War i. In november of 1918 the people of combat nation felt relief that the years of warfare and death were over. Yet another threat to life was reaching across the nations into homes and schools and hospitals, the flu. Influenza pin democrat 1918 killed more people worldwide then killed in combat in the war. Many records housed in the National Archives here in the Washington Area and many other field locations, documents this effort break in the United States and writers reports, books, telegrams show the reach of the 1918 influenza epidemic to all parts of the nation. These records opena a window oo the world of 101 years ago and show us the human and societal cost of the pandemic. They allow us not only to look back at times but perhaps also to look ahead. As thepa information may help guide present inquiries and increase our understanding of the disease. Doctor jeremy brown is an emergency physician and was a Research Director in the department of emergency medicine at the George Washington university in d. C. , hes now the director of office of Emergency Care research and the National Institute of health and doctor brown is the author of articles and books including the oxford of american emergency medicine in the handbook on cardiology emergencies. Hes recently received an nih directors award for his efforto supporting research and nonaddicting methods of pain relief. Jacob apple says brown is clearly a man who knows the flu, not just the physiology and virus or the epidemiologyt of illness but countless fascinating and fun facts about this. And in the wall street journal, highlights browns emergency room experience and in influenza he builds effectively on his clinical and scientific career making the virus itself central to the story he reads history contemporary urology clinical practice together, although his story is a somber one, his account has humor and advice. The best time to visit an emergency room for instance. Please welcome doctor jeremy brown. [applause] thank you so much for those kind words, its not every day you getou introduced by the archivist of the United States. So we are here to talk about influenza and the plague that struck us 100 years ago that resonates all the way through to today, as you mentioned more people were killed in the influenza virus then in the wars, 50 100000000 people worldwide. Here in the United States 675,000 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. It is a sobering thought to think of, if you take the statistics and multiply them by the Current Population of theti United States, the 675,000 deaths were turned out to be about 3 Million Deaths in todays numbers. Put that into perspective and think what that would be like to live there such a thing. Another way of thinking about it was to put the calls of this, im going to come back to this but back in 1918 there was no known cause, viruses had not been discovered yet. So people were dropping from this disease called influenza but nobody really knew what ital was from and we will return to some of the thoughts that were behind it. I think about that and i think about the 1980 outbreak of hiv which was incredibly frightening and yet we knew that i had to be a virus, took it three years to identify but at least we knew what we suspected that we had a corporate right away. Back in 1980 they had no idea. One other thing to put this into perspective, as you all know we are sadly living through an epidemic of a very different kind, the Opioid Epidemic which has claimed so many deaths in this country, the news over the last couple of years was the death rate, it is so high that it has dropped the average Life Expectancy inso the u. S. And you may have seen that statistic. If you look at the average six presidency because a large number of death, the average Life Expectancy has dropped, that is shocking, how much has a drop by. If you look at the data ishe drop by one tenth over the year. That is a terrible statistic but its one tenth of a a year. The 1918 epidemic cause such a loss of life that it dropped the Life Expectancy in the u. S. By ct12 years. 12 years, 120 times greater than what we have seen with the current opioid crisis. Again putting in it to perspective as to what it really was, since were in the archives, i thought it would be fun to actually look at archive material that actually affects and shows what happens here in the nations great capital. So these in the following slides are from the Washington Post and i think it tells a brief story of a much complicated event, this is the Washington Post from saturday september 14 in 1918, not the front page and it tells us that the spanish influenza was spreading across u. S. , was not reported yet in the papers in large numbers and 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 influenzape n boston and they seem to be sweeping from east to west, was actually started somewhere in the midwest but it was already ramping up in the very next day they reported that 90 people in boston had died, these were deaths among soldiers and sailors. The plague built momentum and more and more people died in by october the second on the front page of the Washington Post we were told that the work hours were changed, that the federal data has been staggered to checa the influenza spread and the people have to take shifts, washington, d. C. Was not the only city to do this by any means, in fact it happened in the most of the cities that were affected. The idea was if we could stop people from mingling although we did not know it was a virus that was causing this, we did understand somehow keeping away from people is probably a good idea. So theaters were closed down in some places, restaurants closed or staggered their hours, stores had staggered