Plague Doctor Costumes Were Actually a Good Idea

There are a lot of unfortunate misconceptions out there about the infamous bird-beaked costume worn by plague doctors. One misconception is that this costume was worn during the Middle Ages. Another misconception is that the costume was supposed to protect the doctor by “scaring” the disease away. Another misconception is that the costume was totally ineffective.

In reality, the plague doctor costume was only invented in the seventeenth century and the beak was supposed to protect the doctor by supposedly filtering infectious vapors from the air he breathed, not by “scaring” the disease. Plague doctor costumes were undoubtedly flawed, partly due to limited understanding of how disease was spread and partly due to technological limitations, but the idea behind them was actually a good one and they probably did provide doctors with some degree of protection from the plague.

How plague doctors are normally portrayed in modern culture

In popular culture, plague doctor costumes are almost universally presented as examples of how stupid and superstitious people supposedly were during the Middle Ages. For instance, in the 30 September 2019 episode of The Late Show with Stephen Colbert, Stephen Colbert gives a monologue in which he talks about Donald Trump’s then-ongoing impeachment.

Near the end of the monologue, Stephen tells a joke in response to the news that President Donald Trump had retweeted a tweet from a novelty twitter account called “Trump But About Sharks,” which tweeted quotes from Donald Trump only with words replaced to make them about sharks. Stephen says:

“The president of the United States just tweeted the phrase “pro-shark media,” which means we’ve officially entered the dumbest time in human history, beating the previous dumbest time, when we thought a spooky bird mask could protect you from the black plague. Congrats bird mask!”

The camera immediately cut to person wearing a plague doctor costume dancing to a soundalike version of the 1991 song “Get Ready for This (Orchestral Mix)” by the Dutch dance music group 2 Unlimited.

I’ll admit that I personally found the dancing plague doctor hilarious. Nonetheless, it is important to point out that the plague doctor costume is, in fact, far from the dumbest thing humans have ever come up with. In fact, while the plague doctor costume was undoubtedly flawed in a number of ways, it was an important step in the right direction and it probably actually did provide doctors with some degree of protection against the plague.

ABOVE: Screenshot of the dancing plague doctor from Stephen Colbert’s monologue on 30 September 2019 about Donald Trump’s impeachment

Stephen Colbert is far from the first person to cite the plague doctor costume as an example of medieval stupidity and backwardness. Examples of this idea can be traced back to at least the early twentieth century and probably even before that. For instance, a public service announcement poster issued by the U.K.’s Ministry of Labour and National Service at some point between 1939 and 1945 shows a cartoon version of a plague doctor mask with the warning:

“The medieval quack wore this head-dress to frighten infections away. Today we prefer science to spells and prevention to cure. So get FIRST AID for all wounds.”

The poster is clearly intended to appeal to people’s desire to be scientific and reasonable in contrast to those dumb medieval people. Unfortunately, while the message about using First Aid is certainly one worthy of dissemination, all the information presented in this poster about the plague doctor costume is completely inaccurate.

For one thing, as I discuss in this article I wrote in May 2019, the Middle Ages were not the time of universal superstition and ignorance that they are normally portrayed as and there were actually many important ideas and innovations that came out of this period of history. Furthermore, the plague doctor costume wasn’t actually worn during the Middle Ages at all.

When the costume was invented in the seventeenth century—long after the end of the Middle Ages—it wasn’t a “quack” idea; in fact, it was designed in accordance with the best scientific and medical information available at the time. Finally, the plague doctor costume wasn’t designed to “frighten infections away,” but rather keep the doctor from being exposed to potentially harmful miasmata in the air.

ABOVE: Public service announcement poster issued by the U.K.’s Ministry of Labour and National Service between 1939 and 1945

When and where the plague doctor costume was used

Contrary to what most people have been led to believe, the standard bird-beaked plague doctor costume as we know it today was never used during the Middle Ages because it was not invented until long after the end of the Middle Ages. Dates for when the Middle Ages ended vary, but they are generally agreed to have ended sometime in around the fifteenth century.

I usually pick 1453—the year when the city of Constantinople fell to the Ottoman Turks, thus marking the end of the Byzantine Empire—as the date when the Middle Ages can be said to have ended. Other people say that the Middle Ages lasted until Christopher Columbus made his first voyage to the Americas in 1492. Other people say the Middle Ages ended in 1500 just to have a nice round number. It’s all very subjective, but it is generally agreed that, by the beginning of the sixteenth century, the Middle Ages were over.

