ABSTRACT
The earliest interest in occupational diseases arose from the investigations of Bernardino Ramazzini (1633-1714), who was professor of medicine in Padua, Italy. His book ‘De morbis artificium diatriba’ (Thesis on the diseases of workers) described for the first time a very wide range of disorders, which he attributed to work, but his most important observation was that doctors should enquire about their patients’
occupations. The Industrial Revolution in Europe brought with it a great expansion of manufacturing industry, and the ensuing prosperity was associated with considerable increases in population and life expectancy, but paradoxically an increase also in illness as a result of poverty, overcrowding, infectious disease and hazardous working conditions. The entrepreneurial ethos that led to this was balanced by the development of the concept of professionalism, originally the disinterested desire to alleviate the suffering of those less fortunate, and the late 19th century was characterized by the development of legislation aimed at protection of workers from exploitation as well as by the growth of the public health movement. It was during this period that the first descriptions of the clinical features and pathology of occupational diseases were recorded. Several of the earliest to be recognized were cancers – scrotal and skin cancer in Scottish oil shale refiners (although scrotal cancer in chimney sweeps’ apprentices – climbing boys – was first described by Percivall Pott in his Surgical Works in 1766), lung cancer in Bohemian metal miners, and bladder cancer in aniline dye workers. Other almost equally serious conditions were also common in the industrial world at the turn of the 20th century – silicosis, lead and arsenic poisoning, and the effects of radiation, for example. This pattern has now changed, metal poisonings and the classical occupational cancers having almost been eliminated in the developed world, pneumoconiosis being under partial control, and diseases caused by pesticides, asbestos and other chemicals having taken their place. Most of the classical conditions are relatively uncommon save in countries now passing through their own industrial revolutions. The type of work people do in the developed world has led to recognition of a different spectrum of less dramatic but often very troublesome and chronic conditions – dermatitis, vibration injury and deafness, subtle changes in neuropsychological function related to chronic chemical exposures, locomotor problems, especially related to the spine, and overuse injury such as tenosynovitis. Finally, psychological disease of the anxiety-depression type is commonly related, at least in part, to problems in the workplace. Interestingly, this pattern of work-related ill-health is much closer to that which Ramazzini described than to what has traditionally been taught to medical students for the large part of the last 50 years.
