«2014 Med Segur Trab (Internet) 2014; Suplemento Extraordinario n.º 2: 34-41 MEDICINA y SEGURIDAD del trabajo Medical biographies and their ...»
2014 Med Segur Trab (Internet) 2014; Suplemento Extraordinario n.º 2: 34-41
MEDICINA y SEGURIDAD del trabajo
Medical biographies and their historical significance. The figure and the work of
Bernardino Ramazzini (1633-1714)
Las biografías médicas y su significado histórico. La figura y la obra de Bernardino
Rosa Ballester Añón
History of Science Unit. Faculty of Medicine. Miguel Hernández University.
Correspondence Rosa Ballester Añón.
History of Science Unit. Faculty of Medicine. Miguel Hernández University.
Campus of Sant Joan d´Alacant.
Ctra. Alicante- Valencia km. 8.7.
Sant Joan d´Alacant 03550. Spain.
E-mail: Rosa.firstname.lastname@example.org Abstract The figure of Bernardino Ramazzini has been the subject of much research in a wide range of fields.
The literature varies in its level of interest and in general leans towards a hagiographical approach. Written from the perspective of new currents in historiographical research on the biographies of scientists in general and doctors in particular, the aims of this work are twofold: on the one hand, to review some of the studies made of Ramazzini from different history of science and medicine perspectives, and on the other, to reconstruct the significance and most relevant features of his contributions to the genesis and development of Occupational Medicine.
Key words: Ramazzini, Bernardino; Eighteenth Century; Occupational Medicine, History, Medical biographies.
Resumen La figura de Bernardino Ramazzini ha sido objeto de abundantes acercamientos desde muy diversos ámbitos, de interés desigual, y, en general, con un fuerte componente hagiográfico. Desde la perspectiva de las nuevas corrientes historiográficas sobre las biografías científicas en general y las de los médicos en particular, el objetivo del trabajo es doble: por un lado, hacer un recorrido sobre algunos de estudios a él consagrados desde diferentes perspectivas ofrecidas por la historia de la medicina y de la ciencia y, en segundo término, reconstruir el significado y los rasgos más relevantes de sus aportaciones a la génesis de la medicina del trabajo y la salud laboral.
Palabras clave: Ramazzini, Bernardino; Siglo XVIII, Medicina del Trabajo, historia; Biografías médicas.
Medical biographies and their historical significance. The figure and the work of Bernardino Ramazzini (1633-1714) 34 Rosa Ballester Añón 2014 Med Segur Trab (Internet) 2014; Suplemento Extraordinario n.º 2: 34-41 MEDICINA y SEGURIDAD del trabajo
INTRODUCTIONMedical biographies, the framework of this study, are one of the oldest historiographical genres. There is a long tradition of bio-bibliographical dictionaries which set out the life and publications of the leading medical figures. A paradigmatic example is the Biographisches lexikon, published in Berlín in 1929, a useful reference work which provides personal information that we can use in teaching and research. Another important example in Germany is the Grosse Aertze (München, 1932) by Henry Sigerist.
Today, this genre is a dynamic area within the field of medical and scientific historiography. In recent years there has been renewed interest in this subject but from positions which differ from the traditional perspectives. It is a genre that lends itself to the development of a presentist view of history and apologetics, among other reasons because it offers suitable conditions for the veneration of the past but also offers an unreliable view of reality1. It is not possible to limit the biography to the mere imitatio herois of which Laín Entralgo had written in his monograph on the great doctors2.
Exponents of these new perspectives are to be found in a series of papers that have substantially modified the biographical approaches; either from a reflection on their historical significance3 or in their application to a specific field such as the case of Michael Bliss on the internist and regius professor of Oxford University, William Osler4, one of the contemporary physicians who has been the subject of the most studies.
This interest in biographical discourse illustrates the tension between the singularity of the individual and his or her unique, unrepeatable life and the representative being of a specific epoch, movement or process. Ramazzini, the Italian author, is an essential reference in the history of occupational medicine, epidemiology, and occupational and environmental health. Indeed, Ramazzini is an icon, and the most literal sense of this iconic vision is the image taken from J.G. Seiller’s engraving (1716), which has been widely disseminated and reproduced in numerous historical and current texts on pathology and occupational health.
An example of this interest is the reference to Ramazzini in the pages of the first issue of the Il Lavoro. Rivista di Fisiologia, Clinica e Igiene del Lavoro, where he was described as the “glorious Italian doctor” who two hundred years before had aroused interest throughout the World in the health of working people. Edited by Luigi Devoto (1864-1936), the man who at the beginning of the century in Milan inspired the Clinica of the Lavoro, the journal became the official voice of the Società Italiana di Medicina del Lavoro set up some years later5. However, this recognition came after long decades of neglect of his person and his work. In spite of the initial success of his most emblematic work, of De morbis artificum diatriba (1700) which, as we shall see below was reedited with new contributions and translated into other languages throughout the eighteenth century and the early decades of the nineteenth century, in fact his work was largely ignored until the beginning of the twentieth century.
The aims of this article are twofold: on the one hand, to trace some of the studies on Ramazzini from different perspectives of the history of medicine and science, and on the other, to reconstruct the most relevant sense and features of his contributions to the birth of occupational medicine and occupational health.
THE PRESENCE OF RAMAZZINI IN MEDICAL AND SCIENTIFIC HISTORIOGRAPHYAbundant references to the meaning of the Ramazzini’s work are to be found in most general histories of medicine and science. However, he is not included as an entry in the monumental Dictionary of Scientific Biography (1970-1980). This absence can be explained if we take into account the fact that the dictionary carries biographies of scientists from all fields of knowledge. On the contrary, we do find references in other general works, from those published in the mid-twentieth century6 to the most recent7.
