In the 1930s in Britain, industrial medicine was a clinical discipline, the main purposes of which were to diagnose disability in applicants for work, to identify industrial disease in the dangerous trades, and to provide first aid treatment for those injured or taken sick in the workplace. Following rapid developments in epidemiology and occupational hygiene and with more emphasis on "group health" and less on "individual care", occupational medicine has tended to become less of a clinical discipline; yet clinical skills are needed to assess fitness for work, to identify adverse effects of work, and to undertake consultations on a variety of health problems. Although care of the individual worker is a major task, an occupational health service has a responsibility for the health of the workforce as a whole, using epidemiology to plan and administer health care, to identify and control work related disorders, and to promote health by identifying positive factors in the organisation that induce a sense of well being; and by health screening and education programmes. Academic occupational health should not lose its identity as a clinical discipline in any merger with environmental health. Medical skills are needed to assess fitness for work and to identify human responses to adverse factors in the environment and to evaluate control measures.