 Good afternoon. I'm David Farrier, the Archivist of the United States, and it's a pleasure to welcome you to the William G. McGowan Theater here at the National Archives today, whether you're here in the theater with us or joining us through our Facebook or YouTube channels, and a special welcome to our C-SPAN audience. Before we hear from Dr. Jeremy Brown about his new book Influenza, The Hundred-Year Hunt to Cure at the Deadliest Disease in History, I'd like to tell you about two other programs happening this month in the McGowan Theater. On Friday, March 8th at noon, Tina Cassidy will talk about her new book, Mr. President, How Long Must We Wait, which explores the complex relationship between notable suffragist Alice Paul and President Woodrow Wilson. And on Monday, March 18th at noon, Jesse Morgan Owens tells the story of a photograph that transformed history in her book, Girl in Black and White, the story of Mary Mildred Williams and the abolition movement. Check our website at archives.gov or sign up at the table outside the theater to get email updates. You'll also find information about other National Archives programs and activities. And another way to get more involved with the National Archives is to become a member of the National Archives Foundation. The Foundation supports our education and outreach activities. Visit its website, archivesfoundation.org, to learn more about the Foundation and how to join online. Last November, we marked the centennial of the end of World War I. In November 1918, the people of combatant nations felt relief that the years of warfare and death were over. Yet another threat to life was reaching across those nations into homes and schools and hospitals. The flu. The influenza pandemic of 1918 killed more people worldwide than were killed in combat during the war. Many records housed in the National Archives here in the Washington area and our other many field locations document this outbreak in the United States. Letters, reports, patient record, books, telegrams and photographs show the reach of the 1918 influenza epidemic to all parts of the nation. These records open a window onto the world of 101 years ago and show us the human and societal costs of the pandemic. They allow us not only to look back at that time, but perhaps 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. He is now director of the Office of Emergency Care Research at the 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 a Handbook on Cardiology Emergencies. He's recently received an NIH Director's Award for his effort supporting research and non-addicting 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 Bynum, writing in the Wall Street Journal, highlights Brown's 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, Dr. Brown's account is punctuated by some humor and much avocular advice, like the best time to visit an emergency room, for instance. Ladies and gentlemen, please welcome Dr. Jeremy Brown. Thank you so much for those kind words. It's not every day you get introduced by the Archivist of the United States. So we're here 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 that was the majority of that was influenza. It's 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 3 million deaths in today's 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 we're 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 we're 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 what we suspected that we had a culprit right away. Back in 1918, they had literally had no idea. And one other thing to put this into perspective, as you all know, we're sadly living through an epidemic of a very different kind today. It's 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 it has dropped the average life expectancy in the U.S. You may have seen that statistic, but if you look at the average life expectancy, because of the large numbers of deaths of younger people, the average life expectancy has dropped. That's shocking. How much has it dropped by? Well, if you look at the data, it's dropped by one tenth of a year. Now, that's a terrible statistic, but it's one tenth 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 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 we're at the archives, I thought it would be fun to actually look at some archival material that actually affects what shows what happens here in the nation's great capital. So this and the following few slides are all from the Washington Post. I think just tell a very brief story of a very much more complicated event. So this is the Washington Post from Saturday, September 14th, 1918. It's not the front page. It tells us that the Spanish influenza was spreading across the U.S. It wasn't 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 maladies seemed to have been sweeping from east to west. It wasn't actually, it was actually probably started somewhere in the Midwest, but the malady was already sort of ramping up and the very 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 the most of the cities that were affected. The idea was that if we could stop people from mingling, although we didn't know that 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 piece of, this reporting in the book, it's a particularly sobering one. And this comes a couple of weeks after that announcement about closures. By October 13, 1918, the Washington Post reported on this headline, the ghoulish coffin trust, that the price of coffins had skyrocketed. And that 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 the middle of October here in Washington, 91 people, more people had died in a 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 