Document aJv0BLzE7aNBGN1V5jGr0d5Xy

! e to relieve i he ed. as a routine ;ery earlier than 1 lung has been /ailed, thoraroent mediastinal ion that phrenic inuing aniridia! :o the comph:-.- symptoms arc lous individual.- The symptoue decompcn-a- sented. horacopla.'ty ; should be /.! s a preventive 'Ird. Lalir.o-Arm-rit ntrvc ia the tr,-.u . Ztschr. f. Tulxrt.. ain in pulrr.oiur. noajj-y t-.bert j.i-ti- ovrrlonitd i r-.ucH jcir oa "The Lrrvt Ciilrd a-.-.f.-.iiun :Eat errm -.o &?--- \ PLAINTIFF'S EXHIBIT | 01 (ofrO.O) 1934 \ Saranac Taboratorp for tfje ^tubpW of tuberculosis OF THE EDWARD L. TRUDEAU FOUNDATION REPORT OF THE DIRECTOR AND FINANCIAL REPORT For the Year Ending September 30, 1934 REPRINTS OF SCIENTIFIC PAPERS i 4 tljeParana: Hake 3cabcmp of fFlcbicinc The Sdrdndr f-rtfwratory. iliouTn^ dt ihc left fftf nru; John flldr^ W itijj THE SARANAC LABORATORY The fan that the Saranac Laboratory Hi* always been a aeparate insoruaon fror. the Research and ClirucaJ Laboratory of the Trudeau Sana to.-, urn is no: generally understood Both laboratories are sponsored and controlled by the Trudeau Foundation, but the Saranac Laboratory is located at 7 Church Street in the village of Saranac Late and not at the Sanatorium The properties of the Saranac Laboratory consist of the original building, given to Dr. E. L. Trudeau by Mr. George C. Cooper in 189a as a private research laboratory, together with the John Black Wing, of which a reprodurnon of a photograph appears m this report. The wir.g has been donated by Mr. and Mrs. Frank B. Black in memory of their aon. The addition contains the bbrary and lecture room, erected in 1977 and 197S. and private research rooms which are now in the process of construction There are also two animal houses. V.'hile the Saranac Laboratory cooperates with the Sana tor. urn in e-.cry possible way and serves as the headquarters for the Trudeau School cf Tuberculosis, it provides ciagr.osac facilities to the physicians pramccng m the village and carries on independent researches in the teid cf ruberculosis and associated conditions. To avoid the existing confusion, the Trudeau Fcundaucn is publishing an annual repor. cf the Saranac Laboratory" under icparate cover I % i \ THE SARANAC LAKE ACADEMY' OF MEDICINE In the early pin of July. 1931. a group of physnans in Saranac Lake met in the John Black Room to discuss ways and means for supporting the diagnostic and research activities of the Saranac Laboratory during a penod of diminishing income. They were of the unanimous opinion that this institution is essential to the continued ezisence of the village as a center for the scienooc treatment and study of tuberculous As a concrete eiprcssion of this feeling they consotuted themselves the nucleus of a body to be known as the Saranac Lake Academy of hledicine Its object is "to foster interest in the pursuit of soenooc mediant in Saranac Lake" through the agency of the Suir.i: Laboratory. Its members pledge themselves to support the activities of this institution in every possible way and to seek assistance from others for its operation. The active members are physicians practising in Saranac Lake, but associate, sustaining, and life memberships are also open to interested laymen. In the fr.ancial report fc: the current year will be found a list of the present members. ' The formation of the Academy created nothing new, die Laboratory, the Library, the diagnostic service, the vcientifc lectures and research have always been an integral part of the medical life of the village, but by many they have been freely accepted as a natural heritage from the great foundei of this health community. By membership in the Academy of hfedicme, cr by contr.buticns through it, anyone can fee! that he has a pan m keeping alive the Trudeau ideals for the furtherance of medical scen.ce ' --h /; ./v\*t > v t r Js f -sV . 1 DEMY ans in Saranac Laic .1 for auppcmng the tory during a penod os opinion that this e village a* a center as. As a concrete ie nucleus of a body ne. Its object is "to j-anac Lake" through pledge themselves to ble way and to seek cinberj are physciam and life memberships epon for the current new; the Laboratory, o and research have village, but by many oa the great foundei cademy of Medicine, has a part in keeping men re. Rcpcr. of the Dire::cr CONTENTS Financial Statement Repr.nts of Sriencic Papers: Inhaled Sibra and its Erect upon Normal and Tubcrruious Lung! Leroy U. Gardner Relationships Between Hypcrsensitiveness and Immunity in Tuberculous Donald E. Cumminc* and Anthony B Delamant Tuberculosis of the Uterus and Fallopian Tubes with a Report of Tuo Cases Treated with X-rays Edwin M. Jamison Tuberculin: Its Preparation and Use m the Treatment and D.agncus of Pulmonary Tuberculosis Leroy U. Gardner and Eduard R Baldwin t ^ * , < ri r r, ; <r,~ . . . ' - w r-.;. CN .