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September/October 2008 • Historically Speaking 29

RELIGIOUS RESPONSES TO : A ROUNDTABLE*

THANKS TO THE SEMINAL WORK OF WILLIAM MCNEILL gion and widespread disease in the West. We also asked David Arnold and Howard and Alfred Crosby, historians pay much more attention to the impact disease has had Phillips to explore two specific cases outside of —one from , the other in history. Historians, however, have been slower to consider the nature and variety of from . Then we commissioned Duane Osheim to use these essays to com- religious responses to epidemic disease. To help readers think about this relatively neg- ment on the overall topic of religion and epidemic disease in history. lected topic, we invited Andrew Cunningham to comment in general terms about reli-

EPIDEMICS, , AND THE DOOMSDAY SCENARIO‡ Andrew Cunningham

udden and fierce outbreaks of disease have 2. 1348-49: , known since the 19th always proved traumatic to societies, and one century as the . of the major responses has customarily been Sapocalyptic fear and the search for scapegoats or 3. 1490s: the sexually-transmitted disease divine messages. This was true of the Black Death known in the past as “the pox” or “the of 1348 as it was still true of AIDS in the late 20th French disease.” It is today usually assumed century. to have been syphilis. For centuries in Christian society people have made direct connections between the outbreak of 4. 1490s: , the deadly disease of epidemic disease and Doomsday. Not only were those crowded together in unsanitary con- and pandemics thought to herald the end ditions, such as besieging armies or be- of the , in the sense that they were punish- sieged towns, prisons, etc. ments for the sinful, but pestilences had been among the signs of the Second Coming that Christ 5. 1831-32: . himself had warned his followers to watch for (Matthew 24.3-13). It is not only the pain, suffer- 6. 1890s: plague, from China to Europe. ing, and many sudden deaths that make people so Possibly the same disease as 1348-49, but afraid in an epidemic, but also the accompanying more probably not. disruption of civil society, especially as the food supply often breaks down, the living cannot cope 7. 1918: “.” Killed 20 million with burying the dead, and those who can flee fast people in seventeen weeks. and far. An epidemic is a disease that literally “falls on 8. 1980s to the present: AIDS. the mob” (demos in Greek). The term has been cur- rent since antiquity. An epidemic is any disease that But while the list of pandemics is quite short, kills many people, kills them quickly, kills them in an the (if we could make it with any unpleasant way, and which usually is arbitrary in its degree of accuracy) would be very, very long. In manner of action, not being choosy as to whether early modern Europe, epidemics—meaning here "Vigil of the dead." A 14th-century miniature from Paul the victims are old or young, fit or unfit. The appar- Durrieu, Les Heures à l’usage d’Angers de la collection sudden outbreaks of with a 10% or higher ently arbitrary manner in which epidemics kill is one Martin Le Roy (Pour les Membres de la Société, 1912). mortality—were very frequent. It has been calcu- of their most important features, because it renders lated that in the 150 years from 1500 to 1650 there an epidemic writ large. The term is meant to con- most precautions irrelevant. were seventeen occasions on which a particular epi- vey the scale and spread of the outbreak, not its A , by contrast, is a term coined from demic spread widely across the whole continent, an greater severity or mortality. Journalistic usage of the Greek in the 19th century to characterize an average of once every nine years. In the commercial the term is much looser, however, and primarily, I epidemic that is everywhere (pan in Greek), or at centers epidemics were particularly frequent: Ams- think, because of the resonance of “pandemic” least all over the known world at a given time. It is terdam, for instance, experienced some twenty-four with “panic,” English-speaking journalists tend outbreaks during that period. Dense populations today to use the term without discrimination for favor the spread of epidemics, and trading centers any major outbreak of disease. But strictly speak- naturally encourage travel both in and out. Towns ing the great pandemics of the past of which we *This roundtable is sponsored by a grant from the John Templeton were death traps in the , and Foundation. have any record are only these: the richer and more active the town, the more sub- ‡ This article is partly based on chapter 4 of Andrew Cunningham and ject it was to frequent epidemics. The countryside, 1. 541 A.D.: the so-called “Plague of Jus- Ole Peter Grell, The Four Horsemen of the Apocalypse: Religion, , by contrast, was in general a safer place to live, at and Death in Reformation Europe (Cambridge University Press, tinian.” 2001), where full citations for all quotations can be found. least as far as disease was concerned. So not only 30 Historically Speaking • September/October 2008

