also noted that cauterization was quite common as treatment for animal and man.
	“In these countries they not only treat camels and donkeys in this way, but men, too. If anyone suffers from sciatica they fetch a cotton cloth, bind it very firmly to the thickness of a thumb, set it alight and cauterize the spine up to the neck, so that a space of two or three fingers’ width lies between each branding-mark. In a similar way they treat colic, cauterizing both sides of the navel. To remove a headache they apply this treatment behind the ears and on the temples.”[15]
	After Krump’s caravan travelled the Darb Al-Arba’in (the forty-days-route) from Egypt, they stayed for a while at Mosho at the third cataract of the Nile. There he described the household utensils (grinding mill consisting of two stones which are turned about by means of a stick or by hand in the same way as painters grind their colours), cooking vessels (earthen pots), drinking vessels (hollowed pumpkin split in the middle), foods (fowls, chickens, kids, sheep, fish, lentils, rice, beans, kisra[4] bread made of dura and dates), busa (dura beer), and the abundance of game.

William George Browne

	William George Browne travelled from Egypt by the Darb Al-Arba’in to Darfur in 1793. He settled at Kobbe, disguised as a North African Arab, until his return in 1796 by the same route. His narrative, published in 1800, though criticized for inaccuracy, remains an authority on Darfur. In it, he devoted a chapter to remarks on health conditions in the Sudan and Egypt.[5] Trachoma (psorophthalmia), he noted, was particularly common in Egypt and, northern Sudan. The causes of the disease, he thought, were dust and irritant fats. He also noted that the higher the social standing of the people, the less the incidence of the disease. Plague, the disease which always ravaged the Turkish empire, was epidemic in Egypt, and had been there since 1348 [the year the plague ravaged Europe]. He mentioned smallpox as the main epidemic disease, and local methods of inoculation were recorded. Scurvy was existent in Darfur, especially in years of poor crops. He described syphilis as:
	“The disease which attacks the principles of generation, and destroys in its source, one among the few solaces with which human life is sparingly diversified ... does not appear in Egypt with all the terrors that mark its course in other countries.”[16]
	At that time, he continued, the tertiary forms of syphilis—aneurysm, tabes, and general paralysis of the insane—were only too common sequelae in Europe, but in the tropics they were rare in comparison with the frequency of the disease.
	Leprosy was one of the commoner diseases in Egypt and Darfur. People also suffered from tapeworms, enlarged spleens [possibly due to bilharzia or malaria], liver diseases, jaundice, herniae, hydroceles, haemorrhoids and fistulae. Herniae were treated with locally-made trusses, and haemorrhoids and fistulae with cautery. Childbirth was particularly easy. Sunstroke was uncommon and rabies almost unknown. Aphrodisiacs such as natron, infusions of tamarhinde [Tamarind, Tamarindus indica], and hashish [Cannabis, Cannabis sativa] were in great demand as medicines.[6]

Johann Ludwig Burckhardt

	The Swiss scholar and explorer, Johann Ludwig Burckhardt (1839-1908), traversed the Sudan on his way to Makka in 1812-1814. Speaking Arabic fluently, he dressed as an Arab and travelled as a Muslim merchant. He entered the country through Wadi Halfa. In his book Travels in Asia[17], he recorded the diseases he met with in Berber and Shendi towns in 1814.
	The people of Berber, he said, were on the whole a healthy race, probably due to the situation of the town on the edge of the desert. When the Nile was in flood, a fever called wirdee [wird is a generic Arabic name for fever] occasionally became epidemic. It did not occur every year, but when it did, there was a high incidence of death among those afflicted. Plague was unknown, and he had never heard of a case south of the Assuan cataract.
	Every eight or ten years, smallpox, brought in by the Suakin traders, became epidemic. A serious epidemic broke out in 1812, which, coupled with a famine, was said to have carried off over two thirds of the population. Burckhardt himself knew that over fifty members of one family died from smallpox in that year. Mild cases were few, and those who contracted the disease were heavily pocked. The mortality rate in children was said to be less than in adults. He reported a method of inoculation called dag el jederee (see also page 284) and noted that it was not practised extensively. In this method, the fluid of an infected pustule was rubbed into an incision wound made in the leg of the person to be inoculated. Venereal diseases and ‘ophthalmia’ were common, but not as much as in Egypt. He saw one case of guinea worm at Berber, probably an imported case, and said that although the more usual places for the worm to appear were the arms and legs, he saw one case in which the worm came out in the breast.
	He also noted that there was a large slave market at Shendi, and although the slaves endured great hardships, they were not so strong as their masters. A large proportion of slaves died long before they ever reached the market, and many travellers mentioned the rapidity with which some diseases overtook the slaves after their capture.
	At Shendi, a particularly fatal inflammatory fever, probably cerebro-spinal meningitis, carried off large numbers of slaves. A slave who had had smallpox would sell at a higher price than one who had not. If a female slave became pregnant, her master would do his best to procure an abortion. This was done with various drugs (given orally), by beating the woman on the abdomen, or by putting the extract of the dead sea fruit[7] on a piece of cotton inside the vagina. Slaves that snored, or ground their teeth at night, fetched a poor price. If a slave had a disease which did not clear up within the time prescribed by the vendor, he or she could be returned.[8]