^ vV THE SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS OF THE EDWARD L. TRUDEAU FOUNDATION Leroy U. Gardner. M D.Ducaor ond Poikolopu Arthur J. Vorwald, M.D.Aursurni Pctkalogisc Thomi* M. Durkin, M.E. _____ __________________ ____ Arnriant Cnenui Wmield O. Keliey, B.A.Clinical Pathologist Douglas S MrCrua, B.S. (E.E )______ ______ ____Photographer Womi Dworsk:_____________________ Ajr.siur.t in ipen*ncr.Lul Pomology Catherine W. Cur rungs ...Lirrjnon and Scrf--ry Roy Di>*tonPimtoJ Scctcjury Junes V. LunreLl___________ :____________ Pu-chatting Agnt and Technician George Hulpr.t:Technician Anthony Deiaha.n: Tccr.mc.cn Frank Creedon. Technician Andrew J. RedLmVoluntary Airman: J. Cloyd DownsVoluntary /jr.iun; WdLarr. LaBour.ryAii-.r-art Henry C. Stout Aunsta nt niLD ANw COSSUir.NC STAFF Donald E. Cur-rungs, B S._____ Aur-mam Director ir. Chu-gr cf Field WoiV Homer L Sam.pvon. D S: ---------------------- --------- Ccnju.t-.r g RoentgenoLogm Darue! M Erum.oel, M D.____________________________ Clinical Consultant Robert N. Downs--------------------------------------------------------.. X-rey Superwsor Re-hard Libby----------- ----------------------- -------- ----------------- X-ray Technician Roonarc Walters----------------------------------------------------------- X-ray Technician V.e.V.n Berg............................................... Eac tens'.: pea'. Technician end Clerk Dorotr.y P. nogcr:----------------------------------------------------- X r a % ^`.enegraoher SPIZ1M F.I5I aAC.M STw^INTS A O Seserar.:;. D................................................................. Ealuroore. Md. A Landau, M.R.C P....... ......................................... Cap* Town, South Atr.tti i :r: f l-S ! -OR IS .TION rector end Pathologist . Asnsesm Pathologist ... Asnstsnt Chemist ...Clinical Pathologist ....... Photographer .xpenrr.enioJ Pathology .ibronen end Secretory ... Financial Secretory Agent end Technician Tecftnicicn .......... Technician ....------------ Techn-.cien -- Voluntary Ainu?-.: -- Voluntary Assistant ....___ ------------ Assistant Assistant E i ! m Charge of Field Vx'oi\ 1 insulting Roentgenologist -------- Clinical Ccnsultjr: ^ ---------- X-ray SuperrucT ------- X-ray Technician --------- X-ray Technician ical Technician end C.'rrr ----- X-rcx Stenographer ZN7S -------------- Baltimore. Cape Town, South A REPORT OF THE DIRECTOR OF THE SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS -- 1934 -- LlROY U. GaJONER. M D, Director A well Lnow-n authority in the e!d of public health once remarked that the research trucent only begins to produce results of real sacruioance when he is taken out of his laboratory and sent into the teld. VrJe some neigh: qualify thus generalisation, it cannot be gainsaid that coercive investigator., of disease can only progress in dose contact with the patient. In tunes pas: the Sarar.a: Laboratory was a successful pioneer instirution in the cudy of tuberculosis. Dr. Trjdeau and Dr . Baldwin, with their associates, had ample clinical material about them on which-they could draw- for their soenuf.c studies of thus disease. When the problem of the inhalation of dust as a farter in the production of tuberculosis was begun there was brtle thought that it might deserve years of study and that it would subsequently prove to be a subject of widespread popular interest. For years the attack was directed almost wholly along experimental lines. Few persons rufenr.g from disease due to tnhaled dust iciar.6 their way to Saranac Lake. To study shcosis in the human *ub;ec: it was necessary to visit the centers of industry and such visits at best could be turequen: and of short duration. " There seemed no choice but to continue on a purely experimental basis unless the investigation were removed to a mining or other industrial community. Then came years of mngency when the outlook for Enanmal eupport from private philanthropies was most gloomy. But thus apparent misfortune proved to be a turning point m the program of the institution. Because ether sources of income had failed we were forced to make r.ew alliances and in dome so were brought into inornate contact with the much needed clinical rr.ater.a! for a well balanced investigation. It is hoped that we may proc: by our oppomumoes and justify the coniden.ee that La; been plated m us To take advantage cf the struaoon r. was necessary' to expand Important members cf the research, rein had to be sen: into the eid to mudy conditions o: dust generation and its cfects upon men who work in it. New members had to be secured to investigate- the problems that developed More apace was essence! that these men might work, for the old laboratory was r.ct expected 10 accommodate more than vc or six investigators Las: year's report cited the progress that had been made m thus program cf expansion Thus year sees us ready to ocgir- -peracons on tine broader basts I V T' ^ V *- f I Two major e!d invest: gam cits are w progress unde.