456 STUDENTS’ GUIDE 1955-56

It is to be hoped that the deliberations of the industrial-health advisory committee will lead to the creation ofmore posts for doctors interested in occupational medi-cine. These posts fall into various categories, such asthose in the Civil Service, the nationalised industries,research organisations, the universities, and factories.But, though the importance and opportunities of industrialmedicine are increasingly recognised, it cannot yet besaid that in salary or prospects the openings in this workare always as favourable as those in the NationalHealth Service. For industrial posts within the CivilService, the prospects may improve after the RoyalCommission on the Civil Service reports, but at presentthis service does not offer enough senior appointments toassure promotion to all who earn it. Moreover, as thingsare at present, the top posts in the medical Civil Serviceare often filled by doctors who previously held appoint-ments outside the service, and this is a discouragement tothose who are contemplating entry through the basic grade.The appointments as medical officers to factories and

other industrial organisations vary in attractiveness,both as regards opportunities and salaries. In some theconditions and prospects are good, and the BritishMedical Association has laid down a scale of minimumsalaries.The main Government department supervising the

health of industrial workers is the Factory Departmentof the Ministry of Labour and National Service. Thisdepartment, which up to 1940 worked under the HomeOffice, dates from 1833 and administers the Factory Acts(1937 and 1948) with regulations on accident and sicknessprevention, hours of work, amenities, and canteens. Theinspectorate numbers about 412, of whom 16 are doctors.Members of the department, whether lay or medical, takepart in the activities directed towards the prevention ofillness and maintaining the health of the factory popula-tion. The medical inspectors are stationed in London,Birmingham, Sheffield, Liverpool, Bristol, Manchester,Glasgow, Leeds, and Wolverhampton ; and from thesecentres they are able to deal with factory health andconditions in any part of the country. Under them 1750general practitioners give part-time service as appointedfactory doctors (previously called examining surgeons),examining all young entrants into industry, and periodic-ally all those engaged in specific dangerous processes.In addition there are about 300 doctors employed whole-time in factories or groups of factories, and about 3000(maybe more) in part-time work. An interesting develop-ment in recent years has been the setting-up of medicalservices for looking after workers on trading estates.Three such schemes, at Slough, Hillington, and Bridgendare well established and others are projected to servethe trading estates at some of the " new towns." It hasbeen a common criticism of the industrial medical servicesthat the workers at small factories are not catered for,and these three group services might well form a modelfor a national service. It is well to bear in mind, how-ever, that even in factories where there are no doctors aclose watch on conditions is maintained by the factorydepartment.Apart from the factory department, other government

departments deal with various aspects of the industrialmedical services. For instance, the Post Office, whichemploys more workers than any other department, hashad a medical service since 1855 ; and since it deals withengineering and manual workers in addition to officestaffs, it is partly an industrial medical service. ThePost Office medical staff is now directed by the chiefmedical adviser to the Treasury, who has in addition astaff of 15 doctors which deals with the health problemsof the Civil Service. The Inspectorate of the Ministry ofFuel and Power has a medical section with a few full-timemedical inspectors. The National Coal Board provides acomprehensive industrial medical service for the industrywhich now has a large staff of whole-time doctors. TheMinistry of Supply Medical Service with 40 doctors,deals with the health of the workers in the Royalordnance factories, and in the research stations. The

Ministry of Pensions and National Insurance has a

medical staff both at headquarters and in the regions,which advises on compensation for industrial injuries aswell as for other causes of ill health. The former silicosisand asbestosis board is now a part of the medical serviceof the Ministry. On the staff of the pneumoconiosis

medical panels, ’as they are now called, are 24 whole-time medical officers who deal with the diagnosis andcertification for compensation of cases of silicosis,asbestosis, and some other forms of pneumoconiosis.They also carry out periodical medical examinations ofworkers engaged in some scheduled occupations in whichcases of pneumoconiosis are likely to arise. The centresfrom which the panels work are Swansea, Cardiff, London,Manchester, Sheffield, Bristol, and Edinburgh. Some ofthe newly nationalised industries have established medicalservices-for example, the London Transport Executive,a part of the British Transport Commission. TheLondon Transport Executive employs a chief medicalofficer with 9 full-time doctors. The National DockLabour Board also has a medical service consisting of 7full-time medical officers and 1 part-time medical officer.Some, but not all, of the regional boards of the nationalisedgas industry have appointed whole- and part-timedoctors to look after the health of the workers. A moveis on foot to set up medical services in all regions, andduring the year several new appointments have beenmade.

