Gate the reason we here this evening. Please join me in welcoming david randall. [applause] thank you all for coming. Especially given the weather outside. It is nice to be inside where it is dry. Outside where its wet. One thing i realized, so my first book was about sleep science and when i went and talked about that book, i realize many people coming to the talks because they had their own sleep disorders. And they want to talk with someone about it. This book is about the plague. If you think you have the plague, this is not the place for you. I think theres hospital about three blocks that way, that is the better that is where you should go instead. One of the questions people always ask me is how did you get interested in this book . Well, the last book i wrote was about malibu, a family that used to own all of malibu and how they got it and lost it. In an extra one of the main characters comes up to San Francisco around 1900 and theres a little bit is watching this is the wickedness place ive been here and it seems that the plagues here. I got stuck by the word rumors. Either you knew it would be there or not everyone knew about the outbreak. So i looked into it and i learned that there was a conspiracy between city officials, the governor of california and the states most powerful newspapers to conceal the truth of the plague. And by extension, but millions of peoples lives at risk. Id never heard of this before. And i started realizing that this was actually three stories in one. Story of a disease, a place and people. We can go through all of those. Starting off with bubonic plague. Most people have heard of it because in a middle school or high school you are about the plague in europe and it killed half of the population. It is the same disease. It never really went away. And what happens when you have bubonic plague is that you get what is called a slowswollen gl that fills with blood. Thats where the bubonic plague comes from. You typically die within 48 or 72 hours. And longer stays in your body before you die it can change in different forms. It starts with bubonic plague then becomes in your bloodstream and then finally it becomes you can just spread it by coffee. And this is what decimated europe. People coughing and just it wiped everybody out. At the time, there was no, the time of this outbreak was in the early 20 century, there is no cure for the disease. And there was no vaccine. We still have no vaccine now so what happens, this is the steamship age where the world was connected, people and goods were closer than ever before. So the disease can travel stronger and faster than before. People dont know why but start spreading and rapidly. So reaches hong kong, decimates the city. Hospitals there reporting Something Like a 95 percent death rate among patients. Eventually kills 10 Million People in china. It kills another 5 Million People in india. It spreads to austria, scotland and seems like it is only a matter of time before the plague reaches north america for the first time. And to remember this is an area where science is still on the doorstep of the modern age. This is a time where many doctors are discovered a good dr. If youre fast because there is not pain medication, not Everything Else. The idea that science and medicine is something that people in White Lab Coats do with microscopes and xray machines and Everything Else, it is still only in its infancy. It is all becoming accepted. This is when science is really fighting for legitimacy. And this is the disease that no one knows what to do with. Even though it is almost the modern age it really still is not that different from the middle ages. Nothing has changed in 500 years. They just know that this is the disease that you cant fight, it has no cure and you dont know what to do with. So you have on one hand, the most terrifying disease in American History and it spreading again and where does it spread to . It spreads to San Francisco which is perhaps the least, worst place in the world for it to spread. And theres many reasons why. Before going to that, before that, one thing to know when you get the disease, it is a gruesome death. I will be little bit from the book and you know this is, is probably one of the grocer scenes in the book. If youre a little squeamish, thats why. I learned a lot of money, i learned a lot of very gross things while working on this book. I held back on most of them. If you really want to hear the grossest stuff, come to me afterwards and i will tell you. So before the plague reached San Francisco, it reached honolulu. And it was found in chinatown there as well. So in the scene, doctor lee is a dr. In chinatown, the victims name is and who brings them to doctor lee is a man named faun. They live in essentially the same flophouse in chinatown. He saw that he was near death and he picks him up, puts him on his back and walks him two or three blocks to the Doctors Office trying to save his life. So this is the scene. Doctor lee was alone when he burst in and laid him in front of him. The man was covered in feces and vomit. And raved in apparent madness productively struggled to hold the new patient still. All the while wondering how he was still alive. His pulse racing as the body was facing internal tear will the four had was so warm to the touch that doctor lee fought the answer to pull his hand away. When he yelled the scream sounded wet as if emerging from below the sea. The mans skin which days before had glimmered in the balmy hawaiian son, was with black spots and open red sores. Leaving the line between the bottletransfer bodily tissue and outside world. A mixture of blood and foam were leaking and his mother son of ruptured blood vessels and he soon fell into a coma from which doctor lee knew he would never recover. You have a terrifying, gruesome disease come into San Francisco. San francisco at the time was still essentially wild west. San francisco was the most important city in the western half of the country. The biggest city, the richest city. The most connected to the rest of the world to trade. You know boats come into the golden