we're nearing the end of it. Throughout the epidemic, both here and nationally, people of course had various remedies. And this is an example of a remedy that actually played throughout the fall and winter of 1918. And we're going to come back and talk about this, but I want you to remember these words. This is a remedy called laxative bromo quinine. And it contains a laxative. We'll come back to that. It was thought to be very, very helpful in cases of influenza. And quinine, quinine, which is a pill, a medicine that until fairly recently was the go-to medicine for malaria. It's now been superseded by others. But quinine was thought to be helpful in influenza. And so people were making this laxative bromo quinine. I find it interesting that if you look at the beginning, it says the following, as Spanish influenza is an exaggerated form of grip, one of the words of influenza, laxative bromo quinine tablet should be taken in larger doses than prescribed in ordinary grip. So it's a really big epidemic, so you better take a lot of this medicine. And we'll come back and talk about these particular remedies. So these and several others, several other tonics, were advertised both to treat the disease and also, of course, to prevent it. So again, another marketing opportunity for our business is laxative bromo quinine. By December the 8th of 1918, the Washington Post had thought that we were coming to an end and it put this little piece, this little 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. It's 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 some various suggestions there. Some believe that there was some kind of tacit agreement, not censorship, but tacit agreement between the newspapers and the government to play this thing down. But if you're going to put a statistic like that, that influenza costs more than the whole of World War I in terms of lives, putting it on page 20 is really not going to, I think, get the attention that deserves. So it's a little bit of a mystery and I'm sure we'll have some very smart archivists who can perhaps shed some more light on why this and other reports were sort of tucked in to the back of the papers. Finally, we hit a record. We had 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. So, again, it was reported. It wasn't hidden. But you'd 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, for doctors, there's a typo there, naval doctors in determining the cause and method of transmission of the disease and preventative, I guess that's meant to be preventative measures. Now, that's really quite another remarkable side of this 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 bromolaxative quinine tablets, which I don't think people really look forward to to cure them. So I think an example of everyday 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 examples from the Washington Post that tell us a little bit about what happened here in Washington DC. I'm just going to switch here to a second slideshow and this one will run itself. So if it all works fine, you'll see some images as we talk through. So for today, what I'd 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 it's changed less than you would have hoped. The second focus is 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 absolute remarkable evolution and leap in our understanding of exactly what's going on. And finally, we're 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 we'll find again that we still have a lot of work to do. So let's start with the treatments. 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 influenza. Actually, this turns out not to be as crazy as it sounds because many of these gas works actually contain chlorine. Chlorine gas was used during the war and we know that chlorine is a great antiseptic. It kills everything, including people. So very likely the chlorine, in fact, and some work that was done showed that factory workers in these places had influenza at slightly lower rates than other people, probably because, yes, they were inhaling little bits of chlorine and the whole atmosphere was bathed in the chlorine gas and that probably reduced the amount of free virus floating around. So it wasn't a completely crazy thing to take your children to inhale factory gases. There was some upsides of treatment back then. Whiskey was extremely popular as was Champagne. These were prescribed by senior physicians and so not everything was difficult. As we said, enemas were used, enemas actually were used to treat everything. Back then, there was really very little you could do, so an enema was thought to be clean everything out. So enemas were quite popular and one of the most remarkable things is bloodletting. Now, bloodletting 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 that is in the blood causing the disease. It dates back to at least the 5th century BC and George Washington was probably killed by bloodletting. As he lay dying from a throat infection, his senior doctors 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 taken from George Washington as he lay dying on his death, on his bed and he passed out or entered a swoon and it was caused as it was called then and within a few hours he was dead. So our own President George Washington underwent this procedure. The doctors then tried to think about reanimating George Washington by using, and I'm not making this up, sheep's blood. At that time, though, fortunately, good sense prevailed and they decided enough is enough with the bloodletting and the sheep's blood and they let him rest in peace. But what is remarkable to me is that bloodletting 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. There's