Byssinosis, respiratory symptoms and spirometric lung function tests in Tanzanian sisal workers

ABSTRACT Byssinosis and other respiratory symptoms and acute and chronic changes in FVC and FEV_1·0 were investigated in 77 workers in sisal spinning and 83 workers in sisal brushing departments in six Tanzanian sisal factories. Although the prevalence of byssinosis in spinning departments was found to be low (5·2%), it was very high in brushing departments (48·2%). Workers in brushing were exposed to sisal dust for a significantly longer period (11·77 ± 7·3 years) compared to workers exposed to sisal in spinning (2·85 ± 2·56 years). Although the number of smokers in brushing (42%) was similar to that in spinning (37%), smokers were more prone to byssinosis than were non- or ex-smokers after standardisation for duration of exposure. We were unable to measure dust levels in this study, but dust levels in spinning and brushing are cited from previous studies. These confirm our impression that the dust level in spinning is higher than that in an average cotton carding department and far higher in brushing than in spinning. Acute falls in FVC and FEV_1·0 were found during the work shift. The extent of the fall in FEV_1·0 correlated well with the severity of byssinosis; 75% of the workers with grade II byssinosis and 33% of those with grade ½ + I were found to have acute falls in FEV_1·0 greater than 0·2 litres. However some workers, 10% in spinning and 33% in brushing, who denied symptoms of byssinosis, were also found to have acute falls in FEV_1·0. Some workers had slight or severe chronic ventilatory impairment from dust (FEV_1·0 less than 80%, or less than 60% of the respective predicted values), and these workers were mostly from the brushing department. The prevalence of chronic cough and chronic bronchitis was found to be negligible in workers in the spinning and in the brushing departments: 9·6% had a chronic cough and 12% had chronic bronchitis. It is concluded that a high prevalence of byssinosis associated with chronic and acute changes in FVC and FEV_1·0 occurs in the brushing departments of sisal factories, and that this is related to lengthy exposure, high dust level and smoking.     

Diurnal Variation in Ventilatory Capacity: An Epidemiological Study of Cotton and other Factory Workers employed on Shift Work

The change in F.E.V._0·75 during a working shift was studied in a random sample of 473 men employed in three cotton mills in The Netherlands working a three-shift system. Results were also obtained for 198 men, not exposed to industrial dust, who were working in a biscuit factory and two textile factories in the same area. The men were seen only during the shift on which they were working at the time of the study.

Men with byssinosis gave a typical picture of the effects of cotton dust on susceptible workers: a generally low F.E.V. with a marked reduction during the shift; –0·16 l. on the early morning shift, and –0·25 l. and –0·33 l. respectively on the afternoon and night shifts.

Men without byssinosis in the card and blow rooms showed mean changes in F.E.V. during the shift similar to those of men working in the spinning room: a slight rise in the early morning shift of +0·02 l. followed by a fall in both afternoon and night shifts in the region of –0·10 litres. This pattern of change was also found among the workers in the non-dusty factories. The rise in the early shift cannot be explained by the clearing of mucus from the air passages; cotton workers without respiratory symptoms and men in the non-dusty factories who did not produce sputum still showed an increase in F.E.V. during the early shift, though less marked than that of men with respiratory symptoms or who produced phlegm.

The evidence suggests that a diurnal variation in lung function exists and should be taken into consideration both in epidemiological studies and when ventilatory capacity tests are used in periodic medical examinations.

     

A study of the acute and chronic changes in ventilatory capacity of workers in Lancashire cotton mills

Berry, G., McKerrow, C. B., Molyneux, M. K. B., Rossiter, C. E., and Tombleson, J. B. L. (1973).Brit. J. industr. Med.,30, 25-36. A study of the acute and chronic changes in ventilatory capacity of workers in Lancashire cotton mills. A prospective study of workers in 14 cotton and two man-made fibre spinning mills in Lancashire was carried out over a three-year period. A questionnaire on respiratory symptoms was completed at the start of the survey and again two years later. Up to six measurements of ventilatory capacity were made at six-monthly intervals. From these measurements the rate at which the forced expiratory volume (FEV₁) was declining (annual decline in FEV) was evaluated for 595 subjects. Six of the mills were visited on Mondays and in 199 operatives the ventilatory capacity was measured at both the beginning and end of the shift to evaluate its acute fall during work (Monday fall in FEV).

