Albert Sharman (1903–1970): Gynaecologist,inventor and teacher

Introduction

Albert (Bert) Sharman was born in Glasgow on 28 July 1903, the oldest of four children of Jacob and Celia Sharman (nee Ognall) Jewish immigrants who had arrived in the city from Russia in the 1890s. ^{1 1} Jacob Sharman, a tailor, left his parents to settle in Glasgow as a teenager in 1892. Celia's father, Lazarus Ognall, hailed from Kovno (now Kaunas) in Lithuania and worked in Glasgow as a garment worker making waterproof clothing and was very involved in the activities of the growing Jewish community in the Gorbals. By the time of the First World War, Jacob and Celia, who had married in 1902, had moved southwards to the Langside area and Albert had his secondary education at the nearby Queens Park School where he had been an outstanding pupil. He was dux in his final year there before proceeding to the University of Glasgow to study medicine.

He had a distinguished undergraduate career. He was a medalist in surgery, pathology, materia medica and diseases of the ear, nose and throat. He had distinctions in anatomy, physiology and pathology and acted as a university demonstrator in his subjects while still an undergraduate. While still a medical student he graduated BSc in 1925 and he completed his medical studies with MB ChB with commendation in 1927. He passed the Membership examination of the College of Obstetricians and Gynaecologists (MCOG) in 1931 and was elected to Fellowship of what was now the Royal College (FRCOG) in 1951. He was admitted to Fellowship of the Royal College of Surgeons of Glasgow in 1962.

He was awarded three postgraduate doctorates from the University of Glasgow over the next 20 years. The first was an MD (Doctor of Medicine) which was awarded in 1933 for ‘Studies on the Bacteriology and Chemistry of the Vagina’. Next was a PhD (Doctor of Philosophy) which was awarded in 1944 for ‘Studies in Human Sterility with special reference to the Investigation and the Patency and Function of the Fallopian tubes and of the Condition of Endometrium’. Finally, his DSc (Doctor of Science) thesis entitled ‘Histological and Physiological Studies on the Reparative Processes following Parturition in the Human, with special reference to Endometrial Regeneration and Ovulation: Together with an Experimental Study of the Effects of Hormones upon Regeneration in the Guinea Pig and Rat’ was awarded in 1953. While it is not unusual for medical graduates to obtain MD and PhD degrees, the DSc is only achieved after a much more substantial body of work usually accumulated over a career in scientific research. These doctorates marked the progression of his research during his distinguished career.

These years were also formative in terms of the development and recognition of obstetrics and gynaecology as a medical specialty. The British College of Obstetricians and Gynaecologists was founded in September 1929, and it was granted a royal title in 1938 and its Royal Charter followed in 1947 after the Second World War.

In his lifetime, he held many research scholarships, beginning with a McCunn scholarship in conjunction with the British Medical Association at the outset of his career. For 40 years, he was a member of the visiting staff of the Royal Samaritan Hospital for Women and from 1956 he was the senior consultant in charge of the wards and was Director of Research into Reproductive Biology. From 1931 he was a teacher of medical undergraduates in gynaecology at Glasgow University and the Anderson College of Medicine, an extra-mural school of medicine which functioned from around 1800 until 1947. He was appointed lecturer in clinical gynaecology at Glasgow University in 1954.

Obstetrics in Glasgow 1926–1930

Sharman's attention to detail can be seen in a note about research he had carried out in Glasgow based on 20,000 pregnancies in the district around the Glasgow Royal Maternity and Women's Hospital during 1926–1930. ² These were his years as a junior doctor, and they had a profound effect on his choice of career. He wrote that only 27% of women giving birth there had attended the ante-natal clinic and 692 mothers who had planned home births were transferred to hospital. There were 50 maternal deaths making a maternal mortality of 2.5 per 1000 cases often following puerperal sepsis. ² Twenty years later, Sharman's examination of post-partum regeneration of the endometrium still included 10 post-mortem uteri in the extensive sampling from endometrial biopsies though now all specimens were noted to be free of puerperal infection. ³

At the same time, concern was being expressed about the implications for Britain with a declining birth rate. The average birth rate in Britain had dropped from 4.85 children per family in 1880 to 2.84 in 1915, which carried implications for both the military and the civilian workforce. At the same time, infant mortality remained stubbornly high and only began to fall in the decades after the First World War. ⁴ There was a lengthy mention of the question of fecundity, the potential for childbearing in a given group, which was of concern to governments at the time. Sharman presided at an event, ‘packed to the door’ in May 1936 held in the Usher Hall, Edinburgh, a popular event for major concerts and recitals. The meeting was part of a Scottish-wide conference with the theme ‘Future of the Race? Birth Control Advice Urged’.

