The plague doctor: origins, costume, and meaning

The figure of the plague doctor — the long coat, the wide-brimmed hat, the gloves, the boots, and the long, hollow beak stuffed with aromatic herbs — is one of the most recognisable images in European visual culture. It is also one of the most misleading. The costume was not worn during the Black Death of 1347–1351. It was devised in the early seventeenth century, by a French physician who was designing it for the plague outbreaks of the 1610s and 1620s, several centuries after the original pandemic. The fact that the costume has come, in the popular imagination, to stand for the entire age of plague is itself a piece of historical evidence — evidence of the way in which a single piece of professional equipment, repeated endlessly in popular prints, has come to define a period it never represented.

This article examines the real history of the costume, the medical theory behind it, the institutional role of the plague doctor in early modern cities, and the visual afterlife of the figure in art and in the cinema. The wider context is set out in the overview of the Black Death and the cultural and religious impact of the Black Death. The medical response of medieval doctors to the original pandemic is treated in Medieval medical responses to the Black Death. The visual world of the late Middle Ages in which the figure of the plague doctor is most often placed is examined in How the Black Death influenced medieval art.

Charles de Lorme and the Treatise of c. 1619

The standard attribution of the plague doctor costume is to Charles de Lorme (1584–1678), a French physician who served as personal doctor to four successive French kings, from Henri IV to Louis XIV, and who was the leading medical figure in Paris in the early decades of the seventeenth century. De Lorme was a committed Galenist and a friend of the great Parisian medical faculty, and he designed the costume in the context of the major European plague outbreaks of the 1610s and 1620s — the plague of Paris in 1619, the great plague of London in 1625, the plague of Lyon in 1628, and the Italian plagues of 1629–1631.

De Lorme’s design was set out in a brief treatise, the Remède très utile et très experimenté, pour se préserver de la peste et de toute contagion (c. 1619), and in a series of letters to his medical colleagues. The costume, in his description, consisted of:

A long coat, made of heavy waxed linen or, where the doctor could afford it, of morocco leather, that covered the body from the neck to the ankles.
A mask with eye-holes of glass, and a long, hollow beak, often half a foot long, filled with aromatic substances — roses, carnations, mint, camphor, myrrh, laudanum, and (in some accounts) cloves and ambergris.
Gloves of leather or waxed cloth, that covered the hands completely.
Boots of leather, that came up to the knee.
A wide-brimmed hat, often red, that finished the costume at the top.
A long wooden wand, that the doctor used to feel the pulse of the patient, to point at sites of pain, and to direct his assistants from a safe distance.

The treatise was not published in book form in de Lorme’s lifetime, but it circulated in manuscript, and its basic design was rapidly adopted by the magistrati di sanità of the Italian cities, by the Parisian Bureau de la Santé, and by the German Sanitätskollegien. By 1630 the costume was, in effect, the standard uniform of the plague doctor across Catholic Europe; by 1650 it had spread to Protestant Germany and the Low Countries; by 1700 it was the standard visual reference of the entire plague-doctoring profession.

The Miasma Theory Behind the Beak

The design of the costume is intelligible only in the context of the miasma theory of disease, which de Lorme inherited from his medieval and Renaissance predecessors and which would remain the dominant European theory of epidemic disease until the bacteriological revolution of the late nineteenth century. The theory, descending from the Hippocratic treatise On Airs, Waters, and Places and codified by Galen in the second century, held that epidemic diseases such as plague were caused by poisonous airs, or miasmata, that were breathed in by the patient or that entered the body through the pores of the skin. The miasma was produced, in turn, by a particular conjunction of climatic, terrestrial, and astronomical factors: the decay of organic matter, the eruption of volcanoes, the conjunction of the planets, the corruption of the air after earthquakes.

The miasma theory was not absurd, and the practitioners of the early seventeenth century, de Lorme among them, were at the leading edge of contemporary medicine. The observation that bad smells were associated with disease was reasonable, given the absence of germ theory, and the prescription of strong-smelling substances as protection was, in some cases, of marginal benefit: camphor is in fact a mild antiseptic, and the burning of aromatic woods may have helped to mask the smell of decomposing bodies. The beaked mask, in particular, was designed to expose the air breathed by the doctor to a long column of aromatic material before it reached his nose. The wand, similarly, was designed to allow the doctor to examine the patient without exposing himself to the corrupted air. The whole costume is, in effect, a piece of early modern personal protective equipment, designed according to the best medical theory of the day.

The costume was also, and not incidentally, a piece of theatre. The plague doctor was a figure of the early modern city, and the costume served not only to protect the doctor but to mark him out, in the streets of a city in plague-time, as a servant of the public health. The beaked mask, the long coat, the wand: each was, in its different way, a signal to the population that the wearer was the official representative of the sanità, and was entitled to enter houses, to seize the property of the dead, and to direct the burial of the bodies. The costume was, in short, both a medical instrument and a piece of administrative uniform.

