International research on arsenic contamination and health.

Abstract

Some historical notesArsenikon, the Greek word meaning arsenic, was used during the Renaissance to mean potent or male. Hippocrates (460 BC), the father of modern medicine, and Galen (129 AD), the two most famous physicians of the Roman Empire, are said to have used a paste containing arsenic tetrasulphide to treat ulcers (1,2).Inorganic arsenic compounds have been used in medicine since these ancient times. Over the past 150 years, arsenic has been used for treating dermatitis herpetiformis, asthma, syphilis, epilepsy, psoriasis, trypanosomiasis, amoebiasis, and other conditions (3-6). In 1786, Thomas Fowler introduced his own 'Liquor Arsenicalis'-a 1% solution of potassium arsenite, coloured with a tincture of lavender-which contained a very high concentration (5,000,000 ppb) of arsenic (7). Fowler's treatment involved 24 doses, and the total course of 280 drops was equivalent to about 60 mg of arsenic, especially psoriasis. During the decades, following the introduction of Fowler's solution, arsenic is still used in homeopathic (8) and herbal medicine (9-11), although enormous adverse effects of this medication have been reported (3-6). It has also been recognized as a modern intravenous treatment for acute promyelocytic leukaemia (12). Results of recent research suggest that arsenic trioxide, in combination with other agents, may have therapeutic uses for other malignancies (13).Arsenic compounds have also been used, since ancient times, as poisons. The death of the French emperor Napoleon Bonaparte, on 5 May 1821, was believed to be due to slow poisoning with arsenic (14). He was exiled on the Island of St. Helena in the middle of the Atlantic Ocean following his defeat at the Battle of Waterloo in 1816.Studying exposure in the general populationsArsenic, a ubiquitous element in the earth's crust, is a constituent of many different minerals. Concentrations of arsenic vary in the environment, e.g. 0.03-0.25 part per million (ppm) in soil, 0.023-0.25 ppm in plants, up to 55 ppm in groundwater, 0.0001-0.08 ppm in seawater, 3-170 ppm in fish, 0.008-0.85 ppm in wine, and up to 0.00049 or 0.63 mg/m3 in urban air (3-6). One in every 60 people (~100 million people) on the planet is living in an area where they may be exposed to 50 μg/L of arsenic or above in drinking-water, and one in every 30 people may quaff water with 10 μg/L of arsenic or above which is the WHO guideline for drinking-water (15).Twenty-six papers on health effects of arsenic exposure and mitigation of arsenic contamination have been assembled in the two issues (June and September) of the Journal. In these two special issues, seven studies are reported from North and South America (16-19). North and South America have large tracts of arsenic-rich groundwater. Exposure is spotty in areas of the Pampean Plain of Argentina, which is much bigger than Bangladesh and West Bengal. In Argentina, the first arsenic-induced skin lesion was recorded in 1917 (3-5). The disease was named Bel Ville disease after the name of the town in which the cases were reported. In Chile, the first case was recorded in 1962 (3-5).Arsenic contamination of water in several Asian countries are also reported in the two special issues (20-25). In Asia, the first health effects from arsenic contamination in drinking-water were reported in Taiwan (26,27). In South Asia, the Bengal Basin, encompassing the world's largest delta, is geologically very young, comprising the convergent Ganges, Brahmaputra, and Meghna rivers. The first health effects were discovered in West Bengal by dermatologist K.C. Saha who diagnosed patients as having arsenic-caused skin lesions in 1982 (28). Skin-lesion patients from Bangladesh were also first identified by him in Kolkata in 1984 (29). The Department of Public Health Engineering (DPHE) of Bangladesh first reported arsenic contamination of groundwater in Bangladesh in 1993 (30). Unique exposure from burning of arsenic-rich coal in the Guizhou province (21,23), widespread contamination in China (22,23) and Nepal (24) are also reported in this issue. …