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Hunter’s Diseases of
Occupations
Tenth edition

Peter J Baxter, Tar-Ching Aw,

Anne Cockcroft, Paul Durrington and
J Malcolm Harrington
First published in Great Britain in 1955 as Diseases of Occupations by
Edward Arnold Publishers
Sixth edition 1978
Seventh edition 1987
Eighth edition 1994
Ninth edition 2000
This tenth edition published in 2010 by Hodder Arnold, an imprint of
Hodder Education, an Hachette UK Company,
338 Euston Road, London NW1 3BH

http://www.hodderarnold.com

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Dedication

Donald Hunter CBE MD FRCP

1898–1978

Physician, The London Hospital

Senior Censor, Royal College of Physicians of London
Director, MRC Department of Research in Industrial Medicine
Founder Editor, British Journal of Industrial Medicine
Author, Diseases of Occupations
This page intentionally left blank
Contents

Contributors xiii

Preface xvii

List of abbreviations used xix

PART ONE – GENERAL CONSIDERATIONS 1

Section One: History and Development of Occupational Medicine 3

1 Donald Hunter and the history of occupational health: precedents and perspectives 5
Joseph Melling and Tim Carter
2 The changing face of occupational diseases 24
Peter J Baxter, Tar-Ching Aw, Anne Cockcroft, Paul Durrington and J Malcolm Harrington

Section Two: Diagnosis of Occupational Disease 31

3 The occupational history 33
Tar-Ching Aw
4 Occupational exposure to hazardous substances 43
John W Cherrie and Sean Semple
5 Biological monitoring 56
John Cocker and Howard J Mason

Section Three: Extent and Attribution of Occupational Disease 75

6 Epidemiological methods and evidence-based occupational medicine 77
David Coggon
7 Attribution of disease 89
Anthony Newman Taylor and David Coggon
8 Compensation schemes 96
Anthony Newman Taylor and David Walters

Section Four: Legal Issues 111

9 Medicolegal reports and the role of the expert witness 113
Diana M Kloss

PART TWO – DISEASES ASSOCIATED WITH CHEMICAL AGENTS 123

Section One: Occupational Toxicology 125

10 Occupational toxicology: general principles 127
Peter G Blain and Robert D Jefferson
11 Risks and hazards in occupational and environmental exposures 141
Robert L Maynard
viii Contents

Section Two: Metals 149

12 Introduction 151
Tar-Ching Aw
13 Aluminium 153
Perrine Hoet
14 Antimony 159
Malcolm R Sim
15 Arsenic 160
Malcolm R Sim
16 Beryllium 162
Lee S Newman and Holly M Christensen
17 Cadmium 167
Perrine Hoet
18 Chromium 173
Tom Sorahan
19 Cobalt 175
Perrine Hoet
20 Copper 180
Peter Aggett
21 Gold 183
Peter Linnett
22 Iron 185
Peter Aggett
23 Lead 188
Peter J Baxter and Hideki Igisu
24 Magnesium 199
Peter Aggett
25 Manganese 201
Grant McMillan and Finlay D Dick
26 Mercury 214
Peter J Baxter and Hideki Igisu
27 Molybdenum 221
Malcolm R Sim
28 Nickel 223
Tom Sorahan
29 Phosphorus 225
Malcolm R Sim
30 Platinum group metals 226
Peter Linnett
31 Polonium 231
Iain Blair
32 Silver 234
Peter Linnett
33 Thallium 236
Hideki Igisu and Tar-Ching Aw
34 Tin 238
Tar-Ching Aw and Hideki Igisu
35 Tungsten 241
Perrine Hoet
36 Uranium 243
Iain Blair
37 Vanadium 246
Finlay D Dick
38 Zinc 249
Peter Aggett
 Contents ix

Section Three: Gases 251

39 Gases 253
Peter J Baxter
40 Reactive airways dysfunction syndrome and irritant-induced asthma 310
Jon G Ayres
41 Deliberate use of chemicals in warfare and by terrorists 314
Robert L Maynard

Section Four: Other Chemical Exposures 319

42 Organic chemicals 321
Tiina Santonen, Antero Aitio and Harri Vainio
43 Pesticides and other agrochemicals 395
Ian Brown, Annalisa Chiodini, Chiara Somaruga and Claudio Colosio
44 Welding 421
Grant McMillan
45 The semiconductor industry 444
David Koh and Judy Sng

