We trace in this page and whenever pertinent in other pages of this site the roots of the Sudanese health culture in earlier and extant civilizations, namely that of the Nile Valley. We also identify the foreign traits that came from afar and from the neighbouring cultures that contributed to and modified the indigenous elements. Like other North African countries, the Sudan contacted and interacted with Mediterranean and Middle Eastern cultures as well as with neighbouring African states. Also, the Pre-Islamic Arabs who came to the Sudan as traders, and after the arrival of Islam, as conquerors and missionaries, brought into the country elements of Islamic, Arabic, as well as Babylonian, Far Eastern, and Greco-Roman cultures. Other contacts came through migration, pilgrimage, the bilateral exchange of scholars and students of fiqh (Islamic jurisprudence). Also, many foreign communities have settled, intermarried, and, eventually, acquired Sudanese nationality. The Ja’afra and Coptic Egyptians, for example, have settled in various parts of the northern Sudan. The Nigerians, however, wandered through central Sudan on their way to the Muslim holy land in Makka in Saudi Arabia. En route they frequently settle, sometimes permanently. Their permanent settlements are found in the White Nile district and the Gezira. A Sultanate by the name of Myorno in Sennar is exclusively Nigerian.
Unlike many African countries, the Sudan has long borders with nine different states, and is separated by the Red Sea from Saudi Arabia and the Yemen. Many tribes live and move freely across these borders exchanging, in the process, various cultural elements. The Azande tribes, for example, move freely across the frontiers common to the central African Republic, Zaire and the Sudan. The ‘Ababda and the Nubians share the northern frontiers with Egypt, while the Gimir, Masalit and Um-Bararu live and move freely across the Sudan’s western frontier with Chad. Some branches of the Amar’ar and the Bega tribes are Sudanese, and others, Ethiopian or Eriterean. The Zubaidiya of eastern Sudan still maintain their Saudi nationality while in the Sudan. Nigerians preferred to settle in the Sudan while journeying at ease from Nigeria in pilgrimage to Makka. Their community in the country now numbers in the region of hundreds of thousands, with a large proportion holding Sudanese nationality. Health culture and traditional medicine have been particularly susceptible to these foreign influences. In this chapter, some of these influences are highlighted.
Arab links with the Sudan have existed since the dawn of history. They started with the early movements of Arabs into the Sudan, which historians trace back to pre-Islamic times. The Arab traders entered the Sudan through three major routes: north Africa, west Africa and the Red Sea. Despite these early links, definitive Arabization of the Sudan started only with the rise of Islam in the seventh century. The early Arabs did not contribute much to the spread of Islam in the country, and it was not until the 15th century that Islamization proper started, through Sufi missionaries. It is noteworthy, however, that the Islam they preached, accommodated various unorthodox practices, animistic customs and beliefs, and was, as far as the local people were concerned, a less exacting religion. This, as we will see later, had a major influence on the prevalent health beliefs and practices.
In the history of cultural exchange between the Sudan and the rest of the Muslim world, pilgrimage has been particularly important. During the annual congress, hundreds of thousands of Muslims from all over the world have met in the holy land. There, apart from practising religious rites, they have exchanged ideas, skills, and, as one might expect, medicinal recipes. Several Arabian, Babylonian, Greco-Roman, Far eastern, and even Egyptian elements, were also introduced through the Arabs.
The early Arabs practised frequent purgation using simple mineral and plant preparations. They believed that this is a necessary purification process that cleanses the body of harmful dirt. Furthermore, immigrant Arabs had brought with them the materia medica of Egyptian, Babylonian and Greco-Roman cultures. In the Sudan, the immigrant Arabs found flora similar to theirs but with greater variety and abundance. They were, thus, able to develop their healing skills and techniques.
The Prophet Muhammad drew general guidelines for managing health and sanctioned many folk remedies. Al-tibbb Al-Nabawi (The Prophet’s Medicine), is a generic name given to several versions of edited sayings and deeds of the Prophet Muhammad that were related to medicine and health. The versions in wide circulation in the Sudan are those of Ibn Al-Qayyim and Al-Zahabi.
The Arabs also widely practised cautery, blood-letting and cupping in managing health and disease. Similar procedures using similar or identical instruments have been identified in the clinics of northern Sudanese healers.
