and in some she's got gotta do it the journalist discusses how running for office made her realize the importance of local politicians to their communities. look for the titles and book bookstores these coming weeks. .. ..

>> the influenza pandemic of 1918 killed more people worldwide and killed in combat during the war. many records from the national archives in the washington area and other many field locations document this in the united states reporting of the 1918 influenza epidemic to all parts of the nation. the's records open a window into the world 101 years ago to show us the societal cost of the pandemic they allow us not only to look back at that time but also as the information may help to guide present-day inquiries to understand the disease.

an emergency physician and research director at the george washington university here in dc now director of research at nih. the author of peer-reviewed articles and books including the american handbook of emergency medicine. he recently received the nih director's award for supporting research of non- object one - - addictive methods to obtain relief. from the new york journal of books is clearly a man that knows the flu not just the epidemiology but countless fun facts about the scourge. and to highlight experience

influenza builds on the scientific career making a central to the story and with the clinical practice together although his story is somber it is punctuated by humor and advice like the best time to visit in emergency room. please welcome doctor jeremy brown. [applause] >> thank you so much for those kind words not every day you are 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 to today.

more people were killed with the influenza virus 50 to 100 million people worldwide in the united states 675,000 deaths civilian deaths and of the 160,000 combat casualties killed in world war i, over half died from disease and that was influenza. it's a sobering thought to think if you take those statistics to multiply them out by the current population of the united state states, those tests would be about 3 million in today's number so to put that into perspective to think what would it be like to live through such a thing? another way to think about it was to put the cause of this

but back in 1918 there was no known cause viruses actually have not been discovered yet. people were dropping from this disease called influenza nobody knew what it was from so i think about that with the 19 on - - 1980 outbreak of hiv which was incredibly frightening we knew it had to be a virus it took us years to identify it but it was what we suspected but in 1918 they literally had no idea. and putting this into perspective as you know sadly we are living through an epidemic of a different kind today of the opioid epidemic resulting in so many deaths in this country the news over the last couple years is actually the death rate is so high it

has dropped the average life expectancy in the us. if you look at the average life expectancy because of the large numbers of death and younger people the average has dropped. that is shocking. how much? look at the data by one tenth every year. that's a terrible statistic but 1918 the epidemic caused such a large loss of life it dropped the average life expectancy by 12 years. 120 times greater than what we have seen with the current opioid crisis. i thought it would look on - - be fun to look at the data.

all from the "washington post" and then the story of a much more complicated event this is the "washington post" saturday september 14 in 1918 not the front page but it tells us the spanish influenza was spreading across the us it wasn't reported yet in the papers in large numbers in washington dc but it had begun to spread across the us. now the following day the "washington post" reported 90 people died of influenza in boston and the records they were keeping probably started in the midwest that they were ramping up and then the very

next day that 90 people in boston had died. these were among soldiers and sailors. and then to build momentum on the front page of the westing to post they were told the work hours had changed now washington dc was not the only city to do this in fact it happened in most of the cities that were affected. the idea was if we could start people from mingling even though we didn't know it was the virus that was causing this we could understand to keep it away from people is a good idea. businesses close down, restaurants change their hours stores had staggered

hours with the attempt to keep people spaced away from each other so the working hours of the federal government changed around the beginning of october. it is particularly sobering coming a couple of weeks after the announcement after 1918 "washington post" reported on the headline that the price of coffins had skyrocketed and this was an example of people taking advantage of a terrible situation in fact they write the coffin trust holds the people of washington of the city by the throat and extorting from them outrageous prices for coffins and disposal of the dead and the "washington post" goes on to suggest that the department of

justice should step into instantly put a stop to the high prices of coffins it cost more to bury your dead because the coffin makers figure they could make a buck it was the middle of october more people died in the short amount of time and it was suggested it was quite hopeful there was no evidence of that but it was hoped perhaps we were nearing the end of it. throughout the epidemic this is an example of a remedy to the fall and winter of 1918 we will come back and talk about this but remember the words this is a remedy it also has

quite mean which is a medicine that until just recently was the go to medicine for malaria. it has now been superseded by others but it was thought to be helpful in the influenza so i find it interesting that if you look at the beginning of the spanish influenza is the exaggerated form in the quite mean tablet should be taken in larger doses so it is a really big epidemic so take a lot of this medicine. so we will come back and talk about these remedies so these and several others were advertised both to treat the

