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ATE DOCUMENTS

MOMTAMA

TATE BOARD OF HEALTH

■1S)(S0

mh BHEMMSAL REPORT

MONTANA STATE LIBRARY

3 0864 0016 3055 0

The thirtieth biennial report has been prepared to fill the 1901 legislative requirement
that the State Board of Health "shall, at the opening of each session of the legislative assem-
bly, submit to the assembly, through the governor, a full report of all its investigations and
such suggestions and recommendations which will result from such investigations and also,
such additional recommendations in the matter of public health in this state, as it shall deem
proper ... it shall gather such information ... for diffusion among and use by the people."

The report is prepared in two parts :

( 1) Administration and General Services includes reports of those sections of the Board's or-
ganization which are not limited to any one program but are essential to the effective function-
ing of each of the public health programs. The activities in Part I are those of these sections not
reported elsewhere in the report. However, many of the activities of these sections are reported
in Part II of the Public Health Programs. A detailed index will be found at the back of this
report, which will enable the reader to follow these services which are woven throughout many
or all of the Board's programs.

(2) Public Health Programs include the reports which control or prevent disease, and which
promote the public health of Montana's citizens.

This arrangement is used to prevent duplication in reporting wherever possible, and to cut
confusion which sometimes occurs when the administrative organization cuts activities into sec-
tions.

TABLE OF CONTENTS

Introduction

Part I. ADMINISTRATION AND GENERAL SERVICES
Central Administration

Civil Defense
Legislation

Local Health Services
Family Health Services
for Mentally 111

Bacterological Laboratory

Virus Laboratory

Page

Public Health Education

Public Health Nursing
Records and Statistics

Part II. PUBLIC HEALTH PROGRAMS 38

Maternity, Infancy &
Pre-School

Health of School-Aged
Child

Child Health Services

Crippled Children's Services
General
Cleft Lip-Cleft Palate

Dental Health

Center for Cerebral Palsy
& Handicapped Children,
Billings

Acute Communicable
Tuberculosis
Venereal Disease
Cancer

Safe Water
Pollution Abatement
Water Pollution Council
General Sanitation
Food & Drug

Disease Control
Heart Disease
Rheumatic Fever
& Heart Diagnostic
Center,

Great Falls

Environmental Sanitation

Chronic Disease
Occupational Health
Chemistry Laboratory

Swimming Pools
School Building Plans
Educational Aspects of
Environmental Sanitation

Hospital Facilities
Hospital & Medical Facilities

Survey & Construction
Licensure of Hospitals & Homes for Aged

Part III. FINANCIAL TABLES
Index

88
91

BIENNIAL REPORT
July 1. 1958 -June 30, 1960

^'T^^si^X

Board Members Dr. Berg, Mrs. Hanson and

Mr. Losleben review exhibit on Stream

Pollution Samples.

MONTANA

STATE BOARD OF HEALTH

David T. Berg, M.D., President.
R. J. Losleben, Vice-President. ...

H. W. Bateman, M.D

Paul H. Bowden, D.D.S

...Helena

Malta

.Choteau
Butte

Mrs. Helen Johnson Bozeman

Mrs. George W. Hanson ...Superior

S. C. Pratt, M.D - Miles City

G. D. Carlyle Thompson, M.D Helena

Secretary

Board Members Dr. Pratt, Dr. Thompson

(sec'y), Dr. Berg and Dr. Bowden study

exhibit on Radiation Control.

-1 —

WATER POLLUTION COUNCIL MEMBERS

Fred Palmer, Forsyth, Chairman
Fred Buck, Helena

Walter Everin, Helena, Vice-Chairman
John Hazen, Butte

J. Staid, Billings

G. D. Carlyle Thompson, M.D., Helena
Winton Wedemeyer, Fortine

C. W. Brinck, Helena, Secretary

ADVISORY HOSPITAL COUNCIL

W. J. Fouse, Helena, Ex-officio
Edwin Grafton, Helena

David Gregory, M.D., Glasgow
Msgr. James J. Donovan, Billings*
H. H. James, M.D., Butte
Robert D. Howe, Billings

Mrs. Waldo Moberly, Sweet Grass**
G C. Taylor, D.D.S., Billings
Mrs. R. J. Jesse, Missoula
R. R. Veldman, Libby***

G D. Carlyle Thompson, M. D., Helena,
Chairman

•Appointed to fill unexpired term of Sister Theresa of the Cross, Great Falls (Deceased 1-25-59)

"Appointed July 11, 1958, replacing Mrs. Dean King, whose term expired.

•••Replaced Walter Neils, Libby, who resigned May 6, 1959. Mr. Veldman resigned, effective September 1, 1960, and was re-
placed by Mrs. Anna B. Brockway, Libby.

COMMITTEES ADVISORY TO THE STATE BOARD OF HEALTH

Montana stale Denfo
dssociofion's Denial
Adv Committee

STATE BOAR0 OF HEALTH

Advisory Hospital
Council
(2)

Heollh ot School- Age Child

Joint Adv Council

(3)

Montana Health Planning
Council

Civil Defense Health
Services Professional
Advisory Committee

it) Includes Committees on Cancer, Fractire S Orthopedic, Hearts Rheumatic Fever,
Industnol Welfore, Moternol a Child Welfore, Public Health, Tuberculosis,
and Fmergency Medical Service

12) Appointed by Governor (3) With Deportment of Public fnstrucfion

(4) Created of Legislative Suggestion

—2-

^7%c&cctc t& fraid fo .

four citizens who have either retired or died during this biennium and who have made lasting contri-
butions to the public health of Montana. The four are listed below:

JOHN K. COLEMAN, M.D. (1905-1959)

Dr. Coleman, Butte, an orthopedic surgeon, practicing in Butte for 23 years,
was one of the first Orthopedists in the State to work with the State's Crippled
Children's Program. He started participation in this program in 1936 and was
still actively participating at the time of his death. He, along with Louis W.
Allard, M.D., Billings orthopedist, covered the State at the time clinics were
first started for crippled children by the Orthopedic Commission and the Wel-
fare Department. He made distinctive contributions to crippled children in
Montana through his continuous personal devotion and his faithful service.
He was a leader among professional workers in this program and did much to
encourage their activities.

HENRY E. GARBER

Mr. Garber, a registered professional engineer, retired from the State Board
of Health staff on March 15, 1960. He had been employed on the staff of the
division of Environmental Sanitation since 1941. For the last several years
he had been responsible for the review of all school building plans for con-
struction and remodeling. He had also worked on the review of plans for
swimming pool and other public facilities and recommended them for Board
approval. Prior to that time he worked in the program for municipal water
and sewer systems. He contributed long and faithfully to the environmental
sanitation program.

MAUD M. GERDES, M.D. (1902-1959)

Dr. Gerdes, obstetrician and gynecologist, was an active member of the
Montana Medical Association Committee on Maternal and Child Welfare. She
maintained her interest from the time of her establishing practice in Billings
in 1942 until the time of her death. Much of this time she was a member of
the committee. During the period of her interest in Montana's children and
mothers, the deaths in these groups decreased considerably. In 1957 she
discontinued her practice in Billings and for about a year was the full-time
health officer in Public Health District I (Big Horn and Rosebud Counties). She
then moved to Miles City and became a member of the Garberson Clinic staff
there. Those with whom she worked pay tribute to her contributions.

HARRIET PATTERSON. R.N.. P.H.N. (1909-1958)

Mrs. Patterson, Poison, served in public health nursing positions in Mon-
tana, beginning in 1936. She was employed in Public Health District II (Lake-
Sanders Counties) at the time of her death. In addition to her public health
nursing services, she was active in both community and professional organi-
zations during her public health career. At the time of her death she was the
vice-president of the Montana Public Health Association, and had previously
served as its treasurer.

STATE BOARD
OF HEALTH
ORGANIZATION

Administration

G. D. Carlyle Thompson, M.D.
Act'g. Exec. Off.
7-1-58—7-1-60
Reappointed Exec.
Off. 7-1-60

Robert James
Administrative
Officer

Bacteriology

Laboratory

Edith Kuhns, Dir.

A. Howard Fieldsteel, Ph.D.
Dir. Virus Laboratory

Child Health

G. D. Carlyle Thompson, M.D.
Dir. 7-1-58—7-1-60
Appointed Act'g. Dir.
7-1-60

Dental Health

G. D. Carlyle Thompson, M. D.
Act'g. Dir. 7-1-58—9-1-58

A. H. Trithart, D.D.S.
Appointed Dir. 9-1-58

Disease Control

John D. Glismann, M.D.
Director 7-1-58—1-1-59

Mary E. Soules, M.D.
Appointed Dir. 1-1-59

Environmental Sanitation

C. W. Brinck, Director

Local Health Services

G. D. Carlyle Thompson, M. D.
Acting Dir.

Public Health Education

K. Elizabeth Burrell, Director

Public Health Nursing

Wava L. Dixon, Director

Records and Statistics

John C. Wilson, Director

HOSPITAL FACILE TIES

Robert J. Munzenrider, Director

Part I. ADMINISTRATION AND GENERAL SERVICES

The Board's professional and technical staff turnover in 1960 was only half that of 1959 and the

clerical turnover in 1960 was 1 3 that of 1959.
Requirements for matching Federal funds with those of the State became a real problem with loss

of Federal funds occurring for the first time since 1951.
Inadequate office quarters continues to be a problem.

Finances, Budget

During this biennium the greatest problem
has been that of matching the Federal grants-
in-aid for the various health categories. With
the exception of special project funds. Federal
-rants must be matched dollar for dollar with
State funds. Federal funds have been increas-
ing slowly over the past five years. The
amount of State funds appropriated has not
been sufficient to fully match available Federal
funds with the result of program curtailment
in certain areas. It was during the first year
of the biennium that all Federal matching
funds were placed on a 50-51) basis. Prior to
this, although some funds were matched this
way, others were one State dollar to two
Federal dollars.

Total State appropriations for the 1959-61
biennium were 5\ under those for the 1957-
59 biennium and had to he stretched to cover
the higher costs of salaries, supplies and serv-
ices. As a result it was necessary to abolish
some long established staff positions in certain
basic health programs, to limit funds for crip-
pled children's surgery and hospitalization and
to reduce by 50' < basic financial aid to local

Fiscal and personnel matters of the Board are carried
out in the Central Administration Section.

health services. At the same time new staff
positions were established for special pro-
grams supported through special Federal pro-
ject grants.

At the present time $400,000 yearly in
State funds is necessary to match Federal
categorical grants or to defray State adminis-
trative expenses of health department pro-
grams that are financed by Federal funds.
Many basic and essential health services long
established by Montana law also require fi-
nancing from State funds as they are not
eligible for Federal participation. Thus with
a State appropriation averaging slightly under
$400,000 annually, it is clearly evident that
all Federal funds cannot be matched. Pro-
grams requiring State payment of administra-
tive expenses are the hospital construction
-rant program of about $800,000 yearly and
the sanitary facilities construction grants pro-
gram of about $500,000 yearly. Indian health
construction funds of another $500,000 are
processed.

In lanuarv 1960, there was initiated a spe-
cial project of "Family Health Services to the
Mentally IH" which is financed wholly from
Federal funds made available by the U. S.
Public Health Service. National Institute of
Mental Health. This project began with a
budget of $17,346 in fiscal 1960 and has a
budget of $55,426 in fiscal 1961. It will ex-
tend over a period of three to five years on
a declining basis.

The special project in venereal disease
case finding which was started in fiscal year
1957 was continued through the biennium with
a budget of $7,500 in fiscal 1959 and $18,300
in fiscal 1960.

In fiscal year 1960 the I". S. Children's
Bureau allotted $9,300 of special funds through
the State Board of Health to enable the Great

-5—

Falls-Cascade Health Department to make an
evaluation of the health status of selected
groups of (heat Falls children. Included in
the survey were approximately 190 Indian
children sixteen years of age or under from
Mill 57 and Mount Royal.

The special Cleft Lip-Cleft Palate Pro-
gram was carried through its fourth year dur-
ing the biennium on $50,000 of Federal funds
yearly. The project entered the fifth and final
year on lulv 1. 1960. On termination of the
special project continuation oi this type of
work will require State funds.

The budgets for the two years of the bien-
nium averaged approximately $10,500 higher
than those of the previous biennium. The
fiscal 1959 budget was lower than that of
either of the two previous years. The in-
creased budget in 1960 was attributable to ad-
ditional Federal grants, some of which could
not be utilized because of lack of State match-
ing funds. Federal funds amounted to 53%
of the budget in fiscal 1959 and 57% in fiscal
1960.

MONTANA STATE BOARD OF HEALTH

Budgets and Expenditures

State and Federal Funds

FISCAL YEARS 1954 to 1961

Year Total Federal* State**

1961 Budgeted ..$1,023,850 $605,317 $418,533

(Preliminary i

1960 Budgeted 972,101 553,374 418,727

Expended 919,220 534,962 3X4.258

1959 Budgeted 926.366 493,316 433,050

Expended 897,837 47", 552 418,285

1958 Budgeted 932,970 498,9X2 433,988

Expended 872.225 475,203 397,022

1957 Budgeted '44,522 553,595 390,927

Expended 854,877 523,751 331,126

1956 Budgeted 851.7110 475.463 376,243

Expended 795.106 459,595 335,511

1955 Iiudgeted 681,735 308,581 373,154

Expended 660,793 295,701 365,092

1954 Budgeted 695,047 337,924 357,123

Expended 637,320 324,800 312,520

♦Excludes Federal construction grants for hospital,
medical and sanitary facilities.
♦♦Contributions are included in State fur.ds.

Total expenditures of $897,837 in fiscal year

1959 and $919,220 in fiscal 1960 averaged
$36,303 higher than the fiscal 1958 expendi-
tures of $872,225. I I Mail of budgets, expendi-
tures and trends since 1954 are shown in Part
I I I of this report.)

SBH Budgeted Funds *

1954-1961

1,100,000

1,000,000
900,000

*~ All Funds

•
/
/
/

"- J

Federal Funds ^^

800,000

Z 700,000

a 600,000

500,000

/\ ^

400,000

^V^,.' "j/r state Funds

300,000

200,000

100,000

1954 1955 1956 1957 1958 1959 I960 1961
Fiscal Yeors

* Excludes federal construction grants for hospital,
medical, and sanitary facilities

Information from Federal sources indicates
that allotments to Montana from Public Health
Service and Children's Bureau grants for fis-
cal year l'»dl will be somewhat in excess of
those of the past biennium.

Detail of Receipts from Fees
As authorized by State statutes, the various
divisions of the State Board of Health collected
and deposited in the State general fund the
receipts for licenses and certified copies of
certificate^ issued. During the biennium
%7i,2\Z was deposited in the general fund.
In addition. $5,418 was collected for water
analyses performed for private individuals and
deposited in the special fund used to defray
a portion of the laboratory operative expenses.

Detail of Receipts From Fees

CI)

■- -

—
r

; —

■z-

- <Ji

— .

CfiiJ

= -

z
H

1958-59 ..

... 2.932

, 773

12,735

445

545

14.883

39,313

1959-60 ..

... 2,486

7,909

13.210

321

490

14.902

39,318

Total

5,418

15,682

25.945

766

1,035

29.785

78.631

Personnel

\ continual process of recruitment has been

successful in maintaining personnel in most

staff positions for a good percentage of each

year. Technically trained personnel are in

-6—

short supply in many categories, and in some
categories extremely scarce. It has been es-
pecially difficult during the past year to find
applicants for medical, engineering, public
health nursing, bacteriology, occupational ther-
apy and speech and hearing therapy positions.
The infrequent salary scale adjustments which
have been possible on limited budgets do not
permit real competition with private industries
for personnel in those categories where tech-
nical training requires recruitment on a re-
gional or nationwide basis.

The institution of the special project of
"Family Health Services for the Mentally 111"
has been hampered because (if the difficulty of
employing public health nurses. The special
pic Meet in the control of venereal disease and
the heart disease control program have been
less effective than desired because the program
staffs are short in public health nursing per-
sonnel. With two impending vacancies in
the staff of the Bacteriological Laboratory at
the end of the biennium, it is found that there
are very few qualified bacteriologists available
for employment. During the last fiscal year
only one bacteriologist was examined for State
staff positions, and that was for an advanced
position. An increasing number ol college
graduates in technical and scientific fields are
going on to graduate schools, with the result
that there are fewer applicants for positions in
the entrance classifications.

Staff Turnover
The staff turnover for professional and
technical positions was lower than that of
the previous biennium with the turnover for
fiscal year 1960 only 70' , that of fiscal 1959.
The turnover for the clerical positions re-
mained high during the first year oi this bi-
ennium then declined drastically during the
second year. The improvement for all classes
seems to be due in part to more adequate
salary schedules and opportunities for ad-
vancement to new positions. It may also be
partly explained by the fact that many changes
in personnel occurred just prior to the start of
the biennium. and several separations will be
effective shortly after tin- close of the bien-
nium. Also, during the last year the compensa-
tion schedules for the clerical and stenographic
positions were made more competitive to those
of other State agencies. It has since been much

130
120
110

I 00
90

1 60

S 50

I 40

SBH Budgeted Full- time Positions
1954 - 1961

all employees

, '

professional 8 technical staff

clerical staff

1954 1955 1956 1957 1958 1959 I960 1961
Fiscal Years

easier to recruit and retain personnel in com-
petition with other employing agencies.

It has not been possible during the last
two years to attract a public health physician
to direct the Division of Child Health Services.
Recruitment is hampered by the fact that Mon-
tana is far from established medical centers
and centers of population, and by the fact
that Montana's salary offers cannot compete
with those of other state or local health de-
partments.

The Divisions of Dental Health and Dis-
ease Control have had full time directors dur-
ing the biennium and their health programs
have been carried to high standards. These
directorships had been vacant a good part of
the lime of the previous biennium.

Budget restrictions during the biennium
made it necessary to abolish several long es-
tablished staff positions. The number of posi-
tions has remained relatively constant because
of the institution of special projects utilizing
wholly Federal funds to which some personnel
could be transferred. At the expiration of the
special projects, trained personnel must be
released unless State and Federal matching
funds are available for the continuance of basic
State healt h programs.

There has been little progress made in the
development of health services at the local
level. Salaries offered by local departments
are not high enough to attract persons from
out of State. Applications are received from
out-of-State sanitarians but salaries offered
an- not sufficient to cause them to leave other
positions and accept Montana employment.
No local area has budgeted for a health educa-
tor and health education services on the State
staff are not adequate to fill the needs.

Staff Turnover

% %
1954 1955

1956 1957 1958 1959 1960

1 'rofessional-
Technical 4'' 1!

( [erica!

. 7n 112

1 :
55

17 12
60 23

Office Quarters
During Fiscal 1960 Federal inspectors com-
pleted the audit of the State Laboratory Build-
ing. It is expected that final payment of Fed-
eral participation will be made early in the
1961 fiscal year. The laboratories are now
operating in well equipped quarters. 'I he cri-
tical need at present is for space for those of-
fices not connected to laboratory services.
Many offices are over-crowded, with resultant
loss of efficiency. Some provision must soon
be made of adequate office quarters in order
to permit the performance ol office duties with
efficiency.

Early in the biennium the Health. Medical,
Special Weapons and Radiological sections of
the Montana Operations Survival Plan were
brought to completion in the preliminary
stage. Under a special Federal project, part-
time and temporary assistance of one person
was made available through the State Civil
I lefense I >irect< >r.

These plans replaced those adopted in 1952.
Before the current sections can be considered
complete and ready for use much more work
is needed.

These sections continued the Executive
Officer of the Slate Board of Health as the
Director of the Health and Radiological Serv-
ices in time of national or enemy disaster. As

in 1952, the ke) staff for Civil Defense and
Radiological Services are designated from the
regular employees of the State Board of
Health, but in some instances practicing phy-
sicians and other volunteers will need to be
utilized in some appointments.

District Plan Practical

The new plan, for the first time provides a
practical approach to health problems through-
out the State by establishing ten districts and
several sub-districts which are shown on the
map on page 9. Such an arrangement, which
overlaps the county and city political subdivi-
sion limits, provides the only way to utilize
Montana's health manpower and resources in
an efficient manner.

Delegation of Responsibility

During the biennium Civil Defense Health
Services were clarified on the national level.
This brought about the delegation of responsi-
bility and authority in all aspects of health
services in Civil Defense to the I'. S. De-
partment of Health, Education ami Welfare —
Public Health Service. This responsibility and
authority was formerly in the Office of Civil
Defense and Defense Mobilization.

With the adoption of the National Man-
power Plan, the Public Health Service and
the State Health Agencies are also given con-
trol over essential Health Manpower. Other
manpower skills are controlled by the D. S.
Department of Labor and its State component,
the Employment Service and the Selective
Service System. This makes it possible to
plan for the use of the skills of those per-
sons in essential health services. Such a plan
was initiated in Montana at the end of the
biennium.

In the past, what work was done in Civil
Defense Health Services and Radiological
Health has been carried on entirely by State
Hoard of Health staff employed for other du-
ties. To implement the new plan and carry
out the program efficiently the assignment oi
one full-time person with clerical assistance,
necessary travel and provisions for carrying
out training throughout the State will lie
needed. State funds for this purpose in the
new biennium can be minimized by the avail-
ability of Federal matching funds.

-8—

MONTANA
OPERATIONAL
SURVIVAL
PLAN
JULY 1958

Health, Medical and Radiological Service

Districts and Sub-districts
(includes Biological and Chemical Defense)

Gallatin County Civil Defense
Organization Tested

The Gallatin County Civil Defense Organi-
zation was tested on a limited basis during
the Madison Valley Earthquake in August
1959. The State Organization was not tested.
However, the State staff immediately entered
the picture in investigating the public water
supplies, sewage disposal facilities and the
food supplies available in the area. Xo major
problems were encountered in these area- oi
public health protection.

It is fortunate that this disaster occurred
in a rural area since it is recognized that the
Stale organization is not fully prepared to
mobilize fur the prompt and adequate handling
(if a disaster of this scope in a populous area.

xe^i

ttOH

The 1959 legislative assembl) enacted sev-
eral bills which relate to public health. A brief
resrme of these bill-, follows:

Concerning Tuberculosis Control
This bill makes it possible for am person
with tuberculosis to be admitted to the State
Sanitarium. Intil the passage of this bill only
tuberculosis patients who were citizens of the
State for one year if a male, and five months
if a female could be admitted to the State

Sanitarium. This not only denied Sanitarium
care to some persons but it directly contributed
to the spread of tuberculosis in the community.

A second lull was enacted that relates to
tuberculosis control. This lull permits the
commitment of certain patients with tuber-
culosis to the Sanitarium or another facility
which provides care for tuberculosis patients,
if these patients refuse hospitalization or leave
the hospital against medical advice and are
found to be a public health menace. This law
also provides procedures to require persons
suspected of haxing tuberculosis to submit to
an examination. This will make it possible to
protect the community against persons with
communicable tuberculosis or persons exposed
to communicable tuberculosis and who refuse
to comply with the State Board of Health
regulatii ins.

These laws and their application and limita-
tions are described further in the Disease Con-
trol Section of this report on page 63.

Requiring Registration of Sanitarians

Until this law was passed there had been
no registration of sanitarians, also, there were
no legal qualifications established for a person
who called himself a sanitarian, except for per-
sons employed as sanitarians through the Mon-
tana Merit Svstem Council.

-9—

The law provides for the State Board of
Health to appoint a Sanitarian's Registration
Council. This council issues certificates upon
evidence that the applicant meets the estab-
lished qualifications. This law is discussed
further in the Environmental Sanitation sec-
tion of this report on pages 78 ami 79.

Nursing and Boarding Homes for Aged
Persons Redefined
Previous to the passage of this act the li-
censing of nursing and hoarding homes for
the aged applied only to homes caring for five
or more persons and did not specify relation-
ships. The new law redefines the boarding or
nursing homes for aged persons as being a
home where two or more aged persons unre-
lated l>v blood or marriage reside, board or
receive nursing cue.

Water Pollution Act Amended

This amendment to the Water Pollution
Act relates to new industries coming into the
State which discharge wastes into a stream
or a portion of a stream which is excluded
from classification. It requires that wastes so
discharged must meet the same requirements
as required in the classification of the down-
stream portion of the stream.

State Pumbing Code Requires State Board
of Health Approval

The law creating a State Plumbing Hoard
also provides for the establishment of a State
Plumbing Code. This code must have the
approval of the State Board of Health before
it is effective. Its purpose is to promote and
protect the public health through the establish-
ment of minimum standards for plumbing
work.

SBH Approval Required on Rules for

Recreational Use of Public Fishing

Reservoirs and Lakes

The State Fish and (lame Commission was
authorized to promulgate and enforce rules
governing the recreational uses of public fish-
ing reservoirs and lakes constructed by the
Commission or on reservoirs and lakes which
it operates under agreement with a Federal
or State Agency or private owner.

The rules are to be in the interest of public
health, public safety and protection of proper-

ty. They are subject to review ami approval
by the State Board of Health as to their pro-
tection of public health and sanitation before
they become effective.

Disposition of Rabid Dogs

In the law relating to the licensing of dogs
by the county commissioners and municipali-
ties an important public health aspect is in-
cluded which states that "any dog suspected
of having rabies or known to have bitten any
human or animal, shall not be killed or other-
wise disposed of until released by the Counts-
Health Officer or his agent." By holding these
dogs they can be observed and examined. This
is of great importance to the physician in
reaching a decision on administering anti-
rabies vaccine to the person bitten.

Contract Marriage Requirement

The law now requires that persons who are
participants in "unsolemnized" or "contract''
marriages shall be required to file a premarital
blood test certificate with the marriage decla-
ration. Before the enactment of this bill these
persons were not included in the law which
requires premarital tests lor the detection oi
syphilis in making application for a marriage
license.

Fire Extinguisher Regulation
This law relating to fire extinguishers re-
quired in public buildings, states that these
fire extinguishers must not contain certain
"toxic or poisonous vaporizing liquid."

Licensing Required for Frozen Food
Processing Plants

The law requiring the licensing of refrig-
erated lockers by the State Board of Health
was amended to include the licensing of frozen
food processing plants.

Continued Study of Alcoholism Authorized

A Joint Senate Resolution was passed which
authorized the State Board of Health to con-
tinue the study of alcoholism in Montana, and
its concomitant problems, and to report the
findings and recommendations as to the ap-
propriate steps to be taken for the prevention
and cure of alcoholism to the next legislative
assembly. This is further discussed in the
Health Education Section of this Report on
pagre 30.

-10-

^accU '%e<zlt& SetviceA

Full-time local health departments,
working with professional people in
health and related fields, assist
citizens in protecting community
health.

Local Health Departments made marked improvement in reporting.

Cascade City-County Health Department notes fortieth anniversary.

Mental Health Unit established in State Board of Health. Special Federal grant awarded to carry
out "Family Health Services for the Mentall 111". Purpose is to carry out public health services to
mentally ill patients and their families in the community.

AREAS WITH FULL-TIME HEALTH
DEPARTMENTS

The most important progress made in local
health department services in the biennium
was the strengthening of the four existing
full-time health departments. The counties
providing this service arc Cascade, served by
the Cascade City-County Health Department;
Gallatin served by the Gallatin City-County
Health Department; Big Horn and Rosebud
Counties and the Crow and Cheyenne Indian
Reservations served by Public Health District
I ; and Lake and Sanders Counties and the
Flathead Indian Reservation served by Public
Health District 1 1.

Although there has been considerable public
interest in the establishment of full-time serv-
ices for a few other counties, none have as
yet materialized.

The laws of the nation place responsibility
for the health of the people with the States;
the Montana Constitution establishes this re-
sponsibility in the State of Montana. Since
the State Board of Health was created in 1901
l>v the legislature, it has had the responsibility
for public health in Montana.

\\ ith few exceptions, either by legislative
action or Board policy, the carrying out of
mam of the State's responsibilities has been
wiselv delegated to local Boards of Health.
The State Board has assumed local operational
responsibility only when there is an immediate
threat to the health of the public in which the
local area is not assuming its responsibilities
or where multiple political subdivisions are
concerned. However, the State Board has
continued to set standards and rules and regu-
lations pertaining to health matters as pro-
vided in State law.

The Board's staff provides consultative serv-
ices, and in some instances supervision for the
local areas. Financial aid to counties is an
item in the Board's budget.

Reporting Improved

The four full-time health departments have
very gratifyingly improved their quarterly re-
porting. The l'HIl law states that the "local
health officer shall prepare a quarterly report
which shall set forth the general health and
sanitary conditions of his district, give an ac-
count of all his activities as health officer

-11-

Pictured from left to right,
are the public health dentist,
health officer, sanitarian and
public health nursing super-
visor. They are all members
of the Cascade City-County
Health Department staff. In
addition, the staff includes:
121 2 public health nurses,
three sanitarians, one sani-
tarian aide and three cleri-
cal staff members. Through
a special project grant the
following additional staff are
planned: associate health of-
ficer, public health nurses,
psychiatric social worker and
clerical staff.

fc-T

"S*»

during the previous quarter, and Mich other
information as the State Board of Health may
call for".

In addition to these quarterly reports, all
four of these departments prepared a sum-
mary of their activities and current progress
for publication in Treasure State Health, the
Board's official publication; Cascade and Pub-
lic Health District I also issue annual reports.

The two districts have improved their serv-
ices to the Indian population. They are mak-
ing improvements toward meeting the contract
agreement between State Board of Health and
the l". S. Public Health Service, Division of
Indian Health, in providing public health serv-
ices for the Indian population on the reserva-
tions in their respective district-.

Staffing the full-time health departments has
improved. In fact, the increase in the em-
ployment of public health nurses in the State
has been largely in these departments rather
than in the unorganized areas of the State.
For the first time the five budgeted public
health nursing positions were filled in Public
Health District I.

Except for a few month-, without full-time
health officer services in Public Health Dis-
trict I, the health officer positions have been
filled. Cascade, in addition to the full-time
health officer, will employ an associate health
officer early in the next biennium.

Health Education services have been con-
tinued by the State Board of Health on a
full-time basis in Public Health District I and
half-time in District II. This has been made
possible through I". S. Public Health Service
funds, made available through the Indian
Health contract.

