What Happened When Americans Had to Wear Masks During the 1918 Flu Pandemic

Med­ical pro­fes­sion­als have had a par­tic­u­lar­ly dif­fi­cult time get­ting peo­ple in the Unit­ed States to act in uni­son for the pub­lic good dur­ing the pan­dem­ic. This has been the case with every step that experts urge to curb the spread of COVID-19, from clos­ing schools, church­es, and oth­er meet­ing places, to enforc­ing social dis­tanc­ing and wear­ing masks over the nose and mouth in pub­lic spaces.

The resis­tance may seem symp­to­matic of the con­tem­po­rary polit­i­cal cli­mate, but there is ample prece­dent for it dur­ing the spread of so-called Span­ish Flu, which took the lives of 675,000 Amer­i­cans a lit­tle over a hun­dred years ago. Even when forced to wear masks by law or face jail time, many Amer­i­cans absolute­ly refused to do so.

“In 1918,” writes E. Thomas Ewing at Health Affairs, “US pub­lic health author­i­ties rec­om­mend­ed masks for doc­tors, nurs­es, and any­one tak­ing care of influen­za patients.” The advi­so­ry “grad­u­al­ly and incon­sis­tent­ly” spread to the gen­er­al pub­lic, in a dif­fer­ent cul­tur­al cli­mate, in some impor­tant respects, than our own, as Uni­ver­si­ty of Michi­gan med­ical his­to­ri­an J. Alexan­der Navar­ro explains.

Nation­wide, posters pre­sent­ed mask-wear­ing as a civic duty – social respon­si­bil­i­ty had been embed­ded into the social fab­ric by a mas­sive wartime fed­er­al pro­pa­gan­da cam­paign launched in ear­ly 1917 when the U.S. entered the Great War. San Fran­cis­co May­or James Rolph announced that “con­science, patri­o­tism and self-pro­tec­tion demand imme­di­ate and rigid com­pli­ance” with mask wear­ing. In near­by Oak­land, May­or John Davie stat­ed that “it is sen­si­ble and patri­ot­ic, no mat­ter what our per­son­al beliefs may be, to safe­guard our fel­low cit­i­zens by join­ing in this prac­tice” of wear­ing a mask.

Despite the civic spir­it and gen­er­al­ized pub­lic sup­port for mask wear­ing, pass­ing local mask ordi­nances was “fre­quent­ly a con­tentious affair.” Debates that sound famil­iar raged in city coun­cils in Los Ange­les and Port­land, both of which reject­ed mask orders. (One offi­cial declar­ing them “auto­crat­ic and uncon­sti­tu­tion­al.”) San Fran­cis­co, on the oth­er hand, brought the police down on any­one who refused to wear a mask, impos­ing fines and jail time.

These mea­sures were adopt­ed by oth­er cities, as well as abroad in Paris and Man­ches­ter. “Fines ranged,” Navar­ro writes, “from US$5 to $200,” a huge amount of mon­ey in 1918, and a good amount for many peo­ple out of work today. Even in cities that did not impose harsh penal­ties, “non­com­pli­ance and out­right defi­ance quick­ly became a prob­lem.” Much of the resis­tance to wear­ing masks, how­ev­er, came lat­er, after a first wave of flu infec­tions sub­sided. When pre­cau­tions were relaxed, cas­es rose once again, and new mask man­dates went into effect in 1919.

San Francisco’s Anti-Mask League formed in protest, attract­ing some­where between 4,000 and 5,000 unmasked atten­dees to a Jan­u­ary meet­ing. Some of their objec­tions rest­ed on an ear­ly study that found scant evi­dence for the effi­ca­cy of com­pul­so­ry mask-wear­ing. How­ev­er, a lat­er com­pre­hen­sive 1921 study by War­ren T. Vaughn, notes Ewing, found that the data was too sketchy to draw con­clu­sions: “The prob­lem was human behav­ior: Masks were used until they were filthy, worn in ways that offered lit­tle or no pro­tec­tion, and com­pul­so­ry laws did not over­come the ‘fail­ure of coop­er­a­tion on the part of the pub­lic.’”

Vaughn con­clud­ed, “It is safe to say that the face mask as used was a fail­ure.” Many behav­iors con­tributed to this out­come. As we see in the pho­to­graph at the top of anony­mous Cal­i­for­ni­ans wear­ing masks and hold­ing a sign that reads, “Wear a mask or go to jail,” many did not wear masks prop­er­ly, leav­ing their nose exposed, for exam­ple, like the woman in the cen­ter of the group. Notably, instead of social dis­tanc­ing, the group stands shoul­der to shoul­der, ren­der­ing their masks most­ly inef­fec­tive.

The kind of masks most peo­ple wore were made of thin gauze. (“Obey the laws and wear the gauze. Pro­tect your jaws from sep­tic paws,” went a jin­gle at the time.) The mate­r­i­al was­n’t at all effec­tive at clos­er dis­tances, where today’s quilt­ed cot­ton masks, on the oth­er hand, have been shown to stop the virus a few inch­es from the wearer’s face. Still, masks, when com­bined with oth­er mea­sures, were shown to be effec­tive when com­pli­ance was high, though much of the evi­dence is anec­do­tal.

What can we learn from this his­to­ry? Does it under­mine the case for masks today? “We need to learn the right lessons from the fail­ure of flu masks in 1918,” Ewing argues. The over­whelm­ing sci­en­tif­ic con­sen­sus is that masks are some of the most effec­tive tools for slow­ing the spread of the coro­n­avirus, and that, unlike in 1918, “Masks can work if we wear them cor­rect­ly, mod­i­fy behav­ior appro­pri­ate­ly, and apply all avail­able tools to con­trol the spread of infec­tious dis­ease.”

