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Wednesday, September 23, 2020

Lessons from 1918 Spanish flu: When mask laws triggered protests in US

Then, as today, an intense debate had ensued over the utility and convenience of wearing masks. Citizens neglected the ordinance, showed defiance, and some also organised protests.

Written by Adrija Roychowdhury | New Delhi | Updated: August 9, 2020 8:31:35 pm
Lessons from 1918 Spanish flu: When mask laws triggered protests in US A Spanish Flu victim in St Louis, USA. (Source: Wikimedia Commons)

In 1918, when Americans were busy aiding the Allied powers in the First World War that was raging across Europe, they were beset at home by a deadly influenza epidemic. The Spanish influenza is recorded to have killed ten times more Americans than were killed by German bombs and bullets in the war.

The Spanish flu arrived in America at a time when mass transportation, mass consumption and warfare had opened up public spaces, where infectious diseases could spread. One of the most widespread and devastating epidemics of the 20th century, the flu had also arrived at a time when medicine had advanced by leaps and bounds. Historian Nancy Tomes, in her article, ‘“Destroyer and Teacher”: Managing the Masses During the 1918–1919 Influenza Pandemic’, explained how the influenza epidemic of 1918 was “simple to understand, but difficult to control.

The flu was first reported in March 1918, at an army base in Kansas where close to 100 soldiers had been infected. Within a week, the number of cases grew five times. As thousands of soldiers deployed for the war moved across the Atlantic, the flu spread with them. Local authorities rolled out a large number of measures to control its spread including shutting down of schools, banning public gatherings, no spitting, and the like. The one measure that turned into a point of debate, was the mandatory wearing of masks. Then, as today, an intense debate had ensued over the utility and convenience of wearing masks. Citizens neglected the ordinance, showed defiance, and some also organised protests that like today, were politically motivated.

Mandatory masks for all – A first time law during the Spanish flu

The practice of covering nose and mouth as a sanitary practise is traced back to early modern Europe. During the spread of the Bubonic plague, doctors wore a beak-shaped mask filled with perfume. The reason behind wearing this mask was the belief that contagious diseases spread through noxious pollutants in the air or miasma. Perfume-filled masks were believed to be capable of protecting those wearing it. This practise though, began to die out by the 18th century.

An engraving of a plague doctor of Marseilles made in 1721 CE (Source: Wikimedia Commons)

The use of face masks, as is done today, can be traced back to the 1880s when a group of surgeons devised a strategy to stop germs from entering wounds. Johann Mikulicz, head of the surgery department at the University of Breslau (now Wroclaw, Poland), started wearing a face mask which he described as “a piece of gauze tied by two strings to the cap, and sweeping across the face so as to cover the nose and mouth and beard.” “The face mask stood for a strategy of infection control that focused on keeping all germs away, as opposed to killing them with chemicals,” wrote biologist Bruno J Strasser and historian Thomas Schlich in their research paper, A history of the medical mask and the rise of throwaway culture’.

But till the influenza epidemic of 1918-19, the use of face masks was restricted to the confines of the operating room. The Spanish flu ushered in a new era in the history of face masks, when for the first time, doctors, patients as well as residents in America were asked to wear the mask outside their homes.

Mandating the mask – A patriotic act

Mask wearing rules first came up in the Western states. By the end of fall of 1918, seven cities of the USA had come up with mandatory mask laws including San Francisco, Seattle, Oakland, Sacramento, Denver, Indianapolis and Pasadena, California. It was San Francisco, however, that was at the forefront of the mask laws.

Barbers wearing masks during the epidemic (Source: Wikimedia Commons)

On October 18, the city’s health officer, Dr. William C. Hassler ordered all barbers to wear masks when in contact with their customers, and asked clerks who came in contact with the general public to wear them as well. In the following days he added hotel and bank employees, chemists, store clerks and anyone else serving the public to the list. Citizens too were mandated to wear masks in public. The ‘mask ordinance’ of October 22, made San Francisco the first city mandating the use of face masks which had four layers. The city was soon referred to as the ‘masked city’.

