Depictions of Disease and Medicine in the Islamic world: early approaches to picturing pestilence.

Can these Islamic works serve as a guide through today’s coronavirus crisis?

Epidemics of the plague and other diseases were a reality in the Middle East long before the Black Death. The common term used to refer to most of these diseases was waba’ which not only referred to the plague, but extended to include epidemics such as typhus, smallpox, cholera etc. There were five main plagues in the history of the Islamic Empire, the Black Death being the sixth major epidemic, dating from the 7th — 14th centuries.

Early Islamic empires had a limited and very different understanding of epidemic diseases than we do today, and their interpretations were both religious and cultural. Three principles derived from the Prophet’s teachings influenced the actions of early Islamic communities and their attitudes towards plague:

1. Plague was a mercy and a martyrdom from God for the faithful Muslim and a punishment for the infidel;

2. A Muslim should neither enter nor flee a plague-stricken land;

3. There was no contagion of plague, because disease came directly from God. [1]

Special diets were prescribed to ward off disease including delicacies such as pickled onions, lentils, pumpkin seeds, Indian peas and bitter pomegranates. Scents played a huge role in preventive medicine as it was thought that improving the quality of the air would build the body’s resistance to disease. Citrons, lemons, violets, roses, sandalwood and solutions of vinegar and rosewater were used along with talismans, blood-letting devices, supplications and prayer, and even hand washing automatons to guard against the ‘great dying’, maut kathir, that ‘annihilated the people’.

Measures that resemble today’s social distancing alongside personal hygiene were paramount, as according to Ibn Khatimah, baths and cohabitation were to be avoided, and it was especially important to maintain morale.

Psychological advice necessitated experiencing joy, serenity and relaxation in pleasant and attractive company. In addition to the Quran, history books, comedy works, and romance stories were recommended to occupy the mind.

As we navigate similar circumstances today, similarly employing measures to protect against a pandemic with unknown parameters, looking at these works allows us to see similarities in a new light, appreciate their beauty and intricate details and inspires us to cope.

[1] Dols, Michael Walters. The Black Death in the Middle East. Princeton University Press, 1977.

A doctor treats wounds in this 12th-century illustration from the Maqamat, a collection of Islamic tales.

The Maqamat (the Assemblies of Hariri) were 50 stories whose protagonist Abu Zayd, a wandering beggar and virtuoso poet, made a living by way of trickery and talk. Little is known about al-Wasiti, the Iraqi painter and calligrapher responsible for these intricately illustrated manuscripts, identifiable by his lengthy signature:

“this manuscript, both texts and pictures, was completed by the wretched slave of God, Yahya ibn Mahmud ibn Yahya ibn Abi al-Hasan ibn Kuwwarih al-Wasiti, who begs his lord for mercy, for his forgiveness, his pardon, on the evening of Saturday of the sixth day of the month of Ramadan in the year 634…” (Saturday May 3, 1237)

Baghdad was the epicentre of the Islamic world for centuries. At this time, with a population of 1.5 million, it was the largest city in the world.

This 13th century manuscript illustration from the Maqamat shows doctors visiting a patient. Arab physicians divided medicine into two areas: ‘the preservation of health which aims to retain the state of a healthy individual and prevent him or her from becoming ill’; and ‘the restoration of health which aims to return the sick person to his natural healthy state’.

The burial of a man who has died from the plague, 13th-century Persian illuminated manuscript. Bibliotheque Nationale, Paris

Writers at the time made colourful, macabre accounts of their cities’ death tolls, noting the scarcity of coffins and shrouds, preachers and gravediggers. Dead bodies were everywhere, deposited in open trenches, transported in baskets on windows, biers (frames for carrying bodies), ladders and doors, carried onto camels and thrown into the Nile. Burials were extremely expensive and became a luxury for those who could afford it, and a burden for the poor.

“The processions of coffins through the streets looked to observers like camel caravans; the biers were carried in such numbers from the Mosque of the Believers to the gate of Qarafah cemetery that the portal looked like a great white vulture hovering over the dead.”

Names of the dead were announced in street processions, accompanied by the cries and lamentations of mourners — in the streets and in people’s homes.

There are numerous illustrations that cover a wide variety of ailments and treatments, such as this 18th century miniature indicating treatment for smallpox, based on Ibn Sina’s (Avicenna’s) ‘The Canon of Medicine’, Turkey, c. 1020 CE.

The Persian physician and philosopher Ibn Sina (also known as Avicenna) notably wrote the The Canon of Medicine, an encyclopedia of the medical knowledge that became widely used across the Islamic world. Ibn Sina wrote the most influential medical discussion of plague, his plague descriptions provide diagnostic and treatment explanations, building on the theories of the Roman physician and philosopher Galen and the Greek physician Hippocrates. Ibn Sina’s oeuvre includes philosophy, Islamic theology, astronomy, psychology, physics, mathematics, alchemy, geology and poetry. In this 18th century Turkish miniature, a scene is illustrated from The Canon of Medicine depicting the treatment prescribed for smallpox.