Fertility and sterility

In 1947 Sharman published a paper on aspects of human infertility based on more than a decade of running his Fertility Clinic.^{5,6,7,8,9 3} The Clinic, founded in 1931 for ‘the investigation and treatment of the infertile marriage’, was the first of its kind in Britain though many more were set up over the following years. This recognised Sharman's Glasgow clinic as the pioneer in this field. Sharman's rationale for the clinic was that ‘Although infertility is one of the oldest of human problems it is only within the present century that real progress has been made in its study’.

Sharman was one of 15 co-signatories, headed by Mary Barton, to a letter published in 1943 which began by noting that a tenth of all marriages were childless but that permanent childlessness was rarely deliberate. It concluded that the childless and small family reflect lower fecundity rates than an excessive unwillingness to reproduce and stressed the need to provide facilities for the skilled diagnosis and treatment of all grades of infecundity. ^{10 4} In fact British birth rates had been falling from the last decades of the nineteenth century and there was a need to know if this represented parent choice or whether there were medical factors involved. Fertility clinics provided help for childless couples but could also serve the national interest. Sharman's fertility clinic had recently shown an increase in the number of cases, from 303 attending in 1938 to 505 in 1942. Sharman proved himself to be both a skilled diagnostician and an innovative inventor in the field of fertility management. He was aware that treatment of infertility depended on an accurate diagnosis of the cause and thus he needed access to better investigative techniques. This led to his involvement in new methods to determine patency of the Fallopian tubes and establish the precise diagnosis of the condition of the endometrium.

Sharman's kymograph

Tubal insufflation enabled the assessment of patency and Sharman indicated the importance of peristaltic movements or contractions in the human Fallopian tube which had never been directly visualised until August,1946, when he observed them during an operation for the removal of a diseased ovary. Sharman can claim responsibility for the refinement of both the endometrial biopsy pipette and the kymograph for insufflation of the Fallopian tubes (Figure 1). Tubal insufflation to demonstrate the patency of the Fallopian Tubes was first described by Dr Isidor Clinton Rubin in 1920. Rubin made modifications to his original apparatus, changing the insufflated gas to carbon dioxide from oxygen and in 1928 he described a kymographic method to demonstrate the pressure at which the gas escaped through the tubes.^{11,12 5}

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Figure 1.

Sharman's Kymograph: Hong Kong Museum of Medical Sciences (donated by Dr Y K Tsao) Early models were manufactured by Kelvin, Bottomley & Baird Ltd (UK), which later became Kelvin Hughes Limited (UK).

Kymographic insufflation is a simple procedure which can be undertaken in the out-patient or consulting room and not only differentiates between permeability and non-permeability but can indicate spasm and tubal stenosis and yields information as to the functional state of the tubes and, in certain cases, of the ovaries. Sharman's kymograph for tubal insufflation apparatus was shown at the Royal Society of Medicine in 1943. Use of these instruments became widespread in Britain and around the world and some of the earlier models can now be seen in medical museums. ^{13 6} With increasing use for the technique Sharman produced a paper in the British Medical Journal in 1944 showing the benefits of his kymographic tubal insufflation apparatus. ¹⁴ The more technical aspects of the procedure are shown here and were published separately ¹⁵ :

Carbon dioxide is supplied to the apparatus by a cylinder enclosed in a metal container on top of which is a registering manometer. The revolving drum is operated by an electric motor. The front panel of the instrument shows, reading from left to right, (1) dial indicating the pressure (and quantity) of gas in the supply cylinder, (2) a tap indicator to regulate accurately its rate of flow, and (3) knobs to turn gas on and off (the upper one controls supply within the regulating system).

Sharman continued to perform tubal insufflation routinely, both as a diagnostic and as a therapeutic procedure in all cases of primary sterility at his clinic and in the wards of the Royal Samaritan Hospital for Women until 1947 (Figure 2). By the end of the 1940s, the procedure was then discontinued at the sterility clinic as a routine measure, so that comparative experiments might be carried out, not only to assess the results of other methods of treatment but also to attempt a critical evaluation of the therapeutic merits of insufflation. The findings indicated little difference in subsequent pregnancy rates between insufflation, passing a uterine sound, bimanual palpation and hormone therapy. ^{16 7}

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Figure 2.

