I am grateful to Dr. Franklin White for the following historical review of the early 18th century De Morbis Artificum: Diseases of Workers by Bernadino Ramazzini.
Franklin is the author of the recently published biography of his father, Frank White, Miner with a Heart of Gold (posting of 21st September, 2020) and of the historical reviews of De la Pirotechnia and De Re Metallica.
Introduction: Emerging Sciences of the Late Middle Ages
Expanding European economies during the fifteenth and sixteenth centuries spurred demand for gold and silver, as a basis for currencies as well as for jewelry. As underground mining expanded to meet this demand, recognition and concern for the health and safety of miners and metal workers increased.
The first publication dealing with the hazards of an occupation was a brochure written in 1472 by Ulrich Ellenbog, a physician of Augsburg, Germany. His focus was preventive: to inform goldsmiths and others working with gold and silver how to avoid the toxic effects of such metals as mercury and lead.[1]
The first published account on the ill-health of miners and ways of preventing this was published by Agricola in 1556, in his famous treatise De Re Metallica. However, this account was secondary to his detailed descriptions of mining and smelting.[2]
Eleven years later, in 1567, the first monograph on the occupational diseases of miners and smelter workers, appeared in Germany. Its author was Theophrastus Bombastus von Hohenheim, also known as Paracelsus. Entitled Von der Bergsucht oder Bergkrankheiten (on Miners’ Sickness and other Diseases of Miners), he discussed etiology, pathogenesis, prevention, diagnosis and therapy.[1]
Agricola and Paracelsus were “renaissance men”: broadly educated in the arts, botany, mineralogy, mining, medicine, and natural philosophy. Among other initiatives, they inspired a movement among physician-scholars focused on the health hazards and consequences of different fields of work.
The first full scale treatise focused entirely on occupational health was De Morbis Artificum diatriba, a dissertation by Bernadino Ramazzini (1633-1714), a physician-scholar of Modena, Italy.[3]
About Bernardino Ramazzini
Ramazzini was born in 1633 at Carpi, an ancient town dating from the Etruscan culture of north-central Italy. It was then known for its straw plaiting industry, and today remains an active industrial and crafts centre. Earning a medical doctorate at Parma in 1659, he continued his studies in Rome. He then practised as a public physician in the towns of Canino and Marta in Viterbo province. On moving to Modena in 1671, he was in favour with the ducal family of Este.[1] When the University of Modena was established in 1678, he was appointed Professor of the Theory of Medicine.[4] Addressing public health issues such as epidemic typhus, he can also be viewed as an epidemiologist.
In 1700 he was appointed chair of Practical Medicine at the University of Padua, where he launched his De Morbis Artificum diatriba (published at Modena in the same year). Based not only on his clinical observations, it drew from his innumerable visits to worksites where he observed actual hazards associated with different occupations. From this he developed his core principle:
“a prudent diagnostician will inquire first of all as to a new patient’s occupation, since the condition of the humours… is profoundly affected by the kind of work in which he is engaged.”[3]
He recognized that how people lived and worked directly influenced their health:
“Many an artisan has looked at his craft as a means to support life and raise a family, but all he has got from it is some deadly disease, with the result that he has departed this life cursing the craft to which he has applied himself”[3]
At that time, when the attention of doctors was devoted to the most wealthy patients, it was unexpected and unusual that a doctor devoted his attention to investigate workers’ health issues.[4]
“…many of our own clinicians would laugh at any… professor… if they saw him… descending to explore regions underground so as to investigate the hidden recesses of nature… But let them learn from… Galen (129 – c. 216) …who went down into… (a ferrous sulphate cave-mine)… to a depth of about one-eighth of a mile and observed… green water dripping into a pool… of a suffocating and almost intolerable odor…” workmen hastily carrying out this acidic water.[3]
He understood the connection between working conditions, health and public policy:
“Not only in antiquity but in our own times also laws have been passed...to secure good conditions for workers; so it is right that the art of medicine should contribute its portion for the benefit and relief of those for whom the law has shown such foresight...”[3]
De Morbis Artificum diatriba
Each chapter of the “diatriba” describes a disease(s) associated with a particular type of work followed by supporting literature where it existed, workplace descriptions, questions and advice for workers, and remedies. He recognized that not all workers' diseases were attributable to exposures to chemical or physical agents in the work environment: many appeared to be caused by motions and postures.
