Pneumoconiosis Due to Cotton Dust (Byssinosis)

Abstract

Byssinosis, a form of pneumoconiosis due to prolonged inhalation of cotton dust, has long been recognized as a cause of ill health among British cotton-mill workers. In 1936, C. Prausnitz (2) and co-workers, under the auspices of the British Medical Research Council, published an account of their extensive investigations into the causes of respiratory disease in this industrial group. A brief review of this work follows. Sickness caused by respiratory disorders is frequent in cotton mill operators, particularly those working in departments in which there is a continuously high content of cotton dust in the air. Many operators working in such departments experience a typical illness, referred to as “stripper's asthma” or “cotton-mill fever,” an insidious disease characterized initially by evidence of upper respiratory irritation with moderate fever. The first attack soon subsides, but with continued employment in this type of work a dry irritating cough and attacks of breathlessness develop, with a sense of constriction in the chest. These symptoms are aggravated on return to work on Mondays after a week-end of absence from the mill. In a period of years, symptoms become more severe; “Monday-morning fever” continues into later days of the week, with aggravation of symptoms. The cough grows worse, becoming spasmodic, with production of small quantities of sticky, tenacious sputum. If the affected person quits the mill before symptoms become too severe and enters some type of out-of-door work, these disappear and health is regained. If, however, he remains in the same type of employment, he becomes progressively worse, with a prospect of invalidism with emphysema, bronchitis, and ultimate cardiac failure. Fletcher, co-worker of Prausnitz, examined radiographically 100 persons with “mill fever.” He describes the appearances as those of chronic bronchitis with associated emphysema; there were no particular roentgen features specific for the disease. A short summary of the findings and experimental observations of Prausnitz and his co-workers follows: 1. Card-room air of cotton mills is rich in dust particles less than 2 microns in diameter and still richer in ultramicroscopic particles capable of easy penetration into deep air passages. 2. The protein fraction of cotton dust has an irritating effect upon the deeper tissues of the lungs and produces definite inflammatory lesions. Animals subjected to prolonged inhalation of cotton dust showed marked thickening of the inter-alveolar septa as a result of edema, leukocytic and dust cell infiltration. 3. Patients working in cotton mills who develop “card-room fever” all become hypersensitive to cotton-dust protein.