Covering Only the Nose and Mouth:

Towards a History and Anthropology of Masks

Sumida Tomohisa, Keio University [About | Email]

Translated by Jadie Iijima, Waseda University [About | Email]

Volume 21, Issue 3 (Translation 4 in 2021). First published in ejcjs on 20 December 2021.

Abstract

This study presents a brief historical overview of the development and spread of facial masks for the prevention of the spread of communicable diseases, focusing on the recollections of Japanese who lived during the first popularisation of this preventative measure.

First published in Japanese as “Bikō nomi o ōu mono: masuku no rekishi to jinruigaku ni mukete” 鼻口のみを覆うもの : マスクの歴史と人類学にむけて, in Gendai shisō 現代思想 (Contemporary Thought) 48, no. 7 (2020): 191–199. http://www.seidosha.co.jp/book/index.php?id=3414.

Keywords: Julius Jeffreys, Jan Mikulicz-Radecki, Carl Flügge, Wu Lien-teh, Kitazato Shibasaburō, masks, public policy, health, pandemic

In 2020, as the Novel Coronavirus (COVID-19) continued to spread, the question of whether one should or should not wear a mask remained on the minds of people around the world. For medical personnel, patients, and those who may come in close contact with them, the use of masks has always been recommended. But when it comes to the average asymptomatic person, although some countries and regions have made the wearing of face masks compulsory, the World Health Organisation (WHO) and the Centers for Disease Control and Prevention (CDC) had, as of March 2020, called for restraint in the use of face masks. [1]
 
Leading up to our current moment in time, what sort of masks have been worn by whom, and for what purposes have they been used? This essay will examine the history of face masks for patients, medical personnel, and various other groups of people. [2]

 1 The “Respirator” in Japan

 
This ad from February 1879 (Meiji 12) is often cited as the earliest record of the face mask in Japan (Figure 1) (Miyatake 1925: 65; Ishii 1944: 1175–1176), [3] “The Respirator.” It seems to be black in colour. One covers only the mouth (image right) and the other covers both the nose and mouth (image left). The ad copy explains that there is a metallic insert of some sort, that it is domestically produced, and that it is made for everyday use and for the prevention of illness. Here, the message is clearly intended not for medical personnel or patients, but rather for the broader public.
 

 

Figure 1: Iwashi-ya Matsumoto Ichizaemon, “Respirator Ad,” 1879, https://dl.ndl.go.jp/info:ndljp/pid/1182351/42.

In actuality, an image of that same mask was listed in Kokudai Jūbei’s Ijutsu-yō Zusho 医術用図書 [Encyclopedia for Medical Use], a catalogue of medical instruments published two years earlier. Additionally, in Iryōkikai Zufu 医療器械図譜 [Illustrated Catalogue of Medical Instruments] (1878) compiled by Matsumoto Ichizaemon, the entrepreneur behind the previously mentioned ad, as well as in Shirai Matsunosuke’s Iyōkikai Zufu 医用器械図譜 [Book of Illustrations of Medical Instruments] (1886), its name is listed as “Jeffreys’s Respirator” (Figure 2).
 
 

Figure 2: Matsumoto Ichizaemon eds., Iryōkikai Zufu, 1878, pp. 95–96, https://dl.ndl.go.jp/info:ndljp/pid/833113/52.
 
These all refer to the respirator, a device named and patented in 1836 by the British physician Julius Jeffreys (1800–1877), which would be developed in later years.
 
For what reason did Jeffreys invent the mask? Before examining that question, let us first review the history of masks since ancient times.

2 Pliny the Elder, Agricola (, da Vinci), Kodō Zuroku 鼓銅図録
 

In most dictionaries and encyclopedias, the first listed definition of masks refers to those worn as a disguise or as part of a performance. The majority of these masks cover the entire face or only its upper half, but for the purposes of this article, I will limit my usage of the word to refer only to those that match what is today commonly referred to in Japanese (and other languages around the world as of 2020) as a “mask”: one that covers the lower half of the face, meaning only the mouth and nose.
 
By this definition, masks that cover the mouth and nose for the same reasons they cover the rest of the head, such as ninja hoods or niqabs worn by Muslim women, are omitted. The post-17th-century plague doctor masks seen in countries like France and Italy, though an infamous staple of medical history, are similarly omitted. [4] Masks made for other uses, such as men yoroi facial armor and belly dancers’ veils, may also cover only the mouth and nose, but these will be omitted as well.
 
An early example of the face mask comes from the mining industry. In Pliny the Elder’s Natural History written in the 1st century AD, there is an account of those who polish cinnabar (written here as minium (lead(II, IV) oxide Pb3O4)) using animal bladders to cover their faces.
 
