Document Z8JwyZ5MDjzkp7ZoYxpaqQnd7

FACULTY OF MEDICINE OFFICE OF THE DEAN PLAINTIFF'S EXHIBIT MPGILL UNIVERSITY MONTREAL / February 20th, 19 3 1. a. S. Knight^* Ssq. , L.D. , Metropolitan Life Insurance Co., 1, Madiscnft Avenue, New Yorfc/City. My dear Sr. Knight, Many thanks for your letter of the 11th February. It came to me vhan I was ill in bed with influenza - hence the delay in my reply. I cannot tell you how much we have appreciated the opportunities which have been afforded through the grant from the Metropolitan Life Insurance Company to carry on our work in Industrial Medioine. While it is quite true that the grant was originally intended for a survey of industries in general, nevertheless in conversation with Sr. Wade Wright and Mr. Burnette at the time the plans which we had under way were well known to them, and have met with their endorsement and approval since. It was our idea that we should, first of all, establish the Industrial Hygiene Separtment here, and, in the course of time, we would be sufficiently advanced to broaden its scope and as you will see from the reports we have already forwarded the interests of industrial hygiene in this way. I regret very much that we did not send you the annual reports from Dr. Pedley when they were issued, but I am now forward ing them to you for your perusal. With reference to the conversation which Dr. Pedley had with Mr. McConnell regarding some piece of research, I think there must be some misunderstanding. As I already wrote to Dr. Frankel, Dr. Pedley, while retaining his position as Professor of Industrial Medicine, was transferring some of his activities and time to the sooial welfare work of the city, which, of course, is very closely 0451 AS Knight, Bsq.,M.D 2 February 20,1931 linked up with Industrial Medicine. Inasmuch, too, as the money which has been allocated to him for Industrial Medicine wae voluntarily relinquished in view of the stipend which he received from the so^cial welfare group, we felt it was a wise procedure to spend some of that money along lines of research. It wss not at all intended, however, that this grant, which was meant for Industrial Hygiene in general, should he entirely devoted to that purpose. On the other hand, we have under way a variety of investi gations which relate to the subject of Industrial Medicine, e.g., } a survey of tuberculosis in industries in the Province of Quebec, / and this work is being undertaken by a committee and a group of / experts who are taking the matter very seriously, and I think I will get results which are very illuminating. Inasmuch as a good deal of the work which is in con templation is in connection with disease of industry, we had thought of engaging a chemist at a very modest salary, which would help in solving some of these problems we are investigating, such as the importance of mercury and sulphur dioxide in the etiology of industrial disease. You already know, perhaps, of Dr. Pedley's very important investigations in the bronze industry, and of the work that he has done in cleaning up some of the lead poisoning stiuations in our onn city. j 7/hat we should like to contemplate then, in the near future, / is a continuance of the activities we have been doing, and the en- listing of the interests of mors industries in forming health surveys and linking them up more closely with our hospital clinics. This, with the other activities mentioned in our report, as well as the efforts of research would embrace the work for the next two 1 1 years. Professor Fleming is Director of our Department of Public Health and Preventive Medicine, and under his aegis the work of industrial Medicine is carried on and is kept closely in touch with all these activities. In view, too, of his very close con nection with all the public health activities of the city and of the province, he has been a very significant help in the programme to enlarge its usefulness. I feel sure that you will agree with me that this kind of work is of capital importance in approaching the subject, and its success depends largely on the firm establishment of the University and civic and provincial group before we embark on any wider national soheme. This is all the more true, inasmuch as a survey of the industries of the whole country will involve in a consider ably larger outlay than we donsider spending. 0452 A S . ) S3 f M* D 3 February 20,1931. To summarise some of the activities, may I add the following:- 1. The establishment of an industrial clinio at the General Hospital. 2. The creation of medical departments in various industries, financed by the in dustries themselves. 3. The organization of a night dental clinio for workers on a cost basis. 4. The organisation of the Industrial Medical Association of the Province of Q.uebeo. 5. Courses of lectures on industrial hygiene to physicians. 6. Various studies of diseased conditions in industry. 7. Participation in the Montreal Health Survey one of the finest surveys of the.kind pub lished in any city. Add to this the very wide spread propaganda that is being carried on, and will continue to be carried on,to Introduce the citizens to industrial hygiene; among which efforts may be mentioned the establishment of a workshop for handicapped in dividuals, the organization of occupational therapy workshops, and investigation into the health acitivlties of the city in connection with the City Board of Health, which has been a real factor in promoting civic and industrial health. In conclusion, I would merely say that the industrial hygiene work that is being done has been an acknowledged success by those who are competent to judge, and I feel is distinctly worthy of being supported and continued as much as possible. Very cordially yours. 0453 copy/ REPORT OF THE ACTIVITIES OF THE INDUSTRIAL CLINIC, MONTREAL GENERAL HOSPITAL, FOR THE YEAR SEPTEMBER 1, 1929 to AUGUST 31, 1930, CLINICAL The clinical work in the Hospital as distinguished, from that done in the field has continued as in the past, and an additional duty has been assumed, namely the supervision of the health of the Hospital employees. This was undertaken as a service to the Hospital, and has little value from the University standpoint. The new activity calls for an examination of all new employees of the Hospital, and requires that all cases of illness among the Hospital employees be reported to the In dustrial Clinic. During the year 80 pre-employment examinations and 38 periodic re-examinations were performed. 410 sick employees of the Hospital were seen and followed until the termination of their illness. This system, as it operates at present, is not entirely satisfactory on account of the number of departments which engage their own personnel, and a considerable number of new employees are being engaged with no examination. However, it is hoped that as the value of this examination be comes appreciated all departments wili take advantage of it. The study of occupational diseases among the Out-patients of the Hospital continues. Some results of this work are now appearing. One concern, which formerly contributed a large number of cases of lead poisoning to this Clinic, has established a new factory, partly on account of the severe lead hazard which existed in the old plant, and another firm has installed a fume removal system which should reduce the hazard very considerably. 22 cases of active lead poisoning were treated and investigated. Two of these were of special interest, and have been written up for publication or report, one in the Journal of Industrial Hygiene and one before the Montreal Medico-Chirurgical Associa tion. Lead poisoning was one of the principal diseases seen, although several cases of occupational skin diseases were in vestigated. In this connection an arrangement was made between one manufacturer and the Skin Department of this Hospital to under take an investigation of a dermatitis caused by a certain lotion of his. This investigation was carried through to a very satis factory conclusion by the Skin Department. It may oe stated here that the legal aspect of occupational diseases is in a very unsatisfactory condition in this Province, since no provision is made for compensation through the '.7orkmen's Compensation Act. This matter was brought to the attention of the Province of Quebec Safety League, and a committee was form ed to investigate it, but so far, unfortunately, this committee has been very inactive. 2 The Industrial Dental Clinic has had a very satisfactory year. Its clientele increased, and consequently an increase of staff was necessary. 268 new patients were treated and 984 treatments given. I believe this Clinic is of real value to the community. Inaustrial workers can get goqd dental service at a low cost, and since the Clinic is operated at night, they need not lose time fnora their work. The financial status of the industrial Dental Clinic is satisfactory, the fees from the patients being sufficient to pay the operating cost. FIELD ACTIVITIES. The plant Medical Departments have continued to carry on their work, and have given general satisfaction so far as can be determined. It is our practice to send to each plant manager a monthly report covering the activities of his Medical Department, and indicating the state of health of his employees. Frequently suggestions are made as to improvements in hi3 plant from the standpoint of health. These suggestions are always gladly received, and usually followed. In these Medical Departments 1056 physical examinations were made during the past year, 15,605 surgical treatments and 6536 sickness treatments were given, and 889 nursing visits made to the homes of the employees/ A number of firms have been approached in regard to establishing medical departments, but no success has attended our efforts this year. I believe there is no doubt that the services already established have given satisfaction, but the idea has not sold itself, and we have had very few unsolicited requests for information and advice about the organization of medical services. It is possible that the general industrial depression has been responsible for this. Four new activities were proposed during the year: (1) A study of asbestos workers. (2) A study of a large group of workers by X-ray to determine the incidence of tuberculosis. (3) A study of psychological tests for automobile drivers with the view to decreasing accidents. (4) The organization of an Occupational Therapy Workshop and an Industrial Workshop for hand icapped individuals. (1) The asbestos study is nearing completion. 102 individuals were examined clinically and by X-ray at the plant of the Canadian Johns-Manville Co. in Asbestos, P.Q. in July 1930. Other groups were examined at Thetford Mines in Sep tember 1930, but these do not come within the purview of this report. This study is being carried on with the co-operation C 0455 3 of the Metropolitan Life Insurance Co., and it is expected that valuable information on the subject of asbestosis will be forthcoming. It Is hoped that permission to publish the results will be obtained. (2) The Tuberculosis Survey will probably be commenced during the coming year in co-operation with the Canadian Tuber culosis Association,,the Sun Life Insurance Co. and other bodies. Since tuberculosis is such an important disease in the Province of Quebec, particularly among industrial workers, it is ex pected that results of real value will accrue from this study. (3} The psychological study of automobile drivers was discussed in committee and then proposed to the Insurance Casualty Underwriters Association, but they did not show sufficient interest to warrant continuing the matter. (4) The organization of the Occupational Therapy and the Industrial Workshops for handicapped individuals is still mooted, and will, it is hoped, be accomplished in the future. In that connection the Birector of the Industrial Clinic has served as President of the Association of Occupational Therapy and has visited a number of workshops in other cities to acquaint himself with their organization and operation. EDUCATIONAL. Lectures have been given at the University in the, Faculty of Medicine, the School of Social Work, the School of Graduate Nurses and the Department of Architecture. Several addresses have been given to clubs and societies in Montreal and elsewhere. A paper, "Lead Poisoning in 3rass and Bronze Industries" was read before the Industrial Hygiene Section of the American Public Health Association at its Annual Meeting in Minneapolis in October 1929. Another paper, "The Incidence of Occupational Deafness and Methods for its Prevention", was read before the 11th Annual testing of the American association of Organizations for the Hard of Hearing in New York in June 1930. Through the Province of Quebec Safety League and the Montreal Council of Social Agencies representation was made to the Provincial Department of Public V/orks and Labour on behalf of handicapped workmen who are discriminated against by the Uorkmen's Compensation Act. In this connection the Director of the Industrial Clinic was asked to read a paper before the International Association of Industrial Accidents Board and Commissions at its Annual Meeting in Wilmington, Del. in Sept. 1930. '` 0456 4 The Direcyor of the Industrial Clinic served as Chairman of the Industrial and Economic Section of the 2nd Canadian Conference of Social 7orlc held in Toronto in May 1930. The Industrial Medical Association of the Province of Quebec has held five regular meetings during the year. The attendance at these meetings has been between 20 and 35. The members regularly attending the meetings appear to enjoy them, and I believe the organization of this Association has been well worth while. It plans during the coming year to send lecturers to different parts of the Province and so extend the influence of the Association more widely. The Director of the Industrial Clinic attended six national or international meetings during the year as follows: The annual Meeting of the National Safety Council, the Annual Meeting of the American Public Health Association, the Second Canadian Conference of Social Work, the American Association of Organizations for the Hard of Hearing and two meetings of the Conference Board of Physicians in Industry. In resigning the position of Director of the Industrial Clinic I wish to say that-it is my belief that the Industrial Clinic should be cont.nuad along ths lines already established. Although numerically the number of cases seen and treated i3 not large, the location of the Clinic and its activities have served the useful purpose of