Friday, January 29, 2016

1700: Ramazzini's cure for occupational asthma

Once Ramazzini discovered that many his patients had occupational asthma, he studied the works of previous authors to discover the ideal remedy or cure.

He said:
Figure 1 --
Michael Ettmuller (1644-1668)
He was a German physician.

For asthmatic affections caused by metallic fumes, Etmuller, On respiratory ailments, suggests certain specific remedies and states that for this type of asthma the usual remedies have no effect. Accordingly, for this serious type he advises sweet mercury, turpeth mineral, cathartics, diaphoretic antimony, a bezoartic of gold, and the like. (1, page 29)
There were other remedies as well, depending on the hazards inhaled per the occupation.  For tinsmiths, Ramazzini said:
They should... be treated as though they were suffering from miner's asthma and should carefully avoid anything that is peculiarly drying.  Butter, milk, emulsions of almonds and of melon seeds, ptisan of barley, and the like will be beneficial. (1, page 61)
For those who inhale gypsum, he wrote:
Once gypsum has been taken into the body it does not yield easily to treatment, but various remedies were prescribed by ancient writers to correct the disorders contracted from it.  Galen, in Book II of his Antidotes, recommends a solution of the ashes of vine twigs. Guaineri approves, and prescribes the aforesaid ashes, a third of the dose by weight; Senert praises mouse dung. I have prescribed for workers of this class oil of sweet almonds freshly extracted, and emulsions of melon seeds, and these gave some relief." (1, pages 83-85)
Bakers and millers, who inhale the powders of flour, and of whom wearing a scarf over their mouth and nose is of little use, Ramazzini recommends:
To wash the face thoroughly with water, to rinse the throat very often with vinegar and water; to take oxymel and to purge themselves frequently in some way or other; when the breathing is oppressed, they should take an emetic so as to expel the sticky deposit from the passages.  I have seen men cured by an emetic, and some of them were almost at the last gasp. (1, page 227)
Ramazzini had reasonable expectations regarding the many individuals who were stricken with occupational illnesses, particularly "those workers (who) are liable to various diseases on account of the unwholesome nature of the materials that they mine, dig out, or handle and use in their workshops."  (1, page 87)

He understood that there was little means of protecting them other than changing occupations, which he reasonably expected not to happen.  So he continued to recommend coverings over the mouth and nose, even though he knew this was of little use.

Plaato (427-347 B.C.)
In regards to treating them, therefore, he references the Greek phlosopher Plato who records a discussion with Socrates regarding the desire of the god Asclepius and physicains to take care in treating commoners.

Ramazzini said Plato, through the words of Socrates, was one of the first to record the plight of hard working impoverished commoners, and the need for physician to cure them.  Ramazzini quotes Plato, who uses the voice of Socrates:
When a carpenter falls ill he expects his doctor to cure him by an emetic or purging or cauterising or a knife. But if he is ordered to begin a long course of dieting or to put compresses on his head or the like, he at once objects and says that he has no time to be ill and that it is not worth his while to drag out his life by sestoring, now to one now to the opposite treatment, and meanwhile neglects his craft. Then he says goodbye to the doctor, returns to his usual way of life, recovers and carries on his work, or if his body fails to bear up against the disease he dies and is rid of his troubles." (1, pages 87-9)(1)
Ramazzini then quotes Plato, through the words of Socrates again, describing the remedy.  (9, page 89)
For when a doctor has to treat men of this class his first duty is to restore them to health as quickly as possible by means of suitable and generous remedies.  Indeed, one often hears these poor wretches begging their doctors either to kill or cure them.  So when you treat the ailments of workers your chief care should be to give them remedies that work quickly and are ready to hand; otherwise they fret themselves to death from the weariness of prolonged illness and mental distress about the poverty and need of their families... Just so I have often observed in my practice that if working men do not get well quickly they go back to their workshops while still ailing and often evade the roundabout methods of the doctors.  (9, page 89)
This would be the mindset of the majority of the populace, or the working class, most of whom would find themselves poor, and most of whom would find themselves lame by their hard work by the age of 40 in many cases.

What they would not want, as noted by Plato and then Ramazzini, for the physician to take away his livelihood; his ability to do his work to support himself and his family.

Those who are rich, on the other hand, may have a unique perspective, as Ramazzini  (in paraphrasing Plato) explained: (9, page 89)
Of course in the case of the rich who have abundant leisure to be ill one may use that sort of treatment; they sometimes pretend to be ill just to show how well they can afford it... I mean men who pay doctors a trifling fee to sit by their bedside; but you must not treat busy workmen like that.   (9, page 89)
Ideally, it is thought from reading his observations, that Ramazzini would prefer to prescribe for such patients that they seek another line of work, although he understood, as did Plato before him, the reality of this prescription is that it will not come to fruition unless the patient finds himself completely lame and unable to return to work, or died.

As noted in the introduction of his translation of Ramazzini's book, Wright said:
In more than half the chapters, the chief risk to workers is the particles, usually 'sharp and acid', emitted from the materials handles and taken per os et nares -- a favorite phrase.  It is very dangerous for them to breathe, for every where is dust, animal, vegetable, ormineral; he would have welcomed a more effective gas-mask than the loose bladders and glass masks that had been more or less in use since the time of Pliny (23-79 A.D.).  But his real difficulty is that it is impossible to persuade workers, even when they are his patients, to take the simplest precautions.  In vain did he recommend personal cleanliness, the luxury of clean clothes on holidays, moderation in food, drink, and exercise, or warn them to avoid 'blocking the ores of the skin', when, scantily clothed, they left the overheated workshops for the chilly streets.  In several chapters occurs the phrase "with curses they repudiate their job", but they nearly all persist in it, in spite of his warnings that they should exchange it for one that better suits some peculiar physical condition; and some of them die with that curse on their lips.  His deep concern for the alleviation of the hardships suffered by the humblest workers is naturally not qualified by any reference to the interest of their employers, about whom he is silent; nor does he mention the possibility of unemployment." (1, xxvii)
After the publication of his book"De Morbis Artificum Diatriba," published in 1700 and 1714 Ramazzini was mocked by his peers for opposing common thought. His ideas were rejected.

He worked as professor of medicine at the University of Padua until he died at the age of 81 in 1714. (3) (4)


  1. Ramazzini, Bernardino, writer,  "Disease of Workers," Wilmer Cave Wright, translator, 1964, New York, Hafner, page 243
  2. Ramazzini, ibid, pages 87-89; original quote by Plato from the following: Plato, "Republic," Book III.  A few passages later, Homer writes: "What profit would there be in his life if he were deprived of his occupation... but with the rich man this is otherwise, of him we do not say he has any specially appointed work which he must perform, if he would live.  He is generally supposed to have nothing to do.... if a man was not able to live in the ordinary way he (the god Asclepius) had no business to cure him; for such a cure would have been of no use either to himself, or to the State."  The Republic is a discussion between the Greek writer and philosopher Plato and his teacher, the Greek philosopher Socrates.
  3. "Bernardino Ramazzini Facts,",, accessed 7/13/13
  4. "Bernardiino Ramazzini,",, accessed 7/13/13
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