Historical Perspective

Early European medical encounters in the Sudan in the pre-Turco-Egyptian period 1503-1820

Tarik A Elhadd, MD FRCP (Edin) FACE

Department of Medicine, Endocrine Section, The Diabetes & Endocrine Centre, Alwakra Hospital, Hamad Medical Corporation, Doha, Qatar

من كتابات الرحاله و المستكشفين االوربيين عن الطب و الطبابه في السودان ما قبل الفتح التركي المصري 3030 – 3283 م

د. طارق عبدالكريم الهد مؤسسة حمد الطبيه الدوحه, قطر

منذ ايام هيرودوتس الذي كان اول من كتب عن " ارض السودان "بمسماها القديم " نوبيا , "شكلت االراضي جنوب الصحراء الكبري و جنوب وادي النيل لغزا محيرا لالوربيين القدماء .و من ناحية اخري مثلت منابع النيل حافزا للمستكشفين االوربيين في القرن التاسع عشر لسبر غور مجاهل افريقيا ابتداء من المبشر و المستكشف االسكتلندي ديفيد ليفنجستون و انتهاء بريتشارد بيرتون و جون سبيك و صموءيل بيكر .الجدير بالذكر ان معظم هوالء الرحاله تقمصوا ثياب االطباء وادعي اكثرهم معرفة والماما بالطب و علم الطبابة السيما االسكتلندي جيمس بروس الذي اسمي نفسه الحكيم يعقوب و االنجليزي ويليام براون و االنجلوسويسري يوهان لودفيج بركهاردت . كان اول طبيب وطاءت قدماه بالد النوبه هو الفرنسي شارلس بونسيه والذي اوفد من قبل االمبراطور لويس الرابع عشر الي عاهل اثيوبيا اياسو االول في العام 1699 كسفيرا و مطببا من داء الم به .مثلت كتابات بونسيه قصب السبق عن بالد النوبه و مملكة الفونج و لكن روايات جيمس بروس كانت هي حجر الزاويه لبداية استكشاف منابع النيل و بالد السودان .ارسي هوالء الرحاله اللبنات االولي لسجل الطب في السودان و يتناول هذا البحث بعض ما كتبه هوالء الرحاله و عما شاهدوه من امراض في المناطق التي زاروها و كذلك عن ما مارسوه من تطبيب و ايضا عن مالحظاتهم عن الطب الشعبي في الفتره التي سبقت الفتح التركي المصري.

Abstract medicine in their quest to gain access to this To Europeans, Sudan represented a vast unspoilt land. They skillfully managed to mysterious mix of ethnic entities, races and exploit the power, influence and wisdom tribes which and for many millennia scattered afforded to those who possessed the over a vast mostly undiscovered, unwritten knowledge and skill to treat and cure the sick about expanse of deserts, Savannah plains and and relief suffering. Exploiting their jungles. Up to, and until well into modern rudimentary medical knowledge those times this extended land through which flew explorers managed to impart a favourable the Nile splitting the country nearly through impression on both rulers, as well as natives its middle creating images of an exotic land of the land they travelled in. that never stopped tantalising explorers and Some, like the French explorer Charles tempting them to visit and travel through the Jacques Poncet were physicians, yet others land of the Nile. The ever present motive has like Theodoro Krump, James Bruce and Lewis been the desire to discover the springs that Burckhardt were, although not fully fledged feed the great river and what lies beyond the physicians, had nevertheless, if judged by the scorching desert. Therefore comes as no standards of their heyday, received some surprise that the early contacts between Sudan education in simple medical treatments and and Europe were very much foiled by several the use of medicinal products. Their European explorers whose ambitions drove subsequent writings not only provided them to visit and explore the country and valuable insights into the geography and write about its history, geography and people. history of Sudan, but provided invaluable Some of those early explorers somehow used information about the various diseases and

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Historical Perspective Early European medical encounters in the Sudan Tarik A Elhadd ailments that were afflicting the population population of many villages. That was the and were then prevalent in the country. The only time when plague had reached and observations and writings of those medical affected the Sudan on record. The group then pioneers furthermore provided first hand passed through ‘Hafir Maschu’ on the eastern historical insights into some of the widely bank of the Nile and were hosted by the practiced traditional Sudanese medicine and ‘Nubian Prince of Argo’, whom Poncet treatment interventions that were based on ‘treated from an ailment’. This is probably faith and religious beliefs, as well as long held was the first European medical encounter in mythical dogma and superstition. the Sudan. Poncet and his companions then Keywords: Sudan, Medical history, passed through Dongola where they were Traditional Sudanese Medicine, Nubia, Fung hosted by its King and eventually they Kingdom of Sennar, European travelers, reached Sennar in February 1699. Here, they explorers, Turco-Egyptian Sudan spent three month as guests of the Fung King