gaining contact with industry, and it seems likely that as time goes on the field of usefulness of the Clinic will be enlarged. It was my hope at first that more use could be made of the clinical material passing through the Compensation Clinic, but so far no method has been found to handle this material in a useful way. A study was carried on last year of the accident cases of several large firms, fcht since these firms did not send all their cases to the Clinic a proper statistical background could not be determined and the result of the study were of no practical value. I believe that the present change in personnel affords a good opportunity for the re-organization of the Industrial Hygiene Service. There is need in this part of" the country for a well trainee, chemist in the field of Industrial Hygiene, and it is my belief that one should be engaged. The space is avail able in the Department of Public Health and Preventive Medicine, and many problems await a man qualified in this field. At the present time Industrial Hygiene activities at Mc&ill University are severely hampered by the absence of skilled assistance in chemistry. Respectfully submitted, (Signed) Frank G. Pedley, 0457 The Industrial Clinic copy/' REPORT' OF THE ACTIVITIES OF THE INDUSTRIAL CLINIC, MONTREAL GENERAL HOSPITAL, FOR THE YEaR SEPTEMBER 1, 1928, to AUGNST 31,1929, CLINICaL (A) The investigation of occupational diseases among the Out Patients of the Hospital has progressed this year in the same manner as the previous year. The number of cases for in vestigation does not appear to be increasing, and I am of the opinion that thi3 aspect of the work, while valuable from a re search standpoint, is less important than some of the other activities of the Clinic. actually there were 523 cases referred to the Industrial Clinic during the period. Among these were 30 cases of active Lead Poisoning, 3 cases of chronic arsenic poisoning. Three cases of carbon monoxide poisoning were seen in the Hospital wards, but these were not Industrial cases. (B) The examination of Food Handlers referred to the Hospital for certificates has been continued. Actually there have been 275 of thesd examined. (C) 383 Industrial accident cases were questioned with regard to the causation. The figures for this study are in the process of compilation, and cannot be given. The difficulties of a study of this type from hospital records becomes apparent as soon as it is undertaken, for one has no assurance that all accident cases of a given company come to the Hospital for treat ment. FIELD ACTIVITIES (A) The Plant Medical Departments which were established in the first year of the operation of this Clinic have continued satisfactorily, and have handled a tremendous volume of work. In the year under review 1295 physical examinations have been performed, 17052 accident treatments given, 5914 sickness treatments and 947 nursing visits. These statistical statements only describe the work of these Medical Departments in part. I believe there is general satisfaction on the part of the various plant managers in the operation of these Medical Departments. A number of firms have been approached in regard to the formation of Medical Departments, but only 2 have done so. Both these firms have engaged physicians recommended by the industrial Clinic, and are operating along the general lines recommended by the Clinic. Luring the year one large steel company established a Health Service with a full time physician in charge. The Industrial Clinic was consulted in regard to the organization of this, and actually conducted the service for six weeks during the absence of the physician on account of sickness. Another large plant manufacturing company established a Health Service, stimulated I believe by this Clinic, but tha Clinic was not consulted as to its organization. r 2 (B) The idea of co-operative Health Sercie to small plants, which was sponsored by the Canadian lianu.factu.rers Association, has made no progress this year. (C) There have been several calls for investigation of plant conditions. a fairly extensive study was made in one bronze foundry. A number of air analyses for lead were carried through. The results of these studies form the basis of a paper to be read at the annual meeting of the American Public Health Association this fall. A study of the carbon monoxide hazard in a large garage was commenced last winter, but was discontinued for lack of apparatus. The purchase of suitable apparatus is contemplated and it is hoped to continue this study during the coming year. SDUI^TIONAL. (A) Lectures in Industrial Hygiene have been given to the third year students, the students in architecture, the School of Graduate Nurses, the School of Cocial 'Hoik, and the pupil nurses of the Montreal General Hospital. (B) A special course of 12 lectures with field visits was given to the Public Health Nurses in the School of Graduate Nurses. (C) 6 Popular lectures have been delivered at various clubs and societies in Montreal, and one in Toronto. MISCELLANEOUS. (A) An Industrial Dental Clinic was opened in December 1926. The Clinic is self-supporting so far as running expenses are con cerned, but the Hospital donates the use of the space without charge for rent, light, heat and laundry. At this Clinic 132 cases have been treated. There has b-?en a total of 785 treatments given. In the organization of this Clinic two firms donated 350.00 to purchase the necessary equipment. A total of 1720.46 has been received by the Industrial Dental Clinic, of which the sum of <1491.43 has been paid for salaries and supplies, leaving a balance of <299.03. I wish to acknowledge here with thanks the services of the various dentists, who have spent their time at this Clinic with rather inadequate renumeration, and to the nurses, who voluntarily gave their time to assisting the dentists. (B) The staff of the Clinic assisted in the production of the periodic Health Examination Film of the Canadian Medical Associa tion. This occupied a very considerable amount of time, but was considered well worth the time spent. (C) The industrial Medical Association of zhe Province of Quebec conducted a successful year. a jtnioa of the French and English associations took place, and this united Association in collaboration with other organizations was able to render con siderable service to the 7/orkmen's Compensation Commission of the > 0459 t 3 Province of Quebec in the extensive revision of their Tariff. Several general meetings were held during the year, and a very successful dinner meeting at the annual meeting of the Canadian Medical Association. (D] An effort has been made to obtain permission to study the effect of asbestos fibre on the health of workers. Two large companies were approached in this regard. The first one, possibly on account of financial difficulties, was unwilling to sponsor such a study. The second has decided to undertake an investigation for itself with our assistance and advice. It is to be hoped that information of scientific talue will be forth coming from this. (E} The director of the Industrial Glinic attended 4 conventions during the year under review. Respectfully submitted, (Signed) Prank &. Pedley, The Industrial Clinic. OHSlfl February 11,1931 Or* Char1m F. Martin Dana of the Faculty of Medicine MeQl11 Unirersity Montreal, Canada My dear Doctor Martin We vast to eonfer with you a bit about tba authorization froa this Coapany under which McGill Unirersity haa bean carrying on a certain line of work since January 1926* You will recall that underthe terns of the authorisation $5,000 a year for fire years eae appropriated to pay the coat of a surrey by the School or Chair of Industrial Hygiene of Industries in Canada "with a rise of improving their hygienic conditions." is we understand it your people did not do any work under that appropriation during 1925 but the $5,000 drawn In 1926 was used, for work done In 1927* We understand, further, that the work, was likewise carried on in 1928 and 1929 and the appropriations were drawn to pay for it* are do not recall haring seen any reports of the actual work psrforned, though, and we wonder Aether you hare copies of any auoh re ports that you can send to us? The particular inoentire for this inquiry at just thio tine is that we hare a letter of .January 28,1931 froa Dr Frank 0* Podley which saysi "When X was In Mew York a fsw weeks ago, X spoke to you on the subjeet of using the aoney granted by the Metropolitan Life Insurance Coapany to UcQill University for Industrial Hygiene In soae work of pure researoh. You were going to think the natter orer and let as knew what your ideas were on tbs subject* This letter is merely to Jog your memory*" fill you please tell us now what special work is being carried on by McGill now that could be considered as under that authoriza tion, or Aat you bare la contemplation, and what you adrlse? Of course you know, and we know, that the terns of the appropriation oould not possibly be changed* With kindest regards and hoping that you will surely get into the way of coning to see as Aenever you ere don here, we are, Yery truly yours, 0460 uwsTrt k t nrp wmrm 0461 Ml. HAY MOMTSOH .. oAaiiim13 prmicw 'raw x3*r* 8EC0ND VICK-PHZSIDKNT Dr. FR^KEL 4th Floor r< o*y JSh SMWE. <zZ. /? ,0 s tarn C 0462 t&sr **r4 --.i.- ~-r~- - 04AJJIMAM. BOARD OF OIRXCTOKS NORMAN OAWES cxcamvc director FRANK 9. PEDLEY. M.O MESCAL ADVISOR A. GRANT FLEMING. M.Q. QiUNMAN. auoocr COMMTTTOK . B. STEVENSON CHAIRMAN. 1*11 CAMPAIGN H. F. THORNHILL chairman rxeet/nve committee F. o. KNOWLES HON. TAEASURDt OINHAM MOLSON Financial Federation OF THE MONTREAL COUNCIL OF SOCIAL AOSNdES 1421 ATWATER AVENUE MONTREAL WILBANK 1151 SCCRSTARV LIONEL E. BRITTLE Njsucrrr snrrART MARJORIE BRADFORD January 28th, 19SI. J. W. McConnell Bsq., M.D., Metropolitan Life Insurance Company, 1 Madison Are.. New York: City, N.Y. Dear Dr. McConnell; When I was in New York a few weeks ago, I spoke to you on the subject of using the money granted by the Metropolitan Life Insurance Company to McGill University for Industrial Dyglene in some work of pure research* You ware going to think tho matter over and let me know what your ideas were on the subject* This latter is merely to jog your memory* Yours very truly, TGP.GJ. Trank 0. Pedley, M.D. 0463 \ V-* - - r'KL <. i &: > FACULTY OK ItEDIOZNB OEEtCE OK THE DEAN M9G Dear Dr. beg to acknowledge with very many thanfce your kind note and cheque for $5,000.00 - made out to the order of McGill University. The Bursar will send an official receipt; this is merely to give expression to my personal appreciation of your continued courtesy. With kind regards, believe me Very sincerely yours. Dr. Augustus Knight, * 04& v"v Medical Director - Metropolitan Life Insurance Company, 1, Madison Avenue, Few York. K0 August 161929 Dr. Charles 7* Martin* Dean Faoulty of Medicine McGill University Montreal* Canada Dear Doator ^ tfe are very pleased to enclose no the Company's check for $5*000 to the order of McGill University as this year's payment under the terms of the appropriation* Yours very truly* M'JDICAii DIRECTOR 0466 In ra Appropriation of $5,000 a Tear for Tire Tears - McGill Univarsity,Montreal* Ur* Sheehan, Auditors* In aeoordanos with the resolution of the Board of Directors mads January 6, 1926, will you pleaae draw a check to tbs order of McGill University for $5,000 for the subscription due for the year 1929, covering the cost of a Survey of Industrial Hygiene of Industries in Canada? K-DG August 14, 1929* Medical Director* 0467 August 14,1929 5C-DS Doctor Charles F. liartia, Doan Faculty of Uediaine UoGill University Jlantrsol, Quebec Canada tty dear Doctor Itartln In tho absence of Doctor 'bright your letter of Auguat 6th haa just boon refarred to no upon my rotors to the Hone Office. The only rsoscxx that the payment from tho Company for this year has not boon made is because it had not been requisitioned by flcQlll. Be are asking now that the cheek shall be sent immediately. Tours very truly. UEDIOAL DIRECTOR. 0468 na -C OB 3d Floor 0469 jfaw. 'rC^^, & /jU_ ^ S'ftrd. t^rief T%Lc A ?*ce**r, -^* tvCCf* *t*+*4f{*&&&*$/f M? GILL UNIVERSITY' MONTREAL FACULTY OF MEDICINE OFFICE OF THE DEAN August 6th, 1929 Dr. Wade bright. Metropolitan Life Insurance Co., 1, Madison iTanus, Hew Tort City. Dear Dr. Wright, This is just a private letter to let you know that the Central Office of the University is embarrassed to know what to do about the grant of $5 000.00 from the Metropolitan Life Insurance Company. You will remember that they were good enough to give us that grant for five years, and this last year's grant has not been paid in. I hate to ask about it officially, but thought I might write to you privately to see what I could do about the matter. With all kind regards and hoping to see you in Montreal again soon, - Affectionately yours, 0470 January 6th, 1926 The President brought to the attention of the Committee the request from Sir Arthur Currie, Principal of the UeCill University, that we make an appropriation of $5,000* a year for five years to pay the cost of a survey by the school or chair of Industrial Hygiene of industries in Canada with a view of improving their hygienic conditions* The President said that this plan appealed very strongly to Or* Bade Wright of the Home Office Staff, who has charge of the Industrial Hygiene, Dr. Knight of the Medical Division and Dr. Prankel, head of the Welfare Division* Under Croup Policies in Canada, the Company has some 15,000 or 16,000 working men covered by group policies; in addition, we have well over a million lives insured in Canada, a large proportion of which are working people and their families* A survey such as proposed would be of great benefit to the Company in its care of these policyholders directly and through their employers* Such a survey has never been made in Canada; there is no institution and none of the Governments have taken up work of this character. In the United States the Federal Government and various other welfare agencies cover the field. After thorough discussion by the Committee a resolution was passed making the appropriation requested* Ur. Sheehan Will you please send them $5,000 for 2nd year? Kay 17, 1928 (Signed) A. S. K. 0471 An extract of Doctor knight's letter to Doctor Charles F. Lartin dated February 24th. / 1 Wade Wright has been telling ns in repeated talks about your having appointed Dr. Pedley as Chief of the Industrial Clinic at the General Hospital and ae Lecturer at the University. V/right feels certain that you are setting up an altogether worth while program and predicts certain success for it. Good for youi You certainly hsve our cordial best wishes in all that you undertake. Very truly youre 1EDICAL DIRECTOR 0472 An extract of Doctor C. F. Martin's letter to Doctor Knight dated February 19th. Pedley has accepted the position as Chief of the Industrial Clinic at the General Hospital and a lectureship in that subject at the University. He will take on his duties in August. Sincerely yours (Signed) C. F. Martin 0473 February 9, 1925, V*a>**" Dr. C. P. Mirtin, Dean, McGill University, Montreal, Caned*. Deer Dr. Martins It *te very pleaeant to see again your nano vhen Dr. Knight referred to me your request for Info motion regarding the eervleoe vhich the Department of Publle Bealth of BoGill might offer to an insurance ooapany vhich proaired to help support It. 2 aa sending you several recent publications, the outgrowth of the Ooapany*s cooperation In community health aetivitee, aleo a copy of a bulletin ieeued by the Bureau ef which Z sa & aeaber, indieating the aort of Gervieee in the field of industrial hygiene ahioh ee extend to our policyboldere. Z aa lith kind regarde to Ire. Martin and your good self, Sincerely youre, Bade iright, M.D. Assistant Medical Director In Chtrge of ladnetrlal Hygiene 0474  ------------*----------------- Or- KNIGHT/ MEDICAL .mpsixtik 'Phone, 164 ^ 3d Floor ^9475 - l, 1 2. uivU \v\aA(^ V Ol *x . 