The Face Mask – A Life-Saving Device Pioneered by Dr. Wu Lien-teh

Dr. Mesny went on to attend the sick in one of these hospitals, without wearing the mask that Dr. Wu had recommended.  As a result, Dr. Mesny contracted the disease and died.

Left: White cotton rectangular surgical mask with inverted pleat in center to allow for expansion over the nose, circa 1930-60, courtesy of the Museum of Health Care (Link) Right: Adult Unisex Face Mask (3-pack) from the GAP, circa 2020.

It is now mandatory in several cities across Ontario, including Kingston and Toronto, for citizens to wear non-medical face masks/coverings in all indoor public settings.  The face mask has become a regular staple of life across the world during the COVID-19 pandemic.  Healthcare workers don their N-95 respirators, while other citizens pull on surgical style face coverings, sometimes printed with paisley patterns, sports team logos, and superhero insignia.

The history of the masks that we wear have their roots in a few different areas, including both from the medical community, as well as from the Personal Protective Equipment of firefighters and soldiers in the late 19th and early 20th century.  The first surgical mask came in 1899 when Carl Flügge (1847-1923) was working on tuberculosis research when he developed his droplet theory of infection.  This theory proved that microorganisms can be expelled as droplets from the respiratory tract and reach another person. Flügge, his pupils, and successors conducted further experiments to determine that droplets are especially expelled during activities of talking, coughing, blowing, and sneezing.[1]

Portrait of Dr. Wu Lien-teh, circa 1910-1915. (Courtesy of the Library of Congress PPOC.)

However, the reason we know to wear a mask during the pandemic is because of the work of Dr. Wu Lien-teh (1879-1960) in 1910 during the Manchurian Plague. Dr. Wu Lien quickly deduced that this disease was a pneumonic plague because of how quickly it was spreading through the population. Based upon this theory, he recommended that people wear a mask that covered the mouth and nose.  But he was disregarded and discredited by almost all doctors because of his young age and race.

Across the communities impacted by the outbreak,medical officers went on treating patients, without wearing masks. One respected French doctor, Gérald Mesny (years), was among the medical professionals who did not believe in the need for the masks and he openly criticized Dr. Wu and humiliated him in a very racist manner.  Dr. Mesny went on to attend the sick in one of these plague hospitals, without wearing the mask that Dr. Wu had recommended.  As a result, Dr. Mesny contracted the disease and died.[2]  Dr. Mesny’s death shocked the medical community and as a result, support for the face mask quickly increased.  After 7 months of vigilant quarantine treatment, and mask wearing, the plague was under control.[3]

Doctors wearing gauze masks designed by Dr. Wu Lien-teh during the Manchurian Plague. (“Wearing anti plague masks, front and side views”, circa 1910-11, Courtesy of the University of Hong Kong Libraries.)

By the time the 1918 Influenza epidemic came erupted, people remembered Dr. Wu’s work from the Manchurian plague.  While mask wearing was not universal, it was implemented with the intent to help slow the spread. However, the 1918 Influenza was much more aggressive than the 1911 disease.  Additionally, masks and other preventative protocols were not properly implemented in the 1918 Influenza.  For example, people wore masks in public, but not in workplaces or when socializing.[4]  This was too little and too late; approximately 500 million people (1/3 of the total world population) became infected and 50 million people died.[5]  

Since the reusable face masks of 1918, the technology has continued to evolve. In the mid 1900s the medical field began to transition to the disposable system, in which the reusable masks and other products were put aside in favour of items that would be thrown away after one use.  This total disposable system was partially an attempt to improve hospital sterility – an idea long ago instigated by Joseph Lister – and also an attempt to save labour costs.[6]  The 1930s, the early version of the disposable face mask was made of paper; by the 1960s, the surgical face masks were composed of non-woven, synthetic fibres.[7]  The surgical face mask has seen few adaptations since the late 20th century and remains intended for healthcare professionals to use during procedures to prevent the spread of bacteria from the wearer to the patient.