were epidemics experienced frequently, but their ef- ers. The only cure was either an antidote or some it was spread especially by soldiers. It had reached fects were very visible, especially to town dwellers. attempt to appease or placate the First Cause. right across Europe within five years, and affected In the context of the kind of medicine taught Given this understanding of the origin of epi- people from the poorest ranks of society to kings in universities and practiced by physicians on the demic constitutions of the air, attempting to pla- and cardinals. well-to-do, epidemics were anomalous. Galenic cate God was a natural—rather than a When the disease first broke out it was fear- medicine was developed for the treatment of indi- supernatural—thing to do, just as it was to practice some and extraordinarily painful, causing its suffer- viduals, not crowds of sick people. The quality of astrology. By contrast, to place the first cause of ers to scream with pain all day and, even more so, the air that a person breathed and the management epidemics in the stars themselves was considered all night. The writer of our first-hand account was of the “non-naturals” as they were called (food and superstitious: good Christians did not do this, rec- Ulrich von Hutten, a humanist in the service of the drink, sleep and wake, evacuations) were critical to ognizing that the stars were neither secondary nor Archbishop of Mainz, who had contracted the dis- the maintenance and restoration of health. The pre- primary causes. Because epidemics were interpreted ease while a soldier in Italy in 1509 or 1510 and cise constitution of the individual patient—age, way in this way as natural phenomena, it was always easy who suffered grievously from the disease for many of life, diet, and so on—were what made him or to be wise after the event, and retrospectively spot years. His book was called Of the Wood Called Gua- her vulnerable to illness. And illness or disease was the clear signs in nature that it was coming. Among iacum, that Healeth the French Pox, and it was first pub- not an attack on the individual by lished in Latin in 1519. According to some disease-causing entity from out- von Hutten, the physicians would at side, but rather resulted from an im- first have nothing to do with the dis- balance of the patient’s humors. For Christians the visitation of disease has ease because it was so horrible: Customarily, therefore, the physician devised a regimen or a program of always been an ambiguous matter, since For when it first began it was of treatment that would maintain or re- their God is a benign god, and nothing such filthiness, that a man would store the particular balance of the hu- scarcely think this sickness, that mors in a particular individual. There happens without His will and knowledge. now [i.e,. in 1519] reigneth, to be was no room in this theory for under- of that kind. There were boils, standing or treating many people si- sharp, and standing out, having multaneously suffering from the same illness. the portents of epidemics were eclipses and fiery the similitude and quantity [i.e., size] of Indeed, even where the physician noticed during stars in the heavens, mists and lights in the sky as a acorns, from which came so foul humours epidemics that many people were suffering and consequence of the air becoming corrupted, and and so great stench, that whosoever once dying from the same disease, he believed that its animals coming out of their lairs and dying in great smelled it, thought himself to be infect. particular in each particular patient would numbers. The colour of these pustules was dark be unique. Therefore each individual needed to be For Christians the visitation of disease has al- green, and the sight thereof was more treated in a unique way. ways been an ambiguous matter, since their God is grievous unto the patient than the pain it- The Galenic physician interpreted epidemics a benign god, and nothing happens without His will self: and yet their pains were as though as the product of a specific poison: specific in that it and knowledge. Obviously God sends disease, and they had lain in the fire. caused this particular set of symptoms and effects, obviously it must be as punishment for sin. But it and a poison in that like other poisons it acted di- was not always clear, even to men of religion, quite There was considerable variation in the manifesta- rectly on the heart as a result of having been which sins were being punished by a particular vis- tion of symptoms, but the pustules usually started, breathed in from the air. The only medical cure for itation of a pestilence, nor why the good died under in males, on the penis. The astrologers predicted a specific poison was, of course, a specific antidote, God’s justice as well as the wicked. Though unable that the disease would only last seven years and and charlatans and quacks of all types, from bath to answer these questions in a final way, the church, then disappear, but instead after seven years the dis- attendants to butchers, were quick to offer for sale whether Catholic or Protestant, still remained the ease turned into a somewhat milder form, without different drugs or treatments. In conventional med- center for seeking divine intervention against this the acorn-like pustules or so much stench. But the icine the best advice, which could only realistically divine punishment. For the expiation of sins, and to pain continued to be excruciating. “If any thing be taken up by the rich, was to go away quickly, stay plead for the mercy of God, Christian churches may cause a man to long for death, truly it is the away as long as possible, and return slowly. While often called for communal fasts and instituted torment of this sickness,” von Hutten wrote. “For this advice might sound cynical, it actually was built prayer marathons, together with the carrying of this pestilence besides all his vexations and tor- on the view that the air was the source of poison- relics in procession through the streets, often ac- ments (which pass far all other) only with his foul- ous ferments: moving to new air would avoid the companied by lay or religious flagellants. ness and loathliness is able to make one weary of disease. First-hand accounts of epidemics are rare for his life.” Hutten felt driven to the sin of suicide As far as the causes of epidemics were con- obvious reasons, and first-hand accounts from sur- under the pain, and only hesitated when he remem- cerned, the conventional view—held by learned vivors of epidemics are even rarer. So we are par- bered his Christian duty of manfully suffering great physicians as well as by the religious—was that God ticularly fortunate in having a detailed account from torments and pains for Christ’s sake. was the First Cause of diseases, as of everything a sufferer of the pox, when that disease was new, The pain was in the joints, but it also came else. Most people (though not all) believed that and before people understood that it was spread from the running sores all over the body, and from God acted through secondary causes, that is to say He through sexual intercourse. The first large outbreak the holes that appeared in the flesh as it putrified, used natural means. Thus conventional wisdom had of it occurred in 1494, in the army of King Charles so that one could see the bone and watch it being it that God in His wisdom decided to send an epi- VIII of that had recently been besieging eaten away. According to von Hutten, there were demic to a specific population. He carried this out Naples. Given this first appearance, it is no surprise agonizing sores in the bladder, the liver, and the by causing particular conjunctions of the planets, that the French called it the Neapolitan disease, stomach. Ulrich von Hutten’s case of the disease or bad aspects of the stars (literally “dis-asters”). while those to whom it was spread equally naturally began in his left foot. As it rose up his leg the skin These in turn would cause a change, a corruption, called it the French disease. Others were to call it over the shin began to rot in many holes, very in the air, leading to the creation of a specific invis- the Polish disease, the German disease, or the Span- painfully, and over these holes “was a knob so hard ible poison. This poison then entered the body ei- ish disease. The variety of early names that this dis- that a man would have thought it a bone.” He could ther through the lungs or via the pores of the body, ease was given indicates how its arrival was hardly stand up because of the pain; the calf and making the victim now a source of to oth- perceived: that it originated from outside, and that knee were very cold, the thigh consumed and worn September/October 2008 • Historically Speaking 31

away; one buttock virtually withered away. The pain in the 19th century led to the perception that epi- in his left shoulder was so great that he could not *** demics are purely natural phenomena, subjects of raise his arm, and both shoulders were withered. science rather than eschatology. In the 1870s and There was a constant voiding sore below his ribs Some 350 years later a cholera pandemic struck Eu- 1880s, as a result of the complementary but rival on the right side, and a constant stream from the rope. This 19th-century pandemic had a significant work of in France and of Robert top of his head, running down his back. If you influence on the thinking of Justus Hecker (1795- Koch in Prussia/ in their laboratories, the touched the place where this filthy stream began, it 1850), a third generation professor of medicine— identity of each epidemic disease was located in the felt as though the skull was fractured. Von Hutten and soon of the —at distinct micro-organism () that caused it. recovered because (he believed) he used the new Friedrich-Wilhelms University in Berlin. When Between them, Pasteur and Koch and their imme- cure of guaiacum wood. cholera arrived in Europe in 1831, Hecker focused diate pupils discovered and isolated, over a mere Von Hutten started his treatise with the words, his attention on major epidemics in history. He read three decades, the causal micro-organisms of many “It hath pleased almighty God,” Visum Deo est, “that medieval and early modern chronicles, rediscovered of the important infectious epidemic diseases: an- in our time sicknesses should arise which were un- the great plague of 1348-49 (which had been for- thrax, typhoid, gonorrhoea, , cholera, known to our forefathers.” This view was shared gotten), and named it the “Black Death.” He fur- , tetanus, diarrhoea, , plague, by medical men. The court physician in Ferrara, ther learned of a dancing mania of the Middle botulism, , syphilis, and others. Corradino Gilino, wrote in 1499, “We also see that Ages, and the strange disease of the “English Laboratory medicine presented a quite new the Supreme Creator, now full of wrath with us for sweat” that had broken out in the 16th century and view: science can discover measures to prevent the our terrible sins, punishes us with this cruellest of only seems to have affected Englishmen whether at spread of a particular micro-organism, and even ills which has now spread not only through Italy home or abroad. Subsequently, Hecker worked on cure epidemics by developing . God and but across almost the whole of Christendom. the of the 2nd century A.D. On the apocalypse are no longer part of the discussion. Everywhere is the sound of trumpets; everywhere each of these past epidemics Hecker wrote a short And yet some of that apocalyptic hysteria still the noise of arms is heard . . . . Let us say, with the book in the early 1830s, which was quickly trans- crops up when we are confronted by a new epi- Prophet in the sixth psalm, ‘Lord, do not censure lated into other languages. Almost single-handedly demic or pandemic whose pattern or origin we do me in your anger nor in your wrath afflict us.’ This Hecker had recovered these momentous events of not understand. It was the case in 1918 with the I believe is the cause of this savage plague.” Some disease history, and he has thus appropriately been Spanish flu, and again the case with AIDS at the theologians claimed the sin in question being duly styled the originator of historical pathology. But end of the last century: scapegoats are sought punished by God was luxuria: “seeing that the guilty Hecker also saw these epidemics as momentous in among minorities in the population. And, in the organ [i.e., the penis] is the organ which suffers, the the development of . For Hecker’s case of AIDS, it was even seriously proposed that theologians admire that just and equitable maxim, interpretation of these epidemics was peculiar. He nature (rather than God) was punishing us for the for a like sin a like penance.” regarded them as cosmic in origin, and caused by “unnatural” sexual excesses of the previous three The decade of the 1490s was most unfortunate Providence (though not sent as divine punish- decades. in that it witnessed the appearance of not one but ments). He saw them as occurring in vast cycles, two pandemics: pox and typhus. The latter arose and their effect was to “renovate” nature. He be- Andrew Cunningham is senior research fellow in the primarily from the new modes of warfare, particu- lieved that the story of epidemics, if it could be history of medicine in the department of history and larly the widespread use of siege tactics, which told, would be allied to the history of the mental philosophy of science at the . pinned down both the besieger and the besieged in development of the human race! In other words, He is the author of The Anatomical Renais- frightful conditions. Moreover, “plague” (or diseases the reaction of human society to such as sance: The Resurrection of the Anatomical that contemporaries called plague) continued to ap- epidemics could over time improve the moral con- Projects of the Ancients (Scolar Press, 1997). pear every few years, regularly killing its thousands. dition of mankind. So, although Hecker was cer- He wrote and presented the thirty-part BBC radio se- All these epidemics and pandemics had significant tainly dealing in terms of historical pathology, it was ries—now available on CD—The Making of economic—and sometimes political—effects, and not in a form that would today be recognized as Modern Medicine (BBC Audiobooks, 2007). these disruptions of society encouraged the view scientific. that people were living in the Last Days. The development of laboratory medicine later