0476 T-SM i'ACULTr OK M.KOICIXB Ofvicb op Taa Dma? McGill uisiv^irsity MONTREAL January Twenty-sixth, 1 9 2 5. Dr. A. S. Metropolis DEV Y I Life Insurance Co., K.- FEB 31ir$/<L Dear Dr. Kni Ever so many thanks for your kind attention to my request. I was delighted to hear of Dr. Wade Wright; he vas one of the bright jewels that I wanted to get into the McGill crown, but the monied interests of the Insurance Companies beat me out*. I can use the information you send on admirably, but I was also looking for literature which I thought might have been issued by some of the men in your Company who look after demonstrations, as in Tuberculosis, etc., in communities. However, I think I can get some from other sources. Meanwhile, accept my very best thankB for all your kindness and attention; it is a shame to bother bo busy a man as yourself. If you want a rest, come up to Montreal, and I shall be glad to take care of you! With all kind regards, believe me Very cordially yours, 0477 * (COPY) January 21,1925 Dr. Charles F. Martin Dean Me Gill University Montreal, Canada My dear Doctor Martin Immediately upon receipt of your welcome letter of January 10th, I determined that the one present member of our medical staff who can best answer the questions that you ask is Dr* Wade Wright,formerly of Boston and now physician here as one of the Assistant Medical Directors, having particularly to do with the work and functions of the Group ^ealth Division. Unfortunately Dr. Wright is at his home with an attack of the grip just at present, but he received your letter prpmptly and now eays in reply: Quotation With kindest personal regards and trusting that you will come to ue very freely and just as often as you ever feel like it for any information or any help that we might be able to give, I am, Very truly yours, MEDICAL DIRECTOR ___ r*. 0478 K-G Janaary 21,1925 Dr. Charles F. Martin Dean Me Gill liiiverwity Montreal, Canada tty daar Dcertor Martin 0479 Imnedlstsiy upon receipt ef jour welcome lattar af January 10th Z datandaad that tha ana praaant maober af aur Medical Staff aha can hast ansaar tha question* that you ask la Dr* fhds Wright, formerly of Boston, and bow physician bars as ona of tha Assistant Medical Direetors haring particularly ta do alth the so tic and functions of tha Group Life Division. Unfortunately Dr* right is at his hens alth an attack af tha grip just at praaant but hs received your lattar promptly and naw says in reply, "Uueh interasted in Dr* Uartin** letter ta you* Dr* Uartin la a treasured friend* 1 have had sane alight knowledge ef his plana far tha Department of Prevent!va Medicine at McGill Univarsity. The Departs)ant, unless 1 an such mistaken, la not a very thriving an* aa yet* but Martin has high hopes for it* Ho would know, X toko it, 'what could a wall organised, wall financed department dot* the Sun Life might sell ask* if itpecured a mortgage on McGill- for such service so wo might uki Sschnleel guidance in regard to mattore affecting community or individual health* such as, aid in preparation of publicity, occasional research matters not involving great outlays of sonsy, field investigations as of sanitation* sator, or milk supplies, er industrial haiards* The help of the university night soil be enlisted in stimulating and guiding public health activities in eoaounltioa in which the carrier night bo particularly interested* X fool that the useful* ness ef the tkiiveroity could be mode apparent in relation to group insurance much mere readily than in any other way* Xt would serve, perhaps,in sene such way as do our own Welfare Division and Pelieybelderw* Service Bureau* This is vague, bat discussion, 2 feel sure, eeuld erystails# the vugueheea late S) nothing definite* Observation ef eur scheme at Harvard leads me te add that Martin should not only be prepared te render certain types ef service bat certain services, sere er lees routine perhaps,should be specified* Unless there is a definite, tangible quid pro quo the interest of a financial supporter may well laagsish after a few years.* Kith kindest personal regards and trusting that yon will eeae te ue very freely sad jest as often as you ever fed like it for spy informatics, er mj help that ss night be able to give* 1 am. Wary truly yourw, ^ WSffiCC*t. DEUECTOE TO: Dr. Kn. FROM: Dr. - : MEMORANDUM: 0480 s Much interested in Dr. Martin's letter to you. Dr. Martin ie a treasured friend. I have had some slight knowledge of hie plane for the Department of Preventive Medicine at McGill University. The Department, unless I am much mistaken, ia not a very thriving one as yet - but Martin has high hopes for it. He would know, I take it, nwhat could a well organized, r.ell financed department do?". The Sun Life might well ask - if it secured a mortgage on McGillfor 6uch service as we might ask: Technical guidance in regard to matters affecting community or individual health - such te, aid in preparation of publicity, occasional research matters not involving great outlays of money, field investigations as of eanitation, water, or milk eupplic-s, or industrial hazards. The help of the University might well be enlisted in stimulating end guiding public health activities in communities in which the carrier might be particularly interested. I feel that the ueefulnes. of the University could be made apparent in relation to group insurance much more readily than in any other way. It would serve, perhaps, in some such way as do our own Welfare Division and Policyholders' Service Bureau. This is vague, but discussion, I feel sure, could cryetalize the vagueness into something definite. Observation of our scheme at Harvard leads me to add that Martin ehould not only be prepared to render certain types of service but certain services, more or less routine perhaps, should be specified. Unless there is a definite, tangible quid pro quo the interest of a financial supporter may well languish after a few years. < i (\ January 19, 1925. .IN.'*'.>.%A/ ft 'W, V - ' iCfcGILL UNIVERSITY MONTREAL. Facultv OF1 MKUIC1.V1S OfTicz op tqh Umax January 10th, 1925. /^ A. S. Knigfit, J?sq., M.D. Metropoliian/tife Insurance Company, NEW YOKC,JS. T. % asoK___ 9481 Dear Dr. Knight Js.. I wonder if you can do me a great favour! One of our local Insurance Companies here is, I think, interested in our Department of Public Health, \ and the authorities are willing to do something for the University provided I can-show them in some concrete fashion along what lines a Department of v '' * *' . ...... Preventive Medicine can contribute, so to speak, dollar for dollar, on behalf of their policy holders. While, of course, I have a very good notion on the academic side of how a Department of Preventive Medicine does this, I would like very much to get any "dope" I could to put on paper a formulated plan which would appeal to a business organization. I thought, perhaps, in view of the very extensive work along these lines that you are constantly doing, you might have some loose literature which you might pass on to me! It means a great deal to our School and to me personally if I can put a thing like thin across, and any help you can give me would be very gratefully received. With all good, wishes for the New Year, believe me Very sincerely yours, fyfyUjvctLi. . 3 MEMORAMIXHt HR. F. M. SMITH VICE-PRESIDENT INDUSTRIAL DIVISIOH----- October 15, 1947 ri#J You asked about thej Industrial Hygiene Buroau charges, Perhaps you would like aore specific figures tftfflTl was able to gire you orer the phone. The Industrial Hygiene Bureau, including the Industrial Hygiene Laboratory, spent approximately $71,000 In 194*3. The budget for 1947 was 198,830, the increase being accounted for by tbe return of Dr. McConnell full tine, the return of Mr. Ferry (a laboratory technician), the addition to the staff of Mr. Battista, a ventilation engineer, increased salary, and other costa, etc. In the first eight nontha of 1947 the expenditures were $63,493 or budget, against a theoretical budget allowance of 66 2/3 $. of the This expenditure is a part of general Welfare costa and is prorated accordingly. The prorates at present are as follows, based on policies in force on Daccabar 31, 1945 (including eligible Group certificate holders) i Industrial Department Ordinary Department Group Department Group Life Group Annultiaa Group Accident & Health Group Personal Aeoident and Health -- 72*0.3.4325$$ - _JEL25$----- , - 4.56$ "/ .64$ - 2.51$ .54$ We nake certain chargas for travel and incidental expenses when field surveys are sM.de for Group policyholders. In 1946 we collected on this account $2,487.25* In nine aanths of this year we have collected $2,336.51. The great bulk of this expenditure goes to servo Group policyholders. There is of course a nail use of industrial hyglena litsrature to asst requests from non-insured groups. We also receive and answer a certain amber of inquiries regarding industrial health problsas from non-insured individuals sad agencies. This really amounts to probably not aore than 1$ of tbs total. It is true that some of Dr. McConnell's time Is given to other general Welfare natters, through consultation, service on coaaltteea, etc. In that way a small portion of his salary might theoretically be allocated to interests other than Group. His salary is in this budget. Dr. Lanza's is not. (P< t/1 . 0482 D. B. Armstrong, H. D. Second Vice-President, Health sad Welfare '-'T' = U t 'V ~ X\ I\ THE INDDSTRIAL HYGIENE LABORATORY of the METROPOLITAN LIFE INSURANCE COMPANY W. J. McConnell, B.S., M.D, Assistant Medical Director, in charge of Industrial Health Service f The Metropolitan Life Insurance Company for many years has maintained in connection with the Industrial Health Service of the-Policyholders' Service Bureau an industrial health research laboratory whose technical staff p&a 'V'*****" -/a ) m*/ facilities- are made-avalIJahln without oast to-Metropeliyin Opoup-pollayholders and tijrin^ufittinn whfrr-T*/ei wvtiHttt -Tf nr'Mnrj "`H Tndiia^ri*! f n7i 1 ayhftHnrfi ornpi riyiifl g fiii< Mm ki.iuiy i factories, shops and offices of environmental conditions affecting health, such as: Atmospheric pollution by injurious dusts and fumes Ventilation Illumination ' Special occupational hazards The work carried on in the Laboratory of Industrial Hygiene has so expanded in recent years that the Company will open in November in its new building model physical and chemical laboratories fully equipped for the study of industrial health problems. Chemists and technicians make thjs required observations in factories, mills or other industrial establishment!, collect necessary air samples by means of the most modern devices, and subsequently complete their studies in the Laboratory At the Home Office. In connection with field studies, air samples * are taken under actual industrial conditions and analyzed for the dust content or for poisonous substances in this laboratory. There is thus acquired definite information which furnishes a sound basis of knowledge which can^Qse serve in the -2- full recognition of unfavorable working conditions and in the development of measures for their abatement. The-Jndustrial Health Service fully recognizes the confidential relationship which should exist between the Company and those whom it serves. It undertakes no field investigation except on the invitation of the Insured and with his unqualified cooperation. Sany of the scientific instruments used in these studies are designed especially for application to field studies. All instruments are calibrated in the physical laboratory before use in the field work. Wherever the physical air factors are studied in working places,by aeans-of the Tyese weeewiiag wat md a record of outdoor conditions is made by means of the Tycos recording wet and dry bulb thermometer^with a seven-day chart, having a small electrically-driven fan for drawing the air over the thermometer bulb for determining the outside temperature and humidity conditions. For inside work, in addition to the sling psychrometer, specially constructed psychrometers are used. These consist of small electrically driven fans for drawing the air at a velocity of 600 linear feet per minute, first over a dry bulb thermometer and then over Urn wet bulb thermometer, both mounted in a trumpet-shaped intake tube, painted dull black so as to avoid beat losses by radiation. The wick of the wet bulb thermometer is supplied with water in a small reservoir on the under side of the trumpet directly below the wet bubli thermometer. The whole apparatus is mounted on an adjustable stand. These instruments are set up in different sections of the plant and readings are taken at regular intervals, the number taken being determined by the rapidity of temperature and humidity changes. This type of instrument was adopted because it was found that the recording type of psychrometer was not sensitive enough to record small and rapid changes, due to the slow heat transfer, the quantity of metal, and the actuating liquid in the recording type. 0484 -3- The anemometer is used for measuring high air velocities and the kata-thermometer is used to determine air motion of low velocities. The kata-thermometer is_ aa_instrument designed to record temperatures in degrees