From conjecture and refutation to the documentation of occupational diseases in Taiwan.

The documentation of occupational diseases in a developing country like Taiwan is a challenge to an occupational physician. For lack of a system including material safety data sheet (MSDS), workers are usually not aware of what chemicals they are exposed to. Since many occupational diseases have long latencies and do not show any specific symptoms and signs, recognition and identification of the occupational origin are often very difficult. Using databases which provide a relatively complete list of industrial chemicals and a set of specific signs and/or symptoms, combined with the epidemiologic approach of conjectures and refutations--i.e., considering and ruling out all possible alternative explanations--we have documented eight kinds of occupational diseases and an outbreak of botulism. We recommend that a similar approach be applied to any other country with a similar situation, and that a system involving an identification sheet (e.g., MSDS) for each chemical be advocated and implemented in such countries as one means to enable prompt recognition and prevention of occupational diseases.