EPIDEMIC IN INDIA David Arnold

t is now nearly thirty years since the World tween a quarter and a third of all cases, smallpox left places where it was , were and chil- Health Organization declared that smallpox many of those who survived blind or with severely dren, and the recurrence of smallpox in epidemic had been eradicated. South was one of the disfigured faces. Solely reliant on person-to-person form, every four to seven years, marked the mass in- Idisease’s most enduring strongholds: as recently as communication, the smallpox struck with ter- fection of a new pool of unprotected individuals. 1958 smallpox claimed more than 150,000 lives in rifying speed and violence. The victim suffered in- The only virtue in smallpox, if anything so horrific India.1 Long on the wane even before the mid-20th tense pain: a burning fever was followed by the can be said to have one, was that those who had century, as a result of ’s populariza- eruption of large pustules that transformed the once been attacked by the variola virus acquired life- tion of smallpox immunization through , human body into a suppurating mass that reeked of long to the disease. It was recognition of it is perhaps now difficult to recall the depth of hor- death and decay. Adding to its tragic consequences, this peculiar characteristic that had inspired human ror this virulent disease once inspired. Fatal in be- most of those who fell prey to this foul disease, in attempts to forestall the disease, whether by inocu- 32 Historically Speaking • September/October 2008

lating vulnerable individuals with live smallpox mat- 21,000 fatalities between 1837 and 1869, represent- Hindu deity, the goddess Sitala. Equivalent female ter (variolation) or, following Jenner, by vaccinating ing 5-10 % of all deaths. In 1849-50 alone, 6,100 deities, known under a variety of different names, them (with a derived from cowpox) so as to smallpox deaths were recorded in the city. Even after were to be found in many parts of south India as artificially induce immunity. Jennerian vaccination had been introduced to large well. Sitala was not part of the original Vedic pan- Originating in Old World Eurasia, smallpox ap- parts of British India by the mid-19th century, mor- theon and may have been a local deity who rose to pears to have become widely prevalent in China, tality from the disease remained very high, with at prominence as smallpox grew more widespread and India, Mediterranean Europe, and by least 4 million deaths between 1865 and 1899. In established from the 7th century onward. Ralph the 7th century A.D. It thrived on human popula- years when epidemic smallpox raged, it accounted Nicholas has recorded the rise of a Bengali litera- tions dense enough to sustain its cyclic recurrence for a third of all recorded deaths.3 Except in remote ture about the goddess starting in the 16th and 17th in epidemic form, but it also spread out along trade, areas, the disease appears to have been almost uni- centuries, but also notes earlier representations of pilgrimage, and invasion routes into new regions and versal. Unless protected by inoculation, everyone the goddess in Hindu shrines and temples from Gu- previously unprotected peoples. With the movement could expect to experience the disease at some stage jarat in the west to Bengal in the east.6 Although of Europeans from the 15th century onward across of their lives, usually as young children. So common there are some references to Sitala as “the goddess of the Atlantic and around the Cape of spots,” the conventional image of Good Hope into the Indian Ocean the deity represents her not as being and Pacific, smallpox moved rapidly afflicted by the disease but as simul- into regions and among populations taneously its disseminator and the that had no previous experience of, protector against its ravages. She ap- and hence immunity to, the disease. pears as a calm but powerful female By the 16th century smallpox had as- presence, with large, commanding sumed an almost pandemic form, eyes. She rides on an ass, carrying in though it principally manifested itself her outstretched hands a pitcher of in localized epidemics. Without the water and a broom and bearing on need for insect vectors or long peri- her head a basket of grain. The god- ods of incubation, smallpox could dess’s image embodies both the na- even move in advance of European ture of the disease and the manner exploration and conquest, devastating of its containment. The basket of indigenous peoples, weakening their grain represents the grain- or lentil- capacity to resist invasion and all but like pustules that were the primary eliminating them from lands thrown feature of the disease. By shaking her open to European annexation and head Sitala spreads the disease, but, if settlement. Few diseases, so the argu- she so chooses, she can sweep it ment goes, had so great an impact on From William Crooke, The Popular Religion and Folk-lore of Northern India, vol. 1 (, away with her broom before it causes 1896). indigenous populations or did so distress. The name “Sitala” means much to shift the balance of power the “Cool One,” in recognition of towards invading whites. And for the the goddess’s intrinsic desire to be indigenes themselves, it was difficult not to believe was the disease that it came to be thought of as an cool despite the frequent human neglect or miscon- that so sudden, so horrifying, so fatal an affliction inescapable ordeal, a necessary rite of passage (for duct that incites her fiery rage.7 The pitcher of water was a kind of curse, a form of divine retribution. those who survived) into adult life. As late as 1879, and the ass refer to the widespread belief that since But how was smallpox understood in those coun- Sir Sayyid Ahmad Khan observed that smallpox was smallpox was a “heating” disease, evident through tries—like India—that were not new to smallpox, the raging fever it caused, it needed to be tackled by where, for all its episodic peaks of intense destruc- the inevitable bridge which every child has means of various “cooling” substances—such as tion, it had long ceased to be rare and exceptional, a to cross before entering into life; and recov- cold water and asses’ milk—or by the sufferer being phenomenon that had somehow to be accommo- ery from the disease is considered second wafted with cool, wet leaves from the neem tree, sa- dated within the patterns and beliefs of everyday birth . . . . Other diseases are looked upon as cred to Sitala and believed to have both cooling and lives? accidental; but small-pox is regarded, as in- medicinal properties. Smallpox was commonly India was, so far as we know, one of the regions deed it is, [as] almost universal. It touches thought of as a form of possession, with the god- where smallpox was most widely entrenched. Small- the keenest of human susceptibilities; for dess showing by her fiery fever that she had occu- pox epidemics occurred there roughly every four to there are thousands in this country who, pied the body of her . Her presence needed, seven years, at times reaching out beyond India into though spared by it from death, still have accordingly, to be treated with the reverence appro- neighboring and Afghanistan or, carried traces of its violence in the deep marks on priate to a presiding deity: hymns were sung prais- by traders and by pilgrims on hajj to Mecca, travel- the face or the loss of an eye.4 ing the goddess, cool drinks were offered and ing across the Arabian Sea to and the cooling medicaments applied for fear that the wrath Red Sea coast. It is possible, too, that the smallpox A British medical officer, writing a few years earlier of the goddess might be aroused and the sufferer’s that invaded southern Africa and penetrated else- about northern India, similarly observed that it had condition made worse. If the patient died, his or her where around the Indian Ocean during the first cen- become “quite a saying among the agricultural and body was not cremated in the usual way but buried turies of European commerce and contact may have even wealthier classes never to count children as per- or released into a stream—the heat of the goddess issued from India rather than Europe. Within South manent members of the family until they have been might prevail even after death. Asia itself, smallpox, its impact accentuated by mal- attacked with and recovered from smallpox.”5 Sitala could be counted among the many and famine, may have had an even higher The Indian response to the near inevitability and “godlings of disease” worshipped in villages across case fatality than in Europe—at times in excess of almost constant visibility of smallpox was complex, India.8 Some took the form of mother goddesses, 30 %. Smallpox was said to be “the scourge of and it offers a rather different view of how religion protectors of the village community from calamity India,” and “one of the most violent and severe dis- was implicated in human responses to disease. as well as reminders of the ever-present danger of eases to which the human race is liable.”2 In Calcutta, Across a large swathe of northern, eastern, and cen- disease. Other, lesser deities held responsibility for capital of British India, smallpox accounted for tral India smallpox was identified with a popular particular diseases. Thus when cholera erupted in September/October 2008 • Historically Speaking 33

