Treating the (Last) Pandemic: Heroin, Aspirin, and The Spanish Flu

On September 16th, 1918, Lieutenant Colonel Philip S Deane, head of Health and Sanitation at the Emergency Fleet Corporation, claimed the outbreak of the Spanish Flu on the East Coast was due to the crews of a handful of German submarines who had made it to New York. How ever it had gotten there, it was the Germans’ fault, and in any case, it was no big deal. In the same statement, he said the Spanish Flu was, “Nothing more or less than old-fashioned grippe.” Grippe was a term for the common flu.

Sound familiar? Despite apparent precautions being taken, the Spanish Flu claimed its first victim in the US in Philadelphia, spreading among the sailors and marines until the naval hospital was completely overwhelmed and hundreds of people needing immediate help were transferred to the nearest municipal hospital or treated outside in the navy yard.

Within 24 hours, 41 deaths were recorded in Boston. More were reported throughout New England, and as it began to spread to the civilian population, a nationwide warning against public hysteria was issued. The virus worked quickly, and it could develop into pneumonia.

All around the world, the death toll was staggering, with an estimated 50 million people losing their lives before it was over. But then, as now, people didn’t necessarily know what they were dealing with or how to treat it.

In a 1918 article on “the so-called influenza epidemic,” Chicago doctor Albert J. Croft suggested that the Spanish Flu wasn’t a virus at all, but the result of gasses from the First World War ascending to the atmosphere and forming a kind of toxic dome around Earth. It made more sense to him than a virus spreading quickly enough to infect people on opposite sides of the planet; it had to be environmental, or at the very least, Divine Retribution for the war—which plenty of people believed (and vehemently blamed the Germans for starting).

Assuming the flu was a toxin, Dr. Croft recommended laxatives to flush it out, along with saline enemas. He also recommended phenacetin, a pain reliever that destroyed kidneys (and also killed Howard Hughes), and strychnine.*

But Dr. Croft was not the only person recommending enemas and strychnine. An October memorandum from the base hospital at Camp Zachary in Kentucky outlined the standard treatment for patients admitted with the Spanish Flu.

It started out simple enough, as everyone had the equivalent of Vick’s Vaporub applied to the nose, and they were given a cup of warm milk and a basic enema. More severe cases were treated with small doses of strychnine or an enema of hot black coffee, brandy, and water.

And worse—yes, worse—for this type of enema, you’d have to hold it there for 20 minutes.

Coffee with brandy is delicious. There’s a certain logic to treating the Spanish flu with a Spanish coffee, but I’m pretty sure you’re supposed to drink it.

If you can believe it, that wasn’t actually the worst of it. Patients with a cough or chest pain—basically all of them—were given heroin.heroin-bottle-collection_1518_canvas

As an opiate, heroin was effective as a cough suppressant, but that’s not the only thing it was used for.

As William Small explained in the Eclectic Medical Journal of August 1919, sleep was critical for surviving the Spanish flu. As fever and chills could make it difficult to sleep, anything that would help you to sleep was a good thing. Laudanum would have been the obvious answer, but no:

“It has been our custom never to allow a sleepless night. Tepid sponging may first be tried, but, if insufficient, the patient should be given heroin hypodermically, repeated once or twice, if necessary, at intervals of an hour and a half until sleep is obtained. A satisfactory night’s rest is almost always followed by considerable improvement in general condition.”

You’d certainly think so.

Heroin

This sounds shocking to us now, but at this point, heroin had been used in medicine for about twenty years.

Medical grade heroin—also known as diamorphine—was first synthesized by British chemist C.R. Alder Wright in 1874. Nothing really came of his experiment until 1897, when another chemist tried again.

Felix Hoffmann worked for Bayer pharmaceuticals in Germany. If Bayer sounds familiar, it certainly should—it’s still one of the biggest pharmaceutical companies in the world. They still sell one of Hoffman’s most famous inventions—aspirin, which he synthesized on August 10th, 1897.

