During the worst pandemic in history, patients saw a terrifying image before dying. A black figure in a wide-brimmed hat watched them from the other side of round glasses. Its face was that of a bird with a long, misshapen beak. In one of his gloved hands he carried a long stick with which he examined the patient, most of the time to check if he was already dead. It was the plague doctor.
This outfit is currently one of the most popular costumes at the Venice carnivals. It goes back to the plague epidemics that ravaged Europe and ended up annihilating a third of its population. On many occasions the case fatality rate was almost 100%. Its origin, its cause, its contagion, its treatment were unknown. It caused so much terror that it was avoided to name it with euphemisms as “the evil that runs”.
The black plague arrived in Europe on a ship of sick sailors from the Black Sea in 1348. In successive waves over the next four centuries it killed hundreds of millions of people. Five centuries passed until the cause of the disease was identified: the bacteria Yersinia pestis transmitted by the flea bite. These insects traveled the world aboard rats, which in turn were accidentally transported by humans in cars and ships along the main trade routes, first that of silk from the original focus in Asia and then throughout the Mediterranean. Then, as now, human activity exploded the pandemic.
Seven centuries after the black plague, Dr. Mark Earnest of the University of Colorado (USA) remembers this week the day he entered a room to examine his first covid patient. He was covered in two layers of gloves, apron, mask, and goggles. “I felt a wave of guilt,” he writes in the prestigious magazine. New England Journal of Medicine, “I wore a catastrophic protection suit that made me unrecognizable and that was not to protect my patient, but me.” Earnest felt like a plague doctor.
But the terrifying figure of the plague doctor is a symbol of the revival of knowledge and science in the face of religious or fantastic beliefs. The beak of the mask was filled with perfume and vinegar because, in theory, it disinfected the stinking air released by the sick and thought to be causing the infection. The entire body was sealed, wrapped in a waxed robe to avoid contagion. And that stick was already a measure to keep the safety distance. It was a prime example of the sanitary protection team.
“With the plague of 1348, the modern era of healthcare begins”, summarizes the Italian doctor Sergio Sabbatani. It is amazing to see how many of the things we are seeing during the worst pandemic so far in the 21st century were urgently invented in the fourteenth.
In Venice – a city in the middle of a lagoon – islands were designated to which the convalescents were taken and where all foreigners who arrived by boat for 40 days were to remain, the quarantine – from the Italian quaranta-. The ships that were free of disease waved a yellow flag, which even today designates the letter q, for quarantine.
The 40 days are a legacy of the power of the Church. “It is the time that Jesus spent in the desert surviving the temptations of the devil and since it was thought that the plague was a divine punishment, it was so established,” recalls the historian José Luis Betrán, author of History of the epidemics in Spain (The sphere of books). The book details the advance of the black plague in Spain from the ports of Levante such as Barcelona and Valencia to the interior of the country during an epidemic that lasted years, which came to kill one in five Spaniards and which reappeared throughout the centuries always causing the same terror.
“Some had that if they could get to the window at once, they threw themselves into the street and died, that as there was only a man or a woman taking care of them and the maddened had so much strength, they could not stop them,” writes the artisan Miquel in 1651. Parets about the plague in Barcelona.
The first attempts to establish networks of informants date back to that time to have real data on the epidemic and also the obscurantism and manipulation of data to prevent the news of an epidemic from spreading, since it was then that entire cities began to close to contain the plague, explains Betrán. Erroneous theories date back to that time with a striking resemblance to today, such as that the plague had been deliberately manufactured. The theory fueled hatred of the possible culprits, the Jews, who were hunted down and killed in many European cities, from Barcelona to Strasbourg.
Due to the plague, the first closures of borders and sanitary cords were established and the obligation on pain of death for travelers to enter through checkpoints where they quarantined, fumigated and covered in vinegar. Imitating Venice, many cities and kingdoms created public health commissions made up of superintendents who “came to control meat, fish, crustaceans, fruit, grain, wine, water, the construction of hospitals, cemeteries, lazarettes , funerals, medicines, doctors, the poor, travelers, prostitutes, “says Sabbatani.
The doctors and surgeons, sanitarians of the time, were frequent victims of plague. In the Venice of 1348, of 18 registered plague doctors, five died and another 12 abandoned their profession for fear of contagion.
Something like this lived Juan Tomás Porcell when he accepted the order to end the plague epidemic in Zaragoza in 1564. All his predecessors in office had fallen ill or died. Porcell cared for 2,000 infected people in the makeshift hospital for the epidemic outside the city. Every day he walked the streets picking up new patients. I saw dantesque images; newborn babies hugging their dead mothers who the wet nurses had to feed with their own milk at the risk of getting it, because they also had the plague.
Trying to save a child Porcell made history of medicine. He performed an autopsy on a pregnant woman dead of the plague. He managed to remove the baby from the womb still alive, but died soon after. The doctor did at least five systematic autopsies to analyze organ damage, the composition of the buboes, and the swollen glands, especially where the flea, which used to be the armpit or groin, was bitten by the presence of hair. This was a record for the time, because no other doctor with the courage to risk doing autopsies on plagued is known. Porcell survived the plague and described his findings in a medical treatise written in Spanish that circulated throughout Europe.
Without intending to, Porcell created the discipline of clinical pathology that is still practiced in hospitals and “announces what will be the scientific revolution of the following generations,” highlights science historian Consuelo Miqueo. His case “is paradigmatic of a modern attitude for basing its preventive and therapeutic proposals on experience, on the clinical and pathological observation of a very high number of cases (2,000), analyzing variables with a procedure that is based on the modern clinical epidemiology ”.
The first time a human being saw the true cause of the plague, he could not identify it. It was in 1658, when Athanasius Kircher took blood from a plague and put it under his rudimentary microscope. He saw strange corpuscles move in the fluid in a changeable way. The cause of the unmentionable disease will only be discovered in 1894, when Alexandre Yersin and Kitasato Shibasaburo independently identified the bacillus Yersinia pestis. 546 years had passed since the arrival of the black plague in Europe.
Despite effective antibiotic treatments, the disease continues to cause sporadic outbreaks, especially in poor regions, but also in developed countries like the United States. The last outbreak, in 2017, left 2,300 infected and more than 200 dead in Madagascar.
There is one last parallel between the past and the present. The plague was the first time in history that the world was globalized by the effect of a single microbe. Seven centuries later, we are in the same situation.
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