proportionate to body temperatures. By measuring the rate of cooling of the kata-thermometer, it is possible to calculate the air motion. In order to correlate the significance of skin temperatures of workers exposed to high temperatures and humidities, these are measured by means of an instrument^, built according to specifications developed by the O.S.P.H.S. and the U.S. Bureau of Mines,cooperating with the American Society H. & V.E. The thermo-electric method used depends on the fact that whenever two dissimilar metals are in contact an electro-motive force is set up, the magnitude of which depends upon the temperature of the point of contact. A measure of this electro-motive force is, therefore, a measure of the temperature of the function of the. two metals. The thermocouple is made by welding one end of each of two wires of different metals or alloys, as copper and constantan, the junction of these wires is placed at the point the surface of which is to be measured. The copper wire goes directly to a potentiometer, an instrument for measuring electro motive force. The other end of the constantan wire Ib joined in a constant tempera ture bath, to a second copper wire, which also goes to the indicating instrument. The thermocouple is standardized by Immersion in constant temperature baths in thermos bottles, so that electro-motive force readings on the potentiometer indicate temperature directly. The method usually employed for collecting air samples for dust determina tions is known as the Greenburg-Smith impinger method. This apparatus is very efficient and readily transportable and also easily adaptable for taking half hour air samples at the breathing level and in close proximity to the worker. By means ' 0485 -4- of the impinger a column of air is drawn through a glass tub*, through a constricted orifice and then impinged at right angles upon a horizontal surface immersed under a liquid (either distilled water or distilled water and alcohol) in a wide mouthed pyrex flask. Thus the surface tension of the liquid is broken down and the dust particles are entrapped in the solution. The impinger it. actuated by suction supplied by steam ejectors operated by compressed air. The rate of air flow, during sampling, is measured by means of a small vacuum gauge inserted into the suction line. The flasks are then corked with rubber stoppers and transported to the laboratory for analysis and count*. The electric precipitator, an instrument designed upon the principle of a Cottrell precipitator, is used for collecting air samples for the purpose of determining particle size measurements of dust. The electric precipitator is placed in a position similar to that of the impinger. The air is drawn through this instrument by means of a weM. rotary fan, run by a motor, the quantity being measured by a flow meter. Wherever grab samples of air are desired either the konimeter, an instrument much used for dust determinations in South Africa, or the Owens jet dust counter and settling chamber, a method popular in Great Britain, is used. The samples collected in the field are subjected in the laboratory to either a chemical analysis whenever poisonous substances, such as lead, mercury, manganese, etc. are inspected, or dost counts and particle size measurements are made of such substances as silica, asbestos, and dusts known to cause changes in the lungs when Inhaled. It is obvious that only particles in a state of very fine subdivision can possibly penetrate to the lung tissue. It has been commonly accepted that only particles of less +-hn 10 microns can reach the lung tissue. A micron is one-twenty five-thousandth of an inch. 0486 -5- It, , is, necessary to count with the aid of the microscopes, using a standard procedure -nese minute pa: /<------------------------- -- in order to estimate the dosage of harmful dusts to which workers are exposed. Particle size measurements are made by taking microphotographs at a known magnification of the dust and then enlarging the negative further by projecting the images upon a screen by means of a stereopticon. The longest diameters of the images of the dust particles are then measured upon the screen. From the results of a sufficient number of these measurements a curve is plotted of the size frequency relations on Hazens* logarithmic -<U probability paper, the logarithms of Hw function measured in microns plotted as ordinates and the probability of occurrence as abscissae. It is a simple procedure to interpolate from these plots, which develop into straight lines. the frequency of occurrence of any. eiw&d dust particle: iess than ten microns present in the particular dust under investigation. TtuHJe are llluuU'UllVfi" Of Lie tjpt jf Bhalyses the laboratory is ^ U > i . /, v " i -v ^ called uuuu Lu watt". Other analyses, aintfaw the determination of carbon monoxide gas escaping into rooms occupied by workers; analyses of water used for drinking purposes; and the collection and dstection of poisonous vapors JX*j of all varieties escaping into mnln iiiiiiph npn fiiinntlnnT nff Mill l.ahnrntYiij, Illumination studies are conducted in factories where adequate and proper lighting is^essential factor in production and in the protection of workers. Standard methodised for measuring levels of illumination are employed. Photographs are made of hazardous processes and of the locations where samples are taken for the purposes of identification. 0487 -6Recent studiee of the Laboratory of Industrial Hygiene have concerned such matters as the effects upon the lungs of various inorganic dusts such as rock dust produced in hard rock drilling; the atmospheric pollution by specific poisonous substances; temperature, humidity and air movement in various industries. For example, dust studies were made in foundries and in asbestos mills and reports were prepared concerning the extent of the dust hazard and embodying recommendations for its control. The Laboratory has at its command exceptional library facilities to supplement the many sources of information made available through its wide 0488 -7and numerous contacts with health work in various industrial and mercantile organizations. The Service endeavors tn every Instance to be of the utmost practical assistance to those who submit problems for its consideration. When indicated, visits are made to policyholders to assure a comprehensive first hand understanding of the circumstances which are involved. The study of those insured Groups showing an unfavorable and excessive sickness or death rate, makes it possible to localize, by cause or sex or age group, the particular health problems most urgently calling for attack. The individual policyholder thus receives direct information of the objectives against which corrective measures should be directed. . 0489 Activities of the Metropolitan Life Insurance Cospaxy for and Promoting Public Health and Personal Hygiene / The program of the Metropolltan Life Insurance Company for the promotion of public health and personal hygiene is carried out primarily through the Welfare Division of the Company. This program is aimed es sentially at the health of the policyholders, numbering approximately 25,000*000, (and particularly the industrial .jolicyholaors - about 21,000,000), though indirectly it affects the well-being of the general population of the country. The principal lines of effort are as follows* A. Health Education Essentially this involves the interpretation of scientific findings concerning disease prevention and health promotion in popular terms, and their presentation to the policy holders in an attractive, intelligible form. This involves* 1. The distribution of literature* From 1909 until July 1, 1927, the Company distributed, through its field force or through health officers, schools, and social agencies, a total of 462,442,055 publications dealing with the prevention of disease and with health promotion. The great bulk of these publications wa3 placed in the homes of policyholders by field agents in Tuairtng their routino Insurance contacts. 21- The use of health films. The three most important films of the Company, deal ing with smallpox, diphtheria, and health examinations, have already been seen by reported audiences of over eight million people. 5. This educational work is supplemented by the use of ex hibits, posters, film strips for use In projection machines, the carrying on of clean-up campaigns, antidiphtheria campaigns, health examination campaigns, lectures, talks, etc. 4. For work with schools, parent--teachers associations, and women*s dubs, special literature, films, exhibits, posters, scientific papers, and other material are pre pared. In schools, a special effort is being made to educate the children concerning the heroes of preventive medicine, such aa Jeuner, Reed, Pasteur, and Trudeau) in cooperation with parent-teachers associations, a special campaign ia being conducted to 0490 -?- encourage the thorough examination of And defect correction among the preschool population of the United Statesj with the aid of rumen's clubs, special studies in hundreds of coanranities are under way, concerning the health laws of those cities, and the rights and duties un der those laws of the citizens# 5. For i amt grants and those seeking citizenship, a speciel service is carried on, involving advisorycare of immigrant friends of policyholders, coooeration with local agencies in citizenship capaings, and the distribution of citizenship liter ature, 460,394 booklets of this type having been used in 1926, B# Nursing Care to Policyholders The Company provides a visiting bedside nursing service, without cost, to all acutely ill industrial policyholders, in over 4,250 cities and towns in the United States ard Canada# This service is provided either directly try sala ried nurses or through Cooperative affiliations with local nursing associations. The nurse, who gives care only whan the patient is under th^ supervision of a physician, to follow out the physician's instructions as to the needs of the patient, advises Ja member of the family as to how to give supplementary care, and instructs all members of the family concerning disease prevention, home hygiene, and related subjects# Within the last eighteen years, over 27,000,000 nursing visits have been provided for industrial policyholders# In 1926, a total of 3,168,417 visits were given to sick industrial, intermediate, or group policyholders. ; effprta Thia service isc supplemented by other^ on the part of the Company, to insure the high standard and efficiency of the work done# Through scholarships at nursing schools, public health ifuraing institutes, a correspon dence course, and through the establishment of public health nursing training'eehters, the staff of graduate and registered nurses is kept in closest touch with the latest developments in the public health nursing field# C# Experiment and Demonstration In addition to bedside care and the popularisation of scientific knowledge, the Company has endeavored through a number of rfrAwnaia to contribute to the body of scien tific fact essential to the conquest of preventable dis ease# wvMpiaw of such efforts are as follows! 0491 - 3- 1. Hie Framingham community health and tuberculosis demonstration in Massachusetts, 7*ere, over a period of seven years, the Company financed, through the National Tuberculosis Association, an effort to control tuberculosis, resulting in a drop in the tuberculosis death rate from 121 per hundred thousand to 38 per hundred thousand in the seven year period. 2. Tlie Thetford Mines infant welfare experiment. In Thetford Mines, Quebec, a demonstration of methods of child care and infant mortality prevention re sulted in a drop in the infant death rate from 300 to 98 per thousand born,, following which the Pro vince of Quebec appropriated $500,000 for similar work throu^iout the Province* 3, Subsequent to the ir-fluensa epidemic in 1918, the Company appointed and financed an InfluenzaPneumonia Coamission, rhi,ch has been making signi ficant studies into the cause of influenza, improved serological methods of treating pneumonia, bacterio logical factors in common colds, etc. , 4* 1 special campaign to eliminate diphtljeria has been carried on for a number of years, culminating in a five year anti-diphtheria campaign in {New York State* For this work, special literature, a film, an ex hibit, a poster, and other material have been pro vided, for use not only by the Company*a field staff, but also by cooperating health and social agencies* Since the initiation of this campaign in 1921, the diphtheria mortality among the children of the policy holders of the Company has declined 6Q*1* l 5, it the present time the Company is also financing a special study of burial problems and funeral costs, questions with which insurance companies and social agencies have for many years been deeply concerned* 0* Cooperation with Other Agencies From time to time, the Company has found it expedient to ex tend aid to established and reputable health movements, both public and private in character* Through these channels, ap propriate opportunities have been taken advantage of for farthering important public health activities* From time to time, new much needed work has been initiated, subsequent ly to be taken over by an established public health agency* Efforts of this kind have been found to be of direct, as well as indirect benefit to policyholders* , 0492 Temporary financial grants or staff assistance in import ant pieces of work, or awards, prises, or scholarships have bsen extended to such agencies as the United States Public Health Service, United States Department of Labor, the Post Office Department, state and local health depart ments, voluntary organizations working in the tuberculosis, child health, social hygiene, and mental hygiene fields, schools, and colleges. As examples of movements fostered in this way, there may be mentioned a standard milk ordinance campaign being conducted in cooperation with the United States Public Health Service; an extansLve survey of municipal health conditions, initiated through the imerican Public Health Association; a prize essaycontest offered through the American Social Hygiene Associa tion; the development of a Department of Industrial Hygiene at McGill University in Montreal; the establishment of a sum mer course for health officers at the Massachusetts Institute of Technology; etc. Through cooperation with such agencies, and rdth the aid of the Company's field staff, sueh has been done in many commun ities to create and cryatalizq public sentiment in favor of health laws) bond