udPEl^TT OF.
STATE DOCUMENTS
f i' i^Jli i1 <J . ^ A
4 -A.'' Ji- J .ii u Cj i
TWENTY - THIRD
BIENNIAL REPORT
of the
Montana
State Board of Health
For the Years
1945 - 1946
VITAL STATISTICS FOR THE YEARS
1944 - 1945
PONTANA STAlE L1B??AK.
930 East Lyndaie Avenue
Helena, Montana 59601
MONTANA 3TATE LIBRARY
TWENTY - THIRD
BIENNIAL REPORT
of the
Montana
State Board of Health
For the Years
1945 - 1946
VITAL STATISTICS FOR THE YEARS
1944 - 1945
NArAlltLC I'RINTINa CO., HKLKNA, MONV
STATE OF MONTANA
STATE BOARD OF HEALTH
D. T. BERG, M. D., President Helena
R. V. MORLEDGE, M. D. Billings
R. C. Monahan, M. D. Butte
C. S. Houtz, M. D Havre
THOS. F. WALKER, M. D Great Falls
MR. R. J. LOSLEBEN Malta
MR. OTTO BRACKMAN Helena
B. K. KILBOURNE, M. D., Executive Officer, Helena
ADMINISTRATION DIVISION
B. K. Kilbourne, M. D., Executive Officer
The past biennial period has been one in which the State Board of
Health has been confronted by many problems, chief of which has been
that of maintaining sufficient trained personnel to carry out a well-
rounded Public Health Program that could meet the needs of all the
people all of the tim«.
On April 1, 1946 Dr. W. F. Cogswell, Executive Officer, under whose
guidance the department had developed from its early inception to one
of the most important in state government, resigned. At the time of
his resignation he was dean, in point of service, of all the state health
officers, and Montana has reason to feel proud of the able direction
he gave to the growth and development of public health work during his
years of service.
The legislature of 1945 added one new division, that of Tuberculosis
Control, to the State Board of Health. It also passed a law making
possible the organization of full-time county or district health depart-
ments. This, from the standpoint of public health, is the greatest need
in the State at the present time. Less than one-third of the population
of the State has available the minimum amount of public health services
which are considered essential if the people are to enjoy the maximum
of health.
Another critical situation confronting the department of health is
that of adequate office space for the department. At the present time
different divisions occupy office space in four different buildings, one of
them being two and one-half miles from the Board of Health Building.
This adds to confusion in the integration of the work of the different
divisions and to administrative direction.
All the divisions during the biennial period have at some time been
seriously handicapped by lack of personnel. This has been particularly
true as to trained professional personnel.
In spite of all the problems and difficulties resulting from the late
war, this State has enjoyed the lowest incidence especially from epi-
demics and communicable diseases, of any biennial period for which the
State Board of Health has records.
MERIT SYSTEM COUNCIL
Employees of the State Boaid of Health are selected through the
State Merit System administered by the Merit System Council. The
Council members are Dr. Francis A. Thomson of Butte, The Right
Reverend Emmet J. Riley of Helena, and Dr. E. Martin Larson of Great
Falls. The Council employs Melvin P. Martinson of Helena as Super-
visor. During the past two years, extensive revisions have been made
in classification and compensation plans for the agency. Many new
classes of positions have been added and specifications for older posi-
tions have been brought up to date. Examinations have been given
for all classes of clerical positions and a qualifying examination is
planned for professional employees in the near future. In 1945 and the
first ten and one-half months of 1946, twenty-one new employees of the
State Board of Health have been selected from Merit System registers
after passing appropriate examinations.
The Merit System rules also provide for a uniform system of vaca-
tion and sick leave as well as standard procedures for promotions and
salary advancements.
MONTANA STATE BOARD OF HEALTH
DIVISION OF COMMUNICABLE DISEASES
The following is a biennial report of activities of the Division of
Communicable Diseases and the Division of Rural Health Work for the
period October 1, 1944 to September 30, 1946.
The personnel of the Department includes:
B. K. Kilbourne, M. D., Executive Officer
Nancy Mihelic, Senior Stenographer
The incidence of communicable disease and the deaths resulting
therefrom have been the lowest for any biennial period in the records of
the State Board of Health.
The work of the department has consisted of field investigations of
diseases threatening to appear in epidemic proportions, assistance to
local health officers in controlling threatened epidemics, assistance in
immunization campaigns and other control measures, and educational
work as related to the spread and control of communicable disease. Ac-
curate records have been kept of cases reported through local health of-
ficers showing the incidence of the various communicable diseases as
they occurred throughout the state during this period.
The accompanying tables show the number of cases of communicable
diseases reported to the State Board of Health. Table I shows the cases
reported for the last three months of 1944, 1945, and the first nine
months of 1946. Table II gives the record of the principal communicable
diseases as reported in Montana for each year since 1920.
Influenza showed a considerable increase during the months of
January, February and March, 1946. The epidemic was mild in char-
acter and was not reflected by a marked increase of deaths from influ-
enza during that period.
Encephalitis. There has been a marked decrease in the number of
cases of encephalitis reported during this biennial period over the pre-
ceding period.
Typhoid Fever. 1945 showed a slight increase in the number of cases
of typhoid fever as compared with the previous biennium, the number
of cases reported being 45. There has been considerable reduction in
1946, only 21 cases being reported in the first nine months. Most of the
cases have been single cases and nothing resembling an epidemic in
any one area has occurred.
Rocky Mountain Spotted Fever. A smaller number of cases of
Rocky Mountain Spotted Fever has been reported during this biennium
than during any similar period on record. The reduction in incidence of
human cases cannot be explained alone on a basis of immunizations
done, but the incidence of ticks throughout the state has been markedly
less than for any other similar period. Only two cases were reported
in 1945 and eight cases in 1946.
8 TWENTY-THIRD BIENNIAL REPORT
Diphtheria. During 1945 there was an increase in the cases of
diphtheria in the state over those of the years of the previous biennium.
The number of cases was greater than it should have been, as diphtheria
is one disease for which we have practically absolute protection, and
shows the need for a more intensive immunization campaign.
Tularemia. The number of cases of tularemia has been practically
the same for each year, although markedly less than it was during the
previous biennium. Whether this reduction in cases is due alone to the
decreased incidence of ticks throughout the state is questionable.
Sylvatic Plague. During the summers of 1944, 1945 and 1946 the
State Board of Health continued to operate a laboratory truck for the
investigation and detection of bubonic plague in rodents. No new areas
of infection were found in any of the counties of the state during these
seasons. There has been a marked decrease in the rodent population,
particularly ground squirrels, in most sections of the state during the
biennial period. Whether this has been due to poisoning campaigns or
due to epizootic occurring among rodents, is not certain.
Poliomyelitis. This is the one disease that has appeared in epidemic
proportions in the state each year during the biennium. In 1945, the
cases were limited particularly to three counties in the state, Yellow-
stone, Big Horn and Carbon, while in 1946 the incidence was general
throughout the state and cases were reported from 33 counties. 1946
was characterized by one of the largest epidemics throughout the United
States and the incidence per 100,000 population in Montana was con-
siderably lower than many of the other states.
Cancer. Beginning with the fiscal year 1946-1947, certain funds
have been made available to the State of Montana by the Federal Gov-
ernment for Public Health work, designated to be used in the cancer
program. This program is just being initiated and consists of an edu-
cational and service type of program. It is being worked out on a co-
operative basis with the Montana Division of the Women's Field Army.
A register of cancer cases will be maintained in the State Board of
Health office so that more knowledge may be available as to the in-
cidence of cancer and the results of the various types of treatment that
are being made available. Provision will be made for more early and
adequate diagnosis, particularly for indigent or semi-indigent cases.
Through the Cancer Committee and the State Medical Society a more
intensive program of reporting cancer cases will be carried on and
adequate studies made on the reports.
VENEREAL DISEASES
Venereal disease still continues to be one of the major com-
municable disease problems. While syphilis seems to be fairly well
reported throughout the State, we do know that the cases of gonorrhea
reported do not reflect the actual incidence.
During the biennial period we have continued to receive from the
Armed Forces reports of contacts throughout the state who are sus-
pected of being sources of venereal infection developing in military per-
MONTANA STATE BOARD OF HEALTH 9
sonnel. Where sufficient information to identify the contacts has been
made available, the follow-up has been done through local health of-
ficers and nurses, and many of these reported suspected sources of in-
fection have been examined and placed under treatment. The number
of such contacts investigated during the period has been 406.
No new clinics have been organized during the biennial period but
the venereal disease clinic operated by the Health Department at Great
Falls continues, and treatment has been provided through the Health
Department in Gallatin County for indigent cases. In many instances
local county physicians have also made free treatment available for in-
digent cases.
The State Board of Health has made available drugs for the treat-
ment of syphilis, free to any physician in the state upon request. 17,373
doses of arsenicals, 17,890 doses of bismuth, 18,600,000 units of penicil-
lin and 3,500 grams of sulfa drugs, for the treatment of syphilis and
gonorrhoea, have been distributed to private physicians and the clinic.
The total cost to the state for this period was $4,302.17.
BIOLOGICALS
The State Board of Health has continued to make available at State
Board of Health prices, to local Boards of Health and schools, immuniza-
tion material for smallpox, diphtheria, typhoid fever and whooping
cough. There has been a marked increase in the last biennial period
in the use of immunization material for whooping cough. Tables IX,
X and XI show the amounts distributed by the State Board of Health
during the biennial period.
DIVISION OF RURAL HEALTH
The Division of Rural Health continues to be combined with the Di-
vision of Epidemiology, the Epidemiologist serving as the Director.
With the passage of an enabling Act for the creation of County and
District Health Units by the 1945 legislature, considerable interest has
been developed in such organizations. One of the former full-time City-
County Health Departments has been reorganized under the new law.
No new units have been organized in the state during this period. At the
present time there are four counties with which the cities combine to
operate as full-time health departments. One other county would be so
operating if a person to fill the position of full-time health officer was
available. It is hoped that during the next biennial period considerably
more interest and activity may be developed and several full-time units
organized. One of the full-time units which was without a health of-
ficer at the end of the last biennial period, has been supplied during
the period.
TWENTY-THIRD BIENNIAL REPORT
TABLE I
CommunicabJe Diseases Reported in Montana
Including Deaths from Communicable Diseases Not Previously Reported as Cases
Diseases
1944
(3 mos.)
1945
1946
(9 mos.)
Anthrax — -
ChiCKenDox
1,045
2,483
2,283
80
1
8
1
5
2,377
30
493
219
24
1
1
1,530
272
86
2
698
139
4
373
10
45
9
340
341
459
1
28
f;026
Diphtheria -
Dysentery, Amoebic - - -
Dysentery, Bacilliary -
Dysentery, Unclassified
37
2 .
25
1
44
3
1
1
Encephalitis, Epidemic
- . 1
4
1 03
5
821
Mrrlnrin
7
29
24
6
1,688
Measles (German)
Meningitis Meningoccus
521
12
Meningitis, Non-Epidemic
2
Meningitis, Pheumococcic
Miimp^
ZZ. "298
61
1
1,156
Pneumonia
341
Vnliomyplitis
7
103
Rocky Mtn. Spotted Fever __ -
Scarlet Fever
Septic Sore Throat
Smnllpov
1
205
1 6
2
8
274
49
1
Tuberculosis
1 32
273
Tiilnremin
1
12
Typhoid Fever
TlnHulnnt Fever
9
5
249
72
94
.'."Z Y
21
7
Whooping Cough
Gonorrhoea
Syphilis
Tetanus
138
237
251
1
Trachoma
46
TABLE II
Record of Certain Important Diseases from 1920
Number of Cases Reported Each Year
Year
Tubercu-
losis
Ty-
phoid
Diph-
theria
Small-
pox
Scarlet
Fever
Menin-
gitis
Polio-
myelitis
Spot'd
Fever
Meas
les
1920
1921
863
568
241
187
144
159
130
244
1 17
108
133
371
120
137
142
184
136
81
123
96
80
57
32
26
15
23
16
45
21
269
412
426
456
548
329
208
182
231
142
77
105
32
106
178
145
85
62
50
86
117
133
86
70
102
80
44
1,066
1,466
636
732
950
376
395
575
853
547
379
129
142
33
19
749
762
898
314
55
8
4
3
7
12
4
1
891
620
676
843
1,040
1,337
2,065
2,209
846
1,139
1,355
1,223
868
612
628
1,975
3,579
1,328
1,000
1,036
1,C44
1,047
697
690
1,399
698
274
19
12
23
21
16
12
42
165
188
149
62
31
18
10
22
35
48
23
17
6
16
10
12
31
42
26
15
25
26
47
16
182
41
12
22
65
7
20
58
9
13
321
7
12
31
14
6
108
33
13
26
38
86
103
26
26
58
51
47
34
37
38
32
23
22
34
100
68
74
125
65
31
12
32
32
107
45
28
6
2
8
4,491
2,561
1922 _...
1923
1924
368
604
648
67
2,535
6.049
1925
1926
1927
620
528
463
486
2,596
1,372
1 928
448
840
1 929
536
4,308
1930 --
1931
534
579
664
1,634
1932
568
5,476
1933
1934
1935
465
638
432
2,178
2,105
7,397
1 936 ._...
497
457
1937
486
656
1938
5 1 5
3,405
1939
1940
455
451
7,498
1,310
1941
466
951
1942 ._
402
3,150
1 943
386
5,767
1944 -
508
3,798
1945 373
1946 (9 mos.) - 273
493
1,688
MONTANA STATE BOARD OF HEALTH
TABLE III
Poliomyelitis — 1944 (3 mos.)
By Sex and Age Groups and Month oi Onset
11
0-9
10-
19
20-29
30-39
40 &
Over
Month
M F
M
F
M F
M F
M
F
Total
October
November
December
CN 1 1
1
1
1
1
— -
1
4
1
2
2
1
1
1
1
1
7
TABLE IV
Poliomyelitis — 1 945
By Sex and Age Groups and Month oi Onset
0-9
10-19
20-29
30-39
40 & Over
Month M_
January _
February
March
April
May ....
June 1
July 2
August ,^._ 3
September 1 1
October _.. 8
November -.. „ 3
M
M
M
M
Total
1
3
9
34
26
5
December
2
1
1
— -
— -
— -
--
1
5
30
21
13
10
2
3
2
4
1
86
TABLE V
Poliomyelitis — 1946 (9 mos.)
By Sex and Age Groups and Month of Onset
0-9
10-19
20-29
30-39
40 & Over
Month M F M F M
January 2 1 .-. 1
February 1 4
March 3 2 —
April —
May ....
June -- 2
July 8 4 5 2
August 14 10 4 2 1
September .— — - 7 4 8 3 5
35 25 17 10 6
M
M
Total
6
6
5
1
2
19
32
32
103
TWENTY-THIRD BIENNIAL REPORT
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MONTANA STATE BOARD OF HEALTH
13
TABLE IX
Amount of Various Immunization Materials Distributed
by State Board of Health — 1944 (3 mo.)
Month
Diphtheria
Toxoid
Smallpox
Vaccine
Typhoid
Vaccine
Pertussis
Vaccine
Diptussis
Vaccine
Scarlet
Fever
Immuniz
October ..^
November
December
840
8 1 0
1,770
135
270
750
1
20
150
175
100
—
10
3,420
1,155
21
425
10
TABLE X
Amount of Various Immunization Materials Distributed
by State Board of Health — 1945
Scarlet
Smallpox Typhoid Pertussis Diptussis Fever
Vaccine Vaccine Vaccine Voccine Immuniz
Diphtheria
Month Toxoid
January - _.. 480
February 1 ,950
March _ _ 1,260
April 330
May 450
June 213
July _. 270
August — 450
September 270
October ._ 1,110
November 540
December : 240
7,563
95
200
685
40
75
295
20
....
285
75
295
160
25
85
40
250
140
40
150
225
85
175
105
5
75
355
40
300
85
40
75
180
20
2,830
490
1,400
10
TABLE XI
Amount of Various Immunization Materials Distributed
by State Board of Health — 1946 (9 mo.)
Scarlet
Diphtheria Smallpox Typhoid Pertussis Diptussis Fever
Month Toxoid Vaccine Vaccine Vaccine Vaccine Immuniz
January 90 80 .... 125
February 270 175 .... 100 250
March _.-. 270 500 50
April -- 1,650 2,000 .... 105
May ..-_ - 930 560 _... 150 10
June 330 183 14 100
July 210 310 .... 150
August 200 120 ... 175
September 880 420 20 535 530 - -
4,830 4,348 34 1,490 790
14 TWENTY-THIRD BIENNIAL REPORT
To: B. K. Kilbourne, M. D., Executive Officer, State Board of Health.
From: Division of Maternal and Child Health
Personnel as of October 1, 1946:
Robert E. Mattison, M. D., Director
Vacancy, Assistant Director
K. Elizabeth Anderson, M. A., Health Education Consultant
Vacancy, Field Health Educator
Vacancy, Nutritionist
Isabel Peaslee, Senior Clerk
Lois O'Connell, Senior Stenographer
Margaret Sandbo, Senior Stenographer
Marjorie Wieglenda, Senior Stenographer
Shirley Broderson, Junior Clerk-Typist
The Legislative Assembly of 1945 enacted legislation changing the
name of the Child Welfare Division to the Division of Maternal and Child
Health.
The Division of Maternal and Child Health is responsible for a
statewide program to improve the health of mothers and their children.
This program is enhanced through funds available under Title V of the
Social Security Act which is administered by the U. S. Children's Bureau,
Federal Security Agency. Administrative duties require formulation of
plans and budgets for approval by the Children's Bureau, preparation of
reports of the Division as required by the Children's Bureau, and su-
pervision of all services under the jurisdiction of the Division. Further
duties have included the administration of the E. M. I. C. program and
the local administration of the American Academy of Pediatrics Child
Health Survey.
The Maternal and Child Welfare Committee of the Montana State
Medical Association serves as a technical Advisory Committee to the
Division. All literature is reviewed by this committee and their ap-
proval is obtained for all medical procedures.
Consultation is supplied to the Division through a regional medical
consultant of the U. S. Children's Bureau.
The Division herewith submits the biennial report for the period
October 1944 through September 1946 of the following activities.
1. Literature Distribution:
Prenatal letters in series of nine are sent monthly to all patients
authorized under the E. M. I C. program. These letters are also sent
to other expectant mothers at the i-equest of the attending physician,
the public health nurse, or the mother.
The Children's Bureau pamphlet entitled "Infant Care" is distributed
to the various hospitals in the state so that every mother with a new-
born baby may be given a copy before she leaves the hospital. The
MONTANA STATE BOARD OF HEALTH 15
pamphlet is distributed through physicians and public health nurses for
mothers who are delivered at home. The quota for Montana is 6,000
copies annually. Two thousand four hundred are distributed as de-
scribed, by the Division. Three thousand six hundred are distributed by
the two U. S. Representatives. This number is inadequate for the num-
ber of births in the state.
Other pamphlets are distributed only on request. An attempt is
made to provide authentic material on the various aspects of maternal
and child health and related health problems. These pamphlets give
information concerning maternal, infant, and child care; nutrition; social,
mental, and personal hygiene; public health; hearing and vision con-
servation; and dental health.
Additional literature is available through the Health Education
Service.
In the period covered by this report, 3,125 series of prenatal letters,
14,545 pamphlets, and 4,800 copies of "Infant Care" were distributed.
2. Silver Nitrate:
Silver Nitrate ampules have been furnished to hospitals, physicians,
and nurses for prophylactic treatment of the eyes of newborn babies.
During the biennium 16,490 ampules were distributed.
3. Well Child Conferences:
These conferences are conducted by local physicians assisted by
public health nurses. The physicians are remunerated for their services.
The conferences provide regular health supervision for infants and pre-
school children as outlined by the Division. Vaccination for smallpox,
immunizations against diphtheria and whooping cough, and tuberculin
testing are included in the services. This program has been limited due
to shortage of physicians and limitation of public health nursing per-
sonnel. Conferences have been conducted in Cascade and Gallatin
Counties through the local health department and in Ravalli, Valley,
Chouteau, Teton, and Yellowstone Counties through participation by
local physicians.
4. Premature Infant Care Program:
This program as described in previous reports has been maintained.
A consultant is available to hospitals and physicians for special care
as well as demonstration of care for premature infants. If possible,
incubators are supplied for hospital use.
The demonstration program for premature care in Cascade County
as described in the previous report has been maintained.
5. Maternity Hospital Licensing:
The necessary inspections for licensing the various hospitals was
curtailed for lack of personnel. However, at least one medical and
nursing inspection was made during the biennium. The cooperation
shown by the hospitals was most gratifying. In spite of wartime limita-
tions, many improvements were made. There is need for further im-
provements.