Charles Jacques Poncet & Theodoro before leaving for Gondar. Poncet’s writings Krump: The earliest European medical about the city, its inhabitants, (which he encounters in the Sudan estimated were a hundred thousand souls), the Since medieval times only few European royal family and their entourage, the trade in explorers or travelers assumed the role of Sennar, are probably the first European physicians while travelling through the North account of the Fung Kingdom of Sennar. and East African hinterlands. The major Intriguingly, Poncet did not mention in his reasons were to have an easy passage, to gain journals anything about the art of medicine help or to impress. During the era of the Fung and medical practice in the Sudan or Sennar Kingdom of Sennar (1503-1821), and despite the relatively long spell he spent there. following the travels and writings of David The only two remarks he made was an ha-Rubeini, a Jew, whose stories were a account of his earlier treatment of Prince of subject of dispute and controversies, in Argo, the vassal of King of Dongola, (which Sennar(1) the first documented encounter of he only mentioned ein passe), plus the Sudanese people with European travelers was incident of him being presented with a six with the French physician Charles Jacques month old ‘Turkish’ girl (probably the child was very light in colour), who was almost Poncet. Poncet travelled through the Sudan in (2) 1698-1699 on his way to Gondar as an envoy dying and Poncet could do little to help her . of the French Monarch, Louis XIV, to the Following this successful venture, the French Abyssinia monarch, Iyyassu I, ‘The Great’. Monarch Louis XIV sent a diplomatic mission Poncet, who was a physician by training and to the Abyssinian Emperor with several Jesuit apothecary by practice, gained a reputation in missionaries in 1700. This mission included Egypt among the Turkish elite and the Theodoro Krump, a Bavarian Catholic European residents following his arrival in missionary whose subsequent writings, ‘Palm- Cairo in 1691. On his journey to Gondar he Baum’, represents a rich treatise for the life in was accompanied by Haji Ali, the Abyssinian Sudan on the eve of the seventeenth century imperial representative, and Father Charles and contains the earliest footage of medical Francis Xavierius de Berevendet, a Jesuit practice in the ‘Kingdoms of Dongola and Sennar’ during the zenith of the Fung priest. The group left Cairo in November 1698 (3) and travelled down the bank of the Nile. Sultanate . According to Jay Spaulding Poncet wrote about the devastating effect of (2008), the writings of Theodoro Krump ‘in the plague epidemic that reached the upper many ways represents the most important fringes of Nubia and wiped out the whole single written source concerning the pre- colonial history of the Sudan as it has 170 Sudan Med J 2014 December;50(3)

Historical Perspective Early European medical encounters in the Sudan Tarik A Elhadd provided an invaluable testimony about the used the practice of ‘cupping’ and leeching structure functioning of the Funj government and he mentioned that the same practice was before the fall of the Unsab dynasty….and done by Sudanese native doctors. Krump went contributes data of unparallel quality on the on to treat the Fung Monarch himself from an organization and conduct of the trans- accidental wound he sustained in his right Saharan caravan trade, the commerce in foot. In his journals, Krump write ‘The year slaves, Sudanese medical practices, Sudanese 1702. On the twelfth of January the king sent relations with Ethiopia and a wide array of me a ‘mursal’ (messenger) ordering me to often unexpected vignettes of daily life’(4). It is come to him to treat a wound which he had not clear from the available records whether carelessly given himself in the right foot with Krump had had any formal medical training or his sabre. Fortunately I healed him within a whether his expertise in medical practice in few days with the balsam of Innocent XI’ the Sudan was an amateur enterprise. (ibid). Krump would later be summoned to However, several of the names he used for treat the Sheikh of Qarri, the Abdallabi King, various remedies and medicines he gave to the main vassal of the Fung Sultan. Krump people he treated were medical names in Latin also mentioned that during his stay in Sennar (ibid). So it is highly likely that he had had he was called almost daily to attend the sick. some sort of medical knowledge, but whether He once cured ‘Sheikh Idris’, son of the this was acquired through apprenticeship (in viceroy, from jaundice, and the son of the preparation for his missionary journeys) or Qadi and an Arab sheikh from syphilis. He whether he had specific training, one cannot went on to state that syphilis is very common be certain. It appears that it was a common in Sennar. Krump also practiced cupping and practice in those days to prepare travelers or leech which was a known practice among the those involved in specific discovery missions ‘Sudanese native doctors’, he would even use to have some medical knowledge of common their technique of cauterization as he saw it to diseases specially those encountered in the treat a fellow priest when they were travelling tropics. His writings about the medicines he back to Egypt in 1702. used, the cases he treated and the illnesses he Krump following his return to Rome retired described imply that he had a good grasp of back to his native land of Bavaria in Germany. some form of medical knowledge, at least by His journals were published in 1710. In 1705, the standard of the seventeenth century. another group of Franciscan Jesuit Also we know from Krump’s accounts that missionaries were despatched to Ethiopia via prior to his arrival in Sennar in May 1701 Sennar. This mission which was led by Le there were already a group of Jesuit Noir du Roule, had the Paris graduate? missionaries who possibly arrived shortly Zantiote? Greek physician, Agostino Lippi after the trip of Charles Poncet. Among these among its members which consisted of several was Father Pasquale whom Krump referred to Jesuit priests. Dr. Lippi (1678-1705) was sent as the ‘Private Physician’ of the Fung Sultan as a private physician to the Abyssinian (ibid). Both Krump and Pasquale were given Emperor, Iyassu I(5). The mission had to travel the revered heyday title of ‘Mua’llim’ which through Sennar, but for reasons which are not was used by the Fung people for clear the group was plundered and its leader professionals. Furthermore, both were given was murdered. It is possible that this occurred Arabic names, with Pasquale as ‘Mua’llim during the clash between Badi III and his Yusuf’’ and Krump as ‘Mua’llim Yunus’. vassals when there was significant turmoil in Reading through his ‘Palm-Baum’ translated Sennar. One can only speculate. and summarised by Jay Spaulding, Krump Several decades later in 1772 the first Briton

