consultant who works in private practice earns more when on the staff of a

medical school.

In many medical schools there are clinical professors in each of the major

specialties—such as surgery, internal medicine, obstetrics and gynecology

and psychiatry—and often of the smaller specialties as well. There are also

professors of pathology, radiology, and radiotherapy. Whether professors or

not, all doctors in teaching hospitals have the two functions of caring for

the sick and educating students. They give lectures and seminars and are

accompanied by students on ward rounds.

Industrial medicine. The Industrial Revolution greatly changed, and as a

rule worsened, the health hazards caused by industry, while the numbers at

risk vastly increased. In Britain the first small beginnings of efforts to

ameliorate the lot of the workers in factories and mines began in 1802 with

the passing of the first factory act, the Health and Morals of Apprentices

Act. The factory act of 1838, however, was the first truly effective

measure in the industrial field. It forbade night work for children and

restricted their work hours to 12 per day. Children under 13 were required

to attend School. A factory inspectorate was established, the inspectors

being given powers of entry into factories and power of prosecution of

recalcitrant owners. Thereafter there was a succession of acts with

detailed regulations for safety and health in all industries. Industrial

diseases were made notifiable, and those who developed any prescribed

industrial disease were entitled to benefits.

The situation is similar in other developed countries. Physicians are bound

by legal restrictions and must report industrial diseases. The industrial

physician's most important function, however, is to prevent industrial

diseases. Many of the measures to this end have become standard practice,

but, especially in industries working with new substances, the physician

should determine if workers are being damaged and suggest preventive

measures. The industrial physician may advise management about industrial

hygiene and the need for safety devices and protective clothing and may

become involved in building design. The physician or health worker may also

inform the worker of occupational health hazards.

Modern factories usually have arrangements for giving first aid in case of

accidents. Depending upon the size of the plant, the facilities may range

from a simple first-aid station to a large suite of lavishly equipped rooms

and may include a staff of qualified nurses and physiotherapists and one or

perhaps more full-time physicians.

Periodic medical examination. Physicians in industry carry out medical

examinations, especially on new employees and on those returning to work

after sickness or injury. In addition, those liable to health hazards may

be examined regularly in the hope of detecting evidence of incipient

damage. In some organizations every employee may be offered a regular

medical examination.

The industrial and the personal physician. When a worker also has a

persona! physician, there may be doubt. in some cases, as to which

physician bears the main responsibility for his health. When someone has an

accident

or becomes acutely ill at work, the first aid is given or directed by the

industrial physician. Subsequent treatment may be given either at the

clinic at work or by the personal physician. Because of labour-management

difficulties, workers sometimes tend not to trust the diagnosis of the

management-hired physician.

Industrial health services. During the epoch of the Soviet Union and the

Soviet bloc. industrial health service generally developed more fully in

those countries than in the capitalist countries. At the larger industrial

establishments in the Soviet Union, polyclinics were created to provide

both occupational and general can for workers and their families.

Occupational physicians were responsible for preventing occupational

diseases and injuries, health screening, immunization and health education.

In the capitalist countries, on the other hand, no fixed pattern of

industrial health service has emerged. Legislation impinges upon health in

various ways, including the provision of safety measures, the restriction

of pollution and the enforcement of minimum standards of lightning,

ventilation, and space per person. In most of these countries there is

found an infinite variety of schemes financed and run by individual firms

or equally, by huge industries. Labour unions have also done much to

enforce health codes within their respective industries. In the developing

countries there has been generally little advance in industrial medicine.

Family health care. In many societies special facilities are provided for

the health care of pregnant women mothers, and their young children. The

health care needs of these three groups, are generally recognized to be so

closely related as to require a highly integrated service that includes

prenatal care, the birth of the baby. the postnatal period, and the needs

of the infant. Such a continuum should be followed by a service attentive

to the needs of young children and then by a school health service. Family

clinics are common in countries that have state-sponsored health services,

such as those in the United Kingdom and elsewhere in Europe. Family health

care in some developed countries, such as the United States, is provided

for low-income groups by state-subsidized facilities, but other groups

defer to private physicians or privately run clinics.

