Today I am raising a glass of gin and tonic to the memory of Bernardino Ramazzini who was born on this day in 1633. He was an Italian physician who was one of the first to realise the value of cinchona bark, from which quinine (and therefore tonic water) is derived, in the treatment of malaria. He was also the first man to make a serious study of occupational diseases. Although certain work related diseases had been noted before, it was generally thought that illnesses were caused by an imbalance in humours within the body.
He began to study diseases that were caused by a person’s occupation whilst he was studying at university in Parma. It began with a chance encounter with a cesspool cleaner who suffered from an eye infection. From him, he learned that it was a common affliction amongst others of his profession that often led to blindness. He then began to visit people in their workplaces, note the conditions and ask them if there were any illnesses that were common to their profession.
He went on to study over fifty different groups of workers including miners, apothecaries, cheese makers, millers, painters, soap makers, corpse bearers, laundresses, stonemasons and midwives. In 1700 he published his findings in a book called ‘De Morbis Artificum Diatriba’ (Diseases of Workers). As well as the obvious hazards such as dust and working with corrosive or poisonous materials, he also noted that various postures or repetitive motions could also lead to problems. He described how exhausting it is to be doing a job where you are continually standing up. But he recognised that it is also bad to be sitting down all day crouched over your work and that it was likely to cause back pain. When he talked about clerks, he also mentioned problems caused by writing all the time. To have your muscles and tendons in your arm strained and your hand continuously moving in the same direction, he noted, leads eventually to weakness in the writing hand. If you spend a lot of time bent over a keyboard, you probably know that feeling.
Although there was often little he could do about the hazards he identified, he recommended ways of avoiding problems such as periods of rest for people doing heavy manual work, moving about a bit for people who have to sit down all the time. Things that sound like common sense to us now because we’ve heard it so often, but most of his colleagues thought it was nonsense.
For midwives, Ramazzini noted the importance of washing in wine or vinegar, because catching syphilis from their patients was a very real danger. He discovered that painters tended to suffer from convulsions, which he identified as due to the minerals in their paints and the fumes from their varnishes. He noticed that they also tended to lick their pencils and go about with ‘nasty daubed clothes’. When he visited apothecaries, they complained of ‘stupidity and lethargy’ when preparing any medicine containing opium. For this, he recommended stepping out into the fresh air frequently. He felt very sorry for corpse bearers, because of the tradition of burials in a family vault. It meant they were forever having to take the dead down into cellars full of rotting corpses. He much admired the rural practice of putting the body in a box, digging a hole in a field, burying it and leaving it there. He could only suggest that the vaults were opened some time prior to burial: “so the imprisoned steams may gradually fly out.” He did add though that, sadly, he never knew an old corpse bearer.
If you want to know about the diseases of wrestlers or learned men, or anything else, you can browse a translation of his book here. Around the 4th century BC, Hippocrates had recommended a doctor to ask his patient what sort of pains he had, what had caused them, how many days he had been ill, whether his bowels were working and what sort of food he ate. Ramazzini suggested adding to the list a sixth question: “What is your occupation?”