Tag Archives: plague

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. 

Plague extent.

Study reveals true scale of one of the world’s deadliest plagues

New research shows that one of the deadliest plagues in the world was even more far-reaching than previously believed.


Image credits Alchemilla Mollis

The work was carried out by an interdisciplinary team from the Max Planck Institute for the Science of Human History in Germany and the Harvard University. They covered 21 archaeological sites across Europe and the Mediterranean that date back to the Plague of Justinian, back in 541 A.D. They report that the plague affected even more of the world than previously believed, reaching as far as the post-Roman British Isles.

Plagues for days

“This study shows the potential of paleogenomic research for understanding historical and modern pandemics by comparing genomes across millennia,” Johannes Krause, director of the Max Planck Institute and co-director of the Max Planck-Harvard Research Center for the Archaeoscience of the Ancient Mediterranean and the paper’s corresponding author, said in a statement.

This outbreak was one of the deadliest events in humanity’s history, killing an estimated 25-50 million people (between 13-26%) of the world’s population at the time of its first outbreak. It nearly brought the Byzantine Empire and its neighboring Sasanian Empire to the brink of collapse. Justinian’s Plague was the single deadliest pandemic to afflict Europe (and perhaps the world as a whole) until the Black Plague, and made repeated appearances until the year 750. The Black Death is estimated to have killed every 1 in 2 or 3 people living in Europe at the time. It was caused by the same bacteria.

The Justinian Plague gets its name from the Byzantine Emperor Justinian, who ruled the eastern portion of the Roman Empire from Constantinople (today’s Istanbul) after the fall of Rome and the western Empire. The pandemic started during the reign of Emperor Justinian, and spread from Constantinople and ports around the Mediterranean. Accounts from the time say that the plague wiped out half of Constantinople’s population, although these have yet to be confirmed. Such impacts are still under active investigation by historians, archaeologists, and experts in ancient DNA at the Max Planck-Harvard Research Center for the Archaeoscience of the Ancient Mediterranean (MHAAM). In the current study, the team reconstructed the genomes of eight Y. pestis strains from samples gathered in France, Germany, Spain, and Great Britain.

Geographic extent of the First Pandemic and sampled sites.
Image credits Marcel Keller et al., (2019), PNAS.

Samples that the team recovered at these sites were examined for genetic traces of Yersinia pestis, the bacteria known to have caused the plague. The first finding was the confirmation that this was the plague that swept the Mediterranean during Justinian’s time, even if it is recorded under various names in historical documents.

Secondly, the team could chart the evolution of the bacteria over time. They report that the strains that popped over the two-century-long pandemic were quite diverse genetically. Samples taken during the latter days of the pandemic show Y. pestis had shed genes relating to two virulence factors, they explain.

“It’s a fantastic example of how we can get new results that are really important in a debate that, kind of paradoxically, is heating up right now about whether the Justinianic pandemic was an important thing or not, just as new evidence really starts to appear,” says paper co-author McCormick.

“The archaeological and archaeogenetic evidence is opening up a whole new — not just a chapter — a whole new book on this great story.”

The team also found traces of the plague in Britain, an area where it hadn’t been previously confirmed. The bacterial DNA found there is more basal, the team explains, which suggests that it arrived there directly from areas where the plague was first reported — such as Egypt — rather than the Roman Empire.

“If that’s so,” McCormick said, “that suggests almost direct transmission from Egypt to Britain.”

This last tidbit is especially interesting. Given that the plague spread from and around the Mediterranean, one would assume that any Y. pestis in Britain would have been carried there by Romano-Celts moving into the islands after the Romans left, a century later. However, the team found the bacteria in an Anglo-Saxon cemetery, among people who were expanding their control of Britain at the time. The question now is how the four infected individuals in Britain contracted the plague — a finding which the team says will give us a better understanding of the social, political, and economic dynamics of the day.

McCormick said researchers will continue to expand the picture of this period, focusing on the role the plague played not just in human health, but, given its extraordinary death rate, also in warfare, politics, economics, and a whole host of other human activities.

“We now have a pathogen whose molecular history we can follow for thousands of years,” McCormick said, adding that our understanding of the plague’s impact on this era will continue to grow. “The jury’s out, evidence is accumulating, and we’re all going to learn as we go forward.”

The paper “Ancient Yersinia pestis genomes from across Western Europe reveal early diversification during the First Pandemic (541–750)” has been published in the journal PNAS.

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.

Arizona fleas now carrying the plague, doctors warn

Fleas in at least two Arizona counties have tested positive for the plague. Yes, the plague.

Plague-carrying fleas have been detected in Arizona. Image credits: Wikipedia.

Plague: it’s not a word you hear very often these days. It’s something you’d likely associate with medieval Europe than modern America. But the plague is still alive and kicking. Between 1900 and 2012, there have been over 1,000 cases of the plague, with 80 percent of them being bubonic plague, the same infection that killed at least 25 million people during the 6th-century outbreak, and a third of human population during the Middle Ages.