Sanitation services, with a few months ex
ception have also been available in all four
ot the departments, during the biennium.

The immunization surveys which have been
conducted show the level of immunization in
( ascade and Gallatin Counties to be very high
and in Public Health District I higher than in
areas surveyed where there was no full-time
department.

Cascade Notes 40th Anniversary
1(|(>0 marks the fortieth anniversary of the
Cascade City - County Health Department.
This is Montana's oldest health department.
It serves the largest population and has the
most extensive program.

Several new developments have occurred in
this area during the biennium. These included
the provision of field experience for public
health nursing students from the Montana
Slate College School of Nursing. With the
assistance of the I*. S. Children's Bureau and
the State Board of Health, a pediatric evalua-
tion was made in addition to the regular Child
Health Services. This evaluation included 134
Indian children and 88 non-Indian children
from families in the lower economic group.
Discussion groups for Education for Parent-
hood were established, a Conservation of Hear-
ing Program was initiated, the mosquito con-
trol program was improved, food service per-
sonnel training was carried out.

With assistance from the State Board ol
Health, an analysis of the dental records of
1,408 Great Falls children ha- started. From
the preliminary random sampling of 250 of
these records it is shown that the 30-year-old
dental health program has paid dividends.

-12-

The local public health nurses provided services for
approximately 30,000 persons during the biennium.

This is the only local health department in

the State which employs a public health den-
tist.

Through a National Institute of Mental
Health grant, the department has started an
extensive five-year mental health study.

Gallatin City-County Health Department
The Gallatin City-County Health Depart-
ment has continued to provide field experience
in public health nursing for Montana Slab
College students which was started in 1955
This was one of the first areas in the State
to initiate a professional services committee
as an adjunct to the Education for Parenthood

Program. During the past year, the Health
Department in a joint effort with the State
Board of Health is undertaking a pilot pro-
gram with the operators of nursing homes to
explore needs and methods for improving pa-
tient care through extending the health de-
partment facilities and other community re-
sources.

A dental survey was made with assistance
from the practicing" dentists in Bozeman and
the dental division of the State Hoard of
Health to ascertain the benefits of seven years
of controlled flouridation in the public water
supply. This survey showed the same bene-
ficial results (a <>()', reduction in dental caries)
are being received by the Bozeman children
who have drunk water with the recommended
amount of fluorides (1 p. p.m.) as has been
experienced elsewhere. The survey also shows
that nearly 1 3 of the six year olds (the group
who have had the benefits of fluoridation all
their lives) bad newer experienced dental de-
cay.

The Gallatin County health officer and public health

nursing staff provide field experience for the Montana

State College school of nursing students.

Local sanitarians check school playground equipment
as a part of their work on the school environment.

The Gallatin public health staff participated
in the Civil Defense Organization called into
action by the Madison Valley earthquake dis-
aster in August, 1959. From the experience
gained here, guidance in gearing for natural
disaster as well as for Civil Defense, will not
only be helpful to this county in improving its
organization but also to others in the State
and nation. This experience will not only im-
prove the "paper disaster plan" but also im-
prove procedures in the abihtv to function in
tune of emergency need.

—13—

Public Health Districts I and II

Emphasis has continued in these two de-
partments in attacking the Indian Health prob-
lem, not only to improve the health status of
the Indian populations but by so doing the
health of the citizens in these communities will
be improved, since "disease knows no boun-
daries".

With improved staffing reported earlier,
progress is being made. In the spring of l'^''
a joint program review was made in the two
districts. This was participated in by the
districts' staffs and the U. S. Public Health
Service staff from the Indian Health Division
office in Hillings, and State Hoard of Health
staff.

From this review priorities were established
for concentrated work during the next three
vears and specific plans were made to im-
plement programs to meet the needs.

Before this concentrated program was
started it was estimated that the health prob-
lems of Montana's Indians were estimated at
10-13 times higher than for the rest of the
State's population. Information material on
"Attitudes, Beliefs, Habits and Culture as
They Affect Public Health" on these three
Indian reservations has been collected to aid
in staff understanding and in the development
of approaches to improve this low health
standard. The purpose of the program is to
bring the level of the health of the Indian
population up to an acceptable standard. It
is also aimed to assist the Indians through
education and cooperative planning to assume
responsibility for his personal and community
health.

OTHER AREAS

Local areas without full-time health depart-
ments have shown little change during the
hiennium. No counties have employed public
health nurses who did not employ them dur-
ing the last hiennium. There are still about
half the counties providing no public health
nursing services.

\ alley County is the only county to employ
a full-time sanitarian since the last reporting
period. Liberty has joined Hill and Blaine
Counties in getting part-time services from the
sanitarian who was already serving these two
counties. There are still 36 counties in the
State lacking sanitarian services.

Through education and cooperative planning the pub-
lic health staff in Districts I and II aim to help the
Indian people assume responsibility for their personal
and community health.

Many of the public health programs in Mon-
tana cannot lie carried out effectively flue to
the lack of trained personnel in local areas.
The work that can be carried out by the State
Board of Health staff in local areas which
should normally be carried on by local staft
is extremely limited. As a general rule it can
onl} cover emergency situations. There is no
plan to increase the State staff to carry on
this work since it is generally recognized to
lie better public health practice to employ staff
locally. However, unless local areas assume
this responsibility in the not too far distant
future, a new plan tor providing local public
health services in Montana may have to he
developed.

This Indian mother and her three children consult

with the public health nurse in getting the children

ready for the opening of school.

FAMILY HEALTH SERVICES
FOR THE MENTALLY ILL

In January, 1"60, a Mental Health Unit
was established in the State Board of Health
for the purpose of administering a special pro-
ject known as "Family Health Services for
the Mentally 111". The Project is financed
through a grant provided by the l". S. Public
Health Service's National Institute of Mental
Health for a period of three years with the
possibility of a two-year extension. Services
will be developed initially to include follow-up
of patients released from the State Hospital,
but as si ion as feasible, the services will add
pre hospital admissions, and later non-hospital
patients. Community education on mental
health also will he developed during the demon-
stration period.

The mental health authority in Montana
is the State Hospital. However, the Stale
Hoard of Health recognizes the mental health
aspects of many of its pro-rams as well as
the public health implication in the field of
mental health. Realizing its component re-
sponsibility, the Hoard's staff feels that in
joining forces with the State Hospital much
can he accomplished in surmounting this grow-
ing health problem.

Both State agencies realize that hospitaliza-
tion is only one aspect in the treatment of a
mental illness that began long before the pa-
tient was hospitalized and which is by no
mean- finished when the patient is released
from the I tospital.

Of the patients admitted to the Montana
State llo-pital in any given year, half of them
received treatment before. Many of them re-
turn to the Hospital because they did not re-
main under medical supervision, because of
their inability to meet the difficulties encoun-
tered in family and community life or, because
of lack of better understanding on the part of
the family and community in helping them in
their adjustment. With the increased use of
modern drug therapy and improved services
the average length of hospitalization has been
shortened in recent years. There is need for
supportive service at the community level when
the patient returns to his home. It is hoped
that this program will help reduce the re-ad-
mission rate.

The State Board of Health Project is close-
lv related to and in fact developed out of the
need demonstrated by the State Hospital's
Field Service Program which was initiated in
1957. The scope of the Hospital's Field Service
Program is continuity of treatment, liaison
with local health and social agencies, and edu-
cation in the field of mental health.

The chart on page 17 shows the cooperative
relationship between these two projects.

The Liaison Committee between Montana
State Hospital and the State Board of Health
was formed and has met regularly for coopera-
tive interagency planning in Mental Health.
Activities of this committee have included
planning for exchange of information between
the two agencies and statewide program plan-
ning. Activities also carried out have been in-
forming local medical societies and law en-
forcement officials of the efforts of the two
agencies in relation to follow-up services after
patients are released from the Hospital as well
as efforts toward providing pre-admission serv-
ice- for the mentally ill and their families.

The Project

The Project was planned to provide public
health nursing and other health services to
the mentally ill patients and their families.
The project is also planned to provide health
education services to help the community gain
a better understanding and to create an at-
mosphere conducive to the rehabilitation of
the patient who has returned to the communi-
ty. The scope of the project was determined
as continuity of care, treatment follow-up. early
detection, and prevention of mental illness
through development and improvement of com-
munity health services; medical, public health
nursing, and health education. Consultation
was arranged for in the areas of psychiatry,
psychiatric social work, mental health, and
psychiatric nursing.

Objectives
Because of the preventive aspects of mental
illness and the need for early detection as well
as rehabilitation the State Board of Health's
project was planned with some of its objectives
a- f. ill. iws :

—to demonstrate public health nursing
family health services for the mentally ill
l,, stimulate and strengthen interest and
to increase the confidence and skill of

-15-

public health nurses in caring for the
mentally ill and their families
—to identify the mental health principles
being used in generalized public health
nursing services

to determine the impact of referral of
mental patients on local health services
as well as on State hospital services

— to cooperate with other agencies and
disciplines in providing for continuity of
care for the mentally ill and to determine
if additional resources are necessary and
where these are available

— to extend and promote professional and
community interest and understanding
in the field of mental health.

Geographic Area Served
The Project functions in 26 counties oi
Montana already covered by generalized public
health nursing services and Silver Bow and
1 )eer Lodge Counties. Since Silver Mow and
I leer Lodge Counties lack generalized public
health nursing service, the Project provides
for placing three full-time public health nurses
m that area with services supplemented by
specialized state staff from Helena. These two
counties will he the center of intensive effort.
A field office was established in the Butte-
Anaconda area at St. James Community Hos-
pital, Butte.

The staff of this project was planned to
include five public health nurses, one health
educator, and two clerks: two public health
nurse positions remain to lie filled. C. D.
Carlyle Thompson. M.D., Executive Officer
of the State Board of Health, was named as
Director of the Project. Consultant services
of Robert J. Spratt, M.D., Superintendent of
the State Hospital and Director of the Mental
Hygiene Clinics, and members oi his staff
were arranged.

Two advisory committees are planned for
the Project; one to be a state-wide committee
and the other a local committee for the Butte-
Anaconda area.

Area conferences on "schizophrenia . one
of the serious mental illnesses, were held for
public health nurses throughout the State.

Even though the program is Mill in its in-
fancy, enough work has been done to stimulate

an increase in public health nursing visits
which have been made on behalf of the Mental
Health Program. This is shown on the graph
below.

These conferences helped to increase inter-
est and understanding of the nurses in serving
mental patients in cooperation with the State
Hospital staff and the family physician.

PUBLIC HEALTH NURSING
IN MENTAL HEALTH

VISIT3

1955 - 1959

93 '56 '3 7 "38 '39

63 '36 '87 '38 'S»

'83 '96 '87 '88 'SB

GRAPH shows increase in Public Health Nursing
visits in mental health during 1959, following first
joint efforts of Montana State Hospital and the State
Board of Health in program for released hospital
patients.

A five-day "Orientation-In-Service Edu-
cation Program" for local public health nurses
was jointly planned with Montana State Hos-
pital and was initiated in June, 1960. State
Hoard of Health staff attending this program
are Public Health Nurses. Medical Social
Worker and Health Education Consultants.
The purpose is to give those working in com-
munities more knowledge of the treatment
facilities at the Hospital and a broader under-
standing of mental illness with its impact on
the patient, his family, his local community
and the State.

With the development and initiation of
the Project during the current biennium it is
expected that during the next biennium a
mental health program will pay dividends to
the State.

-16—

MONTANA . . .

STATE BOARD OF HEALTH

STATE (MENTAL) HOSPITAL

Integrated Projects

FAMILY HEALTH SERVICES TO
MENTALLY ILL

FAMILY SERVICE
PROGRAM

Liaison Staff

G. D. Carlyle Thompson, M.D.
Executive Officer

Mrs. Esmer King, R.N.

Scope: Treatment Follow-up, Detection and Pre-
vention of Mental Illness through Development
and Improvement of Community Health Services:
Medical, Public Health Nursing and Health Edu-
cation.

r» M II

t:'..j

{ A

28 Counties with Public Health Nurses

Robert J. Spratt, M.D.
Superintendent

T. E. Fasso. M.S.W.

Scope: Continuity of Treatment, Liaison with Lo-
cal Health and Social Agencies and Education in
Mental Health.

Field Workers in 4 Centers

— 17-

Fluorescent Antibody technique ini-
tiated for rapid diagnosis in rheu-
matic fever heart disease program.

^act&iiatayiazt ^.<z&a%ctf<ncf,

*%C<2,6liy6.t& <*£ t&e ^iettttiutn:

Establishment of Bacteriological and Virological Laboratories in State Laboratory Building.

Acquisition of equipment for fluorescent antibody technique for rapid detection of Group A beta-
hemolytic streptococci in throat cultures.

Membrane Filter Technique utilized in Water Pollution Abatement Program, to make possible more
rapid reporting and simplifying water testing program.

Studies conducted on "anonymous" acid-fast group of organisms associated with tuberculous-like
disease in humans.

Inspection and evaluation made of all laboratories in State requesting approval for serologic test-
ing for syphilis.

Workshop in performance of VDRL slide test for syphilis held.

Initiation of new transport media for culture of gonococci, available to physicians on request.

Study made in cooperation with U.S.P.H.S. Rocky Mountain Laboratory at Hamilton on Q fever.

Virus laboratory adequately equipped to study most of common viruses and rickettsial diseases
found in humans in this area.

Isolation of influenza Type A2 (Asian) made in May, 1959.

PROGRAM OBJECTIVES AND
ACTIVITIES

The bacteriological and virological labora-
tories carry out the following delegated re-
sponsibilities to meet the requirements of the
Board's public health program.

i 1 I Routine and special bacteriological
tests are performed which include the technical
laboratory services provided for all programs.
This is done by making examinations for the
detection and control of communicable disea -< -
which include bacteriological, serological and
virological studies relative to human diseases
These studies are conducted upon various clin-
ical material- at the request of physicians,
clinics, hospitals, institutions, local health de-
partments, and other divisions of the State
Hoard of Health and other State departments.

Laboratory services are provided as a l>a-i>
for environmental health control purpose- in
the fields of public water supplies, stream
pollution abatement and certain dairy products.

Technical and supporting services are
provided for other public health programs
and special investigations and methodological
studies are made.

I _' i Local laboratories requesting approval
for syphilis serology are evaluated. This work
consists oi visits to laboratories and a stud)
of their personnel, quarters, equipment, and
methods. During the year check specimens
will be mailed to each laboratory to determine
it- technical proficiency in the actual perform-
ance of the serologic test or tests for which
approval has been requested.

-18-

(3) Consultative and Training services are
provided. Training is offered on a limited
basis through refresher courses. These are
for laboratory workers in other laboratories in
bacteriological, serological and virological
techniques. Visits to private and hospital lab-
oratories are available on a limited basis for
ci insultative purpi ises.

New Activities

The establishment of the Bacteriological
Laboratory Division in October 1958 in space
in the Slate Laboratory Building has provided
greatly expanded working facilities and has
made possible the development of new testing
procedures some of which were long delayed
because of hazardous working conditions in
the old laboratory. The laboratory was also
greatly handicapped by inadequate space in
the old State Board of Health Building where
it had been housed since 1920.

Through the acquisition of equipment for
fluorescent antibody techniques it is possible
for the laboratory to provide services for the
Rheumatic Fever Heart Disease Control Pro-
gram. This technique provides for the detec-
tion of Group A, beta-hemolytic streptococci
in throat cultures much more rapidly than in
procedures previously used. The use oi this
technique can be expected to also be applied

Animals are a useful adjunct in the laboratory diag-
nosis of tuberculosis.

soon to many- other laboratory procedures, in-
cluding detection of virus and rickettsial in-
fections.

A supplemental diagnostic test for syphilis
was initiated, the treponemal test, KRP. Its
use will provide a supplemental diagnostic aid
for the differentiation of false biologic sero-
logic reactions for syphilis.

Laboratory Inspections and Training

The inspection and evaluation of 46 of 48
local laboratories in the State has been car-
ried out. These are the laboratories that re-
quested approval for running serologic tests

Refresher workshop held in
May, 1960 for medical tech-
nologists provided practical
experience.

for syphilis. These laboratories must be regis-
tered annually and must meet recommended
standard-. Physicians carrying out tbe pro-
visions of tbe State's prenatal and premarital
laws requiring blood tests for syphilis, must
submit specimens to either tbe State Board
of Health laboratory or to a local laboratory
approved by the Board.

A workshop in tbe techniques for the
VDRL slide test was held in May 1%0 for
20 medical technologists. Consultant and
teaching aid was given by Miss Alwilda Wal-
lace from the V. D. Research Laboratory in
Atlanta. Georgia.

This training course was well received.
Since it was held the Board has been notified
that several of the laboratories have revised
their toting services to conform to standard
methods presented at the workshop. Until
adequate -pace was provided by the move into
the State Laboratory Building, this service
could not be i iffered.

A new shipping media has been initiated
to In- used in transporting cultures of gono-
cocci and other fastidious organisms that do
not survive other shipping methods. This will
make available to physicians without special
laboratory facilities, identification studies for
the detection of cases of gonorrhea, pertussis
and other bacterial diseases.

In order to keep abreast of the rapidly
changing field, laboratory personnel from the
Board's staff attended refresher training
courses in the laboratory diagnosis of tuber-
culosis, the diagnosis of other bacterial dis-
eases and the fluorescent antibody techniques
at the Communicable Disease Center of the
I". S. Public Health Service in Atlanta, Geor-
gia. There has been participation of the staff
in correspondence and extension courses of-
fered by the Communicable Disease Center, in
the fields of parasitology, tuberculosis and
mycology.

Special Studies
Several special studies have been carried
out during the biennium. This included com-
parative studies made on the use of the milli-
pore filter as a means of testing the bacterial
content of waters in the water pollution pro-
gram. A cooperative study was carried out
with the I'. S. Public Health Service Rocky
Mountain Laboratory in Hamilton in a sur-

vev to determine tbe incidence of antibodies
for Q fever in the general population of the
State.

Laboratorv services were furnished for the
detection of pinworms in rectal slide - type
preparations as a part of a pediatric survey
carried out hv the Cascade City-County Health
Department.

Studies 011 the characterization of the
groups of atypical acid-fast bacilli belonging
to the genus Mycobacterium have been ham-
pered by the lack of qualified personnel to
assign to this project. The purposes of these
studies are to distinguish between members
of this group and the true tubercle bacilli as
well as to determine their possible significance
when associated with abnormal chest condi-
tions.

LABORATORY TRENDS

The great need for relating microbiology,
including virology, to epidemiological investi-
gations of disease is becoming more and more
important. Laboratory reports are considered
more in the light of an epidemiological ap-
proach rather than an isolated laboratory find-
ing. This requires a closer relationship be-
tween the laboratory and the staff of the I Ur-
ease Control Division responsible for epide-
miology.

The character of laboratory work is chang-
ing so rapidly that the use of more complex
instruments and more highly trained labora-
torv personnel are needed to carry out the
increasingly intricate test procedures which
are now required. Some of these include cyto-
chemical tests for Mycobacterium to determine
their pathogenicity, and the fluorescent anti-
bod}' technic for the rapid diagnosis of bac-
terial, viral and rickettsial diseases.

Difficulty in the recruitment of qualified
bacteriologists is nationwide. Adoption of tbe
present salary schedule should he ol assistance
in the recruitment of replacement workers.
However, the laboratorv is -till faced with the
continuing problem of training relatively inex-
perienced scientific worker- which reduces the
competency of the laboratory. The funda-
mental basic training acquired in the univer-
sities must be supplemented by actual working
experience before the worker can be utilized
effectivelv.

20—

Trends in Diagnostic Services
In the accompanying Table I. comparative

statistics for the various types of specimens
submitted and the examination findings are
shown. A total of 135,956 examinations made
in the 1958-60 fiscal year period, represents a
decrease of 11,532 made over the preceding
biennium when 147,488 were reported. It will
he noted that the greatest decrease occurred
in serologic tests for syphilis which accounted
for 9,838 of the 11,532 decrease. This may he
attributed to the increased number oi private
laboratories throughout the State which are
approved for this testing service. There was
an increase of 356 examinations for tubercu-
losis which represents a large work load in-
crease due to the time required to prepare
and process the specimens.

The Board, at its July 1960 meeting, took
action to discontinue the services that had been
available for the Rh factor and blood grouping

determinations. This action was given con-
sideration due to the availability of this service
at hospital and clinic laboratories in the State.
Since the Maternal and Child Welfare Com-
mittee of the .Montana Medical Association
requested the Hoard to provide this service in
1950, the number of determinations had risen
from 470 in 1951 to 6,310 in 1960.

.Another reason for discontinuance of this
service is the increased demand for laboratory
personnel in other duties and the increased
time necessary for laboratory studies asso-
ciated with the other programs described
earlier in this report.

The number of shipping containers, collec-
tion bottles, culture material and other items
necessarv for the proper collection, submission
and examination of laboratory specimens to-
taled 186,566 during the biennium. These were
furnished upon request to the physicians and
other medical and health agencies.

TABLE I.

BACTERIOLOGICAL LABORATORY

COMPARATIVE STATISTICS — SPECIMENS AND EXAMINATIONS

1956-58— 1958-60

EXAMINATIONS

Specimens Specimens Gain or Examinations Examinations Gain or
1956-58 1958-60 Loss 1956-58 1958-60 Loss

Bacteriology Program

Syphilis 78.55» 71,846 —6,693 88.377 78.559 —9,838

Gonorrhea 80(1 594 - 206 800 594 - 206

Diphtheria 1.508 219 -1,289 1.508 219 —1.289

Enteric Cultures 1,036 "44 92 1,036 "44 "2

Tuberculosis 4,563 4.785 + 222 10,307 10,663 5-6

Rh Factor 5,765 6,081 +2.518 5.765 6,081 +2,518

Blood Grouping 13 26 + 15 2.217 4,825 +2,606

Lactobacilli Counts 1.245 664 - $7" 1.245 664 579

Dairy Products.... 1.597 848 - 549 1,397 848 ■ 549

Water Analysis, Bacterial ... 17.160 16.464 696 17.161) 16,464 6'K,

Agglutinations 5,075 2.278 795 18.445 15.444 —5,001

Miscellaneous 1.755 2.465 + 750 1.255 2.675 '1.458

TOTAL SPF.CIMEXS 114.828 107.212 —7.676

TOTAL EXAMINATIONS 147,488 155,956 —11,532

Virology Program — See Report Virus Laboratory for detailed Classification, p. 22.

TOTAL SPECIMENS RECEIVED 1.848

TOTAL EXAMINATION'S RUN 6,914

!1 —

Water samples are received from every community
in the state, for bacterial and chemical testing.

The Board's laboratory is becoming in-
creasingly involved in virological studies since
facilities for this service became available in
1958. One or more of the serologic tests shown
in the table below were used during the bi-
ennium to determine antibody titers against
the following viruses or rickettsiae :

influenza A & B polioviruses

adenoviruses lymphocytic

choriomeningitis
psittacosis —

lymphogranuloma Colorado tick fever

venereum ,

Q fever

mumps „ ,

Rocky Mountain

western equine spotted fever

encephalitis , , ,

typhus and herpes

St. Louis simplex

encephalitis

Antibodies were found against all of these
organisms except typhus and St. Louis en-
cephalitis.

TABLE II.

SUMMARY OF TESTS PERFORMED IN

VIRUS LABORATORY — JULY 1, 1958 —

JUNE 30, 1960

TOTAL SPECIMENS RECEIVED.... ...1,848

TOTAL EXAMINATIONS 6,914

Types of Examination
Serologic

Complement-Fixation Tests 2.212

Neutralization Tests 474

Capillary Agglutination Tests

(Q Fever) - 5,741

Hemagglutination-Inhibition Tests 69

Virus Isolation Studies 351

Number Positive Isolations (<e>

L'nsatisfactory Specimens 37

TESTS NOT RUN (Acute

specimens only received) 330

\ total of 351 virus isolation attempts were
made on various tissues and body fluids. These
were carried out in embryonated eggs and tis-
sue cultures. Although isolation of viruses is
relatively simple, identification is frequently a
loir,; ami tedious procedure. Nevertheless, 96
viruses were isolated including Influenza Type
A_' (Asian i. adenoviruses, polioviruses Types
1 and 111, Coxsackie B3.

Special facility in virus laboratory
provides for a sterility room.

Special Epidemiological Studies for
Viral Agents
On two occasions the Virus Laboratory
was called in to aid local physicians where
unusual outbreaks of disease had occurred.
1"he first was an explosive epidemic of polio-
myelitis occurring mi the Blackfeet Indian
Reservation. It was quickly determined that
the etiologic agent was Type I poliovirus.

... ,

■

Roller drums are used in special isolation procedures
for viral agents.

—22—

\ltlmugh there were 19 cases with 17 para-
lytic, only one involved a triply vaccinated
child. Epidemiologic studies revealed that a
large portion of the child population, although
healthy, were excreting this virus. The pro-
portion of virus excretors as determined by-
laboratory isolations was the same irrespective
of vaccination status. This confirmed the be-
lief that Salk vaccine protects against paralytic
disease, but does not prevent the carrier state,
emphasizing the necessity of universal vacci-
nation.

Another opportunity to carry out epide-
miologic studies occurred in May. 1959, at the
Girls' Vocational School in the Helena Valley.
An unusually large number of the girls were
suffering with an upper respiiatory infection.
Influenza A2 (Asian) virus was isolated from
three of the girls and serologic studies re-
vealed that influenza Type I! had also been
active recently among this group. This out-
break occurred at a time when Asian influenza
virus was thought not to be active and had
been found only sporadically in a few isolated
areas of the country.

Thus it was demonstrated that where
prompt action is taken, it is relatively simple
to determine the etiology of an epidemic and
take proper steps to prevent its spread.

The Virus Laboratory also worked with
local health authorities in Helena in making
examinations of selected sample-, of Helena
sewage for enteroviruses. These examinations
were made in 1959 prior to the expected polio-
myelitis season. The purpose was to determine
if there were poliovirus excretors in the city
and whether by finding poliovirus a relation-
ship with the subsequent occurrence of polio-
myelitis could be determined. Although no
polioviruses were isolated, neither were there
reported cases of poliomyelitis in Helena.
However, two unidentified viruses were iso-
lated from the sewage.

To a limited extent, laboratory investiga-
tions were carried out at the request of local
veterinarians. This related to upper respira-
tory infection in cattle and enteritis in swine.
This raises the question of the relationship
between human and animal \ irus diseases and
requires much further exploration.

RECOMMENDATIONS

To provide adequate laboratory services for
the new programs there is a need for continued
evaluation of older and previously authorized
services and curtailment of outmoded tests.

There is a growing demand for evaluation
of all diagnostic laboratory services by both
medical and health laboratories. Activities in
the field of professional education need to be
expanded especially to include all of the newer
microbiologic procedures undertaken by the
State laboratory. This is necessary to permit
their effective use by physicians and laboratory
workers in local areas. To encourage the adop-
tion of such new and improved services, an-
nouncements pertaining to their use should
be made available to interested groups or per-
sons, by assembly and distribution of such
information at periodic intervals through meet-
ings and by mail. Instruction for the proper
selective collection and submission of clinical
materials for studies should be supplemented
from time to time by additional current in-
fi irmation.

New concepts oi antibody-disease relation-
ships may now be achieved by use of the fluo-
rescent antibody techniques which may permit
immuno-chemical studies never before possible
as well as serving as a rapid diagnostic tool
for certain of the communicable diseases.

Provision for a continuance of training of
the technical staff should be made, especially
in the newer methods for bacterial analysis of
water and in mycological and viral techniques.
Additional workshop-, should be held in se-
rologic tests for syphilis to promote better
testing standards in the laboratories request-
ing approval for this service as well as in the
newer microbiological isolation and identifica-
tion procedures.

Extension of the present limited training
program for hospital and clinic medical tech
nologists should be made to include, when re-
quested, student trainees from the State col-
lege and university for training in public
health diagnostic methods.

Consideration should be given to special
studies and investigative projects, which might
be acceptable as a basis for consideration for
application for grant fund-, from Federal agen-
cies.

-23—

*Pcc6-ttc *t¥ecdt& Sducatian

Graphs, charts and other visual aids
are a part of the work done in the
division of Health Education which
contributes to the Board's educa-
tional program.

The material for the revision of the "Guide for the School Health Program" was completed. The
publication of the "Guide" is anticipated early in the next biennium.

Two State-wide Conferences on "Alcoholism in Business and Industry" were held.

With the assistance of the Narcotic and Alcoholism Advisory Committee to the State Board of
Health a second study on "Alcoholism in Montana" is being made at the request of the 1959
legislature.

A public health educator was assigned near the end of the biennium for full-time services to the
mental health unit.

Information, in pamphlet form, was prepared on "Indian Attitudes . . . Beliefs . . . Customs . . . Cul-
ture as They Affect Public Health Among the Indians." This was done for Public Health Dis-
tricts I & II.

General Health Education
Health Education Services are chiefly pro-
vided and reported in programs of Child
Health, Dental Health. Disease Control, En-
vironmental Sanitation and Mental Health. In
this section the general activities not reported
elsewhere are reported and the Narcotic and
Alcoholism Education Program is reported
here.

WORKING WITH PEOPLE

Public Health Education is most effectively
carried on by working directly with people,
principally through groups with some indi-
vidual conferences. Group work consists chief-
ly cii institutes, seminars, committee meetings,
work conferences, workshops and staff meet-
ings. Exhibits, films, 1 ks, pamphlets and.

other visual aids or written work are effective
aids, supplementing other educational methods

During the biennium the public health edu-
cation staff members working with other pub-
lic health staff members, have participated in

program planning and evaluations and have
provided services in most of the Board's edu-
cational programs. This staff also assumes
major responsibility for the mechanical de-
tails of gn >tip meetings.

New trends in the Heart Disease Control Program
were discussed at one of the professional staff semi-
nars. On display is the Board's new microscope for
using the new fluorescent antibody technique pur-
chased with special heart grant funds for $3,000.

-24-

Small group discussions were a part of the in-service

training program on "Improving One's Abilities to

Work with Groups".

In-Service Staff Training
Staff Seminars for the Board's professional
staff are held each month at which new scien-
tific information, new techniques and new-
programs are discussed. This division par-
ticipates in planning for these seminars with a
staff committee and makes the arrangements
for carrying out these meetings.

