Centennial of world war i. In 1918, the people of combatant were relieved the fear of war was over. Yet another threat to life was reaching across the nation into homes and schools and hospitals, the flu. The influenza pandemic of 1918 killed more people worldwide than killed during combat during the war. Many records housed in the National Archives in the Washington Area and other many field locations document this outbreak in the United States, letters,reports, patient records, books, telegrams show the reach of the 1918 influenza epidemic to all parts of the nation. These records open a window to the world 100 years ago and show the human and societal cost of the pandemic. They not only allow us to look back in time, but look ahead to the information they contain may help guide present day inquiries and increase our understanding of the disease. Dr. Jeremy brown is an emergency physician and was the Research Director in the department of emergency medicine at the George Washington university here in d. C. He is now director of the office of Emergency Care research at National Institutes of health. Dr. Brown is the author of more than 30 Peer Reviewed articles and three books, including the oxford american handbook of emergency medicine, and the handbook on cardiology emergencies. Hes recently received an nih directors award for his efforts supporting research and nonaddictive 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 countless fascinating and fun facts about the scourge. And William Bynam highlights his experience. In influenza he builds on his scientific career making the virus central to its story. He leaves history and contemporary virology and clinical practice together, although his story is a somber one, dr. Browns account is pung punctuated by humor and when to visit the emergency room. Ladies and gentlemen, dr. Jeremy brown. [applaus [applause] thank you so much for those kind words. Its not every day you get introduced by the archivist of the United States. So were 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 were killed in the influenza virus than in the wars. 50 to 100 Million People worldwide. Here in the United States, 675,000 deaths, civilian deaths and 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 of that was influenza. Its a sobering thought to think that if you take those statistics and multiply them out by the Current Population of the United States, those 675,000 deaths would turn out to be about three Million Deaths in todays numbers. To put that into perspective and think, what that would be like to live through such a thing. You know, another way of thinking about it was to put the cause of this, and were going to come back to this, but back in 1918 there was no known cause. Viruses had actually not been discovered yet. So people were dropping from this disease, called influenza, but nobody really knew what it was from and were going to return to some of those, the thoughts that were behind this. I think about that as i think about the 1980 outbreak of hiv which was incredibly frightening and yet we knew that it had to be a virus, it took us three years to identify it, but at least we knew, we suspected that we had a culprit right away. Back in 1918 they literally had no idea. And one other thing to put this into perspective as you all know, were sadly living through an epidemic of a different kind today, its the opioid epidemic, claimed so many deaths in this countries. The news the last years, the death rate is so high its dropped the average Life Expectancy in the u. S. , you may have heard that, seen that statistics. If you look at the average Life Expectancy, the young people, average Life Expectancy has dropped, its shocking. How much has it dropped by, look at the data, 1 10 of a year, thats a terrible statistics, but its 1 10 of a year. The 1918 great flu epidemic caused 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 weve seen with the current opioid crisis. So, again, putting it into some kind of perspective as to what this thing really was. Now, since were at the archive, i thought it would be fun to actually look at archival material that actually affects, shows what happens here in the nations great capital. So, this and the following few slides are all from the Washington Post and i think to tell a brief story of a much more complicated event. So, this is the Washington Post from saturday, september 14th, 1918. Its not the front page. And it tells us that the spanish influenza was spreading across the u. S. It wasnt really reported yet in the papers in large numbers. In washington d. C. , but it had begun to spread across the u. S. Now, the following day the Washington Post reported that 90 people had died of influenza in boston and that the malady seemed to be sweeping from east to west. It really wasnt probably started in the midwest. But the malady was ramping up and the next day they reported that 90 people in boston had died. These were deaths among soldiers and sailors. The plague builds momentum, more and more people die and by october the 2nd on the front page of the Washington Post, we were told that the work hours have changed, that the federal day has been staggered to check the influenza spread and the people are to take