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

Sudan Med J 2014 December;50(3)

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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

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

د. طارق عبدالكريم الهد

مؤسسة حمد الطبيه

قطر , الدوحه

الصحراء الكبري و جنوب وادي النيل شكلت االراضي جنوب , "نوبيا " بمسماها القديم "ارض السودان " ايام هيرودوتس الذي كان اول من كتب عن منذ

عشر لسبر غور مجاهل افريقيا ابتداء من للمستكشفين االوربيين في القرن التاسع من ناحية اخري مثلت منابع النيل حافزا و .محيرا لالوربيين القدماء لغزا

بالذكر ان معظم هوالء الرحاله تقمصوا الجدير .جون سبيك و صموءيل بيكر ليفنجستون و انتهاء بريتشارد بيرتون و المبشر و المستكشف االسكتلندي ديفيد

و االنجليزي ويليام براون و جيمس بروس الذي اسمي نفسه الحكيم يعقوب بالطب و علم الطبابة السيما االسكتلندي ب االطباء وادعي اكثرهم معرفة والماماثيا

.يوهان لودفيج بركهاردت االنجلوسويسري

اثيوبيا اياسو االول في االمبراطور لويس الرابع عشر الي عاهل الفرنسي شارلس بونسيه والذي اوفد من قبل اول طبيب وطاءت قدماه بالد النوبه هو كان

كانت هي حجر و مملكة الفونج و لكن روايات جيمس بروس كتابات بونسيه قصب السبق عن بالد النوبه مثلت .داء الم به كسفيرا و مطببا من 1699 العام

كتبه هوالء في السودان و يتناول هذا البحث بعض ما لسجل الطب الرحاله اللبنات االولي هوالء ارسي .النيل و بالد السودان الزاويه لبداية استكشاف منابع

الطب الشعبي في الفتره التي مارسوه من تطبيب و ايضا عن مالحظاتهم عن في المناطق التي زاروها و كذلك عن ما الرحاله و عما شاهدوه من امراض

.التركي المصري سبقت الفتح

Abstract

To Europeans, Sudan represented a

mysterious mix of ethnic entities, races and

tribes which and for many millennia scattered

over a vast mostly undiscovered, unwritten

about expanse of deserts, Savannah plains and

jungles. Up to, and until well into modern

times this extended land through which flew

the Nile splitting the country nearly through

its middle creating images of an exotic land

that never stopped tantalising explorers and

tempting them to visit and travel through the

land of the Nile. The ever present motive has

been the desire to discover the springs that

feed the great river and what lies beyond the

scorching desert. Therefore comes as no

surprise that the early contacts between Sudan

and Europe were very much foiled by several

European explorers whose ambitions drove

them to visit and explore the country and

write about its history, geography and people.

Some of those early explorers somehow used

medicine in their quest to gain access to this

vast unspoilt land. They skillfully managed to

exploit the power, influence and wisdom

afforded to those who possessed the

knowledge and skill to treat and cure the sick

and relief suffering. Exploiting their

rudimentary medical knowledge those

explorers managed to impart a favourable

impression on both rulers, as well as natives

of the land they travelled in.

Some, like the French explorer Charles

Jacques Poncet were physicians, yet others

like Theodoro Krump, James Bruce and Lewis

Burckhardt were, although not fully fledged

physicians, had nevertheless, if judged by the

standards of their heyday, received some

education in simple medical treatments and

the use of medicinal products. Their

subsequent writings not only provided

valuable insights into the geography and

history of Sudan, but provided invaluable

information about the various diseases and


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Early European medical encounters in the Sudan Tarik A Elhadd

ailments that were afflicting the population

and were then prevalent in the country. The

observations and writings of those medical

pioneers furthermore provided first hand

historical insights into some of the widely

practiced traditional Sudanese medicine and

treatment interventions that were based on

faith and religious beliefs, as well as long held

mythical dogma and superstition.

Keywords: Sudan, Medical history,

Traditional Sudanese Medicine, Nubia, Fung

Kingdom of Sennar, European travelers,

explorers, Turco-Egyptian Sudan

Charles Jacques Poncet & Theodoro

Krump: The earliest European medical

encounters in the Sudan

Since medieval times only few European

explorers or travelers assumed the role of

physicians while travelling through the North

and East African hinterlands. The major

reasons were to have an easy passage, to gain

help or to impress. During the era of the Fung

Kingdom of Sennar (1503-1821), and

following the travels and writings of David

ha-Rubeini, a Jew, whose stories were a

subject of dispute and controversies, in

Sennar(1)

the first documented encounter of

Sudanese people with European travelers was

with the French physician Charles Jacques

Poncet. Poncet travelled through the Sudan in

1698-1699 on his way to Gondar as an envoy

of the French Monarch, Louis XIV, to the

Abyssinia monarch, Iyyassu I, ‘The Great’.

Poncet, who was a physician by training and

apothecary by practice, gained a reputation in

Egypt among the Turkish elite and the

European residents following his arrival in

Cairo in 1691. On his journey to Gondar he

was accompanied by Haji Ali, the Abyssinian

imperial representative, and Father Charles

Francis Xavierius de Berevendet, a Jesuit

priest. The group left Cairo in November 1698

and travelled down the bank of the Nile.