The mean annual decline in FEV for cotton workers was 54 ml/year and it was only 32 ml/year for workers in the man-made fibre mills but this lower value was attributable almost entirely to one of the two mills. For the jobs near the carding engines the annual decline was 22 ml/year higher than for speed-frame tenters. The annual decline for cigarette smokers was 19 ml/year greater than for non- and ex-smokers. The annual decline in FEV was not found to be related to symptoms of byssinosis or bronchitis, nor to present dust levels, bioactivity of the dust or air pollution, although the expected effect attributable to byssinosis turned out to be less than that which the survey was designed to detect.

The mean Monday fall in FEV was higher in cotton mills than in man-made fibre mills among those without symptoms of byssinosis and was correlated with present dust levels. For those with symptoms of byssinosis an increased Monday fall was found only in those processing coarse cotton.

For those subjects who completed the respiratory questionnaire on two occasions the chronic and acute changes in FEV were examined in relation to the change in symptoms of byssinosis. No association was found for annual decline in FEV but the Monday fall in FEV was greater for those who developed byssinosis during the survey than for those who remained free of symptoms, and was less for those who lost their symptoms than for those who retained them.

     

Byssinosis, Chronic Bronchitis, and Ventilatory Capacities in Workers Exposed to Soft Hemp Dust

A study was made of 93 women and 13 men employed in the spinning department of a factory in Yugoslavia processing soft hemp (Cannabis sativa). There were seven occupational groups, with average concentrations of total airborne hemp dust ranging from 2·9 mg./m.³ to more than 19·5 mg./m.³. Thirtyeight women and 11 men, employed in other departments of the factory with average total dust concentrations below 1·0 mg./m.³, were studied as controls.

In the spinning department 40·6% of the workers had byssinosis and 15·1% had chronic bronchitis (defined as persistent cough and phlegm on most days for as much as three months each year during the last two years). None of the controls suffered from either disease.

After adjustment for age, sitting height, and sex, the F.E.V._0·75 and F.V.C. measured at the beginning of the shift were used to assess the long-term effects of hemp dust on the ventilatory function of the lung. The age-adjusted ratio F.E.V._0·75/F.V.C. was also used. A comparison between the control group and the seven exposed groups showed no meaningful association between ventilatory function and present levels of dust exposure, but byssinotics with chronic bronchitis had a mean age-adjusted F.E.V._0·75/F.V.C. ratio significantly lower than that of workers with neither disease (P<0·05).

Acute effects of hemp dust, measured by the change in F.E.V._0·75 and F.V.C. during the shift, were considerable. There were marked reductions in the mean F.E.V._0·75 and F.V.C. during the shift in all the occupational groups exposed to high concentrations of dust. Byssinotics with chronic bronchitis had a significantly greater mean decrease in F.E.V._0·75 during the shift than the byssinotics without chronic bronchitis, and the workers with neither disease (P<0·02).

There is no doubt that the dust of Cannabis sativa hemp can cause byssinosis and at least temporary impairment of ventilatory function, varying in severity according to the level of dust exposure and the presence of respiratory disease.

     

A population study in cotton ginnery workers in the Sudan

Khogali, M. (1969).Brit. J. industr. Med.,26, 308-313. A population study in cotton ginnery workers in the Sudan. An epidemiological study in cotton ginneries in the Sudan covered 323 permanently employed ginnery workers, a random sample of 35 seasonal farfara workers, and a control group of 24 members of a fire brigade. All the workers studied were men.

The study showed a prevalence of byssinosis (defined as chest tightness starting on return from the annual holiday and continuing for at least three consecutive days) in 20% of the ginnery workers and in 48·6% of the farfara workers. Workers exposed to dust showed a mean fall in F.E.V._1·0 of -0·10 litre during the shift, while workers not so exposed showed a mean rise of +0·23 litre; this difference was statistically significant. The F.E.V._1·0 was adjusted for age and standing height. The adjusted means of F.E.V._1·0 were significantly lower for workers exposed to dust compared with those in the control group.

The workers with byssinosis showed a statistically significant fall in F.E.V._1·0 when compared with all ginnery workers; and a highly significant fall when compared with cotton workers without chest symptoms. An attempt was made to grade the byssinotics according to the extent of fall in F.E.V._1·0 during the shift.

The concentration of fine dust (< 7 μ) was measured in each work place. There was a statistically significant association between the prevalence of byssinosis and the concentration of fine dust when comparing the ginnery and farfara workers. Also, there was a significant relationship between the mean adjusted F.E.V._1·0, the mean fall in F.E.V._1·0, and the fine dust concentration.