shifts. Now, washington d. C. Was not the only city to do this by any means. In fact, it happened in most of the cities that were affected. So the idea was, if we could stop people from mingling, although we didnt know it was a virus that was causing this, we did understand somehow that keeping away from people was probably a good idea. So, theaters were closed down in some places, restaurants either closed or staggered their hours, stores had staggered hours and then an attempt to keep people spaced away from each other. So, the working hours of the federal government changed around the beginning of october. I talk about this piece this reporting in the book. Its a particularly sobering one, this comes a couple of weeks after this announcement about closures. By october 13th, 1918, the Washington Post reported, and this headline, the ghoulish coffin trust, that the price of coffins skyrocketed and this was an example of people, people taking advantage of a terrible situation. And in fact, they write the coffin trust is holding the people of this city of boston of washington, holding the people of this city by the throat and extorting from them outrageous prices for coffins and disposal of the dead. In fact, the Washington Post here 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 makers figured they could make a buck. By the middle of october, here in washington, 91 people, more people have died in the short amount of time and it was suggested that the crest is now in sight. That was actually quite hopeful. There was no evidence of that, but it was hoped that perhaps were nearing the end of it. Throughout the epidemic, both here and nationally, people, of course, had various remedies and this is an amount of a remedy that actually played throughout the fall and winter of 1918 and were going to come back and talk about this, but i want you to remember these words. This is a remedy called laxative bromo quinine, a laxative, and quinnine, and it was the goto for malaria and its now been superceded by others, but it was thought to be helpful in influenza. So people were making this laxative bromoquinine, it says that spanish flu is one of the grip, and it should be taken in larger doses than prescribed in order grip. So its a really big epidemic so you better take a lot of this medicine. Well come back and talk about these remedies, so they were to treat the disease and also of course to prevent it. So, again, another marketing opportunity for our businesses, laxative, bromo qunine. And the Washington Post thought it was come to go an end and put a little piece, a snippet that said that spanish influenza is more deadly than war. And that is indeed the case. We know that. But what struck me here is the placing of this piece of journalism. Its a back page, page 20, tucked in next to an ad for dining room chairs. That the epidemic was more deadly than the war, stuffed in there. Why was this not front page news . What had happened. And there are various suggestions there, some believe there was a tacit agreement, not censorship, but tacit agreement between the newspapers and the government to play this thing down. If youre going to put a statistic that influenza costs more than the whole of world war i in terms of life, putting it on page 20 is really not going to get the attention it deserves. So its a little bit of a mystery, im sure we have some very smart archivists who can perhaps shed some more light on why this and other reports were sort of tucked into the back of papers. And finally, we hit a record. We hit earlier reports that we were nearing the crest here in washington d. C. , but unfortunately, no, more deaths than anytime since the record of last october occurred. 16 deaths from flu in a single day in the city of washington. Again, this was also tucked away near the real estate and legal record recordings. So, again, it was reported. It wasnt hidden, but youd have to sort of look for this to really understand what was going on. And the final slide i want to share with you of reporting from our from the Washington Post was on exactly this day, march the 5th, 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 who volunteered to go up 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 the doctors theres a typo there, naval doctors in determining the cause and method of transmission of the disease and preventative, i guess its meant to be preventative measures. Thats really quite another remarkable side of the story that people would volunteer to be involved in research on this very deadly epidemic, that was not understood, and for which there was no cure other than the bromo laxative tablets that i dont think at that people really looked forward to to cure them. So, i think an example of every day heroism of people putting their lives to some degree on the line in order to try and understand what was actually going on, what was this terrible disease. So these are just a few examples from the Washington Post that tell us a little bit about what happened here in washington d. C. Im just going to switch. Im just going to switch mere to a second slide show and this one will this one will run itself. So if it all works, fine. Youll see some images as we talk through. So for today, what id like to