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 Medical
Student’s Library
Initiated in 1999 to mark the Centenary
of the Odessa State Medical University
(1900 — 2000)

Edited and Published by V. M. Zaporozhan,

the State Prize-Winner of Ukraine,
Academician of the Academy of Medical Sciences of Ukraine

CHIEF EDITONIAL BOARD:

V. M. ZAPOROZHAN, (Chief Editor),

Yu. I. BAZHORA, I. S. VITENKO,
V. Y. KRESYUN (Vice Chief Editor),
O. O. MARDASHKO, V. K. NAPKHANYUK,
G. I. KHANDRIKOVA(Senior Secretary),
P. M. TCHUYEV

The Odessa State

Medical University
 Dear Reader,
When in 1999 the lecturers and researchers of the Odessa State Medical Uni-
versity started issuing a series of books united by the collection entitled “Medi-
cal Student’s Library” they had several aims before them.
Firstly, they wanted to add new books to the Ukrainian library of medical lit-
erature that would be written in Ukrainian, the native language of the country.
These books should contain both classical information on medicine and the lat-
est information on the state of the art, as well as reflect extensive experience of
our best professionals. Secondly, our lecturers and specialists wanted to write
such books which reflected the newest subjects and courses that have recently
been introduced into the curricula, and in general there have been no textbooks
on these subjects and courses at that time.
These two aims have successfully been coped with. Some dozens of text-
books and workbooks published in these years have become a good contribution
of their authors and publishers to the development and making of the Ukrainian
national educational literature.
The next step that we decided to undertake was to issue a unique series of books
in foreign languages. The foreign students taking their medical education in the
Ukraine, our University included, are expecting such books to be published. Other
countries are also waiting for them as the Odessa State Medical University is a
Fellow Member of the International and European Association of Universities. Our
Medical University is over a hundred years old and has long since become a center
of various original medical schools and trends. These are headed by well-know
medical professionals whose competence is acknowledged not only in this country,
but abroad as well.
Valery ZAPOROZHAN,
Editor-in-Chief of the Series “Medical Student’s Library”
the State Prize-Winner of Ukraine,
Academician of the Academy of Medical Sciences of Ukraine
GENERAL HYGIENE
AND
ENVIRONMENTAL
HEALTH
Recommended
by the Central Methodological
study relating to Higher Medical Education of Ministry
of Public Health of Ukraine as a textbook for students
of Higher Medical Educational Establishments
of the IVth level of accreditation using English

Odessa
The Odessa State Medical University
2005
BBC 5
UDC 616

Editor: M. M. Nadvorny, MD, PhD, Professor, the Head of the General Hygiene
Department, the Odessa State Medical University, Odessa, Ukraine

Authors: M. M. Nadvorny, MD, PhD, Professor, the Head of the General Hygiene
Department, the Odessa State Medical University, Odessa, Ukraine
P. S. Nikov, MD, PhD, Professor, General Hygiene Department,
Odessa State Medical University, Odessa, Ukraine
Yu. M. Vorokhta, MD, Lecturer, Information Coordinator, the General Hygiene
Department, the Odessa State Medical University, Odessa, Ukraine
Yu. A. Rudenko, MD, PhD, Associated Professor, the General Hygiene
Department, the Odessa State Medical University, Odessa, Ukraine
Reviewers: V. G. Bardov, Academician, MD, PhD, Professor, the Head of the
General Hygiene Department, of the National Medical University
named after O. O. Bogomolets
V. A. Kondratyuk, MD, PhD, Professor, of the Ternopil State
Medical Academy named after I. Ya. Gorbachevsky

The textbook contains information about history, goals and objectives on general
hygiene. There are presented modern concepts about the prevention of diseases. Prin-
cipal parts of the preventive medicine are described, including hygiene of the air en-
vironment, hygiene of water supply, hygiene of nutrition, hospital hygiene, hygiene
of children and adolescents, etc.
The textbook is intended for the students of high medical schools.

Загальна гігієна та екологія: підручник / М. М. Надворний, П. І.

Нікова, Ю. М. Ворохта, Ю. С. Руденко. За ред. М. М. Надворного
— Одеса, Одес. держ. мед. ун-т, 2005. — 300 с.(Б-ка студента-медика).
Мова англ.
ISBN 966

Підручник містить інформацію про історію, цілі та задачі загальної

гігієни. У ньому представлені сучасні концепції щодо профілактики
захворювань. Надані принципові положення профілактичної медицини, у
тому числі гігієни навколишнього середовища, гігієни водозабезпечення,
харчування, госпітальної гігієни, гігєни дітей та підлітків тощо.
Для студентів вищих медичних закладів.
Рис. 45. Табл. 66. Бібліогр.: 40 назв.

ББК 5

ISBN 966-7733-47-5 © М. М. Надворний,П. С. Нікова, Ю. М. Ворохта,

ISBN 966-7733-6 Ю. С. Руденко, 2005.
© Одеський державний медичний університет, 2005.

6
 PREFACE

General Hygiene and Preventive Medicine is rap- disease gave place to newer concepts — multifac-
idly developing branch of medicine. Many differ- torial causation. Social and behavioural aspects of
ent disciplines contributed to the growth of Preven- the disease have been accorded a new priority. Con-
tive Medicine: physicians provided health screen- temporary medicine is no longer solely an art and
ing and diagnosed diseases; sanitary engineers built science for the diagnosis and treatment of diseases.
water and sewerage systems; epidemiologists traced It is also the science for the prevention of disease
the sources of disease outbreaks and their modes of and promotion of health. Today technical sophisti-
transmission; vital statisticians provided quantitative cation of modern medicine is not an answer to eve-
measures of births and deaths; lawyers wrote sani- ryday common ailments of the vast poor in the coun-
tary codes and regulations; public health officers try. Physicians role is no longer confined to diag-
provided care and advice to the sick in their home; nosing and treating those who come to the clinic.
sanitary inspectors visited factories and markets to He is also responsible for those who need his serv-
enforce compliance with public health ordinances; ice but can not come to the clinic. Health of the peo-
and administrators tried to organise everyone with- ple is not only the concern of health care providers.
in the limits of the health departments budgets. Gen- It is the responsibility of the community also to iden-
eral Hygiene thus involved Epidemiology, Sociolo- tify and solve their own health problems through
gy, Psychology, Law, Statistics, Environmental their active participation.
Health and Engineering as well as biological and Alma-Ata declaration in 1978 specified that Pri-
clinical sciences. mary Health Care approach was the way of achiev-
Preventive Medicine developed as a branch of ing the goal of Health For All by 2000. Primary
medicine distinct from Public Health. By definition, Health Care approach stressed that “essential health
preventive medicine is applied to “healthy” people, care should be made universally accessible to indi-
customarily by actions affecting large numbers or viduals and acceptable to them, through their full
populations. Its primary objective is prevention of participation and at a cost the community and the
disease and promotion of health. It got a firm foun- country can afford”.
dation only after the discovery of causative agents The represented textbook includes all basic top-
of diseases and the establishment of the germ theo- ics of General Hygiene. Authors are recognized au-
ry of disease. thorities in each of these areas and have made the
Decades old concept of health care approach has chapters current and practical. They added modern
experienced a dramatic change. Today health is not glossary of the terms using in the preventive medi-
merely an absence of disease; it is related to quality cine and general hygiene, modern references and
of life instead. Health is considered a means of pro- useful Internet URLs.
ductivity. Thus health development is essential to Authors would like to thank those people who
socio-economic development as a whole. Since helped with the physical preparations and typing of
health is an integral part of development, all sec- the manuscript.
tors of society have an effect on health. Scope of We thank you, the Reader, who selected this book
medicine has extended from individual to commu- for studies.
nity. Study of health and disease in population is Enjoy this very interesting and important health
replacing study of disease in man. Germ theory of science.

7
 Chapter 1
HISTORY, SCOPE AND
METHODS OF GENERAL HYGIENE

Hygiene is a basic preventive science. It studies Physical factors (microclimate, noise, ionizing ra-
influence of the environmental factors on the hu- diation, vibration, air pressure) present various kinds
man organism and social health; it has the goal to of energies. They form an environment we live in
determine and substantiate theoretically hygienic but all these factors can be the hazards too. For ex-
norms, sanitary regulations and measures, realiza- ample, high air temperature can cause overheating
tion of which provides optimum condition for life and heat stroke, intensive noise — cochlear neuri-
and activity of people, improving the health and pre- tis and deafness, etc. Biological factors are microbes,
venting diseases. viruses, fungi, and helminthes. They can cause dis-
General hygiene is the science of health and em- eases of the man and animals, spoil food products,
braces all factors that contribute to healthful living. damage sanitary-technical equipment. In the real life
The world “hygiene” is derived from GIGEIA (the a human being is under the influence of not only
goddess of health in Greek mythology). one but also a complex of environmental factors.
This subject studies the factors which influence They use the terminology: combined influence —
the human body, create the threshold values and influence of several factors of common origin (for
maximum admissible concentrations, levels and dos- example, several chemical compounds); common
es for these factors. There are psychogenic (infor- influence means several factors of different origin
mation) and material (chemical, physical, biologi- are acting; complex influence is characterized by the
cal) factors (Fig. 1). Afferent stimulation causes var- situation when only one factor is present but it has
ious emotions (grief, horror, joy, etc.), changes of different routes of exposure.
physical state of the organism. Positive emotions are The main aim of the subject is the prevention
realized in positive changes: better blood supply of of diseases. Successful prevention depends upon
the brain, heart, normalization of blood pressure. knowledge of causation, dynamics of transmis-
Distress, negative emotions can cause disease. They sion, identification of risk factors and risk groups,
are risk factors for myocardial infarction, hyperten- an organization for applying these measures to ap-
sion, ulcerous disease, diabetes etc. Great part of propriate persons or group and continuous evalu-
afferent loading has a social nature. Chemical com- ations and development of procedures applied.
pounds are often necessary for vital activity and Nowadays prevention is defined in terms of three
health, but they can be the cause of disease. For ex- levels:
ample: iodine deficit causes goiter and cretinism, — primary prevention — identification and cont-
chemical hazards (pollutants) can cause poisoning. rol of health and safety risk;

Environment

Environmental factors

Natural factors Social factors

Fig. 1. Main Environ-

Mechanical Physical Chemical Biological Labor Private Socioeco- mental Factors Influencing
life nomic status Human Health

8
 — secondary prevention — early diagnosis and supplemented by laboratory analyses (chemical,
treatment of medical condition; physical, microbiological and others) which allow
— tertiary prevention — reduction of conse- to characterize environment from the qualitative
quences of the medical condition. side.
Hygiene is dealing with the first level mainly. There are the widely different used kinds of
The aim of primary prevention is to maintain health hygienic experiments:
by removing the precipitating causes and determi- 1. Experiment with simulation of natural condi-
nants of departures from good health. tions is used for examining and predicting process-
The principal topics of the subject are: es which are going on in the surrounding world (for
— Hygiene of atmospheric air example, for examining the influence of chemical
— Water supply hygiene admixtures on the processes of self-clearing of wa-
— Hygiene of nutrition ter in reservoirs).
— Occupational hygiene 2. Laboratory experiment on animals helps to
— Radiological hygiene study the influence of environmental factors on the
— Hygiene of children and teenagers organism which meets the goal to substantiate hy-
— Hospital hygiene gienic norms. In the process of this experiment the
— Hygiene of extreme situations following methods are used: physiological, bio-
— Tropical hygiene, etc. chemical, immunological, histological, microscop-
Hygiene is a science of preserving and promot- ic, radiobiological, genetic and others.
ing the health of both the individual and the com- 3. Chamber experiment on people is used to
munity. It has many aspects: personal hygiene (prop- study the influence of some factors on the human
er living habits, cleanliness of body and clothing, organism and determine the norms. This method is
whole-some diet, a balanced regimen of rest and used to study such factors as microclimate, illumi-
exercise); domestic hygiene (sanitary preparation of nation, noise, neuropsychic strain, etc.
food, cleanliness, and ventilation of the home); pub- 4. “Natural” experiment helps to study influence
lic hygiene (supervision of water and food supply, of environmental factors on the human health in real
control on communicable disease, disposal of gar- life conditions, for example, studying health of peo-
bage and sewage, control of air and water pollution); ple (especially children) who live at different dis-
industrial hygiene (measures that minimize occupa- tance from enterprises throwing out toxic gaseous
tional disease and accident rate); mental hygiene substances into the atmosphere. Natural experiment
(recognition of mental and emotional factors in allows to check-up hygienic norms which were de-
healthy living) and so on. The World Health Organ- termined in the experiment on animals.
ization (WHO) promotes hygienic practices on the One of the main and difficult hygienic problems
international level. is studying the influence of environment on the
Health is derived from the old English word hal, health.
meaning hale, whole, healed, sound in wind and According to the opinion of Ukrainian scientists
limb. The preamble to the constitution of the WHO health is normal and harmonious physical and psy-
describes health as “a state of complete physical, chic development of the human being, normal func-
mental and social well-being, not merely the absence tioning of all organs and systems which can adapt
of disease or infirmity”. to unfavourable influences in normal conditions of
The hygienic researches methods are following: life, absence of diseases and preconditions to them,
1) the method of sanitary examination and de- high physical and mental ability to work which al-
scription; lows to fulfill his social and biological functions. A
2) the experimental methods: subjective side of the health manifests itself in a
— experiment with simulation of natural condi- good mood, absence of pains, normal functioning
tions; of organs of sense, adequate psychic reaction to the
— laboratory experiment on animals; environment.
— chamber experiment on people; The health of individuals is studied by way of
— “natural experiment”; medical examinations with the usage of anthropo-
3) the sanitary statistic methods: metric, clinical, physiological, biochemical, immu-
— the method of mathematical modeling; nobiological, roentgenological and other methods of
— the epidemiological method. examination. Their participation in labour and oth-
The specific hygienic method is a method of san- er types of activity must be taken into account.
itary examination and describing which is used for The health of a certain group of people or of all
studying the environment. Sanitary examination and population of the populated area (region, republic,
describing is carried out according to special pro- etc.) is studied with the help of the sanitary-statis-
grams (schemes) which contain questions. Answers tic method. There are different criteria which cha-
to these questions characterize the object which is racterize physical development, demographical in-
being examined hygienically. As a rule it is usually dices (birth rate, death rate, average life span and

9
others), morbidity and pathology of the studied Some countries don’t have a unified system of stand-
group. ards. In the USA the Permissible Exposure Limits (PELS)
The epidemiological method is close to the sani- are OSHA standards, which must be upheld by the em-
tary — statistic method. It is used for studying inci- ployer at all times. In some cases, the Threshold Limit
dence of disease (hypertension, coronary disease, di- Value (TLV) established by ACGIH may be lower than
the OSHA PEL. Permissible Exposure Limit (PEL) —
abetes, ulcerous disease, etc.). They are studied dur-
an exposure limit that is published and enforced by OSHA
ing a certain period (a year, a month), on a certain as a legal standard. PEL may be either a time-weighted-
territory (different regions of the city, republic), average (TWA) exposure limit (8 hour), a 15-minute short
among different groups of population (which differ term exposure limit (STEL), or a ceiling (C). Threshold
one from another by age, gender, occupation, con- Limit Value (TLV) is airborne concentrations of substanc-
ditions of water and food supply, conditions of life es devised by the ACGIH that represents conditions un-
and others). Analysis of these data is used for de- der which it is believed that nearly all workers may be
termining causes and conditions which favor the de- exposed day after day with no adverse effect. TLVs are
velopment of disease, for liquidation of disease as advisory exposure guidelines, not legal standards, that are
regional pathology, for planning prophylactic meas- based on evidence from industrial experience, animal
ures. studies, or human studies when they exist. There are three
different types of TLVs: Time Weighted Average (TLV-
The methods of mathematical statistics and mod-
TWA), Short Term Exposure Limit (TLV-STEL) and
eling are widely used. Ceiling (TLV-C). Time Weighted Average (TWA), the
Complex hygienic methods are: the method of average time, over a given work period (e.g. 8-hour work-
theoretical substantiation of hygienic norms, the day) of a person’s exposure to a chemical or an agent.
method of studying the health of a certain group of This time is determined by sampling for the contaminant
people (workers, students, etc.) in the connection throughout the time period. TLV (TWA) is an 8-hour
with their conditions of life, the method of studying time-weighted average believed to be the average con-
hygienic factor. Each of these methods uses the com- centration to which most workers can be exposed during
plex of above mentioned methods. an 8-hour workday, day after day, without harmful effects.
The hygiene aim is preserving and promoting the TLV (STEL) is a 15 minute “short term exposure limit”.
health. Its objectives are: Ceiling (C) is a maximum concentration never to be ex-
ceeded.
1. Studying environmental factors.
2. Studying interaction between the human or-
Basic objects which are under the hygienic norms
ganism and environment.
setting can be divided into two groups. The first
3. Environmental hygienic standards and guide-
group contains factors of anthropogenous origin
lines development.
which are unfavourable for a human being, and are
4. Substantiation of sanitary supervision.
not necessary for the normal life activity (dust, noise,
5. Prospective analysis of environmental health.
vibration, ionizing radiation, etc.). MAC, MAL and
Hygiene has close links with social medicine and
LD are those parameters which are set for this group
public health, clinical epidemiology, pediatrics, occu-
of factors. The second group contains factors of na-
pational health, human ecology and other sciences.
tural surrounding which are necessary (in certain
amount) for normal life activity (food-stuffs, solar
radiation, microclimatic factors and others). For this
HYGIENIC STANDARDIZATION group the following parameters must be set: opti-
mum, minimum and maximum admissible parame-
ters.
Environmental standards are definite ranges of
In those cases when factors influence the human
environmental factors which are optimal or the least
not only directly (physiologically) but also indirectly
dangerous for human life and health. In Ukraine ba-
(through the environment) all types of possible in-
sic objects of hygienic standardization are:
fluence must be examined at hygienic norms setting.
1. MAC — maximum admissible concentration
For example setting of hygienic norms for toxic sub-
(for chemical admixtures, dust and other hazards)
stance in the water of natural reservoirs determina-
(They use MAC in Canada, MAK in Germany and
tion of maximum concentrations must be based on
CMA (“concentration maximale acceptable”) in
worsening of organoleptic properties of the water
France).
(an organoleptic sign), toxic influence (a sanitary-
2. MAL — maximum admissible level (for phys-
toxicological sign) and disturbance of processes of
ical factors).
self-clearing of reservoirs (a general sanitary sign).
3. LD — dose limit (for ionizing radiation).
In this case MAC is set according to that harmful
4. Optimum and admissible parameters of micro-
parameter which is characterized by the lowest lev-
climate, lighting, solar radiation, atmospheric pres-
el of concentration. Such parameter is called limit-
sure and other natural environmental factors.
ing.
5. Optimum and admissible daily requirements
Important methodological problems of hygienic
in food and water.
norms setting are:

10
 1) possibility of application of data got in the equilibrium between the organism and environment.
experiment on animals to people; Degree of different constants of the organism must
2) conception about levels of harmful influence be taken into account. Changes of stable constants
(MAC and MAL, must be below them). indicate the hygienic significance of changes. Thus,
Possibility of application of results got in the according to these conceptions threshold dosage of
experiment on animals to people and study of toxic toxic substance is that minimum concentration of it
influence of chemical substances (and some physi- in the object of environment influence which brings
cal factors) is corroborated by hygienic and toxico- about changes in the organism that result from phys-
logical investigations. It was an idea to use the so iological adaptation reactions.
called reserve coefficients or “coefficients of extrap- But some investigators consider that distinction
olation” to increase the safety of hygienic norms. It between adaptation and compensatory processes is
was made because of different sensitivity of animals conditional. That’s why threshold of action must be
and people. It was recommended to decrease exper- considered as any statistically reliable deflection of
imental MAC 2, 100 and more times as much in de- physiological and biochemical reactions (parame-
pendence on the toxic abilities, cumulative action ters) in tested animals from animals of the control
of substance and type of the experiment on animals. group. In this case threshold of action and conse-
It the possible to apply data of the sanitary-toxico- quently MAC will be some lower. It is considered
logical experiment on an “average animal” to an that such a principle can be used while setting the
“average human being”. But it is more difficult to of norms for factors which influence the whole pop-
apply these data to human population among which ulation.
genetic and other differences are present (age, dis- A group of scientists have come to the conclu-
ease, pregnancy, etc.) which stipulate differentiated sion that there are no threshold dosages for mutage-
sensitivity to the agents. This problem is theoreti- nous or cancerogenous substances because even the
cally unsolved today. But in practice solution is smallest concentration of them can cause mutation
found in increase of types of experiments on ani- (or development of tumour) in the organism. It is
mals of a different age, on pregnant animals with known that degree of risk is in proportion to the dos-
disease modeling and in increase of reserve coeffi- age and quantity of people who were under the in-
cient and obligatory checking the hygienic norms fluence of cancerogenous (mutagenous) substance.
reliability (MAC and MAL in natural conditions). This conception is approved by the International
As it was said, one of the main problems of hy- Committee of Radiation Safety (ICRS) in relation
gienic norms setting was elaboration of correct con- to mutagenous and cancerogenous influence of ion-
ception about the level of harmful influence. Some izing radiation. That’s why MAL of ionizing radia-
investigators consider that it is necessary to distin- tion must not bring about more frequent develop-
guish the level of biological influence and the level ment of tumours or mutations than spontaneous level
of harmful influence. According to their conception of this pathology which is typical for people living
all first stages of physiologic and biochemical re- in normal non-polluted conditions. Conception of
actions which occur as a result of influence of a fac- ICRP about the non-threshold influence is cruel and,
tor are within limits of adaptation possibilities of therefore, the best measure is to protect the health
the organism. Only when they “come out” of their of the human being from the influence of such dan-
limits, reaction of the organism has a compensatory gerous factors.
character. In this case their influence can be con- But it was found out in experiments on animals
sidered as harmful because physiologic and bio- with decreasing dosages of cancerogenous substanc-
chemical reactions get hygienic significance. But it es that there can be such concentration at which tu-
is too difficult to determine the distinction between mours occur no more often than in the control group.
adaptation and compensatory processes in the ex- Besides the following fact is against the conception
periment. about non-threshold action of cancerogenous (mu-
To solve this problem the following rules should tagenous) substances. It was found out that substanc-
be used — data got in the experiment can be con- es differ one from another by dosage which brings
sidered hygienically valuable only if they are sta- to development of tumour (mutation). Supporters of
ble (for example, during one month), reliable in the the non-threshold theory consider thresholds imag-
comparison with the control group and especially inary because of small number of animals in the ex-
progressive in time. It is recommended to apply periment. For example, cancerogenous substance
loading method which allows to compare adaptation inducts tumours with the frequency 2,000 per
resources of animals being tested with the control 1,000,000 animals; it means that probability of tu-
group. Besides, it is recommended to orient basi- mour development is low — 0.2 per 100 animals.
cally on integral parameters of organism condition Supporters of the non-threshold theory suggest to
(weight, temperature, functionality of CNS, concen- set MAC or MAL according to the following way:
tration of sugar in the blood, etc.) or changes on the to determine the dependence of “dosage — effect”
organism level which show the upset of relative for 4–6 dosages of cancerogenous (mutagenous)

11
substance on animals, extrapolate the obtained data As it was shown by investigations in most cases
into small dosages and find the dosage which slight- there is no interstrengthening or inhibition but sum-
ly increases the level of spontaneous pathology. mation. So, we can calculate an additive effect of
Let’s study the methodical scheme of hygienic two or more factors. Each factor must be expressed
norms of substantiation using, the example of MAC in parts of its MAC or MAL.
for some toxic substances. The first stage is to study
physical and chemical properties of the substance, C
1 C C
——— 2
+ ——— n
+ ... + ——— ≤1
elaboration of methods of quantitative determina- MAC1 MAC2 MACn
tion of this substance in different subjects, determi-
nation of its regimen of action on the human (dura- For example, concentration of fluorine in the air
tion, interruption, changes of intensity), ways of is 0.001 mg/m3 (MAC — 0.005 mg/m3) and con-
getting into the organism, study migration in differ- centration of benzol is 0.16 mg/m3 (MAC — 0.8 mg/
ent elements of the environment, mathematical pre- m3), in the sum 2/5 of MAC (1/5 of MAC of fluo-
diction of factor existence in different surroundings. rine + 1/5 of MAC of benzol) — less than 1 MAC.
The second stage is studying direct influence on the So, summarized influence of these two chemical
organism. It is started from “sharp” experiments, the substances is safe.
main goal of which is getting initial toxicometric A summarized effect in complex influence can
data about the substance (determination of LD50, or be calculated in the same way.
LC50, threshold of acute action (LIMac) and others. Numbers of MAC of toxic chemical substances in
With the knowledge of physical and chemical prop- Ukraine are various: for the air of a working zone —
erties of the substance, its initial toxicological char- more than 800, water — 700, atmosphere air — 200,
acteristics and approximate level of MAC can be food-stuffs — more than 200, soil — more than 30.
calculated. The third stage is conduction of “suba- At present the theory of biological equivalence
cute” experiment during l–2 months for determina- is being elaborated. It can be used for substantia-
tion of cumulating coefficient and the most vulner- tion of summarized influence of different factors and
able physiologic systems and organs specification setting of norms of maximal admissible loading
of mechanisms of action and metabolism. The fourth (maximum admissible intensity of influence of to-
(basic) stage is carrying out “chronic” experiment tal factors of environment on the humans).
which lasts 4–6 months in case of modeling of oc- Ideally, regulators would like to eliminate all
cupational conditions, 8–12 — communal condi- pollution and its risks, but this is usually not a real-
tions, 24–36 — studing the aging processes and tu- istic expectation. Regulators must address the most
mours induction. important risks and decrease them to the level at
During the experiment integral parameters are which they believe the risks are smaller than the
studied. They reflect condition of animals, degree benefits of the activity causing the pollution.
of load of regulative systems, functions and struc- This is similar to what millions do each day when
ture of organs which take part in processes of me- they balance the risks of an automobile accident with
tabolism (activity of enzymes), influence of func- the convenience and necessity of driving. Just as a
tional loadings. This study allows to determine hy- driver will buckle up and drive defensively to be
gienically significant threshold of LIMac and sub- safer, agencies take a regulatory action to eliminate
threshold dosages of the substance. Having knowl- as much risk as possible without losing the benefit.
edge about subthreshold dosages and with the help Scientific results may show that certain hazard-
of extrapolation coefficients, MAC of the substance ous substances pose a low health risk to people, but
can be calculated according to the sanitary-toxico- the public may still be concerned about these haz-
logical sign. ardous substances because of different attributes of
In laboratory experiments on human threshold of risk. Other attributes may affect people’s perceptions
taste, sense of smell, reflexive and irritating influ- of risk:
ence are examined. These data and results of influ- — How serious and dreaded is the illness?
ence of the factors on the sanitary conditions of life — How certain is scientific knowledge?
(for example, green plantations, transparency of at- — What is the catastrophic potential?
mosphere) are compared with MAC according to the — Who bears the risk?
sanitary-toxicological sign. — Is the risk voluntary?
Study of influence of the factor on the organism — Who receives the benefits of the “risky” ac-
and health in natural conditions is possible only af- tivity?
ter introduction of this factor in working surround. Risk analysis describes risks numerically in sci-
Elaboration of express-methods of norms setting entific notation, for example 1×10 -5, which means
is an important task. They are based on connection that there is one chance in 100,000 of an event oc-
between threshold of chronic influence of the sub- curring. It is important to note that these risk statis-
stance and its chemical structure (physical and tics are population averages, while risk analysts usu-
chemical properties, LD50 , LC50 or other character- ally estimate risk to the maximum exposed individ-
istics). ual.
12
 Health risk is the probability, or chance, that ex- an organized civic life, in cities that had layouts,
posure to a hazardous substance will make disease. streets and drainage system (Fig. 2).
Animal experiments or human studies provide in- Moenjodaro is the archaeological site of Indus
formation about how hazardous a substance is. They Civilization, which flourished here some 5000 years
use the results of such studies to estimate the likeli- ago. Moenjodaro excelled in practically every con-
hood of illness at different levels of exposure. ceivable facet of town planning. Indus Valley set-
Information on exposure comes from two plac- tlements all followed the same basic plan. Streets
es: monitors placed on factory smokestacks or at and houses were laid out on a north-south, east-west
special places in your community, or from mathe- grid, and houses and walls were built of standard-
matical models that estimate exposure based on size bricks. Even early agricultural settlements were
amounts of chemicals released. constructed on a grid. Nearly every Harappan home
had a bathing platform and a latrine and some In-
dus Valley cities reached heights of 40 feet in part
because of concern about hygiene. Cities often grow
upon their foundations over time, but in the Indus
HISTORY OF HYGIENE Valley, homes were also periodically elevated to
avoid the risk of runoff from a neighbor’s sewage.
Each neighborhood had its own well, and elaborate
In the development of hygiene we determine the covered drainage systems carried dirty water out-
empiric, the descriptive, the experimental and the side the city.
modern period. Empiric (ancient) period is charac- By circa 3500 B.C., the Sumerians had developed
terized by the development and accumulation of ba- many of the features that characterized subsequent
sic hygienic knowledge. civilizations. The largest medical treatise from an-
The first historical data about hygienic pracrice cient Mesopotamia is known as “Treatise of Medi-
are known from ancient Egypt, Mesopotamia and cal Diagnosis and Prognoses.” Many of the plants
India. The practice of hygiene for the community, incorporated into the “asu” medicinal repertoire had
as distinct from that of the individual, began early, antibiotic properties, while several resins and many
at least in its most simple forms. The Hebrews pre- spices have some antiseptic value.
scribed for the isolation of lepers, and for the hygi- The earliest known “hygiene kits” are Sumerian
enic disposal of human excreta. The Cretans had sets made of gold and silver and dated about 3500
piped water and flush closets before the siege of B.C. They consist of ear scoops, tweezers and tooth-
Troy (1250 B.C.); and the Chinese, Greeks and lat- picks. The sets usually fit into decorated gold or sil-
er Romans and Arabs had model sanitation in their ver carrying cases. Two prescriptions from ancient
cities. No sight is more remarkable than that of the Assyria-Babylonia are important in the history of
water-pipes and sewers, still intact in the founda- oral hygiene. The first was intended to remove film
tions of the Aesculapian hospital, where Galen prac- and deposits on the teeth, whiten discolored teeth
tised in the first century A.D., at the foot of the and prevent bad breath. A mixture of “salt of Akkad,
acropolis of Pergamum in Asia Minor. ammi, Lolium, and pine turpentine” was applied to
The people of Paleolithic Soan survived in the the teeth and then rubbed with the finger. Then the
region for a considerable period and transformed mouth was to be rinsed with a mixture of “kurun-
themselves gradually from the hunting stage to the nu-beer, oil and honey”. The second prescription
conditions of a well-settled life. Excavations at Sarai describes a method of cleaning the mouth. The first
Khola, Harrapa, Amri, Moenjodaro, Kot Digi and known written mention of soap was Sumerian on
other sites have established that in 2350 B.C., the clay tablets dating about 2500 B.C. They were found
pre-historic people of the Indus Valley developed a in the area of the Tigris and Euphrates river. The
sophisticated base on agriculture economy. The site
of Mehergarh situated at the foot of the Bolan Pass
(Baluchistan) is believed to be the earliest civiliza-
tion in the world. It predates the civilizations of
Egypt and Mesopotamia. It was occupied from 7000
B.C. to 2000 B.C. and is the earliest Neolithic site
where we have first evidence of domestication of
animal and cereal cultivation and also the center for
craftsmanship as early as 7000 B.C. The ages of set-
tlement goes back to about 8000 B.C. and even that
early period there were well developed villages with
agriculture, the beginning of animal domestications
and evidence of long distance trade. The ruins of
Moenjodaro in Sind and of Harrappa in the Punjab,
tell the tale of highly cultured people. They lived Fig. 2. Ancient Drainage System in Moenjodaro

13
tablets spoke of the use of soap in the washing of to cleanse clothes and pots and found in the ruins
wool. Another Sumerian tablet, dating 2200 B.C., of Pompeii.
describes a “soap” formulation of water, alkali and The Bible describes medical and sanitary prac-
cassia oil. tices remarkable for the time. It says people should
By contrast with Indu cities, city dwellers in an- bury their excrement [Deut. 23:13].
cient Mesopotamian cities tended to draw water “And thou shalt have a paddle upon thy weap-
from the river or irrigation canals and they had no on; and it shall be, when thou wilt ease thyself
drains. abroad, thou shalt dig therewith, and shalt turn back
Women and men of Ancient Egypt held appear- and cover that which cometh from thee. For the
ance in high regard. Good hygiene and grooming LORD thy God walketh in the midst of thy camp.”
habits played and important part of their lives and It requires people to wash themselves after touch-
reflected a person of breeding. Even by today stand- ing a dead body. It notes that the eighth day after
ard Ancient Egyptian women are known for their birth is the safest time to perform circumcisions.
beauty. Tomb paintings depict the owners in the lat- The earliest source of Greek medical knowledge
est fashions in wigs, clothing, and makeup. Cosmet- and descriptions of ancient Greek medical practic-
ics were not considered a luxury but a necessity for es is Homer. The two epic poems attributed to Hom-
daily life and many examples of makeup, perfume, er, the Iliad and the Odyssey, date to around the
and toiletry items are found in tombs. A hairy body eighth century BC. Beyond the description of
was not desired by either sex and shaving was a must wounds, to a lesser extent Homer also recorded the
for the wealthy. Women kept their hair short and care given to an injured warrior. Among the warri-
even were known to shave their heads. Elaborate ors, however, there were a few who were consid-
wigs adorn the heads of the wealthy. Henna was used ered to be specialists in the art of healing through
to dye the hair, nails and body. means of herbal remedies and bandaging. One of
The Ebers Papyrus, a medical document from these doctors was Machaon, the son of the legen-
about 1500 BC, shows evidence that Egyptians dary healer Asclepius who later became deified.
bathed regularly and that they combined animal and When Machaon was wounded himself, however, he
vegetable oils with alkaline salts to create a soap- was treated by being given a cup of hot wine sprin-
like (sic) substance for washing. Up to now, there kled with grated goat cheese and barley [Iliad XI.
have been no artifacts showing any sort of menstrual 638].
hygiene in the ancient Egypt. But there is a laundry Greek physician Hippocrates (c. 460 – c. 370
list from which some researchers infer the existence B.C.) was the first to recognize the environment’s
of pad, belt and tampon-like items, but translating role in disease etiology (traitte On Airs, Waters, And
from lists is a tough job. Places); recognized early epidemics. He based med-
The Egyptians practiced a form of water man- icine on objective observation and deductive reason-
agement called basin irrigation, a productive adap- ing. He taught that medicine should build the pa-
tation of the natural rise and fall of the river. They tient’s strength through diet and hygiene, resorting
constructed a network of earthen banks, some par- to more drastic treament only when necessary.
allel to the river and some perpendicular to it, that Romans deeply believed that transcendental prac-
formed basins of various sizes. tices such as superstition, rituals, and a belief in
The earliest evidence of water control in ancient spells would rid the country of disease. This was
Egypt is the famous historical relief of the mace based on the idea that disease came from the anger
head of Scorpion King which dates to around 3,100 of the gods. In 90 BC Roman general Gaius Marius
BC. It depicts one of the last predynastic kings, hold- transformed the Roman army into the incredibly dis-
ing a hoe and ceremoniously cutting a ditch in a grid ciplined, professional, highly trained entity. The
network. Besides attesting to the importance of these practical professional army was much less con-
waterworks and the great ceremony attached to cerned about pleasing the gods and much more con-
them, this picture confirms that Egyptians began cerned about keeping their men in battling condi-
practicing some form of water management for ag- tion. Thus, medical practitioners in the army felt the
riculture about 5,000 years ago. But they did not use same way and operated on a trial-and-error basis,
water purification. passing whatever they learned on to others and to
Pliny the Elder reports the Phoenicians as pre- future generations.
paring it from goat’s tallow and wood ash in 600 Romans did not yet really understand how germs
BC. A bible reference of the same age, to soap, may related to disease, but they did use many of the tech-
be misleading and reflect the translator’s expecta- niques that killed germs, techniques that were not
tion at the time of King James, as the Hebrew word reinvented until much later. For example, they boiled
in question, Borith, properly means any substance their tools before use and would not reuse the same
which cleanses; some authors speculates that it was tool on a patient before reboiling. Wounds were
a lathering paste of Fuller’s Earth and impure soda washed with “acetum”. Over the years, Roman war
mixed with wine, a paste of a kind used by Romans doctors also learned how to prevent many battlefield

14
epidemics. They accomplished this by placing forts typical Roman must have lived almost entirely out-
away from insect infested swamps. They also in- side of his tenement house, in the streets, shops, la-
stalled drains and sewers to transport sewage away trines, baths, and arenas of the city. The domicile
from the men. Similarly, they invented sophisticat- must have served principally as a place to sleep and
ed permanent hospitals, with specialized rooms for store possessions.
different tasks, and with isolation of some patients Rome’s water supply system was one of the mar-
from others to reduce the spread of disease. Central vels of the ancient world. Romans, at first, turned
heating and good ventilation also helped patients. to the Tiber River, local springs, and shallow wells
Some authors indicate that hygiene in the Roman for their drinking water; but water obtained from
World was limited to the rich and famous, except these sources grew polluted and became inadequate
for those who could afford the public baths or ther- for the city’s growing population. It was this neces-
maes, as running water did not reach the poor’s ten- sity that lead to the development of aqueduct tech-
ements from the aqueducts; these lesser folks re- nology. The date of the first aqueduct is assigned to
lieved themselves in pots or commodes which were the year 312 B.C. During the time of Frontinus, nine
emptied into vats located under staircases and these aqueducts conveyed water from distant springs and
emptied into cesspools throughout the city. The rich streams to Rome. The water in the aqueducts de-
and famous, from the emperor on down, enjoyed scended gently through concrete channels. Multi-
running water in palaces and mansions from lead tiered viaducts were used to cross low areas. Invert-
pipes connected to the aqueducts. At Pompei, for ed siphons were employed (sparingly) when valleys
instance, all houses except the poorest had water were particularly deep. Tunnels, burrowed through
pipes fitted with taps, and the waste water was piped hill too difficult to skirt, were equipped with verti-
away into sewer or trench. cal shafts for inspection and cleaning. Debris
It was for reasons of ritual that the Romans cleaned from the tunnels was dumped beside the
washed frequently. Romans, including women and openings to the vertical shafts. Modern archaeolo-
slaves, would wash every day and would have a thor- gists have been able to locate long abandoned con-
ough bath on every feast day if no more often. At duits by finding the piles of debris. Various vestig-
Rome itself, baths were taken daily. es of aqueduct bridges are still in evidence in and
Romans learned of soap from the Germans some around modern Rome (Fig. 3).
time in the first century CE, and that previous to As one might expect, Roman water quality stand-
that they used urine (ammonia) for clothes. Using ards were remedial, taking into consideration only
the two in combination, of course, would be even such factors as taste, temperature, smell, and appear-
more effective. Urine was apparently treated in some ance. Since the quality of water from the nine aq-
way before use. It may have been either a chemical ueducts varied, the worst waters were used for arti-
process or a distillation. cial lakes and irrigation, and the best for drinking.
Ovid’s advice on grooming includes hair remov- Early opinions on the amount of water delivered by
al, and not just men’s beards. Whether this was ac- the aqueducts varies from a low of 322,000 cubic
complished by shaving, plucking or other depilato- meters per day to a high of 1,010,623.
ry practices is sometimes hard to tell. Julius Caesar Water from the baths, latrines, palaces, fountains,
was noted by Suetonius to have been meticulous in etc., as well as other urban runoff was discharged
hair removal. Pervasive hair removal was charac- into Rome’s drainage and wastewater collection sys-
teristic of Egyptian priests, maybe as a form of pu- tem. Several centuries before the birth of Christ,
rification; for practical purposes, it reduces suscep- Etruscan engineers built the initial drainage system
tibility to lice, for instance. (Cloaca Maxima) whose main outlet into the Tiber
Romans used an instrument (strigil) for scrap- River still exists 28 centuries later. The covered
ing the skin. Bear in mind that oil was used in clas- drains were designed on such a large scale that in
sical times for removing grime, and unlike soap certain sections wagons loaded with hay could drive
which forms a lather with water and can be rinsed through with ease. Rome’s sewers and drains emp-
off, the oil had to be scraped off; thereafter, in a tied directly into the Tiber, whose polluted state must
water-rich area a bath could be taken, and in other have been a constant problem for the Roman popu-
cases clean (scented) oils could be used to finish lace.
off the job. The strigil at first glance looks a bit like The Roman sewers have been overpraised. De-
a clasp-knife, handle and blade being in total about spite their longevity, they ignored basic sanitary
8 inches in most cases. The blade is gently curved principles. They carried sewage, urban runoff, and
to accommodate the curves of the body and the han- drainage water together. This multiple employment
dle is sometimes of another material such as bone made it necessary to have large openings along the
or ivory. streets. These openings exposed Rome’s populace
Most of Rome’s dwellings were ill-supplied with to the effluvia of the sewers. To mitigate this dan-
heat, light, and water. The sanitary arrangements, if ger to public health, Romans had only two protec-
judged by modern standards, were inadequate. The tions: the masses of water from infiltration and the

15
 Fig. 3. Ancient Aqueduct in Tu-
nisia

aqueducts which constantly flushed the drains, and philological. His medical writings encompass near-
the hilly nature of the city which gave the drains a ly every aspect of medical theory and practice in
steep slope. his era. In addition to summarizing the state of med-
The Roman sewer system probably carried off icine at the height of the Roman Empire, he reports
at least as much water as the aqueducts provided. his own important advances in anatomy, physiolo-
Consumptive use in Rome was not high and there gy, and therapeutics. His philosophical writings can-
was a lot of infiltration into the drains from ground- not be easily separated from his medical thought. It
water (parts of Rome are constructed over swamps). is difficult to overstate the importance of Galen for
The flow of the Tiber River was greatly increased European medical thought in the centuries between
by discharges from Rome’s sewers. the fall of Rome and modern times. Even as late as
Romans without indoor toilet facilities were 1833, the index to Karl-Gottlob Kühn’s edition (still
forced into one of two options. For a relatively small the only nearly complete collection of Galen’s Greek
charge they could enter one of the city’s public la- works) could be designed for working medical prac-
trines or they could use chamberpots. (The Roman titioners as well as for classical scholars. The book
latrine system must represent one of history’s earli- “De sanitate tuenda” (On Hygiene) described hygi-
est employments of the pay toilet, or more correct- enic requirements and was used by Galen’s follow-
ly, pay latrine, since the modern toilet was not in- ers: Avicenna and Maimonides.
vented until the sixteenth century.) According to his- In Medieval Europe hygiene was not always a
torical data there were 144 public latrines in Rome priority and medieval diets were lacking in vital nu-
in the later Empire. Apparently mostly concomitant trition. Barbers doubled as surgeons, and a good
of the public baths, which only makes sense as they bleeding was often the cure prescribed. Overcrowd-
could share water and sewerage. Public urinals con- ed and polluted cities were common. In 1257 Queen
sisted of buckets, dolia curta. The contents were reg- Eleanor of Provence is forced to leave Nottingham
ularly collected and sold to the fullers for cleaning Castle for Tutbury Castle because heavy coal smoke
wool etc. fouls the air. Before this case unendurable air pol-
Galen, the physician and philosopher, was born lution from wood smoke led Henry II’s wife Elaan-
at Pergamum in 129 A.D. He was educated at Smyr- or of Aquataine to flee Tutbury Castle in 1157. In
na (modern Izmir), Corinth, and Alexandria. In 157 1306 the king Edward I forbids coal burning in Lon-
he returned to his native city and got a prestigious don when Parliament is in session. Like many at-
appointment: physician to the gladiators. From au- tempts to regulate coal burning, it has little effect.
tumn 157 to autumn 161 he gained a valuable prac- In 1347–1350s bubonic plague decimates Europe,
tical experience in trauma and sports medicine, and creating the first attempts to enforce public health
he continued to pursue his studies in theoretical and quarantine laws.
medicine and philosophy. By 161 A.D. Galen, that The idea that medieval people rarely bathed is a
time 32, may have realized that even a great and persistent but false one. Most people washed them-
prosperous provincial city like Pergamum could not selves on a regular basis. Going without washing
offer the opportunities his talents and ambition de- was considered a penance even in the early Middle
manded. He left, returning only for a three-year span Ages. Soap, possibly invented by the Gauls some-
from 166 until some time in 169. The rest of his time before Christ, was in widespread use through-
career was spent in Rome. Galen’s works fall into out Europe by the end of the ninth century, and made
three main categories: medical, philosophical, and its first appearance in cake form in the twelfth cen-

16
tury. Public bathhouses were not uncommon, although their ostensi-
ble purpose was often secondary to their clandestine use by prosti-
tutes.
The earliest Italian medical school opened in Salerno in the ninth
century A.D., and as the place where the streams of classical, Arab
and Jewish medicine flowed together was the predecessor of the med-
ical renaissance.
Avicenna, or in Arabic, Abu Ali al-Husain ibn Abdallah ibn Sina
or simply Ibn Sina (as he is called by Persians) (980–1037), was a
physician, philosopher, and scientist. He was the author of 450 books
on many subjects, many on philosophy and medicine. His most fa-
mous works are The Book of Healing and The Canon of Medicine,
also known as the Qanun. He is considered “The Father of modern
medicine” and is one of the greatest physicians of all time. (Some
sources actually state that Avicenna was born in Hamadan) (Fig. 4).
A number of medical texts have survived from the Salerno school
on various aspects of medicine. The best known is the Regimen Sani-
tatis Salernitanum, the Salerno Book of Health. The book is filled with
practical suggestions for maintaining health, at a time when medicine Fig. 4. Abu Ali al-Husain ibn Ab-
was largely ineffective in curing sickness. dallah ibn Sina
The study of occupational disease was virtually ignored until 1473
when Ulrich Ellenbog published his pamphlet on occupational dis-
eases and injuries among gold miners. He also wrote about the toxic
action of: carbon monoxide, mercury, lead and nitric acid. The field
of industrial hygiene was boosted by his instruction in hygiene and
other preventive measures. This period is a start of of descriptive hy-
gienic science development.
Georg Bauer (Georgius Agricola) was born in Glauchau, in the
province of Saxony (now Germany); Agricola studied classics at the
Leipzig University, taught Latin and Greek for a few years, and then
in 1522 began to study medicine, first at Leipzig and then at Bologna
and Padua in Italy. He took his degree in 1526 and became a practic-
ing doctor; however, he never seems to have been terribly enthusias-
tic about his profession, devoting most of his energy to studies of min-
ing and geology. He died in 1555, one year before the posthumous
publication of De Re Metallica (“On the Nature of Metals”). In this
book Agricola reviewed everything then known about mining, includ- Fig. 5. Georgius Agricola
ing equipment and machinery, means of finding ores and occupation-
al diseases of miners (Fig. 5).
Bernardo Ramazzini (1633–1714), the father of occupational
medicine, publishes De Morbis Artificum Diatriba (English title, print-
ed in 1764 was The Diseases of Artificers, which by their Particular
Callings they are most Liable to, with the Method of Avoiding them,
and their Cure).The book describes the hazards of 52 occupations,
including leather tanning, wrestling, and grave-digging. Ramazzini says
that with a general improvement in diet and less arduous work, peo-
ple would be better able to resist attacks on their health. Ramazzini
also noticed that nuns tended to have a higher incidence of breast can-
cer and that lead miners and workers often had skin the same color as
the metal (Fig. 6).
Johann Peter Frank (1745–1821) was born in Rotalben in Ba-
varia. He studied medicine at Heidelberg University. After taking a
French degree at Pont à Mousson to enable him to practise medicine
in Lorraine, he lived at Bitsch with his German wife for two years
before returning to Germany and joining a practice in Baden. In his
spare time he worked at his book on preventive medicine, System ein-
er vollstandigen medicinischen Polizey, but when he was unable to Fig. 6. Bernardo Ramazzini
find a publisher he threw the volume on the fire. In 1773 he found a
patron in the Prince-Bishop of Speyer and rewrote his manuscript on

17
public health, which was published by Schwan of Mannhein. Despite
the Bishop’s patronage his book was frowned on by the church be-
cause it disapproved of his criticism of celibacy but he went on to
publish five more volumes. Frank conducted a medical “grand tour”
of Europe holding chairs at Göttingen, Pavia, Vienna and St Peters-
burg. In these universities he revolutionized the teaching of medicine
and earned the devotion of his pupils. In Vienna, he implemented Jen-
ner’s discovery of the value of vaccination and, despite retiring to
Freiburg with a pension in 1808, returned to practice in Vienna in 1811
and ended his life there (Fig. 7).
True development of hygiene started with inplementing an experi-
mental method.
Max von Pettenkofer (1818–1901), a German chemist and hygienist.
Pettenkofer is considered to be a founder of hygiene and he is known for
his researches in the ventilation of dwellings, sewage disposal, and spread
of cholera. He developed a reaction for the detection of bile acids and a
method of the quantitative determination of carbon dioxide (Fig. 8). Fig. 7. Johann Peter Frank
Carl von Voit (1831–1908). A German physiologist whose defin-
itive measurements of gross metabolism in mammals, including hu-
mans, helped to establish the study of physiology of metabolism and
laid the foundation for modern nutritional science. He is also one of
the “fathers” of hygiene of nutrition.
Carl von Fluegge (1847–1923) established the first German Insti-
tute for Hygiene at Goettingen, and was its first director. He became a
professor of hygiene at the University of Goettingen in 1885, in Bre-
slau in 1887, and eventually in Berlin. In 1886, together with Robert
Koch, he began publishing the Zeitshcrift für Hygiena (abbreviated
Z. Hyg.), under their joint editorship.
Max Rubner (1854–1932) studied with Voit; constructed the first
accurate respiration calorimeter in Marburg (1889); professor of hy-
giene (1891) and physiology (1909) in Berlin; developed concepts of
proportionality of body surface areas to energy requirements; collab-
orated with Heubner to measure energy needs of infants.
Edmund Alexander Parkes (1819–1876) is a foundator of the
British hygienic scientific school. During the Crimean war he investi-
gated the sanitary condition of British army. In 1860 he was invited to
become the first Professor of the Military Hygiene in the Royal Army Fig. 8. Max von Pettenkofer
Medical School. In 1863 Parkes produced his manual of Practical Hy-
giene which was to run to four editions within nine years (Fig. 9).
The second half of the XIX century occupies a peculiar place in
the world history of formation and development of prophylactic med-
icine. It was the period when empirical hygiene whose sources had
become a thing of the past obtained experimental-scientific substanti-
ation and became one of the leading fields of the contemporary medi-
cal science and health care of the population. It was favoured by cer-
tain objective conditions, in particular, negative results of industriali-
zation and urbanization, population migration and distribution of mass
infectuous diseases.
Hygiene had not been delivered at medical faculties in Russia be-
fore the 60-s of the XX century. It was a part of various departments
and disciplines. There were no practical h and separate examination
in hygiene, the volume and content of teaching hygiene was not regu-
lated but depended on general education and professional trends of
the professor whose department was responsible for teaching hygiene.
Hygiene was delivered at the Department of Medical Police that unit-
ed forensic medicine, medical law, veterinary police with epizootic
diseases and hygiene. Due to the objective circumstances listed above
and proceeding from the society requirements most competent medi- Fig. 9. Edmund Alexander Parkes
cal scientists thought it expedient to create a special department of
hygiene.
18
 Fedor Erisman (Guldreich Friedrich) (1842–1915) is a founder
of scientific hygiene in Russia and New Independent States. He’s Swiss
by origin. In 1869–1896 he lived in Russia. Professor of the Moscow
University (since 1882), in 1896 he was withdrawn because of politi-
cal views. He developed classical traits and guidelines in all principal
parts of hygiene. In 1891 he organized the first sanitary-epidemiolog-
ical station in Russia (now — the Moscow Erisman Research Insti-
tute of Hygiene) (Fig. 10).
Alexey Dobroslavin (1842–1889) is a founder of experimental and
military hygiene in Russia. He created the first hygienic laboratory in
St.-Petersburg (Fig. 11).
Viktor Subbotin (1844–1898) is the first Ukrainian professor of
hygiene. During 1870 and in early 1871 V. Subbotin, who knew Ger-
man, worked mainly in Munich in the laboratories of M. Pettenkofer
and K. Voit. In 1871, V. Subbotin was elected an assistant-professor
of the Kyiv University and soon appointed the Head of the Depart-
ment of Hygiene, Medical Police, Medical Geography and Statistics.
The introductory lecture of the course of hygiene was delivered by V. Fig. 10. Fedor Erisman
Subbotin on December 4, 1871 (the first analogous lecture at the De-
partment of Hygiene of the Peterburg Medical-Surgical Academy was
read by O. P. Dobroslavin on November, the 19th of the same year).
The Department of Hygiene at the Medical Faculty of the Kyiv Uni-
versity was the first department of such kind in Ukraine. A credo of
V. Subbotin as a teacher was elucidated by the thought that the “task
of hygiene teaching cannot and shall not be restricted by the stating
of a certain amount of information to the students, it should also con-
sist in the training of physicians who can really be practical special-
ists in the development of hygienic truth in the personal and social
human life”. The results of Subbotin’s investigation have been pre-
sented elucidated in 50 publications on various problems of preven-
tive medicine. The works by V. Subbotin are mainly devoted to the
problems of general and communal hygiene. Problems of hygiene of
hospitals, sanitary protection of water bodies, medical geography oc-
cupied the leading place among them (Fig. 12).
The modern period of hygiene development is characterised by de-
velopment of risk assessment and management in environmental sci-
ence and integration with other branches of preventive medicine. Fig. 11. Alexey Dobroslavin

HISTORY OF GENERAL HYGIENE DEPARTMENT OF

THE ODESSA STATE MEDICAL UNIVERSITY
The general Hygiene Department of the Odessa Medical Faculty
was founded in 1903 by Grigory Khlopin. His scientific works pro-
moted the experimental direction in hygiene. The equipment of de-
partment was very contemporary, it used the best technical and scien-
tific achievements of that time. Khlopin was the head of the depart-
ment in 1903–1904. He investigated the influence of sanitary state of
city and sea port on morbidity and mortality. 146 scientific works were
written by Khlopin. His themes were environmental health, sanitary
microbiology, epidemiology, hygiene of nutrition, occupational and
military hygiene (Fig. 13).
In 1904 the head of the department was Magnus Blauberg. He
made the fundamental researches in the problems of wine falsifica-
tion and other aspects of hygiene of nutrition.
Ivan Kiyanitzin was the head of the General Hygiene Department
in 1905–1915. He’s written over 30 scientific works about chemical
analyses of water, air, food.
57 scientific works on hygiene of nutrition, military hygiene were
the result of Nickolay Kostyamin activity. He was the Head of the Fig. 12. Viktor Subbotin

19
 Department in 1915–1952. The Odessa regional society of hygienists
and epidemiologists was founded by him in 1938.
Alexander Stoyanovsky was the Head of the General Hygiene
Department in 1952–1966. He was the author of 60 scientific works.
He wrote the theme “Water and Water Supply” in the hygiene text-
book that had many editions. The book “The Influence of Surround-
ing Conditions upon Immune-Biologic Reactivity of the Organism”
was one of the first in the USSR on theme of methatoxic action of
harmful determinants of environment and immunologic changes in the
human organism.
The way from a post-graduate student to the head of general hy-
giene department was gone by Dmitry Babov. He was the Head of
the Department from 1966 to1983. His scientific interests were based
mainly on elaboration of communal hygiene.
In 1983–1996 and since 2004 Nickolay Nadvorny was the Head of
the General Hygiene Department. He is considered to be a foundator
of maritime hygiene in Ukraine. His 214 works dedicated to the prob-
Fig. 13. Grigory Khlopin lems of environmental and occupational health.

20
 Chapter 2
AIR ENVIRONMENT AND HEALTH

CLIMATES AND HEALTH Usually a certain climate is spread over the large
area about hundreds and even thousands kilometers.
The human organism exists constantly interact- However, some regions of this large area can differ
ing with the environment, one of the most impor- by their climate-weather conditions from each oth-
tant components of which is climate. Tropic hygiene er. That’s why such a notion as microclimate was
is marked out as a special field of hygiene owing to approved in climatology (the science about the
the fact, the climate of tropics has a great influence Earth’s climate). It means the features of physical
upon the hygienic life conditions and the conditions condition of the near land layer above a relatively
of human health. small plot of the land. So, we can speak about the
Climate is a long-term weather regimen, corre- microclimate of the wood, field, sea-coast, moun-
sponding to the geographical country and repeating tain slopes, oriented to the parts of the world dif-
appropriately. ferently, about the microclimate of a vale, a town, a
Main climate-forming factors are: the latitude of street and so on.
the country and the intensity of solar irradiation, the Now, many sciences adjoining to the climatolo-
appropriateness of atmospheric circulation, the type gy are developed. Medical climatology studies the
of land surface (dry land, relief, water and so on), influence of climate-weather conditions upon the
the closeness of seas and oceans. human organism and works out the methods of us-
Climate-weather conditions have a direct or me- ing climatic factors with the treatment and prophy-
diated influence upon people. The examples of a lactic aim. Medical geography studies the appropri-
direct influence are: the action of weather conditions ateness of influence of climatic and social-econom-
upon human heat exchange, ultra-violet rays of so- ic conditions upon hygienic life conditions, health
lar radiation — upon the exchange of calcium. The conditions and features of infectious and non-infec-
latter is a very important thing for the prophylaxis tious diseases spread in different geographical re-
of rickets. gions. The materials of investigations are widely
Mediated action of climate is connected with the used in the working out and planning of correspond-
influence upon the character of human household ing programs and prophylaxis.
and working activity, upon the pathological agents From the medico-geographical point of view
of infectious diseases and their carriers. The latter tropics are the part of earth’s surface, situated in the
fact conditions the geographical specificity of spread equatorial (from latitude 10 degrees North to lati-
of different diseases. That’s why regional climatic tude 20 degrees South), torrid (from latitude 10 to
conditions must be taken into consideration while 20 degrees North and from latitude 10 to 20 degrees
working out hygienic recommendations for the civ- South) and subtorrid zones (from latitude 20 to 30
il (dwelling houses, hospitals) and industrial build- degrees North and from latitude 20 to 30 degrees
ings, rational nourishment and way of life, for the South).
choice of adequate clothes and footwear, work and Medical climatology considers the climate of
rest regimen, prevention of diseases and education these zones as tropical. Tropics contain a consider-
of the future generations. In his “Aphorisms” able part of dry land, almost the whole Africa,
Hyppocratus said, that the diseases proceeded dif- Southern Asia and the south of East Asia, a large
ferently in different climatic conditions. He offered part of Latin America, Oceania. More than a half
the climate therapy for the treatment and health im- of people live in this part of the Earth. The transi-
provement, which is widely practiced at present. tional zone adjoins the torrid zone (Mediterranean

21
region, the Front and the Middle Asia, the south of B — Dry Climates are characterized by little rain
the USA, some regions of the Far East). They are and a huge daily temperature range. Two subgroups,
characterized by the features of torrid and temper- S — semiarid or steppe, and W — arid or desert,
ate zones. are used with the B climates.
The Köppen Climate Classification System is C — In Humid Middle Latitude Climates land/
the most widely used for classifying the world’s cli- water differences play a large part. These climates
mates. Most classification systems used today are have warm, dry summers and cool, wet winters.
based on the one introduced in 1900 by the Rus- D — Continental Climates can be found in the
sian-German climatologist Wladimir Koeppen. interior regions of large land masses. Total precipi-
Koeppen the divided the Earth’s surface into climat- tation is not very high and seasonal temperatures
ic regions that generally coincided with world pat- vary widely.
terns of vegetation and soils. E — Cold Climates describe this climate type
The Koeppen system recognizes five major cli- perfectly. These climates are part of areas where
mate types based on the annual and monthly aver- permanent ice and tundra are always present. Only
ages of temperature and precipitation. Each type is about four months of the year have above freezing
designated by a capital letter (Fig. 14). temperatures.
A — Moist Tropical Climates are known for their Further subgroups are designated by a second,
high temperatures a year round and for their large lower case letter which distinguish specific season-
amount of a year round rain. al characteristics of temperature and precipitation.

Fig. 14. Climate Classification by Koeppen

22
 f — Moist with adequate precipitation in all c — Cool, short summers with less than four
months and no dry season. This letter usually ac- months over 10°C in the C and D climates.
companies the A, C, and D climates. d — Very cold winters with the coldest month
m — Rainforest climate in spite of short, dry sea- below — 38°C in the D climate only.
son in monsoon type cycle. This letter only applies h — Dry-hot with a mean annual temperature
to the A climates. over 18°C in the B climates only.
s — There is a dry season in the summer of the k — Dry-cold with a mean annual temperature
respective hemisphere (a high-sun season). under 18°C in the B climates only.
w — There is a dry season in the winter of the Heat and precipitation extremes are presented in
respective hemisphere (a low-sun season). Tables 1–3.
To further denote variations in climate, a third Hygienic Meaning of Solar Radiation in Trop-
letter was added to the code. ical Conditions. The sun is the origin of heat, light
a — Hot summers where the warmest month is and power for the biosphere. Solar power forms air
over 22°C. These can be found in the C and D cli- currents and the change of weather connected with
mates. them. It determines the climate of the country and
b — Warm summer with the warmest month be- makes the existence of organic life possible. Food
low 22°C. These can also be found in the C and D contains the power of the sun, at the expense of
climates. which we live.