PART THREE – DISEASES ASSOCIATED WITH PHYSICAL AGENTS 455

Section One: Noise 457

46 Sound, noise and the ear 459
Richard T Ramsden and Shakeel R Saeed

Section Two: Vibration 487

47 Hand–arm vibration syndrome 489
Ian J Lawson, Frank Burke, Kenneth L McGeoch,
Tohr Nilsson and George Proud
48 Whole body vibration 513
Massimo Bovenzi and Keith Palmer

Section Three: Heat and Cold 523

49 Heat and cold 525
E Howard N Oakley

Section Four: Barometric Pressure 545

50 Diving and work at increased pressure 547
Stephen Watt and Andrew Colvin
51 Working at high altitude 570
Peter JG Forster
52 Flying and spaceflight 591
Mike Gibson, David Gradwell and Alyson Calder

Section Five: Radiation 621

53 Ionizing radiations 623
Chris Sharp and Fred A Mettler Jr
54 Non-ionizing radiation and the eye 644
Michael E Boulton and David H Sliney
55 Extremely low frequency electric and magnetic fields 663
Leeka Kheifets and Gabor Mezei
56 Radiofrequency fields 675
Gabor Mezei and Leeka Kheifets
x Contents

PART FOUR – DISEASES RELATED TO ERGONOMIC AND MECHANICAL FACTORS 683

Section One: The Musculoskeletal System 685

57 Repeated movements and repeated trauma affecting the musculoskeletal system 687
Cyrus Cooper and Keith Palmer

Section Two: Back and Spinal Pain 713

58 Occupational back pain 715
Jos H Verbeek and Frederieke Schaafsma

PART FIVE – OCCUPATION AND TRANSMISSIBLE DISEASES 725

Section One: Occupational Infections 727

59 Occupational infections 729
Julia Heptonstall and Anne Cockcroft
60 Zoonoses 750
Alastair Miller and Julia Heptonstall

Section Two: Bioterrorism and Biotechnology 771

61 Bioterrorism 773
Julia Heptonstall
62 Genetic modification and biotechnology 782
David Roomes

PART SIX – WORK AND MENTAL HEALTH 799

Section One: Work and Stress 801

63 Introduction to work and stress 803
Peter Baxter, Tar-Ching Aw and Anne Cockcroft
64 Work, stress and sickness absence: a psychosocial perspective 804
Maurice Lipsedge and Michael Calnan
65 Mental health at work: psychological interventions 823
Adrian Neal

Section Two: Work and Psychiatric Disorder 831

66 Work and psychiatric disorder: an evidence-based approach 833
Nick Glozier, Max Henderson, Neil Greenberg and Simon Øverland

Section Three: Substance Abuse 857

67 Substance abuse and the workplace 859
Jonathan D Chick

PART SEVEN – RESPIRATORY DISORDERS 871

Section One: General Issues 873

68 Imaging in occupational lung disease 875
Paul M Taylor
69 Work and chronic air flow limitation 889
David J Hendrick
70 Health effects of ultrafine/nanoparticles 903
Ken Donaldson, Robert J Aitken, Jon G Ayres, Brian G Miller and C Lang Tran
71 Health effects related to non-industrial workplace indoor environments 921
Jouni JK Jaakkola and Maritta S Jaakkola
 Contents xi

Section Two: Organic Dust Diseases 939

72 Occupational asthma 941
Paul Cullinan and Anthony Newman Taylor
73 Byssinosis and other cotton-related diseases 958
CAC Pickering and Robert Niven
74 Extrinsic allergic alveolitis 970
Paul Cullinan and Anthony Newman Taylor

Section Three: Inorganic Dust Diseases 983

75 Inorganic dusts: general aspects 985
Anne Cockcroft
76 Asbestos and asbestos-related diseases 990
David Weill and Anne Cockcroft
77 Epidemiology of asbestos-related diseases 1000
Robin M Rudd
78 Other fibrous mineral dusts 1011
Anne Cockcroft
79 Silica and silica-related diseases 1014
Anne Cockcroft
80 Epidemiology of silica-related disease 1021
Kyle Steenland
81 Other non-fibrous mineral dusts 1029
Anne Cockcroft
82 Metal dusts and fumes 1040
Benoit Nemery
83 Berylliosis 1050
Holly M Christensen and Lee S Newman