16 TWENTY-THIRD BIENNIAL REPORT
To date no licenses have been issued as all necessary inspections
have not been completed. The inspections that have been made have
revealed the need for a general minimum standard law for all hospitals
operating within the state. Since such a law is necessary, and since it
has been impossible to issue licenses provided by the present law, the
activities of the Division in this regard is planned to be those of in-
spection, demonstration, and recommendation. General consultation is
provided in the same manner as that provided under the premature in-
fant care program.
The present regulations need to be rewritten. It is hoped that this
can be done as part of a minimum Standard Law if such legislation is
enacted.
6. Maternal and Infant Mortality and Stillbirth Studies:
Maternal mortality rate in Montana compares favorably with any
other registration area. There has been a steady decline in the rate for
the past several years. A detailed study of all maternal deaths since
1940 is being conducted. A complete report of these will be made at a
later date to the Montana State Medical Association through the Medi-
cal Advisory Committee.
Infant mortality and stillbirth studies have not been made. Pertinent
data concerning these deaths are kept in the office for future study if
personnel becomes available.
7. Postgraduate Education for Physicians:
This program has not functioned during the war. The continuation
of this program is strongly urged by the Medical Advisory Committee
and plans for its continuation in the near future are being formed.
8. Emergency Maternal and Infant Care Program:
The regulations of this program were altered somewhat in October
1945. Since that time, the program has operated well. There have been
objections to some policies. However, practically all physicians and
hospitals in the state are continuing participation.
The number of authorizations has shown a steady decrease since
the end of the war and will continue to decrease as the Armed Forces
become smaller. The program is limited to the duration of the war
and six months thereafter as provided by the Congress of the United
States.
A study of the care of these patients in Montana is being made.
Since most physicians practicing obstetrics in Montana have participated
in the program, valuable information concerning the care of expectant
mothers in Montana is anticipated.
The required cost accounting statements submitted by participating
hospitals has produced comparative figures of incalculable value. They
can be used not only to determine the cost of hospital care but also can
be used by the hospitals in planning their management on a more
equitable basis.
MONTANA STATE BOARD OF HEALTH 17
In the biennium, 2,272 maternity cases and 912 infant cases were
cared for under program. $153,509.72 was paid physicians and $153,-
444.68 was paid hospitals.
9. Premarital and Prenatal Examinations:
The Legislative Assembly of Montana at the 29th Session enacted
a law relating to the prevention of congenital syphillis. This required
a standard serological test to be performed on all pregnant woinen and
further that the result be reported to the State Board of Health and that
all birth certificates shall state if such blood test was made. The first
month after the law was enacted, 40 per cent of the birth certificates
showed evidence of such tests. At the present time, 95 per cent of the
birth certificates contain the required information.
A law requiring similar examinations to be performed on persons
requesting marriage licenses is recommended by the Division. The Mon-
tana State Medical Association, the Montana Parent and Teachers' As-
sociation, Montana Federation of Women's Clubs, the Montana Federa-
tion of Business and Professional Women, and the Montana Public
Health Association favor similar legislation.
10. Summer Round-Up of Children:
The Director of the Division served as State Chairman for the
Summer Round-Up project of the Montana Parent and Teacher Associa-
tion. The reports on this activity have not been compiled. Since the
resignation of the Director who acted as chairman, this project will be
carried on by the Montana Parent and Teacher Association. The Di-
vision will act only in a consultant capacity.
11. Cooperation With Other Agencies:
The services of the Division are made available to all agencies and
professional and lay groups. Professional meetings attended included
the Montana State Medical Association, Public Health Association, Tu-
berculosis Association, Parent and Teacher Association, Hospital Asso-
ciation, and Vocational Rehabilitation Council.
The Director was a member of the Governor's Committee for a
Hospital Survey of Montana. A preliminary report has been submitted
by this committee.
The Assistant Director acted as local Executive Secretary for the
American Academy of Pediatrics Study of Child Health Services. This
study was sponsored by the Montana State Medical Association through
its Maternal and Child Welfare Committee. A preliminary report on the
Child Health Services in Montana will be available before the report
is made by the American Academy of Pediatrics.
12. Health Education:
Health Education Services aim (1) to give scientific knowledge in
the field of health and (2) to create proper attitudes for the practical
application of accepted health principles and procedures. Through this
sei'vice it is hoped to stimulate public thinking and action so that both
personal and public health will be protected, maintained, and improved.
18 TWENTY-THIRD BIENNIAL REPORT
Health Education Service is given (1) through cooperation witli
other agencies by committee work, participation in group meetings, in-
stitutes, workshops and addresses (2) direct teaching (3) examination
and distribution of literature (4) circulation of films and posters.
The staff includes a Health Education Consultant and a Field Con-
sultant in Health Education. With the resignation of the Health Edu-
cation Consultant in January, 1946, the Field Consultant was appointed
to that position and at the present time the position of Field Consultant
has not been filled.
Through the present biennium efforts have continued to be chiefly
directed through the schools. The school health program has shown
considerable progress. Emphasis has been placed on the development of
all phases of this progTam, i.e., health service, healthful school living,
health guidance, and a healthful environment. The influence of the
school in the improvement and development of the public health pro-
gram is recognized as a potential force in the community.
Close relationship has been continued with the State Department of
Public Instruction. The consultants work closely with the supervisors
in that department, the state high school supervisor, the elementary
supervisor, and the supervisor of health, physical education and rec-
reation.
In the fall of 1945, the field consultant in health education took part
in each of the county institutes held by the State Department of Public
Instruction. This made it possible to contact practically all of the
teachers, both high school and elementary in second and third class
school districts and all the elementary teachers in rural schools as well
as many city and county superintendents and principals.
The Executive Officer, the Maternal and Child Health Director, the
Director of Public Health Nursing, the Generalized Public Health Nurs-
ing Consultant, and the Health Education Consultant have met fre-
quently with public school personnel at local teachers' meetings.
Field appraisals have been continued. .The appraisal of the health
program in a school requires from a day to as long as two weeks, de-
pending upon the size of the system. Whenever possible, a return visit
is made. If possible the administrator and public health nurse accom-
pany the consultant. When this is not possible or feasible, the report,
with recommendations, is given in both oral and written foi'm. The
recommendations usually include suggestions for correction, improve-
ment, or expansion of the program as it already exists. In all aspects
of these school visits one of the fundamental aims is to try to show
administrators and teachers how to assume their responsibilities in the
health program.
Since the school lunch and physical education activities both make
important contributions to the health of the student, encouragement
is always given for the development or expansion of these programs.
Coordination of health and guidance programs is always recommended.
During the spring of 1946, Directors of the Division of Sanitation
and Division of Food and Drug and Health Education Consultants took
MONTANA STATE BOARD OF HEALTH 19
part in the clinic for the study of Building and Renovation of Schools,
sponsored by the School Administrators Association.
There has been more participation in teacher training in health edu-
cation than formerly. The need for emphasis in this phase of the pro-
gram has been apparent to members of both state and local public
health staffs. The State Superintendent of Public Instruction also has
been aware of the need and has been anxious to have health education
included in pre-service teacher-training curricula and has asked that
teacher-training departments offer extension courses in health educa-
tion to teachers in-service.
Furthermore, it is expected that teachers who have had a basic
course in health education will contribute to the public health program
in their respective communities. They will learn what a full time public
health unit can do for a community and they will probably give impetus
to the support or creation of county or district full time public health
units. The Director and Health Education Consultants were members
of a state committee, organized for the purpose of writing a suggested
syllabus in Health Education for the teacher-training departments in
the various units of the University of Montana. This course was pre-
pared to be offered to all students who expect to teach and is therefore
a basic course rather than a course to be offered to specialists or majors
in health education.
The course aims to teach an understanding and proper attitudes
in the (1) importance of a positive viewpoint in health, the value, need
for and methods for obtaining optimal health, (2) health problems of
the school age child and suggestions for the proper management of
these problems, (3) observation and procedures for teacher appraisal of
child health, (4) mental health in the classroom, (5) essentials of an
effective school health program i.e., healthful school environment,
healthful school living, health service, and health instructions, (6) inter-
relationship of home, school, and community, (7) the teacher's health.
It is expected that this committee will continue to function as a sub-
committee of the State Health Committee.
The Consultant in Health Education was loaned to the Eastern
Montana Normal School at Billings to teach this basic course in health
education during the 1946 summer session. The course was offered as a
four quarter-credit course during a ten-week session. There were 48
students enrolled in the class. Two of the students were local public
health nurses and all but three of the others had had previous teaching
experience. Thirty-eight of these students planned to teach in the state
and four planned to continue their study at the school. Some specialists
were called in for lectures in the area of their specialty. Among them
were the Executive Officer of the State Board of Health, Director and
two Nursing Consultants of the Division of Public Health Nursing in the
State Board of Health, the Elementary Supervisor in the State Depart-
ment of Public Instruction, Nutrition Specialist in the Extension Depart-
ment, and two of the critic teachers in the training school of the college.
Conferences have been held with instructors in the other teacher
training institutions and the health education consultant has met
20 TWENTY-THIRD BIENNIAL REPORT
with classes in health education in these institutions for from one to
three class periods. She also gave guidance to curricula committees at
the State College and at the State University in setting up curricula
offering a major in health education, such major courses to be offered
when trained staff personnel is available to teach such courses.
One of the aims of those working in the field of public health is to
make services an educational experience and in this endeavor health
education consultants have often been able to serve in an advisory ca-
pacity.
Many divisions of Public Health include the school health program
as one of the areas in which they work. Because health educators have
had some training and experience in both health and education, it is pos-
sible to make distinctive contributions in planning the total school
health program.
Very close working relationships have been established with the Di-
vision of Public Health Nursing. The development, clarification, and
expansion of the school health program has been due to, in a great
measure, cooperative planning. An outline of responsibilities for the
administrator, public health nurse and teacher in health service, healthful
environment and health instruction was prepared jointly and serves as
a guide to those developing a school health program.
Occasionally the Director of Public Health Nursing, a Nursing Con-
sultant and the Health Education Consultant meet together with school
personnel. When this is not feasible each tries to implement the plan
keeping the total program in mind.
Because there are no health educators at the present time in local
public health offices the public health nurse must often carry consid-
erable advisory responsibility in health education in the school health
program. Therefore, the health education consultants work very closely
with the local public health nurses.
Participation in the program of many other groups has been made
by members of other divisions of the State Board of Health. The Health
Education Consultant has participated in the meetings of the State
School Board Association, Hill County Association of School Trustees
and Clerks, Montana Education Association, State Kiwanis Association,
Women's Clubs, Parent Teacher Associations, Mother's Clubs, Women's
Field Army for the Control of Cancer, Nursing Education Classes, Farm-
ers Union, State Extension Department, State School Administrators
Association, Public Health Nurses, and Parents of Cerebral Palsied. She
was a participant in the health education workshop held at the State
College in the summer of 1946. In the American Association of Health,
Physical Education, and Recreation, the Health Education Consultant
is a member of the Committee on Local, State, and District Associations.
Until April 1946, she was one of the three Vice Presidents of its North-
west District and President of the State Association. The Health Edu-
cation Consultant is a lay member of the Board of Directors of the
Montana League of Nursing Education, the Board of Directors of the
State Organization for Public Health Nursing and a member of the
State Nutrition Committee.
MONTANA STATE BOARD OF HEALTH 21
The Health Education Consultant attended the National Convention
of the American Association of Health, Physical Education, and Recrea-
tion which was held in St. Louis and the Northwest District Association
Convention in Seattle in 1945.
A considerable amount of new literature is examined and each year
new books are added to the lending library. These books are loaned on
request to professional and lay citizens.
Up-to-date and scientifically accurate pamphlet material is dis-
tributed.
With the approval of the State Superintendent of Public Instruc-
tion, health records and guides are supplied to the elementary and high
schools of the state. These guides include cumulative health records,
health information blanks, nurse-teacher work sheets, school health ap-
praisal blanks, dental cards, classroom growth records, bulletin and
wall chart on the control of communicable disease, daily health records,
Snellen vision charts, and teacher's requests for nursing service blanks.
These records and guides are almost universally used in the schools
in the state and form a guiding nucleus around which the school health
program develops. The use of these records helps parents, school and
public health personnel understand the child as a whole and bring to
attention his physical, mental, and emotional needs. The cumulative
health record has been accepted by most elementary teachers as equally
essential as the academic records. The practice of continuing the record
into the high schools is developing and it is expected that on the stu-
dent's entrance into college, the college will request these records along
with the academic record of the student in order to utilize the health
information which has been kept throughout the pre-school, elementary,
and high school years.
The general circulation of posters has been discontinued this past
year and local agencies are urged to purchase their own. During the
current biennium several new films have been purchased and deposited
with the Department of Visual Education in the office of Public In-
struction and are circulated by that department.
The Division of Maternal and Child Health requires the use of the
public health nurses to maintain its activities. Until recently, Public
Health Nursing was a unit of the Division. Such close cooperation re-
quires the joint use of office facilities. Office space in the Capitol
Building was made available by the Board of Examiners in 1944. At the
present time two divisions, namely the Division of Public Health Nurs-
ing and the Division of Services for Crippled Children share this space
with the Division of Maternal and Child Health. The space is over-
crowded. Plans for expansion of all programs have been formulated.
Additional space is necessary to adequately carry out these plans as
well as to handle the necessary increase in personnel.
Respectfully submitted,
ROBERT E. MATTISON, Director
Division of Maternal and Child Health
22 TWENTY-THIRD BIENNIAL REPORT
To: B. K. KILBOURNE, Executive Officer, State Board of Health
From: Division of Services for Crippled Children
Personnel as of October 1, 1946:
Robert E. Mattison, M. D., Director
Vacant, Assistant Director
Margaret Kerns, Medical Social Consultant
Vacant, Physiotheapist
Grace Johnsrud, Senior Stenographer
Ella Ellingson, Intermediate Stenographer
The foUov/ing is a biennial report of the Division of Sei-vices for
Crippled Children for the period from November 1, 1944, to October 1,
1946.
1. General Information:
Services for crippled children were established by state law in 1921
with the creation of the Montana Orthopaedic Commission and were re-
organized and expanded in 1936 in cooperation with the Federal Govern-
ment as outlined in Title V of the Social Security Act administered by
the United States Children's Bureau. These services were administered
by the Montana Department of Public Welfare from 1936 until 1941
when, through State Legislative Enactment, they were transferred to
the State Board of Health, under the Division of Services for Crippled
Children.
The Division administers services for crippled children to every
political sub-division of the state. Funds are derived from Federal and
State appropriations. No funds are derived from county or non-official
organizations. $90,102.23 State funds and $41,940.70 Federal funds were
expended for crippled children's services for the two-year period ending
June 30, 1946.
Diagnostic clinic service is available to all children in the state under
twenty-one years of age irrespective of the financial circumstances of
the family. Children are accepted for medical and surgical care under
the program who have defects requiring orthopaedic care and plastic
surgery, and whose parents are financially unable to obtain care
privately.
2. Case Finding:
Case finding, a basic part of the program, was carried out con-
tinuously by local public health nurses, the orthopaedic nursing con-
sultant, local physicians and the local departments of Public Welfare.
Records of crippled children from birth certificates were secured each
month through the DivLsion of Vital Statistics. To determine the need
of these children for orthopaedic care, letters were sent out and visits
were made to local physicians and to parents. A register of all known
phvsically handicapped children in Montana has been maintained since
1938. Between November, 1944, and October 1, 1946, 1,227 children
were added to the register. There were 587 closed for various reasons
MONTANA STATE BOARD OF HEALTH 23
during- the same period, leaving a total of 2,724 children on the case
register as of October 1, 1946.
3. Clijiic Service:
Field clinics were held throughout the state in the spring and
autumn of each year. During the biennium forty-four clinics were held
in fifteen centers in the state. These centers were located so that chil-
dren in all areas of the state were given access to the clinic service twice
a year. Local public health nurses and the Departments of Public
Welfare were responsible for the organization of the clinics and they
were assisted in this by the orthopaedic nursing consultant. An ortho-
paedic surgeon and a pediatrician served each clinic. The clinics were
for diag"nostic purposes but they also provided the means for the super-
vision and follow-up of children who had previously been accepted for
care. A total of 2,435 children were examined in clinics between No-
vember 1, 1944, and October 1, 1946. Of this number, 827 children were
new patients and the remaining 1,608 children returned for follow-up
service. The attendance of the clinics ranged from 30 to 115 children.
Several clinics were of two days duration but the majority were one
day clinics.
4. Hospitalization and Ortliopaedic Care:
Orthopaedic service was provided by four orthopaedic surgeons in
the state: L. W. AUard, M. D., of Billings; J. K. Colman, M. D., of
Butte; S. L. Odgers, M. D., of Butte; and John C. Wolgamot, M. D., of
Great Falls. There were three consulting pediatricians on the staff, O.
M. Moore, M. D., of Helena; Ellis Adams, M. D., of Great Falls; and D. L.
Gillespie, M. D., of Butte. In addition, another pediatrician, A. L.
Gleason, M. D., of Great Falls, participated in the diagnostic clinics.
F.. A. Hagman, M. D., of Billings, another pediatrician, participated in
t'le program on a fee for service basis. These pediatricians attended
field clinics, giving physical examinations to all patients and/or gave
pediatric consultation service to hospital patients. The four treatment
centers for crippled children were Great Falls, Helena, Butte, and Bil-
lins-s. The hospitals participiating in the program were St. Vincent's
Hosoital, Billings; Deaconess Hospital, Billings; Murrav Hospital, Butte;
St. James Hospital, Butte; Montana Deaconess Hospital, Great Falls;
p.nd Shodair Hospital, Helena.
During the two-year period ending October 1, 1946, 370 children
have received medical and surgical service. Of this number, 270 chil-
drrn v/ere hospitalized and the remaining 100 children secured medical
care in the physicians' offices or were provided with special apoliances.
Thes*^ figures represent an undunlicated count for many children v/ere
admitted to hospitals several times during the two-vear period. There
v/ere 365 hospital admissions for this period with a total of 12,700 days
Viospitalization provided.
5. Cerebral Palsy Proja^rani:
In January, 1945, a phvsiotherapist. Miss Ruth Hansen, was em-
ployed on a part time basis for a cerebral palsy program in Billings. A
small project was instituted for the training- of selected children and the
24 TWENTY-THIRD BIENNIAL REPORT
Eastern Montana Normal School participated in the project by making
the facilities of the school available to the physiotherapist. Between
January, 1945, and August, 1945, 24 children received special training
and many of these children profited materially from this short period
of training. The project was discontinued in August, 1945, when Miss
Hansen resigned to secure postgraduate training.
The project demonstrated the value of and the need for a service
which woud provide a continuous training program for children with
cerebral palsy. It is planned to establish a program for the special
training of children with cerebral palsy as soon as personnel is avail-
able. Only one hospital in the state has facilities for the training of
these children and a limited number of children have received training
by a physiotherapist under the direction of the orthopaedist. This pro-
gram will be enhanced by a State Society for Crippled Children and
Adults. The organization of this society is being planned for Montana.
6. Rheumatic Fever:
Although the plan for the administration of a rheumatic fever pro-
gram was approved by the United States Children's Bureau, the pro-
gram has not developed because of the lack of medical direction and
other personnel. While the rheuniatic fever program has not been
carried out according to the former plan, children have been given
medical care when special need was indicated.
7. State Staff:
During the biennium the state professional staff consisted of one
physician, one orthopaedic nursing consultant, and a medical social
consultant who was added to the staff in August, 1946. In counties
with public health nurses, the orthopaedic nursing consultant gave con-
sultant service to public health nurses for case finding and nursing
follow-up of medical service. In counties with no public health nurses,
the orthopaedic nursing consultant gave direct service to the crippled
children. It is planned to secure additional orthopaedic nursing con-
sultants since it is impossible for one consultant to give consultation
and direct services to all areas in the state.
8. Cooperation with Other Agencies:
During the biennium, close cooperation continued with the Depart-
ment of Public Welfare, the State Bureau of Vocational Rehabilitation
and the National Foundation for Infantile Paralysis. The local Depart-
ments of Public Welfare assisted in locating and reporting crippled
children as well as making a financial and social study for each family
applying for orthopaedic services. One hundred and forty children over
the age of sixteen whose medical care had been completed but who had
a residual handicap and required vocational training were referred to
the State Bureau of Vocational Rehabilitation. A representative from
the Bureau of Vocational Rehabilitation attended each clinic and in-
terviewed all applicants for this service.