a report in the Lancet, one of the leading medical journals in the world, one of the leading medical journals in the United Kingdom. And if you think about it, the name the Lancet is named after the device, the little hollow tube that you would take blood from. So leading medical journal today is called the Lancet to Remind us of bloodletting. And the report mentions that in 1916, that's two years before this great flu pandemic. There was a there was another pandemic, another epidemic, excuse me, in some of the military camps in Great Britain. And the doctors have tried everything, including they said, including bloodletting. So it was 1916. Now this is the lifetime of my own grandfather. In 1916, physicians were trying bloodletting on these poor patients. And of course, it didn't work. But the physician said, it didn't work. But we think that it didn't work because we tried it too late. And had we tried bloodletting a little bit sooner in the clinical care of these soldiers, that that maybe it worked. And then there were reports in the in 1918, the height of the epidemic of bloodletting. And in fact, the reports were that yes, sometimes bloodletting works for for influenza. So you can see, if it wasn't the enemas that got you, the bloodletting might get you. And it was a really a quite a nasty array of medicines that we had to try and treat this. We saw earlier an ad for concoction that contained quinine we as we've said it was a useful drug for malaria, but useless as a treatment for flu. Because it's a useful drug in malaria, it reduces the the fever cycle. And the idea here was, well, if quinine reduces fevers in malaria, then it will reduce fevers in influenza, obviously to quite different mechanisms of disease. But that was the thought process behind it. But of course, a completely useless drug and incidentally dangerous in inappropriate doses. As I've said, anybody, 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 grand 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 actually published them. And I'm going to read a little bit, a passage that describes what this person went through. So over a period of three weeks, he was treated with a punishing battery of barns, mustard plaster, a home remedy rubbed on the skin, aspirin for fevers, codeine for cough, phenolphthalein, a cancer causing laxative, cough medicine, camphorated oil, seven enemas, seven, rectal tubes, don't ask, milk of magnesia, another laxative, God help him, yourotropine, a bladder antiseptic and tincture of benzoin. These were all administered to this patient in 1936. And actually, in the in the paper that was published, you can see the arrows along the timeline where all 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 castor 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 that's 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 a an inconvenience. It's not life threatening. And it's something that we generally deal with at home, a friend or a family come round, give us some hot soup. We have a couple of days in bed. And usually that's it. But of course, some of us end up in the emergency department. And over my time as an emergency physician, I got to treat many, many, possibly hundreds who knows, maybe thousands of patients with with influenza over the many years. And there we have things that we didn't have 100 years ago, right? We have an emergency department. We have blood tests that can tell us what's happening. We have x-rays so that we can actually get a real good look at the lungs and see if there's any evidence of secondary pneumonia or even primary pneumonia, we can get people intravenous fluids. Sorry, we can give people intravenous fluids and treat them in that way. And of course, we have antibiotics today. Now let's be very clear, antibiotics should not be given to patients with influenza. They do not work. We all know this, even though they're prescribed unnecessarily often even today, they don't work, but they do work to help treat the secondary infections, the pneumonias, the bacterial pneumonias that come as a result of the primary viral influenza. And we have those antibiotics today. They were not available. They weren't really not available to the early 30s. And it it's a remarkable thing that today we believe that the majority of deaths that occurred in the great flu epidemic were second were caused by secondary pneumonias that we would be able to treat today. So that's good news. We also have other medications to treat fevers, not quite in. We have medications like aspirin or Motrin or Tylenol. But I came across a very interesting study that suggests that perhaps we shouldn't be giving medications for people's fevers quite as often as we do. This was a study out of McMaster University in Canada. And they looked at this a modeling. And they said, what happens if you give tens of thousands of people with the flu some medicine to reduce their fever? Well, many of them will feel better quicker, right? Because having a high fever and shivers and shakes and chills that's miserable, they'll feel better quicker until they'll get out of bed quicker. And what will happen? Oh, they'll come downstairs and cough over their friends and their children and go to work and cough over them. And the suggestion from this group at McMaster University and listen to this was that by treating a fever for patients in, let's say the emergency department, you might increase transmission rates by by about 1% 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 people's 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 shouldn't get some something for your fever because she says, there's a paper from McMaster University that's