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A new hope for protection from adverse health

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IJEP 17 ( 5 ): 334 - 339 ( Received on February 7, 1997 )
A New Hope for Protection From Adverse Health Effects of
Exposure to Silica Bearing Dusts
R. Kotecha and G.D. Agrawal
Envirotech Instruments Pvt. Ltd., A - 271, Okhla Industrial Area. Phase - /, New Delhi - 1 10 0 2 0
IMPORTANCE OF SILICA AS HEALTH IMPAI-
RING AGENT
Prevalence of silica in breathing air
The distribution of silica in soil is almost similar to
that of carbon in organic matter. In mass - wise
abundance on earth, silicon element is next only to
oxygen and the earth's, crust is predominantly com-
prised of silica and silicates. About 12 % of earth's
crust consists essentially of free silica mostly quartz,
this being only second to feldspar in abudance
as a mineral. Feldspar again has a large component
of combined silica. Thus silica either crystalline cr
amorphous, either free or combined, forms part of
most dust particles in the environment, whether
produced and raised by natural forces, like winds,
quakes and volcanoes, or by hoofs of cattle and
horses, or by agricultural operations of ploughing,
winnowing, threshing and shelling, or by sweeping,
dusting and cleaning in houses, compounds and
streets, or by transport vehicles whether bullock -
carts, chariots, automobiles or what - so - ever.
As for industrial processes, almost all mining and
metallurgical processes, and crushing and grin -
ding anywhere, involve production of dust with var-
ying contents of silica. Refractories, glass - fact-
ories, brick - making and several other industries
involve extreme concentrations of free silica and
workers in these, suffer high exposures to silica but
coal - miners, stone - crusher workers and workers
in slate - pencil or agate or any of the large number
of stone dressing, polishing or grinding based units,
also get equally seriously exposed. Worst of ail,
even the common office - going citizen or home -
working house - wife or school - going child in our
rather highly dust - laden urban or even rural envi-
ronment in India, particularly in the north - Indian
plains gets exposed to large quantities of silica as a
part of the inhaled dust. The observed ranges of co-
ncentrations of total and respirable (finer than 10
micron ) dust particles, or SPM, and the likely silica
contents for some urban, industrial and rural areas
in India are given in table 1. It is thus obvious
that no - one can avoid exposure to silica, particu-
larly if living and working in the arid and semi - arid
plains of north India.
Risk of severe silica - exposure in India
Even if one were to consider primarily those expo-
sed to high concentrations of silica, present in their
occupational environment, the numbers become ex-
tremely large, as seen from table 2 as prepared
by Dr H.N. Syed from 1 99 1 Labour Statistics. And
this table totally leaves out the agricultural and
non - formal sectors where the numbers of severely
exposed, may be even larger.
Diseases resulting from silica exposure
Silicates and particularly free silica are insolu-
ble, or only sparingly soluble, under natural con-
ditions and have a tendency to 'set' or form
hard durable deposits. Once inhaled, they can-
not get easily flushed out or be assimilated by
the natural body processes and start cumulating
in the respiratory tract and even the lungs. This in-
terferes with pulmonary function and causes a num-
ber of c'inical symptoms, to gat diagnosed as 'bron-
chitis' in the earlier phases. Not being amenable to
the normal bronchitis treatment, the case, with time,
gets being called 'chronic bronchitis'. More severe
stages are named 'pneumoconiosis' and are very
prevalent amongst mining and industrial workers.
Quartz and other forms of free silica are highly fib-
rogenic and result in fibrosis of the lungs, result-
ing in collagenous pneumoconiosis'. Even combined
silica, though not resulting in fibrosis of lungs,
causes significant damage to lungs and is termed,
'non - collagenous pneumoconiosis.' The latter can
cause rheumatoid arthritis symptoms first observed
by Caplan in 1947 in Kolar gold mine workers,
and called 'rheumatoid pneumoconiosis' or Caplan's
syndrome. Due to similarity of symptoms and patho-
logy, the above disease - forms keep being wrongly
diagnosed as tuberculosis, rheumatism, arthritis, etc.
334 iiMOIAM J ENVIRONMENTAL PROTECTION, V O L 17, NO. 5, MAY 1997
© 1997 • Kalpana Corporation
Table 1. Observed dust and likely silica contents in India
Location Total suspended Respirable (below Likely silica Main silica
particulates (SPM), 1 0 (*) fraction, % content, % contributor
Hg/m8
Towns and cities
Bombay 2 0 0 - 4 0 0 35 - 55 1 - 5 Beach sand
Calcutta 100 - 4 5 0 30 - 50 2 - 8 Fragile soil/silt
Delhi 3 5 0 - 8 0 0 25 - 50 5 - 10 Dust storm/soil
Jaipur 2 0 0 - 7 0 0 25 - 40 5 - 10 Dust storm/soil
Kanpur 200 - 6 5 0 30 - 40 5 - 10 Dust storm/soil
Madras 100 - 2 0 0 40 - 60 1 - 5 Beach sand
Rurai areas
Mezoram 50 - 150 15 - 30 3 - 5 soils
Rajasthan 150 - 3 5 0 10 - 25 5 - 10 Dust strom/soil
Karnataka 100 - 200 10 - 30 3 - 5 Soils
Industrial area
Around cement plants 5 0 0 - 2 0 0 0 10 - 20 1 - 3 Industrial dust
and lime kilns
Around refractories 3 0 0 - 1500 15 - 40 5 - 20 Industrial dust
Around thermal power 3 0 0 - 1500 10 - 30 3 - 10 Industrial dust
house (flyash)
Mining areas 5 0 0 - 3 0 0 0 5 - 10 3 - 10 Mine and road c
Shop - floors
Agate-grinding 20 - 877 mg/m8
80 • 90 80 - 85 Industrial dust
Slate-pencil 20 - 500 mg/m3
80 - 90 50 - 60 Industrial dust
Stone-crushing 10 - 40 mg/m8
40 - 60 10 - 80 Industrial dust
The extreme form of disease resulting from accu-
mulation of silica in lungs, causing lesions and fib-
rosis of lungs, is termed 'silicosis' which is a highly
debilitating, incurable and hence terminal disease
and yet is often wrongly diagnosed as merely tube-
rculosis, due to similarity of clinical symptoms,
though obviously the patient does not respond to
anti - tuberculosis - treatment and keeps on getting
worse. Some observed prevalence of severe silica -
dust caused ailments in India is given in table 3.
