Several surgical operations are performed for reasons other than curative. These include, in addition to shulukh (cosmetic scarring), tattooing, perforation of the ear lobe, nose and lips. Other procedures are mutilating and disfiguring, and have been performed with this goal in mind. These include castrating males to make them fit for certain jobs, or amputating fingers or limbs as judicial punishment. Female circumcision is widely believed to be necessary to protect or promote the cherished values of chastity and modesty in women.
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Several cosmetic procedures such as shulukh (facial scars), washm (tattoos), and fisada (superficial scars), are performed surgically. Shulukh are common among tribes of Arab stock, though also known among indigenous tribes prior to Arab migration to the Sudan. Yusuf Fadl Hasan traced the shulukh back in the ancient world, especially in Tropical Africa and early Arabia, and discussed the various reasons given for inflicting them in his book Al-Shulukh.
The tribes who inflict shulukh do so, especially on males, as characteristic tribal or clan brands. The scars may also characterize a Sufi fraternity or may be purely cosmetic such as in women. They may be protective in function. An unusual pattern of scars is inflicted on a precious child’s face to protect it from untimely death. This is especially done when the family has repeated deaths, or when a child is born just after its father’s death. Here, for example, a single vertical scar is inflicted on the cheek so that the hovering father’s spirit would not recognize it. In intense grief in the death of a close relative or a beloved one, a ‘T’ pattern is added to the usual set of scars. Similarly, a different pattern is inflicted to protect one from dying of grief. In all these cases, the different pattern is believed to camouflage the bearer from the onslaught of the Angel of Death or hide a precious child from the Evil Eye.
The scars are made by experts who understand fully the social requirements and comply with the prevalent norms of beauty. To prepare the face for the surgical procedure, they first outline the site with a marker. They, then, cut on the markings with a razor-blade and remove the skin away. The resulting wound is immediately filled with oil as styptic and to aid healing.
Among the Dinka, the initiation of youths is ushered in by removal of the lower teeth, infliction of gornum (tribal markings around the head), and, finally cicatrisation. The Hadandawa of the eastern Sudan and the Nuba of the west are the indigenous tribes that are known to inflict shulukh as tribal markings. Some members of the Azande tribe of the Sudan occasionally produce facial scars such as those of the Arabs by painting the face with the caustic juice of a local plant known as leshi, thus producing spurious scars.
Tribes of Negroid stock have made use of their skin’s ability to form keloid in order to make characteristic facial and body marks. The Nuba and several tribes of southern Sudan have made use of this phenomenon in order to make scars on different parts of the body, in particular around the navel, nipples and over the abdomen. Whatever the reason for inflicting these scars, the practice among all ethnic groups, throughout the country, is dying out if it has not already vanished.
Both in Tira and Moro one of the symbols of married status is the cicatrisation of the bride. The Tira perform this operation after the bride has joined her husband, the Moro during the last five days which she spends in her parental home. Later in life—thirty-six to forty years or later as in Otoro—men undergo a prestige-enhancing cicatrisation after which he is called a romaco (dermaco). The operation is a test of endurance, which is achieved in two sittings. At the fist one, the arms, shoulder, and thigh are treated, at the second which is 2 weeks later, the rest of the body. The cicatrized man is then given the emblem of horse hair fly-switch and a necklace of cowrie shells. As far as girls are concerned, before marriage is consummated, they undergo the first light cicatrisation on arms, shoulders and thighs. A later major cicatrisation on back, chest, and belly follow when they are moved into their husband’s house.
Among the Nyima, stages in adolescence and manhood are defined with age grades. Each grade is four years long. Small boys when 12 to 16 years are called boys. During this period they have their face-markings cut and body and neck cicatrized. The operation is done by a woman expert who is paid one piastre (formerly seven cowrie shells) without any accompanying ceremonial. Girls and women also have their back, belly and buttocks cicatrized, which operation entails no ceremonial and no relation as to time or occasion.
Lip perforation is practised by some tribes of the southern and western Sudan like the Gour, Nuba and Koma. It was a custom universal among women and occasional among men. The operation is performed in early childhood. One or both lips are perforated with the point of a spear and pegs of gradually-increasing size inserted until sizable cylinders of wood, stone or metal can be introduced. The cylinders lie flush with the outer surface of the lip, the upper and lower incisors being removed for their better reception within.
Nose and ear perforation are universal procedures throughout the country. One ala or both alae of the nose and lobes of both ears are pierced to hold a variety of ornaments of different sizes and weights. The nasal septum is sometimes pierced by the Azande women to receive a long moustache-like straw or thin stick.
