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3






EIGHTH BIENNIAL REPORT



OF THE



State Board of Health



OF



MONTANA



FIFTH BIENNIAL REPORT



OF THE



State Registrar of Births and Deaths



I^CNT
830



TANA STATE L!BRARY1
East Lyndale Avenue 1915-1916



Heleia, Montana 59601



W. F. Cogswell, M. D., Secretary



APR 2 2004



MONTANA STATE LIBRARY



3 0864 0016 3053 5




EIGHTH BIENNIAL REPORT



OF THE



State Board of Health



OF



MONTANA



FIFTH BIENNIAL REPORT



OF THE



State Registrar of Births and Deaths



1915-1916



W. F. Cogswell, M. D., Secretary



INDEPENDENT PUBLISHING CO
HELtM/.. MONTANA



MEMBERSHIP OF THE
MONTANA STATE BOARD OF HEALTH.



D. J. DONOHUE, M. D., President, Butte.

W. J. BUTLER, D. V. S., Vice-president, Helena.
HON. S. V. STEWART, Governor. Helena.
HON. J. B. POINDEXTER, Atty. Gen'l, Helena.

E. F. MAGINN, M. D,, Butte.
S. A. COONEY. M. D., Helena.

W. F. COGSWELL,, M. D., Secretary, Helena.



DEPARTMENT OF PUBLIC HEALTH OF THE
STATE OF MONTANA.



OFFICE OF THE SECRETARY,

Helena, Montana, December 31, 1916.

Hon. Samuel V. Stewart. Governor,
Helena, Montana.

Sir:

In compliance with the provisions of the laws of the
State of Montana. I hand you herewith the Eighth Biennial
Report of the State Board of Health, and the Fifth Biennial
Report of the State Registrar of Births and Deaths.

The delay in the transmission of this Report is due
to the recent fire which destroyed the Water and Food
Laboratory at Bozeman and delayed the laboratory report.

I wish to express my appreciation of the hearty support
given me by yourself and other members of the State Board
of Health.

Respectfully submitted,

W. F. COGSWELL,

Secretary.



CONTENTS

Page

Recommendations — - 5

Communicable Diseases - 7

Spotted Fever 7

Anterior Poliomyelitis - - 7

Trachoma - . ..— .- - 9

Typhoid Fever —- 10

Smallpox .._- - . : 11

Diphtheria -.- - 11

Scarlet Fever - 11

Tuberculosis 12

Bacteriological Laboratory - 13

Waters and Sewers 14

School Buildings - — - 15

Licensed Embalmers - — : 15

Registration of Births and Deaths 16

Divisions of Foods and Drugs 55

Report of Food and Drug Laboratory 63

Hotel Regulations . - - - - 55



RECOMMENDATIONS



Local and County Health Officers.

I wish again to call your attention to the unsatisfactory
method of appointing local and county health officers, and to
recommend an amendment to the present law whereby two
adjoining counties may be permitted to unite in the employ-
ment of a whole time district health officer. This appoint-
ment should be for a term of at least four years, and should
be made from a list of physicians furnished by the State
Board of Health.

Child Welfare Division.

A Child Welfare Division to the State Board of Health
should be created. This Division, in addition to other work,
should have general supervision over the work of the school
nurses and public health nurses in the state.

Such a Division could be maintained without a direct
appropriation from the State, by a marriage license fee.
The argument in favor of such fees being used to support
this Division, being that when parties enter the marriage
relation, they should make some provision for the protection
of the health of the children resulting from such marriage.

Licenses.

In accord with the provisions of the Food and Drug Law,
the State Board of Health issues licenses to bakeries, con-
fectioneries, slaughterhouses, meat markets, dairies, restaur-
ants, hotels, lunch counters, and dining cars in the State.
These licenses are issued free to any person applying for
them irrespective of the sanitary conditions surrounding the
place of business.

The Secretary of the State Board of Health should be
given authority to with-hold a license when he has satisfac-
tory evidence of grossly insanitary conditions existing on llie
premises of parties applying for a license.

Instead of these licenses being issued free, a fee of Two
Dollars should be charged and the money so collected could
be profitably used in establishing and maintaining a well-
equipped and efficient bacteriological laboratory.

