476

Retired-officer AppointmentsThese may be held from the date of retirement until the age

of 65. The annual salary ranks from El 130 to E1400, in additionto pension.

Further information may be obtained from the AssistantDirector-General, The War Office (A.M.D.2), London, S.W.I.

ROYAL ARMY DENTAL CORPS

Registered dental surgeons of British nationality or citizensof the Irish Republic who are liable for service under the NationalService Act may apply for short-service commissions for not lessthan 3 years on the active list, with a reserve liability up to 8 yearsfrom the date of their appointment. Those (both men and women)who are not liable for service may apply for short-service commissionsfor varying periods of between 2 and 8 years on the active list. Anantedate of seniority counting towards increments of pay and timepromotion may be granted for postgraduate civil professional experi-ence ; previous commissioned service in the Armed Forces is alsotaken into consideration. A tax-free gratuity is payable. Officers ordental surgeons (male) may be appointed to permanent commissionsdirect or at any time during the short-service or National-Serviceengagement. Until further notice, those so appointed will be paid aspecial grant of &1250 (taxable) after one year’s satisfactory service asdental officers. The period of their short-service commissions willreckon towards ultimate retired pay and service gratuity, but wil’.not entitle them to short-service gratuities. Dental surgeons who areeligible to apply may obtain full particulars and application formfrom the Under-Secretary of State, The War Office (A.M.D.6)London, S.W.1.

Royal Air Force Medical BranchThe Royal Air Force offers an attractive career to fully

registered men and women medical practitioners who are

British subjects or citizens of the Irish Republic. Normally,the upper age-limit for applicants is 33, but older applicantsmay be considered. Appointment is usually to short-servicecommissions for three, four, five, or six years in the first

instance, each of which may be extended to complete a maxi-mum period of eight years’ service. Exceptionally, suitablecandidates may be appointed to permanent commissions directfrom civil life. Short-service officers may apply for permanentcommissions at any time during their service.

Medical officers come into contact with flying and airevacuation of sick and wounded, as well as the clinical special-ties and the treatment of Service families. There are, inaddition, opportunities in aviation medicine, hygiene, andindustrial medicine.

For regular officers, antedates of seniority may be admissiblefor recognised civil experience. These antedates reckontowards pay, seniority, and promotion. The normal rank onappointment is flying-officer, with promotion to flight-lieu-tenant after one year’s reckonable service, to squadron-leaderafter eight years’ reckonable service, and to wing-commanderafter seven years’ satisfactory service in the substantive rankof squadron-leader. Officers recognised as R.A.F. specialistswill be promoted to the rank of group-captain after eight years’satisfactory service in the substantive rank of wing-com-mander, and to ranks above group-captain by selection. Pro-motion to group-captain and above for non-specialist officerswill be by selection.

Officers serving on permanent commissions may be allowedstudy-leave with full pay and allowances to take approvedpostgraduate courses, for which tuition fees on an approvedscale may be granted. Officers having experience or aptitudein a specialty may be employed on specialist duties and subse-quently earn recognition as junior specialists with additionalpay of 4s. per day and as Royal Air Force specialists withadditional pay of 12s. per day. Non-specialist medical officersbelow the rank of group-captain will be awarded additionalpay of 4s. per day on gaining a registrable diploma in publichealth, industrial health, or tropical medicine, provided thatin each instance the prescribed period of study occupied anacademic year.

Officers appointed to permanent commissions will receivea grant of E1500 (subject to income-tax) after one year’ssatisfactory service and they will be entitled to retired pay and

bther benefits after completion of service. Short-seme:officers will, on completion of their commissions, be paid atax-free gratuity at the rate of E200 for each year of satisfactor,service. Arrangements exist to preserve their superannuMmrights under the National Health Service (Superannuatior.Regulations, 1950.

Further information can be obtained from the Unda-Secretary of State for Air, Air Ministry, M.A.1, 1-6, Tavistoa.Square, London, W.C.1 (Euston 5040, ext. 310).