Poncet wrote about the devastating effect of

the plague epidemic that reached the upper

fringes of Nubia and wiped out the whole

population of many villages. That was the

only time when plague had reached and

affected the Sudan on record. The group then

passed through ‘Hafir Maschu’ on the eastern

bank of the Nile and were hosted by the

‘Nubian Prince of Argo’, whom Poncet

‘treated from an ailment’. This is probably

was the first European medical encounter in

the Sudan. Poncet and his companions then

passed through Dongola where they were

hosted by its King and eventually they

reached Sennar in February 1699. Here, they

spent three month as guests of the Fung King

before leaving for Gondar. Poncet’s writings

about the city, its inhabitants, (which he

estimated were a hundred thousand souls), the

royal family and their entourage, the trade in

Sennar, are probably the first European

account of the Fung Kingdom of Sennar.

Intriguingly, Poncet did not mention in his

journals anything about the art of medicine

and medical practice in the Sudan or Sennar

despite the relatively long spell he spent there.

The only two remarks he made was an

account of his earlier treatment of Prince of

Argo, the vassal of King of Dongola, (which

he only mentioned ein passe), plus the

incident of him being presented with a six

month old ‘Turkish’ girl (probably the child

was very light in colour), who was almost

dying and Poncet could do little to help her(2)

.

Following this successful venture, the French

Monarch Louis XIV sent a diplomatic mission

to the Abyssinian Emperor with several Jesuit

missionaries in 1700. This mission included

Theodoro Krump, a Bavarian Catholic

missionary whose subsequent writings, ‘Palm-

Baum’, represents a rich treatise for the life in

Sudan on the eve of the seventeenth century

and contains the earliest footage of medical

practice in the ‘Kingdoms of Dongola and

Sennar’ during the zenith of the Fung

Sultanate(3)

. According to Jay Spaulding

(2008), the writings of Theodoro Krump ‘in

many ways represents the most important

single written source concerning the pre-

colonial history of the Sudan as it has


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provided an invaluable testimony about the

structure functioning of the Funj government

before the fall of the Unsab dynasty….and

contributes data of unparallel quality on the

organization and conduct of the trans-

Saharan caravan trade, the commerce in

slaves, Sudanese medical practices, Sudanese

relations with Ethiopia and a wide array of

often unexpected vignettes of daily life’(4)

. It is

not clear from the available records whether

Krump had had any formal medical training or

whether his expertise in medical practice in

the Sudan was an amateur enterprise.

However, several of the names he used for

various remedies and medicines he gave to

people he treated were medical names in Latin

(ibid). So it is highly likely that he had had

some sort of medical knowledge, but whether

this was acquired through apprenticeship (in

preparation for his missionary journeys) or

whether he had specific training, one cannot

be certain. It appears that it was a common

practice in those days to prepare travelers or

those involved in specific discovery missions

to have some medical knowledge of common

diseases specially those encountered in the

tropics. His writings about the medicines he

used, the cases he treated and the illnesses he

described imply that he had a good grasp of

some form of medical knowledge, at least by

the standard of the seventeenth century.

Also we know from Krump’s accounts that

prior to his arrival in Sennar in May 1701

there were already a group of Jesuit

missionaries who possibly arrived shortly

after the trip of Charles Poncet. Among these

was Father Pasquale whom Krump referred to

as the ‘Private Physician’ of the Fung Sultan

(ibid). Both Krump and Pasquale were given

the revered heyday title of ‘Mua’llim’ which

was used by the Fung people for

professionals. Furthermore, both were given

Arabic names, with Pasquale as ‘Mua’llim

Yusuf’’ and Krump as ‘Mua’llim Yunus’.

Reading through his ‘Palm-Baum’ translated

and summarised by Jay Spaulding, Krump

used the practice of ‘cupping’ and leeching

and he mentioned that the same practice was

done by Sudanese native doctors. Krump went

on to treat the Fung Monarch himself from an

accidental wound he sustained in his right

foot. In his journals, Krump write ‘The year

1702. On the twelfth of January the king sent

me a ‘mursal’ (messenger) ordering me to

come to him to treat a wound which he had

carelessly given himself in the right foot with

his sabre. Fortunately I healed him within a

few days with the balsam of Innocent XI’

(ibid). Krump would later be summoned to

treat the Sheikh of Qarri, the Abdallabi King,

the main vassal of the Fung Sultan. Krump

also mentioned that during his stay in Sennar

he was called almost daily to attend the sick.

He once cured ‘Sheikh Idris’, son of the

viceroy, from jaundice, and the son of the

Qadi and an Arab sheikh from syphilis. He

went on to state that syphilis is very common

in Sennar. Krump also practiced cupping and

leech which was a known practice among the

‘Sudanese native doctors’, he would even use

their technique of cauterization as he saw it to

treat a fellow priest when they were travelling

back to Egypt in 1702.

Krump following his return to Rome retired

back to his native land of Bavaria in Germany.

