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PLAINTIFF'S EXHIBIT 1933 i. tEfjc Saranac XCaborabor? for tfjc >tubp of ZCubmuIoste OF THI EDWARD TRUDEAU FOlWDATiOH ------------------------------------- ' REPORT OF DIRECTOR and FINANCIAL REPORT - FOR. THE TEAR DHDIHC SEPTEMBER. 10. 1911 .j * * \ ! REPRINTS OF SCIENTIFIC PAPERS fEfjr ^aranac Hake Sfeabemp of jflcbirinc THE SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS OF THE EDWARD L. TRUDEAU FOUNDATION Leroy U. Gardner, ME.-----------Thomas M. Durkin, M.E. --------Winfield O. Kelley, BA.-----------Douglas S. MrCrum, B.S. (E.E.) Morris Dwordd, C.PH.------ -------Catherine M. Cummings------------Roy Da)ton____________I--i----Junes V. Lutrrcll-----------------------George Hulpria __ _____________ _ Anthony Delahant----------------------Andrew J. Red tin_______________ Everett 1_ Wore------ ------------------William LiBounty----------------- -- Henry C. Stout__------------------- ------------------- Dinner and Pathologist ----- - ---------------Asrittanl Chemtst _____ ____________ Clinical Pathologist ----- -------------- --------------- Photographer -- Asrirtant in Experimental Pathology --_____ ___ Librarian and 'Secretary ------------------------- financial Secretary ---- Purchasing Agent and Technician! --------------------------- -------- -- Tcchnician j ------- .-------------------------- Technician -- Voluntary Arrirtaru in Oiemirtry -------- Voluntary Technical Ain'rlaui --------- . . -----------------------------Airutant ---------------------------------------- Airirtanl Field and Consulting Sta/f Donald E Cummings. B.S.______Airutant Director rm Charge o/ Field Wor\ Homer L. Simpson_____________ _______________ Consulting Roentgenologist Daniel M. Brum&el, M.D.______ ___ ___ ____________ _ CLnicoi Coniultant Robert N. DownsX-Ray Supervisor Richard Libbey _ X-Ray Technician Richard WlitersX-Ray Technician Dorothy P. Rogers1-------------------------------------------------- X-Ray Stenographer fpR -IS .TION 2trrrtor and Pathologist ____ Aw'iunl Chemist - Clinical Pathologirl ___________Photographer Experimental Pathology Librarian and Secretary Financial Secretary g j\gcnl and Technician Technician -------- --____ Technician / Auuunt in Chemistry tary Technical Assistant -------------------- Auinant ___ ______ Airiiiant K in Charge of Field Wor\ miulttng Roentgenologist ____Clinical Consultant ---- X-Ray Supervisor ------ X-Ray Technician ---------X-Ray Technician ---- X-R^y Stenographer Report of the Director Financial Statement CONTENTS Reprints of Scientific Papers s The Pathologic Reaction in Various Pneumonoconioses Lutor U. GaADNM. i i Experimental lnhalao'on of Bituminous Coal Dust and Its Effects .Upon Primary Tuberculous Infection in Guinea Pigs _ Liaor U. Gaxdne*. Donald E. Cuusjikcs and Geiaid R. Down t The Reaction to Fine and Medium Sited Quarts and Aluminum Oxide Particles -- Silicotic CirrhosT of the Liver Leaot U. Caadneji and Donald E. Cuvmincs i Pathology of So-Called Acute Silicosis Tutor U. Gaasneji Silicons and Its Relationship to Tuberculosis Lutor U. Gaadnejc A Study of Tuberculous Infection by Way of the Female Genital Tract: A Supplementary Report Edwin M. Jameson The Heart and Tuberculosis: Mediasrinil Distortion as a Source of Circulatory Embaraa-ment Daniel M. BausiriEL -c: THE SARANAC LABORATORY The fact Out the Saranac Laboratory has always been a separate institu tion from the Research and Clinical Laboruory 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 given to Dr. E. L Trudeau by Mr. George Q Cooper in 1894 as } private research laboratory, together with the John Black Room, an addition which, houses the medical library and lecture room, and special buildings forj animals. While the Saranac Laboratory co-operates with the Sanatorium in every possible way and serves as the headquarters for the Trudeau School of Tuber culosis, it provides diagnostic facilities to the phynaans practicing in the village and carries oa 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. REPORT OF THE DIRECTOR OF THE SARANAC LABORATORY - FOR THE STUDY OF TUBERCULOSIS 193) Lixor U. Caxdnex. M.D. )RY It is a pleasure to announce the consummaoon of the plan suggested in , the Director's report of last year whereby the Saranac .Laboratory is enabled been a separate insn'tu- to undertake a comprehensive experimental, clinical, epidemiological, and be Trudeau Sanatorium engineering investigation of pncumonokoniosii as a causative factor in the: ponsored and controlled production of tuberculosis. This most desirable approach to the problem! oratory is located at - 7 at the Sanatorium. - of the original building xx in 1894 as a private oam, an addition-which d special buildings for should advance our knowledge more effectively than by attacking it along,,* any tingle 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 L comprehend and alleviate dust hazards which may be discovered and furthermore they are fundamental so define the etiology of a disease like ' j he Sanatorium in every rvdeau School of Tuberj'a'ans practicing in the field of tubc-culosis and pneumonokonioss. 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 m is publishing an r*.., cover from that of ment of Trudeau Sanatorium, and the Saranac Lake ipcaalists practicing in the held of chest diseases. Not only will this combiaanon of resources permit a more comprehensive scientific investigation but it allou-t us to offer industry a consulting sendee for the detection of posable hazards from dust, for the proper examination of ru employees, for recommendations to improve working condioons 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 tbe field. He will train engineers already employed by the industries in the technique of making atmospheric dust determinations; he will have supervision over vcntilaoon, over clinical laboratory work in the 1 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 I department, who is now in charge of all roentgenological eliminations. ] Under their direction are technicians also trained by Mr. Sampson. At the present time Mr. Richard Libby is already at work and Mr. Richard Walters i will begin in the near future. Thar excellent training will insure satisfactory films which will be sent to Mr. Sampson, for interpretation. Where plant physicians arc available we propose to secure their co-operation in making physical eiaminaiions: if no suitable local physician can be found Dr. D. M. Brumfic) of Saranac Lake will make them. S Simultaneously with this investigation in the field, a laboratory rrudy of the particular dusts and their effect upon the normal and ruberculouj animals * will be undertaken. The final co-ordinaoon of data from all of.lhese sources ihould enable ut to obtain a clearly defined picture of any given duet hazard. Ai reported last year, a contract was made with Oglcbay Norton and Company to carry out cuch a study in an iron mine which they operate. This * work ii now in progreat, together with animal experiments using ore and rock dusu from the mine in question. In the Spring we were approached by the United Sutes Gypsum Cexnpany ^ to make a survey of their plant and employees in Oakfield, N.Y. Their operations comprise mining, pulverising and calcining gypsum dust together with the manufacture ol gypsum plaster, wall board and various other products. A series of dust counts was made in representative parts 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 concentrabans developed in certain parts pf the plant, there were no