     

A comparative study of respiratory function in female non-smoking cotton and jute workers

Valić, F., and Žuškin, E. (1971).Brit. J. industr. Med.,28, 364-368. A comparative study of respiratory function in female non-smoking cotton and jute workers. To compare the effect of cotton and jute dust, respiratory symptoms were studied and respiratory function measured in 60 cotton and 91 jute non-smoking female workers of similar age distribution, similar length of exposure to dust, and exposed to similar respirable airborne dust concentrations. Cotton workers had a significantly higher prevalence of byssinosis, of persistent cough, and of dyspnoea (P < 0·01) than jute workers. Among cotton workers 28·3% were found to have characteristic symptoms of byssinosis, whereas none was found among jute workers.

Exposure to cotton but also to jute dust caused significant reductions of FEV_1·0, FVC, and PEF (P < 0·01) over the first working shift in the week. Functional grading of jute and cotton dust effects has shown that about 30% of cotton workers had functional grades F1 and F2, while only 13% of jute workers were found in the same grades (F1). It is concluded that cotton dust may be considered more active than jute though the latter cannot be considered inactive.

     

Relationships between dust level and byssinosis and bronchitis in Lancashire cotton mills

Berry, G., Molyneux, M. K. B., and Tombleson, J. B. L. (1974). British Journal of Industrial Medicine,31, 18-27. Relationships between dust level and byssinosis and bronchitis in Lancashire cotton mills. A prospective survey of workers in 14 cotton and two man-made fibre spinning mills was carried out. A questionnaire on respiratory symptoms was completed at the start of the survey by 1 359 cotton workers and 227 workers in man-made fibre mills and again two years later by about half of these workers. Dust measurements were available for 772 women and 234 men cotton workers.

The prevalence of bronchitis was found to be unrelated to dust level but for women was related to years of exposure. The change in symptoms of bronchitis was unrelated to dust level or to length of exposure. There was, however, an increased prevalence of bronchitis in the cotton mills when compared with the man-made fibre mills, and also over the two-year period a greater proportion of symptom-free workers developed symptoms and a lower proportion of those with symptoms lost their symptoms in the cotton mills than in the man-made fibre mills.

The prevalence of byssinosis was related to smoking habits, the smokers having about 1·4 times as much byssinosis as the non- and ex-smokers after allowing for exposure. Byssinosis was associated with the dust level and years of exposure, more so for the women, and an association between the incidence of new cases over the two years and dust level was also found. After allowing for dust level, years of exposure, and smoking there were still differences between the occupational groups in byssinosis prevalence. Strippers and grinders had the highest prevalence followed by drawframe tenters. Speedframe tenters, card tenters, and comber tenters had similar prevalences and ring spinners the lowest.

     

VENTILATORY CAPACITY CHANGES ON EXPOSURE TO COTTON DUST AND THEIR RELEVANCE TO BYSSINOSIS IN AUSTRALIA

The same plan of investigation as was used in a previous study of jute workers (Gandevia and Milne, 1965) has been applied to a survey of 50 workers in the blowroom and carding and spinning area of a Sydney cotton mill. Significant decreases in ventilatory capacity were recorded on Friday, Monday, and the following Thursday, with, on the average, complete `overnight' recovery, as indicated by similar morning values. Slightly, but not significantly, greater differences were observed in seven subjects with mild byssinotic symptoms and in five subjects with an observed productive cough on request. No effect of sex, shift, or history of cough and sputum was demonstrable. By contrast with the jute workers, no influence of smoking habit was apparent. The larger decreases in ventilatory capacity were observed in those with the higher F.E.V.<sub>1·0</sub>:F.V.C. ratios, whereas the reverse trend was noted in the jute workers. The occurrence of significant large decreases in those employed in the industry for less than a month, in conjunction with other evidence, suggests that a factor of `self-selection' may be operative among cotton employees in this country and may be related to the apparently low prevalence of clinically important byssinosis. Attention is drawn to two different patterns of change of ventilatory capacity over a week in subjects exposed to dusts sometimes associated with symptoms of byssinosis; the relationship of these changes and of chronic bronchitis to the development of clinical byssinosis is discussed.     

