OCCUPATIONAL HEALTH

COURSE LECTURES
ASS PROF P E N
ONYEMACHI
 DEFINITIONS
• Health is a state of complete physical,
mental and social wellbeing and not merely
an absence of disease or infirmity.
• The states of health or disease are the
expression of the success or failure
experienced by organism in its efforts to
respond to adaptively to environmental
challenges
 DEFINTIONS
• Occupation
 job: the job by which somebody earns a living
 activity: an action or process on which time is spent
 act of occupying: an act of occupying or the state of
being occupied
 MILITARY invasion: the invasion and control of a
country or area by enemy forces
 time of occupying: the period of time during which
something is occupied. relating to work: relating to or
caused by somebody's job
 SAFETY
 Freedom from danger, harm, hazards
 Protection from, or not being exposed to the
risk of harm or injury
 Lack of danger: Inability to cause or result in
harm, injury or damage, viz; People are
beginning to question the safety of medicine
 A safe place; a place or situation where harm,
danger or loss is unlikely.
 DEFINTIONS
• DISEASE:
 A condition of abnormal vital function
involving any structure, part or system of
any organ
 A specific illness or disorder is
characterized by a recognizable set of signs
and symptoms, attributable to hereditary,
infection, diet or environment
 OCCUPATIONAL DISEASES
Diseases due to physical agents
 Heat –heat hyperpyrexia, heat exhaustion, heat
syncope, heat cramps, burns and local effects such
prickly heat
 Cold - Trench foot, frost bite, chiblains
 Light – Occupational cataract, miner’s nystagmus
 Pressure – Caisson disease, air embolism, blast
(explosion)
 Noise – occupational deafness
 OCCUPATIONAL DISEASES
 Radiation – Cancer, Leukaemia, aplatic
anaemia, pancytopenia
 Mechanical factors – Injuries, accidents
 Electricity – Burns, electrocution
Diseases due to chemical agents
 Gases – CO2, CO, HCN, CS,NH3, N2,
H2S,HCL,SO2 they cause gas poisoning
 OCCUPATIONAL DISEASES
 Dusts (Pneumoconiosis) Inorganic dust
Coal dust – Anthrocosis, Silica – Silicosis
Asbestos – Asbestosis, cancer lungs
Iron – siderosis
 Organic (vegetable) dust
Cane fibre – Bagasosis, cotton dust –
Byssinosis, Tobacco - tobacossis
 OCCUPATIONAL DISEASES
Hay or grain dust – Farmer’s lung
 Metals and their compound
Toxic hazards from lead, mercury, cadmium,
manganese, beryllium, arsenic, chromium
etc
 Chemicals: Acids, Alkalies. Pesticides
 Solvents: Carbon bisulphide, benzebe,
trchloroethylene, chloroform etc
 OCCUPATIONAL DISEASES
 Diseases due to biological agents:
Brucellosis, leptospirosis, anthranx,
actinomycosis, hydatidosis, psittacosis,
tetanus, encephalitis, fungal infections etc
 Occupational cancers: cancer of the skin,
lungs, blader
 Occupational dermatosis: Dermatitis,
eczema
 OCCUPATIONAL DISEASES
 Diseases of psychological origin: Industrial
neurosis, hypertension, peptic ulcer,
migraine, stress, conflicts etc
 ILO/WHO EXPERT COMMITTEE 1950
OH is all the activities and programmes
organized and carried out so as to achieve and
maintain the highest level of health for all the
people who work. These are achieved by
processes which look at the enterprise from
the perspective of the totality of the
environment of the work place. They do so by
working on that environment to make it
conducive to man’s physiological and
anthropological make-up and in addition, by
fitting each worker to his work.
 SOME HISTORY
GLOBALLY - B. RAMAZZINI
(Hippocrates, Galen, Pliny the Elder
and Agricola, prior to that)
-Percival Pot
-George Baker
-Charles Turner Thackrah
-Thomas Legg
-Alice Hamilton
In Nigeria: - Mr. Britnell
- Dr. G.O. Sofoluwe
 LEGGES APHORISMS
1. “Unless and until the employer has done everything –
and everything means a great deal – the workman can
do next to nothing to protect himself, although he is
naturally willing enough to do his share”
2. “If you can bring an influence to bear external to the
workman – that is over which he has no control – you
will be successful; and if you cannot or do not, you
will never be wholly successful”
3. “Practically all industrial lead poisoning is due to the
inhalation of dust and fume, and if you stop their
inhalation you stop the poisoning”.
4. “All workmen should be told something of the danger
of the material with which they come into contact,
and not be left to find it out for themselves –
Number 1, 2, and 4 are sometimes referred to as Legge’s
three aphorisms as they deal with the general methods of
prevention of diseases and ailments in industry.

