Sources of study

	The Sudan is vast; it encompasses different terrain and climatic zones, ranging from arid deserts to tropical forests and equatorial jungles, with a host of disease vectors found in a precarious environment. Consequently, a variety of diseases—epidemic and endemic—are known, and to face them, people have tapped the resources of this environment—plants, minerals and animal products—in the management of their health. In this way, the Sudanese, like many others, have amassed a great corpus of curative methods, techniques and recipes.
	Relevant data has been gathered from the accounts of travellers and missionaries who have visited the country in the last three centuries. In scope, the data ranges from that contained in the famous Sudanese chronicle Al-Tabaqat, which covered the Funj era, to the miscellaneous records here and there in more recent works.
	From these sources and others, it is possible to conclude that the Sudanese were generally healthy. However, their country was swept by several epidemics, many of which were imported from neighbouring countries, and which were frequently connected with famine and drought. These included cerebro-spinal meningitis, cholera, and smallpox. Fatalities due to these epidemics were massive..
	Baker, for example reported that he witnessed an epidemic of smallpox so bad that ‘the natives were dying like flies’.[1] Others reported that the disease sometimes decimated whole villages. Indeed, each wave of an epidemic, reporters agreed, left the population weaker and vulnerable.
	Endemic diseases such as malaria, quinea worm infestation, venereal diseases (syphilis, gonorrhoea and yaws), leprosy, and child diseases (measles, chickenpox and diphtheria), were all very familiar to most people.[2]
	Andrew Balfour solicited and edited pioneering articles on local medical practices and customs in different parts of the Sudan, in the Wellcome Research Laboratories Reports of 1908, 1911 and 1913. In these reports, four articles were written by Anglo-Egyptian medical army officers, who worked in different parts of the country after the reconquest of the Sudan in 1899. Balfour also added some additional notes contributed by Sir Rudolph Baron von Slatin Pasha, Inspector General, Sudan Government, which, he says, were derived from Slatin Pasha’s extensive experience of dervish customs and from information furnished by one of the more reputable local hakims. The notes included narratives of the treatment of syphilis, gonorrhoea, dysentery, dabas, headache, neuralgia and other diseases.
	A brief survey of the most common ailments people suffered from, and how they managed them, is given in this chapter. The items described should serve as an epitome of forms and techniques of treatment, rather than an inventory of known illnesses and recipes. In addition, here and there some exotic, and undoubtedly ingenious, curative methods are alluded to. For example, in northern Sudan nocturnal enuresis of children is treated with an interesting method; a beetle is wrapped around the penis of the affected child in such a way that it wiggles with the first drop of urine passed. When this happens, the child wakes up disturbed, and when this is repeated over many days, the child wakes up without the help of the beetle.

Chest complaints

	Cough is considered a disease in its own right rather than a symptom, and as such is given several names denoting its character, severity and duration. For example, cough in general is called quhha. When it is light, it is nasma, khabita when coarse. Some of the appellations are pathognomonic of specific diseases. For example, um qanatu and al-katkota is whooping cough. Nafas and fakak sadr are designations reserved for asthma, which is known by its characteristic breathlessness and audible wheezes. Pulmonary tuberculosis is easily identified when the cough is protracted and accompanied by blood-stained sputum and nosar (wasting). The disease is known interchangeably as al-sul, al-marad al-barid and maqtu’ al-tari.
	Various recipes and techniques are employed in the treatment of coughs. The following items are taken as internal medicines for all types: decoctions of karkade (Hibiscus sabdariffa) qarad (sunt pods, Acacia arabica) um gheleghla (Astrochlaena lachnosperma), qurunful (cloves), gum arabic, ganzabil (ginger), kholongan (Alpinia galanga) tea leaves, and nabaq roots (Ziziphus spina-christi); a macerate of qalyat ‘aish (roasted sorghum) ground and mixed with qarad; powdered ganzabil pods mixed in honey or donkey’s milk, and abu al-‘issail (particularly for whooping cough); sesame or fish oil are popular for soothing irritant and dry coughs. Qarad pods and karkade (red sorrel) are sometimes sucked, qurunful smoked in a pipe and qarad pods burnt for incensing to soothe an irritant cough. In tuberculosis, red chili is sometimes added to food, and sorghum mould is sometimes added in chronic cough.
	In all types of chest complaints, cupping, scarring and cauterizing the painful sites of the chest wall are resorted to, especially below the clavicle or at the site of pain or swelling. The patient’s heel is sometime cauterized to ‘root out’ cough. A little piece of mistika (mastic) is warmed and rubbed over a child’s chest and covered with a piece of cloth as treatment for acute cough and for nazla, zukam, sutam (common cold). In nazla (coryza), fumes of boiled kasbara (Coriandrum sativum), or burnt harjal (Solenostemma argel) and sugar are considered beneficial especially when nazla is accompanied by dosha (dizziness).
	Abu sufuf (pleurisy) is treated by scarring over the ribs. Four rows of 4-5 scars are inflicted on each side of the chest and then rubbed with natron till blood gushes out.[3] Alligator lung or elephant dropping are said to be good for asthma. Sometime al-risha (the uvula) is incriminated as a cause of intractable cough and consequently excised to achieve a cure. Quranic verses are frequently inscribed on a triangular piece of qara’ (pumpkin) and worn around the neck for whooping cough.

