Una pequeña historia de la medicina del trabajo en Venezuela / A short history of occupational medicine in Venezuela

Se presenta una recopilación de hechos relacionados con la salud y seguridad en el trabajo, en forma de aproximación, sin intentar un análisis histórico, siguiendo un hilo transversal del rol de la medicina, en lo que ha significado a través del tiempo la salud física y mental del trabajador. Se discute la contradicción entre la salud y el trabajo, intentando dar una explicación de cómo los diferentes sistemas económicos han intentado mediar en esta contradicción. El artículo hace hincapié en las circunstancias, que en el caso venezolano, condujeron al desarrollo de hecho y de derecho de la atención de la salud de quien trabaja, primero de nuestros ancestros, los indios americanos, luego de los esclavos negros y con el pasar del tiempo, de los trabajadores de las minas en el siglo XIX y delos trabajadores petroleros en el siglo XX, siglo que a partir de 1950, con la graduación en Inglaterra del primer médico ocupacional venezolano, el Dr. Emigdio Cañizales Guédez, vio crecer exponencialmente los profesionales que se sumaron a este campo del ejercicio profesional, que incluyó servicios en las empresas, gremios, y finalmente, los postgrados. Se trae a la memoria a personas de todo el país, que, desde su lugar de acción, dieron su aporte para que la Medicina del Trabajo o Medicina Ocupacional ocupe hoy un lugar estratégico en lo que significa la empresa nacional, sea pública o privada(AU)

A compilation of facts related to health and safety at work is presented, in the form of an approximation, without attempting a historical analysis, following a transversal thread of the role of medicine in what physical and mental health has meant over time. Who works the contradiction between health and work is discussed, trying to explain how different economic systems have tried to mediate this contradiction. The article emphasizes the circumstances that in the Venezuelan case led to the de facto and legal development of health care, first of our ancestors, the American Indians, then of the black slaves and over time of the workers of the mines in the 19th century and of the oil workers in the 20th century, a century that from1950, with the graduation in England of the first Venezuelan occupational doctor, Dr. Emigdio Cañizales Guédez, will see the professionals who joined grow exponentially. To this field of professional practice, which will include services in companies, trade unions and finally postgraduate courses. The article brings to mind people from all over the country, who from their place of action, gave their contribution so that Occupational Medicine or Occupational Medicine now occupies a strategic place in what the national company means, whether public or private(AU)

Bernardino Ramazzini's De Morbis Artificum Diatriba on Workers' Health-the Birth of a New Discipline.

This paper provides a picture of the observations made over three hundred years ago by Bernardino Ramazzini (1633-1714) in light of current topical issues ranging from health problems related to work and lifestyle habits to the current burdensome COVID-19 pandemic. The main aspects of his work consist of descriptions of disorders linked to environmental risks, suggestions for measures for risk protection, and recommendations for healthy living. This paper focuses on Ramazzini's most relevant achievements by (1) analyzing the episodes that stimulated the composition of his main work and highlighting some observations on which current epidemiological and toxicological studies are based; (2) reviewing his work showing not only the systematic descriptions of work-related illnesses caused by occupational factors but also his sound etiological and physiopathological contributions to the field of occupational lung diseases, breast cancer, and environmental disorders; and (3) remarking on his main observations in the fields of risk prevention and health promotion, also in the light of some highly topical issues related to unhealthy lifestyle habits and the COVID-19 pandemic.

De Elton Mayo a Ivar Oddone: redescobrir a instrução ao sósia / From Elton Mayo to Ivar Oddone: rediscovering the instruction to the double

O presente texto foi publicado originalmente como prefácio de uma obra de Yves Clot em homenagem a Ivar Oddone. Decidimos publicá-lo no formato de artigo, com a autorização do autor, por considerarmos que traz importantes e atuais contribuições para o campo do trabalho em intercruzamento com diversas teorias: Clínica da Atividade, Ergologia, Ergonomia, Saúde do Trabalhador, dentre outras. Neste texto, Yves Clot retoma aspectos significativos da obra de Ivar Oddone e tece reflexões sobre aspectos originais dessa, nem sempre considerados pelos estudiosos da área. Assim, faz uma análise comparativa com as propostas apresentadas por Elton Mayo, as quais se sagraram como importante ferramenta para o desenvolvimento do capitalismo industrial sob a suposta égide do enaltecimento do aspecto humano nas situações de trabalho. Ao contrário das concepções e práticas de Mayo, que foram efetivamente voltadas para o aumento da produtividade das empresas e, portanto, para a exploração dos trabalhadores, Oddone buscou reconhecer e valorizar o saber dos operários, com o intuito de que esse se configurasse como um contrapoder ao ampliar o seu poder de agir na situação de trabalho, aspectos que são amplamente discutidos por Clot no texto que ora apresentamos.¹

