By Natalie Taylor

 

A 17th century plague doctor did not exactly inspire a sense of calm. He would appear in a head-to-toe leather overcoat, leather gloves, a wide-brimmed hat, gripping a wand to poke and prod the patient. The most terrifying part of the costume was the long-beaked mask and thick glass spectacles. The beak had two small holes and was stuffed with straw and aromatic herbs, such as mint, camphor, cinnamon and myrrh. The getup was based on a misguided idea that illness was carried by “miasma”—foul-smelling “bad air.” 

 

The medical use of masks faded away with the plague, and for centuries doctors went maskless. Folks did begin to warm up to the idea that inhaling certain airborne flecks and dust could be harmful, and a miner’s mask was created in 1799. During the 19th century, factory workers began to wear masks to avoid inhaling dust and other particles in the air.

 

The transition from miasma to germ theory was a slow one, and doctors continued to go without masks. In 1897, surgeon Paul Berger, believing that saliva could contain disease-causing bacteria, figured that spitting into a patient’s open abdomen during surgery was not a good idea. He began advocating the use of masks, but few doctors agreed with him. One of them stated bluntly: “I have never worn a mask, and quite certainly I never shall do so.” And in 1905, Dr. Alice Hamilton wrote about watching surgery in an operating theater where “when the light was from a certain direction…(one) could see…a continuous spray of saliva coming from the mouth of the surgeon….” 

 

It was not until the 20th century that facemasks became part of medical gear. In the fall of 1910, the Manchurian plague broke out and Cambridge-educated doctor Wu Lien Teh arrived at the epicenter of the outbreak in northeast China. Wu required all doctors, nurses, and even burial staff to wear face masks. At the time, the medical community ridiculed Wu. But eight years later, when the Spanish flu of 1918 turned into a pandemic, face masks became ubiquitous. Police, medical workers, and even residents in some U.S. cities were all required to wear face masks.

 

As medical knowledge of the germ theory of disease became firmly established, masks became commonplace in medical settings. Throughout the 20th century various types of masks were developed. Most commonly, they were made of cotton gauze and held in place with a metal frame. In the 1960s disposable masks gained popularity, and in 1972, the N95 respirator mask was invented and became a healthcare standard in 1995.

 

The history of masks is closely tied to scientific discoveries and the history of epidemiology. It is a testament to the need not only for innovations but for changing public opinion. We can certainly see this today with the COVID-19 pandemic, where in some parts of the world the use of masks has moved beyond scientific evidence to the realm of politics.

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