Historians traditionally have divided the occurrence of the bubonic plague (Yersinia Pestis) into three pandemics that date roughly to 541–750, 1347–1722, and 1894–present.
Note of the Editor: This article, “Plague and Contagion” written by Justin K. Stearns, is Chapter Eleven, Pages 112-119, extracted from the book “1001 Cures: Contributions in Medicine & Healthcare from Muslim Civilisation” editor Peter Pormann, published by the Foundation for Science, Technology and Civilisation, UK. The content of this chapter is relevant to the current pandemic environment around the world.
“To abandon an entire community, which one has been called to govern, and to leave it without official or government, exposed to all kinds of danger such as murder, riots, and every imaginable disaster is a great sin. It is the kind of disaster that the devil would like to instigate wherever there is no law or order…. Yes, no one should dare leave his neighbour unless there are others who will take care of the sick in their stead, and nurse them.“
Martin Luther, Whether one may Flee from a Deadly Plague (ed. Wiencke 1968, 113-138)
“I wrote down my frank views on this matter and announced in every assembly in which I conversed that caution and care had to be taken in every area where there was an epidemic or plague, and that this was both a revealed ruling and a rational law. I went further and argued that doing so was recommended if not prescribed, and that entering epidemic areas was forbidden according both to revealed law and reason, and that it was not something that was done by either the intelligent or the learned. I also stated that only those afflicted with the malady of insanity or possession would consider themselves above this view.”
Idrīs ibn Ḥusām al-Dīn al-Bidlīsī, Risālat al-ʿibāʾ ʿan mawāqiʾ al-wabāʾ_
(Sulemaniye Esad Efendi MS 275, fols. 102–61, on fol. 103b.)
These two passages, written within a few decades of each other at the beginning of the sixteenth century illustrate well the historiographic perils of addressing the ways in which Muslims responded to the challenge of epidemic disease – especially plague – during the pre-modern period. Several generations of European and American historians of both Europe and the Middle East have argued that Muslim attitudes towards plague were characterised by fatalism, that Muslims believed that to die of the plague was martyrdom, and that Muslims rejected the phenomenon of contagion because the Prophet Muḥammad had denied it. In this chapter, I will show that the case was quite different, and that a rich and complex religious and medical tradition has been distorted. This has happened due to a modern preoccupation with empiricism, rationality, and a widespread belief in the incompatibility of religion and science. Conversely, I will also argue that it would be mistaken to see in individual strands of the pre-modern Islamic tradition precedents for contemporary responses to epidemic disease. The reality is quite distinct: the creativeness of Muslim responses to epidemic diseases and their transmission has been obscured precisely because it took place within a series of frameworks that are quite foreign to us today. These medical and theological frameworks predate both the nineteenth-century laboratory conception of disease and the myth of the irreconcilable relationship of science and religion.
The first of the two passages given above with its stress on a Christian’s responsibility for taking care of his brethren was authored by the Protestant reformer Martin Luther (d. 1546). The second with its strident defence of avoiding the plague and of the compatibility of reason and revelation comes from the plague treatise of a Kurdish scholar writing for the Ottoman Sultan Selim II, Ḥusām al-Dīn al-Bidlīsī (d. 926/1520). These examples function to complicate the easy identification of Islam and Christianity with the respective stereotypical responses of fatalism and self-preservation. Instead, they encourage us to look more closely at how people of faith constructed their understandings of plague and contagion.
Historians traditionally have divided the occurrence of the bubonic plague (Yersinia Pestis) into three pandemics that date roughly to 541–750, 1347–1722, and 1894–present. While this periodisation has increasingly come into question – the evidence for the Middle East suggests that the separation of especially the second and third pandemic may be artificial – it is clear that the Muslim community encountered plague very early on in its development. In c. 638, during the initial expansion of Muslim armies into Syria that led to the conquest of Jerusalem, the plague struck the Muslim forces, killing many of them. This encounter, referred to in Muslim sources as the plague of ʿAmwas, figured prominently in the later materials related to plague and contagion. These accounts were collected in the compendiums of Prophetic tradition (ḥadīth) and chronicles of the history of the Muslim community that were compiled from the eighth to the tenth centuries. In brief, the accounts, many if not most of which took the form of Prophetic traditions, can be summarised as follows: plague had been a punishment for earlier peoples, but was a mercy for Muslims, and if they died from it, they received the reward of martyrdom. Still, Muslims should not enter a land where they knew plague was present, nor should they leave a place where it had broken out. One of the Prophet’s companions related this last tradition to the second caliph ʿUmar (d. 644), who, when approaching Syria from the Ḥijāz during the plague of ʿAmwas, decided to return instead to Madīna. Challenged by other Companions that he was fleeing from what God had decreed for him, ʿUmar responded that he was fleeing from the decree of God to the decree of God.
