A drawing of a person in a gas mask surrounded by smoke.

What’s Behind the Mask

By Elizabeth Mullen ~

A man kneels at the feet of a woman holding a beautiful mask over a skeletal face while cupids look on.
Behind the Mask, 1851
National Library of Medicine #101435427

As the end of October approaches many people begin to think about costumes. A Halloween mask could frighten your friends, hide your identity, or help you pretend to be someone or something you are not.

This Halloween, choosing the right mask and wearing it properly is especially important for public health and safety.

While there are many kinds of cultural masks—for ceremony, art, or entertainment—there is another important category of masks: protective equipment for health and safety. The collections of the National Library of Medicine include a variety of images depicting people using this category of masks in a variety of historical contexts.

Protective masks have a long history. For centuries people employed masks of various kinds to protect against occupational and environmental dust, smoke, and toxic materials. In the 17th century Charles De Lorme is reputed to have developed the now widely recognized plague doctor personal protective equipment (PPE) suit with its distinctive beak shaped mask. Cholera epidemics in the 18th century prompted caricatures of the measures people took to ward off the infection. The end of the 19th century brought great leaps in understanding about microorganisms but it took some time for knowledge to be converted into practice. Even the best medical care of 1881 took insufficient care of infection.

Around the turn of the 20th century the respiratory infection tuberculosis was a leading cause of death and a lot of research was being conducted on what caused it and how it spread. When the 1918 influenza appeared, face masks were one of the public health measures recommended by officials. Increasingly health care workers began to regularly rely on masks to prevent infection and by 1935 most American surgeons were using cloth masks of some kind in the operating room. Today surgical masks are intrinsic to the representation of a surgeon.

This period also saw a focus on occupational safety masks and ventilators. Chemical warfare in The Great War drove use of gas masks for soldiers (and horses) in the military. (The war also drove research in plastic surgery and facial prosthetics, usually painted copper masks to cover scars received in battle.)

By the1970s expanding industry and the labor rights movement brought about the Occupational Safety and Health Act (OSHA) to address the need for safety in the workplace, including PPE. Today,  occupational safety masks are an ordinary part of many people’s work lives. In October 2020, masks are a common feature of our lives and an important tool to help slow the spread of COVID-19.

Perhaps this Halloween you’ll want to stay home in front of the TV and find out what’s behind this mask.

Explore more images of medical masks in NLM Digital Collections.


As you plan for the holiday, be sure to read and follow guidelines for Halloween offered by the U.S. Centers for Disease Control and Prevention (CDC), and, as always, follow the main CDC guidance on masks to help slow the spread of COVID-19.

Illustration of people wearing cloth face masks

Photo of Elizabeth Mullen outside in front of a building.Elizabeth A. Mullen is Manager of Web Development and Social Media in the History of Medicine Division at the National Library of Medicine.

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