Worm and parasitic infestation

	Intestinal parasites that infest man are known categorically as daidan (worms), but when the infesting worm is Taenia Saginnata, the name hanish is given. Qirfat al-dud (Albizia anthelmintica) is the commonest cure for all worms. It is powdered, mixed with milk and taken on an empty stomach. Guinea worm infestation is particularly common in the Sudan. It attracted the attention of early travellers; most probably due to the dramatic way the local people extract it from the body.
	James Bruce visited Abyssinia, the Sudan and Egypt (1765-1777) and gave a shrewd account of guinea worm infestation—the parts most susceptible, a clinical description of the disease and how it was managed. Nonetheless, when his book appeared, he we was branded as a highly imaginative liar.[4] He wrote:
	“The plague appears indiscriminately in every part of the body, but oftenest in the legs and arms. I never saw it in the face or head, but far from affecting the fleshy parts of the body only, it generally comes out where the bone has least flesh upon it. Upon looking at the worm on its first appearance, a small black head is extremely visible, with a hooked beak of whitish colour. Its body is seemingly of a white silky texture very like a small tendon, bared and perfectly cleaned. After its appearance, the local people of these countries who are used to it, seize it gently by the head and wrap it round a thin piece of silk, or a bird’s feather. Every day or several times a day, they try to wind it up on the quill as far as it comes readily, and upon the smallest resistance, they give over for fear of breaking it. I have seen four feet or something more of this extraordinary animal winded out with invincible patience in the course of three weeks.”[5]
	It is interesting to note that this is still the commonest treatment. Ferindeet (guinea worm), Drachonculous medienensis is known to penetrate the skin while wading in pond water. The Nuba extracted it as described above, but they also devised a special type of patten with very high heels and leather strapping to protect them against catching the worm in the first place.
	Um jiljil or jiljil (Aristolochia bracteolata) is known to expel worms if taken orally. One dose of 80 seeds of pumpkin is said to dissipate worms from the intestines. Worms infesting purulent wounds are treated with hijlij (Balanites aegyptiaca) chewed to paste and applied to the wound. Um abaka (Gardenia lutea) and takirti (Albizzia anthelmintica), which were identified by Anderson in Kordofan, also expel worms if taken orally.[6]
	Figure 20: Nuba pattens usually worn with leather strapping for protection against guinea worm.

Smallpox

	Healers and laymen alike have differentiated between al-burjum (chickenpox), (also known as al-burjuk), and hisba (measles). Judari has always been difficult to diagnose except during epidemics. They have also identified several types of skin rashes, and labelled the itchy dam al-tayyir. The infecting agents in all these diseases were not known, but methods of contagion were suspected, and, therefore, the many ways of management developed.
	We have no evidence that people knew the agent that caused smallpox. Healers infrequently confuse its diagnosis with impetigo, psoriasis and other skin lesions. People refer to the deadly smallpox as judari al-karufa, a phrase indicating that the disease is so virulent that it is contracted through breathing.
	Smallpox is a highly dreaded and stigmatized disease. It has been known in the Nile valley and neighbouring countries for around a millennium and a half.[7] During recorded history, a number of devastating epidemics have scourged the land, giving rise to appallingly high mortality. Of all diseases, smallpox was unique in lending itself to traditional control measures, and more than one method of variolation, prevention and treatment were practised.
	With the exception of anointing the skin with oil, which is particular to the Sudan, other preventive measures were also known in neighbouring Egypt and Ethiopia. People shut themselves indoors. The sick were segregated and sometimes the population moved en masse.
	Traditional variolation is practised to protect cattle against cowpox and abu qinniet (pleuro-pneumonia). In cowpox, a piece of the lung of an infected cow is cut after it has died, and sewn in an incision inflicted in the ear of a healthy cow. In cases of pleuro-pneumonia, inoculation is done on the tip of the cow’s tail. In abu lisan, a piece of cloth is soaked in the saliva and tears of an infected cow and the contents blown up the nostrils of a healthy animal.
	Several methods of traditional inoculation were practised in the Sudan in the early days. Some were perhaps indigenous to Africa, others were probably Arabian.[8]
	Inoculation was known and practised long before the Mahdiyya. Pus was taken from a pustule of an infected person and rubbed into a scarified wound of a healthy one. A highly infected person was preferred as a donor to somebody lightly infected; the disease caught from a heavily infected person is said to have spent itself, and, therefore, would not be severe if caught. Bloss noted that the mortality among those inoculated was only about two or three percent, which, considering the total mortality, was very small.[9]
	Bruce in 1790 described the commoner type of inoculation, tishteree el jidderee (buying the smallpox). This type was common among the Shulluk, the Nubi and Arabs. In Bruce’s words ‘women, both the blacks and Arabs, those that live in the plains, like the Shulluk or inhabitants of El Aice, those of Nuba and Guba, those that live in the mountains, all the various species of slave that come from Dyre and Tegla have known a species of inoculation which they call …’
	During the fairest and driest season of the year, and upon the first appearance of smallpox anywhere, women of Sennar go to an infected person and wrap a fillet of cotton cloth around an infected area. They then start bargaining with the patient’s mother over the price of this ‘infected charm’. After it has been bought, it is taken home and tied round the arm of the person to be inoculated. When the person develops the disease, he is supposed to get no more pustules than have been paid for in the bargain.[10]
	W.G. Browne, who travelled from Egypt by Darb A- Arba’in road to Fasher in 1793, also described local inoculation.[11] A less favoured method called dag el jedari (hitting the smallpox) was described by Burckhardt.[12] This method, they observed, was unpopular in both northern Sudan and southern Egypt. Little benefit was said to be gained from this technique, which consists of rubbing the fluid taken from the pustule of an infected person into an incision inflicted on the leg of a person to be inoculated.
	Throughout the Sudan, smallpox patients were isolated and put under the care of elderly persons, such as a woman well past her menopause. In Darfur, a patient was isolated in a cottage called al-kurbaba (kurfa in central Sudan), and nursed by a person who had had the disease before. Patients were fed on a frugal diet, mainly milk and porridge. They lay on beds of ash; where the eyes were inflamed, onion juice was dropped in.
	Among the Fur, however, Beaton writes, smallpox is treated as an honoured guest and referred to euphemistically as grandfather (abo); grain and flour are sprinkled outside houses to propitiate it and to avert a fatal visitation. So far in fact do such propitiatory rites go that sometimes a deputation is sent to an infected village where pustules are punctured and the pus conveyed back to the uninfected village for use in a primitive sort of inoculation.[13] When smallpox hits a village, the Acholi generally isolate the affected cases and whole villages are often burnt after an epidemic. Vaccination is practised, the actual pus of a patient being rubbed into a cut on the forehead of the man who is being vaccinated.[14]