The Prophet had denied the existence of contagion along with a number of pre-Islamic beliefs. He had also counseled that one should flee lepers as if they were lions, while sometimes eating from the same bowl as lepers, and at other times refusing to accept the oath of allegiance of a leper in person. When questioned by a Bedouin regarding the case of a healthy camel who mixed with mangy camels and then became mangy itself, the Prophet rhetorically asked who had caused the first camel to become mangy.
These traditions and accounts were drawn into ninth-century debates between rationalist critics of Prophetic tradition such as the Muʿtazilī al-Naẓẓām (d. 232/847), and defenders of its authority such as the traditionalist Ibn Qutayba (d. 276/889). The Mu’tazila were a theological school that stressed, among other things, the power and efficacy of human reason and who were skeptical of the growing number of accounts Muslims were attributing to the Prophet. Where al-Naẓẓām described many examples of Prophetic tradition being inherently contradictory and at odds with empirical evidence, Ibn Qutayba argued that the body of Prophetic Tradition was coherent when the scope of the individual traditions was properly understood, and that they were compatible with observation. It was this latter position that convinced most Sunni Muslim scholars in subsequent centuries. In the case of plague and contagion it also led to their exploring at length if and why one could flee the plague, while also opening up the thorny issue of what caused diseases to be transmitted.
At the same time in the ninth century that the traditionists were expounding their defence of the Prophet’s and his Companions’ words on plague and contagion, scholars from a variety of religious backgrounds were translating much of the combined medical heritage of the Greeks, Persians, and Indians into Arabic. They were doing this in Baghdad, the new capital of the second major Muslim caliphate, the ʿAbbasids (r. 750–1258). Within the humoral medical tradition that scholars living in the Muslim world appropriated from these translations and subsequently developed, there was a clear number of epidemic diseases – plague and leprosy among them – that they considered to be contagious, although differing on the question of whether they were curable or not. Thus, physicians such as Ibn Sahl ibn Rabban al-Tabari (d. after 855), Qusṭā ibn Lūqā (d. 910 or 920), and Muḥammad ibn Zakarīyā al-Rāzī (d. c. 923) listed a number of contagious diseases in their works, and for al-Rāzī (as for the famous Ibn Sīnā (Avicenna, d. 1037) a century later), the plague, as one of the epidemic diseases, was one of them.
It is important to emphasise, however, that scholars both of medicine and Prophetic tradition understood something quite different by contagion than we do today. We have been exposed to strong states with programmes of public health that impressed the importance of hygiene and the germ theory on the majority of us from a young age. Operating within a humoral framework, the physicians discussed here believed epidemic diseases to be the result of corrupted air, which, once inhaled, altered the individual’s particular temperament. This temperment was the result of a unique balance of the four humours: black bile, phlegm, yellow bile, and blood – and disturbing this balance could result in illness — if not death – if the initial equilibrium could not be reestablished. Implicit within this model was the necessity for the physician to understand each individual’s particular humoral composition before carrying out a treatment.
All Muslim physicians were conversant with, if not specialised in, the religious sciences, as their introduction to literacy had been through the Qurʾān (Ibn Sīnā famously boasted in his autobiography that he had memorised it by age ten). Still, for many of them the medical and theological discourses seem to have applied to different spheres and they did not often expressly address potential tensions between these. A partial exception can be found with the authors of a discipline known as Prophetic medicine, which explicitly reconciled Prophetic traditions on medical matters within a Galenic humoral framework. This genre did not fully come into its own until the first decades of the fourteenth century, and it is perhaps no coincidence that its main proponents (including Shams al-Dīn al-Dhahabī (d. 1348) and Ibn Qayyim al-Jawzīya (d. 1350) argued for the phenomenon of contagion, as they had no theological motivation to deny diseases their own natures with associated causal powers. They came from the Ḥanbalī school and were of the minority of Sunni scholars who did not adhere to either the Ashʿarī or Maturidī schools of theology, both of which professed a theory of occasionalism in which God caused each thing to come into being at every moment. The main purpose of the doctrine of occasionalism was to preserve the absolute unity of God as Creator by denying the existence of any other causal actor. In this fashion, theologians of these schools emphasised the radical dependency of all Creation on God. It was possible to argue for disease transmission within an occasionalistic framework by invoking God’s habit of creating specific events in conjunction with each other in a reliable fashion – and one Ashʿarī thinker who did precisely this was the Moroccan Sufi and theologian Ḥasan al-Yūsī (d. 1691) who addressed contagion at length in his Discourses. Yet, rejecting such theological debates in favour of an implicit theory of secondary causality, in which diseases possessed the ability to transmit themelves due to their own natures, allowed the adherents of Prophetic medicine to accept the theory of contagion.