ROYAL AIR FORCE DENTAL BRANCH

Commissions are available in the Royal Air Force Dental Bran,:to candidates of either sex who possess a degree or licence in dentalsurgery of a British university or licensing board, and who a::

registered under the Dental Act in force in the United Kingdor,.,Dental officers in the Royal Air Force have plenty of scope for ilthe aspects of dentistry in a branch which trains its own technician,and maintains its own laboratories under senior dental officer;,Dental officers serving on short-service or National-Service com. ’,missions may apply at any time for appointment to permanent com- !missions. The length of the period on a short-service commissio-and the period required in the reserve on its completion is the sam,

Bas for medical officers. Similarly, dental surgeons may be grantedpermanent commissions if they can complete at least twenty year,’service qualifying for retired pay. Previous commissioned servicecounts for antedate of seniority rank on appointment, and terms 01promotion the same as for medical officers, while antedates for civilexperience in a recognised professional appointment are given on th: ifollowing basis, subject to a maximum antedate of seven years forsuch experience: first four years, in full; any later experience, in half,Candidates who hold specialist appointments may be allowed tohave their civil experience assessed on a different basis, but withinthe same maximum of seven years. A tax-free gratuity, at the rate or

E170 a year for each year of satisfactory active-list service, is payabi,to short-service officers on transfer to the reserve. Dental officer

appointed to permanent commissions are encouraged to pursue therstudies in postgraduate research and may be allowed up to seven

months’ study leave on full pay and allowances to take approvepostgraduate courses. Until further notice, a grant of E1250, subjecto income-tax, will be made after one year’s satisfactory commissionccservice in the dental branch, to officers appointed to permanentcommissions. Short-service or permanent-commission officers whhave the appropriate higher qualifications and the requisite expenm;:may be recommended for specialist appointments. Further inform,tion may be had from the Under-Secretary of State, Air MinistnM.A.6, 1-6, Tavistock Square, London, W.C.1 (Euston 504,ext. 106).

Health Services at Home

PUBLIC HEALTH

AMONG the divisions of the nation’s health services, pubL;health ranks next in size and importance to the genera’practitioner and hospital services and it offers a satisfactorycareer to the young doctor keen to work for the welfare of the

community as well as for the individual.Under the National Health Service Act of 1946, council

counties and county boroughs were designated " local hearauthorities " and had conferred upon them, and through therupon their medical officers of health, wide responsibilities forprovision of personal health services. These include a duty

provide clinics and other services for mothers and yourchildren, domiciliary midwifery, home nursing, demesne herhealth visiting, immunisation, vaccination, and ambularservices. Wide powers are also given to these authorities

prepare and administer schemes for the prevention of di’-and for the care and aftercare of sick persons. Recentlyconcepts have been developing in the mental-health seryand there will be considerable expansion in local-=;-authority responsibilities as the result of the recommendin the report of the Royal Commission on the Law rto Mental Illness and Mental Deficiency. In most countrycounty boroughs the medical officer of health is prinClpi.: medical officer and is thus responsible for the preventiveservices covering children of all ages. In some areas :-’coordination has been secured by placing the authority’s

477

welfare services also under the medical officer of health. Underthe Local Government Act of 1958, many of these health andwelfare functions may now be delegated to the larger countydistrict authorities.

In county boroughs, boroughs, and urban and rural districts,the medical officer of health is responsible for environmentalhygiene. In contrast with the early days of public health when themedical officer of health was personally concerned with theexecution of many sanitary duties, health departments are noworganised to free him from much of the detailed work, which isperformed by trained lay officers, or even transferred to the careof other departments-as in the case of water-supply andsewerage disposal. Naturally, the extent of this devolution ofresponsibility varies widely, and in rural areas problems ofwater-supply and sanitation are still a major concern of themedical officer of health. The supervision of housing condi-tions is also a responsibility of the health department. All thiswork remains under the general control of the medical officer ofhealth, and he must supervise the purity of water-supplies eventhough their production is not his concern. Though lessconcerned with detailed work, supervision must be farwider than that exercised by his predecessor of a hundredyears ago.

