What happened in the 1918 Spanish Flu epidemic regarding mask wearing regulation?

In the first wave of the epidemic in Vancouver, Dr. F. Underhill and the Mayor of Vancouver advocated for “veils” or masks, made out of gauze. An article in the Daily Province on October 28, 1918 noted that the Japanese community in Vancouver was already wearing gauze veils “under the advice of their three Japanese physicians who have been successfully fighting the epidemic in the Japanese colony.” 

“Rooming house people” and shop keepers were universally wearing flu masks in the Japanese community and Dr. Underhill advised the public to “realize the necessity” of wearing a cheesecloth or gauze veil or a double strip of gause fastened around the nose and mouth. He also said the gauze could be medicated with a good antiseptic, and the cost was small for such veils and masks.

Elsewhere San Francisco had a mask order in October of 1918, which was dismissed in November and then reinstated in the second wave of the flu in January 1919. Fines for not wearing a mask ranged from 5 to 10 dollars, along with a ten day prison sentence.

Becky Little on History.com notes that at the time mandatory mask regulations came to cities, people that did not mask up could receive prison time, fines, or risk “having their names published in the paper, revealing that they were a “mask slacker”.

Hygiene changed at this time, especially in New York City where regulations were enforced to stop people spitting on the streets. There was advice to keep your face turned away from others on street cars, and to cover your mouth and nose when you coughed. Fresh air and exercise were advocated, as well as the tie-in that such good habits could also arrest other diseases such as pneumonia and tuberculosis.

There is also a move from individualism to a more collective way of looking at health with citizens being urged to protect themselves and also protect others. One message at the time was a jingle stating

Obey the laws and wear the gauze. Protect your jaws from septic paws”.

Did wearing masks help? Tim Adams of The Guardian states that requiring mandatory mask wearing did appear to flatten the curve in San Francisco, and the practice was adopted in European cities as well. Newspapers had cut-out designs for masks in their pages, and church and service groups produced masks. Mr. Adams notes that when the mandatory mask requirement was lifted after the first wave, people in San Francisco threw their masks on the sidewalks and streets in celebratory abandonment.

Sadly by January 1919 San Francisco went back to a mandatory mask regulation, but at the time also faced protests from the Anti-Mask league. This movement was led by E. J. Harrington, a lawyer and activist who also was a vociferous opponent of the mayor. There were several other women in the Anti-Mask league, as well as several men from unions, and two members of San Francisco council who were against mask regulation.

Christine Hauser in The New York Times reports that the league had its first meeting in January 1919 and demanded the resignation of the mayor and all health officers as well as  the immediate rescinding of the mask regulation. The mandatory masking order was lifted on February 1. The order was lifted too early. Infections continued.

The full  third wave of the flu came to San Francisco in the Fall of 1919, and San Francisco had one of the highest death rates of all urban areas, with 673 people dying per 100,000.

In total San Francisco with a population of one  half million people  had 45,000 people infected with 3,000 lives lost. In the United States with 104.4 million people 675,000 people died.

In Vancouver 900 people died in a  population of about 117,000. Four thousand people died in British Columbia. In Canada with a population around 7.2 million, 55,000 people died of the Spanish Flu.

Where San Francisco was first lauded as a model for control measures, it became the poster child for moving too quickly to get rid of masks and regulations. The YouTube video below outlines some of the history of that fateful decision and has a wonderful  interview with a survivor of the Spanish Flu in San Francisco.


Images: History.com VancouverDailyProvince



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