The Triumph of Death is an oil panel painting by Pieter Bruegel the Elder painted circa 1562. The painting shows a panorama of an army of skeletons wreaking havoc across a blackened, desolate landscape. Fires burn in the distance, and the sea is littered with shipwrecks. The Triumph of Death captured perhaps the greatest event of mass human suffering in the history of civilization: the Black Death (1346–1353). Bouts of plague ravaged Europe intermittently from at least 430-1750; however, it was the period of the Black Death that induced the greatest suffering, claimed the greatest toll of life, and laid the groundwork for the fundamental transformation of the world’s economic and social systems.
In Bruegel’s haunting work, as the skeletons advance they lay waste to the landscape and slaughter the people. The villagers can muster no resistance. In the center foreground the skeletons have captured the church, there is no God here, the desperate prayers and screams of the villagers go unanswered. In Bruegel’s apocalypse, the rage of death plunders the riches of the kingdom and claims the king, whose time has expired. The unchecked army of destruction carries off man, woman, child, and in the natural landscape in which they reside, nothing and no one is spared. And this is some 200 years after the end of the Black Death. While the physical disease had ceased, it left in its wake life and an economy still struggling to return to a semblance of normality. Bruegel may well be capturing the PTSD of the Black Death; the lingering psychological shock of having lived in prolonged fear of a repeat of severe illness, isolation and painful death.
Some diseases, like the 1918 flu, receded. Others, like the bubonic plague, remained, smoldering. H.I.V. is still with us, but with drugs to prevent and treat it. In each case, the trauma for those affected persisted long after the imminent threat of infection and death had ebbed. Covid-19? Will we too live in a cycle of worry and dismay grown out of frustration with the inability to control the virus. We have experienced the frustration of early phase discovery: prominent experts declared at first that masks did not help prevent infection, only to reverse themselves later. Epidemiologists confidently published models of how the pandemic would progress only to be proved wrong. We were warned that the virus was transmitted on surfaces, then later said that, no, it was spread through tiny droplets in the air. They said the virus was unlikely to transform in a substantial way, then came the Delta variant’s greater transmissibility. Many people lost trust in officials amid ever-changing directives and strategies that weakened the effort to control the virus. But at last there came the vaccines.
The advent of the smallpox vaccination brought out the largest single movement of 19th century England: the anti-vaccine movement. But the difference between vaccine skeptics and pandemic misinformation then and now is the rise of social media, which amplifies debates and falsehoods in a truly new way. With H.I.V. there were conspiracy theories and lots of misinformation, but there was not an underlying accelerant of social media. Misinformation about our age’s viral pandemic, ironically, “went viral.” Rage at the government for “overreach”, cries of freedom, fury of the vaccinated at those who refuse to get the shots, rage at those who would mandate masks/lockdowns, and a frustration that astoundingly effective vaccines haven’t yet returned life to normal.
The Triumph of Death depicts, and was painted in, a time when humanity had only a tenuous understanding of what disease was, what caused it or what could be done to prevent, treat or mitigate the spread and impact of disease. It may be tempting to assume that such a scene was a fanciful depiction, but Bruegel’s painting evoked a certain reality of the plague. In 1348, the disease spread so rapidly that before any physicians or government authorities had time to reflect upon its origins, about a third of the European population had already perished. In crowded cities, it was not uncommon for as much as 50% of the population to die. Half of Paris’ population of 100,000 people died. In Italy, the population of Florence was reduced from 120,000 inhabitants in 1338 down to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished. In London the death toll was approximately 62,000. Florence’s tax records suggest that 80% of the city’s population died within four months in 1348. The disease bypassed some areas, with the most isolated areas being less vulnerable to contagion. Overall, the Black Death claimed an estimated 30–50 percent of the European population, between 1347–1352. Scaled to 21st century level, worldwide, 2 billion lives would be lost. But we have history to hopefully guide us, modern medicine to respond, and more institutions ready to react – even as we have more institutions to make the problem more difficult (e.g. international air travel).
There have been many plagues in history, but consider these three plagues: the responses and the impact.
Plague of Justinian—No One Left to Die (Constantinople, 541). The community died off leaving those able to survive the plague thus achieving herd immunity. The plague changed the course of the empire, squelching Emperor Justinian’s plans to bring the Roman Empire back together and causing massive economic struggle. It is also credited with creating an apocalyptic atmosphere that spurred an even more rapid spread of Christianity.
Black Death—Quarantine of arrivals (Europe 1346–1353). The cities of the age slowly learned to quarantine any new arrivals. The infected were allowed to die in quarantine. The uninfected and survivors were eventually released. England and France were so incapacitated by the plague that the countries called a truce to their war. The British feudal system collapsed when the plague changed economic circumstances and demographics. In Greenland, Vikings lost the strength to wage their war expeditions and their exploration of North America halted.
The Great Plague of London—the Lockdowns (1655). With several waves of plague behind them, city officials were quick to implement lockdowns of public events and require the sick and symptomatic to remain in their homes. The disease vectors were aggressively cut with new efforts on rat control, especially in ports and berthing areas. It was the nascent start of public health. But in the meantime, because London was the economic hub of England, a great recession began leading to the beginning of a policy on increasing taxation on their colonies and foreign holdings.
To the above eventually came the medical response of vaccines in response to the smallpox. The accumulated knowledge eventually led to the formation of public health policies, most notable in the many cholera outbreaks in the world. There are more tools available to address pandemic. There are more vectors to spread the virus. There is the accelerant of social media. And there is Bruegel’s vision of the “Triumph of Death.”
When the covid-19 pandemic recedes into the background will there be the PTSD of covid with a lingering psychological shock of having lost a loved one. Will there be a simmering rage against public health advocates? The cry of freedom pitted against the common good?
Bruegel’s painting warns us that just because the disease has abated, it does not mean there are no symptoms of a deeper current infecting the world. Time will tell.