america. and tonight its prime time on up will wrap up at 11 eastern with julie albright exploring the intersection of social behavior and technology and argues that technology has created the largest generational gap thus far. all schedule information can be found on your cable guide. >> last november we marked the centennial of the end of world war i. in november 1918, the people of nations felt relief that the years of warfare and death were over. yet, another threat to life was reaching across those nations into homes and schools and hospitals. the influenza pandemic of 1918 killed more people worldwide then were killed in combat during the war. many records house in the national archives in washington area, and other many field locations document this break in the united states.

reports, books, telegraphs and photographs show the reach of the 1918 influenza epidemic to all parts of the nation. these records open a window onto the world of hundred one years ago and show this human and societal cost of the pandemic. they allow us not only to look back at that time but perhaps also to look ahead. as information they contain may help guide present-day inquiries and increase our understanding of the disease. doctor jeremy brown is an emergency physician and research director the department of emergency medicine at the george washington university here in dc. he is now director of the office of emergency care research at national institutes of health. doctor brown is the author of more than 30 peer-reviewed articles and three books including the american handbook of emergency medicine. in the handbook of cardiology emergencies. he's recently received nih directors award for his efforts

supporting research and non-addicting methods of pain relief. jacob apple writing in the new york journal of books says, brown is clearly a man who knows the flu. not just the physiology and virus or the epidemiology of the illness but fun facts. william bynum writing in the wall street journal, he highlights the emergency room experience. influenza, making the virus itself central to its story. he reads history and contemporary virology and clinical practice together although history is a somber one, his account is punctuated by humor and much advice. like the best time to visit an emergency room for instance. ladies and gentlemen, please welcome, doctor jeremy brown. [applause]

>> thank you so much for the kind words. it is not everyday you get introduced by the archivist of the united states. we are here to talk about influenza. and the plague that struck us 100 years ago, resonates all the way through until today. as you mentioned, more people, more people were killed in the influenza virus then in the wars. 52 hundred million people worldwide, and the united states, 675,000 civilian deaths.of the 116,000 combat casualties, u.s. combat casualties, killed in world war i, over half actually died from disease and that was the majority being influenza. it is a sobering thought to think that if you take the

statistics and multiply them out by the current population of the united states, the 675,000 deaths would turn out to be about 3 million deaths in today's numbers. put that into perspective and think, but that would be like to look to such a thing. another way of thinking about it was to put the, the cause of this. we will come back to this but 1918, there was no known cause, viruses had actually not been discovered yet. so people were dropping from this disease called influenza. but no one really knew what it was from. we would return to some of the thoughts that were behind this. i think about that and i think about the 1918 outbreak of the hiv. which was incredibly frightening and yet, we knew that it had to be a virus. it took us three is to identify it. but at least we knew what we suspected that we do culprit

right away. in 1918 had literally had no idea. one other thing to put this into perspective as you all know, we are sadly living through an epidemic, every different kind today is the opioid epidemic. which has claimed so many deaths in this country. the news over the last couple of years was actually at the death rate is so high it dropped the average life expectancy in the us. you may have heard that forcing the statistic. if you look at the average life, the expectancy because of the large numbers of deaths of younger people, the average life expectancy has dropped. it is shocking. how much has it dropped by? you can look at the data. it struck by 1/10 of a year. that is a terrible statistic but it is 1/10 of the year. the 1918 grateful epidemic because such a large loss of life that it dropped the average life expectancy in the

u.s. by 12 years. 12 years. 120 times greater than what we have seen with the current opioid crisis. putting into what this really was, since were at the archives of the refund to actually look at archival material that actually affects, shows what happens here in the nations great capital. this and the following few slides are all from the "washington post" and i think they tell a very brief story of a much more complicated event. this is the "washington post" from saturday, september 14. in 1918, this was not the front page. it tells us that the spanish influenza was spreading across the us. it wasn't really reported yet in the papers in large numbers. in washington d.c. but it had

begun to spread across the us. now, the following day, the "washington post" reports that 90 people had died of influenza in boston. and that they seem to be sweeping from east to west. it actually was probably started in the midwest but it was already sort of ramping up and the very next day they reported that 90 people in boston had died, these were deaths among soldiers and sailors. the play named momentum, more and more people died. october 2 on the front page of the "washington post" were told that the work hours have changed.the federal day had been staggered to check the influenza spread and the people are to take shifts. washington d.c. was not the only states to do this by any means. in fact, it happened in the most of the cities that were

