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  • Writer's pictureRobin Yong

Medico della Peste 中世紀瘟疫醫生 - 曾经的“死神使者"

Updated: Oct 17, 2021

Medico della Peste - The Plague Doctor - an iconic image in Venice during Carnevale.

I chanced about these costumers at the Venice Carnevale in 2019 whist they visited the Acqua Alta Liberia. The Plague Doctor is not an uncommon theme at the festival, but to see her with the Rat/ Pestilence figure is quite unusual. So I decided to stop them for some travel portraits.

A plague doctor was a physician who treated victims of the bubonic plague during epidemics. These physicians were hired by cities to treat infected patients regardless of income, especially the poor that could not afford to pay.

Plague doctors had a mixed reputation, with some citizens seeing their presence as a warning to leave the area. Some plague doctors were said to charge patients and their families additional fees for special treatments or false cures. In many cases these "doctors" were not experienced physicians or surgeons; instead, being volunteers, second-rate doctors, or young doctors just starting a career. In one case, a plague doctor was a fruit salesman before his employment as a physician. Plague doctors rarely cured patients; instead serving to record death tolls and the number of infected people for demographic purposes.

In France and the Netherlands, plague doctors often lacked medical training and were referred to as "empirics." Plague doctors were known as municipal or "community plague doctors", whereas "general practitioners" were separate doctors and both might be in the same European city or town at the same time.

Because doctors treating the bubonic plague were confronted only with the horrific symptoms and not an in-depth understanding of the disease, they often were allowed to conduct autopsies. These, however, tended to yield nothing.

Plague doctors consequently resorted to some dubious, dangerous, and debilitating treatments. Plague doctors were largely unqualified, so they had less medical knowledge than “real” physicians who themselves subscribed to incorrect scientific theories. Treatments then ranged from the bizarre to the truly horrific. Plague doctors practiced bloodletting and other remedies such as putting frogs or leeches on the buboes to "rebalance the humors." They practiced covering buboes — pus-filled cysts the size of an egg found on the neck, armpits, and groin — in human excrement which probably spread further infection. They also turned to bloodletting and lancing the buboes to drain the pus. Both practices could be quite painful, though the most painful must have been pouring mercury over the victim and placing them in an oven.

Not surprisingly, these attempts often accelerated death and the spread of infection by opening festering burn wounds and blisters.

Some say the primary responsibilities of a plague doctor, or Medico della Peste, should not be to cure or treat patients. Their duties were more administrative and laborious as they kept track of casualties of the Black Death, assisted in the occasional autopsy, or witnessed wills for the dead and dying. Unsurprisingly, this meant that some plague doctors took advantage of their patient’s finances and ran off with their final will and testament. More often than not though, these bookkeepers of the plague were revered and sometimes even held for ransom.

In certain European cities like Florence and Perugia, plague doctors were requested to do autopsies to help determine the cause of death and how the plague played a role. Plague doctors became witnesses to numerous wills during times of plague epidemics, and gave advice to their patients about their conduct before death. This advice varied depending on the patient, and after the Middle Ages, the nature of the relationship between doctor and patient was governed by an increasingly complex ethical code.

Some plague doctors wore a special costume consisting of an ankle-length overcoat and a bird-like beak mask, often filled with sweet or strong-smelling substances (commonly lavender), along with gloves, boots, a wide-brimmed hat, and an outer over-clothing garment. However, the costume was not worn by all medieval and early modern physicians studying and treating plague patients.

The typical mask had glass openings for the eyes and a curved beak shaped like a bird's beak with straps that held the beak in front of the doctor's nose.The mask had two small nose holes and was a type of respirator which contained aromatic items. The beak could hold dried flowers (including roses and carnations), herbs (including lavender and peppermint), camphor, or a vinegar sponge, as well as juniper berry, ambergris, cloves, labdanum, myrrh, and storax. The purpose of the mask was to keep away bad smells, known as miasma, which were thought to be the principal cause of the disease. Doctors believed the herbs would counter the "evil" smells of the plague and prevent them from becoming infected.

The wide-brimmed leather hat indicated their profession, and they used wooden canes in order to point out areas needing attention and to examine patients without touching them. The canes were also used to keep people away, to remove clothing from plague victims without having to touch them, and to take a patient's pulse. Yes, after more than 250 years fighting plagues, hope did finally arrive with the invention of the 17th-century equivalent of a hazmat suit. Unfortunately, it didn’t work very well. Most plague doctors had a very short lifespan even with the suit, and those who did not get sick often lived in constant quarantine. Indeed, it could be a lonely and thankless existence for the plague doctors of yore.

According to Michel Tibayrenc's Encyclopedia of Infectious Diseases, the first mention of the iconic plague doctor is found during the 1619 plague outbreak in Paris, in the written work of royal physician Charles de Lorme, serving King Louis XIII of France at the time. After De Lorme, German engraver Gerhart Altzenbach published a famous illustration in 1656, which publisher Paulus Fürst’s iconic Doctor Schnabel von Rom is based upon. In this satirical work Fürst describes how the doctor does nothing but terrify people and take money from the dead and dying.

The city of Orvieto hired Matteo fu Angelo in 1348 for four times the normal rate of a doctor of 50-florin per year. Pope Clement VI hired several extra plague doctors during the Black Death plague to tend to the sick people of Avignon. Of 18 doctors in Venice, only one was left by 1348: five had died of the plague, and 12 were missing and may have fled.

From history, we know that pandemics like the Plague and Spanish flu generally occur once every 100 years, and they last on average 3 to 9 years each time. Many times, the mortality figure is about 50 Million worldwide. Many of us in Asia and Australia dun remember things as such, but in many parts of Europe including Venice, we still have many old buildings which were used as quarantine hospitals.

Each time the course of the disease is the same. Once the disease struck, the people felt overwhelmed as it seems as though they believed that what had happened to others elsewhere could not possibly happen to them. When such big pandemics hit a community, many aspects of life will be turned upside down, from relations within families to its social, political, and economic structures. Theaters will be emptied, and graveyards filled... What follows is almost always the same - quarantine, riots, recession, collapse of the healthcare systems with many mortality amongst medical and nursing staff etc. Many of the afflicted afflicted will die in isolation, alone and uncared for. People with no money, no work and no place to go were soon seen as a drag on resources. Accordingly, people reacted with hopeful cures and responses based on religious belief, folklore and superstition, and medical knowledge. These responses took many forms but, overall, did nothing to stop the spread of the disease or save those who had been infected. Not sure how the current pandemic will pan out and how long it will last, but at the rate it is today, for sure it won't end in the next few months. Current infection figures are higher than ever. Sure we may have more advanced medical supplies and equipment, but we also have a much larger population, many of who prefer social gatherings, financial gains and freedom of speech above health recommendations and government regulations. The next few months and 2022 will be extremely difficult for many countries.

Even with anticipated and hussled opening up of flights and borders, there is the big worry that hospitals will be overwhelmed and the whole system being forced to take a step back again. And even with successful opening of flights and borders, the first group of travelers (apart from diplomats and business people) will be those visiting family and friends rather than those doing leisurely tours.

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