British Journal ofIndustrial Medicine 1989;46:787-790
Prevalence of byssinosis in textile mills at Ahmedabad,
J R PARIKH, L J BHAGIA, P K MAJUMDAR, A R SHAH, S K KASHYAP
From the National Institute ofOccupational Health, Ahmedabad-380 016, India
workers were examined from the spinning departments. The mean prevalence of byssinosis in the
blow section was 29-62%, whereas in the card section it was 37-83%. The concentrations of cotton
dust (dust less fly) were high in the blow and card sections (4 00 mg/m3 in the blow and 3-06 mg/m3 in
the card section). This study suggests that the prevalence ofbyssinosis is not low in the textile mills of
India as reported in many earlier Indian studies.
In an epidemiological study carried out in three textile mills at Ahmedabad, India, 929
Byssinosis is an occupational lung disease often
observed among workers exposed to cotton, flax, and
hemp dust. The severity and extent ofthe problem are
well recognised in the developed countries and control
measures have been implemented to prevent the
disease. This is not true, however, for the developing
countries where the severity and extent ofthe problem
are not well studied and preventive measures are
virtually non-existent.' In India several studies on
byssinosis were undertaken in the past23 (and KC
Thiruvengadam in 1967 and JR Sen in 1968 at Indian
Council ofMedical Research, New Delhi). A review of
the earlier studies on byssinosis suggests a low
prevalence of the disease in most of the Indian textile
mills.3 Our study in one Ahmedabad textile mill,
however, showed a high prevalence of the disease,
especially in the blow and card sections of the mill.4
The study was extended to two other textile mills in
Ahmedabad. The overall findings ofthe study ofthree
textile mills are presented in the present paper.
Material and methods
Three textile mills were included in this study. These
mills, selected from different areas of Ahmedabad,
Gujarat State, India, were using a medium variety of
cotton as the raw material and manufactured only
cotton cloth. The ventilation was poor in the blow and
card sections of these mills. There was no exhaust
device over the carding machines.
At the beginning ofthe studywe tried to obtain a list
ofthe workers in the spinning department ofeach mill
to select a sample based on statistical methods, but
Accepted 16 January 1989
none of the managements could give us an exact
section list of the workers. Nevertheless, we could
(permanent and temporary) number of workers in
permanent, 30 temporary) in the second, and 300 (265
permanent, 35 temporary) in the third. The number of
permanent and temporary workers varied slightly on
each visit depending on the absence of permanent
workers. Since the temporary workers used to get
work (badli) for 15-20 days in a month, their exposure
was irregular. Therefore, it was decided to exclude
them from the study. Thus out of the permanent
workers we could examine 452 (94 17%) workers from
the first mill, 237 (91-15%) from the second, and 240
(90 57%) from the third. Overall, 929 (92.44%) per-
manent workers were examined out of 1005 workers.
From the four sections of spinning department, more
than 95% of the workers were examined from the
dusty sections (blow, card, and frame). Only in the
ringframe section was the coverage low.
A questionnaire specially designed on the basis of
Schilling's recommendations for the diagnosis of
byssinosis and the Medical Research Council (UK)
questionnaire on chronic bronchitis was used in the
study.' The interviews oftheworkers were arranged on
the first day ofthe week after a weekend break.
Pulmonary function tests were carried out on a
vitalograph spirometer. Forced vital capacity (FVC)
and forced expiratory volume in one second (FEV,)
were measured on the first day of the week after a
weekend break at the beginning ofthe shift and after a
minimum exposure of seven hours.
The airborne cotton dust samples were collected by
a cone sampler. A 2 mm x 2 mm of wire gauze was
mill. There were 530 (480 permanent,
first mill, 290 (260
attached to the face of the cone to prevent the "fly"
and thus concentration of cotton dust less fly was
The permanent workers in the spinning department
(blow, card, frame, and ring frame sections) were
examined in this study. Table 1 shows the depart-
mental distribution ofthe workers.
studied in three textile mills
Number ofworkers (exposed to cottondust)
Table 2 A summary ofstudies onprevalence ofbyssinosis in
Indian textile mills
Damodaran et al'
Raghavan et al'
Siddhu et a17
13 (Mill 2)
*At Indian Council of Medical Research in 1967.
tAt Indian Council ofMedical Research in 1968.
Parikh, Bhagia, Majumdar, Shah, Kashyap
The findings of earlier Indian studies on byssinosis
are summarised in table 2. The maximum prevalence
reported is 20% whereas the minimum is 0 99%.
Table 3 shows the departmental prevalence of
byssinosis. The highest prevalence of byssinosis is in
the card section (37 83%) whereas in the blow section
the mean prevalence is lower than the card section
(29'62%). In the frame section the prevalence is still
lower (5 75%), and in the ringframe section it is
negligible (0 65%).
Table 4 shows
different respiratory symptoms of byssinotic subjects.
Monday-that is, on the first day of the week after a
weekend break-are found in a higher percentage of
byssinosis from other respiratory diseases.
Table 5 shows the distribution ofbyssinotic subjects
in different exposure groups. The maximum number
of cases are observed in exposure groups 16-20 years
and 21-25 years but in the subsequent exposure
groups-that is, 25-30 and more than 30 years-the
number of cases of byssinosis decline despite the
longer duration of exposure.
The grade analysis of byssinotic subjects shows the
maximum number in grade 2 (table 6). No case is
observed in grade 1/2.