A Study of Byssinosis, Chronic Respiratory Symptoms, and Ventilatory Capacity in English and Dutch Cotton Workers, with Special Reference to Atmospheric Pollution

An epidemiological survey of 414 English and 980 Dutch male cotton workers was undertaken to determine the prevalence of byssinosis and respiratory symptoms, and to compare the ventilatory capacities in the two populations, with particular reference to the influence of air pollution. The English workers were employed in six mills in Lancashire and the Dutch workers in three mills in Almelo spinning similar grades of cotton.

The methods used included a questionnaire on respiratory symptoms and illnesses, the collection and examination of sputum, and the measurement of the forced expiratory volume over 0·75 sec. Concentrations of smoke and sulphur dioxide were measured in the English and Dutch towns.

The crude rates for byssinosis were similar, 13·5% and 17% respectively in the English and Dutch card and blow rooms, and 1·5% and 1·6% respectively in the spinning rooms. The English workers had significantly higher prevalences of persistent cough and persistent phlegm and significantly lower indirect maximum breathing capacities. These findings were supported by the results of a sputum survey. Nearly twice as many English produced specimens, and the mean volume of sputum was greater for the English workers.

The prevalence of bronchitis, defined as persistent phlegm and at least one chest illness during the past three years, causing absence from work, was higher in the English than in the Dutch workers in both types of work room, but not significantly so after standardizing for differences in age. Since there are important differences in the social security systems of the two countries, which may encourage more absence from illness among the Dutch, a comparison of bronchitis thus defined is likely to be invalid.

The higher prevalences of respiratory symptoms and lower ventilatory capacities in the English are unlikely to be due to observer error. They are discussed in relation to smoking habits, exposure to cotton dust, and air pollution. The most likely explanation of the unfavourable picture presented by the English workers is the much higher level of air pollution in Lancashire.

     

Effects of different vegetable dust exposures

Valić, F., and Žuškin, E. (1972).Brit. J. industr. Med.,29, 293-297. Effects of different vegetable dust exposures. In order to establish the rank of biological activity of vegetable dusts, five groups of non-smoking female workers exposed to similar concentrations of hemp, flax, cotton, sisal, and jute airborne dust, respectively, were compared as to the prevalence of byssinosis, chronic respiratory symptoms, and one-second expiratory volume changes over the Monday shift. The groups were selected in such a way as to differ in the distribution of age and length of exposure to the respective dust as little as possible.

The prevalence of byssinosis in hemp and flax workers was approximately equal (44% and 43% respectively), in cotton workers it was considerably lower (27%), while no byssinosis was caused by either sisal or jute dust. The highest prevalence of other chronic respiratory symptoms was recorded in hemp workers (39%), followed by flax (36%) and cotton workers (27%), while in sisal (13%) and jute workers (13%) it was the lowest.

Significant mean FEV_1·0 reductions over the shift were recorded in all the groups of textile workers with the largest reductions in hemp workers (19%) followed by flax (11%), cotton (8%), sisal (7%), and jute workers (5%). The application of orciprenaline before the shift diminished the mean acute FEV_1·0 falls over the work shift in all the groups studied.

     

BYSSINOSIS IN CARDROOM WORKERS IN SWEDISH COTTON MILLS

The prevalence of byssinosis and chronic respiratory symptoms was studied in 117 workers in four Swedish cotton mills. Changes of forced expiratory volume in 0·75 sec. (F.E.V._0·75) during a Monday and a Wednesday were assessed in 64 male workers in four cardrooms in these mills. Dust sampling was performed with weighed millipore filters.

Prevalences of byssinosis as judged from the workers' histories were 68%, 55%, 44%, and 25% in the four mills; the lowest prevalence of 25% was found in a mill spinning both high grade cotton yarn and rayon. Among 67 workers in the mills having a byssinosis prevalence of 68% and 55%, 60% were non-smokers, 70% had chronic cough, and 27% had chronic dyspnoea. The F.E.V._0·75 decreased on Monday in workers who gave a history of Monday dyspnoea, and to a lesser degree, but still significantly, in those who did not.

In spite of marked differences in fine dust (i.e., dust smaller than 2 mm. diameter) concentrations in the four cardrooms, no significant relations between dust content, byssinosis prevalence, and F.E.V._0·75 changes on Monday could be demonstrated.

The prevention and treatment of byssinosis is discussed. Workers at risk should receive a periodical medical examination including at least a spirographical pulmonary function test at intervals of one year or less.

