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whole of his time to his" official duties." The combined 1

appointments are as follows : Medical officer to the union iworkhouse, f:35 ; medical officer to the union district No. 7,E30 ; probable fees, .610 ; medical officer to the union

cottage homes, E5 ; medical officer to the rural district,.6270; and medical officer to the urban district, <S70. Wehear on good authority that the expense of conveyance,drugs, &c., will fall on the holder of this appointment.The local medical men have protested against the injustice

of including in the office of medical officer of health theduties which are performed by other medical men residentin the district, and were supported by at least two of themembers who saw the danger of some of the work beingneglected. Our main purpose, however, in writing thisletter is to point out to the profession the grave danger theywould be placed in by the creation of a medical bureaucracy,especially an inadequately paid one. These officials will beunder the control, either directly or indirectly, of the Govern-ment. A sufficient number of them will in time become asort of Government medical reserve to be employed underthe Insurance and other Acts on terms which the more

independent practitioner would refuse, a position which wetrust no medical man will accept.The case illustrates the points which were urged by many

speakers at the Joint Medical Officers Associations’ dinner,and shows the urgent necessity of all medical men who holdofficial appointments joining their respective associations, sothat some joint action may be authoritatively taken in viewof the increasing number of local bodies who are seeking tomake these ominous appointments on the spurious ground ofso-called economy.-We are, Sir. yours faithfully,

RASHELL DAVISON,Chairman of Council, Association of Medical Officers of Health.

D. A. BELILIOS,Honorary Secretary, Association of Medical Officers of Health.

KING EDWARD’S HOSPITAL FUND ANDTHE EVELINA HOSPITAL.

To the Editor of THE LANCET.SIR,-I am gratified to notice that in THE LANCET of

Jan. 27th (p. 242) you have been good enough to call atten-tion to the difference of opinion between the King’s Fundand the authorities of this hospital, and take this opportunityof thanking you for so doing.Your article is, however, not quite accurate in one respect,

and I shall be extremely obliged if, in justice to my com-mittee, you will point out that, although the King’s Fundinsisted on an inquiry officer being appointed, their distribu-tion committee have given absolutely nothing to meet theoutlay incurred by having that official and establishing herdepartment on a proper basis, the total cost of which, asstated in my letter to the TMMS, is over .E200 a year.My committee feel that the King’s Fund have acted with

some want of consideration for the hospital throughout thewhole of this business, as the grant of .6150 made at the endof 1910 was the amount usually allotted to this institutionbefore the appointment of an inquiry officer was required.When my committee complied with the request that aninquiry officer be appointed, it was quite expected that theKing’s Fund would meet certainly a considerable proportionof the cost, in addition to the usual grant.

I am, Sir, yours faithfully, D. MALCOLM SCOTT,

Chairman of the Committee of Management.

THE ACETONE-WRIGHT METHOD OFLEUCOCYTE COUNTING.

To the Editor of THE LANCET.SIR,&mdash;Not long ago I sent to THE LANCET an account of

a method of absolute and differential white cell counting in z,one operation. Further experience of this method enablesme to add the following remarks.

1. It is better to use a 1 c.c. pipette graduated in 1/100thsfor measuring the various constituents instead of a graduatedcylindrical vessel. With a pipette the proportions of acetoneand water should be 2 to 13 instead of 3 to 12. I attribute

1 THE LANCET, Jan. 6th, 1912, p. 20.

this difference to the different shapes of water and acetonesurfaces in narrow cylinders.

2. For convenience the acetone and water may be kept as astock solution of 13 per cent. acetone to which 20-25 per cent.of Wright’s stain (diluted four-fifths with methyl alcohol) isadded just before use. The optimum quantity varies with theblood, the dilution, and the time elapsing before counting it.The results seem to be not quite so good as those given byfreshly prepared solutions.

3. Much the best, simplest, and cheapest method is to mixthe Wright’s stain and acetone in a stock solution. Themixture is made thus. Grind up one soloid of Wright’sstain in a glass mortar with successive quantities of methylalcohol ; pour each quantity into a glass measure, allowinga little while for sedimentation in the mortar. When 10 c.c.are in the measure again allow a little while for sedimeqa-tion, and then pour it into a tall, narrow, one-ounce bottleand cork it well. Then treat the residue in the mortar in

exactly the same way with acetone till 10 c. c. are made up.Add this to the stain in the bottle, and then add direct 5 c. c.of methyl alcohol. There should be no precipitate, and thisapparently keeps indefinitely if well corked.

This preparation may be used both for counting with ahaemocytometer and for staining films. With the hsemocyto-meter it is used as follows : Measure 0 - 3 c c. of distilled waterand 0 - 1 c. c. of this mixture into a small cylindrical vessel ofsuch a size as to let a 1 in 10 pipette reach to the bottom.Cork at once and shake well. Using a 1 in 10 pipette, dilutethe blood 1 in 10 or 1 in 20. Draw up the fluid quickly tillthe bulb is nearly full, then hold pipette and cylinderhorizontally and fill to the mark. Thus it is possible to makean absolutely exact dilution quite easily. Still holding thepipette horizontal, remove the cylinder, and cover first thepoint and then the other end of the pipette with thumb andfinger and shake thoroughly, still holding it horizontal. The

cover-glass should be put on the drop as quickly as possible.The method has, of course, all the disadvantages of the1 in 10 pipette methods, but if the rules be adhered to, tobase an absolute count on not less than 100 cells anda differential on 300 cells, absolute accuracy, as checked

by films and Toisson’s method, may be obtained inone-tenth of the time. If the cover-glass is put on smartlythe distribution of the cells is quite even, but it is

perhaps safer to visit equally all quadrants of the disc.I usually follow along the square which is contained by thedisc in making a differential count, and count three of thelarge squares in a Thoma-Zappert slide for the absolutecount. For rough estimation the small-squared area in twodrops will give approximate results, both absolute anddifferential. In ordinary blood this area in each drop willcontain 40 cells if 1 in 20 dilution is used. (The quantity ofstain suggested is usually enough to fill a 1 in 10 counter andleave a little. For a 1 in 100 counter 0’8 8 to 1 - 0 c.c. mustbe made up.)

This " Peking modification " stains films quickly and well,but the usual method must be altered. Cover the film withstain for 20 or 30 seconds, then add an equal quantity ofdistilled water and mix well. Leave this for one minute,then pour it off, but do not wash it off. Dry the film over aflame, and then wash in distilled water ; one dash of water

, from a test-tube is enough. The stain is very clear, the

.

blue is a royal blue. The process takes two to twoand a halfl minutes only and is very economical. Since acetone isadded it seems unnecessary to use the very costly acetone-free methyl alcohol, but ordinary methyl alcohol may,perhaps, contain other undesirable impurities. I have noexperience of this, nor do I know whether the malarialparasite can be stained in this way, but I see no reason todoubt it.The further problem of combining red, white, and differ-

ential counts in one operation has been solved by Schiiffner.2His formulas as reported in the Medical Offleer Supplement

E are :&mdash;Solution A : Sodium chloride, 4 grammes ; phenol,1

3 grammes ; borax, 0’1 gramme ; formalin, 1 c. c. ; and dis-g

tilled water to 1 litre. Solution B: Methylene blue,1 gramme; potass. hydrate, 0.1 gramme; and distilled water

s to 100 c.c. For use add two drops of B to 10 c.c. of A.I It is certainly possible with this stain to make an abso-e lutely accurate white and differential count 12 minutes aftere taking the blood ; the staining does not show clearly sooner.

2 Munchener Medizinische Wochenschrift, 1911, p. 1495.