Public health administrators, like business
managers, find the need to improve communi-
cation. Staff training in this area has been
started. Since practically all State Board of
Health professional staff work with groups, a
training session under the guidance of health
educators, was held to "Improve One's Ability
to Work with Groups". These sessions will be
continued during the next biennium.

Orientation Programs for new staff mem-
bers are held three or four times each year.
Their purpose is to give a brief over-all-view of

As a part of a city-wide citizen's committee the Poison
Jaycees, pictured above, prepare to make a house-to-
house canvass. This canvass was for the purpose of
explaining the need for the passage of water and
sewage bonds. These citizen committees have been
instrumental in the successful passage of several bond
issues in Montana communities.

Public Health in Montana. In addition to the
Board's new staff members, other professional
workers in the State have been attending these
orientation programs. Among the groups that
have participated are: Nursing Instructors
from Montana's Schools of Nursing, State
Hospital (Mental) staff, and several of Mon-
tana's Voluntary Health Agencies.

Special orientation programs have been con-
ducted for other groups. The student nurses
from the Montana State College School of
Nursing, who are taking their quarter's ex-
perience in field training in public health par-
ticipate in an orientation program once during
the quarter. This pro-ram is directed chiefly
to public health nursing activities. A group
of beginning nursing students from Carroll
College have visited each of these programs.
.Another group of students from the workshop
on "Exceptional Children", from the College
of Education in Great Falls, come each sum-
mer to learn more about the Hoard's services
for exceptional children.

Cpper Grade and High School students visit
the Board's offices occasionally. A Boy Scout
from Butte, earned part of his Eagle Scout
Award in this manner.

State Meetings and Committee Work

The health education staff members have
participated in 14 State-wide meetings and
have assumed considerable responsibility in
planning, arranging for, running the meetings
and eval .ting them, and preparing reports
for several of them.

Four State Health Committees, meeting
several times a year, are given health edu-
cator's assistance.

Another area of health educators' work has
included innumerable local meetings, commit-
tee work and health council activities.

Field Training
Field training and or observation in public
health education for students from the Schools
of Public Health at the University of Califor-
nia at Berkeley and from the University of
Minnesota in Minneapolis has continued as
follows: California in 1959: Robert L. Solo-
mon, Pennsylvania i 1 _' weeks); Dr. Valentine
Kerketta, Assam. India (8 weeks); and in
1960: Poorna Shrestha, Nepal (4 weeks).

—25—

The 1960 field training students in health education
examine one of the currently prepared exhibits.

Minnesota in 1959: Dr. R. Subramanium, In-
dia (8 weeks); Mrs. Ivy McGhie, Jamaica (1
week) ; Dr. J. Nath, India (1 week) ; and in
1960, Ivan Buchanan, St. Kitts, West Indies
(8 weeks).

This brings the total of health education
students to 20 who have had this experience
in Montana since 1952. This kind of experi-
ence is required before the Master of Public
Health degree is awarded 1" the students by
Schools of Public Health.

VISUAL AIDS

Another of the services provided by this
division is the construction of visual aids. The
following exhibits have been prepared and
used : Team Management of Cleft Palate Cases
in Montana, Montana Medical Association,
Billings; Montana Dental Association, Kali-
spell ; Western Branch. A.P.H.A., San Fran-
cisco; Pacific Orthodontic Association, North-
ern Component Meeting, Spokane; Montana

Ruear cubes (each equal to 1 teaspoonful of sugar)
are used in the exhibit above to show the sugar
content in foods high in sugar. This exhibit is used
in dental health and nutrition educational programs.

State College, Bozeman; Montana Public
Health Association, Billings; Virus Labora-
tory Services of the State Board of Health,

Montana Medical Association, Billings; Radia-
tion Control in Dentistry, Montana Dental As-
sociation, Missoula; Western Branch Ameri-
can Public Health Association, Denver; Epi-
demiological Approach to the Control of Tu-
berculosis, Montana Tuberculosis Association,
Missoula; The State Board of Health Tuber-
culosis Control Program, Montana Tubercu-
lous Association, Great Falls; Montana State
College, Bozeman; Fluoridation Results in- ■
Montana, Chinook, Roundup, Billings; Hidden
Sweets, used in dental health programs; Work
of a Local Sanitarian, Montana State College,
Bozeman; Where Are the Nation's Alcoholics
ami Who Are the Alcoholics, Second Confer-
ence, Alcoholism in Business and Industry,
Billings, Montana Public Health Association,
Billings, Billings Public Library.

Planning and construction has begun for
new exhibits illustrating the progress which
has been made in Stream Pollution Abate-
ment, the Board's Education for Parenthood
Program and one on Dental Health.

A series of 35 mm slides has been prepared
on: Center for Cerebral Palsy and Handi-
capped Children to illustrate the activities that
are carried on there ; and a series on the State
Board of Health Activities, to use in educa-
tional meetings on public health.

Flannelgraphs on "The Mechanism of Dental
Decay" and "How Germs Spread" were pre-
pared and are being used in the dental health
and sanitation programs.

WRITTEN MATERIALS

The most comprehensive publication pre-
pared during the biennium is the revision of
the Guide for the Montana School Health Pro-
gram. The preliminary work on this Guide
was carried out with the help of a State Com-
mittee representing the State Department of
Public Instruction, the Teacher Training De-
partments in Montana Universities and Col-
leges and many local school administrators
and teachers. Man}- of the experts within the
State and some from outside the State, have
contributed scientific information in their vari-
ous specialties in health topics. State Board
of Health staff, responsible for programs and
activities as thev affect health of the school-

-26—

aged child, have also participated in the prepa-
ration of this "Guide". The major responsi-
bility for its preparation was assumed by the
Division of Public Health Education.

The first edition of this Guide was published
in 1950. The 1960 revision has brought the
material up-to-date and it includes many more
health topics than did the 1950 Guide. Each
section of the Guide includes "Information for
the Teacher", "Suggested Units of Instruction
fnr primary, intermediate, upper grade or juni-
or high school and for senior high school"
levels. It also includes information on "Health
Services to the School Aged Child" and sec-
tions on the "Healthful School Environment."

The collection and approval of the material
was completed during this report period and
the publication and distribution is anticipated
early in the next biennium.

There has been participation by the health
education staff in the revision of the pamphlet
on "Codes for Eating and Drinking Establish-
ments"; the "Education for Parenthood Man-
ual", and the "Premature Nursing Manual".

New pamphlets have been printed as fol-
lows: Handbook for Community Action and
Education in Alcoholism, and The Problem
Drinker in Montana Industry in cooperation
with the Xarcotic and Alcoholism Advisory
Committee to the State Board of Health;
The Sanitary Code for Bakeries and Manu-
facturing Confectioneries; Indian Attitudes . . .
Beliefs . . . Customs . . . Culture . . . As They
Affect Public Health I I listricts I and II ). Bro-
chures have been prepared on the Cleft Lip-
Cleft Palate Program and A Decade of Prog-

ress at the Center for Cerebral Palsy and
Handicapped Children; Summary Reports of
the Activities in the Full-time Health Depart-
ments; A Manual for Registrars; the Fourth
Perinatal Death Study; and a Cardiac Direc-
tory and the Guide and Report Form for the
Health Program of the State P.T.A.

A pamphlet on Public Health Careers has
been assembled and it will be published early
in the next biennium. The publication of the
Biennial Report for the 1956-58 years was
completed. The total number distributed was
2.005 to date. The preparation of the Biennial
Report for the years 1958-60 was started near
the close of the biennium. The issuing of the
Board's official publication. Treasure State
Health each month during the biennium has
continued with a total of 64,000 copies dis-
tributed.

Almost 10,000 individual pamphlets on
health topics were distributed in addition to
those reported elsewhere in this report. Ap-
proximately 143,500 health records have been
mailed out by this division.

For the State Board of Health Library, 234
new scientific books have been purchased. The
Hoard subscribes to /'» health and related
peril idicals.

The Board's Film Library contains 138
health films (16 mm) and 51 health filmstrips.
The loaning and return of these films entailed
1,416 films shipped which were seen by ap-
proximately 15,000 persons.

Informational articles for the press were pre-
pared at intervals.

Books and pamphlet materials are catalogued for the Board's Library.

-27—

Staff Safety Committee

prepares to distribute seat

belts to Board's staff for

personal cars.

SAFETY EDUCATION

The Staff Safety Committee has continued
its activities during the biennium. It has rep-
resentatives from the divisions of Records &
Statistics, Disease Control, Environmental
Sanitation. Public Health Education and Pub-
lic I lealth Nursing.

The purpose of this committee is to Incus
the attention of the staff on the safety aspects
of the Board's public health programs.

The committee promoted a home accident
reporting survey fur the Board's staff; pro-
moted an educational campaign in relation
to the potential dangers of plastic bags when
left within reach of infants and young chil-
dren. The committee also promoted an edu-
cational program on the mouth-to-mouth tech-
nique of artificial respiration.

The recommendation of this committee to
a national manufacturing company led to the
company's discontinuing a television commer-
cial that showed a potentially hazardous situa-
tion. The committee members continued their
interest in the establishment of a poison con-
trol center for Montana.

This committee spearheaded an educational
campaign among the State Board of Health
staff showing the protective value of seat belts
in cars. This program resulted in the staff
purchasing 85 seat belts for their personal
cars.

The Board purchased scat belts for the
front seats of State cars used by the staff
and required that they be used.

NARCOTIC AND ALCOHOLISM
EDUCATION

This educational program has been carried
nut with the advice and assistance of the
Narcotic and Alcoholism Advisory Commit-
tee to the State Board of Health.

A group discussion is one of the best educational
methods used to bring about understanding and the
changing of attitudes. Group discussions are par-
ticularly helpful when the subject for discussion
needs as much clarification as does the problem of
alcoholism.

With the reduction of staff time budgeted
from one full-time health educator to half-
time the activities have necessarily been cur-
tailed. However, public interest and under-
standing in the problem of alcoholism has con-
tinued. This is evident in both community and
professional groups.

Conferences

One of the major activities of the biennium
was sponsoring, with the Advisory Committee,
two State-wide conferences on Alcoholism in
Business and Industry. Thev were held in

-28-

A panel of physicians in public
health, general practice, psychiatry,
and institutional care discuss alco-
holism as a disease.

Helena October 1958 and in Billings January
1960. These conferences attended by 65 and
150 persons respectively, brought about a
growing awareness of the extent and costliness
of alcoholism in business and industry. Tt has
been estimated that of the approximately
18,000 alcoholics in the State 10,000 of them
are in business or industry. It has been found
that 1 1 < > business or industry is immune to
employees suffering from alcoholism, nor is
any level or group of employees immune.
These conferences, plus the fact that alcohol-
ism programs have been successfully developed
in many industries in the nation, have led to
the development of programs in a few of Mon-
tana's industries. < )ther Montana industries
have similar plans underway.

Persons other than representatives from
business and industry and labor groups at-
tended these conferences. Therefore, they
have contributed much to the over-all educa-
tional program in the Slate

A one-day alcoholism conference in White-
fish was held and pul lie interest was evident
by the wide variety of interests of the people
who attended. A local < ommittee on Alcohol-
ism in YVhitefish was formed following this
ci inference.

Community Committees on Alcoholism
Assisting local community committees on
Alcoholism has been another activity of impor-
tance during this report period. I he North-
central Committee on Alcoholism in Great
Falls has continued to be active. Other local
community committees have been formed in
Hillings, hake and Sanders Counties, Sidney,
Lewistown and Livingston. The Missoula
Committee organized prior to 1955 has con-
tinued. These committees are operating with
varying degrees of effectiveness and reflect
the need for continued assistance. They have,
however, been successful enough to point out
the need for similar organizations for other
Montana communities. This committee work
i- an effective educational method in develop-
ing community understanding and in chang-
ing attitudes toward alcoholism as a disease
and the alcoholic as a sick person.

The School Program
The chief activity in the school program
has been the preparation of a unit on "'Al-
coholism" in the Guide for the School Health
Program. School faculties have attended all
the conferences held in the State and many
of them are active in the local alcoholism
committees. Some of the students have also
attended the conferences.

,ik £* Sa

»»« 1 Conferences on alcoholism have

contributed much to the citizen un-
derstanding of the problems of al-
coholism.

—29-

A group of Billings students attending one of the
Conferences on Alcoholism in Business and Industry,
discuss their conference reports which they will take
back to their classmates with one of the Board's health
educators.

The educational materials which have been
made available are included in the general
health education section of this report.

Study and Report On Alcoholism

The most extensive activity has been the
work carried on with the Advisory Committee
in its study of alcoholism in Montana. The
State Board of Health requested the help of
this committee in making a study and report
in accordance with a Senate Joint Resolution
passed by the Thirty-sixth (l''5n) Legislative
Assembly. This resolution authorized and en-
couraged the "continued and extended study
by the State Board of Health of the problems
occasioned by the narcotic-like substances, and
further study of the problems of alcoholism
and to report their findings and recommenda-
tions for the prevention and cure of alcoholism
to the Thirty-seventh Legislative Assembly."

The study will be ready for distribution
early in November of 1960. To make this

study, the chairman of the Advisory Com-
mittee. Winfield S. Wilder, M.D., appointed
five subcommittees. These subcommittees and
their chairmen are : School Education, Mrs.
Barbara Longmaid, Helena, representing the
State Department of 1'ublic Instruction; Com-
munity Education, Mr. C. T. Libbey, Living-
ston, representing the Montana Beer Whole-
salers Association; Professional Education,
William Walter, Ph.D., Bozeman, represent-
ing the I'nivcrsitv of Montana; Treatment
and Rehabilitation, Carl Hammer, M.D., Boze-
man. representing the public health physi-
cians in the State; Business and Industry,
Herbert Wendel, Butte, representing the Min-
ing Industry.

THE NARCOTIC AND ALCOHOLISM
ADVISORY COMMITTEE

The Narcotic and Alcoholism Advisory
Committee to the State Board of Health has
been extremely active during the biennium.
The assistance they have given has made
possible much of the success of the Board's
educational program. The committee's mem-
bership has been increased to include a few
other State-wide organizations and agencies
and representation from four local Alcoholism
Community Committees, this bringing the
groups represented to 41.

From tune to time consultants from outside
the committee are asked to give assistance.
There is a particular need for them particularly
while the Study and Report on Alcoholism in
Montana is being carried on.

"Problems of Alcoholism in
Business and Industry" are
discussed by representatives
of management and labor at
Conference held in Helena.

-30—

'Pu&Cic ^ecdt^ 7twi&i*iy

Local Public Health Nurses made
110,940 visits during the biennium.

*%Cy6£iy6t4 o£ t6e ^iewUutti.

All-time high reached in number of public health nurses employed in Montana.
More than 30,000 individuals were reached through 110,940 public health nursing visits.
Federal traineeships are now available for public health nursing education within the State.
The Cascade City-County Health Department is utilized in addition to the GaJlatin Department
for field training in public health nursing.

Some daily activities of the Public Health Nurse are
being discussed with an interested citizen.

SCOPE BROADENED

A changing society has broadened the scope
of public health nursing activities. Sociological
and economic changes in society and the ad-
vancement of science in the health field have
broadened the scope of public health, and as
a result the activities of the public health
nurses. As public health programs develop to
meet the needs of a changing society, there
has been necessarily an increase in the public
health nurse's activities since these activities
are an integral part of most public health
programs.

This change makes it necessary for the
nurses in public health to be better prepared.
They are challenged to keep pace with the
changes in the activities of the different pro-
fessional people with whom they work, agen-
cies and institutions. It has also become ne-
cessary for the nurse to make more inde-
pendent judgments.

\\ hile the work accomplished to date shows
progress, there is need to continue up-dating
ol the nurse in the existing programs as well
as to prepare her to move into new areas and
to keep pace with the mounting need for
nursing service.

Consultant Services Needs Increase

Aloic intensive supervision is available to
local public health nurses since it has been
possible to increase the Board's consultant
stall by two. This came about through the
availability of special funds during the bien-
nium. The addition of two consultants has
reduced the size of the areas to be served.
This in turn reduced travel time allowing more
consultant time for actual service. However,
.Montana has reached an all time high of 100
nurses in the field of public health which is
ten more than have been employed in anv
previous time. Ninety-two nurses give services

—31—

Nursing Consultant meets
with group leaders as they
prepare for participation in
the Education for Parenthood
Program.

in local areas; consequently there has been
mi decrease in demands for consultation and
supervisory activities.

These local nurses made 53,889 visits during
1958 and 57.051 visits in 1959. This mean-
that more than 30.C00 individuals were reached
in each of the two years. It is also of interest
to note that inure local public health nurses
have been employed during the biennium and
fewer have left the service.

Nursing Consultants Serve in Eight of
the Board's Programs
Three of the nursing consultants have full-
time responsibility in special programs while
the cither five, in addition to their supervisory
responsibilities, have special program responsi-
bilities. The following programs are partici-
pated in by the nursing staff: Communicable

I >isease, Chronic Disease, Dental Health, Ma-
ternal & Child Health. Mental Health. Cardio-
vascular Disease, Crippled Children's Services
and Hospital and Maternity Nursing Services.

Public Health nursing staff serve on three of
the Board's staff committees: Safety. Chronic
Illness and Aging, and the Narcotic and Al-
coholism Advisory Committee to the State
Hoard of Health.

(»tlur State Committees in which the nurs-
ing staff participate are: the Interorganiza-
tional Committee for the Montana League for
Nursing and the Montana Tuberculosis Asso-
ciation, the Montana Heart Association Work-
shop Committee, the State Committee for Ma-
ternal ami Newborn Care, the State Commit-
tee for Improving Family Life Education and
the State Committee on Public Health Facili-
ties in Nursing Education.

The Board's public health nursing staff plan program participation for the

1960-61 year.

-32—

Nursing Consultants have been assigned as
liaison staff to three other State Agencies
which are: The Montana State (Mental) Hos-
pital, the Montana State Tuberculosis Sani-
tarium and the Montana State College School
of Nursing.

Because public health nurses work primarily
with families, the relationship of the Hoard's
nursing staff with these other groups also
serving the citizens, results in better services
to these families.

Training Programs in Public Health Nursing

A higher percentage of public health nurses
are now working in Montana who have had no
academic training in public health nursing.
This fact plus the change in the available
funds for traineeships and the increased op-
portunities in the collegiate schools of nursing
in Montana has changed the Board's nursing
in-service education program.

Collegiate schools of nursing are being util-
ized through traineeships available for basic
public health nursing in-service training. The
Board's staff no longer has this responsibility
and is, therefore, able to concentrate on sup-
plying background information in new trends
and programs through area conferences, in-
stitutes and workshops for the local nurses.

During the biennium, approximately twenty
nurses have received traineeships for regular
and short-term academic training in public
health nursing.

Area conferences, institutes and workshops
have been held for nurses in: .Mental Retarda-
tion. Schizophrenia. Continuity of Care for the
Mentally 111. Health Services for Children.
Handicapping Conditions of Children, Educa-
tion for Parenthood. Prematurity, Emotional
Aspects of Maternal and Newborn Care, Nurs-
ing Care of the Patient with the Decompen-

Student nurse discusses child growth and development
with a mother. This is a part of her educational ex-
perience in public health in the Gallatin City-County
Health Department.

sated Heart, Cardiovascular Nursing. Tuber-
culosis, Venereal Disease. Nutrition and Inter-
viewing Techniques.

Additional educational activities have in-
cluded the execution of a plan for reaching
faculties of nursing schools through meetings
designed to acquaint them with public health
facilities in the State. Public health facilities
in Montana are used by the schools of nursing
for the enrichment of the educational program
of student nurses. The Board's health edu-
cators have participated in this program to
help make these experiences more meaningful
to the students. Field experience for students
in public health nursing has expanded to in-
clude the Cascade City-County Health De-
partment as well as the Gallatin County Health
Department. The Gallatin County Department
has furnished this experience since 1955.

Training sessions for leaders and community
sponsoring groups in the Education for Parent-
hood Program have also been provided.

Recruitment Becomes More Difficult
Because of the changing trends in public
health, it becomes increasingly more impor-
tant to recruit qualified public health nurses.
Though public health nurses' salaries have
improved in Montana, the level of perform-
ance demanded of public health nurses male-
it difficult to compete salary-wise with other
States and educational institutions. The actual
number of vacancies is small, but recruitment
of qualified personnel is so difficult, because
of the multiplicity of circumstances, that it
has been necessary to employ nurses without
satisfactory public health nursing preparation.
Nation-wide recruitment activities produce
comparatively few inquiries and virtually no
applicants, consequently Montana's efforts
have to be intensified.

—i3~

^ec&ictb a*tct Sfati4,tic&

*%Cy6Uy&t6 o£ t&e Siettttiutn:

Birth notifications were issued as photographic copies for the first time.

Manual for local registrars prepared for the first time.

Birth and Death Certificates from 1958 to present are microfilmed. Plans developed to microfilm

certificates now on file from 1918 through 1957 if funds are available.
Birth records for the years 1860 to 1910 and death records from 1860-1917 have been re-indexed

for improved efficiency.
Montana continues to maintain criteria enabling the State to be included in the U. S. Marriage

and Divorce Registration Areas.

A baby was born every 30 minutes in Montana in 1959! To properly record them in the Division
of Records and Statistics in the State Board of Health, the following procedures were carried out for
each of these births :

Step. 1 Mother Gives Infant's Name and Other In-
formation to the Nurse in the Hospital.

Step 3. The Information goes to the Local Registrar

who makes copies and sends the original to the State

Office.

Step 2.

The Certificate is signed by the Physician
who delivered the Infant.

Step 4. The State Office microfilms certificate. A
film copy of the certificate is forwarded to the Na-
tional Office of Vital Statistics and a small photo-
graphic print is sent to the mother.

Step 5. Tabulations for informational purposes and

program planning are carried out quickly with IBM

Equipment.

Step 6. (Pictured top of page 34). The Birth Certifi-
cate is bound in books of 500 and placed in the vault
for permanent safe keeping.

The filing of all vital records is carried on
at the rate of one every 15 minutes. This rate
goes on 24 hours of even day, 365 days of
the year !

'I lie filing of records includes, in addition to
births, deaths, marriages, divorces and annul-
ments, other records such as affidavits, and
court orders.

During the 1958 and 1959 calendar years
the number of records of life's major events
are as f( illows :

1958 1959

Live Births 17.083 17,448

Deaths 6,180 6,521

Marriages 6,142 6,228

Divorces & Annulments .... 2,023 2,062

In general the volume of records filed in-
creases slightly each year as a result of in-
creasing population. In 1940, for example.
11,468 live birth certificates were filed and
m 1950, 15.5' >2.

Local Officials Collect and File Information
This information i> collected throughout the
State by 71 local registrars located in each of
the 56 county seats and 15 other registrars in
strategic locations throughout the State. ( Ither
local officials with whom the Division works
bring the total to 183 persons.

Local registrars are responsible for the fil-
ing of birth, death and fetal death (stillbirth)
certificates in the area under their jurisdiction.
\\ hen these certificates are filed, the Local
Registrar prepares a duplicate copy for the
County Clerk and Recorder and a triplicate

copy for his own file. On the fifth dav of each
month, all original certificates which have been
filed during the previous month, are mailed to
the State < )ffice. The Local Registrar is also
responsible for the issuance of burial-transit
permits for persons who die in his jurisdiction
and for the issuance of disinterment permits.

The local Clerks and Recorders file the dupli-
cate copy of birth, death, and fetal death cer-
tificates and the}' are authorized to issue cer-
tified copies of their record.

When a child is adopted, the State Office
prepares a new birth certificate for the child
showing his new name and the information
concerning his adoptive parents. The duplicate
copy of this new certificate is then forwarded
to the Count}' Clerk and Recorder, and he
returns his cop}- of the original record to the
State Office where it is placed in a confidential
file.

Marriage, divorce and annulment records
are filed by the Clerk of the District Court.
Idle original of these records are kept on file
with these officials and a statistical record
showing the information on the original docu-
ment is sent to the State < >ffice. This informa-
tion is utilized in preparing tabulations re-
garding marriage and divorce in Montana.
The information is also utilized in preparing
a central index of these events for the entire-
State. In this way, it is possible to locate a
marriage or divorce record without contacting
each of the 56 counties.

Local officials are directly responsible for
complete and correct registration in their
own areas. It is in the local areas that much
of the responsibility for good vital statistics
registration lies.

State Office Responsibility
When the certificates reach the State Office,
the}' are immediately checked to see that they
are complete and acceptable for filing. Each
is assigned a State File Number which is
primarily a device used for their location in
the State ( Iffice.

Before the information from death certifi-
cate- can be transferred to the IBM cards, the
cause of death must first be coded in conformi-
ty with the International Statistical Classifi-
cation of Diseases. Injuries, and Causes of
Death.

-35—

LIVE BIRTH RATES Montana
1911- 1959

_ & — y> — <o — <D r~ <TJ IT*

eg cm fi r*> f f ""> a «i»m

ffi 0* 9\ (Ji ^ CT> 0} ?? ?} ^ ?

YEARS

After the information has been transferred
to IBM punch cards it is verified and filed.
However, In-fore the birth certificate is bound
and stored, a notification record is sent to the
parents. This record tells the parents that the
child's certificate is on file and it shows the
vital data contained on it. This makes it possi-
ble for parents to correct any errors that may
have occurred and it gives them a chance to
fill in an)' missing information.

Tabulation of vital statistics data is not an
end in itself but the data collected is used for
public health information, for analysis in pro-
gram planning and in the evaluation of public
health programs.

Montana Deaths
The death rate for Montana for 1957 was
10.0 per 1,000 papulation (1) and for 1058
was 9.6.

DEATHS AND DEATH RATES FOR TEN LEADING CAUSES:

Montana, 1957 and 1958

(By place of residence)

International
1958 List

Rank Number

1957

Cause of Death

Rate per
No. 100,000

Deaths Population

1958

Rate per

No. 100,000 (2)

Deaths Population

410-443

1411-205

330-334

800-962

4X1 M1 M

760-776

;

450

260

970-979

581

ALL CAUSES 6.4S6

Diseases of Heart 2.290

Cancer 873

Cerebral hemorrhage, and other vascular

lesions affecting central nervous system .... 679

Accidents 541

Influenza and pneumonia 274

Certain diseases of early infancy 265

General arteriosclerosis 1 o7

Diabetes Mellitus 118

Suicide 105

Cirrhosis of liver 70

All other causes 1.104

,002.5

6,265

956.5

353.9

2,244

342.6

134.9

858

131.0

104.9

673

102.7

S3. 6

497

75.9

42.5

274

41.8

41.0

249

38.0

35.8

162

24.7

18.2

109

16.6

16.2

101

15.4

10.8

11.6

170.6

1.022

156.0

(1) Estimated mid-year population is 647,000. This estimate is based on preliminary counts from the 1960 Census.
The previous estimate for July 1. 1957 was 678,000.

(2) Estimated midyear population is 655,000. This estimate is based on preliminary counts from the 1960 census.
The previous estimate for July 1, 1958 was 688,000.

-36—

Other information is tabulated and analyzed
as requests come from other of the Board's
divisions and from local health departments.

One of the routine tabulations carried on in
this division is the processing of daily activity
reports for all local public health nurses. Each
nurse submits her daily activity reports for
the month. A summary report of the month -
activities is returned to the local public health
nurse or her supervisor. It is used for program
planning and evaluation. Another of the ex-
amples of the statistical services is that pro-
vided for the pediatric survey done for the
Cascade City-County Health Department dur-
ing the biennium. This study was an evalua-
tion of the health status of 125 Indian children
and ''7 non-Indian children in the lower eco-
nomic groups.

Accomplishments, Needs and Future Plans
This is the second biennium in which .Mon-
tana has met the criteria required by the Na-
tional Office of Vital Statistics for inclusion
in the Marriage and Divorce (and Annulment)
Registration Areas. This means that there is
maintained a central file of these records, that
these records contain certain minimum items
and that the State < M'l'ice has maintained high
standards of accuracy of registration. When
the I . S. Marriage Registration Areas were
established on January 1. 1957, Montana was
one of 19 States and 4 Territories meeting the
established criteria. Montana was one ol 14
States and 3 Territories when on January 1,
1958, the U. S. Divorce Registration Area
was established.

Central registration of births, deaths, and
fetal deaths was inaugurated in l')()7 in this
State. Birth certificates filed during the years
1907-1918 were written on postal cards. These
are filed in drawers in the main vault. Since
they must be filed in such a way they can
be removed for preparation of certified copies.
the possibility of loss js greater than for cer-
tificates bound in volumes. In order to mini-
mize the probability of such loss these records
have been microfilmed and the film is stored
in a vault outside of Helena. This protects the
information contained in these records in case
of destruction of the records in our State vault.

Director of Records and Statistics and Director of
Disease Control analyze graphic data.

If funds are available, it is planned to micro-
film the remaining certificates in the vaults
so that these records will also have this pro-
tects hi.

This procedure should be carried out for
the remaining records in this Division and
will be carried out when funds and personnel
permit.

Re-indexing of birth certificates filed for the
period 1860-1910 and death certificates for
1860-1917 has been completed. This procedure
was started in 1956 to make it possible to lo-
cate certificates more quickly. The original
indexes were no longer satisfactory for con-
tinued use. Additional entries which had been
made in later years could not always be en-
tered in proper alphabetical sequence; hence.
it was often necessary to search several pages
in order to locate the necessary information.
Since searching for these records is difficult,
the possibility of overlooking entries is evident.

Additional space is desperately needed for
the storage of vital records. The storage space
available is smaller than that in many county
offices The vault originally designed for these
records has long been outgrown ami an addi-
tional vault on another floor is being used,
but even this is not adequate.

When funds and staff are available plans
will be made to carry out multiple cause of
death tabulations and detailed analysis of ac-
cidental death fatalities. Plans will also be
made to put tabulations into visual form so
that the information will be more readily un-
derstandable ami more meaningful.

-37—

Part II. PUBLIC HEALTH PROGRAMS

0&itd ^etdtti SenviceA

Speech Therapy is provided in the

Cleft Palate Program and also at

the Center for Cerebral Palsy and

Handicapped Children.