do is focus on three areas of research that i describe in the book. The first looks at how our treatments of influenza have evolved. What did we do 100 years ago to treat this terrible deadly disease and what do we do today . And i think you will find that actually its changed less than you would have hoped. The second focus, its 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, i think, we can all agree, there has been an absolutely remarkable evolution and leap in our understanding of exactly whats going on. And finally, were going to 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, and well find again that we still have a lot of work to do. So lets start with the treatment. So the treatments were not terribly effective. They included mercury, tree bark, inhaling factory gases, yes, that actually happened. People were reported in the south of england to be taking their families and their children to local gas works, actually munition factories where the toxic fumes were thought to somehow reduce the likelihood of getting influen influenza. Actually this turns out not to be as crazy as it sounds because many of these gas works actually contained chlorine gases during the war and we know that chlorine is a great antiseptic, it killing everything, including people. And yes, they were inhaling little bits much of chlorine and atmosphere was filled with chlorine and it wasnt unheard of to take your children to the gas factories. And whiskey was extremely popular as was champagne, described by senior physicians and so, not everything was difficult. As weve said, enemas were used enemas were actually used to treat everything back then. There was very little you could do so an enema was thought to be to clean everything out so enemas were quite popular and one of the most remarkable things was blood letting. Now, blood letting is the process by which blood is removed from the body and the thought is that with that removal of the blood you are taking out the bad humor, the bad thing in the blood thats causing the disease. It dates back to at least the fifth century bc and George Washington was probably killed from blood letting as he laid dying from a throat infection, his senior doctor suggested that we let blood. Now, the junior people were less into this idea and there was a little bit of resistance from them. But, no, as usual the senior people won and blood was let as he was dying on his bed, and he passed out, or a swoon as it was called then, and in a few hours he was dead. Our own president George Washington underwent this procedure. The doctor then tried to think about reenmating George Washington by using sheeps blood. But by then good sense prevailed and enough was enough with blood letting and sheeps blood and let him rest in peace. What was remarkable to me, blood letting was used in the great flu epidemic of 1918 and not just by what we might call quacks today. But this was prescribed by mainstream physicians. And in fact, this was one of the things that sparked my interest in the story of influenza then and now. As theres a report in the lancet, one of the leading medical journals in the world and one of the leading in the United Kingdom and the name the lancet is named after the device, the Little Hollow tube you would take blood from. So leading medical journal today was called the lancet with regards to blood letting. 1916 two years before this great flew pandemic. There was another pandemic, another epidemic, excuse me, in some of the military camps in Great Britain and the doctors had tried everything, including, they said, including blood letting. So it was in 1916 now, this was the lifetime of my own grandfather. In 1916 physicians were trying blood letting on these poor patients and of course, it doesnt work, but the physicians said, well, it didnt work, but we think that it didnt work because we tried it too late. And had we tried blood letting a little bit sooner in the Clinical Care of these soldiers, that maybe it worked and then there were reports in 1918, the height of the epidemic and blood letting and the reports were sometimes blood letting works for influenza. So you can see it wasnt the enemas that got you, the blood letting might get you and it was really quite a nasty array of medicines that we had to try and treat this. We saw earlier an ad for concoction that contained quinine. It was useful for malaria, but useless for flu. Because its a useful drug in malaria it reduces the fever cycle the and the idea was if it reduces fever in malaria, it will reduce in influenza, i believe obviously two quite different mechanisms of disease and a completely useless drug and incidentally dangerous in inappropriate doses. As ive said, everyone was prescribed enemas and one of my favorite discoveries when i was researching the book was from a published paper from i think the grandchildren of a patient who had influenza, not in 1918, but in 1936. So 18 years, almost two decades after the great influenza pandemic, the family had preserved the nursing records of grandfather, found them in the attic and published them and im going to read a little bit, a passage that described what this person went through. So, over a period of three weeks he was treated with a punishing batter of