Table 1. Highest Temperature Extremes

Continent Highest temp., °C Place Altitude, m Date

Africa 57.8 El Azizia, Libya 110.1 September 13, 1922
North America 56.7 Greenland Ranch. Death Valley. CA -53.4 July 10, 1913
Asia 53.9 Tirat Tsvi, Isreal -216.6 June 21, 1942
Australia 53.4 Cloncurry, Queensland 186.6 January 16, 1889
Europe 50.0 Seville, Spain 7.8 August 4, 1881
South America 48.9 Rivadavia, Argentina 202.8 December 11, 1905
Antarctic Region 15.0 Vanda Station, Scott Coast 14.7 January 5, 1974

Table 2. Highest Annual Precipitation Extremes

Continent Highest average, cm Place Altitude, m

South America 1331 Lloro, Columbia 156.0
894 Quibdo, Columbia 36.0
Asia 1186 Mawsynram, India 1.4
Pasific Ocean 1168 Mt. Waialeale, Kauai, HI 1.5
Africa 1029 Debundscha, Cameroon 9.0
Australia 864 Bellenden Ker, Queensland 1.5
North America 650 Henderson Lake, British Columbia 3.6
Europe 465 Crkvica, Bosnia-Hercegovina 1.0

Table 3. Lowest Annual Precipitation Extremes

Continent Lowest average, cm Place Altitude, m

South America 0.1 Arica, Chile 28.5
Africa 0.3 Wadi Halfa, Sudan 123.0
Antarctic Region 2.0 Amundsen-Scott South Pole Station 2.8
North America 3.0 Batagues, Mexico 4.8
Asia 4.6 Aden, Yemen 6.6
Australia 10.3 Mulka, South Australia 48.0
Europe 16.3 Astrakhan, Russia 13.5
Pacific Ocean 22.7 Puako, Hawaii, HI 1.5

23
 Solar irradiation, reaching the surface of the of the part B have an anti-rachitic action as vitamin
earth, consists of 59% of infra-red irradiation, 40% D3 is formed from 7.8-dehydrocholesterol under
of visible one and 1% of ultra-violet rays. Ultra-vi- their action.
olet irradiation is divided into 3 parts: A (the length The thickening and the hardening of epidermis
of the wave is 400–315 nm), B (315–290 nm), C and the formation of melanin are very important pro-
(290–180 nm). The irradiation from the part C tective reactions, which condition the adaptation of
doesn’t reach the surface of the earth, as it is ab- the organism to the solar irradiation. The thickened
sorbed by ozone, placed at a height of 20–30 km. horny layer of epidermis protects from the most ac-
Infra-red irradiation penetrates deeply through tive ultra-violet irradiation. Melanin is formed in the
the skin and provokes heat effect, the following in- cells of the deepest layer of epidermis, it protects
crease of tissue temperature, hyperemia and the in- the cells of derma, vessels and nerves from visible
creased metabolism in the skin. It strengthens bio- and infra-red rays, which can provoke their over-
logical action of ultra-violet irradiation. This fea- heating. Melanin is accumulated in the lowest lay-
ture is used in medicine. ers of the skin in the people with the white skin.
Visible solar irradiation performs the same bio- The people with the dark skin have more melanin
logical action as infra-red one. Besides, it has pho- and it is placed in the more superficial layers too.
tochemical effect. This effect is weaker than ultra- Melanin is not only a passive shield. Owing to its
violet one, as the power of its quanta is enough only chemical structure it extinguishes the surplus of free
for the molecules of some matters. These matters radicals, formed during solar irradiation in the skin.
are optic pigments. Under the influence of visible This protective function isn’t less important than the
irradiation the biochemical reactions, generating absorption of heat rays for the people, who live in
electrical impulses, proceed in retina. They form tropics. Skin cancer occurs more seldom in people
light sensation. with dark skin than in people with white skin in trop-
The light is an important physiological irritant, ics.
which activates the processes of excitation in brain Ultra-violet rays (the part B) have bactericidal
cortex. That’s why in good lighting the activity of feature, connected with its photochemical action,
the visual and other analyzers is improved. The mat- which damages nucleic compounds of the bacterial
ters, formed in retina during photochemical action cell. Vegetative forms of bacteria, viruses, worms
stimulate the function of hypophysis and the cells eggs die under the direct sun rays in 10–15 min.,
of the central nervous system. That’s why the light spores — in 40–60 min. It is of great importance
has a positive influence upon the emotional sphere, for the sanation of the environment in the conditions
improves organism condition and metabolism. It of hot climate. Short-wave ultra-violet irradiation
means that visible irradiation stimulates the organ- (the part C) has the most expressed bactericidal ac-
ism not only by visual analyzer, but also by the skin, tion. It is generated by mercury-quartz lamps and
as we can find some protoporfirine in blood, which special bactericidal (luminescent) lamps. They are
is a photosensibilisator. By pellagra, porfirins quan- used for the disinfection of water, air, rooms, surgi-
tity in blood is increased, that’s why photodermati- cal instruments and so on.
tis and the following pigmentation develop in the Lately it has been found out, that very toxic com-
parts of the skin, irradiated intensively (skin, face). pounds could be formed during the irradiation of
Sulphanile amides and some other medicines are matters, polluting air and ground. So, the complex
also photosensitinogens. During treatment by these of compounds, called photooxidators, is formed as
medicines we must avoid intensive solar irradiation. a result of solar irradiation action upon the compo-
Ultra-violet irradiation, in particular of the part nents of exhaust gases in the atmosphere of towns.
B, is characterized by the strong photochemical ac- They provoke strong irritation of mucous mem-
tion. It provokes the decay of albuminous molecules branes of the eyes and upper respiratory ways (epi-
(protein photolysis), as a result physiologically ac- phora, unbearable cough), the death of plants, ac-
tive compounds are formed (choline, acetyl choline cumulating in the streets of towns in sunny weath-
and so on). They activate the sympathetic-adrenal er. The poisonous photochemical mists are observed
system, metabolic and atrophic processes. UV-rays in towns with the expressed solar irradiation (Los
stimulate tissue growth and regeneration (including Angeles, Mexico, Tokyo)1. Hard poisonings of coun-
postoperational measures), blood production, immu- try-men, who worked in the fields, had been treated
nogenesis, organism resistance to infectious, toxic by polychlorpinen, in sunny weather were observed
and carcinogenic agents. They improve physical and in Iran and some other countries. Very poisonous
mental working ability. compounds, formed from polychlorpinen, were
So, certain doses of ultra-violet irradiation are a found out in the near-land layer of atmosphere. The
strong adaptogenic factor, which increases health photochemical activity of solar irradiation is 2–9
level. Stimulated diseases (hypertension, artherio- times more in tropical countries than in European
sclerosis, cancer, nephritis) develop in the irradiat- ones.
ed animals more slowly. Besides, ultra-violet rays 1See section “Air Pollution”

24
 The biological method is widely used to meas- ter the fracture, the increase of teeth decay rate in
ure the intensity of ultra-violet irradiation. The unit adults. In the northern latitudes the prophylactic ir-
of measurement is biodose. It is the smallest quan- radiation by UV-rays is widely used to prevent “sun
tity of ultra-violet irradiation, provoking hardly vis- starvation” (pregnant women, miners). These meas-
ible hyperemia of untanned skin in 6–20 h after the ures are carried out with the help of erythematic-
irradiation. The minimum daily prophylactic dose luminescent lamps, their spectrum is 20% of visual
preventing rickets in white people is 1/8 of biodose. irradiation, 45% of UV-irradiation of the part A and
The optimal dose with the adaptagenic meaning is 35% of the part B.
1/4–1/2 of biodose. The minimum and optimum Endemic rachitis among young children was
dose in aboriginals of hot countries is 2.5–5 times found out even in Greece and the Mohammedan
more and it depends on the color of the skin. Ultra- countries. It is connected with the traditions. Preg-
violetmeter is a special device used in medicine. nant women, nursing mothers and young children
Ultra-violet irradiation is absorbed by photoelement don’t leave the rooms. The woman’s body is clothed,
and the generated electrical current is registered by the skin is irradiated weakly and their milk have al-
galvanometer. The scale of galvanometer is gradu- most no cholecalciferol. The resistance of the dis-
ated by mcW/cm2. One biodose is equal to 600–800 eased children to the action of harmful factors is
mcW/cm2. Consequently, minimum physiological decreased. When the children become older, they
request of a white man is 100 mcW/cm2, optimum stay in the open air more often and become cured
— 200–400 mcW/cm2. These indices make 250–500 from rickets. The food containing enough calcium
and 500–2000 mcW/cm2 correspondingly for a black is necessary for a quick recovery.
man. The intensity of UV-irradiation makes 15–20 Some people suffer from symptoms of depres-
mcW/cm2 per minute at a noon in a bright sunny sion during the winter months, with symptoms sub-
day in tropics. So, a white man will get his prophy- siding during the spring and summer months. This
lactic dose in 5–10 min, and a black man — in 15– may be a sign of Seasonal Affective Disorder
20 min. (SAD). SAD is a mood disorder associated with de-
The total flow of solar irradiation consists of the pression episodes and related to seasonal variations
direct radiation, coming directly from the sun, and of light. SAD was first noted before 1845, but was
the dispersed one from the whole sky. If the sky is not officially named until the early 1980-s. As sun-
clear, the intensity of the dispersed radiation isn’t light has affected the seasonal activities of animals
considerable, but it contains a large percentage of (i.e. reproductive cycles and hibernation), SAD may
UV-rays. So, if the total intensity of UV-irradiation be an effect of this seasonal light variation in hu-
is 20 mcW per min. on a bright sunny day, then the mans. As seasons change, there is a shift in our “bi-
direct irradiation makes 12 mcW per min and the ological internal clocks” or circadian rhythm, due
dispersed one — 8 mcW per min. (40%). This fact partly to these changes in sunlight patterns. This can
is used in medicine. People, whom the long stay in cause our biological clocks to be out of “step” with
the sun is contraindicated, can get their prophylac- our daily schedules. The most difficult months for
tic dose of ultra-violet irradiation by the dispersed SAD sufferers are January and February, and young-
radiation in the shade. In cloudy sky, the part of the er persons and women are at higher risk. Symptoms
dispersed radiation makes 0.4–0.5 cal/cm2 per min., include:
but it is poor in UV-rays (especially B rays). — regularly occurring symptoms of depression
Due to the air pollution by the dust and smoke (excessive eating and sleeping, weight gain) during
in the settlements we lose 20–40% of UV-radiation. the fall or winter months;
Owing to the admixture of iron and titanium win- — full remission from depression occur in the
dow glass keeps about 80–90% of valuable UV-ra- spring and summer months;
diation of the part B. The glass free of this admix- — symptoms have occurred in the past two years,
ture makes way for the most part of UV-rays and it with no nonseasonal depression episodes;
can be used in hospitals and children’s institutions. — seasonal episodes substantially outnumber
The deficient irradiation of the organism by nec- nonseasonal depression episodes;
essary UV-radiation (“sun starvation”) is observed — a craving for sugary and/or starchy foods.
in the north latitudes and in winter — in the middle Melatonin, a sleep-related hormone secreted by
latitudes. It is connected with the increased number the pineal gland in the brain, has been linked to
of cloudy days, short stay in the open air, warm SAD. This hormone, which may cause symptoms
clothing. It decreases the organism adaptation, leads of depression, is produced at increased levels in the
to anemia, worsens tissue regeneration, resistance dark. Therefore, when the days are shorter and dark-
for toxic, cancerogenic, mutagenic, infectious er the production of this hormone increases.
agents. The deficient synthesis of vitamin D3 and Phototherapy or bright light therapy has been
accompanying disturbance of calcium and phospho- shown to suppress the brain’s secretion of melaton-
rous metabolism provokes rickets in children and in. Although, there have been no research findings
osteoporosis, insufficient regeneration of bones af- to definitely link of this therapy with an antidepres-

25
sant effect, many people respond to this treatment. 500
For mild symptoms, spending time outdoors during 1 2
3

Incidence (cases per mln)

the day or arranging homes and workplaces to receive 400
more sunlight may be helpful. One study found that
an hour’s walk in winter sunlight was as effective as
two and a half h under bright artificial light. 300
Naturally, the pathology, connected with the hy-
perirradiation, is more urgent for the tropics. The 200
stay in the open sun with the uncovered head leads
to sun stroke. This affection is observed by the lo-
100
cal irradiation of the head and neck. Hyperthermia
promotes it. The cause of the local over-heating is 4
infra-red and partially visible irradiation, heating 0
cranial bones (sun stroke). The clinical course 1980 2020 2100 2060
presents headache, the disturbance of cardiovascu- years
lar activity, loss of consciousness, convulsions and 1 — no restrictions; 2 — Montreal protocol, 1987; 3 —
death in severe cases. London amendments, 1990; 4 — Copenhagen amend-
Heat stroke is the most dangerous for children. ments, 1992
The prophylaxis consists of the covering of the head Fig. 15. Skin Cancer Incidence
and prevention of total hyperthermia. Besides, so-
lar irradiation can increase hyperthermal action of
high temperature of air and can promote the appear- It is not difficult to prevent hyperirradiation. It
ance of heat stroke. The stay in the open sun is is necessary to carry out medical recommendations
equivalent to the increase of air temperature by 5– as to sun baths and work in the open air. Young chil-
6°C. dren, old men, people suffering from cardiovascu-
The prolonged stay of undressed man in the open lar, chronic inflammatory, allergic diseases should
sun can provoke the skin inflammatory reaction — get their prophylactic dose in the shade, avoid hy-
photoerythema. If most part of the skin is irradiat- perirradiation and the progression of chronic patho-
ed, photoerythema is accompanied by increase of logy.
the body temperature and total indisposition. The
cause of photoerythema is a surplus irradiation by
UV-rays. Infra-red and visible irradiation increase HOT CLIMATE IMPACT ON HEALTH
the action of ultra-violet radiation. The latent peri-
od lasts for some h. Then at the place of irradiation Most of people gradually adapt to every climate.
we can observe the dilation of vessels, swelling of The adaptative physiological reactions are based on
epidermal cells, the appearance of infiltration, the reflexes, which are mobilized under the action of heat
increased pigmentation. The skin becomes less sen- or cold. The development of human pathological con-
sitive to UV-rays. ditions under the influence of hot tropical climate can
The experiments showed that chronic large dos- be caused by some interconnected factors:
es of UV-radiation provoked the decrease of organ- 1) the disturbance of thermoregulation;
ism resistance to the harmful factors in laboratory 2) the disturbance of regulation of water-electro-
animals (the doses exceed 0.5–1.0 biodose). It is lyte balance;
confirmed by the experiments with people. We can 3) the disturbance of cardio-vascular regulation.
observe the worsening of self-condition, the de- Under the influence of heat, mainly physical and
crease of resistance to the harmful agents, progres- partially chemical phases of thermoregulation are
sion of cardio-vascular diseases and chronic inflam- activated. Heat emission increases and heat-produc-
mations (tuberculosis), disposition to the allergic tion decreases. Both processes act at the same time.
reactions. But in hot conditions the chemical thermoregulation
It is known that surplus solar irradiation provokes isn’t as powerful as the physical one.
the increased rate of face and lips skin cancer. So, In dry hot climate the evaporation proceeds eas-
cancer increases from the north to the south. It dou- ily. By 29°C heat emission increases from 12% to
bles every 4–6 degrees of latitude. Skin cancer 70%. But if the humidity grows on, the air cannot
makes 20–22% from other forms of cancer in the absorb water and heat. The thermoregulation be-
hot regions and only 4–7% in the north. The newly comes disturbed and the overheating develops. In
arrived are affected by cancer of the facial skin 10– such conditions the air movement is very important
12 times more than inhabitants, who defend their for the comfort.
face better. The aboriginals of South Africa are af- Acclimatization for the hot climate is a process
fected by skin cancer 27 times less than white peo- of adaptation to increased heat loads. It is shown as
ple (Fig. 15). the lowering of muscular tone, intensification of

26
thermoregulation, an ability to make much sweat in ume, the increase of its viscosity, hematocrit, the
proportion to heat load and to lower salt concentra- number of RBC. In this case the condition could be
tion in sweat, by the inadequate liquid intake. accompanied by anuria and necrosis of renal canals.
It is found out that the acclimatization has some Chlorides concentration in urine is lowered. Hyposo-
phases: diumaemia and hypochlorideaemia are found out in
— Stage of “alarm” (the first h in a new envi- blood.
ronment) 2. Heat exhaustion with mainly water insufficien-
— Replacement of the old dynamic stereotype cy.
— Incomplete acclimatization Slight cases are met in the everyday life in trop-
— Complete acclimatization ics (when water loss isn’t restored). The expressed
Physiological changes can turn into pathologi- forms occur seldom (for example, when the man
cal ones under certain conditions. Mental health has stays in a desert for a long time). In mild cases the
a great importance for the acclimatization. patient complains of headache, vertigo, weakness,
Most of people, being in tropical countries, are oliguria, a little increase of the body temperature.
able to acclimatize in 3 weeks. Some people with In severe cases, the complaints are: thirst, vascular
good thermoregulatory abilities can acclimatize in collapses, difficult swallowing. The tongue and the
5–7 days. But there are some people very sensitive mucous membranes of the oral cavity are dry. The
to the heat stress, who cannot acclimatize at all. body weight is decreased. Other symptoms are dys-
There are some clinical and experimental data, coordination, coma quickly leading to death. Some-
which are evidence of the advisability of human pre- times, the fit of hyperpyrexia precedes the death.
liminary training to the action of high temperature Prophylaxis. The regulation of water regimen
to get quick acclimatization. It is realized by daily should be followed during the whole hot season.
staying in a heat chamber, where we can model dif- Daily quantity of water is determined by the condi-
ferent types of hot climate. Muscular work facili- tions of environment, the intensity of muscular work,
tates the adaptation to heat. the peculiarities of metabolism, the quantity and
The clothes, the formation of artificial microcli- quality of food. The surplus and irregular drinking
mate (air conditioning) have a great importance for leads to the uneffective perspiration. It is recom-
the organism protection from surplus heat and solar mended to use: 0.5% solution of sodium chloride,
irradiation. green tea, iced acidulated tea, mineral water, fizzy
The breach of water-salt exchange under the in- water. It is advisible to add some condensed milk
fluence of surplus heat is characterized by the next to drinking water. Tomato juice with the table salt,
syndromes: (1) hyposodiumaemia (the syndrome of raw fruits, water-melon, melon; grape-fruit, lemon,
salt insufficiency) and (2) simple dehydration with- orange juice, tamarind juice, soft mineral drinks
out salt loss. slake the thirst. The shower, bathing promote the
In hot climate we usually meet dehydration, but prophylaxis of over-heating. It is necessary to avoid
sometimes we can observe both syndromes. There use alcohol and it is very important to follow the
isn’t a common classification of heat exhaustion. rules of personal hygiene and the day regime.
Most of authors mark out the following basic Heat Fever. Hyperpyrexia — is an acute over-
forms: heating of the organism, caused by the disturbance
1. Heat exhaustion with salt insufficiency. of thermoregulation in hot climate, in hot period of
The most considerable predisposing factors are the year, during stay in overheated premises (hot
abundant perspiration with the unrestored water and shops). Usually it is observed in untrained newly
salt loss, gastro-intestinal disorders with vomiting arrived in tropics or hot countries. Under the influ-
and diarrhea. This type of heat exhaustion is usual- ence of heat, their thermoregulatory system becomes
ly met during hard physical work in hot conditions. exhausted. Hyperthermal diseases (malaria, tropical
The disturbance of water-salt balance (hyposodiu- jungle), alcohol intoxication, vegetative dystony, etc.
maemia) and vascular insufficiency occur in the first have an influence upon the occurrence of heat hy-
place. perpyrexia.
Clinical course. The patient complains of head- Clinical course is variable. The symptoms of
ache, the absence of appetite, sickness, vomiting. heat stroke occur during the maximum insolation
Gradually, painful muscular spasms mainly in the and sometimes after the patient has come from the
muscles of calves and feet develop. It is typical of sun to the shade. If you bring the patient out of a
the patients with the repeated vomiting. Other symp- hyperthermal zone in the prodromal period of the
toms are oliguria, vertigo, ataxia, and hallucinations. disease, help him quickly, the reaction is character-
In severe cases the excitement, turning into the sharp ized by faint, feeling of closeness, weakness, a lit-
inhibition of mental activity and even coma devel- tle increase of temperature, the dilation of pupils,
op. We can observe the signs of the organism dehy- dyspnoe.
dration, orthostatic unsteadiness, vascular insuffi- In severe cases, the symptoms grow quickly. Af-
ciency with the decrease of circulating blood vol- ter the repeated faints with the dramatic adynamia,

27
a severe headache, weakness in legs, tachycardia, number and severity of heat waves. Heat stress is a
sleepiness, sickness, frequent, superficial breathing, well-known danger during prolonged bouts of hot
the squeezing in the chest develop. The skin is dry. weather, especially in cities, which tend to trap heat.
Other symptoms are oliguria, photophobia, the hy- In both New York and Shanghai, for instance,
peraemia of the face and conjunctives, narrow pu- records show that daily mortality rates increase
pils. Salt insufficiency does not always occur. Then, sharply once temperatures exceed a certain thresh-
we can observe a severe neurological condition: the old. During intense heat waves, the death toll attrib-
increasing headache, excitement. Muscular fibrilla- uted to heat stress can be surprisingly high, as oc-
tions, epileptoid convulsions often occur. The curred in Chicago in July 1995, when heat stress
breathing is superficial, frequent, and irregular. The killed 726 people during a 4-day heat wave.
body temperature increases up to 41–43°C. The pa- Midlatitude cities including Washington, Athens,
tient loses consciousness, his pupils are dilated and and Shanghai seem to be at greatest risk for deadly
don’t react to the light, the pulse is faint, filiform, heat waves. In these cities, residents (especially eld-
the peripheral blood supply is decreased. The skin erlies, very young and poor ones) are not acclima-
is dry, hot or covered with sticky sweat. The face is tized to extremely hot weather and are thus more
pale, cyanotic. The defecation is irregular. Abdom- vulnerable to heat stress.
inal reflexes are lowered or absent. Usually we can Among these vulnerable groups, the existence of
reveal albuminuria. The shock develops. previous health problems, greater heat exposure due
Prophylaxis. It is necessary to avoid the pro- to substandard housing, and lack of access to air
longed stay in the open sun with the uncovered head. conditioning are all factors leading to higher heat-
The next measures are: rational work conditions, related mortality. By the middle of the next centu-
clothes, right water regimen, the training of accli- ry, climate change could increase the frequency of
matization. very hot days. The normally hotter average temper-
atures in tropical and subtropical cities seem to help
residents accommodate heat waves better, so they
CLIMATE CHANGE AND HEALTH suffer fewer heat-stress problems, although heat-re-
lated deaths during a 1995 heat wave in New Delhi
Climate influences many of the key determinants indicate that even residents in the tropics can be sus-
of health: temperature extremes and violent weath- ceptible to extreme temperatures.
er events; the geographical range of disease vectors; Conversely, a potential health benefit of warmer
the quantity of air, food, and water; and the stabili- global temperatures could be fewer cold-related
ty of the ecosystems which we depend on. deaths as winters become milder. A recent British
Because climate affects us in so many ways and study estimated that by 2050 an increase in the av-
because the details of how the global climate may erage wintertime temperature by 2.0°C to 2.5°C, as
change are so uncertain, prediction of the health ef- predicted by some climate models, might result in
fects of climate change is vague. But given what is as many as 9,000 fewer cold-related deaths per year
already known about the connection between cli- in England and Wales. Yet, this decrease in winter
mate and health and the magnitude of the global mortality would probably only partially offset ad-
warming that scientists project, predict that future ditional heat-related deaths; studies indicate that
health effects can be substantial. These effects are higher mortality is generally associated with heat
likely to vary widely from region to region, because waves than cold spells.
climate itself is predicted to change differently in In addition to more frequent heat waves, global
various regions. For instance, temperatures are ex- climate change is expected to result in greater weath-
pected to rise more in some areas than others; some er variability overall. In particular, climatologists
places will likely get drier, while others will get believe that relatively small changes in the average
more rain than they do nowadays. global climate in the future could produce large
Health impacts of climate change include direct changes in the frequency of extreme weather events,
effects from temperature and weather extremes and such as hurricanes (cyclones), violent thunder-
from sea-level rise. A number of indirect impacts storms, and windstorms. Through flood and wind
are also likely to arise from changes in precipita- damage, these natural disasters already exact a heavy
tion and temperature patterns, which may disturb burden in the destruction of lives and property.
natural ecosystems, harm agriculture and freshwa- Rising sea levels, another expected consequence of
ter supplies, exacerbate air pollution level, and cause global warming, could adversely affect the health and
large-scale reorganization of plant and animal com- well-being of coastal inhabitants. Sixteen of the world’s
munities. These indirect effects may, in the long run, largest cities with populations of more than 10 million
have greater cumulative impacts on human health are located in coastal zones, and coastal populations
than the direct effects. are increasing rapidly worldwide. Some projects pre-
Direct Impacts. One of the most easily imag- dict that sea level will rise between 0.3 and 1.0 meter
ined impacts of global warming is an increase in the by 2100, with a best-guess estimate of 0.5 meter.

28
 The most immediate threat from such a rise would bled atmospheric CO2 scenario (which could occur
be to those who live directly on the coast, in low- by the year 2040 if current fossil fuel emission
lying areas such as river deltas, or on small island trends continue).
nations such as the Maldives, the Marshall Islands, Infectious agents which cycle through cold-
Kiribati, and Tonga, where land is virtually all with- blooded insect vectors to complete their develop-
in a few meters of sea level already. Rising seas would ment are quite susceptible to subtle climate varia-
inundate many of these islands, increase storm dam- tions. In temperate regions, climate change would
age to the remaining land, and contaminate the fresh- affect vector-borne diseases by altering the vector’s
water supplies found in island aquifers. range, reproductive and biting rates, as well as path-
Delta regions such as the Ganges-Bramaputra ogen development rate within the vector host.
delta in Bangladesh, the Nile delta in Egypt, or the Malaria and dengue fever serve as prime exam-
Niger delta in Nigeria could also suffer a similar fate. ples of climate sensitive diseases. The geographic
The situation in Bangladesh’s densely settled Gan- range of malaria is generally limited to the tropics
ges-Bramaputra delta is probably the most serious. and subtropics because the Plasmodium parasite re-
A recent study projects that a 1-meter sea rise could quires an average temperature above 16°C to devel-
inundate 17 percent of Bangladesh’s total land area op. Freezing temperatures kill overwintering eggs
and displace about 11 million of people (at current of Aedes aegypti, the mosquito carrier of dengue and
population densities). In the Nile delta, a 1-meter yellow fever. Warming trends, therefore, can shift
rise would displace around 6 million of people un- vector and disease distribution to higher latitudes
less costly protection efforts were mounted; and in or altitudes, as was observed in Mexico when den-
the Niger delta, a similar rise would inundate 15,000 gue reached an altitude of 1,700 meters during an
square kilometers of land and force about a half mil- unseasonably warm summer in 1988. In an earlier
lion people to relocate. study in Mexico, the most important predictor of
According to the United Nations, Intergovern- dengue prevalence in communities was found to be
mental Panel on Climate Change (IPCC), anthropo- the median temperature during the rainy season.
genic greenhouse gas emissions are significantly al- Temperature also drives epidemic dynamics of den-
tering the earth climate. By the year 2100, average gue transmission. Viral development time inside the
global temperatures are projected to rise by 2.0– mosquito also shortens with higher temperatures,
2.5°C (range 1.5–4.0°C). This projected rise in tem- increasing the proportion of mosquitoes that become
perature represents a five-fold faster rate of warm- infectious at a given time. Thus, mosquitoes bite
ing than that observed over the past century. These more frequently and are potentially more infectious
IPCC figures even assume a reduction in global eco- at warmer temperatures.
nomic growth rate slowed population growth over Climate-related increases in sea surface temper-
the next half century and improved conservation ature can lead to higher incidence of water-borne
measures. These projections are consistent with cli- cholera and shellfish poisoning. Marine phytoplank-
mate sensitivity to atmospheric CO2 concentrations ton blooms include red tides that cause diarrheal and
observed from ice core data extending over 158,000 paralytic diseases. Vibrio cholerae has been found
years. Sea level also is expected to rise by about 34– to be associated with marine zooplankton, and
52 cm by the year 2100 as a result of ocean ther- blooms from warmer sea surface temperatures could
moexpansion and by melting of glaciers. expand this important reservoir from which cholera
Nowadays the medical community is beginning epidemics may arise.
to examine the consequences that these projections Human migration and damage to health infra-
may portend for public health, and the World Health structures from the projected increase in climate
Organization considers global warming as a serious variability and severity of storms could threaten hu-
public health challenge for the future. man shelters and public health infrastructures and
Under the conditions of global warming, direct indirectly contribute to disease transmission. Human
hazards to human health (e.g. urban heat-island ef- susceptibility to disease might be further compound-
fect and harmful air pollution) may become signifi- ed by malnutrition due to climate impacts on agri-
cant public health problems given current trends in culture.
urbanization. Warmer temperatures combined with We need to understand better the linkages be-
increased ambient UV radiation could worsen pho- tween climatological and ecological change as de-
tochemical smog, especially over urban areas. Ele- terminants of public health. Addressing this newly
vated night-time temperature readings are the most recognized threat will require interdisciplinary co-
significant meteorological variable contributing to operation among health professionals, climatolo-
heat-related mortality; the greenhouse effect is pre- gists, biologists and social scientists, and will ne-
dicted to especially affect these minimum tempera- cessitate research beyond conventional dose-re-
tures, and studies estimate a 3 to 4-fold increase in sponse linear relationships to address complex sys-
heat-mortality in large temperate cities under a dou- tems-based ecological processes.

29
 related many times with ambient monthly tempera-
WEATHER AND HEALTH tures. Complications from these disorders can be
expected at higher temperatures since the body re-
Weather is a complex of physical features of the sponds to thermal stress by forcing blood into pe-
nearland atmospheric layer during a relatively short ripheral areas to promote heat loss through the skin.
period of time (hours, days, weeks). The weather is This increases central blood pressure and encour-
characterized by the complex of meteorological el- ages vasoconstriction. However, increases in heart
ements: solar irradiation, temperature, humidity, air disease are also noted at very cold temperatures as
speed and direction, atmospheric pressure, electri- well.
cal condition of the atmosphere, cloudiness and the A number of studies have also found relation-
presence of precipitations. ships between the numbers of reported migraine at-
Consequently, the weather is a changeable proc- tacks and rapid changes in barometric pressure.
ess, as the climate is stable one and it has a pro- They found that migraines were most likely to oc-
longed influence upon the human organism. cur on days with falling pressure, rising humidity,
Weather has a profound effect on the human high winds, and rapid temperature fluctuations.
health and well-being. It has been demonstrated that The reduction of solar radiation by cloud cover
weather is associated with changes in birth rates, and may also have effects on well-being. By increasing
sperm counts, with outbreaks of pneumonia, influ- the brightness level, the autonomic nervous system
enza and bronchitis, and is related to other morbid- is affected by constriction changes in the eye pupil.
ity effects linked to pollen concentrations and high This increases the rate of physical activity and leads
pollution levels. to a general feeling of well-being. Sun rays cause
Large increases in mortality have occurred dur- chemical changes in neurotransmitter or hormone
ing previous heat and cold waves. synthesis in the brain, perhaps stimulating produc-
Hot weather extremes appear to have a more sub- tion of the hormone epinephrine, which stimulates
stantial impact on mortality than cold wave episodes. the mind and body. Conversely, very low light in-
Most researches indicate that mortality during ex- tensities are often associated with states of relaxa-
treme heat events varies with age, sex, and race. tion, tiredness, and sleepiness.
Factors associated with increased risk from heat ex- To characterize weather changeability they of-
posure include alcoholism, living on higher floors ten use “index of the weather changeability”:
of buildings, and the use of tranquilizers. Factors
N
associated with decreased risk are use of air condi- K = — × 100%,
tioning, frequent exercising, consumption of fluids, n
and living in shaded residences. where K — index of weather changeability
The importance of determining the role of weath- N — number of days with contrast changes
er in human health cannot be understated. There are of weather
a number of other impacts of weather on the gener- n — number of days in a studied period
al health of the population, including morbidity, If K is more than 30%, the weather regimen is
short-term changes in mood, emotional well-being, changeable.
and aberrations from normal behavior. For exam- They use for predicting weather impacts on hu-
ple, asthma attacks, many of which occur from in- man health and for prevention of weather-related
halation of airborne agents such as spores and molds, (meteotropic) diseases some medical classifications
appear to be related to various meteorological vari- of weather. The most known are the Fedorov’s and
ables. Morbidity attributed to pneumonia, influen- the Grigoriev’s classifications (Tables 4, 5).
za, bronchitis, and probably many other illnesses is “Acute weather” is risky for heart attacks, strokes
also weather-related. and developing complications of chronic diseases.
Probably the most intensively-studied weather “Irritative weather” causes exacerbations of chron-
element that affects human mortality is air temper- ic and infectious diseases.
ature, especially the impact of summer heat. The
impact of temperature on morbidity and mortality
can be assessed at both the seasonal and daily lev- Table 4. The A. Fedorov’s Weather Classification
el. The variability in occurrence of numerous illness-
es is linked to somewhat predictable seasonal trends Athmosperic Air move-
Weather Temperature
in temperature, although significant year-to-year dif- pressure ment
types overfalls,
overfalls, velocity,
ferences do occur. Medical disorders such as bron- °C
mm Hg m/s
chitis, peptic ulcer, glaucoma, goiter, eczema, and
herpes zoster are related to seasonal variations in Optimum <2 <4 2–3
temperature. Heart failure (most often myocardial Irritative 3–4 5–8 6–7 m/s
infarction) and cerebrovascular accidents represent Acute >4 >8 > 9 m/s
two general mortality categories that have been cor-

30
 Table 5. The I. Grigoriev’s Weather Classification
Pressure Oxygen
Atmospheric Wind, Temperature
Weather types overfalls, content,
pressure, mm Hg m/s overfalls, °C
mm Hg mg/l
Very favorable >760 0-3.0 – 0–5 > 315
Favorable 755–760 4.0–7.0 1–5 6–8 > 315
Medical control need 745–754 8.0-10.0 6–9 9–14 289–260
Strict medical control need < 745 Storm > 10 > 15 < 260

AIR POLLUTION imals have been harmed by air pollution. Air pollu-
tion has thinned the protective ozone layer above
the Earth. Air pollution can damage buildings, mon-
There are a number of atmospheric gases which
uments, statues, and other structures.
make up the air. The main gases are nitrogen and
Outdoor Air and Health For more than a cen-
oxygen, which make up 78% and 21% of the vol-
tury, severe air pollution incidents in such cities as
ume of air respectively. Oxygen is utilised primari-
London have shown that breathing the dirty air can
ly by animals, including humans, but also to a small
be dangerous and sometimes deadly. In 1880 2,200
degree by plants, in the process of respiration. The
Londoners died in such an incident when coal smoke
remaining 1% of the atmospheric gases is made up
from home heating and industry combined to form
of trace gases. These include the noble or inert gas-
a toxic smog of sulfur dioxide gas and airborne com-
es, the most abundant in which is argon. Hydrogen
bustion particles. But concern about the health ef-
is also present in trace quantities in the atmosphere.
fects of outdoor air pollution did not effectively co-
The remaining trace gases include the greenhouse
alesce until the late 1940s and early 1950s, when
gases, carbon dioxide, methane, nitrous oxide, wa-
air pollution disasters on two continents raised an
ter vapour and ozone, so-called because they are in-
alarm. Both the 1948 “killer fog” in the small town
volved in the Earth natural greenhouse effect (Fig.
of Denora, Pennsylvania, that killed 50, and the par-
16).
ticularly virulent London “fog” of 1952, in which
Air pollution is the presence of noxious substanc-
about 4,000 died, were associated with widespread
es in the air. Air pollution is the hygienic and eco-
use of dirty fuels and were catalysts for government
logical problem. The pollutants cause the diseases,
efforts to tackle urban air pollution (Fig. 17).
change the ecological system condition.
Since then, many nations have adopted ambient
Air pollution can cause health problems includ-
air quality standards to safeguard the public against
ing burning eyes and nose, itchy irritated throat, and
the most common and damaging pollutants. These
breathing problems. Some chemicals found in pol-
include sulfur dioxide, suspended particulate mat-
luted air can cause cancer, birth defects, brain and
nerve damage, and long-term injury to the lungs and
breathing passages in certain circumstances. Above 4 1000
Concentration of smoke, sulfur dioxide, mg/m-3

certain concentrations and durations, certain air pol-

lutants are extremely dangerous and can cause se- Deaths
vere injury or death. Air pollution can also damage
the environment and property. Trees, lakes, and an- 3 750
Deaths per day

Sources of air pollution

2 500

Manmade (athrogenic) Sulfur

Natural dioxide
Volcanic
1 250
eruptions Point sources Mobile sources
Smoke
Dust stroms Plants Vehiles
Sand stroms Factories Transport
Forest fire FOG 0
Roads 0
Open pits 2 4 6 8 10 12 14
Date in december 1952
Fig. 16. Air Pollution Impact on Health Fig. 17. The Consequences of London Smog, 1952

31
ter, ground-level ozone, nitrogen dioxide, carbon Particulate Pollution. Suspended particulate
monoxide, and lead all of which are tied directly or matter is a nearly ubiquitous urban pollutant. Al-
indirectly to the combustion of fossil fuels. Although though particulate levels in North America and
substantial investments in pollution control in some Western Europe rarely exceed 50 µg/m3 of air, the
industrial countries have lowered the levels of these levels in many Central and Eastern European cities
pollutants in many cities, poor air quality is still a and in many developing nations are much higher,
major concern throughout the industrial world. A often exceeding 100 µg/m3. Particulate air pollution
recent assessment by the European Environment is a complex mixture of small and large particles of
Agency found that 70 to 80% of 105 European cit- various origin and chemical composition.
ies surveyed exceeded WHO air quality standards Dust is the most frequent pollutant of the air. It
for at least one pollutant. In the United States, esti- represents itself as a disperse system, in which the
mated 80 million of people live in areas that do not disperse phase is a crushed hard substance, and the
meet U.S. air quality standards, which are roughly disperse medium — air. The dust is the dispersion
similar to the WHO standards. system with a solid phase. It is classified into aero-
Meanwhile, urban air pollution has worsened in suspension and aerodispersion according to sizes of
most large cities in the developing world, a situa- particles.
tion driven by population growth, industrialization, Dust may be organic (of vegetable or animal or-
and increased vehicle use. Despite pollution control igin), non-organic (metallic, mineral) and mixed. In
effects, air quality has approached the dangerous the atmospheric air usually mixed dust is observed.
levels recorded in a number of megacities, such as Main sources of dust pollution of the atmosphere
Beijing, Delhi, Jakarta, and Mexico City. In these are industrial enterprises.
cities, pollutant levels sometimes exceed the WHO Capability of the dust particles to remain in the
air quality standards by a factor of three or more. In suspended condition depends on their sizes and spe-
some of China’s major cities, particulate levels are cific gravity. The size of the particle is long, it will
as much as six times the WHO guidelines. World- remain longer in the air.
wide, the WHO estimates that as many as 1.4 bil- The fate of dust in the respiratory tracts is relat-
lion urban residents breathe air exceeding the WHO ed with the disperseness of dust, which determines
air guidelines. its behavior in the air. On this depends the depth of
The health consequences of exposure to dirty air penetration into the respiratory tracts and their de-
are considerable. On a global basis, estimates of tention in the different parts of the respiratory tract.
mortality due to outdoor air pollution run from Minute dust particles (less than 5 µ) can penetrate
around 200,000 to 570,000, representing about 0.4 into the lungs and can harm the pulmonary paren-
to 1.1% of total annual deaths. As the range of these chyma. Large particles (10–100 mimic) are nearly
estimates indicates, it is difficult to quantify the toll completely held in the upper respiratory tract, caus-
of outdoor air pollution. The health impacts of ur- ing irritation of the mucous and chronic inflamma-
ban air pollution seem likely to be greater in some tory process. The particles with the size 2–5 (mid-
of the rapidly developing countries where pollution dle-dispersing dust) can be passing to the lower res-
levels are higher. The World Bank has estimated that piratory tract (alveoli and terminal bronchioles) and
exposure to particulate levels exceeding the WHO to cause the diseases. 5 µ — 82% adsorbed (in the
health standard accounts for roughly 2 to 5% of all upper respiratory tract), 1.6 µ — 46%; 1.3 µ —
deaths in urban areas in the developing world. 27%; 0.9 µ — 16%.
However, only these mortality estimates do not Besides of disperseness, an important role is
capture the huge toll of illness and disability that played by chemical composition of dust pollution
exposure to air pollution brings at a global level. in the character and degree of influence on the per-
Health effects span a wide range of complications son. It has been established, that aerosol of lead,
from coughing and bronchitis to heart disease and manganese, arsenic, fluorine and many other ele-
lung cancer. Vulnerable groups include infants, the ments may cause some specific manifestations of
elderly, and those suffering from chronic respirato- chronic poisoning. Dust containing cancerogenic
ry conditions including asthma, bronchitis, or em- substances may cause malignant neoplasms.
physema. For example, air pollution in developing Non-toxic dust basically causes mechanical dam-
world cities is responsible for about 50 million cas- age of the respiratory organs, skin, eyes. Meanwhile
es per year of chronic coughing in children young- large dust particles subsiding on the mucous layer
er than 14 years. However, even healthy adults can of nose, nasopharynx, trachea and bronchi, irritate
suffer negative effects. Many of air pollution health them. Presence of conditionally pathogenic micro-
effects, such as bronchitis, tightness in the chest, and organisms in the organs as well as penetration of
wheezing are acute, or short-term, and can be re- pathogenic bacteria into them lead to the develop-
versed if air pollution exposures decline. Other ef- ment of acute and chronic catarrhal processes in the
fects appear to be chronic, such as lung cancer and form of rhinitis, laryngitis, pharyngitis, tracheitis and
cardiopulmonary disease. bronchitis.

32
 Inhalation of highly dusty air may serve as a linked short-term increases in particulate levels, such
cause of pneumoconiosis development — a disease as the ones that occur during pollution episodes, with
of the lungs based on sclerotic and other pathologi- immediate (within 24 h) increases in mortality. This
cal changes. pollution-induced spike in the death rate ranges from
They are caused by the deposition of different 2 to 8% for every 50-µg/m3 increase in particulate
types of dust and further interaction with the pul- levels. These basic findings have been replicated on
monary tissue. One of the most dangerous types of several continents, in cities as widely divergent as
pneumoconiosis is silicosis, caused by the influence Athens, São Paulo, Beijing, and Philadelphia. Dur-
of dust particles of silicon, possessing free silicon ing major pollution events, such as those involving
dioxide in its composition. a 200-µg increase in particulate levels, an expert
The atmospheric air pollution intensity is deter- panel at the WHO estimated that daily mortality
mined by many conditions. Among them are: char- rates could increase as much as 20%. These esti-
acter of fuel, degree of ashes in it, quantity of emis- mates should be viewed with caution, however, be-
sion, meteorological factors which determine the cause some of those who die during a pollution epi-
condition of dust dilution in the atmospheric air and sode have been already sick, and the pollution may
its falling on the soil surface. These processes are have hastened the death by only a few days.
natural processes of self-purification of the atmos- In the aggregate, pollution-related effects like
phere. these can have a significant impact on community
Larger particles, ranging from about 2.5 mc to health. The WHO has identified particulate pollu-
100 mc in diameter, usually comprise smoke and tion as one of the most important contributors to
dust from industrial processes, agriculture, construc- poor health within Europe. In those cities where data
tion, and road traffic, as well as plant pollen and on particulates were available, the WHO estimated
other natural sources. Smaller particles those less that short-term pollution episodes accounted for 7
than 2.5 mc in diameter generally come from com- to 10% of all respiratory diseases in children, with
bustion of fossil fuels. These particles include soot the number rising to 21% in the most polluted cit-
from vehicle exhaust, which is often coated with ies. Furthermore, 0.6 to 1.6% of deaths were attrib-
various chemical contaminants or metals, and fine utable to short-term pollution events, climbing to
sulfate and nitrate aerosols that form when SO2 and 3.4% in the cities with the dirtiest air.
nitrogen oxides condense in the atmosphere. The Atmospheric pollution is capable of rendering
largest source of fine particles is coal-fired power direct influence on the surrounding medium and
plants, but auto and diesel exhaust are also prime human organism. First of all they may aggravate
contributors, especially along busy transportation microclimate of populate places. For example, sul-
corridors. Air pollutants called particulate matter furous gas, falling into atmosphere, transforms into
include dust, dirt, soot, smoke and liquid droplets ions of sulfate or particles of ammonium sulfate,
directly emitted into the air by sources such as fac- forming hard aerosol. These particles may be scat-
tories, power plants, cars, construction activity, fires tered or may absorb sun radiation, promoting in
and natural windblown dust. Based on studies of this way cooling or heating the lower layers of at-
human populations exposed to high concentrations mosphere.
of particles and laboratory studies of animals and Dust plays an important role in the change of mi-
humans, there are major effects of concern for hu- croclimate of populated places. By raising above the
man health. These include effects on breathing and industrial centers, dust particles may form smoke
respiratory symptoms, aggravation of existing res- cover above them, often named as city haze.
piratory and cardiovascular disease, alterations in Dust pollution, first of all causes loss of part of
the body’s defense systems against foreign materi- sun radiation due to its absorption by dust particles.
als, damage to the lung tissue, cancerogenesis and As a result of this, integral intensity of sun radia-
premature death. The major subgroups of the popu- tion in the city is less by 15–25%, than in the vil-
lation that appear to be most sensitive to the effects lages. Loss takes place primarily due to ultraviolet
of particulate matter include individuals with chron- part of the spectrum, and exactly due to rays of wave
ic obstructive pulmonary or cardiovascular disease length from 315 to 290 nm (by 20–30%, and in win-
or influenza, asthmatics, elderlies and children. Nu- ter time by 50–60% and more), which has huge sig-
merous studies associate particulate pollution with nificance for growth and life activity of the organ-
acute changes in lung function and respiratory ill- ism, particularly in the child age.
ness, resulting in increased hospital admissions for Sulfur Dioxide (SO2) is emitted largely from
respiratory disease and heart disease, school and job burning coal, high-sulfur oil, and diesel fuel. As this
absences from respiratory infections, or aggravation gas is usually found in association with particulate
of chronic conditions such as asthma and bronchi- pollution as SO2 is the precursor for fine sulfate par-
tis. But the more demonstrative and sometimes con- ticles separating the health effects of these two pol-
troversial evidence comes from a number of recent lutants is difficult. Together, SO2 and particulates
epidemiological studies. Many of these studies have make up a major portion of the pollutant load in

33
many cities, acting both separately and in concert breath, and chest pain. Exercise increases these
to damage health. effects, and heavy exercise can bring on symp-
SO2 affects people quickly, usually within the toms even at low ozone levels (0.08 ppm). Evi-
first few minutes of exposure. Epidemiological stud- dence also suggests ozone exposure lowers the
ies indicate that SO2 exposure can lead to an acute body’s defenses, increasing susceptibility to res-
health effects typical of particulate pollution. Ex- piratory infections.
posure leads to an increase of hospitalizations and As ozone levels rise, hospital admissions and
deaths from respiratory and cardiovascular causes, emergency room visits for respiratory deseases such
especially among asthmatics and those with preex- as asthma also increase. On average, studies show
isting respiratory diseases. The severity of these ef- that hospital admissions rise roughly 7 to 10% for a
fects increases with rising of SO2 levels, and exer- 0.05 ppm increase in ozone levels.
cise enhances the severity by increasing the volume Ozone is a photochemical oxidant and the major
of SO2 inhaled and allowing SO 2 to penetrate deep- component of smog. While O3 in the upper atmos-
er into the respiratory tract. Asthmatics may expe- phere is beneficial to life by shielding the earth from
rience wheezing and other symptoms at much low- harmful ultraviolet radiation from the sun, high con-
er SO2 levels than those without asthma. When centrations of O3 at ground level are a major health
ozone pollution is also present, asthmatics become and environmental concern.
even more sensitive to SO2 which is a good reminder The reactivity of O3 causes health problems be-
that air pollutants generally do not occur in isola- cause it damages the lung tissue, reduces the lung
tion, but in complex mixtures that create the poten- function and sensitizes the lungs to other irritants.
tial for synergistic effects among pollutants. High Scientific evidence indicates that ambient levels of
concentrations of sulfur dioxide affect breathing and O3 not only affect people with impaired respiratory
may aggravate existing respiratory and cardiovas- systems, such as asthmatics, but healthy adults and
cular disease. Sensitive populations include asthmat- children as well. Exposure to ozone for several h at
ics, individuals with bronchitis or emphysema, chil- relatively low concentrations has been found to re-
dren and old people. SO2 is also a primary contrib- duce significantly lung function and induce respi-
utor to acid deposition, or acid rain, which causes ratory inflammation in normal, healthy people dur-
acidification of lakes and streams and can damage ing exercise. This decrease in lung function gener-
trees, crops, historic buildings and statues. ally is accompanied by symptoms including chest
Ambient SO 2 results largely from stationary pain, coughing, sneezing and pulmonary congestion.
sources such as coal and oil combustion, steel mills, Ozone MAC in Ukraine is 0.1 mg/m3.
refineries, pulp and paper mills and from ferrous Carbon monoxide (CO) is a colorless, odorless
smelters. There are three NAAQS (USA) for SO2: and poisonous gas produced by incomplete burning
— an annual arithmetic mean of 0.03 ppm of carbon in fuels. When CO enters the bloodstream,
(80 µg/m 3); it reduces the delivery of oxygen to the body’s or-
— a 24-hour level of 0.14 ppm (365 µg/m 3); and gans and tissues. Health threats are most serious for
— a 3-hour level of 0.50 ppm (1300 m 3). those who suffer from cardiovascular disease, par-
Sulfur dioxide is an indicator of anthropogenic ticularly those with angina or peripheral vascular
atmospheric air pollution. Its MAC (NIS) is 0.05 mg/ disease. Exposure to elevated CO levels can cause
m3 (MACmax is 0.5 mg/m3). impairment of visual perception, manual dexterity,
Ozone (O3). Ground-level ozone is the major learning ability and performance of complex tasks.
component of the photochemical smog that blankets 77% of the nationwide CO emissions are from trans-
many urban areas. It is not emitted directly but is portation sources. The largest emissions contribu-
formed when nitrogen oxides from fuel combustion tion comes from highway motor vehicles. Thus, the
react with so-called volatile organic compounds focus of CO monitoring has been on traffic orient-
(VOCs) such as unburned gasoline or paint solvents ed sites in urban areas where the main source of CO
in the atmosphere. Sunlight and heat stimulate ozone is motor vehicle exhaust. Other major CO sources
formation, so peak ozone levels generally occur in are wood-burning stoves, incinerators and industri-
the summer. al sources.
Ozone pollution has become widespread in cit- Carbon monoxide MAC in Ukraine is 1 mg/m3.
ies of Europe, North America, and Japan as auto and Chlorofluorocarbons (CFCs) are chemicals
industrial emissions have increased. Many cities in used in great quantities in industry, for refrigeration
developing countries also suffer from high ozone and air conditioning, and in consumer products.
levels, although few monitoring data exist. CFCs, when released into the air, rise into the strat-
A powerful oxidant, ozone can react with near- osphere. In the stratosphere, CFCs take part in chem-
ly any biological tissue. Breathing ozone concen- ical reactions that result in reduction of the strat-
trations of 0.012 ppm levels typical in many cit- ospheric ozone layer, which protects the Earth’s sur-
ies can irritate the respiratory tract and impair face from the sun. Reducing the release of CFCs
lung function, causing coughing, shortness of emissions and eliminating the production and the use

34
of ozone-destroying chemicals is a very important Nitrogen dioxide MAC in Ukraine is mg/m3.
task. Exposure to lead can occur through multiple
Hazardous Air Pollutants (HAPs) are chemi- pathways, including inhalation of air and ingestion
cals that cause serious health and environmental ef- of lead in food, water, soil or dust. Excessive lead
fects. Health effects include cancer, birth defects, exposure can cause seizures, mental retardation and/
nervous system problems, and death due to massive or behavioral disorders. This dramatic decline can
accidental releases, such as the disaster that occurred be attributed to the reduction of leaded gasoline and
at a pesticide plant in Bhopal, India. Hazardous air to the removal of lead from soldered cans. Although
pollutants are released by sources such as chemical this study shows great progress, infants and young
plants, dry cleaners, printing plants, and motor ve- children are especially susceptible to low doses of
hicles including cars, trucks, buses, planes. lead, and this age group still shows the highest lev-
Volatile Organic Compounds (VOCs) produce els. Low doses of lead can lead to central nervous
vapors easily. At room temperature vapors readily system damage. Recent studies have also shown that
escape from volatile liquid chemicals. VOCs include lead may be a factor in high blood pressure and in
gasoline, industrial chemicals such as benzene, sol- subsequent heart disease in middle-aged males. Lead
vents such as toluene and xylene, and perchloroeth- gasoline additives, non-ferrous smelters, and battery
ylene (principal dry cleaning solvent). VOCs are plants are the most significant contributors to atmos-
released from burning fuel, such as gasoline, wood, pheric lead emissions.
coal, natural gas and from solvents, paints, glues, Dust admixtures are the basic of formation of
and other products used at home or work. Vehicle mist. In the places with raised dustiness quantity of
emissions are an important source of VOCs. Many dull days increases. As a result, the unfavorable in-
VOCs are hazardous air pollutants; for example, fluence of climate on the population grows, related
benzene causes cancer. with insufficiency of sunny days, with lowering of
Nitrogen Oxides (NOx) are major contributor to general sunlit, with high humidity of air, etc.
smog and acid rain. Nitrogen oxides react with vol- In definite meteorological conditions, and to be
atile organic compounds to form smog. In high dos- more precise during anticyclone weather, windless
es, smog can harm humans by causing breathing dif- temperature inversion and during entrance of oxides
ficulty for asthmatics, coughs in children, and gen- of sulfur into the atmosphere, toxic mists may form.
eral illness of the respiratory system. Acid rain can In the days of these mists mortality of population
harm vegetation and run into lakes and rivers which considerably exceeds normal mortality.
changes the chemistry of the water, and makes it Besides toxic mists, receiving the name of
potentially uninhabitable for all exept acid-tolerant smokes, photochemical smokes may also form.
bacteria. Nitrogen oxides are produced from burn- Sources of their formation are the presence of ox-
ing fuels, including gasoline and coal. ides of nitrogen, toxic organic substances, carbohy-
Nitrogen dioxide (NO2) is a brownish, highly re- drates. In the definite meteorological conditions, fa-
active gas that is present in all urban atmospheres. vorably preventing accumulation of these substances
NO2 can irritate the lungs, cause bronchitis and in the air, specific mist is formed, causing decrease
pneumonia, and lower resistance to respiratory in- in the visibility, development of unpleasant smell
fections. Nitrogen oxides are an important precur- and irritation of mucous of the eyes, of the upper
sor both to ozone (O3) and acid rain, and may af- respiratory tracts, which causes tearing of the eyes,
fect both terrestrial and aquatic ecosystems. The torturing cough. Molecules of nitrogen oxide present
major mechanism for the formation of NO2 in the in the emitted gases are excited by the energy of ul-
atmosphere is the oxidation of the primary air pol- traviolet rays of the sun, and thereafter by reacting
lutant nitric oxide (NO). NOx plays a major role, with the oxygen of the air, form ozone. The latter
together with VOCs, in the atmospheric reactions by reacting with carbohydrates of the emitted gases
that produce O3. NOx forms when fuel is burned at or of the outlets (wastage) of oil processing enter-
high temperatures. The two major emissions sourc- prises, forms a complex of compounds — photooxi-
es are transportation and stationary fuel combustion dants: of organic peroxides, free radicals, aldehydes,
sources such as electric utility and industrial boil- ketoses, which lead to this indicated pathology.
ers. The first two standards are primary (health-re- The problem of disorders of health in relation
lated) standards, while the 3-hour NAAQS is a sec- with air pollution of by chemical substances arose
ondary (welfare-related) standard. The annual mean long back. One of the first signals of threatening
standard is not to be exceeded, while the short-term danger are toxic mists. In 1930, in Belgium, the
standards are not to be exceeded more than once per whole town population felt sick. In a short time 63
year. During prolonged inhalation of small concen- persons died. Around this city there were factories
trations of nitrogen oxides, bronchitis, loss of ap- producing phosgene and diphosgene. As it is proved,
petite, anemia, destruction of teeth, disorders of gas- the air of the city contained large quantities of SO
tric secretion, activation of tuberculous process, ag- and SO2. Weather was windless during deep anti-
gravation of course of cardiac diseases are observed. cyclone, pressure decreased, there were high humid-

35
ity, temperature inversion. This led to the develop- holds burning dirty fuels are excessive. These esti-
ment of toxic mist and death of the people. Desq- mates must be viewed with some caution, however,
uamation of epithelia of respiratory tracts, high because monitoring in developing countries has been
eosonophilia and hemorrhages were revealed in the limited. Daily averages often exceed current WHO
deads. guidelines by factors of 10, 20, or even more. Peak
Besides of London smog (1952), toxic mists and levels during cooking may exceed these levels by a
photochemical smokes occurred even in the follow- further factor of five or so. Indeed, these data sug-
ing years. As the press informs, life of the citizens gest that many tens of millions of people in deve-
of Ankara, the capital of Turkey, was intolerable loping countries routinely encounter pollution le-
when the air in between the mountains surrounding vels reached during the infamous London killer fog
them was saturated smoke of the furnaces, heated of 1952, leading to a huge of disease eleration and
by low quality coal and mineral oil. Content of car- premature death incidence. One researcher esti-
bon dioxide exceeded 24 times more than the per- mates that as many as 2.8 million deaths per year
missible sanitary norms. Sometimes even during result from breathing elevated levels of indoor
daytime the city seemed to be submersed into gray smoke from dirty fuels (i.e. in excess of the WHO
suffocating mist. Hospitals of Ankara were over- particulate standard). This finding results to about
filled with people, admitted with serious poisonings, 6% of all deaths each year. If this kind of effect is
with exacerbations of cardiovascular and hepatic confirmed, indoor air pollution would be one of
diseases. In these conditions extraordinary measures the largest single risk factors for poor health in the
were adopted by the government. All schools were world.
closed. In spite of cold heating of living premises Epidemiological studies in developing countries
was prohibited until stabilization of the weather, lim- concern the exposure to indoor air pollution from
itations on use of private transport were introduced. dirty fuels with at least four major categories of ill-
Children up to 12 and people over 50 were recom- nesses: acute respiratory infections (ARI) in chil-
mended not to go out of doors. dren; chronic obstructive lung diseases such as asth-
ma and chronic bronchitis; lung cancer; and still-
births and other problems at birth. Of these, ARI
appears to have the greatest health impact in terms
INDOOR AIR: of the number of people affected and the time lost
STILL A MAJOR THREAT due to illness, especially in children younger than 5
years old.
As dangerous as polluted outdoor air can be to Studies in a number of different countries and
health, indoor air pollution actually poses a greater settings have examined a connection between ex-
health risk on a global level. Indoor air pollution is posure to smoke from cook stoves with the devel-
a concern in developed countries, where, for exam- opment of ARI in children. In South Africa, inves-
ple, energy efficiency improvements sometimes tigators found that Zulu children living in houses
make houses relatively airtight, reducing ventilation with woodstoves were almost five times more like-
and raising indoor pollutant levels. In such circum- ly to develop a respiratory infection severe enough
stances, even small pollution sources emanating to require hospitalization. In Nepal, researchers ob-
from a furnace, a new carpet, or from naturally oc- served a significant relationship between the number
curring radon gas can lead to significant human ex- of h spent near the fire and the incidence of moder-
posures. ate and severe cases among 2-year-olds. Likewise,
By far the greatest threat of indoor pollution, a recent study in Gambia found that children car-
however, still occurs in the developing countries, ried on their mother’s backs as they cooked over
where about 3.5 billion people mostly in rural are- smoky cookstoves contracted pneumococcal infec-
as, but also in many cities continue to rely on tradi- tions one of the most serious kinds of respiratory
tional fuels for cooking and heating. Burning such infections at a rate 2.5 times higher than nonexposed
fuels produces large amounts of smoke and other children.
air pollutants in the confined space of the home a Many respiratory infections in the developing
perfect recipe for high exposures. (Liquid and gas- world result in death, and evidence shows that ex-
eous fuels such as kerosene and bottled gas, although posure to cookstove smoke may contribute to high-
not completely pollution-free, are many times less er mortality rates. For example, a study in Tanzania
polluting than these unprocessed solid fuels.) In found that children younger than 5 years of age who
these circumstances, exposure to pollutants is often died of ARI were 2.8 times more likely to have been
far higher indoors than outdoors. Indeed, the World sleeping in a room with an open cookstove than
Bank has designated indoor air pollution in devel- healthy children. Overall studies indicate that ex-
oping countries as one of the four most critical glo- posure to wood smoke from cook fires in poorly
bal environmental problems. ventilated conditions may increase the risk of a
Concentrations of indoor pollutants in house- young child contracting a serious respiratory infec-

36
tion from 2 to 6 times. tomatic gas-analysator) are used.
Adults suffer from ill effects of severe indoor
pollution as well. Several studies found strong links
between chronic lung diseases in women and expo- AIR POLLUTION CONTROL
sure to smoke from open cookstoves. One recent
Colombian study found women exposed to smoke There are used some directions in prevention of
during cooking were more than three times more air pollution:
likely to suffer from chronic lung disease. Other 1) technological methods;
studies suggest that this risk increases in response 2) technical methods (fabric filters: baghouses;
to the years of exposure to smoke. A study in Mex- dust collectors; weld fume collector; electrostatic
ico showed that women who had been exposed to precipitators; scrubbers; NOx Control — SNCR;
wood smoke for many years faced 75 times more NOx Control — SCR; flue gas conditioning;);
risk of acquiring chronic lung disease than unex- 3) architecture-planning measures;
posed women about the level of risk that heavy cig- 4) administrative measures.
arette smokers face. Lung cancer, too, is associated
with high levels of smoke, especially coal smoke, Technological Methods
which contains a plethora of carcinogenic com- Process Change. This technique involves a mod-
pounds. Most studies of coal-smoke exposures have ification of an existing process or the introduction
been conducted in China, where residential use of of a new process. Since 90-s the process change has
coal is still common. More than 20 studies suggest been known as “pollution prevention”; considering
that urban women who use coal for cooking and the example of painting operations in automobile
heating over many years are subjected to a risk of industry. Large quantities of volatile organic com-
lung cancer 2 to 6 times higher than women who pounds and hazardous air pollutants were released
use gas. Rural coal-smoke exposures, which tend to as a result of these operations. After many opera-
be higher, seem to increase lung cancer risks nine tions have substituted water based, low HAP paints
and more times as much. for oil based paints for reducing emissions. Some
Exposure to high indoor smoke levels has also operations have implemented such processes as elec-
been connected with pregnancy-related problems tro-deposition, dip tank and powder coating. Proc-
like stillbirths and low birth weight. One study in ess modification is a popular technique to control
western India found a 50% increase in stillbirths as- air pollution. Major efforts are underway in all in-
sociated with the exposure of pregnant women to dustries to modify processes to reduce pollution.
indoor smoke. Indoor air pollution most likely con- Changes in industrial processes to reduce raw
tributes to excess of heart disease in developing materials and fuels also lead to reduction in air emis-
countries as well. sions. The promotions to use fluorescent lights and
Indoor air microbial pollution characterizing the to conduct energy audits by electric utilities are ex-
risk of disease spreading upon people and animals. amples of less electricity demand. This results in less
The infectious air-borne diseases are: fuel use at the power plant and hence less air pol-
— viral infections: influenza, mumps, rubella, lutants are emitted.
measles, ARVI (acute respiratory viral infections) The use of wind energy, geothermal energy, hy-
(caused by Adenoviridae, Coronaviridae, EBV, droelectric power and solar energy is increasing and
HSV, Paramixoviridae, Rhino-synthicial virus, po- helps in reducing air pollution. The purpose is to
lio and other Enteroviridae etc.), smallpox, Bolivi- “prevent” pollution rather than control it at the point
an hemorrhagic fever, etc.; of release. The goal is not to produce solid or haz-
— chlamidial infections: ornithosis; ardous waste.
— bacterial infection: anthrax, tuberculosis, per- Change in Fuel. This technique involves the use
tussis, diphtheria, plaque, legionellosis, epidemic of less polluting fuel to reduce air pollution. Use of
meningitis, scarlet fever, tularemia, etc. low sulfur fuel instead of high sulfur fuel by elec-
Carbon dioxide is an indicator of indoor air pol- tric utilities is an example of this method. Remem-
lution. Its MAC is 0.1% (optimum concentration for ber that low sulfur fuel is much more expensive than
a human being is as low as 0.07%). Carbon diox- high sulfur fuel. The other choice for an electric util-
ide, by lifting up above the industrial centers, cre- ity can be the use of natural gas as a fuel.
ates conditions for absorption of reverse infrared Use of oil with low ash content or natural gas
radiation of the Earth, which leads to gradual de- for a dryer at an asphalt plant to reduce particulate
crease in cooling of its surface. Exactly with this matter is another example of this method. Introduc-
feature many scientists relate global changes of tion of compressed natural gas, propane, ethanol and
Earth climate to warming up (“greenhouse effect”). oxygenated fuels for automobiles have helped in the
For determination of carbon dioxide methods of vo- reduction of air pollutants. The use of natural gas
lume analysis (Lunge-Zeckendorf’s (sodium), Re- in North America and Europe for winter heating
berg’s methods) and colometric analysis (with au- brought significant improvement in air quality in

37
most cities. Nuclear power plants are relatively pol-
lution free when compared to the coal fired power AIR ENVIRONMENT AND
plants. HUMAN HEALTH
Technical methods include the using of special
equipment to control the pollution, e.g. fabric fil- The air is a vital component of our everyday life.
ters (baghouses; dust collectors), weld fume collec- Microclimate is a thermal status of the limited space.
tors; electrostatic precipitators; scrubbers, etc.) (Fig. It is a combined action of air temperature, radiation
18). heat, air humidity and air movement velocity. Mi-
Architectural planning measures include the croclimate defines the heat state of the organism.
proper planning of residential and industrial areas. Sometimes they mean microclimate as variations of
There are established the different sanitary spaces the climate within a given area, usually influenced
between the industrial objects and residential are- by hills, hollows, structures or proximity to bodies
as: 1000 m for I class of the enterprises, 500 m — of water. The warmth and humidity of the air in close
for II, 300 m — for III, 100 m — for IV and 50 m proximity to a plant or heat/moisture source may
— for V. differ significantly from the general microclimate
Administrative measures include regulations of of the premise.
traffic, codexes and standards of clean air, etc. The air temperature is a measure of the heat con-
The prevention of indoor pollution includes tent of air. Its value depends on the convection —
technical measures, e.g. ventilation, source control air movement. Comfort air temperature for rooms
and air cleaning. Air cleaning can be maintained of resident houses is 18–20°C.
with the use of the mechanic filters, HEPA, ozone The air humidity is a content of evaporation in
emitting air cleaning, electrostatic filters, sorbent the air. It is used:
filters (for removing VOC), UV duct cleaning sys- 1. Maximal humidity — maximal concentration
tem, etc. of moisture for this air temperature and pressure (in
ppm or mm Hg).
2. Absolute humidity — moisture content in an-
input alyzed conditions.
3. Humidity deficit — difference between maxi-
mal and absolute humidity.
4. Relative humidity — ration between absolute
and maximal humidity in the percentage.
5. Dew point temperature — the temperature be-
low which moisture will condense out of the air.
6. Physiological deficit of saturation — differ-
ence between maximally possible saturation of air
with moist at the temperature of the skin and abso-
lute humidity.
sprinkling A psychrometric chart graphically illustrates the
relationships between the air temperature and rela-
tive humidity as well as other properties. A better
understanding of air properties and the psychromet-
ric chart can aid in the selection and management
of the building ventilation system (Fig. 19).
emission recycling As the name implies, relative humidity is a meas-
air ure of how much moisture is present compared to
how much moisture the air could hold at that tem-
perature. Relative humidity, which is expressed as
a percent, is given in weather reports. Lines repre-
senting conditions of equal relative humidities
sweep from the lower left to the upper right of the
psychrometric chart. The 100% relative humidity
(saturation) line corresponds to the wet bulb and the
dew point temperature scale line. The line for zero
percent relative humidity falls along the dry bulb
temperature scale line.
The fact is indoor temperatures are very often
dust removal variable. Humans find the temperature range of 18–
20°C comfortable. Large rooms, hallways, and dif-
Fig. 18. Scrubber ferent exposures along with doors and windows can
effect the temperature.
38
 Fig. 19. The Psychrometric Chart (a model)

Atmospheric temperatures will vary with respect 4) subjective sensations (EET scale);
to the distance from a building. Microenvironments 5) body temperature;
near walls with a southern exposure will be signifi- 6) neurosensoric signs.
cantly warmer while microenvironments near walls The action of overheating microclimate can
with a northern exposure will be cooler. cause chronic and acute overheating (heat stress).
The energy balance of the organism could be cal- Overcooling microclimate can cause local (frost-
culated by the formula: bites, frostnip, chilblains (pernio), “immersion foot”
(trench foot)) and general (common cold) overcool-
M + Qa = R + C + E + G + X ing. Chronic overcooling expresses in decreasing
M — Metabolic energy ability to work and the levered organism’s resistance
Qa — absorbed radiation to unfavourable agents.
R — emitted radiation Operations involving high air temperatures, radi-
C — energy exchanged by convection ant heat sources, high humidity, direct physical con-
E — latent heat energy tact with hot objects, or strenuous physical activities
G — energy exchanged by conduction have a high potential for inducing heat stress in em-
X — net energy loss or gain ployees engaged in such operations. Such places in-
The most of the heat (40%) organism loses by clude: iron and steel foundries, nonferrous foundries,
the emitted radiation, 30% — by convection and brick-firing and ceramic plants, glass products facili-
conduction. The heat lost by irradiation can be de- ties, rubber products factories, electrical utilities (par-
fined with the formula: ticularly boiler rooms), bakeries, confectioneries, com-
mercial kitchens, laundries, food canneries, chemical
Qir = 4.4 [tbody – tr (kcal/m2h)] plants, mining sites, smelters, and steam tunnels.
for conduction: Qcond = 4.5 (tskin – tair).v0.6 Outdoor operations conducted in hot weather,
for evaporation: Qevap = 16 pv, such as construction, refining, asbestos removal, and
where v — air velosity; p — air pressure. hazardous waste site activities, especially those that
For heat state assessment they use: require workers to wear semipermeable or imper-
1) skin temperature (forehead, forearm, hands); meable protective clothing, are also likely to cause
2) perspiration of sweat (Minore’s test, electri- heat stress among exposed workers.
cal conductivity assessment, exact weight methods); Age, weight, degree of physical fitness, degree
3) pulse and breath rate; of acclimatization, metabolism, use of alcohol or

39
drugs, and a variety of medical conditions such as a medical emergency. Persons suffering from heat
hypertension all affect a person’s sensitivity to heat. exhaustion should be removed from the hot envi-
However prior heat injury predisposes an individu- ronment and given fluid replacement. They should
al to additional injury. also be encouraged to get an adequate rest.
It is difficult to predict just who will be affected Heat Cramps usually caused by performing vig-
and when, because individual susceptibility varies. orous physical activities in a hot environment. These
In addition, environmental factors include more than cramps have been attributed to an electrolyte im-
the ambient air temperature. Radiant heat, air move- balance caused by sweating. It is important to un-
ment, conduction, and relative humidity all affect derstand that cramps can be caused by both too
an individual’s response to heat. much and too little salt. Cramps appear to be caused
Heat stroke occurs when the body’s temperature by the lack of water replenishment. Because sweat
regulation system fails and body temperature rises is a hypotonic solution (0.3% NaCl), excess we salt
to critical levels. This condition is caused by a com- can build up in the body if the water lost through
bination of highly variable factors, and its occur- sweating is not replaced. Thirst cannot be relied
rence is difficult to predict. Heat stroke is a medi- on as a guide to the need for water; instead, water
cal emergency. The primary signs and symptoms of must be taken every 15 to 20 minutes in hot envi-
heat stroke are confusion; irrational behavior, loss ronments.
of consciousness, convulsions, a lack of sweating Under extreme conditions, such as working for
(usually); hot, dry skin; and an abnormally high 6 to 8 h in heavy protective gear, a loss of sodium
body temperature, e.g. the rectal temperature of may occur. Recent studies have shown that drink-
41°C. If the body temperature is too high, it causes ing commercially available carbohydrate-electrolyte
death. The elevated metabolic temperatures caused replacement liquids is effective in minimizing phys-
by a combination of work load and environmental iological disturbances during recovery.
heat load, both of which contribute to heat stroke, Heat Collapse. In heat collapse, the brain does
are also highly variable and difficult to predict. not receive enough oxygen because blood pools in
If a person shows signs of a possible heat stroke, the extremities. As a result, the exposed individual
professional medical treatment should be obtained may lose consciousness. This reaction is similar to
immediately. He should be placed in a shady area that of heat exhaustion and does not affect the body’s
and the outer clothing should be removed. His skin heat balance. However, the onset of heat collapse is
should be wetted and air movement around should rapid and unpredictable. To prevent heat collapse,
be increased to improve the evaporative cooling the person (e.g. worker) should gradually become
until professional methods of cooling are initiated acclimatized to the hot environment.
and the seriousness of the condition can be assessed. Heat rashes are the most common problem in
Fluids should be replaced as soon as possible. The hot environments. Prickly heat is manifested as red
medical outcome of an episode of heat stroke de- papules and usually appears in areas where the cloth-
pends on the victim’s physical fitness and the tim- ing is restrictive. As sweating increases, these pa-
ing and effectiveness of first aid treatment. pules give rise to a prickling sensation. Prickly heat
Heat Edema. Lower extremities edema is com- occurs in skin that is persistently wetted by unevap-
monly reported by individuals from the temperate orated sweat, and heat rash papules may become
regions as well as from the tropics. The pathophys- infected if they are not treated. In most cases, heat
iology is unclear but could seem to be due to a com- rashes will disappear when the affected individual
bination of vascular pooling and cutaneous vasodil- returns to a cool environment.
atation. The important point to take is that these pa- Heat Fatigue. A factor that predisposes an in-
tients should rarely be treated with urethics as this dividual to heat fatigue is lack of acclimatization.
does little besides increase their risk for hydratation. The use of a program of acclimatization and train-
Simple reassurance and elevation of the fected pan ing for work in hot environments is advisable. The
should suffice. signs and symptoms of heat fatigue include impaired
Heat Exhaustion. The signs and symptoms of performance of skilled sensorimotor, mental, or vig-
heat exhaustion are headache, nausea, vertigo, weak- ilance jobs. There is no treatment for heat fatigue
ness, thirst, and giddiness. Fortunately, this condi- except to remove the heat stress before a more seri-
tion responds readily to prompt treatment. Heat ex- ous heat-related condition develops.
haustion should not be dismissed lightly, however, Health impact of the microclimate could be eval-
for several reasons. One is that the fainting associ- uated by the indices presented in Table 6.
ated with heat exhaustion can be dangerous because Environmnetal Measurement. Environmental
the victim may be operating machinery or control- heat measurements should be made for each area and
ling an operation that should not be left unattend- for each level of environmental heat to which peo-
ed; moreover, the victim may be injured when he ple are exposed.
or she faints. Also, the signs and symptoms seen in Wet Bulb Globe Temperature (WBGT) should
heat exhaustion are similar to those of heat stroke, be calculated using the appropriate formula. The

40
 Table 6. Changes of the Forehead and Hands Skin Temperature
in Dependence on the Air Temperature, ºC

Air temperature Forehead skin temperature Hand back skin temperature Difference*
10 31.2 24.2 7.7
20 33.5 28.1 5.4
30 35.3 33.1 2.2
35 35.8 35.6 0.2
45 37.0 – –
* — if difference is 2–3°C, man feels warm, 1.8°C and less — hot, more than 6°C — cold.

