Doctors in 1918 had almost nothing in their arsenal that could fight the influenza virus itself. There were no antiviral drugs, no antibiotics for the bacterial pneumonia that killed most victims, and no reliable vaccine. Treatment during the Spanish flu pandemic was overwhelmingly supportive: keep patients warm, hydrated, and resting, and hope their bodies could outlast the infection. What makes the story worth telling in detail is how much effort went into trying everything available, from outdoor hospital wards and experimental blood transfusions to massive doses of aspirin that may have done more harm than good.
Nursing Care Was the Frontline Treatment
The single most important intervention during the 1918 pandemic was skilled nursing. With no way to attack the virus directly, caregivers focused on managing symptoms and preventing complications. This meant monitoring fevers, ensuring patients ate and drank regularly, keeping airways clear, and watching for signs that a case was tipping into pneumonia.1PubMed Central. “Alert to the necessities of the emergency”: U.S. nursing during the 1918 influenza pandemic In New York City, visiting nurses from the Henry Street Settlement and Red Cross volunteers went door to door, entering homes where entire families were bedridden and providing what amounted to the only treatment available.2PubMed. ‘When the city is a great field hospital’: the influenza pandemic of 1918 and the New York city nursing response
The problem was that there simply were not enough nurses to go around. The war had pulled a large share of trained nurses overseas, and the ones who remained were quickly overwhelmed by the sheer volume of cases. In military camps across the United States, influenza and pneumonia sickened roughly a fifth to two-fifths of Army and Navy personnel during the worst months of September through November 1918.3PubMed Central. The U.S. military and the influenza pandemic of 1918-1919 Civilian communities were left scrambling. Families without access to nursing care were often on their own, relying on neighbors, local volunteers, or no one at all. The quality of care you received depended enormously on where you lived, how crowded your city was, and whether anyone was available to check on you.
The Open-Air Approach
One of the more striking treatment strategies came out of a military facility near Boston. Camp Brooks, an emergency open-air hospital set up on Corey Hill in Brookline, Massachusetts, treated 351 sailors during about a month of operation in the fall of 1918. A third of those patients had already developed pneumonia by the time they arrived. The guiding philosophy was simple: maximize sunshine and fresh air, day and night.4PubMed Central. The Open-Air Treatment of Pandemic Influenza – Section: INFLUENZA AT THE CAMP BROOKS OPEN-AIR HOSPITAL
The medical officer in charge, Major Thomas Harrington, had noticed that the worst pneumonia cases tended to come from the most poorly ventilated parts of the transport ships. That observation shaped everything about Camp Brooks. Patients were kept in tents and, in good weather, moved out into the open entirely. At night they were kept warm with hot-water bottles and extra blankets and were fed every few hours throughout the course of their fevers.4PubMed Central. The Open-Air Treatment of Pandemic Influenza – Section: INFLUENZA AT THE CAMP BROOKS OPEN-AIR HOSPITAL Of the 351 patients admitted, 36 died. That case-fatality rate of about 10% was considered relatively low for the time, particularly given how many patients arrived already severely ill with pneumonia. Whether the fresh air itself helped or whether the open setting simply reduced the density of airborne bacteria and virus particles in a way that prevented cross-infection is still debated, but the idea was rooted in a long tradition of open-air treatment for respiratory diseases, particularly tuberculosis.
Aspirin and the Question of Harm
Aspirin was one of the most commonly prescribed drugs during the pandemic, and there is a credible argument that it made things worse for a significant number of patients. Physicians in 1918 were prescribing aspirin at doses that would horrify a modern doctor. Recommended regimens ranged from about 8 to over 31 grams per day, far beyond what we now know to be safe.5PubMed. Salicylates and pandemic influenza mortality, 1918-1919 pharmacology, pathology, and historic evidence For comparison, a typical modern dose for pain or fever is around 1 to 3 grams per day.
At the levels being used in 1918, aspirin produces blood concentrations associated with hyperventilation in roughly a third of recipients and pulmonary edema (fluid in the lungs) in about 3%. A hypothesis published in Clinical Infectious Diseases argues that aspirin may have contributed to both the severity of the viral illness and the incidence of secondary bacterial infection and death. The timing is suggestive: the U.S. Surgeon General, the Navy, and the Journal of the American Medical Association all recommended aspirin use just before the enormous spike in deaths in October 1918. If even a small fraction of patients developed aspirin-induced pulmonary edema on top of an already compromised respiratory system, the results could have been catastrophic.5PubMed. Salicylates and pandemic influenza mortality, 1918-1919 pharmacology, pathology, and historic evidence
This remains a hypothesis rather than a proven cause-and-effect relationship, but it is taken seriously by historians of the pandemic. The broader lesson is that aggressive pharmacological intervention without a solid understanding of the disease can be as dangerous as the disease itself. In 1918, the impulse to “do something” with the drugs available may have compounded the toll.