The Pre-Islamic Arabs excised and infibulated the female genitalia in the belief that this was an effective method of protecting shepherd girls against likely male assaults while they were out unescorted with their grazing sheep. Pre-Islamic satirical poetry defamed men by referring to their uncircumcised mothers. Similar attitudes are held by the Sudanese. The similarity in practice, and the fact that the practice is almost exclusively confined to Sudanese Muslim groups, suggests a possible Arabian origin.
Many divination procedures were evidently derived from Arabian sources (pre-Islamic and Islamic Arabia). Several amulets, invocations, incantations, divination techniques (in particular book and sand divination) are clearly derived from medieval origins.
The Sudanese also shared many of the misconceptions that prevailed in pre-Islamic Arabia. For example, in Arabian as well as Sudanese popular legend, the gazelle transmits jinns (causing junun, lunacy in adult), and represents epilepsy (known as habobat al-sughar, mother of the young), in young children. The same designations are also found in Egypt and Tunisia.
With few exceptions, the list of spirits in the Muslim Sudan, is Arabian. Many of them appear in ancient Arabian folk literature, which is remarkably rich in jinns (spirits) and shayatin (devils and demons); several of these were retained in the Quran, Sunna, and Islamic traditions. The Sudanese and Arabian jinns, however, are not identical, and in the Sudan acquired local names that differ from one area to the other.
As is clearly demonstrated in other parts of this book, the Sudanese have borrowed several theories of causation, as well as methods of diagnosis, prevention and treatment of diseases, from Arabian sources. For example, the standard magical religious methods of ‘azima (incantations with spitting), bakhur (fumigation) and mihaya (erasure of holy verse) for exorcism, are common to both Arabian and Sudanese traditional practice.
Many recipes in the Sudanese materia medica are similar if not identical to those quoted in medieval Arabic texts. It is interesting to trace these sources and explore the extent of their influence on Sudanese practice. We mentioned earlier that the traditional healers—the faqirs and the fakis—have been literate in a predominantly illiterate society, and have made use of several medieval religious texts to promote their power within their society. Many of these healers have combined religious teaching with counseling on secular matters, and healing.
When we visited the maseed at Um Dubban village east of Khartoum in 1980 and other maseeds, we examined the bookshelves of the faqirs in those villages. We found a variety of books including Al-Jahizh’s Al-Hayawan, Avicenna’s Al-Qanun, and several others. This finding confirmed our speculations that Arabic source books were introduced into the Sudan with the early Arab scholars, several of whom were mentioned in the early Sudanese chronicles and a list of the most commonly found books are listed in A Bibliograhphy of Traditional Healthcare in Sudan. The books listed here and several others have equipped the Sudanese practitioners with several magical and religious formulas, and certainly a huge amount of sound secular advice. Text taken out of these books and Quranic verses have been added liberally to amulets and incantations, all of which were and still are used in conjunction with herbal therapy.
Ibn Daif Allah in his historical chronicle, Al-Tabaqat,mentioned why he wrote the book, and listed the Muslim scholars in whose footsteps he followed. He named Abd Al-Ghaffar Al-Nisabouri, Al-Siyouti, and Ibn Hajar Al-‘Asqalani and Ahmad Al-Maqqarri, among others. Apart from Al-Siyouti, none of these Arab scholars are known to have written on medicine, and even Al-Siyouti was mentioned in the chronicle for his methodology of writing rather than for his medical contributions. Nonetheless, the man and many of his works were well-known to the Sudanese faqirs, and his book entitled Al-Rahma fi Al-Tibbb wa Al-Hikma has been a popular manual.It has been published several times (undated) by Al-Halabi and Abbas Ibn Shaqroun Printing houses in Cairo, and by Maktabat Al-Thaqafa in Beirut.
Medieval Arabic books have also been known to healers other than the faqirs and the fakis. Awad Al-Karim Muhammad Hindi, a goldsmith in Omdurman compiled a three-volume compendium of a wide range of information including a section on medicinal recipes and health promoting advices. He named the book Mukhtarat Al-Sayigh and published it in Cairo in 1948. In the introduction to this work, Al-Sayigh listed his sources which are mainly medieval: Al-Qanun and Al-Hawi by Ibn Sina, Al-Tazkira Al-Tibbbiya by Al-Antaki, Al-Kamil by Al-Razi, Al-Risala by Al-Maridini and Al-Tibbb Al-Nabawi (the Prophet Muhammad’s Medicine). This piece of information testifies to the fact that many Sudanese, not necessarily faqirs, had access to and used medieval Arabic medical books.