epidemic form across India in 1817 (and initiated the cluding cold water baths), and the segregation of serve to support such measures. Although powerless first of several pandemics), it gave rise to similar be- those inoculated.11 Although variolation was criti- to eradicate smallpox, the invocation of Sitala that liefs in a disease-causing deity, and women appeared cized and eventually outlawed by the British as far accompanied variolation and the cool and calming who claimed to be possessed by the cholera goddess. more dangerous than vaccination and a potential atmosphere with which householders tried to cope But Sitala occupied a place of exceptional reverence cause of epidemics, it appears to have been effective with the disease and aid recovery gave religious sanc- among disease deities. Sitala became, especially in in a great majority of cases and sufficiently wide- tion to local practices that helped reduce the impact 17th- and 18th-century Bengal, a superior deity, a spread in regions like Bengal to reduce mortality of one of the most devastating disease known to hu- mother goddess to be worshipped not only in village from the disease. mankind. ceremonies during the early spring season when Variolation countered the colonial argument that smallpox first became prevalent, but also celebrated Indians were “apathetic” in the face of disease.12 David Arnold is professor of Asian and global his- in religious hymns and verses. Sitala was also wor- Here was evidence of a sustained and calculated re- tory at the University of Warwick. He is the author of shipped by the Muslims of eastern Bengal (today’s sponse in anticipation of the near inevitability of a a number of works on medical and environmental his- ), who shared much of their culture with dreadful disease. It has, moreover, been argued that tory in India, including Colonizing the Body: Hindus until the Faraizi reform movement in the this was a striking case of the mobilization of local State Medicine and Epidemic Disease in Nine- 19th century sought to win them away from such un- knowledge and of self-help by villagers (who chose teenth-Century India (University of California Islamic beliefs. Nicholas attributes this Press, 1993). outpouring of religious fervor for Sitala to the exceptional of small- pox at that time. Sitala took on the man- The Indian case shows that religious be- tle of a protectress.9 This role is echoed 1 Donald R. Hopkins, Princes and Peasants: Smallpox in in the songs sang by women as they tried liefs do not necessarily stand in the way History (University of Chicago Press, 1983). to cool the body of a smallpox victim, 2 Annual Report upon Vaccination in the North-West fanning it and evoking the goddess: of prophylaxis and treatment but might Provinces for the Season 1866-67, 4; T. Edmondston Charles, Popular Information on Small-pox, Inoculation and actually serve to support such measures. Vaccination (Calcutta, 1870), 1. O Mother, giver of salvation to the world, thou art kind to the 3 Jayant Banthia and Tim Dyson, “Smallpox in Nine- teenth-Century India,” Population and Development Review poor. 25 (1999): 660, 664, 677. My kine have strayed into the forest of to have their children inoculated and paid a small fee 4 Sitala. to the inoculators for doing so).13 But where did this Shan Mohammad, ed., Writings and Speeches of Sir Syed Ahmad Khan (Nachiketa Publications, 1972), 142. O Mother, giver of salvation to the prophylactic practice of smallpox inoculation leave world, thou art kind to the poor. the goddess Sitala? In some cases, variolation seems 5 R. Pringle, “On Smallpox and ,” Lancet What can avail if God gives [a child] to have been carried out with minimal deference to (January 1869), 44.

