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Pestilence is an anthropomorphic personification and one of the Four Horsemen of the Apocralypse. In this role he has appeared alongside the other Riders in Sourcery and Thief of Time. He also has appeared early in the series when the Four Horsemen were described having a card game at Death's house (in The Light Fantastic). Pestilence speaks in a voice that sounds contagious. When bored, he goes to public places such as the restroom in a hospital, and tries to infect people with various diseases (in Thief of Time). Although diseases and pathogens had started existing since the beginning of life, pestilence, i.e. major plagues, is created by human carelessness. So, like all other anthropomorphic personifications that have been shaped by the human concepts, Pestilence has some human traits. In his case, unfortunately, one of his traits is unbefitting of a Horseman; he is easily afraid.

The Colour of Magic mentions Disease, an anthropomorphic personification that's subordinate to Death. The Colour of Magic also lists Famine as subordinate to Death. Disease is another name for Pestilence.

On Roundworld, Pestilence has hung up his tarnished silver crown, disheartened at the existence of asepsis, disinfectants, antibiotics and penicillin, and retired; his place was taken by a new anthropomorphic personification, Pollution. Refer to Good Omens for details.

In an artwork by Paul Kidby, Pestilence is depicted as untidily wrapped in bandages.