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Why did plague doctors wear that weird beaked costume?

The COVID-19 pandemic has become one of the worst health crises in a century, with over five million killed so far by the coronavirus. But, let’s face it: we’ve seen much worse. The Black Death, for instance, loomed like a specter of pestilence for centuries, rapidly spreading, then subsiding, only to return in yet another wave. At one point, the plague killed one-third of Europe’s population in only a few years.

In Medieval times, you knew things were serious when the plague doctor came to town, who was immediately recognizable by his beaked mask. If you thought hazmat suits were scary, the costumes worn by these plague doctors elicited a whole new level of dread mixed with mystery, the kind that would be at home in a David Lynch film.

The plague doctor uniform: was this the first example of personal protective equipment?

Although the Black Plague reached Sicilian ports in the late 1340s, the plague doctors didn’t start wearing their now-iconic fashion until the 17th century. The design of the costume is credited to Charles de Lorme, the personal physician of King Louis XIII of France and the wealthy Médici family. It is believed that de Lorme introduced the uniform in 1619.

The outfit consisted of a long coat that was covered in scented wax, which extended all the way down to the ankle where the feet were dressed in boots made of goat leather. Underneath the coat, the plague doctor wore a short-sleeved blouse that was tucked-in, as well as gloves and a hat made of the same goat leather. But the most defining feature of the outfit is definitely the long-beaked mask that was stuffed with powerfully scented herbs and spices. Finally, the costume was completed by a pair of round glass spectacles tethered by leather bands that also kept the mask tightly to the doctor’s head. A long wooden stick was also part of the look, which the plague doctor used to examine patients but also to ward off desperate and dangerous plague-stricken people.

In order to understand the motivations behind designing such a peculiar uniform, we need some context. The consensus among the most educated physicians of those times was that the plague, like many other epidemics, was caused by miasma — a noxious bad air. Sweet and pungent odors were thought to cancel out the miasma in plague-stricken areas and protect from disease. Nosegays, incense, and other perfumes were sprayed furiously when plague knocked on the door.

Clothing Against Death (1656) by Gerhart Altzenbach. Credit: Public domain.

The first illustration of a plague doctor’s uniform, completed by Gerhart Altzenbach in the mid-1600s, not only features the entire costume but also provides explanations for how each part was intended to protect the wearer from the plague. The six-inch beak worn by the plague doctors was supposed to act as a face mask that filters out the bad air. It was designed so long in order to accommodate herbs enclosed further along in the beak, with only two small holes for ventilation. Many times, the herbs — typically a mixture of more than 50 plants and flavors like cinnamon, myrrh, viper flesh powder, and honey — were burned before the doctor put on his mask.

However, since the uniform was supposed to be worn tightly over the entire body and not leave the skin exposed, the physicians were at least somewhat aware that the plague was spread by close proximity to the infected.

Unfortunately for both plague doctors and their patients, the uniform wasn’t very effective and mostly served to terrorize people.

They couldn’t have known it at the time, but the plague is actually caused by a species of bacteria called Yersinia pestis, which is transmitted from animals like rats to humans through flea bites. You could also catch the plague easily if you came in contact with contaminated fluid or tissue or inhaled droplets from sneezing or coughing patients that had pneumonic plague. So perhaps the costume offered some degree of protection, but without any proper protocols for hygiene and disinfection, the protection was likely marginal at best.

Not only was their outfit ineffective at combating the plague, so were the plague doctors’ strategies — even by the standards of the time.

Some of the “cures” in a plague doctors’ medicine purpose include onions, herbs, and even chopped up snakes that would be rubbed on the boils of the patient. Sometimes a pigeon may have been sacrificed, whose bloody carcass is then rubbed all over the infected body. Others covered blisters with human excrement.

Since the miasma theory was in fashion, almost every house call involved fumigating the house with herbs to purify the air. If the proper odors were not available, people were advised to sit by a fire or even a sewer to drive out the smell of fever.

Baths were also prescribed but not in the most hygienic conditions. Bathing should be done with vinegar and rosewater, alternatively in your own urine.

