by Charlotte A, Bowman! , Peter T. Bobrow Medical geology: y?, and Olle Selinus? new relevance in the earth sciences 1 School of Earth and Ocean Sciences, University of Vi 2 Geological Survey of Canada, Oxawa, Canada 3 Geological Survey of Sweden, Uppsala, Sweden The interdisciplinary field of “Medical Geology responds to the need to better understand the relarion: ships benveen human health and our surrounding envi- ronment. The influence of earth resources, natural envi ronmental factors and land-use on huanan health has Jong been recognized, dating hack to ancient Rome and Peru's Inca civilization. Today finks between the natural environment and health can be found throughout she world. This review introduces she historisat context of this particular type of research, contrasts the direct geo logical and indirect natural hazard influences on health «as a framework of study, elaborates on pathways of ele: mental accumutation in the body and provides examples of specific geochemical behaviours and diseases shat are often associated with ether too much or not enough lof certain elements which comprise the Earth, Introduction Recently the relation hetween adverse health effects an heat met als in our envigonment has gained considerable tention in Various professional journals as well asin the broader public media, Heay metas oF polenta pollutants have heen termed “gengenic cones nants and include sch elements as As, Ph, Cand Hp, Elevated ev cls of these and other potential pollitants have heen recorded in many areas ofthe world including Canada, USA. fia, China and Bangladesh to name afew examples (Figure 1). The recognition that an sntimase Folaionship enists betwcen geology. as measured by imal alt has Jet the development ‘fa new Field of science called Medical Geology Figure # A map of the world indicating some areas that have ‘experienced adverse health effects due to heavy metas. ia, Victoria, Canada (cabowman@ telus.net) For the purpose of this review Medieal Geology is the science stealing wi he ret ‘ankd heat problems it mans. animals ae plants (ef Selinus 2002: Finkelman er al. 2001). Medical ‘gcomedicine, but medical geography on the ater hand as hal & Fy different meaning that is ale to the Drader Felt of mec ical ueology. Medical geography looks at the scoaraphical distribu tion of disease while qot focusing on the underlying geology: it examines the causal associations between specitic diseases andthe physical andl social environments (Foster. 2002) The field of sted Fs complex af requites & multiisciplinary approach using a wide variety of specialists fm geologist, geochemists and medical doe tors 10 veerinarians and biologists Formal recognition of the sub-isipline appears to resi with ‘iess who fis insodated the tore gasatedicine” in 1981 anal atthe ret synonymous wilh “geographic medicine” which was defined “a branch of medicine where geographical and cart apical ethos are used to present medical research results" (La 1990, p. 5). Lite changed until the 197" when Lae (F990. pt icine a6 “the science dealing with the graphic distr rianshp bere geological factors ology is also Known 3s redefined the teres influence of ordinary environmental factors ont bution of health prem. in man and amas This piper provides u general overview of the fick! of Medical Geniogy. The porpese of this review serves intulice the reer to the historical context of this particular type of fesearch, cemteas th direct geological and indirect natural hay influences on eat as 4 framework of study. elaborate on pathy of elemental accumu Tation inthe body and provide esamypks of spovitieefement Behav iours and diseases that afe offen ssoctated With ether f00 much oF fot enovigh of some elements which comprise the Earth. For a detailed treatment of medical geology the reader is encouraged t0 ‘examine the treatise entitled Medical Geology’: Fart Seen Jo Say port of Public Health Prone tin (Selinus, 200). Background — Ensuring human, animal and plant health requires aecesiilty 10 both essential (eg, Cr. Co, Fe, Ca, Se) and not-essel (€.8.- Wnie Ph, As. Hg) clements. Such elements oeeur in ay ing concent lions and Sarmsthearoar de asmosphere.llwsphere and hydra Phere. Ava result pants. snimals and hurnans are regularly exposed to theve and oxher elements, With respect 10 cach essential element all organisms depend! on 4 specific range of tolerance oF adequate range of exposure that is Safe, Defisien or exces fevets of concen tration forthe essential elements can lea to adverse health effets and in certain cases, death. The coneetiration values of the elements ane represcnted in “dase response curve", which is graphical rep resentation indicating the ideal amount of an element needed for maintaining goo healt sy well 38 amounts conteibuting (0 def cicney oF tonieity levels (Figure 2). As expeeted the dose response curve for any given element may differ rom organi co organism, bur the underlying principle of deficiency. ideal concentration and December 2003Deticient Toxic vy toxicity remains constant, For exam ple, V is essent for_ photosynthesis, by blue green a and yet this element is highly toxic to humans. Similarly, Co is required. for fixing N2 in blue- ve and other microorgan- isms. however. is unknown if it is er plants (Kabata-Pendias. 2001) ©. |oeath! ‘Death HEALTH RESPONSE —> (CONCENTRATION OF AN ELEMENT —> Figure 2 A generalized dose response The intimate relationship betxeen zeology and health has long been Known. Ancient philosophers and physicians in countries such as Greece and China long-ago realize the importance of how geology influences health: although. it was not until the advent of modem medicine in the 19th century that actual elements essential to health \were finally recognized. The Greek philosopher Hippocrates (400 B.C.) is considered by ‘most scientists 10 he the Founuler of medical geology. He recognized that environmental factors alfected the distribution of disease (Lag 1990: Foster. 