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Medicine and the Arts


Holmøy, Trygve MD

doi: 10.1097/ACM.0b013e31815c65b8
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“Pesta on the Stairs” is one of 45 large and small drawings in Theodor Kittelsen’s (1857–1914) book The Black Death.1 The artist spent almost 10 years on this morbid, imaginative work before it was published in 1900. The main content of the book is 15 epic poems and 12 whole-page drawings describing the plague that struck Norway in 1349. All the drawings are black and white, reflecting the atmosphere of death, silence, and hopelessness that has shaped our imagination of this dark chapter of our history.

Kittelsen is most famous for his romantic paintings and drawings of the Norwegian landscape, wildlife, and trolls. He was inspired by Norwegian mythology, folk tales, and history and was one of the illustrators of Norwegian Fairytales, which along with the Norse Sagas played an important role in shaping Norwegian identity during the later 19th century. However, as a man of the people with a deep mistrust of the powerful and well-to-do, Kittelsen probably felt more solidarity with the victims of Pesta than with heroic Saga kings.2

The Black Death is also known as The Black Plague, and in Norway as The Great Death of Men. The 14th-century epidemic was the second known outbreak of plague and was probably caused by a particularly virulent form of Yersinia pestis. The Black Death probably originated in the Gobi desert in the 1320s, then followed trading routes to Crimea at the Black Sea.3 In 1346, an Italian eyewitness to the siege of Caffa (now Feodosa) reported that Mongolians dead from the plague were hurled by catapults over the city walls to infest the Genoese defenders, and that Genoese vessels from Caffa brought the plague to Messina, Genoa, and Marseilles. According to Icelandic annals from 1360, the plague came to Norway by an English ship in the late summer of 1349, and killed two thirds of the population in six months.4 This may have been an exaggeration, but it is true that great districts were abandoned. Modern historians have calculated that the population of Norway was reduced by as much as 65%.5 According to old tradition, in some places there were so few survivors that they lost contact with the outside world—some children even grew up without a clear identity as humans. Kittelsen gives one example in The Jostedal Grouse, about a little girl who was the only survivor in the remote mountain valley Jostedalen. When finally found by people from outside, she was as shy as a grouse and covered in feathers.

Pest is the Norwegian word for plague, and the suffix a in Pesta indicates a female personification of the disease. Pesta plays a prominent role in Norwegian folklore about the plague. She was said to be a ghost who appeared as an old, ugly woman dressed in a red skirt. She visited every house and farm and carried the disease to every corner of the country. No place was too remote for her; she walked over the mountains, flew across deep valleys on dark nights, and traveled by boat to islands and fjords. The boatmen always died, but Pesta continued her journey. To gather people, Pesta used either a rake or broom. When she used the rake somebody survived, but when she used the broom everybody died.

People in medieval Norway probably understood that the Black Death was a contagious disease, but they were unable to understand how the plague reached even the most isolated valleys, and they could not protect themselves against the contagion. For them Pesta was probably not only a personification of the fatal disease; her broom and rake and her ability to fly may actually have brought some explanation to the disaster. Combining an evil ghost and a disgusting crone who looked somewhat like a plague victim, Pesta may be regarded as an attempt to demonize both the disease and those transmitting it. This strategy is probably as immortal as Pesta herself; advertisements warned soldiers serving in Germany after World War II against sexually transmissible diseases by showing German prostitutes as elegantly dressed demons.

Kittelsen came across the woman who inspired him to create Pesta close to his home, and he has described this encounter in one of his memoirs, The Book of Oblivion: “She was small, lean and bent, her face greenish-yellow with black spots. Her eyes were squinting, dark and restless and set deep in her skull; now and again a strange, evil light shone in them, and they flickered around in every direction, so that it was impossible to fix her gaze. Her head bobbed up and down. Her mouth moved rapidly—sharp and bitter. She was worse than the plague itself, I thought to myself, hence her name.”2

The sight of Pesta coming up the stairs is horrifying, conveying an immense feeling of impending danger. The perspective is low, giving the impression that the viewer is a child. The darkness is underscored by weak light leaking into the room and the “evil light” shining in Pesta’s eyes. Thus, Kittelsen combines the strong emotions associated with the child’s fear of darkness and the fear of death. “The Black Death” enjoys a unique place in Norwegian literature and illustration. The book contains several masterpieces of suggestive horror and combines Kittelsen’s burlesque imagination and great skill as an artist. It can be understood as a genius pathography of the worst disaster that has struck humankind in historical times, but also as an artistic attempt to portray the timeless fear of death.

Trygve Holmøy, MD

Dr. Holmøy is a consultant neurologist, Department of Neurology, Ullevål University Hospital, Olso, Norway.


1 Kittelsen T. The Black Death (Svartedauen). Oslo, Norway: Stenersen, Kristiania; 1900.
2 Østby L. Theodor Kittelsen. Drawings and Watercolours. Oslo, Norway: Grøndahl Dreyer; 1993.
3 Prentice MB, Rahalison L. Plague. Lancet. 2007;369:1196–1207.
4 Oeding P. The black death in Norway. Tidsskr Nor Laegeforen. 1990;110:2204–2208.
5 Brothen JA. Population decline and plague in late medieval Norway. Ann Demogr Hist (Paris). 1996:137–149.
© 2008 Association of American Medical Colleges