Won - occupational severe silica exposure
From the data of table 3 and the discussion ab-
ove, one may be misled to believe that severe
forms of silica • dust - caused diseases termed as
various forms of 'pneumoconiosis' or 'silicosis' are
essentietly problems for mine and industry workers.
This is totally falsified by cases of 'pneumoconio-
sis' in Ladakh. Obviously, the significant silica - co-
ntents in the frequent dust - storms of Ladakh were
resulting in the symptoms. The prevalence of clini-
coradiological symptoms of pneumoconiosis among
residents of villages severely exposed to dust
storms was as high as 45.3 %. The risk in several
parts of Gujarat, Rajasthan, Haryana and (J P., may
be no less - and definite'y not in Delhi, known to
be at or near the top in respect of ambient SPM
concentrations among the cities of the world (tho-
ugh mostly organic matter, Delhi SPM are bound to
have significant silica contents too ).
In - curability of s'lica - caused disease by mo-
dern medicine
The most worrysome feature of silica - caused imp-
airment of health lies in these being not amenable
to any form of modern 'allopathic' lines of treat-
ment whether medicinal, surgical, or any other and
hence being often termed as 'incurable'. This often
provides motivation for wrong diagnosis, or atleast
late diagnosis, of these ailments as detection would
only demand removal from that work and environ-
ment to avoid further deterioration and yet live with
the disease for the rest of the severely reduced life
with no hope of recovery. Even drugs, like 'predni-
solone' when administered to silicosis patients at
AIIMS Delhi could provide only temporary sympto-
matic relief and that at the cost of significant adv-
erse side • effects.
NDIAN J. ENVIRONMENTAL PROTECTION, VOL. 17, NO. 5, MAY 1997
© 1997 - Kalpana Corporation
335
Table 2. Average employment in Indi=» exposed to
risk of free silica exposures (1991 hand-
book of labour statistics, GOI)
Coal mines 5 , 5 0 , 0 0 0
Limestone mines 5 1 , 0 0 0
Iron - ore mines 4 9 , 0 0 0
Manganes - ore mines 18,000
Copper - ore mines 13,000
Gold - mines 12,000
Stone - mines 1 1,000
Chromite mines 9,000
Magnesite mines 6.000
Other mines 81,000
Mines total 8,00,000
Foundries 2,84,000
Iron and steel industries 2.08,000
Clay products/Refractory 2,22,000
Glass and glass products 6 7 , 0 0 0
Cement/lime 7 8 , 0 0 0
Mica products 12,000
Agate 10,000
Slate pencil 8 , 0 0 0
Stone crushing/cutting/grinding 4,00,000
other industries 3 , 1 1 , 0 0 0
Industries total 16,00,000
Grand total 2 4 , 0 0 , 0 0 0
ETIOLOGY/PATHOLOGY/PATHOGEIMESIS OF
DUST CAUSED DISEASES
Early symptoms diagnosis
The earliest symptoms of dust - caused respiratory
diseases, whether the dusts are organic or mineral,
fibrous or crystalline or amorphous, siliceous or
onn - siliceous are irritation and constriction of th*
upper respirarory tract leading to coughing expect-
oration and dyspnoea. These get diagnosed as 'bro-
nchitis' and treated by expectorants and bactericide!
drugs. On treatment, the symptoms may amelio-
rate, but keep re - appearing, if exposure continues.
In our dusty environment, even those having no occ-
upational exposure to dust, keep suffering from such
mild or early stage of dust - caused diseases as
seen from the high prevalence of such symptoms
e v e n in the general population examined as s h o * n
in table 4.
Medium stage of dust - caused respiratory dis-
eases
As the dust accumulates and penetrates deeper into
the respiratory tract, alveoli start getting congested
and chocked and lung - capacity and functioning
starts getting impaired. This stage can be detected
by pulmonary function tests ( PFT ) by appropriate
spirometers. Both the peak expiratory force ( PEF )
and forced expiratory volume in one second ( FEV
1 ), or one of them, on the ratio FVC/FEV1 may get
affected. In clinical terms, expectoration increases
and may be accompanied with nasal discharge and
in severe cases with strains of blood. Also chest -
pain, headache and body ache appear and get more
severe and frequent. In later phases, recurring or
persistent fever, marked chest pain and expectora-
tion with blood ( Haemoptysis ) are taken to Indi-
cate tuberculosis and treated as such, with some
symptomatic relief but no cure. This phase may
appear only after 5 - 8 year of severe exposure
and may take much longer exposures of lower
levels.
