The major International Standard Industrial Classification (ISIC) group for the leather and fur processing is 323. In the United States, the Standard Industrial Classification (SIC) group for leather and leather manufacturing products industry is SIC 311 (OMB 1987). This group includes establishments engaged in tanning, currying and finishing hides and skins, as well as establishments manufacturing finished leather and artificial leather products and some similar products made of other materials. Leather converter, belting and chamois leather are also included in SIC 311. In addition, parts of SIC 23 (i.e., SIC 2371 and 2386) include establishments involved in the manufacturing of coats, garments, accessories and trimmings made of fur and establishments involved in sheep-lined clothing.
There are many varieties of leather with different characteristics depending upon the animal species and the specific part of the body of the animal from which the hide is obtained. Hides are made from cattle or horse skins; fancy leather from the skin of the calf, pig, goat, sheep and so on; and reptile leather from crocodile, lizard, chameleon and so on.
Employment in the leather and leather manufacturing products industry has been associated with various diseases caused by biological, toxicological and carcinogenic agents. The specific disease associated with exposure in the leather industry depends upon the extent to which the worker is exposed to the agent(s), which is dependent upon the occupation and work area within the industry.
For the tanning process, the epidermis of the hide is first removed and only the dermis transformed into leather. During this process, infection is a constant hazard, since the hide serves as a medium for numerous micro-organisms. Colonies of fungi may develop, specifically Aspergillus niger and Penicillus glaucum (Martignone 1964). To avoid the development of fungi, chlorinated phenols, specifically pentachlorophenol, have been widely used; unfortunately, such chemicals have been found to be toxic to the worker. Yeasts of three genera (Rhodotorula, Cladosporium and Torulopsis) have also been found (Kallenberger 1978). Tetanus, anthrax, leptospirosis, epizootic aphtha, Q fever and brucellosis are examples of diseases that workers could contract during the tanning process due to infected hides (Valsecchi and Fiorio 1978).
Skin disorders such as eczema and contact (allergic) dermatitis have also been diagnosed among leather tanners exposed to preservatives applied to the hides (Abrams and Warr 1951). The leather tanning and finishing process has been shown to have the highest incidence of dermatoses of any working group in the United States (Stevens 1979). Irritations of the mucous membranes of the throat and nose and perforations of the nasal septum may also occur after inhaling chromic acid fumes liberated during the chrome-tanning process.
Tannery workers have the potential for exposure to numerous known or suspected occupational carcinogens, including hexavalent chromium salts, benzidine-based azo dyes, organic solvents (e.g., benzene and formaldehyde), pentachlorophenol, N-nitroso compounds, arsenic, dimethylformamide and airborne leather dusts. These exposures may result in the development of various site-specific cancers. An excess of lung cancer has been observed in studies carried out in Italy (Seniori, Merler and Saracci 1990; Bonassi et al. 1990) and in a case-control study carried out in the United States (Garabrant and Wegman 1984), but this result is not always supported by other studies (Mikoczy, Schutz and Hagmar 1994; Stern et al. 1987; Pippard and Acheson 1985). Chromium and arsenicals were mentioned as possible contributors to the lung cancer excess. A significantly increased risk of soft tissue sarcoma has been observed in at least two separate tannery studies, one in Italy and one in the United Kingdom; the investigators of both studies suggest that the chlorophenols used at the tanneries may have produced these malignancies (Seniori et al. 1989; Mikoczy, Schutz and Hagmar 1994).
A threefold statistically significant excess in pancreatic cancer mortality was noted in a Swedish case control study (Erdling et al. 1986); a 50% increase in pancreatic cancer was also noted in another study examining three Swedish tanneries (Mikoczy, Schutz and Hagmar 1994) and in a study of an Italian tannery (Seniori et al. 1989). Despite the excess risk of pancreatic cancer, no specific environmental agent was identified, and dietary factors were considered a possibility. An excess risk of testicular cancer was observed among leather tanners from the finishing department of one tannery; all three workers with testicular cancer had worked during the same time period and were exposed to dimethylformamide (Levin et al. 1987; Calvert et al. 1990). An excess risk of sinonasal cancer among leather tannery workers was observed in a case-control study in Italy; chromium, leather dust and tannins were indicated as possible aetiological agents (Comba et al. 1992; Battista et al. 1995). However, IARC research in the early 1980s found no evidence of an association between leather tanning and nasal cancer (IARC 1981). The results of a study of the Chinese leather tanning industry showed a statistically significant excess morbidity from bladder cancer among those tanners ever exposed to benzidine-based dyes, which increased with duration of exposure (Chen 1990).
