Jokes and the two previous books is dreamland which is a bestseller and the king and queen of malibu. So with msnbc with the golden gate the race to save america so please join me to welcome david randall. [applause] thank you all for coming especially given the weather outside. It is nice to be where its dry. So then i realize many people come to the talks because they have their own sleep disorders and wanted to talk with somebody about them. This book so if you thank you have the plague this is not the place for you. There is a hospital three blocks that way thats we should go instead. So people say how did you get interested in this book . The last book i wrote was about malibu, a family that used to own aloe one all of malibu how they lost it and then debate comes up to San Francisco. So then i get stuck by the words rumors because one of those things to know about the outbreak. And then to learn there is a conspiracy and then to put millions of peoples lives at risk. And then i realize there are three stories and one its the disease and people and to go through all of those. So starting off with bubonic plague most people have heard of it because middle school and high school we hear about that decimating europe. So this is where the bubonic plague comes from and then within 72 hours and then the longer it stays in your body could change in different forms and then it goes in your bloodstream and finally the most the most maryland form you could get it just by coughing at the time with the early 20th century there is no cure for the disease and then where the world was connected more than ever before. And then the version 1870 . And then started to spread so each is hong kong to decimate the city with that death rate among patients. Eventually kills 10 Million People in china and kills another 5 million in india. It spreads to australia and scotland and it seems theres only a matter of time before it reaches north america for the first time. Thats an important thing to realize this is an era where science and medicine is still in its infancy. Is on the doorstep of the modern age and where many doctors are considered a good doctor if you are fast theres not pain medication that idea that with microscopes and xray machines and it still only in its infancy. So where science is fighting for legitimacy that nobody knows what to do with. And medical science that it really is not that different from the middle ages. Nothing is change in 500 years but you cant fight and has no cure. Then you have the most terrifying disease in history and where does it spread to . San francisco which is the worst place for it to spread. There are many reasons why. But before i go into that. I will read a little bit from the book. This is probably one of the grosser scenes if you are squeamish thats why i learned a lot of very gross things while working on this book. I held back on most of them. So before the plague reached San Francisco it was found in chinatown there as well. So doctor lee is a doctor in chinatown the victims name is a man who brings him to a man named phong and they live in the same flophouse in chinatown. He pick some up put some on his back and walks him two or three blocks to the Doctors Office trying to save his life as he was near death. So this is the scene. Doctor lee first in to leah coin before him he was had feces and vomit he struggled to hold the new patient all the while wondering how he was still alive. A finger or two to his wrist had a racing polls that was facing an internal tear while the four head was so warm to the touch the instinct was to pull his hand away when he yelled it was as emerging from below the sea he had black spots and open sores and open between bodily tissue and the outside world his lymph nodes were so swollen i like a bump like it was pumped full of air and at risk of floating away blood and phone began to leak out of his mouth a sign of ruptured blood vessels and he soon fell into a coma that doctor lee knew he would never recover. So you have a terrifying gruesome disease coming to San Francisco and at the time was still the wild west it was the most important city in the western half of the country the biggest and the richest in the most connected to the rest of the world through trade coming through the golden gate it could be from alaska or russia or hawaii or japan or australia or new york people going around the horn. But San Francisco was still like a boomtown this is only 50 years after the gold rush and state hundreds of people are still walking the streets who literally were gold miners and that whole mindset was there is a place that believed in fate rather than skill because thats what you think what the gold miner mindset is you dont mind for a because you thank you are better than everybody else but you do a because you will thank you will be lucky i will find the right spot to get the biggest nugget and become a wealthy person and if that is your mindset then you dont want anybody to get in the way of you becoming lucky. So there was no idea you could have Public Health or public goods with an idea of civil society. One thing i was struck in the book as San Francisco grew the spending on Public Health declines who have a big city of festering problems of a boomtown where you walk on the street and there is horse carcasses people just throw trash and food in the street expecting the rats to take it away. Said god made them scavengers so let them scavenge. That was the mindset. Not only that but every man for himself type of place is also the first time where people cannot get jobs as easily as before. So they start looking for someone to blame and they find it with chinese immigrants chinatown in San Francisco