Table 7 shows the relation ofsmoking to byssinosis,
although the percentage of byssinotic workers is
higher among the smokers, the chi-squared test is non-
significant at the 0 05 level.
Table 8 shows the mean change in FEV, during the
shift in the byssinotic and control workers. No control
group was studied in millNo 3 as ithad only a spinning
department. The mean FEV,
byssinotic workers is 0-25 1.
Table 9 shows the time weighted averages of dust
concentrations (dust less fly). The dust concentrations
are high in the blow and card sections (4.00 mg/m3 in
the blow, 3 06 mg/m3 in the card section).
decline among 59
Departmentalprevalence ofbyssinosis in three textile mills at Ahmedabad
Prevalence ofbyssinosis in textile mills at Ahmedabad, India
Frequency distribution ofdifferentrespiratory symptoms in byssinotic subjects ofthe three mills. (Figures in
parentheses indicate percentage)
14 (60 8)
Distribution ofbyssinotic cases according to the duration ofexposure
Exposure group (y)
No ofbyssinotic cases
Gradewise analysis ofbyssinotic subjects
No ofbyssinotic subjects
Relation ofsmoking to byssinosis
Chi-squared test = Non-significant at 0-05 level.
andcontrol workers. (Figures inparentheses indicate number
Mean change in FEV, during the shift in byssinotic
Meandifferencein FEV, (l) during shift
-0 29 (21)
-0 18 (17)
+0 01 (91)
mg/in3) in the different departments ofthree textile mills
Mean cotton dust concentrations (dustlessfly
In India several researchers have studied the problem
ofbyssinosis. Their findings are summarised in table 2.
These studies suggest a low prevalence ofbyssinosis in
most of the mills. These observations are surprising
because the textile industry had existed formore than a
century in India with old machinery and without any
dust control devices. By contrast with these findings,
researchers in other countries have observed a high
prevalence ofthe disease. For instance, El Batawi et al
observed a prevalence of27% in card rooms8 whereas
Molyneux and Tombleson found a prevalence of24%
in blow rooms and 36-8% in card rooms.9 Our present
study of three Ahmedabad textile mills shows a mean
prevalence of29-62% in the blow section and 37-83%
in the card section. Thus our observations are almost
similar to the observations ofEl Batawi and Molyneux
and Tombleson.59 Since our observations are on a
survivor population, the actual prevalence may be
higher than reported here. We think that the lower
prevalence reported earlier by other researchers in
India was largely due to confusion of clinical signs of
byssinosis such as the occurrence ofchest tightness or
breathlessness, or both, on the first day of the week.
We have observed that chest tightness and breathless-
ness are present on the first day of the week in most
byssinotic workers (table 5) and therefore they are
cardinal symptoms of byssinosis. To elucidate these
signs, however, special care is required by the inter-
viewer. We recommend that the interview ofthe textile
workers should be arranged only on the first day ofthe
week after an exposure of five to seven hours. In our
experience if the interview is arranged on the other
days of the week, most workers fail to report the
Monday chest tightness and breathlessness. This
might be the reason for the lower prevalence reported
in many earlier Indian studies.
The findings of this study refer only to the textile
mills using amedium variety ofcotton. The prevalence
of byssinosis might be more in mills using coarse
cotton as reported by Roach and Schilling'° and
Molyneux et al.9 An epidemiological study is required
to support this view, however.
Generally, with longer duration of exposure, the
prevalence of byssinosis increases." In the present
study, however, the prevalence has increased up to 25
years of exposure (table 5) but thereafter it declines,
probably because some of the byssinotic workers
prematurely retire owing to respiratory disability.
In our study we have not seen any case of grade 1/2
occasional in grade 1/2, the workers may not notice it
carefully or neglect it as it is mild in nature.
There is some evidence that byssinotic symptoms
are more prevalent among smokers compared with
non-smokers."-'3 We also observed a higher percen-
tage of byssinotic workers among smokers (6.96%
among smokers and 5-37% among non-smokers).
Statistically, however, our results are non-significant
(table 7). This observation is similar to the observation
of Khogali 4 and Mohamed et al'5 and suggests that
the cotton dust has a more powerful independent
effect than smoking.
Zuskin and Valic described a mean decline inFEV,
of 250 ml and 245 ml in two groups of byssinotic
workers.'6 Although the individual observation of
mean decline in FEV, during the shift of each mill
varies to some extent from their observation (table 8),
the overall decline in mean FEV, (249 ml) agrees with
The concentrations of dust less fly were high in all
three mills (table 9) compared with the recommenda-
tions of 0 5 mg/m3 by the British Occupational
Hygiene Society.'7 The time weighted averages were
much higher in the blow section compared with the
card section, whereas the mean prevalence was lower
in the blow section than the card section (table 3). This
may be due to frequent movement of workers away
from the blowing machine where dust is generated
whereas in the card section the machines are placed
Parikh, Bhagia, Majumdar, Shah, Kashyap
close to each other and the workers generally work
near the carding machines most of the time.
In summary, this study has confirmed that the
prevalence of byssinosis in the blow and card sections
oftextile mills usingmedium variety ofcotton is not as
low as reported in many earlier Indian studies and the
cotton dust concentrations are high in the blow and
card sections oftextile mills and need urgent reduction
to prevent further incidence of byssinosis.
We are grateful to the management of all three mills
who provided the facilities to conduct this study and
also the workers whose cooperation made this study
possible. We acknowledge the help of our technical
staff especially Mr M D Patel, Mr Mukesh Vakharia,
and Mr H M Patel who have worked throughout the
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