•Arsenic contamination of groundwater in all 17 blocks of Nadia, India.•People exposed to contaminated water, may suffer from skin lesions and cancer.•Arsenic and iron in groundwater with depths, arsenic in biologic samples.•Dermal and neurologic effects of arsenic, arsenical toxicity in children.•Results are compared with two highly affected districts of West Bengal.

基于近19年对印度Ganga-Meghna-Brahmaputra(简称 GMB)平原(面积569 749 km2,人口超过5亿)地下水砷污染的调查,可以确定印度Ganga-Brahmaputra平原(包括北方邦、比哈尔邦、恰尔康得邦、西孟加拉邦、阿萨姆邦)和孟加拉国普遍受到砷的污染.近期的调查研究也表明,除米佐拉姆邦外,其他各邦的地下水也受到不同程度的砷污染.至今为止,已对印度各邦和孟加拉国的175 000份和50 808份压把井水样进行了含砷量检测,并组织了一支包括皮肤科、神经科和妇产科医生在内的有经验的专家组,对上述地区125 000人进行了临床检查,其中9%患有砷导致的皮肤病损症状.至今共采集分析了60 000份生物样品,包括发样、指甲、尿样及皮肤鳞屑,其中80%的样品含砷量超过允许值,很多人由此受到砷的亚临床损害.在上述砷暴露地区,19 000名儿童经过检查,近1 100人患有砷导致的皮肤病损.该调查结果表明,儿童比成人更容易受到砷的毒性损害.在这种状况下,应着力解决饮水安全问题来减轻砷的危害。

To better understand the magnitude of arsenic contamination in groundwater and its effects on human beings, a detailed study was carried out in Jalangi, one of the 85 arsenic affected blocks in West Bengal, India. Jalangi block is approximately 122 km2 in size and has a population of 215538. Of the 1916 water samples analyzed (about 31% of the total hand tubewells) from the Jalangi block, 77.8% were found to have arsenic above 10 μg l−1 [the World Health Organization (WHO)-recommended level of arsenic in drinking water], 51% had arsenic above 50 μg l−1 (the Indian standard of permissible limit of arsenic in drinking water) and 17% had arsenic at above 300 μg l−1 (the concentration predicting overt arsenical skin lesions). From our preliminary medical screening, 1488 of the 7221 people examined in the 44 villages of Jalangi block exhibit definite arsenical skin lesions. An estimation of probable population that may suffer from arsenical skin lesions and cancer in the Jalangi block has been evaluated comparing along with international data. A total of 1600 biologic samples including hair, nail and urine have been analyzed from the affected villages of Jalangi block and on an average 88% of the biologic samples contain arsenic above the normal level. Thus, a vast population of the block may have arsenic body burden. Cases of Bowen's disease and cancer have been identified among adults who also show arsenical skin lesions and children in this block are also seriously affected. Obstetric examinations were also carried out in this block.

An in-depth study was carried out in Rajapur, an arsenic-affected village in West Bengal, India, to determine the degree of groundwater contamination with arsenic and the impact of this contamination on residents. The flow injection hydride generation atomic absorption spectrometry (FI-HG-AAS) method was used to measure arsenic concentrations in water and biological samples. Dermatologists recorded the dermatological features of arsenicosis. Out of a total of 336 hand-pumped tube-wells in Rajapur, 91% (307/336) contained arsenic at concentrations > 10 microg/l, and 63% (213/336) contained arsenic at > 50 microg/l. The type of arsenic in groundwater, the variation in concentrations of arsenic as the depth of tube-wells changed, and the iron concentration in the wells were also measured. Altogether 825 of 3500 residents were examined for skin lesions; of these, 149 had lesions caused by exposure to arsenic. Of the 420 biological samples collected and analysed, 92.6% (389) contained arsenic at concentrations that were above normal. Thus many villagers might be subclinically affected. Although five arsenic-filtering devices had been installed in Rajapur, it appears that villagers are still exposed to raised concentrations of arsenic in their drinking-water. Detailed village-level studies of arsenic-affected areas in West Bengal are required in order to understand the magnitude of contamination and its effects on people. Villagers are ill-informed about the dangers of drinking arsenic-contaminated water. The contamination could be brought under control by increasing community awareness of the dangers and implementing proper watershed management techniques that involve local people.