In addition to investigations and research into industrialdiseases conducted by medical inspectors of factories,mines medical officers, and works doctors, much funda-mental research into environmental conditions has beencarried out by the investigators of the Industrial HealthResearch Board of the Medical Research Council. Clinicaland field studies made under the aegis of the council’sindustrial pulmonary diseases committee include inquiryinto the pneumoconiosis of coalminers and the byssinosisof cotton workers. The London Hospital department forresearch in industrial medicine was established in 1943,and a few years later, in conjunction with the Ministry ofFuel and Power, a bureau for research into the pneumo-coniosis of South Wales coalminers was set up at Cardiff.Other units of the council dealing with industrial healthinclude the toxicological research unit at Porton, thegroups for research in industrial physiology and psycho-logy in Manchester, Cambridge, and London, and theindustrial medicine research unit at the BirminghamAccident Hospital. There is also a unit for research onclimate and working efficiency at the department ofhuman anatomy at Oxford, a social medical researchunit at the Central Middlesex Hospital, and a statisticalresearch unit at the London School of Hygiene andTropical Medicine. Problems on the health aspects ofatomic energy are being dealt with at Harwell. Researchinto industrial health matters is also being undertakenby the university departments mentioned below. TheInstitute of Social Medicine at Oxford, which worksunder a joint board, also undertakes investigations intovarious aspects of industrial health. University chairsdevoted to industrial or occupational medicine have beenset up at Manchester and Durham. The chair of socialmedicine at Birmingham includes industrial medicinewithin its terms of reference, and the University ofSheffield has appointed a professor.of social and industrialmedicine. Students are likely to hear more about thesesubjects in their undergraduate courses. Postgraduatecourses are held in London, Birmingham, Sheffield, andManchester, and occasionally at other centres. Diplomasin Industrial health (D.I.H.) have been instituted by theSociety of Apothecaries, the Conjoint Board of the RoyalColleges of Physicians and Surgeons, Edinburgh Univer-sity, and the Faculty of Physicians and Surgeons of Glas-gow. The Association of Industrial Medical Officers wasformed some years ago by doctors interested in industrialhealth, and branches have been established in variousparts of the country; the British Journal of IndustrialMedicine is sponsored by this association in conjunctionwith the British Medical Association. The association hasalso since April, 1951, published a quarterly journal, calledthe Transactions of the Association of Industrial MedicalOfficers, which is devoted to the dissemination ofinformation about the practical aspects of industrialmedicine rather than to original research.

PRISONS AND BORSTAL INSTITUTIONS

THE medical service is a part of the general serviceclass of the medical Civil Service. It is under theimmediate control of the Director of Prison MedicalServices at the Prison Commission. The service comprises

457SERVICES ABROAD

principal medical officers, senior medical officers, medicalofficers, and part-time medical officers. Whole-time med-ical officers are appointed to the larger prisons and Bor-stals, and at the most important establishments thereare senior medical officers, assisted by one or more medicalofficers. The senior medical officers also have advisory andother duties in connection with small groups of establish-ments. The medical officer is also required to payattention to sanitation and the general hygiene of theprison and to keep a close watch on food and nutrition.The making of psychiatric assessments, the provisionof medical and psychiatric reports, and the giving ofevidence in court when called upon are importantaspects of the work. Surgical and psychotherapeuticunits are established at selected centres. Candidatesmust be fully qualified and registered and should possessa sound knowledge of medical and surgical practice ;preference is given to those who, in addition, have hadpostgraduate experience in psychological medicine.

Salaries are in accordance with the general Civil Servicescales :

Medical officer* 1500 x .S75-.81800 x 100-.82100.Senior medical officer 2200.

*Linked to age 35, minus P50 for each year below that age ; andplus one increment for each year above that age but notexceeding age 40.

The appointments are pensionable. Unfurnished quarters,when available, are provided at a moderate rental.Appointments are made by the Civil Service Commission,6, Burlington Gardens, London, W.1, to whom allinquiries should be addressed.At the smaller prisons and Borstals no whole-time

medical officers are employed ; local practitioners areusually appointed as part-time officers. Further particu-lars of these appointments can be obtained from thePrison Commissioners, Horseferry House, Dean RyleStreet, London, S.W.I. Revised scales of salary forpart-time medical officers have been agreed with theBritish Medical Association.

