cost-effectiveness. Governments of developing countries have usually found,
for instance, that it is more cost-efficient to provide more people with
basic care.
Teaching. Physicians in developed countries frequently prefer posts in
hospitals with medical schools. Newly qualified physicians want to work
there because doing so will aid their future careers, though the actual
experience may be wider and better in a hospital without a medical school.
Senior physicians seek careers in hospitals with medical schools because
consultant, specialist, or professorial posts there usually carry a high
degree of prestige. When the posts are salaried, the salaries are
sometimes, but not always, higher than in a nonteaching hospital. Usually a
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
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