2002). Hippocrates noted in his treatise, Ore Airs. Warers, and Places (Part 7), that under certain circamstanees, water ‘come’ from soit which produces thermal waters. sue as those hav ing iron. copper, silver, gold. sulphur, alum, bitumen. oF mitre”. and Such water is “bad for every purpose”. Another example is that of Vitruvius. « Roman architect in the ust century B.C. who recog nized potential health dangers related to mining. noting that the water and pollution near mines posed negative health threats (cited in Nriagu, 1983), Later in the first century AD. the Greek physician Galen reaffirmed the potential chinger of mining activitiey when te noted acid misty are often associated with the extraction of Cu from xaberg. 1992), texts dating back to the 3rd century B.C, con Jain several relationships between geology and health. During both the Song Dynasty (1000 B.C.) and the Ming Dynasty (14-17th Cen- hus hung problems related to rock crushing and symptoms of ocet- pabionsl Ph poisoning were recognized, Similarly. the Thang Dynasty alchemist Chen Shao-Wei stated that Pb, Ag. Cu, Sb, Au. tana Fe wore pusisanous (cited in Livny etal. 1998). sts and historians. pro- vide us with es lenge that poor health reflected in the tissues of pre historic cad crs and mnuninnies can be often be linked 10 past det ny wut of severe I deficiency sas wide!) prevalent in ancient China. Greece. Egypt as well as in the Ines state of Peru. This condition was often treat with seaweed. high the ground ¢eited in L Chinese medi Contemporary archaeologists. osteato wal environmental conditions. Goitre for instance. the ince of I, and indicates some degree ‘of knowledge that these ancient eis ilizatinns hae! eetating the treal- ment of dietary deficiencies thioush the use of natural supplements {Selinus. 2002). Besides element detic dlay ancient society introduced the ne lated problems. Although the relationship between Pb ancl a variety of Iicalth risks ate now well documented jn moxlesn society. the rel tionship hay been less well known in the past, Leal hay been exploited for over six millennia. with signiticant proxinetion Degie ning about $000 years sige and increasing proportionately through the Copper. Bronze and Iron Ages. finally peaking about 2000 years ago (Hong er al. 1994 and Nriagu, 1998), Several descriptions of Pb poisoning found in text from past civilizations further corroborate the heavy uses of Pb, Clay tablets from the Middle and Late Assy ian periods (1550 1 600 B.C.) provide accounts. of Pb poisoning wees the use of heavy metals in every Episodes, Vol. 26. nod 2 symptoms. as do ancient Egyptian medical papyri and Sanskrit texts dating to over 3000 years ago (Nriagu. 1983). During the Roman Empire it has been estimated that the annual production of Pb approached 80.000 tonnes (Hong et af., (994 and Nriagu, 1996). ‘Total production of Pb from 2000 years ago to about 1000 years aso is estimated at 29 million tonnes. indicating that about 24% of dis covered Pb reserves were mined in ancient times (Nriagu, 1998), Copper. Zn and Hy Were also mined extensively during the Roman Empire with an estimated annual production oF about 14,000 tonnes. 9,000 tonnes and >2 tonnes, respectively (Nriayu, 1996). During the Roman Empire Pb usage exceeded $50 grams per person per year ‘The main sources being plumbing. architecture ant shipbuilding. Lead safes were used to preserve fruits and vegetables and Pb was also ackled to wine to stop further fermentation and to add colour or Pbouquet (Nriagu. 1983). Large amounts of Ph usage in the daily Tite ‘of Roman aristocracy had a number of negative health implications including: epiclemics of plumbism and saturnine gout, high incidence of sterility and stillbirths as well as mental incompetence. Physiolog: ical profiles of Roman Emperors dating between 50 B.C. and 250) B.C. suggest that the majority oF individuals sutfered from Pl por soning (Nrigga, 19837. in tum, itis generally believed that & con: tributing Factor to the fall of the Roman Empire. in 476 A.D.. may hhave been the result of the excessive use of Pb (Hong et ai. 194). Following the Fall of the Roman Empire there was a dramatic rease in Ph production due to the lack of deposits, such that dur- Medieval times procluction was as low asa few thousand tons per betire it aysin rose with the discovery of Pb and Ag deposits in al Europe in about 1000 8.D, (Hong er ai.. 1994) (Figure 3) (40) 20121 Jo spuesnowlvonsnposd Figure 3 A graph indicating the production and emission of Pb, Cu and Zn through time (modified after Nriagu, 1996), Besides Pb. other elements including Hg. Cu and As were also used in Roman and pre: e. Hy was used during the Roman Ei as in the recovery of Au fomaan times (Fergusson, 1990), For pire to ease the pain of nd Ag. a method! also widely’ used in the [2th century and in Cen- feat and South America in the [6th century (Eaton and Robertson, 1994: Silver and Rothman, 1995), Mercury was also used to treat syphilis during the 16th cen: tury and inthe feltin process in the 1800's (Fig lure 4) (Fergusson. 1990), Copper. on the other hand, was first used in its 7 native form approximately Figure 4 During the 1800's 7000 years ago. with signiti- mercury nitrate was used in the cant production starting {felting process, long term exposure some 200) years later, ancl led to He poisoning, thus the eventwally peaking at a pro- expression "Mad as a Hatter". teething infants as welduction rate of about 15000 tonnes annually during the Roman Empire where it was used for both military and civilian purposes. especially coinage. As with Pb, there was a significant drop in the prostuction of Cu following the fal) of eke Roman Empire remaining Jos unt? about 900 years ago when there was a dramatic increase in production in China reaching a maximum of 13000 tonnes annually (Hong er al. 1996), Greeks. Romans, Arabs and Peruvians used As for therapeutic purposes. since small doses we nt to improve the complex= jon: however. it has also long been used as a poison (Fergusson. 