Appointed Factory Doctor

The protection of juveniles in industry has been a major
aim of all factory and social legislations in the UK
following Industrial Revolution. Consequently the
factories Act of 1833 was inter alia to regulate the labour
of Children and Young Persons in Mills and Factories.
However, it was the 1884 Act that provided for the
appointment of a certifying Surgeon who had to examine
young people and delare them fit for factory
employment.
This term was applied to the doctors who were officially
employed for the purposes of certification and also those
engaged by factory owners to perform the same
function. By the Factories Act of 1948, the name
changed to appointed Factory Doctor.
OCCUPATIONAL HEALTH IN NIGERIA
-Workman Compensation Ordinance 1941 (Decree, Act
1987); Hx before the laws.
- Department of Labour- 1942
- Labour Code Ordinance – 1945 (Decree, Act 1974)
- Ministry of Labour 1951
-Mr. Britnell-1st Chief Inspector of Factories - 1952
- Factory Act – 1955, 1958 (Decree, Act 1987)
- !st National Industrial Safety Conference - 1962.
Britnell (call for a lectureship creation – R. Schram)
- 1st Lectureship in OH, at the University of Lagos
-1st International Seminar on Occupational Health in the
developing Countries; 1968, Lagos.
- 1980s/70s Industrial Nurses Association of Nigeria.
- Division of Occupational & Environmental Health .
FMOH, 1976
- Institute of OH, Oyo State, 1983
THE AIMS OF OCCUPATIONAL HEALTH
1. The promotion and maintenance of the highest
degree of physical, mental and social well being of
workers in all occupations.
2. The prevention among workers of departures from
health caused by their working conditions.
3. The protection of workers in their employment
from risks resulting from factors adverse to health.
4. The planning and maintenance of workers in an
occupational environment adapted to his
physiological equipment; and to summarize.
5. The adaptation of work to man each man to his
job.
INTERACTION BETWEEN WORK AND
HEALTH
- Positive effects of work on health - relief of
boredom, creativity, personal gain
-Positive effects of good health on work –
physical ability, creativity, fueling the
productivity cycle
- Negative effects of (poor) health on work –
incapacity, low productivity, worsening of
illness, danger to others.
- Negative effects of work on health – very
many; all from the 5 hazards areas.
 COMPONENTS OF THE WORK
ENVIRONMENT (& SYSTEMATIC
APPROACH TO IDENTIFYING DISEASE
CAUSATION IN EACH WORKPLACE)
- Physical environment – heat, light, pressure,
humidity, noise, vibration & radiation.
- Biological environment – viruses, chlamydia,
bacteria, yeasts, protozoa, metazoa
- Chemical environment – elements, compounds and
mixtures: as solids, fluids, fumes , vapours.
- Mechanical/Ergonomical environment – the tools
machines of work
- Psycho-social environment- vertical, horizontal
worker relationships; formal and informal workplace
relationships; management and labour relationships
PRINCIPAL DISCIPLINES IN OH &
S & THEIR WORK
- Nurses
-Physicians
- Hygienists
- Engineers/Ergonomists
- Psychologists/Managers
- [Others – Toxicologists, Labour &
safety officers, etc.]
FUNCTIONS OF AN OH SERVICE
1. Pre-employment medical examination
– general & specific (pre-placement)
2. Periodic medical examination
3. Other medical examinations & audits
4. Provision of primary medical care + first aid
5. Environmental monitoring & safety
6. Social and welfare services provision
7. Control of workplace effluents
8. Maintenance of medical records
9. Industrial health education
10. Factory health development (health services
provision, planning & re-planning)
11. Rehabilitation services – physical,
occupational & economic/social.
 PRINCIPLES OF HAZARDS CONTROL &
DISEASE PREVENTION IN OHS
1. Complete elimination – by substitution or change
of process
2. Containment – at source
- by total enclosures
- by partial enclosures
- by limited or regulated time exposures
- by personal protection
3. Adjunct measures – House keeping
- Safety monitoring- environmental,
biological/personal records
- Health education – information, committees,
incentives and disincentives (incl. legislation).
Hierarchy of control of occupational
hazards

This Photo by Unknown Author is licensed under CC BY-SA

 OCCUPATIONAL POISONS – METALS 1

LEAD I
• Uses: Making of pipes, metal sheets, foils, paints, enamels,
glazes, car batteries, solders ; and alkyl lead compounds.
• Hazards: Inhaled dusts and fumes are the most dangerous
(40% absorbed) but organic lead is readily absorbed
through intact skin also.
• Metabolism: Inorganic lead poorly absorbed PO – 10%
only, except Fe and Ca are low in diet. 90% of absorbed in
bones & teeth, 10% in plasma. IL does not cross BBB but
OL does. Excretion mostly kidneys; but small in bile,
sweat and milk also.
 OCCUPATIONAL POISONS – METALS 2

