Historical essay
“Kiss Via Kerchief”: Influenza Warnings in 1918

“Kiss Via Kerchief”: Influenza Warnings in 1918

E. Thomas Ewing

Just over one hundred years ago, New York Health Commissioner Royal S. Copeland responded to the threat of “Spanish” influenza reaching the United States with the reassuring, if completely misguided, prediction that “there is nothing to be alarmed about so far as I can see.”1 Yet the part of Copeland’s warning that “went viral,” to use a modern term, was his declaration that kissing should be avoided. If kissing was deemed necessary, a handkerchief should be used to prevent direct contact with the lips.

The 1918 article’s headline, “If You Must Kiss, Kiss via Kerchief, is Warning,” set the tone for similar proclamations across the US: “Flu May Get You, Should You Kiss” from the Salt Lake Telegram; “Aw, What’s the Use! ‘Don’t Kiss, Except thru a Handkerchief,’ Expert Advises” from the Topeka State Journal; “Kiss Through Handkerchief to Avoid the Influenza” in Vermont’s Norwich Bulletin; and “To Avoid Influenza. People Advised Not to Kiss ‘Except Through Handkerchief’” in Washington’s Evening Star.2f

Most newspapers reproduced the same article text from a New York wire report, although each added its own headline. On August 17, 1918, the Indianapolis Star published the warning under the provocative headline, “Want to Kiss and Escape Grip? Use Handkerchief!” The first paragraph warned persons wanting “to avoid the Spanish influenza or the common garden variety of the same disease” should not kiss “except through a handkerchief.” After stating that Copeland advised “osculatory restraint,” using a specialized term for a common human behavior, the article ended with a remarkably optimistic, yet wholly unfounded, prediction: “Asserting that it was ‘simply influenza,’ without the fever, headaches, delirium, and nervous disorders associated with the Spanish variety, [Copeland] said that every precaution would be taken to prevent the spread of the disease.”3

Transmission electron micrograph of Spanish flu virus. (CDC/Wikimedia Commons)

The national attention to this warning a century ago serves as a cautionary tale of how the American media might respond to a serious health danger today. In this sense, recognizing how information circulates during a public health crisis is almost as important as understanding how a virus circulates among a population. As we anticipate future epidemics or other public health crises, the skills of contextual interpretation are vital to ensuring that public trust in authoritative information facilitates adherence to necessary health measures.

Influenza and Osculation

Despite the humorous tone evident in these commentaries, in fact, Copeland’s list of “don’ts” included many specific actions now recommended by public health authorities: don’t use common eating utensils, don’t use drinking cups used by others, don’t remain near persons who cough and sneeze, and don’t spit in public spaces. Although many newspapers offered a summary of these recommendations, others ignored them and instead exaggerated the warnings about kissing. The Evening Capital and Maryland Gazette and several other papers expanded on this advice by republishing an editorial, often under the headline, “Influenza and Osculation,” which began with: “If your friend or your relative or your best beloved has a runny cold, don’t kiss him or don’t kiss her and don’t kiss them. They may have the ‘Spanish Flu.’” The editorial confidently assured readers that “dangerous germs” were spread by coughing, sneezing, or kissing within a five foot radius, but if people “will learn to keep a distance” from those who are sick, “they will be quite reasonably safe.” People in confined spaces such as trains or street cars should learn to cover their cough and blow their noses “with as much decency as possible.” Returning to the theme in the headline, the editorial concluded: “Kissing should be foregone during the period of the illness. Affection can be expressed without it, and the kisses will be none the less desirable when danger is over.”4

1919: American Red Cross volunteers carry a Spanish flu victim, 1919. (British Red Cross/Flickr)

A few newspapers used this announcement in their editorial sections to make brief, humorous comments. On August 17, the same day as The Sun article that began the viral reporting, the Detroit Times published a boxed text, under the headline, “Better than Nothing,” which emphasized how expert advice might disappoint public sentiments: “Try this on your best girl! New York’s board of health has issued an ukase that because of the danger of ‘Spanish influenza,’ all kissing should be done thru a handkerchief. This may be considered poor taste by some, but the docs declare it is the only safe way.” The Ithaca Journal from New York stated that the Health Board warning will be “tough on the young and romantic.” On November 12, 1918, the Wyoming State Tribune published a poem attributed to “a physician friend,” which combined warnings against kissing with stereotypes of feminine beauty: “You may laugh at the idea / That kissing spreads influenza, / But have you noticed / How many pretty girls have / Had the influenza this year / And how many homely ones / Haven’t?”5

Implications of Kissing Warnings

Warnings against kissing continued as the epidemic caused widespread illness and unprecedented numbers of deaths across the United States. Even as they adopted more drastic measures such as banning public meetings and closing schools, saloons, and stores, local health officials and medical experts echoed Copeland when they cautioned against kissing in Connecticut, Ohio, Salt Lake City, Chicago, and other states and cities.6 Dr. A. J. Gannon, head of the contagious diseases division of the Kansas City Hospital, offered this sweeping commentary in an article published in the Kansas City Times on October 18, 1918:

[gblockquote]Another thing that is contributing largely to the spread of the epidemic is the freedom with which kisses are being bandied around. I believe the epidemic had its start in Kansas City by girls kissing soldiers in the army schools and from the cantonments, who had become carriers for the disease. They carried it to their homes, kissed others, and in their turn these others have aided in communicating the disease. There is a great deal of kissing going on this city every twenty-four hours and if a ban should be placed on it there would be considerable less influenza in a few days.7[/gblockquote]

Clipping from the Democrat and Chronicle, 1918.

