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from 130 to 150 bodies were going through the process ofbuilding, painting, and finishing at the time of my visit. TheStar cars are made in seven different sizes ; some, however,would not appeal to the medical man for professional use.Those that seemed to me as suitable for medical men are madein four sizes and are, I should certainly say, within the reachof the resources of all classes of practitioners. The 8-h.p. and10-h.p. cars will appeal to the man of moderate means,some of the designs in the body work being most suitable.A very handsome Victoria body, known as the Doctor’sVictoria," is fitted with a leather hood, a folding glassscreen, and side doors, and can very well be termed anI I all-weather " car. This body can be fitted to the 8, 10, 12,or 15-h.p. cars. A cheaper type of two-seated body on the8-h.p. and 10-h.p. cars makes a very handsome run-aboutcar for a medical man. These can also be fitted with ahood and screen. The 12 and 15-h.p. cars are more luxuriousmodes of conveyance, taking the shape of broughams orlandaulettes, and are suitable for anyone wishing for a closedcarriage and employing a chauffeur. Another form of closedconveyance is supplied in the 10, 12, or 15-h.p. cars in theway of landaulette or brougham type of body usuallyknown under the term of I I coup6. " This is made for the

purpose of being an entirely closed carriage and is designedto carry two passengers and is driven from the inside.The 12-h.p. seemed to me an ideal car for a medical man,

though the 15-h.p. has the advantage of four speeds insteadof three, and though it is not of course essential to have fourspeeds, still in hilly districts it is much more pleasant, asmany hills cannot be taken on the top speed but do not needthe big drop that there is on three speeders between the topand second speeds, and it is then that the advantage of the

. third speed of a four-speeded car comes in, and this I

especially noticed when taking a run with Mr. Lisle, jun.,in a 15-h.p. Star. It was late when I had seen all over theworks and we started to inspect that quaint town on theSevern, Bridgnorth, so famous for its castle and the

picturesque Hermitage Hill. Firstly through Wolverhamptonitself, and I thus could see how delightfully easy the car wasto drive in traffic, picking up from a crawl on the direct speedin a remarkable way. The engine even for these times ofsilent machines is noticeably quiet and the carburettorshowed how well it was adapted to give correct mixtures atall speeds, even when the throttle was suddenly opened afterbeing nearly shut down in an unpleasant bit of traffic. Assoon as the country was reached, so as to find out for myselfhow the engine pulled, I took over the wheel and found thecar both simple and easy to drive. The leather-faced coneclutch took hold with delightful smoothness and the gatechange speed, though I was not used to this type, workedeasily and silently, so much so that I kept at the wheel bothup and down a nasty curving hill which the car mountedeasily on the third speed, and subsequently the car

negotiated a gradient of about 1 in 8 without difficulty onthe second, while the speed on the flat seemed more thanample. The antiquities of Bridgnorth rather delayed me andI had a train to catch at Wolverhampton and thus I had anexperience of what the car could do when speed was needed.The car certainly seems suited for medical work, and what ismore is good value for the price asked for it. It runs

smoothly, and the Salop roads are an excellent test forsmooth running; it is quite fast on the level and a good hillclimber. The only trivial points that personally I shouldwish altered if I was buying one are that separate plugsshould be fitted for each ignition system, and that meansshould be obtained to increase the tension of the clutch spring,which could easily be done by screwing the shaft and fixinga nut in front of the spring. This latter I understand is not

really needed, only as I was once on a car in which theclutch did slip at an awkward moment through a weakclutch spring, I suppose I am rather a fidget on this trivialpoint. The manufacturers, I think it only right to say, havesucceeded in certainly putting on the market a car wellsuited to the requirements of the profession, and one whichwill do most of its work on the direct speed. I should alsomention that the brakes are very powerful, and that I foundeither set to hold the car in both directions on a really stiffhill.

AN EYE HOSPITAL FOR ABYSSINIA. - Dr.Steinkiihler of Zittau has arranged to travel to Abyssinia forthe purpose of establishing an ophthalmological clinic.

SEVENTIETH ANNUAL REPORT OF THEREGISTRAR-GENERAL.

I.

WE return to the consideration of the main points in thisreport, the recent issue of which we noticed on Feb. 6th ina leading article.

Particular reference is made in the report to thecontinued decline in the marriage rate and the consequentfalling-off in the productivity of the English population.Whilst fully appreciating the importance of these

changes as affecting the future welfare of our countrySir William Dunbar is evidently no pessimist. As becomesthe official entrusted with the custody of the national