Control of infection has always been one of the principalfunctions of the medical officer of health. Laboratory workershave made great advances in the identification of species andstrains of bacteria and viruses and new techniques applied toepidemic control have given the medical officer of health aninstrument of precision in much of his epidemiological work.The application of specific prophylactic measures againstvarious acute infections is now an important function of allhealth departments. Drastic reduction, if not the completeextinction, of many important infectious diseases has become afeasible target for all health departments.Recent developments have increased the opportunities for

the young medical officer to obtain a comprehensive training inpublic health. In the larger towns there are now more posts ofsenior-medical-officer grade, and in counties, schemes ofdivisional administration have been evolved. The work of themedical officer of health to a number of county districtauthorities is often combined with an appointment as assistantor divisional county medical officer of health. The holder ofsuch a post obtains a detailed knowledge of the communityunder his care, and, while retaining a high degree of individualresponsibility, he suffers none of the disadvantages of ruralisolation.A sound clinical background is an essential qualification for

:he new entrant and a course leading to the diploma in publichealth should be taken at an early stage since this qualificationis necessary for anyone seeking an appointment as a medicalofficer of health. For doctors engaged in clinical pre-ventive medicine a diploma in child health, in obstetricsand gynxcology, or in psychological medicine is an

advantage.Individual progress in a public-health career depends

largely, if not entirely, upon the doctor’s personal qualities;for, as adviser to his authority, the reputation of the medicalofficer of health depends on the soundness of the advice hegives. Quite apart from his statutory functions, he has animportant part to play in promoting the health education of thecommunity, and in helping to secure full coordination betweenthe branches of the health service in his area. He is assisted bythe regular liaison meetings, which are held in most regions,between the hospital boards and the county and countyborough medical officers of health. Most hospital boards relyon the medical officer of health to determine the urgency ofthe social grounds for admitting patients to hospital, especiallyin maternity cases and when considering the chronic sick.Some medical officers of health have been appointed as

members of hospital medical advisory committees or of

hospital management committees; and, through the NationalHealth Service Act, a closer relationship with the general-practitioner services has now become possible.

INDUSTRIAL MEDICAL SERVICES

INDUSTRIAL’or occupational medicine is gradually taking itsproper place among the branches of medicine. Whatever maybe the merits or demerits of a classical education, it is certainthat the social stigma placed by the ancient Greeks on themechanical arts and trades led to the neglect of the workingman in ancient medical practice and of the occupational diseasesby medical science. Even now the influence of the classics onthis aspect of medicine has not been entirely dissipated, andit is a rare physician who goes fully into the details of hispatient’s occupation and tries to estimate its effect on his health.This is surprising because there is no study more fascinatingthan that of the physical and mental reaction of man to hisenvironment. Industrial medicine has both preventive andcurative aspects but it is generally regarded as a branch ofpreventive medicine, and of public health in its wider sense,or even of the loosely defined concept of social medicine.

In November, 1954, the Minister of Labour and NationalService announced in the House of Commons that he haddecided to take steps to stimulate the further development ofindustrial health services in work-places covered by theFactories Acts. He later set up a standing industrial healthadvisory committee to carry out a review to ascertain whereindustrial health services most needed to be extended. Twopilot surveys have’been undertaken-one in Halifax and theother in Stoke-on-Trent-and the results of the Halifax surveyhave now been published.

It is to be hoped that the deliberations of the industrial-health advisory committee will lead to the creation of moreposts for doctors interested in occupational medicine. These

posts fall into various categories, such as those in the CivilService, the nationalised industries, research organisations, theuniversities, and factories. But, though the importance andopportunities of industrial medicine are increasingly recognised,it cannot yet be said that in salary or prospects the openingsin this work are always as favourable as those in the NationalHealth Service. For industrial posts within the Civil Service,the prospects have improved slightly as a result of the RoyalCommission on the Civil Service, but even at present this ser-vice does not offer enough senior appointments to assure

promotion to all who earn it. Moreover, as things are at

present, the top posts in the medical Civil Service are oftenfilled by doctors who previously held appointments outside theservice, and this is a discouragement to those who are con-templating entry through the basic grade.The appointments as medical officers to factories and other

industrial organisations vary in attractiveness, both as regardsopportunities and salaries. In some the conditions and pros-pects are good, and the British Medical Association has laiddown a scale of minimum salaries.