WBGT for continuous all-day or several hour ex- Table 7. WBGT Correction Factors, ºC
posures should be averaged over a 60-minute peri-
od. Intermittent exposures should be averaged over Clo* WBGT
Clothing type
a 120-minute period. For indoor and outdoor con- value correction
ditions with no solar load, WBGT is calculated as: Summer lightweight working 0.6 0
clothing
WBGT = 0.7NWB + 0.3GT Cotton overalls 1.0 -2
For outdoors with a solar load, WBGT is calcu- Winter work clothing 1.4 -4
lated as Water barrier, permeable 1.2 -6
WBGT = 0.7NWB + 0.2GT + 0.1DB
Notes: Deleted from the previous version are trade names
where: WBGT = Wet Bulb Globe Temperature In- and “fully encapsulating suit, gloves, boots and hood” includ-
dex ing its clo value of 1.2 and WBGT correction of -10;
* — Clo: Insulation value of closing. One clo = kcal/m 2/hr
NWB = Nature Wet-Bulb Temperature of heat exchange by radiation and convection for each degree
DB = Dry-Bulb Temperature ºC difference in temperature between the skin and the adjust-
GT = Globe Temperature ed dry bulb temperature.
When the WBGT calculating the man’s clothing
is taken into account (Table 7). to air conditioning is the use of chillers to circulate
The Effective Temperature Index (ET) com- cool water through heat exchangers over which air
bines the temperature, the humidity of the air, and from the ventilation system is then passed; chillers
air velocity. This index has been used extensively are more efficient in cooler climates or in dry cli-
in the field of comfort ventilation and air-condition- mates where evaporative cooling can be used.
ing. ET remains a useful measurement technique in Local air cooling can be effective in reducing
mines and other places where humidity is high and air temperature in specific areas. Two methods have
radiant heat is low. been used successfully in industrial settings. One
The Heat-Stress Index (HSI). Although the HSI type, cool rooms, can be used to enclose a specific
considers all environmental factors and work rate, workplace or to offer a recovery area near hot jobs.
it is not completely satisfactory for determining an The second type is a portable blower with built-in
individual worker’s heat stress and is also difficult air chiller.
to use. Another way to reduce heat stress is to increase
Ventilation, air cooling, fans, shielding, and in- the air flow or convection using fans, etc. in the
sulation are the five major types of engineering con- working area (as long as the air temperature is less
trols used to reduce heat stress in hot environments. than the person’s skin temperature). If the dry bulb
Heat reduction can also be achieved by using pow- temperature is higher than 35°C, the hot air passing
er assists and tools that reduce the physical demands over the skin can actually make the person hotter.
placed on a worker. He should be allowed to take When the temperature is more than 35°C and the
frequent rest breaks in a cooler environment. air is dry, evaporative cooling may be improved by
General ventilation is used to dilute hot air with air movement, although this improvement will be
cooler air (generally cooler air that is brought in offset by the convective heat. When the tempera-
from the outside). This technique clearly works bet- ture exceeds 35°C and the relative humidity is 100%,
ter in cooler climates than in hot ones. A perma- air movement will make the person hotter. Increas-
nently installed ventilation system usually handles es in air speed have no effect on the body tempera-
large areas or entire buildings. Portable or local ex- ture of workers wearing vapor-barrier clothing.
haust systems may be more effective or practical in Heat conduction methods include insulating the
smaller areas. hot surface that generates the heat and changing the
Air conditioning is a method of air cooling, but surface itself. Simple engineering controls, such as
it is expensive to install and operate. An alternative shields, can be used to reduce radiant heat. Surfac-

41
es that exceed 35°C are sources of infrared radia- Generally, a spectrum of specific and nonspecific
tion that can add to the heat load. Flat black surfac- complaints is involved. Typical complaints, in ad-
es absorb heat more than smooth, polished ones. dition to the signs and symptoms already listed, may
Shields should be located so that they do not in- also include eye and/or nasopharyngeal irritation,
terfere with air flow, unless they are also being used rhinitis or nasal congestion, inability to concentrate,
to reduce convective heating. The reflective surface and general malaise-complaints. The key factors are
of the shield should be kept clean to maintain its of common character and absence of symptoms
effectiveness. among building occupants when they are not in the
The HVAC (heating, ventilating and air condition- building.
ing) system defines indoor microclimate (Fig. 20). The sick building syndrome should be suspect-
Analyses of Urban Heat Environment. Vari- ed when a substantial proportion of those spending
ous kinds of urban activities have impacts on the extended time in a building (as in daily employment)
urban climate. Higher temperature is observed in the report or experience acute on-site discomfort. It is
urban area. Such temperature shift makes the urban important, however, to distinguish SBS from prob-
area more uncomfortable. Energy consumption for lems of building related illnesses. The latter term is
space cooling would increase, in other words, more reserved for situations in which signs and symptoms
CO2 is emitted due to locally hotter climate condi- of diagnosing illness are identified and can be at-
tion in summer. Environmentally sound city aims tributed directly to specific airborne building con-
at maintaining high amenity inside the city with giv- taminants. The Legionnaires’ disease and hypersen-
ing less impact to the external environment. The ur- sitivity pneumonitis, for example, are building re-
ban climate should be mitigated from this viewpoint. lated diseases.
The factors which influence the urban heat en- There has been extensive speculation about the
vironment are anthropogenic heat discharge, change cause or causes of SBS. Poor design, maintenance,
of land surface and geometric change of the urban and/or operation of the structure’s ventilation sys-
area. The anthropogenic heat becomes direct input tem may be at fault. The ventilation system itself
of heat to the atmosphere. Change of land surface can be a source of irritants. Interior redesign, such
from vegetation to pavement or building area reduc- as the rearrangement of offices or installation of
es latent heat release through evaporation. Construc- partitions, may also interfere with efficient function-
tion of the buildings gives fluid dynamic effects. ing of such systems and discomfort microclimate.
The impact of anthropogenic heat is dominant Another theory suggests that very low levels of
in the nigh ttime and the impact of land use is dom- specific pollutants may be present and may act syn-
inant in the day time. ergistically, or at least in combination, to cause health
Effect of relocation of urban infrastructure and effects. Humidity may also be a factor: while high
buildings on heat environment is simulated to eval- relative humility may contribute to biological pollut-
uate candidate of environmentally sound city. ant problems, an unusually low level — below 20 or
Sick Building Syndrome. The term “sick building 30% — may heighten the effects of mucosal irritants
syndrome” (SBS), first employed in the 1970-s, de- and may even prove irritating itself. Other contribut-
scribes a situation in which reported symptoms among ing elements may include poor lighting and adverse
the building occupants can be temporally associated with ergonomic conditions, temperature extremes, noise,
their presence in that building. Typically, though not al- and psychological stresses that may have both indi-
ways, the structure is an office building. vidual and interpersonal impact.

Exhaust air

Outdoor air
intake Air outdoor
damper

Fen
Filter

Outdoor air Cooling Heating

temperature Return
sensor air grills

Fig. 20. HVAC System

42
 The prevalence of the problem is unknown. The General exhaust ventilation (dilution ventilation)
World Health Organization (1984) report suggest- is appropriate when:
ed that as many as 30% of new and remodeled build- 1. Emission sources contain materials of relative-
ings worldwide may generate excessive complaints ly low hazard. (The degree of hazard is related to
related to indoor air quality. toxicity, dose rate, and individual susceptibility).
2. Emission sources are primarily vapors or gas-
es, or small, respirable-size aerosols (those not likely
to settle).
3. Emissions occur uniformly.
VENTILATION
4. Emissions are widely dispersed.
5. Moderate climatic conditions prevail.
Ventilation is a system of intake and exhaust that 6. Heat is to be removed from the space by flush-
creates a flow of air. ing it with outside air.
Air exchange is the system of intake and exhaust 7. Concentrations of vapors are to be reduced in
that occurs with effective air circulation. an enclosure.
Ventilation may be deficient in: confined spac- 8. Portable or mobile emission sources are to be
es; facilities failing to provide adequate maintenance controlled.
of ventilation equipment; facilities operated to max- Local exhaust ventilation is appropriate when:
imize energy conservation; windowless areas; and 1. Emission sources contain materials of relative-
areas with high occupant densities. Any ventilation ly high hazard.
deficiency must be verified by measurement. 2. Emitted materials are primarily larger-diame-
There are two basic types of ventilation systems: ter particulates (likely to settle).
natural ventilation or airation and artificial ventila- 3. Emissions vary over time.
tion. Combination of both is called mixed ventila- 4. Emission sources consist of point sources.
tion. 5. Employees work in the immediate vicinity of
Artificial ventilation can be general or local, the emission source.
plenty, exhaust or balanced. Combination of gener- 6. The plant is located in a severe climate.
al and local ventilation is called combined ventila- 7. Minimizing air turnover is necessary.
tion. They used plenty ventilation for prevention of Exhaust ventilation systems require the replace-
indoor pollution in the operating room, aseptic box- ment of exhausted air. Replacement air is often
es, etc. called make-up air. Replacement air can be supplied
Industrial ventilation generally involves the use naturally by atmospheric pressure through open
of supply and exhaust ventilation to control emis- doors, windows, wall louvers, and adjacent spaces
sions, exposures, and chemical hazards in the work- (acceptable), as well as through cracks in walls and
ing place. Traditionally, nonindustrial ventilation windows, beneath doors, and through roof vents (un-
systems commonly known as HVAC systems were acceptable). Make-up air can also be provided
built to control temperature, humidity, and odors. through dedicated replacement air systems. Gener-
Inadequate or improper ventilation is the cause of ally, exhaust systems are interlocked with a dedi-
about half of all indoor air quality (IAQ) problems cated make-up air system. Other reasons for design-
in nonindustrial places. Indoor pollutants include but ing and providing dedicated make-up air systems are
are not limited to particulates, pollen, microbial that they:
agents, and organic toxins. People exposed to these — avoid high-velocity drafts through cracks in
agents may develop signs and symptoms related to walls, under doors, and through windows;
“humidifier fever,” “humidifier lung,” or “air con- — avoid differential pressures on doors, exits,
ditioner lung.” In some cases, indoor air quality con- and windows;
taminants cause clinically identifiable conditions — provide an opportunity to temper the replace-
such as asthma, reversible airway disease, and hy- ment air.
persensitivity pneumonitis. If make-up air is not provided, a slight negative
Volatile organic and reactive chemicals often pressure will be created in the room and air flow
contribute to indoor air contamination. The facili- through the exhaust system will be reduced.
ty’s ventilation system may transport reactive chem- HVAC includes cooling, humidifying or dehu-
icals from a source area to other parts of the build- midifying, or otherwise conditioning air for com-
ing. Tobacco smoke contains a number of organic fort and health. HVAC also is used for odor control
and reactive chemicals and is often carried this way. and the maintenance of acceptable concentrations
In some instances the contaminant source may be of carbon dioxide. Improved human productivity,
the outside air. Outside air for ventilation or make- lower absenteeism, better health, and reduced house-
up air for exhaust systems may bring contaminants keeping and maintenance almost always make air-
indoor. conditioning cost effective.
43
 Table 8. Criteria of Ventilation Effectiveness
22.6 × 5 = 188 [cmh]
L = —————
Indirect criteria MAC 0.1 – 0.04%
Carbon dioxide 0.1% Real ventilation volume can be assessed by the
0.07% in the hospitals, OPDs, formula:
kindergartens, etc.
Q = Snv 3,600
Dust pollution 0.15 mg/m3
Air changes per hour (ACH) can be assessed by
Germ pollution 2,500 microbes per m3 the formula:
16 Str. haemolitycus per m3
(Summer) Snv 3,600
K = —————;
4,000 microbes/m3 abc
36 Str./m3
(Winter) where
K — ACH
S — area
Mechanical air-handling systems can range from n — number of fans
simple to complex. All distribute air in a manner v — air velocity in fan
designed to meet ventilation, temperature, humidi- 3,600 — number of seconds in an hour
ty, and air-quality requirements established by the a — height of the room
user. Individual units may be installed in the space b — width of the room
they serve, or central units can serve multiple are- c — length of the room
as. Usually K is 1–3 for resident houses, 3–5 — for
HVAC engineers refer to the areas served by an workshops of enterprises.
air handling system as zones. The smaller the zone, Minimal room volume per man is called air
the greater the likelihood that good control will be cube. It depends on the room type. Thus bedroom
achieved; however, equipment and maintenance air cube can be 25 m3. Air cube can be evaluate on
costs are directly related to the number of zones. a room area basis. There is 13.5 m2 per man as a
Some systems are designed to provide individual standard room area in Ukraine. Height of resident
control of rooms in a multiple-zone system. premises should be no less than 2.7 m, in hot cli-
Considerations in designing an air-handling sys- mate — more than 3 m.
tem include volume flow rate, temperature, humid- As physiological cube they use 37.6 m3:
ity, and air quality. Although not generally recom- k
mended, recirculation is an alternative to air ex- ———— 22.6
p – p 1 = —————
0.1 – 0.04%
= 37.6 [m 3]
changing.
For ventilation assessment they use direct and
indirect criteria.
The indirect criteria of ventilation effectiveness
are pollution indicators. There are carbon dioxide
concentration, dust and germ pollution rate, subjec-
LIGHTING
tive odormetric scales, etc. (Table 8).
Direct criteria are ventilation volume, air replace- Lighting (illumination) is a system of providing
ment frequency and air cube. Needed ventilation the proper luminous flux per unit area on an inter-
volume depends on amount of people: cepting surface at any given point of premise.
kn Illumination of the premises is an important
L = ———;
p–p achievement of civilization. Our vision state depends
1
on a quality of illumination, our life is closely con-
where nected with illumination usage.
L — ventilation volume (cmh — cubic meters Hygienic demands for illumination are follow-
per hour) ing:
k — carbone dioxide volume producing by one — sufficient light. There should be enough light
man per hour (16 l — during sleeping, 22.6 l — at to enable us to see details of objects and surround-
rest, 40 l — at hard work) ings without strain. Fifteen to twenty foot candles
n — number of people in the room is the accepted minimum light required for satisfac-
p — MAC of CO2 (0.1%) tory vision.
p1 — concentration of CO2 in the atmospheric — distribution should be even. Light of the same
air (0.04%) intensity is required over the whole field of work.
For example: needed ventilation volume for room Proper dispersal of light without shadows is required
with 5 people is: for efficient vision.

44
 — avoid glare. Glare is excessive contrast. This ment blocks pack as many dwellings together as
causes annoyance and reduces critical vision. Au- possible. Walls are shared and window spaces are
tomobile headlights at night give off such a glare reduced. For reasons of privacy, windows are small-
that pedestrians feel discomfort and are unable to er and curtains are used. We have begun to air-con-
adjust visually to the surroundings in the presence dition and soundproof rooms, where there is no
of glare. The disappearance of trees from roadsides, scope of an open window. Therefore we have to re-
and the increase of glass fronted buildings, has in- sort to artificial lighting even in during the day-time.
creased the glare factor on roads. The same happens Filament lamps and fluorescent tubes are the two
with polished floors, tabletops, or mirrors in hous- common options in household illumination. The fil-
es. When direct rays of sunlight from windows or ament lamp is usually in the shape of a bulb, pro-
doors hit these surfaces, they give off a discomfort- ducing yellowish light. Hotter filaments emit white
ing glare. light. Filament lamps are available for a range of
— avoid shadows. Shadows are inevitable. But brightness. This light is good for working or study-
too many sharp shadows confuse vision. ing in. But this is unsuitable for decorative purpos-
— no flicker. The light should be steady. Flick- es.
ering causes eye strain. Filament (bulb) lamps emit plenty of heat. The
The optimal lighting is natural. The colour of fluorescent tube is cool, efficient and consumes less
light is not as important as its intensity. But since power. It simulates natural light. The inner walls of
natural light has a soothing effect, the closer the col- the tube are coated with ilumination agent that is
our to natural light, the better its influence on us. close to darkness as well as bright daylight. Bright
During physical examination a physician should use moonlight is measured as 0.1 lx and bright sunshine
day light — it will not mask dangerous signs of dis- is measured as 100,000 lx.
eases (jaundice, cianosis, etc.). They use following light-technical units in hy-
The amount of light received inside a building giene:
is usually only a small fraction of that required — Light power: candela (cd) /LP of point light
because of modifications imposed by the size and sources of monochromatic waves (ν=540.1012 Hz)
position of openings — and will also constantly vary with energy 1/683 W/sr.
owing to the influences imposed on the “whole sky”, Light stream: lumen (lm) /for point light sourc-
illumination level by clouds, buildings and/or other es with LP=1cd in 1 sr.
reflecting planes. Therefore, it is impracticable to Illumination: lux (lx) [=1 lm/m2]
express interior day lighting in terms of the illumi- Luminance of light source: cd/m2
nation actually obtainable inside a building at any Direct lighting provided from a source without
time, for within a few minutes that figure is liable reflection from other surfaces. In daylight this means
to change with corresponding changes in the lumi- that the light has travelled on a straight path from
nance of the sky. the sky (or the sun) to the point of interest. In elec-
The background, usually walls and ceilings, trical lighting it usually describes an installation of
should be of lighter colours and the floor, darker. ceiling mounted or suspended luminaires with most-
Day lighting is influenced by the general structure ly downward light distribution characteristics.
of a building, the design of facades, windows and Indirect lighting provided by reflection usually
skylights, and can be further extended by the use of from wall or ceiling surfaces. In daylight, this means
special devices for redirecting or transporting light. that the light coming from the sky or the sun is re-
Enhancing natural illumination could be provided flected on a surface of high reflectivity like a wall,
by correct position of house and windows placing. a window sill or a special redirecting device. In elec-
Position of the House. It is better the house faces trical lighting the luminaires are suspended from the
oriented to the north or the south. The light is not ceiling or wall mounted and distribute light mainly
uniform through the day in the east or the west. The upwards so it gets reflected off the ceiling or the
north-south oriented house has a better chance for walls.
uniform lighting in the moderate climate. Local lighting means a light fixture or array of
Windows. A tall window facilitates greater pen- fixtures that provides illumination over a small area
etration of light. A broad window enables better dif- such as a service counter in a warehouse, without
fusion of light. The natural lighting is further influ- providing any significant general lighting in the sur-
enced by the extent of sky that is visible. The ideal rounding area (Table 9).
window size should be 10% of the floor space. For hygienic evaluation of indoor illumination
Light colours of the walls and the ceiling reflect you should know the purpose of the building, its
more light and make the room brighter. The lower special location, shady surrounding, number and
portion of the walls and the floor should be darker. shape of windows, type and cleanness of glasses,
Overcrowded constructions hamper natural illu- presence of curtains, flowers and items on window-
mination. Buildings stand in the way of light. Apart- sills, size of rooms, etc.

45
 Table 9. Methods of Illumination Assessment Lighting levels from 300 to 500 lx are generally
considered to be the most appropriate. However,
Natural Artificial paper-based work often requires more light.
Methods
illumination illumination Generally, maximum levels should not exceed
Geometrical angle of falling rays not used 750 lx. People usually find levels above this too
methods aperture angle bright. Excessive light levels may “mask” (or part-
coefficient of depth ly hide) characters or whatever is shown on the
light coefficient screen and create more and brighter sources of glare.
Glare is caused by large differences in light levels
Light-technical day light factor photometry
within the visual field. The eyes try to adapt to these
“Method of not used used large differences and visual fatigue and discomfort
Watts”
may result. In addition, the video display terminal
(VDT) operator may adopt a poor posture while try-
Widely using light coefficient can be determined ing to reduce the glare by changing his or her ori-
with a formula: entation to the screen. This may result in neck and
back pain. There are three types of glare.
LC= S2/S1 Indirect glare occurs when light from windows
were S1 — area of window and S2 — floor area or overhead lighting is reflected off shiny surfaces
In Fig. 21 determination of other geometrical in-
dices is shown.
To know falling rays angle if is divide the dis-
tance between the window and the opposite wall to
the window height: tgα = AB/BC. Similar calcula-
tions could be used to determine shadow angle tgβ
= BD/BC. Difference between falling and shadow
angles is aperture angle.
All geometrical indices give only partial infor-
mation about day lighting. These indices do not take
into account the weather conditions, window con-
struction and room design. For practical purposes
the daylight factor (DLF) is used. This is a percent-
age ratio of the instantaneous illumination level at
a reference point inside a room to that occurring si-
multaneously outside in an unobstructed position. Fig. 22. Photometer
For assessment of illumination rate photometers are
used (Fig. 22). Table 10. Norms of Illumination Rates
for Various Premises
DLF = E internal/E external.100%,
Index Value Premises
where:
E internal — indoor illumination rate (in lx); Aperture angle 5o all
E external — outdoor illumination rate (in lx). Angle of falling rays 27 o all
Coefficient of 2 all
deepnees
Light coefficient 1/2–1/4 operating-room
C 1/5–1/6 classroom
hospital ward
D 1/6–1/8 lodgings
1/10–1/12 store room
γ DLF 0.5% lodging
β α 1% hospital ward
Β A
1.5% classroom
2.5% operating-room
General illumina- for reading 300 (150*)
tion, lx and writing
lodging 75 (30)
Fig. 21. Determination of Falling Angle and Aper- kitchen 100 (30)
ture Angle * — for illumination by bulb lamps.

46
in the field of view, such as terminal screens, desks with Venice blinds. Blinds with vertical slats are also
and other office equipment. Light from sources di- effective. General lighting levels should not be ex-
rectly overhead causes masking glare on the screen, cessive. If a worker needs more light for a job, ad-
partly obscuring what the operator is trying to fo- justable task lighting should be provided. Direct and
cus on. Direct glare occurs when there are bright indirect glare from overhead lights can also be con-
light sources directly in the operator’s field of view. trolled by parabolic filters. These are light-fixture
Windows are often a source of direct glare. covers that allow light to travel only straight down
Ways of reducing both direct and indirect glare and not to disperse at an angle, providing sufficient
include using light-absorbing curtains and blinds and light while minimizing reflection on VDT screens.
positioning terminals so the operator’s line of sight Another option is an indirect lighting system de-
is parallel to windows and overhead fluorescent signed so that light from fixtures does not shine into
lights. Workstations should be located between rows the work area directly but only after being reflected
of overhead lights. Window curtains must be thick off ceilings and walls. This provides even lighting
enough to block most of the light, or they can be used and minimizes glare.

47
 Chapter 3
HYGIENE OF WATER AND WATER SUPPLY

THE HYGIENIC IMPORTANCE lethal. The loss of 25% of water is lethal even at
low temperature.
OF WATER The improvement of cultural and hygienic con-
ditions of life is associated with the increase of wa-
Water is one of the most important elements of ter consumption by a man. It makes about 150–500
the environment. It is necessary for human, animal l daily.
and plant life. It takes part in the formation of hu- The world faces a water crisis. About one bil-
man body structural elements. It makes up to 65% lion people lack access to safe water and three bil-
of the body weight. lion — to appropriate sanitation. There will proba-
Water has a great importance as a dissolver: all bly be two billion extra people on the planet by
physico-chemical processes take place in water so- 2025; so while today’s shortages are for fresh wa-
lutions of the organism. Body tissues are water col- ter and sanitation, tomorrow’s are predicted to be
loidal systems. Water participates in oxidation, hy- for growing crops. Already, 10% of world food pro-
drolysis and other reactions of the metabolism, in duction is drawing down underground water faster
digestion and the transport of nutrient and metabol- than the recharge rates. Water also threatens to cause
ic products in the organism. It takes part in ther- conflicts between regions a state of affairs that is
moregulation (evaporation from the skin and respi- expected to worsen as this century progresses. To
ratory organs). In moderate latitudes water request raise public awareness of these issues and made poli-
of the adult is about 2 litres daily. Water loss by the ticians to act, the World Water Commission (WWC)
perspiration can make 5–12 litres daily during hard held a Forum in March, 2000 in The Hague. The
physical work and in hot climate. At the same time Forum collected together a huge range of people
the loss of sodium chloride, iron and other microe- from governmental, non-governmental organizations
lements and vitamins increases too. (NGOs), workers for the environment and develop-
The human organism is intolerant to dehydration. ment, private sector water providers, trades unions
The loss of 1–1.5 l of water needs to restore water and scientific institutes. They all discussed a docu-
balance by the appearance of the thirst. If water loss ment (World Water Vision: A Water Secure World)
cannot be restored disability for work decreases, the drawn up by the WWC as a basis for action. The
man feels worse at high temperature water-salt ex- Forum culminated in a meeting of ministers from
change and thermoregulation become impaired. It over 140 governments.
leads to the organism overheating. The following The Physical Structure of Water. Lately it was
clinical manifestations are observed in human de- found out, that the structure of water had a certain
hydratation in tropics, depending on the level of physiological significance. It is proved by the ex-
water loss: the loss of 1–5% water (of the body periments, that fresh water, gradually loosing its ice
weight) — the thirst, indisposition, the loss of ap- structure, is characterized by the stimulating
petite, skin hyperemia, irritability, drowsiness, the (adaptagenous) action, which decreases 2 times for
increase of body temperature. The loss of 6–10% 12 h. It explains the refreshing action of frozen wa-
of water cause confusion, dyspnoe, the decrease of ter.
blood volume, the stoppage of salivation, cyanosis, Organoleptic features of water are characterized
dysphasia, unsteady gate. The loss of 11–20% of by its transparence, color, taste and smell. Water with
water — hallucination, swollen tongue, the difficulty bad organoleptic features slakes the thirst poorly.
of swallowing, deafness, reduction of vision, flab- The Chemical Content of Water. Natural wa-
biness of the skin, painful urination, anuria. The loss ters differ from each other by their chemical con-
of 15–20% of water at the temperature of 30°C is tent and the degree of mineralization. The total con-

48
tent of dissolved salts in natural waters is from some tries. Moreover, many hot countries are situated in
dozens to 1,000 mg/l. However, there are some places the regions with water deficit. Frequent use of wa-
in tropics, where water, containing 3,000–5,000 mg/l ter from the bad reservoirs increases the possibility
of salts, is suitable. Salt content is mainly represent- of infection. The predisposing factor is impairment
ed by cations of Ca, Mg, Na, K, Fe and anions of of water-electrolyte balance, leading to the decrease
HCO3-, Cl- and SO 42-. of gastric acidity and its barrier function for some
Water, containing more than 1,000 mg/l of mi- pathologic agents. The spread of helminthoses has
neral salts, can have salt, astringent taste, wors- a great importance for the decrease of human resist-
ens secretion and increases motor function of the ance. Endameba histolytic provokes dysentery- like
stomach and intestines, influences negatively clinical picture and is complicated by abscesses of
upon the assimilation of nutrients and provokes the liver and other organs.
dyspepsia. Hard water containing many salts of Acute intestinal infections (cholera, typhoid fe-
calcium and magnesium almost unsuitable for ver, paratyphuses, bacterial and amoebic dysentery,
everyday use. acute infectious enteritis) belong to water infections
People, who constantly live in the places with- in the first place.
out fresh water are adapted to the water containing The way of transmission of these infections is
1,500–3,000 mg/l of salts. There are no physiologi- fecal-oral. The agents of these diseases get water
cal or biochemical deviations from the norm in the from human faces and everyday sewage from the
inhabitants. settlements. Due to the latent carriers pathogenous
Nitrates (NO3) have the most expressed toxical- microorganisms exist in sewage even in the interep-
ly features. If water containing more than 45 mg/l idemic period. The sewage of the infectious hospi-
of nitrates is used for infants, it leads to water ni- tals is the most dangerous. The cause of water in-
trate methemoglobinaemia. fection can be the navigation, the places of mass
The increase of some microelements more than swimming, washing in the small reservoirs, the soil-
admissible level can lead to geochemical endemics. ing from the lavatories, the infection of wells by
They are fluorosis, provoked by high content of flu- dirty baskets.
orine (more than 1–1.5 mg/l) in water. If fluorine Amoebic dysentery is limited by hot climate. It
content is less than 0.5 mg/l, the rate of theeth de- is considered that about 10% of people are infected
cay increases 2–4 times. by this disease. From 14 to 30% of people are car-
The use of water rich in iodine (30–100 mg/l) riers of this amoeba in different tropic countries,
promotes the decrease of endemic goiter, provoked mainly they are children. Daily the carrier discharges
by the insufficient intake of iodine. to 600 millions of amoebic cysts, which live in the
There were observed the diseases, provoked by environments as long as 0.5–3 months in feces and
high content of lead, mercury, arsenic and other mi- to 8 months in water. They die at the temperature
croelements at the placements of fossilized ores. of 55°C. Water outbreaks of amoebiasis were ob-
Owing to the use of chemicals in agriculture, sta- served after the contamination of reservoir by sew-
ble pesticides can get water of the open reservoirs. age.
Toxic products can be accumulated in water animals Now about 100 viruses discharging by human
(fish, shellfish) in concentrations 3 times exceed- feces are known. Some of them can provoke water-
ing their content in water. borne diseases. Viruses preserve their pathogenous
Lately considerable attention has been paid to the features in the reservoirs and drinking water for a
radioactivity of water. The use of water with the in- long time (up to 200 days). Besides, many of them
creased radioactivity can lead to the negative genetic are stable to the action of disinfectants.
consequences (congenital anomalies), the increase Leptospirosis, tularemia, brucellosis are also
of malignant tumours, blood diseases and so on. spread by water. Water can be the factor of spread
The Epidemiological Significance of Water. of viral conjunctivitis. Trachoma is less spread in
Water is an important factor of transfer of infectious the regions with the sufficient water supply.
diseases. Bad conditions of water supply, sanitary Lamblias cysts, worm eggs, ankilostoma, dracun-
cleaning of settlements and low level of sanitary culosis, schistosomas can get into the human organ-
culture, mainly in the rural population, lead to 43.7% ism by water. They provoke diseases, widespread
of lethal cases caused by infectious diseases, in the in hot countries.
developing countries, in contrast to 10.8% — in the The peculiarities of climate have an importance
developed countries. About 2/3 of patients are hos- for the spread of infections in hot countries. During
pitalized because of infectious diseases, caused by downpour the soil it is washed away to rivers, lakes,
the use of impured water, in the rural areas of tro- beaches, infecting them by pathogenic microorga-
pics and subtropics. nisms. During drought the number and capacity of
The pathologic agents of cholera, typhoid fever, reservoirs is decreased. The quantity of microorga-
bacterial and amoebic dysentery and some other dis- nisms increases, so the possibility of the disease in-
eases can even multiply in the water in hot coun- creases too.

49
 increases. The level of calcium is decreased in the
HYGIENIC REQUIREMENTS FOR blood serum of people, using soft water. Calcium
THE QUALITY OF DRINKING of nutrient matters is assimilated only by 30%; but
calcium of drinking water — by 90%.
WATER AND ITS SANITARY Recommended hardness of water is 2 mg-eq/l
ESTIMATION and MAC is 10 mg-eq/1. However, nowadays, the
optimum hardness should be 5–7 mg-eq/l, calcium
Water used for drink and everyday needs, must content — 150 mg/l and magnesium can form a spe-
correspond to the following demands: cial taste and provoke the irritation of the intestines
— good organoleptic features: refreshing tem- and the increase of peristalsis. If water contains to
perature, transparence, colorless, no smell and no 250 mg/l of sulphates, the admissible magnesium
taste; concentration is to 150 mg/l. But, if the concent-
— the suitability by its chemical content (from ration of sulphates is higher, magnesium content
the physiological point of view harmful matters mustn’t exceed 30 mg/l.
mustn’t be there in dangerous for health and every- Iron usually exists in the form of iron bicarbo-
day life concentrations; nate Fe (HCO3)2. But in contact with air this com-
— the absence of pathogenous microorganisms. pound is oxidized with the brown flakes of Fe(OH)3.
The grounded conclusion about water quality and It makes water turbid and coloured. Subsoil waters
sanitary condition of the reservoir can be made only of Northern India and other countries have large
during the comparison of the data of water analy- concentrations of iron.
ses with the hygienic norms and the results of sani- The concentration of iron more than 0.3–0.5 mg/l
tary-topographical investigation. worsens the appearance of water. The concentration
Active reaction (pH) varies from 6.5 to 9.2. The of total iron in the water-pipe should be no more
most acid are swampy waters, the most alkaline are than 0.1 mg/l.
subsoil waters rich in bicarbonates. Dry residue The concentration of chlorides is 20–30 mg/l in
characterizes the degree of mineralization. It should running water, 30–50 mg/l — in the clean well water
not exceed admissible quantity of 1,000 mg/l. In of the places with saltless soils. Fresh water filtered
some hot countries they should use water, contain- through saline soils, rich in chlorides can contain hun-
ing to 2,000–3,000 mg/l if it hasn’t any unpleasant dreds and even thousands milligrams of chlorides.
taste and doesn’t provoke diarrhea. Water, containing more than 350–500 mg/l of chlo-
Total hardness is conditioned by salts of calci- rides, has a salt smack and can influence negatively
um and magnesium such as carbonates, bicarbo- upon gastric secretion. The recommended concentra-
nates, chlorides and sulphates. If the hardness is up tion of chlorides mustn’t exceed 250 mg/l.
to 3.5 mg-eq/1 the water is soft, from 3.5–7.0 mg- If sulfates concentration is more than 400–
eq/l — water of middle hardness, more than 7.0 — 500 mg/l, water has a brackish smack. It influences
hard and more than 14 mg-eq/1 — very hard. Very negatively upon the secretion of the alimentary ca-
hard water is unsuitable for hygienic needs — tem- nal and provokes dyspepsia. The highest concentra-
porary dyspepsia can occur in the sharp change of tions of sulfates are typical of subsoil waters of
soft water to hard one. The etiological role of hard Northern Africa and Middle East. The recommend-
water in the occurrence of urinary stones isn’t ed level of sulfates is no more than 250 mg/l.
proved but some authors consider that the use of High concentrations of nitrates are met in well
hard water especially in hot countries can provoke water, polluted by the components of nitric fertiliz-
the development and growth of urinary stones. ers and products of organic decay. The concentra-
The epidemiological investigations in England, tion of nitrates should not exceed 45 mg/l to pre-
the USA, Japan, and other countries show the op- vent water-nitrate methemoglobinaemia.
posite dependence on water hardness and the mor- The concentration of fluorine varies from 0.01
tality from cardiovascular diseases. The artificial to 20 mg/l. Usually water of the open reservoirs con-
increase of hardness in some regions had positive tains less fluorine (no more than 0.5 mg/l). High
consequences whereas the artificial softening had concentrations are observed in deep subsoil waters
negative results. The mechanism of protective ac- and in the superficial waters, water supply from deep
tion of hard water is unknown. Is it a result of the reservoirs which is rich in fluorine. The evapora-
presence of calcium, magnesium or some other mi- tion of water in lakes promotes the increase of flu-
croelements (fluorine) or the absence of some mat- orine concentration in hot climate.
ters. Now the scientists put down the protective role Certain quantities of fluorine are necessary for
to calcium, which together with magnesium is a the normal mineralization of bones and teeth. If the
component of myocardium enzyme system and re- concentration of fluorine increases the rate of tooth
gulates electrolyte balance. If calcium level in blood decay appropriately decreases. The concentration of
decreases, QT interval in ECG becomes longer, it’s fluorine should be 1–1.5 mg/l. But high concentra-
risky for arrhythmia, and the risk of sudden death tions of fluorine provoke fluorosis. Many cases of

50
fluorosis were found out in Northern Africa, Asia, presence is evidence only of soil through which
Southern America. water is filtered, and of possible presence of patho-
Fluorine, absorbed in the alimentary canal, acts genic microorganisms. The main cause of ammoni-
upon sensitive dental rudiments, disturbs the forma- um nitrogen and nitrites in natural waters is a de-
tion and mineralization of enamel. The manifesta- cay of albuminous matters, animal corpses, urine,
tion of this disease is a spotted enamel of perma- and feces. Ammonium salts and nitrites can be
nent and milk teeth. In the concentration of 1.5– formed from nitrates in deep subsoil waters. Nitrates
2 mg/l, chalk-like and porcelain-like spots appear are products of oxidation of ammonium salts. Their
in symmetric teeth, sometimes they are yellowish presence in water and absence of ammonia are evi-
(the first or the second degree). The spots may be dence of old contamination by nitrogenous matters
brown with erosion. Such teeth are destroyed early which have been already mineralized. The use of
and it leads to bleeding (the 3rd and 4th degree of nitrogenous fertilizers also leads to the increase of
fluorosis). Lesions of teeth aren’t only manifesta- nitrates in soil waters.
tion of fluorosis. In some regions of Africa, China, The index of organic matters in water is its oxi-
India, Southern America people use water contain- dability. It is expressed by milligrams of oxygen,
ing 5–18 mg/l of fluorine. The long-term use of such spent on the oxidation of organic matters. Artesian
water for 10–30 years leads to generalized osteo- waters have the least oxidability to 2 mg/l. In mine
sclerosis, calcination of ligaments and some disor- wells it reaches 3–4 mg/l. The oxidability increases
ders of the nervous system and internal organs. by the extending of water colour. This index is high-
Radioactivity is determined by the presence of er in open reservoirs. The increase of oxidability
indices which are evidence of the increased natural more than the afore said norms is evidence of pos-
activity of water or its anthropogenous pollution by sible contamination.
radionuclides. The least active are atmospheric wa- Chlorides are one of the evidences of water pol-
ters. The increased radioactivity is observed in the lution, because they contain urine and other waste.
volcanic regions and large industrial centres (at the But their high concentration can be a result of wash-
expense of potassium-40, uranium-238 and so on). ing out from salt soils.
The most intensive radioactive pollution is ob- Consequently, every chemical index can have
served in the location of the electric power stations another nature. Thus, the reservoir can be consid-
and other enterprises using radionuclides, in cases ered contaminated by following conditions:
of damages or bad functioning of sanitary-techni- 1) there are several evidences of pollution;
cal equipment, or improper radioactive waste dis- 2) there is bacterial pollution evidence at the
posal. The natural radioactivity of subsoil waters same time;
depends on the number of dissolved radionuclides, 3) the possibility of contamination confirmed by
which are included in washed rocks and soils. The the sanitary investigation of the water.
radioactivity is mainly conditioned by potassium- Bacteriological Investigation of Water. Previ-
40, radium-226, radon-222, natural uranium and so ously pathogenic microorganisms have importance
on. The least radioactive are subsoil water located from the epidemiological point of view. But this in-
in sedimentary rocks. Usually their activity extends vestigation is very complicated. The investigations
due to increase of mineralization. are carried out by the epidemiological indications,
Medicinal mineral waters have high activity too for example during the outbreaks of water-borne
(up to 2–3 Bc/l) Waters placed closely to the sourc- diseases.
es of radioactive ore and interspatial waters in the Pathogenic organisms occur in low numbers,
sources of oil have very high radioactivity. When there are technically difficult to count and require a
they come out during drilling, they contaminate soil long incubation period (several days). This means
and superficial reservoirs. the procedures are expensive, slow and can be haz-
When radionuclides get water, they are carried ardous to laboratory workers (pure cultures of path-
by the current, absorbed by the bottom, where they ogens). Therefore the concept of indicator organisms
are accumulated. They can get water from the bot- is used, which is not possibly pathogenic itself but
tom or by passing through the biological chains. The occuring in large numbers can acting as a tracer or
concentrations of radionuclides in hydrobionts can index of water quality.
102–104 times exceed their concentration in water. Criteria for choosing the indicator microorga-
Chemical indices of possible pollution, which nism. It should:
have epidemiological value are marked for water — respond to environmental conditions (or treat-
from the sources of water supply. They are organic ment) in a similar manner to the pathogen type of
matters and the products of their decay: ammonium interest;
salts, nitrites and nitrates. Except of nitrates, the afore — occur in larger numbers and therefore always
said compounds in usual concentrations (ammonium be present with the pathogen;
salts — to 0.l mg/l, nitrites — to 0.002 mg/l) don’t — come from the same source as the pathogen
influence the human organism negatively. Their type of interest;

51
 — be easy to isolate and enumerate. cold/anaerobic conditions. The main removal mech-
No organisms completely fulfil criteria so as- anisms are:
sumptions have to be made: — Sedimentation (50–75% of fecal coliforms
Coliforms are the most commonly used. Total with particles sv > 0.05cms–1 )
coliforms (TC) are gram negative, rod-shaped bac- — Sunlight (UV)
teria, ferment lactose with gas formation within 48 — Predation
h at 35°C, wide variety of bacteria, mainly enteric The indirect bacterial indices are widely used on
but also some natural soil and water. Faecal coil- determining water quality.
forms (FC) (E.Coli) is a sub-group identified by in- Microbes number is one of the evidence of wa-
cubation at elevated temperature. All are enteric ter contamination. It is a number of colonies, which
but are not distinguished between warm blooded grow up in a nutrient medium at the temperature of
animals. 37°C and 20°C from 1 ml of water. It is a total bac-
Fecal streptococci — rod-shaped gram-positive terial culture of water. Microbes number of the ar-
106/g feces, ratio of numbers of fecal streptococci tesian wells doesn’t exceed 10–30 in 1 ml. In mine
to fecal coliforms is different between animals and wells the index forms 200–400 per 1 ml, in clean
higher in humans than domestic live stock. There- reservoirs — 1,000, in water from water-pipe — 100
fore can distinguish between humans and animals. per 1 ml in case of epidemiological cleaning. The
However, pollution must be local/fresh (< 24 h) and single determination of microbes number is insuffi-
replication to overcome natural variation in micro- cient. We must determine it in dynamics.
bial counts, e.g. The determination of E. coli and its group is im-
FS:FC portant, as they are discharged out by the human and
Humans 1:4.3 animal feces and are evidence of fecal contamina-
tion. It’s a relative indicator of the risk of intestinal
Cow 1:0.18
water-borne infections.
Dog 1:0.024 The degree of water contamination by E. coli is
Pigeon 1:0.01 determined by coli-tytre and coli-index. Coli-titre is
Elk 1:0.007 the least volume of investigated water where we can
Therefore ratios greater than 1:2 often suggest find out one E. coli. The less titre — the larger fe-
human contamination. cal contamination. Coli-index — is the number of
Cl. perfringens — anaerobic spore forming rod- E-coli in 1 l of water.
shaped bacteria, 104/g feces, they can form spores Coli-titre in artesian water doesn’t exceed 500 ml
which live for a long lime, can indicate remote or (coli-index no more than 2); in sanitary wells — 100
sporadic pollution when other indicators are absent. ml (coli-index — no more than 10).
Techniques for identifying E. coli for 100 years, By GOST-2874-821 and SSanR&N (State Sani-
based upon selective media and incubation to se- tary Rules and Norms) N383 the indices of epide-
lect for organisms (the method of membrane filtra- miological safety of water are: coli-index 3 (coli-
tion and the enzymatic method). The first method titre — no less than 300), microbes number — 100
is based on aseptic filtration of 100 ml through per 1 ml.
0.45 m pore filter, retains bacteria on surface. The
filter is placed in petri dish with sterile membrane
lauryl sulphate broth (media) nutrients. It is incu- Table 11. Hygienic Standards of Drinking Water
bated for 4 hrs at 30°C and 14 hrs at 37°C for TC Quality (Physiological Adequacy)
or 14 hrs at 44°C. If sample is very polluted it is
serially diluted or can be enumerated directly in Recommended
Index
media to avoid filter blocking. At the end of incu- values
bation, yellow colonies are counted (pH change via Total mineralization, mg/dm3 > 100.0
acid production) and reported as presumptive < 1,000.0
counts. For sensitive and legal results this requires Total hardness, mg-eq/dm3 > 1.5
confirmation by further biochemical tests (IMViC < 7.0
or API). Total alcaliness, mg-eq/dm3 > 0.5
Conditions of media and temperature may not let < 6.5
to grow for all of the indicator organisms, suggest- Magnium, mg/dm3 > 10.0
ed that up to 90% of environmental organisms are < 80.0
“unculturable”. Also it was reported they reproduce
Fluorine, mg/dm3 > 0.7
in some natural waters at temperatures over 30°C, < 1.5
so less appropriate in tropical climates.
Enteric pathogens are in unfavourable environ-
mental conditions once outside intestine, but all can
1 GOST — State Standard of USSR using in NIS current-
survive for a time in natural waters especially in
ly

52
 In Ukraine new sanitary rules include indices of ATMOSPHERIC WATER
physiological adequacy (Table 11). These indices
determine adequacy of salt content of drinking wa- Atmospheric water is lightly mineralized (no
ter to biological needs of human organism. They more than 30–50 mg/l), very soft, without color, not
based on the interval between the minimum and very pleasant in taste. Contents of microorganisms
maximum admissible levels in drinking water. and suspended parts depend on the method of gath-
ering and storage of water. For the family purposes
rain-water is gathering from the roof. The best meth-
od is gathering water from the galvanized iron roofs.
The first portion of water washes out dust from the
HYGIENIC CHARACTERISTICS roof. That’s why it is not gathered. Uneven roofs
OF WATER SUPPLY SOURCES from another materials promote accumulation of
dust and leaves, color the water and give it a defi-
nite taste. For the gathering of big amounts of wa-
At the absence of other sources of drinkable wa- ter in the mountain regions special water-gathering
ter in the arid zone of tropics and subtropical zone platforms are used. They are enclosed for the pre-
there can be used rain-water for the water supply of venting of contamination soil by people and animals.
some families or even large groups of people. At- The best method of storage of atmosphere water
mosphere water is often used for drinking and cook- is keeping it in the underground concrete tanks. In
ing; water of opened reservoirs or unfavorable wells the regions where rains are often, people have spe-
— for other purposes. cial barrels with the volume up to 200 litres for the
Structure of water consumption is shown at gathering of rain-water.
Fig. 23. Atmospheric water is not quite safe from the ep-
idemiological point of view. That is why it is rec-
ommended to make disinfection of water before us-
8.5% age.
21.0%
UNDERGROUND WATERS

Ground waters gather on the first from the sur-

face impermeable for water layer (clay, granite,
lime-stones). On that level water forms the first wa-
ter-bearing horizon of soil water. Depending on the
local conditions the bottom depth of this waters is
70.5% within the limits from 1-2 meters to several tens of
meters (Fig. 24).
Glaciers and Ice Caps Ground waters are used for the water supply of
rural population. There shaft or pipe wells are usu-
Ground Water ally used. Usually shaft wells which are supplied
Lakes, Streams and Water Vapour by soil waters produce from 1 to 10 m3 of water per
day. In several cases soil waters can be used for the
Fig. 23. Sources of Fresh Water organizing of small water-pipes in the countryside.

Spring

Pond Artesian
Water well
table
Bedrock Well

Bedrock
Aquiter
Water table
Impermeable
Ground water layer
Fig. 24. Underground Waters

53
 Core waters. When ground waters move along wells can’t be used because of worsening of orga-
impermeable layer they can achieve the place be- noleptic qualities of water (smell of the oil, aromat-
tween two layers impermeable for water. In that case ic smell, salt taste, etc.) or due to result high con-
they become interbed because they are located be- centrations of toxic substances.
tween two layers: bed and roof. Depending on the Springs. Underground waters can independently
local geological conditions interbed waters can form go out to the surface. In such cases they are called
the second, the third and more water-bearing hori- the “springs”. The springs can be formed by soil and
zons. As a rule interbed water fills all the space be- interbed waters as a result of cutting of water-bear-
tween two waterproof layers. If pipe well is made ing horizon on the slope of the hill or in the deep
there, water can ascend in pipes or even run out like ravines (descending spring). If the first water-bear-
a fountain. Such interbed water is called artesian. ing layer breaks off in the ravine or river valley then
The depth of interbed (core) waters is from tens to ascending spring is formed. Quality of the spring
thousands of meters. Such waters are often met in water depends on the water-bearing horizon, organ-
arid zones of tropic countries. ization of captage (construction for water consump-
Interlayer waters differ from soil ones by low tion). Constant and sufficient output springs are used
temperature (5–12°C), constant level and structure. for the organizing of water-pipes in small settle-
Usually it is transparent, without any colour, taste ments.
and smell. Concentration of mineral salts in such Studying of spring contamination cases shows
water is more than in soil ones and depends on the that it occurs at the site of outcome of the spring to
surroundings (rocks) where they accumulate. Inter- the land surface.
layer waters may be such mineralized (very hard That’s why for the preventing of spring pollu-
water, salt, many salts of fluorine, iron or sulfuric tion the following rules must be kept:
hydrogen) that they can’t be used for the water sup- 1. The place of the well organization must be as
ply without preliminary treatment. higher on the relief as possible and far from objects
As a result of long filtration and presence of im- that contaminate the soil. On exploiting the spring
permeable roof which protects core waters from the the place must be kept clean.
pollution they are characterized by the almost com- 2. The walls of the well must be waterproof. Clay
plete absence of microorganisms and can be used lock is usually organized near the upper part of the
for drinking without any treatment. Interlayer wa- walls. This lock prevents the getting of water from
ters are exploited by the way of organizing pipe or, the surface along walls. The well must be covered
rarely, shaft wells. Constant and big outflow (from for the prevention of pollution from the environment.
1 to 200 m/hour) and good quality of water allow Shaft wells. Such wells are usually organized in
to use core waters as the best source of water sup- the villages. They are of round or square form (up
ply of small and average settlements where water is to 1 m2). Distance from the well to the residence of
used in natural form, without preliminary treatment. consumer must not exceed 50–150 m. The place for
But there were cases when epidemic diseases of the well must be at the height and no closer than 30
intestinal infections occur in using of interbed wa- m to the possible sources of pollution, for example
ters. Their contamination is a result of getting of in- lavatory, stables, etc. If a lavatory is located higher
fected water into them from the upper water-bear- on the relief than the well, the distance between them
ing horizon through the crack in the waterproof roof, must be no less than 80–100 m, and sometimes 120–
not through the wells, quarries, unhermetic mouths 150 m. While organizing the well it should be good
of chinks, etc. to reach the second water-bearing horizon if it is not
Lately there have been cases of contamination deeper than 30 m. The bottom of the well must be
of underground waters by the chemical substances opened and walls are worked up with water-imper-
as a result of flooding of shafts and deep quarries meable material. The walls of the well must be high-
by industrial sewage or as a result of soil infiltrat- er than the soil level by 80 cm. A pit of 1–1.5 m of
ing by this waters through the cracks in the storag- depth is dug up around. It’s width must be 1 m. It is
es of such fluids. filled in with clay (“clay lock”). Ground part around
Sanitary workers of tropical countries point out the well in the radius of 2 m should be covered with
the fact that pollution of interbed waters by toxic sand and concrete, stones or bricks.
substances can be more dangerous than pollution of The best method of drawing water is with the
opened reservoirs. It is because underground waters help of hand or mechanic pump. If the water is tak-
couldn’t be seen and tested, their flow is slow, of- en by the bucket, it should be public bucket.
ten without any direction; such facts make the prog- Pipe wells. If soil waters are located not deeper
nosis difficult. Water can stay polluted during a long than 7–8 m, a pipe well is used. They are sunk by
period especially when it is polluted by stable chem- hand and equipped with hand pump with produc-
ical substances. Chemical pollution of underground tivity 0.5–1 m3/hour.
waters stays unnoticed for longer period than pol- In many countries of the Near East, Africa and
lution of opened reservoirs. In such cases artesian Latin America shallow-pipe wells are organized by

54
driving in pipes into the soil. They are called Abys- clonorchosis, opistorchosis, angiostrongilosis, viral
sinian wells. hepatitis and others).
For the organization of deep-pipe well a special The water is greatly polluted in reservoirs near
borehole is bored. A vertical cylindrical borehole settlements and at the places of outflow of industri-
has a diameter of 50–600 mm and depth from 10– al and cattle-breeding sewage.
15 m to 1500 m. To prevent crumbling of walls me- In tropic countries blossoming and development
tallic pipes which are called supporting are driven of plankton and green water-plants are observed in
in into the borehole. Water is drawn from the well reservoirs with stagnant water or with small flow.
with the help of mechanic pumps productivity of Due to their mass dying off the water is colored in
which is about 100 m3/hour and more. green or brown and gets unpleasant scent and taste.
In case of correct organization deep-pipe wells During this process some substances which can be
provide preservation of artesian water from pollu- dangerous for the man form. A slight taste or scent
tion. But sometimes this water can be contaminat- is always present in almost every opened reservoir.
ed through the polluted soil waters which are con- They appear because of decay of organic substanc-
nected with the deeper water-bearing horizon. Soil es in the water and at the bottom, and due to wash-
waters penetrate through rusty supporting pipes. ing out of actinomycetas and products of their ac-
That’s why the upper part of the borehole must be tivity from the soil.
closed up with two columns of supporting pipes. The Superficial waters are slightly mineralized, soft.
space between these pipes is filled in with cement. But in the lakes and reservoirs without any flow con-
Different agents can get into the well through the centration of salts increases due to evaporation of
mouth of the bore-hole. For the prevention of such water especially in the conditions of hot climate.
pollution the upper column of supporting pipes at Opened reservoirs are characterized by instability
the place of entrance of absorbing pipe must be of water qualities which can change depending on
completely hermetically sealed. The space between the season and even the weather (for example, after
the supporting pipes and walls of bore-hole (retro- rains). Rains wash out toxic chemical substances
pipe space) must be filled in with cement. Such (pesticides), agrochemical agents, industrial sewers
bore-holes are used for the water supply of big and others, pathogenic microorganisms especially in
towns. the regions where lavatories don’t meet sanitary re-
Underground waters which feed many oases in quirements. That’s why the quality of water becomes
the Sahara, Eastern Africa, Iraq and other arid re- worse after rains: turbidity increases up to 3–10 mg/
gions often begin to collect tens or even hundreds l, coli-index — to 1 million, concentration of pesti-
kilometres from sites of exploitation on the heights cides and other toxic substances also increases sig-
in the period of monsoon rains. Population in those nificantly.
regions gets underground water with the help of
deep (up to 50–100 m) dug wells. Such underground RESERVOIRS SELF-CLEARING
irrigating constructions are made by karyzes (haz-
ars, filages). Lifting of the water on the surface is In spite of constant flow of different pollutants
made with the help of a special system — garb, into the opened reservoirs in most cases there is no
which is moved by camels. Basic elements of the observed progressive worsening of qualities of the
garb: laces, double pulleys, water-skins. water. It can be explained by multitude physical-
It is the fact that in many arid zones there are chemical and biological processes which provide
large amounts of salt and fresh waters at the depth “self-clearing” (removal) of reservoirs from sus-
of 500–1000 m which can be used for different pur- pended particles, organic substances, microorgan-
poses. Modern boring and water-drawing machines isms and other pollutions.
allow to organize deep bore-holes quickly. At getting of sewage into reservoirs they are
mixed with the water which provide the decreasing
OPENED RESERVOIRS of concentration. Suspended mineral and organic
substances, eggs of helminths and microorganism
Opened reservoirs are fed not only by atmospher- sediment so water becomes more transparent. Dis-
ic waters but also by underground ones. They are solved organic substances get mineralized due to the
usually contaminated from the environment. That’s activity of microorganisms. Biochemical oxidation
why they can be dangerous from the epidemic point is completed by nitrification with the formation of
of view. In tropical regions reservoirs can play a sig- nitrates, carbonates, sulfates and others. The pres-
nificant role in the spreading of infections and ence of dissolved oxygen is obligatory for the bio-
helminthism by using this water for drinking and chemical oxidation of organic substances. In clean
cooking (amebiasis, alimentary infections, drakyn- reservoirs oxygen saturation is more than 50%.
kylosis, leptospirosis, etc.), while swimming (shis- In the process of self-clearing constant dying off
tosomosis, leptospirosis and others), and eating fish, of saprophytes and pathogenic microorganisms oc-
crustacean, mollusks and water plants (dysentery, curs. They die due to decreasing of nourishing sub-

55
stances in the water, influence of sun rays, bacteri-
ophages and antibiotic substances which are dis- SANITARY PROTECTION OF
charged by fungi and other saprophytes. Besides, in RESERVOIRS
the countries with hot climate special conditions
develop in the reservoirs which promote the repro- In many countries protection of reservoirs from
duction of pathogenic microorganisms. contamination by pathogenic microorganisms re-
Special attention should be drawn to existence mains a primary problem. Due to industrialization
of viruses. Due to high resistance of enterovirus- and progressive chemicalization of agriculture (pes-
es they can spread in rivers at considerable dis- ticides, nitrogen and other fertilizers) protection of
tances, far from the source of pollution. At the reservoirs from chemical substances is of great im-
coastal part of seas they are found at a distance portance.
of up to 7 km from the place of pollution. It is Chemical substances may worsen organoleptic
important to notice that viruses can infect mol- properties of water such as unpleasant smell, color
lusks for a long period. Infected mollusks live in and taste. They can influence the microorganisms
the coastal waters of tropical countries and pop- and other organisms of water; provoke death of fish
ulation uses them widely in food. It is known that and decrease activity of microorganisms which take
even those mollusks which fished out in the wa- part in the self-clearing of reservoirs. Some concen-
ters with normal coli-titre became the cause of trations of toxic substances are dangerous for hu-
infectious hepatitis A. mans. Consumption of polluted water can bring
Due to self-clearing of reservoirs the water be- about acute and chronic intoxications.
comes transparent, unpleasant odor disappears, or- It is very dangerous when the reservoirs get sew-
ganic substances are mineralized, part of pathogen- age which contain radioactive substances especial-
ic microorganisms dies and water acquire those qual- ly with a long half-life period. They can accumu-
ities which it had before pollution. The speed of self- late in tissues of water organisms which can be the
clearing depends on the power capacity of reservoir agents of secondary contamination of water and in-
and degree of pollution. creased concentration of radioactive substances in
One of the essential indices of contamination tissues of fish and birds.
degree by organic substances is Biochemical Oxy- Sewage which contain an acid or alkaline com-
gen Demand (BOD). BOD20 it is quantity of oxy- pound, colored substances, oil or products of its
gen which is needed for complete biological oxida- processing worsen the water quality and self-clear-
tion of substances in the volume of 1 litre at the tem- ing processes.
perature of 20°C during 20 days. In sanitary prac- Located in settlements industrial enterprises of-
tice BOD5 is often used. It is quantity of oxygen ten throw out their sewage into city sewerage with-
which is needed for biological oxidation of 1 litre out any previous purification. As a result of this ac-
of water during 5 days. For natural waters BOD5 is tion chemical composition of household-fecal wa-
approximately 70% from BOD20 . In clean reservoirs ters becomes worse primarily by increased concen-
BOD5 is less than 2 mg, and in relatively clean 2– tration of heavy metals, arsenic and other toxic sub-
4 mg (BOD20 — 3–6 mg of O2). stances.
Self-clearing ability of reservoirs is limited. The escape of non-purified sewage into reservoirs
While using opened reservoir it is necessary to concerns the interests of population, agriculture and
follow the rules: industry. That’s why the task of sanitary protection
— the using of bigger reservoir with constant of reservoirs has a state significance and for its ef-
flow of water; fective solution legislative acts must be made.
— protection of reservoirs from the pollution by Water resources of the country are national prop-
sewage and industrial waters and pesticides; erty and must be protected from pollution and ex-
— disinfection of the water. Often, besides dis- haustion. In Ukraine the base of water legislation is
infection, it is necessary to purify the water from The Law about Water (2002), GOST 2874-82
suspended particles and coloring and, in some cas- “Drinking Water” and 2761-84 “Sources of Central-
es, from toxic substances. ized Household-Drinking Water Supply” which pro-
Lately opened reservoirs are used for water sup- vide the necessity of primary satisfaction of drink-
ply with the usage of water-pipe. It is explained by ing and household demands of people. That’s why
the development and modernization of techniques they have great demands to the hygienic conditions
of clearing and disinfection of water and by increase of reservoirs and quality of water in them. There
of water consuming by big modern cities. are also exist “Rules of Protection of Superficial
To summarize the said above, first of all arte- Waters from the Pollution by Sewage” (1988) and
sian waters is the source of water supply. In case of Sanitary Rules and Norms “Drinking Water. Hygi-
impossibility to use artesian waters, other sources enic Requirements to Water Quality in Centralized
should be found. Water Supply”.

56
 These rules demand the carrying out of measures of water supply and storage ponds. It is a long proc-
which must exclude the necessity of throwing out ess. The effectiveness of decolorizing is low. That’s
of sewage into reservoirs. It can be achieved by ra- why, they often use coagulators, which accelerate
tionalization of technologic processes, recurring us- the sedimentation of suspended matters.
age of sewage by industrial enterprises after their As a rule the process of lightening and decolor-
refining (working cycle), throwing out of sewage on izing is completed by filtration through the layers
the fields for irrigation and fertilization. of granular material (sand, activated coal). There are
Rules allow to throw out sewage into reservoirs two methods of filtration: slow and fast.
only in those cases when it can’t be avoided. Sewage Natural settling is realized in the horizontal set-
before throwing out into reservoirs which are used tling tanks, the reservoirs with the depth about some
for the water supply of people or food enterprises meters. Water moves very slowly there, its speed
must be completely purified. After mixing such wa- doesn’t exceed 0.15 m/s. Water stays there for 4–8
ters with the water of reservoir in the worst condi- h, and previously coarse suspended particles are sed-
tions the following demands must be met: (1) don’t imented. The settling within 3–7 days is used in hot
worsen organoleptic qualities of water and outward countries. During that time little particles, the sig-
appearance of reservoirs; (2) don’t worsen processes nificant part of absorbed matters and microorgan-
of self-clearing and existence of organisms; (3) don’t isms are sedimented. If schistosomosis is widespread
pollute the reservoir with pathogenic microorganisms in thas region, water must be in the settling tanks
or chemical substances in toxic concentrations. for about 3–4 days. This pathological agent dies in
Realization of these rules demands theoretically 48 h, if it doesn’t get into the human or animal or-
substantiated Maximum Admissible Concentrations ganism. So, the preservation of water for 2 days in
(MAC) of toxic substances in water. Hygienists de- the settling tank, free of mollusks, is a reliable meth-
termine those concentrations for more than 700 dif- od to prevent the spread of schistosomosis. The tank
ferent chemical agents which can pollute the reser- should contain the walls higher than the ground, and
voir. Each chemical substance must be examined in a screen made of galvanized net with the cells no
3 directions: sanitary-toxicological, organoleptic and more than 3 mm to detain molluscs. These condi-
common sanitary. There are MACs for several tions are very important, as cercaria are stable for
chemical agents: arsenic — 0.05 (sanitary-toxico- the disinfection by chlorine. After the settling wa-
logical), nickel — 0.1 (sanitary-toxicological), cop- ter passes through the slow filter to be lightened
per — 1.0 (organoleptic), zinc — 1.0 (common san- completely. It is a brick or concrete reservoir. There
itary), sodium trichloracetate — 5.0 (common sani- are drainages from concrete slabs or drainage tubes
tary), titanium — 0.1 (common sanitary) and oth- with the openings. The suspending layer of detritus
ers (See Annex 1). and gravel of 0.7 m in the thickness is placed above
the drainage. Above it there is one meter layer of
sand, the diameter of its granules is 0.25–0.5 mm.
Then, they pass water through it with the speed
THE METHODS OF WATER no more than 0.1 m/h.
CONDITIONING. THE HYGIENIC Slow filters clear water well only after their “rip-
CHARACTERISTICS OF WATER ening”: the diameter of pores in the sand decreases,
owing to the keeping of suspended matters in the
SUPPLY AND ITS SANITARY highest layer (Fig. 25). So, small particles, worm
CONTROL eggs and larvae and to 99.9% of bacteria can be de-
tained. Viruses are not absorbed by the clean sand.
There are many methods of water improvement. But after the “ripening”, about 50–99% viruses are
They make it possible to purify water from dangerous kept in the slow filters. If such filters are used cor-
microorganisms, suspended matters, gumines, surplus rectly, they free water from cercaria. At the same
salts, stinking gases, toxic and radioactive matters. time a series of biological processes proceed in the
The use of different methods of water improve- ripped highest layer — biological film: the miner-
ment let us use water resources of the country more alization of organic matters and the death of bacte-
completely and provide the population with quali- ria. The contaminated highest layer of the sand is
tative water. changed in 30–60 days. Slow filters are used when
The traditional methods of water conditioning water turbidity doesn’t exceed 200 mg/l in the small
are: lightening, decolorizing and disinfecting. country water-pipes. They are always used after the
preceding aeration to remove surplus iron and man-
PURIFICATION (LIGHTENING AND ganese (Fig. 25).
DECOLORIZING) The coagulation is used to accelerate the sedi-
mentation of suspended matters, filtration and light-
The lightening and partial decolorizing are achie- ening of water. They add the following coagulators
ved by the long settling. It is realized in the sources to water: Al2(SO4) 3, FeCl3, FeSO4 and so on. They

57
 River Water The water becomes transparent, uncolored, free
of worms’ eggs and 70–98% microorganisms after
Sand the coagulation, settling and filtration. However,
water, passed through the fast filters, must be sub-
Gravel jected to disinfection.
Disinfection and
Fluoridation DISINFECTION
Fig. 25. Slow Sand Filtre
Disinfection is one of the most usable methods
of water improvement. Usually it is a concluding
form unsoluble compounds with the dissolved elec- and very important stage. The better lightening and
trolytes, which are quickly sedimented as flocks. decolorizing the better disinfection. The most spread
These flocks have a large active surface and posi- methods of disinfection in hot countries are differ-
tive electric charge. That’s why they absorb even ent methods of chlorination. Sometimes ozonization
the smallest negative microbe particles and colloi- and UV-irradiation are used also:
dal gumines, taking them to the bottom of the set- — for water-pipes, boiling and filtration through
tling tank. The transparent and uncolored filtrate is the fast filters;
formed after the sedimentation of flocks and the next — for the local (decentralizated) water supply.
filtration of water. The use of coagulators allows to
decolorize water, to shorten the time of settling to Chlorination
2–3 h and to use fast filters. 95% of worm eggs, 90%
and more bacteria and viruses leave water after the Chlorination of water is one of the most spread
coagulation and settling. Coagulation belongs to the methods and it is of great importance for the proph-
most effective methods of water clearing from vi- ylaxis of water epidemics. It is explained by the re-
ruses. The best cleaning is realized by the combined liable disinfection, accessability and cheapness.
coagulator (Al2(SO4)3 and iron salts). The principle of chlorination is based on the
Aluminium sulphate Al2(SO4)3.18H2O is often treatment by chlorine or the chemical compounds,
used as a coagulator. It reacts with the calcium bi- containing active chlorine and able to oxidize and
carbonate and forms Al(OH)3, which is bad-dissol- provoke bactericidal action. Chlorine is subjected
uble and sediments as flocks. to hydrolysis in water: Cl2 + HOH → HOCl + HCl,
so hydrochloric and chloricious acids are formed.
Al2(SO4)3+3Ca(HCO3)2 → 2Al(OH)3+3CaSO4+6CO2. Chloricious acid takes the central place in the mech-
The dose of coagulators is 30–200 mg/l, it de- anisms of bactericidal action. It was thought earlier
pends on the color, turbidity, pH of water and many that the latter was destroyed in water and discharged
other conditions. It is determined by the experiment out atomic oxygen (HOCl → HCl + O-), which was
for the certain water. Lately they have been used the main bactericidal agent. Now, such explaination
large-molecular matters — flocculators (activated si- is considered insufficient. Chlorine in the structure
licic acid), which are active in very small doses (0.2– of chloricious acid and hypochlorite-ion (HOCl →
2.0 mg/l), to accelerate coagulation and economize H + OCl ) free active chlorine, which determines
the coagulator. 5% solution of coagulator is given bactericidal action in water. Not large molecules and
to the mixer with the help of special dosator, where electric neutrality let chloricious acid penetrate
it is quickly mixed with water. Then, the water en- quickly through the bacterial membrane and affect
ters the reaction chamber, where the formation of the cellular enzymes, important for the metabolism
flocks completes in 10–20 min. Such water passes and reproduction. It is assumed, that it reacts with
to the settling tank, where the flocks are sediment- SH-groups of enzymes, which become oxidized.
ed. The size of settling tank corresponds to the set- The reliable bactericidal effect of chlorine is
tling for 2–3 h. achieved if about 0.3–0.5 mg/l of free chlorine or
Then the water is given to the fast filters, where 0.8–1.2 mg/l of connected chlorine are left in water
the layer of sand is 0.8–1.2 m and the granules — after 30–60 min of exposure.
from 0.5–1 mm. The speed of filtration is 5–8 m/h There are 2 stages of chlorine action upon vi-
(it is automatically regulated). Soon after the begin- ruses: the first one, when chloricious acid and hy-
ning of the work, the filtrating film, consisting of pochlorite-ion are absorbed in the viral membrane
the flocks of coagulator and unsedimented particles, and penetrate through it, the second stage is an in-
is formed in the highest layer. It improves the de- activation of viral RNA. Virucidal effect is the most
tain of microorganisms and admixtures. In 8–12 h expressed by the low pH.
the film becomes denser and the speed of filtration Sanitary control of water-pipes includes the de-
decreases. That’s why the work is stopped and the termination of the remaining chlorine in water eve-
filter is cleaned for 10–15 min by the stream of clean ry hour, and the bacteriological investigation — not
water, directed upwards, to remove the film. rarer than once a day.