Ear piercing among the Nyimang of the Nuba Mountains is more than cosmetic; it initiates the girl into womanhood, just as circumcision initiates young men into manhood. This takes place towards the end of the dry season and starts with a short parade round the village, as for men. After her ears have been pierced and ringed in several places, each girl puts on sandals and retires to a prearranged locality on a nearby hill. The period of seclusion is short, varying from seven to fifteen days. On coming down from the hill, the girls go at once to work in the cultivation.
Emasculation of males in Darfur of western Sudan was a known practice during the Fur Sultanate, where the procedure was carried out there and in neighbouring districts. The procedure was summarized by Al-Tunisi in Tashhidh Al-Azhan. The penis, he was told, is severed with a sharp razor, and a thin tin tube is inserted in the urethra to keep it patent. Boiling oil-butter is applied to the wound site as styptic; this is later followed by regular dressings till healing is achieved. Sometimes castration is obtained by crushing the testicles.
The tawwashiyya (eunuchs) usually hold posts of responsibility for which they are particularly suited in the ménage of Sultans and important chiefs where they are entrusted with keeping a close watch over the harem. During the Fur Sultanate, the eunuchs held the posts of al-Shaikh al-abb, which is equivalent to the prime minister and commander-in-chief of the armed forces, among other important functions. Al-bab, Al-Tunisi records, is also a post reserved for eunuchs in Tunisia and Constantinople.
In addition to the Al-Tunisi narrative, Abd Al-Mageed Abdin in Tarikh Al-Thaqafa Al-Arabiyya fil Sudan, traced the debates and queries concerning servitude and castration during the Turkish rule of the Sudan (1821-1887). Both practices were apparently rife during that period. The discussions among the Muslim Imams of the time reflected this and tried to find religious sanctions.
A few skulls with burr-holes have been unearthed in the Sudan in the Sarurab cemeteries north of Omdurman. Carbon-14 dating suggested that the skulls and the rest of the skeletal remains belong to the era 450 BC. to 450 AD. The findings suggest that the burr-holes were made to evacuate extra-dural haematomata resulting from skull fractures or blunt head injuries. The burr holes were made expertly using fine trephining instruments for evacuating trapped blood. They were made in the parietal region or in the fronto-temporo-parietal areas of the calvaria. Each hole is rosette-shaped, smooth in outline and about one inch in diameter. The hole is over the posterior and anterior grooves formed by the respective branches of the middle meningeal artery. The margins of the burr-holes do not demonstrate any feature suggestive of vital reactions that might have occurred, indicating that the patients did not survive for long after the operation.
Amputation of limbs has been anecdotal in Sudanese folk literature. In this operation a gangrenous limb, for example, is put through a hole in a wall and the diseased part is chopped off with a sword. Bleeding is arrested by dipping the stump into boiling oil, which acts as styptic.
 Yusuf Fadl Hasan. Al-Shulukh wa Asluha wa Wazifatuha fi Sudan Wadi Al-Nil Al-Awsat [Arabic]. Khartoum: Khartoum University Press; 1976. 90 pages.
 Sayyid Hamid Hurreiz. Birth, Marriage, Death and Initiation Customs and Beliefs in the Central Sudan: Leeds University; 1966.
 The practice of drawing the sign-of-the-cross in antimony on the forehead of a child running fever, could be seen as a temporary tattoo or cautery.
 Titherington reports that among these tribes these three practices are universal but circumcision is not: the latter seems a matter of caprice and often some sons are circumcised and their brothers not -- apparently at random. Few of the circumcised have encountered Muslims. (Titherington, Major G.W. The Raik Dinka of Bahr El Ghazal Province. Sudan Notes and Records; 1927; 10: 160-209).
 Nadel, S.F. The Nuba: An anthropological study of the Hill Tribes of Kordofan. London: Oxford University Press; 1947: page 218.
 Op. Cit. Pages 236-7.
 Stevenson, R.C. The Nyamang of the Nuba mountains of Kordofan. Sudan Notes and Records; 1940; 23: 75-98.
 Also known as aghawat in Egypt. See Ahmad Abd Al-Rahim Nasr for a narrative of eunuchs in Saudi Arabia (…).
 Al-Tunisi. Op. Cit. Pages 249-267.
 Abd Al-Majid Abdin. Tarikh Al-Thaqafa Al-'Arabiya fi Al-Sudan [Arabic] Beirut: Dar Al-Thaqafa; 1967, page 117.
 Badi, M.H., El Hakim, A.M. Cases of Intracranial Haemorrhage: A History of Head Surgery in the Sudan, 450 BC- 450 AD. Paper presented to the Sudanese Surgeons' Congress (undated) Xerox copy, 2 pp.
Women facial scarring (shulukh) in Omdurman (copy from Y.Fadl Hasan: Al Shulukh)