With the beginning of the roll out of the Coronavirus vaccine, we thought it might be time to have a look at another of our Castle Characters, and at how our ancestors dealt with pandemic illnesses. Castle team member Daniel has been looking at the history behind a very sinister looking individual. It might be one that you are somewhat familiar with. A strange figure, dressed in a sweeping black robe and carrying a wooden cane, their face obscured by both a wide brimmed hat and a very peculiar mask. A mask with a beak, like a bizarre bird that walks like a man.

They used to be called ‘beak doctors’. The Italians called them Medico della Peste. Today we know them as the Plague Doctors. Harbingers of disease and foreboding symbols of ill intent, embodying the principle of long abandoned medical practices, seen today as laughable and silly. But who were these strange men and what was the reason behind their peculiar garb? This post will serve to answer these questions. But before that can be examined, we must first look at the circumstances which created them.

The Black Death

Considered to be one of the worst epidemics in history, the Black Death or the Great Plague began in 1348 and endured to 1350. Believed to have begun in Central or East Asia and travelling along the merchant route known as the Silk Road, it swiftly spread to Europe. The impact was devastating. Most figures show the population in the 1300s in Europe was about 5 million. By the 1400s, it was reduced to 2.5 million.

The most likely culprit was a bacterium dubbed Yersinia pestis. The commonly accepted theory was that it initially infected rats, which were then bitten by fleas. The bacteria infected the flea and caused a blockage in its feeding tubes. The result was when the flea bit a human, it would regurgitate the infected substance into the wound and spread the sickness. From there, it jumped from person to person, either through direct/close contact and contact with infected bodily fluids.

The symptoms were truly dreadful. The first day saw large, apple-sized swellings which typically appeared around the armpit, neck and groin. Over the next four days, the victim would break out in a fever, vomiting, bleeding under the skin (manifested as dark blotches) and painful spasms. After five days, the victim usually died unless the swellings burst. It was incredibly painful and most feared when the symptoms would manifest.

Medical practice at the time was also not prepared for disease of this magnitude. Germ theory would not be discovered until the 19th century, so doctors of the day had to conceive their own ideas for what spread disease. One of the primary theories was the four humours, based on Ancient Greek medical practice and held that the human body was comprised of four elements. These four elements had to be balanced and having an excess or a lack of them resulted in sickness. Another was miasma theory: the idea that a foul smell in the air spread sickness and measures should be taken to ward it away.

However, none of these theories were enough to help doctors stand in the face of the Black Death. With no way of understanding it, they had no way to treat it effectively. Practices like bloodletting (draining an excess of blood to cure sickness) or applying poultices (a bag or substance used to draw out disease) either did nothing or hastened the death of a patient. Before long, doctors would also contract the disease. With no way to cure it, they fled. However, governments still had to try and control the spread and keep track of the impact it was having.

Plague Doctors

With doctors fleeing and people dying, governments seemed to realise that particular measures were called for. Cities and townships formed contracts with individuals whose sole purpose would be to treat those infected with the Plague and to be quarantined with their patients while the outbreak persisted. These were the Plague Doctors.

Because of these desperate times, these doctors were far from the cream of the crop. They could be one of three kinds of people:

·        A young doctor who has yet to establish a practice and is looking to get their start.

·        A doctor whose practice has failed for whatever reason and need a new start.

·        Somebody with no medical experience whatsoever.

The latter element is because Plague Doctors were required for actuarial duties, along with medical ones. They had to submit daily counts of the dead and infected to the governments which hired them. They could also act as witnesses for final wills and testaments, a vital function given how many were dying. As such, medical experience was not as necessary as the willingness to brave these infected zones in the first place.

Even so, Plague Doctors were considered both brave and valuable. In Italy, a contract drawn up for Giovanni de Ventura in 1479 shows as much. In return for his services, he was given a fully furnished house, citizenship for the town and 30 florins a month, to be paid a month in advance. The value of a house speaks for itself, but citizenship meant he could establish a practice of his own in the town, without fear of competition from other doctors. To provide a comparison for his fee, a skilled worker of the time working 200 days of the year would struggle to make 60 florins. 30 florins was the equivalent of 40 grams of pure gold and an attractive fee for a job that bordered on suicide.

