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{"id":21004,"date":"2021-04-22T11:30:41","date_gmt":"2021-04-22T15:30:41","guid":{"rendered":"https:\/\/circulatingnow.nlm.nih.gov\/?p=21004"},"modified":"2024-11-13T14:28:17","modified_gmt":"2024-11-13T19:28:17","slug":"probably-of-great-value-potentially-masks-in-the-us-military-during-the-1918-pandemic","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2021\/04\/22\/probably-of-great-value-potentially-masks-in-the-us-military-during-the-1918-pandemic\/","title":{"rendered":"\u201cProbably of Great Value Potentially\u201d: Masks in the US Military during the 1918 Pandemic"},"content":{"rendered":"<p><em>Circulating Now welcomes guest bloggers E. Thomas Ewing, Jessica Brabble, Ariel Ludwig, Linsey C. Marr, Katherine Randall to discuss their historical research around the reality of how masks were actually used in the military in 1918 and how their effectiveness was evaluated in contemporary reports.<br \/>\n<\/em><\/p>\n<p>During the 1918 influenza epidemic, the US military responded to infectious disease outbreaks with preventive or containment measures including isolation wards, <a href=\"https:\/\/circulatingnow.nlm.nih.gov\/2020\/11\/11\/revealing-data-flu-masks-on-ships-1918\/\">masks<\/a>, improved sanitation, health checks, and quarantine requirements. The use of masks was documented in photographs of patients, nurses, and doctors and the effectiveness of masks was evaluated in studies published after war.<\/p>\n<figure id=\"attachment_21012\" aria-describedby=\"caption-attachment-21012\" style=\"width: 228px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"21012\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2021\/04\/22\/probably-of-great-value-potentially-masks-in-the-us-military-during-the-1918-pandemic\/base-hospital-82_101447471\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?fit=912%2C1200&ssl=1\" data-orig-size=\"912,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Base Hospital 82: Pneumonia ward, showing method of isolation-cubical system.\" data-image-description=\"<p>Caption on Photo reads: Pneumonia ward, showing method of isolation-cubical system.<\/p>\n\" data-image-caption=\"<p>U.S. Army. Base Hospital No. 82, Toul, France: Pneumonia ward, ca. 1918<br \/>\nNational Library of Medicine #101447471 <\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?fit=228%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?fit=778%2C1024&ssl=1\" class=\"wp-image-21012 size-medium\" title=\"Base Hospital 82: Pneumonia ward, showing method of isolation-cubical system.\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?resize=228%2C300&ssl=1\" alt=\"Seven staff male and female in white smocks and masks pose in a room with beds separated by sheets.\" width=\"228\" height=\"300\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?resize=228%2C300&ssl=1 228w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?resize=778%2C1024&ssl=1 778w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?resize=768%2C1011&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?resize=840%2C1105&ssl=1 840w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471.jpg?w=912&ssl=1 912w\" sizes=\"auto, (max-width: 228px) 100vw, 228px\" \/><\/a><figcaption id=\"caption-attachment-21012\" class=\"wp-caption-text\">U.S. Army. Base Hospital No. 82, Toul, France: Pneumonia ward, ca. 1918<br \/><a href=\"http:\/\/resource.nlm.nih.gov\/101447471\"><em>National Library of Medicine #101447471<\/em><\/a><\/figcaption><\/figure>\n<p>A photograph from <a href=\"http:\/\/resource.nlm.nih.gov\/101447471\">Base Hospital No. 82<\/a>, Toul, France, shows two women and four men wearing masks (Illustration 1). Although undated, the photograph was likely from October 1918, when this hospital treated more than five hundred patients with acute respiratory infections. A closer look at the photograph, however, reveals that all of the masks were worn incorrectly, as noses were not fully covered. Photographs like these provide evidence of the differences between theory and practice and help us better understand how the imperfect implementation of masks as a public health measure made judging their effectiveness after the fact difficult.<\/p>\n<p>In the influenza ward at <a href=\"https:\/\/collections.nlm.nih.gov\/catalog\/nlm:nlmuid-101397930-img\">Base Hospital No. 88<\/a>, seven patients stand next to their beds, yet not one is wearing a mask. In the pneumonia ward at <a href=\"https:\/\/collections.nlm.nih.gov\/catalog\/nlm:nlmuid-101397931-img\">Base Hospital No. 88<\/a>, nine patients and one nurse are clearly not wearing masks (Illustration 2) In the influenza ward at <a href=\"https:\/\/collections.nlm.nih.gov\/catalog\/nlm:nlmuid-101398797-img\">Camp Hospital No. 24<\/a>, six patients and one nurse are not wearing masks (Illustration 3). In fact, fully masked patients or medical staff appear in relatively few of the photographs of army hospitals. A photograph of the pneumonia ward at <a href=\"https:\/\/collections.nlm.nih.gov\/catalog\/nlm:nlmuid-101398839-img\">Camp Hospital No. 24<\/a> is unusual in showing one patient and two nurses wearing masks fully covering their noses and mouths.