IJEP 17 ( 5 ): 3 3 4 - 3 3 9
A New Hope for Protection From Adverse Health Effects of
Exposure to Silica Bearing Dusts
R. Kotecha and G.D. A g r a w a l
Envirotech Instruments Pvt. Ltd., A - 2 7 1 , Okhla Industrial Area. Phase - /, New Delhi - 1 10 0 2 0
I M P O R T A N C E 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. A b o u t 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,
w i n n o w i n g , 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 w i t h 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 ( f i n e r than 10
micron ) dust particles, or SPM, and the likely silica
contents for some urban, industrial and rural areas
334 iiMOIAM J ENVIRONMENTAL PROTECTION, V O L 1 7 , NO. 5, MAY 1 9 9 7
© 1997 • Kalpana C o r p o r a t i o n
( Received on February 7, 1997 )
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 f r o m 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 w i t h 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, w i t h 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 1 9 4 7 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 w r o n g l y
diagnosed as tuberculosis, rheumatism, arthritis, etc.
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
8
Hg/m
Towns and cities
Bombay 200 - 400 35 - 55 1 -5 Beach sand
Calcutta 100 - 450 30 - 50 2 -8 Fragile soil/silt
Delhi 350 - 800 25 - 50 5 -10 Dust storm/soil
Jaipur 200 - 700 25 - 40 5 -10 Dust storm/soil
Kanpur 200 - 650 30 - 40 5 -10 Dust storm/soil
Madras 100 - 2 0 0 40 - 60 1 - 5 Beach sand
Rurai areas
Mezoram 50 - 150 15 - 3 0 3 - 5 soils
Rajasthan 150 - 3 5 0 10 - 2 5 5 - 10 Dust strom/soil
Karnataka 100 - 200 10 - 3 0 3 - 5 Soils
Industrial area
Around cement plants 500 - 2000 10 - 2 0 1 -3 Industrial dust
and lime kilns
Around refractories 300 - 1500 15 - 4 0 5 - 20 Industrial dust
Around thermal power 300 - 1500 10 - 3 0 3 - 10 Industrial dust
house (flyash)
Mining areas 500 - 3000 5 - 10 3 - 10 Mine and road c
Shop - floors
Agate-grinding 2 0 - 8 7 7 mg/m 8 80 • 90 80 - 85 Industrial dust
Slate-pencil 2 0 - 5 0 0 mg/m 3 80 - 90 50 - 60 Industrial dust
8 Industrial dust
Stone-crushing 10 - 40 mg/m 40 - 60 10 - 8 0

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 4 5 . 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 w o r l d ( t h o -
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 w o u l d
only demand removal from that work and environ-
ment to avoid further deterioration and yet live w i t h
the disease for the rest of the severely reduced life
w i t h no hope of recovery. Even drugs, like 'predni-
solone' when administered to silicosis patients at
A I I M S 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 1 9 9 7 335

© 1997 - Kalpana C o r p o r a t i o n
 Table 2. Average employment in Indi=» exposed to onn - siliceous are irritation and constriction of t h *
risk of free silica exposures (1991 hand- upper respirarory tract leading to coughing expect-
book of labour statistics, GOI) oration and dyspnoea. These get diagnosed as 'bro-
nchitis' and treated by expectorants and bactericide!
Coal mines 5,50,000
drugs. On treatment, the symptoms may amelio-
Limestone mines 51,000
rate, but keep re - appearing, if exposure continues.
Iron - ore mines 49,000
In our dusty environment, even those having no occ-
Manganes - ore mines 18,000
upational exposure to dust, keep suffering from such
Copper - ore mines 13,000
mild or early stage of dust - caused diseases as
Gold - mines 12,000
seen from the high prevalence of such symptoms
Stone - mines 1 1,000
e v e n in the general population examined as s h o * n
Chromite mines 9,000
in table 4.
Magnesite mines 6.000
Other mines 81,000 M e d i u m stage of dust - c a u s e d respiratory dis-
Mines total 8,00,000 eases
Foundries 2,84,000
As the dust accumulates and penetrates deeper into
Iron and steel industries 2.08,000
the respiratory tract, alveoli start getting congested
Clay products/Refractory 2,22,000
and chocked and lung - capacity and functioning
Glass and glass products 67,000
starts getting impaired. This stage can be detected
Cement/lime 78,000
by pulmonary function tests ( PFT ) by appropriate
Mica products 12,000
spirometers. Both the peak expiratory force ( PEF )
Agate 10,000
and forced expiratory volume in one second ( FEV
Slate pencil 8,000
1 ), or one of them, on the ratio FVC/FEV1 may get
Stone crushing/cutting/grinding 4,00,000
affected. In clinical terms, expectoration increases
other industries 3,11,000
and may be accompanied w i t h nasal discharge and
Industries total 16,00,000
in severe cases w i t h strains of blood. Also chest -
Grand total 24,00,000 pain, headache and body ache appear and get more
severe and frequent. In later phases, recurring or
ETIOLOGY/PATHOLOGY/PATHOGEIMESIS OF persistent fever, marked chest pain and expectora-
DUST CAUSED DISEASES tion with blood ( Haemoptysis ) are taken to Indi-
Early symptoms diagnosis cate tuberculosis and treated as such, with some
symptomatic relief but no cure. This phase may
The earliest symptoms of dust - caused respiratory appear only after 5 - 8 year of severe exposure
diseases, whether the dusts are organic or mineral, and may take much longer exposures of lower
fibrous or crystalline or amorphous, siliceous or 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 5893 820
Mica mining Bihar NIOH Pneumoconiosis 369 39
Copper mines Rajasthan Shaw and Deshmukh Pneumoconiosis 50 21
Coal mines Bihar Shrivastava Pneumoconiosis 20,086 374
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 342 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, V O L 1 7 , NO. 5, MAY 1 9 9 7

