Intended for healthcare professionals


Clinicians' roles in management of arsenicosis in Bangladesh: interview study

BMJ 2004; 328 doi: (Published 26 February 2004) Cite this as: BMJ 2004;328:493

Not only the clinicians in Bangladesh may feel a need for information about arsenicosis

Dear Sir,

I found R. Murshed,R.Douglas , G.Ranmuthugala and b.Caldwell's paper on
the clinician's roles in management of arsenicosis in Bangladesh:
interview study,(1) very informative, particularly in view of that week's
BMJ theme: "what does not work and failure"(2).However I, and I think most
of the medical profession, wish to increase their knowledge, learn from
failures , and address mishaps.

I personally have not encountered arsenicosis in my clinical practice ,
and I must admitt I did not know much about the nature of arsenicosis
myself either. I had wished that the authors had given some information in
their article about the nature and treatment of arsenicosis, particularly
as they may well have first hand exposure and experience. But I got
motivated to go to the Oxford Textbook of Medicine, where I found the
following description of the clinical picture of chronic arsenicosis:

The ingestion of arsenic in contaminated drinking water (recently in
Bangladesh) or ‘tonics’ has led to progressive weakness, anorexia, nausea,
vomiting, stomatitis, colitis, increased salivation, epistaxis, bleeding
gums, conjunctivitis, weight loss, and low-grade fever. Characteristically
there is hyperkeratosis of the palms and soles of the feet, ‘raindrop’
pigmentation of the skin, and ‘Mee’s lines’ on the nails. There is an
increased risk of skin cancer (usually squamous cell epithelioma) in
affected individuals. A symmetrical peripheral neuropathy is typical.
Hearing loss, psychological impairment, and electroencephalogram changes
have been reported. Other chronic effects include disturbances of liver
function and ulceration and perforation of the nasal septum. Chronic
exposure to arsenic has been linked to lung cancer.(3)
( As a luxury it may have been nice to have pictures showing the
characteristic signs: hyperkeratosis, raindrop pigmentation and the Mee's
lines of the nails)

(1) R. Murshed,R.Douglas , G.Ranmuthugala and b.Caldwell's the
clinician's roles in management of arsenicosis in Bangladesh: interview
study;BMJ no 7438,28 Feb 04 page 493/494

(2)Editor's choice,R.SmithBMJ no 7438,28 Feb 04 page 471

(3)Oxford Textbook of Medicine Warrell, David, Cox, Timothy M,
Firth, John D, Benz, Edward J
29 Feb 2004

Competing interests:
None declared

Competing interests: No competing interests

04 March 2004
K.Martin Beckmann
SpR in Child Psychiatry
Ipswich IP 1 3 QW