Table 3. Some reported dust caused occupational diseases in India
Industry/occu- Location Studied by Disease Sample Disease
pation size Occupation
Gold mining Kolar mines Shenoy Pneumoconiosis 5 8 9 3 8 2 0
Mica mining Bihar NIOH Pneumoconiosis 3 6 9 39
Copper mines Rajasthan Shaw and Deshmukh Pneumoconiosis 50 21
Coal mines Bihar Shrivastava Pneumoconiosis 20,086 3 7 4
Stone cutting Rajasthan Sethi and Kapoor Silicosis 72 18
Refractory Rajasthan Shaw and Deshmukh Pneuno/Silico 50 50
Refractary Maharashtra Rane Pnueno/silico 84 50
Refractory Orissa Rao and Sharma Silicosis 160 35
Agate Gujarat Clerk et at. Silicosis 3 4 2 63
Stone cutting Kashmir Saini et al. Silicosis 60 12
Glass bangle U.P. Shrivastava Pneumoconiosis 373 27
Cement factory Orissa Sharma et al. Silicosis „ -
336 INDIAN J. ENVIRONMENTAL PROTECTION, VOL 17, NO. 5, MAY 1997
© 1997 - Kelpana Corporation
Advanced stage of dust - caused respiratory
diseases
Table 4. Prevalence of symptoms among residents
of high - dust areas ( non - occupational
exposure ), in %
Percentage of residents examined showing
various symptoms in Rajgangpur high -
silica area
Silicosis - like lung X - ray abnormalities 4
Markidly affected lung capacity 18
Blood in expectoration ( haemoptysis) 7
Recurring fever 16
Chest pain 21
Headache/body - ache 28
Cough/expectoration 36
Breathless -ness/dyspnoea 45
Percentage of general populatious of high-
dust ( SMP 6 0 0 • 1000 i-ig/m8
) arses of
some places, suffering from severe respira-
tory symptoms :
Kanpur, U.P. 6.5
Haldia, W.B. 4.8
Barauni, Bihar 4.4
Bokajan, Assam 8.6
Chittorgarh, Rajasthan 8.3
Delhi NCR 1 1.2
As the deposit of dust in lungs accumulates, depen-
ding on the nature of the dust, scars, lesions or fib-
rosis of the lung start becoming visible on X • ray
plates indicating advanced, severe and ( suppose-
dly ) irreversible stage of the diseases and termed
silicosis, asbestosis, byssinosis or pneumoconiosis
depending on whether the causative dust was high-
silica, asbestos, vegetable - fibres or mine - dust,
respectively. Amongst these 4 designated types
which pathologically are largely similar, asbestosis
is considered the most dreaded, as dreadful as
lung - cancer, but silicosis is no less dreadful in
terms of suffering and is much - much more pre-
valent. Common physicians diagnose them, media
reports them, and normal citizens talk of them all,
as tuberculosis. It is thus that all our large dusty
towns, Delhi, Calcutta, Kanpur, etc., are reported to
have such high incidence rates of tuberculosis
( TB ) and industries are blamed for this, though
industries discharge no tubercle bacilii into enviro-
nment.
QUEST FOR AN AYURVEDIC REMEDY FOR DU-
ST - CAUSED MALADIES
Need to look toward? Ayurveda
The above sections make it clear that dust - caused
diseases are so rampant and serious for our country
Table 5. Improvement in condition of silicosis patients on administering Kamadgiri formulation S - 8
Symptom Percentage of the sample group having symptomSymptom
At start of
treatment
After 30 day of
treatment
After 60 day of trea-
tment
Symptom
S M N S M N S M N
Cough 100 - - - 20 80 _ — 100
Expectoration 80 20 _ - 10 90 - - 100
Dyspnoea 95 5 - - 5 95 - - 100
Chest pain 70 30 - - 20 80 - - 100
Haemoptysis 15 20 65 - - 100 - - 100
Body - ache 60 20 20 - 10 90 - - 100
Fever 20 25 55 - - 100 - - 100
Ghurghurahat ( lung sound ) 65 35 _ - 5 95 - - 100
Loss of appetite 35 40 25 - - 100 - - 100
Loss of weight 15 45 40 - 5 95 - 5 95
Reduced chest expansion 60 40 - - 30 70 - 10 90
Reduced lung capacity 45 55 - 10 70 20 - 45 55
X - ray abnormalities 30 65 5 25 55 20 15 4 0 45
Legend
S : Severe complaints of the symptom
M : Moderate complaints of the symptom
N : Nil or only slight complaints of the symptom
INDIAN J. ENVIRONMENTAL PROTECTION, VOL. 17, NO. 5, MAY 1997
<© 1997 - Kalpana Corporation
337
that search for appropriate preventive and curative
remedies becomes an urgent need. It is easy to say
that 'prevention is better than cure' and that the
best approach to prevention of dust - caused - dise-
ases is to eliminate or avoid exposure. But how ?
By closing down dust causing industries and pro
cesses, giving up jobs involving working in dusty
environments and vacating dusty urban centres to
stay away in un - polluted areas ? Control of pollu-
tion at source, proper siting of industries, proper
planning of urban centres, plantation of dust - atte-
nuating green - belts are all needed and have to ba
promoted to the utmost. But can such efforts at pol-
lution - control be really and adequately effective ?