58
 Long-term experience of using such a method in The number of active chlorine (mg), necessary
almost all countries of the world is evidence of chlo- for the disinfection of 1 liter of water, is called chlo-
rinated water safety for use. However, lately, the rine-request. It is determined by the experimental
safety of such water has been disputed owing to the chlorination of certain volume of water, subjected
following facts. There was found a trustworthy con- to disinfection.
nection between the concentration of chloroform Besides the correct dose, good mixture and suf-
(carcinogenous matter) in the tap water and the lev- ficient contact of chlorine with water are necessary
el of mortality from cancer of people, who had used for the effective disinfection.
such water. Further studies showed, that different The presence of suspended matters, gumines and
chlororganic compounds (chloroform, tetrachloreth- other organic compounds in water lowers the action
ylene, etc.) and polychlorinated biphenyls had of- of chlorine. That’s why it is necessary to light and
ten been met in the water of open reservoirs very decolourize turbid and colored waters before disin-
polluted by sewerage. fection.
Nevertheless, chloroform and other chloroorgan- The chlorination of water by chlorine-request
ic compounds can be formed in small quantities dur- reliably disinfects water from the intestinal infec-
ing the chlorination of water. All these facts neces- tions (typhoid fever, dysentery, cholera, pathogenous
sitate improvement of water treatment by the fol- strains of E.coli, salmonellas), brucellosis, tularemia,
lowing methods: better purification of water before leptospirosis. There are some disputes about the
chlorination, the use of necessary doses in minimum poliovirus. Many scientists consider, that this virus
quantities, the use of chlorination with the preced- is inactivated by the chlorination for an hour. Wa-
ing preammonization, filtration of chlorinated wa- ter, containing Berket’s rikketsia, amoebic cysts,
ter through the filtres with the activated coal, which worm eggs and the spores of some types of anthrax,
absorbs chloroorganic compounds. It is admissible cannot be disinfected by this method.
to aerate water in the small water-pipes. As a result Chlorination by the Post-Break Doses. Accord-
90% of chloroform and other volatile compounds ing to the results of some investigations the water
are removed. can be disinfected by 2 doses of chlorine: 1 mg/l
Gaseous chlorine, preserved in the steel contain- (before-break dose) and 5.2 mg/l (post-break dos-
ers, is used to chlorinate water in the large water- es), as the concentration of the rest chlorine makes
pipes. A special apparatus chlorator, which measures 0.5 mg/l in both cases.
chlorine input to water, is added to the container. However, by before-break dose the remaining
Chloric lime (3Ca(ClO)2.CaO.H2O) is used for chlorine is determined as chloramin, and by post-
the small water-pipes and other reservoirs. Its bac- break doses — as free chlorine. The bactericidal
tericidal effect is determined by OCl- group, which action of such method is very effective. At the same
forms chloricious acid in water. Chloride of lime time we improve water organoleptic features at the
contains up to 33% of active chlorine. expense of oxidation of organic substances with the
Chlorine dioxide (ClO2), calcium hypochlorite bad smell. It is necessary to use this method in hot
— Ca(OCl)2, containing 60–70% of active chlorine, countries widely.
and different chloramins (organic and inorganic) are Chlorination with the Preammonization
also used for the disinfection. Calcium hypochlo- (Chlorammination). First, they introduce ammo-
rite is more stable than chloride of lime and that’s niac solution and than, in 0.5–1 min, chlorine to the
why it is recommended for hot countries. However, water. As a result chloramins are formed in water:
during the storage in the tropical sun, there were NH2Cl — monochloramin and NHCl2 — dichlo-
some explosions of containers. Oxidizing and bac- ramin. The last one has the most expressed bacteri-
tericidal features of chloramins are inferior to that cidal action. The effectiveness of such method de-
of chlorine and chloric lime. pends on the ratio NH3:Cl. That’s why they use the
Simple Chlorination (by chlorine request). doses of reagents in the following ratios: 1:3, 1:4,
Right choice of the dose is of great importance for 1:6, 1:8. The ratio should be chosen for certain res-
the reliable disinfection. Only about 1–2% of ac- ervoirs individually. This method prevents bad
tive chlorine are spent on the bactericidal action smells, which can appear by the chlorination of wa-
during the disinfection. The rest part is spent on ox- ter, containing phenol and the matters from its group
idation of organic and inorganic matters in water. (as chlorphenols are formed). Chlorphenols impart
All these connected forms of chlorine form such a medicinal smell and smack to the water even in the
notion as “chlorine-absorbability of water”. Differ- small quantities.
ent natural waters have different chlorine-absorba- The speed of disinfection by this method is low-
bility. To disinfect water by such a method, they in- er than that by chlorine. The exposure time should
troduce such amount of chlorine, that the remain- be no less than 2 h.
ing free chlorine should be 0.3–0.5 mg/l and the re- If the water of reservoirs contains ammonium
maining chlorammoniac chlorine — 0.8–1.0 mg/l. salts, chloramines are also formed. This fact decel-
In such a case the organoleptic features of water do erates disinfection. So, it is necessary to define free
not become worse. and connected chlorine separately to determine the
59
reliability of disinfection. Obviously, the presence turbidity, colour and iron salts decelerate the disin-
of only free chlorine is evidence of reliable disin- fection, decreasing the transparence of water. Con-
fection. sequently, it is necessary to light and decolorize
Double Chlorination. In many river water-pipes water before disinfection.
chlorine is given before the settling and then after There are some advantages of UV-irradiation over
the filtration as usual. The introduction of chlorine the chlorination: bactericidal rays don’t denaturate the
before the settling improves the coagulation and water and don’t change its organoleptic features, they
decolorization of water, inhibits the development of have a wider biological action. Their bactericidal ac-
microorganisms in the settling tanks, increases the tion is spread over the spores, viruses and worm eggs,
reliability of disinfection. However, the possibility resistant to chlorine. Many investigators consider this
of chlororganic compounds formation increases too. method the best for the disinfection.
Overchlorination. By this method large doses
of chlorine are used in to the water, for example 10– Boiling
20 mg/l and more. As a result the reliable bacteri- It is the simplest method of disinfection. Vege-
cidal effect is achieved even after the exposure for tative forms of pathogenous microorganisms die in
15 min. By the 30–60 min of exposure even the tur- 20–40 sec at the temperature of 80°C. The water is
bid waters are disinfected reliably. Such agents, sta- almost disinfected until it begins to boil. 5 min of
ble for the chlorine, as Berket’s rikketsia, amoebic boiling provides reliable safety even in the very
cysts, Koch’s bacillus, viruses become dead. But strong pollution by suspended matters, viruses and
even such doses of chlorine cannot destroy spores other pathological agents. During 30 min. of boil-
of anthrax and helminthes eggs. A lot of residual ing most of spores die too. The spores of anthrax,
chlorine remains after the overchlorination. Water worm eggs and larvae are inactivated. Protozoa die
is dechlorinated by the filtration through the layers too. This method is often used in the everyday life,
of activated coal or by the addition of sodium hy- in hospitals, child welfare institutions, in the manu-
posulphite (Na2S2O3.5H2O) in the concentration of factures, railway stations. It is necessary to clean
3.5 mg per 1mg of chlorine. Hyperchlorination is tanks before filling them with the boiled water and
mainly used in expeditionary and military condi- change water every day, as the microorganisms mul-
tions. tiply there very quickly. Water contaminated by Ent.
hystolitica, must be subjected to boiling.
Ozonization of Water When there is much water and the use of boil-
It is widespread in the industrial countries. Ozone ing is unreal, the following methods are used:
is destroyed in water, forming atomic oxygen: O3 — coagulation by aluminium sulphate (100–150
.
→ O2 → O . Now, it is proved, that this mechanism mg/l);
is more complicated: there are many intermediate — settling for an hour;
reactions with the formation of free radicals (e.g. — filtration through the sand filter;
HO2), which also have oxidizing features. Ozone ox- — chlorination for 30 min to the concentration
idizing potential (+1.9) is higher than that one of of the remaining chlorine (1 mg/l).
chlorine (+1.36). From the hygienic point of view,
ozonization is one of the best methods of disinfec- Bacterial Filters
tion: water is well disinfected, organic admixtures Earlier it was said, that worm eggs and amoebic
become destroyed, organoleptic features are im- cysts didn’t die during the chlorination. That’s why
proved. Water becomes blue and it is equated with portable bacterial filters are widely used in many
spring water. tropic countries. Here, the water is filtered through
Ozone dose is 0.5–6 mg/l. Sometimes, higher the special filters — candles (Backfield’s, Cham-
doses are necessary for the lighting of water and berlain’s models) under pressure. The candle is an
improving other organoleptic features. The time of empty cylinder, made of porous ceramic material
disinfection is 3–5 min. The remaining ozone should (for example, porcelain). Water is filtrated through
make up 0.1–0.3 mg/l. The concentration of the re- the external surface of the candle to the inside part.
maining ozone 0.4 mg/l provides the reliable inac- It is liberated from the suspended particles, worm
tivation of 99% viruses for 5 min. eggs, bacteria and even viruses, depending on the
size of pores. The candles are cleaned and boiled
UV-irradiation
for 5–10 min once a week. The series of firms make
The maximal bactericidal effect is achieved by the candles of 3 models. Model “V" — these filters
the waves 250–260 nm, which pass even through are intended to the removing of suspended matters.
the 25 cm layer of transparent and decolorized wa- They can be used at the first stage of cleaning. Mod-
ter. el “N” — middle-porous, intended to clean water
The disinfection proceeds very quickly: vegeta- from worm eggs, cysts and cercaria. Model “W” —
tive forms of microorganisms die in 1–2 min. The small-porous filters, they keep even viruses.

60
 Chemical Tablet Methods Cleaning and Disinfection of Wells
The use of tablets and solutions are widely used It is necessary to clean and chlorinate the wells
for the disinfection in the expeditions and hikes. Tab- periodically. Water is removed from the wells, as
lets “Halazone” contain chloramin, stable during the well as the upper layer of silt and the layer of coarse
storage. The tablet is introduced to a certain volume sand or small gravel is put on the bottom. The walls
of water (usually it is 1 liter), and stirred every 3–5 of the well are treated by 3–5% solution of chloride
min. It can be used in 30 min. But this tablet cannot of lime. When the well is filled with water intro-
be enough for the very contaminated water. duce one backet of 3–5% solution of chloric lime
In this case we can use tablets “Chlor-dechlor”, for every 1 m3 of water. Then the water is stirred
which contain more chlorine and dechlorinated agent and left for 10–12 h. The water is ladled out until
in the middle of the tablet (sodium hyposulphite). the chlorine smell disappears. Some samples of wa-
They introduce one tablet to the water and stir it eve- ter are kept for the analysis. The chlorination of the
ry 2–3 min thoroughly. After dissolving of the exter- well is carried on after its repair, if the data of anal-
nal part of the tablet its central part inactivates the ysis are unfavourable for the presence of infectious
surplus chlorine. If the water is very shady introduce agents.
2–3 tablets at once. In Ukraine, we use tablets “Aq- The chlorination is ineffective if there is a con-
uasept” and “Aquacide”, which contain steady chlo- tamination of subsoil waters. It is necessary to remove
rine-containing preparations. One tablet (3.5 mg of the source of pollution. In this case notify people
active chlorine) is introduced to the 1 liter of water. about the necessity to boil the water or carry out the
Water becomes desinfected in 30 min. chlorination of water in wells for general use. The
Iodine-containing preparations are widespread in chlorination in the wells is inferior to chlorination of
tropical countries. They disinfect water from bacte- reservoirs. But it still lowers the epidemic danger.
ria, many viruses and cysts. The simplest method is Preservation of water with keeping its organolep-
the disinfection by 10% solution of iodine: 2 drops tic features and epidemiological safety is very im-
of such solution are introduced in 1 liter of very con- portant for the hot regions with water deficit. For
taminated water. The water is usable in 20–30 min this reason, large doses of chlorine are used: up to
Tablets “Globaline”, “Potable”, containing sodium 20 mg/l, if water is preserved for 15 days and to 30
tetraglycerate triiodate, disinfect water from bacte- mg/l, if it is preserved during 30 days. Before use,
ria, amoebic cysts, many viruses. They are the best water must be dechlorinated. It is achieved by the
disinfectant matters for the torrid zinc. They are safe filtration through the activated coal and introduc-
for humans. Large tanks for the preservation of wa- ing sodium hyposulphate. It is better to use metal
ter must have sturdy cover and a tap. or concrete tanks for the preservation of water.

61
 Chapter 4
FOOD AND NUTRITION

To maintain the organism functions, we must re- The laboratory methods of the assessment of en-
plenish energy we burn in the course of our activi- ergy value and nutrient composition have the high-
ties and ingest protein, vitamins, minerals and oth- est accuracy but they require complicate and con-
er substances that are essential for many enzyme tinuous investigations as well as significant finan-
systems as well as for growth, tissue repair and re- cial contribution. Thus the screening methods based
generation. The range of dietary requirements is on the calculations are the most popular for hygien-
broad, and it broadens further when there are de- ic assessment of community nutrition. The require-
mands, such as periods of rapid growth in childhood ments for such screening methods include availa-
and adolescence, pregnancy and when metabolic bility of the standard RDA for specific groups of
requirement is enhanced by infection. population; daily or weekly diet content, tables of
Adequacy of nutrition is determined with social- chemical composition of the foodstuffs (see Annex
economic and hygienic methods. The former in- 6)
cludes the balance method and the budget method. The duties of physician providing diet counseling in-
Hygienic methods define a real nutrition. There are clude following elements:
the weighing method, the questionnaire method and 1. Assessing the meal by its energy value and nutri-
the method using a menu. ent composition.
The are the following laws of nutritional adequa- 2. Providing a wide variety of different food
cy: products.
— the law of energetic adequacy; 3. Control on replacing foodstuffs with alterna-
— the law of plastic adequacy; tive ones.
— the law of enzymatic adequacy; 4. Correct distribution of foodstuffs by the meal-
— the law of biotic adequacy; time (i.e. breakfast, lunch, dinner, supper, etc.). Nor-
— the law of biorhythmic adequacy. mally, the distribution of daily calories intake should
The following diseases cause inadequate nutri- be about 30% for breakfast, 40–45% — for lunch,
tion: 20–25% — for dinner. The alternative distribution
1) nutritional deficiency diseases: for 4-time meals is 25% for breakfast, 10% — for
— protein-calorie malnutrition; tiffin, 40% — for lunch and 25% — for dinner.
— kwashiorkor; The findings of the research of diet include the
— alimentary marasmus; following items:
— hypovitaminoses; — correspondence of energy value to the ener-
— others; gy expenditures;
2) overnutrition; — correspondence of nutrient composition of
3) imbalanced nutrition. meal to RDAs;
The methods of balance and budget surveys of — correspondence of the ratio between animal
nutrition are used to estimate the consumption of and vegetable proteins (norm for protein of animal
basic foodstuffs or expenditures for nutrition of origin is 55% or more of total protein intake), ani-
community or individuals. These methods give mal and vegetable fat (norm for vegetable oil is 30%
only restricted evidence for nutrition assessment or more of total fat intake), starch and simple sug-
thus there are used widely more exact methods, e.g. ars (the latter should not exceed 20%);
the use of questionnaires or weighting method. The — adequacy of vitamin intake;
disadvantages of the last two methods are present- — adequacy of mineral salt intake and ratio be-
ed by the impossibility to assess the composition tween calcium and phosphorus (the optimum is
of daily diet. 1:1.5);

62
 — diversity of food during the week recommenda- rives all the nutrients he needs through the diet, it
tions for diet improving. should be well balanced to provide all the nutrients
The alimentary status is the physiological state in proper proportions. While planning a diet for the
of human organism determined by the dietary pat- community, food-stuffs have to be chosen in proper
tern. The alimentary status could be estimated by amounts to provide all the required nutrients and
the correspondence of body weight to age and gen- considering the dietary habits and availability of
der, somatic constitution, biochemical indices of food-stuffs.
metabolism, presence of the signs of alimentary de-
ficiency. The assessment of alimentary status is a
very informative method for medical control on the
nutrition of individuals and community. There are
following classification of alimentary status: NUTRIENTS
1. Optimum (when physiological indices and
body weight correspond to height, age, gender and PROTEINS
intensity of labour).
2. Superfluous (may be determined by congeni- Proteins (strands of amino acids) are compounds
tal predisposition, overeating, poor physical load- containing carbon, hydrogen, oxygen and nitrogen.
ing) that is characterized with increased body weight The nitrogen component of proteins is what differs
(obesity). There are four grades of the obesity: I — its structure from carbohydrates and fats. The word
adipopexis exceeds normal weight by 15–20%; II protein is derived from Greek “proteios” — prin-
— by 30–49%; III — by 50–99%; IV — by 100% cipal or prime. Proteins are, in fact, principal com-
and more). ponents of biochemical systems.
3. Insufficient, or hypotrophy when weight is The primary function of proteins is to support
lower than standard — this state could be deter- growth, and repair tissues (plastic function). They
mined by malnutrition, vigorous physical work, psy- also act as antibodies, hormones, and enzymes. Pro-
cho-emotional stress, etc. teins also help regulate the amount of fluids in the
Some experts (P. Kalmikov) determined folling body, for fluid and electrolyte balance.
categories of alimentary status: (1) pre-morbid — All proteins are made up of building units called
determined by the physiological disruptions or die- amino acids. Once eaten, food protein is broken
tary irrelevance; (2) morbid — weight reducing de- down by the digestion process into amino acids
termined by the disease or starvation. which are then reassembled in the body cells into a
For assessing alimentary status of individuals or specific format to form specific tissue proteins. For
specific groups there are used both subjective (ques- example, proteins in a diet build the proteins of new
tionnaires, interviewing) and objective indices. The tissues, such as an embryo, and a growing baby. Pro-
most popular is body mass index (BMI) or Quete- teins also rebuild tissues that are lost through he-
let’s index. It’s ration between individual’s weight morrhage, burns, and surgery or other worn out cells.
(kg) by the square of his/her height (m2) (Table 12). Proteins are also necessary for neurotransmitters
Man needs a wide range of nutrients to perform synthesis.
various functions in the body and to lead a healthy It is important to know the differences between
life. The nutrients include proteins, fats, carbohy- plant protein sources versus animal protein sourc-
drates, vitamins and minerals. These nutrients are es. Plant proteins do not contain all the essential
chemical substances which are present in the food amino acids needed by the body. For example, an
we eat daily. Man needs all these nutrients, i.e. en- essential amino acid from the animal protein source
ergy, proteins, vitamins, minerals in different called tryptophan produces a vitamin called niacin.
amounts to grow, live and thrive. Since a man de- Methionine is necessary for synthesis of cholin, the
lipotropic substance preventing fatty infiltration of
Table 12. BMI interpretation the liver.
To meet the organism’s needs in irreplaceable
BMI, kg/m 2 Alimentary
status
aminoacids and to maintain a necessary level of syn-
Females Males thetic processes the major importance has equation
< 16 < 16 Hypotrophy III degree of irreplaceable aminoacids, counterbalanced in a
certain quantitative ratio. Presently it is considered,
16–17.99 16–16.99 Hypotrophy II degree
that in estimation of aminoacid value of meal, it is
18–20 17–18.49 Hypotrophy I degree enough to be guided by three irreplaceable amino-
20.1–24.99 18.5–23.8 Admissible deviations acids — tryptophane, lysine, and sulfur-contained
22.0 20.8 Optimum aminoacids (methionine + cystine + cysteine), ratio
25–29.99 23.9–28.5 Obesity I should be 1:3:3.
30–39.99 28.6–38.99 Obesity II After protein is broken down for its main func-
> 40 > 39 Obesity III
tion, some residues should be placed or sent some-
where else. For example, the nitrogen residue is con-
63
verted by the liver from ammonia to urea and sent Table 13. Essential and Nonessential Aminoacids
to the kidneys to be excreted in the urine. A very
little amount of residue comes out as sloughed off Essential aminoacids Non-essential aminoacids
skin, nails and hair. The remaining residue is con- histidine * (His) asparginic acid
verted into glucose and used for energy. arginine (Arg) oxyproline
Proteins provide amino acids for body to build, valine (Val) proline
maintain, and repair cells and muscle tissue, heal
treonine (Tre) alanine
wounds, and support the immune system. It is very
easy to get protein in our diet, in fact, most people in methionine (Met) cysteine
developed countries consume 2–3 times more pro- phenilalanine (Phe) tyrosine
tein than necessary. Excessive protein is stored as fat. thryptophane (Thr) serine
High protein diets including intakes of protein lysine (Lys) glutamic acid
more than 15% of total calories cannot be justified isoleucine (Ile) glycocol
on a scientific basis. For an individual consuming leucine (Leu)
4,000 calories per day, 15% of calories represent 150
valine (Val)
grams of protein or 2 g/kg of the body weight for a
70 kg male (the required daily amount (RDA) is 0.8 * — Aminoacids in italic are essential only for children.
g/kg of the body weight/day). This almost exceeds
the requirement by 270%. High protein diets includ- tary proteins are considered to belong to two differ-
ing intakes above 15% or 2 g/kg of the body weight ent groups, depending on the amino acids they pro-
are either burned for energy to support activity or vide. Complete (high-grade) proteins, which consti-
are converted to fat. In addition, these processes re- tute the first group, contain ample amounts of all
sult in residual nitrogen, which must be excreted the essential amino acids. These proteins are found
through the urine as urea and ketones. This step re- in meat, fish, poultry, cheese, eggs, and milk. Incom-
quires the loss of water, which increases dehydra- plete proteins, which constitute the second group,
tion risk. High protein diets with excessive protein contain only some of the essential amino acids.
intake (5 times as much than RDA) can also cause These proteins are found in a variety of food-stuffs,
a loss of bone calcium and can also put strain on including grains, legumes, and leafy green vegeta-
the liver and kidneys. bles.
Protein can be supplied from animal food sourc- Although it is important to consume the full
es, such as lean meat, poultry, fish, eggs, milk, and range of amino acids, both essential and nonessen-
cheese, or vegetable food sources such as dried tial, it is not necessary to get them from meat, fish,
beans and peas, peanut butter, nuts, seeds, and tofu. poultry, and other complete-protein food-stuffs. In
Bread, cereals and vegetables contribute small fact, because of their high fat content as well as the
amounts of protein to the diet. Plant protein from use of antibiotics and other chemicals in the raising
vegetable sources is usually low in one or more of of poultry and cattle most of those food-stuffs should
the nine essential amino acids. Vegetable protein be eaten moderately. Fortunately, the dietary strate-
sources, in combination, can complement one an- gy called mutual supplementation enables you to
other to provide a high-quality protein. combine partial-protein food-stuffs to make comple-
When protein is consumed, the body breaks it mentary protein — proteins that supply adequate
down into amino acids, the building blocks of all amounts of all the essential amino acids. For instance,
proteins. Some of the amino acids are nonessential. although beans and brown rice are both quite rich in
This does not mean that they are unnecessary, but protein, each lacks one or more of the necessary ami-
rather that they do not have to come from the diet no acids. However, when you combine beans and
because they can be synthesized by the body from brown rice with each other, or when you combine ei-
other amino acids. Other amino acids are consid- ther one with any of a number of protein-rich food-
ered essential, meaning that the body cannot syn- stuffs, you form a complete protein that is a high-qual-
thesize them, and therefore must obtain them from ity substitute for meat. To make a complete protein,
the diet (Table 13). they combine beans with any one of the following:
Whenever the body makes a protein when it brown rice, seeds, corn, wheat, nuts.
builds muscle, for instance it needs a variety of ami- All soybean products, such as tofu and soymilk,
no acids for the protein-making process. These ami- are complete proteins. They contain the essential
no acids may come from dietary protein or from the amino acids plus several other nutrients. Available
body’s own pool of amino acids. If a shortage of in health food stores, tofu, soy oil, soy flour, soy-
amino acids becomes chronic, which can occur if based meat substitutes, soy cheese, and many other
the diet is deficient in essential amino acids, the soy products are healthful ways to complement the
building of protein in the body stops. meatless diet.
Because of the importance of consuming proteins There are many groups which feel that recom-
that provide all of the necessary amino acids, die- mended protein intakes are overdone. This situation

64
likely stems from several independent factors that tive correlation of bone density formation with pro-
all serve to come down in favor of low protein in- tein intake, and a weak positive correlation with cal-
takes. We can discuss some of these issues first and cium intake, there is a strong correlation with a high
then discuss the actual data on protein requirements. calcium to protein ratio. Thus, for a given level of
Protein appears to be receiving a bad rap for sever- protein intake, a minimum level of calcium intake
al reasons. First, animal products are an excellent in required. More protein means more calcium. Fi-
source of good balanced protein. Since plant based nally, the calorie restriction, low protein diets ex-
food-stuffs have lower protein and since the mix of tending lifespan have only been demonstrated in
amino acids in many plants is not balanced accord- small animals with short lifespans living under well
ing to dietary needs of humans, many vegetarians controlled laboratory conditions. What is not clear
have tried to argue that protein requirements are not is how applicable these results are to humans free
as high as indicated by the RDA. Second, given the living in a normal environment.
emphasis in nutrition over the last 15 years has been A final point to be noted is that many criticisms
at lowering fat intakes and saturated fat intakes, are based on the erroneous assumption that 30% of
sources of these items have been targeted for reduc- calories from protein is too much protein. This is
tion in diets. Since, many of the “bad” fatty food- clearly misguided thinking. Protein needs of the
stuffs are also excellent sources of balanced protein, body are determined by absolute amounts, not per-
part of the public health message has been to con- centage. The only way to determine if 30% is too
vince people that they don’t need as much protein much or too little is to know the total caloric in-
as they have been led to believe. Third, individuals take. For example, a diet consisting of only 25 g of
with certain forms of renal disease can slow pro- protein per day is 100% protein, but is clearly defi-
gression with a low protein diet. Fourth, high pro- cient in terms of protein needs; while a diet of 5,000
tein intakes have been associated with a greater de- calories with 10% protein is still consuming 125 g
gree of calcium excretion and reduced bone forma- of protein per day which is about double the cur-
tion in young women suggesting that low protein rent RDA recommendations. The percentage of pro-
diets may prevent osteoporosis. And fifth, low pro- tein is meaningless in terms of protein needs.
tein diets appear to extend lifespan. To evaluate a biologic value of protein chemical
The vegetarian argument can be dealt with easi- and biological methods are used.
ly. The assumption is made that the current RDA The chemical (calculating) method:
actually doubles the measured protein requirement
BV=38.6 + 0.634X (the Mitchell’s formula)
in order to provide enough leeway for variability in
diets. This is simply erroneous. Where this doubling where X — content of limiting aminoacid (%)
notion arises from is the fact that someone fed a diet
devoid of protein will result in a loss of protein from X= — A .100%,
the body of around 30 g per day. However, this is a A1
gross simplification and makes many assumptions where A — quantity of aminocid in tested products
that consuming 30 g ignoring the body’s compen- (mg)
satory adaptations that permit protein to be con- A1 — guantity of aminoacid in ideal protein of
served when in short supply. This is not to say that FAO.
people cannot survive on lower protein intake, but The biologic method (Bender&Miller, 1952):
rather that over time the body will adapt by slowly
lowering lean body mass. 1 – (U – U0) – (F – F0) .100
NUP = ———————————,
The second point is equally fallacious, since it I
ignores the use of low fat and/or low saturated fat where NUP — net utilization of protein
sources of animal protein. There are clearly other I — nitrogen of food
ways to reduce saturated fat intake without resort- U — nitrogen of urine during a diet containing
ing to restricting protein intake, but for this and some tested protein
other reasons discussed here, public health official U0 — nitrogen of urine during a non-protein diet
tend to adopt a narrow viewpoint. The renal disease (endogenic nitrogen)
issue first surfaced in animal studies and does ap- F — nitrogen of feces during a diet containing
ply to humans (in the setting of particular disorders); tested protein
however, it is quite another leap to conclude that F0 — nitrogen of feces during a non-protein diet
excessive protein actually initiates or contributes to Needs in protein for various groups of popula-
creation of renal disease, rather than merely exac- tion are presented in Table 14.
erbating it. There is little evidence in humans that
high protein intakes are associated with the promo-
FATS
tion of renal disease.
The data on osteoporosis are also rather clear Fats are needed in the diet to supply essential
even if misinterpreted. While there is a slight nega- fatty acids, to carry the fat-soluble vitamins A, D,

65
 Table 14. Protein RDA, g/day nary heart disease decreases. Diets of Eskimo and
coastal Japanese are rich in the w-3 fatty acids. Their
Protein of The whole death rate from heart attacks is much lower when
Target groups
animal origin protein
compared to the Western man. It is a major compo-
Children nent of the brain and retina, and has a possible role
Age Gender in nerve transmission. Research has shown that
4–6 both 33 65 many migraine suffers have experienced some re-
7–10 both 39 78 lief from consuming fatty acids.
11–13 boys 46 91 Recently a new term has been added to the fat
girls 42 83 lexicon: trans fatty acids. Since 1990, several stud-
14–17 boys 52 104 ies in women and men have shown trans fatty acids
girls 43 86
to increase total blood cholesterol and LDL (low
Adults density lipoprotein) while decreasing HDL (high
I group of labour intensity density lipoprotein) cholesterol, the protective form
18–29 men 37 67 of blood cholesterol. The Nurses’ Health Study, a
women 30 55 prospective trial involving more than 85,000 wom-
30–39 men 35 63 en, showed a positive association of trans fatty ac-
women 29 52 ids with coronary heart disease. By analyzing indi-
40–59 men 32 58 vidual food-stuffs, this study suggested that trans fat-
women 28 50 ty acids formed during the partial hydrogenation of
II group of labour intensity vegetable oils used in margarine, cookies, cakes, and
white bread accounted for all of the increased risk
18–29 men 42 77 of CHD.
women 34 61
There are naturally occurring trans fatty acids in
30–39 men 40 73
women 32 59 animal fat, but these food-stuffs did not have the
40–59 men 38 69 same association to risk of CHD in this study. An
women 32 58 increased risk of heart attack was evident only
among women consuming more than 0.5 pats of
III group of labour intensity margarine per day. The risk remained significant
18–29 men 50 91 after adjusting for other risk factors for CHD, in-
women 40 72 cluding cigarette smoking, body mass index, hyper-
30–39 men 48 87
tension, alcohol intake, dietary fat intake, and fam-
women 39 70
40–59 men 45 81 ily history of early heart attack. However, the study
women 38 69 did not address the apparent inverse relationship
between trans fatty acid intake and the intake of car-
IV group of labour intensity otene, dietary fiber, saturated fat, monounsaturated
18–29 men 59 107 fat, vitamin/mineral supplementation and the amount
women 46 84 of daily exercise.
30–39 men 56 102 The findings are thought provoking, but conclu-
women 45 81 sions cannot be drawn based on this study alone;
40–59 men 53 96
women 43 78
dietary patterns and lifestyles are what may be re-
lated to increased risk of CHD. Most margarine is
Pregnant women made from vegetable fat and provides no dietary
Pregnancy time cholesterol. The more liquid the margarine the less
first trimester 66 110 hydrogenated it is and the less trans fatty acid it con-
second trimester 69 115 tains. Therefore soft margarines are better than hard
third trimester 72 120 ones.
The American Dietetic Association and the
American Heart Association are not recommending
E, and K and to aid in their absorption from the in- that everyone substitute butter for margarine. The
testine. total amount of fat in the diet is still more impor-
Fats are a group of chemical compounds that con- tant than the contribution of trans fatty acids makes
tain fatty acids. There are three main types of fatty to heart disease risk.
acids: saturated, monounsaturated and polyunsatu- Phosphatides — biologic active substances, con-
rated. Polyunsaturated fatty acids are of two kinds, tained in the brain, heart, liver tissues (the nerve tis-
ω-3 or ω-6. ω-3 fatty acids which are present in fish sue contains them in greatest quantity. From phos-
oils have the potential for improving the health of phatides in products of a meal is most widely sub-
cardiovascular system. Medical reports show that as mitted lecithin (it’s contained in vegetable oils, eggs,
their amount in the diet increases, the risk of coro- butter, etc.).

66
 Sterines are contained in vegetative and animal bohydrate is closely related with the metabolism of
fats. Cholesterol supports metabolism processes in fats. During heavy physical exertions, when expend-
crates, connects poisonous substances and neutral- ed energy is compensated by carbohydrates of food
izes them, takes part in synthesis of bilious acids, and their reserves in the organism, formation of glu-
vitamin D, hormones of suprarenal glands cortex, cose from lipids of sufficiently capacious fat depots
sexual hormones, playing thus important physiolog- takes place. However, often a reverse phenomenon
ical role in the organism, but alongside with it looks is noted: formation of new quantities of fat due to
narrowly and as the factor, which takes part and in excess entrance of carbohydrates with food.
atherosclerosis genesis. Cholesterol metabolism is About 50–70% of the organism requirement in
determined by character of a meal and life-style. It energy is fulfilled by carbohydrates, mainly, of prod-
stabilizes physiological balance between biosynthe- ucts of vegetable origin (grains cereals, etc.). This
sis of cholesterol and using it in tissues, consump- requirement is satisfied by sugars which are pure
tion of folic acid and vitamins C, B12 , B6. The lack carbohydrates.
of fat results in exhaustion and reduction of weight, Absorption of carbohydrates is comparatively
high fat diet results in metabolic disorders, e.g. aci- high and depends on the character of food products,
dosis. the carbohydrates itself and the quality of culinary
processing. Average absorbing rate of carbohydrates
of bread and cereal products composes 94–96%, of
CARBOHYDRATES vegetables — 85%, of potatoes — 95%, of fruit and
pulps — 90%, of pastries and cakes — 95%, of sug-
Carbohydrates are very important factors of nu- ar — 99%, of milk and milk products — 98%.
trition, biological role of which is defined, basical- It follows to note that animal products, as a rule
ly, by their energetic properties. They are dynamic are not essential sources of carbohydrates. Basic
sources of energy, used in the process of muscular carbohydrates of such origin are glycogen and lac-
and mental activity. Energy capacity of 1 g of car- tose. Glycogen, possessing the properties of starch
bohydrates composes 4 kcal (16.7 kJ). Significance is present in small quantities in animal tissues, main-
of carbohydrates as a source of energy is also de- ly, in the liver and muscles and does not possess any
fined (unlike fats) by their capability to be oxidized perceptible significance in nutrition.
in the organism by aerobic as well as by anaerobic Lactose (milk sugar) is present in human milk
mechanism. They not only satisfy the organism re- and in milk of different animals in a quantity of 5 g
quirements in energy, but also promote decreasing and more per 100 g of product. Its energetic role
of acidic changes. Carbohydrates enter the compo- becomes real during systematic consumption of
sition of cells and tissues, and consequently, partic- milk, particularly in child and elderly age.
ipate in plastic processes. Brain functions, osmotic Overall all the carbohydrates depending on the
work of kidneys, many metabolic processes in the complication of their structure, solubility, speed of
liver and other organs depend on them. absorption and use in glycogen formation may be
Many carbohydrates possess expressed biologi- classified as follows:
cal activity, executing specialized functions in the 1) simple carbohydrates — sugars, divided into
organism. To them we refer ascorbic acid with its monosaccharides — glucose, fructose, galactose, and
vitamin properties, heparin preventing coagulation disaccharides — saccharine, lactose and maltose;
of blood, hyaluronic acid, increasing barrier func- 2) complex carbohydrates, including starch gly-
tion of cellular membranes of bacteria, oligosaccha- cogen, pectin substances and cellulose.
rides of womanize milk, detaining growth of some Simple carbohydrates differ by uncomplicated
bacteria in the intestine and promoting normaliza- chemical structure, due to which they are easily sol-
tion of intestinal microflora, heteropolysaccharides uble in water, easily split up (disaccharides) and
of RBC membranes, which determine specificity of ghastly absorbed. They possess expressed sweet
blood groups, and others. taste and therefore belong to sugars. However sweet-
Carbohydrates and their metabolites participate ness of sugars fluctuate in sufficiently wide limits
in the synthesis of nucleic acids, amino acids, glyc- and, when determined by the Bister Wood’s meth-
oproteins, mucopolysaccharides, co-ferments and od, further are the values: saccharose — 100, fruc-
other life important substances. They render protein tose — 173, invert sugar — 130, glucose — 74,
saving action in the organism, promoting in the xilose — 40, maltose — 32.5, ramnose — 32.5, ga-
maintenance of nitrogen balance on a lower level, lactose — 32.1, rafinose — 22.6, lactose — 1.
prevent dehydration and loss of electrolytes by the Amongst the enumerated ones, fructose possesses
tissues. the most weak properties, lactose the most strong.
Reserves of carbohydrates in the organism, ba- It follows to note, that this sign possesses undoubt-
sically, in the liver and muscles, and are compara- ful hygienic significance like coefficient of absorp-
tively not large, in relation what they should enter tion of glucose (0.178) is more than two times than
along with food continuously. Metabolism of car- that one of fructose (0.077).

67
 Monosaccharides are the most simple forms of is considerably less sweet, than glucose, and espe-
carbohydrates, used by the organism. By their chem- cially fructose, but its nutritive values are no less.
ical structure they represent themselves hexes, pos- In human nutrition basic importance is given to
sessing 6 atoms of carbon, 12 atoms of hydrogen, saccharose (sugar cane or beet root sugar), which
and 6 atoms of oxygen in their structures. during hydrolysis in the intestine splits up into two
Most spread monosaccharides are glucose (grape molecules of monosaccharides — glucose and fruc-
sugar) which is present in many fruit and pulps as tose. Sugar is met in many fruit and vegetables, but
well as formed in the organism as a result of hy- particularly in considerable quantities it is present
drolysis of disaccharides and starch of food. Partic- in the roots of sweet potato (12–24%) and in the
ularly bee honey contains large quantity of glucose stems of sugar cane (9–19%), which is the basic raw
(up to 36%) . This is most easily absorbable carbo- material for its industrial manufacturing. In XX cen-
hydrate, entering the metabolic processes without tury in comparison with XIX century consumption
any intermediate changes. It is ghastly and easily of saccharose has increased more than 7 times,
used for nutrition of brain, maintaining of physio- which is explained by the accessibility of its obtain-
logical level of sugar in the blood and creation of ing by high taste and nutritive properties and com-
reserves of glycogen in the liver. paratively cheap price. Content of saccharose in usu-
Consumption of glucose during intensive physi- al sand sugar composes 99.75% and in refined sug-
cal exertions increases endurance of the organism ar — 99.9%.
by 8–10% and promotes restoration of power dur- It has been established, that even single intake
ing rest. It is widely used in medical practice as an of big quantities of sugar or products rich in it leads
effective measure of parental nutrition of postoper- to although to temporary but sharp rise of fat con-
ative and other weakened patients. centration in blood, and in some people — even cho-
By its properties fructose is similar to glucose lesterol. Systematic excessive consumption of such
and it is also valuable and easily absorbable sugar. products may cause a stable disorder of fat and cho-
But some peculiarities are habitual to it, which are lesterol metabolism, development of obesity, lipi-
highly attractive in hygienic respect. It is slowly demia, hypercholesterinaemia, with the deposition
absorbed from the intestine, soon leaves the vascu- of cholesterol in vascular walls, tendency towards
lar bed, and detained by the liver (up to 70–80%) thromboses of coronary vessels (which is also pro-
and other organs and systems, where it is intensely moted by exhaustion of blood platelets). On the
used in metabolic necessities, and easily transformed background of indicated nutrition often hyperplasia
into glycogen. All that promotes prevention of hy- and gallbladder stones, nephrosis, caries of teeth,
perglycemia, lipidemia, and cholesterinemia, tells exhaustion of insular apparatus of pancreas (diabe-
upon on insulin formation function of pancreas. tes mellitus), disorders of composition and function
Besides, fructose is better than glucose in maintain- of intestinal microflora develop. It is known, that
ing physiological level of sugar in the blood during excessive consumption of sugar intensifies transfor-
heavy physical exertions, it follows to note, that con- mation of all present food substances possessing en-
siderably high sweetness of fructose in comparison ergetic values into fat in the body: starch, food fat
with other simple carbohydrates enables us to use and partially protein. Consequently, control after the
it in essentially small quantities for achieving nec- quantity of sugar in diet may prove to be a factor,
essary taste sense, which possesses important sig- regulating metabolism overall and fat — in particu-
nificance during forming of food rations of low ca- lar.
lories. Lactose is made up of galactose and glucose,
In the force of the indicated properties of fruc- present in milk of all animals and human milk. In
tose it is recommended to have in form of an inde- cow’s milk its content on an average composes 4.8%,
pendent food product, particularly for diabetic pa- in breast milk — 7.5%. Lactobacilli fermentate lac-
tients. In this plan it is perspective to use glucose- tose into acetic acid and CO2. On this property the
fructose syrup or maize sugar, widely used in USA, production of all sour milk products is based. As al-
Germany, Japan, England, France and other coun- ready noted, lactose is the least sweet amongst all sim-
tries. They are substituted by usual sugar during pro- ple carbohydrates and is not used in refined form in
duction (manufacturing) of ice-cream, sweet chees- the nutrition, however it possesses undoubtful signif-
es, bakery products, non-alcoholic drinks. Natural icance in composition of milk and in the children nu-
sources of fructose (as well as of glucose) are many trition. Particularly its role during breast feeding is
fruit and pulps (grape, persimmon, cherry and oth- great. It slowly splits up under the action of glucose,
er). In water-melons and melons its quantity is suf- which limits the processes of fermentation, promotes
ficiently high (up to 8% and more). Particularly bee normalization of intestinal microflora, providing pref-
honey is rich in fructose (up to 37.1%). erential growth of lactobacilli, oppressing growth of
Galactose is contained in milk sugar, lactose and putrefactive microorganisms. It is also important to
some polysaccharides — galactones, which are met know, that lactose is the least used in the organism
in composition of many vegetable slimes. Galactose for fat formation.

68
 Maltose (malt sugar) consists of glucose, and not 7. In the stomach and small intestine, fiber di-
found in free form in natural products. It is formed lutes the contents and delays the emptying and the
during hydrolysis of starch and glycogen in the in- absorption of nutrients; this promotes a feeling of
testines and as an intermediate product in the proc- fullness.
ess of fermentation during preparation of beverag- 8. In the large intestine, fiber dilutes the contents
es (beer, kvass) and during obtaining spirit. and provides a place for bacterial growth and di-
Complicated carbohydrates differ by complica- gestion. The water-holding capacity of insoluble fib-
cy of structure of own molecules and poor solubili- er in the lower intestine softens the stool and increas-
ty in water. es stool size, so that the process of elimination is
Starch belongs to the most important food car- easier and faster.
bohydrates, composing nearly 75.8% of their daily 9. In the large intestine, fibre also acts to bind
consumption. High content of starch defines ener- certain chemicals. Different kinds of fiber have dif-
getic value of many products, including bread, ce- ferent binding capacities: when fiber binds choles-
reals, pasta and other flour products, rice, potato, terol-like compounds, it lowers cholesterol, a healthy
beans. result; when fiber binds minerals, it decreases their
In the human organism under the influence of absorption, a less desirable result.
amylase of saliva and pancreas, starch, through amy- Because of these physiological effects, fiber is
lo-, erythro-, archo- and maltodextrines is trans- considered beneficial in preventing, alleviating or
formed into glucose. Espesially as this process is curing a number of diseases and conditions, includ-
completed sufficiently slowly, which provides grad- ing:
ualness of glucose release and its use in energetic — arteriosclerosis;
and other needs. This explains the absence of lipo- — excessive food intake;
genic and lipemic action of starch. — diverticular disease;
Glycogen — “animal starch”, present in liver and — irritable bowel syndrome;
muscles in a quantity of 300–400 g, composing prac- — the Crohn’s disease;
tically the whole reserve of carbohydrates, which — gallstone formation;
without filling are spent by the organism in a peri- — constipation.
od of 12–13 h. As a composite part of food prod- Recent recommendations suggest that we should
ucts, as a result of small content it does not possess be getting fiber from a variety of food-stuffs high
essential significance. However, it promotes pres- in different types of fibers, rather than from dietary
ervation of meat, by transforming it in its process supplements. A healthy diet should provide a mix-
of maturing into acetic acid, which leads to increase ture of both soluble and insoluble fibers. About 8 g
in concentration of hydrogen ions and to the forma- of daily fiber intake should be in the form of solu-
tion of acidic reaction of the medium, preventing ble fibers (pectins), such as: fruit, especially apples
development (growth) of microorganisms. Restora- and citrus, vegetables, especially leafy green varie-
tion of glycogen in the organism takes place by its ties and oat.
resynthesis from blood glucose. Major sources of insoluble fibers (cellulose and
Dietary fibre is a broad term; it includes the fol- hemicellulose) include: wheat bran, whole grains,
lowing chemicals, which form the structural com- legumes, most fruit and vegetables.
ponents of plants, including many of the plant food- A good source of fiber should have at least 3 g
stuffs we eat: (1) cellulose; (2) hemicellulose; (3) of fiber. High-fiber food-stuffs provide 5 g or more.
lignin; (4) pectin; (5) mucilage; (6) gums. The accompanying chart lists a variety of food-stuffs
The first three are insoluble fibers which can ab- and their fiber content (Table 15).
sorb and hold water in the digestive system. The oth- A healthy adult should get 20–25 g of fiber a day,
ers are soluble fibers, which are partially broken based on the assumption that we need 10–13 g of
down in digestion to a gel-like substance, which also fiber a day for every 1,000 calories consumed.
retains water. Unfortunately, most Americans consume only about
Fiber’s ability to hold water and to bind minerals 10 g.
and cholesterol-like materials results in a number of Children aged 3–18 need less fiber than adults,
physiological effects which vary depending on the and they need different amounts at different ages.
type of fiber and/or where it is in the digestive tract. To calculate a child’s daily fiber requirements, add
1. In the mouth, fiber stimulates the flow of saliva. the child’s age to the number five (for 5 g). For ex-
2. It is a natural laxative. ample, a four-year-old child needs 9 g of fiber a day.
3. It absorbs H2O, helps feeling full after eating. To get the appropriate amount of fiber, adults
4. It stimulates peristalsis. should include the following in their diets:
5. It helps to prevent digestive disorders. 1) two to three servings of whole grains (as part
6. It bulks up stools and makes it softer, reduc- of the 6–11 recommended daily servings);
ing risk of developing hemorrhoids and lessening 2) five servings of fruit and vegetables a day;
the discomfort you have already had. 3) one or two servings of legumes every week.

69
 Table 15. Sources of Fibre easily digested in the intestine and their carbohy-
drates soon enter the blood, create excess of ready
Food Amount of fibre, g%
for utilization energetic substances, which due to the
bagel 2.1 impossibility of use are deposited in a form of fat
bran bread 8.5 reserves. Consequently, indicated products possess
white bread 1.9 lipogenic, lipemic and cholesterologenic action with
cornflakes 2.0 all consequences following from this for the health
oatmeal 10.6 of person. In the form of indicated they should be
wheat flakes 9.0 limited in nourishment of elderly persons, as well
barley, pearled (minus its 15.6 in young ones, subjected to hypodynamia and with
outer covering)
tendency to obesity. Products-sources of protected
cornmeal, whole grain 11.0
rice, raw (brown) 3.5
carbohydrates contain sufficient quantity of cellu-
rice, raw (white) 1.0–2.8 lose (more than 0.4%)
apple (with skin) 2.8 Carbohydrates in relation with the possibility of
apricots (dried) 7.8 their substitution by other nutrients do not belong
figs (dried) 9.3 to strongly standardized components of nutrition.
kiwifruit 3.4 Nevertheless their minimal requirements are known.
pears (raw) 2.6 According to M. Logatkin minimal quantity of car-
prunes (dried) 7.2 bohydrates, preventing appearance of ketone bod-
raisins 5.3 ies, composes about 1 g per every gram of daily ra-
broccoli, raw 7.7 tion. From here minimal quantity of carbohydrates,
brussels sprouts (cooked) 2.6 preventing proteins from destruction is equal to 100–
cabbage (white) raw 2.4 120 g a day and warranted — 200–250 g. At the
cauliflower, raw 2.4 end of XIX century Foit determined the norms of
potatoes, white, baked, 5.5
carbohydrates for the adult person on the level of
w/skin
sweet potato, cooked 3.0
500 g a day. In Ukraine 60–70% of daily diet calo-
tomatoes, raw 1.3 ries are covered owing to carbohydrates, which near-
corn chips, toasted 4.4 ly, corresponds this standard. In European diets con-
nuts: tent of carbohydrates fluctuates in a diapason 45–
almonds, oil-roasted 11.2 65%.
coconut, raw 9.0 K. S. Petrovsky (1982) defined the requirement
peanuts, dry-roasted 8.0 of adult people in carbohydrates, not occupied by
pistachios 10.8 hard physical work on the level of 400–500 g;
tahini 9.3 350 g — at the expense of starch and 50–100 g —
tofu 1.2 due to mono- and disaccharides. This author recom-
mended adults to have in their diet on an average
Increasing fiber intake to recommended levels 15% of sugars from overall quantity of carbohy-
may cause some unpleasant effects unless a person drates, in diet of individuals, spending large quanti-
does it gradually and drinks much water. This can ties of energy in a comparatively small period of
help man avoid: time (sportsmen, porters and others) — up to 30–
— gas distention and/or diarrhea resulting from 35%.We should underline, that requirement of peo-
increases of fiber intake; ple in carbohydrates is defined accordingly to their
— colon obstruction caused by very large intake energetic expenditures, as well as by age and sex
of fiber; (Table 16).
— interference with the absorption of some mi- It is also important, that consumption of carbo-
nerals. hydrates is balanced with consumption of proteins
Depending upon the quantity of food fibers in and fats. For individuals, occupied by easy or mech-
the products, carbohydrates are classified into re- anized labour ratio of proteins, fats and carbohy-
fined and protected. To the former we refer vegeta- drates should be 1:1:4, for those occupied by partly
ble sources of carbohydrates, containing less than mechanized labour — 1:1:5, during long period
0.4% of cellulose, as well as sugar food products physical exertions — 1:0.8:6, for aged people —
with overall quantity of carbohydrates (or carbohy- 1:0.8:3.
drates together with fats) more than 70%. In the list Standardization of carbohydrates may also be
of such products there are sugar, honey, sweets, conducted in accordance to energetic value of daily
chocolate, khalva, biscuits, pastry cakes, jam, prod- ration, when in every 1,000 kcal 137 g of these are
ucts of high carts of flour, etc. These products are recommended.

70
 Table 16. Recommended Normatives of Carbohydrates Consumption for Adults, g/day
Age
Group of
labour in- 18–29 30–39 40–59
tensity men women men women men women
I 378 324 365 310 344 287
II 412 351 399 337 378 327
III 440 371 426 358 406 344
IV 518 441 504 427 486 406
V 607 – 574 – 546 –

VITAMINS 1 retinol equivalent = 3.33 IU vitamin of A

activity from of retinol
Vitamins are essential for normal functioning of = 10 IU of vitamin A
specific enzyme systems, e.g. those involved in activity from
methabolism or other bodily activities. If diets are beta-carotene
deficient in specific vitamins, characteristic and RDA of vitamin A:1,000 µg of retinol equiva-
readily recognizable diseases occur; more often, lents per day (in Australia, India and some other
multiple deficiencies and mixed clinical pictures are countries — 750 µg).
seen. Vitamins could be classified into two groups: For the majority of people, most vitamin A ac-
fat-soluble (A, D, E and K) and water-soluble (vi- tivity is derived from carotenoids and this is the saf-
tamins C and group B). est way to have it to avoid vitamin A toxicity. Vita-
Vitamin A. Some food-stuffs contain both vita- min A supplements are more likely to contain pre-
min A itself, and other substances that can be con- formed vitamin A, which is toxic in large amounts.
verted to vitamin A, known as provitamin A, vita- The only adverse effect of excessive intake of caro-
min A precursors or carotenoids. Although it is tenoids appears to be a possible yellow-orange ap-
possible to have a toxic amount of preformed vita- pearance of the skin.
min A, this appears not to be the case with provita- Of great interest is the growing evidence that a
min A, so that it is clearly safer to have more of the high intake of carotenoid-containing food-stuffs may
latter. be protective against certain cancers such as lung
Vitamin A is a fat-soluble vitamin like vitamins and prostate cancer. In general, green leafy vegeta-
D, E and K. It is therefore necessary to have some bles are good sources of provitamin A.
fat in the diet for these vitamins to be adequately There is no recommended intake specifically for
absorbed. provitamin A. Provitamin A has about one-sixth of
One of the most important consequences of vi- the biological activity of retinol so we would need
tamin A deficiency is dryness of the eyes eventual- six times more of provitamin A than of retinol if
ly leading to blindness. It remains one of the main the provitamin was our only source of vitamin A
causes of blindness in the world. Night blindness is supply (Fig. 26).
also an eye complication of early vitamin A defi- Vitamin D originates from animal food (cod liv-
ciency. er, butter, etc). This vitamin is important for the me-
The units for expressing the amount of vitamin tabolism of calcium. Substantial amounts of vitamin
A changed from time to time because of the need to D3 (cholecalcipherol) are produced in the skin by sun-
consider both preformed vitamin A (called retinol) light. From the diet or the skin it is converted into a
and provitamin A (a group of components called biologically active form in the liver and kidneys. Cal-
carotenoids, of which beta-carotene is the most ac- cipheroles promote absorption of calcium and phos-
tive and important). The present custom is to ex- phate from food which is metabolized for minerali-
press the total amount of vitamin A activity as equiv- sation of the bones and cause release of calcium from
alent to so many micrograms of retinol. But some the bones. Uniquely for a vitamin it has hormone-
vitamin preparations may express the amount of vi- like functions. RDA of vitamin D is 400 IU per day.
tamin A in different ways, so to help you compare. Vitamin E originates from plants. It is found in
A list of conversion factors is given below: vegetable oils such as corn, olive, palm, peanut and
1 retinol equivalent = 1 µg of retinol cotton-seed oils. Animals acquire their vitamin E
= 6 µg of β-carotene from plants directly, or by eating other animals that
= 12 µg of other provitamin have derived their vitamin E from plants and stored
A carotenoids. it in their liver, muscles and fat. Vitamin E has an
The original system using international units (IU) important function as an antioxidant. As such, it pre-
was different, so: vents the degradation of polyunsaturated fat and oth-

71
 Highest deficiency
Mild deficiency

Fig. 26. Vitamin A Deficiency in the World

er compounds by oxygen. It may have some addi- is fat-soluble. Those with liver disease may require
tional functions in the membranes of body cells. more vitamin K.
Although an attractive idea, there is really no good Some proteins in bone and kidney are vitamin K
evidence that vitamin E retards the aging process dependent, so that vitamin K may have functions in
or reduces coronary heart disease. these tissues as well (Table 18).
It has been recommended that enough vitamin E Another way of expressing vitamin K require-
should be present in food containing polyunsaturated ment is to say that about 2 µg/kg of the body weight
fat in order to prevent oxidation (degradation) of the per day are needed, but half of these could come
fat. Up to 10% of dietary energy comes from poly- from gut bacteria (Table 19).
unsaturated fat, 10 to 20 mg of vitamin E per day Vitamin B1 (thiamin). Whether there is a thia-
adequately protects the fat and provides enough of min deficiency or not can depend not only on the
the vitamin for an adult. An alternative recommen- amount of thiamin ingested, but on the presence of
dation is that the diet should contain 0.4 mg vita- thiamin antagonists in food.
min E for each 1 g of polyunsaturated fatty acid con- For example, an enzyme (a natural substance that
sumed. Vitamin E can be found in different forms speeds up a chemical reaction), called thiaminase,
known as tocopherols or tocotrienols. Although occurring in raw fish can break down thiamin, and
there is some variation in their biological activity, cause beri-beri in some people. One of the most sig-
about 1 mg vitamin of E is equivalent to 1 IU (Ta- nificant losses of thiamin from food occurs in the
ble 17). milling of cereals. But thiamin is also water soluble
Vitamin K cannot be made by our bodies, but and can be lost in cooking water. It can also be de-
not all vitamin K needs to be obtained from food, stroyed on heating and is sensitive to air or oxygen
because bacteria in our gut can make it. Probably, and also to alkaline conditions. In addition, alcohol
about half of our vitamin K needs can be made by can reduce the availability of thiamin to the body. For
gut bacteria. Vitamin K is involved in the forma- these various reasons, in both developing and devel-
tion of special liver proteins, known as coagulation oped countries, thiamin deficiency can be a problem.
factors, which, when circulating in our blood, re- Thiamin is involved in the action of certain enzymes
duce the risk of haemorrhage or bleeding. Newborns in the body, especially for decarboxylases enable car-
can sometimes suffer from vitamin K deficiency, bohydrate to be used as energy. Thus, thiamin defi-
like people who do not absorb fats, since vitamin K ciency results in Wernicke — Korsakoff’ psychosis,
dry beri-beri and wet beri-beri, respectively.
Table 17. Recommended Daily Dietary The requirement for thiamin relates to the
Intake of Vitamin E Expressed amount of energy, especially carbohydrate consumed
as Alpha-Tocopherol Equivalents (Table 20).
Target group Vitamin E, mg
Table 18. Safe and Adequate Daily
Infants 2.5–4 Intake of Vitamin K
Children 5–11
Target group RDA, µg
Adult men 7
Adult women 7 Infants 10–20
Pregnancy 10 Children and adolescents 15–100
Lactation 9.5 Adults 70–140

72
 Table 19. Vitamin K Content in Some Food-stuffs Tryptophan is a constituent of protein, although not
all proteins are good sources of tryptophan. To ob-
Product Content, µg% tain 1 mg of niacin, we need 60 mg of tryptophan.
Apples less than 5 Thus, if both niacin and tryptophan in food are tak-
Asparagus 21 en into account, the niacin equivalent (mg) in food
Beans, green 22 can be worked out. However, not all niacin in food
may be equally available to the body, because some
Beef, mince 7
are rather tightly bound to other food constituents
Beef, liver 100 and not easily released. Since niacin is water solu-
Broccoli 100 ble, losses can occur by discarding water contain-
Cabbage 100 ing the dissolved vitamin.
Carrots 15 Those at particular risk of niacin deficiency are
Cauliflower 150 the socio-economically deprived, those with a high
Lettuce 200 consumption of corn, which is low in both tryptophan
and niacin, and alcohol abusers. Pellagra is a condi-
Milk (cow’s) 5
tion resulting from niacin deficiency, in which there
Milk (cow’s, skim) 4 are symptoms of dermatitis in skin exposed to the sun,
Oranges less than 5 diarrhoea and dementia. In lesser degree of deficien-
Peas 19 cy, general weakness, loss of appetite and indiges-
Potatoes 20 tion can occur, but these symptoms can also occur in
Soya beans 190 many other circumstances (Table 21).
The forms of vitamin B6 found in food are pyri-
Spinach 240
doxine, mainly in vegetables, and pyridoxal and py-
Strawberries 13 ridoxamine, mainly in food-stuffs from animal
Wheat bran 80 sources. Vitamin B 6 is water soluble and can be lost
Wheat germ 37 by discarding water in which it is dissolved. It is
also sensitive to light, air or oxygen and to alkaline
conditions. Vitamin B6 is involved in the function-
Vitamin B2 (riboflavin). Riboflavin, like other ing of some enzymes (natural substances that speed
water-soluble vitamins, can be lost when cooking. up chemical reactions), especially those involved in
Water containing the dissolved vitamin is discard- protein metabolism, the formation of chemicals for
ed. Riboflavin can be destroyed by the action of ul- transmission of impulses in brain and nerves, and
traviolet radiation in sunlight. A particularly impor- in red blood cell formation.
tant loss of this vitamin can occur in mill packed in With early deficiency of vitamin B6, ill-defined
clear containers when they are exposed to sunlight symptoms such as sleeplessness, irritability and
during or after delivery. The products of this destruc- weakness may occur, but, of course, their presence
tion can also cause a loss of vitamin C. may be for other reasons. If you have been on high-
Riboflavin deficiency results in inflammation of dosage of vitamin B6, you may develop these symp-
the tongue and lips and also cracking and dryness toms during its withdrawal as your body readjusts
of the lips and corner of the mouth (cheilosis) and to more normal intakes. A bigger vitamin B6 defi-
other symptoms. Riboflavin deficiency in children ciency may lead to depression, convulsions, abnor-
causes growth retardation. Inadequate intakes of ri- mal nerve functions (especially in the limbs), der-
boflavin would normally be associated with a defi- matitis, cracking of the skin at the corner of the
ciency of other B-group vitamins, which would re- mouth and the lips, a smooth tongue, and anaemia.
sult in multiple problems. Those at risk because vitamin B6 deficiency in-
Niacin (vitamin PP) can be obtained from food clude alcohol abusers. Certain medications, such as
or made in our bodies from amino acid, tryptophan. the oral contraceptive pill and isoniazid, which are

Table 20. Recommended Daily Dietary Table 21. Recommended Daily Dietary Intake
Intake of Thiamin of Niacin
Target groups and conditions RDA, mg Target groups and conditions RDA, mg
Infants 0.2–0.4 Infants 4–7
Children 0.5–1.2 Children 9–22
Adult men 1.6–2.5 Adult men 14–20
Adult women 1.3–1.9 Adult women 10–14
Pregnancy 2.0 Pregnancy 14–16
Lactation 2.4 Lactation 17–19

73
used to treat tuberculosis, may increase vitamin B6 Table 22. Recommended Daily Dietary
requirement. In some metabolic diseases the require- Intake of Folacin
ment of vitamin B6 is increased.
Target groups and conditions RDA, mg
Vitamin B12 (cyanocobalamin). Animals ulti-
mately acquire vitamin B12 from microorganisms, Infants 50–75
people eating animal products are unlikely to suffer Children 100–200
any deficiency. People in traditional vegetarian cul- Adult men 200
tures probably obtained most of their vitamin B12 Adult women 200
through microbial contamination of food. Small
Pregnancy 400
amounts may also be obtained from water through
its association with soil microorganisms, and from Lactation 350
bacteria normally living in the mouth. With newer,
more hygienic practices, vitamin B12 deficiency
sometimes occurs in people on a vegetarian diet, Biotin (vitamin H) deficiency was first recog-
especially the infants of vegetarian mothers. It has nized not because of inadequate amounts in the diet
been suggested that a few plants, like comfrey, might but because of the effects of a chemical called avi-
be sources of vitamin B12 . din, which is found in raw eggs. Avidin binds and
One reason why vitamin B 12 deficiency is rare inactivates biotin. Biotin can be made by gut bacte-
is that the liver stores in our bodies can last for as ria and absorbed from the large bowel, so that not
long as 5 years or more. Vitamin B12 is water solu- all biotin needs to be obtained from food. Theoreti-
ble and can be lost in cooking water. It is not sensi- cally, antibiotics that affect gut bacteria could re-
tive to heat, light, air or oxygen, but can be destroyed duce the amount of biotin available. Biotin is water
by alkaline conditions. Vitamin B 12 and folacin are soluble, sensitive to air and oxygen as well as to al-
involved together in the formation of the genetic ma- kaline conditions. The vitamin acts as part of en-
terial in the nuclei of body cells (DNA), and in the zyme systems involved in building up chemicals
formation of RNA, which is another important containing carbon and oxygen, such as fats and glu-
chemical involved in protein synthesis. The main cose.
features of vitamin B12 deficiency are anaemia and Infants may be at risk of biotin deficiency, which
disordered function of the central nervous system. shows up as a “seborrheic dermatitis” (Swift’s der-
The condition called pernicious anaemia results matitis) that responds to biotin. Consumption of raw
from an inability to absorb vitamin B12 rather than egg can cause biotin deficiency because protein of
through dietary deficiency. Hence, in this condition, egg-white — avidin which is antibiotin factor. Also,
vitamin B12 injections are given. It is worth noting some infants have a metabolic disorder requiring
that vitamin B12 contains cobalt and our bodies need extra biotin. There has been some suggestion that
for cobalt is a need for vitamin B12. “cot deaths” or the sudden infant death syndrome
Folacin (vitamin B9) is present in many forms may be due, in some cases, to an inadequate intake
in food. It is sometimes referred to as folic acid, or of biotin.
folate. The availability to the body of folacin in food Biotin in human milk averages about 10 µg per
depends not only on the form, but also on other food 1,000 kcal (4,200 kJ) and in infant formulae is usu-
properties, such as acidity, the amount of dietary fi- ally at least 15 µg per 1,000 kcal . However, a high-
bre and the amount of carbohydrates. Folacin is er concentration of biotin may be preferable for in-
water soluble and easily lost in discarded cooking fant formulae because nutrients can be more bio-
water. It is also sensitive to heat, to air or oxygen logically available to the infant from human milk
and to alkaline conditions. Folacin, like vitamin B12, than from infant formulae.
is involved in the formation of the genetic material Vitamin C (ascorbic acid). Probably the first
of newly forming cells and in protein formation. The disease to be recognized as being caused by a nutri-
consequences of deficiency include anaemia and tional deficiency was scurvy, when it was found that
defective lining of the gut, adversely affecting ab- certain food-stuffs could prevent the disease. Scur-
sorption of many nutrients. Since the number of vy was described by the Egyptians and Greeks, but
blood platelets (which play a part in blood clotting) it was Bachstrom in Leiden in 1734 who maintained
can be low with folacin deficiency, a tendency to that it was due to a lack of fresh vegetables in the
prolonged bleeding can also occur. diet. In 1795, the British Admiralty adopted James
Those at risk from folacin deficiency include us- Lind’s recommendations for citrus fruit to prevent
ers of certain medications, pregnant women, the eld- seaboard scurvy and, thereafter, British sailors were
erlies and alcohol abusers (Table 22). nicknamed “limeys”.
Pantothenic acid is widely distributed in nature In scurvy, the connective tissues of the body are
and is present in a wide variety of food-stuffs, efi- defective; the tissues are fragile, and bleeding oc-
ciency is, therefore, very rare. It is water soluble, curs into the skin, from the gums and into deeper
heat sensitive and can be degraded in both acid and tissues. Wound healing is also poor. Changes in the
alkaline conditions. brain and nerve function occur, with mood and per-
74
sonality changes. Muscle weakness and proneness lagen, the intercellular “cement” in healthy condi-
to infection may occur. Our bodies’ ability to de- tion; are essential for the proper absorption and use
toxify certain chemicals may also be reduced in scur- of vitamin C; prevents vitamin C from being de-
vy. It seems likely that there may be lesser degrees stroyed in the body by oxidation; beneficial in hy-
of vitamin C deficiency than the extreme of scurvy. pertension; helps hemorrhages and ruptures in the
Vitamin C can be lost from food-stuffs because capillaries and connective tissues and builds a pro-
of its water solubility, and sensitivity to heat, air or tective barrier against infections. Quercetin is a very
oxygen. The addition of alkalis, such as bicarbonate highly concentrated form of bioflavonoids derived
of soda, and the use of copper cookware can also from citrus fruit. Deficiency may result in varicose
destroy it. veins, tendency to bruise and bleed easily, appear-
People at risk from vitamin C deficiency include ance of purplish spots on the skin.
those who avoid fruit and vegetables, those with
poor cooking, the elderlies, alcohol abusers and cig- MINERAL SALTS
arette smokers. Persons with chronic diseases have
high risk of vitamin C deficiency . The mineral substances play an important role
Recommendations about vitamin C intake were in plastic processes, serve a material necessary for
first concerned with the prevention of scurvy. Rec- construction of tissues of a growing organism. They
ommended intakes of about 30 mg per day do not are necessary for formation of a skeleton, muscular
usually “saturate” the body tissues with vitamin C and other tissues, which define growth of the body,
and, indeed, this may not be necessary. But to satu- for normal development and function of endocrine
rate body tissues, no more than 100 to 130 mg per glands, production of biologically active substanc-
day are required. With intakes above this, our bod- es. In salts of calcium the dairy products, egg yolk,
ies adapt by increasing breakdown of vitamin C or nuts, beans and vegetables are rich. The greatest
excreting it in the urine. From a mixed diet it would quantity of phosphorus is in cottage cheese, egg
be difficult to have more than about 400 to 500 mg yolk, meat, oatmeal, nuts and some fruit. Rye bread,
of vitamin C per day (Table 23). peas are rich in salts of magnesium. The vegetables
It has been suggested that daily intakes of vita- and fruit, meat, fish (also wheaten and rye bread,
min C in excess of 500 mg may be of benefit. There porridges) are rich in salts of potassium. For aver-
is some evidence that amounts of this kind may re- age norm of the cooking salt for children of school
duce the symptoms of the common cold (Polling, age accept 8–10 g per day. The subproducts (liver,
1965). This raises the question of non-nutritional or kidney), fish, egg, caviar, seafood are richest in mi-
drug-like properties of the vitamin. The possible croelements.
adverse effects must also be considered. These in- Sodium occurs naturally in many food-stuffs and
clude: “rebound scurvy”, which may occur if you is also added in the form of salt or other sodium-
are coming off high-dosage of vitamin C; increased containing substances. Common salt or diatory salt
excretion of oxalic acid in the urine which may lead is a chemical compound of sodium and chlorine and
to “stones” in the urinary tract; an increased absorp- is called sodium chloride. The sodium content of
tion of iron in those susceptible to iron overload; food has important implications for health. Salt con-
increased absorption of toxic metals, such as mer- tains about 40% of sodium, and a teaspoon of salt,
cury; and interactions with certain medications, for which weighs about 5 g, contains about 2 g of sodi-
example warfarin, aspirin, antidepressants and the um.
contraceptive pill. Rock salt and sea salt are almost entirely sodi-
Bioflavonoids (hesperidine, rutin, quercetin, um chloride, with only traces of other elements
etc.) are vital in their ability to increase the strength (minerals). Iodized salt contains about 0.03 mg of
of the capillaries (blood vessels) and to regulate their iodine per 1 g of salt. It is intended as a supplement
permeability. They assist vitamin C in keeping col- for people whose diet is iodine deficient. Common

