Wearing a surgical mask out in public today has become one of the most iconic images related to the global COVID–19 pandemic. Similarly, the plague doctor mask was one of the most haunting symbols associated with the Black Death. Once the most feared disease in the world, the plague wiped out hundreds of millions of people during several seemingly unstoppable global pandemics. With their dark, heavy robes and beaked masks, the plague doctor will forever be associated with the bubonic plague, although it wasn’t until the mid-1600s, nearly 300 years after the Black Death swept through Europe, that they first appeared in France and Italy. Nonetheless, the plague doctor – or Medico della Peste – is arguably one of the most enigmatic and fearful figures to have emerged from the Middle Ages.
In theory, the primary duties of a plague doctor focused on treating victims and burying the dead. Plague doctors were also responsible for tallying the number of casualties for public record, and documenting the last wishes of their patients. Furthermore, plague doctors were often summoned to testify and witness wills of the dead and dying. At times, plague doctors were even requested to conduct autopsies in order to better understand how the plague might be treated.
During the medieval era, medical scientists had no idea that disease was spread by microscopic bacteria – later to be known as “Germ Theory.” Instead, they believed that certain diseases, like the plague, were generated and spread by poisoned air called “miasma” – foul smells that emanated from garbage, rotting flesh, and various other organic substances that were perceived as unclean. Also called "bad air" or "night air,” miasma was thought to create an imbalance in a person’s humors, or bodily fluids, that led to illness. Of course, contaminated water, poor hygiene and the lack of sanitation in overcrowded settlements were the real causes of most epidemics that took place up until the 19th century, but this knowledge remained centuries in the future.
As plague doctors came in contact with victims of such deadly disease, they were at risk of falling ill themselves and attempted to take precautions to minimize this danger. The principal designer of the plague doctor costume was Charles de Lorme, a 17th century medical doctor who was the personal physician to three successive French kings – Henri IV, Louis XIII, and Louis XIV – as well as the Medici family of Italy. De Lorme modeled the plague doctor outfit on a soldier’s armor: heavy overcoat, gloves, and boots made from waxed Levantine and Moroccan leather to deflect miasma from head-to-toe and protect the wearer from any unprotected physical contact with the infected population. The suit was then coated in suet, hard white animal fat, to repel bodily fluids.
To further minimize their exposure to the disease, plague doctors also carried long wooden sticks to help them examine infected patients without having to touch them. The sticks were used to check the pulse of the unfortunate people who collapsed in the streets as well as examine the deteriorating condition of their skin. Many plague doctors also utilized their sticks to defend themselves from the hordes of infected and hopeless citizens who approached them, begging them to stop their excruciating pain.
The most iconic feature of the plague doctor costume was, of course, the bird-like beaked mask designed to keep the wearer from inhaling the foul-smelling air that was thought to spread the disease. In his writings, de Lorme described the mask with its nose as “half a foot long, shaped like a beak, filled with perfume with only two holes, one on each side near the nostrils, that can suffice to breathe.” The beak of this primordial gas mask was stuffed with a mixture of scented medicinal herbs that were thought to “filter” out the miasma and protect the wearer from the polluted and infectious air that carried the plague. In particular, plague doctors filled their masks with theriac, a compound of more than 55 herbs and other components such as wormwood (the main ingredient in absinthe), viper flesh powder, cinnamon, myrrh, and honey. The mask could also simply hold a vinegar-soaked sponge, since the strong smell of vinegar was also thought to block miasma. De Lorme believed that the beak shape nose of the mask would give the air sufficient time to be suffused by the protective herbs before it hit plague doctors’ nostrils and lungs.
Finally, the plague doctor donned a prominent black top hat to indicate that he was, in fact, a doctor.
It is uncertain how effective de Orme’s plague suit really was. While de Orme himself lived into his 90s, many plague doctors were not so fortunate, and ended up being victims of the plague themselves. While the mask – stuffed with strong smelling herbs – helped ward off the smell from dead and diseased bodies, it did little to protect the wearer from disease and more likely provided a false sense of security against an unseen enemy. Today, of course, we have better protective gear. N95 respirators worn by medical professionals treating people infected with the coronavirus protect the wearer from inhaling the aerosolized / airborne virus. While paper surgical face masks worn by the rest of the population are less effective, they do provide what the CDC calls "barrier protection" from droplets and "respiratory particles." As such, their primary recommended use isn't for people hoping to avoid catching COVID-19, but for those who already have it to prevent infecting others when they cough or sneeze. Since surgical masks have been shown to decrease transmission rates during flu seasons, health officials are now recommending everyone mask up.
Today we now associate the plague doctor more with death than healing. No sooner had the beaked plague doctors appeared on the streets of France, then they became synonymous with suffering and tragedy. Common people at the time frequently perceived them as the messengers of death and distributors of God’s punishment. More than that, plague masks remain a powerful reminder of how alienating illness can be, as isolation takes hold, against an imperceptible contagion.