Chickenpox and measles

	Chickenpox and measles in their full-blown forms or during epidemics have been differentiated and identified as inevitable childhood maladies. A number of ways of prevention and treatment have been tried. The diseases were formerly believed to be aggravated by any strong odours, whether those of perfume or of cooking. Patients were, therefore, isolated away from any possible exposures.
	The pustules of chickenpox are covered with deep river clay or mud collected from underneath earthenware water pots. The earth probably works as a soothing poultice; antipyretic, astringent, and antibiotic effects are also possible.[15] Hisba (measles) rash is rubbed with the froth of goats’ milk.
	Patients with either measles or chickenpox are isolated in a kurfa, an isolated lodge, whose walls are made of a special red birish (a straw mat), or red cloth, laid on beds covered with red birishs; the red colour is considered to have healing properties and soothes the inflamed eyes. Eye inflammation that usually accompanies these diseases, however, is treated with eye drops made of a decoction of either tundub (Capparis decidua), sorghum or dukhun (Pennisetum typhoides), to which onion juice is added. The body is anointed with oil to limit the spread of skin lesions. When hisba rash appears, full recovery is believed to be imminent. A number of methods are resorted to to expedite this process. They include fumigation with harjal (Trigonella argel), rubbing the skin with goats’ milk, especially when the eyes are inflamed. Patients with chickenpox and measles are not bathed for a period of seven days; they are then bathed with a macerate of ‘aradeb (tamarind, Tamarindus indica), soaked in water over night. In Darfur, flour is spread outside the patient’s room every morning, and the room itself is not cleaned for fear of raising dust.