theoretically, you know, this could increase the death rate by maybe 100. You will probably say, doctor, please give me the medicine. And I know I would. And I know I've prescribed and probably would continue to prescribe something for for people's fevers in the presence of influenza. But there is at least this kind of other way of thinking globally about what we're doing locally and how that might affect transmission and spread. So we have those those medications as well to help us. Then there are some specific medications that treat the flu. Those are namely things like Tammy flu, and the new kid on the block a medication called block severe. These are direct antiviral medications. I'm not going to go into those directly now. Perhaps we can talk about them later. But they're also out there. They probably don't work anywhere near as as efficiently as they should as they've been touted to work. But we'll leave that for later. Alright, so that is the treatment. Enemies, bloodletting, laxatives, whiskey 100 years ago today, the emergency department will stay at home. And of course, connected to the emergency department is the intensive care unit, where the sickest of the sick go to be supported through their care. And in fact, I opened the book with the story of a young lady, mother young mother of two who came down with influenza extremely quickly. She ended up basically in a matter of hours being medivac from her from her small town to Pittsburgh where she was put heart lung bypass machine for several weeks until she recovered from the flu. I mean, that's the miracle of modern medicine today that clearly was not around 100 years ago. So the treatment. Let's 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 didn't know what it was caused by. Now there were some suggestions. Among those suggestions included the conjunction of Jupiter and Saturn. In fact, the conjunction of the planets. In fact, that's where we get the name influenza from. It's from the from the Italian influenza, meaning influence. And the earliest thoughts were in the 15 1600s, or that this disease and it was an entity that you could identify. This disease was caused by something up in the stars. So there was this theory going around and we still have this buried in our history when we refer to influenza today. So perhaps conjunction of Jupiter and Saturn rotting animal carcasses were thought to be one possible explanation. Earthquakes and volcanic eruptions were suggested as possible causes. If fluvia of that word if fluvia discharged into the air from the bowels of the earth and people really didn't know what it was. In fact, at a meeting that occurred in Chicago, public health officials early in the influenza epidemic of 1918, one public health official said the following, we may as well admit it and call it germ X. We have no idea said the leading public health officials. We don't 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 microbiologists and they found a bacterium 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 it's everywhere. And they called this bacterium, they called it bacillus influenza, the influenza bacillus. The problem was that it was not the cause of the disease. It was a secondary pathogen that was found. It was a secondary bacteria. And that that that thought that they found that 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 the bacillus was later changed its name. It was called not bacillus influenza, but haemophilus influenza. And some of you may have heard of haemophilus influenza. It's a nasty bug. Fortunately, we now have very good vaccines against haemophilus. But for many years, I had no idea as a physician, why am I looking or treating this person with what we call H flu? This is nothing to do with the flu. Well, it turns out, 100 years ago, it was thought to have been the cause of the flu. And it was inappropriately named one, one of the historians, Alfred Crosby, one of the historians of the of the great flu called this discovery of bacillus influenza and an authoritative sign pointing in the wrong direction. So yeah, so that was bacillus influenza, secondary pathogen. Now, in 1889, there had been there had been a small epidemic, but there's still a severe one in Great Britain. And it was so severe that actually parliament commissioned a report on the epidemic. And this was reported in in the in 1889 by by Henry Parsons, Henry Parsons, and he was a very, very smart person. And we'll see why. He spoke about various theories that may have caused this 1889 epidemic. One of the theories at the time, and I'm not making this up, was tainted Russian oats. The suggestion was that the Russians were bringing their disease from the east through Europe in these tainted Russian oats. Now, every society actually blamed the outsider for this. But it strikes me as kind of weird that today when we're still blaming the Russians for pretty much everything back in the 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 there's something floating around in the air. And that is, of course, partially true. There is something in the air, although it's person to person contact more. And he suggested that maybe it's a non living particulate matter, which is actually a remarkably accurate description, isn't it, of what a virus turned out to be a non living particulate matter. So it was a little prescient there in describing the the possible cause of the flu. So it was could be Russian tainted oats. It could be a poison in midair. Then he suggested, Well, what if it's a person to person contact? It's not spread by oats or volcanoes or stuff in the air, but one person gives it to another. And here I think Henry Parsons really showed the