Photographs show the reach of the 1918 influenza epidemic to all parts of the nation. These records show us the human and societal cost of the pandemic. They allow us not only to look back at that time but also to look ahead as 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. Hes now director of the office of Emergency Care research at National Institutes of health. Dr. Brown is the author of more than 30 peerreviewed articles and three books including the oxford american hand book of emergency medicine and the handbook on cardiology emergencies. Hes recently received an nih directors award for his efforts supporting research in nonaddicting 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. Also written in the wall street journal highlights browns emergency room experience. In influenza he builds effectively on his clinical and scientific career making the virus itself central to its story. He weaves history and contemporary virology and clinical practice together. Although his story is a somber one, his account is punctuated by some humor and much good advice, like the best time to visit an emergency room, for instance. Ladies and gentlemen, please welcome dr. Jeremy brown. [applause] thank you very much for those kind words. It is not every day that you get introduced by the archivist of the United States. Were to talk about influenza and the plague that struck us 100 years ago resonates all the way through till 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 the majority of that was influenza. It is a sobering thought to think 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 3 Million Deaths in todays numbers. So put that into perspective and think what that would be like to live through such a thing. 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 the thoughts that were behind this. I think about that and 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, think literally they literally had no idea. Were sadly living through an epidemic of a very different kind today, it is the Opioid Epidemic which has claimed so many deaths in this country. The news over the last couple of years was actually that the death rate is so high that its dropped the average Life Expectancy in the u. S. You may have heard that seen that statistic, that if you look at the average Life Expectancy because of the large numbers of deaths of younger people, the average Life Expectancy has dropped. Thats shocking. How much has it dropped by . Well, if you look at the data, its dropped by 1 10 of a year. Thats a terrible statistic but it is 1 10 of the 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 we have 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 archives, i thought it would be fun to actually look at some archival material that actually affects shows what happens here in the nations great capital. So these this and the following few slides are all from the Washington Post, and i think tell a very brief story of a very complicated event. This is the Washington Post from saturday, september 14, 1918. It is 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 has bedun to spread across the u. S. Flow the now, the following day the Washington Post reported that 90 people had died of influenza in boston and that it seemed to have been sweeping from east to west. It wasnt actually. It actually probably started somewhere in the midwest. But the malady was already sort of ramping up. The next day they reported that 90 people in boston had died. These were deaths amongst soldiers and sailors. The plague built momentum, more and more people die. By october 2, on the front page of the Washington Post, we were told that the work hours had 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. The idea was that 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, in 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 reporting in the book. It is a particularly sobering one, comes a couple weeks after the announcement about closures. By october 13, 1918, the Washington Post reported, in this headline, the coffin trust, 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 is holding the people of this city, of washington, holding the people of this city by the throat and extorting from them outrageous prices for coffins and disposal of the dead. And 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 mid october, here in washington, more people have died in a short amount of time, and it was suggested that [inaudible] was now in sight. There were hopes that we were nearing the end of it. Throughout the epidemic, both here and nationally, people of course had various remedies, and this is an example of the remedy that actually plagued throughout the fall and winter of 1918. Were going to come back and talk about this. I want you to remember these words. This is a remedy. It contains a laxative well come back to that thought to be very very helpful in cases of influenza and a pill a medicine that until fairly recently was the goto medicine for malaria. Its now been its now been superseded by others, but it was thought to be helpful in influenza. So people were making this. I find it interesting that if you look at the beginning, it says the following, spanish influenza is an exaggerate form of influenza. The tablets should be taken in larger doses than prescribed in ordinary. It is a really big epidemic so you better take a lot of this medicine. We will come back and talk about these particular remedies. These and several others were advertised both to treat the both to treat the disease and also of course to prevent it. So again, another marketing opportunity for our businesses. By december 8, 1918, the Washington Post had thought that we were coming to an end, and it put this little snippet that said the 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 the back page, page 20, tucked in next to an ad for dining room chairs. The epidemic was more deadly than the war. Why was this not front page news . What had happened . Theres some various suggestions there. Some believe that there was some kind of agreement not censorship, but an agreement between the newspapers and the government to play this thing down, but if youre going to put a statistic like that, that the influenza cost more than world war i in terms of lives putting it on page 20 is not going to get the attention it deserves. It is 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 in to back of papers. Finally we hit a record. Earlier reported that we were nearing the crest here in washington, d. C. , but unfortunately, no, more deaths than any time 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 recording. Again, it was reported. It wasnt hidden, but youd have to sort of look for this to really understand what was going on. The final slide i want to share with you from reporting from the Washington Post, on exactly this day, march 5, 1919, exactly a century ago, exactly 100 years ago to date, 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 for doctors a typo there naval doctors in terming the cause and method of transmission of the disease and preventive i guess thats meant to be preventive measures. Thats another remarkable side of this story that people would volunteer to be involved research on this very deadly epidemic that was not understood and unfortunately there was no cure other than those tablets which i dont think