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Several decades later in 1772 the first Briton To our knowledge, James Bruce was the first who is known to have travelled into the Sudan British explorer to have travelled into the was the Scottish Laird, James Bruce of Sudanese hinterlands. This man has an Kinnaird (Fig 1) assumed the capacity of interesting story. Of a noble background, ‘Hakim Yagoub’ (Hakim (Arabic.) = belonging to a long line of Scottish Lairds physician; Yagoub = Jacob) during his travels (Lords), James Bruce was born in 1733 and in Africa (vide infra). was brought up in the estate of ‘Kinnaird’ which belonged to his family. His father was a senior judge in the court of Scotland, and despite that he was keen for his young son James to follow his footsteps and to be a judge in Scotland, but young James had other thoughts. Since his teenage years he was keen on adventure and travel and he became fascinated by the idea of discovering the source of the River Nile. He lost his mother at an early age, so he went down to London where he was looked after by a relative. Bruce Fig 1: James Bruce of Kinnaird (Courtesy of Wikipedia was educated at Harrow (as was a much later British visitor to Sudan, Winston Churchill), El Hakim Yagoube’: James Bruce, ‘The and showed talents in languages as he became Explorer turned Physician’ the school Latin orator aged 12. Bruce’s ‘In disgust he left London for his Scottish fascination with travel became more pressing estate, to marry, to litigate, and finally, in his after he lost his first wife, so he decided to set widower-hood, to pour out the long, confused, off to satisfy his dream of discovering the brilliant book of his travels which was read source of the River Nile(6). He went on to throughout Europe and revived the stream of learn Portuguese, Spanish and the principles criticism and satire again which was to flow of astronomy. He also befriended the French till long after he was dead’‘J M Reid; Monarch, Louis XVI, who supplied him with ‘Traveler Extraordinary: The life of James astrology and astronomy tools to aid him in Bruce of Kinnaird’ (Fig 2) his future travels. He also learned some

aspects of drawing in Italy. Being kin of King George III, (r. 1760-1820), Bruce succeeded in being appointed as the British Consul in Algeria early in 1763. There he learned Arabic language and also some principles of medicine from Dr Bell, a military British doctor who was attached to the naval ships which patrol the Mediterranean from Algiers. In summer 1765 Bruce resigned his post as consul and headed east along the North African coast travelling through Tunisia and then Libya where he boarded a ship heading towards Crete. The ship was wrecked, and after rescue

Fig 2: A Sudanese woman from Shendi (drawn by he travelled in Asia Minor, learning Greek at Ballugiani) (Courtesy of: James Bruce, Traveler Constantinople, and then left for Syria. At Extraordinary by J M Reid 172 Sudan Med J 2014 December;50(3)

Historical Perspective Early European medical encounters in the Sudan Tarik A Elhadd physician, Dr Patrick Russell, a specialist in now thought, not inferior to the Nile in beauty, tropical illnesses. From Dr Russell, Bruce preferable to it in cultivation of those learned more principles of basic medical countries through which they flow; superior, treatment. Here, the British Ambassador to the vastly superior to it in the virtues and Ottomans obtained a ‘Firman’ from the Sultan qualities of the inhabitants, and in the beauty of Turkey that helped Bruce in his future of flocks crowding the pastures in peace, endeavours. without fear of violence from man or In summer 1768 Bruce landed at Alexandria beast…’(7) as ‘El Hakim Yagoube’ (ibid) accompanied by Early in 1772 Bruce travelled into the his Italian assistant, the painter Luigi Sudanese hinterland of the Fung province of Ballugiani. In Cairo, Bruce approached the Atbara, passing through the frontiers district Mameluke Governor, Ali Bey Abu Al-Dahab of ‘Ras Al Fil’ and its main village, ‘Hor and he befriended him, offering his services as Cacamoot’ (translated by Bruce as the valley a physician. Following a spell at Cairo and of shadow of death, today it is the town of with the help of Ali Bey, he crossed the Red Gallabat). He received some help from its Sea after travelling up the Nile to Assiut. He chieftain, Erbab Gimbro, and proceeded to the then travelled down the eastern coast of main town of the province, Teawa (todays Arabia and then took a British battleship from Gedaref) and having to deal with the Fung Jeddah and went to Yemen. From there he governor of the Fung Atbara Province, Shiekh crossed the narrow strait of the Red Sea to Fidele. Bruce treated his several wives with Mussawaa, the main port of Abyssinia, his purgative. The administration of emetic arriving there in late 1769. Following various produced such a good effect, that a further risky journeys through the land of the Tegrai, attendance was ordered. On this occasion, Bruce eventually reached Gondar where he Bruce wrote ‘the ladies all disrobed, and was taken as the emperor’s private physician. standing before me naked, each demanded to In those days Abyssinia was witnessing be examined. Not content, with this they then turmoil of inter-tribal wars and several demanded that I, likewise should disrobe!!. I conspiracies to depose the emperor. Bruce have been to more than one battle, but surely during the time he spent in the Abyssinian would have taken my chances again in any of Royal Court had the opportunity of describing them to have been freed from that that important chapter in the history of examination’. (ibid) Bruce escaped death in Abyssinia in his journals. At Gondar, the ‘Teawa’, when ‘Sheikh Fedail’ exercised all capital, Bruce thrived for several years avenues of extracting ‘whatever treasures escaping many havocs and conspiracies, and Bruce may have had”. However, he eventually making many friends and foes. He gained succeeded to reach Sennar after travelling via trust and love after his success in treating Beyla (today’s Jebel Beyla), where he treated several members of the Royal family using his its Sheikh ‘with his purgatives’. The Sheikh, “magic” purgative, ‘brucea dysentrica’. Amid being so grateful helped Bruce to reach all this Bruce managed to satisfy, as he Sennar safely(6). believed, the main purpose of his adventure At Sennar, Bruce wrote what is most likely and his ambitious dream of locating the source the first writing of a British man of the Fung of River Nile. Having sight of Lake Tana from Kingdom of Sennar. He narrated his various which the Blue Nile flows, Bruce writes: encounters with the Fung’s King and his ‘I remembered that magnificent scene in my entourage; he befriended the ‘Vice-Vizier’ own native country, where the Tweed, Clyde Adlan, brother of the powerful Vizier, Abu Le and Annan rise in one hill; three rivers, as I Kaylak who was away at the time, involved in