But the worst procedure was bursting the buboes —  painful lymph nodes that form in the armpits, upper femoral, groin, and neck region of individuals infected with the plague — which did nothing to aid the patient. Bloodletting was a common (and highly ineffective) medical procedure during those times employed against a wide range of illnesses, but opening the festering blisters only helped  to further spread the infection to other people. Some patients were even told to drink the pus of lanced buboes.

The satirical engraving of Paulus Fürst, which is also perhaps the most famous illustration of a plague doctor. Credit: Wellcome Collection.

The ineffectiveness of plague doctors and their wacky costumes did not go unnoticed by their contemporaries. In the same year that the first illustration of a plague doctor costume was released, another engraver by the name Paulus Fürst released a satirical version in which he referred to the plague doctors as ‘Doctor Schnabel von Rom.’ (‘Doctor Beaky from Rome’). In one of the sentences on the engraving, Fürst alluded that the doctor ‘does nothing but terrify people and take money from the dead and dying.’

Indeed the plague doctors weren’t even actual physicians most of the time. Instead, they were usually unqualified, poor individuals who didn’t have much to lose when they were hired by municipalities to treat plague patients. As you might imagine, competent and successful doctors weren’t too keen on taking the job, which saw many plague doctors die on the job. Of the 18 plague doctors who worked in Venice at one time during the 14th century, five died and 12 fled.

Not all plague doctors were motivated by good intentions either. A plague doctor was not only tasked with treating and quarantining the ill, but also had responsibilities when it came to assisting in the occasional autopsy or witnessing the wills of the dead and dying. This gave them a lot of power and it was not uncommon for a plague doctor to take advantage of his position and run off with a patient’s finances and objects of worth.

Before COVID-19, the plague doctors were seen as an oddity of history and a great character to go out as during Halloween. But the harsh reality of the pandemic is perhaps making us more sympathetic with these first responders who risked their lives during highly uncertain times. And although most of their medical interventions were not based on science and did more harm than good, the plague doctors were on to something with their head-to-toe uniform. Today, we know for a fact that hazmat suits and even surgical masks can greatly diminish one’s risk of contracting an infectious disease. If it took a very sinister suit to kick things off for personal protective equipment, we should be grateful for having plague doctors, I guess. 

This 5,000-year-old-man may have been the “oldest” plague victim

About 5,000 years ago, a young man in Northern Europe was buried in a region called Riņņukalns in Latvia. As it turns out, the man had been infected with the oldest strain of Yersinia pestis — the bacterium that caused the Black Death plague, which spread through medieval Europe. This is the oldest case of the plague researchers have ever found.

This means that the strain of the infectious bug emerged about 2,000 years earlier than previously thought, according to a new study. The black plague swept through Europe in the 1300s, wiping out as much as half of the population. Later waves continued to strike regularly over several centuries, causing millions of deaths. But we’re still not quite sure when the pathogen first emerged in humans.

“It seems this bacterium has been around for quite a long time,” study co-author Ben Krause-Kyora, who heads the Ancient DNA Laboratory at the University of Kiel in Germany, told ABC News. “Up to now this is the oldest-identified plague victim we have. He most likely was bitten by a rodent and got the primary infection.”

Riņņukalns is an archaeological site next to the River Salaca in Latvia, with layers of mussel shells and fish bones left by hunter-gatherers. The site was first excavated in 1875 by an archaeologist, who found two graves with the remains of a man and a girl. The bones were given to anthropologist Rudolf Virchow, but vanished during World War II.

In 2011, the bones were rediscovered in Virchow’s anthropological collection in Berlin. Shortly after, two more graves were uncovered at Riņņukalns. The remains were thought to be part of the same group of hunter-gatherers as the teenage and the man. Not much was known about their genetic makeup or the infectious diseases they encountered. 

To find out, Krause-Kyora and his team took samples from the teeth and bons of the four hunter gatherers, hoping to sequence their genomes. They also screened their genomic sequences for bacteria and viruses. All individuals were clear of Yersinia pestis, except one – the RV 2039 specimen who was a 20 to 30-year-old man.