In the middle of the fourteenth century, plague struck Central Asia and then spread throughout the countries bordering the Mediterranean. In subsequent decades it returned repeatedly, becoming an accepted if not anticipated fact of life for millions of people. The demographic and economic effects were catastrophic for the Muslim as for the Christian world, with some areas possibly suffering as high as fifty percent mortality, although our knowledge of the demographic realities of this period is quite shaky. Our understanding of the broad impact of the plague on Muslim societies is clearer, although attention has been disproportionately directed to specific areas, Egypt most prominently, in direct relation to the quality of available sources. Owing to its agricultural production being based on an elaborate system of irrigation canals and the way land ownership and labour was regulated under the Mamluk dynasty (r. 1260-1517), Egypt’s economy went into a centuries-long decline following the plague. This was in stark contrast to England, where peasants were able to negotiate more favourable working conditions, and the economy and living standards improved substantially in the century following the initial plague outbreak. These different outcomes were the result of disparate social and economic and not religious factors.
The intellectual response of Muslim physicians and religious scholars to the Black Death differed substantially from their response to the first pandemic. Now they could draw on a range of well-developed discourses, including, in addition to those already discussed, jurisprudence (fiqh) and Sufism (taṣawwuf). Faced with the immediacy of the challenge posed by the plague, scholars drew on all of these fields in the plague treatise. This genre addressed not only how one was to behave during the plague, but what medical remedies were available, and the significance of such an affliction. These treatises were structurally similar to a legal opinion (fatwa) in which a legal authority was asked about his views on a given issue. We possess dozens of them from the fourteenth and subsequent centuries, and they display a wide variety of approaches to plague and contagion. Early examples by Andalusian authors Ibn al-Khaṭīb (d. 1374) and Ibn Khātima (d. 1369) stressed the plague’s contagiousness and the importance of fleeing it, while their eastern contemporaries Ibn al-Wardī (d. 1349) and al-Manbijī (d. 1383) rejected contagion and emphasised how dying of the plague resulted in martyrdom. In the following century, Ibn Ḥajar al-ʿAsqalānī (d. 1448), the prominent scholar of Prophetic Tradition who himself lost three daughters to the plague, devoted an extended treatise to the subject of the plague. In it he rejected the transmission of the plague between humans (as opposed to leprosy) and explained the theological justifications for Muslims attaining martyrdom through dying of the plague (it depends on your intention). Due to his authoritative reputation, his views were influential in later scholarship. Other scholars, however, such as al-Bidlīsī, ignored the martyrdom aspect of the plague completely. In his treatise on the plague, al-Bidlīsī focused on its contagious nature and the importance of protecting oneself. He also included a long discussion of the proper understanding of God’s decree for mankind (after all, why flee if all is predestined?) and the imaginal world (barzakh) where calamities first appear and to which prophets and advanced mystics have access. The difference between his approach and that of Ibn Ḥajar speaks again to the wide variety of opinions among Muslim scholars on the issue of contagion.
Mysticism, which in an Islamic context often refers to Sufism in all its scholarly and institutional contexts, was most directly relevant to Muslim responses to plague through Sufis’ favourable description of reliance upon God (tawakkul), and the ethical duty of Muslims to help each other in times of difficulty. Authors such as al-Ghazālī (d. 1111) in his influential Revival of the Religious Sciences stressed how Muslims should not flee the plague and should tend to the sick. Al-Ghazālī’s opinions continued to inspire Sufis though to the time of the prominent Moroccan Sufi Ibn ʿAjiba (d. 1809), who described how his fellow Sufis stayed with the sick in a time of plague and buried those who died of it without any harm coming to them.
