How the 1918 Pandemic flu was handled with sunshine
 

Fresh air, sunlight and improvised face masks seemed to work a century ago; and they might help us now.
by Richard Hobday
When new, virulent diseases emerge, such SARS and Covid-19, the race begins to find new vaccines and treatments for those affected. As the current crisis unfolds, governments are enforcing quarantine and isolation, and public gatherings are being discouraged. Health officials took the same approach 100 years ago, when influenza was spreading around the world. The results were mixed. But records from the 1918 pandemic suggest one technique for dealing with influenza — little-known today — was effective. Some hard-won experience from the greatest pandemic in recorded history could help us in the weeks and months ahead.

Influenza patients getting sunlight at the Camp Brooks emergency open-air hospital in Boston. Medical staff were not supposed to remove their masks. (National Archives)
Put simply, medics found that severely ill flu patients nursed outdoors recovered better than those treated indoors. A combination of fresh air and sunlight seems to have prevented deaths among patients; and infections among medical staff.[1] There is scientific support for this. Research shows that outdoor air is a natural disinfectant. Fresh air can kill the flu virus and other harmful germs. Equally, sunlight is germicidal and there is now evidence it can kill the flu virus.
`Open-Air’ Treatment in 1918
During the great pandemic, two of the worst places to be were military barracks and troop-ships. Overcrowding and bad ventilation put soldiers and sailors at high risk of catching influenza and the other infections that often followed it.[2,3] As with the current Covid-19 outbreak, most of the victims of so-called `Spanish flu’ did not die from influenza: they died of pneumonia and other complications.
When the influenza pandemic reached the East coast of the United States in 1918, the city of Boston was particularly badly hit. So the State Guard set up an emergency hospital. They took in the worst cases among sailors on ships in Boston harbour. The hospital’s medical officer had noticed the most seriously ill sailors had been in badly-ventilated spaces. So he gave them as much fresh air as possible by putting them in tents. And in good weather they were taken out of their tents and put in the sun. At this time, it was common practice to put sick soldiers outdoors. Open-air therapy, as it was known, was widely used on casualties from the Western Front. And it became the treatment of choice for another common and often deadly respiratory infection of the time; tuberculosis. Patients were put outside in their beds to breathe fresh outdoor air. Or they were nursed in cross-ventilated wards with the windows open day and night. The open-air regimen remained popular until antibiotics replaced it in the 1950s.
Doctors who had first-hand experience of open-air therapy at the hospital in Boston were convinced the regimen was effective. It was adopted elsewhere. If one report is correct, it reduced deaths among hospital patients from 40 per cent to about 13 per cent.[4] According to the Surgeon General of the Massachusetts State Guard:
`The efficacy of open air treatment has been absolutely proven, and one has only to try it to discover its value.’
Fresh Air is a Disinfectant
Patients treated outdoors were less likely to be exposed to the infectious germs that are often present in conventional hospital wards. They were breathing clean air in what must have been a largely sterile environment. We know this because, in the 1960s, Ministry of Defence scientists proved that fresh air is a natural disinfectant.[5] Something in it, which they called the Open Air Factor, is far more harmful to airborne bacteria — and the influenza virus — than indoor air. They couldn’t identify exactly what the Open Air Factor is. But they found it was effective both at night and during the daytime.
Their research also revealed that the Open Air Factor’s disinfecting powers can be preserved in enclosures — if ventilation rates are kept high enough. Significantly, the rates they identified are the same ones that cross-ventilated hospital wards, with high ceilings and big windows, were designed for.[6] But by the time the scientists made their discoveries, antibiotic therapy had replaced open-air treatment. Since then the germicidal effects of fresh air have not featured in infection control, or hospital design. Yet harmful bacteria have become increasingly resistant to antibiotics.
Sunlight and Influenza Infection