Fevers

	Fever, a manifestation of many infections, is seen as a disease caused by almost any natural or supernatural agent. The Evil Eye, however, ranks high among the agents that cause fever in all ages, while um al-subiyan (see page 63) affects only the young and causes other diseases in addition to fever. However, when fever is accompanied by convulsions, the diagnosis is surely directed towards um al-subiyan. In this case, the parents are forbidden from touching the child. The sign of the cross is drawn in soot on the forehead, and the faki is asked as well to pray for a cure. Many plants are used for their antipyretic effects, and some are claimed to be specifically anti-malarial, antibiotic or anti-inflammatory as well.
	The ascites and enlarged spleen in kala-azar and malaria are designated jana al-wirda (the outcome of fever). Because fever is seen mainly as due to supernatural causes, treatment is associated with ritual fumigation, incantation and magico-religious spells including the use of bakhras, mihayas, and the laying-on of hands (see religious healing techniques pages 112-). Physical methods are also resorted to and include massage with coolant herbs and salts, cupping and cautery.
	Among fevers, malaria has attracted a lot of attention and received much better documentation in classical medical and literary works, as well as the best descriptions in local tongues. Fever is known under a variety of labels—humma, wirda, sahraja, and is qualified, when it is a malarial fever, as humma um barid (fever with rigours), hummat kharif (rainy season’s fever), gibbiyya, tiltawiyya and rib’. Ghibbiyya (literally a fever that recurs every other day) is quotidian in northern Sudan[16], and tertian (recurring every third day) in Darfur.[17] Wirda[18] is quotidian in Darfur.
	In 1819, Burckhardt wrote:
	“The people of Berber were on the whole a healthy race probably due to the situation of the town at the edge of the desert. When the Nile was in flood, a fever called wirdee occasionally became epidemic. It did not occur every year but when it did there was a high mortality rate among those afflicted.”[19]
	Al-Tunisi in his narrative of the Darfur kingdoms, Tashhidh Al-azhan bi-sirat bilad Al-Arab wal-Sudan,[20] describes al-humma al-mutbiqa, and likens it to al-nosha (typhoid fever) of Egypt. However, whether this name is actually known in Darfur is doubtful because Al-Tunisi soon adds that, ‘all types of fever are called wirdi by the Sudanese, they do not differentiate between them.’
	People also recognize al-humma al-raj’a (relapsing fever) and abu-farrar (cerebro-spinal meningitis); for treatment, they cup the back of the neck and rub the skin with qarad (Acacia nilotica), and vinegar.
	Awad Al-Karim Muhammad Hindi in his Mukhtarat Al-Sayigh, quoted the views of some notable healers of his time on the causes of fever:
	“Basir Mustafa Bati of Omdurman attributes wirda um barid to accumulation of internal dirt, walking on hot ground, exertion or damm [plethora]. Basira Fatima bit Talib of Berber, classifies fever as either due to nugud al-halaq [syphilis], especially in winter, khiderat [tonsillitis], or ‘afanat al-matar [dampness of rain]. Basira Fatima adds: “if khiderat [infected tonsils] are treated, fever subsides.”[21]
	Purulent wounds draining in the groin and armpits are known to cause ashgaddi (lymphadenitis) and fever. When a child runs fever with rigours, the parents are forbidden from touching him or her because the condition is believed to be due to um al-subiyan. In this case, the faki draws the sign-of-the-cross in antimony or in black soot on the child’s forehead while reading some incantations and selected verses from the Quran. This is a common procedure required to pacify the demons and evil spirits. The ‘uqda (knot, see page 122) is blown upon both for prevention and for cure of fever. A patient is fumigated to exorcise evil spirits, and reverse the ill-effects of the evil eye. The following items are used as fumigants chameleon’s skin, hedgehog skin, tea leaves, common salt, sheeh (Artemisia absinthium), and dofr (dried cartilaginous remains of shell-fish).
	As further treatment for fever, the skin is massaged or rubbed with vinegar, qarad, hinna (Lawsonia alba), mixed with common salt and water, oil or liquid butter. The scalp is covered with sheep’s tallow, and the patient’s bed covered with ground qarad. Wet cupping of the nape is practised both for prevention against various diseases and for treatment. In Darfur, when fever is high, the young patient is cauterized on the forehead. For wirda um barid, recipes include kasbara (Coriander), kurkum (turmeric, Curcuma longa) ‘aradeb (tamarind), mistika (mastic), jardiqa (see entry in A Sudanese Materia Medica page Error! Bookmark not defined.) maqarat, qirfa (cinnamon, Cinnamomum zeylanicum), kholongan (Alpinia officinarum), mahareb (Cymbopogon proximus), sugar and samn (butter oil).
	Internal medicines for fever include the following: macerates of qarad, ‘aradeb, turaiba, and jardiqa, the last two are type of earth taken sometimes with dates; a decoction of harjal; a decoction of murdu known also as gulum (Capparis tomentosa) and tysin (the last three are peculiar to Kordofan). To cool the skin, massage with hinna and khall (vinegar) is practised. The late basir Mahjoub Hamad of Berber used to immerse a febrile patient in Nile water three times to cool down.[22]
	Slatin Pasha, among his observations on the practices of the dervishes during the Mahdiyya, in his book Fire and Sword, mentions that senna (Cassia acutifolia) and ‘aradeb were taken as purgatives by the dervishes for the treatment of fever.
	Irrespective of the cause, splenic enlargement with ascites is known as tohal, marad al-sa’id, um saloki, himl al-rujal (literally man’s pregnancy), wad al-wirda (jana al-wirda). All these alternatives describe the abdomen in Kala-Azar in endemic areas in south eastern Sudan.
	Reduction of the swollen abdomen mechanically by tight bandaging is first tried. Al-qaris (sour camel’s milk) is given to patients to live on exclusively. At the same time, they are required to exercise strenuously. A decoction of several herbs is mixed in camel’s milk. The mixture includes janzabil (Zingiber officinalis), qurunful (Eugenia caryophyllus), qirfa (cinnamon), filfil (Capsicum annuum) cammoun aswad (Nigella sativa), kasbara, shamar (Cuminum cyminum), hilba (fenugreek, Trigonella foenum-graecum), toum (garlic, Allium sativum), basal (onions), and harjal. All are incubated for 3 days, and when it is ready, the patient takes it freely for 12 consecutive days.