xignificcnt changes produced by <he 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 ccc upon nsbcTCulous in/tenon. The evidence thus accumulated corroborates: the prevalent opinion that the inhalation of gypsum, or calcium sulphate, does i not cause changes in the lungs which are deleterious to health, nor docs it - * predispose to tuberculosis. .During the. Fall , the entire group of companies opcnbng iton mines in the northern part of Michigan derided to employ the Laboratory to make a survey of all their mines. They desired to know whether iron mining involves any risk from dust inhi.arion and if so they wished to take measures to minimize this haurd. On November first a contract for 530,000 annually, for a period of three years, was signed between the Laboratory and the following operators: The Cleveland Cliffs Iron Company. The Corrigan. MclCinncy Steel Company, Davidson Ore Mining Company, The XL A. Hanna Company, Agent, Inland Steel Company, Oglehay Norton and Com pany, Agents. Oliver Iron Xf/ru'ng Company. Pickandi Mather and Company, Agents, and Republic Steel Corporation. The original contract with Oglebxy Norton and Company is, of course, superseded by the new one to which they arc parry. Under Xlr. Cummings" direction this field investigation is already under way. Engineers arc bring trained to make dust determination!. Large numbers of roentgenograms made by the technical staff are being tent to Mr. Sampson for interpretation and a series of laboratory investigations of the action of mine dust has been started in 5aranac Lake. It is as yet too early to venture an opinion as to the results of this study, but in time we will have all the necessary informioon to evaluate the effeets of work in iron mines. These contacts have permitted the Laboratory to proceed with its program of research wluch would otherwise have been seriously hampered by the lack of funds. Xlr. Cummings wall, of course, not be able to continue his work 6 ^7^ a laboratory Rudy of tuberculous arum ala n all of these sources of any given dun Hazard. Vith Oglebay Horton and which they operate. Thi . xperimenu using ore-"and ii J Statu Gypsum Company n Oalc field, N.Y. Thear ting gypsum dun together board and various other cpreaentao'vc.pans of this ` periods of time in various uboru, and three different We were able to demon' idons developed in certain ;es produced by the inhaif years. The animals also J there has been no effect accumulated corroborates , or calaura rulphate, does oui to health, nor does it s operating iron mines in ` the Laboratory to male aw whether iron mining f wished to tale measures r SJ0.000 annually, laboratory and the Company, The Corrigan. ; Company, The M. A. glcbay Norton and Comis Mather and Company, taJ contract with Oglebay the new one to which bgaoon is already under determinations. Large stiff are being sent to oratory investigations of : Laic. It is as yet too aidy, but in time we will effects of work in iron proceed with its program !y hampered by the lack ilc to continue his wotk s i \ s b * \ 2 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 fuD a pa ary with five dust^ inhalation experiments in progress, using pure silica, hematite, gypsum, and various combinations of these substances. Nearly 500 guinea pigs and a smaller number of rabbits and whit? rats are involved in these experiments. The chief problems now being 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 silicosis which predisposes to tuberculous infection; the effects of non-bb'ccoux dusts inhaled simultaneously with olio; the continuation of previous studies upon the effect of panicle die in' the production of tissue reaction. A method for recovery and measurement of all the extremely fine inhaled dust parcicln * in portions of the silicotic lung promises to yield valuable information. The previously menboned attempt to develop a rapid method for'deter* mining the dangerous characteristics of various kinds of dusts is still 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 additional experimental data has been accumulated on the relation* ship be"ween silicon's and tuberculous infection, but it has teemed advisable, to defe ' reporting these .finding: until they on be correlated with the con*, dibon in human bongs. In this connection the general problem of the' rclxboruhip between immunity and silicosis is receiving careful artenbon. Some of the chemical problems which Mr. Cummings had started are being continued, notably a study of the various forms of silica and alumina, and the reaction which they produce in animal bssucs. Much bme is being devoted to the deicnninadon of the type of dust found in the lungs of persons dying with different forms of pneumonokoniobs. During the year material from thirty-six such cases has come to the Laboratory for examin ation. Chemical analysis is not an altogether satisfactory method for the idcnbfication 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 tome 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 inverbgabng the occurence of nonpathogemc add fast bacilli in vinous habitats. Dr. JG'nghom and Mr. Dvoraks are continuing their work on vaednabon igajnst tuberculous infection. Mr. Cummings and Mr. Dclahant have nearly completed their study of hypcrsenntivcness and immunity in tuberculous. Dr. J. N. Hayes has been testing the ructions of the lungs to various oils and is also studying their relative effectiveness in t.ic maintenance of olcothorn in the expertmenul animal. Recently he has obtained a grant of 5200 from the E. R. Squibb Company to investigate the effect of irradiated miners] oil on tuber culosis of the pleura. Mr. Winfield Kelley, in co-operation with the x-ray department of the Sanatorium, is artempong to produce pulmonary tubercu losis in cau and to follow the course of the infection rocnigenogra phial]/". If this could be accomplished in a resistant animal Lie the cat it would prove a valuable tool in our studies. for blicasis has been reproduced in this animal which has very large lung fields that arc easily visualised in roentgenograms. Dr. D. M. Br-umfiel is assisting in the study of several of the laboratory obeon's problems. Dr. E. M. Jameson is continuing his investiga tion 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 Tuberculooia 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 1914 we hope to have several physicians frbm the mining companies for whom we are making the field study. If this plan materia Ities considerable time will be devoted to the pathology and x-ray appearance of pneumonokoniosis. Clinical Laboratory Wor^ The diagnostic department has been under the direction of Mr. Winfield O. Kelley since September when Dr. Schw-aru left us to accept a position in the Sanatorium. He is assisted by Mr. Delahant. As will be seen in the appended summary, 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 pabents 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 cast, as many pabents were unable to pay even a moderate fee. The contributions of 12,010 received from the Academy of Medicine have been devoted to the support of this department. Mr. Kelley, who receives no salary but is dependent upon fees, is the recipient of a fellowship and spends part of hit time in the Sanatorium. Summary of Diagnostic Fxomiruiions . hfouember 1, 1932 to biovember 1, 1933 Culturci for dipHOirrii *_____ _ 16 Smnri for Vinerni'i *rfina_____ --. 11 Blood: AffIwLinition (or ry-pboid_______ - 10 DrfidcnLiil (Ounu___________ .____ 101 Red md ^Hitr counit,,. 