“I would rather be blamed for being over cautious than to be responsible for a single death.” Thus spoke Omaha Health Commissioner Dr. E. T. Manning upon issuing a sweeping public health order closing churches, schools, movie houses, theaters, and other places of congregation in the city. It was October 4, very early in Omaha’s influenza epidemic and only a day since an outbreak of thirty cases was reported in Fort Omaha, located just north of downtown. Army personnel immediately ordered the fort closed to visitors and barred soldiers from leaving. Now, Omaha was under its own set of restrictions. It was a rapid move to contain the still nascent epidemic.1
As of yet there were only 25 diagnosed cases in Omaha, although Health Commissioner Manning could not be certain of this number as influenza was not a reportable disease. For the time being, he had to rely on informal reports of area physicians. The outbreak at Fort Omaha and the cases in the city were enough, however, to prompt Manning to act. He hoped the closure order would limit the ability for the public to intermingle and spread the disease. He also urged the public to self-isolate if they felt the symptoms of influenza begin to develop, and to refrain from using common drinking cups or kissing.2
Manning believed the epidemic, and thus the closure order, would be short-lived. After only a day in effect, he told residents that the city’s efforts had already brought the epidemic under control. Given incubation period of influenza, Manning told the public, the effect of the closure order on the spread of the disease could be better estimated in a few days. It would then be possible to determine how much longer the closure order would be necessary. In the meantime, streetcars were ordered to maintain good ventilation and people were reminded once again to remain vigilant.3 Manning was hopeful.
The short notice for the closure order and the belief that Omaha’s influenza situation was not severe enough to warrant such drastic measures left theater owners and managers angry. Most had sold tickets for upcoming shows, and several had sold advertising as well. The Brandeis Theater was expected to lose at least $4,500 on its upcoming performance of “Marry in Haste” alone. Its next production, “Hearts of the World,” would also incur heavy losses unless the order was removed soon. The situation was similar for the rest of Omaha’s theaters. As the manager of the Orpheum explained, even if the closure order were lifted quickly the losses likely would continue for some time, as theaters would have to build up patronage once again.4
Within less than a week, however, it became clear that Omaha’s epidemic would not be over any time soon. There were an estimated four hundred cases in the city, prompting health officials to request that physicians with light workloads pitch in to help those in need. Health Commissioner Manning instructed hospitals to refuse all cases that could be cared for at home to alleviate some of the pressure on staff and health care resources. He also notified the public that the closure order would not be removed any time soon. In fact, he tightened it by banning outdoor gatherings as well, including parades, open-air church services, public funerals, and patriotic meetings.5
Manning may have been quick to respond to Omaha’s epidemic, but he was not very strict in enforcing his orders. After learning of the ban on outdoor gatherings, the athletic director of Creighton University announced that the upcoming football game against Lincoln’s Cotner College would still be played. Manning responded that he would not call the police to halt the event, but instead would ask fans “to stand back of me in this attempt to stop the influenza epidemic,” essentially leaving the matter to public opinion.6 It was not until October 22, when the Nebraska Board of Health issued a statewide closure order and a gathering ban on all groups of twelve or more people, that residents of Omaha were denied their football games.7
Meanwhile, Omaha’s epidemic was growing worse. Hospital space for influenza victims was at a premium as hundreds of cases filled the beds. Nurses were in short supply and high demand. The local chapter of the Visiting Nurses Association struggled to fill shortages, but many area residents were unwilling to expose themselves to influenza by caring for the ill. One city physician, who remained anonymous, reported two nurses for refusing to treat influenza patients.8 Ambulance drivers were also desperately needed, but, as the city soon found, over a third of the applicants contracted influenza before they could be hired.9 Some Omaha residents did volunteer, however, and did their best to help their city through the crisis. More than one hundred area medical students volunteered to be on-call with the Omaha Visiting Nurses’ Association for the duration of the epidemic.10 Many city teachers took nursing courses, volunteered as ambulance drivers, or made flu masks.11
The Nebraska Board of Health lifted the closure order and gathering ban for the state effective on November 1. In Omaha, Health Commissioner Manning announced that the City’s bans would be lifted at the same time, as they were no longer needed.12 Residents were thrilled. Theater owners fumigated their venues, and a few even redecorated, in anticipation of the reopening. The Gayety Theater held a special performance at one minute after midnight on the morning of the reopening. Movie houses opened for special matinees. Department stores held the special sales they had been holding back at the request of health authorities. Restaurants and cafes overflowed with patrons. Downtown bustled with activity. Schools reopened on Monday, November 3.13
