EPA-600/1-78-001
January 1978
Environmental Health Effects Research Series
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RESEARCH REPORTING SERIES
Research reports of the Office of Research and Development, U.S. Environmental
Protection Agency, have been grouped into nine series. These nine broad cate-
gories were established to facilitate further development and application of en-
vironmental technology. Elimination of traditional grouping was consciously
planned to foster technology transfer and a maximum interface in related fields.
The nine series are:
1. Environmental Health Effects Research
2. Environmental Protection Technology
3. Ecological Research
4 Environmental Monitoring
5. Socioeconomic Environmental Studies
6. Scientific and Technical Assessment Reports (STAR)
7 Interagency Energy-Environment Research and Development
8. "Special" Reports
9 Miscellaneous Reports
This report has been assigned to the ENVIRONMENTAL HEALTH EFFECTS RE-
SEARCH series This series describes projects and studies relating to the toler-
ances of man for unhealthful substances or conditions This work is generally
assessed from a medical viewpoint, including physiological or psychological
studies In addition to toxicology and other medical specialities, study areas in-
clude biomedical instrumentation and health research techniques utilizing ani-
mals — but always with intended application to human health measures.
This document is available to the public through the National Technical Informa-
tion Service, Springfield, Virginia 22161.
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EPA-600/1-78-00.
January 1978
BIOLOGICAL EFFECTS OF MANGANESE
by
Marko Saric
Institute for Medical Research
and Occupational Health
Yugoslav Academy of Sciences and Arts
Zagreb, Yugoslavia
Special Foreign Currency Program
Agreement Number 02-513-3
Project Officer
Robert J. M. Horton
Office of the Director
Health Effects Research Laboratory
U.S. Environmental Protection Agency
Research Triangle Park
North Carolina 27711
U.S. ENVIRONMENTAL PROTECTION AGENCY
OFFICE OF RESEARCH AND DEVELOPMENT
HEALTH EFFECTS RESEARCH LABORATORY
RESEARCH TRIANGLE PARK, N.C. 27711
incy
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DISCLAIMER
This report has been reviewed by the Health Effects Research Laboratory,
U.S. Environmental Protection Agency, and approved for publication. Approval
does not signify that the contents necessarily reflect the views and policies
of the U.S. Environmental Protection Agency, nor does mention of trade names
or commercial products consitute endorsement or recommendation for use.
ii
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FOREWORD
The many benefits of our modern, developing, industrial society are
accompanied by certain hazards. Careful assessment of the relative risk
of existing and new man-made environmental hazards is necessary for the
establishment of sound regulatory policy. These regulations serve to
enhance the quality of our environment in order to promote the public
health and welfare and the productive capacity of our Nation's population.
The Health Effects Research Laboratory, Research Triangle Park,
conducts a coordinated environmental health research program in toxicology,
epidemiology, and clinical studies using human volunteer subjects. These
studies address problems in air pollution, non-ionizing radiation,
environmental carcinogenesis and the toxicology of pesticides as well as
other chemical pollutants. The Laboratory develops and revises air quality
criteria documents on pollutants for which national ambient air quality
standards exist or are proposed, provides the data for registration of new
pesticides or proposed suspension of those already in use, conducts research
on hazardous and toxic materials, and is preparing the health basis for
non-ionizing radiation standards. Direct support to the regulatory function
of the Agency is provided in the form of expert testimony and preparation of
affidavits as well as expert advice to the Administrator to assure the
adequacy of health care and surveillance of persons having suffered imminent
and substantial endangerment of their health.
Studies of the health of populations which live in the vicinities
of major air pollution sources are potentially valuable in understanding
the effects of individual pollutants. They offer exposure levels which are
intermediate between those encountered in industry, and those found in
mixed urban ambient air pollution. Forty years ago two studies in Europe
indicated that excess acute respiratory illness could be found in neighbors
of manganese smelters. These studies were done, however, in small mountain
valleys which had extreme pollution. The study here reported is an attempt
to conduct a somewhat similar evaluation of a manganese plant and its
neighbors in a more normal geographic situation.
John H. Knelson, M.D.
