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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

The plague doctor: A macabre image of human response to infectious disease

From time to time I am asked about the presence in our HICprevent masthead of that strange, cloaked character wearing a beaked mask. As those familiar with the history of infectious diseases are no doubt aware, it is the iconic plague doctor: a foreboding figure last seen walking among the infected and dead, using his stick to touch and turn, when the Black Death ravaged Europe in the Middle Ages.

It is little wonder that this bizarrely garbed health care worker became more associated with the disease than a cure. As Yersinias pestis bacteria caused virtually untreatable infections that arose in discolored, swollen lymph nodes or “buboes,” it was a daunting task to attempt to help these fevered, frenzied masses. Various symptoms have been described, including bleeding from the ears, but perhaps the most chilling clinical note is this: “The pain was usually caused by the decaying or decomposing of the skin while the person [was] still alive.” It is estimated that the epidemic killed some 75 million people, roughly half of the population of Europe at the time.

Thus, the image of the plague doctor is certainly an ominous reminder of our continuing vulnerability to emerging infections. However, there is something in this figure – one seemingly conjured from a Poeish masquerade – that also represents vigilance and courage in the face of an unknown infection. Here we see the rudiments of basic barrier precautions, with a robe coated or waxed for protection and even see-through glass eyes in the beaked mask, which contained aromatic herbs and plants to block out the putrid air and the smell of death. The thought was that this “miasmatic ” air was contagious, though we know today that the vast majority of these cases were vector-borne via rats through fleas. This approach was closer to the mark then other interventions, which included bloodletting and other desperations.

Indeed, this prototype medical mask may have actually prevented a few infections. As some bubonic plague patients developed plague pneumonia — aka pneumonic plague — they could have transmitted disease by droplets and possibly through the air over a limited range. The pneumonic version of the disease is often cited as a much-feared bioterror weapon, which if effectively aerosolized would require mass antibiotic prophylaxis of exposed populations. May that day never come. But if it does there will be responders quickly in the field — elaborately garbed and masked, determined to help — wondering just exactly what they are dealing with.