1990), Selenium is another element with a number of associated health issues. especially recognized in China where there are both toxic and deticient regions of the element. Marco Polo during his travels in 1275 10 China noted that some horses of certain regions suffered from an inexplicable and debilitating disease: this disease pattern is now linked to Jhose regions that are high in Se (Selinus, 2002, Along with the written records of “medical geology”. archaeol: also noted links between health and environmerest fie- tors, Analysis of elements in boxe material has provided an excellent foo! to study the diet and nutritional status of the past humans and animals (Krzysatof and Glab, 2001), For instance, the transition from a hunter gather society to an agriculturally based! economy resulted in a major dietary change and an accompanying Fe deti in some populations. [ron in plants is more dificult 1 absorb iron from 3 meat soutee: hence it has been proposed that this new reliance on a crop diet may have resulted in Fe detivfeney and anemia amongs) the genera populace (Roberts and Manchester 1995), Skeletal remains found in the Kentucky Blue Grays atea in the southeastern United States provide & prime example af te retation: ship between genlogy an human health, The area is blanketed by ‘mineral deficient soils and animals present in the region avoid feed: ing there given the lack of available nutrients. Native Americans however, established permanent settlements jn the area and bexan normal crop cullivation practices, Asa result of the soil mineral deti- Key, the maize produced was extremely’ low in Zn and Ma, The oof diet-related health effects that have been clearly documented through the sunly of dental and skeletal pathology in the Rastian remains (Moynahan, 1979, After first being observed in China in the 1930"s, Keshan dis cease (4 potentially fatal form of cardiomyopathy due to Se deti ciency) was eventually linked in the 1970's 20 kaw concentrations of Se in the envirerment (Selinus, 2002) By the 20th Century. links of environmental factors 0 various diseases and disorders fed fo the recognition that trace elements are essential fo human, animal atid plant beabte, he the early 1900°S the link bebseen drinking water containing cease called “fluorosis” (the mottling of teeth and in extreme cases skeletal changes characterized by osteosclerosis and ligamental ca cification) was determined. Leaching of racks. dissolution of fluo rides Sront volcanic gases. fresh and mineral springs. and marine aerosols are all possible sources for F in surtace and ground waters. The normal level of Fis generally regarded as lying between 0.1 and 1 ppm. but in some areas of the would fe-g, parts of India. China and Afiica) tevets as high as 40 ppm have been recorded and shows to be responsible for serious dental and skeletal fluorosis (Selinus. 2002). By the late 1950°s. nine trace elements were recounised as essential to higher life, The nuyher of essential elements 2rew to [4 jn the 1974s and to 20 by the 1980"s. Today there gre 30 elements considered essential for the health and survival of living organisms, (Table 1) (Dunn ant Irvine. 1993), detiviencies led to a a high F content and the dis Table 1 A list of essential elements for iving organisms Ess 1 to all organisms Exsential to most organises C00. Cu. Fe, HOR.LL Me. Mn Mo. NP. Sand Za AL ASB. Br. Ca CALCL.Cr EL Na, NiO. Se, Stand V Medical geology branches Medical geology ean be split into two primary branches based on the number and variability of element sources withig the environment The firss branch is strictly related fo the natural occurrence of el ments in the geologic environment (e.g, ingestion of food grown soils with either element deficiencies or toxicities}, whereas the sec ‘ond branch relates 10 elemental occurrence retative to natural haz ards (eg, earthquakes, voleanic eruptions, flooding and landstides). Geology The geutogy of an area has a direct impact on the regional input of elements into the soil. air and water. In jurn. these inputs, depend- ing on composition, may result in acverse health effects in humans, animals and/or plants. Health issues zekigd 10a region's geology are \isible ia both humans and animals on almost every continent, and can range from As contaminated groundwater in Bangladesh to ‘molybdenosis in Canadian cattle (Hastings «1 ul. 1999), Today, the diverse geographical and geochemical source of human foods in develaped nations ereates a “homogenized diet” tetlecting materials own on a range of soil types, each with different chemical charac teristics and potentially imported from @ number of countries. As a result of this complex sourcing mectanism, element Uleticiencies or toxicities ure generally rare in regards to dietary intake. ditionally. growth, element imbalances in the soil are often amended betore the of crops, thus eliminating any subsequent problems (Underwoed 1979: Planter al.. 1998), Ths, erace efement deficiencies an/or tox seikies that are a result of geological conditions are much easier to ify in animals and people in developing countries since much of the food an! water ingested is obtained directly from the surrounding environment. A few examples will illustrate the effects of geology ct the geochemical environment Arsenic Areay whiek contain high levels of As in the groundwater are found all over the world. however, the Bengal Basin in India repre sents one of the largest problems, with an estimated 40) million indi water with elevated and peteaitally dangerous lev- els of As, The affected aquifers are situated in highly seducing env ronments which favour the mobilization of As. In general, the aquifers are shallow and consist of micaeeous sand. silt and clay of ge. capped by a liyer oF clay ve silt and recent solid ‘organic matiee. Health problenis were first identified in the 1980's, however. the first official diagnosis was not made until 1993. The dominant resulting health problems in the region are skin disorders (e.g.