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tCf)'c Saranac Hafcoratorp . for tfjc s>tubp of {Euberculosfe OF THE EDWARD L.' TRUDEAU FOUNDATION REPORT OF DIRECTOR AND FINANCIAL REPORT FOR THE TEAR ENDING SEPTEMBER 10. 1931 REPRINTS OF SCIENTIFIC PAPERS ZEfjc ^aranac ILakc Sfcabcmp of iflebicinc THE SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS OF THE ' EDWARD L TRUDEAU FOUNDATION Leroy U. Gardner, M.D. ______ ______ __________ _ Director and Pathologist Thomas M. Durkin, M.E.____ ________________________ Assistant Chemist Winfield O. Kelley, BA.___.;Clinical Pathologist Douglas S. McCrum, B.S. (E.E.)___________________________ Photographer Morris Dworsld, C.P.H. --__s__________Assistant in Experimental Pathology Catherine M. Cummings _________________ _______ Librarian and Secretary Roy Dayton____________ ___ i_________ ___ ___________ Financial Secretary James V. Luttrell_______________________Purchasing Agent and Technician George Hulpritt____________________________________ ____ ____ Technician Anthony DeJahant_____________________________________________ Technician Andrew J. Redlin .........__Voluntary Assistant in Chemistry Everett J_ MoreVoluntary Technical Assistant William LaBounty Assistant Henry C. Stout ! Assistant . Field and Consulting Stait Donald E. Cummings, B.S.----Homer L. Sampson--------------Daniel M. BrumfieL M.D. ... Robert N. Downs---------------Richard Libbey-------------------Richard Walters--------------- Dorothy P. Rogers---------------- Assistant Drector m Charge of Field Wor^ --...Consulting Roentgenologist --------......--______ Clinical Consultant ---------------- X-Ray Supervisor ------------------------------ - X-Ray Technician ---- ---- ------- -------- ---------- X*Ray Technician -----------X-Ray Stenographer FOR IS .noN director and Pathologist ____ AsmjLant Chcmirt ___ Cl nice] Pathologist __________ Photographer Experimental Pathology Librarian end Secretary _Financial Secretary g Agent end Technician Technician Technician ) j^jnrLsn: in Chemutry 1 ' Technical Assistant ------------------------------- Assistant -------------------- Assistant TT in Charge of Field Wor\ Jruultinj Roentgenologist Clinical Consultant ------- - X-Ray Supervisor ------ - X-Ray Technician ------- - X-Ray Technician ---- - X-Ray Stenographer i CONTENTS Report of the Director Financial Statement Reprints of Scientific Paper* 1/ The Pathologic Reaction in Various Pneumonoconioses Lzaoy U. Gaadner - Experimental Inhalation of Bituminous Coal Dus and Its Effects Upon . . Primary Tuberculous Infection in Guinea Pigs Leroy U. Gardner, Donald . Cummincs and Gerald R. Dowd The Reaction to FiiiC and Medium Sized Quartz and Aluminum Oxide Particles -- Silicotic Cirrhosis of the Liver Leroy U. Gardner and Donald E. Cummincs Pathology of So-Called Acute Silicosis Leroy U. Gardner Silicon's and lu Relationship to Tuberculosis Leroy U. Gardner ' A Study of Tuberculous Infection by V/ay of the Female Genital Tract: A Supplementary Report Edwin M. Jameson . The Heart and Tuberculosis: Mediastinal Distortion as a Source of Circulatory Embarassment . _ Daniel M. Brumfiel . THE SARANAC LABORATORY The fact that the Saranac Laboratory has always been a separate institu tion from the Research and Clinical Laboratory of the Trudeau Sanatorium is not generally understood. Both laboratories are sponsored and controlled by the Trudeau Foundation, but the Saranac Laboratory is located at 7 Church Street in the village of Saranac Lake and not at the Sanatorium. The properties of the Saranac Laboratory consist of the original building gives to Dr. -. L. Trudeau by Mr. George C. Cooper in 1S94 as a private research laboratory, together with the John Black Room, an addition which houses the medical library and lecture room, and special buildings for animals. While the Saranac Laboratory co-operates with the Sanatorium in every possible way and serves as the headquarters for the Trudeau School of Tuberculos's, it provides diagnostic facilities to the physaans practicing in the village and carries on independent researches in the field of tuberculosis and associated conditions. To avoid the existing confusion, the Trudeau Foundation is publishing an annual report of the Saranac Laboratory under separate cover from that of the Sanatorium. * : PLAINTIFF'S EXHIBIT (1660 (6) DRY been a separate insritu.be Trudeau Sanatorium ponsored and controlled orator)' is located at 7 at the Sanatorium. ' of the originaj building , per in 1894 as a private ` xenn, an addition which d (pedal buildings for the Sanatorium in every Yudeau School of Tubernaans practicing in the / of tuberculosis and undation is publishing an arate cover from that of ? I REPORT OF THE DIRECTOR OF THE SARANAC LABORATORY - FOR THE STUDY OF TUBERCULOSIS 1933 ` . LtAor U. Gaadne*. M.D. It is a pleasure to announce the consummation of the plan suggested in the Director's report of last year whereby the Saranac .Laboratory is enabled to undertake a comprehensive experimental, clinical, epidemiological, and engineering investigation of pneumonokoruoss as a causative factor in the production of tuberculosis. This roost desirable approach to the problem thould advance our knowledge more effectively than by attacking it along any single avenue of approach. Clinical study of disease as it develops under industrial conditions is obviously essential to point out the medical problems involved, but since many of these problems are concerned not only with the individual but with groups and families, epidemiological methods must also be employed. The engineering aspects of the subject are essential to comprehend and alleviate dust hazards which may be discovered and furthermore they are fundamental to define the etiology of a divrav like pneumonokoruoisis. With a knowledge of all these factors at our command, animal experiments can be planned to interpret the principles involved in a more intelligent manner. Such a program of'investigation has been made possible by the establish ment of an intimate association between the Laboratory, the x-ray depart ment of Trudeau Sanatorium, and the Saranac Lake ipeaaliscs practicing in the field of chest diseases. Not only will this combination of resources piennit a more comprehensive scientific invesogabon but it allows us to offer industry a consulting service for the detection of possible hazards from dust, for the proper eiaminaoon of its employees, for recommendations to improve working conditions where these are necessary and for the treatment of any employees who may be found to suffer from occupational disease. Mr. Cummings, the assistant director of the Laboratory, is supervising the work in the field. He will train engineers already employed by the industries in the technique of making atmospheric dust determinations; he will have supervision over ventilaoon, over clinical laboratory work in the fieid, and will co-ordinate the activities of all parts of a study. He is assisted by Mr. Robert N. Downs, a former associate of Mr. Sampson in the x-ray department, who is now in charge of all roentgenological examinations. Under their direction are technicians also trained by Mr. Sampson. At the present time Mr. Richard Libby is already at work and Mr. Pochard Walters will begin in the near future. Their excellent training will insure satisfactory films which will be sen: to Mr. Sampson for interpretation. Where plant physiaans arc available uc propose to secure their cooperation in making physical examinations; if no suitable local physician can be found Dr. D. M Brumficl of Saranac Lake will make them. J .T - s .. t a-p r-'-v, c~n~grr~-yr.->'n r= t/" , w f h-<*. * " Simultaneously with this investigation in the field, a laboratory study of the particular dusts and their effect upon the normal and ruberculous animals will be undertaken. The final co-ordination of data from all of these sources should enable us to obtain a clearly defined picture of any given dust haeard. As reported last year, a contract was made with Oglebay Norton and Company to carry out such a srudy in an iron mine which they operate. This work is now in progress, together with animal experiments using ore and rock dusts from the mine in question. In the Spring we were approached by the United States Gypsum Company ] to make a survey of their plant and employees in Oakfield, N.Y. Their operations comprise mining, pulverising and caJa'nihg gypsum dust together with the manufacture of gypsum plaster, wall board and various other products. A aeries of dust counts was made in representative pans of this * plant; one hundred men employed for maximum periods of time in various departments were given physical and x-ray examinations, and three different animal experiments with gypsum dust were begun. We were able to demon strate that in spite of rather heavy dust concentrations developed in certain . pans of the plant, there were no aignificent changes produced by the inhal ation of this dust during periods as long as twenty years. The animals also have thus far failed to exhibit serious