Director,
Health Effects Research Laboratory
iii
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ABSTRACT
The biological effects of manganese were studied in a town on the coast of
Dalmatia in which a ferromanganese plant has been operating since before World
War II. The study focused on the question of whether the exposure to manganese
can cause a higher incidence of respiratory diseases and, if it can, at what
exposure levels. The study also considered the effects of manganese on the
central nervous system and on blood pressure as well as a possible catalytic
effect of dust containing manganese on the conversion of sulfur dioxide in
the air.
The results obtained show that the rate of pneumonia is influenced by the
exposure to manganese at the level of occupational exposure in the production
of manganese alloys. The actual exposure followed the fluctuations in the
manufacture of ferromanganese and can be assumed to range approximately from
0.15-20 mg/m (mean values for 8-hour work). There are some indications that
an even much lower exposure level may be associated with the morbidity from
pneumonia in the population living in the manganese-polluted area. This lower-
level effect, however, is still an assumption without enough firm evidence to
establish it as fact.
A higher rate of acute bronchitis was recorded during a 4-year followup
at an ambient exposure to manganese present at the comparatively low level of
1 yg/m . Two separate studies on the relationship between the incidence of
acute respiratory diseases and exposure to manganese in groups of school
children and their families partly proved this connection. The incidence of
acute respiratory illness was higher in the town contaminated by emissions
from the ferroalloy factory than on the island chosen as control. It is
possible, however, that some other factors which were not sufficiently con-
trolled might have influenced the obtained results.
The study also indicates that a higher rate of chronic nonspecific lung
disease can be expected in occupational exposure to manganese at the 1 yg/m
level previously mentioned. A possible synergism between the exposure to
manganese and smoking seems to be involved in such an effect.
The investigation supports the observations of other authors that a
developed neurological effect of manganese is present in a very small number
of subjects, even in conditions of a comparatively high exposure.
At the level of occupational exposure to manganese (in the ferromanganese
plant), a hypotonic effect on systolic blood pressure was also observed. The
mean values of diastolic blood pressure did not follow a relative decrease in
the mean values of systolic blood pressure. The differences found in the
behaviours of systolic and diastolic blood pressures may even indicate an
effect of manganese ions on the myocardium.
iv
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The results concerning the possible effect of flue dust containing manganese
on the conversion of sulfur dioxide in air in natural conditions indicate the
existence of a catalytic action of manganese. The question still remains as
to what extent the obtained results refer to the conversion of sulfur dioxide
at comparatively low concentrations of manganese and sulfur dioxide in the
amMent air.
This report was submitted in fulfillment of Foreign Research Agreement
No. 02-513-6 by the Institute for Medical Research and Occupational Health,
Zagreb, Yugoslavia, under the sponsorship of the U.S. Environmental Protection
Agency. This report covers the study period from July 30, 1971, to July 30,
1976. The work was completed as of July 30, 1976.
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CONTENTS
Foreword
Abstract iv
Figures vii
Tables ! viii
Acknowledgment xiv
1. Introduction 1
2. Conclusions 3
3. Recommendations 4
4. Measurements of Manganese and Sulfur Dioxide 5
5. Work Absenteeism Caused by Pneumonia and Bronchitis 23
6. Epidemiological Survey of Certain Effects of Occupational
Exposure to Manganese 38
7. Acute Respiratory Diseases in a Manganese-Contaminated Town Area.. 62
8. Respiratory Diseases in School Children and Their Families in a
Manganese-Contaminated Town Area 74
9. Possible Catalytic Effect of Manganese in Flue Dust on Sulfur
Dioxide 124
1C. Discussion 144
References 148