disease and also of course prevent it. again another marketing opportunity for the laxative. the "washington post" thought we were coming to an end and put this little snippet that the spanish influenza is more deadly than war and indeed that is the case but what struck me is the placing of this piece of journalism page 20 tact in next to an ad that the epidemic was dirtier than the war why was is not front-page news? there are some various suggestions that there was a

tacit agreement between the newspapers if you're going to put a statistic like that that the influenza is more in terms of life on page 20 will not get the attention that it deserves. it's a little bit of a mystery i'm sure there are some archivists that could shed some more light on why this and other reports were tucked into the back of the papers. when we hit record we were nearing the crust in washington dc but unfortunately no. more deaths than any time since the record 16 death from flu in a single day in washington this was also tucked away may be an illegal

record recording. it was reported. it was not hidden but you had to look for this to understand what was going on. and then the final slide is reporting from the "washington post" is exactly this day marc march 5th exactly one century ago. this was a small report that cited to washington boys that volunteered to take part in some experiments to try to understand the cause and the methods and during the recent influenza epidemic that men voluntarily submitted to experiments that enable doctors to determine the method of transmission of the disease meant to be

preventative measures. so they word volunteer to be in research with this very deadly epidemic that was not understood that was not understood other than the laxative tablets. so every day heroism so these are just a few examples from the "washington post" that tell us a little bit about what happened here in washington dc. i will switch to a second slideshow in this will run itself.

>> you will see images as we talk through so i want to focus on three areas of research that i describe in the book the first looks at how treatments have evolved what did we do 100 years ago to treat this disease and what do we do today? you will find it has changed less than you have hoped of how our understanding of how the influenza virus has changed over the last century. what was that we thought cause influenza 100 years ago and what do we know about the same virus today and there we can all agree there has been a remarkable evolution of understanding exactly what is going on. finally we look at how we can

prevent ourselves catching the flu in the first place where vaccines were like 100 years ago and where we are today and we still have a lot of work to do. the treatments were not terribly effective they included mercury, tree bark, inhaling factory gases. that was actually reported taking families and children to munition factories were the toxic fumes were thought to reduce the likelihood of getting influenza as crazy as it sounds because many of these gases contains chlorine we know that is a great antiseptic that kills everything including people so very likely the factory

workers had influenza at slightly lower rates because yes they were inhaling little bits of chlorine and the atmosphere was bathed in chlorine gas and that reduced the free virus so it wasn't completely crazy to take your children to inhale factory gases. there was an upside to treatment whiskey was extremely popular as was champagne as prescribed by senior physicians and enemas were used actually they were used to treat everything there was very little you to do so anime was thought to clean everything out so enemas were popular now bloodletting is the process by which blood is removed from the body that

forces the removal of the blood taking out the bad that is causing the disease. it dates back at least to the fifth century bc and george washington was probably killed by bloodletting as he lay dying from an infection the senior doctor suggested we let the blood other people were less into the idea there was a little bit of resistance but the senior people one and blood was taken from george washington as he lay on his deathbed and within a few hours he was dead so our president george washington underwent this procedure then they tried to think of reanimating him by using shapes blood but then good

sense prevailed they decided enough is enough with the bloodletting and they let him rest in peace. but what is remarkable to me is bloodletting was used in the great flu epidemic of 1918. not just by? today but mainstream physicians and this is one of the things that sparked my interest in the story of influenza then and now in the leading medical journals in the united kingdom the little tube is called the lancet to talk about bloodletting and with this breakthrough pandemic there was another

epidemic from the military camps in great britain and they tried everything including they said bloodlettin bloodletting. this is the time of my own grandfather. in 1916 position on - - positions were trying bloodletting on patients and of course it didn't work but they said we think it didn't work because we tried it too late. had we tried it sooner in the care of these soldiers then maybe it worked then in 1918 at the height of the epidemic of bloodletting yes sometimes it works for influenza. so you could see it wasn't the anime than the bloodletting could get you in there was a

