Are Surgical Masks the New Plague Masks? A History of the Not-Always-Helpful Ways We've Reacted to Pandemics

While it may seem silly today, when Hippocrates defined the four humors—blood, black bile, yellow bile and phlegm—the Greek physician of the fourth century B.C. built on the best science (or natural philosophy) available, systematized in the idiom of the day's most cutting edge technology: hydraulics.

In The Emperor of All Maladies: A Biography of Cancer oncologist Siddhartha Mukherjee describes the Greeks preoccupation with fluid mechanics, spurred by a "revolution" in irrigation and "culminating with Archaemedes discovering his eponymous laws in his bathtub."

"This preoccupation with hydraulics also flowed into Greek medicine and pathology. To explain illness—all illness—Hippocrates fashioned an elaborate doctrine based on fluids and volumes, which he freely applied to pneumonia, boils, dysentery, and hemorrhoids," Mukherjee writes. "In the normal body, these four fluids were held in perfect, if somewhat precarious, balance. In illness, this balance was upset by the excess of one fluid."

His point is simple: how we name and describe disease, and the idiom in which we understand them, affect how the disease is understood and how its sufferers are treated. While the advent of the germ theory of disease has advanced our understanding and our ability to treat diseases, we are not always more rational in how we choose, as individuals, to respond. We have better information, which can lead researchers to vaccines instead of new methods of bloodletting, but our perspectives are still colored by culture and how we interpret our place in the world.

One beneficial expression of this can be seen in how we react to the novel coronavirus, the cause of the COVID-19 pandemic spreading through 157 countries. Rather than the Greek's pursuit of internal balance, inspired by hydraulics, we think of the coronavirus in ways appropriate for the social media age. Using terms like "social distancing" and "self-quarantine," our reaction to COVID-19 is defined in relation to a connected humanity, where the best way to address a disease is to retract from the social network that spreads COVID-19.

This is, without a doubt, an improvement on the past. But just because we have made advances in science, doesn't mean we aren't prone to some of the same superstitions and modes of thinking that accompanied earlier plagues and pandemics.

  • Then: Plague Masks
  • Now: Surgical Masks

With their dark, heavy robes and beaked masks, the plague doctor will forever be associated with the bubonic plague, even though they first appeared in France and Italy in the 1600s, nearly 300 years after the Black Death ripped through Europe and killed up to 60 percent of the continent's people. But while the plague doctor has become an eerie symbol of pandemic death, there's much about the outlandish costume that's more practical than you might think.

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An engraving of Doctor Schnabel, a plague doctor who became known as Dr. Break during an epidemic in Rome. Published by Paul Fürst in 1656. Public Domain Review

Invented by Charles de l'Orme, chief physician to three French kings and friend to the infamous Cardinal Richelieu, the plague doctor outfit included heavy gloves and clothing designed to keep people at a distance and prevent skin-to-skin contact. Plague doctors would use a staff to point out buboes and other indications of plague on patients, without touching.

While the state of medicine in the 1600s—a century that saw a resurgence in bubonic plague epidemics throughout Europe—doesn't map well on to modern debates about public vs. privately funded health care, the plague doctor was hired directly by towns and offered a vital public service to all rungs of society (though many became infamous for extracting additional fees). Not only did they treat the sick, but plague doctors also maintained public records, witness wills, conducted autopsies and dispensed medical advice. Some of the most respected medical minds of the era were plague doctors, including the Swiss physician Paracelsus and, strangely enough, Nostradamus, who advised against the bloodletting commonly used to treat the plague (he instead prescribed a lozenge of rosehips).

But even if they may have engaged in the best medical practices of their day, we now associate the plague doctor more with death than healing. The mask, with its skull-like visage, certainly doesn't help. But stuffed with strong-smelling substances—ambergris, mint, rose petals—the plague doctor's mask actually embodies both practical and erroneous responses to the spreading pandemic. While it undoubtedly helped ward off the smell from dead and diseased bodies, the masks were based on an outdated miasma theory of disease, which held that the plague was spread by foul odors and bad air.

