NOTIFIABLE DISEASES
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- Title
- NOTIFIABLE DISEASES
- extracted text
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NOTIFIABLE
DISEASES
SIGNS ® SYMPTOMS ® DIAGNOSIS
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Introduction
The incidence of notifiable diseases recorded with the
Factory Inspectorate is insignificant, less than a few
hundred. It does not mean that working conditions in
India are extremely good and that only few workers are
affected by the notifiable diseases. In Nandesary
(Gujarat), the doctors treat many workers for dermatitis,
which is a notifiable disease, if it is related to the
occupation of the worker. In many cases in fact it is so.
Yet to the best of our knowledge not a single case of
dermatitis has been notified in that area.
Notifiable diseases are a part of the occupational
diseases selected by the Factories Act (1948). The Act
also says that any doctor who treats a worker affected
by any of the notifiable diseases, should notify it to the
Factory Inspectorate. The expectation is that this
notification will draw the attention of the management
and/or the governmental machinery and in response
they will singly or jointly take suitable remedial steps
and that eventually it will lead to improvement in the
working conditions.
These reference sheets are an attempt to disseminate
information about notifiable diseases among the
clinicians, workers and others interested in this area.
These sheets are in no way substitutes for reference
books.
These sheets are based on the Encyclopaedia of
Occupational Health and Safety by the ILO (1983) and
Chemical Hazards of the Workplace (Proctor and
Hughes, 1978). Attempt has been made to extract and
incorporate as many pointers for detection as possible in
these sheets. This is just a beginning', hence the possible
treatment of these notifiable diseases and the possible
precautions/changes necessary at the workplace, have
not been included here.
We hope that reading through these sheets will
increase the interest of.the clinicians looking after the
health of the workers. In this present form, the sheets
could appear more complicated and technical end
thereby less useful to workers. We hope and plan to
further simplify and to bring out such material which will
be useful to workers as well.
1
Diagnosis, special tests
In industries associated with
Alloys
Ammunition
Ceramics
Inks
Insecticides
Printing presses
Plumbing
Rubber
Storage batteries
Lead lining
Non specific: initial weakness, insomnia, restlessness, forgetfulness, facial
pallor, pallor of eyes; weight loss.
1. Occupational history and
haemopoietic changes
e.g. anaemia, basophilic
stipplings over R.B.C.s etc.
are prime elements in
diagnosis.
Further exposure leads to: abdominal discomfort, colic — many cases wrongly
diagnosed as surgical diseases.
Lead, line on gingival tissues.
Motor weakness including paralysis of extensor muscles of wrist and possibly
ankles, muscle tenderness and afterwards signs and symptoms of neuropathy.
Reproductive organs affected, impaired fertility, still births. In males —
hypospermia, asthenospermia, teratospermia, chronic nephritis.
2. For workers in fertile age,
lead in blood should not
exceed 30 micro-gm/100 ml;
for others, it should not exceed
40 micro-gm/100 ml. If lead in
blood found in excess, then
stoppage of exposure to be
recommended (WHO 1980).
3. Lead in urine should not
exceed 65 micro-gm/l.
Samples should be collected
at the end of the work-shift.
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4. Zinc-protoporphyrin level
should not exceed
3 micro-gm/gm Hb.
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Signs and symptoms
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Industrial occurrence
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Diseases caused by lead and its inorganic compounds
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Diseases caused by lead tetra ethyl
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Gasoline fuel for internal
combustion engines,
(for use as 'anti-knock'
agent)
Refineries
Mild manifestations: Insomnia, lassitude, nervous excitation, lurid dreams in
association with tremors and, spasmodic muscular contractions.
Valid history of occupational
exposure with increased level of
lead in urine more than 350
micro-gm/litre and lead in
blood less than 50 micro-gn>/
100 ml.
More severe responses: Complete disorientation with hallucinations, facial
contortions, episodes of hallucinations may be converted into maniacal or
violent convulsive seizures which may terminate in coma or death.
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Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Chemicals
Detergents
Explosives
Fertilizers
Fireworks
Ignition compounds
Incendiaries
Insecticides
Phosphorus bronze
Iridescent metallic deposits
Rodenticides
Rust-proofing of metals
Safety matches
Irritation of respiratory tract, toothache, excessive salivation followed by pain
and swelling of jaw and osteomyelitis of the jaw bone or 'phossy jaw’, facial
distortion.
1. Occupational history.
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2. Regular X-rays of teeth.
3. After suspicion of jaw injury
further exposure should be
stopped.
4. Pulmonary oedema may
occur in case of exposure
to PC 15 (Phosphorus-pentachloride).
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Diseases caused by phosphorus and its compounds
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Diseases caused by mercury and its compounds
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Acetaldehyde and
acetylene
Acetic acid
Agricultural and
Industrial poisons
Antifouling paint
Artificial silk
Barometers
Chlorine
Electrical apparatus
Incandescent bulbs
Amalgams manufacture
Mercury vapour tubes
Rectifier batteries
Silver ores
Textiles
Thermometers
Treatment of gold
Vacuum pumps
X-ray tubes
Most common: Gingivitis, metallic or bitter taste in mouth, bluish line on gums,
slate grey pigmentation on vestibular side of gums or on the palate or inside of
the cheeks, gastritis; possible dermatitis; cough, breathlessness, bronchitis,
pneumonitis; psychic — euphoria and erethism.