registers, he is careful to set forth in their true proportion thefacts concerning birth and death, for the accurate renderingof which he is responsible. Looking back over the years ofbirth registration we find that the English birth-rate attainedthe highest point in the year 1876, when it amounted to36 3 per 1000 of the population. In order to measure thefall that has since occurred the mean annual rate in thequinquennial period 1876-80 has been adopted as a criterion.Calculated in terms of total population the fall in the birth-rate since that date has exceeded 25 per cent. Based on theproportion of births to women living at reproductive agesthe fall amounted to 31 per cent., while the fertility ofmarried women computed on the ratio of legitimate births towives of conceptive ages showed a decrease of 27 per cent.In other words, if the fertility of married women had beenthe same in 1876-80 and in 1907 the legitimate births wouldhave numbered more than 1, 212, 000 in the latter year insteadof only 881,853, the number actually registered. Unfor-tunately, the birth registers are imperfect in this respect,that they contain no information respecting the age ofmothers, consequently they do not afford the means ofascertaining the fertility of women at the several stagesof the child-bearing period. Nevertheless, the Registrar-General estimates that during the past 30 yearsabout 14 per cent. of the fall in the birth-rateis due to decrease in the proportion of married womenin the female population at conceptive ages-i.e., in theinterval between the fifteenth and the forty-fifth year,and that about 7 per cent. is due to the decrease of ille-

gitimacy. With respect to the remaining 79 per cent. ofdecrease, although some of the reduced fertility may dependon the changed age-constitution of married women in theaggregate, there can, in the Registrar-General’s opinion, belittle doubt that much of it is due to deliberate restriction of

child-bearing. The fact is significant that according to thelatest returns the fertility of English wives is lower thanthat of wives in any other European country except France.

Sir William Dunbar gives interesting particulars of the

present position of this country in respect of "natality, ascompared with the several continental and foreign countrieswhich contribute trustworthy returns. From a table in the

report it appears that if the birth-rate of England andWales be taken as a standard there are 12 continentalcountries with rates above, and only three (Belgium, Sweden,and France) with rates below, that standard. The rates wereabove the English standard by from 11 to 13 per 1000 in theBalkan States, by 9’1 per 1000 in Hungary, by 7-5 5 inAustria, by 6’ 1 in Germany, and by 4’ 5 in Italy.Although complete birth returns for the Russian Empireare wanting, it is of interest to note that the birth-rate there in the last five years averaged 20 per 1000in excess of that of our own country. In Scotland,Switzerland, and Belgium the rate was about the same asthat of England, whilst in Ireland it was 4’9 9 below and inFrance not less than 6’ 9 below that of this country. InOntario the defect was equal to 6 ’ 3 per 1000 and in SouthAustralia 3’ 6 per 1000, as compared with the English standard.The recent decline in natality is by no means peculiarto this country, a similar decline having been experiencedin most of the principal countries of Europe, in New Zealand,and in the states of the Australian Commonwealth. If thebirth-rates of the last five years be compared with those of20 years earlier it appears that, with few exceptions, thedecline has been remarkable. While the fall did not exceed

, 2 per cent. in Switzerland, 3 per cent. in Ireland, and 4 percent. in Spain, it reached 14 per cent. in France and in Italy

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and as much as 16 per cent. in Hungary, in Servia, and inEngland and Wales. Among the Australian colonies thefall ranged from 13 per cent. in Western to no less than36 per cent. in Southern Australia.

Closely connected with the decline of the Englishbirth-rate is the important question of the so-called"natural increase of the population," which is fullydiscussed by the Registrar-General. It is obvious thatthe periodical movements of the population are governedby two factors: (1) the balance between births anddeaths, and (2) the balance between emigration and

immigration. In this country, at all events since 1851, thebirths have always exceeded the deaths in number, andthe emigrants have similarly exceeded the immigrants.Between the quinquennial period 1876-80 and that ended in1900 the average rate of increase of population fell from14’ 56 to 11’ 58 per 1000 living. This was due to the declineof the birth-rate having been more rapid than that of thedeath-rate; in the triennium 1901-03 the rate of naturalincrease again began to recover, owing to the relative declineof mortality having exceeded that of natality ; but since thatdate this tendency has not been maintained, the rate ofnatural increase in 1907 having once more fallen and beingonly 11-27 per 1000 living.Very intimate is the relation of the foregoing considera-

tions to the question of mortality, especially among theyounger members of the community: In the course ofthe last four decades of the nineteenth century the death-rate at all ages had fallen by about 15 per cent., but nocorresponding reduction was recorded in the proportionof deaths at ages under one year, the ratio of theseto total births having been very high and practicallyconstant throughout that period. Since the opening of thepresent century, however, English infantile mortality hasshown an appreciable decline. This may in part be due torecently increased attention to the terrible waste of infantlife which still persists in this country. But there is nodoubt that the succession of favourable seasons we haveexperienced since the date mentioned has considerablyinfluenced this result. The fall of infantile mortality in theyear 1907 merits special attention, for this was mainly dueto the unprecedentedly low rate in the summer quarter.