We have better masks today. N95 respirators and surgical masks are worn by medical professionals treating people infected with the coronavirus. The respirators protect the wearer from inhaling the aerosolized/airborne virus. Surgical facemasks are less effective, providing only what the CDC describes as "barrier protection" from droplets and "respiratory particles." As such, their primary recommended use isn't for people hoping to avoid catching COVID-19, but for those who already have it to prevent infecting others when they cough or sneeze. But since surgical masks have been shown to decrease transmission rates during flu seasons, other authorities, including Hong Kong health officials, recommend everyone mask up.

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A bus passenger wearing a face mask to guard against coronavirus in London, England in March, 2020. Photo by Dan Kitwood/Getty Images

While respirators are vastly more effective than 17th century plague masks, surgical masks aren't all that different, providing a barrier that might be effective, but are ultimately imperfect against viruses. In comparing surgical masks to plague masks, what's surprising is not how it highlights modern medicine against the backwards thinking of earlier centuries, but instead how plague doctors, even while working from imperfect premises, got a few things right, or half-right.

There's still a lot more people got disastrously wrong in historical responses to pandemics. What may be surprising is how often the failures of the past continue into the present.

  • Then: Talismans and Snake Oil
  • Now: Snake Oil and Talismans (Guns)

On the Smithsonian Channel series Mystic Britain: Witches and Demons (above), Dr. Elma Brenner of London's Wellcome Library describes a circular diagram, or "plague charm," meant to guard against pestilence.

"These charms quite often had some kind of instruction to write them on the body, sometimes in blood," Brenner says. "But you could do other things with this. You could copy it onto a scrap of paper and carry it on your body, for instance."

While plague charms would seem out-of-place during the coronavirus pandemic, we still aren't immune to the allure of amulets, charms, talismans and snake oil. In March, the U.S. Food and Drug Administration and the Federal Trade Commission issued warning letters to companies selling "fraudulent COVID-19 products," including herbal teas, essential oils, tinctures and colloidal silver.

In 1621, Oxford University scholar Robert Burton published his masterpiece, The Anatomy of Melancholy, which purported to be a medical textbook addressing melancholia, or what we'd describe today as clinical and other forms of depression. Instead, the book is more a wild miscellany of advice, using a library's worth of sources, stretching back centuries, to address the breadth of human emotional and physical wellbeing. Along the way, Burton lists dozens of folk cures, herbal remedies, magical spells and amulets useful for fighting disease.

Some are recognizable, like St. John's Wort, which Burton describes as most effective at driving away "all phantastical spirits" when gathered "on a Friday in the hour of Jupiter" and hung in a bag around your neck. But other amulets include wolf's dung for colic and "a ring made of the hoof of an ass's right fore-foot." Precious stones, in particular, can be effective in treating just about anything.

But maybe the strangest is an amulet Burton describes his mother using to treat fevers: a spider, trapped in a nutshell and wrapped in silk. But while it's unlikely to catch on today, Burton's reaction to his mother's spider amulet carries with it a cautionary tale for our modern reaction to the coronavirus pandemic.

"Quid aranea cum febre? What has a spider to do with fever? For what antipathy?" Burton writes, doubting his mother's folk remedy. But then he does a little more reading. "Til at length, rambling amongst authors (as often I do), I found this very medicine in Dioscorides, approved by Mattiolus, repeated by Aldrovandus; I began to have a better opinion of it, and to give more credit to amulets, when I saw it in some parties answer to experience."

While initially skeptical of amulets, Burton finds himself a believer after discovering that first century Greek physicians endorsed spider nutshells. This appeal to antiquity remains a potent source of misinformation today: treatments that are described as ancient are assumed to have some efficacy, otherwise why would we have used it for so long?

As a sales tactic, it can be especially potent when wielded by scammers and practitioners of alternative medicine. Silver has a long history of medical use, since the metal is toxic to bacteria, but its uses as an antibiotic are dubious. Nevertheless, alternative medicine peddlers have heralded colloidal silver as a cure-all for all sorts of maladies, including as a treatment for the coronavirus. Far right conspiracy theorist Alex Jones has been advertising the effectiveness of colloidal silver toothpaste in treating COVID-19, while televangelist Jim Bakker has been sued for selling a similar silver-based tincture. So while amulets have largely been set aside in the 21st century, we are still prone to quackery and snake oil.

