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Arabmedicinesurg 00 Hiltuoft

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. H. CAMERON,
307 SKtRBOUHNt i^T.

iPrcscntcD to

of tbe

\Ilniver0it^ of Toronto

Dr. Jalaez H. Elliott


Professor of the History
of Medicine,
1931 - 1942
3, 6-'d

. H. CAMcRON,
307 SHERBOURNE ST.
TOBLONTO.
ARAB MEDICINE
SURGERY
Digitized by the Internet Archive
in 2008 with funding from
IVIicrosoft Corporation

http://www.archive.org/details/arabmedicinesurgOOhiltuoft
Plate I

GENERAL PRACTITIONERS OF THE AURES


b

HAMLET CONTAINING A 'HOSPITAL'


ARAB MEDICINE
f^ ^ SURGERY
^ Study of the

Healmg oirt />/ ^Algeria

BY

M: W. HILTON-SIMPSON, B.Sc.

Author of Among the Hill Folk of Algeria, Sec.

. H. CAMERC- ,

307 SKERBOURWEST.

LONDON X- ^ 4^^
OXFORD UNIVERSITY PRESS
HUMPHREY MILFORD
1923
PRINTED IN ENGLAND
AT THE OXFORD UNIVERSITY PRESS
:

PREFACE
It is with the greatest diffidence that I lay this little work
before students of the History of Surgery, Medicine, and
Pharmacology.
A layman— totally untrained in medical science— I suddenly
found myself in 1913 admitted to some of the secrets of the
reticent Berber and Arab doctors of the Aures Massif,
Algeria.
It is my misfortune that I lacked the knowledge necessary
to enable me to do justice to the opportunities of studying

their art which I have enjoyed.


But for the kindly interest taken in my work by the late

Sir William Osier I should not have ventured to publish


these notes at all.

In the circumstances all that I can attempt in the following


pages is to describe as I have seen it the life and work of the
practitioners of the remote valleys of the Aures Mountains
and, when dealing with their operations and methods of
treatment, to act as the mouthpiece of the native doctors

themselves.
I my heartiest thanks to the authorities at the
wish to offer
Herbarium at Kew and at the Botanical Gardens, Oxford
to Professor E. B. Poulton and Mr. E. W. Holmes, for the care
with which they have determined for me the materia medica I

have collected. To the Council of the Royal Society of Medi-


cine and of the Royal Anthropological Institute for allowing
me to reproduce, in a form amplified as a result of later in-

quiries in the field, material which I have already dealt with in


vi PREFACE
their Proceedings and Journal : the Council of the former
Society having kindly permitted me to use again the photo-
graph of a splint (PI. VI, b) which appeared in the Proceedings of
the Royal Society of Medicine, 1920, vol. xiii and to Professor
:

J. A. Gunn and Dr. Charles Singer for much advice and


kindly criticism. To Mr. Henry Balfour, Curator of the
Pitt- Museum, Oxford, 1 am indebted not merely for
Rivers
permission to publish many illustrations of instruments now
in that Museum, but also for his never-failing encouragement,

without which I should probably never have commenced the,


to me, fascinating study of Shawiya ethnography at all.

Finally, to the French Government, and to all its officers and


officials with whom I have come into contact in Algeria,

I desire to express my deep sense of gratitude for all the


facilities, kindness, and hospitality which my wife and I have
ever received at their hands.

M. W. HILTON-SIMPSON.
Oxford, 1922.
CONTENTS
PAGE
INTRODUCTION i

PART THE GENERAL PRACTITJONER OF


I.

THE AURES 7

PART II. SURGERY 28


Styptics, 28. Anaesthetics, 29. Trepanning, 30.
Asepsis, 28.
Removal of bone from limbs, 39. Substitution of bone in limbs,
41. Fracturesin limbs, 42. Fractures of collar-bone and ribs,
46. Fracture of jaw, 47. Dislocation and muscular injuries, 48.
Hernia, 50. Cautery, 51. Surgery of the eye, 52. Dropsy, 56.
Obstetric surgery, 58. Lithotomy, 59. Circumcision, 60.
Cupping, 62. Snake and scorpion bites, 63. Dentistry, 63.
Sutures, 64. Skin-grafting, 64. Bullet wounds, 64. Dress-
ings, 65.

PART III. MEDICINE 68


Purges and laxatives, 68. Colic and indigestion, 69. Flatu-
lence, 70. Worms, 70. Affections of liver and spleen, 70.
Jaundice, Diarrhoea, 73. Cholera, 74. Fever, 74. Colds,
71.

74. Coughs and chest affections, 75. Bronchitis, 76. Whoop-


ing-cough, 77. Headache, 77. Earache, 77. Rheumatism, 78.
Syphilis, 79. Gonorrhoea, 82. Swollen testicles, 83. Haemo-
rrhoids, 83. Skin diseases, 84. Melanodermia, 85. Bald-
ness, 86. Boils, 86. Abscesses, 87. Affections of the mouth,
87. Dropsy, 87. Small-pox, 88. Measles, 88. Obstetric
medicine, 89. Excessive menstruation, 90. Aphrodisiacs, 90.
Rabies, 91. Inflammationof a vein, 91. Sunstroke, 92. Mumps,
92. Running sores, 92. Burns and scalds, 93.

INDEX OF MATERIA MEDICA .... 94


INTRODUCTION
When in 1912 my wife and I selected the Aures massif on
the fringe of the great Sahara, to the north-east of the modern
tourist resort and French garrison town of Biskra, as a field
in which an ethnographical survey of a branch of
to attempt
the ancient Berber stock, we were guided in our choice by
the geography of the region. We
thought that in a natural
fortress such as the Aures, protected from invasion by preci-
pitous walls of rock on every side and subdivided by a series
of ridges into a number of secluded and wellnigh inaccessible
valleys, we might reasonably hope to find among its Shawiya
Berber inhabitants relics of the past in the shape of arts,
crafts, and customs which have long disappeared from the
more accessible regions of Barbary before the advance of the
successive waves of conquest which have swept over North
Africa since the dawn of history.
In this we were not disappointed. Despite the propinquity
of the civilization of Rome in the great camp of Lambessa,
built upon the plateau to the north of the massif to protect
the Roman farmers from the warlike excursions of the moun-
taineers, its neighbour, the fair city of Timgad, which
and
sprang into being as a result of Roman prosperity despite ;

the Arab conquest and occupation of the surrounding country,


we found that among the Shawiya, a race ethnically distinct
from the peoples of the desert, speaking a dialect of the
ancient Berber language, and scarcely contaminated by an
infusion of Arab blood, we could observe arts, such as the
wheel-less manufacture of a very archaic type of pottery,
which have persisted unchanged throughout countless cen-
turies, and distinct traces of ancient ceremonies and rites
which appear to have undergone little modification since they
2 INTRODUCTION
were described by Herodotus in neighbouring districts of
Libya.^
Nevertheless the conservative Shawiya have in the past
adopted certain of the arts of their more civih'zed neighbours,
and have preserved them unaltered down to the present day.
Examples of these, which I have described elsewhere, are to
be found in an oil-press,^ a clepsydra or water-clock,'' and a
corn-mill driven by a horizontal water-wheel.'*
Later, after a bitter struggle, the faith of Islam, carried so
triumphantly by the Arab conqueror over the lower country
around the massif in the seventh century of our era, spread
to the Berber peoples of the hills, absorbing rather than
destroying many of their ancient cults, bringing in its wake
some of the literature of the Moslem world, and, perhaps most
important of all from the point of view of the student of
Shawi3^a medicine, enjoining the pilgrimage to Mecca as a
religious duty upon all those of its adepts to whom the
undertaking was possible. Thus, though the forbidding
frontiers of the Aures have excluded from
to a great extent
its remote valleys the science and progress of the outer world,

some of the more enterprising of the Shawiya Moslems have


been brought into contact with the oriental learning of their
day in the course of travels to the shrine of their adopted
faith, and have doubtless brought back to their mountain

homes knowledge of arts of which they themselves would have


remained in ignorance but for the pious journeys they had
undertaken.
When we commenced our general ethnographical re-
searches in the Aures had studied a paper by Doctors
I

Malbot and Verneau in L'Aitthropologie^ in which they


described the operation of the trepan as being performed
among the primitive Berbers of the massif, and I determined
to attempt to acquire for the Pitt-Rivers Museum, Oxford,
for which we were to form an ethnographical collection,

^ H.-S., '
Influence of its Geography on the People of the Aures Massif,
Algeria,' Geographical Journal^ vol. lix, Jan. 1922.
^ Man, August 1920. ' Geographical Journal, January 1922.
* Scottish Geographical Magazine, 1922.
' viii, 1897, p. 174.
INTRODUCTION 3

some of the instruments used by their surgeons, instruments


which, I understood, were not to be found in museums in

England, if, indeed, a collection of them existed in any


museum at all. Upon making preliminary inquiries among
French officials on the however, I was informed that
spot,
although many living cases of natives bearing the scar of the
trepan and other operations are constantly observed by
officials (PI. II), the practice of surgery by persons who do
not possess the necessary French qualification is, of course,
prohibited by law, and, consequently, the native practitioner,
in any case fanatically disinclined to impart information to a
Christian stranger, doubly reticent about his methods and
is

even refuses to admit that he practises medicine and surgery


at all. Indeed, one French medical officer whom I consulted
assured me that I should never see either a surgeon or an
instrument although, he stated, operations were frequently
performed in the locality I was about to visit. I was agree-
ably surprised, therefore, to find that in the course of my
general ethnographical work I had made friends with a
nomad Arab who was well known as a successful surgeon,
and who, when once the nature of his calling had been acci-
dently disclosed, not only consented to supply me with some
details of his art and with a set of about ten instruments used
in trepanning, but offered to give me further information if 1
could return to his tribe in the w^inter of 1913-14. This my
wife and I did, and we found our Arab friend quite ready to
keep his promise.
With the help of certain Berber friends made in 1913 I was
also able to get into touch with about eight Shawiya practi-
tioners in the Aures massif itself, who, finding that their
nomad Arab neighbour had suffered no ill effects from the
trust he had placed in me, supplied me
with about fifty in-
struments, a collection of their materia medica, and a good
deal of information as to their medicine and surgery.
I soon realized that, at last, the primitive surgery of the

Aures was beginning to undergo a change, brought about by


the possibility of securing some simple European instruments
and drugs in such centres of civilization as Batna and Biskra,
and I decided that, unqualified as I was to undertake
4 INTRODUCTION
serious researches in native medicine and surgery, I should
be well advised to profit as far as I could by my good fortune
in becoming friendly with so many doctors, a good fortune
which would appear not to have been previously enjoyed by
a European, and to endeavour to collect as much information
as to their methods as was possible for me in the circum-
stances. I determined, therefore, to undertake a third journey
in the Aures in the winter of 1914-15. In August 1914,
however, my ethnographical work came abruptly to an end,
only to be resumed some five years later.
In the autumn of 1919, having described some of the sur-
gery which I had seen in the Aures before the war to the
Historical Section of the Royal Society of Medicine,^ we re-
turned to Algeria and recommenced' our work among the
doctors, with some of whom I had communicated by letter
during the war. In this journey, and during the winter
1920-1, I obtained more than one hundred instruments and
many of the medical notes which, with those brought home
in 1913 and 1914, form the material for the final section of
this book.
perhaps, noteworthy as an example of the extreme
It is,

secrecy with which the natives practise the healing art, that
I became acquainted after the war with practitioners in three

small villages in which I had spent some considerable time in


my previous journeys without having been able to discover
that doctors resided in them at all.
As the value of all ethnographical information is very
largely dependent upon the methods employed by the
observer in the field, I may, perhaps, describe exactly how
I obtained my information. I invariably travelled, accom-

panied by my wife, in the simplest manner possible. We


were attended by no servants other than the muleteers, who
brought their beasts to convey our baggage from village to
village when we moved, but we were always accompanied by
a French-speaking mounted orderly generously lent to us
by the Administration to serve as interpreter and escort.
Among the Shawiya we were attended by Shawiya orderlies,

* Froc. Roy. Soc. of Med., 1920, vol. xiii, p. 47.


Plate II

-^l^^ta^fl^
f

iHr«^fr

k^1^^
^
OPERATIONS ON THE SKULL

OPERATIONS ON THE ARM AND jAVV


;

INTRODUCTION 5

among the nomad Arabs by Arabs. These men, though they


wore the blue cloak of officialdom, were natives of the areas
in which I was working, and in some cases actually relatives
of practising doctors, so that the Arab and Shawiya prac-
titioners knew them personally, and did not hesitate to speak
before them when once they had been convinced that they
had no reason to fear that I should indicate them to the
authorities.
When visiting villages we always stayed in the houses of
the natives in preference to living in a tent outside the vil-
lage, believing that in this way we should have ampler oppor-
manners and customs than would
tunities of studying their
be the case if we some distance from them. Occa-
slept at
sionally we hired a native's house to live and work in
usually we were the guests of the sheikh or kaid in charge
of the village sometimes of the doctor with whom we
;

worked.
There are two methods which can be employed when
attempting to obtain information from a native doctor; the
first is, to work from the disease to the remedy;the second,
from the remedy to the disease. I employed both of these
according to the inclination of the doctor with whom I was
working but, with regard to medicine, I found the second
;

method to be the more satisfactory. Obviously, in studying


surgery, the most practical means of arriving at the instru-
ments used to perform a certain operation (when no genuine
case is available for observation) is to assume an injury
necessitating such an operation and to induce the surgeon to
discuss the treatment he would adopt but in medicine this
;

scarcely holds good, for I found in practice that often, when


I enquired of a doctor how he would treat a given disease,

he would prescribe the use of some plant of which he had


not a specimen at hand, or which would not at the moment
be sufficient for determination by botanists at home, if
collected and pressed in which case I have sometimes been
;

left with the mere native name of a remedy which I have

subsequently quite failed to* identify. On the other hand, in


the majority of the treatments noted, in which I have first
obtained specimens of the materia medica and then proceeded
6 INTRODUCTION
to inquire into their uses, I have been able by the second
method to arrive at more definite results.
As far as possible I have always checked the statements of
one doctor by questioning others upon the same subjects,
and I have been particularly careful to ensure that the plants
given to me by native practitioners are really of the species
they were supposed to be thus, having collected a number
;

of plants from one man, I would pretend, after an interval of


several days, and in some cases years, that I had made some
mistake in their names and get him to re-name them for me.
In every case the names supplied were those originally
told to me, so that I cannot think that any attempt has been
made to deceive me in the matter of the plants employed by
the Shawiya doctors. The materia medica collected has all
been submitted to experts in England, who have kindly
examined it and furnished me with the scientific names which
I have used.
PART I

THE GENERAL PRACTITIONER OF THE AURES


Although throughout Algeria demons, or jenun are ' ',

popularly supposed to bring about most of the diseases as


well as the mischances which vex the human being, with the
result that sorcerers and writers of amulets to counteract
magical causes of illness flourish exceedingly, yet the doctors
of the Aures, whose work is dealt with in these pages, are
men who have definitely studied medicine and surgery. It

cannot, therefore, be asserted that Shawiya la


among the '

medecine ne se distingue pas encore de la magie as Pro- ',

fesssor Edmond Doutte has found to be the case near Mar-


rakesh in Morocco.^ The studies of all the practitioners
with whom I have come into contact had consisted in
apprenticeship to an established doctor, almost invariably a
member of the young man's own family. In most cases the
healing art is handed down from father to son, whole famihes
following the calling of their ancestors thus in one village I
;

found five brothers engaged in the practice of medicine and


surgery, in another three, while in another two cousins are
keeping alive the family tradition inaugurated by their great-
grandfather, who had studied his art under a famous *
mara-
bout ', or member of a saintly family, in Biskra.
It has been suggested by Doctors Malbot and Verneau ^
that surgery has been studied especially in the region known
as the Jebel Shershar on the eastern side of the Aures, and
that doctors who had learned their art there were to be found
in practiceover a wide area of the neighbouring hills and
desert. All the practitioners I questioned on the subject,
however, denied that this was the case, and stated that doctors
were no more numerous in the Jebel Shershar than elsewhere

' En Tribu, p. 26, 1914. ^ Anthropologie, vol. viii, p. 176.


;

8 THE GENERAL PRACTITIONER


and by no means more skilful. One man, however, from the
central portion of the Aures massif informed me in 1914 that
there are surgeons in the Jebel Shershar who specialize in
operations on the head (I met two or three of them in 1920
when I visited their country), and that their art had been
handed down to them by marabouts who, in bygone ages,
'
'

had received divine instruction from angels and had left


behind them manuscripts deahng with surgery and medicine;
but my informant himself claimed to be more skilful in tre-
panning than these specialists, a claim which the latter stoutly
denied.
This suggestion, that the healing art had formerly been in
the hands of maraboutic, or saintly families, is curious, for
not one of the practising doctors I have met with belongs to

such a family^ though the families are very numerous and I ;

have not heard it suggested that marabouts nowadays have


' '

any skill in the heahng art other than as experts in charm


writing, divining, and medical magic in general.
When I visited the Jebel Shershar I considered it possible
that I might find there some zawiya
'
or college; belonging
',

to a maraboutic family in which medicine and surgery is


especially studied and from which the students went forth
into the country round to carry on the healing art, perhaps
equipped with some such form of diploma as Doctor Raynaud
found in the possession of a student from Fez in 1893, and of
which he gives a translation in his Etude sur Vhygiene et la
medecine au Maroc (p. 120). In this quest I failed. The prac-
titioners with whom I became acquainted in the Jebel Sher-
shar all denied that any such institution existed, or that they
had ever heard of a diploma.
I fully realize the rashness, especially when dealing with
a naturally secretive people, of assuming that any given in-
stitution orcustom does not exist among them merely because
I have failed to find any trace of it during my inquiries in the

field. But, at the same time, the overwhelming mass of the


native opinion which I have been able to obtain tends to show
that the healing art is handed down by the oral tradition in
families with no maraboutic status that there is no particular
;

area in the Aures in which it is studied more than in another


;

OFTHEAURES 9
and, although some doctors in the Jebel Shershar undoubtedly
specialize in the operation of the trepan, in the same way in
which the natives of southern Morocco are stated by the
Shawiya to specialize in the treatment of the eye, there is

nothing in the evidence Ihave collected to show that they


are more skilful in this or any other operation than their
neighbours, or that any existing institution in the Aures has
left a particular mark upon medicine or surgery in Algeria.

It seems, then, that the young doctor learns the rudiments


of his art while carefully studying the method of some rela-
tive who is already established in practice. The great major-
ity of doctors can read Arabic, though have met with one I

or two noted practitioners who are quite illiterate. Nearly


all of them are in the possession of books, some in manuscript

which have been handed down from their fathers, others


modern reprints of Arabic authors obtainable in Constantine,
Algiers, or, especially, in Tunis.
Although every doctor I questioned regarded the practical
instruction given by a doctor to his disciple as being of in-
finitely greater value than any study of these books, which
one of them considered to contain much erroneous informa-
tion, the books, if of no great value to the student, are used
to some extent as works of reference by the practitioner, and
I think that they afford us a clue to the origin of the medicine,
if not the surgery, of Algeria. The names of the authors
whose works I most general use among Algerian
found in
practitioners are as follows (i) Suyuti (2) El Haj TIemsani
:
;

(3) Mohammed ben el Haj el Kebir; (4) Ebn el Beitar (5) ;

the Imam Suidi (6) Abi Nasr, known as Cohen el Atthar


;

(7) Daud el Antaky and (8) Abderrezzaq, the Algerian ' '.
;

Of these, the first three authors appear to have devoted as


much of their work to mere magical practices as to medicine,
the work of El Haj TIemsani being considered so valuable to
seekers of hidden treasure, of whom many are said to exist
in Morocco to this day, that the mere possession of the book
is regarded as wealth in itself, while Suyuti's Rahnia is one

of the works principally referred to b}' sorcerers in Algeria,


though it deals with medicine as well as with magic. The
pages of Mohammed ben el Haj el Keber contain a mass of
lo THE GENERAL PRACTITIONER
miscellaneous information in addition to a certain amount of
medical lore.
It is to the writings of the remaining five authors, there-

fore, that themodern practitioner turns in cases which per-


plex him and to refresh his memory as to the uses of some
of his materia medica. Ebn el Beitar was, in the opinion of
Dr. Lucien Leclerc/ the greatest botanist of the East. Born
at Malaga in Spain in the last years of the twelfth century,
he travelled to the east about a. d. 1220, spending some time
in Barbary on the way, during which he noted the use of
employed in the treatment of leprosy,
Ptychotis verticillata, as
by a tribe near Bougie on the Algerian coast, and first made
known the medicinal uses of Pyrethritm at Constantine. His
work on Simples, which several Shawiya practitioners have
told me that they esteem very highly, displays, according to
Dr. Leclerc, a great indebtedness to the Greeks, especially
to Dioscorides and Galen.
The Imam Suidi, born at Damascus in a. d. 1203, and
resident for many years in Syria and Egypt, also refers
copiously in his writings to the Greeks, as well as to bis con-
temporary, Ebn el Beitar. Dr. Leclerc found an abridgement
of his work on Simples at Constantine, as well as two others
in Paris. One of the most successful of the Shawiya prac-
titioners I met with informed me that he possessed copies of
the two latter, which bear the names of Abd el Wahab and
El Sharany as the abbreviators.
Abi Nasr or Cohen el Atthar, a thirteenth-century Jewish
pharmacologist of Cairo, is the author of a work on materia
medica known as Menhaj Eddnkait, which, is much valued by
such doctors of the Aures as possess it, and which Dr. Leclerc
describes as un des plus precieux monuments que la phar-
'

macie arabe nous ait legues '.

