South Dakota has never been immune to epidemic levels of communicable diseases.
Smallpox came to the northern Great Plains with European American fur trappers and traders moving up and down the Missouri River and its tributaries. Smallpox epidemics among the native Mandan, Arikara, and Hidatsa peoples living along the Missouri River in 1781 and 1801 killed thousands. So many people died that the tribes could barely harvest enough food to keep their communities going, let alone defend themselves and their territory. These three tribes were forced northward to a location on the Knife River, northwest of present-day Bismarck, North Dakota.
A deadly smallpox outbreak among the tribes in 1837 was even more disastrous. In June of that year, the steamboat St. Peters made her way up the Missouri River from St. Louis to Fort Clark. At that time, Fort Clark was among the busiest and most populous of the Missouri River trading posts. The Captain of the St. Peters knew that he had at least one case of smallpox on board, but he allowed his crew, passengers and freight ashore anyway. Because people regularly traveled to and from Fort Clark, the disease very quickly spread throughout the region. Ninety percent of the Mandans living in the Knife River community died in the 1837 epidemic. The Hidatsa and Arikara peoples were reduced by approximately half. In October of that 1837, word came to Fort Clark that smallpox was reported among the Sioux, several hundred miles to the South.
Journal entries penned by Francis Chardon, the Fort Clark Superintendent, describe the fear, anger and pain felt by those living and dying in and around the outpost. The people knew what was happening to them and they knew where the disease came from.
Smallpox and other communicable diseases were far less problematic for the European Americans coming to the territory in ever greater numbers throughout the second half of the 19th century. Many had some degree of immunity and many had access to vaccines denied or otherwise unavailable to Native peoples. But no person, and no community was completely immune.
Smallpox came to the town of Jefferson, located in the far southeastern part of what was then Dakota Territory, during the winter of 1880 – 1881. The first case was a sawmill worker named Hahn Patten. It was reported that Patten was exposed to the illness during an out-and-back trip to Sioux City. Patten was confined to his bed and died. His body remained in the house for seven days before the county coroner was able to find someone to bury it. Shortly thereafter, law enforcement officers blocked the roads going into and out of Jefferson and armed guards were posted. There were approximately 150 known cases of smallpox in Jefferson and by the time the epidemic was over in 1881, 82 people were dead – a mortality rate of well over 50 percent.
By 1885 a limited public health infrastructure was in place in Dakota Territory. It included both Territorial and county boards of health. A boom in the number of settlers during the 1880s meant that hospitals were needed and they were built even in relatively small communities. South Dakota’s State Board of Health was established in 1891, bringing formal oversight to these new health care facilities and providing an architecture for public health policies.
In 1892, the most common causes of death by infectious disease were, in order, diphtheria, scarlet fever, smallpox, typhoid fever, whooping cough and measles. (67 South Dakotans died of diphtheria that year.) These would continue to be the prevalent communicable diseases during first 18 years of the 20th century, although an increase in cases of pneumonia, tuberculosis, and cerebrospinal meningitis was noted between 1900 and 1918. (554 people died of tuberculosis and 103 died of typhoid fever from 1912-1914.)
Between 1900 and 1918, community and individual quarantines, school closings, and restrictions on both travel and assembly were imposed occasionally but they were not widespread.
In September 1918, a soldier stationed in Cambridge, Massachusetts became the first South Dakotan to die from the so-called “Spanish Flu.” The flu spread so quickly that it’s difficult to know who might have been “patient zero” in South Dakota. Matthew Reitzel, South Dakota State Manuscript Archivist, wrote an article on the impact of the 1918 flu pandemic in South Dakota for the South Dakota State Historical Society. Reitzel notes that the first three months of the pandemic were the worst in terms of death rate.
“By December of 1918 the total number of deaths via the flu in South Dakota skyrocketed to 1,847, ranking influenza as the No. 1 killer of South Dakotans – a ranking held for the next two years. The flu accounted for 28 percent of the total number of deaths (6,728) in South Dakota in 1918,” Reitzel said.
Reitzel also wrote about the social impacts of the flu, including widespread school closures and quarantine measures.
“Throughout the state, churches, theatres, schools, pool halls, parlors and other public gathering places were closed indefinitely. The flu escalated to the point that the superintendent of the South Dakota Board of Health declared that, “In any community where the disease is prevalent, public gatherings of all kinds are forbidden.” Individuals who had any symptoms of the flu were asked to refrain from public gatherings of any kind. Public drinking cups and towels were prohibited. People were forbidden to congregate at train depots, requiring patrons to buy their train tickets one person at a time,” Reitzel said.
In Rapid City, members of the World War I era “home guard” were authorized to enforce public sanitation laws prohibiting spitting and other acts of careless hygiene in public places.
(Read Matthew Reitzel’s full 1918 flu pandemic article.)
The global flu pandemic tapered off in 1920 but other communicable diseases persisted. In 1921, there were 2,653 reported cases of smallpox recorded in South Dakota. During the 1920s, the South Dakota Department of Health added epidemiology to its list of responsibilities. Measures to improve and maintain the quality of drinking water and sanitary services were imposed and enforced. Scarlet fever was the most reported infectious disease of the time in 1923, there were 373 tuberculosis deaths. The number of cases was disproportionately large among South Dakota’s Native Americans. An Indian boarding school built in Rapid City in 1898 was converted to a segregated TB sanatorium in 1933.
Numbers of measles and chicken pox cases increased in South Dakota during the 1930s and 1940s. Improved tuberculosis vaccines helped significantly reduce the overall incidence of tuberculosis. At the same time, a resurgence of polio myelitis, which had reached epidemic proportions in 1916, began to spread across the U.S. In 1952, at the height of the national epidemic, South Dakota recorded 1,017 cases of polio. Interestingly, 1952 also saw the last two cases of smallpox in the state.
West River Children's Hospital & Polio Center - 1949 (Lesson Plan for Educators)
The last case of polio in South Dakota was recorded in 1963.
About 40,000 South Dakotans were vaccinated against typhoid and tetanus following the 1972 Rapid City Flood.
Some 270,000 South Dakotans were vaccinated against the so-called “swine flu” in 1976.
South Dakota reported its first AIDS case in 1985.
South Dakota leads the nation in West Nile virus incidence. West Nile (WNV) is a mosquito-borne virus that first arrived in the United States in 1999. Since WNV was first found here in 2002, 2,359 South Dakotans have contracted West Nile disease. 38 people have died.
South Dakota has reported a total of 15 hantavirus cases since 1993 and no fewer than 42 cases of Lyme disease since 2000.
Many other well-known or emerging diseases post risks to public health in South Dakota. Among them are dengue fever and various sexually transmitted diseases. South Dakota will not likely become a home to Zika virus, which is known to cause birth defects when transmitted during pregnancy, but South Dakota women who travel to places where the virus is established could become infected.
Despite the eradication, or supposed eradication, of old communicable diseases like smallpox and polio, resurgent and new communicable diseases continue to afflict South Dakotans and continue to challenge both health care providers and policy makers. Epidemics are expected. Draconian measures to protect public health have been put in place before and will be again. The response to the COVID-19 pandemic of 2020 is evolving. The effect that response will have, and the final impact of COVID-19 on the health and well-being of South Dakotans remains to be seen.
Resources for this article and additional information
South Dakota Department of Health
South Dakota: Its History and Its People, George Washington Kingsbury
North Dakota State Historical Society
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