On account of the largeness of this State it is almost
impossible for one laboratory to properly serve all parts of
the State, A very great impetus to public health work



6 REPORT OF THE STATE BOARD OF HEALTH

would be given if the State would render financial aid to
municipalities in establishing bacteriological laboratories. The
director of the central laboratory could have general super-
vision over the branch laboratories receiving State aid.

This arrangement could easily be brought about with
the Two Dollars charged for the licenses issued by the State
Board of Health.

Water Supplies.

The water supplied to the various towns of the State and
used for drinking purposes on the passenger coaches on our
railways should be regularly examined at our laboratory.
In order that this may be done properly, the State Board
of Health should be given authority to classify the various
towns and companies and institute a fee system. Such fees
should go towards bearing the expense of the work involved.



REPORT OF THE STATE BOARD OF HEALTH



COMMUNICABLE DISEASES



Spotted Fever.

During the year 1915 there were thirty-seven cases of
spotted fever reported in the State with eight deaths. For
the first time in the history of the State, cases of this disease
were reported from Big Horn, Custer, Dawson, Fallon and
Rosebud Counties. In previous years some cases had been
reported in Carbon County, but no cases had been reported in
the State east of this county. The cases in the eastern part
of the State were of the Idaho type and much milder than
those occurring in the Bitter Root Valley.

During the year 1916 there were sixteen cases reported
in the State with six deaths. Six of these cases occurred
in the Bitter Root Valley ; the others reported were in the
eastern part of the State. ,

Dr. L. D. Fricks of the Public Health Service and Dr.
W. V. King of the Bureau of Entomology had charge of the
control work in the Bitter Root Valley. A full report of this
work will be found in the Second Biennial Report of the
State Board of Entomology.

Poliomyelitis (Infantile Paralysis).

During the year 1915 there were two cases of infantile
paralysis reported in this State with one death. During the
year 1916 there were eightj^-eight cases reported, with
twenty-one deaths. This would give a fatality of nearly
tw^enty-four per cent. This does not include the cases that
occurred on the Crow Reservation.

The only part of the State where this disease assumed
an epidemic character was at Billings and in Carbon County
bordering on the Crow Reservation. The first case reported
in this section was on the Reservation. This case occurred on
the 11th of July in a child twelve years old. This child died
and was taken to Billings for burial. Shortly after this the
epidemic started in Billings. In our investigation of the
cases in Billings, we could not trace them directly or indirect-
ly to the child that was brought from the Crow Reservation.

On account of the fact that the epidemic was confined
to the part of the State bordering on the Crow Reservation,



8 REPORT OF THE STATE BOARD OF HEALTH

and that the first case occcurred on the Reservation, we
were strongly suspicious that the disease existed on that
Reservation, although denied by the authorities. On ac-
count of this suspicion we made an urgent appeal to the
Public Health Service to make an investigation with a view
to determining whether or not the disease existed within the
limits of the Reservation.

Accordingly Dr. A. J. Lanza of the Public Health Service
was detailed to make an investigation, and on August 14th
this investigation was made by Dr. Lanza, Dr. T. J. Benson,
local health officer of Fromberg, Dr. Gaylord McCoy, county
health officer of Carbon County, and myself. At that time
we found eight cases. A few days after this Dr. J. A. Mur-
phy of the Indian Service made a further investigation and
he reported eighteen cases in all.

In the report that was published in the Journal of the
American Medical Association, Dr. Murphy very positively
asserts that the disease on the Reservation was contracted
from cases in Billings. In his report he overlooks the fact
that the first case occurring in that section of the State
occurred on the Reservation. Dr. Murphy's report is inter-
esting, but it would be more valuable if it were accurate.
On the outbreak of the epidemic in Billings the Board
of Health met and passed the following regulations in order
to control the disease:

"Reg. 1. Any local or county health officer having
knowledge of, or having reason to suspect the presence
of poliomyelitis (infantile paralysis) within his district
shall immediately investigate, if necessary, and shall at
once place under quarantine all persons found suffering
from such disease. Patients suffering from poliomyelitis
shall be effectively screened against flies, and all dis-
charges from such patients shall be properly disposed oi.
"Reg. 2. Quarantine for poliomyelitis shall be abso-
lute, and shall extend for a period of at least six weeks,
and as much longer as the local or county health officer
may deem necessary. On recovery or death of a patient,
the house occupied by such patient shall be thoroughly
fumigated and cleaned. All children exposed to polio-
myelitis shall be quarantined for a period of not less
than two weeks.