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Historical Perspective Early European medical encounters in the Sudan Tarik A Elhadd a long war at Kordofan. Following several by. Usually the old women of the tribe were months at Sennar, Bruce travelled north along the ones who carried out the procedure. A the banks of the Nile where he met ‘Wed price had to be placed on the ‘rag’ and after Agib**’ whom he described as the Arab Chief haggling and bargaining on the price, when it responsible to Sennar for the northern was agreed, the rag would be taken away by sheikhdoms and kinglets. He then reached the person wanting to be vaccinated. The rag Shendi, which was then the main market town would be tied on the arm and when the in northern Sudan on the caravan route to recipient contracted the disease he would only Egypt and the western frontiers, where he have the number of pocks he paid for! spent a few days as a guest of Wed Agib’s Bruce was one of the first to have gathered a sister, ‘lady Sittana’. collection of tropical plants, an entity which at Sittna, helped the Scotsman to prepare for the the time was not known in the West(9). long journey via Berber to Aswan crossing the Ironically he used some of these plants as desert at Abu Hamad which he described as a medicines and purgatives during his travels journey full of ‘sand and simoum*’(7). Bruce’s into the Fung Kingdom of Sennar. These writings about ‘King Ismain’, and the people plants later were known as ‘brucea anti- of the Fung and their origins was used as dysenterica’ (Fig 3). Many of the plants he reference in the subsequent attempts to collected during his trips in Abyssinia document the history of the last Sudanese featured in his journals. Kingdom before the Turco-Egyptian conquest(8). Despite the fact that James Bruce was not a doctor, it is an irony that he ‘rode’ over the glory of ‘their status’ claiming to be one, and making use of the simple knowledge he gained from the two British doctors he befriended. Medicine and its practice in Bruce’s heyday was still in its cradle. However, Bruce, with an impressive wit and with an observant eye, made very useful descriptions of various diseases and ailments he observed during his stay in the Sudan. Bruce described the symptoms and incidence of guinea worm infection, the ‘Medina worm’ (Dracunculus mediensis). He noted that the disease is common where people drank from Fig 3: brucea antidysentrica (drawn by Ballugiani) stagnant water. He also made records of (Courtesy of: James Bruce, Traveler Extraordinary dysentery, the bloody flux, and fevers at by J M Reid Sennar which was probably malaria. He mentioned hepatomegaly, venereal diseases Following his successful return to Egypt, and smallpox epidemics. He also described Bruce eventually went back to London where the native method of vaccination against life did not treat him well. His stories were smallpox, which the natives called ‘buying the disputed, he was cast as a liar, and he went pox’. Here a rag would be wrapped around the into dispute with powerful figures in London arm of an infected person, and the person at the time. Men like Samuel Johnson and wanting to be ‘vaccinated’ would be standing James Boswell were his adversaries. It was not until 1790 that, urged by his friend Daines 174 Sudan Med J 2014 December;50(3)

Historical Perspective Early European medical encounters in the Sudan Tarik A Elhadd