The proper administration of the program conducted by the Division
of Services for Crippled Children requires the participation of consid-
MONTANA STATE BOARD OF HEALTH 25
erable time and personnel provided by the Division of Public Health
Nursing.
The plans provide for considerable expansion in the future. This
is necessary if the handicapped children in the State are to receive ade-
quate care.
Provision should be made establishing a full time Director. The
large scope of the activities of this Division is I'eflected in the fact that
it expends more money than any other Division of the State Board of
Health.
Respectfully submitted,
ROBERT E. MATTJSON, M. D.
Director
Services for Crippled Children
26 TWENTY-THIRD BIENNIAL REPORT
DIVISION OF PUBLIC HEALTH NURSING
To: B. K. Kilbourne, M. D., Executive Officer
The following is a biennial report of activities of the Division of
Public Health Nursing covering the period November, 1944 to October,
1946.
The persormel as of October 1, 1946:
Helen M. Murphy, Director
Wava L. Dixon, Generalized Public Health Nursing Con-
sultant
Sarah N. Barnes, Orthopaedic Nursing Consultant
(Mrs.) Edna Kuhn, Maternal and Child Health Nursing
Consultant
Mary A. Ivanko, Tuberculosis Nursing Consultant
Daisy Prentice, Hospital Nursing Consultant
Vacant, Generalized Public Health Nursing Consultant
Vacant, Orthopedic Nursing Consultant
Marilyn Anderson, Stenographer
Administration: The State Board of Health has full power of su-
pervision and regulation of all public health nurses in Montana through
the Public Health Laws and Regulations of Montana. Public Health
Nursing was a unit within the Division of Maternal and Child Health
and Crippled Children Services until July 1, 1946. Miss Florence
Whipple, State Supervisor of Public Health Nursing, resigned in June
1945 to take postgraduate work and was succeeded by Miss Helen Mur-
phy in July 1945. In July 1946 the Division of Public Health Nursing
was established with a Director of Public Health Nursing in charge. The
nursing consultant staff consisted of one generalized nursing consultant
and one orthopedic nursing consultant, each covering the entire state,
until June 1946 when a maternal and child health nursing consultant was
added to the staff and a tuberculosis nursing consultant was loaned to
the state from the U. S. Public Health Service. A hospital nursing con-
sultant came on the staff in August 1946.
The services of the specialized nursing consultants are necessary to
keep the public health nurses informed concerning the rapidly changing
scene of medical science and its preventive ramifications. These con-
sultants function as specialists but have a broad perspective through
which the best interests of the program as a whole are kept in mind.
They function primarily in cooperation with other divisions to integrate
their special programs into the public health nursing service. A high
standard of proficiency cannot be maintained without new knowledge
necessary to effective performance in the many fields of endeavor.
In 1945 there were 23 counties which had public health nursing service
and 25 in 1946. Five of these counties were organized as full time health
units employing a total of 18 public health nurses. Thirteen unorganized
counties have public health nursing service employing a total of 21
MONTANA STATE BOARD OF HEALTH 27
nurses. In addition, public health nursing sei'vices were available in
other areas in the state through the U. S. Indian Service, Local Boards
of Education, Metropolitan Life Insurance Company, and State and Local
Tuberculosis Associations. These services employed a total of 11 nurses.
During the report period, we had 18 resignations from public health
nurses. We secured 27 nurses for positions. Of this number, three were
returning veterans on military leave, four were graduate nurses, two
were loaned from U. S. Public Health Service, 17 were new to public
health services in Montana, and one was a former employee. There
are 11 positions vacant at the present time. Many counties are inter-
ested in establishing a nursing service whenever personnel becomes
available.
In-Service Training and Staff Development: The in-service training
program in 1945 was carried on through institutes for all public health
nurses in five centers in which all Division Directors of the State Board
of Health participated. In June 1946 an institute on Mental Hygiene was
held in Helena for public health nurses. This institute preceeded the an-
nual meeting of the Montana Public Health Association also held in
Helena thus enabling the attendance of all the public health nurses. In
September 1946 an institute on Tuberculosis Nursing was held in Helena
with all public health nurses in attendance. This institute preceeded the
annual meeting of the Montana Tuberculosis Association also held in
Helena, again enabling the attendance of public health nurses at the
meeting. In 1945 and 1946 the public health nurses had the opportunity
of attending the annual meetings of the Montana State Nurses' Associa-
tion and the State Organization for Public Health Nursing.
The consultant staff offers guidance in the planning and conducting
of local staff programs. Monthly staff meetings are being held in two
areas in the state. It is planned to extend this to all areas having public
health nursing service. Through the supervisory service offered by the
consultant staff, there is opportunity for staff development through in-
dividual and group conferences with the public health nurses.
The state staff has monthly conferences for the purposes of dis-
cussing and planning for the various phases of the public health nursing
services. A planned educational program is part of these monthly
meetings.
Stipends for Study: Twelve nurses were given a stipend for three
months for study in basic public health nursing courses. One nurse was
given a stipend for nine months for postgraduate study in public health
nursing. Four nurses on the staff were given a grant for tuition and
travel for studying on salary a short intensive course in Supervision.
These expenditures were from the U. S. Public Health Service monies
granted the State of Montana. Two nurses were sent for a short in-
tensive course in Maternal Care through funds granted the State of
Montana by the U. S. Children's Bureau.
28 TWENTY-THIRD BIENNIAL REPORT
Statistical Report of Services:
Communicable Disease Control:
Field Visits to Communicable Disease 11,084
Vaccination for Smallpox 14,507
Immunization Diphtheria 10,013
25f/f under 5 years of age, 160f under 1 year of age
Vaccination for Whooping Cough 3,353
44% under 2 years of age
Venereal Disease Visits _ 461
Immunizations for Rocky Mountain Spotted Fever ... 47,532
Tuberculosis Control:
Nursing Visits 11,142
Tuberculin Tests . 24,437
X-rays Taken 13,888
This figure includes mass survey films.
Maternity Service:
Individuals Admitted to Service 5,805
Antepartae Visits 3,513
Postpartae Visits 5,056
Infant Service:
Field Visits 9,815
41% made to infants under 1 month of age
Office Visits 2,006
Pre-School Service:
Field Visits 8,168
Office Visits 5,067
School Health Services:
Examinations by Physicians 8,298
Examinations by Physicians 8,298
Examinations by Physician with Parents Present 3,094
Nurses' Inspection of School Children 19,917
Nursing Visits 27,090
Crippled Children's Service:
Nursing Visits - 3,889
Morbidity Service:
Nursing Visits 2,372
Adult Health Supervision:
Nursing Visits 2,397
Additional services of the public health nurses are reflected in the
reports of the various Divisions of the State Board of Health for it is
largely through them that the services of the health department are in-
terpreted and integrated and made available to the individual and the
family.
Other Services: In addition to the heavy routine duties of the staff,
the following brief statements point up the special work done by the
MONTANA STATE BOARD OF HEALTH 29
nursing- consultants in contributing to the total public health program.
Through the efforts of the health education consultant and the gen-
eralized nursing consultant, our school health services have shown con-
siderable development during the past biennium. Intensive service by
these consultants was given in two areas where new programs were
initiated. Since the results of this intensive service was so well re-
ceived it is planned to give similar intensive service in other areas. The
need for orthopaedic nursing classes in the basis curriculum was a prob-
lem presented during the past biennium. The orthopaedic nursing con-
sultant in cooperation with nursing educators developed a syllubus for
a sixteen-hour and twenty-two-hour course. This syllubus is to be dis-
tributed to the Schools of Nursing in Montana. The maternal and child
health nursing consultant developed a much needed guide for Well-Child
Conferences and a guide for use of volunteers. The tuberculosis nurs-
ing consultant has developed guides for programs of nursing in tuber-
culosis control in addition to the public health educational work that has
been done with community groups. The hospital nursing consultant
is developing guides for nursing care and techniques for hospitals.
The services of the nursing consultants are available to the schools
of nursing for assistance with the content for the basic curriculum for
students, and acceptable care to the patients. Their services are also
available and being used by hospitals for professional staff in service
education.
We express our appreciation for the cooperation and assistance given
this division by the other divisions of the State Board of Health. The
U. S. Public Health Service and the U. S. Children's Bureau through
their consultant staff have rendered a valuable assistance. We acknowl-
edge the continued cooperation given by the Montana Tuberculosis As-
sociation, the State and Local Departments of Public Welfare, and the
Divi'iion of Child Welfare Services.
Respectfully submitted,
HELEN M. MURPHY, Director
Public Health Nursing
30 TWENTY-THIRD BIENNIAL REPORT
BIENNIAL REPORT
BUREAU OF VITAL STATISTICS
To: B. K. Kilbourne, M. D., Executive Officer, Montana State Board of
Health:
Sir: It is my privilege and honor to submit the Biennial Report of the
Bureau of Vital Statistics for your consideration. This report covers the
calendar years 1944 and 1945.
The personnel of the Bureau includes the State Registrar, one senior
stenographer, one intermediate stenographer, one junior stenographer
and a senior clerk.
The Bureau of Vital Saatistics was created by the legislature of
1907 and became effective June 1st of that year. It was created for the
complete and proper registration of births and deaths for legal, sanitary
and statistical purposes. The Bureau was placed under the superin-
tendance of the Executive Officer of the State Board of Health, who was
empowered to make regulations with the approval of the Board of
Health, to carry out the provisions of the Act.
The legislature of 1943 repealed the Vital Statistics Registration
Act of 1907 and reenacted the present law which includes not only the
central registration of births and deaths, but also stillbirths, legitima-
tions, adoptions, marriages, divorces and annulments of marriages.
There is now in a central office a complete history of the principal
events in the lives of the citizens of the state from the "cradle
to the grave." Legislation was also passed in 1943 allowing a citizen,
regardless of place of birth, to place his birth on record in Montana by
court order. The law further regulates the use of Vital Statistics records
as evidence, defines terms, provides penalties for violation and authorizes
the State Board of Health to make and promulgate regulations for the
enforcement of the Act.
There is at least one Local Registrar of Births and Deaths in each
county at the county seat, and where necessary for convenience and to
prevent undue delay in the filing of these records, there are additional
Local Registrars at strategic points for other districts within a county.
The Local Registrars are appointed by the State Registrar with ap-
proval of the State Board of Health.
The attendant at a birth must report the birth to the Local Registrar
within ten days after the birth occurs. The" mortician who handles a
dead body must present a death certificate to the Local Registrar and
receive a burial permit before a body may be in any way disposed. The
Local Registrar must send all original birth, death and stillbirth cer-
tificates to the State Board of Health by the 10th of each month for the
preceding month, and a duplicate record must be filed with the Clerk
and Recorder of the county in which the event occurred.
Clerks of the District Courts must report, on forms furnished by
the State Registrar, all marriage licenses issued and the divorces or an-
MONTANA STATE BOARD OF HEALTH 31
nulments and the adoptions granted in his court, by the 15th of the fol-
lowing month.
Death reporting became accurate and complete much more rapidly
than did birth reporting. Montana was admitted to the Death Registra-
tion Area in 1910, when it was proved to the Federal Census Bureau
that we were registering over 90% of the deaths occuring in the State.
Satisfactory birth reporting was not reached until late in the 1910
decade.. In 1921 the Census Bureau tested our accuracy of birth report-
ing and found we were recording 93% of the births occuring and we
were accordingly admitted as the twenty-fourth state to tlie Birth Regis-
tration Area on January 1, 1922. The latest check on birth reporting,
made in conjunction with the Federal Census of 1940, revealed that 97%
of the births were being properly recorded.
POPULATION
The population figures for the state are 465,000 (Census Bureau es-
timate) for 1944, and 500,000 for 1945. Thousands of citizens left the
state between 1940 and 1943 for the armed forces or to enter war work
in other states. The return to Montana started in 1945. It is extremely
difficult to arrive at any reasonable figures by counties or other minor
civil divisions at this time.
RESEARCH
Total requests received at the office for information, corrections or
certified copies, and the filing of delayed birth records amounted to
21,709 in 1944 and 19,279 in 1945. There were 7,178 certified copies of
birth and 259 certified copies of deaths issued in 1944, compared to
6.048 births and 389 deaths in 1945. Money deposited in the General
Fund was $7,561.17 and $5,707.46, respectively, for the two years.
The state law requires that a copy of any record must be issued
free of charge to the Veterans Administration or to anyone acting for it,
consequentlv there was a marked increase of free certified copies is-
sued in 1945.
INDEX REVISION
The large number of delayed birth records placed on file in the past
few years made it necessary to revise the birth index volumes for the
years from 1925 back as far as registration extends. In addition to the
current index of births, deaths, marriages and divorces during the
biennium, a revised birth index was completed for the years 1917, 1922
19*^3 and 1924. Previous to 1944 revised indexes had been completed for
1918, 1919, 1920 and 1921.
PRENATAL BLOOD TEST
The legislature of 1945 enacted a prenatal blood test law, requiring
all physicians to enter on the birth certificate:
"Was a blood test for syphilis made on mother?
(Yes or No)
Date of test
If test not made, state reason "
32 TWENTY-THIRD BIENNIAL REPORT
The first month the law was in effect, July 19-45, the question was
answered on 39.3% of the birth certificates. Twelve months later the
question was answered 94.9% of the time.
BIRTH NOTIFICATION
From 1925 to July 1, 1945 the Federal Census Bureau furnished the
states with Certificates of Birth Notifications to be sent to all parents
of babies born within the states. These were sent out under the frank-
ing privilege. They contained the essential information of date and
place of birth, the child's name and the father's name and mother's
maiden name. July 1, 1945 these were discontinued and an unverified
copy of the complete birth certificate was sent in its place. This neces-
sitated an unusual amount of clerical v/ork and as 94% of the births in
Montana occur in hospitals the State Board of Health passed a regula-
tion as follows: "Regulation 50 (c). It shall be the duty of the Super-
intendent of any hospital wherein a birth occurs, to present a completed
birth certificate to the mother of each baby born therein, before she
leaves the institution, for review as to the correctness of the informa-
tion contained in the birth certificate. After examining the complete
birth certificate, the mother must sign Item 23, 'I have reviewed the in-
formation on this, my child's birth certificate and find it to be correct.'
Signature of Mother.
When the mother reviews and signs this record there will be no
necessity of sending her an unverified copy and it will be only necessary
to send the unverified copy to the 6% of the parents of babies whose
births do not occur in hospitals. A state Board of Health postcard con-
taining the essential information on the birth certificate is sent to all
parents.
REPORTS TO OTHER AGENCIES
Reports at regular intervals made to other agencies are: Births,
deaths, stillbirths and marriages to the National Office of Vital Sta-
tistics. All deaths over 21 years of age to the State Board of Equaliza-
tion. All deaths over 65 years to State Public Welfare Department,
tuberculosis deaths to the State Tuberculosis Association, cancer deaths
to Women's Field Army and to Cancer Committee of Montana Medical
Association. All auto accident deaths are checked with the State High-
way Patrol and sent to the National Office of Vital Statistics and to the
National Safety Council. All communicable deaths, to the Division of
Epidemiology and the Infant deaths and Maternal deaths to the Division
of Child and Maternal Health. The total deaths to the National Funeral
Directors Association. Special studies are made on request for various
agencies.
MONTANA STATE BOARD OF HEALTH
33
Order
PRINCIPAL CAUSES OF DEATH 1944-1945
1944 1945
Cause Number
fder
Number
1
1,606
2
640
4
484
3
524
5
270
6
198
7
166
8
134
9
132
1. Heart 1,687
2. Cancer 665
3. Apoplexy 546
4. Total Accidents 491
5. Nephritis 308
6. Pneumonia 246
7. Tuberculosis 167
8. Diabetes 131
9. Premature Births 123
These nine causes of deaths account for 77% or over three-fourths
of the total deaths for the two y.ears. Heart Disease alone causes 30%
of the deaths or three of every ten deaths.
The only change in position of the nine leading causes for the two
years is that of apoplexy and total accidents from third to fovu'th
places. Within the accident groups, falls caused the most deaths in
1944 with 134, while motor vehicles claimed the most in 1945 with 121.
Table I, following shows the population, births, deaths, infant and
maternal deaths, communicable diseases and principal causes of death
with their rates by years, 1910-1945.
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MONTANA STATE BOARD OF HEALTH 37
The high lights of the preceding table which covers the past 36
years are: A decided drop in the rates for all the communicable diseases
over which the Public Health authorities may exercise some control. The
most gratifying is that of Typhoid Fever. The Tuberculosis rate has
been cut by two-thirds. The four diseases of childhood: Dyphtheria,
Scarlet Fever, Measles and Whooping Cough, all show gratifying de-
clines. The Infant Mortality rate is one-third of what it was in 1910,
while the maternal rate has dropped over SS'/r. On the other hand
the degenerative diseases of old age, cancer, heart and apoplexy, show
enormous increases. There is little change in meningitis and poliomelitis,
while there is a downward trend in pneumonia, suicides and homicides.
Note: Birth and death rates are per 1,000 population.
Infant and maternal mortality rates are per 1,000 live births.
All others are per 100,000 population.
Table II following gives the births, deaths, marriages, divorces,
adoptions, infant deaths and maternal deaths by counties for 1944:
38
TWENTY-THIRD BIENNIAL REPORT
TABLE n
1944
County
Births Deaths Marriages Divorces Adoptions
Iniant Maternal
Deaths Deaths
Beaverhead 62 61
Big Horn 190 94
Blaine 114 33
Broadwater 75 41
Carbon 70 74
Carter 16 12
Cascade 1,403 510
Choteau 60 46
Custer 314 164
Daniels 103 24
Dawson 261 84
Deer Lodge ._- 286 416
Fallon 65 28
Fergus 319 159
Flathead 460 245
Gallatin 309 168
Garfield 48 12
Glacier 247 104
Golden Valley ..-. 13
Granite 9 13
Hill 417 139
Jefferson 57 30
Judith Basin _.... 1 1 1
Lake 174 140
Lewis & Clark __ 463 279
Liberty 37 19
Lincoln 116 58
McCone 15 9
Madison _. 39 42
Meagher 5 16
Mineral _._. 16 19
Missoula 698 393
Musselshell 82 55
Park 187 120
Petroleum ....__ 1 4
Phillips 98 51
Pondera 117 53
Powder River ..37 15
Powell 110 69
Prairie 47 20
Rovalli 182 106
Richland 228 64
Roosevelt , 207 82
Rosebud 134 63
Sanders 36 42
Sheridan .. 136 60
Silver Bow 942 617
Stillwater 33 40
Sweet Grass ._. 42 31
Teton 23 35
Toole 121 48
Treasure 3 6
Valley 253 78
Wheatland 31 18
Wibaux 5 7
Yellowstone ... 1,261 475
237
35
192
27
64
14
26
51
94 ■
20
8
4
653
198
91
6
177
49
36
141
12
99
58
64
2
90
47
189
73
174
20
3
52
30
5
16
10
115
40
41
6
12
4
84
41
240
96
10
4
100
8
12
2
15
13
5
5
190
8
533
153
52
20
114
43
43
'21
30
40
101
49
14
13
1
107
33
228
6
118
45
36
14
111
18
128
9
545
194
67
5
16
5
44
2
63
21
67
YY
15
8
82
636
199
2
2
2
1
2
1
40
3
4
3
5
1
1
4
17
4
1
2
"Y
8
7
84
1
2
3
"2
24
3
9
1
2
Y
10
2
5
1
7
3
Y
26
1
....
2
39
15
5
1
1
2
33
YY
4
4
9
3
12
21
7
27
10
3
1
20
11
"a
"Y
....
18
1
11
' 6
4
1
4
2
4
6
11
8
3
3
35
2
2
1
4
1
7
51
TOTAL
.10,765 5,615
6,433
1,745
347
391
MONTANA STATE BOARD OF HEALTH
39
Table III following gives the births, deaths, marriages, divorces,
adoptions, infant deaths and maternal deaths by counties for 1945:
TABLE in
1945
County Births
Beaverhead . 50
Big Horn 155
Blaine 92
Broadwater ___. 79
Carbon _. 70
Carter 15
Cascade 1,433
Choteau 52
Custer 347
Daniels 102
Dawson 269
Deer Lodge _ 265
Fallon 102
Fergus 276
Flathead 456
Gallatin 316
Garfield 46
Glacier 231
Golden Valley..
Granite ,. 2
Hill 426
Jefferson 43
Judith Basin ...
Lake 188
Lewis & Clark 398
Liberty 33
Lincoln 106
McCone 6
Mad'son 25
Meagher 6
Mineral ._._ 18
Missoula 806
Musselshell ... 49
Park 197
Petroleum .