His journals were published in 1710. In 1705,

another group of Franciscan Jesuit

missionaries were despatched to Ethiopia via

Sennar. This mission which was led by Le

Noir du Roule, had the Paris graduate?

Zantiote? Greek physician, Agostino Lippi

among its members which consisted of several

Jesuit priests. Dr. Lippi (1678-1705) was sent

as a private physician to the Abyssinian

Emperor, Iyassu I(5)

. The mission had to travel

through Sennar, but for reasons which are not

clear the group was plundered and its leader

was murdered. It is possible that this occurred

during the clash between Badi III and his

vassals when there was significant turmoil in

Sennar. One can only speculate.

Several decades later in 1772 the first Briton


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Several decades later in 1772 the first Briton

who is known to have travelled into the Sudan

was the Scottish Laird, James Bruce of

Kinnaird (Fig 1) assumed the capacity of

‘Hakim Yagoub’ (Hakim (Arabic.) =

physician; Yagoub = Jacob) during his travels

in Africa (vide infra).

Fig 1: James Bruce of Kinnaird (Courtesy of

Wikipedia

El Hakim Yagoube’: James Bruce, ‘The

Explorer turned Physician’

‘In disgust he left London for his Scottish

estate, to marry, to litigate, and finally, in his

widower-hood, to pour out the long, confused,

brilliant book of his travels which was read

throughout Europe and revived the stream of

criticism and satire again which was to flow

till long after he was dead’‘J M Reid;

‘Traveler Extraordinary: The life of James

Bruce of Kinnaird’ (Fig 2)

Fig 2: A Sudanese woman from Shendi (drawn by

Ballugiani) (Courtesy of: James Bruce, Traveler

Extraordinary by J M Reid

To our knowledge, James Bruce was the first

British explorer to have travelled into the

Sudanese hinterlands. This man has an

interesting story. Of a noble background,

belonging to a long line of Scottish Lairds

(Lords), James Bruce was born in 1733 and

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

was educated at Harrow (as was a much later

British visitor to Sudan, Winston Churchill),

and showed talents in languages as he became

the school Latin orator aged 12. Bruce’s

fascination with travel became more pressing

after he lost his first wife, so he decided to set

off to satisfy his dream of discovering the

source of the River Nile(6)

. He went on to

learn Portuguese, Spanish and the principles

of astronomy. He also befriended the French

Monarch, Louis XVI, who supplied him with

astrology and astronomy tools to aid him in

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

he travelled in Asia Minor, learning Greek at

Constantinople, and then left for Syria. At


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physician, Dr Patrick Russell, a specialist in

tropical illnesses. From Dr Russell, Bruce

learned more principles of basic medical

treatment. Here, the British Ambassador to the

Ottomans obtained a ‘Firman’ from the Sultan

of Turkey that helped Bruce in his future

endeavours.

In summer 1768 Bruce landed at Alexandria

as ‘El Hakim Yagoube’ (ibid) accompanied by

his Italian assistant, the painter Luigi

Ballugiani. In Cairo, Bruce approached the

Mameluke Governor, Ali Bey Abu Al-Dahab

and he befriended him, offering his services as

a physician. Following a spell at Cairo and

with the help of Ali Bey, he crossed the Red

Sea after travelling up the Nile to Assiut. He

then travelled down the eastern coast of

Arabia and then took a British battleship from

Jeddah and went to Yemen. From there he

crossed the narrow strait of the Red Sea to

Mussawaa, the main port of Abyssinia,

arriving there in late 1769. Following various

risky journeys through the land of the Tegrai,

Bruce eventually reached Gondar where he

was taken as the emperor’s private physician.

In those days Abyssinia was witnessing

turmoil of inter-tribal wars and several

conspiracies to depose the emperor. Bruce

during the time he spent in the Abyssinian

Royal Court had the opportunity of describing

that important chapter in the history of

Abyssinia in his journals. At Gondar, the

capital, Bruce thrived for several years

escaping many havocs and conspiracies, and

making many friends and foes. He gained

trust and love after his success in treating

several members of the Royal family using his

“magic” purgative, ‘brucea dysentrica’. Amid

all this Bruce managed to satisfy, as he

believed, the main purpose of his adventure

and his ambitious dream of locating the source

of River Nile. Having sight of Lake Tana from

which the Blue Nile flows, Bruce writes:

‘I remembered that magnificent scene in my

own native country, where the Tweed, Clyde

and Annan rise in one hill; three rivers, as I

now thought, not inferior to the Nile in beauty,

preferable to it in cultivation of those

countries through which they flow; superior,

vastly superior to it in the virtues and

qualities of the inhabitants, and in the beauty

of flocks crowding the pastures in peace,

without fear of violence from man or

beast…’(7)