gate before the bridges there obviously. Able to come it could be from alaska, russia, hawaii, japan, australia. It could be from new york. People going around to get up to the golden gate. Into San Francisco. So this was the Meeting Place of the world. But San Francisco was still almost like a boomtown it was also 50 years after the gold rush in only 50 years after statehood. So you saw people walking the streets of San Francisco were literal gold miners. And it was that whole mindset of the city, described in the book. It was a place that believed in fate rather than skill. Because as we think of what a gold miners mindset is. Dont mind for gold because you think youre better. Like mining for gold than everyone else redoing it because you think youre lucky. Im going to find the right spot and become a wealthy person. If that is your mindset that youre counting on being lucky, you do not want anybody to get in the way of you becoming lucky. So there was no idea that you can have Public Health or public goods or the idea that you have a civil society. One thing that was struck by the in the book. As San Francisco grew, the spending of Public Health declined. So you had a big city with a festering problem of a boomtown. A place where you walk in the street and there would be horse carcasses and people just throw trash and food in the street. Praying for an expected for rats to take it away. At the end of the book, i quote someone who said, talking about rats. God made them scavengers so let them scavenge. That was the mindset. Not only that, but San Francisco you know, every man for himself type of place. It is also the first time kind of hitting the middle age. We people cannot get jobs is easily as before. So they start looking for someone to blame and they find in chinese immigrants. Chinatown San Francisco is the largest chinatown outside of asia at the time and still is. It has about 20 percent of the cities population. And like immigrants anywhere, chinese are willing to do the jobs nobody else will. So it is laundry, cooks, porters, hotels Everything Else. There is rampant and blatant antiasian bigotry and racism. In ways that now you look back, it is shocking. The mayor at the time, he later becomes and runs for and wins a seat in the u. S. Senate in california. And his campaigns, signs really say keep california white. That was a focus. It was a very easy scapegoat for all of the problems that were happening in San Francisco. And the governor at the time was a man named henry gage. And like politicians now, he pioneered the idea of calling into he did not agree with anything that was negative, fake news. So you have the worst of these in history coming to a place that in no way want to deal with it. And in no way want to acknowledge they could be in any danger. This is also the gateway to the entire country. So you have everything ripe for a crisis. And low and behold crisis happens. Somebody by the name, a chinese immigrant, the first known victim of plague in San Francisco. A Health Inspector is writing out a death certificate and he does you know, a reexamination of the body. And this is something he has not usually done for the same Health Inspector has already been fired for making up causes of death. You know, it its a stabbing one, a heart attack. He had no idea, he was just writing something down. So hes actually looking at a body for once and he sees a buboes. He jumped back in fear because he knows what he is and he knows the danger and he knows that it could be hong kong, San Francisco could become hong kong very quickly. So you have this danger, you have this disease and you have the people. And so you have at this time, the federal health officer, is the Marine Health service which is the u. S. Public Health Service today. Have it a man by the name of joseph kenyon. Hes known more about plague perhaps than anyone else in the country because he studied with the people who work in the outbreaks in china and india who for the first ones, they discovered how plague is spread where the bacteria that causes plague. But his problem is that he is so brilliant, but he almost has a talent at making people hate him. Im sure that you know people like this or so brilliant and they cannot get the knowledge to someone else to get them to trust them and like them and agree with them. The only reason he was in San Francisco in the first place is almost happenstance anyway. He had been in washington, and the u. S. Surgeon general, somebody writes an article saying that kenyon should be the true Surgeon General because he is bringing the scientific level of Health Service up to a new level. This drives the Surgeon General crazy with envy. He does not want to have any threat to his power so he essentially exiled him to San Francisco to get them as far away from washington as possible. So kenyon is here and he is the forefront, the forerunner of a new era of medicine. And he has done this because of personal pain in his own life. His youngest daughter has recently died from diphtheria. Which is one of those devastating diseases of childhood back then. Power people surviving . With medicine people dont have to die and he read the letter that comes saying every preventable death seems like manslaughter. It weighs very heavily on his conscience so he knows what can happen and he is paranoid. He knows that it only takes one person heading east and suddenly he has the plague in detroit, chicago, pittsburgh cleveland and new york in every stop along the way so much so that there may be no way to ever recover from the disease. The entire country will be wrote. He does whatever he can and he takes drastic measures because he knows its an emergency but because of his aggressiveness everybody recoils from him. City and state officials dont want him to because it can lead to panic on top of that it can decimate the citys economy. California is known as the golden state for a reason. People come out here because they think literally they can find gold or they could find a life of paradise that they want if theres embellishment that there is a plague here everyone