at St. Thomas's, I constantly meet with patients in the early stages of melancholia and other forms of mental disorder, many of them requiring the rest, feeding and removal from home worries and supervision which patients of the classes socially higher can obtain in mental hospitals or private homes. There is at present no provision for the admission of voluntary boarders to county asylums, and yet there are many poor patients who would be suitably treated in that way.

Fortunately, one sees a good many improve even when treated as out-patients, but very often one would like to be able to admit the patient for a month or six weeks to a properly equipped ward for borderland cases.

With regard to the question of the provision of wards in general hospitals for mental cases, it should always be remembered that formerly there were wards for mental cases at Guy's Hospital in its earlier days, but admission to them was not confined merely to borderland or early cases or for the purpose of thorough examination in any special case; many of the cases were chronically insane, and the wards were closed after the passing of the first Lunacy Act in 1845. The question has been re-opened in recent years partly because of the overcrowding of our county asylums, and partly because it is recognized that there are many cases which, when first seen are merely "borderland" cases, and cannot be called insane or lunatics, and to whom it is desirable on all grounds to give an opportunity of recovery before they become so thoroughly broken down as to require asylum care. At present the General Hospitals reject them, and in fact they have not the proper accommodation, nor the proper nursing staff for them, and it is only in the last few years that, thanks to my predecessor Dr. Rayner, the Governors of St. Thomas's decided to give such patients at least the opportunity for examination and the possibility of out-patient treatment, although they could not provide special wards for treatment if the cases were such as needed admission. Following Dr. Rayner's example, I was able to convince the governing body of Charing Cross Hospital of the desirability of starting an out-patient department there, and I have no hesitation in saying that such departments in connection with general hospitals are of the greatest possible use, not only to the patients and their friends who have the opportunity thus of obtaining a special opinion which they otherwise could not afford to obtain, and who, if the patient is not fit for out-patient treatment, can at once be put in the way of other care, but also to the students, who have the opportunity of seeing, no doubt, many very ordinary cases, but often very interesting ones, and most important of all, of recognizing such cases in the early stages.

As the General Hospitals refuse to mental cases the hospitality of their wards, it may be asked where do they have to go? At present they either have to go to the workhouse infirmary, to which as a rule they have the strongest objection, and to gain an entrance to which the services of the relieving officer have to be obtained, or else they have to drift on, often gradually getting worse, until they are bad enough to he sent to the County Asylum.

As detention in the workhouse infirmary can only last for about 17 days, sometimes it happens that the patient rapidly improves but has not fully recovered, is sent out and promptly relapses and has to be re-admitted, whereas six weeks or so at first might have effected a recovery.

Nevertheless there are many patients even under such unfavourable conditions who recover and would do the same with less discomfort to themselves and without the feeling of having been under the Poor Law, if there were special wards for their treatment in connection with general hospitals.

A great experiment is being made in this direction in the City of Glasgow by Dr. Carswell, where it has been found that a large proportion of the early cases presenting mental symptoms do not require asylum care, but can be treated successfully in a mental hospital. The Lunacy Law being far simpler and less exacting in Scotland than in England, the cases are not placed under any form of certificate but the limit of residence is fixed at six weeks, at the end of which time the patient is either sent back to his friends or discharged recovered, or else dealt with under the Lunacy Act.

The cases admitted are just the type of cases requiring medical and bed treatment and not those requiring or fit for such work as agriculture which are of course properly sent to the Asylum.

The important fact which I wish you to note is that this Glasgow mental hospital is really part of a general hospital for ordinary cases and is a separate pavilion.

During the year ending May 15th, 1905, 502 cases were admitted into this hospital and of these 308 or 61-4 per cent. were discharged recovered or relieved, 134 were sent to asylums and 30 died.

The hospital has 50 beds, 25 male and 25 female, about the capacity of two of our wards at St. Thomas's, with an adequate staff of mentally trained male and female nurses.

In every General Hospital there occur from time to time cases of mental disorder intercurrent in the course of other diseases, and in many of these cases the disorder is transient or temporary, and could still be treated in the hospital if, for the time being, the patient could be transferred to a properly constructed ward where many of the facilities for suicide, which bristle in an ordinary hospital ward, would be absent, and in which the permanent nursing staff (sisters

and staff nurses, and male attendants) should have at least 3 years training in asylum work, in addition to ordinary and medical and surgical training.

It seems rather a reproach that many such cases should have to be sent out to the care of the workhouse infirmary whereby they may at once lose the benefit of the special surgical and medical treatment they may have been undergoing, and should not have at least the opportunity of a few weeks care in a mental ward in the same hospital.

At present, however, the risks of treating mental patients in general wards are too great, partly from the construction of the wards themselves and partly because the nursing staff is totally unfamiliar with the course of mental diseases, and, therefore, likely to be unduly alarmed on the one hand where there is no real anxiety, or over confident on the other where there is need for special vigilance. I am well aware that with the demand for beds for surgical, medical and special departments there is little likelihood that beds will be spared in General Hospitals for mental cases, but I have thought it well to mention the movement which is going on elsewhere in this country.

