The three main missions of the hospital are admitting patients, cooperation of physicians, ancilliary facilities for examination and therapy, up to recent the 3rd has been almost impossible to furnish satisfactorily.
At medical facilities, either private clinics or governmental hospitals, in Japan every medical treatment as well as medical supply has been performed at the responsibility and the expense of the physician concerned.
Thus the hospital did not devalop as the common property of doctors.
However, the attempt to establish a central laboratory of clinical pathology is, as it were, great progress for the physician engaging in the laboratory.
To accomplish this laboratory a director of the hospital has to play the biggest role to arrange necessary personnel and to furnish enough equipment.

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Based upon the material prepared by a Unit Study of the Department of the Central Laboratory at the National Hospital of the Welfare Ministry, a plan for a standard Central Laboratory was studied.
For 7 years from 1954 to 1960 the Unit engaged in the following studies;
1. Present status of the Central Laboratory at the national hospitals throughout the country.
2. Types and number of examinations performed at the Central Laboratories.
a. Total number of monthly examinations, number of examinations in proportion to patient beds, and types and numbers of examinations for a year.
b. Percentage of examinations for the types.
3. Investgation of the relationship between the medical treatment and the laboratory examination.
4. Personnel of the Central Laboratory and their work load.
5. Standards of the Central Laboratory from the standpoint of establishment.
6. Examining apparatus of the Central Laboratory.
Using these figures as a basis, we decided upon; a, types of the examination, b, number of the examination, c, standards of the establishment, d, number of the personnel working in the Central Laboratory; such as physicians and technicians, e, examining apparatus needed at the Central Laboratory, f, the organization of the Central Laboratory.
One of the most essential factors in the planning of the Central Laboratory was how to estimate types and numbers of examinations. For this purpose, on about 1, 500 inpatients both at the internal-medical and at the surgical departments during their admission periods, the performed laboratorial examinations were throughly investigated.
Studying carefully the data we selected about 5o types of examination which had been most frequently performed and simultanneously we estimated the number of the examinations.
In order to decided the types and numbers of the examination to be given at the standard Central Laboratory the above mentioned 50 examinations were studied again. It was revealed that at a hospital a patient required between 60 and 75 laboratory examinations in one month.
The standard workload of the laboratory technicians was also decided upon considering their average number of examinations per hour and their average wage per hour.
Judging from the above obtained data, it is concluded that the present status of the Central Laboratory at the National Hospital in Japan is far inferior to our Central Laboratory standards.
It is therefore, desirable that for the purpose of raising the level of the national medical standard, the Central Laboratory be consolidated as soon as possible.

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Regarding improvement of efficiency and rationalzation of the bacteriological laboratory at the National Hospital, investigations were made on a) man power, b) media, c) number and variety of performed examinations and d) equipment. Furthermore, studies were made of the relationship of the above mentioned subjects to the virus-and serological-examinations.
We notice that our present circumstances in this matter necessitates having larger installations and more specific classification of the offices. Simultaneously, we have to make every efforts to increase the efficiency and the rationalization of the bacteriological laboratory, particularly in the field of it's routine works and the organizational function.

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At our hospital for the past three years gradually new test procedures have been used in the chemical laboratory. The gists of the procedures are as follows: -1) simplify the tests, 2) give screening test with largest possible number, 3) then perform the group of laboratory tests which were already scheduled.
1. Simplification of Tests:
Some of our daily laboratory tests are simplified as follows.
a. Various kinds of urine qualitative test i. e. reaction, protein, glucose, urobilinogen, aceton and bilirubin are qualitatively examined by spot test method.
b. Urea-determination by Xanthydrol method.
c. Determination of albumin-globulin ratio by Lugol's solution.
d. Determination of amylase or alkaline phosphatase with “Amylase or Phosphatase Tubes.”
Using above described methods, which are semi-quantitative, we are able to differentiate first the value of the subject whether it is within normal limits or not. Then selecting only the subject with abnormal value we perform orthodox quantitative tests. By doing this simplified procedure the efficiency of our daily various: kinds of tests are greatly increased. Consequently we are able to engage in the tests on a bigger scale with limited personnel.
2. Screening Test of Chemical Consutituens of Blood:
In-patients of our hospital are given seven kinds of simplified hematochemical tests: -hemoglobin, hematocrit, total protein, blood sugar, A/G ratio, icteric index and urea nitrogen. As a general hospital these tests are basically essential for the physician concerned to aid in determining diagnosis. These results are described graphically according to prof. Shibata's “blood spectum” so that these are convenient to the clinician to read.
In the past three years about 4, 000 examinations were made and in half cases of them we collected the results using punch cards.
This screening test benefited us much because on 337 cases (17%) out of 2, 000, each test played a big role such as suggesting or confirmating us the diagnosis, or finding complications.
3. Combination and Order of the test.
Depending upon the purpose of the test, we arranged the order and combination of the tests needed. Initially a primar group of the tests are made, and thereafter these are turned to a second group of tests.
a. Urine quantitative test: These tests are divided into two groups; ordinary and special tests. The ordinary urine tests are consist of specific gravity, reaction, glucose, protein, urobilinogen and the tests are given to each patient at the every clinical department at the time of admission. While the special urine tests consist of sediment, aceton, bilirubin, indican, etc. With the symptoms of the patient, necessary tests are selected.
b. Liver function tests: These tests are divided into three groups. Croup A is to confirm icterus and it consists of icteric index and differential quantitative analysis of bilirubin. Group B is to test excretory function of liver and it consists of BSP; alkaline phosphatase, total cholesterol. Group C is to examine parenchyma) damage of liver and it consists of CCF, choline esterase, A/G ratio, prothrombin time, hippuric acid test, and SCOT. The order of the examination is decided and is described on the test card according to whether the patient has jaundice or not.
c. Kidney function tests: Eight kinds of tests are divided into three groups. Group A is to find the disease in the early stage or to judge the complete recovery, and it consists of qualitative and quantitative-examinations of protein, sediment, and Fishberg's test. Group B is to determine the grade of kidney damage and it consists of PSP and urea clearance tests. Group C is to determine the existence of kidney compensation and it consists of non protein nitrogen, urea nitrogen and creatinine determinations.
d.

