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CLINIC EXPERIENCE IN CONTRACEPTION.

To the Editor of THE LANCET.

SiR,-In THE LANCET of August 12th there appearsa letter with this title from a non-medical woman,Mrs. Marie Stopes, D.Sc., Ph.D. She gives statisticsdrawn from 1000 cases dealt with at her Birth ControlClinic, 61, Marlborough-road, N. The women attend.

ing this clinic are examined and treated only by anurse, unless the latter happens to think that theyneed the advice of a doctor, in which case they arereferred to the consultant medical officer, Dr. JaneLorimer Hawthorne, who does not attend the clinicat any regular times, and who sees only a very smallfraction of the cases.These data, therefore, are based for the most part

on the experience of a nurse uncorroborated bymedical evidence, and the conclusions are arrived atby a medically untrained woman. I venture tosuggest that neither data nor conclusions have muchscientific value. Dr. Marie Stopes, I am sure, isactuated by the highest motives, but her ignoranceof medical matters has led her to advocate, in herbooks, at her clinic, and elsewhere, the use of thegold-pin pessary, which has been condemned byBritish medical men and women as indisputablydangerous, giving rise to sepsis and abortions.

I formerly used the type of pessary known as thesmall occlusive cap, for which such extravagantclaims are made by Dr. Stopes, but found it impos-sible to adjust in a great many cases on account ofabnormality of the cervix. (Dr. Stopes herselfsays,

" Where the cervix is torn, proliferated, seriouslyinjured, or abnormal in any other way this type ofcap is not feasible.") Further, I learned that evenwhere the cervix was normal, the majority of womenfound it impracticably difficult to adjust. Indeed, Iknow one medical woman, married and a mother,who has never been able to adjust it on her ownnormal cervix, in spite of her knowledge of anatomy.I still consider the small occlusive cap suitable fora minority of cases, but as the Dutch Mensingapessary is almost universally applicable (being mucheasier for the patient to adjust, and not contra-indicated by deformity of the cervix) I now considerthe latter greatly preferable.

Dr. Stopes says she sees " certain physiologicalobjections " against its use, but quite neglects tomention what they are.

In conclusion, I would stress the necessity formedical research on the subject of contraception, inorder that the methods at present known may bemore widely subjected to a careful scientific obser-vation, and that, if possible, other more perfectmethods may be found.

I am, Sir, yours faithfully, n

NORMAN HAIRE.New Cavendish-street, W., August 12th, ] 922.

To the Editor of THE LANCET.

SiR,—Dr. Marie Stopes states in THE LANCET ofAugust 12th that she can " see certain physiologicalobjections " to the use of the occlusive pessaryrecommended by me in

" Safe Marriage "1-that sheconsiders it merely the " next best thing " to the capfitting over cervix. I am not a doctor of medicine(nor, of course, is Dr. Marie Stopes), but as an

experienced official reporter I collected all availableevidence and exhibits in London and elsewhere, andbrought these before Sir William Arbuthnot Laneand other medical authorities. My book was writtenunder their expert guidance. The objections to thecap pessary are well known in medical circles, andevidence is available to prove that they cannotalways be fitted securely by individual women, andthat they are apt to be dislodged during intercourse.Sometimes doctors (and often nurses) fit too largefdzes of " Dutch " pessary-say 80 mm. or 85 mm.,

1 "Safe Marriage." By Ettie A. Rout. With Preface bySir William Arbuthnot Lane. Heinemann (Medical Books), Ltd.3s. 6d. net.

whereas 60 to 70 mm. or even smaller proves mostsuitable and serviceable, entailing no discomfortwhatever to either party.

It is not merely a superficial acquaintance withpopular contraceptives that is required, but a clearand deep understanding of the meaning of con-

traception. May I suggest, without offence, thatDr. Stopes’s 1000 local adherents and 10,000 corre-

sponding ones, recorded by fill-up-a-form methods,do not furnish " clinical experience." It is not" evidence " at all-except as to the popularity ofbirth control. Contraception is a branch of medicineand it must be studied and applied in the same wayas any other branch of medicine-otherwise it deterio-rates into quackery. " Science "-not " ChristianScience "-must be applied to this problem ifthe general public is to obtain any real and lastingbenefit T nm our vnnre fHlHlfnnv

London, W., Ajigust llth, 1922. ETTIE A. ROUT.

Obituary.ARTHUR MARMADUKE SHEILD, M.B.,

B.S. CAMB., F.R.C.S. ENG.,CONSULTING SURGEON TO ST. GEORGE’S HOSPITAL, THE HOSPITAL

FOR WOMEN AND CHILDREN, WATERLOO BRIDGE ROAD,AND TO THE HOSPITAL OF SS. JOHN AND ELIZABETH.

