Personal protective equipment and plague doctors

When I was in clinical practice in the mid-1950s, I always wore a white lab coat in my office. Looking back on my days as a young doctor, I think that my coat was more to show who was the doctor in the room than to serve me or my patients with a protective device against germs. Today, in the midst of our pandemic, doctors, nurses, and all other staff members looking after COVID-19 patients have changed their white coats or green scrubs to plastic gowns, rubber gloves, masks, and face shields. I read about one physician who, while bundled up in PPE, wears a photograph of himself on his gown to establish some personalized connection with patients.

The first PPE, a head-to-toe protective suit, was invented in 1619 during the great plague in Europe by Dr Charles de Lorme (1584–1678), a physician to the French King Louis XIII. At that time the cause of the bubonic and pulmonary plague was attributed to miasma, bad air, witchcraft, or punishment from God, but everyone could see that the disease spread by contact with the patient or with bodily fluids or cough-related droplets in the air. The protective clothing was meant for plague doctors who tried to “rebalance humors” by bloodletting, or by applying frogs or leeches on the skin lesions. Most plague doctors were not experienced physicians, many even lacked medical training and had little to offer to the dying patients. Others were employed by the community just to record the number of infected persons. Plague doctors were not supposed to engage with the general public and could be subject to quarantine.

A plague doctor’s protective clothing featured a light wax-coated leather or fabric overcoat that covered the breeches underneath, with the shirt tucked into the pants. The boots were also covered. Gloves were attached to the overcoat’s sleeves. The original doctor’s mask was fashioned from leather coated with wax, resembling the gas masks or gas hoods used in World War I. It had glass eye openings and a small beak that was filled with herbs to purify the putrid air. The large bird-like masks seen in paintings were created years later by artists of the Venetian carnivals, when plague doctors were featured as characters in the parade. 

The plague doctors also carried a cane used to poke or probe the sick person, to avoid close contact. A plague doctor was often the last person the patient saw before they died. They were the harbingers of death.

Today our medical, nursing, and other care professionals clothed in their plastic gowns, gloves, and masks are celebrated as our health care heroes—inspiring all of us and filling us with admiration, trust, and hope. What a change!
—George Szasz, CM, MD

Suggested reading

Charles de Lorme. Wikipedia. Accessed 17 March 2021.

Hawthorn A. Plague doctors and PPE: Today’s gear has nothing on the medical garb of the Renaissance. Accessed 17 March 2021.

University of Western Australia. Personal protective equipment guidelines. Accessed 17 March 2021.

This post has not been peer reviewed by the BCMJ Editorial Board.

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