LEAD II - Poisoning
• Inorganic Lead: Abdominal pain, constipation, vomiting,
metallic taste in the mouth, headache, non-abdominal pain,
asthenia, paraesthesia, psychological symptoms, diarrhoea,
anaemia & spontaneous abortion in women; lead line on
the gums, peripheral neuropathy (wrist drop, etc) and
encephalopathy in the past but now rare even though the
common presenting symptom in the child. Interfers with
heam formation by interfering with sulphadryl (–SH)
group of enzymes. D-amino laevulinic acid (ALA-d) &
coproporphyrin (Cp) in urine – used to be used to monitor
lead poisoning in industries.
 OCCUPATIONAL POISONS – METALS 3

• LEAD poisoning.
• Organic lead – mostly as tetraethyl lead (TEL) and
potentially TML – used as solvents in confined spaces or
sniffed.
• Symptoms: Disturbances of sleep pattern, nausea,
anorexia, vomiting, vertigo and headache, muscular
weakness, weight loss, tremor, diarrhoea, abdominal pain,
hyperexcitability, mania.
 OCCUPATIONAL POISONS – METALS 4

LEAD POISONING – Monitoring

Inorganic: Blood lead <80ug/100ml (3.9umol/l); urinary Cp
and ALA-d also.
Organic: Urinary lead monitoring (<150ug/l or 0.7umol/l) as
OL is not in the blood.

Prevention & treatment:

Exhaust ventilation where fumes and dusts are involved;
protective clothing; Ca ethylene-diamine tetra-acetic acid
(CaEDTA) or penicillamine in IL; Nil for OL, hence extreme
prevention. Copious hand washing and personal hygiene
 OCCUPATIONAL POISONS – METALS 5

• MERCURY.
• Uses: Metallic mercury in the manufacture of
thermometers, switch gear, amalgams with cupper, tin,
silver, or gold; solders containing mercury, tin and lead;
mercury cell rooms in the manufacture of chlorine;
Inorganic mercury in nitrates for leather carrotting, the
sulphide in paints; the red oxide in anti-fouling paints.
• Organic mercury (ethyl, methyl, phenyl & tolyl) in anti-
fungal seed dressing; in anti-slime in paper making; HG
fulminate in the manufacture of explosives.
 OCCUPATIONAL POISONS – METALS 6.

• MERCURY – Hazards.
• During mining, refining (especially from the vapour), in
normal evaporation in labs especially from broken
containers, dental surgeries.
• Inhalation is by far the most dangerous but Hg is well
absorbed via intact skin by which it had been administered
as Rx.
• Organic Hg only as methyl and ethyl have produced
systemic poisoning. The fulminate is a skin irritant only
 OCCUPATIONAL POISONS – METALS 7

• MERCURY – Metabolism
• Lungs – 80% absorbed; Gut <15% inorganic Hg salts,
metallic Hg very negligible, methyl Hg virtually complete.
• Elemental HG crosses BBB easily as well as the placenta;
so also organic Hg; but not inorganic.
• 50% body Hg in the kidneys; excretion via urine, faeces
(methylHG); lungs (vapour), sweat and saliva; and milk
also (dangerous for children).
 OCCUPATIONAL POISONS – METALS 8

• MERCURY – POISONING
• Acute: (especially heated Hg in confined places) acute febrile illness,
cough, dyspnoea, tachypnoea, fever, vomiting,lethargy, tightness in
the chest, rigors, cyanosis. Most resolve spontaneously though
dyspnoea & tightness of the chest may continue for a little longer.
• Chronic: Largely neurologic in organic and psychiatric in inorganic;
shallow complexion; dyspepsia and headaches; gingivitis; excessive
salivation; loose, blackened or eroded teeth; mercury line in gums;
fulminate itch and powder holes; tremor; cerebellar ataxia;
paraesthesia, difficult hearing, constriction of visual fields; hatters
madness (erethism); nephrotic syndrome; mecurialentis
 OCCUPATIONAL POISONS – METALS 9

• MERCURY Prevention and treatment

• Exhaust ventilation, protective clothing and all the other
house keeping rules.
• Chelating agents in poisoning BAL and CaEDTA – less
quick response in inorganic Hg poisoning. Organic Hg
poisoning will require intensive physiotherapy and speech
therapy, yet some permanent disabilities are almost
certain.
 OCCUPATIONAL POISONS – METALS 10

