A history of the medical mask and the rise of throwaway culture

Several explanations have been advanced for this situation, from a panicking public hoarding masks to the offshoring of manufacturing and the disruption of global trade. The history of medicine suggests another factor could be considered: the progressive replacement of reusable face masks by disposable ones since the 1960s. Medicine has been transformed by consumer culture—what Life Magazine enthusiastically named “Throwaway Living” in 1955. The history of the medical mask illuminates how this vulnerability was created.

Covering the nose and mouth had been part of traditional sanitary practices against contagious diseases in early modern Europe. This protection was primarily about neutralising so-called miasma in the air through perfumes and spices held under a mask, such as the plague doctors’ bird-like masks. Such practices, however, had become marginal by the 18th century. Face masks, as they are used today in health care and in the community, can be largely traced back historically to a more recent period when a new understanding of contagion based on germ theory was applied to surgery.

In 1867, the British surgeon Joseph Lister postulated that wound disease was caused by the germs of the microscopically small living entities that Louis Pasteur had recently described. Lister suggested eliminating germs through the use of antiseptic substances. But in the 1880s, a new generation of surgeons devised the strategy of asepsis that aimed to stop germs from entering wounds in the first place. This was a risky strategy. Hands, instruments, even the operator’s exhalations were suspect now.

Johann Mikulicz, head of the surgery department of the University of Breslau (now Wroclaw, Poland) started working with the local bacteriologist Carl Flügge, who had shown experimentally that respiratory droplets carried culturable bacteria. In response to these findings, Mikulicz started to wear a face mask in 1897, which he described as “a piece of gauze tied by two strings to the cap, and sweeping across the face so as to cover the nose and mouth and beard”.

In Paris, the surgeon Paul Berger also began wearing a mask in the operating room the same year. The face mask stood for a strategy of infection control that focused on keeping all germs away, as opposed to killing them with chemicals. Such a narrowly targeted strategy was not uncontroversial. The physician Alexander Fraenkel in Berlin, for example, was sceptical about the “whole surgical costume with a bonnet, mouth mask and veil, devised under the slogan of total wound sterility”. However, masks became increasingly widespread. A study of more than 1000 photographs of surgeons in operating rooms in US and European hospitals between 1863 and 1969 indicated that by 1923 over two-thirds of them wore masks and by 1935 most of them were using masks.