By Drew Nathaniel Keane

The degree of physical adversity and suffering that was commonplace for our ancestors defies our imagination. We live on the other side of advances in technology and medicine that would have seemed marvels and wonders to the pre- and early-modern mind. But the global COVID-19 pandemic has brought risk and mortality into unavoidable focus to a degree unfamiliar to most of us. As we try to come to terms with the pandemic and its implications from the perspective of Christian faith, it may be useful to consider how earlier generations of Christians for whom sickness, suffering, and unexpected death were far more prevalent prayed about such adversity.

From the beginning of this global pandemic many have noted the absence of occasional prayers for widespread illness in the 1979 Book of Common Prayer. Bishop John Bauerschmidt, in a recent Covenant article, observed, “It’s as if the possibility of a societal-wide illness had been forgotten.” By contrast, when the prayer book was promulgated the threat of an outbreak of the bubonic plague was ever present. Between the first edition of 1549 and the 1662 revision the available evidence of parish registers points to five major plague epidemics in London — 1563, 1593, 1603, 1625 — to say nothing of smaller outbreaks. The last major outbreak, forever remembered as the “Great Plague,” came in 1665, and 20% of the city’s population died.

The black death was not, of course, the only epidemic that afflicted the English population before the discovery of vaccines and antibiotics. Measles, whooping cough, influenza, smallpox, and pneumonia, and other deadly sicknesses were not uncommon threats. In 1551 there was a major outbreak of a mysterious sickness called “the sweat,” which usually killed those infected within hours. The sweat is specifically mentioned in a rubric before the Communion of the Sick, permitting an exception to the usual rule that there must be at least two communicants for a Communion service to proceed.


In a paper called “Divine Visitation,” given at a (digital) meeting of the English Prayer Book society last year, Matthew Olver explored the 1662 Prayer Book’s theology of sickness. Building upon Olver’s approach, I offer a close reading of the prayer “in the time of any common plague or sickness,” added to the Prayer Book in 1552:

O Almighty God, which in thy wrath, in the time of King David, did slay with the plague of pestilence sixty and ten thousand, and yet remembering thy mercy didst save the rest: have pity upon us miserable sinners, that now are visited with great sickness and mortality, that like as thou didst then command thy angel to cease from punishing, so it may now please thee to withdraw from us thy plague and grievous sickness, through Jesu Christ our Lord. Amen. (I have modernized spelling and punctuation.)

It follows the traditional compact structure of a collect: invocation (“O Almighty God”), acknowledgement (“which in thy wrath…”), petition (“have pity…”), aspiration (“that like as thou didst then…”), and pleading (“through Jesu Christ…”). In this prayer, the acknowledgement — a divine attribute, action, or promise that relates to the petition — recalls the story told in 2 Samuel 24 and 1 Chronicles 2.

The story is fraught with difficult questions. In brief, 2 Samuel 24 tells how God, provoked by unspecified sin in Israel, moved David, the King of Israel, to a faithless act, namely to take a census. In 1 Chronicles, a satan, an adversary or opponent, is said to have stood up against Israel and moved David to take the census. It is unclear why this was a faithless act, but it is clear that David ought to have known better, because his advisor, Joab, tried to dissuade him and David felt convicted immediately afterward. The prophet Gad presents David with three options for punishment: seven months of famine; three months of being routed by his enemies; or three days of pestilence. David replied, “Let us fall now into the hand of the Lord; for his mercies are great” (v. 14). The angel of the Lord swept through Jerusalem with an epidemic, and was only stopped when David confessed his sin, repented, and prayed for God to have mercy upon his people. In response, God stayed the destroying angel. Instructed again by Gad, David gave thanks by erecting an altar on the spot where God stopped the angel’s advance and offering sacrifice.

Why did Cranmer choose to evoke this story in the prayer for plague? We cannot know for certain, since Cranmer left us no explanation, but we might venture some reasonable guesses. The Sarum Missal, one of the chief sources from which parts of the Prayer Book were adapted, includes a Votive Mass to Turn Away Pestilence. The Introit for this Mass was adapted from 1 Corinthians 21 and 2 Samuel 24. In an English translation it reads:

Remember thy covenant, O Lord, and say to the destroying angel, Stay now thy hand, that the land be not laid desolate, and that thou destroy not every living soul.