REPORT OF THE STATE BOARD OF HEALTH 9

"Reg. 3, Funerala of persons dead of poliomyelitis
shall be strictly private.

"Reg. 4. As soon as a diagnosis is made the attend-
ing physician shall report all cases of poliomyelitis by
the quickest possible method to the local or county health
officer within whose jurisdiction such cases occur. The
local or county health officer shall report to the Secre-
tary of the State Board of Health by wire or telephone
as soon as any case of poliomyelitis is reported to him,
or as soon as he, himself, has made such a diagnosis
on any case he has attended.

"Reg. 5. When an epidemic of poliomyelitis occurs in
any county of this State, the county board of health of
such county shall employ, at the expense of said county,
a duly trained and registered nurse as a public health
nurse, who shall act in cooperation with the county
health officer and under the direction of the State Board
of Health."

Trachoma.

During the month of September, 1916, Dr. Ralph H.
Ross, trachoma expert with the Indian Service, was detailed
to make an examination of the school children on the Fort
Peck Indian Reservation to determine the number of cases
of trachoma.

Knowing that this disease was prevalent among the
Indians on this reservation, I requested Dr. Ross to examine
the eyes of the school children in the towns of Sheridan
County bordering upon the Reservation.

During the month of October he made the examination,
as requested, and has reported as follows:

"October 30, 1916.
"Dr. W. F. Cogswell, Secretary,
"Department of Pubhc Health,
"Helena, Montana.
"Dear Doctor:

"I have just returned from visiting seven towns adja-
cent to Fort Peck Indian Reservation in Sheridan Coun-
ty, they were Medicine Lake, Homestead, Froid, Ante-
lope, Plentywood, Flaxville and Scobey. I found 720
pupils in the public schools of these towns, 30 of which



10 REPORT OF THE STATE BOARD OF HEALTH

were Indians. In the public schools of Poplar and Wolf
Point I found 302 pupils, making a total of 1,022 pupils,
that I examined for eye diseases in Sheridan County.
Enclosed you will find a report of each town giving the
diseased eye conditions found in the pupils named. I
found 20 cases of trachoma and 40 cases of follicular
conjunctivitis.

"Yours very truly,

"Ralph H. Ross,

"Special Physician."

On account of the prevalence of trachoma and follicular
conjunctivitis in the towns mentioned, I believe that the
County Commissioners of Sheridan County should employ a
county nurse to treat these cases under the direction of a
local physician.

Typhoid Fever.

During the year 1915 there were 537 cases of typhoid
fever reported with 57 deaths. During the first eleven
months of 1916 there were 395 cases with 45 deaths. While
it is no doubt a fact that there are some cases of typhoid
fever that are never reported, yet we feel that we are getting
more complete reports of this disease than ever before. The
diminished number of cases is no doubt due to the fact that
in several towns of the State water treatment plants have
been installed.

During the year 1916 there were quite a number of
cases reported from Great Falls. This City, at that time,
was using raw Missouri River water, which at times showed
evidence of contamination. The State Board of Health in
the summer of 1915 issued an order to the City of Great
Falls to install a treatment plant and recommended that
steps be taken to install a filtration plant with treatment.
A temporary hypochlorite plant was immediately installed,
which was later replaced by a liquid chlorine plant. The
question of bonding the City for installing a filtration plant
was submitted to the people and carried by a substantial
majority. Plans for this plant have been submitted to the
State Board of Health and have been approved. The plant
is now under construction.

The town of Glendive secures its waters from the Yellow-
stone river at that place. The water from this river in the



REPORT OF THE STATE BOARD OF HEALTH 11

summer of 1915 showed contamination. The State Board
of Health called the attention of the City authorities to this
fact and, without waiting for an epidemic to occur, they
immediately took steps to put in a proper filtration and
treatment plant. This plant is now in the course of con-
struction.