- changes in skin pigmentation and Keraroyis) (Smeuly and Kin piburgh, 2002), Holocene Molybdenum Elevated natural eves of mofybalenun in the Soil pose a seri ‘ou Healthy concern Foy s around the ‘world if it leads 10 Molybdenosis, Livestock that ingest elevated lev els of Mo are unable to absorb Cu: and the resnling Ca deticieney may lead to growth or reproxiyetive problems. Molybdenosis has. been documented in impala of Lake Nakuss National Park, Kenya and in cattle of Fort Braser. British Columbia, Canada In the case of Lake Nakura National Pash. the pak is situated in a fit valley consisting of a Tertiary Quaternary volcanic suite and associated alkaline sediments. Sodication is the predominant pedo- enic process: the resulting alkaline solonetz soil thus has a low con- centration of several essential trae elements, Thi low trace element status in combination with high pH has resulted in elevated levels of Mo in the surface vegetation, Which in turn, helps explain the Cu Aleficieney found in the park impala population (Maskatl and Thorn: ton, 1996) (Figure 5). Similar prabicms are evident for cattle near Font Fraser, British ‘Columbia, however the geologic process resulting in elevated values sazing livestock in ses era December 2003Figure 5 The effect of Cu deficiency: (A) A Cu deficient cow, note the rough hair and patches of lost hair; (B) the same cow ‘after Cu therapy ns number of iso» lated molybdenum rich deposits, but & history of extensive glacia tions and recent mining activity hi resulted in expansive areas of soits containing widely distributed elevated levels of Mo. The fof Mo is different. This region of Canal com jenriched soily are extensively used for ranching and Farming, thus exposing cattle to plants enriched in Mo, resulting in extensive sols lenosis in the cattle (Hastings er a.. 1999 Ral Radon exposure provides an exampke of the relationship ve human health implications. Radon igh soil and in turn may leak into houses dirough eracks and crsins making ita sig nificant potential health threat of natural raclition (Philp, 1995), Althowath radon concentrations in the air tend 10 be very low due to quick dilution, concentrations can become chigerously. high in poorly ventilated buildings, The most common risk associated with radon exposure is lung cancer (Appleton and Ball, 20012 decay product of uranium, essify migrates thro Natural Hazards The threat to health commonly associated with s natural di {er is some form of bodily harm or even death. And the type of nat tural hazard influences the extent athe impact on health, For exam: ple, volcanoes ancl earthquakes can directly. through the ejection of ash and magne, und indirectly. through the triggering of landslides, input and mobilize elements into the environment that may have term or delayed health problems, usually depending on the amount and concentration of the immediate health implications or lead to lon; particular elements, A dlirect tisk can also transform into an indirect Fisk, for instance voleanie ash fall directly affects an organism's ling. it introduces new elements into the surrounding lungs but in set Episodes. Vol.26, 10.4 cenvironment, possibly contributing hazardous elements into the food. chain, Volcanism and related hydrothermal activity are the principe Processes th metals and other potentially tants to the surface from deep within the earth, Trace elements such as Se, Pb, Cd, Cu, Zi and As are So abundant in plumes of quiescent oF passive volcanoes, thst they commonly become minor or major elements. The annual global release of such elements is estimated at {9000 tones (Hinkley er al., 1999), However, one explosive eruption incredible vol ecrous pollu- can introduce at lary ne of elements into the surface environment, For example, during the eruption of Mt, Pinatubo in June of 1991 an estimated 10 billion tonnes of magma was released to the surface and about 20 million tonnes of SC the atmosphere. Ash ejected from this eruption contained every ele ‘ment in the periodic table including 2 million tonnes of Zn, | milfion tonnes of Cu and $500 tonnes of Cal (Selinus, 2002). Once deposited the elements may lead to future health problems as different processes and activities, such as acid rain and agricultural behav jours. contribute to the remobilization of the elements, The 1783 Lakagigar eruption in Iceland introduced fluoride into the terrestrial ‘was released into, environment that is believed to account for the higher proportion of livestock death that occurred in the area shortly thereafter (Gregory 1996). This also caused a sharp decrease in the economy of Iceland as Well gs causing famine. Similarly. alter the 1970 Hekla eruption, the incidence of fluorosis in the human population of Iceland dis played a measurable increase (Lag. 1990) The threat to animal and human health as a result of such erup- tions provides a good example of both the direct and indirect impact significance of volcanism. The direct impact includes everythit from respiratory problems to deh as a result of ash fall and lava flows to gas clouds: whereas, indirect impact varies widely from ‘monsoon induced landslides to soil contamination. Ash poses one of the largest health risks in a volcanic eruption, causing both short and Jong term health problems such as minor lung irritation Volcanoes can eject large volumes of ash containing high percent ine silica known as cristohalite (Figure 6). The contained in the ash varies between vol ccanoes depending on the composition and the type of eruption. Long-lived andesite dome eruptions often x Tine and crystalline silicate (>3 micrometers in diameters). amount of