Arthur Marmaduke Sheild, who died on August 4that the Island of Coll, was a well-known consultingsurgeon in London, 15 years ago, when he was stilla young man, and the story of his early retirement frompractice was a genuine tragedy. He was an authorityon the surgery of the breast; had made special studyof conditions of the throat and nose where operativetreatment was requisite ; and he was a learneddermatologist. All this by the time he was 40.Then, owing to an illness contracted in the course ofhis professional duties, he was compelled to retire fromactive practice, although the war brought him backto the service of his country in an advisory capacity.Marmaduke Sheild was the son of William Henry

Sheild, of The Gilfach, Pembrokeshire, and was bornat Landawke, Lougharne, Carmarthen, in 1858.After being educated privately, he proceeded to themedical school of St. George’s Hospital. From thatschool he qualified in 1879 with the M.R.C.S. Eng.and the L.R.C.P. Lond., and after holding the usualhouse appointments, he went to Addenbrooke’sHospital, Cambridge, as resident. At the same timehe became an undergraduate at Downing College.In 1883 he graduated M.B., B.S., and returning toSt. George’s Hospital as obstetric resident took theFellowship of the Royal College of Surgeons of Englandin what of recent times must be a rather remarkablemanner, for he passed the primary and final examina-tions in the same month. In 1886 he was electedassistant surgeon at the Westminster Hospital, butshortly transferred his services to Charing CrossHospital, where he was appointed assistant surgeonand lecturer in practical surgery. At this school he alsolectured on diseases of the throat and ear, and acquiredthe experience that led to a considerable practicein oto-laryngology. In 1893 he returned to his oldhospital, being elected to the staff of St. George’sHospital, where he did 14 years of strenuous work assurgeon and teacher. He became full surgeon in1900 and held the post for seven years when, in 1907,he had the appalling misfortune to contract a seriousdouble infection when operating on an abdominalcase. He was gravely ill for many months, andendured a long and cruel ordeal, which terminated withan enforced retirement from the active staff of St.George’s Hospital in 1907, at the early age of 49.He spent the last 15 years of his life in Devonshire,greatly solaced by his studies as a field naturalist andhis devotion to fishing.

Sheild was a practical and informing teacher, andalso wrote some sound works on his special subjects.He was the author of a useful little guide to surgical

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anatomy for students, and published his clinicallectures on Nasal Obstruction and its Treatment. Hewrote a practical treatise on diseases of the ear, thoughhe made no original departures along this line of work,while he contributed the section on Dislocationsand Joint Injuries to Treves’s System of Surgery, andwrote the article on Diseases of the Breast in Quain’sDictionary of Medicine, and articles on Diseases ofthe Nails and -Tumours of Skin in the first edition ofAllbutt’s System of Medicine. His best-known work,however, was the clinical treatise on Diseases ofthe Breast, which he published in 1898. In this bookSheild ignored the pathological aspect of many of themorbid conditions occurring in the gland and kept theclinical view steadily in the forefront. The materialon which the work was based was drawn from the fourlarge institutions with which he had been personallyconnected at different times in his career, showing thatthe design to write the book was one of long standing ;but the main part of the work is a study of all the casesof disease of the breast admitted into St. George’sHospital in the 30 years between 1865 and 1895. Thewhole endeavour in a large book was towardssimplicity and practical advice, and the work wasrecognised upon its appearance as a readable andtrustworthy treatise on diseases of the breast.

In public Sheild was a clear and humorous speaker,as those who have heard him at the medical societieswill remember, while in private life he was a

profoundly witty man. He was an admirable mimic,and is supposed not to have increased his chances ofprofessional advancement by the exercise of thistalent at the expense of his seniors ; as raconteur andconversationalist he was unusually brilliant, and,unlike many with these gifto, he was a cause of goodtalk in others, for he stimulated reflection and helpedthe less ready man to make his points. It is nowonder, therefore, that Sheild with his sound andsteady surgical repute and fascinating social gifts wasa popular and noticeable man, so that the abrupttermination of his successful career was regarded as atragedy.

