UG MBBS students occupational health part 2 which covers lead poisoning, occu. dermatitis, occu. cancers, accidents, radiation hazards, agricultural hazards, sickness absenteeism and health problems of industrialization

1. Occupational Health-II
Dr Mamta G

2. Lead poisoning/Plumbism
• Lead is used in variety of industries
• More industrial workers are exposed to lead
• All lead compounds are toxic - lead arsenate, lead oxide and lead carbonate
are the most dangerous; lead sulphide is the least toxic.
• INDUSTRIAL USES :
storage batteries; glass manufacture; ship building; printing and potteries; rubber
industry etc.
• NON-OCCUPATIONAL SOURCES :
gasoline- lead exhausted from automobiles.
lead exposure -through drinking water from lead pipes; chewing lead paint on
window sills or toys in children.

4. MODE OF ABSORPTION
(1) INHALATION : fumes and dust of lead
(2) INGESTION : less common
• lead trapped in the upper respiratory tract
• ingested in food or drink through contaminated hands
(3) SKIN : organic compounds of lead, especially tetraethyl lead
BODY STORES : The body store of lead is 150 to 400 mg and blood levels average
about 25µg/100 ml.
An increase to 70µg/100 ml blood -clinical symptoms.

5. DISTRIBUTION IN THE BODY
• Ninety percent of the ingested lead is excreted in the faeces.
• Lead absorbed from the gut enters the circulation and enters RBCs.
• It is then transported to the liver and kidneys and finally transported to
the bones
• It may be released to the soft tissues again by bone resorption
• Gets involved in porphyrin synthesis and carbohydrate metabolism.
• Effect on membrane permeability and potassium leakage from RBCs

6. CLINICAL PICTURE :
• Inorganic lead exposure
Abdominal colic, obstinate constipation, loss of appetite, blue-line on
the gums, stippling of red cells, anaemia, wrist drop and foot drop
• Organic lead compounds
CNS symptoms- insomnia, headache , mental confusion, delirium

7. RBC Stippling and Anemia

8. DIAGNOSIS
( 1) HISTORY : a history of lead exposure
(2) CLINICAL FEATURES : such as loss of appetite, intestinal colic, persistent headache ,
weakness, abdominal cramps and constipation, joint and muscular pains, blue line on
gums, anaemia, etc.
(3) LABORATORY TESTS :
(a) Coproporphyrin in urine (CPU) : Measurement of CPU is a useful screening test. In
non-exposed persons, it is less than 150 microgram/litre.
(b) Amino levulinic acid in urine (ALAU) : If it exceeds 5 mg/ litre, it indicates clearly lead
absorption.
(c) Lead in blood and urine : requires refined laboratory techniques.
Lead in urine of over 0.8 mg/litre (normal is 0.2 to 0.8 mg) indicates lead exposure and
lead absorption. A blood level of 70µg/100 ml is associated with clinical symptoms.
(d) Basophilic stippling of RBC : Is a sensitive parameter of the haematological response.

9. PREVENTIVE MEASURES…
(1) Substitution : by less toxic materials.
(2) Isolation : processes giving rise to lead dust or fumes - enclosed and
segregated.
(3) Local exhaust ventilation: to remove fumes and dust promptly
(4) Personal protection : by approved respirators.
(5) Good house-keeping : where lead dust is present- Floors, benches, machines
should be kept clean by wet sweeping.
(6) Working atmosphere : Lead concentration to be kept below 2.0 mg per
10 cu. metres of air (the permissible limit or threshold value).

10. …PREVENTIVE MEASURES
(7) Periodic examination of workers
Laboratory determination of urinary lead, blood lead, red cell count,
haemoglobin estimation and coproporphyrin test of urine should be done
periodically. Estimation of basophilic stippling may also be done .
An Expert Committee of the WHO states that in the case of exposure to lead, it
is not only the average level of lead in the blood that is important, but also the
number of subjects whose blood level exceeds a certain value (e .g., 70µg/ml or
whose ALA in the urine exceeds 10 mg/litre)
(8) Personal hygiene : Handwashing before eating –need washing facilities in
industry. Prohibition on taking food in work places is essential.
(9) Health education : on the risks involved and personal protection measures.