Daud el Antaki, who was born at Antioch as his appella- —


tion implies —
and died at Mecca about 1599, compiled an
alphabetical list of materia medica and an incomplete treatise
on medicine, known as his Tedkirat, which Dr. Leclerc found
to be held in high esteem in Algeria some sixty years ago,

'
Histoire de la Medecine arabe, ii, 225, et seq.
OFTHEAURES ii

and which several Shawiya practitioners have informed me


that they regard as the best work on botany they possess.
From it one doctor in a remote village of the hills had learned
of the transmission of medical science by the Greeks to the
mediaeval Arabs, an item of knowledge which most of my
native friends appear to ignore.
The most modern of our five authors is undoubtedly the
best known to existing practitioners in the Aures, namely,
Abderrezzaq, known as '
the Algerian '. Born in Algiers in

the first half of the eighteenth century, he travelled several


times to Mecca, collecting, in the course of his wanderings,
the notes embodied in his Kashef er Rumuz, the treatise on
materia medica in alphabetical order which has been translated
into French by Leclerc, and which, printed in Arabic at
Tunis, is to be found hands of almost every Shawiya
in the
doctor to-day. It is by the works of Avi-
chiefly inspired
cenna, Ebn el Beitar, and especially, of Daud el Antaky.
Trained, then, and to some extent practised in his art
during his apprenticeship to a master, and equipped with
some of the works of the medical writers we have enumerated,
the young practitioner of the Aures sets out upon his career
undistinguished by any outward sign in dress or special
appellation other than the prefix Si to his name, which,
'
'

should he be able to read, he shares with all lettered natives


of Algeria (PI. I, a). Those practitioners of the hills who are
quite illiterate are in the habit of seeking the assistance of a
scribe or of an '
educated ' friend upon the rare occasions on
which they require to consult their books.
All of the doctors with whom I became acquainted were
obviously intelligent and members of the upper classes if ' ',

the word class can be admitted in referring to one of the'


*
'

most democratic peoples of the world. They were always


comfortably situated with regard to finance, some of them
being really wealthy, their possessions consisting rather in
gardens and in flocks than in actual money, for the Algerian
native usually invests his capital in these as soon as he has
saved enough to make a profitable purchase. I have always
found them to be courteous, hospitable, and, when once their
confidence has been gained, reliable, generous friends ; the
12 THE GENERAL PRACTITIONER
one or two exceptions being suspicious, usually aged, prac-
titioners who could never be persuaded to place their con-
fidence in me, and were, accordingly, unwilling to help me in
my researches while quite ready to accept any gifts of instru-
ments, &c., which I might feel disposed to offer them.
They are invariably general practitioners practising both
medicine and surgery, but, of course, some considered that
they excelled in one of these sciences more than in the other,
so that I have heard more than one man confess that, while
he prided himself upon his surger}^, he did not know much
about medicine, and vice versa though I believe that the few
;

who disclaimed especial surgical skill may have done so with


a view to concealing the instruments with which they worked,
for all those with whom I became really friendly seemed to
regard surgery as a higher art than medicine. It is not in-
frequent to find among them men who specialize in some
particular branch of their profession, such as the trepanning
experts of the Jebel Shershar and elsewhere, two oculists,
both of whom are natives of Morocco, and a very successful
practitioner whose favourite cases are those in which he can
display his skill in reducing dislocations. In referring to any
doctor as successful I have been guided solely by the re-
*
'

putation he enjoys in his own country, for it is quite impossible


to get at any figures which would enable one to estimate their
percentage of success and failure. Success is due, under
God's will, to the skill of the doctor, failure and death to the
will of God alone a point of view, agreeable enough to the
;

doctor, which is readily shared by his fanatical Mohammedan


patients.
If this fatalism of the native has done much to keep alive
Shawiya surgery even in areas whence skilled European
doctors can fairly easily be reached, the Moslem's dread of
amputation, with its unpleasant consequences in the next
world, has done even more. A considerable number of cases
have come to my notice in which the patients have, in the
first instance, been taken to a European hospital, where am-

putation of a limb has been pronounced to be necessary.


Refusing to undergo the operation, these patients have been
removed to their mountain homes, and there, after treatment
OFTHEAURES 13

by native practitioners, have recovered, doubtless owing to


their remarkable hardiness, without the loss of a member.
These triumphs of Shawiya surgery are remembered when
failures are forgotten, and the successful practitioner loses
no opportunity of quoting them as instances of the superiority
of his methods over those of the European.
The doctor visits in their own homes such patients as
cannot, owing to their condition, seek him in his house, the
market-place, the street, or, in fact, anywhere for, as a rule,
;

no special place is set aside for consultations or treatment.


When on his rounds he carries his instruments, dressings,
and his little medicine bottles of reed in a leathern bag with
several pockets, such as can be seen hanging from the saddle
of most desert horsemen when travelling.
In the case of a doctor whose reputation is very wide (and
some of them treat patients from many miles distant), the sick
are usually brought to his village by their relations and lodged
in the house of some friend or, in the case of nomads, in their
tent pitched outside the village, the doctor visiting them
there sometimes, however, a doctor will undertake a con-
;

siderable journey to treat a case, though they not infrequently


fail to respond when summoned to a distant patient.

I have^ only once found a doctor, or rather a family of

doctors, who provided any accommodation for distant patients


in the hamlet in which they lived (PI. I, b). This consisted
in a dingy stone hut, some eighteen feet in length by twelve
in width, devoid of any sort of furniture, in which were
housed three surgical patients, each attended by one or more
relatives, who looked after them and prepared their meals.
The rugs or sacks upon which these people slept were their
own property, the doctors providing them with nothing be-
yond the bare room in which they lived. Occupying, as we
did, the hut adjoining this primitive 'hospital', the groans
proceeding from which rang in our ears all night, my wife
and I were well able to observe its squalor and the miserable
condition of its inmates, who, however, were well on the road to
recovery as a result of the surgeon's treatment of their injuries.
When visiting a patient the practitioner wastes no time in
getting to work. He is, as a rule, sympathetic in his manner,
14 THE GENERAL PRACTITIONER
and, though he sometimes derides those from whom his
methods of treatment wring groans of agony, he seems to do
so more from a desire to distract the patient's attention than
from sheer brutality. I have, however, heard a doctor use
most obscene language to a little girl from whose lip he was
attempting to remove an excrescence (a result, he said, of
maternal impression) by stringing it with a cow's sinew
'
'

steeped in ointment, the child having failed to respond to the


gentler manner in which he first approached her.
It is customary for the patient or his relatives to offer the

doctor such hospitality as they can afford for example, a ;

bowl of milk or a cup of coffee in the case of poor persons,


or a dish of meat and semolina in richer households, while
often gifts of dates or figs are pressed upon him at his de-
parture. These gifts are not intended to form part of his
fee, which would usually be paid in money.
The fees asked for attendance seem to depend largely
upon the patient's capacity to pay. I know of one surgeon
who ordinarily receives from about fifty to sixty francs for
a simple trepanning operation, and up to one hundred and
fifty for a more difficult one and of another practitioner
;

who asked a friend of mine the sum of fifty francs for medi-
cally treating his wife (my friend had, in addition, to pur-
chase some drugs required) but most practitioners appear
;

to behave very generously to the poor, often refusing all


remuneration, and in some cases even providing destitute
patients with food indeed, I have never heard of a Shawiya
;

or nomad doctor who would refuse his services to a neigh-


bour even should he well know that they must be given
gratuitously to a patient unable to pay. The natives them-
selves are by no means willing to incur the expense of pro-
fessional treatment if the patient can be cured at home ; it is

common, therefore, for cases to be considerably complicated


by the injudicious use of folk-remedies suggested by members
of the patient's family before the doctor is called in.

would not appear that any special study of anatomy is


It

undertaken by the Shawiya during their apprenticeship to a


practising doctor indeed, they would seem to gather such
;

information as they can upon this subject by watching their


OF THE AURES 15

master's work. Thus the majority confess that their know-


ledge of many of the organs of the body is very limited, so
that I have only been able to find one doctor who would
attempt to draw for me an anatomical chart (here reproduced,
Fig. i), and all those I have questioned on the subject denied
that they possessed any old charts from which they had
studied anatomy. Practical experience when watching their
master at his work, of course, has taught them a good deal,
and has made them well acquainted with the position of bones
and of the principal organs, as well as of arteries, many
veins, and muscles.
With regard to physiology, the
following details of an operation,
which a widely respected surgeon
considered to be his greatest triumph,
will serve to demonstrate the ignor-
ance of the Shawiya. A
bullet had
traversed the patient's body, passing
out in the vicinity of the kidneys,
and causing a quantity of fat to pro-
trude from its exit hole this fat the
;

surgeon cut away and, having boiled


it down, caused the patient to drink

it,'
in order that it might return to
Fig. I
its proper place in the body This, '.

in the opinion of the surgeon, it did, and the patient re-


covered.
As with anatomy, so with the theory of medicine ; the
Shawiya doctor appears to treat the cases which come before
him more in the light of the experience gained in his appren-
ticeship than from any great knowledge of the theory of
medicine that has been handed down to him namely, the ;

Humoral Doctrine of the Greeks as presented by the Arab


writers. Nevertheless, all the practitioners with whom I
discussed the subject possessed some knowledge of this
theory, which I will set forth as exactly as possible in the
form in which it was explained to me by one of my native
medical friends, whose statements were corroborated by
others.
i6 THE GENERAL PRACTITIONER
The
physical condition of man comprises four character-
Hot, Cold, Damp, and Dry, each of which must be main-
istics,

tained or the individual will die, as a four-legged chair


collapses one leg of it is removed— the simile is the doctor's.
if

Diseases and all materia medica possess these same charac-


teristics, and may possess two of them so that a drug may ;

be Hot and Dry or Cold and Damp, and so forth but my ;

informant appeared to disregard the degrees in heat, dryness,


&c., recognized by the ancient authors.
Disease must be combated by means of drugs possessing
qualities opposite to its own thus a Hot and Dry com-
;

plaint should be treated by means of Cold and Damp


remedies.
In the case of plants, different parts of the same plant may
have different characteristics. To ascertain the character-
istics of his material the doctor have recourse
is compelled to
knowledge is too elaborate to be retained
to his books, for this
in his memory indeed, when stating from memory the
;

characteristics of honey, one of the most used medicines


of Algeria, he described it as Hot and Damp, whereas Abder-
rezzaq, whose work he uses, calls it Hot and Dry,^ a mistake
on the part of the doctor which would seem to support my
suggestion that practice and not theory is the basis upon
which the Shawiya practitioner works.
Another native doctor described the four characteristics
referred to above as belonging to Fire, Water, Air, or Earth,
instead of Hot, Cold, Dry, or Damp.
In diagnosing a disease its characteristics may be ascer-
tained by the following symptoms in Hot diseases the pulse
:

beats at nearly twice its normal rate and the patient is thirsty ;

in Cold diseases, the pulse beats at only three-quarters of its


normal rate and the patient is not thirsty in Dry diseases ;

the patient suffers from irritation of the skin, which he


scratches frequently; in Damp diseases the patient has
a feeling of nausea and drinks but little, while he craves for
fruits such as oranges and pomegranates.
Another practitioner, however, arrives at the characteristic

^ Leclerc's trans., p. 266.


OFTHEAURES 17

of the disease by other symptoms; in Hot maladies the


patient feels hot, while in Cold ones he feels cold in Dry ;

ones he is constipated ; in Damp ones he suffers from


diarrhoea and saliva flows from his mouth while sleeping;
Damp diseases in the opinion of this practitioner, are usually
those in which the spleen is affected.
Such is the theory of medicine as understood by the
Shawiya doctors of to-day, but, in addition, they hold a num-
ber of quaint beliefs on that border-line between medical
science and magic which, among a people still in a primitive
state of culture, is necessarily very indistinct. Thus they
consider that earth (sometimes used as a styptic) must be
good for the human body because the latter is sprung from
it ; that the fat of a lizard, a species of varanus, is useful in
medicine owing to its resemblance {real or imaginary) to
human fat and that the locust valuable as a drug because,
; is

in devastating a country-side, it consumes medicinal herbs.


Some of their materia medica, the uses of which will be
found described in the following pages, are evidently
borrowed from the sorcerer's defensive armoury against
demons or jenun * '.

These disease-spreading beings are popularly supposed to


dislike coral owing to its colour, asafoetida because of its
smell, pepper on account of its taste, and a gall-bladder
owing to its bitterness while, being subject to death, they
;

are supposed to avoid those who wear upon their persons


such spiteful creatures as scorpions or vipers, even though
'
'

merely the dried body, or fragment of the body, of the


reptile be so worn.^
Although the wearing of charms is recommended rather
by sorcerers than by the practising doctors of Aures, one of
my medical friends described to me a treatment by means of
such a charm which may well afford an instance of the
combating of disorders by suggestion which Professor *
',

E. G. Browne believes to have played an important part in


Arabian medicine '^.

* Hilton-Simpson, ' Some Algerian Superstitions ', Folk-Lore, vol. xxvi.


^ Browne, Arabian Medicine, p. 90.

2C66 D
i8 THE GENERAL PRACTITIONER
One eye of the owl is constantly sleepy, the other as
constantly wakeful. Upon placing the two eyes in a bowl
of water the sleepy one sinks immediately to the bottom,
while the wakeful one floats upon the surface. Persons
suffering from insomnia are advised to wear the sleepy eye
suspended from a cord around the neck, while those who
sleep too much wear the wakeful one. In describing a
similar treatment in his Sorcellerie au Maroc (p. 144) the
late Monsieur Mauchamp states that in that country the
eating of the right eye of the owl is believed to induce sleep,
and of the left one to prevent it.
If their acquaintance with anatomy, physiology, and the
theory of medicine is limited, the Shawiya doctors can at least
pride themselves upon their practical knowledge of botany.
They believe that every member of the vegetable kingdom
has its use in medicine if only that use were known, and they
employ a very large number of the plants with which even
their barren country abounds. The doctor, as a rule, himself
collects the wild plants and possesses a very intimate know-
ledge of the localities in which they grow, while such varieties
as are not to be found in the Aures, but flourish in other
parts of Algeria, he purchases, dried, in the native shops of
large centres such as Biskra. Thus, for example, although
sarsaparilla is said by the Shawiya to grow upon the plateau
near Batna, it considered to be inferior for the treatment
is

of syphilis, for which it is used, to the dried plant imported


from abroad, and the latter is accordingly purchased. The
names of the local herbs employed, even in the Arabic
spoken by the nomads, are frequently different from those
used by old Arabian writers, whereas the names of other
medicines, obtained by purchase, are very commonly those
to be found in the Kashef er Riimuz of Abderrezzaq.
Materia medica other than that obtained from fresh plants,
such as sulphide of arsenic, acetate of copper, alum, candy
sugar, the dried myrobalan of commerce, seeds of the ash-
tree, &c., are all purchased in the shops of those enterprising
Berber merchants of the Sahara, the Mozabites, who are
estabhshed in almost every Algerian town, while sometimes
a vendor of drugs may be found in markets such as that of
OF THE AURES 19

Biskra, seated upon the ground with his wares displayed in


Httleheaps around him. In the index of materia medica at
the end of this volume drugs thus purchased are marked with
the letter M.
Having collected his fresh herbs the doctor proceeds to
the manufacture of his medicines. Those which require to
be dried are always placed in the shade for this purpose,
unless a note to the contrary appears against them in the

Fig. 2.

list of treatments which follows, for drying in the sun causes


the plants to lose much of their strength.
Extracts of fresh herbs are obtained by pounding them in
a locally made wooden mortar (Fig. 2), about a foot in height
and four and a half inches in diameter (inside measurement),
with a wooden pestle, the large boss upon the upper end of
which gives it considerable weight while other materia
;

medica seems be reduced to powder by means of smaller,


to
but heavy, pestles and mortars of brass which are procured
in towns.
:

20 THE GENERAL PRACTITIONER


Some it is said only a very few, produce
practitioners, but
their rose, violet,and orange-water, as well as a distillate of
Artemisia herba alba, used as cure for colic, by means of a
'stiir, of which I was lucky enough to obtain a specimen.
This apparatus, of which I give illustrations (PI. Ill, a, Fig. 3)
is made of tin and is employed as follows

The still is composed of two main parts, the receptacle for


'
'

the substance to be distilled, and the condenser, which is


fitted into it above to form a lid. The receptacle, a, contains
about five litres of liquid ; four-fifths of this capacity is taken

up with water, and the remainder filled with the herb which
is to be used. The *
then placed upon a rough locally
still ' is

made earthen bowl, about ten and a half inches is diameter,


measured to the exterior of its thick but friable sides, from
the rim of which three triangular bosses project towards its

centre to support the and in the sides of which three


'
still ',

rectangular holes admit a draught of air to the charcoal fire


which the bowl contains. As the liquid in the receptacle, a,
commences to boil the steam rises to the conical condenser,
B, upon which it is cooled and converted into fluid with the

aid of cold water in the trough, c, which encircles the con-


denser. This fluid runs down the sloping sides of the
OF THE AURES 21

condenser and, being prevented from returning to the recep-


tacle, A, by means of a flange, e, its only exit is to be found
in the sloping tube, d, which with its bent nozzle, f, conducts
the distillate drop by drop to a bottle placed ready to receive
it. As the water in the trough, c, becomes hot, and so useless
for the cooling of the steam, it is drawn off by means of the
spout, G, blocked with a cork when not in use, and
which is

a fresh supply of cold water is poured into the trough. The


junction between the nozzle, f, and the bottle in which the
distillate is to be stored is hermetically sealed with dough
during the process of distilling.
The apparatus was secretly
made in a large town by a
Jewish tin-smith and was copied
from a copper specimen be-
longing to the brother of the
doctor from whom I obtained
it the old copper specimen
;

having been handed down in


the family from an unknown
date.
The samedoctor described
to me, from memory, another
form of still of which I have
'
'

not yet seen a specimen.


From this description I made Fig. 4.
a drawing,
here reproduced,
which the doctor passed as correct (Fig. 4). Obviously the
sketch is inexact in some details, since it is not apparent how
the material gets into the apparatus ; but I have thought it

advisable to place it before the reader in the form in which


my Shawiya friend approved it.

Water is placed in a white metal-lined bowl, a, through


a hole, B, in the side of which passes a pipe, c, from the lower
extremity of the cone-shaped condenser, d. In this con-
denser, which is of metal and provided with no means of
accelerating cooling by evaporation, is placed a fine linen bag,
E, containing the material to be distilled. The condenser
contains no water, but, when the apparatus is placed upon
22 THE GENERAL PRACTITIONER
the the steam arising from the water boihng in a passes
fire,

into D through a number of vertical tubes, f, the projecting


upper ends of which prevent the fluid from exuding by the
same channel and cause it to pass out of the condenser by
way of the pipe, c, to a bottle placed ready to receive it. The
hole, B, is blocked with dough when the pipe, c, has been
passed through it in order to avoid leakage of steam.
Concerning the origin of these stills I could obtain no
'
'

information of value. One practitioner attributes their inven-


tion to a mythical personage in times of the greatest antiquity,
another states that they are described in an ancient book ', '

but he is ignorant of the name of the book or its author.


Certain it is that a very vague reference in verse to the pro-
cess of distillation by means of an apparatus with holes in '

it' is to be found in a recipe for rose-water in the pages of

the Taj el Muluk by Mohammed ibn El Haj el Kebir, who


may well have been attempting to describe the second of the
two types of still mentioned above. The only copy of this
*
'

work I have as yet been able to see (a cheap modern reprint


produced in Cairo) is undated. Shaw, about 1720, noted the
use of a still for the preparation of spirituous liquors in
'
'

Algeria, to which he refers as the alembick the distilling


'
',

apparatus of the modern practitioners being known to them


as el ambi'aq
'
'.