PART EIGHT – OTHER EFFECTS OF WORKPLACE EXPOSURES 1057

Section One: Occupational Diseases of the Skin 1059

84 Occupational diseases of the skin 1061
John English and Jason Williams

Section Two: Occupational Cancers 1079

85 Occupational cancer: epidemiology, biological mechanisms and biomarkers 1081
Manolis Kogevinas, J Malcolm Harrington and Roel Vermeulen

Section Three: Other Systemic Effects 1123

86 Nephrotoxic effects of workplace exposures 1125
Rema Saxena, Pearl Pai and Gordon M Bell
87 Neurotoxic effects of workplace exposures 1151
Michael J Aminoff and Marcello Lotti
88 Hepatotoxic effects of workplace exposure 1171
Thomas W Warnes and Alexander Smith
89 Workplace exposures and reproductive health 1196
Jens Peter Bonde
90 Haemopoietic effects of workplace exposures: anaemias, leukaemias and lymphomas 1215
Edward Gordon-Smith, Anthony Yardley-Jones and Atherton Gray
xii Contents

Section Four: Shift Work 1231

91 Shift work and extended hours of work 1233
Giovanni Costa, Simon Folkard and J Malcolm Harrington

Index 1247

WEBSITE

This book has a companion website available at: www.hodderplus.com/hunters.

The website’s features include:
● over 350 images from the tenth edition, including some in full colour
● Donald Hunter’s original introductory chapters from the early editions of the book
● a selection of over 350 photographs from Donald Hunter’s personal collection – a resource unique to this
publication.
To access this content, please register on the website using the following details:
Serial number: 15gh698ert21
Contributors

Peter Aggett OBE MSc FRCP Massimo Bovenzi MD

Honorary Professor, School of Medicine and Health, Director and Professor of Occupational Medicine, Clinical
Lancaster University, Lancaster, UK Unit of Occupational Medicine, Department of Reproductive,
Antero Aitio MD PhD Developmental and Public Health Sciences, University of Trieste,
Professor HC, Team Leader (retired), Finnish Institute of Trieste, Italy
Occupational Health, Helsinki, Finland Ian Brown OBE BSc FRCP FFOM DDAM
Rob J Aitken BA BSc(hons) PhD FiON Consultant Physician in Occupational Medicine and Toxicology,
Director of Safenano, Institute of Occupational Medicine, Director of Occupational Health, University of Oxford, Honorary
Edinburgh, UK Consultant Physician to the Oxfordshire Primary Care Trust
Division of Public Health, Oxford, UK
Michael J Aminoff MD DSc FRCP
Distinguished Professor of Neurology, School of Medicine, Frank Burke MBBS FRCS
University of California, San Francisco, CA, USA Professor of Hand Surgery, Pulvertaft Hand Centre,