No deaths were reported from whooping cough for the first time in 1958. For the second time there
were no deaths reported from diphtheria in 1958. The first such record occurred in 1951.

The Cleft Lip-Cleft Palate teams made 275 separate evaluations during the biennium.

Joint studies by the Maternal and Child Welfare Committee of the Montana Medical Association
and the State Board of Health continued. Completed were 12 studies on maternal mortality;
the Second and Third Reports on Infant and Stillbirths by Montana Hospitals and the Fourth
Perinatal Death Study Report was made.

The Center for Cerebral Palsy and Handicapped Children provided services for 369 children includ-
ing 143 for speech therapy alone.

The number of children served at 26 Crippled Children's clinics was 2,919 during the 1958 and
1959 calendar years.

Local Professional Service Committees were organized for the Education for Parenthood Program.
938 prenatal women and 296 husbands attended these Education for Parenthood discussion
groups.

A Health Program for the State P.T.A. was developed jointly with the State Board of Health for
the first time.

Third Annual Institute on Maternal and Newborn Care held.

Hearing tests were administered to more than 14,000 school children.

Montana's maternal death rate of 1.7 per 10,000 live births in 1959 was approximately half the na-
tional rate of 3.7 for 1958.

215 children, referred by physicians, accepted on Rheumatic Fever Prevention Program.

The division of Child Health Services is
concerned with programs to improve the health
of mothers, infants and pre-sehool and school-
age children. It also provides Crippled Chil-
dren's Services, including special programs on
Cleft Lip-Cleft Palate and in the cooperative

operation of the Center for Cerebral Palsy
and Handicapped Children located in Billings.
Services from the Board's Heart Diagnostic
Center are also made available to children
registered in the Crippled Children's Program.

-38—

MATERNITY, INFANCY AND
PRESCHOOL

Montana's birth rate for the past two years
has dropped slightly from the previous bien-
nium. The chart below shows the number of
Montana births and the rate and the national
birth rate for the years 1956-1959.

Montana

U. S. Rate

Rate per per

No. of 1,000 Est. 1,000 Est.

Births Population Population

1956 _ 17,705 27.7 24.9

1957 18,219 28.2 25.0

1958 17.275 26.4 24.3

1959 17,646 26.7 24.1

The chart below shows the Montana ma-
ternal mortality rates and the national maternal
mortality rates for 1956-1959 years.
Montana

Rates U.S. Rates

No. of per 10.000 per 10,000

Deaths Live Births Live Births

1956 2 1.1 4.1

1957 5 2.7 4.1

1958 3 1.7 3.8

1959 3 1.7 3.7

In 1956 and 1957, Montana ranked 10th
among the States in its maternal death rate
whereas in 1955 and 1956 the Montana rate
w as second in the nation.

The chart below shows the comparative
infant death rates for Montana and the nation
from 1956-1959.

Montana

No. Infant Rate U.S. Rate

Deaths per 1,000 per 1,000

(Under 1 Yr.) Live Births Live Births

1956 495 28.0 26.0

1957 462 25.4 26.3

1958 444 25.7 27.1

1959 ... 431 24.4 26.4 (Est.)

In the infant death bracket the majority of
deaths continue to occur during the neonatal
period (infant born alive and died within the
first 2!^ days). The number of neonatal deaths
and rates in Montana and the national rates
are as follows for the last four years:

NUMBER OF NEONATAL DEATHS AND

RATES 1956-1959

Montana

No. Rate U.S. Rate

Neonatal per 1,000 per 1,000

Deaths Live Births Live Births

1956 343 19.4 18.9

1957 318 17.5 1" 1

1958 308 17.X 19.5

1959 294 16.7 1" 1 I Est.)

To bring about the reduction in maternal
and infant mortality there has been, for many
years, a close working relationship between the
State Board of Health and practicing- physi-
cians, hospital administrators and nurses, local
public health officers and public health nurses.
These professional workers are constantly
working together in a joint effort to better
both maternal and newborn care and to fur-
ther the reduction of maternal and newborn
morbidity and mortality rates.

The Maternal and Child Welfare Commit-
tee of the Montana Medical Association in
conjunction with the Child Health division of
the State Hoard of Health is continuing the
study of all the infant and maternal deaths as
they occur in the State. These phvsicians pro-
vide consultation to the private physicians at-
tending the case in which a death occurred,
if requested ti > do so.

The third annual report on "Infant and
Neonatal Mortality and Stillbirth Rates by
.Montana Hospitals'' was prepared and dis-
tributed to the administrators of all hospitals
possessing maternity units. The information
in the report included the number of live
births, still births, neonatal and infant deaths
occurring in each hospital along with their
respective rates.

This information was compiled and dis-
tributed without identification, although each
hospital was given its own individual rating.
Each hospital was asked to have the report
reviewed by the administrator, medical and
nursing staffs. The}' were also asked to con-
sider where improvements can be made so as
to assist in the reduction of premature infant
deaths.

State Committee on Maternal and
Newborn Care
1 luring the last biennium the Montana
State Committee on Maternal and Newborn
Care was formed. This committee has repre-
sentation from the Montana League for Nurs-
ing, the Maternal and Child Welfare Commit-
tee of the Montana Medical Association, the
Montana State Board of Health and the Mon-
tana Nurses' Association. During the current
biennium this committee was enlarged in mem-
bership to give better representation of the
medical and ancillary professions. Several gen-

-39—

In-State and Out-of-State participants at Third Ma-
ternal and Newborn Care Institute discuss current
trends in care of mothers and infants.

eral medical practitioners have been added to
the Committee. Representation from the Mon-
tana Hospital Association has also been added.

The first Institute on Maternal and New-
born Care, sponsored by this committee, was
held during the last biennium. The Second
Institute was held in July of 1958 with ses-
sions in Missoula, Great Falls and Billings.

In August, 1959, a third Institute was held
in Billings and Butte.

The third Institute was self-supporting".
Each Institute was attended by approximately
100 physicians, hospital, public health and
student nurses.

A fourth Institute is planned for the first
month of the next biennium.

Since scientific advance-- have made ob-
stetrics relatively safe, it is the feeling of the
State Committee that as much attention should
now be directed to promote the emotional well-
being of the pregnant woman as has 1 ecu given
to bring about the attainments reached in
safety. Therefore the topic chosen for this
fourth Institute is: "Emotional Implications in
Maternal and Newborn Care."

The Maternal and Child Health Nursing
Consultant instituted a new emphasis in her
work with maternity and public health nurses
in five of Montana's communities. This new
emphasis was in the interest of providing con-
tinuity of care for premature infants, mon-
goloid infants and infants with congenital
anomalies. It is aimed to brim,; about closer
working relationships and the exchange ol
useful information between the hospital nurses
and the public health nurses in providing care.
This will make a greater contribution to the

health and welfare of not only the mother
and infant but also promote the well-being
of the entire family.

The local public health nurse will provide
the much needed a distance in the home when
ll e motln r and infant come from the hospital.

Hospital Consultation

In addition to the medical consultation
provided, the State Hoard of Health provides
the services of the Hospital Nursing Con-
sultant in an effort to reduce Maternal and
Infant Mortality. She made 143 nursing visits
to the maternity departments of hospitals. On
these visits she brings new information and
demonstrates new techniques in maternity and
infant care and assists in the improvement of
procedures being carried on. She visited 16
hospitals to provide in-service training for hos-
pital nursing staffs on maternal and newborn
care. There were 1 1 <> nurses participating in
this program, (lasses are conducted for stu-
dent nurses on the nursing care of the pre-
mature infant. During the biennium 35 such
classes for 470 student nurses were held.

This nursing consultant spent a week in-
vestigating an outbreak of infection occurring
in one of the Montana hospital nurseries. She
also followed up this work after a six-month
interval and a plan was developed for the
local pul lie health nurse to visit the homes of
all baliit-s discharged from the hospital to
check closelv on any evidence of further in-
fection.

Maternity Nursing Consultant advises Hospital staff
on best procedures in "formula making".

Nutrition Conferences
Four district meetings for nurses and dieti-
cians were held in the State during the spring
of 1960. The nutritionist from the I". S. Chil-
dren's Bureau, Denver, served as the resource
person at the conference-. They were planned
and directed by the Maternal and Child Health

—40-

Nursing Consultant and the State Board of
Health educators. The purpose of these con-
ferences was to bring up-to-date information
on the findings in nutrition research and the
application of this information to improve the
health of mothers and children.

Special Services
The bacteriology laboratory of the State
Board of Health provided the following Ma-
ternal and Child Health Services during the
biennium :

10,414 premarital blood serology tests
25,684 prenatal blood serology tests

6,072 blood determinations

4.S55 14 1 typings.

The Child Health Division has for loan
to hospitals two oxygen analyzers ami three
incubators. Hospitals also received 1(>,417
ampules of Silver Nitrate. This service, how-
ever, was discontinued in May 1959.

Education for Parenthood Program
Montana's Education for Parenthood Pro-
gram, initiated in 1954, is continuing to expand
and improve. During the biennium, 938 pre-
natal women and 296 husbands attended 43
series of discussion groups that were held in
14 counties in the State. This averages three
series a year in each count}". The discussion
groups meet «m the average of six times for
two hour sessions. The local hospital or pub-
lic health nurse serves as the discussion leader.
The unique feature of these sessions is the
"freedom of discussion" afforded the partici-
pants. Through this educational method, fears,
anxieties and tension are reduced. The ex-
pectant parent has an opportunity to ask ques-
tions which she is afraid sound "foolish".

The accompanying map shows where the
adult and high school sessions have been held:
where there have been only the adult or only
the high school groups, and where this pro-
gram will start in the 1960 school year.

The programs have local sponsoring groups.
In 10 of the 14 counties, the Jayceens sponsor
it. This sponsorship by a community group
is an important factor in the success of the
pn igram.

There are l'1 nurses who serve as nurse
leaders in the adult program at the present
time. Of these, nine are maternity nurses on
the hospital staffs and the remainder are pub-
lic health nurses.

Part of the "Professional Services Committee" meet-
ing in Bozeman to discuss progress of Parent Edu-
cation Program and to make future plans for its
improvement.

A new development in the program is the
organization of Professional County Commit-
tees. These committees consist of those pro-
fessional and sponsoring groups concerned
with maternal and newborn care in the com-
niunitv. The nurses were assisted by health
educators from tile State Hoard of Health staff
in organizing these groups.

These committees have been formed in six
communities, with others underway. The pur-
pose of these committees is for the members
to meet for the purpose of becoming better
informed on the progress of the Education for
Parenthood Program, to evaluate and to make
recommendations for further improvement of
the program.

The Maternal and Child Health Nursing
consultant visited 14 communities on behalf of
this program in 1959 and a similar number in
1958.

Further Services to Pre-School Children
I luring the calendar years of 1958 and 1959,
768 Well-Child Conferences for infants and
pre-school children were held in nine counties
in the State. During these conferences <>.552
children under age six were examined. Of

-41 —

this number 1,596 were seen for the first time.
Most of these children have completed their
immunizations as recommended.

A new child health conference record form
was developed and introduced during the bi-
ennium, and educational meetings in two areas
were held on the improvement of the Child
I tealth Conference.

To further provide improved services to
young children, the maternal and child health
nursing consultant is meeting with the opera-
tors of day care institutions in Lewis and
Clark County. Three meetings with this group
have been held. Their purpose is to determine
the operator's needs as they relate to services
which the local public health nurses might
provide. The findings from this group will
be used in working out a program in other
areas of the State.

More emphasis has been placed on en-
couraging local public health nurses to find
mental health problems early in pre-school
children. This is done as a preventive measure
to get assistance before the problems become
severe.

Public Health Nursing Visits
Jn the maternity program the local public
health nurses made 5,854 home visits and
20,358 visits to infants and pre-school children
during this biennium. The State staff provides
consultation and supervision to the local
nurses.

Working jointly with the State P.T.A., the
National P.T.A.'s policy of recommending
continuous well-child supervision from infancy
through high school, is being implemented.
This program discussed more completely under
the School Health Program, also includes the
promotion of this policy in the pre-school
years.

Emphasis has been directed to the problem
of Mental Retardation. New parent groups
interested in this problem in which local public
health nurses participate, have been formed
in Flathead, Toole and Valley Counties.

.Area nursing conferences have been held
to prepare the public health nurses for their
roles in assisting the parents understand the
problem and what can be done in the best
interest of the mentally retarded child and
his family.

Educational Materials

Educational materials on maternal, new-
born and infant care are provided by the State
Board of Health.

Some educational materials are provided
when Education for Parenthood Programs are
initiated. Films are also loaned. Some ma-
terials are provided at Well-Child Conferences
and other meetings.

The distribution of a series of pamphlets
issued monthly to parents of first born children
is continuing. This series is called "Pierre the
Pelican". The distribution plan was changed
during the biennium. In the interest of econo-
my, instead of mailing these pamphlets for the
twelve months of the child's first year, to all
parents of First born children, the parents are
querried at the time the fourth and ninth
month pamphlets go out. Those parents not
asking that the pamphlets be continued are
dropped from the mailing list and only those
retained who express an interest in getting
them.

The series has been extended this year to
include the first three years of the child's life
instead of just the first year. These pamphlets
for the second and third years are also sent
only on request. This series is designed to
give guidance on child growth and develop-
ment and social behavior of the child. 61,698
of these pamphlets were distributed during
this biennium.

Working jointly, the divisions of public
health nursing, health education, and child
health services, the "Discussion Guide for the
Education for Parenthood Program" was re-
vised, as were the "Maternity Nursing Manual
for Hospitals", the Diet Check Sheets for
these discussion groups and the pamphlet.
"Nursing Care of the Premature Infant".

Exhibits constructed and displayed with
assistance from the division of Health Educa-
tion were: ".Maternal and Infant Mortality
Five-Year Rates" at the Montana Medical As-
sociation's Annual meeting in 1(»58. At the
1959 Institute on Maternal and Newborn Care,
the following were displayed: "Five-Year Pre-
maturity Rate by Counties"; "Five-Year Neo-
natal I >callis by Cause of Death" and the
"Education for Parenthood Program".

—42-

More than half the monthly issues of the
Board's official publication, TREASURE
STATE HEALTH, have contained articles
directly relating to the Child Health Program,
with many more contributing to this program
indirectly.

HEALTH PROGRAM FOR
SCHOOL-AGED CHILD

The School Health Program, although co-
ordinated through this division, is participated
in by other divisions of the Board. Those who
make particular contributions are: Dental
Health, Disease Control, Environmental Sani-
tation. Health Education and Public Health
Nursing.

The most far-reaching contribution to the

health of the School-Aged Child for this bi-
ennium is the completion of the material for
the Guide for the School Health Program.
This publication is explained in more detail
in the Health Education section of this Re-
port.

Hearing Conservation
Hearing Conservation programs have been
significantly extended in local areas during
this biennium. These new local programs are
based on the experience gained in the "pilot"
program carried on in Missoula during the
last biennium.

I luring tin-- report period approximately
14,000 school children have had their hearing
tested either as a part of an over-all testing
program or on a teacher referral to the public
health nurses.

Local public health nurse and teacher confer on health
needs of pupils.

The Missoula program is now incorporated
as a part of the local health and education pro-
grams and is operated on a sustaining basis
with children in specific grades now being
tested each year.

The new programs initiated are in the
* Ireat halls city schools and in all the schools
in Public Health District I (Big Horn-
Rosebud Counties), Stanford. Fort Benton
and Thompson Kails (Public Health District
II, Lake-Sanders Counties) schools have also
carried on hearing conservation programs. In
addition, many other communities are con-
ducting hearing testing programs as direct re-
ferral to the public health nurses.

The first hearing conservation program
among adults was initiated along with the
school program in Thompson Kails.

Included in the Hearing Conservation pro-
grams are: health education, testing by screen-
ing, re-testing and medical follow-up. The di-
vision of health education works closely with

Using the Massachusetts Hearing

Test 10 students are tested at a

time in Public Health District 1

program.

-43—

community and school groups. This aspect of
the program stresses the importance of hearing
conservation, methods of testing and care of
the ears.

"Screening" is now dune by the individual
sweep-test method or by the Massachusetts
Hearing Test. This is a multiple type test
administered to 10 or more children at a time.
by a public health nurse, a speech and hearing
therapist, or a trained volunteer.

The "screening test'' is followed by a
"threshold test", that is, those children sus-
pected of having a hearing loss as a result of
the "screening" test are re-tested individually.
This test is more exact and is conducted by
the public health nurse or the speech anil
hearing therapist. It is on the results of this
test that those children are selected who need
medical referral. The public health nurse
visits the family and explains the need for
physician examinatii >n.

The goal of any testing program is, oi
course, the selection of those children who need
medical examination and the motivation of
the children and their parents to see that this
is carried through. The success of the Mon-
tana program is unique in that between SO',
and 90% of the children referred for medical
examination and treatment where needed are
being seen by their family physicians or by
medical specialists. In the past, too often the
program ended with testing, which brought
no help to the children in need. The rate of
hearing loss is approximately 4'_>', when all
the children in a school are tested; this cor-
responds closely with the national rate. The
large number of children being seen by the
physicians reflects the thoroughness of the
program and the need for teacher, public
health nurse, student, parent and volunteer
participation. It is anticipated that as public
awareness grows, the percentage of children
seen by a physician will rise even higher.

P.T.A. Health Program

The State P.T.A. President and the State
Health Chairman met with the State Board
of Health staff to develop a joint program for
the promotion of health.

Four topics were chosen for the 1960-61
school vear. They are:

1. The Promotion of Regular Health Su-
pervision of Children and Youth, begin-
ning in Infancy and Carrying on
Through High School.

J Studies and Information on Nutrition,
particularly on Children's Breakfasts.

3. Promotion of Dental Health.

4. Adequate Public Health Program.

The State Board of Health staff then de-
veloped a Guide and Report form which will
be distributed to the local P.T.A.'s in August
of 1960. A plan has been developed whereby
a representative from the State Board of
Health will attend each of the six district
P.T.A. meetings in the fall to discuss the use
of this Guide and the Report Form.

Other School Health Services

Activities in the School Health Program
are discussed with the State Department of
Public Instruction through the Joint Staff
Committee. This Joint Committee has repre-
sentatives from the two departments. It has
continued to be active during the biennium as
well as has its .Advisory Council.

Plans for the development of a pamphlet
on Health Careers are underway. It is antici-
pated this will be ready for the High School
and College Guidance Counselors early in the
next biennium.

The pilot program for teen-age education
on Venereal Disease is discussed in the Dis-
ease Control Section of this report on page 66.

The Education for Parenthood Program,
discussed in the earlier part of this section is
carried on in High Schools in the Home Eco-
nomics HI Course as part of the unit on
Family Living. The counties where this is
done are shown on the map on page 41. Serv-
ing as a resource person to this program in
the twenty high schools where it is offered
are fourteen public health nurses. Within the
last two years, 1,110 girls have had the ad-
vantage of this 12-hour course. There is a
steadily increasing number of requests from
school administrators to reach more high
school student^, both boys and girls with this
popular program. So far. few of these re-
quests can be reached due to the scarcity of
local public health nurses.

-44-

A [oint Committee for Improving Family
Life Education has been formed in Montana
with the State Board of Health represented
by the Maternal and Child Health Nursing
Consultant and one of the health education
consultants. This committee with the Eastern
Montana College of Education sponsored a
workshop for professional personnel working
with "Teen-Agers". The professional workers
who attended were those who have services
to offer this age group. The attendance was
excellent, with 150 persons participating. Of
this group, 36 were public health nurses and
12 were hospital nurses. Others attending
were educators, health educators and physi-
cians.

Local public health nurses made 63,433
visits in the interest of school-age students
during this biennium.

Hooks and films are loaned to school per-
sonnel and for I'.T.A. programs.

School Health Records are supplied to
local schools by the State Board of Health.
During the biennium 44,383 Health Informa-
tion blanks and 51,322 Cumulative Health
Records were distributed.

CRIPPLED CHILDREN'S SERVICES

General
When the Crippled Children's Services was
first inaugurated, and for a number of years

thereafter. it~ main function was in the area
i if pure orthopedic problems, with limited serv-
ice to children with cerebral palsy, cleft lip
and cleft palate and rheumatic fever.

Following trends started in the last bien-
nium, this service has now been expanded to

)

The local public health nurses visit the home to help
the family carry out recommendations made at Crip-
pled Children's Clinics.

include large numbers of neurosurgical and
cardiac surgical problems, a broad scope care
of cleft palate cases, and extensive rheumatic
fever control program, and heart diagnostic
service. It also includes newer phases of
modern day rehabilitation care as carried out
in the Montana Center for Cerebral Palsy
and Handicapped Children and the Heart Di-
agnostic Center. Cases in these latter cate-
gories are extremely expensive, costing up to
thousands of dollars apiece fur hospital, sur-
gical, and related professional service care.

Program Problems
A special problem that has been of increas-
ing importance during the past few years is
that of the large number of paraplegics and
quadraplegics found in the teen age group fol-
lowing automobile accidents and gun shot
wounds. During the past year seven such
cases were under care. These problems not
only tax the financial resources of the family,
the (rippled Children's budget, and other pub-
lic funds, but often are complicated by a dis-
couraging lack of appropriate resources within
the State to adequately care for these patients.
At best some cannot be restored to useful citi-
zenship.

\s a matter of policy, after diagnosis has
been established and a determination of need
has been made in connection with the specific
familv of the child concerned, cases are ac-
cepted on the program to the extent that the
familv needs assistance. However, these ad-
missions are limited to conditions which tend
to be chronic and disabling. They are also
limited to those cases where there is reason-
able assurance that such conditions can be
corrected or improved through rehabilitative
procedures, to the end that such child nun
lead a reasonably healthy and useful existence.

Children are not accepted under the pro-
gram for custodial care. This is presenting
an increasingly difficult problem for decision
as in the case of the quadraplegics noted earlier
and other neurosurgical problems.

This decision is based on a review of a
comprehensive case study and report by a
-roup of medical and surgical specialists and
related ancillary workers. Such reviews are
periodic if care is authorized. However, such
decisions mav be influenced by availability of

-45—

funds for the use of funds where the prospect
of correction or improvement is good takes
precedence over those where the prospect is
had or doubtful. These latter cases and cases
receiving their maximum benefit from treat-
ment are likely to become purely custodial,
usually at welfare expense.

Another handicapping problem, because of
budgetary limitations, is the necessity to limit
hospital and surgical authorizations about the
middle of March each year. The funds still
available at this time are reserved for the
most urgent conditions. This, therefore, cre-
ates a backlog of needy cases which must wait
until funds are available in the new year. Not
only does this create a problem in the function
of the Crippled Children's services in the State.
but it undoubtedly creates problems in the
families where such children live. Cnfortunate-
ly, some children who cannot be accepted on
the program must receive hospitalization and
surgery without the family being able to as-
sume the financial responsibility and thus face
a debt which they cannot meet.

Occasionally towards the end of the fiscal
year additional monies have been acquired to
allow reinstatement of hospital and surgical
services to a limited extent.

Case-finding has continued through Crip-
pled Children's Clinics, referrals from public
health nurses, private physicians, welfare work-
ers and an informed public.

However, locating and ser\mg handicapped
children residing in the state still presents
problems. The reasons for this are varied.
Some cases are not referred, or are referred
too late for financial or professional aid. Oc-
casionally this results from physicians or hos-
pital misunderstanding of the services avail-
aide or the family's need before the family
has incurred a substantial debt.

Lack of public health nursing personnel in
many counties is a deterring factor in adequate
referrals and follow up. In some instances
families do not take advantage of available
services because of emotional factors. Con-
tinuing efforts to cope with these problems is
made with the degree of success closely de
pendent upon the staff assistance available.

Number of C C Visits to Clinics 8 Physicians Offices
1954-1960

(with numbers in 1950 shown for comparison)

»'«•.

Physicians Office Visits t

I
I
I

1950 1954 1955 1956 1957 1958 1959

Numbers of Children Receiving Services

The number of children on the Crippled
Children's Register for the last five years on
December 31 of each year is shown below:

1055 . 4,890

1956 5.028

I057 5.281

1958 5.553

I050 5,745

The number of old and new cases to whom
service has been given from 1955-1959 is as
follows :

Year New Cases Old Cases Total

Hi 5 5 640 821 1,461

1956 565 709 1,274

1957 573 (,'Ml 1,203

1958 680 804 1,484

1959 668 767 1,435

As noted above the number of new. old
and total cases fluctuates slightly in the last
five years with the total between 1.203 and
1 .484"

Physician Visits
Formerly the best case-finding procedure
was the Crippled Children's Clinics. Through
1954, thirtv-one such clinics were held in the
Stale each year. These clinics have gradually
been cut down in number and at present only

-46—

Medical Social Worker participates
in the financial planning for treat-
ment and care.

thirteen are being held. Thus, case registra-
tion from this source has been greatly reduced
in the last five years. However, this has been
compensated by the fact that more and more

children are being seen in private physician's
offices for diagnostic and follow-up purposes.
The accompanying graph and chart shows
this change.

Number of Crippled Children New Cases

Given Service By Year In

1954- 1959

Year

1954

1955
1956
1957
1958
1959

Clinics

Physician's
Office

Total

760

S50

539

1(11

640

443

122

565

377

196

S73

384

296

1,8(1

389

279

668

It is believed that this change has not de-
trimentally reduced case-finding. However, it
is believed that any further reduction in clinics
would be detrimental and that it would also
substantially increase the cost.

Through this combination of clinics and
office visits, the State Board of Health at-
tempt-, to arrive at the lowest cost method
of seeing these children and still be in the
child's best interest. It is thought that a large
proportion of the handicapped children need-
ing these services are being seen, although in
some instance^ the referral to the program
is delayed.

Hospitalization
The table below shows the hospital services
provided for children in the Crippled Chil-
dren's Program from 1955-1959.

CRIPPLED CHILDREN HOSPITAL SERVICES BY CHILDREN ADMITTED

HOSPITAL DAYS AND EXPENDITURES

Expenditures calculated in dollars for calendar year.

1955 - 1959

1955

156

3,051

l'\5

$71,134

$444

$22.69

Number of Children Admitted

Total Hospital Days

Average Days Per Patient

Total Expended Hospitalization

Average Expended Per Child

Average Expended Per Child Per Day

'■Excludes Heart Surgery patients admitted to 3 Minnesota Hospitals through Regional Heart Center.

1956

l')57

1958*

1950*

195

217

331

246

3,314

2,829

3,760

3,538

17.0

13.0

11.4

14.3

$'.".255

$61,870

$75,428

$7o,240

$317

$293

$228

$510

$18.66

$22 47

$20.01

$21.55

The table above shows a 58$ increase in
number of children admitted to the hospital
in 1959 over 1955 but the total number of hos-
pital days has increased only Id','. The aver-
age days of hospitalization per patient has de-

creased from

1955 to 14.3

The average expenditure per child
$134 in 1959 as compared with 1955
a\ erage daih per child expenditure d<

in 1959.

is down

with the

iwn $1.14.

-47—

The reimbursable hospital cost for hospitals Changes in Services

used for these services has almost steadily in- While orthopedics still constitutes the larg-

creased, as shown below, in lowest, average es| single group of conditions receiving care

and highest rates during this same period of through Crippled Children's Services they are

time. This is a 42', increase from 1955 to ,,nK about 5<)', of all cases accepted instead

1 ' '5' ' in the average rate. ,,f |i()r; in earlier years.

Reimbursable Hospital Cost

for The two tables below reflect some of these

Hospitals Used for Crippled Children's Services changes:

1955- 1959 „ , . „

Neurological Surgery

1955 1956 1957 1958 1959 Calendar Years 1955 - 1959

Lowest rate $12.87 $15.27 $17.11 $17.11 $17.11 1955 1956 1957 i958 1959

Average rate .... 20.73 21.99 24.42 25.12 29.46 —

Highest rate .... 24.99 27.93 35<>" 33.00 36.42 Xo. Children 14 21 20 Id 16

Number of N'o. Days of

Hospitals 11 11 11 11 11 Hospitalization IS 376 143 192 2*2

Increases in Crippled Children's Case Load in Rheumatic Fever, Acute;

Congenital Malformation of Circulatory System and Chronic Rheumatic Heart

Disease, by Calendar Years 1950 - 59

1950 1951 1952 1953 1954 1955 1956 1957 1958 1959

Rheumatic Fever. Acute.. 7 14 5 8 25 3.1: 19 10 29 28

Congenital Malformation of Circulatory System 6 3 1 22 35 50 39 58 129 145

Chronic Rheumatic Heart Disease 12 4 4 3 3 ^3 ^J7 8^

TOTALS 14 19 10 34 63 86 63 80 175 181

Regional Heart Surgery Services
( >ne of several regional heart surgical cen-
ters supported by the 1". S. Children's Bureau
is the one in Minnesota utilizing the University
Hospital and the Mayo Clinic. Montana is
served by these facilities. Before patients may
be referred they require application for service,
social service review and medical referral like
anv other crippled child in Montana. In addi-
tion, most of them are given diagnostic studies
at the Board's Heart Center in Great Falls with
the medical diagnostic summary forwarded
to Minnesota along with other data. Children
accepted at the Regional Heart Center receive
hospitalization and surgical care at no direct
expense to the Montana program. 1 11 1958
there were three such children, in 1959 — six
children and in the first half of 1960—14 chil-
dren. The Montana Crippled Children's funds
could not have assumed this cost — averaging
$3,0C0 per child. The family is responsible for
all transportation expenses, except for welfare
accepted families.

Rheumatic Fever Program

The State Hoard of I lealth. in 1955, initiated
its Rheumatic Fever Prevention Program.
Through this program penicillin tablets are
provided for children with a previous attack of

RHEUMATIC FEVER PREVENTION PROGRAM CASES BY COUNTIES
June 30, I960
MONTANA

Rheumatic Fever. This disease is initiated in
some unknown way by a streptococcal infec-
tion such as scarlet fewer or "strep" sore throat
and affects most children between the ages oi
5 and 15 years.

Fortunately, only a small percentage oi
untreated strep infections are followed by
Rheumatic Fever. An individual having had
one attack, however, is much more susceptible
to a recurrence following a strep infection. It
has been proved that the continuous use of
penicillin and other antibiotics can prevent
strep infections and thereby prevent recur-
rences of Rheumatic Fever and its frequent
sequel. Rheumatic Heart Disease.

