special session work-relatedness of health problems: a ... of modena and reggio emilia modena, italy...

University of Modena

and Reggio Emilia

Modena, Italy

Special Session

Work-relatedness of health problems:

a Blind Spot in curative care?


and Reggio Emilia

Modena, Italy

Ramazzini revisited:Have doctors learnt the lesson?

G FrancoSchool of medicine – University of Modena

and Reggio Emilia - Teaching hospital, Modena - Italy


and Reggio Emilia

Modena, Italy

Giordano Bruno

Tommaso Campanella

Galileo Galilei

Claudio Monteverdi

Pierluigi da Palestrina

Giorgio Vasari

Guercino

Culture and society in XVII century Italy


and Reggio Emilia

Modena, Italy

Herman Boerhaave“dissection of human bodies”

Francesco Redi

“every living thing comes

from an egg”

William Harvey

“circulation of blood”

Biological Advances in XVII century

Antoine van Leeuwenhoek

“observation of blood circulating

in capillaries”


and Reggio Emilia

Modena, Italy

Health problems in the XVII century

It was rather odd for clinicians of that time to

devote themselves to the investigation of the

relation between health and work

In fact, the majority of population faced health

problems much more basic than work-related

ones and doctors’

attention was

attracted mainly by

the richest people

illnesses


and Reggio Emilia

Modena, Italy

Ramazzini’s interest in workers’

health

At the beginning

• His attention was drawn to workers in foundries andtanneries during his student years

The idea for the treatise

• It came when his attention was attracted by the speed withwhich a sewage worker emptied the sewer at Ramazzini’shouse

• The man answered that too long a stay in such place wouldcause blindness

• Ramazzini found that sewage workers showed severeredding of the eyes and that many of them became blind


and Reggio Emilia

Modena, Italy


and Reggio Emilia

Modena, Italy

Diagnosis

Treatment

Medical Evidence

Right-to-

know,

Education &

Training

Exposure

Restrictions &

Hygienic Measures

Fitness to Job

Pathological

Events

Adaptation of Work

to Man

Prevention

Groups of Workers

Signs and Symptoms Work History

Hazards

Analysis of the Workplace

From: Franco G. Focusing Bernardino Ramazzini’s Preventive View in Health Protection.

1st ICOH Conference on the History of Occupational and Environmental Prevention, Rome, 1998


and Reggio Emilia

Modena, Italy

is also based on

can be avoided by

are characterized by

Diagnosis

Treatment

Medical Evidence

is based on

Right-to-

know,

Education &

Training

Exposure

Restrictions &

Hygienic MeasuresFitness to Job

Pathological

Events

are caused by

are framed by

Prevention

allows

Groups of Workers

are exposed to

Signs and Symptoms

can be observed in

show

are investigated by

Hazards

can explain

can be

detected by

is necessary for

allows


Work History

Adaptation of Work

to Man




and Reggio Emilia

Modena, Italy

is also based on

can be avoided by

are characterized by

Diagnosis

Treatment

Medical Evidence

is based on

Right-to-

know,

Education &

Training

Exposure

Restrictions &

Hygienic MeasuresFitness to Job

Pathological

Events

are caused by

are framed by

Prevention

allows

Groups of Workers

are exposed to

Signs and Symptoms

can be observed in

show

are investigated by

Hazards

can explain

can be

detected by

is necessary for

allows


Work History

Adaptation of Work

to Man

““WhenWhen youyou come come toto a a

patientpatient’’s house, s house, youyou

shouldshould askask himhim.....what.what

occupationoccupation doesdoes hehe

followfollow??”” [ [DiseasesDiseases of of WorkersWorkers. The Latin . The Latin texttext of 1713 of 1713 revisedrevised withwith

translationtranslation and notes and notes byby WilmerWilmer Cave Cave WrightWright. Chicago: The. Chicago: The