The medicines distilled by means of this apparatus are


sold for high prices, the distillate of Artemisia (which is said
to cure colic in five minutes) realizing ten francs per litre,
while that of orange flowers is sold at fifteen francs for the
same quantity.
The weights and measures used in describing doses by
Abderrezzaq, though known to the Shawiya through his book,
are not used by them indeed, the doctors as a rule measure
;

their medicines by means of the coffee-cup, coffee-spoon, and


soup-spoon, all of European manufacture, which are to be
found nowadays in every household of the Aures, and some
few of them, who have procured French scales, even talk
about grammes, but I think that for measurmg drugs the
household utensils mentioned above are in practice far more
frequently used than modern weights.
Plate III

SKULL FOUND NEAR EL OAN lARA


OF THE -AURES 23

The scales usedby those who have not a more modern


instrument consist of two halves of a gourd about six inches
in diameter, neatly cut across, suspended by strings, one
from each end of a wooden bar, which is itself suspended at
its centre by a loose wooden joint from a small handle of

wood, so that it can dip to either side as the substances to


be weighed are placed in the cup-like receptacles formed by
the two pieces of gourd (Fig. 5). Other apparatus, with the
exception of surgical instruments, appears to be absent from
the home of the Algerian doctor ; his bottles usually consist

"Tgr

Fig. 5.

of small cylinders of reed, stoppered with plugs of rag, and


the wool he employs is readily obtained from his own sheep.
In the high parts of the Aures, where the cedar, the
juniper, and the pine are to be found in profusion in the
forests, the doctors and others extract their pitch, which as
we shall find is largely used in medicine, in the following
manner.
The wood is hewn into small pieces and placed in an
earthen bowl, which then turned over on to a dish of the
is

same material, to which it is joined with damp earth in such


a way that the pitch can only exude through a channel left
open for the purpose. I believe that special kilns of pottery
are made for the extraction of pitch, but I have never seen
24 THE GENERAL PRACTITIONER
one myself. The kiln, or the bowl and dish, enclosing the
wood then covered with brushwork and rubbish, which
is

is set on fire and replenished for some time a process :

exactly resembling the baking of Shawiya pottery. As the


wood in the kiln becomes hot the pitch runs out through the
channel left for its passage, to be caught in a bowl or other
receptacle ready to receive it.
From the books to which the Shawiya doctor refers, and
from the fact that in the latter half of the thirteenth century
there existed at Bougie on the Algerian coast (then a de-
pendency of Tunis) a number of medical intellectuals,^ there
seems little room for doubt that the medicine practised in the
Aures to-day is derived from that of the mediaeval Arabians,
and it seems likel}^ that it crept into the fastnesses of these
rugged hills as a result of pilgrimages undertaken by devout
Berbers after they had embraced the faith of Islam, to remain
(like other arts of the Shawiya) but little changed in the
lapse of time. Indeed, I have heard it suggested by natives
that a man who learned his medicine in Egypt had, at some
uncertain date, introduced it into the Aures.
The origin of the surgery described in the following pages
is,however, obscure. As Doctors Malbot and Verneau have
among the Shawiya,^
pointed out in their paper on trepanning
which paper my own notes will be found to amplify rather
than to correct, the instruments now used for this operation
are more primitive than those employed by Hippocrates, to
whom the circular trephine was known, and the French
authors therefore conclude that trepanning had been prac-
tised in the Aures before the Romans brought their own
civilization and the healing art of the Greeks to the country
round, and they consider that the operation may have been
carried out in the Aures from neolithic times.
The instruments, of which I illustrate a number of speci-
mens from the Pitt-Rivers from my own collec-
Museum and
tion, are certainly primitive in form and crude in workman-
ship. Each surgeon designs his own tools, cutting out with
a pair of French scissors a pattern of the blade required in a
^
Leclerc. Hist. Med. arabe, ii. 252.
^ Anthropologies viii. 175.
OFTHEAURES 25

sheet of paper, without first drawing an outline of it. This


pattern he takes to the local jeweller who, for a very modest
sum, casts the blade in a little mould in which he makes the
silver brooches, charm-cases, bracelets, &c., so dear to the
hearts of the Shawiya women, when, a plain round wooden
handle having been affixed to the blade, the instrument is
ready for use. These roughly fashioned tools appear to
serve their purpose for many years, most of the surgeons I
met with having in daily use instruments which had been
handed down to them from their grandfathers.
If it is difficult to establish the origin of Shawiya surgery,
it is no easier to point out the relation of the healing art of

the Aures to that of other districts of Barbary, for, in the


existing state of our knowledge of the ethnography of North
Africa, it is hard to ascertain where and to what extent this
healing art is or has been practised at all. Horneman, who
travelled in Fezzan in 1797-8, while noting the treatment of
'
various sorts of venereal disorders for which he says, the
',

native doctors successfully employed


salts and the fruit of
colocynth,^ has no more to say of the surgeons of that
country than that they possessed sufficient ability to cure a
simple fracture'.^ Richardson, however, writing in 1848,
states in his Travels in the Great Desert of Sahara " that at
Ghadames in dropsy the native doctors cut the body to let
*

out the water, as we do ', and he describes the medicinal use


in Fezzan of a lizard, Uromastrix acanthinurus, employed by
the Shawiya doctors to-day.
In the great desert to the south of Algeria, among the
Tuareg (Berber) nomads, certain materia medica, such as
sarsaparilla, be employed in much the same way
appear to
as in the Aures massif, but I have so far failed to find in the
literature relating to these regions any reference to doctors
who practise medicine and surgery in any way comparable to
that carried on by the Shawiya.
Turning to Morocco we find that Leo Africanus, himself a
Moor, writing in the sixteenth century, asserts that in Hea,
a district in the south-west of that country, there existed in his
^ Travels fror) t Cairo to Mourzoitk, p. 73.
2 Ibid., p. 74. 3 i. 323.
2566 E
26 THE GENERAL PRACTITIONER
day '
neither Phisition nor Surgeon of any learning or
account', and that cautery was the sole treatment for all ills,
though circumcision was practised by specialists. Professor
Edmond Doutte, the eminent French orientalist, whose pro-
found knowledge of the customs and beliefs of Barbary must
entitle his opinion to the greatest respect, tells us ^ that at
Ar'mat, near Marrakesh, 'la medecine ne se distingue pas
encore de la magie '. On the other hand, Dr. Raynaud, in
his ^tude sur V Hygiene et la Medecine an Maroc
(1902),
describes a condition of medicine and pharmacology, emanat-
ing from the institutions of once-learned Fez, similar to that
existing in the Aures, though the surgeons of Morocco, whose
work he mentions, appear to be far less enterprising than the
Shawiya.
Unless we are prepared to believe that surgery such as the
operation of the trepan has existed in the Aures from very
early ages, rendering the massif a district singularly receptive
for later advances in the healing art, it is hard to understand
why the medicine practised in their remote valleys by the
Shawiya of to-day should find its parallel in the neighbour-
hood of a seat of learning once so famous as Fez, when, as
far as I can discover in the literature of Algeria, the country
around the massif has produced no practitioners of medicine
and surgery whose activities have attracted the attention of
writers in ancient or modern times. If the origin of Shawuya
surgery is obscure, its future seems easy to foretell. It can-
not endure much longer. The very numerous men of the
mountains who served France in the Great War have already,
introduced many seeds of change and progress into the
remote valleys of the Aures massif. They have learned,
through their experiences in the hospitals of the various
theatres of war, that European methods of medicine and
surgery are not limited to the giving of a purge and the am-
putation of a limb, as so many Shawiya doctors have solemnly
assured me. With the advent of faith in modern methods
the art of the native practitioner must disappear, however
gamely its exponents may, and will, struggle for its existence.

^ En Tribu, 1914, p. 26.


OFTHEAURES 27

Before he passes from the stage for ever, cannot the


surgeon of the Aures be made to fight one last round against
his country's greatest enemy, venereal disease ? Cannot the
man who, as we shall note in the following pages, makes
light of the removal of bone from skull or limbs be taught to
wield the syringe ?
To this question a layman dare hazard no reply, but I
know, from many inquiries made among the practitioners of
the Aures, that the hitherto conservative surgeon of the
mountains would eagerly embrace any opportunity (tactfully
introduced) of learning those modern methods of dealing with
the scourge which display an immediate effect, and I am
equally certain that their patients would as eagerly demand
the treatment, for which they would undoubtedly be prepared
to pay render its introduction by no means an
sufficiently to
act of charityon the part of the introducer. This much, I am
sure, would the Shawiya doctors be ready and willing to
learn from the European, but probably nothing more.
In the two following sections of this little book I shall
merely endeavour to describe, as the}'' were explained to me
by my doctor friends of the hills and the desert, those of
their operations and methods of treatment upon which I have
been able to glean information.
PART II

SURGERY
Styptics

It would appear, from the numerous requests I have


received for some good material wherewith to check hae-
morrhage, that the natives do not place much faith in the
st3^ptics known to them, among which I found that the
following are applied to wounds :

(a) Ashes of rag or of paper.


ib) A piece of dirty wool dipped in olive
oil (dirty wool is

sometimes used in surgery in preference to clean),


(c) The pounded green leaves of Solanum nigrum,

{d) The fresh leaves or bark of the walnut tree.

{e) Dried goafs dung.

(/) Damp earth (which 'must be good for us since we are


sprung from it ').
(g) Powdered galhiut, or
{h) Sidphide of copper which is rubbed lightly on a wound
to check haemorrhage by causing the tissues to
'
swell '.

Nose bleeding is arrested by the taking of snuff, which, in


the form of powdered leaves of Junipenis phoenicea, L or of
tobacco, is commonly used in the Aures.

Asepsis
Although the surgeon not infrequently makes incisions by
means of a red-hot cutting instrument, this appears to be
done solely in order to check haemorrhage, and no attempt
is made to secure surgical cleanliness. The surgeon washes
his hands and his instruments after use in any water, hot or
cold, clean or dirty, which may be at hand, and he uses for
his pads and bandages strips of dirty cotton dress material
and wool supplied by the women of his patient's family. In
SURGERY 29

addition to this, the patient himself is often in an extremely

dirty condition.
Anaesthetics

It may be taken as a rule that the surgeons of the Aures


and
the desert perform all their operations without the use of an
anaesthetic, the patient being merely held down upon a halfa-

grass mat, a rug, or a sack placed upon the floor (for tables
are unknown in an ordinary Algerian household), while the
surgeon carries out his task. An anaesthetic is, however,
known to most, if not all, of the practitioners I have met, but
they do not as a rule employ it merely because they are
afraid of its effect. A very few of them might, perhaps,
employ it in the case of a patient who was a relation or a
great personal friend whose family could be relied upon to

keep their counsel should the use of the anaesthetic prove


fatal.

The only surgeon who confessed to having used Hyoscya-


mus a/bus, L. as an anaesthetic described the plant as *
a species
of wild opium and stated that
' itsseeds are indistinguishable
from those from which opium is prepared. He informed me
that three grammes weight of the powdered fresh seeds,
swallowed in rose-water, act as a soporific, but seeds which
have been kept for two or three years are very strong, so
that, powdered and consumed in water, they will keep a
patient still for a quarter of an hour while an operation is
performed; for, although he can feel a little pain, he will be
unable to move while under the influence of the drug. This
same surgeon told me
of a, presumably, magical local
anaesthetic which can be obtained from the excrement of
the lizard Uromastrix acanthinurus. The excrement is in
two colours, 'white 'and 'black'. The latter is useless, but
the 'white' excrement, dried and powdered, is applied to
wounds, 'such as those caused by a bullet, and acts as a local
anaesthetic while some such operation as the removal of
a foreign body is carried out.
Despite their knowledge of the use of Hyoscyamus albus,
however, it may be
taken that the surgeons of the hills and
the Sahara perform all the operations hereafter described

without the use of any anaesthetic at all, relying, as they


!

30 SURGERY
claim, upon their delicacy of touch to reduce the patient's
sufferings to a minimum. In the fanciful language of the
Algerian native, one surgeon has informed me that a really
skilful operator can cut through the shell of an egg without
damaging its inner membrane, and all maintain that so gentle
are their methods that their patients never faint during the
operation. Nevertheless one of them stated that he restores
such patients to consciousness by throwing water in their
faces or holding onions beneath their noses.
One successful operator told me that he used no anaesthe-
tic, but added, I look at the patient and he looks at me
* '.

Whether or not this chance remark may refer to the practice


of hypnotism I am quite unable to decide, but I have never
obtained another shred of evidence to support the theory of
its use.
Trepanning
We have already seen that the scar of the trepan is very
frequently to be found upon living natives in and around the
Aures massif, at once a proof of the existence of the local
surgeon and a testimony to his skill. The removal of bone
from the skull is, certainly, the most important operation
which the Shawiya surgeon attempts, and is the one in which
he glories above all others he, therefore, performs it with
;

remarkable frequency. The operation, though believed to


require care, is certainly not regarded by the modern practi-
tioners I have met as critical or even dangerous, indeed
Doctors Malbot and Verneau^ throw an interesting light
upon the native's point of view with regard to injuries to the
skull when they state that the fine imposed in several tribes
of the Aures for breaking a man's head was formerly identical
with that payable for knocking out some of his teeth, and,
further, that Shawiya women have been known to undergo
trepannation in order to support fictitious charges of assault
against husbands from whom they were seeking grounds for
a divorce
The native surgeons I have met with are unanimous in
declaring that injuries" resulting from a blow are the sole

^ Anthropologie, v'ln. 185.


SURGERY 31

cause of their favourite operation, which, they assert, is never


resorted to for the rehef of a malady not so caused, and is
not performed as a magical cure in cases of persons supposed
to be possessed by demons.
'
' Doctors Malbot and Verneau
state that trepanning is sometimes carried out years after the
infliction of the injury which it is intended to relieve, but
some of my informants declared that unless the operation is

performed within seven days of the accident the patient will


die I have, however, known of cases in which a considerable
;

number of weeks has elapsed before the injured skull has


been opened.
Upon this point, therefore, the Shawiya surgeons appear to
hold diverse opinions. All the practitioners I consulted
agreed that on no account must the dura mater be disturbed,
as death will inevitably result should this be done, and that
the sutures, which are believed to be the patient's destiny
written by the hand of Allah, must be left untouched by the
operation. Should doubt exist as to whether or not the
skull be fractured, one doctor is in the habit of giving the
patient (if conscious) some hard substance, such as a grain
of corn, upon which to bite, inability to do so being taken as
indicative of fracture.
Scalping is performed in various ways. One practitioner,
who had himself undergone the operation when a lad, told
me that in his case a piece of meat freshly cut from the right
side of a goat, over its liver, had been bound upon the seat of
the injury for three days, at the end of which time the scalp
had been easily scraped away to allow of the operation. The
majority of surgeons, however, completely remove a portion
of the scalp, usually with the aid of a cyhndrical or slightly
oblong cutting instrument, resembhng a gunmaker's wad-
punch, used red-hot, in which the cutting edge is placed at
right angles to the handle (PI. IV, a, b), variants of this being
small circular or diamond-shaped specim.ens with the cutting
edge in the same plane as the handle (PI. IV, c, d), which had
been designed by one successful operator. The instrument
is firmly applied to the scalp, which is burnt through to the

bone, and then removed by means of a scraping movement


when the hot iron reaches the skull.
32 SURGERY
When scalping with the knife (the ordinar}^ Algerian knife
with a blade about 7^ inches in length and a rounded point
(Pi. IV, e)), or by means of the scalping-knife and saw com-
bined (PI. IV, /and PLV, a), some surgeons, having tied a
handkerchief tightly around the patient's head in order to
check haemorrhage, remove a rectangular portion of the skin
in four straight cuts, others make two incisions intersecting
at right angles and then turn back the points of the scalp
which are retained by means of hooks (PL IV, h, k, I, s, t), or
by a V-shaped spring inserted between the flaps (PL IV, r).
I at first thought that this latter method, by which no portion

of the scalp is actually removed, must have crept into the


Aures at some quite recent date, possibly as a result of
rumours of European methods which might have penetrated
to the hills, but I found later that its stoutest champion was
a very aged and extremely conservative surgeon, whose
reputation is very wide and who regards with the greatest
contempt the European doctor and all his works a person :

who, I am sure, would sooner die than practise any innova-


tion in his art.
Some practitioners employ the knife cold, others red-hot,
while some use an instrument especially made for the making
of incisions by means of a red-hot blade (PL IV, g). This
instrument has three cutting edges, and is also used in
operations upon other parts of the body than the skull. The
long curved edge is intended for long straight cuts, the
shorter straight one for smaller incisions, made by means of
a saw-like manipulation of the instrument, while the sharp
rounded end is used for the opening of abscesses.

When the scalp over the seat of the injury has been re-
moved or turned back many surgeons scrape away tissues
adhering to the bone with the aid of fan-shaped scrapers
(PL IV,yand q), used also as spatulae, or of a combined saw
and scraping instrument (PL V, e), one practitioner stating
that he treats the surface of the bone with powdered bark
of Jiiniperus phoenicea, upon which a little warm butter is

poured, before commencing to work upon it. Sometimes it


is found that the mere scraping of the damaged bone is all

that is required, in which case the operation is quickly at


Plate IV

SCALPING INSTRUMENTS

RETRACTORS, SCRAPERS, AND DRILLS


'

SURGERY 33

at an end the removal of a piece of bone, however, frequently


;

occupies a considerable time and is carried out in different


ways by different surgeons.
The first step in the operation, after the scalp has been
cleared av/ay, usually consists in the perforation of the skull
by means of a drill, though one or two practitioners I con-
sulted disapprove of the use of a drill in operations on the
head. Where the perforation is complete its object is to let
out any pus or blood which may be beneath the bone, but
one surgeon told me that he had removed a considerable
quantity of bone by means of nearly contiguous perforations
with the drill, the bridges left between the holes being sub-
sequently cut away with the saw or knife, while others use
the drill merely to produce a shallow hole in order to serve
as a starting-point for the saw.

Fig. 6.

In the latter case several holes are sometimes made with


the drill ; for example, where cracks in the bone radiate from
a central punctured wound, one surgeon informed me that he
applies the drill to the extremity of each crack, subsequently
connecting the holes thus made by means of the saw, and so
removing the area of bone affected by the cracks. In the
opinion of most practitioners, however, the drill should be
applied to the good bone just clear of the damaged surface,
'
'

and, therefore, beyond the extremities of the cracks.


The drill, which is operated by spinning between the palms
of the hands, is to be found in various forms, in nearly all of
which excessive penetration is artificially prevented owing to
the surgeon's horror of so much as touching the dura mater.
The simplest type of drill (Fig. 6) consists of a flat iron
blade projecting some 2| inches from a plain round wooden
handle 3I inches in length. Near the distal end this blade is
I inch in width, but it narrows abruptly, leaving a shoulder
'

at each side, so that the last -^^ inch is but | inch wide, its
extremity being rounded and ground to a cutting edge. The
'

34 SURGERY
object of the '
shoulders '
is automatically to prevent excessive
penetration. A varying in width from | inch
rounded point,
to I inch, is to be found upon most of the drills I collected,
but a drill with sharp trident points is recommended by some
surgeons, the only such specimen which I secured being far
more coarse than is usual (PI. IV, p) and not intended for use
in trepanning, for which, indeed, some surgeons consider the
trident drill to be useless. From the oldest practitioner I met,
who must have been nearly eighty years of age, I obtained a
drill — once the property of his father — in which excessive
penetration is prevented in a different way (PI. IV, 6).

The
blade consists of a round iron rod, \ inch in diameter,
projecting some 3I inches from a plain round wooden handle.
The distal end is flattened into a curved cutting edge devoid
of shoulders
*
'. Over this blade is drawn a sleeve, consisting
of a piece of wood, slightly conical in form, perforated through-
out its length with a hole through which the blade is passed.
When pressed right home to the wooden handle
the sleeve is

about y\ inch of the blade projects beyond its distal end, but
this amount can be reduced by pulling the sleeve nearer to
the point of the blade and filling the gap thus created between
the sleeve and the handle with a piece of string or rag tied
around the blade. The sleeve having been thus secured to
give the desired penetration, it serves, as do the shoulders '

in other drills, to check any further penetration by the point.


The majority of surgeons appear to use drills such as are
described above, in which the handle consists of a single solid
piece of wood nearly all of them, however, had heard of the
;

double-handled drill illustrated by Doctors Malbot and Ver-


neau \ and one practitioner stated that he used such a drill,
of which he presented me with a specimen (PL IV, m).
In this drill the blade, which is 'shouldered' and has a
wide rounded point, is rigidly fixed to the lower portion of
its round wooden handle, and the handle divided into two
parts, that towhich the blade is fixed being loosely socketed
into the upper part, which is hollowed in the form of a
cylindrical cup, so that the lower portion of the handle may
be spun between the palms while the surgeon maintains
' Anthropologie, viii. 178.
;

SURGERY 35

pressure with his forehead upon the upper end. A number


of wooden pegs driven laterally into the upper part of the
handle prevent the accidental withdrawal of the lower re-
volving portion, the upper end of which, concealed within
the cup, is cut into the form of a knob against which these
pegs would bear should an attempt be made to pull the two
portions of the handle apart. The pegs, however, do not
interfere with the spinning of the lower portion of the handle.
The revolving portion of the handle of this drill, which is very
old, is marked with incised Knes in the form of a close spiral
the blade is a new one.
One practitioner in the Aures told me that the double-
handled could well be operated by means of a bow, but
drill

the man from whom I obtained the specimen described above


stated that this should not be done, for in his opinion the use
of a bow would diminish the surgeon's control of his instru-
ment, and possibly lead to undue violence when the perfora-
tion was nearly complete, with consequent fatal damage to
the dura. The drill having performed its task the operation
is continued with the saw. Most surgeons appear to com-
plete the sawing in one seance, lasting about an hour and a
half, but one practitioner is in the habit of reducing the strain
upon his patient by making but a small incision with the saw
upon the day on which he commences its use, returning daily
to his work until the necessary amount of bone has been sawn
round, a piece the size of a penny sometimes requiring from
fifteen to twenty days before it is completely severed from the
surrounding bone.
In using the saw some doctors steady the blade of the
instrument against the nail of the left thumb, placed vertically
upon the patient's head for the purpose others lay the fingers
;

of the left hand flat upon the patient's scalp beneath the haft
of the saw blade in order to check accidental perforation of
the skull when the bone is nearly cut through.
All the saws I collected, with the exception of one, lend
themselves by their form to either method of manipulation.
They consist of iron or steel blades projecting from rough
round wooden handles, the distal end of the blades being
flattened and, in most cases, turned down nearly at right
36 SURGERY
angles to their hafts, the lower edge of this turned down
portion being serrated with teeth in the same plane as the
handle. In some cases the turned down part of the blade is
slightly fan-shaped (PI. V, a, c,/, h), in others curved (PI. V, b,
and Fig. 7), according to the fancy of the owner.
In other saws the distal end of the blade consists of a flat
rectangular surface, projecting at right angles
to the haft on either side of it, in which one
edge may be serrated, the end forming a scraper
and the opposite edge a scalping-knife (PI. I V,/);
or it may be serrated on both sides, leaving the
end for use as a scraper (PI. V, e) or it may ;

possess three serrated edges (Fig. 8).


One specimen collected (PI. V, a) somewhat
resembles a miniature battle-axe, of which one
edge is serrated and the other fashioned into a
curved scalping-knife, while another, which lacks
the usual wooden handle, has a single serrated
Fig. 7.
edge turned down at right angles at one end,
the '
handle ' end being flattened and slightly curved to form
an elevator (PI. V,/).
The saws vary considerably in fineness ; the
teeth of these
coarser specimens having as few as thrjee teeth to a quarter
of an inch in length of edge, the finer ones as many as seven.

Fig. 8.

The solitary exception referred to above is a roughly made


circular trephine (PI. V, /), manufactured, like all other sur-
gical instruments of the Aures, by a Shawiya jeweller, in
which the central pin projects below the serrated edge and is
immovable. The instrument is new, and the surgeon who
gave it to me declined my offer of a fairly modern European
trephine, as didall the others to whom I tried to present it,

fond though they are of anything else in the way of European


cutlery which can be put to a surgical use. For this reason
I think that the instrument had been made as an experiment,
Plate V

X
o

Q
<

o
>
w

<
O

Oh
w
'

SURGERY 37

possibly according to a verbal description of a trephine


observed by some native patient in a French hospital, and
that it had been found useless to a surgeon who dreads dis-
turbance of the dura mater, as do the Shawiya, owing to the
immobility of the pin the man who gave it to me stating that
;

he had never used it, and evidently attaching no value to it


whatever.
The damaged piece of the skull, having been completely
sawn round, is very carefully means of elevators
lifted out by
(PL V,/ w) and retractors (PI. IV, /z, k, s, /), some surgeons
/, /,

removing it immediately the work of the saw is complete,


others leaving it in position for threeorder that the
days in
*
nerves of the bone ', be dead, may
finding the bone to
'withdraw' on the third day, others again leaving it for from
ten to fifteen days, preventing the scalp from a tendency to
close over it meanwhile by the application of a pad of cotton
material soaked in honey and butter.
After the interval of ten or fifteen days the fragment of bone
will be found to have risen so as to be easily removed. One
practitioner, who immediately lifts away the bone after sawing,
recommends a dressing of gum of the Aleppo pine melted with
sheep's butter (six months or a year old) upon which he lets
fall a few drops of honey, subsequently sprinkling a little of
the ^nQS\. wheat or barley flour upon the dressing. He then
applies a pad of wool, which is retained in position by a

rectangular leaden weight, slightly larger than the hole in the


skull, and fittedwith a boss on its upper surface, through
which is passed a thread wherewith to raise it (PI. V, n).
The object of the weight, the use of which is recommended
by several surgeons, is to check the tendency of the brain *

to rise up through the aperture formed in the skull by the


operation.
This dressing is renewed daily for a fortnight. After
seven days the dura mater will be seen to have become
'
steady save for the pulsation permanently noticeable even
'

when the scalp has closed over the aperture, and it will
appear red in colour instead of white with red lines in it, as
it will have appeared when first revealed by the operation.