to any one? One gets it only when Sitala the deity, but more commonly the practice seems to 6 Ralph W. Nicholas, “The Goddess Sitala and Epidemic Small- gives; the giver of salvation to the world. have been accompanied with the cautious invocation pox in Bengal,” Journal of Asian Studies 41 (1981): 29-33. When Sitala is wroth with one, one of the goddess: it was, in the words of one observer, 7 Susan Wadley, “Sitala: The Cool One,” Asian Folklore Studies 39 finds no pleasure in milk, in the milk-pot, “practically a religious ceremony.” The day before (1980): 33-62. in the son in the cradle, in the house or in the operation a solemn offering of cooling fruits and the courtyard. fluids was made to the goddess, followed on the day 8 W. Crooke, The Popular Religion and Folk-Lore of Northern India, vol. 1 [1896] (Munshiram Manoharlal, 1968), ch. 3. O Mother, giver of salvation to the of the inoculation by incantations to the deity and by world. further hymns and offerings once the success of the 9 Nicholas, “Goddess Sitala,” 33-34. Thou art land and water, and thou art operation was assured. In the meanwhile the inocu- 10 W. Crooke, “Religious Songs from Northern India,” Indian An- the most powerful of all. lated child was treated kindly in the belief that “the tiquary 39 (1910): 285-86. Thou art queen of three regions. O deity presiding over small-pox is in the child’s sys- 11 10 J. Z. Holwell, “An Account of the Manner of Inoculating for Mother, giver of salvation to the world. tem, and any castigation or abuse might offend the the Smallpox in the East Indies,” in A. Dharampal, ed., Indian goddess and draw down her wrath upon the child, in Science and Technology in the Eighteenth Century: Some Contemporary In the eyes of some Western critics the venera- the form of confluent small-pox and death.”14 In European Accounts (Impex India, 1971), 143-163. tion paid to Sitala amounted to devil worship. The other words, Sitala retained her authority even over 12 S. P. James, Smallpox and Vaccination in British India (Thacker, British blamed Indian resistance to Jennerian vacci- a prophylactic practice instituted by humans and in- Spink, and Co., 1909), v. nation largely on the worship of Sitala. In actuality, tended to minimize the impact of the disease over 13 Frédérique Apffel Marglin, “Smallpox in Two Systems of much of the dissent was attached to the coercive which she presided. It is ironic that long after vario- Knowledge,” in Frédérique Apffel Marglin and Stephen A. Mar- methods used by the British and not unreasonable lation had been suppressed and the authorities in in- glin, eds., Dominating Knowledge: Development, Culture, and Resistance doubts about the effectiveness of vaccination. India dependent India sought to make vaccination (, 1990), 102-143. already had an established means of protecting universal, they found it necessary to present small- 14 L. S. S. O’Malley, Bengal District Gazetteers: Balasore (Bengal Sec- against smallpox. This was the practice of variola- pox as a demon that needed to be destroyed.15 retariat Book Depot, 1907), 72. tion performed by itinerant specialists who visited What, then, does smallpox in India tell us about 15 Harish Naraindas, “Crisis, Charisma and Triage: Extirpating villages in the early spring, offering to inoculate the relationship between religion and epidemic—or the Pox,” Indian Economic and Social History Review 40 (2003): 451- those unprotected against the disease. They used at- pandemic—disease? First, it suggests ways in which 55. tenuated smallpox matter (crusts) harvested the pre- the dangerous and seemingly unpredictable relation- vious year and scarified the patient’s skin (usually on ship between a disease and its human hosts could be the upper arm) to insert a small amount of viral ma- normalized. Sitala helped her devotees make sense terial. The operation required care as the patient was, of why epidemics occurred and gave them a means in effect, being subjected to a mild case of the dis- by which to address the near inevitability of the dis- ease in order to “buy” lifelong immunity, and the im- ease’s visitation. Second, the Indian case also shows planting of the virus was followed by a series of that religious beliefs do not necessarily stand in the strict dietary proscriptions, a “cooling” regimen (in- way of prophylaxis and treatment but might actually 34 Historically Speaking • September/October 2008

WHY DID IT HAPPEN? RELIGIOUS EXPLANATIONS OF THE “SPANISH” FLU EPIDEMIC IN SOUTH AFRICA Howard Phillips

ere Lie the Bodies of 75 Na- modernity, modern science, and the faith-shaking As always, generic sins like immorality, drunk- tives Who Died During the experiences of the Great War. In short, such an enness, and lax church attendance featured promi- “H Epidemic—1918.” investigation of the complex ways in which faiths nently in the list of those that were said to have responded to a dire, life-and-death crisis on the called forth God’s wrath. One novel sin, though, This stark, collective epitaph on a plain memorial ground has the potential to shed light on much was that of “worshipping science,” a real si[g]n stone in a long-abandoned company of the times. “Nowadays people speak of 45 kilometers from Cape Town germs and filthy streets and ” as the is one of the very few public reminders cause, “and it is out of fashion and unsci- of South Africa’s greatest natural , entific to refer to sin,” lamented the the so-called “Spanish” epidemic Dutch Reformed Church’s official mouth- of 1918. In the space of six weeks it car- piece. “But God wants us to have no ried off some 300,000 South Africans, or other gods before Him.”2 6% of the population. No calamity before Another burning contemporary issue or since in South Africa—not even that was held to have drawn direct divine HIV/AIDS—has been as swift and lethal intervention was . Against the as this local outbreak of the global pan- backdrop of horrendous, mechanized demic of that year. bloodshed, some Calvinist ministers saw Traumatized by what one contempo- the epidemic as a lesson to those who ar- rary called a veritable “ of rogantly thought that humankind, with all plague,” grieving survivors struggled to re- of its new weapons, had perfected the cover socially, materially, emotionally, and ability to kill. “Isn’t it as if the Almighty psychologically. In a society in which reli- is toying with the murder resulting from gious beliefs were deeply embedded, sinful science?” asked a senior clergyman. most looked to religion for an explanation “Humans may kill in thousands, but God of the catastrophe that had ravaged their Demonstration at the Red Cross Emergency Ambulance Station in Washing- can kill in tens of thousands!”3 Other Re- communities. As pointed out, ton, D.C., during the of 1918. Library of Congress, Prints formed thinkers drew a different conclu- and Photographs Division [reproduction number, LC-USZ62-126995]. people are at their most religious when sion. To them the combination of a their lives and their livelihoods are under terrible war and a devastating plague was serious threat. not mere coincidence. They were eschato- Of what significance is this to historians? The more than just how they sought to make sense logical signs of deeper things afoot, heralds of answer is that to meet the intense popular de- of this particular visitation; they can illuminate, the Second Coming. “‘Maranatha! The Lord is mand for explanations of this disaster, an unusu- too, their core beliefs about their God. coming’ could well be the theme of our thoughts ally large number of them were printed in Within the South African Christian fold, for in these times,” announced a distinguished theolo- journals and newspapers at the time, and so re- example, clergymen of the Calvinist Afrikaner gian in the Dutch Reformed Church.4 At least one main available to historians ninety years later to Dutch Reformed Church saw God as all-power- lay member of the church, Johanna Brandt, went give insight into otherwise transient contemporary ful, the First Cause. The epidemic was obviously even further, prophesying that the Day of Judg- ideas about the cause of this calamity. If probed, the result of “divine visitation,” a moderator of ment was upon them. In a widely circulated pam- these ideas can, in turn, reveal deeper beliefs the church told his congregation. To seek its ul- phlet, The Millennium—A Prophetic Forecast, she about causation, why bad things happen, and the timate source in the chance action of germs was warned that the flu epidemic was only the begin- very nature of God—big existential questions that as misguided as the dog that bites the stone ning of the affliction that was foretold in the historians are not accustomed to ask about past thrown at it without realizing who the thrower Book of Revelations. Much worse was to follow societies. was. Did the plague of lice visited upon Pharaoh’s before Christ returned. Tellingly, her millenarian Moreover, in the case of South Africa the an- not demonstrate how God could transform prophecy came during a particularly harrowing pe- swers are possibly even more revealing, for the the smallest things in nature into a potent instru- riod in the history of the Afrikaner community cultural heterogeneity of the diverse population ment of divine will?1 in South Africa, reminding us of Michael Barkun’s meant that, even if one confines oneself to offi- Even more revealing for the historian is that point that “[m]illenarian movements almost always cial religious explanations, a wide spectrum of such explanations also sought to account for why occur in times of upheaval, in the wake of cul- these was recorded, stretching from four univer- God had sent the epidemic. Punishment for sin ture contact, economic dislocation, revolution, salist religions, Christianity, Islam, Judaism, and was the most common reason offered. What the war, and natural catastrophe.”5 As revealing is the Hinduism, to traditional African religion. This sin was provided a sharp insight into what church fact that at exactly the same moment millenarian makes possible comparisons among the explana- leaders in 1918 felt was so reprehensible as to prophecies were also being heard in several tions of the same phenomenon by several faiths warrant divine punishment on such a scale. This African Christian communities in South Africa, and even by different denominations within a sin- in turn helps delineate their conception of the na- which were equally hard-pressed.6 gle faith, all at a time when religions across the ture of God by setting out what human behavior Most non-Calvinist Christian clergymen began board were being confronted by the challenges of they judged to be anathema to Him [sic]. their attempts to account for the epidemic from a September/October 2008 • Historically Speaking 35