Table 23. Recommended Dietary Intake of Vitamin C

National RDA, mg/day

Target groups and conditions
Australia USA Ukraine
Infants 30 35 35
Children 30–50 45 50
Adult men 30 60 70
Adult women 30 60 70
Pregnancy (2nd and 3rd trimester) 60 80 100
Lactation 60 100 150

75
food additives, such as house-hold soda, some pre- um as it is present in a large number of food-stuffs.
servatives, and monosodium glutamate (MSG), also Deficiency can occur when there are losses result-
contribute to the total amount of sodium we con- ing from excessive urination or from prolonged
sume. vomiting and diarrhoea. Although sodium is an im-
Probably one-fifth of the population, because of portant dietary factor in high blood pressure for
genetic predisposition, may be increasing their risk some people, variations in the ratio of sodium and
of high blood pressure (hypertension) by high sodi- potassium will also affect blood pressure under cer-
um intake. Such people have a high incidence of tain circumstances. An increase in potassium intake
hypertension and strokes. High blood pressure is appears to partly offset the adverse effect of sodi-
rarely seen in those who consume less than 1.2 g um on blood pressure. If you are prone to high blood
(1,200 mg) of sodium per day. But sodium is an es- pressure it would be beneficial to decrease sodium
sential nutrient, and we need a certain amount for intake and increase your dietary intake of potassi-
normal body function. A safe intake is considered um, by eating more food-stuffs having low amounts
to be between 0.9 and 2.3 g of sodium per day, al- of sodium and significant amounts of potassium,
though in special circumstances, such as excessive such as fruit and vegetables.
sweating and diarrhoea, higher levels may be need- The use of potassium salts as substitutes for com-
ed. mon salt (sodium chloride) is dangerous, and over-
There is usually no need to increase salt intake use can be fatal. Excessive potassium intake can
in hot climates to avoid cramps, fainting and other cause heart irregularities and can cause the heart to
symptoms because the body’s hormones will adjust stop beating (cardiac arrest). Potassium supplements
over a few days and conserve body sodium. Exces- and bulk substitutes should not be used without med-
sive heat presents other risks and should, in any case, ical advice. High potassium intake can be particu-
be avoided. larly dangerous for children.
Some people find it hard to reduce their intake Calcium, in combination with phosphorus and
of sodium. We all have an ability to taste salt, but other elements, is necessary to give strength to bones
the extent to which we like our food salted can be and teeth. When our dietary intake of calcium is
modified by experience. The amount of salt we con- greater than our bodies’ requirements some excess
sume cannot be wholly controlled by the moderate of calcium is stored in our bones. When our day-to-
use of the salt shaker at the dinner table. This use day intake of calcium does not meet requirements,
only accounts for about one-third of our daily in- the calcium stored in bone becomes available to
take. Up to half of our salt intake is from processed meet this shortfall.
food, with the balance occurring naturally in food Calcium has other important roles. It is essential
and water. The amount consumed in processed food for normal clotting of blood and is a vital link in
is difficult to control, although with highly salted transmission of nerve impulses. It is also an essen-
food-stuffs, taste is a reliable guide. Some items that tial element in enzyme regulation, in the secretion
do not taste highly salted can contribute significant of insulin in adults, and in regulation of muscle func-
quantities of sodium to our diet because of the tion.
amounts we consume. Examples include bread, to- During periods of growth the demand for calci-
mato sauce, cakes and biscuits. Many “take-away” um is greater than usual, although some calcium is
food-stuffs, such as fish and chips, hamburgers and incorporated into bone at certain other stages of life.
Chinese food, are highly salted. Bottled mineral Thus, children, adolescents and pregnant and lac-
waters can contribute a significant amount of sodi- tating women need additional calcium. Adults con-
um. An indication of sodium content is usually giv- tinually need to replace calcium that is lost from the
en on the label. body in urine and faeces and to a lesser extent in
An increase in potassium intake seems to offset sweat.
the adverse effect that sodium has on blood pres- The bodies’ utilization of the calcium in food can
sure. Food-stuffs that contain significant amounts be adversely affected by the presence of two chem-
of potassium and also low levels of sodium are fresh icals called phytic acid and oxalic acid. Phytic acid
and frozen fruit and vegetables. But there is no jus- is found in the bran portion of cereals, and oxalic
tification for the unrestricted use of potassium salts acid is present in significant quantities in spinach
as substitutes for sodium, as this would present new and rhubarb. The magnitude of the effect depends
problems. Potassium supplements and salt substi- on the amount of these acids we consume and a high-
tutes can be potentially hazardous to health and er intake of calcium may be necessary if large quan-
should only be used under medical supervision. tities of food-stuffs containing oxalic and/or phytic
Potassium, like sodium, is essential for normal acids are eaten. Diets high in protein and salt also
body function. Potassium is necessary for muscle increase the requirement for calcium.
function, the transmission of nerve impulses and for Osteoporosis, a decrease in the density of the
carbohydrate and protein metabolism. It is unlikely bone, is a disease that becomes especially evident
that we would have a dietary deficiency of potassi- in women after the menopause, and is responsible

76
for many serious bone fractures that occur in this tabolism of fats, carbohydrates and proteins, and in
group. It is associated with a decrease of calcium in the effective utilization of many of the B-group vi-
the bones and may be due to an imbalance between tamins, and in energy metabolism.
calcium and phosphorus earlier in life. Obtaining Phosphorus is very widely distributed in both
adequate calcium and avoiding factors that adversely plant and animal food-stuffs. Because of its wide-
affect calcium balance throughout life may be help- spread occurrence, it is unlikely that you will have
ful in preventing the development of this disease. any dietary deficiency. But you could become defi-
In old age it may be difficult to replace lost bone cient if you used large amounts of antacids for a long
calcium. time. Also, people with faulty kidneys could have a
Contrary to a popular belief, finge rnail changes deficiency of phosphorus.
are not an indicator of inadequate calcium intake. Pregnant and lactating women, and children dur-
Many enzyme (natural substances required for ing years of rapid growth (10 to 18 years) should
chemical reactions in the body) systems that are have a higher phosphorus intake of 1,200–1,500 mg
needed for the transfer of energy within our bodies per day.
must have a supply of magnesium. Magnesium also We obtain most of our sulphur from proteins in
plays a part in the normal functioning of muscles the diet. The essential amino acid methionine is one
and nerves. of several sulphur-containing components of protein.
Magnesium occurs widely in food-stuffs, and The proteins are broken down into their constituent
cereals and vegetables are particularly good sourc- amino acids, and the sulphur-containing amino ac-
es. An inadequate supply of magnesium in the diet ids are reused for the formation of body proteins
is rare. However, deficiency can occur as a result needed for growth, tissue maintenance and enzyme
of prolonged vomiting, diarrhoea und other gastroin- production. New sulphur-containing compounds are
testinal disorders. Chronic alcoholics frequently suf- also made by our bodies from the protein compo-
fer from magnesium deficiency, which may be due nents. Some of these have metabolic function, and
to low intake and large losses in urine. some are used to remove potentially toxic substanc-
Iron is an essential element in the diet. It is a es, including certain drugs, from the body.
component of body systems that are involved in the Chlorine is present in food and our body almost
utilization of oxygen. It forms haem, part of hae- entirely in the form of chloride. Chloride is impor-
moglobin. Two thirds of iron in the body presents tant in maintaining water balance, and is an essen-
as haem. The remainder is stored in the liver, spleen, tial component of gastric juice. We get our supplies
bone marrow and muscles where it is present as of chlorine from food mainly in the form of sodium
myoglobin (acting as an oxygen reservoir within the chloride (salt). Dietary deficiency of chlorine is rare
muscle fibres). Iron is involved in the production and is only likely to occur if you have excessive loss-
of red blood corpuscles, oxygen transport. es from your body. This can result from prolonged
We cannot use all food sources of iron with equal vomiting, diarrhoea or profuse sweating. If you are
efficiency. This means that not all of the iron con- on a severe sodium-restricted diet it may be neces-
sumed is available to our bodies. Animal sources sary to obtain chlorine from other sources.
of iron are more readily utilized than those from There is no recommended dietary intake for chlo-
plant food-stuffs. The recommended dietary intake rine in the most countries. For the average adult an
for iron takes into account the varying availability estimated safe and adequate amount of chlorine is
of the iron from food. The presence of vitamin C in closely related to that for sodium and is in the range
the meal can enhance the availability of iron. of 1,700 to 5,100 mg of chlorine per day. To keep
Iron deficiency is the most commonly occurring to this level, most of us would need to reduce the
nutrient deficiency. In healthy people, iron deficien- amount of salt used in cooking or added at the ta-
cy can occur in infancy, during periods of rapid ble. Additionally, highly salted food-stuffs should
growth, because of menstruation, and during preg- be avoided.
nancy. Additional amounts of iron are needed dur- Our bodies need zinc for many different func-
ing these periods. Blood loss and disorders of the tions, which include protein and carbohydrate me-
gastrointestinal tract can also lead to deficiency. tabolism, wound healing, growth and vision. Zinc
Severe iron deficiency can result in anaemia. is vital to 200 enzymes. Zinc metalloenzymes are
Excessive body levels of iron can result in poi- found virtually in every metabolic pathway. Zinc is
soning, although, for healthy individuals, daily in- a component of insulin, involved in formation of
takes of 25 to 75 mg should not cause any effects. bone tissue, healthy skin, vitamin A metabolism,
Poisoning has occurred in children who have eaten phosphorus absorption, linoleic acid transformation.
adults’ iron supplements. It reinforces the immune system. A too high intake
Phosphorus is an important element for many may compromise the absorption of copper. It func-
essential processes in the body. In combination with tions in the antioxidant enzyme superoxide dis-
calcium it is necessary for the formation of bones mutase (copper-zinc SOD). Greater assimilation
and teeth. Phosphorus is also involved in the me- achieved by supplementing a form of zinc with a

77
higher absorption rate such as zinc orotate, zinc in iodine intake. Some food-stuffs, such as cabbage,
amino acid chelate or zinc yeast. Several groups of sprouts and other brassicas contain natural anti-thy-
people are at risk of developing dietary zinc defi- roid substances. In circumstances where both large
ciency. If they restrict their food to vegetables, and quantities of these food-stuffs are eaten and the level
particularly wholegrain cereals, they could become of dietary iodine is marginal, goitre could develop
deficient in zinc. Although zinc is present in these (Fig. 27).
food-stuffs, it is not utilized by the body as efficient- Excessive amounts of iodine can also lead to goi-
ly as the zinc in other sources, such as meat, eggs tre. This has occurred where food-stuffs, such as sea-
and liver. Alcoholics also develop zinc deficiency, weeds, which are rich in iodine, are commonly eat-
due to an inadequate diet and to large losses of zinc en. Although excessive iodine intake is not common,
in their urine. Zinc deficiency also appears to be a it should be noted that, in addition to food, many
problem in some disease states. Inadequate zinc in- cough medicines and milk contaminated with an
take can result in retarded growth, delayed wound iodine containing sanitizing agent also contribute to
healing, loss of taste sensation and dermatitis. iodine intake. But it is unlikely that any harmful
The dietary requirement for zinc must take into effects would occur with habitual intakes up to
account the different degree of availability of zinc 300 µg per day (Tables 24, 25).
in different food-stuffs. Animal products are more The usual form of fluorine in our bodies is flu-
efficient sources compared with cereals. The recom- oride. Populations with a low intake of fluoride
mended dietary intake for zinc assumes that the zinc (about 1.2 mg per day for adults) have more dental
comes from mixed animal and plant sources. For decay (caries) than those with a higher intake (3.5
vegetarians a higher intake may be necessary. to 4.5 mg per day for adults). Main source of fluo-
A human organism should have an adequate in- rine is drinking water (70–90% of total intake). The
take of iodine to form the hormones produced by fluoridation of public water supplies in low fluo-
the thyroid gland. If the dietary level of iodine is ride areas has significantly reduced decay in these
inadequate, the thyroid gland swells and produces areas. The fluoride content of a water supply is of-
goitre. Unless treated, this condition can cause men- ten described by the term “parts per million” (ppm).
tal retardation and stunted growth in children, hair 1 ppm = 0.1 mg/100 ml. About 1 ppm seems to be
loss, slowed reflexes, dry, coarse skin and other ef- the optimal level of fluoride in the water supply; a
fects in adults. Food-stuffs produced in regions litre of such water would provide 1 mg of fluoride.
where soils are low in iodine, such as Tasmania in At 2 ppm, mottling of tooth enamel may occur. The
Australia, the Thames Valley in the U. K., the north- condition of “fluorosis” or excessive deposition of
west region of the USA, northen India, Alpine coun- fluoride in bones, with associated skeleton deform-
tries are deficient in this element. Goitre caused by ities, is only present after prolonged consumption
iodine deficiency can be prevented by supplement- of 20 to 80 mg of fluoride per day. The intake of
ing the diet with added iodine. This is commonly
done by adding sodium iodide to diatery salt to pro-
duce iodized salt. For some people, iodized salt can Table 24. Recommended Daily Dietary
be an important source of iodine, and a change to a Intake of Iodine
low-salt diet should make allowance for the decrease Target groups and conditions RDA, µg/day
Infants 50–60
Children 70–150
Adult men 150
Adult women 120
Pregnancy 150
Lactation 200

Table 25. Iodine Content in Some Food Products

Food Iodine content, µg%
Iodized salt 3,000
Seafood 66
Vegetables 26
Meat 26
Eggs 13
Dairy products 10
Bread and cereals 4
Fig. 27. Endemic Goiter in Philippines

78
 Table 26. Fluoride Content from 10 to 1,800 µg per day. Cobalt in a different
of Some Food-stuffs and Beverages chemical form (i. e. not as a part of vitamin B12 )
Food Fluoride content, mg% will stimulate blood formation, but this is probably
not a normal action.
Crude sea salt 3.5–5.5 When cobalt was used to stabilize beer froth, it
Fish and seafood 0.5–1.0 was found to have a toxic effect on the heart. Its
Tea 0.05–0.2 toxicity, at cobalt intakes of about 8,000 µg per day,
probably arose from its interaction with alcohol it-
self, and other nutritional problems created by al-
fluoride, at the higher end of the safe range, has also cohol.
been associated with reduced osteoporosis (“thin- No definite disease due to deficient molybde-
ning of bones”), which is a fairly common condi- num intake in humans has been recognized. How-
tion in elderly people. Therefore, this also may be ever, it is an element that is part of enzymes that
favourably affected by the fluoridation of water. are involved in the production of waste products
Another cause of fluorosis can be consumption of prior to excretion. The molybdenum content of food-
tea (Tibet, China) (Table 26). stuffs depends on the soil where plant food-stuffs
Chromium is considered to be an essential ele- are grown.
ment for humans. Those without it in their diets, Tin is an essential element for the growth of rats,
such as hospital patients on artificial meal, develop but whether this applies to human growth is not
a diabetes-like condition, with high blood sugar (glu- known.
cose) levels. The availability of chromium to the Copper is an essential part of several body en-
body may depend on the form in which it is present zymes (natural substances required for chemical re-
in food. For example, it is found in a form in asso- actions in the body). It is necessary for iron metab-
ciation with other compounds in brewer’s yeast and olism, for the formation of the brown pigment, mel-
known as “Glucose Tolerance Factor (GTF)”. Eld- anin, in hair and skin, and in the functioning of the
erly people may be an at-risk group from chromi- body’s central nervous system.
um deficiency. Copper deficiency due to inadequate dietary in-
Manganese forms a part of substances essential take is rare. However, a deficiency may arise due to
for body metabolism, known as enzymes, no defi- an inherited metabolic abnormality. Sources of cop-
nite deficiency has been recognized in humans. In per include shellfish, liver, kidney and nuts. The
animals, deficiency can lead to abnormalities of the amount of copper in household water supplies de-
developing skeleton, of balance, and of carbohydrate pends on the type of pipe and the hardness of the
and fat metabolism. Manganese poisoning from food water. More copper is present in water from the hot
is very unlikely. tap than from the cold. For preparing hot drinks it
Selenium is an element that forms part of an is probably safer to heat cold water rather than use
important body enzyme (substances essential for water from the hot tap, particularly for children. In
body metabolism), which has an antioxidant action the U. S. A. an intake of 2 to 3 mg per day for adults
in preventing, for example, breakdown of fats (lip- is considered to be safe and adequate. (It is assumed
ids) to substances that can be damaging to the body. that up to an occasional 10 mg per day is safe for
The enzyme probably takes care of what other anti- adults.)
oxidants like vitamin E have failed to do because Nickel is probably an essential element for hu-
they were not present in sufficient amounts. mans, with several possible roles in maintenance and
Selenium deficiency has been observed in pa- production of body cells. Adequate amounts are
tients receiving parenteral nutrition, but with sele- probably obtained from most diets, provided that the
nium-poor solutions. Keshan’s disease, a disease of gut is functioning properly. There is some evidence
heart muscle affecting children, is a selenium-defi- that a few people may develop a skin sensitivity re-
ciency disease seen in a selenium poor area of North- action to nickel. For these people, acid food cooked
Eastern China. in stainless steel utensils and canned food may need
Cobalt is essential for humans because it is a part to be avoided.
of vitamin B12. This form of cobalt is obtainable After oxygen, silicon is the most abundant ele-
from microorganisms or from animal sources. Vege- ment on earth. Its presence in our bodies might be
table sources of cobalt are more important to ani- thought of as that of an environmental contaminant.
mals that are ruminants (sheep and cattle). Cobalt From the health point of view, most interest has cen-
deficiency in humans is like vitamin B12 deficien- tered on toxicity to the lungs from inhalation of si-
cy, with anaemia and nervous system problems. As lica dust. However, it has been shown in animals
little as 0.1 µg cobalt as vitamin B12 per day is need- that silicon is essential for normal growth. Its ac-
ed by adults. Total cobalt intake may be in a range tion appears to be connected with bone mineraliza-

79
tion and formation of connective tissue. Good sourc- ine triphosphate). ATP plays a vital role in releas-
es are wholegrain cereals and citrus fruit. ing energy for ion transport across membranes; and
Vanadium is an essential element in the diets of the pumping out of sodium from the cells and ex-
people; deficiency affects bones and blood. Vana- changing it for potassium. The most striking effect
dium is considered to be an essential micro-trace- is that it mimics insulin effects — modifies tissue
element for mammalian systems. Influences enzyme responsiveness to insulin. Toxicity has not been seen
systems — horse muscle appears to contain stable with intakes below 4,500 µg per day.
compound of vanadium — vanadyl ATP (adenos- Other minerals are presented in Table 27.

Table 27. Trace Elements and their Role in Nutrition

Hazard caused by excess

Element Usual food source Function
in food
Aluminium From cooking vessels, aluminium-con- Poorly absorbed; Decreased phosphate ab-
taining medications, some fruit and no known function sorption leading to bone
vegetables diseases, altered mental
function
Antimony Food-stuffs stored in enamel No known function Very low toxicity
vessels and cans
Arsenic Crustaceans and fish, contami- Possibly essential Gut, skin, brain and
nated water, fruit and vegetables grown for growth in ro- nerves affected
in contaminated areas or with spray dents, pigs and
residues poultry
Barium Brazil nuts, cereals grown No known function Very low toxicity
in barium — rich soil
Boron Plant food-stuffs Not essential for ani- Very low toxicity
mals, although it is
for some plants
Bromine From fumigated grain and its products Will replace chloride Adverse effects on brain
and so accumulate; and thyroid function
will also be taken up
by the thyroid gland
instead of iodine
Gold Information inadequate No known function Skin, gut and kidney
damage
Lead Variable content in food; more in produce Not essential World Health Organisation
grown near highways with vehicles using suggests tolerable weekly in-
leaded petrol; more in food from metal take of 50 µg/kg of the body
cans than from glass or aluminium con- weight for adults. Excess
tainers; some from reticulated water affectsbrain, blood, bone
and kidneys.
Mercury Mercurial fungicides contaminating food; Interacts with Brain damage, kidny
organic mercury in fish from contaminated selenium damage
water, such as near paper mills; from shark,
which is high up in the marine food chain
with progressive concentration of mercury
Rubidium Soy beans, beef Can act partly as a More toxic in low potas-
substitute for potas- sium diets, with effects on
sium growth and reproduction
Silver From food prepared in silver-plated ves- Not essential Low toxicity
sels, contaminated by silver-lead solders
or stored in silver foil
Strontium Plant food-stuffs have more than animal Found in bone, and May affect growth
food-stuffs. More in bran than the can be replaced by
remainder of cereal grain radioactive stron-
tium from fall-out;
interacts with calcium

80
 Because of the high demand for energy and es-
NUTRITIONAL DEFICIENCY DISEASES sential nutrients, infants and children are at partic-
ular risk of undernutrition. Protein-energy malnu-
There are some nutritional components of meal- trition in children consuming inadequate amounts
which do not have a nutritive value (Fig. 28). of protein, calories, and other nutrients is a particu-
Up to one third of the world’s population goes larly severe form of undernutrition that retards
hungry for much or most of the time. Majority of growth and development (see below). Hemorrhagic
people who do not get enough to eat live in the dry disease of the newborn, a life-threatening disorder,
savannah country of Africa, in the overcrowded na- is due to inadequate vitamin K intake. Deficiencies
tions of Asia and in the urban slums of Latin Ame- of iron, folic acid, vitamin C, copper, zinc, and vi-
rica. tamin A may occur in inadequately fed infants and
In the 1980s there were wide spread famines in children. In adolescence, nutritional requirements
Africa and in the 1990s largely associated with war increase because the growth rate increases. Anorexia
and genocide further localized and regional famines nervosa, a form of starvation, may affect adolescent
have occurred again but in different regions, nota- girls.
ble southern Sudan and in the refugee communities Requirements for all nutrients are increased dur-
on the Rwanda-Burundi-Zaire borders. In the after- ing pregnancy and lactation. Aberrations of diet, in-
math of the Gulf War and the imposition of sanc- cluding pica (the consumption of no-nnutritive sub-
tions, very severe food shortage approaching fam- stances, such as clay and charcoal), are common in
ine affected many of people of Iraq. Also in the early pregnancy. Anemia due to folic acid deficiency is
1990s the economic and political disruption of parts common in pregnant women, especially those who
of the former Soviet Union and the conflicts in the have taken oral contraceptives. Folic acid supple-
former Yugoslavia causes several very severe local- ments are now recommended for pregnant women
ized periods of food shortage. A series of natural to prevent neural tube defects (spina bifida) in their
disasters mainly floods probably aggravated by in- children. An exclusively breastfed infant can devel-
efficient production distribution caused famine in op vitamin B12 deficiency if the mother is a vege-
North Korea in 1995–1996. At any time small num- tarian. An alcoholic mother may have a handicapped
bers of undernourished or starving people can be and stunted child with fetal alcohol syndrome, which
found almost anywhere even in the richest cities in is due to the effects of ethanol and malnutrition on
the affluent industrial nations. They may starve be- fetal development.
cause of inadequacies in the social services. Victims A diminished sense of taste and smell, loneliness,
of this situation are elderly people on inadequate physical and mental handicaps, immobility, and
pensions; children of low-income parents, especially chronic illness can militate against adequate dietary
single parents, etc. intake in the elderly people. Absorption is reduced,
Undernutrition can result from inadequate intake, possibly contributing to iron deficiency, osteoporo-
malabsorption, abnormal systemic loss of nutrients sis (also related to calcium deficiency), and osteo-
due to diarrhea, hemorrhage, renal failure, or exces- malacia due to lack of vitamin D and absence of ex-
sive sweating, infection, or addiction to drugs. Un- posure to sunshine. Irrespective of the age, disease
dernutrition is associated with poverty and social or dietary deficiency there is progressive loss of lean
deprivation, occurring among the poor. The risk of body mass, amounting to about 10 kg in men and 5
undernutrition is also greater at certain times in a kg in women. It accounts for the decrease in BMR,
person’s life, i.e. infancy, early childhood, adoles- total body weight, skeletal mass, and height and for
cence, pregnancy and lactation, and old age. the increase in mean body fat (as a percentage of

Water, food fiber NATURAL COMPONENTS OF MEAL Pigments

Nutrients Taste substances Antinutrients

Proteins Ether oils Enzyme inhibitors
Lipids Spirits Antivitamins
Digestible carbohydrates Organic acids Demineralizators
Vitamins and vitagenes Aldehida and ketones
Mineral salts Enzymes and hormones
Naturalt oxins
Products of food-stuff spoiling

Fig. 28. Daily Requirements, Main Sources and Physiological Role of Nutrients

81
body weight) from about 20 to 30% in men and from are usually emaciated. Alcoholism is the most com-
27 to 40% in women. These changes and a reduc- mon cause of thiamine deficiency in the developed
tion in physical activity result in lower energy and country and may lead to deficiencies of magnesi-
protein requirements compared with those of young- um, zinc, and other vitamins.
er adults. Protein-Energy Malnutrition (PEM). Meeting
In patients with chronic disease, malabsorption energy requirements is basic to survival, and the way
states (including those resulting from surgery) tend in which this is accomplished from protein or non-
to impair the absorption of fat-soluble vitamins, vi- protein sources determines the type of severe PEM
tamin B12, calcium, and iron. Liver disease impairs produced. A diet with excessive non-protein calo-
the storage of vitamins A and B12 and interferes in ries from starch or sugar, but deficient in total pro-
the metabolism of protein and energy sources. Pa- tein and essential amino acids, results eventually in
tients with kidney disease, including those on dial- kwashiorkor. Severe discrepancy of energy and nu-
ysis, are prone to develop deficiencies of protein, trients causes total inanition, which in the young
iron, and vitamin D. Some patients with cancer and child is called marasmus. Intermediate forms are
many with AIDS have anorexia, which complicates termed marasmic-kwashiorkor.
treatment. In patients receiving long-term home Marasmus is the predominant form of PEM
parenteral nutrition most commonly after total or throughout most developing countries. It is associ-
near-total resection of the gut, vitamin and trace ated with the early abandonment or failure of breast-
mineral deficiencies must be especially guarded feeding and with consequent infections, most nota-
against. A physician should be sure that biotin, vi- bly those causing infantile gastroenteritis. Kwash-
tamin K, selenium, molybdenum, manganese, and iorkor is less common and is usually manifested as
zinc are adequately supplied. the intermediate marasmic-kwashiorkor state. It
Vegetarian Diets. The most common form of tends to be confined to those parts of the world (ru-
vegetarianism is ovo-lacto-vegetarianism, in which ral Africa, the Caribbean and Pacific islands) where
meat and fish are eschewed but eggs and dairy prod- staple and weaning food-stuffs such as yam, cassa-
ucts are eaten. Iron deficiency is the only risk. Ovo- va, sweet potato, or green banana are protein defi-
lacto vegetarians tend to live longer and to develop cient and excessively starchy.
fewer chronic disabling conditions than their meat- In marasmus, energy intake is insufficient to
eating peers. Vegans consume no animal products match requirements and the body draws on its own
and are susceptible to vitamin B12 deficiency. Yeast stores. In kwashiorkor, increased carbohydrate in-
extracts and oriental-style fermented food-stuffs pro- take with decreased protein intake leads to decreased
vide this vitamin. Intake of calcium, iron, and zinc visceral protein synthesis. The resulting hypoalbu-
also tends to be low. A fruitarian diet, which con- minemia causes dependent edema; and the impaired
sists solely of fruit, is deficient in protein, salt, and β-lipoprotein synthesis produces fatty liver.
many micronutrients and is not recommended. Marasmic infants show hunger, gross weight
“Fad” Diets. Many commercial diets are claimed loss, growth retardation and wasting of subcutane-
to enhance well-being or reduce weight. A physi- ous fat and muscle. Kwashiorkor is characterized
cian should be alert to early evidence of nutrient by generalized edema, “flaky paint” dermatosis,
deficiency or toxicity in patients adhering to them. thinning and discolouration of the hair, enlarged fat-
Such diets have resulted in frank vitamin, mineral, ty liver, and petulant apathy in addition to retarded
and protein deficiency states and cardiac, renal, and growth. In developing countries, severely malnour-
metabolic disorders as well as some deaths. Very ished children may also be HIV positive. Differen-
low calorie diets (more than 400 kcal/day) cannot tial diagnosis incudes secondary growth failure due
sustain health for long. Some trace mineral supple- to malabsorption, congenital defects, or deprivation.
ments have induced toxicity. Skin changes in kwashiorkor differ from those of
Alcohol or Drug Dependency. Patients with al- pellagra where they occur on parts exposed to light
cohol or drug problems are notoriously unreliable and are symmetrical. Edema in nephritis, nephrosis
when questioned about their eating habits, so mak- and cardiac failure is accompanied by features of
ing judicious inquiries of relatives or acquaintanc- these diseases. Hepatomegaly from disorders of gly-
es may be necessary. Addiction leads to a distur- cogen metabolism and cystic fibrosis must be dif-
bance of lifestyle in which adequate nourishment is ferentiated. Mortality varies between 15 and 40%.
neglected. Absorption and metabolism of nutrients Death in the first days of treatment is usually due
are also impaired. High levels of alcohol are poi- to electrolyte imbalance, infection, hypothermia, or
sonous and can cause tissue injury, particularly of heart failure. Long-term effects of malnutrition in
the GI tract, liver, pancreas, brain, and peripheral childhood are not fully understood. In the adequately
nervous system. Beer drinkers who continue to con- treated case the liver probably recovers fully with-
sume food may gain weight, but alcoholics who con- out subsequent cirrhosis. Humoral immunity is usu-
sume more than 300 ml of hard liquor per day lose ally unimpaired. Cell-mediated immunocompetence
weight and become undernourished. Drug addicts is markeldy compromised in the acute phase but is

82
restored with recovery. Behavioral development may meat moderately vary depending upon the type of
be markedly retarded in the severely malnourished animals, their age and character of their fodder, as well
child. The degree of mental impairment is related as on the part of carcass.
to the duration of malnutrition and age of onset. The Quantity of proteins in meat is 13-18%, and
infant with marasmus is affected most severely than quantity of fat fluctuates depending upon the feed
the other child with kwashiorkor. Prospective stu- of the animal, for example from 3 to 23% in beef and
dies suggest that a relatively mild degree or mental up to 37% in pork. Carbohydrates (glycogen) in meat
retardation persists into school age. are less than 1%. Phosphor, sulphur, potassium, sodi-
Starvation is the most severe form of malnutrition. um and iron (3 mg per 100 gm) are sufficiently more,
It may result from fasting, famine, anorexia nervosa, as well as small quantity of vitamins of B group.
catastrophic disease of the GI tract, stroke, or coma. Nitrogenous extract substances give meat especial
The basic metabolic response to starvation is conser- aroma and taste, exciting secretion of digestive
vation of energy and body tissues. However, the body glands. Meat food increases excitation of the brain cor-
will mobilize its own tissues as a source of energy, tex, stimulates working capacity.
which results in the destruction of visceral organs and However meat products may be the cause of food
muscle and in extreme shrinkage of adipose tissue. intoxication, few infectious diseases and helminthoses.
Total starvation is fatal in 8 to 12 weeks. Protection of consumers health from these diseases is
In adult volunteers who fasted for 30 to 40 days, provided by veterinary and sanitary inspection at all steps
weight loss was marked (25% of initial weight), of movement of meat from slaughter to realization by
metabolic rate decreased, and the rate and amount consumers.
of tissue protein breakdown decreased by about Possibility of meat use of those animals, sick with
30%. In more prolonged starvation, weight loss may brucellosis, foot and mouth disease, erysipelas, enteri-
reach 50% in adults and possibly more in children. tis, septicemia, as well as of those animals which are
Loss of organ weight is greatest in the liver and in- subjected to slaughter is solved by veterinary-sanitary
testine, moderate in the heart and kidneys, and least service, and such meat is considered as conditionally
in the nervous system. Emaciation is most obvious edible and is subjected to disinfection at the place of
in areas where prominent fat depots normally exist. slaughter.
Muscle mass shrinks and bones protrude. The skin Goats most often fell sick with brucellosis. How-
becomes thin, dry, inelastic, pale, and cold. The hair ever in some regions of Argentina 75 to 100% of
is dry and sparse and falls out easily. Most body sys- cows fell sick with brucellosis. Often cows and pigs,
tems are affected. Achlorhydria and diarrhea are rarely sheep are sick with tuberculosis.
common. Heart size and cardiac output are reduced; Meat and organs of the cattle sick with anthrax
the pulse slows and blood pressure falls. Respirato- plaque are not permitted for consumption.
ry rate and vital capacity decrease. The main endo- In anthrax cases the carcass is burned and subject-
crine disturbance is gonadal atrophy with loss of li- ed to burial into ground at the depth no less than 2 m.
bido in men and women and amenorrhea in wom- At the slaughter house, walls, floor and other objects
en. Intellect remains clear, but apathy and irritabili- are disinfected with 4% solution of formaldehyde or
ty are common. The patient feels weak. Work ca- 5% solution of carbolic acids.
pacity is diminished because of muscle destruction After wards slaughter veterinary inspection of
and, eventually, is worsened by cardiorespiratory carcass and investigation of internal organs is com-
failure. The anemia is usually mild, normochromic, pulsorily conducted with the purpose of revealing
and normocytic. Reduction in body temperature fre- diseases, difficult to diagnose while alive: tubercu-
quently contributes to death. In famine edema, se- losis, measles, trichinosis and others. On observa-
rum proteins are usually normal, but loss of fat and tion of single finna in the meat of pigs, it is consid-
muscle results in increased extracellular water, low ered to be conditionally edible and is subjected to
tissue tension, and inelastic skin. Cell-mediated im- realization only after disinfection at the slaughter
munity is compromised, and wound healing is im- house by boiling or freezing it up to -12°C with fur-
paired. ther keeping at this temperature for a period of 10
days. In high contamination with finna (more than
3 finna in an area of 40 cm2) meat is subjected for
technical utilisation. In case of detection of at least
HYGIENIC CHARACTERISTICS one trichina meat is considered as non-edible.
OF ANIMAL FOOD PRODUCTS The liver of the cattle or of sheep may be affect-
ed by Fasciola hepatica. In such cases the liver is
MEAT AND FISH PRODUCTS rejected as defective, and meat is considered to be
conditionally edible.
Meat is an important source of biologically val- If the animal is thin and the tissues are edema-
uable proteins in human nutrition. Chemical com- tous, the whole carcase is rejected as defective. An-
position, organoleptic properties and food value of alogically organs affected with Echinococci should

83
be burned or buried. Conditionally edible meat is dis- late using to enrich the sausages, bread and other
infected at the place of slaughter by boiling of small products. Krill protein paste, minced meat, meat of
pieces (no more than 8 cm) for a period of 25 h. krill and others are manufactured. Inclusion of
In solution of mankind provision problem of most- shrimp paste or minced meat from krill in the diet
ly developing countries with biologically valuable stimulates hemopoiesis and increases adaptive pos-
proteins, the world ocean is among the first to be sibilities and resistance of the organism to toxic, can-
used. Already in 1980s nearly half of the indicated cerogenic agents and ionizing radiation. Products
countries utilized hydrobiontes of the ocean. from krill are rich in fluorine and therefore their in-
Flesh of fish depending upon chemical compo- clusion in ration stimulates osteogenesis and min-
sition and food value is similar to the meat of ani- eralization of the bones, which may be used in proph-
mals. There are 8–25% of protein and what’s more ylaxis and treatment of senile osteoporosis, fractures
they are biologically well-balanced, rich with essen- and teeth decay.
tial amino acids. Content of fats fluctuates from 0.1 Fish and other hydrobiontes belong to easily spoil-
to 29% and more. Fat is of semiliquid consistency and able products. They spoil faster than meat. Therefore
contains large quantities of mono- and polyunsaturat- fish should be freezed soon after fishing.
ed fatty acids, which are easily oxidized by air oxygen, Fish and other hydrobiontes may be the cause of
giving the product with unpleasant smell and taste food intoxication, as well as mechanism of transfer of
during long preservation. Quantity of thiamin and ri- infectious diseases (typhus, paratyphus, dysentery,
boflavin is 0.0005–0.001 g/kg and niacine — 0.001– cholera, infectious hepatitis and others) as well as of
0.05 g/kg. There are retinol and calcipherol present in helminthoses (diphyllabotheuriosis), opisthorciasis,
fatty fish. Particularly livers of sea fish is rich in clonorchiasis, paragonimiasis and others.
them. Meat of the latter is richer than beef in mineral Diphyllobotheuriosis develops after consumption
substances and microelements, particularly in iodine. In of insufficiently boiled, fried or raw fish, infected with
100 gm of sea fish, shellfish, crayfish 30 to 300 mg of larvae of broad tapeworm, — by plerocercoids with
iodine is present, and in seaweed — up to 1,000 mg length of 10 mm and width of 2–3 mm. Tape warm
and more. Inclusion of sea food in the diet enriches mature in the human intestines, its length reaches
nutrition in microelements up to physiological optimum. several meters. Segments of the tapeworm filled with
Fish is rich in extractive substances, easily chang- eggs burst out and are brought out into external envi-
ing into broth. Therefore fish broth, more than meat, ronment by fecal matter. Further eggs may get into
excites secretion of the digestive glands. Fish broth the organism of intermediate host (cyclope, fish) and
is useful in conditions of hot climate, and as an ele- they develop up to the invasive stage. Disease of
ment of prophylactic nutrition. human often leads to pernicious anemia as a result
In the flesh of fish connective tissue is up to 5 times of disorder of endogenic synthesis of cyanocobalamine.
less than in beef, due to this fish boils sooner and the Taking into account, that larva dies at the tempera-
nutrients contained in it are absorbed by 95–97% and ture of 50–55°C within 5 min, consumption of well
more. Due to unique food properties of fish it is boiled or fried fish totally prevents development of
widely used in clinical dietology. this disease, as well as of other helminthoses.
In nutrition shellfish (mussels, oysters, squid, Opistorchis felineus — biohelminth, basic host of
octopuses, etc.) are used. In shellfish there are 10– which is a human, a cat, a dog, a pig and other ani-
17% of biologically valuable proteins, 0.6–1.6% of mals, the first intermediate host — fresh water mollusk
fats, 1.5–4% of glycogen. Mollusks are the sources and the second — carp fishes. In hydrodermic cellu-
of mineral substances, biomicroelements, vitamins of lose and spine muscles of infected fish they found met-
B group. Edible tissues of mussels and ousters are acercaria — insisted larva of oval form with the length
boiled, salted, dried, frizzed, processed into different up to 0.3 mm developed. The human is infected dur-
tinned food. ing consumption of poorly boiled or fried, as well as
Oysters are widely consumed in raw (uncondition- of less salted jerk or raw fish. Larvae of helminth en-
ally fresh). Mollusks are eaten in raw, boiled, salted, ter the liver, pancreas, causing serious damage. For
dried, marinated, baked and fried form. the prophylaxis fish should be fried in small pieces
High food properties are characteristic of crabs during no less than 15–20 min, boiled during 15–20
and shrimps. Many dishes, prepared from crayfish and min from the moment of boiling, with salt using no
shrimps, posses excellent delicacy properties. less than 14% of the fish mass, after that the latter is
In the last years great attention is given to the kept at the temperature of 16–20°C for 2 weeks.
source of biologically valuable proteins — antarctic Measures of social prophylaxis of helminthosis
crayfish (krill) about 30–50 tons of it are fished every transferred through fish and water is protection of
year. Edible tissues of this crayfish contains 15–19% reservoirs from contamination by fecal matters, pro-
of proteins and 2–10% of fats, rich in PUFA (poly- hibition of letting non-disinfected waters (Table 28).
unsaturated fatty acids) and fat soluble vitamins. They Eggs are good food products containing biologi-
are exclusively rich in biomicroelements and vitamins cally valuable proteins (12.5%), fats (12%), vitamins
of B group. They use krill to produce proteinous iso- (thiamin, retinol, nicotinic acid, calcepherol, toco-

84
 Table 28. Meat- and Fishborne Diseases
Disease Pathogenic organism Meat product
anthrax Bacillus anthracis mutton, horseflesh, beef, veal,
goat’s flesh, pork, etc.
brucellosis* Brucella abortus, etc. mutton, goat’s flesh
Q fever* Ricketsia burneti beef, veal, etc.
tuberculosis Mycobacterium bovis liver, lungs, spleen and other sub-
products from ill cows
trichinosis Trichinella spiralis pork, bear’s flesh, walrus flesh
taeniosis Taenia solium pork
taeniarinchosis Taeniarinchus saginatus beef, veal
diphylobotriosis Diphylobotrium latum fish (perch, pike, ruff, burbot,
salmon, smelt fish ,etc.)
opisthorchosis Opisthorchis felineus fish (carp, tench, bream,
red-finned fish, roach, etc.)
clonorchosis Clonorchis sinensis fish (Cyprinidae)
opicthorchosis viverrae Opicthorchis viverrae fish (Cyprinidae)
metagonimosis Metagonimus yokogawai fresh-water fish
heterophyosis Heterophyes heterophyes gray mullet and other fish
nanophyetosis Nanophyetes schikhobalowi fresh-water fish
paragonimosis Paragonimus westermani crabs, crayfish
echinostomoses Echinostoma Rudolphi shellfish
echinochamosis Echinichamus perfoliatus fresh-water fish
sparganosis Diphyllodothrium erinacei europei snakes, frogs

* — the abattoir workers are at risk of these diseases (cutting of raw meat is risky).

pherol, riboflavin) and are rich in phosphor. Eggs spoil Lipids determine value of milk fat and soluble
as a result of drying and growing mouldy and due to retinol and calcipherol, contents of which is more in
damage by putrefactive microorganisms, which enter summer and autumn.
through the shell. Milk contains all necessary mineral salts, but
Salmonella already in the womb may infect eggs particularly rich in absorbable calcium (1.2 g/kg).
of ducks and goose. Therefore their sale to the pop- Out of water-soluble vitamins riboflavin, pyridox-
ulation in commercial network is prohibited; they may ine and pantothenic acid are the most common.
be used only in food industries far preparation bread Milk causes weak secretion of gastric glands and
products during conditions of good baking. With the therefore it is recommended to patients with peptic
purpose of prevention of food intoxication, consump- ulcer and hyperacid gastritis. Lactose promotes for-
tion of such eggs defective in incubator is prohibited. mation of normal intestinal microflora with preva-
For disinfection of eggs which may be infected lence of bifidobacteria preventing putrefaction.
by salmonella they are immersed into 5% solution of Sodium chloride is very less in milk and there-
lime chloride for 5–10 min. fore it is recommended to patients, suffering from
nephritis and edema. Considering absence of nucle-
DAIRY PRODUCTS onic compounds in it, milk is indicated to those with
disorders of purine metabolism.
Milk contain all necessary food substances for the Many components of milk (methionine, choline,
growing organism, present in soluble or sligthly dis- tocopherol, vitamins of B group) are decreasing quan-
persed state, as a result of which it is easily digested tity of cholesterol in blood.
and well absorbed (95–98%). Milk and milk products Milk is an ideal medium for multiplication of mi-
are irreplaceable in child nutrition, in patient and elder- croorganisms. Development of streptococci and lacto-
ly people nutrition. bacilli, decomposing lactose with formation of lac-
The most widespread in the world is cow’s milk. tic acid, leads to sowing of milk.
It contains about 3.2% of biologically valuable pro- In spreading of pathogenic microflora milk may
teins (2.7% of casein and 0.5% of albumin), from 3 be a cause of infectious diseases: intestinal infec-
to 5% of fat and from 4 to 5% (on average 4.8%) of tions, polio, diphtheria, scarlet fever, viral hepatitis.
carbohydrates — lactose. Milk and milk products occupy an important place

85
among the causes of spreading of brucellosis, which this composite parts of milk in chemical relation
not infrequently takes place in hot countries, par- nearly doesn’t change and solubility reaches 98%.
ticularly the countries, where sheep milk is widely Content of moisture in dry milk in hermetic pack-
consumed. Milk and milk products may be the age should not exceed 4%, in non-hermetic 7%. The
source of tuberculous infection. total content of microorganisms in dry milk of high
To provide the epidemiological safety of milk, quality should not exceed 50,000, in dry milk of the
decrease bacterial growth and increase its quantity I sort — 70,000, in dry milk for children — 25,000–
it is necessary to conduct the following steps: 30,000 in 1g of milk. The period of preservation of
1. Strict veterinary control for sanitary condi- dry milk is 8 months in a hermetic package and 3
tions, health of animals. months in a non-hermetic one.
2. Prevention of contamination of milk during Tinned condensed milk capable of being pre-
milking, preservation, transportation, cooking etc served for a long period. To them we refer con-
(cleanliness of the udder and skin of animals, hands densed and sterilized milk, cocoa and coffee with
and clothes of personel, mechanised milking, filtra- condensed milk and others. Condensed milk with
tion of milk through a cloth, observation of health sugar contains water no more than 16.5%, sugar —
and personal hygiene of milkers and other working peo- no less than 43.5%, fat — 8.5%. Acidity is no more
ple in contact with milk); than 48°C (Fig. 29).
3. Cooling of milk up to the temperature less than The best and most used method of making milk
8°C and its fast delivery to consumers. safe is pasteurization. They use also sterilization.
4. Consumption of disinfected milk in food. Several pasteurization techniques are used with dif-
Pesticides, antibiotics, aphlotoxins and other tox- ferent combinations of time and temperature to kill
icants may get into the organism of lactacting ani- pathogens without altering the flavor or consisten-
mals through milk along with food, feed supple- cy of the milk. The pasteurization temperature for
ments, stimulators of growth as well as during con- homogenized, pasteurized milk is usually 72–75°C.
dition of prophylactic and therapeutic measures. In Ukraine the following regime is the most suita-
Since milk is a basic product of child nutrition, ble for pasteurisation: heating of milk at the tem-
it should not contain any toxic admixtures and this perature of 63–65°C for a period of 30 minutes. Last
is a very important element of sanitary-hygienic con- years new method of complete sterilization of milk,
trol. called uperisation is used: through milk vapors are
If milk is obtained from healthy cows with keep- inflated until temperature does not rise up to 150°C.
ing all hygienic rules, it is safe from the epidemic Such milk mountains natural properties, as after pas-
point. But if there are any doubt, disinfection of milk teurization and if it is powed into sterile packets,
should be conducted by 4 methods: boiling, pasteur- may be presewed up to 30 days. The pasteurization
isation, complete sterilization or drying. process may vary from one country to another ac-
During boiling pathogenic microorganisms and cording to national regulations.
part of lactobacilli microflora die but at the same Pasteurization is often combined with other proc-
time milk properties become worse; part of albumin esses such as homogenization to improve the appear-
and potassium salts falls down into sediments, vita- ance and ostensibly the flavor of milk. Other ways
mins and ferments are destroyed, disperseness of fat to safe-guard milk products include freeze-drying
decreases, taste worsens. So to minimize the indi- and condensing. Sweetened condensed milk like oth-
cated changes boiling of milk is substituted by pas- er sweet preparations relies on the high sugar con-
teurisation. centration to kill pathogens.
Dry milk (or milk powder) — wide spread prod- Dry milk (milk powder) is a valuable product,
uct of processing of milk. Food value of dry milk is obtained by drying of spilt whole-pasteurized milk
less than of the whole milk, but it’s widely used in in vacuum chambers. Solution of dried milk in the
nutrition. Food and biological properties of dry milk corresponding quantity of boiled water is called re-
depend upon the method of its preparation — film duced milk. The latter may replace natural milk even
or pulverization. During the film method of drying in nutrition of children. Dry milk is often used in
milk comes in contact with hot (90–120°C) metal- many tropical countries, in particular for realization
lic surface of shaft dryers for a short duration (less of programs of provision of children with milk and
than a minute). Formed film of milk with thickness milk products.
of 0.14–0.2 mm is extracted automatically by spe-
cial knife. However, this method essentially chang- Sour Milk Products
es a composite part of milk particularly proteins, Sour milk products contain large quantity of live
worsens biological properties and solubility of ob- bacteria of homogenous composition (lactobacilli),
tained product. Undoubted fully milk has advantag- which are capable of suppressing growth of other
es, which is received by pulverization method. Dry- types of microorganisms including pus forming.
ing is conducted by hot air (145–160°C) in special With the help of sour milk drinks one can limit or
tanks by scattering of milk in fine particles. During even fatally stop formation of harmful substances

86
 Product Cold water
Steam Ice water

Fig. 29. Milk Pasteurization

in intestine formed by pus forming microbes, as this of milk and cream (8%) mixed with pure culture of
follows from works of I. I. Mechnikov, which may lactic acid streptococci.
participate in forming atherosclerosis and shorten A special group of sour milk is formed by its
the life. Definite types of lactobacilli (acidophilic mixture — iogurts and others, prepared from pas-
coli, lactic acid streptococcus and others) form an- teurized milk by introducing combined ferment, in-
tibiotic substances in sour milk drinks, which are cluding pure culture of lactic acid streptococci,
of bacteriostatic and bactericide activity. For exam- lactobacilli with or without addition of yeast. The
ple acidophilic bacteria produce thermostable anti- newest medical dietetic sour milk products at NIS
biotics: nysin, lactolin, lactomin, streptocin and oth- markets are biokefir, bifidoc and others.
ers, displaying their activity primarily in acidic me- A transitive type of product between the indi-
dium. Therefore use of sour milk acidophilic prod- cated ones of lactic acid fermentation and acido-
ucts in some diseases of the intestinal tract in mod- philic product is acidophilic sour milk, which rep-
erate degree improves microflora of the intestine, resents itself pasteurized milk mixed with pure cul-
which is mainly related with suppression of pus tures of lactic acid of streptococci and acidophilic
forming and pathogenic microorganism. coli.
Lactobacilli are producents of vitamins of group Qualitative index of sour milk: content of fat
B. By way of selection of highly active cultures one 3.2%, (in ryazhenka 6% and 8%), acidity no more
may obtain sour milk products with high content of than 100°C (for iogurts — no more than 140°C),
vitamins. Sour milk products possess different bio- titre of Escherichia coli not below 0.3 ml.
logical and therapeutic properties. Therapeutic ac- Acidophilic products are prepared from pasteur-
tion of sour milk products (drinks) is widely used ized milk with use of pure cultures of acidophilic
during in many diseases of the digestive system. coli. To teraupetic products of this group we refer
They improve gastric secretion, normalise peristal- acidophilic milk, acidophilic paste and acidophilic-
sis of intestine, intestinal microflora, decrease gas fermented milk. On these yeast there are prepared
formation. theraupetical sour milk used for treatment of the in-
Sour milk products are divided into products of testine and few other diseases.
lactic acid and mixed fermentation. Acidophilic milk possesses remarkable antibiot-
Products of lactic acid fermentation. The availa- ic properties. It is prepared on pure culture of aci-
ble sour milk products in Ukrainian market are usu- dophilic coli. Two varieties of culture of acidophilic
ally prepared from pasteurized milk with the use of coli are used: mucous, causing mucous consistency
pure culture of lactic acid streptococci. The Mechan- and not high acidity of a product (140°C) and non-
ikov’s milk products are prepared from pasteurized mucous, put causing high acidity (300°C). One can
milk. Ryazhenka (Ukrainian sour milk) is a mixture obtain product of sour cream consistency by using

87
yeast, made up of 80% of non-mucous and 20% of uretic action and is recommended in diets during dis-
mucous culture. turbed nitrogen excretory function of kidneys, de-
Acidophilic milk is indicated for treatment of compensated diseases of heart, hypertonic disease
child diarrhea and colitis in adults, dysentery and otic desiase.
other diseases. Kefir is prepared of pasteurized whole milk or
Acidophilic Paste. It is prepared of acidophilic fatless natural or reducted cow’s milk with the use
milk by pressing and extracting serum. It’s acidity of yeast, prepared on kefir fungi or on pure cultures
is located between 180–220°C. Antibiotic activity of specially selected microorganisms, causing lac-
of paste enables to decrease intensity of decaying tic acid and alcoholic fermentation.
processes in the intestine during constipation and Fatty kefir from whole milk and fatless kefir are
meteorism. Besides, paste is indicated in treatment differentiated, and depend upon the period of mat-
of achilic gastritis, ulcerative colitis, rectosigmoidi- uration — weak (one day), medium (two days) and
tis and others. strong (three days). In fatty kefir content of fat
High antibiotic (theraupetic) properties differen- should not exceed 90°T, and content of alcohol —
tiate acidophilic-fermented products. Concentration 0.2%, in medium kefir — 105°T and 0,4% in strong
of antibiotic substances in them is moderately high — 120°T and 0.6% accordingly.
due to biosynthesis not only by acidophilic coli, but Kefir is widely used in daily and therapeutical
also by yeast. Acidophilic-fermented milk proposed nourishment. It renders favorable influence on di-
by A. M. Skorodymova is used during treatment of gestion, stimulates motor function of the intestine
tuberculosis, intestinal diseases and furunculosis. (light kefir), decreases intensity of decaying proc-
Sour Cream. It’s prepared of pasteurized cream esses in the intestine, increases diuresis.
by addition of special ferments from mixed culture Koumiss is widely used in Bashkiria, Buryatia,
of lactobacilli. Content of fat of high quality is 36%, Yakytia and Tataria (Russia), as well as in Kyrgys-
acidity — 65–90°T, in sour cream of the I sort — tan and Kazakhstan. Koumiss is prepared of prima-
30% and 65–110°T, in sour cream of the II sort — rily pasteurized milk of mare or cow by way of mix-
25% and 65–125°T. ing it with pure culture of lactobacilli (Bulgarian coli
Curd (cottagecheese). It is prepared of pasteu- and other) and lactic yeast. Koumiss from mare’s
rized milk by mixing it with pure culture of lactic milk is considered to be better, chemical content of
acid streptococci with further processing of clot for which favors in moderate degree those processes
extraction of serum. Curds of 20% and 9% of fat- necessary for obtaining this excellent product.
ness, and fatless with acidity of 200–225°T, 210– Depending upon degree of maturation (ripening)
240°T and 220–270°T correspondingly are availa- koumiss, like kefir is divided into light, medium and
ble at the market. strong. Content of fat in all categories of product
In curd basic components of milk — protein and composes no less than 0.8%. In weak koumiss al-
calcium — are represented in moderately high quan- cohol is no more than 1%, acidity — 60–80°T, in
tities. Fatty curds and hard cheeses are peculiar con- medium — accordingly 1.75% and 81–105°T, in
centrates of milk. They are prepared by curding of strong 2.5 and 106–120°T. As for content of carbon
preliminary pasteurized milk. Fatty curds contain up dioxide koumiss is very good aerated drink.
to 14% of casein and 18% of milk fats. Fatty curds Koumiss renders general (overall) strengthening
are prepared of fattiest milk. Low fat curd contains action, improves process of digestion and absorp-
up to 18% of casein and only 0.5% of fat. Large tion of food substances, stimulates oxidative-reduc-
quantity of methionine is present in casein of curds tion processes in the organism. It is successfully used
out of which choline is synthesized, which prevents since many years during treatment of pulmonary tu-
adipose infiltration of the liver. Curd is reach in cal- berculosis, indicated during chronic bronchitis, en-
cium (up to 150 mg per 100 g). Therefore it is very terocolitis, anacidic gastritis and other diseases.
important to include these products in the diet of Cheeses. Basic substances of milk, highly valu-
patients with liver pathology, elderly patients, preg- ed proteins, fats, calcium and phosphor are repre-
nant women, lactating mothers and children. sented in a higher degree in cheeses rather than in
Therefore curds are considered as natural milk curds (cottage cheese). Therefore these products can
concentrate, possessing high biological value. It is be considered as highly valuable milk concentrates.
enough of 200–300 g of this product so as to provi- Depending upon method of preparation they are
de daily need of the organism in irreplaceable ami- divided into chimosinic and lactic acidic. Original
no acids and calcium. Particularly curds, rich with raw product for them is pasteurized milk.
labile methyl groups, which are easily used in the Rennet cheeses are prepared by method of co-
organism for synthesis of choline are of great im- agulation of milk with digestive ferment (chimosine
portance. They avoid adipose infiltration of bile. or pepsin) with further processing of clot. Process-
Curd promotes excretion of cholesterol from the ing consists in splitting of proteins under influence
organism, hence it may be considered as theraupet- of chimosine (or pepsin) into albumoses and pep-
ical remedy in atheroscleurosis. It also possesses di- tones which further are splitted by ferments, excret-

88
ed by specific microorganisms (lactobacilli and oth- microflora modification and strengthening of the gut
ers) up to aminoacids, which in its turn are subject- mucosal barrier.
ed to splitting. Characteristic pecularity of such split- Food-stuffs containing probiotic bacteria fall
ting in cheeses is absence of formation of any harm- within the functional food-stuffs category and in-
ful combinations during this (indole, scatole and oth- creased commercial interest in exploiting the pro-
ers), which is characteristic of splitting of proteins posed health attributes of probiotics has contribut-
during their decaying. Indicated splitting of proteins ed in a significant way to the rapid growth and ex-
positively acts on their absorption by the organism pansion of this sector of the market. In addition to
and their use for tissue synthesis. The major role probiotics some dairy yogurts now also contain
during preparation of cheeses belongs to biochemi- prebiotics which are non-digestible food ingredients
cal transformation of lactose in lactic acid. that beneficially affect the host by selectively stimu-
Cheeses differ by high content of protein (20– lating the growth and/or activity of one or a limited
25%), fat (25–30%) and what is also important — number of bacteria in the colon, and thus improve
calcium and phosphor. Looking upon contents and host health. Many dairy products containing pro- and
on level of balance of irreplaceable aminoacids prebiotics with associated health claims have been
cheeses are considered to be excellent products of launched onto the market and in some countries these
nourishment. Methionine is 2 times, triptofan 3–4 are an established market segment. The trend is to-
times more in cheeses than in meat. Cheeses differ wards exploitation of the synergistic effect of com-
by exclusively high content of absorbtive calcium bining probiotics with prebiotics, while some of the
(up to 100 mg in 100 g of product, which 100 times earlier products contained probiotic cultures alone.
more than in meat and 8 times more than in curds). Recently it was shown that milk protein and milk
Content of phosphor in cheeses 500 mg or 100 g of fat also contain bioactive components that can ex-
product. Moreover calcium and phosphor in chees- ert specific physiological effects. These effects in-
es are present in condition of optimal balance clude aiding calcium absorption (caseinophos-
(1:0.5), which provides high absorption of both mac- phopeptides), prevention of hypertension (ACE-in-
roelements. Therefore cheeses provide reliable pos- hibitory peptides) and anticarcinogenicity (CLA,
sibility to fulfill demands of the organism in calci- Butyric acid, Vitamin A, D, β-carotene).
um and phosphor in any age groups of population.
For this daily intake of 80–100 g of this product is Milk of Other Animals
enough. Although the value of lactic acid bacteria Besides cow’s milk, milk of other animals is also
(LAB) in food fermentations has been recognised used in different countries.
for centuries, development of the probiotic idea is Goat milk according to its composition is nearly
attributed to I. I. Metchnikoff, who observed that the same as cow’s milk, but its biological value is
the consumption of fermented milk could reverse even higher, as it contains more high-dispersed pro-
putrefactive effects of the gut microflora (Metch- tein and during condensation in the stomach more
nikoff, 1907). From these beginnings the probiotic soft clots are formed. It is held in the stomach of a
concept has progressed considerably and now is the child of breast age for a period which is 2 times less
focus of great research attention worldwide. Signif- than that for cow’s milk. Goat’s milk contains albu-
icant advances have been made in the selection and mins and methionine more than in cow’s milk and
characterisation of specific cultures and substantia- by this index surpasses even breast milk. Size of fat
tion of health claims relating to their consumption. drops in goat’s milk is moderately less than in cow’s
Consequently, the area of probiotics has advanced milk, that’s why lipids in the intestine are easily
from anecdotal reports, with scientific evidence now emulgated and absorbed better.
accumulating to back up nutritional and therapeu- The amount of mineral salts and vitamins in
tic properties of certain strains. goat’s milk is also a little higher. All these facts ex-
Probiotics are microbial cell preparations or com- plain why during some diseases (hypotrophy, ane-
ponents of microbial cells that have a beneficial ef- mia, tuberculosis, infections, hepatitis) pediatricians
fect on health and well being of the host. The health observe better effect in treatment of children who
effects attributed to probiotic consumption which receive goat’s milk.
have been best substantiated with scientific evidence Sheep milk contains nearly 1.5 times more proteins,
include alleviation of lactose maldigestion, cancer fats, many vitamins and mineral substances, than the
prevention, prevention/treatment of infections, se- cow’s milk, its food value is higher. It should be not-
rum cholesterol reduction and modulation of the ed that sheep more often, than other animals get sick
immune system. While the exact mechanism by with brucellosis, but rarely with tuberculosis. There-
which probiotics exert specific health effects is not fore this milk should be compulsorily boiled, and
completely understood, given the range of health curds and brynza (sheep’s milk cheese) — should be
benefits attributed to probiotic consumption, it is held for no less than 2 months after their preparation.
unlikely that each strain will act in the same way. In countries of the Middle East and many other
In general, health effects are related to intestinal hot countries population often consumes goat’s and

89
sheep’s milk. In some regions with hot and dry cli- Table 29. Macronutrient Composition of
mate where cows are poorly acclimatized, basic milk Human Milk and Cow’s Milk
animal is buffalo (Indonesia, Egypt, India and oth-
Component Human Milk Cow’s Milk
ers). Milk of buffalo is richer in fats, proteins, cal-
cium and water-soluble vitamins than the cow¹s Carbohydrates, g/dl
milk. High fatness of milk defines its high energy Lactose 7.3 4.0
value. Consumption of the whole milk buffalo may Oligosaccharides 1.2 0.1
cause diarrhea. Therefore in some countries (for
example, in India) its mixing with fatness or whole Proteins, g/dl
cow’s milk is practiced. Caseins 0.2 2.7
Milk of camels by its composition and energetic Lactalbumin 0.2 0.1
value is similar to cow’s milk, but it is richer in Lactoferrin 0.2 Trace
ascorbic acid (up to 25 mg per 100 g). In deserts Secretory IgA 0.2 0.003
and semidesert camels are not infrequently the sin- β-Lactoglobulin None 0.36
gle source of milk. It is consumed in free form or in
a form of refreshing sour milk drink — shubat. From Milk Lipids, %
shubat a peculiar milk cheese — curt is made, which Triglycerides 4.0 3.2
can be preserved for a long time in desert condi- Phospholipids 0.04 0.04
tions, which is a good source of proteins, fats, car-
Minerals, mM
bohydrates and other nutrients.
Sodium 5.0 15
The Role of Milk in Infants Feeding Potassium 15.0 45
Chloride 15.0 35
The best food for infants is breast milk, which
is evolutionary adapted towards particularities of Calcium 8.0 30
digestion and metabolism at this age. This concerns Magnesium 1.4 4.0
composition of nutrients and the form, in which they
are in the milk, as well as presence of substances
promoting digestion (ferments, phospholipids and 2) From an osmotic standpoint, the secretion of
others) in the breast milk. Besides, breast milk is lactose obligates the concomitant secretion of a large
not subjected to thermal treatment and consequent- amount of water. This water is sufficient to meet the
ly to denaturation. Breast milk contains many com- infant’s needs for sweating and evaporational wa-
ponents of defensive importance: lactoferin, antibod- ter loss, high in a warm climate, as well as for urine
ies, phagocytes, and macrophages. Observations formation.
conducted in India, China and other countries have Because lactose can be synthesized only from
shown that in children fed with breast milk in com- glucose, maternal glucose utilization is increased by
parison with those fed with formula, disorders of about 30% in the fully lactating woman. More than
growth, obesity, respiratory infections, otitis, di- 50 oligosaccharides of different structure also have
arrhea, septicemia occur rarely. been identified in human milk, these compounds
Infant formulas initially were based on cow’s comprise up to 1.2% of mature human milk (com-
milk composition, but have evolved somewhat to pared to about 0.1% of cow’s milk). The compo-
reflect human milk composition. This is still an area nents of these complex sugars include glucose, ga-
of concern. Infant formulas generally are made from lactose, fucose, N-acetylglucosamine, and sialic acid
cow’s milk or soybean ingredients. The casein pro- and represent a significant proportion of the non-
tein ratio for cow’s milk is 80:20 compared to hu- protein nitrogen found in human milk. Some of these
man milk with 40:60 ratio. Human milk does not may act as growth factors for lactobacillus which
form a hard clot in the stomach of the infant as cow’s populates the gastrointestinal tract of the breast-fed
milk does. The presence of β-lactoglobulin (not infants, or as protective factors against certain bac-
present in human milk) or soy proteins in formulas terial toxins. However, their real function is not un-
can lead to a dietary protein allergy (Table 29). derstood.
Human milk has a very high lactose content, 7 g Human milk has a relatively low casein content
per deciliter or about 200 mM and lactose provides as compared to other mammals, approximately 0.2
about 40% of the calories available to the infant. g/dl in mature milk, probably reflecting the relative-
The adaptive significance of this high lactose con- ly slow growth rate of the human infant. Most of the
tent (the highest of any species currently known) is casein in human milk is bound in micellar form. The
probably two-fold: casein micelle also contains most of the calcium and
1) The infant brain is large and requires glu- phosphate. The other major milk proteins that are syn-
cose as a metabolic substrate; lactose is broken thesized in the mammary gland are α-lactalbumin and
down into glucose and galactose prior to intesti- lactoferrin, both are present at a concentration of
nal absorption. about 0.2 g/dl in mature human milk. α-Lactalbumin

90
functions in the synthesis of lactose, the major car- Another amino acid problem in human milk vs.
bohydrate in milk. Lactoferrin is an iron-binding pro- cow’s milk-based formulas is the concentration of
tein found in high concentration in human colostrum phenylalanine and tyrosine. Human milk is low in
and milk. It is considered to be a protective factor in Phe and Tyr (particularly milk from mothers of pre-
milk because of its antibacterial properties. Only term infants). Infants have limited ability to metab-
about 5–10% of its iron-binding capacity is occupied olize these amino acids, which can build up and
so that one mechanism of bacteriostasis is thought to cause Phenylalanine Ketone Urea (PKU babies).
be binding of iron needed by bacteria to multiply. Cow’s milk has lower lactose than human milk.
Lactoferrin concentration in the mammary secretion Lactose may be particularly important as a glucose
is increased in colostrum, during mastitis, and fol- (energy) source for the rapidly developing brain of
lowing involution. The fourth major milk protein is the human infant. Generally, cholesterol is very low
secretory immunoglobulin A (sIgA), also present in in formulas (1–3 mg/dl) compared to human milk
mature milk at a concentration of about 0.2 g/dl. This (7–47 mg/dl) or cow’s milk (10–35 mg/dl). Choles-
protein is synthesized by cells of the immune system terol is needed by the infant in challenging the de-
and transported into milk by a specific mechanism velopment of cholesterol metabolizing enzymes and
described below. It is also thought to act as a protec- it contributes to synthesis of nerve tissue and bile
tive factor; its concentration is much higher in colos- salts.
trum (up to 10 g/dl) and in post-involutional secre- The Ca:P ratio is 2.29 for human milk vs. 1.26
tion than in mature milk. Other proteins in human for cow’s milk. Formulas low in cow’s milk can
milk include lysozyme (which has a particularly high cause hypocalcemia and tetany. High P in formulas
activity in human milk), lipases, growth factors and may lead to hyperphosphatemia and low serum Ca.
many others. Iron is low in human and cow’s milk, and most for-
Although the fat content is highly variable, on mulas are fortified with iron. Both iron and zinc are
the average milk lipids comprise about 4% of hu- more efficiently absorbed from human milk than
man milk. The majority of these lipids are triglyc- from cow’s milk.
erides. About 20% of the triglycerides are synthe- Most lipophilic and many hydrophilic com-
sized from medium chain fatty acids made in the pounds will pass into the milk of the mother. Many
mammary gland itself, the remaining 80% are de- antibiotics, anticoagulants, antithyroid drugs, alco-
rived from plasma. The medium chain fatty acids hol, nicotine, and caffeine will be transferred to the
are unique to mammary secretions. Milk also con- milk. Many lipophilic environmental contaminants
tains phospholipids and cholesterol in much small- which are stored in the body adipose tissue of the
er, but apparently regulated quantities. mother are mobilized during lactation and end up
Compared to the mineral content of most kinds in the milk (such as pesticides, industrial contami-
of milk, human milk contains very small amounts nants like PCBs, and many known carcinogens.
of macrominerals such as sodium (8 mM), potassi- All types of animal milk according to their com-
um (15 mM), chloride (14 mM), calcium (7 mM) position differ from the breast milk. Goat’s milk is
and magnesium (about 1 mM). The low concentra- the nearest to the breast milk by its composition of
tions of these substances reflect both the high con- nutrients and biological properties.
centration of lactose (leaving little residual osmotic At present formulas are widely used (in form of
activity for monovalent ions) and the low concen- powder). The composition of nutrients of these mix-
tration of casein providing little binding activity for tures is close to the composition of breast milk even
calcium. in amino acidic composition of proteins. Nutrients
Several amino acid differences exist between are present in them in such forms, which can be easi-
human and cow’s milk that can present problems in ly absorbed. It was shown that growth of children,
feeding cow’s milk-based formulas to certain in- feeded by formula is moderately better than those,
fants. Human milk has a high cysteine:methionine who received animal milk.
ratio and some taurine. Cow’s milk has a lower In few people diarrhea is observed after drink-
cysteine:methionine ratio and essentially no taurine. ing milk. Their percentage raises with age. The re-
The human infant’s liver and brain have only low action coyld be caused by:
levels of cystathionase, the enzyme that converts 1) low activeness of intestinal lactase (β-galac-
methionine to cysteine (the fetus and pre-term in- tosidase) congenital or acquired in ontogenesis;
fant are completely lacking this enzyme). Cystheine 2) intolerance of lactose or the whole milk.
is important for central nervous system develop- In literature data there is information about low
ment. Taurine is made from cysteine (the enzyme is activeness of intestinal lactase within big groups of
cysteinesulfonic acid decarboxylase), and taurine is population of many developing countries. In relation
needed in the infant for brain development and func- to this it is necessary to introduce correctives in pro-
tion, retinal development and function, and conju- gram of provision of child population with milk and
gation of bile salts. Cow’s milk-based formulas may milk products, partly by substituting it for other prod-
not contain optimal levels of cysteine or taurine. ucts, containing proteins of animal origin.