• SUMMARY OF THE OTHERS

• Cadmium – in alloys, electroplating, alkaline batteries nuclear
reactors, orange paints; Systemic effects of poisoning but major on
kidneys and lungs, prostate ca,^BP, itai-itai dx; Rx CaEDTA.
• Beryllium: Cu alloys, lighting, nuclear Rx; grannulomas; EDTA
• Manganese: alloys, batteries, paints, anti-knock; lung & nerves; EDTA
• Chromium: Alloys & corrosion resistant steels; ENT, lungs incl ca.
• Zink, Nickel,Vanadium, Yellow phosphorus (of phossy jaw” fame,
Aluminium (pulmonary fibrosis), Antimony, Platinum, Silver & Tin
 OCCUPATIONAL POISONS – GASES 1

Occur in three classes:

• Simple asphyxiants – asphyxiate by simply being in
enough quantity as to reduce O2 pp below that which can
sustain respiration
• Chemical asphyxiants – asphyxiate by compound
formation with metabolically important protein.
• Irritants – the less soluble ones are the most troublesome
as they remain in the lungs to cause inflammation, etc
 OCCUPATIONAL POISONS – GASES 2

• SIMPLE ASPHYXIANTS
• Nitrogen: Chokedamp in mines, industrial manufacture of ammonia &
prevention of oxidation in metallurgical processes; blackdamp in
extinguishing miner’s lamp b4 (17.7% & >).
• Methane: Firedamp in mines. (Davey lamp in 1816 reduced this
danger). Wet working & good ventilation in the mines have taken care
of this.
• Carbon dioxide: Fizzy drink Coys, frezing mixtures, fire extinguisher ,
mines, fermenting vats, coke ovens, blast furnaces, agric silos, silage
pits; >3% dyspnoea; >10% coma; Solid Co2 produces slow-to-heal
ulcers.
 OCCUPATIONAL POISONS – GASES 3

• CHEMICAL ASPHYXIANTS.
• Carbon monoxide:Product of incomplete fuel combustion in vehicles
& industries; in mines as afterdamp; in industries as part of coal gas,
producer gas, water gas, blast furnace gas & coke oven gas;
Symptoms of giddiness, headache, weakness of the legs and then
unconsciousness.
• Forms carboxyhaemoglobin – cherry pink anoxia (no cyanosis) with
death if not Rxd in time. Prevention – use of respirators. Rx – 95%
O2+5% CO2 + warmth.
• Others: Nickel carbonyl; H2S (stink damp)in mines, also sewers –
inhibits cytochrome oxidase and the respiratory centre; Hydrogen
cyanide (HCN) – inhibit cytochrome oxidase; Arsine; Stiben &
Phosphine
 OCCUPATIONAL POISONS – GASES 4

• IRRITANT GASES
• Amonia: in fertilizer, refrigerant & anti-oxidant plants –
lung, conjunctival and skin irritation.
• Sulphur dioxide: in sulphur (incl H2SO4) food preservative
& fumigant industries – eye and lung mucus membrane
irritation.
• Nitrous fumes NO2 & NO2O4.; Phosgene (carbonyl
chloride); Fluorine
 OCCUPATIONAL POISONS – SOLVENTS 1
• BENZENE
• Uses & exposure: About the most versatile solvent and
starting point of most organic manuracturing processes.
Currently limited only to enclosed systems. Highly fat
solvent.
• Metabolism: Absorbed via lungs and skin; excretion via
lungs, very little in urine.
• Poisoning: Acute - euphoria, giddiness…death from resp.
failure; Chronic – anaemia, …leukaemia.
 OCCUPATIONAL POISONS – SULVENTS 2

• OTHERS.
• Xylene & Toluene (drowsiness …death; cardiac damage; aplastic
anaemia); Hexachlorobenzene (fungicidal dressings – cutaneous
porphyria); Nitro and amino derivatives of benzene (NB, DNB,TNT,
aniline, DNP, Dinitroortho cresol DNOC) – mostly blood related
poisonings;
• Halogenated hydrocarbons: DDT, Paraquat, organophosphates
• Methyl bromide
• Trichloroethylene – degreaser etc
• Carbon tetrachloride; vinyl chloride
 OCCUPATIONAL LUNG DISEASES 1.

Caused by inhalation of dusts, fumes, gases & vapours.

Major classes include
1 Obstructive airway diseases -asthmatic.
2. Granulomatous diseases – extrinsic allergic alveolitis
3. Chemical pneumonitis
4. The pneumoconiosis – fibrotic lung diseases
5. The others – B anthracis, cancers
 OCCUPATIONAL LUNG DISEASES 2

• Guide to screening, diagnosis & Rx:

• Some have significantly long latency periods, long
preclinical stages at which much can be done still, etc.
• Standard ILO X-rays and classifications.
• Lung function tests of volumes, capacities and diffusions.
• Volumes: tidal, inspiratory reserve, expiratory reserve &
residual; Capacities: functional residual, vital & total lung.
• Other indices: FEV1, FEV1/FVC ratio, RV/TLC ratio.
 OCCUPATIONAL LUNG DISEASES 3.