The main Government department supervising the healthof industrial workers is the Factory Department of the Ministryof Labour and National Service. This department, which upto 1940 worked under the Home Office, dates from 1833 andadministers the Factories Acts (1937 and 1948) with regulationson accident and sickness prevention, hours of work, amenities,and canteens. The inspectorate numbers about 412, of whom18 are doctors. Members of the department, whether lay ormedical, take part in the activities directed towards the pre-vention of illness and maintaining the health of the factorypopulation. The medical inspectors are stationed in London,Birmingham, Sheffield, Liverpool, Cardiff, Manchester,Glasgow, and Leeds; and from these centres they are able todeal with factory health and conditions in any part of thecountry. Under them 1750 general practitioners give part-timeservice as appointed factory doctors (previously called examin-ing surgeons), examining all young entrants into industry, andperiodically all those engaged in specific dangerous processes.In addition there are about 400 doctors employed whole-timein factories or groups of factories, and about 3000 (may be more)in part-time work. An interesting development in recent yearshas been the setting-up of medical services for looking afterworkers on trading estates. Three such schemes, at Slough,

478

Hillington, and Bridgend are well established and others areprojected to serve the trading estates at some of the " newtowns ". One such service is now in operation at Harlow inEssex. It has been a common criticism of the industrial medicalservices that the workers at small factories are not catered for,and these group services might well form a model for a nationalservice. It is well to bear in mind, however, that even infactories where there are no doctors a close watch on con-ditions is maintained by the Factory Department.

Apart from the Factory Department, other Governmentdepartments ’deal with various aspects of the industrial medicalservices. For instance, the Post Office, which employs moreworkers than any other department, has had a medical servicesince 1855; and since it deals with engineering and manualworkers in addition to office staffs, it is partly an industrialmedical service. The Post Office medical staff is now directedby the chief medical adviser to the Treasury, who has in addi-tion a staff of 15 doctors which deals with the health problemsof the Civil Service. The inspectorate of the Ministry of Fueland Power has a medical section with a few full-time medical

inspectors. The National Coal Board provides a comprehen-sive industrial medical service and research programme for the

industry which now has a large staff of whole-time doctors. TheMinistry of Supply Medical Service with 40 doctors deals withthe health of the workers in the Royal Ordnance factories, andin the research stations. The Ministry of Pensions and NationalInsurance has a medical staff both at headquarters and in theregions, which advises on compensation for industrial injuriesas well as for other causes of ill health. The former silicosisand asbestosis board is now a part of the medical service of the

Ministry. On the staff of the pneumoconiosis medical panels,as they are now called, are some 37 whole-time medical officerswho deal with the diagnosis and certification for compensationof cases of silicosis, asbestosis, and some other forms of pneumo-coniosis. They also carry out periodical medical examinationsof workers engaged in some scheduled occupations in whichcases of pneumoconiosis are likely to arise. The centres fromwhich the panels work are Swansea, Cardiff, London, Man-chester, Sheffield, Stoke-on-Trent, Bristol, Birmingham, andEdinburgh. Some of the newly nationalised industries haveestablished medical services-for example, the London Trans-port Executive, a part of the British Transport Commission.The London Transport Executive employs a chief medicalofficer with 9 full-time doctors. The National Dock LabourBoard also has a medical service consisting of 7 .full-timemedical officers and 1 part-time medical officer. Some, but notall, of the regional boards of the nationalised gas industry haveappointed whole-time and part-time doctors to look after thehealth of the workers.

In addition to investigations and research into industrialdiseases conducted by medical inspectors of factories, minesmedical officers and works doctors, much fundamental researchinto environmental conditions has been carried out by thevarious departments of the Medical Research Council. Clinicaland field studies made under the aegis of the council’s industrialpulmonary diseases committee include inquiry into the

pneumoconiosis of coalminers and the byssinosis of cottonworkers. The London Hospital department for research inindustrial medicine was established in 1943, and a few yearslater, in conjunction with the Ministry of Fuel and Power, abureau for research into pneumoconiosis and other diseases wasset up. Other units of the council dealing with industrial healthinclude the toxicological research unit at Carshalton, the groupsfor research in industrial and applied psychology in Cambridge,and London, and the industrial injuries and burns research unitat the Birmingham Accident Hospital. There is also a unit forresearch on climate and working efficiency at the department ofhuman anatomy at Oxford, a social medicine research unit atthe London Hospital, and a statistical research unit at theLondon School of Hygiene and Tropical Medicine. Problemson the health aspects of atomic energy are being dealt with atHarwell. Research into industrial health matters is also beingundertaken by the university departments mentioned below.