—48—

This program has been increasingly used
I iy Montana physicians for their patients. This
is demonstrated by the number of new cases
accepted annually as shown in the following

table

Year Accepted
on Program

Number of
Patients

195S
1956
1957
1958
1959
1960 (first 6 mos.)

T< >TAL

1"
Id
45
(,•>
66
30

245

Although the program was successful, the
State Board of Health anticipated that it would
have tn be discontinued late in the biennium
due to inadequate funds for financing it. At
this time the Montana Heart Association an-
nounced its low-cost penicillin prophylaxis
program and it was hoped that the children
on the Board's program could be transferred
to it. An analysis of the State Hoard of Health
program, however, indicated that the families
of 62.4 percent of the 215 children then on the
program would not be able to afford even the
low-cost drug. The Montana Heart Associa-
tion, when notified of this fact, expressed the
hope that the Board would continue its pro-
gram. Several ways in which the program
could be improved were also brought out by
the analysis and a revised program was pre-
pared. Near the close of the biennium. in the
light of this new information, the Board ap-
proved the continuation as well as a revision
ol its Rheumatic Fever Prevention Program.

The revised program included adults as well
a-- children in economic need. Referrals arc-
accepted from physicians only, as before. Spe-
cial referral forms have been developed which
provide information pertaining to the patient's
history and physical examination and state
the criteria by which cases will be accepted
on the program. A State Board of Health phy-
sician reviews the form to see if the criteria
are met. It is anticipated that approximately
one-half of the cases referred will be accepted
from the data on the form: in the other one-
half consultation by an internist, cardiologist

or pediatrician will lie provided, either at the
Heart Diagnostic Center or on a private basis.
This is contrary to the previous program where
all cases required consultation. Once a patient
is accepted, follow-up is maintained by the
cooperative efforts of physician, the public
health nurse and the State Board of Health.
Annually, the patient must see his physician
at which time a progress report is completed
and returned to the State Board of Health.

In addition to the humanitarian side of pre-
venting recurrent attacks of Rheumatic Fever,
it is also a financial saving to the Board's Crip-
pled Children's Program. By providing the
prophylactic drug the need for recurrent medi-
cal and hospital care for which such children
would be eligible is avoided. At the time of
the above mentioned analysis hospitalization
had been paid for 50 children. Forty-six of
these patients were proved to have Rheumatic
Fever. Of this number, 40 patients (87%)
were enrolled by their phvsician on the State
Board of Health Rheumatic Fever Prevention
Program. Only six patients (IT, ) were not
enrolled and it i- likely that these are being
maintained on prophylaxis on a private basis.
< )f course, the money required to pay for hos-
pitalization lor these 5" patients is many time-,
that necessarv to keep over 200 children on
prophvlaxis annually.

It is felt that the ultimate control of Rheu-
matic Fever recurrence in Montana is nearer
reality due to the improvement and expansion
of the State Board of Health's program and
tin- initiation of the program of the Montana
Heart Association. The latter program had
374 patients, 274 children, and 100 adults en-
rolled at the close of the biennium. The
Board's program had 211 children enrolled at
the same time. The ma]) shows the distribu-
tion of these cases by county. This number is
slightly less than the 216 cases enrolled earlier
in 1960 but this actually represents an in-
crease in patients on prophylaxis since several
patients were found able to afford the low-
cost penicillin and were transferred to the
Montana Heart Association program.

It is anticipated that during the next bi-
ennium nearly all of Montana's Rheumatic
Fever and Rheumatic Heart patients, whether
a child or an adult, in whom prophylaxis is in-
dicated, will he receiving it cither through these
two programs or privately.

-49-

Follow-Up Care
After the Crippled Children's cases arc
found and diagnosed, follow-up care includes
counseling with families and local health and
welfare workers, payment for hospital and
surgical can-. It includes providing braces,
occupational therapj and physical therapy.
Emphasis is given to early case-finding, early
referral for care and family counseling.

Also utilized are local facilities and per-
sonnel. ( Ither agencies that provide special
services, such as the Shrine Hospital and the
Blind Program of the State Department of
Public Welfare are used.

Financial Assistance
The Crippled Children's Program is de-
signed to help families who have children han-
dicapped by some physical disability. The
handicap may be congenital or acquired. The
disability is usualh of such proportion that it
constitutes a major financial drain on the
family in relation to the ability to pay. The
rehabilitation of the child usually requires a
number of years, a good deal of money and
a comprehensive evaluation of the child's prob-
lem.

I luring this biennium it has been observed
that an increasing number of families carry
various types of health insurance. This has
presented a problem regarding the acceptance
of children on the Crippled Children's Program
in order that tax funds would not be committed
to pay for service covered by an insurance pro-
gram to which the family had subscribed. Ap-
plication for Crippled Children's Service are
received from such families because of the
uncertainty of the degree of coverage, if any.
for the condition requiring care and also be-
cause the determination of the insurance ap-
plicability usually is prolonged, not infrequent-
ly requiring many months after care is com-
pleted. Many insurance programs exclude the
crippling conditions needing care, or only paid
in part, often leaving a potential or actual debt
obligation which the family could not meet.
Many factor- relating to the child's disability
and the need for care make it necessary to
proceed with such care without dela\ it the
child's best interest is to be served. While
endeavoring to utilize such insurance programs
to the fullest extent, the primar) obligation of

serving the child in his best interests prevailed.
Cnder these circumstances, unless the family
is able to meet the obligations involved in
providing care, the Crippled Children's service
authorized care subject to insurance adjust-
ment. I luring the biennium. under this pro-
cedure, where the insurance did apply, the
Crippled Children's program received reim-
bursement, usually only in part, occasionally
in full, as a result of insurance payments; such
payments being applied as a credit to Crip-
pled Children's funds reinstating such funds
for care of other eligible children.

Information regarding the changes of em-
phasis on having families participate in pay-
ment for care to the extent of their ability
have been sent to Public Health Nurses, Wel-
fare Departments and others concerned with
this program. Because it is necessary to de-
pend on the assistance of local w-orkers. in-
formation is sent them in written form for
their use and understanding of the program.
Because of limited State staff and unusual dis-
tances in Montana the local areas carry a
good deal of responsibility in referring chil-
dren, submitting application for service and
social studies, and in the follow-up care of
the child.

THE CLEFT LIP-CLEFT PALATE
PROGRAM

Services to children with Cleft Lip-Cleft
Palate handicaps continue to be provided
through the three Montana Cleft Lip-Cleft
Palate Teams. Montana's program continues
to maintain a place of high regard in this field
of rehabilitation. These teams have held 60
team meetings during the biennium.

NUMBER OF CHILDREN RECEIVING CARE

MONTANA CLEFT LIP-CLEFT PALATE PROGRAM
195 0-1959

'50 '51 '52 '53 '54 '55 '56 '57 '58 '59

YEARS

-50-

The chart mi page 50 indicates tin- increase
in number of children with cleft lip-cleft palate
congenital defects receiving care since 1950.
The rapid rise is concurrent with the start of
volunteer team approach in 1955-56 with the
continuing rise under the 5 year special pro-
ject which started July 1. 1957 with a I". S.
Children's Bureau "rant.

The levelling off of the program in 1958
and 1959 was expected as the backlog of old
case-- were caught up and the program became
current with the newborn defects horn each
year.

The tables below shew both the potential
work load and the actual services rendered by
number of children since the start of the
teams.

CLEFT LIP -CLEFT PALATE

1956- 1959

Summary of children in Montana registered during special Cleft Lip-Cleft
Palate program and extent and types of services rendered by number of

children and year.

1956
1957
1958
1959

Year

Total

Enrollment

235

326
335

Newly
Registered

50
47

.35

Birth
Defects

37
36

Cases
Closed

Xot Available
12

Year

No. Cases
Team Evaluation

No.
Lip Surgery

No. No. Rec.

Palate Surgery Orthodontia

No. Rec.
Prosthodontia

1956
1957
1958

*-?
126
134
131

40
40
31

in
13
31
49

is
2(.
21

Team evaluations began in 1955 with 41 cases evaluated.

At close of 1959, 90 are receiving speech therapy or continuing supervision directly through Program
or by referral to Easter Seal Therapist, 59 of these solely through State Board of Health facilities.

Future estimate for team evaluation is 120-130 per year.

Team Successes
Figures do not reveal the individual suc-
cesses achieved and the tacit gratitude of
anxious parents and their bewildered children.
Within the relatively short life of this pro-
gram a great change is noted in the final re-
sults and in the wholesome attitudes of chil-
dren "born into the program" — that is the
children receiving team evaluations ami begin-
ning care in infancy as compared with children
and their families when this team care was not
available to them until later in the develop-
ment of the children. Professional staff reviews cases at Team Meeting.

F«r**

-51—

Speech Therapy
Of the total number of children, 346 regis-
tered in the program on August 31, 1960, about

one out of every four is receiving speech
therapy. '1"" better meet this need a speech
therapist has been employed and assigned to
work in the Great Falls area. It speech therapy
services were more readily available in some of
the more rural areas of the State, the number
of children who need speech therapy could
have it. The number would increase from one
in four to one in three and possibly higher.

Cleft Palate Births Continue to Occur

The number of cleft palate births in the
State continues to average about 34 per year
which is higher than the original estimate. All
indications point to an anticipated registration
of between 390 and 400 cases, after which it is
expected that there will be a gradual decrease
to approximately 320. This number, it is an-
ticipated, will remain fairly stable.

Even though the Montana program is catch-
ing up on the backlog caused by unavailability
of cleft palate teams in the past, no matter how
diligent and complete a program is in effect,
there will always be a fairly large number of
cleft lip and cleft palate children for whom
care is just starting and an even larger number
at midway and at a terminal point in their
care. This is due to the length of time re-
quired for observation and complete care.

Hospitalization

The team evaluations have resulted in the
authorization of over 1,300 days of hospitaliza-
tion during the biennium. This cost has ex-
ceeded $35,000. These days of hospitalization
represent from as little as one day for diag-
nostic work to some cases which have required
the hospitalization of a young patient for as
many as 64 days for an extensive program of
care needed before any type of surgical pro-
cedure could be undertaken. However, the
average length of stay in the hospital for 94
children was 14 days.

Orthodontic and Prosthodontic Procedure Rise

The largest increase in any area of care in
this program during the biennium has been in
the number of orthodontic cases receiving care.
There were 60 children who have received or-
thodontic attention in its initial phase of active
treatment, ft is anticipated that this rise will
continue for at least one or two more years
before levelling off. It is hoped that prelimin-
ary research will bring about a procedure pro-
viding for orthodontic expansion of the new-
borns with bilateral clefts of the alveolus (tooth
sockets) whereby orthodontic procedures in
later years may be minimized somewhat.

Approximately 45 children have received
dental prosthetic attention during the bien-
nium.

Montana Cletl Lip and Palate Program

Number of Registered Cases 346

-52-

Prosthetic devices made when Cleft Palate cannot
be closed by surgery.

Program in Last Year of
U. S. Children's Bureau Grant

At the close of the biennium the U. S. Chil-
dren's Bureau annual grant of $50,000 has only
one more year of the five years to run. At
this time financial support must be made for
the continuation of the program by the State
if the program is to continue.

( )f this current expenditure almost 80%
goes into direct clinical, diagnostic and treat-
ment services to these children. The chief
items of expenditure have been in the areas
of hospitalization and surgery. But as de-
scribed previously there is some shift, not due
tn lessening of surgery, but to the rise of
necessary orthodontic procedures. It is antici-
pated that total hospitalization costs will re-
main fairly static. Surgical costs will level off
at about $3,500 per year and orthodontic costs
will not drop before reaching $4,500 per year.

It is believed that it will lake approximately
$50,000 a year for the next ten \ ears to maintain
the present high standard of care. This static
figure, when coupled with a steadily rising case
luad. indicates more service being given per
dollar unit of care. New surgical and dental
techniques will help to prevent future, hitherto
costly, procedures. Also, as the backlog of
cases, present at the start of the program, is
caught up there will be a lessening of the
number of children needing radical treatment
with extensive hospitalization.

CENTER FOR CEREBRAL PALSY &
HANDICAPPED CHILDREN

The Center for Cerebral Palsy and Handi-
capped Children in Billings has continued to
provide comprehensive services for handi-
capped children maintained by the Center's
Professional Team. The goal of the program
is to give maximum benefit so that each child
may become adjusted physically and emotion-
ally as possible within his capabilities supple-
mented 1>\ his educational growth through
special educational facilities and teachers.

A decade of progress at the Center was
highlighted with special observance on Decem-
ber 10. 1958. An open house and anniversary
banquet were held and the first edition of a
brochure describing the Center and its services
was prepared for this occasion.

The Center is sponsored by the State Board
of Health, the Eastern Montana College of
Education and Billings School District Xo. 1,
with each agency having representation on the
Board which administers the program. The
services are under medical direction and a co-
ordinator is also employed. The College and
the Hillings School District are primarily con-
cerned with providing the educational service
and the College provides the space. The State
Board of Health provides medical and ancillary
medical services.

A total of S51 children have been registered
since the tenter was first started, with 369
receiving services1 during the current bien-
nium.

■This refers to individual children — not the number of
times seen or service hours given. One child may
have as many as 25 clinic sessions. Therapy sessions
vary widely.

Medical services include pediatric examination (pic-
tured above), orthopedic, neurological, psychiatric
services and surgery

53- -

The 369 children were provided treatment
as foil* iws :

Speech Olllj ■— — 143

Cleft Palate only - - - 72

Cerebral Palsy - 11"

Other orthopedic problems 21

(muscular dystrophy, post polio, amyotonia,
congenital, spina bifida)

Miscellaneous 23

(behavior problems, epilepsy, blindness and
retardation )

In addition to these services 450 speech
and hearing evaluations were made between
1955 and 1960.

The professional teams serving these chil-
dren include medical and para-medical evalua-
tions, diagnosis, treatment, special therapies
and education as needed. These services were
provided to individual children as follows:

Services

During Total

Current Since

Biennium 1947

Diagnostic and Evaluation Clinics .... 4" 242

Initial Evaluations 95 431

Re-evaluations for further recom-
mendations and checks on
braces, etc 233 1,228

Children in full-time daily program
i.. receive education and intensive
therapy (the Center's capacity is
approximately 26 at any one time) 51 132*

Children in full-time program re-
leased for placement in public
schools and other public or
private institutions 16 100

*School program started in the spring of 1948.

The table above does not show the number
of times each individual child was seen nor
the number of service hours u;iven. One child
may have had as many as 25 clinic sessions and
a great many therapy sessions, while another
child would have had less.

Program Strengthened
The program at the Center was improved
and strengthened during the biennium by:

1. Providing psychiatric consultation on a
part-time basis. It has been found that
unless the emotional problems which
often accompany handicapping condi-
tions are resolved the physical, educa-
tional and social development of the
child is often hindered.

2. The position of psychologist became a
full-time rather than part-time as was
provided previously. Clinical as well as
testing services are now offered.

3. Remodeling of the physical plant has
provided an enlarged and rearranged
office space providing for improved ef-
ficiencv. An observation room has been

Routine psychological evaluations are now provided

for all children given services at the Center since the

employment of a psychologist on a full-time basis.

built in the speech department for one
way observation. This provides obser-
vation in testing and therapy for stu-
dents in training in special education at
the College.

4. The primary class in the educational
department has been separated into
three sections: Nursery, Kindergarten
and Primary, each meeting for short
periods daily. This division more ade-
quately meets the needs of the larger
group of younger children now in the
program. More vounger children arc- in
the program now than formerly, prob-
ably due to earlier diagnosis and to the
fact that the Center's services are more
widely known and accepted.

5. With the completion of the rehabilita-
tion wing of St. Vincent's Hospital in
May, 1960, beds for patients needing in-
patient rehabilitation services became
available. It was possible to arrange
(on a trial basis) for the Hospital to
accept on a boarding basis, patients
seen at the Center for daily treatment
and classroom work when foster homes
were not possible in Billings. This is
intended for patients ordinarily too se-
verely handicapped for foster home care.

Educational activities for children at the Center

provide part of the therapy needed for the child's

development.

These are the patients who could bene-
fit by services from the Center if in-
dwelling facilities were available when
they were not at the Center. The initial
cost was set at $5.00 per day on a trial
basis. Since the plan was initiated so
late the service had not been used at
the end of the bienniuni.

< )ther changes made include the rotation
of staff physicians. This change was made on
tin- recommendation of the physicians them-
selves. To adjust to a shift in types of pa-
tients seen, one physical therapist position and
one-half occupational therapist position were
eliminated.

1 hrough improved planning and coordina-
tion which was made possible by the sponsor-
ing agencies, with the employment of a Coor-
dinator and Educational Director. August 1st
to May 17, 1960, expanded opportunities were
made available for teachers being trained to
work with handicapped children and to stu-
dents in speech therapy courses. ( ibservation
in all the Center's services is provided for
nurses in training. Some of these student
nurses assist the staff at the summer camp
held in August each year. Improvements have
been made in classroom management at the
Center also. This Coordinator position was
changed to coordinator and director of Speech
Services in May 1960.

Needs
Part ot the physical therapy space has been
lost to the College. There is a need for the
expansion of the bus service to transport chil-
dren hack and forth and enlarged ground level

Occupational Therapy provides development of man-
ual skills through creative and educational activities.

Physical therapist participates in the treatment of
many of the children at the Center.

quarters are needed to serve the expanded case-
load. Residence accommodation with ample
facilities and staff to man a residence are
needed.

Tlie existing college basement space used
since the start of the Center presents many
problems since it was not designed for re-
habilitation services, nor can it be properly
modified structurally for such purposes. With
the growth ol the Center's improvement in
service and the change in the type of the
patients seen, there is evident need for a bet-
ter physical facility.

Gifts Helpful

The Center lias been fortunate in the con-
tinued receipt of unsolicited gifts from private
citizens, service clubs and other organizations.
I hiring the bienniuni an inclinator chair has
been installed to get the children up and down
the stairs. Some new office furniture, an elec-
tric typewriter for classroom use have been
received. Xew bicycles and tricycles have
been acquired and some of the old ones re-
paired. These are used for muscle training
and recreation. General use funds have also
been received.

-55—

'Dentai *i¥ea(t&

Health Educator demonstrates to

fourth grade children parts of tooth

that can be seen in a dental X-ray

picture.

Seven dental surveys conducted including 4,750 children. First county rural school survey done.

Dental program in Cascade City-County Health Department evaluated including records on 1,408
children, shows excellent results.

Dental survey results in three Montana towns where controlled fluoridation of public water sup-
plies has been in effect seven years shows reductions in dental decay ranging from 60 to 70' i .

Bite-wing X-ray program conducted in four schools including 237 children and demonstration pro-
gram at two university summer sessions.

Dental Health Education Workshops conducted for eight P.T.A. meetings with approximately 1,000
people attending.

Radiation control program developed for dental offices. Improvements being made as recommended.

PROGRAM PARTICIPANTS i" care of the teeth and provide interest to

In addition to the Dental Health division the school health instruction program. Indi-

of the State Board of Health, other State vi.hul and £rouP conferences were held with

Board of Health divisions participating in the the teachers in these sch..,.ls to provide assist-

promotion of dental health in Montana are: ance '» methods of teaching dental health, in

Bacteriological Laboratory, Disease Control, the preparation and use of visual aids and in

Environmental Sanitation, Public Health Edu- providing up-to-date scientific literature in this

cation. Public Health Nursing and Records held.

and Statistics. Dental Health Programs at Parent-Teacher

Approximately 61 practicing dentists, and Meetings have been participated in by the

300 P.T.A. members and room mothers have State Board "f Health staff at Butte, Chinook,

participated directly. Columbia Falls, Conrad, Kahspell, Ravalli

County, Ronan, Roundup. St. Ignatius and
EDUCATIONAL PROGRAMS IN Sidney. Approximately 2,000 people have been
DENTAL HEALTH reached in these meetings.
Dental Health Education for the Public Seminars on Dental Health Education have
Dental Health Education Programs have been conducted at the Northern Montana Col-
been carried on in conjunction with the dental lege, the Western Montana College of Educa-
surveys conducted in Cascade, Chinook, Dillon. tion, and the State University. Since this pro-
Fergus Countv School-. Fort Benton. Fort gram was initiated in July 1959, approximately
Shaw. Harlem, Roundup and Twin Bridges. l-<> students have had the opportunity to par-
The dental health surveys provide motivation ticipate in this educational program.

—56—

The students' evaluation of the program
indicates that these seminars have been very
worthwhile. They recommend their continua-
tion for future students enrolled in health
education course-..

In cooperation with the I >i\ ision of Public
Health Education, the following visual aids
and exhibits have been developed: "Hidden
Sugar", which illustrates the amount of sugar
in common sweets; "Mechanism of Dental De-
cay", flannelgraph ; "Dental Benefits of Fluori-
dation in Montana" in chart and graphic form;
"Mental Health Education Materials" available
from the State Hoard of Health; "Radiation
Control Program in Mental Offices", a pamph-
let to supplement this exhibit was also pre-
pared. The Railiation Control exhibit was
shown at the Montana State Dental Associa-
tion meeting in Missoula and at the Western
Branch. American Public Health Association
meeting in Denver in the spring of 1960.

A series of 35 mm slides illustrating the
dental health services and activities of the
State Board of Health and slides of the bite-
wing X-rays have been prepared. These visual
education materials have been used in nearly
all the dental health education programs in
the schools, schools of nursing, colleges, pro-
fessional meetings, P.T.A. and other meetings.

Articles and news releases on dental health
including the results of dental surveys in fluo-
ridated and non-fluoridated areas have been
prepared for publication.

Professional Education
The State Board of Health has sponsored
a one-week post-graduate course in "Dentistry
for Children" at the University of Oregon for
five Montana dentists in April 1959. A -"_■
day seminar on "Preventive Orthodontics and
Tooth Guidance" was co-sponsored with the

Mechanism of dental decay shown
with a flannelgraph at P.T.A. meet-
ing.

Local dentist participates in Post -fluoridation Survey.

More than 60 local dentists have assisted in Dental

Health Programs during Biennium.

Montana Society of Dentistry for Children.
This was held in Montana ami attended by 42
dentists.

In-service training programs were spon-
sored for the public health staff in one county
ami fur the staff in one school of nursing.

PREVENTIVE DENTAL HEALTH
PROGRAMS

Controlled Fluoridation

The following towns have reached a seven-
year level of continuously controlled fluorida-
tion in the public water supply: Bozeman, Chi-
nook and Roundup. Mental surveys were made
by the State Board of Health dental director
and local dentists in these towns to determine
the benefits of fluoridation.

These surveys were organized by public
health nurses who were also active in the
referral program that supplemented the sur-
vey.

A total of 1.741 children's teeth were exam-
ined by the 14 dentists who participated in
the survey. Drinking water histories of these
children were taken and show that approxi-
mately one-half of these children had grown
up drinking fluoridated water since birth.
These children's teeth show to' ! less denial
decay than children the same age who had
been drinking flouride deficient water. The
accompanying graph shows the dental benefits
of controlled fluoridation.

-57-

Iii evaluating this program, the same re-
sults are found which occur nation and
world-wide, but this is the first Montana in-
formation relating to the effectiveness oi fluori-
dation which could be collected.

In addition to pre-and post-fluoridation
surveys, community dental health surveys were
carried on to gather information mi the dental
health status of the child population. These
were done at the request of community groups.
Included in this group were: Twin bridges.
Dillon. Harlem. Roundup, Laurel. Fort Benton,
the Montana Children's Center, 44 rural schools
in Fergus Count}' and nine schools in Ravalli
County.

A total of 7,439 children received dental
examinations during these dental surveys.

The surveys conducted to determine the
value of fluoridation and the surveys conducted
to gather information on the dental health
status were both supplemented by an educa-
tional program. In the latter group children
were referred for further examination and or
treatment to their family physicians when their
conditions so indicated the need.

The survevs were sponsored locally by
Parent-Teacher Associations. Health Councils,
local health personnel and or local dental so-
cieties.

MONTANA DENTAL SURVEYS SHOW SESULTS OF FLUORIDATION

D M F Rale, b, Spcc.i.c Age, in Thre

Common, >,e, ... Each of Th.ee Calegon,

• Ooupcd ID Show Ch.ld.en

0Ppo,,un,t, lo Dnnk Floo,,da,ed Wot.

AGE-LAST BIRTHDAY

"■ :

■..- — supply
shows no fluoridi . in

Butte, 3 Lson

for seven
1 s lives - sutjply

■ ■ ■ rolled 3 . . . . • ■ r. ■ .

.. ■ , -
tain natural]
■ mount: Circle,

Bite-Wing X-Ray Program

Bite-wing X-ray

i- are Conducted

for the purpose of stimulating child visits to
the dentist and to inform parents and children
of the value of dental X-rays as an aid to
diagnosis and treatment. They were conducted
at Conrad. Brady, St. Ignatius. Fort Shaw.
Cascade and Crow Agency.

The program at Crow Agency was a co-
operative program with the Division of Indian
Health, C. S. Public Health Service.

Bite-wing X-rays were taken on a total of
384 children. A limited number of college stu-
dents in the Health Education Course at North-
ern Montana College and the State University
were also X-rayed in the summer of 1959. This
was a demonstration program held in conjunc-
tion with the seminar on dental health, and
dental health education programs were in-
cluded with each of the bite-wing programs,

An evaluation of the program was made at
tlie Conrad and Brad} schools in terms of
child visits to the dentist during the summer

vacation following the X-ray program. Of
the 100 children included in the program. 90
visited their dentists. This compares with a
control group of 113 children in which only
5i>', ,,f them visited their dentists during the
same period of time.

Local Public Health Nurse (second from left above)
is a key figure in Dental Survey Programs. Room
mothers, P.T.A. members or other volunteers assume
responsibility for rosters, mount X-rays in Bite-wing
holders and assist in other ways.

—58-

Dental Referral Card Program
The School and Pre-School Dental Referral
Card Program, which consists of a card dis-
tributed at the school, taken ti> the dentist and
returned to the school when the dental work
has been completed was evaluated. This eval-
uation was participated in by local school ad-
ministrators, public health nurses and others
administering the program locally. Complete
agreement on the value of this program was
not found. Its purpose is to assist in motivat-
ing child visits to the dentist.

Since some local administrators feel the
program is helpful and want to continue it.
others express doubts, this program will be
continued on a selective basis. The program
was initiated more than ten years ago on a
state-vv ide basis.

Radiation Monitoring Service
As a part of the Board's over-all program
on radiation control, a radiation monitoring
service was offered to practicing dentists in
the State. This program began in December
of 1958 and a total of 125 dental offices have
now been monitored. This represents about
one-half of the total and plan-, are underway
to reach the rest of the offices during the
next \ ear.

This program is a part of the industrial
hygiene program of the Division of Disease
Control. The primary objective of the Mon-
tana Radiation Control program is to reduce
radiation from all sources to an irreducible
minimum by means that are practical, eco-
nomical and technically feasible. Appropriate
recommendations are made as each office is
monitored.

An effort was made to find out what modi-
fications had been made to the X-ray machines

monitored. A questionnaire mailed to 11-'
dentists with 74 replies received, indicates a
high degree of follow-up on the recommenda-
tions made. An exhibit illustrating this pro-
gram was prepared and shown at the 1960
annual meetings of the Montana State Dental
Association in Missoula, and the Western
Branch of the American Public Health Asso-
ciation in Denver.

PtR CENT OF CHILDREN BY AGES WHO

WERE FREE OF DENTAL DECAY AND PER CENT

WHO HAD FILLINGS AT TIME OF SURVEY

80%

- %

■»■ X

30%

Z 0 \

\. — ™,™TE;:," "

10%

A'SE 6 YRS

Industrial Hygiene Engineer and Dental Director re-
view findings of Radiation Monitoring Program in
dental offices.

Bozeman Post-Fluoridation Survey shows the Six and
Seven Year olds, as shown above, have received the
maximum benefits of fluoridation. The Eight and
Nine Year olds did not have this benefit early enough,
therefore show somewhat less protection.

Lactobacillus Program
A Lactobacillus Diagnostic Program is also
carried on in cooperation with the bacteriology
laboratory. This service is offered to prac-
ticing dentists as an aid in determining in-
dividual patient susceptibility to dental caries
(decay). It is also used to measure the suc-
cess of a dietaiw program for the control of
dental caries. Thirty-nine dentists have used
this service during the biennium and a total
of 710 laboratory tests were made.

Mouth Protectors
Plans have been made to start a pilot pro-
gram on mouth protectors for athletes engaged
in contact sports. The program is to be done
in two high schools and will be a cooperative
program of the two high schools, the dental
society, the High School Association and the
State Board of Health. Individually fitted
latex rubber mouth protectors have been shown
to reduce mouth and facial injuries by nearly
100 per cent.

-59—

"Dteeaae @<i*t&iol

Study of Records Reveals Status of
Disease in Montana.

The Board's Tuberculosis Control Program revised and up-dated. The Program was developed for
adaptation and implementation in various areas of the State according to their needs.

A physician assigned by U.S.P.H.S. to staff of the Division of Disease Control to specifically direct
a heart disease control program.

A Radiation Control Program developed for dental offices. Plans are underway to monitor medical
and veterinary equipment.

An active Venereal Disease Program being carried out with special Federal Project funds which
increased contact and suspect investigation from 226 in 1958 to 1,042 in 1959.

A Pilot Program to assist nursing home operators provide improved care to their patients initi-
ated in Gallatin County. This will serve as a guide in the development of one phase of the
Chronic Disease Program.

High volume air samples collected periodically at seven locations and examined for various con-
taminants.

Most Montana Industries studied found to be carrying out State Board of Health recommenda-
tions for the reduction of health hazards, particularly in control of dust.

Montana's communicable disease picture for
the last biennium appears similar to the pic-
ture for recent years. Some details, however,
stand out.

In 1958 Montana was one of seven states
epidemic for POLIOMYELITIS. Sixty-eight
cases were reported. < >f these 7?' , were para-
lytic; 2?' < non-paralytic, and 10', i were fatal.
Only <>ne child of this group had been fully
vaccinated for polio at recommended intervals.
This child had only a mild paralysis. 6(>' < of
all reported cases had no vaccination for polio-
myelitis.

