Perhaps somewhat of a symbol of our times, everyone’s new favourite essential accessory – the medical facemask- has very much evolved over history. Niamh Ellen will explore the evolution of this item from its beginnings until present.
In the UK, wearing a face covering will become mandatory in shops and supermarkets in England from July 24 and is already required for public transport.
As wearing this covering permeates more into our everyday lives due to COVID-19, let’s take a look at the medical mask’s evolution throughout some major medical events, starting from the middle ages.
The Black Plague
Emerging in 1347 in East and Central Asia, this bacterial plague ripped like fire through Europe, North Africa and Arabia on the backs of rats and flees transported within trade ships. With 3 plague ‘waves’, this disastrous pandemic lasted hundreds of years and killed millions.
Undoubtedly 17th century Naples was not the place to be; the bubonic plague was well underway and chances of survival you may ask? Bleak. Pesky Yersinia pestis bacteria were wreaking havoc across Europe, having almost wiped out the Naples population. Any unlucky souls presenting characteristic symptoms of feverish, necrotic skin and buboes, were in for a visit from the local Plague Doctor. Their leather-clad image is a staple in the history textbooks; soulless glass eyes, an intimidatingly long cane to prod patients from afar, and the star of the show, that long beak-like mask.
The idea behind this macabre dress (created by French physician Charles de Lorme) was to protect the half- man-half-bird individuals from ‘miasma’, or bad air. Top docs at the time believed that this polluted air rose from rotting ground matter, and poisoned those who ingested it. So, what was the best solution?
Filling the beaks with sweet smelling herbs to ward off the (now considered obsolete) threat of miasmic air. And whilst this unusual scented beak was not intended to prevent bacterial transmission, it still marked a poignant moment in medical mask history. It’s one of the first times a mask barrier was attempted to prevent disease spread, although not the most effective
The Germ Theory
Thankfully, the Black plague started to peter out after quarantine efforts, and so did use of masks. Then came the rise of the 19th century bacterial germ theory. With the help of French chemist Louis Pasteur’s work at this time, which demonstrated the existence of physical disease-causing or ‘pathogenic’ microbes, medical professionals started to (very slowly) warm to the idea of these mini bugs as culprits. Yet the miasmic air theory still floated about the medical community, remaining a believed cause of the likes of deadly cholera, malarial, tuberculosis diseases.
Approaching the 20th century in 1897 came ‘Flügge’s droplets’. Bacteriologist Carl Flügge published his experiments which confirmed tuberculosis (a bacterial infection of the lungs) to be spread via bacteria saliva droplets from coughs and sneezes. And in that same year, a science savvy surgeon Paul Berger decided that this was enough evidence to warrant wearing a face mask during his operations. Sneezing into an open wound? Never a good idea.
And so, the beginnings of the surgical mask were created, typically made of several layers of gauze tied each side to a head cap. It covered the nose, mouth and prized 19th century facial real estate (the beard).
Still, many surgeons didn’t follow suit with many rejecting the efforts of these scientists (a recurring theme in the bygone scientific community), even into the 20th century. Sparking controversy in 1906, British abdominal doctor Berkeley Moynihan published an early textbook championing use of face masks, Abdominal Operations, brutally terming the spit from ones mouth as “worse than the worst London sewage.”
The Manchurian Plague
It wasn’t until the year 1910 which brought with it the Manchurian plague in north eastern China, that face masks started to be taken seriously. This plague originated from marmot animals as their fur became prized commodity and hunting increased, even to sickly animals.
A pneumonic Yersinia pestis strain started to spread, chiefly by air droplets. It severely infected people’s lungs, and killed around 60,000. Manchuria’s situation quickly became desperate, which didn’t go unnoticed by Cambridge educated Dr Wu Lien Teh. Upon his visit, he implemented a range of useful techniques to try and prevent the spread; disinfecting homes and limiting human contact.
He ordered all health workers to wear thick gauze-cotton-cloth hybrid masks which acted like a prototype respirator, yet was made a mockery by the medical community. Many that ignored his advice died from the plague shortly after, due to Wu Lien Teh’s work the outbreak was contained.
This point in history was critical as it was the first attempt of a wide-spread epidemic containment measure, a tall medical feet for a man that reportedly stood at just 5ft 2. It paved the way personal protective equipment (PPE) and our modern-day hazmat suit.
This plague acted as a grim preliminary test almost, ultimately highlighting to the world the important role that face coverings play in reducing number of fatalities, and preventing disease spread. As a result, face masks became critical in the 1918 Spanish flu epidemic.
The modern day
In the 1930-1960s, medical masks started to be produced in materials like disposable paper and were popularised in the USA and Germany. We saw the rise of single-use non-woven synthetic fibre masks; their shape was better moulded to the face and filters could be added. Disposability of products such as syringes, needles and gloves became gold standard throughout hospitals, being viewed as the most clean and effective way to help prevent infections during surgery.
In 1972, the N95 respirator was popularised. Respirators are distinctly different from a surgical mask as they aren’t as loose fitting. Surgical masks can be used to prevent cough and sneeze contamination from person to person. Respirators have an airtight seal to prevent microbes escaping and entering, and will reduce respiratory exposure to contamination such as vapours or gases.
Today medical masks are more than ever crucial to protect us from the COVID-19 virus and save lives, which we now know can be spread via air droplets. Masks have become so widespread to the public domain it’s seen by many as the new norm. Rest assured, these protective masks won’t be going anywhere anytime soon- you can pick up yours now at the local supermarket or even your favourite clothing store.
By Niamh Ellen
Featured photo credit: Cottonbro, Pexels