The London County Council has proposed the erection of reception houses or hospitals for such cases and for other cases of a temporary nature which now go for a short time to county asylums, but if such institutions are founded they should be staffed by those already familiar with the treatment of mental diseases. Patients of the educated classes whose insanity is acute and curable are already provided for in such charitable institutions as Bethlem Hospital and other Hospitals for the Insane, but there is an opportunity for some benevolent individual to found a similar charitable institution for the acute and curable insane of the poorer classes the individuals of which would then often avoid becoming "pauper" or "rate-paid " patients in county asylums and thus ease the ever increasing burden on the rate payer.

I have endeavoured to bring shortly before you some of the points which are constantly brought to one's notice in dealing with mental disorders in private and hospital practice and have to thank the members for so patiently listening to these few remarks.

How to Keep Cigars.

(WITH PROFOUND OBEISANCES TO "THE WORLD AND HIS WIFE."

CARE

YARE should be taken, in the first instance, to buy cigars in proper condition and of the right shape, for no amount of subsequent treatment will improve those that were faulty in the beginning whichever end you smoke first.

Some men have a special chamber fitted up in their house for storing cigars. A room, which never undergoes any extremes of temperature and preferably containing a reliable safe, will do very well. But avoid an apartment where food is kept. Tobacco leaves, like other vegetable matter (with the possible exceptions of vegetable ivory and sauerkraut) have the provoking habit of assimilating any odours with which they are brought into contact. Such things as fried fish, pickled onions, toasted cheese, burnt feathers or iodoform should be kept in a separate part of the house and never allowed to touch one's cigars. A case occurred in the writer's own home where a shilling packet of After Dinner Whiffs lay for a week or two in a box containing a dead canary. Every one of those cigars tasted, smelt and looked like dead canary, with the exception of one, which seemed to favour rabbit. The more delicate aroma of the tobacco was almost lost, and one thus sees how erroneous it is to purchase a supply of smokes in the autumn and salt them down for winter use.

Although the paper envelope in which the cigars have been bought answers very well as a receptacle, a cigar-box, which can be had in any size, and over which one can be had at any price, is better. These are constructed to shut tightly and are made of cedar wood-a very fragrant material. The exterior being covered by tastefully designed pictures of tropical scenery, and often giving one a glimpse of savage life, the box forms a pleasing adjunct to the ornamentation of any room.

Great care should be observed in handling or handing round. A practice indulged in by many a smoker is that of holding a cigar to the ear and "cracking" it to see how it is getting on. The moment this has been done the cigar is spoiled. The outer covering of leaf has been cracked by the supposed test and the aroma escapes at once like gas from a faulty pipe. For this reason cigars should never be allowed to roll about loose in a drawer, lie on the floor or play with the children.

The position of the cigar-box in the room is worth a little thought. If inclined to be too hot, remember that warm air rises to the upper part of a room, and the cigars placed there will become too dry, besides necessitating the use of a ladder when

showing them to friends, whilst a position on the floor exposes them to chilling draughts and careless feet. Again, a situation too near the door is apt to attract the attention of departing visitors who have already outstayed their welcome.

Watch your cigars carefully if you are keeping them for any length of time-it may even be necessary in some neighbourhoods to sit up all night with them, unless they are well known. If any change occurs in the colour or appearance they are becoming damp and should be passed lightly through the mangle, carefully dried in the oven and kept in a stoppered bottle. Too dry an atmosphere, on the other hand, will crack the precious outer, and often only smokeable, leaf of the cigar. The ends should then be snipped off and a little dilute glycerine syringed through. An old newspaper will protect your clothes.

Finally, should you have selected the right kind of cigar-a good tough hardy annual-you will have no anxiety about keeping them. They will always be left on your hands-or at the gate.

The Club Smoking Concert.

Friday, May 25th.

BUSINESS-LIKE and important were the preparations which had been taking place in the club dining room for days past. Extensive scaffolding, rivalling County Council improvements, had gradually evolved itself into a stage under the leisurely but noisy hammering of stalwart carpenters. Protracted sawing of wood was heard and even the most gifted genius could hardly have failed to observe that something out of the way must be going to happen. The neoplasm of a day or two assumed enormous proportions with an almost malignant rapidity and structures of normal function, such as tables and chairs quickly suffered from pressure symptoms. The congestion, though general, was perhaps most typically observed among the waiting staff, who, handicapped by the general reduction of space, skipped, hopped, gyrated, rushed or strolled, according to their habits and abilities, and triumphing over all obstacles, soothed our frenzied brains with assurances that all was "qui' right, sir," and fed our insatiable appetites with buns.

"Are you going to the Smoker?" reechoed from wall to wall, and "Yes, if I can afford it," was the invariable reply.