The researchers compared the bacterium’s genome to ancient and modern Yersinia Pestis strains. The man had been infected with a strain that was part of a lineage that emerged about 7,000 years ago – the oldest-known strain. It may have evolved after breaking away from its predecessor, Yersinia pseudotuberculosis, which causes an illness similar to scarlet fever. 

This strain of the plague didn’t contain the gene that lets it spread from fleas to humans, unlike its medieval counterpart. But the researchers believe the man may have been infected after being bitten by a rodent carrying the bacterium. The man’s genome had signs of carrying the bug in his blood, suggesting he could have died of the infection. 

The fact that only one man and not the rest of the people buried showed signs of infection suggests that this Yersinia pestis srtain may have been less contagious than later strains. The infections caused by it may have occurred in small isolated cases, and evolved to its medieval and modern forms, alongside the growth of human civilization and the development of bigger cities.

The study was published in the journal Cell. 

Photo showing the remains of a 20-year old woman from around 4,900 years ago, who was killed by the first plague pandemic. Credit: Karl-Göran Sjögren.

Scientists find oldest evidence of black plague in 5,000-year-old human remains

Photo showing the remains of a 20-year old woman from around 4,900 years ago, who was killed by the first plague pandemic. Credit: Karl-Göran Sjögren.

Photo showing the remains of a 20-year old woman from around 4,900 years ago, who was killed by the first known plague pandemic. Credit: Karl-Göran Sjögren.

The black plague is a deadly infectious disease that killed off more than a third of Europe’s population during the Middle Ages. However, Yersinia pestis — the bacteria responsible for the disease — has been infecting humans long before there was any historical record of it. Inside a Stone Age limestone tomb in Sweden, scientists found a previously unknown strain of the plague which is nearly 5,000 years old. It’s the earliest known infection of the plague, suggesting that the disease was one of the first major pandemics to wreak havoc among human populations.

“Plague is maybe one of the deadliest bacteria that has ever existed for humans. And if you think of the word ‘plague,’ it can mean this infection by Y. pestis, but because of the trauma plague has caused in our history, it’s also come to refer more generally to any epidemic. The kind of analyses we do here let us go back through time and look at how this pathogen that’s had such a huge effect on us evolved,” says senior author Simon Rasmussen, a metagenomics researcher at the Technical University of Denmark and the University of Copenhagen.

The site at Frälsegården, Sweden, features 78 buried individuals, all of whom died within a 200-year period. The fact that so many people died in a relatively short period hinted that an outbreak may have been responsible for their ultimate downfall.

Nicolás Rascovan, a biologist at Aix-Marseille University in Marseille, France, thinks that the likely culprit is the black plague. Rascovan and colleagues discovered an ancient strain of Yersinia pestis in the remains of a 20-year-old woman, who died 4,900 years ago. Subsequent genome sequencing revealed that the strain carries a mutation that can trigger pneumonic plague, the deadliest form of the plague. Most historical cases of the disease are due to bubonic plague, which occurs when plague bacteria spread to the lymph nodes and cause inflammation.

Previously, the oldest plague bacterium was found in individuals in a double burial in the Samara region of Russia, who both had the same strain of the bacterium at the time of death, 3,800 years ago.

Around the period the women found at the Swedish site died, Neolithic cultures throughout Europe were experiencing a steep decline. One of the leading theories explaining the spread of the black plague suggests that the disease was brought to Europe during the many multi-wave migrations of humans from the Eurasian steps, which started about 5,000 years ago. The diseases which these migratory people brought with them caused massive havoc among European Neolithic farmers, who were replaced by the newcomers — or so the theory goes.

However, genome sequencing shows that the newly found strain diverged from other strains about 5,700 years ago. The woman’s genome isn’t related to that of ancient steppe people either. This means that the strain likely evolved before the Eurasian migration, there in Europe. Between 6,500 and 5,500 years ago, some southeastern European populations started living in so-called ‘mega-settlements’, which could number up to 20,000 people — a huge population for that time. These settlements had people and animals living very close to each other, as well as food stores that attracted all sorts of pests. This is the perfect breeding grounds for deadly pathogens to evolve, the authors note, a fact that seems to be supported by evidence of settlement abandonment after 5,500 years ago.

