Based on the history of the growing awareness and recognition of ailments associated with the manufacture of cotton, it is concluded that recognition of byssinosis in the United States came late. In the American south byssinosis existed in an industry and within a social framework that helped to retard the acceptance of byssinosis as an undesirable but controllable disease. As late as the 1960s, United states medical opinion declared the disease nonexistent in American textile mills. In 1970, the scientific community showed that byssinosis existed in the United States. Mobilization of public opinion, changes in social attitudes, new scientific evidence, and the Occupational Safety and Health Act led to the setting of a standard to control and eradicate byssinosis. Controversy and debate over policy have brought the impact of scientific, sociopolitical, and economic inputs into health policy decisions, the altering perceptions of hazard, and the continually changing definition of risk into focus.