reaction and there has been no effect upon tuberculous infection. The evidence thus accumulated corroborates the prevalent opinion that the inhalation of gypsum, or calcium sulphate, does not cause changes in the lungs which are deleterious to health, nor does it predispose to tuberculosis. ` During the Fall the entire group of companies operating iron mines in the northern part of Michigan decided to employ the Laboratory to make a survey of all their mines. They desired to know whether iron erining involves any risk from dust inha ation and if so they wished to take measures to uu'ru'mite this hatard. On November first a contract for $30,000 annually, for a period of three years, was signed between the Laboratory and the following operators: The Cleveland Cliff's Iron Company. The Corrigan. WcKinncy Steel Company, Davidson Ore Wining Company, The W. A. Hanna Company, Agent, Inland Steel Company, Oglebay Norton and Com pany, Agents, Oliver Iron Wining Company. Pickands Wather and Company, Agents, and Republic Steel Corporation. The original contract with Oglebay Norton and Company is, of course, superseded by the new one to which they are party. Under Wr. Cummings* direction this field investigation is already under way. Engineers arc being trained to make dust determinations. Large numbers of roentgenograms made by the technical staff are being sent to Wr. Sampson for interpretation and a series of laboratory investigations of the action of mine dust has been started in Saranac Lake. It is as yet too - early to venrure an opinion as to the results of this study, but in time we will have all the necessary informioon to evaluate the effects of work in iron mines. These contacts have permitted the Laboratory to proceed with its program of research which would otherwise have been seriously hampered by the lick of funds. Wr. Cummings will, of course, not be able to continue his work r V- .. . . .- * . ^ _ . I f*T * S.V W f t f - - --; IV'I I II * ~f ~ ' "T1 *V raff* .. ., - ` --w- ... - - .. * -v - * rid, a laboratory study of il and tuberculous animals i from all of these sources of any given dust hatard. vith Oglebay Norton and which they operate. This a penments using ore and J States Gypsum Company n Oa It field, N.Y. Their ung gypsum dust together board and various other cpresentaove . parts of this' periods of time in various noons, and three different We were able to demon itions developed in certain jes produced by the inhaly years. The animals also d there has been no effect accumulated corroborates i, or calcium sulphate, docs ious to health, nor does it u -iting iron mines in y Laboratory to male _now whether iron mining ey wished to tale measures tract for $30,000 annually, n the Laboratory and the Company, The Corrigan, ng Company, The M. A. Oglcbay Norton and Com inds Mather and Company, ginaJ contract with Oglebay by the new one to which Jcxrigabon is already under ust determinations. Large cal staff are being sent to laboratory investigations of nac Lake. It is as yet too s study, but in time we will he effects of work in iron to proceed wieh its program ously hampered by the lack ; able to continue his work 1 I i ; i i st X 1 3 I in the Laboratory but arrangements have been made to continue certain portions of it. Research The new dust house built last year is now operating at full capiriry with five dust inhalation experiments in progress, using pure silica, heoabte. gypsum, and various combinations of these substances. Nearly $00 guinea pigs and a smaller number of rabbits and whit* rats are involved in these experiments. The chief problems now bong investigated are the determination of the maximum amount of silica which must be inhaled before progressive disease develops; the determination of the minimum amount of oLcosis which predisposes to tuberculous infection; the effects of non-siliceous dusts inhaled simultaneously with silica; the continuation of previous studies upon the effect of particle size in the production of bssue reaction. A method for recovery and measurement of all the extremely fine inhaled dust parbcln ' in portions of the silicotic lung promises to yield valuable informabon. The previously menboned attempt to develop a rapid method for deter mining the dangerous characteristics of various kinds of dusts is sbll in prog ress. The immediate effects of different kinds of dust particles have been determined but to be of significance these changes must be correlated with the chronic effects produced after months or years have elapsed. Publication must therefore be delayed. Much addibonal experimental data has been accumulated on the relabonship be'wcen sibcoss and tuberculous infection, but it has seemed advisable to defe reporting these finding: uno! they can be correlated with the con dition in human beings. In this connection the general problem of the relationship between immunity and silicosis is receiving careful attenbon. Some of the chemical problems which Mr. Cummings had started are being conbnued. notably a study of the various forms of alica and alumina, and the reaction which they produce in animal tissues. Much time is bang devoted to the determinabon of the type of dust found in the lungs of persons dying with different forms of pneumonokonioss. During the year material from thirty-six such cases has come to the Laboratory for examin ation. Chemical analysis is not an altogether sabsfactory method for the identifies bon of inhaled dust. It is desirable to develop a petrographic tech nique that may be applied to the minute particles which gain access to the pulmonary air spaces. It is hoped that the co-operabon of some specialist in this field may be secured for this purpose. Aside from the major research, other problems are being studied by various local physicians. Dr. Baldwin is invesbgabng the occurence of nonpathogenic arid fast bacilli in various habitats. Dr. Kinghom and Mr. Dworski are continuing thrir work on vacrinabon against tuberculous infection. Mr. Cummings and Mr. Dclahant have nearly completed their study of hypersrnsitivcncss and immunity in tuberculosis. Dr. J. N. Hayes has been tcsiing the reactions of the lungs to vanous oils and is also studying their relative effectiveness in t.se maintenance of oleothorax in the expenmenu! arumal. Recently he has obuincd a grant of $200 from the E. R. 7 Squibb Company to investigate the effect of irradiated mineral oil on tuberculoss of the pleura. Mr. Winfield Kelley, in co-operation with the x-ray department of the Sanatorium, it attempting to produce pulmonary tubercu losis in cats and to follow the course of the infection roentgenographicaUy. If this could be accomplished in a resisunt animal like the cat it would prove a valuable tool in our ecudies, for silicosis has been reproduced in this animal which has very large lung fields that are easily visualized in roentgenograms. Dr. D. M. Brumfiel is assisting in the study of several of the laboratory silicosis problems. Dr. E. M. Jameson is continuing his invesrigadon of genito-urinary tuberculosis. Tcaching There has been no change in this part of our program during the past year. We have participated in the instruction in the Nurses' Training School at the Sanatorium and in the Trudeau School of Tuberculosis. For the latter the course in Pathology was altered to correlate it more intimately with the roentgenological aspects of tuberculosis. In the coming session of 1934 we hope to have several physicians from the mining companies for whom we are making the field study. If this plan materializes considerable rime will be devoted to the pathology and x-ray appearance of pneumonokoniosis. Clinical Laboralory Worl^ The diagnostic department has been under the direction of Mr. Winfield O. Kelley since September when Dr. Schwartz left us to accept a position in the Sanatorium. He is assisted by Mr. Dclahant. As will be icen in the appended summiry, the total number of examinations fell below that for last year by 371. This is a reflection of the decrease in the number of the patients in the village rather than a lack of the use of the Laboratory facilities by the physicians. Much of this work has been done without cost, as many patients were unable to pay even a moderate fee. The contributions of 52,010 received from the Academy of Mediane have been devoted to the support of this department. Mr. Kelley, who receives no salary but iz dependent upon fees, is the recipient of a fellowship and spends part of his time.in the Sanatorium. Summary of Diagnostic Examinations ,, November I, 1932 to November 1, 1933 Cultures for diphtheria -____________ 16 Smrari for Vincent'a anfini___________2) Blood: AcrJuunation for typhoid___ __ _ 10 Difierenual counu ______ 102 Red and white counti-----------------------20) Krma[1obin drttrminjDoni___ 69 Coafulauon Unsc,47 C roupinf___ ______ 76 Culture! ___ _______________._________ 10 Chrnrntry __________________________ 4] Spina) fiuid, unne and other matcrl- lanroui mairnal I or tubercle baollut 6) Stomach contcnta_____ ________ 27 Sputum for tubercle bacillur________ 14 71 Mill, banenolofiral counu ______ 17 Water. bacteno!o(iea1 eiammauon . 