“We think our data fit. If plague evolved in the mega-settlements, then when people started dying from it, the settlements would have been abandoned and destroyed. This is exactly what was observed in these settlements after 5,500 years ago. Plague would also have started migrating along all the trade routes made possible by wheeled transport, which had rapidly expanded throughout Europe in this period,” Rasmussen says.

What’s remarkable is that the plague seems to have made its way into relatively small and isolated settlements, as far north as Sweden. Indirectly, this seems to suggest that even at that time, there must have been intricate and well-developed trade networks which, along with other wares, also carried pestilent diseases.

There are some problems with the researchers’ plague-origin theory, however. The most obvious is that no plague strains have been found yet at any of the mega-settlements where the bacterium is supposed to have evolved. More excavations might eventually uncover black plague at such sites but even so, the findings could help unravel the complicated picture of how deadly pathogens evolved and spread among these ancient human settlements.

 “We often think that these superpathogens have always been around, but that’s not the case,” he says. “Plague evolved from an organism that was relatively harmless. More recently, the same thing happened with smallpox, malaria, Ebola, and Zika. This process is very dynamic–and it keeps happening. I think it’s really interesting to try to understand how we go from something harmless to something extremely virulent.”

The findings were reported in the journal Cell.

Rats (Rattus Rattus) may have been wrongly acused of commiting one of the biggest mass murders in history. Credit: Pixabay.

Fleas and lice from humans, rather than rats, were likely responsible for spreading the Black Plague

It’s wasn’t rodents, but human endoparasites like fleas and lice that seem to be like the most likely carriers of the ‘Black Plague’, the horrible disease that decimated Europe throughout history.

Rats (Rattus Rattus) may have been wrongly acused of commiting one of the biggest mass murders in history. Credit: Pixabay.

Rats (Rattus Rattus) may have been wrongly accused of committing one of the biggest mass murders in history. Credit: Pixabay.

In October 1347, 12 Genovese trading ships docked at the Sicilian port of Messina after a long journey across the Black Sea. Those who greeted the ship weren’t expecting what happened next: most of the sailors aboard the ship were dead, and the few who could muster the strength to sail to safety were gravely ill.

Land lovers naturally came to their rescue, trying to treat the fever which made the sailors gravely delirious but also covered their bodies with black boils that oozed blood. They would soon regret their decision.

Within a week, the sailors were dead, and not long after most of the Messina townsfolk would come to learn first-hand what bearing this fever felt like. They wouldn’t be alone.This highly infectious disease quickly spread from Messina throughout Europe killing over 20 million people in Europe over the next five years. This was the Black Plague, and for centuries the disease would outbreak, recede, then strike again keeping Europe and Asia in a state of constant terror until the late 19th century.

The Dance of Death or Danse Macabre is an allegory on the universality of death. It’s a common painting motif in the late medieval period, heavily influenced by the collective trauma the Black Plague inflicted.

[panel style=”panel-info” title=”What is the plague? ” footer=”Credit: The WHO. “]Plague is an infectious disease caused by the bacterium Y. pestis, usually found in small mammals and their fleas.

People infected through flea bites usually develop flu-like symptoms after an incubation period of 3-7 days. Typical symptoms are the sudden onset of fever, chills, head- and body-aches and weakness, vomiting and nausea. Common antibiotics are efficient to cure plague, if they are delivered very early, because the course of the disease is usually rapid.[/panel]

The Black Plague is an infectious disease caused by the bacterium Yersinia pestis. For years, the consensus was that stowaway rats on merchant ships acted as carriers for the disease. However, recent evidence suggests that we may have been pointing the finger at the wrong guys.

