This article was downloaded by: [New York University] On: 12 May 2013, At: 07:48 Publisher: Taylor & Francis Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Environmental Science and Health, Part A: Toxic/Hazardous Substances and Environmental Engineering Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/lesa20 Arsenic Groundwater Contamination and Sufferings of People in North 24-Parganas, One of the Nine Arsenic Affected Districts of West Bengal, India Mohammad Mahmudur Rahman a , Badal Kumar Mandal a , Tarit Roy Chowdhury a , Mrinal Kumar Sengupta a , Uttam Kumar Chowdhury a , Dilip Lodh a , Chitta Ranjan Chanda a , Gautam Kumar Basu a , Subhash Chandra Mukherjee b , Kshitish Chandra Saha c & Dipankar Chakraborti a a School of Environmental Studies, Jadavpur University, Kolkata, India b Department of Neurology, Medical College, Kolkata, India c Retired Professor of Dermatology, School of Tropical Medicine, Kolkata, India Published online: 24 Jun 2011. To cite this article: Mohammad Mahmudur Rahman , Badal Kumar Mandal , Tarit Roy Chowdhury , Mrinal Kumar Sengupta , Uttam Kumar Chowdhury , Dilip Lodh , Chitta Ranjan Chanda , Gautam Kumar Basu , Subhash Chandra Mukherjee , Kshitish Chandra Saha & Dipankar Chakraborti (2003): Arsenic Groundwater Contamination and Sufferings of People in North 24- Parganas, One of the Nine Arsenic Affected Districts of West Bengal, India, Journal of Environmental Science and Health, Part A: Toxic/Hazardous Substances and Environmental Engineering, 38:1, 25-59 To link to this article: http://dx.doi.org/10.1081/ESE-120016658 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
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This article was downloaded by: [New York University]On: 12 May 2013, At: 07:48Publisher: Taylor & FrancisInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,37-41 Mortimer Street, London W1T 3JH, UK
Journal of Environmental Science and Health, PartA: Toxic/Hazardous Substances and EnvironmentalEngineeringPublication details, including instructions for authors and subscription information:http://www.tandfonline.com/loi/lesa20
Arsenic Groundwater Contamination and Sufferings ofPeople in North 24-Parganas, One of the Nine ArsenicAffected Districts of West Bengal, IndiaMohammad Mahmudur Rahman a , Badal Kumar Mandal a , Tarit Roy Chowdhury a , MrinalKumar Sengupta a , Uttam Kumar Chowdhury a , Dilip Lodh a , Chitta Ranjan Chanda a ,Gautam Kumar Basu a , Subhash Chandra Mukherjee b , Kshitish Chandra Saha c & DipankarChakraborti aa School of Environmental Studies, Jadavpur University, Kolkata, Indiab Department of Neurology, Medical College, Kolkata, Indiac Retired Professor of Dermatology, School of Tropical Medicine, Kolkata, IndiaPublished online: 24 Jun 2011.
To cite this article: Mohammad Mahmudur Rahman , Badal Kumar Mandal , Tarit Roy Chowdhury , Mrinal Kumar Sengupta ,Uttam Kumar Chowdhury , Dilip Lodh , Chitta Ranjan Chanda , Gautam Kumar Basu , Subhash Chandra Mukherjee , KshitishChandra Saha & Dipankar Chakraborti (2003): Arsenic Groundwater Contamination and Sufferings of People in North 24-Parganas, One of the Nine Arsenic Affected Districts of West Bengal, India, Journal of Environmental Science and Health, PartA: Toxic/Hazardous Substances and Environmental Engineering, 38:1, 25-59
To link to this article: http://dx.doi.org/10.1081/ESE-120016658
PLEASE SCROLL DOWN FOR ARTICLE
Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions
This article may be used for research, teaching, and private study purposes. Any substantial or systematicreproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form toanyone is expressly forbidden.
The publisher does not give any warranty express or implied or make any representation that the contentswill be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses shouldbe independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims,proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly inconnection with or arising out of the use of this material.
Kshitish Chandra Saha,3 and Dipankar Chakraborti1,*
1School of Environmental Studies, Jadavpur University, Kolkata, India2Department of Neurology, Medical College, Kolkata, India
3Retired Professor of Dermatology, School of Tropical Medicine, Kolkata, India
ABSTRACT
To understand the magnitude of the arsenic calamity in West Bengal, a detailed
study spanning 7 years was made in North 24-Parganas, one of the nine arsenicaffected districts. Area and population of North 24-Parganas district are4093.82 sq. km and 7.3million, respectively. Fourty eight thousand and thirtywater samples were analyzed from hand tubewells of North 24-Parganas in use
for drinking, cooking and 29.2% of the tubewells were found to have arsenicabove 50mg/L, the maximum permissible limit of World Health Organization(WHO) and 52.8% have arsenic above 10 mg/L, WHO recommended value of
arsenic in drinking water. Out of the 22 blocks of North 24-Parganas, in 20blocks arsenic has been found above the maximum permissible limit and so farin 16 blocks people have been identified as suffering from arsenical skin lesions.
From the generated data, it is estimated that about 2.0million and 1.0million
*Correspondence: Dipankar Chakraborti, School of Environmental Studies, JadavpurUniversity, Kolkata 700 032, India. E-mail: [email protected].
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people are drinking arsenic contaminated water above 10mg/L and 50mg/L level,
respectively in North 24-Parganas alone. So far, in our preliminary study 33,000people have been examined at random from arsenic affected villages in North24-Parganas and 2274 people have been registered with arsenical skin lesions.Extrapolation of the available data indicates about 0.1million people may be
suffering from arsenical skin lesions from North 24-Parganas alone. A sum of21,000 hair, nail, and urine samples analyses from arsenic affected villages show56%, 80%, and 87% people have arsenic in biological specimen more than
normal/toxic (hair) level, respectively. Thus, many may be subclinically affected.Due to use of arsenic contaminated groundwater for agricultural irrigation, riceand vegetable are getting arsenic contaminated. Hence there is an additional
arsenic burden from food chain. People from arsenic affected villages are alsosuffering from arsenical neuropathy. A followup study indicates that many of thevictims suffering from severe arsenical skin lesions for several years are now
suffering from cancer or have already died of cancer.
Key Words: North 24-Parganas district; Arsenic above 10 and 50 mg/L; Arsenicin food chain; Arsenic neuropathy; LOAEL and NOAEL; Arsenical skin lesions.
INTRODUCTION
There are approximately 20 countries in the world where incidence of arsenic con-tamination of groundwater was known before 1999. Arsenic groundwater contamina-tion in more Asian countries has been reported during last two years.[1,2] However, theworld’s four biggest cases of groundwater arsenic contamination and the worst suffer-ings of the people have been in Asia. In order of magnitude, these are Bangladesh,[3–10]
West Bengal, India,[8–21] Inner Mongolia, P.R. China[22–24] and Taiwan.[25–28] In allthese countries, more and more groundwater withdrawal is taking place because ofagricultural irrigation. The magnitude of the arsenic calamity in Bangladesh surfacedduring 1998.[29] After the international arsenic conference in Bangladesh from 8–12February 1998,[29] two reports were published by the ‘‘Guardian’’ a London daily,[30]
with interviews of international funding organizations and arsenic experts. In thatpublished report[30] the World Bank’s local chief said, ‘‘Tens of millions of people areat risk.’’ The World Bank further mentions that in Bangladesh 43,000 villages out of68,000 are presently or could be at risk in the future. A report by the WHO predictsthat, within a few years, death across much of southern Bangladesh (1 in 10 adults)could be from cancers triggered by arsenic. A summary of the present arsenic status inthe nine arsenic affected districts (South 24-Parganas, North 24-Parganas, Howrah,Hooghly, Nadia, Bardhaman, Murshidabad, Malda, and South Calcutta) of WestBengal, as revealed by our survey during the last 15 years, is presented in Table 1.Figure 1 shows the arsenic affected districts, blocks of West Bengal.
