The area was first settled in 1819 by the Jacob Smith Moody family from Keene, New Hampshire. In 1827, settlers Pliny Miller and Alric Bushnell established a logging facility with a dam and sawmill, forming the basis for the village. The first school was built in 1838, and in 1849, William F. Martin built one of the first hotels in the Adirondacks — the Saranac Lake House, known simply as “Martin’s” — on the southeast shore of Lower Saranac Lake. Martin’s would soon become a favorite place for hunters, woodsmen, and socialites to meet and interact.
The village of Saranac Lake, with Lake Flower below and Lake Colby above, from Scarface Mountain to the Southeast.
In 1876, Dr. Edward Livingston Trudeau arrived to treat his own tuberculosis; in 1884, he founded his Adirondack Cottage Sanitarium, starting with a small cottage, called “Little Red”, where two tubercular sisters from New York City became the first patients. Little Red, the first “cure cottage”, was built on a small patch of land on the backside of Mount Pisgah, which was purchased for Trudeau by several of his hunting guides. As more and more patients visited the region, including author Robert Louis Stevenson in 1887, Trudeau’s fame grew. Soon, the sanitarium had grown so that it was entitled to its own post office, which would sort and deliver mail to its many patients. The Trudeau Institute, an independent medical research center, evolved from Trudeau’s work for the sanitarium. In 1964, the Trudeau Institute began researching the functions of the immune system and how it guards against many infectious diseases, including tuberculosis.
Telephone service was introduced in 1884, and the Chateaugay Railroad reached Saranac Lake from Plattsburgh in 1887.
The village was incorporated on June 16, 1892, and Dr. Trudeau was elected the first village president soon thereafter. Electricity was introduced on September 20, 1894, by installing water wheels on the former site of Pliny Miller’s mill. Paul Smith, an important figure in the history of the village, purchased the Saranac Lake Electricity Co. in 1907, forming the Paul Smith’s Electric Light and Power and Railroad Company, which eventually became part of Niagara-Mohawk. At the same time, the village began to stabilize, with public schools, fire and police departments, and other municipal facilities forming.
Knollwood Club on Lower Saranac Lake, home of George Marshall
Starting in the 1890s and for the next 60 years, Saranac Lake was known as “the Western Hemisphere’s foremost center for the treatment of pulmonary tuberculosis”. An effective antibiotic was first used on human TB patients in 1921, but only after World War II did it begin to be widely used in the US. Thereafter, sanatorium treatment began to lose its importance, being phased out completely by 1954, when the sanatorium’s last patient, baseball player Larry Doyle, left. Among the last of the prominent patients who sought treatment for tuberculosis was Manuel Luis Quezon y Molina, the first Filipino president of the Commonwealth of the Philippines, who died in Saranac Lake of the disease on August 1, 1944.
But the village’s preeminence in tuberculosis care had lasting consequences beyond the many large, handsome private cure cottages that were left vacant after the patients were gone. The effect of the hundreds of patients and doctors from all over the world who came to live in the village, many of them prominent in business, literature, science or other fields, many of whom stayed for years, cannot be overestimated. Combined with the area’s popularity with the power elite, who built their Great Camps on the nearby Saranac and Saint Regis Lakes, the effect was to change the sleepy village of 300 of the 1880s into the vibrant “little city” of 8,000, as the village has referred to itself for many years.
Like the cure cottages, downtown buildings included porches for tuberculosis patients.
Mark Twain vacationed on Lake Flower in 1901  at the height of his fame. While there, he wrote a Conan Doyle spoof, “A Double-Barreled Detective Story”.
Saranac Lake became an especially busy town in the 1920s, with the construction of the Hotel Saranac and several new, permanent buildings after multiple fires destroyed a large part of downtown. Bootlegging was common in the village. Legs Diamond visited his brother Eddy, who had tuberculosis and attempted a cure at a local cottage sanatorium. During the 1920s, entertainer Al Jolson and president Calvin Coolidge were semi-frequent visitors to the village — Jolson once performed a solo for three hours at the Pontiac Theater on Broadway.
Beginning in 1936, Albert Einstein had a summer home in Saranac Lake, renting the cottage of local architect William L. Distin; he could often be seen sailing with his wife on Lake Flower. He summered frequently at Knollwood Club on Lower Saranac Lake during World War II, and it was there on August 6, 1945 that he heard on the radio that that atom bomb had been dropped on Hiroshima; he gave his first interview after the event at Knollwood, on August 11.
In 1954, Saranac Lake hosted the world premiere of the Biblical epic film The Silver Chalice, Paul Newman’s film debut. Several of the stars, including Virginia Mayo, visited the village and participated in the winter carnival parade.
In recent years,[when?] Saranac Lake has become a more conventional tourist destination. New York’s governor, Andrew Cuomo, has visited there ever since he was a teenager and regularly vacations there with his family. The Hotel Saranac is a memorable early 20th century Art Deco structure. The former sanatorium is now the corporate call center for the American Management Association.