crystalline si amount of ult of ‘vapour phase crystallization within pyroctustic flows. This was t ease for the Soutrigre be Hills volcano, Montser- rat, British West Indies eruption, spanning. the summer of 1995 t0 the spring of 1998 whose ash contained 10-24% by weight crystalline silica, Long-term expo sure to erystattine sili ccale can result in silico: sis. a fatal lung disease. Areas that were the most susceptible 10 ash hazard had to be evacu ated t0 prevent the Fisk of silicosis (Baxter et al. 1999), In. contrast the 1980 Mount St Helens, Washington State. eruption was short lived and the ash only contained 4% by cristobalite, the risk of long health problems (Wakefield, 2000). term Figure 6 4 10km high ash-cloud from the Soufriére Hills volcano (photo courtesy of Paul Cole)Silicosis is 4 common occupational lung disease in the mining and aggregate industry. but it also occurs in- non-industrial settings due to its abundance in the soil (Figure 7), Silica can become air- ome under arid windy conditions or during agriculture, urban or construction activities as well as during volcanic eruptions. Once in the lungs the small crystalline silica particles. are taken up by ¢ and accumulate near blood vessels: the com forms around these masses. produ fibrous nodules in the lungs, resulting in major respiratory problems and. ia extreme eases, death (Castranova and Vallyathan, 2000), Like volcanoes. earthquakes pose both direct and indirect threats to human and animal health, Direct effects include the struction of property. injury and death: however, the iadicect effects are the focus of medical geology. The majority of these indi rect health problems result from earthquakesinduced landslides that remobilize elements and other potential risk agents such as fungus, In 1994. 4 6.7M earthquake near Los Angeles triggered approxi mately 11,000 landslides that dis utbed soit containing a dimor- hic fungus, known to cause coe Gidioidomycosis oF valley fever. This lung infection results trot the inhalation of airborne arthospores. that have been dis J from the topsoil of semi the earthquake, break oF coceidioidomycosis nccurred consisting of 203, reported cases, 3 of which were Jaral: staistics an order of mage tude higher than normal (Schnei- der et al. 1997) (Figure 8) Siease Figure 7 An x-ray of lungs with silicosis (phuta courtesy of KC, Wan) | Nonoutbreak cases 6] BH Outbreak cases | 30} Nonthndge | 3 | Eanhquake, Ba Snoyi? a | Sx | Be wo 4 s| o's 18 28 8 18 28 8 January Febtuaty waren Figure 8 Coceidiodomycosis cases before and after the 1994 Northridge earthquake (after Schneider et al., 1997). intake, u uptake, and excretion Pathways, in The transfer of heavy metals through living tissue can be addressed as follows: (1) pathways: (2) intake: (3) uptake: and (4) exeretion (Fergusson, 1990) (Figure 9}. There are a number of pathways through which heavy metal exposure may occur ranging from soil sand dust to water to diet, Depending on the pathway, intake i either through ingestion, inhalation or dermal absogption, Ingestion is the most common route of exposure for the general populace. w inhalation and dermal absorption are si tional settings (Adriano, 2001). Once in the body, uptake of an ele- Pathways ~ Dermal absorption Figure 9 Pathways, intake, uptake and excretion of heavy metals in the human body. ment depends on a variety of factors including nutritional status of the individual and size of the particle. The majority of clements are excreted by a number of different mechanisms such ay sneezing ot ‘vomiting Elements may’ be present at tonic oF deficient levels within the environment, but may not necessarily pose a direct risk to health, Exposure, and more importantly biewn salubities. depends om a num: ber of factors ineluding concentration in the source, soil type, patti: cle size as well ay the specitic physical and chemical properties of the contaminant itselt. In other words. the concentration of ap ele iment in the soil or other medium is not sufficient to provide biologi- cal availability 1o the individual organism. Bioavailability is the fraction or amount of element. which is actually available for uptake by fiving matter (Plant er al. 1998) The fate of elements within soil are governed by the chemical system ‘of the soil andl are characterized by: a) the heterogeneous distribution ‘of compounds, b) seasonal and spatial alterations fer physical acd chemical properties (e.g., pH), ¢) the transformation of chemical species (e.g.. electron transfer reactions. diffusion-adsorption into solids), and d) bio-uptake and bioaccumulation. Time. vegetation, microbial activity, water content, geolog’ and heterogeneity of the solid state phase all influence the concentration of trace elements in soils. Rainfall, evaporation and pkint transpiration can change the concentration of trave efements more than tentoft (Kabata-Pendlias and Pendias, 1992); however. the observed variation of major jons is ‘much less. Reaetions involving trace elements vary depending on the ‘weathering environment, the mobility during the weathering pracess as determined by the stability of the host minerals. and the electro: chemical properties of the element (Table 2), Rates of trace element migration in Soils are affected by chemical, physical, and biological soil. properties. including: Eh-pH sysiem, ionic strength, cation exchange capacity and salt content, amount and quality of organic mater, water and temperature, suspended colloidal material, plant December 2008Table 2, Behaviour of certain trace elelments in various weathering environments (based on Kabata-Pendias and Pendias 1992) jes (Kabata-Pendlias species, as well as micro and mesobion sand Penudias, 1992 and Wolk, 190 pH isan important property concerning evetal behaviour in soil systems and probably the most important fctor affecting metal spe: ciation in soils. Under natural soil vonditions the pH ranges between S and 7 (Kubata-Pendias and Ponts, 1992), However, soils ti sed repeatedly change the redo potential thus affect pH, Reducing conditions result in pH increase, wher results ina pH decrease. Acidity is associated with leached Soils, wshereas. alktlinity is associated With dricr env iconments, The aie: 1s oxidation ity of the soil dictated by inputs of acidity from v Dial mass. the atmosphere and the aibifiny of prinyary minerals 10 resist the acidifying affects of leaching. .