<\/p>\n<div data-carousel-extra='{\"blog_id\":1,\"permalink\":\"https:\\\/\\\/circulatingnow.nlm.nih.gov\\\/2021\\\/04\\\/22\\\/probably-of-great-value-potentially-masks-in-the-us-military-during-the-1918-pandemic\\\/\"}' id='gallery-1' class='gallery galleryid-21004 gallery-columns-2 gallery-size-medium'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/circulatingnow.nlm.nih.gov\/2021\/04\/22\/probably-of-great-value-potentially-masks-in-the-us-military-during-the-1918-pandemic\/camp-hospital-24_101398797\/'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"227\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?fit=300%2C227&ssl=1\" class=\"attachment-medium size-medium\" alt=\"A large open tiled room with high windows and cots along all the walls, patients and staff look at the camera.\" aria-describedby=\"gallery-1-21015\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?w=1600&ssl=1 1600w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?resize=300%2C227&ssl=1 300w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?resize=1024%2C774&ssl=1 1024w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?resize=768%2C581&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?resize=1536%2C1162&ssl=1 1536w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?resize=200%2C150&ssl=1 200w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?resize=1200%2C908&ssl=1 1200w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?resize=840%2C635&ssl=1 840w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" data-attachment-id=\"21015\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2021\/04\/22\/probably-of-great-value-potentially-masks-in-the-us-military-during-the-1918-pandemic\/camp-hospital-24_101398797\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?fit=1600%2C1210&ssl=1\" data-orig-size=\"1600,1210\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Camp Hospital 24\" data-image-description=\"\" data-image-caption=\"<p>U. S. Army Camp Hospital No. 24, Langres, France: Influenza ward, ca. 1918<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?fit=300%2C227&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Camp-Hospital-24_101398797.jpg?fit=840%2C635&ssl=1\" \/><\/a>\n\t\t\t<\/div>\n\t\t\t\t<figcaption class='wp-caption-text gallery-caption' id='gallery-1-21015'>\n\t\t\t\tU. S. Army Camp Hospital No. 24, Langres, France: Influenza ward, ca. 1918\n\t\t\t\t<\/figcaption><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/circulatingnow.nlm.nih.gov\/2021\/04\/22\/probably-of-great-value-potentially-masks-in-the-us-military-during-the-1918-pandemic\/base-hospital-88_101397931\/'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"231\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?fit=300%2C231&ssl=1\" class=\"attachment-medium size-medium\" alt=\"In a long wood floored room lined with beds separated by sheets people pose sitting at the foot of the beds.\" aria-describedby=\"gallery-1-21014\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?w=1559&ssl=1 1559w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?resize=300%2C231&ssl=1 300w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?resize=1024%2C788&ssl=1 1024w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?resize=768%2C591&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?resize=1536%2C1182&ssl=1 1536w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?resize=1200%2C924&ssl=1 1200w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?resize=840%2C647&ssl=1 840w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" data-attachment-id=\"21014\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2021\/04\/22\/probably-of-great-value-potentially-masks-in-the-us-military-during-the-1918-pandemic\/base-hospital-88_101397931\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?fit=1559%2C1200&ssl=1\" data-orig-size=\"1559,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Base Hospital 88\" data-image-description=\"\" data-image-caption=\"<p>U.S. Army. Base Hospital No.88, Langres, France: Pneumonia Ward, ca. 1918<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?fit=300%2C231&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-hospital-88_101397931.jpg?fit=840%2C646&ssl=1\" \/><\/a>\n\t\t\t<\/div>\n\t\t\t\t<figcaption class='wp-caption-text gallery-caption' id='gallery-1-21014'>\n\t\t\t\tU.S. Army. Base Hospital No.88, Langres, France: Pneumonia Ward, ca. 1918\n\t\t\t\t<\/figcaption><\/figure>\n\t\t<\/div>\n\n<p>All together, we looked at fifteen photographs from a dozen hospitals that depict <a href=\"https:\/\/www.shgape.org\/the-mask-law-will-be-rigidly-enforced\/\">actual mask use<\/a>. Of the 87 people (65 patients and 22 medical staff) in the photographs, 16% are wearing masks correctly, 5% are wearing masks incorrectly, and 79% are not wearing masks at all. Medical staff were more likely to wear masks: 36% of nurses, doctors, and orderlies wore masks, as compared to just 9% of patients (chart 1). Given all that we have learned in the past year about how masks prevent infection, the relative absence of masks during the 1918 epidemic is quite striking.