Early in 1772 Bruce travelled into the

Sudanese hinterland of the Fung province of

Atbara, passing through the frontiers district

of ‘Ras Al Fil’ and its main village, ‘Hor

Cacamoot’ (translated by Bruce as the valley

of shadow of death, today it is the town of

Gallabat). He received some help from its

chieftain, Erbab Gimbro, and proceeded to the

main town of the province, Teawa (todays

Gedaref) and having to deal with the Fung

governor of the Fung Atbara Province, Shiekh

Fidele. Bruce treated his several wives with

his purgative. The administration of emetic

produced such a good effect, that a further

attendance was ordered. On this occasion,

Bruce wrote ‘the ladies all disrobed, and

standing before me naked, each demanded to

be examined. Not content, with this they then

demanded that I, likewise should disrobe!!. I

have been to more than one battle, but surely

would have taken my chances again in any of

them to have been freed from that

examination’. (ibid) Bruce escaped death in

‘Teawa’, when ‘Sheikh Fedail’ exercised all

avenues of extracting ‘whatever treasures

Bruce may have had”. However, he eventually

succeeded to reach Sennar after travelling via

Beyla (today’s Jebel Beyla), where he treated

its Sheikh ‘with his purgatives’. The Sheikh,

being so grateful helped Bruce to reach

Sennar safely(6)

.

At Sennar, Bruce wrote what is most likely

the first writing of a British man of the Fung

Kingdom of Sennar. He narrated his various

encounters with the Fung’s King and his

entourage; he befriended the ‘Vice-Vizier’

Adlan, brother of the powerful Vizier, Abu Le

Kaylak who was away at the time, involved in


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a long war at Kordofan. Following several

months at Sennar, Bruce travelled north along

the banks of the Nile where he met ‘Wed

Agib**

’ whom he described as the Arab Chief

responsible to Sennar for the northern

sheikhdoms and kinglets. He then reached

Shendi, which was then the main market town

in northern Sudan on the caravan route to

Egypt and the western frontiers, where he

spent a few days as a guest of Wed Agib’s

sister, ‘lady Sittana’.

Sittna, helped the Scotsman to prepare for the

long journey via Berber to Aswan crossing the

desert at Abu Hamad which he described as a

journey full of ‘sand and simoum*’(7)

. Bruce’s

writings about ‘King Ismain’, and the people

of the Fung and their origins was used as

reference in the subsequent attempts to

document the history of the last Sudanese

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

stagnant water. He also made records of

dysentery, the bloody flux, and fevers at

Sennar which was probably malaria. He

mentioned hepatomegaly, venereal diseases

and smallpox epidemics. He also described

the native method of vaccination against

smallpox, which the natives called ‘buying the

pox’. Here a rag would be wrapped around the

arm of an infected person, and the person

wanting to be ‘vaccinated’ would be standing

by. Usually the old women of the tribe were

the ones who carried out the procedure. A

price had to be placed on the ‘rag’ and after

haggling and bargaining on the price, when it

was agreed, the rag would be taken away by

the person wanting to be vaccinated. The rag

would be tied on the arm and when the

recipient contracted the disease he would only

have the number of pocks he paid for!

Bruce was one of the first to have gathered a

collection of tropical plants, an entity which at

the time was not known in the West(9)

.

Ironically he used some of these plants as

medicines and purgatives during his travels

into the Fung Kingdom of Sennar. These

plants later were known as ‘brucea anti-

dysenterica’ (Fig 3). Many of the plants he

collected during his trips in Abyssinia

featured in his journals.

Fig 3: brucea antidysentrica (drawn by Ballugiani)

(Courtesy of: James Bruce, Traveler Extraordinary

by J M Reid

Following his successful return to Egypt,

Bruce eventually went back to London where

life did not treat him well. His stories were

disputed, he was cast as a liar, and he went

into dispute with powerful figures in London

at the time. Men like Samuel Johnson and

James Boswell were his adversaries. It was

not until 1790 that, urged by his friend Daines


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Barrington, he published his treatise of what is

considered as extraordinary travels (6). His

travels would very much stimulate later

explorers to follow his footsteps and verify his

stories. After the substantial accuracy of his

travels were thereafter demonstrated, his quest

to discover the River Nile captured the

imagination of the British explorers in the

second half of the nineteenth century to

eventually succeed in fulfilling that dream.

The substantial accuracy of his Ethiopian and

Sudanese travels has since been demonstrated,

and it is considered that he made a real

addition to the geographical knowledge of his

day.

The pre-Turco-Egyptian period: Brown &

Burckhardt

W G Browne medical encounters in Darfur

‘If any medical professor should chance to

advert to them, the writer is too conscious of

the superficiality of his own knowledge not to

perceive that little satisfaction will be derived.

But persuaded that the art of healing, even at

this day, abounds little less in experimental

than in the age of one of its brightest

ornaments, who makes the confession, he is

induced to believe, scarcely any fact relative

to it, or any experiment, faithfully narrated,

can be wholly destitute of its use’. W G Browne, Travels in Africa, Egypt & Syria

from the year 1792-1798.

The London born English explorer, William

George Browne, having read James Bruce’s

journals became fascinated by the prospect of

travelling into the interiors of Africa.

Following his studies in Oxford, Browne used

the fortune left to him by his father to finance

a trip to the Middle East and Africa. He

travelled in Syria, Egypt and Africa and

accurately described some of the diseases he

had seen or opted to ‘treat’. Like other

European travelers of the time, Browne

portrayed himself as a ’Frankish physician’.

