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tV {. Annual Report of The Saranac Laboratory, for the Study of Tuberculosis OF THE HDWARD L TRUDEAU FOUNDATION FOR THE YEAR 1941 SARANAC LAKE, N.Y. 02 018 191, 5- PLAINTIFF'S. IS'.': ^E3XH1IB1IT.0 WV-1051 1 THE SARANAC LABORATORY ' -Ttf fact tlut the Saranac Laboratory has ftfoiy* been a separate tnsmutKm from the Research and Clinical Lahorwury of the Tnidcsu Sanatnnum n rv CWCfally tindcncand. Both Jahoratone* are sponsored by the Trudeau Fnuiv datum, hit the Santuc Laborslory a located at ? Church Street in the viliact* of Saranac Lake and not at the Satw^tmim. The proper*** c( the Saranac Laboratory consist of the original hujldmt*. ffivfft to Dr. . L Trudeau hy Mr. George C. Cooper in IS94 as a private research iaKtratiry, together with the John Black wing, donated hy Mr. and Mr* Frank D Biack in memory of that wo. The addUton eonti<vr* the liheaty and lecture reom, erected in 1927 and and private rvxareh mvw <** itrocted n,lV\t. There arc also two animal house*. To avutd cnnfwHon. the Trudeau Foundation puNohe* separnce report' of the Trudeau Sanatorium and the Saranac Lthoricnry. 02 018 1915 THE SARANAC LABORATORY Txusrm Uy U. Gardner, MIX., Dittaor Edward R. Baldwin, M.D. Oliver B. James, 7di.Wf W/liura P. The*np*on, M.D Roy 8ayiU Serrewrv Dunald E. Cummin**, B.S, Aamant Director * <*a/ge / jr,w w0T^ 09 01 S < a ^ \ THE SARANAC LABORATORY FOR THE STUDY OF TUBERCULOSIS OF THE FnwARD L TRUDEAU FOUNDATION tADOMTORY STA^F Lcruy U. Gardner, M.D.______ Arthur VorwakJ, Ph.D., M.D. .............. Director .......... Pafhdlnjpn Thomas M, Durkin. M.E. ..____ Chemist and Engineer Espw S. Uncn, Jrf, B.S. M.A., Ph-D, Petrographer Doogias S. McCrum. B.S.. <> .... Photographer *d Assurant Engineer Mom? Dworsfci. &,$,, C.P.H. ---- Cftmc*' Bictcrin/ogin and Amxtant m . Experimental PerMngy , Httrfton F. Hcslmgton, M.D. ... Ftlfaw tn PdthNngv * Catherine M. Cummings ----__ Lihfnn and Seeretarv Roy Dayton --............... ........ Financial Secretary James V, LuOfcll .............<------ Purchasing Agent and Terhumon George C. Hulpritt __ Techtin mm Anthony B.Dclaham --...____ ............... Techno urn John 0. Schmidt............... .. .........Clinical Ijibrtiuinnan Andrew j RcdKn ...............TMTM--.. Technician Frjocic T. Creedon .. --. ... -........ TeehmoMti Edward Gutter .......----------...--.... TeehnKi.m R*hqr E. UMy____ Amram Technicwn Raymond LaRose .... Assistant Tedmwn Stephen Phillips, B.A, ........----- ........ Voluntary Assistant R<**rt Banker Aoniiim Homy C. Stout ...... ....................... -.............................. ........... Axuuanr firm Asr> r*)NSUL7i*c stai> Donald E. Cummings. BS. .... Assistant Doeetor m charge aj Field W,\rl Edward C. ). Utkin. B.S.. M S....................................................f,e Cm Hornet'U S^mpton. D.Si. ....___............ Camumng Racntgeo'iWni Daniel M. BrumM. M.D........................................................ CWel Consultant N. Downs................................................... Roentgenological RHp.mwr Richanl Ualtm................... ...................... ......... Roentgena/ogrcal Teehmcun Huyn Loo*tan ............................ Rovurgcneiiigtcul Tck /mu >ii> E-Clayton Qumn Batrerjylaguol Termtivtan *mI Clvfc Helen R Smith................................................................................ Siey..*rher 02 OlS `1917 CONTENTS Repin of the Director Financial .Statement ' Reprint* of Scientific Papm: Loots K. Berkelhauer X*Rsy Di/fwvlton. An Important Tevlht PncutRoeetivus Research * Leroy U. Gardner, Morris Dworsm, Anthoky B. DriAKANT Evperimenrai Study of Inhibitor Effect* of Alumtirt Cow /villas m Silicons > Arthur j. Vorwalo Cavities in the Silteottc I.ting I ANNUAL REPORT OF THE DIRECTOR of the Saranac Laboratory for 1941 LEROY U. GARDNER, M.D.