Vaccine Hesitancy – Egypt 1866

Archaeological evidence suggests that smallpox has been present in Egypt for some 3000 years and later was a recurrent problem across the Islamic world, as well as Europe. Accurately described by the physician al-Razi in the 10th century, vaccination or variolation (transferring matter from a smallpox scab from one person to another through a scratch or up the nose) had been practised in China since the 6th century A.D. and perhaps even earlier in India.

In Egypt, around 1800, there are reports of 60 000 deaths each year. The Ottoman ruler, Muhammad Ali Pasha, began in 1819 to institute a plan for general vaccinations and the logical people to carry this out were the barber-surgeons, known and trusted by the locals. While the Bedouin had long been enthusiastic about protecting their children in this way, the fellahin (peasantry) was reluctant, largely because they did not trust the government and thought it was a way of “marking” their children for conscription. Religious objections and concerns about mixing Muslim and Christian blood also played their part, and attempts to bribe the vaccinators were not uncommon.

After the serious epidemic of 1836, official efforts intensified, with barber-vaccinators being trained and records kept. Gradually, the message got through and by 1850, the decline in child mortality was affecting the population statistics. The following anecdote, describes a perhaps surprising pocket of vaccine hesitancy.

We have just had a scene, rather startling to notions about fatalism, etc. Owing to the importation of a good deal of cattle from the Sudan, there is an expectation of the prevalence of small-pox, and the village barbers are busy vaccinating in all directions. To prevent the infection brought, either by the cattle or, more likely, by their drivers. Now, my made had told me she had never been vaccinated, and I sent for Hajji Mahmood to cut my hair and vaccinate her. To my utter amazement the girl, who had never shown any religious bigotry and does not fast, or make any demonstrations, refused peremptorily.

It appears that the priests and sisters appointed by the enlightened administration of Prussia instil into their pupils and penitents that vaccination is a “tempting of God” Oh oui, she said, je sais bien que chez nous mes parents pouvaient recevoir un procès verbal, mais il vaut mieux cela que d’aller contre la volonte de Dieu. Si Dieu le veut, j’aurai la petite vérole, et s’il ne le veut pas, je ne l’aurai pas”*. I scolded her pretty sharply, and said it was not only stupid, but selfish.

“But what can one do?” as Hajji Mahmood said, with a pitying shake of his head, “these Christians are so ignorant!” He blushed, and apologized to me, and said, “It is not their fault; all this want of sense is from the priests who talk folly to them for money, and to keep them afraid before themselves. Poor things, they don’t know the Word of God – ‘Help thyself, oh my servant, and I will help thee’” This is the second contest I have had on this subject. “Last year it was with a Copt, who was all Allah kareem** and so on about his baby, with his child of four dying of smallpox. “oh man”, said Shaikh Yusuf, “if the wall against which I am now sitting were to shake above my head, should I fold my feet under me and say Allah kareem, or should I use the legs God has given me to escape from it?

*Oh yes, she said, I know that my parents could well be subject to an official report, but that is better than going against God’s will. If God so wishes, I will catch smallpox, and if He doesn’t, I won’t.

** God is generous

Letters from Egypt 1862-1869, Lady Duff Gordon, re-edited with additional letters, Gordon Waterfield, Routledge and Kegan Paul, London 1969, pp 249-50.

Lady Duff Gordon went to Egypt in 1862, suffering from consumption, and died there in 1867. Her charming, sympathetic, entertaining and highly informative letters were originally edited by her mother and now by her great grandson, Gordon Waterfield.

There is a vast literature on smallpox and vaccination, but for further details on vaccination in Egypt, see Lives at Risk, Public Health in Nineteenth-century Egypt, LaVerne Kuhnke, University of California Press, 1990 and on-line at

N.B. In case I have infringed copyright on any occasion, please notify me and I will immediately delete the post.

Cocolitzli – the Great Plague – Mexico 1576 A.D.

In about 1575-6, Mexico was struck by the worst epidemic, the region had ever known. Witnesses there at the time spoke of half or even two thirds of the population succumbing – a higher mortality rate even than the Black Death. The Spanish physicians did not recognise any of the European diseases with which they were familiar and which had also decimated the Indian population: smallpox, measles, typhoid….and so adopted the Nahuatl term, which basically meant “plague”: coclitzli.

There are a number of fairly horrifying medical descriptions of the disease, but the constants were high fever, terrible thirst, bleeding from all the orifices and jaundice. Alonso López, surgeon at the Hospital Real de Indias, wrote:

…The sick suffered an unnatural thirst. They could never get enough water, because the heat of the poison in their stomachs and hearts was so great and when these fumes rose to the brain, in two days they went mad. Those suffering this disease became very yellow and jaundiced. The urine passed by the sick was very dark and very thick. Those who passed much urine were the ones who lived….

In an attempt to understand the disease, autopsies were performed by doctors of both nationalities and again there are detailed descriptions. Usually forbidden by the Church, they had also been allowed at the time of the Black Death for the same purpose. It was noted that none of the doctors taking part in the autopsies contracted the disease – although obviously they would have had no protective clothing of any kind.

Cocolitzli spread with great speed from the Mexican highlands, as far south as Guatemala, but it was noted that infection levels were uneven and there was debate as to whether this was due to ethnic differences or to the very different levels of wealth and hence living conditions of the Spaniards and the Indians. Francisco Hernández de Toledo, court physician to Philip II remarked:

It attacked the young in particular and the old, even if very ill, often succeeded in shaking it off….This is how it seemed to be at the beginning, although little by little it came to affect all sectors of the population, regardless of age and sex.

First it invaded the regions of the Indian tribes, then the places inhabited by Indians and Ethiopians (blacks); then it reached the people of mixed race, Indian and Spanish; still later the Ethiopian areas and then, last of all, it attacked the Spaniards.

Juan Baptista Pomar, of mixed noble indigenous and Spanish heritage, pointed out that although Spaniards were less apt to die than Indians and highlanders died in far greater numbers than those in the richer lowlands, this was also a social issue: “the wealthy, well-dressed, well-housed and well-provided” were the least likely to succumb. Poverty as much as race was the issue.

There was even some awareness that the terrible dislocation of the original society caused by the Conquest might have had an effect. Juan de la Vega, writing an account of his area, says:

In their original state they ate little, living off the countryside on plants and grasses and small creatures and they went naked and were accustomed to bathe at midnight, but now they no longer do these things and they eat more.

Although malnutrition was much more likely to have been a factor than simply change of diet.

The terrifyingly high mortality rate which left whole villages and even regions deserted had very serious implications not only for indigenous culture, but for the survival of the Spanish, who were dependent on their labour.

The Viceroy, D. Martín Enriquez appreciated the desperateness of the situation from the social point of view and exhorted both medical practitioners and the religious to go and provide what physical and spiritual aid they could, while lay helpers were to “go from house to house, cleaning the discharges of the sick, since in truth mismanagement and slovenliness were the cause of great harm, and providing them with clean clothes and supplying them with food.”

In spite of all their efforts, the doctors neither managed to find a cause of the disease nor any effective remedy. Francisco Hernández, in common with most of the other practitioners, relied on the age-old complex drug Atriaca – Theriac – now reformulated with the aid of Aztec pharmacologists using local herbal medicines. It was ineffective.

Some were convinced that cocoliztli could be attributed to astrological phenomena, while many, of course, believed it was God’s punishment for the sins of the people and the traditional processions and prayers were organized to implore mercy.  No doubt the Indians – secretly – also performed rites to appease their ancient gods, whom they felt had been betrayed.

As is almost always the case in times of epidemic, there was the great problem of burying the dead. One of the Jesuit records tells that: …in the churches and cemeteries, there was not an unoccupied space for a single dead person… they threw them into a great trench, young and old together….and as the churches were not sufficient to bury them all – whole fields needed to be consecrated.”

Medical men, both indigenous and Spanish, studied the disease, searching for causes and looking for cures. Bernardo de Sahagún, in his great work on Mexico in Spanish and Nahuatl, names twelve Aztec doctors. There was much discussion then – and the debate is still on-going – as to what the disease really was.

