The 1918 Spanish Flu pandemic unleashed a devastating wave of mortality across the globe, distinguished by its unusual lethality that struck down many healthy young adults. Medical science at the time faced a profound challenge, operating without modern virology, effective antiviral medications, or widespread antibiotics. Physicians lacked the tools to combat a disease that killed an estimated 50 to 100 million people worldwide because they did not understand its viral cause. Treatment during this era was thus a matter of improvisation and supportive measures, focused entirely on helping the patient’s body survive the relentless infection.
The Foundation of Care: Rest and Symptom Management
Since no cure for the viral infection existed, the primary strategy employed by medical professionals was comprehensive supportive care. Absolute bed rest was universally mandated, intended to conserve the patient’s strength and minimize metabolic demands while fighting the illness. This measure was considered the most reliable intervention available to prevent the flu from progressing.
Maintaining adequate hydration was another fundamental component of care, though this was often difficult to manage in overwhelmed hospitals and home-care settings. High fevers were a common and dangerous symptom, often managed through non-pharmacological methods like hydrotherapy. This involved applying cold compresses or using cold water baths to physically lower the body temperature.
For patients suffering from severe respiratory distress and cyanosis, attempts were made to deliver oxygen, sometimes using primitive oxygen tents or administering oxygen under the skin. Many hospitals also adopted “open-air” treatment, moving patients onto porches or into tent wards to ensure constant ventilation. This practice, rooted in the belief that fresh air helped dilute infectious “miasmas,” may have provided some benefit by preventing close-quarters transmission.
Combating Secondary Bacterial Pneumonia
The majority of deaths during the pandemic were not caused by the influenza virus alone, but by secondary bacterial pneumonia. The virus damaged the lining of the respiratory tract, creating an environment where common bacteria, such as Streptococcus pneumoniae and Staphylococcus aureus, could easily invade the lungs. This co-infection led to a rapid and often fatal decline in the patient’s condition.
Treating these overwhelming bacterial infections was nearly impossible in the absence of penicillin, which would not be widely available for another quarter-century. Physicians attempted to provide passive immunity using anti-serums. These fluids, derived from the blood of horses or recovered human patients, contained antibodies intended to fight common pneumococcal strains, but they were often of limited effectiveness.
Doctors also experimented with early chemical antiseptics in desperate attempts to sterilize the body, though these had little systemic success against bacteria deep within the lungs. The medical community also explored “mixed-strain” vaccines, prepared using cultures of the bacteria believed to be causing the pneumonia. These vaccines were largely ineffective because they did not address the primary viral infection that predisposed patients to the bacterial invasion.
Pharmacological Approaches and Experimental Remedies
In the absence of a known cure, a variety of drugs and chemical agents were administered, often based on historical precedent or anecdotal evidence. The most widely used medication was aspirin (acetylsalicylic acid), which was aggressively promoted by medical authorities for pain and fever relief. Unfortunately, the recommended doses were dangerously high, often exceeding 15 to 20 grains (nearly 1 gram) every few hours.
Current analysis suggests that this high-dose aspirin regimen may have contributed to overall mortality. Salicylate toxicity causes pulmonary edema, where fluid accumulates in the lungs, mimicking or worsening the severe respiratory symptoms of the flu. This potential misuse of aspirin may have been a factor in the high death rate among otherwise healthy young adults who were more likely to take the recommended medication.
Other remedies included quinine, a drug successfully used to treat malaria, which was mistakenly believed to possess “anti-microbic” properties against influenza. Many popular cold remedies also contained quinine, often combined with laxatives like castor oil. This was based on the incorrect belief that flushing the system would rid the body of disease toxins. Historical records also show the use of alcohol, such as whiskey, which was sometimes prescribed by doctors as a stimulant, a sedative, or a general comfort measure.