- Lhe superv.con of Mr. Cummings. the assistant dcrectcr. Seven! thousand x-ray tins Live been Liken ind interpreted by Dr. Sampson ind his assistants. Three more members hive joined Lhe regular laboratory rue and ruo graduate scuden.ts will wort with us during the coming year.'The John Black Wing. providing *u new rooms for research purposes, is now neanr.g completer. md almost enough funcs ire in sigh:, to 4ios:y_i JS4.iSj.03 budget for Lie costing year. FIELD P10C1UVM y I On November rs: i contract wis renewed with members of the Like Superior Iron Ore Producers Association to continue the program of investi gation md prevennon of disease due to dust among their miners. One coDpiny of the group decided not to participate in the program this year for reisons other thin dissaosfareon with the services rendered. V/hcle their wuhdraw-al miter.illy reduces the income thit we derive from this source, st is probible thit responsibility for fewer men will enable us to mike a more thorough cudy of those that remain Lis: year's esort was devoted largely to a genera! survey of the industry and the inauguration of a program to prevent the formation of dust. This year the data already in hand will be analysed, the. dust prevention measures will be applied to all parts of the vinous runes involved and e* a mi nation of many of the miners will be repeared to determine whether they have developed changes that cay be progrexsve. A considerable number of autopsies have been obtained upon men previously examined. A comparative rrudy of the anatomical changes with the x-ray shadows in Lins madt before death will add to the general knowledge of the action of mixtures of silica and other substances Like iron. There is good reason to believe that the presence of the iron favorably influences the picture so that the nuca is r.ot as harmful as n might be when inhaled in the pure mate. A bacteriological cudy of the sputum of miners with non-tuberculous infections of the lur.gs is m progress and autogenous vaccines are being used to L-eat some of these cases A considerable number of infections with the Fned.'ander bacillus and associated organisms have been discovered. /mother study was begun in a small group of Cuorspar mines and mills during the rummer. The program involved the determination cf a possible hacard from lHis substance and. if such ecms, the recommendation of methods fer its correction A considerable group cf employees has tern examined by the mine physician and their x-rayelms have been rrudied here. Tuber culosis is prevalent m the community as a whole but whether exposure to uorspar dust is responsible has net yet been ascertained. No autccs-.es have yet been secured to ceierm-ine the anatomical erects cf inhaling this dust so that we shall be forced to rely upon animal tape .-.menus tha: are r.cw m progress. Tne tele work m the gypsum plan: reported las: year is eom.oieted and it has been possible to give the industry a clean bill cf health Recently a survey was made of a porcelain p'.-.i.t and a. plan cf invtszcat-.cn was capped cut. It w-.i! proceed aJcr.g the lines cf other ir.ves^cazcr.s 6 i t \ i- -r > ;. nn?'. 7 "y.-- 1 mder the tupemsion of msand x-ray lm$ have assistants. Three more i rao graduate students i Black Wing, providing ; conpleton and aJmos: budge: for the cortmg All credit is due to Mr Cummings for the successful prosecution of this work Tnc cfinals of the companies with whom he ls working have repeatedly praised the work which he doing and, here in the laboratory, w-e are apprenatve of the r.annal supper, made possible by his eocns, and of the x-ray and autopsy materia! that comes through him. Without the co operation of Dr. Sampson, at the Sanatorium, such an investigation would he quite impossible and the direr.or is glad of the opportunity to express his appreciar.cn. The associated eld workers,-Mr. Downs. Mr. Libby and Mr Walters have loyally done their pan in making a success ot Lie undertaxing --They ail deserve praise lor their cevoton to Lieir work. h members of the Lake the program of invest ing their miners. One laboratory rx5larch ) the program this year vices rendered. While at ut denve from this men will enable us to Last year's ecn was > and the inauguration :s year the data aireacy ts wj]J be apphed-to all of many of the nine.* developed changes that rsies have been obtained udy of the anatomical r death will add to the ta and other substance; e presence of the iron s not as harmful as it riologica! study of th.e. the lung; is in progress me of these cases A ' baallus and associated The problems already under invesagation have been cor.anusd durng the year. The inhalation; of pure quanta, pure gypsum, pure hemaate, i ferrupnous chen and a truxrure of gypsum and quarts ane snll in progress Tne hemante and gypsum dusts cause no appreciable damage in the lungs* and have no serious erect upon coexistent tuberculous iniecaon. The chen. which contains a considerable amount of quarts, causes more damage in Lie norma! lung and result; in some progression of a rubercuious iniecaon. However, Lie chances that develop ane not nearly as severe as those produced by pure silica. Tuberculosis m the chert ammais progresses for a erne and then becomes stationary or tends to heal with marked scanr.no. or brosis. Mixture; cf equal pans of gypsum and quanta dust fail to produce signecan: changes in the lungs. On the other hand, groups of animal; exposed on alternate weeks to pure quartc and pure gypsum cus: arc developing typical silicosis Thus experience points to a proteetve actor, on the part cf gypsum cf--st. probably because Lie gypsum pintcits tend to clump together in Lie atmosphere. Liey prevent Lie irtiaiatcn