There were repeated waves of cocoliztli, perhaps even earlier – one codex mentions that “in 1549 many Indians died”. It was noted, both in the Nahuatl chronicles and by the Spaniards, that outbreaks occurred when the great drought that afflicted Central and North America across the mid-16th century was briefly broken by heavy rains. It has been suggested that the disease was an indigenous viral haemorrhagic fever and the rains produced a population explosion in the mouse that acted as vector. Recent research, however, has given rise to an alternative theory; that it was in fact a form of salmonella imported from Europe. The debate clearly has political as well as scientific implications.

And then, strangely, at the beginning of the 19th century, cocoliztli seems to have disappeared.

There is a large scientific literature on cocoliztli from the medical pint of view and a useful bibliography in Spanish and English is given in the Wikipedia article. Particularly informative for the non-specialist are articles by Rodolfo Acuna-Soto and others on-line at

Numerous documents, many in the Archivo General de Indias in Seville and various codices, such as the Florentine Codex of Bernardo de Sahagún or the Telleriano-Remensis Codex contain information about the epidemic. The codices are available on-line, but a number of the documents are currently hard to access.

For much of the material in the post I am indebted to the excellent article by Elsa Malvido and Carlos Viesca La epidemia de cocoliztli de 1576 on-line at

There is also an interesting article on the earlier epidemic by Sandra Elena Guevara Flores on-line at;

N.B. In case I have infringed copyright on any occasion, please notify me and I will immediately delete the post.

Theriac – a Very Sovereign Remedy for the Plague – Galen c.166-170 A.D.

Theriac – the origin of our word treacle – is a complex medicine, some of the recipes for which sound like the witches’ incantation in Macbeth:

    Double, double toil and trouble;

    Fire burn and caldron bubble.

    Fillet of a fenny snake,

    In the caldron boil and bake…..

    One version required four vipers, 55 herbs, took 40 days to prepare and 12 years to mature.

    Other recipes are purely herbal and many contain opium and hemp, which may help to explain their popularity.

    It is thought to take its origins from the experiments of Mithridates of Pontus in the 2nd century B.C., to find an antidote to every poison. It is reported that he was so successful that when, captured by the Romans, he tried to poison himself, it proved impossible.

    Galen, also from what is now Turkey, was one of the greatest and most influential medical researchers and practitioners of antiquity. Marcus Aurelius, summoned him to be his medical attendant and it was perhaps through him that he took theriac daily as a preventative. Galen was in Rome at the time of the Antonine Plague and wrote extensively both on it and on the recipes for theriac and its uses.

    The following quotations from On Theriac to Piso, traditionally attributed to Galen, are from the excellent work by Robert Adam Leigh (see below). In it Galen discusses every aspect of theriac from how he learned about it to its preparation – including very detailed descriptions of how the vipers should dealt with – its prescription for a wide range of diseases and use, external as well as internal, recommended dosages and the best way to store it. The following are a few brief extracts:

I listened because the book was thoughtfully written by a certain man called Magnus, a man well versed in his art and practised not only in the experience of practical matters but also in theory, being well trained in accurately reasoning on the basis of the facts. At least he was thought to be the best of us doctors because of his excellence in these matters by the kings of those days, perhaps partly – it seems to me – because his nationality was ideally suited for him to learn the art of medicine. For he was of a Cretan family, and it seems likely that Crete, just as it bears many kinds of herbs, should also bear a man of this kind to be as it were a useful drug for mankind……

We know that the divine Marcus Aurelius who lately reigned righteously over us, because of the close and intelligent attention he paid to the constitution of his body used the drug greedily and as if it were a food. For because of him the drug became more widely known and the power of its action became clearer to men. For from the state of health which the emperor acquired the antidote gained increased faith in its power. But under that emperor only the fact of its use was known to the cognoscenti; but under our present great emperors its use has become general…….

I think Andromachus called theriac “Galene” in the verses set out above because out of the storm caused by illness it produces the calm, so to speak, of health in the body. For example it cures chronic headaches and vertigo and hardness of hearing and weakness of vision, and sometimes it strengthens the organ of taste……[A long list of diseases which theriac combats, especially rabies]

And in general theriac like a healing remedy gives precise help both when externally applied and when drunk to those bitten by mad dogs. And this same antidote has also shown itself in plague conditions to be the only one able to help those who drink it, no other form of help being constituted in such a way as to resist an evil of such magnitude. For plague like a kind of wild beast does not just kill a handful but spreads over entire cities and destroys them horribly, when some evil change happens to the air enabling it to kill, and because of the necessity to breathe men cannot escape the evil but draw the air into themselves like a poison through their mouths.

And so I commend the most wonderful Hippocrates because he treated that plague which spread among the Greeks from Ethiopia just by a change and alteration of air so as to change the nature of what people were breathing. So he ordered that fire should be lit across the whole city with the fire and stipulated that the material burnt consist not simply of wood but of the sweetest scented garlands and flowers and that they should drip on it the richest and most sweetly scented myrrh so that men should experience relief by breathing air that had been made clean in this way. I think that theriac as if it were itself a cleansing fire entirely protects those who drink it in advance from catching the disease during a plague epidemic and has the power to heal those who have already caught it altering and changing the harmful quality in the air they are breathing and preventing it from further damaging their constitution…..

And I especially advise you to take the antidote on your travels when you make a journey in winter when the air is cold. For it will be as it were a good garment for your innards and able to supply them with a good deal of warmth. And I know that it contributes to the intelligence and sharpness of the soul. For it causes the senses to work strongly and makes the mind clear of exhalations and causes it to reason more accurately. To put it briefly, it causes the body to be without ailment so that it is not destroyed by anything harmful. For the power of the drug is varied and so great that it produces such freedom from harm, especially when wild beasts are in the mixture. For they say that Mithridates that great warrior took, not theriac (which was not yet invented) but another complex antidote named after him, for it was called Mithridatium, and that the immunity it gave him meant he could not be killed while he was taking the drug…..

One of Many Lists of Ingredients for Theriac

Weigh out rose petals equal to 12 drachms and add Illyrian iris and mix in an equal amount of sweet-boughed black liquorice and the seeds of sweet French turnip. Add the juice of fragrant garlic germander, taking Assyrian balsam from within. Put in the same amount of cinnamon by weight and do not forget to add an equal amount of agaric and myrrh and sweet scented Saussurea Lappa and crocus grown in the Corycian cave; and add cassia and sweet scented Indian nard and camel-hay the wonder of the nomad Arabs and incense and black pepper and shoots of dittany and green horehound and rhubarb. Do not let cassidony be omitted, nor parsley. And let sweet scented mint and the piercing tear of Libyan terebinth, warm ginger and well branched cinquefoil two thirds of a drachma each be added and four drachma weights of hulwort. And bring boughs of dwarf pine and storax and bald money and grape bearing cinnamon and nard brought by a man of Galatia. Bring Lemnian red earth and spikenard from the Black Sea and seed of Cretan ground oak and the fine leaves of malabathron and cooked copper ore and gentian root and anise and the juice of hypocist and the fruit of balsam adding shining gum and fennel seed and cardamom from Ida. And add powdery cicely. And add and mix well in the dark sap of the milk thistle and an equal amount of shepherds purse and as much hypericum, and ajowan and one fourth as much of ferula persica and twice as much of the secretions of the Istrian beaver and a thin root of birthwort and seed of Athamanta Cretensis and dry asphalt which burns against the lairs of serpents. And mix an equal amount of all-heal juice with centaury adding an equal part of shining all-heal. Soften these in a mortar with a lot of wine as much as comes in liquid tears. Cut up small and mix up all the woody bits with Attic honey.

Theriac continued to be a staple medicine in the Byzantine world. According to the Golden Peaches of Samarkand, in 667, ambassadors from Constantinople presented the Tang Emperor with a supply of it. A contemporary Chinese pharmacologist commented on its usefulness and theriac continued to travel along the Silk Road.

Western Europe seems briefly to have lost the recipe. When King Alfred asked the Patriarch of Jerusalem for some effective medicines, he was sent theriac and a recipe for it was set down in The Leech Book of Bald, dated c.900.

The Islamic world inherited and preserved much of classical scientific knowledge and there are numerous works on theriac. The splendid Paris manuscript of the Kitab al-Diryaq, dated 1198, includes portraits of nine medical scholars, including Galen, with their recipes for theriac and 12 pages of illustrations of the ingredients.

By the 12th century, theriac was being manufactured at Venice – logically, as the city was a major terminus of the spice trade – and was widely exported; in England, theriac was known as Venice Treacle. There was, however, competition from other cities in Italy, as well as from Cairo and Constantinople.