Prenatal clinics provide a number of elements. There is first, the care of

the pregnant woman, especially if she is in a vulnerable group likely to

develop some complication during the last few weeks of pregnancy and

subsequent delivery. Many potential hazards, such as diabetes and high

blood pressure, can be identified and measures taken to minimize their

effects. In developing countries pregnant women are especially susceptible

to many kinds of disorders, particularly infections such as malaria. Local

conditions determine what special precautions should he taken to ensure a

healthy child. Most pregnant women, in their concern to have a healthy

child, are receptive to simple health education. The prenatal clinic

provides an excellent opportunity to teach the mother how to look after

herself during pregnancy, what to expect at delivery, and how to care for

her baby. If the clinic is attended regularly, the woman's record will he

available to the staff that will later supervise the delivery of the baby:

this is particularly important for someone who has been determined to be at

risk. The same clinical unit should he responsible for prenatal, natal, and

postnatal care as well as for the care of the newborn infants.

Most pregnant women can he safely delivered in simple circumstances without

an elaborately trained staff or sophisticated technical facilities,

provided that these can be called upon in emergencies. In developed

countries it was customary in premodern times for the delivery to take

place in the woman's home supervised by a qualified midwife or by the

family doctor. By the mid-20th century women, especially in urban areas,

usually preferred to have their babies in a hospital, either in a general

hospital or in a more specialized maternity hospital. In many developing

countries traditional birth attendants supervise the delivery. They are

women, for the most part without formal training, who have acquired skill

by working with others and from their own experience. Normally they belong

to the local community where they have the confidence of

the family, where they are content to live and serve, and where their

services are of great value. In many developing countries the better

training of him attendants has a high priority. In developed Western

countries there has been a trend toward delivery by natural childbirth,

including delivery in a hospital without anesthesia, and home delivery.

Postnatal care services are designed to supervise the return to normal of

the mother. They are usually given by the staff of the same unit that was

responsible for the delivery. Important considerations are the mailer of

breast- or artificial feeding and the care of the infant. Today the

prospects for survival of babies born prematurely or after a difficult and

complicated labour, as well as for neonates (recently born babies) with

some physical abnormality, are vastly improved. This is due to technical

advances, including those that can determine defects in the prenatal stage,

as well as to the growth of neonatology as a specialty. A vital part of the

family health-care service is the child welfare clinic, which undertakes

the care of the newbom. The first step is the thorough physical examination

of the child on one or more occasions to determine whether or not it is

normal both physically and, if possible, mentally. Later periodic

examinations serve to decide if the infant is growing satisfactorily.

Arrangements can be made for the child to be protected from major hazards

by, for example, immunization and dietary supplements. Any intercurrent

condition, such as a chest infection or skin disorder, can be detected

early and treated. Throughout the whole of this period mother and child are

together, and particular attention is paid to the education of the mother

for the care of the child.

A pan of the health service available to children in the developed

countries is that devoted to child guidance. This provides psychiatric

guidance to maladjusted children usually through the cooperative work of a

child psychiatrist, educational psychologist, and schoolteacher.

Geriatrics. Since the mid-20th century a change has occurred in the

population structure in developed countries. The proportion of elderly

people has been increasing. Since 1983, however, in most European countries

the population growth of that group has leveled off, although it is

expected to continue to grow more, rapidly than the rest of the population

in most countries through the first third of the 21st century. In the late

20fti century Japan had the fastest growing elderly population.

Geriatrics, the health care of the elderly, is therefore a considerable

burden on health services. In the United Kingdom about one-third of all

hospital beds are occupied by patients over 65; half of these are

psychiatric patients. The physician's time is being spent more and more

with the elderly, and since statistics show that women live longer than

men, geriatric practice is becoming increasingly concerned with the

treatment of women. Elderly people often have more than one disorder, many

of which are chronic and incurable, and they need more attention from

health-care services. In the United States there has been some movement

toward making geriatrics a medical specialty, but it has not generally been

recognized.

Support services for the elderly provided by private or state-subsidized

sources include domestic help, delivery of meals, day-care centres, elderly

residential homes or nursing homes, and hospital beds either in general

medical wards or in specialized geriatric units. The degree of

accessibility" of these services is uneven from country to country and

within countries. In the United States, for instance, although there are

some federal programs, each state has its own elderly programs, which vary

widely. However, as the elderly become an increasingly larger part of the

population their voting rights are providing increased leverage for

obtaining more federal and state benefits. The general practitioner or

family physician working with visiting health and social workers and in

conjunction with the patient's family often form a working team for elderly

care.

In the developing world, countries are largely spared such geriatric

problems, but not necessarily for positive reasons. A principal cause, for

instance, is that people do not live so long. Another major reason is that

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