B-ENT , 2009, 5, 195-202 A Historical Vignette (15) “Be proud of yourself: you have a History!”

The nose and the plague

J. Tainmont Winston Churchill Avenue 172, P.O. Box 9, 1180 Brussels, Belgium

Abstract. The nose and the plague . Although the plague does not cause any specific nasal pathology, the miasma theory and the repulsive smell of the disease were factors that contributed to a strong emphasis on the nose. To stop the spread of the disease, it was thought necessary to saturate the nose with protective scents (hence the nose of the plague doctors) (Figure 1), or simply to hold one’s nose. Moreover, the nose was long considered to be an outlet for mucus from the encephalon, and so induced nose bleeding and sneezing were advised when the plague seemed to be attacking the brain.

Figure 1

Figure 1. Photomontage showing a “plague doctor” wearing an enormous nose containing protective scents. In the background, an allegory of the plague: “Golconda” by René Magritte (1953).

“The nose was beak-shaped, full of perfumes and anointed inwardly with balsamic matter. There were only two holes, one on each side, at the place of the openings of the natural nose. But that is sufficient for breathing and for conveying, with the air that is breathed, the impression of the drugs contained towards the front of the beak. ”1 196 J. Tainmont

1. The Plague, a serial killer character . We should be aware epidemics of the time, can with a bad odour that a “ pestis ” in Antiquity or probably explain that secondary the Middle Ages was not neces - meaning. Today in French, that ... the corpses abandoned every - sarily the plague as we under - secondary meaning persists where which are devoured finally stand it today. In the case of the alone: the sense of a dreadful by the scattered survivors, the “plague” of Athens that led smell . great pestilence that requires the Pericles’ death in the fifth cen - beautiful ladies of the court to tury BC or the “plague” during 2. The Miasmas hold their noses when they visit which St Louis died outside the handsome gentlemen of the Tunis in the 18 th century, the Homais ... was laden with a stock army for a pleasure party diseases in question may have of camphor, of benzoin and aro - (G. Duhamel , Refuges de la been cholera or typhus. In addi - matic herbs. He was also carrying lecture, IV ). tion, in veterinary medicine, the a large jar full of chlorine water to A long time ago, when travel - word peste/plague is still used expunge the miasmas (Flaubert , ling in Morocco, I stood on a today with the original meaning Mme Bovary, III, IX ). small rise observing the works of of “ non-specific mortal epi - a dyer whose multicoloured bar - demics ”, and not to designate The word miasma was very fre - rels gave off a terrible smell. the “plague” in the sense used quently used to designate the Suddenly an Italian tourist cried in human medicine today. A plague and it is important to out “ Que malodore ! Que pestilen - current example of this usage understand its meaning well. The tia !“ The memory of the dreadful can be found in “avian plague”, word comes from the Greek mias - plague and its legacy of fatal which is caused by a virus and ma (miasma), meaning “ the stain smells emerged here, still not by Yersin's bacillus. caused by a murder ”, which in embodied in the language of this • The plague was also connected turn was derived from the verb traveller. with the word fléau (a scourge). miainw (miainô): “to dye“ in That word came from Latin fla - Homer (a curious coincidence • The French word peste (i.e. the gellum , a whip. It indicated “a with the situation described above plague) now persists where the thing seeming to be the instru - in Morocco!) and then “to soil English word pest in this sense ment of the divine wrath ”. This with blood, sometimes with dust has fallen into disuse (except idea is also concealed in the or tears”. Other derived words in weaker meanings such as etymology of the English word attested to the pre-eminence of the a pest, a person who pesters). Plague , which comes from the notion of murder: namely the stain Etymologically, pest