Persons employed in the manufactories in preparing minium protect the face with masks of loose bladder-skin, in order to avoid inhaling the dust, which is highly pernicious; the covering being at the same time sufficiently transparent to admit of being seen through (Pliny the Elder 1855: 123).
 
This bladder, while preventing the inhalation of toxic particles, would still be transparent enough for its wearer to see through. Figure 3 shows a reproduction of one, as used in the 1945 American documentary The Air We Breathe.


 
 Figure 3: Mine Safety Appliances Company, The Air We Breathe, 1945, https://catalog.archives.gov/id/46905.
 

A similar description is found in Agricola’s De Re Metallica (1556).
 
At Altenberg in Meissen [in modern-day Germany] there is found in the mines black pompholyx, which eats wounds and ulcers to the bone; this also corrodes iron, for which reason the keys of their sheds are made of wood. Further, there is a certain kind of cadmia which eats away the feet of the workmen when they have become wet, and similarly their hands, and injures their lungs and eyes. Therefore, for their digging they should make for themselves not only boots of rawhide, but gloves long enough to reach to the elbow, and they should fasten loose veils over their faces [uesicas laxas illigent faciei]; the dust will then neither be drawn through these into their wind-pipes and lungs, nor will it fly into their eyes. Not dissimilarly, among the Romans the makers of vermilion took precautions against breathing its fatal dust. (Agricola 1912: 214–215)
 
Here too it is stated that the eyes, along with the mouth and nose, are covered. One might note that, in their original texts, Pliny the Elder and Agricola use very similar expressions—“laxis vesicis” and “uesicas laxas,” respectively (Agricola 1912: 215).
 
Of the several hundred people pictured in the 292 figures of De Re Metallica, only two cover their mouths and noses (Figure 4) (Agricola 1912: 422, 424). The text accompanying this illustration states the following on the smelting process.


 
  

Figure 4: Georgius Agricola, De Re Metallica, 1556, pp. 422 (left), 424 (right), https://la.wikisource.org/wiki/De_re_metallica/Liber_IX.
 
In order that the heat of the fire should not burn his face, he covers it entirely with a cap, in which, however, there are holes through which he may see and breathe (Agricola 1912: 421).
 
We cannot be entirely certain whether the two images here match the description in the text, but the fact remains that those involved in smelting would cover not only the mouth and nose but the entire head (excluding the eyes) as well.
 
Looking beyond the mining industry, we can see that the act of covering the nose and mouth can be found in Da Vinci’s (1452–1519) notebooks as well. This entry speaks to Da Vinci’s capacity as a military engineer.
 
To throw poison in the form of powder upon galleys.
Chalk, fine sulphide of arsenic, and powdered verdigris may be thrown among the enemy ships by means of small mangonels. And all those who, as they breathe, inhale the said powder with their breath will become asphyxiated.
But take care to have the wind so that it does not blow the powder back upon you, or to have your nose and mouth covered over with a fine cloth dipped in water [ja sottile peza bagnjata (una sottile pezza bagnata)] so that powder may not enter. (Da Vinci 1938: 218–219)
 
However, there are no records to indicate whether or not these masks were actually used.
 
In Japan, the Kodō Zuroku (produced circa 1801), which depicts metallurgical processes at the Besshi copper mine, contains an image showing three people using cloths to cover their noses and mouths (Figure 5) (Masuda c. 1801). [5] As with the image shown in De Re Metallica, only those involved in smelting processes involving fire use head coverings that also cover the nose and mouth.


 Figure 5: Kodō Zuroku, c. 1801, pp. 4a (left), 4b (centre), 6a (right), https://www.imes.boj.or.jp/cm/research/senpu/kodozuroku/.
 
In summary, what is common to both De Re Metallica and Kodō Zuroku is the fact that, of the large number of mine workers, only a few involved in certain smelting processes would cover their mouths and noses.
 
Furthermore, there is a good possibility that, at least before the 18th century, few outside of the world of mining had any reason to cover only the mouth and nose. [6]

3 Jeffreys’s Respirator, Fukumen 福面/覆面 for Miners
 

It seems that it was only in the 19th century that the masks to cover only the mouth and nose would appear.
 
The Japanese masks mentioned in the first part of this essay were derived from Jeffreys’s 1836 patent-approved “respirator.”
 