Putting infected patients out in the sun may have helped because it inactivates the influenza virus.[7] It also kills bacteria that cause lung and other infections in hospitals.[8] During the First World War, military surgeons routinely used sunlight to heal infected wounds.[9] They knew it was a disinfectant. What they didn’t know is that one advantage of placing patients outside in the sun is they can synthesise vitamin D in their skin if sunlight is strong enough. This was not discovered until the 1920s. Low vitamin D levels are now linked to respiratory infections and may increase susceptibility to influenza.[10] Also, our body’s biological rhythms appear to influence how we resist infections.[11] New research suggests they can alter our inflammatory response to the flu virus.[12] As with vitamin D, at the time of the 1918 pandemic, the important part played by sunlight in synchronizing these rhythms was not known.
Face Masks Coronavirus and Flu
Surgical masks are currently in short supply in China and elsewhere. They were worn 100 years ago, during the great pandemic, to try and stop the influenza virus spreading. While surgical masks may offer some protection from infection they do not seal around the face. So they don’t filter out small airborne particles. In 1918, anyone at the emergency hospital in Boston who had contact with patients had to wear an improvised face mask. This comprised five layers of gauze fitted to a wire frame which covered the nose and mouth. The frame was shaped to fit the face of the wearer and prevent the gauze filter touching the mouth and nostrils. The masks were replaced every two hours; properly sterilized and with fresh gauze put on. They were a forerunner of the N95 respirators in use in hospitals today to protect medical staff against airborne infection.
Temporary Hospitals
Staff at the hospital kept up high standards of personal and environmental hygiene. No doubt this played a big part in the relatively low rates of infection and deaths reported there. The speed with which their hospital and other temporary open-air facilities were erected to cope with the surge in pneumonia patients was another factor. Today, many countries are not prepared for a severe influenza pandemic.[13] Their health services will be overwhelmed if there is one. Vaccines and antiviral drugs might help. Antibiotics may be effective for pneumonia and other complications. But much of the world’s population will not have access to them. If another 1918 comes, or the Covid-19 crisis gets worse, history suggests it might be prudent to have tents and pre-fabricated wards ready to deal with large numbers of seriously ill cases. Plenty of fresh air and a little sunlight might help too.
Dr. Richard Hobday is an independent researcher working in the fields of infection control, public health and building design. He is the author of `The Healing Sun’.
References
Hobday RA and Cason JW. The open-air treatment of pandemic influenza. Am J Public Health 2009;99 Suppl 2:S236–42. doi:10.2105/AJPH.2008.134627.
Aligne CA. Overcrowding and mortality during the influenza pandemic of 1918. Am J Public Health 2016 Apr;106(4):642–4. doi:10.2105/AJPH.2015.303018.
Summers JA, Wilson N, Baker MG, Shanks GD. Mortality risk factors for pandemic influenza on New Zealand troop ship, 1918. Emerg Infect Dis 2010 Dec;16(12):1931–7. doi:10.3201/eid1612.100429.
Anon. Weapons against influenza. Am J Public Health 1918 Oct;8(10):787–8. doi: 10.2105/ajph.8.10.787.
May KP, Druett HA. A micro-thread technique for studying the viability of microbes in a simulated airborne state. J Gen Micro-biol 1968;51:353e66. Doi: 10.1099/00221287–51–3–353.
Hobday RA. The open-air factor and infection control. J Hosp Infect 2019;103:e23-e24 doi.org/10.1016/j.jhin.2019.04.003.
Schuit M, Gardner S, Wood S et al. The influence of simulated sunlight on the inactivation of influenza virus in aerosols. J Infect Dis 2020 Jan 14;221(3):372–378. doi: 10.1093/infdis/jiz582.
Hobday RA, Dancer SJ. Roles of sunlight and natural ventilation for controlling infection: historical and current perspectives. J Hosp Infect 2013;84:271–282. doi: 10.1016/j.jhin.2013.04.011.
Hobday RA. Sunlight therapy and solar architecture. Med Hist 1997 Oct;41(4):455–72. doi:10.1017/s0025727300063043.
Gruber-Bzura BM. Vitamin D and influenza-prevention or therapy? Int J Mol Sci 2018 Aug 16;19(8). pii: E2419. doi: 10.3390/ijms19082419.
Costantini C, Renga G, Sellitto F, et al. Microbes in the era of circadian medicine. Front Cell Infect Microbiol. 2020 Feb 5;10:30. doi: 10.3389/fcimb.2020.00030.
Sengupta S, Tang SY, Devine JC et al. Circadian control of lung inflammation in influenza infection. Nat Commun 2019 Sep 11;10(1):4107. doi: 10.1038/s41467–019–11400–9.
Jester BJ, Uyeki TM, Patel A, Koonin L, Jernigan DB. 100 Years of medical countermeasures and pandemic influenza preparedness. Am J Public Health. 2018 Nov;108(11):1469–1472. doi: 10.2105/AJPH.2018.304586.
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Thank you for this very informative post. I was raised with fresh air and sunshine, continue to this day. My mother would scold us to 'go outside and get the house stink of ya'.

Many decades ago, my DD had a wicked diaper rash. My grandmother told me to put her bare-bottomed little self out in the sun for ten minutes every few hours. It worked.