1. Occupational history.
Nervous system involvement on two lines
a) Fine intention tremors resembling that in multiple sclerosis.
b) Parkinsonism with tremors at rest and reduced motor function, this may
occur without gastro-intestinal symptoms, unsteady staggering gait,
mask-like faces, absence of balance recovery reflexes, tremor begins with
subtle trembling of fingers. Eyes — reddish-grey discoloration of crystalline
lens.
2. Mercury in urine should not
exceed 50 micro-gm/litre.
3. Mercury in blood should not
exceed 3 micro-gm/litre.
4. Examination for presence
of tremors at rest or with
movement.
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Diseases caused by manganese
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
'Anti-knock' agent in petrol
Ceramics
Driers of linseed oil
Dyeing and bleaching of
textiles
Electrode coating of
welding rods
Glass
Inks
Mining of manganese
Paints and pesticides
Production of fertilizers
Production of steel and alloy
steels, aluminium alloys,
copper alloys, drycell batteries,
potassium permanganate
and other manganese
compounds
Tanning of leather
Chills, fever, dryness in mouth, headache, influenza like illness, weakness.
1. Based on personal
occupational history,
information from relatives,
friends, colleagues should
be collected for diagnosis.
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Nervous form of poisoning:
Initial symptoms — difficult to diagnose but most important phase as removal
from exposure at this stage may arrest course of poisoning. These include
weakness, apathy, headache, vertigo, bouts of excitability, unsteady gait,
difficulty in co-ordinated movements, may be period of sexual excitation
followed by hypogenesis followed by increasing indifference
2. Manganese content in hair
is normally below
4 micro-gm/kg.
Objective symptoms — voice becomes monotonous and sinks to whisper,
speech irregular; inability to run, fixed appearance of face — hilarious or
dazed; difficulty in walking backwards.
3. Manganese in urine of non
exposed persons is from 1 to
8 micro-gm/litre but may be
upto 21 micro-gm/litre.
Further — disorders affecting gait become more pronounced (cannot walk
backwards), tremors in lower limbs.
4. Manganese in faeces
60 micro-gm/kg or above
suggests occupational
exposure.
Diseases caused by arsenic
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Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Insecticides and fungicides
Manufacture of certain types of
glass
Metallurgy — in hardening of
copper, lead, alloys
Pigment production
Rodent poison
Smelting of copper ores (as
by-product)
Conjunctivitis, visual disturbances; ulceration and perforation of nasal septum;
pharyngitis, pulmonary irritation, peripheral neuropathy; hyper-pigmentation
of skin, palmar and plantar hyper-keratoses, dermatitis, skin cancer; may
cause cancer of the lung, larynx, lymphatic system or viscera.
1. The diagnosis depends upon
analysis of urine for arsenic.
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Impairment of peripheral circulation, resulting in gangrene of the fingers and
toes. Liver damage has been observed in the animals.
A fatal case following a spill of arsenic trichloride has been reported. Some
organic arsenicals, such as arsanilates, have a selective effect on the optic
nerve and can cause blindness. Excess lung cancer mortality has been observed.
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Acute intoxication with arsenic compounds is usually accompanied by anaemia
and leucopenia. These also occur in cases of chronic arsenic poisoning.
Dermatological disorders may occur.
Possible incidence of resorption and malformed offspring in a smelting
environment.
Urinary levels of arsenic
above 0.7 to 1.0 mg/litre in
exposed individuals may
indicate harmful exposure,
but dietary factors must.first
be ruled out.
2. A determination of arsenic
in hair and nails may be
useful, although its value
has been questioned in
industrial exposures because
of the difficulty in
removing all external
contamination.
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Diseases caused by nitrous fumes
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Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Bleaching of rayon (as stabilizer)
Manufacture of nitric acid
Many industries (as by-product',
intermediate’product)
Powerful lung irritants. High concentrations may cause sudden death.
1. Occupational,history.
Death may be caused by delayed pulmonary oedema, initial signs on exposure
may be no more than moderate irritation of eyes and respiratory tract.
Possibility of death may ensue sometimes even several weeks after exposure
and may be associated with bronchiolitis fibrosa obliterans.
2. Chest X-rays for basal scars.
Chronic effects — drowsiness, dizziness, vomiting, associated with presence of
methaemoglobin in blood, lung function may be affected.
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3. Blood test for
methaemoglobin.
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Diseases caused by carbon disulphide
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Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Industrial solvent (widely used
for alkalies, cellulose, fats,
oils, resins and waxes)
Manufacture of optical glass
Oil extraction
Pesticides (is itself used as a
pesticide)
Viscose rayon
This is primarily a neurotoxic poison. Symptoms indicating central and
peripheral nervous system are most important. In chronic poisoning, the
damage may be permanent.
1. Carbon Disulphide effect can
be measured by determining
the amount in urine,.blood or
expired air. These are rough
estimations.