The Greco-Roman philosophers (8th-6th C.B.C.) established the four humours theory, which came to dominate Arabian science and medicine and all systems derived from it throughout the world. The theory was based on a rigid classification of disease, drugs, and diet according to humoral types. This theory brought nutrition into a prominent place in health and disease, established rigid systems and regimens of diet for the sick, and formalized them as crucial parts of the healing art. Some scattered evidence, both written and oral, indicates that the Sudanese may have had some knowledge of the four humours theory as early as the 10th century A.H. as anecdotes in Ibn Daif Allah Al-Tabaqat indicate.
Due to physical proximity, through commerce and frequent invasions, Egypt has had a great influence on many aspects Sudanese life. This is naturally more marked in the northern parts of the country. It was through Egypt, that the Sudan was introduced to various other cultures. This was because Dynastic Egypt had contacts, through commerce and conquest, with the countries of the Mediterranean region and Asia. These contacts had a great influence on Egyptian pharmacy. During the Ummyyad Caliphate, ancient Egyptian books on chemistry, medicine and astrology were translated into Arabic.
Just as in Egypt, where medicine was part of religion, people in the Sudan venerated the Nile and the Moon. Both entities appeared frequently in Sudanese rituals as well as mythology and folk literature. It was quoted in historical records, that in Egypt a young woman used to be sacrificed to the Nile god Hap when inundation was imminent. There is evidence that similarly, in early Sudan, people used to sacrifice the first born-son of the family.
The Egyptian influence in the realm of spirits is not so specific as that of the Arabs. In Egypt, the qarin or qarina (companion) is a double born with every individual; the Sudanese do not share this concept. In Egypt, the ka and the ba are two distinct types of soul. The ba, depicted as a bird, leaves the body after death and resides in heaven, visiting the burial places periodically. It may be likened to the pre-Islamic hama or the Sudanese ba’ati (ghost of a dead person)-- a non-Arabic word which might have been derived from the Arabic ba’th (resurrection) or from some local tongues.
In 1884, Anglo-Egyptian forces defeated the Mahdi’s army, led by Abd Al-Rahman Al-Nugumi, at Tawshki. Among the Sudanese who were taken prisoners, two had formerly been interested in the trade of medicinal plants; they were known as Al-Taiman (the Twins). While in captivity, they added to their experience and knowledge of medicinal plants; when released, they came back to the Sudan to start the first herbal shop in the country, in Omdurman. The several shops that the Taiman opened throughout Omdurman and other cities had a marked influence on traditional Pharmacopoeia of the Sudan. The Taiman were the sole importers, and only distributors, of medicinal plants in the country for a long time.
The intellectual exchange between Egypt and the Sudan, through the movement of several ‘ulama (religious scholars) who were educated in Al-Azhar, had a real impact on traditional medical techniques and practices. Through that exchange, most medieval medical texts (Arabic and Egyptian) were introduced into the Sudan.
A few years ago, Dr. Sobhi Al-Hakim, a Sudanese Obstetrician and Gynaecologist, deposited in the Central Records Office in Khartoum, surgical instruments and a medical manuscript. He believed that both were important historical findings. The manuscript belonged to his grandfather Ahmad Yusuf Al-Hakim who came to the Sudan as a medical practitioner in the Egyptian Army, and worked in Donqola and Berber for over half a century. He performed different operations, including the removal of stones from the bladder and ureters, the amputation of limbs, the excision of tumours, and tooth extractions.
We studied the manuscript, and found that it was an extract of Al-Rahma fi Al-Tibbb wa Al-Hikma, a book usually attributed to Galal Al-Din Al-Sioyouti. Nonetheless, we think this finding is interesting, suggesting as it does that the author, a medical graduate and a specialist in surgery with postgraduate training in Paris, still retained Al-Rahma as a medical text worthy of being read and extracted. If Al-Hakim was serious in referring to this book, then he has helped to draw a clear picture of the type of medicine practised then in the Sudan.
