Smallpox / Ceiling Light

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Fail Blog has a picture of a panel with two switches labeled as follows:

天花燈                  夜燈

This photograph elicited considerable discussion at Fail Blog, but — despite well over 150 comments — there was much consternation and little comprehension of why or how the confusion occurred.  The quality of the discussion at ADS-L was much higher (though far more limited), yet still left a number of questions unresolved.

Since, in the past, many Chinese friends (and even many Chinese teachers) have asked me why the Mandarin words for "smallpox" and "ceiling" share the same two characters, I've decided to make a fairly determined effort to explain how it happened.  Here's the etiology, not of smallpox, but of the failure.

夜燈 means exactly what the translation on the panel says:  YE4DENG1 — "night light" — so we won't worry about that.

天花燈 is TIAN1HUA1DENG1 — "sky flower light."  How in the world do we get "smallpox" out of that?

The problem arises because the word for "ceiling" in Mandarin is TIAN1HUA1BAN3 天花板 ("heaven flower board," a reasonable enough term since proper ceilings were decorated and "heaven" signifies "above," hence, "a decorated board above"), while the word for "smallpox" is simply TIAN1HUA1 天花 ("heaven flower[s]").  Obviously, the label on the left should have been "ceiling light," not "smallpox."

There is also a more scientific term in Chinese for "smallpox" and that is DOU4CHUANG1 痘瘡, but it is much less used than TIAN1HUA1 (Google hits 3,390,000).  Aside from the simple fact that it is more technical, I suspect that people avoid DOU4CHUANG1 (Google hits 88,400) partly because it looks and sounds a lot more scary than TIAN1HUA1.  First of all, both characters have the frightful Kangxi radical 104 for "illness, sickness" on the top and left side; just looking at 痘瘡 bashes you with a double dose of disease.  Second, the first character means "pox," and its phonophore calls up associations of some bean-like eruption.  Third, the CHUANG1 character means "skin ulcer," not a very pleasant thing to contemplate.  Certainly, TIAN1HUA1 天花 ("heaven flower[s]") is a lot easier to deal with than DOU4CHUANG1 痘瘡 ("bean-like pox — skin ulcer")!

There is much controversy in the medical literature over just why "smallpox" is called TIAN1HUA1 in Chinese.  Most people would agree that the HUA1 ("flower[s]") part refers to the appearance of the pustules that cover the body of the afflicted.  See the photographs here and here.

Now comes the hard part:  why should smallpox pustules be characterized as "heaven(ly)"?

Fundamentally, there are two main theories in Chinese medical thought about the characterization of "heaven(ly)" for smallpox pustules.  The first is that they were caused by a smallpox deity (TIAN1 can also refer to deities).  Others hold that the smallpox deities (which were very much in evidence in premodern Chinese towns and villages) were there to protect people from smallpox, not cause them to get it.  The second main theory is that smallpox was "natural, innate, inborn"; I shall explain in detail below what the connection with TIAN1 is in this case.  A growing consensus among contemporary researchers seems to accept the second main theory over the first one.

I would add an additional theory of my own that I don't think has ever been broached before.  Namely, perhaps "heavenly flowers" was used as a sort of euphemism for this horrible disease.  I do not think that, if indeed such a euphemism were operative to any degree, it necessarily would have been employed instead of one or another of the above explanations, but rather it might have been used concurrently as a way to soften the harsh reality of the affliction.  The main reason I make this suggestion is because the expression TIAN1HUA1 天花 ("heaven flower[s]") was already well established in Buddhist terminology before it was applied to smallpox.  Consequently, it would have been a familiar term that could have been used euphemistically in a novel way to refer to smallpox pustules.

TIAN1HUA1 天花 ("heaven flower[s]") was the Chinese translation of Sanskrit KHA-PUS.PA = KHA-CITRA ("a picture in the sky") — anything impossible or not existing.   TIAN1HUA1 天花 ("heaven flower[s]") was also the Chinese translation for various Sanskrit plant terms, but I don't want to go into them because they are too botanically complicated and not really essential for our purposes anyway.  I should mention, however, that one of the plants with which TIAN1HUA1 天花 ("heaven flower[s]") has been associated is Hibiscus mutabilis (common name "cotton rose").  If we look at pictures of Hibiscus mutabilis, the red ones do bear a resemblance to smallpox pustules (the white ones resemble the final stages of the flaking scabs to a lesser degree).