91
 Sorghum and sorghum cultures (gaolan, durra,
HYGIENIC CHARACTERISTICS cafire, siallu, pearl millet, rag) attract a special at-
tention. Sorghum cultures are stable against drought,
OF VEGETABLE FOOD their motherland is Africa. They have 10–13% of
PRODUCTS proteins, 71–72% of carbohydrates, 3–45 of fats.
Suger content in the stem of some sorts is high. In
spite of the fact that sorghum does not contain large
GRAIN, BEAN AND OIL CULTURES amount of cellulose (2%), it is a more rough food
for a man that other grain cultures. They are used
Rice. This plant is mainly grown in subtropical for nutrition of poor people of countries of Africa
zone and other zones. Its production is 400 mln of and Asia. It is being substituted by wheat and rice;
tons per year. In many countries (Japan, India and sorghum is used as forage for poultry cattle.
others) rice is the main cultivating plant. Because After rice and wheat, millet is the third most used
of lack of gluten rice is used for production of cere- grain. Two varieties are widely cultivated — pearl
al. For this purpose the grain is separated from ex- millet (Bajra) and finger millet (Ragi). Pearl millet
ternal coating and embryonic membranes. In such seeds are very small and yellowish-grey in colour.
condition food substances are well preserved. It con- It is used primarily in the Northern and Western parts
tains up to 75% of starch, 12% of proteins, 2.5% of of India for its flour which is used to make differ-
fats and only 0.65–0.9% of gluten. Proteins of rice ent kinds of bread, depending on the region. Gujar-
are mostly biological valuable vegetable fats. It con- athis make Bajra Potla (Bhakri), Batlou, Dhevra,
tains sufficient amount of vitamins and mineral sub- Talipeeth — different kinds of flatbreads made with
stances. While producing of polished rice all the millet flour. Finger millet or Ragi, which is consid-
membranes, embrionic layer and germ are removed ered superior to pearl millet, is used to make dosas
from the rice. That’s why polished rice is by 2–4% and roti in Southern India. Millet grains are also
of starch richer but there is low contents of proteins, used to make pulaos. Millet is rich in protein, B grop
fats, gluten, mineral substances and vitamins. Ear- vitamins, phosphorus and iron. Different sorts of
lier such rice was the cause of development of B1 millet are also stable against drought and cultivated
avitaminosis (beri-beri disease) and B1 hypovitami- in some countries of Africa. One kind of millet cul-
nosis in South-Eastern Asian and other countries in tures — fenyo (Digitaria exilis) is used in South
which rice was the main grain plant. Africa as cereal for cooking of pilaf and in pulver-
Maize. It is one of the ancient grain plants. It ized form is added to different flours.
was grown in Mexico in the VI century B. C. It is In the latest years in many countries there was
one of the widely spread grain plant, annual pro- cultivated triticale — the first artificially made grain
duction of which is 450 mln of tons. Maize grain is culture; it was made by the way of amalgamation
consumed cooked. The following products are made of chromosomes of wheat and rye. The most attrac-
from maize: maize flour, cereal or the so called tive features are crop capacity, resistance against
bursted grains. The germ of maize grain contains unfavourable soil, climate conditions and diseases,
30% of fat which is used for preparing maize oil. and also good food qualities. Amount of proteins is
Endosperm contains up to 78% of starch, 7% of pro- approx. 11.7–22.5%, starch — 73.8%, fats —
teins, 1.5% of fats; it is used for preparation of flour. 2.24%, mineral substances — 0.43%. Proteins are
Flour is used for cooking jelly-like products (such rich in lysin (more than wheat ones), their common
as hominy), polents, bread. But bread is slightly po- biological value is higher than that of other grain
rous and has small quantity of cellulose. Maize cultures. But bread qualities of the flour from triti-
grains have small amount of triptofan and nicotina- cale is worse than that of wheat flour.
mide. That’s why these proteins are not biological- Bean seeds which are rich in proteins are con-
ly valuable as wheat and rice proteins. Low niacin siderable part of the food ration of people in a
coefficient was the cause of pellagra in many coun- number of agrarian countries. Bean cultures contain
tries among poor people who eat mostly maize. At from 15 to 37% of proteins, 26–63% of starch-con-
present in the world there have been conducted the taining substances, from 1 to 6% of fats. The only
selection program to optimize amino acid structure exception is soy-bean which contains 18–20% of
of maize by the way of increasing triptofan and lysin fats. Bean cultures are rich in cellulose — 3–7%.
content. But because of big content of cellulose they are di-
Barley, oats are widely spread in the world; mil- gested worse than grain cultures. Biological value
let and sorghum cultures — in tropic countries. Bar- of proteins is lower than that of grain-cultures. Soy-
ley, oats and millet are consumed in the form of flour bean is only exception.
and cereal. Peculiarities of oats products are high Bean cultures can contain antialimentary factors
amount of fat — 6% in cereal and 7% in flour. Pro- (e.g. substances which blockade tripsin and chemo-
teins amount is 12–15%, carbohydrates — 56–65%, tripsin) and sometimes — small amount of toxic
cellulose — 1% (flour) and 2.5% (oatmeal). substances, e.g. white haricot bean contains thermi-

92
caly unstable agent with haemagglutination ability 0.13% of proteins, 0.4% of glucose, 0.13% of fats.
— fasin. After prolonged thermal treatment which It is used as fresh drink. Coconut oil is produced
decompose cellulose food biological value of beans from copra which is after refining is used in food.
increases. In contrast to other vegetable oils it contains up to
The most spread leguminous are soy-bean (world 85% of saturated fatty acids and poor in tocophe-
production is approx. 90 mln of tons), haricot bean, rols. Coconut oil is important part in producing of
pea, horse bean, noot, china, mash and others. In margarine.
many developing countries where there is a deficit Oil palm grows in tropics of Africa and Asia.
of animal proteins beans proteins are valuable ad- Oil which is obtained from stones of the palm is di-
dition to grain cultures in the diet. rectly consumed in food and also is used in produc-
Soy-beans. By the chemical composition they tion of margarine. It is close to coconut one by its
take a unique place among grain and bean cultures. qualities: it contains 80–85% of saturated fatty ac-
Soy-beans contain 37% of proteins. It is more than ids, 1–2% of linole and 16–19% of olein acids.
in any other food product. Their proteins are char- The first place among all root-plants is taken
acterized by high content of essential amino acids by potato (more than 300 mln of tons per year). It
and that’s why they have the greatest biological val- contains up to 14% of starch, 15% of proteins, 1–
ue in comparision with other vegetable proteins. As 2% of sugar, 20–30 mg% of vitamin C, and vita-
compared to wheat flour content of lysin in soy-bean mins of B group. Potato is mostly spread in tropics
flour is 1.5 times more, triptofan and methionine — of Central and North America.
3 times. Soy-beans are the source of oil, flour, soy- Manioc takes important place in this group (pro-
bean milk and cheese. Isolated and concentrated soy- duction more than 100 mln tons per year). It is cul-
bean protein obtained from the flour is used as a tivated in the whole tropic zone. The mass of root
nutritional addition, for example, to sausage-meat. is 0.8–2 kg. It contains 24% of carbohydrates (in-
In addition to high biological value and compara- cluding 1.2% of sugar), 1% of proteins, 0.5% of fats,
tively low price proteins have high functional qual- 3% of cellulose. Amount of mineral substances and
ities. That’s why soy-bean is used for preparing dif- vitamins in manioc is less than in batata and potato.
ferent artificial products including those which im- It is important to emphasize that some sorts of
itate meat products. manioc contain toxic cianogenous glycoside (ap-
From ancient time people use vegetable products prox. 30–67 mg/kg). Concentration of glycoside is
with high content of fats. These products are differ- more in the peel (15–20 times) than in pulp. If con-
ent sorts of nuts, seeds of oil cultures. Vegetable oils centration of glycoside is above 80 mg/kg, such
are obtained from seeds of cotton, sunflowers, cru- roots are considered to be poisonous. It is recom-
cifers (mustard, winter-cress and others), cacao, oil mended to eat only root-plant which contain no more
palm, sesame, hazel-nuts, coconuts, olives and oth- than 50 mg/kg of glycoside. It is a thermicaly sta-
ers. As for containing of PUFA (Poly-Unsaturated ble substance; so, it can not be completely destruct-
Fatty Acids) and tocopherols the most valuable are ed during cooking. In the process of drying out 75%
oils gotten from germs of maize, seeds of sunflow- of glycoside are destructed. Starch washed out of
ers and cotton. the pulp is free from this glycoside.
Refined cotton oil contains 33–50% of linole and The root-plants free from the peel are boiled as
29–44% of oleinic acid. potato. Boiled manioc contains 80–85% of starch,
Peanut is an important oil culture. It contains 0.4–4.2% of sugars, 1–2.5% of proteins, 0.5–1.2%
60% of fats, 15–20% of nitrogen-free substances, of fats. Besides population of tropical zone prepare
2–4% of cellulose. Peanut is rich in vitamins of B the product which is called hari from manioc. For
group, tocopherols, cholin. Peanut oil has palatable that purpose roots are peeled out, pulverized and
taste and contains 7–26% of linole, 51–80% of olein squeezed out the juice of this mass. Then this mass
fat acids. Oilcake is the product which remains af- must be boiled and dried out. Prepared hari (1/4 of
ter the extraction of oil. It is rich in proteins and roots mass) contains 10–15% of water, 80–85% of
vitamins and it is used for production flour which carbohydrates, 0.5–1.4% of proteins and 1% of fats.
is primary used as forage. There are almost no glycosides in hari.
In tropical climate conditions peanut and peanut Manioc flour can be sifted on the hot stove. This
flour are often damaged by mouldy fungi including granulated product is called tapioca which is wide-
aspergills which produce aflatoxin — toxic and can- ly used in pastry-cook production. Tapioca contains
cerogenous substance. Taking into consideration the 12.6% of water, 80% of carbohydrates, 0.7% of pro-
fact that peanut is widely cultivated in tropic coun- teins and 0.2% of fats. Tapioca is poor in mineral
tries prophylaxis of aflatoxicosis in such countries substances and vitamins. Energy value of 100 g of
is to be an urgent problem. tapioca is 345 kcal.
Coconut palm growths in tropic regions. Coco- Important starch-containing root-plant culture is
nut is the source of coconut milk and nucleus crumb batata (sweet potato). Its annual production is more
which is dried out (copra). Coconut milk contains than 75 mln of tons. The mass of root-plant is 4–

93
5 kg. It contains 24% of carbohydrates, 2% of pro- during 7–8 days) they get good gustatory and food
teins 1. 5% of fats, 3% of cellulose. Besides of qualities. During this process of ripening starch turns
starch, there are other carbohydrates which add into sugar (changing of the taste), protopectin —
sweet taste to batata. Mineral and vitamin compo- into water soluble pectin (changing of consistence,
sition is close to that of potato but batata has more formation of aromatic substances) and other chem-
carotin (0.36–1.0 mg/100 g). ical processes.
Yams and taro are also related to this group of All sorts of bananas are divided into two groups
cultures which are gradually substituted by mani- according to the character of their possible use. The
oc. Yams contains to 29% of carbohydrates, 2% of largest part of them are bananas of the group of
proteins, 0.03% of fats and 1% of cellulose. Root- plentins which contains a large amount of starch.
plant of yams and taro are eaten uncooked. They are used in boiled state or dried and pulver-
ized into flour. They contain about 64% of water,
12% of starch, 19% of sugars, 1.2% of proteins,
FRUIT AND VEGETABLES 0.8% of fats, 0.8% of cellulose. Bananas are not rich
in vitamin C (approx. 0.7 mg per 100 g) but contain
The most spread vegetables in the world are cab- a number of α-carotins (0.7 mg per 100 g) and vita-
bage, carrot, beet, onion, garlic, dill, parsley, tur- mins of B group, especially riboflavin (0.6 mg per
nip, radish, cucumber, aubergine, pepper, spinach 100 g). Those sorts of bananas are consumed by lo-
and others. In the regions with hot climate water- cal population. In some regions of India, Indonesia,
melon cultures are cultivated. Malaysia and especially tropical Africa importance
An important part of food ration of a modern man of bananas in the nourishment of population can be
is fruit. Energy value is not high (it is approx. 60 compared with importance of bread in conditions
kcal per 100g) but they have good taste. They are of moderate climate.
rich in different sugars, organic acids and vitamins. The second group consists of sweet bananas
Citrus plants widely spread in tropical countries which are usually exported. Content of water is 72–
include several tens of sorts of fruit which have good 76%, carbohydrates — 22–27% (16% of sacharose,
taste and dietetic qualities. Every year production 11% of reduced sugars), proteins — 1.3–1.5%, fats
of citrus fruit is more than 40 mln tons. They are — 0.1–0.6%, other substances — 0.8–0.9%. Be-
such fruit as oranges, tangerines, grape-fruit, lem- sides, they are used for preparation of jams, can-
ons, limes, citrons and others. died bananas, banana flour, dried bananas, etc.
Citrus fruit has a great significance in dietary of In South-West Asia, North America and Sahara
sick people. There are 5% of inverted sugar, 3% of there are regions where the date-palm is cultivat-
sacharose, 1% of citric acid in the pulp of sweet or- ed. Dates are a good food product (“bread of
ange. Because of thick peel and acidity of its juice deserts”). They contain about 72% of carbohydrates
different vitamins (including vitamin C) are well (including 60% of sugars among which sacharose
preserved in orange. Citrus fruit are rich in substanc- prevails), 7.5% of proteins, 2.5% of fats, 3–6% of
es which have properties of vitamin P. Orange, tan- cellulose. They contain vitamins of B group espe-
gerines, grape-fruits, pampelmus are eaten in raw. cially niacin and pantothenic acid (0.8 mg of each
They are also used in pastry-cook production. per 100 g). They can be kept for a long period. In
Other citrus fruit (lemon, lime) contain great ancient times dates were the most popular food for
amount of citric acid in the pulp. The amount of or- sailors and travelers in deserts.
ganic acids in the lemon is 6–8%, inverted sugars Bread-fruit tree is spread in Indonesia, Poly-
— 2–3%, sacharose — 0.5%. Juice of this citrus nesia and nearly located regions. Fruit of this tree
fruit are used for preparing fresh drinks, culinary is round or oval of 10–12 cm in diameter. Their pulp
products and confectionery. People often prefer tea has many fibers and yellow colour, the signs of a
with lemon from all the hot drinks. Lemon peel con- ripe fruit. Fruit are eaten raw, boiled, baked and they
tains vitamin C 2–3 times more than the pulp. Lem- are used for bread baking. Fruit contain 65% of wa-
on juice stimulates immunity of the organism, has ter, 19% of starch, 12% of sugars, 1.5% of proteins,
antiscorbutic, antianaemia and other curable quali- 0.2–0. 5% of fats and 1% of cellulose.
ties. Mango is one of the best Indian fruit-delicacy.
Banana — is an important vegetable culture. It Average mass of fruit is 300–400 g (sometimes up
is considered that banana is one of the first food to 2–4 kg). The pulp is of yellow colour and has
products and one of the first plant which is started palatable sweet taste, strong aroma which reminds
to be cultivated. It grows primary in tropical zone smell of apricot, melon or lemon. The pulp contains
with increased humidity. Harvests of bananas from 75–85% of water, 11–20% of sugars (mostly sacha-
one hectare is approximately 100 times more than rose), 0.2–0.6% of organic acids, 0.5–1% of pro-
wheat and 40 times — than potato. Bananas must teins, small amount of mineral substances but a lot
be unripe because only in artificial conditions (in of ascorbic acid (approx. 25 mg per 100 g), α-caro-
rooms with temperature 16–17°C, humidity 85–90% tins, vitamins of B group. They are often used in

94
juices, jams and other products. In India the fruit
are used for preparation of marinades, Indian dish- Microbial Food Poisonings
es: cari and chashni. Mango juice is used in popu- Food bacterial toxicoses are acute food-borne
lar medicine as a remedy against a lot of diseases diseases caused by microbic toxins. There are bot-
including cholera and plague. ulism and staphylococcal toxicoses.
Avocado is a fruit tree which grows in Ameri- Botulism is a rare but serious foodborne disease.
can tropics. The fruit’s size is from 7 to 20 cm. The It is caused by contamination of certain food-stuffs
pulp is of a yellow-green colour, butter consistence by the botulism bacterium commonly found in the
and the same taste but with smack of walnut and soil. Cl. botulinum are gram positive, spore produc-
smell of bay leaf. Seeds of avocado are uneatable. ing bacilli. They are obligate anaerobic. Due to plas-
Composition: 60–70% of water, 1.2–1.8% of pro- mid contained in some Cl. botulinum organisms they
teins, 10–29% of fats, 5–10% of carbohydrates; en- can product 7 neurotoxic types of botulinum toxin:
ergy value is 218 kcal per 100 g. Oil contains 77% A, B, C1, D, E, F, G under anerobic conditions.
of olein and 10% of linole acids. Pulp of the fruit There are released by autolysis as a prototoxin.
contains many water soluble fat-soluble vitamins. Bound to hemagglutinins and inhibits degradation
Avocado is used for preparing of canned products. by digestive enzymes is doubtful.
Papaya (melon tree). Fruit are from 0.4 to Risk associated food-stuffs: home canned vege-
20 kg of weight. Taste depends on the sort of papa- tables and mushrooms, smoked fish and preserved
ya. Some sorts have sweet taste, the others are with- sea food, sausages. Recent epidemics in USA were
out taste, the others have bitter smack. Pulp is of caused with Peyote cactus tea, Mascarpone cream
dark-yellow or orange colour. It contains 85–88% cheese.
of water, 0.4–0.7% of proteins, 0.25% of fats, 8– There are two different illnesses: adult botulism
12% of sugars (mostly monosacharides), sufficient and infant botulism. An adult may become ill by
amount of vitamins (ascorbic acid — up to 46 mg/ eating spoiled food containing the botulism toxin.
100 g, carotin — up to 2 mg/100 g). The pulp of This toxin is produced when the bacteria grows in
papaya (specially unripe fruit) contains enzyme pa- improperly canned food and occasionally in contam-
pain which is similar to pepsin. This fact allows to inated fish. Infant botulism is caused by eating the
use papaya in curative diet. spores of the botulinum bacterium. For infants one
Tropical zone is rich in different plants. So, any source of these spores is honey. When contaminat-
country depending on its climate conditions and ed food is eaten by adults, toxin is absorbed from
food needs can choose optimum from hygienic po- the intestines and attaches to the nerves causing the
sitions, plants to be cultivated. It’s important to em- signs and symptoms of botulism. Early symptoms
phasize that the role of fruit of tropic and moderate include blurred vision, dry mouth, difficulty in swal-
zones as the source of vitamins is almost similar. lowing or speaking, general weakness, and shortness
of breath. The illness may progress to complete pa-
FOOD POISONING AND ralysis, respiratory failure, and death. When infants
ITS PREVENTION eat contaminated food, the spores grow in the in-
testines and release toxin. Diagnosis is made by the
Food poisoning is toxic foodborne disease. The presence of appropriate neurologic symptoms and
modern classification of food poisonings divides by laboratory tests that detect toxin or by culture of
them into three groups: microbial, non-microbial and Clostridium botulinum bacterium from the patient’s
unconfirmed ethiology (Fig. 30). stool. Infant botulism is more common in spring and

FOOD POISONING

Microbial Unknown ethyology Non-microbial mycotoxicosis

toxicoinfection bacterial toxicosis caused with caused with food- caused with
poisonous stuffs which got chemical
food-stuffs poisonous peculiari- admixture
mixes ty temporarily

vegetable animal vegetable animal pesti- me- food others

origin origin origin origin cides talls additives

Fig. 30. Classification of Food Poisonings

95
summer and is rare in winter. Infants younger than pressure and pulse rate may occur. Recovery gener-
one year of age, particularly between the ages of two ally takes two days, However, it us not unusual for
to four months, are at highest risk. Symptoms in- complete recovery to take three days and sometimes
clude muscle weakness, a weak cry, a poor suck (dif- longer in severe cases.
ficulty in feeding), feeble crying, constipation, head A-toxin dose of less than 1.0 µg in contaminat-
lag, increased heart rate and a decreased gag reflex. ed food will produce symptoms of staphylococcal
A baby with infant botulism is described as a “flop- intoxication. This toxin level is reached when S.
py baby”, as the baby will have weak muscles, es- aureus population exceeds 100,000 per gram.
pecially in the arms, legs and neck. In the diagnosis of staphylococcal foodborne ill-
Although there are very few cases of botulism ness, proper interviews with the victims and gath-
poisoning each year, prevention is extremely impor- ering and analyzing epidemiologic data are essen-
tant. Home canning should follow strict hygienic tial. Incriminated food-stuffs should be collected and
recommendations to reduce contamination of food- examined for staphylococci. The presence of rela-
stuffs. In addition, because the botulism toxin is de- tively large numbers of enterotoxigenic staphyloco-
stroyed by boiling for 10 minutes, people who eat cci is good circumstantial evidence that the food
home-canned food-stuffs should consider boiling the contains toxin. The most conclusive test is the link-
food before eating it to ensure safety. A county ex- ing of an illness with a specific food or in cases
tension home economist can provide specific in- where multiple vehicles exist, the detection of the
structions on safe home canning techniques. To help toxin in the food sample(s). In cases where the food
preventing infant botulism, infants less than 12 may have been treated to kill the staphylococci, as
months old should not be fed honey. in pasteurization or heating, direct microscopic ob-
Facts about botulism prevention: servation of the food may be an aid in the diagno-
1. The best prevention is canning or preserving sis. A number of serological methods for determin-
food with appropriate heat, pressure and low pH. ing the enterotoxigenicity of S. aureus isolated from
2. Spores of Cl. botulinum survive 2 h at 100°C, food-stuffs as well as methods for the separation and
Inactivated at 120°C. detection of toxins in food-stuffs have been devel-
3. Boiling food before canning at high elevations oped and used successfully to aid in the diagnosis
may not inactivate the spores! of the illness. Phage typing may also be useful when
4. Factors favoring spore germination: low acid- viable staphylococci can be isolated from the incrim-
ity (pH > 5.0); low O2; high water content. inated food, from victims, and from suspected car-
5. Toxin: inactivated after 1 min at 85°C, or 5 rier such as food handlers.
min at 80°C. Food-stuffs that are frequently incriminated in
6. Avoid exposure of infants to honey (may con- staphylococcal food poisoning include meat and
tain Clostridium botulinum spores). meat products; poultry and egg products; salads such
7. There are no immunity from subsequent epi- as eggs, tuna, chicken, potatoes, and pasta; bakery
sodes of botulism intoxication. products such as cream-filled pastries, cream pies,
Staphylococcal food poisoning (staphyloenter- and chocolate eclairs; sandwich fillings; and milk
otoxicosis; staphyloenterotoxemia) is the name of and dairy products. Food-stuffs that require consi-
the condition caused by the enterotoxins which some derable handling during preparation and that are kept
strains of S. aureus produce. S. aureus is a spheri- at slightly elevated temperatures after preparation
cal bacterium (coccus) which in microscopic exam- are frequently involved in staphylococcal food poi-
ination appears in pairs, short chains, or bunched, soning.
grape-like clusters. These organisms are Gram-pos- Staphylococci exist in air, dust, sewage, water,
itive. Some strains are capable of producing a high- milk, and food or on food equipment, environmen-
ly heat-stable protein toxin that causes illness in tal surfaces, humans, and animals. Humans and an-
humans. imals are the primary reservoirs. Staphylococci are
All people are believed to be susceptible to this present in the nasal passages and throat and on the
type of bacterial intoxication; however, intensity of hair and skin of 50% or more of healthy individu-
symptoms may vary. The onset of symptoms in sta- als. This incidence is even higher for those who as-
phylococcal food poisoning is usually rapid and in sociate or come in contact with sick individuals and
many cases acute, depending on individual suscep- hospital environments. Although food handlers are
tibility to the toxin, the amount of contaminated food usually the main source of food contamination in
eaten, the amount of toxin in the food ingested, and food poisoning outbreaks, equipment and environ-
the general health of the victim. The most common mental surfaces can also be sources of contamina-
symptoms are nausea, vomiting, retching, abdomi- tion with S. aureus. Human intoxication is caused
nal cramping, and prostration. Some individuals may by ingesting enterotoxins produced in food by some
not always demonstrate all the symptoms associat- strains of S. aureus, usually because the food has
ed with the illness. In more severe cases, headache, not been kept hot enough (60°C or above) or cold
muscle cramping, and transient changes in blood enough (7.2°C or below).

96
 The true incidence of staphylococcal food poi- is a frequent sobriquet. The most frequent clinical
soning is unknown for a number of reasons, includ- syndrome of infection includes watery diarrhea, ab-
ing poor responses from victims during interviews dominal cramps, low-grade fever, nausea and ma-
with health officials; misdiagnosis of the illness, laise.
which may be symptomatically similar to other types Volunteer feeding studies indicate that a relative-
of food poisoning (such as vomiting caused by Ba- ly large dose (100 million to 10 billion bacteria) of
cillus cereus toxin); inadequate collection of sam- enterotoxigenic E. coli is probably necessary to es-
ples for laboratory analyses; and improper labora- tablish colonization of the small intestine, where
tory examination. Death from staphylococcal food these organisms proliferate and produce toxins
poisoning is very rare, although such cases have which induce fluid secretion. With high infective
occurred among the elderlies, infants, and severely dose, diarrhea can be induced within 24 h. Infants
debilitated persons. may require fewer organisms for infection to be es-
For detecting trace amounts of staphylococcal tablished.
enterotoxin in food-stuffs incriminated in food poi- During the acute phase of infection, large num-
soning, the toxin must be separated from food con- bers of enterotoxigenic cells are excreted in feces.
stituents and concentrated before identification by These strains are differentiated from nontoxigenic
specific precipitation with antiserum (antienterotox- E. coli present in the bowel by a variety of in vitro
in) as follows. Two principles are used for the pur- immunochemical, tissue culture, or gene probe tests
pose: (1) the selective adsorption of the enterotoxin designed to detect either the toxins or genes that
from an extract of the food onto ion exchange res- encode for these toxins. The diagnosis can be com-
ins and (2) the use of physical and chemical proce- pleted in about 3 days.
dures for the selective removal of food constituents ETEC is not considered to be a serious foodborne
from the extract, leaving the enterotoxin(s) in solu- disease hazard in countries having high sanitary
tion. The use of these techniques and concentration standards and practices. Contamination of water
of the resulting products (as much as possible) has with human sewage may lead to contamination of
made it possible to detect small amounts of entero- food-stuffs. Infected food handlers may also con-
toxins in food. taminate food-stuffs. These organisms are infre-
There are developed rapid methods based on quently isolated from dairy products such as semi-
monoclonal antibodies (e.g. ELISA, Reverse Pas- soft cheeses. Infants and travelers to underdeveloped
sive Latex Agglutination), which are being evaluat- countries are at most risk of infection.
ed for their efficacy in the detection of enterotoxins With the availability of a gene probe method,
in food. These rapid methods can detect approxi- food-stuffs can be analyzed directly for the presence
mately 1. 0 ng of toxin/g of food. of enterotoxigenic E. coli, and the analysis can be
Food toxicoinfections are acute noncontagious completed in about 3 days. Alternative methods
diseases, developing during consumption of food which involve enrichment and plating of samples
heavily polluted with agents (105–10 6 microbes per for isolation of E. coli and their subsequent confir-
1 g or 1 ml). They are characterized by: mation as toxigenic strains by conventional toxin
a) short incubation period (average 6–24 h); assays may take at least 7 days.
b) spesific dietary history for all sick persons; Among EEC are the enteropathogenic (EPEC)
c) outbreaks and epidemics if product was real- strains. EPEC are defined as E. coli belonging to
ized through centralized catering organization or serogroups epidemiologically implicated as patho-
trade organization; gens but whose virulence mechanism is unrelated
d) local epidemiology; to the excretion of typical E. coli enterotoxins. E.
e) fast outbreak cessation after removal of source coli are gram-negative, rod-shaped bacteria belong-
(incrimed product); ing the family Enterobacteriaceae. The source(s) and
f) gastroenteritis. prevalence of EPEC are controversial because food-
Currently, there are four recognized classes of borne outbreaks are sporadic. Humans, bovines, and
enterovirulent E. coli (collectively referred to as the swine can be infected, and the latter often serve as
EEC group) that cause gastroenteritis in humans. common experimental animal models. E. coli are
Among these are the enterotoxigenic (ETEC) present in the normal gut flora of these mammals.
strains. They comprise a relatively small proportion The proportion of pathogenic to nonpathogenic
of the species and have been etiologically associat- strains, although the subject of intense research, is
ed with diarrheal illness of all age groups from di- unknown.
verse global locations. The organism frequently Infantile diarrhea is the name of the disease usu-
causes diarrhea in infants in less developed coun- ally associated with EPEC. EPEC cause either a
tries and in the visitors there from industrialized watery or bloody diarrhea, the former associated
countries. The etiology of this cholera-like illness with the attachment to, and physical alteration of,
has been recognized for about 20 years. the integrity of the intestine. Bloody diarrhea is as-
Gastroenteritis is the common name of the ill- sociated with attachment and an acute tissue-de-
ness caused by ETEC, although “travelers diarrhea” structive process, perhaps caused by a toxin similar
97
to that of Shigella dysenteriae, also called verotox- breaks, however E. coli O157:H7 outbreaks have
in. In most of these strains the shiga-like toxin is implicated sprouts, unpasteurized fruit juices, dry-
cell-associated rather than excreted. EPEC are high- cured salami, lettuce, minced meat, and cheese
ly infectious for infants and the infective dose is pre- curds. Raw milk was the cause of a school outbreak
sumably very low. In the few documented cases of in Canada.
adult diseases, the dose is presumably similar to oth- Hemorrhagic colitis infections are not too com-
er colonizers (greater than 106 of a total dose). mon, but this is probably not reflective of the true
The distinction of EPEC from other groups of frequency. Because of the unmistakable symptoms
pathogenic E. coli isolated from patients’ stools in- of profuse, visible blood in severe cases, those vic-
volves serological and cell culture assays. Serotyp- tims probably seek medical attention, but less se-
ing, although useful, is not strict for EPEC. vere cases are probably more numerous. Some vic-
Common food-stuffs implicated in EPEC out- tims, particularly the very young, have developed
breaks are raw beef and chicken, although any food the hemolytic uremic syndrome (HUS), character-
exposed to fecal contamination is strongly suspect- ized by renal failure and hemolytic anemia. From 0
ed. Outbreaks of EPEC are sporadic. Incidence var- to 15% of hemorrhagic colitis victims may develop
ies on a worldwide basis; countries with poor sani- HUS. The disease can lead to permanent loss of kid-
tation practices have the most frequent outbreaks. ney function. In the elderlies, HUS, plus two other
Occasionally, diarrhea in infants is prolonged, symptoms, fever and neurologic symptoms, consti-
leading to dehydration, electrolyte imbalance and tute thrombotic thrombocytopenic purpura (TTP).
death (50% mortality rates have been reported in This illness can have a mortality rate in the elder-
third world countries). lies as high as 50%.
EPEC outbreaks most often affect infants, espe- All people are believed to be susceptible to he-
cially those that are bottle fed, suggesting that con- morrhagic colitis, but young children and the elder-
taminated water is often used to rehydrate infant ly appear to progress to more serious symptoms
formulae in underdeveloped countries. more frequently.
The isolation and identification of E. coli in food- Campylobacter jejuni is a gram-negative slender,
stuffs follows standard enrichment and biochemi- curved, and motile rod. It is a microaerophilic or-
cal procedures. Serotyping of isolates to distinguish ganism, which means it has a requirement for re-
EPEC is laborious and requires high quality, spe- duced levels of oxygen. It is relatively fragile, and
cific antisera, and technical expertise. The total anal- sensitive to environmental stresses (e.g. 21% oxy-
ysis may require from 7 to 14 days. gen, drying, heating, disinfectants, acidic condi-
E. coli serotype O157:H7 is a rare variety of E. tions). Because of its microaerophilic characteris-
coli that produces large quantities of one or more tics the organism requires 3 to 5% oxygen and 2 to
related, potent toxins that cause severe damage to 10% carbon dioxide for optimal growth conditions.
the lining of the intestine. These toxins (verotoxin This bacterium is now recognized as an important
(VT), shiga-like toxin) are closely related or identi- enteric pathogen. Before 1972, when methods were
cal to the toxin produced by Shigella dysenteriae. developed for its isolation from feces, it was be-
of Hemorrhagic colitis is the name of the acute dis- lieved to be primarily an animal pathogen causing
ease caused by E. coli O157:H7. abortion and enteritis in sheep and cattle. Surveys
The illness is characterized by severe cramping have shown that C. jejuni is the leading cause of
(abdominal pain) and diarrhea which is initially bacterial diarrheal illness in the United States. It
watery but becomes grossly bloody. Occasionally causes more disease than Shigella spp. and Salmo-
vomiting occurs. Fever is either low-grade or ab- nella spp. combined.
sent. The illness is usually self-limited and lasts for Although C. jejuni is not carried by healthy in-
an average of 8 days. Some individuals exhibit wa- dividuals but it is often isolated from healthy cat-
tery diarrhea only. tle, chickens, birds and even flies. It is sometimes
Infective dose is unknown, but from a compila- present in non-chlorinated water sources such as
tion of outbreak data, including the organism’s abil- streams and ponds.
ity to be passed person-to-person in the day-care Because the pathogenic mechanisms of C. jeju-
setting and nursing homes, the dose may be similar ni are still being studied, it is difficult to differenti-
to that of Shigella spp. (as few as 10 organisms). ate pathogenic from nonpathogenic strains. Howev-
Hemorrhagic colitis is diagnosed by isolation of E. er, it appears that many of the chicken isolates are
coli of serotype O157:H7 or other verotoxin-produc- pathogens.
ing E. coli from diarrheal stools. Alternatively, the Campylobacteriosis is the name of the illness
stools can be tested directly for the presence of vero- caused by C. jejuni. It is also often known as campy-
toxin. Confirmation can be obtained by isolation of E. lobacter enteritis or gastroenteritis. C. jejuni infec-
coli of the same serotype from the incriminated food. tion causes diarrhea, which may be watery or sticky
Undercooked or raw hamburger (ground beef) and can contain blood (usually occult) and fecal leu-
has been implicated in many of the documented out- kocytes (white cells). Other symptoms often present

98
are fever, abdominal pain, nausea, headache and mus- shellfish dwelling in these environments. V. para-
cle pain. The illness usually occurs 2–5 days after haemolyticus-associated gastroenteritis is the name
ingestion of the contaminated food or water. Illness of the infection caused by this organism.
generally lasts for 7–10 days, but relapses are often Diarrhea, abdominal cramps, nausea, vomiting,
(about 25% of cases). Most infections are self-limit- headache, fever, and chills may be associated with
ing and are not treated with antibiotics. infections caused by this organism. The illness is
The infective dose of C. jejuni is considered to usually mild or moderate, although some cases may
be small. Human feeding studies suggest that about require hospitalization. The median duration of the
400–500 bacteria may cause illness in some indi- illness is 2.5 days. The incubation period is 4–96 h
viduals, while in others greater numbers are re- after the ingestion of the organism, with a mean of
quired. A conducted volunteer human feeding study 15 h. Disease is caused when the organism attaches
suggests that host susceptibility also dictates infec- itself to the individuals’ small intestine and excretes
tious dose to some degree. The pathogenic mecha- an as yet unidentified toxin.
nisms of C. jejuni are still not completely under- Infective dose is greater than one million micro-
stood, but it does produce a heat-labile toxin that organisms; this dose may be markedly lowered by
may cause diarrhea. C. jejuni may also be an inva- coincident consumption of antacids (or presumably
sive organism. by food with buffering capability).
C. jejuni frequently contaminates raw chicken. Diagnosis of gastroenteritis caused by this organ-
Surveys show that 20 to 100% of retail chickens are ism is made by culturing the organism from the di-
contaminated. This is not overly surprising since arrheic stools of an individual.
many healthy chickens carry these bacteria in their Infections with this organism have been associ-
intestinal tracts. Raw milk is also a source of infec- ated with the consumption of raw, improperly
tions. The bacteria are often carried by healthy cat- cooked, or cooked recontaminated fish and shellfish.
tle and by flies on farms. Non-chlorinated water may A correlation exists between the probability of in-
also be a source of infections. However, properly fection and warmer months of the year. Improper
cooked chicken, pasteurizing milk, and chlorinating refrigeration of seafood-stuffs contaminated with
drinking water will kill the bacteria. this organism will allow its proliferation, which in-
C. jejuni is the leading cause of bacterial diarrhea creases the possibility of infection. Major outbreaks
in the developed countries. There are probably num- have occurred during the warmer months of the year.
bers of cases in excess of the estimated cases of sal- Sporadic cases occur along all coasts. Diarrhea
monellosis (2 to 4,000,000/year). Complications are caused by this organism is usually self-limiting, with
relatively rare, but infections have been associated few cases requiring hospitalization and/or antibiot-
with reactive arthritis, hemolytic uremic syndrome, ic treatment. All individuals who consume raw or
and following septicemia, infections of nearly any improperly cooked fish and shellfish are suscepti-
organ. The estimated case/fatality ratio for all C. je- ble to infection by this organism.
juni infections is 0.1, meaning one death per 1,000 Methods used to isolate this organism from food-
cases. Fatalities are rare in healthy individuals and stuffs are similar to those used with diarrheic stools.
usually occur in cancer patients or in the otherwise Because many food isolates are nonpathogenic,
debilitated. Only 20 reported cases of septic abor- pathogenicity of all food isolates must be demon-
tion induced by C. jejuni have been recorded in the strated. Although the demonstration of the Kana-
literature. Meningitis, recurrent colitis, acute chole- gawa hemolysin was long considered indicative of
cystitis and Guillain — Barre syndrome are very rare pathogenicity, this is now uncertain.
complications. Clostridium perfringens is an anaerobic, gram-
Although anyone can have a C. jejuni infection, positive, sporeforming rod (anaerobic means una-
children under 5 years and young adults (15–29) are ble to grow in the presence of free oxygen). It is
more frequently afflicted than other age groups. widely distributed in the environment and frequently
Reactive arthritis, a rare complication of these in- occurs in the intestines of humans and many domes-
fections, is strongly associated with people who have tic and feral animals. Spores of the organism per-
the human lymphocyte antigen B27 (HLA-B27). sist in soil, sediments, and areas subjected to hu-
Isolation of C. jejuni from food is difficult be- man or animal fecal pollution.
cause the bacteria are usually present in very low Perfringens food poisoning is the term used to
numbers. The methods require generally a micro- describe the common foodborne illness caused by
aerophilic atmosphere with 5% oxygen and an ele- C. perfringens. A more serious but rare illness is
vated concentration of carbon dioxide (10%). Iso- also caused by ingesting food contaminated with
lation can take several days to a week. type C strains. The latter illness is known as enteri-
Vibrio parahaemolyticus (and other marine Vi- tis necroticans or pig-bel disease. The common form
brio spp.) Both pathogenic and non-pathogenic of perfringens poisoning is characterized by intense
strains of the bacterium can be isolated from ma- abdominal cramps and diarrhea which begin 8–
rine and estuarine environments and from fish and 22 h after consumption of food-stuffs containing

99
large numbers of those C. perfringens bacteria ca- food poisoning. The onset of watery diarrhea, ab-
pable of producing the food poisoning toxin. The dominal cramps, and pain occurs 6–15 h after con-
illness is usually over within 24 h but less severe sumption of contaminated food. Nausea may accom-
symptoms may persist in some individuals for 1 or pany diarrhea, but vomiting (emesis) rarely occurs.
2 weeks. A few deaths have been reported as a re- Symptoms persist for 24 h in most instances. The
sult of dehydration and other complications. Necrot- emetic type of food poisoning is characterized by
ic enteritis caused by C. perfringens is often fatal. nausea and vomiting within 0.5 to 6 h after con-
This disease also begins as a result of ingesting large sumption of contaminated food-stuffs. Occasional-
numbers of the causative bacteria in contaminated ly, abdominal cramps and/or diarrhea may also oc-
food-stuffs. Deaths from necrotic enteritis pig-bel cur. Duration of symptoms is generally less than 24
syndrome are caused by infection and necrosis of h.
the intestines and from resulting septicemia. This Some strains of B. subtilis and B. licheniformis
disease is very rare. have been isolated from lamb and chicken incrimi-
In most instances, the actual cause of poisoning nated in food poisoning episodes. These organisms
by C. perfringens is temperature abuse of prepared demonstrate the production of a highly heat-stable
food-stuffs. Small numbers of the organisms are of- toxin which may be similar to the vomiting type tox-
ten present after cooking and multiply to food poi- in produced by B. cereus.
soning levels during cool down and storage of pre- The presence of large numbers of B. cereus
pared food-stuffs. Meat, meat products, and gravy (greater than 106 organisms/g) in a food is indica-
are the food-stuffs most frequently implicated. tive of active growth and proliferation of the organ-
Institutional feeding (such as school cafeterias, ism and is consistent with a potential hazard to
hospitals, nursing homes, prisons, etc.) where large health.
quantities of food are prepared several h before serv- Confirmation of B. cereus as the etiologic agent
ing is the most common circumstance in which per- in a foodborne outbreak requires either isolation of
fringens poisoning occurs. The young and elderly strains of the same serotype from the suspected food
people are the most frequent victims of perfringens and feces or vomiting of the patient, isolation of
poisoning. Except the case of pig-bel syndrome, large numbers of a B. cereus serotype known to
complications are few in persons under 30 years of cause foodborne illness from the suspected food or
age. Elderly persons are more likely to experience from the feces or vomiting of the patient, or isola-
prolonged or severe symptoms. tion of B. cereus from suspected food-stuffs and de-
Standard bacteriological culturing procedures are termining their enterotoxigenicity by serological
used to detect the organism in implicated food-stuffs (diarrheal toxin) or biological (diarrheal and emet-
and in feces of patients. Serological assays are used ic) tests. The rapid onset time to symptoms in the
for detecting enterotoxin in the feces of patients and emetic form of disease, coupled with some food ev-
for testing the ability of strains to produce toxin. The idence, is often sufficient to diagnose this type of
procedures take 1–3 days. food poisoning.
Bacillus cereus is a gram-positive, facultatively A wide variety of food-stuffs including meat,
aerobic sporeformer which cells are large rods and milk, vegetables, and fish have been associated with
whose spores do not swell the sporangium. These the diarrheal type food poisoning. The vomiting-type
and other characteristics, including biochemical fea- outbreaks have generally been associated with rice
tures, are used to differentiate and confirm the pres- products; however, other starchy food-stuffs such as
ence of B. cereus, although these characteristics are potato, pasta and cheese products have also been
shared with B. cereus var. mycoides, B. thuringien- implicated. Food mixtures such as sauces, puddings,
sis and B. anthracis. Differentiation of these organ- soups, casseroles, pastries, and salads have frequent-
isms depends upon determination of motility (most ly been incriminated in food poisoning outbreaks.
B. cereus are motile), presence of toxin crystals (B.
thuringiensis), hemolytic activity (B. cereus and oth-
ers are beta-hemolytic whereas B. anthracis is usu- NON-MICROBIAL FOOD POISONINGS
ally nonhemolytic), and rhizoid growth which is
characteristic of B. cereus var. mycoides. There are unhomogeneus group of foodborne dis-
B. cereus food poisoning is the general descrip- eases. They are not spread so widely as microbial
tion, although two recognized types of illness are food poisonings but can have high incidence in the
caused by two distinct metabolites. The diarrheal regions with poor sanitary control on food safety.
type of illness is caused by a large molecular weight
Ciguatera Fish Poisoning
protein, while the vomiting (emetic) type of illness
is believed to be caused by a low molecular weight, Ciguatera is a form of human poisoning caused
heat-stable peptide. by the consumption of subtropical and tropical ma-
The symptoms of B. cereus diarrheal type food rine finfish which have accumulated naturally oc-
poisoning mimic those of Clostridium perfringens curring toxins through their diet. The toxins are

100
known to originate from several dinoflagellate (al- ally self-limiting, and signs of poisoning often sub-
gae) species that are common to ciguatera endemic side within several days from the onset. However,
regions in the lower latitudes. in severe cases the neurological symptoms are
Manifestations of ciguatera in humans usually known to persist from weeks to months. In a few
involves a combination of gastrointestinal, neuro- isolated cases neurological symptoms have persist-
logical, and cardiovascular disorders. Symptoms ed for several years, and in other cases recovered
defined within these general categories vary with the patients have experienced recurrence of neurologi-
geographic origin of toxic fish. cal symptoms months to years after recovery. Such
Clinical testing procedures are not presently relapses are most often associated with changes in
available for the diagnosis of ciguatera in humans. dietary habits or with consumption of alcohol. There
Diagnosis is based entirely on symptomology and is a low incidence of death resulting from respira-
recent dietary history. An enzyme immunoassay tory and cardiovascular failure.
(EIA) is used to detect toxic fish in field situations. All humans are believed to be susceptible to
Marine finfish most commonly implicated in ciguatera toxins. Populations in tropical/subtropical
ciguatera fish poisoning include the groupers, bar- regions are most likely to be affected because of the
racudas, snappers, jacks, mackerel, and triggerfish. frequency of exposure to toxic fishes. However, the
Many other species of warm-water fishes harbor increasing per capita consumption of fishery prod-
ciguatera toxins. The occurrence of toxic fish is spo- ucts coupled with an increase in interregional trans-
radic, and not all fish of a given species or from a portation of seafood products has expanded the ge-
given locality will be toxic (Fig. 31). ographic range of human poisonings.
Initial signs of poisoning occur within six h af-
ter consumption of toxic fish and include perioral Shellfish Poisoning
numbness and tingling (paresthesia), which may Shellfish poisoning is caused by a group of tox-
spread to the extremities, nausea, vomiting, and di- ins elaborated by planktonic algae (dinoflagellates
arrhea. Neurological signs include intensified par- in most cases) upon which the shellfish feed. The
esthesia, arthralgia, myalgia, headache, temperature toxins are accumulated and sometimes metabolized
sensory reversal and acute sensitivity to tempera- by the shellfish. The 20 toxins responsible for par-
ture extremes, vertigo, and muscular weakness to alytic shellfish poisonings (PSP) are all derivatives
the point of prostration. Cardiovascular signs in- of saxitoxin. Diarrheic shellfish poisoning (DSP) is
clude arrhythmia, bradycardia or tachycardia, and presumably caused by a group of high molecular
reduced blood pressure. Ciguatera poisoning is usu- weight polyethers, including okadaic acid, the di-

— highest incidence of ciguatera

— mild incidence of ciguatera

Fig. 31. Worldwide Distribution of Ciguatera Fish Poisoning

101
nophysis toxins, the pectenotoxins, and yessotoxins. dose of toxin ingested, may be as little as 30 min to
Neurotoxic shellfish poisoning (NSP) is the result 2 to 3 hr, with symptoms of the illness lasting as
of exposure to a group of polyethers called breve- long as 2 to 3 days. Recovery is complete with no
toxins. Amnesic shellfish poisoning (ASP) is caused aftereffects; the disease is generally not life threat-
by the unusual amino acid, domoic acid, as the con- ening.
taminant of shellfish. ASP: The toxicosis is characterized by the onset
Ingestion of contaminated shellfish results in a of gastrointestinal symptoms within 24 hr; neuro-
wide variety of symptoms, depending upon the logical symptoms occur within 48 h. The toxicosis
toxin(s) present, their concentrations in the shell- is particularly serious in elderly patients, and in-
fish and the amount of contaminated shellfish con- cludes symptoms reminiscent of Alzheimer’s dis-
sumed. In the case of PSP, the effects are predomi- ease. All fatalities to date have involved elderly pa-
nantly neurological and include tingling, burning, tients.
numbness, drowsiness, incoherent speech, and res- All humans are susceptible to shellfish poison-
piratory paralysis. Worse characterized are the ing. Elderly people are apparently predisposed to the
symptoms associated with DSP, NSP, and ASP. DSP severe neurological effects of the ASP toxin. A dis-
is primarily observed as a generally mild gastroin- proportionate number of PSP cases occur among
testinal disorder, i. e. nausea, vomiting, diarrhea, and tourists or others who are not native to the location
abdominal pain accompanied by chills, headache, where the toxic shellfish are harvested. This may
and fever. Both gastrointestinal and neurological be due to disregard for either official quarantines
symptoms characterize NSP, including tingling and or traditions of safe consumption, both of which tend
numbness of lips, tongue, and throat, muscular to protect the local population.
aches, dizziness, reversal of the sensations of hot The mouse bioassay has historically been the
and cold, diarrhea, and vomiting. ASP is character- most universally applied technique for examining
ized by gastrointestinal disorders (vomiting, di- shellfish (especially for PSP); other bioassay pro-
arrhea, abdominal pain) and neurological problems cedures have been developed but not generally ap-
(confusion, memory loss, disorientation, seizure, plied. Unfortunately, the dose-survival times for the
coma). Diagnosis of shellfish poisoning is based DSP toxins in the mouse assay fluctuate considera-
entirely on observed symptomatology and recent bly and fatty acids interfere with the assay, giving
dietary history. false-positive results; consequently, a suckling
All shellfish (filter-feeding molluscs) are poten- mouse assay that has been developed and used for
tially toxic. However, PSP is generally associated control of DSP measures fluid accumulation after
with mussels, clams, cockles, and scallops; NSP injection of the shellfish extract. In recent years con-
with shellfish harvested along the Florida coast and siderable effort has been applied to development of
the Gulf of Mexico; DSP with mussels, oysters, and chemical assays to replace these bioassays. As a re-
scallops, and ASP with mussels. sult a good high performance liquid chromatogra-
Good statistical data on the occurrence and se- phy (HPLC) procedure has been developed to iden-
verity of shellfish poisoning are largely unavaila- tify individual PSP toxins (detection limit for saxi-
ble, which undoubtedly reflects the inability to toxin = 20 fg/100 g of meats; 0.2 ppm), an excel-
measure the true incidence of the disease. Cases are lent HPLC procedure (detection limit for okadaic
frequently misdiagnosed and, in general, infrequent- acid = 400 ng/g; 0.4 ppm), a commercially availa-
ly reported. Of these toxicoses the most serious one ble immunoassay (detection limit for okadaic acid
of public health perspective appears to be PSP. The = 1 fg/100 g of meat; 0.01 ppm) for DSP and a to-
extreme potency of the PSP toxins has in the past tally satisfactory HPLC procedure for ASP (detec-
resulted in an unusually high mortality rate. Symp- tion limit for domoic acid = 750 ng/g; 0.75 ppm).
toms of the PSP develop fairly rapidly, within 0.5
to 2 h after ingestion of the shellfish, depending on
the amount of toxin consumed. In severe cases res- Scombroid Poisoning (Histamine Poisoning)
piratory paralysis is common, and death may occur Scombroid poisoning is caused by the ingestion
if respiratory support is not provided. When such of food-stuffs that contain high levels of histamine
support is applied within 12 h of exposure, recov- and possibly other vasoactive amines and com-
ery usually is complete without side effects. In un- pounds. Histamine and other amines are formed by
usual cases, because of the weak hypotensive ac- the growth of certain bacteria and the subsequent
tion of the toxin, death may occur from cardiovas- action of their decarboxylase enzymes on histidine
cular collapse despite respiratory support. and other amino acids in food, either during the pro-
NSP: The onset of this disease occurs within a duction of a product such as Swiss cheese or by
few minutes to a few h; duration is fairly short, from spoilage of food-stuffs such as fishery products, par-
a few h to several days. Recovery is complete with ticularly tuna or mahi mahi. However, any food that
few aftereffects; no fatalities have been reported. contains the appropriate amino acids and is subject-
DSP: The onset of the disease, depending on the ed to certain bacterial contamination and growth

102
may lead to scombroid poisoning when ingested. However, recent reports of the production of tetro-
Initial symptoms may include a tingling or burn- dotoxin/anhydrotetrodotoxin by several bacterial
ing sensation in the mouth, a rash on the upper body species, including strains of the family Vibrionace-
and a drop in blood pressure. Frequently, headaches ae, Pseudomonas sp., and Photobacterium phos-
and itching of the skin are encountered. The symp- phoreum, point toward a bacterial origin of this fam-
toms may progress to nausea, vomiting, and diarrhea ily of toxins. These are relatively common marine
and may require hospitalization, particularly in the bacteria that are often associated with marine ani-
case of elderly or impaired patients. mals. If confirmed, these findings may have some
Diagnosis of the illness is usually based on the significance in toxicoses that have been more direct-
patient’s symptoms, time of the onset, and the ef- ly related to these bacterial species.
fect of treatment with antihistamine medication. The The diagnosis of pufferfish poisoning is based
suspected food must be analyzed within a few h for on the observed symptomatology and recent dietary
elvaluating levels of histamine to confirm a diag- history.
nosis. Poisonings from tetrodotoxin have been almost
Fishery products that have been implicated in exclusively associated with the consumption of puff-
scombroid poisoning include the tunas (e.g. skip- erfish from waters of the Indo-Pacific ocean regions.
jack and yellowfin), mahi mahi, bluefish, sardines, Several reported cases of poisonings, including fa-
mackerel, amberjack, and abalone. Many other prod- talities, involved pufferfish from the Atlantic Ocean,
ucts also have caused the toxic effects. The prima- Gulf of Mexico, and Gulf of California. There have
ry cheese involved in intoxications has been Swiss been no confirmed cases of poisoning from the At-
cheese. The toxin forms in a food when certain bac- lantic pufferfish, Spheroides maculatus. However,
teria are present and time and temperature permit in one study, extracts from fish of this species were
their growth. Distribution of the toxin within an in- highly toxic in mice. The trumpet shell Charonia
dividual fish fillet or between cans in a batch can sauliae has been implicated in food poisonings, and
be unequal, with only some sections of a product evidence suggests that it contains a tetrodotoxin de-
causing illnesses and others not. Neither cooking nor rivative. There have been several reported poison-
canning, or freezing reduces the toxic effect. Com- ings from mislabelled pufferfish and at least one re-
mon sensory examination by the consumer cannot port of a fatal episode when an individual swallowed
ensure the absence or presence of the toxin. Chem- a California newt. From 1974 through 1983 there
ical testing is the only reliable test for evaluation of were 646 reported cases of pufferfish poisoning in
a product. Japan, with 179 fatalities. Estimates as high as 200
The onset of intoxication symptoms is rapid, cases per year with mortality approaching 50% have
ranging from immediate to 30 min. The duration of been reported. Only a few cases have been reported
the illness is usually 3 hr, but may last for several in the United States, and outbreaks in countries out-
days. All humans are susceptible to scombroid poi- side the Indo-Pacific area are rare.
soning; however, the symptoms can be severe for The first symptom of intoxication is a slight
the elderlies and for those taking medications such numbness of the lips and tongue, appearing between
as isoniazid. Because of the worldwide network for 20 min to three h after eating poisonous pufferfish.
harvesting, processing, and distributing fishery prod- The next symptom is increasing paraesthesia in the
ucts, the impact of the problem is not limited to spe- face and extremities, which may be followed by sen-
cific geographical areas. sations of lightness or floating. Headache, epigast-
ric pain, nausea, diarrhea, and/or vomiting may oc-
cur. Occasionally, some reeling or difficulty in walk-
Pufferfish Poisoning (Tetradon Poisoning, ing may occur. The second stage of the intoxication
Fugu Poisoning) is increasing paralysis. Many victims are unable to
Fish poisoning by consumption of members of move; even sitting may be difficult. There is in-
the order Tetraodontiformes is one of the most vio- creasing respiratory distress. Speech is affected,
lent intoxications from marine species. The gonads, and the victim usually exhibits dyspnea, cyanosis,
liver, intestines, and skin of pufferfish can contain and hypotension. Paralysis increases and convul-
levels of tetrodotoxin sufficient to produce rapid and sions, mental impairment, and cardiac arrhythmia
violent death. The flesh of many pufferfish may not may occur. The victim, although completely para-
usually be dangerously toxic. Tetrodotoxin has also lyzed, may be conscious and in some cases com-
been isolated from widely differing animal species, pletely lucid until shortly before death. Death usu-
including the California newt, parrotfish, frogs of ally occurs within 4 to 6 hr, with a known range of
the genus Atelopus, the blue-ringed octopus, star- about 20 min to 8 h.
fish, angelfish, and xanthid crabs. The metabolic All humans are susceptible to tetrodotoxin poi-
source of tetrodotoxin is uncertain. No algal source soning. This toxicosis may be avoided by not con-
has been identified, and until recently tetrodotoxin suming pufferfish or other animal species contain-
was assumed to be a metabolic product of the host. ing tetrodotoxin. Most other animal species known

103
to contain tetrodotoxin are not usually consumed by poisonings are generally categorized by their phys-
humans. Poisoning from tetrodotoxin is of major iological effects. There are four categories of mush-
public health concern primarily in Japan, where room toxins: protoplasmic poisons (poisons that re-
“fugu” is a traditional delicacy. It is prepared and sult in generalized destruction of cells, followed by
sold in special restaurants where trained and li- organ failure); neurotoxins (compounds that cause
censed individuals carefully remove the viscera to neurological symptoms such as profuse sweating,
reduce the danger of poisoning. Importation of puff- coma, convulsions, hallucinations, excitement, de-
erfish into the United States is not generally per- pression, spastic colon); gastrointestinal irritants
mitted, although special exceptions may be grant- (compounds that produce rapid, transient nausea,
ed. There is potential for misidentification and/or vomiting, abdominal cramping, and diarrhea); and
mislabelling, particularly of prepared, frozen fish disulfiram-like toxins. Mushrooms in this last cate-
products. gory are generally nontoxic and produce no symp-
The mouse bioassay developed for paralytic toms unless alcohol is consumed within 72 h after
shellfish poisoning (PSP) can be used to monitor eating them, in this case a short-lived acute toxic
tetrodotoxin in pufferfish and is the current method syndrome is produced.
of choice. An HPLC method with post-column re- Mushroom poisonings are almost always caused
action with alkali and fluorescence has been devel- by ingestion of wild mushrooms that have been col-
oped to determine tetrodotoxin and its associated lected by nonspecialists (although specialists have
toxins. The alkali degradation products can be con- also been poisoned). Most cases occur when toxic
firmed as their trimethylsilyl derivatives by gas chro- species are confused with edible species, and a use-
matography/mass spectrometry. These chromato- ful question to ask of the victims or their mushroom-
graphic methods have not yet been validated. picking benefactors is the identity of the mushroom
they thought they were picking. In the absence of a
Mushroom Poisoning (Toadstool Poisoning) well-preserved specimen, the answer to this ques-
Mushroom poisoning is caused by the consump- tion could narrow the possible suspects considera-
tion of raw or cooked fruiting bodies (mushrooms, bly. Intoxication has also occurred when reliance
toadstools) of a number of species of higher fungi. was placed on some folk method of distinguishing
The term toadstool (from the German Todesstuhl, poisonous and safe species. Outbreaks have oc-
death’s stool) is commonly given to poisonous curred after ingestion of fresh, raw mushrooms, stir-
mushrooms, but for individuals who are not experts fried mushrooms, home-canned mushrooms, mush-
in mushroom identification there are generally no rooms cooked in tomato sauce (which rendered the
easily recognizable differences between poisonous sauce itself toxic, even when no mushrooms were
and nonpoisonous species. Old wives’ tales notwith- consumed), and mushrooms that were blanched and
standing, there is no general rule of thumb for dis- frozen at home. Cases of poisoning by home-canned
tinguishing edible mushrooms and poisonous toad- and frozen mushrooms are especially insidious be-
stools. The toxins involved in mushroom poisoning cause a single outbreak may easily become a multi-
are produced naturally by the fungi themselves, and ple outbreak when the preserved toadstools are car-
each individual specimen of a toxic species should ried to another location and consumed at another
be considered equally poisonous. Most mushrooms time.
that cause human poisoning cannot be made non- Specific cases of mistaken mushroom identity
toxic by cooking, canning, freezing, or any other appear frequently. The potentially deadly Sorrel
means of processing. Thus, the only way to avoid Webcap Mushroom (Cortinarius orellanus) is not
poisoning is to avoid consumption of the toxic spe- easily distinguished from nonpoisonous webcaps
cies. Poisonings occur most commonly when hunt- belonging to the same distinctive genus, and all
ers of wild mushrooms (especially novices) misiden- should be avoided. The Early False Morel Gyromi-
tify and consume a toxic species. In the USA and tra esculenta is easily confused with the true Morel
Australia immigrants collect and consume a poison- Morchella esculenta, and poisonings have occurred
ous domestic species that closely resembles an edi- after consumption of fresh or cooked Gyromitra.
ble wild mushroom from their native land. Some- Gyromitra poisonings have also occurred after in-
times poisoning occures when mushrooms that con- gestion of commercially available “morels” contam-
tain psychoactive compounds are intentionally con- inated with G. esculenta. The commercial sources
sumed by persons who desire these effects. for these fungi (which have not yet been success-
Mushroom poisonings are generally acute and fully cultivated on a large scale) are field collection
are manifested by a variety of symptoms and prog- of wild morels by semiprofessionals. Cultivated
noses, depending on the amount and species con- commercial mushrooms of whatever species are al-
sumed. Because the chemistry of many of the mush- most never implicated in poisoning outbreaks un-
room toxins (especially the less deadly ones) is still less there are associated problems such as improp-
unknown and positive identification of the mush- er canning (which lead to bacterial food poisoning).
rooms is often difficult or impossible, mushroom Most of the psychotropic mushrooms (Inoc-

104
ybe spp., Conocybe spp., Paneolus spp., Pluteus culenta and G. gigas) contain the protoplasmic poi-
spp.) are in general appearance small, brown, son gyromitrin, a volatile hydrazine derivative. Poi-
and leathery (the so-called “Little Brown Mush- soning by this toxin superficially resembles Aman-
rooms”) and relatively unattractive from a culi- ita poisoning but is less severe. There is generally
nary standpoint. a latent period of 6–10 h after ingestion during
The Fly Agaric (Amanita muscaria) and Panther- which no symptoms are evident, followed by sud-
cap (Amanita pantherina) mushrooms are large, den onset of abdominal discomfort (a feeling of full-
fleshy, and colorful. Yellowish cap colors on some ness), severe headache, vomiting, and sometimes
varieties of the Fly Agaric and the Panthercap are diarrhea. The toxin affects primarily the liver, but
similar to the edible Caesar’s Mushroom (Amanita there are additional disturbances to blood cells and
caesarea), which is considered a delicacy in Italy. the central nervous system. The mortality rate is rel-
Another edible yellow capped mushroom occasion- atively low (2–4%). Poisonings with symptoms al-
ally confused with yellow A. muscaria and A. pan- most identical to those produced by Gyromitra have
therina varieties are the Yellow Blusher (Amanita also been reported after ingestion of the Early False
flavorubens). Orange to yellow-orange A. muscar- Morel (Verpa bohemica). The toxin is presumed to
ia and A. pantherina may also be confused with the be related to gyromitrin but has not yet been identi-
Blusher (Amanita rubescens) and the Honey Mush- fied.
room (Armillariella mellea). White to pale forms of The final type of protoplasmic poisoning is
A. muscaria may be confused with edible field caused by the Sorrel Webcap mushroom (Corti-
mushrooms (Agaricus spp.). Young (button stage) narius orellanus) and some of its relatives. This
specimens of A. muscaria have also been confused mushroom produces orellanine, which causes a type
with puffballs. of poisoning characterized by an extremely long
The normal course of the disease varies with the asymptomatic latent period of 3 to 14 days. An in-
dose and the mushroom species eaten. Each poison- tense, burning thirst (polydipsia) and excessive uri-
ous species contains one or more toxic compounds nation (polyuria) are the first symptoms. This may
which are unique to few other species. Therefore, be followed by nausea, headache, muscular pains,
cases of mushroom poisonings generally do not re- chills, spasms, and loss of consciousness. In severe
sembles each other unless they are caused by the cases, severe renal tubular necrosis and kidney fail-
same or very closely related mushroom species. ure may result in death (15%) several weeks after
Several mushroom species, including the Death the poisoning. Fatty degeneration of the liver and
Cap or Destroying Angel (Amanita phalloides, A. severe inflammatory changes in the intestine accom-
virosa), the Fool’s Mushroom (A. verna) and sever- pany the renal damage, and recovery in less severe
al of their relatives, along with the Autumn Skull- cases may require several months.
cap (Galerina autumnalis) and some of its relatives, Ingestion of any number of Inocybe or Clitocybe
produce a family of cyclic octapeptides called aman- species (e.g. Inocybe geophylla, Clitocybe dealba-
itins. Poisoning by the amanitins is characterized by ta) results in an illness characterized primarily by
a long latent period (range 6-48 h, average 6-15 h) profuse sweating. This effect is caused by the pres-
during which the patient shows no symptoms. Symp- ence in these mushrooms of high levels (3–4%) of
toms appear at the end of the latent period in the muscarine. Muscarine poisoning is characterized by
form of sudden, severe seizures of abdominal pain, increased salivation, perspiration, and lacrimation
persistent vomiting and watery diarrhea, extreme within 15 to 30 minutes after ingestion of the mush-
thirst, and lack of urine production. If this early room. With large doses, these symptoms may be fol-
phase is survived, the patient may appear to recov- lowed by abdominal pain, severe nausea, diarrhea,
er for a short time, but this period will generally be blurred vision, and labored breathing. Intoxication
followed by a rapid and severe loss of strength, pros- generally subsides within 2 h. Deaths are rare, but
tration, and pain-caused restlessness. Death in 50– may result from cardiac or respiratory failure in se-
90% of the cases from progressive and irreversible vere cases.
liver, kidney, cardiac, and skeletal muscle damage The Fly Agaric (Amanita muscaria) and Panther-
may follow within 48 h (large dose), but the dis- cap (Amanita pantherina) mushrooms both produce
ease more typically lasts for 6 to 8 days in adults ibotenic acid and muscimol. Both substances pro-
and 4 to 6 days in children. Two or three days after duce the same effects, but muscimol is approximate-
the onset of the later phase, jaundice, cyanosis, and ly 5 times more potent than ibotenic acid. Symp-
coldness of the skin occur. Death usually follows a toms of poisoning generally occur within 1–2 h af-
period of coma and occasionally convulsions. If re- ter ingestion of the mushrooms. An initial abdomi-
covery occurs, it generally requires at least a month nal discomfort may be present or absent, but the
and is accompanied by enlargement of the liver. chief symptoms are drowsiness and dizziness (some-
Autopsy will usually reveal fatty degeneration and times accompanied by sleep), followed by a period
necrosis of the liver and kidney. of hyperactivity, excitability, illusions, and delirium.
Certain species of False Morel (Gyromitra es- Periods of drowsiness may alternate with periods of