<\/p>\n<figure id=\"attachment_21011\" aria-describedby=\"caption-attachment-21011\" style=\"width: 840px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"21011\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2021\/04\/22\/probably-of-great-value-potentially-masks-in-the-us-military-during-the-1918-pandemic\/military-masks-chart-1\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?fit=1205%2C862&ssl=1\" data-orig-size=\"1205,862\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Military Masks Chart 1\" data-image-description=\"<p>87.7% of patients and 54.5% of staff wear no masks.<br \/>\n9.2% of patients and 36.4% of staff wear masks correctly.<br \/>\nThe remainder wear masks incorrectly.<\/p>\n\" data-image-caption=\"<p>Masks in Military Camps (65 patients, 22 medical staff)<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?fit=300%2C215&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?fit=840%2C601&ssl=1\" class=\"wp-image-21011 size-large\" title=\"87.7% of patients and 54.5% of staff wear no masks. 9.2% of patients and 36.4% of staff wear masks correctly. The remainder wear masks incorrectly.\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?resize=840%2C601&ssl=1\" alt=\"A chart compares 9.2% of patients and 36.4% of staff shown wearing masks in historical photographs.\" width=\"840\" height=\"601\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?resize=1024%2C733&ssl=1 1024w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?resize=300%2C215&ssl=1 300w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?resize=768%2C549&ssl=1 768w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?resize=1200%2C858&ssl=1 1200w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?resize=840%2C601&ssl=1 840w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Military-Masks-Chart-1.png?w=1205&ssl=1 1205w\" sizes=\"auto, (max-width: 840px) 100vw, 840px\" \/><\/a><figcaption id=\"caption-attachment-21011\" class=\"wp-caption-text\">Masks in Military Camps (65 patients, 22 medical staff)<\/figcaption><\/figure>\n<p>This evidence of inconsistency in mask behavior partially explains the mixed conclusions regarding mask effectiveness in US military reports following the epidemic. The authoritative history, <a href=\"https:\/\/collections.nlm.nih.gov\/catalog\/nlm:nlmuid-14120390R-mvset\"><em>The Medical Department of the United States Army in the World War<\/em><\/a> introduces the section, \u201c<a href=\"https:\/\/collections.nlm.nih.gov\/bookviewer?PID=nlm:nlmuid-14120390RX9-mvpart#page\/122\/mode\/1up\/search\/value+of+face+masks+worn+by+the+whole+of+a+command+has+been+the+subject+of+much+argument\">Use of the Mask<\/a>,\u201d by acknowledging that the \u201cvalue of face masks worn by the whole of a command has been the subject of much argument.\u201d (p.118) While it \u201cappears to be generally conceded that the use of the mask by attendants on the sick, exposed constantly to infection, is of value,\u201d the study called attention to the fact that \u201cattendants, especially nurses,\u201d were disproportionately \u201cattacked,\u201d even though they regularly wore masks. The report offers an ambivalent recommendation about masks in medical facilities: \u201cUnder these circumstances judgment as to the value of the mask becomes difficult.\u201d<\/p>\n<p>A review of mask mandates for camps and bases leads to even more equivocal conclusions. Statistics from US facilities found that 51% of 41 camps using masks and 52% of 77 camps not using masks reported above average rates of influenza, leading to this assessment after the war:<\/p>\n<blockquote><p>\u201cIt is evident that the mask may be an efficient means of limiting the spread of infection. It is equally evident that unless the necessary conditions are fulfilled in the construction and wearing of the mask it may be useless\u2026. For this reason, statistics as to the results attained in the general use of the mask in Army camps during the epidemic are of doubtful value.\u201d (<a href=\"https:\/\/collections.nlm.nih.gov\/bookviewer?PID=nlm:nlmuid-14120390RX9-mvpart#page\/122\/mode\/2up\/search\/value+of+face+masks+worn+by+the+whole+of+a+command+has+been+the+subject+of+much+argument\">pp.119-120<\/a>)<\/p><\/blockquote>\n<p>Yet the report also conceded that \u201cno one has expressed the opinion that the mask properly used can do harm,\u201d while \u201cexperimental evidence points to the probability of its usefulness.