nasty array of medicines that we had to treat this we saw earlier an ad for the concoction containing coining that it was a useful drug for malaria but useless as a treatment for flu because it's useful for malaria it reduces the fever cycle and that it reduces fevers and malaria and influenza through quite different mechanisms of was of disease a completely useless drug and it has been dangerous in appropriate places. everyone was prescribed enemas and one of my favorite discoveries those who have

influenza and after the great influenza pandemic and to read the past on - - a passage. over a period of three weeks and codeine's for cough and a laxative castrated oil rectal tubes milk of magnesia and bladder antiseptic these are all administered to this patient in 1936 in the paper

published you can see the arrows on the timeline. the patient received at least five prescribed doses of whiskey. at least there is that and 40 doses of castor oil. the seven enemas may have been necessary because he was given at least 39 doses of codeine which suppresses coughing but also causes constipation. so that is what life was like 100 years ago but with the vast majority of this influenza is an inconvenience and it's something we genuinely deal with with the

couple of days in bed of course some of us end up in the emergency department may be to treat hundreds of thousands of patients we have an emergency department and what can tell us what is happening and then to see if there is any evidence of pneumonia or even give them intravenous fluids and treat them in that way and of course we have antibiotics today. let's be very clear, antibiotics should not to give to patients with influenza. they do not work even though

they are prescribed unnecessarily often. they don't work but they do treat the secondary infection the bacterial pneumonia that come as a result of the primary viral influenza. we have those today. those were not available until the early thirties and it is a remarkable thing that today that the majority of deaths that occurred in the great flu epidemic was caused by secondary pneumonia so also medications to treat fevers motrin or tylenol but i came across a very interesting study that suggests perhaps we should not be giving medications to people quite as often as we do they looked at

the modeling and said if you get tens of thousands of people with the flu to reduce the fever and with the shivers and the shakes so that they will get out of bed quicker and then come downstairs and cough on them so that suggestion was by treating the fever the patients in the emergency department you might increase transmission rates by 1 percent and given the enormous see of this disease they suggested an additional 500 deaths per year in the united states as a result of treating people's fevers. if you come to the emergency department with influenza today and your doctor sees you have a fever of 103 and

suggest you probably should not get that and then say doctor please give me the medicine and then continue to prescribe for people's figures with the influenza. and that could affect transmission. and there are specific medications like tamiflu and the new kid on the block is a direct antiviral medication perhaps now we can talk about them later but they are out

there they don't work anywhere near as efficiently as they should so that is the treatment for laxatives, whiskey 100 years ago today the emergency department and of course connected was the sickest of the sick the fact i open the book with the story of a young lady a young mother of two who came down with influenza extremely quickly and basically within a matter of hours was evacuated from her small town to pittsburgh for several weeks until she recovered. that is the miracle of modern medicine today that was not around 100 years ago so now the treatment what the they

know today and 100 years ago? i think in many respects this is the most frightening aspect of the pandemic we just didn't know what it was caused by but among those suggestions the conjunction of the planets that's we get the name influenza to mean influence the earliest thoughts was that this disease that you could identify was caused up in the stars so it still buried in the history referring to influenza today. rotting animal carcasses earthquakes and volcanic

eruptions was suggested as a possible cause. discharge into the air from the bowels of the earth and people really didn't know what it was. it at a meeting that occurred of 19181 public health official said the following we may as well admit and call it germ x. we don't know what causes it and where we are. one example of a cause that was not a cause was a discovery in 1892 in berlin by a microbiologist and they found a bacteria from people who died from the flu and they said this must be the cause

the call the influence of bacillus it was not the cause but a secondary pathogen secondary bacteria and it turned out not to be correct there are several different instances in the history of the flu some of you may have heard of it and then to see why am i treating this person it was thought to be the cause of the flu and inappropriately named it was call this

discovery and then they point in the wrong direction. so as the secondary pathogen. in 1889, there was an epidemic severe in great britain and was so severe that actually parliament commissioned a report on the epidemic. this was quoted in 1889 by henry parsons who is a very smart person and we will see why. he spoke of different theories that may have caused the epidemic. one of the theories at the time was painted russian oats.

suggesting that the russians were bringing the disease through europe. now every society blamed outsiders for this but it's weird today we still blame the russians for every much everything and that perhaps they were behind it as well. but then he dug a little deeper and said it could be the weather something floating around in the air that is partially true. there is something in the air. this is another living particulate.