In acute poisoning, early excitation of the nervous system resembling alcoholic
intoxication occurs, followed by depression, with stupor, restlessness,
unconsciousness and possibly death. Nausea, vomiting, headache are common.
In chronic poisoning, neuritis and disturbance of vision are common. Sensory
changes such as a crawling sensation in the skin, sensations of heaviness and
coldness, and visually "veiling" of objects are noticed first. Gradual loss of
strength follows. Also wasting of the muscles.
Mental symptoms vary from simple excitation or depression and irritability to
mental deterioration, Parkinsonian paralysis and even insanity, insomnia, loss
of memory and personality changes.
A widely used test is iodine
azide test based on a special
test of the urine.
2. Two or three medical
examinations annually are
advisable. A neurologist and
a psychiatrist should
participate in such
examinations.
Chronic fatigue is very common. Sexual disorders in women, menstrual
disturbances and more frequent abortions are described.
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Carbon Disulphide passes the placenta and may be present in the tissues of the
fetus.
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Diseases caused by benzene
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Chemical syntheses (widely used
as a fuel, a chemical reagent,
a solvent, an additive of
motor fuel, and a raw
material)
Manufacture of detergents,
pesticides, solvents and
paint removers
Production of styrene, phenol,
cyclohexane and other
organic chemicals
Shoe-making
Acute poisoning — narcotic action, a local irritant effect on the skin and
mucous membranes, central nervous system depression.
1. Tests for phenol levels in urine
have been used as an index
of benzene exposure.
Chronic poisoning — damages blood-forming tissues and results in
hyporegenerative anaemia. The ultimate injury may be potentially incurable.
Early symptoms — vague complaints of fatigue, loss of appetite, headache,
dizziness and an anaemic appearance.
Continued exposure — may cause euphoria, nausea, a staggering gait and
coma. Inhalation of lower concentrations (250 to 500 ppm) produces vertigo,
drowsiness, headache and nausea.
It often causes irreversible injury to the bone marrow. This may develop into
true aplastic anaemia leading to total or partial destruction of all elements of
the bone marrow. Leukopenia, pancytopenia and thrombocytopenia (all
related to destruction of cells in the blood) may be caused.
A clear relationship between exposure to benzene and the large incidence of
leukaemia has been established.
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2. If signs, symptoms of CNS
depression occur, obtain
blood glucose and rectal
temperature; perform a
complete neurologic
examination.
3. A complete blood count is
necessary (anaemia is severe
and is normochromic and
normocytic in type; platelets
are reduced in numbers
aspirated bone marrow is
usually acellular).
Diseases caused by chromium
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Chromium plating
Chromium salts
Leather tanning
Metallurgy
Photomechanical processing
Refractory bricks
Ulcers (even sometimes perforation) of the nasal septum and fingers; irritation
of the conjunctiva pharynx and larynx and asthmatic bronchitis.
1. Diagnostic studies should
include electrocardiogram,
sputum gram stain and
culture, differential white
blood cell count, and arterial
blood gas analysis.
Frontal headaches; wheezing; dyspnea; cough and pain on inspiration;
jaundice; impaired liver function; lung cancer.
2. Increased levels of chromium
in the urine are indicative of
occupational exposure but
should be interpreted with
caution.
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Anthrax
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Abattoirs
Agriculture
Bone and bone meal processing
Breeding
Butchery
Hair and bristle processing
Ivory and horn processing
Stock farming
Tanneries
Veterinary work
Wood industry
Cutaneous anthrax: A red spot appears at the site of the infection, which
develops into a papule with a necrotic centre. Large collateral oedema
develops around the pustule.
Cutaneous-epidemiological
data (i.e. contact with infected
animals or their products) and
the characteristic clinical
symptoms.
Pulmonary anthrax begins suddenly and assumes form of severe haemorrhagic
pneumonia and death follows within 24-28 hours.
Examination should be made of
cultures from the pustule.
Intestinal and pulmonary forms
— based mainly on
epidemiological data —
exposure or occupation.
Sputum in pulmonary form and
blood in the septic form need to
be tested.
The detection of Gram-positive
bacteria, immunofluorescence
tests may be used as diagnostic
techniques.
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The skin allergic test with
anthraxin is most sensitive.
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Silicosis
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Certain foundry operations like
sandblasting etc.
Cutting of quartzite, agate,
gneiss, granite and slate
Manufacture of glass and
porcelain etc.
Manufacture of pottery
Mines and quarries
Stripping and relining of
steel furnaces
Initial micronodular stages of silicosis are asymptomatic and are revealed only
by periodic radiological examinations.
1. The radiological feature is
due to the occurrence of
"egg-shell" type calcification
of the lymph glands in 2-4% of
silicosis cases.
The first symptom of silicosis is dyspnoea on exertion. As a rule there are no
other subjective symptoms.
The three chief complications of silicosis, which are also the most frequent
causes of death are: pulmonary tuberculosis, respiratory insufficiency, and
acute pulmonary infection.
The clinical signs and symptoms tend to be progressive with continued
exposure to silica. Symptoms become exacerbated by pulmonary infections
and cardiac decompensation. Symptoms include cough, dyspnoea, wheezing,
and repeated nonspecific chest illnesses.
