The influenza pandemic of 1918 and 1919 was the most deadly flu outbreak in history, killing up to 50 million people worldwide.
In the United States, (population in the US at the time was 103.21 million) the virus is said to have killed around 675,000 people, which in reality, is unknown as recording keeping, like today, was a impossible task in reflecting any degree of accuracy.
Local governments rolled out initiatives to try to stop its spread. These varied by region, and included closing schools and places of public amusement, enforcing âno-spittingâ ordinances, encouraging people to use handkerchiefs or disposable tissues and requiring people to wear masks in public.
The following is a pictorial of those historical events 102 years ago….
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From the earliest recognition that a more deadly form of influenza was spreading quickly in fall 1918, US public health authorities recommended masks for doctors, nurses, and anyone taking care of influenza patients.
Newspapers provided instructions on âHow to Make Masks at Homeâ and published photographs of masked nurses. Masks were just one of the ânon-pharmaceutical interventionsâ or âsocial distancingâ policies, to use modern terms, adopted to contain the epidemic, along with closing schools, prohibiting public gatherings, and advising changes in personal behavior.
However, many people refused to wear them during the Spanish Flu of 1918, saying that government-mandated mask enforcement violated their civil liberties. An âAnti-Mask Leagueâ was even formed in San Francisco to protest the legislation.
It turns out that men needed more convincing than did women to heed the advice of public health officials. Some men associated masks with femininity, and behaviors like spitting, careless coughing, and otherwise dismissal of hygiene made men the âweak links in hygienic disciplineâ during the 1918 pandemic, according to a 2010 report published in the US National Library of Medicine. For that reason, public health leaders rebranded personal care as a display of patriotism and duty to make men to wear masks.
âThe influenza pandemic offered a teaching moment in which masculine resistance to hygiene rules associated with mothers, schoolmarms, and Sunday school teachers could be replaced with a more modern, manly form of public health, steeped in discipline, patriotism, and personal responsibility,â reads the report.
The transition from recommending masks for health care providers to encouraging and even requiring masks in public happened gradually and inconsistently. Most famously, San Francisco, California, along with other Western cities such as Seattle, Washington, Juneau, Alaska, and Phoenix, Arizona, passed laws requiring masks in public.
Violators could be ticketed, fined, and imprisoned. Within weeks, however, as the number of cases and deaths decreased, recommendations and even regulations to wear masks were relaxed and then eliminated.
Did masks prevent the spread of the Spanish flu?
Experts reviewing evidence from 1918 concluded that flu masks failed to control infection. In December 1918, the American Public Health Association recommended that the âwearing of proper masksâ should be compulsory for medical staff, occupations such as âbarbers, dentists, etc.,â and âall who are directly exposed to infection.â
The committee also found, however, that the evidence âas to beneficial results consequent on the enforced wearing of masks by the entire population at all times was contradictory,â and thus the committee did not recommend âthe widespread adoption of this practice.â The committee did recommend that persons âwho desire to wear masksâ should be âinstructed as to how to make and wear proper masks, and encouraged to do so.â
In 1919, Wilfred Kelloggâs study for the California State Board of Health concluded that mask ordinances âapplied forcibly to entire communitiesâ did not decrease cases and deaths, as confirmed by comparisons of cities with widely divergent policies on masking.
Masks were used most frequently out in public, where they were least effective, whereas masks were removed when people went inside to work or socialize, where they were most likely to be infected. Kellogg found the evidence persuasive: âThe case against the mask as a measure of compulsory application for the control of epidemics appears to be complete.â
In a comprehensive study published in 1921, Warren T. Vaughn declared âthe efficacy of face masks is still open to question.â 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 âfailure of cooperation on the part of the public.â Vaughnâs sobering conclusion: âIt is safe to say that the face mask as used was a failure.â
In 1927, Edwin Jordanâs definitive study, published in the Journal of the American Medical Association as a series of articles and then as a book, determined that masks were effective when worn by patients already sick or by those directly exposed to victims, including nurses and physicians.
Jordan also acknowledged, however, that âmasks are uncomfortable and inconvenient, as anyone who has worn them can testifyâ and require a great deal of âdiscipline, self-imposed or other.â Jordan came to a more guarded conclusion: âThe effect of mask wearing throughout the general community is not easy to determine.â
The Mortality of the Spanish Flu
The Spanish flu infected around 500 million people, about one-third of the worldâs population. Estimates as to how many infected people died vary greatly, but the flu is regardless considered to be one of the deadliest pandemics in history. An estimate from 1991 states that the virus killed between 25 and 39 million people.
A 2005 estimate put the death toll at 50 million (about 3% of the global population), and possibly as high as 100 million (more than 5%). However, a reassessment in 2018 estimated the total to be about 17 million, though this has been contested. With a world population of 1.8 to 1.9 billion, these estimates correspond to between 1 and 6 percent of the population.
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A public health worker carries a spray pump.
In this November 1918 photo, a nurse takes the pulse of a patient in the influenza ward of the Walter Reed hospital in Washington, D.C.
âTo Prevent Influenza!â poster, from Illustrated Current News, 1918.
A man sprays the floor of an open style bus with an anti-flu spray.
Influenza patients. 1918.
An emergency hospital in Kansas.
âWear a mask or go to Jailâ.
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(Photo credit: The LIFE Images Collection via Getty / U.S. National Library of Medicine / National Archives / Atlantic Magazine / Text: âFlu Masks Failed In 1918, But We Need Them Now, â Health Affairs Blog, May 12, 2020. / Business Insider).
Article, courtesy of
Rare Historical Photos