Almost immediately, however, Omaha began experiencing new influenza cases and deaths. Manning had not expected the sudden spike, and was surprised at the news. He attributed the cases to tonsillitis or bad colds–although this did not explain the rise in the death toll–but warned the public that social distancing measures might once again be implemented. In the meantime, he told residents of the South Side and Florence neighborhoods, where the spike was most noticeable, to voluntarily quarantine themselves.14 At Creighton University, 420 members of the Student Army Training Corps were quarantined after several of them developed influenza symptoms.15
Manning was reluctant to resort to another closure order, despite the fifty to seventy new influenza cases being reported each day. The problem with a second closure order for Omaha, he argued, was that it would be ineffective unless surrounding communities took the same measures. Otherwise, residents could simply go outside the city for entertainment and public gatherings, contract influenza, and bring it back to Omaha with them. As Thanksgiving approached, however, it became clear that something needed to be done to stem the rising tide of new influenza cases. The Nebraska Board of Health issued a warning against group celebrations and events, and Manning asked that Omaha residents comply by not attending public gatherings.16
As November rolled into December, new cases continued to crop up across the city. Manning responded by launching a public education campaign, believing that it would be much more effective than a second closure order. The health department used newspaper cartoons, posters, lantern slides in movie theaters, and leaflets, all with the phrase ‘Cover up each cough and sneeze; If you don’t you’ll spread disease,’ hoping that it would prove more catching than influenza. Manning also called for the isolation and quarantine of individuals with influenza symptoms and directing physicians to placard homes of influenza patients to prevent visitors from entering the premises.17 Personal responsibility, not group action, Manning believed, would bring the epidemic to an end.
That did not preclude more active measures, however. Anti-pneumonia vaccine doses were made available to physicians for free. Unfortunately, Manning soon discovered that some doctors were charging as much as $10 to administer the injection.18 To prevent crowding in downtown stores, he also suggested that retailers open earlier in the day, giving customers more flexibility in when they shopped.19 To prevent crowding on public transportation, Manning prohibited streetcars from carrying more passengers than could be seated and ruled that at least one window in each car must be kept open at all times.20 Public dances were ordered closed. Poolroom owners were strong-armed into agreeing to a voluntary anti-crowding measure: two players and two spectators per table.21 Theaters were ordered to use alternate-row seating to reduce capacity. Most theaters did this by roping off half of their rows, only to find patrons casually stepping over the ropes to sit wherever they pleased.22
On Christmas Eve, with the epidemic across Nebraska still raging, the state Board of Health made influenza a mandatory quarantine disease, with fines ranging from $15 to $100 for violations. Approximately 1,000 homes in Omaha were placarded, with their occupants unable to leave for at least four days after the last fever had subsided. Manning disagreed with the state quarantine order–despite his general stance that personal responsibility was the best way to bring the epidemic to an end–but announced that he did not intend to formally protest the state Board’s decision.23
Omaha’s business interests were growing increasingly upset by what they considered to be half-baked health orders coming from both the Nebraska Board of Health as well as Manning. The Chamber of Commerce protested the quarantine order. Theater and movie house owners protested the alternate-row seating they were being forced to use. Patrons were ignoring the order, and there was little they could do to enforce it. They argued for a full citywide closure order that would bring the epidemic to a quick end, or to remove the alternate-row order altogether. Manning removed the seating order effective Monday, December 30. He also removed the public gathering ban, such as it was. Dancing, however, was not permitted until 6:00 pm on New Year’s Day.24
By the first days of 1919, Omaha’s influenza situation had improved dramatically. Small numbers of new cases and a few deaths were reported throughout January and February, and several dozen homes were placed under quarantine as late as February 14, but the main threat had passed. By this time, nearly 1,200 people in Omaha died as a result of the epidemic.25 The result was a total excess death rate of 554 per 100,000 people, making Omaha’s epidemic one of the more severe in the nation.
1 “No Epidemic, But Omaha is Near Closed,” Omaha World Herald, 5 Oct. 1918, 1; “City Takes Step to Prevent Any Epidemic Here,” Omaha Daily Bee, 5 Oct. 1918, 1.