\ikalinity is determined by parent material, vegetation and hydrology. [1 general. desorption of metals ineteases with increasing pH: thus, nretals are more soluble in un acidic environment. In such environments. Zn. Ma. Cu. Fe, Co ‘and B are easily leached and i the pH rises above 7, hey are likely is true for Mo and to form stable compounds. however. the rever Se (Kubata-Pendias and Pendias. 1992), Organic matter influences the physical. chemical. and biologi cel properties of soil including its structure, sacra 9vicuo Wate ent supply. cation exchange capacity, and pH buttering capabilities (Pierzynski er af.. 1994), Thus, the organic maticr content of soil influences the bioavailability of certain ek essential 10 biochemical weathering and the geoclepuical eyeing of trace elements (Kabati-Pendias and Pend, 1992), All reactions between organic matter and individual cations result in Water-soluble and/or water-insoluble substances. Organic matter van absorb trace clements and organic pollute the risk of contaminatinn of surtace ae ins, Orzanic mater is as Well ay inorganic and organic cases. therefore reduc Intake Ingestion Ingestion is the primary source of expressed throngh gies, food and heverage, and soil and dust, Even though the main intake of heavy metals through ingestion veers via. diet. geophagia ako contributes towards aecumalation, Geophagia, ako known as pica, is the intentional or unintentional eating of soil for clay and is & common practice in some cultures and countries especially within Africa (Abrahams. 1997). Geophagia is often an attempt t offset mineral imbalances or deficiencies, however it may :lso impair the intestinal uptake of trace elements such as Fe and Zn (Mills. 1996: Smith et. 2000), Studies of Turkish women who use _zcoph 1-10 supplemem their diet with Fe suggest that the practice may infact be causing the Fe deticieney (Moynahan, 197%), Episvades. Vol Geophagia was a common practice i cectain ancient cultures: for example, the consumption of edible clays was so common in prehis: torie South America that an extensive network was established (Browman, 1981).(Figure 10), Figure 10 Photograph of geophagical materials that are available ‘for purchase in Kampala, the capital of Uganda (Photo courtesy of P. Abrahams). As noted earlier. in developed countries where food comes From a variety of sources elemcot deficiency or toxicity is not typi cally a problem. Nonetheless, the ingestion of soil and dust isa mayer source of element exposure in young children and may therefore be ‘concern (Fergusson, 1990), Ingestion is the most important route of exposure to contaminants in soil or dust, with children between the nl 4 years being the most susveptible group. Between the ages of Qand 2 children typically ingest small amounts fof dust and soil through normal mouthing behaviour. whereas. bbewween the ages of 2 and 7 the largest quantities ae often ingested, and afier the age of 7. ingestion is Considered insignificant. Iti est mated that the average child ingests about 80 milligrams of soil and dust each day, Up to 80% of an entire lifetime dose af some persis tent heavy metals may occur inthe first 5 years of lie (Ontario Min istry of Health, 1997), ‘sof 4 months Inhalation aly for airborne particles such as dust. Due to the minimal amount of soil or dust normally inhaled, this route of exposure is not considered a significant risk 6 Ivor health, Sull, under certain conditions such as volcanic eruptions, in highly arid or desert regions or in areas with high concentrations of ce 12 disease may result from this exposure path: | population (Ruttenber and Kimbrough, 1995). The amount of material infiled and the amount of aerosols deposited internally in the 5s olten controlled by an individual's breath ing cycle (breaths per minute) and ventilation rate (volume breathed perday) (Fergusson, 1990) {Figure}, Inhatation is the primary ps Dermal Absorption The shin of humans can act as a barrier to water particles, ionic inorganic species and materials of a high molecular weight, bat it is vulnerable to lipid soluble non-polar substances (e. nometal lic compounds and compounds soluble in some organic solvents). The only way for an exogenous compound to penetrate the skin is to diffuse directly through the cells of between the cells. The space between the cells contains fat that can be dissolved by organic sol vents increasing the skins permeability to certain chemicals (Sterner. 1999). Control on chemical absorption include; area of eontact, ura- tion of contiet, chemical and physical attraction between the conte ‘minant and the shin, aind the ability of the contaminant to penetrate the skin (Fergusson, 1990: Ruttenber and Kimbrough. 