Derby, UK
Tar-Ching Aw MB PhD FRCP FRCPC FFOM FFPHM
Professor and Chair, Department of Community Medicine, Alyson Calder MBChB BSc MRCP FRCA
Faculty of Medicine and Health Sciences, United Arab Emirates Department of Anaesthetics, Glasgow Royal Infirmary,
University, Al-Ain, UAE; Adjunct Professor, Gillings School of Glasgow, UK
Global Public Health, University of North Carolina, Chapel Hill, Michael Calnan MSc PhD
USA; Visiting Professor, Canterbury Christ Church University, Professor of Medical Sociology, University of Kent,
Kent, UK Canterbury, UK
Jon G Ayres BSc MBBS MD FRCP FRCPE FFOM FRCPSG Tim Carter MSc FRCP FFOM
Institute of Occupational and Environmental Medicine, Chief Medical Adviser, Maritime and Coastguard Agency,
University of Birmingham, Edgbaston, UK Department of the Environment, Transport and the Regions,
Peter J Baxter MD MSc FRCP FFOM London, UK
Consultant Physician in Occupational and Environmental John W Cherrie BSc(Hons) PhD FFOH
Medicine, University of Cambridge and Addenbrooke's Hospital, Research Director, Institute of Occupational Medicine,
Cambridge University Hospital NHS Foundation Trust, Edinburgh, UK
Cambridge, UK Jonathan D Chick MA MBChB MPhil DSc FRCP (Edin) FRC Psych
Gordon M Bell BSc MB ChB FRCP(E) FRCP Consultant Psychiatrist, Royal Edinburgh Hospital; Part-time
Renal Unit, Royal Liverpool University Hospital, Liverpool, UK Senior Lecturer in Psychiatry, Edinburgh University and Honorary
Peter G Blain CBE PhD FRCP(Lond) FRCP(Edin) FFOM FBTS FBS Professor, Health Sciences, Queen Margaret University,
Professor of Environmental Medicine, Medical Toxicology Centre, Edinburgh, UK
Newcastle University, Wolfson Unit, Newcastle upon Tyne, UK Holly M Christensen MSPH
Iain Blair MA MB BChir Axion Health Inc., Denver, CO, USA
Department of Community Medicine, Faculty of Medicine and Anne Cockcroft MD DIH FRCP FFOM
Health Sciences, United Arab Emirates University, Al-Ain, UAE Senior Reseach Fellow, CIET group; Visiting Professor,
Jens Peter Bonde MD PhD Dr Med Sc Autonomous University of Guerrero, Mexico
Professor of Occupational Medicine and Epidemiology, John Cocker MSc PhD
Department of Occupational and Environmental Medicine, Health and Safety Laboratory, Buxton, UK
Copenhagen University Hospital, Copenhagen, Denmark David Coggon OBE MA PhD DM FRCP FFOM FFPH FmedSci
Michael E Boulton BSc PhD Professor of Occupational and Environmental Medicine,
Department of Anatomy and Cell Biology, University of Florida, MRC Epidemiology Resource Centre, University of
Gainesville, FL, USA Southampton, UK
xiv Contributors