Additional Pertinent Publications 151
vi
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FIGURES
Number Page
1 Yearly cycles of monthly mean manganese concentrations in the
ambient air at six measuring sites compared with monthly
production rate of ferroalloys for 1972-1975 19
2 Yearly cycles of monthly mean sulfur dioxide concentrations in
the ambient air at six measuring sites for 1972-1975 20
3 The map of the area under study 21
4 Zoning of the town area according to the measured concentrations
of manganese in the air 22
5 Variations in daily means 139
6 Variations in daily means 140
7 Variations in daily means 141
8 Relationships between sulfates and ammonium concentrations 142
9 Relationship between sulfates and manganese concentrations 143
vii
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TABLES
Number Page
1 Annual Mean and Maximum Concentrations of Manganese in the
Ambient Air (yg/m3) 9
2 Annual Mean and Maximum Concentrations of Sulfur Dioxide in the
Ambient Air (yg/m3) 10
3 Frequency Distribution of Weekly Manganese Concentrations at
Three Sites within 0.75 to 2.75 km from the Ferromanganese
Factory, 1972-1975 11
4 Manganese Concentrations in Indoor Air at the Ferroalloy Plant
(Measurements in April 1972) 12
5 Manganese, Cobalt, Chromium, and Nickel Concentrations in Total
and Respirable Dust in Indoor Air at the Electrode Plant
(Measurements in April 1972) 13
^ Manganese Concentrations in Indoor Air at the Ferroalloy Plant
(Measurements in July 1974) 14
7 Manganese Concentrations in Total and Respirable Dust in Air at
the Electrode Plant (Measurements in July 1974) 15
8 Frequency Distribution of Manganese Concentrations in Urine
(Samples From April-May 1972) 16
9 Arithmetic Means and Standard Deviations of Manganese Concentra-
tions in Urine (Samples from April-May 1972) 17
10 Comparison of Manganese Concentrations in High-Volume (HV) and
Low-Volume (LV) Samples 18
11 Number of Workers in Compared Groups (1971 Data) 26
12 Number of Workers with Pneumonia and Bronchitis During 1959-1971.. 27
13 Number of Absences Due to Pneumonia by Years (1959 to 1971) 28
14 Number of Absences Due to All Forms of Bronchitis by Years
(1959 to 1971) 29
(continued)
viii
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TABLES (continued)
15 Number of Pneumonia Attacks per 111 Worker During 1959-1971 30
16 Number of Acute and Not Specifically Defined Bronchitis per 111
Worker During 1959-1971 31
17 Number of Male Workers from Direct Production in the Compared
Groups (September 1975) 32
18 Number of Workers With Pneumonia and Bronchitis During 1972-1975. 33
19 Number of Absences Due to Pneumonia by Years (1972 to 1975) 34
20 Number of Absences Due to All Forms of Bronchitis by Years
(1972 to 1975) 35
21 Number of Pneumonia Attacks per 111 Worker During 1972-1975 36
22 Number of Acute and Not Specifically Defined Bronchitis per 111
Worker During 1972-1975 37
23 General Characteristics of Compared Workers 44
24 Distribution of Compared Workers According to Smoking Habits 45
25 Prevalence of Phlegm (Part-Day) in Compared Groups of Workers
Categorized by Smoking Habits 46
26 Prevalence of Regular Chest Wheezing in Compared Groups of
Workers Categorized by Smoking Habits 47
27 Prevalence of Chronic Bronchitis in Compared Groups of Workers
Categorized by Smoking Habits 48
28 Forced Expiratory Volumes in Compared Groups of Workers 49
29 Forced Expiratory Volumes in Manganese Alloy Workers Categorized
by Length of Exposure and Smoking Habits 50
30 Prevalence of Chronic Bronchitis in Combination with Certain
Objective Findings in Compared Groups of Workers Categorized
by Smoking Habits 51
31 Disability Retirement Rate for 1968-1972 in the Town Area,
Ferroalloy and Electrode, and Light Metal Factories 52
32 Prevalence of Subjective Symptoms in Compared Groups of Workers.. 53
(continued)
ix
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TABLES (continued)
33 Prevalence of Certain Subjective Symptoms in Workers from
Ferroalloy Plant Categorized by Smoking Habits 54
34 Prevalence of Certain Subjective Symptoms in Workers from
Electrode Plant Categorized by Smoking Habits 55
35 Prevalence of Certain Subjective Symptoms in Workers from
Aluminum Rolling Mill Categorized by Smoking Habits 56
36 Prevalence of Neurological Signs in Compared Groups of Workers... 57