George August Schweinfurth

	George August Schweinfurth travelled in eastern Sudan collecting botanical species in 1864 and 1868. He also travelled as far as Khartoum, and then descended down the Nile to the Azande land in the south, where he discovered the Uele river in 1870-71. In his book Heart of Africa, he mentioned that leprosy existed in the southern provinces. Apart from this, he recorded little information of medical interest.[18]
	He also had interesting comments on Sudanese morals and customs. He judged that all the Arabs had in common the same single aim of existence: to do as little as possible and to sleep much.[19] He observed that the Nubians exhibited a more decided idleness and dislike for work than any other people. About the custom of extracting the lower teeth among the Negroes, he said ‘it is hard to determine, … and is quite beyond my comprehension.’[20]
	Several tribes in the southern Sudan were described as cannibal by early travellers and geographers. Some writers claimed to be eye-witnesses to some acts of cannibalism. Schweinfurth shared with other travellers the opinion that some southern Sudanese tribes were cannibals. He did not hesitated to assert that the Zande were anthrophagi. He even claimed that the Zande themselves did not disown their cannibalism; that on, the contrary, they gloried in their reputation as cannibals, and, because of this, they were much dreaded by other tribes.[21] The cannibalism of the Monbuttoo tribes, he said, was said to be unsurpassed by any nation in the world. He felt bound to record, however, that there were some Zande who turned with such aversion from any consumption of human flesh, that they would refuse to eat out of the same dish with who was a cannibal.[22]

The Tinnes

	The Tinnean Expedition[9] to the Sudan was a remarkable and tragic journey organized and financed by three illustrious Dutch ladies: Mme Henriette Loise Marie Tinne, her sister Mlle. Adrienne de Capellen, and Mlle. Alexandrine Tinne, Mme. Tinne’s daughter. Theodore Kotschy, co-editor of the book that contained the botanical results of the expeditions,[23] wrote in the preface the following:
	“The principal object of this journey was a desire to learn about the Ethiopians, those inhabitants of the banks of the Nile whence it has been the custom, up to the present, to take slaves. They wished to contribute as far as they could to the abolition of a traffic so shameful and already prohibited by laws. Moreover a keen love of science and new knowledge counted not a little in the motives which involved them in their perilous enterprise.”[24]
	During the excursion, which started in July 1861, two of the ladies, Mme. Tinne (20/7/1863), her sister, Mme. Adrienne and Dr. Steudner, the botanist and phytographer of the Expedition (10/4/1861), two Dutch servants, among other unidentified number of the team, died of fever. The survivors left the Sudan by way of Sawakin and Berber in March 1864.
	The results of the expedition were remarkable in terms of botanic surveys covering chiefly the areas watered by the Bahr Al-Ghazal river, between 9° and 10° North Latitude and 27° and 32° East Longitude (Meridian of Greenwich).[10] Seventy seven species and genera were described, 24 of which for the first time. The expedition remains to be an excellent example of collaborative scientific ventures in which the efforts of the philanthropist, naturalist, geographer, explorer, botanist, and phytographer, are gainfully combined. The plant samples were professionally collected and preserved, described, and some items were deposited in the Imperial Herbarium of the Court of Vienna. However, no evidence of anti-slavery campaign was reported on.

Wilhelm Junker

The German traveller and naturalist, Wilhelm Junker (1840-1892), explored the River Sobat and the western tributaries of the Upper White Nile, from 1876 to 1878. After some time in Europe, he came back to the Sudan in 1879. He spent four years with the Azande and Monbuttu peoples of the southern Sudan. He discovered the River Mbomu, the important northern tributary of the Uele. In his book Travels in Africa, during the Years 1879-1883, he emphasized that the tribes of Idio and Bamba, known as Makaraka, were cannibals.[25]