The preparation of theriac was extremely complicated and its production came to be carefully controlled. If it failed to give the desired result, the physician could always blame it on some impurity or production failure, for which he was not responsible. A 13th century Arabic manuscript has a miniature showing a pharmacist being beaten up by a group of irate doctors.

Attempts to control the quality of spices and medicines are very old – as was the temptation to cut corners and adulterate expensive ingredients in order to maximise profits. In a market inspector’s handbook from 12th century Seville, the author, Ibn Abdun, describes some of the methods of cheating over, for example, saffron.

The Black Death, gave rise to a vast medical literature on the plague and theriac was considered the prime remedy and preventive. Production and exports soared, and attempts were made to introduce some sort of standards, especially at Venice, to preserve the reputation of the brand.

During the Great Plague in London in 1665-6, Directions for the Cure of the Plague, issued by the Royal College of Physicians discusses theriac – or Venice Treacle – as well as general recommendations for the preservation of health, some of which sound quite familiar today. J.P. Griffin has suggested, in an extremely interesting article (see below), that the whole process of establishing standards and purity in drug production began with the efforts to ensure that theriac was made strictly in accordance with the given formula.

Theriac continued to be made throughout the 19th century and in Naples up until the beginning of the 20th. I always thought the Friar’s Balsam of my childhood, now no longer manufactured, was a last faint echo of that very ancient remedy.

There is a large bibliography on Theriac – see the Wellcome Collection. One or two works mentioned are given below.

The quotations are taken from Galen on Theriac – On Theriac to Piso, Attributed to Galen Robert Adam Leigh PhD Thesis – U. of Exeter On-line:

Also: published by Brill, Leiden, 2015

Griffin, J. P. (2004). “Venetian treacle and the foundation of medicines regulation”. British Journal of Clinical Pharmacology. 58 (3): 317–325.

Fleming, Rebecca, Galen and the Plague

Kitab al-diryaq – some images available at:

Schafer, Edward H. (1985), The Golden Peaches of Samarkand: A Study of T’ang Exotics, University of California Press, 1963

Stone, Caroline, The Muhtasib, SAW Sept/Oct, 1977, pp.22-25

N.B. In case I have infringed copyright on any occasion, please notify me and I will immediately delete the post.

Litany to St Roch – Protector against Plagues

St Roch – San Roque or San Rocco – was born in Montpellier in the 14th century. Devout from childhood, on his parents’ death, he gave his inheritance to the poor and set out for Rome. This was at a time when Italy was in the grip of a plague. At Cesena, Rimini and elsewhere he nursed the sick with devotion and courage and effected many cures, considered miraculous. At Piacenza, he fell ill and was driven out of the town. He made himself a shelter in the woods, where a dog belonging to local nobleman found him, bringing him bread each day and licking his wounds to heal them. Returning at last to Montpellier, he was thrown into prison by his uncle and died there. According to the Golden Legend, an angel entered the prison and left a tablet promising that those who called upon St Roch in times of epidemics and plagues would find relief. He was an immensely popular saint with numerous churches dedicated to hm across the world. In paintings, he is usually shown exhibiting a plague bubo and accompanied by the faithful dog. At a time when doctors could do little or nothing, the processions, litanies and votive offerings made to one who was no only a saint, but had himself survived the plague must have given a sense of hope and agency in a desperate situation. This is part of one of the many versions of the Litany of St Roch.

Saint Roch, confessor,
pray for us.

Saint Roch, given to the prayers of your parents,
pray for us.

Saint Roch, brought up in holiness,
pray for us.

Saint Roch, mortified from your infancy,
pray for us.

Saint Roch, giving away all your goods to the poor
after the death of your parents,
pray for us.

Saint Roch, who did quit your country to live unknown,
pray for us.

Saint Roch, taking care of the sick at Rome,
pray for us.

Saint Roch, attacked by the plague at Florence,
pray for us.

Saint Roch, cured of the plague by the grace of God,
pray for us.

Saint Roch, consoling men in public calamity,
pray for us.

Saint Roch, taken as spy, put in prison,
pray for us.

Saint Roch, prisoner four years,
pray for us.

Saint Roch, patient in sickness,
pray for us.

Saint Roch, model of a recluse,
pray for us.

Saint Roch, by love of shame,
pray for us.

Saint Roch, pattern of chastity,
pray for us.

Saint Roch, pattern of patience,
pray for us.

Saint Roch, dying in the odor of sanctity,
pray for us.

Saint Roch, praying against the plague,
pray for us.

Saint Roch, whose image carried in procession by the fathers in Council
dispersed the plague at Constance,
pray for us.

Saint Roch, honored in hospitals,
pray for us.

Saint Roch, whose worship is universal,
pray for us.

Saint Roch, whose images are universal,
pray for us

Samuel Pepys – The Great Plague London 1665

I had not planned to quote The Diary of Samuel Pepys, because it is so well known, but several people told me he should by no means be left out. His account is remarkable, because in spite of living through an epidemic which is estimated to have killed as many as 100 000 people out of the London population of c.450 000, he continued his normal life almost unchanged. The plague was endemic in London and so, as in other years, he sent his wife out of town for the dangerous summer months and theatres (his great passion) were closed, but most of his daily diary entries continue to be taken up with work, his travels around London and out to shipyards at Deptford and Greenwich, news of Anglo-Dutch hostilities, music, social occasions, including an important wedding he helped to organize, shopping and opportunities for flirtation. The plague is always there, but very much a backdrop. He notes its increase with disquiet, but not panic, as well as the gradual emptying of London, the closing of shops and the departure of King and Court and, eventually, his own Naval Offices. His cold-blooded calm and acceptance of what is going on around him, well aware he may be struck down at any moment is in remarkable contrast to modern reactions.


Thence to Westminster, where I hear the sicknesse encreases greatly….Thence by coach and late at the office, and so to bed. Sad at the newes that seven or eight houses in Bazing Hall Street [in the City] are shut up of the plague.


I was much troubled this day to hear at Westminster how the officers do bury the dead in the open Tuttle-fields [area south of St James’ Park] pretending want of room elsewhere; whereas the New Chappell churchyard was walled-in at the publick charge in the last plague time, merely for want of room and now none, but such as are able to pay dear for it, can be buried there.


So walked to Redriffe, where I hear the sickness is, and indeed is scattered almost everywhere, there dying 1089 of the plague this week. My Lady Carteret did this day give me a bottle of plague-water home with me. So home to write letters late, and then home to bed, where I have not lain these 3 or 4 nights………This afternoon I waited on the Duke of Albermarle, and so to Mrs Croft’s where I found and saluted [kissed] Mrs Burrows who is a very pretty woman for a mother of so many children. But, Lord! to see how the plague spreads. It being now all over King’s Streete, at the Axe and next door to it, and in other places.


So home and late at my chamber, setting some papers in order; the plague growing very raging, and my apprehensions of it great.


I to Fox-hall [Vauxhall pleasure gardens]…..but I do not see one guest there, the town being so empty of any body to come thither. Only, while I was there, a poor woman come to scold with the master of the house that a kinswoman, I think, of hers, that was newly dead of the plague, might be buried in the church-yard; for, for her part, she should not be buried in the commons, as they said she should……

I met this noon with Dr Burnett [Pepys’ doctor], who told me, and I find in the newsbook this week that he posted upon the ‘Change [Royal Exchange], that whoever did spread the report that, instead of the plague, his servant was by him killed, it was forgery, and shewed me the acknowledgment of the master of the pest-house, that his servant died of a bubo on his right groine, and two spots on his right thigh, which is the plague.


After a little other discourse and the sad news of the death of so many in the parish of the plague, forty last night, the bell always going, I back to the Exchange, where I went up and sat talking with my beauty, Mrs Batelier, a great while, who is indeed one of the finest women I ever saw in my life……

The sicknesse is got into our parish this week, and is got, indeed, every where; so that I begin to think of setting things in order, which I pray God enable me to put both as to soul and body.


At home met the weekly Bill, where above 1000 encreased in the Bill, and of them, in all about 1,700 of the plague, which hath made the officers this day resolve of sitting at Deptford, which puts me to some consideration what to do. Therefore home to think and consider of every thing about it, and without determining any thing eat a little supper and to bed, full of the pleasure of these 6 or 7 last days.