2. A detailed record of
occupational history is
necessary. This may include
the duration and degree of
exposure to dust, the
probable proportion of
quartz or other forms of free
crystalline silica in the dust.
3. A good chest X-ray together
with the case history must
form the basis for the
diagnosis.
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Diseases caused by chlorine
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Bleaching agents (it is itself
a bleaching agent)
De-tinning and de-zincing
of iron
Metal fluxing
Processes of chlorination
of chemicals
Production of chlorine
Sterilization of water supplies
and swimming pools
Synthetic chemistry (as
a reagent)
Chlorine is a potent irritant of the eyes, mucous membranes, respiratory system
and skin; exposure causes pulmonary irritation.
Diagnostic studies should
include electrocardiogram,
sputum gram stain and culture,
differential white blood cell
count, and arterial blood
gas analysis.
Accidental exposure of humans to unmeasured but high concentrations for
a brief period causes burning of the eyes with lacrimation, burning of the nose
and the mouth with rhinorrhea, cough, choking sensation, and substernal pain.
These symptoms are frequently accompanied by nausea, vomiting, headache,
dizziness and sometimes syncope. Vomit frequently contains blood due to the
lesions of the mucous membrane.
The cough may be intense and associated with pain behind the breastbone.
Cellular damage may occur with excretion of fluid in the alveoli, which maybe
fatal if adequate treatment is not given immediately. Massive inhalation
produces pulmonary oedema, fall of blood pressure, and in a few minutes,
cardiac arrest.
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Prolonged exposure to atmospheric chlorine concentrations of 5 ppm results in
disease of the bronchi and a pre-disposition to tuberculosis.
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Diseases caused by bromine
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
'Anti-knock' compounds for
gasoline
Bleaching agent
Dyestuffs
Fuel additives production
Gold extraction
Military gas
Production of bromine
It is a severe irritant of the eyes, mucous membranes, lungs and skin.
These should include
electrocardiogram, sputum
gram stain and culture,
differential white blood cell
count and arterial blood gas
analysis.
Exposure to low concentrations results in copious mucous secretion in the
upper air ways, inflammation of the eye-lids, lacrimation, coughing, epistaxis
respiratory difficulties, vertigo and headaches. Occasionally, these
symptoms are followed a few hours later by nausea, diarrhoea, accompanied
by stomach pains, hoarseness and respiratory difficulty with symptoms of
asthma; crepitations are heard in the lungs.
Inhalation of high bromine concentrations causes inflammatory lesions to the
mucous membranes of the upper airways. The tongue and palate appear
inflamed. Asthmatic bronchitis, photophobia and blepharospasm may
occur. Fatal chemical burns of lungs are possible.
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Diseases caused by iodine
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Photographic film
(Rare occurrence in industry,
used only if no substitute
is found)
Iodine vapour, even in low concentrations, is extremely irritating to the
respiratory tract, eyes and to a lesser extent, to the skin.
If severe exposures are
suspected, diagnostic studies
should include
electrocardiogram, sputum
gram stain and culture,
differential white blood cell
count, and arterial blood
gas analysis.
Exposed workers experience a burning sensation in the eyes, lacrimation,
blepharitis, rhinitis, stomatitis and chronic pharyngitis.
Headaches and a feeling of tightness in the chest have been reported.
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Diseases caused by fluorine
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Aircraft piston engines
Conversion of uranium
tetrafluoride to uranium
hexafluoride
Electrolytic refining and
pickling of metals
Electroplating
Etching of glassware
Manufacture of artificial
cryolite, certain refrigerants
and insecticides
Production of metallic
aluminium (to make
aluminium fluoride
intermediate)
Synthesis of high octane
petrol by alkylation (as
hydrofluoric acid)
Inhalation of high concentrations causes larygeal spasm, bronchospasm,
followed by delayed pulmonary oedema.
Mucous membrane irritation
may be similar to viral upper
respiratory tract infection but
the latter may be characterised
by fever, myalgias, and
lymphocytosis.
Mice exposed to sublethal concentrations had pulmonary irritation and
delayed development of neurosis in the liver and the kidneys.
Chronic inhalation to low doses may produce mild dyspepsia.
Abnormal radiographs of bones
particularly tibia and fibula
bearing small bony spicules are
characteristic of chronic
exposure.
Excretion of fluorides in
mother's milk and urine of
exposed persons is
characteristically high.
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Diseases caused by halogen derivatives of aliphatic hydrocarbons*
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Industrial occurrence
Signs and symptoms
Diagnosis, special tests
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In industries associated with
Chemicals (as solvents,
refrigerants, anaesthetics,
fumigants, etc.)
Plastic intermediates
Gauge fluids
These chemicals are lung irritants. The severity of effect depends on the
particular chemical in question and its concentrations.
1. Occupational history.
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They cause injuries to eyes and repeated exposure to fumes may result in
irreversible damage.
Affected skin is dry and is cracked, chapped on repeated contact.
’Some examples of above
type of chemicals are
chloroform, chloromethane,
vinyl chloride, carbon
tetrachloride, etc.
Vinyl chloride is a carcinogen and other chemicals of the above type are
suspects.
