Course:SPPH381B/Essays/Occupational Health: Hippocrates to Ramazzini - Desiree
Introduction
Occupational health has been a concern for thousands of years because individuals have been in occupational roles for this amount of time. The workplace is where an adult spends the majority of their time in a week so the environment and tasks required at that workplace will have an impact on their health. The practice of occupational health began with Hippocrates (460-370 B.C.), who discovered a link between lead poisoning and miners. In the 1st century A.D. Pliny the Elder made remarks on the use of wearing masks to protect workers from dust. The medieval and renaissance periods brought forth many changes in occupational needs and regulations. This period is characterized in occupational health by the mention of the importance of hearing protection in the Medical poem of Salerno and the remark made by Paracelsus that “the dose makes the poison”. Finally, in 1633-1714, Ramazzini, later deemed the father of occupational health, made detailed descriptions of various occupational diseases.
Hippocrates
One of the earliest applications of occupational health was by Hippocrates (460-370 B.C.). Hippocrates was natural and observational, and his medicine included three principle features; the careful and systemic examination of the symptoms, reception to ideas of all sources, and willingness to elaborate on the cause of the disease [1]. Hippocrates believed in the humoral theory, which states that there are four 'humours' in the body (blood, black bile, yellow bile, and phlegm) which cause malaise when not in balance, and involves cures such as exercise, dietary changes, and bloodletting to restore balance and heal people [2]. Emphasis was placed on seasonality and quality of air and water as influences of health and Hippocrates' writings describe the horrible working conditions in which individuals were placed [3]. One population of workers he examined were miners in which he noted the incidence of lead poisoning among them. Hippocrates described the symptoms and diseases found in miners working with lead. Today, the effects of lead poisoning are still a prevalent occupational hazard and the description of symptoms has grown to include blindness, hearing loss, slurred speech, tremors, delayed reaction times, pregnancy complications, and personality changes, among others. General symptoms of malaise, fatigue, and weight loss may also be noticeable and one of the most prevalent symptoms associated with lead poisoning are cognitive deficits, especially in young children.
Pliny the Elder
In the 1st century A.D. Pliny the Elder wrote about occupational health. He wrote Naturalis Historia in 77 A.D. which was an encyclopedia of many subjects involving the natural world as well as technology and warfare [3]. Pliny wrote “The fumes from silver mines are harmful to all animals” and “when well shafts have been sunk deep, fumes of sulfur or alum rush up to meet the diggers and kill them.” He wrote about masks to protect silver miners, derived from animal bladders [4] which allowed the miners to see without inhaling the fatal dust. His ideas and insights were respected and cited for centuries, following his death in Pompeii upon eruption of Vesuvius, perhaps from curiosity [3].
The Medical Poem of Salerno
The Schola Medica Salernitana is considered the oldest medical school of modern civilization [5]. The most famous work of the school was the Regimen Sanitatis Saleritanum or the Medical Poem of Salerno. This is a poem that encompasses two centuries of medical knowledge and describes topics such as rational, dietetic, and hygienic precepts to achieve health and well-being through moderation and tolerance. The poem grew to 3520 verses as additions were made by the works of many authors [5]. The poem has a verse on the sensitivity of hearing and hearing loss, which is a prevalent issue among workers who are often exposed to noise above the safe level.
“Our hearing is a choice and dainty sense, and hard to mend, yet soon it may be marred… things that breed it most offense, Blows, fall and noise…” There is another verse concerning the quality of the air [6]. “The air must be pure, habitable, and bright, It should neither be contaminated nor smell of the sewer”
Paracelsus
The Medieval and renaissance periods reawakened interest in occupational health after a low ebb in medicine during the Dark Ages (500-1050) [1]. The growing infrastructure and implementation of environmental regulations [3] encouraged the emergence of occupational medicine as a distinct biomedical focus in Europe [6]. There was a demand for construction and decoration which involved the opening of many work sites as well as a need for workers to fill those open positions. The hazards encountered by these workers were often undocumented and the quality of their treatment was uncertain, leading to a younger mortality rate in workers than the individuals employing them [3]. Paracelsus (1493-1541) was a prevalent voice during these times and was at the center of these issues as he had first hand knowledge of exposed workers as a mining physician [6]. He coined the term “the dose makes the poison” which describes that all substances are poison and that it is the dose of the substance you receive which dictates whether or not the substance will cause harm. This notion is used today in dose-effects curves which analyze the adverse effect relative to the dose received. These curves describe the threshold, or point at which an individual will become sick, and the NOAEL, the level at which there is no observable adverse effect. These curves are then used to set the occupational exposure level. This is defined as the safe level at which most workers working 40 hours a week will not get sick.
