With the removal of many COVID-19 restrictions in the UK, advice regarding wearing face masks has been dropped from general guidelines for the public. It is hardly surprising, given the evidence for the level of protection they offer, that many have chosen to keep their masks on. In addition to and closely intertwined with these medical concerns, there are sociocultural reasons that individuals may choose to wear a mask, or not. Some may seek to escape other people’s invasive gaze by covering their face, while others may wish to express notions of individual freedom by refusing masks. Masks have become symbols of cultural anxieties and identities as well as a product of scientific advice.

A sickroom in a sixteenth-century German translation of Petrarch’s Remedies for Fortunes,

Masks have inspired multiple art forms since the start of the pandemic. They have even appeared in our pandemic dreams. While the mask functions as a barrier, it can also be considered as another medium for the expression of desires and anxieties. In the previous century, as a result of the trauma of chemical warfare in the First World War, the gas mask acquired a similar symbolic place in cultural consciousness, manifesting in contemporary art. The masks appearing in our twenty-first-century pandemic dreams can assume overtly historical dimensions, occasionally taking the form of the beak-like mask supposedly worn by the medieval plague doctor. Due to the notoriety of the Black Death, the devastating outbreak that first swept Europe between 1346 and 1352, the image of the masked doctor has become an emblem of premodern protective clothing. The beak mask was more likely an early modern parody of the plague doctor suit than an accurate image of medieval medical attire. It was considered a costume as early as the mid-seventeenth century, as Johannes Lingelbach’s Carnival in Rome indicates. Today, it has come to signify the fatality, contagiousness, and omnipresence of the invisible threat of COVID-19. But even in less exaggerated depictions of the medieval face mask, it played a symbolic role in the past.

Face masks can be traced as far back as ancient Greek medicine and to the Levitical laws regarding the skin-related impurities identified as leprosy in the Middle Ages. From the fourteenth century onwards, they emerged as one of the most important lines of defence against plague, described in European medical writings. We now know that the pathogen responsible for the bubonic plague was the bacterium Yersinia pestis, the vectors for which are fleas (although the pneumonic plague was transmissible between humans via respiratory droplets). Contemporaries, however, believed that plague, just like leprosy and many other diseases, was mainly airborne. Understandings of transmission were shaped by contemporary concerns about ‘infected’ or ‘corrupt air’, vested in humoral models linking the environment and the human body. Medieval medicine placed the human body within a complex network of influences from astral to dietary. These influences were thought to engender pestilences or make individuals more susceptible to disease by causing an imbalance of the four humours. This is not to suggest that medieval medicine lacked a concept of particles. Corrupt humours were thought to infect the air via emission from an infected individual’s breath, excreta, and skin pores, while a person could absorb corrupt air via the same pores. Similar modes of transmission were thought to be at work in leprosy, sweating sickness, and many other diseases. Based on such theorisations, medieval physicians offered comprehensive preventative guidance concerning diet and physical activity, but when it came to protective equipment, the first line of defence was the face mask.

What was the mask worn in the Middle Ages like? In one early treatise on plague from the 1370s, the author noted that when visiting patients, he ‘took a sponge or a piece of bread soaked in vinegar … and put it on his nose and mouth’.  Almost a century later, this treatise was translated into Middle English and printed, without changing the guidance on face masks. In a second translation, published in 1534, the advice remained unchanged. The face mask was also depicted in medical illustrations. One early sixteenth-century collection of medical treatises depicted a physician examining a plague-stricken patient while holding either a pomander filled with sweet herbs or a sponge in front of his mouth and nose. The use of face masks was not restricted to physicians. In a woodcut of a sickroom from a sixteenth-century German translation of Petrarch’s Remedies for Fortunes, two observers held cloths over their mouths and noses. Similar illustrations existed concerning prevention of contracting leprosy. For instance, in a thirteenth-century glass panel in the Trinity Chapel of Canterbury Cathedral, the leper Richard Sunieve is tended by his mother, who has wrapped a scarf around her mouth due to leprosy’s supposed contagiousness. Further, in a manuscript from the late fifteenth century, a priest covers his mouth and nose when hearing the confession of a leper. In perhaps one of the most famous manuscript illustrations of medieval leprosy, the leper wears a scarf, used to cover one’s mouth and prevent infection of others.