Introduction. To understand the severity of related health effects of chronic arsenic exposure in West Bengal, a detailed 3-year study was carried out in Murshidabad, one of the nine arsenic-affected districts in West Bengal. Methods. We screened 25,274 people from 139 arsenic-affected villages in Murshidabad to identify patients suffering from chronic arsenic toxicity for evidence of multisystemic features and collected biological samples such as head hair, nail, and spot urine from the patients along with the tubewell water they were consuming. Results. Out of 25,274 people screened, 4813 (19%) were registered with arsenical skin lesions. A case series involving arsenical skin lesions resulting in cancer and gangrene were noted during this study. Representative histopathological pictures of skin biopsy of different types of lesions were also presented. Out of 2595 children we examined for arsenical skin lesions, 122 (4%) were registered with arsenical skin lesions, melanosis with or without keratosis. Different clinical and electrophysiological neurological features were noticed among the arsenic-affected villagers. Both the arsenic content in the drinking water and duration of exposure may be responsible in increasing the susceptibility of pregnant women to spontaneous abortions, stillbirths, preterm births, low birth weights, and neonatal deaths. Some additional multisystemic features such as weakness and lethargy, chronic respiratory problems, gastrointestinal symptoms, and anemia were also recorded in the affected population. Discussion. The findings from this survey on different health effects of arsenic exposure were compared to those from previous studies carried out on arsenic-affected populations in India and Bangladesh as well as other affected countries. Conclusion. Multisystemic disorders, including dermal effects, neurological complications, and adverse obstetric outcomes, were observed to be associated with chronic arsenic exposure in the study population in Murshidabad, West Bengal. The magnitude of severity was related to the concentration of arsenic in water as well as duration of the exposure.

magnitude of arsenic groundwater contamination, and its related health effects, in the Ganga-MeghnaBrahmaputra (GMB) plain—an area of 569,749 km2, with a population of over 500 million, which largely comprises the flood plains of 3 major river systems that flow through India and Bangladesh. Design: On the basis of our 17-yr–long study thus far, we report herein the magnitude of groundwater arsenic contamination, its health effects, results of our analyses of biological and food samples, and our investigation into sources of arsenic in the GMB plain Setting: The GMB plain includes the following states in India: Uttar Pradesh in the upper and middle Ganga plain, Bihar and Jharkhand in the middle Ganga plain, West Bengal in the lower Ganga plain, and Assam in the upper Brahmaputra plain. The country of Bangladesh is located in the Padma-Meghna-Brahmaputra plain. In a preliminary study,1 we identified arsenic in water samples from hand-operated tubewells in the GMB plain. Levels in excess of 50 ppb (the permissible limit for arsenic in drinking water in India and Bangladesh) were found in samples from 51 villages in 3 arsenic-affected districts of Uttar Pradesh, 202 villages in 6 districts in Bihar, 11 villages in 1 district in Jharkhand, 3,500 villages in 9 (of a total of 18) districts in West Bengal, 2,000 villages in 50 (of a total of 64) districts in Bangladesh, and 17 villages in 2 districts in Assam. Study Populations: Because, over time, new regions of arsenic contamination have been found, affecting additional populations, the characteristics of our study subjects have varied widely. We feel that, even after working for 17 yr in the GMB plain, we have had only a glimpse of the full extent of the problem. Protocol: Thus far, on the GMB plain, we have analyzed 145,000 tubewell water samples from India and 52,000 from Bangladesh for arsenic contamination. In India, 3,781 villages had arsenic levels above 50 ppb and 5,380 villages had levels exceeding 10 ppb; in Bangladesh, the numbers were 2,000 and 2,450, respectively. We also analyzed 12,954 urine samples, 13,560 hair samples, 13,758 nail samples, and 1,300 skin scale samples from inhabitants of the arsenic-affected villages. Groundwater Arsenic Contamination in the Ganga-Padma-