The plague was transmitted through fleas, which themselves were transported around by rats. Our living conditions have improved dramatically so we don’t live as closely to rats and fleas as we used to, but the plague never really went away. It resurfaces from time to time in different parts of the world — and now, it’s resurfacing in Arizona.

“Navajo County Health Department is urging the public to take precautions to reduce their risk of exposure to this serious disease, which can be present in fleas, rodents, rabbits and predators that feed upon these animals,” the public health warning states. “The disease can be transmitted to humans and other animals by the bite of an infected flea or by direct contact with an infected animal.”

The other county is the Coconino County, where doctors found infected fleas on local prairie dogs. Residents have been warned to pay extra attention, especially when hiking or camping in these areas.

The Centers for Disease Control and Prevention (CDC) notes that it’s not completely unexpected for something like this to happen. Sub-Saharan Africa and Madagascar are especially prone for plague resurfacing. Also, nowadays, treatment exists for the disease. If untreated, the disease can spread through the body, but if you detected early, it’s easily curable. If you think you’ve been bitten by a flea in the area, contact your doctor immediately.

Skull of a plague victim whose DNA was extracted by the Harvard researchers. Credit: STATE COLLECTION OF ANTHROPOLOGY AND PALAEOANATOMY MUNICH

Hidden Roman graveyard helps track the plague’s evolution from a mild stomach upset to a mass murderer

Skull of a plague victim whose DNA was extracted by the Harvard researchers. Credit: STATE COLLECTION OF ANTHROPOLOGY AND PALAEOANATOMY MUNICH

Skull of a plague victim whose DNA was extracted by the Harvard researchers. Credit: STATE COLLECTION OF ANTHROPOLOGY AND PALAEOANATOMY MUNICH

Using the latest genetic sequencing techniques, researchers extracted and analyzed the DNA of unfortunate plague victims from the 6th century Roman Empire. The bodies were found by accident buried in a graveyard outside Munich, Germany, more than five decades ago. Though far from solving the puzzle, the findings will help establish how Yersinia pestis, the Black Plague-causing bacterium, evolved from a benign nuisance into a mass murderer.

Thanks to modern medicine, infectious diseases can be largely contained and pandemics are rare. When they do happen, as with Ebola or Zika, science is quick to act by developing vaccines and drugs that keep diseases at bay or eradicate them completely. Only a century ago, however, the word “plague” alone struck terror. For more than 1,500 years this terrible disease, sometimes known as the Black Death, would come and go in waves sweeping Eurasia and killing between a third and a half of the population. But some 5,000 years ago, the ancestor of the bacterium that causes the plague would only trigger an upset stomach in its hosts. Somewhere in its evolutionary timeline, the bacteria developed strains that inflicted delirious fever, black boils that oozed blood, culminating in a very painful death five days after the first symptoms showed.

While the Black Plague is famous for its Dark Age killing spree, the first major outbreak recorded in history started around 541 C.E. in the Roman Empire. The Emperor Justinian, who was ruling from Constantinople at the time, issued a state decree mandating clerks to record every dead body that leaves a city’s gate. The death toll was so unprecedented, though, that at some point people lost track. They gave up at around 230,000.

Some of these Roman victims from Justinian’s time were discovered in Altenerding, Germany. Underneath gardens and roads, construction workers discovered the remains of 1,451 people, then alerted local archaeologists. Not too far from this site, scientists found another mass grave where they discovered bodies dated 6th century which succumbed to the plague. Michael McCormick, a Harvard historian who studies the Justinianic plague and his colleagues decided to investigate whether this newly found graveyard also contains plague victims.

To this end, the researchers pulled teeth from 20 skeletons. Blood-borne pathogens like the plague linger in the dental pulp where there are a lot of blood vessels, so this is where scientists reckoned they would be most successful in sequencing the DNA. Even so, only two skeletons rendered viable plague DNA for analysis. It was enough though since the results were more detailed than those carried out in the nearby German site.

The analysis found 30 points in the genome that were different from other strains of the plague. That was to be expected since the plague mutated various strains — it’s even alive today in some regions of the world like India and Madagascar.

While the genome analysis doesn’t explain how the plague came to be, it helps piece together an evolutionary timeline which eventually will lead to the very origin. This is important because we might learn how a benign bacteria can suddenly mutate into a devastating killer. We’ll be much more prepared the next time it happens.

“Understanding what happened during history, understanding when plague emerged, and how it transformed — that is very interesting from a basic point of view,” said Elisabeth Carniel, a plague researcher at the Institut Pasteur in Paris “But also it shows that these kind of events can occur again at any time, anywhere in the word. Understanding how it happened in pestis might be useful to be prepared in case of other types of outbreaks.”