688 IRELAND.

Louis Hospital. Their report to the Societe Nationalede Chirurgie is a strong plea for wholesale, systematic,active immunisation with the Pasteur Institute’sanatoxin in the place of random passive immunisa-tion with serum, 650,000 ampoules of which wereissued by the Pasteur Institute in 1934. To stressthe comparative futility of serum treatment, theCommission note that in more than 70 per cent. ofthe cases of tetanus observed the infection wascarried through some trifling injury such as a pin-prick or a superficial scratch, and in more than6 per cent. the site of entry of the germ was notdemonstrable. Tetanus serum is apt to be given toolate, but whatever may be decided about the routineuse of a vaccine, serum will still have a limited fieldof action, notably in those cases in which the subjectof severe infected injuries has not already beenvaccinated against tetanus, and is in need of passiveimmunisation at once. In such cases the Com-mission recommend a subcutaneous injection oftetanus anatoxin in the scapular region followedabout a quarter of an hour later by a subcutaneousinjection of serum in the abdomen or thigh ; muchimportance is attached to these two injections beingin different parts of the body. The Commission arein favour of combining tetanus vaccination with thetyphoid and paratyphoid vaccination already com-pulsory in the army. For children, tetanus and

diphtheria vaccination could be combined. TheCommission are in favour of repeating such vaccina-tion every year or two, in spite of the fact that,according to Ramon and Zoeller, the immunityconferred by tetanus vaccination is still demonstrablefive years later.

A SANATORIUM FOR FRENCH STUDENTS

Some ten years ago the late Prof. Leon Bernarddeclared that French tuberculous students shouldhave a sanatorium of their own. This suggestionbore fruit when a sanatorium, differing in manyrespects from the typical private or public institution,was built at St. Hilaire-du-Touvet, overlooking awide - expanse of characteristic French scenery.Though this sanatorium began to receive patientstwo years ago, it was not till this summer that itwas officially opened by M. Herriot. On thisoccasion Dr. Rist drew attention to the revolutionarychanges which have come over the regime prescribedfor the tuberculous since the days, still in the memoryof the present generation, when the physician in

charge ambled round from one patient to another,preaching the gospel of the simple life and keepingup his patients’ morale. The part he played was soeasy that he could manage some 150 patients unaided.In the sanatorium of to-day, the deck chair has beenrelegated to a position of minor importance, andtreatment has become highly technical, active, andoperative, with collapse therapy requiring greatmanipulative dexterity and the aid of many ancillaryservices, not least those of the radiologist. Thesanatorium has also become a centre of scientificresearch and of teaching-functions which requireteam-work in a large institution. The small, isolatedbuilding is, or should be, as dead as your Queen Anne.

LABORATORY ASSISTANTS

In a recent number of Concours Médical Dr. G.Lavalée takes exception to the growing custom ofemploying untrained young women as laboratory assis-tants. He would find a place here for the poor medicalstudent who at present earns money by hawkingpatent medicines or even ushering cinema patronsinto their seats in the intervals between lectures and

examinations. Dr. Lavalee holds that where importantverdicts depend on the accuracy, conscientiousness,and judgment of such assistants, the scientific staffof the laboratory has no right to cover unskilledlabour. This staff would doubtless have an answerready-that supervision is vigilant, that proceduresare checked at all stages, and that the interpretationof a result by a medical student working in his sparetime is no more likely to be accurate than one bya permanent member of a laboratory staff, howeversuperficial is her knowledge of pathology. Dr.Lavalee’s plea for the employment of needy medicalstudents in laboratories may impress their directors,but surely not to the point of dismissing a singlecompetent employee.

IRELAND

(FROM OUR OWN CORRESPONDENT)

THE TASK OF THE HOSPITALS COMMISSION

A REPORT of the Irish Hospitals Commission waspresented to the Minister for Local Government andPublic Health early in the summer, but up to thepresent no information has been given as to itscontents. The secretary of the commission has,however, addressed a letter to certain local authoritiesin which a little light is thrown on the present positionof the commission’s labours. He states that, inaccordance with the Public Hospitals Act, 1933,a survey of hospital facilities in the Irish Free Stateis being made. The survey has been completedas regards voluntary hospitals, and much valuableinformation has been acquired. As no survey ofhospital facilities would be complete without theinclusion of hospitals, infirmaries, and sanatoriumsunder the control of local authorities, the upkeep ofwhich was provided mainly out of rates, a questionnaireis being issued, asking the average number of patients,number of beds, numbers admitted and dischargedduring the year, average cost, and other matters.The questionnaire has been designed to elicit informa-tion regarding all types of hospitals and institutionsunder the control of local authorities, which providefacilities for housing and treating the sick.

THE LATE DR. J. T. ELLIOTT

The death is announced of Dr. John TrimbleElliott, of Smithborough, the doyen of the medicalprofession of County Monaghan and one of the mostrespected of country practitioners in Ireland. Dr.Elliott qualified 64 years ago and has spent nearly allhis professional life as dispensary medical officer ofSmithborough. A modest and unassuming man,he had a fund of shrewd common sense which madehis services much sought after on both professionaland lay committees. He took an active part inmedical organisation and was for many years a

member of the council of the Irish Medical Associa-tion and honorary secretary for his county. Hewas also a strong supporter of the Royal MedicalBenevolent Fund.

LLANELLY HOSPITAL.-The total income for thishospital last year was £11,809, the highest figure yetreached, and the patients admitted numbered 3809, anincrease of 555 over the previous year. Expenditureamounted to £10,657, so that the excess of income overexpenditure was nominally £1152, but actually after

allowing for depreciation only E684. A new nurses’home is being built and, apart from equipment, will costover £11,000.