Royal Samaritan Hospital for Women, Glasgow (closed in 1991).

Writing in 1950 Sharman reflected on around six thousand insufflations carried out at Royal Samaritan Hospital for Women by various members of staff. ^{17 8} Carbon dioxide had been the only gas used and with the recent introduction in Britain of aqueous radiopaque substances, such as Visco-Pyelosil ⁹ he affirmed that there should be no longer any place for an oily contrast medium in the investigation of tubal patency. He considered that the procedure was established and safe with pelvic infection a rare complication. However, many studies questioned the accuracy of the results showing both false positives and false negatives and even repeated insufflations failed to establish the state of tubal health. The procedure was dropped in favour of radiology and laparoscopy. ¹⁸

Clearly, a major cause of infertility related to major tubal damage. He was able to show that gonococcal infection, widely suspected, was of less importance than previously thought. ¹⁰ In the past, it had been widely accepted that in most instances the occlusion of the lumen results from gonococcal salpingitis or from tubal infection from a nearby pelvic lesion (particularly appendicitis) or from congenital hypoplasia. His main findings were the presence of apparently non-patent Fallopian tubes (38%), anovular cycles (6.4%) and tubercular endometritis (5.34%). ¹⁹ Seminal examination in 114 husbands revealed marked deficiency in 13.2% and azoospermia in 18.4%. His discovery that a significant cause of primary sterility was undiagnosed tuberculosis was followed by further analysis which showed that endometrial tuberculosis is 15 times more common in sterile than in fertile women.

His studies with tuberculous salpingitis continued after the War. In a paper in 1952, he focussed on the cases where the endometrium appeared to be normal, yet histological examination revealed areas tuberculous infection. ²⁰ Most patients examined in this study were in good general health and were aged between 20 and 30 years but Sharman counselled that a negative biopsy did not exclude disease elsewhere and that further biopsies might be required. In these cases, there was a high risk of tubal occlusion and care had to be taken with insufflation lest it cause further spread of the disease. He was able to show that tuberculosis was the cause of tubal occlusion in a quarter of patients with primary sterility. By 1953 chemotherapy for TB was available but he could not report any pregnancies after treatment. He concluded by stating that eliminating tuberculous lesions would best be by dealing with TB in the community at an earlier stage. In a comment after the paper the journal editor commented that many other British clinics did not report such a high prevalence of TB but that if they used Sharman's persistence, they would probably find it. In any case, in an area where TB was endemic, as in the West of Scotland, the presence of tuberculosis should always be considered.

He was also able to dispel congenital hypoplasia as a case of tubal occlusion, as described by the German gynaecologist Carl Clauberg in 1938. ¹¹ His studies at the Royal Samaritan Hospital for Women, Glasgow, during the years 1936–1940, indicated that minor degrees of uterine hypoplasia have little relation to infertility and while major degrees of hypoplasia are uncommon, they seriously affect the fertility prognosis. ²¹ Looking at a series of 863 consecutive cases of primary sterility he found a minor degree of hypoplasia in almost exactly half while only 14 patients (1.7%) had a major degree. Where endometrial tuberculosis was present tubal blockage in was found to be 61.8%.

Endometrial biopsy

In his investigation of sterility, Sharman had been frustrated by the lack of a method of endometrial biopsy which aided diagnosis but would also be simple and pain-free and could be carried out without anaesthesia as an outpatient. Various techniques had been tried: curette, punch and suction but the resultant tissue was often unsatisfactory histologically. Working with H L Sheehan they produced a biopsy method which produced the tissue required and produced nothing more than minor discomfort and thus could be done as an outpatient with no aftercare needed (Figure 3). ^{22 12} The new biopsy curette, which did not require uterine dilatation, though what Sheehan and Sharman called minor discomfort, was not accepted universally, and prevented a wider uptake. The benefit to patients with infertility or with disturbances of menstruation was considerable and Sharman anticipated that there would be a definite scientific value in studying the endometrial responses to various hormones.

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Figure 3.

Illustrations accompanying the British Medical Journal article showing both the slide and biopsy histology.

Following some discussion at a clinical meeting of the British Medical Association in 1965 on attempts to increase fertility in subfertile women by administration of steroid hormones, Sharman reviewed 1575 cases of primary infertility. ^{23 13} The pregnancy rate of 6% at the end of 12 months after the administration of oral contraceptives compared unfavourably with the rates Sharman had described with tubal insufflation (17.4%), passing a uterine sound, bimanual pelvic examination alone (10.8%) and injection of a combination of progesterone with oestradiol benzoate (19.6%).