The Institute of Social Medicine at Oxford, which works undera joint board, also undertakes investigations into variousaspects of industrial health. At the London School of Hygieneand Tropical Medicine, the Rockefeller Occupational Heal=Unit was established in 1956. University chairs devoted toindustrial or occupational medicine have been set up at Man-chester and Durham. The chair of social medicine at Birmine-ham includes industrial medicine within its terms of referenc"and the University of Sheffield has appointed a professor 0:

social and industrial medicine. Students are likely to hear morzabout these subjects in their undergraduate courses. Post-graduate courses are held in London, Birmingham, Sheffield,and Manchester, and occasionally at other centres. Diplomasin Industrial Health (D.I.H.) have been instituted by theSociety of Apothecaries, the Conjoint Board of the RoyaiColleges of Physicians and Surgeons, and the Faculty of

Physicians and Surgeons of Glasgow. The Association o:

Industrial Medical Officers was formed some years ago bydoctors interested in industrial health, and branches have beenestablished in various parts of the country; the British Tournoiof Industrial Medicine is sponsored by this association in con-junction with the British Medical Association. The associationhas also since April, 1951, published a quarterly journal, calledthe Transactions of the Association of Industrial Medical Officers,which is devoted to the dissemination of information about the

practical aspects of industrial medicine rather than to origins)research.

PRISONS AND BORSTAL INSTITUTIONS

THE medical service is a part of the general-service class ofthe medical Civil Service, under the immediate control of the ’,Director of Medical Services at the Prison Commission. Thework is mainly clinical and the medical officer is responsiblefor the physical and mental welfare of the inmates, a responsi-bility which extends to a general oversight of the hygiene ofthe establishment in which he is working. The service i

expanding to meet the needs of a rising inmate population anuthe increased demands of present-day methods. It offers arattractive career to medical practitioners who are interestedin the various problems connected with crime and the under.standing and treatment of criminals. The medical and surgicalcases seen are comparable with those met with in outside

practice. The various establishments have their own hospita:accommodation; a large prison, for example, may well have ahospital with up to 100 beds. The doctor in a prison or borstalis a member of a team whose efforts are directed towardthe rehabilitation of those committed to its charge. On themedical side the aim must be not only to attend to ordinarday-to-day medical care but to discover, and if possible to

remedy, disabilities and maladjustments which hinder the

training of the offender and make it more difficult for him toregain a place among law-abiding citizens. Although noi -member of the National Health Service the prison medica-officer maintains a close liaison with the hospital and specialfacilities of that service, and thereby gains much both for hispatients and himself by contact with advances in medic-knowledge and procedures.

-

There are now over seventy establishments under the c-: trol of the Prison Commissioners, and as is to be expectthey vary very much in their size and purpose depending on theclass of inmate, and the medical requirements differ accoringly. At the larger establishments the medical work is in ahands of whole-time medical officers, whereas the institutions are served by part-time doctors who are u.-.local general practitioners. The more important prisons :-have as many as four or five full-time medical officers, to,-,",

’

with psychologists and psychological testing assistants. -’

few prisons there are also psychiatric social workers. Prinand senior medical officers have advisory and other dutiesconnection with small groups of establishments. The mec-

: officer is called upon to make medical and psychiatric r,2.-’: to the Commissioners from time to time. In remand . the preparation of reports to court and the giving of : -

479

evidence, particularly in regard to the mental condition ofoffenders, are important aspects of the work. Postgraduateexperience in psychiatry is therefore an advantage. Surgicaland psychotherapeutic units are established at selected centreswhere the work is undertaken mainly by visiting specialistsworking on a sessional basis and in close association with theregular medical staff.The national scales, in accordance with the general Civil

Service scales, are: .

Medical officer* E1690 rising by seven annual increments to a

maximum of E2300.Semor medical officer E2650Principal medical officer E2950

* Linked to aged 35 minus S45/50 for each year below that age, and plusone increment for each year above 35 up to 40 years of age.

Officers serving in London receive E40 to E50 a year more, and until1962, officers in certain provincial areas receive slightly less than the nationalrate.