72 We iff. cheroirjJ elimination -Smcart ior (onococrui ______ Unne ______ ___ _ _____________ - JM .. 2 9J0 Auioprnou* vacnnei ..._______ .___ Pathological ipramrm _____________ 129 Autopnci, hurem ___________ _ _ 5J Anim*l inoculated for diJfnoiu ... H XJucrllinrous ciaminauoni 102 Crand total __________________________________ 8 `-5'"'jK- - A t vv- td mineral oil on ruber- ' Suf .peration with the x-ray luce pulmonary tubercuon roentgenographically. J like the cat it -would been reproduced in this ire easily visual;led in yt study or several of the continuing his invesdga- Mr. Cummings' absence and the increased amount of work that will be undertaken will neccaatate the employment of more full time members of the staff. An effort is being made to find a properly trained pathologist and bacteriologist to reb'eve the director of some of his responsibilities. Sev eral prospective candidates are being considered Mr. Thomas M. Durkin, a craduate of Cornel! in mining engineering, has been serving as voluntary' assistant in the chemistry department for eight months; he is now joining the regular staff as assistant chemist. We are fortunate to find a man with his training to devote to the laboratory phases of a problem such as ourv. Mr. Winfield O. Kelley has taken over the direction of the diagnostic ram during the past year. 3' Training School at the Josis. For the latter the sore intimately with the department and is also engaged in research here and at the Sanatorium. The director takes this opportunity to express his appredaoon to every member of the staff for their loyal co-operaoon during the year of reduced incomes and salaries To Dr. Spencer Schwartz. who retired in September, everyone is grateful for his faithful though inadequately compensated several physicians from the field study. If this ad to the pathology and services in the diagnostic department. Graotude is expressed to three voluntary assistants. Miss Laura Ladd, Mr. Everett L More and Mr. Andrew J. Redlin. Miss Ladd and Mr. More will not be with us during the coming year, but Mr. Redlin will continue as assistant in chemistry. Great credit is due to Mr. Cummings for developing and organising the field research activities, for without the income from this source very lirtle direction of Mr. V/ineld i us to accept a position t_ As will be jeer, in the of the Laboratory work could continue. It is regrettable that his own researches must be interrupted, but his engineering training particularly qualifies him for the type of work in which he is now engaged. fell below that for :i_ .n the number of the of the Laboratory facilities one without cost, as many re. The contributions of have been devoted to the Tecerves no salary but is up and spends part of his Buildings Even at the present time the accommodations of the Laboratory are inadequate to carry on the work in progress, and for the proposed increase in the tuff addirional space becomes imperative. The logical place for expansion is above the John Black Room which was erected with this possibility in mind. It gives us very great pleasure to announce that Mr. and Mrs. Frank B. Black have most generously offered to provide the needed addition to the building. This further manifestation of their faith in the Saranac Laboratory is inspiring and gratifying. Plans are now under con msnoTU sideration and it is hoped that construction may be commenced in the Spring. 1. 1933 For furnishing and equipping this addition the support of other friends will rtmti________________ 2t rubtrclr bcf))us - -- --,14 5 \ So!ofcjJ count) 37 moloficiJ fsammition . 53 i undoubtedly be secured. Mr. Henry Upham Harns has already given $250 t o\r for this purpose. . Publications and Reports BitaJ cnnimuon - 363 gonococcus_____________ 7 5 In the field of pneumonokoniosis seven papers have been delivered before 920 various scicnbfic organizations. Reprints of five of them that deal with vxcnnrs ___ 6 v * oripnal work are bound with this report. Material for study is being l rpcaotni______ _____-- 129 gathered from every possible source, both human and experimental animal. Human - _ --------- 51 Xulatrd (or <f>a(nout M ui mminj'joni_____- - 103 % Whenever possible personal inspection of field conditions is being made. For example, the paper on "So-Called `Acute' Silicosis" was written after I studying all available data at the place where this condition was developed. _____________________________ J83S 9 fv The two remaining reprints in this volume are by Dr. Brumfiel and Dr Jameson respectively. The former deals with cardiac displacements ix chronic tuberculosis and the liner is a report of further observations os experimental genital tuberculosis. ' Finances The accompanying financial statement for the past fiscal year shows a bal anee in the treasury. This was made possible by various economies and by the receipt of income that was not anticipated when the budget was preparec and the work for the year was planned. The extra income was derived frotr contributions to the Academy of Medicine, from the contract with the U. S Gypsum Company and from a contribution of 5500 from "a group of friends". These friends are a number of industrialists in Milwaukee and the vicinity who, under the leadership of Mr. Benjamin E. Kuechle of the Employer: Mutual Insurance Company, and Mr. Harold Falk, raised a fund to bring together a group of specialists to inform themselves about silicosis. This wa_' ' the meeting mentioned in last year's report which Mr. Cummings and the director, among others, addressed in Chicago. After all expenses for thi: meeting had been paid an unexpended balance was turned over to the Labor atory for research purposes. We take this opportunity to thank them public!) for their help. For the coming year an income of approximately 5-0,000 is anticipated from various sources. Salaries have been raised at least to the same level a: they were before the enforced reduction of last year ar.d in some instance: there have been further increases commensurate with the services rendered One additional man has already been placed upon the payroll of the researcl staff and another will be employed some time during the year. Six new names appear on the payroll of field personnel and Mr. Cummings has beer transferred from laboratory to field work. The field expenses and moneys allocated to the x-ray department wil amount to approximately 516,500, leaving a balance to be expended in thi Laboratory of about 525,500. With the increases in salary that havt been made this sum will hardly be adequate to carry on the full progran of research that has been outlined. However, we have fairly good assuranct that certain new sources of income will become available and that some o! the older pledges on which we had not counted may be renewed. AJ1 receipt: from the Academy of Medicine will be devoted to carrying the diagnostic department. The only contribution that will be asked of the Trudeau Foundanon, whose income is depleted, will be a fellowship for the main tenance of the clinical diagnostician. It is a pleasure to acknowledge our debt and sincere appreciation to al the friends who have so loyally supported the Laboratory during a trying period. The assistance of the many lay contributors to the Academy of Medi one it extremely gratifying. The contributions of one large donor, the Metro pobtan Life Insurance Company, have been the mainstay of the experiments work during the past 6ve years To this company we are deeply grateful Tlit outlook for the coming year is brighter, hut we have greatly widenre the scope of our work and it behooves us to be diligent in seeking out new sources of support It is hoped that our activities may justify the trust tha has been placed tn us. 10 by Dr. Brumel and Dr. cardiac displacements in f further observation* on 4 as scal year shows a balnous economies and by the the budget was prepared income was derived from >e contract with the U. S. from "a group of friends", lilwaukee and thf*via'nity Cuechle of the Employer* k, raised a fund to bring ; about silicas*. This was * Mr. Cummings and the after all expenses for this turned over to the Laborairy to thank them publicly :ely $42,000 is anticipated : least to the same level as -e id in some instances - v. ,ie services rendered, the payroll of the research u.-t.-.g the year. Six new d Mr. Cummings ha* been the x-ray department will .ace to be expended in the ase- in salary that have carry on the full program havr'fairly good assurance available and that some of y lx renewed. All receipts to carrying the diagnostic oe asked of the Trudeau i fellowship for the main- sincere appreciation to all -aboraiory during a trying rs to the Academy of Medr one large donor, the Metroainsiay of the experimental ny we are deeply grateful ot we have greatly widened diligent in seeking out new may jusnfy the trust that tr r 75 A. ' RECEIPTS AND EXPENDITURES PARIANACLABORATORY FOR THE STUDY OF TUBERCULOSIS rc October 1, 1932 to September JO, 193J Receipts: Eilahce on hand Oct- 1, 1932 .................................................... $2,853.70 Fran, endowment held in trust by Trudeau Foundation: is Interest pn securities . a'a-.Interest pn cash balances . . cCifrr for maintenance of work: . $2,450.00 11.22 $2,461.22 cr ^Adirondack Fund for the . . Tuberculous . . . . Jr. .Anonymous (per Dr. Baldwin) mi lAgnes Musser Eckert Fellowship ' TGroup of Friends" . . , 1,000.00 . 