He travelled from Egypt into the Sudan

aiming primarily to follow the route of James

Bruce into Nubia, then to Abyssinia travelling

through Sennar. However, and due to some

local troubles in the region of Dongola,

Browne was forced to change his plans and

travel to Darfur instead, where he was

received as ‘Daif-es-Sultan’ (guest of the

Sultan). Browne arrived at Kobbe, the

Darforean caravan front town and reached el-

Fasher in the summer of 1793. He remained in

Darfur for about 3 years (1793-1796) and

returned to Egypt. In his book, ‘Travels in

Syria, Africa and Egypt (1799) Browne

described a broad range of diseases and

medical conditions, from spring catarrh

(known at the time as the Egyptian

ophthalmia), to Smallpox, Plague, Leprosy,

Guinea worm, Syphilis and Scurvy, to name

but few. In this section, we will confine our

discussion to those diseases he had described

from his 3 years in Darfur(10)

.

Through what appears to had been a matter of

personal interest Browne wrote extensively

about spring catarrh. This seems to have been

based on his own observations as well as

contemporary concepts about the causes of the

illness and its treatment. He stated that he had

not witnessed this common cause of

‘defective vision’ in Darfur. It is noteworthy

that his observations were very accurate and

similar to those of the first British doctors

who worked over a hundred years later in

Sudan and who reported that the ‘Egyptian

Ophthalmia’ tends to be less seen as one

travels southward from Egypt and deeper into

Sudan Browne confidently stated that plague,

a dreadful scourge especially in the

Mediterranean and the Levant has not been

witnessed in the Sudan. With the exception of

a few cases amongst the returning pilgrims

from Mecca early in the twentieth century,

Sudan remained free through the centuries

from the menace of plague which has

devastated other countries in the Middle East.

In contrast, Browne described smallpox as ‘a

condition much dreaded by the people of the

Soudan, whether Moors or Negros’.

Interestingly, he noted that the fatality rate


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among the ‘Negros’ tended to be much higher.

Browne attempted to inoculate five slaves as

desired by their master. He gave them a strong

dose of senna prior to the procedure. Three

survived and two perished. Browne observed

that Guinea worm (Medina worm) is seen

mostly among the Fertit, a tribe that lives in

the south western Sudan. He gave an

elaborate description of this ailment and the

natives’ way of treating it. Interestingly,

Browne made the excellent observation that

‘the disease seems to originate in the water,

which is replete by animalcules, and which no

attempts are made at purifying it!! Later on

and during the ninetieth century the disease

life cycle was described by the notable

Bulgarian Physician Hristo Stambloski, who

was then exiled to Yemen (1877-1878)(11)

.

Stambloski’s descriptions supported Browne’s

observation as Cyclops, a water parasite, was

identified as the vector in disease

transmission.

Browne went on in his interesting medical

accounts to refer to syphilis which he said is

less formidable in Darfur than in Egypt. By

contrast he observed that leprosy was not

uncommon in Darfur, and that he was once

intrigued to witness a case of early leprosy

cured under his observation by a ‘salve, native

of a Kingdom called Baghermi, but the means

he had used he could not be prevailed on to

disclose’. Browne also described cases of

‘splenic tumours’ which he probably meant by

cases of splenomegaly. He diligently used

‘James’ powder* as an emetic to treat these

cases. (*Author: he probably meant the emetic

substance brucea antidysentrica named in

honour of the Scottish explorer, James Bruce,

who first introduced it to Britain from

Ethiopia(12)

. Browne went on to describe

cases of haemorrhoids and fistula-in-ano,

observing that Darfurean healers treated the

conditions by applying cauterisation in the

case of the former and topical application

without incision for latter. Browne remarked

that he found cases of hernia to be less

common in Darfur than in Egypt.

Browne documented Contemporary medicines

used by the natives to treat various disease

conditions. These ranged from ‘natrun’ to

‘tamarind’, to phlebotomy and the ancient

practice of leeching and the use of some

substances as aphrodisiacs. This last he

remarked were, unsurprisingly on high

demand, Finally, Browne made some crude

‘anthropological ‘remarks on the

characteristics of the ‘negro race’. He

described at some length the practice of

female genital mutilation or female

circumcision as called by those who practice

it, which he stated is less common in Darfur.

Browne was forced to stay in Darfur and his

requests to travel to Sennar were repeatedly

turned down by Sultan Abdel-Rahman el-

Rasheid, the Sultan of Darfur, Browne had, in

1796 been eventually allowed return to

Egypt. Following his return to Britain in 1798,

he made a second spree of travels ion 1800,

this time however he headed east into Asia

Minor and Persia where he travelled to Tibriz

where, in 1813 he was murdered.

John Lewis (Johann Ludwig) Burckhardt

& Travels in Nubia

In the footsteps of his two predecessors, but

with a rather different intention to discover the

source of River Niger, the Anglo-Swiss,

Johann Ludwig Burckhardt (b. 1786,

Lausanne) made landmark contribution to our

understanding of the Middle East and the

Sudan in the build up to the reign of

Mohamed Ali Pasha in his extending empire.

