By Jessica Brabble, Ariel Ludwig and E. Thomas Ewing
In October 1918, Virginia’s first lady, Marguerite Inman Davis, worked as a volunteer nurse fighting the flu in an emergency hospital in Richmond. A photograph published in the Roanoke World-News on Oct. 19, 1918, and republished widely across the United States, depicted Davis “wearing a mask to protect herself from the disease germs.”
This historical example is relevant today as Virginians deal with requirements to wear face coverings in public for the first time in more than a century. In 1918, masks were mandatory for only a small proportion of the American population, mostly in cities located in the western United States, and usually for only a few weeks.
In 2020, by contrast, most states have adopted some form of compulsory mask requirements. A review of historical evidence of masking in Virginia in 1918 suggests lessons that confirm the value of requiring masks to contain COVID-19.
The most common use of masks in 1918, as suggested by the photograph of Davis, was by those caring for the sick. Early in October, the Richmond Times-Dispatch published directions for nurses battling the epidemic. Each nurse was supposed to receive two gauze masks, to be worn over the nose and mouth.
Upon leaving the sick room, they were told to carefully remove their mask and thoroughly wash it in an antiseptic solution. Family members of the sick also were supposed to wear masks. Later in the month, the Big Stone Gap Post printed urgent recommendations from the State Board of Health that “masks be used by all persons caring for or compelled to visit those sick with influenza.”
Masks were made visible by enthusiastic reports, often accompanied by photographs, of women volunteers making masks. In Norfolk, the Red Cross provided every city, state and federal official with free masks; in Roanoke, every volunteer nurse was given masks; in Richmond, masks could be purchased for 3 cents. The great demand in Richmond resulted in people waiting in long lines to acquire masks.
Some Virginia localities required masks for certain occupations dealing with the public. An Alexandria health officer “directed all waiters, waitresses in lunch rooms, barbers, and employes [sic] of soda water fountains to wear masks against influenza while serving the public and also to protect their customers.”
In Newport News, the draft board wore masks during public sessions. The Lynchburg Department of Health required “bank tellers, streetcar employees, barbers, and dentists to wear masks.” On Oct. 14, John Harris, a Lynchburg streetcar conductor, was arrested for refusing to wear a mask. Other than this one example, we have not found other instances of mask defiance in Virginia, probably because requirements never were imposed on the public.
Did masks work? In December 1918, Richmond physician Dr. A. G. Brown offered his own answer: “During this terrible epidemic the proper use of a properly made mask undoubtedly protected many people from ‘taking’ the ‘Spanish Flu’.”
According to Brown, masks worn correctly and sterilized between uses prevented “micro-organisms” from spreading diseases, leading to the recommendation that the “use of the mask should become more general.”
What lessons can be learned from Virginia’s experience with masks during the 1918 influenza? First, the most important use of masks, as with any personal protective equipment, is by caretakers, including nurses, physicians and family members, who are in direct contact with sick or infected people.
Second, health officials and physicians in 1918 generally agreed that masks worked if they correctly and consistently were worn by the public, which included keeping the masks clean, avoiding contamination, and covering the nose and mouth. Third, masks seemed quite popular, as long as their use was voluntary and the epidemic was in an acute phase.
One important difference between the 1918 epidemic and our current situation is the potential for prolonged use of masks. As we enter the third month of the governor’s mandate on mask use in summer 2020, with no end in sight, we already have exceeded the length of time any American had to wear a mask in 1918.
History thus can guide us to understand the value of wearing masks to prevent the spread of disease, but we need to find a new way to live with masks as an urgent public health measure in the months — or years — ahead.
Jessica Brabble is a second-year graduate student in history at Virginia Tech. Contact her at: firstname.lastname@example.org
Ariel Ludwig recently received her doctoral degree in Science and Technology in Society (STS) from Virginia Tech. Contact her at: email@example.com
E. Thomas Ewing is a professor of history at Virginia Tech. Contact him at: firstname.lastname@example.org
More information about their flu mask research can be found at: https://sites.google.com/vt.edu/flumasks/home