is proba - Greek πlhgh /“ plègè ”, through of the blood that has been shed. bly linked with the Latin adverb Latin plaga meaning a stroke or Finally, miasma also had the reli - pessum meaning “in the bot - blow . gious meaning found in the tom”, a word associated with • The word pestilence . In Latin, tragedies: the sense of profana - the Latin noun pes “le pied ” pestilentia had the same tion, of sacrilege. (the foot). Pessum also had a meaning as pestis . In Antiquity, None of this is found in French. figurative meaning that is now apparently, neither of these two The word was introduced to mean seen in the French “ une perte ” words had the connotation of a the effluvia (impalpable particles ) (a loss), for instance in the bad smell. to which infectious diseases were expression pessum ire: “ aller à In Old French (12 th century), attributed before the discovery of sa perte ” (to go on the road to both words were used with the microbes. Miasmas were not ruin). This etymology allows us same meaning (“plague”), as in therefore specific to the plague to understand the original sense Latin. But from the 13 th century and could be associated with other of pestis as a contagious dis - onwards, pestilence in French infectious diseases such as malaria. ease, an epidemic with a par - acquired the supplementary At the very beginning of the ticularly fatal character. During sense of “ foul smell, putrid 19 th century, miasma had the more Antiquity, pestis indicated every miasma ”. The observation of general sense of “emanations, highly contagious and serious the terrible smell of the corpses gases dangerous to health pro - infection without any specific affected by plague, during the duced by the decomposition of Historical Vignette 197 animal or vegetal matter”, the leged pathway for the miasmas on applied using different methods. sense that now prevails in English. their way to the lungs and then Paré gives us the details: Finally, in the middle of the onto the heart, the seat of life. The In the town 19 th century, by extension, miasme miasmas passed also directly to Magistrates and police officers came to mean a “ disagreeable and the brain through the nose. Finally were required to ensure that, as in unhealthy smell ”. they could penetrate through the Hippocrates’ time, fires were lit to The origin and the modus pores of the skin, particularly if purify the air and that fragrant operandi of the miasmas . they were opened 2 subject to the things like turpentine or broom Miasmas could come from diverse influence of warm baths. 2 were thrown on the embers. In the sources: first from plague patients same way, as in Tournai, soldiers through their sweat or faeces, then 3. The use of the protective per - placed gunpowder without can - from their corpses, abandoned due fumes (Figures 2,3,4) nonballs into artillery, loosing off to the shortage of graves. Climatic shots to eliminate the contamina - conditions were another source, When we entered the house of the tion in the air with the smell of the an example being warm and Moroccan, we were enveloped by smoke. 2 humid air, which favours the rapid a cloud of oriental fragrances: the In dwellings (Figure 3) putrefaction of corpses. This phe - sweet and penetrating perfume of The air had to be waved around nomenon could be aggravated the rose water went to our heads the patient with a fan or with a big where there were large numbers of and reminded us of the mysteries linen sack soaked in water with corpses, for instance after a battle of the harem and the marvels vinegar and attached to a long or a shipwreck. Stagnant water, of the Thousand and One nights. stick. The room was perfumed marshes, sewers and wells pro - (T. Gautier, Voyage en Espagne, with aromas: incense, myrrh, ben - duced miasmas that formed p. 281). zoin, laudanum, styrax, roses, clouds, which could fall again in At that time, disinfection was leaves of myrtle, lavender, rose - the form of rain, contaminating called parfumage (the act of mary, sage, basil, savory, wild the plants. The nose was a privi - perfuming ). The perfumes were thyme, marjoram, broom, pine

