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May 28, 1982

Bacterial endotoxin may be culprit in 'Monday fever'

JAMA. 1982;247(20):2765-2773. doi:10.1001/jama.1982.03320450009005

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Byssinosis, the chronic lung disorder that is said to affect thousands of cotton mill workers, has been recognized as a serious occupational health risk for several decades.

However, although debate continues about causative agents and appropriate ways to eliminate them from the workplace, the good news is that the risk of contracting byssinosis is now considered to be substantially reduced. This is the result of a cotton dust standard implemented by the Occupational Safety and Health Administration (OSHA) in 1978.

Byssinotic patients exhibit a characteristic "Monday syndrome"—coughing, wheezing, shortness of breath, chest tightness, and decreased ventilatory capacity—that is most marked early in the work week or after a vacation. With continued exposure, the symptoms extend further into the work week and eventually lung function is permanently impaired even in the absence of dust exposure.

Cotton fibers seemed at first to be the obvious culprit as early epidemiologic studies found a