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In the 4th century AD, Saint Basil the Great, one of the most distinguished doctors of the Church, admonished the faithful: "No man shall let his hair grow long or tattoo himself as do the heathen, those apostles of Satan who make themselves despicable by indulging in lewd and lascivious thoughts. Do not associate with those who mark themselves with thorns and needles so that their blood flows to the earth. Guard yourselves against all unchaste persons, so that it cannot be said of you that in your hearts you lie with harlots"

An edict issued by the Council of Northumberland in 787 makes it clear that the Fathers of Church distinguished between profane tattoos and Christian tattoos. They wrote: "When an individual undergoes the ordeal of tattooing for the sake of God, he is greatly praised. But one who submits himself to be tattooed for superstitious reasons in the manner of the heathens will derive no benefit there from." The heathen tattooing referred to by the Council was the traditional tattooing of the native Britons, which was still practiced at the time.

Medieval crusaders who reached the Holy Land had crosses tattooed on their arms as souvenirs of their travels, and it is likely the custom that continued throughout the Middle Ages.

One of the oldest souvenir religious tattoos is referenced in a manuscript written in 1612 by William Lithgow on writing about a pilgrimage to the Holy Land:

Early on the morrow there came a fellow to us, one Elias Areacheros, a Christian habitour at Bethlehem, and perveierfor the Friars; who did ingrave on our severall Armes upon Christ's Sepulchur the name of Jesus, and the Holy Crosse; being our owne option, and desire; here is the Modell thereof. But I deciphered , and subjoined below mine, the four incorporate Crowns of King James, with this Inscription. In the lower circle of the Crowne, Viva Jacobus Rex; returning to the fellow two Piasters for his reward.

Several accounts of tattooing in Palestine can be found in travel journals of Christian pilgrims and the practice continued well into the twentieth century. In 1956, a professional tattooist, Jacob Razzouk was using tattoo designs carved on woodblocks that had been handed down from father to son in his family since the seventeenth century. The blocks he used were copied and published in Carswell's book Coptic Tattoo Designs, printed in a limited edition of 200 copies in 1956. The book contains reproductions of 184 prints together with descriptions of the traditions and symbolism associated with each design. There are only two definite dates in the collection of woodblocks and one is Armenian and dates to 1749 and the other is Resurrection one dating to 1912.

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