Figure 2. A physician feels the pulse of a plague victim, while holding to his nose a sponge impregnated with vinegar, “Fascicul Medicine te Antwerpen“, 1521. Figure 3. Appliance for fumigation used during the plague. Hôtel Dieu Museum of Lyon. The word “perfume” contains the word fume ! Figure 4. The plague victims of Jaffa, by Jean-Antoine Gros, 1804, Louvre. 198 J. Tainmont cone, small pieces of pine tree, in rose water, rose vinegar, cloves, 4. Charles Delorme and the cloves... A billy goat had to be a little crushed camphor and he nose of the plague doctors kept at home because his smell will have to smell it often” 2 (Figures 5,6,7,8,9,10) prevented the pestilent air from On the painting “the plague vic - settling there (in accordance with tims of Jaffa” (Figure 4), ... the carnival of the masked the proverb “one bad smell chases Bonaparte touches the bubo in the physicians of the black Plague... away another one”). In the sum - armpit of a plague victim, evoking (Camus, La Peste, p. 52) mer, the room had to be sprinkled the famous gesture of the kings of with cold water mixed with vine - France. The officer standing to Charles Delorme (1584-1678), gar or with rose water if the Bonaparte’s right is holding a who was physician to Louis XIII, patient was rich. handkerchief soaked in a protec - and then to Louis XIV, was a very Near the mouth and the nose tive liquid to his nose and mouth. fashionable doctor (Figure 11). In Montpellier, the physician The painting was commissioned Henry IV said that le jeune Bernard de Gordon recommended by Bonaparte himself. On his Delorme gentilhommait la méde- keep a sponge soaked with vine - return from Egypt, Vincent Denon cine (“the young Delorme made gar or a small bag full of herbs in instructed the painter Antoine- medicine gentlemanly”). He put front of the mouth and the nose. Jean Gros, who made the painting Bourbon l’Archambault on the Paré advised holding a sponge in Paris in 1804. The episode dates map as a spa town and the city still in the hand because “ it contained from 1799 and the painting is in has a “Charles Delorme Square”. better than anything else the the Louvre. The truth of the scene He was an advocate of antimony virtues and spirits of aromatic and was disputed. Some claimed that and he used it as the basis for odoriferous things to be sniffed at the general was very helpful to “Delorme powder” that was used with the nose by keeping them the sick. Others, on the contrary, as a purgative. Mme de Sévigné near the mouth”. For instance, spread the rumour that he ordered used it for her “vapours”. “soak for one night in strong the physician Desgenette to give Delorme’s rival, Guy Patin, said vinegar and brandy: rue, lemon opium to about seventy plague that “he purged too much”. balm, rosemary, scordium, sage, victims to hasten their death and Delorme was also the inventor absinth, cloves, lily of the valley, to break the vicious circle of con - of a “red stock” that was a major saffron, root of angelica (Figure tagion... success. It owed its name to the 2). Then take a sponge soaked or Finally, in a mask colour of the roots of sorrel it moistened in the aforesaid water. One of the characteristic contained. According to some, Now the patient will be able to features of the dress worn by Delorme was the “greatest charla - hold in his hands a sponge soaked plague doctors. tan of his century”.

Figure 5. Plague doctor, museum of the Hospices civils of Lyon. The model dates from the 17 th century. Figure 6. Plague doctor. Frontispiece of J.-J. Manget‘s “ Traité de la peste recueilli des meilleurs auteurs anciens et modernes... “, Geneva, Philippe Planchi, 1721. Figure 7. Plague doctor: Doktor Schnabel von Rom (“Doctor Beak of Rome“); engraving by Paul Fürst after J. Columbina, Rome, 1656. Historical Vignette 199

Figure 8. A watercolour of a physician’s mask with a sort of cape; lazaret of Venice, late 17 th /early 18 th century. Figure 9. Plague doctor. Caricature by J. M. Füsslin, 17 th /18 th century. Figure 10. Plague doctor. Carnival mask, Venice.