people really looked forward to cure them. So i think an example of every day heroism, of people putting their own 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 a few examples from the Washington Post that tell us a little bit about what happened here in washington, d. C. Im going to switch im going to switch here to a second slide show, and this one will this one will run itself. the second focus is going to be the understanding of the virus has changed over the last center. Cost influenza years ago but we know about that same time yesterday . I think we can all agree absolutely remarkable evolution whats going on. Finally, how we can prevent ourselves from catching the flu. Looking at vaccines, vaccines we are today and will find again we still have a lot of work to do. Lets start with the treatments. The treatment were not terribly effective they included mercury tree bark, inhaling factory gases, ups, could actually happen. People reported south of england they took their families and children to munitions factories toxic fumes thought to somehow reduce the likelihood of getting influenza. Activist turned out to be as crazy as it sounds because many of these gas works contain chlorine used during the work. We know its antiseptic, it kills everything including people. Very likely, work that was done factory works in these places had influenza at slightly lower rates probably because yes, they were inhaling bits of cory in the atmosphere was bathed in a public reduced the amount of free virus floating around. It wasnt completely crazy thing to cure children to inhale factory gases. Theres an upside of treatment back then, whiskey was extreme popular and somewhat champagne. They were prescribed by senior physicians so not everything was difficult as we said must used to treat everything. Emma was not to be cleaning anything out. One of the most remarkable things is bloodletting. Bloodletting is the process by which is removed from the body. This removal of the blood, taking out the bad things in the blood causing the disease. It dates back at least to the fifth century bc bc George Washington probably killed by bloodletting as he lay dying from an infection, a senior doctors suggest we let blood. The people were last to this idea and theres a bit of senior people one influx was taken from Fort Washington i see lay dying on his bed and he passed out within a few hours, he was dead. President George Washington underwent this procedure. The doctor then tried to think about reanimating George Washington using from not making this up, keeps blood that time prevailed and enough is enough with the blood but sheeps blood they let him rest in peace. Once remarkable to me bloodletting was used in the great flu epidemic of 1980. Not just by what we might call . Today but this was prescribed by mainstream physicians and this was one of the things that sparked my interest in the story of influenza. The report from the leading medical journals in the baltimore leading medical journals in the United Kingdom same doctor, its a hollow tube you take blood from. The report mentioned in 1916, two years before the breakthrough pandemic, is another pandemic, another epidemic in the camps in Great Britain doctors did everything including bloodletting, this is the time of my grandfather and physicians were trying bloodletting on these poor patients. Of course, it didnt work but the physician said it didnt work but we think it could work because we tried it too late. Had we tried bloodletting sooner with the care of these soldiers, that maybe it would work. Then in 1918, the height of the epidemic of bloodletting and the report was yes, sometimes bloodletting works for influenza. So if you can see, if it wasnt the anime that got you, the bloodletting might get you in it was a nasty array of medicines we had to try and treat it. We saw earlier and add a concoction that we said was useful drug for malaria but useless for treatment of flu. Because its a useful drug and malaria, it reduces the cycle. The idea that it reduces fevers and malaria, it would reduce fevers and influenza to a different mechanism of the disease but that was the thought process behind it. A completely useless drug and dangerous and appropriate one. Everyone was prescribed and most and one of my favorite discoveries disturbing the book was from a published paper for my think the grandchildren of patient who had influenza, not in 1890 and 1836. Eighteen years, almost two decades after the great influenza pandemic, the family preserved the records of grandfather, and published them. Im going to read a little bit passage that describes. Over a period of three weeks, he is treated with a punishing one, they brought them forth skin, fevers, a cancer causing laxative, cough medicine, oil, seven enemas, rectal tubes, dont ask. Milk of magnesia and and antiseptic. These are all administered for this patient 1936 and in the paper, you can see various things given. The patient received at least five subscribed things of whiskey and 14000. Actually, certain enemas may have been medically necessary because they were given at least 89 doses of coping which the press is coughing which also called constipation. So thats what life was like when you have influenza. Back 100 years ago or so. What about today . For the vast majority of us, influenza is a little bit of inconvenience. Like threatening it something generally deal with at home, friends or family, and usually thats it but of course, some of us and in the Emergency Department. I got to chief many, possibly hundreds or thousands of patients with influenza over the many years. There we have things we did. You have an Emergency Department, we have blood that can tell us what is happening for tests. We have xrays so we can get a good look at the lungs and see if theres any evidence of pneumonia, we can get fluid. We can get fluid and treat them in that way. Of course, we have antibiotics today. Lets be very clear, antibiotics should not be given to patients with influenza. They do not work. We all know this even though they are prescribed unnecessarily, often even today. They dont work. They do work to help treat the secondary infections, pneumonia is the bacterial of pneumonias that comes as a result of the primary viral influenza. We have as antibiotics today, they were not available in the early 30s and its a remarkable thing. Today, we believe the majority of deaths occurs in the great plains a epidemic. Secondary pneumonias we would be able to treat today. Thats good news. We also have other medications to treat fevers, medications like aspirin or motrin or tylenol i came across an interesting study that suggests perhaps we shouldnt be giving medications for people we see quite as often as we do. Its a study at a university in canada and they looked at modeling and they said what happens if you give tens of thousands of people with the flu some medicine for a fever . Well, many will feel better quicker. High fever, they will feel better quicker. So they will get out of bed quicker. What will happen . Will come down stairs and coughed all over the friends and children and go to work in a couple of them. The suggestion from this group at the university was not by treating a fever, my increased transmission by about 1 and given the enormity of this disease, they suggested he might actually get an additional 500 deaths a year in the <