balms, mustard plaster, a home remedy on the skin. Aspirin for fever, codeine for thoughts. Phenol, a cancer causing laxative, seven enemas, seven, rectal tubes, dont ask. Milk of magnesia, god help him, and a tincture. And this was published and you can see the timeline where all of these various things were given. The patient received at least five prescribed doses of whiskey, so there is at least that, and 14 doses of caster oil. Actually, his seven enemas may have been medically necessary because he was given at least 39 doses of codeine, which suppresses coughing, but also causes constipation. So thats what life was like when you had influenza back 100 years ago or so. What about today . How do we do today . Well, for the vast majority of us, the vast majority of us, influenza is a little bit of an inconvenience. Its not life threatening and its something that we generally deal with at home, our friends or family come around and give us hot soup, a couple of days in bed and usually thats it, but of course, some of us end up in the Emergency Department and during my time as an emergency physician, i got to treat many, many, who knows, maybe thousands over the many years and there we had things we didnt have 100 years ago, right. We have an Emergency Department. We have blood tests that can tell us what is happening. We have xrays, so we can actually get a real good look at the lung and see if theres any evidence of secondary pneumonia or even primary pneumonia. We can give people intravenous fluids. Sorry, we can give people intravenous fluids and treat them in that way and of course, we have antibiotics today. Now, lets be very cheer, antibiotics should not be given to patients with influenza, they do not work. We all know this. Even though theyre prescribed unnecessarily often even today. They dont work. They do work to help treat the secondary infection. The pneumonia, the bacteriaal pneumonias that come as a result of the primary viral influenza and we have those antibiotics today. They were not available, they really were not available until the early 30s and its a remarkable thing that today we believe that the majority of deaths occurred in the great flu epidemic were caused by secondary pneumonias that we would be able to treat today. Thats good news. We also have other medications to treat fevers, not quinine, we have aspirin, motrin, or tylenol, but i came across a very interesting study that suggests that perhaps we shouldnt be giving medications for peoples fevers quite as often as we do. This was a study out of mcmasters in canada and they looked at a modelling, and what happens if you give tens of thousands of people with the flu medicine to reduce their fever . Well, many of them will feel better quicker, right . Having a high fever and shivers and shakes and chills, theyll feel better quicker and get out of bed quicker. What will happen . Theyll come downstairs and cough over their friends and children and go to work and cough over them. The suggestion from the group at Mcmaster University was, listen to this, by treating a fever by patients say in the Emergency Department, you might increase transmission rates by about 1 is and given the enormity of this disease, they suggested that you might actually get an additional 500 deaths per 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 doctor sees that you have a fever of 103 and she suggests that you probably shouldnt get some something for your fever because she says, theres a paper from Mcmaster University that theoretically, you know, this could increase the death rate by maybe 100 you would probably say, doctor, please give me the medicine and i know i would. And i know ive prescribed and would probably continue to prescribe something for peoples fevers in the presence of influenza, but there is at least this kind of other way of thinking, globally, about what were doing locally and how that 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, mainly things like tamiflu, and the new individual on the blocks, bloxafir. And wont go into them and maybe talk later. Those are out there and probably dont work as efficiently as they should, touted to work, but well leave that for later. All right, so that is the treatment. Enemas, blood letting, laxatives, whiskey, 100 years ago. Today, emergency room, stay at home and of course connected to the Emergency Room Department the intensive care unit where the sickest of the sick go for their care. I open the book with a story of a young lady, mother of two who came down with influenza quickly and ended up basically in a matter of hours being medivaced from a small town to pittsburgh where she was put on a heartlung bypass machine before she recovered from the flu. Thats the miracle of modern medicine today that clearly was not around 100 years ago. So the treatment. Lets now think about the cause of influenza. What do we know about the cause today and what did they know 100 years ago . So, i think in many respects, this is the most frightening aspect of the great influenza pandemic, that they just didnt know what it was caused by. Now, there was some suggestion among those suggestions included the conjunction of two in fact, the conjunction of the thats where we get the name influenza from, italian