affected. the idea was if we could stop people from mingling, although we do know is a virus -- we knew that keeping away from people was a good idea but businesses were closed down in some places, restaurants either closed or staggered their hours. stores had staggered hours. an attempt to keep people away from each other. the working hours of federal government changed around the beginning of october. i thought about the spieth, this reporting the book. it's particularly sobering. it comes a couple weeks after the announcement about closures. october 13, 1918 the "washington post" reported on the headline, the ghoulish -- the price of coffins had skyrocketed and it was an example of people, people

taking advantage of a terrible situation. in fact, the right, the trust is holding people of the city or washington, holyfield the city by the throat. and extorting from them outrageous prices for coffins and disposal of the dead. and the fact the "washington post" goes on to suggest that the department of justice should step in and instantly put a stop to the high prices of coffins. it cost more to bury your dead because the coffin -- they could make a buck. by 1991, more people died in this short amount of time it was suggested that the crust is now in sight. it is actually quite hopeful, there is no evidence of that. but it was hoped that perhaps we are nearing the end of it.

throughout the epidemic, both here and nationally, people have various remedies. this is an example of a remedy that actually played throughout the fall and winter of 1918. will come back and talk about this. i want you to remember these words.this is a remedy called laxative -- it contains a laxative, will come back to that. thought to be very helpful in cases of influenza. in medicine until fairly recently was the go to medicine for malaria. it has now been superseded by others but it was thought to be helpful in influence appears of people making this laxative and i find it interesting that if you look at the beginning,

spanish influenza is an exaggerated form of -- laxative of quinine should be taken in larger doses than prescribed in ordinary. it's a really big epidemic so you better take a lot of the medicine. will come back and talk about these particular remedies. so these and several others, several of the tonics were at the time, both to treat the disease and also of course, to prevent it. again, another marketing opportunity for our businesses. laxative, -- quinine. by december 8 of 1918, the "washington post" had thought that we were coming to an end and it put this little piece, this little snippet that said spanish influenza is more deadly than war. and it is indeed the case. we know that.

but what struck me here is the placing of this piece of journalism. it is a back page. page 20. tucking next to an ad for dining room chairs. the epidemic was more deadly than the war. why was it not front page news? what happened? some believe there was some kind of passive agreement, not since she -- not censorship. if you going to put a statistic like that, influenza cost more than the whole of world war i in terms of life, putting it on page 20 is really not going to i think, get the attention it deserves. a little bit of a mystery actually have some very smart archivists that can shed more light on why this and other reports were sort of tucked into the back of places.

finally, we had early reports out we were nearing the crest in washington d.c. but unfortunately no, more deaths than any time since the record of last october. 16 deaths from flu and a single day is mississippi, again this is tucked away in legal record recordings. again, it was reported, it was not hidden. but if you have to sort of look for it to understand what was going on. and the final slot i want to share with you, reporting from the "washington post" was on exactly this date, march 5 1919. exactly a century ago. exactly 100 years ago today. this was a small report that was in the "washington post" that cited two washington boys i volunteered to go to boston

and to take part in some experiments that were trying to understand the cause and the methods of transmission. during the recent influenza epidemic, we read, men voluntarily submitted to experiments to -- for doctors, enable doctors and to determine the cause and method of transmission of the disease and preventative i guess preventative measures. it is really quite another remarkable side of the story. the people would volunteer to be involved in research on this varies of epidemic that was not understood in a forceful and there is no cure other than the bromo laxative tablets. i think the example of everyday heroism, people put in their own lives to some degree online, in order to try and

understand what was actually going on, was this terrible disease? these are just a few examples from the "washington post" that tells a little bit about what happened here in washington d.c.. i'm just going to switch here to a second slideshow. this one will run itself. if it all works fine, you'll see some images of the talk. today we are like to do is focus on three areas of research that i described in the book. the first looks at how the treatments of influenza have evolved. what do we do 100 years ago to treat this terrible deadly disease and what do we do today? and i think you'll find that actually, it's changed less than you would have hoped.