of cgmicar.: quantities cf quartc Tr.e experiment is not yet complete but the implications are fasnnatng in Lieir possible bearing upon sheets prevention. A study of the companar.ve reacton of diferent speces of animals to silica dust is now completed Guinea pigs, rabbits, cats, white rats, w-hite :orspar mines and mills rninaton of a possible mmendanon of method; ees has been examined i irudied here. Tuberit whether exposure to ."tamed. No autopsie; ejects of inhaling tht; 1 experiment; that are mice, and domesr.c fowl have developed reaction to inhaled silica Th.e rats develop changes most nearly resembling Liose in human beings. The tnjetton of shea suspensions into tadpoles and goldish produces a marked tssuc reactcn which resembles that m Lie mammals One may conclude that cLu is a poison for Lie cssuci of a large variety of animals. Injection cf silica and other forms of dust into Lie veins of rabbits is being used extensively to us: Lie:: capacity to cause damage. Silica causes a sp'etc; crrhosis cf Lie Liver which does no: occur with ether dusts Lius far treated The minimum dose necessary to produce reactor, and Lie erect of diterer: petrographic forms c: sciica art being irrver.igated. year is completed and I cf health Recently n of mvcscigation was investigators The progressive nature cf chcct; in arumals is being irudied Li animals eipcsed for var,m: pence's of err.c ar.C Lien removed to a norma! atmosohere. X-ray tin; are taken Iren erne to tune to demonstrate progression Th.e subject cf tuberculosis susceptibility in the ciioor.c tsrues is still under investigation Thus year Lie posterity o: aJ;crater, li Lie immune 5 *-**<*- '---- .V iy> "ti* Wfcj r; ~ cate is being rrudied in elLcccjc animals infected w-.th tubercle bacilli. . Collateral experiments with pneumococci and iptrochactal infections are j planned to check the observations on Tuberculosis. Tr.e narked cmulanry : between the tissue reacoon to the tubercle bacillus and uiica pamcles suggests tha: Lhe injury produced by these rwo lubsianoes tr.ay be fundamentally the i tame in spue of their obvious dioirenee in composition ! Another *et of ex pertinents just started will test the cssue reacoon to a representative group of slicates (nlica in combination with bases) w-hicn haw common industrial uses. Tnecreocaily these cucates are not expected to produce serious damage in the body but Lhe possibility that Lhey may consorute an industrial haiard is often quesuoned One of them. asbestosi is exceptional and is now a well recognised cause of puimonary disease: Another known as jencte has been suggested as an important factor inf auding shea to produce the condition of siico&is. Mr. McCrun has completed a senes of wax to odds of silicone nodules- from the lungs of experimental animals and from, those of humary beings. Tnese model; demonstrate the similarity between the animal lesions and Lhose . in man Boih develop very- largely in relation to branches of the pulmonary ^ artery. Another group of models graphically diustraiea how aiLcooc nodules compress a.nd Lhus interiere with the function c: tr.e lymphaoc vessels, tr.e j drainage system of the lur.g Soli another demonstrates how Tuberculous infection penetrates into the interior of a preer-abiished sliconc nodule. In addition 10 these studies, earned cn by the rcg-jlar larx3.-a:cry Dr. H. hi Kcr.ghorn is continuing his era by of a ruhercuiccs vaccnc Dr. J. N. Hayes is srJl working on the erect of inhaled oil and upon tlie problem of eipemnerta! oleothorax. Dr E. M Jameson is snil srudyir.g geruio-unr.ary Tuberculosis. Dr. D hi Srum.rel is coilecung daia cn the number of silicone panents under treatment in tuberculocs sar.ator.a through - out Lhe country. He is espemaiiy Liter esccd m tscertairung the efert of treatment in paaents with a ocm.pueaar.g rubercuio-ss TtACKISC In addition to the usual program of teachur.g. ve days of the 19u-i session of the Trudeau School of Tuberculosis were devoted entirely to the subject of niiccxs A program was arranged covering all phases of the subject: ecology. pathology, diagnosis by chruaa! and roentgenological methods, presence.-., anc mecico-lcga: aspects It is a pleasure to acknowledge our graarudr to the eminent auihor.aes m them various telds who volunteered their services to lead tr.e discusaor.s Dr. F-. P,,. Jones, of the U. S. Public Health Service, spoke on etiology; Mr. D E. Cummings, ass sum director of the laboratory, covered other phases of bus subject w-.th special reference to atm.ospher.c cur. determination * r.e pathology of the disease wi discussed by the director of tine laboratory. Pro: Philip Drinker, of the Harvard School of Public Health, discussed engineering methods cf dust p.-evcr.ncn ,'r.d eLmon accn D: H K. Par.coast, of th.e University of Pennsylvania, an: Dr. Home: L. Sampson, cf the Trudeau X-ray Laboratory, spoke or. the roentgenological appearances m ciicosis Dr. Henry S Kessler. N J. Rehabiiiunon Clinic, 10 * ' 0.1.