\u201d The title of this essay is derived from this report\u2019s strikingly ambivalent determination that \u201cthe mask is probably of great value potentially.\u201d (pp.119-120)<\/p>\n<p>The <a href=\"https:\/\/catalog.hathitrust.org\/Record\/009702537\"><em>Annual Report of the Surgeon General of the US Navy<\/em><\/a> reached the even more critical conclusion that wearing masks was \u201cnot a practicable measure and little or no good was accomplished.\u201d (p. 433) The concerns began with the design but also included criticism about behaviors that compromised their effectiveness:<\/p>\n<blockquote><p>\u201cMasks of improper design, made of wide-mesh gauze, which rest against the mouth and nose, become wet with saliva, soiled with the fingers, and are changed infrequently, may lead to infection rather than prevent it, especially when worn by persons who have not even a rudimentary knowledge of the modes of transmission of the causative agents of communicable disease.\u201d (<a href=\"https:\/\/babel.hathitrust.org\/cgi\/pt?id=hvd.32044004485355&view=1up&seq=758\">p. 434<\/a>)<\/p><\/blockquote>\n<p>Although \u201con theoretical grounds it is good practice to require those who visit, examine, or wait upon the sick to wear masks,\u201d results from medical facilities were not conclusive. At the Naval Training Station at Great Lakes, Illinois, only 14% of medical staff wore masks, yet their infection rate of 8.3% was higher than the 7.9% rate for those not wearing masks. The Navy Surgeon General report concluded that \u201cthe use of masks in barracks is not a practicable measure of value under ordinary routine conditions\u201d and thus recommended against \u201ccompelling persons at large to wear masks during an epidemic.\u201d (p. 434)<\/p>\n<p>While these broad surveys were unable to find conclusive evidence about mask effectiveness, reports at the local level tended to credit masks along with other measures for controlling the disease. At Base Hospital No. 58, according to the <a href=\"https:\/\/catalog.hathitrust.org\/Record\/005639085\">Army Surgeon General\u2019s Annual Report<\/a>, all patients were \u201cmasked upon admittance\u201d and required to \u201cwear masks as long as sick in the hospital.\u201d This measure, along with isolating infectious disease cases and practicing good hygiene, was credited with keeping infection rates low. At Base Hospital No. 80, \u201cthe cubical [sic] and mask system of handling all respiratory cases as well as contagious cases was installed as soon as we began receiving patients, and a good deal of the credit must be given to this measure for the good results obtained.\u201d (pp. 1998-1989) At the Philadelphia Navy Yard, where the medical officer \u201cordered that gauze masks be made and distributed among the yard employees,\u201d the <a href=\"https:\/\/catalog.hathitrust.org\/Record\/009702537\">Navy Surgeon General\u2019s<\/a> report concluded that \u201cthere is good reason to believe that this procedure contributed largely to the preservation of the health of the employees, as not one department or portion of a department in the yard was forced to slacken its work in the least.\u201d (p. 300)<\/p>\n<p>These photographs and reports indicate that the use of masks during the 1918 epidemic was neither universally practiced nor uniformly evaluated. By contrast, public health experts in 2020-2021 have consistently <a href=\"https:\/\/www.cdc.gov\/covid\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/prevent-getting-sick\/diy-cloth-face-coverings.html\">endorsed the use of masks<\/a> and mask mandates have been widely imposed, although these measures have been publicly contested and occasionally disregarded. Evidence from the 1918 epidemic leads to three conclusions: first, the main challenge is explaining why this change in behavior is so vital to protecting the health of all; second, <a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/science\/science-briefs\/masking-science-sars-cov2.html\">understanding how masks work<\/a> to filter droplets and aerosols can be persuasive for individuals and policy-makers; and third, masks will not work if they are not worn correctly and consistently. The cognitive dissonance we feel when looking at photographs of unmasked patients and staff in infectious disease wards a century ago is a reminder of why we now <a href=\"https:\/\/www.cdc.gov\/covid\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/prevent-getting-sick\/i-wear-a-mask-because.html\">choose to wear masks<\/a> in any situation with the potential for infection.<\/p>\n<div style=\"text-align: justify; padding-bottom: 20px;\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2013\/10\/e_thomas_ewing.