◆◆◆◆◆◆◆◆◆◆◆◆◆◆CHAPTER 40 ◆◆◆◆◆◆◆◆◆◆◆◆◆ Infectious Diseases and Arts Pierre Vidal,1 Myrtille Tibayrenc,2 and Jean-Paul Gonzalez3 1Anthropologist, French Ministry of Foreign Affairs, Pays de Sault,Aude, France 2Allaince française, Bangkok,Thailand 3Institut de Recherche pour le Développement, IRD, U178, Paris France & Mahidol University, Bangkok,Thailand “When leaving his surgery on the morning of April Dr. Bernard Rieux felt something soft under his foot. It was a dead rat lying in the middle of the landing.” —Albert Camus [12] FOREWORD seventh art). There are the utilitarian arts (high-technology products), and, more contemporary still, television, or the Treating infectious diseases as the theme of artistic produc- eighth art, and comics, a ninth art. Reference can also be made tion is attempting a truly impossible task that artists have more classically to applied arts, the decorative arts, performing nevertheless committed to: Art is many-faceted and diverse arts, and, more specifically, to Art Nouveau, popular arts, the and references to infectious diseases abound. “poorman’s art” (made of objects from daily life) [84]. In a highly exhaustive sense, any human creation, whether With this profusion of domains, schools, and interpreta- it be material or spiritual, stems from an art, which, however, tions, we probed where our quest, our subject appeared requires certain aptitude, theoretical or technical knowledge unmistakably in image and text. Indeed, the fine arts, resulting from learning. Often in the introduction, the art his- literature, and cinema provide us with a number of exempla- torian has claimed that there was no art, but that there were ry successes where our topic is expressed superbly; other types only artists. In other words, through an object or a work of of artistic work, however, have also captured our imagination art, individuals express their esthetic feeling—within a for their original interpretation of infectious diseases. Of religious, social, or cultural context—a work of art sets off an course, we could have cited the marks of infectious diseases emotion in the person who sees it or hears it or simply detected in the most recent rock paintings or in the artwork perceives it with his or her senses. of ancient Egypt; and, at the frontier of history and medical How many categories can artistic production be divided art, we could have consulted the wonderful illustrated works into? Let us say that it involves all the modes of expression of of the sixteenth century used by the practitioners of medicine, beauty and imagination. One art theoretician wrote “An who were then at the threshold of the passage from art to object is a work of art in and of itself only in relation to an science. Finally, cinema—scientific in nature—today proposes interpretation” [15]. Reference works suggest a variety of beautiful examples of art at the service of medicine with rich domains in which art is expressed: the dramatic arts, opera, the and wonderfully human works on themes that have never fine arts—still referred to as the spatial arts—including archi- been explored by the artist, such as onchocercosis with Mara, tecture, engraving, painting, sculpture, and, for more than the Lion’s Eye [93]: there are many others. 150 years now, photography.We can add to these the tempo- This text is also an essay; whether in a scattered or targeted ral arts (music, dance, and cinema, which has become the manner, it is simply a pioneering look turned to artistic Encyclopedia of Infectious Diseases: Modern Methodologies, by M.Tibayrenc Copyright © 2007 John Wiley & Sons, Inc. 677 678 ◆ ENCYCLOPEDIA OF INFECTIOUS DISEASES: MODERN METHODOLOGIES representations of infectious medicine or the great pestilen- with a heart condition and syphilis, never stopped producing. tial calamities. We will take the liberty of a few particular Infectious diseases are even more rarely treated, but some of critical comments on one work of art or another, where an them so profoundly marked the suffering populations as victims infectious disease plays a role or helps to give particular light that they became the subject of artistic expression (e.g., the to the suffering of humanity. plague and its many representations in the dances of death). The works of the fine arts—the collection of roughly 20 For centuries, art and science—and philosophy—were literary works that we will refer to, and the nearly 100 films confounded, and medical art referred to knowledge acquired that we will cite or comment on—seem to us to provide suf- by learning, a gift from he who exercised it. This confusion ficiently rich light to the entire panoply of these productions, between science and art endured until the middle of the nine- which we hope will incite the reader to further research. teenth century, at least in the West. Pasteur and Koch, among We note that in artistic production, infectious diseases in others, were the founders of a true