• OBSTRUCTIVE AIRWAY DISEASES

• Immediate asthma: reaginic (type 1) asthma occuring
predominantly in atopic people – wools, furs, feathers,
wheat grain, maize grain.
• Late (intermission) asthma – cotton (weavers cough),
gums, wood dusts, formalin, printers asthma (due to
different gums
• Byssinosis through grades C½, 1, 2 & 3.
• Others – Hard metal Dx, Isocyanates, chrome.
 OCCUPATIONAL LUNG DISEASES 4

• GRANULOMATOUS LUNG DISEASES

• Extrinsic allergic alveolitis – a type III mediated
hypersensitivity reaction to mostly fungal proteins –
farmers lungs, bagassosis, suberosis, bird fanciers disease,
malt workers disease,
• Thesaurosis (from natural or synthetic rasins) – hair
dressers, etc.
• Vineyard sprayers’ lung (cupper sulphate)
• Humidifier fever
• Beryllium disease
 OCCUPATIONAL LUNG DISEASES 5

• CHEMICAL PNEUMONITIS
• These are usually due to many toxic gases and fumes
which damage the respiratory epithelium and alveolar
capilaries; viz,
• The halogens
• Nitrous fumes
• Sulphur dioxide
• Phosgen (carbonyl chloride)
• Cadmium fumes
 OCCUPATIONAL LUNG DISEASES 6

• THE PNEUMOCONIOSIS – pneumo, lung; conious, dust

• Benign pneumoconiosis: siderosis, argyrosiderosis,
stannosis (Jos, Nigeria), baritosis (denser than stannosis),
etc
• Fibrotic pneumoconiosis: Silicosis and its association with
Tb; Asbestosis and the hyaline pleural plaques; Coal
workers pneumoconiosis including simple
pneumoconiosis, progressive massive fibrosis (PMF) and
Caplan’s syndrome
 OCCUPATIONAL LUNG DISEASES 7

• RESPIRATORY FUNCTION TESTS IN OLD

• Disease VC FVC FEV1 Gas Exchange
• Silicosis !! !
• Acute silicosis !! !! !!!
• Simple CWP ! ! !
• PMF !! !!
• Asbestosis !! !! !! !!
(FEV1:FVC greater then normal in asbestosis)
• Asthma ! !! !!
• Byssinosis !! (cont !! During wrk)
• Extrinsic AA !! !!
 OCCUPATIONAL DERMATITIS 1

• OD is one of the commonest OHDx in many caucasian

countries and aetiologically can be classified thus:
• Physical OD – due to heat, cold, electricity, sunlight or
radiation.
• Chemical OD – due to organic and inorganic agents.
• Mechanical OD – due to friction, pressures or trauma.
• Plant & plant product OD – due to rasins, lacquers,
• Other biological OD – infective agents (e.g., anthrax),
insects and mites.
By far chemical agents are the greatest culprits.
 OCCUPATIONAL DERMATITIS 2

• MECHANICAL FACTOR OCCUP. DERMATITIS

• Cuts and abrasions which may get infected
• Repeated trauma callosities – farmers, carpenters, painters,
cobblers, dress makers, floor sweepers, wood cutters.

• PHYSICAL FACTOR OCCUPATIONAL DERMATITIS

• Heat/perspiration softening of protective skin
• Heat/friction/perspiration – intertrigo, heat rash
• Cold – frostbite, chilblains, trench foot
• Electric or radiation burns, cancers.
 OCCCUPATIONAL DERMATITIS 3.

CHEMICAL DERMATITIS
• These are responsible for most of occupational dermatitis, the
chemicals acting either as primary irritants or sensitizers or both.
• Primary irritants: degreasing, dehydrating, denaturing proteins,
disturbing osmotic pressure of skin cells.
• Alkali are the most troublesome and the list enormous.
• Limited egs include: Inorganic alk – hydrates & carbonates of Na, K,
NH4, Ba Ca; Organic alk – ethanolamines, methylamines; Inorganic
acids – chromic,nitric, sulphuric, etc; Organic acids – acetic, carbolic,
lactic, salicylic; Elements & their salts – antimony, arsenic, chromium,
mercury, nickel, etc; Solvents – Petroleum, coal tar, chlorinated
hydrocarbons, turpentine, etc; Acne producers – Petroleun oils,
cutting oils, pitch, tar, paraphine, chloro----, etc
 OCCUPATIONAL DERMATITIS 4