In another part of this report will be shown the number
of towns that have improved their water supply by proper
treatment.

Smallpox.

During the year 1915 there were 546 cases of smallpox
with one death. During the first eleven months of 1916
there were 540 cases with one death.

On account of the extreme mildness of this disease
people are losing their respect for it and are neglecting
vaccination. This is unfortunate, for the time will un-
doubtedly come when a more virulent form of the disease
will appear and will find good soil for its spread in an un-
vaccinated generation. In several places in the State on
the appearance of smallpox, the State Board of Health has
issued orders for the school children to be vaccinated. The
Board has this authority in the presence of an epidemic.
Otherwise there is no law requiring the vaccination of
school children.

Diphtheria.

In 1915 there were 159 cases of diphtheria reported in
the State with 17 deaths. During the first eleven months of
1916 there were 209 cases, with 19 deaths.

In two towns in the State epidemics of diphtheria
amongst the school children were traced to carriers in healthy
children. As soon as these carriers were put under control
the epidemics in both places ceased.

Scarlet Fever.

During the year 1915 there were 376 cases of scarlet
fever reported, with 12 deaths. During the first eleven
months of 1916 there were 362 cases with 8 deaths, the
total number of cases reported for the biennial period being
738 with 20 deaths. This is a much better showing than
that of the previous biennial period, which showed 1,365
cases with 107 deaths.



12 REPORT OF THE STATE BOARD OF HEALTH

Tuberculosis.

During the year 1915 there were 444 deaths from tuber-
culosis in Montana, and during the same period there were
only 200 cases of this disease reported. The first eleven
months of 1916 there were 363 deaths and only 281 cases
reported. It is very evident that we are not getting a
complete report of the cases of this disease. An effort will
be made during the coming year to get better reports.

The law requires that the attending physician, as soon
as diagnosis is made, report his cases of tuberculosis to
the local or county health officer. In order that some follow-
up work may be done on this disease, there should be em-
ployed in each County a public health nurse, working under
the direct supervision of the County Health Officer, and in
accord with the rules and regulation of the State Board of
Health. This nurse would be very valuable in preventing
the spread of tuberculosis by going into the homes of the
tubercular and instructing them how best to prevent the
spread of the disease.

During the past year Dr. A. J. Lanza of the United
States Public Health Service, has been making an investiga-
tion of the sanitary conditions in the mines at Butte, with
special reference to the spread of tuberculosis amongst min-
ers. The Doctor has not confined himself to purely investi-
gational work, but has aided very materially in organizing
the local relief agencies, working with the State and Anti-
Tuberculosis Associations. A tuberculosis clinic has been
established, which at the present time is being conducted by
Dr. Lanza.

The State Anti-Tuberculosis Association, which was or-
ganized in the summer of 1916, is showing signs of valuable
activity, and is cooperating with the State Board of Health
in control measures. A great many people in the State are
of the opinion that we have very little tuberculosis in Mont-
ana, but we have only to turn to our death records to dis-
prove this idea.



REPORT OF THE STATE BOARD OF HEALTH



13



BACTERIOLOGICAL LABORATORY



The following table shows the amount of work done in
the Bacteriological Laboratory during 1915 and 1916.



1915.

Widal Diph.



Tbc.



January 38 24 14

February 51 14 12

March 40 8 16

April 51 12 17

May - 42 7 13

June 35 13 13

July 31 9 18

August 62 8 23

September 73 .... 15

October 49 6 16

November 52 .... 19

December _. 36 5 17

Total -. 560 106 193



Total

Other for

Month



2

1



76
77
66
81
62
62
58
93
88
71
71
58



863



1916 Total

Widal Diph. Tbc. for

Month

January 24 12 12 48

February 54 3 13 70

March .: 42 10 20 72

April _ _ 51 33 14 98

May - ___- 36 13 19 68

June 36 5 14 55

July 56 34 19 109

August -. 65 11 6 82

September 71 11 25 107

October .. __ 72 66 11 149

November 23 100 13 136

December

Total 530 298 166 994



14 REPORT OF THE STATE BOARD OF HEALTH

WATER AND SEWER SYSTEMS.