Although 42.7million people are living in the arsenic affected nine districts, thisdoes not mean that all are drinking arsenic-contaminated water and will suffer fromarsenic toxicity. But there is no doubt that they are at risk. Figure 2 shows how thenumber of arsenic affected blocks/villages have increased with more and more surveyduring last 15 years. When we started in 1988 we knew about 22 arsenic affected
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villages from 12 blocks/police stations and at present more than 3000 villages from 74blocks are arsenic affected. Even after working for the last 15 years in the arsenicaffected areas ofWest Bengal, we have realized that we are still merely seeing the tip ofthe iceberg. We have realized that, for an organization such as ours, it would takemore than a few decades to survey the actual magnitude of the arsenic calamity inWest Bengal. So, we decided to survey one district in details. We chose North24-Parganas district because of certain reasons, and these are: (1) from our preli-minary survey up to 1994, we found North 24-Parganas to be of intermediatemagnitude in its severity of arsenic problem compared with the other affected districts.The magnitude of Murshidabad and Malda appeared severe, while that of Howrah,Hooghly, Bardhaman and South Calcutta appeared mild, and North and South24-Parganas and Nadia were characterized as intermediate; (2) communication withNorth 24-Parganas is not difficult; and (3) in North 24-Parganas, we have a group oflocal youths who are working in our group and doing our preliminary field survey.Most of them are arsenic victims and have mild arsenical skin lesions. Althoughsporadically we surveyed North 24-Parganas from 1988, a systematic approach forthe study was adopted in September, 1994. During last 7 years we spent about 4600 hfor our study in North 24-Parganas district.
NORTH 24-PARGANAS DISTRICT
Figure 3 shows the position of North 24-Parganas district in West Bengal. It is insouth east part of the state and lies in the Bhagirathi–Hooghly river sub-basin and has
Table 1. Present arsenic status in West Bengal, India (up to April 2002).
West Bengal
Area (sq. km) 89,193Population (million) (according to 1991 Census) 68
Total number of districts 18No. of arsenic affected districts (groundwater arsenic above 50mg/L) 9Total number of water samples analyzed 115,000
%of samples having arsenic>10 mg/L 50.3%of samples having arsenic>50mg/L 25.1Area of arsenic affected districts (sq. km) 38,865
Population of arsenic affected districts (million) 42.7Number of arsenic affected Blocks / Police Station 74Number of arsenic affected villages (approx.)where groundwater arsenic above 50 mg/L
3000
Total hair, nail, urine, skin-scales samples analyzed 25,000Arsenic above normal level (average) in biological samples 89%People drinking arsenic contaminated water above 50mg/L(approx.) (million)
6
People screened for arsenic patients (preliminary survey) 86,000Number of registered patients with clinical manifestations 8500 (9.8%)
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bordering areas with Satkhira and Jessore districts of Bangladesh (both these twodistricts of Bangladesh are highly arsenic affected). The administrative structure ofWest Bengal consists of 18 districts, and North 24-Parganas is one of the districts.Further more, each district has several blocks. In North 24-Parganas there are22 blocks (Fig. 3). Each block has several Gram-Panchayets (GP) and in eachGP thereare several villages. Total area and population of North 24-Parganas are 4093 sq. km
Figure 1. Shows the arsenic affected districts/blocks in West Bengal, India.
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and 7.3million, respectively (1991 Census). More than 95% of the population usehand tubewell water for drinking and around 70% for cooking. Most of the tubewellsare of shallow depth (15–50m). Part of the water supply also comes from the PublicHealth Engineering Department (PHED) and Rural Water Supply Schemes (RWSS),government of West Bengal. These supplies are also from groundwater sources.Normally these tubewells are above 100m depth and 15–20% of these tubewells arealso arsenic contaminated above WHO recommended value of arsenic in drinkingwater of 10 mg/L and 5–10% above 50 mg/L. In this district, thousands of shallow bigdiameter tubewells (discharge 20 cubic meter of water per hour) are in use for irriga-tion and their numbers increasing every year. These wells in general are sunk withoutmaintaining the minimum safe distance between one and the other to avoid interfer-ence, which has resulted in a sharp decline in water level. A study report on Degangadone from 1980–1992 shows that water level fluctuation is increasing over the years.[31]
In North 24-Parganas the available surface water resource is enormous. Other thanrivers such as Ichhamati/Jamuna and Bhagirathi (in block Barakpore), flowingthrough North 24-Parganas, it has many big wetlands like, Nangla Beel, Bari Beel,Duma Beel, Kankan Beel, etc. The total area of these beels are about 90 sq. km. Areaof total ponds amounts to about 100 sq. km. Other than this it has flooded river basins,ox-bow lakes, a few canals and saline water bodies. One canal known as ‘‘MoraPadma’’ is about 15–20 km long. The annual rainfall of North 24-Parganas is about2000mm. Surface water was once the main source of water in North 24-Parganas.Use of it declined over last few decades and now in this district, groundwater is themain source of water for household and agriculture purposes neglecting the availablesurface and rain water. Since there is no water withdrawal regulation people usegroundwater as they wish.
Figure 2. Increase of arsenic affected blocks and villages/wards in West Bengal with time
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This article describes (a) arsenic contamination situation in one of the nine arsenicaffected districts, North 24-Parganas of West Bengal, (b) number of hand tubewellspresent in North 24-Parganas and people drinking contaminated water with arsenicabove 10 and 50 mg/L, (c) arsenic intake from food cultivated by arsenic contami-nated water, (d) arsenical neuropathy in affected villages, and (e) an estimation ofpopulation suffering from arsenical skin lesions in North 24-Parganas district.
