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====The 1918 During the Flu Pandemic and Masks==were people punished if they did not wear masks? ==By the autumn of 1918 in the United States, it was clear the flu pandemic was becoming out of control and that surging cases across the country required public health officials to issue direct guidance for people to wear masks. For some states, masks were part of a broader set of policies such as social distancing, washing hands, and general cleanliness to avoid spreading the virus. Some cities in the Western United States, including some towns now where we see hostility to wearing masks, passed laws that required masks to be worn at all times by the autumn of 1918. These laws were implemented in places all over the United States, including Phoenix, San Francisco, and even Juneau, Alaska (Figure 1).

==Did medical professionals support wearing masks?==Nevertheless, most people or places that had rules requiring masks generally had no major issues or incidents. Only after substantial declines in deaths and infections did most of these cities gradually removed the requirement about masks.<ref>For more on laws, and ways cities got people to wear masks in the 1918 flu pandemic, see: Crosby, Alfred W. <i> America's Forgotten Pandemic: The Influenza of 1918</i>. 2nd ed. Cambridge ; New York: Cambridge University Press, 2003.</ref>

Masks in 1918, however, were criticized for both being ineffective and having a limited value in slowing the spread of the 1918 virus. The American Public Health Association in December 1918 concluded that wearing masks should be compulsory for medical staff, barbers, dentists, and other occupations that come into close contact with other individuals. Even though it was found that masks were not always effective, most of their concerns were a result of masks made from inappropriate materials or the incorrect usage of these masks. In essence, they supported the masks' use of masks, but only if they were used properly and created with the correct materials. Thus, the board recommended that only workers in close contact wear them, and others who wish to do so should be instructed on the proper way of making and wearing masks. However, a later study in 1927 showed that those who wore masks generally did help limit the spread of the 1918 virus. The study also determined many misconceptions of what masks were for, which was part of the problem.  Masks should be presented to the public as devices that help infected people spread their infection, whereas many people saw them differently and took them even to be a stigma. The study also recognized there is likely hostility in wearing masks in countries emphasizing individual freedom. The study made clear that masks should be presented as something that should be worn because it reflects the presence of a serious disease where public and community health is more important than individual rights at a given time.<ref>For more on this study looking at the effectiveness of masks in 1918, see: Jordan, Edwin. <i>Epidemic Influenza: A Survey</i>. Chicago: University of Chicago, 1927. </ref>

Thus, the board recommended that only workers in close contact wear them and others who wish ==Other Efforts Related to do so should be instructed on the proper way in making and wearing Masks==Not all cities passed such laws requiring masks. A later study in 1927 did1918, however, show that those who wore but there were still efforts to get people to wear masks generally did help . One action attempted to limit get people to wear masks by stating that the effort was patriotic since it helped prevent the spread of the 1918 virusto US soldiers. The study also determined there were many misconceptions of what masks were for pandemic severely impacted the United States troops both in the US and Europe. This effort worked because it appealed to people's patriotism and this was part of gave them a tangible way to support the problemwar effort.

Masks should be presented to the public as devices that help infected people from spreading their infectionThere were still some dissenters, whereas many people saw them differently and took them to even be a stigma. The study recognized also there is likely hostility an Anti-Mask League was formed in wearing masks in countries emphasizing individual freedomSan Francisco. The study made clear that Other cities, such as Seattle, tried appealing to people's fashion sense to get people to wear masks should be presented as something that should be worn because it reflects the presence of a serious disease where public and community health is more important than individual rights at a given time.<ref>For more on this study looking at the effectiveness of masks in 1918One newspaper, see: Jordan, Edwin. <i>Epidemic Influenza: A SurveySeattle Daily Times</i>. Chicago, even created headlines titled: "Influenza Veils Set New Fashion: University of Chicago, 1927Seattle Women Wearing Fine Mesh With Chiffon Border to Ward Off Malady. </ref>"