A physician takes a plague patient’s pulse and smells a pomander. Original image in: Joannes de Ketham, Fasciculus medicinae. Italian (Milano: Seinzenzeler, 1516), leaf c7v. ZAe 19b (Historical Medical Library of The College of Physicians of Philadelphia).

The Galenic foundation on which medieval medicine was built was able to accommodate new phenomena within its scheme quite easily without the need to alter its fundamental models of infection. As a result, when the mysterious ‘Sweating Sickness’ swept across England in the late-fifteenth to mid-sixteenth centuries, similar preventative advice was offered. In 1552, English physician John Caius recommended that one should always have one’s ‘handkerchief on [one’s] nose and mouth, both inside the house and outside, either steeped in perfume … or vinegar mixed with oil of roses’. In some places, it was recognised that the sole use of masks did not seem to adequately prevent transmission. In late-sixteenth-century Italy, for instance, it was recommended to wear leather clothing as a defensive layer against the absorption of corrupt or polluted air through skin pores. Combine face masks and protective clothing, and you get a premodern PPE designed according to the latest guidance!

Similar to our own COVID-stricken time, the most obvious form of anxiety expressed by medieval mask-wearers concerned contamination. Corrupt air appeared in literary works, such as Piers Plowman (late 14th century), in which Reason preaches:

And proved that the plague was for sin purely
And the wind from the southwest on a Saturday evening
Was clearly for pride and no other cause. (Passus V, ll. 115–17)

The pandemic was readily intertwined with cultural issues, with ‘sin’ identified as one cause of infection. Indeed, even in medical literature, moral depravity was treated as the chief factor in the generation of diseases. In a plague tract from 1534, those who ‘abuse themselves with women’ were deemed ‘more disposed to the sickness’. Individual infections such as leprosy, plague, and sweating sickness were associated with sins such as lechery, pride, and gluttony, as well as with activities such as sex work, sexual indulgence, and religious heterodoxy. It was due to this common association that lepers, sex workers, and Lollards (religious dissidents) were expelled from towns for spreading infection; the former two groups were even accommodated next to one another outside towns. Face coverings worn by lepers were not only intended to prevent transmission, but also, especially in the later Middle Ages, to morally mark the patient as someone engaging in improper conduct. On the other hand, when worn by healthy people to prevent contracting disease, the mask functioned as a statement, dissociating the wearer from moral iniquity. As shown by illustrations of lepers and those visiting patients, the sick person’s mask constituted a part of a uniform, which was typically different from the healthy person’s mask made from materials such as cloth or sponge. Thus, unlike today, there was rarely any ambiguity regarding whether the mask-wearer was infected or not.

 

A priest covers his mouth while hearing a leper’s confession in a 15th broadside on the treatment of leprosy patients.

In the centuries following the Black Death, masks were enmeshed in the cultural fabric of medieval and early modern Europe, not only because of the continuation of outbreaks across a long period of time, but also due to anxieties regarding moral conduct. Although it has been rightly argued that the experience of the COVID-19 pandemic should not be reductively equated with the Black Death, the double function and resilience of the mask in the late medieval and early modern periods suggests that we are living through a similar historical moment in this particular respect. Both in the past and today, masks have become an emblem of illness, anxieties, and identity. Analysing their symbolic manifestations can help us make better sense of the cultural imagination of our own time.

Sadegh Attari is a doctoral researcher in English Literature at the University of Birmingham. He is also a committee member of Pandemic Perspectives, an interdisciplinary collective studying the impact of the COVID-19 crisis.

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