The American Influenza Epidemic of 1918: A Digital Encyclopedia

As in every city, it is impossible to know just how the first case of influenza was contracted in San Francisco. According to contemporary newspaper reports, however, a local man who had returned to his home after a recent trip to Chicago brought the disease to San Francisco. Learning of the case on September 23, San Francisco Health Officer Dr. William C. Hassler ordered the man to the city hospital and placed his home under quarantine. The hope was that these actions might stop the spread of the disease in its tracks, sparing San Francisco from an epidemic. However, by October 9 the city had at least 169 cases of influenza. Only a week later that number had jumped to over 2,000. San Francisco’s epidemic had started. 1

As the number of cases began to rise sharply, the city Board of Health issued a series of recommendations to the public on how best to avoid contracting influenza. City residents were advised to avoid streetcars during peak rush hour times, asked to not dance in public places and to avoid crowds, and instructed to pay particular attention to their personal hygiene as well as that of their children. Dance halls were closed. Streetcar conductors were ordered to keep the windows of their cars open in all but rainy weather, hospitals were ordered to only accept patients who absolutely required their care, and hospital physicians and nurses were instructed to wear gauze masks when with flu patients. As in nearly every other American city, the need for nurses was severe, and the board made the call for volunteers and for existing nurses to put in extra hours each day until the epidemic subsided.2

Within two days, however, the number of influenza cases in San Francisco had reached a whopping 2,179, and it became clear to Health Officer Hassler that a more drastic set of measures that those initially implemented would be required if the city were to make any headway in checking the spread of the disease. On the evening of October 17, Mayor James Rolph met with Hassler, members of the board of health, the Red Cross, the Army and the Navy, the United States Public Health Service, the United States Shipping Board, and theater, movie house, and other amusement place owners to discuss the growing epidemic and the possibility of issuing a closure order.

Hassler shared his doubts about a closure order, but suggested that a short closure order would “limit most of all the cases to the home and give the other places a chance to thoroughly clean up and thus we may bring about a condition that will reduce the number of cases.” Several in attendance felt that a general closure order would induce panic in the people, would be costly, and would not stop the spread of the epidemic. Theater owners and dance hall operators supported a closure order, hoping that it would bring a quick end to the epidemic that was already causing a drastic reduction in revenue (one owner estimated that his receipts had fallen off 40% since the start of the epidemic). After some discussion, the Board of Health voted to close all places of public amusement, ban all lodge meetings, close all public and private schools, and to prohibit all dances and other social gatherings effective at 1:00 am on Friday, October 18. The Board did not close churches, but instead recommended that services and socials be either discontinued during the epidemic or held in the open air. City police were given a list of the restrictions and directed to ensure compliance with the order. The Liberty Loan drive, always the concern of citizens as they tried to outdo other cities in fundraising, would be allowed to continue by permit, as would all public meetings. 3

Despite the closure order and gathering ban, the centerpiece of San Francisco’s crusade against influenza was the face mask. Several other cities also mandated their use, and many more recommended them for private citizens as well as for physicians, nurses, and attendants who cared for the ill. But it was San Francisco that pushed for the early and widespread use of masks as a way to prevent the spread of the dread malady. On October 18, the day that the other health measures went into effect, Hassler ordered that all barbers wear masks while with customers, and recommended clerks who came into contact with the general public also don them. The next day, Hassler added hotel and rooming house employees, bank tellers, druggists, store clerks, and any other person serving the public to the list of those required to wear masks. Citizens were again strongly urged to wear masks while in public.4 On October 21, the Board of Health met and issued a strong recommendation to all residents to wear a mask while in public.5

The wearing of a mask immediately became of a symbol of wartime patriotism. A Red Cross public service announcement stated bluntly, “the man or woman or child who will not wear a mask now is a dangerous slacker,” calling into question the patriotism of those who refused.6 The local Labor Council issued a warning that no members would be allowed to work unless they wore a mask.7 Mayor Rolph told the public that “conscience, patriotism and self-protection demand immediate and rigid compliance” with the mask order.8 California governor William Stephens echoed this language a day later with his own public service announcement, telling Californians it was the “patriotic duty for every American citizen” to wear a mask, a “duty which each citizen can easily perform to our country and our State” in a campaign against influenza that “must be fought.”9 By drawing on the rhetoric and imagery of the war effort and the heavy-handed patriotism that went along with it, city and state health officials hoped to inveigle if not outright bully residents into compliance.