37 Ferroalloy Workers with Neurological Signs by Level of Exposure
to Manganese 58
38 Mean Values of Systolic Blood Pressure in Workers by Age Groups.. 59
39 Mean Values of Diastolic Blood Pressure in Workers by Age Groups. 60
40 Mean Values of Systolic and Diastolic Blood Pressure in Workers
not Including Hypertonics 61
41 Structure of the Population of the Town by Zones According to
Manganese Concentrations in Air 65
42 Incidence of Acute Respiratory Diseases in 1972 66
4 3 Incidence of Acute Respiratory Diseases in 1973 67
44 Incidence of Acute Respiratory Diseases in 1974 68
45 Incidence of Acute Respiratory Diseases in 1975 69
46 Accumulated Incidence of Acute Respiratory Diseases During
1972-1975 70
47 Accumulated Incidence of Acute Respiratory Diseases During
1972-1975 - Males 71
48 Accumulated Incidence of Acute Respiratory Diseases During
1972-1975 - Females 72
49 Accumulated Incidence of Acute Respiratory Diseases During
1972-1975 by Age 73
50 Age and Height Comparisons of Boys (1972-1973) 81
51 Age and Height Comparisons of Girls (1972-1973) 82
(continued)
x
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TABLES (continued)
52 FEVo.ys in Compared Groups of Boys (1972-1973) 83
53 FEVo.75 in Compared Groups of Girls (1972-1973) 84
54 FEVi.o Percent in Compared Groups of Boys (1972-1973) 85
55 FEVliQ Percent in Compared Groups of Girls (1972-1973) 86
56 Age and Height Comparisons of Boys (1974-1975) 87
57 Age and Height Comparisons of Girls (1974-1975) 88
58 FEVo.75 in Compared Groups of Boys (1974-1975) 89
59 FEVo.75 in Compared Groups of Girls (1974-1975) 90
60 FEVi.o Percent in Compared Groups of Boys (1974-1975) 91
61 FEVi.o Percent in Compared Groups of Girls (1974-1975) 92
62 Structure of Compared Families by School Location of 2nd Graders
(1972-1973) 93
63 Structure of Compared Families by Zones of Living (1972-1973) 94
64 Families with Children Below 10 Years by Location of Schools
(1972-1973) 95
65 Socioeconomic Data on Families by School Location of 2nd Graders
(1972-1973) 96
66 Members of Family Per One Room by School Location of 2nd Graders
(1972-1973) 97
67 Parents' Smoking Habits by School Location of 2nd Graders
(1972-1973) 98
68 Number of 111 Persons in Families by School Location of 2nd
Graders (1972-1973) 99
69 Distribution of 111 by Disease Rate by School Location of 2nd
Graders (1972-1973) 100
70 Acute Respiratory Diseases in Families by Categories; by School
Location of 2nd Graders (1972-1973) 101
102
103
(continued)
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TABLES (continued)
71 Acute Respiratory Disease, Bedridden, with Elevated Temperature -
Physician Consulted; by School Location of 2nd Graders
(1972-1973) 104
72 Structure of Compared Families by School Location of 2nd
Graders (1974-1975) 105
73 Structure of Compared Families by Zones of Residence (1974-1975). 106
74 Number of Families with Children Under Age 10 by School Location
of 2nd Graders (1974-1975) 107
75 Socioeconomic Data of Families by School Location of 2nd Graders
(1974-1975) 108
76 Members of the Family per One Room by School Location of 2nd
Graders (1974-1975) 109
77 Smoking Habits of Parents by School Location of 2nd Graders
(1974-1975) 110
78 Number of 111 in Families by School Location of 2nd Graders
(1974-1975) Ill
79 Distribution of 111 by Disease Rate and School Location of 2nd
Graders (1974-1975) 112
80 Categories of Acute Respiratory Diseases in Families by School
Location of 2nd Graders (1974-1975) 113
81 Acute Respiratory Disease, Bedridden, Elevated Temperature -
Physician Consulted; by School Location of 2nd Graders
(1974-1975) 116
117
82 Number of Fathers in Compared Groups by Home Location 118
83 Number of Mothers in Compared Groups by Home Location 119
84 Respiratory Symptoms and Forced Expiratory Volumes in Men
Smokers by Zones According to Manganese Concentrations in Air.. 120
85 Respiratory Symptoms and Forced Expiratory Volumes in Men Non-
smokers by Zones According to Manganese Concentrations in Air.. 121
86 Respiratory Symptoms and Forced Expiratory Volumes in Women
Smokers by Zones According to Manganese Concentrations in Air.. 122
87 Respiratory Symptoms and Forced Expiratory Volumes in Women Non-
smokers by Zones According to Manganese Concentrations in Air.. 123
(continued)