201 HcreiclobiA dcicmuniooni _____ It CoJguJitJOA urar *1 Grouping 71 Cull Uf C 1--------------- --------------------------------- 10 Chcnniiry si Spinal fiuid. unni jnd Oihrr oxitftl- Itnroui m*irni! for lutcrclc biolluii !! Cund lot*! ________ __ _ Slomtrh commit 31 Sputum for tubffdr biollui 1ST! Mill. bnrnolocc*J counu .________ 17 bturnoIogicAl rnminiuon _ 51 N^^itrr, cbfrorcjJ fjirruniiion_______ 16 5 Smcin for ronocoecut 7 Unnc______ ...___ _____ ....______ ______ 920 Auiofcnoui vitnnri - r - .. _____ 6 PiiKologifil iprament_______ _______ _ 139 Autopuci. humin _____ ___ 11 Animili moculjicd for dtrgnotit - H XdiKrMjnrout tttminjoom . . 102 8 t' -'neral oil on tubersn with the x-ray U. pulmonary tubercuon roentgenographically. J like (he ext it would ccn reproduced in (hit lie easily visual/ted in aertudy of tcvcrai of the cononuing hit invescigi- - ram during the part year, s' Training School at the Jodi. For the latter the tore intimately with the e teverai phyua'ant from the field midy. If thii ad to the pathology, and direction of Mr. Winfield i ut to accept a- position V. At will be seer. in the tjont fell below that for :ate in the number of the 7 Laboratory facilities i .hout cost, as many re. the concribubont of have been devoted to the receives no taJary but is up and spends part of hit lariani 1. 193 J tubercle bsallui -__---1 C11 ototKii counts ---- -------- 17 mologicxJ tnmiruLon -- U iinj iiiraintuoA ________16! gonococcus ....----- --. 7 970 iitnnti ...__ 6 ptootni___________ -- 179 umsn___ ___ _______ ____ 11 iwlsicd 1or diitnol,i-----l4 niminltioni__________ 102 ________lilt ai * X w m i * X9% crt. i. P. P; .\ ` Su Mr. Cummings* absence and the increased amount of work that will be undertaken will necessitate the employment of more full time members of the tuff.* An effort it bong made to find a properly trained pathologist and bacteriologist to relieve the director of some of his responsibilities. Sev eral prospective candidates are being considered. Mr. Thomas M. Durkin, a eraduate'of Cornell in mining engineering, has been serving at voluntary assisunt in the chemistry department for eight months; he is now joining the regular staff at assisunt chemist. We are fortunate to find a man with hit training to devote to the laboratory phases of a problem such as curt. Mr. Winfield O. Kelley has uken over the direction of the diagnostic department and is also engaged in research here and at the Sanatorium. The director takes thit opportunity to express hit appreriiDon to every | member of the tuff for their loyal co-operabon during the year of reduced ^ incomes and ulirics To Dr! Spencer Schwartz, who reu'red in September, everyone is grateful for hit faithful though inadequately compenuted < services in the diagnostic department. Gratitude u expressed to three voluntary assisunts. 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 conbnue as assisunt in chemistry. - T Great credit is due to Mr. Cummings for developing and organising the i field research activities, for without the income from this source very Is trie 1 of the Laboratory work could continue. It is regrettable that his own researches must be interrupted, but his engineering training parocularly qualifies him for the type of work in which he is now engaged. Buildings Even at the present time the accommodarions of the Laboratory are inadequate to carry cm the work in progress, and for the proposed increase in the tuff addibonal space becomes imperative. The logical place for expansion it 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 grabfying. Plans are now under con sideration and it is hoped that construction may be commenced in the Spring. For furnishing and equipping this addition the auppon of other fnends will undoubtedly be tecured. Mr. Henry Upham Harris has already given 5110 for this purpose. Publications and Reports In the field of pneumonokonioui seven papers have been delivered before various seientjfie organizations. Reprints of five of them that deal with oripnal work are bound with this report. Material for study is being gathered from every possible source, both human and eipcnmenul animal. Whenever povnhlc personal inspection of field conditions is being made. For example, the paper on "So-Called `Acute* Silicosis" was written after studying all available dau at the place where this condition was developed. 9 The two remaining reprints in this volume are by Dr. Brumfiel usd Dr. 'Jameson respectively. The /turner deals with. cardiac displacemcntr in chronic tuberculoot and the latter is a report of further observation* oo experimental genital tuberculosis. Finances The accompanying financial statement for the part fiscal year shows a bal* ance in the treasury. This was made possible by various economies and by the receipt of income that was not anticipated when the budget was prepared and the work for the year was planned. The extra income was derived from contributions to the /icadcmy of Medicine, from the contract with the U. S. Gypsum Company and from a contribution of J50C from "a group of friend*". 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 tc^ bring together a group of specialists to inform themselves about silicosis. TH* was the meeting mentioned in last year's report which Mr. Cummings and the director, among others, addressed in Chicago. After all expense* fdr thi* meeting had been paid an unexpended balance was turned over to the Labor atory for research purpose*. We take this opportunity to thank them publicly for their help. For the coming year an income of approximately $42,000 >* anticipated from various sources. Salaries have keen raised at least to the same level as they were before the enforced reduction of last year ar.d in some instances there have been further increases commensurate with.die services rendered. One additional man has already been placed upon the payroll of the research cz and another will be employed same time during the year. Six new names appear on the payroll of field personnel and Mr. Cummings has been transferred from laboratory to field work. The field capcnscs and moneys allocated to the x-ray department will amount to approximately $16,100, leasing a balance to be expended in the .-Laboratory of about $25,500. With the increases in salary that have been made this sum will hardly be adequate to carry on the full program of research that has been outbned. However, we have fairly good assurance that certain new sources of income will become available and that tome of the older pledges on which we had not counted may be renewed. All receipts from the Academy of Medicine will be devoted to carrying the diagnexstie 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 all the friends who have so loyally supported the Laboratory during a trying period. The assistance of the many lay contributors to the Academy of Mediane it extremely grari/jing. The contributions of one large donor, the Metro politan Life Insurance Company, have been the mainstay of the experimental woik during the past five years To this company we are deeply grateful. The outlook for the coming year is brighter, hut wc have greatly widened the scope of our work and it behooves us to be diligent in seeking out new sources of support. It is hoped that our actiones miy jusnfy the trust that has been placed in us ,, PLAINTIFFS i exhibit by Ot. Brumfael and Dr. cardiac displacements in f further observation* on art fiscal year shows a balrious economics and by the the budget was prepared i income was derived from i contract with the U. S. from "a group of friends" dwjukce and thf"vicinity 'uechle of the Employers k, raised a fund to bring about silicosis. This was , Mr. Cummings and the ftcr all expenses for this turned over to the Labor* ity to thank them publicly Jy 542,000 is anticipated least to the same level as or and in some instances LL <he services rendered. Toll of the research he year. Six new Mr. Cummings has been ic x-ray department will e to be expended in the see-in salary that have irf on the full program avr'fairly good assurance -ailablc and that some of In renewed. All receipts o .