Venereal diseases

	Venereal diseases used to be quite common in the Sudan to the extent that whole tribes were said to have perished because of the ensuing sterility. Al-bol al-har (burning micturition), though a symptom of urinary tract infection, is considered a disease in its own right. Sayalan, hasar (gonorrhoea) is sometimes confused with bejel (lymphogranuloma inguinale). Sass, zuhri (syphilis) is fairly well known in its different stages, which are described. The syphilitic ulcer is known as safra (the yellow sore), the skin rash, darish, and the tertiary manifestations halaq (circles), giqqail, sharr, sass and nugud al-halaq. People incriminated sexual intercourse as a cause of al-boal al-har (Gonorrhoea?), halaq, sass or jiggail (syphilis).
	In Kordofan, the appearance of syphilitic sores, ulcers and other skin lesions is considered an ‘outlet’ for the disease, and, therefore, beneficial. The syphilitic sore, ulcer and skin lesions are generally not treated. Treatment regimens include starving the patient and use of drastic purging and enforcing diuresis. Haematuria induced with local catheterization is looked upon as essential to cure. Anderson reported, early this century, that the diagnosis of syphilis is very uncertain amongst the people of Kordofan, and that many lesions, such as impetigo and psoriasis are confused.[23] But he added: ‘Wonderful cures’ are of course reported on all sides, and the non-professional English official is quite convinced in many cases that the local Hakim possesses mysterious knowledge and drugs far superior to the mercury and iodides of the English physician.’[24]
	Al-khashaba and burma treatment regimens are popular throughout Muslim Sudan; they vary from locality to locality and from healer to healer, but in minor details only. Al-khashaba[25] is an enforced starving dietary regime accompanied by disciplinary measures imposing penance on patients, particularly those with venereal diseases.[26] Fat and salty food are restricted and the patient may eat only dried ‘ishba (sarsaparilla). This herb is powdered and mixed with an equal amount of sugar and taken twice daily. It is also made as a paste mixed in honey. During treatment, the patient is kept in a quiet place, avoiding any extremes of emotions, and confined to a room under the care of an old woman. The patient should not eat cheese, beef, molokhiya (Jew's mallow, Corchorus olitorius) or use salt. The regime continues for forty days after which the patient is allowed to undergo incensing with burning aromatic wood.
	In the ‘burma’ regime, three pounds of turaiba[27] are mixed in six pounds of water in a burma (earthenware pot), and left to stand for 3 days. Half a pound is drunk every morning and evening for a week, during which time the patient eats only dry saltless dura bread and drinks half a pound of samin (ghee). During the second week, goats’ meat, dura bread with half the usual ration of salt, is allowed. In a medical tour to western Kordofan in 1917, Negib Eff. Yunis, reported on the burma treatment as practised by the Baggara. He said that the herbalist collects iron filings and adds some qarad, ‘aradeb, ‘atroun (natron) and certain herbs. The mixture is boiled in a burma for 24 hours, the quantity of water being increased whenever evaporation makes this necessary. The patient is admitted into the house of the herbalist and remains under his supervision for 15 successive days. In the meantime, the patient is permitted to take freely of the contents of the burma but little else. When released, the patient is very weak and emaciated; he goes away to come back for another session in few months time.[28]
	Several recipes are prescribed as internal medicines for the treatment of syphilis including ‘atroun in milk and samin; decoctions of tiebra root, denobia root and daiu root (peculiar to Kordofan); decoctions of shirkaila no. 2, karkade (red sorrel), tibet-tree root, with khara hadid[29] (iron smelter refuse), or a decoction of dukhun (bull-rush millet, Pennisetum typhoides) drunk in protracted cases.
	The syphilitic lesion is occasionally cauterized, and powdered root of ghrur, kursan fruit (Boscia senegalensis), natron and turaiha (Pterocarpus lucens) are sprinkled over long-standing ulcers, or turaiba (anti-syphilitic earth), which is imported from the Nile or obtained from the vicinity of Bara, is taken as pills or as a drink.[30] In the Wellcome Reports alluded to earlier, the recipes collected for syphilis included: milk and butter mixed with burnt natron, or pure honey mixed with green tutiya.[31] This is to be taken daily before breakfast for three days. During this treatment, the body should be washed and perfect cleanliness observed. The diet should consist of beef, onions and vegetables, and sexual intercourse avoided. The bread in these diets should consist of saltless white dura or dura shami (maize), with no onions. Feterita dura should not be used. The patient should be fumigated with talh wood (Acacia albida).
	Slatin Pasha added:
	“As regards the ‘turaiba’ treatment, it is said that no other medicine is so effective for syphilis because our forefather Adam was made of earth!”[32]
	For the treatment of gonorrhoea, the patient is submerged in a tepid infusion of hilba.[33] This medicinal bath is repeated for three days. To speed recovery, half-sweetened black tea is left in the open all night, and drunk for seven days.
	The symptoms of gonorrhoea are infrequently confused with other causes of pyuria and haematuria, which may or may not share al-bol al-har (burning micturition). When these symptoms are found, an infusion of jardiqa, honey, cocoa, or hinna is taken orally. The Sherkaila No. 2 Root taken with milk is claimed to be particularly effective in children, and in the treatment of syphilis.
	The adverse effects of the traditional treatment of the genito-urinary tract, especially gonorrhoea, are reported. Some of the local cures are considered not only ineffective, but also dangerous. Deaths due to anuria, acute ascending nephritis, gangrene of the penis and scrotum, with severe vomiting, diarrhoea, and acute inflammation of the kidneys with haematuria, are reported. Though rab’a (Trianthema pentandra) root taken by mouth is considered very effective in treating burning micturition, it is incriminated as the most probable cause of certain cases of poisoning and death which were reported following some local prescriptions for the treatment of gonorrhoea. R.G. Anderson has this to say:
	“The native treatment of gonorrhoea is not only ineffective but most dangerous. There have been three deaths in the Civil Hospital, El Obeid, during the last year from malpraxis in this direction, one from, anuria, another from acute ascendant nephritis, and a third from gangrene of the scrotum and penis. Each of these unfortunates had, prior to admission, undergone a course, resulting in severe vomiting, diarrhoea, and acute inflammation of the kidneys, with haematuria, the passage of blood being looked upon as an essential to the cure. In the case of the patient who died from anuria, raba’ was the drug used (as indeed I suspect in all three instances)”.[34]
	Mahlab (Hypoestes verticillaris) seeds are taken in marisa (a local alcoholic fermented drink) for the treatment of gonorrhoea and other cases of burning micturition. In Kordofan, a number of plants are reported to be effective remedies for burning micturition; these include gadda (Ferula foetida) powder, kharasmi (worm seed), sheeh (wormwood) and kalto (Ximenia americana), which is particularly known to cause severe diarrhoea an vomiting. The roots no. 1 and 3 from Shirkaila and ‘irq al-kujur (unidentified taxonomic name) are all taken in milk or in marisa, some of them with tragic consequences. Bamiya (okra, Hibiscus esculentus) is sometimes cooked into a paste and eaten as treatment.
	As yet another treatment of gonorrhoea, the fruit of hanzal (colocynth) is emptied of its seeds through a rounded hole at one end. The resulting cavity is then filled with milk in the evening and allowed to stand all night, being drunk the following morning. The same fruit lasts for three days, when, if a cure is not complete, another should be used.[35]
	Catheterization of the penis with instillation of medicinal infusions is performed using an eagle’s quill. An infusion of kalto is also instilled into the urethra using a locally-made tin or a pierced horn-syringe. Rectal infusions through a perforated sheep’s horn are sometimes tried, especially when there is sinus or prostatic involvement. Daily infusions of abu lebru (Boerhavia plumbaginaceae) fruit are given. Sitting on warm samin and local fumigation for women are also resorted to. Potent diuretics are identified in sha’ir (barley, Hordeum sativum) khilla (Ammi visnaga), marisa and damsiesa (Artemisia absinthium), ‘usher (Calotropis procera) and dar sini (Cinnamon, Cinnamomum zeylanicum).

