California State Board of Health, 1920: "Masks have not been proved efficient enough to warrant compulsory application"

Share this:

---

NoMask.info

As I have previously reported, California Governor Gavin Newsom is obsessed with the 'Anti-Mask Brigade' of 1918. He often invokes their opposition to masks in his speeches, warns that history repeats itself, and claims that wearing masks contributed a great deal to the eradication and control of the Spanish flu.

But are Gavin's claims true?

No. They are proven false by none other than the California State Board of Health and W. H. KELLOGG, M. D.

Please share this report widely. As the saying goes, those who don't learn from (actual) history are bound to repeat it.

The following are very interesting excerpts from a 100-year-old report published in The American Journal of Public Health entitled 'AN EXPERIMENTAL STUDY OF THE EFFICACY OF GAUZE FACE MASKS' by W. H. KELLOGG, M. D., Secretary and Executive Officer, California State Board of Health, AND MISS GRACE MACMILLAN, Bacteriologist in the State Hygienic Laboratory.

The very first paragraph declares:

"Masks have not been proved efficient enough to warrant compulsory application for the checling of epidemics, according to Dr. Kellogg, who has conducted a painstaking investigation with gauzes. This investigation is scientific in character, omitting no one of the necessary factors. It ought to settle the much argued question of masks for the public."

At the end of the report, six conclusions are listed:

CONCLUSIONS.

1. Gauze masks exercise a certain amount of restraining influence on the number of bacteria-laden droplets possible of inhalation.

2. This influence, is modified by the number of layers and fineness of mesh of the gauze.

3. When a sufficient degree of density in the mask is used to exercise a useful filtering influence, breathing is difficult and leakage takes place around the edge of the mask.

4. This leakage around the edges of the mask and the forcible aspiration of droplet laden air through the mask is sufficient to make the possible reduction in dosage of infection not more than 50 per cent effective.

5. It remains for future controlled experiments in contagious disease hospitals to determine whether the wearing of masks of such texture as to be reasonably comfortable are effective in diminishing the incidence of infection.

6. Masks have not been demonstrated to have a degree of efficiency that would warrant their compulsory application for the checking of epidemics.

They furthermore concluded:

"... Studies made in the Department of Morbidity Statistics of the California State Board of Health did not show any influence of the mask on the spread of influenza in those cities where it was compulsorily applied, and the Board was, therefore, compelled to adopt a policy of mask encouragement, but not of mask compulsion. Masks were made compulsory only under certain circumstances of known contact with the disease and it was left to individual communities to decide whether or not the masks should be universally worn.

The reason for this apparent failure of the mask was a subject for speculation among epidemiologists, for it had long been the belief of many of us that droplet- borne infections should be easily con- trolled in this manner. The failure of the mask was a source of disappointment, for the first experiment in San Francisco was watched with interest with the expectation that if it proved feasible to enforce the regulation the desired result would be achieved. The reverse proved true."

"...The masks, contrary to expectation, were worn cheerfully and universally, and also, contrary to expectation of what should follow under such circumstances, no effect on the epidemic curve was to be seen. Something was plainly wrong with our hypotheses."

---

---

Below are excerpts from 3 more pages of the report. I have highlighted interesting parts in bold.

You can download the PDF here:
https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.10.1.34

---

Special thanks to Nate Itkin on Twitter for sharing this invaluable information! He was responding to Horror writer Stephen King, who was posting pro-mask propaganda.

Thanks. Now let's see what happened & learn from history for a change. Cloth masks were an epic failure according to the CA Board of Health. This is what they said.https://t.co/oMuEeeH7ZT pic.twitter.com/hwm4vV609H

— Nate Itkin (@kdogni) July 15, 2020

---

More excerpts:

THE recent epidemic of influenza brought forcibly to attention the use of the gauze mask as a pro- tection against infection. The supposition that influenza is a droplet-borne infection suggested to many the idea of controlling its spread by requiring the wearing of face masks, and accordingly the measure was adopted in many towns and cities, principally in California. Unfortunately for the rational application of such a measure little was known of the requirements for the proper making of a gauze mask, although during the year 1918 four or five articles on the protective value of masks had appeared. One of these by Weaver* detailed his experiences in diminishing infections among the nursing staff at the Durand Hospital by the use of masks of two layers of gauze (quality not mentioned). The incidence of scarlet fever and of the carriage of diphtheria seemed to be markedly lessened, although the results are somewhat diminished in value by the fact that the experiment was not a controlled one; comparisons were made between two periods of time, during one of which the mask was used and during the other it was not.

* Weaver, The Value of the Face Mask and Other Meas- ures. Jour. A. M. A., Jan. 12, 1918.

Capps* at Camp Grant tried the mask to prevent infection in ambulances and among patients while temporarily outside of cubicles. He gives no information as to the quality of gauze or number of layers and no figures or specific comparisons, and his conclusions are, that after masking, no cases of scarlet fever appeared in the wards whereas there had been just before a series of six consecutive cases.

Haller and Caldwellt conducted some bacteriological experiments to determine the protective value of different layers and meshes of gauze. They found that 300 strands to the inch (the sum of the warp and the woof multiplied by the number of layers) were necessary, when worn by the person coughing in - the experiment, to stop the planting of colonies on agar plates, and that 220 strands were sufficient when placed over the plate instead of over the mouth of the cougher.