====Other Efforts Related to Masks====Not all cities passed such laws requiring The idea of calling them veils, rather than masks in 1918, but there were still efforts was intended to get people to wear feel they were more of a fashion item, perhaps similar to how some maskstoday are relatively decorative (Figure 1). One effort attempted to get people to wear masks by stating that Perhaps also the effort was patriotic since it helped prevent the spread of the virus to US soldiersnewspaper took liberty with interpreting them as a new fashionable trend. However, who were severely impacted some ways suggested by the pandemic both in the US and in Europe while servingnewspapers made masks useless, despite any positive intentions these newspapers had (Figure 2). This seems to have worked as it appealed to Finally, embarrassing people's patriotism and feeling of supporting were also tried by the war effortauthorities. There were still In some dissenters and even an Anti-Mask League was formed in San Francisco. Other citiesplaces, such as Seattle, did try appealing to the local newspaper printed the names of people's fashion sense as a way who were caught not wearing masks. <ref>For more direct and indirect methods used to get people to wear masks, see: Bristow, Nancy K. One newspaper, <i>Seattle Daily TimesAmerican Pandemic the Lost Worlds of the 1918 Influenza Epidemic</i>. Oxford: Oxford University Press, even created a headlines titled: "Influenza Veils Set New Fashion: Seattle Women Wearing Fine Mesh With Chiffon Border to Ward Off Malady2017." </ref>

==Why did people refuse to wear masks? ==The idea of calling them veils, rather than masks, was intended to get standard complaints people to feel did give in 1918 on why they were more of a fashion itemdid not wear masks did vary, perhaps similar to how besides the main reason being that some masks today are relatively decorative (Figure 1)saw them as impinging on their personal freedom. Perhaps also One of the newspaper took liberty with interpreting them as a new fashionable trendmost common complaints was they were hot and stuffy. Some ways suggested by newspapersbusinesses worried masks would limit sales, howeveras people would not want to wear them, made so they would not go outside and shop. Others pointed out that masks useless, despite any positive intentions were ineffective. Many of these newspapers complaints had (Figure 2). Finallysome merit, embarrassing people was another tactic usedalthough they could have been remedied or at least minimized, with some places having the local newspaper print the names of people who were caught not such as wearing a mask.<ref>For masks properly to make them more direct comfortable and indirect methods effective and providing information as to why they were being used to get people to wear masks, see: Bristow, Nancy K. <i>American Pandemic the Lost Worlds of the 1918 Influenza Epidemic</i>. Oxford: Oxford University Press, 2017for public health.</ref>

====Complaints and Concerns====The standard complaints people did give in 1918 on why they did not wear masks did vary, besides the main reason being that some saw them as impinging on their personal freedom. One of the most common complaints was they were hot and stuffy. Some businesses worried masks would limit sales, as people would not want to wear them so they would not go outside and shop. Others pointed out that mask were ineffective. Many of these complaints had merit, although they could have been remedied or at least minimized, such as wearing masks properly to make them more comfortable and effective as well as providing information as to why they were being used for public health. For instance, people were caught making holes in their masks so they could to smoke, negating the utility of a mask. Protests did spring up, including those organized by anti-mask groups such as the Anti-Mask League. Still, but generally , people complied with either the laws requiring masks to be worn or followed due to public pressure and a sense of duty.<ref>For more on complaints and concerns about masks in 1918/1919, see: Phillips. H, and David Killingray, eds. <i>The Spanish Influenza Pandemic of 1918-19: New Perspectives</i>. Routledge Studies in the Social History of Medicine 12. London ; New York: Routledge, 2003.</ref>

====Summary====The 1918 -1920 flu pandemic offers us valuable insights into efforts to get getting people to wear masks as well as and common complaints against them. Similar to today, American society debated its utility and looked at issues of personal freedom and comfort. While many concerns and issues faced are familiar to us, people were also were creative in attempting to get people to follow community health practices. This ranged from These efforts included punishment, to embarrassment, appealing to patriotism, or making wearing creating more fashionable masks a more positive experience such as fashion sense. While these tactics were not always effective, they did also generally get convinced people to mostly wear masks at least in parts of the United States such as in the West.