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In recent years various kinds of clinical biochemical analyses are used at the laboratories of meny hospitals, However, in order to accomplish the mission to perform analytical services or analyses on obtained specimens, we have difficulty due to shortage of qualified medical technicians.
And for the purpose of improving efficiency of the clinical laboratories we feel that they should be equipped with the automatically operating machines.
For this reason an Auto-Analyzer was about three months ago installed in our hospital laboratory. We have already started using this machine to analyse blood glucose and blood urea nitrogen, and in the near future this machine will also be used for cholesterol determination.
Since the Auto-Analyzer is capable of analyzing various kinds of specimens, we have to make every efforts to collect more and more specimens.
At present we are obtaining them from three other national hospitals; 2nd Tokyo, Setagaya and Ohkura Hospitals.

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The Ministry of Health and Welfare Japan has delegated me to observe about sixty clinico-pathological laboratories in the U.S.A. and Europe. The U.S.A. and England, in their hospitals, have large numbers of completely centralized clinico-pathological departments on a big scale which are convenient to offer good services for patients and are capable of supplying laboratory data with accuracy and speed. And they are equippt to train the residents in pathology and the laboratory technicians.
These laboratories are devided into subsections and these laboratories have schools for the technicians.
In most of the laboratory centers there are large numbers of pathologists, technicians, and clerical workers such as secretary, typist, etc. The laboratory centers are performing, far more various kind of fine and difficult examinations than the Japanese hospitals. For example, the number and the ratio of autopsy are remarkably larger and higher than those in Japan.
Regarding the establishment and the equipment, the room temperature and humidity are comfortablly controlled and each room has enough test machines and papers working and describing recorded automatically.
Almost all hospitals have their own exhibition rooms for pathology or medical museum enabling the hospital trainees to get necessary instructions.
Summary:
1. In order to offer better services for the patients, the Japanese hospitals will have to build similarly centralized system of the clinicopathological laboratories sponsored by large numbers of the pathologists and technicians equipped with better apparatus such as they are in the U.S.A. and England.
2. It is believed that one of the best procedure to rate the hospitals in the U.S.A. and Europe is to observe the laboratory activity and the autopsy ratio of each hospital.
3. It is also deemed necessary that in order to raise the qualiy of hospital activity, Japan will have to establish more ratinalized policy on the training and the board examinations for the clinical pathologists.

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After the World War II in Japan clinical laboratories have been centralized in most of the hospitals, and at present it is our problem of common sense to solve that each hospital must have it's centralized laboratory.
Regarding administration of the central laboratory, however, there are quite number of unsolved problems of which the following points are particularity discussed and interested in by me. They are:
1. The scope and variety of the clinical examinations to be carried on at the central laboratory as it's routine work.
2. The necessity to divide a central laboratory into several subsections.
3. A system to train clinical pathologists.

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The Laboratory activity at tuberculosis sanatoria has been comparatively simple, since the main mission of the institute was the investigation of tubercle bacillus. However, with the progress and the wide spread use of chemotherapy and surgical therapy of tuberculosis, the business of the laboratory is gradually becoming complicated. Consequently it is necessary to establish a modern and an adequate system to accomplish the mission.
1. When an establishment lacks equipment, then a joint cooperation with the neighbouring establishments will be required to perform special examinations.
2. The author finds in fact that even a slight deviation from 37.0°C of an incubator temperature will give undesirable effect on the result of drug sensitivity tests. And the author finds that many incubators in our daily use do not keep constant temperature, particularly, in the winter.
3. Since there are several cases in which the laboratory technicians were infected by resistant tubercle bacillus, careful considerations have to be made on the problem of laboratory infection.
4. To be a good laboratory technician, one has to be not only competent for the job, but also one has to be a trustworthy person. From this viewpoint the author realizes that there are well qualified personnel among the TB convalescents.
5. There are some special reasons that the TB convalescents seem to be suitable for this occupation. It is fairly difficult for them to get other jobs with adequate pay, Individuals who have experienced the difficulties of tuberculoses convalescences usually have a sincere desire to do outstanding job in any endeavor.

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The author explained the present situation on the training and the education of the clinical laboratory technicians in Japan, and he added his opinion how the method of the training shuold be improved in the near future.

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For the progress of medical science methods of medical examination have also to become finer and more correct. For this reason various kinds of the medical examinations being performed at each hospital should be centralized. And the centralized system will increase the speed of routine work of the hospital.
1. We are aware of the fact that having the assistance of the Ministry of Health and Welfare Japan almost all the national hospitals are at present in process of completing their officies of the medical laboratory. Simultaneously we feel it necessary that in addition to the arrangement of the modern laboratory equipment, a careful schedule has to be made for laboratory technicians particularly on a) number of personnel to be assigned, b) their positions describing duty, responsibility, wage, etc.
2. Whether we desire it or not, we believe that the medical laboratory of our hospitals are in the position of teaching centers. Not only to perform many kinds of examinations on specimens collected from other hospitals, but also we, as our proper duties, have to train the young students or technicians.
3. Although it is hard for us to become a perfectly qualified laboratory staff in a short period of time, we have to continue our daily study and reseach works to supply satisfactory services for the patients of the hospital.

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