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).[1] 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).[2]

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.[3]

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)[4] 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,[5] 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,[6] 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[7] 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.[8]

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.[9]

More local cures for eye ointments have been reported by Beiram.[10] 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.

References