The Plague Doctors TRANSCRIPT Sponsor message (none) Today on our show we’ll learn about how plague doctors, clad from head to toe in oiled leather, wearing goggles with crystal eyepieces, and beaked masks, came to represent a “costume of death” even as they sought to heal. How did these “doctors” hired by the government, roaming from town-to-town into plague-stricken areas, counting the dead, and administering dubious treatments manage not to disappear into the fog of history like link-boys or knocker-ups? Plague doctors lived in the netherworld between medicine and undertaking, larceny and bookkeeping, and life and death. Here’s a terrific quote summing up society during a plague: “All I can say is that on this earth there are pestilences and there are victims– and as far as possible one must refuse to be on the side of the pestilence.”― Albert Camus (Pronounce: Alber Camoo), The Plague. Plague doctors were often second-rate physicians, young physicians without much experience, or men who had no certified medical training at all. They weren’t even hired to cure patients or treat them; instead they were supposed to document all of the deaths. How did one of the most terrible periods of disease in history lead to the rise of the plague doctor, who wasn’t even, really, a physician? THE DEATH TOLL In October 1347, a ship came from the silk road and docked in Messina, Sicily. Aboard the ship were not only sailors, but rats. Lots of plague-carrying rats and the Black Death came along with them for the ride. 20 million people had already died in Asia. (Probably an undercount). Between 1347 to 1352 at least 25 million people died in Europe. This was almost 40% of the population (some estimates indicate 60%). Half of Paris's population died. It took pretty much 150 years for Europe’s population to recover. Living during the Dark Ages meant feudalism, superstition, and misery—at least among the serfs. They feared God’s wrath, fell to disease, and were often severely hungry. If they didn’t die young, they often perished on a battlefield on behalf of their Lords. After the outbreak of the Black Death, doctors and scientists tried to fit the disease into their existing understanding of medicine. They defined the plague in terms of the theory of four bodily humors (blood, phlegm, yellow bile, and black bile). They argued Black Death was a pestilential fever that corrupted the humors, causing lymph nodes to become swollen with blood and pus. If you’re still with me and not off gagging in your bathroom, here’s what they thought: Doctors noticed these tended to form in the groin, armpits, and neck and took this as evidence of the body expelling humors from the nearest major organs. Stay with me here, according to these doctors, the plague could be prevented by strengthening the humors or keeping them in balance through a detailed medical plan or regimen such as changes in diet, causing "beneficial" vomiting and urination, and bloodletting. In 1348, the king of France asked professors for their advice as the plague approached the royal capital. They looked to both medicine and astrology, generally considered a serious science at that time, to explain the cause and spread of the plague. The air of the Earth, they theorized, was overheated and corrupted by a 1345 conjunction of the planets Mars, Saturn, and Jupiter (hot in astrological influence) in the zodiac sign of Aquarius (a wet sign). This unnaturally hot and moist air blew across Asia toward Europe, causing plague wherever it passed. When medieval doctors referred to a pestilence, they often did not mean the disease itself, but the poisoned air. Doctors encouraged people to wear or hold sweet or bitter substances, such as violets or vinegar and to fire cannons to combat this plague air with gunpowder smoke. Many people carried bouquets of flowers which they held to their faces, not only to ward off the stench of decomposing bodies, but because they thought this would fumigate their lungs. If you’ve heard the children’s rhyme “ring around the rosy/a pocketful of posie/ashes, ashes, we all fall down” now you know what they are referring to. As the plague’s ferociousness was felt, reputable doctors moved away from infected areas very quickly. Those who took their place, the so-called plague doctors, were basically paid hacks hired by desperate cities. It was their job to deal with everybody, regardless of economic status. However, if you were wealthy, they did invent their own cures and tinctures available for a fee. The basic idea behind the plague doctor costume was basically the same as today’s PPE—meant to cover the body. It was constructed of boots, leggings, an overcoat, gloves, and a hood—all made of leather coated in suet to repel bodily fluids. The costume also included a mask attached directly to the overcoat, with crystal eye goggles, a long, bird-like beak, and crowned by a top hat to indicate that the wearer was, indeed, a physician. They also carried long wooden sticks used to communicate with patients, examine them without touching them, and to beat away those who were more desperate or aggressive. On the other hand, some patients believed the plague was punishment from God and begged the plague doctor to whip them in repentance. Sort of a steampunk meets “The Birds” look. The look of these public servants are now an iconic symbol of the plague. The beak of the mask was stuffed with herbs and spices such as camphor, mint, cloves, and myrrh. And sometimes the herbs were set aflame before they were put in the mask so that the smoke could further protect the plague doctor. These doctors arrived in doorways, smoke billowing from the air holes in the beak of the mask, sweaty, smelly, and, sometimes, peddling false cures. From arsenic to poultices of onion and butter, sprinklings of dried frog or chopped up snake to floral compounds and even bloodletting didn’t slow the plague. There are records of sufferers coated in mercury and baking them in an oven or inducing diarrhea to relieve the patient’s system of the invading demons. The beak doctors, as they came to be known, lived under constant quarantine, wandering the countryside and city streets like pariahs until desperate families needed them. As you can imagine, they died in great numbers along with their patients. The primary responsibilities of a plague doctor were not to cure or treat patients. Their duties were more administrative as they kept track of casualties, assisted with autopsies, or witnessed wills for the dead and dying. The disease was terrifyingly efficient: you could go to bed healthy and die overnight. Today, we know the bubonic and subsequent plagues like pneumonia were caused by bacteria carried by rats and became common in urban settings. The last urban outbreak in the US occurred in 1924 in Los Angeles and nowadays we use antibiotics to cure people. No one really knows why the plague ended. There are many theories, though. The plague certainly acted as a catalyst for significant developments in medicine and public health regulation. Scientists turned to dissection, the study of blood circulation, and sanitation to find ways to combat the spread of the disease. Modern sanitation and public-health practices have greatly mitigated the impact of the disease but have not eliminated it. While antibiotics are available to treat the Black Death, according to The World Health Organization, there are still 1,000 to 3,000 cases of plague every year. The phrase “quarantine,” by the way, was coined during the outbreak of the Black Plague in Venice in the early 15th century. One city shut its borders for 30 days to try and stave off the wave of death, another confined incoming sailors to their ships for thirty days before they could enter. Europe felt the effects Black Plague for nearly 10 years before the disease began to subside. However, it returned every decade or so until the 18th century—luckily, never quite as deadly. Other researchers believe the plague subsided due to the genetic evolution of human bodies and bacteria itself. Truth told? Nobody knows for sure. The plague that devastated the globe still holds mysteries.