the second focus is going to be how our understanding of the influenza virus has changed over the last century. what was it that we thought caused influenza 100 years ago and what do we know about that same virus today? and there think we can all agree there have been an absolute remarkable, evolutionary and leap in our understanding of exactly what was going on. finally, we will look at how we can prevent ourselves from catching the flu in the first place by looking at vaccines. what vaccines were like back then 100 years ago and where we are today. will find again that we have a lot of work to do. the treatments were not effective. they include mercury, tree bark, and factory gases. actually happened, people reported in the supplemental to be taking their families in the

children's local gas and emission factors were the toxic fumes were thought to somehow reduce the likelihood of getting influenza. it turns out not to be as crazy as it sounds because many of these contain chlorine. chlorine gas used during the war and no chlorine is a great antiseptic. it kills everything including people. so very likely that the factory these places had influenza at slightly lower rates than other people because yes, they were inhaling little bits of chlorine in the whole atmosphere is big no chlorine gas and it probably reduced the amount of free verse floating around. it was in a completely crazy thing to take your children to inhale factory gases. there was some upside. there was whiskey, these were prescribed by senior physicians. not everything was difficult

and as we said, animals, they were used to treat everything. back then there was very little you could do. an enema was thought to be, clean everything up. they were quite popular and one of the most remarkable things is blood lesson. this is the process by which blood is removed from the body and the thought is that with the removal of the blood you are taking out the bad thing that is in the blood causing the disease. it dates back to at least the fifth century bc. and george washington was probably killed by blood lansing as he laid dying from a throat infection producing your dr. suggested -- the other people less into the idea. and those little bit of resistance from them but none of them unusual but senior

people one end blood was taken from george washington as he laid dying on his bed. and as he passed out or introduce -- as it was called them. our own president, george washington, underwent this procedure. doctors then tried to think about reanimating george washington by using, i'm not making this up, shapes blood. at that time there was good since that prevailed and said enough is enough with the blood and the shapes blood and they let him rest in peace. but what is remarkable to me is that this was used in the great flu epidemic of 1918. and not just by what we might call -- this was by mainstream physicians. in fact it was one of the things that sparked my interest in the story of influenza then

and now. there is a report in one of the leading medical journals in the world, one of the leading medical journals in the united kingdom, if you think about it the name is named after the device, a little tube that you would take blood from. so it is called a lancet. the report mentions that in 1916, those two years before this great blue pandemic, there was another pandemic, and of epidemic, in great britain, and the doctors had tried everything including the said, including blood lansing. since 1916, this is a lifetime of my own grandfather. in 1916, physicians would try this on the poor patients and of course, it did not work. but the physician said it did not work but we think that it didn't work because we tried it too late. and had we tried it sooner in the clinical care of the

soldiers, it may be at work. and there were reports in 1918, the head of the epidemic of blood lansing in the report aureus, sometimes it works for influenza. so you can see if it wasn't the animals that got you, the blood lansing mikey. it was a nasty array of medicines that we had to try and treat this. we saw earlier, an ad for concoction that contains quinine it was a useful drug for malaria. but useless as a treatment for the flu. because it is useful in malaria it reduces the for recycle. if it reduces fever and malaria it will reduce fever and

influenza. obviously two quite different mechanisms of disease but that was the thought process behind it. of course, a completely useless drug and incidentally, dangerous and appropriate dose. as a said, ever was prescribed animals. my favorite discoveries when i was researching the book was from a polish paper i think from the grandchildren of a patient who had influenza. september 19, 2018 but in 1936. 18 years, almost 2 decades after the great influenza pandemic, the family had preserved the nursing records of grandfather, they found in the attic and publish them. i'm going to read a little bit passage that describes what this person went through. over a period of three weeks he was treated with a punishing -- a home remedy rubbed on the skin, and something for fever.