Our experience so - far proves otherwise. And
often, effective pollution - control to eliminate dust -
caused ailments shall imply costs almost impossi-
ble to pay at this stage of our development. Making
our mines and small - scale industry dust - free,
may in reality require closing them down. And if
prevention is the key to health, why have all the
antacid tablets and other digestive medicines and
not rely merely on total control of diet ? Obviously,
like all other areas of bodily sufferings, one should
search for remedies that would first minimise the
harmful effects of dust exposure ( particularly silica
exposure) and those that would offer a cure in
case one does become sick with silicosis pneumo-
coniosis or other dust caused diseases. With all
options in other modern systems of medicine tried
so far, proving in - effective or hardly effective, and
often also involving severe side - effects, attention
should obviously go to Ayurveda which evolved on
ages - long experience of Indian conditions and
may offer remedies not likely to have adverse side -
effects.
Dust - caused diseases in ayurveda
Even in modern medical science, attention to dust
caused diseases was given only after the industrial
revolution made the situation in respect to such
diseases rather acute. Thus silicosis, asbestosis,
byssinosis, pneumoconiosis are all relatively recen-
tly coined words and the detailed prognosis of these
diseases is still only being worked out through re-
search. In these circumstances, it would be vain to
expect these diseases or their equivalent to be men-
tioned in Ayurvedic texts which were created when
such industries did not exist. And yet dust was
always there, as was silica, and cotton and other
vegetable fibres. As a comprehensive health sci-
ence, Ayurveda could not have ignored respiratory
system and it is ailments - even those caused by
dusts. And one finds in these texts significant de-
tails of the structure, characteristics, inter - relation-
ships and ailments of 'Prana - vah - Shrotah', the
various vessels and conduits involved in the pro-
cess of respiration including the tiniest alveoli. And
amongst the 'Prana - vah - Shrotah - Dushiti' or
maladies of the respiratory tract, are also described
those caused by 'Raj or dust'. Acharya Charak men-
tions 18 types of 'Kshaya' involving functional de-
struction of various body - systems. 'Raj - yaks-
hma', the equivalent of common tuberculosis or TB
involves several of these etiological factors or
Kshaya's. One are some of the forms of 'Kshaya'
also get invariably associated with 'Prana - vah -
Shrotah - Dushte'. These could be caused by expo-
sure to excess 'Raj', and the symptoms and progno-
sis shall be very close to present day dust - caused
diseases, silicosis, asbestosis, byssinosis or pneu-
moconiosis. That 'Kshaya' of several forms get in-
volved in both, relates these dust - caused disea-
ses to Raj - yakshma' or TB and indicates the many,
many similarities not just in lung - radiography but
in symptoms, like fever, weight loss, loss of appe-
tite, dispnoea, anaemia, etc., etc. If 'Raj caused'
Parana vah - Shrotah - Dushts could be taken to
be the Ayurvedic equivalent ( or pre - cursor) of
the present - day dust caused diseases, the reme-
dies, treatment and protection measures described
in Ayurvedic texts for 'Raj' caused 'Parana - vah -
Shrotah - Dushti' could prove successful in handling
these diseases. Obviously only research could con-
firm.
Ayurvedic line of approach to tackle silicosis
Thus in ayurvedic terms, silicosis could be descri-
bed as 'Parana - vah - Shortah - Dushti' caused by
significant quantities of silica accumulating in
•Prana - vah - Shrotas' leading to 'Kha - vaigunya'
in the respective 'shrotas' and interfering with the
function of 'avalambaka - kapha' to increase the
'guruta' of the 'kapha' and hampening functiory of
•vata', particularly 'parn' and 'udan', 'Vayu' through
the process of 'sanga' or 'avaran'. The 'Kaphavritta -
pran' and 'Kaphavretta udan' would be the chief
pathological factors in the manifestation of the diss
ases as in the general case of 'Vata - Kshaya'. The
line of prevention and treatment of silicosis could
follow the lines suggested by Acharya Chakrapani in
his treatise 'Chakradatta', with appropriate modifica-
tions and supplementation.
3 3 8 INDIAN.! PNVinnMMCMTAi D D A T c M i n n w/» - i r»
THE NEW RAY OF AYURVEDIC HOPE
After a thorough and critical study of various Ayur-
vedic texts, Dr Kotecha Post - graduate Vaidya,
with considerable research and practising experi-
ence after several trials evolved an ayurvedic for-
mulation tentatively termed 'Kamadgiri formulation
S - 8 designed to ameliorate, and in - time practi-
cally and functionally cure even advanced stage
patients of silicosis. The formulation was tried on
20 proven cases of advanced silicosis and in just
30 day resulted in very significant amelioration
of almost all debilitating symptoms and after 60
day of administration of the formulations improvem-
ents in pulmonary function test and on lung X - ray
plates were noticeable as seen from table 5. Obvio-
usly much more trials and clinical tests under differ-
ent conditions shall need to be done to scientifically
establish the value and constraints of the treatment
but the results are encouraging enough to offer a
ray of hope for those having developed this dread-
ful disease.
An Ayurvedic formulation to act as a preventive and
ameliorative measure for dust - caused ailments in
general, and silicosis in particular, is even more
promising and 'Kamadgiri formulation S-7' has evo-
lved after trials for this task. The formulation in-
cludes small daily dosages of a 'Vati' ( Ayurvedic
pills ) and of an 'Avaleha' ( ayurvedic sausage ). To
have the formulation tested on field on a large eno-
ugh scale, it is proposed and offer this to selected
industrial organisations at a subsidised rate of
around Rs 1 per person per day, in case they pro-
mise to administer it to 50 % of the workers ex-
posed to large concentrations of silica in their daily
work, while the other 50 % continue the usual
routine without this formulation and the results of
comparing the two groups are provided on a quar-
terly basis. It may be mentioned that the un - sub-
sidized cost of the daily dosage shall come to bet-
ween Rs 3 and 4 per head per day.