right way for us to think about things. He said, Let's get some data. If it's person to person contact. So 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, 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, who are selling the tickets. And of course, they are inside, so they're not exposed to the outside, but they're 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, feeding the coal into that big steam engine, their rates of flu were really much lower than the clerks, even though they were outside exposed to the flu via and who knows what from volcanoes. And from here he suggested that really it's really probably nothing to do with the atmosphere, but it's more to do with person to person contact. So from a simple look at some records, this guy Parsons figured out that probably we're on to something in the person to person sphere. And then he said the following. He also suggested that perhaps animals have something to do with it. And here he was really on the side of the line. 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. And of course, we know today that birds are intimately related to the spread of influenza and new strains. So back in 1889, Henry Parsons, I think, was really onto something when he discussed the possibility that birds were involved, that birds were involved. So there's an example, I think of people trying to think this through in a fairly logical way. And almost coming to the right conclusion. Now, today, of course, we know what causes influenza. There is no doubt. It's a viral particle, which is many, many times smaller than a bacterium. We were able to take photo micrographs of this when the electron microscope was developed and able to be used around 1839. And so we have pictures of influenza, the influenza virus pictures and diagrams. In fact, scientists today know that the genetic code of the influenza virus, how it's eight viral genes work together, what its viral coat looks like, the proteins on that viral code, what those proteins do, and how they make us sick. And so the degree of advances, I think, from this suggestion that it's something in oats, to something that we can see and identify and know a lot about is really, I think, a remarkable example of the progression of science for over a century. Now we can identify the viral particle down to its genetic makeup, its genetic construction. So in that respect, I think we've come a long way in understanding the cause, the cause of the disease, which brings us to the last part now, which is the way that we've changed in terms of vaccines and prevention. So there were attempts to produce early vaccines to influenza. Now Louis Pasteur back in the 1880s had, of course, developed his own set of vaccines, most famously to rabies. And that doesn't necessarily mean that he knew what the virus was, but he had a suggestion that it was something that was in the nervous tissue, and he managed to propagate nervous tissue and take samples and make them weaker and weaker and weaker until he figured out that what he had now was a weakened thing, he called a virus. And that's how he produced his rabies vaccine. So we know that people were producing vaccines back then. But of course, what they were using were bacteria. That was secondary pathogens and not the primary pathogen which was influenza. So for instance, in early 1919, Edward Rosinot from the Mayo Clinic isolated five different kinds of bacteria from patients. And he mixed them all together. And he managed to inoculate over 100,000 people with his, with his vaccine. We're not sure what the clinical outcomes were, the records aren't great, but he certainly tried to do something. Now in Boston, at the Tufts Medical College, Dr. Timothy Leary made a vaccine. Now, he made a blended vaccine using the strains from the Chelsea Hospital, the Chelsea Naval Hospital, a nurses nose from the Carney Hospital, and the infected wards of Camp Devons not far from Boston. And he made a concoction and gave them to people. And actually, this his, his vaccine ended up being sent to San Francisco, where 18,000 people were inoculated with his vaccine. So that's Dr. Timothy Leary. And in case you're wondering, yes, the answer it is the same Dr. Timothy Leary. In fact, this is the uncle of the famous Dr. Timothy Leary in Boston. He who wanted us to turn on tune in and drop out. It's his uncle who created this attempt at a vaccine 100 years ago. So that's attempts at vaccines back then. What do we do today? What do we have today? Well, we do have vaccines against the flu. Many of us in this room have will take them every year. And you know, those of us who are involved in health care have to get the flu vaccine. It makes sense for us to try and prevent the transmission. But it's really not a very good vaccine. I mean, if you think about it, right, mumps, measles, rubella, polio, you get them once or twice as a kid. And you're done, right? You're done. You're finished. That's it. You're good to go. You won't get the disease ever. But in terms of flu, we get we're told that we need to get it every year. A new flu shot. I just had it last year in the year before. We're dealing with a vaccine that is really not on the same on the same level of effectiveness as these others. In fact, in a good year, in a good year with the wind blowing in the right direction, the flu vaccine is about 50 to 60% effective at best, at best last flu season, it was less than that was in the 20 to 30% range. So So why is this right? Why is this flu vaccine so hard to create? And the answer is that that we have this hollow ball that creates the eight that contains the eight genes of the flu virus. And it makes these proteins on the surface and