coding for cough, and a cancer-causing laxative.cough medicine, oil, seven animals, seven. tubes, don't ask, milk of magnesia, and other laxative, god help him. a blood antiseptic and tincture of benzoine. you can see the time and were all these various things were given. the patient received at least five prescribed doses of whiskey. so there's at least that. and 14 doses of castor oil. actually, the seven enemas may have been medically necessary because he was given a list 39 doses of coding which suppresses coughing but also causes constipation. so, that is what life was like we had influenza back 100 years

ago. what about today? how do we do today? the vast majority of us, influenza is a little bit of an inconvenience. not life-threatening and it is something that we generally deal with at home, a friend or family come and give us hot soup, leave a couple of days in bed and usually that's it. but of course, some of us end up an emergency department. over my time as an emergency physician i got to treat many possibly hundreds, who knows, maybe thousands of patients with influenza over the many years. and there we have things that we didn't have 100 years ago. if emergency department, we have blood tests that can tell us what's happening. we have x-rays so we can actually get a real good look at the lungs and see if there's evidence of pneumonia and we

can get people intravenous fluids. sorry. we can get people intravenous fluids. and treat them in that way. and of course, we have antibiotics today. let's be very clear, antibiotics should not be given to patients of influenza. they do not work. we all know this. people know they are prescribed unnecessarily, often even today. they don't work. but they do work to help treat the secondary infections, pneumonia, bacterial pneumonia that come as a result of the primary viral influenza.they have them say they were not available, not until the early 30s and it's a remarkable thing that today we believe the majority of deaths occurred in the great flu epidemic were caused by secondary pneumonia that we would be able to treat today. so that is good news.

we also have other medications to treat fevers, not quinine woman a case like aspirin or motrin or tylenol. and i came across a very interesting study that suggests perhaps you should be giving medications for people's fevers quite as often as we do. this is a study in canada and they looked it this and this and what he figured tens of thousands of people with the flu so medicine to reduce the fever? well, any of them will flow better quicker because having a high fever was shakes and chills, -- the suggestion from this group at mcmaster university was that by treating a fever for patients in the emergency department you might increase transmission rates by

about one percent and given the enormity of this disease, they suggested you might actually get an additional 500 deaths a year in the united states as a result of treating peoples fevers. now, if you come to the emergency department with influenza today, and your dr. sees that you have a fever of 103, and she suggests that you probably shouldn't get something free fever because she says, there's a paper for mcmaster university that theoretically, you know this could increase the death paper may be 100 -- you'll probably say doctor, please give me the medicine. i know i would. i would prescribed and would probably continue to prescribe something for people's fevers in the presence of influenza but there is at least this kind of are the way of thinking globally about what we are doing locally and how it might affect transmission and spread.

so we have those medications as well. to help us. and then there are some specific medications that treat the flu, those are mainly things like tamiflu and the new kid on the block, -- is a direct antiviral medications. all not going to those directly now. perhaps we can talk about them later. there also out there, they probably don't work anywhere near as efficiently as they should but they been touted to work but we will leave that for later. all right, that is the treatment. enemas, blood lansing, laxative, whiskey, 100 years ago, today, the emergency department, state home and of course the intensive care unit. where the sickest of the sick go to be supported through their care. in fact open the book with a

story of a young lady, a young mother of two that came down with influenza extremely quickly. she ended up basically in a matter of hours being medevac from her small town to pittsburgh where she was put on a bypass machine for several weeks until she recovered from the flu. when is a miracle of modern medicine today that clearly was not around 100 years ago. so the treatment. let's now think about the cause of influenza. what do we know about the cause today? and what did they know 100 years ago? i think in many respects this is the most frightening aspect of the great influenza pandemic. they just didn't know what it was caused by. there were some suggestions. among those suggestions included the conjunction of jupiter and saturn. in fact the conjunction of the planets. that is where we get the name

influenza from produce from the italian meaning influence. and the earliest thoughts were in the 1600s, that the disease, it was an entity that you could identify, this disease is caused by something in the stars. there was a theory going on and resolve this very no history were looking influenza today. perhaps conjunction of the planets, rotting animal carcasses, earthquakes and volcanic eruptions. they were suggested as possible causes. effluvia discharge into the air from the bowels of the earth. people really didn't know what it was. in fact, at a meeting that occurred in chicago public health officials earlier in the influenza epidemic of 1918, one public health official said the following. we may as well admit it and call it germ x.