It may have worked for most residents, but there were still many who refused to wear a mask. Hassler and Mayor Rolph therefore moved to make wearing a mask in public mandatory. They asked the Board of Supervisors to pass a mandatory mask ordinance as quickly as possible so that the city could “prevent half or more of the sickness and death which we are now confronted.” There were still people, they stated, who, “through failure to realize the seriousness of the menacing disease, or possibly through captiousness or disregard of the public health,” were not taking the recommendations seriously.10 The ordinance was drafted by the city attorney’s office to ensure its legality and quickly passed. Starting on October 25, every resident and visitor of San Francisco would be required to wear a mask while in public or when in a group of two or more people, except at mealtime.11

Both city officials and local newspapers reported widespread compliance with the mask order, estimating that four out of five people were wearing their masks in public even before the ordinance was passed.12 Unfortunately, many of the masks were constructed of dubious materials even more porous and ineffective than the standard surgical gauze most often used. Health officials and various mask “experts” touted the effectiveness of all sorts of materials. Woods Hutchinson, a New York-based physician who traveled the country in the fall of 1918 espousing the virtues of the face mask as a means of preventing the spread of influenza told newspaper readers in late-October that masks had been effective in the East, and that “chiffon veils for women and children have been as satisfactory as the common gauze masks,” as a way of enticing fashion-conscious women to don masks. As supplies of gauze masks ran low, the chairman of the San Francisco chapter of the American Red Cross suggested that women craft flu masks from linen. The San Francisco Chronicle described some city residents as wearing masks ranging from standard surgical gauze to creations resembling nosebags, from the Turkish-inspired muslin yashmak veil to flimsy chiffon coverings draped lazily across the mouth and nose. Some wore “fearsome looking machines like extended muzzles” on their faces as they walked the streets and shopped in downtown stores.13

For city officials, the importance was not so much in the specifics of mask construction but rather in compliance with the letter of the ordinance. While the vast majority of San Franciscans followed the mask order, police arrested one hundred and ten people on October 27 alone for failure to either wear or keep their masks properly adjusted.14 Each was charged with “disturbing the peace,” and the majority given a $5 fine, with the money to go to the Red Cross. Nine unfortunate souls arraigned before one particular judge were sentenced to short terms in the county jail. The next day, another group of fifty violators were arrested; five were sent to jail, and seven others given fines of $10 apiece. Arrests continued in the following days, with the majority receiving small fines and a few being sentenced to a few days in jail. As the city chief of police later told reporters, if too many residents were arrested and given jail terms for failure to wear their flu mask, he would quickly run out of space in his cells.15 As the days rolled on and more arrests were made, the city jail did become rather crowded, and police justices were forced to work well into the evenings and on Sundays to clear the cases.16

For some, wearing a mask was simply a nuisance, and if they believed they could get away without donning one in public they tried. Others may simply have been among those unfortunate enough to be caught during a momentary lapse or when they thought no one would notice. This was especially the case for commuters who passed through San Francisco, many of whom were caught with their masks dangling from their chins while they enjoyed a morning pipe on the ferry. One such gentleman, caught by police, explained that he was “a director of the Crocker-Woolworth Bank, and I have to hurry up to open the vault.” To ensure that there could be no excuses, the Red Cross set up a stand at the ferry terminal to sell masks to those who did not have them for their commute. Most of these cases were dismissed with a stern reprimand and a promise by the offender to be more vigilant in the future.17

While most residents caught without a mask were simply forgetful or minor transgressors, some harbored deep resentment over being forced to wear a mask while in public and made it a point to scoff the law. One woman, a downtown attorney, argued to Mayor Rolph that the mask ordinance was “absolutely unconstitutional” because it was not legally enacted, and that as a result every police officer who had arrested a mask scofflaw was personally liable.18

Meanwhile, the epidemic continued to grind on, although the number of new reported cases had begun to decline. By the end of October, San Francisco had experienced a total of nearly 20,000 cases of influenza and over 1,000 deaths. Still, the situation had improved enough for Hassler to recommend re-opening the city. On November 13 the Board of Health voted to lift the various bans starting on Saturday, November 16. Due to the high numbers of cases still being experienced in the Mission district and the North End, theaters there were kept closed for an additional week. All across the city masks had to be worn by every patron of every theater, and the order to wear masks had to be shown on screen before each performance. Hotels and restaurants could resume their musical entertainment, but no dancing was allowed.19 Schools did not re-open until November 25. In a double blow to children, the holiday break was shortened and the school day extended by 20 minutes in elementary schools and 45 minutes in high schools.20

