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Plague doctor during historical pandemics

Bloodletting, beer and the Bard: a brief history of pandemics

As tragic and disruptive as the COVID-19 pandemic has been, and may still prove to be, human history is littered with similar outbreaks.

While researching this article, we discovered that quarantine, lockdown and social distancing measures have been tried out during pandemics and other crises for at least the past 700 years, and so one could argue that our approach to containing the spread of COVID-19 in 2020 is nothing new.

In the 1300s, as Europe faced the bubonic plague (the ‘Black Death’), it became common in certain regions to ban traders from entering cities if they were suspected of carrying the disease. There is also evidence that, in Venice, incoming ships suspected to contain plague victims would be quarantined offshore until any potential contamination was ruled out.

Later in 1648, in the United States, following yellow fever outbreaks in Barbados, Cuba, and the Yucatan, the state of Massachusetts ordered all ships arriving to Boston from the West Indies to be quarantined because of “ye plague or like in[fectious] disease.”

If this is one of the first large scale quarantine efforts, it’s possible that the following is an example of an early ‘self-quarantine’.

It was said that as the Black Death swept through Europe, Pope Clement VI. self-isolated between two enormous burning fires which were intended, presumably, to stave off any airborne infections. Buildings in Limousin, France, where he resided at the time must have been considerably fireproof since he survived this rather dangerous technique.

Nowadays, as many people find themselves furloughed, they are told on social media that this is an opportunity to be creative, pursue hobbies and personal development. This advice was perhaps followed in the most exemplary fashion in the 16th/17th Centuries by the Bard himself, William Shakespeare.

At the time, pandemics, plagues and pestilence frequently caused theatres to close, with people self-isolating to protect themselves. It appears it was during a period of ‘lockdown’ that he wrote some of his most famous work.

It is believed that a great number of his works, including Romeo and Juliet and King Lear, must have been written between 1592 and 1594, at the same time as widespread theatre closures due to the plague epidemic.

Quarantine and social distancing measures were thus widely adopted in the face of pandemics, but by the 1500s, we start to see reports of inoculation to combat diseases.

In China and India, as smallpox ravaged populations, vaccination was performed via exposure to small amounts of the smallpox disease. Smallpox sores were scratched into the arm of a healthy volunteer, in the belief that minor exposure would inoculate the subject against contracting smallpox more seriously. Similarly, it is believed that in China, powdered smallpox sores were blown into the nostrils of volunteers instead.

There has been much discussion in the UK media in 2020 about COVID-19 exacerbating class differences because traditionally working class jobs seem to put workers at a higher risk of contracting and dying from the virus.

Outbreaks of disease, as well as economic downturns, are of course hardest on those with lesser means and this was no different during smallpox outbreaks of the 17th century. As the western medical community experimented with treatments, it was the wealthiest among the population who would be first in line for new medicines. Though the poorer classes were at greater risk of contracting smallpox, English doctor Thomas Sydenham noted that the upper classes seemed to die from smallpox at a higher rate than the poor even if symptoms were mild. One explanation was that new medical treatments, which were not affordable to most, were in fact more harmful to the patient than the disease itself! Thomas Dover, a patient of Thomas Sydenham, who would also eventually become a doctor, recorded his own ‘discharge summary’ documenting his treatment and worsening of symptoms:

“Whilst I lived in Dr Sydenham’s house, I had myself the Small Pox, and fell ill on the Twelfth Day. In the beginning I lost twenty two Ounces of Blood. He gave me a Vomit, but I find by Experience Purging much better. I went abroad, by his Direction, till I was blind, and then took to my Bed. I had no Fire allowed in my Room, my Windows were constantly open, my Bed-Clothes were ordered to be laid no higher than my Waste. He made me take twelve Bottles of Small Beer, acidulated with Spirit of Vitriol, every twenty Four hours. I had of this Anomalous Kind [of smallpox] to a very great Degree, yet never lost my Senses one Moment.”

— Thomas Dover, The Ancient Physician’s Legacy to His Country

It makes for grim reading and, looking back, perhaps the 12 bottles of beer infused with “spirit of vitriol” (sulfuric acid) every 24 hours may have contributed somewhat to his afflictions.

Sadly, despite improvements to living standards worldwide and incredible developments in the pharmaceutical world, epidemics and even pandemics are an enduring feature of the modern world.

It is optimistic to believe that COVID-19 has arrived out of the blue, and may be dispatched just as swiftly once a vaccine is found. Although we have the means to develop safe and effective treatments, history tells us that many diseases are hard to completely eradicate.

An example of this is Cholera, which swept across most of the world in 1817, and still persists today in economically embattled areas with poor sanitation and overpopulation around the world.

Pandemics are thus a key feature of our past and of our future. However, it is heartening to see so much investment in research around the globe, as we scramble to find treatments and vaccines to help us tackle our own pandemic of 2020.



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