After a fortnight of daily renewal the dressing is replaced


;

38 SURGERY
every second day for a month or six weeks, at the end of
which time the patient should be restored to normal health.
Another surgeon advises the sprinkling of powdered burnt
alum upon the wound, over which he then places a pad
another uses the powdered leaves of Ajuga iva, Schreb., and
Teucrium polium, L., mixed together, for sprinkling upon a
dressing of butter, while another employs a butter dressing
upon which is sprinkled some powdered saffron and white
cone sugar before pitch of the pine is poured over it.
None of the surgeons apply stitches to the scalp, and none
attempt to replace the bone removed by any form of artificial
plate. I heard a couple of stories, however, of such replace-

ment having been successfully attempted in the past, the


grandfather of one present-day Arab surgeon being credited
with having replaced, by means of a cap of plaited halfa grass,
enormous .quantities of bone which he had removed from a
patient's skull, a feat which is supposed to have been rivalled
by an old-time Shawiya, who used a piece of camel's skin as
his material.
Only one practitioner has told me of any restrictions imposed
upon the diet of a person who has been trepanned. This
man states that the patient may eat meat, honey, and butter,
but must avoid pepper, vinegar, potatoes, turnips, lemons, and
eggs.
Such is the operation of the trepan as described by the
various native practitioners with whom I discussed it. All
agree as to the comparative ack of danger which accompanies
it, and all declare that it causes little or no suffering to the

patient owing to the extreme dehcacy of touch with which


they claim to work, one of those who take the longest time
over the operation stating that the gradual method he adopts
reduces to a minimum the pain inflicted he further declares
:

that the operation of removing bone from the skull relieves


the pain of the injury as pain is instantly relieved by the
removal of a thorn from the flesh,and at once restores con-
sciousness to a patient who is unconscious when the operation
is commenced.
I need scarcely enumerate all the instances of successful
trepanning which have come under my notice in the Aures,
SURGERY 39

for according to Doctors Malbot & Verneau tous ces faits '

sont en Algeria pure banalite but I will cite one case, the
',

first with which I was made acquainted.

In the early spring of 1913, I was taken by a nomad Arab


surgeon at the foot of the hills to see a boy of about fourteen
years of age, who, in addition to a fractured had sus- tibia,

tained a violent blow upon the crown of his


left side of the
head. The tibia had been set and some bone had so recently
been removed from his skull that I was able to observe the
edge of bone cleft by the saw upon one side of the hole, over
which the scalp had not yet re-formed. One year later I met
the lad, in apparently perfect health, and I collected for the
Pitt-Rivers Museum the piece of bone which had been
removed from his skull (PI. V, o).
In a Moslem community, in which the desecration of a
grave regarded with the greatest repugnance, I could
is

scarcely expect that any native would procure for me a skull


bearing the scar of the trepan. Indeed had I so much as
suggested it, my general ethnographical work would have
come abruptly to an end, so unpopular should I have become.
A European, however, presented me with a skull which had
been found at the foot of the Aures massif during road-
repairing operations at a point some twelve kilometres to the
south-west of El Qantara on the high road to Biskra. This
skull (PI. Ill, d) appears to have been trepanned and shows
signs that the patient lived, but for a short time only, after the
operation. I was, however, unable to obtain any further
information relating to it.

Removal of Bone from Limbs.


Injuries to bone in the limbs resulting from wounds in-
flictedby muzzle-loading fire-arms charged with any sort of
projectile which may be handy, such as scrap-iron and stones,
are certain to be numerous among a hot-tempered people by
whom the blood feud is regarded as an almost sacred
still

heritage and, as we have seen, they not infrequently


;

afford the Shawiya or Arab surgeon an opportunity of


adding to his laurels at the expense of the French medical
40 SURGERY
authorities in administrative centres or garrisoTi towns, when
the latter find amputation to be necessary.
Such wounds frequently necessitate the removal of damaged
bone from limbs. The required incision is made with an
ordinary native knife, which, according to one practitioner, is
used cold 'should the patient not object to losing blood', or
hot, should he '
object to doing so '.
A special cutting instru-
ment with three edges is also used hot by one surgeon for
this purpose, as well as for the removal of the scalp in tre-
panning (PI. IV, g).
The and the surrounding tissues drawn
incision made,
aside by means of retractors or springs such as are used for
the scalp, the surface of the bone is explored with the aid
of a fine spoon-shaped probe (PI. VIII, h,j, s), and detached
fragments of bone are removed by means of tweezers
(PI. VIII, n).

According one surgeon, a saw should not be used to


to
separate pieces of bone which it is desired to remove from

a limb, but this should be done with European scissors or


with a knife; other practitioners, however, employ their
trepanning saws for this purpose, and one used a saw
specially made for it. This instrument, which I collected
(PI. VIII, in), consists of a rectangular bar of iron, eight
inches in length, of which five and a quarter inches are flat-
tened to form the blade. Three and a quarter inches at the
distal end of this blade are serrated with fairly fine teeth.
The saw is not fitted with a wooden handle. A typical case
of the successful removal of bone from a limb without the
insertion of anything to take its place is one which I observed
in March 1914.
The man, had been severely injured three months
patient, a
before by a gunshot wound in the right leg, the doctor having
removed considerable quantities of bone from the tibia so
that the man had no other support when standing than that
afforded by the fibula. When I saw him his leg was much
swollen, and he was still undergoing treatment, which con-
sisted in dressing the nearly healed wound with a mixture of
olive oil and the surgeon's upon which some powdered
saliva,
leaves of Jiiniperus phoeniceawQve sprinkled before a bandage
was applied.
SURGERY 41

The surgeon told his patient that he must avoid cold, and
must not yet stand upon he did in order
his injured leg (which
to demonstrate the success of the surgeon's handiwork), be-
cause by so doing he would cause the blood to flow too freely
into the limb. He further stated that the patient would be
permanently lame. The surgeon regarded this case with
exceptional pride and satisfaction, for, he said, the patient
had been taken to a European practitioner,
in the first instance
who had declared amputation of the limb to be necessary.
I have noted many examples of the successful removal of

bone from limbs, and have sent to the Pitt- Rivers Museum
several fragments thus taken away from persons whom I

have met when cured ; for example, the piece of a tibia


illustrated (PI. VIII, q).

Substitution of Bone in Limbs.


In the case referred to above nothing was substituted for
the bone removed from the patient's which a gap had
tibia, in

been created. The reason for this is that nearly all the
surgeons I met with were agreed that the replacement of bone
b}^ any foreign material can only be effected where the injured
bone is well surrounded by tissues which would retain that
material in position, and that nothing can, accordingly, be
done to replace a fragment removed from the tibia. There
is, however, on record a well-authenticated case of an orderly

in the employ of the French. who, when a boy, sustained so


severe a fracture of the tibia that a piece of bone came out '
',

and was replaced by a fragment from the leg of a sheep,


inserted by the lad's father the limb being thus rendered
;

perfectly strong and serviceable.


The substitution of animal bone for bone damaged by
gunshot wounds in other parts of the body is by no means
rare, and has been successfully performed by several of the
native practitioners I have met. 1 have myself observed

many natives upon whom the operation has been performed,


among them an elderly sheykh whose arm had been shattered
by a pistol-shot some years before, but which had been com-
pletely restored by the insertion of a fragment cut from the
leg of a dog after, as the successful operator was careful to
42 SURGERY
point out, amputation had been pronounced by a European
to be necessary.
Most surgeons believe that the bone of a dog is the most
suitable material for replacement, but that of a sheep is con-
sidered to be nearly as good, while one practitioner advises
the use of porcupine's bone. There may, perhaps, be some
now-forgotten magical reason for the use of the last-named
substance, for the right fore-foot of the porcupine, set in
silver, isvery generally worn by nursing mothers both in
the desert and the hills for the cure and prevention of sore
breasts.
Having removed the damaged bone and trimmed the edges
of that left in the limb, the surgeon carefully cuts to the

required length a piece of bone from a freshly killed dog (the


local animal is about the size of a small collie), and so shapes
its ends that it will fit neatly into the gap made in the patient's

bone. He then places it in position in the Hmb and applies


bandages and splmts, the substituted bone being held in
place by the surrounding tissues alone, no attempt at wiring
it to the human bone being made. Such an operation, in the
case of an elderly man, should result in a cure in from two
to two and a half months.

Fractures in Limbs.
In the case of a simple fracture of, for example, the tibia,
after thebone has been set, a little butter w^hich, in the opinion
of some surgeons, should be devoid of salt, is lightly rubbed
over the seat of the injury, and some wheat flour is sprinkled
thereon. One
surgeon, however, held that butter should be
applied to the head only, oil being more suitable for the
limbs, while another advises a poultice of equal parts of
barley flour and the powdered leaves of Passerina hirsuta, L.,
instead of the dressing of butter or oil, the poultice remaining
in position until the seventh day after its application.
Thelimb having been bandaged with strips of cotton
material, over which a layer of sheep's wool is sometimes
placed, splints are applied. These vary in form. One prac-
titioner applies four straight flat pieces of any wood which
may be at hand, one to the front, one to the back, and one to
SURGERY 43

each side of the hmb, retaining them in position by means of


cotton bandages, and firmly lashing the foot in a natural
posture to a piece of board which is fixed to the wall, if the
patient resides in a house, or which is driven as a peg into
the ground in the case of an injured tent dweller (PI. VI, a).
In the opinion of this surgeon swelling of the foot is an indi-
cation that knitting is progressing favourably, while swelling
above the seat of the injury shows that the reverse is the
case.
Another surgeon keeps by him specially prepared splints,
four in number, of the hard wood of the local juniper hewn
in a slightcurve to fit the limb with an adze, a relic in form
of the Bronze Age. The two pieces destined to support the
sides of the limb are broad, that for the front surface narrow
and shorter than the rest, while the back splint is slightly
longer than the others, and is carved into a fork at one end
to enclose the heel (PI. VI, b}. All four pieces are connected
by two cords of twisted goat's hair, each cord being passed
through a pair of holes near each end of the side splints, and
tied around the back and front pie&es these cords are used
;

for securing the sphnts upon the limb.


It appears that a development of this read3'-made contri-

vance may be found in the jebira (bag) sphnt, much favoured


'
'

by many practitioners, and applied to the tibia, as well as,


perhaps more generally, to the arm. This consists of a
combination of splints and bandage held in place by two or
three tourniquets.
The simplest specimen I collected is composed of a strip
of white French canvas upon which are sewn with twine six
flat pieces of white wood, each about seven inches long, and

from one inch to one and a quarter inches in width, placed


parallel to one another at intervals of from one to one and
three-quarter inches. The edges of the strip of canvas are
folded back over the ends of the wooden splints and sewn
down with twine. Two projecting flaps at one side of the
canvas are passed through two slits in the opposite side,
when the sphnt is placed upon the limb, to retain it tem-
porarily in position while the tourniquets are applied. These
consist of two small oblong pieces of wood cut from a thin
44 SURGERY
branch of a tree, perforated throughout their length, and two
loops of twine. The loops are placed around the limb, one
over each end of the and the pieces of wood inserted
splint,
through them, the being then twisted in opposite
latter
directions until a sufficient pressure has been attained, when
a stick, thrust through the perforations in both pieces of
wood, firmly locks the tourniquets in position. The splint
can thus be tightened or its pressure relaxed, as swelling
decreases or increases, without removing it from the injured
limb, by merely twisting the tourniquets as required and
re-locking them with the stick.
I collected two other specimens of this 'jebira' splint, in

which the six flat pieces of wood are replaced in one case by
seven and in the other b}^ eight strips of split bamboo, stitched
to goat-skin two pieces of bamboo from two to three inches
;

long serving to twist the cords which hold each in position.


In the most elaborate form of 'jebira of which I obtained
'

examples the place of the pieces of wood or split bamboo is


taken by strips of stiffly plaited halfa-grass, sixteen in number,
7I inches in length and f of an inch wide, sewn parallel and
almost contiguously to one another upon a piece of roughly
tanned goat-skin, the edges of which are folded back to cover
their ends and also the sides of the two external strips. Each
strip is neatly covered with plaited white cotton fabric.
Three tourniquets, consisting of loops of goat's-hair cord and
pieces of bamboo, locked by means of a stick passed through
the bamboos, retain the appliance in position.
This ever ready and easily adjusted splint (PI. VI, c, d) is
of considerable rigidit}^ owing to the density of the plaiting
of its halfa-grass strips, but is not so unyielding as those of
wood or split bamboo. Wood is preferred to plaited halfa-
grass in cases of fractured thighs. Cotton material is wrapped
around the injured limb before the application of the 'jebira'
splint. In cases in which splinters have become detached
from the bone by the injury this splint is considered to be
especially useful, as the pressure it exerts upon the limb
causes the fragments to force their way out through the skin
which, when necessary, is cut to facilitate their passage. I
have observed several instances of the 'jebira' in use for
Plate VI

STRAIGHT SPLINTS WITH PEG CURVED SPLINTS FOR TIBIA

METHOD OF SECURING THE lEBIRA


'
THE '
lEBIRA' SPLINT
SURGERY 45

a fractured upper arm. In such cases the surgeon places


a pad, often consisting of a kid's skin stuffed with wool or
bran, in the arm-pit, and supports the forearm by means of
a shng. This is done in order to prevent the shoulder from
*

drooping '.

Should the fracture of the limb have been caused by a


bullet, holes are cut in the 'jebira' to coincide with the
entrance and exit holes of the missile, in order that these
may be dressed without the removal of the splint.
Fractures of limbs are necessarily frequent in a rugged
mountainous country such as the Aures, in which a large
portion of the male population is occupied with the herding
of goats upon precipitous rocky hill-sides, and the work of
the Arab and Shawiya surgeons in dealing with these
injuries seems to be remarkably successful. One practitioner,
however, informed me that, when suffering from an attack of
fever, he had so badly placed the hand of a girl, a bone in
whose forearm he had set, that he had been obliged to re-
break the bone some time later and set the limb afresh.
In 1919 I witnessed the following remarkable treatment of
an injury to the knee which, brutal though it was, was carried
out by a surgeon well known over a great extent of country
as a highly successful performer of trepanning and the sub-
stitution of bone in limbs.
The patient, a man of about thirty years of age, had fallen
upon a cliff-face when tending goats, and had sustained,
according to the surgeon, a transverse fracture of the knee-
cap, the upper portion of which had been drawn up by mus-
cular contraction and required to be restored to its normal

position. The knee was considerably swollen. The surgeon


carefully measured the distance between the summit of the
knee-cap and the ankle in both legs, and, having failed to
force the injured bone downwards by means of great pressure
exerted by his thumbs, then laid the round wooden handle of
an instrument above the bone and struck this handle several
hard blows with a hammer. This performance was repeated
three times, after which a re-measurement of the limbs seemed
to indicate a satisfactory position of the knee-cap, and bandages
were applied above and below the knee. These bandages
46 SURGERY
were connected by stfips of rag at each side of the knee to
prevent their displacement, the knee-cap itself being left
uncovered. A red-hot disk-headed cautery, resembling a
large 'French' nail (Plate VII, a), was then applied in light
touches to the skin over the knee-cap, some hot cedar-pitch
was smeared upon the cauterized surface, and a pad con-
sisting of foul wool, cut specially from the hind quarters of a
sheep for the purpose, was bound over the injured knee.
The patient, who was held down by four assistants, groaned
and endeavoured to writhe while the pressing and hammering-
were in progress, and appeared to be on the verge of losing
consciousness, but no sooner was the bandaging of his knee
complete than he partook of a hearty meal and commenced to
discuss with me, as if nothing unusual had happened to him,
some point connected with a hand-loom near by in which
I was interested.
The surgeon, on our way from the house, told me that the
patient would always be lame. A year later, when revisiting
the surgeon, I inquired after this Spartan patient, and was

told thathe had recovered but was slightly lame, the doctor
remarking that he was now of the opinion that the knee-cap
had been dislocated but not fractured.
It appears, from inquiries made relative to this case, that

the natives do not attempt to wire together surfaces of bone


separated by fracture.

Fractures of the Collar-hone and Ribs.

A fracture of the collar-bone, which is regarded as a serious


injury, having been set, is treated by the application of
cautery in a series of dots upon the skin along the course of
the bone.
Cautery is similarly used in the treatment of a fractured
rib, for which one practitioner recommended the application
of a paste composed of a coffee-cupful of wheat flour, some
salt^ and eggs up to the number of seven (a magical number).

This paste is said to cause the ends of the bone to knit. It


is curious that the same surgeon who insisted upon the

absence of salt from the butter smeared upon a fractured


SURGERY 47

should recommend
tibia, its inclusion in the dressing for a
broken rib.
Should a fractured rib be depressed, one of my native
surgeon friends states that it should be drawn back into its
natural position by means of suction applied with the aid of
an ordinary tin bleeding cup (PI. VIII, r), which operation
he naively described as very exhausting for the doctor.
Bandages should be only fairly tightly applied to a fractured
rib.
Fracture of the Jaw.
Nothing can be inserted to replace shattered bone in the
jaw, and, as a rule, no splint is applied when this is fractured.
One surgeon informed me, however, that he had applied a
curv^ed wooden splint beneath a jaw, both sides of which had
been broken, securing the splint by means of bandages
passing over the top of the head the patient, who was fed
;

entirely upon milk, recovering in three weeks.


Another practitioner, before bandaging a simple fracture
of the jaw, applies an ointment of honey and butter, upon
which some powdered gallnut is subsequently sprinkled, and
later applies either, {a) powdered linseed boiled in milky with
which it forms a paste or (J)) a similar paste made of milk
;

and the powdered leaves of malloiv {Malva sylvestris, L.), or


[c) a paste consisting of old crushed dates, from which the

stones have been removed. These three pastes are considered


equally useful.
In 1921 I observed a case in which a large piece of bone
had been removed from the jaw by a Shawiya surgeon, the
patient being a man of about forty years of age (PI. II, d).
A bullet had entered the jaw-bone on the right side about
three-quarters of an inch from the point of the jaw, and had
passed out on the left side about one inch from the point it ;

had then pierced the inner side of the left arm. The patient's
lower jaw had been fractured and so shattered that a frag-
ment measuring, on the inner curve, one and a quarter inches
in length with a maximum depth of half an inch, had been
removed with the aid of a pair of European scissors (PI. VIII,
p). The two ends of the jaw-bones, left separate by the
fracture, were drawn together by means of bandages, and
48 SURGERY
when I felt the interior of the patient's mouth, two months

after he had received his injury, they seemed to have knit


remarkably well. Owing to the loss of his lower front teeth,
the sockets of four of which were included in the bone
removed, the man was able only to partake of soft food, but his
face showed no disfigurement whatever, the entry and exit
holes of the bullet being concealed by a small stubbly beard.
Indeed, I sat beside the patient in a coffee-house for some
considerable time before I became aware that I was in the
presence of the injured man I had been brought to interview.
The bullet which had rendered necessary this operation
also inflicted considerable damage upon the patient's left
arm, causing much suppuration, and, according to the surgeon,
severing a vein, as a result of which the third and fourth
fingers of the hand became dark in colour and immovable.
Regarding these fingers as dead the surgeon cut them off,
no objection being raised to the removal of a dead member,
performing this operation in a very crude manner by cutting
straight through their middle joints without leaving any flap
of skin to cover the bones left in the hand. The stumps had
not healed when I saw the patient.

Dislocation and Muscular Injuries,

Dislocations are regarded by one surgeon, who enjoys a


great reputation for his skill in their reduction, as more
serious than the fracture of bone in a limb. The hip-joint
can be dislocated in four different directions, the position of
the foot indicating in which direction it has taken place. The
foot is pulled out straight and hard to allow of reduction.
Dislocation of the wrist having been reduced by pulling
strongly at the hand, the Hmb is put into sphnts, and cautery
is applied over the joint. A displaced knee-cap is worked
back into position by hand, the limb having been coated with
oil. Poultices of fresh coivs dung and salt are applied hot to
the part affected after a dislocation has been reduced.
One of the most noted surgeons I met with informed me
thatmuscle cannot be broken, the symptoms usually attributed
to this cause being in reality due to the displacement of a
portion of the flesh. The remedy which he suggests for this
SURGERY 49

isone which is regarded by Arab and Shawiya alike as a


panacea for nearly all the ills that flesh is heir to, namely
a hot bath followed by massage at a '
hammam', or bath-house,
to be found in every large centre such as Batna or Biskra,
but of which few villages in the Aures can boast.
The attendants at the hammam are accustomed to mas-
' '

sage their patrons with some skill, but with a roughness


which renders the treatment extremely trying to a European.
Where this treatment is impossible cautery is resorted to.
Other practitioners, however, declare that muscle can be
broken.
For contracted muscles in the hand some surgeons make
incisions with the knife in the palm and on the inside of the
fingers in order to produce relaxation, while one aged doctor
told me that for muscular contraction of the elbow he weights
the hand with a stone, and for a similar affection of the knee
he attaches heavy stones to the feet and causes the patient
to ride a donkey as much as possible, so that the weight of
the stones may extend the limbs.
A native friend of mine, now well past middle life, had been
recommended by a surgeon to enclose each of his fingers in
the hollow of a reed for a period of fifteen days, in order to
straighten their top joints, which had been bent for a con-
siderable time. The surgeon did not suggest any cutting of
the muscles before commencing this treatment.
In the case of fluid forming around a joint which has been
severely wrenched, an incision is made with a knife to allow
the fluid to escape. One of the camel drivers I employed
some seventeen years ago when travelling in the Sahara, had
opened his own knee with a red-hot knife for this purpose.
Sprains, in which no fluid forms, are treated by lightly
touching the skin around the part affected with a red-hot
pointed instrument, of which several types are in use

Among the commonly employed folk-remedies for sprains


and bruises found that poultices of mule's dung and salt are
I

applied to a sprained ankle a rag, containing a little sail, is


;

dipped into very hot olive oil and dabbed upon a twisted
' '
50 SURGERY
knee and camel's fat, wrapped in rag, is warmed over a fire
;

and gently rubbed upon the part wrenched or bruised.