     

Byssinosis among Winders in the Cotton Industry

In a mill spinning coarse cotton the prevalence of byssinosis and other respiratory symptoms, and the F.E.V._1·0, were measured in a group of 29 men and 117 women employed in the winding room. All the men and 95% of the women at risk were included.

Dust concentrations, measured with a modified Hexhlet at various work points in the winding room, ranged from 1·65 to 6·05 mg./m.³ total dust. These concentrations are higher than 1·0 mg./m.³, which is the threshold limit value for cotton dust recommended by the American Conference of Governmental Industrial Hygienists. The mean dust concentration was 3·48 mg./m.³ compared with 2·85 mg./m.³ in the card room of the same mill.

The prevalence of byssinosis was 18·8% among the women and 13·8% among the men. A comparison among the women showed that those with symptoms of byssinosis had, on the average, significantly lower F.E.V.s than women of similar age without such symptoms. Four women and one man with moderately severe symptoms of byssinosis showed evidence of permanent respiratory disability with effort intolerance and a substantial diminution in F.E.V._1·0. Further studies should be carried out in other winding rooms because, if these findings are repeated elsewhere, they would indicate the necessity for medical surveillance, dust control, and extending the compensation scheme to include winding room workers.

     

A survey of respiratory disease in cotton operatives: Part II. Symptoms, dust estimations, and the effect of smoking habit

Fox, A. J., Tombleson, J. B. L., Watt, A., and Wilkie, A. G. (1973).Brit. J. industr. Med.,30, 48-53. A survey of respiratory disease in cotton operatives. Part II. Symptoms, dust estimations, and the effect of smoking habits. In association with a survey of cotton workers dust levels were measured in 11 of the mills. Levels varied from 1·15 mg/m³ to 4·8 mg/m³ excluding fly. Analysis of the survey of workers in relation to the dust levels showed an increase in abnormal symptoms and a greater reduction in ventilatory function in those exposed to the higher dust concentrations. No such relationship was found between dust concentration and prevalence of bronchitic symptoms. Smokers showed a higher frequency of byssinotic symptoms and a greater loss of ventilatory function than non-smokers at all levels of dust exposure. The correlation between dust levels and the frequency of byssinotic symptoms and the loss of ventilatory function was increased by including a time factor. By expressing the dust exposure as mg years/m³ it can be predicted that approximately 10% of subjects exposed to 0·5 mg/m³ of dust for 40 years will have the symptoms of byssinosis.     

Ventilatory Capacity in Miners. A Five-year Follow-up Study

A five-year follow-up of ventilatory capacity in over 95% of a random sample of men living in the Rhondda Fach has been carried out. Miners and ex-miners with and without simple pneumoconiosis have been compared with non-mining controls, and the effect of ageing, mining, dust exposure, and tobacco smoking has been assessed. The change in Indirect Maximum Breathing Capacity (I.M.B.C.) between the two surveys appeared to be independent of age, suggesting that a linear decline in this function with age is a tenable hypothesis. An average decline of 1·865 ± 0·274 litres per minute each year in the I.M.B.C. was observed, and this fall was not significantly increased either by mining or by exposure to coal dust as measured by the number of years spent working underground.

In the non-miners a greater decline in I.M.B.C. was observed in smokers than in non-smokers, and this decline was greater in the heavy than in the light smokers. The decline in the non-smokers was 0·489 ± 0·714 litres per minute compared with 1·524 ± 0·319 litres per minute in the light and 3·338 ± 0·420 litres per minute in the heavy smokers. In the miners and ex-miners without pneumoconiosis a greater decline in I.M.B.C. was observed in smokers than in non-smokers, but there was no relation between the rate of decline and the amount smoked. The decline in the non-smokers was 0·950 ± 1·071 compared with 2·164 ± 0·485 and 2·080 ± 0·428 litres per minute in the two smoking groups. In the men with simple pneumoconiosis (category 3) there appeared to be no relation between decline in lung function and smoking habits. The decline in non-smokers was 1·492 ± 0·594 compared with 1·956 ± 0·357 and 1·438 ± 0·467 in the two smoking groups. The decline in I.M.B.C. over five years in non-miners smoking 15 g. tobacco per day and over was significantly greater than the fall estimated from the age specific trend. A possible explanation is that there has been a recent change in the effect of heavy smoking on ventilatory function resulting in a more rapid decline.

A greater decline in I.M.B.C. was observed in men with respiratory symptoms than in those without.