Phillios 85
Pondera 120
Powder River . 1 1
Powell 88
Prairie 19
Ravalli 150
R=chland 213
Roosevelt 232
Rosebud 145
Sanders 27
Sheridan 103
Silver Bow 844
Stillwater 33
Sweet Grass .. 31
Teton 20
Toole 98
Treasure 8
Vallev 242
Wheatland 20
Wibaux 4
Yellowstone ... 1,251
Deaths Marriages
Infant Maternal
Divorces Adoptions Deaths Deaths
69
79
37
29
70
6
486
50
146
18
88
332
35
132
235
175
25
84
7
33
133
35
9
97
184
12
66
12
41
15
11
379
38
116
2
47
57
18
67
12
103
68
73
61
38
54
619
22
35
37
47
3
81
16
10
524
301
28
284
44
62
21
33
67
143
25
9
8
719
292
90
8
226
50
40
5
158
21
148
66
98
9
123
57
244
83
218
22
4
62
56
8
12
14
164
65
44
4
13
14
93
47
294
157
15
146
18
17
4
27
21
9
6
232
5
647
226
63
24
154
53
2
1
57
26
30
52
123
70
12
10
2
140
43
298
21
132
45
72
20
165
16
155
6
582
253
84
15
30
8
52
76
24
105
Y9
21
7
118
925
290
1
2
3
1
3
1
50
5
7
3
6
3
13
10
8
1
3
1
"i
77
2
26
5
2
"i
1
1
5
1
26
2
2
2
1
57
13
4
"4
1
31
1
13
10
4
6
14
13
8
3
26
8
12
31
2
2
"2
7
10
6
9
7
1
1
41
" 1
7
5
1
39
TOTAL
10,403 5,378
8,147
2,380
353
357
15
40
TWENTY-THIRD BIENNIAL REPORT
The total births reported in 1944 were 10,765 and was a decrease
under 1943 of 493. The birth rate was 23.1. The National birth rate for
1944 was 20.2. Montana's rate was 2.9 higher than the National rate.
The year 1945 showed a decrease of 362 births as compared to 1944.
There were 10,403 births registered that year, with a rate of 20.8 per
1,000 of population.
SUMMARY OF THE BIRTH STATISTICS OF 1944 AND 1945
1944
1945
Total
10,765
10,403
January
860
843
February
829
750
March
907
916
April
918
878
May
919
913
June
905
881
July
975
965
August
943
879
September
923
909
October
850
839
November
877
813
December
855
817
Males
5,555
5,392
Females
5,210
5,001
Sex ratio
107 males to
108 males to
100 females
100 females
White
10,060
9,694
Indian
567
573
Mexican
97
99
Yellow
18
23
Brown
12
8
Black
11
6
Illegitimate
153
205
Twins
106
114
Triplets
1
Stillbirths
177
171
Births occurred
away from mother's
usual residence
1,695
1,910
MONTANA STATE BOARD OF HEALTH
41
There were 5,615 deaths reported for 1944 with a rate of 12.1 per
1,000 of population. This was an increase of 124 over 1943. The rate
may be compared with the National rate for 1944 which was 10.6.
Montana's death rate was 1.5 per 1,000 higher. For 1945 there were
5,378 deaths registered, a decrease of 237 from 1944. The death rate
was 10.8 per 1,000.
Death Summaries 1944 and 1945 by Month, Sex, Marital State and Color
Deaths
1944
Per Cent
1945
Per Cent
Total
5,615
100.0
5,378
100.0
January
559
503
February
469
408
Mar-ch
507
474
April
462
462
May
450
447
June
471
416
July
458
421
August
386
411
September
419
396
October
443
454
November
496
475
December
495
511
Males
3,493
62.2
3,450
64.2
Females
2,122
37.8
1,928
35.8
Single
1,511
26.9
1,402
26.1
Married
2,321
41.3
2,259
42.0
Widowed
1,455
25.9
1,393
25.9
Divorced
201
• 3.6
208
3.9
Unknown
127
2.3
116
2.1
White
5,262
93.7
5,101
94.8
Indian
290
5.2
206
3.8
Mexican
24
0.4
OO
0.6
Black
20
0.4
26
0.5
Yellow
18
0.3
12
0.2
Brown
1
42
TWENTY-THIRD BIENNIAL REPORT
MARRIAGE
SUMMARY
1944-1945
Month
1944
1945
January
445
542
February
419
442
March
441
493
April
554
505
May
529
509
June
675
795
July
513
696
August
521
734
September
591
784
October
596
864
November
557
846
December
592
937
Total
6,433
8,147
Color
Groom
Bride
Groom
Bride
White
6,205
6,220
7,920
7,917
Indian
127
128
130
141
Yellow
48
50
39
39
Mexican
32
25
32
31
Brown
14
3
7
1
Black
7
7
19
18
Marital State of Those Obtaining Marriage
License
Single
4,488
4,317
5,769
5,327
Divorced
1,512
1,598
1,882
2,118
Widowed
433
518
496
^ 702
Official at
; Wedding Ceremony
Religious
3,635
56.5%
4,716
57.9%
Civil
2,798
43.5%
3,431
42.1%
DIVORCE
SUMMARY
1944-1945
Month
1944
1945
January
148
145
February
124
154
March
122
163
April
130
173
May
133
175
June
164
174
July
133
203
August
176
186
September
161
234
October
189
261
November
116
257
December
149
255
Total
1,745
2,380
MONTANA STATE BOARD OF HEALTH 43
GROUNDS FOR DIVORCE
Cruelty
Desertion
Neglect
Other
970
389
41
147
1,432
466
220
262
PLAINTIFF
Husband
Wife
Other
516
1,222
7
743
1,629
8
THE GREATEST FREQUENCY OF
MARRIAGES AND DIVORCES OCCURRED
1944
1945
County
Marriages
Divorces
Marriages
Divorces
Cascade
653
198
719
292
Yellowstone
636
199
925
290
Silver Bow
545
194
582
253
Missoula
533
153
647
226
Lewis & Clark
240
96
294
157
The marriage rate for the state was 13.8 per 1,000 of population
in 1944 and 16.3 in 1945. The divorce rates were 3.8 and 4.8, respectively.
In 1944 there were 3.7 marriages performed to one divorce granted,
while in 1945 the ratio was 3.4 to 1.
In the marriage summary it will be observed that with the excep-
tion of decreases in the months of February and March and the large
increase in June of each year, there was an almost continual increase in
the marriages by month from the beginning of 1944 through the end
of 1945.
During the two-year period, less than an average of 225 licenses
were issued to other than persons of the white race.
In the summaries by counties it is interesting to note that many of
our less densely populated counties on the borders of the state issue
many more licenses in proportion to population than do the more densely
populated counties in the central portions of the state. This is due,
undoubtedly, to the fact that there is no waiting period or health test
required in Montana as there is in our neighboring states.
For divorces there is a gradual increase by months for the two-year
period. Cruelty is by far the outstanding cause for divorce, and the
wife is the plaintiff in seven out of ten cases.
Respectfully submitted,
L. L. BENEPE,
State Registrar
44 TWENTY-THIRD BIENNIAL REPORT
REPORT OF THE DIVISION OF SANITARY ENGINEERING
Biennial Period Ending October 31, 1946
H. B, Foote, C. E., Director.
W. M. Cobleigh, E. M., A. M., Dean (Emeritus) School
of Engineering, State College, Bozeman, Counsult-
ing Engineer.
C. W. Brinck, M. S., Chemical Engineer and Assistant
Director.
Milton Brown, B. S., Bacteriologist.
Henry Garber, Sanitary Engineer.
Grace Taylor, Stenographer.
To: B. K. Kilbourne, M. D., Executive Officer, Montana State Board
of Health:
I have the honor to report to you the work of the Division of
Sanitary Engineering of the State Board of Health for the biennial
period ending October 31, 1946.
The principal work of the Division of Sanitary Engineering is com-
prised of the following activities:
1. Bacteriological and chemical examination of water samples of
both public and private supplies and for various Federal
Agencies.
2. Field inspections of public and private water supplies.
3. Field inspections of sewage disposal systems.
4. Field inspections and examination of samples in stream pol-
lution problems.
5. Field inspections of public swimming pools.
6. Inspection of plans for public water supplies.
7. Inspection of plans for public buildings.
8. Inspection of plans for public sewage disposal systems and for
waste disposal from industrial plants.
9. Inspection of plans for public swimming pools.
Laboratory Testing of Water
The testing of samples of water makes up the bulk of the laboratory
work. A check upon the condition and operation of public water sup-
plies is obtained by frequent routine bacteriological tests. In order that
each supply will receive proper attention at regular intervals, a calendar
has been prepared which lists for each week the cities to which sampling
equipment is to be sent. By this calendar, plants giving the water
relatively complete treatment, such as filtration and softening, are
PROPERTY OF
U. S. V. A.
MONTAl&R!^t9C4ff^B(^fiB/6E HEALTH 45
ment are sampled once a month. Other plants are sampled from four
to six times a year, the frequency depending upon the character of the
supply or more particularly the source of the water. Those ground
watei's which appear to be the most constant in quality are sampled less
frequently. We have in Montana several public water supplies which
are given no treatment, although taken from surface sources. These
are watched carefully and the sampling is consequently somewhat more
frequent.
The standards of the U. S. Public Health Service, which are applied
particularly to waters used in interstate traffic, promulgated by the Sur-
geon General of the U. S. Public Health Service on February 19, 1946,
call for a minimum of one sample each month from each water supply.
The total number of samples from each supply per month depends not
upon the source and type of treatment, but upon the population served.
This requires, therefore, an acceleration of sampling of those particular
supplies.
In view of the fact that the American Water Works Association has
adopted the U. S. Public Health Service standards for county-wide ap-
plication, poses a question to us as to how it may be possible to increase
our sampling and water testing to bring the schedules into conformity.
The State Board of Health owns a considerable number of insulated
shipping cases and bottles which are used for the collection and ship-
ment of samples. These are sent by express, properly sealed, to the
collector who, after the collection of samples, packs them with ice, seals
and returns them to the laboratory by express, charges collect. The col-
lector is usually the local water superintendent or the health officer,
who is carefully instructed in the matter. For the sealing, a self-locking
tin seal is used on which is stamped the name of the State Board of
Health, and a number for identification. The standard sample bottle
used is of 125 ml. (approximately 4.4 oz.) capacity, with a 34-inch
mouth, and provided with a bakelite screw cap %-inch long. A thin
gasket is placed in each cap.
This system fits very satisfactorily into our extensive territory
where the visiting of supplies is attended by considerable expense. The
local collectors cooperate excellently so that little delay due to their
failure to collect is experienced.
In view of the requirements for larger numbers of samples, it is
probable that we will be obliged to test many public water supplies by
transmitting samples through the mails.
In the testing of water from the many private supplies, samples
are transmitted by mail in mailing tubes, a stock of which is kept on
hand. In the laboratory such samples are tested only for bacteria of
the coliform group, although they are also observed as to their physical
quality, turbidity in comparison with silica standards being measured
and recorded.
In the case of the Indian and National Park Service work, as well
as other government work, the samples have been sent to the laboratory
under Government frank or bill of lading.
46 TWENTY-THIRD BIENNIAL REPORT
There are now in Montana 115 cities, towns, and other communities,
and seven state-owned institutions with public water systems. Of the
total of 149 water sources furnishing water to these systems, 92 are
from ground sources and 57 from surface sources. The population served
in these communities and state institutions is approximately 303,500, or
55 per cent of the total population of 554,136 as shown by the 1940
census for the State of Montana.
Through an arrangement with the State College, Bozeman, the data
obtained from chemical analyses of water samples have been sent to
them for interpretation from the standpoint of the suitability of such
waters for irrigation, in cases where such information is requested.
Inasmuch as the same analytical data can be used for interpretation from
the standpoint of domestic use and irrigation use, this arrangement
eliminates much duplication of analyses. The same may be said of
arrangements with Dr. Butler, of the Livestock Sanitary Board, rela-
tive to the suitability of waters for stock watering purposes.
In any bacterial testing of water, the laboratory follows the stand-
ard methods of the U. S. Public Health Service. In the chemical analy-
ses, either these standards or those of the Association of Official Agri-
cultural Chemists are followed. Our laboratories are well provided with
both equipment and supplies. Brilliant Green Bile confirmatory media
is employed, all lactose broth tubes showing any percentage of gas
being inoculated into the confirmatory medium.
The following tabulation shows the amount of laboratory work done
during the past twenty-four months:
Bacteri- Per Cent
ological Chemical of Total
Samples from Public Water Supplies 8,261 87 78.2
Samples- from Private Water Supplies 1,021 402 13.2
Samples from Tourist Camp Water Supplies 71 2 0.6
Samples from School Water Supplies 250 5 2.2
Samples from United States Government 146 19 1.9
Samples from Miscellaneous Sources 236 175 3.9
(including those from stream pollution studies)
Total 9,985 690 100.0
GRAND TOTAL 10,675
Field Activities
The field work is done by railway, bus and automobile travel, mostly
the latter. It is the intention and endeavor of this Division to see each
public water supply once a year, and the larger ones — especially the puri-
fication plants — oftener. Frequently it is necessary to return to a given
city to make follow-up investigations or to investigate special con-
ditions where they may arise. When investigating these public water
supplies, the city or water company officials are interviewed and the
trips and inspections are made in their company. The owners and oper-
ators of public water supplies in Montana are aware of the necessity
of maintaining proper sanitary conditions and excellent cooperation is
MONTANA STATE BOARD OF HEALTH 47
usually found. In this way the maximum benefits to be derived from
inspections are obtained. For the most part, too, the men in charge
of the public water supplies in this State are awake to the modern trends
in water treatment and water quality.
When in a given city, private water supplies, swimming pools, and
ice fields are visited and inspected as required, in addition to other
public structures, including the municipal sewer system.
Public Water Supply Improvements
There has been little in the way of improvements in public water
supply systems in Montana during the past two years. Such as have
been made have been in treatment and such work as has been necessary
to keep the water flowing. Two new water supplies have been con-
structed, one at Fairfield and the other at Highwood, approximately
1,000 people being served.
New wells to augment the present water supplies have been drilled
at Deer Lodge, Ekalaka, Plentywood, Havre, Wolf Point, Richey, Three
Forks, Twin Bridges, Whitehall, Poplar, and Helena, both for the City of
Helena and the State Vocational School for Girls. In most places the
water obtained has been similar to that previously used. However, at
Three Forks, the water is softer and has a lower fluorine content than
the waters from the two wells which have furnished the city water for
many years. Likewise, at Twin Bridges, the new well for the city will
furnish water of much improved chemical quality.
New distributing reservoirs and new extensions or replacements to
distribution systems have been built or are in progress at Billings, Fort
Benton, Great Falls, Harlowton, and Sunburst. The new storage tank
at Fort Benton is of steel, while those at Great Falls and Harlowton are
of concrete.
It is worthy of note that the extensive improvements in the distri-
bution system at Billings have given a considerable amount of trouble,
especially at one point, in that great difficulty has been encountered in
securing proper disinfection.
The new distribution system at Sunburst replaced entirely the old
system, which was of wood, and in that locality did not withstand the
soil conditions.
At Cascade a new hypochlorite disinfecting plant has been installed
in a new house for the disinfection of water obtained from the springs.
This is also true at Lima where the Union Pacific Railway Company has
installed disinfection of the water furnished their employees and the
citizens of the community.
The new disinfecting equipment at Great Falls has been installed of
a greater capacity so that excess chlorination may be effected.
At Whitefish, the city has installed a liquid chlorine plant in the
pump house so that water drawn from Whitefish Lake in emergencies
may be disinfected.
48 TWENTY-THIRD BIENNIAL REPORT
Emergency Disinfection of Water Supplies
During the past year an emergency hypochlorite plant was installed
in the city pump house at Twin Bridges during an emergency there.
The State Board of Health has secured a second hypochlorite ma-
chine from the Proportioneers Company, which is electrically operated.
This is available for emergency use.
Planning Future Water Supplies
Engineers have been engaged to study the possibilities of and make
plans for a new water supply system at Boulder, Montana. The course
will doubtless be ground water, obtained by the drilling of a well.
At Broadus, it is planned to build a new water system, artesian
water of good chemical quality being available in that vicinity.
At Crow Agency a well has been drilled, and when materials for
distribution systems are available that system will, doubtless, be built.
At Cut Bank, bids will soon be received for the construction of a new
source of water, tests of ground water possibilities to be made first.
Test wells are under construction at Drummond, a community which
is now incorporated, and which hopes to have a new water supply sys-
tem in the near future.
At Froid, Montana, in the eastern part of the state, engineers have
been engaged to design a new water supply system, the water source
doubtless being a well which will have to be constructed.
At White Sulphur Springs, engineers have designed a new intake on
Willow Creek, some new flow line piping, and a new reservoir of ap-
proximately 450,000 gallons capacity, which may be either of steel or
concrete, depending upon relative costs.
At Hardin, Montana, some improvements are planned for the filtra-
tion plant, whereby greater settling capacity will be available.
Engineers have been engaged at Harlem, Montana, to plan for re-
vamping of the whole filtration plant to increase its capacity and to
modernize it.
At Helena, the City Commission has under consideration the build-
ing of an additional flow line to bring more water to the city from the
Ten Mile system.
Improvements in Sewerage and Sewer Systems
There has been considerable activity in extending sewerage facilities
in our various communities in connection with attempts, in most cases,
to provide more housing which is so critically short at this time. Plans
have been approved and work is under way, or contemplated for prosecu-
tion, at Billings, Bozeman, Browning, Chinook, East Helena, Great Falls,
Havre, Helena, Malta, Plentywood, and Shelby.
Plans for new sewer systems have been reviewed and approved for
Broadus, Cascade, Chester, Culbertson, Dutton, Hot Springs, Lodge
Grass and Sheridan.
MONTANA STATE BOARD OF HEALTH 49
Treating plants for sewage on systems already built and in use are
planned for Billings, Bozeman, Chinook, Havre, Plentywood, Conrad and
Choteau.
Populations affected in the above two categories is about 56,000.
The citizens of some communities are seriously contemplating the
need for improved sanitary facilities, and some preliminary surveys and
studies have been made of Boulder, Darby, Drummond, Froid, Gardiner,
Harlem and Rudyard. In some instances Federal aid has been applied
for in these communities, so that the necessary engineering may be
accomplished.
Stream Pollution Studies
Our studies of stream pollution problems have continued much as
they were conducted during the previous biennium. Further observa-
tions and investigations were made on the Yellowstone River at Laurel
and Billings, to a distance of approximately thirty miles downstream.
An intensive study was made of the stream pollution situation at
Great Falls on the Missouri River.
Further studies were made of the Milk River, not only from Havre
through Harlem, but on the lower reaches, especially in the vicinity of
Malta, and downstream therefrom.
Studies were also made on the Big Muddy in the northeast part of
the state, which will be affected profoundly by the program of the U. S.
Reclamation Service under the Missouri Basin Program.
Some isolated points on various streams have been viewed and
studied where the streams might be affected by local circumstances due
to some contemplated waste disposal. Conditions were thus observed on
the Clark Fork of the Columbia, the Flathead, the Ruby, the Beaver-
head, the Boulder, and the Powder Rivers.
There has been little expansion in industrial activity which pertains
to stream pollution. There is much indication, however, that industrial
expansion is contemplated, and already the State Board of Health has
been contacted by industrial processors to determine their responsibilities
and our attitudes concerning various projects.
On the Rattlesnake Creek in Missoula County there are located a
rendering plant and a slaughter and meat processing plant. Because
the wastes from these establishments were discharged to the stream,
users of the stream waters lodged complaint. Court action was finally
necessary before the practice was stopped, the district court issuing
a permanent injunction in the circumstances.
The State Legislature, in 1945, amended the state law relative to
stream pollution in an attempt to protect and preserve the rights of in-
dividual water users in addition to the rights of public water supply
users. This amendment is having a far reaching effect, and is proving
the necessity of a closer control, since the streams in Montana are so
intimately associated with the health and well-being of our rural
50 TWENTY-THIRD BIENNIAL REPORT
citizens. In fact, this amendment is the reason for a considerable volume
of the stream pollution work which has been done during the biennium
just closing.
Drainage Problems
In our last report we called attention to troubles which are com-
monly encountered due to the presence of high ground waters in our
various communities. These problems continue to bother us and city
officials, and, in one case particularly, will be responsible for an added
cost of sewage treatment, estimated by the engineer at approximately
259f over the cost which would otherwise have to be met.
In another case in which the city is obliged to pump the sanitary
sewage, the volume of ground water infiltrating to the sewer system is,
in effect, overloading the pumping plant, and is causing an excessive
pumping cost.