it could be russian tainted oats but then he suggested that than one person to another and i think here is where this is the right way to think about things and so let's get some data. so what he did with the british railway system. and then to feed the steam engine and then to compare that influenza rate. and compared those to the rates of influenza and of course they are inside and they are within constant contact with people.

and those i had the influenza illness. and the railway engineers driving the train the rates of flu even though it exposed to who knows what they're probably has nothing to do with the atmosphere so a simple look at some records and then to say in the following that perhaps animals have something to do with it. and suggested and then has to do with the spread.

with the spread of influenza and in 1989 and with those involved and then today of course we know there is no doubt. and with the microscope to be developed in 1839. pictures and diagrams doctors today know the genetic code

that those genes work together and what the proteins do and that degree of that suggestion it is something from oats is something that we can see and identify and know a lot about is really a remarkable example and science over a century with that genetic construction. so in that respect with the cause of the disease. and with the vaccines and prevention.

and then to develop his own set of vaccines similar to rabies that was in the nervous tissue to propagate to make them weaker and weaker and to figure out now what he had was a virus and that produces rabies. but what they were using was is bacteria and not the pathogen of influenza but and then to have five different kinds of bacteria and then managed to inoculate 100,000 people with his vaccine.

so he tried to do something. so timothy leary made a vaccine using the strains from the chelsea naval hospital and made a concoction and gave them to people and actually his vaccine was sent to san francisco for 18000 people were inoculated with the vaccine. and in case you are wondering, yes this is the uncle of the famous doctor timothy leary in boston who wanted us to tune in with this

type of vaccine from 100 years ago. what do we have today? we do have vaccines against the flu. people take them every year and it's really not a very good vaccine. to get polio you are done. you won't get the disease ever but with the flu we are told we have to get a new flu shot every year. and with the vaccine that is not on the same level of effectiveness.

in a good year at best it was a 2030 percent range so why is this flu vaccine so hard to create? the answer is it contains the eight genes of the flu virus that makes these proteins on the surface and that is how it is created but the problem is that the flu is such a good master of disguise that it changes the makeup very quickly. when it mutates from one to another so when we think we figured out what type of flu will be around that it is species a then it mutates now

the vaccine is no longer effective and we did not realize species b and c would be the one so we did not include those in the vaccine and you were not vaccinated against those which is the reason incidentally that some of us get the flu vaccine not because it didn't work for that strain but there were other strains we were not vaccinated against or a change the surface structure like changing the overcoat to the black overcoat and that's what's going on with the flu vaccine to stay one step ahead all the time and this is a similar story with the promise of the hiv vaccine and from

the immune system so we still don't have a good influenza vaccine. and those samples that were sent to the lab to figure out the exact flu species that is prevalent what they had through the most recent outbreak and incidentally they do the same for us. and for what happens in the northern hemisphere. and then they make the best educated guess that they can. based on the evidence that we have, the most likely species would be this and this and to

this day much of the vaccine is used with eggs it's very hard to grow so they grow it on the eggs that was what was used 100 years ago. and that was the majority of the vaccine has something to do with eggs. and the beginning of the fight and then to create a vaccine although it's not very effective i must remember that in certain age groups with

those compromise conditions? and pregnant women are encouraged for some reason with the complications and with the high risk groups to be vaccinated a question. and then to have that effect and those high risk groups are targeted will say if you want one but there is no campaign. the cdc says everybody over the age of six months should get vaccinated.

but is not the advice that was given overseas and we can talk about it's the big difference the way we talk about the flu. the high risk group is for those otherwise healthy adults it doesn't really do a whole lot. so we need a universal flu vaccine without having to get it and what specific strain of flu that is a goal of universal vaccine and to target that flu virus that it doesn't change. so that we can target and the

immune system will recognize and then kill the virus and that for an suit one - - from the instance i am not here representing the federal government im here on my own time these are my own personal views but the nih is very very focused on trying to find a universal flu vaccine and with that nih sponsored trial of a candidate from israel and other companies that are doing this from the nih will this

work or will it not work will we see a universal flu vaccine? i know but that is certainly the goal we have a long way to go. and the treatments are very different thankfully. we understand the virus with the deep and profound way but are we able to use that knowledge and then build the vaccine? not quite yet. so my hope looking forward for us to see influenza as a disease of the past and the way we think about smallpox as a disease of the past that was eradicated it's important to try to move toward the goal

