Search

On occasion of the Centenary of the "Clinica del Lavoro Luigi Devoto", its researchers suggested that awareness of its historical identity and scientific development should constitute the basis for the future of the Institution. The directors of the Institute who have succeeded one to the other over the years have left a vivid report of the vast amount of work developed in several research fields and also of the original results achieved with significant impact on the scientific community and on society. Content analysis of "La Medicina del Lavoro" allowed us to shed light on strong bonds existing between manufacturing techniques, work organization and health, in the different political and social periods in which they developed. Many actions have been defined and several research subjects have been renewed (according to current demands and new methodological possibilities) between the past and the present, nevertheless many new approaches need to be taken in the fields of epidemiology, indoor air quality, ergophthalmology, muskuloskeletal disorders, environmental and molecular toxicology, and further research will be undertaken thanks to the potential of this discipline for the future. The aim of this report is also to express our thanks to all the medical and non-medical staff who have made their contribution over 100 years of engagement.

In the second half of the seventies, at the same time as the control of silicosis was achieved thanks to pathogenetic and preventive developments, the major efforts of the Clinica del Lavoro in the pneumological field were focused on studying dose-response relationship in asbestos-exposed subjects. Thus for the first time biological indicators (and not radiological ones) were mentioned for asbestos diseases. Bronchoalveolar lavage (BAL) allowed to compare an internal dose indicator (number of bodies/ml) and schlerogenous effect indicators (dose-response). Our experience over nearly 20 years for exposure assessment in asbestos-related diseases, based on over 500 cases has produced the following results: parenchymial asbestosis is dose-dependent while pleural plaques are dose-independent; epidemiologic data on existence of asbestos resistant subjects were confirmed; asbestos bodies proved to persist in alveolar cavities for several decades. At present, with the ban of asbestos and the increase in forensic medicine cases regarding past asbestos exposures, our Department demonstrated the importance of asbestos body counting in BAL as an objective indicator of asbestos exposure. Besides the asbestos issue, two less frequent work-related diseases were studied and in this regard bronchoalveolar lavage proved to be a substantial diagnostic tool, sometimes even decisive: these were hard metal disease and hypersensitive pneumonitis. In subjects exposed to hard metals, our experience showed the presence of a large lymphocytic alveolitis with CD4+/CD8+ reverse ratio for bronchial asthma and macrophagic-eosinophylic alveolitis characterized by several "bizarre" giant cells in the case of interstitial disease. In extrinsic allergic alveolitis, we noted the presence of a large lymphocytic alveolitis mostly with CD4+/CD8+ reverse ratio, persisting also during clinical remission of the disease.

This paper, as a contribution for the centenary celebration of the establishment of the "Clinica del Lavoro Luigi Devoto" in Milan (Italy), presents a brief 30 year history of the activities of its Department of Occupational Epidemiology. Studies and methodological contributions that characterized the first decade of activity are presented and grouped under the heading of analysis of known health effects. The second decade was dominated by the studies and activities that originated from the Seveso accident (dioxin), with an initial interest towards molecular epidemiology, which became increasingly relevant during the third decade when we addressed topics like melanoma, lung cancer, and benzene, in addition to dioxin. More traditional occupational approaches were not dismissed and cohort mortality studies are currently under way (textile dyeing and finishing industry, sulfuric acid, tetrafluoroethylene). Pros and cons of the epidemiologic approach are discussed in the context of occupational health and the strength of its methodological apparatus is suggested as a fundamental tool for studying adverse occupational health effects. In contrast, it is stressed how occupational epidemiology has been poorly used in the application of law 626/94. Considering that contemporary epidemiology is much more inclined towards the discovery of new work-related risks (electromagnetic fields, air pollution) than the description of known health effects, the paper suggests that occupational epidemiology enlarge its interests: people and environment outside the factories might be good candidates for study.