* . A yeah Aft) the idea probably Kerned academic to most people tbit healthy worklneft m mines, factories and munitions plants are as essentia] as armies in the field. `Today (his statement is Rentnliy accepted as a basic objective and a concerted effort is being mack to reduce time lost from sickness. In she inter* lude after the last war we learned how to protect workmen against chronic diseases like lead and hcrunl pissniung, silicosis, asbesrosi* and tuNteubsia? what we need new is more trained physicians and industrial Hygienist* to put this knowledge into practice in every plant in the country. Their job mil never be finished for the old hazards arc inherent in industrial practice and new ones are constantly arising with technological advance. These chronic conditions often cause total permanent disability in skilled workmen whose replacement mean* morula of training. But today we arc coming to realise that the aggregate of time loat from acute illnesses is even more ecnoudy ham* pering industrial output. As the Saranac Lataratory played a part in discovering and disseminating knowledge for the control of chronic disease* of the lungs, so u is hoped that ic may he useful in the ease of the more acute conditions. Some of our old problems, to be discussed in this report, must be set aside until more propitious times even though they may be important in the control trf disrate: others we shall try to continue, Tuberculosis is a chronic divas: but in time* of stress, with restriction* upon diet and hygienic living, its frequency always increases. Already the rates arc beginning to nw, even m this country, and abroad (here are Kents that tuberculosis is taking ns usual war time toll. We must know more about the factors th-t arc responsible for such increases; it is {r*aiMc that research might reveal essential ingredients that eouIJ be ruppticd to deficicnt diets at a cuss that would not prove iruuf<rabk. We should continue to inquire whether the promiMOg leads with the newer chenuthenpy offer any hope for tuberculosis. There * much to be d*>ne but. hkc every one else, we arc trying to adjust ourvrJvv* to the needs of the hour and to make our facilities available for'study of the health problems that arc most urgent. 7 Research Program One study of immediate significance haa ju*t been completed with equip* Went Juasod by the Gcactil Ekttric Cojrrpsmy. This involved daily explore of normal And tuberculous animal* to fume* pradoced by electric arc welding foe froed of one year. Coated rod* vt burned to produce a*fume em- largely of iron and o*k* of nitrogen. In csaMidung the tfmeentration that wSd he wlmted by guinea pig*, "white eats, and m*, I? percent of the guinea pegs died from chemical pneumonia during the first three weeks and considerably more must have nrtferrd non-fatal attack* judging hy scars Ken in animals killed at later dates. In spite of these severe inflamatory reaction* m their lung*, animals already infected with attenuated tubercle ba cilli failed to devdop progress** euhereuVvrs. .* they do with quant duat. Fmm this wc could conclude that continued exptwurc to such fumes does not bnfavonWf mfloenez developing rtibcTCvtlruu. Animal* with parts*Hy healed tuherculous infection* of the lungs likewise showed no reactivation of their to* bwJe* when subsequently eapwed to the fume* fm 1 to 10 months, inhalation infection after 10 months daily exposure to weldim* fumes produced essentially dw safe** type of tohetculwi* as that m normal contras. These experiments led us tn conclude that the fumes from this type of welding rod have no effect upn mtsvc aujcepdbibty to tuberculosis. The results have practical signin' . cance in view of the widespread use nf arc welding in indurery of all kinds *nd they are of theoretical interest in indicating that pulmonary irmation per se is'not necessarily unfavorable so the course of associated tuberculosis. Another study by Dr. Vorivald and Dr. Benjamm Etstcn. anaesthetist at the Saranac Lake General Hospital, bears on the same central problem. They are investigating the effect* of the anaesthetic gases, ethylene, eyclo* propane, nitrous oxide and ether upon tuhercufrtdi in animals. CorcspWtvm of their work will give information of practical and theoretical siRmfieaive The experiment <ki the inhalation of g{js u*i fibre*. sucmwd \ lnt year* report, continued to htn* negative rentft* after months of djy expsure. To make dHJhly certain that fibre* of ths* have prof^rncj which prevent their bcinc inhaled into the Junes. we have <*t.iined from t!