Jeffreys, a doctor trained in Edinburgh and London, had worked as a surgeon in India before returning to Britain in 1835 (Zuck 1990, 2004; Marshall, A. & Marshall, J. 2004). He hypothesised that the bad cough that his older sister suffered from was worsened by the cold, dry air in London, and had first designed a large humidifier. This later became the idea upon which John Snow (1813–1858), known for his epidemiological research on cholera, would base his invention of the chloroform inhaler.
 
Jeffreys then invented the “respirator,” which received a patent in 1836 (Figure 6) (Hodson 1836: 211–219). Much like our masks today, it covered the nose and mouth, but contained a metal lattice inside. This would trap heat and moisture with each exhalation and allow the wearer to inhale warm, humid air. This invention marked the birth of masks to be used by patients.
 


 
 

Figure 6: Jeffreys’s “Respirator” (Hodson 1836: 211–219), https://books.google.co.jp/books?id=in44AQAAMAAJ&pg=RA2-PA212.
 
Some doctors criticised the device for being distributed without the need for a medical prescription. Nevertheless, Jeffreys became a fellow of the Royal Society in 1841, and the mask was even exhibited at the Second London World Fair in 1862.
 
Additionally, some of these were advertised not only for people with respiratory diseases but for the general public as well, as a means of disease prevention. This marked the emergence not only of masks for patients but of preventative masks for everyday use.
 
As stated at the beginning of this essay, the respirator was introduced in Japan around 1877 (Meiji 10) at the latest. The “kokyūki [breathing machine]” that, 19 years later, made its appearance in the novel Bake Ichō [Monster gingko] (1896) by Izumi Kyōka (1873–1939) seems to bear a resemblance to Jeffreys’s. In this scene, Tei recalls the time when Tokihiko, her husband 15 years her senior, had returned to their home in Kanazawa, a city facing the Sea of Japan, for the first time in several years (Izumi 1896: 13–14). Tokihiko, at the time in his early thirties, had been attending a university in Tokyo, but had fallen ill with diseases of the lung and stomach. Tokihiko was “almost too thin to recognise,” and wore sunglasses,

and he had pressed against his mouth that so-called kokyūki…
 
Tei then “smiled, despite herself,” “because the way he was dressed looked so funny.” The sunglasses were “to protect his eyes from sand in the awfully dry, dusty winds” of Tokyo, and “he says he’s wearing the kokyūki to treat his lung disease.” He was also growing an “eisei-hige [hygiene-beard],” which suggests a literal interpretation of the effort to keep out “the lung disease bug.”


The statement “that so-called kokyūki” suggests that, although the word “kokyūki” would be understood by the reader, it was not yet a very common term.
 
Before concluding this section, I would like to introduce one other example of covering the nose and mouth. This is the “fukumen” mask, which appears in mid-19th century records from the Iwami Ginzan Silver Mine (Narita 2017; Toya 2011; Fujimoto 2020).[7] Umeboshi pickled plums are placed in the nosepiece, and a silk cloth sewn onto the metal frame is soaked in “persimmon juices.” The umeboshi acid was said to make dust particles less likely to stick, and also stimulate saliva production which would protect the throat. Miya Tachū (1827–1870) wrote of this in his Saisei Higen [A Proposal to Save Lives] (1858), and he himself entered the mines to test these effects. According to Toya Yoshio, this image in a private collection (likely illustrated by Iwami Ginzan grounds manager Abe Kōkaku) can most likely be traced back to this occasion.
 
The two 19th century masks I’ve introduced here, both Jeffreys’s and the “fukumen,” are designed to have metal or pickled plums placed inside, rather than to be used specifically for the purpose of covering the mouth and nose alone. This would only become the explicit purpose of masks after the advent of bacteriology. 

4 Surgery, The Plague Outbreak of 1910, The Spanish Flu of 1918


 It was in 1897 that medical personnel began wearing masks, starting with surgeon Jan Mikulicz-Radecki (1850–1905) of the University Hospital in Breslau (of the former German Empire; present-day Wrocław, Poland) (Spooner 1967). Carl Flügge (1847–1923), bacteriologist and hygienist at the University of Breslau, demonstrated the concept of “droplet transmission,” and, taking his findings into account, Mikulicz-Radecki began wearing masks during surgery. Since 1885, Flügge had served as editor of the Zeitschrift für Hygiene und Infektionskrankheiten (Journal of Hygiene and Infectious Disease) alongside Robert Koch.
 