This is a problem with which most built up communities are con-
fronted, and it is necessary to establish policies regarding such problems
to the end that the burdens caused by such high ground water will be
reduced and the troubles controlled.
It is our opinion that the engineering problems confronting the com-
munity engineers and adpiinistrators should be thoroughly studied, vari-
ous methods of control should be planned, and the cost evaluated. The
treatment of large volumes of infiltration water where sewage treat-
ment is required is an unreasonable financial burden. All infiltration
water should be excluded from new sewers, and ground waters should be
lowered by proper drainage, by other means than through the sanitary
sewage system.
Miscellaneous Activities
The Director and members of the staff have been called upon to
take part in various conferences and meetings.
On December 11, 1944, your Director was invited to talk to the
Montana Society of Engineers, holding a meeting in Butte. On this
occasion the topic was "Public Water Supplies — Big Business." The
subject matter presented was regarding all the water supplies in the
state, the volumes of water delivered, and the population served. It was
shown that through improvement in the sanitary quality of public water
supplies, the death rate from water borne diseases had greatly decreased.
In January of 1945 a trip was made to New York City in connection
with a meeting of Secretaries of various sections of the American Water
Works Association. Being secretary of the Montana Section, your Di-
rector attended this two-day conference. It was productive of much
value in the conduct of the American Water Works Association Section.
In October, 1945, the Red Cross held a conference in St. Louis to
which were invited the State Sanitary Engineers of this area. Your Di-
rector attended this conference and took part in the discussions which
had to do primarily with the subject of disaster relief. From the dis-
MONTANA STATE BOARD OF HEALTH 51
cussions there developed a better understanding- of the respective func-
tions of sanitary engineers in health departments, and of Red Cross
workers where they are called to assist in disaster relief.
On three occasions talks were given to Public Health Nurses re-
garding the work of the Sanitary Engineering Division. The purpose of
these meetings was to acquaint the Public Health Nurses with the func-
tions and scope of work so that, in their contacts vv^ith the people in
their respective districts, they could intelligently advise concerning as-
sistance to be obtained in respect to sanitation of water supplies, sewage
disposal, and school houses.
At the instigation of this staff, an invitation was sent to all drillers
of water wells in Montana to attend a conference in Helena, at which
various subjects might be discussed to the material benefit of the well
drillers and the State Board of Health. This meeting was held in Hel-
ena on March 22 and 23, 1946, with 23 well drillers in attendance. The
total registration, made up of well drillers, State and Federal officials,
and others interested, was 44. Out of this meeting came the expres-
sion, on the part of the well drillers, of a desire to form a State Asso-
ciation. A president and secretary were elected, and an agreement was
made to meet, as an association in November of this year.
In July of 1946, at the request of the people at the State College in
Bozeman, your Director attended and spoke to the conference of health
workers. The subject was "Rural Sanitation," and the occasion was
the meeting of the Health Education Workshop. A model farm house,
surrounded by a fence, and with a well, cistern, and septic tank was used
for illustration.
In September of 1946, at the invitation of the U. S. Army Officers
stationed at Fort Peck, your Director attended a conference at which
plans for the development of recreational areas around the shores of
the Fort Peck reservoir were explained. Our expressed opinion was that
the plans, as outlined, should result in expanded recreational facilities
for a large number of Montanans, and the surroundings will be healthful.
In October, 1946, at the invitation of the Program Committee of
the American Society of Civil Engineers, a brief write-up of Sanitary
Engineering in the Missouri River Basin was prepared to be presented
to that Society when they met in annual convention in Kansas City.
In addition, there have been many conferences with city engineers,
health officers, and city councilmen regarding various matters of muni-
cipal sanitation.
Certification of Water Supplies
The U. S. Public Health Service has assisted the State Board of
Health in inspections necessary for certification of waters used on
interstate carriers. The work of these officials has largely been in the
inspection of watering point sanitation. We have made the water. supply
inspections. In 1944, seventeen reports and recommendations were made,
calling for 14 approved and 3 provisional certificates. In 1945 we made
reports and recommendations covering 17 supplies, 14 of which were
52 TWENTY-THIRD BIENNIAL REPORT
approved and 3 of which were provisional. The work for 1946 is not
yet completed.
Tabulation of Field Work
The following tabulation shows the amount of field work done dur-
ing the past twenty-four months:
Per Cent
No^ of Total
Inspection of Public Water Supplies 299 44.8
Inspection of Private Water Supplies * 23 3.4
Inspection of Sewage Disposal Systems 160 24.0
Inspection of Swimming Pools 12 1.8
Miscellaneous Inspections 173 26.0
Total 667 100.0
For the State Planning Board
At the request of Governor Ford, special studies were conducted at
the State Training School at Boulder and the State Orphans' Home at
Twin Bridges. The facilities given special consideration were water
supply and sewerage, and recommendations were made and presented
to the State Planning Board.
At Boulder, where the gravity flow line from South Fork of the
Boulder River is badly deteriorated, recommendation was made to de-
velop the total water supply from three wells to be drilled on the ground
of the institution.
Also, at that institution, the sewerage should be improved to col-
lect all sewage from the two school areas at a common point, there to
construct a suitable treatment plant of the mechanical type.
At Twin Bridges, chemical treatment of the present water to pre-
vent corrosion is the recommendation. This treatment, using a meta-
phosphate in the form of a ball, is now being applied. It is too soon to
conclude as to all the advantages but improvement is said to be notice-
able after but a few weeks of use.
The sewage from this institution should be treated (it is now dis-
charged untreated to the Beaverhead River) and recommendations were
made to collect all wastes at a common point, there to treat them. It is
hoped that, after treatment, no discharge to the river will be necessary,
but that the plant effluent may be spread on adjacent land.
Office Work
The office work consists of the writing of reports on all laboratory
work done, or field investigations made, and in replying to letters of in-
quiry relative to matters which concern this Division. It also includes
the inspection of plans which are submitted for various public water sup-
ply and sewage disposal systems, school buildings, and swimming pools.
PROPERTY OF
U. S.V.A.
BRANCH OFFICE NO. 11
MEBICAI. MONTAUTAc^fTETE FS^^SE^fi^^ff^RENCE tlBMARY
Fees
The only source of income collectable by this Division is the annual
fees levied against public water supplies.
By July 1, 1945, (fiscal year 1944-1945) $3,720.00 had thus been col-
lected, and by July 1, 1946 (fiscal year 1945-1946) $3,260.00 were col-
lected.
This money has been deposited with the State Treasurer as received.
Examination of Plans
A total of 88 plans were examined during the past 24 months, classi-
fied accoi'ding to the following tabulation:
New City (Public) Water Systems 1
Extensions and Improvements to Existing Public
Water Systems 18
New City (Public) Sewer Systems (Including
Treatment Plants) 10
Extensions and Improvements to Existing Public
Sewer Systems 30
Other Industrial Sewage Disposal Systems 1
New and Additions to Public School Buildings 17
Miscellaneous (Mostly Public Buildings) 5
Sanitation of War Housing 2
Total 88
Montana Section, American Water Works Association
Our Section of this national association is active. Its 20th and 21st
annual sessions were held in Lewistown in 1945 and in Butte in 1946.
After 20 years as Secretary-Treasurer (one year as Chairman) your
Director resigned and Mr. Brinck, of the staff, was elected to succeed
to the position.
Montana Sewage Works Association
This association, formed in 1944, held its second meeting in Butte
in 1946.
The membership now numbers 34. We are a member of the Federa-
tion of Sewage Works Associations, a nationwide organization. Your
Director is Secretary-Treasurer.
Personnel
Mr. C. W. Brinck, Sanitary Engineer and Assistant Director, re-
turned on January 1, 1946, to the Division, following his service in the
Army during the war.
Miss Grace Taylor has served as stenographer since January 1, 1946.
Dean W. M. Cobleigh has served as Consultant, doing much of the
field and report work in connection with our stream pollution study ac-
tivities.
54 TWENTY-THIRD BIENNIAL REPORT
Mr. H. E. Garber, and Mr. Milton Brown have continued on the
staff.
All members of the staff have given full measure of service dur-
ing this period.
For the Future
During the coming years it is anticipated that this Division will
continue the activities so far found by experience to be fully justified
and should be ready to extend its activities as demanded by conditions
in the state as they develop and change.
Such activities as the sanitary surveys, work on fluorine content
of waters, the testing of sewage treatment plants to determine their
efficiencies, the technical instruction of water and sewage plant oper-
ators and the assisting of the general public through circulars of in-
formation concerning sanitation are among the more important ac-
tivities seen at this time.
The present staff is kept constantly busy and is the minimum which
should be maintained if the services for which we are called upon are
to be satisfactorily performed.
During the past two years there have been examined chemically 690
samples, 402 of which have been for individuals who desii'ed the in-
formation for their own home use. Increased information concerning
fluorine contents of waters and the affect of this material in conjunction
with other mineral ingredients on the health of young children is re-
sulting in more demands for this type of work. The increased use of
electricity in rural areas and the desire of our rural population for softer
and better water supplies have resulted in a marked increase (not count-
ing the special work of two years ago in connection with arsenic poison-
ing). The work is greater than possible for the one chemist now em-
ployed for all analytical work of the Food and Drug and the Sanitary
Engineering Divisions. An additional chemist is needed.
Another Sanitary Engineer should be employed full time to meet
adequately the expanding work of this division.
Conclusion
In concluding this report, it is our pleasure to express appreciation
for the cooperation given this Division by the other divisions of the State
Board of Health, and also the valuable assistance given us by W. M.
Cobleigh, Dean Emeritus of the State College at Bozeman. The engi-
neers of the U. S. Public Health Service have also given us valued as-
sistance whenever we have requested it. For this we are grateful.
Respectfully submitted,
H. B. FOOTE, Director,
Division of Sanitary Engineering.
MONTANA STATE BOARD OF HEALTH 55
BIENNIAL REPORT OF THE FOOD AND DRUG DIVISION
November 1, 1944 to October 31, 1946
To: B. K. Kilbourne, M. D., Executive Officer:
It is my duty and privilege to herewith submit the biennial report
of the Food and Drug Division of the Montana State Board of Health
for the period beginning November 1, 1944 and ending October 31, 1946.
The Food and Drug Division of the State Board of Health functions
to protect the health of the people by securing for them as far as pos-
sible, foods and drugs that are not adulterated, misbranded, handled, or
served under insanitary conditions. Work is conducted under authority
of the State Food and Drug Act of 1911 and consists of:
1. Cooperating with local, county, and reservation health officers
in making inspections.
2. Enforcing regulations adopted by the State Board of Health
under authority granted the Board by law.
3. Licensing food handling and food manufacturing establishments
as required by law.
4. Revoking licenses of insanitary establishments.
5. Collecting samples of food and drugs for laboratory analysis to
determine whether or not they comply with the law.
6. Prosecuting those found selling illegal foods or drugs or other-
wise failing- to comply with the Food and Drug law.
7. Cooperating with Federal authorities in the control of interstate
shipments of foods and drugs.
In addition to the duties of the Food and Drug Division as concerns
actual food and drug work, the division is required to enfoi'ce the Mon-
tana Mattress Act of 1941, which requires sterilization and disinfection
of all second hand materials used in mattresses or bedding, and the law
also requires the proper labeling and tagging of all mattresses. No ad-
ditional money has ever been appropriated by the legislature for the
additional personnel necessary to enforce this law. As a result, the en-
forcement has been carried on by mail only, and the department has con-
cerned itself only with proper labeling of products shipped into the state.
The 1945 session of the legislature passed a bill authorizing the
State Board of Health to inspect homes for the aged and provided fur-
ther that reports of these inspections be made to the Department of
Public Welfare. Here again, the legislature made no provision for ap-
propriating any money for the hiring of personnel necessary for quarter-
ly inspections, as required, and as a result, the department has checked
only those establishments on which we have received complaints.
The Food and Drug Division is also charged by the Secretary of the
State Board of Health with the enforcement of the State Narcotic Act.
56 TWENTY-THIRD BIENNIAL REPORT
This act provides for the inspection of pharmacies and hospitals in an
effort to determine whether they are keeping adequate records as re-
quired by law. The law also requires that narcotics be properly stored
in order to protect those handling the narcotics as well as the supply
itself. In the biennium of 1940-1942, in cooperation with the State
Board of Pharmacy, the Food and Drug Division did inspect all phar-
macies and hospitals. In the bienniums 1942-1944 and 1944-1946 no in-
spections of this type were made. No provision has ever been made in
appropriations to the Food and Drug Division for an adequate inspec-
tion program as required by law.
The 1945 session of the legislature also enacted two companion bills,
one requiring that restaurants employing five or more persons provide
proper rest rooms and locker facilities for employees. The companion
bill provides that all establishments where employees are required to
stand for long periods of time on concrete floors must provide adequate
matting protection. It has been impossible to enforce the provisions of
this act during the critical shortage period we have experienced during
and since the war. Personnel has not been available to make adequate
follow ups on inspections and owners of establishments have not been
able to acquire supplies for properly equipping their establishments.
INSPECTIONS
Since early in 1942, the Food and Drug Division of the State Board
of Health, in common with many other departments, has operated with a
smaller personnel than is the usual custom. According to the law of
the State of Montana, the local health officers and their deputies are
supposed to check and inspect every establishment within their areas
once each thirty days, and a complete report is to be mailed to the State
Board of Health.
To facilitate this inspection work, blanks are furnished for noting
sanitary conditions about the establishments, and they are to be graded
or scored according to conditions noted. The ideal situation is one in
which the local health officer handles all minor complaints and violations
without asking for aid from this office. However, it is customary for
most local inspectors or health officer's to consult with us concerning
these violations, and we are called upon to write many letters concern-
ing the conditions which have been noted.
During the past biennium, the inspections made by local health
officers have remained at approximately the same level as during the
previous biennium. Part time and local health officers, generally speak-
ing, do not make inspections as required by law. The State of Montana
is still suffering from a sevei'e shortage of doctors and most local health
officers are on a part time basis, and the press of private practice does
not allow time for adequate inspection programs.
Five counties of the state operate under the county-city health unit
plan. However, of these five counties, at the present time there are only
four that have full time sanitary inspectors. Despite this fact, these
four sanitary inspectors furnish the larger share of the reports re-
MONTANA STATE BOARD OF HEALTH 57
ceived from the county officers. In one city of the state there is a city
inspector who reports regularly to the State Board of Health. This city
is in a county which does not have a full time city-county unit.
During the past two years we have received from health officers
and inspectors a total of 12,676 inspections. The bulk of these have
come from those departments maintaining full time sanitarians. It is
the experience of this department that adequate inspections are made
only when a full time sanitarian is employed. The full time local health
officer has too many matters of medical importance to allow him to
spend the time necessary for good inspections. In the past two years,
the number of state made inspections has fallen considerably. The total
number of inspections made by state inspectors was 2,468. There are
a number of reasons for this decrease in state inspections. Of primary
importance is the lack of personnel. From September, 1945 to Novem-
ber, 1945 the state department had no inspectors. From April, 1946 to
May, 1946 there were no inspectors, and since September 1, 1946 the
state office has not had any personnel in the field. At no time since
1944 has the state had more than one inspector. Lack of transportation,
adequate salaries, and trained men has made it imDossible for the Food
and Drug Division to maintain any field force of any consequence. This
condition has existed, even though the amount of work which we have
been required by law to do has increased considerably.
Tourist camp inspections and tourist camp licensing decreased dur-
ing the year 1945. In 1945 there were licensed 380 tourist camps and
guest lodges. The year 1946 showed an increase over 1945, but is still
below the licensed camps operating in 1941. In 1941 the division li-
censed 532 camps and in 1946 licensed 475. Due to the severe housing
shortage existing in most communities throughout the state, a great
many tourist camps are operating on a full time rental basis and be-
cause of this fact are not subject to the license lav/s of 1929. Prior to
1941 all tourist camps in the State of Montana were graded on an A,
B, C, rating. Since 1941 no camps have been graded, and it is doubtful
whether such grading can be resumed for the year 1946. The Montana
Tourist Camp Owners Association relied on these grades to establish
membership in their organization, and in a recent conversation with the
past president of the organization I learned that the maintenance of
membership will again be based on our graded ratings. We have, how-
ever, furnished to various persons lists of tourist camps operating with-
in the state, and these lists have been used for advertising purposes.
Lists are furnished to the Montana State Chamber of Commerce each
year.
LICENSES
Since 1921 licenses have been required of all food handling establ-
lishments within the State of Montana. These establishments include
public eating places, meat markets, manufacturing bakeries, delicates-
sens, confectioneries, bottling works, canneries, soda fountains, ice cream
parlors, soft drink establishments and beer parlors, tourist camps, and
guest lodges. The licenses required of tourist camps were included in
an act passed in 1929.
58
TWENTY-THIRD BIENNIAL REPORT
Listed below are the number of licenses collected and the fees for
those licenses over a period of years extending back to the year 1922.
Food Camp Fees
Year Licenses Licenses Collected
1922 2,974 . . $ 5,948
1929 4,268 117 8,770
1936 5,116 322 10,876
1938 5,413 480 11,786
1940 5,773 558 12,662
1942 5,405 460 11,730
1944 4,409 341 9,500
1945 .- 4,561 380 9,882
1946 5,163 475 11,276
Licenses issued by the State Board of Health are primarily regula-
tory. Under the law an establishment operating in an insanitary or un-
satisfactory manner may have its license revoked and the establishment
ordered to be closed until such time as it is placed in good condition.
We have attempted to use this authority only as a last resort and only
if the operator of the establishment has been warned of the insanitary
conditions and given ample time in which to correct them.
We have, in connection with these inspections, a new system of
duplicate checking on all establishments in the state. By devising an
inspection form which can be carried by the sanitary inspector, the in-
spector is able to look back to former inspections and check to see what
improvements have been made. Any letters or recommendations pre-
scribed for insanitary establishments are attached to these inspections
in order that the inspector may refresh his memory. We have found
that this system has been quite satisfactory and has resulted in con-
siderable improvement.
In 1946 the number of licenses issued increased considerably over
1945. This, we believe, is due to two factors: first, a large turn-over
in ownership of establishments, and second, an actual increase in the
number of establishments. During the biennium 1943-1944, there was
a steady decrease in the number of establishments. This figured out
approximately 13 Or. This decrease corresponded quite closely to a de-
crease in population of the same percentage. At the present time, the
Vital Statistics Department is using the 1940 census as a basis for their
figures. Therefore, the increase in the number of licensed establishments
corresponds closely to the increase in population. More public eating
place licenses have been issued in 1946 than in any year previously. It is
expected that with the lifting of war time restrictions our license figures
in 1947 should correspond very closely with the peak year of 1940.
FOOD ESTABLISHMENT SANITATION
It is fundamental that any establishment operating to manufacture
or dispense foods or beverages must have good water, fly-tight toilet
facilities, and adequate, prompt disposal of garbage. It is also neces-
sary that all work areas, store rooms, and utensils be kept in good con-
MONTANA STATE BOARD OF HEALTH 59
dition and adequate refrigeration be provided for spoilable foods in the
amounts usually kept on hand. Personal cleanliness of those engaged
in the preparation , distribution, and sale of foods is also very important.
Probably one of the greatest hazards with which we have to contend
in this present day and age is the improperly washed glass, knife, fork,
spoon, or other utensil with which the mouth may come in contact dur-
ing eating or drinking. Such improperly washed materials may be re-
sponsible in part for the spread of such diseases as mumps, diphtheria,
tuberculosis, measles, influenza, cerebrospinal fever, whooping cough,
Vincent's Angina, lobar pneumonia, common colds, scarlet fever, and
German measles.
PROSECUTIONS
The Food and Drug Law does not provide for, nor is it the policy of
the State Board of Health to prosecute every violation of the laws or
regulations. However, continued violation and disregard of warnings is
followed by complaints being filed with the county attorneys having
jurisdiction. This often does not mean the guilty party is punished as
provided for by law. At certain seasons, notably election years, it has
been difficult to get some county attorneys to take any action.
It would be advisable for the Board to be able to retain their own
attorney to whom all cases for prosecution could be referred for prompt
and efficient action and eliminate the dilatory methods employed by
some county attorneys.
Fines collected as a result of prosecution for violation of the Food
and Drug laws are deposited with the State Treasurer to be placed in
the General Fund.
Only one complaint against a food handling establishment has been
filed in the past biennium. The case was tried in a justice court and a
conviction was obtained against the offender. The place in question
has since been sold and is now being operated in conformity with the
laws of the State of Montana. The department has still continued the
policy of notifying offenders by way of the county attorney, who in-
forms them of the consequences if violations are continued.
