Medical Mask History and The Rise of Throwaway Culture
The shortage of masks during the COVID-19 pandemic has become a symbol of the fragility of modern medicine and public health. Several explanations have been proposed for this situation, from the panic of public hoarding to the offshore outsourcing of manufacturing and the disruption of global trade. Medical history shows that another factor can be considered: since the 1960s, disposable masks have gradually replaced reusable masks. Medicine has changed from a consumer culture-in 1955, “Life” magazine enthusiastically named it “Throwaway Living”. The history of medical masks illustrates how this loophole was created written by Dr. Hasnat Alamgir.
Covering the nose and mouth has become part of the traditional hygiene measures against infectious diseases in early modern Europe. This kind of protection is mainly to eliminate the so-called mi gas in the air through perfumes and spices (such as the plague doctor’s bird mask) that are covered under the mask. However, by the 18th century, this approach was trivial. Nowadays, the history of masks used in healthcare and communities can be traced back to modern times, when people had a new understanding of infectious diseases based on the theory of bacteria and applied them to surgical operations.
In 1867, the British surgeon Joseph Lister speculated that the wound disease was caused by the tiny, tiny living entities recently described by Louis Pasteur. Lister recommends using preservatives to eliminate bacteria. But in the 1880s, a new generation of surgeons invented aseptic surgical strategies designed to prevent bacteria from entering the wound in the first place. This is a risky strategy. No doubt the hand, the instrument, and even the operator’s exhalation. John Mikulich, head of the Department of Surgery at Breslau University (now Wroclaw, Poland), began to collaborate with the local bacteriologist Carl Flügge. He proved through experiments that respiratory droplets carried Cultivated bacteria. In response to these findings, Mikulitz began to wear a mask in 1897. He described the mask as “a piece of gauze tied to a hat with two ropes and swept across the face to cover the nose, mouth, and beard”. In the same year, in Paris, surgeon Paul Berger also began to wear masks in the operating room. Face masks represent a strategy to control infections. The focus of this strategy is to keep all bacteria away rather than killing them with chemicals. This narrowly targeted strategy is not without controversy. For example, Dr. Alexander Fraenkel of Berlin expressed doubts that “the overall surgical gown with full cover, mask, and veil is based on the slogan that the wound is completely sterile”. However, masks are becoming more and more common. A study of more than 1,000 photos of surgeons in operating rooms in American and European hospitals between 1863 and 1969 showed that by 1923, more than two-thirds of people were wearing masks, and by 1935, most people were wearing masks. Wearing a mask.
During the Manchurian plague of 1910-11 and the influenza pandemic of 1918-19, masks were mainly used to cover the mouth and nose (and beard), making masks a means to protect medical staff and patients from infection outside the operating room. During the 1918-19 influenza pandemic, police, medical personnel and even residents of certain cities in the United States must wear masks, although their use often caused controversy. However, in cities like San Francisco, the decline in flu deaths is partly due to the mandatory policy of wearing masks. At this point, the principle of wearing masks goes beyond the original purpose of the operating room: they now also protect the wearer from infection.
At the same time, masks continue to develop medicine. Although medical scientists reached a consensus on the general functions of masks, in the first few decades of the 20th century, they tried to determine the most effective type of masks and obtained various design patents. Masks are usually made of several layers of cotton gauze, sometimes with a layer of impermeable material, which is fixed by a metal frame. As Mikulicz and Flügge suggested in the operating room, their main purpose is to prevent the spread of respiratory droplets from the wearer. As an American inventor explained, most masks are washable and the metal parts can be sterilized, so “masks can be used for a long time”. He obtained a patent for medical masks in 1919.
Medical researchers tested the filtration efficiency of reusable masks and compared it with an experiment that involved the cultivation of bacteria spread in the laboratory by atomization of the mask or by infectious volunteers wearing the mask, And observational research in a clinical setting. They found that the degree to which masks filter bacteria varies greatly. However, if used properly, some masks are believed to prevent infection.
Medical masks began to be replaced by disposable paper masks in the 1930s, and in the 1960s they were increasingly made of synthetic materials for single use. By the early 1960s, advertisements for new filter masks made of non-woven synthetic fibers were published in nursing and surgical journals. These filter masks are disposable. The advertisement emphasizes its performance, comfort, and convenience. Unlike most traditional medical masks, these cup-shaped respirator masks fit tightly on the face and are designed to filter not only the air that enters, but also prevent the spread of droplets, just like traditional masks. These masks can only be used once because their synthetic fibers will deteriorate during the sterilization process.
Replacing reusable masks is part of a broader shift in-hospital care, which hospital administrators called the “disposable total system” in 1969, which includes syringes, needles, trays, and surgical instruments. To some extent, disposability is believed to reduce the risk of harming infertility. However, another reason for the switch to disposable masks is to reduce labor costs, promote material management, and respond to the increasing demand for disposable products caused by active marketing activities among health care workers. Disposable items are very convenient, which is a clear advantage for anyone “who has seen staff take apart the tape and reassemble the autoclaved linen mask”, as British medical researchers said in 1980 Like that.
Industry-sponsored research found that the new synthetic masks are superior to traditional reusable cotton masks. However, in comparative studies, reusable masks are more often omitted. In 1975, in one of the latest studies including industrially produced cotton masks, the author concluded that reusable masks made of four layers of cotton muslin are superior to popular disposable paper masks and new artificial respirators. He pointed out that “the effect of incorporating cotton fabric into a good mask design may be as good as synthetic fabrics.” Some studies have shown that cleaning reusable masks may tighten their fibers, thereby increasing their bacterial filtration efficiency. In the absence of commercial cotton masks, recent studies have only compared handmade or homemade masks with industrially produced disposable masks and found that the latter is better. These results strengthen the idea that reusable masks are potentially unsafe to a certain extent, and partly hinder further research on well-designed and industrially manufactured reusable masks.
During the COVID-19 pandemic, health authorities in some countries have advised citizens to wear masks in public under certain circumstances. In this case, many grassroots initiatives have emerged, which is a typical feature of our participation era to help people sew cloth masks for personal use at home, and provide medical services to nearby hospitals in certain communities. These simple masks usually ignore some design elements, which are crucial to the efficiency of early cotton masks. However, at least in some places, the public’s response has been enthusiastic, at least judging by the number of people watching the instructional video. The local production of reusable masks used in the community provides the last solution for some people and provides comfort for many, but it has made little contribution to solving the global shortage of personal protective equipment. For medical staff and hospitals, even if it is not for repeated use, in some cases, they are still trying to disinfect disposable masks. This method is a far cry from the carefully designed, manufactured, and tested reusable masks until the 1970s.
Reusable masks were once an important part of the medical arsenal. However, with the transition to disposable masks in the 1960s, industrial production and further research on reusable masks were stopped. In the future, disposable masks and respirators will certainly continue to be an important part of medical personal protective equipment, because some of them have filtering qualities specifically designed for healthcare situations. In order to avoid the shortage of masks during the next pandemic, people should not only consider building a large number of disposable masks but also consider the risks of applying disposable consumer culture to life-saving equipment. Maybe one day, maybe it is possible to talk about protective masks again. What medical researchers wrote in 1918: “Masks can be washed repeatedly and used indefinitely.”