Up betimes, and down to Deptford, where, after a little discourse with Sir G.Carteret, who is much displeased with the order of our officers yesterday to remove the office to Deptford, …….But, Lord! to see in what fear all the people here do live would make one mad, they are afeard of us that come to them, insomuch that I am troubled at it, and wish myself away. But some cause they have; for the chaplin, with whom but a week or two ago we were here mighty high disputing, is since fallen into a fever and dead, being gone hence to a friend’s a good way off. A sober and a healthful man. These considerations make us all hasten the marriage, and resolve it upon Monday next, which is three days before we intended it. Mighty merry all of us, and in the evening with full content took coach again and home by daylight with great pleasure, and thence I down to Woolwich, where find my wife well, and after drinking and talking a little we to bed.


At noon to dinner, where I hear that my Will [Hewer – Pepys manservant/assistant and later close friend] is come in thither and laid down upon my bed, ill of the headake, which put me into extraordinary fear; and I studied all I could to get him out of the house, and set my people to work to do it without discouraging him, and myself went forth to the Old Exchange to pay my fair Batelier for some linnen, and took leave of her, they breaking up shop for a while….


Will was with me to-day, and is very well again. It was a sad noise to hear our bell to toll and ring so often to-day, either for deaths or burials; I think five or six times.


Thus I ended this month with the greatest joy that ever I did any in my life, because I have spent the greatest part of it with abundance of joy, and honour, and pleasant journeys, and brave entertainments, and without cost of money; and at last live to see the business ended with great content on all sides…..

Thus we end this month, as I said, after the greatest glut of content that ever I had; only under some difficulty because of the plague, which grows mightily upon us, the last week being about 1700 or 1800 dead of the plague.


I was forced to stay a great while before I could get my horse brought over, and then mounted and rode very finely to Dagenhams; along the way people, citizens, walking to and again to enquire how the plague is in the City this week by the Bill [recording the mortality rate]; which by chance, at Greenwich, I had heard was 2,020 of the plague, and 3,000 and odd of all diseases; but methought it was a sad question to be so often asked.

Mr. Marr very kindly staying to lead me the way. By and by met my Lord Crew returning, after having accompanied them a little way, and so after them, Mr. Marr telling me by the way how a mayde servant of Mr. John Wright’s (who lives thereabouts) falling sick of the plague, she was removed to an out-house, and a nurse appointed to look to her; who, being once absent, the mayde got out of the house at the window, and run away. The nurse coming and knocking, and having no answer, believed she was dead, and went and told Mr. Wright so; who and his lady were in great strait what to do to get her buried. At last resolved to go to Burntwood hard by, being in the parish, and there get people to do it. But they would not; so he went home full of trouble, and in the way met the wench walking over the common, which frighted him worse than before; and was forced to send people to take her, which he did; and they got one of the pest coaches and put her into it to carry her to a pest house. And passing in a narrow lane, Sir Anthony Browne, with his brother and some friends in the coach, met this coach with the curtains drawn close. The brother being a young man, and believing there might be some lady in it that would not be seen, and the way being narrow, he thrust his head out of his own into her coach, and to look, and there saw somebody look very ill, and in a sick dress, and stunk mightily; which the coachman also cried out upon. And presently they come up to some people that stood looking after it, and told our gallants that it was a mayde of Mr. Wright’s carried away sick of the plague; which put the young gentleman into a fright had almost cost him his life, but is now well again.


By and by to the office, where we sat all the morning; in great trouble to see the Bill this week rise so high, to above 4,000 in all, and of them above 3,000 of the plague. And an odd story of Alderman Bence’s stumbling at night over a dead corps in the streete, and going home and telling his wife, she at the fright, being with child, fell sicke and died of the plague.


The people die so, that now it seems they are fain to carry the dead to be buried by day-light, the nights not sufficing to do it in. And my Lord Mayor commands people to be within at nine at night all, as they say, that the sick may have liberty to go abroad for ayre. There is one also dead out of one of our ships at Deptford, which troubles us mightily; the Providence fire-ship, which was just fitted to go to sea. But they tell me to-day no more sick on board. And this day W. Bodham tells me that one is dead at Woolwich, not far from the Rope-yard. I am told, too, that a wife of one of the groomes at Court is dead at Salsbury; so that the King and Queene are speedily to be all gone to Milton. God preserve us!


It was dark before I could get home, and so land at Church-yard stairs, where, to my great trouble, I met a dead corps of the plague, in the narrow ally just bringing down a little pair of stairs. But I thank God I was not much disturbed at it. However, I shall beware of being late abroad again.


Thence to the Exchange, where I have not been a great while. But, Lord! how sad a sight it is to see the streets empty of people, and very few upon the ’Change. Jealous of every door that one sees shut up, lest it should be the plague; and about us two shops in three, if not more, generally shut up.


After church to my inn, and eat and drank, and so about seven o’clock by water, and got between nine and ten to Queenhive, very dark. And I could not get my waterman to go elsewhere for fear of the plague. Thence with a lanthorn, in great fear of meeting of dead corpses, carried to be buried; but, blessed be God, met none, but did see now and then a linke (which is the mark of them) at a distance. So got safe home about 10 o’clock, my people not all abed, and after supper I weary to bed.


Up, and after much pleasant talke and being importuned by my wife and her two mayds, which are both good wenches, for me to buy a necklace of pearle for her, and I promising to give her one of 60l. in two years at furthest, and in less if she pleases me in her painting, I went away and walked to Greenwich, in my way seeing a coffin with a dead body therein, dead of the plague, lying in an open close belonging to Coome farme, which was carried out last night, and the parish have not appointed any body to bury it; but only set a watch there day and night, that nobody should go thither or come thence, which is a most cruel thing: this disease making us more cruel to one another than if we are doggs.


This day I am told that Dr. Burnett, my physician, is this morning dead of the plague; which is strange, his man dying so long ago, and his house this month open again. Now himself dead. Poor unfortunate man!


…. I went forth and walked towards Moorefields to see (God forbid my presumption!) whether I could see any dead corps going to the grave; but, as God would have it, did not. But, Lord! how every body’s looks, and discourse in the street is of death, and nothing else, and few people going up and down, that the towne is like a place distressed and forsaken.


Up and, after putting several things in order to my removal, to Woolwich; the plague having a great encrease this week, beyond all expectation of almost 2,000, making the general Bill 7,000, odd 100; and the plague above 6,000. I down by appointment to Greenwich, to our office, where I did some business, and there dined with our company …….where a good venison pasty, and after a good merry dinner I to my office, and there late writing letters, and then to Woolwich by water, where pleasant with my wife and people, and after supper to bed.

Thus this month ends with great sadness upon the publick, through the greatness of the plague every where through the kingdom almost. Every day sadder and sadder news of its encrease. In the City died this week 7,496 and of them 6,102 of the plague. But it is feared that the true number of the dead, this week is near 10,000; partly from the poor that cannot be taken notice of, through the greatness of the number, and partly from the Quakers and others that will not have any bell ring for them.


Church being done, my Lord Bruncker, Sir J. Minnes, and I up to the Vestry at the desire of the justices of the Peace, Sir Theo. Biddulph and Sir W. Boreman and Alderman Hooker, in order to the doing something for the keeping of the plague from growing; but Lord! to consider the madness of the people of the town, who will (because they are forbid) come in crowds along with the dead corps to see them buried; but we agreed on some orders for the prevention thereof. Among other stories, one was very passionate, methought, of a complaint brought against a man in the towne for taking a child from London from an infected house. Alderman Hooker told us it was the child of a very able citizen in Gracious Street, a saddler, who had buried all the rest of his children of the plague, and himself and wife now being shut up and in despair of escaping, did desire only to save the life of this little child; and so prevailed to have it received stark-naked into the arms of a friend, who brought it (having put it into new fresh clothes) to Greenwich; where upon hearing the story, we did agree it should be permitted to be received and kept in the towne.

4 .9. 1665

….. it troubled me to pass by Coome farme where about twenty-one people have died of the plague, and three or four days since I saw a dead corps in a coffin lie in the Close unburied, and a watch is constantly kept there night and day to keep the people in, the plague making us cruel, as doggs, one to another.