105
excitement, but symptoms generally fade within a in some mushrooms of unusual sugars, amino ac-
few h. Fatalities rarely occur in adults, but in chil- ids, peptides, resins, and other compounds.
dren, accidental consumption of large quantities of The Inky Cap Mushroom (Coprinus atramentar-
these mushrooms may cause convulsions, coma, and ius) is most commonly responsible for this poison-
other neurologic problems for up to 12 h. ing, although a few other species have also been
A number of mushrooms belonging to the spe- implicated. A complicating factor in this type of in-
cies Psilocybe, Panaeolus, Copelandia, Gymnopilus, toxication is that this species is generally consid-
Conocybe, and Pluteus, when ingested, produce a ered edible (i. e., no illness results when eaten in
syndrome similar to alcohol intoxication (sometimes the absence of alcoholic beverages). The mushroom
accompanied by hallucinations). Several of these produces an unusual amino acid, coprine, which is
mushrooms (e.g. Psilocybe cubensis, P. mexicana, converted to cyclopropanone hydrate in the human
Conocybe cyanopus) are eaten for their psychotropic body. This compound interferes with the breakdown
effects in religious ceremonies of certain native of alcohol, and consumption of alcoholic beverag-
American tribes, a practice which dates to the pre- es within 72 h after eating it will cause headache,
Columbian era. The toxic effects are caused by psi- nausea and vomiting, flushing, and cardiovascular
locin and psilocybin. The onset of symptoms is usu- disturbances that last for 2–3 h.
ally rapid and the effects generally subside within Young fruiting bodies of the sulfur shelf fungus
2 h. Poisonings by these mushrooms are rarely fa- Laetiporus sulphureus are considered edible. How-
tal in adults and may be distinguished from iboten- ever, ingestion of this shelf mushroomhas caused di-
ic acid poisoning by the absence of drowsiness or gestive upset and other symptoms in adults and vis-
coma. The most severe cases of psilocybin poison- ual hallucinations and ataxia in a child.
ing occur in small children, where large doses may All humans are susceptible to mushroom toxins.
cause the hallucinations accompanied by fever, con- The poisonous species are ubiquitous, and geograph-
vulsions, coma, and death. These mushrooms are ical restrictions on types of poisoning that may oc-
generally small, brown, and not particularly fleshy; cur in one location do not exist (except for some of
they are seldom assumed to be edible by wild mush- the hallucinogenic mushrooms). Individual speci-
rooms innocent hunters. Poisonings caused by in- mens of poisonous mushrooms are also character-
tentional ingestion of these mushrooms by people ized by individual variations in toxin content based
with no legitimate religious justification must be on genetics, geographic location, and growing con-
handled with care, since the only cases likely to be ditions. Intoxications may thus be more or less se-
seen by the physician are overdoses or intoxications rious, depending not on the number of mushrooms
caused by a combination of the mushroom and some consumed, but on the dose of toxin delivered. In
added psychotropic substance (such as PCP). addition, although most cases of poisoning by higher
Numerous mushrooms, including the Green Gill plants occur in children, toxic mushrooms are con-
(Chlorophyllum molybdites), Gray Pinkgill (Entolo- sumed most often by adults. Occasional accidental
ma lividum), Tigertop (Tricholoma pardinum), Jack mushroom poisonings of children and pets have
O’Lantern (Omphalotus illudens), Naked Brimcap been reported, but adults are more likely to actively
(Paxillus involutus), Sickener (Russula emetica), search for and consume wild mushrooms for culi-
Early False Morel (Verpa bohemica), Horse mush- nary purposes. Children are more seriously affect-
room (Agaricus arvensis) and Pepper bolete (Boletus ed by the normally nonlethal toxins than adults are
piperatus), contain toxins that can cause gastroin- and more likely to suffer very serious consequenc-
testinal distress, including nausea, vomiting, di- es from ingestion of relatively smaller doses. Adults
arrhea, and abdominal cramps. In many ways these who consume mushrooms are also more likely to
symptoms are similar to those caused by the deadly recall what was eaten and when, and are able to de-
protoplasmic poisons. The chief and diagnostic dif- scribe their symptoms more accurately than children
ference is that poisonings caused by these mush- are. Very old, very young, and debilitated persons
rooms have a rapid onset, rather than the delayed of both sexes are more likely to become seriously
onset seen in protoplasmic poisonings. Some mush- ill from all types of mushroom poisoning, even those
rooms (including the first five species mentioned types which are generally considered to be mild.
above) may cause vomiting and/or diarrhea which Many idiosyncratic adverse reactions to mush-
lasts for several days. Fatalities caused by these rooms have been reported. Some mushrooms cause
mushrooms are relatively rare and are associated certain people to become violently ill, while not af-
with dehydration and electrolyte imbalances caused fecting others who consumed part of the same mush-
by diarrhea and vomiting, especially in debilitated, room cap. Factors such as age, sex, and general
very young, or very old patients. Replacement of flu- health of the consumer do not seem to be reliable
ids and other appropriate supportive therapy will predictors of these reactions, and they have been at-
prevent death in these cases. The chemistry of the tributed to allergic or hypersensitivity reactions and
toxins responsible for this type of poisoning is vir- to inherited inability of the unfortunate victim to
tually unknown, but may be related to the presence metabolize certain unusual fungal constituents (such

106
as the uncommon sugar, trehalose). These reactions
Honey Intoxication
are probably not true poisonings as the general pop-
ulation does not seem to be affected. Honey intoxication is caused by the consump-
Health promotion is very important in the pre- tion of honey produced from the nectar of rhodo-
vention of mushroom poisonings. People should dendrons. The grayanotoxins cause the intoxication.
avoid to collect unknown mushrooms. It’s prohib- The specific grayanotoxins vary with the plant spe-
ited to sell mixture of the mushrooms at the mar- cies. These compounds are diterpenes, polyhydrox-
ket. ylated cyclic hydrocarbons that do not contain ni-
trogen. Other names associated with the disease is
rhododendron poisoning, mad honey intoxication or
Red Kidney Bean (Phaseolus vulgaris) grayanotoxin poisoning.
Poisoning, Kinkoti Bean Poisoning, Fabism The intoxication is rarely fatal and generally lasts
The onset time from consumption of raw or un- for no more than 24 h. Generally the disease induc-
dercooked kidney beans to symptoms varies from es dizziness, weakness, excessive perspiration, nau-
between 1 to 3 h. The onset is usually marked by sea, and vomiting shortly after the toxic honey is
extreme nausea, followed by vomiting, which may ingested. Other symptoms that can occur are low
be very severe. Diarrhea develops somewhat later blood pressure or shock, bradyarrhythmia (slowness
(from one to a few h), and some persons report ab- of the heart beat associated with an irregularity in
dominal pain. Some persons have been hospitalized, the heart rhythm), sinus bradycardia (a slow sinus
but recovery is usually rapid (3–4 h after the onset rhythm, with a heart rate less than 60), nodal rhythm
of symptoms) and spontaneous. (pertaining to a node, particularly the atrioventricu-
Phytohaemagglutinin, the presumed toxic agent, lar node), Wolff — Parkinson — White syndrome
is found in many species of beans, but it is in high- (anomalous atrioventricular excitation) and com-
est concentration in red kidney beans (Phaseolus plete atrioventricular block.
vulgaris). The unit of toxin measure is the hemag- The grayanotoxins bind to sodium channels in
glutinating unit (hau). Raw kidney beans contain cell membranes. The binding unit is the group II re-
from 20,000 to 70,000 hau, while fully cooked beans ceptor site, localized on a region of the sodium chan-
contain from 200 to 400 hau. White kidney beans, nel that is involved in the voltage-dependent acti-
another variety of Phaseolus vulgaris, contain about vation and inactivation. These compounds prevent
one-third the amount of toxin as the red variety; inactivation; thus, excitable cells (nerve and mus-
broad beans (Vicia faba) contain 5 to 10% the cle) are maintained in a state of depolarization, dur-
amount that red kidney beans contain. ing which entry of calcium into the cells may be fa-
The syndrome is usually caused by the ingestion cilitated. This action is similar to that exerted by the
of raw, soaked kidney beans, either alone or in sal- alkaloids of veratrum and aconite. All of the ob-
ads or casseroles. As few as four or five raw beans served responses of skeletal and heart muscles,
can trigger symptoms. Several outbreaks have been nerves, and the central nervous system are related
associated with “slow cookers” or crock pots, or in to the membrane effects.
casseroles which had not reached a high enough in- In humans, symptoms of poisoning occur after a
ternal temperature to destroy the glycoprotein lec- dose-dependent latent period of a few minutes to two
tin. It has been shown that heating to 800°C may or more h and include salivation, vomiting, and both
potentiate the toxicity five-fold, so that these beans circumoral (around or near the mouth) and extrem-
are more toxic than if eaten raw. In studies of cas- ity paresthesia (abnormal sensations). Pronounced
seroles cooked in slow cookers, internal tempera- low blood pressure and sinus bradycardia develop.
tures often did not exceed 75°C. In severe intoxication, loss of coordination and pro-
The disease course is rapid. All symptoms usu- gressive muscular weakness result. Extrasystoles (a
ally resolve within several h from the onset. Vom- premature contraction of the heart that is independ-
iting is usually described as profuse, and the se- ent of the normal rhythm and arises in response to
verity of symptoms is directly related to the dose an impulse in some part of the heart other than the
of toxin (number of raw beans ingested). Hospi- sinoatrial node; called also premature beat) and ven-
talization has occasionally resulted, and intrave- tricular tachycardia (an abnormally rapid ventricu-
nous fluids may have to be administered. Although lar rhythm with aberrant ventricular excitation, usu-
of short duration, the symptoms are extremely de- ally in excess of 150 per minute) with both atriov-
bilitating. entricular and intraventricular conduction distur-
All persons, regardless of age or gender, appear bances also may occur. Convulsions are reported
to be equally susceptible; the severity is related only occasionally.
to the dose ingested. In the seven outbreaks men- Grayanotoxin poisoning most commonly results
tioned above, the attack rate was 100%. Prevention: from the ingestion of grayanotoxin-contaminated
do not use raw beans and bean flour for baking honey, but although it may result from the inges-
tion of the leaves, flowers, and nectar of rhododen-

107
drons. Not all rhododendrons produce grayanotox- ications of range animals sometimes occur in areas
ins. Rhododendron ponticum grows extensively on under drought stress, where plants containing alka-
the mountains of the eastern Black Sea area of Tur- loids are common. Milk from dairy animals can be-
key. This species has been associated with honey come contaminated with the alkaloids, and alkaloids
poisoning since 401 B.C. have been found in the honey collected by bees for-
The increased desire of people for natural (un- aging on toxic plants. Mass human poisonings have
processed) food-stuffs, may result in more cases in occurred in other countries when cereal crops used
grayanotoxin poisoning. Individuals who obtain to prepare food were contaminated with seeds con-
honey from farmers who may have only a few hives taining pyrrolizidine alkaloid.
are at increased risk. The pooling of massive quan- All humans are believed to be susceptible to the
tities of honey during commercial processing gen- hepatotoxic pyrrolizidine alkaloids. Home remedies
erally dilutes any toxic substance. and consumption of herbal teas in large quantities
The grayanotoxins can be isolated from the sus- can be a risk factor and are the most likely causes
pect commodity by typical extraction procedures for of alkaloid poisonings in the developed countries.
naturally occurring terpenes. The toxins are identi- The pyrrolizidine alkaloids can be isolated from
fied by thin layer chromatography. the suspect commodity by any of several standard
alkaloid extraction procedures. The toxins are iden-
Pyrrolizidine Alkaloids Poisoning tified by thin layer chromatography. The pyrrolizi-
Pyrrolizidine alkaloid intoxication is caused by dine ring is first oxidized to a pyrrole followed by
consumption of plant material containing these al- spraying with Ehrlich reagent, which gives a char-
kaloids. The plants may be consumed as food, for acteristic purple spot. Gas-liquid chromatographic
medicinal purposes, or as contaminants of other ag- and mass spectral methods also are available for
ricultural crops. Cereal crops and forage crops are identifying the alkaloids.
sometimes contaminated with pyrrolizidine-produc-
ing weeds, and the alkaloids find their way into flour Food mycotoxicoses
and other food-stuffs, including milk from cows Food mycotoxicoses are diseases occurring as a
feeding on these plants. Many plants from the Bor- result of consumption of food products, containing
aginaceae, Compositae, and Leguminosae families toxic metabolites of life activity of specific groups
contain well over 100 hepatotoxic pyrrolizidine al- of microscopic fungi. Mycotoxins are recorded in
kaloids. history as far back as 5,000 years ago in China. Be-
Most cases of pyrrolizidine alkaloid toxicity re- sides ergot and mushroom poisonings, reports as
sult in moderate to severe liver damage. Gastroin- early 1861 indicate that a suspected mycotoxin af-
testinal symptoms are usually the first sign of in- fecting humans was reported in Russia, and in 1891
toxication, and consist predominantly of abdominal there was a report of mouldy rice in Japan to be toxic
pain with vomiting and the development of ascites. to man. This review reports on the early literature
Death may ensue from 2 weeks to more than 2 years on mycotoxins affecting human up to 1960, which
after poisoning, but patients may recover almost is the time of the discovery of aflatoxin, and to our
completely if the alkaloid intake is discontinued and present knowledge where this problem still persists.
the liver damage has not been too severe. They proceed acutely, but often — chronic. Myco-
Evidence of toxicity may not become apparent toxins are resistant to influence of high temperatures
until sometime after the alkaloid is ingested. The (200 degree Celsius and more). At present there are
acute illness has been compared to the Budd — Chi- no reliable methods of disinfecting of products con-
ari syndrome (thrombosis of hepatic veins, leading taminated by mycotoxins. Most significant amongst
to liver enlargement, portal hypertension, and as- mycotoxins are aflatoxicoses, fusariotoxicoses and
cites). Early clinical signs include nausea and acute ergotism.
upper gastric pain, acute abdominal distension with Historically, the aflatoxins were discovered as a
prominent dilated veins on the abdominal wall, fe- consequence of the death of 100,000 of turkey poults
ver, and biochemical evidence of liver disfunction. (“Turkey X disease”), ducklings and chicks in Eng-
Fever and jaundice may be present. In some cases land in 1960 with a loss of at least several hundred
the lungs are affected; pulmonary edema and pleu- thousand dollars. The problem was eventually traced
ral effusions have been observed. Lung damage may to feed contamination, specifically a shipment of
be prominent and has been fatal. Chronic illness Brazilian peanut meal used as poultry feed produced
from ingestion of small amounts of the alkaloids by Old Cake Mills, Ltd. in London. This meal,
over a long period proceeds through fibrosis of the termed Rosetti meal (from the name of the ship in
liver to cirrhosis, which is indistinguishable from which it was imported), proved to be both toxic and
cirrhosis of other etiology. carcinogenic and was found to be contaminated with
Reports of acute poisoning among humans are the common fungus, Aspergillus flavus.
relatively rare. Most result from the use of medici- Aflotoxicoses. The aflatoxins are a group of se-
nal preparations as home remedies. However, intox- condary fungal metabolises which have been epi-

108
demiologically implicated as environmental toxin ogen in many species, including nonhuman primates,
and carcinogens in man. They are substituted cou- birds, fish, and rodents. In each species, the liver is
marins containing a fused dihydrofurofuran moie- the primary target organ of acute injury. Metabolism
ty. There are four primary aflatoxins, named B1, B2, plays a major role in determining the toxicity of afla-
G1 and G2, from their blue and green fluorescence, toxin B1; studies show that this aflatoxion requires
respectively, on thin-layer chromatographic plates. metabolic activation to exert its carcinogenic effect,
As was generally known to be the case with afla- and these effects can be modified by induction or
toxin toxicity and carcinogenicity, a similar poten- inhibition of the mixed function oxidase system.
cy series, namely AFB1 > AFB2 > AFG1 > AFG2 Aflatoxicosis in humans has rarely been report-
> has been established for aflatoxin — induced mu- ed; however, such cases are not always recognized.
tagenic activity and DNA damage. Aflatoxicosis may be suspected when a disease out-
It was established that they were produced by break exhibits the following characteristics:
fungi of family Aspergillus: A. flavus and A. — the cause is not readily identifiable;
paraziticus. Aflatoxins according to their chemical — the condition is not transmissible;
structure belong to furocumarines. At present around — syndromes may be associated with certain
15 aflatoxins are known. The most toxic is aflatox- batches of food;
in B1. They posses highly powerful hepatotoxic and — treatment with antibiotics or other drugs has
hepatocancerogenic influence. Cancerogenic active- little effect;
ness considerably exceeds than that of benzopyrene — the outbreak may be seasonal, i. e., weather
and dimethylnitrozamine of “ethanol” cancerogens. conditions may affect mold growth.
Aflatoxicosis is poisoning that results from in- The adverse effects of aflatoxins in animals (and
gestion of aflatoxins in contaminated food or feed. presumably in humans) have been categorized in two
The aflatoxins are a group of structurally related tox- general forms.
ic compounds produced by certain strains of the fun- 1. Acute aflatoxicosis is produced when moder-
gi Aspergillus flavus and A. parasiticus. Under fa- ate to high levels of aflatoxins are consumed. Spe-
vorable conditions of temperature and humidity, cific, acute episodes of disease may include hemor-
these fungi grow on certain food-stuffs and feeds, rhage, acute liver damage, edema, alteration in di-
resulting in the production of aflatoxins. The most gestion, absorption and/or metabolism of nutrients,
pronounced contamination has been encountered in and possibly death.
tree nuts, peanuts, and other oilseeds, including corn 2. Chronic aflatoxicosis results from ingestion of
and cottonseed. The major aflatoxins of concern are low to moderate levels of aflatoxins. The effects are
designated B1, B2, G1, and G2. These toxins are usually subclinical and difficult to recognize. Some
usually found together in various food-stuffs and of the common symptoms are impaired food con-
feeds in various proportions; however, aflatoxin B1 version and slower rates of growth with or without
is usually predominant and is the most toxic. When the production of an overt aflatoxin syndrome.
a commodity is analyzed by thin-layer chromatog- In the world aflatoxins have been identified in
raphy, the aflatoxins separate into the individual corn and corn products, peanuts and peanut prod-
components in the order given above; however, the ucts, cottonseed, milk, and tree nuts such as Brazil
first two fluoresce blue when viewed under ultravi- nuts, pecans, pistachio nuts, and walnuts. Other
olet light and the second two fluoresce green. Afla- grains and nuts are susceptible but less prone to con-
toxin M is a major metabolic product of aflatoxin tamination.
B1 in animals and is usually excreted in the milk In well-developed countries, aflatoxin contami-
and urine of dairy cattle and other mammalian spe- nation rarely occurs in food-stuffs at levels that
cies that have consumed aflatoxin-contaminated cause acute aflatoxicosis in humans. In view of this,
food or feed. studies on human toxicity from ingestion of afla-
Aflatoxins produce acute necrosis, cirrhosis, and toxins have focused on their carcinogenic potential.
carcinoma of the liver in a number of animal spe- The relative susceptibility of humans to aflatoxins
cies; no animal species is resistant to the acute tox- is not known, even though epidemiological studies
ic effects of aflatoxins; hence it is logical to assume in Africa and South-East Asia, where there is a high
that humans may be similarly affected. A wide var- incidence of hepatoma, have revealed an associa-
iation in LD50 values has been obtained in animal tion between cancer incidence and the aflatoxin con-
species tested with single doses of aflatoxins. For tent of the diet. These studies have not proved a
most species, the LD50 value ranges from 0.5 to 10 cause-effect relationship, but the evidence suggests
mg/kg of the body weight. Animal species respond an association.
differently in their susceptibility to the chronic and One of the most important accounts of aflatoxi-
acute toxicity of aflatoxins. The toxicity can be in- cosis in humans occurred in more than 150 villages
fluenced by environmental factors, exposure level, in adjacent districts of two neighboring states in
and duration of exposure, age, health, and nutritional North-West India in the fall of 1974. According to
status of diet. Aflatoxin B1 is a very potent carcin- one report of this outbreak, 397 persons were af-

109
fected and 108 persons died. In this outbreak, con- The ergot alkaloids are derivatives of Lysergic
taminated corn was the major dietary constituent, acid (ergotamine), isolysergic acid (ergocristine) or
and aflatoxin levels of 0.25 to 15 mg/kg were found. dimethyl ergoline (agoclacine). Pharmacologically,
The daily aflatoxin B1 intake was estimated to have these compounds are rapid acting, powerful oxytox-
been at least 55 mg/kg of the body weight for an ics, i. e., they stimulate the smooth muscle of the
undetermined number of days. The patients experi- uterus. They are also weak vasoconstrictors.
enced high fever, rapid progressive jaundice, ede- Descriptions of ergot poisoning written in the
ma of the limbs, pain, vomiting, and swollen liver. Middle Ages were quite vivid. There were severe
One investigator reported a peculiar and very nota- internal feeling of heat and intense thirst, multiple
ble feature of the outbreak: the appearance of signs ulcerations of the skin, a burning sensation of the
of disease in one village population was preceded limbs, the feeling of ants and mice crawling under-
by a similar disease in domestic dogs, which was neath the skin, the drying and turning black of hands,
usually fatal. Histopathological examination of hu- arms, feet and legs, blindness, dementia and mental
mans showed extensive bile duct proliferation and degeneration.
periportal fibrosis of the liver together with gastroin- Acute ergot poisoning today is essentially a prob-
testinal hemorrhages. A 10-year follow-up of the lem only in chemotherapy and rarely has it occurred
Indian outbreak found the survivors fully recovered recently as a result of eating. The symptoms include
with no ill effects from the experience. A second vomiting, diarrhea, intense thirst, a tingling, itchy
outbreak of aflatoxicosis was reported from Kenya and cold skin, a rapid, weak pulse, confusion, and
in 1982. There were 20 hospital admissions with a unconciousness.
60% mortality; daily aflatoxin intake was estimat- Chronic ergot poisoning today seems limited to
ed to be at least 38 mg/kg of the body weight for an accidents in treating patients for migraine headaches.
undetermined number of days. The extremities, especially the feet and legs, become
Although humans and animals are susceptible to cold, pale, and numb because of the constriction of
the effects of acute aflatoxicosis, the chances of hu- the local blood vessels resulting in diminished blood
man exposure to acute levels of aflatoxin is remote flow. Walking becomes painful and eventually gan-
in well-developed countries. In undeveloped coun- grene develops.
tries, human susceptibility can vary with age, health, Pink Roat Disease. In 1961, Birmingham et al
and level and duration of exposure. reported a phototoxic dermatitis which had been
Maximal permitted content of aflatoxin B1 in shown to be endemic among white harvesters of cel-
food products is 10 µg. In the products for child nu- ery. It was believed that exposure to celery oil and
trition presence of aflatoxin is not permitted in sunlight was reponsible for the dermatitis. Also, it
Ukraine. was noted that the dermatitis was more severe when
Ergotism. Infection of grasses and cereals with rotted celery was handled. Experimentally, only ex-
fungal species of genus Claviceps produces sclero- tracts of rotted celery produced the characteristic
tia (compact hyphal structure). The pharmacologi- blistering lesions of celery dermatitis. Celery rot
cal properties of ergot were recognized in the sec- (“pink rot”) is a fungus disease produced by Scle-
ond half of the 16th century, and about 100 years rotinia sclerotiorum.
later, cereal grains containing ergot were shown to Two psoralens were isolated and identified from
be the cause of these epidemics in Europe. In 1951 “pink rot” celery which were not delectable in healthy
there was an outbreak of “bread poisoning” in a extracts. The psoralens and a group of linear furo-
small town in France. Apparently moldy rye was coumarins containing a furan ring fuse at the 2.3 po-
sold illegally (to avoid a grain tax) in central France sition to the c-6 and c-7 of the coumarin structure.
to a miller, who ground the rye and mixed it with The affected areas were the hands and forearms,
flour which he then sold to a baker. but the lower legs, chest, abdomen, and back also
On August 15, 1951, many people ate small affected if the worker wore shorts and no shirt. The
amounts of bread which may have been made lesions were healing with depigmentation for many
from this contaminated flour. About 200 people months. The incidence was said to be greater after
became ill, as did many domestic animals, dogs, a rain and before the use of fungicides to control
cats, poultry, fish, fed the same bread. A total of fungal growth on the celery.
25 people suffered from severe delirium. A recent Psoralens, especially 8-methoxypsoralen and tri-
outbreak occurred in Ethiopia, 97 of 42,000 peo- methypsoralen have been used successfully to treat
ple developed gangrenous ergotism. Claviceps vitiligo, which is a progressive, localized achroma-
purpura is the common ergot on rye and wheat. nia of the skin resulting from a functional abnor-
The fungus lives over winter in the form of scle- mality of the melanocytes, apparently due to the loss
rotium, a dense mass of fungus cells. Usually the of function of the tyrosinase system.
sclerotia are somewhat larger and also less dense In apparent careless use of psoralens as suntan-
than the seeds of the host plant on which they are ning agents to augment the tanning capabilities of
borne. the skin, excessive amounts of the agents were used,

110
and after exposure to the sun, a severe dermatitis 4. Laryngeal edema and stenosis of the glottis
developed. caused by esophageal lesion, resulting in death be-
Alimentary Toxic Aleukia. The bulk of the liter- cause of asphyxiation.
ature on blood-forming disease is written in Russian, Fourth Stage. A recovery period if clinical help
for it is in the Soviet Union that the disease has been is provided in time.
a problem. Perhaps as early as 1913, a foodborne dis- Yellowed Rice Syndrome. Epidemics of an acute
ease, possibly from eating fusarium — contaminat- heart disease broke out in rural Japan a hundred
ed bread, occurred in Siberia. During the war years years ago, the etiology of which was never deter-
of 1941–1945 larger outbreaks occurred more fre- mined. Uraguchi (1971) analyzed the records of cas-
quently than in the 1930, is involving several districts es of the disease called acute cardiac beri-beri
in Western Siberia and European Soviet Russia. (Shoshinkakke) and concluded that the ailment was
Soon the toxicity of rye was related to the growth probably a human mycotoxicosis.
of toxigenic strains of Fusarium on the cereal seed Acute cardiac beri-beri was associated with the
which absorbed much moisture and provided a suit- consumption of polished rice and was initially
able medium for the growth of cryophilic fungi. thought to be avitaminosis. In 1910, however, the
It has been suggested that the epoxytricho- Japanese government took action to exclude mouldy
thecenes, T-2 toxin, played a role in Russian alimen- rice from the markets and the incidence of acute car-
tary toxic aleukia (Bamburg, et al. 1969). It is shown diac beriberi dropped dramatically.
that T-2 poisoning in chickens resembles the my- Uraguchi (1971) suggested that acute cardiac
cotoxin poisoning associated with Russian overwin- beri-beri may have resulted from eating “yellowed
tered grain. The trichothecenes are produced by var- rice” Such a food-stuffstuff became pigmented and
ious species of Fusarium especially Fusarium toxic to rats, and produced symptoms similar to
graminearum (F. roseum), F. moniliforme, etc. The those observed in humans affected with beri-beri.
trichothecenes are a complex group of sesquiterpe- Penicillium Poisoning. Toxin producing fun-
noids containing the trichothecane nucleus, charac- gi are Penicillium islandicum (Luteoskyrin and
terized by an olefinic bond at the 9, 10 position and cyclochlorotine), P. citreoviride (citreoviridin),
an epoxy group at the 12, 13 position. P. rugulosum (Rugutosin) and citrinum (citrinin).
The descriptions of the disease, dividing the clin- The empirical formula of citreoviridin is
ical feature into four stages, indicate that the dis- C23H30O6. It contains one methoxy group and dou-
ease seems to result from toxic injury to the hemat- ble bonds.
opoletic, autonomic nervous, and endocrine systems. The clinical manifestations of acute cardiac beri-
First Stage. This is a rapid onset of irritation to beri, begin with palpitation, precordial distress, and
the upper gastrointestinal tract, begining a few h af- tachypnea; followed by nausea and vomitting, and
ter ingestion of the toxic cereal product, often bread. difficult breathing.
The contaminated food would have a peppery taste Within a few days, the patient suffers severe an-
and produce a burning sensation from the mouth to guish, pain, severe restlessness, or sometimes vio-
the stomach. Within a few days, the patient devel- lent mania. The right heart is dilated, heart sounds
ops acute gastro-enteritis, with nausea, vomiting and are abnormal, blood pressure is low, and pulse is
diarrhea. This local effect persists for 3 to 9 days rapid, sometimes exceeding 120 beats/min, and the
and then spontaneously ends, even when the victim patient faints.
continues to eat the poisoned grain. The dyspnea increases, the skin of the extremi-
Second Stage. A slow degeneration of the bone ties becames cold, dry, and cyanotic, and the voice
marrow occurs within 9 weeks. Visible skin hemor- becames husky. Finally the pulse becames feeble,
rhage appears and hematologic examination reveals a the pupils dilated, consciousness is lost, and respi-
marked decrease in the total number of leukocytes. ration fails.
Before hemorrhages appear, some patients display Balkan Nephropathy (Ochratoxicosis). In 1957
nervous system problems: irritation, weakness, fatique, to 1958, an unusual chronic disease of the kidney
vertigo, headache, palpitation and slight asthma. occurred endemically in Yugoslavia, Rumania, and
Third Stage. The most serious stage comes about Bulgaria with a prevalence of 3–8%, mainly in ru-
suddenly and has four essential features: ral areas where food is home grown. It was com-
1. Hemorrhagic syndromes begin with petechial mon in 30–50-year-old females. In Yugoslavia, 6.5%
hemorrhage on the skin, axilliary and inguinal are- of blood samples contained ochratoxin A at concen-
as, arms, thighs, face and head. trations between 3 and 5 mg/g of serum (Hurt et al,
2. Necrosis begins in the throat and spreads 1982).
throughout the mouth and into the larynx, vocal Barnes (1967) suggested that plant toxins or
cords, lungs stomach and bowels. mycotoxins may be an environmental factor caus-
3. Impaired hematopoietic and reticuloendothe- ing this human disease. Krogh et al, (1974) present-
lial systems permit widespread bacterial infection ed preliminary evidence to associate the human dis-
in the necrotic areas. Lymphnodes become enlarged. ease with ingestion of ochratoxin A (OTA).

111
 This nephrotoxic compound occurs in feeds and Urgent care for intoxicated persons
food-stuffs and is considered a major determinant of
porcine nephropathy, a form of kidney damage strikingly
similar to that seen in Balkan nephropathy cases. Report about the case of food poisoning
Renal porcine nephropathy has been reported reg- (should be sent to sanitary inspector during 24 h
ulary from Denmark since 1928. The law in Denmark after occuring the case)
requires that all abnormal gross appearance of kid-
neys must be analysed for OTA and the toxin con-
centration exceeds 10 µg/g which corresponds to 50 Order for laboratory tests: vomiting masses, feces,
µg/ml in the blood, the entire carcass is condemned. incrimed food products
Nephropathy has also been reported in chickens.
Toxin-producing fungi are Aspergillus ochra- Group of sanitary inspection: sanitary inspector,
ceous and Penicillium viridicatum. Ochratoxin is a physician, administrator, cook
dihydroisocoumarin derivative produced by seven
species of Penicillium and six species of Aspergil-
lus including A. ochraceous. Plan of inspection
The disease is of a vague onset without acute man-
ifestations. Among the earliest and most frequent
complaints are headache, lassitude, easy fatigue, and Interviewing of patients, personnel of
anorexia. The typical syndrome includes a shallow, catering organisation
coppercolored skin, yellowing of the palms and soles,
anemia in the preazotemic stage, and perhaps occa- Sanitary inspection of kitchen, medical examina
sional profuse intermitent hematuria, due to tumors tion of personnel, report preparing
of the urinary passages; there is no hypertension or
edema. It becomes evident that in the endemic vil-
lages, when a high incidence of urinary tract tumors Conclusion about the results of inspection
and both diseases follow a similar pattern of geo-
graphic clustering, age and a sex distribution.
General principles of sanitary surveillance on the Preventive and sanitary measures
food poisoning cases shown in Figure 32.
In the Annex 4 we present summarized data Fig. 32. The Scheme of Investigation of Food Poi-
about food poisonings and their prevention. soning Cases

112
 Chapter 5
CHILDREN’S AND ADOLESCENT’S HYGIENE

Children’s and Adolescent’s Hygiene is a science that children’s physical development and health de-
of protection and strengthening of the growing gen- pended upon surrounding conditions of work and
eration health, studying influence of surrounding mode of life. Erisman was interested in problems
factors on infant organism and developing optimal connected with hygienic conditions of classes,
conditions for its harmonic growth. planning of natural lighting of the classrooms. Un-
You can easily understand the importance of chil- der his leadership models of class-rooms, different
dren hygiene if you take into consideration the fol- types of school furniture were designed. F. Eris-
lowing: man synthesized the existing studies and wrote the
Children under 18 are a considerable part of the first manual of school hygiene “The School Hy-
population (38–40%). giene” in 1870.
Children are the future of any country. The health A. Dobroslavin is the founder of the department
state of the grown up population depends on the chil- of Hygiene in Military Academy in St. Petersburg
dren’s health state. (1871). The principal attention was paid to the prob-
The final purpose of hygiene is prolongation of lems of medical conditions of schools. He also stud-
human beings life; maintenance of high productive ied the pupils’ overstrain in schools. The great at-
capabilities of the organism for a long period. tention to the problems of hygiene in schools was
The objectives of hygiene are: paid by the followers of Erisman and Dobroslavin.
1. Regular study of environmental factors influ- There are main factors that helped to create this
ence on infant health in dynamics taking into con- discipline as an independent one:
sideration because sensibility to these factors is 1. The quantity of this group of population.
changing during growth and development. 2. Peculiarities of the conditions necessary for
2. Elaboration of scientific norms and health im- this group of population (conditions of studies,
proving measures. Theoretical principles of such work, life, etc.).
elaboration are: compulsory condition of any action 3. Peculiarities of the reaction of a child’s organ-
of surrounding factor and morpho-functional readi- ism in the same time conditions in comparison with
ness of the growing organism to interaction. So the adults.
above norms are not permanent, they are changed Participants of the First Global Review and Co-
at different stages of age. ordination Meeting on Integrated Management of
3. Compulsory control of health improving meas- Childhood Illness, held in Santo Domingo, 9–12
ures effect. September, 1997 recognized that:
The hygiene of children and teenagers is closely — each year, worldwide, more than 11 million
connected with such biological sciences as anato- of children die before they reach the age of 5 years;
my and physiology, pediatrics, closely related hygi- — 70% of these childhood deaths are caused by
enic disciplines (nutrition hygiene, occupational five common, preventable or easily treatable child-
hygiene, etc. In the sphere of preventive measures hood conditions: pneumonia, diarrhoea, measles,
against children’s infectious diseases it is connect- malaria and malnutrition (Fig. 33);
ed with epidemiology and medical microbiology. — throughout much of the developing world
The founders of this branch of science in Russia families do not have access to the basic means to
are A. Dobroslavin and F. Erisman prevent these conditions nor to the simple treatments
In 1884 F. Erisman founded the department of needed to stop them from being fatal;
hygiene in the Moscow University. He paid great — in some countries and globally, achievement
attention to the problems, connected with physical of the World Summit for Children goals for child-
development and vision of children. He found out hood mortality and morbidity reduction by the year

113
 2. Assimilation processes prevail over dissimi-
Malaria Other causes Malnutrion lation ones (importance of quality composition of
2.25% 14.40% 55.00% the diet).
Measles There are some age periods in child’s life which
3.15%
differ from each other according to their morpho-
Diarrhoea
8.55% functional features: the womb period; the newborn
period; the infant age; the nursery age; the prechool
Acute age; the school age.
respiratory Pental causes The health state of children is controlled by dif-
infections 8.10% ferent doctors: neonatalogists, pediatrists, hygien-
8.55% ists, etc. Preventive measures are different for each
period.
Fig. 33. Main Death Causes in Infancy The womb period is a control of infant health
state before a birth, because there is close connec-
2010 will require a massive and immediate renewal tion between infant and mother organisms.
of commitment and effort; This connection is confirmed by existence of
— this situation represents a failure to guaran- connection between:
tee the fundamental rights of children as embodied — pre-birth holiday duration and new-born baby
in the Convention on the Rights of the Child. weight;
— hygienic life conditions of the pregnant wom-
an and the still-born;
— professional features of the woman job (ef-
ANATOMICAL AND fection of toxic factors even of little intensity on the
organism, ionizing radiation — resulting in embri-
PHYSIOLOGICAL FEATURES OF oteratogenic action, decrease of immune reaction of
CHILD ORGANISM the mother and baby, hypolactation).
The most numerous group of children’s popula-
The infant organism is not just a small copy of a tion comprises the children and teens of school age.
grown up organism. It has some distinctive peculi- The school period demands the greatest attention of
arities — morphological, functional and psycholo- doctors because this period comprises 2 main peri-
gical. ods in the development of the child’s organism:
The different anatomical and histological struc- 1) children at the age of 7 — the age between
ture and biochemical composition determine differ- the pre-school period and the school period. At this
ent functional insufficiency in comparison with an age in the life of a child work appears as obligatory
adult organs and systems. In biological plan we can classes to which children are not used because of
see inadequacy of adopting mechanism, greater sen- their anathomical and physiological development
sitivity to action of the surrounding factors and par- especially because of instability of the central nerv-
ticularly, to crossing interactions: infant organism ous system;
react even to insignificant deviation from optimal 2) the period of pubescence — the development
life conditions. On the other side an infant organ- of the whole organism is rapid and uneven. At this
ism is able to develop widely mechanisms of adap- period some functional disorders in different sys-
tation to surrounding conditions during growth and tems of the organism can be observed and the doc-
development process. So infant development is not tor’s task is to prevent the influence of different fac-
only a growth, i. e. increase of body weight because tors, according to which these functional changes
during growth process there are deep quality chang- can be transformed into pathological ones. It is a
es occur. Development consists of three intercross- pity but nowadays a lot of diseases are associated
ing processes: with the violation of rules in the system of educa-
— Growth tion. They can be observed among the pupils in our
— Differentiation of tissues and organs schools:
— Shape building — defects of carriage — 28–28%;
The growth process is uneven — periods of in- — diseases of ears, throat and nose — 28%;
tensive growth are followed by periods of slowing — disorders in vision, sometimes, a very high
down. During this time intensive differentiation of per cent;
tissue and organs, their shape building, increase of — rheumatism — 23%.
the organism functional possibilities occur. A very Among the causes influencing the health of pu-
important feature of the infant organism is peculi- pils the main causes are the violation of medical and
arity of metabolism: hygienic norms — desks in schools, class-rooms be-
1. Intensity of metabolism is twice more than that ing overcrowded, insufficient lighting of working
one of grown ups (it is necessary to take into consi- places, disproportion of school furniture. Due to
deration calculating daily food ration). these problems the doctor’s task are:
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 1. The analysis of health and physical develop- 2. Anomalous posture and bad habits, such as:
ment of pupils and organization of medical preven- — standing leaning on one leg. This habit caus-
tive measures. es the wrong position of the pelvis as a result we
2. The organization of anti-epidemic measures observe the flank curvature of the spine;
for the prevention of infectious diseases. — the wrong position while sitting at the table
3. Systematic control of the medical and hygi- with one leg being on the chair-bottom. Such a pos-
enic conditions in schools and the fulfillment of the ture violates the position of the humeral zone and
daily routine. the pelvis;
4. The involvement of teachers and parents into — reading in bed;
the active work connected with health control of the — identical movements; e.g. using the same leg
children. while going by scooter or jumping on the same leg
As it was mentioned above, the hygiene of chil- and so on.
dren and adolescents is closely connected with some Of all the causes mentioned above the main one
other biological and pedagogical disciplines and it is considered to be wrong proportions of the furni-
builds its work considered the peculiarities of the ture. Sometimes the curvature of the spine can be
child’s organism at different periods of his life. observed even in preschool institution and at schools
The organism of the child and the adolescents the process is progressing.
differ from the organism of the grown-up. The main This process not only mutilates children but also
peculiarity of the young organism is considered to affects the functioning of the organs of the chest and
be its general development which starts from the as a result it is very difficult to treat this illness. As
moment of its conception and finishes at the age of it was mentioned above the main cause of scoliosis
20–25. During the process of the development of is a wrong position at the desk. As a rule in our
the growing organism different qualitative changes schools pupils study in two-shifts and in the same
take place, we observe the development of differ- classroom the pupil of different age can sit at the
ent organs and systems as well as their interaction. same desks (e.g. pupils of the second and the fifth
The development of the organism is a compli- forms). In such a case it is very difficult to find a
cated process consisting of three factors: solution of the problem.
1) the growth — the increase of proportions of The development of carriage defects can be ob-
the body; served when a pupil carries a heavy school-bag in
2) the specific development — the distribution his hand.
of tissues and organs; Preventive measures against the violation of the
3) formation of the body. carriage and the curvature of the spine in preschool
Osseous System. The process of ossification institutions as well as in schools children should sit
starts in the womb of the mother and comes to its at the convenient desks. At the beginning of the
end at the age of 16–17 (for girls) and at the age of school year, a suitable desk should be chosen for
18–19 (for boys). The children’s bones contain a lot each group of pupils with the help of a doctor.
of organic substances, little amount of calcium and The usage of correct furniture slowes down the
phosphorus. As a result they are flexible and can be process of violation but the work of teachers be-
bent. The spines of children are often curved. The comes more difficult as they have to watch that chil-
spine has three slight curves — one in the neck, the dren do not take the wrong position at the desk.
other in the upper back and the other in the lower Another preventive measure is the use of a satchel
back. These curves are normal and can be seen from instead of a school bag.
a side view. From a back view, the spine should ap- The children with scoliosis should be sent to the
pear straight. special physiotherapy room for preventive gymnas-
If the spine has a side-to-side curve, the curve is tics. Deformation of the osseous system includes the
called scoliosis. There are two main types called deformation of the thorax. The development of the
postural and structural. The first one can be correct- thorax is a slow process, it is completed at the age
ed and is caused by some irregularity of posture. of 21–25. Chest deformation affects negatively the
Structural scoliosis can be due to abnormalities or development of the lungs, the heart and the large
diseases of bones, muscles or nerves. Between the blood vessels. To prevent such violations teachers
ages of about 9 and 14, children’s bones grow rap- should pay attention to the position of a child at the
idly. At this time, the back-bone or spine may some- desk.
times show signs of developing scoliosis. Early de- When in a sitting position, the spine can take on
tection enables early treatment. This may control the many different postures ranging from the very up-
condition and prevent other problems developing in right, back supported sitting posture to the unsup-
later years. The scoliosis is closely connected with ported, relaxed posture. When the legs are crossed
violation of the position of the body. while sitting, the strain on the lumbar muscles in-
What are the causes of the defects of carriage? creases and also creates a greater strain on the neck
1. The furniture does not fit the proportions of muscles. The neck must compensate to provide an
the body — a chair, a desk, a bed, etc. upright head position. During long sitting without
115
any type of back support, the spinal cord posture It should be explained to such parents that ex-
deteriorates due to muscle fatigue caused by incor- cessive fat may lead to the diseases associated with
rectly contracted muscles and ligaments. Pressure metabolism and cardiovascular system.
on the intervertebral discs of the lower lumbar spi- Cardiovascular System. The weight and the
nal column increases by 30% in the sitting posture. shape of the heart, its position in the thorax, the
Therefore, a lumbar support was designed to de- structure of tissues, vessels — all this change year
crease muscle fatigue and strain on the interverte- after year. These changes are reflected on the func-
bral discs. This support system must be compact and tional peculiarities of the cardiovascular system of
easily carried around. children. The cardiovascular system of babies is
Muscular System. The muscular system pro- characterized by imperfectness, but the heart mus-
vides the fulfillment of children’s movements. The cle is quite heavy, as a result, the greater amount of
structure and functional peculiarities of muscles de- blood goes through the heart at the same time in
velop during the long period of childhood. This comparison with grown-ups.
process is uneven. In the beginning the muscles of The heart of a child grows more intensively when
extremities start to develop. At the age of 6–7 the he is one year old as well as at the period of puber-
development of upper extremities can be observed, ty. The growth of the heart is slower than the growth
then the muscular power, coordination and precise- of blood vessels till 6–7 years but at the period of
ment of movements go on. pubescence it accelerates.
The weight of muscles increases year after year. As a result, the heart pushing the necessary quan-
The interrelation between weight of the body and tity of blood into the arteries develops some mechan-
the weight of the muscles is the following: ic power and it leads to the high arterial pressure.
— a baby — 23% The scientific research showed that hypertension
— 8 year-old boy — 27% among grown-ups often started at an early age. The
— 15 year-old boy — 32%. main causes of the development of hypertension are:
— 17–18 year-old boy — 44% the functional condition of the cardiovascular sys-
The chemical composition of children’s muscles tem (this was mentioned above), emotional and psy-
differs from that of grown-ups. They are rich in wa- chological influences, which can be observed at the
ter and the persentage of albumen, fat and salt is periods of pubescence and physical tension (for ex-
low. Only at the adolescent age of the chemical com- ample, among the youths who go in for sports). One
position of children’s muscles becomes the same in of the signs of the disease is a neurotic state of the
comparison with grown-ups. person. It can be manifested as irritability, petulance.
Children’s muscles become tired very quickly but Another sign of the disease is considered to be sleep-
because of the metabolism this tiredness is not very ing disorders. Hypertension among the youths is asso-
long. ciated with the peculiarities of the cardiovascular sys-
At the pre-school period the characteristic pecu- tem, it can be caused by shocks but as usual the main
liarity of the muscular system is considered to be cause is considered to be prolonged strains that is ex-
the slow development of the flexors and small mus- cessive mental and physical activity, not enough sleep,
cles. troubles in the family or at school and smoking.
Because of the late development of the muscles That is why it is very important to exclude ex-
of bones, it is very difficult for children at pre-school cessive physical and emotional strains so that the
age to fulfill work with small objects. The muscu- development of the cardiovascular system can be
lar system of such children is weak and such po- normal. Pupils should constantly make physical ex-
sures as sitting and standing cause tiredness. That ercises, keep to the hygienic time-table, work on the
is why the measure against tiredness is to let chil- open air. Sometimes even loading at school should
dren move. To prevent the strain of muscles such be changed if it negatively affects the health of a
positions of the body should be minimized. particular pupil.
The negative development of the osseous mus- Organs of Breathing. The peculiarities of the
cles leads to the precipitation of fat in the child’s organs of breathing among children are the follow-
organism. The excessive fat leads to the underde- ing: the upper airways are narrower in comparison
velopment of the osseous muscles, negatively affects with grown-ups, nasal sinuses are weaker, the mu-
the activity of the heart, at the same time the excess cous membrane of the respiratory pairways is ten-
weight of the child influences the work of the car- der and can be easily injured. As a result, different
dio-vascular system leading to earlier and harder infections penetrate into the organism of a child
forms of tiredness. more often and cataral process leads to breathing
Lately because of the specific psychology of disorders. The breathing of children is superficial
some parents who want their children to be plum- and more frequent. Such breathing is not suffucient
my, the number of children with obesity considera- for proper ventilation of lungs, that is why children
bly increased. At some places the number of such especially need fresh air and physical exercises out-
children is 4–5%. door.

116
 Fresh air is necessary for metabolism. The vol- As it was mentioned above a special attention
ume of ventilation of the lungs per 1 kg of the body should be paid to the prevention of the hands and
weight (per 1 min) is: feet because they cool down first. The position of
— a baby — 220 cm3; the hands and feet is distant and that is why the cir-
— a 6 year-old child — l58 cm 3; culation of blood in them is not so good as in the
—a 14 year-old boy — 128 cm3; other parts of the body.
— a grown up — 96 cm3. Organs of Chewing. The first teeth erupt at the
Hygiene of the organs of breathing should lead age of 6–7 months, by the end of the first year a
to the normal development of the thorax. The fol- child has 8 teeth and by the end of the second year
lowing rules should be taken into consideration: — 20 deciduous teeth. The delay of the eruption of
a) the correct posture of a child at the desk, ta- milkteeth is a sign of the malformation in the de-
ble and so on; velopment of the organism. This sign can be ob-
b) breathing exercises for the development of the served when the child suffers from rachitis, when
thorax and its muscles; the supply of calcium is not sufficient and in some
c) going in for sports especially swimming, ski- other cases. The first permanent teeth erupt at the
ing, sledges; age of 6–8 and to the age of 12–14, all 20 milk teeth
It is very important to teach children to breath are changed into permanent. The wisdom teeth are
deeply and rhythmically. cut at the age of 18–25 (Table 30).
Skin. The relative surface of the child’s skin is The children’s permanent teeth are covered with
bigger in comparison with grown-ups. thinner enamel (in comparison with grown-ups’).
For 1 kg of the body weight: That is why they are more predisposed to teeth de-
— a baby — 704 cm2 of the skin surface; cay.
— a 6-year-old boy — 456 cm2; Children should be examined by the dentist no
— a 14-year-old boy — 423 cm2; less than two times a year, only in such cases teeth
— an adult man — 221 cm2. decay can be revealed and treated in proper time.
This peculiarity, explains great heat irradiation Gullet. The food is pushed from the gullet to the
in children. The heating value is also higher. Every stomach because of peristalsis and mechanic irrita-
day a baby produces 91 kcal for 1 kg of weight, a tion of its lower section. But at an early age, strong
1–2 year-old child — 81 kcal, 14 year-old — 52 mechanic and chemical irritation of the gullet be-
kcal, and a grown up — 35–41 kcal. cause of the tender mucous membrane can lead not
The skin of the child contains more capillaries to the better work of peristalsis but to the spasm of
and they are wider in comparison with grown ups. its cardial part (cardiospasm). As a result, the food
One third of the blood flows through the skin among doesn’t reach the stomach and with the help of emet-
grown-ups and a half and even 2/3 among children. ic movements it is pushed of it.
At the same time the regulation of the circulatory Stomach and Intestine. The stomach of children
system from the side of the central nervous system (in volume) is smaller than the stomach of grown-
(CNS) is not sufficient. It results in cooling of the
child’s organism. Table 30. Age of Eruption of Deciduous
At the age of 11–14 the reaction from the side and Permanent Teeth
of the CNS comes to its end, the skin becomes more
developed and a youth stands cooling more easily. Teeth Number Age of eruption
The children’s epidermis is thin and as a result dif- Deciduous (20 total)
ferent infections can easily penetrate into the organ-
Lower central incisors 2 5–9 months
ism and cause diseases of the skin. The preventive
measures are the following: Upper central incisors 2 8–12 months
1. The skin should be clean, the clearness pro- Upper lateral incisors 2 10–12 months
tects the penetration of bacteria. Lower lateral incisors 2 12–15 months
2. The skin should be trained to extreme envi- 1st molars 4 10–16 months
ronmental temperature. The training of skin with Canines 4 16–20 months
respect to the influences of environment should be 2nd molars 4 20–36 months
fulfilled with the help of air bath, water bath and
Permanent teeth (32 total)
sun bath.
3. It is necessary to take care of the children’s 1st molars 4 5–7 years
clothes. A special attention should be paid to the Incisors 8 6–8 years
hands and feet: Bicuspids 8 9–12 years
a) the clothes should meet the requirements of a Canines 4 10–13 years
season, weather and work; 2nd molars 4 11–13 years
b) the clothes shouldn’t prevent movements;
3rd molars 4 17–26 months
c) the clothes shouldn’t prevent ventilation.

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ups and in the beginning of life it is just a dilatation son with grown-ups. As a result the front back axis
of the gullet. The acidity of the gastric juice and the of the crystalline lens is shorter, it provides long-
digestive power of ferments are less in comparison sightedness. The development of eyes lasts till the
with grown-ups. At the early period of life the in- age of 9–12. The refractive system of the eyes and
testine microflora is not developed (before the birth the development of the character of refraction are
of a child its intestine is sterile). All these factors formed till this period of life.
cause the development of dysfunctions of the ali- At the age of 9–10 the longsightedness often
mentary canal. transforms into normal but in unfavorable conditions
Constipation among children can be explained it can be transformed into shortsightedness. The
by the insufficient development of the intestine per- shortsightedness can be observed among people of
istalsis, its muscles and elastic fibers. The causes different age, but as usual it develops at a school
of constipation are also the weakness of the stom- period. The examples of innate shortsightedness are
ach and intestine walls which is the result of long quite rare.
sitting at the desk and insufficient usage of the ac- The development of shortsightedness is the fol-
tive rest. lowing. Under the influence of the visual strain
Taking into consideration these peculiarities of while looking at different objects at a short distance
the digestive organs, the volume of the stomach, low we can observe the spasm of accommodation. The
acidity and activity of digestive ferments, weak per- crystalline lens become more curved. The shorten-
istalsis it is necessary to do the following: ing of accommodative muscle under the influence
1) children should be fed four times a day so that of unfavorable conditions becomes unchanged. As
the stomach should not be overloaded; a result the accommodative muscle doesn’t relax
2) children should consume easily assimilated even after work, the inner membranes of the eyes
meat food and especially dairy produce because are always strained. Besides the inclined position
these products demand little amount of gastric juice; of the head worsens the outflow of blood and it leads
3) to exclude from the diet piquant, sour, irritat- to the increase of tension in the eyes. These factors
ing and hot dishes; cause the lengthening of the front-back axis of an
4) to strengthen the peristalsis, children should eye that is the development of shortsightedness.
consume more fruit, vegetables, berries and cere- The unfavorable conditions are as follows:
als; 1) forced close examining of the object;
5) physical exercises that strengthen the abdomi- 2) insufficient lighting, irregular lighting, the
nal cavity. blinding-light;
Organs of Sense. Newborn organs of sense are 3) the wrong position of children at the desk at
developed insufficiently. No coordination of eyes school, the distance between a book and eyes is not
movement, no possibility to fix eyes on any objects correct;
during the first two months, non-clear sight. 4) strained visual work during a long time.
Insufficient development of ears. Acoustic duct The longer visual work goes in unfavourable con-
is short and narrow. This duct is in vertical posi- ditions the figger percentage of children suffers from
tion. Ear-drum is in horizontal position. The mid- shortsightedness.
dle ear cavity is filled with liquid. Later this liquid It is interesting to point out that the percentage
will be dried and air enters the middle ear from the of short-sighted pupils is lower in the country. It can
Eustachian tube and the baby begins to react to be explained by the fact that natural lighting pre-
acoustic irritants. vails in the country schools and probably they have
Organs of taste are developed to the greatest ex- higher level of resisance of the organism.
tent and this should be taken into consideration The degree of the development of shortsighted-
while preparing meals for children. ness depends upon the following reasons:
Skin pain sensitivity is low. 1) the geographical latitude of the surroundings
The visual organs of a newborn are not prepared that is the light climate of the place;
to the normal activity: photophobia, coordination of 2) the routine and full value of nourishment, the
eye movements is weak as well as the fixation on consumption of vitamins A, C and others;
objects. The visual characteristics develop rapidly. 3) norms of work and rest;
The difference between black and white appears in 4) sufficient natural and electric lighting.
the beginning of the first year of life. Then a child It’s shown that acuity of vision becomes lower
distinguishes red, then green, blue and at last — yel- in theoretical classes and at the sport classes it re-
low. Full differention of colours appears at the end mains unchanged and sometimes it becomes even
of the 3rd year of life. higher. Low acuity of vision leads to the develop-
The main peculiarity of the anatomic-physiologic ment of shortsightedness.
development of the eyes of children is the follow- The development of myopia is considered to be
ing: the crystalline lens (at preschool and early caused by insufficient and irregular lighting. Light
school age) is of a more curved shape in compari- is a direct and adequate irritant of the eyes. Under

118
the influence of sufficient lighting, all the functions cial lighting the norm is 500 lx versus 300 lx in the
of the eyes are considerably increased: regular schools, light coefficient is 1:3.
a) acuity of vision (shapes, sizes of objects); The high level of lightening is necessary in the
b) unstability of legible sight (acuity of vision schools for children with poor hearing. The fact is
for a long time); that the main load falls to the visual analyser, 93%
c) accomodation (the peculiarity of the eyes to of all school lessons are studied by means of sight
accomodate to legible sight at different distances). in comparison with 40% at regular schools. The
It was proved experimentally, that the change of norms are the same as at schools for children with
lighting from 40 to 140 lx causes the increase of poor vision.
the reading speed by 15%. The main task of primary and secondary schools
The dependence of the sight on lighting can eas- as well as colleges is to bring up well educated and
ily be observed among pupils with pathologic re- healthy young people. However students health in-
fraction. The change of lighting in the class room dex is alarming. At present only 15% of secondary
from 30 to 120 caused the increase of the visual ca- school final-year students can be considered to be
pacity of work by 14% among children with nor- apparently healthy. Visual organ pathology, damage
mal refraction and by 22% among short sighted chil- of attitude, neurocirculatory dystonia, alimentary
dren. tract illnesses are mainly spread among students.
That is why one of the main preventive meas- Among causes of reduction of visual acuity the most
ures is considered to be the creation of optimum frequent is myopia. Its spread increases from 3 to
lighting. 5% among first-formers and up to 50% and more
The basic hygienic demands of lighting are the — among final-year students. Even small degree of
following: myopia results in considerable reduction of visual
1) the sufficient level (it’s a standard, but they acuity that restricts the professional fitness of first-
are not optimum); year students. School myopia has a tendency to
2) prevalence of light in the sphere of sight; progress up to medium and high degree that is from
3) prevention of blinding light (tube lamps, illu- 20 to 45% among seniors in the general structure
mination is 300 lx); of refraction anomaly. Progressing myopia still re-
4) to avoid sharp and deep shadows; mains one of the main causes of blindness and poor
5) the spectrum of radiation of artificial light vision. “School” myopia is by far the commonest,
sources should be close to the natural light. affecting 30 to 50% of the population. It starts dur-
That is why children’s welfare institutions are to ing school age (commonly at 10–12 years old), and
be built in such a way that there is a lot of lighting. increases to between 1 to 10 D by early adulthood.
But first of all sufficient natural and electric light A correlation of the process of school myopia
should be provided at schools because it is there development and progress with pedagogical, psy-
where children have constant, long visual work for chological, ergonomical, hygienic, somatic factors
the first time of their life. were studied using a computer multi-factor analy-
The natural lighting of class rooms except the sis. In addition a new method of division of chil-
peculiarities of the school sight depends upon a sea- dren diseases into prevention groups according to
son. Especially the low level of lighting is observed main bad factors was worked out in order to cor-
in autumn and winter. At this period the natural rect them. The method makes it possible to elabo-
lighting should be compensated by artificial light- rate a complex of individual disease prevention ac-
ing. tions for each child. On the basis of revealed regu-
It is worthy to point out that there is an opinion larities training methods of development and
about the confusion of natural and artificial light- progress of school myopia prevention were worked
ing badly affecting the development of sight. This out. This enables to increase mass character of pre-
opinion is widespread even among doctors and vention measures and to improve their efficiency and
teachers. But in practice it was not confirmed, on availability. The preventive program consists of 3
the contrary, the most optimum indicators of sight main sections: information and prevention, diagnos-
functioning were observed with natural lighting, tic (including monitoring), and medical correction.
then with mixed and at last with artificial lighting. Information and Prevention. Training students
That is why additional lamps should be placed at and their parents in save visual work skills, meth-
any part of the day when the natural lighting is not ods of visual damage prevention (lectures, train-
sufficient enough. ing at schools, providing knowledge through teach-
The lighting has a great importance in special- ers, instructive and educational literature, mass
ized schools for children with poor vision and hear- media).
ing. As it was mentioned above, the high level of Secondary school and college teachers training
lighting positively influences the vision functioning. in methods of choosing optimum visual work, visu-
That is why in those schools the norm of lighting is al disorder prevention (lectures, seminars for school
higher that that in the regular schools. E.g. for artfi- and post graduate school teachers).

119
 Lectures for school physicians and nurses, for The cortex develops considerably during the
general practice physicians, ophthalmologists, pedi- third year of life, at this time the language forma-
atricians on control of myopia, asthenopia and oth- tion is going on. Stock of words is about 500. Some
er school pathology. words are not pronounced distinctly. For further in-
Thus, the curriculi of medical and pedagogical fant development it is necessary to meet more and
universities should include training in the preven- more people.
tion ofvisual disorders in children and adolescents The peculiarities of infant development are: dur-
as well as older scholars engaged intensive visual ing the nursery period the children only imitate the
work. behaviour of the adults. At this time the real irri-
Dispensary System and Monitoring consists in tants are very important. The infant’s parents and
the following measures: teachers are perfect in his eyes. So proper bringing
— preventive examination of secondary school up is very important. The other feature is infant’s
and college students according to a plan developed word-building, critical attitude to the words and their
by the authors of the program that allows to exam- meaning. The most important age for proper bring-
ine the whole staff quickly and completely within ing up is up to 5 years.
the period of 7–10 days; During junior school age the cortex development
— data base development with a subsequent continues; some nervous cells become perfect, the
multi-factor analysis, setting up preventive groups new nervous ways are developing, the considerable
of students, working out recommendations for indi- growth of the frontal parts of the cerebrum is tak-
viduals and a staff. ing place and makes physiological basis for abstract
— establishing a dispensary system for teachers. thinking. Talking about peculiarity of the higher
To monitor the state of their visual functions. Ini- nervous system of children it is necessary to em-
tial and further examination can be held both at a phasize:
school and in the Center during teachers training in — processes of dynamic equilibrium between
pre-school preventive medicine class. exaltation and inhibition processes are manifested
Treatment and correction of the following: poorly;
— main bad factors determined with the help of — inhibition zone around the exaltation zone is
the multi-factor computer analysis; weak so children can easily pay attention to a new
— anomalous visual and motor stereotype of stu- irritant;
dents; — self-induction is expressed well (inhibition
— psychological correction; zone formation inside of exaltation zone);
— practicable recommendations on how to make — morphofunctional inefficiency of the cortex.
hygienic conditions at school and at home better; The nervous system unites and regulates the ac-
— school pathology so to prevent the diseases tivity of the whole organism. The development of
progression in the clinic of school preventive medi- the nervous system and the brain in children and
cine center. youth is considered to be the process of great inter-
Nervous System. The nervous system develop- est because during childhood the formation of per-
ment is a subject of special interest because the nerv- sonality can be observed.
ous system, from one hand, unites and controls the The psychology forms on the bases of the de-
vital activity of the whole organism and, from the velopment of the brain cortex. To the moment of
other hand, the human being psychology formation birth the central and the peripheral system are not
and perfection are going on the basis of the cortex developed at all. Especially it concerns the cerebral
development. Before the birth the central and periph- cortex.
eral nervous system are not developed yet, particu- The weight of the brain of a newborn is 1/8 of
larly, the cortex and the closest under-cortex centers. the body weight and in grown ups it is 1/40. The
The cerebrum weight of a newborn is relatively great surface of the cerebral hemispheres is comparative-
(1/8 of the body weight and achieves 410 g). How- ly smooth, convolutions of the brain are weak. In
ever the surface of the big cerebral hemispheres is the functional respect of all parts of cerebrum, the
relatively smooth during the first months, convolu- cortex is not developed, that is why all living proc-
tions are not distinctive. The nervous cells of hemi- esses of children are regulated mainly by subcorti-
spheres are primitive, immature, having simple shape. cal centres.
The cortex is not developed well and all the vi- In the first 2–3 months conditioned reflexes can’t
tal processes are controlled by under cortex centres. be formed because of poor development of cortical
In the cortex the inhibition processes prevail. Chil- innervations, more than that the usual irritants bring
dren sleep much. During the process of growth and the cerebral cortex to the deep physiologic sleep.
development the cortex becomes more perfect, the In the second half of the first year of life the de-
cerebrum weight is increasing (the first year of life velopment of conditioned connections goes from all
— 1,100 g, the seventh year — 1,250 g, adults — organs of perception: eyes, ears, skin, etc. During
1,400 g). this period the basis of future speech sounds is laid.