The idea for the standard plague doctor costume, on the other hand, was first developed by the French physician Charles de Lorme (lived 1584 – 1678) in 1619, which, depending on when you think the Middle Ages ended, is somewhere between one and two centuries after the end of the Middle Ages. Earlier doctors before Charles de Lorme had used various suits for protection against the plague, but there is currently no evidence to suggest that any of them ever used the standard bird-beaked costume that is now so infamous.

By the time the plague doctor costume was invented, the Renaissance and the Protestant Reformation had both already happened, the English colony of Jamestown had already been founded in Virginia, and Queen Elizabeth I, William Shakespeare, and Caravaggio were all already dead. No matter how you look at it, the plague doctor costume is clearly a product of the Early Modern Period (which I say lasted c. 1453 – c. 1750), not the Middle Ages (which I say lasted c. 476 – c. 1453).

ABOVE: Engraving by Gerhart Altzenbach dated to 1656 depicting a plague doctor from the city of Rome wearing plague doctor outfit

It is unfortunately extremely common for people to confuse things that happened during the Early Modern Period with things that happened during the Middle Ages. For instance, as I discuss in this article from October 2018, there were no widespread, church-sanctioned witch trials during the Middle Ages. The witchcraft hysteria in western Europe actually began in around the late sixteenth century and continued into the seventeenth century. For almost the entire Middle Ages, the official teaching of the church was that witches did not exist and that belief in witchcraft was heretical.

Leaving aside the question of the era in which the plague doctor costume was invented, it is important to emphasize that it was not seen as a “quack” idea at all at the time. Charles de Lorme, the plague doctor costume’s inventor, was a highly esteemed physician who served as chief physician to King Henri IV, King Louis XIII, and King Louis XIV.

Certainly, most of Charles de Lorme’s ideas and practices would be laughed at if someone tried to implement them today, since our knowledge of medicine has improved greatly since his time. At the time, though, he was a widely respected medical expert. (Incidentally, he was also quite remarkably long-lived, since he died on 24 June 1678 at the age of about ninety-four.)

It’s also worth observing that the plague doctor costume was not universally used throughout Europe. It was mainly used in France and Italy, although it was sometimes also used in parts of Germany and Austria. The costume was rarely used in Britain or in the English colonies in North America. Indeed, part of the reason why the plague doctor costume has become so inextricably associated with superstition in the popular mindset is because it was mainly used in Catholic countries and English Protestants came to cite it as evidence of Catholic ignorance.

ABOVE: Frontispiece of a plague doctor in full habit from Jean-Jacques Manget’s Treatise on the Plague, published in 1721

The rationale behind the plague doctor costume

The plague doctor costume was developed in accordance with the miasma theory of disease, which was, at the time, the most widely supported theory of disease among medical experts. The miasma theory held that diseases were caused by “miasmata,” or infectious vapors in the air. Miasmata were usually assumed to be produced by sickness and by decaying organic matter. It was believed that miasmata could be prevented or reduced through improved sanitation and hygiene.

Today, we know that the miasma theory of disease is incorrect. Nonetheless, it was rooted in the empirical observation that poor sanitation allowed diseases to spread. Many of the measures intended to prevent the spread of disease that were originally introduced based on the miasma theory have since proven effective—not because diseases are spread through “bad air,” but rather because diseases are caused by pathogens (i.e. microscopic entities such as bacteria, viruses, protozoa, fungi, viroids, and prions), which are more easily spread under unsanitary conditions.

Likewise, the plague doctor costume, which was created to keep out miasmata, may have had some effectiveness at keeping out germs. Indeed, the basic idea behind the plague doctor costume was basically the same as the idea behind a modern hazmat suit; the costume was meant to cover the whole body in thick leather, leaving no skin exposed, and the beak was meant to filter the air the doctor breathed.

The costume consisted of boots, leggings, an overcoat, gloves, and a hood—all made of stiff Moroccan or Levantine leather coated in wax to repel bodily fluids and to keep miasmata from penetrating. The costume also included a mask attached directly to the overcoat, with glass goggles to cover the eyes and a long, bird-like beak.

ABOVE: Photograph from Wikimedia Commons of damaged components of a seventeenth-century Italian plague doctor costume that were discovered in 1889 by Theodor Weyl in a lazaretto on Poveglia Island, which served as a quarentine station for the city of Venice

This beak was often made out of a metal such as bronze and it was filled with sweet-smelling substances, which could include dried flowers, various sweet-smelling herbs and spices, or even a sponge filled with vinegar. The mask had two small holes for the doctor to breathe through. The belief was that the sweet-smelling substances would purify the air and keep the doctor safe from breathing in the miasmata.