Barrington, he published his treatise of what is through Sennar. However, and due to some considered as extraordinary travels (6). His local troubles in the region of Dongola, travels would very much stimulate later Browne was forced to change his plans and explorers to follow his footsteps and verify his travel to Darfur instead, where he was stories. After the substantial accuracy of his received as ‘Daif-es-Sultan’ (guest of the travels were thereafter demonstrated, his quest Sultan). Browne arrived at Kobbe, the to discover the River Nile captured the Darforean caravan front town and reached el- imagination of the British explorers in the Fasher in the summer of 1793. He remained in second half of the nineteenth century to Darfur for about 3 years (1793-1796) and eventually succeed in fulfilling that dream. returned to Egypt. In his book, ‘Travels in The substantial accuracy of his Ethiopian and Syria, Africa and Egypt (1799) Browne Sudanese travels has since been demonstrated, described a broad range of diseases and and it is considered that he made a real medical conditions, from spring catarrh addition to the geographical knowledge of his (known at the time as the Egyptian day. ophthalmia), to Smallpox, Plague, Leprosy, The pre-Turco-Egyptian period: Brown & Guinea worm, Syphilis and Scurvy, to name Burckhardt but few. In this section, we will confine our W G Browne medical encounters in Darfur discussion to those diseases he had described ‘If any medical professor should chance to from his 3 years in Darfur(10). advert to them, the writer is too conscious of Through what appears to had been a matter of the superficiality of his own knowledge not to personal interest Browne wrote extensively perceive that little satisfaction will be derived. about spring catarrh. This seems to have been But persuaded that the art of healing, even at based on his own observations as well as this day, abounds little less in experimental contemporary concepts about the causes of the than in the age of one of its brightest illness and its treatment. He stated that he had ornaments, who makes the confession, he is not witnessed this common cause of induced to believe, scarcely any fact relative ‘defective vision’ in Darfur. It is noteworthy to it, or any experiment, faithfully narrated, that his observations were very accurate and can be wholly destitute of its use’. similar to those of the first British doctors W G Browne, Travels in Africa, Egypt & Syria who worked over a hundred years later in from the year 1792-1798. Sudan and who reported that the ‘Egyptian The London born English explorer, William Ophthalmia’ tends to be less seen as one George Browne, having read James Bruce’s travels southward from Egypt and deeper into journals became fascinated by the prospect of Sudan Browne confidently stated that plague, travelling into the interiors of Africa. a dreadful scourge especially in the Following his studies in Oxford, Browne used Mediterranean and the Levant has not been the fortune left to him by his father to finance witnessed in the Sudan. With the exception of a trip to the Middle East and Africa. He a few cases amongst the returning pilgrims travelled in Syria, Egypt and Africa and from Mecca early in the twentieth century, accurately described some of the diseases he Sudan remained free through the centuries had seen or opted to ‘treat’. Like other from the menace of plague which has European travelers of the time, Browne devastated other countries in the Middle East. portrayed himself as a ’Frankish physician’. In contrast, Browne described smallpox as ‘a He travelled from Egypt into the Sudan condition much dreaded by the people of the aiming primarily to follow the route of James Soudan, whether Moors or Negros’. Bruce into Nubia, then to Abyssinia travelling Interestingly, he noted that the fatality rate

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Historical Perspective Early European medical encounters in the Sudan Tarik A Elhadd among the ‘Negros’ tended to be much higher. that he found cases of hernia to be less Browne attempted to inoculate five slaves as common in Darfur than in Egypt. desired by their master. He gave them a strong Browne documented Contemporary medicines dose of senna prior to the procedure. Three used by the natives to treat various disease survived and two perished. Browne observed conditions. These ranged from ‘natrun’ to that Guinea worm (Medina worm) is seen ‘tamarind’, to phlebotomy and the ancient mostly among the Fertit, a tribe that lives in practice of leeching and the use of some the south western Sudan. He gave an substances as aphrodisiacs. This last he elaborate description of this ailment and the remarked were, unsurprisingly on high natives’ way of treating it. Interestingly, demand, Finally, Browne made some crude Browne made the excellent observation that ‘anthropological ‘remarks on the ‘the disease seems to originate in the water, characteristics of the ‘negro race’. He which is replete by animalcules, and which no described at some length the practice of attempts are made at purifying it!! Later on female genital mutilation or female and during the ninetieth century the disease circumcision as called by those who practice life cycle was described by the notable it, which he stated is less common in Darfur. Bulgarian Physician Hristo Stambloski, who Browne was forced to stay in Darfur and his was then exiled to Yemen (1877-1878)(11). requests to travel to Sennar were repeatedly Stambloski’s descriptions supported Browne’s turned down by Sultan Abdel-Rahman el- observation as Cyclops, a water parasite, was Rasheid, the Sultan of Darfur, Browne had, in identified as the vector in disease 1796 been eventually allowed return to transmission. Egypt. Following his return to Britain in 1798, Browne went on in his interesting medical he made a second spree of travels ion 1800, accounts to refer to syphilis which he said is this time however he headed east into Asia less formidable in Darfur than in Egypt. By Minor and Persia where he travelled to Tibriz contrast he observed that leprosy was not where, in 1813 he was murdered. uncommon in Darfur, and that he was once John Lewis (Johann Ludwig) Burckhardt intrigued to witness a case of early leprosy & Travels in Nubia cured under his observation by a ‘salve, native In the footsteps of his two predecessors, but of a Kingdom called Baghermi, but the means with a rather different intention to discover the he had used he could not be prevailed on to source of River Niger, the Anglo-Swiss, disclose’. Browne also described cases of Johann Ludwig Burckhardt (b. 1786, ‘splenic tumours’ which he probably meant by Lausanne) made landmark contribution to our cases of splenomegaly. He diligently used understanding of the Middle East and the ‘James’ powder* as an emetic to treat these Sudan in the build up to the reign of cases. (*Author: he probably meant the emetic Mohamed Ali Pasha in his extending empire. substance brucea antidysentrica named in Burckhardt was born in a noble Swiss family honour of the Scottish explorer, James Bruce, from Basel, which suffered greatly during the who first introduced it to Britain from French Revolution. This tempted both father Ethiopia(12). Browne went on to describe and son to seek refuge in Britain. Burckhardt cases of haemorrhoids and fistula-in-ano, had his early studies at Leipzig and Gottingen observing that Darfurean healers treated the in Germany, and then in 1806 he left for conditions by applying cauterisation in the England. He was recommended to Sir Joseph case of the former and topical application Banks by one of his ex-professors in without incision for latter. Browne remarked Germany. Banks was then President of the