The collect in that same Mass includes language readers will find familiar:

O God, who desirest not the death of a sinner, but rather that he should repent, we beseech thee graciously to convert thy people unto thyself; that whilst they remain devoted unto thee thou mayest mercifully put away from them the rod of thy wrath.

The first half of the acknowledgement is found in several prayers in the Sarum Missal. It is based upon Ezekiel 33:11, “I have no pleasure in the death of the wicked; but that the wicked turn from his way and live.” Cranmer uses this phrase three times in the prayer book: in one of the three Good Friday Collects; in the ante-penultimate prayer in the Commination; and, most significantly, in the form of Absolution for Morning and Evening Prayer: “Almighty God, the Father of our Lord Jesus Christ, who desireth not the death of a sinner, but rather that he may turn from his wickedness and live…” Occasional prayers, like the plague prayer, were added to the regular rota of services, at the end of Morning or Evening Prayer, so when the plague prayer (alluding to 2 Samuel 24) was used, the allusion to Ezekiel 33:11 would also have been heard in the absolution.

In place of an epistle, Sarum assigns a lesson from the Old Testament for this Mass, namely — you guessed it! — 2 Samuel 24:15-19. So, it seems highly likely that the Votive Mass to Turn Away Pestilence was in Cranmer’s mind as he crafted the prayer “in the time of any common plague or sickness.”

Perhaps the ambiguity in the narrative over the cause of God’s wrath contributed to the selection. 2 Samuel 24:1 begins in medias res, “And again the anger of the Lord was kindled against Israel.” Nothing in the preceding chapter provides a clue as to the particular provocation, yet we know it was sin. Divine anger is the opposition of perfect justice to whatsoever falls short thereof. Thus it is that we can reconcile the apparent conflict of 2 Samuel 24:1 with 1 Chronicles 21:1, “And Satan stood up against Israel.” “Satan” is simply an untranslated Hebrew word that means “adversary” or “opponent.” That is precisely what divine wrath is, the opponent of all unrighteousness. Perhaps the narrative’s omission of the particular sins that provoked the Lord’s anger and led to the plague suggested its usefulness as a theological lens through which to view sickness, which the Prayer Book (from 1549 through the 1892 American revision) frequently characterized as God’s “visitation.”

The prayer characterizes us as “miserable sinners,” echoing the daily confession of sin in Morning and Evening Prayer, the daily liturgical framework to which this prayer would be added: “O Lord, have mercy upon us, miserable offenders. Spare thou them, O God, which confess their faults.” While we now tend to use “miserable” in a subjective sense — to describe a feeling of sadness — the prayer book has in view its objective meaning. Miserable literally means “in need of mercy,” which is precisely the substance of the petition: “have pity upon us.”

The plague prayer is offered by those who daily confess, “We have erred, and strayed from thy ways like lost sheep. We have followed too much the devices and desires of our own hearts. We have offended against thy holy laws.” In other words, we have been led not by charity but cupidity, not love but lust. While we now tend to confine lust to sexual urges, the word means desire broadly speaking, particularly uncontrolled or excessive desire, which tends towards destruction: “When lust hath conceived, it bringeth forth sin: and sin, when it is finished, bringeth forth death” (James 1:15). Dominated by desire, “We have left undone those things which we ought to have done, and we have done those things which we ought not to have done.” In short, “there is no health in us.” This admission, omitted from the 1979 Prayer Book, is often misunderstood. “Health” means wholeness, soundness of soul and body. It is the inverse of misery: what is healthy is not lacking, not wanting, not in need of mercy. So, the phrase does not mean “there is nothing good in us.” Rather, it means, we are pervasively wounded, broken, and in need of help. The carefully crafted language of the general confession is a theologically precise description of sin. This is what the prayer for time of plague means when it refers to us as “miserable sinners”: it is because of sin that we stand in need of mercy and pray, “have pity upon us.”

