Doctors started wearing the first surgical masks in 1897. They weren’t much more than a glorified handkerchief tied around one’s face, and they weren’t designed to filter airborne disease—that’s still not the point of surgical masks today. They were (and are) used to prevent doctors from coughing or sneezing droplets onto wounds during surgery.
This distinction between a mask and a respirator is important. It’s why healthcare professionals are upset that they’re being instructed to wear surgical masks when respirators are unavailable. Masks are not only made of different materials; they fit loosely on the face, so that particles can come in from the side. Respirators create an airtight seal so they actually filter inhalation.
The first modern respirator is born from plague—and racism
In the fall of 1910, a plague broke out across Manchuria—what we know now as Northern China—which was broken up in politically complex jurisdictions shared between China and Russia.
“It’s apocalyptic. Unbelievable. It kills 100% of those infected, no one survives. And it kills them within 24 to 48 hours of the first symptoms,” says Lynteris. “No one has come across something like this in modern times, and it is similar to the descriptions of Black Death.”
What followed was a scientific arms race, to deduce what was causing the plague and stop it. “Both Russia and China want to prove themselves worthy and scientific enough, because that would lead to a claim of sovereignty,” says Lynteris. “Whomever is scientific enough should be given control of this rich and important area.”
The Chinese Imperial Court brought in a doctor named Lien-teh Wu to head its efforts. He was born in Penang and studied medicine at Cambridge. Wu was young, and he spoke lousy Mandarin. In a plague that quickly attracted international attention and doctors from around the world, he was “completely unimportant,” according to Lynteris. But after conducting an autopsy on one of the victims, Wu determined that the plague was not spread by fleas, as many suspected, but through the air.
Expanding upon the surgery masks he’d seen in the West, Wu developed a heartier mask from gauze and cotton, which wrapped securely around one’s face and added several layers of cloth to filter inhalations. His invention was a breakthrough, but some doctors still doubted its efficacy.
“There’s a famous incident. He’s confronted by a famous old hand in the region, a French doctor [Gérald Mesny] . . . and Wu explains to the French doctor his theory that plague is pneumonic and airborne,” Lynteris says. “And the French guy humiliates him . . . and in very racist terms says, ‘What can we expect from a Chinaman?’ And to prove this point, [Mesny] goes and attends the sick in a plague hospital without wearing Wu’s mask, and he dies in two days with plague.”
Other doctors in the region quickly developed their own masks. “Some are . . . completely strange things,” Lynteris says. “Hoods with glasses, like diving masks.”
But Wu’s mask won out because in empirical testing, it protected users from bacteria. According to Lynteris, it was also a great design. It could be constructed by hand out of materials that were cheap and in ready supply. Between January and February of 1911, mask production ramped up to unknown numbers. Medical staff wore them, soldiers wore them, and some everyday people wore them, too. Not only did that help thwart the spread of the plague; the masks became a symbol of modern medical science looking an epidemic right in the eye.