11. Periodic health examination

12. MANAGEMENT :
The major objectives in management of lead poisoning
prevention of further absorption
removal of lead from soft tissues
prevention of recurrence
Early recognition of cases will help in removing them from further exposure.
A saline purge will remove unabsorbed lead from the gut.
The use of d-penicillamine has been reported to be effective. Like Ca- EDTA,
it is a chelating agent and works by promoting lead excretion in urine.
Lead poisoning is a notifiable and compensatable disease in India since 1924

13. Occupational cancer
1. Skin cancer
• Cancer of the scrotum and of the skin in other parts of the body was caused
by coal tar, X-rays, certain oils and dyes.
• 75 per cent of occupational cancers are skin cancer.
• A hazard among gas workers, coke oven workers, tar distillers, oil refiners,
dye-stuff makers, road makers and in industries using mineral oil, pitch, tar.

14. Chimney sweep's cancer, also called soot wart, is a squamous cell
carcinoma of the skin of the scrotum. It has the distinction of being the first
reported form of occupational cancer.

15. 2 . Lung cancer
• Lung cancer is a hazard in gas industry, asbestos industry, nickel and
chromium work, arsenic roasting plants and in the mining of radio-active
substances (e.g., uranium).
• Nickel, chromates, asbestos, coal tar (presumably 3-4 benzpyrene), radio-
active substances and cigarette-smoking are proved carcinogens for the
lungs.
• Arsenic, beryllium and isopropyl oil are suspected carcinogens.
• 19 out of 20 lung cancers are attributed to tobacco smoking, air pollution
and occupational exposure.

16. LUNG CANCER

17. 3. Cancer bladder
• Cancer bladder is caused by aromatic amines, which are metabolized in the
body and excreted in the urine.
• The industries associated with cancer bladder are the dye-stuffs and dyeing
industry, rubber, gas and the electric cable industries.
• The following have been mentioned as possible bladder carcinogens
: Beta-naphthylamines, benzidine, para-amino-diphenyl, auramine and magenta

18. Cancer
Bladder

19. 4 . Leukaemia
• Exposure to benzol, roentgen rays and radio-active substances give rise to
leukaemia.
• Benzol is a dangerous chemical and is used as a solvent in many industries.
• Leukaemia may appear long after exposure has ceased.

20. Characteristics of occupational cancer
(1) They appear after prolonged exposure
(2) The period between exposure and development of the disease may be as
long as 10 to 25 years
(3) The disease may develop even after the cessation of exposure
(4) The average age of incidence is earlier than that for cancer in general
(5) The localization of the tumours is remarkably constant in any one
occupation
Personal hygiene is very important in the prevention of occupational cancer.

21. Control of industrial cancer
The control measures comprise the following
(1) elimination or control of industrial carcinogens: exclusion of the carcinogen
from the industry, well-designed building or machinery, closed system of
production, etc.,
(2) medical examinations,
(3) inspection of factories,
(4) notification,
(5) licensing of establishments,
(6) personal hygiene measures,
(7) education of workers and management, and
(8) research

22. Break
Check out
these apps by
ILO

23. Occupational dermatitis
The causes may be
 Physical - heat, cold, moisture, friction, pressure, X-rays and other rays
 Chemical - acids, alkalies, dyes, solvents, grease, tar, pitch, chlorinated phenols etc.
 Biological - living agents such as viruses, bacteria, fungi and other parasites
 Plant products - leaves, vegetables, fruits, flowers, vegetable dust, etc.
The dermatitis-producing agents are further classified into :
(1) primary irritants e.g. acids, alkalies, dyes, solvents, etc. cause dermatitis in workers
exposed in sufficient concentration and for a long enough period of time.
(2) sensitizing substances-due to sensitization of the skin (allergic).

24. PREVENTION
(1) Pre-selection : The workers should be medically examined before
employment and those with predisposition to skin disease should be kept away
from jobs involving a skin hazard.
(2) Protection : against direct contact by protective clothing, long leather gloves,
aprons and boots. The protective clothing should be frequently washed and kept
in good order. There are also barrier creams which must be used regularly and
correctly.
(3) Personal hygiene : There should be available a plentiful supply of warm water,
soap and towels. The worker should be encouraged and educated to make
frequent use of these facilities.
(4) Periodic inspection : There should be a periodic medical check-up of all
workers for early detection and treatment of occupational dermatitis. Health
education must be given.

