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  • Alex Cloherty

Masks through the ages

A few days ago, I came across a picture of a plague doctor. You've probably seen pictures of the almost sci-fi-esque protective gear that 17th century European physicians wore to protect themselves from contracting the bubonic plague from their patients. They sported the bizarre combination of miniscule spectacles, a long coat covered in wax, a broad-brimmed hat, leather gloves, and, the most characteristic of all, a beak-shaped mask. This get-up was emblematic of the time, just as bell bottoms were of the 60s.

After a day of giving dirty looks and emitting audible grumbles at people who came too close to me in the supermarket or on the streets, I took one look at the beaked mask with my newfound 2020 vision (haha) and exclaimed to my partner, "Look! They even knew how to socially distance! We have learned nothing!"

I was partially right. In the middle ages, the beaked mask did indeed force its wearers to keep some distance from their plague-ridden patients. However, this detail did not stem from any molecular understanding of disease transmission, as do today's distance guidelines.

Well into the 1800s, the dominant theory of disease was "Miasma Theory", which held that infectious diseases like the plague, cholera, tuberculosis, and malaria (which literally translates to "bad air" from old Italian) were transmitted by a poisonous air. The idea behind the beaked masks was to purify this poisonous air - primarily by means of infusing the air inhaled by the mask's wearer with scented herbs that were enclosed at the point of the beak. In the end, wearing these plague masks may have helped a little, by encouraging uninfected mask-wearers to keep distance from infected patients. However, the beaked masks did have holes in them to let air in, the masks were only worn by physicians and not by the general public, and there were a host of other hygiene problems at the time that contributed to massive plague transmission. Altogether, any positive effect of mask-wearing during the plagues was probably minimal if any.

The bubonic plague outbreaks were by no means the last time people have donned masks to protect themselves from infectious disease. Before 2020, most people didn't even realize that the world experienced a deadly influenza pandemic in 1918 - it was totally overshadowed by the World Wars, although it likely claimed even more lives than the Great War. Masks were mandated in 1918 to try to stop the spread of the deadly flu, and in regards to masks, the instructions for their wear were remarkably similar to today: "Take a piece of gauze the size of a sheet of typewriter paper. Fold it twice, so that it will fit an envelope. Then attach strings to the four corners and tie these strings at the back of the neck. The mask covers the nose and mouth, so that the wearer breathes through four thicknesses of gauze. A clean handkerchief is just as good as the gauze.”

When I searched "Masks influenza 1918" earlier today, one of the first articles that came up was entitled, "Everyone wore masks during the 1918 flu pandemic. They were useless." Upon reading the article, though, it becomes clear that the root the efficacy problem with masks is much the same as that with birth control pills: user error.

But, halfway through this same article that claimed that masks were useless in 1918, the author brings in descriptions of people removing masks periodically to spit tobacco, cutting holes in their masks to smoke, or removing masks because they "prevented free breathing". Indeed, a 2007 analysis of interventions adopted across cities in the United States of America during the 1918 flu pandemic indicates that interventions like mask wearing, lockdowns, and quarantines did probably help - but as this University of Berkeley blog puts it, the main problem was probably that "Some Americans, then as now, do not like being told what to do. They especially do not like being instructed by experts."

And now, we come to the present. Since the 1700s, we have adopted the germ theory of disease, which has given us great advances in medicine and epidemiology. Even since 1918, our cumulative knowledge and understanding of infectious disease has grown exponentially. However, we are running into the same problems. Perhaps it partially comes down to human nature, to underestimate risks that are perceived as distant or unlikely to have immediate impact - the very same problem we are running into with climate change. Or perhaps scientists are partly to be blamed - encased in our ivory towers, our academic writing has become overly complex and needlessly opaque, leading to reduced understanding and increased suspicion of the very experts the world needs to be listening to to safeguard our futures. It's hard to say. I'll be continuing to try to do my bit by posting on Microbial Mondays, and answering questions that you send in. But, one thing is fairly for certain about these times. As those beaky masks were emblematic of the bubonic plagues of past centuries, N95s and home-made fabric masks will likely remain the symbols of 2020.

Happy new year to you all, and until next time - remember this:


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Jan 05, 2021

Wonderful piece here Alex, thanks!

"Some Americans, then as now, do not like being told what to do.They especially do not like being instructed by experts."

This sentiment - clearly quite prevalent at present - chokes me up ... I wouldn't attempt to do my own surgery, I wouldn't fly in a plane built by a plumber, and I wouldn't seek legal advice from an entomologist ... so, why - why - do people distrust (authentic) expertise?! We're a puzzling species and we've paid a price for this behaviour in the past, and, evidently, are continuing to do so.

Cheers, michael

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