100.00 1,000.00 500.00 Li*'.i:MeiropaiiL*n Life Insurance Co. TuntMilbank Memorial Fund . . 5.000.00 3.000.00 ir>:i3Misccllaneous donations . . 120.00 Tii. Oglcbay Norton 6? Co. . . . 3.750.03 ,T.*Saranac lake Academy of Medicine 2,010.00 trU. S. Gypsum Company . . . 2.375.00 5U:-S. Public Health Service . . 1,099.98 . Total of gifts ...... From Trudeau Foundation .. 19,955.01 3,000.00 25.416.23 .-...Total Receipts (carried forward) $28,269.93 'Scr follioinc pair* for Jill of donon I 11 1 -----.HI ^TT t-CT~C~. . i' ^,'V'-'V<*.i-:'i->>-` *vT'C^-^-l 'L'i-.'-.vc-.v-'T'^ 'or;.>*'..'.'."C^'-sv r/' PLAINTIFF'S I EXHIBIT 1660 (131 1 * 1 ; s\T=v^iTi -s^'rS.-V^ c? zt-fxx RECEIPTS AND EXPENDITURES SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS October 1, 1932 to September 30, 1933 ' Total Receipt* (brought forward) 528,269.93 Disbursement*: Salaries ............................................. Animals and feed.............................. 1,147.10 Supplies and equipment . . . 1,232.40 Fuel .................................................... 506.56 Gas .................................................... 136.35 Light and power.............................. Telephone ...................................... Laundry ............................................. Repairs ............................................. Library ............................................. 335.45 93.37 81.94 79.32 544.99 Publications ...... 238.55 Traveling expenses.............................. 271.82 ' Animal House: Building .... 92.22 Equipment ... 830.59 Miscellaneous expenses and supplies . 922.81 185.22 Contingent: extra supplies ' and equipment for new work . 864.90 Total cost of work carried on -- 524,115.06 Donation returned to donor . . 500.00 Toul disbursed .............................. 524,615.06 Balance on Hand Sept. 30, 1933 .. 12 3,654.87 --***** Mm S* *n* --iiaiinK.v'^' ^ 1934 . ^fje Parana: Laboratory for tfjc >tubp of ^ubmuloste OP THE EDWARD L. TRUDEAU FOUNDATION REPORT OF THE DIRECTOR AND FINANCIAL REPORT For the Year Ending September 30, 1934 REPRINTS OF SCIENTIFIC PAPERS {Cfjc^araiiarHa&c Scabcmp of jfFkbfrinc fry. Ihowing at ,he \t t tftf n B The fact that the Saranac Laboratory has always been a separate insti tution from the Research and Clinical Laboratory of the Trudeau Sanatorium is not generally understood. Both laboratories are sponsored and controlled by the Trudeau Foundation, but the Saranac Laboratory is located at 7 Church Street in the village of Saranac Lake and not at the Sanatorium. The properties of the Saranac Laboratory consist of the original budding, given to Dr. E. L Trudeau by Mr. George G Cooper in 1894 as a private research laboratory, together with the John Black Wing, of which a repro duction of a photograph appears in this report. The wing has been donated by Mr. and Mrs. Frank B. Black in memory of their son. The addition contains the library and lecture room, erected in 1927 and 1928, and private research rooms which are now in the process of construction. There are also two animal houses. _ Whde the Saranac Laboratory cooperates with the Sanatorium in every possible way and serves as the headquarters for the Trudeau School of Tuberculosis, it provides diagnostic facilities to the physaans practicing in the village and carries on independent researches in the field of tuberculosis and associated conditions. To avoid the existing confusion, the Trudeau Foundation is publishing an annual report of the Saranac Laboratory under separate cover. ' THE SARANAC LAKE ACADEMY OF MEDICINE In the early part of July, 1931, a group of physidans in Saranac Lake met in the John Elack Room to discuss ways and means for supporting the diagnostic and research activities of the Saranac Laboratory during a period of diminishing income. They were of the unanimous opinion that this institution is essential to the continued existence of the village as a center for the sdendfic treatment and study of tuberculosis, As a concrete expression of this feeling they constituted themselves the nucleus of a body to be known as the Saranac Lake Academy of Medicine. Its object is "to foster interest in the pursuit of sdendfic medicine in Saranac Lake" through the agency of the Saranac Laboratory. Its members pledge themselves to support the acdvines of this insdrudon in every possible way and to seek assistance from others for its opera don. The active members are physidans practising in Saranac Lake, but assodate, sustaining, and Life memberships are also open to interested laymen. In the financial report for the current year will be found a List of the present members. The formation of the Academy created nothing new; the Laboratory, the Library, the diagnostic service, the sdendfic lectures and research have always been an integral part of the medical life of the village, but by many they have been freely accepted as a natural heritage from the great founder of this health community. By membership in the Academy of Medidne, or by contributions through it, anyone can feel that he has a part in keeping alive the Trudeau ideals for the furtherance of medical sdence. ^ADEMY B pKysauu in Saranac Laic id meins for supporting the Laboratory during a period nanimous opinion that this e of the village as a center bercvdosis. As a concrete dves the nudeus of a body Medicine. Its object is **ts e in Saranac Labe" through rabers pledge themsdves to y po'-ble way and to seek ave abers are physicians ining, and Life memberships .ncial report for the current thing new; the Laboratory, lectures and research have of the village, but by many age from the great founder the Academy of Medicine, iat he has a part in beeping dical fdence. rU^t of the Director CONTENTS Financial Statement Reprints of Saeno'fic Papers: Inhaled Silica and its Effect upon Normal and Tuberculous Lungs Leroy U. Gardner Rdao'onships Between Hypersensia'veness and Immunity in Tuberculosis Donald E Cummincs and Anthony B. Delahant Tuberculosis of the Uterus and Fallopian Tubes with a Report of Two . Cases Treated with X-rays Edwin M. Jameson Tuberculin: Its Preparation and Use in the Treatment and Diagnosis of Pulmonary Tuberculosis Leroy U. Gardner and Edward R_ Baldwin THE SARAH AC LABORATORY FOR THE STUDY OF TUBERCULOSIS OF THE EDWARD I- TRUDEAU FOUNDATION Leroy U. Gardner, XI.D.---------------------- '_______ __ Director and Pathologist Arthur J. Var-wild, XI.D.-------------------___ _____ _____Assistant Pathologist Thomis XI. Durkin, XLE._______________ ____ ________ Assistant Chemist WinSeld O. Kelley, BA._____________________ ________ Clinical Pathologist Douglas S. WcCrum, B.S. (E.E.)___ Photographer Xlorris Dworslu ---------------- ------------- Assistant in Experimental Pathology Catherine XI. Cummings_____________________ ____ Librarian and Secretary Roy Dayton --_----------------- --______ ___ _____________ Financial Secretary James V. Luttrell--------------- --- ----------- ----- Purchasing Agent and Technician George Hulpritt-------------------------------------------------------- Technician Anthony DelahantTechnician Frank Creedon -------------------------------------------------------------------------- Technician Andrew J. Redlin____ ______ .______ _________________ Voluntary Assistant J. Cloyd Downs-------------------------------------------------------- Voluntary Asssrsam William LaBountyAssistant Henry C- Stout------------------------ Assistant rtUD AND OONSULTINC STAFF Donald E. Cummings, B.S. Homer L. Sampson, D.Se. Daniel XI. BrumSel, XI.D. Robert N. Downs_______ Richard Libby___________ Richard Walters________ Xlelvin Berg_____________ Dorothy P. Rogers______ Assistant Director in Charge of Field Wcn\ -----------------------Consulting Roentgenologist ----------------------------------Clinical Consultant ------------------------------------ - X-ray Supervisor ---------------------------- --------- X-ray Technician --- -----------------------------X-ray Technician --------- Bacteriological Technician and Cler^ ------------------------------------- X-ray Stenographer SPECIAL research students A O. Severance, XI.D. A Landau. XI.R.C.P .. --------------- Baltimore, Xld. Cape Town, South Africa ORY FOR ZXJLOSIS UNDATION ___ Director and Pathologist _____ ___Auuunt Pathologist __________ Assistant Chemist ____ ____ Clinical Pathologist ___------------ --- Photographer 11 in Experimental Pathology ------- Librarian and Secretary _______ Financial Secretary chasing Agent and Technician ----------------------------Technician ------ ---------------------Technician ---- Technician ----- Voluntary Assistant 1------------Voluntary