The pattern of the disease we now know as byssinosis has been established over the years in medical literature. It is not the same as mill fever, mattress-maker's fever, or weaver's cough, which are caused by contaminated batches of fiber. It is distinguish able from bronchitis in its earlier stages, and some disabled byssinotics may never develop sputum. The pathological findings are not those of an extrinsic allergic alveolitis such as farmer's lung, and emphysema is not an invariable finding. It seems unlikely therefore that bacterial endotoxins or allergy play a part in the etiology of the disease. A direct pharmacological effect on the smooth muscle of the airways by water-soluble substances appears likely.
Although a fall in FEV 1 over the first shift of the week may occur in a high proportion of byssinotics, it cannot be used as a diagnostic tool in individual cases. The diagnosis of byssinosis for compensation purposes is entirely dependent on the symptomatic history. Smoking certainly aggravates the effect of cotton dust.
The proportion of those who develop the early grades of byssinosis and go on to disabling disease does not appear to be large when assessed from compensation cases.
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