Female circumcision is known in the Sudan as al-tahura al-far’auniyya (pharaonic circumcision) or more commonly far’auniyya, (pharaonic). The term ‘pharaonic’ suggests that the practice is of Egyptian origin, yet this is not corroborated by any evidence. In the Sudan, local derivatives of the word far’auni (pharaonic) are used to denote ferociousness to describe, for example, the temper of the flooding Nile, or to signify a start of a relapse of an aggressive episode of a mental illness or, for that matter, the onset of any hot temper. We may understand this phenomenon as a way of ascribing potency to anything alien or imported; Egyptian women, for example, know zar as al-zar al-sudani.
Ancient Babylonian and neighbouring cultures have influenced Sudanese traditional practices in more than one way. Babylonian traits are seen in magical practices where, in those ancient times, magic dominated all aspects of life, including medicine. Other traits could be detected most clearly in divination procedures, and in the contents of amulets and talismans, in astrology and in numerology.
The symbols used in Sudanese amulets are similar to those of ancient Babylonian languages, and the names invoked for help or to be averted are corruptions of those of Babylonian deities. The numerical squares that are frequently drawn, are Syriac in origin, and the numerical patterns that recur in all magical formulae are apparently sexagesimal, and, therefore, Sumerian in origin. Almost every medieval Arabic medical book that is available to the Sudanese traditional healer is rich in magical seals, numerical squares and names reminiscent of Babylonian origins. People believe in these magical formulas so strongly that one such formula derived from Shumus Al-Anwar by Al-Tilmisani, precipitated acute excitatory reactions.
Numerology, applied to Sudanese shulukh (facial cosmetic scars), raises an intriguing possibility. It is popularly believed that some shulukh patterns are protective, and it has been noted that, in the Muslim Sudan, many patterns share the nominal figure (111) (one hundred and one). This figure is the equivalent of Kafi one of the ninety-nine names of God, or the equivalent of alif, the name of the first letter in the Arabic alphabet, a letter that is greatly esteemed in Muslim mysticism. Yusuf Fadl Hasan reviewed the subject of facial scarring in his book Al-Shulukh and quoted the above hypothesis but did not support it because, according to him, the numerical equivalence does not give 111, a conclusion that we think needs revision. Kafi is, indeed, equivalent to 111 whether the conversion is done through the Maghribi aiqash list, or the Mashriqi abgad.
The Sudan shares an extensive border with neighbouring Ethiopia and Eritrea. Across this border, many tribes move freely between these countries, speak the same languages and share the same culture. Several cultural features have been interchanged in the process. One such is zar, which, researchers seem to agree, originated in Ethiopia and diffused from there to the Sudan and other neighbouring counties. It is difficult to say whether zar was originally a religious function, a social cult or a healing practice, and the origin and etymology of the word has been a subject of discussion for some time. The word itself is thought to be derived from Zara, a town in Iran, or from Zar, a village in the Yemen. Occasional reference to the Sudanese zar as jama’a (company), have misled some writers into tracing, the word back to the Arabic root yazur (to visit).
Zar is most probably Ethiopian in origin, and the word an Amharic loan-word derived from the ancient Agau religion of the animist Kushites, whose sky-god was called jar. Adopted by the Abyssinians (who were converted from Agau to Christianity), the word came to mean an evil spirit.
Zar was also described by Plowden in his posthumous book, Travels in Abyssinia and Galla Country, published in 1868. Plowden likened zar to the tom-tom dance. The practice was also mentioned by several French travellers who visited Abyssinia. In 1888, zar was referred to by the Dutch scientist Hurgronje, in his book on Mecca (English translation, 1937). Hurgronje traced the origin of zar back to Abyssinia. Later, the practice was described by the American McDonald in his book Aspects of Islam in 1911, in which he mentioned a relevant paper written by Madam Rushdi in 1884. George Edward Lane, in Modern Egyptians, first published in 1836, did not mention zar. It has been repeatedly asserted by researchers that a meticulous observer such as Lane could not have omitted to mention zar, or any similar practice, were it ever performed in the Egypt of that time.