Arsenicosis is chronic subclinical or clinical toxicity due to high level of arsenic in body. Diagnosis of arsenicosis was derived by chronological establishment of facts: (a) arsenic as the cause of malady, (b) drinking water (tubewell water) as the vehicle of arsenic, (c) soil as the source of arsenic, (d) mechanism of leaching of arsenic from soil, and (e) cause of prevalence in particular areas of the country. Arsenicosis has been classified by the author into 4 stages, 7 grades and 20 subgrades. Stage I is pre-clinical or grade 0. While clinical features were not found at this stage, high level of arsenic metabolites was observed in urine. As disease progressed to stable phase of grade 0, high level of arsenic was also found in nails, hair, and skin scales. Stage II or clinical stage is divided into 4 grades, (1) Melanosis, (2) Spotted keratosis in palms/soles, (3) Diffuse keratosis in palms/soles, and (4) Dorsal keratosis. Clinical complications are grouped in stage III and grade 5. Malignancy is considered in stage IV and grade 6. There is a concern of both underdiagnosis and overdiagnosis. Therefore, cases of arsenicosis should be cautiously evaluated. Melanosis was the earliest cutaneous sign of clinical arsenicosis. Mild cases of melanosis could only be revealed by a thorough comparison with normal palms. Similarly mild cases of keratosis might not be visible and could only be revealed by careful palpation of palms and soles. Combination of melanosis and keratosis in adults indicated clinical diagnosis of arsenical dermatosis (ASD) that should be confirmed by showing high arsenic concentration in body tissues e.g., nails, hair, skin scales. Isolated melanosis or keratosis in newborn or children below 2 years almost negated the diagnosis of arsenicosis. Genetic melanosis or keratosis is often present since birth. Isolated melanosis or keratosis in adults should be differentiated from non-arsenical dermatosis and proven by absence of high arsenic level in nails and hair. Non arsenical causes of diffuse melanosis, spotted melanosis or leucomelanosis and localized or generalized keratosis can be clinically differentiated from arsenicosis by absence of pigmentation and keratosis in palms/soles.

Homeopathic medicine is commonly believed to be relatively harmless. However, treatment with improperly used homeopathic preparations may be dangerous. Case Reports. Case I presented with melanosis and keratosis following short-term use of Arsenic Bromide I-X followed by long-term use of other arsenic-containing homeopathic preparations. Case 2 developed melanotic arsenical skin lesions after taking Arsenicum Sulfuratum Flavum-l-X (Arsenic S.F. 1-X) in an effort to treat his white skin patches. Case 3 consumed Arsenic Bromide 1-X for 6 days in an effort to treat his diabetes and developed an acute gastrointestinal illness followed by leukopenia, thrombocytopenia, and diffuse dermal melanosis with patchy desquamation. Within similar to2 weeks, he developed a toxic polyneuropathy resulting in quadriparesis. Arsenic concentrations in all three patients were significantly elevated in integument tissue samples. In all three cases, arsenic concentrations in drinking water were normal but arsenic concentrations in samples of the homeopathic medications were elevated. Conclusion. Arsenic used therapeutically in homeopathic medicines can cause clinical toxicity if the medications are improperly used.

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 arsenic affected districts. Area and population of North 24-Parganas district are 4093.82 sq. km and 7.3 million, respectively. Fourty eight thousand and thirty water 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 arsenic above 50 µg/L, the maximum permissible limit of World Health Organization (WHO) and 52.8% have arsenic above 10 µg/L, WHO recommended value of arsenic in drinking water. Out of the 22 blocks of North 24-Parganas, in 20 blocks arsenic has been found above the maximum permissible limit and so far in 16 blocks people have been identified as suffering from arsenical skin lesions. From the generated data, it is estimated that about 2.0 million and 1.0 million people are drinking arsenic contaminated water above 10 µg/L and 50 µg/L level, respectively in North 24-Parganas alone. So far, in our preliminary study 33,000 people have been examined at random from arsenic affected villages in North 24-Parganas and 2274 people have been registered with arsenical skin lesions. Extrapolation of the available data indicates about 0.1 million people may be suffering from arsenical skin lesions from North 24-Parganas alone. A sum of 21,000 hair, nail, and urine samples analyses from arsenic affected villages show 56%, 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, rice and vegetable are getting arsenic contaminated. Hence there is an additional arsenic burden from food chain. People from arsenic affected villages are also suffering from arsenical neuropathy. A followup study indicates that many of the victims suffering from severe arsenical skin lesions for several years are now suffering from cancer or have already died of cancer.

