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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2008.134627v1 99/S2/S236    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Hobday, R. A. Articles by Cason, J. W. PubMed PubMed Citation Articles by Hobday, R. A. Articles by Cason, J. W. Related Collections Health Care Facilities/Services Prevention History Public Health Practice Other Environment

Richard A. Hobday, PhD and John W. Cason, PhD

At the time of the study, Richard A. Hobday was with the School of the Built and Natural Environment, University of the West of England, Bristol. John W. Cason was with the Department of Infectious Diseases, King's College London School of Medicine, London, England.

Correspondence: Requests for reprints should be sent to Richard Hobday, PhD, Department of Architectural Studies, University of Wales Institute, Cardiff, Llandaff Campus, Western Avenue, Cardiff, CF5 2YB, United Kingdom, and Natural Environment, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, England (e-mail: ra.hobday{at}virgin.net).

The H1N1 "Spanish flu" outbreak of 1918–1919 was the most devastating pandemic on record, killing between 50 million and 100 million people. Should the next influenza pandemic prove equally virulent, there could be more than 300 million deaths globally. The conventional view is that little could have been done to prevent the H1N1 virus from spreading or to treat those infected; however, there is evidence to the contrary. Records from an "open-air" hospital in Boston, Massachusetts, suggest that some patients and staff were spared the worst of the outbreak. A combination of fresh air, sunlight, scrupulous standards of hygiene, and reusable face masks appears to have substantially reduced deaths among some patients and infections among medical staff. We argue that temporary hospitals should be a priority in emergency planning. Equally, other measures adopted during the 1918 pandemic merit more attention than they currently receive.