different view of God. Their God was more dis- for, acting on medical advice, several local author- abundant. Nevertheless, it is clear that Hindus, tant from everyday human conduct and less in- ities decided to try and prevent infection spread- Jews, and Muslims all acknowledged God’s pri- clined to intervene directly to punish sin, a stance ing by banning all indoor gatherings, including mary role in sending the disease, yet none was in- that had developed out of the encounter with sci- church services. Clergymen’s responses varied, re- clined to probe the reason why, at least in public. ence and modernity over the preceding century. flecting the uncertainty in the minds of many Muslims accepted it unquestioningly as the “People speak of it [the flu epidemic] as an ‘Act when the teachings of faith and science collided “Takdier [Will] of Allah”; Hindus felt it might be of God,’ a legal phrase, I know,” lamented the so directly over a matter widely supposed to con- an expression of an unspecified divine wrath; Anglican Archbishop of Cape Town, “but it cern life and death. Predictably, Calvinists had the while the country’s senior rabbi felt that it was seems to me to put the matter into an altogether fewest doubts. The ban, declared their journal, useless to speculate about the epidemic’s causes wrong light. The Enemy who sows tares certainly was plainly unchristian for “it prevents a commu- and origins. “Let us frankly confess that such found a congenial soil in the slums here.”7 A fel- nal approach to the Lord when people are suffer- knowledge is too wonderful for us,” he told a me- low bishop spelled out these ideas more fully in ing His trials and punishments.”10 Most Anglican morial service for flu victims. “It is too high for an article in the official Church Chronicle. He did ministers also expressed themselves in favor of us to attain unto it.”13 not believe “that God has sent the influenza be- continuing regular services, either because it was a For adherents of traditional African religion, cause He is angry with us, and has determined to time when people were looking to their religion responsibility for the devastating flu epidemic was punish us.” Rather, the source of the epi- very specific and intensely personal. Oper- demic’s devastation lay in the fact that ating within a religious framework in For adherents of traditional which their Supreme God was far removed certain conditions…laid down by the from humankind’s daily round of activities, Creator as necessary to our health, African religion, responsibility for they saw misfortunes like the epidemic as have been neglected, wilfully, it may stemming either from ancestors (rightly) be, or, what is more likely, in igno- the devastating flu epidemic was punishing the misconduct of individuals rance . . . . We know already that who had offended them or from the ne- fresh air, cleanliness, nourishment, are very specific and intensely personal. farious actions of malevolent witches or our allies in contending with disease, wizards who were humans with an evil in- and that on the other hand, foul air, tent born of anger, envy, or selfishness. dirt, poor and insufficient food, are ene- in particular for help and comfort or because not The patchy sources that survive point to the lat- mies strongly entrenched in the house- to do so would imply that appealing to God com- ter as a not uncommon explanation among such holds of thousands of people in this munally was useless in such circumstances. Some believers, for in the wake of the unprecedented country....[W]e who tolerate such clergymen tried to resolve their dilemma by short- epidemic the colonial authorities noticed a surge conditions are guilty before God and hu- ening services or holding them out of doors, but in cases in which witches or wizards were manity.8 many ignored the ban, pointing to the non-clo- “smelled out” by witch doctors or witch finders. sure of gathering places like bars, shops, and mar- For instance, the commissioner of police for one It was within such a social gospel framework kets. Only a handful of ministers actually largely African region reported patronizingly that that ministers of other Christian denominations suspended services on explicitly explained the epidemic, too, although they differed grounds, but one, the Congregationalist chaplain The recent Influenza Epidemic ravaged as to the degree of God’s involvement. Presbyte- to the mayor of Cape Town, triggered an outcry the Natives and in their ignorance they rians hinted at a more direct role in punishing hu- when he criticized those churches that remained ascribed the visitation to various causes manity’s neglect of social conditions, other open when cinemas, theaters, and dance halls and reasons, blaming friends and relatives Nonconformists at a lesser role. For instance, a were being forced to close. With a flourish of for having caused the illness and death of Methodist synod resolved that “this calamity, per- theological modernism, he proclaimed, those near and dear to them. There has mitted of God, was largely due to the social con- been an increase of Smelling-Out cases ditions amid which vast numbers of the people On general grounds, if the churches are and a resultant increase in the number of are compelled to live.”9 Some Christian publica- to open for public assembly, I fail to see crimes of violence reported, also mainly tions minimized God’s role even more. why we should discriminate against the- due to the witch-doctor.14 “[I]gnorance and neglect, not God, are responsi- atres. Whatever ecclesiastics may think ble for disease,” averred a Congregationalist mag- about our newly-made acquaintance, the He illustrated the grave consequences of such azine, while its Baptist equivalent made no bacillus catarrhalis, there is no essential smelling out by referring to a case in which a mention of God at all in its account of the epi- difference between a congregation assem- man suspected by a witch finder of being the demic. The Catholic Magazine, after months of vac- bled for public worship and a crowd cause of two deaths earlier in 1918 had now been illation, eventually attributed the outbreak to an gathered to witness the screening of a definitely labeled by the witch finder as a wizard undefined “Nature.” film.11 who was responsible for all the flu deaths in the For all their variations, each of these interpre- village. His fellow villagers had responded quickly, tations sought to reconcile belief in an omnipo- The dismay that this stance elicited from both attacking his kraal and killing him, his wife, and tent God with the discoveries of science and lay and clerical quarters was widespread. A Calvin- child and wounding his two teenage sons. medicine during the previous one hundred years. ist journal felt that, in comparison, its belief in “Many cases of homicide and serious assault re- That they were not always successful in doing so the primacy of the spiritual over the physical was sulting from ‘smelling out’ have come to my no- is indicated by the fact that numerous Africans, “old-fashioned and unscientific,” but, on balance, tice recently especially after the outbreak of dissatisfied with mainstream Christianity’s inability “closed churches fill us with greater fear than the influenza,” noted the local solicitor-general the to protect them or to provide an adequate expla- bacillus catarrhalis.”12 In the event, most local au- following year.15 nation of the disaster, abandoned their mission thorities were sufficiently prudent not to enforce Ninety years later, readers in parts of the churches in the wake of the epidemic and estab- the ban on church services, at least if most of world with little experience of life-threatening epi- lished breakaway churches of their own. their congregants were white-skinned. demics may find the preceding explanations quaint Nor did such attempts to find a compromise Evidence of how adherents of non-Christian and naive. Yet I wonder whether they would still between faith and science remain purely academic, universalist faiths interpreted the epidemic is less be as blasé were avian flu, for instance, to esca- 36 Historically Speaking • September/October 2008