When successful and commercialised, the formula-
tions should provide a break - through in fight aga-
inst silicosis and dust - caused - diseases.
i.*....i<-.iT>i DDrttcoTinM v/ni 17 Nrt B MAY 1997 339

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A new hope for protection from adverse health

  • 1. IJEP 17 ( 5 ): 334 - 339 ( Received on February 7, 1997 ) A New Hope for Protection From Adverse Health Effects of Exposure to Silica Bearing Dusts R. Kotecha and G.D. Agrawal Envirotech Instruments Pvt. Ltd., A - 271, Okhla Industrial Area. Phase - /, New Delhi - 1 10 0 2 0 IMPORTANCE OF SILICA AS HEALTH IMPAI- RING AGENT Prevalence of silica in breathing air The distribution of silica in soil is almost similar to that of carbon in organic matter. In mass - wise abundance on earth, silicon element is next only to oxygen and the earth's, crust is predominantly com- prised of silica and silicates. About 12 % of earth's crust consists essentially of free silica mostly quartz, this being only second to feldspar in abudance as a mineral. Feldspar again has a large component of combined silica. Thus silica either crystalline cr amorphous, either free or combined, forms part of most dust particles in the environment, whether produced and raised by natural forces, like winds, quakes and volcanoes, or by hoofs of cattle and horses, or by agricultural operations of ploughing, winnowing, threshing and shelling, or by sweeping, dusting and cleaning in houses, compounds and streets, or by transport vehicles whether bullock - carts, chariots, automobiles or what - so - ever. As for industrial processes, almost all mining and metallurgical processes, and crushing and grin - ding anywhere, involve production of dust with var- ying contents of silica. Refractories, glass - fact- ories, brick - making and several other industries involve extreme concentrations of free silica and workers in these, suffer high exposures to silica but coal - miners, stone - crusher workers and workers in slate - pencil or agate or any of the large number of stone dressing, polishing or grinding based units, also get equally seriously exposed. Worst of ail, even the common office - going citizen or home - working house - wife or school - going child in our rather highly dust - laden urban or even rural envi- ronment in India, particularly in the north - Indian plains gets exposed to large quantities of silica as a part of the inhaled dust. The observed ranges of co- ncentrations of total and respirable (finer than 10 micron ) dust particles, or SPM, and the likely silica contents for some urban, industrial and rural areas in India are given in table 1. It is thus obvious that no - one can avoid exposure to silica, particu- larly if living and working in the arid and semi - arid plains of north India. Risk of severe silica - exposure in India Even if one were to consider primarily those expo- sed to high concentrations of silica, present in their occupational environment, the numbers become ex- tremely large, as seen from table 2 as prepared by Dr H.N. Syed from 1 99 1 Labour Statistics. And this table totally leaves out the agricultural and non - formal sectors where the numbers of severely exposed, may be even larger. Diseases resulting from silica exposure Silicates and particularly free silica are insolu- ble, or only sparingly soluble, under natural con- ditions and have a tendency to 'set' or form hard durable deposits. Once inhaled, they can- not get easily flushed out or be assimilated by the natural body processes and start cumulating in the respiratory tract and even the lungs. This in- terferes with pulmonary function and causes a num- ber of c'inical symptoms, to gat diagnosed as 'bron- chitis' in the earlier phases. Not being amenable to the normal bronchitis treatment, the case, with time, gets being called 'chronic bronchitis'. More severe stages are named 'pneumoconiosis' and are very prevalent amongst mining and industrial workers. Quartz and other forms of free silica are highly fib- rogenic and result in fibrosis of the lungs, result- ing in collagenous pneumoconiosis'. Even combined silica, though not resulting in fibrosis of lungs, causes significant damage to lungs and is termed, 'non - collagenous pneumoconiosis.' The latter can cause rheumatoid arthritis symptoms first observed by Caplan in 1947 in Kolar gold mine workers, and called 'rheumatoid pneumoconiosis' or Caplan's syndrome. Due to similarity of symptoms and patho- logy, the above disease - forms keep being wrongly diagnosed as tuberculosis, rheumatism, arthritis, etc. 334 iiMOIAM J ENVIRONMENTAL PROTECTION, V O L 17, NO. 5, MAY 1997 © 1997 • Kalpana Corporation