Assistant ------ ------------- Assistant ------------- Asristant frSAFf ector in Charge of Field Wci^ -- Consuming Roentgenologist ---------Clinical Consultant ------------ --- X-ray Supervisor -------- ------- X-ray Technician ------------- - X-ray Technician -^logical Technician and Cler\ -------------X-ray Stenographer .TUDES'TS ________ Baltimore, Md. Cape Town, South Africa REPORT OF THE DIRECTOR OF THE SARANAC LABORATORY . FOR THE STUDY OF TUBERCULOSIS . -- 1934 -- * \ Lzxor U. GaXDNEX, M.D., Director A well known authority in the field of public health once remarked that the research student only begins to produce results of real significance when he is taken out of his laboratory and sent into the field. While some might qualify this generalisation, it cannot be gainsaid that effective investigation of disease can only progress in close contact with the patient. In times past the Saranac Laboratory was a successful pioneer institution in the study of tuberculosis. Dr. Trudeau and Dr. Baldwin, with their associates, had ample clinical material about them on which-they could draw for their scientific studies of this disease. When the problem of the inhalation of dust as a factor in the production of tuberculosis was begun there was Little thought that it might deserve years of study and that it would subsequently prove to be a subject of widespread popular interest. For years the attack was directed almost wholly along experimental lines. Few persons suffering from disease' due to inhaled dust found their way to Saranac Lake. To study silicosis in the human subject it was necessary to vis't the centers of industry and such visits at best could be infrequent and of short dura don. There seemed no choice but to continue an a purely experimental basis unless the investigation were removed to a mining or other industrial community. Then came years of stringency when the outlook for financial support from private philanthropes was most gloomy. But this apparent misfortune proved to be a turning point in the program of the institution. Because other sources of income had failed we were forced to make new alliances and in doing so were brought into inornate contact with the much needed clinical material for a well balanced investigation. It is hoped that we may profit by our opportunities and justify the confidence that has been placed in us. To take advantage of the situation it was necessary to expand. Important members of the research staff had to be sent into the field to study conditions of dust generation and its effects upon men who work in it. New members had to be secured to investigate the problems that developed. Wore space was essential that these men might work, for the old laboratory was not expected to accommodate more than five or six investigators. Last year's report died the progress that had been made in this program of expansion. This year sees us ready to begin operations on the broader basis. 7 STS' V.~ ' Two major field investigations are in progress under the supervision of Mr. Cummings, the assistant director. Several .thousand x-ray films have been taken and interpreted by Dr. Sampson and Us assistants. Three mare members have joined the regular laboratory staff and two graduate students will work with us during the coming year. The John Black Wing, providing sis new rooms for research purposes, is now nearing completion and almost enough funds are in sight to satisfy a 514,390.00 budget for the coming year. miD ntoc&AU On November first a contract was renewed with members of the Lake Superior Iron Ore Producers Association to continue the program of investi gation and prevention of disease due to dust among their miners. One company of the group decided not to participate in the program this year for reasons other than dissatisfaction with the services rendered. While their withdrawal materially reduces the income that we derive from this source, it is probable that responsibility for fewer men will enable us to make a more thorough study of those that remain. Last year's effort was devoted largely to a general survey of the industry and the inauguration of a program to prevent the formation of dust. This year the data already in hand will be analysed, the dust prevention measures will be applied to all parts of the various mines involved and examination of many of the miners will be repeated to determine whether they have developed changes that may be progressive. A considerable number of autopsies have been obtained upon men previously examined. A comparative study of the anatomical changes with the x-ray shadows in films made before death will add to the general knowledge of the action of mixtures of silica and other substances like iron. There is good reason to believe that the presence of the iron favorably influences the picture so that the silica is not as harmful as it might be when inhaled in the pure state. A bacteriological study of the sputum of miners with non-tuberculous infections of the lungs is in progress and autogenous vaccines are being used to treat some of these cases, A considerable number of infections with the Friedlander bacillus and associated organisms have been discovered. Another study was begun in a small group of fluorspar mines and mills during the summer. The program involved the determination of a possible hazard from this substance and, if such exists, the recommendation of methods for its correction. A considerable group of employees has been examined by the mine physician and their x-ray films have been studied here Tuber culosis is prevalent in the community as a whole but whether exposure to fluorspar dust is responsible has not yet been ascertained. No autopsies have yet been secured to determine the anatomical effects of inhaling this dust so that we shall be forced to rely upon animal experiments that are now in progress. The field work in the gypsum plant reported last year is completed and it has been possible to give the industry a clean bill of health. Recently a survey w-as made of a porcelain plant and a plan of investigation was mapped out. It will proceed along the lines of other investigations. 8 tcss under the supervision of al thousand x-ray films have -id his assistants. ' Three more i and two graduate students r ->_i Black Wing, providing taring completion and almotr 70.00 budget for the coming -d with members of the Lake ntinut the program of invesri* s among their miners. One .ate in the program this year ie services rendered. While oe that we derive from this fewer men will enable us to main. Last year's effort was idustry and the inauguration . Tliis year the data already measures will be applied to all vatioa of many of the miners have developed changes that autopsies have been obtained ive 'y of the anatomical cath will add to the it silia and other substances u; the presence of the iron jica is not as harmful as it bacteriological study of the ns of the lungs is in progress rat some of these cases. A lander bacillus and associated of fluorspar mines and mills r determination of a possible : recommendation of methods nployees has been examined : been studied here Tuberlie but whether exposure to ascertained. No autopsies lical effects of inhaling this inimal experiments that are 1 last year is completed and n bill of health. Recently i plan of investigation was other investigations. All credit is due to Mr. Cummings for the successful prosecution of this work. The officials of the companies with whom he is working have repeatedly praised the work which he doing and, here in the laboratory, we arc appreciative of the financial support made posable by his efforts, and of the x-ray and autopsy material that comes through him _Without the co operation of Dr. Sampson, at the Sanatorium, such an investigation would be quite impossible and the director is glad of the opportunity to express his appreciation. The associated field workers, Mr. Downs, Mr. Libby and Mr. Walters have loyally done their part in making a success of the undertaking. They all deserve praise for their devotion to their work. laboratory research The problems already under investigation have been continued during the year.' The inhalations of pure quartz, pure gypsum, pure hematite, ferruginous chert and a mixture of gypsum and quartz are still in progress The hematite and gypsum dusts cause no appreciable damage in the lungs and have no serious effect upon coexistent tuberculous infection. The chert, which contains a considerable amount of quartz, causes more damage in the normal lung and results in some progression' of a tuberculous infection. However, the changes that develop are not nearly as severe as those produced by pure silica. ' Tuberculosis in the chert animals progresses for a time and then becomes stationary or tends to heal with marked scarring, or fibrosis. Mixtures of equal parts of gypsum and quartz dust fail to produce significant changes in the lungs. On the other hand, groups of animals exposed on alternate weeks to pure quartz and pure gypsum dust are developing