Sir Humphry Rolleston, who was elected to thestaff of St. George’s Hospital on the same day. writes:" Sheild’s was a complex personality and often,perhaps generally, a somewhat critical or even cynicalattitude was assumed as a form of camouflage forhis underlying kindly and rather sentimental nature.Thus it was that at different times his characterseemed puzzling if not contradictory-at one timethe hard-headed business man, at others verging onthe hyperconscientious. Another side that might haveremained unsuspected by those familiar only withhis professional activities was his intense love ofnature and of the country ; it was thus that whenattacked in comparatively early life with pulmonarytuberculosis he went to a remote Scottish villagewith the determination that if his time was up he wouldat any rate get some country life and fishing first.It is, perhaps, fortunate that his end came whenpresumably he was enjoying his favourite occupationin the distant Hebrides. Sheild was a most impres- sive teacher and irresistibly recalled Sir George Humphry’s methods and manner of driving the essen-tials of surgical practice into students. He seemedindeed to have imbibed much from that great masterunder whom he had worked as house surgeon atAddenbrooke’s Hospital, Cambridge. His popularityas a teacher was deservedly great, and had he not beenobliged by illness to leave London his success inconsulting practice, already assured and considerable,would have been an ample reward for his earlystruggles and persistent industry."

EDWARD HUGH EDWARDS STACK, M.B.,B.CH.CAMB., F.R.C.S. ENG.,

OPHTHALMIC SURGEON TO THE BRISTOL ROYAL INFIRMARY.

THE death at the age of 55 of Mr. E. H. E. Stack removes one who was well known in Bristol and theWest of England as an ophthalmic surgeon. He wasborn in County Tyrone in 1866, and was educated

at Haileybury. Cambridge, and St. Bartholomew’sHospital. At the last-named he distinguishedhimself by winning the Brackenbury medical scholar-ship, and holding more resident appointments thananyone before or since. He was house physician toDr. Gee, ophthalmic house surgeon, extern and internmidwifery assistant ; -and it is believed that he wasnominated house surgeon to Mr. Langton, but did nothold office owing to a rule limiting the number ofappointments tenable by one individual. This recordserves to illustrate his ability, industry, and wideinterest in all branches of medicine. In 1897 Stackwent to Bristol as house physician to the RoyalInfirmary after taking his F.R.C.S. diploma. In1902 he became house surgeon, and in 1906 waselected assistant surgeon. In 1914 he became fullsurgeon, but on Dr. Ogilvy’s death he decided tospecialise in eye work and was appointed ophthalmicsurgeon at the Royal Infirmary. Later he suc-

ceeded to a vacancy as surgeon to the Bristol EyeHospital.

Stack was a brilliant clinician in any branch ofmedicine that he touched. He had learned from Geethe mental habit of brushing aside non-essentials, andlike Gee too, he was quick to observe unusual featuresof disease in his patients and appraise their importance.Widely informed, Stack was not worried by the factthat individual cases did not conform to type. Itwas perhaps this characteristic in his teaching thatstudents appreciated and carried away with them intotheir practices. In fact, he always aimed at teachingmen to practise medicine rather than to pass examina-tions, and he did not allow them to forget that whenthey left hospital they would be treating sickpeople, not diseases. Until he devoted himselfentirely to eye work he had been surgeon to theBristol Orthopaedic Hospital and Home for CrippledChildren, for he was very fond of children as patients;in fact, his ingenuity in devising " test types " forchildren too young to read gave his consulting-roomthe quaintest appearance. It was full of toys andhumorous pictures drawn to Snellen’s scale.

During the war Mr. Stack did much admirablework as ophthalmic specialist to the 2nd SouthernGeneral Hospital in Bristol, and at No. 56 GeneralHospital in France. He was not a frequent con-

tributor to medical literature, but among his paperswere a careful description of one of the few cases ofleontiasis ossea recorded in England, and (jointlywith Dr. Carey Coombs) a good account of theocular effects of mustard gas, both of which werepublished in the Bristol Medico-Chirurgical Journal.He was a good churchman and at the time of hisdeath held office as churchwarden at St. Paul’s Church,Clifton. He leaves a widow and four children.

RICHARD NEVILLE HART, M.D.CAMB.Dr. Neville Hart, who died suddenly at his residence

in Bournemouth on July 22nd, was a cadet of an oldNorfolk family, whose father practised at Erith. Hewaseducated at Norwich Grammar School, at Cambridge,where he achieved distinction, and later he studied inParis and at Bonn. After obtaining his degrees, hisfirst appointments were those of resident physicianand resident surgeon to the West London Hospital, andsenior resident physician to King’s College Hospital.He was subsequently appointed registrar, and placedon the staff of the hospital. He also acted as

assistant medical officer at the London CountyAsylum, Epsom. This appointment he relinquishedabout 1908, and took up his residence in Bournemouth,where he practised until his death. He was anindefatigable worker, studious and punctilious to adegree, with an extraordinary memory. For manyyears Dr. Hart was a member of the BournemouthTown Council, and played an active part in publicaffairs. He was an expert chess player, and could playfour visualised games simultaneously, usually winningthree and drawing one. He was also no mean musician.His early death at the age of 43 years leaves a gap in alarge circle of friends and patients.