Bangladesh is grappling with the largest mass poisoning of a population in history because groundwater used for drinking has been contaminated with naturally occurring inorganic arsenic. It is estimated that of the 125 million inhabitants of Bangladesh between 35 million and 77 million are at risk of drinking contaminated water (1, 2). The scale of this environmental disaster is greater than any seen before; it is beyond the accidents at Bhopal, India, in 1984, and Chernobyl, Ukraine, in 1986. This paper suggests guidelines for responding when a population is exposed to arsenic, and it is based on information from several visits to Bangladesh made by Allan H. Smith as a consultant for the World Health Organization between 1997 and 1998 (3–5).
In 1983, the first cases of arsenic-induced skin lesions were identified by K.C. Saha then at the Department of Dermatology, School of Tropical Medicine in Calcutta, India (6). The first patients seen were from West Bengal, but by 1987 several had already been identified who came from neighbouring Bangladesh. The characteristic skin lesions included pigmentation changes, mainly on the upper chest, arms and legs, and keratoses of the palms of the hands and soles of the feet (Fig. 1). After ruling out other causes, water sources used by the patients were analysed, and the diagnosis of arsenic-caused disease was confirmed. The primary drinking-water sources for the patients were tube-wells, which drew water from underground aquifers (Fig. 2) (6).
Bangladesh is grappling with the largest mass poisoning of a population in history because groundwater used for drinking has been contaminated with naturally occurring inorganic arsenic. It is estimated that of the 125 million inhabitants of Bangladesh between 35 million and 77 million are at risk of drinking contaminated water (1, 2). The scale of this environmental disaster is greater than any seen before; it is beyond the accidents at Bhopal, India, in 1984, and Chernobyl, Ukraine, in 1986. This paper suggests guidelines for responding when a population is exposed to arsenic, and it is based on information from several visits to Bangladesh made by Allan H. Smith as a consultant for the World Health Organization between 1997 and 1998 (3–5).In 1983, the first cases of arsenic-induced skin lesions were identified by K.C. Saha then at the Department of Dermatology, School of Tropical Medicine in Calcutta, India (6). The first patients seen were from West Bengal, but by 1987 several had already been identified who came from neighbouring Bangladesh. The characteristic skin lesions included pigmentation changes, mainly on the upper chest, arms and legs, and keratoses of the palms of the hands and soles of the feet (Fig. 1). After ruling out other causes, water sources used by the patients were analysed, and the diagnosis of arsenic-caused disease was confirmed. The primary drinking-water sources for the patients were tube-wells, which drew water from underground aquifers (Fig. 2) (6).
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