What Was a Plague Doctor? The Beak Mask and What It Was For

A plague doctor was a physician hired under contract by a city to treat plague victims during an outbreak, and the role was as much administrative as medical. Towns appointed them because ordinary physicians fled, and the appointee was frequently a second-rate practitioner, a young doctor without a practice, or someone with no medical qualification at all, since the pay was the attraction and the risk was extreme. The contracts survive and set out conditions including a salary, a pension for the family if the doctor died, and a period of quarantine before the doctor could return to treating ordinary patients. The duties went well beyond bedside care: the plague doctor recorded deaths, gave evidence for wills since notaries would not enter infected houses, performed autopsies and reported to the civic authorities on where the outbreak was spreading, which made the position a piece of public health administration in an era that had no such concept by name.

The outfit is generally credited to Charles de Lorme, physician to Louis XIII, who described it in the early seventeenth century, and every element followed from miasma theory, the belief that disease was carried by corrupted air recognisable by its stench:

• •A beak of around six inches filled with aromatic material, including dried flowers, herbs, camphor, vinegar sponges and spices, intended to filter or overpower the bad air before it was breathed
• •Glass eyepieces to protect the eyes, which were also thought to admit the corruption
• •A full-length overcoat of waxed or oiled leather or heavy cloth, so that the corrupted air would slide off rather than soak in
• •Gloves, boots and a hat, leaving no skin exposed
• •A wooden cane, used to examine patients without touching them, to lift bedclothes, and sometimes to keep the desperate at a distance
• •The theory was wrong, since plague is spread by the bacterium Yersinia pestis, carried chiefly by fleas on rodents and transmissible person to person in its pneumonic form, but a sealed leather garment and a cane that keeps you at arm's length are a reasonable barrier against fleas and droplets regardless of why they were adopted

The Black Death reached Europe in 1347 and killed perhaps a third to a half of the population within about six years, and no plague doctor wore a beaked mask during it. Plague did not leave afterwards: it returned in waves for four centuries, with major outbreaks including Milan in 1630, Seville in 1649, London in 1665 and Marseille in 1720, and it was during these later waves that the costume appeared and spread, mostly in Italy and France rather than everywhere. Contemporary illustrations of it are largely satirical engravings, the best known being a German print with a mocking verse in fake Latin, which means the most familiar image of the outfit is a caricature. The mask entered the Venetian carnival repertoire as a character, the medico della peste, which is how it survived into modern costume shops long after the profession ended.

What the doctors actually did was largely useless and frequently harmful, because the theoretical framework offered nothing to work with. Standard interventions included bloodletting, lancing the buboes, the swollen lymph nodes that give bubonic plague its name, applying poultices of substances ranging from herbs to dried toad, burning aromatic fires to purify the air, and administering theriac, a compound of dozens of ingredients including opium that had been prescribed since antiquity. Some remedies were actively dangerous, including mercury. The interventions that helped were the ones that had nothing to do with medicine: isolating the sick, restricting movement, burning contaminated bedding and imposing quarantine, which Venice and Ragusa pioneered with a forty-day detention of arriving ships, the quaranta giorni that gave the practice its name. Those measures worked because they interrupted transmission, and they were adopted on the reasoning that they kept corrupted air away from the healthy.

A plague doctor was a physician contracted by a city during an outbreak, hired because established doctors fled, and paid to treat the sick, record deaths, witness wills and report on the spread. The beaked mask dates to about 1619, not to the Black Death of 1347, and every part of it followed from the belief that disease travelled in corrupted air. The costume probably did offer real protection against fleas and droplets, for reasons its designers had no way of knowing, while their treatments did not.