meaning influence, the earliest thoughts in the 15, 1600s were that this disease, it was an entity that you could identify, this was caused by something up in the stars. There was a theory going around and we have this buried in our history when we refer to infle inflew influenza. Jupiter and saturn. Rotting animal carcasses, earthquakes and eruptions. Effluvia from the bowels of the earth. People doesnt know what it was. At a matter in chicago, Public Health officials early in the influenza epidemic of 1918. One Health Officials said the following, we may as well admit it and call it germ x. We have no idea, Public Health officials, we dont know what causes it and where we are. Now, an example of a cause that was really not a cause was a discovery in 1892 in berlin by some microbiologist and they found a bacteria on the lung samples of people who had died from the flu and they said, aha, this must be the cause of the flu because its everywhere, right . And they called this bacteria, influenza baccilus. The problem was it was not the cause of the disease, it was a secondary pathogen that was found. A secondary bacteria and that that that thought that they found the bacteria and it turned out not to be correct, that happened several, you know, in several different instances in the history of flu. The baccillus was later changed its name and called not baccillus influenza, but hemophilis, but for many years i had no idea as a physician why am i treating this person with hflu. This is nothing to do with the flu. 100 years ago it was thought to have been part of the flu and named and one of the historians said this discovery of influenza, an authoritative sign pointing in the redwing wrong direction. So that was the secondary pathogen. In 1889 there had been a small severe one in Great Britain. It was so severe, parliament commissioned a report on the epidemic and this was reported in the in 1889 by Henry Parsons. He was a very, very smart person. Well see why. He spoke about various theories that may have caused this 1889 epidem epidemic. One of the theories at this time, im not making this up, was tainted russian oats. The suggestion was that the russians were bringing their disease from the east through europe and these tainted russian oats. Now every society blamed an outsider for this, but it strikes me as kind of weird were 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, as i said was smarter than that and he dug a little deeper. So he suggested, he said, well, it could be the weather. Perhaps theres something floating around in the air and that is of course, partially true, there is something in the air although its person to person contact more. And he suggested that maybe its a nonliving particulate matter, which is actually a remarkably accurate description, isnt it, of what a virus turned out to be, a nonliving particulate matter. So it was a little prescient there in describing the possible cause of the flu. So it could be russian tainted oats, it could be a poison in midair. Then he said what its a person to person contact. Its not by volcanos in the air, but one person gives it to another. And Henry Parsons showed us the right way to think about things. Lets get data if its person to person contact. What he did was he looked at the illness rates on the British Railway system and he compared the rates of the engineers who were feeding the steam engines and the coal, who worked outside, but far away from people. And he compared those influenza rates, how many people reported sick from that group of workers, he compared those to the rates of influenza among the clerks inside selling the tickets. Of course theyre inside not exposed to the outside, but in Constant Contact with people. And he simply compared the two and he found that of course, it was the clerks who had an increased rate of influenza illness because they were in contact with people and the Railway Engineers driving the train, standing outside and feeding coal into the big steam engine, their rates of flu were lower than the clerk, even though they were outside exposed to the effluvia from the volcanos and really its nothing to do with the atmosphere, but more to do with person to person contact. So a simple look at some records, this guy parsons figured out that probably were onto something in the person to person sphere. And 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 and he goes into this in some detail in his report. Of course, we know today that birds are intimately related to the spread of influenza and new strains. So, back in the 1889, Henry Parsons was really onto something when he discussed the possibility that birds were involved. That birds were involved. Theres an example, i think of people trying to think this through in a fairly logical way and almost coming to the right conclusi conclusion. Today we know what what causes influenza we will leave this portion of cspan2s book tv. You can watch all of our programs online at book tv. Org. The u. S. Senate is about to gavel in for a pro forma session part of cspan2s commitment to bring you live gavel to gavel coverage of the senate. Senator majority leader mcconnell said he hopes to approve funding for a Small Business loan program. Live coverage here on cs