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Association of Promoting the Discovery of the quarter. I mean to set out next month, by land Interior of Africa. At the time the association for Upper Egypt, as soon as the state of the was looking to recruit a talented traveller into Nile renders the voyage practicable. I shall the interior parts of West Africa, with push on beyond the first cataract and follow intention of exploring the Bournu Kingdom. the course of the river by the second and third Burckhardt learned Arabic at Cambridge and cataract, towards Dongola. That country London and also received lectures in farther up than Derr, has never been visited chemistry, astronomy, medicine and surgery by any travellers… were it not for the in the build up to his travel. He was then sent Mameluks who have settled at Dongola, and to Aleppo where he received further education taken possession of that country, I might hope in Arabic language, studied and learned the to reach that point.’.. ; yet I am informed by Koran and Islamic theology, and he learned many of the natives, that the borders of the the way and customs of the ‘Mohamedans’. river are full of ancient temples and other Here Burckhardt became disguised as Hajji antiquities, resembling those of Luxor, and the Ibrahim Abdalla Al-Shami, a Turkish Isle of Philae were it not for the Mameluks merchant (Fig 4). who have settled at Dongola, and taken possession of that country, I might hope to reach that point’(13). About the same time, Mohamed Ali Pasha was strengthening his grip on Egypt, the Mamelouks had fled south to Upper Egypt and deep into Nubia. Having befriended Mohamed Ali Pasha and obtained a ‘Firman’ from him to aid him in his travels to Nubia, Burckhardt set off on his first trip into Nubia in January 1813 and travelled along the bank of the Nile with the help of a guide from the Aga of Asswan through Upper Egypt into

Fig 4: Burckhardt disguised as Hajji Ibrahim Wadi Halfa. He then passed the Island of Say, Abdallah El Shami (Courtesy of Wikipedia) the Sukkot, and then into the Mahass homeland reaching the upper frontiers of During the two years he spent in the Levant, Dongola. He returned back to Asswan by the he made some exploration into Palestine, 31st of March 1813. After a year of waiting Lebanon and current Jordan. Burckhardt was for a suitable caravan to join, Burckhardt then considered the first European to have executed a second journey that began on the witnessed and documented the historical city 2nd of March 1814, this time crossing the of Petra (in today’s Jordan). After some time Nubian desert from Asswan to Berber. Here in Syria, Burckhardt was instructed by the he stayed for two weeks and then traveled Society to go to Egypt to join some caravans During the two years he spent in the Levant, that normally travelled into the Bournu he made some exploration into Palestine, country through Fezzan in current Libya. In Lebanon and current Jordan. Burckhardt was winter 1812, and having missed the Fezzan considered the first European to have caravan, he wrote to the association ‘The witnessed and documented the historical city delay thus occasioned in my Fezzan of Petra (in today’s Jordan). After some time expedition, I shall endeavour to make in Syria, Burckhardt was instructed by the profitable to African geography, in another Society to go to Egypt to join some caravans

