Bernardino Ramazzini is on the job

Looking for a career in healthcare? Occupational medicine, with its focus on treating work-related injuries and illnesses, is “the medical specialty ranked among the highest in satisfaction and lowest in professional burnout”, claims the American College of Occupational and Environmental Medicine.

It might come as a surprise to learn that the “scientific foundation to modern industrial hygiene – that is, today’s occupational medicine” – was laid by Italian physician Bernardino Ramazzini and his book De morbis artificum diatriba (Diseases of Workers), published in Modena, Italy, in 1700, “in which he described the effects of work on health for some 50 professions”.

In a 2002 paper published in the Croatian journal Archives of Industrial Hygiene and Toxicology (Arh Hig Rada Toksikol), researchers say Ramazzini’s work “is still relevant” and “deserves much greater attention”.

A 2013 paper in the Italian journal Annals of Hygiene: Preventative Medicine for the Community (Annali Di igiene: Medicina Preventiva e di Comunità) calls Ramazzini the “father of occupational medicine” and says “his thinking… is remarkably anticipatory of some concepts and trends of modern public health”.

The book took “at least” 10 years to conceive and write, says a 2015 paper in the journal Occupational and Environmental Medicine (OEM). “Ramazzini was 67 when he completed it, with more than 40 years of medical practice behind him.”

According to the paper, “Ramazzini tells us that the idea of writing a treatise on workers’ diseases came to him while watching tradesmen emptying his cesspit at home”.

In the book, describing the stresses of one occupation, Ramazzini says, “It follows that women weavers, I mean those who are engaged wholly in this occupation, ought to be particularly healthy and robust, otherwise they break down from overwork and as they get on in years are compelled to abandon this trade… Therefore in work so taxing moderation would be the best safeguard against these maladies, for men and women alike; for the common maxim ‘Nothing to excess’ is one that I excessively approve.”

Ramazzini was born in Carpi, Italy, on 4 October 1633. A 2001 article published by the American Journal of Public Health (AJPH), headlined “Bernardino Ramazzini: The Father of Occupational Medicine”, says that as a medical student at Parma University, he was already studying the diseases suffered by workers.

“In 1682, when he was appointed chair of theory of medicine at the University of Modena, Ramazzini focused on workers’ health problems in a systematic and scholarly way. He visited workplaces, observed workers’ activities, and discussed their illnesses with them. The medicine courses he taught were dedicated to the diseases of workers.”

The AJPH says each chapter of Diseases of Workers contains a description of the disease associated with a particular work activity, “followed by a literature analysis, workplace description, questions for workers, disease description, remedies, and advice. The clinical picture was directly observed by Ramazzini, who questioned workers about their complaints. He regularly asked his patients about the kind of work they did and suggested that all physicians do the same.”

Importantly, the AJPH says Ramazzini “realised that not all workers’ diseases were attributable to the working environment (chemical or physical agents). He observed that a variety of common workers’ diseases appeared to be caused by prolonged, violent, and irregular motions and prolonged postures.”

It says Ramazzini “studied the relationship between certain disorders and postural attitudes, repetition of movements, and weight-lifting and anticipated some preventive measures”.

Ramazzini believed progress in medicine should focus on physiology and clinical questions, and “should also cover the health of the population, observing any relations between environmental factors and disease”, says the OEM.

It says his approach “was influenced by the Hippocratic doctrine of ‘airs, waters, places’”, and also “refers to the need to test new criteria for observation ‘on the population’, using new tools for processing and interpreting the findings”.

Ramazzini linked doctor and worker, it says, because he saw “that a social and economic change was under way and, as an example, in his De Morbis, he insisted that manual workers should be granted full rights of citizenship”.

In his book, the OEM says, “the body of each chapter consists of a review of the literature, most of it found in general medical texts written by other physicians. However, he also looked at works by chemists, sociologists and even poets – a forerunner of today’s interdisciplinary attitudes.”

It says the book is structured under four main headings. The first groups the tasks “that expose workers to diseases connected to handling or working with minerals and metals, or other raw materials extracted from the earth”. The second comprises “workers who absorb toxins by inhalation, from the air”.

“The third heading deals with those activities that expose workers to fluids such as water, milk and alcoholic beverages. The fourth, and last, heading comprises diseases due to unnatural postures or positions held for long periods.”

He also emphasised that the four categories “presenting specific risk factors related to work are also linked – in some cases decisively – to the person’s social status, current lifestyle habits or even those of previous generations”. Ramazzini died on 5 November 1714, and the OEM paper calls for admiration of his foresight. “In today’s world, with its economic and financial problems, globalisation of work and continual shifts in a 24-hour cycle, Ramazzini offers us a highly topical lesson: medicine still merits a central place not only in debate in the scientific community, but above all in transferring scientific knowledge to policymakers.”