George Alexander Hoskins

	The British archaeologist George Alexander Hoskins (died 1863), visited Egypt and the Sudan in 1833. He toured the northern region, making archaeological drawings and notes throughout his tour. He wrote his memoirs in a book called Travels in Ethiopia. After his encounter with the Arab tribes of northern Sudan, he had this to say, sharing the view of other European travellers, that an Arab accepts whatever comes across his way with unquestioned resignation:
	“Endowed with an imperturbable stock of apathy more comfortable perhaps, although not so intellectual as European philosophy, they submit to a distressing accident, which would throw one of our countrymen almost into fever, without allowing their equanimity to be in the least disturbed. ‘Mactub min Allah’, ‘it is written, it is the will of God,’ they explain with placid resignation, and instead of brooding over their misfortune, become immediately reconciled to it, and with amazing facility banish it from their thoughts.”[26]
	In The Nile Tributaries of Abyssinia, Baker wrote:
	“The name of God is coupled with every trifling incident in their life and they believed in the continual action of Divine special interference …. Nothing can happen in the usual routine of daily life without a direct connection with the Hand of God, according to the Arabs’ belief.”[27]

James Bayard Taylor

The American diplomat, traveller, (and translator of Faust), James Bayard Taylor, visited the Sudan in 1851-2. He considered that the Arab fatalism gave him a calm and equable temperament under all circumstances, and ‘God wills it’ or ‘God is merciful’ was the solace of every misfortune.[28]

H.A.R. Gibb

Some early writers alluded to above wanted to convey the message that Muslim providentialism and indolence go hand in hand, and that an Arab can never change, improve his conditions or progress unless he gets rid of his habits of resignation and laziness. Abbas provided a more recent view. He quoted the modern English Orientalist H.A.R. Gibb as saying:

“Muslim ‘fatalism’ … does not go very much beyond that found in any community (Muslim, Christian or Hindu) in which poverty and ignorance breed resignation in the face of bodily ill, physical disasters and the violence of tyrants. The ordinary Muslim takes thought for the morrow, like any other, and he assumes, like other civilized persons, that given actions will produce given results; and even in the matter of his future in the next life he takes predestination much more lightly than the Calvinists, since he believes that, whoever they may be whom God has predestined to hell fire, they are certainly not to be found in the Orthodox Muslim community.”[29]

John Petherick

	John Petherick (1875-1942), a Welsh mining engineer, trader and explorer, lived at Al-Ubiyyid and traded in gum Arabic from Kordofan, from 1848 to 1853. He was engaged in different activities between the years 1853-8. In 1858, he was appointed vice-consul in Khartoum till 1864, when he left office because of allegations that he was involved in the slave trade. In his writings, he had something positive to say about what other travellers considered a dirty and repugnant operation, the dilka or, as he calls it, the Turkish bath. This came from direct experience; he, while feverish, had undergone the procedure:
	“After a little consideration, although not much liking the idea of being smeared with oil, I submitted to the operation and found its effects much less unpleasant than I anticipated. The following morning I awoke quite revived; the feverishness had entirely subsided and with a calm and refreshing sensation through my limbs and body.”[30]
	Petherick also described how the people of Kordofan treated smallpox. He said:
	“As soon as the disease is pronounced, a bed of ashes is prepared on the ground, upon which the patient is laid in a state of nudity, and from which he is not removed until either carried to the grave, or until, by a marvel, he recovers. The only remedy applied is the juice of raw onions to the eyes when they become attacked.”[31]

Ignatius Palmme

	In 1834, Ignatius Palmme wrote his observations on the diseases of Kordofan. He said that the chief diseases are fevers, dysentery, abscesses about the neck (called durore) [tuberculous adenitis!],[11] dropsy, small pox, jiggers, skin diseases, and lues [syphilis]. For treating durore, he said, ‘they open the abscesses with the actual cautery, and when the matter is discharged, dress the wound with an ointment prepared of butter and clay’. He said that syphilis had been totally unknown in this region in the preceding century, and the local people had only been inoculated a few years before he wrote, when the stationing of Egyptian troops in the province, provided the impetus and the technical means. He also described how the local people of Kordofan give lavage through an enema syringe.
	“The lavements [lavages] are administered in the following manner: they take the thigh bone of a fowl, and clearing away the marrow, fasten to it a portion of the intestines of a sheep, into which they pour a decoction of qara’ [pumpkin!], and then insert the pipe into the anus, compressing the gut until the whole of the contents pass into the abdomen.”[32]
	Many travellers shared the image of the Negro as a brute, a beast or at best a child; Pallme thought that it was necessary to treat them like children; for their mental faculties were very limited, and they were, indeed, on the lowest scale in this respect.[33]
	As the Negroes were bestial and childish, they could not be expected to have any religion—judged most of the writers.[12] “Historic man believes in divinity; the tribes of central Africa know no God; are they of our Adamite race?” asked Sir Samuel Baker.[34] It was thought that the Negro was incapable of understanding the truths of religion. General Gordon believed that it was impossible that the Negro could ever be got to understand the love of God in Christ. He, therefore, concluded that the Negro races must pass the ‘period of their youth before they could be taught.[35]