Although as always happens, this epidemic
stimulated immunizations throughout t h e
State, again in 1959 there were seventeen cases
of poliomyelitis. Thirteen of these eases were
paralytic ; thirteen had no vaccination for polio.
There were two persons who died, neither of
whom had any vaccination.

Eleven of these cases occurred during Oc-
tober. November and December.

In the first six months of 1960, there were
six cases of poliomyelitis reported — all of
these were paralytic and again only one had
been fully vaccinated; lour had had no vac-
cination.

—60—

Montana has had no cases of Smallpox for seven

consecutive years. Vaccination against this disease is

recommended every five years.

Many attempt-, base been made throughout
the biennium to urge Montanans to 1>e pro-
tected adequately for poliomyelitis -but im-
munization still lags, especially in the pre-
school group and in those persons over twenty.
The estimated effectiveness of the recom-
mended four doses of Salk vaccine for polio
reported by the U. S. Public Health Service
in Xc>\ ember 1''59 was '•()', ur better against
paralytic polio. Surveys in late 1959 have
shown that in areas in Montana, levels of pro-
tection for Polio are as low as 31/3 to a high,
in areas with full-time health departments of
90' , -97' , .

1959 marked the seventh consecutive year
that Montana has had no cases of SMALL-
POX. This is an enviable record but one
which, if continued, demands a population that
is protected by .smallpox vaccination. To attain
this protection, everyone must be vaccinated
for smallpox every five years throughout life.

DIPHTHERIA blackened the disease pic-
ture in the State during the biennium. There
were thirteen cases reported in 1958. Of these.
only one had any immunization for diphtheria
and her protection had lapsed years before.
I liphtheria is a preventable disease.

The two cases of diphtheria reported in
1959 were traced to an unsuspected carrier as
the source. Recent studies have shown that

diphtheria carriers are more frequent than has
been thought. It again behooves Montanans
to keep up their diphtheria protection.

WHOOPING COUGH increased from 169
reported cases in 1958 to 237 cases in 1959.
Ibis, too, is a preventable disease. Protection
against this disease is usually included when
children are properly immunized.

INFECTIOUS HEPATITIS is a cause
for real concern in Montana. In 1958, there
were 424 cases reported and in 1959, there
were 294 reported cases with five deaths. This
disease appears to peak in incidence every five
to ten years. It is a difficult disease to control
as carriers may spread the disease and not be
ill themselves. Unsanitary practices and con-
ditions are usually involved when the disease
occurs. Protection for a limited time is avail-
able to close contacts by the use of gamma
gli ibulin.

TYPHI )l 1 ) FEVER, when it occurs, is the

result of | r sanitary practices, usually poor

food handling methods. In 1958, there were
eight cases reported; in 1959, there were six.
Interestingly, one case reported was traced to
a carrier who had the disease 45 years ago.
She had prepared food for the person who con-
tracted typhoid fever.

I luring the biennium. the typhoid carrier
list was reviewed and reports on all known
c a r r i e r s w ere received. Health officers
throughout the State are aware of who they
are and where they work'. Typhoid carriers
are not allowed to work in jobs involving food
or milk handling.

DYSENTERY (especially shigella) and
SALMONELLA [NFFCTIONS, although
seldom reported as cases, are other indicators
of poor community sanitation and personal
hygiene and according to laboratory reports
are increasing in number. Dysentery among
our Indian population is a real blot on our
dist-ase picture.

The tabtilaiton on page 62 shows the re-
ported number of streptococcal infections and
rheumatic fever cases for 1954 to 1960. Strep-
tococcal infections include streptococci sure
throat and scarlet fever. The increased number
of cases probably reflects better reporting by-
physicians, rather than a real increase in the
disease itself. Recent attention to and in-

—61-

creasing use of prophylactic drugs in prevent-
ing rheumatic fever relapses probably explains
the increased reporting. Described more fully
in the Section on Heart Disease.

STREPTOCOCCAL INFECTIONS AND

RHEUMATIC FEVER CASES REPORTED IN

MONTANA FROM 1954-1960

Year Strep Infection Rheumatic Fever

1954 433 8

1955 .. >s* "

1956 468 4

1957 1.082 8

1958 2.1.'5 74

[959 1,866 95

1960 ( \\ eek ending
July 2. I960).... 1,796 113

INFLUENZA remain- high in Montana.
In 1958, 4,645 cases wen- reported which rose
to 5,496 cases in 1959. During l'^'1. we again
had a wave of Asian Influenza as proven
serologically and by isolation in the State
Board of Health virus laboratory from repre-
sentative cases throughout the State.

In the first six months of 1960, the number
rose to 7,223 influenza reported cases. This
was a continuation of the Asian influenza wave.

M [• \SLKS case- dropped from 8,250 re
ported cases in 1958 to 5.544 reported cases
in 1959.

Only one case of ROCKY MOUNTAIN
SPOTTED FLYER was reported in 1958.
There were four cases in 1959. In 1958, no
case- of TULAREMIA were reported; in
1959, there were four cases. There were three
cases of BRUCELLOSIS reported in 1958;
in 1959 there were no cases. There were no
human cases of arthropod home ENCEPHA-
LITIS reported during the biennium. MEN-
INGITIS cases dropped from 25 cases in 1958
to 17 cases in 1959.

Recognizing the evidence of Q FEVER
infection in Montana cattle, the State Board
of Health, in order to protect the public health.

requested the Livestock Sanitary Board to re-
quire the pasteurization of all milk distributed
to the public from any dairy herd found to
be Q fever infected.

Fortunately, there have been no human
RABIES case- during the biennium. How-
ever, rabies in hats in Montana was proven in
1959, resulting in constant vigilance to discover
rabies not only in human- but in domestic and
wild animals. The public was alerted to the
situation for their protection.

The Division of Disease Control has con-
tinued to work closely with the Livestock
Sanitary Board to be aware of any old or new
animal diseases which may he transmissible
to man.

A new disease entity was added to Mon-
tana'- disease picture during the biennium. In
late 1958 and early 1959, a rare epidemic of
PHLEBITIS began among 9 student nurses
in Billings and 42 residents of Laurel and
I 'ark City. Epidemiological aid was requested
from the US. I'. U.S. Communicable Disease
Center to assist in the investigation of the
disease.

The cause of the disease was not deter-
mined. There was involvement of both dee])
and superficial veins, usually in the legs, al-
though, some tenderness occurred in the arms.
Irritability and emotional upset appeared to
accompany the symptoms. Findings suggested
autonomic nervous system involvement. Tin-
disease in some cases was very severe. The
disease occurred most frequently in women
and, other than the student nurses, the age
range was between 30 and 45.

The Division of Disease Control has been
most interested in the control of STAPHY-
LOCOCCUS infections in hospitals and their
spread into the community and then back to
the hospital. There has been participation in
meetings and conferences with hospital per-
sonnel, practicing physicians, and public health
nur-e-. Personnel from the State Board of
Health are available, on request, to help in-
vestigate any outbreak.

NEWLY REPORTED FIVE
^25 1 • &■;■;■;:

A new look was given to
the control of tuberculosis in
Montana during the bien-
nium.
Laws and Regulations for
the Control of Tuberculosis

For many years, protection
of the community against
communicable tuberculosis
by persons who have refuse<
to comply with State Board
of Health regulations, has
been a problem. The 1959
Legislature passed a law.
which permits the commit-
ment of these persons if they
are found to be a public
health menace. The law also
provides that persons suspected of having tu-
berculosis must submit to an examination.
Rules and regulations were adopted by the
State Board of Health to comply with this
law defining communicable tuberculosis ami
establishing procedures relating to the diag-
nosis of communicable tuberculosis.

The 1959 Legislature also removed resi-
dency requirements for admission to the State
Sanitarium, which has always been a problem
in Montana. Transient persons with communi-
cable tuberculosis Could spread their disease
in a community because sanitarium facilities
were not available to them.

Unfortunately, for the protection of their
people and of the community at large, the
tribal councils in our Indian population have
not all accepted these laws as yet.

To give further protection to school chil-
dren, the State Board of Health, working with
the Department of Public Instruction, revised
the health certificate for teachers in Montana
so that they are certified free from communi-
cable tuberculosis by their physicians. Pre-
liminary standards for the determination of
communicable tuberculosis for use by health
officers in countersigning these certificates

•YEAR TUBERCULOSIS CASE RATES BY COUNTY-
MONTANA 1955-1959

were adopted by the State Boan

Health.

The New Look in Tuberculosis Control

The new look at Montana's tuberculosis
picture pointed up some very glaring facts:
although the death rate for tuberculosis in

180 I - 57 6 { High Quortile)

57 5- 32 7 ( Medium High Quortile)

Q 326-21 7 (Medium Low Quortile)

□ 216-0 0 (Low Quortile)

Montana is rapidly dropping (as shown in the
accompanying chart), Montana still has not
controlled the spread of the disease to our
population when the number of new cases re-
ported continues to remain high. This insidi-
ous disease causes disability and economic
hardship not only to the patient but involves
his entire family.

This major disease problem still remains in
specific areas involving a comparatively small
number of counties. To improve this picture.
several important principles have been set up
by the State Board of Health as the basis of
a state-wide tuberculosis control program.
These are :

1. Cases must be found, their contacts must
be examined and all cases must be super-
\ ised by adequate follow-up.

2. Intensive case finding among contacts
(who need to be identified) of known
tuberculosis cases should be routine in
every county. Case finding activities
when possible should be directed par-
ticularly toward these population groups
and counties in Montana where the prev-
alence is known or suspected to be high.

.i. In order for the State Board of Health
to fulfill its legal responsibility to con-
trol tuberculosis, reporting of all cases
l>v physicians, sanitariums, and other
hospitals is needed.

-63-

4. Support is needed for the necessary State
and local staff to carry out the program.

This program is approved to be used as
a guide and its application will vary accord-
ing to the needs of specific areas in the State.

rhese principles oi tuberculosis control are
in accord with the Report of the Arden House
Conference on Tuberculosis held in November,
1959, made jointly by the National Tubercu-
losis Association and the United States Pub-
lic Health Service, except as they pertain to
widespread use of chemotherapy as a public
health measure and certain research proposals.
The type of control program outlined for Mon-
tana is recognized in this report as an inter-
mediate step toward the eradication of tuber-
culosis. The Report is being studied further
for application and suitability to Montana.

\n exhibit was prepared to illustrate the
complete program. It has been shown at the
annual meeting of the Montana Tuberculosis

Association and at Montana State College.

Program with the Mew Look Started
Implementation of this program started
among the Indian group where the problem
is one of the greatest in the State. 1 luring the
last six months of the biennium the State
Hoard of Health loaned mobile X-ray equip-
ment to the Division of Indian Health to con-
duct a survey of all Indians on the Montana
Indian Reservations. This was completed
toward the end of June 1960 and intensive
case follow-up is being carried out on cases
and suspects found.

Public Health Nurses in many areas of
Montana have been assisting the Montana
Tuberculosis Association in the Eollow-up of
their tuberculosis testing program for school
children.

State Board of Health and State Sanitarium staff

members exchange information on patients under

care.

Case registers at the State and local health
department levels have been more fully de-
veloped and utilized to reflect the current
status of tuberculosis of every tuberculous
patient in Montana. These allow free inter-
change of information about patients among
professional persons and agencies. They allow
a means of determining whether or not the
patient is receiving medical care and following
medical recommendations, not only to protect
his health but that of the community.

The establishment of closer liaison in tuber-
culosis control between the State Sanitarium
and the State Hoard of Health and the Division
of Indian Health and the State Board of
Health has paid dividends. The exchange of
information between the State Sanitarium and
the State Hoard of Health on out-patients with
tuberculosis has been initiated. Previously this
exchange was carried out only on in-patients.

The local public health nurse is an impor-
tant link in tuberculosis control. During 1958.
1,162 visits were made to diagnosed tubercu-
losis cases by public health nurses and that
year in behalf of the control of tuberculosis,
they made 3,342 visits. In 1959, 966 visits were
made to diagnosed tuberculosis cases, and to
contacts and suspects they made 3,030 visits.
Adequate public health nursing staff and ac-
tivities on the local level are a necessity to
control tuberculosis. Unfortunately there are
still 50' < of the counties without these services.

SBH Laboratory Services in T.B.

Without the close cooperation of the State
Hoard of Health Bacteriology Laboratory and
other laboratories throughout the State, tuber-
culosis control would be very difficult. In
1959, the State Hoard of Health laboratory
performed 5.431 tests on 2. 421 specimens for
tuberculosis. In 1958, there were 5.342 tests
done on 2,359 specimens.

T.B. Deaths T.B. Cases Reported

Year Number Rate* Number Rate

1959 .. 37 5.6 2.^4 35.3

1958 45 6.5 292 44.6

1957 68 10.0 301 46.5

1956 48 7.1 282 44.1

1955 SO 7.6 429** 68.0

*Rate per 100,000 population

"Reflect increase resulting from State-wide X-ray
survey

1/e*te%eat *Di&ecue (^outlet

The ultimate goal of the Venereal Disease
Control Program in the State Board of Health
is the eradication of syphilis. The immediate
goal is to establish effective control. Effective
control means that every syphilis case is re-
ported and the individual interviewed to find
out who the sex contacts are. It also means
that these contacts must be found, and exam-
ined. Then, every person diagnosed with the
disease must be treated.

Only through close cooperation between
the practicing physicians in the State and the
Board's staff can this program be carried out.
The practicing physicians are responsible for
diagnosing, reporting and treatment of each
case. The physicians also help in locating some
of the contacts.

SYPHILIS CASES REPORTED

IN MONTANA, BY YEAR, I948-I959

6 00

500

400

300

;..

/•-..

200

I00

46 49 50

62 63 34 69 86 97 96 99
YEAR

Special Project

In late 1957, a special Venereal Disease
Project Grant was given to the Sl'.ll by the
I'. S. Public Health Service. These grants
have continued throughout this biennium.

The principal objective in the project was
to improve the reporting of venereal disease in
the State. The accompanying graph shows a
considerable improvement in reporting dur-
ing the 1959 year. The Disease Control Di-
rector personally contacts all physicians re-
porting cases of syphilis.

Public Health Nurses, cooperating with the
practicing physicians, are responsible for the
interviewing of cases and the investigation of

contacts. A nurse working on the State staff
is available for this activity in counties where
there are no local public health nursing serv-
ices. The chart below shows the public health
nursing visits from 1956 through 1959.

PUBLIC HEALTH NURSING VISITS

REPORTED BY NUMBER, KIND OF VISIT,

AND NUMBER OF ADMISSIONS

1956- 1959

Total Home Office

Year Visits Visits Visits Admissions

1956 78 50 2K 46

1957 89 54 35 50

1958 281 164 1 17 176

1959 .. 3h2 116 246 195

The accompanying graph also shows con-
siderable variation in the reporting of syphilis
through the years. It probably does not give
a true picture of the incidence of the disease.
However, in 1959, intensive follow-up was done
on positive laboratory reports and from the
449 cases of syphilis reported, a true picture
is beginning to evolve. Of the 44' > cases re-
ported. 190 of them were from previous years
but they were not reported until 1959. This
follow-up procedure is being continued. At
the end of the first half of the 1960 year, 126
cases of syphilis had been reported in Montana.

Effective follow-up is also aided by the
operation of an interstate reporting system of
venereal disease. A telephone report is made
to the health department of jurisdiction on
each infectious case. This makes prompt trac-
ing and investigation possible on persons with
venereal disease, who travel from one State
to another.

Gonorrhea Control Program
< )f the other venereal diseases, gonorrhea
is the most prevalent. In 1958, there were
296 cases reported as compared to 309 cases
in \'>5'K During the first six months of 1960,
there were I'M cases reported. According to
these figures, a 24' I increase in gonorrhea
during the 1960 fiscal year can be expected.

Gonorrhea cases are interviewed for con-
tact- and contacts followed up by the public
health nurses as they are in reported cases
and contacts in the syphilis control program.
The contacts are examined and all diagnosed
cases are treated by the practicing physicians.
Only then can the spread of the infection be
broken.

-65-

Promotion of community responsibility in

the control of venereal disease is particularly
imp< irtant.

Venereal Disease Education

An effective educational program is under-
way in Billings. It is a community project
aimed specifically at the control of the disease
among teenagers. Reported cases of infectious
syphilis in Montana in the 10-20 age group
lias increased from 7.5', of the total reported
cases in 195S to 10.295 of the reported cases
in 1959. Reported eases of gonorrhea showed
that 17'< were in this age group in both years.

This educational program includes the use
of the film, "The Innocent Party". Its use,
with discussion, was recommended by the Ad-
visory Council to the Joint Staff Committee
i State Board of Health and State Department
of Public Instruction). One of the members
of the Council, a practicing physician from
Billings, is carrying out this educational pro-
gram in this city.

Because of the nature of the subject, the
film was first shown to a wide variety of
groups including approximately 500 adults in
the community. The parents of teenage chil-
dren were asked to indicate whether or not
they recommended this film, with discussion,
be used in teenage education on venereal dis-
ease. Of the two hundred fifty responses to
this question, 247 said yes. Many indicated
that it should be shown without delay and
indicated that as many as possible of the
teenagers in the community have the oppor-
tunity for the educational program.

The students who have seen the film have
shown a great deal of interest and recommend
that all teenagers see it. It was shown to a
class at Montana State College and these stu-
dents, remembering their own earlier teenage
years, recommended that it be shown to junior
high school aged children and not wait until
the students reach senior high school.

With this most satisfactory pilot program,
it is planned to initiate it in other area- of
the State. The use of this film is included
in the suggestions for teachers in the Venereal
Disease Section of the Guide for the Montana
School Health Program.

Laboratory Services in VD Control
During the biennium, the Division of Dis-
ease Control has continued to depend on the
Bacteriological Laboratory and private labora-
tories in the State for laboratory services
needed in the VD control program.

During l'1.^1'. a workshop on VDRL slide
testing procedures and their interpretation for
the diagnosis of syphilis was provided for
laboratory personnel working in the State.
Funds for travel of the participants was pro-
vided by the project funds.

Project funds are also provided for the
State Board of Health serologist to visit and
recommend for approval the private labora-
tories in the State that carry on serological
testing for the diagnosis of syphilis in the
State. New manuals on "Serologic Tests for
Svphilis" have also been distributed during
the biennium. To enable this program to be
carried out, a laboratory helper was employed
for a period of three months using project
funds to assist in the absence of the serologist.

(faucet (^atttwl

Cancer ranks as a leading cause oi death
in all age groups in Montana except in chil-
dren under one year. In 1958 there were 858
deaths from cancer and in 1959 there were
920 deaths (provisional figures).

The need to develop a more extensive and
effective coordinated effort aimed at improv-
ing the overall cancer control pro-ram in Mon-
tana has been recognized for some time. 1 he
practicing physicians, the State Board of
Health, the Montana Division of the Ameri-
can Cancer Society, and other agencies are
interested in making better services available.

Lack' of trained personnel with time to as
sist in a State-wide coordinated program, the
comparativelv few full-time local health de-
partments, a- well as the very nature of Mon-
tana itself with its large area and low popula-
tion density, have posed definite problems to
an effective cancer control program.

To facilitate the development of such a
program, the State Board of Health has ap-
plied for a grant from the U. S. Public Health
Service for the purpose of obtaining additional
trained personnel to develop medical and nurs-
ing seminars at convenient centers throughout
the State.

- ,-„,

^ hen a community has advanced in de-
velopment of cancer activities, special projects
may be set up.

It is hoped that better reporting of cancer
will result so that the State Board of Health's
cancer register will become a valuable tool in
cancer control by furnishing leads for further
important epidemiological studies in Mon-
tana.

The public health nurses' activity in cancer
control in Montana during the biennium rose
from a total of 73 cases admitted in 1958 to
92 cases in 1959. These cases required 946
nursing visits.

A unit on cancer for the Guide for the
Montana School Health Program has been
prepared.

Diseases of the heart and blood vessels ac-
count for over fifty per cent of Montana's
deaths and are one of the leading causes of
disability. This is also true for the countrv
as a whole. Jt has been estimated that there
are 40,000 persons with these diseases now
living in Montana. The Board's work in this
field is concentrated in two programs: 1) the
Heart Disease Control Program and 2) the
Rheumatic Fever and Heart Diagnostic Center.

THE HEART DISEASE CONTROL
PROGRAM

Activity in this program has greatly in-
creased since the acquisition of a full-time
Heart 1 >i.-ea>e ( '< mtn >1 1 hrector in the Division
of Disease Control. This physician is on loan
from the U. S. Public Health Service for a
two-year period. A full-time cardiovascular
nursing consultant has also been appointed
and began her assignment at the close of the
biennium.

Rheumatic Fever and Rheumatic
Heart Disease
Much emphasis has been placed on rheu-
matic fever and rheumatic heart disease. The
incidence of these diseases in Montana is one
of the highest in the nation. This has been
borne out by a recent two-year study on Col-
lege Freshmen. The Montana State College
and the Montana State University have par-
ticipated in this national study. The results

58.000
v, ST. 000
- 56.00p
o 55.000
* 54,000
r 53,000

1000
9 0 0

PUBLIC HEALTH NURSING VISITS IN ALL
CATEGORIES. RHEUMATIC FEVER AND
CARDIAC DISEASES MONTANA, 1958 ond 1959

I 1956 | JAN - DEC)
1 1959 I JAN- DEC )

ALL CATEGORIES RHEUMATIC FEVER CARDIAC

show that in students whose permanent resi-
dence is Montana, the rate of rheumatic heart
disease is 55.0 per 1,000. This is more than
twice the national rate of 25.4 per 1,000.

Public health nursing visits to rheumatic
fever and cardiac (heart) patients have in-
< reased during this biennium. In the calendar
years 1958 and 1959, 2.8$ and 3.2$ respective-
ly, i'f all visits were made to patients in these
two categories. The graph above shows
the number of visits in each of these catagories
compared to the total number of visits in all
categories for these two years.

Rheumatic fever and rheumatic heart dis-
ease are now known to be preventable. This
i> dune by the use of antibiotics, especially
penicillin, for the treatment and prevention of
streptococcal infections which are known to
precede rheumatic fever. By preventing the
initial or recurrent "strep"' infections the at-
tacks of rheumatic fever are thereby also pre-
vented.

The Board's Rheumatic Fever Prevention
Program provides daily penicillin tablets to
thi isc patients with a previous history of rheu-
matic fever to prevent recurrences. The pa-
tients must also be known to have economic
need in order to be eligible for this assistance.
Iln- program was begun in 1955 and recently
underwent a thorough evaluation. Several im-
provements were made, one of them being the

-67-

acceptance of patients age 21 and over for
these services. Heretofore, the program was
available only to those persons under 21 years
of age through the Crippled Children's Pro-
gram of the Hoard. This is further discussed
on pages 48 and 49 in this report. Adult pa-
tients receive medication through the Division
of I 'isease Control.

The plan for a College Freshman Rheu-
matic I Hsease Study has been e x t e n d e d
through the Hoard's Heart Program. It will
receive the cooperation of all Montana's Col-
leges which require entrance physical examina-
tions. This extended program will begin in
the fall of 1960. The national study mentioned
earlier in this section in which the State Uni-
versitv and the State College have participated,
shows that only 7.1', of Montana's students
for whom daily medication was thought indi-
cated were currently on prophylaxis.

The Montana study is for the purpose of:

1. assisting in the evaluation of the rheu-
matic fever and rheumatic heart disease
picture in the State

2. learning where improved care is needed

3. conducting an educational program for
these students.

As stated above, the identification and
treatment of streptococcal infections are a pre-
requisite to the prevention of rheumatic fever.
Literature containing scientific advances in
this field has been sent to all Montana physi-
cians and public health nurses. In addition,
the Bacteriological Laboratories culture ma-
terial from several hundred throat swabs year-
lv for the isolation of this organism.

A recent innovation in the identification of
the streptococcus has been the development
of the Fluorescent Antibody Technique. This
special and very expensive equipment has re-
cently been purchased for the Bacteriological
Laboratory. It was acquired through the I'. S.
Public Health Service. The great advantage
of this method is that a positive identification
of streptococcus by type can be made in three
to four hours. The conventional culturing
methods heretofore used require 24 to 4S hours
before identification can be made. With early
diagnosis adequate therapy may be used to

prevent complications of the infection such
as rheumatic fever, rheumatic heart disease
and glomerulonephritis (a kidney disease).

Cooperative Relationships
In the heart disease program there is con-
tinued active liaison between the Hoard's staff,
including the staff at the Heart Center, and
tin- Rheumatic Fever and Heart Committee of
the Montana Medical Association.

Cooperative working relationships have
been strengthened between the State Board
of Health staff and the Montana Heart Asso-
ciation. Two Cardiac Nursing Institutes were
held during the biennium. They were spon-
sored by the Montana Heart Association, the
Montana Nursing Association and the Mon-
tana League for Nursing. These institutes
were participated in by State Board of Health
members from the divisions of disease control,
public health nursing and health education as
well as by a large number of local public health
and hospital nurses.

A joint project between the Hoard and the
Heart Association has been the publishing of
a "Directory of Services to Cardiac Patients".

I his booklet provides a rather complete and
concise reference work to the diagnostic, thera-
peutic, educational, financial and rehabilitative
services available to Montana's heart patients.

The booklet is for the use of Montana physi-
cians, public health personnel, Montana Heart

Association local Councils and other interested
professional groups.

RHEUMATIC FEVER AND HEART
DIAGNOSTIC CENTER

The Rheumatic Fever and Heart Diagnostic
Center, located in Great Falls, is provided for
the purpose of serving Montana physicians on
a diagnostic and consultative basis. It is now
serving an increasingly broader base of family
physicians.

The Center serves to fill the specialized
needs of rheumatic and congenital heart dis-
ease patients ( 1 ) under the care of private phy-
sicians, in addition to those children who are
(2) eligible for care under the Hoard's Crip-
pled Children's Program.

The establishment of this Center in 1956
has made it possible to handle within the State
the most difficidt cardiac diagnostic problems,

-68—

especially as they relate to heart surgery. Prior
to this the facility was only a Rheumatic Fever
Center having heen established in 1949.

The procedures instituted in 1956 provide
for cardiac catheterization and angiocardio-
graphy, also a third and new technique, the
Dye Technique, has heen initiated recently.
The information revealed from these proce-
dure-- usually makes it possible for the physi-
cians to determine the exact type of defect in
the patient's heart. Thus, if so indicated, the
corrective siirgerv can he recommended.

The patient and his own physician deter-
mine how, when, and where to follow the rec-
ommendations, as in any other type of consul-
tation service.

With the establishment of the procedures
m 1956, it was realized that a fair backlog of
clinical material existed in the State. By the
end of 1958 this backlog of cases was pretty

Catheterization is used as diagnostic procedure in
Heart Disease at Center.

well cleared. The activity of the past eighteen
months is a fairly clear reflection of the cur-
rent rate at which cases are being found anil
referred to the Center.

The tables below show the number of pa-
tient.-- -een and tlie types of diagnoses made
on these patients during the current and last
biennium period.--.

RHEUMATIC FEVER AND HEART DIAGNOSTIC CENTER — JULY 1, 1956 - JUNE 30, 1960

July '56 July '57 July '58 July '59 Total

June '57 June '58 Total June '59 June '60 1960

Total Cases Seen... ..133 188 321 295 233 548

Clinic Visits 153 266 419 332 279 611

New Cases 59 113 172 153 143 296

Consultation* 7 104 111 221 246 467

Cardiac Catheterization 0 34 34 35 19 54

Angiocardiograms 0 5 5 11 6 1/

1. Congenital Heart Disease ... 89 137 127 264

2. Rheumatic Fever and Rheu-
matic Valvular Heart

Disease 33 62 61 123

3. Normal Heart including

Innocent Murmur 37 77 54 131

4. Other Diseases 13 V) 12 31

■Casus seen by medical consultants other than the Director of the Center.

It is of interest to note that of the total number of congenital and rheumatic disease cases seen
during the current biennium the ratio runs slightly over two to one. This is similar to the experi-
ence during the past few years in almost all centers of this type.

At the Heart Center, the patient is inter- including all of the heart diagnostic team
viewed, his history taken and an electrocardio- members is held. The heart diagnostic team
gram and fluoroscopic examination made. On includes cardiologists, a pediatrician, the ra-
the following morning during the clinic period diologist and the public health nurse. Each
complete blood tests are performed followed case is discussed thoroughly and a team recom-
by an examination by the clinic physicians. mendation is made.
At the completion of the clinic a conference

—69—

Public Health Nurse and technician study findings
from catheterization.

Following this the patient and his family
are counseled by one of the physicians with
regard to the recommendations. If a heart
catheterization and or an angiocardiogram are
to be done at the Heart Center, the patient is
admitted to the hospital that same afternoon.
These special procedures are performed dur-
ing the laboratory period the following morn-
ing.

Needs

During the past biennium it has continued
to be necessary for most heart surgery and
all open heart surgery patients to go out of
the State lor operation. Until open heart pro-
cedures are available in Montana, patients must
still go out of the State for this care.

During 1959, a staff committee on Chron-
ic Illness and Aging was established in the
State Board of Health. This committee recom-

'Tgif

Consultation on patient's X-ray between cardiac spe-
cialists and Center's director.

mended that the first activity to be initiated
should l>e a program, directed by the Disease
Control Director, to develop assistance for
nursing and or hoarding homes to provide
improved patient care. The program was de-
veloped in close coordination with the Division
of Hospital Facilities which is responsible for
the licensure program in these homes. The
divisions of public health nursing, health edu-
cation, and environmental sanitation are co-
operating in this program.

A pilot study with the Gallatin City-County
Health Department and the Nursing Home
Operators in that county was initiated. The
objectives of the program are:

1 . To establish a working relationship be-
tween the staffs of local health departments
and operators of nursing homes. This was done
through meetings at which the operators dis-
cussed their problems and needs. In turn, the
local health department and the State Board

Nursing Home operators, local
and State Public Health staff
discuss ways and means to pro-
vide better patient care.