we don't know what causes us and where we are. an example of a cause that was really not a cause was a discovery in 1892 in berlin by some microbiologist. they found a bacterium on the lung samples of people that died from the flu. and they said aha!this must be the cause of the flu because it's everywhere. they called it bacillus influenza. the influenza bacillus. the problem was that it was not the cause of the disease, it was a secondary pathogen that was found. it was a secondary bacteria and that, that thought that they found bacteria and it turned out not to be, it happened in several different instances. they later changed the name, it was not called bacillus influenza but haemophilus

influenza. some of you may have heard of this. it's a nasty bug, fortunately have a vaccine. but for many years i would like to hear a physician why we treating this person with the h fluid has nothing to do with the flu? turns out it was thought to be the cause of the flu. and one of the historians of the great flu called this discovery bacillus influenza and authoritative -- pointing the wrong direction. so yeah, that was bacillus influenza. secondary pathogen. in 1899 there'd been a small epidemic but is a severe one breaker and it was so severe that actually parliament commissioned a report in the

epidemic. this was reported in 1889 by henry parsons. henry parsons, he was a very smart person and we will see why. he spoke about various theories that may have caused this 1889 epidemic. one of the theories of the time and i'm not making this, was tainted russian oats. the suggestion was that the russians were bringing the disease from the east through europe and tainted russian -- not every outside society blame this but today we are still blaming the russians for pretty much everything. back in the great flu epidemic and earlier perhaps the russians were behind it as well. but parsons said was smarter than that and he dug a little deeper. he suggested. he said, it could be the weather. perhaps there is something floating around in the areas of

course partially true, there is something in the air although is person-to-person contact more. he suggest that maybe and non-living particulate matter. it's an actual description of a verse turned out to be a nonliving particulate matter. so describing the possible cause of the flu. it could be russian tinted oats, it could be a poison in midair. then he suggested, what about person-to-person contact? is not spread by oats or volcanoes what one person gives it to another. and here think henry parsons really showed the right way first thing about this. he said let's get some data. if it is person-to-person contact. what he did was, he looked of the illness rates on the british railway system. and he compared the rates of the engineers who were feeding

the steam engines and the calls that worked outside but far away from people. and he compared those influenza rates, how many people were sick from that group of workers. he compared those to the influenza among those inside selling tickets. and of course the inside, not exposed to the outside but in constant contact with people. and he simply compared the two indy found that of course it was the clerks who had an increased rate of influenza. because they were in contact with people and the railway engineers driving the train standing outside, feeding the colons that big steam engine, their rates of flu were really much lower. even though they were outside exposed to the effluvia and lord knows what from volcanoes. it's really probably nothing to do with the atmosphere but it is more to do with person-to-person contact. from a simple look at some

records, this guy parsons stuck it out but probably we are onto something in the person-to-person. and then he said the following. he also suggested that perhaps animals have something to do with it. and here he was really on the money.he suggested that perhaps birds or horses or dogs had something to do with the spread. he goes into in some detail in his report. and of course we know today that birds are intimately related to the spread of influenza and new strains. back in 1889, henry parsons said that was really onto something and he discussed the possibility that birds were involved. that birds were involved. is an example think of people trying to think this through and a fairly logical way. and almost coming to the right conclusion. today of course we know what causes influenza. there is no doubt. it is a viral particle which is many times smaller than bacteria. we are able to take

photomicrographs of this when the electron microscope was developed and able to be used around 1839. so you pictures of influenza virus. pictures, diagrams, and fact, scientists today know that the genetic code of the influenza virus, eight viral genes work together, what the viral code looks like, proteins on the coat, with the proteins do and how they make us sick. and so the degree of from the suggestion that is something in oats to something that we can see, and identify and know a lot about, is really a think a remarkable example of the progression of science. over one century. now we can identify the viral particle down to the genetic

makeup, the genetic construction. so in that respect, i think we have come a long way in understanding the cause of the disease. which brings us to the last part. the way that we change in terms of vaccines and prevention. they were attempts to produce early vaccines to influenza. now back in the 1880s, of course he developed his own set of vaccines.most famously to rabies and doesn't necessarily mean that he knew what the virus was. but he had suggestion that it was something in the nervous tissue and he managed to propagate nervous tissue and make them weaker and weaker until he figured out that what he had was a weekend virus and that's how he produced the rabies vaccine. we know that people were producing vaccines back then. but of course what they were using were bacteria.