Section 1653 of the Revised Codes of Montana reads in
part as follows :

"Cities, towns and all other corporations, companies
or persons shall submit to said Board for its advice
and approval their proposed system of water supply or
of the disposal of drainage or sewerage, and no ctiy,
town or persons or company shall proceed to build or
install or enlarge or extend any system of water supply,
drainage or sewerage disposal, without first obtaining
the approval of the State Board of Health. In this
Section the term 'drainage' means rainfall, surface and
subsoil water only, and 'sewage, means domestic and
manufacturing filth and waste."

In accordance with this provision of the law the follow-
ing plans for water and sewer systems from the following
towns have been received and approved:

Big Timber, Sanitary Sewer System, October 12, 1916

Broadview, Water System. May 19, 1916.

Bozeman, Sanitary Sewer System, May 16, 1916.

Bozeman, Storm Sewer System, May 1, 1916.

Belgrade, Sewer System, August 24, 1916.

Clyde Park, Water System, March 29, 1915.

Chinook, Filtration Plant, October 4, 1915.

Columbus, Water Works & Filtration Plant. October 27,
1915.

Columbus, Sewer District No. 1, May 17, 1916.

Fromberg Water System, January 31, 1916.

Great Falls, Filtration Plant, June 26, 1916.

Geraldine, Sewer System, June, 1915.

Glendive, Filtration and Treating Plant. August 4, 1916,

Harlowton, Water Works & Sewer System, Aug. 30, 1916.

Havre, Sewer System, July 17, 1915.

Hysham Water System, November 1, 1915.

Hardin, Sanitary Sewer System, October 12, 1916.

Hinsdale, Sewer System, November 18, 1916.

Judith Gap, Water & Sewer System. October 26, 1915.

Lavina, Sewer System, April 4, 1915.

Manhattan, Sewer System, April 2, 1916.

Medicine Lake. Water System, August 17, 1915.

Poison, Sewer System, July 26, 1915.



REPORT OF THE STATE BOARD OF HEALTH 15

Poison, Sewer District No. 2, February 28, 1916.
Ryegate, Water System, October 4, 1915.
Sidney, Water & Sewer System, August 18, 1915.
Sheridan, Municipal Water Works, October, 1916.
Three Forks, Water Works System, August, 1916.
Troy, Water Works System, November 18, 1916.
Wibaux, Water & Sewer System, August 31, 1916.

School Buildings.

The law requires that the plans for new school buildings
shall be submitted to the State Board of Health for its
approval. In accord with the provisions of this law, the
number of plans submitted are as follows:

From January 1, 1915 to December 31, 1915.

Plans examined, approved and filed 39

Rurral school plans examined and approved 53

Blue prints furnished to rural districts 195

Total .- 287

From January 1, it>i6 to October 31, 1916.

Plans examined, approved and filed 51

Rural school plans examined and approved 86

Blue prints furnished to rural schools 132

Total - - - - - 269

LICENSED EMBALMERS.

One of the duties of the State Board of Health is to
examine candidates for embalmers' licenses. In order to
make this examination as practical as possible, the State
Board of Health appointed E. L. Flaherty of Helena and
James Cassidy of Butte, licensed embalmers, to act with the
Secretary in conducting these examination. The regular
examinations are held in April and October.

During the past biennial period thirty-eight licenses
have been issued by examination and nineteen by recipro-
city. Montana reciprocates with Iowa, North Dakota, Color-
ado, Washington, Wisconsin, Nebraska, Idaho, Minnesota,
Ohio, Louisiana and Kansas.



16



REPORT OF THE STATE BOARD OF HEALTH



DEATHS (EXCLUSIVE OF STILLBIRTHS) REPORTED TO THE STATE

1915. ARRANGED ACCORDING TO COUNTIES,



TABLE NO. 1.



JANUARY






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Onctpr . .


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i i








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AnapoTKia . . .




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... - -


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Flathparl Rxol of


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. . .1.. .






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nnllatin "Rxfl of






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TOTALS : .









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1



REPORT OF THE STATE BOARD OF HEALTH



17



BOARD OF HEALTH FOR THE TWO YEARS ENDING DECEMBER 31,


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