The surgical style masks are notably different than some other masks used by healthcare professionals.  The surgical face mask is not designed to protect against airborne bacteria and viruses with smaller particles, such as tuberculosis or COVID-19. Instead, these kinds of infectious diseases require a more complex form of face mask that, unlike the surgical mask, is used to protect the wearer from incurring infection from others.  These respirator style masks originate in the early 1900s, as a means to protect against the chlorine gas that the German Army used on the Western Front during World War I.  After the initial attacks in April 1915, Canadian physician Cluny Macpherson designed a respirator after witnessing a German soldier don a canvas bag over his head when gas was released on the Allies.  The War Office in Britain responded quickly by sending out instructions to the public for how to make Macpherson’s respirator out of cotton wool and three layers of bleached cotton gauze.[8]

Left: Macpherson Respirator, circa 1915. (Courtesy of the Museum of Health Care) (Link) Right: University Armories, Officers Training, gas mask drill. (Courtesy of City of Toronto Archives, Globe and Mail Fonds, Fonds 1266, Item 69233.)

As gas masks evolved, they remained very cumbersome due to their heavy, fibreglass filters.  Mask wearers wanted something that would be more comfortable and less burdensome to wear for extended periods of time.  In response, the multinational corporation 3M produced a specialized PPE in 1972.  This single use respirator, called the N95 mask, used similar technologies to fibreglass to produce a mask  composed of lightweight synthetic materials to capture microscopic particles.[9]  The N95 masks were used primarily for industrial applications – such as natural disaster cleanup, mould removal, and in factories – before being modified to assist medical professionals in the 1990s.[10]  In the current era, the Centre for Disease Control (CDC) recommends that healthcare workers wear the N95 mask when in contact with patients with infections that are transmitted from inhaling airborne droplets, like tuberculosis, SARS, and COVID-19.[11]

If you would like to hear more about face masks and the work of Dr. Wu Lien-Teh, I encourage you to check out the podcast 99% Invisible, Episode 399 “Masking for a Friend”


About the Authour

Jessica Lanziner

(Margaret Angus Research Fellow, 2020)

Jessica Lanziner is currently in the Master of Museum Studies program at the University of Toronto and an alumna from Queen’s University, holding a Bachelor of Fine Art and Art History. With previous positions like work at the Uxbridge Historical Centre, Jessica has had the opportunity to work with collections of dental materials from a local early 20th century dental offices, igniting her interest in the history of healthcare in Canada.  


Citations

[1] Ronald Hare. “The Transmission of Respiratory Diseases” Royal Society of Medicine, Vol. 57, no. 3 (March 1964): 222.

[2] Lee, Kam Hing, Danny Tze-ken Wong, Tak Ming Ho, and Ng Kwan Hoong. “Dr. Wu Lien-teh: Modernizing post-1911 China’s public health service”, Singapore medical journal. Vol. 55, no. 2 (2014): 99-102. https://doi.org/10.11622/smedj.2014025.

[3] Zhongliang Ma and Yanli Li. “Dr. Wu Lien Teh, plague fighter and father of the Chinese public health system”, Protein Cell. Vol. 7, no. 3 (2016): 157-158. https://doi.org/10.1007/s13238-015-0238-1.

[4] Kellogg, Wilfred. “The Wearing of Gauze Masks” in Influenza, a study of measures adopted for the control of the epidemic, 12. Sacremento: California State Printing Office, 1919.

[5] Centre for Disease Control. “1918 Pandemic (H1N1 Virus)” Pandemic Influenza, Past Pandemics. Last Modified March 20 2019. https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html. 

[6] Strasser, Bruno and Thomas Schlich. “A History of the Medical Mask and the Rise of Throwaway Culture”, The Lancet, (May 22 2020). https://doi.org/10.1016/S0140-6736(20)31207-1.

[7] Strasser, Bruno and Thomas Schlich. “A History of the Medical Mask and the Rise of Throwaway Culture”, The Lancet, (May 22 2020).

[8] Grayzel, Susan. “Defense Against the Indefensible: The Gas Mask, the State, and British Culture during and after the First World War”, Twentieth Century British History. Vol. 25, no. 3 (2014): 418-434. doi:10.1093/tcbh/hwu035.

[9] Government of Canada. “Respiratory Protections Against Airborne Infectious Agents for Healthcare Workers”, OSH Answers Fact Sheets, Canadian Centre for Occupational Health and Safety. Last updated June 8 2020. Accessed June 8 2020.

[10] Wilson, Mark. “The Untold Origin of the N95 Mask” COVID-19, Fast Company. Last modified March 24 2020. Accessed June 8 2020. https://www.fastcompany.com/90479846/the-untold-origin-story-of-the-n95-mask.

[11] Government of Canada. “Respiratory Protections Against Airborne Infectious Agents for Healthcare Workers”, OSH Answers Fact Sheets, Canadian Centre for Occupational Health and Safety. Last updated June 8 2020. Accessed June 8 2020.


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