In ordinary circumstances the loss of infant life is heavierin the third quarter than in any other part of the year, and sorecently as 1899 the deaths under one year in the third

quarter averaged more than a fourth part of the infants bornin the same period. In the summer quarter of the year 1907,however, the deaths did not exceed 99 in every 1000 birthsand were fewer than in any other quarter of the year. It is

commonly understood that hot and dry seasons are excep-tionally destructive to child life ; but there have been severalcooler and wetter summers than that of the year under

notice, and yet in none of these has infantile mortality fallenso low. From this it may reasonably be hoped that thefavourable result in 1907 was in some measure due to

increasing care in the feeding and general nurture ofthe little ones. There still remain in England manyagencies that prejudicially affect infant life ; promi-nent amongst these may be mentioned ante-natal in-

fluences, maternal ignorance and neglect, food contaminationby flies, impure milk, insanitary environment, overcrowding,and the industrial employment of mothers. It will beremembered that in the report of the Duke of Devonshire’sCommittee on Physical Deterioration this topic was fullydiscussed, the opinion being there expressed that among theyounger women of the present day there is evidence of

increasing carelessness and defective sense of responsibilitywhich can only be disastrous to the rising generation. Withthe statistics of the causes of infantile mortality we shalldeal at a later stage ; meanwhile, it is important to note thatof the total mortality under the age of one year about one-third part occurs in the first month of life, and that of thedeaths at this early stage about three-fourths are caused by agroup of conditions that may conveniently be described asimmature. The conclusion can hardly be avoided that muchof the waste of infant life at the present day is due either toignorance or to callous neglect on the part of the mothers.It is important to note that among male infants the propor-tion of deaths from immaturity-i.e., from premature birth,congenital defects, atrophy, &c.-exceeds that among femaleinfants by from 20 to 27 per cent. It is common knowledgethat the mining, textile, and pottery districts of Englandhow very badly in the scale of infantile mortality ; not

only are the rates excessive in many of the large boroughs ofthese districts, but they are equally so in most of thesmaller towns. In Staffordshire, Cheshire, Lancashire, andGlamorganshire there are several groups of towns carryingon the industries here specified. In not fewer than eight ofthese towns-viz., Bilston, Longton, Tunstall, Stalybridge,Burnley, Farnworth, Ince-in-Makerfield, and Aberdare-theproportion surviving their first birthday does not amount to onein every five children born. On the other hand, the surprisinglylow death-rates prevailing at those ages in the towns ofErith, Swindon, and Burton-on-Trent clearly prove thatindustrial urban life is not necessarily incompatible with thewell-being of infants. Speaking generally, it is found thatexcessive waste of infant life is associated with a high birth-rate as well as with overcrowding and with undue industrialemployment of married women; nevertheless, there are

several towns with a low birth-rate and little overcrowdingand with no excess of factory employment, but in which thechild mortality is still very high. Towns such as these not

only produce a smaller number of children but lose anundue proportion of that smaller number. Whilst there areseveral areas in urban as well as rural England where infantmortality is low, comparing favourably with the healthiestplaces abroad, there are, on the other hand, many industrialcentres where persistently excessive death-rates indicate grossneglect in the conservation of infant life. It may fairly becontended that any future reduction in the mortality of

young children will depend on a due recognition of responsi-bility by parents quite as much as on any practicableimprovement of local sanitary conditions.With respect to the Notification of Births Act, which has

recently received the Royal assent, Sir William Dunbarremarks that although only an adoptive Act it is already inforce in 124 urban or rural districts in England. What mayeventually result from its general adoption it is, of course,too early to judge, but he expresses the hope that the Act,"along with other motive forces, will prove an effectivebarrier with which to stem the tide of infantile mortality."

! From the brief summary which we have given of this sectionof his report it is evident that the Registrar-General by noI means subscribes to the depressing view entertained by somepersons concerning the outlook presented by the decliningproductivity of the English population. Whilst not disputingthe seriousness of that decline, he adduces reasons to showthat its influence is to a considerable extent counteracted bydeclining fatality among the survivors. This position hesupports in the following way. "The birth-rate in 1907," hesays, ’’ was 26 - 3 per 1000, against an average of 28’ 4 in theten years immediately preceding. But in those ten yearsonly 855 out of every 1000 infants born lived to be one yearof age-that is to say, the birth-rate of 28’4 corresponded toa one year old rate’ of 24 - 3. In the year 1907 the rate ofsurvival to one year was 882 per 1000, and therefore the birth-rate of 26’ 3 per 1000 corresponded to a one year old rate’of 23-2. Therefore, although the birth-rate in 1907 showeda falling off of 2’ 1 per 1000 of population, compared withthat of 1897-1906, the one year old rate’ showed a fallingoff of only l’ 1 per 1000 ; and I would point out that furthercalculation shows that if the rate of survival to one year ofage could have been raised to 924 per 1000 in 1907 the oneyear old rate’ in 1907 would have been 24. 3, or preciselythe same as in 1897-1906, notwithstanding the reduction inthe birth-rate. If, therefore," he concludes, "the rate ofinfantile mortality should still further fall it will have animportant bearing on the effective upkeep of the population."

THE ROYAL COLLEGE OF SURGEONS OFENGLAND: THE HUNTERIAN ORATION

AND FESTIVAL DINNER.

THE Hunterian Oration was delivered on the afternoon ofFeb. 15th, when the Prince and Princess of Wales honouredthe College by their attendance. Their Royal Highnesseswere received by the President, the Vice-Presidents, andthe Secretary, and proceeded to the reception-room, wherein the presence of the members of the Council the Prince

signed the roll and assumed the gown as an honorary

Fellow, after receiving his diploma from the President.The whole company then proceeded to the theatre, where