2 “Spanish Flu Dates Back to Before Christ,” Omaha Daily Bee, 5 Oct. 1918, 10.
3 “Flu Epidemic Now Believed Under Control,” Omaha Daily Bee, 6 Oct. 1918, 1.
4 “Closing of Theaters by Flu Quarantine Entails Heavy Losses,” Omaha Daily Bee, 5 Oct. 1918, 10.
5 “Spanish Flu Gains; 400 New Cases Here,” Omaha World Herald, 11 Oct. 1918, 1; “Quarantine on Flu Will Not be Off Sunday,” Omaha Daily Bee, 12 Oct. 1918, 6; “Manning Stops All Outdoor Gatherings,” Omaha World Herald, 16 Oct. 1918, 2.
6 “Creighton to Play Despite Flu Order,” Omaha World Herald, 17 Oct. 1918, 1; “Flu Situation Growing Better from Day to Day,” Omaha Daily Bee, 19 Oct. 1918, 10.
7 “Manning Issued New Spanish Flu Orders,” Omaha World Herald, 23 Oct. 1918, 7.
8 “Terror of Flu Hampers Work of Aiding Sick,” Omaha Daily Bee, 19 Oct. 1918, 10; “Nurses Refuse to Work; Whisky Needed in Some Cases,” Omaha Daily Bee, 20 Oct. 1918, 12.
9 “Says Flu Germs May Develop into Bright’s Disease,” Omaha World Herald, 25 Oct. 1918, 3.
10 “Preventive of Pneumonia is Prepared Here,” Omaha Daily Bee, 26 Oct. 1918, 12.
11 “Loyal Teachers Give Good Service during Epidemic,” Omaha World Herald, 27 Oct. 1918, 28.
12 “Flu Ban Lifted at Midnight on Friday,” Omaha World Herald, 30 Oct. 1918, 9.
13 “Omaha to Bloom Saturday after Month of Gloom,” Omaha Daily Bee, 1 Nov. 1918, 13; “Flu Lid is Off; Gayety Starts with S.R.O. Sign,” Omaha Daily Bee, 2 Nov. 1918, 1.
14 “New Flu Cases Increase and Lid May Return,” Omaha Daily Bee, 7 Nov. 1918, 7; “Urges Continuance of Flu Precautions,” Omaha World Herald, 7 Nov. 1918, 18.
15 “Influenza Epidemic Again Gains Footing in Three Districts,” Omaha Daily Bee, 12 Nov. 1918, 5.
16 “Asks Thanksgiving Plans be Restricted,” Omaha World Herald, 28 Nov. 1918, 2.
17 “Big Campaign against Flu Starts Today,” Omaha Daily Bee, 1 Dec. 1918, 15; “Measures Taken to Again Combat Epidemic of Flu,” Omaha World Herald, 11 Dec. 1918, 1.
18 “No Strap Hangers on Street Cars; Anti-flu Order,” Omaha World Herald, 13 Dec. 1918, 14.
19 “Must Educate Public to Flight Flu Epidemic,” Omaha Daily Bee, 13 Dec. 1918, 7.
20 “No Strap Hangers on Street Cars; Anti-flu Order,” Omaha World Herald, 13 Dec. 1918, 14.
21 “Omaha Taking Measures to Combat the Flu,” Omaha Daily Bee, 14 Dec. 1918, 5.
22 “22 Deaths from Flu as Citizens Dodge Orders of Health Commissioner,” Omaha Daily Bee, 19 Dec. 1918, 2.
23 “Business Men Aroused over Health Order,” Omaha Daily Bee, 24 Dec. 1918, 1; Quarantine Flu Cases in 1,000 Homes,” Omaha World Herald, 24 Dec. 1918, 3.
24 “Business Men Aroused over Health Order,” Omaha Daily Bee, 24 Dec. 1918, 1; “Manning Turns Down Theater Men’s Request,” Omaha Daily Bee, 25 Dec. 1918, 12; “Dr. Manning to Remove Skip Row Rule on Monday,” Omaha Daily Bee, 28 Dec. 1918, 7; “Flu Situation in Omaha Looks Good,” Omaha Daily Bee, 1 Jan. 1919, 1.