xii
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TABLES (continued)
88 Arithmetic Means and Standard Deviations of All Parameters
at Two Sites [[[ 128
8r Significance of Difference Between the Means of Data Shown
in Table 88 ............................... . .................... 129
90 Correlation Between SCK , SOit /SOa Ratio and SOj and Other
Parameters [[[ 130
91 Mass Median Diameters and Geometric Standard Deviation of
Particulate Pollutants ......................................... 131
92 Arithmetic Means, Standard Deviations, and Range for All
Measured Parameters ............ . ............................... 132
93 Correlation Between SOz, Relative Humidity, and Particulate
Components [[[ 133
94 Arithmetic Means and Standard Deviations of SOa and Suspended
Particulate Components Near a Ferromanganese Factory ..... . ..... 134
95 Correlation Differences Between SOa and Particulate Components
Near a Ferromanganese Factory .................... . . ............ 135
96 Average Concentrations (X) and Range of Suspended Particulate
Components at Three Sites (N=35 Days) .......................... 136
97 Correlation Between SOi, and Particulate Components at Three
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ACKNOWLEDGMENT
The work presented in this report was performed by the following staff
of the Institute for Medical Research and Occupational Health, Zagreb:
Scientists: ^0. Hrustic, M.D., M.Sc.; S. Lucic-Palaic, M.D., M.Sc.;
A. Markicevic, M.D., specialist in occupational medicine; M. Gomzi,
M.D., M.Sc.; V. Macek, M.D., M.Sc.; M. Fugas, chemist, M.Sc.;
M. Gentilizza, chemist, Ph.D.; R. Paukovic, chemist, M.Sc.; B. Wilder,
physicist, M.Sc.; A. Sisovic, chemist.
Statistician: A. Holetic.
Technicians: K. Pondeljak, V. Dugac, J. Kukulj, J. Hrsak.
Consultant: E. Ofner, M.D. chest physician, from the Medical Center,
Sibenik.
Assistance in sample analysis: I. Sterkele, pharmacist, from the
Medical Center, Sibenik.
During the study we have also received valuable assistance from Dr. R.
Hcrion of the U.S. EPA.
xiv
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SECTION 1
INTRODUCTION
The results presented in this report have been obtained over a period
of 5 years. The study focused on investigations of whether the exposure to
manganese can cause a higher incidence of respiratory diseases and, if it
does, at what exposure levels. The effect of manganese on the central
nervous system has also been considered. A further aim of the study has
been to determine how far the effect of manganese on respiratory organs
may be enhanced by simultaneous action of sulfuric acid which may be formed
by catalytic oxidation of sulfur dioxide on the surface of manganese par-
ticles, and to determine if this action occurs in flue gases and in the
free atmosphere under natural conditions.
The study was carried out in a town on the coast of Dalmatia where there
has been a ferroalloy Cferromanganese) plant since before World War II. The
plant employs about 1,400 workers of whom about 450 are occupationally exposed
to managanese. In addition to the production of manganese alloys, the plant
produces electrodes. The plant is situated in the close vicinity of a resi-
dential area of the town so that a part of the inhabitants are directly
exposed to the emissions of the plant. According to the last census (in 1971)
the town has a population of about 31,000. The stack effluents are occa-
sionally dispersed to distant town regions depending upon the wind direction.
The investigations have included:
1. Measurements of manganese and sulfur dioxide concentrations in
air in the polluted area and measurements of manganese in the
working environment and in the urine of exposed workers.
2. A retrospective analysis of absences from work caused by
pneumonia and bronchitis in the ferroalloy factory.
3. An epidemiological survey of the prevalence of chronic non-
specific lung disease and neurological disturbances and of
arterial blood pressure values in workers occupationally
exposed to manganese.
4. A followup of the incidence of acute respiratory diseases in
the inhabitants of the town area contaminated by manganese.
5. A study of the rate of acute respiratory diseases in groups
of school children and members of their families in the
manganese-contaminated area.