*e munii* faaurcra some exceedingly fine gla6 vcc4. not m eommeraal production. ,iml wre continuing the cxpnmtre of the animals for aivnhef six months. In spite of the fact that the w fibre* are microns or less in diameter, we arc still finding practically none of it in the June*- It seems highly improbable that the commercial class fibre* used for insulating porpeof' could vver be inhaled into the Jons* for they are at least three times a* duck. Jr a therefore con cluded that glass weeb which is irritating to the skin of many individuals, a can have no effect upon the lungs. S 1 A report on the inhibitory action of aluminum hydroxide was deferred to include chemical confimatian of the anatomical *tudi and for the inclusion of comparative data on thr action of metallic aluminum. We arc now certain that come of the hydroxides of aluminum will absolutely prevent the develop* ment of esUcon* when introduced in auffsdcstt quantritex into the tame tissues where quartz it concentrated Immature adieotic lesions ean be ahwerd and made to rflfiyw by tuning aluminum therapy after the introduction of quartz, but mature fibrous silicotic nodules are not altered. Infected tmn tbt animal body, aluminum hydroxide is retained for least a year. Attempts to substitute finely powdered metallic aluminum for the hydroxide have re* peaudly failed to have any effect upon silicotic reactions. The reason a ** that,the meul it incapable of neutralizing the quartz, hut Chat it flocculates ** readily that it t* not dtanhuted to the cells containutc quarts, Our ex* fvnence it limned to various methods of injection and has not included the erudal one of inhalation. However, we feel that even by inhalation the hydroxide should be more effective and have therefore just carted an inhala* tion test Moth one form of this substance. Extensive research U aim in proems upon the effects c>5 theje compounds on tuberculous infection. A number of collateral experiments are being done to learn whether aluminum in natural compounds, like the different day minerals and certain silicates, ran Ve iretd by action of living tissues to protect against free silica. Further study of ceramic materials it indicating that at the high tempera* lures to which they are.subjected much of the quartz it converted tn trrdymite j \ and These conversion forms of fret artica we have previously shown to be as active or more active than quartz itself. However, the heat al forms layers of inert glass about the fine grains of free silica and relatively little of.this is broken away in the process esf trinding. As * cornrqottict, injec tion of **groc" parcelc* ground tn Ifl microns and under causes no silicotic reaction in spite of the fact that the material contains approximati-ly <0 per cent free silica. After treatment with acid. which dit^lvcs the protectw layer of glass, injected "croc" produces typical silicon*. Similar result* arc heme prduerd with a vttling <Uv from a pottery. This material contain* ahoyt 1$ percent free silica as cnsrobdjte, tridymue and quana. 30 percent glass and 50 percent mullstr. At first it was thought that the altimtnum in the latter compound mielrf be the inhibitor. but ts the claw and rwi the mullue attacked hy acid treatment it now seems probable that the protective mechanism is mechanical in nature. Evidence is also accumulating to indicate that the presence of neither carbonates nor free alkalies accelerates the action of quant in the Kxly. Tbit w<xil<i controvert the theory that tofuMe nltea is responsibly for the produc tion of silicosis. j , j i 9 no AIC ^ /* <% on asfesuv itl progresses. The observation* to dale r<> indicate that she very short flvo produced by dry