MATERIALS AND METHODS
Instrumentation
Flow injection-hydride generation atomic absorption spectrometry (FI-HG-AAS)system was assembled from commercially available instruments and accessoriesin our laboratory. A Perkin-Elmer Model 3100 atomic absorption spectrometerequipped with a Hewlett-Packard Vectra Computer with GEM software, Perkin-Elmer EDL system-2, arsenic lamp (lamp current 400mA) and Varian AASModel Spectra AA-20 with hollow cathode As lamp (lamp current 10mA)were used. Details of the instrumentation have been described in our earlierpublications.[11,12,17,18]
Reagents and Glassware
All reagents were of analytical reagent grade. Distilled deionized water was usedthroughout. The reducing solution of 1.25% (m/v) NaBH4 (Merck, Germany) in0.5% (m/v) NaOH (E. Merck, India) and 5.0M solution of HCl (E. Merck, India)were used for flow injection analysis. Details of the reagents and glassware are givenelsewhere.[11,12]
Sample Collection
Tubewell water samples were collected in polyethylene bottles prewashed withnitric acid water (1:1) and after collection, nitric acid (0.1% v/v) was added aspreservative. Details of the collection procedures have been described in our earlierpublications.[11,12,17] Hair, nail, and urine were collected from arsenic victims andthose living in arsenic affected villages. Spot urine sample were collected in pre-washed polyethylene bottles. The samples were not subjected to any chemicaltreatment. Immediately after collection, the samples were stored in salt ice mixtureand later, on return to the laboratory kept at �20�C until analyses were carried out.Skin scale samples were collected from the people suffering from hyperkeratosis andkeratosis. Details of the collection procedure for hair, nail, skin-scales, and urinehave been described elsewhere.[11,12]
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Digestion Procedure
Inorganic arsenic and its metabolites were determined directly from urine sampleswithout any digestion. Procedure for cleaning and the mode of digestion of hair, nail,and skin-scale samples have been previously described.[11,12,17]
Analysis Procedure
Arsenic in water, acid digested hair, nail, skin-scale, and urine was measured byFI-HG-AAS. Details of procedure have been described elsewhere.[11,12,17]
RESULTS AND DISCUSSION
Water Analysis and Expected Number of Hand Tubewells in
North 24-Parganas
Out of 22 blocks of North 24-Parganas we have so far collected 48,030 watersamples from hand tubewells villagers are using for drinking and cooking. Table 2shows the water samples collected from each block and distribution of number ofsamples in different concentration ranges of arsenic. Figure 4 presents the bar diagramofconcentration ranges of arsenic against the percent of samples. It appears fromTable 2and Fig. 3 that out of 22 blocks in North 24-Parganas only 2 blocks i.e., Sandeskhali 1and Sandeskhali 2 are at present safe with respect to maximum permissible limit ofarsenic (50 mg/L). In Sandeskhali 1 and Sandeskhali 2, most of the tubewells are deep(above 150m). Shallow tubewells are saline, so people do not construct shallowtubewells. Due to same reason, we have not found arsenic in tubewells water ofsouthern part of Hingalganj block as all tubewells are of higher depth. But we gotarsenic in the northern part of Hingalganj area close to Hasnabad (Fig. 3) block whereshallow tubewells with sweet water are abundant. We have noticed that many deeptubewells (>100m) in Nadia, Murshidabad, and northern part of North 24-Parganasare contaminated. In the southern part of North and South 24-Parganas districts, thedeep tubewells are usually not contaminated, and the reason is that there are thick claybarriers separating the uncontaminated deep aquifer from contaminated one.
There is no officially available information on how many hand tubewells are pre-sent in North 24-Parganas district. Although we have collected and analyzed watersamples from 48030 hand tubewells fromNorth 24-Parganas, we still feel this is only asmall percentage of total tubewells we have analyzed fromNorth 24-Parganas. Privatetubewells are more than 90% of the existing hand tubewells in arsenic affected districtsof West Bengal. In most of the arsenic affected areas of these nine districts, usuallywater is available round the year in hand tubewells used and at shallow depth.Installation of a hand tubewell of one pipe and one filter (about 8m) is quite cheapand costs about 50US dollar. Inmany families there aremore than one hand tubewellsfor their use. It is no doubt that in all blocks of North 24-Parganas, number ofhand tubewells are not same. To get an idea of total number of hand tubewells in
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North 24-Parganas we surveyed for about a year the total number of hand tubewells inDeganga, one of the 22 blocks of North 24-Parganas and our door to door surveyshows the number of tubewells in Deganga block is close to 15,886. Total populationof Deganga is 234,142, so roughly 15 people are using one hand tubewell. Furtherfrom our semi-microlevel survey in Kolsur GP of Deganga block, we found that thereare 16,879 people and 1550 hand tubewells in the Kolsur GP. So 11 persons are usingone hand tubewell. From our study of number of users from one tubewell in arsenicaffected villages in Bangladesh and other blocks of West Bengal, we found in anaverage 20 peoples are using one tubewell, considering some of the blocks containmore tubewells, some of them less. We expect in 22 blocks of North 24-Parganas(population 4.1million) there are approximately 0.2million hand tubewells.
An Estimation of Population Drinking Arsenic Contaminated
Water Above 10mg/L and 50mg/L in North 24-Parganas(Only on the Basis of Our Survey)
To know about the number of people drinking arsenic contaminated water above10 and 50 mg/L in North 24-Parganas district, we (20 people) are working in all the22 blocks of North 24-Parganas for the last 7 years (total working hours 4600).A scientific approach is made on the data generated including 48,030 hand tubewell
Figure 4. Distribution of arsenic in tubewells water in North 24-Parganas district.
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water samples analyzed for arsenic only from North 24-Parganas district to knowpeople drinking contaminated water above 10 and 50 mg/L.
Table 3 shows water analysis for arsenic in all 22 blocks of North 24-Parganasand the percentage of tubewells having arsenic above 10 and 50 mg/L and thepopulation drinking arsenic contaminated water above 10 and 50 mg/L. FromTable 3 we have calculated people drinking arsenic contaminated water above 10and 50 mg/L on the basis of percentage of tubewells in the blocks having arsenicabove 10 and 50 mg/L which we expect directly related to population of each block.This is considered, as our survey report shows about 95% people in this district usetubewell water for drinking purpose and we have collected water samples coveringalmost equally from each village of the blocks. Total population in these 22 blocksaccording to 1991 Census is 4.1million. From Table 3 it appears 1.8million and0.93million people are drinking arsenic contaminated water above 10 and 50 mg/Lonly from 22 blocks of North 24-Parganas. To verify our approach of calculation,we have further studied one block Deganga of North 24-Parganas in detail.We collected water samples from all Gram Panchayets (GP) and villages andanalyzed 62.6% of the total tubewells of Deganga block (Table 4). In this blockfrom our detailed study we have found that 15 people are drinking water from onehand tubewell. On this basis when calculated it appears 135,795 and 88,950 peopleare drinking arsenic contaminated water above 10 and 50 mg/L, respectively. Thusour consideration of population in Denganga block from Table 3 drinking contami-nated water above 10 mg/L (133,460) and 50 mg/L (87,334) appears quite similar toour individual detailed study of Deganga block where we had covered 62.6% of thetotal tubewells. For further confirmation that we are not biased in our estimation wefully surveyed one village, Fakirpara of Kolsur GP (Table 5). From Table 5it appears that in Fakirpara village 95.6% and 89% people were drinking arseniccontaminated water above 10 and 50 mg/L, respectively. Thus it appears from thestudy of Deganga block and Fakirpara village i.e., a semi-microlevel and microlevelstudy that a higher percentage of people drinking contaminated water than we esti-mated as a whole for 22 blocks of North 24-Parganas (Table 3). So considering allresults, it appears that in 22 blocks of North 24-Parganas approximately 2.0millionpeople are drinking contaminated water above 10 mg/L and 1.0million above 50 mg/Lmay not be an over estimation. Total population of North 24-Parganas is 7.3millionaccording to 1991 Census and 8.9million in 2001 Census. In this calculation we havenot considered the population (3.1million according to 1991 Census) living in North24-Parganas which is part of greater Calcutta. Therefore, people drinking arseniccontaminated water above 10 and 50 mg/L in North 24-Parganas will be much higherthan what we calculated for 22 blocks of North 24-Parganas. In the same way totalnumber of tubewells will also increase.