25 Report of the Health Department of Omaha for the Year 1918 (Omaha, 1918), 16, and Report of the Health Department of Omaha for the Year 1919 (Omaha, 1919), 11.
|200||Excess Death Rate (per 100,000)|
September 25, 1918
City Health Commissioner Dr. E.T. Manning declares that influenza is not dangerous unless there are complications. Children with fresh colds are to be barred from school in order to prevent the spread of influenza.
October 2, 1918
A man dies from what physicians deem is Spanish influenza.
October 5, 1918
Health Commissioner Manning closes churches, schools, theaters, movies, dances, lodges, and similar indoor gathering places. Manning also orders the street railway company to increase car ventilation and encourages them to keep all windows open. Physicians are advised to report all cases.
October 7, 1918
The Health Department requests that physicians provide numbers of cases they have encountered within the previous 24 hours. Health Commissioner Manning believes the epidemic has been at least temporarily checked.
October 8, 1918
Health Commissioner Manning states that the disease is gaining, rather than losing force, but he believes there is no cause for alarm. He estimates there are 2,000 cases in Omaha.
October 10, 1918
Miss Florence McCabe, head of Visiting Nurses, urges all practical nurses and every woman who has completed a course in home nursing and hygiene to report for duty immediately as nurses are already working overtime and on Sundays.
October 11, 1918
Health Commissioner Manning estimates 400 new Omaha cases, and four deaths are reported. Manning instructs hospitals to refuse cases that can be cared for at home, due to a shortage of resources and staff.
October 12, 1918
The South Side library is busy, but a health official says there is no danger of influenza spreading through books.
October 15, 1918
Health Commissioner Manning is optimistic, but urges continued vigilance and no overeating. He estimates that there are 4,000-5,000 cases in the City and does not know when the ban may be lifted.
October 16, 1918
Health Commissioner Manning bans all outdoor gatherings, including parades, church services, and patriotic meetings.
October 17, 1918
Father McWilliams, the athletic director of Creighton University, announces that the Creighton-Cotner football game will be played, despite the ban on gatherings. Health Commissioner Manning says he will not use police force to prevent the game, but calls on the public to take care.
October 18, 1918
Up to 30% of the employees of the four largest packing houses in southern Omaha are ill. The total number of cases from all plants is 1,189.
October 19, 1918
Pneumonia wards at hospitals are overflowing, but Health Commissioner Manning says more wards will open soon. Manning also notes the death rate may increase as the most severe cases die, but states that this is not a sure indication of increasingly severe epidemic. The Visiting Nurses’ Association of Omaha struggles to fill shortages because of citizens’ unwillingness to expose themselves to influenza patients.
October 21, 1918
Health Commissioner Manning indicates that the epidemic is waning in Omaha.
October 23, 1918
100 cases and 26 deaths are reported for the day. Health Commissioner Manning states that all public gatherings, indoors and outdoors, are banned until at least November 2. Public gatherings are defined as groups of 12 or more people.
October 24, 1918
Public schools will keep paying teachers despite school closures. Businessmen complain they cannot observe the ban on gatherings, and that they are forced to ask customers to wait outdoors or in hallways. Health Commissioner Manning receives many calls from women who believe they’ve been socially slighted after failing to receive party invitations in wake of the ban.
October 25, 1918
Police Superintendent Ringer refuses Health Commissioner Manning’s request for confiscated whiskey for use in hospitals on the grounds that this would violate the law. Mayor Edward Parons Smith and Manning appeal to district court judges who release the confiscated whiskey with the caveat that the disease emergency justifies the action.
October 26, 1918
It is announced that a vaccine prepared by the joint efforts of Health Commissioner Manning, the University of Nebraska College of Medicine, and Creighton Medical College will be made available.
October 27, 1918
Health Commissioner Manning suggests that Omaha citizens spend Sundays at home without visitors in order to help prevent the spread of influenza. Manning issues poolrooms an ultimatum against crowding. If nothing changes in the halls, he will close them on Monday (10/28).
October 28, 1918
Health Commissioner Manning says hospitals are treating fewer and fewer cases and that although it is impossible to say when the quarantine will end, the City’s prospects are improving.
October 29, 1918
Theaters have been fumigated, and sometimes redecorated, in anticipation of possibly reopening on Saturday (11/2), should the ban be lifted. The influenza vaccine release is delayed to later in the week.
