Shoe-makers' polyneuropathy in Italy: the aetiological problem

Area of Science:

• Occupational Health
• Toxicology
• Neurology

Background:

• Shoe-makers' toxic polyneuropathy has been reported since 1957, with triorthocresylphosphate (TOCP) previously suspected as the cause.
• Previous studies found little to no TOCP in affected factories, and seasonal patterns inconsistent with direct absorption.
• The disease predominantly affects workers in small, low-hygiene shoe factories, particularly women.

Purpose of the Study:

• To clarify the etiology of shoe-makers' toxic polyneuropathy.
• To investigate the causative agents in shoe factory environments.
• To understand the epidemiological characteristics of the disease.

Main Methods:

• Studied 122 shoe industry workers with toxic polyneuropathy (1971-1974).
• Visited workplaces and collected samples of glues and solvents for chemical analysis.
• Analyzed chemical composition of substances used in factories where cases occurred.

Main Results:

• Polyneuropathy affects glueing, cleaning, and even indirectly exposed workers.
• The disease is more prevalent in women (68%) and manifests severely in winter/spring.
• Chemical analysis revealed high concentrations (>80%) of low-boiling point paraffin hydrocarbons (e.g., n-hexane) in glues and cleaning fluids.

Conclusions:

• Paraffin hydrocarbons, not TOCP, are likely responsible for shoe-makers' toxic polyneuropathy.
• Low hygiene standards in small factories contribute to exposure.
• Further investigation into the neurotoxic effects of these hydrocarbons is warranted.