The use of masks by medical personnel for the purpose of disease prevention began with the Manchurian plague in 1910–1912 (Lynteris 2018). [After the initial publication of this article, it became clear that the use of masks at this time harks back to those which were seen during the 1899–1900 plague pandemic in Osaka (Sumida 2021a, 2021b; Zhang 2021; Lynteris, Sumida, & Zhang 2021; Hyun & Sumida 2020).] Wu Lien-teh (1879–1960), who was born in Penang, Malaysia, and educated at Cambridge, arranged the prototype. At the “International Plague Conference” of April 1911, which was held by the representatives of 11 countries including Wu Lien-teh and Kitasato Shibasaburō (1853–1931), he clarified the proper use of masks by medical personnel.


[I]n view of the special danger of infection by inhalation that has been manifest during the past epidemic, the sanitary staff should be provided with masks of uniform pattern and instructed in their proper use.

The best form of mask is a simple, three-tailed, gauze and cotton-wool pad, which should be destroyed, or disinfected, after each tour of duty. (Strong 1912: 394)


 The use of masks by the general public for disease prevention was prompted by the Spanish Flu epidemic in 1918–1920. At this time, certain American municipalities, including San Francisco, adopted ordinances to require the wearing of masks. Still, expert opinion on their effectiveness has been divided since then (Crosby 1989).
 
The Special Committee of the American Public Health Association convening in December of 1918, while obligating the use of masks in hospitals, reserved judgment on their use by the general public.
 
The evidence before the committee as to beneficial results consequent on the enforced wearing of masks by the entire population at all times was contradictory, and it has not encouraged the committee to suggest the general adoption of the practice. Persons who desire to wear masks, however, in their own interests, should be instructed as to how to make and wear proper masks, and encouraged to do so (SC/APHA 1918). [8]
 
And so the mask spread from the operating room and into cities, but throughout the century since then, the question of whether or not the general public should wear masks has yet to reach a consensus (Horii 2012; Takizawa 2010; Ōtsuki et al. 2010).

5 Masks in Everyday Life
 

Following the 1918 Influenza pandemic, the use of masks gradually spread to the mainstream. In Yumeno Kyūsaku’s 1933 novel Ankoku Kōshi (Dark Minister), a character is described in one section as “wearing a black kuchiōi mouth-covering in the latest style” (Yumeno 1933).
 
From this point on, the history of masks can be reconstructed from the memories of those alive today. [9] Okumura Misako (1929–), who grew up during the 1930s in Ujiyamada (present-day Ise city) of Mie prefecture, would wear a homemade white mask sewn by grandmother Mina (1888–1964) before going outside on days when strong winds stirred up dust. Although Mina had only attended school for the four years of compulsory primary education, she would read the Fujin no Tomo [Women’s Companion] magazine and The Collected Works of Hani Motoko, and was keen to try new things. However, Misako’s two younger sisters do not recall any similar experiences, so this may have only been a temporary phase in their family.
 
M. M. (1927–), who grew up in the town of Taki in Mie prefecture, remembers wearing a mask on cold mornings while riding a bicycle to junior high school. Some mornings he wore a black mask, other mornings, a mask made of white gauze. Sumida Masao (1902–1992), an elementary school principal in Ujiyamada city, would also wear a black mask when biking to his workplace on cold mornings.
 
Similarly, T. (1925–), who grew up during the 1930s in Keijō prefecture (present-day Seoul), wrote down her recollections on wearing colourful gauze masks and black masks with breathing holes to protect against the cold, as documented by a respondent of Hōgetsu Rie’s questionnaire:


Gauze masks were a winter staple. Red and black velvet masks were sold as well. In later years, masks with breathing holes around the nose emerged, and these were made of artificial leather. These were used because the winters in Keijō were freezing—similar to those in Niigata prefecture, which lies along the same latitudinal line. At the same time, we used ondol floor heating and heaters (fueled by coal or yeontan) for long hours at a time, and the soot would enter through the breathing holes; it would make us laugh to see how, when we took off our masks, the skin below our noses would be stained in the shape of Zhang Zuolin’s mustache (Hōgetsu 2010: 245). [10]
 

And so the face mask, used initially as respiratory protection or for the prevention of illness, came to be used in everyday contexts as protection against dust or the cold.
 
Later, the incidence of mask usage in Japan continued to rise, even in comparison with the rest of the world. As a result of the air pollution issues of the 1960s and the growing prevalence of cedar pollen allergies since the 1970s, for many, the sight of people wearing masks in public no longer seems out of place. In recent years, more than a few people have begun to wear masks as a fashion statement, and it is not rare to spot a middle schooler wearing one in the middle of class.
In this article, I have traced the history of the mask to give an overview of their various uses throughout time, and show how historically unusual it is for a mask to cover only the nose and mouth. This hypothesis, that masks covering only the nose and mouth were hardly ever used before the 18th century, will require further corroboration.
 