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"2106\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2013\/11\/05\/exploring-chicagos-spanish-flu-of-1918\/e_thomas_ewing\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2013\/10\/e_thomas_ewing.jpg?fit=240%2C294&ssl=1\" data-orig-size=\"240,294\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":""}\" data-image-title=\"E_Thomas_Ewing\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2013\/10\/e_thomas_ewing.jpg?fit=240%2C294&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2013\/10\/e_thomas_ewing.jpg?fit=240%2C294&ssl=1\" class=\"alignleft wp-image-2106\" title=\"E. Thomas Ewing\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2013\/10\/e_thomas_ewing.jpg?resize=93%2C114&ssl=1\" alt=\"Portrait of Tom Ewing outside.\" width=\"93\" height=\"114\" \/><\/a><em>E. Thomas Ewing is a professor of history at Virginia Tech, with research interests in the history of influenza epidemics. In 2018, he directed a <\/em><a href=\"https:\/\/circulatingnow.nlm.nih.gov\/2018\/01\/23\/the-evolution-of-viral-networks-h1n1-ebola-and-zika\/\"><em>summer workshop<\/em><\/a><em> on the 1918 influenza epidemic funded by the National Endowment for the Humanities in partnership with the History of Medicine Division, National Library of Medicine. <\/em><a href=\"https:\/\/twitter.com\/EThomasEwing\"><em>@ethomasewing<\/em><\/a><\/div>\n<div style=\"text-align: justify; padding-bottom: 70px;\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Jessica-Brabble.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"20147\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2020\/11\/11\/revealing-data-flu-masks-on-ships-1918\/jessica-brabble\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Jessica-Brabble.jpg?fit=698%2C800&ssl=1\" data-orig-size=\"698,800\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Jessica-Brabble\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Jessica-Brabble.jpg?fit=262%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Jessica-Brabble.jpg?fit=698%2C800&ssl=1\" class=\"alignleft wp-image-20147\" title=\"Jessica Brabble\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Jessica-Brabble.jpg?resize=93%2C107&ssl=1\" alt=\"An informal portrait of a young woman outdoors.\" width=\"93\" height=\"107\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Jessica-Brabble.jpg?resize=262%2C300&ssl=1 262w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Jessica-Brabble.jpg?w=698&ssl=1 698w\" sizes=\"auto, (max-width: 93px) 100vw, 93px\" \/><\/a><em>Jessica Brabble is a second-year graduate student in history at Virginia Tech , with research interests in disability history, the history of popular culture, and entertainment history. <a href=\"https:\/\/twitter.com\/jmbrabbs\">@jmbrabbs<\/a><br \/>\n<\/em><\/div>\n<div style=\"text-align: justify; padding-bottom: 80px;\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Ariel-Ludwig.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"20146\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2020\/11\/11\/revealing-data-flu-masks-on-ships-1918\/ariel-ludwig\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Ariel-Ludwig.jpg?fit=360%2C480&ssl=1\" data-orig-size=\"360,480\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Ariel Ludwig\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Ariel-Ludwig.jpg?fit=225%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Ariel-Ludwig.jpg?fit=360%2C480&ssl=1\" class=\"alignleft wp-image-20146\" title=\"Ariel Ludwig \" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Ariel-Ludwig.jpg?resize=93%2C124&ssl=1\" alt=\"A young woman in glasses.\" width=\"93\" height=\"124\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Ariel-Ludwig.jpg?resize=225%2C300&ssl=1 225w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Ariel-Ludwig.jpg?resize=300%2C400&ssl=1 300w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Ariel-Ludwig.jpg?resize=150%2C200&ssl=1 150w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/11\/Ariel-Ludwig.jpg?w=360&ssl=1 360w\" sizes=\"auto, (max-width: 93px) 100vw, 93px\" \/><\/a><em>Ariel Ludwig recently received her doctoral degree in Science and Technology in Society (STS) from Virginia Tech. Her research addresses the intersection of medicine, public health, and the criminal justice system.<\/em><\/div>\n<div style=\"text-align: justify; padding-bottom: 40px;\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Marr-2020-Mask.