Dr Ramazzini (1633-1714) and the Occupational Diseases of Midwives and Wet Nurses

Archives ofDisease in Childhood 1993; 68: 337-339 337 Arch Dis Child: first published as 10.1136/adc.68.3_Spec_No.337 on 1 March 1993. Downloaded from PERINATAL LESSONS FROM THE PAST Dr Ramazzini (1633-1714) and the occupational diseases of midwives and wet nurses Peter M Dunn Bernardino Ramazzini was born in Carpi near Modina in Italy in 1633. He studied medicine in Parma and took his doctorate in 1659. After a year with Dr Rossi in Rome, he prac- tised for some years in the province of Viterbo until a severe bout of malaria caused him to return to his home town. On recovering he married Francesca Righi. They had a son who died in infancy and two daughters. Carpi served as a summer resort for many of the leading families of Modina. Impressing them with his learning and charm, Ramazzini was invited in 1671 to move to the city where he quickly gained the patronage of the ruling d'Este family. In 1678 Duke Francesco II founded a university in Modina and Ramazzini was appointed Professor of the Theory of Medicine, a post that he held for the next 22 years. We are told that Ramazzini was a lean man of sallow complexion with black hair that became prematurely white and was concealed by an elegant wig. He dressed ...:~~~~~~~~~~~~~~~~~~~~~~~..X ..: ^,' t... well and walked so fast that his students had Dr Bernardino Ramazi.A -(1V in difficulty keeping up with him. Games he Dr Bernardino Ramazzini (1633-1714). avoided but he thoroughly enjoyed playing http://adc.bmj.com/ chess. He paid little attention to the affairs of the household but in all else was a hard occupations such as the glass workers and worker and a keen observer. mirror makers, the blacksmiths, the apothe- In 1700 Ramazzini was persuaded to accept caries, and the cleaners of privies and cess the Chair of Practical Medicine in Padua. He pits. There is also a chapter on the diseases of was 67. In 1707 he was made President of the learned men, of whom he wrote: Venetian College and two years later became on September 29, 2021 by guest. Protected copyright. Primarii of the medical faculty. But by this '. nearly all learned men . suffer the time his health and eye sight were failing and drawbacks of a sedentary life; but I except in 1714 he suffered a severe apoplexy. Dr medical practitioners. It is commonplace that Morgagni and other colleagues hastened to to become erudite you must keep sitting; so his bedside but he died a few hours later. He day and night they sit absorbed in the delights was 82. His body was laid to rest in the of study and oblivious of the harm done to Church of the Nuns of St Helena in Padua. their bodies, until the unheeded causes of dis- Dr Ramazzini, a contemporary of Malpighi eases steal in on them little by little and con- and Leibnitz with whom he corresponded reg- fine them to their beds. I have already indicat- ularly, was one of the great figures of 17th ed above the disorders brought on by a century Italian medicine. Besides being a sedentary life, so I shall not dwell on this fur- scholar and clinician he studied barometry ther . .. Of all who follow the learned profes- and hydrostatics. He was also a distinguished sions, those who are most exhausted by their hygienist and epidemiologist in the Hippo- studies are men who are preparing to publish cratic mould. Indeed, on being elected a an edition of their own works and have set member of the Viennese Academy of Curiosi their hearts on winning immortal renown. But Naturae in 1691, he was the name of I mean only those who are truly learned, for University of Bristol, given Southmead Hospital 'Hippocrates III'. However, it was for his very many are possessed by a mania for writ- work on occupational diseases that he is best ing and hurry to publish stuff that is badly put Correspondence to: Professor P M Dunn, remembered. His magnum opus called the together, abortions rather than the mature off- Department of Child Health, Diseases of Workers, first published in 1700 spring of their brains. They are like certain Southmead Hospital, Southmead Road, and expanded in 1713, is a medical classic.1 It poets who dash off a century of poems, Bristol BS10 5NB. deals with the diseases of over 50 different 'standing on one foot', as Horace says. Now 338 Dunn the truly learned who look forward to winning of intercourse with and even the sight of their Arch Dis Child: first published as 10.1136/adc.68.3_Spec_No.337 on 1 March 1993. Downloaded from for their names fame and renown that will last husbands, so that they cannot visit their own long, wear themselves out by working day and homes and children; this only makes them night so that sometimes they die before they long the more for that forbidden intercourse, bring