issues for public improvements, such as water supplies, sewage disposal systems, tuberculosis hospitals, etc.; the adoption of milk ordinances; the development of opposition to anti-vaccination and antl--vlvisection propaganda and legisla tion, etc. This program of the Welfare Division of the Company is supplemented by related efforts carried out through other divisions of the Company's organiza tion. Chief of these are as follows* I. The Medical Division Through this Division, a periodic medical examination service is extended to ordinary, intermediate, and group policyholders. For many years this service has been offered to ordinary policyholders, and up to the present time, over 550,000 examinations have been given at the Company* s cost, through the medium of an outside, in dependent agency, namely, the Life Extension Institute. That this service Is a valuable one is indicated by the fact that among poli cyholders who have been examined and advised concerning tlieir health the death rate has been 18% lower than the actual mortality of all ordinary policyholders who could properly be compared with them. H. The Group Division Through the Policyholders* Service Bureau of this Division, reaching as it does, large groups of employees in a great variety of indus tries, there is extended, for the benefit of employer and employee, an industrial hygiene service, including industrial health surveys, advice on medical, nursing, clinical, and health educational prob lems, aid in the prevention of health and safety hazards, supple mented in the safety field by cooperative efforts at street and com munity, as wall as factory accident prevention* 1 0493 - 5- IHi. The Publicity Division The educational work carried on by the Welfare Di vision, as outlined above, is supplemented by daily morning radio exercises offered through a number of _the more important radio stations, radio health talks, and an extensive series of health advertise ments in the popular magazines, reaching a group of readers estimated to be in the neighborhood of 60 to 80 million, IV. The Statistical Division In this Division, a great deal of statistical research is carried on in health, medical, and social problems, in extensive series of community surveys as to sickness prevalence has bean carried out, and numerous contribu tions are made to the statistical side of disease con trol. V. Real Estate Division Under the auspices of this Division, the Company several years ago initiated an important housing development in a congested neighborhood of Hew York City, where hygianically constructed and economically operated living facilities are provided for over 2,100 families In lowpriced dwellings, affecting the welfare of thousands of individuals. This demonstration of the practicability of establishing sanitary, yet reasonably profitable housing facilities In congested neighborhoods at low rentals, has been a very far-reaching and significant stimulus to the development of similar projects under various auspices. 71. Health lark for Employees (Approximately 41,000) While this is not strictly a matter of public health pro motion, yet the example set by the Company in providing for the welfare of its employees has undoubtedly been an Important factor in the development of stmil ar measures in other fields. In the Hatropolitan, this work is the responsibility of the Medical, Personnel, Commissary, and other branches of the organization. It includes a compul sory annual medical examination of all employees, a semi annual dental examination, the operation of a sanatorium for tuberculosis and other conditions, of 290 beds at Mount McGregor, H. !, a luncheon service for Home Office employee*, and the fostering of numerous educational classes, recreation developments, etc. The morbidity and mortality experience among the employee group clearly demonstrates the hygienic, as well as the economic advantages of these constructive health measures. . 0494 -e- Costs and Results* The more or less intangible effects of the general public health efforts of the Company, as carried out in coopera tion with numerous outside agencies, are, of course, hard to determine. There seems to be no question but that these efforts have stimulated and aided many important develop ments in the United States and Canada. This fostoring of much needed practical sarvic93 has been paralleled by the Company*s efforts to contribute to scientific research, as indicated. It is, however, possible to measure the value of the public health and personal hygienic activities carried out essen tially for policyholders. It is possible to measure this by means of a satisfactory criterion, namely, the death rate. The accomplishments in this field may be indicated as follows* Since 1909, the Company has spent $6,445,877.11 for general welfare work, including health education,research, etc. Dur ing this period, it has also spent $20,418,738.56 for nursing serrtffe* to policyholders. This represents a total expenditure over this period of $26,864,615.47. The effect of this among the industrial policyholders may be measured by* 1. Health Results In 1911, the general mortality of the industrial policy holders of the Metropolitan Life Insurance Company was 24.5$ higher than the mortality of the population of the Registration Area of the United States as a whole. By 1925, the mortality among Metropolitan policyholders had improved at such a rate as to bring it 1.3$ under the rate for the Registration Area. From 1911 to 1925, the average duration of life for the country as a whole increased by 5.1 years. For Metro politan industrial policyholders, this increase was 8.8 years. the During this period, M decline in tuberculosis mortality in the Registration area was 45$) for Metropolitan in dustrial policyholders, it was 56.5$. During the same period, the Metropolitan -typhoid fever mortality declined 81.6$, and the death rate for communicable diseases of children declined 56*2$. Ih all instances, the Metro politan death rate went don mud* faster than.-tfcstsrofvtfci- jWBrf ill ii tion. 0495 Economic Results During the period 1911 to 1928, the general mortality rate among Metropolitan industrial policyholders im proved so much more rapidly than that of the general population as to result in a cumulative net saving in mortality, in excess of the general population improve ment, of approximately 275,000 lives. In deferred death claims, this represents a saving of about $85,000,000. As indicated above, all of this work was carried out at an approximate expense of $27,000,000, resulting in a theoretical profit of $38,000,000 - a profit which, in a mutual cooperative enterprise, such a3 the Metropolitan Life Insurance Company, must go back to the owners of the Company - m=r:. the policyholders in increased dividends or cheaper insurance, & financial benefit supplementary to the disease prevented, the health conserved, and the lives prolonged. . 0496 RESEARCH ACTIVITIES of the METROPOLITAN LIFE INSURANCE COMPANY 1 Madison Avenue New York 'f 7 1. Framingham Community Health and Tuberculoais Demonstration: Appropriations for research in tuberculosis and community health problems; through committee of the National Tuberculosis Ass'n., 1916-1924: $189,511.60 2. Thetford Mines (Quebec): Infant Welfare Experiment: Study and demonstration of infant mortality prevention:1921-1926: $29,556.29 3. Study of Visiting Nursing Co3t3 and Accounting Methods: Through committee of National Organization for Public Health Nursing; 1922-1925: $19,603.95. 4. Influenza-Pneumonia Commission: Study of etiological factors; serological methods of treatment; etc. 1919 - June 30, 1927: $277,029.87 plus $25,000 appropriated for current year. 5. Study of Snuffles in Rabbits: 1926-1927: $5581.85 6. Bacteriological Study of Common Colds: Dec. 1925 -- to date: $20,000 per year. 7. rial matte Vaccine Inquiry: Appropriation for case studies in New York Cit7 and laboratory work on animals at Company Sanatorium; 1920 to-date: Approximately $3000 yearly in New lork, together with $6176.71 to date at the Sanatorium redearch.laboratories. 8. Study of Measles Immunology: 1924-1925: $6089.77 . 0497 9. Studies of MuniciPal Health Department Practices: Through committee of American Public Health Ass'n.; 1920 - to date: $60,000. 10. Tuberculosis Among School Children: Appropriation to special committee of Company, Oct. 1926: annually for three years. $12,000 2. 11. Tuberculosis and Silicosis Among'Miners: In Picher, Okla., district, in co-operation with the United States Bureau of Mines; 1927 ----- : $8000 annually for three years. 12. .Study of Bacillus Abortus Infections and Related Problems: 1927: $5000. 13. Study of Morbidity Statistics: Sickness surveys in many cities: 1915-1927 14. Studies of School Hygiene, through Metropolitan Advisory Educational Group Diphtheria immunization methods: Hand-washing facilities, etc. 1925-1927: $6000. 15. Studies and Demonstrations in Industrial Hygiene in Canada: Conducted for Company ty McGill University, Montreal; 1920 ----- : $5000 annually for five years. 16. Study of Typhoid Fever Incidence. Carriers, etc.: In Montreal; 1927 ----- : $6500. 17. Burial Problems and Funeral Cost. 1'hrough Burial Survey Committee; September 1926: $25,000 appropriated. 18. Studies of Air Pollution-By Dust. Fumes, and Gases: At Home Office Industrial Hygiene Laboratory; 1926 ----- : $6000 annually. 19. Quantitative Analysis of Urine Specimens: Conducted through Home Office Laboratory Facilities. 20. After-Mortality of College Athlateat For "Presidents' Committee of Fifty on College Hygiene." statistical work. $1000 plus 21. Surveys of Unemployment in American Cities: 1914-1915: A general study in co-operation with the United States Bureau of Labor Statistics. 22. Economic Value of Human Life: A general study of human life values. To be published in 1928. 23. Relation Between Climate and the Deathratat For Rational Research Council, Committee on the Atmosphere and Man. (1923-1927) / 0498 3. 24. Many Additional Statistical Studies of Morbidity. Mortality. Longevity. et< Carried out through the facilities of the Company's Statistical Division, the more important of which are: --a-. b. c. d. e. f. g. h. i. j. Typhoid Fever in American Cities. 1860 to 1926. Cancer Mortality Data. 1911-1922. Cancer in Belation to Overweight. Suicide Mortality. Mortality in Childbirth and in arly Infancy. 1925-1927. Mortality Among Insured Wage Earners and Their Families. 1911 to 1916. Mortality According to Build. Reight. and Spine Length, 1925-1926. Heights and Weights of New York City children. 14-16 Years of ige.1915. Mortality of Southern Communities from Typhoid Fever, Malaria. Pellagra. Tuberculosis, and all causes. 1916. Life Tables of the American Population (Annually). 1c. Population Growth and the Size of the Family. 1. Status of Maternity and Infant Hygiene in the United States. 1927. 25. Additional Laboratory Investigations? In the John Rogers Hegeman Memorial Laboratory at the Company's Sanatorium at Mt. McGregor, New fork, including: a. Studies upon the sedimentation reaction and the complement fixation test in tuberculosis. b. The action of alpha-lobelin on respiratory stimulation in animals. c. The action of mineral oil in the lungs. d. Histological examinations of tonsillar tissues; blood examinations in specialized group of tuberculous patients, etc. 26. Personnel Studies, including: a. Clerical Test Scores and Schooling. b. Study of one and two days absences ty age and cause. c. Study of value of mental tests in terms of efficiency ratings, schooling, and turnover. 27. Trade Inquiries: Conducted through the Group Division and the Policyholders Service Bureau of the Company, including: a. Study of research methods as employed ty New England industries, at the request of the New England Council. . 0499 4. b. Study of methods employed bjr railroads in promoting co operation between employees and management. c. Analysis of management methods in iron foundries. --d.: Studies of industrial, street, and home accidents and accident prevention. e. Incuiries, at reouest of the California Vineyardists Ass'ns., concerning grape packing, distribution, and related proolems. f. Study of Migration of Industry, at request of National Electric Light Ass'n. 0500 RESEARCH ACTIVITIES of the METROPOLITAN LIFE insurance compary Expenditures Since 1916. Current Costs, and Committments 1. Fram-ngham Community Health & Tuberculosis Demon stration 2. Thetford Mines Infant Welfare Experiment 3. Study of Visiting Nursing Costs 4. Influenza-Pneumonia Commission 5. Snuffles in Rabbits 6. Bacteriological Study of Common Colds 7. Calmette Vaccine Inquiry 8. Mealses Immunology 9. Municipal Health Department Practices 10. Tuberculosis Among School Children 11. Tuberculosis and Silicosis Among Miners 12. Bacillus Abortus Infections 13. Sickness Surveys * 14. Studies of School Hygiene 15. Industrial Hygiene in Canada (McGill Oniv.) 16. Typhoid Fever in Montreal 17. Burial Survey 18. Studies at Industrial Hygiene Laboratory 19. Quantitative Urinalysis * '20. After-Mortality of College Athletes 21. Unemployment Surveys * 22. Economic Value of Human Life * 23. Climate and the Death Rate * 24. Additional Statistical Studies on Morbidity, Mortality, Longevity, etc. * 25. Additional laboratory Investigations Into Pathologyand.Histology of Tuberculosis,.etc. * 26. Personnel Studies * 27. Trade Studies 8 169,511.60 29,556.29 19,603.93 302,029.87 5,561.85 40.000.00 (2 yrs.) 9,176.71 6,089.77 60.000. CIO36.000.00 (3 yrs.) 24.000.00 (5 yrs.) 5.000.00 6.000.00 25.000.00 (5 yrs.) 6,500.00 25.000.00 12.000.00 (2 yrs.) 1,000.00 TOTAL $ 802,050.02 Costs absorbed in routine laboratory or division operations. - 0501 2 11. TuberJulosis and Siligacis Among Miners: In PiJher, Okla., district, in co-operation with the United States Bureau of Mines? 1927 ---- $u000 annually for three years. 12. Study pf Bacillus Abortus Infectiions and Related Problems: 1927: $5000. 13. Study bf Morbidity Statistics: Sicknejss surveys in many cities: 1915-1927 14. Studied of School Hygiene, through Metropolitan Advisory Educational Group; Biphtneria immunization methods: Hand-wash.ng facilities, etc. 1925-1927: ?6000. 15. Studies and Demonstrations in Intll istrial Hygiene in Canada: Conduc ;ed for Company By McGill 1 piversity, Montreal; 1926 ---f50'JO annually for five years. 16. Study of Typhoid Fever Incidence. Carriers, etc.: real; 1927 ---- : l`650:. 17. Problems and Funeral Cyst. iVir. '.i.vh burial Survey Comn ttee: September 1926: 25,0 "J appropriated 16. studio: of Air Pollution By Dust,| Furies. and Cares: At UoMe Office Industrial py?iene T/'borst -ry; 1926 -- -'6000 annually. 