They gave no detailed tables of their experiments, and took no account of the possible leakage around the edge of the mask, which occurs in actual practice, nor of the influence of aspiration of droplet-laden

* Joseph A. Capps, Thie Face Mask in Control of Contagious Diseases. Jour. A. M. A., March 30, 1918.

t David A. HaHler and Raymond C. Caldwell, The Protective Quality of Gauze Face Masks. Jour. A. M.

---

Experimental Study of Efficacy of Gauze Face Masks air through the gauze. Doust and Lyon* also reported on some bacteriological experiments in which they used Bacillus prodigiosus in the mouth of the cougher.

They found that colonies passed easily through ten layers of coarse and also of medium gauze, but not through three layers of butter cloth. Their results do not agree with those of Haller and Caldwell, who found that seven layers of medium gauze "gave complete protection." Masking of plates was not reported on. If we grant that influenza is a droplet- borne infection, it would appear that the wearing of masks was a procedure based on sound reasoning and that results should be expected from their application. Studies made in the Department of Morbidity Statistics of the California State Board of Health did not show any influence of the mask on the spread of influenza in those cities where it was compulsorily applied, and the Board was, therefore, compelled to adopt a policy of mask encouragement, but not of mask compulsion. Masks were made compulsory only under certain circumstances of known contact with the disease and it was left to individual communities to decide whether or not the masks should be universally worn.

The reason for this apparent failure of the mask was a subject for speculation among epidemiologists, for it had long been the belief of many of us that droplet- borne infections should be easily con- trolled in this manner. The failure of the mask was a source of disappointment, for the first experiment in San Francisco was watched with interest with the expectation that if it proved feasible to enforce the regulation the desired result would be achieved. The reverse proved true.

* Brewster C. Doust and Arthur Bates Lyon, Face Masksin Infection of the Respiratory Tract. Jour. A. M. A., Oct. 12, 1918.

The masks, contrary to expectation, were worn cheerfully and universally, and also, contrary to expectation of what should follow under such circumstances, no effect on the epidemic curve was to be seen. Something was plainly wrong with our hypotheses.

We felt inclined to explain the failure of the mask by faults in its application rather than by any basic error in the theory of its use. Consequently, Bulletin No. 31* of the Board of Health brought out the fact that where it was sought to control influenza by compulsory wearing of masks certain obstacles developed. These were:

First, the large number of improperly made masks that were used. Second, faulty wearing of masks, which included the use of masks that. were too small, the covering of only the nose or only the mouth, smoking while wearing, etc. Third, wearing masks at improper times. When applied compulsorily masks were universally worn in public, on the streets, in autombiles, etc., where they were not needed, but where arrest would follow if not worn, and they were very generally laid aside when the wearer was no longer subject to observation by the police, such as in private offices and small gatherings of all kinds. This type of gathering with the attendant social intercourse between friends, and office associates seems to afford particular facility for the transfer of the virus.

If, as seems probable, the virus is droplet-borne, this form of contact, where people are conversing with one another, would, of course, be much more dangerous than crowd association of strangers, even under the circumstances of gathering in churches and theatres.

* Influenza-A Study of Measures Adopted for the Con- trol of the Epidemic. W. H. Kellogg,

---

We were not satisfied, however, with this seemingly perfectly satisfactory explanation. We felt it to be imperative, if the mask were not to be permanently discredited, that more definite information be obtained concerning its uses and limitations. If, as we believed, the gauze mask is useful as a protection against certain infections, it would be unfortunate if its uncontrolled application in influenza should result in prejudicing critical and scientific minds against it. That there was danger of this is evidenced by many letters received from prominent sanitarians all over the country. It was, therefore, determined to carry out a set of experiments that should demonstrate finally just what type of mask should be used against droplet- borne infections, and what measure of protection could be expected through their use.

It is the object of this paper to set forth these experiments, and it is believed that they are fairly complete, so far as it is possible by laboratory methods alone to arrive at a conclusion. It will remain for future controlled experiments in contagious disease hospitals to dispose of such questions as conjunctival entry of virus, hand infection, etc.

All previous laboratory experiments with which we are familiar have over-looked certain conditions in the practical application of masks which might have an important bearing on the true facts. It occurred to us that the mere settling by gravity of micro-organisms through layers of gauze stretched over petri plates did not simulate at all the natural conditions of forcible aspiration through the gauze that obtains during inhalation by a masked individual. Another possible source of error which it was desired to investigate was the possibility of droplet laden air passing around the edges of a mask and then entering the nostrils without filtration. A long series of preliminary experiments was necessary, much of which will be passed over without description as being of little interest, although of extreme importance as a foundation for the later decisive operations.

The first procedure that occurred to us, as it has to others, was the inoculation of plates, both covered with gauze and uncovered, by coughing over them at various distances. It was soon determined that an artificial enrichment of the secretions was necessary, and this was secured by spraying the mouth and throat of the cougher with a suspension of Bacillus prodigiosus. It was also decided, after many tests, to abandon the inoculation by coughing, as it was found that no degree of uniformity could be maintained. The counts varied enormously from one moment to another.

Consequently, controls were rendered of less value and an undesirable variation was shown between individual experiments. For the purpose of imitating, as closely as possible, natural conditions of forcible suction through the gauze, an arrangement was constructed from a glass dish 9. inches deep and 4' inches in diameter with ground edges and having for a cover a glass plate having a round groove ground on one face to fit tightly the edge FIGURE 1. - f lM M .,.