Methodological notes
ICOH chronology along its 100 years of life
ICOH along its 100 years of life has played a basic role in spreading occupational medicine world wide in spite of institutional troubles, two world wars, headquarters move: hence the documentation kept up to date is rather poor.
An attempt to reorder the archives at the Milan office was started in the early 90’s (see Triennial Report 1990-1992) and more recently at the ISPESL office in Rome.
Except for the last years however, the material is quite fragmentary and miscellaneous and even basic series like constitutions are not entirely available in the present archives.
Besides, ICOH ever since its birth has mainly played an international role so that it is rather difficult to go back to the documentation rebuilding links, relationships and connections.
Under these conditions it is extremely hard to appropriately investigate ICOH history on account of the great importance of this organizations along the past century.
An internationally wide research would be necessary, covering both the disciplinary issues and the institutional, organizational and political-cultural problems encountered in such a broad organization, with a systematic digging out on sources available in the different countries.
As a first step and in view of systematization, the information (specially at institutional and organizational level) available at the ICOH archives and the series of congress proceedings available at the Library of “Clinica del Lavoro” of Milan have been chronologically ordered within the current scenario. The latter materials are being re-ordered and informatized and will be a invaluable tool to go more in depth of occupational health history at international level. Thanks to the courtesy of the Clinica staff, use has been made of the parts dealing with congress preparation and organization as well as institutional materials.
Owing to the fact the for some periods there is an overabundant documentation while for others materials are lacking, it has been decided to regularly schedule chronology above all around the triennial congress steps.
The venue and a short summary of the event are reported next to the date. Then a short description of the event is always provided: if possible and appropriate in-depth information are given (substantially concerning association life and relationships with other international authorities).
When possible, organizational management charts have been reconstructed and journals “Il Lavoro” and “Il Ramazzini” provided information on the first stage of Commission life, even if nowadays constitutions and regulations issued along the century are not all available.
Milanese origins
ICOH was founded in 1906 within the International Exhibition of Milan dedicated to labour issues. The Exhibition was organized to celebrate the Simplon tunnel completion, a huge work financially and technologically speaking, a symbolic expression of the will to approach different countries along a common path and a celebration of the technique capability to reduce hard work, dangers, sacrifices of human lives brought about by such endeavours. During the works, actually “only 106 fatalities” were reported, which would be a tragic balance today but at that time was considered as an undoubted progress as compared with the Saint Gothard tunnel, accomplished fifteen years before.
These are the reasons why Italian occupational health milieus decided to organize an international Congress dedicated to occupational health issues.
Italian occupational health was an extremely young discipline. After the pioneer works by Giordano on “carusi” (extremely young miners of Sicilian sulphur mines), research centres were developed in Florence and Milan. In Florence, Gaetano Pieraccini was the initiator of a school that laid the bases of “occupational health” as a discipline originated from “hygiene/work physiology/medical clinic” triad, to renew medicine-society relationship. While the Florentine school was close to reformist socialist circles and “medical socialism”, the Milanese school was closer to the huge industrial development of the Lombard town and focused on the internationally innovative project of a “Clinica del Lavoro”, promoted by Luigi Devoto.
In this context, the hygienist medical doctor Malachia De Cristoforis, who was also a reputed politician, a Senator of the Italian Kingdom and an influential Mason (Grand Master of the Italian Grand East) launched in 1902 the idea of a medical Congress on occupational health issues to the held during the Milan Exhibition.
The 1906 Congress and the First International Commission
World exhibitions at that time were the favourite venues for international congress organization in a wide range of scientific fields: tens or even hundreds of congresses were organized during each relevant exhibition.
In Italy the preparation was extremely accurate and prolonged, concerning not only medical environments but also state and local administrations, and was in close connection with the ongoing project of “Clinica del Lavoro”.
