Bernardino Ramazzini

Born 1633
Died 1714

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Italian physician, born November 3, 1633, Carpi, duchy of Modena; died November 5, 1714, Padua, Republic of Venice.

Biography of Bernardino Ramazzini

Bernardino Ramazzini is considered a founder of occupational/industrial medicine. His studies of occupational diseases and advocacy of protective measures for workers encouraged eventual passage of factory safety and workmen’s compensation laws. In 1700 he wrote the first important book on occupational diseases and industrial hygiene.

Bernardino Ramazzini was born in a rather tumultous period of European history. In Italy the tribunal of the inquisition had just banned the teachings of Galileo Galilei and made the delinquent renounce his heresy. North of the Alps Europe was ravaged by the Thirty Years War.

The son of the petite bourgeoisie
Ramazzini was the son of Bartolomeo and Catarina Ramazzini, a not particularly well-to-do but respected couple of the petite bourgeoisie. After receiving his first education from Jesuits, in 1652 he entered the University of Parma, which had been founded by Duke Rainutio I in 1599. After studying philosophy for three years, he commenced the study of medicine in 1655. In 1659 he was conferred doctor of philosophy and medicine at Parma. He then went to Rome to continue his studies under Antonio Maria Rossi (1588-1671), son of Gerolamo Rossi, life physician to Pope Clemens VIII. Little is known about Ramazzini’s days in Rome, but we know that the knowledge he acquired of the trades of this town were important to his subsequent work on occupational medicine, De morbis artificum diatriba.

Besides training Ramazzini, Antonio Maria Rossi also obtained for him a position as town physician in Canino in the duchy (Kirchenstaat-Fürstentum) of Castro, a poor province about one day's journey north of the Papal state. This area was ridden with malaria, and Ramzzini fell sick. Moving to Marta, another small town in the same province, improved his condition, but soon he settled in his native town of Carpi. Here he found time for intellectual pursuits, like reading antique literature.

Professor at Modena
In 1671 Ramazzini left the provincial Carpi and moved to Modena, where he was at first heavily opposed by the academic establishment. However, in 1682, Duke Francesco II of Modena gave him the assignment of establishing a medical department at the university and gave him the title of professor “medicinae theoricae.” When the Academie San Carlo was officially opened the following year, Ramazzini gave the address Oratio instaurationis.

During the following years he worked closely with his colleague Francesco Torti (1658-1741), and also lectured on medical practice, although Torti formally alone was responsible for medicinae practicae.

This was the period when the use of chinchona bark (from which the alkaloid quinine is derived), was introduced as a new superdrug in the treatment of malaria. Ramazzini was a strong proponent of such treatment, recognizing the introduction of this medicament as a revolutionary event in the history of medicine, completing the downfall of the classic Greek physician Galen's medical theories advocating administration of purgatives in the treatment of disease. Still, however, the collaboration, if not the friendship between Ramazzini and Torti fell apart when Torti published a propaganda paper for the new superdrug and startet prescribing it on a large scale. Ramazzini found this an abuse and wrote so.

Ramazzini’s time in Modena was one of diligent scientific work and characterized by a frequent written contact with some of the most learned men in his time. He was corresponding with Marcello Malpighi (1628-1694), Antonio Valisnieri (1661-1730), Giovanni Batista Morgagni (1682-1771), Giovanni Maria Lancisi (1654-1720), Gottfried Wilhelm Freiherr von Leibniz (1646-1716) and several other contemporaries.

Like many prominent physicians of his day, Ramazzini was a highly versatile individual - clinician, epidemiologist, sanitarian, poet, philosopher, and scholar. At Modena he was a distinguished citizen of the town, frequently invited by the Duke to give addresses, and a member of the elitist body Degli Dissonanti in Modena. Due to his reputation, in 1693 he was accepted as a member of the German body Academia Caesareo-Leopoldina naturae curiosorum, under the byname of Hippocrates III. He was the first Italian member of this society.

Early works
In the 1690s Ramazzini made the first epidemiological works that were to make him famous beyond the borders of Italy. The first of them was De constitutione anni M. DC.LXXXX (Works, 1690). In it Ramzzaini gives an acribic description of of epidemic diseases of man and animal in the rural area around Modena. Ramazzini evaluated the couses of all the epidemic diseases of the area according to Hippocrates, based on soil, climate, water and, above all, air. His studies included chick-pea poisoning (1690) and malaria (1690-1695).

After a work on the water supply of Modena in 1694, in 1698 he published on the oil mines of Monte Zibino. This was a continuation of a work started as early as in 1462 on the initiative of Duke Borso d’Este and continued by Francesco Ariosto, whose manuscript had been printed in 1690. Not satisified with just revising old stuff, Ramazzini investigated the matter himself, producing a completely new dissertation on, among other things, the therapeutical value of petroleum.

Occupational diseases
It is not known when Ramazzini commenced work on his De morbis artificum diatriba(Diseases of Workers), but it is known that he lectured on this topic as early as in 1690. Published in 1700, this is the first comprehensive work on occupational diseases, and a milestone in the history of occupational medicine.

