Review of Arsenicosis in West Bengal, India — A Clinical Perspective

Abstract

Arsenical calamity of West Bengal and Bangladesh from ground water is the greatest arsenical calamity of the world. Arsenicosis from tube well water in West Bengal and Bangladesh was discovered by the author in 1982 and in 1984, respectively. The diagnosis of arsenic toxicity was confirmed by high arsenic levels in nails, hair, and skin scales of the patients. Most of the arsenicosis occurred due to the intake of water containing more than 0.05 mg/L of arsenic from shallow tube well of depth within 50 to 150 ft. The source of arsenic is mainly geological. The disease was known to exist in a village since 1955. Only two instances of arsenicosis of exogenous cause were found. About 300,000 people from 1206 rural areas (villages) of 76 blocks in 9 districts of West Bengal were found to be affected. About 6 months to 10 years (average of 2 years) are required to develop symptomatology. Melanosis is the earliest sign. Melano-keratosis appearing in adults is almost a certain sign of arsenicosis. Malignancy often develops 10 to 20 years after the onset of symptoms. 250 cases of cancers were found, of which 212 were skin cancers; these are mostly squamous cell carcinoma. The clinical spectrum has been classified by the author into four stages, seven grades and 20 subgrades by the author. Four stages are (1) preclinical, (2) clinical, (3) complication, and (4) malignancy. Chelating drugs are of little benefit in keratotic stage and the stage of complication. The massive problem can only be solved if the people in affected communities are provided with arsenic free water on a large scale or alternative sources so that they could avoid consuming arsenic contaminated water.