Up by 5 of the clock, mighty full of fear of an ague, but was obliged to go, and so by water, wrapping myself up warm, to the Tower, and there sent for the Weekely Bill, and find 8,252 dead in all, and of them 6,878 of the plague; which is a most dreadfull number, and shows reason to fear that the plague hath got that hold that it will yet continue among us. Thence to Brainford, reading “The Villaine,” a pretty good play, all the way.


Where, when I come home I spent some thoughts upon the occurrences of this day, giving matter for as much content on one hand and melancholy on another, as any day in all my life. For the first; the finding of my money and plate, and all safe at London, and speeding in my business of money this day. The hearing of this good news to such excess, after so great a despair of my Lord’s doing anything this year; adding to that, the decrease of 500 and more, which is the first decrease we have yet had in the sickness since it begun: and great hopes that the next week it will be greater. Then, on the other side, my finding that though the Bill in general is abated, yet the City within the walls is encreased, and likely to continue so, and is close to our house there. My meeting dead

corpses of the plague, carried to be buried close to me at noon-day through the City in Fanchurch-street. To see a person sick of the sores, carried close by me by Gracechurch in a hackney-coach. My finding the Angell tavern, at the lower end of Tower-hill, shut up, and more than that, the alehouse at the Tower-stairs, and more than that, the person was then dying of the plague when I was last there, a little while ago, at night, to write a short letter there, and I overheard the mistresse of the house sadly saying to her husband somebody was very ill, but did not think it was of the plague. To hear that poor Payne, my waiter, hath buried a child, and is dying himself. To hear that a labourer I sent but the other day to Dagenhams, to know how they did there, is dead of the plague; and that one of my own watermen, that carried me daily, fell sick as soon as he had landed me on Friday morning last, when I had been all night upon the water (and I believe he did get his infection that day at Brainford), and is now dead of the plague. To hear that Captain Lambert and Cuttle are killed in the taking these ships; and that Mr. Sidney Montague is sick of a desperate fever at my Lady Carteret’s, at Scott’s-hall. To hear that Mr. Lewes hath another daughter sick. And, lastly, that both my servants, W. Hewer and Tom Edwards, have lost their fathers, both in St. Sepulchre’s parish, of the plague this week, do put me into great apprehensions of melancholy, and with good reason. But I put off the thoughts of sadness as much as I can, and the rather to keep my wife in good heart and family also. After supper (having eat nothing all this day) upon a fine tench of Mr. Shelden’s taking, we to bed.


…..and there drank a cup of good drink, which I am fain to allow myself during this plague time, by advice of all, and not contrary to my oathe, my physician being dead, and chyrurgeon out of the way, whose advice I am obliged to take, and so by water home and eat my supper, and to bed, being in much pain to think what I shall do this winter time; for go every day to Woolwich I cannot, without endangering my life; and staying from my wife at Greenwich is not handsome.


At noon to dinner to my Lord Bruncker, where Sir W. Batten and his Lady come, by invitation, and very merry we were, only that the discourse of the likelihood of the increase of the plague this weeke makes us a little sad, but then again the thoughts of the late prizes make us glad.


I hear by every body how much my poor Lord of Sandwich was concerned for me during my silence a while, lest I had been dead of the plague in this sickly time.


About 4 or 5 of the clock we come to Greenwich, and, having first set down my Lord Bruncker, Cocke and I went to his house, it being light, and there to our great trouble, we being sleepy and cold, we met with the ill newes that his boy Jacke was gone to bed sicke, which put Captain Cocke and me also into much trouble, the boy, as they told us, complaining of his head most, which is a bad sign it seems. So they presently betook themselves to consult whither and how to remove him. However I thought it not fit for me to discover too much fear to go away, nor had I any place to go to. So to bed I went and slept till 10 of the clock and then comes Captain Cocke to wake me and tell me that his boy was well again. With great joy I heard the newes and he told it, so I up and to the office where we did a little, and but a little business.


Called up by Captain Cocke (who was last night put into great trouble upon his boy’s being rather worse than better, upon which he removed him out of his house to his stable), who told me that to my comfort his boy was now as well as ever he was in his life.


But, Lord! what a sad time it is to see no boats upon the River; and grass grows all up and down White Hall court, and nobody but poor wretches in the streets! And, which is worst of all, the Duke showed us the number of the plague this week, brought in the last night from the Lord Mayor; that it is encreased about 600 more than the last, which is quite contrary to all our hopes and expectations, from the coldness of the late season. For the whole general number is 8,297, and of them the plague 7,165; which is more in the whole by above 50, than the biggest Bill yet; which is very grievous to us all.


Up between five and six o’clock; and by the time I was ready, my Lord’s coach comes for me; and taking Will Hewer with me, who is all in mourning for his father, who is lately dead of the plague, as my boy Tom’s is also, I set out, and took about 100l. with me to pay the fees there, and so rode in some fear of robbing.


By and by to dinner about 3 o’clock and then I in the cabbin to writing down my journall for these last seven days to my great content, it having pleased God that in this sad time of the plague every thing else has conspired to my happiness and pleasure more for these last three months than in all my life before in so little time. God long preserve it and make me thankful for it! After finishing my Journal), then to discourse and to read, and then to supper and to bed, my mind not being at full ease, having not fully satisfied myself how Captain Cocke will deal with me as to the share of the profits.


I do end this month with the greatest content, and may say that these last three months, for joy, health, and profit, have been much the greatest that ever I received in all my life in any twelve months almost in my life, having nothing upon me but the consideration of the sicklinesse of the season during this great plague to mortify mee. For all which the Lord God be praised!


This night I hear that of our two watermen that use to carry our letters, and were well on Saturday last, one is dead, and the other dying sick of the plague. The plague, though decreasing elsewhere, yet being greater about the Tower and thereabouts.

The plague lingered on, but abated through the winter and Pepys mentions it less and less often.

Anyone wishing to read The Diary in full should go to the wonderful website, which originally put up the Diary entries each day on their corresponding date with a vast array of fascinating notes and comments. It can be found at

Claire Tomalin – Samuel Pepys: the Unequalled Self is highly to be recommended for biography and background.



For millennia, leprosy was one of the most feared diseases, but also one of the most mysterious, in part because any one of a range of skin complaints may have been mistakenly identified as leprosy.  It was believed to be highly contagious, hence lepers being exiled from their communities. But it also had a strange way of appearing and disappearing; the reasons are still being debated in the scientific community.

Although it was known earlier, there was an epidemic in Europe in the 11th-14th centuries, to which the church and the community responded with alms houses and hospitals. But, after the Black Death, it seems that in Europe the disease was in retreat and many of the charitable institutions were put to other uses for lack of patients.

 In some parts of the world, such as India, it continued to be endemic, but there were also unexpected epidemics, for example in Norway at the beginning of the 19th century. This outbreak led to considerable research in the country, with attention being paid to questions of hygiene and poverty, as possible causes. The nature of the disease was established in mid-century by the Norwegian, Gerhard Henrik Armauer Hansen – hence it is now commonly known as Hansen’s Disease.

Other epidemics occurred, for example in Hawai’i, in the 19th century, when a virgin population came into contact with a disease against which they had no resistance, perhaps carried by Chinese immigrants or foreign sailors.

I would have liked to have had a first person account from Norway or Hawai’i, but failed to find one, however, the following, collected in Columbia in the 21st c., reflect the experiences suffered across the world over the centuries.

My father took me to see my aunt, who lived in Socorro, so that I could say good-bye to her. She knew of my situation and took me to a place some distance from the house, where one could see the mountains quite a long way away to the south. And then she said to me, showing me the mountains in the distance: my little son, those mountains over there in the distance are where they are going to take you and none of those whom they take there ever leave again, because they die. Because their arms fall off and their hands fall off and their feet fall off and they become completely disfigured, and they never again let them out of that place. So we here never see them again.

An account of the journey to the lazaretto collected in 2013 in the leper colony of Contratación:

My mother proved to be sick and in those days they hunted down sick just as today they hunt down the guerrillas, and so she had to go to Contratación….

A very mixed group of lepers painfully made their way through the pass in the mountains…..worn out elders, men in the prime of life, young mothers, marriageable girls  and even babes-in-arms made up the band….Some of the sufferers carried their possessions, bringing with them an old mat, a towel, their blanket, and some might have a fine cock, multi-coloured and one-eyed, with a fighting spur, and a dog, thin and worn out, like honour itself…There are always sad and disturbing scenes. The mother who finds her beloved daughter in the group, the son who recognizes his father….It is paradoxical to see the husband who was not prepared to follow his partner when she was sacrificed and driven out into exile; buttressed by prejudice, beset by fears, he believed – wrongly – that he would be spared the fatal disease….