The use of camel's, fat was recommended to me, with
beneficial effect, when I had severely bruised my knee in
falling from a mule in the higher northern portion of the
Aures massif, a region in which the camel is not to be found ;

an instance, perhaps, of the rarity of the material increasing


itsvalue in the opinion of the native, who could more easily
have obtained the fat of several other animals, such as the
goat, the sheep, or even the mule.

Fig. 9.

Hernia.

Infantile umbilical rupture caused by excessive crying


after circumcision, is prevented by binding over the navel,
by means of cotton rags, the circular wooden head of a
spindle whorl, some two and a half inches in diameter, or
a plaster disk, three inches in diameter, made of powdered
limestone, to be found in many districts (Fig. 9).

This rupture, of which diarrhoea is a symptom, is also


commonly caused by the shock produced by jumping from
a height, and is known as 'fallen navel', for the navel is
believed to drop inside the body
* In order to restore it to
',

its proper position oil is rubbed upon the skin, and a bowl

containing a piece of lighted paper is pressed tightly over


the '
navel ', which is drawn up into position by the suction
caused by the vacuum produced by the burning paper in the
'

SURGERY 51

bowl, a treatment which recalls the use of the '


cupping glass
of modern times.
Rupture in adults appears to be treated by cautery alone,
no surgeon I have met with having ever applied a truss to
a grown-up person.
Cautery.
I have already mentioned the use of cautery in the treatment
of several injuries ; it is, indeed, a first favourite among the
Shawiya and the Arabs for almost every conceivable ailment,
laymen often applying it to themselves or to their friends
without calling in the doctor. Almost any piece of iron,
heated in the fire, serves for its application, but there are
various forms of special instruments in use by the surgeons.
In cases of twisted joints a pointed instrument (PI. VII,
b, h,j) is applied in light quick touches around the injured

part; flat rectangular cauteries (PL VIII, /) are similarly


applied to the abdomen, as are others in which a disk at the
distal end (PI. VII, a) recalls the appearance of a large
'
French nail (I have seen such a nail fitted into a wooden
'

handle for the purpose) while some sores and suppurating


;

wounds are treated by means of a searing cautery (PI. VII, k)


closely resembling, in miniature, the sickle-hook of the
country, from which, indeed, it may well have derived its

shape, for General Daumas, in his Horses of the Sahara}


states that the sickle itself is used for firing these animals,' '

and I have seen a broken sickle which was used in applying


cautery to human beings.
For the cautery so much esteemed as a remedy for dis-
orders of the spleen, an instrument is used (PL VII, /) in
which twin or triple points are turned at right angles to the
resembling in form
rest of the blade, the twin-pointed variety
the flesh-hook of the Aures, which have served themay itself
purpose in the past, and suggested the shape of the special
instrument now employed. In applying cautery to the side
over the spleen the skin should be raised by an assistant in
order that the heat may not damage the internal organs.
For mild cautery in cases of splenic trouble in infants, a
^ Translation by James Hutton, p. 76.
52 SURGERY
short wooden spike VI I, ^), used in the manufacture of
(PI.
halfa-grass sandals, hghtly apphed to the skin after being
is

heated by fire, and not by friction, as Burckhardt states that


a cautery made of oak was heated by the nomad tribes of
Arabia. In this practice I found no trace of the use of
boihng which Hippocrates applied by means of a box-
oil

wood and Aetius with the aid of a root of birthwort,^


spindle,
but in the use of the sandal-maker's wooden spike and in the
application of cautery for rheumatism with the aid of a heated
root of Thapsia garganica (a treatment used in the desert) we
may perhaps find survivals of these methods.
One surgeon of the hills recommends for swollen hands '

or feet a treatment in which pine pitch is smeared over the


'

part affected, and a red-hot iron is passed three times over


the surface thus prepared, without, however, touching it.
Abscesses are frequently opened by means of a red-hot
instrument fitted with a rectangular blade, one edge of which
is sharpened (PI. VII, c), or with twin curved points (PL VII,/),

or in which the distal end is curved and hollowed as in a


carpenter's gouge (PI. VII, d)\ a flat strip of brass, heated
over a fire, is also used for this purpose, as is a flat iron
spike, pointed at one end and square at the other either end ;

being used as required.


In addition to its surgical uses cautery is also employed, as
Monsieur Edmond Doutte points out,^ in the magical opera-
tions directed against the Evil Eye in various districts of
Barbary, and was apparently so used in Arabia at the time of
the Prophet Mohammed.
Surgery of the Eye.
Affections of the eye are very common in Algeria, owing
not only to the dust and glare of the desert and the barren
rocky hills, but also, no doubt, to the unpleasant habit of
removing a foreign body from a friend's eye by hcking the
eyeball with the tongue, which is much practised by the
natives, and has been noted by Dr. Leared in Morocco.^ We
^ Milne, Surgical Instruments in Greett and Roman Times , p. 120.
^ Magie et Religion dans I'Afrique dii Nord, p. 324.
^ Morocco and the Moors, p. 279.
Plate VII

CAUTERIES

DENTAL AND OPHTHALMIC INSTRUMENTS


SURGERY 53

have already seen that a number of the doctors to be found


in the Aures and the desert speciaHze in the treatment of

these affections, in the course of which they sometimes resort


to surgical operations. When a white film, which is remark-
ably prevalent, forms over the eyeball, proceeding from the
corner nearest to the nose, it is treated before the operation
for its removal by the application of a powder prepared in

the following manner. Some fluid extracted by pounding in

a mortar the leaves of Lyciuni Europaeum is placed in an


empty egg-shell, the opening in which is closed with dough.
The shell is then imbedded in a dish of semolina, which is
'steamed', in the manner usual for the preparation of the
Algerian national dish known as Kuskus '. After remaining
'

in the semolina all night the extract within the shell will be
found to have solidified it is then dried in the sun, and
;

pounded powder for application to the eye.


into
The doctor who recommended this treatment did not give
me any reason for its use. The film, now ready for removal,
is carefully lifted by means of a small and very sharp-pointed
hook and skinned away towards the corner nearest to the
' '

nose, where it is snipped off with scissors, some wool dipped


in oil containing salt being appUed to the part to check
haemorrhage.
The hooks used (PL VII, n, o,p, q, r) vary in length from two
to five inches, and are made of strong iron or brass wire, or
of a flat narrow strip of copper, or, rarely, of silver, the distal
end being sharply pointed and bent back to form a hook, and
the handle end usually curved into the form of a ring.
*
'

All the scissors I have seen in the hands of Algerian


surgeons have been of European manufacture the very old ;

locally made pair of which I give an illustration (PI. VII, n)


having been handed down from an unknown date in the
family of the practitioner who gave it to me. It is now blunt,
rusted, and quite useless.
After the removal of the film, a powder, rendered as fine as
possible by being passed through a piece of rag, <7W<^ consisting
of equal parts of saltpetre, ahim, saffron, and eggshell, is intro-
duced into the eye, the surgeon blowing it from a large quill.
54 SURGERY
The eye is then covered with a bandage for eight or ten
days, after which it will be found to be cured.

Should the film over the eyeball be very large it is scratched


a with the point of a knife (one surgeon uses a small
little

flat strip of iron, both ends of which are ground into rounded

cutting edges) (PI. VII, s), and a powder composed of exactly


equal parts of ostrich-egg-shell, pearls, coral, and the baked
body of a scorpion, having been strained through a rag, is-
introduced into the incision made with the knife. After a
time the film turns black, when it is daily bathed with a lotion
consisting of a little powdered saffron mixed in rose water,
used warm in winter and cold in summer the film over the
;

eye disappearing after about a month of daily bathing.


The surgeon who described this treatment to me naively
remarked that it was very expensive, and it seems to me to
be suggestive of medical magic derived from some ancient
book, for coral and scorpions are largely used to combat the
machinations of demons in Algeria it is, nevertheless, a fact,
;

that all the ingredients used for the powder can be obtained
in Barbary.
Another practitioner employs a different method for the
removal of film which wholly or partially obscures the vision,
and which he described as a sort of skin appearing to con-
'

tain fluid'. He inserts laterally behind the film, from the


outer side of the e^'e, a thin brass spike, the point of which
is fairly sharp, and then twists the spike round and round so

that it rolls up the film until the lower eyelid is reached,


when the film is cut away. The instrument is made entirely
of brass, its spike being about three-quarters of an inch in
length (PI. VII, /). This surgeon, a native of Morocco, enjoys
a very wide reputation as an oculist in the Aures, the country
of his adoption, patients coming to his village from a very
large area to undergo treatment at his hands, and there is
little doubt that he has proved remarkably successful in

removing film from the e3^es of many.


This film is also treated in some cases without recourse to
an operation, one of the following substances being blown, in
powdered form, into the eye from a quill pearls (only in:

cases in which the film is not believed to have been caused


;

SURGERY 55

by contact with small-pox pustules) ; chicken- or ostrich-egg-


shell; or a mixture of five parts of burned and powdered
camel's flesh and one part of human hair, pounded together
in a mortar or of burned iron, saffron, acetate of copper, catkin
;

of Piper longum, and white sugar candy, of which latter mix-


ture as much as will cover a penny piece is blown from the
quill at one time.
The following lotions are also recommended by various
practitioners for the treatment of the same affection powdered
;

saffron and sugar candy mixed with the milk of a ivoman


ivhite

the extract obtained b}^ pounding in a stone mortar the fresh


soft red root of Zizyphus lotus, Willd., (applied drop by drop
in incipient cases) or rose zvater in which have been bottled
;

two or three small multipede insects to be found in water, of


which I have hitherto failed to acquire a specimen.
For inflammation of the eye some surgeons draw off blood
by means of incisions made in the inner membrane of the
eyelid, arresting the haemorrhage, when sufficient has been
allowed to flow, by the application of olive oil. Others recom-
mend the appHcation of a cold compress of rag soaked in the
milk of a woman or of powdered ivhite sugar candy dissolved
;

in a mixture of rose zvater and milk or of powdered sugar


;

candy, saffron and rose zvater; or of a very little alum, some


white of egg, olive oil and vinegar mixed in equal parts.
The crushed leaves of Sonchus maritimus, L., are also
applied to the eye to draw out the inflammation
'
as is the ',

skin of a viper boiled in olive oil, the latter treatment doubtless


emanating from the universal belief in viper's skin as a
defensive weapon against the attacks of demons.
Various liquids are applied 'drop by drop to the eye for
inflammation, among them being the extract of pounded fresh
leaves of Beta vulgaris, L., squeezed into the eye from the
gall-bladder of a jackal, or of either the Dorcas or Cuvier's
gazelle (the method of
its application doubtless arising from

the common magical use of a gall-bladder and from an idea


of sympathetic magic, the eyes of the gazelle being much
admired by the poets of the desert and the hills). The extract
of pounded leaves of Marrubium supinum, L., or of a species
of Pimpinella (resembling a small wild variety of celery) ; or
56 SURGERY
the fluid from the capsules of Solanum nigrum, L., var. vil-
losum ('houndberry known to the Shawiya and the Arabs
',

as grapes of the jackal ') are similarly introduced for inflam-


'

mation, but without the aid of a gall-bladder.


For e^^es which tend to 'weep a mixture of equal parts of
'

the seeds of cotton, seeds of quince^, and the white pith from the
nodes of bamboo, is warmed and introduced into the eye,
being considered also a useful remedy for stye while blood ' ',

from the freshly cut throat of a hoopoe is employed for the


same purpose, a further example of the persistence in use of
magical substances among the oculists of the Aures.
A drooping upper lid of the eye is shortened by a small
operation. Two of the sharp hooks used in the removal of
film are inserted one at each end of the lid, so that the point

[v:
GC
Fig. io.

of each hook protrudes from the skin, having pierced the eye-
lid twice ; the little lateral ridge of skin thus drawn up on
the eyelid is then clipped away with scissors or carefully slit

with a sharp knife, and the edges of the slit so made are
stitched together with horse-hair or silk, a daily dressing of
the antimony, used by the women of the Aures to darken
their eyelids and eyebrows, being applied until the slit is

healed.
In another method of shortening the eyehd the skin is not
cut, but the ridge picked up by the hooks is stitched with silk
or horse-hair to form a '
reef, this reef being then clamped
by means of a minute cane-splint, slit down the centre, and
bound at each end with cotton (Fig. lo). A dressing of
antimony is applied daily for four days, and upon the eighth
day the splint falls away, leaving the eyelid shortened by the
healing of the perforations made for the stitches.

Dropsy {Surgical Treatment).


Although James Richardson, who visited Ghadames in
Fezzan in 1845, states in his Travels in the Great Desert of
'

SURGERY 57

the Sahara, i, 323, that there in dropsy the native doctors


'

cut the body to let out the water, as we do ', I have found no
example of this treatment in and around the Aures.
Setons, however, are employed in its treatment by both
Arab and Shawiya. The symptoms recognized are constant
thirst and the distension of the abdomen by fluid. One
doctor considers cold to be the cause of the disease, which is
known as saqya from a verb-root signifying to water
'
',
'

(a root whence also springs the word 'saqiya', irrigation


canal).
I witnessed the introduction of setons as a remedy
In 1914
for dropsy in a remote hamlet of the Aures. The surgeon
first reduced to powder in a brass mortar some acetate of

copper, which he then mixed with three coffee-spoonfuls of


honey and a very little water, subsequently melting the mix-
ture over the flame of a small European lamp. In this mixture
were steeped the setons, consisting of three strips of old and
dirty red cotton dress-material. The upon his
patient lying
back, an assistant proceeded to pinch up with the forefinger
and thumb of each hand, a ridge of skin, some two-thirds of
an inch in height, transversely across the body an inch above
the navel, beside which ridge (on the side farthest from the
navel) he laid a flat strip of copper. The surgeon then thrust
a red-hot pointed iron instrument through the ridge of skin
immediately above the navel, making the incision from the
side on which the strip of copper protected the surrounding
skin from contact with the red-hot iron.
The instruments used for the perforation of the skin are
straight (PI. VIII, b, g), or curved (PI. VIII, a), a curved in-
strument resembling a coarse packing-needle (PI. VIII, e)
perforated with an eye at its blunt end, sometimes serving
also to introduce the setons into the holes made by its point.
One of the setons was then passed through the hole so made
with the aid of a coarse copper needle (PI. VIII, c), two
similar setons being subsequently introduced, one on each
side of the first and about two inches from it. The ends of
the setons were left hanging loose, but another surgeon told
me that he usually knots the ends of each one together to
prevent their accidental withdrawal. At subsequent visits
;

58 SURGERY
the setons are drawn up and down to facilitate the exodus of
the fluid, of which as much as a litre is said to be so drawn off.

Although in the case described only three setons were


inserted, another surgeon recommends four, while a third
advises six, introduced in the lines of three each, one line
above the navel and one below it. It is said that the setons
are not removed, but are left in place until the skin falls '

apart when they come away by themselves.


',

After the setons had been inserted in the case I witnessed


in 1914 some cold pitch o{ Jimiperus phoenicea was smeared
upon the skin around them and over the abdomen, and
cautery was applied in light quick stabs by means of a red-
hot instrument with a flat rectangular iron blade (PI. VI 1 1,/)
all over the area treated with pitch, some powdered henna

(leaves of Lawsonia inermis) was sprinkled freely over the


burns, and the patient's body was covered with a piece of
old cotton dress-material, retained in position by means of
strips of the same stuff. The patient did not exhibit the
slightest sign of suffering during the perforation of his skin
by the red-hot instrument and the introduction of the setons
he groaned and flinched a little, however, during the subse-
quent application of cautery.
Some notes upon the medicinal treatment of dropsy will
be found under that heading in the final section of this book.

Obstetric Surgery.

Delivery usually so easy that professional assistance is


is

rarely required. The newly-born child is not immediately


washed, but the umbilical cord is dressed with antimony, and
the child swathed in clothing. In the case of skilled assistance
being rendered necessary by the position of the child, the
doctor oils his hand and arranges the child into a natural
position. In the event of this being impossible living children
are, very rarely, dismembered and removed, as are those who
die before birth, in the following manner.
The surgeon oils his hand and lays the flat side of the
blade of a sharp native knife along his extended forefinger,
so as to keep its edge from inflicting damage until it is

required to be used. In this position he inserts his hand,


Plate VIII

en
H
Z

en
P
O
w
<

u
CO
SURGERY 59

turning the blade of the knife so that hes edge-upwards, it

with its back along his finger, when he ready to commence is

dissection. The portions of the child thus dismembered are


removed with the aid of iron hooks. After the operation one
practitioner asserts that an infusion of melon flowers should
be drunk by the patient for cleansing purposes and as an aid
to urination.
appears that this operation is very rarely performed
It

upon human beings but one or two of my surgeon friends


;

state that they have successfully carried it out upon animals.


I have never met with a native who claimed any practical

knowledge of the Caesarean operation, although one surgeon


informed me that he had read of it in an old book.

Lithotomy.
When '
little stones like shot hinder urination ', half a coffee-
spoonful of the following mixture is taken morning and
evening : one part of powdered leaves of Mentha rotimdi-
folia, L., three parts of honey, and one-half of an imported
cantharide beetle (known in Algeria as the 'Fly of India').
This causes dissolution of the stones. If in from twenty-five
to thirty days a cure is not effected, the surgeon resorts to
lithotomy, which operation, however, appears to be but rarely
performed.
The calculi are sought with the finger, which is often
inserted in the rectum for this purpose, and when they have
been located a small incision is made with the knife to allow
of their removal. Sometimes the urethra has
to be opened,
a long fine probe being inserted into provide a surface
it to
against which to cut. The incision thus made is immediately
sewn up and dressed, the operation causing no permanent
hindrance to urination.
Operations upon the penis, other than the universal cir-
cumcision of male infants, do not seem to be performed by
native surgeons as a rule, injuries thereto being merely
dressed. A very aged Shawiya practitioner, however, who
at one time enjoyed a ver^^ wide reputation as a successful,
if brutal, operator, claims to have removed a penis injured

by a gunshot wound and replaced it with a reed. The


6o SURGERY
suspicious and reticent old man would give me no details of
the operation, which he stated was the most he had
difficult
attempted, and had proved completely successful but the ;

case is remembered by the older men over a wide tract of


country in the Aures and the neighbouring desert, and is
freely quoted as an example of the old surgeon's remarkable
skill.
Circumcision.
In 1920 I was present at the circumcision of two boys in

a Shawiya hamlet. The occasion was marked by much


dancing and rejoicing on the part of the women of the families
concerned and their invited guests, several magical practices
being .employed to keep away from the patients the 'jenun',
or demons, so much dreaded in Algeria. These practices, of
which examples are the firing of a gun at the moment when
the actual operation is complete, and the subsequent double
series of seven rotar}^ movements of an attendant's hand con-
taining salt around the patient's bod}^ — the salt being after-

wards sprinkled upon his head are perhaps more suitable
for description in a work dealing with folk-lore than in an
account of the surgery of the Aures.
The operation itself was quickly and neatly performed,
both children being treated in exactly the same manner.
The first patient, a child of eleven months, was laid upon
a large up-turned circular wooden dish (used in the prepara-
tion of unleavened bread), upon which a considerable quantity
of powdered earth had been placed to form a couch, and was
held by an assistant who supported the child's back with his
left hand, and held its feet with his right so that the legs were

extended.
The operator, zvho was not a practising Shawiya surgeon,
then produced a small stick, some four inches in length, cut
so as to leave a knob at one end (Fig. 11). Having drawn
back the foreskin, dipping his finger and thumb in the dust .

of the mud floor to improve his grip, he pressed the knobbed


end of the stick against the glans penis and drew the foreskin
over the knob on to the stick, to which he secured it with
string so that the knob prevented its withdrawal. He then
drew a loop of clean woollen thread tightly around the fore-

SURGERY 6i

skin,between the glans and the knob of the stick, and severed
the by one quick downward cut of an ordinary
foreskin
native knife between the knob and the woollen loop, the
latter serving to protect the glans.
A slight variation of the operation was described to me by
a surgeon, who gave me a stick used as above, in which one
end, instead of being knobbed, had been hollowed into a cup-
like depression (Fig. 12). In this depression a small round

Fig. II.

pebble is placed, and the foreskin drawn forward and tied to


the stick so as to retain the pebble in position between the
glans and the end of the stick.The cut is made between the
stickand the pebble, which latter protects the glans. This
surgeon recommends only a dressing of antimony after the
cut has been made, but in the two cases I witnessed more
elaborate treatment was used.

Fig. 12.

Immediately the foreskin had been severed a raw egg was


opened at one end and pressed upon the penis, so that the
latter was inserted in the egg through the broken shell it —
seems just possible in view of the fact that the breaking of
an Q.gg by the bride is one of the Shawiya marriage rites,
that it may be used in circumcision as an emblem of fertihty
and the penis and surrounding parts of the body \vere liberally
besprinkled with the powdered leaves of Juniperus phoenicea
upon which some melted butter was poured. Then some
more powdered juniper leaves were sprinkled, followed by
powdered goafs dung, more melted butter and still more
powdered juniper leaves, in the order given. After which
the child was enveloped in swaddling clothes, and the opera-
62 SURGERY
tion was complete. The dried goat's dung may, perhaps,

be regarded as a styptic though it is not appHed direct to

the wound for it is used to check haemorrhage after cupping
has been resorted to.
Another dressing recommended for use after circumcision
consists of a mixture of the powdered under-bark of pine,
goaf s fat, and butter.