As mentioned before, the shortages existing in building materials
and equipment for food handling establishments has resulted in a more
liberal policy on the part of the department in the prosecution of of-
fenders. We realize that it is next to impossible for establishments to
obtain materials which they need to improve the sanitary conditions of
their establishments. Until the establishment of the Civilian Production
Office, the Food and Drug Division was able to certify establishments
for materials. However, since the freezing of materials for veterans'
housing, the department is no longer able to certify for building ma-
terials, and as a result, we have tried to relax our regulations suf-
ficiently to allow operation of establishments, even though they are not
in the best of condition. We have confined our sanitary inspection work
mainly to proper dish washing facilities, and proper handling of food.
Good sanitary conditions can be obtained in most any establishment
when these two features are observed.
394
42
1
3
7
738
738
1
9
12
12
5
5
5
15
4
5
3
14
549
549
60 TWENTY-THIRD BIENNIAL REPORT
The sanitary condition of food handling establishments is about the
same as it has been during the preceding biennium. We have tried to
carry on in the field a limited educational program to aid employers and
employees.
LABORATORY
In the past two years the laboratory has analyzed 1,780 samples.
The following table shows how these samples were classified in the
laboratory.
1944-1946
Not Investi- Un-
Passed Passed gational official Referred Total
Meat and Meat Products 298 96
Carbonated Beverages 31 11
Drugs 1 2
Dairy Products
Fruits and Vegetables 4 4
Liquor
Poisons -.
Miscellaneous 1 1
Water Samples
Chemical analysis of water samples are added in the total inap^nu'^'i
as the work is done in the Food and Drug Laboratory by Food and Drug
Personnel. Further tabulation of water samples will be found in the
report of the Sanitary Engineering Division.
Although the total number of samples analyzed in the laboratory
decreased from the previous biennium, the total number of tests made in
the laboratory reinained about the same. This means that the work
which we are now doing is more complete and that there are not as
many routine samples run as has been done previously. Chemical
analyses in the laboratory are becoming more specialized.
In addition to the work done directly for the Food and Drug Di-
vision and the Sanitary Engineering Division, the laboratory also does
analysis work for the Dairy Division and the Horticulture Division of the
Department of Agriculture, analyses for the Liquor Control Board, the
State Purchasing Agent, and upon request, for law enforcement officials.
The results of our meat analyses in 1945 were sent to the Office of Price
Administration to aid in fact finding and enforcement.
Miscellaneous analyses included samples of:
Lunch Meat Black Pepper
Tallow Peaches
Soft Drinks Liquid Soap
Disinfectants Popsicles
Soap Bone Meal
Olive Oil Other Items
Aid was given to several law enforcement officials in the analyses
of drugs suspected of causing poisoning, and aid was given also to sev-
MONTANA STATE BOARD OF HEALTH 61
eral officials in autopsy work. Three samples were run for the sheriff
of Park County, and in one sample the laboratory found barbiturates.
The specimens analyzed were found on a man suspected of kidnaping.
Tests for poisons were run on samples sent in by Doctor Farr of Billings.
The results of these tests were negative. A sample of meat was ana-
lyzed for Harry Ramsey, sanitarian of Fergus County, who reported a
considerable amount of dog poisoning in the City of Lewistown. The re-
sults were negative. A sample of reducing pills was run for dinitroph-
enol. A sample of insecticide was analyzed upon complaint of a user
who was burned severely. This case was investigated in cooperation
with the Federal Food and Drug Administration. A sample of wine sus-
pected of poisoning was analyzed for the Chief of Police of Kalispell,
Montana. A stomach and its contents were analyzed for the County
Attorney of Madison County. A sample of tooth powder and stomach
contents were analyzed for the sheriff of Lewis and Clark County and a
positive test for strychnine was obtained. A sample of viscera sent in
by Doctor Ohlmacher of Missoula was analyzed and traces of pheno-
barbital were found in the brain. In all, a total of fifteen samples were
anaylzed for poisons of various types.
The following table shows the official action taken by the laboratory
on samples analyzed in our laboratory during the previous five bien-
niums.
1937-38 1939-40 1941-42 1943-44 1945-46
Samples Passed 183 1,775 1,549
Samples Not Passed 143 1,325 778
Unofficial . ^ 28 385 39
Investigational .- - 167 95 102
Referred to Other Depts. 447
Water Samples 208
957
335
353
114
12
11
41
10
668
761
634
549
521 3,580 3,119 2,666 1,780
SPECIAL INVESTIGATION
Special investigations were carried out in cooperation with the Fed-
eral Food and Drug Administration. Samples were collected in Butte,
Great Falls, and Billings of Colusa Oil. This oil is a pure, unrefined
petroleum product and bore false claims as to curative powers. Vinegar
samples were collected in Butte at the request of the Federal Food and
Drug Administration.
The Federal Food and Drug Administration called on the Food and
Drug Division for assistance in inspections of the Eddy Cake Factory in
Helena, Montana. Inasmuch as the Federal Food and Drug Adminis-
tration did not have any representative in the State of Montana, the
Food and Drug Division and its personnel were deputized to carry on
investigations at their request. The cake factory was inspected on
June 27, again on July 20 and on October 23, 1945. Two of these inspec-
tions were made in company with federal inspectors. In connection with
the inspections made of the Eddy Cake Factory, the director of the Food
and Drug Division and Mr. Flemming, inspector of the Food and Drug
62 TWENTY-THIRD BIENNIAL REPORT
Division were subpoenaed as witnesses at a Federal Court hearing
on August 7, 1945. The Food and Drug Division called for aid
from the Federal Food and Drug Administration in the sam-
pling of three thousand pounds of coffee delivered in Helena. This
coffee was reported as being contaminated by an arsenic moth spray en
route. The Director of the Division, in company with Mr. McKinlay of
the Federal Food and Drug Administration sampled the coffee and sam-
ples were analyzed in the laboratory in Helena. Negative results were ob-
tained and the coffee was returned to the shipper. At the request of the
Federal Food and Drug Administration, the director of the division su-
pervised the destroying of two hundred eight packages of fig bars
which were found to be moldy. Mr. Purvis, sanitary inspector for Mis-
soula County, supervised the relabeling of canned beans in a warehouse
in Missoula. These beans were incorrectly labeled and the Federal Food
and Drug Administration asked for aid in supervising the relabeling.
Mr. Shea, Sanitarian for Cascade County, ordered the destruction of
wormy peanuts found in a warehouse in Great Falls.
At the request of Mr. McMaster of the Dairy Division of the De-
partment of Agriculture, the director of the Food and Drug Division, in
company with Mr. Foote of the Sanitary Engineering Division, investi-
gated the water supply and sewage disposal at the Central Park Cheese
Factory in Gallatin County. Special investigations were also made by
the director of the division at the canning plants of the Red Lodge Can-
ning Company in Stevensville and Red Lodge. These inspections were
made prior to the beginning of the canning season at the request of the
canning company. A special investigation was also made at the Bitter-
root Canning Company in Hamilton. Mr. Bain, Sanitarian for the City
of Billings, embargoed fifty-four gallons of orange concentrate contain-
ing monochloracetic acid. Samples of canned peas were collected in
Great Falls at the request of the Federal Food and Drug Administra-
tion. Since November 1, 1945, the Federal Food and Drug Administra-
tion has a resident inspector assigned to the State of Montana. This was
done largely at the request of the director of the Food and Drug Di-
vision in order that more efficient administration of the federal laws
could be made in the state. At the same time, the State of Montana was
placed solely under the supervision of the Seattle Station of the Federal
Food and Drug Administration.
At the request of the United States Public Health Service, the di-
vision also conducted investigations concerning garbage disposal in cities
throughout the state. A questionnaire was sent out to the cities, tabu-
lations were made of the results, and put at the disposal of representa-
tives of the Public Health Service. Three special inspections were made
of the Havre Bottling Works in Havre, Montana. This work was done
because of complaints arriving from users of products of the plant.
Extraneous material of one type or another was reported to this office
and it is hoped that the situation has now been corrected.
HOTEL INSPECTION
The Montana Hotel Law provides that the State Board of Health
shall adopt rules for the enforcement of the Act and also shall have au-
MONTANA STATE BOARD OF HEALTH 63
thority to engage or appoint such assistants or inspectors as may be
needed in enforcing the Act. Under this authority it has been made the
duty of each city, county, or reservation health officer to make an an-
nual inspection of all hotels in his district. Blanks are furnished the
health officer by the State Board of Health so that a report can be sub-
mitted as to the condition of the establishment. Copies of the state hotel
laws and regulations are furnished for distribution. Particular stress
is laid on cleanliness, length of sheets, ventilation, fire escapes, and gen-
eral sanitation.
CLERICAL WORK
Since the Food and Drug Division has been able to employ a full
time stenographer the office work has increased considerably. Collec-
tion reports concerning the analyses of samples collected are returned
more promptly. All food handling establishments having a grade below
90 are written and have letters concerning conditions which must be met
to satisfy the regulations. These letters are now sent out within two
weeks after the inspections have been made.
By revising our' license forms and application forms, the mailing of
licenses and the handling of moneys collected is more efficient and ac-
curate.
Due to the fact that the division has several new duties, the actual
office administration has become increasingly heavy. It is necessary
that mimeographed copies of various laws be made available to all in-
terested persons and this requires a considerable amount of time spent
in mimeographing and mailing. With the increase in special investiga-
tions required by these laws, it is also necessary that long reports be
made to other agencies in the state, and this, in turn, necessitates addi-
tional work. Since the end of the war, inquiries have become increas-
ingly heavy concerning insecticides and fungicides and their laws. Spe-
cial files have been set up to handle the amount of work caused by these
inquiries. Development during the war of new insecticides and fungi-
cides and disinfectants has caused a tremendous increase in the number
of inquiries concerning these products.
MISCELLANEOUS ACTIVITIES
During the 1945 session of legislature, the Food and Drug Division
again attempted to have enacted a Uniform Food, Drug and Cosmetic
Act. Copies of the proposed act were prepared and mailed to all legis-
lators prior to their arrival in Helena. The bill was introduced in the
Senate by Sherman Smith, Senator from Lewis and Clark County. The
director of the division was required to appear at a hearing concerning
this act. The main opposition arose because of the fact the Federal
Food and Drug Act was used as a model, the main contention being
that in using federal regulations as a standard, the Food and Drug Di-
vision would in turn be indebted to the federal government and become
a sounding board for them. It was admitted by various members of the
committee hearing this bill that the opposition was unfounded. How-
ever, the bill was killed in committee. During the past biennium the
64 TWENTY-THIRD BIENNIAL REPORT
director of the division has been called upon to make more and more
personal appearances before groups interested in public health. Ad-
dresses were delivered to two bottlers conventions, to the meat packers
association, and to the Home Econom.ics classes at the Montana State
College. In addition, talks were given to three public health nurses'
institutes and to nurses in training at Great Falls. One talk was de-
livered to the public health nurses during the Public Health Association
meeting held in Helena in 1946. This talk was concerned with the proper
sanitary operation of school lunch programs. In 1945, the director of
the division was appointed to serve on the Montana Nutrition Committee
and has attended four meetings held in Bozeman. The director also ap-
peared before the Medical Association Auxiliary of Lewis & Clark County
and two special meetings of the Parent-Teachers Association of Helena.
As a result of pressure brought to bear on the Board of Health of Lewis
& Clark County, a sanitarian was appointed in April of 1946. Several
meetings were held with the local Board of Health and the Parent-
Teachers Association concerning this program. Special investigations
were made of the Montana Home for the Aged at Billings, as required
by an act of the 1945 legislature. Two other inspections were made, one
in Three Forks, and one in Bozeman of homes for aged. Reports of these
inspections were made to the Department of Public Welfare. A talk
was delivered to the Montana Federation of Labor at their annual meet-
ing in Billings in 1945. An explanation was given to the federation of
the difficulties involved in adequate restaurant inspection and enforce-
ment of the 1945 law. It was explained to the federation that because
of the lack of personnel and the inability of restaurant operators to re-
model their establishments, a considerable time would have to elapse be-
fore adequate enforcement of the law could be attained.
PERSONNEL
During the past two years there has been considerable turnover in
personnel in the Food and Drug Division. As explained previously, it is
difficult to get men to work in the field. Lack of adequate financial
means prevents the payment of salaries necessary for the hiring of good,
trained men, and in some instances when men were willing to work, lack
of transportation prevented their employment. Credit must be given to
R. M. Fleming, who served with the Department until September, 1945,
to John Martello, who served as an inspector from November, 1945 to
April 1, 1946, and to Hugh Butler, who served from May 1, 1946 to
September 1, 1946. The bulk of the laboratory work during the past
biennium was done by L. S. Champa, Senior Chemist, who has since
transferred to the Industrial Hygiene Division. Since March 1, 1946
Matt A. Klein has been serving as Junior Chemist in the laboratory. The
director of the division and Marjorie Kennett, Senior Stenographer, are
the only ones of the personnel who have served completely through the
biennium.
The present trend in food and drug work indicates that certain
changes should be made in the present operating program of the di-
vision. Experience has show^n that sanitary inspections should be made
more frequently if the sanitation program is to be successful. Trends
MONTANA STATE BOARD OF HEALTH 65
also indicate that the division should expand its educational activities
and should extend to those persons working in food handling establish-
ments a planned course of study, administered by local or state health
departments, in order that they may learn proper sanitary procedures.
Cooperation of employers and employees is essential in a program of this
type. If the maximum efficiency is to be obtained, the division must
increase its field force. This increase is necessary until such time as
there are provided more fulltime local health units employing full time
sanitarians. It is to be hoped that with the enactment of the new dis-
tricting law more counties will avail themselves of the opportunity of
having full time health districts. Inspections should be made of all food
handling establishments at least once each thirty days in every town
and city throughout the state. In this way, and this way only, can
adequate inspection program be attained.
With the increased variety of work handled in the laboratory, and
presuming that our field personnel will again be at strength, more space
and more equipment is needed for the carrying on of proper laboratory
routines. Our present laboratory can adequately accommodate two
chemists, and at times conditions become crowded with only two men.
Changing methods of analyses require the purchase of new equipment
from time to time. Under present conditions, it is impossible to house
new equipment needed. With an increase, either in the state staff, or
an increased number of sanitarians due to the establishment of local
health units, the administration problems will increase. If our work
is to be properly carried on, more clerical help will become essential.
This is particularly true because of the increase of duties imposed on the
department by new legislation. Present facilities could not possibly
provide adequate space if the department is to carry on all its work to
the best benefit to the people of the state. It is hoped that the legisla-
ture will see fit to consider the establishment of a combined laboratory
building in which the Food and Drvig Division could be housed.
The program of the Food and Drug Division during the past two
years has suffered severely because of lack of personnel caused by a
shortage of funds and transportation facilities. The program of the di-
vision has been cut down to contain the most essential items, and it is
the belief of the director of the division that these essential items have
been handled to the best advantage of all concerned.
The department gratefully appreciates all cooperation received from
all divisions of the State Board of Health and from all local health units.
Respectfully submitted,
ELTON M. ANDREW,
Director,
Food and Drug Division.
66 TWENTY-THIRD BIENNIAL REPORT
REPORT OF THE KYGIENIC LABORATORY DIVISION
Biennial Period 1944-1946
Edith Kuhns, B.S., Director.
Harry P. Gelsing, B.A., Assistant Director
Helena Wolfe, B. A., Senior Bacteriologist.
Florence V. Goedert, B. S., Junior Bacteriologist.
Kathryn Deloug-hery, B. S., Junior Bacteriologist.
Harold Barnes, Laboratory Assistant.
Annabelle Houchin, Intermediate Stenographer.
Lynette R. Johnson, Junior Stenographer.
Ina Kay Scott, TjT)ist.
Jack Breckenridge, Laboratory Helper.
To Dr. B. K. Kilbourne, Executive Officer:
The report of the activities of the Hygienic Laboratory is herewith
submitted for the biennial period ending Nov. 1, 1946.
The functions of the Laboratory continue to be as outlined in the
previous biennial reports with the exception of a few additional activities
as discussed below.
The figures upon the volume and scope of the activities during the
past two years are based upon the fiscal periods from July 1, 1944 to
July 1, 1946 since our records are more complete for this period than
if they were extended to Nov. 1, 1946.
No attempt has been made to evaluate the statistics upon the posi-
tive reactions obtained, for it is not known how many individuals are
represented since several samples are often submitted from the same
person. This is especially true in the case of blood and spinal fluid
specimens submitted for serological tests for syphilis, particularly when
the patient is under treatment. Furthermore, individuals suffering from
other illnesses may sometimes give false reactions so that the laboratory
findings do not constitute a diagnosis. This same may hold true in
diseases other than syphilis. Therefore, no conclusion as to prevalence
of various diseases may be drawn from the results.
A slight decline was shown in the number of examinations made
under those of the previous corresponding biennial. A total of 215,606
examinations were completed for the fiscal years 1944-1946 as compared
with 251,373 for 1942, 1944, a decline of 36,766 examinations. This was
due almost in its entirety to the decrease of blood specimens submitted
by the Selective Service and was to be anticipated. This was counter-
balanced in a small sense by the submission of prenatal blood specimens
after the law requiring such tests became effective July 1, 1945.
MONTANA STATE BOARD OF HEALTH 67
Tables I, II, III, and IV are presented for your consideration and
were formulated to indicate the trend of work completed during the past
two years. They are self explanatory.
Table I shows a comparative classification of examinations for years
1944-45 and 1945-46.
TABLE I
Comparative Classifications of Examinations 1944-1946
1944-45 1945-46 or Loss
Gain
Total Syphilis 90,748 100,189 -f 9,441
Blood and Spinal Fluid Wassermann „.__ 45,182 49,844 -f4,662
Blood and Spinal Fluid Kahn 44,791 49,408 -f4,617
Treponema, Smears and Sera 7 3 — 4
Spinal Fluid, C. C. and Globulin 768 934 + 166
Total Gonorrhea 954 1,260 -f 306
Smears „„ .. 953 1,256 -I- 303
Cultures 1 4+3
Tuberculosis 1,122 1,202 — 102
Spurtum, Microscopic 919 851 — 68
Other Body Fluids, Microscopic 25 11 — - 14
Guinea Pig Inoculations 157 146 — 11
Cultures _. 21 12 — 9
Agglutinations 5,374 8,188 +2,814
Typhoid-Paratyphoid Fevers 2,864 4,160 +1,242
Undulant Fever 944 1,350 + 406
Tularemia 926 1 ,356 + 430
Proteus OX- 19 17 26 +9
Heterophile Antibodies 623 1,350 + 727
Blood Cultures 910 1,254 + 344
Stool and Urine Cultures — 414 306 — 98
Diphtheria 1,262 1,573 + 311
Miscellaneous - 866 466 — 400
GRAND TOTAL ^ 101,350 114,256 +12,906
68
TWENTY-THiRD BIENNIAL REPORT
Table II gives a detailed tabulation of examinations.
TABLE II
HYGIENIC LABORATORY
Report of Laboratory Examinations for July 1, 1944 to July 1, 1946
T3
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Syphilis
Kolmer Comp.-Fix. Test
Blooci 4,071
Spinal Fluids 115
Pleural & Other Fluids
Kahn Precipitation Test
Blood 3,285
Spinal Fluids
Pleural & Other Fluids...
Spinal Fluids
Colloidal Gold
Globulin
Treponema Pallidum
Darkfield
Stained Smears
Gonorrhea
Smears 381
Comp.-Fix. Test ._
Cultures
Typhoid-Paratyphoid Fevers
Blood
Micro-Agglutination Test
B. Typhosus
B. Paratyphosus "A"
B. Paratyphosus "B"
Macro-Agglutination Test
B. Typhosus
"H" Aggl 78
"O" Aggl. 33
B. Paratyphosus "A"
B. Paratyphosus "B" 10
Blood Cultures
B. Tyohosus — 7
B. Paratyphosus
Feces
B. Typhosus 55
B. Paratyphosus
Urine
B. Typhosus 2
B. Paratyphosus
Bile
B. Typhosus
B. Paratyphosus
Water
B. Typhosus
B. Paratyphosus
Milk
B. Typhosus
Dysentery
Amebic
Feces
Bacillary
Blood for Aggl.