grinding Have wry hriV effect. Before reporting on thi* group **f espertmemj we hope ttat collateral research will dcmcwwntc the fwxhaftism by wKitfa ukssos xjsam the tisuci. CHiscmtbns on tht differences in the response of various species of animals **> inhaled asbestos indicate that a ebonies! factor must be involved in addition to the one of mechanical irriutksj deviously suggested. Extrapulmrmary tissues of all species aod the lungs of certain species have the power of dts* saving these fibres quite rapidly. With Ok fibre gone there can V nP mcehani* cal irritation. Apparently the lungs of man and the guinea pig offer the optimum chemical environment for the preservation of the fibres in such state that k ean continue to irritate the tissues. Probably the cmting applied to the mineral fibres to form the ashenais body prtxecu the cells against further irritation. The work with asbestos has indicated that the chemical emwomem of the lung is unique and differs materially from that in other organs. This conclusion entirely escaped us in working with a universal irritant like quarts, which will oust reatdwn in any organ of any ayeoes oC Jmmisi M this is true. tfien the effeets of minerals ether than quarts and the vanous forms of free alia must be tested in the lungs to determine their euemial capacities to produce fibrosis. Proceeding on this premise we arc now cheeking the effects in the lungs of Ift if tlie SOvnJd silicates tl*t had been ptwioudy tested by intravenous and intraperitoneal injections. Time and limited factlute* \voufJ not permit inhalation experiments with so may pore minerals *n we have had to resort to injection by intratracheal tube. TV guinea pig is ita aitimjl of choice as it is the one whose rtspwe to the advMitnrm silicates most cEnvly approximates that of man. Dr. Vorwald and Mr. Delahant have solved the difficult problem of making repeated intratracheal infections inn* thec small animalv Completion of a year's observation on each of these iffirate duus should provide much needed information on their capacity to cause signtfi* cam degrees of pneumoconiosis. A comKswd p*dv'k>gic*l and study tight p,r* <ff Uuig< from miners of tremoJitc talc is in preparation for publication. T.\U* i< one of the ^licates whose JrmcoJ effect has hmg been questtuned. TrcnW'U* i* a sfftrau* that may exhibit fibrous structure like asN'&nv* The product of the tnmc whew s)k'ic men worked consists of about equal parts of thev txw* mineral* with small but variable amounts ol quarts. At! tK* brnc* of the tetxs thtiw more or less pneumoconiosis but the reaction is apparently a response to the mixture of minerals A silicotic elemrnt probably interfere* with free Ivmph.v tie drainage anJ may cauv nodular fihr*< withut tlw lung<; iW .i-lvsniomi .ircmi'litc and pnJvbty aavwory fihnMjs mineral* pnOuce atHMiuo Indies 10 02 01 R loon i arid alia excite the fon&ation of an unusually cellular type of connective tissue. The part pl*)d by the uk\ the name Wider which chc product is marketed, has not been established. The inference h dear that it would be unwise to assume that rimffar reactions would occur to everything known commercially is talc. The fKtwc described i that which happened to re*uh from inhaUman unusual combination of minerals in one location. An experimental study should be made m order to determine the relative importance of the different . dements in dug mixture. This is something we Have long been anxious to undertake, but until funds are available the mechanism must remain a subject for speculation. Enough determinations of the free adiea content on the lungs of persons employed in dusty industries have hxn finished to indicate trends. - Generally the huge for free silica values between ooc-Half end oneddunh tSir^e for tool sjlkaalthough this ts not invariably true. Often the advanced r**? of mas* awe conglomerate silicosis seems to have lea* rihea in the ash than the one with small scattered nodules. Comparisons based uys\ the usual fannn of refer* cnee, such as