Effects on the nervous system — inebriation,excitation,
passing into necrosis is typical.
Death may result due to acute severe exposure,.
2. Referring to literature on the
particular chemical in
question.
3. In case of CNS depression,
blood glucose, rectal
temperature to be noted and
complete neurological
examination to be done.
4. Liver function tests, if liver
injury is suspected.
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Headache, nausea, convulsions, paralysis, visual disturbances, tremors.
affected speech are evidence of complicated involvement of the central
nervous system.
Harmful effects on kidneys, liver are reported.
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Pathological manifestations due to exposure to radioactive
substances and X-rays
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Industrial radiography
Nuclear reactors
Radium dial painting
Uranium mining
Use, analysis; or manufacture
of radioactive materials
X-ray clinics
Exposure of the entire body or large portion of the body to doses of radiation
in excess of 1 Gray (Gy), results in nausea, vomiting, perhaps diarrhoea within
hours of exposure. Gastro-intestinal symptoms usually improve in a day — then
second phase starts — a period of relative well being, may last upto a week.
Third or toxic phase is characterised by recurrence of intestinal symptoms,
ulcerations occur in mouth and throat, may lose hair, gross intestinal bleeding
may be present.
Drop in the lymphocyte count
followed by slower and biphasic
fall in granulocyte and platelet
counts. Possible gradual fall in
red blood cell count.
In intestine, ulceration of
mucous membrane is possible.
Acute effects — drop in lymphocyte count, interstitial fibrosis in case of
localised exposure.
Late effects — leukaemia and.other forms of cancer.
If embryo is exposed — morphological abnormalities in development of
nervous system or death of infants is possible depending upon the dose and
duration of exposure.
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Skin cancer
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Industrial occurrence
Agent
Signs and symptoms
Diagnosis, special tests
In industries associated with
Arsenical insecticides
arsenic
Firm non inflammatory waxy papule which may have
uniformly dark pigmentation.
Skin cancer takes many years
to develop, early stages readily
detectable by visual inspection.
Coal, gas, coke, asphalt etc.
pitch, tar, or
tarry products
Squamous cell carcinoma appears as a small but firm
erythematous nodule. Tumouous growth.
Outdoor workers and
industrial ultra-violet use
ultra-violet
radiation
Brown black coloured lesion that starts to enlarge, change
colour, bleed or ulcerate. The lesion is more often
smaller than 1.5 mm
Radiation workers
ionising radiation
Shale oil refining, cotton
industry, paraffin wax,
oil refinery etc.
lubricating and
cutting oils
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Occupational history indicates
regular checking for skin cancer.
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Toxic anaemia
Signs and symptoms
Diagnosis, special tests
In industries associated with
Pallor, easy fatigue, breathlessness on exertion, giddiness,
Exposure to —
palpitation
Benzene
X-rays
Ionising radiation
Lead
Carbon monoxide
Arsine
Aromatic amines
Nitro compounds (like nitro
benzene, aniline, TNT)
Alkaline chlorates
Nitrites
Nitrates
Insecticides
Manufacture of phenyl hydrazine,
toluene, acetanilamide,
methyl chloride, mercury
1. Occupational history
Industrial occurrence
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2. The agents listed have different effects eg
exposure to carbon monoxide forms
carboxyhaemoglobin in blood. Some
haematological indicators:
: basophilic
lead
stippling of
erythrocytes
occurrence of
nitro compounds
aromatic amines : reticulocytosis
in regenerative
phase of haemo
lytic anaemia
ionising
: increase in binuclear
radiation
lymphocytes.
3. Spectrophotometric analysis of denaturated
haemoglobin.
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Toxic jaundice
Diagnosis, special tests
In industries associated with
Arsenic, antimony and ferrous
iron compounds
Loss of appetite, nausea, vomiting and
abdominal pain are followed by a tender,
enlarged liver and jaundice, with pale stool's
and dark urine.
An important biochemical feature is the
high level of serum amino — transferase
(transaminase)
Carbon tetrachloride (widely used in
dry cleaning, as constituent of fire
extinguishers and as industrial
solvent)
Chlorophenothane (DDT)
High fever, rapidly increasing jaundice, mental
confusion and coma with a fatal termination
from massive-necrosis of the liver.
A full occupational history is necessary.
The presence of hepatitis B surface antigen
and antibody should be determined.
Hepafosplenomegaly may be detected
clinically, by radiography or more precisely
by grey scale ultrasonography.
M G
Methyl chloride, tetrachloroethane,
chloroform, nitrobenzenes, dinitrophenol,
trinitrotoluene, toluene, chlorinated
naphthalenes, and chlorinated diphenyl
(used as solvents, degreasers and
refrigerants, and in polishes, dyes and
explosives)
Hepato-toxic
ii t f i i o U ' i U U V
Signs and symptoms
si si li
Industrial occurrence
Vinyl chloride (in production of polyvinyl
chloride)
Yellow phosphorus
22
e
Occupational dermatitis due to primary irritants and sensitizers
Occupations
Irritants
Bakers, chemical,
cleaners, construction,
electroplating,
engineering, leather,
metal, paint,
pharmaceutical, plastic,
printing, rubber, textile,
etc.