Arrival in the colony could also involve traumatic meetings with family. The following is an oral account given in 2014 by a woman in the lazaretto of Agua de Dios:

The arrival was dramatic. Very painful though and very sad, because my Papa thought I was in Popayán. A man who had come to collect me at the first check point before the entry to the lazaretto called a policeman and told him they should warn my father…..he said: “Look for ‘Chucho the partygoer’, that is Chucho Gonzales, because his daughter is here, arrived from Popayán.” My father didn’t believe it then and there, so the policeman and the manager sent a driver, who was called Señor Carmona, whose hands were diseased and also his nose, but he had good eyes, blue, blue…..and the policeman said to me: “Come on, little girl, they have come for you, do you hear? Your father has sent for you and is over there waiting.” [And they said to Papa]: “Look, look! There’s your little daughter! There’s your little daughter!” [And the father answered]: “Daughter? That skinny little thing? No, no, no! My daughters are in Popayán studying. Where did you pick this child up? Well, if you picked her up, keep her, because she’s not mine!” Then Papa said; “Where are you from, little one? I don’t see that you’re from Popayán, no, not Popayán.” My sister recognized me and pulled me out of the window of the car and screamed and cried: “It’s our little girl! It’s our little girl!” [I asked] “Why are you crying, Papa?” [The father answered]: No, because I’m happy, little one, because you came here to be with us, oh yes, you are going to be here with us.”

From: Historial oral y memoria de los enfermos de Hansen en dos lazaretos de Colombia: trayectorias de vida, conflictos y resistencias; Natalia Botero-Jaramillo, Jessica Mora-Blanco, Nelson Daniel Quesada-Jiménez; Hist. cienc. saude-Manguinhos vol.24 no.4 Rio de Janeiro Oct./Dec. 2017


N.B. In case I have infringed copyright on any occasion, please notify me and I will immediately delete the post.

Japan – Smallpox – 735-7 A.D. and after

tsuyu no yo wa
tsuyu no yo nagara
sari nagara

This world of dew
is truly a world of dew,
and yet…and yet….

This poem was written by Issa, one of the greatest of the haiku poets, on the death of his little daughter. Issa’s life was a long series of tragedies, rarely referred to directly in his poetry. He was a devout Buddhist, and dew was the classic image for the evanescence of life.

Half a century earlier, Fukuda Chiyo-ni, one of the best women writers of haiku, had also written a poem for the little son who had loved dragon-flies and died young:

tombo tsuri kyou

wa doko made

itta yara

Dragonfly catcher,
How far have you gone today
In your wandering

Both children had died of smallpox.

By the 18th century, smallpox was endemic in Japan, but the disease was largely associated with children, for whom it was often fatal.

According to contemporary Chronicles – unfortunately, I have not had access to the original sources – in the 6th century, a King of Korea sent Buddhist images to Japan. This was said to have angered the kami, the native gods, who later took their revenge with a violent epidemic. In 584, more images, texts, priests and even a temple architect were sent to encourage conversion:

Again the land was filled with those who were attacked with sores and died thereof. The persons thus inflicted with sores said: “Our bodies are as if they were burnt, as if they were beaten, as if they were broken, and so lamenting they died.”

The debate raged as to whether the disease was the punishment of the Shinto gods on account of the honour paid to the new religion, or the punishment for not accepting Buddhism and its commandments wholeheartedly.

After the Emperor Bidatsu – believed to be the first Emperor to die of smallpox – was succeeded by his brother Yomei, who also allegedly died of the disease, Bidatsu’s widow, the Empress Suiko, came to the throne and ruled for thirty-five years. Prince Shotoku, Yomei’s son, acted as regent, and when his father was stricken in 585, he vowed to build a temple to the “Buddha of Medicine”. This was the Hōryū-ji at Nara.

Other early sources relate that the later epidemic was brought in by a Japanese fisherman shipwrecked in Korea. He returned to Kyushu, bringing the disease with him, which then spread.

As Nara grew in size and the country developed more urban centers and better communications, waves of disease became increasingly serious. In 735-7, there was a terrible epidemic in which it is estimated that about a third of the population died. This led to major social, economic and religious repercussions.

The Emperor Shomu, himself a Buddhist, ordered the building of temples and, finally, vowed the construction of the Daibutsu – Great Buddha – at the Tōdai-ji in Nara, one of the largest images in the world, in the form of Vairocana, who was believed to have negotiated a truce with the indigenous gods.

After the great epidemic, smallpox became established in Japan and there were repeated outbreaks, although none as devastating as that of the early 8th century.

As elsewhere, medical literature devoted to the disease developed*. The 10th century I Shinho recommended the use of red for sufferers – hangings, bedding, clothing, etc, to mitigate the effects of the illness, something also believed in Europe. This persisted in folk practice in many countries into the 19th century. The I Shinho also recommended the setting up of isolation hospitals, indicating some awareness of the mechanics of transmission.

The I Shinho was written about the same time as the Persian physician and scholar Rhazes (al-Rāzī) wrote his treatise On Smallpox and Measles and Chien Chungyang wrote the first scientific description of smallpox in China. According to Joseph Needham, Rhazes was visited by a Chinese medical scholar in Baghdad, but whether they shared information is not known.

In the indigenous, as opposed to Buddhist tradition, in Japan, smallpox was deified as hōsōgami, the smallpox god, who was placated, especially in Okinawa, with songs and dances and other rituals and with much use of the colour red. There is even a collection of smallpox poetry to which, unfortunately, I have not had access. In another strand of folk belief, various heroes were credited with expelling the smallpox demon, which became a popular subject for prints.

*An extremely interesting Sino-Japanese manuscript on smallpox dated c.1720 can be seen on line at Michael Kühn  

Donald R. Hopkins, The Greatest Killer: Smallpox in History, Chicago University Press, 2002

Joseph Needham, et al., Science and Civilisation in China, vol VI, Cambridge University Press, 2000

tsombo tsuri kyou

Whether One May Flee a Deadly Plague – Martin Luther – 1527

Martin Luther was at Wittenburg, 56 miles SW of Berlin, when the plague arrived in August, 1527. Luther and other teachers were enjoined to leave, but he refused, although his son fell sick, the wives of two friends died and the monastery where he had his home was turned into a hospital. Before the plague struck, Johann Hess, a follower of Luther, had written to him to ask whether it was proper for Christians to flee such deadly plagues. This was a question that had also long been raised in the Islamic world (see posts by Miss Tully, Abd al-Latif al-Baghdadi and Ibn al-Wardi). Luther’s response is, in some respects, curiously similar to that of the Muslim theologians. In spite of his virulent anti-Semitism, in the following letter, Luther does not blame the Jews for the epidemic, as had been the case on a number of occasions in the Middle Ages (this was partly, no doubt, because they dealt in furs and used clothing, although the mechanism of transmission was not understood), but sees it in the first instance as the punishment for sin, facilitated by the carelessness of man. He postulates that whether or not it is right to flee depends largely on  one’s presence being required by individuals or the community.

Your letter, sent to me at Wittenberg, was received some time ago. You wish to know whether it is proper for a Christian to run away from a deadly plague. I should have answered long ago, but God has for some time disciplined and scourged me so severely that I have been unable to do much reading or writing……..

To begin with, some people are of the firm opinion that one need not and should not run away from a deadly plague. Rather, since death is God’s punishment, which he sends upon us for our sins, we must submit to God and with a true and firm faith patiently await our punishment. They look upon running away as an outright wrong and as lack of belief in God. Others take the position that one may properly flee, particularly if one holds no public office…..….all those in public office such as mayors, judges, and the like are under obligation to remain……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 fires, murder, riots, and every imaginable disaster is a great sin.

He enumerates the people who are morally obliged to stay, adding:

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…..