From the Sudan, zar possibly spread to Egypt and Saudi Arabia. Similar practices are known in some parts of East Africa and Iran, and there is a great similarity between zar and the Indian practice of stirring a holy script in milk and drinking it to alleviate symptoms of disease. In the Sudan, Egypt, Ethiopia, and Saudi Arabia the practice is known as zar, in Somaliland sar, in Nigeria bori zar or bori. The saka possession cult among Taita women in Kenya, and, in Morocco, the Gnawa practices for exorcising the jinn, share similar features with zar.
The Sudanese epigram: ‘nas al-shariq ya fuqara ya shu’ara, nas al-gharib ya ‘arraqa ya warraqa,’ divides the Sudan into two geographical and cultural zones: western and eastern. The western region comprises the Kordofan and Darfur regions; the eastern region represents the rest of the Muslim Sudan. The epigram describes the dominant attributes of the people of each region: those of the eastern Sudan are fuqara (religious scholars or mystics) and shu’ara (poets), and the western are either ‘arraqa (magic-mongers dealing in magical roots), or warraqa (medicine men who write amulets and charms serving black magic). The epigram also sums up well the type of influence west African cultures have exerted on the Sudan. The west African group that has made the most appreciable impression on the Sudan is the Nigerian. This group is known to be very well versed in the magical arts, and many of them are street peddlers who sell herbs, roots and amulets in almost all Sudanese towns.
 The foreign communities that have settled in the Sudan since 1820 include: Coptic Egyptians, Syrians, Lebanese, Yemeni, Indians, Jews and Greeks. Ethiopians and Eriterean have always been seen as next of kin to the peoples of eastern Sudan; their movement into other parts of the Sudan has been gradual and steady.
 Tigani Al-Mahi. The Arabian Roots of Traditional Medicine in the Sudan. in Ahmad Al-Safi and Taha Baasher (eds.) Tigani Al-Mahi Selected Essays. Khartoum: Khartoum University Press, 1984: l39-43.
 Ibn Al-Qayyim. Al-Tibbb Al-Nabawi. Cairo: many editions in Arabic.
 Al-Zahabi. Al-Tibbb Al-Nabawi. Cairo: Republican Library, 1946. (Many editions, in Arabic.)
 Muhammad Al-Nur Ibn Daif Allah (1727-1809 or 1810). Kitab Al-Tabaqat fi khusus Al-awliya wa 1-salihin wa 1-ulama wa I-shu'ara (1805!) ed. Yusuf Fadl Hasan, Khartoum: Khartoum University Press, 1985.
 See editor's notes on these shaikhs in Muhammad Al-Nur Ibn Daif Allah ( -1809), Kitab Al-Tabagat fi Khusus Al-Awliya wa 1-Salihin wa 1-Ulama wa 1-Shu'ara (1805!) ed. Yusuf Fadl Hasan, Khartoum: Khartoum University Press, 1985: page 35, and the appended list of Arabic books mentioned in the book, page 417.
 Muhammad Al-Nur. Op. Cit., page 18.
 The book, however, may not have been written by Al-Siyouti at all. Haji Khalifa in Kashf Al-Zunun attributed the book to Al-Shaikh Mahdi Ibn Ali Ibn Ibrahim Al-Subairi Al-Yemeni Al-Muhaji Al-Maqqarri (D. 814 A.H. ), and had also seen a manuscript of the same book stating in its frontispiece that it was written by shaikh Al- Attibba (chief of physicians) Gamal Al-Din Muhammad Ibn Ibrahim Al-Mahdawi Al-Yemeni. Ibn Al-Nadim in Al-Fihrist was also quoted as saying that the book was written by Al-Subairi Al-Maqqarri and not by Al-Sioyouti. Isam Al-Din Abd Al-Raouf, in an article called Mulafat Al-Siyouti (Al-Siyouti’s Publications) contributed to The Al-Siyouti Commemoration Conference in Cairo 6-10 March 1976, did not mention this book among the man's publications (which were claimed to be more than 300). Whoever was the author, the book remains a constant companion to many fakis and faqirs.
