Public Health and Health Care Resources in Rural Montana

The circumstances that rural and urban Montanans lived in not only created different sets of risk factors for influenza, but also allowed different access to public health and health care resources. Agricultural pursuits required a large amount of land and meant that great distances separated rural Montanans from their neighbors. Visits to neighboring homesteads and communities and transient farm, ranch, and railroad workers allowed the spread of influenza in these sparsely populated areas, but once the virus weakened rural residents the distance to travel for health care proved too much. Rural Montanans depended upon one another for care, support, and cooperation in order to keep influenza at bay, especially when official intervention failed.

In rural Montana, the great distances between settlements meant that very few residents had ready access to health care. Often, a single physician served an area of hundreds of square miles. Dr. Harry B. Tice served as the county health officer and sole physician of the Upper Musselshell drainage; his death from pneumonia in January 1919 left an area over one hundred miles across without a healthcare provider. The south central Montana community of Rapelje had no facilities for its three hundred cases, so Dr. Alfred C. Dogge converted schools and churches into emergency hospitals and used wagons to transport the ill. The centralized treatment locations allowed Dr. Dogge to provide care for individuals that, had they remained spread out, may not have received adequate attention. The efforts Dr. Dogge and his volunteers took to improve efficiency of care in this rural area kept the death toll at five. Orlean Daems Bassett accompanied her father, one of the Madison Valley’s only physicians, on house calls. Dr. Bassett, she recalled, possessed the only “fever thermometer” in the area.

Many retired physicians returned to service for the duration of the pandemic to assist communities without a provider. Dr. O.M. Lanstrum, a retired physician campaigning for the United States Senate, postponed all speaking dates and campaign engagements when the Rocky Mountain Front community of Choteau lost their physician to influenza. Dr. Lanstrum reported to Choteau immediately to give aid. Dr. J.J. Leiser of East Helena traveled seventy miles to Cascade, a community with no physician, when thirteen residents presented with influenza in one day.

Some communities were unable to obtain a medical provider, and heroic civilians often stepped up to help their neighbors. A Mr. Christler of Havre drove into surrounding rural communities to check on isolated families. It is unknown how many his efforts saved, but among them was a family of eleven; all suffered from influenza, and no one was available to prepare food, obtain clean water, or heat the house. Mr. Christler accomplished these tasks, allowing the family members to not only recover from influenza, but avoid starvation or freezing. Untrained volunteers in Harlowton set up an emergency hospital. They buried several individuals, but just as many recovered. The number of cases, however, was often too much for the few rural providers and kindhearted residents, and many individuals died before they had an opportunity to receive assistance. For example, a family of five in Miles City died before anyone discovered they were ill.

Other rural communities around the state petitioned the governor for assistance. An urgent telegram from tiny Ringling reported that it was “impossible for the one and only doctor” in the county to “even attempt to reach all those afflicted.” The people of the central Montana community of Suffolk were without a physician and could persuade no providers from neighboring municipalities to help them; they pleaded with the governor for aid. Governor Stewart found there was little he could do and replied that he consulted the State Board of Health on the matter. It is unknown if Ringling and Suffolk received the medical aid they desperately needed.

The Red Cross provided resources and personnel for communities in need. In cities and rural communities around the state, Red Cross chapters supplied gauze masks for residents to wear to avoid spreading germs and provided afflicted families with meals and assistance. Their most important effort was providing nursing care. Treatments doctors prescribed were ineffective against influenza; patients benefitted most from bed rest and the care nurses provided, which consisted of providing basic comfort like feeding, changing bed linens, and ensuring fluid intake. However, the war effort occupied many of Montana’s nurses, and few were available to treat the state’s influenza patients. To help increase nursing provider numbers, the Red Cross set hourly wages for its nurses. They also provided voluntary service for families unable to pay and asked private citizens to volunteer as “visiting nurses.” “There are not sufficient nurses in Butte to meet this emergency,” the city’s Red Cross Chapter advertised: “Offer your services as a visiting nurse (experience not necessary).”

The State Board of Health worked tirelessly in the autumn of 1918 mandating prevention measures, filling calls for medical providers, and providing mitigation guidance, all in an effort to slow the spread of influenza and provide relief to desperate communities. Secretary W.F. Cogswell and fellow Board members watched influenza make its way throughout the country and instituted prevention measures and regulations at the first sign of the disease in Montana. The Board required local health officers to immediately report all cases and outbreaks, close schools and prohibit public gatherings when influenza was “in epidemic form in any community,” and isolate influenza patients until recovery. Infection control measures in hospitals included screening all incoming patients for influenza, separating influenza patients from others, and disinfecting “all discharges from the nose and mouth of patients.”

The Board knew that these measures did not prevent influenza from becoming epidemic in other states and regions and suspected the same for Montana; thus, their efforts focused on mitigation and relief. The Board foresaw the challenges ahead and wired the United States Public Health Service to request six doctors and 25 nurses for Montana. However, by mid-October, less than a month after the first suspected influenza death in the state, requests for assistance overwhelmed the Board. More petitions for providers arrived than the Board could fill, and there was “nothing…to indicate the board [would] be able to meet these appeals from influenza stricken communities.” Despite the efforts and attention of rural physicians, nurses, volunteers, and officials, life in rural Montana posed too many challenges to successfully combat the spread of influenza.

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