Leather probably constituted a the nasal prominence of the useful barrier against the fleas, a physician! (Figure 9). fortunate coincidence because the 3. The nose of the plague doctor role of the fleas in the transmis - also has a place in the realm sion of the plague was only known of fantasy. This is probably a at the very end of the 19 th century. joke intended to ward off the memory of the plague that 1. A mask of this type was found ravaged Venice at the end of the in a lazaret of Venice, dating Middle Ages. The suit of the from the 17 th /early 18 th century. plague doctors is sometimes It is made of a sort of supple attributed more to the Italians oilcloth coated with a yellow than to the Frenchman Delorme matter with the colour and the (Figure 10). Figure 11. Charles Delorme, physician of flexibility of diachylon: the the faculty of Montpellier (1584-1678). beak is made of bronze and is 5. The iconographic tradition of composed of two lateral wings the held nose (Figures 12,13,14, closed with wire netting in 15,16,17) He is also credited with the idea which aromatic substances of the famous protective suit used were placed. It was probably – In the Bardi di Vernio chapel in the plague epidemic that afflicted located in the Institute of the Santa Croce church in Paris in 1619: “ he had a suit made Hygiene in Rome until 1900, Florence, there is a fresco by for himself in morocco leather where a certain Dr. Sambon Maso di Bianco dating from that the air penetrates with much made a watercolour of it 4 about 1340. This follower of difficulty. He placed garlic and (Figure 8). Giotto depicts the miracle of rue in his mouth, incense in his 2. An engraver from Zurich, a St Sylvester, a pope of the nose and the ears, covered his certain Jean-Melchior Füsslin 4th century. The latter succeeded eyes with spectacles, and dressed (1677-1736), made an engraving in defeating a dragon hidden in in this way he attended the sick... showing a caricature of a the bottom of a pit who was he never forgot his dress... with a plague doctor with two small blamed for the slaughter of 300 mask in the same morocco leather clouds of odoriferous vapours men a day. Sylvester tied up his to which he had attached a nose come out from his nose. One jaws with a thread! At the time, half a foot long to divert the would be tempted to attribute the dragon was the symbol malignancy from the air. 3 these to concealed inhalators in of the plague. Moreover, the 200 J. Tainmont

Figure 12. “The miracle of St Sylvester”, by Maso di Bianco, Florence, 1340. See also Figure 17. Figure 13. “The triumph of Death”, by Buffamalco or Traini, Pisa, 1350. Figure 14. “The Pestilence”, by Gaetano Zumbo, Firenze, 1680-1700.

Figure 15. Minor character holding his nose at the side of the physician taking the pulse of a plague victim. “Fascicul Medicine te Antwerpen“, 1521 (see also Figure 2). Figure 16. Two fragments from the “ Peste des Philistins ” or “ Peste d’Ashdod ” by Nicolas Poussin, Paris, 1630.

character shown here is holding – The fresco “The Triumph of same. A few yards away from his nose against the miasmas. Death” can be found in the the knight, we see open coffins We believe that this painting is Campo Santo of Pisa. It is a containing plague victims the first example of the icono - painting by Bonamico Buffa - (Figure 13). graphic tradition of the held malco, or possibly Francesco – Antonio Zanchi painted “The nose associated with the plague Traini. The work dates from Plague in Venice” in 1666. (Figures 12,17). about 1350. The gesture is the Here, we see a man holding his Historical Vignette 201

Figure 17. Illustration showing St Sylvester’s miracle, according to the golden legend of Jacques de Voragine. At the bottom of a pit, St Sylvester is tying together the jaws of a dragon, an emblem of the plague in Roman-Byzantine monuments. The repulsive breath of the dragon is shown by the way in which the religious figure on the right is gripping his nose (Maso di Bianco, chapel of Bardi di Vernio, basilica Santa Croce, Florence, 1340). This is probably the oldest expression of the iconographic tradition of the blocked nose associated with the plague. In other versions, the dragon is thought to be the symbol of the year reaching its end. The number of the stairs descending to the pit was not about 40, as in the golden legend, but 365, so that St Sylvester’s Day was 31 December.