-- `-j ith tubercle bacilli, -.aetal infections are ie marked smilanry iica panicle* suggest? x fundamentally the he cuue reaction to n with base;) which .tej are not expected btlity that they may ne of them, asbestos, f pulmonary disease, important factor in J> of bIicod'c nodules sse of human beir.es jmal lesions and these dies of the pulmonary s how silicoDC nodules lymphacc vessels. Lhe ates how tuberculous . slitcroc nodule, gular laboratory naff. ruberculoas vaccne. aled oil and upon the tesen is sell srudyui,; collecong data on thr iocs sanatona through ertairung the erect oi vr days of the 19M devoted enarely. to the trtng all phases of the i and roentgenological pleasure to acknowledge is eids who volunteered les, of the U. S Public r.gs, assistant director ci h special reference to atease was discussed by the : the Harvard School cf : prevention and e!:n:n .syivarua. and Dr. Homer e on the roentgenological J. Rthabiiitar.on Clinic. d. scr.bed the clinical aspects of the disease. Prof. Wn. S McCann, of the University cf Rochester, spoke on the physoiegy of the toroid lung Dr A J Lar-ta of the Metropolitan Life Insurance Company summamed the scier.r.tc aspect* of the discussion and outlined the measures that are being adopted to handle the problem both from the medical and legislative view points Mr. Paul Foiger, an attorney from Rochester, N.Y., discussed the medico legal phases' of the subject. Most of the speakers remained for the ensre week and took part in the informal discussions that constituted a very important part of the session. Tne John Black Room was crowded to capacity. Fifty-two speccal students registered for the week; M men from the regular tuberculosis course elected to remain and the res: of an audience of11*0 was made up of invited guests and local physicians. Tne group was com posed of mdust'ial physiccans and executives, insurance omcials, and state compensation commissioners. An unomcial transcript of the proceedings was prepared by Mr. B L Keuchlc of the Employers Mutual Insurance Company of Wausau. Wisconsin, and his associates Drs Belkr.ap, Benton, Carhart. Er.cer. Ford, Gray, Habbe, and Lotc. Copies were odered for sale at 55.00 and the enure proceeds were donated to the laboratory. It is with peculiar pleasure that we express* our gratitude to Mr. KuechJe and those w-ho assisted bum in this w-ork. PUBLICATIONS AND ILIPORTS Only four papers have been published this year cw-.r.g to Lhe far. tha: pending exper.mer.ts have not ye: been completed These have been c: a genera! nature, dealing w-.th the etiology and pathology of silicosis and ether p.icumonokomoses A repr.r.t cf one of them, delivered beiore the genera! aession of the American Medical A.ssociauon and representatives cl the group is included in this volume. Others were presented before the Ar.cr.cn Institute of M:rung and Metallurgical Engineers, the National Safer/ Con gress. and the Radiological Society of America A general article. Pneur.onokcnjosis," wnr.cn for International Cunts, w-.il appear lo June Three papers by Dr Gerald R. Dowd, formerly bacteriologist c.n the naf. are m press Addresses were made before the physicians of the General Electr.c Company at Schenectady, and before a legislative committee of the State of Massachuscets Considerable r.me has been devoted to the meetings of a commir.ee cf the Korucide Club appened to formulate a cJasnocuticn of siiicotic lesions and their appearances on the x-ray dim. 1: is the hop; cf this ccmmir.ee to ofer a rtandarc nomenclature that cam be generally adopted Tm* volume also contains reprmts of an address c.n Hypersenstuvcntss and Jmmunty in Tuberculosis by Mr Cummings and Mr. Deiahar.t. of a paper by Dr Jameson cn Tuberrulccs of the Uterus and Fallopian Tubes, end a Summary cn Tuberculin by Dr. Baldwin and the director. STa TT On October test Dr. Arthur J Vcruald joined the ituf as assistant 11 i \ pathologist. Trained at the Urzvcrsry cf Chicago. ind r-~.-- - to us after a year of post-graduate work at Cambridge, he brings to ou: proclems fresh points of view. H:s excellent training and his e'r.thus.asm. have already satisfied everyone that he is a moat fortunate choice. Mr. J Cioyd Dorris, a chemical engineer of discretion. is a voluntary asostant who has many cmes proved his worth by solving problems concemed with the preparation of dusts for animal injection We consider ourselves coos: fortunate that he can be with us Mr. Frank Creedon worked so well and faithfully as a voluntary assistant last year that he was taken on to the regular car as histological technician on October rst. Two speaal research students are already at work upon c!:cos:s problems, and a third w-.ll amve shortly. Dr. A. O. Severance, of Baltimore, has earned on experiments dealing with silicosis in sh and amphibia. Dr. A. Landau. M R.C.P., of Cape Town, South Afnca, recently came to us from Brompton Hospital on a Dorothy Temple Cross Research Fellowship. Hz is working on the compar-aove influence of various silicates on the suscepti bility to rubcrculous infection. Dr. F. Warden Brown, an Oxford graduate holding a Radciif Travelling Fellowship, will shortly begin an intensive study of the accon cf one of the silicates known as senate. It was recendv .claimed that this substance rather than quartz was the cause of sliccsis. In the eld Mr. Richard Walters served faithfully as x-ray