In the first edition, Ramazzini discusses 42 groups of workers, the very first chapter – perhaps most notably - being devoted to miners. Of potential interest to modern miners are chapters on gilders, chemists, potters, tinsmiths, glass workers, sulphur workers, blacksmiths, gypsum and lime workers, stone cutters, and salt makers. A second edition, published in 1713, added 12 more groups, including coppersmiths, grinders, and brick makers.[3] He died in the following year, at the venerable age of 81 years.
"Diseases to which Miners of Metals are Exposed."
This chapter opens with the generic statement:
“Various and manifold is the harvest reaped by certain workers from the crafts and trades that they pursue; all the profit they get is fatal injury to their health… from two causes. The first and most potent is the harmful character of the materials that they handle, for these emit noxious vapours and very fine particles inimical to human beings and induce particular diseases; and second I ascribe to certain violent and irregular motions and unnatural postures of the body, by reason of which… serious diseases gradually develop therefrom.”[3]
He quotes the ancient Roman poet Ovid (43 BC – 17/18 AD):
“Men go down into the bowels of the earth, and what she has hidden away and consigned to the Stygian shades they dig out, wealth, provocative of evils.”[3]
He immediately acknowledges that Ovid was referring to moral evils, but then argues that the same statement may be applied to “the evils that attack men’s bodies”, listing examples such as the following (my medical translations in parentheses):[3] dyspnoea (shortness of breath), phthisis (tuberculosis), apoplexy (unconsciousness), paralysis (loss of motor function), cachexy (wasting), swollen feet (self-explanatory), joint pains, and palsy (loss of motor control e.g., tremors). He emphasizes: “…the lungs and brain of … workers are badly affected, the lungs especially.”[3]
He considered mercury mining the most lethal, citing Gabriele Falloppio that “mercury miners can hold out for barely three years”, and Michael Ettmuller that within four months “they become subject to palsy of the limbs, paralytic, and suffer from vertigo” … caused by “the mercurial spirits which are… injurious to the nerves.”[3] These descriptions remain consistent with 21st century medical science.
He notes:
“…mines are either damp because water keeps settling at the bottom of the shaft, or they are dry, and… fire sometimes has to be used… in splitting the rocks. In damp mines that contain stagnant water the legs of the miners are affected, not only by the dense and poisonous vapours… but also… when the fragments of split rock fall… and… workers are suffocated and fall headlong… Moreover… when (fire)… is needed to soften rocks it elicits… pernicious fumes from the mineral substances, so that the… miners are plagued by every one of the elements.”[3]
He makes the following social commentary:
“The mortality of those who dig minerals is very great, and women who marry men of this sort marry again and again.”[3]
Among his sources, he cites Agricola, Lucretius, Bernardo Cesi, Jesuit author of Mineralogia (1636), and Ramelow who wrote a German treatise on paralysis and palsy among metal workers, among others. He refers to works of art depicting slavery in ancient mining, pointing out that the conditions of his own day are not necessarily improved upon this. He advocates to church leaders.[3]
Conclusion
Bernadino Ramazzini is considered the founder of the field of occupational medicine. His “diatriba” gave prominent attention to the diseases of metal miners, while addressing ultimately the health implications of some 54 occupations. He is aligned with the “scientific revolution”, a transformative period for ideas across mathematics, physics, astronomy, and biology based on verifiable evidence. Translated into French, German and English, Ramazzini’s book remained the major text for this branch of preventive medicine until the early 19th century when industrialization created new complexities requiring new approaches.
References
1. George Rosen. Introduction to the Translation. Diseases of Workers by Bernardino Ramazzini. New York Academy of Medicine. The History of Medicine Series. No. 23 Hafner Publishing Company. New York, London 1964.
2. Franklin White. De Re Metallica: treatise of Georgius Agricola Revisited. Annals of the Royal College of Physicians and Surgeons of Canada. 1994;27:163-6.
3. Bernardino Ramazzini. Diseases of Workers. Translated from the Latin text. De Morbis Artificum of 1713 by Wilmer Cave Wright. 546 pages. Academy of Medicine. The History of Medicine Series. No. 23 Hafner Publishing Company. New York, London 1964.
4. Giuliano Franco. Editorial. A Tribute to Bernardino Ramazzini (1633-1714) on the tercentenary of his death. Occupational Medicine. 2014; 64(1):2-4.
