Let’s talk about face masks.
Health officials continue to advise wearing face masks to prevent people from getting COVID-19 and spreading it to others. But many have chosen NOT to wear masks for a variety of reasons, including people not realizing — or not caring — that they might get infected and be fine, but they could spread the virus to somebody else who could die.
I finally entered the 21st century. I didn’t get the latest smartphone, AirPods, or an electric vehicle, nor did I join the Noom diet. I got a homemade mask to wear in public during the COVID-19 pandemic. Last year, no one would have ever imagined that face masks would be one of the top-selling items in the world. Now that the majority of the world is wearing masks, a thought came across my mind. Where did masks come from in the first place?
The first mask may have been in the form of branches, mud, and leaves strategically placed on the face to provide camouflage during a hunt or skirmish. Or, it may have been in the form of red or yellow ocher, or another pigment, used to highlight (or hide) facial attributes in order to enhance beauty. Are people wearing “masks” when they put on makeup; I would argue the answer is yes. The idea for the first mask may have even come during an early game of peekaboo, in which a parent or other adult surprises a child into laughter by hiding behind a tree or a pair of hands.
Distinctive styles of masks have evolved through time. The pre-Hispanic Americans in 1200BC were noted for facial masks and in the Andes, masks were used to dress the faces of the dead. These were originally made of fabric, but later burial masks were sometimes made of beaten copper or gold and other materials.
If you happened to find yourself in 17th-century Naples, you would be able to associate with what we are feeling right now. The Plague of 1656 was in full swing and would claim an estimated 300,000 lives in Naples alone. As we know, globally we are far ahead in # of casualties and those infected. If you were one of the unlucky humans to come down with symptoms of the disease, a visit from the plague doctor may have been in your future.
The plague doctors’ uniform didn’t exactly inspire a sense of calm. They wore a head-to-toe leather overcoat paired with leather gloves, breeches, boots, and a wide-brimmed hat. The whole outfit was modeled after a soldier’s suit of armor. Reminds me of a “Bird Man.” The doctor during this time played several roles. In addition to caring for patients with the disease, the physician was responsible for burying the dead, administering last rights, documenting last wishes, hearing last wills, and tabulating census records for public logbooks. In effect, the plague doctor served as a nurse, an undertaker, a registrar or county clerk, and a spiritual minister. The plague doctor’s uniform — the personal protective equipment (PPE) of the day — is now iconic.
By far the most harrowing part of the costume was the long-beaked mask. The mask had thick glass spectacles and two small holes in the beak. The beak was stuffed with straw and aromatic herbs, such as mint, myrrh, rose petals, cloves, and camphor, among others. It’s even possible that the cumbersome beak helped to create a small amount of “social distancing.” Imagine having to wear this mask! Given that Charles de l’ Orme, the inventor of this mask, lived into his 90s (a remarkable old age for the time) he may have been on to something. He certainly is identified as being the first to promote face coverings designed to diminish the spread of illness. De l ‘Orme developed it based upon the theory of miasma, an idea dating back to ancient Greece. The theory held that foul smells caused disease.
During the 18th century, the plagues of the past faded away, as did the use of masks. In the early 1700s, the occasional beak might still adorn a doctor inspecting quarantined ships, but for the most part, doctors went mask-less.
Humans in the 18th century (and even as far back as Pliny the Elder and Leonardo da Vinci) understood that inhaling certain airborne particles and dust could be harmful. This eventually led Prussian mining official Alexander von Humboldt to invent a miners’ respirator in 1799.
Throughout the 19th century, doctors continued to go without masks while workers in factories used them to help filter particle-ridden air. British physician and writer Benjamin Ward Richardson once said, “Science… is conquered by free will,” noting that until people realize its “usefulness,” the face mask “will have to wait.” And so, the face mask waited. Sounds familiar?
In 1897, French surgeon Paul Berger became one of the first surgeons to ever wear a face mask during an operation. Berger was super interested in the work of German bacteriologist Carl Flügge; who discovered that saliva can contain disease-causing bacteria. Berger, being a smart guy, figured that spitting into a patient’s open abdomen during surgery probably wasn’t a great idea. Berger’s mask tied above his nose and was made from six layers of gauze, and its lower edge was sewn to the top of his sterilized linen apron. Maybe he was more concerned about protecting the beard he was wearing, but he certainly pushed a paper “On the Use of a Mask in Operating,” before the Surgical Society of Paris. The reception as in today’s world, wasn’t exactly warm. In the discussion following Berger’s lecture, a Monsieur Terrier scoffed at the proposal saying, “I have never worn a mask, and quite certainly I never shall do so.”
At least Berger made a dent into the social conversation; but in order for the narrative to move forward, it took five more years, a 20th-century plague, and another courageous doctor to start to popularize the facemask movement. After claiming its first life in the fall of 1910, the Manchurian plague’s death toll would rise to 60,000 in the following four months. 31-year-old, Cambridge educated Dr. Wu Lien Teh arrived at the epicenter of the outbreak in the northeastern Chinese city of Harbin. Wu required ALL doctors, nurses, and even burial staff to wear face masks. Pandemics come and ago, but in Dr. Teh’s view, face masks were eternal.
At the time, the medical community ridiculed Dr. Teh for the move. It’s because of Dr. Teh that face masks became so important during the 1918 Spanish flu epidemic. Police forces, medical workers, and even residents in some U.S. cities were ALL required to wear face masks.
While doctors generally agreed upon masks’ usefulness, there was still a lot of experimentation with design. Throughout the early decades of the 20th century, a variety of styles of masks were created. Most commonly, masks were made of cotton gauze and held in place with a metal frame. The modern disposable masks grew in popularity in the 1960s, and in 1972, the N95 respirator mask arrived, becoming a healthcare standard in epidemics in 1995.
The history of masks is in many ways a history of epidemiology. While the plague doctors of the 17th century certainly had a scary outfit, de l’Orme’s miasma-inspired leather overcoat and bird mask didn’t prevent anyone from contracting the plague. The transition from miasma to germ theory was a slow one, but already in the 1800s there was an understanding of the usefulness of face masks in factories.
It’s a testament to the need not only for innovations like the face mask but for changing public opinion. If the face mask had been adopted more quickly, countless lives could have been saved.
With several outbreaks of infectious diseases and flu, and the rise of smog from modern industry, the materials in masks have continued to evolve to better filter viruses and pollution. In addition to the SARS epidemic in 2003, the last large-scale use of masks in China was due to smog in 2012. That year, the term “PM2.5” began to enter public awareness, and mask models such as N95 and KN90, which can filter out this fine particulate matter, became highly popular.
The 3M mask is short for Minnesota Mining and Manufacturing Co., the company which has produced these masks since 1967. Interestingly, the idea of 3M came from women’s disposable bras. An employee proposed the inspiration that a disposable mask could protect workers’ noses and lungs in harsh operating environments such as mining and smelting.
More research is needed, including defining exactly what is a safe physical distance, both indoors and outdoors as we experience our own pandemic. As we continue to learn from the past and apply new innovative approaches, it’s important to apply preventive measures and wear face masks when physical distancing is not possible. In time, more effective, comfortable and reusable masks will become available. We should not be frightened by the possibility of airborne spread of coronavirus; we should do something about it. This starts with wearing a mask and setting a standard.