Arsenic in Urine (Arsenic Metabolites) Hair, Nails, and Skin-Scales from
Villages of North 24-Parganas, Where We Have Found Arsenic Patients
Around 21,000 hair, nail, skin-scale, and urine (only arsenic metabolites weremeasured), samples were analyzed for arsenic from the villagers in the area where
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we have found arsenic patients is presented in Table 6. About 10–15% of thesesamples we have analyzed are from people having arsenical skin lesions. But theanalytical report shows that 87%, 56%, and 80% of the samples we have analyzedhave arsenic in urine, hair and nail above normal/toxic level (hair), respectively.During our dermatological survey in the affected villages we have observedthat often 30–40% population drinking the same arsenic contaminated water,may not show arsenical skin lesions, but their hair, nail, and urine contain highconcentration of arsenic. Thus many of the villagers may not be showing arsenicalskin lesions, but there is a possibility that they are sub-clinically affected. Theoverall water analysis results show (Fig. 4) that more than 47.2% of tubewellsare safe to drink according to the WHO recommended value (10 mg/L). So about47% people did not show an elevated level of arsenic in the biological samples. Tounderstand why body burden is higher to those using safe water for drinking andcooking but living in arsenic affected villages, we made a study. In our study[14]
safe water from a source having arsenic less than 2 mg/L has been supplied for 2years to 5 affected families to study in terms of loss of arsenic through urine,hair, and nail. The study finally showed that despite having safe water fordrinking and cooking, the study group could not avoid an intake of arsenictime and again through food grown in contaminated water, food materials con-taminated through washing and the occasional drinking of contaminated water.Even after minimizing the level of contamination it has been found that due toelevated background arsenic level, the concentration in urine does not reach anormal level.
ARSENIC FROM FOOD CHAIN IN AFFECTED VILLAGES
In arsenic affected areas ground water is the major source of water for agricul-ture and many of such sources are arsenic contaminated. We collected andanalyzed soil, rice and vegetable samples from 10 fields for 21 months whichwere cultivated using arsenic contaminated groundwater (arsenic concentrationrange was 103 mg/L to 827 mg/L) in Kolsur Gram-Panchayet in the Degangablock of North 24-Parganas district, West Bengal. The average arsenic concentra-tion in soil (n¼ 68), rice (n¼ 21), and vegetable (n¼ 44) are 22.60 mg/g(range 11.23 mg/g to 43.08 mg/g, dry weight), 0.323 mg/g (range 0.120 mg/g to0.663 mg/g, dry weight), and 0.027 mg/g [range 0.004 mg/g to 0.120 mg/g, wetweight (after conversion from dry weight to wet weight)], respectively. Ourpreliminary study by IC-ICPMS on total inorganic and organic arsenic compoundsin rice (n¼ 4) and vegetable (n¼ 7) irrigated by contaminated water show thataround 95% and 5% of the compounds are inorganic and organic arsenic inrice and 94% and 6% are inorganic and organic arsenic in vegetable, respec-tively.[10] From over all study of 21 months it appears that in villages wherecontaminated groundwater is used for cultivation and people consume local riceand vegetable more than 100 mg of arsenic per day is the contribution from riceand vegetable to individual villager.
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ARSENIC NEUROPATHY
In our field studies, we have been regularly examining patients of arsenic toxicityfor evidence of neurological involvement.[8,9,19] We have given due stress on analyz-ing neurological features in these cases as our observations on large number ofsubjects revealed disabling neurological symptoms frequently complained by thepatients. The exposed persons are clinically examined first of all for the primaryevidence of arsenical skin lesions. Those with identified source of drinking arseniccontaminated water are neurologically examined with special reference to the pre-sence of neuropathic symptoms and signs. Arsenic neuropathy is confirmed by thepresence of dermatological features and analyses of arsenic in water and biologicalsamples (hair, nail, and urine). Other possible causes and alternative explanations ofneuropathy are excluded in all the cases.
In North 24-Parganas, we examined 66 subjects with arsenical skin lesions resid-ing residence in village and Gram Panchayet, Mohanpur under Barrackpore 2 blockfor evidence of neuropathy. Their arsenic content of water was quite high and somefamilies were drinking water with arsenic level of 800 mg/L. Clinical neuropathieswere identified in 23 cases of the 66 subjects i.e., 34.8% of the cases. Of thesepatients, 20 (30.3%) cases were suffering predominantly from sensory neuropathyand 3 (4.5%) from sensorimotor neuropathy of which one patient was severelyaffected. The incidence of neuropathy in this group was somewhat less comparedwith 37.3% found in our studied group of patients from Nadia and Murshidabad.[9]
However, in another small group of 12 patients of arsenicosis from the village ofShibalaya, Kasimpur gram panchayet of Amdanga block of North 24-Parganas, theincidence of neuropathy was low, only 2 persons (16.7%) being affected. At the timeof neurological examination, these persons had already stopped ingestion of arseniccontaminated water for more than 5 years. One of these cases who presented withpersisting neurological features used to drink water with arsenic level as high as1007 mg/L and had arsenic level in nails 7240 mg/kg and in hair 3170 mg/kg 6 yearsearlier. His mother who was a patient of arsenicosis died with skin cancer. Themagnitude of neurological involvement depends on factors like duration andamount of arsenic exposure and nutritional status. In addition, our observationsrevealed that neuropathic disabilities were more common in persons with continuedarsenic exposure.
ARSENIC TOXICITY AND HEALTH STATUS OF NORTH
24-PARGANAS POPULATION FROM ARSENIC EXPOSURE
Toxicity of arsenic has been discussed in literature.[35–37] In West Bengal, thecommon arsenical symptoms have been discussed in our earlier publications.[9,21]
The USEPA has used the Reference Dose (RfD) as an estimation of a daily exposureto the human population that is likely to be without appreciable risk of detorioushealth effects, even if exposure occurs over a lifetime.[38–40] It is generally expressed inunits of milligram of As per kg of body weight per day (mg/kg/day). Usually, doses
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at or less than the RfD are not likely to be associated with adverse health effect butabove the RfD the probability of adverse effects will be increased. But it does notmean that all doses below the RfD are acceptable (risk free) and that all doses aboveRfD are unacceptable. The RfD is derived from a No-Observed-Adverse-Effect-Level (NOAEL), or Lowest-Observed-Adverse-Effect-Level (LOAEL), identifiedfrom subchronic or chronic study and divided by an uncertainty factor(s). The RfDis calculated as follows:
RfD ¼ ðNOAEL or LOAELÞ=Uncertainty FactorðsÞ
Selection of the uncertainty factor in the calculation of the RfD is based on profes-sional judgement, while considering the entire database of toxicological effects ofarsenic.
The health status of arsenic exposed individuals at Deganga area of North24-Parganas has been assessed through questionnaire responses[10,20] and through theuse of physician performed examination. In this study the dermatological featureswere used along with hair, nail, and urine analyses as indicator of arsenic toxicity.From our preliminary survey of last 7 years examining 33,000 people from arsenicaffected villages, we have registered 2274 (6.9%) people having arsenical skin lesions.During our survey in arsenic affected villages we are always looking for lowestconcentration of arsenic contaminated water that caused arsenical skin-lesions.Avoiding all possible errors we have so far identified three cases in a family inFakirpara village with diffuse melanosis and mild spotted melanosis who were drink-ing arsenic contaminated water close to 100 mg/L (arsenic in hair, nail, and urineabove normal level) out of 2274 patients registered from North 24-Parganas.Although it is found that even drinking 100 mg/L for many years[41] people of cityof Fallon, Nevada, USA are healthy without any complication. Even in our study inCalcutta we have found a family (6 people) drinking 260 mg/L arsenic (with 4 to6 times higher level of arsenic than normal level in hair, nail, and urine) but have noarsenical skin-lesions. We feel three important interrelated factors to be consideredfor arsenical skin lesions are (i) how long drinking, (ii) how much drinking,and (iii) nutrition status. From our field experience in arsenic affected villages ofWest Bengal and Bangladesh, it appears that poor people with malnutrition are moreaffected from arsenical skin lesions. We are calculating LOAEL to adults in North24-Parganas, West Bengal on the basis of the lowest concentration where we haveobserved arsenical skin lesions i.e., 100 mg/L. However, Mazumder[42] reported pig-mentation in 13 cases and thickening of palm and sole in 4 cases out of 3235 personsdrinking water having arsenic level between 10 mg/L and 50 mg/L.
