Today when a contagion appears we have a clear sense of aetiology, treatment, epidemiology and prevention. This was not the case in the Medieval period when the Black Death emerged. The prevailing Christian belief system suggested that God’s wrath at the sins of the population was the most likely cause. But illness still required human assistance as well as prayer beseeching divine intervention. So it was not surprising that medical advice was sought to work out how to manage the plague.
Doctors
In 1348, the French king commissioned 46 ‘masters of medicine’ at the University of Paris to produce one of the most important early scientific works concerning the Black Death. This Compendium de epidemia per collegium facultatis medicorum Parisius, is fascinating for its thoughts on possible aetiologies of the plague which included: earthquakes, floods, unseasonable hot and humid weather due to planetary conjunctions (especially Mars, Jupiter and Saturn), and miasma or ‘bad air’. Susceptible individuals were thought to be corpulent, persistent worriers with a ruddy complexion who followed a bad lifestyle with too much exercise, sex and bathing. Eventually the search for a scapegoat led to foreigners, sex workers, Jews and the poor being blamed for outbreaks of the plague which legitimized acts of violence directed towards these people.
This treatise or consilium is one of around 24 known plague tracts that were in circulation between 1348 and 1350, but by the year 1500 there were over 900 consilia (including some in verse form) written by a range of self-professed experts. Despite their best efforts, most of the doctors who wrote theses died from the plague.
While some doctors were involved in the treatment of the sick, most treatment was undertaken (pun intended) by ‘medical specialists’ known as ‘Plague Doctors’ who were not experienced physicians and often lacked medical training. Given the rudimentary and misleading medical knowledge of the period this may not have been a huge problem.
These specialists were employed by civic bodies to treat both rich and poor and were fundamental to the care of plague victims and for the documentation of the pestilence. Due to the devastation caused by the plague, plague doctors were considered to be very valuable, were paid well, and were given special privileges, for example the ability to perform autopsies to research a cure. However, their exposure to plague cadavers often resulted in their own deaths. Of 18 plague doctors in Venice, only one was left by 1348 – five had died of plague, and 12 were missing and may have fled.
Colour copper engraving of Doctor Schnabel [ Dr Beak], a plague doctor in seventeenth-century Rome, published by Paul Fürst, ca. 1656
We hear a lot about how essential ‘Personal Protective Equipment’ is for frontline workers dealing with the current pandemic but it is not the first time that a version of the Hazmat suit has been used for this purpose. Plague doctors often wore a special costume, believed to be invented by the French physician Charles de L’Orme (1584-1678) in 1619 and first used significantly in Naples in 1630 before being rapidly adopted and required across Europe.
The ‘Plague Hazmat suit’ consisted of a light, waxed fabric or leather overcoat, a broad-brimmed hat, and a mask with glass eye openings and a beak-shaped nose, typically stuffed with straw, herbs and spices or sometlmes a sponge soaked in vinegar. The herbs and spices included: juniper, roses, mint, camphor, cloves, laudanum and storax which were believed to protect against miasma. Plague doctors would also commonly carry a cane to examine and direct patients without the need to make direct patient contact.
This odd costume was not entirely useless as it did offer some protection against the transmission of germs and the cane also allowed a degree of social distancing. As plague doctors were such a common and recognisable sight, the costume eventually entered the collective imagination and inspired the Commedia dell’Arte character Dr Pesta as well as carnival masks in Venice.
Treatment
In the Medieval period, medical treatment was largely informed by the ideas of the Greek physician, Galen (130-216 CE). Galen believed that illness was caused by an imbalance of the four humours – blood, phlegm, yellow and black bile – caused by the effect of miasma on susceptible people. Treatment was predicated on restoring the balance to create a ‘harmony of the humours’ and commonly involved blood-letting (including phlebotomy and the application of leeches), purgatives, diet, warm baths and various herbal and mineral concoctions supplied by apothecaries who worked with the doctors.
The treatments prescribed by plague doctors would often include: sealing windows shut, stoking the fire with juniper, sprinkling the floor with vinegar, filling a house with spiders or toads to absorb the bad air, eating only a little sour food, avoiding sexual intercourse, commanding the infected to inhale ‘bottled wind’ or take urine baths or purgatives, blood-letting until the patient passed out and applying frogs or exotic animals to lanced buboes.
One English doctor, John Colle, was particularly convinced by the ‘bad air’ hypothesis and believed that the best treatment was more bad air. He advised his community to gather around public latrines and to inhale deeply to counteract illness and protect themselves from the ‘plague miasma’.
Corpse carriers
Many of us will remember the scene in Monty Python’s ‘Holy Grail’ where the corpse carrier appears with his cart shouting: “Bring out your dead!”: https://www.youtube.com/watch?v=GU0d8kpybVg. Corpse carriers were also an essential part of the ‘service industry’ as it was believed that putrefying bodies added to the miasma which was the prevalent theory of the cause of the Black Death. This was not a desirable job so galley slaves, prisoners of war and gaol inmates who volunteered for the work were promised freedom if they survived.
Known as becchini in Pistoia or as the ‘terrible men’ in Florence they retrieved corpses from the streets and broke into silent houses to load bodies onto tumbrels. People who refused to relinquish bodies to these collectors were subject to hefty fines. In Venice men in barges called piatte hooked floating corpses out of the canals.
Like doctors and apothecaries, corpse carriers often wore amulets around their necks containing flowers, orange peel, nutmeg, myrrh, sulphur and arsenic to ward off noxious odours. Smoking pipes was also common as it was believed that tobacco also purified the air.
It is no surprise that as corpse carriers had significant contact with the dying and dead many succumbed to plague. They were often kept in a form of early ‘social isolation’ and forbidden to have contact with the healthy although their access to houses meant that many also engaged in theft, assault and rape.
We live in a much more enlightened medical age but currently still have few real treatments for COVID-19 other than respiratory support, pain and fever management, and time. Of concern is the number of spurious treatments which have been proffered online and are in many ways not far removed from those prescribed by plague doctors.