If you happened to find yourself in 17th-century Naples, you were in for a rough time. The Plague of 1656 was in full swing and would claim an estimated 300,000 lives in Naples alone. If you were one of the unlucky souls to come down with the buboes and high fever symptomatic 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. (Take a second to appreciate just how stifling this outfit would be in a hot Neapolitan summer.) The doctors were armed with a wand that, along with the rest of the getup, would indicate the doctor’s profession and could be used to poke and prod patients. The whole outfit was modeled after a soldier’s suit of armor. Fitting, when you consider that far more people died of plague than combat in the 17th century.
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.
The plague doctor’s face gear marks an important moment in the history of the medical mask. The beak, developed by the French medical doctor Charles de Lorme, was among the first face coverings designed to diminish the spread of illness.
The beaked mask, alas, wasn’t too effective on that front. De Lorme developed it based upon the now-defunct theory of miasma, an idea dating back to ancient Greece.The theory held that foul smells or “bad air,” like that from rotting carcasses or food, caused disease.
During the 18th century, the plagues of yesteryear 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.
Folks 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 (and all-around Renaissance man) Alexander von Humboldt to invent a miners’ respirator in 1799.
Throughout the 19th century, doctors continued to go without masks while workers in factories were encouraged to use them to help filter particle-ridden air. In an Irish flax-spinning factory, workers were said to have worn a “crape mask.” But when the British physician and writer Benjamin Ward Richardson visited said factory, he saw not a mask in sight. In his book, On Health and Occupation, he sums up why mask-wearing didn’t exactly take off in the 19th century. “Science… is conquered by free will,” he wrote, noting that until people realize its “usefulness,” the face mask “will have to wait.” And so, the face mask waited.
In 1897, French surgeon Paul Berger became one of the first surgeons to ever wear a face mask during an operation. Berger was familiar with the work of German bacteriologist Carl Flügge, who discovered that saliva could 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. (He had a dope beard to protect.) On February 22, 1899, Berger read a paper, “On the Use of a Mask in Operating,” before the Surgical Society of Paris. The reception 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.”
It would take decades for doctors to get with the program and start wearing face masks. In a 1905 article for the Journal of the American Medical Association, physician Alice Hamilton documents the lack of masks used in surgery, even at innovative medical schools. She writes, “I was told by a student in a large medical college in Chicago that he had often noticed at the clinics of a certain surgeon that, when the light was from a certain direction, he could see, from his seat in the amphitheater, a continuous spray of saliva coming from the mouth of the surgeon while he discoursed to the class and conducted his operation.” Clearly, that surgeon missed Berger’s memo.
A year after Hamilton’s article, the British abdominal doctor Berkeley Moynihan published one of the first textbooks to advocate for face masks. In his 1906 book, Abdominal Operations, Moynihan concludes (in a stomach-flipping metaphor) that the bacterium spewed from a person’s mouth is “worse than the worst London sewage.” Unless the surgeon, assistants, and anyone else nearby were absolutely silent, they should definitely have masks on. Later in the book, he throws some considerable shade at doctors who practice without face masks, writing, “it is the custom among the unenlightened to scoff at the necessary precautions taken by those who practice aseptic surgery; the meaning of the word ‘aseptic’ is forgotten.”
It took five more years, a 20th-century plague, and a courageous doctor to start to popularize the facemask. 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 doctor 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.
At the time, the medical community ridiculed Wu for the move. A prominent French doctor working with Wu in Manchuria pointedly went against Wu’s call for mask-wearing. He died days later from the disease. It’s because of Wu 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, patents were issued various styles of masks. Most commonly, masks were made of cotton gauze and held in place with a metal frame. Moderns disposable masks grew in popularity in the 1960s, and in 1972, the N95 respirator mask was invented, 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 getup, de Lorme’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.
The medical world was much slower to adopt the innovation. For nearly 50 years, doctors fought against wearing masks, until the Manchurian plague became a lethal testing ground for the face mask’s importance. 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.