Burckhardt was born in a noble Swiss family

from Basel, which suffered greatly during the

French Revolution. This tempted both father

and son to seek refuge in Britain. Burckhardt

had his early studies at Leipzig and Gottingen

in Germany, and then in 1806 he left for

England. He was recommended to Sir Joseph

Banks by one of his ex-professors in

Germany. Banks was then President of the


177



Association of Promoting the Discovery of the

Interior of Africa. At the time the association

was looking to recruit a talented traveller into

the interior parts of West Africa, with

intention of exploring the Bournu Kingdom.

Burckhardt learned Arabic at Cambridge and

London and also received lectures in

chemistry, astronomy, medicine and surgery

in the build up to his travel. He was then sent

to Aleppo where he received further education

in Arabic language, studied and learned the

Koran and Islamic theology, and he learned

the way and customs of the ‘Mohamedans’.

Here Burckhardt became disguised as Hajji

Ibrahim Abdalla Al-Shami, a Turkish

merchant (Fig 4).

Fig 4: Burckhardt disguised as Hajji Ibrahim

Abdallah El Shami (Courtesy of Wikipedia)

During the two years he spent in the Levant,

he made some exploration into Palestine,

Lebanon and current Jordan. Burckhardt was

considered the first European to have

witnessed and documented the historical city

of Petra (in today’s Jordan). After some time

in Syria, Burckhardt was instructed by the

Society to go to Egypt to join some caravans

that normally travelled into the Bournu

country through Fezzan in current Libya. In

winter 1812, and having missed the Fezzan

caravan, he wrote to the association ‘The

delay thus occasioned in my Fezzan

expedition, I shall endeavour to make

profitable to African geography, in another

quarter. I mean to set out next month, by land

for Upper Egypt, as soon as the state of the

Nile renders the voyage practicable. I shall

push on beyond the first cataract and follow

the course of the river by the second and third

cataract, towards Dongola. That country

farther up than Derr, has never been visited

by any travellers… were it not for the

Mameluks who have settled at Dongola, and

taken possession of that country, I might hope

to reach that point.’.. ; yet I am informed by

many of the natives, that the borders of the

river are full of ancient temples and other

antiquities, resembling those of Luxor, and the

Isle of Philae were it not for the Mameluks

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

Wadi Halfa. He then passed the Island of Say,

the Sukkot, and then into the Mahass

homeland reaching the upper frontiers of

Dongola. He returned back to Asswan by the

31st of March 1813. After a year of waiting

for a suitable caravan to join, Burckhardt then

executed a second journey that began on the

2nd of March 1814, this time crossing the

Nubian desert from Asswan to Berber. Here

he stayed for two weeks and then traveled

During the two years he spent in the Levant,

he made some exploration into Palestine,

Lebanon and current Jordan. Burckhardt was

considered the first European to have

witnessed and documented the historical city

of Petra (in today’s Jordan). After some time

in Syria, Burckhardt was instructed by the

Society to go to Egypt to join some caravans


178



that normally travelled into the Bournu

country through Fezzan in current Libya. In

winter 1812, and having missed the Fezzan

caravan, he wrote to the association ‘The

delay thus occasioned in my Fezzan

expedition, I shall endeavour to make

profitable to African geography, in another

quarter. I mean to set out next month, by land

for Upper Egypt, as soon as the state of the

Nile renders the voyage practicable. I shall

push on beyond the first cataract and follow

the course of the river by the second and third

cataract, towards Dongola. That country

farther up than Derr, has never been visited

by any travelers… were it not for the

Mameluks who have settled at Dongola, and

taken possession of that country, I might hope

to reach that point.’.. ; yet I am informed by

many of the natives, that the borders of the

river are full of ancient temples and other

antiquities, resembling those of Luxor, and the

Isle of Philae were it not for the Mameluks

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

Wadi Halfa. He then passed the Island of Say,

the Sukkot, and then into the Mahass

homeland reaching the upper frontiers of

Dongola. He returned back to Asswan by the

31st of March 1813. After a year of waiting

for a suitable caravan to join, Burckhardt then

executed a second journey that began on the

2nd of March 1814, this time crossing the

Nubian desert from Asswan to Berber. Here

he stayed for two weeks and then traveled

further south, staying for few days at ‘Damer’

and finally reaching Shendy on the 17th of

April 1814. After spending one month in

Shendy, Burckhardt set off again for Suakin,

the old medieval port on the Red Sea, taking

the route along the Atbara River via ‘Goz

Radjab’, and then into the ‘Taka’ region and

finally reaching Suakin on June 26th , 1814.

After crossing the Red Sea to the ‘Hijdaz’ in

Arabia in July 1814 and staying at ‘Dijidda*’,

(*Possibly an old way of writing Jeddah, the

ancient port on the Red Sea in Arabia) then

performing the ‘Hajj’ in November 1814, he

returned to Cairo in June 1815 after spending

some time in ‘Medina’. Burckhardt while in

Arabia suffered a diarrhoeal illness which

became chronic and lingered on for the

subsequent two years and led eventually to his

untimely death in Cairo on 17th of October

1817.

