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History of Face Masks

In times such as when an infectious agent that is transmitted by air causes a pandemic, common sense dictates that we must protect ourselves by all available means. Being under the global health crisis like today, one of the methods tested and approved to bring protection to our lives is through wearing a face mask.

(Source: Elements.envato.com)

Currently, there are many debates in the modern community about the effectiveness of wearing face masks in order to avoid the exposure to infectious agents like SARS-CoV-2 which causes the infection known as Covid-19 or Influenza virus that causes flu. However, no matter what the community stands for, the truth still remains - face masks have been utilized for a long time for medical and health purposes in order to prevent infections transmitted by air.

So while many people fight over on how really effective wearing a face mask during this Covid-19 Pandemic, history has already taught us that face masks have been providing the protection that we need to stop the transmission of deadly pathogens. From the Plague to Covid-19, face masks have evolved over time to do its job in keeping us safe.

With that, if you are interested in how the face mask came to be, let us run through its history.

Ancient Days

There is archaeological evidence that objects similar to face masks were utilized in the 6th century BC. There were some images and paintings in the walls of Persian tombs of Royals that also indicate the use of such objects. In those images, there are people wearing cloth over their mouths. However, their function might not be the same as what we know today as face masks, but it is one of the first few evidence that ancient people wore facial coverings that function very closely to face masks. 

In Asia, specifically in China during the Yuan Dynasty in the 13th century, a kind of scarf woven with silk and gold threads is thought to be the earliest item in the land that is indistinguishable to present day’s face mask. Also during the same era, according to historians, there are written accounts that servants who served the Emperor during meals needed to wear silk scarves to cover their mouths and noses. It was believed that servants had to wear these silk scarves in order to prevent their breath from impacting the smell and taste of the food the Emperor.

Middle Ages to Renaissance Period

In the early modern age, it is a well-documented fact that medical professionals during time wore beak-like masks in order to treat patients suffering from the bubonic plague. These medical professionals were termed as “beak-doctors” because the masks they wore were that similar to a beak of bird supposedly filled with herbs such as clove or cinnamon as well as medicinal liquids. During this time period, the beak-doctors were dressed in black cloaks and dark hats and thus, became the symbol of the deathly epidemic of the Middle Ages. People during the middle ages believed that the miasma caused the plague. They  termed it as “blight.” It was proclaimed that spoiled air from the East had caused the transmission of this miasma. With that, medical professionals wore masks this time in order to protect themselves from the blight. In present times, there are two masks displayed in German museums that are suspected to be forgeries from a younger date. These typical masks have glass openings for the eyes and a curved beak shaped like a bird's beak with straps that held the beak in front of the doctor's nose. Nevertheless, there are still some debates whether these beak-doctors were really medical professionals back in the day or were people who did not really possess the knowledge in medicine.

19th century

Joseph Lister, Louis Pasteur, and Ignaz Semmelweis were the people who in the 19th century revolutionized our understanding of microorganisms and infectious diseases. Their research into bacteriology, infection in wounds, prevention of disease, raised operative techniques to a new plane where their observations, deductions and practices changed clinical medicine and surgery throughout the world. Their discoveries in the 19th century placed the trend-setting discourse about wound infections and their prohibition and containment.

As the years go by, many more scientists used the concepts of Lister, Pasteur, and Semmelweis to develop studies that further expand the human knowledge on infectious disease. One of them is the hygienist Carl Friedrich Flügge. In 1897, he published his works on the development of droplet infections as part of his research on the genesis of tuberculosis. During this year, the respiratory system as a transmitter of germs came into focus of research and already mandated instructions to keep distance. In the same year, Flügge, Theodor Billroth, and Johannes von Mikulicz published a paper in which they highly recommended using a “mouth badge” when performing surgical operations. In this paper, they described a one-layered mask made out of gauze. At this time, Mikulicz is already well-known for he was responsible for the introduction of sterile gloves made from cloth. He noted in their paper the applicability of surgical mask for it offers protection while also allowing use to breath through it easily.

The following years, Hübner, Mikulicz’ assistant, resumed the topic of using masks, however described a two-layered mouth protection made of gauze that can prevent driblet spread that may contain infectious agents. Following this study, more research findings regarding the germ content in the operating room air emerged. Not until 1910, the use of mouth and face covers was uncommon in surgery and in hospitals in general. Nevertheless, during almost the end of the 19th century, British surgeon B.G.A. Moynihan utilized and taught the use of a multilayer face mask made of gauze when performing surgical operations.

Modern Days

The surgical mask was used first in the operating rooms of Germany and the USA in the 1920s. During this time, Martin Kirschner in his multi-volume operational theory elaborately described the need to wear a facemask in order to fight off infections. In the United States, following the First World War, more and more research addressed facemasks with varying degrees. However, even with a number of already rising evidence on the use of face masks, they were still not generally accepted as of this time. According to written accounts, interns and nurses were already wearing facemasks made of cloth or gauze but head physicians rejected them in all phases of an operation for they were considered irritating by them.

The research on the role of facemasks developed in Germany and the USA in the middle of the 1930s. However, washable and sterilizable masks with varying numbers of gauze layers only gained approval for use internationally for surgical procedures in the 1940s.

In the first decades of the 20th century, medical professionals have already agreed on the function of masks. However, many still attempted to determine the most effective and efficient type of masks. There were many patents on various designs that were put in place. Meanwhile, masks continued to be developed in medicine. During the early decades in the 20th century, masks were commonly manufactured from a number of layers of cotton gauze, sometimes with an additional layer of impervious material, held by a metal frame.

(Source: Elements.envato.com)

In the 1960s, medical masks became increasingly made out of synthetic materials for single use. During this time, non-woven synthetic materials were used in filtering masks and were greatly advertised. Compared to most traditional medical masks, these cup-shaped respirator masks were much more comfortable because they fitted snugly on the face and were designed to filter both incoming and outgoing air in order to prevent the spread of droplets like traditional masks. Furthermore, because their synthetic fabric would deteriorate during sterilisation, these filtering masks were all disposable.

In 1969, a “total disposable system” which included syringes, needles, trays, and surgical instruments, led to the substitution of reusable masks. One of the reasons for establishing this system is because there is reduction in the risk of contamination when medical materials are disposable. Another reason is to reduce labour costs, control the management of supplies, and to respond to the increased demand for disposables that aggressive marketing campaigns had created among health-care workers.

In the present 21st century, 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.

Today, with the ongoing public health crisis, disposable masks and respirators remain an essential part not only of medical personal protective equipment for health workers but also of day-to-day protective barriers for all people. With the evolution of face masks from mere facial coverings to possessing specific filtration qualities designed for health-care situations and for daily-use, face masks surely have come a long way. We know that face masks will still be developed in the future in order to provide even greater protection for users but for now, we hope that we get to see the day soon where we do not have to wear them outside our homes again.

References:

  1. Global Times. 2012. The evolution of face masks. Retrieved from: https://www.globaltimes.cn/content/1179358.shtml. Retrieved on 23 April 2021.
  2. Isaacs, D. 2021. Mask wearing: A historical, cultural and ethical perspective. J Paediatr Child Health, 57: 176-177. https://doi.org/10.1111/jpc.15162
  3. Matuschek, C., Moll, F., Fangerau, H. et al. The history and value of face masks. Eur J Med Res 25, 23 (2020). https://doi.org/10.1186/s40001-020-00423-4
  4. Strasser, Bruno J et al. 2020. A history of the medical mask and the rise of throwaway culture. The Lancet, Volume 396, Issue 10243, 19-20

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