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Industrial diseases

An accurate knowledge of industrial diseases, like diseases of the skin, can best be acquired by actual experience.

So much depends upon the nature of the employment, its conditions and surroundings, so much upon the vigour and health of the workers, their habits and mode of life, that, without this knowledge, diagnosis is difficult, and treatment unsatisfactory. Of the truth of this statement the writer's own experience affords ample proof.

In 1887, a young woman suffered from periodic attacks of violent pain in the gastric region, thought to be due to chronic dyspepsia. The usual sedatives gave little or no relief, nor was the correct diagnosis arrived at until one evening she vomited her food, which was found to be mixed with yellow chromate of lead. She was employed in the heading, or carding department of a dye work, in which the atmosphere was hot and loaded with the dusty poison, with which the yarn was dyed. Case upon case followed, and as the girls were free to resume work after recovery, the disease increased in intensity. One patient became totally blind, several suffered from convulsions, and one died from coma after about six hours' illness. Aerial poisoning by lead was then unknown, and the employers would not admit that the illness was due to the nature of the work, especially as the girls had never handled the poison. At my suggestion, an efficient fan was erected and the epidemic immediately ceased. In the following winter sporadic cases cropped up, and, on investigation, I learned that these were due to the occasional stopping of the fan, owing to the workers complaining of cold caused by it when in operation. (1)

But diseases of occupation vary greatly in their causation, and it may be convenient to group them according as they are induced by (1) dust, (2) gas fumes or vapour, and (3) micro-organisms.

Dust is the most prolific source of disease in our factories and workshops, and the danger is proportionate to its composition; for statistics prove that, among those engaged in certain industry occupations, the death rate is fully four times larger than that among agriculturists. Even dust, which is per se innocuous, becomes harmful when the quantity inhaled is so great that it cannot be expelled by the ciliary filaments of the air passages, as it thus reaches the lung tissue, and causes induration and pigmentation, as in anthracosis due to coal dust. As has been shown, lead poisoning is caused by a chemical dust which is dissolved and absorbed; the dust, which is given off by an emery wheel being chiefly composed of silicious and metallic particles, wounds and irritates the lung tissue; while the dust of potassium bichromate, acting as a caustic, produces the "chrome hole" of those engaged in its manufacture.

Lead poisoning is the most prevalent of all industrial diseases. During the year 1907, there were notified to the Home Office no fewer than 578 cases, of which 26 were fatal. These notifications chiefly included dippers and others, who, engaged in potteries, are constantly exposed to lead, either in solution or in the form of dust; white lead workers; coach and motor-car painters, who inhaled the dust in the process of sand-papering; enamellers, who sprinkle the dry powder over red hot hollow-ware to form a glaze; printers, from handling the type; and a large number of workers engaged in smelting, type-founding, and stereotyping, from inhaling the fumes of the molten metal. Nor does this number include the countless cases, which, occurring in other industries, are never heard of, and may never have been recognised, until advanced degeneration has rendered the case hopeless.

Symptoms and Treatment. A frequent sign that a person is exposed to lead poisoning, is the presence of a blue line along the margins of the gums where they are joined to the teeth, and this is generally more marked on the lower than on the upper gum. It is only unmistakable when the teeth are present, as the line is composed of sulphide of lead from the combination of the dust with the sulphuretted hydrogen generated by the decaying food between the teeth. It is generally more marked when due to inhaling the fumes, but though it may be present in every instance, it affords no positive proof of poisoning. It is simply a confirmatory sign. Bloodlessness is also a constant symptom of the disease, and the pallor always seems to me to be more intense than in other forms of anaemia or wasting diseases. Lead has a very marked effect upon the red corpuscles of the blood, and no doubt this accounts for the well known susceptibility of anaemic females, and also for the occurrence of miscarriages. Recently, it has been ascertained that the red corpuscles of those affected by lead poisoning are basophilic, and this is now considered a most trustworthy sign*

Lead has a still more deleterious effect on the nervous system, the earliest signs being colic, constipation (sometimes diarrhoea), and vomiting. The pain, various in intensity, paroxysmal in character, most severe at the umbilicus, and not accompanied by a rise in temperature. These symptoms, along with a slow pulse and presence of the blue line along the gums, differentiate the disease from peritonitis, or appendicitis.

*It is well to remember, however, that this condition is generally found in cases of advanced anaemia from other causes.

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