 Al-Siyouti, Abu Al-Fadl Abd Al-Rahman Ibn Al-Kamal Abi Bakr Galal Al-Din (Al-Siyouti Al-Khudari Al-Shafi'i). Al-Rahma fi Al-Tibb wa Al-Hikma [Arabic]. Cairo: Abbas Abd Al-Salam Ibn Shaqroian; Undated; Many Editions. 223 pages.
 Haji Khalifa. Kashf Al-Zhunun bi Asma Al-Kutub wa Al-Funun [Arabic]. Istanbul; 1942; Many editions.
 The books named Al-Tibb Al-Nabawi (the Prophet Muhammad's Medicine) were many. They had been compiled by Muslim exegesists starting from the 10th century A.D. The most important are those compiled by Al-Zahabi, Ibn Qayyim Al-Jawziyya, and probably Al-Siyouti. For more discussion on this topic see Ismail H. Abd Allah. at-Tibb an-Nabawi or The Medicine of the Prophet. University of Wisconsin (unpublished paper.)
 Awad Al-Karim Muhammad Hindi (Al-Sayigh). Mukhtarat Al-Sayigh (The Goldsmith Collection) [Arabic]. Cairo: Maktba'at Al-Zahran; 1949; 3 vols.
 Ibn Sina (Avicenna), Abu Ali Al-Hussein Ibn Abd Allah (D. 1037 A.D., 428 A.H.). Al-Qanun fi Al-Tibbb [Arabic]. Rome: First edition, later published in Egypt, Iran, India, and Europe many times; 1593. Note: Avicenna referred to Dioscorides book 'Plants' as a source.
 Ibn Al-Baitar, Dhia Al-Din Abd Allah Ibn Ahmad Ibn Muhammad Al-Maliqi (D. 1248 A.D., 646 A.H. ). Al-Jami' Li Mufradat Al-Adwiyya wa Al-Aghzhivya (Mufradat Ibn Al-Baitar) [Arabic]. Cairo: Matba'at Bulaq; 1874 (1291 A.H.); 4 Vols. Note: Many manuscripts are available around the world. Also published in Baghdad, and translated into French (1877-1883), German (1870-1872), and Turkish. The book has many synopses.
 Al-Maridini, Abd Allah Ibn Ali Ibn Osman (D. 769 A.H). Al-Risala.
 This has been refuted by various folklorists (see page Error! Bookmark not defined.).
 Bakhur al-taiman (Al-Taiman incense) is a panacea for the treatment and prevention of almost all ailments.
 Dr. Ahmad Yusuf Al-Siddiq Al-Hahiawi, nicknamed Al-Hakim (1802-1893), born in Hahiya, in Al-Sharqirya, Egypt, graduated in Abu Za'bal College of Medicine, Cairo, in 1828 in the second group of students to matriculate. He specialized in surgery in France, then joined the Egyptian army in the Sudan as a medical officer. He was appointed Medical Director of Donqola and Berber hospitals, where he practised medicine and surgery till his death.
 Boss interviewed Bimbashi Hassan Effendi Zeki, a medical officer during the siege of Khartoum, and recorded the following data about the town before its fall. He said that there were many doctors in Khartoum, the best known being Nessib Salim, who was an Egyptian who performed many operations including bladder stones, madura, wounds and abscesses. Chloroform was used as an anaesthetic, though it was viewed with a certain amount of fear at first. (Bloss, J.F.E. Notes on the Health of the Sudan Prior to the Present Government, Sudan Notes and Records; 1941; 24: 131).
 Al-Hakim's brother, Yusuf, also worked as a Medical Director of Kassala hospital. He got married in that region, died and was buried there in 1863.
 Numerology is the study of the magical meaning and occult significance of numbers. The ancient civilizations of Egypt, Babylon and China, not to mention others, shared the belief that numbers have meaning and mystic properties, and that their manipulation controls human life one way or the other. In numerology, each letter in the alphabet has an assigned numerical value for which it can be substituted, and, therefore, interpreted in divination or for magical purposes.
 Al-Tilmisani. Shumus Al-Anwar [Arabic]. Cairo; Many Editions.
 Tigani Al-Mahi. Op. Cit.
 Yusuf Fadi Hasan. Al-Shulukh: Origin and Function in Central Sudan's Nile Valley Region (in Arabic), Khartoum: Khartoum University Press, 1976: 83-4.