In this situation, Italian occupational health referred to the international context not only as a necessary comparison and exchange reference scientifically and operationally, but also as a validation and acknowledgement tool, that is as an important factor to support the national context development. In this sense the foundation of the International Commission is to be considered as an opportunity to make this exchange scientific channel a lasting one beyond the temporary season of the Exhibition. It also explains the particular organization of the Commission, at least along the first decades of its life, with a peculiar dialectic between national and international decision-making bodies and with a major role played by Italian component in the central heart of the organizational structure. In fact the first regulations and constitutions had produced a little formalized commission, substantially an expression of the congress, practically only in charge with forthcoming congress preparation. The Commission had been appointed among Congress participants with a typically international composition, with a large number of represented countries: France, Prussia, Switzerland, Sweden, Bavaria, Austria, Hungary, Belgium, the Netherlands, Canada, United Kingdom. Other major countries joined the national congress of Palermo in 1907 such as Russia and Greece, but the role of Italy remained a major one since the President Malachia de Cristoforis was Italian like the secretary Carozzi and the two Vice-presidents Gaetano Pieraccini and Luigi Devoto.
The series of Congresses continues: Brussels 1910
The Second International Congress was held within another International Exhibition in Brussels in 1910.
The years between the Milan and the Brussels Congresses were very important since it was in those years that the forthcoming actions were defined. The network of international relationships was finalized with the adhesion of major countries like the USA and the Commission started to have a preliminary organization. In fact the second congress was prepared by coordinating the contributions by participating countries through “Commissions de patronage” including governmental authorities and academic, scientific, industrial and State administration personalities and “Comités exécutifs” including specialized medical doctors. Moreover, national Organizational Committees were established to collect adhesions within each country. In 1910 the Commission included 19 countries and 29 members and in the same year already a series of National Committees had formed or were under way (Germany, France, Switzerland, Austria, Hungary, Bulgaria, the Netherlands, Canada, United Kingdom, Spain, United States, Greece, Italy).
During these first years the Commission was having a rather continuous and regular life. It was an extremely light structure, as stated by 1910 constitution with an extremely small managing group (President, secretary, two Vice-presidents) by constitution residing in Italy and with headquarters at the “Clinica del Lavoro” (which enabled a regular life even with a very little budget, of a few thousand liras). At the same time, however, thanks to the commitment of managing organs, during this period the Commission could start and implement some relevant and lasting initiatives like bibliographic service and periodical “Bulletin”.
The First World War
The First World War was a very strong breakdown, prolonging its effects far beyond 1914-1918. Not only did it prevent the meeting of the 3rd Congress, called in Vienna in September 1914, but it also involved occupational health in the troubled critical process of scientific internationalism produced by the war. Besides, the first President, Prof. Malachia de Cristoforis, passed away in those years so that the following congress was held only in 1925 in Amsterdam, but jointly with work accident medicine association, starting a series of joint congresses that lasted over the whole period between the two wars.
Period between the two wars and relationship with the committee for work accident medicine
The Permanent Commission for work accident medicine would even have merged with occupational health but at the Amsterdam Congress Devoto realized that such a merger would have been not at all advantageous for occupational health since study of occupational diseases was quite disregarded at state level: there were many legislative gaps and quite often teaching and university research were not adequately promoted whereas study of work accidents was much more considered. Hence occupational health risked to get the worst of it, and this is also the reason why after some unsuccessful negotiations, the Commission Bureau refrained from attending the Budapest Congress in 1928 that however was maintaining the joint congress form and was officially included as the 5th of the series into the Congress list.
In this context, a meeting (the 4th one) of the Commission was held in 1929 in Lyon within a congress of its own (which however was not included into the list of international congresses), devoted to silicosis, occupational cataracts, ductless gland injuries in intoxications. The congress played a major role in restating the identity of Permanent Commission that had been seriously threatened by the proposed merger.
The new Commission Constitution was also presented at the Congress aimed at evidencing the need felt by occupational health for social legislation reforms, social security measures, promotion of university teaching, strongly supported by governments.
Constitution still provided for a very light organization but with a double closed number: in total no more than 100 members for the whole Commission and at national level no more than 8 per country. At that time such limit was achieved only by Germany, United Kingdom and Italy.
Along these years the Commission had substantially a European-continental scope: with the exception of the area of the British Empire, the USA and Japan, all the other countries were European. The Old continent was well covered even if with some remarkable exceptions. But the most outstanding feature of that period is no doubt the collaboration that restarted in Geneva in 1931 with the Comité Permanent International pour l’Étude de la Médecine des Accidents du Travail (still with some prevalence of the latter from the organizational standpoint). Such collaboration was then confirmed in 1935 in Brussels where the congress was organized by Dr. Glibert, former general inspector of the occupational health service, and a top personality in the field, succeeded by Devoto after his death.
