Mask debates are nothing new

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At a campaign stop last week, President Donald Trump asked a rhetorical question about his Democratic opponent, former vice president Joe Biden: “Did you ever see a man who likes a mask as much as him?” His mockery of masks – like the photograph of Biden and vice-presidential candidate Kamala Harris wearing masks featured on their campaign website – reflects how disputes about mask-wearing have become part of the political terrain in 2020.

During the 1918-1919 influenza epidemic Americans also debated mask-wearing guidelines. Then, as now, state and local governments frequently took different approaches to wearing masks, and citizens often resisted mandates to wear them. Yet, politics weren’t the driving factor behind these debates.

In 1918, most public health officials agreed that masks should be worn by nurses, physicians, family members and anyone else caring for influenza patients or entering their homes. The rationale was clear: “to guard against breathing in dangerous germs,” explained a bulletin by the United States Public Health Service. This consensus on the value of medical masks was confirmed by widely published photographs of masked nurses and doctors, often under dramatic headlines, such as “St. Louis ‘Flu’ Fighters Wearing Masks.”

But the government urged people who weren’t caretakers to wear masks as well to contain influenza. The most enthusiastic advocates implemented ordinances requiring masks be worn by everybody in all public spaces. In Indianapolis, where the Board of Health required “persons to wear gauze masks when in public assemblies or any other crowded places indoors,” leaders emphasized the positive impact on public health: “While (mask-wearing) is not comfortable nor a convenient thing to do, nevertheless it is the method adopted by the best medical skill as a preventive against the spread of the disease.” San Francisco Health Officer William Hassler told citizens: “Wear your gauze masks at all times and ridicule the person who refuses to wear one.” Hassler predicted that if everyone wore masks, including while at home, this measure could cut the number of cases and deaths in half.

San Francisco later recorded one the highest death rates in the country.

Throughout the epidemic, city health officers disagreed about masks. The Detroit Department of Health issued a bulletin advising the use of masks by those attending patients, but explicitly rejected their broader use because “unless it is used intelligently it may be made a source of infection to the wearer.” In South Bend, Ind., Dr. E. G. Freyermuth, secretary of the Board of Health, rejected the policy adopted in Indianapolis and other cities because masks were “injurious to the health of the wearer,” since they prevented the inhalation of pure air: “Of my own accord I would never order the wearing of these masks here, only when persons are with influ

of enza patients.”

Most health officials tried to find the right balance between these two extreme positions by advocating for masks in certain occupations, for a limited period of time and mostly on a voluntary basis. For example, the Los Angeles City Council debated mask policies several times in October 1918, but ultimately decided to recommend masks in public without any mandate requiring universal use. Although masks were not legally mandated in Birmingham, Ala., a mask recommendation was enforced at a general meeting held at City Hall where “no one was allowed to attend without wearing a gauze mask,” and “those who refused to wear them were turned away and refused entrance to the session.” In Ogden, Utah, a requirement that clerks wear masks in stores was repealed in part because the fines imposed by courts placed an unfair burden on poor people.

In 1918, an avowed purpose of mask recommendations and mandates was to allow for more normal behaviors, such as shopping, going to school or participating in public assemblies. Public health officials provided detailed and accessible explanations of how a gauze mask trapped influenza germs (viruses had not yet been discovered) as they traveled in larger droplets.

But when health departments allowed people in masks to crowd together with the idea that the mask alone would protect them, it didn’t work, influenza spread and the focus on masks actually defeated the purpose of social distancing behind the mandates.