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Historical Perspective Early European medical encounters in the Sudan Tarik A Elhadd that normally travelled into the Bournu and finally reaching Shendy on the 17th of country through Fezzan in current Libya. In April 1814. After spending one month in winter 1812, and having missed the Fezzan Shendy, Burckhardt set off again for Suakin, caravan, he wrote to the association ‘The the old medieval port on the Red Sea, taking delay thus occasioned in my Fezzan the route along the Atbara River via ‘Goz expedition, I shall endeavour to make Radjab’, and then into the ‘Taka’ region and profitable to African geography, in another finally reaching Suakin on June 26th , 1814. quarter. I mean to set out next month, by land After crossing the Red Sea to the ‘Hijdaz’ in for Upper Egypt, as soon as the state of the Arabia in July 1814 and staying at ‘Dijidda*’, Nile renders the voyage practicable. I shall (*Possibly an old way of writing Jeddah, the push on beyond the first cataract and follow ancient port on the Red Sea in Arabia) then the course of the river by the second and third performing the ‘Hajj’ in November 1814, he cataract, towards Dongola. That country returned to Cairo in June 1815 after spending farther up than Derr, has never been visited some time in ‘Medina’. Burckhardt while in by any travelers… were it not for the Arabia suffered a diarrhoeal illness which Mameluks who have settled at Dongola, and became chronic and lingered on for the taken possession of that country, I might hope subsequent two years and led eventually to his to reach that point.’.. ; yet I am informed by untimely death in Cairo on 17th of October many of the natives, that the borders of the 1817. river are full of ancient temples and other The journals of Burckhardt describing his antiquities, resembling those of Luxor, and the travels in Nubia and other places were Isle of Philae were it not for the Mameluks published posthumously by his employer, who have settled at Dongola, and taken ‘The Association of Promoting the Discovery possession of that country, I might hope to of the Interior of Africa’ in 1822. Burckhardt reach that point’(13). ingenious writings were a major source of About the same time, Mohamed Ali Pasha information about the geography and history was strengthening his grip on Egypt, the of the Nubian Sudan in the prelude to the Mamelouks had fled south to Upper Egypt Turco-Egyptian invasion by Mohamed Ali and deep into Nubia. Having befriended Pasha in 1821. Burckhardt’s time in Egypt Mohamed Ali Pasha and obtained a ‘Firman’ and Sudan was rich in the historical events from him to aid him in his travels to Nubia, that were taking place in the region and Burckhardt set off on his first trip into Nubia greatly influenced the history and future of its in January 1813 and travelled along the bank people. In his treatise, he wrote extensively on of the Nile with the help of a guide from the the people, the climate, the habits and on the Aga of Asswan through Upper Egypt into oral history of various inhabitants of the Wadi Halfa. He then passed the Island of Say, Sudan. It was soon after Mohamed Ali Pasha the Sukkot, and then into the Mahass ascendancy into power and the time of his homeland reaching the upper frontiers of great imperial conquests in Arabia, and his Dongola. He returned back to Asswan by the bloody conflicts with his rivals, the 31st of March 1813. After a year of waiting Mamelouks. Burckhardt very much followed for a suitable caravan to join, Burckhardt then some of the travel footsteps of James Bruce in executed a second journey that began on the the Nubian desert. He also befriended and was 2nd of March 1814, this time crossing the guided by the other Briton, George William Nubian desert from Asswan to Berber. Here Browne whom he met in England prior to him he stayed for two weeks and then traveled setting off on his travels. What is relevant here further south, staying for few days at ‘Damer’ is that Burckhardt has made ingenious

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Historical Perspective Early European medical encounters in the Sudan Tarik A Elhadd observations on various medical conditions returned back to Cairo, he wrote; [‘smallpox during his travels in the Sudan. This, when is very destructive whenever it gains ground. taken together with those of Bruce and Last year it was added to famine, and death Browne make the backbone of what we know was very numerous. It had been brought to about medicine and diseases in Sudan in the Berber by the people of Taka, who had Eighteenth and Nineteenth centuries. received it from the Souakin traders; it spread Burckhardt, like his other two predecessors, over all the country up the Nile….’] He went Bruce and Browne, portrayed himself as a on to comment on what could be an visitor who possess medical knowledge and interesting ‘epidemiological account’ of how expertise in curing the ill and infirm. In the population was affected to various degrees addition to his ‘impersona’ of Hajji Abdalla depending on the age of individual sufferers. Ibrahim Al-Shami. He observed that the third who recovered A title he adopted for himself since 1810 from the disease tended to bear its mark on when in Aleppo, Syria, (1810-1812). ‘I got their face and skin. He described the periodic myself introduced to one of their chiefs as a outbreaks of epidemics every eight to ten physician in search of medicinal herbs…’(13). years, and described the method of inoculation Burckhardt made extensive and detailed l practiced in the Nile Valley which was called records about the various medical problems he ‘dak-el-Jedri’, and the medicine used by the saw or heard of during his travels. While in natives to attempt to cure those infected, by Egypt, and in the wake of the 1812 Cairo stating [‘the only cure for the smallpox was to Castle massacre of Shahin Pasha along with rub the whole body with butter three or four 120 of the Mamelouks, at and their fleeing times a day and to keep themselves closely south, a famine broke out in Upper Egypt shut up’]. Burckhardt wrote of the smallpox followed by a smallpox epidemic in Nubia. outbreak of 1815 while he was in Egypt, According to Burckhardt, half of the stating that the epidemic took the lives of population of Nubia perished in the aftermath. fifty two persons of the ‘Temsah’ family of While in Berber, Burckhardt made interesting the ‘Meyrafabs’, amongst whom was ‘Mekk remarks on the health of Berber inhabitants; Idries’, Burckhardt’s host in Berber. He [The people of Berber appear to be a healthy recorded that the nearby town of ‘Damer’ race. There seemed to be few invalids, and the suffered less during the smallpox epidemic place being situated on the skirts of the desert, than Berber, and that: ‘in ‘Shendy’s Slave the air is certainly wholesome. I was told of Market’ the slave who bears the smallpox fever called wardé, from woid (rose) which marks would bring more money than the one seems to be epidemic, and often proves who doesn’t’(12). He wrote that among the mortal; the people of Dóngola are very slaves, the practice of castration was carried subject to it; it exists during the time of high out on specially those destined for ‘export’ to water, but it does not make its appearance Turkey and Arabia, where they are used as every year’.] It was very likely that ‘guardians of female virtue’!. ‘Two years ago, Burckhardt was referring to ‘malaria’ as the Mohamed Ali Pasha caused two hundred typical description. He went on to state young Darfur slaves to be mutilated, whom he ‘plague was unknown, and from what I heard sent as a present to the Grand Signior’. during my former journey in Nubia, I have Burckhardt witnessed these operation during reason to believe that it never passes the the time he spent in Upper Egypt waiting for cataract of Assouan’. . On the smallpox his second expedition into Nubia He stated epidemic that broke out in the preceding year that ‘it is carried by two Coptic monks (who to his travel and again in 1815 when he had excelled their predecessors in dexterity) in