Be that as it may, KHA-PUS.PA, or TIAN1HUA1 in Chinese translation, were the divine flowers in the Lotus sutra, one of the most popular Buddhist texts in East Asia.  These divine flowers in the Lotus sutra were of four kinds, two red and two white.  It is curious that, in the 10-12 day period of development of the disease from macules to papules to pustules to lesions and finally scabs, they pass through stages of firm, fleshy redness to flaky, depigmented whiteness.

Another way of writing TIAN1HUA1 天花 ("heaven flower[s]") in Chinese is TIAN1HUA1 天華, which also means ("heaven flower[s]"); this form was used to translate Sanskrit DIVYA-PUS.PA ("divine flower" — Ner[i]um odorum).

Smallpox became endemic in China around the 10th century, well after the Buddhist terminology in the Lotus sutra had become established and people were thoroughly familiar with the notion of TIAN1HUA1 天花 ("heaven flower[s]").
Once smallpox was endemic, it became a disease of children, almost a rite of passage.  If they survived smallpox, they were safe and had a good chance of growing up to adulthood.  People began to assume that some component of smallpox was inborn, a "fetal poison" (TAI1DU2 胎毒) that everybody carried around — the toxic residue of conception, some said — and that under the influence of seasonal energy (SHI2QI4 時氣), it would erupt into a case of smallpox.  In this sense, smallpox was "innate" ("inborn," "natural" — in Chinese, TIAN1 天 can imply all of these things as well as "heaven").  This theory of the "fetal (i.e., innate) poison" that could potentially cause smallpox was already prevalent from the Tang period (618-907).

The theory of "fetal (i.e., innate [heaven-born] poison)" also ties into Chinese medical ideas about XIAN1TIAN1 先天 ("pre-heaven, i.e., congenital") traits and HOU4TIAN1 後天 ("post-natal") disorders.

Just before I finished writing this blog, Randy Alexander wrote to me from Jilin (China) and mentioned that he had made a new addition to the discussion at ADS-L.  Randy's remarks are mostly focused on Manchu materials but are very helpful for understanding the sensitivity of late imperial Chinese toward this terrifying illness.  There can be no doubt that the Manchus dreaded this disease; two of their emperors died from it, Shunzhi (1638-1661) and Tongzhi (1856-1875).

The leading researcher on the history of smallpox in China is Chia-feng Chang.  Here are some of his important publications on the subject (Randy mentions the last one in his post):

Chang Chia-feng. 1995. “Strategies of Dealing with Smallpox in the Qing Imperial
Family,” in Hashimoto, Jami, Skar, eds., East Asian Science, 199-205.
______. 1996a. “Aspects of Smallpox and its Significance in Chinese History.”
Ph.D. dissertation, University of London, School of Oriental and African Studies.
______, [張嘉鳳]. 1996b. “Qing chu de bi dou you cha dou zhidu” 清初的避痘與查痘
制度 (Eradicating and diagnosing smallpox during the early Qing dynasty”).
Hanxue yanjiu, vol. XIV, no. 1, 135-56.
______, [張嘉鳳]. 1996c. “Qing Kangxi huangdi cai yong rendou fa de shijian yu yuan
yinshi tan,” Zhonghua yishi zazhi 26.1, 30-2.
______. 2000. “Dispersing the Foetal Toxin of the Body: Conceptions of Smallpox
Aetiology in Pre-modern China.” In Conrad and Wujastyk, eds., Contagion:
Perspectives from Pre-Modern Societies, 23-38.
______ 張嘉鳳. 2001. “‘Jiyi’ yu ‘xiangran’—yi Zhubing yuanhou lun wei zhongxin
shilun Wei Jin zhi Sui Tang zhijian yiji de jibing guan” ‘疾疫’與‘相染’以
“諸病源候論”為中心試論魏晉至隋唐之間醫籍的疾病觀 (“Epidemics and
Contagion: Using the Treatise on the Origins and Symptoms of Various Diseases
to discuss the medical perspective on illness from the Wei and Jin to the Sui-Tang
period”). Taida lishi xuebao 27 (June): 37-82.
______. 2002. “Disease and Its Impact on Politics, Diplomacy, and the Military: The Case of Smallpox and the Manchus (1613–1795)” Journal of the History of
Medicine and Allied Sciences 57.2: 177-197.

