Masked History

As we enter into the 4th week of Illinois’ Shelter-in-Place order, request from medical personnel for cloth mask are becoming more and more frequent. Their hope is that by wearing the masks over their N95 respirators they will be able to extend the life of the respirator by keeping it clean; allowing them to stretch the already limited supply of PPE (Personal Protective Equipment). Along with the CDC suggestion to the public to wear cloth mask when they leave their homes, and businesses requiring customers to cover their nose and mouths before entering stores, masks have never been so prevalent in Western society as they are now. 

The earliest known use of a mask for health reasons dates back to 1720 during the bubonic plague. It was believed the disease was spread by a miasma that leaked from the ground and corrupted the air. It was common for grave diggers to be seen with stripes of cloth wrapped around their faces for protection from the sickness. Charles de l’Orme, a physician to the King of France, took this idea a step further, developing the plague mask. It was a full hood that covered the wearer’s head with an elongated nose, similar to a bird’s beak, that could be filled with incense to protect the doctor from the air and the disease. Even after the discovery of bacteria in 1870’s, and the belief in miasma falling out of favor, the design of masks did not change much.   

In 1897 the first surgical masks used by physicians were strikingly similar to the stripes of fabric grave diggers had used during the plague. They were considered by many to be glorified handkerchiefs and they were not designed to protect the wearer, but to prevent the wearer from coughing or sneezing large droplets onto their patients. One medical student from Chicago reported that when a mask was not in use by the surgeon, he was often able to see a continuous spray of saliva coming from the surgeon's mouth from his seat in the amphitheater. The surgical mask used in hospitals today are modeled off these first masks.

The first filtering mask was invented in 1910, when a case of pneumonic plague broke out in Manchuria, what is now Northern China. A doctor named Lien-teh Wu autopsied a victim and discovered the disease was not spread through fleas as originally thought but through the air. Working off the medical face masks already in use in the west, he designed a mask from layers of gauze and cotton that wrapped completely around the face and filtered the wearers inhalations. His design was eventually adopted, as it filtered pathogens and was easy and cheap to construct with materials immediately on hand. By the 1918 Spanish flu, Wu’s mask was well known and companies around the world started manufacturing similar designs to abate the flu’s spread. Wu’s mask is the precursor to today’s N95 mask.

During World War I and II, masks covered the soldiers entire face preventing them from breathing in the poisonous gas released on the battle field. Similar masks, using fiberglass for filtration, were developed for the mining industry to prevent workers from breathing in coal dust and developing black lung. While these masks saved lives, they were difficult to breathe through and uncomfortable to wear. By the 1950’s construction workers were pushing for gear that would protect them while being less cumbersome than the full head masks currently in use. 

At the same time a décor editor for House Beautiful, Sara Little Turnbull, realized the potential of a new technology developed by 3M that imbedded tiny particles of plastic into fabric. She tested several different uses for the technology but spending a lot of time visiting sick family members in the hospital she came up with the idea to create a ‘bubble’ surgical mask based on the design of a bra cup. When it was discovered the mask could not filter pathogens it was rebranded as a dust mask. In the 1970s the Bureau of Mines and the National Institute for Occupational Safety and Health worked to create the first criteria for single use respirators. By the 1980s the company had created a filter that would trap dust or viruses while allowing the wearer to breath easily. They even added a slight electrostatic charge that would trap the very small particles making it a more efficient filter.

The N95 masks created by 3M were primarily used in industrial construction, until it was brought back into the medical field during the 1990s with the rise of drug resistant Tuberculosis. The N95 specifications were updated to be used in a medical setting and doctors began to wear them while treating patients. Despite their usefulness, respirators such as the N95 are rarely used in hospitals when surgical mask provides adequate protection. It is only during events like the 1990s Tuberculosis outbreak and today’s Covid-19 pandemic, when hospitals across the world rely on the N95 mask for their protection and ours.