University of Chicago Press, 1940), p. 13]University of Chicago Press, 1940), p. 13]




and Reggio Emilia

Modena, Italy

““WhenWhen youyou come come toto a a patientpatient’’ss

house, house, youyou shouldshould askask himhim.....what.what

sortsort of of painpain hehe hashas, , whatwhat causedcaused

themthem, , howhow manymany daysdays hehe hashas beenbeen

illill……”” So So sayssays HippocratesHippocrates in in hishis

workwork De De AffectionibusAffectionibus


and Reggio Emilia

Modena, Italy

““Accordingly I have tried to unearth inAccordingly I have tried to unearth in

the shops the shops of craftsmen, for these shopsof craftsmen, for these shops

are schools whence one can depart withare schools whence one can depart with

more precise knowledge...and, which ismore precise knowledge...and, which is

the the main thingmain thing, to suggest , to suggest medicalmedical

precautions for the preventionprecautions for the prevention and and

treatment of such diseases as usuallytreatment of such diseases as usually

affect affect ththe workerse workers””


and Reggio Emilia

Modena, Italy

Stone-cutters

Sulphur-workersTanners

The Learned

Tinsmiths

Tobacco-workers

Vintners

Voice-trainersand Singers

Weavers

Well-diggers

Workers onminutes objects

Workers whostand

Writers andNotaries

Painters

Plasterers andLime-workers

Porters

Potters

Printers

Razor and LancetGrinders

Runners

Sailors andRowers

Salt-workers

Sedentary workers

Soap-makers

Soldiers

Starch-makers

Farmers

Fishermen

Fullers

Gilders

Glass-makers

Healers byinunction

Hemp Flax, andSilk-workers

Horsemen

Hunters

Laundresses

Lutestring-makers

Midwives

Miners

Nurses

Oilmen

Apothecaries

Athletes

Bakers andMillers

Bathmen

Blacksmiths

Brick-makers

Carpenters

Cheese-makers

Chemists

Cleaners ofcesspits

Confectioners

Coppersmiths

Corn-sifters andMeasurers

Corpse-workers

Syllabus of occupations in the de Morbis Artificum Diatriba


and Reggio Emilia

Modena, Italy

The relationship between occupations

and diseases

Chemicals agents

• Dangerous materials chemicals such as

mineral dusts for miners and stonecutters,

vegetable particles for tobacco and carding

workers and vapours for vintners and

confectioners, could be inhaled or penetrate the

skin

• Disorders were classified according to the agent

From: Franco G. Ramazzini’s and workers’ health. Lancet 1999

Franco G. Bernardino Ramazzini’s “De Morbis Artificum Diatriba”. American Journal of Public Health 2001


and Reggio Emilia

Modena, Italy


and diseases

Physical agents

• Excess noise affecting coppersmiths

• Other physical agents (heat, cold, humidity) as

potential causes of illnesses for people such as

glassworkers, bakers, brickmakers and

laundresses




and Reggio Emilia

Modena, Italy


and diseases

Impossibility to ascribe all workers’ diseases

to chemicals or physical agents

Common diseases caused by

• maintenance of prolonged stationary postures or

unnatural postures (workers who stand,

sedentary workers, grooms, scribes, weavers)

• activities requiring heavy muscular effort

(porters, woodworkers)




and Reggio Emilia

Modena, Italy

““……itit isis muchmuch betterbetter toto preventprevent thanthan toto

cure, and so cure, and so muchmuch easiereasier toto foreseeforesee

future future harmharm and and avoidavoid itit ratherrather thanthan

havehave toto getget ridrid of of itit after after havinghaving fallenfallen

preyprey””..


and Reggio Emilia

Modena, Italy

Would Ramazzini’s colleagues

appreciate the topic?

He knew his colleagues would not appreciate

this new approach, because it required to

abandon habits of cleanliness and

refinements

“...I hesitate and wonder whether I shall

bring bile to the noses of the doctors...

if I invite them to come to the latrines”


and Reggio Emilia

Modena, Italy

Ramazzini revisited:Have doctors learnt the lesson?

G FrancoSchool of medicine – University of Modena

and Reggio Emilia - Teaching hospital, Modena - Italy

special session work-relatedness of health problems: a ... of modena and reggio emilia modena, italy...

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