  • 2. Table 1. Observed dust and likely silica contents in India Location Total suspended Respirable (below Likely silica Main silica particulates (SPM), 1 0 (*) fraction, % content, % contributor Hg/m8 Towns and cities Bombay 2 0 0 - 4 0 0 35 - 55 1 - 5 Beach sand Calcutta 100 - 4 5 0 30 - 50 2 - 8 Fragile soil/silt Delhi 3 5 0 - 8 0 0 25 - 50 5 - 10 Dust storm/soil Jaipur 2 0 0 - 7 0 0 25 - 40 5 - 10 Dust storm/soil Kanpur 200 - 6 5 0 30 - 40 5 - 10 Dust storm/soil Madras 100 - 2 0 0 40 - 60 1 - 5 Beach sand Rurai areas Mezoram 50 - 150 15 - 30 3 - 5 soils Rajasthan 150 - 3 5 0 10 - 25 5 - 10 Dust strom/soil Karnataka 100 - 200 10 - 30 3 - 5 Soils Industrial area Around cement plants 5 0 0 - 2 0 0 0 10 - 20 1 - 3 Industrial dust and lime kilns Around refractories 3 0 0 - 1500 15 - 40 5 - 20 Industrial dust Around thermal power 3 0 0 - 1500 10 - 30 3 - 10 Industrial dust house (flyash) Mining areas 5 0 0 - 3 0 0 0 5 - 10 3 - 10 Mine and road c Shop - floors Agate-grinding 20 - 877 mg/m8 80 • 90 80 - 85 Industrial dust Slate-pencil 20 - 500 mg/m3 80 - 90 50 - 60 Industrial dust Stone-crushing 10 - 40 mg/m8 40 - 60 10 - 80 Industrial dust The extreme form of disease resulting from accu- mulation of silica in lungs, causing lesions and fib- rosis of lungs, is termed 'silicosis' which is a highly debilitating, incurable and hence terminal disease and yet is often wrongly diagnosed as merely tube- rculosis, due to similarity of clinical symptoms, though obviously the patient does not respond to anti - tuberculosis - treatment and keeps on getting worse. Some observed prevalence of severe silica - dust caused ailments in India is given in table 3. Won - occupational severe silica exposure From the data of table 3 and the discussion ab- ove, one may be misled to believe that severe forms of silica • dust - caused diseases termed as various forms of 'pneumoconiosis' or 'silicosis' are essentietly problems for mine and industry workers. This is totally falsified by cases of 'pneumoconio- sis' in Ladakh. Obviously, the significant silica - co- ntents in the frequent dust - storms of Ladakh were resulting in the symptoms. The prevalence of clini- coradiological symptoms of pneumoconiosis among residents of villages severely exposed to dust storms was as high as 45.3 %. The risk in several parts of Gujarat, Rajasthan, Haryana and (J P., may be no less - and definite'y not in Delhi, known to be at or near the top in respect of ambient SPM concentrations among the cities of the world (tho- ugh mostly organic matter, Delhi SPM are bound to have significant silica contents too ). In - curability of s'lica - caused disease by mo- dern medicine The most worrysome feature of silica - caused imp- airment of health lies in these being not amenable to any form of modern 'allopathic' lines of treat- ment whether medicinal, surgical, or any other and hence being often termed as 'incurable'. This often provides motivation for wrong diagnosis, or atleast late diagnosis, of these ailments as detection would only demand removal from that work and environ- ment to avoid further deterioration and yet live with the disease for the rest of the severely reduced life with no hope of recovery. Even drugs, like 'predni- solone' when administered to silicosis patients at AIIMS Delhi could provide only temporary sympto- matic relief and that at the cost of significant adv- erse side • effects. NDIAN J. ENVIRONMENTAL PROTECTION, VOL. 17, NO. 5, MAY 1997 © 1997 - Kalpana Corporation 335
  • 3. Table 2. Average employment in Indi=» exposed to risk of free silica exposures (1991 hand- book of labour statistics, GOI) Coal mines 5 , 5 0 , 0 0 0 Limestone mines 5 1 , 0 0 0 Iron - ore mines 4 9 , 0 0 0 Manganes - ore mines 18,000 Copper - ore mines 13,000 Gold - mines 12,000 Stone - mines 1 1,000 Chromite mines 9,000 Magnesite mines 6.000 Other mines 81,000 Mines total 8,00,000 Foundries 2,84,000 Iron and steel industries 2.08,000 Clay products/Refractory 2,22,000 Glass and glass products 6 7 , 0 0 0 Cement/lime 7 8 , 0 0 0 Mica products 12,000 Agate 10,000 Slate pencil 8 , 0 0 0 Stone crushing/cutting/grinding 4,00,000 other industries 3 , 1 1 , 0 0 0 Industries total 16,00,000 Grand total 2 4 , 0 0 , 0 0 0 ETIOLOGY/PATHOLOGY/PATHOGEIMESIS OF DUST CAUSED DISEASES Early symptoms diagnosis The earliest symptoms of dust - caused respiratory diseases, whether the dusts are organic or mineral, fibrous or crystalline or amorphous, siliceous or onn - siliceous are irritation and constriction of th* upper respirarory tract leading to coughing expect- oration and dyspnoea. These get diagnosed as 'bro- nchitis' and treated by expectorants and bactericide! drugs. On treatment, the symptoms may amelio- rate, but keep re - appearing, if exposure continues. In our dusty environment, even those having no occ- upational exposure to dust, keep suffering from such mild or early stage of dust - caused diseases as seen from the high prevalence of such symptoms e v e n in the general population examined as s h o * n in table 4. Medium stage of dust - caused respiratory dis- eases As the dust accumulates and penetrates deeper into the respiratory tract, alveoli start getting congested and chocked and lung - capacity and functioning starts getting impaired. This stage can be detected by pulmonary function tests ( PFT ) by appropriate spirometers. Both the peak expiratory force ( PEF ) and forced expiratory volume in one second ( FEV 1 ), or one of them, on the ratio FVC/FEV1 may get affected. In clinical terms, expectoration increases and may be accompanied with nasal discharge and in severe cases with strains of blood. Also chest - pain, headache and body ache appear and get more severe and frequent. In later phases, recurring or persistent fever, marked chest pain and expectora- tion with blood ( Haemoptysis ) are taken to Indi- cate tuberculosis and treated as such, with some symptomatic relief but no cure. This phase may appear only after 5 - 8 year of severe exposure and may take much longer exposures of lower levels. Table 3. Some reported dust caused occupational diseases in India Industry/occu- Location Studied by Disease Sample Disease pation size Occupation Gold mining Kolar mines Shenoy Pneumoconiosis 5 8 9 3 8 2 0 Mica mining Bihar NIOH Pneumoconiosis 3 6 9 39 Copper mines Rajasthan Shaw and Deshmukh Pneumoconiosis 50 21 Coal mines Bihar Shrivastava Pneumoconiosis 20,086 3 7 4 Stone cutting Rajasthan Sethi and Kapoor Silicosis 72 18 Refractory Rajasthan Shaw and Deshmukh Pneuno/Silico 50 50 Refractary Maharashtra Rane Pnueno/silico 84 50 Refractory Orissa Rao and Sharma Silicosis 160 35 Agate Gujarat Clerk et at. Silicosis 3 4 2 63 Stone cutting Kashmir Saini et al. Silicosis 60 12 Glass bangle U.P. Shrivastava Pneumoconiosis 373 27 Cement factory Orissa Sharma et al. Silicosis „ - 336 INDIAN J. ENVIRONMENTAL PROTECTION, VOL 17, NO. 5, MAY 1997 © 1997 - Kelpana Corporation