Cement, lime,
Chromium’, nickel, mercury
detergents, organic
and cobalt salts; epoxy
solvents, soaps, turpentine, resins, turpentine, azo
synthetic coolants
dyes, formaldehyde,
abrasives, nitro-paints,
fungicides, etc.
acids, hardeners, dyes,
alkalies, peroxides, pesticides,
weed-killers, gum, inks,
chlorinated diphenyls,
disinfectants, etc.
Sensitizers
Signs and symptoms
Diagnosis, special tests
Eczematous lesions
Occupational history
Referring to detailed list of
irritants, sensitizers
Observing if many workers in
identical situations develop
cutaneous changes, patch tests.
23
Byssinosis
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Cotton, flax and soft hempr
(especially in ginneries, bale
pressing plants, mixing and
card rooms, and linen, rope,
textiles and twine making)
Early stages — occasional chest tightness or respiratory irritation on the first
day of the working week.
1. Characteristic history of chest
tightness.
As the disease progresses — chest tightness and/or shortness of breath extends
to the other days of the week.
2. There is a marked fall in
ventilatory capacity during
work.
Eventually, the worker may become severely affected on every working day
with permanent and severe effort intolerance.
3. Measurement of FEV 10 or
airway resistance at'the
beginning and end of the
work shift on the first day of
the week may help not only
to confirm the diagnosis, but
also to identify workers who
are susceptible to the dust
without visible symptoms.
4. Diagnosis is made primarily
from a history of exposure to
cotton dust.
24
Asbestosis
Industriol occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Brake linings
Cement
Filler for plastics
Fire smothering blankets
Mining of asbestos
Safety garments
Thermal and electric
insulation
Increased breathlessness on exertion, aching or transient sharp pains in the
chest; persistent dull chest pains; haemoptysis; presence of high-pitched fine
crepitations at full inspiration and persisting after coughing.
Detailed occupational history
of exposure to asbestos is a
prime element in diagnosis.
Chronic and acute pleurisy is now a recognised sequel to asbestos dust
exposure. Acute pleurisy is associated with pain in chest, fever, leucocytosis
and a raised erithrocyte sedimentation rate in blood.
The chest radiograph is
important.
Greater vulnerability to lung cancer.
Others include, localised pleural thickenings, which may become radiopaque
through calcification; restrictive pulmonary function; rales; dyspnoea;
cyanosis, dry cough and finger clubbing.
The pattern of lung function
provides the important third
component in diagnosis. The
total lung volume is reduced
and especially the forced vital
capacity |FVC), is reduced.
25
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
High noise levels (in textiles,
engineering, boilers, compressors etc.)
Four phases of development of the chronic effect:
Monitoring noise levels at the
work place.
Audiometric examination.
4. Feeling of hearing insufficiency is manifest.
O O C
C)
O
6
Reduction in hearing capacity is not only quantitative but also qualitative,
that is, sounds are perceived in an abnormal manner.
O
3. Normal hearing is affected — if background noise is present, incapability
of picking up components of a conversation, cannot hear ticking clock, etc.
('•)
2. Intermittent ringing in ears.
Ci c>
1
1. Ringing in the ear at the end of the work shift, slight headache, tiredness,
dizziness.
c c> Ci C c o o c o c 0 c> ci o
Noise induced hearing loss
26
e
Asbestosis
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Brake linings
Cement .
Filler for plastics
Fire smothering blankets
Mining of asbestos
Safety garments
Thermal and electric
insulation
Increased breathlessness on exertion, aching or transient sharp pains in the
chest; persistent dull chest pains; haemoptysis; presence of high-pitched fine
crepitations at full inspiration and persisting after coug’hing.
Detailed occupational history
of exposure to asbestos is a
prime element in diagnosis.
Chronic and acute pleurisy is now a recognised sequel to asbestos dust
exposure. Acute pleurisy is associated with pain in chest, fever, leucocytosis
and a raised erithrocyte sedimentation rate in blood.
The chest radiograph is
important.
O
o
D
■3
Greater vulnerability to lung cancer.
Others include, localised pleural thickenings, which may become radiopaque
through calcification; restrictive pulmonary function; rales; dyspnoea;
cyanosis, dry cough and finger clubbing.
The pattern of lung function
provides the important third
component in diagnosis. The
total lung volume is reduced
and especially the forced vital
capacity |FVC), is reduced.
25
Noise inauced hearing loss
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
High noise levels (in textiles,
engineering, boilers, compressors etc.)
Four phases of development of the chronic effect:
Monitoring noise levels at the
work place.
1. Ringing in the ear at the end of the work shift, slight headache, tiredness,
dizziness.
Audiometric examination.
2. Intermittent ringing in ears.
3. Normal hearing is affected — if background noise is present, incapability
of picking up components of a conversation, cannot hear ticking clock, etc.
4. Feeling of hearing insufficiency is manifest.
Reduction in hearing capacity is not only quantitative but also qualitative,
that is, sounds are perceived in an abnormal manner.
26
e
e
c
..