Insect stings and snake bites

	Poisonous snakes, scorpions and other harmful animals and insects are identified, their habits and habitat are known, and, when man or animal is bitten, traditional management begins. Antidotes derived from the local flora are prepared, and amulets (including herbal items) are worn for protection.
	It is known that these creatures do harm through poison introduced through the skin when it is breached by a sting or a bite. A tourniquette proximal to the affected site is immediately applied. The site itself is incised as quickly as possible, and all blood sucked out. The patient is immobilized and transferred to the shade. Inactivity and rest are thought to speed recovery by arresting the spread of the noxious material to the rest of the body.
	Evans-Pritchard reports on the Azande submitting an accused to the poison oracle by giving the subject a strychnine-like potion to drink:
	“If the poison were going to kill a boy it would not kill him while he sat still on the ground, though he would suffer spasms of pain that would make him stretch his arms backwards, gasping for breath. When a boy fell to the ground efforts were made, with the king’s consent, to revive him by administering a slimy mixture made from the mboyo plant, the kpoyo tree, and salt. This made him vomit the poison. Afterwards they carried him to a brook-side and laid him in the shade and poured cold water over his face.”[36]
	Abd Allah Abd Al-Rahman, in his book Al-‘Arabiyya fil-Sudan[37], mentions that it is a common custom among Sudanese Arabs to attach women’s jingling bells to a man bitten by a snake to prevent him from sleeping for a few days; poison was thought to spread in the body during sleep[38].
	The incriminated scorpion, if found, is killed and tied on top of the stung site. If it is a snake, it is buried to keep it away from the effect of the hot sun. Cure is believed to take effect through the principle of ‘like cures like’, that is, if the snake is left exposed to the scorching heat, the patient suffers similarly, and vice versa.