Cupping.
Blood-letting is very frequently carried out, especially in

the spring, when the natives consume large quantities of


butter-milk, which they believe to produce headache and
dizziness. This minor operation is performed by laymen as
well as by surgeons, but I have not found any particular class,
such as barbers, who specialize in it in the Aures.
The usual method is to make up to six incisions with the-
knife on each side of the back of the patient's neck and then
to apply the bleeding-cup. This locally made instrument
(PI. VIII, r) consists of a small tin cup, slightly conical in
form, narrower end closed, the wider one left open.
its

From near the open end rises a curved spout to the extremity
of which is tied a small piece of leather. The open end of
the cup having been placed over the incisions in the neck,
the operator apphes suction with his mouth to the end of the
spout in order to start the flow of blood into the vacuum thus
produced, closing the spout with the piece of leather referred
to above, and binding it with string, immediately he withdraws
his Hps.
have also seen blood drawn from a vein in the forehead
I

over the left eye without the aid of a cup, the patient's neck
having been tightly bandaged with a handkerchief before the
incision was made. I have never observed the practice of

drawing blood from the arm mentioned by El Bekri ^ as


having existed in Fez in the eleventh century of our era.
To counteract the feeling of faintness produced by cupping
the patient often drinks coffee without sugar, or eats a lemon,
during the operation.

^ de Slane's translation, 1913 edition, p. 246.


SURGERY 63

Snake and Scorpion Bites.


For snake-bites
in the hands or toes, three incisions with
the knife are made in the back of the hand or foot and the
bleeding-cup applied in the usual manner, the surgeon placing
butter in hismouth before commencing the suction, as a safe-
guard to himself. Swellings resulting from snake bite are
cauterized.
One surgeon is in the habit of opening the part bitten and
binding over it the skin of a dog, freshly killed for the pur-
pose, which is beheved to withdraw the poison on the
principle of a poultice. Should the first dog's skin fail to
bring about the desired effect, the treatment is repeated until
dogs to the magical number of seven have been killed and
their skins employed.
The by either snake or scorpion is sometimes
part bitten
opened with the knife and the fat of either of the two lizards
Uromastrix acanthinurus or Varamis griscus is rubbed into
the wound a mixture oi pitch and wheat bran being similarly
;

rubbed into incisions for the cure of scorpion bites. Persons


bitten by snakes or scorpions are caused to drink an infusion
of mint [Mentha rotimdifolia, L.).

Dentistry.
The extraction of teeth is very usually performed by jewel-
lers in the Aures, nearly all of whom possess forceps
(PI.VII, m), which contain either two or, more rarely, three
'
claws' on either side, and of which one or both sides of the
handle are curved to facilitate the grip. I have seen one
double specimen, i. e. two forceps which had one bar of their
handles in common, such as is illustrated in Dr. Raynaud's
Medecine au Maroc (p. 130) among a number of instruments
used in Morocco.
One Arab surgeon gave me a hook (PI. VII, /), which is
inserted behind the roots for the extraction of particularly
firm stumps, stating that it is more efficacious in such cases
than the forceps. This man stated that he had endeavoured
to check toothache by filling a cavity in the tooth with opium,
but that this treatment had proved unsatisfactory. Indeed,
64 SURGERY
he appeared to be quite ignorant of the cause of toothache,
although he is very widely known for his skill as a surgeon,
particularly in trepanning. A layman informed me that the
pain of toothache is caused by an insect '
(doubtless he'

referred to the nerve) within the tooth, and that this insect
can be killed by filling the cavity, should there be one in the
tooth, with a mixture of lime and pitch, which will cause the
tooth to cease from troubling or to break. Gum asafoetida
is also used for the plugging of a hollow tooth.

The mouth is sometimes rinsed with vinegar in which a


viper's skin has been steeped; or with an infusion, in vinegar,
of thyme or of the fruit of colocynth while the fresh-bruised
;

leaves of Marruhivmi supitmm, L,, are chewed as a cure for


toothache, as are those of the wild olive, the wild leaves being
considered more efficacious for this purpose than those of
the cultivated olive tree.

Sutures.
It appears that wounds, other than those in the face and
made in lithotomy, are rarely
the incisions sutured, the edges
being merely drawn together by means of bandages torn
from any old cotton material which may be at hand.
When used, the sutures, of horse-hair, silk, or very rarely, of
wire, are inserted in holes previously made with a needle
(which in olden days was of silver) and tied separately.
When the wound is healed they are cut and withdrawn.
Skin-Grafting
Is said by one surgeon be sometimes practised in the
to
hills and the desert, but neither he nor any other practitioner
I have met with had ever attempted it.

Bullet Wounds.
The bullet is sought with the aid of probes, straight or
spoon-shaped at one end (PI. VIII, //, j), made in various
lengths and thicknesses of iron, brass, or more often, of
copper. Should the bullet have penetrated very far into the
body it is often left in the wound, owing, I presume, to the

surgeon's dread of interfering with the internal organs. In


SURGERY 65

other cases it is removed by means of a spoon-shaped probe


or of long forceps (PI. VIII, 0), an incision being made with
the knife, often used hot, to clear the way when necessary.
Some surgeons dress thewound by inserting into it, with the
aid of a probe, a rag steeped in honey and alum, leaving the
rag in the wound, and renewing this dressing daily for five
days, at the end of which time the wound should be ready to
respond to a surface dressing.
Dressing is also carried into deep wounds upon strips of
cotton threaded through holes, resembling large eyes of *
'

needles, to be found in some probes (PI. VIII, 7', u)\ in this


case the cottonis not left in the wound.

Other practitioners inject melted butter into the wound by


means of a European syringe, which nearly all the surgeons
now possess, the old-time native instrument having practically
disappeared. This latter (PI. VIII, ^) consists of a tube of
oleander wood, some six inches in length, narrow at one end,
but extending to a bell mouth at the other. The melted
*
'

butter, or other liquid dressing, is inserted into the wide end


of the tube to which the surgeon applies his lips, blowing the
dressing into the open wound through the narrow end of the
tube.
Butter or a mixture of honey and butter are commonly thus
introduced into bullet wounds, a surface-dressing, which is
considered particularly useful in these cases, being a mixture
of acetate of copper, sulphide of copper, and ammonium chloride
(all purchased in the large towns), powdered and boiled in

honey to form a paste.


Bullet wounds, in which the projectile still remains, and
from which, for any reason, no surgical operation is performed
for its removal, are treated by the application of a little
powdered stdphide of arsenic, which is intended to 'draw out
the bullet '.

Dressings for Wounds.


A number of dusting powders are prepared by the Shawiya
for application to cuts, such as :

The dried and powdered leaves of Globularia alypum


{a) ;

%Dried and powdered leaves of Tamarix gallica, L.,


mixed in equal parts with alum ;
66 SURGERY
(r) Dried and powdered leaves of Ajiiga iva, Schreb.,
mixed with a little alum ;

[d) Green leaves of Marrubiitm supinum, L., dried in the

sun, powdered, and mixed with a little alum ;

{e) Dried and powdered leaves of Erodium guttatum,


Willd. ;

(/) Five parts of the dried and powdered leaves of Ero-


dium malocoides, I'Her., mixed with one part alum;
ig) A dried and powdered plant of a species of Arle-
ntisia ;

[h) The dried and powdered leaves of Teucriuni polium,


L, ; or
(i) ancient books suggest the use as a dusting powder of
the bod}' of the larva of a beetle which be found upon is to
the roots of Thapsia garganica and to destroy suppurating
;

flesh around a wound the dried leaves of Salvia clandestina,


L. (var. angustifolia) are applied in the form of powder.
As I have pointed out when describing the dressings used
by surgeons, after operations, a mixture of honey and butter is
most commonly employed, and these substances are frequently
used in conjunction with other materials thus powdered ;

leaves of Erodium botrys, L. (known to the Arabs as '


mother
of the wound') are applied in butter or in oil; or a httle
powdered sprinkled on the previously
sidphide of arsenic is

applied butter and honey; or the powdered leaves of Teucrium


polium are similarly employed or powdered seeds of Pega-
;

num harmala are sprinkled upon a coating of butter or the \

berries oi Juniperus phoenicea, L., pounded to pulp, are mixed


with honey, in the proportion of three parts pulp to one part
honey, and half a table-spoonful oi pitch from the sdime Jumper
added to the mixture before application upon a pad of wool.
Powdered leaves of theyfr tree or powdered ^/flC/^^^rrjV leaves
are also sprinkled upon a coating of butter previously spread
upon the seat of the injury.
A mixture oi pitch ^.n^ pine gum is used as a dressing for
wounds : as is the rotten bark of Juniperus oxycedrus, pow-
dered and mixed with ivJiite of egg, especially for cuts on the
face ; or the powdered roots of Rubia tinctorum, also mixed
with white of egg; or powdered leaves and flowers of Thy-
: ;

SURGERY 67

melaea hirsuta, Endl. {Passerina hirsuta, L.) mixed with red


or white vinegar or the fresh leaves, bruised by pounding,
;

oi Apium nodiflorum, Reich.


For Suppurating Wounds fresh leaves of Erodium malo-
coides, I'Her,,whose Arabic name implies 'sewing', for it
'sews up a wound', are applied to the injury; or powdered
roots of Pyrethrum are applied in honey or the roots of ;

either Narcissus tazetta, L. {Polyanthus narcissus) or Rubia


tinctorum are boiled in milk and used as a poultice as is the ;

powdered plant of A^iemisia herba alba, similarly boiled in


milk.
The following ointments are also used for suppurating
wounds and sores
{a) Six parts of the dregs of red vinegar boiled over a
charcoal fire with six parts of honey, and mixed with one part
of acetate of copper ;

[b) One cupful of olive oil boiled up with a quarter of

a cupful of fat from a goafs kidney, one-fifth of a cupful of


yellow candle grease, one-sixth of a cupful of acetate of copper
and a piece of aloes as large as a thimble, this ointment is
especially useful in winter as it is '
hot '

(c) Honey, previously boiled up to 'clear' it, is heated


until it simmers with equal parts of powdered Malva sylvestris,
L., ammonium chloride, saltpetre, seeds of Peganum harmala,
sulphide of copper, cloves, lemon peel, acetate of copper, and, a
little only, benjoin and red vinegar after this ointment has
;

done its work of cleansing the wound, the following is applied


to cause it to heal.
{d) Honey heated till it simmers with equal parts of red
vinegar, acetate of copper, and myrrh and aloes.
: ;

PART III

MEDICINE
Purges and Laxatives. Some of the native doctors in-
variably commence a course of treatment by administering
a purge, of which, as well as of laxatives, they possess a fair
selection, the stronger varieties being
(a) Forty grammes of the dried and powdered leaves of

Thymelea hirsuta, Endl. [Passerina hirsiita, L.) are eaten in


a dish of steamed semolina.
[b) Fragments of a clean root of Thapsia garganica are

inserted into a piece of beef, which is then cooked in butter


the pieces of root having been removed after cooking, the
meat and the melted butter are consumed by the patient.
(c) Five grammes weight of the soft interior of the fruit

of colocynth (not the seeds), when fully ripe, mixed with a


coffee-spoonful of pure honey is eaten before breakfast.
[d) The seeds of Euphorbia lathrys (spurge) are given as
follows by the heart of one or, if
different practitioners :

necessary, two having been removed and thrown


seeds
— —
away for they are poisonous the rest of the seeds are
swallowed in a mixture of rose-water and milk a powdered :

seed, of which the outer skin or husk has been removed, is


mixed with sugar and swallowed in the morning, half a seed
only being administered to invalids and a smaller quantity to
children one seed rolled in honey and swallowed in the
;

morning, the patient subsequently partaking of hot soup, acts


as an emetic as well as a purge.
{e) As much of the powdered seeds of Peganum harmala

as can be placed upon a ten-centimes piece is eaten in honey


in the morning, the patient lying down until the dose has had
its effect.
MEDICINE 69

(/) The powdered dried leaves of another Euphorbia


(possibly Guyoniana) are taken in honey, four grammes of
powder to half a coffee-spoonful of honey should this dose
;

act too violently its effects can be stayed by swallowing olive


oil.

[g] A quantity of cinnabar powdered and mixed in a litre


of water or of milk is given as a purge, one coffee-cupful of
the liquid constituting the dose.
Milder purges or laxatives are used in the form of an
infusion in water of Senna indica or alexandrina, or of a
mixture of water and the powdered niyrobalan of commerce
{Terminalia chebula), while an infusion of Mentha rotundi-
folia, L., or of the leaves of Ecballivim elaterium, Rich,
(squirting cucumber), are employed for the same purpose.
The seeds or roots of the latter can also be used in addition
seeds producing the stronger and the roots
to its leaves, the
the milder doses. As a corrective for the stomach of a
suckling infant a very small quantity of the dried and pow-
dered leaves of Globularia alypum, L. is administered in milk,
while the stewed fresh leaves of the same plant, made into
a kind of jam, are eaten by adults in daily doses of a coffee-
cupful for fifteen days as a cure for a feeling of being
generally *
out of sorts '.

Colic and Indigestion. A considerable number of the


following remedies for coUc and indigestion, such as Arte-
misia herba alba and Cttmittum cyminum, L., appear to be
known to most natives, and are not used only by medical
practitioners.
For Colic an infusion in water of the flowers of:
Artemisia herba alba, to which sugar has been added
(a)

to counteract its bitterness, or of a whole plant of Delphininm


Balansae, Boiss. et Reut., or of the powdered leaves of a local
variety of Thyme are drunk ;

A
mixture of the seeds of Negella sativa and of
{b)

Cuminum cyminum is powdered and taken in honey, the


powdered seeds of the latter alone, mixed with sugar, being
considered useful in cases of colic in infants.
(c) Half a coffee-spoonful of the powdered leaves of
70 MEDICINE
Erodium rnalocoidcs, I'Her. swallowed in a soup-spoonful of
honey is said to relieve immediately the pains of colic.
For indigestion.
{a) An infusion in water of Artemisia absinthum or of
Mentha rottmdifolia, L. is drunk, or
[b) The dried leaves of Ajiiga iva, Schreb. are powdered
and eaten in honey, or
(c) The extract obtained by pounding a whole plant of

Beta vulgaris; L. is swallowed, or


{d) A kind of jam made by stewing the fruits of the
Cyprus tree is consumed while for ;

Flatulence is recommended an infusion in water of either


Thyme or Artemisia herba alba or Ptychotis atlantica (which
latter is also swallowed when powdered in hot milk for sore
throats and as an aid to urination) the water in which leaves
;

of Teucrium politim, L. have been soaked without boiling is


also given for flatulence, and the leaves of a herb closely
resembling, both in appearance and in their scent, those of
a small celery and which is stated at Kew to be a species of
Pimpinella are eaten cooked with meat for the same complaint.
For chill on the stomach a very small quantity of an infusion
of the powdered leaves of Thyme, which has been bottled for
storage, or a coffee-cupful of a similar infusion of the fresh
leaves of Rosemarinus officinalis, L. or of Artemisia herba alba
is swallowed daily for a few mornings before breakfast, the
last-named infusion being also considered as valuable in cases
of Worms, though the number of applications I have received
for medicine for this complaint may indicate that, in reality,
this very easily obtained remedy is not particularly efficacious.
For stomach troubles in general an extract obtained by
heating the sliced-up roots of Capparis spinosa, L. (var.
rupestris, Sibth.) in a dry receptacle over a fire is swallowed
inwater or in food.
Affections of the Liver and Spleen, apparently very
common among the Shawiya and the Arabs, are treated in
one or other of the following manners :

[a] When the liver or the spleen is enlarged the symp-

toms observed are thirst, a yellow complexion, a bad taste in


the mouth, a quick pulse, a distended feeling of the stomach,
:

MEDICINE 71

and constipation. One of the purges noted having first been


administered, equal parts of the powdered seeds of Cuminum
cyminum and the dried and powdered roots of Tamarix gallica
are mixed with honey in the proportion of one part powder to
four parts honey, and one coffee-spoonful of this mixture is
swallowed an hour before eating every morning and evening
for, in severe cases, as long as one month, the patient mean-

time eating very little salt and no pepper or vegetables he ;

may, however, partake of butter, fresh milk, tea instead of


coffee, barley semolina and roasted meat —
the meat usually
being consumed stewed in Algeria; he should avoid cold and
exertion.
% The liver can be cleaned by slowly masticating two
* '

and a half grammes of the seeds of Foeniculum vulgare, L.


(common fennel) daily for fourteen days, while one soup-
spoonful of the extract obtained by pounding fresh leaves of
Solammi nigrum taken each morning, or a similar extract of
the leaves of Marrubium supinum, L., drunk in warm water,
may be used for the sam.e purpose, and in cases in which the '

roots of the liver are not working (to use my Shawiya


'

informant's own phrase) the following 'treatment may be


adopted
{c) Bruise the roots of Riibia ttnctorum (madder) and boil

them in water, thus producing a red liquid mix half a litre


;

of this liquid with a similar quantity of an infusion of the


roots of Zizyphus lotus, also a red fluid, and administer half
a coffee-cupful daily before breakfast,
[d] Tie up in fine cotton material some onions, previously
bruised in a mortar, and wring out their juice. Mix in a
bottle one coffee-cupful of this extract with similar quantities
of olive and red or white vinegar, the white variety for
oil
preference. Open very carefully an egg which has stood in
clean water all night and pour its contents into a cup. Fill
the empty egg-shell with the mixture from the bottle, and
cause the patient to drink this dose and, immediately after-
wards, to swallow the egg. This treatment, if carried out
every morning before partaking of food or coffee, should
effect a cure in six or seven days.
Jaundice is treated by administering daily before breakfast
72 MEDICINE
one coffee-cupful of a mixture of one part of the dried and
powdered leaves of Capparis spinosa, L. and five parts of
honey, no vegetables, sour foods, nor spices being allowed
to the patient during treatment and the following quaint
;

remedy for jaundice was also recommended by one of the


most successful practitioners I met with.
He pounds the fruits of Ecballium elaterium, Rich, to
extract their fluid this he places in a bowl and allows it to
;

settle, after which he bottles the clear fluid, throwing away


the sediment at the bottom of the bowl.' He causes the
patient to lie upon his back, and then places one drop of the
clear extract from the bottle into each of the patient's nostrils
so that '
it runs into his head '. In five minutes a yellow
foam-like discharge will exude from the patient's nose, and
the jaundice, of which the symptoms are a yellow tint in the
complexion and white of the eye, as well as irritability on the
part of the sufferer, will be found to be cured at once. The
seeds, leaves, or roots of the 'squirting cucumber' can be
used as described (the first being the strongest and the roots
the weakest), or fresh leaves of the plant may be inserted in
the pa:tient's nostrils.
Some doctors recommend bleeding on the crown of the
head for jaundice, but my informant stated that the use of
'
squirting cucumber ' as described above is to be preferred.
He also advised the washing of the patient in an infusion of
mint (of which he recognizes four varieties in addition to
Mentha rotundifolia, L.) in the treatment of this complaint.
For Affections of the Spleen some doctors advise the
swallowing of powdered flint in pills of honey, their suggestion
being that the flint causes the honey to rise as leaven '
'

causes dough to expand this treatment should be carried


:

out every morning for seven days. Another form of treat-


ment for the same complaint consists in preparing an infusion
of the fresh leaves and young shoots of Tamarix gallica, L.
(only bushes growing in the desert at some distance from
water should be employed), and boiling four parts of this
infusion with one part of vinegar, in order that the two in-
gredients may mix well, the resulting mixture being drunk
daily by the patient for seven days, and being, further, applied
MEDICINE 73

as a lotion to his side over the spleen. A small quantity of


ginger can be added to this mixture with advantage if it be
obtainable.
A third remedy for affections of the spleen (those in which
*
grains dans le rate are a symptom)
' is to administer one part
of the very bitter dried and powdered whole fruits of Cap-
paris spinosa, L. mixed with four parts
(var. rupestris, Sibth.)

of honey, the dried and powdered leaves of the same plant


being also used, but with a weaker effect. The fluid extracted
by pounding a fresh plant of Beta vulgaris, L. is drunk for
splenic troubles as well as for indigestion, while an infusion
of the leaves of the male Marrubimn supinum, having been
strained, swallowed for the same complaint, and the leaves,
is

dried, and the small black seeds of Rufa graveolens, L. pow-


dered and mixed in equal parts with honey, half a coffee-
spoonful of the mixture being taken each morning, constitute
yet another remedy for affections of the spleen.
Diarrhoea. As a check to diarrhoea seeds of Trigonella
gladiata, Stev. (fenugreek), burnt iron, sugar, and wheat are
powdered and mixed in exactly equal parts, one coffee-spoon-
ful of the mixture being swallowed, washed down with water :

or rice is given in milk; or powdered gallnut (of the oak) is


taken in milk; or a little honey is eaten each morning, the
patient being allowed no water to drink, but partaking of
an omelette of eggs and butter containing some powdered
'
haklilt a dried milk much used as a flavouring to foods in
',

the Aures or the roots of the oak tree are boiled to obtain
;

a red fluid which, when strained and re-boiled, will be found


to be rather thick, and is administered daily, one coffee-
spoonful before breakfast, instantly to check diarrhoea.
Two plants used in the treatment of liver complaints are
alsorecommended for diarrhoea, namely Foentcidum vulgare,
L.,whose dried and powdered roots are mixed with honey,
two parts of" powder to three parts of honey, a coffee-spoonful
of the mixture being swallowed daily for five. days; and
Zizyphus lotus, Willd., whose dried fruits are powdered, and
half a coffee-spoonful of the powder is consumed in the
morning before breakfast in an egg cooked *
a la coq ', but not
very hard-boiled
'
'.
74 MEDICINE
Cholera appears not to be treated by the Shawiya doctors,
its ravages, in common
with those of other epidemics, being
combated by withdrawing the population of the stricken vil-
lage to the shelter of the high-lying pine-forests which are
considered impregnable by the armies of jenun or demons,
'
',

which are believed to cause the outbreak, as I have explained


in Folklore (vol. xxvi, pp. 245 and 246) an instance of the
:

adoption of a very practical measure resulting from a magical


idea.
For Fever, which is common enough in the Aures and the
desert, especially the variety which recurs every three days,
I found remarkably few forms of treatment other than
magical observances {such as the wearing of charms) or the
use of quinine, which is now well known to the natives, and is
obtained in tablet form in the large towns : one doctor, how-
ever, suggested that the drinking of an infusion of any of the
five varieties of mint with which he is acquainted is useful in
cases of fever, while for the headache resulting from such
cases the patient should bathe the head in an infusion of the
fresh leaves of either hiula viscosa, Ait., vine, orange, walnut,
or bottle gourd, after which he should apply fresh leaves of
any one of these to the head.
A layman in a desert oasis advised fumigation in the smoke
of burning date-stones as a remedy for fever, and a sorceress,
also from the desert, employs Sesamum for the same purpose
and also a combination of rue and the seeds of Peganum
harmala, substances much used in magic besides which
:

hoopoe^ s feathers, black sheep's wool, and oleander leaves are used
for the fumigation of patients suffering from fever, a form of
treatment which owing to its slight practical effect and its
undoubted magical origin may perhaps bridge the almost
negligible gap between primitive medical science and the art
of magic.
Colds in the head are treated by causing the patient to
inhale steam obtained by pouring water upon a hot hearth-
stone, the inhalation taking place through an inverted halfa-
grass funnel such as is used for filling goatskins or the ;

smoke of burning sugar and walnut shells together is also in-


haled, care being taken to close the eyes, which may be
MEDICINE 75

injured by the smoke arising from the sugar. An infusion


of the seeds of Cynoglossum pictum, Ait. is drunk once daily,
a small coffee-cupful constituting the dose, for five days ;

while two other methods of treating a cold in the head consist


in {a) eating a hot loaf of the ordinary flat unleavened bread
of the country, which is folded over on itself and encloses
some pounded garlic this should be eaten without partaking
;

of any liquid, and the patient should forthwith go to bed and


cover himself well with rugs, a cure resulting next day or ;

{b)the swallowing of a raw egg upon which pepper has been


sprinkled.
Coughs and Chest Affections. In the treatment of these
we find that Pyrethriim^ which, as we have seen, was found
by Ebn el Beitar to be in use in Algeria before he introduced
it to the scientific world of his day, is recommended by the
doctors as well as by the ordinary natives of the Aures.
The roots of Pyrethrum are taken in soup or they are ;

powdered and swallowed in milk at bedtime, the patient also


retaining a piece of the root in his mouth so that he swallows
the liquid from it ; or the powdered roots are eaten in cow's
butter night and morning or an infusion of the roots is drunk
;

at bedtime or equal parts of Pyrethrum root, fenugreek seeds,


;

Piper cubeba and musk^ powdered and mixed together are


swallowed, one spoonful night and morning for seven days,
during which time lemons may not be eaten.
In addition to the use of Pyrethrum a considerable number
of other remedies are employed for the chest coughs to which
the natives, owing perhaps to the cold winds blowing from
the snow-capped peaks of the Aures while the sun is powerful
in the lower valleys, appear to be particularly subject. Among
them we have noted :

[a) An infusion of equal parts of the pounded leaves of


Sonchus maritimus and cinnamon, to which a little sugar is
added to counteract its bitterness dose, one tablespoonful
;

night and morning.


