Vintage photos of masked individuals and crowds during the 1918 influenza pandemic have been circulating in news stories and on social media. What I find particularly interesting is that they all seem to wearing very similar masks, consisting of a white, rectangle and two ties, like this one worn by barbers:

Or this mask, covering the face of an elevator operator:

Why are they all so alike, especially considering the diversity of homemade and store-bought masks in our current reality?

Two factors explained the uniformity in masks then (and lack thereof now). First, many of the masks were created and distributed by Red Cross volunteers. And when people had to make their own masks, they could follow the straightforward, Red Cross-issued instructions that encouraged the use of white gauze and ties. Sample masks to be used as demos were sent to local chapters. Before masks were required, people were encouraged to use handkerchiefs, but this doesn’t appear to be as common as the gauze coverings.

The Red Cross was heavily involved in directly and indirectly caring for influenza patients. Newspapers encouraged people to do their part to help the sick, especially ill enlisted men. And they did. Volunteers donated chicken, rags, pajamas, canned jellies and fruits, and other items.

And when did wearing masks become required during the Spanish Flu? Not as quickly as some “Spanish Flu as a Lesson”-type stories may lead you to believe (messages that have been using as cautionary tales for the current pandemic. I debunk one here). In 1918, many folks were still getting used to the concept of sanitary practices in the hospital. This April 1918 gem explains why nurses sometimes wear face masks to care for contagious patients.

It wasn’t common practice for the general public to wear masks then (or now, at non-pandemic times). Doctors and nurses masked up during the spring outbreaks in the military camps (downplayed and ignored by media). No evidence suggests that regular people wore masks during this time.

In the summer of 1918, news media reported on the deadly disease as it spread through Asia and then Europe. However, nothing suggests that the U.S. prepped for influenza to come home. Articles focused on a different type of protection — the gas mask — needed to protect soldiers from poison gas attacks in the trenches.

Warnings of the impending influenza appeared in July. At the end of the month, 5 cases were documented at Camp Eberts in Arkansas, but incidence remained low for the next month. August newspapers documented illness and deaths aboard ships headed for the U.S.

As ships were being quarantined at New York and other ports, September 13th, Public Health Reports published the Navy’s preparation plan for handling the epidemic, including “Methods for the control of the disease.” Quarantine and isolation, at least for the Navy, were deemed “impracticable” due to the prevalence of healthy carriers. The final section advised mask-wearing for patient attendants and discouraged gatherings:

Excerpts of this report were published in newspapers across the country, paired with stories of rising cases, for the next few months.

By mid-September, influenza had become epidemic in some of the army camps and continued to spread across the country. On September 18, the Richmond Times-Dispatch reported that the local Red Cross chapter had requested 4,000 face masks for caregivers the previous day. The next day, a Connecticut paper recommended masks made from gauze for those near influenza patients.

Over the next two weeks, reports of Red Cross volunteers producing masks for nurses and other influenza attendants in military camps increased, as did cases of influenza. Still, there was no indication that regular people had started wearing face masks, nor had quarantine (outside of ports) been implemented.

Approximately 23,000 cases had erupted at military camps before soldiers were advised to wear masks while training. Female volunteers made them for the Red Cross, producing an average of 1 every 5 minutes. Cases of influenza reached epidemic levels in 26 states before it became common for even enlisted men to wear masks.

Like we’ve experienced in the last three months, society shut down before masks became required. Similar to now, restrictions varied by city and state. Flu mask ordinances were implemented primarily in November and December, as barber shops, theaters, and other crowded places began to open. In some places, everyone was required to wear masks. More often, though, care attendants, those in recovery, barbers, and elevator operators were required to don masks, while others were simply encouraged, especially those riding on street cars.

Contrary to numerous social media posts and contemporary articles on “Spanish Flu,” mask-wearing did not occur immediately, nor was it universally required and accepted. That said, the wide distribution of masks by the Red Cross made them much more accessible, especially for those enlisted and/or caring for patients.

Note: In researching for this blog post, I examined newspaper coverage using the search terms “masks” and “influenza” from March through December 1918 (and beyond). I weeded through numerous articles about gas masks. Even at the height of the pandemic, war news dominated media outlets.