In 1700, This Guy Knew Standing Was Bad for Your Health

The link between posture and health problems is ancient, and apparently more obvious than I realized. Or perhaps Bernardino Ramazzini (1633–1714) was just particularly perceptive. Ramazzini was a Northern Italian scholar who, during the course of his distinguished career, advocated the use of cinchona bark as a treatment for malaria. He also noted the different rates of cervical and breast cancer between nuns and married women. Later, this observation would lead to the discovery of hormonal risk factors for these cancers.

Ramazzini’s particular scholarly interest was the connection between occupation and health. His magnum opus, De Morbis Artificum Diatriba (Diseases of Workers), earned him the moniker “the father of occupational medicine.”

His book provided a comprehensive look at the occupational health hazards different types of workers were exposed to. Many chapters are devoted to specific vocations (farmers, fishermen, midwives, miners, wet nurses, etc.), but there are also two chapters broadly devoted to “Workers Who Stand,” and “Sedentary Workers.”

Workers Who Stand

Some of the hazards he ascribes to standing workers (which in his day included blacksmiths, masons, and carpenters) are eerily on-the-nose today.

He observed, “The trades that require them to stand make the workers peculiarly liable to varicose veins; for the strain on the muscles is such that the circulation of the blood, both flux and reflex, is retarded, hence in the veins and valves of the legs it overflows and causes those swellings called varices…Now when the muscular fibres of the legs and loins are stretched, there is pressure on the arteries that extend downward; hence in that curtailed space they cannot push the blood forward with as much force as they use when one is walking and the action of the muscles is reciprocal. Hence the blood that is returning from the arteries into the veins does not receive from the impulse of the arteries the force needed to make it rise perpendicularly and so, deprived of that stimulus in the rear, it stops short and produces varices in the legs.”

Granted, that explanation of varicose veins would be out-of-date in a modern textbook, but for the time, it wasn’t a bad description.

Ramazzini also posed an insightful question. “It is worth while to discuss why standing, even for a short time, proves so exhausting compared with walking and running, though it be for a long time.”

He cites another Italian scholar, Giovanni Alfonso Borelli, whose answer tickles his fancy. “[T]his ingenious author ascribes to the fact that the same muscles are kept continually in action; for nature, he says, delights in and is restored by alternating and varied action; that is why walking does not cause intense fatigue, and it is true that those who stand are less fatigued if they put their weight now on one foot and now on the other. This natural instinct may be observed in animals also, as in hens, which sometimes stand on one foot and hold up the other; and in quadrupeds, for now and again one sees asses rest one hind foot in the stirrup, when they are kept standing.”

The “ulcerated legs” and “weakened joints” Ramazzini ascribes to standing workers are understandable today. But some of the complications he ascribes to standing, such as “kidney trouble” and “bloody urine” are harder to puzzle out. Since he specifically links these symptoms to servants and nobles at court, perhaps there is another factor involved. I’m speculating here, but both urinary tract infections (which can lead to bloody urine) and kidney stones can be caused or exacerbated by dehydration. I doubt the servants of Spanish princes were hauling around liter bottles of Poland Spring.

Ramazzini also notes that, “[W]eakness of the stomach goes with a life of standing; for when we stand and hold ourselves erect it is forced to sag, whereas in the sedentary life and when the body is bent forward, the stomach rests on the intestines; that is why when we suffer from any sort of stomach trouble we bend the whole body forward and draw up the knees and legs.”

…Uh-huh.

Sedentary Workers

Workers in sedentary occupations, such as tailors, weavers, and cobblers, were prone to their own complaints. Ramazzini didn’t spend a lot of time thinking about software engineers or graphic designers, so many of his observations don’t translate to modern-day white-collar workers. However, his insistence that, “All sedentary workers suffer from lumbago,” wouldn’t sound out-of-place today.

The workers he examined spent their work days stooped over items they held on their laps or on low benches. Their jobs involved doing finely-detailed work, often with poor lighting. They suffered from eye trouble, and Ramazzini bluntly states that, “They are not really hump-backed so much as round-shouldered like monkeys.”

He noted that tailors in particular were likely to suffer from sciatica, as well as other leg complaints like numbness and lameness. In one gloriously tactless passage, he writes, “It is a laughable sight to see those guilds of cobblers and tailors on their own special feast-days when they march in procession two by two through the city or escort to the tomb some member of their guild who has died; yes, it makes one laugh to see that troop of stooping, round-shouldered, limping men swaying from side to side; they look as though they had all been carefully selected for an exhibition of these infirmities.”

For reasons that are not clear to me, he also associates sedentary occupations with venereal disease, diarrhea, and skin conditions, the latter of which he attributes to “unwholesome humors.”

Other Valuable Observations

If it’s not clear by now, Diseases of Workers is as entertaining as you could expect an 18^th century medical text to be. Ramazzini’s mix of outdated and perceptive insights is particularly notable in his chapter on “Diseases of the Jews.”

“The Jews are a people whose like is not to be found on the face of the earth; nowhere have they a fixed abode, but they are in every country; they are a lazy race, but active in business; they do not plough, harrow, or sow, but they always reap. Now these people are pursued by various diseases which result from the trades that they pursue, and not, as is commonly believed, from some infirmity of the race or from their unwholesome diet. Moreover, it is a mistake to ascribe a disgusting smell to Jews as though this were an innate and racial characteristic; for the smell that one notices in their common people is due to their mean homes and the mean poverty in those homes. We may be sure that when they lived at Jerusalem where perfumes abounded, they were clean and neat and had a pleasant smell.”

By the way, that awful smell the Jews were apparently known may have been another occupational hazard. Ramazzini later went on to describe typical occupations of Jews in his area, which, as he tells it, involved laundering sick bed linens, repairing waste-soaked mattresses, and collecting used rags. I can understand how that might impart a certain undesirable odor.

Takeaways

Occupations and their associated hazards have changed a lot since 1700, and thankfully, medical practices have improved. Diseases of Workers has been superseded by more recent medical texts, but Ramazzini’s style of observation is needed now as much as ever.

Today, the fashion in medicine is to see health as a function of nutrition, genetics, culture, and class. The stresses placed on the body by occupation or posture are of secondary concern. That is, at least, until injuries or health problems make these stresses impossible to ignore.