The first report on arsenic in hand tubewells, dugwells and spring water was published in 1976 from India. It was reported that people were drinking arsenic-contaminated water in Chandigarh and different villages of Punjab, Haryana, Himachal Pradesh in northern India. High arsenic was found in the liver of those suffering from non-cirrhotic portal fibrosis (NCPF) and drinking arsenic-contaminated water. Arsenic groundwater contamination in the state of West Bengal first came to notice during July 1983. The problem first came to international attention after the international conference held in Calcutta during February 1995. Before Bangladesh's arsenic episode was discovered, West Bengal's arsenic problem was known as the world's biggest arsenic calamity. During July 1983, 16 patients with arsenical skin lesions were identified from one village in the district of 24-Parganas where people were drinking arsenic-contaminated water from their hand tubewells in West Bengal. The present arsenic situation from 38,865 km(2) of affected area with a population of 50 million in West Bengal up to August, 2002 is as follows: 3150 villages from 9 districts, 78 blocks/police stations have been identified where groundwater contains arsenic concentrations above 50 mug/l On the basis of 125,000 water analyses by a laboratory method from the arsenic-affected areas it was estimated that more than 6 million people are drinking arsenic-contaminated water above 50 mug/l. So far, from our preliminary survey 8500 patients with arsenical skin lesions have been registered from 250 villages, and extrapolation of available data indicates that may be 300,000 people are suffering from arsenical skin lesions from 9 arsenic-affected districts of West Bengal. The source of arsenic is geologic. The mechanism of arsenic contamination from the source to the aquifer has not yet been established.Groundwater arsenic contamination from industrial effluent discharge by a company producing paris-green (copper-aceto-arsenite) and the suffering of people in Behala - Calcutta came to notice during 1989. The highest arsenic concentration in soil near the effluent discharged point was found to be 10,000 mug/gm and the highest arsenic concentration in hand tubewell water was 38,000 mug/l. The total number of people using arsenic-contaminated water was 7000, and around 200 people were identified with arsenical skin lesions.In the Rajnandgaon district of the state of Chattisgarh in India, a few villages were found where both dugwells and hand tubewells are arsenic contaminated. The source of arsenic is also geologic. The highest concentrations of arsenic found in the dugwells and hand tubewells were 520 and 880 mug/l, respectively. About 130 people were affected with arsenic poisoning. The number of people estimated to be at risk was 10,000.About 1000 people are suspected to be suffering from arsenical skin lesions from the Semria Ojha Patty village of Sahapur police station in Bhojpur district of Bihar in the middle Ganga Plain. The magnitude of the problem in Bhojpur district hence in Bihar is unknown.

Arsenicosis in West Bengal, India and Bangladesh was discovered by the author in 1982 and 1984, respectively. Since 1983, periodical field surveys showed increasing severity of arsenicosis. The disease due to arsenicosis was confirmed by high arsenic level in consumed water, urine, nails, hair, and skin scales. The arsenic content was initially estimated by silver diethyldithiocarbazine method at the School of Tropical Medicine and much later by flow injection hydride generation atomic absorption spectrometry method at the School of Environmental Studies, Jadavpur University, Kolkata, India.According to severity, progression of arsenicosis has been classified by the author into 4 stages, 7 grades, and 20 sub-grades. The 4 stages are I) pre-clinical, II) clinical, III) complication, and IV) malignancy. Each stage is further graded as follows. Pre-clinical (stage I) is graded 0 with 2 sub-grades; 0-a (labile or blood phase) and 0-b (stable or tissue phase). Clinical stage (stage 11) has been sub-divided to four grades, 1) melanosis, 2) spotted keratosis on palms or soles, 3) diffuse keratosis on palms and soles, and 4) dorsal keratosis. Each of the four grades has been further sub-divided into three sub-grades, a, b, and c according to severity. Complications (stage III) and malignancy (stages IV) are graded 5 and 6, respectively; each of the grades has been further sub-divided to a, b, and c.The features of different sub-grades are as follows, diffuse melanosis on palms (1-a), spotted melanosis on trunk (1-b), generalized melanosis (1-c), number of keratotic nodules 0-6 (2-a), number of keratotic nodules more than 6 (2-b), large keratotic nodules (2-c), diffuse keratosis on palms or soles (3-a), diffuse keratosis on both palms and soles (3-b), diffuse keratosis complete on whole palms and soles (3-c), nodular lesions on hands or feet (4-a), nodular lesions on hands and feet (4-b), nodular lesions on hands and feet along with extension of keratosis all over the body (4-c), palpable liver (5-a), jaundice (5-b), ascitis (5-c), malignancy with single lesion (6-a), malignancy having two lesions (6-b), and malignancy having more than two lesions (6-c).The various stages of arsenicosis can be treated as follows. Grade 0 can be eliminated by replacing arsenic contaminated with arsenic-free water, high protein diet, and fresh fruits. In addition, this treatment can be applied to the patients of advanced grades along with the supply of arsenic-free water. Bronchitis and obstructive asthma can be treated by antibiotics and bronchodilators, respectively. The chelating agent, dimercaptopropane sulfonate, therapy is carried out at grade 2-b onwards; complications may be prevented however, there is little improvement of keratosis. The prognosis of grade 5-b onwards is poor. At the stage of malignancy, i.e. stage 4 (grades 6-a, 6-b, and 6-c), surgical removal can only help patients of grade 6-a and 6-b provided glands are not affected. The role of antioxidants is under trial.Such differentiation of various stages of arsenicosis is helpful to detect asymptomatic cases in preclinical or sub-clinical phase and to find the severity of the disease in order to prevent its further progress to complication and malignancy stages.