hours, in an attempt to keep people space away from each other. The working hours of the federal government changed around the beginning of october. I talk about this piece this reporting in the book is a particularly sobering one and it comes a couple weeks after the announcement of closures. By october 13, 1918, the Washington Post reported on the headline the ghoulish coffin, the price of coffins had skyrocketed. And this was an example of people taking advantage of a terrible situation and in fact they write the confidence holding the people of the city of boston of washington by the throat and extorting outrageous prices for coffins and disposal of the dead. In the Washington Post goes on to suggest that the department of justice should step in and instantly put a stop to the high prices of coffins. It cost more to bury your dead because the coffeemakers figured they could make amo buck. The middle of october in washington more people had died in a short amount of time and the crest was in sight, that was hopeful, there is no evidence 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, this is an example of a remedy that actually played throughout the fall and winter of 1918 and will come back and talk about this but i want you to remember these words, this is a remedy that contains a laxative, will come back to that, thought to be very, very helpful in cases of influenza and a medicine that was the go to medicine forec malaria. It is now been superseded by others but it was thought to be helpful in influenza, people were making the laxative and i find it interesting if you look at the beginning as spanish influenza is an exaggerated form of grit, one of the words of influenza, it should be taken in large of those then prescribed an ordinary great, its a really big epidemic so you better take a lot ofit this medicine. We will come back and talk about these particular remedies so these and several others were advertised both to treat the disease and also of course to prevent it again, another marketing opportunity for businesses, laxatives and bruma 1918 the Washington Post thought that we were coming to an end and they put this little piece that said spanish influenza is more deadly then war, 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 that the academic was more deadly than the war, why was this not frontpage news. What had happened, these very suggestions, some believe there was a passive agreement, not censorship the passage agreement between the newspapers and the government the play this thing down but if youre going to put a statistic like that the influenza cost more than the whole of world war i, putting on page 20 is really not going to get the attention. Its a little bit of a mystery and im sure will have very small that can shed more light on all this and other reports and tucked into the back. Finally we hit a record, early reported that we were near the creston washington, d. C. And to note more destin sensor record of last october occurred, 16 deaths from the flu in a single day in the city of washington, again this was tucked away in maybe real estate and legal record recording. Again it was reported, it was not hidden but you have to look for this to understand what was going on. In the final slide i want to share with you of reporting from the Washington Post was on exactly the same march the fifth, 1919, exactly a century ago. Exactly 100 years agoh today. This was a small report that was in the Washington Post that cited to washington boys who volunteered to go out to boston and to take part in an experiment that were trying to understand the cause and the methods of trumps mission, during the recentmi influenza epidemic we read men voluntarily submitted to experiments for doctors to determine the cause and method of transmission of the disease and preventative measures. That is quite another remarkable side of the story that people would volunteer to be involved in research on this barely deadly epidemic that was not understood and for which there was no current than the tablets which i dont think people really look forward to to cure them. I think an example of everyday heroism of people putting their own lives to some degree on the line in order to understand what was actually going on, what was this terrible disease. These are just a few examples from the Washington Post that tell us a little bit about what happened in washington, d. C. , im just going to switch to a second slideshow in this one will run itself. If it all works fine, you will see some images as we talked through. Today i would like to focus on three areas of research, one that i described in the book, the first looks at howard treatments of influenza have evolved. What do we do 100 years ago to treat this terrible deadly disease and what do we do today. And i think you will find that it has changed less than you wouldve hoped, the second focus is going to be howard understanding of influenza virus have changed over the last century. What caused it and what to be know about that same virus today and i think we can all agree that there has been an absolute remarkable evolution and understanding of whats going on. Finally were going to look at how we can prevent ourselves from catching the flu in the first place by looking h at vaccines, what vaccines were like back then 100 years ago and where we are today and will find that we still have a lot of work to do. So lets start with the treatments. The treatments were not terribly effective, they included mercury, free bark, and inhaling factory gases, that actually happened, people were reported in the soft of england to take their families and their children, munition factories where the fumes were thought to reduced the likelihood of getting influenza. It