As far as medical practice is concerned, they were about as successful as their better trained counterparts. They were required to treat all patients, regardless of their standing in society but the treatments were all based on current (incorrect) medical theory.  Interestingly, Plague Doctors were given leave to be more experimental with their treatments. For example, they were allowed to perform autopsies, something considered to be sacrilegious at the time. A few apparently took advantage of desperate families and charged them extortionate fees for their treatments, even though their money came from the government and not their patients.

Outbreak Two: The Plague’s Revenge

Like a popular series of films or books, the Black Death had several sequels following its initial introduction in the 14th century. Most notably, a series of outbreaks occurred in the 17th century and recurred until the 19th century. It cropped up repeatedly throughout Europe and the area of the Mediterranean.

This is also where Newcastle ties into plague history. We had our own outbreak of the disease from May to December in 1636. Dr Jenisen, a contemporary of the time, remarked how ‘it increaseth, rather it rageth and runneth through like wildfire’. Much like the outbreak which currently besets us, people were shut up in their homes as part of quarantine. In the time it spread, an estimated 5,631 people from a population of 12,000 died. The overwhelming numbers saw these unfortunates buried in mass graves, known as plague pits. They can be found almost anywhere there is a church in Newcastle, including our neighbour St Nicholas’s Cathedral!

It is also in this century in which see the Plague Doctors granted the outfits that would earn them their infamous place in history.

Clothes make the man

We come now to the distinctive outfit of the Plague Doctor. It was first conceived in the 17th century by Charles d’Lorme, in 1630. He was quite a reputable physician and served as doctor to three French kings: Henry IV, Louis XIII and Louis XIV. He supposedly based it on a soldier’s canvas gown, covering the individual from head to toe. He describes the outfit in his own way:

The nose [is] half a foot long, shaped like a beak, filled with perfume with only two holes, one on each side near the nostrils, but that can suffice to breathe and carry along with the air one breathes the impression of the [herbs] enclosed further along in the beak. Under the [waxed] coat we wear boots made in Moroccan leather [goat leather] from the front of the breeches in smooth skin that are attached to said boots, and a short-sleeved blouse in smooth skin, the bottom of which is tucked into the breeches. The hat and gloves are also made of the same skin… with spectacles over the eyes.

The clothes, especially the mask, were designed in congruence with miasma theory. Logically speaking, if there is a foul air which spreads disease, the best way to counter it is with a more pleasant scent. The beak itself was designed to hold these herbs and flowers. Anything with a strong smell was acceptable, such as camphor, cloves, mint and myrrh. Some doctors even set these smouldering to provide greater protection.

The rest of the outfit was designed to protect the doctor from the miasma and fluids of the victim in similar fashion. The waxed coat is covered in a layer of suet (animal fat) to seal it against anything that might contact the doctor’s skin. The thick leather boots, coat and gloves add another layer of protection. The wide-brimmed hat was a sign of their station as doctors. Plague Doctors would also sport a wooden cane which allowed them to check their patient’s pulse, move clothing and bed sheets or else direct their charges, all without having to make physical contact. They could also be used in self defence against the disillusioned or the desperate.

Successes or Duds?

There is some debate as to the effectiveness of these outfits. Though the reasoning behind them is somewhat flawed, their execution is quite sound (at least for the time). Minimising physical contact with the sick with use of protective clothing is something very much practiced in medicine today, with particularly infectious diseases. The layer of suet and thickness of the clothes may have also granted some degree of protection from the fleas that spread the Plague.

But with a lack of understanding with contamination and disposal procedures we see in medicine today, there also exists the possibility that Plague Doctors provided another vector through which the disease might be spread. With the fluids that would be making contact with their coats and their canes poking and prodding multiple plague victims, it’s not an unreasonable conclusion to make. There is also no guarantee of 100% protection for the doctors themselves. I think we should be thankful that even with our latest plague, our government hasn’t reinstated their use!

Thus concludes the sordid history surrounding these terrifying doctors. While there is no direct evidence that Newcastle ever employed a Plague Doctor, the Black Death is still a significant aspect of our city’s history (tune in for a future post on the subject). As such, we have our own Plague Doctor who can sometimes be found roaming the Castle, ever on the lookout for signs of sickness.

Keep an eye open for him the next time you visit. Don’t worry, he’s perfectly friendly! Mostly…