forth'. and from brooding over their troubles night and day they fall into fits of violent hysterics . Ramazzini's book also contains chapters of . For I observe that among the common peo- the diseases affecting midwives and wet nurses ple mothers always nurse their infants, unless from which the following extracts are taken: prevented by some accident, and they sleep every night with their husbands and do not abstain from the usual sexual intercourse; yet ON MIDWIVES '. there is no possible doubt that the uterine there is no evidence that this does any such flux that precedes and follows a birth pos- harm by spoiling the milk as doctors appre- sesses a malignant and poisonous quality, as is hend and imagine when they prescribe strict evident where there is sudden suppression or chastity for those who are nurses in the houses diminished flow of the lochia .. Now while of the nobility and princes . The fact is that the women in labor are seated on the chair, in this city very few of the nobility employ the midwives stand by leaning forwards with nurses in their houses because high living hands outstretched to receive the infant, and makes them unbearably immodest and saucy. they keep standing at this task for several . Hence they nearly always hand them over hours; hence from the dripping lochia they to nurses who rear them in their homes along suffer such serious injury to their hands that with their own children, but they prefer to these sometimes become inflamed and ulcer- entrust them to country women rather than to ated by that corrosive, acrid matter. Femel, women of the city so that they may be nour- marvelling at the virulence of contagious dis- ished on richer milk'. eases, cites the case of a midwife who, while attending a confinement, contracted so seri- Concerning the sympathy between breasts and ous a lesion in her hand that it finally rotted uterus: 'We must certainly believe that the and fell off; however, he does say that the Divine Architect fashioned the uterus and patient was infected with the French disease the breasts with some structure, some con- [syphilis] . How, then, shall the medical trivance that so far escapes us, so designed profession safeguard and deliver these women that by an established routine conception in when they deliver, how assist them to follow the uterus is followed by the generation of their calling with all possible impunity? The milk in the breasts, on the analogy of what we only way is for them to wash their hands and now know happens when the fetus breaks out arms in water or wine when they have a of its prison, and its lungs, which for nine breathing spell; when their work is done they months had nothing to do, thereupon enter should wash the face and rinse the throat with on their function as the outer air begins to vinegar and water, put on clean clothes when enter the mouth and to inflate them by its so that the fore- they go home, in short be very careful to keep elastic force; simultaneously http://adc.bmj.com/ themselves clean. I was told by an aged mid- men ovale falls into disuse and the blood cir- wife that, whenever she attended a woman culates by other channels. We must therefore who was either suspected of suffering from the concede that a marvellous sympathy between French disease or was in any way sickly, she the breasts and the uterus does exist; but so used to wait till the patient was in the very last far it has not been explained by the sagacity of throes before she placed her on the chair; this man or come under the eye of the anatomist .. This marvellous sympathy of the breasts was to shorten the time in which her own on September 29, 2021 by guest. Protected copyright. hands would be wetted by the contaminated and uterus, those two sources of desire, is lochia'. amply demonstrated when the nipples are rubbed, for this, as women admit, is a strong incentive to venery. Carpi says that handling ON WET NURSES the breasts, especially the nipples which Concerning sexual intercourse: '. .. nurses are become erect like the penis, stimulates lan- liable to hysterical troubles, particularly those guid desire'. who live in the houses of the great and eat rich succulent food but are carefully guarded from Concerning too frequent breast feeds: 'I cannot intercourse with their husbands ... Nearly all take leave of nurses without suggesting to writers on the regimen of nurses accept as them one very important precaution to be fol- beyond question, as a sort of oracular utter- lowed in their own and the child's regimen, ance, the doctrine that a nurse ought to which is that they must not be too generous abstain from sexual intercourse or her milk with their milk and give the infant the breast will be spoiled .

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