Background The Russian influenza, which began in late 1889, has long been recognized as a major global epidemic yet available statistical evidence for morbidity and mortality has not been fully examined using historical and epidemiological tools. This study of cases and deaths in Indiana during the extended time period associated with the Russian influenza is the first scholarly effort to determine the number of victims from this influenza outbreak across a broad regional case study in the US.

Methods The sources for this study include historical records from the US Census, Annual Reports from the Indiana State Board of Health, and death notices published in newspapers. The available evidence is analyzed using historical and epidemiological methods to determine the consistency of reporting categories, the accuracy of death records, and the applicability of contemporary categories for measuring mortality.

Results In the 3 years during and following the outbreak of “Russian influenza” in January 1890 in the state of Indiana, approximately 3200 died specifically of this disease while a total of 11 700 died of influenza and other respiratory diseases. These results confirm that extremely widespread influenza contributed to higher than normal death rates by causing additional deaths in related categories, especially pneumonia and other respiratory diseases.

Conclusions More reliable and thorough analysis of morbidity and mortality during the Russian influenza based on systematic and critical review of local, regional, and national statistics can inform contemporary understanding of the long‐term history of influenza epidemics.