While endometrial biopsy remains the standard test for detecting endometrial disease recent developments have refined Sharman's methods which were limited by uncertainty about the origin of the tissue, which is obtained in a blind procedure, and the difficulty of obtaining adequate specimens in some women. ²⁴

Artificial insemination

Another aspect of the functioning of his clinic can be found in Gayle Davis's chapter ‘A Tragedy as Old as History: Medical Responses to Infertility and Artificial Insemination by Donor in 1950s Britain’ which appeared in The Palgrave Handbook of Infertility in History: Approaches, Contexts and Perspectives, which was published online in 2017. ²⁵ Davis showed how ‘the infertile patient was characterised, perceived and treated by the medical profession in 1950s England and Scotland’. Artificial insemination with donor sperm (AID) only reached the Scottish legal system in 1957 when a Mr Maclennan sought a divorce on the ground of his wife's adultery and Mrs. Maclennan ‘alleged’ that the child to which she had given birth had been conceived as a result of AID. ¹⁴ Lord Wheatley's judgement was that whatever else Mrs. Maclennan may have done she had not committed adultery so far as the law of Scotland was concerned though it could constitute a grievous marital offence against a non-consenting husband. The case meant that the problem of artificial insemination finally registered in the public consciousness. The Government responded by setting up the Feversham Committee in 1958 with a brief to see how fertility clinics were operating and how artificial insemination was being used. ^{26 15}

Davis indicated that the evidence, both written and oral, presented to the Committee:

…. offers rich insights into medical thinking and practice, and into the complex sociomedical politics and ethical anxieties which surrounded the topic.

Sharman was one of the medical witnesses and this gave him the opportunity to explain how dealt with sterility and the use of AIH and AID. He advised that female patients who were asked ‘to bring along a specimen of the husband's semen’ must also be requested to supply proof that this was indeed her husband's semen and that he had consented to the procedure. This was, Sharman explained, because ‘the woman could bring along a substitute semen if she so felt […]. We have no proof: we are injecting it in good faith’. ¹⁶

A member of the Feversham Committee then pointed out that:

any woman who would ‘go to the trouble of bringing the semen of a man other than her husband’ would ‘surely try ordinary methods of adultery’.

Sharman responded defensively that he had ‘no doubt […] from the way an occasional woman talked to him, that she did indulge in adultery’. ¹⁷ He explained that if the husband was found to be totally sterile, he would have a ‘heart-to-heart talk’ with his wife and ask her to keep that information to herself. I told the wife she was ‘not to go home and blurt out the whole truth of the matter…. I saw marriages going on the rocks, ruin and divorce, through telling the husband’. The result might be subterfuge. The husband was instead told that he was ‘impaired’ but that there was ‘hope with treatment or in time things might remedy themselves’, thus any resulting pregnancy using AID might be passed off as resulting from marital intercourse. As Sharman's clinic was only for married women his practice was to refer the husband at the earliest opportunity to Mr W. S. Mack at the Urological Department of the Royal Infirmary for independent investigation, and, where possible, a Huhner post-coital test was also done. ¹⁸

Reluctance by many gynaecologists to practise AID appears to have stemmed from a complex blend of legal, practical and moral factors. Sharman said that he had made enquiries to the Medical Defence Union, only to be told that the organisation ‘would not guarantee that somebody who had had artificial insemination with donated semen could not bring a legal action’ against that doctor. In its submission to the Feversham Committee, the Department of Health for Scotland claimed that there was ‘some uncertainty’ as to the legality of the procedure, since the National Health Service had failed to issue guidelines on it and recommended that the doctor ‘seek to safeguard himself by securing the written consent of all parties to the transaction’. ¹⁹

One of the other practitioners of AID who gave evidence at the Feversham Committee was Mary Barton (1905–1990). She had founded one of the first fertility clinics in England and AID was available. She claimed to be careful in matching characteristics in the donor semen though leaving the recruitment of donors to her husband, the sex researcher Bertold Wiesner. ^{27 20} Sharman was one of the co-authors of Sterility and Impaired Fertility: Pathogenesis, Investigation and Treatment, 2nd edition (London and New York, 1948) along with Barton and Wisener, Cedric S L Roberts and Kenneth MacFarlane Walker.

Another link to Barton was the letter to the British Medical Journal in 1943 signed by Barton and Sharman and a number of other prominent British and American experts in the management of sterility. Sharman wrote that his Glasgow hospital maintained a sterility clinic and that numbers, as noted, attending were increasing. A similar increase of attendances was also seen in the other British Fertility Clinics which had proper facilities for the diagnosis and treatment of sterility.