[b] Roasted seeds of Cuminum cyminum, L. and Negella

saliva powdered and mixed with btttter, one year old dose, ;

one coffee-spoonful night and morning.


;

76 MEDICINE
[c) Pounded leaves of Lavcndida tnultifida, L. eaten with
butter, one year old.
[d) A soup made of garlic and grains of either wheat or
barley, which must have been spht in two, is eaten the :

remedy being found in the garhc.


[e) The patient drinks oil instead of water.
(/) The berries of Juniperus phoemcea, L. are boiled
thoroughly and the
in water, left in the boiling pot all night,
infusion strained and bottled. This infusion will keep good
for several days in winter, but soon becomes sour in summer
time. It is given, fresh, in doses of half a coffee-cupful night
and morning for coughs.
{g) The powdered plant of Peganum harmala is eaten in
the morning mixed with honey.
{h) An infusion of roots of mallow {Malva sylvestris, L.)

which have been washed, scraped and cut into sections, is


given, one coffee-cupful night and morning.
While for coughs in which difficulty of respiration or a
shortness of breath are symptoms,
(/) One spoonful of an infusion of the dried leaves of

Pergularia tomentosa, L. [Daemia cordata R. Br.) is swallowed


night and morning for three days women who are enceinte,
;

however, may not take this or ;

{/) the flowers of Datura metel, L., dried and broken up,
are smoked in the form of a cigarette, or
{k) An infusion of the pounded leaves of Rosemarinus

officinalis, L. is drunk.
For coughs in children.
(/) A very little of the powdered roots oi Pistacia atlantica,
Desf. (terebinthe) is swallowed in oil, or
{m) One soup-spoonful of amixture of a species of
Lycoperdon and butter, heated together, is eaten each morning.
For Bronchitis, a mixture of powdered linseed and honey
had been recommended by a native doctor to a Jew who
informed me that the treatment had proved very beneficial
while one doctor uses the following medicine for bronchitis,
and has also found it to be efficacious in cases of gas poisoning
resulting from the war. He boils the flowers of violet in an
-enamelled pot until they become 'white', when the flowers
MEDICINE ^^

are thrown away and the remaining water is thickened with


sugar until it reaches the consistency of jam. The patient
takes his supper at 5 p.m., and swallows a coffee-cupful of
a mixture of a very little of this 'jam and water at bedtime,
'

and on rising in the morning for five da3^s. Sometimes a


poultice is applied for chest coughs, and this consists of

powdered colocynth, Lawsonia inermis (henna), Thapsia gar-


ganica, and a little red pepper mixed in honey.
Whooping Cough is usually treated by causing the patient
to drink asses' milk, a remedy which is very highly esteemed
by the natives, who claim that cures have been effected
after only three or four bowls of the milk have been con-
sumed.
Headache. The dried and powdered leaves of either
Thymus munbyanus, Boiss., Ecballtuni elaterium, Rich., Ajuga
iva, Schreb., or Mentha Rotundifolia, L., are administered in
the form of snuff for headache, which is also treated by
bathing the head with an infusion of the fresh leaves of the
first named or of the seeds of Hyoscyanms albiis, L., both of

which are regarded as soporifics and powdered seeds of


;

Peganum harmala and cloves mixed in vinegar are applied


to the head encased in the outer skin of a Barbary-fig (cactus)
leaf as a remedy for headaches, possibly on account of their
magical value.
Earache. An infusion of the powdered leaves of Thymus
munbyanus, strained through a cotton-rag before use, is intro-
duced a drop at a time into the ear which is painful as a result
of chill, as is a drop of the extract obtained by pounding
fresh leaves of Ajuga iva mixed with olive oil; while the dried
blood of a lizard, very common in the Sahara, Uromastrix
acanthinurus also mixed with olive
, oil, is employed in the
same way and regarded as a remedy for deafness.
is

The fresh capsules of asphodel, Asphodelus microcarpns,


are pricked, and the fluid they contain squeezed into the ear
for earache, which is considered by one of the doctors I met
with to be due to an affection of the side of the skull, and
asphodel is further employed in the treatment of earache in
conjunction with olive oil, a hole being made in the fresh root
of the plant which, the hole having been filled with olive oil,
78 MEDICINE
is heated and squeezed over the ear so that the oil and the
moisture from the root may drop into it.
A remedy for earache in children is prepared by bottling
flowers of rosemary, Rosmarinus Toiirneforti, de Noe, in oil
of Sesamum, and exposing them to the heat of the sun for
forty da3's, at the end of which time the flowers are thrown
away and the oil kept for introduction into the ear.
Twoforms of treatment for earache, which are also applied
to inflamed eyes, furnish us with additional examples of a
combination of medical science and magic, namel}^ the appli-
cation of a viper s skin boiled in olive o//and the introduction,
by means of the gall-bladder of a jackal, into the eye or ear
of an extract obtained by pounding leaves of the beet, Beta
vulgaris, L. for, as I have pointed out in Folklore (vol. xxvi,
:

pp. 230 and 248), the viper, owing to its spiteful disposition,
and a gall-bladder, on account of its bitterness, are highly
distasteful to the demons, which, in the opinion of the Shawiya
and the Arabs, are the cause of disease.
Rheumatism. As far as I, a layman, could judge, rheuma-
tism appeared to be very prevalent among the Shawiya. The
poultice alluded to as a remedy for chest affections, consisting
of colocynth, Lawsonia inermis, Thapsia garganica and red
pepper mixed in honeys is applied to the part affected or a :

mixture of one part of powdered roots of Thapsia garganica,


three parts of honey and a little powdered sulphur, heated

together to cause them to mix well, is similarly applied, or


a poultice of the extract obtained by pounding leaves of
Hyoscyamus albus, L., wrung out in rag and mixed with linseed
is used to ease rheumatic pain as is another poultice made
:

of the pounded leaves of Solanum nigrum, applied wrapped


in rag.
A nomad practitioner recommended that the part affected
by rheumatism should be bled or tattooed (tattoo is used in
medical magic for the treatment of some diseases, especially
of the eye) or that a heated root of Thapsia garganica should
;

be applied to the part after the manner of applying cauter}',


or that a mixture of olive oil and salt should be used as a lini-
ment, or some very sour white vinega) should be rubbed upon
the seat of the pain.
MEDICINE 79

Syphilis must, I think, rank among one of the more


common of the diseases to which the natives of the Aures
and the desert are subject, and it is well known to all the
practitioners I have met with under the name of The Great '

Sickness The doctors unanimously declared that they


'.

could cure syphilis, but some of them referred to the necessity


of repeating treatment should a patient again become infected,
so that it may well be that reappearance of the disease in
uncured cases is mistaken by the Shav/iya for re-infection.
Although the forms of treatment suggested by the three
best-known practitioners with whom I discussed the disease
are in the main similar to one another, yet there are certain
differences in them, so that I may with advantage describe
the remedies recommended by each.
The first of these doctors states that he recognizes no less
than ninety-nine symptoms of syphihs in its various stages,
and that nearly all the sickness in the Aures is, in one way
or another, attributable to it. It is noteworthy, perhaps,
that the number ninety-nine appears to have a certain mystic
significance in Algeria. The first symptom observed by this
doctor, before the appearance of the primary chancre, is the
hardening of a gland or, as he expressed it, vein ', on the '

inner side of the arm just over the elbow-joint, which becomes
as hard as a stone '. As a later symptom he recognizes
'

'
sweHing of the bones'. In treatment he takes the roots of
Sarsaparilla and the seeds ofLepidum sativum^ L., pounds
them to powder, and mixes two parts of each of the resultant
powders with one part of roasted wheat flour; this powder,
being mixed with one pound of honey, is administered to the
patient each morning and evening before meals for fifteen
days, one coffee-spoonful constituting the dose, but, in mild
cases, seven days of this treatment will suffice. This period
of treatment followed by fifteen days in which no drugs
is

are given, but in which the patient is carefully dieted, no


cooked meat other than roast mutton, no butter, no salt, and
no pepper being allowed to him, while to quench his thirst
he must partake of an infusion of Sarsaparilla instead of
water he may partake of olive oil should he wish to do so.
;

All this time the patient must sit in a room alone and avoid
8o MEDICINE
allexcitement, and no filthy conversation must take place in
his hearing. As an alternative to sarsaparilla this doctor
recommends the leaves of Globularia alypum to be used
instead of it while an infusion of a whole plant of Peganum
;

harmala can be taken as a beverage in place of the sarsaparilla


referred to above.
The same practitioner also recommends two forms of fumi-
gation for syphilis, one, in the steam of boiling roots of
Globularia alypum, or, as an alternative, in the smoke ffom
burning a substance, resembling saltpetre in appearance,
which produced by mixing the ashes of the salt-tasting
is

leaves o{ A triplex halimus, L. with


a little water and allowing
the mixture to dry.
A second doctor recommended the following forms of
treatment. The seeds of Peganum harmala are collected
during the summer and kept for four years, but for no longer,
as they then commence to deteriorate in value. These seeds,
which are said to be used for no less than seventy-three forms
of treatment, are excellent for syphilis. A purge, preferably
castor-oil, having been given
at the outset, one pill consisting
of a little powdered and mixed with honey is
of these seeds
swallowed night and morning for fifteen days, after which
a cure is effected. The powdered seeds are said to be intoxi-
cating like alcohol, and the seeds are so powerful that for
woman's use they are soaked in water to reduce their strength,
when they can be administered whole without being reduced
to powder. In mild cases of the disease a little of the pow-
dered seeds is daily placed beneath the patient's tongue.
During treatment salt must be avoided, and tea (as opposed
to coffee), and milk should be drunk.
As an alternative to the above treatment the same practi-
tioner advises the daily consumption of one packet of the *
'

powdered roots of salha (the dried Sarsaparilla which is


*
'

sold by native druggists in areas in which the fresh plant is


unobtainable), mixed with one packet of the powdered seeds
'
'

of Lepidum sativum, L., and washed down with a draught of


water, all the patient's food during treatment being cooked in
an infusion made from dried and powdered salha leaves, '
'

seeds of Lepidum sativum, not powdered, and roots of salha *


',
MEDICINE 8i

also not powdered. patient may not partake of bread


The
which contains any nor of fruit, vegetables, coffee, beef,
salt,

goat's flesh, nor butter-milk though fresh milk is allowed,


;

as is tea. He must eat in solitude, and may not smoke. This


diet is followed for forty days, at the end of which time
a cure is effected, any re-infection (or return) of the complaint
being treated in the same way. In the case of mild attacks
half doses of the medicine are prescribed.
The same doctor also suggests the fumigation of syphilitic
patients in the smoke of burning cinnabar, but he says the
patients should hold some oil in their mouths during the
fumigation as cinnabar contains mercury, and its fumes may
loosen the teeth. As wash for primary chancres he uses
a mixture in water of sulphide of copper and antimony, a sub-
stance much used by Algerian women to darken their eye-
brows and eyelids. For syphilitic sores on the nose and face
he uses a very quaintly prepared dusting powder. He catches
a number of specimens of a cantharide beetle, which in April
frequent the flowers of Jhapsia garganica and the olive tree,
and which Professor Poulton has identified as Mylabris oleae,
Cast. var. Rimosa (a variety, I believe, which is uncommon
in collections). He places these beetles in a bottle, carefully
wiring down the cork, and buries the bottle for forty da3^s in
the summer in manure, preferably that of the horse. Nothing
isbottled with the insects, but during their interment they
decompose, leaving maggots among the debris of their bodies,
which debris these maggots consume. The maggots are
then collected and crushed to powder upon a white plate,
and applied to syphilitic sores on the nose and face, which
sores will heal after-three or four daily applications. In the
case of dry sores the powdered maggots may be retained
by the admixture of a small quantity of cow's
in position
butter containing no
salt. We shall find later on that these
powdered maggots are put to another use in the treatment of
Boils.
The third doctor who gave me careful details of the treat-
ment of syphilis recognizes a quick pulse, inability to swallow
easily, and 'pains all over' as symptoms of the disease; some
patients also displaying external sores. He takes a new
82 MEDICINE
earthen bowl, and in it he prepares an infusion of a whole
plant of Globularia alyptim, L., cut into small pieces. All
bread and steamed semolina, the usual native fare, eaten by
the patient must be cooked in this infusion for thirty days,
and no salt or condiment may be used in its preparation, so
that should the patient desire to eat butter such butter must
be fresh and contain no salt. He also prepares thirty small
'
packets of powdered salha (the dried Sarsaparilla of local
'
'
'

commerce), one packet being swallowed by the patient


morning and evening for fifteen days, the only liquid refresh-
ment allowed him during this period consisting of an infusion
oifresh Sarsaparilla roots. After this treatment has been in
progress for four days a little meratry, Lawsonia inermis
{herma dried for sale), and Ruta graveolens, L., are WTapped
in paper and thrown on the fire, the patient shrouding him-
self in his burnous or hooded cloak, so as to expose his
'
',

whole body to the smoke, but taking care to close his eyes,
ears, nose, and mouth to which the fumes are injurious. The
fumigation is carried out once daily, and the resulting cure is
permanent.
This practitioner, hke the other two, is of opinion that
cleanliness of person and surroundings is of the utmost
importance in the treatment of syphilis, and that the patient
should be left quietly in a room apart where no disgusting
talk can reach his ears.
Gonorrhoea, another very common complaint in the hills
and the desert, is treated by one doctor by sprinkling dried
and powdered stinging nettles mixed with jasmine powdered
(purchased in the towns) around and upon the penis and
scrotum at night, the patient being forbidden to ride or to
have sexual intercourse another causes the patient to drink,
;

night and morning, one coffee-cupful of an infusion of the


roots of a plant which is stated at Kew to be probably yw?/c«5
maritinms, Lam., the stem of which is not used while a third ;

practitioner, in the treatment of both sexes, advises the


swallowing of a little of the powdered seeds of Lepidum
sativum, L., followed b}^ the drinking of an infusion of a
species of thyme, pronounced by Dr. Church of Oxford to be
probably Thymus fontanesi, var. pallcscens, this form of treat-
; ^

MEDICINE 83

ment constituting an aid to urination. Urination is also


increased bymeans of either of the following medicines :

(a) One coffee-cupful of the pounded


of an infusion
leaves of Rosemarintis drunk each morning
officinalis, L.,
before breakfast (this was advised for the male sex only)
{b) An infusion of a whole plant of Delphinium Balansae,

Boiss. et Reut., taken internally ; or


(c) The extract obtained by pounding fresh leaves of a
species of Pimpinella, resembling a small celery in appearance
and scent, is mixed with a little water and swallowed, one
tablespoonful before breakfast and at bedtime. Another aid
to urination, said also to be valuable in the treatment of
'
stone ', consists in olive oil and a mixture of
swallowing
/loney and the powdered fruits of the ash tree olive oil being :

sometimes introduced into the penis by means of a French


syringe for the same purpose.
Stricture, for which one surgeon stated that he could
perform an operation, is treated by causing the patient to
swallow half a coffee-cupful of a mixture consisting of one
litre of pure olive oil and one franc's worth of acetate of copper

which dose may be repeated next day if necessary, and which


is said to '
force' urination.
One met with suggested a mixture of the seeds
doctor I

of stinging nettles and raisin pulp, presumably swallowed, as


a suitable remedy for stricture.
Swollen Testicles are treated by the application of a hot
poultice of barley flour and the pounded fresh leaves of
Hyoscyamus albus, L. or by the daily consumption for seven
;

days of a coffee-spoonful of an infusion of the leaves of Ec-


ballium elaterium^ Rich., swallowed with a cup of coffee the :

seeds, leaves, or roots of this squirting cucumber may be


*
'

so used at will, the seeds being the strongest and the roots
the least powerful.
Haemorrhoids, when external, are sometimes surgically
treated by passing through them a cow's sinew steeped
in ointment, a needle being used to make way for the
sinew, but several other remedies are employed, often by
laymen, such as the application of the ashes of leaves of
Globularia alypum, L., mixed with the ashes of the leaves of
84 MEDICINE
Juniperus oxycedrus, L., in oil or water, or the eating of a
coffee-spoonful of honey and garlic, which mixture is also
applied to the anus, forms of treatment which are also used
in cases of internal haemorrhoids.
One doctor advises the appHcation of the fluid resulting
from heating jv6)/>^ of egg in a pot; or the fumigation of the
anus in the smoke of a fruit of colocynth which has been
cooked in cinders and sliced in half, upon which a little salt
has been sprinkled.
Another pounds the interior of a colocynth fruit, mixes it
with a few spoonfuls of honey to form an ointment, heats it
and applies it on a pad of rag to the anus, where it should
remain all night, the severe pain which this treatment is said
to cause being alleviated by the application of melted butter,
sheep's butter being universally regarded as the best for
medicinal purposes.
Anointment also used in the treatment of haemorrhoids,
but which is said to be very expensive for some reason which

I am quite unable to fathom, is made of a mixture of pine

pitch, camphor, mint, and salt crystals;


possibly the salt used
is of a kind which is not easily obtainable and, therefore,

comparatively expensive.
Patients are sometimes made to eat yolk of egg fried until
it becomes black as pitch
'
', one spoonful being consumed
daily, while a diet of oil, butter, and unleavened bread is
followed to the exclusion of meat, dates, and vegetables.
The cast skin of a local viper is also eaten as a cure for
'
'

haemorrhoids, being cut into small pieces, and made into


a kind of cake with semoHna.
Skin Diseases. A very remarkable proportion of the
children of the Aures and of the desert, more especially the
latter, suffer from a form of itch which produces scabs all
over the head and consequent loss of hair.
A mixture of the ashes oi oleander leaves, gunpowder, sulphur,
and hotiey (fresh butter, with no salt in it, can take the place
of the last named) is used as an ointment for this itch, or the
fat of either of the two lizards, Uromastrix acanthinurus, or

Varanus griscus is used as an ointment (the similarity between


the Latin name of the latter and its Arabic designation,
;

MEDICINE 85
'
Waran ', is remarkable) ; or the powdered roots of Thapsia
garganica mixed by heating with honey, in the proportion of
one part powder to three parts honey, to which a Httle sulphur
is added, is also used as an ointment for itch and to remove

warts while another ointment for the same purpose is made


;

of the ashes of Artemisia herba alba mixed with olive and


almond oil. The pitch of pine is applied to the head for the
same complaint, a pad being laid over it consisting of sheep's
wool, which must be dirty. It is curious that the use of dirty
wool, often cut from the hind quarters of the sheep, is insisted
upon in various magical observances in Algeria and also for
the cleansing and contraction of the vagina.
I have found two lotions in use in the treatment of itch,

one consisting of two parts of the extract of pounded leaves


of Solanum nigrum, L. (var. villosum, Lam.), mixed with one
part of the gall secretion of a cow, which is also applied to
pimples on the face and the other of an infusion of the
;

bruised leaves of oleander. An infusion of mint, Mentha


rotundifolia, L., is taken internally for itch.
For small White-headed Pimples the patient is fumigated
in the smoke of a burning plant of Deverra scoparia, Coss
while '
Rue remedy for several complaints, is also
butter ', a
applied to them, beingmade as follows. The leaves of Ruta
montana, L., are boiled in water until the water becomes
yellow, when the leaves are thrown away and the water
strained. The water is then mixed in equal parts with olive
oil, the mixture being boiled until only half the original
quantity remains. It is then bottled and stored for subse-
quent use.
The milk-like sap from the stem of Pergularia tomentosa, L.
{Daemia cordata, R. Br.), from which the Arabic name of the
plant, Halib ed daba milk of the she-ass '), is derived, is con-
('

sidered to be injurious to healthy skin, but its application is


recommended to eat away dead skin by which scabs may,
'
',

perhaps, be meant.
Melanodermia, which found in Morocco and stated by
is

Dr. Raynaud in his ^tude sur I' Hygiene et la Mddecine au


Maroc (p. 146) to correspond with the melas of Celsus, is '
'

not uncommon in the Aures and the Algerian Sahara. It is


;