All the entries refer to his pioneering role in the concern of doctors for the health of
working people. They also quote biographical data such as the fact that he was a contemporary of Giovanni Maria Lancisi (1654-1720), the arquiater of Pope Clement XI and professor of the La Sapienza in Rome, and had a close relationship with the pathologist avant the lettre, Giovanni Battista Morgagni (1682-1771). Mention is also made of his correspondence with Marcello Malpighi (1628-1694) and how he influenced other such authors as Charles Thackrah (1795-1833), who wrote a brief and well-known leaflet under the title The effects of Arts, Trades and Professions and of civil states and habits on living on Health and Longevity (Longman, London,1831). The most recent reference book on medical biographies offers a detailed entry on Ramazzini including the most representative secondary bibliography8.
The contextualization of the Italian author within the framework of the social, political and scientific situation of the time and the manner in which he fits into the scheme of the history of occupational health offer clues to the understanding of his work.
The incipient industrialization of Europe during the seventeenth century meant doctors were faced with new health problems arising from new occupational activities. Ramazzini would take his place in the tradition which commenced at the start of the modern period.
At the height of the Renaissance, Paracelso described the illnesses which afflicted miners, Georg Agricola (in his treatise on mining techniques) had gone so far as to propose technical improvements to protect the health of miners and Mateo Alemán produced a secret report on the labour conditions in the Almadén mines. In the seventeenth century, there was an increase in the numbers of this type of study and new initiatives were taken such as clinical observation in other non-mining occupations. While not detracting from the importance Ramazzini’s work, these studies do indicate that it did not appear spontaneously but was rather another step in a process and tradition which would continue into the future. At the height of the Enlightenment, between 1779 and 1789, Johann Peter Frank published the first systematic treatise on public hygiene which included abundant references to the health of working people and throughout the eighteenth century numerous monographs appeared on diseases related to the world of labour9. Classic works include the contributions of two important historians of Italian medicine who in the years between 1930 and 1960, contextualized Ramazzini’s work within the context and culture of his time and the cities in which he lived10. The great historian of public health, G. Rosen, usually sparing in praise and gratuitous hagiography, considered that Ramazzini’s work was as crucial as Andrés Vesalio’s Humani corporis Fabrica (1543) had been for the history of anatomy or G. B. Morgagni’s contributions had been in the history of pathology11. Finally, we cannot ignore the existence of the Collegium Ramazzini in Modena, the fact that the Istituto di Storia della Medicine della Università degli studi di Padova regularly organizes scientific conferences on Ramazzini and his times, and that testament to his inspiration can be found in other various eponymous societies12.
Separate attention needs to be paid to the collection of studies written by labour medicine and labour health professionals. As we mentioned above, since the early institutionalization of this field these experts have held the figure of the Italian author as an essential reference. There are huge numbers of studies in journals13 and specialty monographs, introductions to anthologies of Ramazzini’s texts or, even more frequent, the transcription and/or translation of his most emblematic work, De morbis artificum.
This is the case, for example, of the Spanish edition (1983), produced under the auspices of the National Institute of Safety and Hygiene at Work and based on the Padua edition of 1713 with the addition of the biography written by his nephew and published in Opera Omnia (1718)14. The dedication and presentation of the work could not be more expressive: the edition was planned as a homage by the National Institute of Health to all those health professionals who had in one way or another focussed their activity within the field of occupational medicine. It would be the start of a “cultural library of occupational medicine, something which links us to our origins and allows us to access the vitality that our authors exude”15. Although in chronological terms there was a Spanish language edition published previously in Argentina, its impact was far more limited. The translation of 1983 is extremely thorough and of great interest. It is the work of philologists and has
a well-documented prologue. Recently, in 2007, the National School of Occupational Medicine-Health (part of the Institute Carlos III since 2000) has undertaken the task of reediting the work.
THE FIGURE AND HIS WORK: THE BEGINNINGUnlike the experience with many other authors, in the case of Ramazzini modernday historians enjoy copious information provided by the author himself through his work and his epistolary with such relevant contemporaries as Morgagni or van Leuwenhoeck (1632-1733), the biography written by his nephew16, the references of later authors and the historic studies on the figure and his times.
First and foremost it should be said that he was a worthy representative of Baroque medicine and in this sense, we should highlight the range of subjects in which he took an interest; from medicine to experimental sciences, to philosophy or literature. Nor was his interest purely humanistic (his knowledge of the classics and philosophy), it was also human and characterised by compassion. Derived from the Latin term cum passio, literally ‘suffer together’, compassion is a human sentiment which reveals itself through an understanding of the suffering of others17. As has often been pointed out and as he himself reported, to a large extent Ramazzini wrote his most emblematic work as an empathic response to some of those people whose professions represented a serious health risk.
The many biographies of the author share the same series of milestones that we will synthesise. According to the information on the cover of the editions of the Opera omnia18 “carpensis philosophi ac medici”, Ramazzini was born in Carpi, in the Emilia Romaña, on 4 October 1633. After an early training with the Jesuits in his home town, he graduated in philosophy and medicine in 1653, in Parma. He then left for Rome together with Antonio María Rossi (1588-1671) and later practised in Canino and Marta, in the Dukedom of Castro, where he contracted malaria, an endemic pathology in the dukedom and adjacent regions, which forced him to return to his home town.
His departure for Módena, in 1671, provided him with the opportunity to act as assistant to Antonio Ferrarini and it was there, twenty years later, as a result of his growing reputation, that he would be appointed court physician. He was hired as Professor of Medical Institutions and Theory of Medicine in the refounded university.