techmnar. for six months untd his health forced hum to return for a period of rest. His work was appreciated no: only here in his own orriruiaocn, bui by the physiaans wuh whom he was associated at a mine hospital We trust that the interruption is only temporary. The other members of the car remain as heretofore. The director uses this oppomiury to think all of them for the loyal service drat they arc rendering and expresses his appreciation of their cooperation. I p * I ; J j BUILTINCS A year ago it was announced that XL-, and Mrs Frank B. Black had oFezed to provide funds for additional laboratory work rooms The John Eiack Wir.g is now nearing completion. It consists of the John Black Room, the Lbrary and lecture room which these generous doners gave in 1527, and their recent gift of five new private labcrator.es located in a story above. In order to satisfactorily join the roof cf the new wmg w-.th that of the old building it was necessary to extend the front gable cf tie lane:. By so doing another la'ge, well-lighted room was created in the atom of the old building Tne photograph as reproduced m the from of this repen shows the great improvement made in tie front elevation by this change. The cx additional work rooms and cures will fill a long-felt war.: by relieving the chrome state cf congestion that has seriously ham.p-ered cu* work in the pas: several years A necessary adjunct to the new addition was an increase in the heating pia-nt Rather than tjppiemc.n: an already overloaded ryr.er.i, it was found to be more economical to install new furnaces and to repipe tie enure plan: Two new oil furnaces with a cocrd-.ratcd system cf piping i: 11 '7".11v:".vi i i .s >i V . . , N rr>;- / .v nd coming to us after to our problems fresh husiasm have already mcuon. is a voluntary solving problems conjectioa We consider u a voluntary- aisistant histological technician upon olicosis problems, nee, of Baltimore, has .nd amphibia. Dr. A. ently came to us from earch Fellowship. Hr hcates on the susceptin, an Oxford graduate tly begin an intensive incite. It was recently cause of shcosis. lly as x-ray technician n for a period of res: irgamcaaon, but by the ospital. We trust that rre. The director Lakes 1 service that they arc oeranon. rv Frank B. Black had work rooms. Tne John ISIS of Lhe John Black ous donors gave in 1917, located in a story above, wir.j with that of the bie of the lane:. By so in Lhe ar.ic of the olo ont of this re per. show s by this change. The s:\ r-feit want by relieving mpered cur w-erk m the addioor. was an increase ready overloaded rystent. furnaces and to repipe ir.ated system of pip:r.g are now m operanen It appears that the heacr.g cost! for Lhe entire plant, induing the new addioon, may be less than L-.a: fer Lhe old buiiir.g aJone. Our gratirude to Mr and Mrs Black for this new gift u unbounded, and as we occupy and use the new plant we shall have a continual cause to be mindful of their generosity. Toward furnishing and equipping the.new work rooms, we have already received" SI^JO. ` Of this sum 5250 0^; from Mr Her.ry L' Harris, was acknowledged last year. Dr. Frederick Wilson has recently donate: SI000. which is deeply appreciated. Thus sum will rcrce to put rwo or too:: rooms . into commission, and as fas; as further funds can be procured the ethers... - . wiil be furnished and occupied. ! CLINICAL LaBORaTOXY wcill The iagnostic department has operated most eferovely under the dirercon of Mr. Kelley, assisted by Mr. Delahan: and Mr. Huipntv V-'niie the fees collected are entirely inadequate to rupport the service, the receipt of 51109. from Lhe Saranac Lake Academy of Medicine has made its ccnrnuaoen, possible. Mr. Keiley's fellowship at Lhe Sanatorium secures him his living expenses and his part-time-associates receive par. of thetr salar.es from the Academy receipts The following is a summary of Lie various diagnostic examinations made during the year ending December 11. 1534: ' j SUMMvAY OF DIAGNOSTIC tioaiNATIONS November 1, 1933 to December 31. 193s Diphtheria culture* 9 for tubertie batiilu*________________ Scran for Vinccm'i Ar.f.na________. 10 Sicmilb ccr.lcr.u_____________________ 4 Eiood : banrnologitai counti__________ 45 Ajpiuf.natjcn for rjrphcid________. 36 \V.rr. barter.eit(i:iJ mint:.-... 75 Diterenual counts_________________ . 161 'wV.e:, chtmtii eaauini-.cn_______ Red and %'rutc counti . 269 Smears fci gontxotcui______________ 6 He.-nct.'ahir. deierrsinaoona________. Ill L'nne........... .............. .... ............ ................. 133 7 Coagulation tine___________________. 41 Autegrncji vitcr.ei prepared______ 19 Grouping_______________________ . 101 Piih.ilogiiaJ ipeorctei_____ _________ no Culturei_______________________ . 1) /ujtcpuci. hu"in ....... Chc=u-itry ...___ ______ _ . t: /-email u-.ocjia-.cd for diiinoui___ 45 Sedirt er.u-.on ______ __ ________ s M;4;tlir.reji ejj^r.iscsi_________ 2*0 & Sputum fer tubercle bioiiui___ .1577 Spi.