Vindicating rats

Researchers at the Universities of Oslo and Ferrara compared various transmission vectors (rats, airborne, and humans) inside a contagion dissemination computer model. To everyone’s surprise, the rats-based rate of spreading was nowhere near consistent with the historical records. The airborne model also returned about the same results as the rodent-based one. Instead, in the case of human transmission, the modeled rate of spreading plague matched the facts.

So rather than fleas carried by rats, it seems more likely that fleas and lice carried by humans — all in ample amount given Middle Age hygiene — were the ones spreading Black Plague.

“While it is commonly assumed that rats and their fleas spread plague during the Second Pandemic there is little historical and archaeological support for such a claim,” the authors wrote in the Proceedings of National Academy of Science.

“Our results support that human ectoparasites were primary vectors for plague during the Second Pandemic, including the Black Death (1346–1353), ultimately challenging the assumption that plague in Europe was predominantly spread by rats.

Previously, a similar study performed by researchers in London reached the same conclusion, finding the disease spread too fast for carriers to be rats, leaving only one possible explanation – the carriers were humans.

“The evidence just isn’t there to support it,” said Barney Sloane, author of The Black Death in London. “We ought to be finding great heaps of dead rats in all the waterfront sites but they just aren’t there. And all the evidence I’ve looked at suggests the plague spread too fast for the traditional explanation of transmission by rats and fleas. It has to be person to person – there just isn’t time for the rats to be spreading it.”

Modern sanitation and public-health practices have greatly mitigated the impact of the plague but have not eliminated it. You might be surprised to hear, for instance, that 15 cases of bubonic plague were reported in the United States last year. The plague can be successfully treated with antibiotics, but only with a prompt diagnosis and treatment. Last year, the island state of Madagascar — one of the richest biodiversity hotspots on Earth –was hit by a new, devastating Bubonic plague outbreak which claimed the lives of 209 people. The death rate is 16% among patients who have been treated and between 66% and 93% among those who are not treated, according to the CDC.

Exonerate the rats – it was gerbils that brought the Black Plague

It’s always the cute ones – a team of Norwegian researchers found that the Black Plague, which arrived in Europe in the 14th century and wiped out up to 200 million people was brought by gerbils, not by rats.

Gerbils may be responsible for bringing the Black Plague to Europe. Image via Pet Info Club.

The Black Plague is one of the most devastating epidemics humanity has encountered, originating in Central Asia and traveling along the Silk Road, reaching today’s Turkey and Ukraine. From there, it spread to the Mediterranean area and across the entire continent, wiping out 30-60% of the continent’s population. Until now, scientists believe the agents which carried the pathogen were rats – but Prof Nils Christian Stenseth, from the University of Oslo claims othwerwise:

“If we’re right, we’ll have to rewrite that part of history.”

The thing is, in order for rats to thrive and carry the disease across the entire continent, you would need some specific climatic conditions.

“For this, you would need warm summers, with not too much precipitation. Dry but not too dry. And we have looked at the broad spectrum of climatic indices, and there is no relationship between the appearance of plague and the weather.”

The emergence of the disease in Europe. Image via Wiki Commons.

In order to see if the climate was suitable for rats, he and his team analyzed 15 tree ring records, which carry with them the conditions in certain years. Tree ring analysis can be used to determine certain aspects of past climatic – including the amount of rain. They then compared these tree rings with 7,711 historical plague outbreaks to see if the weather conditions were right. As it turns out – they weren’t.

However, their results indicated spectacular conditions for another plague-carrying rodent – the giant gerbil – to thrive. They believe this is the main carrier of the Black Plague.

“We show that wherever there were good conditions for gerbils and fleas in central Asia, some years later the bacteria shows up in harbour cities in Europe and then spreads across the continent,” Prof Stenseth said.

The conditions he is referring to is a wet spring followed by a warm summer – something which gerbils love, and rats – not  so much.

“Such conditions are good for gerbils. It means a high gerbil population across huge areas and that is good for the plague,” he added.

The team is now working to confirm their results with DNA analysis. If this checks out, then we can exonerate rats for causing one of the biggest epidemics mankind has faced.

“We originally thought it was due to rats and climatic changes in Europe, but now we know it goes back to Central Asia.”