typical silicosis. This experience points to a protective action on the part of gypsum dust; probably because the gypsum particles tend to clump together in the atmosphere, they prevent the inhalation of significant quantities of quartz. The experiment is not yet complete but the implications arc fascinating in their posable bearing upon alicoas prevention. A study of the comparative reaction of different species of animals to silica dust is now completed. Guinea p'gv, rabbits, cats, white rats, white mice, and domestic fcrw-l have developed reaction to inhaled silica. The rats develop changes most nearly resembling those in human beings. The injection of a'lica suspensions into tadpoles and goldfish produces a marked tissue reaction which resembles that in the mammals. One may conclude that riliea is a poison for the tissues of a large variery of animals. Injection of silica and other forms of dust into the veins of rabbits is being used extentively to test their capaciry to cause damage. Silica cs iw a speafic arrhosis of the liver which does not occur with other dusts thus far treated. The otinimum dose necessary to produce reaction and the effect of different petrographic forms of silica are being investigated. The progressive nature of olicoris in animals is being studied in animals exposed for varying periods of time and then removed to a normal atmosphere. X-ray films are taken from time to time to demonstrate progression. The subject of tuberculosis susceptibility in the silicotic tissues is stfll under investigation. This year the possibility of alteration in the immune 9 Rate is being studied in silicodc animals infected with tubercle bacilli. Collateral experiments with pneumococcus and "irpirochaetal infections are planned to check the observations on tuberculosis. The marked similarity between the tissue reaction to the tubercle badllus^nd silica parades suggests that the injury produced by these two substances may be fundamentally the same in spite of their obvious difference in composition. Another set of experiments just started will test the tissue reaction to a representative group of silicates (silica in combination .with bases) which have common industrial uses. Theoretically these silicates are not expected to produce serious damage in the body but the possibility that they may constitute an industrial hazard is often questioned. One of them, asbestos, is exceptional and is now a well recognized cause of pulmonary disease. Another known as seriate has been suggested as an important factor in aiding silica to produce the condition of silicons. Mr. McCrum has completed a aeries of wax models of silicodc nodules from the lungs of experimental animals and from those of human beings. * These models demonstrate the similarity between the animal lesions and those in man. Both develop very largely in relarion to branches of the pulmonary artery. Another group of models graphically illustrates how silicodc nodules compress and thus interfere with the funedon of the lymphadc vessels, the drainage system of the lung. Stall another demonstrates how tuberculous infection penetrates into the interior of a preestablished s'b'cotic nodule. In addition to these studies, carried on by the regular laboratory staff. Dr. H. M. Kinghom is continuing his study of a tuberculosis vaccine. ` Dr. J. N. Hayes is still working on the effect of inhaled oil and upon die problem of experimental oleothorax; Dr. E. M. Jameson is still studying genito-urinary tuberculosis. Dr. D. M. Brumfiel is collecting data on the number of silicotic patients under treatment in tuberculosis sanatoria through out the country. He is espea'ally interested in ascertaining the effect of treatment in patients with a complicating tuberculosis. TTACHtNC In addition to the usual program of teaching, five days of the 1934 ' session of the Trudeau School of Tuberculosis were devoted entirely to the subject of silicosis. A program was arranged covering all phases of the subject: etiology, pathology, diagnosis by clinical and roentgenological methods, prevention, and medico-legal aspects. It is a pleasure to acknowledge our gratitude to the eminent authorities in their various fields who volunteered their services to lead the discussions. Dr. R. R. Jones, of the U. S. Public Health Service, spoke on etiology; Mr. D. E. Cummings, assistant director of the laboratory, covered other phases of his subject with speaal reference to at mospheric dust determination.The pathology of the disease was discussed by the director of the laboratory. Prof. Philip Drinker, of the Harvard School of Pubbc Health, discussed engineering methods of dust prevention and ebtrunanon. Dr. H. K. Pancoast, of the University of Pennsylvania, and Dr. Homer L Sampson, of the Trudeau X-ray Laboratory, spoke on the roentgenological appearances in silicosis. Dr. Henry S. Kessler. N. J. Rehabilitation Cbruc, 10 =7Zmj-Ti "ZT^Vr ted with tubercle baa'ili. spirochaetal infecoons art x. The marked similarity and silica parades suggest! may be fundamentally the dtion. - test the tissue reaction to ,'i nanon with bases) which : olicates are not expected possibility that they may A One of them, asbestos, tuse of pulmonary disease, as an important factor in models of silicone nodules ^m those of human beings, the animal lesions and those branches of the pulmonary ;strates how silicone nodules >f the lymphatic vessels, the tnonr.rv.es bow tuberculous bushed silicotic nodule, the regular laboratory staff, of a tuberculosis vaedne. of inhaled oil and upon die {. J -on is sail studying cl s leering data on the ibercuiobs sanatoria throughn ascertaining the effect of rulosis. ting, five days of the 1914 were devoted entirely to the covering all phases of the linical and roentgenological t is a pleasure to acknowledge arious fields who volunteered L Jones, of the U. S. Public namings, assistant director of t with spedal reference to atie disease was discussed by the tr, of the Harvard School of dust prevention and drain- Pennsylvania, and Dr. Homer spoke on the roentgenological N. J. Rehabilitation Clinic, . described the clinical aspects of the disease. Prof. Wm. S. McCann, of the University of Rochester, spoke on the physiology of the fibroid lung. Dr A. J. Larua of the Xfetropobtan Life Insurance Company summarued the sdentific aspects of the discussion and outlined the measures that are being adopted to handle the problem both from the medical and legislative view points. Mr. Paul Folger, an attorney from Rochester, N.Y., discussed the medico-legal phases of the subject. Most of the speakers remained for the entire week and took part in the informal discussions that constituted a very important part of the session. The John Black Room was crowded to capacity. Fifty-two special students registered for the week; 14 men from the regular tuberculosis course elected to remain and the rest of an audience of 130 was made up of invited guests and local physicians. The group was com posed of industrial physicians and executives, insurance off dais, and state compensation commissioners. An unofficial transcript of the proceedings was prepared by Mr. B. Keuchle of the Employers Mutual Insurance Company of Wausau, Wisconsin, and his associates Drs. Belknap, Benton, Carhart, Emer, Ford, Gray, Habbe, . and Lotz. Copies were offered for sale at $3.00 and the entire procerds ' were donated to the laboratory. It is with peculiar pleasure that we express our gratitude to Mr. Kuechle and those who assisted him in this work. PUBLICATIONS AND HiPORTS Only four papers have been published this year owing to the fact that pending experiments have not yet been completed. These have been of a general nature, dealing with the ecology and pathology of silicosis and other pneumonokonioses. A reprint of one of them, delivered before the general cession of the American Medical Association and representatives of tie group is included in this volume. Others were presented before the Americn Institute of Mining and Metallurgical Engineers, the National Safety Con gress, and the Radiological Society of America. A general article, "Pneumonokoruosis.'