Another relevant collaboration was identified, ever since the years of Devoto’s presidency, with the Bureau International du Travail, employing, among others, Luigi Carozzi, the Commission secretary ever since the Commission birth.
The Second World War
The Second World War outbreak, foreboded already during the Frankfurt Congress, scheduled in the same days as the Munich Conference, again disrupted the occupational health international organization.
Dr. Glibert’s passing away further worsened the situation and the only reference point remained Luigi Carozzi who, immediately after the end of the war, resumed the international relationship network and re-established organizational and institutional continuity. An easier task since Dr. Glibert, in spite of 1929 constitution provisions, had decided not to move the headquarters from the “Clinica del Lavoro” of Milan.
The address outlined by Carozzi referred more to Commission origins that to the period between the two wars: the 9th Congress held in London in 1948 was numbered following the pre-war series, but it was a Congress organized only by the Commission Internationale Permanente pour la Médecine du Travail with a significant change in the title. After the first congress on “Maladies du Travail” and the following on “Maladies Professionnelles” or gain work-related diseases, the London Congress included also in its title the new denomination of the Commission and became “Congrès International de Médecine du Travail”. As stated by Vice-president Mazel in his closing speech, the point was passing from study of disease to prevention and “surveillance continue de l’hygiène du travail et de la santé du travailleur”.
Relaunching of ICOH in the second post-war period
It is worth recalling that many conditions at workplace had changed or were deeply changing: not only in the specific field of occupational health where the address by Mazel had a thoroughly new impact but also in the relationships with the other international bodies. The Commission mission ever since the beginning had been establishment of a scientifically rigorous reference parameter for a series of social practices (from treatment to prevention) by developing studies and research and promoting a specific culture in the field through international contacts.
In the second post-war period, in addition to BIT, other international organizations were developing within the United Nations, covering fields close to occupational medicine, and hence a comparison study was made necessary. Besides, a lot of realities concerned with occupational health were appearing on the world scenario in the frame of a decolonization and growing process of countries outside Europe. Moreover, occupational health contents were enlarging and developing with advances of considered knowledge and realities.
In this context, the Commission structure that had substantially remained a very light organizational scientific-professional association, quite Europe-centered, started to remarkably change.
Relationships with international organizations sensibly increased ever since the beginning, the number of participating countries increased as well as the number of members and above all between 1956 and 1957 its organizational structure underwent a significant change.
The new organizational structure
The Commission along its first half a century of life had a very small management (President, Secretary, Vice-presidents), while the number of full members was much higher. The members were selected by co-optation among the distinguished personalities in the field of occupational health in the different countries following more or less complex rules, fixing an overall closed number but trying to account for equilibriums of national representativeness and to enable access of new countries. On the other hand, full members could not meet unless exceptionally outside congresses (and without a full legitimacy since in any case ratifications by non attending members had to be sent by mail).
Therefore congresses were the crucial venues also organizationally. Constitution up to the 1957 turning point, clearly indicated that the Commission Bureau, consisting at the time only of President and Vice-presidents plus Secretary and Treasurer, had authority up to the designation of the hosting country. From that moment onwards all competences (as well as organizational charges and financial liabilities) were taken over by the National Committee of the hosting country, that was becoming fully responsible for related authorities including the faculty of constituting into organizing Committee, selecting other outstanding personalities. The President had only the right of some formal decisions regarding the time of opening speech and the assembly.
In other words, along the first fifty years, the structure was a very light organizationally speaking, with a small number of members, little funding and few fixed structures but however able to take over rather heavy organizational tasks thanks to the periodical moving of organizational workloads to the single countries.
The turning point between 1956 and 1957 changed name and organization to the Commission that became an open association with no closed number, thus greatly increasing members and represented countries, but above all addressed an evolution ascribing more weight to in-depth and continuous scientific connection activities, strengthening central needs on topical basis.