it's against those proteins that the virus, the vaccine is created. The problem is that flu is such a good disguiser, a master of disguise that it changes the the makeup of those surface proteins very, very quickly, very, very quickly. And it mutates from one kind to another. So that when we think we've got, we figured out what kind of flu is going to be around with species A, well, it turns out the species A then sort of mutates in and the vaccine is no longer effective against species A. Oh, and by the way, we didn't realize that species B and C were actually going to be the ones. So we didn't include those in the vaccine. And, and therefore we weren't, you weren't vaccinated against those, which is the reason, incidentally, by the reason that some of us get the flu vaccine and we end up with the flu. Right? It's because not because the vaccine didn't work against that particular strain, but because there were either other strains that we weren't vaccinated against, or because the original strain changed its surface structure just that bit so that it was like changing an overcoat from a brown overcoat to a black overcoat, and the immune system didn't recognize it. And that's what's going on with the flu vaccine. It stays one step ahead of us all the time. And this is a similar story with HIV, right? The promise of an HIV vaccine was we'd have it within a year or two, so we were told in 1980. Still not there. These viruses are very clever at changing their surface and at hiding from the immune system. And so we still don't have a good influenza vaccine. The way we make the vaccine, incidentally, is we have about 120 or so laboratories across the world run by the World Health Organization. They look at samples that are sent to their lab and try and figure out exactly the kind of flu species that is prevalent. We look at Australia and what they had in their most recent influenza outbreak because it's there, you know, in their winter is our summer. And we try and figure that out. And incidentally, they do the same for us. So it's that they look at see what happened in the northern hemisphere and adjust themselves for the oncoming flu season in the summer. And then doctors make the best educated guess they can. And they say, well, based on the evidence that we have, the most likely species are going to be this and this and this. And we're going to make the vaccine. And into this day, the majority of the much of the vaccine is produced using eggs. The vaccine is very hard to grow. So it's actually grown on eggs, which is the same thing that was used a century ago. There is some vaccine that is made using cell technology. And that allows us to have a vaccine that is not created on eggs. But still, those those are simply the methods that we have today that are that are left over from us 100 years ago. So so the majority of the vaccine is still to this day has something to do with with eggs and needing to be grown on that medium. So in many respects, we're really at the beginning of the of the fight here against against influenza by preventing it and creating a vaccine. Now, while that is all true, and it's not a very effective vaccine, we must remember that in certain groups, in certain age groups, it's extremely important to get the vaccine, the high risk people, right? So those are children, the elderly, those with immune compromised conditions, people who've been taking steroids or may have undergone chemotherapy, pregnant women, extremely important for pregnant women to get the influenza vaccine. For some reason, there are the slightly more that are an increased risk of complications from influenza. And so those are some of the high risk groups that should certainly be vaccinated. There's no question there. In terms of everybody else, the data out there is is harder to really find an effect on the flu. In fact, for instance, in the United Kingdom, those high risk groups are targeted. And everybody else can sort of well, if you want one, you can get one, go talk to your primary care doctor, but there's no campaign, right? Here in the US, we have a campaign, the CDC says everybody over the age of six months should get vaccinated. Period. That is that is the advice that we're given here in the United States. It's just worth pointing out that this is not the advice that is given overseas. And we can talk about why that might be another time. But it's a big it's an important difference, I think in the way we think about about the flu. So for high risk groups, it's very important for healthy, otherwise healthy adults, the evidence is that influenza vaccine doesn't really do a whole lot. So what do we need instead? Well, we need a universal flu vaccine, a vaccine that will work from year to year without having to get it again each year, a vaccine that will work in all age groups, and a vaccine that will work in all geographic areas, right? Regardless of what specific strain of flu is is is running rampant in your area. So that is the goal of the universal flu vaccine. Right. And to do that, we have to target that flu virus, which we understand very well, and find a bit of it that doesn't change. Find a bit of that flu virus that we can target and and that our then our immune systems will recognize and latch on to it and we will kill that virus, no matter what particular strain of influenza it was. It sounds easy. It's a very hard thing to do in reality. And we're still not there yet. But I will say that, for instance, the National Institutes of Health where I work, and I just want to pause and let you know that I'm not here representing the federal government's views on the great influenza epidemic of 1918. I'm here on my own time, and