19. <\i;,ntitptlve Analysis of 111*118 Specimens: Condvc<i?d throirli Office r,->c r-1 r. 'ciliV-es. 20. After-'I <11L- 1 It.' ' f Col1.e?e Athletes: For "Pi c'- lient-1 C'j~. \ , .oo of Flj'tv on r .>11 re nt- t.nti.c'1 'Oi'lr. >:.:c. ;'l-i> plur 21. Survey y:en_)loj'_.i_ .nt i_n_Ajnericj n r'. e.': 19K-l~|l;.: ,re:i . r ati.i !.v in co-to .cr- t <n with the "n to:1 ctrton "it" i >; r.'b-r {'tntirv.es. Fco-to- l'-l ; V lue of H-q'i-n J>. he: A re.ic: 1 study jf h'Hi'.n life / 1 n-. Ti he published in 1923. 25. Rel 2-i t h fetv esn C..L mi i,rn j !c- thr-to: rj r .'or ? rch Council, ?wn. (&;*.. "-ix 7) I'tfee on 're "tmus >he"e and f / -r .. -axesg. rt, lit fieri: lit; Inl.-ncv, 1 e r ""miller,.1911 to ISlc Ifrrt- li ty_ >cccr In- r . 'gl.-'-.t. .'n1' " ir.e T.cnrtli. 10:.T-19^c'. _.1 ! : '-tv chit > ren, 11-1E 1er r. o_ cre.l&l in fonnur-itic" from T"u',vi<J "over, '* Ifris. Pfell^rr?. Tocoictf1': is, -ny_ Jl_ fipvscs, 1S1C. riern Po- 'il '< i ~ r. ( ^nrur-llz). ul.3T.iun truf.tt 1. Fltv.turj cf '`rtrrnlt;/ cn<' inf- rA_v_i.sr._e in vie. . n-te-.i i- ten. ll-Uf. M'U-t lorir.l L: rx>rr t. r;~ Invent'.- 1. t . r.s s In th: Jc'-n To rr- n "mri-l-l Tr-t-ry rt tic Con -rv'r. ?an?t<:riun sit it. Vc^-rr: --r, t.-n;, ir.nl.- . rt il-icr u- on i*-o -r t ;..'t ir. tccrc'-'" t. Tie scti;n of ai> i. tin r: rr.i n r-r.:! tl r. fixrti n ccl in cn rer pinto re stirm' - ion in *nin-1 . T-,c. rcticn of miner-1 cl ir tlo lun\-~. si. ULrt.olo ic 1 e---i. ".5- of to ssi"!7 -r tin: urr; clooi ex- rai-V-tf. nr ii r..c-ci.- l.Lrr-ii -re-., of tiii.rrc..,iovr -tirr-.t-, etc. Per: 1 cV-_ c"fj_ i'.c7v- -inri h. CLcric-1 'feet fc>; . .-m 'c'rl- li c. c. *'t . ' . v- - n . t -- -. ryr sijrcnctr c; - r n'; c<* re. e. rt'i. - c.' v: lue of mcni - 1 tt .rtr- in to;-- o;' ef ieioncy rrtirifrp, .sisv. Ii:.-, * ml tum-v.-r. , lii-. Q| inr ir. cr: Conu- ctec tl.r- cl: tire fro \ livi-:c. -no tie Polic.-hol-.ierr Service :'iui3-lu t'..o Co-i ny, i cl .-.in;: a. ftufy v f rerre :-cl. net.-.-.sis nr r; Icvc-- try Ic. rs-. ' nl inlortr oc, .-It - It. re c.:x .-f tf- '1 E: '..-n' C: ceil. SEMORAHDUM D#a*cber 7, 1828 Dr. Frankall ------- 1 Possible Hospital Insurance Project For purposes of orientation, I*d like to sot up on paper, certain angles of a possible insurance project for hospital care, along the lines of previous and current discussions. Of ourse many facts, possibly including certain essential ones, are lacking. For this and ^ther reasons of expediency, it nay be only for theoretical consideration at this tiu.e Foliosing conferences with the A.M.A. representatives and others, I suggested some tice ago, the possible advisability of a private, joint session between representatives of certain medical, social, and insurance agencies, for the consideration of numerous projects under say or being proposed in the medical service fields, there -e^e almost an infinite variety of complications and possibilities, and whether such a conference would accomplish any more than is being done through the Committee on the Cost of Medical Care, is a question, However, as you said recently, probably the only way to test th* practicability of certain proposals is to try them out in a limited way* It seems probable that a cumber of experiments, in addition to those already under way, will be initiated during the next decade. Among these possibilities, a simple hospital treatment scheme would seen to have many advantages and fewer basards than a project that might involve outpatient or home methods of care, as has been indicated, indeed, by the suggestions which you, yourself, have aade to hospital organizations in times past in Re* fork City. Obviously, there is to you in the subsequent suggestions, little if anything that la new, and probably much lacking that yon would add. Its value, if any, lies in the mechanical assembling of ideas and suggestions from several sources. Skat seen to bear on the problem. Relative Advantage* of a Hospital Caro Project Compared with hone or other treatment proposals, the outlining of a hospital care project would seem to be relatively simple and premising for a number-of ramsons* Hospital care would involve for the aoet port, operative needs and might indeed be restricted to that in the beginning. It is much easier to estimate the probable cost# of operative care than of general medical care, and much simpler to get surgeons to agree to a standard aeale of charges. It would be easier to scours th* collective committment of a group of doctors to a sat of hospital operative charges, end this i&lght be dona without materially reducing the average income of the surgeon from operations ~ a consideration that would favor tha cooperation, or at least the acquiescence of the doctors from the start. 0505 Sr* Fpankel *2* December 7, 1929 This type of project is also one which, has received sons promotion and publicity through A.H.A. executives (particularly Dr. Harriss). It is a project in which a number medical and social groups are interested, and probably willing to cooperate. The possibilities of securing aid and initial underwriting from such an agency as the Kosenw&ld fund are excellent* On would suppose that for in surance company participation, with our accident and health precedent, there would be required no special legislation and no particular appropriations beyond the overhead for the establishment of a new bureau or division for the adminis tration of the carrier's obligations in such an insurance plan. Possible Site It would seem that such an experiment might best be initiated in a medium sised city, where there is a fairly closely knit and relatively small medical organisation, one or more good general hospitals open to most of the medical and surgical practitioners in the community, and an industrial organisation and situation which would promise to furnish the channels for the promotion of the insurance through large, well-distributed groups in the community. Iw Bedford, itself, has many advantages from the point of view of sise, medical organisation, and hospital equipment, though the economic situation there is not favorable* It might even be done la as small a community as Framingham, where incidentally, there is an excellent tie-up between hospital, medical group, and leading industries. It is not inconceivable that it oan be tried in a restricted city area, if ex cellent and sympathetic medical leadership were assured, as might be the case in Brooklyn* Then, there are the California possibiliti s, and recently Dr* Ulohael Davis has indicated that there may be an unusually promising opportunity in Durham, 8,0. Participating Agencies Xn any event, the principal participants in such a project might be several if not all of the following groups! 1* The local hospital organisation* 2* The hospital medical staffs and the county medical society* 5* Local industries* 4* An outsid# contributor for the experimental overhead, such as the Bosenwald Fund, ft* An insurance oampany as carrier or re-insurer. 6, The oitltene thsmaelves, either individually, or as employees, or through employee organisations* V# The local health' organisation, in its preventive medical activities -- health education, health examinations, etc. 8. The state government through its Insurance Commission or department* frfalqiftrfl^ion For the operation of such an experimental unit, there would probably have to be organised, a responsible local group, representing possibly several of 0506 Dr* /rankel .*..8* ^eOober 7, 1929 the potent!*! participating agencies, but essentially the hospital and sedlcal groups, the insurance carrier, and the underwriting fund. This group would have the genoraZrreapQnsibility of government ox' the experiment, the determination of policies, the administration of a special reserve, the direction of sales and promotion, and the initial planning in order to guard against the outstanding difficulties, such asr Chief Difficulties 1. The determination of a satisfactory relationship for the physicians and surgeons with the hospital, and with the insurance scheme in general* 2* The working out of sales and promotion meth da which would insure a wide coverage and avoid an adverse selection* 8* The determination of an experimental basis for setting a premium that would cover the oosts of assured benefits, otc. Functions of Participants flthout attempting * detailed stmtenent, it can be generally indicated that the hospital would be responsible for providing the facilities, probably for making the collections and distributing fees for medical service in accordance with a uniform and approved scale* Jh physicians on the hospital staff would have to agree as to a uniform scale of fees and the hospital, itself, would have to work out, probably through ita medical staff, an understanding with the county medical jobp. that would cover specific problems of eligibility for physicians to perform certain types of medical and surg-cal work, a method for a check upon certifications of illness or disability, to* The New Bedford experience seems to indloete that this may not be as com plicated ae would at first appear* Local Industrie# might participate in several ways. In Nw Bedford, they are making a contribution to the reserve for every individual atployae who joins either as an individual or through a mutual aid association* Tha private mould be responsible for a special reserve and assistance in carrying the initial' expense and overhead for an experimental period# The ^nsur^gm oompany would have to assume the responsibility and be given the fine! authority in the determination of risks, premiums, range of benefits, to* Zt would aot directly or indirectly ae tha oarrier, and sight be used through its loesl machinery to aid in the promotion and sales of the sickness or hospital insurance* The preventive medical aspects of the experiment mould be fostered by the local health authorities, and aa intensive and adequate sanitary and preventive medical program might prove to be a considerable factor In producing a favorable experience as regards the incidence of illness, especially if the scheme reached 0507 Dr* Frenkel December 7, 1928 bayond operative needs* Thu citixans-thoaselvaa sight be related to the medical serrica and insurancr privileges either as individuals, as is now being attempted in ifaa Bedford) or on a family basis, as is being tried out in Brattleboro; or as groups of em ployees, as in the Tennessee Coal and Iron Company, or the 2ndicott~l0hnson plant) or through mutual aid association relationships, as has been pretty thoroughly developed in the Dennison plant in Framingham; or possibly in relatiohship to previously established group insurance contacts. Feasible Advantages There ore, of course, not inconsiderable hasards in such a project as veil as difficulties as yet unsolved and not accurately msasureabie. However, the advantages of such an dxperlment, should it be at all successful, promise to be many. 1. It might stand as a very important fioneerlng experiment and demonstration In tha fields of medicine and insurance* * 2. It should furnish accurate and uniquely valuable date on the cost of eic&nea* care* r 8. It ought to insure for the group covord, more adequate hospital care than has hitharto bean devised, and if successful, would demonstrate a method for materially enhancing the financial resource# of the hospital itself, probably relieving it to a greet extant, of a load of charitable or inadequately com- pensatod service* 4. It is believed that thus relating more closely individuals to medical service and thus encouraging individuals to purchase medical care on a wholesale basis in advance, would have a distinct preventive effect through the encouragement of early diagnosis and adequate treatment* 5. If successful, it might lead to an extension of a service that would cover acute illness, outpatient cere, home medical and nursing provisions, etc* 6. It ought to improve tha. economic and professional status of the nodical pro fession and the cohesion and stability of the medical personnel. Through a free choice of physicians within a legitimate range, it should preserve the private practice of medicine and at the same time, of quackery and cultism* It should also launch the pTljl^jr: ^wP^SM0iore extensively into tha field of the private practice 7, Bar-So&yf^^^^^^ss, might furnish a procedure which could be demona to tha compulsory sickness and health Insurance schemes of foreign countries, and might open up a very extensive field for privets in surance endeavor. Donald 8, Armstrong, H,fl* Fourth Vice-President 0508 PUBLIC EDUCATIONAL up. RESEARCH ..CTI7ITIES OF TEE RELFERE DL OF THE L1ETROPOLIT.-N LIFE INSURANCE COMPANY 1. Ia 1915, at the request of the United States Department of Labor, unem ployment surveys were made by the Company's agents in forty-five cities. The surveys were published by the Department of Labor. 2. Between LSI5-and 1917, the Company conducted sickness surveys in various cities and in certain uoal mining regions. These uero aade to secure ade quate morbidity statistics and, in particular, to determine the percentage of individuals non rc-oui,irg adequate medical care. 3. In 1916 the -omcany cu-' /crated with the national Tuberculosis Association in conducting & t.eveu-..'tai' experiment In tuberculosis control in the town of Framingham, and financed the project. At the enc of the seven years, the death rate from tuberculosis had dropped from 1P1 per 100,000 to 38 per 100,000. 4. In 1918 an extensive survey of health and suni-Viry conditions in the city of New Orleans was undertaken jointly rdth the 3Jura of Health of that city. 5. In 1920 a grant was made to the American Public Health association to cover the expense of a Committee organized to study health department practices in the larger American cities, to determine the relative ef fectiveness of various methods employed by health departments and to standardize and Improve municipal health machinery. The work of this Committee has resulted in the establishment by the Association of a per manent field service for advising and assisting health officer*.^'muni cipalities, counties, and states in their problems of administration and public health Drocedure. 6. A demonstration was undertaken in Thetford Mines, Quebec, to reduce the infant death rate in the Province. A maternity center baby clinic, in charge of a French physician and French-speaking nurses, was opened to give instruction to mothers in prenatal and postnatal care. At the end of three years, the infant death rate had dropped from 300 per 1,000 bom to 96 pear 1,000. These results induced the Provincial government to appropriatfira 5500,000.00 for similar work in other communities. 