Services Abroad

HER MAJESTY’S OVERSEA SERVICE

VACANCIES for medical officers occur in nearly allColonial Territories, the greatest number being in tropicalAfrica (e.g., Nigeria, Kenya, Uganda, Tanganyika, &c.).Candidates who wish to make their career in thoseterritories may become members of the medical branchof H.M. Oversea Civil Service, and in that case theassurance given by the Secretary of State in Parliamentabout conditions of service and pension rights will apply,should the territory in which the officer is serving attainself-government.’ Candidates must ordinarily be Britishsubjects holding medical qualifications registrable in theUnited Kingdom and have completed their preregistra-tion year. They must normally be under 40 or 45 yearsof age, according to the age of retirement in the territoryto which they are appointed. In West Africa this is50 years, and in most other territories 55. In manyterritories officers may serve beyond the age of retire-ment with the Governor’s permission. Contract appoint-ments for short terms are available for candidates whoare above the age-limits or who, while being withinthese limits, do not wish to commit themselves to acolonial career at the outset. Doctors in the NationalHealth Service may also avail themselves of a schemewhich has been brought into operation in many colonialterritories whereby they take up appointments up tosix years without loss of pension rights in the NationalHealth Service. The scheme provides for the paymentof a gratuity on leaving the service, but those who areeligible and who wish to transfer to the permanent andpensionable establishment of a Colonial Medical Depart-ment will have opportunities to do so. The serviceoffers special opportunities and experience npt obtainableat home, and that experience will be of great value todoctors both in practices and in hospital appointmentsif they elect to return to this country. Officers appointedto the permanent service are normally required to takea course in tropical medicine and hygiene either beforegoing overseas or during their first leave.

1. Colonial no. 306 of 1954. H.M. Stationery Office.

Medical officers are usually appointed in the firstinstance for general duties, which require all-round abilityand a balanced outlook upon both preventive and curativemedicine. Such duties often imply the charge of a districthospital and responsibility for the medical administrationof a district, although many officers are employed onclinical duties in the large hospitals. Some posts areconcerned purely with public-health work and for thesethe possession of a D.P.H. or special experience in pre-ventive medicine is necessary. In the general field thereare ample opportunities for original investigation, andsubsequent specialisation is encouraged. Opportunitiesare offered wherever possible for officers to study forpostgraduate qualifications in approved branches ofmedicine, surgery, or public health.A large number of specialist appointments exist which

are normally filled from within the service by officerswith the necessary aptitude and qualifications. Forthese appointments a very high standard of professionalattainment is required. Senior administrative appoint-ments are also almost invariably filled by the promotionof serving officers. Promotion takes place in the adminis-trative or specialist branches either in the territorywhere the officer is serving or on transfer to another.The scope for promotion is therefore considerable. Anofficer need not transfer if he does not wish to. Thetotal of the establishments of the various governmentmedical departments amounts to some 800 Europeanmedical officers and an even greater number of officersappointed locally.

Officers possessing qualifications or experience inpathology would be considered for appointment to thelaboratory establishments. Workers in the laboratoriescarry out pathological and biochemical examinations forclinical, forensic, and public-health purposes. In thisbranch has been carried out a great deal of the researchwork which has led to important advances in the know-ledge of tropical medicine and local health problems.Vacancies exist from time to time for women doctors,especially for those with special experience in obstetrics,school health, child welfare, and nutrition, although theiremployment is not necessarily confined to these subjects.

Naturally in tropical and subtropical countries diseasespeculiar to hot climates predominate in the generalpattern of morbidity ; but the whole gamut of patho-logical conditions found in temperate climates occurs inthe tropics, and doctors in the service are expected tokeep abreast of the trend of modern medical opinionin Britain.Of late years progress in the control of tropical diseases

has been so rapid that Europeans can now live in comfortand in hygienic surroundings in areas which two decadesago were notoriously unhealthy. There is still, however,a great deal to be done ; and with the expansion ofmedical services to raise health standards in all colonies,the service offers special opportunities and ample scopefor initiative and original observation in clinical subjects,preventive medicine, and research. Full particulars ofterms and conditions of service may be obtained fromthe Director of Recruitment, Colonial Office, SanctuaryBuildings, Great Smith Street, London, S.W.I.

FEDERATION OF RHODESIA AND NYASALAND

THE Federal government took over the administrationof the health services previously maintained by theGovernments of Southern Rhodesia, Northern Rhodesia,and Nyasaland on July 1, 1954. The rates of pay forfull-time officers are :