© 1997 - Kelpana Corporation
Advanced stage of dust - caused respiratory As the deposit of dust in lungs accumulates, depen-
diseases ding on the nature of the dust, scars, lesions or fib-
Table 4. Prevalence of symptoms among residents rosis of the lung start becoming visible on X • ray
of high - dust areas ( non - occupational plates indicating advanced, severe and ( suppose-
exposure ), in % dly ) irreversible stage of the diseases and termed
silicosis, asbestosis, byssinosis or pneumoconiosis
Percentage of residents examined showing depending on whether the causative dust was high-
various symptoms in Rajgangpur high - silica, asbestos, vegetable - fibres or mine - dust,
silica area respectively. Amongst these 4 designated types
Silicosis - like lung X - ray abnormalities 4 which pathologically are largely similar, asbestosis
Markidly affected lung capacity 18 is considered the most dreaded, as dreadful as
Blood in expectoration ( haemoptysis) 7 lung - cancer, but silicosis is no less dreadful in
Recurring fever 16 terms of suffering and is much - much more pre-
Chest pain 21 valent. Common physicians diagnose them, media
Headache/body - ache 28 reports them, and normal citizens talk of them all,
Cough/expectoration 36 as tuberculosis. It is thus that all our large dusty
Breathless -ness/dyspnoea 45 towns, Delhi, Calcutta, Kanpur, etc., are reported to
Percentage of general populatious of high- have such high incidence rates of tuberculosis
dust ( SMP 6 0 0 • 1 0 0 0 i-ig/m 8 ) arses of ( TB ) and industries are blamed for this, though
some places, suffering from severe respira- industries discharge no tubercle bacilii into enviro-
tory symptoms : nment.
Kanpur, U.P. 6.5
QUEST FOR AN A Y U R V E D I C REMEDY FOR DU-
Haldia, W.B. 4.8
ST - CAUSED M A L A D I E S
Barauni, Bihar 4.4
Bokajan, Assam 8.6 Need to l o o k t o w a r d ? Ayurveda
Chittorgarh, Rajasthan 8.3 The above sections make it clear that dust - caused
Delhi NCR 1 1.2 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 symptom
At start of After 30 day of After 60 day of trea-
treatment treatment tment
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 40 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 1 9 9 7 337

<© 1997 - Kalpana Corporation
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 d o w n 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 w o u l d first minimise the
harmful effects of dust exposure ( particularly silica
exposure) and those that w o u l d offer a cure in
case one does become sick w i t h 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 w h i c h 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-
338 I N D I A N . ! PNVinnMMCMTAi D D A T c M i n n w/\»
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. A n d
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 w i t h '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 - c u r s o r ) 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 w i t h 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' w o u l d 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 c o u l d
f o l l o w the lines suggested by Acharya Chakrapani in
his treatise 'Chakradatta', w i t h appropriate modifica-
tions and supplementation.
-i r»
THE NEW RAY OF A Y U R V E D I C HOPE
After a thorough and critical study of various Ayur-
vedic texts, Dr Kotecha Post - graduate Vaidya,
w i t h 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
i . * . . . . i < - . i T > i DDrttcoTinM v/ni
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
w o r k , while the other 50 % continue the usual
routine w i t h o u t this formulation and the results of
comparing the t w o 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.
17 Nrt B MAY 1 9 9 7 339