It would be mistaken to evaluate the various opinions presented in these treatises according to modern criteria, or to attempt to divide them, for example, into rational on the one hand and religiously anti-empirical on the other. Ibn Ḥajar, in his rejection of contagion and his argument for jinn being the causative agent of plague laid out empirical evidence for his position: when the plague afflicted a house, only some within it died while others went untouched. The Granadan Ibn al-Khaṭīb, whom many in recent scholarship have seen as extraordinary in his explicit rejection of Prophetic traditions that conflicted with what he believed was empirical proof of contagion, relied in turn on the scriptural authority of Prophetic tradition when it came to traditions that supported his own views. Allowing ourselves to anachronistically evaluate these two positions according to modern medicine, we find Ibn Ḥajar’s position closer to current medical understandings of plague. Bubonic plague, after all, is not contagious, but requires a vector such as a flea to be transmitted, although it is possible that Ibn al-Khaṭīb may have witnessed cases of pneumonic plague, which can be transmitted directly from one person to another. When it came to medical remedies, which were offered both by proponents and opponents of the contagiousness of plague, these varied but involved dietary proscriptions, bloodletting, and at times ointments of violets. A belief in the validity of prayers, magical squares, amulets and talismans was also widespread among Muslims alongside more narrowly medical prescriptions, evidence of the influence of the occult sciences on medical theory and practice.
Figure 3. Depicting a scene in the hospital at Cordóba, then in Al-Andalus (Muslim Spain), this 1883 illustration shows the famed physician Al-Zahrawi (called Abulcasis in the West) attending to a patient while his assistant carries a box of medicines. (Source)
European Colonialism, Quarantine, and the Malleability of Tradition
As the plague continued to afflict the Muslim Mediterranean world down into the nineteenth century, scholars continued to address the social, medical, and spiritual challenges it posed. They also continued to disagree, and in doing so drew on the opinions of earlier scholars. The Yemeni reformer al-Shawkānī (d. 1836) drew extensively on Ibn Ḥajar in his rejection of the plague’s contagiousness, and the Algerian Ḥamdān Khoja (d. after 1258/1842) found al-Bidlīsī’s arguments useful in his own argument that the Ottoman Empire should adopt the European system of the quarantine. The Ottoman state had isolated travellers coming from epidemic areas since the sixteenth century. Yet, a quarantine involved isolating healthy travellers for a period of time so that it could be ascertained if they were sick or not. Muslims did not employ quarantines until the eighteenth century, and then within the Mediterranean they were generally enforced by European powers, most often in connection with the movement of Muslim pilgrims heading towards or returning from the pilgrimage to Mecca. These same powers routinely violated the quarantine when it suited their economic interests. Drawing in part on Russian policies in the Balkans, the Ottoman Empire converted an earlier system of lazarets (tahaffuzhane) into a full-fledged quarantine system at the end of the eighteenth century. At the beginning of the nineteenth century, both the Ottoman empire and Muhammad Ali’s Egypt openly acknowledged the contagious nature of the plague. In the latter case, this was against the advice of the anti-contagionist French doctor Antoine Clot (d. 1868), showing that anti-contagionism remaining influential in Europe at this time as well. In both cases the two states adopted the quarantine system as part of a series of comprehensive reforms to address their comparative military and economic disadvantage vis-à-vis European powers. Both states also justified doing so with the selective citation of Prophetic tradition and the example of the second caliph ʿUmar, thereby carrying the premodern debates forward into a new era.
In the twentieth century the contagiousness of plague became widely accepted in the Muslim world. As with the Ottoman adoption of quarantine in the nineteenth century, Muslim scholars, such as the former Grand Mufti of Tunis Muḥammad al-Mukhtār, have in recent decades stressed the compatibility of Prophetic Tradition with the proper understanding of contagion. Still, just as it was a distortion of Muslim intellectual heritage for historians to characterise Muslims in the premodern period as fatalistic when facing the plague, so it would also be a mistake to claim that the sum of Islamic thought on the issue was the caliph ʿUmar’s decision to turn back from the plague or the Prophet’s advice to flee lepers. In the last two centuries, Muslims have witnessed many European and American scholars and representatives of colonial and postcolonial empires portray their scholarly inheritance as irrational or characterised by blind imitation. Much of the work of the last two generations of scholars working on Islam and the Middle East has gone towards correcting these depictions by exploring the complexities and creativity of Muslim scholarly works in the formative and now evermore the post-formative period as well. Let us not, however, extend this corrective tendency too far in the understandable but mistaken desire to characterise premodern Islamic heritage as somehow constitutive of modern science or public health policy. Such a move would not only misrepresent classical Islamic scholarship on plague and contagion, which was rooted in a humoral and not a bacterial understanding of disease aetiology, it would also fundamentally cloud our ability to understand the creative and insightful choices Muslim scholars made when faced with epidemic disease, choices that were framed within epistemological paradigms distinct from those found in a world governed by a laboratory model of the disease.