0
0
__
Diseases caused by beryllium
0
3
3
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Alloys (as hardening, agent)
Nuclear reactors (as moderator)
Acute effects — swollen and hyperaemic mucous membranes, bleeding points,
fissures and ulceration. Severe chemical pneumonia with pulmonary oedema,
may result in death.
1. History of exposure.
2. Consistent clinical findings.
Chronic — due to inhalation, onset characterised by weakness, easy fatigue
and weight loss without cough. Following an illness nonproductive coughing,
shortness of breath is felt. Joint pains. X-ray changes, may be renal calculi
will occur.
3. Tissue assays of beryllium.
Concentration in lung tissue
as high as 0.05 micro-gm per
100 gm is a strong indicator.
Skin injuries — allergic contact dermatitis on exposed parts of the body. If it
enters in an abrasion, granulomata formation takes place. Conjunctivitis with
severe periorbital oedema with dermatitis or alone may occur.
4. Differentiation from
sarcoidosis is difficult; in
beryllium disease lymph node
and ocular involvement,
hypercalcemia are absent.
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
0
3
3
3
27
Diseases caused by carbon monoxide
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Blast furnaces
Boilers
Garages
Industrial gases
Metallurgy (as reducing agent)
Mines
Organic syntheses
Production of metal carbonyls
Tunnel construction and
maintenance
Headache, tachypnoea, nausea, weakness, dizziness, mental confusion,
hallucinations; cyanosis, syncope.
1. History of exposure.
28
2. Blood cherry pink in colour.
Acute exposure may lead to death.
Residual mental damage may persist even after signs of improvement.
Exposure to 50 ppm for 90 minutes may cause aggravation of angina pectoris.
3. Level of carboxyhaemo
globin above 40% — collapse,
above 25% — headache,
nausea.
4. Depression of the S-T
segment of
electrocardiogram.
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Industrial syntheses (such as
manufacture of dyestuffs,
coal tar, urea, isocyanates
and their derivatives,
carbonic acid esters, acid
chlorides)
Insecticides production
Metallurgy
Pharmaceuticals
Eye irritation, dryness or burning sensation of the throat, vomiting, pain in
chest, cyanosis.
1. Occupational history.
Severe skin or-eye burns due to splashes of liquefied phosgene.
2. Electrocardiogram, sputum
gram stain and culture should
be included.
The symptoms of severe respiratory distress may be delayed upto 72 hours.
Delayed onset of pulmonary oedema with cough and foamy sputum, severe
cyanosis, may lead to pneumonia.
Death possible also due to cardiac failure.
rr
f >
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r
ar Frr r
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UOUOUCjU O VQ O O U O U O U U C C O U U U U O u
Diseases caused by phosgene
29
Diseases caused by isocyanates
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Manufacture of elastomers of
polyurethane
Paints
Pesticides
Polyurethane foam
Varnishes
Irritation of skin may range from itching to widespread eczema. Irritation
of mucous membranes. Lacrimation of eyes is common but, rarely, even
conjuctivitis is noticed.
1. Occupational history.
30
Most serious and common are effects on respiratory system.
May begin with asthmatic attacks, may lead to unconsciousness. Rhinitis is also
possible.
2. Workers with allergic
cutaneous or respiratory
antecedents are more
affected.
Coal miner’s pneumoconiosis
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Coal mines
High coal dust concentrations
Minor respiratory impairment in case of simple pneumoconiosis.
1.
Severe respiratory disability in case of complicated pneumoconiosis.
2.
Occupational history.
Lung X-rays with radiological
technique of high order and
presence of consistent
shadows in X-ray plates.
Linear (irregular), or rounded
(regular) opacities,
frequently located in the
upper lung zones.
Refer to ILO classification of
pneumoconiosis (1971; 1980)
Occupational cancer
Occupational cancer does not differ clinically and histopathologically from other cancers. In diagnosis, detailed occupational history is the main
diagnostic assessment. As a useful tool the following table (which is not exhaustive) is given.
Industrial occurrence
Reported or suspected agent
Site of the cancer
In industries associated with
Asbestos production
asbestos
lung, pleura
Boot, shoe manufacture and repairs
leather dust, benzene
nose, bone marrow
Chemicals production
vinyl chloride
isopropyl alcohol
dyes (also users)
BCME, CMME
auramine
vinyl chloride monomer
not identified
benzidine, 2-naphthylamine, 4-amint>diphenyl
BCME, CMME
auramine and other aromatic amines
liver
paranasal sinuses
bladder
lung
bladder
Chromate production, plating, pigment
chromium
lung
Copper smelting
arsenic
lung
Construction
insulation, pipe covering
asbestos
lung
32
(continued)
Occupational cancer (continued)
Industrial occurrence
Reported or suspected agent
Site of the cancer
Furniture
wood dust
nose
benzo(a) pyrene
coal carbonisation products,
alpha and -beta naphthylamine
lung
lung, bladder,
scrotum
Mining
arsenic
asbestos
iron
uranium
arsenic
asbestos
not identified
radon
lung, skin
lung
lung
lung
Nickel refining
nickel
nasal sinuses, lung
Petroleum
polycyclic hydrocarbons
scrotum
Roofing, asphalt work
benzo(a) pyrene
lung
Rubber, tyres
benzene
Ship building, motor vehicles, transport
asbestos
lymphatic and haematopoietic
system (leukaemia), bladder
lung
Steel production
benzo(a) pyrene
lung
Gas production
coke plants
gas works
Industrial occurrence
Signs and symptoms
Diagnosis, special tests
In industries associated with
Aromatic amines
Cadmium
Carbon disulphide (bisulphide)
Cresol
Lead
Lithium
Mercury
Naphthalene
Phenol
Oliguria and signs similar to arteriosclerotic renal disease.
