Three Centuries of Indecision

Editors’ Note: See also Workers Are Us in today’s issue.

Bernardino Ramazzini (1633–1714), an Italian physician, was appointed to the chair of theory of medicine at the University of Modena in 1682 and served as professor of medicine at the University of Padua from 1700 until his death. He is often called “the father of occupational medicine.”

His book on occupational diseases, published in 1700, De Morbis Artificum Diatriba (Diseases of Workers), outlined the health hazards of chemicals, dust, metals, repetitive or violent motions, odd postures, and other disease-causing agents encountered by workers in more than 50 occupations. This was one of the founding and seminal works of occupational medicine and played a substantial role in its development. He proposed that physicians extend the list of questions that Hippocrates recommended they ask their patients by adding, “What is your occupation?” Ramazzini engaged in epidemiological studies of workers to diagnose work-related illnesses and injuries.

It is much better to prevent than to cure, and so much easier to foresee future harm and avoid it rather than have to get rid of it after having fallen prey.

Ramazzini saw prevention as being better than cure. In a lecture given in 1711, he suggested that “it is much better to prevent than to cure, and so much easier to foresee future harm and avoid it rather than have to get rid of it after having fallen prey.”

Contemporary pundits, particularly newspaper editors, routinely and consistently praise Virginia’s slow motion approach to passing new legislation, especially where the subject may be innovative or run counter to received wisdom, e.g. Medicaid expansion. There is no rule or chronological measure to gauge the proper amount of time from recognition of an issue to a social or legislative resolution . This phenomenon is painfully apparent in the state’s workers’ compensation law, where injuries sustained due to repetitive motion or stress employment (RMI/RSI) activities are not recognized for purposes of receiving benefits.

Under the Workers’ Compensation Act, an injury is compensable only if the injured employee can demonstrate (1) an identifiable, singular incident; (2) that occurs at some reasonably definite time; (3) an obvious sudden mechanical or structural change in the body; and (4) a causal connection between the incident and the bodily change. The Supreme Court of Virginia has stated that “injuries resulting from repetitive trauma, continuing mental or physical stress, or other cumulative events, as well as injuries sustained at an unknown time, are not ‘injuries by accident.’” [Morris v. Morris, 238 Va. 578, 589, 385 S.E.2d 858, 865 (1989).]

Virginia is one of only a few states that does not recognize repetitive motion (consistent use of a jackhammer) or stress (continued lifting of heavy materials over a period of time) as causative of work-related injuries requiring compensation.

Virginia is one of only a few states that does not recognize repetitive motion (consistent use of a jackhammer) or stress (continued lifting of heavy materials over a period of time) as causative of work-related injuries requiring compensation. Recently, the Virginia General Assembly passed legislation that directs the state’s Workers’ Compensation Commission to study the implications of covering repetitive motion and stress injuries in the state workers’ compensation system.

Epidemiology as a medical discipline is much in the news as the nation addresses the coronavirus pandemic. A shorthand definition of the term reveals that it is the branch of medical science that investigates the factors that determine the presence or absence of diseases and disorders. Epidemiological research helps us understand how many people have a disease or disorder. Including Virginia, government responses and actions in the face of the coronavirus have been taken even before comprehensive hard data have been developed by epidemiologists. Why, then, is it taking the Commonwealth so long to acknowledge RMI/RSI? 

After all, only three centuries have elapsed since Ramazzini’s findings.



Categories: Health Care, Issues, Local, National

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