Annalisa Chiodini MD PhD Edward Gordon-Smith MA MSc FRCPath FRCP FMedSci

Department of Occupational and Environmental Health of the Professor Emeritus of Haematology, St George’s,
University of Milan, S Paolo Hospital Unit, and International University of London, UK
Centre for Rural Health of the University Hospital San Paolo, David Gradwell PhD BSc MB ChB FRCP DAvMed FRAES RAF
Milan, Italy RAF Consultant Adviser in Aviation Medicine and
Claudio Colosio MD PhD Whittingham Professor in Aviation Medicine, Royal Air Force
Assistant Professor of Occupational Health and Director Centre of Aviation Medicine, Royal Air Force Henlow, UK
of the International Centre for Rural Health, Department of Atherton Gray MB ChB MD FRCPath FRCP
Occupational and Environmental Health of the University of Consultant Haematologist, Great Western Hospitals NHS
Milan, S Paolo Hospital Unit, and International Centre for Rural Foundation Trust, Swindon, UK
Health of the University Hospital San Paolo, Milan, Italy
Neil Greenberg BSc BM MMedSc ILTM MEWI DOccMED MFFLM MD MRCPsych
Andrew P Colvin MRCGP MSc MFOM DRCOG DipIMC Defence Professor of Mental Health, Academic Centre for
Regional Occupational Physician Scotland and Northern Ireland, Defence Mental Health, Kings College London, UK
Atos Origin, Glasgow, UK
J Malcolm Harrington CBE MSc MD FRCP FFOM FMedSci
Cyrus Cooper MA DM FRCP Emeritus Professor of Occupational Medicine, University of
Director and Professor of Rheumatology, MRC Epidemiology Birmingham, Birmingham, UK
Resource Centre (University of Southampton), Southampton
Max Henderson MBBS MSc PhD MRCP MRCPsych
General Hospital, Southampton, UK
Senior Lecturer in Epidemiological and Occupational Psychiatry,
Giovanni Costa MD Institute of Psychiatry, Kings College London, UK, and Consultant
Professor of Occupational Medicine, Department of Occupational Liaison Psychiatrist, Kings College Hospital, London UK
Health, University of Milan, Milan, Italy
David J Hendrick MSc MD FRCP FFOM
Paul Cullinan MD FRCP FFOM Emeritus Professor, University of Newcastle upon Tyne,
Department of Occupational and Environmental Medicine, and Consultant Physician, Royal Victoria Infirmary, Newcastle
Royal Brompton Hospital/NHLI, London, UK upon Tyne, UK
Finlay Dick MD MRCGP MFOM Julia Heptonstall MSc MB BS FRCP FRCPath DTM&H
Senior Lecturer in Occupational Medicine, Environmental and Consultant Clinical Microbiologist, Scarborough and NE Yorkshire
Occupational Medicine Group, University of Aberdeen, UK NHS Trust, UK
Ken Donaldson BSc(Hons) PhD DSc FIBiol FRCPath FFOM Perrine Hoet MD PhD
Queens Medical Research Institute, University of Edinburgh, Professor, Université Catholique de Louvain, Louvain Centre
Edinburgh, UK for Toxicology and Applied Pharmacology (LTAP), Brussels,
Paul Durrington MD FRCP FRCPath FAHA FACP FMedSci Belgium
Honorary Professor of Medicine, Consultant Physician, Hideki Igisu MD PhD
Cardiovascular Research Group, School of Biomedicine, Director of the Fukuoka Central Health Evaluation and Promotion
University of Manchester, Manchester, UK Center, Fukuoka, Japan
John English MBBS FRCP Jouni JK Jaakkola MD DSc PhD
Consultant Dermatologist, Nottingham University Hospital, Professor of Public Health, Institute of Health Sciences,
Nottingham, UK University of Oulu, Finland and Professor of Environmental and
Simon Folkard PhD DSC HON FRCP Occupational Medicine, Institute of Occupational and
Visiting Professor, Paris-Descartes, France and Professor Emeritus, Environmental Medicine, University of Birmingham, UK
Swansea University, UK Maritta S Jaakkola MD PhD
Peter JG Forster MD FRCP Professor of Respiratory Medicine, Respiratory Medicine
Honorary Consultant Physician, James Paget University Hospital, Unit, Institute of Clinical Sciences, University of Oulu, Finland
Great Yarmouth and Associate Tutor, School of Medicine, Robert D Jefferson BSc MB BS FFOM CMIOSH
University of East Anglia, Norwich, UK Consultant in Environmental Medicine and Deputy Director,
Mike Gibson PhD MPhil MB ChB FFOM DAvMED DDAM FRAES Medical Toxicology Center, University of Newcastle, The Wolfson
Medical Director, Corporate Health Ltd, The Buckingham Centre, Unit, Newcastle upon Tyne, UK
Slough, UK Leeka Kheifets PhD
Nick Glozier MA MSc MBBS MRCPsych FRANZCP PhD Professor, UCLA School of Public Health, Department of
Associate Professor of Psychological Medicine, Disciplines of Epidemiology, Los Angeles, CA, USA
Psychological Medicine and Sleep, Sydney Medical School, Diana M Kloss MBE LLB(Lond) LLM(Tulane) Hon FFOM
University of Sydney, Sydney, Australia and Institute of Barrister, Gray’s Inn and Honorary Senior Lecturer,
Psychiatry, Kings College London, UK University of Manchester, Manchester, UK
 Contributors xv