The black masks of the early 19th century, developed with a metal insert for those suffering from lung diseases, came to be used by many against infectious diseases. The white masks used in hospitals since 1897 following advancements in microbiology also came to be used by medical workers and the general public alike to prevent infectious diseases. And in everyday settings, masks are worn for cold weather or even to make a fashion statement. Our relationship with the face mask continues to become ever deeper and more diverse.

Notes

1. On April 3rd, 2020, in light of significant community-based transmission, the US CDC changed their policy to recommend the use of “cloth face coverings” by asymptomatic people (https://twitter.com/CDCgov/status/1246208612722192385). Likewise, the WHO finally changed their policy on June 5th (https://twitter.com/WHO/status/1268986094042992640).
 
2. In the process of writing this essay, I was lucky enough to receive the support of many people. As some of my theories verge on hypothesis, I’ll refrain from mentioning all names, but I’d like to give special thanks to Hirono Yoshiyuki 廣野喜幸, who was of great help in the beginning stages of my research, Kamimura Daichi 上村大地, Takahashi Sakino 高橋さきの, and Tsuruta Sōto 鶴田想人, who lent their support to research and writing activities. Supplementary information for this essay will be added to my website “The History and Anthropology of Masks” as needed (https://sites.google.com/view/hamask2020). With the exception of Horii (2012, 2014), previous research on the cultural history of masks is extremely limited. The subject is barely touched upon even within the works such as Tomes (1998) and Smith (2008).
 
3. The Kitatama Yakuzaishikai’s website features pictures of masks collected by Hirai Tamotsu 平井有 (https://www.tpa-kitatama.jp/museum/museum_06.html).
 
4. In Horikoshi Kōhei’s manga “My Hero Academia” (Weekly Shōnen Jump, 2014–), many of the members of the group Shie Hassaikai, who appear during the “Hero Internship Arc” (volumes 14–18) wear masks. That the plague masks worn by characters Chisaki Kai (aka Overhaul) and Setsuno Tōya are ones that cover only the mouth and nose can be said to be a modern rendition of the plague mask.
 
5. Apart from this, in Nihon Ishi Gakkai (1978), Kaokake facial coverings are pictured in the “image of subuki smelting” in the Ikuno Ginzan Emaki 生野銀山絵巻 [Ikuno Ginzan Silver Mine Picture Scroll].
 
6. Exceptions will be added to my website “The History and Anthropology of Masks.”
 
7. Records of the Ōkuzo Kinzan in Akita-han Goldmine from 1826 indicate the use of “a thing called fuku-men 覆面.” Miura Toyohiko 三浦豊彦 imagines its shape based on late 19th century reports from the goldmine on the “fuku-men フクメン,” but it is unclear whether these were any similar (Miura 1976). On Miya Tachū 宮太柱, see Amano (1989).
 
8. Similar controversies seem to have been present in Japan as well. This is exemplified in a contribution to the “Readers’ Voices” column of the Yomiuri Shimbun newspaper: “The Faculty of Medicine at Kyoto Imperial University published experimental results showing that [masks] are of little use, and though professors banded together to oppose this decision, they were unable to conclude their ineffectiveness definitively” (October 2nd, 1920, p. 4).
 
9. The anecdotes below were collected during phone interviews in March 2020 with the following relatives within the fourth degree: Okamura Misako 奥村操子, Sumida Kumiko 住田久美子, Sumida Yoshihisa 住田芳久, Migita Kenzō 右田研三, Migita Masako 右田昌子, Miyako Yōko 都洋子, M. H., M. M., Watanabe Nami 渡辺奈美, and Watanabe Hiroo 渡辺紘男.
 
10. When Hōgetsu interviewed 19 people who attended elementary school during the prewar Shōwa period for her doctoral thesis, the subject of face masks did not come up in conversation (Hōgetsu’s email to the author, March 15, 2020).

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About the Author

Sumida Tomohisa 住田朋久 is a visiting research fellow at the Graduate School of Human Relations, Keio University. He graduated from the University of Tokyo with a Master’s degree in the History of Science and is currently working for a Japanese public think tank. His work explores the social dimension of science as it relates to topics such as nature conservation, air pollution, pollen allergies, and masks. https://researchmap.jp/sumidatomohisa.

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About the Translator

Jadie Hokuala Iijima Geil is an undergraduate student at the Waseda University School of International Liberal Studies. She is a research assistant for Department III (Artifacts, Action, Knowledge) of the Max Planck Institute for the History of Science, and worked as a core team member for the project “The Mask—Arrayed”
(https://www.mpiwg-berlin.mpg.de/research/projects/mask-arrayed).

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