nose. A sketch of the painting difficulty among the corpses, to indicate a very poor prognosis. can be found in the Kunst - carrying the body of a plague By contrast, from a therapeutic historische Museum of Vienna. victim (Figure 14). point of view, nosebleeds were The painting was intended for – In 1630, inspired by a drawing actually pursued in some cases. the wall lining the stairs of the by Raphaël that has since been Scuola Grande di San Roco, a lost, Nicolas Poussin made • We have texts describing the saint who provided protection “The Plague of the Philistines” poor prognosis associated with against the plague in Venice. or “Plague of Ashdod” (Louvre). nosebleeds. For instance, in the – “The Pestilence” is a coloured We see two characters holding Decameron, Boccaccio wrote wax model by Gaetano Zumbo their noses near the bodies of that, in the East, nosebleeds (Museo di storia della Scienza, plague victims (Figure 16). were a sign of a fatal outcome: Firenze). It was made between “the disease ... in the East, 1680 and 1700. We see here a 6. The nasal outlet as a thera - where bleeding from the nose street cleaner, the monatto , peutic agent for the plague was the clear sign of an whose nose is protected as well inevitable death ”. 5 as might be with a piece of Spontaneous nosebleeds during the Michel de Nostredame (Nostra - cloth. He is advancing with plague were generally considered damus), when he had went to 202 J. Tainmont

treat the plague in Aix en spontaneously and it was of exerting too strong an attrac - Provence, noticed that those advised to allow the blood to tion on the brain, which could whose noses began to bleed flow spontaneously, albeit with - cause apoplexy, vertigo and died rapidly: “ In the year 1546 in certain limits. Indeed, if the other bad accidents. 2 when I was elected and hired in loss of blood was too great, the city of Aix en Provence... intervention was required by References and Related Topics where the plague was so intense introducing into the nose a cot - and terrible... Several patients, ton plug ... or some restrictive 1. Manget J-J. Traité de la peste . who had the marks of the matter made of hair from the Geneva, 1721. plague, a carbuncle behind the region between the thighs or 2. Paré A. Œuvres complètes. shoulder or before their breast, from the breast of a rabbit ... , 24 ème livre « De la peste ». were subjected to a violent sealed earth incorporated with Chapters III, VII, XI, XIII, nosebleed that lasted night and plantain juice... XXI, XXVIII, XLIII. Slatkine day, and they died. 6 • Sleep through the intermedi - reprints, Geneva; 1970. • By contrast, a few years later, in ary of the nose . Finally, if the 3. Abbé de St Martin M. « Moyens 1585, Paré wrote that if Nature headaches persisted and if the faciles et éprouvés dont could not evacuate the venom poor patient could not sleep, a Monsieur de Lorme, premier of the plague that reached the handkerchief was positioned at médecin et ordinaire de trois de brain, patients would suffer the level of the nostrils. It was nos Rois... s’est servi pour vivre from headaches because of the soaked in sleep-inducing drugs: près de cent ans» . Caen, 1683. congestion of blood in the brain crushed poppy flowers, hen - 4. Blanchard R. Notes historiques and the presence of putrid bane, water lily, mandrake or sur la peste . Archives de parasi - vapours. Bleeding was then camphor dissolved in vinegar tologie, Paris ; 1900. beneficial, particularly at the and rose water. 2 5. Boccace. « Decameron ». First level of the nose. Bleeding was • In order to achieve the opposite Day, Introduction (1348-53). also used at the level of the of induced sleep, the induced Translated by Jean Bourciez, head, either from the temporal sneeze was also useful to spur Bordas, Paris; 1988. arteries or the cephalic vein on the animal faculty, to stimulate 6. de Nostredame M. Nostra - the most painful side. To induce it to defend itself and to expulse damus : Opuscule . First part, a nosebleed, the patient had to the vapours (miasmas) molest - chapter VIII. Bibliothèque blow his nose, scratching the ing the brain. To induce a municipale of Lyon, 1555. inside of his nostrils or pricking sneeze, a feather or a caustic 7. Avram M, Collet S, Eloy P, his nasal mucous membranes powder like hellebore, euphor - Bertrand B, Rombaux P. with a pig bristle, all while bia, pepper, mustard, or other Olfactory testing in rhinology maintaining the head in a for - similar middle for sneezing was clinic. B-ENT . 2009;Suppl. ward and downward position. introduced into the nostrils . 11:18. Sometimes, in favourable cases, Once again, it was important no the nosebleed would occur to go too far because of the risk