Manolis Kogevinas MD PhD Benoit Nemery MD PhD

Centre for Research in Environmental Epidemiology (CREAL), Professor of Toxicology and Occupational Medicine, Department
Municipal Institute of Medical Research (IMIM-Hospital del Mar), of Public Health, Katholieke Universiteit Leuven, Belgium
CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Lee S Newman MD MA FCCP FACOEM
Spain and National School of Public Health, Athens, Greece Professor of Environmental and Occupational Health, University
David Koh MBBS MSc(om) PhD FFOM FFOMI FFPH FAMS of Colorado Denver, Colorado School of Public Health, Denver,
Professor, Department of Epidemiology and Public Health, CO, USA
Yong Loo Lin School of Medicine, National University Anthony Newman Taylor OBE FRCP FFOM FMedSci
of Singapore, Republic of Singapore Deputy Principal, Faculty of Medicine, Imperial College,
Ian J Lawson MBBS CMIOSH FFOM FACOEM FRCP London, UK
Chief Medical Officer, Rolls-Royce plc, Derby, UK
Tohr Nilsson MD PhD
Peter Linnett MB BS FFOM Associate Professor, Department of Occupational and
Formerly Group Occupational Physician, Johnson Matthey plc Environmental Medicine, Sundsvalls Hospital Sweden
Maurice S Lipsedge MPhil FRCP FRCPsych FFOM(Hon) Robert Niven MBChB BSc MD MFOM FRCP
Emeritus Consultant Psychiatrist, The South London and University of Manchester and University Hospital of South
Maudsley NHS Trust, Visiting Senior Lecturer in the Department Manchester, Manchester, UK
of Psychological Medicine within Guy’s, King’s and St Thomas’
E Howard N Oakley BA MB BCH MSc
School of Medicine, London, UK
Head of Survival and Thermal Medicine, The Institute of Naval
Marcello Lotti MD Medicine, Alverstoke, Gosport, UK
Professor, Università degli Studi di Padova, Dipartimento di
Simon Øverland PhD PsyD
Medicina Ambientale e Sanità Pubblica, Padua, Italy
Research Centre for Health Promotion, Faculty of Psychology,
Howard J Mason MSc PhD University of Bergen, Norway
Health and Safety Laboratory, Buxton, UK
Pearl Pai MBChB MD FRCP
Robert L Maynard CBE FRCP FRCPath FFOM FBTS
Renal Unit, Royal Liverpool University Hospital, Liverpool, UK
Honorary Professor of Environmental Medicine, University of
Birmingham, UK Keith Palmer MA BM BCh FFOM FRCP DRCOG
Professor of Occupational Medicine, MRC Epidemiology Resource
Kenneth L McGeoch MB ChB MRCGP FFOM
Centre, University of Southampton, Southampton General
Consultant Hand Arm Vibration Syndrome (rtd)
Hospital, Southampton SO16 6YD, UK
Grant McMillan MD MSc FRCP FRCP(Glasg) FFOM CFIOSH
CAC Pickering FRCP FFOM DIH
Independent Occupational Physician, Honorary Senior Clinical
Professor of Occupational Medicine, North West Lung Centre,
Lecturer, University of Birmingham, UK
Wythenshawe Hospital, Manchester, UK
Joseph Melling BSc PhD
George Proud BS BDS MD FRCS
Professor, Director of the Centre for Medical History,
Emeritus Consultant Surgeon, Royal Victoria Infirmary,
University of Exeter, UK
Newcastle upon Tyne, UK
Fred A Mettler Jr MD MPH
Richard Ramsden MD ChB FRCS
Board Certified Radiologist, US representative, United Nations
Professor of Otolaryngology, Victoria University of Manchester,
Scientific Committee on the Effects of Atomic Radiations,
Manchester Royal Infirmary, Manchester, UK
Emeritus Professor of Radiology, University of New Mexico,
Former Main Commission Member, International Commission on David Roomes MRCGP MFOM LLM
Radiological Protection, Albuquerque, NM, USA Medical Director, Employee Health Management,
Gabor Mezei MD PhD GlaxoSmithKline, Stevenage, UK
Electric Power Research Institute, Palo Alto, CA, USA Robin M Rudd MA MD FRCP
Alastair Miller MA FRCP FRCP(Edin) DTM&H Consultant Physician, London Lung Cancer Group,
Tropical and Infectious Disease Unit, Royal Liverpool University London, UK
Hospital, Liverpool School of Tropical Medicine, Liverpool, UK Shakeel R Saeed MB(BS)(Lon) FRCS(Ed) FRCS(ORL, Lon) MD (Man)
Brian G Miller BSc(Hons) PhD CStat Csci Professor of Otology/Neuro-otology, University College London
Principal Epidemiologist, Institute of Occupational Medicine, Ear Institute, Consultant ENT and Skullbase Surgeon, The Royal
Edinburgh, UK National Throat, Nose and Ear Hospital and Royal Free Hospital,
London, UK
Adrian Neal BA(Hons) MA ClinPsyD
Principal Clinical Psychologist (Coventry and Warwickshire Tiina Santonen MD PhD MSc
NHS Partnership Trust) and Lecturer/Practitioner (Coventry and Team Leader, Finnish Institute of Occupational Health, Helsinki,
Warwick Universities Clinical Psychology Doctoral Programme) Finland