This text was initially published as a preface written by Yves Clot in honor of Ivar Oddone. We decided to publish it as an article, authorized by the author, as we believe that it brings important and current contributions to the field of work, in interseccion with several theories: Clinic of Activity, Ergology, Ergonomics, Worker's Health, among others. In this text, Yves Clot takes up highlights of Ivar Oddone's work and produces reflections about its original aspects, not always considered by experts in the field. Thus, he makes a comparative analysis with those aspects and the proposals presented by Elton Mayo, which have become an important tool for the development of industrial capitalism under the supposed appreciation of the human sides in work situations. Contrary to Mayo's conceptions and practices, which were aimed at increasing the productivity of companies and, therefore, at the exploitation of workers, Oddone sought to recognize and value the knowledge of workers, intending that this was used as a kind of counterpower, by expanding its power to act in the work situation, points that are widely discussed by Clot in the text that we present now.

Con los nervios de punta: de la medicalización a la psicologización de los quebrantos mentales en el trabajo. Bogotá y Medellín, 1898-1961 / With the nerves on the top: from medicalization to psychologization of mental breakers at work. Bogota and Medellín, 1898-1961

En este artículo se analizará el modo en que la neurastenia y la fatiga fueron objetivadas por la medicina dentro del ámbito laboral en las ciudades de Bogotá y Medellín, durante la primera mitad del siglo XX. De ahí la necesidad de tomar como referencia la identificación de los presuntos padecimientos ligados a la esfera del trabajo intelectual y físico. A la reivindicación de los comportamientos frugales para aminorar los efectos de aquellos padecimientos, se le vino a adicionar la creciente psicologización del mundo del trabajo promediando dicha centuria. Aquella psicologización se volvió una herramienta que amplió el espectro de la anormalidad, en medio de la metamorfosis experimentada por el aparato productivo y la diversificación de la estructura laboral a nivel nacional

In this article it will analize the way in which nervous exhaustion and fatigue were objectified by the medicine inside the labour environment in the cities of Bogota and Medellin, during the first half of twentieth century. From there the necessity of taking as reference identification of alleged hardship related to intellectual and physical work sphere. To the demand of frugal behaviours to minimize the effects of that hardship, it added the growing psychologization of world work in the middle of the century. That psychologization was turned into a tool that extended the spectrum of anormality, in the midst of the metamorphosis experienced by the productive system and diversification of labour structure nationally

Jean Rodier: History of Manganism in Morocco.

Jean Rodier (1920-2003), distinguished researcher and scientist, directed the Toxicology Department of Hygiene Institute of Rabat under the French Protectorate. From 1946, he developed numerous lines of research in occupational health, in particular on Manganism, a neurological disorder that impacted miners in his home country of Morocco. His many papers on Manganism, only one of which was published in English, describe field and laboratory research studies that focused its prevention and management.

[Actuality and originality in the scientific thought of Angelo Iannaccone (1925 - 1982).] / Attualità e originalità nel pensiero e nell'azione scientifica del Prof. Angelo Iannaccone (1925 - 1982).

SUMMARY: Background. Angelo Iannaccone is certainly one of the most important personalities in the field of occupational medicine of the last century. Aims. The fiftieth anniversary of the Post-graduate School of Occupational Medicine of the Catholic University of Rome gives us the opportunity to define this extraordinary figure of man and scientist, at over 35 years from his death. Results. Prof. Iannaccone was among the very first, if not the first to deal with chronobiology and occupational ergonomics in Italy, adopting the modern perspective of "upstream" prevention, since the design phase, which had to be based on the adaptation of work to man and not vice versa. He carried out important and pioneering studies on the effects of benzene on the hematopoietic apparatus and of various industrial toxicants on the neuroendocrine system. In establishing the formative principles for the occupational physician, he devoted a significant space to industrial hygiene, in the interdisciplinary perspective of prevention sciences. He gave a significant contribution to the scientific society of occupational medicine, first as a member of the board, then as the president of the Italian Society of Occupational Medicine and Industrial Hygiene. He realized the Institute of Occupational Medicine of the Catholic University of Rome and founded the post-graduate school. Conclusions. Prof. Iannaccone's contribution to occupational health and industrial hygiene emphasized applied research and prevention in the workplace.

