Medieval Plague Doctors: Masked saviours or grim harbingers of impending death?

As the Black Death swept across Europe, towns and cities appointed plague doctors to treat victims, record deaths, and give advice on containment measures.

Many of the earliest plague doctors were not highly trained physicians. Some were barber-surgeons, apothecaries, or individuals with only basic medical knowledge who accepted the position because of the pay.

In many cases, town councils hired them under contract, which included a promise of a fixed salary because wealthier citizens rarely volunteered for such dangerous work.

Records from Italian cities such as Venice and Florence mention the employment of plague doctors in the 1340s.

Their responsibilities focused on documenting deaths, witnessing wills, and advising on quarantines rather than performing medical procedures. 

The first plague doctors combined civic duty with personal risk but often lived separately from the general population in order to avoid spreading the disease.

In return, many contracts gave them special rights, including exemptions from taxes or guaranteed pensions for their families.

Their role became an early attempt by local governments to manage public health at a time when medicine still relied on ancient Greek and Roman theories about humours and miasmas. 

By the seventeenth century, the famous plague doctor costume had become a standard in parts of Europe.

Charles de Lorme, chief physician to Louis XIII of France, described a leather suit, gloves, boots, and spectacles designed to protect the wearer from miasma, which doctors believed spread the plague through poisoned air.

Engravings from the mid-seventeenth century popularised the long beaked mask that was filled with aromatic herbs such as mint, cloves, and myrrh.

Glass eyepieces covered the eyes, and a waxed leather or oilcloth overcoat protected the body from supposed contact with infection. 

The costume also featured a wide-brimmed hat and a wooden cane, which doctors used to examine patients or to keep them at a distance.

The cane allowed them to lift clothing, point to areas on the body, and even fight off desperate relatives.

The entire outfit created a terrifying figure that became associated with death in the minds of many Europeans.

Even though the design gave limited protection, it became one of the earliest examples of personal protective equipment in Western medical history. 

Medical practices in the Middle Ages relied heavily on theories from antiquity, particularly the idea that disease arose from uneven levels of the four humours: blood, phlegm, yellow bile, and black bile.

Plague doctors attempted to treat patients through bloodletting, lancing buboes, and prescribing mixtures of herbs.

Some treatments were applied as unusual poultices that were intended to draw out poison, which lacked any real scientific basis.

Other practitioners gave out potions that contained mercury, arsenic, or ground gemstones, which often worsened the patient’s condition. 

Public health measures, which formed part of the plague doctor’s duties, included advice to light large fires in the streets or carry out smoke treatments to cleanse the air.

Quarantine became an increasingly common practice in port cities like Venice, which enforced a forty-day isolation period for ships that arrived from infected regions.

In fact, the word quarantine derived from the Italian quaranta giorni, meaning forty days.

Even though the treatments rarely saved lives, the advice of plague doctors helped to limit the spread of infection through early forms of isolation. 

Communities often saw plague doctors with mixed feelings. They were meant to bring hope to the sick but they also reminded everyone of the ever-present threat of death.

The mask and costume, which appeared at the bedside of those already near death, created fear among many.

Many believed the doctors were omens of mortality rather than healers. Some towns viewed them as money-seekers because many doctors demanded high pay for work that carried extreme risk.

Records from German and Italian cities show cases in which plague doctors abandoned their posts during outbreaks, which led to accusations of fear. 

In popular culture, plague doctors' image entered folklore through depictions in art and theatre, and practically became figures of theatrical dread.

Children in some regions of Europe were warned to behave or risk a visit from the plague doctor.

Over time, the image became less associated with healing and more associated with death, particularly as the treatments offered little chance of recovery. 

Several plague doctors became known for their writings or actions during outbreaks.

Michel de Nostredame, later known as Nostradamus, worked as a physician during plague outbreaks in France in the 1530s.

He recommended improved hygiene and clean water, advice that proved more effective than many contemporary remedies.

Other figures such as Niall Ó Glacáin and Jean-Jacques Manget wrote detailed accounts of their experiences treating plague victims. 

Also, a man called Charles de Lorme was a physician to three French kings, and he became known for his description of protective clothing in the 1610s to promote the use of specialised garments long before germ theory existed.

Later imagery of the plague doctor costume drew inspiration from these descriptions and engravings, which meant that his work influenced European ideas about contagion and personal protection equipment. 

The disappearance of plague doctors resulted from advances in medical knowledge and the decline of plague epidemics in Europe after the eighteenth century.

As understanding of disease transmission improved, medical professionals abandoned practices based on miasma theory.

The final major outbreak in Western Europe occurred in Marseille in 1720, after which large-scale bubonic plague events became rare.

By the nineteenth century, hospitals and trained physicians replaced the need for contracted plague doctors. 

The development of modern medicine and the growth of public health systems made the role obsolete.

Protective clothing also evolved into more practical designs that were used by doctors and nurses in infectious wards.

The recognisable mask and costume survived only as a symbol of one of history’s most terrifying pandemics: now remembered in art, theatre, and popular culture as a haunting reminder of the fear of disease.