The Plague Doctor in the Early Modern City

The institutional role of the plague doctor, in the seventeenth and eighteenth centuries, was the result of a long development that began in the wake of the Black Death of 1348 and culminated in the permanent magistrature di sanità of the Italian cities. The first permanent sanità was established in Venice in 1486; by 1600 nearly every major Italian city had a permanent health board. The boards had the power to isolate infected households, to seize and burn the clothing of the dead, to restrict the movement of travellers, to declare a laisser-passer or a bolletino di sanità for those who had to travel, and to appoint plague doctors. The magistrato of Milan, for example, employed four plague doctors in 1576 and thirty-one in 1630.

The role of the plague doctor in the early modern city was not a prestigious one. He was a junior member of the medical profession, often a person of no great experience, who was paid a salary by the city and given certain privileges, including the right to seize the property of those he attended who died. He was required, by the terms of his contract, to attend all cases of suspected plague in the district assigned to him, to report the cases to the magistrato, to direct the isolation of the household, and to supervise the burial of the dead. He was often assisted by becchini, the gravediggers, and by guardiani, who were responsible for the isolation of the infected houses. The work was dangerous, and the mortality among plague doctors was high.

The plague doctor was, in this sense, one of the first public health officials in European history. He combined clinical practice with public health administration, and his role was understood, by contemporaries, as a form of state service. The system worked, in many cases, to limit the spread of the disease; it also provided, in many cases, the model for the public health systems of the eighteenth and nineteenth centuries. The French médecin de peste of the early modern period, for example, is the direct ancestor of the modern French médecin-inspecteur de la santé publique.

The Plague Doctor in Art and Imagination

The plague doctor entered the visual tradition of European art at much the same time as the costume was devised. The most famous early image is the painting by the French artist Georges de La Tour of c. 1630, in the Louvre, which shows a plague doctor lighting a candle beside a sleeping figure. The candlelight illuminates the mask, with its long beak and its round eye-holes, and the effect is both intimate and terrifying. De La Tour’s image is unusual: it shows the doctor not in the streets of a city, but at the bedside of a single patient, and it suggests that the costume could be a vehicle for tenderness as well as for terror.

The plague doctor was a popular subject of prints in the seventeenth and eighteenth centuries. The best-known series is that of the French engraver Nicolas de Larmessin III, whose Recueil des plus illustres proverbes of c. 1690 includes a series of plague doctors in costume, with the long beak and the wide-brimmed hat. The prints were widely circulated, and they established the iconography of the costume in the popular imagination. The Italian engraver Giuseppe Maria Mitelli produced a similar series in the 1690s, and the German engraver Johann Andreas Pfeffel produced another in the 1740s. By the late eighteenth century, the plague doctor was a standard figure in the popular prints of every European country.

The figure has been a favourite subject of writers. The French novelist Albert Camus, in La Peste (1947), used the plague doctor as a central figure: Dr. Rieux, the narrator, is a modern equivalent of the médecin de peste, and the novel is in part a study of what it means to continue to practise medicine in a city in which one-third of the population is dying. The Italian philosopher Giorgio Agamben, in Homo Sacer: Sovereign Power and Bare Life (1995), used the plague doctor as a central image of biopolitics, the modern form of state power that operates on the body of the citizen.

In the cinema, the plague doctor has appeared in countless films, often as a symbol of death, danger, and contagion. The figure of the beaked doctor has been a stock image of horror cinema since the 1960s, and the costume has been used in films as diverse as Ingmar Bergman’s The Seventh Seal (1957), in which the figure of Death plays chess with a medieval knight, and the modern cycle of films about contemporary epidemics, in which the costume is often used as a shorthand for the vulnerability of modern medical systems to ancient pathogens.

From Historical Figure to Cultural Icon

The plague doctor is, in the end, a piece of historical evidence for the long history of the response to epidemic disease. The costume is a coherent answer to a particular medical theory; the medical theory was a coherent answer to a particular set of clinical observations; the observations were the result of several centuries of practice, in which doctors of every European country had been trying, with the resources at their disposal, to understand and contain the most lethal epidemic disease of the pre-modern world. The fact that the answer was wrong — that the Yersinia pestis bacterium is in fact transmitted by the rat flea, and not by miasmata — does not diminish the historical significance of the costume. It is, in its way, a monument to a particular moment in the history of medicine: the moment at which the European medical profession had a theory of epidemic disease that was coherent, plausible, and wrong.

The costume has, in the end, come to stand for something much larger than itself. It is the visual shorthand of the entire age of plague, from the Black Death of 1348 to the last great European outbreak of Marseilles in 1720. It is, in this sense, an emblem of the vulnerability of human beings to the diseases that they cannot understand, and of the courage of the medical practitioners who continued to work at the bedside of the sick, even when they knew that the disease was likely to kill them. The fact that the costume was anachronistic for the original Black Death does not diminish its significance. It is, in fact, a reminder that the memory of the plague has its own history, and that the popular image of the plague doctor is a piece of cultural memory rather than a piece of historical fact.

References

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Cosmacini, Giorgio. Storia della medicina e della sanità in Italia. Laterza, 1987.
Naphy, William, and Andrew Spicer. Plague: Black Death and Pestilence in Europe. Tempus, 2000.
Slack, Paul. The Impact of Plague in Tudor and Stuart England. Routledge & Kegan Paul, 1985.
Park, Katharine. Doctors and Medicine in Early Renaissance Florence. Princeton University Press, 1985.