Occupational health responses to COVID-19: What lessons can we learn from SARS?

On 31 December 2019, the World Health Organization (WHO) received reports of pneumonia cases of unknown etiology in the city of Wuhan in Hubei Province, China. The agent responsible was subsequently identified as a coronavirus-SARS-CoV-2. The WHO declared this disease as a Public Health Emergency of International Concern at the end of January 2020. This event evoked a sense of déjà vu, as it has many similarities to the outbreak of severe acute respiratory syndrome (SARS) of 2002-2003. Both illnesses were caused by a zoonotic novel coronavirus, both originated during winter in China and both spread rapidly all over the world. However, the case-fatality rate of SARS (9.6%) is higher than that of COVID-19 (<4%). Another zoonotic novel coronavirus, MERS-CoV, was responsible for the Middle East respiratory syndrome, which had a case-fatality rate of 34%. Our experiences in coping with the previous coronavirus outbreaks have better equipped us to face the challenges posed by COVID-19, especially in the health care setting. Among the insights gained from the past outbreaks were: outbreaks caused by viruses are hazardous to healthcare workers; the impact of the disease extends beyond the infection; general principles of prevention and control are effective in containing the disease; the disease poses both a public health as well as an occupational health threat; and emerging infectious diseases pose a continuing threat to the world. Given the perspectives gained and lessons learnt from these past events, we should be better prepared to face the current COVID-19 outbreak.

The health of restaurant work: A historical and social context to the occupational health of food service.

The United States currently has over one million restaurants, making food service one of the largest workforces and industry sectors in the nation's economy. Historically, concern for the health of early restaurant workers was tied largely to the hygiene of the food and thus the wellbeing of the customer rather than the individuals preparing the food. The landscape of occupational illness and injury that resulted is fraught with some of the starkest health disparities in wages, discrimination, benefits, injuries, and illness seen among US laborers. These disparities have consistently been associated with social class and economic position. Conditions identified during the early years of restaurant work, before the introduction of occupational safety and health protections, persist today largely due to tipped wages, dependence on customer discretion, and the management structure. Research and intervention efforts to control occupational health hazards should be directed toward the socioeconomic and structural roots of health problems among food service workers in the United States. Such efforts have important implications for enhancing worker protections, improving wages, and restructuring working conditions for restaurant and food service workers. They also suggest opportunities for occupational health practitioners and researchers to contribute to system-level change analysis to address centuries-old occupational health challenges still facing one of the largest sectors of workers in the country.

Lessons from a historic example of diving safety rules violation: the case of Greek sponge divers.

This study presents a historical example of systematic safety rules violations by professional sponge divers in Greece during the early 20th century. In light of absolute unaccountability in favour of economic competition and in the absence of state oversight, the profession of sponge diving had developed into a deadly undertaking. The study is based on a report compiled by Professor of Hygiene and Microbiology Konstantinos Savvas, which was addressed to the Ministry of Marine Affairs. Savvas' report rested on data concerning hospitalised divers derived from the medical records of warship 'Kriti' (Crete), which escorted groups of Greek fishing vessels to four of their expedition in the Mediterranean over the period 1900-1903. Although the events explored herein took place at a time much different from the modern era with its numerous advancements in hyperbaric medicine, enhanced divers' professionalism and the establishment of labour rights and strict safety regulations, we should not overlook the human factor of professional exploitation that leads to the violation of safety rules. On the other hand, supervisory authorities entrusted with the responsibility of overseeing professional activities ought to be vigilant on a constant basis, especially in times of economic crisis that may lead to lax state functioning.

A Short History of Occupational Safety and Health in the United States.