Why Most People Actually Died
A crucial piece of context for understanding treatment in 1918 is that the influenza virus itself was rarely what killed people directly. The overwhelming consensus among experts at the time, confirmed by modern pathology studies, was that deaths resulted from secondary bacterial pneumonia caused by organisms that normally colonize the upper respiratory tract, primarily pneumococci, streptococci, and staphylococci. Without this secondary infection, most patients would have recovered.6PubMed Central. Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness
This matters because the tragedy of 1918 treatment lies partly in what did not yet exist. Antibiotics, which would have been the most impactful tool against these bacterial complications, would not become clinically available until the 1940s. Doctors could recognize pneumonia, they could describe its progression in detail, and they knew perfectly well it was what killed their patients. They just could not treat it effectively. The best they could offer was supportive care to keep the patient alive long enough for the immune system to fight off both the virus and the bacteria on its own. For young, otherwise healthy adults, whose immune systems sometimes overreacted in a way that made the initial viral damage worse, this was often not enough.
Convalescent Blood and Serum Therapy
Some physicians tried transfusing blood or serum from people who had recovered from the flu into patients who were still sick. The logic was straightforward even before the mechanisms were fully understood: a recovered patient’s blood should contain something that helped them fight off the disease, and transferring that substance might help a patient currently losing the fight. This was not a new idea in 1918. Convalescent blood and serum had been used empirically for various infectious diseases before the pandemic, though without the controlled trials that would later become the standard for evaluating treatments.7PubMed Central. The true historical origin of convalescent plasma therapy
Results during the pandemic were mixed and hard to evaluate. The serum had to be collected from recovered patients, processed, and administered relatively quickly, all under wartime and pandemic conditions. There were no standardized protocols. Some physicians reported encouraging outcomes, while others saw little benefit. Still, the concept was sound, and it resurfaced during later outbreaks, including during the early months of COVID-19 more than a century later.
Experimental Bacterial Vaccines
One of the more ambitious medical efforts during the pandemic was the rapid development and deployment of vaccines. These were not vaccines against the influenza virus, which had not yet been identified. Instead, they targeted the bacteria that scientists either believed caused influenza or knew were responsible for the deadly secondary pneumonias. The leading candidate for the cause of influenza at the time was Pfeiffer’s bacillus (Bacillus influenzae), which had been proposed as the causative agent in the early 1890s and dominated medical discussion for nearly three decades.8PubMed Central. The state of science, microbiology, and vaccines circa 1918 Many researchers, however, could not consistently find this organism in flu patients, and the debate about what actually caused influenza was far from settled when the pandemic hit.
Despite the uncertainty, vaccine development moved fast. Edward Rosenow, a pulmonary specialist based in Rochester, Minnesota, created a mixture of killed pneumococci, streptococci, staphylococci, and Pfeiffer’s bacillus. After small-scale safety trials, the Mayo Foundation distributed his vaccine to physicians and hospitals within a roughly 320-kilometer radius. Rosenow’s own data suggested that the mortality rate among unvaccinated control patients was about four times higher than the rate for those who received all three doses.9Social History of Medicine. The Efficiency of Bacterial Vaccines on Mortality during the ‘Spanish’ Influenza Pandemic of 1918–19 – Section: The 1918–19 Studies of Mixed Bacteria Vaccines
Those numbers sound impressive, but the broader picture was murkier. Bacterial vaccines of various formulations were used widely during the pandemic for both prevention and treatment. Some were based solely on Pfeiffer’s bacillus; others contained multiple organisms found in victims’ lungs. Although many initial reports claimed success, the results across different locations and formulations were inconsistent and sometimes contradictory.10PubMed. The fog of research: influenza vaccine trials during the 1918-19 pandemic Without modern trial designs, randomization, or blinding, it was nearly impossible to tell whether the vaccines genuinely helped or whether the patients who received them simply differed in other ways from those who did not. Still, some of these mixed-bacteria vaccines may have provided real protection against secondary pneumonia even if they did nothing against the influenza virus itself, an idea that continues to interest researchers.
Public Health Measures as Treatment by Proxy
When individual treatment options are limited, prevention and containment become forms of treatment for a community. Cities across the United States and around the world imposed quarantines, closed schools and theaters, banned public gatherings, and staggered business hours to reduce crowding. Many communities, particularly in the American West, also mandated the wearing of gauze face masks.
Compliance was a persistent problem. In Denver, store owners openly told the city health department they would refuse to turn away unmasked customers. One department store employee declined to wear a mask on the grounds that “an authority higher than the Denver Department of Health was looking after her well-being.” Streetcar conductors, worried about confrontations, refused to enforce the order on their trolleys. Even with police stationed on busy corners and fines ranging from $10 to $200, a majority of Denver residents still refused to wear masks.11PubMed Central. Politics, Pushback, and Pandemics: Challenges to Public Health Orders in the 1918 Influenza Pandemic – Section: MANDATORY MASK ORDERS The parallels with more recent pandemic responses are hard to miss.