Thanks to Che-chia Chang, Marta Hanson,  Hilary Smith, Charlotte Furth, and Wenkan Xu for assistance with the medical literature.


  1. Tim Silverman said,

    August 19, 2009 @ 4:39 pm

    A little off topic, but I just want to remark that it is not unusual for the same god to both cause and protect against a calamity such as a disease. For instance, both the Babylonian plague god Erra and the Greek god Apollo both caused plague and were associated with healing, although with Erra it is perhaps the case that his primary attribute was as a cause, while Apollo was most strongly associated with medicine and healing. But generally, if a god is in control of some natural phenomenon, it is not so surprising that they can both cause and prevent it.

    I seem to have some vague recollection of smallpox being associated with flowers in Europe too, but unfortunately so vague that I can't place it and don't trust it much.

  2. Blinde Schildpad said,

    August 19, 2009 @ 5:49 pm

    @Tim Silverman

    Maybe you're thinking of the supposed connection 'twixt the nursery rhyme Ring a Ring o' Roses and bubonic plague.

  3. Michael Rank said,

    August 19, 2009 @ 6:02 pm

    The photo of the "smallpox light" is hilarious and Victor's posting is impressively erudite, but where can I see the discussion on fallblog? seems to be a rather crummy advertising site, I must be looking in the wrong place…

  4. Shannon said,

    August 19, 2009 @ 6:19 pm

    @Michael Rank: It's at

    (I only know this because I saw it via FailBlog on RSS.)

  5. nandita said,

    August 19, 2009 @ 6:35 pm

    Michael, the failblog post and comments are here:

    There is a small pox goddess in Hindu mythology, Shitala Devi, who is responsible for the disease and its cure. Small pox is known as 'devi' (goddess) in some parts of India.

  6. Rachel said,

    August 19, 2009 @ 6:35 pm

    This made me think immediately of ‘Saigon Rose’ which I thought was possibly linked to the above, but on a quick check it seems more likely that that phrase has more of a ‘Typhoid Mary’ origin than any sort of link to what I had imagined were either : a) rose-type skin blemishes/rashes or b) female genitals.
    I just thought that was a propos because at least idea a) could be relevant to many diseases. But I do think the link between flowers-female genitals and flowers-disease has occurred in history.

    It’s not clear at all which disease ‘Saigon Rose’ even refers to, I get ‘a particular sexually transmitted disease ’from the Wikipedia for ‘Digger Slang’ (Australian Army Slang). I had always thought it referred to Syphilis and the rosey rash it brings up. But looking up on Google it is used most often for a strain of gonorrhea, at least for the few links I was prepared to check – you get quickly into ‘quack treatment’ territory if you look.

    @ Michael Rank: It's FAILBLOG not FALLBLOG re: all the discussions about the word fail'. If you ever meet anyone that doubts that 'fail' is a noun – well, they have pictures.

  7. dr pepper said,

    August 19, 2009 @ 6:38 pm

  8. Luther Deese said,

    August 19, 2009 @ 8:45 pm

    We know that Tian Hua Ban (Heaven Flower Board or Plank) means ceiling. Ergo, a Tian Hua Deng would then be a ceiling light. No problem there. We also know that Tian Hua (Heaven Flower) means smallpox — but, we don't know the 'why' or etymology in either case. I'll have to do a bit more research and get back to you. I can certainly see why a translation program would have a problem with Tian Hua Ban.

    Luther Deese

  9. Webmaster-Translations said,

    August 19, 2009 @ 8:51 pm

    The disease of small pox is indeed called Devi – देवी in some parts of India .
    The word also means a deity in Sanskrit & Hindi.