is the largest chinatown outside of asia at the time and still is with 20 percent of those cities population and like immigrants anywhere the chinese are willing to do the jobs nobody else will. Laundry and cooks and horde hotels and there is blatant racism and bigotry that now you look back it is shocking so the mayor at the time later becomes to run for the u. S. Senate seat in california and his Campaign Signs say keep california white. That was the focus it was a very easy scapegoat for all the problems that were happening in San Francisco. So the governor at the time was a man named henry gage and like politicians now, he pioneered the idea to call anything he did not agree with , fake news. So the worst of these in history coming to a place that in no way wants to deal with it or acknowledge it could be in any danger in this is also the gateway to the entire country. You have everything right for our crisis and lo and behold the crisis happens. A chinese immigrant is the first known victim of the plague and San Francisco a Health Inspector is writing out a death certificate and he does a cursory examination of the body. The same Health Inspector has been hired on fired before for making up causes of death. It is a heart attack, he has no idea he just writes it down now he looks at the body he jumps back in fear because he knows what it is and the danger and he knows San Franciscos could be hong kong very quickly he has us danger and the disease and then finally the people. So you have a federal Health Officer that is the forerunner of us Public HealthService Today a man who was in San Francisco is thought of as one of the most brilliant doctors in the entire country and knows more about plague than anybody else in the country because he studied with those who operate in china and india when the first ones are discovered the bacteria that causes plague. But his problem is he is so brilliant he almost has a talent at making people hate him. Im sure you know people one you know people like this they cannot get them to trust them and like them and agree with them the only reason hes in San Francisco the first place is happenstance anyway. He had been in washington and the us Surgeon General , somebody writes an article saying he should be intrusive he brings a scientific level of to a new level this drives the Surgeon General crazy with envy he doesnt want a threat to his power so exiles him to San Francisco to get him as far away from washington as possible. So he is here and the forerunner of a new era of medicine and has done this because of personal pain in his own life. His daughter, his youngest daughter has recently died from diphtheria which is one of the most devastating diseases of childhood back then but now we have vaccines but that had not happened so he was so depressed he quit medicine and then he came back because he felt there was a way out of the pain and studied in germany where the studies of the first vaccinations when he sees children the same age of his daughter receiving shots and recovering as if by magic. So i describe as if prometheus has returned stealing a secret from the gods he cannot imagine. So he knows with medicine people dont have to die than people back home say every preventable death is on his conscience. And he is paranoid. He knows it only takes one person to get on a train heading east and then suddenly it spreads. And then to take drastic measures. But because of that everybody recoils from him city and state officials because if they do that can lead to public panic to decimate the citys economy and people think to acknowledgments of the plague here that the economy will collapse theres no need to acknowledge his disease the City Health Officials trying to take money from the city coffers and those who have natural allies want nothing to do with him because they think that he thinks he is better than all of them. And it is proven that the time and it prevents by 40 percent in the have very obvious and detrimental side effects it almost seems is the disease itself. And then to knock down doors and then ejecting people from it. And then to find the bodies and then and then they hide the bodies the governor and they say there is an outbreak show me the victims but he doesnt know where so with those 200 victims of the played and then he quarantines the entire state of california nobody can leave estate and to say that he should be hanged from this so essentially another comes up and then he was spotted is the most brilliant doctor someone who is a little bit lazy but what he has going for him is he has the ability to get people to like him and trust him and the best of San Francisco the willingness to fail to look at things in the different way. But that only asians can get. So he starts to treat the disease as if it is a real disease that anybody can get. And he does. He does have those connections with people in the chinese are starting to show the victims and then the big mystery of the book and i dont want to give away too much all the other big cities that have an outbreak it spread slowly and then into the population it hasnt exploded yet in San Francisco but they dont know what it is so who knows the clock is ticking faster and faster. So he starts implementing all the radical ideas that we now take for granted which is public sanitation and does things like Institute Street sweeping or rat proof trash cans and sidewalks of the rats cannot burrow underneath and demonstrates they knew since the middle ages rats were associated with playing but they didnt know how it was spread hes the first to demonstrate conclusively it is the fleas that spread the disease. So he institutes the rat Eradication Program that