As this short history of occupational safety and health before and after establishment of the Occupational Safety and Health Administration (OSHA) clearly demonstrates, labor has always recognized perils in the workplace, and as a result, workers' safety and health have played an essential part of the battles for shorter hours, higher wages, and better working conditions. OSHA's history is an intimate part of a long struggle over the rights of working people to a safe and healthy workplace. In the early decades, strikes over working conditions multiplied. The New Deal profoundly increased the role of the federal government in the field of occupational safety and health. In the 1960s, unions helped mobilize hundreds of thousands of workers and their unions to push for federal legislation that ultimately resulted in the passage of the Mine Safety and Health Act of 1969 and the Occupational Safety and Health Act of 1970. From the 1970s onward, industry developed a variety of tactics to undercut OSHA. Industry argued over what constituted good science, shifted the debate from health to economic costs, and challenged all statements considered damaging.

How the Seven Countries Study contributed to the launch and development of cardiovascular epidemiology in Italy. A historical perspective.

The Italian research group of the Seven Countries Study of Cardiovascular Diseases (SCS), through the independent use of the national cohorts and data, had the lucky opportunity, starting in the early 1960, to launch the Italian research in epidemiology of cardiovascular diseases (CVD). In this way, the Italian Section of that international study became the first investigation with baseline measurements in various cohorts, subsequent re-examinations, systematic search for morbid events, and follow-up for mortality up to 50 years. A large number of scientific aspects has been tackled including estimates of morbidity and mortality rates, the association of risk factors with cardiovascular events and total mortality, the role of risk factor changes, the use of multivariable models, the role of lifestyle behavior, the determinants of all-cause mortality including risk factors rarely measured in other studies, the identification of characteristics of a condition called Heart Disease of Uncertain Etiology (HDUE), the production of predictive tools for practical use and several other issues. All this has been enhanced by the availability of extremely long follow-up data rarely found in other studies. Field work organization, measurement techniques, diagnostic criteria, data handling and computing had the limitations and difficulties typical of those times, the mid of last century, when CVD epidemiology was at its beginning. All this represented anyhow the start of CVD epidemiology research in the country and was the stimulus to the start of other studies and a valuable collaboration with some of them.

Edgar Leigh Collis: Industrial lung disease and ergonomics.

Edgar Collis was appointed as the second Medical Inspector of Factories in 1908, holding the post until the outbreak of the First World War when he became Medical Director of the Ministry of Munitions. After the war, he was appointed to the chair in public health in the University of Wales. He held this post while living in Lossiemouth in Scotland, some 570 miles distant. His research interests were in industrial lung disease, industrial hygiene, and the health of coal miners. He made important contributions to the first and third subjects, but was a less significant figure in the field of industrial hygiene. Among his achievements were the recognition of the relationship between silicosis and tuberculosis, the harmful effects of non-silicaceous coal dust, and the need to fit the worker to the job, and the job to the worker.

[Historical changes in medical examinations for those engaged in specified work in Japan: Work covered and criteria].

OBJECTIVES: In Japan, so-called "medical examinations for those engaged in specified work" involve the same tests as those in general medical examinations, regardless of the type of work engaged in. The role of these medical examinations and "medical examinations with specified items for those engaged in harmful work operations" is also unclear. Therefore, questions have been raised about the appropriateness of the work covered by this medical examination. However, its legal system is complex and difficult to interpret. This study clarifies the changes in the type of work and their criteria covered by this medical examination. METHODS: We investigated laws and regulations, notifications, papers, and publications related to the history of medical examinations for those engaged in specified work. RESULTS: In 1947, Article 48 of the former ordinance on industrial safety and health stipulated that those engaged in work involving the handling of harmful substances that require special safety and health management shall undergo so-called "medical examinations for those engaged in specified work." Quantitative criteria for this work were indicated in a notification in 1948 in the form of tentative reference values, and they have not changed significantly since then. As a result, many of the standards used to determine who is subject to medical examinations for those engaged in specified work have exceeded allowable concentrations. CONCLUSION: The work covered by medical examinations for those engaged in specified work and its criteria have hardly been modified in approximately 70 years. In view of the changes in social environment and improvement in management methods for harmful work, it is necessary to rearrange the purposes and roles of the medical examinations with specified items for those engaged in harmful work operations and medical examinations for those engaged in specified work and to reconsider the method of the medical examinations for those engaged in specified work.

