Activities of the ‘Patronato INCA’, Office of Casale Monferrato 

by Dott. Daniela Degiovanni



1978-1990:  750 reports of occupational diseases found in workers of Eternit

Diseases most frequently reported :

bronchial pneumonia caused by silicate
lung tumours
pleural and peritoneal mesotheliomia
tumours in various places (larynx, kidneys, pulmonary tumours, metastase characterized by neoplasmas in various places in patients affected by asbestosis)

Number of recognized cases compensated – initially by ‘INAIL’ or after first administrative appeal:

82 (10,9%)

Number of cases for which legal steps were taken:

590 (78,4 %)

367 – asbestosis, bronchial pneunomia caused by silicate

223 – development of primitive neoplasms or pulmonary metastase characterized by the development of neoplasms in various places

Number of positive legal actions:

367/590 (62,2 %)

255 – asbestosis, bronchial pneunomia caused by silicate:




bronch. caused by silic.




112 – development of neoplasms + widow’s pension:

pulmonary tumors


58m, 4w



13m, 7w

mesoth. perit.


6m, 6w














1m, 1w

mts. pulm.


9m, 1w


My name is Daniela Degiovanni; I am an oncologist and work in the Hospital of Casal Monferrato. For the last 25 years I have treated asbestos-linked diseases. Within the space of time available, I would like to present to you briefly the results of my work of the past 20 years, as a medical-legal consultant for the largest Patronato Sindacale (organization established by the Union for the free assistance of workers, retired people, invalids etc. in the field of social security) of my city.

The aim of this lecture is to stress how a solid scientific training, together with a strong social motivation, can exceed the limits of the legislative and standard restrictions and redefine new routes.

From 1978 to 1996 I performed activities of medical-legal consultancy in the field of occupational diseases with the Patronato INCA of the trade union CGIL of Casale Monferrato, a town that had witnessed, from the beginning of the 20th century until 1986, the activities of the company ETERNIT, the biggest European industry of products of cement-asbestos (employing over 2.000 workers). The task of the Patronato is to see to the reporting of occupational diseases to the INAIL (Institute for Insurances against Industrial Accidents) and to the relevant requests for compensation for those workers who show clinical and instrumental?? signs of disease. Since the INAIL represents the Insurance Company it is, as such, characterized by a strong, often eccessive, rigour in the assessment of the medical-clinical documentation and vice versa, by a sparse attention to the symptoms declared by the workers.

It is understandable how important, in this context, the role is of the consultant doctor of the Patronato, due to the fact that the course of the procedure of the report presented by the Patronato depends on his/her training and motivation, which applies also to the legal action, in case of refusal of recognition by the INAIL.

For 20 years I have performed a work that enabled me to get to know, professionally as well as intimately, more than 2000 workers of Eternit.

By listening to their stories of suffering and anger, by examining their lungs affected by the inhaling of billions of fibres breathed in non-protected working conditions, totally deprived of security systems, I developed a deep moral conscience towards them which enabled me, confronting innumerable difficulties, to fight against cultural prejudices and lack of response. against rigorous conservative mentalities and systems closed to any innovation. Often, the struggle finished in a defeat, but the efforts were also rewarded by substantial results, by the recognition of the maximum right of the workers, i.e. the right to health, as well as by the evolution of the legislation.

Some "historical" and unforgettable struggles waged at the local level turned into victories for the workers at a national level.

I remember, for instance, the victory that my Patronato obtained in 1980 when, after 3 legal actions brought against the INAIL which had denied the recognition of occupational disease to 3 workers affected by pleural mesothelioma and by pulmonary tumor without pulmonary asbestos (up until that moment the presence of asbestos was decisive for the granting of compensation of damages by the Court for the workers affected by pleural mesothelioma or pulmonary tumor), we obtained not only the recognition of the damages by the Court, but also such a response with regard to these cases at the national level that shortly afterwards also the INAIL was forced to modify the List of Occupational Diseases, including in the diseases to be compensated the cases of mesothelioma and pulmonary tumor, without asbestosica interstiziopatia?.

In the course of these years we obtained the recognition by the INAIL of the principle of "concausalità" (concurrence of causes) when determining the death of persons suffering from asbestos affected by pulmonary metastase by tumors neither pulmonary nor pleural, but at different places such as colon, stomach, kidneys, with subsequent reversibility of the incapacity allowance to the surviving spouse.

Prior to 1978 legal proceedings were very seldom brought by the Patronato against the INAIL in order to obtain compensation of damages for the disease or the reversibility to the surviving spouse. The group that was formed in those years, consisting of doctors, trade union representatives, lawyers, volunteers, decided to set up a pilot project.

This project was concerned with starting legal proceedings each time the doctor would recognize in the case at hand the concrete terms to commence proceedings.

It was a very exacting undertaking, thwarted and sometimes not without danger. From 1987 until 1990 namely…..see Tables.

We are of the opinion that the activities performed from ’78 until ’96 were very rich in experiences and positive reactions. That which we have learnt from these activities can be summarized as follows:

  • In the absence of laws or clear regulations or in the presence of archaistic laws, often it is the social motivation that determines the most significant changes in the obtaining of an objective.

  • The legal doctor or the company doctor has a primordial function in the defence of the health of the citizen-worker.

  • At this moment, more than ever, we need doctors trained in labour medicine. However, the specialization in itself is not sufficient, if not linked with the "curiosity" to gain more-in-depth knowledge, to involve him/herself in the first person. Working conditions are far too much subject to strong and biased interests to be completely entrusted to the Legislator or, worse, to the sensibility of the employer.

  • If in Casale in the past this group of persons (doctors, union representatives, volunteers, lawyers, workers) had not been ready to involve themselves personally in order to obtain the results that we have seen, many rights would not have been recognized and many citizens, left alone, would not have obtained justice.


Dott. Daniela Degiovanni

Casale Monferrato

June 8, 2001



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