7. An independent Advisory Committee was appointed to make a thorough and impartial study of funeral costs. The result of this study has been pub lished in a book by John C. Gebbart, Director of the Survey, entitled "Funeral Costs*, and has resulted in the undertakers, themselves, appoint ing as Advisory Bureau, in an endeavor to standardize burial costs. 8. In order to standardize the cost of the nursing visit in various cities, the Company made an appropriation to a committee appointed by the National Organization ror Public Health Nursing, to make a study of this subject. The results have been published and are being used by nursing association throughout the country in computing costa. 0509 .9^ The Company cooperated nith the Canadian National Committee for Cental Hygiene in a campaign to disseminate information relative to senttl health. The Company also cooperated in the educational campaign of tha Social Hygiene association of Canada. 10. The Company cooperated eith the American Child Health Association tn printing copies of the raports of tha Health Sections of two meetinga~of the Tcrld federation of Education Associations. 11. Cooperation with tbs Children*a Bureau of the Notional Tuberculosis Association, the Boy Scouts of America, and the Director of the Cansus to procure legislation in six states compelling registration of vital statistics. 12. Cooperation eith a special committee to bring about a coordination of welfare activities in the various departments of the federal Government. 15. Cooperation eith the Sings County Medical Society in tha prepara tion of a manual for health examinations to be distributed to all physicians in the United States. 14. Cooperation with the American Child Health Association In providing a scholarship for a teacher in Memphis, Tennessee, sho gave the most practical instruction promoting good health and sanitation, and- also providing a health education traveling fellowship which was woaby a teacher to study health education in Europe* In November, 1917 and 1918, the Company also provided scholarships for nurses to take courses in public health nursing through the George Peabody College ofi Nashville, Tennessee, and the School of Social Work and Public Health of Richmond, Virginia. 0510 The following ara current educational or research acitivities: 1. Influenza-Pamumonia Commission and the bacteriological study of com-mon colda_ 2. The Calmette vaccine inquiries at the Kegeaan Memorial Laboratory at lit. McGregor, and at Bellevue Hospital under the direction of Dr. Park. 5. Studies of School Hygiene through the Metropolitan Advisory Educa tional Groupj Diphtheria Immunization in Schools, made through the Massachusetts Institute of Technology. Handwashing Facilities in Schools, made through the Massachusetts In stitute of Technology. Teachers Health, made through Teachers* College of Columbia Univer sity. School Health Study of Newton, Massachusetts, made through the Uni versity of Michigan. 4. Studies of typhoid fever incidence, carriers, etc., following the ty phoid epidemic in Montreal. 5. Continued diphtheria prevention campaign in cooperation with State and local Departments of Health. 6. Continued campaign for the adoption of standard milk ordinances in cooperation with the United States Public Health Service. 7. Health appraisals of cities and small towns in cooperation with the National Federation of TTomen's Clubs. 8. Cooperation with the National Parent-Teachers Association in the sum mer round-up of pre-school children and other activities. 9. Campaign for the development of school debates on health heroes in cooperation with Bchools and educational leaders. 10. Survey of Cost of Medical Care, in cooperation with the Committee on Cost of Medical Care. This committee is composed of representatives of medical and health organizations throughout the country. A five year program has been planned, covering various phases of medical care*. The Company is making a special study of cost of medical care in families among its Industrial policyholders. 11. Special cancer campaigns in cooperation with the Amarlean Society for the Control or Cancer, especially in Massachusetts, North Caro lina, and Missouri. 12 Activities of the Tan! grant Service and Citizenship Bureau in pro moting citizenship among foreign-born policyholders, in developing English classes, etc. 0511 15. An educational caaoaign, in cooperation with tbo American Heart Association, to disseminate throughout this country ana Canada infomation concerning the prevention and treatment of diseases of the heart. 14. For the past two years the Company has been cooperatiJli with the Massachusetts Institute of Technology in a suncer course in pub lic health for health officers. 15* Cooperation with the University of Montreal, the Health Lepartcent of -ontreal, and the Tuberculosis League of Montreal in de veloping a school for public health nursing for French-speaking nurses in that city, to raise the standards of nursing and de velop modern technique. HKKHK8<HH? iH> Iho above list of welfare activities does not take into account our more or less routine though extensive piece of work in tho nursing field, the use of the new eahiblt lor county fairs and elsewhere, etc. 0512 .......... In addition, there are' activities primarily fostered by other divisions, but in which we are interested, that ought to be included in any complete list of Company measures. I have in nrfnri anch studies as the following: A - Medical Division interests in 1. The tuberculosis study among school children in Philadelphia. a,. X-ray study of tuberculosis of school children at Saranac Lake. 2. The studies of bacillus aborus infections. 5. The health examination propaganda carried on with the Gorgas Memorial Institute. B -- Activities of the Policyholders Service Bureau, 3uch as 1. Tuberculosis and silicosis among miners In Picher, Oklahoma, in cooperation withaiUaited-fitatse.Bureau of Mines. 2. Studies and demonstrations in industrial hygiene in Canada in co operation with McGill University. 5. Studies of air pollution, duat, silicosis, etc., among rock workers in Hew lork City. C - Additional special laboratory angles being carried out either at Mt. McGregor or in the Home Office Laboratory. D - The Company's Economist'3 studies, with which the Welfare division has been cooperating, into the questions of insurance among indigents, possible over-insurance of Industrial policyholders, etc. 0513 0514 -2' 3XHIBIT A To Policy-holders' Service Bureau: "metropolitan life insurance company .Porm Q.L.I.81C Jmam 1922 In re John Smith* Co. Date._.....June._6i._i923-------------- 192.... Address New York City. . Group an<* ^CC*<^ent]contract has been closed on date of___ sli*_&.JL9i33_________ 192- by..... Jj.gphAt.tao^..Hay..YQrk_City--------------------Business__ Dfip.t^_Stora----------------------- No. of Lives.. Commission to_____ Assistant Wan agar- Jonaa- .District. BwlA________ ________ Amt. of Ins. Lift. #70.000 Credit to---------------------- --------------- ----------- "----- Over-riding credit to Sales Representative----- 5upery^s$yr_iiacy;____ ____ Policy fa .ffarfvo------teS-S-mS----------------------------- 192----------------- "^3^} b-b. Correspondence should be conducted with Mr--R Waitr--RraeidantTitle Branches of firms are also located at.. Schedule of Insurance: At least SmonthB of service or over, #500. a piece. Executives may be covered for 2$- times the average of the balance of the Group at the time of writing. Proceeds of the Policy to be paid in52. weekly installments. To remain fixed. Threemonths probationary period. Annual basis. #150* check received as advance payment. Forms SO will be sent in this week. Remarks: > /' .............. 0515 Manager, Group Division. r -3- Th* Group Sales Division gets their information from the salesman on the attached form. Metropolitan Life Insurance Company TO THE GROUP UFE DIVISION: Date------------------------------------------- 192__ (PbaNoM) Address_______________________________________ Nature of Business A Group Life Application is attached together with check In amount of f----------------------- Was binding receipt given? (Yes--No) Number of lives coveredEstimated Total Amount of life Insurance $. Correspondence with firm should be addressed to Mr._____________________ _____Title__. (FTlutNumcJ Give name and location of branches included in this group. Give name and location of branches not included, if any Commission toDeb(TUW it No Credit toDistri(TBcI* t____________________________ _____________ Rats Was a definite rate quoted? (Yes--No) Rate estimated wasbecause (advise per cent, colored, nationality of employees, standard of working and living conditions, mentioning all extra hazards involved) WEI the employer pay the entire premiums? (Yes--No)------------------ If not, what proportion? CartnyicATg Material Is certificate material attached? (Yes--No) It will be forwarded by----------------------------------192. What have you promised regarding certificate material------------------------------------------------------------------------ Forms The Farms GXJJO will be forwarded by______________________________ _ Announcbmrnts I. Is suggested copy for local Newspaper Publicity wanted? (Yes--No) II. Is a write-up for firm's magazine wanted (Yes--No) m. "You axe Insured" posters will be forwarded from Home Office. (If special individual announcements are requested, so state, giving reasons.) Nursing Are employees located in your District covered by Nursing Service? (Yes--No) State what brandies, if any, are not covered by Nursing Service. F 192____________ 0516 i i v^;.- -4- The information on the form G.L.I. SI ia often not complete, and re have discovered branches cf a Group Thick have been insured but which have never had service, as ve have been notified only of the main office. The sales men are more careful than formerly, as they are using our service more, but their reports still are not vary full. This last week we have had two cases where our original letters to manager and nurse were both sent out incorrectly due to meagre information. 3. OUR PROGRAM OF ACTION The Groups are divided tsrritorily among four correspondents, whose duty it is to see that the Groups are informed of the nursing, literature and welfare services, that shipments of literature are made them every six weeks, and that other services 6uch as physical examination are suggested to them, and that information that they request is given to them. To carry out this program, the form announcing the closing of a Group.,with a hietory card the top of which has been filled out, like attached (Exhibit B) ' ie sent to the proper correspondent. She proceeds as follows: A. Checks up with the Welfare Division on the nursing situation. 5. Studies the situation with the Group, taking into consideration its eize, location, industry, nationality of workers. If sold by a Borne Office salesman, she usually consults with him. (See Exhibit C) Taking all these things into consideration, with the local situation with this manager if he has handled other Groups, she then writes her initial letter. The form from the Sales Division shows whether the service for a particular Group ie to be handled with the Group direct or with a local manager. About five-sixths of the Groups are handled through our managers. 4. CONTENT OF LETTERS (I would like to emphasize that these are not form letters and that the material is adapted to local situations. The content is similar in most cases). 1. WITH NURSES (a) If this nurse has never had Groups before, a letter similar to Exhibit D is sent. This latter includes the name of the Group, a paragraph explaining Group Insurance, and paragraphs explaining the Group Nursing Forms which are sent with the letter. A questionnaire, asking that she call on the Group and report back to the Metropolitan, is included; also a leaflet on instructions and recommendations in re nursing for employees insured under Group Insurance policies. The nurse is told that enough N. S. 2Ga and N.S* 3s have been sent her to cover the insured .* - 0517 / DR. CHRISTIHBtlN -ASSISTANT MEDICAL DIRECTOR I am in receipt this morning of a letter from W Dr. Gardner, in which he states as follows: "I received this morning the first annual contribution from the Mutual Companies of $5000 with assurance that it would be continued during 1935 and 1956. "The stock companies are still debating but I have been told that when the summer vacation period is over the matter will receive attention by the proper authorities. Tou recall that on July 2nd, a resolution was passed as follows: 'I move that this meeting instruct Mr. Whitney to present a resolution to the Executive Com mittee of the National Bureau(of Casualty and Surety Underwriters,)recommending that the Bur eau appropriate $5000 for each of three years to the Saranac Laboratory for research on silicosis problems specified by the Medical Directors Com mittee and the Engineering Department of the Bureaill" September 4, 1934 Assistant Medical Director 0518 To-the fitcoutlvo 0519 " >' Oft June 85*1929 the Welfare Cooaltteo "sutberised an appropriatien of $9*000* par year for fir* years to tho Saranao Laboratory for tho purpose of ambling it ia oooporation with this Coapany to continue baoterieloglaal stadias of silicosis*" Dseoahor 14*ltSI X wrato to Doctor Lonxa* "I abovad to tho frseidsttt tho Xirat and second paragraph an Pago 2 of Dr* Gardnay+a latter of poofK&or 12th to you* and tho Prtsidsat oayo that with oroato taming ao they art now wa mat not premise fad in adtaaeo but that you can any that wo look upon, tho proposition and upon tha results that aro being acaogipllehsd with favor and that oar dispoaitloa trill bo to roooamtnd ranawal of tho $9*000 appropriation for another two years baginning July 1*1994 unless aoatwnllo something bappana to nako u JCneidor tuoh aotlon inadvisable** (Those two paragraphs trarot "Had n kootlng in Chicago with rapraaontativao of tha i&itual Inouranoa Companies (Llbarty* Lupbermantt S&pleyofe and American* I think*) Whiting and KfOtkla organised it to aonaidar a roooaroh program which thay would finance Ibera at tho Laboratory* In qr ipeash to than X mentioned that tho had carried no for $9*000 annually during tho last 9 yaars* hut that X two not tory certain that you would ba dbla to aantiaut* X there* fora aikod than to raplaaa thin grant with $5*000 of thair ton t* ton* ' tittuo tha study on tfi and Oiliofoif* thay had pravioualy writtaa nio for a schedule of nsMM&ry axpoHjMfetel work in whioh t included a study of solubility* noutroliaatictt of silica aation in$hs body and irawity in tJ> jjoi-piatneai** Iffar .my gpaiiOh thay took ay.htoatii may by asking 1$. if fjiaaid do oli thii pragraa tlonttanocualy if;thor'goo.no $10*000 a year`for tho newt I year* oad yy$uiutod"|rOii to ma^ipue. with your prat* oat aontyibutian* It fan ba donf end I told thaw *$?'