Since America at that time was still fighting the war, local authorities framed measures to control the spread of the disease with a touch of patriotism. The orders were given the impression of protecting the troops from the outbreak. Consequently, a Red Cross public service announcement stated- “The man or woman or child who will not wear a mask now is a dangerous slacker.” Mayor James Rolph of San Francisco on the other hand announced that “conscience, patriotism and self-protection demand immediate and rigid compliance” with the mask order.

Letter carrier in New York city wearing a mask during the flu. (Source: Wikimedia Commons)

‘To mask or not to mask’- Resistance and enforcement

As in 2020, the ordinance to wear masks in 1918 too saw firm resistance from several Americans. Consequently, violators of mask laws were fined $5 or $10, or were put under 10 days of imprisonment.

Writing in the BBC magazine website, History Extra, professor E Thomas Ewing explained that most violations of mask ordinances resulted from “ indifference, ignorance, or convenience.” “In San Francisco, most of the 110 arrested on the first day had masks around their necks, which suggests their refusal was more about convenience than principled opposition to the rules,” he wrote.

There were also those who claimed that the masks were detrimental to their safety. Ewing provided an anecdote of a mechanic at Tucson, Arizona, who admitted to not wearing a mask, claiming “it was not safe to do so, as it would have interfered with his vision and rendered himself liable to injury from the machine.” At Santa Barbara, California, a physician, Dr. J. Clifford responded to his arrest by stating that he did not believe in using the mask since it did not do anything to control the spread of the epidemic.

In November 1918, residents of San Francisco were allowed to remove their masks as their health department announced the epidemic was over. The city celebrated with utmost joy. “Waiters, barkeeps and others bared their faces. Drinks were on the house. Ice cream shops handed out treats. The sidewalks were strewn with gauze, the “relics of a torturous month,” wrote journalist Christine Hauser, in an article in the New York Times.

The celebrations were short lived though, since within weeks the number of influenza cases spiked again, and in December 1918, the mask ordinance was reinstated. Responding to this imposition, a self-styled ‘anti-mask’ league was created. “The same people who celebrated their bare-faced “liberation” when allowed to remove face masks in November 1918, now organized protests against the return of this public health measure,” wrote medical historian, Brain Dolan, in his article, ‘Unmasking History: Who Was Behind the Anti-Mask League Protests During the 1918 Influenza Epidemic in San Francisco?’

The first thing the group did was to call for a public meeting with the intention of distributing petitions asking for the dismissal of city health officer, William Hassler and threatening Mayor Rolph with recall if he did not comply with the demands of citizens.

Dolan suggested that the ‘anti mask’ league was more politically motivated than medically. The president of the league, E.C. Harrington, along with other important members, had political motivations behind calling for the resignation of Rolph.

A century later, when San Francisco mayor, London Breed ordered the city’s residents to “wear face coverings in essential businesses, in public facilities, on transit and while performing essential work,” a heated debate ensued once again on the efficacy and feasibility of masks. Unsurprisingly, the city’s eventful history with mask laws is being studied for lessons. Dolan explained the lessons from the comparison – “As with this historical example, we see that enforcing complete compliance of a measure which radically alters social behavior overnight is near impossible. However, the attempts to persuade the majority to comply today appear to yield better results than in the past in controlling the spread of disease. That is where we may take comfort in not looking like the past.”

Further reading

“Destroyer and Teacher”: Managing the Masses During the 1918–1919 Influenza Pandemic by Nancy Tomes

Unmasking History: Who Was Behind the Anti-Mask League Protests During the 1918 Influenza Epidemic in San Francisco? by Brian Dolan

To mask or not to mask: A note on the 1918 Spanish epidemic influenza epidemic in Tucson by Bradford Luckingham

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