Eleven days later, the man who gave the world aspirin invented heroin.Drug_store_sign_for_products_Heroin_and_Aspirin_before_US_Heroin_ban_1924

At the time, morphine addiction was a serious problem in Europe and the United States following the Franco-Prussian War and the American Civil War, so Bayer tried to develop a less addictive alternative. The drug Hoffman created didn’t come out quite as expected—it was twice as potent as morphine, and it would become one of the most addictive substances in the world.

It was called heroin after the German word heroisch, meaning “heroic” or “strong.”

When it first hit the market, it was hailed as a wonder drug. They said it was a non-addictive substitute for morphine without as many side effects. Between 1898 and 1910, Bayer advertised it as a cure for headaches and general malaise, and it was sold in cough syrup for children. It was even given to babies to help them sleep.

In its capacity as a replacement for morphine, heroin became a recreational drug in the United States as early as 1912.

It wasn’t exactly difficult to get. Heroin was a common ingredient in over-the-counter remedies. One of these was Hayes Healing Honey. For just 35 cents, you could get a bottle containing morphine, heroin, and chloroform in 7% alcohol. While honey does help a sore throat, whether Hayes actually contained any is anybody’s guess. Packages are rare now, and honey isn’t listed as an ingredient.

Local drug stores carried heroin products, and you could even get it through the mail—it was so popular that it was sold in the then-iconic Sears & Roebuck catalogue. For $2.50, you could get several doses, a syringe, and a stylish travel case. Much of the advertising was aimed at women, who handled more of the childcare and were more likely to become addicted themselves. Apart from veterans, women were the most likely to use it for various illnesses as well as menstrual cramps, insomnia, and pain related to childbirth.

By the time the Spanish Flu started in 1918, heroin had become prescription-only in the United States, but prescriptions weren’t exactly hard to come by, and the country’s addiction had long since set in. It was still used in hospitals and cures for the common cold. Heroin was part of the standard treatment for the Spanish Flu as it was an effective cough suppressant and helped people to sleep.

As we know now, heroin is incredibly dangerous. As easy as it is to overdose now, it would have been far more likely in the chaos of overrun hospitals during the Spanish Flu. The cause of death would have been hard to identify. Like those who lost their lives to the Spanish Flu, many would have appeared to have died in their sleep.

Oddly enough, Hoffman’s other invention—aspirin—may have caused several deaths attributed to the Spanish Flu as well.

In 1917, just one year before the Spanish Flu, Bayer lost its patent on aspirin in America. American companies flooded the market with it to try to compete, but the boxes didn’t include any dosage information. For a long time, no one knew exactly how much you were supposed to take.

Still, when the Spanish Flu came to the United States, aspirin was recommended as a treatment and bought in huge quantities by the Navy as well as the general populace. The Journal of the American Medical Association advised people to take up to twenty-five tablets a day, more than twice the maximum safe dosage as we now know it.

Just like heroin, aspirin overdose looks a lot like the flu. People would take it to treat the flu and, apparently not recovering, they would continue to take more until they died of what was assumed to be the flu. We have no way of knowing how many deaths from the Spanish Flu were actually caused by aspirin or heroin overdose.

Heroin was banned in the United States in 1924.

Jessica Cale

*Do NOT try this at home

Sources

Nicholas Bakalar. In 1918 Pandemic, Another Possible Killer: Aspirin. The New York Times.

Dallas Morning News. The Theory Advanced by Dr. Albert J. Croft of Chicago. December 8th, 1918.

Memorandum For the Treatment of Influenza Pneumonia, Base Hospital, Camp Zachary, Taylor, Kentucky. MS C 38 Glentworth Reeve Butler Papers, 1917 – 1918. October 3rd, 1918.

New Orleans States. German Pirates Bring Influenza. September 19th, 1918.

James Rambin. In 1918, Austinites Faught a Pandemic by Getting Drunk and Doing Heroin. Towers.

William D. D. Small. The Treatment of Influenza. The Eclectic Medical Journal. August, 1919.

Yale School of Medicine. From Cough Medicine to Deadly Addiction, a Century of Heroin and Drug-Abuse Policy.