will stop coming. Economy will collapse and theres no need and no want to acknowledge this disease. The City Health Officials also saying he was amiss for himself trying to take money from the city coffers. The doctors who should be as natural allies want nothing to do with him because they think he thinks hes better than all of the many kind of does. They dont want anything to do with him whatsoever and then the chinese in chinatown who are at the frontline of the disease recoil and they start calling him the wolfe doctor especially after there is no vaccine and no medicine for the plague at the time. There is a cera him where if you take it its proven in some studies in india at the time that it prevents your chance of getting the plague by 40 which isnt that much but at the same time it has very obvious and detrimental side effects. You become flush for several days and you have a high fever. Yet delusions, you have nausea and body aches and pains. Its like getting the dates is also kenyan tries to go through chinatown with Police Officers forcibly injecting people with this. Nobody wants to do then it causes a riot in chinatown. In chinas town they start hiding the bodies. He doesnt know where the disease is spreading. He doesnt know where its going next and because they are hiding the bodies the governor and other people can point to your saying theres an outbreak here show us the bodies and he cant. He knows they are out there but he doesnt know where so he he has gone by this time 200 victims of the plague but he thinks there are many times more in there most likely are. He eventually quarantines the entire state of california. He says if nobody leaves the state will get a signed paper from them saying they are healthy and this drives everybody in california insane. They say they kenyan should be hanged for this. He is essentially run out of town and rupert blue comes in and where is canyon was thought of as the most brilliant doctor someone who is a little bit lazy he has been a little bit lazy but what he has going for him is he is very nice. He has this ability to get people to like him and trust him and if you think of the best of San Francisco the willingness to look at things from new angles he is willing to look at things in a different way so as brilliant as he is he can never get past the idea. Plague is thought of as a disease. The thought of something that can get so he starts treating the disease is a real disease that anybody can get and he does things that are considered radical at the time. He hires at chinese translator and treats them like a full member of the staff and starts Building Trust along the chinese were kenyan state in this laboratory and angel island. Lieu opened up a laboratory in chinatown itself. He walks the streets making connections with people and soon people, the chinese are starting to show him where the bodies are he finds bodies they kenyan was never able to find in the big mystery in the book and i dont want to give away too much in every place in the world all the other big cities where theres an outbreak that spread slowly at first and then it explodes into the population. It hasnt exploded yet in San Francisco and something is provided that and they dont know what it is but they know its biting time. Bluenose that the clock is ticking faster and faster and faster so he starts implementing all these radical ideas which we now take for granted in terms of public sanitation. He does things like Institute Street sweeping for the First Time Ever rat proofing trash cans having cement sidewalk so rats can grow underneath and hes the first one to demonstrate that they knew since the middle ages that rats are associated with the plague but they didnt know how the plague was spread. He was the first one to demonstrate that its the fleas on the rats that are spreading the disease so he institutes a rat eradication program. He overall he does everything from paying people a quarter for every rat they bring to him so essentially he creates teams of young kids going to the city to get as many rats as they can. He gets of healthy rats and the guys there for different colors red, blue and green and puts them in the sewer system and the put the flyers saying if you see a different rat let us know. This is the only way to track the subterranean passageways through the cities and knees trying to find out where they should lay traps and where the rats are coming from and how they are migrating everything he can to understand this disease. Because of all this overtime they killed Something Like 2 million rats which is five times the citys population. He contains the disease in chinatown. Its safe enough that he is sent out somewhere else to stop the next fire. Then theres the great earthquake in San Francisco in 1906 and now the plague has spread everywhere. Before the disease the most terrifying forms this is what happens. 60 people die in the span of two weeks or so. Not only are people dying quickly but they are throughout the city now. You can no longer just say its a disease of chinatown or disease of emigrants. Now its from north beach to contra costa, its everywhere and the geography of San Francisco when you think about it from a publichealth if its perhaps the most terrifying landscape you could ever deal with, everything from oceans to skyscrapers to horse tables predict every possible thing you can think of that you have to deal with so blue for a focus on Public Health and Everything Else he is able to once again contain the disease and one of the big lessons you might take from this book is that diseases are not confined to the past. All you have to see as the Measles Outbreak now. A lot of things we have thought we have moved past are still going to come back again. Its not only the hard science that saves the day. Kinyoun knew the science and he knew the epidemiology and he knew how to track the disease. He ended up for failure because he ignored the soft science of persuasion which is almost as important as the hard science in a crisis. Blue have that. He knew how to people get Peoples Trust in him to take steps