Historical Review: Novel Therapeutics in the 1919 Influenza Epidemic

JP Foong,¹ M Foong,¹ J Foong,¹ C Heffernan,¹ P Heffernan,¹ B Izzard,¹ P Izzard,¹ D Nunes,¹ E Suttie,¹ C Suttie,¹ I Suttie,¹ JJ Suttie,²

^{1 Equal first author, 2 University of New South Wales, Sydney, Australia, Murrumbidgee Local Health District}

Introduction

Recent pandemic responses have inspired a renewed interest in the development of public health and therapeutic responses. The post-war spread of influenza had a high morbidity and mortality and devastating secondary social effects. Changes in the antigenic construction of the virus have resulted in antigenic drift. Because of this device, the virus is able to bypass the body’s immune system, which would not be able to identify and bestow immunity to a new strain. Influenza A also experiences another type of change called antigenic shift, which can happen when a cell becomes at the same time infected by two dissimilar strains. When new subtypes of influenza A develop suddenly, this can produce a worldwide pandemic in a short period of time. This review considers the public health restrictions that were mandated more than a century ago.

Social & Legal Restrictions

Because of its remoteness from Europe, Australia had months to make the necessary preparations. To counter the influenza, Australia tried to stop the virus from reaching the mainland. The Australian Quarantine Service monitored

the spread of the pandemic and implemented maritime quarantine on October 17, 1918, after learning of outbreaks in New Zealand and South Africa. Due to an ease of maritime quarantine restrictions, the influenza was introduced into Victoria in January, 1919. The government’s attempts at preventing the spread of the virus included: masks (which were mandatory); the temporary operative discontinuance of libraries, schools, places of entertainment, and places of worship; vaccines; restrictions of movement; and ‘social’ distancing. The states arranged emergency hospitals, vaccine stations, ambulance services, medical staff, and public awareness measures.

Novel Therapeutics

‘Dr. Bernard Kaufman, a graduate of Melbourne University, who treated about 2500 cases of influenza when the epidemic was at its worst phase in America, in a letter to Mr. R. O. Bernacchi, of Melbourne gives the following advice to influenza patients :

Leave your bed on no account whatever. This is absolutely important. Keep the windows- open - lots of fresh air - but the room warm. Then take a good hot whisky, lemonade, and sweat and during the sweating process keep drinking plenty of warm drinks. Keep warm cover on the bed. Keep arms under the cover and well tucked in. Take a good laxative - best of all in castor oil- two tablespoons in orange juice ; not Epsom or Rocherlea salts ; these are really harmful. Then hot mustard plaster right around the chest, back and front, particularly the back. Repeat these at least three times daily. In case you do not know how to make a mustard plaster here are the directions : Take one part of mustard and add three parts of flour, mix thoroughly. Add enough cold water to make a fairly thin paste. Spread with knife over a piece of sheeting, then cover mustard with another layer of sheeting, and put in frying pan and warm up. Put this on as hot as one can tolerate, and allow to remain for about 20 minutes. At this time turn down a corner to see if the chest and back are well reddened. If so remove ; if not, allow to remain for ten minutes more, and again inspect. If O.K, remove ; if not, allow to remain for ten minutes more, and then inspect. When reddened enough, remove and rub chest and back with warn camphorated oil, and cover chest and back with a pneumonia jacket'.¹

Early vaccination programs feature inoculations with sputum from actively infected patients. There is no available evidence in the literature meeting normal standards of blinded randomised controlled clinical trials.

Discussion

The following was written to The Melbourne Argus by Dr. S. D. Bird, of Melbourne, formerly a lecturer at the University there:

‘The following treatment which, if followed out so soon as the well-known symptoms show themselves, has never failed on my experience to either arrest or most materially shorten and modify the course of the influenza disease.…The backbone of the treatment is the germicide medicine whose composition is as follows 120th of grain of perchloride of mercury, 1 quarter of a grain of sulphate of quinine, enough diluted hydrochloric acid to dissolve it, a few drops of glycerine, and a dessert spoonful of distilled water, always in a glass or porcelain measure. If there is much pain in the chest, a teasing cough, or extreme anxiety of mind and fear of death, about 1-24th of a grain of hydrochlorate of morphia should be added to the first few doses this should be given every quarter of an hour for 8, 10 or 12 times according to the severity the case the temperature will begin to fall after the 5th or 6th dose and will soon be normal or nearly so. The medicine should not be suddenly stopped but gradually discontinued, any mark of return of the fever being a warning to revert to the quarter of an hour doses. I may remark that the minuteness of the dose of the perchloride renders it perfectly innocuous, and children are just as safe in taking it as adults, in proportionate dose'.²

Conclusion

Many pandemic public health responses, including mask mandates and social restrictions, remain unchanged in the last century.³ There remains little robust research into the unintended socioeconomic effects of restrictions. International travel restrictions delayed the onset of the epidemic in Australia, but isolationism was eventually suspended and the pandemic emerged as travel recommenced.

Specific therapeutics were sometimes bizarre and lacked therapeutic trials. Practitioners and companies seeking to profit from the pandemic remained a constant across the pandemic outbreaks, however the main form of therapies were elixirs and experimental vaccines. 

References

1. Kaufman, B Personal correspondence to Bernacchi, R.O., 1920.
2. Bird S,D, Correspondence The Melbourne Argus, 2019.
3. "Pandemic Influenza Risk Management WHO Interim Guidance" (PDF). World Health Organization. 2013. p. 25. Archived (PDF) from the original on 21 January 2021. Retrieved 21 August 2021.  
4. Beiner, Guy (2021). "Rediscovering the Great Flu between Pre-Forgetting and Post-Forgetting". In Beiner, Guy (ed.). Pandemic Re-Awakenings: The Forgotten and Unforgotten 'Spanish' Flu of 1918–1919. Oxford University Press. pp. 346–376.