Dr. Gannon’s identification of romantic kissing as the genesis for the local epidemic is scientifically suspect yet revealing of the underlying gender dynamics embedded in this warning and its recirculation. Most allusions to kissing implied what just a few stated openly: a young man should control his desire to kiss a young woman. Yet a few articles, like the secondary warning in Gannon’s caution, referred to kissing friends and relatives, suggesting an affectionate rather than romantic behavior. The presence, and absence, of gendered dimensions in these articles is suggestive of the challenge of bringing a gendered lens to the understanding of influenza, which has mostly been interpreted as if gender did not matter. As historian Nancy Bristow argues, however, gender shaped the experience of the influenza epidemic for many Americans, as lack of effective cures or treatments by physicians, who were predominantly male, meant that female nurses provided much of the care for patients as they suffered through the disease.8 Whereas most health measures governed public behavior, the kissing ban was an attempt to regulate personal interactions that mostly occurred within private spaces.

Lessons from 1918

Historical analysis of kissing warnings in American newspapers raises troubling questions about how the American people today might respond to a public health crisis such as a widespread outbreak of influenza. In early 2018, when influenza cases and even deaths suddenly increased, the Trump White House was noticeably silent about the potential danger of the disease and the importance of proven health measures. By contrast, during the 2009 H1N1 flu outbreak, the White House took the lead in educating the public, with President Barack Obama declaring: “I don’t want anybody to be alarmed. But I do want everybody to be prepared,” following a highly visible summit with top health and national security advisers.

Thinking carefully about risk mitigation measures recommended by authorities, without being distracted by “viral moments,” could result in a more responsible relationship between the American public, health agencies, and the media. One legacy of observing the recent centennial of the 1918 influenza epidemic must be a better informed and healthier public able to respond thoughtfully and effectively to warnings about serious health dangers.


  1. The Sun (New York City), August 17, 1918, p. 12. Return to text.
  2. Salt Lake Telegram, August 17, 1918, p. 3; Topeka State Journal, August 17, 1918, p. 1; Norwich Bulletin, August 17, 1918, p. 1; Evening Star (Washington, DC), August 17, 1918, p. 2. Return to text.
  3. Indianapolis Star, August 17, 1918, p. 1. Return to text.
  4. Evening Capital and Maryland Gazette, August 30, 1918, p. 2. Return to text.
  5. Detroit Times, August 17, 1918, p. 4; Ithaca Journal, August 20, 1918, p. 4; Wyoming State Tribune, November 12, 1918, p. 4: https://www.genealogybank.com. Return to text.
  6. Hartford Courant, September 18, 1918, p. 10; Dayton Daily News, September 26, 1918, p. 6; Salt Lake Telegram, September 20, 1918, p. 1; Chicago Tribune, September 20, 1918, p. 9. See discussion of handkerchiefs more broadly as a public health measure and cultural symbol in Nancy Tomes, “Destroyer and Teacher: Managing the Masses during the 1918–1919 Influenza Pandemic,” Public Health Reports, 2010, Vol. 125 (Supplementary 3): 48–62. Return to text.
  7. Kansas City Times, October 18, 1918, p. 1. Return to text.
  8. Nancy Bristow, “It’s as Bad as Anything Can Be’: Patients, Identity, and the Influenza Pandemic,” Public Health Reports, 2010, Vol. 125 (Supplementary 3): 134–144. Return to text.

Featured image caption: Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston. (Courtesy Otis Historical Archives/Wikimedia Commons)

E. Thomas Ewing is a professor in the Department of History at Virginia Tech. He teaches courses in Russian, European, and world history. His research on the history of epidemics, including Russian flu (1889) and Spanish flu (1918), has been published in Influenza and Other Respiratory Viruses, Current Research in Digital History, Computer IEEE and Medical History. At Virginia Tech, he coordinates the Data in Social Context program that sustains an interdisciplinary approach of data analytics, computational skills, and critical thinking in the humanities and social sciences. He has received funding from the National Endowment for the Humanities to run workshops on the 1918 Spanish Influenza, Images and Texts in Medical History, and Viral Networks.E. Thomas Ewing is a professor of history at Virginia Tech, with research interests in the history of influenza epidemics. He has published essays in Nursing Clio on preventive measures during the 1918 pandemic, including a ban on kissing, a ban on the liquor traffic, mask fashions, and Stockton health officer Minerva Goodman (the latter two essays with Jessica Brabble and Ariel Ludwig).