- Historical overview
- Aims and functions of occupational health services
- Disorders due to chemical agents
- Disorders due to physical agents
- Disorders due to infectious agents
- Disorders due to psychological factors
The inhalation of a variety of dusts is responsible for a number of lung and respiratory disorders, whose symptoms and severity depend on the composition and size of the dust particle, the amount of dust inhaled, and the length of exposure. The lung diseases known as the pneumoconioses result when certain inhaled mineral dusts are deposited in the lungs, where they cause a chronic fibrotic reaction that leads to decreasing capacity for exercise and increasing breathlessness, cough, and respiratory difficulty. No specific treatment is known, but as with all respiratory disorders patients are urged to quit smoking, which aggravates the condition. Suggested measures for limiting exposure include using water and exhaust ventilation to lower dust levels and requiring workers to wear respirators or protective clothing, but such procedures are not always feasible. Coal worker’s pneumoconiosis, silicosis, and asbestosis are the most common pneumoconioses.
As its name suggests, coal worker’s pneumoconiosis (also known as black lung) occurs most frequently among coal miners and workers involved in the transporting or processing of coal. It is generally benign in its early stages, but after a variable number of years of exposure to coal dust, progressive massive fibrosis may develop, ending in cardiorespiratory failure. Miners and quarry workers are the people most likely to suffer from silicosis. Because silica is found in many rocks and is used in a variety of industries, workers involved in stonecutting, grinding, drilling, foundry work, sandblasting, pottery making, and the manufacture of abrasives are also at risk. Silicosis is an aggressive form of pulmonary fibrosis that speeds the progress of tuberculosis. Routine chest X rays can aid early diagnosis by revealing abnormal shadowing. Asbestosis is more difficult to detect in the early stages because chest X rays usually reveal little until the disease is advanced. From onset asbestosis progresses more rapidly than the other pneumoconioses and can result from relatively low exposure. Asbestos is the general term for a number of fibrous silicates that are used primarily in various fireproofing, insulation, and cement products. In addition to pulmonary fibrosis, inhaling asbestos fibres has also been shown to cause lung and other cancers.
Prolonged exposure to certain plant and animal dusts can cause asthma, even in people without a predisposition for allergies. Specific hazards include dusts from flour, grains, and wood and wood products. Cotton workers and others handling hemp or flax may develop a condition known as byssinosis, similar to asthma. The group of diseases known as farmer’s lung, malt worker’s lung, bird fancier’s lung, and so forth are caused by an allergic inflammatory reaction to the fungal spores present in moldy hay or barley, bird droppings, feathers, and a variety of other organic materials. Symptoms initially resemble those of influenza or pneumonia, but repeated episodes eventually lead to pulmonary fibrosis with chronic respiratory impairment. The only treatment for these disorders is avoiding exposure to the dusts.
Disorders due to physical agents
When working in a hot environment, humans maintain normal body temperature by perspiring and by increasing the blood flow to the surface of the body. The large amounts of water and salt lost in perspiration then need to be replaced. In the past, miners who perspired profusely and drank water to relieve their thirst experienced intense muscular pain—a condition known as miner’s cramps—as a result of restoring their water but not their salt balance. When salt in the requisite amount was added to their drinks, workers no longer developed miner’s cramps. Heat exhaustion is characterized by thirst, fatigue, giddiness, and often muscle cramps; fainting can also occur. Heatstroke, a more serious and sometimes lethal condition, results when prolonged exposure to heat and high humidity prevents efficient perspiration (by preventing evaporation of sweat), causing the body temperature to rise above 106° F (41° C) and the skin to feel hot and dry. If victims are not quickly cooled down, coma, convulsions, and death can follow. To prevent heat exhaustion or heatstroke, workers unaccustomed to high temperatures should allow adequate time (ranging from days to weeks) for their bodies to become acclimatized before performing strenuous physical tasks.
Work in cold environments may also have serious adverse effects. Tissue damage that does not involve freezing can cause inflammatory swelling known as chilblains. Frostbite, or the freezing of tissue, can lead to gangrene and the loss of fingers or toes. If exposure is prolonged and conditions (such as wet or tight clothing) encourage heat loss, hypothermia, a critical fall in body temperature, may result. When body temperature falls below 95° F (35° C), physiological processes are slowed, consciousness is impaired, and coma, cardiorespiratory failure, and death may ensue. Workers exposed to extreme cold require carefully designed protective clothing to minimize heat loss, even though a degree of acclimatization occurs with time.
Decompression sickness (caisson disease) can result from exposure to high or low atmospheric pressure. Under increased atmospheric pressure (such as that experienced by deep-sea divers or tunnel workers), fat-soluble nitrogen gas dissolves in the body fluids and tissues. During decompression the gas comes out of solution and, if decompression is rapid, forms bubbles in the tissues. These bubbles cause pains in the limbs (known as the bends), breathlessness, angina, headache, dizziness, collapse, coma, and in some cases death. Similarly, the gases in solution in the body tissues under normal atmospheric pressure form bubbles when pressure rapidly decreases, as when aviators in unpressurized aircraft ascend to high altitudes too quickly. Emergency treatment of decompression sickness consists of rapid recompression in a compression chamber with gradual subsequent decompression. The condition can be prevented by allowing sufficient decompression time for the excess nitrogen gas to be expelled naturally.