For North 24-Parganas
LOAEL ¼ ð100mg=L� 4L=dayÞ=50kg ¼ 8mg=kg=day:
Considering consumption of 4L water per day and 50 kg average body weight.In this calculation contribution of arsenic from food chain has not been considered.Our preliminary study also shows that as arsenic contaminated groundwater is usedfor agriculture in arsenic affected villages, substantial amount of inorganic arsenic iscoming from food chain, mainly from rice and vegetable[10] to the villagers. Thusdrinking water alone should not be considered for calculation of LOAEL in the
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affected villages of North 24-Parganas. More study is needed to know arseniccontribution from food chain and its effect in LOAEL calculation. For calculationof NOAEL we have assumed the arsenic in drinking water that produced no arsenicalskin lesions for life long exposure (WHO’s finding) i.e., 10 mg/L. So the value comes
NOAEL ¼ ð10mg/L� 4L=dayÞ=50 kg ¼ 0:8 mg=kg=day:
Here also arsenic content in food per day has not been considered.The values have been compared with several other studies, Chakraborty and
14 mg/kg/day; Abernathy et. al.[38] LOAEL¼ 14 mg/kg/day. Taking together, severalstudies all over the world, there is an indication that chronic intakes of about10 mg/kg/day or higher may result in dermatological and other signs of arsenic toxicityand several studies indicate that values below 1 mg/kg/day have no significant effect.[46]
Based on these considerations the reference dose (RfD) from the NOAEL value isas below.
RfD ¼ ð0:8 mg=kg=dayÞ=3 ¼ 0:26 mg=kg=day:
where 0.8 mg/kg/day¼NOAEL and uncertainly factor¼ 3.
Dermatological Features of the People of North 24-Parganas District
A systematic approach to study arsenical dermatological features of the affectedvillagers in North 24-Parganas was started from September, 1994. During the last84 months, we spent 12 months (about 2000 h) in a door to door dermatological andsocio-economic study[10,20] in one Gram Panchayet, Kolsur of Deganga block ofNorth 24-Parganas. The total population of Kolsur GP is 16,879 and out of thatwe had examined 11,000 people, and we have identified 580 villagers with arsenicalskin lesions (5.3%). During last 7 years other than Kolsur GP, we visited with ourmedical team 80 times (600 h) in arsenic affected villages in 10 blocks of North24-Parganas and examined 33,000 people, and found 2274 (6.9%) people witharsenical skin lesions. Out of 22 blocks of North 24-Parganas, in 16 blockswe have identified arsenic patients, and so far we have surveyed only 62 villages in10 blocks with dermatologists in a scattered way, and in the rest 6 blocks, we haveidentified arsenic patients but could not make a routine study with dermatologistsdue to time constraint and man power shortage. A preliminary survey report ispresented in Table 7.
Distribution of dermatological features of the arsenic victims of North24-Parganas district is presented in Fig. 5.
Cancer and Gangrene Patients in North 24-Parganas
During our field survey in all 62 villages where we have found arsenic patients,at least a couple of families from each village reported pre-mature death of their
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relatives and death due to cancer, who had arsenical skin lesions. However, we haveno proof that the deaths were due to arsenicosis. In fact, in the remote villages evena death certificate is not necessary for cremation. A few examples can be cited out ofa few hundreds reported by villagers.
A resident (female, age¼ 30; village Merudandi; block: Basirhat) is at presentsurviving with her only son (age 12) and both of them have arsenical skin lesions(Fig. 6). She told us that her husband, father-in-law, mother-in-law, and second wifeof her husband, all died of cancer and all of them had severe skin lesions of the typeshe has. Another villager, of village Tegharia, Mathpara, Gaighata block, handedover to us a list of nine people from families surrounding his house (and most ofthem are his distant relatives) which included his brother, and all of them had died ofcancer during the last 10 years, and all of them had severe skin lesions. InKamarpara of Shanpukur village of Deganga block, a large number of people areaffected by arsenical skin lesions and some of seriously affected villagers died of
Figure 5. Distribution of common dermatological features due to arsenicosis among thevictims of North 24-Parganas district of West Bengal. SM_P¼ Spotted melanosis on palm;
DM_P¼Diffuse melanosis on palm; SM_T¼ Spotted melanosis on trunk; DM_T¼Diffusemelanosis on trunk; LEU_M¼Leuco melanosis; WB_M¼Whole body melanosis;SK_P¼ Spotted keratosis on palm; DK_P¼Diffuse keratosis on palm; SK_S¼ Spotted kera-
tosis on sole; DK_S¼Diffuse keratosis on sole; Dor¼Dorsal keratosis; CH_BRON¼Chronicbronchitis; LIV_EN¼Liver enlargement; and CARCI¼Carcinoma.
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cancer. These are only a few out of the many cases in North 24-Parganas. Usually, atthe village-level, pathological reports of ulcers in patients who have arsenical skinlesions are not available unless we take the initiative to test it. Table 8 shows thedermatological features of eight such pathologically confirmed cancer patients withsevere skin lesions from North 24-Parganas. Figures 7 and 8 show some of them.We are almost ignorant of the people in these blocks suffering from internal cancersamong those having arsenical skin lesions. The reason we do not get information ofinternal cancers is that the villagers are too poor to make such expensive investiga-tions. Other than cancer, we have many examples where amputation was donebecause of gangrene in arsenic affected patients (Fig. 9). What we are observing inour followup study among seriously arsenic affected patients is that, in course of
Figure 6. Mother with her only son, both having arsenical skin lesions (village: Merudandi,
block: Basirhat- I, North 24-Parganas, West Bengal).
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time, many of them are getting cancer. In village Ambikanagar, block Degangawe found a patient (Fig. 10) who had an ulcer during February, 1995 but withinnext 2 years he died of cancer. Biagini while studying Monte Quemado arsenicincident of Cordoba province, Argentina[47] followed 116 patients with clear sign ofchronic arsenic disease over a number of years. After 15 years of follow up,[48] 78 haddied, 24 from cancer (30.7%).