-urying the diagnostic asked of the Trudeau fellowship for the maxn- vnerre appreciation to all moratory during a trying to the Academy of Medi>e large donor, the Metronstay of the experimental we are deeply grateful. w< have greatly widened jgtni in seeking out new nay justify the Lrurt that *.( is:" .l: jts a. t receipts and expenditures .-SARANACLABORATORY FOR THE STUDY OF TUBERCULOSIS !&;' u October. 1, 1932 to September. JO. 19JJ Receipts: .Balance oo hand Octl 1. 19J2 ................................................... From, endowment held in trust by- Trudeau Foundation: ls . Interest. pn securities . 52.4 50.00 di'.lnierest pn cash balances 11.22 cGtfsrfar maintenance of work: 52.461.22 52.851.70 ` ct tAdirondack Fund for the . Tuberculous . - lr. --Anonymous (per Dr. Baldwin) yi lAgrve* Musser Eckert Fellowship TCroup of Friends" ... Lis-.iMctropaliun Life Insurance Co. ruiithiilbank Memorial Fund in.itMiscellaneous donao'ons Tit Oglcbay Norton b* Co. . .t.JSaranac Lake Academy of Median irU. S. Gypsum Company SU.-S. Public Health Service . Total of gifts .... From Trudeau Foundation 1.000.00 . 100.00 1.000.CO 500.00 5.000.00 1.000.00 120.00 ,3,750.01 2 010.00 2,375.00 1.099.98 19,955.01 3.000.00 25.416.23 .-..-.Total Receipts (carried forward)..................................... 528 269 93 r..-' *Srr (olli-vin; pi{c for litl of donori I 11 :Y -~ :--"3 :: ^rrrrr--rrz'7,~^ r.-.yyy -- J_- J! : 1 vwj j-rty J- 7^:-rr,' 3 i PLAINTIFF'S I f exhibit H 1660 Q3V JItt \ RECEIPTS AND EXPENDITURES SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS October 1, 1932 to Seetewbea 30, 1933 ------- i ` <5 Total Reca'pu (brought forward)..................................... 328,269.93 Disburaemrali: Salaries ............................................ 317,412. 48 Animals and feed ..... 1,147.10 Supplies and equipment ... 1,232.40 _^ j Fuel .................................................... 306.56 . Gat ....................................................... 136.55 Light and power.............................. 335.45 Telephone 95.37 Laundry ....... 81.94 Re pain ....... 79.32 Library ....... 544.99 Publicanam ........................................ 252.55 Traveling expenses . . . . . 371.82 Animal House: Building . . . 92.22 Equipment . . . 830.59 * ------------Miscellaneous expenses and aupplies . 922.81 185.22 Contingent: extra supplies and equipment for new work . 864.90 Total cost of work carried on ----------------- 32 4,1 15.06 Donation returned to donor.............................. 500.00 Total disbursed ............................................ ............................ 324,61 5.06 *\ i. ,#r it 1934 'SHje ^aranac Haioratorp for tfjc >tubp of tCuteuIoSte OP THE EDWARD L. TRUDEAU FOUNDATION * ------------------ t REPORT OF THE DIRECTOR ^ AND FINANCIAL REPORT 30, 2934For the Year Endinc Septemder j 15 4 T i REPRINTS OF SCIENTIFIC PAPERS tnjc^aranac Hate Sfeabemp of fFTcbicinc v>^- '"-I THE SARANAC LABORATORY The fact that the Saranac Laboratory has always been a separate insti tution from the Research and Clinical Laboratory of the Trudeau Sanatorium ii not generally understood. Both laboratories axe sponsored and controlled by the Trudeau Foundation, but the Saranac Laboratory it located at 7 Church Street in the village of Saranac Late and not at the Sanatorium. j jj The properties of the Saranac Laboratory conn's of the original building. given to Dr. E. L Trudeau by Mr. George C. 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 bouses. a T q While the Saranac Laboratory cooperates with the Sanatorium in everyr possible way and serves as the headquarters for the Trudeau School of Tuberculosis, it provides diagnostic facilities to the phyna'ans 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 physa'uu in Saranac Lake met in the John Black Room to discuss ways and means for supporting the diagnostic and research activities of the Saranac Laboratory during a pyxiod of diminishing income.' They were of the unanimous opinion that this institution is essential to the continued existence of the village at a center for the scientific treatment and study of tuberculosis. As* a concrete expression of this feeling they constituted themselves the nucleus of a bfdy to be known as the Saranac Lake Academy of Medicine Its object is `Tto foster interest in the pursuit of scientific medicine in Saranac Lake'" through the agency of the Saranac Laboratory. Its members pledge themselves to support the activities of this institution in every possible -way and to seek assistance from others for its operation. The active members are physicians practising in Saranac Lake, but associate, 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 scientific lectures and research have always been an integral pan 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 membcrahip in the Academy of Mediane, or by contributions through it. anyone can fee1 that he has a part in keeping alive the Trudeau ideals for the furtherance of medical science. ACADEMY ahysfa'ans in Sinmc Like I nuns for supporting the laboratory during a period utimous opinion that this of the village as a center irculosii. As a concrete ves the nucleus of a body (edidne. Its object is "to in Saranac Lake" through bers pledge themselves to passible way and to seek <e members are physicians ' and life memberships eport for the current rig new; the Laboratory, - cruxes and research have the village, but by many ;e from the great founder e Academy of Mediant, : he has a part in keeping cal science. Ripurt of the Director CONTENTS ** , Financial Statement Reprints of Scientific Paper*: Inhaled Silica and its Effect upon Normal and Tuberculous Lungs 1 J > ; Leroy U. Gardner, ' .............. ' ' : * . Relan'oruhips Between Hyperscruidvencu and Immuniry in Tuberculosis T Donald E. Cunlmincs and Anthony B. DttAHA>rT' Tuberculosis of the Uterus and Fallopian Tubes with a Report of Two Cases Treated with X-ray* : Edwin M. Jajjcson Tuberculin: Its Prepara bon and Use in the Treatment and Diagnosis of Pulmonary Tuberculosis Leroy U. Gardner and Edward R_ Baldwin R H B THE SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS OF THE EDWARD L TRUDEAU FOUNDATION I Leroy U. Gardner, M.D.______ ________ "_______ _ Director end Pathologist 'Arthur J. Varwild, M.D. , -- _____ _____________ _ Asrirtant Poihologrrt Thomas M. DuAan, M.E._____ ____ _________________ - Ainrum Chemist Winlseld O. Kelley, BA. ______ Clini&st Pathologist Douglas S. McCrum, B.S. (E.E.)- Photographer Morris DworsiiAiriuaru in Experimental Pathology Catherine M. Cummingi .