turns out not to be as crazy as it sounds because many of these contain chlorine, chlorine gases used during the war and we know chlorine is a great antiseptic, kills everything including people. So very likely that chlorine and work that was done shows a factory work has slightly lower rates probably because yes they were inhaling little bits of chlorine and they hold atmosphere in the chlorine gas and that probably reduced the amount of free virus around, was not a complete crazy thing to take your children to inhale factory gases, there is upside of treatment back then, whiskey was extremely popular and was champagne, these are prescribed by senior physicians and so not everything was difficult, as we said enemas they were actually used to treat everything back thing, that was something you could do so that was thought to be to clean everything out, and enemas quite popular in one of the most remarkable thing is blood blessing. Its a process by which blood is removed from the body and the thought with the removal of the blood you are taking out the bad thing in the blood causing the disease. It dates back to the 50 century d. C. And George Washington was probably killed by this as he lay dying from a throat infection, his senior dr. Suggested that we do this. The junior people were less into thiswe idea and there was a lite bit of resistance but as usual the senior people one and blood was taken from George Washington as he lay dying on his bed and he passed out and within a few hours he was dead. Sorry own president George Washington underwent this procedure, the doctor then tried to think about reanimating George Washington im not making this up using cheaps blood at the time good sense prevailed and they decided enough is enough and they let him rest in peace. What is remarkable to me is bloodletting was used in 1918 and not just by what we might call quacks today, but this was described by mainstream physicians and in fact this was one of the things that spark my interest in the story of influenza in these report, one of the leading medical journals in the United Kingdom and if you n think about it, the lancet is named after the device that you would take blood from, the medical journal todays call the lancet. In the report mentions in 1916, two years before the flu pandemic, there was another pandemic, another epidemic in some of the military camps in Great Britain and the doctors tried everything including bloodletting, so it was 1916, this is the lifetime of my grandfather and in 1916 physicians were trying bloodletting on these poor patients and of course it did not work but the physician said it did not work but we think but it didnt work because we tried it too late. Had we tried bloodletting a little sooner into curving soldiers, that maybe it worked, there were reports in 1918, the height of the epidemic of bloodletting and in fact the reports were sometimes bloodletting works for influenza. So you can see if it was not the enemas that got you the bloodletting might get you and it was really quite an austere rate of medicines that we had to try to treat this. We saw earlier in ad for concoction and we said it was a useful drug for malaria but useless as a treatment for flu. Because its a useful drug malaria, and reduces the fever cycle and the idea was if it reduces fevers and malaria then it will reduce fevers and influenza obviously to quite different mechanismsin of diseae but that was the thought process behind it but completely useless drug and incidentally dangerous and inappropriate. As i said everyone was prescribed enemas and one of my favorite discoveries when i was researching the book was from a published paper from the grandchildren of a patient who had influenza, not 1918 but in 1936, 18 years, almost two decades after the great influenza pandemic, the family had preserved the nursing records of grandfathers and found them in the attic and actually published in. Im going to read a little bit of a passage that describes what this person went through. Over a period of three weeks he was treated with a punishing battery of bombs, muscle blaster, a home remedy rubbed on the skin, aspirin, for fevers, coding for a period tree no sailing, a cancercausing laxative, cough medicine, oil, seven enemas, seven, rectal tubes, dont ask, milk of magnesia, another laxative, god help them, a bloodletting intercepted, these were all administered to this patient in 1936 and actually in the paper that was published you can see thawhere the various things are given. The patient described five doses of whiskey, theres at least that in 14 doses of cost o costl coding suppresses coffee but also causes constipation. But thats what life was like we had influenza back 100 years ago or so. What about today. Well, for the vast majority, influenza is an inconvenience, not lifethreatening and its something that we generally deal with at home, the friends of the family come down and give us hot soup in a couple of days in bed and usually thats it but of course some of us in the Emergency Department, we got to treat many, many possibly hundreds, maybe thousands of patients within influenza over the many years and there we have things that we did not have 100 years ago, we had an Emergency Department, we had blood test that can tell us what is happening, xrays so we can get a real good look at the lungs and see if theres any evidence of pneumonia, we can get fluids. Sorry we can get people intervened as fluids. In treat them in that way. And 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 the prescribed unnecessarily often for today, they do not work but they do work to treat the secondary infection in the ammonia that comes as a result of the primary viral influenza we have vira antiviral today and