Pain and consciousness

	As in other societies and cultures, different varieties of pain are described by the Sudanese. Likewise, the reactions to pain and the expression of it, are influenced by special social and psychological factors. A number of pain-killers are known and used, but not as many as one would hope for, nor in a potency to make any sizeable surgical intervention endurable. The concept of anaesthesia as is known in modern medical practice is not developed, but recipes that alter the state of consciousness are known.
	Observers believed that the Sudanese display a high degree of tolerance and stoicism to pain, something the Sudanese themselves boast of having. Indeed, tolerance to pain seems to be an important attribute of Sudanese manhood. It is deemed shameful that a man should complain of pain or show fear in situations of distress. It is a matter of pride, for example, to move the whole body, instead of turning the head alone when one is shouted at from behind. Not only that, but if one is being bitten by a dog, one should not turn to push the dog away; others should do this instead. It is, equally, shameful to flee any life-threatening situation, and certainly not a death penalty. In many tribes, a praise-song of a hakkama (a tribal poetess) in a dancing party is all a young man can hope for in life. Such songs spread a man’s valiant deeds (or cowardice acts) among the tribe, and therefore enhance or revile a young man’s reputation.
	In marriage ceremonies, young men, mostly eligible bachelors, practise butan (ritual whip-flogging). In front of girls they vie with their rivals in bravery, endurance, and manly prowess. Each pair of rivals take their shirts off, and, in turn, whip each other on the naked back until one falls unconscious or arbitrators intervene to call it a draw. The whiplashes produce scars so deep that one wonders how they are tolerated and borne without a word uttered or even a grimace. If one of the rivals were to show the slightest reaction to whipping he would be labelled a coward, and girls would not accept him in marriage. Another show of courage is when, in a marriage ceremony, a man in love approaches his beloved girl while she is among others, takes his knife out of its case, utters words that assert that he is the one who will protect her, and starts scarring himself with the knife until the audience stop him. The girl would be duly flattered.
	Signs of such ventures were frequently seen on the bodies of men in earlier days. Other procedures are also cited as examples. Shulukh (ritual facial marks), fisada (blood letting), kai (cautery), tajbir (bone-setting), male and female circumcision, among other surgical procedures, are all performed without anaesthesia or analgesia. Even the young boast of their endurance to pain by performing shatara among themselves. Young boys heat a date palm seed by rubbing it vigorously over a smooth stone, and apply it immediately to each others forearm. The most courageous is the one who tolerates the painful stimulus without wincing. The one who utters a cry or shows undue signs of feeling pain will be held in disgrace and lampooned.
	Pain is described as alam or waja’, and, though these terms are interpreted differently, they also connote an underlying disease process. For example, when one complains of waga’ kila (kidney pain) or waga’ kabid (liver pain), one is actually complaining of an ailment somewhere in the region of the loins or the right hypochondrium, respectively.
	People complain of waga’ ras and suda’ (headache), shaqiqa (migraine). When headache is thought to be due to fahq (neck twisting) or muscle sprain, the nape is massaged and lifted up with the two thumbs, in a procedure called rafa’ al-fiqar (nape lifting up).[39] A mild, transient and throbbing headache is treated with a scarf tied tightly around the head, just above the eyebrows. Persistent headaches need more aggressive management, and are usually referred to the faki, who treats them with ‘azima (spitting cure) and incantations. In the treatment of shaqiqa headache, the faki draws squares on clean sand in which he inscribes special letters and numbers; then he puts a probe in each square in turn while reading some selected verses from the Quran.
	General measures for treating headache include the application of a variety of poultices which are considered to alleviate headache. Among these are poultices of harjal, shebb (alum), hinna (Lawsonia alba), salt (qa‘ab salt in particular), and goats’ butter. These are applied to the cleanly-shaven scalp, Cammoun aswad is sniffed together with samn through a special instrument called mis’at. The same procedure is applied in the treatment of the mentally ill; both situations are based on the same inherent misconception. Like the ancient Greeks and early Arabs, the Sudanese believe that the nostrils are directly connected to the brain and, therefore, that nasal secretions descend from its base; hence the name nazla (coryza).[40]
	Sometimes, a patient with a chronic headache that is not responding to a drink of haza (Haplophyllum tuberculatum) for example, is described as rasu fat-ha, i.e., he has an ‘open head’. The case is diagnosed by measuring the circumference of the head vertically and transversely to establish this fact. To close the head, a band is wound around the head over the temples and a key or a piece of wood is used for tightening. A mixture of wadak (tallow) and zait (oil) is poured over the crown of the head. The procedure is repeated every day for three days until the head is declared ‘closed’.