The fact that the mask was shaped like a beak was actually totally irrelevant to its intended purpose. No doctor thought that the beak shape itself was going to protect them from the plague; it was the herbs that were in the beak that were supposed to do the protecting.

Meanwhile, plague doctors also carried a long wooden rod with them so they could inspect their patients without having to touch them or even go near them. This rod could be used to lift articles of clothing to check for buboes or to check a patient’s pulse to see if they were still alive.

Some versions of the plague doctor costume also included a broad-brimmed hat, which was worn over the hood and mask. This, however, was a non-essential component of the costume; it was merely meant to indicate that the wearer was a doctor, since doctors in those days often wore broad-brimmed hats to signify their profession. The hat was not thought to provide any protection from the plague and it is unclear whether all plague doctors necessarily wore this hat.

ABOVE: Photograph from Wikimedia Commons of a surviving seventeenth-century plague doctor mask from Austria or Germany on display in the Deutsches Historisches Museum in Berlin

Why the costume was probably partially effective

The bubonic plague is caused by the gram-negative, sporeless, non-motile, coccobacillus bacterium Yersinia pestis. Yersinia pestis can cause three different kinds of infections in humans, all of which are extremely deadly. These three different kinds of infections can be transmitted in different ways:

• Bubonic plague, the most common form of the plague, which is primarily transmitted through bites from fleas carrying the disease
• Pneumonic plague, a deadlier and rarer form of the plague that occurs when Yersinia pestis infects the lungs. This form can develop as complication of bubonic or septicemic plague or be independently transmitted through the breathing in of airborne droplets carrying the Yersinia pestis bacterium.
• Septicemic plague, the rarest and deadliest form of the plague, which cannot be transmitted from person-to-person, but develops as a complication of bubonic or pneumonic plague when Yersinia pestis bacteria multiply in the blood

The stiff, waxed leather exterior of the plague doctor costume probably helped protect the doctor from fleas. The outfit was flawed because the bottom of the overcoat was open, allowing fleas to potentially jump up inside it. Nonetheless, underneath the overcoat, plague doctors also wore waxed leather boots and leggings, which probably protected them some from the fleas.

The beak full of the herbs probably wasn’t especially effective at preventing the doctor from breathing in airborne droplets. The herbs probably did very little—if anything—to disinfect the air the doctor was breathing and the holes allowed droplets to enter the beak. Nonetheless, the beak probably did have some slight effect, since the smallness of the holes probably reduced the amount of air the doctor was breathing from his environment, thereby reducing his chances of inhaling airborne droplets bearing the Yersinia pestis bacterium.

The rod probably provided the doctor with a great deal of protection by allowing him to examine the patient without getting too close. The patients could certainly still cough on him even from a distance, but it was probably safer for him if he stayed further away.

There was probably not much danger of the doctor catching the plague from bacteria on his suit when he took it off, since plague bacteria can’t survive very long at all without a host body. The bacterium can be almost instantly destroyed by sunlight or by simply drying out, meaning, by the time the doctor took off his outfit, any plague bacteria that had lodged on it were probably long dead. Nonetheless, in good practice, plague doctors really should have at least gotten a new rod for examining patients every time they examined a new one.

ABOVE: Modern reconstruction of what a seventeenth-century plague doctor probably would have looked like, based on both contemporary depictions of plague doctors and surviving plague doctor masks

Conclusion

In short, the costumes worn by plague doctors in the seventeenth century probably actually did protect the doctors wearing them to some extent. They were far from the most effective protective garments that the doctors could have worn, but they probably did provide some level of protection.

Far from being thought of as an example of “medieval” stupidity, the plague doctor costume should really be thought of as an important (but flawed) early precursor to the modern hazmat suit, because, as I mentioned earlier, the basic idea is essentially the same. The plague doctor costume was meant to protect the doctor and filter the air he breathed, not to “frighten infections away” as that old public service announcement poster put it.

The plague doctor costume was flawed because there was an opening in the bottom for fleas to jump in and the mask didn’t adequately filter the air the doctor breathed. Modern hazmat suits have solved both of these problems; the bottoms of the suits are always closed and the suits usually have self-contained breathing apparati. In other words, we have learned from the mistakes and successes of the past and developed better methods of protection from disease. I’m sure Charles de Lorme would be pleased.

ABOVE: Photograph from France 24 of workers in Thailand in January 2020 wearing modern hazmat suits to keep safe from COVID-19. The plague doctor costume should be seen as an important early precursor to the modern hazmat suit—not as an example of “medieval” stupidity.