Occupational medicine and the clinician.

Occupational medicine has been formally recognized as a specialty since 1978 but until recently it has been practised largely outside the National Health Service so that its content and scope may be unfamiliar to many doctors. The Faculty of Occupational Medicine which has just celebrated its tenth anniversary has, as one of the features of the examination for Associateship, a requirement to pass in a practical clinical test; possession of the diploma of Membership of the Royal College of Physicians (MRCP), however, allows exemption from it. This is a reflection of the origins of occupational medicine in clinical medicine. As the medical historian Henry Sigrist wrote 'occupational diseases are different from other diseases not biologically but socially'. The founding fathers of the specialty, Ramazzini (1633-1714), Charles Turner Thackrah (1795-1833) and Donald Hunter (18981978), to name a few, were all general clinicians. In fact the general practitioner and the medical or surgical specialist are still much more likely to be the first to see occupational disease than a specialist in occupational health. One function of the latter is, of course, that of promoting prevention; indeed occupational diseases as seen in the first half of this century are now uncommon. The activities of occupational physicians together with those ofother members ofthe occupational health team such as occupational hygienists have contributed substantially to improved standards in the workplace, and to the decline in occupational diseases. Another approach which has been used increasingly over the last three decades is the application of epidemiological techniques in the study of illness (particularly cancers) in working groups, especially in diseases which may occur frequently in the population at large, but may also be caused by specific occupational exposures. However, it remains important to be able to deal adequately with the occupational diseases which still occur and to consider in differential diagnosis the possibility of a work-related disease; there is also always the possibility of a new and unrecorded condition turning up in consulting room or clinic as has happened a number of times within the professional lifetime ofmany of us; for example, liver cancer from exposure to vinyl chloride, and occupational asthma from isocyanates and other inhaled materials.