Education And Debate


BMJ 1996; 313 doi: (Published 14 September 1996) Cite this as: BMJ 1996;313:674
  1. P H Appleby
  1. Paul Appleby is divisional director of Building Health and Safety, a division of Thorburn Colquhoun, London.

    The idea that buildings can make people ill is one that undermines deep seated beliefs in the function of buildings. Buildings are supposed to provide shelter and a safe environment where people are protected from the elements. The idea of illness associated with manufacturing or mineral extraction is reasonably well understood. However, people becoming ill because of exposure to some unseen agent in their home, school, or office can create a panic out of proportion to the risk.

    Building related illnesses fall into two categories: those that have an identifiable cause—such as legionellosis, humidifier fever, and conditions resulting from exposure to known substances such as asbestos, lead in paint, formaldehyde, etc—and those that have no readily identifiable cause but can be described only by a group of symptoms known as sick building syndrome.

    Algal growth on drift eliminators of a building's cooling tower—a potential source of pollutants.

    Sick building syndrome

    The term sick building syndrome is used to describe a situation in a building where more people than normal suffer from various symptoms or feel unwell for no apparent reason. The symptoms tend to increase in severity with the time that people spend in the building and to steadily improve or disappear when people are away from the building.


    The symptoms associated with sick building syndrome are those associated with common illnesses and allergies, usually in a relatively mild form so that many sufferers may not see a doctor and may not take time off work.

    Symptoms associated with sick building syndrome

    • Eyes—irritated, itching, dry, watering

    • Nose—irritated, itching, runny, dry, blocked

    • Throat—sore, constricted, dry mouth

    • Head—headache, lethargy, irritability, difficulty in concentrating

    • Skin—dryness, itching, irritation, rashes


    There is no single known cause of sick building syndrome, but there are several risk factors that have been identified from a large number of studies on the epidemiology of the syndrome and investigations …

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