overall he does everything from paying people for every rat they bring to him to create teams of young kids and then gets a bunch of healthy rats and dies there for different colors and put some in the sewer system to say if you see a different color rat let us know so this is the only way to track the passageways to the city where they are coming and how they are migrating. Because of all this overtime they kill like 2 million rats which is five times the space population it is safe enough he sent out then there is a great earthquakes on earthquake in San Francisco and the most terrifying forms this is what happened. Sixty people died in the span of two weeks and they are dying quickly into no longer say now from north beach and it is everywhere and that geography San Francisco is the most terrifying landscape you could ever deal with. Everything from forest to oceans to skyscrapers it is every possible thing you could deal with. So focusing on Public Health he is able to once again contain the disease and one of the big weapons i took from the book is that diseases are not confined to the past. And its not only the hard science and he knew the science and to turn track the disease with a soft side of persuasion in a crisis. He had that in spades to get people to trust in him to take steps not only to protect themselves but for everybody else. And of the american heroes that nobody hears about because of peoples lives were saved he later becomes a general to himself after the 1918 flu outbreak. So think about your job nobody stays. But he is driven by his own reasons and with his personal pain but to a different extent. And his older brother victor was a family favorite and he becomes a war hero. And so to realize and then my purpose is to heal. So he follows that his entire life. And then is San Francisco in the 19 hundreds in the Mexican American community. Not very far from the conversation now with the twin towers facility. And Mexican American immigrants to die after finding the disease rat at his house. Over the next two weeks 75 people die and its all connected back to him. His daughter dies. The woman who help came take care of him dies, her family dies, the nurses that took care of them die. The hospital drivers die. The priest who does last rights die. And once again city officials and businesses across the area start firing everybody who is latino is an immigrant disease who dont want to be connected with it l. A. Is a huge place going from the port to pasadena is 30 or 40 miles i cant spread that quickly so he takes radical step to show that it isnt racially biased but focused on science and then to recognize disease in a different way with the need for Public Health and sanitation. It isnt just a tidy story. There might be another crisis again because Climate Change and then the climate gets worn are warmer and the breeding season because 15000 in a single year. They can jump off of a four Story Building and collapse their bodies and on top of that they can swim but rats can survive almost anything they can has 72 pups in a year if you extend the breeding season because its longer thats another 12 or 15. Than they have their own descendents at two or three months old. Thats why it is a hyper fertility rate. The more fleas there are the more playing there is and the more contact between humans and the disease. Speaking with someone who is a professor at uc davis. And that certain areas in the country people know plague is a risk. There is a sign when you go to yosemite be careful of the squirrels they can carry plague. People there are no it is a risk factor and other places they dont. It looks like another disease and looks like the flu. So as it geography of diseases change, they will start to come to places you dont expect. I dont want to oversell it. Where it will be an outbreak. But it is a risk and one of the things is that people dont change. So perhaps we show of the persuasion in a crisis and to help solve the problems of the future. Thank you very much for coming im happy to answer any questions you may have. So through constructing a timeline and how you manage to figure that out . One thing i was very fortunate to find is a couple things. One is that kenyon had a habit of writing really long angry letters to people like 60 pages. So that was an invaluable resource. I also found the late great nephew may be another great who still had 100 letters that he wrote to family members back from carolina so it was incredible for me to hold this from 120 years ago and compare what other people were saying in the newspapers to what he was feeling so hes in union square after the earthquake to say if you can contain this it will be okay and essentially to say i have no idea what im doing or if its even possible if i have to quarantine i will go out to california against you can see the difference between private and public. This is the era of telegrams and wires and they are sending a constant flurry between washington and here and for some reason i dont know why the whole surface had policy they would collect them and publish them in a gigantic book. You can see people talking about each other behind their backs in real time saying they can not show more selfrestraint than i thought possible so you really get a feel that day by day how the pressure rises higher and higher and you feel like you are there they really didnt know what they were doing at all but they knew people were dying. Thank you very much for coming i appreciate i hope you enjoy the book. [applause] and im happy to sign copies as well. [inaudible conversations] last november remarked the centennial and in november 1918 people thought relief the years of warfare and death were over