What Smallpox Claims

Where the Perimeter of Protection Ends

The United States had a smallpox vaccine in 1832. It had a vaccination program.

The NuÉta people were not in it.

This was not an accident. It was a selection. Secretary of War Lewis Cass ran the program. He chose which Native Nations received protection. His criteria were simple. Tribes "friendly to the United States" got the vaccine. Tribes with "important economic roles" got it. Tribes being forced west from the southern states got it.

The NuÉta did not qualify. Cass said the Upper Missouri fur trade was no longer worthwhile. He cited 1825 treaties that called the NuÉta "hostile." So he excluded them. "No effort would be made under any circumstances," he stated, to vaccinate up there.

By February 1833, more than 17,000 Indigenous people along the frontier were vaccinated. An agent asked to extend the program to the Upper Missouri that same year. His request was denied.

The policy was set. The perimeter of concern was drawn. The NuÉta were outside of it.

The steamboat St. Peters arrived at Fort Clark on June 19, 1837. There was "frolicking." The boat was there for less than a day. It unloaded trade goods. It loaded bales of fur. Then it left, heading upstream.

It left smallpox behind.

The first recorded death in the NuÉta villages came on July 14. By the end of July, the respected leader MáhtoTóhpa (Four Bears) was dying. The trader Francis Chardon wrote down his last words.

"I have loved the whites," Four Bears said. "I do not fear Death... but to die with my face rotten, caused by those dogs the whites." He told his people to look at their families. "All dead or dying."

Chardon soon gave up counting the dead. "They die so fast that it is impossible," he wrote on August 11. The social fabric tore. Suicide, previously unknown among the NuÉta, happened. People tried to kill Chardon. A people were broken.

In the spring of 1837, about 2,000 NuÉta lived near the Knife River. By October, 138 were left. A mortality rate of ninety-three percent.

This was not a tragedy. It was a policy, executed.

The name "Mandan" is a scar from this era. It is not what the people called themselves. A French explorer heard "Mantannes" from Assiniboine guides in 1738. He wrote it down. It became Mandan. Before 1837, the people called themselves Numą́khų·ki. It means "many men, people." After the genocide, the survivors called themselves NuÉta. It means "our people."

Imagine that. Having to wear a name given to you by the people who decided you were not worth saving.

The legal framework for protection already existed. The 1831 Supreme Court decision in Cherokee Nation v. Georgia established the federal trust responsibility. It said the United States had "moral obligations of the highest responsibility and trust" toward Native Nations. The 1832 vaccination exclusion proved that trust was a fiction. Protection was a discretionary budget item. Some lives were optional.

That logic never expired. It just found new budgets.

Today, the obligation is managed by the Indian Health Service. The system is "chronically underfunded." That is the phrase used by IHS Director Roselyn Tso in testimony to Congress on May 8, 2024. She said this despite a 69 percent budget increase over the previous decade.

The numbers are blunt. Medicare spends about three times more per person than IHS. Veterans Affairs and federal prison healthcare both spend about double. From 2009 to 2024, Congress appropriated roughly $100 million less per year than IHS stated it needed. This is an annual choice.

The result is measurable. A 2023 report by the U.S. Commission on Civil Rights found "Native Americans continue to die at higher rates than other Americans in many categories of preventable illness." The cause was cited directly: "inadequate federal funding."

This is the modern shape of the old policy. A preventable death is still a choice.

The mechanism is bureaucratic now, but the principle is identical. During the October 2025 federal government shutdown, a treaty-backed health program for Native diabetics lost its funding immediately. The federal government's own operations were protected by advance appropriations. The treaty obligation was not. Some lines in the budget are still treated as optional.

Double Ditch is the name of the great NuÉta city abandoned after a different smallpox wave in 1781. Its ditches are still visible in North Dakota. They were defensive fortifications for a community of thousands. European americans use Double Ditch as a dog park and go there during winter to take holiday photos.

Those ditches once marked a perimeter of protection for a living city. Now they just mark how far that protection ever really went. The line Lewis Cass drew in a ledger in 1832 is still being drawn. It is drawn in spreadsheets and shutdowns. It is a silent, bureaucratic perimeter. It is the boundary where lives are still weighed against cost.

The St. Peters only had to visit once. The policy it delivered never left.