Early Detection of Occupational Diseases World Health Organization,• Geneva, 1986 ISBN 92 4 154211 X ©World Health Organization, 1986 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation of WHO publications, in part or in coco, application should be made to the Office of Publications, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. TYPESET IN INDIA PRINTED IN SINGAPORE 85/6514-Macmillon/Sinppore Nat. Printer,-5000 Contents Page Preface vii Introduction ix Chapter 1. Principles of early detection of occupational diseases ............................ · 1 APPROACHES TO THE EARLY DETECTION OF THE MAIN OCCUPATIONAL DISEASES Chapter 2. Pneumoconioses caused by sclerogenous mineral dusts . .. .. .. .. .. .. .. .. .. 9 Chapter 3. Bronchopulmonary diseases caused by hard metal dusts .. .. .. .. .. .. .. .. 26 Chapter 4. Bronchopulmonary diseases caused by cotton dust, flax, hemp, or sisal dust: byssinosis. .. 30 Chapter 5. Occupational asthma . .. .. .. .. .. .. 35 Chapter 6. Extrinsic allergic pneumonitis . .. .. .. .. 40 Chapter 7. Diseases caused by beryllium and its toxic compounds. .. .. .. .. .. .. .. 44 Chapter 8. Diseases caused by cadmium and its toxic compounds. .. .. .. .. .. .. 48 Chapter 9. Diseases caused by phosphorus and its toxic compounds. .. .. .. .. .. .. .. 53 Elemental phosphorus and its inorganic toxic compounds .. .. .. .. .. .. .. 53 Organophosphorus compounds .. .. .. 57 Chapter 10. Diseases caused by chromium and its toxic compounds . .. .. .. .. .. .. .. 63 Chapter 11. Diseases caused by manganese and its toxic compounds. .. .. .. .. .. .. .. 69 iii iv CONTENTS Chapter 12. Diseases caused by arsenic and its toxic compounds . 7 4 Chapter 13. Diseases caused by mercury and its toxic compounds . 79 Chapter 14. Diseases caused by lead and its toxic compounds 85 Chapter 15. Diseases caused by fluorine and its toxic compounds . 91 Chapter 16. Diseases caused by carbon disulfide . 97 Chapter 17. Diseases caused by toxic halogen derivatives of aliphatic and aromatic hydrocarbons . 102 Carbon tetrachloride . 105 Trichloroethylene. 108 Hexachloronaphthalene. 112 Polychlorinated biphenyls. 115 Vinyl chloride . 118 Chapter 18. Diseases caused by benzene and its toxic homologues . 122 Benzene . 122 Toluene . 127 Xylene . 130 Chapter 19. Diseases caused by toxic nitro and amino deriva­ tives of benzene and its homologues. 134 Aniline . 134 Nitrobenzene. 138 Chapter 20. Diseases caused by nitroglycerin and other nitric acid esters . 142 Chapter 21. Diseases caused by alcohols, glycols, and ketones 146 Alcohols and glycols . 146 Ketones . 150 Chapter 22. Diseases caused by asphyxiants: carbon monoxide, hydrogen cyanide and its toxic derivatives, and hydrogen sulfide . 154 Carbon monoxide . 154 Hydrogen cyanide and its toxic derivatives . 158 Hydrogen sulfide. 162 Chapter 23. Hearing impairment caused by noise . 165 Chapter 24. Diseases caused by vibration . 170 Chapter 25. Diseases caused by compressed air. 175 Chapter 26. Diseases caused by ionizing radiation. 180 CONTENTS v Chapter 27. Occupational skin diseases. 188 Chapter 28. Primary epitheliomatous cancer of the skin . 194 Chapter 29. Infectious and parasitic diseases. 198 CLINICAL AND LABORATORY TESTS FOR THE EARLY DETECTION OF OCCUPATIONAL DISEASES IN THE MAIN ORGANS AND SYSTEMS Chapter 30. The respiratory system . 207 Chapter 31. The nervous system . 214 Chapter 32. Blood and the blood-forming system . 220 Chapter 33. The digestive system-gastrointestinal tract and liver. 225 Chapter 34. The urinary system. 231 Chapter 35. The cardiovascular system. 236 Chapter 36. The locomotor system. 239 ENVIRONMENTAL ASSESSMENT AND BIOLOGICAL MONITORING Chapter 37. Procedures for environmental assessment of exposure ........................... 243 Chapter 38. Biological monitoring of exposure . 247 Bibliography 252 Annex 1. Questionnaire on respiratory symptoms . 264 Annex 2. Contributors and reviewers. 270 Preface An important aspect of the control of occupational disease is early detection, so that treatment can be given while the disease is still reversible. In 1974, the Executive Board of the World Health Organization requested the Director-General to undertake " . the collation and evaluation of methods for the early detection of health impairment in the gainfully employed ... ". 