     

Respiratory symptoms and ventilatory function in sisal dust exposure

Summary A study of respiratory symptoms and ventilatory function was made in a group of 51 non-smoking female workers exposed to sisal dust and 51 control subjects matched in age and height. A higher prevalence of persistent cough (17.6%), persistent phlegm (13.7%), chronic bronchitis (9.8%) and nasal catarrh (19.6%) was found in sisal workers than in controls (5.9, 5.9, 5.9 and 0%, respectively). Not a single case of byssinosis was found in the workers surveyed.In sisal workers, FEV_1.0, FVC and PEF significantly decreased over the work shift (P<0.01). Control workers did not show significant acute changes in ventilatory function over the shift. Inhalation of Alupent (orciprenaline) before the shift significantly diminished acute reductions in ventilatory capacity during the shift. The results suggest that sisal dust does not cause byssinosis but affects ventilatory function of the exposed workers.     

An epidemiological study of respiratory symptoms in Lancashire mills, 1963-66

Molyneux, M. K. B., and Tombleson, J. B. L. (1970).Brit. J. industr. Med.,27, 225-234. An epidemiological study of respiratory symptoms in Lancashire Mills, 1963-66. An epidemiological study of card and blowroom workers in 14 cotton spinning and two man-made fibre spinning mills in Lancashire has been carried out on a prospective basis of six-monthly examinations over three years. The number of operatives to be included was decided so as to give a sufficient sample for the statistical assessment of fall in FEV, at the same time allowing for population movement. The examination of each worker included a history, a questionnaire of respiratory symptoms, and a measurement of forced expiratory volume in one second. The results in this paper, which will be followed by others on other aspects of the survey, give the prevalence of both byssinosis and bronchitis, according to the definition given, in the 1 359 cotton workers and 227 man-made fibre workers, seen at least once, and also the dust levels in the mills. Eight of the mills processed coarse and six medium cotton.

The total prevalence of byssinosis, as defined, is 26·9%, being higher in coarse than in medium cotton mills, and the occupational groups most affected are strippers and grinders, carders and undercarders, and draw frame tenters. In coarse mills symptoms develop in some men and women within the first four years of exposure, and in medium mills between five and ten years' exposure. Repeat questionnaires in about half the population, two years after the first questionnaire, showed the development of symptoms of chest tightness in an appreciable number not previously affected. The incidence of bronchitis is increased in operatives with symptoms of byssinosis, but is influenced by age and smoking.

Total dust levels averaged 3·1 mg/m³ in coarse miles and 1·2 mg/m³ in medium mills. The findings indicate that dust control measures, though they have produced considerable improvement, are not now fully effective with present methods of production.

     

A study of rope workers exposed to hemp and flax

Smith, G. F., Coles, G. V., Schilling, R. S. F., and Walford, Joan (1969).Brit. J. industr. Med.,26, 109-114. A study of rope workers exposed to hemp and flax. Respiratory symptoms and ventilatory capacities were studied in 54 men and 22 women exposed to the mixed dusts of hemp and flax in an English rope factory. The preparers and most of the spinners were exposed on average to concentrations of 1·7 mg./m.³ total dust and 0·5 mg./m.³ fine dust. Those employed on subsequent processes had lower exposures at concentrations of 0·5 mg./m.³ total dust and 0·1 mg./m.³ fine dust.

Six men, all in the high exposure group, had symptoms of byssinosis. After adjustment for age and standing height there was no statistically significant difference in the forced expiratory volume (F.E.V._1·0) between those in high dust concentrations and those in low concentrations; neither was there a significant difference between the ventilatory capacities of men with and without byssinosis.

This study shows that byssinosis is an occupational hazard confined to male workers in this factory. It does not appear to be a very serious problem and will diminish with the increasing use of synthetic materials instead of natural fibres.

     

Byssinosis in the Waste Cotton Industry

This paper is of some historical interest. It describes an investigation to determine whether byssinosis occurred among workers in the waste cotton industry. It was undertaken in 1950 at the instigation of the Minister of National Insurance.

The materials used in the industry were (1) cotton that had been previously spun, and (2) waste material discarded during the preparations for spinning higher grades of yarn. A proportion of raw cotton was sometimes blended with the waste.

Twenty-two mills, representative of the industry, were surveyed. All the men in these mills, who were over 35 years of age and with at least 10 years' exposure to cotton dust, were seen. The investigations included a work history, a clinical examination, an assessment of effort dyspnoea, and a chest radiograph.