25. Radiation hazards
• A number of industries use radium and other radio-active substances, e.g., painting of
luminous dials for watches and other instruments, manufacture of radio-active paints,
mining of radio-active ores, monozite sand workers and handling of their products.
• X-rays are used both in medicine and industry.
• Exposure to ultraviolet rays occurs in welding processes.
• Infrared rays are produced in welding, glass blowing, foundry work and other processes
where metal and glass are heated to the molten state, and in heating and drying of painted
and lacquered objects.

26. Effects of radiation-
Acute exposure - burns, dermatitis and blood dyscrasias
Chronic exposure - malignancies and genetic effects.
Lung cancer may develop in miners working in uranium mines due to inhalation of radio-active dust.
Preventive measures
(1) Inhalation, swallowing or direct contact with the skin should be avoided.
(2) In case of X-rays, shielding should be used to reduce the exposure below allowable exposures.
(3) The employees should be monitored at intervals by use of film badge or pocket electrometer devices.
(4) Suitable protective clothing to prevent contact with harmful material should be used.
(5) Adequate ventilation of work-place is necessary to prevent inhalation of harmful gases and dusts.
(6) Replacement and periodic examination of workers should be done every 2 months. If harmful effects
are found, the employees should be transferred to work not involving exposure to radiation, and
(7) Pregnant women should not be allowed to work in places where there is continuous exposure.

29. Occupational Hazards- Agriculture
• Occupational health in agriculture sector is a new concept.
• Agricultural workers have a multitude of health problems - a fact which is often forgotten
The health problems of workers in agriculture may be enumerated as below-
(1) ZOONOTIC DISEASES : The close contact of the agricultural worker with animals or their
products -brucellosis, anthrax, leptospirosis, tetanus, tuberculosis (bovine) and Q fever.
(2) ACCIDENTS : Agricultural accidents are becoming more frequent as a result of the
increasing use of agricultural machinery.
-Insect and snake bites are an additional health problem in India.

30. Anthrax
in cattle
Pesticide spray in field
Farmer’s
Lung

31. (3) TOXIC HAZARDS : Chemicals are being used increasingly in agriculture either as fertilizers,
insecticides or pesticides. Agricultural workers are exposed to toxic hazards from these
chemicals.
Associated factors such as malnutrition and parasitic infestation may increase susceptibility to
poisoning at relatively low levels of exposure.
(4) PHYSICAL HAZARDS : The agricultural worker may be exposed to extremes of climatic
conditions such as temperature, humidity, solar radiation, which may impose additional
stresses upon him.
-He may also have to tolerate excessive noise and vibrations, inadequate ventilation and the
necessity of working in uncomfortable positions for long periods of time.
(5) RESPIRATORY DISEASES : Exposure to dusts of grains, rice husks, coconut fibres, tea,
tobacco, cotton, hay and wood are common where these products are grown.
The resulting diseases - e .g., byssinosis, bagassosis, farmer's lung and occupational asthma,
appear to be widespread

33. Accidents…
• Some industries are known for accidents, e.G., Coal and other mining industries, quarries, construction work.
• Nearly 3 million mandays are lost yearly in india because of accidents.
• To the worker, the loss is in terms of his wages, apart from human suffering;
• To the industry, it is in terms of compensation costs, provision of medical care, lowered morale , lowered
production and damage to machinery and goods; to the nation in terms of lost production.
CAUSES
(a) HUMAN FACTORS : responsible for 85 % of all accidents
(1) PHYSICAL : The physical capabilities of the worker eg his visual acuity; his hearing may be inadequate.
(2) PHYSIOLOGICAL FACTORS :
(a) Sex : less accidents in women : men = 5:24
(b) Age: Younger ages and the very old again are more prone
(c) Time: minimum at the beginning of the day and increase gradually as fatigue sets in.
(d) Experience : Approx. 75 % of the employees had accidents in their first 1 year of work.
(e) Working hours : increase whenever the working hours increase.