De morbis artificum diatriba outlines the health hazards of irritating chemicals, dust, metals, and other abrasive agents encountered by workers in 52 occupations. Among them were miners, potters, masons, wrestlers, farmers, nurses, soldiers, and many others. He even discussed the topic of overtaxed minds among “learned men.” In discussing the aetiology, treatment, and prevention of these diseases Ramazzini often goes back to Hippocrates, Celsus, and Galen, and, after summarizing their observations, relates his own experience with the various diseases. Ramazzini even concerned himself with the occupational diseases of women. In this section he recommends precautions against syphilitic infections, as well as cleanliness among midwives.

From Modena to Padua
Ramazzini remained in Modena for eighteen years, until 1700. That year he accepted an invitation to the chair of practical medicine in Padua, where the Republic of Venice had the most reputed medical faculty in the country. He held his inaugural address “in Patavineo Ateneo” on December 12. It was attended by teachers and students from all the faculties.

During his time in Padua Ramazzini was one of the most celebrated medical scientists of Europa. In 1706 He was invited as a member of the Roman Accademia degli Arcadi and the Royal Prussian Society in Berlin.

Ramazzini supported the denouncing of astrology by authors such as Pico della Mirandola (1463-1494). On this basis Ramazzini rejected “astral” explanations for the epidemics in man and animal, like the epidemic of cattle plague in the Venetian Republic in 1710-1711.

At this time his age bagan to take its toll. He suffered from problems of the heart and circulation, and of headache. Despite this, in 1709 the council of Venice made him professore medicinae primario, but “with the freedom that he he was only obliged to teach when his condition so permitted.” Despite his ailing health (he eventually fell blind), however, he wrote a book of advices on healthy living to the hereditary prince Francesco d’Este. In 1713, the year before his death, he made a revised and expanded edition of his main oeuvre.

Ramazzini died of apoplexy on November 5, 1714. His postmortem investigation was done by Giovanni Battista Morgagni, who included the protocol in his major work De sedibus et causis morborum.

Collegium Ramazzini
In 1982, an international community of scholars formed an organization in his honour, the Collegium Ramazzini, in order to advance the study of occupational and environmental health issues around the world. It was founded by Dr. Irving J. Selikoff of the Mount Sinai School of Medicine in New York. The annual meeting of the Collegium takes place in Carpi. The town of Carpi, in honour of its famous son, has provided the international headquarters of the Collegium. A Ramazzini Award is conferred annually by the town of Carpi on those scientists, designated by the Collegium who have made outstanding contributions to the furtherance of the aims of Bernardino Ramazzini in safeguarding health.

“When you come to a patient’s house, you should ask him what sort of pains he has, what caused them, how many days he has been ill, whether the bowels are working and what sort of food he eats.” So says Hippocrates in his work Affections. I may venture to add one more question: what occupation does he follow?
Diseases of Workers, Preface. Translated by W. C. Wright.

The mortality of those who dig minerals is very great, and women who marry men of this sort marry again and again. According to Agricola, at the mines in the Carpathian mountains, women have been known to marry seven times.
Diseases of Workers, Preface. Translated by W. C. Wright.

All sedentary workers...suffer from the itch, are a bad colour, and in poor condition.. . . for when the body is not kept moving the blood becomes tainted, its waste matter lodges in the skin, and the condition of the whole body deteriorates.
Bernardino Ramazzini, 1700.

The following quotes are excerpted from a translation published by the University of Chicago Press, 1940:

"[I have seen] workers in whom certain morbid affections gradually arise from some particular posture of the limbs or unnatural movements of the body called for while they work. Such are the workers who all day stand or sit, stoop or are bent double, who run or ride or exercise their bodies in all sorts of [excess] ways."
" . . . the harvest of diseases reaped by certain workers . . .[from] irregular motions in unnatural postures of the body."

Standing
"Those who work standing . . .carpenters, sawyers, carvers, blacksmiths, masons . . .are liable to varicose veins. . . [because] the strain on the muscles is such that the circulation of the blood is retarded."
"Standing even for a short time proves exhausting compared with walking and running though it be for a long time. . . . Nature delights and is restored by alternating and varied actions."

Sitting
"Those who sit at their work suffer from their own particular diseases." [As noted back in Roman times by the learned slave] Plautus, ‘sitting hurts your loins, staring, your eyes.’"

Repetitive hand motions
"I have noticed bakers with swelled hands, and painful, too; in fact the hands of all such workers become much thickened by the constant pressure of kneading the dough."

Word processing
"The maladies that affect the clerks arise from three causes: first, constant sitting; secondly, incessant movement of the hand and always in the same direction; and thirdly, the strain on the mind . . ."
"The incessant driving of the pen over paper causes intense fatigue of the hand and the whole arm because of the continuous . . . strain on the muscles and tendons."
"An acquaintance of mine, a notary* by profession, who, by perpetual writing, began first to complain of an excessive wariness of his whole right arm which could be removed by no medicines, and which was at last succeeded by a perfect palsy of the whole arm. . . . He learned to write with his left hand, which was soon thereafter seized with the same disorder."
*Ramazzini notes that in those days a notary was a type of unusually fast scribe "skilled in rapid writing," apparently serving what today would be the court reporter’s function.

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