This is the rationale at the base of special Committees (later scientific Committees) focused on given subjects that were started in those years and, unlike national Committees, were going to develop continuously, and not only in view of congress schedules; they included different national realities according to different competences and could organize “special meetings” on topical issues and not on national basis.
Enlargement to new geographic areas and new scientific topics
In the meantime, also the Commission management strengthened: the Bureau remained quite small but increased its coordination and control powers both on new scientific committees and national organizing committee still in charge with triennial congress preparation.
The latter, in their turn, expanded over new geographic areas. In 1960 for the first time the Ocean was crossed (New York), in 1969 an Asian country (Japan) hosted the congress, in 1978 Yugoslavia took over (first time for a socialist country), and in 1981 Egypt was the first African country.
Another basic aspect is the great activity of Scientific Committees. The original four committees (one of which devoted to constitution revision), turned into some tens and were also acknowledged by constitution starting from 1966. At that time there still were Scientific Committees aimed at investigating special issues of occupational health, teaching committees dealing with organization of course and lectures and finally committees with organizational tasks for Commission operation. In all cases however they are still under the strict control by the Board.
In its turn the Board remarkably increases to ensure more representativeness to an ever increasing number of countries and geographic areas adhering to the Commission. At first this enlargement passed through the increase of Vice-presidents’ number who became 7 in 1966. Then in 1975 the Constitution provided a Board of 16 members in addition to President, immediate Past President and Secretary-treasurer.
Scientific Committees
The 1975 Constitution provisions specially applied to Scientific Committees that were further strengthened organizationally (combination with the other kinds of committees was dropped) with consequent increase in autonomy. In fact the Commission President (now the exact denomination is “Permanent Commission and International Association on Occupational Health” that is “Commission Permanente et Association Internationale pour la Médecine du Travail”) assisted by an appropriate advisory committee of the Board, just appointed Committee Chairs and secretaries who in their turn appointed respective members. Chairs were also financially responsible for their committee activities: financial contributions by the Commission to committees were envisaged as well as at a later stage, some income in favour of the Commission based on scientific Committees’ activities.
Via these passages, between the 60’s and the 70’s the Scientific Committees became not only the backbone of scientific activity of study and research but also a major organizational body definitely contributing to Commission organization.
Development and organizational changes
Also International Congresses were affected by this organizational and scientific arrangement. The number of participants progressively increased as well as the number of presented contributions. Parallel session were implemented (in Vienna in 1966 the congress was held in no less than14 rooms simultaneously) as well as poster sessions and multimedia. Topics broadened and became more specialized with relation to scientific Committees that were working regardless on scientific issues but obviously affected also Congress contents.
Congress issues were on the other hand extremely complex and varied and focused on a series of topics beyond occupational health as traditionally conceived , for example underdevelopment and environment problems that were strongly debated in the two past decades.
During the 80’s, the Constitution was first revised and between the Sidney and the Helsinki Congress major initiatives were started, with a further revision of constitution and planning of a Code of Ethics for Occupational Health Professionals.
Constitution revision of 1990 did not only provide organizational adjustments or changes, even if of great importance like Board election by mail or establishment (again) of the headquarters at “Clinica del Lavoro” but newly defined the Commission goals (it had become in the meantime “International Commission on Occupational Health”) as an international, non-profit, non-political, scientific and multidisciplinary organization.
The Code of Ethics
The first version of the Code of Ethics was completed in the early 90’s.
As stated in the introduction to the first edition (1992) the initiative was going to meet the requirements by different countries to work out professional ethical codes for occupational health professionals differing from those addressed to general practitioners for several reasons:
“There are several reasons why an International Code of Ethics for Occupational Health Professionals, as distinct from codes of ethics for all medical practitioners, has been adopted by the International Commission on Occupational Health (ICOH). One is the increased recognition of the complex and sometimes competing responsibilities of occupational health and safety professionals towards the workers, the employers, the public, public health and labour authorities and other bodies such as social security and judicial authorities. Another reason is the increasing number of occupational health and safety professionals as resulting from the compulsory or voluntary establishment of occupational health services. Yet another factor is the emerging development of a multidisciplinary approach in occupational health which implies an involvement in occupational health services of specialists who belong to various professions.”
The code of ethics was later updated also at the light of remarks by a large number of ICOH members in the following years up to 2002 edition.