-70—

of Health staff explained their functions and
available services. Plans are being developed
tn work together on those problems and needs
in which the health department can give assist-
ance. I he orthopedic nursing consultant of the
State Bo:. I'd of Health has taught Mime of the
techniques for the care of bed-ridden and other
patients with handicaps.

2 To help interpret the role of the pub-
lic health department, particularly the public
health nurse, in assisting the nursing home
personnel provide improved patient care. A
meeting in which the practicing physicians par-
ticipated was held ti> discuss this

3. To assist in better utilization of com-
munity resources to help meet the needs of
nursing home patients. An occupational thera-
py program has been instituted in one of the
nursing homes. This is being carried on by
voluntary workers in the community.

4. To assist in the development of a bet-
ter understanding of the operation of nursing
homes, patient and family needs, among the
residents of the community.

This program had a good start at the close
of the biennium and it is anticipated that it
will be well developed on a continuing basis
early in the next biennium. It is expected bet-
ter patient care will result and it will provide
the State with the basis for a program extend-
ing public health services to the nursing homes
in all areas i if the State.

Board's Orthopedic Nursing Consultant demonstrates
positioning of nursing home patients.

Industrial Hygiene Engineer measures fume control
through the hood on a lead pot in printing plant.

OCCUPATIONAL HEALTH

During the biennium two hundred and
fiftv-one industries were studied. In these in-
dustries 711 recommendations were made for
the control of components determined to he
detrimental to the health of the workers. The
workers associated with these operations,
numbered approximately 11,370.

The Board's occupational health program
is directed toward the protection of the work-
ers health ami well-being. It is concerned with
those factors relating to the conditions under
which they work and the stresses of the in-
dustrial envin mment.

In carrying out this work the hazards of
occupational disease and industrial public
health problems are found to he chiefly those
resulting from exposure t < > toxic substances.
The seriousness of the exposure is dependent
upon the nature of the toxic dust, fumes, mist
vapors, gases and radiation. Agricultural
workers may he exposed to certain other haz-
ards such as organic dusts and economic poi-
s< ms.

When the industry is studied various kinds
uf samples are taken and measured in the field
or are brought into the Board's laboratory.
Typical samples which are collected are: ar-
senic, phosphine, lead free silica, fluorides,
manganese, oxides of nitrogen, aldehydes, car-
bon monoxide, zinc oxide, barium, chrome.
carbon dioxide, cadmium, sulphur dioxide,
cyanide, selenium. There are also a few others.

The evaluation of noise and radiation levels
in several operations as well as the concentra-
tion of dust-bearing free silica and other ma-
terials are also determined

Performance tests are made on existing
ventilation equipment. Consultation services

-71-

tn industries on the construction of new ven-
tilation systems are provided. The application
of the principles of safe ventilation was high-
lighted during the biennium when the Hoard
was notified that 28 defective Thurm heaters
had been shipped into Montana. These beaters
had been installed in trailers which were for
sale in this State. This type of heater bad
caused 17 deaths in other states just previ-

( lllsl Y.

The l)ivisii>n of Disease Control assumed
the responsibility of tracing all these beaters
in the State and for alerting the owners to
the dang'er. Fortunately no deaths occurred
in Montana from these defective beaters.

Progress in industry has been satisfactory.
generally, during this period although a few
industries have problems that have not been
completely solved. Many of the problems re-
maining arc iii considerable technological dif-
ficulty. In those which are not, however, legal
action may be indicated if the recommenda-
tions fur control oi hazardous situations are
nut carried out sunn.

Activities in agricultural health have been
increased, and it is expected that a substantial
part of the occupational health activities will
be directed to agricultural industries, princi-
pally from the standpoint of organic dust con-
trol and association with economic poisons.

Exposures to silica-bearing dust, lead fumes
and oxides oi other metals and tn vapors of
solvents appear to be the major components

of industrial hazards.

Radiation Control

Activities in radiological health have in-
creased considerably over this biennium with
the monitoring of over 13) dental X-ray ma-
chines and three medical X-rav machines.

This is a part of the radiation control pro-
gram intended to reduce radiation from all
sources to an "irreducible" minimum and still
maintain its Use where necessary.

Initiated about a year and a half ago, the
monitoring program in dental offices is aimed
at reducing unnecessary radiation in the use
of dental X-ray procedures. The monitoring
in about half the office- was completed before
the close of this report period. A plan has
been developed to elicit the help of a dental

student in the COSTEP (U.S.P.H.S. student
training) program to complete the monitoring
of the dental offices this summer. The ac-
complishments of this program are described
in the Dental Health section of this report
on page 59.

Plans have been developed with the vet-
erinarians in the State for tin- monitoring of
all veterinary X-ray machines, and it is hoped
that the monitoring of those used by physicians
can be started soon.

Measurements of radioactive fall-out from
dust has been done for the U. S. Public Health
Service on a 24-hour basis, seven days a week,
since April 1958. Collection of precipitation
for radiation activity was started in April 1%0.

During 1959, the long-lived beta activity
bomb debris steadily declined with most of
the activity being less than one micro-micro-
curie per cubic meter of air. The highest ac-
tivity recorded was during the summer of
1958 when about 3(H) micro-microcuries were
determined during one sampling period.

Milk sampling for radioactive material has
begun. This is also a program of the I*. S.
Public Health Service in which the Hoard is
participating.

Isotopes and other radioactive materials,
except radium, are under the jurisdiction of
the Atomic Energy Commission ami the Board
has not been asked to participate in the in-
spection of isotope users in the State. The
findings of this inspection program are not
known in the State.

Air Pollution

Air pollution activities have been accele-
rated, somewhat, with particulate and gas
samples being collected in eight communities
to establish the levels of general pollutants and
to determine the components of the air where
new industries are to be located. High-volume
air samples are analyzed tor various metals.
such as arsenic, lead, zinc and manganese, tars,
particulate weight, and fluorides. Methods of
collection and analysis are similar to those of
the 17. S. Public Health Service air pollution
network s,, that our results can be compared
with those of other cities throughout the
I'nited States. It is expected that the air
pollution sampling will continue as time per-
mits.

Aii air pollution sampler set up in Helena
in November 1956, in cooperation with the
I'. S. Public Health Service, has been operat-
ing throughout the biennium, the samples be-
ing sent to Cincinnati, Ohio, for analysis. The
collections are made from two to three times
a month for 24-hour periods.

Chemist measures radioactive substances in Montana
surface waters.

THE CHEMISTRY LABORATORY

The chemistry laboratory is a part ol the
Division of Disease Control and provides
services for several of the Board's programs.
Samples submitted by the Montana Highway
Patrol t'> be analyzed for alcohol content are
also examined by this laboratory.

For the biennium the tntal number of sam-
ples submitted numbered 3,381 and 8,478 de-
terminations were made. This is an increase
of 1,389 determinations.

Water samples, numbering 1,568, were an-
alyzed for the Division of Environmental Sani-
tation, About 47 per cent of these water sam-
ple-, were for the stream pollution abatement
program. One of the chemists is assigned to
work full-time with the summer pollution con-
trol team. The remainder of the water sam-
ples analyzed were made for the purpose of
determining the fitness of public water sup-
plies for domestic use.

Examinations mi samples of foods and
drugs were made on 323 samples. Of these
11 samples were cranberries, which were the
most urgent and unusual activity of the chemi-
cal laboratory. These examinations on cran-
berries, which were on sale in Montana, were
carried on in cooperation with the I . S. Food
and I Irug Administration. The examinations

were made for the determination of a cancer
producing chemical weed killer — animo tri-
azole. Most of the berries sampled ware cleared
free of this chemical by the Federal Food and
Drug Administrate m.

Measurements of radioactivity were made
on surface water samples. This is a new
activity initiated during the current biennium.
This type of analysis is being made to establish
background data on levels of radiation as Beta
activity. All the public water supplies in the
State are being analyzed to establish baseline
radiation levels.

Special instruments were purchased since
they are required for this particular analysis.
The chief chemist attended a short course on
radio nuclides at the Robert A. Taft Sanitary
Engineering tenter in Cincinnati to study the
best methods for making this type of analysis.
A radiochemist from this Center visited the
State Board of Health laboratorj to assist in
setting up the new equipment and the pro-
cedure to do this type of work.

There were 46 miscellaneous samples an-
alyzed during the report period. Some of these
were toxicological samples. At times it is ne-
cessary to establish which of man)- poisons has
caused illness or deatli and this is done by
making a schematic chemical analysis of the
sample submitted. < )thers included samples
from the State Department of Agriculture and
the Stale Purchasing Department. Any sam-
ples from the Department of Agriculture are
examined by field screening methods and re-
quire further study for confirmation.

Two samples were received from the Bu-
reau of Internal Revenue for alcoholic content.
This test was made to establish the presence
of illegally produced alcohol.

Precision instruments are used for official tests in
the Board's Chemistry Laboratory.

-73—

Sewage Lagoon pictured above
treats human sewage.

&ctvi%04ime*ttal Sanitation,

*ity6y6.Ciy6,t& o£ t&e ^CcuttcutH.

MONTANA MUNICIPAL WATER SUPPLIES

Classification of the Yellowstone, Clark Fork and Kootenai Rivers for water pollution control was
made. Basic data for classifying the Missouri for this same purpose has been gathered.

Paper pulp mill at Missoula removed all wastes from the Clark Fork River. Sewage treatment
plants have been placed in operation in 21 communities and 8 more are under construction.

First Sanitarians Registration Board appointed following 1959 legislation.

99.9 °o of the people served by Montana Municipal water supplies have "safe" water available.

Swimming Pool Regulations Brought Up-to-date.

Approximately 14,000 State Board of Health Food Handling and Processing and Motel licenses
have been issued.

^i&piam *Deve£ofeme*tt&

NEEDS FOR SAFE WATER INCREASE

A few years ago, when a
public water supply system
was designed to provide 100
gallons of safe water per per-
son per day, it was consid-
ered adequate. Today it is
necessary to design systems
on the basis of 150 to 200
gallons per person per day.
This increased use as placed
a demand upon Montana mu-
nicipalities to take water
from new sources, some of
which at one time were not
considered desirable. Conse-
quently because of these two
factors, the size of water
treatment plants has had \*>
be increased.

I he chart shows the sources of municipal supplies. The diagram shows that 20$ of the

water supplies in Montana. In looking at the municipalities obtain water from surface water

diagram it will be noted that the larger com- supplies yet these sources serve 45% of the

munities arc dependent upon surface water urban population. It is also noted that 13 corn-

Persons Served from Various Sources Sources of Water for Municipal Supplies
(1950 Census) July I960

-74-

munities use both wells and surface supplies for
32% of the population. In other words, 33%
of the communities that use water from tin-
surface in whole or part supply 75% of the
water used by Montana's urban population,
while wells that are the only source of water
for 50' i of the municipalities, serve only 21 'i
of the people. The balance of the population
takes its water from springs.

Montana citizens arc fortunate in having
safe water available to 99.9 per cent of those
supplied by public water supplies. Only seven
of the 146 public water systems are not ac-
ceptable at this time and these seven supplies
serve only 1.200 persons out oi a total of
333.000 people that use water from public
supplies. Persons living in communities that
have unsafe water have been warned that their
water supply is contaminated. In most cases
the amount of money available in the com-
munity is not sufficient to make improvements
to the supplies due to the limited income in
these seven communities.

Surface supplies are subject to pollution
more readily than the supplies from wells.
This of course requires complete treatment oi
the surface water in order to purify it and
make it safe for consumption.

In order to insure safe public water sup-
plies each municipal water system in the State
is inspected at least once each year by State
Hoard of Health engineers. Plans for new
systems, extensions, changes or other mollifi-
cations to the system are reviewed by the en-
gineers before the State Hoard of Health skives
approval. This work requires considerable en-
gineer's time.

Periodic water samples arc obtained for
bacteriological and chemical testing in the
State Hoard of Health laboratories. 12,534
bacteriological and 573
chemical tests were
performed in this lab-
oratory for municipal
water supplies. In ad-
dition to this, there
were a large number of
private samples tested.
This is shown in the
table of laboratory tests
and field investigations. pr0per chlorination of
This is shown in Table municipal water supply
. , , prevents water - borne

1 below: disease.

TABLE I

Engineering Inspections Made by

Environmental Sanitation Division,

July 1. 1958 t.. June 30, 1960

Number

Inspections of Municipal Water Supplies 336

Inspections of Private Water Supplies

for individuals S

Inspections oi Sewage Disposal Systems

(Public) 244

Inspections of Swimming Pools IS

Miscellaneous Inspections 88

Total

<>XK

WATER SAMPLES TESTED
July 1. 1958 to June 30, 1960

Bacterio- Chemi-
logical cal Total

Public Water Supplies 12.534 573 13.107

Private Water Supplies 2,201 256 2,457

School Water Supplies 320 320

Tourist Court Water Supplies 153 153

U.S. Gov't. Water Supplies ... 569 569

Stream Pollution Studies 515 740 1,255

Miscellaneous Sources 133 1 134

Totals

16,425 1,570

17,995

Fees collected for this work are shown in
Table 2 beh >w :

TABLE 2

Fees collected from Municipalities for Water

Analyses and Inspection

Fees for Fiscal Year 1957-58... $16,037.50

Fees for Fiscal Year 1958-59 $16,845.00

POLLUTION ABATEMENT

Surface streams can carry only a minimum
amount of pollution, if the surface water sup-
plies arc to be safe. Wink- the State Board
of Health lias always recognized the principle,
it did allow in former years direct pollution
of risers, but always subject to the provisions
that treatment of the wastes would be neces-
sary. In 1952, the Hoard notified all cities of
the requirement to discontinue discharge oi
raw sewage within a period of seven years or
by [uly 1, 1959. All but a few cities are now
treating or are now in the process of treating
their wastes.

In 1955, the Water Pollution Act extended
and augmented the Board's responsibility in
this field. This act also established the Water
Pollution Council providing a method to deal
with pollution not affecting the public health.

-75-

SEWAGE ABATEMENT

1 luring tlio past five years,
municipalities h a v e been
aided by Federal Grant mon-
ey to provide treatment for
sewage before it is dis-
charged into the Montana
streams. During the last bi-
ennium, there were 21 sew-
age treatment plants placed
in operation. Another eight
plants are presently under
construction and their com-
pletion is anticipated during
the 1' 'i >■ > calendar year.

Nine communities received
sewage fund allocation from
the beginning of fiscal year 1956 to June 30,
1958. This -rant sum amounted to $242,960.

Awards Made During Period July 1. 1958

to June 30, 1960.

Federal Sewage

Status of Municipal Sewage Treatment
In Montana

7- 15 -60

Town

Construction Amount

Big Timber -

Box Elder

Bridger

Deer Lodge

Drummond

Eureka

Fort Benton

Fromberg

1 rlasgow

< ilendive

West Glendive

Crcat Falls

I [arlowton

Helena - -

K, dispell

Kevin -

Livingston -

Malta

Manhattan

Metropolitan Sanitary

District 1, Silver Bow

Montana State Hospital

Warm Springs

Pi ilson

Shelby

Sheridan -

State Training School Boulder
Mate Vocational School

for < iirl — Helena

Sidney

Stevensville

Ti iwnsend

Whitehall

Winifred

Wolf Point

Valier

15.570

8,460

9.208

70,200

10,500

21.645

41.706

13,860

46,500

172.411

25.930

25l).(lO(l

12.937

162,600

(,3.iiilll

1S.3XS

156,078

40,066

12.193

250.000

43.790
72.900
24.570
25.470

30. 'Hill

52.500
11,608

10.500

30,902

(,,II78
29,100
11.302

Total $1,763,284

* 1950 Conjus

The chart above shows the percentage of
the Montana sewered population (364.250)
provided with satisfactory sewage treatment
plants in the State as of July 15, 1960. Most
of the communities have proceeded to develop
these facilities, without court orders being
processed. However, because of inaction, the
Board requested the Attorney General's office
to issue orders for four cities to treat the sew
age. These cities were not progressing as they
should have in providing for these facilities,
having been warned in 1952 that this must
be done. Public hearings were held by the
Board before the orders were given. At these
hearings representatives had an opportunity
to show cause for not complying with the
Board's request. The status of sewage treat-
ment service to the remainder of the sewered
municipal population is also shown above. By
I une 30, 1962, there should be no raw sewage
from any municipality discharging into Mon-
tana's streams.

The State Board of Health collected,
tabulated and analyzed data so that the Water
Pollution Council could classify the Yellow-
stone, the Clark Fork, and the Kootenai Rivers
and their tributaries.

The basic data has been gathered for the
Missouri, and the tabulation of this data is
now being completed. It is anticipated that
this material will be ready early in the next
biennium so that the classification of this

-76—

Sewage lagoon treats oil refinery waste.

stream can be mark'. This work is carried on
by the State Hoard of Health engineers, the
summer teams, and an aquatic biologist loaned
to the State Board of Health by the Montana
Fish and Game Commission.

With the gathering of data and the classi-
fication of the streams, definite standards have
been established which must be maintained by
any person or municipality or company that
desires to discharge waste into that stream.
This program has received excellent coopera-
tion (from Montana's industries). In many
instances industrial wastes have been prac-
tically eliminated from the streams. However,
there is work still left to be done since some
of the smaller industries are not doing as much
as they should.

Pictured above is one of Montana's many new me-
chanical sewage treatment plants under construction.

With new industries coming into the State,
work is carried on continuously by the staff
to be certain that wastes from these industries
do not pollute Montana waters. Pollution can
be eliminated and industries still can function.
This can be accomplished by enforcing the
legislation in a proper manner with the same
waste disposal criteria for all.

Difficulty is still being experienced with
the wastes from stock and feed yards, which
is excluded by Pollution Control Legislation.
This ma}' create a serious problem insofar as
cleaning up some streams when public health
is not involved unless the present legislation
is modified.

-
j

Staff collects river bottom organisms and the organisms found are identified and typed.
This determines the degree of river pollution

-77—

WATER POLLUTION COUNCIL

Passage of the Water Pollution Act in 1955
strengthened Montana's pollution laws by add-
ing pollution control procedures for all other
matters than those affecting public health.
The Water Pollution Act creating the Water
Pollution Council, in extending the Hoard'
responsibility makes the State Board of Health
the administering agent for council action and
provides for a staff member to serve as the
Secretary of the Council. The Water Pollution
Council is a seven member board. Four mem-
bers are appointed by the Governor and three
are ex-offici<> members. The membership of
the Council is shown on page 2. During the
bienninm the Council held five meetings and
conducted three hearings. These were to classi-
fy the Yellowstone, Clark Fork and Kootenai
Rivers. The hearings were held at Pollings,
.Missoula and Kalispell. The classifications
adopted for these streams strengthen the State
Hoard of Health 1952 policy by preventing dis-
charge oi raw sewage into any streams in
Montana and establishes a minimum treatment
of human sewage consisting of primary treat-
ment plus chlorination. Lagoon treatment
greatly exceeds this requirement.

GENERAL SANITATION

The sanitation of the environment con-
cerned with food and drink establishments,
motels and tourist courts is carried on by the
sanitation personnel in the State Board of
Health and by the sanitarians employed in the

Landfill disposal provides a suitable method for con-
trolling rats and flies from breeding at garbage dumps.

local areas. The State Hoard of Health sani-
tarians coordinate and unify the activities of
the local sanitarians who are employed in
twenty of Montana's counties. The counties
that provide sanitarian services are shown
on the accompanying map. The work of the
State staff is done through supervision, con-
sultation and by assisting locally in the train-
ing of people that are working in fond and
drink, and housing. They also evaluate the
effectiveness of work carried on locally.

Sanitarian Registration Required
For the first time, legislation enacted in
1959 requires the registration of sanitarians
within the State. A Registration Council was
established which examines and certifies the
sanitarians. The law defines a sanitarian as "a
person who is trained in the physical, biologi-
cal, and sanitary sciences to carry out in-
spectional and educational duties in the field
of environmental sanitation." It makes it

MONTANA

COUNTIES WITH FULL-TIME
SANITARIAN SERVICES

COUNTIES WITH PART-TIME
SANITARIAN SERVICES

78-

mandator}' that any person offering services
as a sanitarian, or using, assuming or adver-
tising in any wav the impression that he is a
sanitarian must be registered by the Council.
The State Board of Health, under this legisla-
tion, appoints the secretary-treasurer of the
Council from its staff and two other members
from a series of names suggested by the Mon-
tana Association of Sanitarians.

The Aln nt an a Sanitarian's Registration
Council had two official meetings and one un-
official meeting in 1959. Prior to July 1. 1960,
one unofficial meeting was conducted.

In date, the Council has registered 25 Sani-
tarians, in Montana, and is processing three
applications, at present.

The main portion of the work of the Coun-
cil has been devoted ti> drafting by-laws and
policies for operation of the Council. These
by-laws were approved by the State Hoard of
Health on May 17. 1960. Applications have
been developed and printed, as well as copies
of the registration law. Also, certificates were
designed and printed by the Council.

Hairnets and caps are recommended to prevent hair
from getting into food. This is a part of the instruc-
tion included in the sanitation training classes.

is hoped that sanitarians will be employed in
the remaining 36 comities since it i- difficult
for the part-time health officer to carry on this
activity adequately.

To assist in the enforcement of laws and
regulations, several modifications of existing
regulations are now being developed. They
include the motel and hotel, the tourist camp-
ground, and the locker plant and frozen f 1

processing regulations. These regulations es-
tablish minimum requirements and are estab-
lished under Molilalia law to protect the public.
At the same time they protect the business
man who i- already complying with the stand-
ards, against the competition with establish-
ments not complying.

Food and Drug Control Work

In addition to the work carried on locally,
the State Board of Health Sanitarians carry
out the necessary work to enforce the Montana
Food and Drug Law. This Montana work is
carried on in cooperation with the Federal Food
and Drug Administration. It includes the ac-
tivities needed m the control of the adultera-
tion and misbranding of foods and drugs sold
in Montana. The cranberry problem which de-
veloped in the fall of 1959 and the removal of
dved potatoes from the market are examples.
The dyed potatoes have been removed from
the market because when dyed, they have the
appearance of new potatoes. Since these po-
tatoes arc actually a year old this practice is
classified as an economic fraud.

A continuous program for collecting and
testing hamburger samples is carried on to
prevent an inferior product from being mar-
keted. Hamburger samples have been found

Food Service Personnel Training
During the last biennium, 12S sessions for
food service training were carried on with
assistance from the Division of Health Edu-
cation. These sessions were attended by 2.081
persons and were held in 13 different areas of
the State. During the same two-year period,
four three-day training conferences were held
for the local sanitarians.

The Board's sanitarians also work with
local part-time health officers in counties where
there are no sanitarians, in the investigation of
the causes of food-borne illnesses and to take
steps in the prevention of future outbreaks. It

Chemist and sanitarian examine the label on a loaf

of bread. They also examine the content of the bread.

These examinations are to determine the accuracy of

the labeling.

—79-

which contain excessive water and Fat. the
pre ence of cereal and in Mime cases preserva-
tives.

Labels for foods and drugs are reviewed by
this staff in order to determine whether or not
the information is complete and to ascertain
mi statements are not made which would mis-
lead i he public.

. .» -

Determining residual chlorine in swimming pool water
is done to provide for safe water for swimmers.

SWIMMING POOLS

Fourteen new public swimming pools have
been constructed in Montana during the cur-
rent biennial period. This is a great increase
over the last biennium activities and is a re-
flection of the national trend for swimming
pools. However, the numl er of ] Is in Mon-
tana does not compare with the number in
main other states flue ti> the cooler climate.
! ngineers review plan,1- and inspect swimming
] oolf

'llie swimming pool regulation was rewrit-
ten tu bring it in line with present practices
and permit use of new equipment. The regula-
tion includes natural hot water plunges which
were not included in the earlier regulation.

SCHOOL BUILDING PLANS

The building consultant in this division.
who i- also an engineer, reviews the plans for
school buildings, which totaled 24/1 for the
current biennium. This is more than two plans
a week. In the previous biennium 252 plans

were reviewed. The school plan- are reviewed
from the standpoint of heat, light, plumbing
and ventilation. Close liaison is maintained
with the Slate Department of Public Instruc-
tion in tin- area.

EDUCATIONAL ASPECTS OF
ENVIRONMENTAL SANITATION

The Division of Environmental Sanitation
attempts to carry o--t it- program through edu-
cational mean . While legal action may be
resorted to at time-, this is only a final ex-
pedient alter all other method- have failed.
The engineers and sanitarians have been con-
ducting a program using educational methods
throughout the years. At the present time the
staff of tin- division i- augmented by services
from the 1 livision of II e a 1 t h Education.
Through these services citi/en committee- have
been formed in several area- to provide an
opportunity for better understanding of health
need- and how they can be met. Through the
efforts of these citizen committees the com-
munity education program is extended and
more of the population may understand the
need for improved sanitation.

An outstanding example of tin- type oi
activitv i- the Sanitation Committee in Greal
Falls. This committee has been active in the
passage of the local restaurant ordinance, the
local milk ordinance, a bond issue for sewage
disposal and for educational effort directed
toward the mosquito control program.

Two of nine cabinets which are pictured above, hold a

part of the 18,000 blueprint sheets. These blueprints

are used in reviewing plans for water and sewage

systems, swimming pool and school building plans.

—80-

Iii order to bring to the attention of Mon- Yet. today in Montana because the Board

tana citizens various sanitation problems films, lacks authority practically every city having

exhibits, newspaper articles, flyers, article in a population of 5.0C0 or more has a serious

Treasure State Health, and other written ma- fringe area problem which is getting no atten-

terials have hern prepared from tunc to time. tion. The same problem exists in some oi the

Sanitation has 1 ecu given a prominent part -.mailer areas. Loaning agencies are refusing

in the "Guide for the School Health Pro- to loan money on property in these areas be-

gram"' which will be available soon. cause of this hazard and this adds to the prob-

The educational program to promote great-

1cm.

er at, -en understanding in the areas of en- Some of the most serious conditions exist in

vironmental sanitation needs to be extended Libby, Kalispell, Billings, and Anaconda.

and intensified.

Significant "Pio&Cema & 7teed&

1 egislation is required to consolidate the
license which the Board issues for restaurants,
cafes, lunch counters, dining cars, manufac-
The suburbia problem faces Montana as it turing bakeries, manufacturing confectioneries,

does cities in the rest of the nation. The trend meat markets, canneries, soda fountains, ice

of people moving from the congested city areas cream parlors, soft drink establishments, bot-

to the outlying areas has created a problem tling works, tourist courts and locker plants.

with the construction of continuous dwellings \n establishment carrying on more than one

along the highways. In Montana the problem ,,,- t]iese activities must have a license for each

of obtaining proper water or sewage supplies under the present system.

In the interest of economy and efficiency
legislation permitting the issuance of one li-
cense to each establishment would eliminate
much of the needless work and confusion now
existing.

and adequate disposal in these sections is
serious.

In an area outside a city where there is
onlv one dwelling, or on a farm where there
is isolation from close neighbors there is little
(rouble. But with the trend of dwellings being
developed on a plot no larger than a quarter During this biennium, the licensing lees

or a half acre, the sewage from the septic tank for these activities brought in $30,075.00. This

of one dwelling seeping into the well of an- money which goes into the State's General

other is a growing hazard. Fund, is not enough to cover the cost ol the

There is no zoning nor any other require- present license fee pro-ram. It is therefore

meuts that will prohibit one householder from suggested that a Sin. 00 fee be charged for

locating a septic tank in an improper manner, the one license to cover all the activities of

and there is no legal recourse until the sewage each operator. The $2.00 fee, initiated in 1919,

contaminates the neighbor's well. The State was satisfactory for that time but due to in-

Board of Health needs legislation to control flation is not a satisfactory amount today,

this kind of pollution ,„ areas outside the city Another need in the State's legislation is

hunts that will give the Board the same kind fof spedfk ,egislatlon establishing standards

ol authority which it has inside the municipal,- f(jr .^ swimmin„ ])(„,u ,„,th natura] and ar_

ties. W ithin the municipalities the State Board tifkia] ;uu] a|] bathing placeSi Th(. Board lleeds

oi Health reviews all plans lor water and
sewer extensions and sees that water and sewer

to have authority to close a pool if it is not
being properlv operated. The Board now has
lines are properly located. The citizens locat- author, tv to dose a pool if an actual problem

,ng in areas ,n the city s outskirts assume that ^.^ , m nQt unti, t]u,n

tin same kind oi protection is afforded as has

been provided within the city limits. They also Most of the new pools that are being con-

know there is a State Plumbing ('ode to pro- structed are cooperating and meeting require-

teci the water lines by preventing sewage and ments but the State law does not require this,

waste water from backing up into the water It would be of material help ,1 the pool status

lines under unusual conditions, and they ex- would be clarified and the Stale Board oi

pect protection. Health's responsibility spelled out.

—81—

delated /tctivittea

The staff of the Environmental Sanitation
Division participates in Water Pollution
Council meetings, Montana Section of the
American Water Works Association, the Mon-
tana Sewage and Industrial Waste Associa-
tion and the Montana Sanitarians Association.

The staff also participates in the schools
which arc held each fall in cooperation with
Montana State College, American Water
Works Association and the Montana Sewage
and Industrial Wastes Association, and the
Montana Municipal League for water and
sewage plant operators at which usually from
40 to 50 persi ms attend.

On five occasions the past year, members
of the staff have been subpoenaed to court
involving court hearings on stream pollution
and the purported fish kill, a lagoon problem
for a tourist court, a municipal lagoon loca-
iton, and the treatment of water for a slaugh-
ter house.

The secretary for the Montana State Hoard
of Plumbing Examiners and for the Montana
Water Pollution Conned ami the Montana
Sanitarians Registration Council are required
1>\ law to be State Board of Health employees
from this division.

a it it'll'-

*%a&fUt<zt *?<zcttitie&

St. Joseph's Hospital and Nursing
Heme in Poison is one of the facili-
ties which received construction as-
sistance from the Hill-Burton and
Indian Health Federal funds. The
old hospital on the left above has
been remodeled for nursing home
use.

Revisions in standards for Nursing Homes, Boarding Homes and Hospitals adopted.

Hospital construction at an all-time high in 1959 with 16 projects under construction.