late into a lethal pandemic in 2008. Would they 1 De Kerkbode, , 1918, 138; Het Kerkblad, November 9 Daily Dispatch, February 3, 1919. perhaps again be searching for an ultimate cause 1, 1918, 1. 10 De Kerkbode, October 31, 1918, 1034. beyond nature? Certainly the initial responses to 2 De Kerkbode, October 17, 1918, 140. the AIDS pandemic in the 1980s suggest that they 11 Cape Times, October 26, 1918. 3 Handelingen van de Zeste Vergadering van den Raad der Ned. would. Geref. Kerken in Zuid Afrika, 1919, 37. 12 De Kerkbode, October 31, 1918, 1035.

Howard Phillips is a professor in the department of 4 Gereformeerd Kerkblad, , 160. 13 In Memoriam. Memorial Service for Members of the Jewish Com- munity Who Died during the Epidemic. Held in the Great Synagogue, historical studies at the University of Cape Town. 5 Michael Barkun, Disaster and the Millennium (Yale University Cape Town, 24 November 1918, (Cape Town Hebrew Congre- He is the author of Black October: The Im- Press, 1974), 45. gation, 1918), 6. pact of the Spanish Influenza Epidemic of 6 Robert R. Edgar and Hilary Sapire, African Apocalypse: The 14 Cape Archives, Cape Town: CMT 3/872, file 638.1, Annual 1918 on South Africa (The Government Printer, Story of Nontetha Nkwenke, a Twenieth-Century South African Report of Transkei Division of South African Police for 1990) and co-editor with David Killingray of The Prophet (Ohio University Center for International Studies and 1918, 4. Spanish Influenza Pandemic of 1918-19: Witwatersrand University Press, 2000), ch. 1; Bengt Sundkler, Zulu Zion and Some Swazi Zionists (Oxford University Press, 15 Cape Archives, Cape Town: CMT 3/942, file 820, Solicitor- New Perspectives (Routledge, 2003). 1976), ch. 4. General, Grahamstown to Secretary for Native Affairs, July 18, 1919 enclosed in Secretary for Native Affairs to Chief 7 University of the Witwatersrand Library, Historical and Lit- Magistrate Transkei, July 28, 1919. erary Papers Division, AB 186 (Archbishop W.M. Carter Let- ters), Carter to Lord Wenlock, All Saints Day, 1918. [All translations into English in the text are by the author] 8 Church Chronicle, November 28, 1918, 456-467.

RELIGION AND EPIDEMIC DISEASE Duane J. Osheim

ohn Snow’s tracking of cholera the transformation he describes in 19th-century London and seems too stark, especially in the JRobert Koch’s subsequent iden- case of religious ideas and behav- tification of vibrio cholerae as the dis- iors. We merely need to recall that ease’s cause can stand as markers of in late 15th- and 16th-century Italy the transformation in our under- the cult of the St. Roch exploded standing of epidemic disease, and in popularity, the shrine of the by extension of the space left for Holy House of Loreto became religion in modern medicine. The popular throughout Europe, and widespread introduction of antibi- the Venetian government fulfilled a otics after the Second World War vow by constructing the Paladian seemed to validate the insights masterpiece, the Redentore. All of about illness and health implicit in these phenomena were responses to epidemiology and bacteriology. In a pestilence. previous work Andrew Cunningham All of our authors are describ- observed that since the rise of the ing a number of religious contexts laboratory, the very definition of a within which contemporaries un- disease has been based on a micro- derstood epidemic disease. The Broadside, Mexico City, 1910. Library of Congress, Prints and Photographs Division [repro- bial analysis rather than a sympto- duction number, LC-DIG-ppmsc-04798]. simplest way to think about these matic one.1 In this respect, essays is to note that Cunningham Cunningham argues, we cannot is describing religion as a stage in a compare ancient and modern diseases. And yet, clers and doctors came to believe that they under- process. Arnold’s discussion of smallpox in India, David Arnold’s analysis of smallpox in India and stood plague and had no need for religious expla- on the other hand, shows the place of religion in Howard Phillips’s discussion of the religious re- nations. “God slips into the background,” Cohn a system of thought. Finally, Phillips’s discussion sponse to the Spanish Flu in South Africa, both writes.2 He rejects the idea that the medieval of the responses to the Spanish Flu in South of which occurred during this period of revolu- plagues led to a retreat into religious dogma—at Africa allows us to see the ways in which religious tion, should give pause to those who believe that least after the initial experience of the Black ideas influence the very fabric of public life. In all the experience of epidemic disease in the past half Death. Chroniclers and doctors may not have ac- cases, we should add, there is no single predictable millennium should be read as a narrative of mod- tually understood what they were observing, but religious response. The influence of religion, like ernization and secularization. they believed they did. Cohn describes Europeans disease itself, depends very much on the environ- Secularization is implicit in Cunningam’s ac- in the 15th century as generally “[m]oving away ment.4 count, but Samuel K. Cohn, Jr. perhaps has put from utter despair, stargazing, and prayers to In each of these essays a remote God can re- the thesis most forcefully. For example, he has ar- God.”3 Cohn is surely correct when he suggests main as a first cause, even as contemporaries dis- gued that in the 15th and 16th centuries, chroni- that attitudes toward epidemic disease changed, but cussed secondary causes. Cunningham notes that September/October 2008 • Historically Speaking 37