1. Occupational history.
In case of carbon disulphide, pathological changes in cardiovascular
system with predilection for cerebral, coronary, and renal circulation.
In case of cadmium, proteinuria involving proteins of low molecular weight
(20,000-30,000) is observed.
Exposure following inhalation of metallic mercury for months or years may
lead to glomerular lesions.
2. Urine analysis (table
attached for limits in urine).
3. The above should be backed
up by more detailed analysis,
such as renal clearance.
Urine exam (routine) will
show high specific gravity
and presence of albumin.
o o o o o o
Toxic nephritis
c
c
c
G _
G
C e-
€
4. Blood exam will show high
levels of urea, creatinin.
On the whole renal functions
are depressed showing
accumulation of waste
metabolites.
5. in case of workers exposed
to mercury, cadmium, and
aromatic amines, even slight
haematuria should be
considered.
34
C e.
C .
C _
C .
c
c
e
c
e
c
c
e.
FACTORIES ACT, 1948
The Schedule
(See sections 89 and 90)
LIST OF NOTIFIABLE DISEASES
1. Lead poisoning, including poisoning by any preparation or
compound of lead or their sequelae.
2. Lead tetra-ethyl poisoning.
3. Phosphorus poisoning or its sequelae.
4. Mercury poisoning or its sequelae.
5. Manganese poisoning or its sequelae.
6. Arsenic poisoning or its sequelae.
7. Poisoning by nitrous fumes.
8. Carbon bisulphide poisoning.
9. Benzene poisoning, including poisoning by any of its
homologues, their nitro or amido derivatives or its sequelae.
10. Chrome ulceration or its sequelae.
11. Anthrax.
12. Silicosis.
13. Poisoning by halogens or halogen derivates of the
hydrocarbons of the aliphatic series.
14. Pathological manifestations due to —
(a) Radium or other radioactive substances;
(b) X-rays.
15. Primary epitheliomatous cancer of the skin.
16. Toxic anaemia.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
Toxic jaundice due to poisonous substances.
Oil acne or dermatitis due to mineral oils and compounds
containing mineral oil base.
Byssionosis.
Asbestosis.
Occupational or contract dermatitis caused by direct
contract with chemicals and paints. These are of two types,
that is, primary irritants and
allergic sensitizers.
Noise induced hearing loss (exposure
to high noise levels).
Poisoning by beryllium.
Poisoning by carbon monoxide.
Poisoning by phosgene.
Poisoning by isocyanates
Coal miner's pneumoconiosis.
Occupational cancer.
Toxic nephritis.
Items 23 to 29 added by amendment.
35
Urine
Other
Blood
Urine
Other
Arsenic
0.35 mg/l
2 micro-gm/gm
hair
—
1 mg/l
—
Fluorine
—
—
—
—
10 micro-gm/
100 ml
—
5 mg/l
25 micro-gm/l
Lead
1 mg/l
10 micro-gm/24 h
a
—
—
Chromium
—
—
—
—
—
50 micro-gm/gm
creatinine
Mercury (metallic)
—
—
—
Based on 'Encyclopaedic of Occupational Health and Safety', ILO (1983), P. 818
36
,▼
i
laboratory
“normal"
upper limit
mean + 2SD)
'
Protoporphyrin IX (PP)
o /y o o c 6 <> r> o n ri
’
,
400 micro-gm/l
(persons over
reproductive age)
300 micro-gm/l
(women of
reproductive age)
’ T
Blood
0.05 mg/r
1 I T
VI
c c c c o o Cl
Biological exposure limits
r>
Normal values
Toxic
substance
ft
r> c c
’ ’ V’ V
Exposure limits : biological
About Us
The Society for Participatory Research in Asia (PRIA) is a non-profit voluntary
organization registered under the Indian Society's Act.
We work with local groups and activists involved in the education,
empowerment and organization building efforts and struggle of the
marginalized and underprivileged sections of society. We extend support
through research, training, networking with groups on common issues and
preparation and dissemination of learning materials. During the last six years
of our work we have involved ourselves on various issues on primary health
care and adult non-formal education, problems of deforestation, land
alienation and large dams, women and work, rural sanitation, management of
NGOs and occupational health and safety, and workers' education.
This booklet is prepared in support to our involvement on the issue of
occupational health and safety.
The text of this booklet has been prepared by Vijay Kanhere.
Dr NK Mehrotra has provided his valuable comments in finalization of this
text. We are thankful to DrAnant RS, Dr PC Jain and DrDB Vyas and, above
all, DrNK Mehrotra for providing help at different stages in organizing the
text.
________________________
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Society for Participatory
Research in Asia
45 Sainik Farm, Khanpur
New Delhi 110 062
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