1995) and \water content ofthe skin where there isa dramatic increase in the dif fusion rate with increased moisture content (Stemer, 1999), For27 Fégure 11 Dust storms and other similar events may result in the inhalation of heavy metals. ‘example, the skin of the legs and a . than thar of the palm, making chemical absorption much faster in the former areas of the body ms is roughly’ ten times thin plake Daopernti ot the mechanism of take ingestion. inhalation or dermal absorption. elements must pass dhoush a series organs beens entering the blond stream, Ingested particles pass thous the gastrointestinal tact, tate particles pass hough the Fespiralory tract. and dermally absorbed elements enter directly into the blood stream, The intake ofan element also dictates ows much the body ‘il absorb Farcxemple only of ingested Cit absorbed cone tras to 504 of inhaled Ca (Philp, 1995) Once an clement i ingested there are number of factor that influence ihe absorpvinn proces, These inclade the chemistry of the seta. expecially solubility. the amount of foe! eaten aswell the {ype of dict. For example, with fll stomach one is fikely to absorb anch less Pb as compare 1 an emply stomach. In gener. metals ‘vith low Solubility an water ae fess readily absorbed than soluble compounds (e.. Cal, Ha. TI. Ater the material has been ingested i moves theoush the oesophasus into the stomach. The somal hay normal pH betwcen I and 4nd under these highly acid conditions heavy metas will turn into their chemical form and become cationic ‘or anionic. From the stomach, the digested material then moves 10 the dodenuy and smal iestines where the pH is between 6.7 Most of the absorption of elements axetr inthe exten. jejunum and ileum. Inthe smal intestine meta are absorbed through du sion as well fitting into Specific membrane transport systems (Stemer, 1999) An example OF this isthe association hetween Ca and Pb. Because Caan hare roughly the same size. the boy cane not feily distinguish betwen the to elements hus the incorpo ration of Bb into bone matrix can occur at the expense of Ca, Lead thoes not pose direct risk in his form butt eam exchange frely ith Gain box! and may tevin easily broken bores with ae. Dictary defiiencies of Ca. Cu, Fe. Zn, protein and Vitamin D have eon showin to promote gastrointestinal tract absorption of Ph and Cd. sehercas Ca deficorcy resus in greater Pb retention inthe bones (Smith, 1992), The absorption factor varies greatly from clement to eloment.and can be a high 3s 100% for Awad as low as <8% for Bi land TI, The absonption factor of Pb in adits is approximately Me but in infants absorption ranges from about 25 0 53% (Fergusson 1990), Mucose of the gastrointestinal tice protects against many chemical and biological gets, preferentially allowing liid-soluble compounds to pas into the bloodstream, Chemicals not absorbed by the upper sostrointestinal macy um damage the fining of the farge intestine. Materials on the surace of the gastointestina tract ca be absorbed through the wall nd move directly into the blood siream, Vomiting and diarthoea are highly effective ways to remove toxins from the gastrointestinal tract (Rottener and Kiembrowgk, 1995) Once inhaled, particle size. shape and cha y in the fate of the elements within the body. Material deposited in the upper ainways of the respiraiosy: system iy absorbed daeoigh the epithelium or cleared by a variety of processes at three levels within the respiratory tract: (1) nasopharynx, (2) tracheobronchial tree, and (3) lower alveolar zone. Particles hepseen 5 and 20 micrometers see eposited in the nose and the pharyny. particles between Land 5 micrometers reach the bronchioles and alveoli, and particles less than 0.5 micrometers are usually eyhaled. In the nasopharynx, dhe inhaled! particles are deposited on fine hairs and the epithelium in the passages of the nose, Expulsion is achieved through nose blowing. sneezing. coughing. mucociliary action snl swallowing, Relatively insoluble particles that are present on the ciliated regions of the nasopharynx are deposited on «| mucous blanket. This mucous blan- ket is essential to clearance of particles inthis region of the respira lory tract, for it moves the particles 10 the pharynx where they are ‘mixed with saliva and swallowed (Ruttenber and Kinybrough, 1995). However. the intestine may absorb any particle size that gravels down with the mucous (0 the stomach, In other words. the mucous. blanket docs not excrete particles from the boxy but does protect the lungs (Sterner, 1999), In the tracheobronchial tree. inhaled particles removed from the air stream through sedimentation and difu- sion. Once a particle is deposited it is either removed! by coughing ancl/or mucociliary action or it i absorbed in the blood. The lower alveolar zone is not ciliated and the inhaled particles that are deposited here may be phagocytized and moved towards the ciliated thelium by alveolar macrophages. The cells help in preventing parties trom penetrating the alveolar wall, Macrophages. however. tend to concentrate isritants and toxins. magnilying their pathogenic clfects. Particles that are not cleared may be transported teross the respiratory epitfiefium (© the Iymphatic and circulatory systems, ‘whereas particles that remain trapped in the lungs may result in lung disease (Ruttenber and Kimbrough, 1995). Lang diseases, such as asbestosis anf beryliosis among others, are the biggest health risk related to the inhalation of particles, Preu- moconiosis isa general term for lung diseases caused by inhaled par ticles that accestiulate in bronchiofes and afveoti where they cannot bbe expelled. The accumulation of significant quamities of asbestos fibres in the lungs leads to local tissue reaction, which consists nail)’ of adittase fibro and thickening oF the Walls of the alveoli btherwise know as asbestosis. Bersliosis is rare form of pneumo- cconiosis attributed to beryllium exposure (Rowland and Cooper. 