Left, The Basin of the Reckoner, dispersed manuscript, 1315, the Museum of Fine Art, Boston. Right, The Basin of the Two Scribes. Detached folio from a Manuscript, 1315

Bloodletting was prescribed by Ibn Sina and Ibn Khatimah as an effective treatment for victims of the plague. It was believed to relieve fever and excess blood in the body, and by decreasing the mass of the blood in the body, the life-force in the arteries would be freed. People eventually practiced bloodletting without a physician’s supervision, as both a prescriptive and preventive measure. Ibn Khatimah also prescribed cupping, patients would be given rose syrup and vinegar syrup concoctions and bled where their pain was most severe. This proved unsuccessful, however, in advanced and recurring cases.

Left, Flanked by figures indicating his tutelage from master physicians (the figure on the right may represent first-century Greek physician Dioscorides), a saydalani — as an early pharmacist was called in Arabic — is shown at work in his dispensary, in which hang a variety of vessels for alchemical production. The illustration comes from 12th-century Iraq. Right, A physician with a patient about to vomit. Taken from a 13th-century copy of the Arabic version of Dioscorides’ On Medicinal Substances.

A five-volume work, De Materia Medica was written by the Greek physician Pedanius Dioscorides in the Roman Army, 50–70 CE. In his pharmacopoeia, Dioscorides classifies medicinal plants and the medicines that can be derived from them. An influential work for medicine, it was translated widely, with additional commentary and illustrations in the various editions. As one of the first scientific works to be translated from Greek to Arabic in 9th century Baghdad, it had a long-lasting effect on medicine in the Islamic world.

Hand-washing automaton with flush mechanism, folio from ‘The Book of Ingenious Mechanical Devices; by al-Jazari, 1315 (opaque w/c, ink & gold on paper)

Ismail al-Jazari was a Muslim polymath: a scholar, inventor, mechanical engineer, artisan, artist and mathematician. He wrote The Book of Knowledge of Ingenious Mechanical Devices, essentially as a book of engineering ‘tricks’. In it he describes 100 mechanical devices, detailing instructions for their construction. Though his devices built on earlier works by other inventors such as the Banu Musa Brothers and philosopher al-Saghani, among others, a great number of his inventions, components and processes were entirely unique. Al-Jazari was responsible for developing the earliest water supply system (in 13th century Damascus) operated by gears and hydropower, to supply water to mosques and hospitals. He incorporated a number of humanoid automata in his inventions. His hand-washing automaton utilises a flush mechanism similar to those now used in modern toilets. As depicted in this manuscript illustration, the female automaton stands next to a basin full of water. Once the lever is pulled, the water drains, and the female robot refills the basin.

A Medical Consultation, from ‘The Book of Kalila and Dimna’ from ‘The Fables of Bidpay’ (gouache on paper), Islamic School, 14th century

A book of allegorical fables narrated by two jackals, Kalila wa Dimna is one of the most popular books ever written. Originally Indian, the stories serve as a moral and ethical guide for humanity, addressing a wide range of issues in an accessible manner. These fables developed into a kind of popular literature and were translated widely and shared in the form of illuminated manuscripts. Ibn al-Muqaffa translated the Arabic version from the original Pahlavi manuscript.

In the book, Barzouyeh, the chief of Persian physicians, was sent by the King on a mission to India to obtain and translate the copy of Kalila and Dimna to include amongst the treasures of the kings of Persia. This 14th century illustration of a medical consultation likely depicts Barzouyeh, whilst the 18th century illustration shows him setting off on his journey.

‘Barzouyeh’s Mission’ Folio 5v, 6r from a Kalila Wa Dimna of Bidpai (18th century), Ink and opaque watercolour on paper. The Met Museum, The Alice and Nasli Heeramaneck Collection, Gift of Alice Heeramaneck, 1981

Left, a 14th Century Egyptian prayer against the Plague by Siraj al-Din al-Bulqini (d. 1403) copied here in an 18th century work by the Ottoman Sufi Ismail Haqqi Brusawi (d. 1725). Right, designs from a manuscript by Hajj Rashid al-Habishi al-Mashriqi (d. 1382)

The practices of many Muslims at the time, in response to the plague and similar epidemics, incorporated magic in the form of incantations, prayers and talismans. Muslims believed that the jinn — supernatural beings that inhabit the earth alongside human beings — were responsible for all nameless evil and anxiety, and the Islamic faith offered remedies for it. Prayers and inscribed talismans relied on the use of asma Allah al-husna (the divine names of God) which were considered to have occult properties. This 14th century Egyptian du’a (prayer) for protection against the plague was ideally read daily for protection of oneself, kin, property and children and forms the basis of the present-day travel supplication. It reads:

“in the name of God, all Merciful, ever Merciful. My God, I seek refuge in you from the blistering plague and its mighty affliction of self, family wealth and children. God is greater, God is greater, God is greater than what I fear and guard against. God is greater…”

These designs from the manuscript of al-Mashriqi employ the divine names of God to ward against plague and, in particular, the burning fever that accompanied it. These designs would be engraved into rings, that were worn and also submerged into water, that, when drunk was believed to have healing properties.