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Revisiting an old treatment for infectious disease: Fresh air

A century ago, a surprising remedy for the Spanish Flu emerged from a series of tents on Corey Hill just off Washington Square in Brookline.

Triage tents are being set up in Central Park to help in the battle against the coronavirus, and while other cities are also seeing triage tents spring up, no one is advocating for the outdoors itself as a treatment.JUAN ARREDONDO/NYT

Virtually forgotten by history, largely ignored in the medical world, a surprising remedy for the Spanish Flu pandemic emerged in desperate days a century ago from a series of tents on Corey Hill just off Washington Square in Brookline.

The mass health scare accounted for more than a half-million deaths in the United States and more than 50 million worldwide — and Massachusetts stumbled upon a treatment with unlimited possibilities and an unlimited supply: Fresh air.

Faced with an onslaught of influenza cases, state health department officials in seven hours created a colony of more than 200 tents on the Brookline hill that today is favored for its walking paths and stunning panoramas of Boston’s skyline. The tents housed 351 merchant marine trainees who had contracted the disease on a ship in Boston Harbor and were “successfully treated by the open-air method,’’ according to the Boston Medical and Surgical Journal, which since 1928 has been known as the New England Journal of Medicine.

Might this early 20th century episode have 21st century implications?


“The open-air treatment, even during a week of severe rain storms almost every day, has proved highly efficacious,” the journal reported, “and the men have been sent back to their ships with renewed strength.’’

This surprising course of treatment for the disease — an affliction sometimes called “La Grippe” — was essentially a medical application of the generations-old notion of “taking the air.”

Indeed, open-air treatments date to the battle against tuberculosis in the Royal Sea Bathing Hospital in Kent, England, in 1791. As the 1918 influenza pandemic was subsiding, Sir Leonard Hill, a physiologist and a fellow of Great Britain’s elite Royal Society, argued in the British Medical Journal that breathing cool air was an effective method of fighting influenza infection. But it did not become part of the standard treatment. Some 90 years later, the idea of fresh air as a remedy to illness was revisited when Richard A. Hobday and John W. Cason argued in the American Journal of Public Health that fresh air had proven successful in Brookline during the Spanish Flu and suggested that, in the present day, “much more fresh air may be needed than is currently specified for hospitals, schools, offices, homes, and isolation rooms.”


In Brookline in 1918, the primitive yet powerful remedy of fresh air proved so successful that tent or shack communities were installed in Lawrence, Ipswich, and Haverhill as well as at the Medfield State Asylum for the Insane, now known as the Medfield State Hospital.

Social distancing was also in the mix. Brockton, Fall River, New Bedford, and Taunton were among the hardest hit Massachusetts cities in 1918. The state imposed theater, school, church, club, and saloon closings, reflecting what the medical and surgical journal described as concerns about “the contagion which daily menaces the public health of the thousands who work in the city and who must ride to and from their places of employment.”

“One of the most serious causes of the spread of the present epidemic of grip,” Massachusetts health commissioner W.C. Woodward said, “is the congestion occurring at rush hours in railroad and subway stations, railroad trains, elevated trains and trolley cars.”

These concerns about proximity were well known nationally. But the Massachusetts open-air remedy was not well-known, which is why the health department sent word to its counterparts across the country that “fresh air and sunshine are the most helpful aids which the department has found in the treatment of influenza and the Massachusetts department desires to help all other states as much as possible.’’


Compelling as the 1918 story is, no one is suggesting that COVID-19 patients be set outside in the early spring chill, though as the current crisis has deepened, modern auxiliary hospital tents have been installed at Carney Hospital in Dorchester and in several places across the country, including Munster, Ind., and Canton, Ohio, and, just the other day, even New York’s Central Park. Before long, hundreds of temporary tent field hospitals may be scattered across the country.

Assuring better ventilation in hospitals is a tool some medical specialists are advocating for — and it could be of special value in protecting health care workers who are exposed to coronavirus droplets in the air from COVID-19 sufferers who are coughing up contaminated secretions.

“Fresh air is a disinfectant,” said retired Air Force Surgeon General Lt. Gen. Paul K. Carlton Jr., a professor of surgery at Texas A & M University who advocates doubling the air exchanges per hour in hospital rooms. “I don’t know of any downside. It’s not free, but it’s not expensive.”

Massachusetts officials were pleased that the death rate at the Brookline outdoor facility in 1918 was lower than about 10 percent — a staggering figure and about the same as the death rate from COVID-19 in Italy, according to the Centre for Evidence Based Medicine at the University of Oxford. The current American death rate from the coronavirus is well under 2 percent — and perhaps might benefit from a prescription that the actors in the 1967 rock musical “Hair” sang about: Let the sunshine in. And maybe more fresh air.


David M. Shribman, a former Globe Washington bureau chief, is a nationally syndicated columnist.