Doctor's Review: Medicine on the Move

November 23, 2014
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Doctors of the Black Death

The infamous plague doctors of the Middle Ages were a fearsome sight

Being born in Medieval Europe was like losing the historical lottery — superstition reigned, feudalism flourished and misery was the rule, not the exception, among the long-suffering serfs. Yes, to live in the Dark Ages was to know disease and hunger intimately, to fear the wrath of a vengeful God (courtesy of His almighty Church), and to die young or on the battlefield. And yet, among those countless cold winters and violent wars fought for cruel lords, few could argue that 1348 was probably the single worst year be alive in pre 20th-century Europe.

When the rats and fleas carrying Yersinia pestis surreptitiously hitched a ride down the Silk Road with merchants and soldiers, no one could have predicted the toll this taste for spices and the latest in luxury goods would have on the population of Europe. After decimating tens of millions starting in China, it raced though central Asia and northern India. The bubonic plague made official landfall in Sicily in 1347. Within five years, it had spread to virtually all of Europe, Russia and the Middle East.

The perfect plague

The first wave was the worst, killing some 25 million in Europe alone. By 1400 — a mere 50 years after the pandemic began — various epidemics and resurgence had reduced the world’s population from about 450 million to between 350 and 300 million, maybe less. Roughly 150 million individuals succumbed to the nightmarish symptoms of the Black Plague.

First, swollen lymph nodes would signal infection. Within days, these painful buboes would blacken and then burst, spewing forth pus and blood. Dark purplish patches all over the body were par for the course. The lucky ones would recover, while others would soon go on to suffer high fever and agonizing episodes of spasmodic pain, vomiting and retching while blood sometimes filled their lungs. For the fortunate, death would come quickly; others lingered in a state of delirium for days.

Panic, desperation and grief reigned supreme, from the humblest burgs to the most vibrant cities throughout Europe. All manner of prayers and bargains and cures were attempted, but to no avail. With no antibiotics available to fight the dreaded bacteria, the plague would simply have to run its course. The plague did not entirely disappear from European soil until the 19th century as smaller but still deadly outbreaks occurred continuously in the decades that followed.

Once the plague’s full force was felt, it didn’t take long for most reputable and well-trained doctors to recognize its vicious and virulent nature. Moreover, any physician with even a lick of sense soon realized that the "cures" being employed were anything but, and sometimes even accelerated the death spiral. And so, most of them ran away. It was really the only sensible thing to do.

Those who took their place — the so-called plague doctor or Medico della Peste — were often little more than paid hacks and second-rate physicians hired by desperate municipalities. These eerily clad public servants would become an iconic symbol of the plague that we easily recognize to this very day... harbingers of doom in a very dark chapter in the history of human suffering.

Desperate times

To say people didn’t know much about the plague was an understatement. From its origins, to its spread, to its cure, the physicians whose sole purpose was to treat this infamous killer knew little more than those whom they were treating. They did, however, understand one thing with perfect clarity: the fact that it spread quickly and easily. Desperate times called for desperate measures.

Poultices of onion and butter, sprinklings of dried frog, arsenic, floral compounds and even a generous bloodletting or two were no match for this killing machine. The closer the patient was to dying, the more desperate the cures became. Accounts exist of coating sufferers in mercury and baking them for a while in the oven, though this was likely not as unpleasant as some of the creative means by which diarrhea was induced to relieve the patient’s system of the invading demons. Those with no medical training were often even more creative in their attempts to cure.

Nothing worked to halt the spread. The bodies piled up quickly and were carted away, dumped unceremoniously into mass graves. Hundreds were burned at a time. Entire villages succumbed and simply ceased to exist. Coping the best they could, the living often went crazy with fear, committed suicide, threw themselves into all-consuming religious devotion or indulged in a Bacchanalian end-of-days-style orgies that would have made Caligula blush. Murderers and thieves were let out of jail on the condition they agree to help with the removal and incineration of bodies.

Public service, plague-style

Presumably, their principal task of the plague doctors was to help treat and cure plague victims, and some did give it their best shot. In actual fact, however, the plague doctors’ duties were far more actuarial than medical. Most did a lot more counting than curing, keeping track of the number of casualties and recorded the deaths in log books.

Plague doctors were sometimes requested to take part in autopsies, and were often called upon to testify and witness wills and other important documents for the dead and dying. Not surprisingly, many a dishonest doc took advantage of bereaved families, holding out false hope for cures and charging extra fees (even though they were supposed to be paid by the government and not their patients).

Then, as now, it seems a life of public service was occasionally at odds with the ambitions of some medically minded entrepreneurs. Whatever their intentions, whatever their failings, plague doctors were thought of as brave and highly valued; some were even kidnapped and held for ransom.

Creepy costume

By the 1600s, the plague doctor was a terror to behold, thanks to his costume — perhaps the most potent symbol of the Black Death. The protective garment was created by the 17th-century physician Charles de l’Orme (1584-1678). De l’Orme had been the physician of choice for several French kings (one Henri and a Louis or two), and was also a favourite of the Medici family in Italy. In 1619 — as a carefully considered way to protect himself from having to visit powerful, plague-infested patients he couldn’t say no to — de l’Orme created the iconic uniform. Its dramatic flair certainly made it seem like a good idea, and the costume quickly became all the rage among plague doctors throughout Europe.

Made of a canvas outer garment coated in wax, as well as waxed leather pants, gloves, boots and hat, the costume became downright scary from the neck up. A dark leather hood and mask were held onto the face with leather bands and gathered tightly at the neck so as to not let in any noxious, plague-causing miasmas that might poison the wearer. Eyeholes were cut into the leather and fitted with glass domes.

As if this head-to-toe shroud of foreboding wasn’t enough, from the front protruded a grotesque curved beak designed to hold the fragrant compounds believed to keep “plague air” at bay. Favourite scents included camphor, floral concoctions, mint, cloves, myrrh and basically anything that smelled nice and strong. In some French versions of the costume, compounds were actually set to smolder within the beak, in the hopes that the smoke would add an extra layer of protection. A wooden stick completed the look, which the plague doctor used to lift the clothing and bed sheets of infected patients to get a better look without actually making skin-to-skin contact.

Useless outfit?

Despite the fact that de l’Orme himself lived to the ripe old age of 96 — an impressive feat for a physician living in the plague years — his famous contribution to medicine probably did very little to quell the actual spread of the disease. The beak doctors, as they came to be know, dropped like flies or pretty much lived under constant quarantine, wandering the countryside and city streets like pariahs... until of course desperate families needed them.

As a tribute to your fallen brothers from eras gone, why not encourage your kids to try on something a little different for Halloween this year? Explain some of the history behind these death doctors, and they’re sure to find the Medico della Peste every bit as terrifying as any vampire, witch, ghost or ghoul...

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