• CHEMICAL DERMATITIS – SKIN SENSITIZERS

• Many chemicals do not irritate the skin but produce cell-mediated
hyper-sensitivity reaction – contact dermatitis. They pass the dermis
and react with a protein to form a hapten against antibodies are
formed.
• A formidable list; but some irritants are also sensitizers viz
bichromates, phenols & formaldehyde.
• Some principal sensitizers: Dye intermediates – aniline & cpds, nitro-
& chloro- cpds; Dyes – aniline, malachite green,etc; photo developers;
rubber accelerators & anti-oxidants; insecticides; oils; resins; coal tar
& prods; explosives; plasticizers; others
 OCCUPATIONAL DERMATITIS 5

• CHEMICAL DERMATITIS – CLINICAL ISSUES

• Note that sensitivity rashes may occur away from the area
in contact with the sensitizer – erythema, irritation,
vescicles, weeping, crusting; ulceration in some.
• Good occupational Hx very important in diagnosis,
including inquiry into like complaints by wrk colleagues.
• Then patch test minding it’s pit falls.
• Rx cessation of exposure or oil protection in mild cases
• Occupational acne by oils, pitch and tar; some chlorinated
hydrocarbons & mineral oils
 OCCUPATIONAL DERMATITIS 6

• PLANT & PLANT PRODUCTS DERMATITIS

• A formidable list but mostly of Anacardiaceae, Liliaceae &
Primulaceae plant groups.
• Affecting mostly farmers, gardeners, nurserymen & florists – e.g.,
tulip finger in farmers handling bulbs.
• Toxic wood dermatitis among carpenters, wood machinists, workers in
wood yards, cabinet makers, ship builders and furniture makers;
culprits being the saw dusts, the sap, the polishings or the oil of the
wood. Papulo-vescicular rash, cardiac symptoms, influenza-like,
asthmatic & facial & eye symptoms may all occur.
• Exhaust ventilation,, protective clothing & respirators can all help to
reduce exposure.
 OCCUPATIONAL DERMATITIS 7

• DERMATITIS BY OTHER BIOLOGICAL AGENTS

• Grain itch, barley itch, copra itch, grocers’ itch, by mites.
• Scabies in dirty camps; cattle mange (dairyman’s itch)
• Skin colour changes due to chromates (yellow) & TNT. Also picric
acid, silver nitrate, metol (photographers), pitch & tar; arsenic
• Vitiligo in p-tert-butylphenol (PTBP) – adhesive resin workers in the
car industry.
• Prevention in total avoidance, total enclosure of processes, protective
clothing (masks & goggles), personal cleanliness; barrier creams of 3
types – vanishing, water repellant (for acid & alkali) or oil & solvent
repellants.
 OCCUPATIONAL CANCERS 1

• 1st recognition of OCs was in 1775 by Percival Pott,

surgeon @ St Bartholomew’s Hospital in chimney sweeps.
• Features of earlier ages of onset, exposure to putative
agents & usually a long latency of exposure, 20 yrs & >
• Two major classes of chemical carcinogens – polycyclic
aromatic hydrocarbons & aromatic amines as carcinogens
or co-carcinogens.
• Skin Ca causes – sooth, pitch, tar, arsenic, mineral oils,
ultra-violate light (farmers), radiation.
• Prevention – protective clothing, good personal hygiene &
high level of watchfulness.
 OCCUPATIONAL CANCERS 2

• BLADDER CANCERS
• 1ST occupational bladder ca in Germany in 1895 in aniline
dye workers though not caused by aniline itself.
• Agents are b-naphthylamine, benzidine, dimethylbenzidine
(o-tolidine), dichlorobenzidine, xynylamine
• Prevention is by substitution or strict control – including
regular screening where no substitute can be found
• Other tumors of the renal pelvis, the ureters & the urethra
had been reported in men exposed to aromatic amines,
usually who had had bladder cancers
 OCCUPATIONAL CANCERS 3

• Liver cancers – benzidene, arsenical insecticides &

angiosarcoma due to VCM.
• Bronchial cancers – uranium, radium, radon (a-particles)
• Lung cancers – arsenic, (& nasal passages also for)
arsenic, wood dust & leather; chromates, asbestos and iron
ore miners due to radon
• Mesothelioma of the pleura and peritoneum esp. due to
crocidolite.
• Leukaemia from ionizing radiation, benzene, toluene,
xylene.
• Osteocarcinoma with radium (paints)
 OCCUPATIONAL CANCERS 4

• TESTING CHEMICALS FOR CARCINOGENICITY

• Is part of occupational toxicology.
• Ames test
• Animal tests
• Long term human monitoring
OCCUPATIONAL HEALTH IN AGRICULTURE 1