Ramazzini
Ramazzini is known as the first influential figure in the study of occupational health, which has earned him the title “ father of occupational health” [7]. Bernardino Ramazzini (1633-1714) considered epidemiology and sanitation as his main endeavours [3], and is known for his detailed description of occupational diseases. His work covered many occupations such as miners, midwives, carpenters, apothecaries, athletes, and weaver. Ramazzini has been cited by numerous medical authors, and his observations of people and their work is used in today’s descriptions of work-related illnesses [8]. He was a pioneer in the implementation of ergonomics and posture as a cause of disease especially in sedentary work [3]. He made recommendations for the need of periods of rest, exercise, and change of posture, as well as washing hands and faces [3]. Ramazzini also made recommendations to quit working when respiratory conditions arose [3]. Ramazzini made an important addition to the questions that Hippocrates suggested healthcare professionals ask, being the inquiry of the type of occupation the individual is involved with. Additionally, Ramazzini was interested in finding causation of a disease made from observations and described that “it is much better to prevent than to cure, and so much easier to foresee future harm and to avoid it rather than have to get rid of it after having fallen prey”. This quote reflects the nature of occupational health today, and it is insights such as this that have lead to the recognition of Ramazzini as the father of occupational medicine and as the individual to whom the activity and thought of the endeavour of occupational health is attributed [8].
Conclusion
The study and application of occupational health has very early beginnings and has been explored throughout history. In the present day there are still numerous findings to be added to the bulk of information that comprises occupational health. The early studies of Hippocrates, Pliny the Elder, Paracelsus, and Ramazzini are still relevant to current occupational health. Hippocrates developed a code of ethics that is still present today, this code is incorporated into an oath that physicians take in the pursuit of the healing art [1]. The questions devised by Hippocrates, as well as Ramazzini’s addition, are also congruent with questions asked in medicine today. Paracelsus’ dose-response relationship is apparent in today’s NOAEL curves, and the importance of masks, described by Pliny the Elder, to protect workers from various dusts and particles, is a practice that is still employed in the modern world.
References
- ↑ 1.0 1.1 1.2 Cruse, J. M. (1999). History of medicine: the metamorphosis of scientific medicine in the ever-present past. The American journal of the medical sciences, 318(3), 171-180.
- ↑ Wellcome Library, London. (n.d.) Humours. Retrieved from http://www.sciencemuseum.org.uk/broughttolife/techniques/humours
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Gochfeld, M. (2005). Chronologic history of occupational medicine. Journal of occupational and Environmental Medicine, 47(2), 96-114.
- ↑ Salvaggio, J. E., O'neil, C. E., & Butcher, B. T. (1986). Immunologic responses to inhaled cotton dust. Environmental health perspectives, 66, 17.
- ↑ 5.0 5.1 De Divitiis, E., Cappabianca, P., & De Divitiis, O. (2004). The “schola medica salernitana”: the forerunner of the modern university medical schools. Neurosurgery, 55(4), 722-745.
- ↑ 6.0 6.1 6.2 Blanc, P. D. (2012). Historical perspective of occupational and environmental lung disease. In A Clinical Guide to Occupational and Environmental Lung Diseases (pp. 1-26). Humana Press.
- ↑ Franco, Giuliano, and Francesca Franco. "Bernardino Ramazzini: The Father of Occupational Medicine." American Journal of Public Health. © American Journal of Public Health 2001, Sept. 2001. Web. 30 Jan. 2017.
- ↑ 8.0 8.1 Felton, J. S. (1997). The heritage of Bernardino Ramazzini. Occupational medicine, 47(3).