second-degree pathogens and not the primary influenza. for instance, in early 1919, edward -- from the mayo clinic i slid 5 different types of bacteria from patients and mixed them all together and he managed to inoculate over 100,000 people with his vaccine. we're not sure what the chemical outcomes were but he certainly tried. to do something. now in boston, at the tufts medical college, doctor timothy leary made a vaccine. he made a blended vaccine using strains from the chelsea hospital, the chelsea naval hospital, and nurses knows from the carney hospital and the infected wards of camp devon not far from boston. he made a concoction and given to people and his vaccine ended

up being sent to san francisco where 18,000 people were inoculated with the vaccine. that is doctor timothy leary. in case you're wondering yes, the answer is, is the same doctor timothy leary. in fact, this is the uncle of the famous doctor timothy leary in boston. he who wanted us to tune in and drop out, it was his uncle who created this vaccine 100 years ago. so, that is attempts a vaccine back then. what we do today? what do we have today? we do have vaccines for the flu. many of us in this room have, will take them every year. and you know, those of us who are involved in healthcare have to get the flu vaccine. it makes sense for us to try and prevent the transmission. but it's really not a very good vaccine. if you think about it, right, mumps, measles, rubella, you

get them once or twice as a kid and you are done. right? you are done, finish, that's it, you're good to go! you won't get the disease ever. but in terms of the flu, we are told we need to get it every year and a new flu shot.i just had it last year and the year before. we deal with a vaccine that is really not on the same level of effectiveness as these others. in fact, in a good year, in a good year with the wind blowing in the right direction, the flu vaccine is about 50 to 60 percent effective at best. at best. last flu season was less than that in the 20 to 30 percent range. so why is this? why is this flu vaccine so hard to create? and the answer is that we have this -- creates or contains eight genes in the flu virus and it makes proteins on the surface and it is against the proteins of the vaccine is

created. the problem is, the flu is such a disguise or, a master of disguise it changes the makeup of the surface proteins very quickly. and it mutates so we think that we have got, phaedo what kind of flu will be around it turns out the species then mutates and it is no longer effective. and by that we didn't realize that b and c would be the ones we didn't include those in the vaccine and you are not vaccinated against them.which is the reason incidentally the reason that some of us get the flu vaccine and we end up with the flu. it is not because vaccine did not work on that particular strain but because they were either other strains that we were not vaccinated against or because the original strained changed the surface structure

just like changing from a brown to a black overcoat and the immune system didn't recognize it. and that's what's going on with the flu vaccine. it's a similar story with hiv. the promise of an hiv vaccine was, he would have it within a year or two we were told in 1980. still not there. these viruses are clever at changing their surface and hiding from the immune system and so we still have a good influenza vaccine. the way we make the vaccine incidentally is that we have 120 or so laboratories across the world. they look at samples that are sent to the lab and try to figure out exactly a kind of species that is prevalent. we look at australia and what they had their most recent

influenza outbreak. in their winter it is our summer. we try and figure that out and incidentally they do the same for us. they look at what happened in the northern hemisphere and adjust themselves for the oncoming flu season in the summer. then doctors make the best educated guess they can. and they say based on the evidence that we have, the most likely species will be this and this and this. and we're going to make the vaccine. to this day the majority, much of vaccine is produced using eggs, is very hard to grow so it's actually going on eggs which is the same thing that was used a century ago. there is some vaccine made using cell technology and it is for vaccine not created on eggs but still, those are simply the methods that we have today that are left over from 100 years ago. the majority of vaccine is still to this day, has something to do with eggs and needing to be gone on that medium.

in many respects we really at the beginning of the fight here against influenza by preventing it and creating a vaccine. while that is all true and it is not very effective vaccine, we must remember that in certain groups, certain age groups, is extremely important to get the vaccine. the high risk people. there's her children, the elderly, those with immune compromise conditions, people that are taking steroids or undergoing chemotherapy and pregnant women, extremely important for pregnant women to get the influenza vaccine. for some reason they are slightly at an increased risk of complications from influenza. and so those are some of the high risk groups that should certainly be vaccinated. in terms of reverence, the data out there is harder to really

find an effect on the flu. in the united kingdom, the high-risk groups are targeted and everybody else sort of, if you want when you can get one, go talk to primary care dr. but there is no campaign. here in the u.s. we have a campaign, the cdc says everyone over the age of six months should get vaccinated, pear. that is the advice that we have in the united states. it is worth pointing out that this not the advice that is given overseas and become talk about why that might be another time but it is an important difference i think in the way that we think about the flu. it's very important for healthy otherwise healthy adults, the vaccine doesn't really do a whole lot. what we need instead? we need a universal flu vaccine. a vaccine that will work from year to year without having to get it again each year. the vaccine that will work in all age groups and a vaccine