* written for International Clinics, will appear in June. Three papers by Dr. Gerald R_ Dowd, formerly bacteriologist on the staff, arc in press. Addresses were made before the physicians of the Genera] Electric Company at Schenectady, and before a legislative committee of the . State of Massachusetts. Considerable time has been devoted to the meetings of a committee of the Koru'dde Club appointed to formulate a classification of silicotic lesions and their appearances on the x-ray film. It is the hope of this committee to offer a standard nomenclature that can be generally adopted. This volume also contains reprints of an address on Hypersenstivenexs and Immurury in Tuberculosis by Mr. Cummings and Mr. Dclahant, of a paper by Dr. Jameson on Tuberculoss of the Uterus and Fallopian Tubes, end a Summary on Tuberculin by Dr. Baldwin and the director. STAFF On October first Dr. Arthur J. Vorwald joined the staff as assistant 11 pathologist. Trained at the University of Chicago, and coming to us after a year of post-graduate work at Cambridge, be brings to our problems fresh points of view. Hjs excellent training and his enthusiasm have already satisfied everyone that he is a most fortunate choice. ' Mr. J. Goyd Downs, a chemical engineer of distinction, is a voluntary assistant who has many times proved his worth by solving problems con cerned with the preparation of dusts for animal injection. We consider ourselves most fortunate that he can be with us. Mr. Frank Creedon worked so well and faithfully as a voluntary assistant last year that he was taken on to the regular staff as histological technician on October first. Two special research students are already at work upon silicosis problems, ' and a third will arrive shortly. Dr. A. O. Severance, of Baltimore, has carried on experiments dealing with silicosis in fish and amphibia Dr. A. Landau, M.R.C.P, of Cape Town, South Africa recently came to us from Brampton Hospital on a Dorothy Temple Cross Research Fellowship. He is working on the comparative influence of various silicates on the suscepti bility to tuberculous infection. Dr. F. Warden Brown, an Oxford graduate holding a Radcliff Travelling Fellowship, will shortly begin an intensive study of the action of one of the silicates known as seriate. It was recently claimed that this substance rather than quartz was the cause of silicons! In the field Mr. Richard Walters served faithfully as x-ray technia'an for six months until his health forced him to return for a period of rest. His work was appreciated not only here in his own organization, but by the physicians with whom be was associated at a mine hospital. We trust that tie interruption is only temporary. The other members of the staff remain as heretofore. The director takes this opportunity to thank all of them for the loyal service that they are rendering and expresses his appreciation of their cooperation. BUILDINGS A year ago rt was announced that Mr. and Mrs. Frank B. Black had offered to provide funds for additional laboratory work rooms. The John Black Wing is now nearing completion. It consists of the John Black Room, the bbrary and lecture room which these generous donors gave in 1927, and their recent gift of five new private laboratories located in a story above. In order to satisfactorily join the roof of the new wing with that of the old building it was necessary to extend the front gable of the latter. By so doing another large, well-lighted room was created in the attic of the old building. The photograph as reproduced in the front of this report shows the great improvement made in the front elevation by this change. The six additional work rooms and offices will fill a long-felt want by relieving the chronic state of congestion that has seriously hampered our work in the past several years. A necessary adjunct to the new addition was an increase in the heating plant. Rather than supplement an already overloaded system, it was found to be more economical to install new furnaces and to repipe the entire plant. Two new oil furnaces with a coordinated system of piping n 02go, and coming to us after brings to our problems fresh his enthusiasm have already raoice. of distinction, is-a voluntary th by solving problems con* mal injection. We consider LS. hfully as a voluntary assistant staff as histological technician : work upon silicosis problems. Severance, of Baltimore, Las n sh and amphibia. Dr. A. ica, recently came to us from oss Research Fellowship. He hous silicates on the suscepn* i Brown,.an Oxford graduate 11 shortly begin an intensive n as seriate. It was recently vas the cause of silicosis, faithfully as x-ray technician return for a period of rest, own organitadon, but by the tain' pitaL We trust that * .\ .eretofert. The director takes c lorya] service that they are or coopera non. iff .Mr*. Frank B. Black had Um / work rooms. The John consists of the John Black generous donors gave in 1927, lories located in a story above. new wing with that of the m gable of the latter. By so cited in the attic of the old ie front of this report shows don by this change. The six long-felt want by relieving ly hampered our work in the new addition was an increase an already overloaded system, new furnaces and to repipe coordinated system of piping 2 PLAINTIFF'S i EXHIBIT 1660 (27) 9 ------------------ I e are now in operation. It appears that the heating costs for the entire plant, I including the new addition, may be less than that for the old building alone. Our gratitude to Mr. and Mrs. Black for this new gift it unbounded, and as we occupy and use the new plant we shall have a continual cause to be r*. mindful of their generosity. & Toward furnishing and equipping the new work rooms, we have already received 51250. Of this sum 5250.00, from Mr. Henry U. Harris, was acknowledged last year. Dr. Frederick Willson has recently donated 51000. which is deeply appreciated. This sum will suffice to put two or more rooms into commission, and as fast as further funds can be procured the others will be furnished and occupied. - * clinical laboratory wort The diagnostic department has operated most effectively under the direc tion of Mr. Kelley, assisted by Mr. Delahant and Mr. Hulpriti. While the fees collected are entirely inadequate to support the service, the receipt of 51229. from the Saranac Lake Academy of Medicine has made its continuation possible. Mr. Kelley's fellowship at the Sanatorium secures him his b'ving expenses and his part-time associates receive part of their salaries from the Academy receipts. The following is a summary of the various diagnostic examinations made during the year ending December 31, 1934: SUMMARY OF DIAGNOSTIC EXAMINATIONS November 1, 1933 to December 31, 1934 ____Diphthrrii minim . 9 Satan for Vinctnt'* Angina - - 10 Blood: Agglutination for typhoid______ 16 161 269 111 41 Grouping _ 101 11 12 Sedimentation__ __ 54 Sputum for tubercle badllui______1177 Spina] fluid, urine and other material 5toEl irk mmmfi .. 4 MJk, baaeriologica! couou - . 48 Water, bacteriological examination... 75 . 426 6 Urine 1117 Autogenous vacanet prepared____ _ 19 Pathological apcomefil ___ ______ . 110 . 24 Animali inoculated for diagnosis __ 46 MitctUantoui examination* r ----- -- 280 Total _ _ _ _ - _ 4990 Of the autopsies performed, 7 were on cases of silicons with tuberculosis sent to the laboratory from the field. One was a of uncomplicated silicosis with death from generalised cardio-vascular renal disease. Of tne "pathological specimens'* 8 were lungs or portions of lungs from individuals who died after being exposed by occupation to dust of one kind or another. These were submitted for diagnosis by phyriaans in various parts of the country. 13 P- * r if At the end of the year, September 30, 1933; the financial statement showed an apparent balance of 53,654.87. This wis accounted for by advance payments of certain annual grants made during the fiscal year. The money tvas allocated to specific researches that were completed during the year. Likewise, at the end of the current year, there is an apparent balance of 510.390.81, which represents advance payments for work to be done during the coming year. In June a group of Mutual Insurance Companies through the American Mutual Alliance pledged their support to a three years* silicosis research program and paid thor first annual installment of 55,000 in September. In October a similar group of stock insurance companies, through the National Bureau of Casualty and Surety Underwriters, made a similar three-year pledge and recently paid one semi-annual installment of $2,5''. Each of these groups is financing certain specific problems of mutual inter to them and to the laboratory. The Metropolitan Life Insurance Company has renewed its annual pledge of 55,000. for the continued study of infection in association with silicosis. The U. S. Gypsum Company made an additional grant of 51,000. for the continuation of experimental studies, on the protective action of gypsum dust against the inhalation of silica. Experiments begun during the past * year were not completed and they seemed of sufficient importance to warrant continuation. . The decreased income from the iron ore study has been apportioned between field and research laboratory expenses in approximatly the same ratio as last year. After deducting the costs of carrying on the work in the field and the payments due Dr. Fampson's laboratory for x-ray consul tation, there remains only about 56,110. to carry on animal experimentation. This will not cover the actual cost of the work here but it is of such importance that the balance is bang provided from ocher sources. The fluorspar study, with a grant of $3000. is self-supporting as no long-term dust inhalation on animals is involved. The receipts from Mr. Kuechle's sale of Silicosis Symposium proceedings have amounted to 5655., but none of this money was received prior to the end of our fiscal year on October 31, 1934. A