	Waja’ al-kila (kidney pain), which includes renal colic and all types of loin pain, is relieved by a decoction of bizr al-khilla (visnaga, Ammi visnaga) taken orally; this is believed to expel stones from the urinary passages. Infusions of mahareb (cymbopogon proximus) or sha’ir (barley) are drunk to clear the urinary passages. Haza (Haplophyllum tuberculatum) sheeh (wormwood, Artemisia absinthium), harjal (Trigonella argel) damm al-ikhwa (Daemonorops sp.) and habbat al-muluk (croton oil seeds, Jatropha curcas), yansoun (anise, Piminella anisum), carawya (caraway, Carum carvi), na’na’ (peppermint, Mentha viridis), and qurunful (cloves, Eugenia caryophyllus), are powdered and ingested as internal medicines, to relieve pain or expel stones.
	Waga’ al-kabid (liver pain) stands for all types of pain and discomfort arising in the right hypochondrium. Dry cupping, scarring, blood letting and cautery, are frequently performed over the site of pain. As internal medicines, powdered sha’ir hindi, hijlij (Acacia aegyptiaca), ikhwa, senna mekki (Cassia acutifolia) are mixed together and taken orally first thing in the morning.
	A mixture of powdered karawiya, qurunful, za‘tar (thyme, Thymus vulgaris), zangabil (ginger, Zingiber officinalis), and qirfa, is taken sometimes in honey for the treatment of waja’ al-kabid. Also, sha‘ir, a known diuretic, is believed to be a radical cure for jaundice.[41]
	Waga’ al-qalib (heart pain) refers to epigastric pain. For the treatment of this malady, an infusion of hilba or harjal, is prepared singly or added to ‘aradeb, and taken freely. Harjal, ‘aradeb, cammoun aswad (black cumin) mastic and sukkar nabat (white barley sugar) are powdered and taken twice daily.
	When the al-dhafiera (toothless gum) of an infant is itchy and painful during teething, it is either rubbed with a piece of charcoal or cauterized. Alternatively, the baby is given a sheep’s tail or ‘irq al-teeb (Iris germanica)[42] to suck and bite on.
	To protect a child against any possible problems that might accompany teething later, the newborn is lifted four times towards the shrines of the two holy men, Hamad and Khogali,[43] invoking them for blessing and protection against this particular malady.
	A number of medicinal plants are applied locally to alleviate toothache. These include ‘aradeb, filfil, tumbac (tobacco, Nicotiana tobacum), shatta (chili, Capsicum frutescens), and qurunful. The latter is also chewed or smoked for gingivitis. Alternatively, ‘afus (gall nuts) powder or dalli (Trianthema salsoloides) ash are mixed with tallow or water respectively and applied to the swollen cheek. Teeth and gums are brushed with neem (Azadirachta indica) or arak (Salvadora persica) twigs and rubbed with ‘ud qarha (Cucurbita pepo) or qurunful powder.
	According to faki Al-Mahgoub Muhammad of Berber,[44] wag’ al-mafasil (joint pain) is either due to sass (syphilis) or to buruda (coolness). If it is due to buruda, efforts are directed to reverse it by fumigation, exposure to direct heat or with a ‘sand cure’. The affected area, after anointing with oil, is exposed to the heat of a charcoal fire. Alternatively, a red brick is heated, sprinkled with water to put the flames out, wrapped in cloth and applied to the affected area. To achieve the same effect, a trench the size of the man’s body is dug is the ground. Burning wood is put in it for some time; this is then cleared away and the trench sprinkled with water. The patient’s affected limb is anointed with oil; he lies on a straw mat and is covered with blankets. He stays in the pit for an hour. The procedure, particularly prescribed for lumbago, is repeated until a cure is achieved.
	Fumigation with talh is universally believed to be beneficial in rheumatic pains, referred to as rutuba. Dry and wet cupping and cautery of the affected area are sometimes resorted to. The Qa’ab[45] valley is frequently visited for a ‘sand cure’. This is resorted to in chronic joint pains and for other intractable illnesses. The patient’s whole body is anointed with oil and buried in the sand to cause profuse perspiration. The ‘bath’ is followed by massage, and the patient is given rich food. The regime goes on for a few days (usually more than 10 days).
	Internal medicines are also given to alleviate joint pain. These include a decoction of either khiyar shanbar (Cassia fistula), kasbara, harjal or mahareb. The cooked paste of toum, milk, ghee and ‘asal nahl (honey) are also given. The late shaikh Yaqoub shaikh Hagu of Sennar, claimed that this last recipe is most beneficial. Sometimes, purgation with a decoction of ‘aradeb and senna taken orally, may precede treatment, qutran (tar) made of burnt ‘amyoqa seeds, is used as a paint for the affected part. Dukhun flour, dates and hilba are mixed in water and taken as internal medicine.[46]
	Al-motaib (dysmenorrhoea) is treated with harjal or strong unsweetened coffee. Mosa and mardhaifa designate uterine colic in general, and are treated with hilba. Robe (sour milk), is taken for waga’ al-jarat (post delivery uterine colic). The tip of a spear or a knife is directed towards the painful site when the colic is thought to be due to the woman giving birth to a boy after a girl; if vice versa, a woman is then described as qalba (reversing).
	Waga’ al-‘uyoun (literally eye pain), refers to all types of eye infections, and is treated with lotions, powdered tea leaves, qarad, dome, habat al-‘ain, myrrh, saffron, lobia tayeba, tumbac, filfil, shatta, onion and lemon juice, rihan and ‘irq al-dahab.[47]
	More local cures for eye ointments have been reported by Beiram.[48] However, he believes that:
	“Such local medicines are dangerous whether in powder or liquid form. In the first case they could be highly injurious by producing abrasions, and secondly they may be dangerous through chemical toxicity or pH variations. Both may introduce fungus infections or other virulent organisms into the eye.”
	When medicines are of no help and the eyes become a source of repeated trouble, two or three superficial scars are inflicted on the temples as a measure in treating some chronic eye ailments. A large proportion of people who were originally from the northern Sudan, where trachoma and other eye infections prevail, carry the characteristic two to three superficial scars on both sides of the temples.