Nfld. & Labrador·Apocalypse Then

Plague doctors and PPE: Today's gear has nothing on the medical garb of the Renaissance

If today's personal protective clothing is impersonal, its 17th-century equivalent was downright sinister, writes Ainsley Hawthorn.

If today's personal protective equipment is impersonal, its 17th-century equivalent was downright sinister

This is a 17th-century German or Austrian plague doctor mask, from the collection of the Deutches Historisches Museum. (Anagoria/GNU Free Documentation License)

Since the onset of the pandemic, doctors, nurses and other medical practitioners who find themselves working closely with COVID-19 patients have traded their familiar white coats and scrubs for plastic gowns, vinyl gloves, respirator masks and face shields.

A number of physicians have written about how much more difficult it is to build rapport with patients through the barrier of all this personal protective equipment. Some have even taken to wearing photographs of themselves on their gowns to help their charges, many of whom are facing a life-or-death struggle, feel less alienated, less alone.

Our modern equipment, though, has nothing on the medical garb of the Renaissance. If today's protective clothing is impersonal, its 17th-century equivalent was downright sinister.

Even if you've never heard of a plague doctor, you've almost certainly seen an image of one: an imposing figure in an ankle-length cloak, a wide-brimmed hat and, most strikingly, a beak-shaped mask.

Far from your approachable family physician, the plague doctor looks like something out of a nightmare. His outfit, though, was actually an early example of personal protective equipment.

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

The plague, an illness caused by a bacterium called Yersinia pestis, circulated Eurasia and North Africa for thousands of years, occasionally exploding into devastating pandemics that killed millions. During the late Middle Ages and the Renaissance, European cities employed plague doctors — physicians who were tasked with treating plague victims, and plague victims only, to avoid spreading the disease.

Tending to plague patients paid well but was risky business. Of 18 plague doctors who worked in Venice during the Black Death of the 14th century, five died and 12 fled.

French royal physician Charles de Lorme believed there must be steps that could be taken to make the occupation of plague doctor safer. He was practising medicine at the height of the Scientific Renaissance, when scientific principles were being applied to solve a wide range of problems. Why not use the advances that had been made in the field of medicine to protect doctors themselves?

Plague doctor costumes are worn at the Venetian Carnival. (Fotogoocom/Creative Commons)

In 1619, de Lorme had an idea for a head-to-toe protective garment that would shield doctors working with plague patients from infection. The garb included boots connected to breeches, a shirt tucked in at the waist, and gloves, with an overcoat worn over the entire outfit. Made entirely of wax-coated leather and constructed so none of the physician's skin would be exposed, this outfit would be impervious to body fluids.

The most arresting feature of the ensemble was the birdlike mask. If you see someone dressed like a plague doctor today, their mask will typically be a long, white curve sculpted from papier-mâché. These modern masks are based on the Medico della Peste costumes from Italian Commedia dell'Arte and the annual Venetian Carnival, where the plague doctor became a prominent character.

The original plague doctor masks, on the other hand, the ones worn by physicians, were fashioned from leather like the rest of the doctor's protective gear and had a much less ornamental appearance. More than anything else, they resembled the early gas masks or gas hoods that were used in World War I, shortly after their invention by Newfoundlander Cluny Macpherson.

This is a First World War British P helmet, used as a gas mask, c. 1915. (Stephen C. Dickson/Creative Commons)

The 17th-century medical devices were hoods that covered the doctor's entire head and overlapped his overcoat at the base of the neck. They had glass lenses over the eyes and a cone-shaped protuberance over the nose and mouth with two small holes on either side to let air in.

De Lorme, of course, invented this protective equipment long before we discovered that germs and microbes are responsible for the spread of contagious disease; nonetheless, it was probably at least somewhat successful in safeguarding doctors against illness.

At the time of De Lorme's innovation, the most popular explanation for disease epidemics was miasma theory, which posited that outbreaks were caused by noxious vapours in the air. These fumes, produced by rotting waste or stagnant water, were thought to explain why many people in the same vicinity would fall ill around the same time.

Still, despite the prominence of miasma theory in the medical community, even laypeople could see that the more closely someone interacted with a plague victim, the more likely they were to take ill themselves. In the 1500s and 1600s, some scientists began to think that diseases like plague might be spread by tiny particles that a sick person exhaled or that sloughed off a sick person's body.

The plague doctor's ensemble responded to both of these theories of infection. The impenetrable clothing prevented the doctor from coming into contact with any contagious particles, and the tip of the mask's "beak" was filled with a mixture of herbs meant to purify the air the doctor was breathing.

This is a watercolour of an early 17th-century plague doctor's costume. (Wellcome Trust/Creative Commons)

The types of plague that were circulating in the 17th and 18th centuries, when the plague doctor outfit was in use, were spread mostly by airborne respiratory droplets, similar to COVID-19. Although the beaked mask was no N-95 respirator, it might have slightly reduced the doctor's chances of inhaling these droplets.

More significantly, the interconnected leather garments would have prevented plague bacteria from touching the doctor's skin, whence they could later be transported to his mouth, nose and eyes. Plague doctors also carried a rod that they used to examine patients from a safe distance, in a kind of enforced physical distancing.

Whatever its effectiveness, the plague doctor's getup popularized the idea that protective clothing could play a role in preventing the spread of illness and paved the way for the protective equipment our medical professionals rely on in today's pandemic.

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