the cdc estimates between 30 and 50000 people each year die of influenza. it's a soft number. that is the ballpark figure it is in the high risk group predominantly. so we really have to try to think about ways we can improve our own vaccinations so one day we can make influenza a thing of the past. thank you for your time. [applause] >> any questions? >> somebody lay on - - made a lot of money with the facemasks in this culture we don't see them as commonly as in asia when they get a cold. so my question is how effective are those? there was a picture you show that spit causes death and if

you spit in the eye that would be potentially dangerous. can you talk about that perspective? and then the use of the math scores this something that can help prevent the spreading of that? >> that's a wonderful question. thank you. of course masks do something. even the cheap mask you can buy add a pharmacy has a filtered mesh if you cover it you breathe through the mesh it will stop something. what is it stopping? it might be stopping your secretions if you coffin to the mask and it catches the sputum but does it catch the viral particle somebody else has coughed out? almost a not. the thing about the facemask then they become clogged and

then they are completely useless. i think what we are seeing is the interesting idea, don't sneeze on other people or coffin other people please. that makes sense but the suggestion that we will stop this by wearing a facemask to see the picture of the happily married couple hugging each other with a facemask. clearly that is a pr example and it does very little but we do know one of the most important thing you can do to get the antiviral medicine it's wash your hands. so to remind us of what we need to do when we have the flu in terms of the

intervention these masks do very very little. >> thank you for your talk i am curious to hear you talk about the cultural differences where the us encourages everyone to get vaccinated where sometimes they don't. >> yes i can go into this in some detail. united states cdc recommendation everybody over the age of six months gets vaccinated and high risk groups only everyone else you can if you want but it's not being pushed. but the difference is how we approach if you look at the cdc website you will read

influenza is a serious disease with complications that include death. everybody over the age of six months should get the vaccine look at the nih basically said the following you don't have to see a primary care doctor about it if you need to but you will be fine that's basically the nih view of influenza and if you look at these two very different approaches it's dangerous that can kill you. maybe it is a nuisance but you will be all right. so the cdc says it's a potentially deadly disease

even though it's not very good that's at least use it or do something so let's use it where we really need to use it which of those is correct? influenza is potentially a deadly disease that's for 1 percent of the people that will get it and a tiny number of people that will get it only does the increased risk from the disease from those high risk populations in the united kingdom approaches also correct so which of these two messages drive us this decides how we respond to the vaccine the cdc decides this is the best approach and the data is

purely the personal observation and then to talk about that group as the young healthy middle-aged adult probably does very little. but yet as you know in the beginning august you will see we are ready to have the flu vaccine here we will give you a coupon. come get it. so with a potentially deadly disease and how we look at the vaccine and of course the question is if it works we should try to use it that is the approach of many aspects of the american health system even though it might not work terribly well they are much

more circumspect talking to the chief petty officer of the uk vaccine program and he said in the united kingdom they include things like doesn't make sense and if you add up the numbers to have a big campaign for healthy adults to get the influenza vaccine when so few of them proportionately will end up to get second take time off work so this is a very different approach of the two different cultures. >> i'm a history graduate student at george mason university. suffice it to say i am a stickler on sources. i am just curious what sampling of sources you used? i know you mentioned newspaper articles and medical diaries

but more specifically i'm interested in the use of secondary sources to bolster your own medical knowledge that you already have. >> it's a good question maybe now i will get in trouble with a historian in the room. the truth is that i use both. i began with ever secondary sources that i could do whatever was published in the last decade there are some very good books out there on influenza. but now you have the resource of this thing called the internet. i don't think it was available to the degree when other books came out you could do a search through hundreds of newspapers for the keyword influenza and

you could get the gems of information. those are primary sources that the "washington post" reported the death rate was great from world war i that we've never seen that reported observation and what it tells us how to approach the flu. and now here we are at the national archives where we have a lot that is available to us but what's nice when they discover something that has been hidden away in a box. and with those primary sources and from those early reports of bloodletting and then to

get a different view on things. thank you for the question. we are out of time. thank you very much for your time and attention i hope everyone of you will stay healthy this flu season. [applause] [applause] . . . .