The Prophylactic Treatment of the Spanish Influenza

Treatments such as this Ayer’s Cherry Pectoral were marketed during the early 1900’s for a variety of maladies including influenza. As was shockingly common at the time, this medication included heroin. (Source: Museum of Healthcare at Kingston, Accession no. 996001222)

The following blog post was contributed by Andrew Belyea, who is the Museum of Health Care’s 2017 Margaret Angus Research Fellow. Andrew has a degree in Life Science from Queen’s University and will start at the Queen’s School of Medicine in the fall.  This is Andrew’s sixth blog post in a series he will be writing throughout the summer. Special thanks to Trustees of the Estate of Larry Gibson, Graeme Fraser & Jay Rayner, for their generous support of this fellowship.

With the wide-sweeping devastation of the Spanish Influenza in the Fall of 1918, communities around the world were eager to come together and share insights and ideas about protective treatments and therapies. When the epidemic hit Kingston, the local medical community was in the midst of an unfortunate chapter in their history. As with other university cities, a healthy relationship between Kingston and Queen’s School of Medicine was important for the region. With stagnant funding, there was talk of splitting the medical school up, sending students to Ottawa and Toronto to finish their medical training. (The Kingston community must thank Dr. Guilford Reed for bringing the city back to medical relevance. For more information about Dr. Reed, read my post about him here: Because of this lull, many Kingston physicians looked elsewhere to enhance their understanding of the epidemic and generate treatment ideas. One of the major sources they drew from was the American Public Health Association.

On the first day of the American Public Health Association’s annual meeting in November 1918, the Illinois Influenza Commission was created. The work of this committee, spearheaded by Dr. R.A. O’Neill, was immediately published in the Association’s journal because of the epidemic’s urgency. At the meeting, it was noted by Dr. E.C. Jordan how more than 60% of those who died in the epidemic were between 20 and 40 years old, a stark difference from the standard influenza that normally affected young, old, and immunocompromised individuals. He commented that this likely indicated “a radical difference in the causal agent of this pandemic.”[1] At the time, the causal agent of the flu was unknown, although it was suspected to be one (or several) species of bacteria.

Upon the conclusion of the annual meeting, there were three prophylactic measures that were announced, including measures to:

  1. “Break the channels of communication by which the infective agent passes from one person to another.
  2. “Render persons exposed to infection immune or at least more resistant by the use of vaccines.
  3. “Increase the natural resistance of persons exposed to the disease by augmented healthfulness.”1

Another prominent Canadian physician, Dr. F.H. Wetmore, the Chairman and Secretary of the New Brunswick Provincial Board of Health, offered his treatment ideas in response to the Illinois Influenza Commission’s proclamation:

“Some of the methods by which these channels are broken are, isolation of the sick, wearing of masks, and washing of hands by the nurses and attendants, and the care of the sputum.”[2] Describing the challenge associated with quarantining influenza carriers and mild cases, Dr. Wetmore lamented on the difficulty associated with controlling the spread of the disease. He described his personal experience of implementing both prophylactic and therapeutic vaccines during the epidemic. Using mixed stock vaccinations made by G.H. Sherman Bacteriological Laboratories out of Detroit, Dr. Wetmore provided different vaccination amounts to patients according to their disease status: therapeutic doses were given to ill individuals while weaker prophylactic doses were provided to members of the family. He reported that earlier inoculation decreased the future risk of pneumonia, suggesting proactive inoculation may be helpful.

The primary recommendation given to all patients at the time was bed rest, with fresh air and good nursing. The windows were to be kept open with the patient’s bed moved as close to the fresh air as possible. Beyond this though, the recommendation for vaccination varied based on each doctor’s personal approach. Some viewed any vaccination as helpful and provided it immediately, while others were more hesitant and used it only when deemed necessary. In hindsight, the best tactic was to provide vaccination regardless of a patient’s stage of illness, presuming an effective vaccination was available.

Upon diagnosis, the recommended diet was a large amount of liquids: a mixture of two parts milk to one part lime and/or a combination of one egg per pint of milk was recommended. As for medicine, it was encouraged to clear the digestive tract as early as possible with a saline cathartic such as Epsom salts. Acidosis was normally present, and thus an alkaline treatment with sodium bicarbonate or potash citrate would be prescribed. Aspirin was given for pain while a cough was treated with 1/12g(83mg) of heroin. (To put that in perspective, for an opiate-naïve person taking heroin for the first time, the lethal level of heroin is between 75-375mg.) If insomnia developed, heroine or a stronger opiate may have been used.

An interesting study of the prophylactic use of a vaccine was conducted at the Naval Training Station in San Francisco. Minaker and Irvine (1919) demonstrated beneficial results from the use of a mixed prophylactic vaccine. Since this research was based out of the West coast, the authors were able to proactively test a vaccine prior to the flu’s arrival from the East. Uniquely, the Naval Station was based on an island more than 1.5 km from each of San Francisco and Oakland, allowing the influenza cases to be completely isolated. As with many of their contemporaries, Minaker and Irvine found their inoculated populations fared better, with fewer cases of influenza and a lower mortality rate, as compared to uninoculated individuals (Tables 1 and 2). The exception to this trend is found with inoculated corpsmen, a group that experienced an 11% mortality rate as compared to 2.1% in uninoculated nurses and attendants.

Table 1. Results of uninoculated participants at the Naval Training Station, San Francisco.[3]

Uninoculated Persons Population Influenza Mortality
Number of Cases Percent of Cases Number of Cases Percent of Cases
San Francisco and Oakland 625,000 33,065 5.3 3,035 9.2
Mare Island Navy Yard 8,232 1,296 15.7 65 5.0
Nurses and attendants, San Francisco hospitals 550 186 33.8 4 2.1
Los Angeles 600,000 9,124 1.5 612 6.6

Table 2. Results of voluntarily inoculated participants at the Naval Training Station, San Francisco.3

Uninoculated Persons Population Influenza Mortality
Number of Cases Percent of Cases Number of Cases Percent of Cases
San Francisco civilians 1,080 14 1.4 0 0.0
Marines at Mare Island 1,950 35 1.8 1 2.8
Hospital corpsmen on duty in influenza wards 270 9 3.5 1 11.0
Naval Camp, San Pedro 3,100 53 1.7 0 0.0

Over the last few blogs, many studies have been highlighted that demonstrated the importance of an influenza vaccine. While Kingston’s medical community was put back on the map by Dr. Reed’s influenza research, it was necessary to form interdisciplinary research committees to generate a diversity of treatment ideas. As such, most Kingston doctors enhanced their understanding of the epidemic through reading international publications that offered a wide variety of treatment approaches. Although skeptics were vocal about their opposition to the early and unnecessary use of a vaccine either prophylactically or therapeutically, the majority of research suggested that vaccines were extremely effective. With a short-lived epidemic, the medical world was divided in two: there were those who supported the use of influenza vaccines and those who opposed them. In large part, those who opposed vaccines were not fundamentally against them; they wanted to use a tried-and-true technique rather than an untested vaccine.

[1] O’Neill, R.A., C. St. Claire Drake, J.O. Cobb. “Committee Reports: Influenza Epidemic.” American Journal of Public Health (New York) 9.11 (1919): 876.

[2]Wetmore, F.H. “Treatment of Influenza.” Canadian Medical Association Journal 12.9 (1919): 1075.

[3]Minaker, A. J., and R.S. Irvine. “Prophylactic use of Mixed Vaccine Against Pandemic Influenza and its Complications: At the Naval Training Station, San Francisco.” Journal of the American Medical Association 72.12 (1919): 849.

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