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 wits 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 wits 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 it 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.

Groundwater arsenic (As) contamination in West Bengal (WB, India) was first reported in December 1983, when 63 people from three villages of two districts were identified by health officials as suffering from As toxicity. As of October 2001, the authors from the School of Environmental Studies (SOES) have analyzed > 105000 water samples, > 25000 urine/hair/nail/skin-scale samples, screened approximately 86000 people in WB. The results show that more than 6 million people from nine affected districts (total population approximately 42 million) of 18 total districts are drinking water containing greater than or equal to 50 mug l(-1) As and > 300000 people may have visible arsenical skin lesions. 2700 villages have so far been identified where groundwater contains arsenic above 50 mug l(-1). The As content of the physiological samples indicates that many more may be sub-clinically affected. Children in As-affected villages may be in special danger. In 1995, we had found three villages in two districts of Bangladesh where groundwater contained greater than or equal to 50 mug l(-1) As. The present situation is that in 2000 villages in 50 out of total 64 districts of Bangladesh, groundwater contains As above 50 mug l(-1) and more than 25 million people are drinking water above greater than or equal to 50 mug l(-1) As. After years of research in WB and Bangladesh, additional affected villages are being identified on virtually every new survey. The present research may still reflect only the tip of iceberg in identifying the extent of As contamination. Although the WB As problem became public almost 20 years ago, there are still few concrete plans, much less achievements, to solve the problem. Villagers are probably in worse condition than 20 years ago. Even now, many who are drinking As-contaminated water are not even aware of that fact and its consequences. 20 years ago when the WB government was first informed, it was a casual matter, without the realization of the magnitude this problem was to assume. At least up to 1994, one committee after another was formed but no solution was forthcoming. None of the expert reports has suggested solutions that involve awareness campaigns, education of the villagers and participation of the people. Initially, international aid agencies working in the subcontinent simply did not consider that As could be present in groundwater. Even now, while As in drinking water is being highlighted, there have been almost no studies on how additional As is introduced through the food chain, as large amounts of As are present in the agricultural irrigation water. Past mistakes, notably the ceaseless exploitation of groundwater for irrigation, continue unabated today; at this time, more groundwater is being withdrawn than ever before. No efforts have been made to adopt effective watershed management to harness the extensive surface water and rainwater resources of this region. Proper watershed management and participation by villagers are needed for the proper utilization of water resources and to combat the As calamity. As in groundwater may just be nature's initial warning about more dangerous toxins yet to come. What lessons have we really learned? (C) 2002 Elsevier Science B.V. All rights reserved.

Exposure periods from 6 months to 10 years (average 2 years) are required to develop arsenicosis symptoms, depending on the concentration of arsenic in water, the amount of daily water intake and the nutritional status of the person consuming such water. Melanosis is the earliest sign. Melano-keratosis appearing in adults is almost a sure sign of arsenicosis. The clinical spectrum has been classified into 4 stages, 7 grades and 20 subgrades. The stages are (1) preclinical, (11) clinical, (III) complications and (IV) malignancy. In the preclinical stage (grade 0), urine, nails, hair and skin scales show high concentrations of arsenic but melanosis and keratosis are absent. The clinical stage has four grades: (1) melanosis; (2) spotted keratosis in palms and soles; (3) diffuse keratosis in palms and soles; and (4) dorsal keratosis. The complication stage (grade 5) involves lungs, liver and other organs. The malignancy stage (grade 6) develops 10-20 years after the onset of symptoms. Chelating agents are of little benefit in keratosis and the advanced stages. Malnutrition often hastens the appearance of signs, and good nutrition often has a protective influence and it delays the appearance of signs. The only way at present to prevent the progress of the disease is to stop consuming arsenic contaminated water.