weight of dry tissue, arc not particularly informative because the weight of a given volume of diseased lung is much greater than that of a corresponding ncraiaf structure. In the latter, a cubic inch of lung tissue is made up of thin partitions between air spaces, whose site is determined by their degree of distention, and of the included vessels ami bronchioles. The diseased organ may contain no empty spaces at all but be comfvwcd of dense scar tissue or of misses of exudate. In discrete nodular ril/ccsis combinations of these two cates are present. As the amount of solid ttswc increases the ratio of its weight to that of a given weight of quarts decreases This fact became cbvious n analysing the lungs of groups f guinea pigs sacrificed at monthly intervals during an exposure to high enwentxations of quartv For the first 22 months (He ratio of $iO, to dry lung tissue steadily increased; then it began to decrease in spite of the fact that the c*p*ufc continued. Until the twelfth month there was little proIsfcratHw of tissue; most of the reaction was limited to phagocytes within the air spaces Then nodules began to form and the weight of the lungs materially merravd If one had the weight of the wl**tc huTTiiTj lungs washed free of Wood, a * point of reference, companions should be more valuable, I'Ut this is rarely determined and the organs are usually submitted to the laboratory immersed in fixing fluids. Of course the ideal analysis would be based upon the dry weight of a whole lung but such treatment would preclude other essential mcrbxis of study and would be most expensive. We have searched in vain fur rome chemical element which might remain suSoently constant to serve as a haw of reference. Prrf\My we shall have to h< content with establishing tlic limits for free idles to he expected in different types of tissue. The study Km convinced us of the futility of 12 02 01S 1922 atinKiting diagnostic e&mficance to the quantise* of tottf sites in the tissue*. Dr. Vorwald is obtaining imercRing therapeutic reaulta ia tuberculous toimtli given * tulphotw drug analogous to promin* He is aUo espenmeptmt* upon the effects of continuous intravenous thetapy with other compounds. This work, financed by a grant from Merck and Omipany, is not sufficiently advanced to justify dteusoon. In eoSahonttiem with Dr. Osar Richards of the Research Department of the Sfmeer Lens Company, Dr. Votwald is also studying the spedfidty of aurattuse fluorescence of the tubercle hadHui They are attempting to be certain that no other substance likely to be inhaled into the lungs will behave in a sntuUr manner. They arc also studying eases of tubercu!o*iljeoss in vdneb acid fast harifti arc rarely demonstrable hy ordinary"naming technique?. In June the Laboratory held its fifth symposia*! The subject this year waa 'Takrcufesi* in Industry" and silicosis was considered only inddcntally asnwg the many V*r environmental factors of jhr working f^acc that have been alleged as causes of tuberculosis. Twenty-eight speakers presented data on the nature, causes, frequency, and control of the disease. The evidence pmcmed indicaud that no industrial factor is in any way comparable to frre silica as a specific alterant of native resistance to tuberculosis The effects of ether pulmonary Irritants *d poisons that have been thought to lower resistance %xt not apparent on critical analysis of industrial experience. Most tuberculosis would appear to be precipitated by more subtle factors operating in the hemp rather than in the place of work. Infection can of course talc place anywhere but tb& probabilities o( contact infection while \\ wotk are no prater than those outside except in the case of the nurse, physician and hospital attendant. About 75 physicians and others interested in industnal hygiene attended the meeting. The proceedings have been published and ate available ac the National Tuberculosis Association in New York City. This organisation has al#o helped us to dispose of the remaining copies of the Fourth