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Siout (=Assiout), and that only the slaves it issuing from the arm, the breast, and knees, brought from the Borgho, to the west of though its favourite place seems to be the calf Darfur were mutilated prior to them been sold of the leg’. and sent elsewhere’. He went on to describe He made some epidemiological remarks those mutilated slaves in what can be stating that it was rare in people from Shendy regarded as typical medical textbook than those from Kordofan. He described the description of hypogonadal males. few cases of ‘ophthalmia’ he saw. Venereal Interestingly enough, Burckhart also wrote disease, he observed was commonly seen, and extensively in his journals about the practice he made the interesting observation that its of Pharonic circumcision (Synonym: Female consequences tended to be less fatal than in Genital Mutilation), in what could also be Egypt, and that he never personally saw any regarded as an important footage of the of those ‘with ulcerated faces’ (referring to the history of practice in the early nineteenth facial mutilation in the aftermath of tertiary century. He remarked on the arrival of some syphilis) which he saw frequently in Egypt. ‘slave girls’ to Shendy who ‘were called During his one month in Shendy, the most mukhayet (consutae) from an operation which important trading post in Central Sudan at the has been described by Mr Browne. I am time, Burckhardt wrote about various unable to state whether it is performed by medicines used by the native medical their parents in their native country, or by the practitioners, stating that ‘grocers and merchants, but I have reason to believe by the druggists are the most frequented of any…’ later. Girls in this state are worth more than and those sell various herbs and native others; they are usually given to the favourite medicines imported from either India, Egypt mistress or slave of the purchaser, and are or other parts of Sudan such as Sennar, often suffered to remain in this state during Kordofan and Darfur. These herbal cures the whole of their life’. He went further to included among others Fenugreek (called write ‘the daughters of the Arabs, Ababde and Helba), antimony (local name Kohol), gerfa Djaafere, who are of Arabian origin, and (cinnamon shrub), Sembil, Mehalab and a inhabit the western bank of the Nile from fruit called ‘tamr el-Berr’ imported from Thebes, and generally those of all the people Kordofan, which is used to treat flatulence, on to the south of Kenne as far as Sennar, which Burckhardt commented that ‘it is undergo circumcision, or rather excision believed here to be a remedy for flatulence, of (*excisio clitoridis), at the age of from three to which many people here complain’ (ibid). six years. Girls thus treated, are also called The diarrhoeal illness Burckhardt developed Mukhayaet’. (ibid) while in Medina in 1815 became chronic and Burckhardt noted piles to be very common eventually led to his demise in October 1817. among the ‘country people’ and less among It is not clear whether it was a form of the ‘slaves’. He stated that he first saw parasitic dysentery, tuberculous enteritis or genuine Guinea worm in Shendy and some other type of inflammatory bowel remarked that it was very common ‘in disease. One can only speculate. Soudan’, where people call it ‘the fertit’ ------* (Author: probably named after people from Wed Agib’ is likely ‘Agib Almanjuluk’, or one of his descendants, the Abdallabi King at Halfaya Fertit which is near Darfour). Interestingly ** Simoum; an Arabic word meaning intense heat waves enough he remarked that ‘the worm does not typical of Sudanese summer attach itself exclusively to the leg; I have seen

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References 1. Hillelson SDR. David ‘ha’ Rubeini an 7. Reid JM. Traveler extraordinary: the life early visitor to Sennar. Sudan Notes & of James Bruce of Kinnaird, Eyre & Records 1933; 16:155-75. Spottiswoode 1968. 2. Monsieur P. A voyage to Ethiopia in the 8. Crawford OGS. The Fung Kingdom of years 1698, 1699, 1700. W Lewis, Sennar, with a geographical account of London: Covent Garden;1709. the Nile region. Gloucester, John 3. Theodoro K. Hoher und Fruchtbarer Bellows, 1951 Palm-Baum des Heiligen Evangelij 9. Nigel Hepper F. On the botany of James (Augsburg: Georg Schulter & Martin Bruce’s expedition to the source of the Happach, 1710). Blue Nile. J Soc Biophy Nat Hist 1980; 4. Jay S. The Sudanese travels of Theodoro 9(4):527-37. Krump, 1700-1702, 1974, ww.kean.edu/ 10. Browne WG. Travels in Africa, Egypt & jspauldi /krump2home.html. Syria 1792-1798, Londres, 1799. 5. Hill RL. A Biographical dictionary of the 11. Autobiography. Diaries. Recollections. Anglo-Egyptian Sudan, Oxford, 1951. Berberian11.tripod.com/stambolski 6. James Bruce. Travels to Discover the memoirs.htm Source of the Nile, In the Years 1768, 12. Brucea antidysentrica. Medical 1769, 1770, 1771, 1772 and 1773. Five dictionary.http://medicine.academic.ru/14 Volumes, GGJ and J Robinson, London, 495/brucine. 1790. 13. John L Burckhardt. Travels in Nubia, Cambridge Library collection, London, John Murray, Albemarle Street, 1819.

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