----- - -...... ....... Librarian and Secretary Roy Dayton_______ _______________ ________________ __ Financial Secretary James V. Lucorell___________ ___________ Purchasing Agent and Technician George Hulpritt___________ ________________________------------- - Technician Anthony Delahant____ ___ ___________________ _______________ Technician Frank Creedon___ ___________________ _______________________ Technician Andrew J. Redtin_____ ________ ____________________ Voluntary Airittani J. Cloyd Downs -__________________________ Voluntary Ainrtanr William LlBounty____ Airutanl Henry C. Stout_Ainttant FCEAD AND CONSULTING STAFF Donald E. Cummings, B.S. Homer L Sampson. D.Sc. Daniel M. Brumfiel, M.D. Robert N. Downs---------Richard Libby___________ Richard Walters________ Meivin Berg___________-- Dorothy P. Rogers______ __ Asrutant Director in Charge of Field Woi^ ____________________ Comuliing Rocnigenologiit ____________ _ Clinical Coruultant _______________________________ X-ray Supervisor __________________________ _ X-ray Technician ---------------------------------------- X-ray Technician --------------- Bacieriologi'cat Technician and Clcr^ ------------------------------------- X-ray Stenographer SPECIAL MSEAACH STUDENTS A O. Severance, M.D.----------------------------------------------------- Bala'raore. Md. A Landau. M.R.C.P----------------------------------------- Cape Town, South Africa T^rcr^rr. . j PLAINTIFF'S f EXHIBIT | 1660 (21) i t)RY FOR CULOS1S .undation ____Director arid Pathologist ________ Assistant Pathologist ------------ Asrinant Chemist ............... Clinical Pathologist ------ ----- ----------- Photographer as in Experimental Pathology Librarian and Secretary --------- - Financial Secretary chasing Agent and Technician ------------- ---- _--- --- Technician ------------ --------------Technician ------ --____ ____ Technician ,1 Voluntary Assutaiu _ Voluntary Asrutant ________ .Assistant ------------------ Assistant STAFF ector in Charge of Field Wm^ --. Consulting Roentgenologist --___ OlinicoJ Consultant --------- --------X-ray Supervisor ----- ----- X-ray Technician ------ --------- X-ray Technician -iclogical Technician and Cler\ ------------- X-ray Stenographer rrUDENTS --------------------- Baltimore, Md. ----- Cape Town, South Afncu ! I > i l i t REPORT OF THE DIRECTOR OF THE SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS -- 1934-- -' }\ Leaoy U. Gaxdnea. W.D., Director A well known authority in the eld 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 toast might qualify this gencraliiacion, it cannot be gainsaid that effective investigation of disease can only progress in close contact with the patient. In times past I 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 x factor in the production of tuberculosis was begun there was brtle thought that it might deserve years of study and that it would subsequently prove to be x subject of widespread popular interest. For years the attach was directed almost wholly along experimental lines. Few persons suffering from disease' due to inhaled dust found their way to Saranac Lake. To study silicons in the human subject it was necessary to visit the centers of industry and such visits at best could be infrequent and of short duration. There seemed no choice but to continue on a purely experimental basis unless the invesbgabon were removed to x mining or other industrial community. Then came yean of stringency when the outlook for financial support from private philanthropies was most gloomy. But this apparent misfortune proved to be a turning point in the program of the instiruaon. 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 invcso'garion. It is hoped that we may profit by our oppomjruoes and justify the confidence that has been placed in us. To take advantage of the siruao'on it was necessary to expand. Important members of the research tuff had to be sent into the field to trudy 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. More space was essenoal that these men ought work, for the old laboratory was not expected to accommodate more than five or six investigators Last year's report a'tcd the progress that had been made in this program of expansion. This year sees us ready to begin operabons on the broader basis. 7 * Two major ficid investigations ire in progress under the supervision of Mr. Ciunniings, tic aiiuunt director. Several .thousand x-ray imz have been taken md interpreted by Dr. Sampson and Hz assistants. Three store members have joined the regular laboratory staff and two graduate crudcno will work with uz during the coming year. The John Black Wing, providing zix new rooms for research purposes, is now nearing completion and almost enough funds are in light to satisfy a J54.J90.00 budget for the coming year. nr i o rxocitAii On November first a conera a was renewed with members of tke Lake Superior Iron Ore Producers Association to continue the program oflinvcsri* gaoon 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 rejponobOiry 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. Thus year the data already ' in hand will be analysed, the dust prevention measures will be applied to all pans of the various mines involved and era miration of many of the miners will be repeared 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 end 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 ia the pure state. A bacteriological study of the sputum of miners with non-tuberculous infections of (he 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 email group of fluorspar mines and mill* during the rummer. The program involved the determination of a possible hzaard from this substance and, if such easts, the recommendation of methods for its correction. A considerable group of employees has been examined by the mine physician and their s-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 art now in progress. The field work in the gypsum plant reported last year is completed and it has been passible to give the industry a clean bill of health. Recently a survey was made of a porcelain plant and a plan of investigation was mapped out. It will proceed along the lines of other investigations. S  under the supervision of housand x-ray films hive hit assistants." Three more iriff and two graduate students "Jve John Black Wing, providing nearing .completion and almost ,390.00 budget for the coming l ved with members of the Lake ono'nue the program of investiiisz among their miners. One ipate in the program this year the services rendered. While ame that we derive from this fewer men will enable us to xmain. Last year's effort wai industry and. the inauguration a. ITUs year the data already measures will be applied to all ination. of many of the miners have developed changes that f autopsies have been obtained ovc study of the anatomical bfnje death will add to the nl' silica and other substances the presence of the iron is not as harmful as it .teriological study of the ns of the lungs is in progress eat some of these cases. A Hander bacillus and associated of fluorspar mines and mills : determination of a possible : recommendation of methods nployces has been eaamined r been rrudied here. Tuberale but whether exposure to ascertained. No autopsies -lical effects of inhaling this inimaJ experiments that are 1 last year it completed and n bill of health. Recently t plan of investigation was other investigations. 