EDITORIAL |
ICOH one hundred and the Simplon tunnel
This year sees the centenary of the International Congress of Occupational Health and the 28th ICOH meeting is to be held in Milan, Italy, during June 2006. The special cover of this issue of Occupational Medicine celebrates the ICOH centenary. The Simplon tunnel was instrumental in this birth and the train poster on the cover recognizes the unique place that this feat of engineering holds in the creation of an international occupational health movement 100 years ago.The 1906 ‘Universal Exhibition’ celebrating the achievements of human ingenuity in science, technology and arts was organized in Milan. The exhibition was marked by the opening of the Simplon tunnel linking Milan to Switzerland and France. At 19.8 km, the tunnel was the longest railway tunnel in the world, only superseded by construction of the Seikan tunnel in Japan in 1984. The Simplon represented the first heyday of tunnelling in Switzerland (1870–1920) closely connected with the extension of the railway network in the Alps.
The Simplon tunnel lies under the Grand-St-Bernard Pass and is the oldest of the Alpine pass routes, in use at least since the Bronze Age (about 800 BC). Tribes and armies have tramped their way to and fro for millennia; in 390 BC, a Gaulish army crossed to defeat Rome and Hannibal's famous crossing of the Alps in 217 BC, reputedly with elephants, is indelibly associated with the Grand-St-Bernard, though there is little actual evidence of it. The first road was constructed by Augustus around 50 BC and by 1800 some 20 000 people were using the road annually for trade and travel. During the wars of the 1790s, entire armies crossed the pass and in May 1800, Napoleon led 40 000 troops into Italy, on the way consuming 21 724 bottles of wine, a tonne and a half of cheese, 800 kg of meat and ran up a bill with the pass hospice of 40 000 Francs before departing with a wave of his hand. Fifty years later, the monks received 18 500 Francs towards payment but had to wait until May 1984 for a token gesture of account settling from French President François Mitterrand. The pass is also famous for St Bernard dogs product of an unknown cross between a mastiff, Great Dane and/or Newfoundland in 1708 and more recently when it featured in the film The Italian Job where Michael Caine and his gang crashed their coach full of gold and ultimately came up with the immortal line ‘hang on a moment lads, I've got a great idea ....’
The German civil engineer Alfred Brandt (1846–99) was primarily responsible for the successful driving of the Simplon. He first saw the difficulties of tunnel construction as a young railroad engineer during the construction of the 14.9 km double track St Gotthard tunnel between Italy and Switzerland. This work used a pneumatic drill and blasting but Brandt designed a hydraulic drill which was used successfully to build the Arlberg tunnel (Austria–Switzerland). The maximum overburden for these tunnels varied between 1600 and 2150 m. He was commissioned to dig the Simplon tunnel and innovated by driving two separate tunnels 17 m apart, connected by crosshatches to provide for ventilation, temperature control and a circuit for debris-removal trains. He died early in the project, it is said from the strain of overworking himself.
With the construction of the Simplon tunnel, trains rapidly superseded the St Bernard road, and in 1964 a motorway tunnel opened beneath the pass in order to safeguard traffic flow all year-round.
Construction of tunnels normally took a heavy toll in terms of numbers of deaths, injuries and diseases among workers. The hazards of tunnel construction were particularly risky during construction of the Simplon. Inflows of cold water as high as 18 000 l/min were encountered in fractured marble units and at one location, hot water (46°C) discharged from fracture zones at rates up to 6300 l/min. Such fractures also serve as conduits for toxic and explosive gases and the inflowing water can be chemically aggressive.
Construction of the Simplon however saw a tipping point in terms of workers' welfare. In 1902, the British Medical Journal wrote:
It is impossible to look at the noble columns of Karnak or the senseless masses of the Pyramids, at the colossal monoliths of Baalbec, or even the delicate myriad spires of Cologne, without thinking of the tribute of human life which was sacrificed in their erection. The humanitarianism of this age is usually blatant and often misdirected, but no praise can be too high for the precautions which it has prompted modern taskmasters to take on behalf of their workmen (constructing) the Simplon Tunnel [1].
The hospitals at both ends are provided with all modern appliances, and are in telephonic communication with the installation plant and the place at which work is proceeding. The housing of the 4,500 workmen is carefully looked after, and there is but little overcrowding. The vigilance of the contractors and the skill of their medical men, Drs. Volante and Pommata, has been fully rewarded. Seven and a-half miles of the tunnel have been completed, and thus far there have only been 6 deaths from accidents. Of the diseases to which the miners are liable, the commonest are those resulting from the rapid alternations of temperature, such as rheumatism, bronchitis, and intestinal catarrh. Heart disease is rare, as the workmen are medically examined before being taken on. The precautions taken to ensure purity of drinking water have rendered the works till now free from enteric fever and ankylostomiasis. The importance assigned by the contractors to hygienic questions has been of enormous value to their labourers, and must in the long run prove economical to themselves.
However, despite these provisions, it was concerns about the toll of tunnel construction among other things that prompted a group of physicians and scientists to convene an international meeting on occupational health and safety. This was devoted to three main issues: work-related physiology, pathology and hygiene; prevention of work-related disease and social assistance. Three hundred delegates attended the Congress which was closed on 13 June with the creation of the International Permanent Commission on Occupational Health, subsequently ICOH.
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The year before had also seen the creation of the Clinica del Lavoro by Luigi Devoto in Milan. The proposal for the project prepared by Devoto was presented, discussed and accepted during a historical meeting of the Municipality Council of Milan on 20 November 1902. Subsequently, its creation was approved by a State law on 5 July 1905 and the laying of the foundation stone took place in December 1907 and the official inauguration on 20 March 1910, once the different units making up the original setting had been completed. The Clinica del Lavoro therefore represents the world's first established occupational health clinic.
ICOH at 100 is a remarkable feat worthy of celebration. Milan and the Simplon tunnel are instrumental in that achievement.
Honorary Editor
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