Journal Article Cutaneous malignancy in arsenicosis Get access K.C. Saha K.C. Saha The School of Tropical Medicine, EC‐21, Sector 21, Bidhannagar, Calcutta 700 064, India E‐mail: poddars@cal3.vsnl.net.indebasaha@yahoo.com Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 145, Issue 1, 1 July 2001, Page 185, https://doi.org/10.1046/j.1365-2133.2001.04316.x Published: 01 July 2001

Fifty districts of Bangladesh and 9 districts in West Bengal, India have arsenic levels in groundwater above the World Health Organization's maximum permissible limit of 50 μg/L. The area and population of 50 districts of Bangladesh and 9 districts in West Bengal are 118,849 km2 and 104.9 million and 38,865 km2 and 42.7 million, respectively. Our current data show arsenic levels above 50 μg/L in 2000 villages, 178 police stations of 50 affected districts in Bangladesh and 2600 villages, 74 police stations/blocks of 9 affected districts in West Bengal. We have so far analyzed 34,000 and 101,934 hand tube-well water samples from Bangladesh and West Bengal respectively by FI-HG-AAS of which 56% and 52%, respectively, contained arsenic above 10 μg/L and 37% and 25% arsenic above 50 μg/L. In our preliminary study 18,000 persons in Bangladesh and 86,000 persons in West Bengal were clinically examined in arsenic-affected districts. Of them, 3695 (20.6% including 6.11% children) in Bangladesh and 8500 (9.8% including 1.7% children) in West Bengal had arsenical dermatological features. Symptoms of chronic arsenic toxicity developed insidiously after 6 months to 2 years or more of exposure. The time of onset depends on the concentration of arsenic in the drinking water, volume of intake, and the health and nutritional status of individuals. Major dermatological signs are diffuse or spotted melanosis, leucomelanosis, and keratosis. Chronic arsenicosis is a multisystem disorder. Apart from generalized weakness, appetite and weight loss, and anemia, our patients had symptoms relating to involvement of the lungs, gastrointestinal system, liver, spleen, genitourinary system, hemopoietic system, eyes, nervous system, and cardiovascular system. We found evidence of arsenic neuropathy in 37.3% (154 of 413 cases) in one group and 86.8% (33 of 38 cases) in another. Most of these cases had mild and predominantly sensory neuropathy. Central nervous system involvement was evident with and without neuropathy. Electrodiagnostic studies proved helpful for the diagnosis of neurological involvement. Advanced neglected cases with many years of exposure presented with cancer of skin and of the lung, liver, kidney, and bladder. The diagnosis of subclinical arsenicosis was made in 83%, 93%, and 95% of hair, nail and urine samples, respectively, in Bangladesh; and 57%, 83%, and 89% of hair, nail, and urine samples, respectively in West Bengal. Approximately 90% of children below 11 years of age living in the affected areas show hair and nail arsenic above the normal level. Children appear to have a higher body burden than adults despite fewer dermatological manifestations. Limited trials of 4 arsenic chelators in the treatment of chronic arsenic toxicity in West Bengal over the last 2 decades do not provide any clinical, biochemical, or histopathological benefit except for the accompanying preliminary report of clinical benefit with dimercaptopropanesulfonate therapy. Extensive efforts are needed in both countries to combat the arsenic crisis including control of tube-wells, watershed management with effective use of the prodigious supplies of surface water, traditional water management, public awareness programs, and education concerning the apparent benefits of optimal nutrition.

Working on West Bengal—s arsenic calamity for last 10 years & in Bangladesh for last 4 years even now we feel we are at the tip of the iceberg. Thus we need to know as early as possible the real magnitude of the arsenic calamity. According to WHO, the possibility of getting skin lesions exists among those drinking 1,000μg of arsenic per day for several years. & our analytical report on water indicates that a large sum of population are consuming above 1,000μg of arsenic per day. Our thousands of hair, nail & urine analyses from the affected villages indicate that more than 80% of population have higher arsenic body burden. Thus many may not be showing arsenical skin lesions but may be sub-clinically affected. Further if it is true that arsenic toxicity appears after several years of exposure, then the picture may actually be far more grim than it appears at present, & children our future generations are at a greater risk.