contract for diagnostic work at the Northwoods Sanatorium has been renewed with the Adirondack Fund for the Tuberculous. This yields 51,000. which is applied toward an assistant's salary. The Agnes Musser Eckert Fellowship provides for another worker. The loyal support from the Milbank Memorial Fund constitutes a back-log on which we have relied so long. Receipts through the Saranac Lake Academy of Medicine amounted to $1,229., all of which was applied to the operation of the diagnostic department. E. R_ Squibb 6* Sons made an appropriation of $200.00 to Dr. J. N. Hayes for his investigation of the action of various oils in the pleural cavity. For the coming year anticipated operating expenses will amount to $54,390. in addition to a sum of 58,500. to equip and furnish the new- work rooms in the John Black Wing. Income is in sight to cover all but $4,000. of the regular budget and we have faith that this and the special 14 30, 1933, the financial statement his wax accounted for by advance . ring the fiscal year. The money ere completed during the year, there is an apparent balance of ents for work to be done durinc ul Insurance Companies through support to a three years' silicosis usual installment of $5,000 in ock insurance companies, through ry Underwriters, made a similar .mi-annual installment of $2,500, ecific problems of mutual interest ipolitan Life Insurance Company r tlae continued study of infection additional grant of $1,000. for the protective action of gypsum serinents begun during the past { su5rient importance to warrant otc sntdy has been apportioned senses in approximatly the same osts of carrying on the work in son's laboratory for x-ray consulcarry on animal experimentation, he work here but it is of such vided from other sources. The s self-supporting as no long-tcnn f Silicosis Symposium proceedings money was received prior to the .934. A contract-for diagnostic ten renewed with the Adirondack ..000. which is applied toward an n Fellowship provides for another Ibank Memorial Fund constitutes ig. Receipts through the Saranac $3,229., all of which was applied mt priation of $200.00 to Dr. J. N. : various oils in the pleural cavity, crating expenses will amount to ). to equip and furnish the new icume is in sight to cover all but ve faith that this and the special equipment fund will be secured during the year. To make our sta * shiud have a petroprapher to identify and analyse the rock specimens from hich dust for experiments are now prepared. At the present time we axe torccd to rely upon the generosity of other* for this service. In conclusion the director wishes to express his gratitude to Dr. Baldwin, director.of the Trudeau Foundation, for his hearty support, to all his associates for their loyal cooperation, and to those whose financial assistance has made posable the continuation of our work. , 15 '^ ; SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS RECEIPTS AND EXPENDITURES October I, 1933 to September 30, 1934 Receipts: Balance on hand October 1, 1933 ----------------------- From endowment held in trust by Trudeau Foundation __________________ --_ 51,873.00 Other interest and exchange__________ 1J.69 Gifts for maintenance of work: Adirondack Fund for the Tuberculous 1,000.00 Mr. Henry Upham Harris_________ 250.00 Hillside Huor Spar Mines______ 250.00 Dr. Leroy U. Gardner____________ 375.00 Dr. Hugh M. Kinghom (on pledge) 1,000.00 Mr. Lawrence Macfarlane_________ 300.00 Metropolitan Life Insurance Co.__ 3,749.94 Michigan Ore Mines 27,500.00 Milbank Memorial Fund_________ 3,000.00 Miscellaneous Gifts *___________ 105.00 National Atwiarion of Mutual Casualty Companies_________ 5,000.00 Oglebay Norton 6* Company____ 416.67 Mr. Arthur B. Purvis_____________ 750.00 ' Rosiclaire Lead Fluorspar * Mining Companies_____________ 375.00 Saranac Lake Academy of Medicine* 1,229.00 E. R. Squibb fir* Sons_____________ 200.00 U. S. Gypsum Company________ 2,875.00 _______ 53,654.87 1,890.69 Total of gifts Total receipts (carried forward) 48,375.61 -------------- 50,266.30 ,53 921.17 * See following pages for list of donors i> UDY OF TUBERCULOSIS ditures sex 30. 1934 I u SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS RECEIPTS AND EXPENDITURES Octobex 1, 1933 to September 30, 1934 53,614.87 .87J.00 1J.69. ----------- ,1 000.00 250.00 2J0.00 375.00 l.or ' 31 3.749.94 :7.ioo.oo 3.000.00 105.00 1,890.69 5.000.00 416.67 750.00 375.00 1.229.00 200 00 2.875.00 48,375.61 ________ - 50,266.30 53.921.17 Tool receipts (brought forward) ____ J3.921.17 .Dubun emeriti: * For Libontory work and maintenance: Salaries 18,905.14 Supplies and equipment___________ 2,211.46 Animals and feed____________ 1,915.04 Fuel 704.55 Gas______ ________________________ 162.57 Electric light and power_________ 500.63 Library 4 50.66 Telephone ____ 103.01 Laundry________________________ 79.52 Publications _____________________ 396.35 Travel _____ 246.84 Repairs __________ 69.46 Miscellaneous ___________________ 96.70 . ------------------ 25.841.93 For work in the eld: Salaries ________________ 14,219.98 Travel, including automobile, etc__ 1,533.43 Advances to workers for expenses 625.00 Miscellaneous __________________ 111.54 ------------------ 16.489.95 Total cost of work 42,331.88 Transferred to Trudeau Foundation, reimbursement for funds advanced for new animal house built in 1933 ___________ 1,193.48 Total disbursed______ _____ _--_____--_______________ ____ 43,530.36 Balance on hand September 30, 1934 17 10,390.81 --Li 7^.7j * . Contributions . to the - SARANAC LABORATORY ' From October 1, 1933 to September 30, 1934 (Note: Item* in *econd column received after October la to be credited in 1931 nanaial report) Adirondack Fund for the Tuberculous 1,000.00 249.99 Mr. and Mrs. Frank B. Black, for building 5,500.00 Mrs. Bigelow Crocker, . thru Dr. H. M. Kinghom . . . 5.00 5.00 Mrs. Charles L. Crocker, thru Dr. H. M. Kinghom . . . 25.00 50.00 Mr. Henry Upham Harris, . toward new building .... 250.00 Hillside Fluor Spar Mines. . . . 250.00 500.00 Dr. Leroy U. Gardner .... 375.00 25.00 General Refractories Company . . 50.00 Dr. Hugh M. Kinghom (fulfilling pledge . toward animal house completed 1933) 1,000.00 Mr. B. E. Keuchle and associates, sale of publication, "Silicosis Symposium" 655.00 Mr. Lawrence Macfarlane, thru Dr. H. M. Kinghom . . 300.00 Metropolitan Life Insurance Company 3,749.94 2,499.96 Michigan Ore Mines, thru Pictands, Mather S' Company 27,500.00 6,358.54 Milbank Memorial Fund ... . 3,000.00 National Association of ` Mutual Casualty Companies . ,. 5,000.00 National Bureau of Casualty and Surer}' Underwriters . . . 2,500.00 North American Refractories Company 25.00 Oglcbay, Norton 6? Company . . 416.67 Mr. Arthur B. Purvis, thru Dr. H. M. Kinghom . . . 750.00 Rosidairc Lead and Fluorspar Company 375.00 375.00 Carried forward . . 42,971.61 18.718.49 ORY . ber 30, 1934 ifW October la report) 1,000.00 249.99 ing 5,500.00 . 5.00 5.00 . 25.00 50.00 . 250.00 . 250.00 . 375.00 . * 50.00 e t 1 00 500.00 25.00 ' ' * 655.00 300.00 3,749.94 2,499.96 27,500.00 6,358.54 . 3,000.00 . 5,000.00 . 2,500.00 t 25.00 . 416.67 . 750.00 / 375.00 375.00 42,971.61 18,718.49 Brought forward............................... Saranac Laic Academy of Medicine Mrs. John F. Archbold . Clinton J. Ayres, Inc. . ` Dr. Edward R. Baldwin Dr. Robert J. Bede . Boyce Ef Roberson . . Dr. H. A. Bray . i Dr. H. B. Brown . . Dr. Lawrason Brown . Dr. David A. Cooper . Mrs. F. C. Deemer . Dr. Joseph T. Eagan . Mrs. A. C. Erkander . Mr. H. C. Eyer . . Miss Anna L. Gilbert . Dr. Albert G. Hahn . Dr. John N. Hayes . Dr. Fred H. Heise . . Mr. Fred A. Howland . Dr. E. M. Jameson . Dr. Hugh M. Kinghom Mr. Herbert R. Leggett Mr. Wm. C. Leonard . Dr. S. S. Lichtman . Dr. Edgar Mayer . . Kir. H. S. Parker . . Mr. R. F. Plank . . Dr. Samuel Post . . . Dr. J. Woods Price - . Dr. Walter L. Rathbun Dr. John C. Russell . Dr. Homer L. Sampson Sanatorium Gabriels . . Miss Ophelia Sawtell . Dr. David T. Smith . Miss Dorothy Smith . Mr. Robert B. Smith . 42,971.61 IS.71S.49 50.00 ' 50.00 ' 50.00 15.00 20.00 25.00 10.00 50.00 50.00 50.00 25.00 10.00 10.00 25.00 10.00 50.00 25.00 50.00 25.00 5.00 10.00 34.00 50.00 10.00 10.00 10.00 10.00 50.00 25.00 10.00 10.00 100.00 25.00 10.00 15.00 25.00 10.00 Carried forward . . . . 43,905.61 18,803.49 u Cf < Brought forward ..... 43,905.61 18,803.49 Dr. Willard B. Soper . 1 . ..{ 50.00 Dr. Earl R. Templeton . . . . ` 10.00 Mr. Lewis S. Thompson . . . - 50.00 Dr. Charles C. Trembley' . . 25.00 Miss Jean Turnbull . . . ! 20.00 Dr. William A. Wardner . _ . 50.00 Dr. George E. Wilson . . . . 65.00 In Memory of Sydney Lunt Wood . 50.00 Dr. Warriner Woodruff . . 25.00 E. R. Squibb 6? Sons, thru Dr. J. N. Hayes . U. S. Gypsum Company . ' . . . 200.00 . . ' . 2,875.00 250.00 Utica Mutual Insurance Company 100.00 - Dr. Frederick and Mr. Thomas A. Willson, * toward equipment of building . 1,000.00 Mrs. S. L. and Mr. John P. Wood, in Memory of Sydney Lunt Wood . . 20.00 45,375.61 20,213.49 Mr. Frank Connable, thru Dr. Elliott P. Joslin, a Microchemical Sugar Apparatus 20