86 MEDICINE
treated by the application of a lotion formed of equal parts of
white vinegar and the extract obtained by pounding the leaves
of Ruta graveolens, L.
For the complaint in which the skin becomes white in
patches and the blood also becomes white, to quote my native
informant, a mixture of the extract of pounded fresh leaves
of Beta vulgaris, L., and almond oil is recommended, but I
have not yet discovered how or in what quantities it is
administered.
Baldness is treated by the application of a lotion made by
boiling a viper's skin in olive oil; or of a mixture of olive oil
and the ashes of a green lizard, known to the Arabs as
*
burrion a specimen of which I have not yet obtained. A
',

lotion to make the hair fine and red is prepared by mixing


' '

an extract of the pounded leaves of Beta vulgaris, L., with


powdered henna [Lawsonia inermis).
*
'

Boils are treated by causing the patient to drink a coffee-


cupful of the extract obtained by pounding young leaves of
Genista spartioides, Spach. [Retama monosperma, Boiss.), after
which he is well wrapped up to induce perspiration having ;

freely perspired, he drinks hot mutton broth strongly spiced


with red pepper. If in three days the boils have not dis-
appeared they are regarded as syphilitic, and the patient
fumigated. For small boils on the hands three and a quarter
grammes weight of viper s skin is divided into three parts,
and each part eaten enclosed in a date.
To large boils, which each consist of a number of smaller
ones and which tend to spread, an ointment is applied made
by mixing cedar pitch with ashes of the root of the globe '

thistle
', Echinops spinosus, L., the outer skin of the root
having first been scraped away.
In order to cause boils to burst and to draw out the pus
which they contain a fresh leaf of Cynoglossum pictum, Ait.,
is bound upon the part or half of a fruit of colocynth, which
;

has been heated over a fire, is similarly bound, the bitterness


of it being noticeable in the patient's mouth as it is applied
or a poultice consisting of a dhedifig, heated and besprinkled
with a httle olive oil, is used for the same purpose the last ;

two forms of treatment being recommended for Biskra *


MEDICINE 87

Button '
as well as for ordinary boils. A dusting powder
consisting of the dried leaves of Pergularia tomentosa, L.
[Daemia cordata, R. Br.), finely powdered is applied daily for
two or three days to boils which spread upon the arms and
legs while for those which appear upon the arms and thighs
;

and give off a watery discharge the part affected is bathed


with a mixture of sulphide of copper, after which some pow-
dered maggots of the Mylahris beetle, already referred to in
the treatment of syphilis, are applied as a dusting powder.
In three or four days a cure is affected by this treatment.
Abscesses, under which headmg I have included the
affection described to me as a '
painful swelling ', are treated
by means of various such as the dried plant of
poultices,
Sonchus maritimuSy L., mixed with milk and flour which,
apphed tepid, causes the swelling to disappear without
breaking or the pounded green leaves of Plantago major, L.,
;

mixed with an equal quantity of powdered beans upon which


a few drops of vinegar is sprinkled a mixture, in honey, of
:

colocynth, Lawsonia inermis, Thapsia garganica (all powdered)


and a little red pepper or dried and powdered leaves of
:

Thymelaea hirsuta, Endl. {Passerina hirsuta, L.), boiled in


niilk or vinegar; or fresh leaves of Hyoscyamus albus, L.,
pounded in a clean mortar, and applied hot, in barley flour,
the last two forms of treatment being especially recommended
for causing the abscesses to break.
Should the surgeon find it necessary to open a swelling
contaming pus he uses powdered flint as a dusting powder.
Upon painful swellings in general the powdered fruits of the
Cyprus are sprinkled.
Affections of the Mouth. For receding gums the patient
bites the fresh root ofEryngium campestre, L., and applies
the bitten end to his gums for gums which are sore or
;

ulcerated the mouth is rinsed with an infusion of olive leaves


in two coflfee-cupfuls of water in which ten grammes of alum
have been dissolved while for the soreness of the tongue
;

resulting from an excessive use of tobacco olive leaves are


chewed and retained in the mouth all night or a solution of ;

alum in water is used to rinse the mouth.


Dropsy is sometimes treated by the introduction of 'setons'.
88 MEDICINE
One doctor, however, recommends the drinking, morning
and evening, of a tablespoonful of water in which the roots
of Zizyphus lotus, Willd., have been soaked all night this ;

dose acting as a thirst quencher and a slight aperient or, as ;

an alternative, he suggests one tablespoonful, taken morning


and evening, of a mixture of water and the extract from
pounded green leaves of a species of Pimpinella or an in- ;

fusion of the leaves of Rosemarinus officinalis, L. while ;

another doctor advised the external application to the abdo-


men of an extract from the pounded leaves of Nasturtium
officinale, R. Br., after the patient has taken a bath, this
treatment being intended to disperse the 'water in the
stomach '.

As a thirst quencher an infusion of Cynodon dactylon, L., is


recommended to those suffering from the above complaint
and also to mothers, who should not partake of too much
liquid.
Small-pox regarded as most serious, and its result is
is

believed to be hands of God alone the only treatment


in the ;

for the disease I have yet found is identical with that sug-
gested for Measles, and consists in attaching the bladder of
a freshly killed lamb or goat to the patient's head so that the
urine it contains can touch his head, but not flow away (this
is said to restore consciousness in extreme cases), the patient

being made to eat honey every day.


But inoculation against small-pox is known, and is carried
out by applying a little pus from a sore of an infected person
to three scratches between the forefinger and thumb of the
person to be inoculated, a method similar to one described as
existing in Arabia by Burckhardt in his Notes on the Bedouins
and Wahdbys (London, 1831, vol.
i, p. 91). This inoculation,
however, can only take place during an outbreak of the
disease, for the Shawiya have no means of storing the
necessary pus for future use.
Inoculation is also practised in the following manner for
illnesscaused by the bite of certain spiders. A yellow insect,
resembling a bee, frequents the Thapsia garganica plant in
the spring, especially in the stony desert to the south of El
Qantara. This insect is caught and placed in a white bottle
:

MEDICINE 89

of boiled water, in which it is exposed to the full blaze of the

summer sun from thirty to forty days, when it will be


for
found to have fermented the part affected by the bite of the
;

spider is then scratched, and a little liquid from the bottle


introduced into the scratches after the manner of vaccination ;

the patient taking a purge and drinking tea.


These spiders are said to deposit liquid near to the eye of
their victim, the tissues round the eye becoming much swollen,
the liquid referred to above is used to bathe such swellings,
but must not touch the eyeball itself or blindness will result.
Of this bee-like insect I have not yet secured a specimen it ;

is said, in life, to pursue and kill the dangerous spiders when

it finds them upon the Thapsia plant.

Obstetric Medicine. Accouchement is usually easy


among the Shawiya and the Arabs, the doctor being rarely
called in, although as we have seen, occasionally an operation
is performed for the removal of a dead child. To ascertain
whether or no a woman is enceinte the red liquid resulting
from boiling pounded roots of madder [Rubia tinctoritm) is
given to her to drink, and if the subsequent urine is red she
is pronounced not to be pregnant, while should the urine be
'
white she is considered to be enceinte.
'

It may be that madder is believed to induce menstruation,

a suggestion which we shall find to be supported when we


examine Shawiya methods of preventing conception.
It is bad for a woman to drink more than a very little water

at the time her child is born, the illness resulting from im-
moderate consumption of water being treated in one of the
three following ways
{a) Eggs are made into an omelette and powdered stems
of a plant which, according to Leclerc's translation of Abder-
rezzaq, appears to be Thapsia villosay are sprinkled upon
them, the patient eating such an omelette every morning for
three days ; or
[b) A
loaf of unleavened bread in the preparation of
flat

which goaf s fat has been liberally used, is eaten, and the
stale
patient allowed to walk a little, after which she may drink
a large quantity of water ; or
(c) A plant of Capparis spinosa, L., is boiled in oil, which
90 MEDICINE
the patient drinks each morning for three days when a cure
will result.
When the child is badly placed and delivery accordingly
impeded a mixture of powdered carrot seeds, the body of the
beetle, Mylabris oleae, var, Rtmosa, and a plant of Euphorbia
is placed in hot water and allowed to cool. When cold one
coffee-cupful of the mixture is swallowed, and within five
minutes the child will be born. There is no loss of conscious-
ness on the part of the patient, but, in the words of the doctor
who described this treatment to me, the mixture '
forces the
child to be born '.

woman which render delivery


In cases of malformation in a
impossible, conception prevented or abortion caused by
is

the doctor, and doubtless in other cases as well, though many


old women can be found to assist an erring friend in this
respect by magical and other practices without summoning
medical aid. A root of madder {Rubia tinctoriim, L.) is scraped
clean and a piece of it about two-thirds of an inch in length
is inserted into the vagina and causes menstruation to re-

commence even if it has not occurred for three months, a


treatment the success of which is absolutely guaranteed by
my Shawiya informant.
Conception is also prevented by fumigating the vagina in
the smoke of burning sulphur', or by swallowing castor-oil
seeds which have been dipped in the warm blood of a freshly
being prevented for one year for
killed rabbit, conception
each seed so swallowed or foam from the mouth of a male
;

camel in the 'rutting' season is consumed in water for the


same purpose.
Excessive Menstruation is checked by swallowing an
infusion of blackberry seeds ; or a coffee-spoonful of a powder
consisting o{ fenugreek seeds {Trigonella gladiata, Stev.), burnt
iron, sugar and wheat, mixed in exactly equal parts.
Aphrodisiacs of a magical nature are very commonly em-
ployed in Algeria, and I have described some of them in the
Journal of the Royal Anthropological Institute (vol. xliii) and
in Folklore (vol. xxvi).
Theeating of nuts and honey before breakfast is a very
usual course followed by men to attain increased sexual
MEDICINE 91

virility : while the consumption of a sheep's testicles cooked


with olive oil, garlic, butter, and honey is also recommended

for thesame purpose as is the eating of goat's flesh stewed


:

with powdered leaves of Ajuga iva, the patient previously


steaming his genital organs in the vapours arising from the
dish as it stews. Pyrethrum is also employed as an aphro-
disiac, twenty-five grammes of its powdered roots being
heated with half a pound of honey which, when cold, is rolled
into pills the size of a bean one pill being swallowed in the
;

morning for fifteen days, and one in the evening, when sexual
be required.
virility will
Rabies very common in the dogs which are to be found
is

in every Algerian hut or tent and to prevent hydrophobia


;

resulting from the bite of an animal suffering from it the


victim eats three little lumps, each as big as a grain of wheat,
of the powder obtained from the maggots of the decaying
beetle Mylahris oleae, var. Rimosa, which, as we have seen,
is used in the treatment of syphilis, the three lumps being

enclosed in a date, and the dose taken once daily. In order


to ascertain if hydrophobia will result from a bite, the victim
bites off a piece of bread and offers it to a dog, if the dog
accepts it hydrophobia will not result, but should it refuse
the morsel the victim knows that he is infected, for the dogs
have a power of detecting the presence of the disease.
Other means of preventing hydrophobia consist in causing
the patient to eat a little of the dried leaves of Ajuga iva,
Schreb., in honey (a little only, as too much will cause colic),

or a little of the extract of a pounded fresh plant of Genista


Spach. {Retama monosperma, Boiss.), is swallowed
spartioides,
in a cupful of water daily for seven days, some doctors
recommending its use for three days only, and stating that it
acts as a vomitive.
Inflammation of a Vein. The following treatments were
recommended by two practitioners for acute pain in a vein in
the leg which would appear to be caused by inflammation of
the internal saphenus vein : five grammes weight of the pulp
of colocynth is eaten in a coffee-spoonful of pure honey, a purge
which cleanses the bad blood that causes the pain ; or a wal-
nut shell, split in half, is attached to the leg about four inches
92 MEDICINE
above the ankle, and acts as a receptable to hold in place
some Clematis Jlammula, L., which will cause an abscess (or,
perhaps, ulcer) to appear and to run for ten days, after
' '

which a cure results. The natives say that this abscess or


ulcer, which is very deep, is the cause of the pain along the
course of the vein. The rubbing of the leg with ostrich fat is
also suggested for this complaint.
Sunstroke is said to be immediately cured by applying to
the head a mixture oi barley flour, pounded onions,dir\(\ a little
vinegar, which is the only remedy I have found for a complaint
that does not seem to be so frequent as might be supposed
under the Saharan sun.
Mumps are treated by the external application of powdered
roots oi Lyciiim eiiropaemn, L., cooked in milk or vinegar; or
of the ointment known as Rue Butter which, prepared as
already described, is used for sores, backache, pimples, and
ear-ache.
Before concluding my notes on Shawiya materia medica
with a list of dressings for sores, &c., I may mention one
remedy which, upon the authority of Daud el Antaky, one
doctor informed me was a panacea for all ills which afflict
the human body from the chest to the head inclusive, namely
powdered seeds of Peganum harmala mixed with hot water
and oil of poppies drunk sweetened with sugar.
We have noted the use of Peganum harmala for several
complaints, but, in the opinion of my informant, it is valuable
for all ills of the parts of the human body mentioned.
Running Soresare treated by the application of a fresh
leaf ofCynoglossum pictum, Ait., or by sprinkling the ashes
of a whole dried plant oi Anabasis articulata, Mog., upon a
coating of butter placed upon the sore to retain the ashes in
position or by washing the sore with an infusion of the
:

fresh leaves of Anabasis articulata or by the application of


:

fresh pounded leaves of the peach tree.


once witnessed the following treatment of sores, not deep
I

ones, upon the outer side of both legs above the ankles of a
man about fifty years of age. The doctor applied melted
butter, sheep's or cow's butter serving equally well, to the
sore on the right leg, sprinkled some powdered litharge upon
MEDICINE 93

it and, having covered it with a pad of wool, bandaged it up.

The left leg was first washed with soap and then treated in
the same way save that a layer of squashed dates, as thick as a
pancake, was bound to the part in place of the pad of wool.
The doctor left some powdered gallnut to be daily applied in
honey and butter by the patient's wife. Legs of children
which are rendered sore by urination are sprinkled with the
powdered imder-bark ofpine.
Burns and Scalds are both treated alike, the white of a
raw egg is applied to the injured part and roots of the thistle
are chewed in the mouth and the juice thus extracted is also
applied, as it is to blisters which have been pricked.
INDEX OF MATERIA MEDICA
(Items purchased in towns marked M)

Jjiiga tva, 38, 66, 70, 77, 91. Colocynth, 25, 64, 68, 78, 84, 86,87,
Almond oil, M, 85, 86. 91.
Aloes, M, 67. Copper, acetate, M, 18, 55, 57, 65,
Alum, M, 18, 38, 53, 55, 65, 66, 87. 67, 83.
Ammonium chloride, M, 65, 67. — sulphide, M, 28, 65, 67,81, 87.
,

Anabasis articidala, 92. Coral, M, 17, 54.


Antimony, M, 56, 58, 61, 81. Cotton, M, 56.
Apium nodiflorum, 67. Cow, gall, 85.
Arsenic, sulphide, M, 18, 65, 66. Cumiimm cyminum, 69, 71, 75.
Artemisia, 66. Cyiiodon dactylon, 88.
Artemisia absinthum, 70. Cynoglossum pictum, 75, 86, 92.
Artemisia herba alba, 20, 22, 67, 69, Cyprus, 70, 87.
70, 85.
Asafoetida, M, 17, 64. Date, 47, 74, 86, 93.
Ash tree, seeds, M, 18, 83, Datura metel, 76.
Ashes, 28. Delphinium Balansae, 69, 83.
Asphodelus microcarpus, 77. Deverra scoparia, 85.
A triplex halimus, 80. Dung, cow, 48.
— ,
goat, 28, 61.
Barbary fig, 77. — , mule, 49.
Barley, 37, 42, 76, 83, 87, 92.
Bamboo, 56. Earth, 17, 28.
Beans, 87. Ecballium elaterium, 69, 72, 77, 83.
Beetle, larva, 66. Echinops spirtosus, 86.
Benjoin, M, 67. Egg, chicken's, 46, 53, 55, 66, 71,
Beta vulgaris, 55, 70, 73, 78, 86. 73, 75, 84, 89, 93.
Blackberry, 66, 90. — ostrich, M, 54, 55.
,

Butter, 32, 37, 38, 42, 47, 61, 62, 65, Erodium botrys, 66.
66, 73, 75, 76, 84, 91-3. Erodium guttatum, 66.
Erodium malocoides, 66, 67, 70.
Camel fat, Eryngium campestre, 87.
— fiesh, 55.50. Euphorbia, 69, 90.
— foam, 90. Euphorbia lathrys, 68.
Camphor, M, 84.
Candle grease, M, 67. Fenugreek, see Trigonella.
Cantharides, M, 59. Fig, 86.
Castor oil, M, 80, 90. Fir, 66.
Capparis spinosa, 70, 72, 73, 89. Flint, 72, 87.
Carrot, seeds, 90. Flour, 37, 42, 46, 87.
Cedar, 23. Foemculum vulgare, 71, 73,
Cinnabar, M, 69, 81.
Cinnamon, M, 75. Gallnut, oak, M, 28, 47, 73, 93.
Clematis flammula, 92. Garlic, 75, 76, 84, 91.
Cloves, M, 67, 77. Gazelle, gall, 55.
INDEX OF MATERIA MEDICA 95

Genista spartioides, 86, 91. Oak, roots, 73.


Ginger, M, 73. Oleander, 74, 84, 85.
Goat, fat, 62, 89. Olive, leaves, 64, 87.
— kidney, 67.
, Olive oil, 28, 40, 42, 49, 50, 53, 55,
Gunpowder, M, 84. 66, 67, 69, 71, 76-8, 83, 85, 86, 91.
Onions, 71, 92.
Hair, human, 55. Opium, M, 63.
Honey, 37, 47, 57, 59, 65-73, 76-80, Orange, 20, 22, 74.
83-5, 87, 88, 91, 93. Ostrich, fat, 92.
Hyoscyamus albus, 29, 77, 78, 83, 87.
Peach, leaves, 92.
Inula viscosa, 74. Pearls, M, 54.
Iron, burnt, M, 55, 73, 90. Peganum harmala, 66-8, 74, 76, 77,
80, 92.
Jackal, gall, 55. Pepper, red, 17, 75, 77, 78.
Jasmine, M, 82. Pergitlaria tomentosa, 76, 85, 87.
Juncus maritimns, 82. Pimpinella, 55, 70, 83, 88.
Juniper, 23. Pine, 37, 62, 66, 93.
Junipenis oxycedriis, 66, 84. Piper Ciibeba, M, 75.
— phoenicea, 28, 32, 40, 58, 61, 66, Piper longitm, M, 55.
76. Pistacia atlantica, 76.
Pitch, 23, 24, 63, 64, 66.
Lavendida multijida, 76. — cedar, 23, 46, 86.
,

Lawsonia inermis (henna), 58, 77, — pine, 23, 38, 84, 85.
,

78, 82, 86, 87. Plantago major, 87.


Lemon-peel, 67. Poppy, oil, M,
92.
Lepidmn sativum, 79, 80, 82. Ptychotis atlantica, 70.
Lime, M, 64. Pyrethrum, M, 10, 67, 75, 91.
Linseed, M, 47, 76, 78.
Litharge, M, 92. Quince, 56.
Lizard, green, 86. Quinine, M, 74.
— uromastrix, 25, 29, 63, 77, 84.
,

— , varaniis, 17, 63, 84. Rabbit, blood, 90.


Lyciimi eitropaeiim, 53, 92. Raisin, 83.
Lycoperdon, 76. Rice, M, 73.
Rosemarinus officinalis, 70, 76, 83,
Malva sylvestris, 47, 67, 76. 88.
Marrubium siipinum, 55, 64, 66, 71, Rosemarinus Tourneforti, 78.
73- Rosewater, 20, 22, 54, 55, 68.
Melon, flowers, 59. Rubia tinctorum, 66, 67, 71, 89, 90.
Mentha rotundtfolia, 59, 63, 69, 70, Rue, 74, 92.
72, 77. 85. Ruta graveolens, 73, 82, 86.
Mercury, M, 82. Ruta montana, 85.
Milk, 47, 55, 67-9, 73, 75, 87, 92.
— , asses', 77. Saffron, M, 38, 53-5.
— , dried, 73. Saliva, 40.
— , woman's, 55. Salt, M, 46, 48, 49, 53, 78, 84.
Mint, 72, 74, 84. — , crystals, M, 84.
Musk, M, 75. Saltpetre, M, 53, 67.
Mylahris oleae, beetle, 81, 87, 90, 91. Salvia clandcstina, 66.
Myrobalan, M, 18, 69. Sarsaparilla, M, 18, 25, 79, 80, 82.
Myrrh, M, 67. Scorpion, 54.
Senna, M, 69.
Narcissus tasetta, 67. Sesamum, M, 74, 78.
Nasturtium officinale, 88. .Sheep, testicles, 91.
Negella saliva, 69, 75. Snuff, M, 28.
96 INDEX OF MATERIA MEDICA
Solanmn nigrum, 28, 56, 71, 78, 85. Thymus Fontanesi, 82.
Sonchiis niariihntts, 55, 75, 87. Thymus tiitinbyanus, 77,
Stinging-nettles, 82, 83. Trigonella gladiata, 73, 75, 90.
Sugar, M, 38, 69, 73, 74, 77, 90, 92.
Sugar-candy, M, 18, 55. Vine, 74.
Sulphur, M, 78, 84, 85, 90. Vinegar, M, 55, 64, 67, 71, 72, 77,
78, 86, 87, 92.
Tamarix gallica, 65, 71, 72. Violet, 20, 76.
Teucrium polium, 38, 66, 70. Viper, 55, 64, 78, 84, 86.
Tliapsia garganica, 52, 66. 68, 77,
78, 85, 87, 88. Walnut, 28, 74,
Thapsia vtllosa, 89. Wheat, 37, 42, 46, 63, 73, 76, 79,
Thistle, 93. 90.
Thyme, 64, 69, 70.
Thymelaea hirsuta, 42, 66, 68, 87. Zizyphus lotus, 55, 71, 73, 88.
R Hilton-Simpson, Melville
653 William
Am5 Arab medicine & surgery"

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