Pregnancy testing

In the Obituary, Walker Naddell wrote that Sharman ‘also initiated an immunological test for pregnancy and developed a new technique which is now established and is worldwide in its use’. ²¹

Yet, Sharman's presence in recent literature on the development of modern pregnancy testing is lacking, perhaps because many different researchers, Sharman among them, had been collaborating with different companies. He had been interested in pregnancy tests from an early stage in his career. In a letter to the British Medical Journal in November 1937 ²⁸ he commented on unsatisfactory nature of the Antuitrin S Intradermal Pregnancy Test saying that it was not dependable with a false negative rate of 13.2% and a false positive result of 4.9%. However, he felt that the technique ‘should not be totally rejected without further consideration, as it possesses interesting potentialities’. Indeed, the 1960s was a decade of intense research into studying the hormones involved in pregnancy testing.

In October 1964, he published an article with T Pearston on an immunological pregnancy test. ²⁹ Preceding the paper by a few months, in December 1963, Sharman had a letter published in The Lancet ^{30 22} commenting that recent letters in the journal had discussed false positive results in existing tests and that:

This correspondence and letters and reports elsewhere, together with a sense of urgency, prompt my letter, which is in the nature of a preliminary communication on trials of a new immunological technique, which takes only two minutes, carried out at the Royal Samaritan Hospital for Women, Glasgow, in recent months.

Sharman was able to state that in 247 tests the diagnosis of pregnancy had an accuracy of 100% with no false positives or false negatives. Consequently, he claimed that this suggested that:

a major breakthrough or revolution’ in pregnancy testing is at hand. In our opinion, if further tests continue to give results such as we have obtained, and our findings are substantiated by others, this test will supersede and make obsolete all biological tests. Its accuracy is greater than that of any pregnancy test yet described, and its simplicity is such that we have trained house-surgeons to do the test, virtually as a side room method.

At the time of writing the new antiserum and antigen were available only for research and trial and had not yet been made available for marketing but the manufacturers had informed him that they already had 3410 statistically analysed results to support the test.

However, other researchers were also active. In the same year, a paper by B M Hobson in the Journal of Reproduction and Fertility showed how pregnancy testing was now much simplified and could be done quickly and accurately using the Ortho Gravindex-Slide test. ³¹ The author commented that ‘The experience of Sharman with Gravindex is exceptional’. The only perceived problem with Gravindex, which gave results in 4 minutes, compared to Pregnosticon tests, which took 2 hours, was that the latter was much better for batch testing as a hundred tests could be set up and read in 3 hours.

Sharman's experience included all immunological tests, including the recently introduced Prepurex by Wellcome Reagents, which he noted had given excellent results in a large number of cases. He was still not comfortable at this time with allowing pregnancy tests to be done by people with little training saying that he could not ‘support the statement, in an advertisement for one of the commercial “laboratory in-a-box” kits that, “the test is so simple that your receptionist can be using it expertly within minutes”’. While this, he said, ‘may often be true, but surely there is danger here in “borderline cases”, such as cases of uterine mole, abortion, and ectopic pregnancy’. He expected to do his own tests rather than employ technicians saying, ‘I agree with Dr Hobson that results should be confirmed by clinicians’.

While Sharman pressed for ‘the adoption of the technique which we introduced and which we have used in this hospital’ he also indicated that he did not ‘wish to discuss and compare results with other commercial tests, mainly because they will be discussed in a forthcoming publication’. ³² This was an allusion to a book chapter, still in press, but this was just months before his death, when he was already in poor health, and there is no record of it being published. ²³

On the S S Athenia

Sharman was a regular attender at international conferences, and he took his place on the S S Athenia on the 1st of September 1939, due to sail from Glasgow to Montreal with brief stops in Liverpool and Belfast. It was not a good time for trans-Atlantic travel as the liner left Glasgow just as Hitler's troops were invading Poland. The ship was torpedoed on the 3^rd of September just after Britain declared war on Nazi Germany and was the first British ship to be sunk by enemy action during the Second World War. As the Athenia was a passenger ship the sinking was described as a war crime, which the Nazis tried to cover up, denying their responsibility and even suggesting that Britain had sunk the ship to get American sympathy to join the war. Germany only admitted responsibility in 1946.