Syrof^ium on Silicosis, tlic supply of which is now completely ex hausted. We take this occasion tn c*pres< our gratitude u the Employer' Mutual Liability Insurance Company of WtVronin who published the pr-tccdmc!1; nl the lour Symposia no SiJei* at theif own esfvnv. Tler cnninbotion t<> the laboratory from the sale of shew books now totals Jfi,U9.57, A moss interesting study in the physiology of sdieotic and nomi.d fcrvms e*fused in du# } being carried on at a mine owned by the Republtc Stcvl Corporation. preliminary man investigation of the therapytic value of alum' inum > uhcosii. T! company has erected an addition to it* Ivwptta! in which bc*w* ibe physWoocsl lahonoocy and it remitting us to study a l>rt:c group . uf hs employees on company time, a not inconsiderable contribution when tt 12 09 Cl 1 S i O o \ it rrtlitAl that each sdhjcct mutf he kept in the laboratory for 2 half a day for each period of rtudy, The apct*t\$ etpctvsci are befog carried by the Dcpamoenr of Pbywotoffy of the Trudeau Sanatorium aupplcmented by t VXitA from the American Mutual Alliance of Cumpematitm Insurance Com* panic*, The unxk under the sinteitm of our physiologist, Pr. George W. Wright, with the coHahoratiun and advice of Professor Wiliam S. McCann and Pr. K. L. Xahrridcf of the School of Medicine of Rochester University, Thi* study of pulmonary fuACUon m a group of active, working miners, on whom we have already cra four or five annual chest roentgenogram*, should yield extremely valuable infonaadon upon the general subject of pulmonary dinbfoty. The correlation of pulmonary /unction with roentgenognphie appearance*, physical fading* and subjensvt ewnpkirtf* it essential for evalu* aurt the effect* of sofoceiueft* aluminum therapy. In February cw Petiographer, Mr. Louis Oerkelhamer, accepted a pxdon vah the 0. S. Roseau of Mine*. We arc mast fortunate to have m hi* pU Dr. Eapcr S. Uwcn, Jrd, formerly of the Department of Mineralogy And Petrography at Harvard University. In June Dr,' Humon F, Hcslincton iff Vandetbilt University Medical School joined the Laboratory staff as pel* low in pathology. He \>u been able to rtUcvt Dr. Varvraid of much of the routine pathological work. Mr. Roy GritwIJ kit our araff to join the Depart* ment of Thysiology a* icchnician. Mr. Rchert E, Liddy and Mr. Raymond LaRosc graduated from the voluntary to the regular staff as assistant tech* itidcutt. * The usefulness of the John Alack Rnnm has teen greatly increased by an indirect ffuwtaceM lifting system. We arc indebted to the Saranac Lake Medical Society for a contribution of toward the cow of this wnprovc* mem. The entire suff of the Laboratory has teneftfed by the imaxiU'ioit of floreeseent lights throughout all the work rooms and office*, where the need for better tlluminadort baa long been felt. Tbit Ku faectv made pcetftd* ^ eomn* buttons of 12TG.00 from Mr. and Mrs. Woodward Clark and from Mr. Stephen PhdliQS. We are harry m acknowledge our gratitude to item. TA Field Division The field division of the Laboratory fotw*w.v tftoemV under the direction of Mr, Cummins**. We still maintain supervision of tte indusfiil operations and mines mentioned in prrv>y reports Mtat important are the *n* mineseffthe Lake Super** dwki, t%ftc tton mine in oonhrfn S'cw York, and certain subsidiary Ofvratims hh<* lime sonc quames aod a oJ mine * Wot Virginia. T1 repeated annua! examinations of the rmpfm-evs in tlic*c mduKtin hv*e,provided much of the dau upon \i'htch our concepts of dust 15 no mo A e< diseases axe fountkd. THU ha* Veen aupplemrmed by material from tncidcuul surveys in other industries and by a considerable number of autopsies. Diagnostic H'orfc Under Dr. Vurwaldfc sMe direction, Wr. Schmidt, Mr. DworsW, Mr. Ddihant and Mr. Hulpmt, all member* of the research suit, have pnwided the local hospitals and the patents in the village with adequate diwnrwic Jahoeatory.aetvke. The total number of fjvomctu submitted was f,758 with l.W supplementary examinations. These included all of the usual tests in clinical