1 Early detection of occupational diseases was further emphasized in the Programme of Action on Workers' Health which was endorsed by the World Health Assembly in 1980. As a step towards improving workers' health, this book has been produced as a guide for health professionals to the early detection of occupational diseases. The diseases included here are classified according to the hazardous substances that cause them and correspond with the list of occupational diseases adopted by the International Labour Conference at its sixty-sixth session in 1980. The book also includes chapters on the physiology of the main organ systems affected by the various chemical, physical and biological substances en­ countered in occupational settings and the tests that may be used for early detection of disease. The information presented in this publication is based on research carried out by WHO Collaborating Centres in more than thirty countries. The final preparation of this book was done by a WHO Scientific Group on the Early Detection of Occupational Diseases which met in Geneva from 26 October to 1 November 1982. The Scientific Group examined, reviewed, and adapted material contributed by various authors specifically for the book. The contributors, and the members of the Scientific Group are listed in Annex 2. The World Health Organization is grateful to all those who participated in the preparation of this manual. Special thanks are due to Professor J. C. McDonald, who actively participated in the development of the publication from its early stages to the final draft. Dr J. V. Homewood, Dr L. Ivanova-Cemisanska, Dr H. Thiele, and Dr E. Zschunke contributed papers on health education, the reproductive system, health examinations, and skin diseases, respect­ ively. Information from these papers was used in the preparation of the book. The World Health Organization and the Scientific Group extend their special thanks to them. 1 Handbook of Resolutions and Decisions of the World Health Assembly and the Executive Board. Volume II. Geneva, World Health Organization, 1979 (resolution EB53/23). vii Introduction Occupational diseases are caused by exposure to harmful chemical and biological agents and physical hazards at the workplace. Although they may appear to occur less frequently than other major disabling diseases, there is evidence that they affect a considerable number of people, particularly in rapidly industrializing countries. In many cases, occupational diseases are severe, and disabling. However, two factors make them easily preventable: first, the causal agents of these diseases can be identified, measured, and controlled; second, the populations at risk are usually easily accessible and can be regularly supervised and treated. Furthermore, the initial changes are often reversible if treated promptly. The early detection of occupational diseases is consequently of prime importance. This book is intended to serve as a guide to the early recognition, diagnosis, and treatment of occupational diseases. It is addressed to health professionals at various levels responsible for occupational health. It is also anticipated that it will facilitate the organization of occupational health services at the workplace. An additional function of this book is to create awareness among policy-makers, employers, and workers and their representatives of the possibility of preventing occupational diseases and of the preventive measures that should be taken by the occupational health services. It will also help countries in carrying out effective health monitoring of working populations and in obtaining adequate information on occupational exposure and its adverse effects on health. At the present time, occupational diseases are under-reported and it is hoped that this book will encourage governments to adopt appropriate regulations concerning the notification of occupational diseases. It is recommended that regulations concerning occupational health should provide that every worker, if potentially exposed to an occupational hazard, should have access to health supervision and advice on appropriate placement and job selection from the medical point of view. All health examinations should be carried out during working hours and should be free of charge. This book is divided into four parts. The first part (Chapter 1) deals with the principles