Probable Estimation of Population Suffering from Arsenical
Skin Lesions in North 24-Parganas
Just as it is often asked, how many people are drinking arsenic contaminated waterabove 10 and 50 mg/L in the arsenic affected districts, so also it is frequently asked, howmany people are suffering from arsenical skin lesions in these affected nine districts?During the last 7 years, we have done some study to understand this situation.According to toxicologists, arsenical skin lesions should not be considered as a simpleskin disease. The manifestation on skin is the effect of internal damage. In EPAreport[35,46] while calculating RfD and drinking water equivalent level (DWEL) it isstated that chronic intake of about 10 mg/kg/day or higher may result in dermatolo-gical and other signs of arsenic toxicity. World Health Organization in its report[49]
states—several years of exposure of approximately 1000 mg of arsenic per day may
Figure 7. Bowens with spotted, diffuse and leuco-melanosis (village: Bishnupur, block:
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give rise to skin effects. In the arsenic affected areas of West Bengal average adultsdrink 4L of water per day,[10] so 1000 mg of arsenic per day is equivalent to 4Lof 250 mg/L of arsenic-containing water. According to a study conducted byChakraborty and Saha et al.[43] in 14 villages of West Bengal, the lowest arsenicconcentration in drinking water producing dermatosis was found to be 200 mg/L.The report from Thailand also indicates arsenical dermatosis from 200 mg/L of arsenicin drinking water.[50] From the observations in the Cordoba (North Argentina) it isconcluded[47] that regular intake of drinking water containing more than 100 mg/L ofarsenic leads to clearly recognizable signs of intoxication.
For, how long the people of affected villages in West Bengal are drinking contami-nated water and suffering from arsenical skin lesions are not known. The first report
Figure 8. Squamous cell carcinoma (SCC) on head and thumb (village: Chandpur Rail line,
Block: Basirhat-II, North 24-Parganas, West Bengal).
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published on this issue was by Saha[51] where it was stated that 18 cases were clinicallydiagnosed at the School of Tropical Medicine’s skin out patients department during1983. They came from two districts; 24-Parganas and Nadia. An arsenic patient whodied recently in Jadavpur, Calcutta, stated in his interview[52] that he got his skinlesions during the late 70s, although he was diagnosed to be an arsenic patient in1988. During our field survey we asked the old villagers from when they were findingthe skin lesions and they reported that it was from the late 70s.[53]
On the basis of available information about the concentration of arsenic in drinkingwater that may result skin lesions we grouped 100 mg/L of Cordoba,[47] 200 mg/L ofWest Bengal[43] and Thailand,[50] WHO reported value 1000 mg/day[49] which isequivalent to 250 mg/L considering from our study water consumption 4L per dayfor adults in North 24-Parganas.[10] EPA’s report that chronic intake of 10 mg/kg/dayconsumption of arsenic may cause dermatological and other sign of toxicity[35,46] hasalso been considered. 10 mg/kg/day is equivalent to 125 mg/L of arsenic in tubewell
Figure 9. Right leg amputated due to gangrene (village: Merudandi, block: Basirhat-I, North24-Parganas, West Bengal).
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water considering 50 kg per body weight from our field study for adults and 4L ofwater consumption per day. Finally from our last 15 years field experience in WestBengal and 7 years in Bangladesh registering 12,195 patients with arsenical skinlesions, we may expect that 300 mg/L arsenic in drinking water for many years maycause arsenical skin lesions. We have presented in Table 9, number of people drinkingarsenic contaminated water in North 24-Parganas at the concentration of 100, 125,200, 250, and 300 mg/L and may suffer from arsenical skin lesions.
The population that may have arsenical skin lesions in North 24-Parganas asdescribed above is calculated on the basis of 48,030 water samples analysis fromNorth 24-Parganas and also considering the observation from various workers andthose of WHO and EPA. From Table 9, it appears about 0.1million people are
Figure 10. Squamous cell carcinoma (SCC) on sole with spotted keratosis (village:Ambikanagar, block: Deganga, North 24-Parganas, West Bengal).
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drinking arsenic contaminated water above 300 mg/L from North 24-Parganas andmay have arsenical skin lesions. Since many features like (a) quantity and concen-tration of arsenic in water individual drinking (b) nutrition status, and (c) synergisticand antagonistic effect of the other compounds present in water may play an impor-tant role,[54] the effect may vary from area to area, country to country. For last 7years we are making systematic dermatological surveys in the affected villages of sixaffected districts of West Bengal (in Burdwan district only two blocks covered forpatient screening) and 7 years in 31 arsenic affected districts of Bangladesh. Westarted to work in North 24-Parganas from 1988 and at the beginning survey wasdone occasionally, but during the last 7 years a detailed study was done on onedistrict North 24-Parganas, one block Deganga, one GP Kolsur, and one villageFakirpara, of the same district. An attempt was made to find a corelation on actualsurvey results and calculations made on the basis of water analysis where people aredrinking arsenic contaminated water at various levels.
In our preliminary dermatological survey so far we have examined at random86,000 people from affected villages of six arsenic affected districts (North24-Parganas, South 24-Parganas, Murshidabad, Nadia, Malda, and Burdwan) ofWest Bengal. In other three affected districts, Hooghly, Howrah, and Calcutta wehave not yet screened people for arsenical skin lesions. From these six districts wehave registered 8500 (9.8%) people with arsenical skin lesions. In the whole North24-Parganas we have examined 33,000 people, and out of them 2274 (6.9%) havebeen identified with arsenical skin lesions. While surveying the district North24-Parganas, we have realized after 600 h study for screening arsenic patients in North24-Parganas that we have covered only a small portion of the whole district, so wedecided to cover in details Deganga, one of the 22 blocks of North 24-Parganas.From Deganga block we had examined 11,870 people and 786 (6.6%) people havebeen identified as patient. We further realized that one block like Deganga is eventoo much for a detail study, so we considered to a semi-microlevel study in one grampanchayet. We chosen Kolsur GP of Deganga block, North 24-Parganas district.The total population of Kolsur is 16,879 and we had examined at random 11,000(65%) and found 580 people (Table 10) with arsenical skin lesions (5.3%) although2059 people were drinking arsenic contaminated water above 300 mg/L. A furtherextensive epidemiological study was made jointly with the Institute for PostGraduate Medical Education and Research, Calcutta for a year[55] in 57 villagesof 21 blocks of South 24-Parganas district (7683 people were examined by hometo home visit). An intensive survey of 5087 people residing in 25 arsenic affectedvillages of five affected blocks (Baruipur, Sonarpur, Bhanger-I/II, and Magrahat-II)was made. The clinical and epidemiological survey demonstrated that pigmentation(8.82%) and keratosis (3.64%) were the most specific diagnostic parameters ofchronic arsenicosis. Further, clinical examination of scattered households of twovillages per block was carried out in the form of a scattered survey. This surveyincluded 2596 persons belonging to 32 villages of 16 blocks. The prevalence ofchronic arsenicosis, characterized by pigmentation was found among 5% of thestudied population.[55] This survey has quite a lot of similarity with our study onKolsur GP. Although over all study shows that 5% of the population may havearsenical skin lesions but there are many villages where more people are suffering.
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One such village is Fakirpara village (GP: Kolsur; block: Deganga; district: North24-Parganas) we had examined all 764 people of the village and found 175 witharsenical skin lesions (22.9%) (Table 5).
CONCLUSION
From the overall study of North 24-Parganas, one of the nine arsenic affecteddistricts of West Bengal, it appears that the magnitude of the calamity in this district ismore severe than what our preliminary study showed. The study has further revealedthat cancer patients are increasing among those suffering from severe arsenical skinlesions. It is reported that children are more susceptible to arsenic poisoning butusually do not show arsenical skin lesions[8,9] before the age of 10 (exceptionsare found if the water contains very high arsenic or moderate arsenic with severemalnutrition). Thus a new generation may be at risk. Since at present there is almostnomedicine for chronic arsenic poisoning, scientists all over the world should considerthe issue a major challenge and find out a way to save the affected population. It isobserved from our study that people having mild arsenical skin lesions may get betterwhen safe water is used and skin lesions in many cases disappear. A safe water supplyis amatter the government should consider immediately. SinceWest Bengal has a hugesurface water resource, above 2000mm of annual rainfall, a proper watershedmanagement is urgently needed. Surface water management and its proper utilizationfor pisciculture, duck-breeding etc., may enhance the state’s economy.