Accidents are also a leading cause of disability in leather tannery workers. Slips and falls on wet and greasy floors are common, as are knife cuts from the trimming of hides. In addition, the machines used to process the hides are capable of crushing and inflicting bruises, abrasions and amputations. For example, United States Bureau of Labor Statistics (BLS) data for 1994 have shown an incidence rate in SIC 311 for injuries and illnesses combined of 19.1 per 100 full-time workers and an incidence rate for injuries alone of 16.4. These results are over 50% higher than the all-manufacturing incidence for illnesses and injuries combined, 12.2 per 100 full-time workers, and the incidence of 10.4 for injuries alone (BLS 1995).
The handling and processing of leather in the manufacturing of shoes and boots may entail exposures to some of the same chemicals used in the tanning and finishing processes as cited above, giving rise to similar diseases. Furthermore, different chemicals used may also produce other diseases. Exposures to the toxic solvents used in adhesives and cleaners and to airborne leather dusts are of particular concern. One solvent of specific concern is benzene, which can produce thrombocytopenia; depression of the red blood cell, platelet and white cell counts; and pancytopenia. Benzene has largely been eliminated from the footwear industry. Peripheral neuropathy has also been found among workers in shoemaking factories due to n-hexane in the adhesives. This, too, has largely been substituted for by less toxic solvents. Electroencephalographic changes, liver damage and behavioural alterations have also been reported in connection with exposure to solvents in shoeworkers.
Benzene has been judged to be a human carcinogen (IARC 1982), and various investigators have observed excess leukaemias among workers exposed to benzene in the shoe industry. One study included the largest shoe manufacturing facility in Florence, Italy, consisting of over 2,000 employees. The study results revealed a fourfold excess risk of leukaemia, and benzene was cited as the most likely exposure (Paci et al. 1989). A follow-up to this study showed an over fivefold risk for those shoe workers employed in jobs where benzene exposure was substantial (Fu et al. 1996). A study in the United Kingdom examining mortality among males employed in shoe manufacturing found an elevated risk for leukaemia among workers handling glues and solvents which contained benzene (Pippard and Acheson 1985). Various studies of shoe industry workers in Istanbul, Turkey, have reported an excess risk of leukaemia from exposure to benzene. When benzene was later replaced by petrol, the absolute number of cases and risk of leukaemia dropped considerably (Aksoy, Erdem and DinCol 1974; 1976; Aksoy and Erdem 1978).
Various types of nasal cancer (adenocarcinoma, squamous-cell carcinoma and transitional-cell carcinoma) have been associated with employment in shoe manufacture and repair. Relative risks in excess of tenfold have been reported from studies in Italy and the United Kingdom (Fu et al. 1996; Comba et al. 1992; Merler et al. 1986; Pippard and Acheson 1985; Acheson 1972, 1976; Cecchi et al. 1980) but not in the United States (DeCoufle and Walrath 1987; Walker et al. 1993). The elevated nasal cancer risks were almost entirely accounted for by employees “heavily” exposed to leather dust in the preparation and finishing rooms. The mechanism by which exposure to leather dust may increase the risk of nasal cancer is not known.
Excesses of digestive and urinary tract cancers, such as bladder (Malker et al. 1984; Morrison et al. 1985), kidney (Walker et al. 1993; Malker et al. 1984), stomach (Walrath, DeCoufle and Thomas 1987) and rectal (DeCoufle and Walrath 1983; Walrath, DeCoufle and Thomas 1987) cancers, have been found in other studies of shoe workers but have not been consistently reported and have not been linked with particular exposures in the industry.
Ergonomic hazards causing work-related musculoskeletal disorders (WRMDs) are major problems in the shoe manufacturing industry. These hazards are due to the specialized equipment used and hands-on work requiring repetitive movements, forceful exertions and awkward body postures. BLS data show men’s footwear to be one of the “industries with the highest rates of nonfatal illness disorders associated with repeated trauma” (BLS 1995). The incidence rate for the total footwear industry for illnesses and injuries combined was found to be 11.9 per 100 workers, with 8.6 being the incidence rate for injuries alone. These rates are slightly less than the incidence rates for all manufacturing. WRMDs in the shoe manufacturing industry include conditions such as tendinitis, synovitis, tenosynovitis, bursitis, ganglionic cysts, strains, carpal tunnel syndrome, low-back pain and cervical spine injuries.
Fur processing involves the activities of three categories of workers. Fur dressers flesh and tan skins; fur dyers then colour or tint the skins with natural or synthetic dyes; and finally fur service workers grade, match and bale dressed furs. Dressers and dyers are exposed to potential carcinogens including tannins, oxidative dyes, chromium and formaldehyde, whereas fur service workers are potentially exposed to residual tanning materials while handling previous dressed furs. Very few epidemiological studies have been conducted on fur workers. The only comprehensive study among these workers revealed statistically elevated risks of colo-rectal and liver cancer among the dyers, lung cancer among the dressers and cardiovascular diseases among the service workers as compared to overall rates in the United States (Sweeney, Walrath and Waxweiler 1985).