The first steps of industrial hygiene and occupational toxicology at the Clinica del Lavoro di Milano under the guidance of Luigi Devoto.

INTRODUCTION: The Clinica del Lavoro, the first clinic for occupational diseases of the world, was inaugurated in Milan on 20 March 1910; its first director was Luigi Devoto, who was in charge until 1935. The purpose of this work is to review the activities of industrial hygiene and toxicology carried out at the Clinica del Lavoro under the guidance of Devoto. METHODS: Documents published by the Istituti Clinici di Perfezionamento, a group of clinics of which the Clinica del Lavoro was part, record the birth and organization of this structure and the presence of a laboratory of chemistry; documents by Devoto and other authors were also retrieved to extrapolate specific information on activities of industrial hygiene and toxicology. RESULTS: The Clinica del Lavoro, at the time of its inauguration, included four laboratories: of chemistry, clinical physics, histopathology and bacteriology. The chemistry lab was located on the first floor and was composed of 6 well-lit rooms, modernly equipped with work benches that could accommodate 12 people. In Devoto's view, the chemistry laboratory, supported by that of clinical physics, had to assess the toxicological properties of chemicals commonly found in the workplace and to reveal the mechanisms of induction of damage to humans. In the first 30 years of activity, the Clinica del Lavoro investigated various diseases deriving from exposure to chemical agents, including saturnism, or lead intoxication, mercurialism, phosphorism, benzolism, sulfocarbonism, dust diseases. Several assays were developed and applied to measure toxicants in different biological and environmental mean as evidenced by scientific publications starting from 1920. CONCLUSION: In Devoto's view, industrial hygiene and toxicology were essential tools for the research and prevention of occupational diseases since the first years of activity of the Clinica del Lavoro.

The birth of modern industrial hygiene and occupational toxicology. A historical reconstruction through the analysis of the contributions of three protagonists.

BACKGROUND: The Clinica del Lavoro of Milan provided several contributions to industrial hygiene and occupational toxicology during the twentieth century. OBJECTIVES: Describe the first years of the laboratory of industrial hygiene of Milan through three figures who played a leading role: Enrico Carlo Vigliani, Nicola Zurlo and Gianmario Cavagna. METHODS: Scientific literature of the period 1948-1970 was investigated, also interviewing first-hand witnesses of that period. RESULTS: Enrico Vigliani was the first European scholar to understand the importance of a laboratory of industrial hygiene within his institution. Thanks to the support of private (Montecatini) and public (INAIL) institutions he succeeded in creating a laboratory in 1948. Nicola Zurlo, who directed this structure in the first thirty years, conducted innovative studies on chronic mercury intoxication, lead intoxication and silicosis, designing and creating instruments for capturing and analyzing atmospheric dust and protection devices. He conducted analysis of the health effects of organophosphorus insecticides and started to study the air pollution. Zurlo also provided an epistemological and methodological content to the discipline. Gianmario Cavagna, one of the first Italian toxicologists, contributed to the discovery of the origin of fevers caused by the inhalation of metal fumes and to the studies on the pathogenesis of byssinosis, hypothesizing a role of bacterial endotoxins in the genesis of this disease. CONCLUSIONS: The contributions provided by these three protagonists to industrial hygiene and occupational toxicology were relevant and made in those years the Clinica del Lavoro of Milan as a landmark, not only in Italy but also abroad.

A History of Industrial Hygiene: the Clinica del Lavoro in Milan and the Italian Association of Industrial Hygienists.

In 1969, the Italian Association of Industrial Hygienists (AIDII) was founded in Milan by Academics working at the Clinica del Lavoro, one of the oldest institutions for work prevention in the world and within the most prolific institutes in the world on Occupational Medicine and Industrial Hygiene. AIDII was founded as a scientific association with the primary purpose of promoting the development, deepening and dissemination of Industrial Hygiene, the scientific discipline aimed at identifying, assessing and controlling chemical, physical and biological risk factors (as well as transversal risks) either inside or outside the workplace, which can alter the health and wellbeing status of workers and/or the general population, for the purpose of effective prevention and protection of human health. Over the decades, the activities of AIDII have evolved to meet some of the current needs and challenges, while remaining consistent with the basics set by the founders.