Graduation Date

Fall 12-18-2015

Document Type


Degree Name

Doctor of Philosophy (PhD)


Medical Sciences Interdepartmental Area

First Advisor

Robert S. Wigton, MD

Second Advisor

Philip W. Smith, MD

Third Advisor

JoAnn Carrigan, PhD


The purpose of this historical case study was to understand and describe rural community experiences during the 1918 influenza pandemic in Nebraska.

Examining the rural experience in Nebraska during the 1918 influenza pandemic provided a new level of insight into the differences and similarities between the urban and rural experience. As related by a detailed study of Omaha during the 1918 pandemic, the community was devastated by disease. Despite public ordinances and health department warnings, streetcars ran at capacity, parades were held to raise money for war bonds, and the annual Aksarben Coronation took place. Cases of flu were too numerous to count as physicians and nurses were overwhelmed.

The experience of rural communities in October through December of 1918 was rich, humorous, and tragic. Some communities, like Wayne and Red Cloud, had less disease. It is clear that rural location did not provide protection from the virus. Lack of access to basic services like supportive health care may have led to more deaths in counties lacking infrastructure such as hospitals, as was the case in both Cherry and Scottsbluff counties. Geographic isolation did not keep the virus away, nor would being in a crowd guarantee illness. Often multiple families died together and loss was all around. Public grief was palpable. Physicians and nurses were exhausted and over worked, at times breaking down at the tragedy they saw. Amidst all the horror there was some humor, as Santa got arrested for breaking the quarantine and well-meaning children raised the money to pay his fine.

The most over-arching conclusion based on the evidence from this study is that nothing can completely protect you from influenza, and some rural communities may have a false sense of security if they think influenza cannot reach them. This study shows that influenza can and will spread anywhere geographically, even to the most remote locations. Few things can stop pathogens in pursuit of infection.