ACKNOWLEDGEMENT
The authors thank Shankar Dey, Bijan Pal, Pijush Ray, Manik Pal, Shibu Pal,Rahul Amin, and Nakuleshwar Pal for their extensive help in the field survey. Theauthors also thank GautamDas, Shikha Chowdhury, Shyamal Biswas, Anup Sarkar,and Ashok Das of Gaighata Science Organisation, Gaighata, North 24-Parganas,West Bengal for field survey. Financial support from School of EnvironmentalStudies, Jadavpur University is greatly acknowledged.
REFERENCES
1. Economic and Social Commission for Asia and the Pacific; Geology and Health:Solving the Arsenic Crisis in the Asia Pacific Region. ESCAP-UNICEF-WHOExpert Group Meeting, Bangkok, May 2–4, 2001.
2. Berg, M.; Tran, H.C.; Nguyen, T.C.; Pham, M.V.; Schertenleib, R.; Giger, W.Arsenic contamination of groundwater and drinking water in vietnam: A humanhealth threat. Environmental Science and Technology 2001, 35 (13), 2621–2626.
3. Smith, A.H.; Lingas, E.O.; Rahman, M. Contamination of drinking water ofarsenic in Bangladesh. A Public Health Emergency. Bull. World Health Org.2000, 78 (9), 1093–1103.
MARCEL DEKKER, INC. • 270 MADISON AVENUE • NEW YORK, NY 10016
4. Tondel, M.; Rahman, M.; Magnuson, A.; Chowdhury, I.A.; Faruqee, M.H.;Ahmad, S.A. The relationship of arsenic levels in drinking water and theprevalence rate of skin lesions in Bangladesh. Environ. Health Perspect.1999, 107, 727–729.
5. Ahmad, S.A.; Bandarnayake, D.; Khan, A.W.; Hadi, S.A.; Gias, U.; Halim,M.A. Arsenic contamination in groundwater and arsenicosis in Bangladesh.Int. J. Environ. Health Res. 1997, 7, 271–276.
6. Watanabe, C. Environmental arsenic exposure in Bangladesh: water versusextra-water intake of arsenic. Environ. Sci. 2001, 8 (5), 459–466.
7. Milton, A.H.; Hasan, Z.; Rahman, A.; Rahman, M. Chronic arsenic poisoningand respiratory effects in Bangladesh. J. Occup. Health. 2001, 43, 136–140.
8. Chowdhury,U.K.; Biswas, B.K.; Chowdhury, T.R.; Samanta,G.;Mandal, B.K.;Basu, G.K.; Chanda, C.R.; Lodh, D.; Saha, K.C.; Mukherjee, S.C.; Roy, S.;Kabir, S.; Quamruzzaman, Q.; Chakraborti, D. Groundwater arsenic contami-nation in Bangladesh and West Bengal, India. Environ. Health Perspect. 2000,108, 393–397.
9. Rahman, M.M.; Chowdhury, U.K.; Mukherjee, S.C.; Mandal, B.K.; Paul, K.;Lodh, D.; Biswas, B.K.; Chanda, C.R.; Basu, G.K.; Saha, K.C.; Roy, S.;Das, R.; Palit, S.K.; Quamruzzaman, Q.; Chakraborti, D. Chronic arsenictoxicity in Bangladesh and West Bengal, India: a review and commentary.Clinical Toxicology 2001, 39 (7), 683–700.
11. Chatterjee, A.; Das, D.; Mandal, B.K.; Chowdhury, T.R.; Samanta, G.;Chakraborti, D. Arsenic in ground water in six districts of West Bengal,India: the biggest arsenic calamity in the world, Part I. Arsenic Species inDrinking Water and Urine of the Affected People. Analyst 1995, 120, 643–650.
12. Das, D.; Chatterjee, A.; Mandal, B.K.; Samanta, G.; Chakraborti, D. Arsenicin ground water in six districts of West Bengal, India: the biggest arseniccalamity in the world, Part II. Arsenic concentration in drinking water, hair,nails, urine, skin-scale and liver tissue (Biopsy) of the affected people. Analyst1995, 120, 917–924.
13. Das, D.; Samanta, G.; Mandal, B.K.; Chowdhury, T.R.; Chanda, C.R.;Chowdhury, P.P.; Basu, G.K.; Chakraborti, D. Arsenic six districts of WestBengal, India. Environ. Geochemistry and Health 1996, 18, 5–15.
14. Mandal, B.K.; Roy Chowdhury, T.; Samanta, G.; Mukherjee, D.P.;Chanda, C.R.; Saha, K.C.; Chakraborti, D. Impact of safe water for drinkingand cooking on five arsenic affected families for 2 years in West Bengal, India.Science of the Total Environment 1998, 218, 185–201.
MARCEL DEKKER, INC. • 270 MADISON AVENUE • NEW YORK, NY 10016
16. Chakraborti, D.; Basu, G.K. Biswas, B.K.; Chowdhury, U.K.; Rahman, M.M.;Paul, K.; Chowdhury, T.R.; Chanda, C.R.; Lodh, D. Characterization ofarsenic bearing sediments in gangetic delta of West Bengal-India. In ArsenicExposure and Health Effects; Chappell, W.R., Abernathy, C.O., Calderon,R.L., Eds.; Elsevier Science: New York, 2001; 27–52.
17. Samanta, G.; Roy Chowdhury, T.; Mandal, B.K.; Biswas, B.K.; Chowdhury,U.K.; Basu, G.K.; Chanda, C.R.; Lodh, D.; Chakraborti, D. Flow injectionhydride generation atomic absorption spectrometry for determination ofarsenic in water and biological samples from arsenic affected districts of WestBengal, India and Bangladesh. Microchemical Journal 1999, 62, 174–191.
18. Samanta,G.; Chakraborti,D. Flow injection atomic absorption spectrometry forthe standardization of arsenic, lead and mercury in environmental and biologicalstandard reference materials. Frenius J. Anal. Chem. 1997, 357 (7), 827–832.
19. Chowdhury, U.K.; Biswas, B.K.; Roy Chowdhury, T.; Mandal, B.K.; Samanta,G.; Basu, G.K.; Chanda, C.R.; Lodh, D.; Saha, K.C.; Mukherjee, S.C.; Roy, S.;Kabir, S.; Quamruzzaman, Q.; Chakraborti, D. Arsenic groundwater contam-ination and sufferings of people in West Bengal, India and Bangladesh. In TraceElements in Man and Animals 10; Roussel, A.M., Anderson, R.A., Favier, A.E.,Eds.; Plenum Corporation: New York, 2000; 645–650.
20. Mandal, B.K.; Biswas, B.K.; Dhar, R.K.; Roy Chowdhury, T.; Samanta, G.;Basu, G.K.; Chanda, C.R.; Saha, K.C.; Kabir, S.; Roy, S; Chakraborti, D.Groundwater arsenic contamination and sufferings of people in west bengal,India and Bangladesh: status report up to March 1998. In Metals and Genetics;Sarkar, B., Ed.; Plenum Corporation: New York, 1999; 41–66.