It is this connection between the experience of suffering, including sickness, and sin that was challenged by 20th-century liturgical revisions. Massey Shepherd, explaining why the 1928 American Prayer Book revised the prayers for sickness so heavily, said “Naturally Christian sentiment rebelled against this point of view.” While the 1928 Prayer Book does retain this conceptualization of sickness and sin, it reduces the frequency of prayers that explicitly articulate it. The 1979 goes further, essentially expunging this view. Only one of its prayers connects suffering to sin, the prayer “For the Sanctification of Illness” (p. 460). It is perhaps part of what Urban T. Holmes (one of the leaders of the 1979 revision) meant when he said the new Prayer Book aimed to shift away from what he called “the Tudor deity” (see Olver’s discussion).

A great many fellow Episcopalians have told me “Anglicans don’t believe that!” or “that’s Baptist theology” in response to the idea of illness and sin being connected. In a similar vein, Bishop N.T. Wright concluded in a popular Time essay,

It is no part of the Christian vocation, then, to be able to explain what’s happening and why. In fact, it is part of the Christian vocation not to be able to explain — and to lament instead.

While it is true that the Christian vocation does not involve identifying immediate, particular causes for particular ills, surely the bishop overstates his case. The Fall, sin, and divine visitation do aim to provide a way of viewing suffering. They cannot fully answer the question “why?” but they are not irrelevant either. The absence of these suggests that the essay offers a significantly different account of suffering than that expressed in the Book of Common Prayer before the 20th century revisions.

It is popular to assume this view reflects the Calvinism of early modern English Protestantism. But as we have already seen from the Sarum Missal, this conceptualization of illness is neither uniquely Calvinist nor Protestant at all, but is shared by pre-Reformation theology and liturgy. In response the question whether death and other bodily defects are the result of sin, Aquinas answers:

By the sin of our first parents original justice was taken away… Wherefore, original justice being forfeited through the sin of our first parent; just as human nature was stricken in the soul by the disorder among the powers… so also it became subject to corruption, by reason of disorder in the body.

Now the withdrawal of original justice has the character of punishment… Consequently, death and all consequent bodily defects are punishments of original sin. And… they are ordered according to the justice of God, who inflicts them as punishments. (Summa Theologiae I-II.85.5)

Put the other way around, the narrative of the Fall is the answer to the question, “Why is the world full of suffering and sickness that leads to death?” So, of course, sickness has its origin in sin.

That is not the same thing as saying the particular sickness of an individual is always or usually the direct result of a particular personal sin, but that sickness as such is a consequence of sin generally. 2 Samuel 24 tells of the death of 70,000 because their ruler missed the mark of his calling to “execute justice.” And, if David did that which he ought not to have done, how many of his counselors and confidants, we might wonder, did not do what they ought to have done that could have influenced his decision. And, as already noted, David’s sin was prompted by some unspecified general sin in which the nation was embroiled. The picture that emerges is not one in which it is possible to draw direct connections between particular sins and particular adverse consequences, but rather one of the multiplication of the consequences of countless sins, each extending in overlapping ripples. The proposition that suffering derives from sin is no more than another way of saying, “This is not how things ought to be!” — the very message that the physiological phenomenon of pain signals with a clarity that transcends words. In a technical sense, then, pain is an angel, a Greek loan word meaning “messenger.”

We tend to assume that when pre- and early modern Christians spoke of the world as teeming with demons and angels that they spoke as children with hyperactive imaginations. Perhaps that is the case or perhaps we have misunderstood their vocabulary. When God intervenes (whether directly or indirectly) to restrain the exponential multiplication of the consequences of all the good we have omitted and the error we have committed — “those evils that we most justly have deserved,” as the Litany puts it — the prayer in time of plague conceptualizes that as God commanding the destroying angel to cease from punishing.

What are we to make of the fact that as the prevalence of physical suffering and mortal illness dropped dramatically in the 20th century so too did the general acceptance of the theological understanding of suffering and death shared by the old prayer book and the pre-Reformation Church? I do not know the answer to that question, but I think it a conversation worth having. As a preliminary step, I think it is useful to reexamine the old prayers with a view to making sense of why they conceptualized suffering as they did, open to the possibility that 20th-century critics may have misunderstood some of their vocabulary or paradigms. We may find there is something of greater comfort there than we had assumed.

Drew Nathaniel Keane is a Senior Lecturer in the Department of Writing and Linguistics at Georgia Southern University in Statesboro.

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