• Agriculture as all processes involved in food production

(plant and animal) from breeding to harvesting and
primary processing till it is passed on to the buyers for
consumption of industrial processing.
• Two broad classes of animal and plant farming or of
peasant (subsistence) and commercial agriculture.
• Health problems are based on the same approaches of
deriving from the 5 components of the work environment,
peasant and commercial and treated as such.
OCCUPATIONAL HEALTH IN AGRICULTURE 2

• Physical hazards: Effects of suns heat and UV light, noise from aging
tractors, planters and harvesters, from floods and lightening in the
open field.
• Psych-social hazards: Effects of isolation and physical home
separation in distant and migrant agriculture, low productivity and
relative poverty and deprivation from social amenities in distance
peasant agriculture; farmland and pastureland ownership conflicts.
• Mechanical hazards in knife, hoe, tractor accidents.
• Biological hazards in hookworm, other helminthiasis, dracontiasis,
schistosomiasis, snake bites, scorpion and other insect bites, snake
bites, finger tulips, other plant dermatitis and asthmas, bagassosis,
farmers lungs, brucellosis, bovine Tb, Leptospirosis, tetanus, anthrax,
OCCUPATIONAL HEALTH IN AGRICULTURE 3

• Chemical hazards: Due to fertilizers (nearly zero) and pesticides – as

herbicides, insecticides, rodenticides, etc.
• Three major groups of insecticides – organohalogens and
organophosphates and the others.
• Garamoxone as paraquat and weedol as paraquat and diquat are
herbicides commonly used in agriculture. Immediate mortal poisoning
with 15mls produce burning sensations of mouth, throat and stomach
followed by liver and kidney failure. Some may survive only to
deteriorate some 5 days later to pulmonary failure from massive
fibrosis and proloferative inflammation.
• Treatment & control from thorough legislation, education; gastric
lavage using adsorbents – fuller’s earth or bentonite.
OCCUPATIONAL HEALTH IN AGRICULTURE 4

• Halogenated hydrocarbons: BHC, DDT (diechloro-

diphenyl trichloroethane), dieldrin, aldrine, endrine, etc.
Effects on the nerves. Acute and chronic poisoning
especially the latter. Withdrawal and tranquilization in
acute; chronic hardly treatable. Other effects on the fauna
& flora.
• Organophosphates: Parathion, malathion, etc. Acute
poisoning mostly. Highly biodegradable. Cholinesterase
inhibitors with related symptoms – “Ijesha shakes”.
Withdrawal, atropinization and pralidoxime is
organophosphate proven as the cause.
OCCUPATIONAL HEALTH IN AGRICULTURE 5

• Carbamate insecticide: Organophosphate inhibition hence

much like them in presentation. However, pralidoxime is
not antidote and may worsen the disease if given. Hence
all organophosphat-like poisonings must be proven before
going beyond atropinization
 SOCIAL SERVICES IN THE INDUSTRY 1

• Toilet and cloakroom facilities and use. Requirements.

• Canteen and other eating services.
• Recreation and sporting facilities.
• Housing and schooling facilities; PMC extension to
family.
• Transportation facilities.
• Others – e.g., telephone, health and social insurance;
retirement benefits, workman compensation; employment
of disabled persons.
 SOCIAL SERVICES IN THE INDUSTRY 2

• Contribution of these to health and social well being of the workers.

• Firms up to a given size in some developed countries are required by
law to employ a certain percentage of their workforce – eg 3% in the
1970s in the UK. Jobs like lift operators, telephone operators, minor
clerical jobs.
• Also parastatals set up for the retraining and employment of these
workers – Disablement Resettlement Officer (DRO), Blind Persons’
Resettlement officer (BPRO). Also Employment Service Agency
(ESA) & Manpower Services Commission on the wither arena. Larger
firms may have their own rehabilitation centres and do similarly good
or even finer jobs.
 OCCUPATIONAL HEALTH & PHC 1.

• Though not listed in the essential minimum 8 component

services of PHC @ Alma-Ata, the definition of PHC
which talks about “health services to the people where
they live and WORK” already implies OHS as part of
PHC; as indeed is every aspects of Community health
must be covered if ever “health for all” is to be achieved.
• All the services of OHS are essentially promotive and
preventive, including primary medical care.
• Several countries have since included it as part of their
PHC – e.g., the Fiji Islands.
 OCCUPATIONAL HEALTH & PHC 2

• Training and orientation of PHC staff on OHS.

• Orientation of OHS staff on PHC.
• Health and Safety (or OH) Committees in the workplace
and their functions – examples.
• E.Gs. of morbidity patterns in OHS in Nigeria for
appreciation of its fitting with PHC; the healthy worker
effect – to maximize the benefits of occupational good
health.
 OH RECORDS, DISEASE NOTIFICATION 1

• OH records as an important function of an OHS and why.