Whether the masks of 1918 were effective is a separate question from whether they were worn. The gauze masks in use were far less sophisticated than modern surgical or N95 masks, and their ability to filter virus-laden droplets was limited. But the broader public health measures, especially early and sustained closures, did make a measurable difference. Cities that implemented non-pharmaceutical interventions quickly and kept them in place longer generally experienced lower peak death rates than those that acted slowly or lifted restrictions prematurely.
Patent Medicines, Folk Remedies, and Entrepreneurial Opportunism
The vacuum left by the absence of effective medical treatment was quickly filled by commercial products of dubious value. In Britain, brands like Formamint (a throat tablet), Chymol (an antiseptic inhalant), and Lifebuoy Soap marketed themselves aggressively as protections against the flu.12Journal of Historical Research in Marketing. Commercialising public health during the 1918-1919 Spanish flu pandemic in Britain Their advertisements blurred the line between general hygiene advice and specific medical claims, leveraging public fear into sales opportunities. Similar patterns played out in the United States and elsewhere, where newspaper advertisements promoted everything from whiskey and quinine tonics to turpentine rubs and onion poultices.
Households that could not access or afford a physician relied on whatever folk knowledge was available. Mustard plasters on the chest, camphor worn in bags around the neck, garlic eaten raw, and kerosene-soaked rags applied to the throat were all common. None of these had any effect on the influenza virus, but some may have provided symptom relief or a sense of agency in a situation where people felt powerless. The psychological dimension of treatment should not be dismissed entirely: in a pandemic where isolation, terror, and helplessness were pervasive, the act of doing something, even something ineffective, mattered to patients and families.
Herbal and Non-Western Approaches
Not all alternative treatments were opportunistic patent medicines. In John Day, Oregon, a Chinese herbalist named Ing “Doc” Hay prescribed herbal formulas aimed at treating flu symptoms and personally boiled and delivered herbal decoctions to Chinese laborers at their work sites, as well as to non-Chinese patients in the surrounding community. According to accounts of his practice, none of the laborers he treated died during the pandemic.13PubMed Central. Doc Hay: A Chinese Herbalist Combating the 1918-1919 Influenza Pandemic in America
Hay’s success is documented but difficult to interpret in rigorous terms. His patients may have been a self-selected group, younger workers who were less severely ill to begin with. He may have treated relatively few patients overall, making survivorship more likely by chance. Or his herbal formulas may have offered genuine supportive benefits, such as fever reduction, improved hydration through warm liquids, or anti-inflammatory effects. Traditional Chinese medicine includes numerous herbs with pharmacological activity that Western medicine later validated in other contexts, so it would be a mistake to assume his remedies did nothing. What Hay’s story does illustrate clearly is that treatment during the pandemic was not a single, monolithic Western medical enterprise. Communities drew on whatever knowledge traditions were available to them.
The Military Hospital Experience
Military camps were some of the hardest-hit environments during the pandemic. Crowded barracks, shared mess halls, and the constant influx of new recruits created ideal conditions for the virus to spread. Influenza and pneumonia killed more American soldiers and sailors during the war than enemy weapons did.3PubMed Central. The U.S. military and the influenza pandemic of 1918-1919
Medical officers in these camps had somewhat more resources than civilian physicians, including larger staffs, dedicated hospital wards, and more systematic record-keeping. Camp Brooks was a product of this military infrastructure. But those advantages were often overwhelmed by the sheer scale of illness. At the peak, military hospitals ran out of beds, then ran out of floor space, then ran out of linen. The high morbidity rates disrupted induction and training schedules across the country and rendered hundreds of thousands of personnel unable to serve. Treatment in these settings was the same supportive nursing care available to civilians, just delivered in a context where the density of cases made cross-infection almost impossible to prevent. The war effort and the pandemic fed into each other: the movement of troops spread the virus globally, and the virus in turn crippled the military apparatus that spread it.
What 1918 Treatment Tells Us About Medical Limits
The Spanish flu arrived at an awkward moment in the history of medicine. The germ theory of disease was well established. Bacteriology had made enormous strides. Vaccines against several bacterial diseases existed and worked. But virology was in its infancy, antibiotics had not been discovered, and the tools that would eventually tame influenza, from antiviral drugs to mechanical ventilators to modern intensive care, were decades away. Physicians understood enough to recognize what was killing their patients (bacterial pneumonia after viral damage) but lacked the pharmacological means to intervene effectively.6PubMed Central. Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness
That gap between diagnosis and treatment shaped everything about the 1918 response. It explains why nursing care was so central, why public health measures bore so much of the burden, why experimental vaccines were rushed out despite uncertain evidence, and why patent medicine advertisers found such fertile ground. It also explains why the death toll was so staggeringly high. Estimates range from 50 to 100 million deaths worldwide, though the true number is unknowable. The pandemic remains the clearest modern illustration of what happens when a highly transmissible respiratory pathogen meets a population with no immunity and a medical system with no targeted treatment. Every intervention tried in 1918, from fresh air to aspirin to convalescent serum, was essentially a way of buying time for the patient’s immune system. For millions, that time ran out.