The journals of Burckhardt describing his

travels in Nubia and other places were

published posthumously by his employer,

‘The Association of Promoting the Discovery

of the Interior of Africa’ in 1822. Burckhardt

ingenious writings were a major source of

information about the geography and history

of the Nubian Sudan in the prelude to the

Turco-Egyptian invasion by Mohamed Ali

Pasha in 1821. Burckhardt’s time in Egypt

and Sudan was rich in the historical events

that were taking place in the region and

greatly influenced the history and future of its

people. In his treatise, he wrote extensively on

the people, the climate, the habits and on the

oral history of various inhabitants of the

Sudan. It was soon after Mohamed Ali Pasha

ascendancy into power and the time of his

great imperial conquests in Arabia, and his

bloody conflicts with his rivals, the

Mamelouks. Burckhardt very much followed

some of the travel footsteps of James Bruce in

the Nubian desert. He also befriended and was

guided by the other Briton, George William

Browne whom he met in England prior to him

setting off on his travels. What is relevant here

is that Burckhardt has made ingenious


179



observations on various medical conditions

during his travels in the Sudan. This, when

taken together with those of Bruce and

Browne make the backbone of what we know

about medicine and diseases in Sudan in the

Eighteenth and Nineteenth centuries.

Burckhardt, like his other two predecessors,

Bruce and Browne, portrayed himself as a

visitor who possess medical knowledge and

expertise in curing the ill and infirm. In

addition to his ‘impersona’ of Hajji Abdalla

Ibrahim Al-Shami.

A title he adopted for himself since 1810

when in Aleppo, Syria, (1810-1812). ‘I got

myself introduced to one of their chiefs as a

physician in search of medicinal herbs…’(13)

.

Burckhardt made extensive and detailed l

records about the various medical problems he

saw or heard of during his travels. While in

Egypt, and in the wake of the 1812 Cairo

Castle massacre of Shahin Pasha along with

120 of the Mamelouks, at and their fleeing

south, a famine broke out in Upper Egypt

followed by a smallpox epidemic in Nubia.

According to Burckhardt, half of the

population of Nubia perished in the aftermath.

While in Berber, Burckhardt made interesting

remarks on the health of Berber inhabitants;

[The people of Berber appear to be a healthy

race. There seemed to be few invalids, and the

place being situated on the skirts of the desert,

the air is certainly wholesome. I was told of

fever called wardé, from woid (rose) which

seems to be epidemic, and often proves

mortal; the people of Dóngola are very

subject to it; it exists during the time of high

water, but it does not make its appearance

every year’.] It was very likely that

Burckhardt was referring to ‘malaria’ as the

typical description. He went on to state

‘plague was unknown, and from what I heard

during my former journey in Nubia, I have

reason to believe that it never passes the

cataract of Assouan’. . On the smallpox

epidemic that broke out in the preceding year

to his travel and again in 1815 when he had

returned back to Cairo, he wrote; [‘smallpox

is very destructive whenever it gains ground.

Last year it was added to famine, and death

was very numerous. It had been brought to

Berber by the people of Taka, who had

received it from the Souakin traders; it spread

over all the country up the Nile….’] He went

on to comment on what could be an

interesting ‘epidemiological account’ of how

the population was affected to various degrees

depending on the age of individual sufferers.

He observed that the third who recovered

from the disease tended to bear its mark on

their face and skin. He described the periodic

outbreaks of epidemics every eight to ten

years, and described the method of inoculation

practiced in the Nile Valley which was called

‘dak-el-Jedri’, and the medicine used by the

natives to attempt to cure those infected, by

stating [‘the only cure for the smallpox was to

rub the whole body with butter three or four

times a day and to keep themselves closely

shut up’]. Burckhardt wrote of the smallpox

outbreak of 1815 while he was in Egypt,

stating that the epidemic took the lives of

fifty two persons of the ‘Temsah’ family of

the ‘Meyrafabs’, amongst whom was ‘Mekk

Idries’, Burckhardt’s host in Berber. He

recorded that the nearby town of ‘Damer’

suffered less during the smallpox epidemic

than Berber, and that: ‘in ‘Shendy’s Slave

Market’ the slave who bears the smallpox

marks would bring more money than the one

who doesn’t’(12)

. He wrote that among the

slaves, the practice of castration was carried

out on specially those destined for ‘export’ to

Turkey and Arabia, where they are used as

‘guardians of female virtue’!. ‘Two years ago,

Mohamed Ali Pasha caused two hundred

young Darfur slaves to be mutilated, whom he

sent as a present to the Grand Signior’.

Burckhardt witnessed these operation during

the time he spent in Upper Egypt waiting for

his second expedition into Nubia He stated

that ‘it is carried by two Coptic monks (who

excelled their predecessors in dexterity) in


180



Siout (=Assiout), and that only the slaves

brought from the Borgho, to the west of

Darfur were mutilated prior to them been sold

and sent elsewhere’. He went on to describe

those mutilated slaves in what can be

regarded as typical medical textbook

description of hypogonadal males.