After having been starved of most entertainment outlets for a month, San Franciscans packed the city’s theaters, movie houses, and sports arenas. On the first day they were allowed to re-open their doors the downtown theaters all held charity performances, with proceeds going to the United War Work campaign. The Orpheum sold out all of its shows as Roscoe “Fatty” Arbuckle, a frequenter of San Francisco and an acquaintance of Mayor Rolph, made an appearance and influential San Francisco banker and son of a forty-niner William H. Crocker donated $500. The Hippodrome was at capacity all day, and both the Alcazar and the Curran opened to similarly full houses.21 At the Civic Auditorium, the boxing crowd gathered to watch Fred Fulton win an easy decision over Willie Meehan. In attendance were several notable sporting men of the city, including several supervisors, a congressman, a justice, a Navy rear-admiral, Mayor Rolph, and Health Officer Hassler. The men were so easily identified because none was wearing a mask, as still required by law. All were caught on film by a police photographer, who sent copies of the prints to his chief for further action. Hassler paid a $5 fine on the spot, admitting that his mask may have dropped a bit while he was smoking a cigar. Several days later, Mayor Rolph was shown a photograph of his unmasked visage and fined $50 by his own police chief.22

At noon on November 21, San Franciscans simultaneously removed their masks as a whistle-blow sounded across the city, the result of Mayor Rolph’s annulment of the ordinance the previous day.23 Requests by the health department to conserve gauze amounted to little as residents joyously ripped the hated masks from their faces and unceremoniously tossed them in the streets. As the Chronicle aptly described the scene, “the sidewalks and runnels were strewn with the relics of a torturous month.”24 The order to hold fast until noon was taken seriously, as one man found out when he tried to blow his unmasked nose just seconds before 12:00, only to be yelled at by a nearby police officer to “Cover your mouth, mister!”25

The celebrations were unfortunately short-lived. On December 7, Mayor Rolph, after being informed by Hassler of a slight recrudescence of the disease, publicly declared that influenza was once again epidemic in San Francisco and requested that residents once again don their masks. Hassler believed that the epidemic had been stamped out, and that the new cases were the result of infectious outsiders from other parts of the state entering San Francisco. Business closures and a gathering bans were not considered, as it was believed that re-masking would be all that was necessary to rid the city of the disease once and for all.26

When the number of new cases being reported to health authorities dipped slightly, it gave all involved hope that a second peak was not on its way. Hassler, the Board of Supervisors, and a small committee of representatives from the business community met and decided that a second mandatory mask order was not necessary for the time being but that citizens be warned to voluntarily wear masks.27 The reprieve was only temporary. On January 10, with over 600 new influenza cases reported for the day, the Board of Supervisors voted to re-enact the mask ordinance beginning January 17, despite strong evidence that, as one newspaper put it, “the compulsory wearing of masks does not affect the progress of the epidemic.28

Once again, San Franciscans put on their flu masks, and once again complaints were lodged. One man wrote Hassler that masks served no purpose, adding that if the health officer wished to wear a mask he could freely do so, “and as far as I am concerned, I hope he will have to wear one for the next five years.” He opined that the mask ordinance stood on shaky legal ground, and that it would likely be dissolved if the issue were brought before the courts.29 Sentiment was so strong against the mask that several influential San Franciscans, including a few physicians as well as a member of the Board of Supervisors, formed “The Anti-Mask League” which held at least one public meeting to denounce the ordinance and to discuss ways to put an end to it. Over 2,000 people attended the event.30

On February 1 mask detractors got their wish. Mayor Rolph once again proclaimed the mask ordinance rescinded following a meeting of the Board of health, which determined that the epidemic situation had improved enough that the measure was no longer necessary.31 Without fanfare but relieved to be rid of the masks as well as the epidemic, San Franciscans removed their gauze coverings and went about their business as families, organizations, institutions, and the city slowly pieced back together life as it existed before the plague.

The epidemic brought nearly 45,000 cases of influenza to San Francisco and killed over 3,000 of its residents in the fall of 1918 and the winter of 1919. On numerous occasions throughout the fall of 1918 and winter of 1919, Hassler had made statements that San Francisco was the only large city in the entire world to check its epidemic so quickly. By mid-February 1919, however, when the United States Public Health Service released figures on the nation’s epidemic, it became clear that Hassler had been wrong: San Francisco was reported as having suffered the most of all major American cities, with a death rate approaching 30 deaths per 1,000 people.32 With more complete and accurate data today, we now know

that San Francisco fared slightly better. Still, the city's total excess death rate

due to influenza and pneumonia during the epidemic was a whopping 673 per