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"20049\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2020\/10\/22\/droplet-infection-explained-in-pictures\/marr-2020-mask\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Marr-2020-Mask.jpg?fit=740%2C800&ssl=1\" data-orig-size=\"740,800\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Marr-2020-Mask\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Marr-2020-Mask.jpg?fit=278%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Marr-2020-Mask.jpg?fit=740%2C800&ssl=1\" class=\"alignleft wp-image-20049\" title=\"Linsey C. Marr\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Marr-2020-Mask.jpg?resize=93%2C100&ssl=1\" alt=\"A woman wearing a cloth facemask stands outdoors.\" width=\"93\" height=\"100\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Marr-2020-Mask.jpg?resize=278%2C300&ssl=1 278w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Marr-2020-Mask.jpg?w=740&ssl=1 740w\" sizes=\"auto, (max-width: 93px) 100vw, 93px\" \/><\/a><em>Linsey C. Marr is the Charles P. Lunsford Professor of civil and environmental engineering at Virginia Tech. She studies the airborne transmission of viruses and applies interdisciplinary approaches to study pollutants in indoor and outdoor air. She received an <\/em><a href=\"https:\/\/commonfund.nih.gov\/newinnovator\"><em>NIH New Innovator Award<\/em><\/a><em> in 2013. <\/em><a href=\"https:\/\/twitter.com\/linseymarr\"><em>@linseymarr<\/em><\/a><\/div>\n<div style=\"text-align: justify; padding-bottom: 60px;\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Randall_-2020-Mask.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"20050\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2020\/10\/22\/droplet-infection-explained-in-pictures\/randall_-2020-mask\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Randall_-2020-Mask.jpg?fit=740%2C800&ssl=1\" data-orig-size=\"740,800\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Randall_-2020-Mask\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Randall_-2020-Mask.jpg?fit=278%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Randall_-2020-Mask.jpg?fit=740%2C800&ssl=1\" class=\"alignleft wp-image-20050\" title=\"Katherine Randall\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Randall_-2020-Mask.jpg?resize=93%2C100&ssl=1\" alt=\"A woman wearing a cloth facemask in an interior room.\" width=\"93\" height=\"100\" srcset=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Randall_-2020-Mask.jpg?resize=278%2C300&ssl=1 278w, https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2020\/10\/Randall_-2020-Mask.jpg?w=740&ssl=1 740w\" sizes=\"auto, (max-width: 93px) 100vw, 93px\" \/><\/a><em>Katherine Randall is a doctoral candidate in the Rhetoric and Writing program at Virginia Tech. Her research focuses on medical rhetoric and health communication. In 2018, she and Dr. Ewing co-edited <\/em><a href=\"https:\/\/www.nlm.nih.gov\/news\/Open_Access_Book_Now_Available.html\">Viral Networks: Connecting Digital Humanities and Medical History<\/a><em>, which grew out of an interdisciplinary <\/em><a href=\"https:\/\/circulatingnow.nlm.nih.gov\/2018\/01\/23\/the-evolution-of-viral-networks-h1n1-ebola-and-zika\/\"><em>workshop<\/em><\/a><em> hosted by the History of Medicine Division of the National Library of Medicine. <\/em><a href=\"https:\/\/twitter.com\/katierandall\"><em>@katierandall<\/em><\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Circulating Now welcomes guest bloggers E. Thomas Ewing, Jessica Brabble, Ariel Ludwig, Linsey C. Marr, Katherine Randall to discuss their<\/p>\n","protected":false},"author":19605840,"featured_media":21013,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"\u201cProbably of Great Value Potentially\u201d: Masks in the US Military during the 1918 Pandemic #histmed","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[12763,51014],"tags":[273907,678875829,22379,541876,136219,488,12074,569498],"class_list":["post-21004","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-collections","category-guests","tag-1900s","tag-covid-19","tag-data","tag-digital-humanities","tag-epidemic","tag-military","tag-photograph","tag-spanish-flu"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2021\/04\/Base-Hospital-82_101447471_feature.jpg?fit=900%2C401&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3xcDk-5sM","jetpack-related-posts":[],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/21004","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/users\/19605840"}],"replies":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/comments?post=21004"}],"version-history":[{"count":24,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/21004\/revisions"}],"predecessor-version":[{"id":45716,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/21004\/revisions\/45716"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media\/21013"}],"wp:attachment":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media?parent=21004"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/categories?post=21004"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/tags?post=21004"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}} |