that will work in all geographic areas. regardless of what specific strain of flu is running around rampant in your area. that is the goal of universal flu vaccine. and to do that, we are to target that flu virus which we understand very well. and find a bit of it that doesn't change. find a bit of the flu virus that we can target and that our immune system will recognize and latch onto it and will kill the virus to matter what particular strain it was. it sounds easy. very hard thing to do a reality. we are still not there yet but i will say that the national institutes of health where work i will you know that i am not here within the federal government views on this great influenza epidemic in 1918. the nih where work is actually very very focused on trying to find a universal flu vaccine.

pouring a lot of money and research time and effort into that. there is in fact an nih sponsored trial of a -- of passive -- there are companies out there doing this it is underway right now. for the nih. who knows, will it work will it not work? will we see universal flu vaccine? i don't know. i know we will see one soon but it is certainly the goal of what we trying to do with the vaccine. some have a long way to go. if we look at where we were 100 years ago and where we are today, the treatments are very different thankfully. but we still lack real good treatments for influenza. we understand the virus in a remarkable and deep and profound way, in a way that is unimaginable a century ago.

there -- we are not there yet although that's where the research efforts are going. i hope looking forward is that we really will be able to see influenza not just as a story of the past but a disease of the past in a way that we think about smallpox. as a disease of the past, it was eradicated. it's important to try and move towards this goal, the cdc estimates anywhere between 30 and 50,000 people each year in the u.s. dive influenza. it is a soft number, it is not great, not extreme accurate but the ballpark figure. a lot of people still get the disease and is in the high-risk groups predominantly. we really don't have to try and think about ways that we can improve our own vaccinations so that we will be able to hopefully make one day influenza a thing of the past. thank you for your time.

[applause] >> any questions? i'll be happy to take them. sir? >> thank you. somebody made a lot of money with facemasks back then. and we see this today. in this culture we don't see them as commonly as you see in asia where they wear them when they get a cold or don't want to give a call to someone else. my question is how effective are those? because there was a picture you showed that spit causes death. if you spit in your eye i assume it will be uncomfortable as well as potentially dangerous. you talk about the perspective in regards to the filtering and is it just a comfort on ours and back then to use masks or is it a reality of something that can help prevent spreading of that? >> it's a wonderful question, thank you. of course, masks to something. right? they do something, even the cheap math that you can buy at the local pharmacy have a filter mesh that if you cover you will be breathing through

the mesh. but it will stop something. question is what is it stopping? it might be stopping your secretions if you cough in the mask and it captures the sputum that you are coughing up or doesn't stop the viral particles that someone also scoffed out from quipping the mask? also not. and the other thing about facemasks is that after a full amount of time they become clogged. and then they are completely useless and don't do anything. so i think that what we are seeing is an interesting idea. in other words, don't sneeze over people, do not cough over people that make sense. but the suggestion that if we really going to stop this by wearing a facemask, i think you may have seen a picture of the happily married couple, husband and wife hug each other wearing facemasks. right, so i mean, it's clearly i think a pure example and something that probably does very, very little but we do

know that one of the most important, the most important thing that you can do to prevent fleas not to get antiviral medicine from your doctor. it's not turn up at work when you're sick. wash your hands if you're helping somebody looking after someone with the flu and do not cough over people. i think this reminds us of what we need to do we have the flu but in terms of an intervention, the small paper masks almost certainly do very little. over there. >> thank you for the talk. i will be curious to hear you say more about you mention the cultural differences between the way the u.s. encourages everyone to get vaccinated whereas in europe sometimes they don't. why is that and which do you think is correct? >> okay. i go into this in some detail. to be clear, and the united states, the cdc recommendations that everybody over the age of

six months get vaccinated and in the uk, and parts of europe. high-risk groups only. everyone is to catch you up but it is not being pushed. i think the difference is how we approach this. if you look on the cdc website for example, you will read that influenza, and paraphrasing of inflows is a serious disease with complications including death. since that's the case, everyone over the age of six should get the vaccine. i was looking at the website and all power physically basically says the following. influenza is a bit of a nuisance. you will be up, you will feel unwell for a couple of days, you don't really have to go see her primary care dr. about it because probably there's not a lot they will do but you know if you need to you can but stay indoors, and you will be fine. that's basically what the

