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• W3036117409 abstract "Rampant infectious human diseases have been documented throughout written history, and the impact of these calamities have been captured in contemporaneous and retrospective literature, visual arts, music, and drama. These accounts share with us the horrors of disease, their demographics, the roles of potential healers, and the scope of devastation on individuals and on their societies. Of these events, none has been more infamous or disastrous than the outbreak of the bubonic plague, known as the Black Death, in the 14th century. This bubonic plague, spread by infected fleas and rats, reached Europe from the East by ship around 1347 [2, 4, 5]. Eventually, the pandemic claimed at least 50 million lives in Europe, 30% of the population, before subsiding 4 to 5 years later. Compared to earlier civilization, 14th century Europe had become increasingly urban, with citizens commonly travelling by land and sea. Both social crowding and flourishing transportation made the spread of infectious disease more efficient. Indeed, the plague continued to recur without warning or geographic deference during the next three centuries. Reports suggest that the worldwide mortality may have been as high as 200 million [9]. It was clear enough that the disease was transmitted by direct contact with infected individuals, leading some to abandon the sick and seek refuge elsewhere, if not literally quarantine the dying. Instructions to isolate the victims of overt, widespread disease (such as leprosy) or even poorly understood but natural bodily functions like menstruation, appear in the Bible (in Leviticus 13:18-23 and Leviticus 15:19, respectively). In the absence of understanding the pathogenesis of the Black Death, many were quick to assume this seemingly boundless and inescapable catastrophe was vengeance by God for human sins. Widespread efforts to atone for culpable behavior led to the purging of those considered heretics, particularly pogroms against the Jews, presaging the Spanish Inquisition a century later [1, 4, 5]. Among the many artists depicting the impact of the Black Death on western society was Pieter Bruegel the Elder. Born between 1525 to 1530 in Brabant, Netherlands, Bruegel trained in France and Italy [6, 10], before settling in Antwerp. He came of age at a time when artists were expanding their scope beyond religious subject matters. Known for his large and densely populated landscapes and peasant scenes, Bruegel is considered the most influential and accomplished Renaissance painter from the Netherlands. In contrast to his usual subject matter, Bruegel’s The Triumph of Death (Fig. 1) is an expansive and busy scape of land and sea shrouded beneath a dark and ominous sky. His oil on oak panel painting, completed in 1562, is approximately 4 feet by 5 feet. In it, we see a dense collection of vignettes of death on a blackened, scorched earth. The work is filled with skeletons and human remains, fires, shipwrecks, leafless trees, rotting fish and executions; death and disease are perpetrated on all sectors of society from peasants to royalty to clergy. The Triumph of Death shows the plague as indiscriminating, fateful, and futile to resist [7, 8]. Whether Bruegel chose skeletons to represent those killed by the plague or as the disease (or the devil) itself makes little difference. It was clear that contact with those infected, dying, or dead would surely spread the Black Death.Fig. 1: Pieter Bruegel the Elder, The Triumph of Death, c.1562, Oil on oak panel. (Photo: Priscila Costa. CC BY 2.0. Resolution increased to 300 DPI).In the upper left, skeletons ring a bell signaling a death knell. Another skeleton holds a large hourglass, symbolizing the passage of time, with the cruel end in sight. Similarly, a large cross stands near the center of the painting, but offers no defense against a hideous death. There is no salvation in this scene, no redemption, and resistance is useless. Who or what was responsible for this carnage is not directly answered in the painting, but the wrath of an angered God or work of the devil, are the most likely explanations, as the nature of disease at this time was a mystery.Fig. 2: A depiction of a plague doctor is shown.Help is nowhere to be seen. Physicians are absent as potential healers. Prelates are present but ineffectual. Draining boils and seeking favor with God proved useless against the plague at the time of Bruegel. Two hundred years later, as outbreaks of the plague stalked Europeans as a way of “life,” there appeared in Rome a curious and ultimately useless healthcare provider—the Plague Doctor (Fig. 2). Even by then, with contemporary norms of medical knowledge and clinical effectiveness, the plague doctors were generally poorly equipped in knowledge and skill [2, 3]. The plague doctors were, however, striking in their appearance. Their garb is reminiscent of a modern-day “hazmat” suit, a full-body armor of presumed protection, the renaissance version made from waxed leather or canvas, including gloves, boots and a hat. The distinctive mask, bird-like in appearance, included eye holes covered with glass and an elongated nose or beak that was generally filled for defensive purposes with an aromatic stuffing [3]. Whether pestilence described in the Bible, or the cycles of contagion that followed, a poor understanding of the pathogenesis, the unavailability of successful interventions, or both have left people—then and now—in fear. Widespread beliefs in fate and concepts of religious faith—such as those illustrated in The Triumph of Death—have to some degree been supplanted by the expectation that science will deliver a triumph over death, rather than the triumph of death. But regardless of how our current bout with pestilence concludes, we can be certain that “modern” medicine, chronicled by 21st century media rather than oil-on-panel, will also appear primitive in the future." @default.
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• W3036117409 date "2020-05-29" @default.
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• W3036117409 title "Art in Science: Pieter Bruegel the Elder and the Plague" @default.
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• W3036117409 doi "https://doi.org/10.1097/corr.0000000000001325" @default.
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