'I e! AH credit is due to Mr. Cummings for the successful prosecution of this work. The ofioaJs 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 possible by bis efforts, and of the x-ray and autopsy material that comes through him .Without the ay operatiotf of* Dr. Sampson, at the-Sanatorium, such an investigation would be quite impossible and the director is glad of the opportunity to express hit appreciation. The attoo a led field workers, Mr. Downs, Mr. Libby and Mr. Walters have loyally done their pan in making a success of the undertaking. They all deserve praise for their devotion to their work. uteoiutToar juseaxch The problems already under investigation have been continued during' the year. The inhalations of pure quaru, pure gypsum, pure hematite, ferruginous chert and a mixture of gypsum and quartz axe still in progress " The hematite and gypsum dusts cause r>0 appreciable damage in the lungs and have no serious effect upon coexistent tuberculous infection. The chert, which contains a considerable amount of quaru, causes more damage in the normal lung and results in tome progression* of a tuberculous infection. T 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 tcarring. or fibrosis. Mixtures of equal pans of gypsum and quarts dust fail to produce significant changes in the lungs. On the other hand, groups of animals exposed on alternate weeks to pure quaru and pure gypsum dust are developing typical silicosis. This experience points to a protective action on the part of gypsum dusi; probably because the gypsum particles tend to clump together in the atmosphere, they prevent the inhalation of significant quantities of quaru. The experiment is not yet complete but the implications arc fascinating in their possible bearing upon silicosis prevention. A study of the comparative reaction of different species of animals to silica dust is now completed. Guinea pigs, rabbits, cats, white rats, white mice, and domestic fowl have developed reaction to inhaled silica. The rau develop changes most nearly resembling those in human beings. The injection of silica suspensions into tadpoles and goldfish produces a marked tissue reaction which resembles that in the mammals. One may conclude that silica is a poison for the tissues of a large varicry of animals. Injection of silica and other forms of dust into the vans of rabbits is being used extensively to test their capiary to cause damage. Silica causes a specific cirrhosis of the liver which docs not occur with other dusts thus far treated. The minimum dose necessary to produce reaction and the effect of different petrographic forms of silica are being investigated. The progressive nirure of rilicosis in animals is being trudied in animals exposed for varying periods of time and then removed to a normal atmosphere. X-ray films are taken from Omc to time to demonstrate progression. The subject of tuberculosis susceptibility in the silicotic tissues is still under investigation. This year the possibility of ajtcrition in the immune 9 cute u being studied in dL'coo'c animals infected with tubercle bacilli. Collateral experiments with pneumococcus and "VpirochitaJ infections ire planned to check the observations on tuberculous. The milked cmili-rity between the tissue reaction to the ruberdc ba allusrand clioa particles suggest! thil the injury produced by these two substances miy be fundamentally the ume in spite of their obvious difference in composition. Another set of experiments just rtined w01 test the tissue reaction to i representative group of silicates (silica in combiruo'on .with bases) which have common industrial uses. Theoretically these sdicates 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 slica to produce the condition of clitoris. Mr. McCrum has completed a series of wax models of silicotic nodules from the lungs of experimental animals and from those of human beings. * These models demonstrate the similariry between the animal lesions and those in man. Both develop very largely in relation to branches of the pulmonary artery. Another group of models graphically illustrates bow silicotic nodules compress and thus interfere with the function of the lymphatic vessels, the drainage system of the lung. ScQl another demonstrates how tuberculous infection penetrates into the interior of a preestablished silicotic 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 stU working on the effect of inhaled oil and upon die problem of experimental oleothorax; Dr. E. M. Jameson is soil studying geruio-urinary tuberculosis. Dr. D. M. Brumfiet is collecting data on the number of silicotic parients under treatment in ruberculoris sanatoria through out the country. He is especially interested in ascertaining the effect of treatment in patients with a complicating tubercuJoris. TZaCHINC In addio'on to the usual program of teaching, five days of the 19J-1 session of the Trudeau School of Tuberculosis were devoted entirely to the subject of siL'caris. A program was arranged covering all phases of the subject: etiology, pathology, diagnosis by dinicaj 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 special reference to at mospheric dust deiermination.The pathology of the disease was discussed by the director of the laboratory. Prof. Philip Drinker, of the Harvard School of Public Health, discussed engineering methods of dust prevention and elimin ation. Dr. H. K. Pancoasl, of the University of Pennsylvania, and Dr. Homer L. Sampson, of the Trudeau X-ray Laboratory, spoke on the roentgenological appearances in silicons. Dr. Henry S. Kessler, N. J. Rehabilitation Clinic, 10 r1 tr- ' with tubercle bacilli. haera! infections art it "he marled similarity i and olica particles suggests i may be fundamentally the action. ! tost the tissue reaction ta ibirudon with bases) which sc elicates are not expected k possibility that they may icd. One of them, asbestos. Lime of pulmonary disease. . as an important factor in t models of sliootic nodules -om those of human beings, the animal lesions and those o branches of the pulmonary jstrates how silicotic nodules of the lymphatic vessels, the monstrates how tuberculous bL'shed silicotic nodule the regular laboratory naff, of a tuberculosa* vaccine. of inhiled oil and upon the I. Jameson ia small studying el is. collecting data on the ibcrculotis sanatoria through- --ruining the effect of ing, five days of the 19H ./ere devoted entirely to ahe covering all phases of the inical and roentgenological is a pleasure to acknowlrdgt arious fields who volunteered . Jones, of the U. S. Public .mmingi, assistant director of with special reference to at: thserve was discussed by the r, of the Harvard School of dust prevention and cLmin'ennsylvania. and Dr. Homer pole on the roentgenological N. J. Rehabiluaoon Cbnic, described the clinical aspects of'the disease. Prof. Wo. S. McCann, of the University of Rochester, spoke on the physiology of the fibroid lung. Dr A. J- Lanaa of the Metropolitan Life Insurance Company summariicd the scientific 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 Folgcr, an attorney from Rochester, N,Y-> discussed the .medico-legal phases of the subject. Most of the speakers remained for the entire wees and tool 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; H 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 phytidans and executives, insurance o rials, and sate i compensation commissioners. An unofficial transcript of the proceedings was prepared by Mr. B. E ' Keuchle of the Employers Mutual Insurance Company of Wausau, Wisconsin, , and his associates Drv Beltnip, Benton, Carhart, Emer, Ford, Gny, Hahbe, . and Lou. Copies were offered far sale at 55.00 and the entire proceeds were donated to the laboratory. It is with peculiar pleasure that we express our gratitude to Mr. Kueehle and those who a sorted him ia this work. J PUBLICATIONS AND JLEPORTS 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 etiology and pathology of rilieosis and other pneumonokoru'oves. A reprint of