Medical masks - an age-old history
By Kelly MacNamara
Just like quarantine and confinement, masks were around long before Covid-19. This AFP story tells the ancient history of these age-old protections against infectious diseases.
PARIS, May 14, 2020 (AFP) - A mysterious and deadly disease rips through the population causing a fearful public to adopt hastily-made masks as experts debate how best to slow the spread of infection.
A scene this week from cities in Europe and the United States tiptoeing out of lockdown?
Not quite. It was more than a century ago during the Manchurian plague when masks were taking their place as the most visible tool of epidemic control. Then as now, geopolitics and distrust of science threatened to derail the public health response.
But it was not until the mid-1800s that scientists identified microbes and developed "germ theories" to explain the mechanics of infection.
Masks were already becoming common in operating theatres by the 1890s, when a plague emerged in Hong Kong
and spread across the globe.
The pathogen arrived in Manchuria in 1910 -- where Russia, Japan and Imperial China were jostling for control -- sparking fears it could hitch a ride on newly-built rail lines to Beijing, or even as far as Europe.
It was a terrifying pestilence with a fatality rate nearing 100 percent.
"It killed everyone it infected, and it killed them within 24 to 48 hours from the first symptoms," said Christos Lynteris, a medical anthropologist at St Andrews University in Scotland. "That was apocalyptic."
'Plague fighter' : Among the specialists sent to lead the response was a young doctor named Wu Lien Teh.
Born in Malaysia and educated at Cambridge, Wu struggled to be taken seriously as he attempted to convince colleagues the plague was not only transmitted by fleas on rats, like bubonic plague, but also that it was spreading from one human being to another.
It meant people would need masks to block the infection. In his autobiography "Plague Fighter", Wu bemoaned public fatalism.
"It needed something startlingly tragic to jolt these people out of their lethargy," he said.
That came with the death of prominent French doctor Gerald Mesny.
According to Wu's version of events, Mesny dismissed the younger doctor as a "Chinaman" and refused to believe his theory that the plague was pneumonic.
Mesny then visited a hospital without covering his face and died within days.
Suddenly, masks were in high demand.
"Almost everyone in the street was seen to wear one form of mask or another," Wu wrote.
Images of the Manchurian plague show medical staff swathed in thick bandages covering their entire heads. Hooded sanitary workers had cloths wrapped tightly around their mouths and noses as they transported bodies to pits hacked out of the ice-stiffened earth for cremation.
Wu "tried to develop how the strings would work so that you could carry a corpse and the mask would still be on your face," said Lynteris, describing the push to systematically expand face protection to at-risk workers and members of the public as "completely unprecedented".
The nascent use of photography in world newspapers also drew attention to the masks, helping to "define the way we imagine epidemics", he said.
Fatal 'miasmas' : For hundreds of years -- long before the concept of germs -- people have covered their faces to try to ward off disease.
During the bubonic plague in the Middle Ages, some European doctors wore beak-like masks to protect against "miasma", imagined as air pollution linked to rotting matter and bad smells.
"It was thought that dangerous atoms would not adhere to leather trousers and gowns made of waxed fabric," said Yale historian Frank Snowden, in his book "Epidemics and Society: From the Black Death to the Present".
"A wide-brimmed hat could defend the head, and a mask with a protruding beak extending from the nose could carry aromatic herbs that would protect the wearer from the fatal miasmatic smells."
Miasma theories continued to dominate until the 1800s.
It was not until the latter half of the 19th century that germ theories -- developed by France's Louis Pasteur, Germany's Robert Koch and others -- began to revolutionise the understanding of infection.
During the SARS epidemic in 2003 masks became everyday items in affected places like Hong Kong.
Masks were also used widely in the United States in the 1918 flu pandemic, which killed tens of millions of people, but Lynteris said societies in the West have a "very weak memory" of that crisis.
"So the mask being introduced now in Europe, or the Americas, that's a completely new experience," he said.