The appointments are pensionable, without contributionsbeing required, and on retirement normally a pension andlump-sum gratuity are payable. There is also a contributorywidows’ and children’s pension scheme. Pensionable serviceunder the National Health Service and established CivilService may be aggregated for pension. Unfurnished quarters,when available, are provided at a moderate rental.Permanent appointments are made by the Civil Service

Commission, 6, Burlington Gardens, London, W.1, to whominquiries for such appointments should be addressed. Onoccasion temporary full-time appointments are available andfor such appointments as well as for part-time appointmentsparticulars can be obtained from the Prison Commission,Horseferry House, Dean Ryle Street, London, S.W.I.

Services Abroad

HER MAJESTY’S OVERSEAS CIVIL SERVICE :MEDICAL BRANCH

THE medical departments of the Governments of the terri-tories overseas for which the Secretary of State for the Coloniesis responsible offer a wide range of openings to the right typeof doctor. There is a large field of medical opportunity inthese territories and whatever political future they may have,there is no doubt that they will require the help and adviceof British medical men for many years to come. The work of amedical officer overseas is many-sided and requires a doctor ofall-round capabilities. There is an immense and fascinatingfield of clinical work, but the doctor must be prepared tooccupy himself with a good deal of public health and socialmedicine. He must, of course, be ready to work with non-European colleagues and although the actual conditions oflife and work vary greatly from territory to territory, life abroadhas many pleasant features and often gives more scope formdividual responsibility than life in Britain.Vacancies occur in many parts of the world. The greatest

number is in tropical Africa. Candidates must ordinarily beBritish subjects holding medical qualifications registrable inthe United Kingdom, and should normally be under 45 yearsof age. In some territories permanent appointments are avail-able. Candidates selected for permanent appointments becomemembers of the medical branch of Her Majesty’s OverseasCivil Service. Many future appointments are likely to be madeon the basis of short-term contracts, usually renewable, andcarrying a generous gratuity on termination. Doctors in theNational Health Service may take temporary appointmentsc. erseas up to six years without loss of pension rights.

In the first instance medical officers are usually appointed forgeneral duties, which require a balanced outlook upon bothpreventive and curative medicine. Such duties often involve- ..: charge of a district hospital and responsibility for theradical administration of a district. Although many officers_. _ employed on clinical duties in the large hospitals, somep-.n are purely concerned with public-health work and for

the possession of the D.P.H. is generally necessary.

There are many specialist appointments which, if per-marient, are normally filled from within the service by officerspossessing the necessary aptitude, experience, and qualifications,wherever they may be serving. Senior administrative appoint-ments are filled by the promotion of serving officers whoseopportunities are not necessarily confined to the territoriesin which they are serving.

Officers possessing qualifications or experience in pathologycan be considered for appointment to the laboratory establish-ments. Workers in the laboratories carry out pathologicaland biochemical examinations for clinical, forensic, and public-health purposes.

There are a number of posts for women doctors, particularlyfor those with special experience in obstetrics, school health,child welfare, and nutrition, although their employment isnot necessarily confined to these subjects.

Salaries vary considerably from territory to territory inaccordance with local conditions. Some existing salary scalesfor medical officers are:

Specialists and senior administrative officers receive super-scale salaries ranging broadly from E2300 to E3075 and inmany territories’there are cost-of-living allowances and allow-ances for children’s education. Passages are free and quartersare usually provided at a low rental. Leave is generous andofficers pay income-tax at local rates, mostly much lowerthan those in the United Kingdom. Private practice is allowedto a limited extent in some territories, according to localregulations.

It is impossible here to give more than a brief outline ofmedical appointments in the territories overseas and candi-dates are advised to seek fuller information from the Directorof Recruitment, Colonial Office, London, S. W.1.

FEDERATION OF RHODESIA AND NYASALAND

THE Federal Government administers the health servicesof Southern Rhodesia, Northern Rhodesia, and Nyasaland.The rates of pay for full-time officers are:

Government medical officers are permitted private generalpractice in the rural areas; the value of this varies considerablyand may reach E1000 a year, but where the net receipts fallbelow E200 a year a payment is made to bring the total receiptsto that figure. In other areas no private practice is allowed andan allowance of E200 a year is paid in lieu. Medical officers ofhealth who have not been promoted before reaching the topof their scale are paid a non-pensionable allowance at therate of E50 a year for each year they remain at the top of their