one of them, delivered before the general session of the American Xfedical Association and represenutives of the 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, -Pneumonoloru'oiis," written for International Clinics, will appear in June. Three papers by Dr. Gerald R. Dowd, formerly bacteriologist on the raff, are in press Addresses were made before the physicians of the General Electric Company at Schenectady, and before l legislative committee of the State of Massachusetts. Considerable time has been devoted to the meetings of a committee of the Koru'ride Club appointed to formulate a classification of silicotic lesions and thear 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 addresj on Hyperrcntitiveness and Immunity in Tuberculosis by Mr. Cummings and Mr. DcJahant, of a paper by Dr. Jameson on Tuberculosis of the Uterus and Fallopian Tubes, end a Summary on Tuberculin by Dr. Baldwin and the director. ST ATT On October first Dr. Arthur J. VorwaJd joined the ataff as assistant 11 pathologist. Trained at the Uru'vcrstry of Chicago, and coming to us after a year of post-graduate work at Cambridge, he brings to our problems fresh points of view. His caoellcnt training and his enthusiasm have already satisfied everyone that he is a moa forrunite choice. * ' Mr. J. Ooyd Downs, i chemical engineer of distinction, is a voluntary assistant who has many times proved hit worth by solving problems cun' cemed with the preparation of dusts for animal injection. We consider ourselves most fortunate that he can be with us. Mr. Frank Creedon worked to well and faithfully as a voluntary assistant last year that he was taken oa to the regular staff as histological technidam on October first. Two spedal research students are already at work upon salicosis problems, ' and a third will arrive shortly. Dr. A. O. Severance, of Bal cud care, has carried on esperimencs dealing with sHieoss in fish and amphibia Dr. A Landau, M.R.C.P4 of Cape Town, South Africa, recently came to us from Brompton Hospital on a Dorothy Temple Cross Research Fellowship. He- is working on the comparative influence of various silicates oil the suscepti bility to tuberculous infection. Dr. F. Warden Brown, an Oxford graduate holding a Radclaff Travelling Fellowship, will shortly begin an inteKsivt study of the action of one of the silicates known as seriate. It was recently claimed that this substance rather than quarts was the cause of clicosis. 1 , In the field Mr. Richard Walters served faithfully,*! x-ray technidaa for six months uned his health forced him to return for a period of rest. His work was appreciated not only here in his own organisation, but by the physia'ans with whom he was associated at a mine hospital. We trust that tiie 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 appreaation of their coopcrariao. BULLDJNCS A year ago it 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 library 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 artic 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 chronie state of congestion that has seriously hampered our work in the past several years. A neces-sary adjunct to the new addition was an increase in the healing 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 12 TTrr t and coming to us after c bring* to our problem* fresh hi* enthusiasm have already choice. of distinction, is -a voluntary irth by solving problems' con* limal injection. We consider us. Ithfully a* a voluntary assistant staff a* histological technician t work upon silicosis problems. Severance, of Baltimore, has n fish and amphibia Dr. A. ica, recently came to us from oss Research Fellowship. Hs rious silicates on the suscepci* n Brown,.an Oxford graduate 11 shortly begin an intensive m as seriate. It was recently vas the cause of silicosis, faithfully as x-ray technician return for a period of rest, own organization, but by tit: nine hospital We trust that 'fere. The director takes al service that they arc ^operation. i-l.:Mrx. Frank B. Black had .>./ work rooms. The John consists of the John Black renerous donors gave in 1927, ones located in a story above, new wing w/th that of the it gable of the tarter. By so tated in the attic of the old e front of this report thows ion by this change. The six long-felt w/ant by relieving y hampered our work in the new addition was an increase n already overloaded system, tjcw furnaces and to repipe coordinated system of piping PLAINTIFF'S f EXHIBIT i 1660 (27) are now- in operation. It appears that the hearing costs for the entire plant, including the new addition, may be less than that for the old building alone. Our graorude to Mr. and Mrs. Black for this new gift if unbounded, and as we occupy and use the new plant wr shall have a continual cause to be Biindful of their generosity. -! . Toward furnishing and equipping the new work rooms, we have already -- received 51250. Of this xum 5250.00, from Mr. Henry U. Harris, was acknowledged last year. Dr. Frederick Willson has recently donated 51000. which is deeply appredited. This sum wril] suffice to put two or more rooms into commission, and as fast a* further funds can be procured the other* will be furnished and occupies! cukical ijsaaAATOJir woax 1 d The diagnostic department ha* operated most effectively under the direc tion of Mr. Kelley, axssted by Mr. Delahant and Mr. Hulpritr. While the? fee* collected are entirely inadequate to support the service, the rtedpt of 51229. from the Saranac Lake Academy of Medicine ha* made it* continuation possible Mr. Kelley's fellowship at the Sanatorium secure* him hi* living i expenses and his part-time associate* receive part of their salaries from the \ Academy receipts. The following is a summary of the various diagnostic examination* made during the year ending December 31, 1934: SUUMAXY or DIAGNOSTIC UUU4JNAT10NJ November 1, 1933 to December 31, 1934 DipkiScru rulturcj --- ----------- Soon for Vincent** Anpna _ JO Blood; i^jjluuoioon for typhoid __ 16 DiffcjcnoiJ count* - 141 Red and hiu count*------ 269 Hemoglobin drtermintbona . 111 Coj f uJiuon doc _____________ 41 Ci oupin - 101 Culture i-------- n Otcmiitry-------------- r , 1] $<d. menuuon------- - --- --- 54 Sputum for ruberdc bicaUui t 577 SpintJ t uid. unm And other material far rvibcieJc hstiUui Stomach contcnta ____ MJh bancholofica] couau ___ 10-J 4 41 Ulster, bacteriological examination--. 75 U/41 cl, chemical craminioac ____ 426 Swm for jonoeverua 6 Urine1J17 lAutoftnoui vacantt prepared Pathological iptOBcnl -- 19 no Aulopuci, human 34 Animals inoculaltd for diagnotii -- 46 Miactllinroua caaminaDooa . 20 TotsJ .4990 Of the autopsies perfonned, 7 were on rasnt of silicosis with tuberculous sent to the laboratory from the field. One was a race of uncomplicated silicosis with death from generalised cardio-visrular renal disease. Of the "pathological specimens" 8 were lungs or portions of lungs from individuals who died after being exposed by occupation to dust of one kind or another. These were submitted for diagnosis by phydrian* in various parts of the country. 