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The History of PPE in Medicine

Asklepios, the god of medicine, wearing a face mask
Credit for the mask: “Design vector created by freepik

On today´s World Day for Safety and Health at Work by the UN, I cover a very current topic for everyone who can not work in home office: the use of PPE (personal protection equipment) at work.

The use of PPE goes back to ancient times and started within the military: Soldiers could safe their bodies from some injuries by using armours, a shield and a helmet. This protection in turn could lead to a victory at the end.

A non-military use goes at least back to the Middle Ages, when blacksmiths protected themselves from getting burned. The benefit of PPE in medicine is at least known since the 16th century by the use of the plague doctor´s costume.

All PPE aim to protect those who wear them. Generally, there are the following types of PPE:

  • respiratory PPE, like gas masks and respirators
  • for the head, like hats
  • for the face
  • for eyes, like goggles
  • for ears
  • for the hand, like gloves
  • for foot, like shoes
  • full body suits, such as the plague doctor´s costume.

The correct use of PPE in medicine does not just keep medical personnel save and healthy but also patients: e. g. surgical masks worn by medical personnel prevent patients from contamination during operations.

The Plague Doctor´s Costume

Cooper engraving of “Dr. Beak” – 1656 AD

Some Plague doctors, who treated patient suffering from the “Black Death”, used special costumes, from the 17th century onwards. This plague doctor´s costumes included:

  • a light,
  • a beak-shaped mask, which was filled with intensive smelling herbs & spices – like myrrh, mint, roses and lavender – plus straw or a vinegar sponge. It had glass eye openings and two small nose holes: Based on the miasmatic theory the masks were thought to protect from the bad air, that caused the disease;
  • gloves,
  • boots,
  • a wide brimmed-hat,
  • a waxed fabric or leathern overcoat and
  • wooden canes for examination.

Did you know …
that beak-shaped masks entered popular culture as masks for the Carnival of Venice.

X-Ray Protection

At the beginning nearly everything was x-rayed. The consequences were burns, dermatitis, cancer or the loose of hands and arms. To avoid that safety cloths for healthcare workers and later patients against X-Rays were invented. Below you see protection cloths from 1910 and 1920/58:

Radiation protection 1910 @Deutsches Röngten-Museum
Radiation protection apron and gloves 1920/1958 @Sciene Museum London

These two pictures reflect the development in PPEs: Over time they got smaller, more comfortable to wear and more protective.

The romantic story of Gloves

The chief nurse of the operating room in Johns Hopkins Hospital, Caroline Hampton, suffered from a skin reaction to mercuric chloride, which was used for asepsis, in 1889. Her soon-to-be husband, William Halsted, asked the Goodyear Rubber Company if they could produce thin rubber gloves for her protection. 5 years later Halsted implemented the use of these sterilized medical gloves at the Johns Hopkins Hospital.

In 1964, the first disposable latex medical gloves were produced by Ansell: It was based on the technique for making condoms.

Racism & The Invention of Modern Masks

The beak-like mask of plague doctors is a very early form of today´s medical masks.

The Manchurian plague (1910-1911) lead to the invention of modern masks:

Plague workers during the Manchurian Plague

Lien-teh Wu (1879-1960) was appointed by the Chinese Imperial Court to battle the disease: Wu found the reason for the spread of the plague, which was not caused by fleas but spread through the air.

Due to his education in the West he know about surgery masks and adopted them. But his result was doubted by some doctors, including the French doctor Gérald Mesny: Mesny offended him by using racist terms and decided to treat patients without Wu´s mask. Ironically, Mesny died 2 days later with the plague.

Wu´s mask

His mask was industrially produced and worn by healthcare workers, soldiers and everyday people. It became a symbol of modern medical science and reached international newspaper coverage.

Respiratory PPE

Even though respiratory protection was already used according to Pliny the Elder (23-79 AD) and Leonardo da Vinci (1452-1519), the focus was on mining: Pliny the Elder described the use of loose animal bladder skins and da Vinci recommended to cover mouth and nose with wet cloths.

In WWI the focus was on protecting soldiers from chemical warfare by wearing gas masks. The Spanish Flue within WWI lead to the use of respiratory PPE in healthcare.

Summing up, it can be said that PPE are essential for healthcare workers: COVID-19 proved that not providing PPE to medical personnel leads to the death of many, not only doctors and nurses, but also patients.

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