national health service view of influenza is. and if you have these two very different approaches to describing a disease, it's a potentially dangerous disease that can kill you as opposed to it's a bit of a nuisance but you'll be all right.so the cdc says it is a potentially deadly disease, you know the influenza vaccine isn't terribly good, let's use it, it's at least something. where's in the united kingdom they say it's not terribly good vaccine so let's not use it when we need to but most people will not need it. which of the two are correct? they're both right, aren't they? influenza is indeed a potentially deadly disease. but that is only from .001 percent of the people who will get it. and the time number people who go to get it, proportionately how many get sick. it is only those who are at increased risk from the disease.

those high-risk populations. and the united kingdom approach, it is a bit of a nuisance with that's about it. this also correct. which of these two messages drives us is going to decide i think how we respond to the vaccine. and we are decided in united states, the cdc we decide this is the best public health approach. i think the data as far as i read them and this is purely a personal observation. the data really is in high-risk group people should get it, is still not terribly effective but and everybody else, let's talk about that group, the young healthy middle-aged adult, probably does very little. and yet, as you know, beginning of august, you'll see signs in the pharmacy saying we are ready to give the flu vaccine. come and get it. we'll give you a coupon. or something like that.

two very different approaches. it is a bit of a nuisance, it's a deadly disease and i think he drives how we look at the vaccine. and of course, i think this is a bit of a larger discussion but the question, if it kind of works we should use it. that is the aspect of the american health system. if it works, put it out there. even though my network terribly well, even though there are problems with it. in the united kingdom i talked to the chief officer. he said in the united kingdom the think about things beyond how well it works they think it does make sense he says if you edit the numbers it doesn't make sense economically to have a big campaign for healthy adults to get the influenza vaccine when so few of them proportionately are going to end up getting sick and taking time off work. so we will just leave it at a very different approach to the

two different cultures. yes, sir? >> good afternoon, doctor brown. i am a history graduate student at george mason university. does it suffice to say i am stickler on sources. i'm just curious what sampling of sources you used. i know your newspaper articles and some medical diaries but i was actually more specific interested in your use of secondary sources to kind of bolster your own medical knowledge that you already have. >> it is a new question. i think american trouble now there's a historian in the room. the truth is i use both. obviously i began with one of the secondary sources occurred, premeasured everything that had been published in the last decade or so in the popular

literature. there are good books on there about influenza and i was actually talking to dave before we came in. but now you have the resources of the, this thing called the internet. and i don't know that it was available to the degree that it is with the other books that came out. you can do a search for hundreds of newspapers for the keyword, influenza. you can do by city, state, by time.you can get these information, like i should do just now. those are primary sources something anybody's actually really, i don't think i've seen that. the "washington post" reported that the best way for influence was greater than the best rate in the world war i. i've actually never seen that as a reported observation and what it tells us about how we approach the flu. thankfully, i'm sure you also go visit national archives.

we have a lot available to us relatively simple combinations of courses when historians discover something that no one else is found hidden away in a box. and of course, is a story i think you and others are keen to find that. but a lot of primary sources going back to reading the original articles, taken the medicine out like the other ports in 1916, they will mention the secondary literature but when you go back and read you can get a different view on things. thank you for that question. were out of time, thank you for your time and attention. i hope that each and every one of you will stay healthy as we end this flu season. [applause]

>> tuesday at 7 pm eastern on c-span. live coverage from george washington's home, mount vernon. talking about the new book the president. noted historians rank america's best and worst chief executives. with douglas brinkley, medford and smith and saturday at 2:30 pm eastern, booktv has live coverage from the museum with historians kenneth ackerman and david stewart talking about the president's. noted historians rank america's best and worst chief executives. presidential leadership, tuesday at 7 pm eastern on c-span. from mount vernon. saturday 2:30 pm eastern on c-span two from the -- on c-span2 from the museum. >> now a book to be discouraged of the recent san antonio book festival. you hear from several authors of the next few hours including douglas brickley, hector garcia, and marie brenner. the fulled