not only to protect themselves but to protect everybody else. Blue is one of those people who actually, he was one of the american heroes that nobody knows about because millions of peoples lives were saved. He later becomes a u. S. General himself. He moved to that job after the 1918 flu outbreak. He does this radical thing of staying with the Health Service. Just think about your job. Whoevers the ceo or boss gets demoted and they stay. Nobody stays, date go and do Something Else but blue is driven by his own reasons and kinyoun was driven by his personal pain. Blue is Something Like the seventh of eight kids or something and his older brother for your with a family favorite and he becomes a war hero. Rupert blue decided as a kid perhaps victors purpose in live is to hurt in perhaps my purpose is to heal so he follows that there is entire life. Theres another outbreak of the plague in los angeles in 1924 and just like in San Francisco in the 1900 it happens in the mexicanamerican immunity. Its not very far from where the Union Station is now where the twin towers facility is one of the largest in california and he dies after finding a diseased rat under his house. Over the next two weeks Something Like 75 people die. They call it the trail of death connected back to him so its not only him, his daughter dies, the woman from the house next door became lord help take care of them she dies. The nurses that took care of them die. The hospital drivers die. The priest who delivered the rights last rites died. Once again city officials in the l. A. Area they say this is an immigrant disease and when one is the bee connected with it. L. A. Is a huge place going from the port of pasadena 30 or 40 miles. Disease can spread that quickly. Blue comes in once again takes of the radical step of showing that medicine is not racially biased. Its focused on science and he creates this new era where we recognize disease in a different way and we recognize the need for Public Health and sanitation in a different way. This is not just one of those stories of the past. We see how close we came to a crisis and patter cells in the back, were we lucky . There might be another crisis and that is because of climate change. Disease is spread by fleas on rats and other rodents. As it gets warmer the breeding season are rats and rodents extends and rats are hyperfertile animals. A single pair of rats can have 15,000 descendents in a single year. Their teeth are stronger than steel. They can jump up a fourstory building and be fine. They can collapse their bodies and their schools down to the size of the pinhole so they can fit almost any opening and on top of that they can swim. Rats can survive almost anything a single pair of rats will have 72 pups in the year. Fixed in the breeding season by three or four months because its warmer and thats another 12415 and rats have known descendents to two or three months old. The more rats there are the more fleas there are in the more fleas there are there is going to be more contact with humans and the disease. I was speaking to somebody who was a faster at uc davis and he is at one of the best schools in the world. She was tell me in certain worlds of certain countries people know that people can carry plague. People there are no the plague is a risk so they look for it. Other places they dont and in the first 12 hours of the plague it looks like a lot of other diseases. Looks like the flu basically so the geography of diseases changed and the geography of climate changes that diseases will start coming when you dont expect them puts more people in danger. I dont want to be overzealous. Its not a Michael Creighton novel where everything will be an outbreak and we are all going to die but it is a risk and one of the things this book shows is as much his time is changed, people dont change so perhaps when you can show lessens the rupert blue showed us of how important persuasion is in a crisis and look to the past to help solve the problems of a new future. Thanks for coming and im happy to answer any questions you have. There were rumors of the plague outbreak and there were officials trying to cover it up and bring to my also how did you construct this fine line of when the outbreaks actually started and what tools did you use and how did you manage to figure out what was going on . Thats a great question. One thing i was very fortunate to find was one kinyoun had a habit of writing really long angry letters to people like 60 page letters. That was an invaluable resource. Then i also found a great great nephew and there might be another grade in there or not of rupert blue who had a hundred letters he wrote to family members in south carolina. It was incredible for me to hold a letter from 120 years ago and compare what blue was thing saying in the newspaper to what is actually feeling. He was in the square after the earthquake saying we can contain this and its going to be okay and essentially wrote a letter back home saying i have no idea what im doing for this is even going to be possible and we might have to quarantine San Francisco. Thats the difference between the private and public and the other thing was this era of telegrams and wires. For some reason and i dont know why the telegraph service had a policy that they would collect them all and publish them in a gigantic book so you can see people talking about each other behind their backs in real time. Somebody was saying kinyoun was showing more constrained than i thought possible. You really got the feel as i was writing the book the field that day by day how the pressure continued to rise higher and higher and higher and the he got to see that they really didnt know what they were doing at all but they knew the people were dying. Thank you very much for coming. I appreciate it and i hope you enjoy the book. [applause] and im happy to sign copies as well. [inaudible conversations] we asked dina titus better reading list. A force i have to read academic journals but when i read for entertainment and pleasure its usually when i travel. I just came back from greece so i was reading