1. Richard Hobday is not a medical doctor.
2. He is using data from 1918 science, which was incredibly limited because they lacked the technology to expand their scope of understanding of knowledge.
3. He brings his bias to the table in all discussions - he is a proponent of the sun as a cure for pretty much everything.
4. He uses himself as a reference which should be the biggest red flag: you can't say "this is true because I said so" in science.

But doesn't its publication in the American Journal of Public Health lend it some measure of legitimacy? I would like to think so.

Is this why I have never had the flu (well, maybe once but it was more of a common cold with a 102 fever for a couple of days)? I can count on one hand how many colds I've had ever. I've always spent lots of time outside as I like to work on our property. I love the outdoors and maybe that has kept me healthy all these years.

I disagree. The article accurately references tactics used in 1918 for a virus of which NO VACCINE EXISTED. While sunlight may not be a cure for everything, it is a natural disinfectant and increases Vitamin D which has been proven to increase immune response to viruses.

Ah, 1918, when hysterectomies and lobotomies were used to treat mental disorders and mercury and arsenic were prescribed for venereal diseases.

It is also the #1 cause of skin cancer. It will also cause permanent untreatable retinal burn and blindness if you stare into it long enough. It is also the singular cause of sunburn.

It's much less risky to simply wipe some rubbing alcohol over your skin, and take a Vitamin D supplement, if that's your concern.

OK, you have an agenda that I don't agree with. 'Nuff said.

There is no agenda, and there is nothing for you to agree or disagree with. These are actual facts.

The person who wrote the article is NOT a medical doctor. That is a fact. If you disagree with it, it will still be true.

The Spanish Flu ended on its own, as most virii do over time. There was no cure for it, and treatments for it were hit or miss with each patient. Some survived with treatment, some survived without treatment. Some died with treatment, and some died without treatment. It didn't matter what treatment was used - it was a virus that ravaged the immune system. It wasn't cured by sunlight. That is FALSE information. You can disagree with this fact if you want, but it will still be false information.

Hobday is a pseudoscience writer. Being published doesn't change that, and in fact the peer reviews on any of his sunlight-as-cure papers are less than complimentary, as a whole. He is not a credible source.

Saying sunlight was a valid treatment for the Spanish Flu is sort of like saying that diving into a vat of bleach is a valid way to get an ink stain off of your shirt.

You are right about all of this. However:

In 1918, if you were coming home from the war on a troop ship or living in a crowded tenement house in a big city, conditions were often damp and warm, and people who didn’t have some disease were in close proximity with people who did. Meanwhile, people who had a disease might also be next to people who had some other disease or to people who were coughing out more of the pathogens other people were trying to fight off.

Beyond doubt, many pathogens multiply more readily in a dark, damp, still environment where there is nourishment for them. (Like the inside of a Petri dish with a nourishing broth in it, right, that helps pathogens grow quickly and become easier to see. Or like inside your throat or lungs.)

Spacing out people and cutting their contact with other sick people helps the sick and, perhaps more importantly, helps those who haven’t caught the pathogen. The UV light in sunlight definitely can kill many organisms. That’s why all of my household water flows past a UV sterilizing light. Dry air can also shrivel many pathogens or kill them. (Humid air, meanwhile, can help you breathe better by keeping your airways moist.) I’ve read that in the wards with wide open windows, day and night, the reason people healed faster was probably because of less reinfection from other patients, and it helped the nurses and orderlies avoid infection. This was the best treatment for tuberculosis for a long time—it gave people room to heal themselves.

Exposure to sunlight in moderation can help. Fresh air away from contagion can help, too. Cleanliness is crucial. This is a lot like what we are now calling “social distancing.” Getting fresh air is a great idea, whether on your porch or going for a walk. By all means walk and talk with friends, but keep a prudent distance apart. Keep track of each other.

We’ll get through this.

Clearly, sunshine is not a cure or there would be thousands of naked people running around in China and Europe. However, If you go out in the sunshine, and get some fresh air, you are more likely to have a better attitude when you come back inside. And, a good attitude has been shown to affect how people fare during any recovery. The lesson here should be: Get out of your house once or twice a day. Walk around your yard, or sit in the sun. You can talk to your neighbors from across the street; you don't have to be on top of them. You'll feel better and have more energy when you go back in! Stay healthy, everyone!

Great! We could now expect cases of 2nd and 3rd degree burns to flood the ER.

Fresh air and sunshine are a necessity in my life, always.

Don't forget your sunscreen!

Not every medical professional is a Doctor. No one said the Spanish Flu was cured by sunlight but many of those who received more sunlight exposure did recover while many who did not died. Your saying sunlight does not help denies the proven medical science that flu and other corona viruses do dissipate as temps warm with more sunshine. You don't like the guy, fine. but he does quote actual fact.