this generally was the case in early modern Europe, And she, like the Pestfrau, seemed to offer an expla- Cristofano and the Plague, makes a similar point about just as Phillips finds a number of religious leaders nation of why some died and some did not. Cer- 17th-century Tuscany.7 in South Africa who easily accommodated modern tainly religions struggled with explaining why some What we learn from these three essays, of medicine, simply assuming that it described condi- sickened and others did not. The story of Job re- course, is that there is no single or predictable re- tions established by the Creator. Thus however re- counts just such a struggle. ligious response to epidemic disease. Nor is it cor- mote a God or religious explanation might be, What seems missing in the Indian response to rect to assume religious responses are always belief could accommodate a modern, microbial smallpox is the search for individuals or groups re- apocalyptic. It might be better to recognize that re- understanding of life. We merely need recall that sponsible for the tragedy. Europeans sometimes at- ligion, like gender, class, or race, is a category of even as literary critics proclaim that Darwin leaves tributed outbreaks of plague to marginal, analysis. The religious response to epidemic disease no room for God, the director of the Human seemingly sinister groups. In the 14th century lep- may best be seen as a frame, a constantly shifting Genome Project continues to proclaim his belief.5 ers and Jews were blamed. Later the Romani peo- frame, subtly influencing illness and human re- But in fact, as we look at sponses to it.8 these essays we will see that re- ligious responses are not sim- Duane J. Osheim is chair of the ple, nor are they uniform. They Corcoran Department of History at do, however, seem to fall along the University of Virginia. He is a continuum. The most dra- presently working on responses to epi- matic responses are those Cun- demics in medieval and early modern ningham associates with the Italy. He most recently co-edited, with apocalyptic predictions of the Sharon Dale and Alison Williams, Christian Gospels—Luke 21:11 Chronicling History: Chroniclers predicts , , and Historians in Medieval and pestilences, “and great signs Italy ( from heaven.” The 14th-cen- State University Press, 2007). tury plagues and the initial spread of the great pox fit this model well. Phillips reports that some in South Africa came to 1 Andrew Cunningham, “Transforming a similar conclusion. But it is Plague: The Laboratory and the Identity of Infectious Disease,” in Andrew Cunning- important to realize that it was ham and Perry Williams, eds. The Laboratory the combination of signs and Revolution in Medicine (Cambridge University not just plague itself that com- Press, 1992), 209-244. mentators noticed. The Black 2 Samuel K.Cohn, Jr, The Black Death Trans- Death was preceded by devas- formed: Disease and Culture in Early Renaissance tating earthquakes; the Great Europe (Oxford University Press, 2002); the “Dance of Death,” from Raymond Crawford, Plague and Pestilence in Literature and Art (Oxford, quote is from Cohn, “Triumph over Pox spread in the wake of the 1914). Plague: Culture and Memory after the Black French in Italy; and in Death,” in Truus van Bueren and Andrea van Keerdam, eds., Care for the Here and the South Africa it was World War Hereafter: Memoria, Art and Ritual in the Middle I that led believers to proclaim, “the Lord is com- ple were implicated. And finally, northern Italians Ages (Brepols, 2005), 36. ing!” In fact, it may well be that war and earth- believed that plagues were caused by the untori, evil 3 Cohn, “Triumph over Plague,” 39. quakes were more likely to excite apocalyptic people who spread disease by rubbing a mysterious speculation than disease. When epidemics arose in- ointment on the walls of public buildings and the 4 Paul W. Ewald, “The Evolution of ,”Scientific Ameri- can (April 1993): 86-92. This is a point Cunningham also dependent of other signs, the religious response covers of prayer books.6 South Africans blamed makes in the larger study from which his essay is drawn, An- was more reflective. witches for the deadly flu. It often seems that a drew Cunningham and Ole Peter Grell, “The Pale Horse: Dis- In Christian terms, by far the most typical re- search for a scapegoat is a natural response to epi- ease, Disaster and Death,” in The Four Horsemen of the Apocalypse: Religion, War, Famine and Death in Reformation Europe sponse was to acknowledge “God’s just anger.” demic disease. Yet these responses, too, have a pat- (Cambridge University Press, 2000), 298-304. Cunningham notes how easily pox and sexual li- tern, an epidemiology. Attacks on lepers and Jews cense fit together. But in the Christian West, in the 14th century were not universal, but fol- 5 See for example, Philip Kitcher, Living with Darwin: Evolution, Design, and the Future of Faith (Oxford University Press, 2007) avarice, gluttony, sodomy—all manner of social lowed a pattern similar to earlier rumors of well and Francis S. Collins, The Language of God: A Scientist Presents and personal sin—might have occasioned God’s poisonings. And the anti-Semitic attacks spread Evidence for Belief (Free Press, 2006). wrath. In India, perhaps because of the ubiquity along a path from the south of France into 6 William G. Naphy, Plagues, Poisons and Potions: Plague-Spreading of smallpox, or perhaps because of the subconti- Switzerland and the Rhine Valley that was different Conspiracies in the Western Alps, c.1530-1640 (Manchester Univer- nent’s religious pluralism, the disease does not from the movement of plague. In South Africa at- sity Press, 2002. seem to have ignited moral reflection. In the case tacks on witches were fueled by well-established 7 Carlo M. Cipolla, Cristofano and the Plague: A Study in the His- of South Africa, some Christian moralists seem to tensions in families and villages. tory of Public Health in the Age of Galileo (University of Califor- have connected Spanish flu to a sinful neglect of Finally, in all three areas (although it is not an nia Press, 1973). sanitary conditions while others saw the moral issue Cunningham pursues) part of the religious 8 Maureen C. Miller, “Religion Makes a Difference: Clerical lapse of secularism. But in general it may well be response may well have been a reaction to state and Lay Cultures in the Courts of Northern Italy, 1000-1300,” that sin can be an explanation only if disease is power and not simply to disease. Sitala offered a American Historical Review 105 (2000): 1095-1130. For a discus- sion of the cultural context of illness and disease see Mark relatively unexpected. means to reject heavy-handed British imperial med- Harrison, Disease and the Modern World: 1500 to the Present Day There is nothing in the European or South icine. The Calvinists’ angry rejection of modern (Polity Press, 2004). African experiences quite like Sitala, the Hindu medicine and complaints about the unchristian ac- deity. Perhaps the German Pestfrau or the Swedish tions of public officials were clearly related to plague boy would have been similar. Sitala did have broader issues between the Afrikaner and the a long history before joining the Vedic pantheon. British. Carlo Cipolla’s fascinating microhistory,