. Thay aro putting it op to thair chiefs and ta'aa tar feel that thara la geadprospeci of oaoeOMo "However* X don't wont to bo pot in tha position of haw* lag Oiihaod that tho Vat* is going to quit before % hava aakad for a rattawai-Of tho, appropriation and f don't wet- than to bo bargaining with yo* to swathing fhaa you hato^4foa4y dene of mfo and nay not fofl f!# tf 'ffmm do 1 lay ftll e*Ms on tht tablo*-) ^ - the.I yaair appropriation described abort will tomlnato at tha o&d of this ajbifth* Doctors Lama and IfcConneil attended tho Conferences on Siliaaaia at Caromo last week and Dootor Lanaa says that on June 89th.ha "hfd Xansh with Dr* Gardner* ineempany with throa : Or fotyt rapraaantotitaa Of thf Afsooiation af ntuol, 9a#ualty Cosrpanies* During tho luncheon, Df* dawm* .msufred telegfifi. titi* tho secretary af ihio Association, notifying hin that tho Aoaooiatioh had Bade him a gnat of 05*000 gad would be inclined to Ueteei favorably to a raqueat for tho tonswal of. this groat for a period of years and also possibly tho increasing of tho .mount* " It was tho hops of tho;yepreoeatativee of tho Aosooiatieat prsaast to hats this grant increased to $10*000 a yaar for. throa years* r# Graff* who ropra#4nto tho National Board of Surety and Casualty Dndsrwritars* stated that ho thought it was probable that tho stock companies inelndcd in this AsBooiatlott vould slcp support the Saranac Laboratory and it is ny intention to discuss this with -2- 1fir* Albert Whitney at a meeting that ve are to have this week* As soon as X hear of any farther action by the casualty companies, X shall inform yon." The question of occupational diseases efaieh are associated with tuberculosis is of more importance to-day to the firms and mage earners which ve cover with insurance, than at any time previous. Results of great value have already been attained by these research workers at Sarmnae laboratory, and the promises of further end con tinued discoveries is the near futurs ere brilliant. The high mor tality from tuberculosis among our Industrial policyholders vho are engaged in harmful occupations can and should continue to bo attacked by just such research as the Serosae group are maMwg and putting into operation. Ve therefore recommend that this Company's appropriation of $5,000 per year beginning July 1,1934 be renewed for 3 years, if possible, and for 1 year anywy. Juno 29,1934 K-Q. 0520 \ To the Sxeoutivs On Jaw 5*1929 the Welfare Coadttee "authorised kb appropriation of #5,000* per pear far fire /ear* to the Saranac laboratory for the jnrpese of ambling it in cooperation with thle Conpany to continue bacteriological studies of siliooais*" Deeeobsr 14*1933 Z vrote to Dooter Lanin* "1 ohrnrad to the President the first sad seoond paragraph ea Page 2 of Or* Gardner* e letter of December 12th to youj end the President snyo that with events toning as they are nee vs ansi not proaloe far in adsnnee hot that yon eaa eay that va lsek opea the prepeeitiea and open the reeolte that ore being aeoeeqpliahad vith fever end that our disposition eill be to roooaaend renooal of the #5*000 Appropriation for another toe years bsglnalag July 1*1934 tales* aeanehile something happens to ake no eonaider anoh aotloo inadvisable*" (Those too paragraphs verei "Bed a meeting in Cfaieage with representatives of the itotual Intoranso Conpaniaa (liberty* ImAemsno* Baployer* and Aaorloen* Z think*) Shiting and KeueULe orgudsad it to eonaider a reeearoh program ohich they would fisanoe here at the Laboratory* In cy speech to then Z aootioned that the Bet* had serried ne for #5*000 annually during the last 5 years* hut that Z oaa not very certain that you oould be able to continue* Z there* fore asked then to replaee this grant ulth #5*000 of their eon to con tinue the etudy on 19 and sillaosis* They had previously written me tar a schedule of necessary experiments! work la ohleh Z included a study of solubility* neutralisation of eilioa action ia the body and immunity in IS and pacoraonla* After ay apeeeb thqp took ay breath aaay by no if X could do all this program simultaneously if they gave me #10*000 a year for tbo nest 3 years and persuaded you to continue vlth your pres ent contribution* Zt can be done end Z told them so* They ere putting it up to their chiefs sal same to feel theft there is good prospect of success* "Bosovsr* Z don't sank to bo put ia the position of hav ing assumed that the nets is going to <piit before 2 have asked for a reaesal of the appropriation and Z don't seat them to be bargaining with yon to do something shea you have already dons eo mush and cay not feel able to do more* 8o Z lay all cards on the table*") 0 5 2 JL the 5 year appropriation described above vill terminate at the end of this month* Doctors Lsssa and ueCoonoll attended the Conferences on Silieesls aft Baranao last week and Doeter lease aaye that on Juno 80th ho "hod lunch vith Sr* Gardner* la coajpnny vlth three or four representatives of the Association of Butual Casualty Coryanieo* During the luncheon* Dr* Oerdaor received a telegram from the Secretary of this Association* notifying him that the Association had made him a grant of #5*000 and voald bo inclined to listem favorably to a request for the reaesal of this grant for a period of years and also possibly the increasing of the amount* Zt oas the bops of the representatives of the Aaaooiotion preeoat to have this grant laereaaod to #10*000 a year for three years* Hr* Graff* oho represents the national Beard of Surety end Casualty Oadorsriters* stated that ho thought it oas probable that tho atoek ooapaudea included in thin Association oould also oupport the Sarame Laboratory and it is my 1stantion to discuss this vith Hr* Albert Ibitaay at a Mating that m am to law this wwt An moon as t hear of any fUrihsr aetlea by tba casualty enogianlas, I ball infers ynt" The quaatlon of oeonpetlanal diseases which am associated with tuberculosis la of am importance to-day to tha firms and wage aarsars wldeh wo cover with inaeraneo* than at any tirae previous* Results of groat value have already boon attained toy thaas rosaareh workers at Saraane Laboratory* aad tha praadsao of further and con tinued discoveries Is tha soar future are brilliant. Tba high nortality fron taborealoais anang ear Industrial polleyholdera who ere eagsged in harafui eeeupetione sen and ahould eontinua to ba attaekod toy Just sash rccoarah ns tha Serena* group are making and putting into opomtiea* Vo therefore reeoaenad that this Cenpany'a appropriation of $5*000 par yaar bagtanlag July 1*1934 he renewed for 3 years* if possible* and far 1 yaar anyway* Jtane 29*1934 K-C. 0522 Dr* Lsroy U. Gardner Director Saranac laboratory for the Study of Tuberculosis 7 Churoh Street Saranac Lake* Hew York ay dear Doctor Gardner Thanks for your good letter of October 18th. I am glad* indeed* tnat you and :ir* Cummings could go along with Dr* Lnzw to Thetford and that you found that riait well worth while* You are correct in doing aa you like about traveling expenses to Plcber. They could be token out of the Metropolitan authorisa tion* if you choae* but it ia better to take then froa the Public Health Service so long ae Dr* Thompson has expreseed a willingness to allow it* I had quito a long talk with President Doker about the contents of the third paragraph of your letter and he thinks that this Company really should confine its work to the United States and Canada where it conducts its business and that it would not be possible to spare Dr* Lanza for the length of time that the Tieit to South Africa would take. 1 have discussed it all with Dr* Lanza since talking with the President and I find that he end I both agree that that attitude is the right one to take* I hope* therefore* that yd!t can agree* without disappointment* although Z can well appreciate what a fins thing it would be if you and Dr* Drinker and Dr* Lanza could go to that Continent as representatives of the Public Health Service* soon* I am* With kindest personal regards and hoping to see you Yoars very truly* r'Tt) 0523 OrTKnfgM wts obliged to leave the #(flee before signing th* sieve letter dictated by him. II33ICAL DZR3CT0H The Edward Ij Trudeau Foundation OF THB TRUDEAU SANATORIUM SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS SARANAC LAKE, N. Y. OFFICE OF THE DIRECTOR 7 CHURCH STREET Dr. rtUKUs The Metro, Dev; Lor . ght, L'edical :an Life Ins Ycrh Dear- Dr. Knight, I wish to report that both Dr. Cummings and I went to Thetford with Dr. Lanza and f'r. Burnett and enjoyed a most profitable inspection of the production of asbestos. The background which such trips afford for experimental work well repays the time spent, I am certain. Dr. Lanza told me that you had said that I might take the expense of a trip to Picher out of the Metropolitan funds.*V:e have decided that it would be more us.gfif^^o employ these funds in e: perimental work, andVDr. Thompson is willing to allow travel expenses from the rublic health Service, We will therefore not encroach at this time upon the Metropolitan accoount. .ken I v.as in Washington recently, the Surgeon-General asked me if I would be able to go to South nfrica next summer to represent the Public Sealth Service at the Conference of the Investigators of Dus ty Trades. He suggested that it might be desirable to have the United States represented by three men. One of the Drinkers could cover the attempts at pre vention of dust inhalation; Dr. Lanza would be able to report on the working conditions and the clinical picture in various types of pneumonokoniosi3 in ,u:ierica; and I would represent those interested in the exper imental aspects of the problem. He intimated that my expenses might be paid by the Public Health Service, but said nothing about those of the other men suggest ed. I sincerely hope that if this delegation can go, the Metropolitan could arrange to take care of Dr. Lanza, 0534 Dr Augustus Knight -2- October 18, 1929 for I at least would feel somewhat timid in attempting to interpret the general phases of this problem, without more knowledge than I possess at the present time. With best wishes, I am. LUCriKA Director -n. 0525 October 14, 1929 Ur. Hoy Dayton, Secretary The Eduard L-Trudoau Foundation Trudeau Sanatorium Saranac Lake, Nov York Dear Sir Replying to the laet paragraph of your letter of October 7th, pleaae do not hesitate at all to send the bills and vouchers to us for *e are glad to see then and handle then for you* Very truly yours MEDICAL DIRECTOR 0526 V`0 J The Edward ]> Trudeau Foundation FOR RESEARCH AND TEACHING IN TUBERCULOSIS OF THE TRUDEAU SANATORIUM THE TRUDEAU SCHOOL OF TUBERCULOSIS OFFICE OP THE SECRETARY SARANAC LAKE, N. T.------- OFFICE OP THE DIRECTOR SARANAC LAKE, N.Y. RESEARCH AND CLINICAL LABORATORY TRUDEAU, N. Y. THB SARANAC LABORATORY SARANAC LATE, N. Y. October 7th, 1929. Dr. Augustus Metropolitan New York City , Medical Director, 3. C0 , a; ;.iy dear Doct In accordance with our correspondence of August 20th and 22d, I beg to enclose in the form of a bill our state ment of expense during August and September in connection with the silicosis studies at the Saranac Laboratory, together with invoices for the various amounts paid by the Foundation on thisaccount. If there is someone else in the Metropolitan organization to whom these bills should be sent I would be glad to know so as not to bather you unnecessarily. Very sincerely 0527 The Edward 1/ Trudeau Foundation FOR RESEARCH AND TEACHING EN TUBERCULOSIS OF THE TRUDEAU SANATORIUM THE TRUDEAU SCHOOL OF TUBERCULOSIS OFFICE OF THE SECRETART SARANAC LATE, N.Y;------ OFFICE OF THE DIRECTOR SARANAC LAKE, N.Y. RESEARCH AND CLINICAL LABORATORY TRUDEAU, N. T. THE SARANAC LABORATORY SARANAC LAKE, N. Y. September 25th, 1929. Dr. August S. Medical Directo Metropolitan L New York City. s. Co., y-- Dear Doctor I regret that the resolution was not enclosed in your letter, but I think you must have received it by thiB time from Dr. Trudeau, as it was my intention that he would for ward it to you. We certainly appreciate your help and without it much of our work would have to be curtailed. As it is, we have not sufficient income to carry the Trudeau School and we are trying to carry on with a considerable demand from various sour ces, having at present thirteen enrolled'for next year's course. Our budget for the school is $5000, and it was supper8%y Mr. Samuel Mather for the first ten years; but now we must look"- elsewhere, though we have good hopes. X hope you will stop and see us whenever you are in the neighborhood. Very sincerely yours. 0528 K-DG Septeaber 26, 1929* Doctor F B. Trudaau, Secretary Trudaau Sanatoritua Trudaau, S# York lly doar Dootor Trudaau Thank you ever ao much for a oopy of tha appreciative resolution ooaaorning this Company which tha Trustaaa of tha Trudaau Sanatorium pasaad at their meting of Septei&er 7th* I an sending it along to tha President, and know that ha will read It with interest and pleasure* Toura vary truly, MEDICAL DIRECTOR. * v 0529 JAUM ALEX. '% M.D. GEORGE B. BREWBTCR TREASURER Trudeau Sanatorium Trudeau.N.Y. PRA.NC1S B. TRUDEAU. U.D. KCRfTARY EDWARD R. BALDWIN. M.D. CHAIRMAN EXEC. COMMITTEE C. A. ARMSTRONG SUPERINTENDENT ~ ---- September 23, 1929. S^gbt, Dr Augustus Metropolitan Life Insurance Company New York City. Dear Dr. Kni^a#: st* 2.5 It gives me great pleasure to inclose a resolution passed at the last meeting by the board of trustees of the Sanatorium, thanking you and your Company for the cooperation in our work at the Saranac Lake Laboratory, and for your generous financial aid. Very sincerely yours. FBTtKAT Secretary 0530 JAUtS ALEX. Ut~ IR. M.D. PRUIDI' CEORQt S. BREWSTER TREASURER C. R. ARMSTRONO SUPERINTENDENT Trudeau Sanatorium Trudeau,N.Y. FRANCIS *. TRUOCAU, U.O. amettwrAmr SOW ARB R. SALOW1N, M.O. CHAIRMAN EXBC. COMMITTEE Resolution Passed, at the Summer Meeting of the Trustees of the Trudeau Sanatorium, September 9th, 1929 To the Metropolitan Life Insurance Company: The Trustees of the Trudeau Sanatorium are conscious of their obliga tion to the Metropolitan Life Insurance Company for their pledge to the aid of the scientific work of the Saranac Laboratory directed by Dr. Gardner, and wish to inscribe a vote of thanks upon the min utes. 0531