Modern talismans aren't just peddled by grifters and scammers either. Guns have become uniquely American amulets during the coronavirus outbreak. Buyers cite the need for protection against civil disorder and their looting neighbors. But while medical systems throughout the world are overtaxed by COVID-19, no country is experiencing the kind of social breakdown gun buyers imagine. When it comes to objects meant to ward against evil or danger, but with zero effectiveness against the coronavirus, the massive increase in firearms and ammunition exemplifies talismanic thinking.

  • Then: Virus Lends Virtue
  • Now: Virus Protects Nature

We also remain prone to a strange form of fatalism, which valorizes the coronavirus pandemic as an unavoidable, even necessary, reaction to the state of humanity. In his Anatomy, Burton summarizes some of the positive views held by religious authorities and philosophers:

"Sickness, diseases, trouble many, but without cause; 'It may be 'tis for the good of their souls'; pars fati fuit ['twas part of their destiny], the flesh rebels against the spirit; that which hurts the one must needs help the other. Sickness is the mother of modesty, putteth us in mind of our mortality; and when we are in the full career of worldly pomp and jollity, she pulleth us by the ear, and maketh us know ourselves. Pliny calls it the sum of philosophy, 'if we could but perform that in our health, which we promise in our sickness.'"

In this formulation, disease becomes an expression of virtue, either because suffering results in some form of purification, or because it makes us humble. Similar sentiments are still expressed today. On Sunday, Florida megachurch pastor Guillermo Maldonado—who hosted a January rally for President Donald Trump, according to Right Wing Watch—described the coronavirus as the fulfillment of Biblical prophecy and a harbinger of the End Times. He described the virus as a test of his parishioners faith and virtue, urging them to ignore public health warnings to demonstrate they truly sought God's protection (he has since suspended services).

But while religious justifications for disease as somehow "good for the soul" still exist today, the mindset also takes on different, more modern forms. You may have seen viral tweets celebrating the return of wildlife to spaces previously dominated by humans and their pollution:

But notice also a darker undercurrent, which describes the coronavirus as a form of retributive justice; a purification for the planet, instead of the soul:

Actor Vanessa Hudgens (High School Musical, Spring Breakers) offered a dramatic example of fatalism masquerading as a form of brave realism, even virtue, in an Instagram Live video posted Tuesday.

"I'm sorry. But it's a virus. I get it. Like, I respect it, but at the same time, even if everybody gets it... yeah, people are going to die, which is terrible, but inevitable," Hudgens said in the video, since deleted. Hudgens issued an apology for the video, but the mentality can be found everywhere, from St. Patrick's Day revelers to Florida retirees.

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Orders and best practices put out by Elizabeth I during a plague outbreak in 1592. Wellcome Collection / Public Domain

In 1722, Londoner Daniel Defoe, already famous for his novel Robinson Crusoe, published A Journal of the Plague Year, a novelistic account of the last major bubonic plague epidemic to strike England, the Great Plague of 1665. The meticulously researched historical fiction includes many of the same public reactions as those seen today, including defiant partying in a pandemic's looming shadow, talismanic thinking and the spread of snake oil cures and inaccurate medical information.

"They ran to conjurers and witches, and all sorts of deceivers, to know what should become of them (who fed their fears, and kept them always alarmed and awake on purpose to delude them and pick their pockets), so they were as mad upon their running after quacks and mountebanks, and every practising old woman, for medicines and remedies; storing themselves with such multitudes of pills, potions, and preservatives, as they were called, that they not only spent their money but even poisoned themselves beforehand for fear of the poison of the infection; and prepared their bodies for the plague, instead of preserving them against it," Defoe writes in his fictional Journal.

While the far lower mortality rate and modern medical science mean the coronavirus pandemic will never approach the horrors of historical plagues, we can find in the past some of the same responses as today, including the rush to hoard supplies and the same proliferation of bad information. Instead of confronting death in the "heaps of dead bodies lying unburied" described by Defoe, we check and recheck the Johns Hopkins coronavirus tracker. We may not be seeking cures using the Philosopher's Stone, as surgeon Sigismund Bacstrom attempted in the 1700s, but we are, in our character, much the same as people were then.