• Routine sources of information include: workers case
notes, factory register of machines and their routine
maintenance checks as Fac. Laws require, routine factory
accident records, notified accident records,
routine/periodic medical exam records, routine
environmental hygiene records, routine occup. Dx
notification records, prescribed dx compensation records,
other workman compensation records, other routine
service records (pre- and post-leave, preretirement, etc).
• Records kept even after retirement
 OH RECORDS & DX NOTIFICATION 2

• Two notifiable industrial events – to the nearest factory

inspectorate:
• Accidents occasioning death or loss of working capacity of
a given duration (5 days in Nigeria). If accident is first
notified and the patient dies later, then the later should also
be separately notified.
• Designated occupational diseases.
• Examples of use of OH records in research – tracing
patients and contacts after they had left the job, in
determination of aetiology or factory defense in some
cases of compension.
 OCCUPATIONAL EPIDEMIOLOGY 1

• The meeting point of all epidemiological methodologies –

population and clinical epidemiology.
• Population Epidemiology. Clinical Epidemiology
• Incidence (Pr & Rt) Case reps & series
• Prevalence (Pt & Pd) Clinical Population reviews
• PMS, C-S AS, CCS, Prop Morbidity Studies
• HCS, PCS CCS
• Community trials RCTs & related
• Others: social, economic, screening & diagnostic tests,
correlation, etc.
 OCCUPATIONAL EPIDEMIOLOGY 2

• Special place of case reports, PMS, C-SAS & HCS.

• Important methodological issues
• Long latency periods
• The healthy worker effect.
• Threshold exposure
• Internal and external controls
• Importance of records
 PRE-EMPLOYMENT & PERIODIC MEDICAL
EXAMINATIONS 1

• P-EME: Objectives – to ascertain the general state of

health of prospective employees so that those who are ill
may be treated before employment, properly placed if with
a state incompatible with some jobs in the place and
determine those who would otherwise need disability
employment assistance.
• PPME: Objectives – to determine the baseline
physiological/health status of given organs in subjects
being employed in certain well known hazardous job so
they can more usefully be monitored thereafter; viz, as in
dusty jobs, noisy jobs, driving, etc.
 PRE-EMPLOYMENT & PERIODIC MEDICAL
EXAMINATIONS 2

• 1ST level in most well developed settings is done by the

OHN or medical assistant – covers socio-demographic
data, medical history, anthropometry, urinalysis, gross
cardiovascular and locomotive assessments.
• 2nd level by the company medical officer may be done only
for those recommended to be so needed by the OHN. It
will include more detailed organ systems examination as
well as X-ray.
• Pre-placement ME is done at this time only for people
going to work in known hazardous jobs. Discuss examples.
 OCCUPATIONAL HEALTH IN THE
PETROLEUM INDUSTRY 1

• 4 Sections of the petroleum industry need to be

considered:
prospecting, mining, refining and marketing.
• Same 4 components as sources of hazards, accidents and
disease need to be considered in each section.
• In prospection the important factors are psycho-social
from isolation, disposable cash problem; physical from
rough weather and drill noise and biological from wild life.
 OCCUPATIONAL HEALTH IN THE
PETROLEUM INDUSTRY 2

• In petroleum extraction & sea transport

• Exposure to all types of weather from the arctic to the
most tropical.
• The strenuous work of drilling: noise, fall from heights,
^accident rates, toxic gas and other fluids, skin irritation by
the chemicals.
• Explosives and radio-active substances used in some of the
industries, blow-outs explosions, also asphyxiation frm the
gases, anaesthetic effects, “sour crudes” (H2S) with rapid
knock down effects.
 OCCUPATIONAL HEALTH IN THE
PETROLEUM INDUSTRY 3

• Sea transport problems, mostly at loading

• Fire & explosions (precaution with smoking, working in
confined spaces, etc)
• H2S poisoning of sour gases
• Noise and vibration.
 OCCUPATIONAL HEALTH IN THE
PETROLEUM INDUSTRY 4

• Petroleum refining
• Processes range from cracking (viscosity breaking &
coking), alkylation, reforming, isomerization, hydro-
treating and lubricant processing
• Toxicity from respiratory and skin absorption especially in
confined spaces; skin irritation
• Fires and explosions.
• Others: vibration
 OCCUPATIONAL HEALTH IN THE
PETROLEUM INDUSTRY 5

• Marketing
• Loading with respiratory and skin exposure problems
• Fire and explosions always.
• Long distance drivers and disposable cash problem, RTAs
• ?sniffing fuels and other habits