  • 4. Advanced stage of dust - caused respiratory diseases Table 4. Prevalence of symptoms among residents of high - dust areas ( non - occupational exposure ), in % Percentage of residents examined showing various symptoms in Rajgangpur high - silica area Silicosis - like lung X - ray abnormalities 4 Markidly affected lung capacity 18 Blood in expectoration ( haemoptysis) 7 Recurring fever 16 Chest pain 21 Headache/body - ache 28 Cough/expectoration 36 Breathless -ness/dyspnoea 45 Percentage of general populatious of high- dust ( SMP 6 0 0 • 1000 i-ig/m8 ) arses of some places, suffering from severe respira- tory symptoms : Kanpur, U.P. 6.5 Haldia, W.B. 4.8 Barauni, Bihar 4.4 Bokajan, Assam 8.6 Chittorgarh, Rajasthan 8.3 Delhi NCR 1 1.2 As the deposit of dust in lungs accumulates, depen- ding on the nature of the dust, scars, lesions or fib- rosis of the lung start becoming visible on X • ray plates indicating advanced, severe and ( suppose- dly ) irreversible stage of the diseases and termed silicosis, asbestosis, byssinosis or pneumoconiosis depending on whether the causative dust was high- silica, asbestos, vegetable - fibres or mine - dust, respectively. Amongst these 4 designated types which pathologically are largely similar, asbestosis is considered the most dreaded, as dreadful as lung - cancer, but silicosis is no less dreadful in terms of suffering and is much - much more pre- valent. Common physicians diagnose them, media reports them, and normal citizens talk of them all, as tuberculosis. It is thus that all our large dusty towns, Delhi, Calcutta, Kanpur, etc., are reported to have such high incidence rates of tuberculosis ( TB ) and industries are blamed for this, though industries discharge no tubercle bacilii into enviro- nment. QUEST FOR AN AYURVEDIC REMEDY FOR DU- ST - CAUSED MALADIES Need to look toward? Ayurveda The above sections make it clear that dust - caused diseases are so rampant and serious for our country Table 5. Improvement in condition of silicosis patients on administering Kamadgiri formulation S - 8 Symptom Percentage of the sample group having symptomSymptom At start of treatment After 30 day of treatment After 60 day of trea- tment Symptom S M N S M N S M N Cough 100 - - - 20 80 _ — 100 Expectoration 80 20 _ - 10 90 - - 100 Dyspnoea 95 5 - - 5 95 - - 100 Chest pain 70 30 - - 20 80 - - 100 Haemoptysis 15 20 65 - - 100 - - 100 Body - ache 60 20 20 - 10 90 - - 100 Fever 20 25 55 - - 100 - - 100 Ghurghurahat ( lung sound ) 65 35 _ - 5 95 - - 100 Loss of appetite 35 40 25 - - 100 - - 100 Loss of weight 15 45 40 - 5 95 - 5 95 Reduced chest expansion 60 40 - - 30 70 - 10 90 Reduced lung capacity 45 55 - 10 70 20 - 45 55 X - ray abnormalities 30 65 5 25 55 20 15 4 0 45 Legend S : Severe complaints of the symptom M : Moderate complaints of the symptom N : Nil or only slight complaints of the symptom INDIAN J. ENVIRONMENTAL PROTECTION, VOL. 17, NO. 5, MAY 1997 <© 1997 - Kalpana Corporation 337
  • 5. that search for appropriate preventive and curative remedies becomes an urgent need. It is easy to say that 'prevention is better than cure' and that the best approach to prevention of dust - caused - dise- ases is to eliminate or avoid exposure. But how ? By closing down dust causing industries and pro cesses, giving up jobs involving working in dusty environments and vacating dusty urban centres to stay away in un - polluted areas ? Control of pollu- tion at source, proper siting of industries, proper planning of urban centres, plantation of dust - atte- nuating green - belts are all needed and have to ba promoted to the utmost. But can such efforts at pol- lution - control be really and adequately effective ? Our experience so - far proves otherwise. And often, effective pollution - control to eliminate dust - caused ailments shall imply costs almost impossi- ble to pay at this stage of our development. Making our mines and small - scale industry dust - free, may in reality require closing them down. And if prevention is the key to health, why have all the antacid tablets and other digestive medicines and not rely merely on total control of diet ? Obviously, like all other areas of bodily sufferings, one should search for remedies that would first minimise the harmful effects of dust exposure ( particularly silica exposure) and those that would offer a cure in case one does become sick with silicosis pneumo- coniosis or other dust caused diseases. With all options in other modern systems of medicine tried so far, proving in - effective or hardly effective, and often also involving severe side - effects, attention should obviously go to Ayurveda which evolved on ages - long experience of Indian conditions and may offer remedies not likely to have adverse side - effects. Dust - caused diseases in ayurveda Even in modern medical science, attention to dust caused diseases was given only after the industrial revolution made the situation in respect to such diseases rather acute. Thus silicosis, asbestosis, byssinosis, pneumoconiosis are all relatively recen- tly coined words and the detailed prognosis of these diseases is still only being worked out through re- search. In these circumstances, it would be vain to expect these diseases or their equivalent to be men- tioned in Ayurvedic texts which were created when such industries did not exist. And yet dust was always there, as was silica, and cotton and other vegetable fibres. As a comprehensive health sci- ence, Ayurveda could not have ignored respiratory system and it is ailments - even those caused by dusts. And one finds in these texts significant de- tails of the structure, characteristics, inter - relation- ships and ailments of 'Prana - vah - Shrotah', the various vessels and conduits involved in the pro- cess of respiration including the tiniest alveoli. And amongst the 'Prana - vah - Shrotah - Dushiti' or maladies of the respiratory tract, are also described those caused by 'Raj or dust'. Acharya Charak men- tions 18 types of 'Kshaya' involving functional de- struction of various body - systems. 'Raj - yaks- hma', the equivalent of common tuberculosis or TB involves several of these etiological factors or Kshaya's. One are some of the forms of 'Kshaya' also get invariably associated with 'Prana - vah - Shrotah - Dushte'. These could be caused by expo- sure to excess 'Raj', and the symptoms and progno- sis shall be very close to present day dust - caused diseases, silicosis, asbestosis, byssinosis or pneu- moconiosis. That 'Kshaya' of several forms get in- volved in both, relates these dust - caused disea- ses to Raj - yakshma' or TB and indicates the many, many similarities not just in lung - radiography but in symptoms, like fever, weight loss, loss of appe- tite, dispnoea, anaemia, etc., etc. If 'Raj caused' Parana vah - Shrotah - Dushts could be taken to be the Ayurvedic equivalent ( or pre - cursor) of the present - day dust caused diseases, the reme- dies, treatment and protection measures described in Ayurvedic texts for 'Raj' caused 'Parana - vah - Shrotah - Dushti' could prove successful in handling these diseases. Obviously only research could con- firm. Ayurvedic line of approach to tackle silicosis Thus in ayurvedic terms, silicosis could be descri- bed as 'Parana - vah - Shortah - Dushti' caused by significant quantities of silica accumulating in •Prana - vah - Shrotas' leading to 'Kha - vaigunya' in the respective 'shrotas' and interfering with the function of 'avalambaka - kapha' to increase the 'guruta' of the 'kapha' and hampening functiory of •vata', particularly 'parn' and 'udan', 'Vayu' through the process of 'sanga' or 'avaran'. The 'Kaphavritta - pran' and 'Kaphavretta udan' would be the chief pathological factors in the manifestation of the diss ases as in the general case of 'Vata - Kshaya'. The line of prevention and treatment of silicosis could follow the lines suggested by Acharya Chakrapani in his treatise 'Chakradatta', with appropriate modifica- tions and supplementation. 3 3 8 INDIAN.! PNVinnMMCMTAi D D A T c M i n n w/» - i r»
  • 6. THE NEW RAY OF AYURVEDIC HOPE After a thorough and critical study of various Ayur- vedic texts, Dr Kotecha Post - graduate Vaidya, with considerable research and practising experi- ence after several trials evolved an ayurvedic for- mulation tentatively termed 'Kamadgiri formulation S - 8 designed to ameliorate, and in - time practi- cally and functionally cure even advanced stage patients of silicosis. The formulation was tried on 20 proven cases of advanced silicosis and in just 30 day resulted in very significant amelioration of almost all debilitating symptoms and after 60 day of administration of the formulations improvem- ents in pulmonary function test and on lung X - ray plates were noticeable as seen from table 5. Obvio- usly much more trials and clinical tests under differ- ent conditions shall need to be done to scientifically establish the value and constraints of the treatment but the results are encouraging enough to offer a ray of hope for those having developed this dread- ful disease. An Ayurvedic formulation to act as a preventive and ameliorative measure for dust - caused ailments in general, and silicosis in particular, is even more promising and 'Kamadgiri formulation S-7' has evo- lved after trials for this task. The formulation in- cludes small daily dosages of a 'Vati' ( Ayurvedic pills ) and of an 'Avaleha' ( ayurvedic sausage ). To have the formulation tested on field on a large eno- ugh scale, it is proposed and offer this to selected industrial organisations at a subsidised rate of around Rs 1 per person per day, in case they pro- mise to administer it to 50 % of the workers ex- posed to large concentrations of silica in their daily work, while the other 50 % continue the usual routine without this formulation and the results of comparing the two groups are provided on a quar- terly basis. It may be mentioned that the un - sub- sidized cost of the daily dosage shall come to bet- ween Rs 3 and 4 per head per day. When successful and commercialised, the formula- tions should provide a break - through in fight aga- inst silicosis and dust - caused - diseases. i.*....i<-.iT>i DDrttcoTinM v/ni 17 Nrt B MAY 1997 339