Where no such emergency exists and where enough people are available for nursing and taking care of the sick, and where, voluntarily or by orders, those who are weak in faith make provision so that there is no need for additional helpers, or where the sick do not want them and have refused their services, I judge that they have an equal choice either to flee or to remain. If someone is sufficiently bold and strong in his faith, let him stay in God’s name; that is certainly no sin. If someone is weak and fearful, let him flee in God’s name as long as he does not neglect his duty toward his neighbour but has made adequate provision for others to provide nursing care……

It would be well, where there is such an efficient government in cities and states, to maintain municipal homes and hospitals staffed with people to take care of the sick so that patients from private homes can be sent there — as was the intent and purpose of our forefathers with so many pious bequests, hospices, hospitals, and infirmaries so that it should not be necessary for every citizen to maintain a hospital in his own home. That would indeed be a fine, commendable, and Christian arrangement to which everyone should offer generous help and contributions, particularly the government. Where there are no such institutions — and they exist in only a few places — we must give hospital care and be nurses for one another in any extremity or risk the loss of salvation and the grace of God ..…..

Now if a deadly epidemic strikes, we should stay where we are, make our preparations, and take courage in the fact that we are mutually bound together (as previously indicated) so that we cannot desert one another or flee from one another. First, we can be sure that God’s punishment has come upon us, not only to chastise us for our sins but also to test our faith and love — our faith in that we may see and experience how we should act toward God; our love in that we may recognize how we should act toward our neighbour.

I am of the opinion that all the epidemics, like any plague, are spread among the people by evil spirits who poison the air or exhale a pestilential breath which puts a deadly poison into the flesh. Nevertheless, this is God’s decree and punishment to which we must patiently submit and serve our neighbour, risking our lives in this manner as St. John teaches…..

This I well know, that if it were Christ or his mother who were laid low by illness, everybody would be so solicitous and would gladly become a servant or helper. Everyone would want to be bold and fearless; nobody would flee but everyone would come running….

Those are nothing but lies; whoever wants to serve Christ in person would surely serve his neighbour as well. This is said as an admonition and encouragement against fear and a disgraceful flight to which the devil would tempt us so that we would disregard God’s command in our dealings with our neighbour and so we would fall into sin on the left hand.

Others sin on the right hand. They are much too rash and reckless, tempting God and disregarding everything which might counteract death and the plague. They disdain the use of medicines; they do not avoid places and persons infected by the plague, but lightheartedly make sport of it and wish to prove how independent they are. They say that it is God’s punishment; if he wants to protect them he can do so without medicines or our carefulness. This is not trusting God but tempting him. God has created medicines and provided us with intelligence to guard and take good care of the body so that we can live in good health..…

Moreover, he who has contracted the disease and recovered should keep away from others and not admit them into his presence unless it be necessary. Though one should aid him in his time of need, as previously pointed out, he in turn should, after his recovery, so act toward others that no one becomes unnecessarily endangered on his account and so cause another’s death……if everyone would help ward off contagion as best he can, then the death toll would indeed be moderate. But if some are too panicky and desert their neighbours in their plight, and if some are so foolish as not to take precautions but aggravate the contagion, then the devil has a heyday and many will die….

Some are even worse than that. They keep it secret that they have the disease and go among others in the belief that by contaminating and poisoning others they can rid themselves of the plague and so recover….. My advice is that if any such persons are discovered, the judge should take them by the ear and turn them over to Master Jack, the hangman, as outright and deliberate murderers.

If in the Old Testament God himself ordered lepers to be banished from the community and compelled to live outside the city to prevent contamination [Leviticus 13–14], we must do the same with this dangerous pestilence so that anyone who becomes infected will stay away from other persons, or allow himself to be taken away and given speedy help with medicine. Under such circumstances it is our duty to assist such a person and not forsake him in his plight, as I have repeatedly pointed out before. Then the poison is stopped in time, which benefits not only the individual but also the whole community, which might be contaminated if one person is permitted to infect others. Our plague here in Wittenberg has been caused by nothing but filth. The air, thank God, is still clean and pure, but some few have been contaminated because of the laziness or recklessness of some. So the devil enjoys himself at the terror and flight which he causes among us. May God thwart him! Amen.

The long letter ends with advice on preparation of the soul at such times and a disquisition on the need for proper places of burial.

From Martin Luther, Luther’s Works, Vol. 43: Devotional Writings II, ed. Jaroslav Jan Pelikan, Hilton C. Oswald, and Helmut T. Lehmann, vol. 43 (Philadelphia: Fortress Press, 1999), 119–38. On-line at

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Ibn al-Wardi – On the Advance of Plague – 1348

Ibn al-Wardi (1292-1348/9) was a Syrian historian and geographer.

The Plague frightened and killed. It began in the land of darkness. Oh, what a visitor! It has been current for fifteen years. China was not preserved from it nor could the strongest fortress hinder it. The plague afflicted the Indians in India. It weighed upon the Sind. It seized with its hand and ensnared even the land of the Uzbeks. How many backs did it break in what is Transoxiana? The plague increased and spread further. It attacked the Persians…and gnawed away at the Crimea. It pelted Rum with live coals and led the outrage to Cyprus and the islands. The plague destroyed mankind in Cairo. Its eye was cast upon Egypt, and behold, the people were wide awake. It stilled all movement in Alexandria. The plague did its work like a silkworm. It took from the tiraz*factory its beauty and did to its workers what fate decreed.

Oh Alexandria; this plague is like a lion which extends its paw to you. Have patience with the fate of the plague, which leaves of seventy men only seven.

Then, the plague turned to Upper Egypt. It also sent forth its storm to Barqah. The plague attacked Gaza, and it shook Asqalan severely. The plague oppressed Acre. The scourge came to Jerusalem and paid the zakat**[with the souls of men]. It overtook those people who fled to the al-Aqsa mosque, which stands beside the Dome of the Rock. If the door of mercy had not been opened, the end of the world would have occurred in a moment. It, then, hastened its pace and attacked the entire maritime plain. The plague attacked Sidon and descended unexpectedly upon Beirut, cunningly. Next, it directed the shooting of its arrows to Damascus. There the plague sat like a king on a throne and swayed with power, killing daily 1000 or more and decimating the population. It destroyed mankind with its pustules. May God the Most High spare Damascus to pursue its own path and extinguish the plague’s fires so they do not come close to her fragrant orchards.

Oh God, restore Damascus and protect her from insult. Its morale has been so lowered that people in the city sell themselves for a grain.

Oh God, it is acting by Your command. Lift this from us. It happens where You wish; keep the plague from us. Who will defend us against the horror other than You the Almighty? . . .

How many places has the plague entered. It swore not to leave the houses without [taking] their inhabitants. It searched them with a lamp. The pestilence caused the people of Aleppo the same disturbance. It sent out its snake and crept along. It was named the “Plague of the Ansab.” ***It was the sixth plague to strike in Islam. To me it is the death of which our Prophet warned, on him be the best prayers and peace.

One man begs another to take care of his children, one says goodbye to his neighbors. A third perfects his works, and another prepares his shroud. A fifth is reconciled with his enemies, and another treats his friends with kindness. One is very generous; another makes friends with those who have betrayed him. Another man puts aside his property; one frees his servants [slaves]. One man changes his character while another mends his ways. For this plague has captured all people and is about to send its ultimate destruction. There is no protection today from it other than His mercy, praise be to God.

Nothing prevented us from running away from the plague except our devotion to the noble tradition. Come then, seek the aid of God Almighty for raising the plague, for He is the best helper.

Ibn al-Wardi goes on to mention the medical precautions taken in Aleppo:

 Oh, if you could see the nobles of Aleppo studying their inscrutable books of medicine. They multiply its remedies by eating dried and sour foods. The buboes which disturb men’s healthy lives are smeared the Armenian clay. Each man treated his humours and made his life more comfortable. They perfumed their homes with ambergris and camphor, cyprus and sandal. They wore ruby rings and put onions, vinegar, and sardines together with the daily meal. They ate less broth and fruit but ate the citron and similar things.

In the Muslim world, there was a tension between the learning of the physicians, based on classical medicine and the religious tradition, based on the Hadith, or sayings of the Prophet Muhammad. According to the latter, disease of any kind came from Allah, perhaps as punishment for sin, and any attempt to avoid it was impious and anyway pointless, because no matter where one fled, if it was Allah’s will, one would die. The question of contagion was, therefore, in a sense irrelevant. To die of plague was considered martyrdom and martyrdom was highly desirable, as affording immediate entry into paradise, hence Ibn al-Wardi’s words, contrasting the attitude of the Muslim and the non-Muslim:

The dwellers of Sis are happy with what afflicts us, and this is what you can expect from the enemies of the true religion. God will spread it to them soon so that He will put plague upon plague.

