The History of Sioux Sanitarium as a Segregated Tuberculosis Clinic

By Kibbe Conti

The Rapid City Indian School closed in 1933, after a shift in federal policy away from forced removal to Indian boarding schools. The Civil Conservation Corps, a federally-funded Depression-era work relief program, briefly occupied the grounds, using them to house workers and their families. The site was then converted into a segregated tuberculosis (TB) sanitarium for Native Americans.

Sioux Sanitarium. In the 1930’s, the federal government focused on treating TB among Native Americans. The disease had long ravaged cities and towns across the nation and was prevalent among Native communities, especially in villages or boarding schools with high population densities. The disease persisted for decades, and by World War II, as many as 10 percent of Native Americans examined for military service tested positive for TB.

Hoping to curb the spread of the disease and treat patients, construction began on the main hospital building of the Sioux Sanitorium in 1938. It opened a year later and treated solely American Indian TB patients from 1939 to the 1960s. These years were the darkest in the institution’s history, with few therapies available other than extended rest and sunshine, and many patients succumbed to the disease and passed away at Sioux San. Some of the patients are believed to be buried on or near the Sioux San grounds. Discovered in 1943, the antibiotic streptomycin would eventually be developed to effectively treat TB. But that took time, and many patients died while the medication was refined.

The Madonna Swan Story

The story of one Lakota woman’s ordeal and survival from TB is detailed in Mark St. Pierre’s book The Madonna Swan Story. It illustrates the disparity in facilities and patient care between the primarily Native Sioux Sanitarium and a predominately white sanitarium in Custer, South Dakota. Madonna was admitted to Sioux San in December of 1944 at the young age of 16.  Isolated there for seven years, she witnessed death on a nearly daily basis as few treatments were available.  When she was told she only had a few weeks to live, Madonna fled her confinement without permission and returned to her family home in Cherry Creek, South Dakota.

Facing the threat of quarantine again, her father refused to return Madonna to the Indian sanitarium.  Instead he wrote to an old friend, Henry Standing Bear, who advised them to see a doctor in Pierre and gain a referral for admittance to the “white” TB sanitarium in Custer.  When she was denied admittance and told to return to Sioux San, Madonna’s father, James Hart Swan, would not accept this denial and gained an audience with South Dakota Governor Sigurd Anderson.  James Swan explained their situation and the governor, who considered himself an early advocate for human rights, arranged for Madonna to be accepted at the Custer facility, where she was admitted in the autumn of 1950.

In Custer, Madonna found a facility different from Sioux San, with nicely landscaped grounds, where patients could wear their own clothing and stroll the campus. One physician promised Madonna and her parents that he would do everything in his power to help her. Later he learned of a surgical procedure that was new in the United States. It would require the removal of several ribs and the upper lobe of Madonna’s diseased lung, as well as a secondary surgery to remove the rest of the lung. Madonna received antibiotic treatment for the remaining lung, and after a very difficult recovery, she was finally cured of TB in 1953, a full ten years after noticing the first symptoms. Madonna Swan later married, raised a son, and became a Head Start teacher back in her community. She was honored as the North American Indian Woman of the Year in 1983 and will forever be a symbol of strength, courage and perseverance to all who read her story.

Indian Health Service (IHS)

In 1955, Sioux San came under the administrative jurisdiction of the Indian Health Service (IHS), which was, at the time, a new division within the U.S. Public Health Service. By 1960, the death rate from tuberculosis had declined by almost 50 percent and was no longer a major public health threat. This brought about the closing of many sanitariums.

At the close of the TB era in the mid-1960’s, Rapid City’s Indian population was growing.  Elders and community leaders began advocating for access to treaty obligated healthcare services for Natives residing in urban settings. Many of which live in Rapid City due to federal relocation policies placing them there.  Congress appropriated funds in 1966 for a pilot IHS clinic in Rapid City. The outpatient clinic grew to include dental services, a 38-bed inpatient hospital, a behavioral health clinic, and provided substance abuse counseling services. It also offered an urgent care division, optometry clinic, and a Native women’s clinic. IHS continues to operate Sioux San as an urban Indian hospital today in fulfillment of the federal government’s treaty-based healthcare commitments to Native Americans.  

Ted Stephens III