  10. Bathrobe said,

    August 19, 2009 @ 8:51 pm

    "The Greatest Killer: Smallpox in History" by Donald Hopkins is on the web and has interesting reading about smallpox and the great horror that the Mongols and Manchus had of it.

  11. Dan Milton said,

    August 19, 2009 @ 11:07 pm

    I noticed that the title in the third reference uses simply DUO4. My Chinese-English dictionary gives this as 1) smallpox, 2) smallpox pustule and does not have DUO4CHUANG1.
    Is the extended form perhaps used in speech to make it clear the speaker isn't talking about beans, which isn't necessary with the disease radical in the written form?

  12. dr pepper said,

    August 20, 2009 @ 2:13 am

    Hmm, mongols feeling horror as opposed to causing it. That's rare indeed.

  13. Nicki said,

    August 20, 2009 @ 7:28 am

    Hmm, failblog isn't loading for me in China…GFW?

  14. Sven said,

    August 20, 2009 @ 1:21 pm

    Regarding "heavenly" and smallpox: in Serbian/Croatian, the main word common to terms for smallpox, cowpox and chickenpox is "boginje", meaning "goddesses". I wonder if Slavs have imported the idea of divine connection of those diseases (through Mongols or Turks, perhaps) or if the idea developed independently.

  15. möngke said,

    August 20, 2009 @ 2:36 pm

    In Slovenian, the term for '(small)pox' is koze, also meaning 'goats'; 'chickenpox' is norice, literally 'madwomen' (although more with the connotation of 'mad(ness-causing) things'). Not connected with heavens, divinity or anything like that, but there are probably equally interesting etymological stories behind these terms.

  16. Jongseong Park said,

    August 20, 2009 @ 7:42 pm

    The term used in Korean and Japanese is 天然痘, read cheonyeondu in Korean and tennentō in Japanese. 痘 is the character for 'pox', as mentioned above, and 天然 is a word that means 'natural', so the term translates roughly as 'natural pox'. Is there perhaps a connection with the Chinese term, with which it shares the first character 天? I doubt there is much to this, but I thought it would be worth bringing up.

  17. Nicki said,

    August 21, 2009 @ 5:00 am

    Hey, I just came across 天花板 in my daily Chinese reading practice, and knew it because I'd just read this post the other day. Thanks!

  18. Randy Alexander said,

    August 21, 2009 @ 8:45 am

    For those interested in the Manchu aspect mentioned above, I have now cross-posted it here with nicer formatting than the ADS-L version.

  19. Victor Mair said,

    August 21, 2009 @ 10:37 am

    Correction: Chang Chia-feng is a woman.

    Luther Deese: I think that you probably didn't get a chance to read the second page of my post.

  20. Charles Belov said,

    August 23, 2009 @ 1:49 am

    @ Victor re "I suspect that people avoid DOU4CHUANG1 partly because it looks and sounds a lot more scary than TIAN1HUA1."

    Interesting then that the Cantonese typically post catfish on their menus as "pond louse" (tɔng sət) at least in the SF Bay Area.

  21. Victor Mair said,

    August 24, 2009 @ 1:54 pm

    From Neil Kuster:


    Smallpox is also known as 天行痘 (among various other monikers such as
    天行斑瘡,天痘,天庖瘡,天黯,痘瘡,豌豆瘡,百嵗[SUI岁]瘡,虜瘡) and 疫病 epidemic diseases such as 痘病 are also referred to as 天行病.

    The rashes appear and grow and fill with fluid, becoming pustules, looking
    like flowers budding and growing, and then when the rashes wither and dry
    after about a week, looking like withered flowers.


    Many of the alternative names for smallpox that Neil mentions are prefixed by TIAN1 ("natural") or TIAN1XING2 ("prevalent, epidemic"). The last term he cites, TIAN1XING2BING4, means simply "epidemic disease."

  22. John said,

    August 25, 2009 @ 1:34 am

    Chang Chia-feng is from Taiwan, not China (unless you meant China in the sense of the Chinese-speaking world). She teaches at National Taiwan University.

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