Then & Now | Face masks’ wide public use began with Spanish flu, and soon embroidered ones became popular

There’s nothing new about wearing face masks to combat the spread of disease – reusable, patterned cloth ones were worn by many in the Spanish flu epidemic

The practice spread widely, even to rural Australia, as this writer was reminded on a visit to an elderly godmother soon after the Sars outbreak ended in 2003

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Barbershop staff wear face masks for protection during the Spanish flu oubtreak that swept the world between 1918 and 1921. Photo: Bettmann Archive via Getty Images

Jason Wordie

Published: 8:45am, 8 Mar 2022

The Spanish flu epidemic, which broke out in 1918 and claimed tens of millions of lives by the time it finally subsided, in 1921, first brought the concept of face masks to the world’s attention.

Hitherto seen only in operating theatres and similar medical settings, this earlier global pandemic helped make populations aware that forms of nose and mouth covering, such as face masks, helped reduce the spread of highly transmissible infectious diseases.

Broader public health lessons from the Spanish flu epidemic had been generally absorbed by the 1930s; among the hygiene-conscious Japanese, in particular, along with parts of East Asia influenced by Japanese cultural norms, such as Korea and Formosa (now Taiwan), face masks became commonplace among anyone with respiratory infections liable to cause coughing and spitting.

Influenza was not the only disease where face masks were deployed in an effort to “flatten the infection curve”. During the wartime Japanese occupation of Hong Kong, a sudden diphtheria outbreak in the Sham Shui Po prisoner-of-war camp swiftly led to quarantine of patients in specific huts to help break the chain of infection.

A street sweeper wears a cloth face mask while working during the 1918 influenza pandemic in New York. Photo: Gado/Getty Images

Confirmed cases were isolated, and camp-produced masks, made from white cotton, gauze or other fabrics, were worn by all those undergoing quarantine, and anyone else who came into close contact with them. These masks were sterilised by boiling before reuse. Scarce resources meant single-use disposability – the norm today for such items – was impossible.

Face masks also became commonplace during the Spanish flu epidemic in some seemingly unlikely places. Not long after Hong Kong’s severe acute respiratory syndrome (Sars) outbreak subsided in 2003, I visited my elderly godmother in rural Queensland.

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