-.ai j;d. unne and ether cti'.maJ1 Te--iJ ------------- --------------------------------- 4 7 7 0 7 were cn cases of ciiroos w-.th rubercu Ions sen: to Lit laboratory from the :id. One was *a case of unoom r" uiitosis with death from gencraltctd cartho-vascular renal disease Of "pathological specimens" were lungs cr peroons of lungs from individuals who died after being exposed fcy occupation to cm. c: cr.c kind c: another. These were rubmttted for iagr.osis by physetans tr. van ous pans cf Ln: country. 13 O-- TL *. ff.riaa ->. < r>*. .j rl . 4. .- t " J ' 77>- . V; N. V nsAsczs At Lie er.d of Lhe s:al year. September JO. 1903. the o.iancia! ss cement shou-ed an apparent balance of 53.65< 57. Tnis uu accounted for by advance payments of certain annual grants cade during the tscal year Tne coney WiJ .allocated to specie- researches Lhat acre cocpieted during the year. ` Likewise. at the end of the cunent year, mere is an apparent balance of 510,393 SI, which represents advance pavnents for work to be. done dur.nc the coning year. In June a group of Muruai Insurance Companies through the American Mutual Alliance pledged their support to a three years' silicosis research program and paid their trst annual installment of 55.COO m September. In October a similar group of nock insurance companies, through the National Bureau of Casualty and Suren- Underwriters, made a cmilar three-year pledge and recently paid one semi-annual installment of S3.500. Each of these groups u flnanang certain specie: problems of mutual interest to them and to the laboratory. The Metropolitan Life Insurance Company has renewed its annual pledge of 55,000. for the continued irudy of infection in association with sbeoss. The U. S. Gypsum Company made an additional grant of 51,003. for the continuation of experimental studies on the protreove amen of gypsum . dust against the inhalation of clica. Experiments begun during the past year were not completed and they seemed of su5cie.it importance to warrant continuation. Tne decreased income from the iron ore study has been apportioned between e!d and research laboratory expenses in apprcxim.a:';y Lie same ratio as las: year. After deducting the costs of earning on the work in the eld and the payments due Dr. Sampson's laboratory for x-ray consul tation, there remains only about 55.110. to carry on arena' eipermenuticn This will not cover the actual cos: cf the work here bui it is of such importance Lhat Lhe balance is being presided from ctr.er sources Tr.c fluorspar study, with a grant of 53000. is aeif-suppomr.g as no long-tenn oust inhalation on animals is involved Tne receipts from Mr. Kueohle's sale of Silicocs Sym.pc-oum. proeeedmes have amounted to 565 5., but none of Lhis money was received pnor to Lhe end of our scal year on October 31. 19J-*. A contract for diagnostic work a: the N'orthwoods Sanatorium has been renewed with th.e Adirondack Fund fer Lhe Tuberculous. Trus yieidi, 51.COD. w.hiih is app! :ed toward an assir.a TitS salary. Tne Agnes Musscr I cVem. Fellowship proved es (or ano:hier werke r. Tne loyal support fro-- Lhe Miibank Mcrr.cr.ai Fu nd conmruies a backL - log: cm which we have relied so long Receio h the 5ara r.i: Lake Aia demy cf Me drome simounted to Sl.::5.. all cf which was app Led to the cc?ration of Lie ciagnc szz ctparrrr.cn:. E. R.' Scu-.bb cr` Son* ma de an ap;prcpnar.cn cf 5:00 CD to Dr. J. N Hayes fer hrs investigation of the action c: various c: ii in the pleura! ca\'ty For th.e coming year ar.octpatec operating expenses will amount to 15 0 50. Li addition to a rum of Si.5 30 to equip and furnish Lit r,n w-erk rooms m the Jo.nn o.acx L*. mg Income is m cgr.t to cover all bu: 5<.COD. cf the regular budge: and wC hue tu-. that thus and th.e speoa! ! 1 ; 1* i ' f.t . p\' \V.' * - cxju^r.icni fund uni! be secured dr.r.c the year. To cake cur stai' co.-p!rtr , S`uJ hate a petroprapher10 i-er.u:y and analyse the rock specimens from h:ih due for experiments are nou- prepared, .hi Line present tune tve are iirr.i-d u> rely upon the generoEty of others for thus serv.ee Jn conclusion the director toshes to express his gratitude to Dr Baldv.n, ^rector of the Trudeau Foundation, for h:s hearty supper., to a!! hts associates inritheir loyaJ cooperation. and to those sa-'nose sr.ancal assistance has cade the conunuacon of our tt-ork. 15 -j i - i" T^v.^TTpr-rn.-,^^.--'.ie^rrrv-- i .: - ,'v .v v.- tau v<t- - r..' ;T-* ';-V"v-'1 nt. tVDf, saranac laboratory for the study of tuberculosis RECEIPTS AND EXPENDITURES October 1. 1933 to Septlmser 30. 1534 t Rtcnpu: Balance on hind October 1, 1933 _______ Froa endowment held in trust by Truceuu Foundation 51,875.00 Other interest and exchange__________ 15.69 Gifts for maintenance of work: Adirondack Fund for the Tuberculous 1,000 00 Mr. Henry Upham Hams_________ 250 CO Hillside Fluor Spar Mines______ 2 50.00 Dr. Leroy U. Gardner____________ 37 5 OO Dr. Hugh M. Kang'nom (on pledge) 1.000 00 Mr. Laurence Mactarlane_____ ___ 300 00 Metropolitan Life Insurance Co. __ 3.7495a Michigan Ore Mines 27,500 00 Milbank Memorial Fund _______ - 3,000 00 Miscellaneous Gifts * ____________ 105.00 Nancra! Assoeacon of Mutual Casualty Companies ___________ 5,000 00 Oglebay Norton tr Company____ 416 67 Mr Arthur B. Punns_____________ 750.CO Ros-clatre Lead tr Fluorspar Miring Com pa rues_____________ 37 5 CO Saranac Lake Academy of Medicare* 1.229.00 E. R. Scui'cb tr Sens........................ 2COOO U. S. Gypsum Company------------- ` 2.875.00 1,850.69 53,654.g7 * i r-!J Total receipts (earned forward) 48.275.61 50,266.30 1,521.17 * See /c.'