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ANNOTATIONS

A WOMAN FOR THE G.M.C.?" JUSTICE," said Lord Darling, " is, like the Ritz,

open to all" ; and membership of the GeneralMedical Council is open to women. Indeed one

woman was elected to it some years ago as a directrepresentative of medical practitioners in Englandand Wales, though she died before taking her seat.As was pointed out at the B.M.A. meeting in Aberdeenlast week, any electing body can choose a woman,and if a woman is wanted the machinery for herelection is fully available. No doubt that will

satisfy the formalists; but in actual fact theimmediate chances of a woman being elected tosucceed Christine Murrell on the G.M.C. are littlebetter than those of a woman succeeding ElizabethBlackwell as a student of St. Bartholomew’s Hospital.The B.M.A. was assured by several representatives,including the only woman speaker, Miss BeatriceTurner, that females desire no more than equality ofopportunity, which (it was said) they already possess.How far this self-mortification is really prevalentamong women doctors we do not pretend to judge ;but we are not enamoured of machinery that doesnot work, and to any practical person interested inmaking the G.M.C. more representative it must seeman anomaly that in a profession with 6000 womenmembers (out of 60,000) there should not be a singlewoman in the council of 39 which directs its educationand discipline. All questions of administration andpolitics concern women as much as men ; they areequally interested in the welfare of the community ;and there is no doubt that their judgment andexperience would be of value in the penal anddisciplinary work of the council. Women are oftencalled as witnesses ; many of the complaints maybe against women; and. in all the really difficultcases women are concerned in one way or another.Of the existing council 27 are nominees of

licensing bodies, which are unlikely to put in a

woman, however eminent, as their only representative,and 7 are elected as direct representatives of practi-tioners in the several parts of the United Kingdom.Dr. Murrell was herself chosen as one of these

representatives : s before her election she had beena member for fifteen years of the metropolitan branchcouncil of the B.M.A. and had presided over it ;for eight years she had been a member of the B.M.A.council and she had served on fifteen of its com-mittees and subcommittees. Her record of publicwork was outstanding and it may well be beyond thecompass of later candidates. At all events theB.M.A. meeting, despite a motion that one of thenominees of the association should be a woman,decided at Aberdeen on male candidates, Mr. BishopHarman and Dr. E. A. Gregg, for nomination tovacancies in the near future for direct representatives.There remains the fact that the Privy Council hasthe disposition of 5 seats, which it allots to supplythe council with members from branches of themedical profession not otherwise represented there.It was the Privy Council which, in response to

parliamentary pressure, and very wisely, appointeda lay member of the council, and we hope it willtake the next suitable opportunity to fill this other

conspicuous gap.OCCUPATIONAL THERAPY .

THE latest addition to the facilities for occupa-tional therapy in Bristol is the Allendale Curative

Workshop where equipment has been installed for

treating patients, both " hospital " and private,at all stages of physical disabilities caused by accidentor disease. The workshop, which is under the careof the staff of the Dorset House school of occupationaltherapy, will ultimately be developed into a full-time rehabilitation centre and a number of patientsfrom the local fracture clinics have already passedthrough it. Last year Dr. Elizabeth Casson (lt2ed.Pr. 1938, 197, 265) outlined the work that has beendone in this field for patients suffering from nervousdisorders at Dorset House, for cases of rheumaticheart-disease and other medical conditions at BristolGeneral Hospital and Southmead, for cases of pul-monary tuberculosis at Ham Green, and for ortho-psedic cases at Bath Orthopaedic Hospital. Shelaid down four principles on which the use of occupa-tional therapy is based. First, it must be prescribedby the patient’s medical practitioner in categoricalterms. Secondly, the prescription must take dueregard both of the individual patient’s mental andphysical make-up and of the nature and extent of hisdisability. Thirdly, it must be carried out by a

specially trained therapist who has the necessaryknowledge of anatomy, physiology and psychology,and a wide experience of crafts and occupations.Fourthly, it must be sufficiently engrossing to directthe patient’s attention away from his disability.Dr. Casson urged that, apart from its use in hospitalsand institutions, there is a wide opening for occupa-tional therapy among private cases, where it can beprovided by the hour in the patient’s own home,in the same way that massage is given.

CONSTRICTIVE PERICARDITIS

li’our years ago a paper by wmte in these pagesexcited considerable interest in the syndrome ofchronic constrictive pericarditis, and since then a

number of operations have been performed for therelief of an otherwise incurable cardiac disability.The publication by Heuer and Stewart of sevenconsecutive and successful operations of this kindmerits attention because it brings out several newpoints in both diagnosis and treatment. The improve-ment they describe and illustrate by photographs isso striking that their paper should also help to remindthe practitioner of the existence of the syndrome andthe necessity of taking it into account in all cases ofpersistent ascites. The presence of a pericardial scarshould always be suspected where there is ascites andenlargement of the liver in the absence of thecommoner causes of congestive heart failure. The

diagnosis is established by direct measurement of thevenous pressure, which is always increased, and by aseries of other findings, which include a pulse that issmall in volume and an electrocardiogram of low

voltage. The radiograms show a cardiac silhouettethat is either smaller than normal or at the mostmoderately enlarged, and in some cases deposits ofcalcium may be clearly seen especially in the lateralview. Under the fluoroscope it may sometimes beobserved that contraction of the several chambers ofthe heart is much diminished. In the cases recordedby Heuer and Stewart careful medical treatmentpreceded operation, the measures employed includingcomplete rest in bed on a diet low in salt-contentbut with a high protein component. Paracentesis ofthe ascitic fluid was also carried out, and free fluid

1. White, P. D., Lancet, 1935, 2, 539.2. Heuer, G. J., and Stewart, H. J., Surg. Gynec. Obstet. 1939,

68, 929.