There were 117 civilian passengers and crew killed and many injured. About 50 passengers and crew died when one of the lifeboats capsized and was crushed in the propeller of Knute Nelson, a rescue ship. Many crew members were killed in the vicinity of where the torpedo hit. Fortunately, there were enough ships in the vicinity west of Rockall, and about 200 miles west of Ireland, to rescue more than a thousand survivors in the many hours before the Athenia sank. ^{33 24} Some were taken on to Halifax in Canada, and about half landed at Galway in Ireland. Royal Navy destroyers and the Knute Nelson returned some passengers to Glasgow. Sharman had been in Lifeboat 10, the last Lifeboat, of twenty-six, to be rescued. Many passengers were seriously injured and had to be hospitalised on shore, but many others were suffering from less significant injuries and were accommodated and treated in one of Glasgow's hotels. The Glasgow based Daily Record recounted that Sharman was still tending to survivors in Glasgow's Beresford Hotel on the 5^th of September. ²⁵

Books

Sharman's books whether aimed at the general public or to obstetricians and gynaecologists were written towards the end of his career. His first foray into medical texts was a co-operative venture with Cedric Lane-Roberts, Kenneth Walker, B P Wiesner and Mary Barton in publishing Sterility and Impaired Fertility - Pathogenesis, Investigation and Treatment, Hamish Hamilton Medical Books, 1948. He was the sole author of the later books, which covered much of the ground he had written about in his academic papers and letters to the medical press.

First was his 72-page From Girlhood to Womanhood, which was published in 1960 by E & S Livingstone Ltd (Edinburgh and London) as part of a series of books on aspects of health and childcare for the general public. Written as a guide to mothers dealing with their teenage and the delicate issues of puberty and the facts of life it was widely welcomed in the medical and nursing press. Its Foreword was written by Lady Isobel Barnett, then a well-known television personality from her appearances on the popular BBC panel show What's My Line? The GP journal The Practitioner commended its style as being ‘clear and without any suspicion of sentimentality’.

Another short book from this time aimed at the general public was The Middle Years; The Change of Life, (1962) which was also published by E & S Livingstone Ltd In the Foreword, Sir John Peel ²⁶ pointed out that ‘We live in an era of health education for the lay public’. However, he emphasised that Sharman's skills as a communicator and expertise as a gynaecologist made him an ideal person to write about the menopause dispelling what he called ‘so much mumbo jumbo of superstition and old wives’ tales’. Sharman indicated in the Preface that he was motivated to write the book by over 30 years’ experience in gynaecology where he encountered ‘widespread ignorance, worry and even fear’ before and during the menopause. His aim was to blend ‘the scientific with the more picturesque and imaginative’ making explanations as ‘clear as possible but not to oversimplify them’. Sharman understood, from the perspective of 1962, that he was writing to explain to married women, and their husbands, how to cope with the inevitable physiological changes in ‘the middle years’ noting that a couple of generations earlier that the average life span allowed women barely a decade after the menopause. Both these books stress the importance of marriage and the need for husbands to support their wives and for mothers to be able to answer all the daughters’ questions. While the books were seen to be ground-breaking in the information they provided, their presentational layout matched the limited standards of the time.

His longer book Reproductive Physiology of the Post-Partum Period, E. & S Livingstone, 1966 was much more specialised, being based on his DSc thesis and featured his research on a day-by-day description of the regenerative endometrium during the three months following confinement with histology from post-mortem uteri and one post-hysterectomy uterus. Profusely illustrated with black and white images, it also covered the establishment of ovulation and the reappearance of menstruation concluding with a chapter describing experimental work on guineapigs and rats and the effect of ovariectomy ²⁷ and subsequent hormone administration on endometrial regeneration. The book covered recent advances in contraception with intrauterine devices and with oral contraceptives but beginning with the advances made from the days of William Hunter at the end of the eighteenth century through the subsequent years till the last third of the twentieth century.

Personality

Sharman was a member of many learned societies in Britain and overseas. A member of the British Medical Association he was honorary treasurer and deputy secretary for seven years of the Glasgow division and was a representative at the Annual Meetings in 1934–1936 and 1941. He was a most sought after after-dinner speaker, with a great sense of humour and presentational skills. He was an enthusiastic Rotarian and a past-President of the Glasgow Rotary Club. He was also active as a Freemason, reaching the rank of Grand Master of Glasgow's Lodge Montefiore in 1938. He died on the 19th of February 1970 after a long illness and his funeral was attended by family, friends, former patients and representatives of hospital and the other organisations he had served. A memorial service was held later by the Lodge. ²⁸