1983), Regarless of the intake, ingestion inhalation or dermal absorp- sion. eventually a fraction of the initial element enters the blood simeam. Once an element enters into the took it is circulated throughout the blood stream and reabsorbed by various organs. Depending on the element, toxic agemts can damave develop mature blood cells and induce Hess by activating de iene sys tem, For instance, in mature red blood cells, Pb inhibits enzymes and alters cell metabolism. impairing heme synthesis and shortening the lifespan of red hlood cells, generating the condition Aaawe as anaemia (Ontario Ministry of Health, 1997), The body eliminates toxic elements ina variety of ways, Atthe cellular level. climination occurs through active riansport, fieration and diffusion, whereas particles are either exhaled through the lungs, excreted in urine by the kidneys. facces. seercted in sweat, saliva oF ‘Sputum of are further metabolized in the digestive system and then eliminated through Feces (Sterner, 1999: Ruttenber and Kimbrough, 1995), Conclusion The interdisciplinary field of "Medical Geology” has arisen from the need to understand the relationships between human health and our surmunding environment, bot natural ant anthropogenic. it deals December 2003swith the Tinky between geology and associated health problems in ‘humans, animals und plants and is recognised by numerous leadin, scientific organisations including the Geological Society of Amer ica, the International Society of Trace Element Biochemistry, the International Academy of Pathology. United States Geological Sur- vey and the Society for Environmental Geochemistry and Health. The influences of earth resources, natural environmental Factors and lancl-tse on human health have been recognized for thousands of years. The Romans noted links between mining and negative heath elieets, while ancient Chinese texts describe the relationship between rock crushing and lung disease. El also addressed in the ancient world with many civilizations treating seaweed. Since the industrial revolution, but especially over the past few decades. there has been a growing concern on the impact oF agriculture, resource exploitation and urbanization on human health. For example. if China there is both high and low areas each with their own set of health problems (e.g.. Keshan dis- cease and Kaschin-Beck disease) Most reseaich focuses on agricultural ane! industrial landscapes in developing countries where a direct relationship between the geol- ‘ogy and element intake is observed (e.g. As rich coal in China, cademic Muorasis in regions of India), Numerous of studies have also examined health issues ithe urhan-industrial environment, For instance. in the United States. Mielke (1993), Mielke et al. (1983) and Mielke et al (1997) have linked inner-city Pb levels with ele vated blood Pb levels in children, Simiar results have also been reported in Eutope (Kelly et al. 1996: Osman et al.. 1998: Patterson ct al., 1996). These studies are not directly related to the geology of a tegion. rather the contamination duc to industrialization and auto= mobile use [All of the above studies show that knowledge of geoloy geomorphology is essential 1» understanding, and thus eradicating (oF preventing. a range of ent ironmental health problems. [GCP pro: ject 454 has made great progress in advancing the field of Medi Geology through numerous short courses. on Metals, Health and the Environment held world ste. including Zambia (2001), Chile and Russia (2002) and Lithuania (2008) itre usin Acknowledgements The authors semain fully responsible tor all errors and omissions presented in this paper. We greatly appreciate the financial support fof JGCP #454, the Canadian National Committee of IGCP, the BC Geological Survey Branch, University of Victoria, Geological Sur- vey of Canaukat and the Geological Survey ot Sweden, The detailed review comments of Ross Knight greatly improved the manuscript Abrahams. PW. 1997, Geophagy (soil consumption) a! i Supplements tion in Ugands. Tropical Medicine and International Health, 2617-623, Autiano, D.C. 200}, Trace Elements in Tertessial Environments; Biogen ‘chinisty: Bioavailability and Risk of Metals. Springe Verlag, p. $67. Appleton. 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Conlelra, MJA.R. Butchins, MG. Fibrin JW. Serunjogt. L. and Tomkins, AM. 2000, The bioaeeessiiliy of essential and potentially toxic frace elements in Kopical soils from Mukono District, Cg: Journal of the Geovogical Society. London 197. pp 885-891 Sterner. O.. 1909, Chemistry. Heath and Environment: Wiley-VCH. 345 p Underwood, EJ. 1979. Trace elements a health: an overview, Phil, Frans Royal Society of London, 288, pp, S14 Wokeriel@, 2. 2H. Am Erupdion OF Sitios: Grirmmemtal Health Per spectives, 1K, pp. 300 Wolt, 1994, Soil Solution Chemistry: Applications to Environmental Set griculture: loin Wiley & Sons. kle.. 45 p. Charlotte Bowman has a BSc (Hon fours) and MSc from the School of Earalt and Ocean Sciences ar the Universiny of Vietoria, For her mas: ers she Jooked at the pesensial health implications of whan soil and children’s health. During her MSc she spent a semester stuisirg a the Geochemical Branch of Swedish Geological Survey, Reseureh inter ests include environmental geochemisirs and Beall did aed ical geology Peter Bobrowsky ix Head of the Canada Landslide Loss Reduction Program in he Geological Survey of Camacks, Ottawa, Canada. tte Has a PAD (1989) in Quaternary Geology fram the University of Alberta, He js an Adjunct Professor, Schoo! of Earth and Ocean Sciences, Univer siny of Vietoria, Vice President of WIGS and tnernational Co-leader ef IGCPELSE int Medical Geotoys His main research inrerests include wrul hazards. engineering geol- fagy and environmental geote Dr. Olle Setinus ts a FID chemist working with the Golo’ eal) Survey of Sweden (SGU? Dur inng the 19608 and 1970s he worked fin mineral explorarion wish a min inng company atud at SGU, Since she beginning of he F980s, Dr. Selinus research work has been focused on environmestal geochemistry and geostatistiral awetleads, including research on medical geology. Me hhas served as the organizer of sev eral international conferences i his field! anud has published ove manuscripts. Deputy leas of Division of Environment and Ger ehemisiry av SGU ad aves prose head of external reseurclt J developmen. He serves as offic: COGEOENVIRONMENT us tor of the UGS Special Iitiat've 101 Medial Geoloxy. anul co-chair of the IGCP. project #484 Mesivul Geology, Web site huyp wrerraned icalgeology.org December 2003