Journal Reference: Boris V. Schmida, Ulf Büntgen, W. Ryan Easterdaya, Christian Ginzlerb, Lars Walløee, Barbara Bramantia, and Nils Chr. Stensetha. doi: 10.1073/pnas.1412887112

A stain of the Yersinia pestis bacterium, responsible for the plague that ravaged Europe between 1347 and 1351, killing about 30 million people (AFP/CDC/File)

Black Plague genome sequenced by scientists

The black plague, or black death as it’s also referenced, is a deadly infectious disease which killed off more than a third of Europe’s population during the middle ages. The bacteria responsible for the disease has been confirmed by genetic scientists as Yersinia pestis, and recently, building off the research which found this particular strain, German scientists have successfully sequenced the entire genome of the bacteria. According to their study, the bacteria responsible for one of the most devastating pandemics in human history has little changed in the past 600 years.

Through their remarkable research, German, Canadian and American scientists have managed to reconstruct for the first time the genetic structure of a pathogen older than 100 years, which will now allow them to track changes in the disease’s evolution and virulence, offering at the same time a better understanding of modern infectious diseases.

“The genomic data show that this bacterial strain, or variant, is the ancestor of all modern plagues we have today worldwide. Every outbreak across the globe today stems from a descendant of the medieval plague,” said Hendrik Poinar, of Canada’s McMaster University, who worked with the team.

“With a better understanding of the evolution of this deadly pathogen, we are entering a new era of research into infectious disease.”

For their rearch, the time escavated skeletons from London’s East Smithfield “plague pits”, a common burial ground home to the final resting place of thousands of people struck by the black plague. Eventually, they found promising specimens and subsequently proceeded in extracting, purifying and enriching specifically for the pathogen’s DNA from the dental pulp of five bodies. Linking the 1349 to 1350 dates of the skeletal remains to the genetic data allowed the researchers to calculate the age of the ancestor of Y. pestis that caused the mediaeval plague.

So it has it, that the vicious bacteria during its more than 660 years of evolution has remained more or less the same.

“We found that in 660 years of evolution as a human pathogen, there have been relatively few changes in the genome of the ancient organism, but those changes, however small, may or may not account for the noted increased virulence of the bug that ravaged Europe,” says Poinar.

“The next step is to determine why this was so deadly.”

After it peaked during 1348 and 1350, the plague went on to erupt in a few isolated, not so dramatic cases well until the 19th century. Its modern ancestor exist to this day, however, and is reportedly responsible for killing 2,000 people each year.

Johannes Krause Of Germany’s University of Tubingen, who also worked on the study, said the same approach could now be used to study the genomes of all sorts of historic pathogens.

“This will provide us with direct insights into the evolution of human pathogens and historical pandemics,” he said in a statement.

The black plague sequenced genome research was published in the latest edition of the journal Nature.

Rats not responsible for black plague

A recent study has shown that the plague spread so quickly that the carriers couldn’t have been rats, as is commonly believed.

The black plague, or black death as it is sometimes referred to was a disease outburst so horrible that it killed some 30-60% of the population of Europe. Even to this day, few diseases have been even nearly as deadly; and most of the blame was taken by rats, who were believed to be the carriers. However, a study conducted in London by Barney Sloane, archaeologist, showed that the disease spread so fast that the carriers couldn’t be rats, and that there is only one possible explanation – the carriers were humans.

“The evidence just isn’t there to support it,” said Barney Sloane, author of The Black Death in London. “We ought to be finding great heaps of dead rats in all the waterfront sites but they just aren’t there. And all the evidence I’ve looked at suggests the plague spread too fast for the traditional explanation of transmission by rats and fleas. It has to be person to person – there just isn’t time for the rats to be spreading it.”

He even raised some questions about the disease itself, casting some doubt on whether it was in fact bubonic plague or not.

“It was certainly the Black Death but it is by no means certain what that disease was, whether in fact it was bubonic plague.”

The study is still a work in progress, and probably more light will be cast on the matter soon enough.