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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