these are my own personal views. But the NIH where I work is actually very, very focused on on trying to find a universal flu vaccine, pouring a lot of money and a lot of research time and effort into that. There is in fact an NIH sponsored trial of a of a of a possible candidate produced by a company called buy buy on Vax from Israel. There are other companies out there that are doing this that is underway right now from the NIH. And who knows? Will this work? Will it not work? Will we will we see a universal flu vaccine? I don't know. I don't know if we'll see one soon. But that is certainly the goal of what we're trying to do with the vaccine. So we certainly have a long way to go. So if we look at where we were 100 years ago and where we are today, the treatments are very different, thankfully, but there's still we still lack real good treatments for influenza. We understand the virus in a remarkable and deep and profound way in a way that was unimaginable a century ago. But are we able to use that knowledge and then build the vaccine? Not quite yet. We're not there yet, although that's where the research efforts are going. So my hope then looking forward is that we really will be able to see influenza as not just a story of the past, but as a disease of the past in the way that we think about smallpox as a disease of the past, a disease that was eradicated. It's important to try and move towards this goal. The CDC estimates that anywhere between 30 and 50,000 people each year in the US die of influenza. It's a soft number. It's not a great not extremely accurate number, but that's the sort of the ballpark figure. So a lot of people still get this disease and die from it. It's in the high-risk groups predominantly where that happens. So we really have to try and think about ways that we can improve our own vaccinations so that we will be able to hopefully make a one-day influenza a thing of the past. Thank you for your time. Any questions? We're happy to take your time. Thank you. Somebody made a lot of money with face masks back then and we see those today. And in this culture we don't see them as commonly as we see in Asia where they wear them when they get a cold or don't want to give a cold to somebody else. My question is how effective are those? Because there was a train picture you showed of spit causes death and if you get spit in your eye I would assume that would probably be uncomfortable as well, potentially dangerous. Can you talk about that perspective in regards to what you're measuring or is it just a comfort on all of ours and back then to use masks or is this a reality of something that can help prevent spreading of that? Sure, that's a wonderful question. Thank you. So of course masks do something, right? Masks do something. Even the cheap masks that you can buy at the local pharmacy have a filtered mesh so that if you cover it you will be breathing through that mesh but that mesh is going to stop something. Now the question is what is it stopping? Right? It might be stopping your secretions if you cough and the mask captures the literally the sputum that you're coughing out. Does it stop the viral particles that someone else has coughed out from creeping through the mask? Almost certainly not. And the other thing about face masks is that after a short amount of time they become clogged, right? And then they're completely useless, they're not doing anything. So I think that what we're seeing is an interesting idea. In other words don't sneeze over people, please. Don't cough over people. That makes sense. But the suggestion that we're really going to stop this by wearing a face mask, I think you may have seen that picture of the happily married couple, husband and wife, hugging each other wearing face masks. So I mean that's clearly I think a PR example and something that probably does very very little. But we do know that one of the most important, perhaps the most important thing that you can do to prevent flu, isn't to go out and get an antiviral medicine from your doctor. It's to not turn up at work when you're sick. It's to wash your hands if you're helping somebody look after somebody with the flu and it's not to cough over people. So the masks I think remind us of what we need to do when we have the flu. But in terms of an intervention, these small paper masks are almost certainly doing very very little. Over there. Thank you for the talk. I'd be curious to hear you say more about you mentioned the cultural differences between the way the U.S. encourages everyone to get vaccinated whereas in Europe sometimes they don't. So why is that and which approach do you think is correct? Okay. Yes I go into this in some detail. So to be clear, in the United States the CDC's recommendation is that everybody over the age of six months gets vaccinated in the UK and in parts of Europe. High risk groups only everybody else. You can if you want but it's really not being pushed. I think that the difference is how we approach the flu. If you look on the CDC website for example, you will read that influenza and I'm paraphrasing here but influenza is a serious disease with complications that include death. Since that's the case everybody over the age of six months should get the vaccine. Now if you go on the websites, I was looking at some of them recently from for instance the National Health Service in England. I'm going to paraphrase again. It basically says the following influenza is a bit of a nuisance. You're going to be up, you're going to be feel unwell for a couple of days. You don't really have to go see your primary care doctor about it because probably there's not a whole lot she's going to do but you know if