Interestingly enough, Burckhart also wrote

extensively in his journals about the practice

of Pharonic circumcision (Synonym: Female

Genital Mutilation), in what could also be

regarded as an important footage of the

history of practice in the early nineteenth

century. He remarked on the arrival of some

‘slave girls’ to Shendy who ‘were called

mukhayet (consutae) from an operation which

has been described by Mr Browne. I am

unable to state whether it is performed by

their parents in their native country, or by the

merchants, but I have reason to believe by the

later. Girls in this state are worth more than

others; they are usually given to the favourite

mistress or slave of the purchaser, and are

often suffered to remain in this state during

the whole of their life’. He went further to

write ‘the daughters of the Arabs, Ababde and

Djaafere, who are of Arabian origin, and

inhabit the western bank of the Nile from

Thebes, and generally those of all the people

to the south of Kenne as far as Sennar,

undergo circumcision, or rather excision

(*excisio clitoridis), at the age of from three to

six years. Girls thus treated, are also called

Mukhayaet’. (ibid)

Burckhardt noted piles to be very common

among the ‘country people’ and less among

the ‘slaves’. He stated that he first saw

genuine Guinea worm in Shendy and

remarked that it was very common ‘in

Soudan’, where people call it ‘the fertit’

(Author: probably named after people from

Fertit which is near Darfour). Interestingly

enough he remarked that ‘the worm does not

attach itself exclusively to the leg; I have seen

it issuing from the arm, the breast, and knees,

though its favourite place seems to be the calf

of the leg’.

He made some epidemiological remarks

stating that it was rare in people from Shendy

than those from Kordofan. He described the

few cases of ‘ophthalmia’ he saw. Venereal

disease, he observed was commonly seen, and

he made the interesting observation that its

consequences tended to be less fatal than in

Egypt, and that he never personally saw any

of those ‘with ulcerated faces’ (referring to the

facial mutilation in the aftermath of tertiary

syphilis) which he saw frequently in Egypt.

During his one month in Shendy, the most

important trading post in Central Sudan at the

time, Burckhardt wrote about various

medicines used by the native medical

practitioners, stating that ‘grocers and

druggists are the most frequented of any…’

and those sell various herbs and native

medicines imported from either India, Egypt

or other parts of Sudan such as Sennar,

Kordofan and Darfur. These herbal cures

included among others Fenugreek (called

Helba), antimony (local name Kohol), gerfa

(cinnamon shrub), Sembil, Mehalab and a

fruit called ‘tamr el-Berr’ imported from

Kordofan, which is used to treat flatulence, on

which Burckhardt commented that ‘it is

believed here to be a remedy for flatulence, of

which many people here complain’ (ibid).

The diarrhoeal illness Burckhardt developed

while in Medina in 1815 became chronic and

eventually led to his demise in October 1817.

It is not clear whether it was a form of

parasitic dysentery, tuberculous enteritis or

some other type of inflammatory bowel

disease. One can only speculate. -------------------------- * Wed Agib’ is likely ‘Agib Almanjuluk’, or one of his

descendants, the Abdallabi King at Halfaya **

Simoum; an Arabic word meaning intense heat waves

typical of Sudanese summer


181



References

1. Hillelson SDR. David ‘ha’ Rubeini an

early visitor to Sennar. Sudan Notes &

Records 1933; 16:155-75.

2. Monsieur P. A voyage to Ethiopia in the

years 1698, 1699, 1700. W Lewis,

London: Covent Garden;1709.

3. Theodoro K. Hoher und Fruchtbarer

Palm-Baum des Heiligen Evangelij

(Augsburg: Georg Schulter & Martin

Happach, 1710).

4. Jay S. The Sudanese travels of Theodoro

Krump, 1700-1702, 1974, ww.kean.edu/

jspauldi /krump2home.html.

5. Hill RL. A Biographical dictionary of the

Anglo-Egyptian Sudan, Oxford, 1951.

6. James Bruce. Travels to Discover the

Source of the Nile, In the Years 1768,

1769, 1770, 1771, 1772 and 1773. Five

Volumes, GGJ and J Robinson, London,

1790.

7. Reid JM. Traveler extraordinary: the life

of James Bruce of Kinnaird, Eyre &

Spottiswoode 1968.

8. Crawford OGS. The Fung Kingdom of

Sennar, with a geographical account of

the Nile region. Gloucester, John

Bellows, 1951

9. Nigel Hepper F. On the botany of James

Bruce’s expedition to the source of the

Blue Nile. J Soc Biophy Nat Hist 1980;

9(4):527-37.

10. Browne WG. Travels in Africa, Egypt &

Syria 1792-1798, Londres, 1799.

11. Autobiography. Diaries. Recollections.

Berberian11.tripod.com/stambolski

memoirs.htm

12. Brucea antidysentrica. Medical

dictionary.http://medicine.academic.ru/14

495/brucine.

13. John L Burckhardt. Travels in Nubia,

Cambridge Library collection, London,

John Murray, Albemarle Street, 1819.

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

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