Feces 25
Urine 1
Bile
Swabs. Rectal
355
31
87,374
652
82,541
10
1,779
2,364
64
8,709
8
T
850
852
94,164
862
94,199
94,164
862
664
36
850
852
10
1
10
41
2,209
2.209
5
5
2,118
2,186
86
2,061
2,135
2
71
43
26
30
4
210
2,293
2,292
92
2,292
2,293
2
1 1
20
2,162
2
2
532
2 591
_ 1
591
1
5
7
7
2
2
2
27
27
27
2
90
5
"""'6
12
14
115
6
115
6
6
6
MONTANA STATE BOARD OF HEALTH 69
TABLE II — (Continued)
Report of Laboratory Examinations for July 1, 1944 to July 1, 1946
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Brucella Infection
Blood Agglutination
28
1
48
1
3
1
6
3
343
11
152
1
1
32
38
1
6
2
103
6
2,210
2
2,142
1
._____„
1
2
127
25
14
12
2,287
3
1,544
7
"""i
3
13
1
3
4
24
54
2
1
1
66
4
60
3
...
2,294
3
8
3
Opsonocyptophagic Test — .
Tularemia
Blood Agglutination
Blood Cultures
2,282
1
7
1
Streptococci
Beta Hemolytic
Throat & Nose Cultures
17
2
6
17
Other Cultures
-
2
Non-Hemolytic
Throat & Nose Cultures
6
Other Cultures
Meningitis
Meningococcus
Spinal Fluids
3
3
Throat Cultures
Other Types
Other Types
Spinal Fluids
Parasitic Diseases
Ova & Parasites
Feces
—
—
139
5
1
5
139
5
26
20
18
2,799
18
139
Specimens for Identificat'n
Fungi
Direct Microscopic
Cultures —
Diptheria
Direct Smear
5
26
20
18
Cultures
2,799
Virulence Test
18
Tuberculosis
Blood
Comp-Fix. Test
Spinal Fluid
Comp-Fix. Test
Sputum
Microscopic
1,762
8
23 ■
22
1,762
Direct Smear
Animal Inoculation
1
8
23
Culture
18
Urine
Direct Smear
Microscopic
Animal Inoculation
Culture
Body Fluids
Culture
Direct Smear
9
189
7
3
9
191
7
3
3
19
71
2
n
1
3
9
189
7
3
3
Microscopic -
4
19
68
Spinal Fluids
6
Animal Inoculation
1 1
Culture — - —
Feces
MicroscoDic
1
1
3
AniTTinl Inoculation
4
4
70
TWENTY-THIRD BIENNIAL REPORT
TABLE II — (Continued)
Report of Laboratory Examinations for July 1, 1944 to July 1, 1946
o
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Pneumonia
Typing Neufeld (Direct) ._
Typing Mouse inoculation
Transudates & Exudates
Typing Neuield (Direct) __
Typing Mouse Method -—
Vincent's Infection
Smears
Cultures
Malaria
Blood Smears 42
Whooping Cough
Cough Plates
Vaccines Prepared Autogenous
Special Investigations
Food Poisoning
Bacteriological —
Toxic
Microscopical Examinations
Bacteriological Examinations
Serological
Chemical „ —
Animal Tests -
Discharges-Pus, Sputum, Etc.
Microscopical
Bacteriological
Pleural & Other Fluids -
Blood
Cultures (Not Typhoid)-^
Red Cell Count — -
White Cell Count —
Diff. Count - — -
Smear, Stippling
Spinal Fluid
Microscopical
Cell Count -
Bacteriological - —
Chemical __
Urine Analysis
Microscopical
Physical Chemical — -—
Pregnancy Test
Bacteriological -
Nasal Smears
Eosinophiles -—
Organisms
Miscellaneous Examinations
Feces for Occult Blood 8
Cultures for Identification.-.
Specimens for Identification
Milk for B Coli 1
Smears for Organisms
Cultures for Organisms
Hetrophile Antibodies 30
Blood for Typing
Animal Tests (Autopsies) — -
Proteus OX- 19 1
Unclassified
Blood Rh. Factor
Culture for Fungi
Culture for Anthrax
Stool for Amoeba _ _
82
1
39
52
12
47
2
18
,838
38
58
2
2
4
34
1
12
1
41
131
150
12
39
2
1
20
8
3
1
43
149
,973
150
43
12
41
2
3
6
121
121
1
1
99
98
2
2
7
7
1
1
2
2
2
2
8
4
1
1
2
1
14
14
1
1
4
35
26
1
1
12
12
1
3
3
1
20
8
3
1
48
145
10
150
2
11
22
2
3
6
TOTAL
215,606 106,270
MONTANA STATE BOARD OF HEALTH 71
The greater part of the work continues to be concerned with exam-
inations of specimens for venereal diseases since at the present time
89.4 ''/r of the total number of examinations may be thus classified. Table
III presents the picture clearly.
TABLE III
Total Examinations for Venereal Diseases 1944-1946
Total
1944-45 1945-46 1944-46
Total Syphilis __. 90,748 100,189 190,937
Wassermann 45,182 49,844 95,026
Kahn 44,791 49,408 94,199
Treponema, Smear and Darkfield 7 3 10
Spinal Fluid, C. G. and Globulin 768 934 1,702
Total Gonorrhea - 954 1,260 2,214
Smears .-. - 953 1,256 2,209
Cultures .-..- 1 4 5
TOTAL VENEREAL DISEASE EXAMINATIONS 91,702 101,449 193,151
OTHER TYPES EXAMINATIONS 9,648 12,807 22,455
EXAMINATIONS, GRAND TOTAL ALL TYPES 101,350 114,256 215,606
SPECIMENS, GRAND TOTAL ALL TYPES 50,422 55,848 106,270
Requests for shipping containers continue to increase and it is felt
that many are standing idle upon the shelves in the offices of physicians
and hospitals throughout the state. A check will be made of outgoing
and incoming containers to the various individual offices as soon as
clerical help permits, since such a comparative study usually results in
the recovery of a large number of non-circulating containers. Table IV
gives the total number distributed for the years 1944 to 1946.
72 TWENTY-THIRD BIENNIAL REPORT
TABLE IV
Specimen Containers and Materials Shipi)ed During
July 1, 1944 to July 1, 1946
1944-45
1945-46
Total
1944-46
45,486
79,195
17,661
30,056
2,317
4,127
2,347
4,197
683
1,499
2,198
3,756
964
1,759
1,208
2,727
1,293
2,845
376
805
329
709
13
2
Vials, Blood - - 33,709
Containers, Mailers for Blood Specimens 12,395
Cultures, Loefflers 1,810
Swabs, Sterile 1,850
Containers, Mailers for Throat and Nose
Specimens 816
Slides, Glass 1,558
Containers, Glass Slide - 795
Jars, Sputum . . 1,519
Containers, Sputum Jar 1,552
Jars, Feces 429
Containers, Feces, Jars 380
Darkfield Outfits
Blood Culture Outfits 11
G. C. Culture Outfits
Intestinal Parasite Outfits
Brucella Culture Outfits
Keidel Vacuum Tubes 769
Miscell. History Slips 130
Positive Syphilitic Serum 3
Miscellaneous Media
Culture Media, Sabourauds 4
Chocolate Agar Plates .. .
Blood Agar Plates .
S. S. Agar Plates 20
Agar, Plain, Slants
Antigens, Various
Tularense
24
2
1,105
1,874
674
804
50
53
12
16
9
9
4
4
10
30
12
12
PERSONNEL
The personnel of the division has remained on a permanent basis for
over one year w^ith the exception of several changes in the office staff.
One of the former senior bacteriologists returning from the Service in
March, 1946 resumed his duties at that time but resigned to enter medi-
cal school in September. It proved of material assistance to have one
extra person available to serve as a fill-in for the various vacancies
during vacation periods. Funds are available at the present time for one
full-time Senior Bacteriologist if a competent person can be found. A
definite need will exist if the plans discussed later are to materialize.
Report of Seientitic Work
Syphilis: A total number of 190,937 examinations were conducted
during 1944-46 for syphilis. Of these 95,026 were Kolmer Wassermanns
and 94,109 were Kahn Standard tests. The balance consisted of 1702
MONTANA STATE BOARD OF HEALTH 73
examinations of spinal fluids for Collodial Gold Curves and Globulin and
10 examinations for Treponema.
Evaluation of the performance of both the Kolmer and Kahn tests
in our laboratory was again requested and granted by U. S. Public
Health Service. The ratings were as follows:
Kolmer Simplified Compliment-Fixation Test
Sensitivity Specificity
Control Laboratory 88.4% 100 %
Montana Laboratory 83.9% 99.6%
Kahn Standard Precipitation Test
Sensitivity Specificity
Sensitivity Specificity
Control Laboratory 83.19o 100.0%
Montana Laboratory 79.4% 100. 0%>
A law was established by legislative action effective July 1, 1945 re-
quiring that a sample of blood be taken from every pregnant woman and
submitted to an approved laboratory for a standard serological test for
syphilis. The term "approved laboratory" shall mean a laboratory ap-
proved for this purpose by the State Board of Health, a "standard sero-
logical test" shall be a test recognized as such by the State Board of
Health. Passage of this law has bi'ought in an estimated 10,000 addi-
tional blood specimens in the first year of its operation.
Gonorrhea
A total of 2,214 examinations for gonorrhea were performed, of
which 2,209 were a study of smears: A shipping outfit for the cul-
turing of gonococci, designed after that employed by New Jersey, which
has proven to be of practical value, has been adopted and is now ready
for distribution upon request to those physicians desiring it.
Tuberculosis
The culturing of sputum and various body fluids for tuberculosis has
been established and is now being done upon request. This will be
adopted as a routine measure as soon as personnel is sufficient to as-
sign to this duty. It is anticipated that the modified Lowenstein's Media
as advocated by the Tuberculosis Division of the USPHS will be em-
ployed with Corper's media as an accessory media.
Agglutinations
Requests for agglutinations of all types have increased materially
within the past year. All bloods submitted for a Widal test are now
subjected to an agglutination test for the typhoid-paratyphoid group,
undulant fever, tularemia and for the presence of heterophile anti-
bodies. The latter measure was adopted routinely about a year ago but
the low percentage of positive reactions encountered, less than 1%,
renders the performance of this test of doubtful value as a routine pro-
cedure. All blood clots are cultured after removal of the sera.
74 TWENTY-THIRD BIENNIAL REPORT
There have been no outbreaks during this biennum, of a serious
nature aside from a few cases of diarrhea in several of the institutions.
Special materials for culturing were furnished upon request of the
medical officer in charge in each of the cases.
Special studies have been undertaken in several cases of suspected
mycotic infections, both cutaneous and respiratory. Since this service
is inadequately provided for in most hospital and clinic laboratories, we
feel justified in devoting as much time as necessary to assist the physi-
cians in the diagnosis of those often obscure conditions.
No other special studies have been accomplished.
Physical Equipment
Very little new physical equipment has been secured since the pre-
vious report. A Steiger-Stimpson Slit Lamb for assistance in reading
the Kahn tests has been of material value to us as a time saving de-
vice. A new Spencer Medical Microscope complete with carrying case
was secured, together with a Spencer Microscope Lamp. These, to-
gether with several new reference books and additional publications,
aside from the regular stock supplies, constitute the acquisitions to the
permanent equipment for the past two years.
An attempt will be made within the next year to procure 1 new
centrifuge, a larger steam sterilizer, a new Kahn shaker to replace the
present outworn machine, as well as several other replacements for
basic equipment that has passed its expected efficiency and upon which
a great deal of time and repairs must be spent at the present time to
keep them in running order.
Proposed Future Development of Diagnostic Services
■ Any discussion of future plans must of necessity be influenced na-
turally by the conditions under which these are formulated.
The Hygienic Laboratory Division created on October, 1917 con-
tinues to carry on its work in the same quarters assigned to it at that
time with the exception of one additional room which serves as office
space. It is evident that assignment of further duties to this division
must be considered carefully in the light of the cramped conditions under
which the present and anticipated increasing volume of work is under-
taken.
The Blood Bank Division established with an initial appropriation
of $20,000 by Legislative action February, 1944 for the purpose of pro-
ducing human blood plasma, and placed under the supervision of the
Hygienic Laboratory, has not been developed and set up due to the
difficulties of various nature encountered ever since its inception. Since
no space adjacent to the Hygienic Laboratory was available, even on
any of the other floors, although the ground floor is at present occupied
in its entirety, by one of the other state departments, it became neces-
sary to seek quarters elsewhere. The only space available which seemed
suitable for its needs was situated in a building about two miles distant.
MONTANA STATE BOARD OF HEALTH 75
near the airport. This building, formerly used as an N.Y.A. dormitory
and now owned by the city of Helena, possessed built-in refrigeration
space, ample store room, and kitchen facilities for cleansing of the glass-
ware. It was accordingly leased from the city with the intentions of im-
mediately renovating and reconverting it into a laboratory suitable for
carrying on the functions of the newly established Blood Bank Division.
However, it was found that even if the materials needed were available
and many of them including suitable radiation were not, the cost of re-
conversion alone, under the inflated building costs would entail the ex-
penditure of the greater part of the $20,000 appropriated for the fiscal
years 1944-46 for both the establishment and maintenance of the bank.
Pending decision of the best course to follow, several pieces of basic
equipment were purchased, when available, and placed in storage. The
immediate establishment of this division was rendered less urgent by a
factor which unexpectedly entered the picture, the distribution to the
various states, beginning January, 1946 of large quantities of dried hu-
man plasma by the American Red Cross. This was surplus plasma re-
turned to this organization by the Armed Forces after cessation of hos-
tilities. It was estimated by the Red Cross at that time that the supply
from this source would fill the needs of all states for at least wo years.
In view of the rapid developments in the field of blood and its
derivatives and the limited funds available in a sparsely populated state
such as ours, it is probably advisable to proceed rather conservatively
into the program.
If additional funds could be obtained to provide for the reconversion
of the entire building mentioned above and also for a separate animal
unit to care for the transfer of the entire Hygienic Laboratory Division
to this location, ample space would be available to care for its present
activities and also allow for material expansion for some years to come.
The housing of these two units adjacent to each other would result in
much lower administrative costs than if separated.
Plans were considered by a group designated as the Laboratory
Planning Commission, for the construction of a building to care for all
the combined laboratory units of all State Divisions including those of
the State Board of Health. However, building costs and lack of ma-
terials would seem to prohibit such construction for some years to come.
Hence, the plan discussed above, namely the reconversion of the
building above described, appears to be the most practical solution to
our immediate crowded conditions as well as to the establishment of the
Blood Bank Division. Since actual separation of certain other divisions
from the building housing the Administrative Division of the State Board
of Health has already been necessary and further moves seem enevitable,
the anticipated separation of this division is not establishing a pre-
cedent.
The proposed move as planned would provide also for expanded
facilities for animal quarters. The need for such expansion will be
urgently felt if the plans of the Tuberculosis Division materialize as
anticipated when the Laboratory will be called upon to verify by animal
inoculation many of the suspicious cases of tuberculosis encountered in
76 TWENTY-THIRD BIENNIAL REPORT
the state-wide survey being made at the present time by the mobile unit.
Additional animal stock will be needed also, after establishment of the
Blood Bank, for checking of all lots of plasma for toxicity. The re-
quest for an appropriation of $5,000 for the erection of an animal house
was rejected by the 1944 Legislature.
A companion bill to the prenatal law enacted in 1945 requiring every
applicant for a marriage license to undergo a serological blood test for
syphilis was introduced for consideration in 1945 but failed in passage
by a narrow margin. It is hoped that the bill would be reintroduced at
the 1947 session since Montana is one of the few states which does not
require this protective health measure.
There is a great deal of discussion at present concerning Rh typing
and whether this procedure should be adopted as a state service. Lack
of adequate typing sera is the greatest handicap thus far to the de-
velopment of this program. It may be advisable to assist the hospitals
and clinics to establish their own typing programs rather than attempt
to develop it as a function of the state laboratory.
Evaluation of intra-state hospital and clinic laboratories has not
been undertaken as desired due to lack of adequate personnel to assign
to this function. To carry on this project effectively would entail nearly
the entire time of one senior bacteriologist. However, it is planned def-
initely to begin in January, 1947 the submission of blood sera specimens
to various of the hospital laboratories requesting this service, for the
purpose of evaluating their performance of serological tests for syphilis.
It is hoped then to extend the evaluation to microscopic staining tech-
niques and materials since it is believed this may be of direct benefit to
those laboratories who have limited opportunity for the study of certain
of the communicable diseases. Representative slides of the various or-
ganisms are being collected at the present time for this purpose.
There is difinite need for a Director of Public Health Education not
only in this division but in the others as well, to facilitate the disemina-
tion of educational information concerning all health measures and to
act as a liason agent between the State Board of Health and many of
the other agencies and individuals interested in the field.
Recomniendations
Most earnest consideration should be given to the plans for ex-
panding the housing facilities of the laboratory with its various ac-
tivities. Upon this one factor depends to a large extent the ability of
the division to undertake any new work or perform with efficiency the
duties now assigned to it.
*6'
We wish to thank you for your cooperative assistance with our
problems when presented to you and for your guidance in the months
just past.
Respectfully submitted,
EDITH KUHNS, Director.
MONTANA STATE BOARD OF HEALTH 77
DIVISION OF INDUSTRIAL HYGIENE
Paul M. Giever, Director
Advisory Committee appointed by Montana State Board of Health:
James D. Graham, President of the Montana Federation of Labor,
Helena.
Dennis McCarthy, Representative of Trades and Labor Council,
Butte.
J. J. Carrigan, General Manager of Mines, Anaconda Copper Mining
Company, Butte.
Carl J. Trauerman, Secretary, Mining Association of Montana,
Butte.
Dr. A. T. Haas, Chairman, Committee on Industrial Hygiene,
Montana Medical Association, Missoula.
To: B. K. Kilbourne, M. D., Executive Officer:
The following report presents a summary of the activities of the
Division of Industrial Hygiene for the period from December 1, 1944 to
October 30, 1946.
The Division has continued to carry out the program as originally
planned for the department with special sections of that program re-
ceiving greater attention as deemed necessary for the war effort. The
object of the department has at all times been to assist labor and
management in achieving and maintaining the most healthful working
conditions possible through the recognition, evaluation, and assistance in
the control of occupational health hazards.
Two meetings of the Advisory Board have been held and much valu-
able assistance has been received from this committee in the way of sug-
gestions and recommendations on policies and procedures.
On December 1, 1944 the personnel of this department consisted of
Dohrman H. Byers, Acting Director, on loan from U. S. Public Health
Service, Mr. Hilmer N. Hansen, Industrial Chemist, and Miss Solveig
N. Lee, Senior Stenographer. Mr. Byers was recalled by the U. S.
Public Health Service and Mr. Paul M. Giever was appointed Director
and Industrial Hygiene Engineer effective August 21, 1946. Mr. Hil-
mer Hansen resigned June 15, 1946 and Mr. Ludwig S. Champa, Analyst
for the Food and Drug Division, was transferred to the Industrial
Chemical Laboratory on July 1, 1946.
A continued effort has been made to procure necessary equipment
for engineering field studies and for the chemical laboratory. At the
present time, the laboratory is quite adequately equipped but several
important pieces of field apparatus are still required to completely equip
the engineering section.
OCCUPATIONAL DISEASE REPORTING
The reporting of occupational diseases is still not being accom-
plished satisfactorily. This phase of the industrial hygiene program
has not to date received the complete cooperation of members of the
state medical profession. An extensive campaign to improve this con-
dition was made but resulted in no change. In this campaign, letters
78 TWENTY-THIRD BIENNIAL REPORT
and occupational disease report blanks were sent to all doctors in the
state. Now that the extreme shortage of physicians in the state is
somewhat relieved, a new effort will be made to make this phase of the
industrial hygiene program function.
Three occupational disease reports were received in the twenty-three
month period covered by this report. One was a case of occupational
undulant fever, and the other was a possible carbon monoxide poisoning.
One probable occupational disease case is being worked on at the present
time. This case was reported by the patient and is probably an occupa-
tional arsenic poisoning.
ATTENDANCE REPORTING
At the present time, monthly reports of attendance records are
being received from two industrial plants employing approximately 1,500
persons. This service was instituted by the Industrial Hygiene Division
in an effort to encourage management to locate causes of industrial ill-
nesses and industrial health hazards within the plant. This division pre-
pares a yearly critical graph analyses for the companies submitting
these records. This analyses assists in evaluating sick absenteeism
problems. This program will be continued although much of the pres-
sure on absenteeism has been relieved since the close of the war.
EDUCATION
Education is one of the important phases of the industrial hygiene
program and has been carried on through the use of motion pictures and
addresses by members of the staff before various groups at frequent in-
tervals. An extensive poster and literature campaign was carried on
during the war but has been dropped in the past year.
It is recognized that much more work is n-ecessary along the lines
of education to adequately establish the industrial hygiene program to
the point where all occupational diseases are reported and management
and labor request industrial hygiene surveys for every suspected health
hazard in their operation.