Relat­ed Con­tent: 

Japan­ese Health Man­u­al Cre­at­ed Dur­ing the 1918 Span­ish Flu Pan­dem­ic Offers Time­less Wis­dom: Stay Away from Oth­ers, Cov­er Your Mouth & Nose, and More

What Hap­pened to U.S. Cities That Practiced–and Didn’t Practice–Social Dis­tanc­ing Dur­ing 1918’s “Span­ish Flu”

The His­to­ry of the 1918 Flu Pan­dem­ic, “The Dead­liest Epi­dem­ic of All Time”: Three Free Lec­tures from The Great Cours­es

Josh Jones is a writer and musi­cian based in Durham, NC. Fol­low him at @jdmagness

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Comments (14)
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  • Todd Milner says:

    Just proves that their is a huge num­ber of a type of Amer­i­can who refus­es to learn ANYTHING except what the descen­dants of the top tier of The Gild­ed Age choose to use to manip­u­late them with.

  • Even Steven says:

    Just wear the mask. If not for you then for some­one’s Nana.

  • Dina says:

    I would like to know in 1918 did they every found a cure for the virus in 1918 ?

  • Jill Strecker says:

    I will NOT use a mask!!!! Social dis­tance is good enough, we are NOT in a com­mu­nist coun­try yet!!!
    If law’s are passed to take away clean air to breathe that’s the day I leave Amer­i­ca.
    TRUMP strong 2020

  • gwr says:

    Well Jill, Don­ald Trump has been doing his best to strip away the reg­u­la­tions that help keep our air clean, so you might want to start pack­ing your bags.

  • S says:

    You’ll dear­ly regret your IGNORANCE when you or your fam­i­ly become infect due to stu­pid­i­ty. #brain­washed­MA­GAt

  • Victoria says:

    I am not into name call­ing (and I hope you dont live in Florida)but Your’e a self­ish idiot! Do you wear a seat­belt? Wear­ing a mask isnt dif­fi­cult and I dont do it for me I do it for my moth­er and old­er neigh­bors.
    I’m also #TrumpStrong2020

  • Steve Merideth says:

    Please wear a mask. I’m a triple threat receiv­er. I’m a dia­bet­ic can­cer sur­vivor with heart issues. The only thing going in my favor to keep me Covid neg­a­tive is if you wear a mask. Our air is not clean any­way, we just cant see the. Please, let’s all come togeth­er and make Amer­i­ca strong again.
    Remem­ber… Unit­ed We Stand.

  • Carrie says:

    Actu­al­ly, you could stay home and quar­an­tine instead of rely­ing on the behav­ior of every­body else to keep you safe. That is the fun­da­men­tal prin­ci­ple of cap­i­tal­ism.

  • Ingrid Turk says:

    These days it’s rec­om­mend­ed that masks be made out of QUILTING COTTON, not quilt­ed cot­ton. Quilt­ing cot­ton is dense­ly-woven, read­i­ly avail­able, and comes in end­less colours and pat­terns. Quilt­ed cot­ton isn’t breath­able.

  • Katy says:

    Wow Jill. Mask wear­ing is what you are will­ing to leave the coun­try over? Enjoy your trav­els. We don’t real­ly want you to stay and infect us all. Besides, good luck find­ing a coun­try that isn’t requir­ing masks at the moment. Amer­i­cans are the ones choos­ing stu­pid­i­ty over safe­ty, and the actu­al data backs that up. But it does look like you choose to wear the “I’m a stu­pid Amer­i­can” badge with hon­or. I’d rather wear the mask than that badge. Maybe it’s just a good exam­ple of human­ized nat­ur­al selec­tion.

  • jeans de moda de hombre says:

    Al mar­gen de lucir pren­das fáciles de com­bi­nar con las que acer­tar siem­pre, no está de más añadir ese toque que te difer­en­cia del resto y que te hace ir a la moda al 100%.

  • Mary says:

    I agree with Car­rie. I can’t wear a mask for very long because I can’t breathe when wear­ing one. Some places have an excep­tion in that if there’s a med­ical rea­son a per­son can’t wear a mask, the per­son is exempt.

  • WILLIAM says:

    If some­thing is 1000 times or more thin­ner then one sin­gle tiny hear, why do you think that mask will pro­tect you?
    Wear mask, keep dis­tance… sound like rules from prison camp for those who are sen­tenced for heavy crimes. Or rules of ruth­less dic­ta­tor­ship. Such rules are well known from camps of Stal­in Sovi­et Union or camps from Milo­se­vic Ser­bia in attack on oth­er nations in ex-Yugoslavia.
    Do not be fooled, please.
    Only very sta­ble organ­ism with high lev­el of immu­ni­ty is capa­ble to defend them­selves from all kind of ill­ness.
    Alka­lize drink­ing water, eat a lot of rasp­ber­ries, a lot of broc­coli, cau­li­flow­ers, kale, use black cumin seed oil (Nigel­la sati­va), eat chardon­nay grape along with pits, …
    East­ern Vir­ginia Med­ical School rec­om­men­da­tion:

    Mild­ly Symp­to­matic Covid patients (at home):
    ■ Vit­a­min C 500mg BID and Quercetin 250–500 mg BID
    ■ Zinc 75–100 mg/day (acetate, glu­conate or picol­i­nate). Zinc lozenges are pre­ferred.
    ■ Mela­tonin 6–12 mg at night (the opti­mal dose is unknown)
    ■ Vit­a­min D3 2000–4000 u/day

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