Dr Wu Lien Teh: hero of the pandemic mask

“Human activity in this place seems to have completely died out; the streets are empty and deserted … The [shops] are closed. Dogs alone roam in the streets …”

NO, not a description of contemporary New York, but an eyewitness account of the Manchurian pneumonic plague of 1910–11, cited in a book by Yale medical historian Professor William Summers.

The plague, which was originally transmitted from marmots to humans, is estimated to have killed close to 100% of those infected, around 60 000 people in total.

Appointed to head the medical response was Dr Wu Lien Teh, a young Malaysian-born doctor who had received his medical degree from Cambridge in the UK.

On arrival in Manchuria in 1910, Dr Wu conducted the epidemic’s first post-mortem and identified the organism responsible, Yersinia pestis. He convinced the Russian and Japanese authorities to cremate the dead and cancel trains, isolating Manchuria to prevent spread of the disease.

According to his own account, Dr Wu had some difficulty convincing medical colleagues that the pathogen was directly transmissible between humans, rather than via animal vectors such as rats or fleas.

His efforts to introduce an “antiplague mask” also met with some resistance. He later told the story of a French medical colleague who, dismissing Wu’s claim the disease was airborne, refused to wear the mask and was dead within days of contracting the disease.

Based on the surgical masks that had come into use over the preceding decade, Dr Wu’s masks included extra protective layers and more secure ties to allow for outdoor use.

Writing in the 1920s, Wu described the mask as a “three-tail gauze bandage” containing a pad of cotton wool to cover the respiratory entrance. There are some historical pictures accompanying this article by medical anthropologist Christos Lynteris.

“The aim was for this device to be worn by doctors and other medical or paramedical staff, operating in diverse contexts such as plague hospitals, the open-air cremation of plague corpses, and the work of removing, guarding and examining plague contacts,” Dr Lynteris wrote in Medical Anthropology in 2018.

“It was also meant to be worn by patients, contacts, and, to the extent that this was possible, by the entire affected population.”

This was the first time such an epidemic containment measure had been attempted, and at the time Lynteris was writing, it had been matched only by the widespread use of masks in the influenza pandemic of 1918–19.

The importance of masks in an outbreak of infectious disease has of course come back to prominence in recent months, as we face a new pandemic.

With medical supply chains stretched to the limit, horrifying images have emerged of doctors and nurses seeking to protect themselves with home-made devices, even garbage bags.

The mortality rate among doctors during the Manchurian plague has been variously estimated (from 5% in Summers’ book, to 46% in the 1960 BMJ obituary for Wu Lien Teh).

It will be some time before we fully understand the impact of coronavirus disease 2019 (COVID-19) on health workers around the globe, but one thing we do know: they deserve to be protected by the best technology we can summon.

Jane McCredie is a Sydney-based health and science writer.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.