35. (3) PSYCHOLOGICAL : carelessness, inattentiveness, overconfidence, slow cerebration, ignorance,
inexperience, emotional stress and accident proneness. Psychological factors appear to be more
important factors than physiological factors.
(b) ENVIRONMENTAL FACTORS :temperature, poor illumination, humidity, noise and unsafe
machines. Unsafe machines account for 10- 20 per cent of all accidents.
Prevention: 98 % of the accidents are preventable
(1) adequate preplacement examination.
(2) adequate job training.
(3) continuing education.
(4) ensuring safe working environment.
(5) establishing a safety department under a competent safety engineer.
(6) periodic surveys for finding out hazards.
(7) careful reporting, maintenance of records and publicity.
…Accidents

36. Sickness absenteeism
Sickness absence is an important health problem in industry.
It may seriously impede production with serious cost repercussions, both
direct as well as indirect.
Absenteeism is a useful index in industry to assess the state of health of
workers, and their physical, mental and social well-being.
The rate of absenteeism was reported to be 8 to 10 days per head per year.

37. Causes of Sickness absenteeism
(a) Economic causes : if the worker is entitled to sick leave with pay, he tends to avail of this
privilege by reporting sick.
(b) Social causes : These are the social and family obligations such as weddings, festivals,
repair and maintenance of ancestral house and similar other causes. Some of the workers who
come from rural areas go back to their villages, for short or long periods, during sowing and
harvest seasons.
{c) Medical causes : About 10 per cent of the days lost were found to be due to occupational
accidents. Respiratory and alimentary illnesses have also been found to be important causes.
(d) Non-occupational causes : nutritional disorders, alcoholism and drug addiction
PREVENTION: for better utilization of resources and maximising the production.
(1) good factory management and practices
(2) adequate preplacement examination
(3) good human relations and
(4) application of ergonomics.

38. Health problems-industrialization
Industrialization = a social and economic revolution in the culture of a nation

39. Community health problems of industrialization
(1) ENVIRONMENTAL SANITATION PROBLEMS
(a) HOUSING : slums and insanitary dwellings due to migration of people from the
country-side for employment.
(b) WATER POLLUTION : discharge of industrial wastes without treatment, into water
courses. Pollution control measures should be instituted in the planning stage itself in
the process of industrialization.
(c) AIR POLLUTION : discharge of toxic fumes, gases, smoke and dusts into the
atmosphere. It requires proper town planning and zoning to eliminate this hazard.
(d) SEWAGE DISPOSAL : Lack of facilities for the disposal of sewage leads to pollution of
water supply, contamination of soil with parasites and their ova.

40. Asia’s biggest slum: Dharavi, Mumbai
POPULATION = 1 million
1 toilet for every 1,440 people
4,000 cases of typhoid a day
In movies: Slumdog and Gullyboy

41. (2) COMMUNICABLE DISEASES : tuberculosis, venereal diseases, and food and water borne
infections and mosquito borne diseases
(3) FOOD SANITATION : typhoid fever and viral hepatitis
(4) MENTAL HEALTH : Failure of adjustment leads to mental illness, psychoneurosis, behaviour
disorders, delinquency. etc.
(5) ACCIDENTS : congestion, vehicular traffic and the increased tempo of life in addition to those
that occur in the factories.
(6) SOCIAL PROBLEMS : Alcoholism, drug addiction, gambling, prostitution, increased divorces,
breaking up of home, juvenile delinquency, higher incidence of crime
(7) MORBIDITY AND MORTALITY : high morbidity and mortality from certain diseases.
For example the incidence of chronic bronchitis and lung cancer is higher in industrialized areas
than in rural areas.
The crude death rate and infant mortality rate tend to be high in industrial areas.
because the level of public health is generally low, the average expectation of life is less than that
in industrially advanced countries.

42. • End of class 2 of Occupational Health.
• End of class questions: 2 marks each
1Q. Clinical features and diagnosis of Lead poisoning.
2Q. Common types of occupational cancers.
3Q. Occupational hazards in agricultural workers.