21. Roy Chowdhury, T.; Mandal, B.K.; Samanta, G.; Basu, G.K.; Chowdhury,P.P.; Chanda, C.R.; Karan, N.K.; Dhar, R.K.; Lodh, D.; Das, D.; Saha, K.C.;Chakraborti, D. Arsenic in groundwater in six districts of West Bengal, Indiathe biggest arsenic calamity in the world: the status report up to August 1995.In Arsenic: Exposure and Health Effects; Abernathy, C.O., Calderon, R.L.,Chappell, W.R., Eds.; Chapman & Hall: London, 1997; 91–111.
23. Lian, F.W.; Jian, Z.H. Chronic arsenism from drinking water in some areas ofXinjiang, China. In Arsenic in the Environment. Part II: Human Health andEcosystem Effects; Nriagu, J.O., Ed.; John Wiley and Sons Inc.: New York,1994; 159–172.
24. Xiao, J.G. 96% well water is underintakable. Asia Arsenic Network Newsletter1997, 2, 7–9.
25. Tseng, C.H.; Tai, T.Y.; Chong, C.K.; Tseng, C.P.; Lai, M.S.; Lin, B.J.;Chiou, H.Y.; Hsueh, Y.M.; Hsu, K.H.; Chen, C.J. Long term arsenic exposureand incidence of non insulin dependent diabetes mellitus: a cohort study inarseniasis-hyperendemic villages in taiwan. Environ. Health Perspect. 2000,108 (9), 847–851.
26. Tseng, W.P.; Chen, W.Y.; Sung, J.L.; Chen, J.S. A clinical study of blackfootdisease in taiwan: an endemic peripheral vascular disease. Mem. Coll. Med.Natl. Taiwan Univ. 1961, 7, 1–17.
MARCEL DEKKER, INC. • 270 MADISON AVENUE • NEW YORK, NY 10016
27. Yeh, S. Relative incidence of skin cancer in Chinese in Taiwan: with specialreference to arsenical cancer. Natl. Cancer Inst. Monogr. 1963, 10, 81–107.
28. Tseng, W.P.; Chu, H.M.; How, S.W.; Fong, J.M.; Lin, C.S.; Yen, S. Prevalenceof skin cancer in an endemic area of chronic arsenicism in Taiwan. J. Natl.Cancer Inst. 1968, 40, 453–463.
29. International Conference on Arsenic Pollution of Groundwater in Bangladesh:Cause, Effects and Remedies, Jointly Organized by School of EnvironmentalStudies, Jadavpur University, India and Dhaka Community Hospital,Bangladesh, Dhaka, February 8–12, 1998.
30. Pearce, F. Arsenic in theWater. The Guardian, London, February 19, 1998, 1–3.31. Report on Arsenic Pollution in Groundwater in West Bengal, October 1994,
Committee constituted by Government of West Bengal, Vide NotificationNo. PHE-1/716/3D-1/88 Part I Dated 6.4.1992 of PHE Dept. Government ofWest Bengal.
32. Arnold, H.L.; Odam, R.B.; James, W.D. Disease of the Skin. In ClinicalDermatology; W.B. Saunders: Philadelphia, 1990.
33. Ioanid, N.; Bors, G.; Popa, I. Beitage zur kenntnis des normalen arsengehaltesvon nageln and des gehaltes in den faillen von arsenpolyneuritits [in German].Zeit Gesamte Gerichtl Med. 1961, 52, 90–94.
34. Farmer, J.G.; Johnson, L.R. Assessment of occupational exposure to inorganicarsenic based on urinary concentrations and speciation of arsenic. Br. J. Ind.Med. 1990, 47, 342–348.
35. National Research Council. Arsenic in Drinking Water; National AcademyPress: Washington, DC, 1999.
36. Arsenic in Drinking Water 2001 Update; National Academy Press: Washington,DC, 2001.
37. World Health Organization. Environmental Health Criteria 224, Arsenic andArsenic compounds, 2nd Ed.; Geneva, 2001.
38. Abernathy, C.O.; Marcus, W.; Chen, C.; Gibb, H.; Write, P. Report on ArsenicWork Group Meeting, Office of Drinking Water, Office of Research andDevelopment, USEPA, Memorandum to Cork, P.; Preuss, P. Office ofRegulatory Support and Scientific Management, USEPA, 1989.
39. USEPA Integrated Risk Information System (IRIS). Online. Office of Healthand Environmental Assessment, Environmental Criteria and Assessment Office,Cincinnati, O.H., 1993.
40. Abernathy, C.O.; Dourson, M.L. Derivation of the inorganic arsenic referencedose. In Arsenic Exposure and Health; Chappell, W.R., Abernathy, C.O.,Cothern,C.R.,Eds.; ScienceandTechnologyLetters:Northwood,1994;295–303.
41. Fontaine, J.A. Regulating arsenic in nevada drinking water supplies pastproblems, future challenges. In Arsenic Exposure and Health; Chappell,W.R., Abernathy, C.O., Cothern, C.R., Eds.; Science and TechnologyLetters: Northwood, 1994; 285–288.
42. Guha Mazumder, D.N. Chronic arsenic toxicity in West Bengal. Curr. Sci.1997, 72 (2), 114.
43. Chakraborty, A.K.; Saha, K.C. Arsenical dermatosis from tubewell water inWest Bengal. Ind. J. Med. Res. 1987, 85, 326–334.
45. Cerbrian, M.E.; Albores, A.; Aquilar, M.; Blakely, E. Chronic arsenic poison-ing in the north of Mexico. Human Toxicol. 1983, 2, 121–133.
46. Draft drinking water criteria document on arsenic submitted by human riskassessment branch. Health and Ecological Criteria Division, Office of Scienceand Technology, Office of water, US Environmental Protection Agency:Washington, D.C., 1992.
47. Biagini, R.E. Hidroarsenicismo cronico y muertr por canceres malignos(in Spanish). Semana Medica 1972, 141, 812–816.
48. Astolfi, E.; Maccagno, A.; Fernandez, J.C.G.; Vaccara, R.; Stimola, R.Relation between arsenic in drinking water and skin cancer. Biological TraceElement Research 1981, 3, 133–143.
49. World Health Organization. Arsenic: Environmental Health Criteria 18,Geneva, Switzerland, 1981.
50. Oshikawa, S. Re-examination of a Cohort of Subjects with Arsenical SkinLesions Ten Years after Inception. M.Sc. Thesis in Epidemiology, Prince ofSongkla University, 1998.
52. I don’t want to die. The Statesman, a daily newspaper, Calcutta, March 22,1998www.thestatesman.net
53. Chakraborti, D.; Rahman, M.M.; Chowdhury, U.K.; Sengupta, M.K.; Lodh,D.; Chanda, C.R.; Saha, K.C.; Mukherjee, S.C. Arsenic calamity in the indiansub-continent. What lesions have been learned? Talanta 2002, 58, 3–22.
54. Harding-Barlow, I. What is the status of arsenic as a human carcinogen. InArsenic Industrial, Biomedical, Environmental perspectives; Lederer, W.H.,Fensterheim, R.L., Eds.; Nostrand Reinhold: New York, 1983; 203–209.
55. Guha Mazumder, D.N.; Haque, R.; Ghosh, N.; De, B.K.; Santra, A.;Chakraborti, D.; Smith, A.H. Arsenic in drinking water and the prevalenceof respiratory effects in West Bengal, India. International J. of Epidemiology2000, 29, 1047–1052.