bacteriology. chemistry and htitofogy* There were f? poet mortem examination* and )6S surreal specimen! were received from the Saranac lake General Husptial. Outride phyriaaw have submitted lu^c tissue tm \7 ^cases involving the diagnosis of j1rwij and related conditions. Through Mr. * lurcrel! the Laboratory maintains daily supervision of chlorination of the village water supply with frequent fcuttrielogiai mwimtinr*. M*. Dumrskt. by special arrangement, hat charge of the. Board of Health laboratory of the village and he doc* the bacteriology there for the control of milk and food. Tht thttt papets Vound with this report do not <avutiue an index of the activities of the laboratory during the p year. The Director, and the Pathologist, Dr. Vorwald, have made numemus unpublished addr<r. before medical and other groups. On two notations this involved a full day's discussion of the subject of disease dor to dust in a pew graduate etmnv organized by Columbia University for Rival personnel. In addition u. ' arranging and participating in the Laboratory Symposium on Tuberculous in Industry, the Director spent considerable time in editing the procccdun** *f the meeting. It has been derided that in the interest* nf economy future annual report* will not idcludc reprints nf published papers. There will he a brief abstract of each paper tn indicate it* content and anyone wishing repnm may ifctaiu if. without co*. on request. Again fbe Director acknowledge* hi* indebtedness to all whose *uptwt ha* made it possible to carry out this pmyrjm. a loyal riaff wb*i hxv* K.v un tiring in their effort*, a sympathetic hoard of trustees, and the many fiuanci.il supporters without whose confidence none of us could have accumptatad anything. 14 02 018 1926 SARAHAC LABORATORY FOR THE STUDY OF TUBERCULOSIS RECEIPTS AND EXPENDITURES Yi ending September 30. 1941 Bafcnare on lund Oct*cr I. 1940------------------------*______ ___ $5,680.20 Recetpw: Gift* and other receipt# for maintenance of plant aad *ork ___ ___ $52,547.32 Refund# of insurance premium* ____ .......... 22.50 From Trudeau Foundation ....--.--........... 13,256.65 Total receipts for year___65,326.47 Total of previous balance and receipt* -- 71,506.73 Expenditures: Salaries fot research and field surveys ........... Travel and other expense* of worker* ........... Permanent equipment ....................... Repair* ami improvement* ................. Fuel, hght, insurance, animaU, feed, supplies and other running expense* .............. 54,384.11 2,907.55 667.15 1.674.62 F.8 73.20 Total expenditures for the year 68.506.73 Bubner on hand September 30. 19*1 ...................... 3,000.00 Sev following page*fof h uf contnhuton CONTRIBUTIONS TO THE SARANAC tABORATORY From Octefccr i, 1940 to September 30, 1941 Xvrfttj -- Ue*i In euluhtn ovlwr J*t, JiM. \u l* iu 1W2 fr^.rt. Adirondack Fund for the Tuberculous SI.000.00 $249.99 Anonymous (for special apparatus) . 300.00 Mr. and Kirs. Woodward D. Clark 250.00 Mrs. Bigelow Crocker Mrs. Charles L Crocker . . 10.00 . 50.00 IG0 $0.00 Dr. Leroy U. Gardner . 335.00 90.00 General Hospital of Saranac Lake . . 1.000.08 250.02 Industl Hygiene Foundation of America 3,500.00 ?$0.00 Inland Sfcet Company . 1,874.99 437.49 Jobns-Manville Corporation . 5,000.00 1,250.00 Mr. \V. G. Laidlaw .... . 1,000.00 Merck & Company .... . 2.500.00 Miscellaneous contributions . 873,50 337.50 Owens-Coming FiberfUs Corporation . 2,955.00 449.00 Mr. Stephen fhfliips .... 250.00 KcJcands, Mather & Company, for Laic Superior Iron Ore Association 22.500.00 5,625.00 Portland Cement Association . . 2? LOO Republic Steel Corporation . 3,000.00 75G.OQ Employers Mutuals Ins. Co. (Sale of Symposia Reports).... . 545.25 21.00 Saranac Lake Medical Society . St. Joseph Lead Company . 185.00 * 1,375.00 State Insurance Fund .... . 750.00 125.00 Stebbins Engineering Company . 350.00 United States Gypsum Company . . 642.50 125.00 In memory of Sydney tom Wood; Misr Sarah C. Anxdstead . 5,00 Miss Susan Wood .... . 50.00 $2,547.32 11,205.00 iC 02