Hotel Dieu (St. Joseph) Hospital, at Poison, was the first hospital in the nation which was ap-
proved and completed, utilizing Federal Indian Health funds in a community hospital to in-
clude beds for Indians. Other similar facilities are under construction at Poplar and Wolf
Point.

Annual revision of State plan for hospitals and medical facilities adopted by Board on recommenda-
tion of Advisory Hospital Council.

Survey started in hospitals, nursing homes and homes for the aged. Information being collected
includes: (1) the numbers of persons with chronic diseases and the numbers of aged; (2) the
needs for facilities and improved care.

'Zto&ft.Ctat and Wedictd t?acitttie± Survey and (?4it4&u<ctio(t

The Federal Hospital Survey and Con-
struction Act, commonly Known a-, the llill-
Burton Act, was extended l>\ the Congress
from June 30, 1959 to June 30, 1964. This al-
lowed the scheduling of additional projects
both in tlic- hospital and medical facilities cate-

gories. As of June 30, 1960, forty-one (41)
projects have received financial assistance in
hospital and medical facilities construction
since the beginning of the program. July 1,
1947.

—82

During the biennium the hospitals under
construction during the previous biennium
were completed, as well as some of those cov-
ered by this report period, with additional pro-
jects placed under construction. Five new
hospital projects were scheduled and placed
under construction and three projects under
medical facilities. These projects represent a
total expenditure of $1 1 .48S.445.7S having an
estimated Federal share of $3,112,420.80 and
$558,553.14 of Indian Health grants. The sum-
mary of these projects is given in the table
on Page 87.

Hospital Construction Under Indian
Health Act
A new phase in the program was brought
about by action of the Eighty-fifth Congress

to utilize Indian hospital construction funds in
community hospital construction in order to
provide beds for the Indian population in a
reservation area. This make-- it possible to
provide a community with better hospital fa-
cilities than could be provided if two small
hospitals were constructed in the same area.

each serving only a part of the population.
Indian Health funds could not be used in this
manner prior to the recent legislation by the
Congress. Hospitals receiving these Indian
Health Funds must provide a specified number
of beds for the Indian population and be in a
reservation area for which the Indian Health
Services have determined that hospital beds
fi ir I ndians are needed.

The Hotel Dieu (St. Joseph's Hospital) pro-
let at Poison, pictured on page 82. was the first
hospital in the United States to be authorized
for construction under the Indian Health Act.
Hill-Burton funds were also used in this pro-
ject which is now completed. Both Federal
funds are also utilized in the hospitals under
construction at Wolf Point and Poplar. Under
this program Indian Health monies are granted
for the total construction of the Indian beds,
with Hill-Burton funds participating in the
non-Indian portion of the projects. The three
hospital projects completed or currently under
construction in this program have received
$558,553.14 in Indian funds with an anticipated
$320,125.00 for a new facility at St. Ignatius.

PROJECTS CURRENTLY SCHEDULED FOR CONSTRUCTION

Facility and Location Kind of Facility and Number Beds

Poplar Community Hospital, Poplar ....22 general hospital beds, 13 of which arc for In-

dian population
20 nursing home beds

Trinity Hospital. Wolf Point...- 39 general hospital beds, 9 of which are for Indian

populatii mi

Billings Deaconess Hospital. Billings 84 general hospital beds addition and remodeling

St. Clare Hospital, Fort Benton Nurses Residence

Holy Family Hospital, St. Ignatius 20 general hospital beds, 12 of which are for In-

dian population
10 nursing home beds

Faith Lutheran Home, Wolf Point 40 nursing home beds

Miles City Nursing Home, Miles City S2 nursing home beds

State Plan Revised
The State Plan for Hospital and Medical
Facilities was revised for a two-year period
covering the fiscal years 1959 and 1960. The
revisions were adopted by the Board on the
advice of the Advisory Hospital Council fol-
lowing a public hearing.

Projects scheduled for construction from
applications of eligible sponsors must be in
accordance with the State Plan. Preference
is given to areas having the greatest unmet

needs [or facilities or services. Federal funds
are granted on a matching basis of 40' ; of
the total eligible project costs. In some in-
stances full participation cannot be granted
due to the limited Federal monies received by
M< mtana.

All Federal monies allocated to Montana
were utilized with the exception of Rehabili-
tation Facilities funds (not transferable to
any other category). During the biennium
Montana received $50,000.00 for each year for

-83—

The Big Horn Community Hospital at Hardin is a
typical combination of new construction in a small
community with a small general hospital and nursing
home. Others which are similar have been constructed
at Ft. Benton, Forsyth, and Poplar and plans are un-
derway for one at St. Ignatius.

Rehabilitation Facilities construction. Of the
fiscal year 1958 monies $42,560.00 was utilized
in the St. Vincent's Hospital project and the
balance of 87. 440. 00 was transferred to the
State of Utah for a rehabilitation center at
the University of Utah Medical School at Salt
Lake City. Of the 1959 monies $5,000.00 was
utilized in the rehabilitation facilities at the
St. Vincent's Hospital with the balance of
$45,000.00 again transferred to the State of
Utah for use in the rehabilitation facility at
the University of Utah. In making these
transfers the State of Utah, and the University
oi I tab. agreed to make the new facility avail-
able to Montana for patients that could not
be cared for in Montana rehabilitation centers.
This will also benefit Montana in the teaching
and training of students in the medical and
para-medical fields for staffing of Montana
rehabilitation facilities.

Federal allotments received by Montana
were :

1959 1960 Total

Medical

Facilities $300,000.01) $300,000.00 $ 600,000.00

I [i ispital
Construction .... SS1.0S6.00 598,392.00 1.149,448.00

$1,749,448.00

Payments made to sponsors are on the
basis of completed work, services rendered and
equipment delivered at the site at the time
inspections are made for payments. The pay-
ments made during any biennium may be from
current and or previous fiscal year allotments.
Monies allocated to Montana must be utilized
within a two-year period. During the bien-
nium 33 project payments were made:

Medical Facilities $ 674,878.84

Hospital Construction 1,138,687.12

Making a total of $1,813,565.96

The State Board of Health's Bacteriological
Laboratory was moved from the old Board of
Health Building into the new laboratory facili-
ties ot the State Laborator) Building in ( )ct<>-
ber, 1958 while the Virus Laboratory occupied
its new laboratories in September, 1958.

The hospitals with nursing home units at
Hardin and Fort Benton were completed and
occupied during this report period. Bids were
opened on June 16, 1960 for a second project
at Fort Benton to provide a Nurses Residence
for the newly completed hospital and nursing
home.

Projects currently under construction in-
clude the Trinity Hospital at Wolf Point to
provide 39 general hospital beds (9 Indian and
30 non-Indian) and the Poplar Community
Hospital to provide 22 general hospital beds
(13 Indian and 9 non-Indian) and 20 nursing
home beds for the Indian and non-Indian popu-
lation.

'I he hospitals replaced through new con-
struction at Poison and Hardin are being re-
modeled to serve as nursing home- or homes
for the aged.

Rehabilitation and Chronic Disease Facilities
The completion of the St. Vincent's Hos-
pital addition and remodeling for rehabilitation
beds brings to Montana for the first time
multi - disability rehabilitation facilities and
services on an in-patient and out-patient basis.
These facilities will assist in the rehabilitation
of disabled persons through an integrated
program of medical, psychological, social and
vocational evaluation and services on an in-
patient and out-patient basis. Facilities for
out-patient rehabilitation services are also
available in (ireat kails by a private agenc\
without Federal aid.

S ■■

Nurses' station in a newly constructed Montana hos-
pital is pictured above.

The Silver Bov\ Count} General and Chron-
ic I lisease Hospital at Butte has been complet-
ed and will I e open to receive patients early in
luly. 1960. The Cascade County Convalescent
Hospital at Great Falls is nearing completion
and should be ready to receive patients during
the latter part of 1960. The completion of the
Silver Bow Count} General and Chronic Dis-
ease Hospital brings to .Montana its first
Chronic Disease Hospital. These new beds are
for the treatment of chronic illnesses includ-
ing the degenerative diseases in which treat-
ment and care will be administered by or under
the direction of persons licensed to practice
medicine or surgery in the State. Thus pro-
gress is being made in providing facilities and
services for the increasing number of aged, the
rehabilitation of the disabled and for persons
suffering from long term illness.

*%<xme& far Me /4yed>

Under the licensing program the following
is a summary of facilities licensed by the State
Board of Health at the close of the biennium :

62 General Hospitals 3,503 beds

1 Tuberculosis Hospital 285 beds

11 Nursing Homes - 451 beds

Nursing Homes (sub-units oi

General Hospitals 194 beds

'>2 Homes for the Aged ... 1.402 beds

Inspections were made of all hospitals,
nursing homes and homes for the aged prior
to the issuance of licenses.

Interest in Nursing Homes and
Homes for the Aged

There is also much interest in the State to
provide improved nursing homes and homes
for the aged. Custer County voted a bond
issue in [une, I960 for the construction ol a
51 bed nursing home to be located at Miles
City. A fund raising drive is contemplated
for the construction of the proposed 40 bed
Faith Lutheran Home at Wolf Point. Draw-
ings and Specifications for these projects are
in the process of preparation in order that bids
may be received early in 1961. Teton and
Valley Counties will vote on bond issues for
the construction of nursing homes in the Nov-
ember, l'"i(>, General Election. There is also
considerable interest by proprietary groups for
the construction of nursing home facilities.

A Birthday celebration adds to congeniality among the
residents in a nursing home.

••__<•*■ ..iff *?:~±Z

The "Conne Rest Home" at Ronan is one of the

pleasant homes for people desiring to live in a small

home.

Survey of Aged and Patients
With Chronic Disease

In conjunction with the inspections of all
facilities during the latter part of the biennium
a survey is being conducted of all chronic and
aged persons in hospitals, nursing homes and
homes for the aged. This survey will include
information as to number of persons, sex, age,
mental status, degrees of activities and inter-
ests, type of care given, type of care needed,
bed status, walking status, mental condition.
continence, physician's services, person's diag-
nosis, dental needs and care, source of person's
funds for care and charges for person's care.
The data gathered will be used in the prepara-
tion of the 1961 revision of the Montana State
I Man for Hospital ami Medical Facilities Con-
struction and also for developing a program
for the improvement of patient care in nursing
homes and homes for the aged.

—85—

Residents in a Gallatin County Nursing Home are
pictured above while they are participating in an occu-
pational therapy program. This is a part of the Pilot
Program in this county between the local public health
department and the nursing home operators in an
effort to improve patient care. The local public health
nurse and a volunteer occupational therapist who par-
ticipate in the program are included in this picture.
Through the utilization of community resources serv-
ices can be extended to the nursing home residents.

Revised Standards Adopted

The Division working with a sub-commit-
tee of the Advisory Hospital Council, the
State Fire Marshal and the Department of
Public Welfare developed revised standards
for nursing homes and homes for the aged.
The proposed revisions were reviewed by in-
terested groups and organizations before bring-
ing the revised standards to the Advisory Hos-
pital Council and after making some changes
were presented to the Board for adoption.
These were adopted by the Board at its
November 7. 1959 meeting.

In adopting the revised standards the Board
determined that all facilities which made ap-
plication for renewal of license for the 1959-
1960 year and those making new applications
before November 7, 1959 be licensed on the
basis of existing standards.

Any application received for a new facility
after November 7. 1959 was licensed under the
revised standards. The revised standards be-
come effective for all homes July 1. 1960.

These standards serve as the basis for the
State Board of Health licensing program. The
revision is in much more detail than the pre-
vious standards and contains a large amount
of informational material which will assist
operators and hospitals in improving care to
persons in these facilities.

The major change in the standards is the
provision for the classifying of homes for the
aged into three classes :

(1 ) Those providing skilled nursing care

(2) Personal care

l.}) Boarding homes only.

Requirements that must be met in each
of these classifications are specified in the
standards in each classification. The fire pre-
vention requirements are more stringent than
those formerly included in the standards.

1 >ue to State and national publicity and the
problems families face on the aged ami the
need for better facilities counties, non-profit,
and proprietary -roups are interested in pro-
viding better facilities. Prospective operators
make frequent visits to the Division offices to
obtain information as to the construction and
operation of homes. While many private op-
erations would be interested in providing better
facilities the necessary finances are not avail-
able to them for the necessary construction.
Through Federal legislation the Federal Hous-
ing Administration has a loan arrangement for
such construction, while others must resort to
private financing for this construction.

The Division in cooperation with the Divi-
sion of Disease Control, Public Health Nursing
and Health Education is planning a program
to assist nursing home operators in improving
patient care. A pilot program in Gallatin
Count v was instituted to determine bow the
public health staff can assist the nursing home
operators in improving the patient care. It is
expected that through this pilot program a
pattern will evolve so that assistance may be
extended throughout the State.

— S6—

SUMMARY OF PROJECT CONSTRUCTION SCHEDULES

June 30, 1960

Project

Location

Total
No. of Estimated
Beds Cost

Estimated

Federal

STATUS

I. HOSPITAL FACILITIES

State Laboratory Building
Hotel Dieu

Helena

Poison 40

St. Clare Hospital Fort Benton

Big Horn Co. Memorial Hospital Hardin .

Cascade Co. Convalescent Hospital ...Great Falls
Poplar Community Hospital Poplar

Trinity Hospital _ Wolf Point

Billings Deaconess Hospital Billings

St. Clare Hospital (Nurses Res.) Fort Benton

Holy Family Hospital St. Ignatius

$1,239,558.26

$ 151,438.39

872,219.72

282,400.23
166.019.14

lili
III

299,631.22

118.908.24

278,576.81

108,119.14

80
22

1.277.897.21
460,171.81

328,500.00
77,220.89
265,000.00

III'.
Ill

554,445.37

169,823.31
127,534.00

HB
IH

1.559,14041

450.000.00

109.000.00
533.540.83

43.600.00
213.416.33
320.124.50

III'.
Ill

$7,184,181.64 $1,943,426.53

Indian Health (Grants made)
Indian Health (Anticipated)

$ 558,553.14
320.12450

Total Indian Health $ 878,677.64

Completed

Completed
Contracts awarded 10/10/58
Contracts awarded 12/17/59

Contracts awarded 7/2/59

Contracts awarded 9/16/59

Bids opened 6/16/60
Preparing Drawings and Spec.

II. MEDICAL FACILITIES

Silver Bow Co. General and

Chronic Disease Hospital Butte

St. Clare Hospital Fort Benton

Big Horn Co. Memorial Hospital Hardin

Cascade Co. Convalescent Hospital ...Great Falls

St. Vincent's Hospital Billings

Poplar Community Hospital Poplar

Faith Lutheran Home Wolf Point

Holy Family Hospital St. Ignatius

Miles City Nursing Home Miles City ..

114 $2,328,331.95

16 169.585.44

10 86.428.21

42 323.673.89

14 106.400.00

$ 398.795.20

67,249.28

33,505.71

111,500.00

42,560.00

20 211,087.24 83.926.20

40 392,654.00 157,016.60

10 151,048.41 60,419.36

52 535.055.00 214,022.00

Completed

Contracts Awarded 10/10/58

Contracts awarded 7/15/59
Completed

Contracts awarded 12/17/59

Preparing Drawings & Spec.

Preparing Drawings & Spec

Preparing Drawings & Spec.

$4,304,264.14 $1,168,994.35

-87—

PART IN FINANCIAL TABLES

Montana State Board of Health

Total Expenditures and Encumbrances

Fiscal Years, 1955-1960

1955

ADMINISTRATION 1 103,188.14)

General 68.890.50

Merit System 6.828.30

Training 7.936.72

RECORDS AND STATISTICS1 19.532.62

DISEASE CONTROL (111,420.32)

General 21,364.73

Polio Vaccine Dist. and Use

Chest X-Ray Survey 89,729.07

Drugs and Biologies 326.52

Heart Diagnostic Center2

Venereal Disease Spec. Proj

CHILD HEALTH SERVICES (205.672.61)

Maternal and Child Health 34.988.49

Crippled Children 23,641.43

Clinics and Auxiliary Services 28.659.93

Hospitalization 70.619.20

Cerebral Palsy Center 36,466.97

Rheumatic Fever Center ' 4,988.87

Appliances 6.307.72

Cleft Palate Spec. Proj

PUBLIC HEALTH NURSING ( 19,558.03)

HEALTH EDUCATION ( 37,700.11)

General 30.975.36

Narcotics and Alcohol _ 6,724.75

ENVIRONMENTAL SANITATION ( 53,817.52)

General

Water Pollution

Sanitarian's Reg. Council

LABORATORIES ( 47,609.35)

Bacteriological 47,609.35

Virus

HOSPITAL FACILITIES ( 15,776.53)

DENTAL HEALTH ( 13.497.34)

LOCAL HEALTH SERVICES ( 52.552.96)

General 8,697.04

Mental Health Spec. Proj

Aid to Local Areas 43.855.92

TOTAL 660,792.91

Federal 295,701.25

State 323,057.07

Other 42.034.59

1 Included in Administration 1955 through 1958.

: Rheumatic Fever Center changed to Heart Diagnostic

: Refunds exceeded expenditures.

1956

1957

1958

1959

1960

(128.244.94)

(136,826.40)

(137,589.38)

( 66.739.36)

( 60,259.37)

89,577.54

91,088.03

83,914.18

53,361.16

50,610.54

7,579.25

7,520.10

8,024.17

8,115.09

8.466.52

4,517.41

9,765.19

9,473.02

5.263.11

1.182.31

26,570.74

28,453.08

36,178.01

( 38.693.89)

( 40,433.85)

(193.338.91)

(151,469.99)

( 89,325.13)

( 93,866.48)

(108,790.46)

59.295.28

58,427.91

71.598.87

71,203.06

71,851.98

123.402.10

75.086.82
6,006.31

9.759.89

till 1 64

5.565.00

- 838.72

418.79

1,739.95

6,383.95

14,630.35

17,977.49

24.164.12

3,934.63

4.267.14

11,034.41

(243,381.41)

(245.828.89)

(270,029.39)

(310.804.34)

(304,936.35)

48,975.69

46.454.50

42.878.97

56.797.74

63,311.96

45.486.84

27,467.91

31,683.64

39,256.52

38,905.04

38,181 95

37,115.98

44,732.26

Hi. 112 50

41,279.64

61,584.37

46.992.09

56.507.88

67,533.19

59,478.83

36,541.08

44,255.57

44,327.15

45,432.39

43,433.54

5.769.91

5,363.20

5.889.62

5,669.78

6,841.57

8,178.10

38.179.64

44,009.87

50,002.22

50.349.24

( 17, 128.46)

( 15,766.93)

( 23,879.55)

( 23,340.67)

( 22,168.02)

( 29.060.98)

( 36,431.74)

43.::9);(i:, i

( 46,976.43)

( 43.584.70)

21.360.70

33,697.91

37,621.02

41.409.07

37.545.35

7.700.28

2.733.83

5.777.03

5,567.36

6,039.35

( 56,791.05)

( 72,696.13)

( 89.725.36)

( 99,965.35)

(107,261.20)

57.790.54
31,934.82

65,114.26
34,851.09

67,073.32

40.071.64

(121,672.59)

116.24

( 52,911.25)

( 84,443.36)

( 99,904.10)

( 90,533.46)

52,911.25

54,042.14

72.826.78

69,368.50

66,632.76

30,401.22
( 25,182.86)

48,845.81
( 28,930.19)

30,535.60
( 30,891.29)

23.900.70

( 20,730.84)

( 31,546.31)

( 16,948.16)

( 16,167.78)

( 11.101.94)

( 18,536.22)

( 25,385.02)

( 36,570.49)

( 70.063.41)

( 56,572.98)

( 68,118.39)

( 84,321.57)

10,251.91

13 567 96

3.328.52

13,080.04

26,318.58

56,495.45

53.244.46

68,118.39

71,241.53

795.106.49

854,877.49

872.224.56

897.836.52

919.220 31

459,594.66

523,750.80

475.202.62

479,552.16

532,565.39

329.505.97

328,765.31

393,356.21

418,284.36

386,654.92

6,005.86

2.361.38

3,665.73

Center in 1957.

_88—

SUMMARY OF EXPENDITURES AND ENCUMBRANCES, by Sources

JULY 1, 1958 TO
JUNE 30, 1959

JULY 1, 1959 TO
JUNE 30, 1960

ADMINISTRATION

General

Merit System

Training

State

( 17,798.27)
17,798.27

RECORD'S AND STATISTICS .. ( 38.693.89)

DISEASE CONTROL ... ( 42,896.68)

General 39.851.67

Drugs and Biologies 167.52

Heart Diagnostic Center 2.877.49

Venereal Disease Special Project

CHILD HEALTH SERVICES (117.572.82)

Maternal and Child Health 9,421.57

Crippled Children .... .. 15,967.61

Clinics and Auxiliary Services 19,149.49

Hospitalization 32.794.65

Cerebral Palsy Center 40,239.50

Appliances

Cleft Palate Special Project

PUBLIC HEALTH NURSING ( 8.406.55)

HEALTH EDUCATION ( 29.664.46)

General 24,097.10

Narcotics and Alcohol 5.567.36

ENVIRONMENTAL SANITATION .. ( 59.708.40 1

General 43.615.11

Water Pollution 16.093.29

Sanitarians Registration Council

LABORATORIES ... ( 56,021.65)

Bacteriological 56,021.65

Virus

HOSPITAL FACILITIES ( 30,891.29)

DENTAL HEALTH ... ( 8.339.00)

LOCAL HEALTH SERVICES ( 8,291.35)

Aid to Local Areas _ _ 8,291.35

Mental Health Special Project

TOTAL 418.284.36

Federal

48.941.09)

35,562.89

8,115.09

5.263.11

( 50,969.80)

31,351.39

251.27

15,100.00

4,267.14

(193.231.52)
47,376.17
23,288.91
26.963.01
34.738.54
5.192.89
5,669.78
50.002.22

( 14.934.12)

( 17.311.97)
17,311.97

( 40,256.95)
21.499.15
18.757.80

( 43.882.45)
13,346.85
30.535.60

( 10,197.22)

I 59.827.04)
59.8-27.04

479.552.16

Total

( 66,739.36)

53,361.16

8,115.09

5,263.11

( 38,693.89)

( 93,866.48)

71,203.06

418.79

17,977.49

4,267.14

(310.804.34)
56,797.74
39,256.52
46,112.50
67.533.19
45,432.39
5,669.78
50,002.22

( 23,340.67)

( 46,976.43)

41.41 7

5.567.36

( 99,965.35)
65,114.26
34,851.09

( 99,904.10)
69.368.50
30,535.60

( 30.891.29)

( 18,536.22)

( 68.118.39)
68,118.39

State

( 13.748.91)
13,748.91

( 40.433.85)

( 38.597.10)
38,593.70

3.40

1104,627.311
18,164.12
19,185.04
14,361.32
2.710 41
43.433.54
6,423.64
349.24

( 3,631.04)

( 25,310.20)

19,270.85

6,039.35

( 71,141 15)

45,887.55

25,137,36

116.24

( 48,192.76)
48,192.76

( 31.546.31)
( 7,030.02)

897.836.52

384.258.65

Federal

( 46,510.46)

36.861.63

8.466.52

1,182.31

( 70.193.361

33.258.28

1.739.95

24.160.72

11,034.41

(200.309.04)
45,147.84
19.720.00
26,031.97
57.654.77

1.754.46
50,000.00

( 18.274.50)
18.274.50

I 36,120.051
21,185.77
14,934.28

( 42.340.70)
18.440.00
23,900.70

( 18,355.00)

( 84,321.57)
71,241.53
13,080.04

534,961.66

Total

( 60,259.37)

50,610.54

8,466.52

1,182.31

( 40,433.85)

(108,790.46)

71.851.98

1,739.95

24.164.12

11,034.41

(304,936.35)
63.311.96
38.905.04
40.393.29
60,365.18
43,433.54
8,178.10
50.349.24

( 18,536.98) ( 22,168.02)

( 43,584.70)

37,545.35

6.039.35

(107,261.20)

67,073.32

40,071.64

116.24

( 90.533.46)
66,632.76
23,900.70

( 31.546.31)

( 25.385.021

( 84.321.571
71,241.53
13,080.04

919,220.31

Summary of State Board of Health

Expenditures and Encumbrances by Object

Fiscal Years 1959 and 1960

State and Federal Funds
Exclusive of Construction Grants

Object

July 1, 1958
June 30, 1959

July 1, 1959
June 30, 1960

Total

. $ 496,754.94

$ 530,997.30

$1,027,752.24

Travel

37,035.80

43.157.52

80,193.32

Social Security

9,454.62

12,487.67

21,942.29

P. E. R. S

16,050.25

17,289.49

33,339.74

Office Expense

57,121.77

54,572.47

111,694.24

Scientific Supplies

29,236.80

15,273.70

44.510.50

Merit System

8.115.09

8.466.52

16,581.61

Industrial
Ace. Insurance ....

5.871.07

4,583.01

10,454.08

Training

6.307.14

1,182.31

7,489.45

Drs. Fees, Clinics
and X-Rays

69.067.37

74,410.62

143,477.99

Hospitalization

84,393.86

72.119.75

156.513.61

5,669.78

8.178.10

13,847.88

Miscellaneous

4.639.64

5,260.32

9.899.96

Aid to Local Areas

68,118.39
$ 897,836.52*'

71,241.53

139,359.92

Totals

$ 919.220.31*

$1,817,056.83

"Encumbrances — 1959 -
1960-

$ 21,048.91
• 16,318.53

—89—

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—90—

INDEX

Subject Page

ACUTE COMMUNICABLE DISEASE 60-62

ADMINISTRATION and GENERAL

SERVICES ?-37

YLCOHI iLISM (Narcotic

and. ........ 10, 24. 28, 29. 30

AIR POLLUTION 72-73

BIRTHS 34-35, 36

BITE-WING X-RAY 58

BOARD MEMBERS 1

CANCER CONTROL 66, 67

CEXTKK F< PR CFREKR \L PALSY and

HANDICAPPED CHILDREN 38, 53, 54, 55

( ENTRA L A DMIN1 STRAT I ON

CHILD HEALTH SERVICES. 38-55

CIVIL DEFENSE 8, 9, 13

CHRONIC DISEASE . ..70,71,84,85,86

CLEFT LIP-CLEFT PALATE.... 38, 50, 51, 52, 53

COMMITTEES 2, 29, 30, 39, 45

COUNCILS

CRIPPLED CHILDREN .. 38, 45-55

DEATHS and DEATH RATES 36, 38, 39

DENTAL HEALTH 1-'. 13, 21, ?(>-?<>

DISEASE CONTRI PL 60-73

EDUCATION FOR

PARENTHOOD... .. 12, 13, 32, 41
ENVIRONMENTAL SANITATION 74-81

FILMS - 27

FOOD and DRUG CONTROL . 79-80

FINANCES 88, 89, 90

Budget 5-6, 7

FLUORIDATION 57, 58, 5"

HEARING COXSERYATIOX .. 43

HEART DISEASE 24, 67-70

HEART DIAGNOSTIC CEXTER 38, 68, 69, 70

HEART SURGERY 48

HIGHLIGHTS OF

BIENNIUM.-5, 11, 18, 24, 31, 34, 38, 56, 60, 74, 82
HOSPITAL FACILITIES .. 40. 82-87

Hospital Advisory Council 2. 86

HOSPITALIZATION .. .. 47. 48, S2. 83

IMMUNIZATION

INDIAN HEALTH 11-12, 14. 24. 83

INFANT HEALTH and Pro-School

Health - 39, 40, 41. 42

INFLUENZA - 22. 2s

LABORATORIES

Bacteriology 18, 1". 20. 21, 22, 25. 41, 64

Virus 22. 2J

Chemistry 73

LACTOBACILLUS 59

Subject

Page

LEGISLATION 9, 10, 77, 81

LIBRARY 27

LICENSING 10. 88

LOCAL HEALTH SERVICES .. 11, 12, 13, 14

i ascade-City-County

Health Department.-- 11, 12, 13

Gallatin City-County

Health Department - 13

Public Health District- I and II 14

( tther Areas - - I4

Family Health Service- for Mentally 111- - 15-17

MATERNAL HEALTH - 39

MENTAL HEALTH 15, 16, 17
MOUTH PROTECTORS .. 59

NURSING and BOARDING

HOMES 10. 7o, 71, 85, 86

NUTRITION 40

OCCUPATIONAL HEALTH .. .. 71, 72, 73

ORGANIZATION 4

PLUMBING CODE - 10

P( )LI( (MYELITIS - - 22

P.-T.A HEALTH PROGRAM . 33.43,44

PUBLIC HEALTH CAREERS 21

PLTBLIC HEALTH EDUCATION

12, 13, 24, 25, 26, 27, 28, 29, 30, 42. 56, 66, 67, 80, 81

PUBLIC HEALTH NURSING

12. 13, 14. 15, 16, 31, i2. 33, 40. 42. 45, 46
PUBLIC HEALTH PROGRAMS 38-90

Q FLYER - 20

RADIATION CONTROI - 59, 72

RE( < IRDS and STATISTICS - 34-37

REGISTRATIONS 34. 35

REHABILITATION 84

RHEUMATIC FEVER . 1". 48. 49, 67-68, 69

SANITARIANS "• I4. 7i>'

SANITATION 78, 79

SAFETY EDUCATION 28

SEWAGE 76-77

SCHOI >L

HEALTH ... 26, 27. 29, 30, 42, 43, 44, 45, 80

STAFF

4-7

SI \TE (MENTAL) HOSl'IT \I 15, 16. 17

SWIMMING POOLS .. •• 80

TUBERCULOSIS "■ 20, 63-64

Sanitarium "> °4

VENEREAL DISEASE .... 18. 19, 20, 21, 44. 65. 66

WATER POLLUTION

Water Pollution Council 2. 78

Water Pollution Act 10

Abatement 75-76. 77

W \TER SUPPLIES 74-75

-91-

Additional details regarding the
work of any division or section

are available from

STATE BOARD OF HEALTH

Helena, Montana

McKee Printing Co.

Butte, montan*

p*mt

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'■•'■^

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>/,_-

;■■

MONTAMA

TATE BOARD OF HEALT

ini

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MMh BHENMAL REiPGRT

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