There were 140 men who had never been exposed to any dust hazard other than waste cotton. In this group were found seven (5%) men with disabling byssinosis and 35 (25%) men with lesser degrees of the same disease. There were also 15 (11%) men with bronchitis or emphysema without byssinosis.

Thus it was established that byssinosis did occur in the waste cotton industry. Insurance cover, under the National Insurance (Industrial Injuries) Act, 1946, was subsequently extended to workers in the waste cotton industry.

The survey provided no evidence that either the type of waste cotton processed or an admixture of raw cotton played a significant part in the aetiology or incidence of the disease.

     

RESPIRATORY FUNCTION AND SYMPTOMS IN ROPE MAKERS

This paper gives the results of a small environmental, symptomatic, and respiratory function study of byssinosis in a rope factory. An attempt was made to relate the changes in ventilatory function during the working day to the differing dust concentrations within the factory. The tests used included the forced expiratory volume, the forced vital capacity, and, in half the subjects, other derivatives of the forced expiratory spirogram. The inspiratory airways resistance was measured by the interrupter technique.

Measurements were made at the beginning and end of a working shift on either a Monday or a Tuesday in 44 subjects, of whom 22 were in a relatively dusty part of the factory and 14, involved in making wire rope, were exposed to very little dust.

None of the subjects had symptoms of byssinosis, but significant falls were found in the F.E.V._1·0, F.V.C., and other derivatives of the forced expiratory spirogram in those in the dusty parts of the factory. There was some evidence that the peak flow rate, the maximal mid-expiratory flow, and similar indices might be a little more sensitive as measures of the acute changes in ventilatory capacity during the day than the F.E.V._1·0 and F.V.C. There were no significant changes in the airways resistance by the interrupter technique but the results were rather variable.

The fall in ventilatory capacity during the day was not greater in those with symptoms of chronic cough and sputum than in those without, nor did it seem to be related to smoking, but the number of subjects studied was small.

     

A Clinical and Environmental Study of Byssinosis in the Lancashire Cotton Industry

The prevalence of byssinosis was measured in a population of 189 male and 780 female workers employed in three coarse and two fine cotton mills. Ninety-eight per cent. of the male and 96% of the female population were seen.

The workers were graded by their histories as follows:

Grade 0—No symptoms of chest tightness or breathlessness on Mondays

Grade ½—Occasional chest tightness on Mondays, or mild symptoms such as irritation of the respiratory tract on Mondays

Grade 1—Chest tightness and/or breathlessness on Mondays only

Grade 2—Chest tightness and/or breathlessness on Mondays and other days

The dust concentrations to which the workers were exposed were measured with a dust-sampling instrument based on the hexhlet. Altogether 505 working places were sampled. In the card-rooms of the coarse mills 63% of the men and 48% of the women had symptoms of byssinosis. In the card-rooms of the fine mills the corresponding prevalences were 7% for the men, and 6% for the women. Prevalences were low in the spinning-rooms in the coarse mills. The mean dust concentrations in the different rooms ranged from 90 mg./100 m.³ in one section of the card-room in a fine mill, to 440 mg./100 m.³ in one of the card-rooms of the coarse spinning mills. The prevalence of byssinosis in the different rooms was closely related to the overall dustiness (r = 0·93). For the three main constituents of the dust, namely, cellulose, protein, and ash, the prevalence of byssinosis correlated most highly with protein, particularly with the protein in the medium-sized dust particles, i.e., approximately 7 microns to 2 mm.

The symptoms of byssinosis may be caused by something in the plant débris which affects the respiratory tract above the level of the terminal bronchioles. This is the site where the medium-sized dust deposits. The possible importance of the fine dust is discussed.

For routine measurements in industry, it is necessary to have a method of assessing dustiness in which the sampling equipment is simple and assessment rapid. As total dust concentration is relatively easy to measure, and correlates closely with the prevalence of byssinosis, permissible levels of dustiness have been expressed in terms of total dust. On comparing the prevalence of byssinosis among workers with short and long exposures and low and high concentrations (Table 11), it appears that a mill with a concentration of 100 mg./100 m.³ or less would be reasonably safe, but in dusty card-rooms it seems that such levels are not possible to achieve at present. As it is necessary to adopt a realistic target that can be achieved, it is suggested that dust concentrations in cotton mills should be less than 250 mg./100 m.³ and that periodic medical examinations should be adopted to protect susceptible workers who can be advised to leave their dusty environment before they are permanently disabled.