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 During the second year of life simultaneously 3) the correct organisation of physical education
with the development of cerebral cortex and its ac- that includes interesting and non-excessive physi-
tivity the creation of new conditioned reflexes can cal work.
be observed. At the age of 2–2.5 a child possesses If children have classes, prepare the homework,
all features of the development of cortical system, have meals, go to sleep at the same time and their
and the general structure of the cerebrum slightly daily routine is constant and regular, all the proc-
differs from that of a grown up. esses of the organism go normally and rhythmical-
In the functional respect the cerebral cortex de- ly.
velops more intensively during the 3rd year of life. Hygiene of the nervous system of children and
At this period the development of speech can be adolescents is closely connected with the hygienic
observed. organization of all educational work. The excessive
In the last years of preschool period (from 4 to overstrain of children and adolescents leads to the
6) the functional development of cerebrum is in- overstrain of the nervous system. It results in:
creased, analytic and synthetic activity of the brain 1) quick tiredness;
is more complicated. At the early school period and 2) unsound sleep and even sleeplessness;
at the period of pubescence we observe the contin- 3) headache;
uation of the brain development through the forma- 4) high excitability;
tion of new nervous cells and pathways, i.e. the func- 5) low level of mental functions such as memo-
tional development of all nervous systems. At the ry, attention, perception and learning.
same time the intensified growth of frontal lobes The normal development of the nervous system
leads to the exactness and coordination of move- depends upon the conditions and influence of the
ments. The cerebral cells finish their formation and surroundings.
go through the special energetic structural develop- The atmosphere in the family and at school
ment, the formation of convolutions as well associ- should create high spirits. Cleanness and order, good
ative tissues correcting some parts of cerebrum attitude of teachers and parents are favourable for
comes to its end. The number of associative tissues the normal development of the nervous system. The
increases at the age of 16–18. All this forms the well balanced nourishment is also of great impor-
more logical basis for the processes of associative, tance (especially the usage of products containing
logical abstract thinking. vitamins of B group). But the most significant fac-
The development, and physiologic activity of tor for the nervous system of children and adoles-
cerebrum at the period of pubescence are influenced cents is considered to be correct organization of
by the changes in the organism — the high activity sleep. Shakespeare called sleep the “Chief nourish-
of the thyroid grand, sexual glands which raise the er in life’s feast.” The normal sleep provides the full
activity of CNS and cerebrum. rest of the organism, especially of the CNS, organs
The teachers should take into consideration all of sense and muscular system. The main hygienic
these facts while communicating with youths. demand to the sleep of children and adolescents is
Functionally the child’s brain at the preschool considered to be the rate of its length according to
and early school periods is not matured. The young- the age. The younger the child, the longer his sleep
er the child, the more the processes of excitement must be.
prevale over the inner. This prosess can easily irra- Children and adolescents should go to bed at the
diate that is spread all over the cerebral cortex, it same time. The regular succession of sleep and be-
violates the work of concentration of these process- ing awake leads to the fact that children fall asleep
es. The result is a low level of attention and of the more easily. Insufficient duration of sleep leads to
nervous system among children; especially when the inertia, tiredness, lowering of mental functions, ex-
organisation of educational work is not good haustion of the nervous system, low level of resist-
enough. ance of the organism.
Psychomotor and intellectual development are For correct (in hygienic respect) organization of
affected by innate intelligence (in general, the higher sleep the time after supper should be spent in calm
the intelligence, the more rapid the development); atmosphere excluding the possibility of being
familial patterns (e.g. late walking, talking, and blad- awaked. Of course before sleep, thinking work, read-
der control all commonly occur in a particular fam- ing of books, noisy plays, telecasts should be avoid-
ily); environmental factors (e.g. a lack of appropri- ed. The best way out is to go for a walk for 15–20
ate stimulation can impede normal development); min before going to bed. At this time children may
and physical factors (e.g. hypotonia or deafness may listen to the calm music, speak to the parents, etc.
alter normal development). At the same time parents should not let children
For the development of the nervous system and eat before going to bed. Because of the reflection,
its cerebral hemispheres it is important: diafragm rises and weighs the heart and lungs vio-
1) the correct organisation of daily routine; lating their normal activity and it leads to restless
2) the rate of thinking load; sleep. It is forbidden to give children before sleep

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such food, exciting the nervous system, as choco- Dynamics of physical development as an increas-
late, coffee, strong tea etc. The supper of children ing process followed by decreasing period has point-
should be light and no later than one hour before ed out the somatic development parameters varia-
going to bed. The temperature in the room should bility with social and regional aspects that reflects
be no more than 15–16°C and remain constant dur- living conditions and socio-economic transforma-
ing the sleep. tion. These modifications not only reflect quantita-
tive aspect of development but also interest the bi-
omorphosis as well as specific pathology.
Height/Length. Linear growth is measured as
GROWTH AND PHYSICAL length (child lying down) in those younger than 2
DEVELOPMENT years of age, and as height (child standing) after that.
Typically, the infant increases in length about 30%
Growth is a normal process of increase in size; by the age of 5 months and more than 50% by the
physical development is a normal process of growth age of 1 year; height at 5 years is about double birth
and differentiation (progressive change in function length. Linear growth continues to slowly decrease
and/or morphology). Growth and physical develop- until the onset of puberty. If puberty is delayed,
ment are multifaceted processes involving genetic, growth in height may virtually cease.
nutritional, and environmental (physical and psycho- The extremities grow at a faster rate than the
logic) factors. Disturbances in any of these may al- trunk, leading to a gradual change in relative pro-
ter growth and development. Optimal growth and portions. The crown-to-pubis/pubis-to-heel ratio is
development require optimal health. 1.7 at birth, 1.5 — at 1 year, 1.2 — at 5, and 1 — at
Growth from birth to adolescence occurs in two 10.
distinct patterns. The first (from birth to about the Weight. Increase in weight follows a curve sim-
age of 2 years) is one of rapid but decelerating ilar to that of height. The infant doubles his birth
growth. The second (from about 2 years to the on- weight by 5 monthes of age, triples it by 1 year, and
set of puberty) shows more consistent annual incre- almost quadruples it by 2. Between ages of 2 and 5,
ments. the annual increments are fairly similar. Subsequent-
A child’s height relative to his peers tends to re- ly, yearly increments increase slowly until the on-
main the same. An exception may occur during the set of puberty.
first year of life, when some children grow faster or A baby weighs about 3 kg at birth, and loses 150–
slower than their peers before establishing their ul- 200 g in the first three to four days. After that he
timate pattern, which is primarily genetic in origin. grows rapidly and gains about 25 to 30 g a day for
Growth variation during the first year is due in part the first three months and a little less rapidly after
to maternal factors (e.g. uterine size). Boys demon- that. The widely accepted formula that a baby dou-
strate little difference from girls in height and growth bles his birth weight at five months and trebles it at
rate during infancy and childhood. one year is not universal and large true even though
It is well known that during ontogenetic growth some smaller babies weighing around 2.5 kg at birth
process human body’s resistance to risk factors is may be four times their birth weight at one year of
diminished, which interferes with development proc- age.
ess. Under these circumstances, environmental ad- The length of the baby at birth is 48 to 50 cm
justment can be looked at as an expression of bio- and at one year of age becomes 1.5 times as much.
logical and psycho-intellectual dynamics. Therefore Average growth in weight and height during the first
the concept of natural and social history of children five years. Age-weight growth per week is:
and teenagers’ health and illness has to be in close 0–3 months — 200 g
connection with human growth process and also 4–6 months — 150 g
with child’s physical and neuro-psychic develop- 7–9 months — 100 g
ment. 10–12 months — 50–75 g
The level of physical development as a quanti- Weight growth per year:
tative expression of biological potential represents, 1–5 year — 2.0 kg
time wise, a dynamic strictly determined by either Age-height growth per year:
positive or negative oscillations of the welfare. In 1st year — 25 cm
Eastern Europe mean values for basic somatic pa- 2nd year — 10–12 cm
rameters: height, weight, chest circumference, cra- 3rd year — 7–9 cm
nial circumference, have gone through following 4th year — 6–8 cm
changes: 1950–1978 highly increasing, stationary or 5th year — 6–8 cm
even decreasing between 1978–1985 and starting You should remember that these data are aver-
1992 stabilization of the values with slight tenden- ages and all babies will not conform to this pattern.
cy of increasing mean values and prepuberty, pu- There is a wide range within which a baby’s growth
berty development acceleration. is considered normal. The following table gives you

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some idea of the expected weights and heights of Physician should assess expression of physiologi-
well-nourished Indian children at various ages. It cal curvatures (cervical and lumbal lordosis, thora-
should be emphasized once again that children vary cal kyphosis), presence of pathological curvatures
a great deal in their weight and height at different of a backbone (hyperlordosis, hyperkyphosis, scol-
ages. Some are taller, others — shorter, which may iosis). The legs can be normal, O-shaped or C-
be due to family characteristics. Some have narrow- shaped.
er, lighter bones, others are broad built. What is For an estimation of sexual development of the
more important is the growth rate of the child and girls there are used the following parameters:
the direction of his growth curve at a particular point M — degree of development of mammas
of time (Table 31). Ax — axillary pilosis
Growth and size depend on environmental con- P — pubical pilosis
ditions as well as genetic endowment. Physical de- Me — menarche
velopment of the children is an important index of A0P 0Ma0 — absence of secondary sexual at-
public health. It depends on two groups of the fac- tributes
tors: biologic (congenital) and environmental. A1P1 — an individual direct hair at the centre of
The physical development is set of the pheno- the pubis and armpit
typical, morphological and functional characteris- A2P2 — growth of hair only at the centre of the
tics of the organism of the individual reflecting in- pubis or armpit
fluence of the factors of external environment. The A3P3 — rich twisted hair on all area of the pubis
physical development is defined by two groups of and armpit
the factors: constitutional-biological (genotype, the M1 — edematous areola and increase of its siz-
current of embriogenesis) and external (physical, es, under the nipple a small site of a glandous tis-
chemical, biological and information factors of the sue
surroundings) also is one of the most informative M2 — conic breast, the areola is pale, the nipple
parameters of a condition of public health. is flat
The physical development of children and teen- M3 — form of the breast is hemispheric, the ar-
agers is estimated with the help of the following eola is pigmented, the nipple is towers above it
groups of parameters: Me0 — absence of menstruation
— Anthroposcopic (somatoscopic) Me1 — menarche at the moment of examination
— Anthropometric (somatometric) or about 1 month prior to examination
— Physiometric Me2 — irregular menstruation
— The data of medical examination Me3— regular menstruation
Anthroposcopic parameters are defined by a Estimation of the boys:
method of the inspection. Estimate a constitution, Ax — axillary
habitus, form of the chest, backbone, legs, feet, de- P — pubical pilosis
gree of development of secondary sexual attributes L — condition of laryngeal cartilages
(hairs in armpit, on the pubis (mons veneris), on the A0P0L0 — absence of secondary sexual attributes
face, development of laringeal cartilages, the muta- A1P1 — an individual direct hair at a root of the
tion of a voice in the young men; in the girls — de- penis and in the armpits
gree of mammas development, menarche approach). A2P2 — growth of a hair only at the centre of
The survey will be carried out at natural illumi- the pubis or armpit
nation, the child should be undressed up to under- A3P3 — rich twisted hair on all area of the pu-
wear. The researches will be carried out in a premise bis, scrotum and armpit
with a comfortable microclimate (temperature of air L0 — absence of the laryngeal prominence, chil-
18–20°C, humidity 40–60%), equipped by a hang- dren’s timbre of a voice
er for clothes, low couch, little carpet for legs.
Basic constitutional types are astenic, normosten- Table 31. Average Weight of Well-Nourished Indian
ic and hyperstenic. The proportional constitution Children at Different Ages (WHO, 2002)
smoothed bony prominence (claviculi, spinae ili-
acae, spinae scapularum etc.), thickness of the skin- Age Boys, kg Girls, kg
fatty fold up to 2 cm is characteristic for the child Birth 3 2.9
with a normal constitution and satisfactory nourish- 6 months 7.5 7
ment. Children have clearly expressed bony promi-
1 year 9.5 9
nences, the thickness of the fold does not exceed 1
cm. Well nourished children have smoothed bony 2 year 11.5 11.0
prominences, significant thickness of skin-fatty fold. 3 year 14.0 13.5
The chest can be normal, conic, cylindrical, in- 4 year 15.5 14.5
fundibular, rachitic in shape. 5 year 17.5 16.5
The back is estimated as round, flat or normal.

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 L1 — beginning of the voice mutation
L2 — incomplete voice mutation, developed la-
ryngeal prominence
L3 — male timbre of the voice
For exception of errors in measurements of an-
thropometric research will be carried out in the
-zα/2 zα/2
morning time.
The measurement of growth is made with the
help of length-meter in standing and sitting position. -α/2
The examined should contact to a vertical rod of à
length-meter by a nape, scapulas, glutei and hells α/2
(for children with X-figurative deformation of legs
— knees). In measurement of growth for sitting
child he should contact to a rod of a length-meter µ − 2σ µ − σ µ µ + σ µ + 2σ
with shoulder blades and buttocs. Feet should be
placed separately (at the angle of 45°). The head of Fig. 34. Normal Distribution
the examined is in such position that the line con-
There are two approaches for the assesment of
necting the outside corner of the eye with the tra-
growth development. The first one is based on the
gus of the concha of the auricle is horizontal. The
population surveys and allows to determine risk
turns of a head in the parties are excluded. A rod of
groups and problem territories both on a local and
the length-meter is being moved down easily, with-
international level (Fig 35, 36). The second approach
out effort.
is based on the assessment of individual growth de-
The measurement of the chest circumference will
velopment in comparison with standards. This ap-
be carried out in quiet breathing of the examined
proach is presented by the methods of indices, stand-
(small children are distracted by a toy or conversa-
ard deviations, regression seals and percentile scales.
tion). For definition of excursion of the thorax de-
fine a circle of the chest at height of the maximum
breath and exhalation. A centimetric tape impose
behind under the bottom corners of shoulder blades, SCHOOL HYGIENE
in front at a level of the IV rib (in boys — on nip-
ples, in girls with advanced mammas — under the Kindergarten is an institution of preschool edu-
breast). cation. In Ukraine there are both types of kinder-
The measurements of weight are made with the gartens — private and governmental. They should
medical scales. The child stands on middle of a plat- be placed in the residential area far from sources of
form of the sliding-weight scales. Weight is recor- noise and pollution. Area size is determined by the
ded on scale with the maximum accuracy (up to number of children. If a kindergarten has up to 160
50 g). After measurement the scale lock should be children so area for each child should be 45 m2, if
closed. more — 35. A kindergarten serving area has a radi-
With the help of a special tool it’s defined a biac- us of 300 m. The area is subdivided into such func-
romial diameter, the sizes of a pelvis (are more often tional zones: economic (includes warehouses, ga-
a bicristaric diameter), transversal and sagittal diam- rage, boiler building, laundry, kitchen), the zone of
eter of the breast. Other anthropometric indices are playgrounds, the zone of vegetations and zone of
presented by the circumferences of the shoulder, kindergarten building. The kindergarten area should
thigh, calf, forearm and head, as well as by cranio- have 2 entrances as minimum. Percentage of build-
metric data and lengths of the extremities and their ing area does not exceed 25%, minimum percent-
segments. age of the area occupied by vegetations is 55%. The
The physiometric parameters are united by re- maximum quantity of floors for kindergarten build-
sults of various functional tests. The vital capacity ing is 2. Premises for children of young age should
of the lungs is determined with the help dry and be placed at the ground floor.
damp spirometers, with the manual dinamometer — The kindergarten building should have centrali-
force of a hand, with back-force dinamometer — zed water supply (in the country — local water sup-
force of the spine muscles. The measurements are ply system), sewage disposal. They provide kinder-
repeated two-three times. The best result is record- garten with hot water (autonomic boiler or two in-
ed. dependent intakes of hot water pipes.
The data of medical examination unite results of The main principle of building planning is
the physical examination of the child and reflect the “group isolation”. It means that every age group has
valid condition of health at the moment of survey. own set of premises. In the observation it makes
Usually data of physical development are distribut- possible do not close kindergarten. A set of premis-
ed normally (Fig. 34). es includes a dressing room, a group room (used as

124
 the highest prevalence of stunting

Fig. 35. Geographical Distribution of Stunting in Infants

the highest prevalence of stunting

Fig. 36. Geographical Distribution of Stunting in Children at Ages less than 2 Years

a dining-room and class room also), a bedroom, a the street. If they inoculate children in the kinder-
service room and lavatory. Every “group section” garten (not in the polyclinic), all vaccines have to
has two entrances — one to the street and another be stored in the refrigerator. The temperature inside
— to internal corridor of the kindergarten. If two a refrigerator should be no more than +5°C, it’s
groups have common exit they should use it by the measured daily and data are recorded in the special
schedule. Toys in the group room should be accord- register. Also the nurse of the kindergarten has a reg-
ing to the children’s age. It’s prohibited to use toys ister of antropometry and complete set of medical
from the other groups. Every week all premises documentation (individual charts of children and
should be washed with disinfectants, regular clean- medical books of staff). Every morning before re-
ing is made 3–4 times during a day. Disinfectants ception to the group the nurse inspects children for
are changed every 7 days, laundry — every 10 days. signs of infection (fever, coughing, rhinitis, rash,
Drinking water for children should be stored in the etc.). Data of examination are recorded in the reg-
group, it’s forbidden to use tap water for drinking. ister.
Children eat in the group room, after every meal all Demands to personal hygiene of staff and chil-
dishes are washed and disinfected. dren are very strict. A staff person should be en-
A medical room should have an isolator. It’s sit- sured that a child’s hands are washed before meals,
uated at the ground floor and has a separate exit to snacks, after toileting and after being diapered. Cloth

125
towels and washcloths should be labeled with the to maximize each child’s education and health po-
child’s name, used only by the named child and laun- tential for a lifetime.
dered weekly. The operator shall arrange a laundry School Counseling, Psychological, and Social
schedule with the parent. Paper towels may be used Services. These activities focus on the cognitive,
as towels and washcloths. Paper towels should be emotional, behavioral, and social needs of individ-
discarded after each use. A child shall have a la- uals, groups, and families. They are designed to pre-
beled toothbrush. Toothbrushes should be stored vent and address problems and to facilitate learn-
with the bristles up and exposed to circulating air. ing and healthy behaviors and development.
Paper cups for drinking water are discarded after one Healthy School Environment. This is the physi-
use, or water fountains should be used for between- cal, emotional, and social climate of the school.
meal drinking by children who are not bottle-fed. Designed to provide a safe physical plant as well as
Lavatory for staff should be isolated from children a healthy and supportive environment that fosters
lavatories. learning.
Good health is essential for learning. Health is School-Site Health Promotion for Staff. This in-
not only the absence of disease but also complete cludes assessment, education, and fitness activities
physical, mental, and social well-being. When for school faculty and staff. It is designed to main-
school aged children are not in good health, they tain and improve the health and well-being of school
become distracted, unable to concentrate in school, staff who serve as role models for students.
keep up with their demanding schedules, and some- Family and Community Involvement in Schools.
times even unable to attend school. Years ago the These are partnerships among schools, families, and
biggest threat to the health of school children came community groups and individuals. They are de-
from contagious diseases such as tuberculosis, diph- signed to share and maximize resources and exper-
theria, measles, mumps, and rubella. Today most tise in addressing the healthy development of chil-
health risks have their roots in social or behavioral dren, youth, and their families.
conditions. When these problems emerge, they can Schools have evolved from purely educational
disrupt students’ lives, classrooms, and the school facilities into sources of employment, social and
environment. When students are sick, distracted, or health services, cultural opportunities, and recrea-
absent, schooling becomes ineffective. For students tion and entertainment for their surrounding com-
to become productive, responsible citizens, schools munities.
must help them develop health-promoting skills and A healthy school environment encompasses both
behaviors and attend to the physical, mental, and the physical and psychosocial surroundings in which
social components of their lives. For the past dec- students and school personnel are expected to work.
ade, education and health experts have suggested A healthy school environment supports learning and
that a coordinated school health program that goes contributes to students’ health by: minimizing distrac-
beyond classroom instruction and integrates eight tions; minimizing physical, psychological, and social
components in the most efficient way for schools hazards; creating a climate in which students and
to ensure the health of their students. There are: school staff do their best work; expecting that all stu-
Comprehensive School Health Education. This dents can succeed; implementing supportive policies.
classroom instruction addresses the physical, emo- The physical school facility represents the ex-
tional, and social dimensions of health; develops ternal, tangible environment. Physical conditions
health knowledge, attitudes, and skills, and its tai- can include school bus safety, adequate water and
lored to each age level. It is designed to motivate classroom supplies, physical security of the build-
and assist students to maintain and improve their ing, as well as acoustics, ventilation, heating and air
health, prevent disease, and reduce health related conditioning, and lighting. As mentioned before, at
risk behaviors. least half of the nation’s public schools contains an
Physical Education. This instruction that pro- environmental hazard, such as asbestos, contaminat-
motes lifelong, safe, physical activity. It is designed ed water, or poorly ventilated indoor air. Psychoso-
to develop basic movement skills, sports skills, and cial conditions, on the other hand, encompass the
physical fitness, as well as to enhance social and attitudes, feelings, and values of the students and
emotional abilities. staff and may require more extensive changes. The
School Health Services. These are preventive presence of gang violence as well as weapons, drugs,
services, education, emergency care, referral, and alcohol and tobacco on school grounds contribute
management of acute and chronic health conditions. to this aspect of a school’s environment. Class size
They are designed to promote the health of students, and the availability of community-based extra-cur-
identify and prevent health problems and injuries, ricular activities also facilitate the psychosocial en-
and ensure care for students. vironment of a school. To ensure healthy develop-
School Nutrition Services. These services inte- ment, a number of model health practices can be in-
grate nutrition education, nutritious and appealing tegrated into core curriculums. For instance, schools
meals, and an environment that promotes healthy could promote participating in active lifestyles, eat-
dietary behaviors for all children. They are designed ing well-balanced meals, abstaining from alcohol,
126
tobacco and other active drug use, and minimizing schools, disclosed a decreased level of adjustment
risk-taking behaviors, including sexual activity. to scholar demands, situated 0–12 months below
Equally important are student and staff percep- normal.
tions of the interactions that take place within the Inclusion of these children into mass general
school environment. This less tangible component schools has had an obvious benefit input towards
of environmental health is frequently referred to their IQ which became 10–20 points greater than a
as school climate. Climate encompasses both so- pre-school period scores (93.8 in first grade of
cial and physical elements, and creates an infra- school over 82.5 in pre-school). Acquisitions on
structure that makes physical, social and emotion- speech level are shown by increased values of IQ
al health. in the first and second grade of primary school (97.2
Ergonomic studies comprised scholar adaptability and 92.8). Delayed behavior and psycho-intellectu-
and scholar’s psycho-intellectual capacity, approach- al development of institutionalized children are ex-
ing issues of mental load and psychological fatigue. plained by the monotony of life conditions, lack of
Specific investigation methodology was established exercise, the absence of individualization in care and
and evaluation criteria of adaptability and mental fa- education, insufficient development of affective and
tigue were structured. Scholars’ psychological limits social contact, lack of warmth from care staff, lack
are conditioned by their functional particularities of of contact between children who play one next to
nervous system and sensorial and motor abilities. Dis- another and not one with other. Researches need to
regard of these limits makes improbable determina- be orientated in the future, with priority, towards the
tion of scholar activity dysfunction. activity that implies a high level of mental load and
Studies carried on between 1994–1998 on sec- a high volume of abstract and creative thinking.
ondary and high school pupils revealed that normal
physically and psycho-intellectual developed stu- SCHOOL DISEASES
dents showed both objective (cardio-vascular, mus-
cular, sensorial indicators) and subjective (health The top ranked diseases are: ocular chronic dis-
status self-evaluation) modifications that demon- eases, failure to thrive, rickets consequences, chronic
strate scholar fatigue. Collective administration of disease of Waldayer lymph nodes, gained deforma-
anxiety test Cattel showed increased anxiety on the tions of the spine. Studies found a high percentage
studied group indicates disorders varied from mild of pupils with disharmonic development, weight
anxious neurosis to severe anxious neurosis that re- deficit in pupils from all grades and all counties tak-
quested psychiatric assistance. Relation between en into study.
high school performance with high level of anxiety Risk factors with impact on health status are:
in schoolgirls has been demonstrated. non-ergonomic school furniture, effort curve is not
Study of knowledge functional modifications in- taken into account, artificial illumination is inappro-
dicators (attention tests, test on work capacity) has priate in classrooms, craft rooms, laboratories, de-
showed modifications in work capacity curve even ficient potable water supply. Inappropriate micro-
in the conditions of reduction of working week from climate, deficient ventilation and sometime lack of
6 to 5 days. Previous studies showed that the aca- furniture, floors and toilets hygiene put pupils at risk
demic performance increases from Monday through for diseases. Epidemiological triade after holidays
Wednesday, under the new conditions Tuesday is the is an active surveillance method into schoolchildren
maximum, starting Wednesday performance de- collectivities that enables information on epidemi-
creases gradually, so that a Friday it is the lowest. ological potential and risk for health in school chil-
Study of time allocation revealed manifestations dren. Diseases diagnosed at triage are found in 1.5‰
of overload syndrome on the account of scholar of scholar population and are mainly infectious, both
manuals, subject’s planner both saturated with in- contagious and parasitical. Incidence of angina is
formation, data, and inappropriate structure of schol- increasing so that in 2,000 it reaches the value of
ar schedules. Another finding of our researches was 0.56‰. Pediculosis and scabies are at constant per-
scholar disadaptive syndrome considered as a form centage: 0.03-0.07‰ scabies and 0.8–1.2‰ pedic-
of social disadjustment that creates premises for fur- ulosis. There are though differences between coun-
ther difficult integration. ties related to local/regional particularities. There is
Children’s confrontation with scholar demands a need for hygienic and sanitary, epidemiological,
generates typical sets of attitudes that lay at the ba- education for health measures with national dimen-
sis of behavioral changes, related to the pupil’s. The sion aiming to reduce the incidence of these diseas-
level and establishment of scholar education are sig- es and to eradicate scabies and lice.
nificantly influenced by definitory variables for so- School building should be placed in the residen-
cio-familial environment especially cultural factors tial area far from sources of pollution. The service
and mainly the level of parental instruction. The area has 500 m in radius, for lyceum and colleges
study on pupils who were institutionalized since pre- — without limits. School area has from 0.5 to 3 ha
school period and now attending mass general and is subdivided into economic zone, zone of veg-

127
etation, zone of sports grounds and school building
zone. The built area can occupy up to 25% of school ERGONOMIC WORKPLACE FOR
area, vegetation takes 55% as minimum. Sports zone PC STUDIES
takes about 30% of the area. In Ukraine it is estab-
lished that maximum height of school building is 3 Computers should accord to TCO 99 or TCO 95
floors. School building has two or more entrances. (glare reducing screen, ergonomic monitor). The top
They use the systems of school building: of monitor screen is approximately on the eye lev-
a) centralized — all premises are situated in one el. The best is use indirect lighting. The keybord and
building. It’s typical for the most urban schools; mouse should be ergonomic. The elbow angle
b) decentralized — school has some buildings should be physiological (70–90°) and wrist angle
(for primary school grades, secondary school, ca- does not exceed 10°. The chair should support the
tering unit, administrative unit, sports unit, dormi- correct posture — the thigh is horizontal, the knee
tory (hostel) for board schools, etc.); is bent at 90° or more. Feet should be flat on the
c) combined — has features of the both systems. floor or foot rest (Fig. 37).
School is provided with systems of water sup- School Syllabus. The hygienic organization of
ply, canalization, gas and electricity. the educational classes at school is aimed at saving
Primary grades are placed at the first floor of the the work ability during the whole day of study, to
building. Their square is 1.25 m2 per a pupil. remove the fatigue, i. e. to make this work hygienic
For secondary school this ratio is 1.5 m2. The and pedagogically effective. There are five school
height of school premises should be no less than 3.5 days in a school week. The weekly workload in
m. For classrooms of chemistry, biology, informat- terms for students should be determined by the
ics, physics two premises units are used. They con- school curriculum. The maximum permitted work-
sist of study room and laboratory (for IT class — load should be:
server room). Chemistry classroom should be 1) 20 h in grade 1;
equipped with local exhaustion and be placed on the 2) 23 h in grade 2;
upper floor of the school building. 3) 25 h in grades 3 and 4;
The school furniture should be ergonomic, e.g. 4) 28 h in grade 5;
accord with the height of the child. They use terms 5) 30 h in grades 6 and 7;
differentia (distance between table and chair by the 6) 32 h in grade 8;
vertical), distance of the back support (between back 7) 34 h in grade 9;
edge of the desk table and back of the chair) and 8) 35 h in grades 10–12.
distance of sitting (between back edge of the desk
table and front edge of the sit of the chair). Differ-
entia should be equal to level of the elbow of the
sitting pupil +5 cm. Distance of sitting should be Top of screen is at Screen 26–36′′
negative (2–3 cm). If distance of sitting is positive approximately eye from eyes
it can cause thoracic hyperkyphosis. High differen- level
tia cause right-side scoliosis, low differentia — left
side scoliosis. Use a glare-reducing
screen, and indirect
In the West they use height of sitting in inches lighting
(14′′, 16′′, 18′′, etc) as the desk size. Modern desk
can be combined as a unit. It’s light, safe and ergo- Elbow angle should
nomic. be 70 to 90°
In Ukraine we use the system of sizes of desks Wrist angle should
marking by Cyrillic letters and color marks (Table not exceed 10°
32). These marks are used only for desks (1–
4 grades). Horisontal
thigh
Table 32. The Sizes of School Desks
Group of Color mark (a ring
Pupil’s height with D=25 mm or strip Knee to bend at 90°
school and more
furniture with width 20 mm)
A Up to 130 cm yellow Feet flat on
the floor or
Б 130–145 cm red a footrest
В 145–160 cm blue
Г 160–175 cm green
Д 175 cm and more white Fig. 37. Hygienic Requirements to the Workplace in
IT Department.

128
 Limit duration of a lesson in the first grade is up Tiredness after a mental work is a result of the
to 35 minutes. The best regimen for the first grade violation of cortex-subcortex interrelations followed
pupils is the following: September-October — 3 by breeches in a cortex neurodynamic and efficien-
classes × 30 min; November-December — 4 class- cy on the one hand and negative changes in the re-
es × 30 minutes and from January — 4 classes × 35 actions of vegetative system on the other hand. The
minutes. Short breaks in the lesson are used for fa- prophylaxis of tiredness prevents from the violation
tigue prevention. The least ability to work is on of high nervous activity and vegetative functions,
Monday and Friday, the maximum — Wednesday. cardiovascular system; it helps to maintain the ca-
So test papers should be excluded on these days. pacity for work.
It’s very important to change kinds of children To observe the day’s regimen means to divide
activities from the intellectual work to the physical the day’s time into certain fixed periods and to spare
— from classes of mathematics, foreign language each period some sort of activity or relaxation so
— to craft, drawing or music. It’s forbidden to place that all kinds of rest and activity would be embraced
difficult subjects after sports classes. It’s necessary taking into consideration children’s age and state of
to avoid doubling of lessons. health. The regimen is considered to be right if it
The breaks between classes should be no less gives enough time for all the necessary elements of
than 10 minutes, for lunch children have 30 min life activity and at the same time maintains a high
break. For children rest recreation premises should capacity for work:
be organized. — various kinds of activity (studies at school and
The maximum number of students in a class at home for schoolchildren), their optimum duration,
should be 36. In case of a small number of students, reasonable alternation and regularity;
a combined class should be formed of students from — rest with the maximum stay in the open air;
different classes. From grades 1–4, there may be up — regular and sufficient feeding;
to 20 students in a combined class formed from 2 — sleeping of full value.
classes, from 3 classes up to 15, and from 4 classes Children of 6 years old are to sleep 11.5 h (10 h
up to 10 students. In grades 5-9, there may be up to at night, 1.5 hour in the afternoon).
15 students in a combined class formed from 2 con- Studies at school are conducted according to a
secutive classes. There may be up to 30 students in curriculum. To restore capacity for work and prevent
an extended day group. There may be up to 25 stu- tiredness rest must be given. It’s efficiency to a great
dents in a group at a boarding school. extent depends upon it’s organization.
Homework Policy. Homework is an important If children rest in the open air and their rest is
part of the learning process, and you should expect planned and organized carefully it may have an ad-
to have homework assignments each day. On the ditional positive effect on children’s organisms.
average, students in grades 5 and 6 should expect 1 Such rest promotes blood oxygentaion, increases
to 1.5 h of homework each night; students in grades lungs ventilation. Children must stay in the open air
7 and 8 should expect 2 to 2.5 h of homework each no less than 2–2.5 h (best of all before the begin-
night. Summer reading assignments will be the only ning of classes, after them and before going to bed.
ones required during vacation time. Homework as- Children must have some free time (1–1.5 h a day
signments may require reading and/or writing. for younger schoolchildren and 1.5–2.5 h a day for
Sometimes you will need to spend time reviewing senior ones), which they stand by their own op-
classroom assignments material so that you are pre- tion. But there are some kinds of activity within
pared for quizzes and tests. You will also be given this time which must be under control. This is see-
some long-term assignments like special projects ing films and especially TV-programs. It’s known
and reports. Learn to tackle these assignments by that children under 7 spend about 12–24 h a week
doing a little each day instead of waiting until the in front of TV-set which leads to tiredness, but not
last minute. It would be helpful for you to block out relaxation.
your work time on a calendar for long-term projects. According to the modern researches younger
Budgeting and organising pupil’s time are very im- schoolchildren may watch TV maximum 1 hour
portant skills which he/she should develop during while senior pupils can do it 2 h a day, no more than
school years. 2–3 times a week. Age peculiarities, state of health
Hygienic Basis of the Regime of Children. must be taken into consideration as well as what
Children develop in the course of organised activi- children are interested in, how well they do at school
ty of various forms and duration. This activity (if etc. Enough time for self service, hygienic procedure
its organisers keep in mind children’s anatomic and must be envisaged in the regimen. It’s necessary to
physiological peculiarities, their possibilities and keep strictly to the routine for those children who
health) can stimulate the development of nerve sys- are in extended-day groups at school. The require-
tem, speech, analyser, promotes a normal growth and ments here are the same as for children who go home
development. But children’s activity is far from be- after classes. So schools where such groups exist are
ing unlimited, and tiredness comes after it. to have special conditions.

129
 Wrong organization of the day regimen has a neg- — carry out medical examination of children;
ative effect on the state of health, causes tiredness, — divide them into groups of health;
delays growth and development of children. So the — divide them into groups for training;
day regimen is an indispensable condition for bring- — define a kind of physical exercises and train-
ing up children successfully. ing procedures indicated to this or that child.
General Health Education in the Developing By condition of health and physical development
Countries. Health and Hygiene lessons cover most children can be divided into 3 groups.
of the tropical diseases found in the area, e.g. ma- The basic group includes healthy children with
laria, bilharzia, sexually transmitted diseases includ- slight functional deviations in the cardiovascular
ing HIV/AIDS. The lessons are structured to cover system or insignificant deviations in physical devel-
causes, symptoms, treatments and prevention of opment. It’s possible to carry out all kinds of physi-
these diseases. Most of the family members have cal education.
improved their living standard in the areas of health The preparatory group — poor trained children,
and hygiene. This is shown by decrease in malaria, with functional deviations of the cardiovascular sys-
diarrhoea, STDs cases in clinics. Through motiva- tem or the respiratory system, who has chronic bron-
tion, creativity and initiatives, self reliance has been chitis or recover after acute infections. It’s neces-
the promoted in the sense of income generating ac- sary to observe moderate dosage of physical load-
tivities which address the problem of unemployment ing, to limit running, jumping, etc.
nationally and internationally through self-employ- The special group are children with rheumatic
ment, as well as creating jobs for others. Families fever etc. The sport classes are limited or absolute-
receive lessons and campaigns on the importance ly forbidden.
of sanitation. As a result of the lessons, families dig Special tests are made to determine a degree of
pits for latrines, mould bricks, pay the builders, training state. In improvement of health condition and
while the project provides materials such as cement, physical development of the child, the doctor can
mash-wire, reinforcement and fly-screen together transfer him from the third group to the second one,
with other NGOs. from the second to the first one after examination.
Physical Training. Physical training is one of While transferring children from one group of phys-
the factors of external environment, which can ical training to another one the basic parameters
strengthen a condition of health, raise stability of should be study of functioning of the organism with
the organism to the influence of the adverse factors. the help of functional tests on dosed muscle loading.
The basic way of physical education is the phys- For children of preschool age the Levi-Gorinevsky’s
ical exercises and training of the organism. Under test — 30 jumps for 20 seconds is used. Pulse rate,
the action of physical training positive changes take breathing rate and blood pressure are considered as
place in the organism: functional parameters of the organism.
— the metabolic processes are normalized; im- Three types of reactions are observed:
munological properties of the organism are rised; 1) the reaction of a usual type: the pulse becomes
— the functions of the organism are improved; frequent in the first 10 s. By 1–6 beats blood pres-
— the coordination of movements is improved; sure increases by 5–10 mm Hg;
— the endurance, stability to the factors of ex- 2) the insignificant deviations consist in increase
ternal environment is increased; of pulse and breathing rate after received loading.
— new conditionally-reflexive connections, the The restitution of pulse is delayed about 3 minutes
improved nervous-emotional tonus, protective mech- but no other signs of poor health are observed;
anisms. 3) significant dyspnoe, deterioration of health,
The following principles should form the basis arrhytmic pulse, disturbance of blood pressure re-
of physical training: systematic training; gradual action:
training; integrated approach; individual approach. — systolic pressure reduction
Medical control of physical training includes the — diastolic pressure reduction
following complex of measures: The doctor working at school should also pro-
— medical supervision on the condition and dy- vide:
namics of health; 1. Scheduled primary and repeated surveys of
— study of reactions of the organism on physi- children for division into groups of physical train-
cal loading; ing. It’s necessary for the admission to lessons of
— participation in measures on preventive main- physical training in sports sections, to participation
tenance of traumatism during employment, in tour- in competitions, in tourist campaigns, for a direc-
ist campaigns; tion into sports schools).
— sanitary supervision at places for physical 2. Control of lessons of physical training, reali-
training. zation of “physical culture pauses”, competitions,
Therefore before starting physical education the etc., prevention of traumatism, consultive work with
doctor should: the teachers.

130
 To prevent sport traumas the following actions gin shivering at lower body temperatures, because
are forbidden: they generate more heat without shivering. A big
a) the premature admission to training of recov- hallmark of cold-acclimatized people is improved
ering children, suffering from chronic diseases, poor ability to sleep in the cold. Cold acclimatization may
trained; involve either increased or decreased skin tempera-
b) lengthening of training, disturbance of rules tures, depending on circumstances. In some cases,
of personal hygiene (exercises after meal, on an skin blood flow increases to keep extremities warm
empty stomach, in poor sleeping, training with chil- and to resist cold injury. In other cases it decreases
dren having skin lesions, excoriations, etc.). to reduce heat loss. For example, skin temperatures
The correctly constructed lesson consists of four of Australian Aborigines were lower while sleep-
parts: ing than those of the unacclimatized Europeans.
The introduction — 5–7 min. The main principles of body tempering are the
The preparatory part — 12–15 min. same as for physical training:
The main part — 20–25 min. (1) systematic training; (2) gradual training; (3)
The final part — 3–5 min. Restoration of the or- integrated approach; (4) individual approach.
ganism to initial condition. Air bathing is an effective and simple method of
Physical loading should be given in the main tempering. The air bath should be pleasant and if it
part. is taken progressively will prove to be so. Its dura-
“Tempering” — special training of adaptive ca- tion must depend on the temperature and on the age
pacities of the organism which increase the level of of a child. He/she must not be permitted to chill.
antistress resistance. Main target of the hardening Cold water removes heat from the body 25 times
techniques is thermoregulation system. In English faster than cold air. The immediate effects of sud-
speaking nations they use terms “heat acclimatiza- den immersion in cold water (15°C) can be a debil-
tion” and “cold acclimatization”. The main idea of itating, short duration (approximately 2–3 min), re-
body tempering (like in tempering steel) is the con- flex response called cold shock. This response in-
cept that everyone can increase “natural immunity” cludes life-threatening respiratory and cardiovascu-
by air baths, water procedures and sun bathing (Ta- lar effects. The respiratory effect involves quick
ble 33). onset (less than 30 s) uncontrollable rapid breath-
Cold acclimatization is a process of gradually ing which impairs breath-holding and facilitates as-
increasing resistance to cold through regular cold piration of water (which can lead to drowning). The
exposure. Major examples of acclimatization to cold cardiovascular response involves an immediate con-
are the indigenous people of the African Kalahari, striction (closure) of the blood vessels near the sur-
the Australian desert, and Tierra del Fuego in South- face of the body, an increase in heart rate and a surge
ern Chile. Many sleep outdoors nearly naked in in blood pressure.
freezing temperatures. Acclimatization occurs in For pouring it is recommended to use warm wa-
people working outdoors year round and fishermen ter (30–32°C). Every 2–3 days temperature of wa-
who dunk their hands in cold water all winter to tend ter is reduced by 1°, reaching till 19–20 for the
their nets. Children acclimatization to cold is an younger schoolboys and 17–16 for adolescents.
important measure in the prevention of overcooling Duration of taking shower is 1–2 min. After
and acute respiratiry diseases. shower it is necessary to wipe a body carefully and
True cold acclimatization involves at least three massage it. The duration of all water procedures
adaptations. Cold-acclimatized children people be- should be no more than 1–3 min. The especially
strong influence is rendered by sea bathing in a com-
bination with swimming (temperature of water,
Table 33. Kinds of Tempering Procedures movement of waves, chemical structure of water).
General All this trains mechanisms of thermoregulation re-
Procedures Partial sulting in methabolism raising, optimizing in lung
(whole body)
ventilation, increasing of pulse and blood pressure,
Convective Air bathing increasing of red blood cells quantity, training of the
procedures
nervous system. The swimming renders positive in-
Conductive Showering Wiping fluence on physical development of the children.
procedures Bathing Pouring To begin sea bathing tje temperature of water
Winter Barefoot should be no less than 20°C. The duration of bath-
swimming walking ing during first days should be no more than 3–5
Other Sun bathing min with subsequent lengthening of bathing time up
Sauna
to 20–30 min.
The sanction for usage with a reservoir for bath-
Russian bath ing children is given by local sanitary epidemiolog-
Hamam (Turkish bath) ical station. The depth of water in a place of bath-

131
ing of the younger schoolboys should be no more 5. Children love playing outdoors but usually are
than 1–1.5 m. A place, up to which it is authorized not aware of the harmful effects of UVR.
to children to float follows, to designate by identi- The most noticeable acute effect of excessive
fication marks. During bathing children the presence UVR exposure is erythema, the familiar inflamma-
of the adults is necessary. tion of the skin commonly termed sunburn. The
The action of ultra-violet irradiation on the or- symptoms of a mild sunburn are reddening of the
ganism is a complex process. Under influence of skin caused by vascular dilatation and some swell-
ultraviolet irradiation denaturation of fiber occurs, ing, while in severe cases the skin will blister. In
that causes increase of quantity of proteolysis prod- addition, most people will tan from darkening of
ucts including histamine. These products irritate the existing melanin or through the UVR stimulation of
nervous terminations in the skin, vessels, that caus- melanin production, which occurs within a few days
es changes in the functional condition of the nerv- following exposure. A further, less obvious adap-
ous centers. It conducts reflective reactions on the tive effect is the thickening of the outermost layers
part of a number of organs and systems. of the skin that attenuates UVR and decreases the
The solar baths for children can be organized on penetration to the deeper layers in the skin. Current
a river or sea side or in the special solarium. The estimates suggest that a suntan can offer a sun pro-
greatest pressure UV-radiation is observed at the tection factor (SPF) of between 2 and 3. Depending
noon. To avoid excessive strong action of UV rays on their skin type, individuals vary greatly in their
on the child’s organism, the best time for solar baths skin’s initial threshold for erythema and their abili-
is considered to be 9–10 a. m. Also children should ty to adapt to UVR exposure. Chronic exposure to
avoid direct solar irradiation and use some other rules: UVR also causes a number of degenerative chang-
1. The reception of solar baths is supposed only es in the cells, fibrous tissue and blood vessels of
after 1.5–2 h after meal. the skin. These include freckles, naevi (moles) and
2. Solar baths after vigorous physical activity lentigines, which are pigmented areas on the skin,
(playing football, volleyball, athletics, gymnastics) and diffuse brown pigmentation. UVR accelerates
are contraindicated. skin aging, and the gradual loss of the skin’s elas-
3. Prior to the beginning and after termination a ticity results in wrinkles and dry, coarse skin.
solar bath it is necessary to accept an air bath by Although the data remain preliminary, there is
duration in 15–20 min. increasing evidence for an immunosuppressive ef-
4. Head should be covered by the light hat or cap. fect of both acute high-dose and chronic low-dose
5. After a solar bath the bathing in the river or a UVR exposure on the human immune system.
cool shower is recommended. Children require a special protection, as they are
6. The duration of solar baths should be strictly at a higher risk of suffering damage from exposure
regulated. to UVR than adults. Encouraging children to take
In children of the senior school age the first bath simple precautions will prevent both short-term and
can last for 5 minutes, with the subsequent daily in- long-term damage while still allowing them to en-
crease by 5 min. The general duration of baths joy the time they spend outdoors. Shade, clothing
should be no more than 1.5–2 h. and hats provide the best protection.
During solar bathing it is necessary to supervise Before accepting child of 6 years old in Ukrai-
a condition of pulse and state of health of the pu- nian primary schools they check out school maturi-
pils. Acceleration of pulse by 30%, occurrence of ty of children. School maturity is a complex char-
nausea, the headaches require the immediate termi- acteristic of the readiness for studies to school. They
nation of a solar bath. use medical and psychological criteria of school
Children are at a higher risk of suffering dam- maturity (Table 34).
age from over-exposure to UVR than adults, in par- The indications for delay of school are as fol-
ticular because of the following: lowing: absence of the permanent teeth; body length
1. The child’s skin is thinner and more sensitive,
and even a short time outdoors in the midday sun Table 34. Criteria of Readiness of the Six-Year-Old
can result in serious burns. children for Studies in the Secondary School
2. Epidemiological studies demonstrate that fre- Criteria Characteristics
quent sun exposure and sunburn in childhood set the
stage for high rates of melanoma in later life. Medical-biological teeth age (permanent
3. Children have more time to develop diseases dentition)
with long latency, more years of life to be lost and physical development
more suffering to be endured as a result of impaired health state (status praesens
health. and diseases history
4. Children are more exposed to the sun. Esti- Psychophysiological quality of articulation
mates suggest that up to 80% of a person’s lifetime results of the Kern-Irasek’s
exposure to UVR is received before the age of 18. test

132
less than M–15D (by local standards); increase of The test of Kern-Irasek can be conducted indi-
the growth less than 4 cm per year; infectious hepa- vidually or in a group of 10–15 children. The final
titis; pyelonephritis, diffuse glomerulonephritis; investigation is carried out with each child separate-
myocarditis (nonrheumatic); epidemic meningitis, ly in a special room. A child (or a group of chil-
meningoencephalitis; tuberculosis; rheumatic fever- dren) is given a sheet of paper. In the right top cor-
blood diseases; frequent respiratory viral diseases ner of the sheet the investigator writes the name and
(more than 4 times a year); vegetative dystonia (of surname, the age of the child, the number of the
hypotonic or hypertonic type); valvular defect (con- nursery school, the date of the investigation. The
genital or rheumatical); chronic bronchitis, bronchial pencil is put so that the child could easily take it
asthma, chronic pneumonia (if it’s exacerbation or with his right or left hand (Fig. 38, 39).
there is no steady remission in the year); ulcerous Instructions:
diseases of the stomach or duodenum, chronic gas- 1. Draw a man, please.
tritis, chronic gastroduodenitis (in aggravation stage, 2. Copy the written sentence.
with frequent relapses and with uncomplete remis- 3. Copy the dots.
sion); anemia (Hb 8.0–10.7 g%); adenomatous veg- Before doing the first task a child gets the fol-
etation of III degree, chronic adenoiditis; hypertro- lowing instruction: “Here draw a man as you can.”
phy of faucial tonsils (of III degree); endocrinopa- The other explanations assistance or remarks con-
thy, goiter, diabetes mellitus, etc.; neurosis (logone- cerning the mistakes and faults of the picture are
uroses, hysteria, etc.); retardation of the mental de- forbidden. If the child can not get down to the work
velopment; child’s cerebral paralysis; trauma of the the investigator can encourage him like this: “Good
cranium; epilepsy; enuresis; eczema, neurodermitis for you. You’ve begun your work very well. Go on
(if there are widespread skin lesion); myopia with drawing.” If the child wants to draw a woman, the
progressing tendency (> 2.0 D). investigator should explain to him (her) that all the
children draw a man and he (she) must draw a man.
Discription of Kern — Irasek’s test If the child has already begun to draw a woman, he
Equipment: a sheet of paper (A4), cards 7–8 × (she) may be aloud to finish the picture but after
13–14 cm with the inscription: “He ate a soup” and that the investigator insists on drawing a man next
grouped dots. (The inscription has vertical size of to the picture of woman.
the letters 1 cm, capital letter has size of 1.5 cm; After the picture has been finished the reverse
the dots have diameter of 2 mm, distance between side of the sheet is divided into 2 parts by a hori-
the dots across and vertically is 1cm). zontal line.

1 2 3 3 4 5

Fig. 38. The First and Second Subtest of the Kern- Fig. 39. The Third Subtest of the Kern-Irasek’s Test
Irasek’s Test

133
 Before fulfilling the second task 5–10 cards (7– — to do exercises for small muscles or bones
8 cm × 13–14 cm) must be prepared. The sentence development: modelling, embroidering, etc.;
“He ate soup” (the vertical size of the letters — — this work must be conducted under the guid-
l cm, of the capital letter — 1,5 cm) is written on ance of grown-ups;
the cards. The card with the sentence is placed in — the studies in order to help a child to get rid
front of the child. of the faults in pronouncing (conducted by a doc-
Evaluation: the best result is 1, the worst — tor-logopedist.
5 scores (by every subtest). If the child has more So, the children whose biological age corre-
than 9 scores he’s unready for school. sponds to their passport age or passes age, whose
To estimate the quality of pronounciation a child morphological and functional development are har-
is asked to call the subjects (in the pictures) in whose monic, whose speech and pronounciation are well
names the following sounds are used: developed, who are healthy (I and II groups of
— sonoric R — hard and palate, L — hard and health) and have passed successfully the test of Kern
palate; — Urasek are fit for schooling.
— whistling S — hard and palate, Z — hard and Scientific research of hygienists, physiologists and
palate; teachers have shown that children under 6 can be taught
— hissing gh, sh, ch, shch. at school but some requirements must be satisfied:
Pictures are picked out so that each of the sounds — their state of health must be taken into con-
would be used at the beginning, in the middle and sideration;
the end of the word. All the faults in pronouncing — they must be ready functionally for schooling;
the word are recorded. — they must have enough room and favourable
The existence of the defects in pronouncing at conditions for studies;
least one of the above-mentioned sounds means that — the curriculum and methods of teaching must
the task hasn’t been fulfilled. A child isn’t consid- be adjusted to the functional peculiarities of the age;
ered to be fit for schooling if he (she) gets 9 and — hygienic recommendations concerning the re-
more balls for the test of Kern-Urasek and has a fault gime of studies must be kept;
in pronounciation. — the normal feeding and physical training must
To correct the deviations revealed it’s recom- be organized taking into consideration age peculi-
mended: arities of children.

134
 Chapter 6
RADIATION SAFETY

Radiation hygiene includes dosimetrical (inves- inelastic dispersion, atom ionizing, nuclei exaltation,
tigation of radiation sources and levels) and radio- brake radiation. Length of β-particles track formu-
biologic directions (experimental and epidemiolog- la is: for air R = 400 × Eβ for light materials (alu-
ical researches of ionizing radiation influence upon minum, glass) — Rβ = 0.2 Eβ, if E < 0.5 MeV
health), theory and methodology of hygienic certi- For β-particles volume density of ionizing is in
fication of admissible levels of irradiation and san- 1,000 times less than for α-particles. For β-parti-
itary-organization direction making ways for anti- cles with energy 4 MeV the length of track is
radiation protection. 17.8 m in air, 2.6 cm — in water, 9.8 mm — in alu-
Radioactivity — spontaneous transformation of minum.
elements nuclei in other ones with formation of ion- Positronic β-decay occurs for some artificial iso-
izing radiation. topes:
There are the following kinds of radioactive de-
cay:
32
15P → e+1 + 32 14Si
α-decay is very typical for natural radioactive el-
ements with high numbers (they have low link en- A X
Z → e+1 + AZ-1 Y
ergy):
K-capture (orbital electron capture) is concur-
226
88Ra → 42He + 22286 Rn rent process with positronic β-decay:
A X
Z → 42He + A-4Z-2Y 64 Cu
29 + e-1 → 64 28Ni
α-particles are helium nuclei. Their energy is
spent on exaltation and ionizing of atoms in the in-
A X
Z + e-1 → AZ-1Y
teraction with matter mainly (but if α-particles has nuclear fission:
penetrated in nucleus it’s able to do nuclear reac- 235
92 U + 10n → 90 36Kr + 14056 Ba + 510n
tion). Length of α-particles track depends on their
initial energy, number, atom mass and substance 90
36Kr → 9037 Pb → 90 38Sr → 9039 Y → 9040 Zr
density. Linear density (quantity of ion pair on the
unit of track) of ionization depends on the particles If nuclear fission is being carried out for radio-
energy but volume density of ionization depends nuclides with high atom number and mass more than
also on a depth of their penetrating. Penetrative ca- critical the process has a chain character (chain re-
pacity of α-particles is low (for α-particles with en- action) and goes to explosion.
ergy 4MeV length of track in air is 2.5 cm, in bio- Thermonuclear reaction occurs only at temper-
logic tissue — 31 µ, in aluminum — 16 µ) because atures about several millions of degrees of Celsius:
they have big mass and charge, but indices of linear 2 + 31T→42He + 10n + E(17.57 MeV)
1D
and volume density of ionization are high.
Electronic β-decay is typical for natural and ar- 6 Li + 10n→31T + 42He, etc.
3
tificial elements:
X rays and γ-rays have interaction with irradiat-
40
19 K → e-1 + 4020 Ca ed substances in form of photoelectric effect (mainly
for E = 1–500keV), dispersion and forming of pairs
A X
Z → e -1 + AZ+1Y + ν “electrone-positrone.” They have high penetrating
There are an elastic and inelastic interactions of capacity and their track length is hundreds meters
β-radiation with substance. Inelastic interaction are in air.

135
 Neutrons have elastic and inelastic interaction 3. Biochemical — interactions of primary and
with substance. Neutrons are classified into slow secondary radicals with biosubstances. The most
neutrons: cold neutrons (E < 0.025 eV), hot neu- sensitive process is oxidative phosphorilation; the
trons (0.025–0.5 eV) and overheat neutrons enzyme dysfunction expresses in damage of ATP
(>0.5eV). production system. Protein molecules and dezoxiri-
The radioactive decay law: quantity of isotope bonucleinic complexes (DNA in complexes with
atoms transformed in 1 s is proportional to their proteins, RNA and enzymes). Proteins change their
general quantity or in equal time intervals there configuration, it takes place aggregation of proteins
takes place the nuclear transformation of equal because disulfide links are forming. The protein de-
parts of active isotope atoms: naturation is the result of deep changing in its struc-
ture. Dose about 5–10 Gy realized in transforma-
dN
— = –λN tion of mucopolysaccharides. Peroxidative oxidation
dt
of lipids (POL) which has a character of chain re-
after integralization of the equation we have: λ = action occurs.
0.693/Τ, where T — a half-life period (time for de- The cells with haploid chromosome set (sperma-
caying of an half of all isotope atoms) and (λ — is tozoids, ovocytes) are more sensitive to ionizing ra-
the constant of life. Isotopes are divided into short- diation action than diploid cells. Cells especially
living (period of half-life is calculated in seconds, sensitive for radiation in anaphase and kataphase of
minutes, h, days) and long-living (from some month mythosis. Hypoxy decreases the tissue sensitivity for
to billions of years). ionizing radiation.
The radioactivity unit in System International is The biologic effects of ionizing radiation is di-
beckerel (Bc) — 1 decay per second. Another unit vided into three groups: somatic, somato-stochastic
is curie (Cu) =3.7 .10 10 Bc. and genetic (Fig. 40). The first group is presented
For characterizing of ionizing radiation interac- by deterministic effects, includes acute and chronic
tion with substances it’s being used exponential, ray disease, ray combustions, alopecea, ray cataract,
absorbed, effective and equivalent doses. clinical registered frustration of hemopoesis, tem-
Exponential dose characterizes the ionization of porary or constant sterility. This effects have close
air with X-rays or γ-rays. In SI the unit is coulomb link with radiation dose and they forms in short time
on kilogram (C/kg). But it’s very often used roent- after action of radiation factor. For example the dose
gen (R) as the unit of the dose. 1R=2.58.10-4 C/kg= of 1–2 Sv makes the light form of acute ray disease
1 unit of CGS/cm3 (1.08.1010 ion pair in 1 cm3) but the dose of 10 Sv is absolutely mortal. The
Absorbed dose shows how much energy of ioni- threshold character of the effects is used for prog-
zing radiation is absorbed by the unit of mass. We nosis and for reconstruction of the doses (Fig. 40).
use Gray (Gy)=1J/kg in SI and rad (radiation ab- Somato-stochastic effects include effects man-
sorbed dose) = 0.01 Gy=100 erg/g. ifesting in the life of the individuum (from the mo-
Equivalent dose is absorbed dose multiplied on ment of fertilisation to death). There are cancero-
radiation coefficient. SI has especial unit for it: genic and teratogenic effects.
Sivert (Sv)=1J/kg. We use rem (biologic equivalent
of rad) =0.01 Sv also.
Effective dose characterizes the biologic effect BIOLOGIC EFFECTS OF
for all human body and its organs from influence of IONIZING RADIATION
ionizing radiation. The units are the same as for
equivalent dose. Determined Stochastic
In practice of radiation hygiene it’s being used
capacity of dose — ratio of dose gain to time inter-
val.
Ionizing action of every γ-radiation sources is Somatic Somato-stochastic
expressing in mg or γ-equivalent of radium =8.4 R/ – acute radiation disease – cancerogenic effect
h.cm2. – chronic radiation – teratogenic effect
Biologic action of ionizing radiation: disease
Interaction of ionizing radiation with biologic tis- – radiation combustions Genetic
sue has three stages: – alopecia – genetic mutation
1. Physical — absorption of ionizing radiation en- – ray cataract – chromosomal
ergy in described interactions. It takes only 1.10-19 s. – aberration
– clinical registered dis-
It’s able to destroy cells if energy of radiation is orders of hemopoiesis
enough high. Intracellular water absorbed 50% of
– temporary or constant
energy and organelles and biomolecules take 50% too.
sterility
2. Physical-chemical — production of active
radicals. The main process is water radiolysis, the Fig. 40. Biological Effects of Ionizing Radiation
process takes about 10-11 s.
136
 For calculation of cancer risk they use laws of B: people living or working in condition with
“dose-effect” interaction in the low doses. There are possibility of irradiation (near atomic power station,
simple statistic models (linear, square, linear- in geochemical provinces with a high level of radi-
square). The preference is given back to the last. The ation background, surgeons, nurses of radiological
question about threshold level for cancerogenic ef- department in hospital, etc).
fect is unclear now. If they are found, all the system C: other population.
of hygienic reglaments should be changed. The following limits of the dose in Ukraine are
Genetic effects include genetic mutation and used (NRB-97) (Table 35):
chromosome aberration. For category A there are established:
At present the most of specialists consider tera- Admissible limit of inhalation input ALIinhalA.
togenic effects can be determined. The action of the Admissible concentration of the radionuclide in
ionizing radiation in the early stages of embriogen- the air of working zone ACinhalA.
esis and gestation has as the threshold absorbed dose Admissible density of the particles in the air of
of 0.1 Gy. working zone ADPA.
Gormesis — is a recently discovered beneficial Admissible power of an external radiation dose
effect of low doses of ionizing radiation upon the APED.
human health. It expresses in high tolerance to en- Admissible contamination (ACA) of the skin,
vironmental factors actions. overalls and working surfaces.
The principal tasks of radiation safety system For category B:
are:1) to prevent the determined effects by limiting Admissible limit of inhalation income AIhalB.
irradiation dose under threshold values; 2) to use Admissible concentration (AC) of the radionu-
all maintenance and measures to increasing of prob- clide in the air of working zone ACinhalB.
ability of stochastic consequences taking into ac- Admissible density of the particles in the air of
count social and economical vectors. a working zone.
Principles of radiation safety: 1) the principle of Admissible power of an external radiation dose
the norm setting not to exceed an established dos- Admissible contamination (ACA) of the skin,
age limit; 2) the principle of evidence practice (ex- overalls and working surfaces.
clusion of any ungrounded, additional to prognosed, For category C:
irradiation); 3) the principle of optimization (low- Admissible inhalation MAIinhalC and ingestive
ering of radiation dose to a possible low level). MAIingestC.
Limit of the dose (LD) is the maximal average Admissible air concentration PCinhalC and water
value of individual equivalent dose of ionizing ra- concentration PCingestC.
diation per year for the critical group if equal irra- Admissible eject (AE) into the objects of envi-
diation during 70 years did not lead to unfavoura- ronment.
ble changing in human health detecting by contem- Dose loading should accord to these equations:
porary diagnostic technology.
E Iingest Iinhal ≤ 1
The critic group is the biggest by quantity group ———— + Σ———— + Σ————
Dlext ALIingest ALIinhal
of the category B persons with uniform life condi-
tion, age, gender or other factors if it had a maxi-
mal level of radiation influence in the limits of in- Hlens
≤1
stitution, its sanitaric-guarding zone and observa- DLIens
tion zone. Hskin
Sanitary-guarding zone is the territory around ≤1
DLskin
institution or the source of radiation contamination
where it is a risk of highing of admissible levels of Hexterm ≤ 1
irradiation (in the state of normal work of institu- DLexterm
tion).
Observation zone — is the territory where there
is a possibility of irradiation due to established lev- Table 35. Ukrainian National Standards
els. of Radiation Safety
The critical organs group:
I — gonades, marrow. Limits of Effective dose, mSv/year
II — lens; endocrinic, muscular, parenchimatous, dose A B C
lymphoid tissue etc.
LDe 20 2 1
III — bones, fibrous connective tissue.
Categories of irradiated person: LDlens 150 15 15
A: people working with radiation sources (con- LDskin 500 50 50
stantly or temporary): physicists, radiologists, work- LDextrem 500 50 –
ers of atomic power station, roentgenologists, etc.

137
 It is used an additional limited dose for women The time of radionuclides stay in the organism
in the reproductive age (< 45): an equivalent dose depends on the half-life period (T) and the period
should not exceed 1 mSv/month on the hypogastri- of half-excretion (Te).
um skin and the receipt of radionuclides per year For various radioactive isotopes Teff form from
does not exceed 1/20 of the admissible limit for per- some h (for example 24Na, 64Cu), days (131I, 32P, 35S)
sonnel. The purpose of these measures is to limit to some decades (226Ra, 90Sr).
the equivalent dose of fetus irradiation so it exceeds Chronic ingestion or inhalation is more risky than
less than 1 mSv in 2 month of unrevealed pregnan- single income.
cy. For calculation of the part in general radiation
For pregnant women it’s forbidden to work with they use the sum of multiplication of evry element
ionizing radiation source. After the pregnancy has per year on its dose coefficient. Time for calcula-
been verified the woman shoud change her occupa- tion of the expected effective dose is established as
tion place to a safe one for all pregnancy and lacta- 50 years for categories A and 70 years — for all
tion period. For students younger than 21 the sources population.
of ionizing radiation used for studies must not ex- The admissible average annual volume activity
ceed DL. is the limit of annual receipt to volume of air (wa-
At zones of radiation disaster only men-volun- ter) contaminated with radionuclide.
teers can work. They should know about possible The total effective dose for population of catig-
doses of irradiation and risk for health and give a ories B and C should not exceed 5 mSv/year if the
written concent to take part in dangerous works. The duration of work is less than 2000 h/year. Average
dose should be no more than 100 mSv/year by the healthy velocity is 1.2 m3/y and nuclides of urani-
permission of regional state sanitary institutions, in um family is in equal balance.
the dose less than 200 mSv/year — by the permis- Average power of γ-radiation dose: 3.8 µSv/h.
sion of the State Sanitary Department. It is forbid- Average annual equivalent volume activity of
den to increase the doses of ionizing radiation for 222Rn: 310 Bc/m3, 220Rn (toron) 68 Bc/m3.
the following categories: the workers who have tak- Average activity of 238 U in the industrial dust ~
en 200 mSv/year as a result of radiation disaster and 28/f kBc/kg, where f — dust pollution in breathy
workers having medial contradictions. zone (rg/m3).
For limitation of internal radiation they use the Principles of optimization and evidence based are
limits of annual receipt. Its value depends on the ra- necessary to limit radiation by technogenic and nat-
diotoxicity of radiation elements. Radiotoxicity — ural sources. The radiation of population by man-
the feature of radioactive isotopes to cause the path- made sources is limited by control of the techno-
ologic changes after ingestion or inhalation. Radio- logical processes.
toxicity depends on: (1) kind of radioactive decay; Natural radiation background is formed by the
the most dangerous is α-active substances (an equiv- natural sources of ionizing radiation: External
alent dose is 20 times as much than for β-action sub- sources of extraterrestrial origin (cosmic rays);
stances); (2) the average energy of a decay; the ab- External sources of terrestrial origin (radionu-
sorbed dose is directly proportional to the energy clides of minerals, waters, air); Internal air
of radiation. (3) the scheme of radioactive decay; sources (incorporated radionuclides). There are
(4) way of income to the organism. primary and secondary cosmic rays. Primary cos-
There are 3 ways of radionuclides income to the mic rays consist of protons (92%), α-particles
human’s organism: inhalation, ingestion, percutan- (7%) and nuclei of other elements. Secondary
ic introduction. The first is the most dangerous be- cosmic rays consist of mesons (80%) and β-par-
cause the volume of inspirited air is about 7.3 · 106/ ticles (Fig. 41).
years and coefficients of assimilation are higher. The Natural radioactivity with terrestrial origin de-
ingestion of radionuclides usually less and resorp- pends on the geochemical and geophysical peculi-
tion coefficient is enough low. arities of the territory.
Distribution of radionuclides by the bodies and Natural radioactivity of the air is connected with
systems is following: osteotropic isotopes cumulate emanation and 14C and other substances in nuclear re-
in the bones (Ge, Sr, Ba, Ra, It, Zr, Plutonium cit- action to upper layers of atmosphere (above 9,000 m).
rates), hepatotropic isotopes cumulate in the liver Natural radioactivity of waters depends on their
(Ce, La, Pm, plutonium nitrate, etc.; equally dis- condition. Meteoric water has low activity. Under-
persed (T (31H), 14C, Rn, Cs) and with tendency to ground water cavity caused by salts of 40K, 226Ra,
cumulate in muscles (K, Rb, Cs). 222Rn mainly. The lowest activity has waters of se-
All radionuclides are classified by their radio- dimentary rocks. Waters of open reservoirs has an
toxicity: very high radiotoxicity, high radiotoxicity, activity depending on geochemical hydrogeological
middle radiotoxicity, low radiotoxicity. and climatic conditions.

138
 Works of II class should be provided in isolated
RADIATION SAFETY rooms, III class — in special rooms. The frequency
of ventilation in the second class rooms is 5, and in
There are open and closed sources of ionizing the third class — 3.
radiation. Laboratories of I–II classes have 2 sewage sys-
The main principles of radiation protection: tems: household-fecal and special. If daily volume
“Protection by time” has been used for work with of liquid radioactive waste does not exceed 200 1
low active sources. For protection they use manip- so these are collected in special containers for fu-
ulators and other distension tool, system of automat- ture transfer to centralized special burial place. In-
ic control and operating include multi-media tech- ternal decoration of premises for III class work in-
nology. A principle of protection by shielding is used clude: painting walls with oil paint by 2 m from
in combination with other principles. The best ma- floor, and other surfaces — with glue oil. The floors
terial for protection from X-rays and γ-rays is lead should be covered with linoleum or plastic. Corners
and steal. For protection from radiation they use should be rounded, covering of floor — rised to
water, paraffin, concrete and other materials contain- walls without cracks. Using of soft furniture is for-
ing a lot of hydrogenous atoms. For shields absorb- bidden. Water supply is provided from independent
ing β-radiation they use light material organic glass, inputs. The tops should have mixers and turn on with
plastic, aluminum, but for very power β-sources they pedal or elbow device.
should use additional shields for protection from Individual protective equipment can be for eve-
brake radiation. ryday using or for short-time using. All equipment
Open sources of ionizing radiation are risky for should be suitable for desactivation, be steady to
radioactive contamination of surrounding. The ra- chemical agents.
dionuclides pass to the environment as the gases The important direction of radiation safety is “ra-
(222Rn, 31H, 89Cr, 133Xe, etc). diation aseptic”. It’s a prevention of contamination
The radiation protection for work with open of worker’s overall and skin. Desactivation — is the
sources is presented by principles of protection by complex of preventive measures for decreasing of
quantity, by time, by distance, by shielding. mediation pollution of environmental objects.
Isolation of technological processes; optimization They use physical (mechanical means, dissolv-
of sanitary-technical equipment; using of individu- ing, using of electro-magnetic fields, ultra-sonic,
al protective means; personal hygiene of personal; etc.) and chemical (complexones, detergents, min-
dosimetric control; desactivation. eral acids and oxidants). For control of efficiency
Works of I class are provided only in a separate of desactivation measures and radiation loading on
building with an isolate entrance. All buildings are personal (population) they use dosimetry.
divided into 3 zones: Sanitary dosimetric control is an important ele-
I — “hot” (“dirty”) — for placing equipment of ment of radiation safety. Radiometry is measuring
chambers (boxes), communication and other main of radioactivity in food-stuffs, building materials,
sources of radioactive pollution. industrial raw materials and dosimetry is the sani-
II — periodically served repairing — transport tary control of irradiation of personnel.
rooms. The main tasks of dosimetric service are: con-
III — rooms for personnel: operating rooms, etc. trol of power of γ- and neutron pencils in industrial
premieres; control of radioactive gases and aerosols
in the working zone air; dosimetric control of all
work with radionuclides; individual dosimetric con-
Radon Medical X-rays trol of external radiation; individual control on the
55% 11% contents of radionuclides in the organism or sepa-
Nuclear medicine
4% rate critical body; training of personnel; control of
radionuclide escape into the atmosphere; keeping of
Consumer products special documentation (operative register of the duty
3% team).
Tirrestrial Principles of dosimetry equipment: ionization;
8% scintillation; photochemical (and photographic);
thermoelectrical; biological.
Cosmic Radiation disasters include: the detonation of a
8% nuclear weapon; a nuclear power plant event; the
dispersal of radionuclides by conventional explosive
Internal or the crash of a transport vehicle; losses of radio-
11% active waste.
Any of these events could occur unintentionally
Fig. 41. Natural Radiation Background or as an act of terrorism. Nuclear facilities (e.g. pow-

139
 Table 36. Classification of Radiation Disasters
Level Disaster Criterium Example
0 No influence on the safety
I Insignificant Functional deviation in the operating, no risk
II Middle gravity Disrepair of equipment, deviation in normal
exploiting. Problems with evaluation of radiation
safety measures
III Serious Escape of radioactive substances (no more than Bandellos, Spain. 1989
5-time admissible day load)
Over-irradiation of personnel (>50 mSv)
IV Restricted Contamination of environment without irradiation St-Saurent, France, 1980
of population
V With the environ- Significant emission Tri-Mail-Land, USA. 1979
mental risk
VI Grave Windscale, UK, 1957
VII Global Chernobyl, USSR, 1986

er plants, fuel processing centers, and food irradia- From 26.04 to 02.05.1986 the power of escape
tion facilities) are often located in highly populated was decreased. The height of jet was 1,200 m on
areas, and with time the risk of mechanical failure 27.04 maximum of radionuclide concentration — at
increases. 600 m. fluent elements (I, Cs) were detechable at
Modern classification of radiation disasters (Ta- high altitude (6–9 km). Refrectory elements (Ce, Cr,
ble 36): Ne) was found only at territory of USSR, as a re-
I — without radiation loading to personnel (pop- sult of local sedimentation. Contamination of the air
ulation) or contamination; was registered in Sweden, Finland, Poland, DDR (on
II — personnel (population) took external irra- 27.04.1986), in France, Belgie and Netherlands (on
diation higher than LD; 1.05.1986), in the Northern Balcanes (on 2.05.1986),
III — contamination of environmental; in the southern Greece (on 3.05.1986), in Israel,
IV — external and internal irradiation of the per- Kuwait, Turkey.
sonnel (population); All Nothern hemisphere was contaminated with
V — contamination of environmental and exter- radionuclides. High radioactivity of air was record-
nal and internal irradiation of the personnel (popu- ed in Japan (on 2.05.1986), Chine (4.05.1986), In-
lation). dia (5.05.1986), Canada and USA (5–6.05.1986).
Total collective effective dose for Chernobyl dis-
aster was 600,000 men-Sv, where 53% of this dose
INTERNATIONAL SCALES DISASTERS fall on the Europe, 36% — on the NIS, 8% — Asia,
AT A-POWER STATION 2% — Africa, 0.3% — America.
On the ground of radiation monitoring data they
Chernobyl A-power stadion is placed in the east- evacuate from Kiev, Gomel, Bryansk and Gytomir re-
ern part of Belorussian-Ukraine Polesie, at the riv- gions about 115,000 people. From 26.04.1986 they are
er Pripiat side. Water-cooling reactors with graphit given to population lived nearly power plant the tab-
retandatus are geterogenic chained reactors on hot lets of sodium iodide. After they forbid consumption
neutrons. There used uranium bars enriched with of food-stuffs produced in the contaminated area.
235U as the fuel, the graphite as the reterdator and All preventive measures include: liquidation of
boilong water as the heat conductor. the radionuclide waste; decontamination of territo-
At the moment of explosion content of radionu- ry; conservation of 4th block; decontamination of
clides was their content in the fuel, but it was en- 30-km zone and restoration of household activity in
riched with isotopes of iodine, tellure, cesium and this zone; organization of control system on the ra-
inert gases. diation situation.

140

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