FIELD STUDIES
The Industrial Hygiene Division conducted field studies in 119 plants
involving 6,228 workers; made 23 follow-up visits to render further as-
sistance and to re-evaluate hazards by checking proficiency of correc-
tive measures installed. Recommendations for elimination or control
of health hazards* were made which affected 4,462 persons. Of the 119
field studies made, 21 were at the request of industry or labor, and 3
were made as a result of occupational disease reports.
A survey of most of the newspaper shops was conducted in 1945
and early 1946. This survey covered 32 establishments and approximate-
ly 300 persons. It was gratifying to determine that in nearly all these
establishments, little or no lead hazard existed. This was due to the
fact that lead melting operations conducted at a relatively low tem-
perature produced a minimum amount of exposure to a limited number
of persons.
The carbon monoxide survey of garages started in 1944 was con-
tinued and in nearly all commercial garages a pertinent carbon monoxide
hazard was found to exist, or conditions were found which would in-
dicate that such a hazard could exist under normal winter operating
conditions.
MONTANA STATE BOARD OF HEALTH 79
Members of the Industrial Hygiene Division accompanied a survey-
team from the offices of Admiral Boone in a survey of housing, sani-
tation, welfare and recreational facilities in several of the coal mines in
the state which had been taken over by the Government. Administra-
tion of these mines is in the hands of Navy Personnel under Admiral
Boone.
A study of oxygen administration in infant incubators was con-
tinued for the Public Health Nursing Division. This work has been con-
ducted intei'mittently for the past four years. In this experiment, de-
terminations of the characteristics at various rates of oxygen flow were
made on a Gordon-Armstrong Incubator.
LABORATORY AND FIELD ANALYSES
Arrangements were made with the Industrial Accident Board where-
by the Industrial Hygiene Division would do the necessary laboratory
work to analyze coal and dust samples for rock dust and ash content,
and also mine air samples for methane and oxygen. Several groups of
these samples have been analyzed.
From samples collected in field studies, 1,102 chemical analyses
were made. This number is exclusive of control and development work
on chemical methods. A total of 1,470 field determinations were made
by portable test apparatus or direct reading instruments. A total of
2,572 laboratory analyses and field determinations were made.
A summary of this work according to constituents is presented in
the following table:
TABLE I
Summary of Chemicai Laboratory and Field Analyses
No. of Study
Materials Analyzed Analyses
Dust Counts —
Silica - 9
Coal 4
Nuisance - 8
Lead 445
Arsenic 30
Zinc 28
Cadium 41
Oxides of Nitrogen 218
Oxygen 91
Chlorinated Hydrocarbons 11
Methane 24
Sulphur Dioxide 23
Organic Solvents = . 1
Manganese 36
Carbon Dioxide 133
Field Determinations —
Illumination 2
Carbon Monoxide , 1,180
Air Velocity 126
Relative Humidity 48
Combustible Gases 20
Temperature - -. 94
80 TWENTY-THIRD BIENNIAL REPORT
DIVISION OF TUBERCULOSIS CONTROL.
Biennia! Report 1945-46
Personnel as of November 15, 1946:
Arthur E. Rikli, M. D., Director.
Henry Arnoux, Photofluorographic Operator.
Opal Arnoux, R. N.
Louise T. Betzner, Senior Stenographer.
EveljTi Beecher, Junior Stenographer.
Hollie Morey, Junior Clerk-Typist.
I. Creation of the Division of Tuberculosis Control.
The 29th Legislative Assembly of the State of Montana
created in the State Board of Health a Division of Tuberculosis
Control. In Chapter 170 of the 1945 Session Laws, the Act is
described as follows:
"An act relating to public health, establishing a Division of
Tuberculosis Control in the State Department of Health, provid-
ing for a director of such division, providing for acceptance of
grants or other funds and making an appropriation by the State
for carrying out provisions of this act." It was approved March
5, 1945.
This act was instigated by the State Medical Association,
the Montana Tuberculosis Association and many other public
spirited, health-minded groups. These groups are now integrating
their forces to assist in carrying out the intentions of this act.
II. Appointment of the Director.
It was not until April, 1946 that the present director was
obtained on loan from the U. S. Public Health Service. This was
done after many months' delay during which the State Board of
Health was unable to find a qualified man to act as director of
this division. The loan will continue until such a man is found
' to assume the responsibility.
III. Montana Tuberculosis Association Presents Mobile Photofluoro-
graphic Unit.
On April 25, 1946, Dr. E. M. Larson, president of the Montana
Tuberculosis Association, presented to Dr. B. K. Kilbourne, Execu-
tive Officer of the State Board of Health, a $25,000 mobile, photo-
fluorographic unit. It was purchased with funds obtained from
the sale of Christmas Seals. The unit is to be operated by the
Division of Tuberculosis Control throughout the State of Montana.
It will make free miniature chest X-ray facilities available to all
communities. This unit is capable of taking 100 miniature chest
X-rays per hour; it is not necessary for the subject to disrobe.
MONTANA STATE BOARD OF HEALTH 81
IV. Purpose of the Mobile Unit.
A chest X-ray is the only way that one can be sure that he
does not have the contagious disease, pulmonary tuberculosis. It
is the most efficient means of detecting this potentially fatal
disease in its early stages. Tuberculosis in its early stages is
most surely and rapidly arrested, thus preventing the infected
person from giving this disease to another individual. The person
who has early tuberculosis is unaware of his symptoms and is
not likely to go to his family physician for his annual physical
examination, including a chest X-ray. This unit will assist in
taking chest X-rays of every individual who wishes to take ad-
vantage of the service.
V. Availability of the Mobile Unit.
This service has been made available only to those communi-
ties which have requested it. Priority has been shown to those
communities near or in which the incidence of deaths due to
tuberculosis is highest, to those communities from which re-
quests have come from both the people of the community and its
medical group, and to those communities where there are the
best facilities available for following up the tuberculosis case find-
ing program.
VI. Mechanics of the X-ray Program.
Following requests from the community, the Division of Tu-
berculosis Control obtains approval and sponsorship for the pro-
gram from the local health department, medical society and tu-
berculosis association. The field secretary from the Montana Tu-
berculosis Association then goes into the community to assist
in the organization of a health education program to prepare the
community for the arrival of the mobile unit. Upon the arrival
of the X-ray unit and its technicians, along with clerical as-
sistance furnished by the community, miniature chest X-rays are
taken of those persons wishing to take advantage of the service.
They first register, giving their name and those of their family
physicians. The X-ray report, if there are no significant abnor-
malities visualized, is given directly to the subject. If significant
abnormalities are found, the X-ray report is given by the health
department to the subject's family physician. A request is then
sent to the subject asking him to go to his family physician for
diagnosis and disposition. The follow-up of each case is carried
out by the cooperative efforts of the family physician, the public
health nurse and the health department.
Vn. Progress of This Program.
The mobile unit was first put into action on June 3, 1946.
Since that time it has given service to 6 state institutions, 10
counties and 24 communities, taking a total of 19,666 chest X-rays
during the period ending October 10, 1946. A summary of these
projects is as follows:
82 TWENTY-THIRD BIENNIAL REPORT
Total number of films taken 19,666
Number of unsatisfactory films 545
Total number of persons examined 19,121
(Difference between preceding two items)
Percentage of Total
Of this total, there were Persons Examined
Essentially negative 18,568 97.10%
Definite tuberculosis 44 0.23%
Suspected tuberculosis 212 1.10%
Other pathology 297 1.55%
These figures are obtained from our primary impression on
the survey films.
VIII. Tuberculosis Cases Reported.
Recognizing the fact that no health department, state or
local, can effectively prevent or control disease without knowl-
edge of when, where and under what conditions cases are occur-
ring, tuberculosis, a contagious and potentially fatal disease, was
made reportable to the Health Department by the physician
treating or examining the case by Section 1500 of the Public
Health Laws, effective February 13, 1913. The following table
is an analysis of the source of the original report.
Sources of Original Report of Tuberculosis Cases
In 1944 (3 mo.), 1945 and 1946 (9 mo.)
Year
Local
Physician
Sanatorium
Death
Certificate
Other
Total
1944 (3 mo.)
1945
1946 (9 mo.)
65
107
59
43
148
125
24
73
64
45
25
132
373
273
TOTAL
231
326
161
70
778
From this table we make the following observations:
1. Less than 30% of the cases are first reported by local physi-
cians.
2. Approximately 50% are first reported upon their admission to
the Sanatorium.
3. Over 20% of the cases are not reported till they die.
A further breakdown of the table above as to age and sex
of those cases reported is as follows:
MONTANA STATE BOARD OF HEALTH
83
Tuberculosis Cases Reported in 1944 (3 mo.), 1945-1946 (9 mo.)
By Sex and Age Groups
1944 (3 mo.)
Age Groups Male Female Total
0-4 3 -- 3
5-9 —
10-14 4 4
15-19 6 6
20-29 8 9 17
30-39 4 5 9
40-49 . 6 1 7
50-59 12 -- 12
60-69 — _. 6 2 8
70-Over 1 1 2
Age Not Given 48 16 64
Sex Not Given -..
TOTAL _— 88 44 132
1945
Male Female Total
1946 (9 mo.)
Male Female Total
5
3
19
14
20
26
25
13
99
6
2
1
9
14
7
6
8
6
4
61
14
2
6
12
33
21
26
34
31
17
160
17
4
2
"2
14
8
10
13
14
9
83
4
3
1
l"l"
6
6
2
4
4
52
8
5
1
2
25
14
16
15
18
13
135
21
232
124 373
159
93 273
2.
From this table the following observations are made:
That the age analysis is based on less than 50 9^ of
the cases because the age was not given when the
disease was reported.
That the age group at which most cases are reported is
between 20 and 29.
3. Sex was not given in 38 of the 778 cases reported.
4. There are 479 reported cases of men to 260 women, a
ration of less than 2 to 1.
IX. Ratio of Cases Reported Per Annual Death.
There has been no attempt to differentiate active and inactive
cases or pulmonary and extra pulmonary. All have been classed
just as tuberculosis.
84
TWENTY-THIRD BIENNIAL REPORT
Ratio of Cases Reported Per Annual Death From Tuberculosis
From 1920 to and Including 9 mo. of 1946
Deaths
Cases Reported
Ratio of Cases
to Deaths
1920
419
863
2.06
1921
356
568
1.59
1922
383
368
0.96
1923 ;
395
604
1.53
1924
434
648
1.49
1925
396
620
1.56
1926
- - 377
528
1.40
1927
373
463
1.24
1928
357
448
1.26
1929
357
536
1.50
1930
337
534
1.59
1931
329
579
1.76
1932
307
568
1.95
1933
282
465
1.65
1934
265
638
2.40
1935
257
220
432
497
1.69
1936
2.26
1937
235
486
2.06
1938
239
515
2.16
1939 -
239
455
1.91
1940
225
451
2.00
1941
201
466
2.31
1942
195
402
2.06
1943
199
386
1.95
1944
167
508
3.05
1945
166
373
2.25
1946 (9 mo.)
108
273
2.53
From the above table we observe
1. Reporting of cases has improved during the past five to ten
years.
2. It has been estimated * that there are "as low as three and
as high as twelve living cases per annual death" and that an
average for most communities would fall around nine cases
per annual death. From these estimates, we might conclude
that we have yet to find in Montana from five to seven cases
of tuberculosis per annual death from the disease. We hope
that our chest X-ray program will help us find those cases.
X. Miscellaneous Activities Assisted by Funds Appropriated for the
Control of Tuberculosis.
A. Division of Public Health Nursing.
1. Salary for some of the nurses of the Division of Public
Health Nursing of the State Board of Health.
*Chadwick and Pope, "The Modern Attack on Tuberculosis."
MONTANA STATE BOARD OF HEALTH 85
2. Travel expenses, etc., for the Institute on Nursing in Tu-
berculosis.
B. Hygienic Laboratory
1. Salary for technician and equipment to be used by the
State Hygienic Laboratory.
C. Division of Industrial Hygiene.
1. Equipment purchased for study of X-radiation by the
Division of Industrial Hygiene.
D. State Sanatorium
1. A photofluorographic attachment was purchased for the
X-ray equipment at the State Sanatorium.
E. Silver Bow Tuberculosis Association
1. Full payment of salary of a nurse and a photofluor-
ographic operator, as well as for some of the X-ray sup-
plies, for the Silver Bow Tuberculosis Association.
XI. Fundamentals of the Program of This Division.
As we are developing our tuberculosis case finding pro-
gram, we are trying to stimulate the creation of more and better
facilities for medical care and isolation of persons having tuber-
culosis. At the present time, recurrences of the disease are fre-
quent. Until we have a drug or some treatment which will pre-
vent these recurrences, we must rely upon a rehabilitation i>ro-
gram which will assist in directing the arrested case of tuber-
culosis into activities which will not contribute to recurrence of
his disease. As each community has assumed its responsibilities
in assisting in the diagnosis and treatment of the tuberculosis
patient, it must now recognize its responsibility to the family
of the patient with tuberculosis and protect them against social
and economic distress.
XII. The Aim of This Division.
It is the aim of this division to integrate the activities of the
various forces now active in controlling tuberculosis and to sup-
plement them where necessary so that there will be an accelera-
tion in the decline of mortality and morbidity due to tuberculosis.
Respectfully submitted,
ARTHUR E. RIKLI, M. D.
Director, Division of
Tuberculosis Control.
86
TWENTY-THIRD BIENNIAL REPORT
ITEMIZED DIVISIONAL EXPENDITURES
October 1, 1944 to September 30, 1946
M. S. Stanley, Fiscal Agent
ADMINISTRATION
Salaries
Travel
Office Supplies & Equipment
Insurance —
Maintenance & Repairs —
Miscellaneous
Totals
EPIDEMIOLOGY & VENEREAL DISEASE
Salaries
Travel
Office Supplies & Equipment
Scientific Supplies & Equipment
Arsenicals
Biologicals
Miscellaneous — - - -
Totals
HYGIENIC LABORATORY
Salaries
Travel
Office Supplies & Equipment — .
Scientific Supplies & Equipment
Animals & Expense
Maintenance & Repairs
Totals
SANITARY ENGINEERING
Salaries
Travel
Office Supplies & Equipment .,-
Scientific Supplies & Equipment
Maintenance & Repairs
Miscellaneous & Express
Totals
VITAL STATISTICS
Salaries
Travel
Office Supplies & Equipment
Totals
FOOD & DRUG
Salaries
Travel
Office Supplies & Equipment -
Scientific Supplies & Equipment
Totals
INDUSTRIAL HYGIENE
Salaries :
Travel
Office Supplies & Equipment ^
Scientific Supplies & Equipment
Miscellaneous .._
Totals
MERIT SYSTEM
Totals
$ 14,782.14
State
Federal
Grand Total
$
17,350.00
719.91
1,536.39
1,288.26
592.71
1,440.00
$
11,457.09
433.20
509.38
330.99
$
28,807.09
1,153.11
2,045.77
1,619.25
592.71
1,440.00
$
22,927.27
$
12,730.66
$
35,657.93
$
5,654.12
937.61
645.60
55.31
4,213.75
1,795.54
20.00
$
6,485.00
668.85
658.02
81.08
150.00
$
12,139.12
1,606.46
1,303.62
136.39
4,213.75
1,795.54
170.00
$
13,321.93
$
8,042.95
$
21,364.88
$
21,948.18
93.91
718.84
639.30
236.81
343.21
$
17,835.72
278.05
2,542.26
3,150.11
1,367.29
62.25
$
39,783.90
371.96
3,261.10
3,789.41
1,604.10
405.46
$
23,980.25
$
25,235.68
$
49,215.93
$
16,686.58
385.68
934.38
789.34
208.66
134.61
$
12,374.83
3,957.35
913.09
904.56
1,464.95
$
29,061.41
4,343.03
1,847.47
1,693.90
208.66
1,599.56
$
19,139.25
$
19,614.78
$
38,754.03
$
17,417.66
218.62
1,080.42
$
2,945.00
44.20
1,553.01
$
20,362.66
262.82
2,633.43
$
18,716.70
$
4,542.21
$
23,258.91
$
11,215.00
686.08
846.13
753.50
$
9,380.00
1,156.22
924.85
262.39
$
20,595.00
1,842.30
1,770.98
1,015.89
$
13,500.71
$
11,723.46
$
25,224.17
$
9,529.73
1,548.50
945.50
1,920.91
837.50
$
474.19
22.90
131.70
150.54
$
10,003.92
1,571.40
1,077.20
2,071.45
837.50
$ 779.33
6,523.14
6,523.14
$ 15,561.47
6,523.14
6,523.14
MONTANA STATE BOARD OF HEALTH
87
ITEMIZED DIVISIONAL EXPENDITURES— (Continued)
PLAGUE INVESTIGATION
Salaries
Truck Expense .__
Supplies & Equipment
Totals ^ --
TRAINING
Stipend
Tuition _._ _ _
Travel •_
Totals
MATERNAL & CHILD HEALTH
Salaries -
Travel
Office Supplies & Equipment
Communications
Printing & Binding
Publicotions for Distribution .__.
Scientific Supplies
Contingent
Totals
PUBLIC HEALTH NURSING
Administration — Salaries
County Nurses — Salaries
Travel
Totals .._.
PUBLIC HEALTH EDUCATION
Salaries
Travel .]".."
Office Supplies Expense ^^^
Totals
CRIPPLED CHILDREN
Salaries
Doctors Fees & Treatment
Hospitalization
Travel
ADoliances ___
Office SuDolies & Equipment ..-.
Scientific Suoolies & Equipment
Communications
Printing & Binding
Contingent __
Totals
BLOOD BANK
Office Sunnlies & Equipment ...
Scientific Eauioment
Repairs & Remodeling
Totals __-..
TUBERCULOSIS CONTROL
Salaries _
Travel
Office SuDolies & Equipment
Scientific Supplies & Equipment
Totals
CASCADE COUNTY
Salaries
Travel
Totals
State
Federal
Grand Total
$
3,850.56
454.77
209.53
$
3,850.56
454.77
209.53
$
4,514.86
$
4,514.86
$
5,545.50
1,150.10
209.15
$
5,545.50
1,150.10
209.15
$ 6,904.75
$ 7,324.77
$ 6,904.75
$
12,586.62
572.85
33.25
7.74
$
15,004.60
3,703.17
1,617.61
2,627.64
3,023.28
1,269.98
700.86
9.00
$
27,591.22
3,703.17
2,190.46
2,660.89
3,031.02
1,269.98
700.86
9.00
$
13,200.46
7,624.84
201.46
$
27,956.14
12,640.04
25,431.93
4,926.31
$
41,156.60
20,264.88
25,431.93
5,127.77
$
7,826.30
$
$
42,998.28
5,558.44
1,651.41
114.92
$
$
50,824.58
5,558.44
1,651.41
114.92
$ 7,324.77
$
14,197.96
$
4,709.44
$
18,907.40
14,553.70
14,587.86
29,141.56
51,51 1.41
20,184.80
71,696.21
6,775.68
803.03
7,578.71
2,248.13
960.95
3,209.08
734.01
120.18
854.19
455.28
455.28
111.73
326.80
438.53
27.27
57.98
85.25
55.18
20.00
75.18
$
90,670.35
$
41,771.04
$132,441.39
$
172.92
5,370.00
917.20
$
172.92
5,370.00
917.20
$
6,460.12
$
6,460.12
$
2,546.86
1,138.36
$
1,050.00
$
3,596.86
1,138.36
441.23
3.87
415.10
2,020.46
3,686.07
5,706.53
$
6,116.91
$
4,739.94
$
10,856.85
$
19,080.56
1,952.80
$
19,080.56
1,952.80
$
21,033.36
$
21,033.36
88 TWENTY-THIRD BIENNIAL REPORT
ITEMIZED DIVISIONAL EXPENDITURES— (Continued)
State
FERGUS COUNTY
Salaries
GALLATIN COUNTY
Salaries
Travel
Totals
LEWIS & CLARK COUNTY
Salaries
Travel ._ _ ._
)
Federal
Grand Total
$
3,295.29
$
3,295.29
$
6,375.61
457.45
$
6,375.61
457.45
$
6,833.06
$
6,833.06
$
810.00
50.30
$
810.00
50.30
Totals — :. $ 860.30 $ 860.30
MISSOULA COUNTY
Salaries.- $ 10,111.80 $ 10,111.80
Travel 1,040.85 1,040.85
Totals $ 11,152.65 $ 11,152.65
GRAND TOTALS $250,642.39 $268,576.65 $519,219.04
EMERGENCY MATERNAL &
INFANT CARE
Medical Services & Hospitalization $324,223.77 $324,223.77
' ,:i'
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