October 30, 1918
Today it is announced that the influenza ban is to be lifted on Friday (11/1) by order of Health Commissioner Manning. Churches and schools plan to reopen promptly.
November 1, 1918
The influenza ban is now to be lifted tomorrow morning. Businesses, theaters, and churches are preparing for the resultant rush of people. Vaccinations against pneumonia are expected to begin on Monday (11/4) when a large supply of serum becomes available.
November 3, 1918
The gathering ban is lifted and theaters, moving picture shows, and churches open.
November 4, 1918
Reverend T.J. Mackay of All Saints’ church changes communion practices in view of influenza safety measures-rather than drinking from the communion cup, congregants are asked to dip their wafers.
November 7, 1918
11 deaths and 30 cases were reported in the 24 hours leading to yesterday morning. Health Commissioner Manning says he had not expected these reports, and explains that if conditions worsen the gathering ban may be enforced again.
November 12, 1918
The South Side and Florence experience spikes in the number of cases and Health Commissioner Manning suggests that people voluntarily quarantine themselves in these areas, but he will not yet make quarantine obligatory.
November 14, 1918
Health Commissioner Manning says that fourteen deaths occurred from pneumonia for every death caused by influenza, and that cases themselves were very violent and severe in nature. He says the overall death rate in Omaha is low.
November 20, 1918
Health Commissioner Manning says that cases of influenza continue to be reported, but aren’t of a severe nature. The city will not be quarantined again but Manning says the danger is still marked.
November 28, 1918
Health Commissioner Manning reports that a State Board of Health notice advises restriction of Thanksgiving celebrations as much as possible. He says that 50 to 70 new cases of influenza are reported daily and reminds people to take precautions over the holiday.
December 1, 1918
A campaign begins today to educate the public via various promotional devices such as newspaper cartoons, posters, lantern slides, leaflets, and the slogan “Cover up each cough and sneeze, for if you don’t you’ll spread disease.”
December 5, 1918
Miss Florence McCabe, Head of Visiting Nurses, requests the use of private autos for visiting nurses attempting to care for influenza patients.
December 11, 1918
Health Commissioner Manning urgently requests cessation of public gatherings once more after 32 deaths occurred Monday (12/9) from influenza. Physicians are required to place placards on homes with influenza patients.
December 12, 1918
Health Commissioner Manning declares he will not reinstitute the ban on gathering in public. Manning issues an order prohibiting streetcars from carrying more passengers than can be seated, and requiring at least one window in every car be left open.
December 13, 1918
Passenger situations are becoming tense as the streetcar company expresses frustration with Health Commissioner Manning’s order, issued yesterday, which prohibits streetcars from carrying more passengers than can be seated. Retailers agree to run an ad campaign urging women to shop in the mornings, to spread Christmas merchandise over more counters than usual, and to stay open from 9am until 9pm.
December 17, 1918
Streetcar conductors have failed to enforce ventilation requirements Health Commissioner Manning may use the police force to respond to this issue.
December 20, 1918
To date there have been 850 deaths in Omaha from influenza.
December 21, 1918
Health Commissioner Manning and Mayor Smith continue the ban on public and private dancing as a measure against influenza.
December 24, 1918
The State Board of Health makes influenza a mandatory quarantine-illness. As a result, homes in Omaha are to be placarded and quarantined, and the residents are not to leave for a minimum of four days after fevers have ended. Physicians are asked to telephone the Health Department as soon as a flu case is confirmed so as to expedite quarantine measures. The Omaha Chamber of Commerce and Business Interests is planning to protest the policy. Health Commissioner Manning again asserts his belief that quarantine is pointless.
December 25, 1918
Six men from the Health Department place placards on quarantined homes today.
December 27, 1918
Forty homes are under quarantine, and there are nine new cases reported today.
December 28, 1918
Health Commissioner Manning will lift all influenza restrictions on Monday, except for the ban on dancing. The influenza education campaign begun four weeks ago (12/1) is to continue: “Cover up each cough or sneeze, for if you don’t you’ll spread disease.”
January 1, 1919
Four new deaths are reported.
January 28, 1919
Health Commissioner Manning says the epidemic appears to be over. No new cases are reported today.
February 1, 1919
Three new cases are reported and a total of 42 houses are quarantined.