medical science that the their epidemic or endemic forms seem to have frightened the technology and progress of biology refined incessantly. As artists, some representing their own suffering in disease, con- such, at the end of the twentieth century, doctors who veying visual or auditory expressions to release the audience’s believed they had finished with infectious diseases—and artists emotion. But the relation of the arts to medicine, including with their morbidity—found themselves plunged in yet what touches infectious diseases, is vast, from the person who another confrontation, which they did not expect: the emer- suffers to the mystery of an elusive and insidious germ, from gence of new diseases, unheard of syndromes, new germs. the microcosm to the macrocosm, from plants that heal to the These emerging diseases have imposed themselves on medical imaginary. thinking and have awoken the ancestral fears of the great Our purpose is threefold, each part concentrating on one plagues that we believed forever buried. domain:The fine arts, essentially drawing and painting, liter- Our conclusion will attempt to draw a few lessons from ature, in particular the novel, and cinema, excluding televi- this endeavor: The meaning of infectious events in the sion production that today remains little or poorly refer- collective unconscious and how art has used them to sensi- enced, or with little in the way of originality in its inquiry. tize its audience. Beyond this use by the world of art, we Infectious diseases and epidemics find frequent representation propose a reflection on the use that is made of the infectious in the narrative arts: Literature has the very early examples of phenomenon in communications and the media, in today’s the ancient texts and rarer illustrations in poetry; cinema economic stakes, in politics, and in beliefs. begins in the 1930s, with a few even earlier examples from the days of silent films. Art—it must be said again and again—expresses and trans- 40.1 THE FINE ARTS: PICTORIAL forms emotions and feelings; and the representation of death is REPRESENTATIONS present in all the arts. Even medical illustration, which is meant to be descriptive and informative, outside of emotion and feel- Art is the essence, preserved for eternity,of the history of the ing, often achieved the status of art in past centuries before the human soul. Through the violence wreaked by the great existence of photography.We have also taken a few examples epidemics of the past—and now those of the present—on the in music and dance, often accompanied by a booklet referring psyche of our populations, it is not surprising to find quite a to a literary work: For example, La Dame aux Camélias and its rich pictorial representation of this theme in the history of tearful (tragic, romantic) ending with the heroine’s death from art: works inspired by illness, religious images, historical consumption; she would inspire a number of artists [5]. In paintings, medical painting, self-portraits of diseased artists, addition, the extremely rapid progress of today’s imagery tech- memorial plaques, and photographic documentaries. niques at times draw near artistic creation. Major catastrophes caused by the great infectious diseases After the great themes of love, war, human life, and death, resounded with particular force in each era, pushing artists to medicine, and especially disease, is an inspiration for artistic elude traditional artistic values in favor of an art closer and expression, such as tuberculosis during the romantic period closer to reality, in perfect harmony with the intimate suffer- and the diverse plagues that fed all fears. ing of the human being. Although illness, as the object of inspiration, did not greatly Images intended to terrify,lure, mark the day’s events, pro- tempt the artist, it became imperative to the artist’s creation by vide knowledge, exorcise evil, rebel, or immortalize: the drama it generated in society (e.g., syphilis), and when the Representations of infectious diseases were organically trans- artist himself suffered in his body and soul (e.g.,through a hand- formed over the centuries, echoing human history. From the icap of traumatic origin as for Henri de Toulouse-Lautrec or Middle Ages to the present, despite the extreme changes in even Frieda Khalo, or a chronic disease such as Vincent Van the status of artistic works and of the artist, the myriad images Gogh’s epilepsy or his lead poisoning from the use of toxic pig- inspired by epidemics are echoed in society in political, com- ments brought about by his passion for colors). In 1880, Pierre mercial, and even religious terms. In our contemporary Auguste Renoir broke his right arm and painted with his left epoch,AIDS is emblematic of this with its procession of false hand: He continued to paint until his death handicapped by certainties based on ignorance as much as discrimination and repeated bouts with chronic arthritis.