The plague is for Muslims a martyrdom and a reward, and for the unbelievers a punishment and a rebuke. When the Muslim endures misfortune, then patience is his worship. It has been established by our Prophet, God bless him and give him peace, that the plague-stricken are martyrs. This noble tradition is true and assures martyrdom. And this secret should be pleasing to the true believer. If someone says it causes infection and destruction, say: God creates and recreates. If the liar disputes the matter of infection and tries to find an explanation, I say that the Prophet, on him be peace, said: who was infected the first? If we acknowledge the plague’s devastation of the people, it is the will of the Chosen Doer. So it has happened again and again.

Ibn al-Wardi wrote some verses on the plague, two days before he died of it at Aleppo in 1349:

I am not afraid of the plague as others are – It is a martyrdom, or else a victory. If I die, I rest from rivalry and strife, If I live, my eye and ear [understanding] will be healed

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

*tiraz  – officially produced textiles of the highest quality, generally with calligraphic inscriptions, or the factories where they were woven.

** zakat – alms-giving (2.5%), religiously mandated in Islam.

*** ansab – sacrificial alters from before Islam.

Owing to libraries being closed due to our present plague, I was not able to find a translation for Ibn al-Wardi’s text. The quotations here are taken from the internet and were often not credited. I believe the most probably sources are the following.

Michael W. Dols, The Black Death in the Middle East, (Princeton; Princeton University Press, 1977).

Michael W. Dols, “Ibn al-Wardi’s Risalah Al- Naba’ ‘An Al-Waba’, A Translation of a Major Source for the History of the Black Death in the Middle East,” in Dickran K. Kouymjian, ed. Near Eastern Numismatics,  Iconography, Epigraphy and History (Beirut; American University of Beirut, 1974).

There is an extensive literature on the Black Death, but an in interesting article on the different perceptions of contagion in Islam is:

 “There is no contagion, there is no evil portent”: Arabic Responses to Plague and Contagion in the Fourteenth Century, Robin S Reich – available on-line at

And a useful survey of Arabic Plague literature:

Lawrence I. Conrad, Arabic Plague chronicles and treatises in Studia Islamica no.54 (1981) pp.51-93.

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Meditations in Time of Plague – Marcus Aurelius – c.161-180

The Meditations – literally “Things to One’s Self” – of the Emperor, Marcus Aurelius, is one of the best known and best loved works of philosophy. Teaching American students European history and culture in the early 2000s, it was almost invariably the text they picked out as being the most interesting and “relevant”.

Marcus Aurelius was of the Stoic school of philosophy. As he tries to define a “good life” and a “good man”, the themes to which he returns again and again are the need to accept the workings of nature – including loss and death – to avoid being dominated by worldly desires, the importance of charity and kindness to all, but above all calm courage and resignation when faced with what cannot be changed.

All this becomes very personal when it is realized that much of the work was written against the background of the Antonine Plague. It began in 165-6 and devastated the Roman Empire, which recovered largely thanks to Marcus Aurelius’ firm leadership and enlightened policies, so much so that his reign was considered on balance a happy one.

Marcus Aurelius’ adopted brother and co-Emperor died of the plague; up to 10% of the population succumbed and, among many other results, tax revenues from Egypt plummeted; civic building works had to be suspended for fifteen years for lack of money and man-power; mining was disrupted, something reflected in the dramatic fall in lead pollution in Greenland ice cores*; the army was so depleted that new recruitment and immigration arrangements had to be made.

There is debate about the nature of the plague in question, which is described in some detail by the great physician Galen, but the fairly general consensus is that it was small pox **. He remarks that that the mortality rate was much higher among the poor and the slaves, and where people were crowded together, as in the army, and that this was characteristic of epidemics. Himself a Stoic, he bore the loss in a fire of all his possessions, including a vast collection of medical texts, with equanimity.

The Meditations seem to be personal jottings, not rigorously organized and intended for publication and this is, perhaps, their attraction. Himself in poor health, he had survived the plague and outlived his beloved wife, Faustina, and many of their children. He is writing to convince himself, not as an academic exercise.

Marcus Aurelius begins his Meditations looking back over his life and, in a few very moving sentences, recalling and thanking those who had most influenced him:

From my grandfather Verus I learned good morals and the government of my temper.

From the reputation and remembrance of my father [who died when Marcus Aurelius was three] , modesty and a manly character.

From my mother, piety and beneficence, and abstinence, not only from evil deeds, but even from evil thoughts; and further, simplicity in my way of living, far removed from the habits of the rich.

From my great-grandfather, not to have frequented public schools, and to have had good teachers at home, and to know that on such things a man should spend liberally.

From my tutor, to be neither of the green nor of the blue party at the games in the Circus, nor a partisan either of the Parmularius or the Scutarius at the gladiators’ fights; from him too I learned endurance of labour, and to want little, and to work with my own hands, and not to meddle with other people’s affairs, and not to be ready to listen to slander.

From Diognetus, not to busy myself about trifling things, and not to give credit to what was said by miracle-workers and jugglers about incantations and the driving away of daemons and such things; and not to breed quails for fighting, nor to give myself up passionately to such things; and to endure freedom of speech; and to have become intimate with philosophy……

From Rusticus …..I learned….. to write my letters with simplicity, like the letter which Rusticus wrote from Sinuessa to my mother; and with respect to those who have offended me by words, or done me wrong, to be easily disposed to be pacified and reconciled, as soon as they have shown a readiness to be reconciled; and to read carefully, and not to be satisfied with a superficial understanding of a book; nor hastily to give my assent to those who talk overmuch; and I am indebted to him for being acquainted with the discourses of Epictetus [ex-slave and one of the greatest Stoic philosophers], which he communicated to me out of his own collection.

From Apollonius I learned freedom of will and undeviating steadiness of purpose; and to trust to nothing but reason, not even for a moment; and to be always the same, in sharp pains, on the occasion of the loss of a child, and in long illness; and to see clearly in a living example that the same man can be both most resolute and yielding…….

From Sextus, a benevolent disposition, and the example of a family governed in a fatherly manner, and the idea of living in harmony with nature; and gravity without affectation; and to look carefully after the interests of friends; and to tolerate ignorant persons, and those who form opinions without consideration…..

From Alexander the Platonic, rarely, unless absolutely necessary, to say to any one, or to write in a letter, that I have no leisure; nor continually to excuse the neglect of duties required by our relationship to those with whom we live, by alleging urgent occupations…….

From my brother Severus, to love my kin, and to love truth, and to love justice…..


Do not act as if you had ten thousand years to throw away. Death stands at your elbow. Be good for something while you live and it is in your power

Time is like a river made up of the events which happen, it is a violent stream, for as soon as a thing has been seen, it is carried away, and another comes in its place, and this will be carried away too.

The unripe grape, the ripe bunch, the dried grape, all are changes, not into nothing, but into something which does not yet exist.

Be like the promontory against which the waves continually break, but it stands firm and tames the fury of the water around it.

When a man kisses his child, said Epictetus, he should whisper to himself, “To-morrow maybe you will die.”

– But those are words of bad omen.

“No word is a word of bad omen,” said Epictetus, “which expresses any work of nature. Or if it is so, it is also a word of bad omen to speak of the ears of corn being reaped.”


Don’t let yourself forget how many doctors have died, furrowing their brows over how many deathbeds. How many astrologers, after pompous forecasts about others’ ends. How many philosophers, after endless disquisitions on death and immortality. How many warriors, after inflicting thousands of casualties themselves. How many tyrants, after abusing the power of life and death atrociously, as if they were themselves immortal.

How many whole cities have met their end: Helike [destroyed in a tsunami in 373 B.C.], Pompeii, Herculaneum, and countless others.

And all those you know yourself, one after another. One who laid out another for burial, and was buried himself, and then the man who buried him – all in the same short space of time.

In short, know this: Human lives are brief and trivial. Yesterday a drop of semen; tomorrow embalming fluid, ash.

To pass through this brief life as nature demands. To give it up without complaint.

Like an olive that ripens and falls.

Praising its mother, thanking the tree it grew on.


The Meditations are available on-line at

*The Antonine Plague Revisited, Richard Duncan-Jones, Actos 52 (2018) pp.41-72 and on-line at

**Galen and the Plague, Rebecca Fleming, on-line at