.'ouir.g pegci /cr Im cj c'or.rrj 16 8 8 8 *8 8 8 8 8 8 V im ! OF TUBERCULOSIS rRE5 3. 1934 S3,65 4 E7 X) >9 1,890.69 100 5.67 0.00 5.00 9.00 TOGO 75.00 4S.175.61 --- 5C.:5.n 51.52 117 SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS RECEIPTS AND EXPENDITURES ~OC70SER 1, 1911 70 SEPTEMBER 10. 1514 Total receupu (brought forward) 51,511.37 ZOuburjetnenm For Laboratory work and maintenance i Salaries.................................................. 18.905.14 Supplies and equipment___________ 2.011 4 6 Aru.7;aij and feed ________________ 1.915.04 Fuel ....................................................... 704.55 Gas ............................................-.......... 160.5 7 Eiectrtc light and power_________ 5 03.6i Library 4 50.66 Telephone ________________________ 101.01 Laundry ________________________ 79 5 2 Publication: ................................. -- Travel ................................................ 196 15 246 E4 Repair: 69 46 Miscellaneous ________________-__' 96.70 ----------------- For work in the e:d: 25.541.5! Salaries .............................................. 14.219 5S Travel, including automobile, etc 1,51141 Advances to workers for expenses 62 5.00 Miscellaneous __________________ 111.54 ----------------- 36.459.55 Tcial cor. of work 42,111.55 Trar.'i'erred to Trudeau Four.caoon. reimbursement for funds advanced for new arum a I house built m 1911 ----------------- 1.155 45 eta! disburse: Eali.nce on hand September 10. 192-4............. ..................... 17 4 1.510 16 10,150 51 *I J I 1 ir** 7- r CONTRIBUTIONS TO THE SARANAC LABORATORY From October 1, 1933 to September 30," 1934 (NOTE; Items >n second column received liter October In to be credited in 1935 tninr.il report) Adirondack Fund for the Tuberculous 1,000.00 249.99 Mr. and Mrs. Frank B. Black, for building 5,500.00 Mrs. Bigelow Crocker, thru Dr. H. XI Kinghom . 5.00 5.00 Xlrs. Charles L. Crocker, thru Dr. H. XL Kjnghom . 25.00 50.00 Xlr. Henry Uphan Hams, toward new building . 250.00 Hillside Fiuor Spar Xlines .... 250.00 503.00 Dr. Leroy U. Gardner . 3 7 5.CO 25.00 General Refractories Coxcany 50.00 Dr. Hugh XL Knghom (fulfilling pledge toward animal house completed 193 3) 1,000.03 Xlr. B. E. Keuchle and associates, sale of pubb'eation, "Sdicosis Symposium" 65 5 .CO Xlr. Lawrence Xlacfarlane, thru Dr. H. XL King'nom . 300.0: Xletropobtan Life Insurance Company 3, / 49.94 2,499.96 XLchigan Ore Xlines, thru Pickancs, Xlather cf Company !27,503.00 6.358.54 XLlbank Xlemorial Fund . 3,003.03 National Association of Xlutual Casualty Companies 5,033.03 National Bureau of Casualty and Surer)' L-nderw-nters North American Re:ra:to::si Company 2,503.03 25.03 Oslebay, Norton tf Company 416.67 XL. Arthur B. Purvis, tpj-j Dr. H. XL Kingdom . 750.03 Rosiclaire Lead and Fluorspar Company 375.CO 375.03 C a. ~ Z C ICP^'oTC . * * * -.971.61 18,718.49 is OO r 0, 1934 October )a ) 0.00 249.99 5,500.00 5.00 5.00 25.00 50.00 50.00 50.00 75.00 50.00 500.00 25.00 )00.00 655.00 300.00 749.94 2,499.96 500.00 6,355.54 .000.00 ,000.00 2,500.00 25.00 416.67 750.00 375.00 375.00 .971.61 15,715.49 B.-vught forward . Saranac Lake Academy of Medicine Mr*. John F. Archbold . CLmon J. Ayres, Inc. . Dr. Edward R. Baldwin Dr. Robert J. Beck Boyce cf Roberson . Dr. H. A. Bray ~ 'Dr. H. B. Brown . Dr. Lawrason Brown . Dr. David A. Cooper . Mrs. F. C. Deemer Dr. Joseph T. Eagan . Mrs. A. C. Erkander . Mr. H. C. Eyer Miss Anna L. Gilbert . Dr. Albert G. Hahn . Dr. John N. Hayes Dr. Fred H. Heise . Mr. Fred A. Howland . Dr. E. M. Jameson Dr. Hugh M. Kinghcm Mr. Herbert R. LeeEert Mr. Wm. C. Leonard . Dr. S. S. Uchrman Dr. Edgar Mayer . Mr. H. S. Parker . Mr. R. F. Phnk Dr. Samuel Post Dr. 1. Woods Price Dr. Walter L. Rathbun Dr. John C. Russel! Dr. Hcmer L. Sam.rson Sanatorium Gabr.eis . . M:;s Ophelia Sauted Dr. David T. Smith Miss Dorothy Smith Mr. Robert B. Smith . 4;, 971.61 IS 71S.49 50.00 50.00 50.00 . 15.00 . ....20.00 25.00 10.00 50.00 50.00 50.00 25.00 10.00 10.00 25.00 10.00 50.00 25.00 50.0-0 25.00 5.00 10.00 24.00 50.00 . . 10.00 10.00 10.00 10.00 50.00 25.00 1 10.00 10.00 . 100.00 10.00 1 5.00 25.00 10.00 Cc, :;c*. 43,905.6! IS 502.49 19 '*7 ; - r." ; , r' *. 'i\' * .C-`j s. -v- r. Brought forward............................. 43,905.61 1S.S03.49 Dr. Willard B. Soper 50.00 Dr. Earl R. Templeton . 10.00 Kir. Lewis S. Thompson 50.00 . Dr. Charles C. Trembley . 25.00 Miss Jean Turnbull 20.00 Dr. William A. Wardner . 50.00 Dr. George E. Wilson . 65.00 In Memory of Sydney Lunt'Wood 7 50.00 " ..............- Dr. Warnner Woodruff 25.00 i E. R. Squibb cr Sons, thru Dr. J. N. Hayes . . 200.00 U. S. Gypsum Company . . 2,875.00 250.00 Utica Mutual Insurance Company . 100.00 Dr. Frederick and Kir. Thomas A. Willson, toward equipment of building . l.ooo.oo Mrs. S. L. and Kir. John P. Wood, in Memory of Sydney Lun: Wood . 10.00 j i 45,375.61 20.213.49 Mr. Frank Cor.nable, thru Dr. Elliott P. Joslin, a Microchemical Sugar Apparatus it 1H ,l \ * -v' r* : v.