13 nNANcrs |f- PLAINTIFF'S I i EXHIBIT H 5 1660 U8) B a ------------ nB >*> l\ 1 1 At the end of the fivil yen, September JO, 193$; the, finanaal statement showed an apparent balance of $3,65 4.87. This waa accounted for by advance payment* of certain annual franca made during the fiscal year. The moneyr r.ia allocated to specific reaearche*'that wrre axapletad during the year.' Likewise, at the end of the current year, there is an apparent balance of J10.J90.81, which repreaent* advance payments far work to be done during the coming year. In June a group of Mutual Insurance Companies through the American Mutual Alliance pledged their rupport to a three year*' silicons research program and paid their first annual installment of $5,000 in September. Ln October a similar group of stock insurance companies, through the National Bureau of Casualty and Surery Underwriter*, made a titular three-year pledge and recently paid one semi-annual installment of $2{50Q. Each of these groups is financing certain specific problems of mutual interest to them and to the laboratory. The Metropolitan Life Insurance Company has renewed its annual pledge of $2,000. for the continued study of infection in association with rilicosis. - The U. S. Cypsum Company made an addiciona! grant of $1,000. Tor the continuation of eaperimental 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 waxrint continuation. The decreased income from the iron ore study ha* keen 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 $6,110. 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 other sources. The fluorspar study, with a grant of $1000. i* self-supporting a* no long-term dust inhalation on animals is involved. The receipts from Mr. Kucchle'a sale of Silicosis Symposium proceeding* have amounted to $615., but none of this money was received prior to the end of our fiscal year on October Jl, 1934. A contract for diagnostic work at the Northwoods Sanatorium has been renewed with the Adirondack Fund for the Tuberculous. This yields $1,000. which is applied toward an assistant's salary. The Agnes Mutscr 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 $1,729., all of which was applied to the operation of the diagnostic department. E. R_ Squibb fif Sons made an appropriation of $200.00 to Dr. J. N. Hayes for his investigation of the action of various oils in the pleural caviry. For the coming year anticipated operating expenses will amount to $54,190. in addition to a sum of $8,500. to equip and furnish the newwork roomt in the John Black V/ing. Income ia in sight to cover all but $4,000. of the regular budget and we have faith that this and the spatial 30, 1933, (he firuna'al totement Hi was accounted lot by advance > ring the fiscal year. The money crc completed during the year, there is an apparent balance of aits for -work to be done durinc sal Insurance Companies through support to a three years* silicosis muaJ installment of 55,000 in odt insurance companies, through ry Underwriters, made a similar . . mi-annual installment of $2,500, cd&c problems of mutual interest jpolitan Life Insurance Company r the continued study of infection additional grant of 51,000. for ~ the protective acoon of gypsum serimenu begun during the past f sufficient importance to warrant ore study has been apportioned senses in approximatly the same cats of carrying on the *vork in son's laboratory for x-ray consulcarry on animal experimentation, he work here but it is of such ivided from other uxirccs. The t self-supporting as no long-tcnn f Silicosis Symposium proceedings money was received prior to the .934. A contract'for diagnostic eat renewed with the Adirondack .,000. which is applied toward an rt Fellowship provides for anothrr lbank Memorial Fund constitutes lg. Receipts through the Saranac 51.229., all of which was applied mt. pruo'on of 5200.00 to Dr. J. N. - various oils in the pleural cavity, rraong cipcnsex will amount to 2. to equip and furnish the nrw scome is in sight to cover all but ve faith that this and the special l f i a i (vjoipmcnt fund will be secured during the year. To make our su have a petroprapher to identify and analyse the rock specimens from .mhuh-dust for experiments art now prepared. At the present time wt are forced to rely upon the generosity of others for this service. In conclusion the director wishes to express his gratitude to Dr. Baldwin, iLr.vtor of the Trudeau Foundation, for his hearty support, to all his associates tnc their loyal cooperation, and to those whose financial assistance has made gntuM,- the continuation of our worL , r 15 r \i njUf OF TUBERCULOSIS SD1TURES cbek 30, 1934 ___ 53.614.87 1.871.00 15.69. T---------- 1,890.69 - 1.000.00 250.00 250.00 375.00 1,000.00 300.00 .' " ''.94 70 .00 305.00 5.000.00 416.67 750.00 375.00 1.239.00 200 00 2.875.00 ____ 48.375.61 ___________ 50.766.30 53.921.17 SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS RECEIPTS AND EXPENDITURES " Octobex 1, 1933 to Septembex 30, 1934 * Tool receipts (brought forward)___ _____ i 53,921.17 j Disbursements: ' Far Laban lory work and maintenance: Salaries___________________________ 18.905.14 Supplies and equipment ___________ 2,211.46 Animals and feed_____________ 1,915.04 Fuel_______________________ 704.53 Cas 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 field: Salaries --------- --- -------- --------------- 14.219.98 Travel, including automobile,etc -- 1,533.43 Advances lo workers forexpenses 625.00 Miscellaneous ----------- -------- ------ 111.54 ------------------ 16.489.95 \ i 1 Toul cost of work--------------------------------------------- 42,331.88 Transferred to Trudeau Foundation, reimbursement for funds advanced for new animal house built in 1933 ___________ 1,198.48 Total disbursed______ .------------------------------------------------------------ 43,530.36 Balance on hand September 30, 1934 ---- ..------------ ...__..... 10,390.81 -r-rzr-nrr npRY .. . . . aber 30, 1934 ifter October Is ! report) 1.000.00 249.99 ing 5,500.00 9 5.00 5.00 25.00 50.00 250.00 .250.00 375.00 50.00 500.00 25.00 1.000.00 655.00 JOO.OO 3,749.94 2,499.96 27,500.00 6,358.54 3.000.00 5.000.00 2,500.00 25.00 416.67 750.00 375.00 375.00 2,971.61 18,718.49 R Ilri^ght forward.............................. 42,971.61 18,718.49 Saranac Late Academy of Medicine Mrs. John F. Archbold .... 50.00 Clinton J. Ayres, Inc. . Dr. Edward R. Baldwin ' 25.00 50.00 : Dr. Robert J. Beck . ' . 50.00 Boyce 6r Roberson . I Dr. H. A. Bray . I ? Dr. H. B. Brown . . 15.00 20.00 10.00 Dr. Lawrason Brown . 25.00 i Dr. David A. Cooper . 10.00 V Mrs. F. C. Dceiner . . 50.00 : \ 4 s Dr. Joseph T. Eagan . If Mrs. A. C. Erkander . 50.00 50.00 Mr, H. C. Eyer . .. . 25.00 * Miss Anna L. Gilbert . .' 10.00 \ Dr. Albert G. Hahn 4 10.00 . . r. * Dr. John N. Hayes 25.00 15.00 1 ii Dr. Fred H. Heise . .. 10.00 Mr. Fred A. Howland . 50.00 Dr. E. M. Jameson 25.00 Dr. Hugh M. Kinghom 50.00 Mr. Herbert R. Leggett 25.00 Mr. Win. C. Leonard . 5.00 Dr. S. S. Lichunan 10.00 Dr. Edgar Mayer ... 34.00. 5 Mr. H. S. Parker ... 50.00 L Mr. R. F. Plank . . . a" Dr. Samuel Post 10.00 10.00 Dr. J. Woods Price - . 25.00 Dr. Waker L. Raihbun 10.00 Dr. John C. Russel] 10.00 Dr. Homer L. Sampson 50.00 Sanatorium Gabriels . . Mi;s Ophelia Sawtell Dr. David T. Smith Miss Dorothy Smith Mr. Robert B. Smith . 25.00 10.00 10.00 . 100.00 10.00 Carried forward .... , ,43 905.61 18 803.49 19 Brought forward............................. 43,905.61 18,803.49 Dr. Willard B. Soper . 1 . ..j 50.00 Dr. Earl R. Templeton . . * 10.00 Mr.. Lewis- S. Thompson . Dr. Charles C. Tremblcy' . ( 50.00 * 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 . . 200.00 4 U. S. Gypsum Company . . ' . 2,875.00 250.00 Utica Mutual Insurance Company * 100.00 Dr. Frederick and Mr. Thomas A. Willson, I toward equipment of building * Mrs. 5. L. and Mr. John P. Wood, in 1,000.00;1 Memory of Sydney Lunt Wood . . JO.OO 4J.375.61 20,213.49 Mr. Frank Connable, thru Dr. ELL'on P. Jredin, a Microchenical Sugar Apparatus 20