you need to you can but stay indoors and you're going to be fine. That is basically what the National Health Service view of influenza is. And if you have these two very different approaches to describing a disease it's a potentially dangerous disease that can kill you versus it's a bit of a nuisance but you'll be alright right. Those are two very different ways of approaching what we should do about the disease. So the CDC says well if it's a potentially deadly disease even though the influenza vaccine isn't terribly good let's use it at least something. Whereas in the United Kingdom they say look it's not a terribly good vaccine so let's use it where we really need to use it but most people won't need it right. Which of those two is correct? Well they're both right aren't they? Influenza is indeed a potentially deadly disease but that's only for 0.001% of the people who are going to get it and in those tiny number of people who are going to get it proportionally to how many people get sick it's only those who are increased risk from the disease those high risk populations. And the United Kingdom's approach it's a bit of a nuisance but that's about it. That's also correct. So which of these two messages drives us is going to decide I think how we respond to the vaccine and we have decided in the United States the CDC has decided that this is the best public health approach. I think the data as far as I read them and this is purely a personal observation the data really is that in high risk groups people should get it it's still not terribly effective but it does something but in everybody else so let's talk about that group as the you know the young healthy middle aged adults probably does very very little and yet as you know beginning of August you will see signs in your pharmacy saying we're ready to give the flu vaccine here come and get it we'll give you a coupon or something like that. So two very different approaches is that a dead potentially deadly disease is a bit of a nuisance and that I think drives how we look at the how we look at the the vaccine and of course I think this is a bit of a larger discussion which the question is well if it kind of works we should use it right that seems to be the approach of many many aspects of the American health system if it works put it out there right even though it might not work terribly well even though there are problems with it it works get it out there in the United Kingdom are much more circumspect in fact I talked to the chief medical officer of the UK vaccine program who who's the person who sort of leaves the discussion and he said in the United Kingdom they think about things beyond how well the vaccine works they include things like is it makes sense economically to do this and if you add up the numbers he said it just doesn't make sense economically to have a big campaign for healthy adults to get the influenza vaccine when so few of them proportionally are going to end up getting sick and taking time off work so we'll just leave it as a very different approach to these in the two different cultures separated by a pond. Yes sir. Hi I got good afternoon Dr. Brown my name is Derek Stroop I'm a history graduate student at George Mason University so suffice it to say I'm quite a stickler on sources so I was just curious at what sampling of sources you used I know you had mentioned newspaper articles and some medical diaries but I was actually more specifically interested in your use of secondary sources to kind of bolster your own medical knowledge that you already have. Sure well when you it's a good question I think I might get in trouble now there's a historian in the room so well the truth is I used both obviously I began with whatever secondary sources I could I read pretty much everything that had been published in the last decade or so in the popular literature there are several books very good books out there on influenza and I was actually talking to Dave just before we came in but now you have the resource of this thing called the internet and I don't know that this was available to the degree that it is with the other books that came out you can do a search for hundreds through hundreds of newspapers for the keyword influenza you can do it by city, by state, by time and you can get these gems of information like I showed you just now so those are primary sources I don't think anybody has actually really dug dug into I've never seen that for instance the fact that the Washington Post reported that the death rate for influenza was greater than the death rate in World War One and it was on the back page of the Washington Post I've actually never seen that as a reported observation and what it tells us about how we approach the flu so thankfully and sure as a historian you're also grateful for this and here we are in the remarkable archives right the National Archives a gem of history here we have a lot that is available to us with relatively simple tools the nice things of course is when the historian discovers something that no one else has found it's hidden away in a box and of course there's a historian I think you and others are very keen to find that but a lot of primary sources going back reading the original articles teasing out the medicine from those like those earlier reports of bloodletting in 1916 they were of course mentioned in secondary literature if you go back and read the primary literature you can get a different view on things so thank you for that question okay we are out of time ladies and gentlemen so thank you very much for your time and for your attention and I hope that each and every one of you will stay healthy as we end this flu season