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6. A study of the possible catalytic effect of manganese-containing
flue dust on the conversion of sulphur dioxide in air.
The report of the results obtained is divided into sections (4-9), and
each section is written as a self-contained entity. Section 10 contains a
discussion which summarizes the results. Following the discussion are
references and a list of publications pertinent to the subject of this
report.
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SECTION 2
CONCLUSIONS
A retrospective analysis of the data on absenteeism due to pneumonia in
workers occupationally exposed to manganese in the production of manganese
alloys showed a higher rate of the disease compared with two other groups of
workers with a much lower exposure. In another part of the study performed
during a 4-year period on the population living in the manganese polluted
area, there are indications that an even much lower exposure to manganese may
influence the morbidity from pneumonia, but this relationship remains only
an assumption without enough firm evidence to establish it as fact.
The same 4-year followup study indicated that an ambient exposure to
manganese of the order of magnitude of 1 yg/m3 is associated with a higher
rate of acute bronchitis. Two additional 6-month studies of school children
and their families support these results to some extent. The registered
incidence of acute respiratory diseases was higher in the town contaminated
by emissions from the ferroalloy factory than on an island chosen as control.
A slight increase in forced expiratory volumes in children was also notice-
able as one moved farther from the ferroalloy plant.
In addition to the influence on the rate of pneumonia, occupational
exposure to manganese at an assumed level, ranging approximately from 0.5-
20 mg/m3, seems to produce an effect on the rate of chronic nonspecific
lung disease. Smoking appears to be a synergistic factor which enhances
the action of manganese. At the level of the same occupational exposure
to manganese, a hypotonic effect on systolic blood pressure was also
observed.
Only a certain number of workers with a comparatively high occupational
exposure developed individual neurological signs (mainly tremor at rest)
which might be connected with the action of manganese.
The results of the investigation performed in natural conditions suggest
that flue dust containing manganese possibly has a catalytic effect on the
conversion of sulfur dioxide in the air. The exact extent to which these
findings can be attributed to the sulfur dioxide conversion at relatively
low concentrations of manganese and sulfur dioxide in the ambient air and
the extent to which they reflect the results of the processes within the
plume remain to be determined.
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SECTION 3
RECOMMENDATIONS
The study reveals several specific areas toward which additional work
needs to be directed. Following the indications that low-level inhalation
exposure to manganese may cause some adverse health effects, further studies
are required to clarify the dose-effect and dose-response characteristics
of manganese. Particular emphasis needs to be put on the pulmonary effects
and on the central nervous system effects of low-level and long-term exposure,
and the effects of manganese on blood pressure and heart muscle need to be
better understood. As organo-manganese fuel additives could significantly
increase the exposure of the general population if they come into widespread
use, all potential biological effects of manganese, including those minor
ones, such as the higher rate of cold or bronchitis, should be appropriately
assessed.
In addition to the study of these biological effects of manganese, the
catalytic action of manganese in the ambient air at small concentrations of
manganese and sulfur dioxide, as well as the interactions of manganese with
other pollutants, needs further study.
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SECTION 4
MEASUREMENTS OF MANGANESE AND SULFUR DIOXIDE
MATERIALS AND METHODS
Measurement of Sulfur Dioxide and Manganese in the Ambient Air
Daily samples of sulfur dioxide and weekly samples of manganese were
collected continuously at one site within the factory grounds and at five
sites around the factory: site A, 750 m SE; site B, 2,000 m ESE; site C,
2,750 m SE; site D, 5,500 m SSE; and site E, 25 km WNW (control point).
Manganese was collected on membrane filters (35 mm collecting surface)
and sulfur dioxide in sequence in a 1 volume percent solution of hydrogen
peroxide at an air flow of about 1.3 1/min. The total volume of the air
sample was recorded by a gas meter. The air sample entered the sampling
system through an inverted funnel connected with the sampling train. In
this way large particles were removed from the air stream. Sulfur dioxide
was determined by the acidimetric method and manganese by atomic absorp-
tion spectrophotometry. Measurements were made over a 4-year period, from
1972 to 1975.
Measurement of Manganese Concentration in the Indoor Air of the Ferroalloy
and Electrode Plant
In the ferroalloy plant, samples of the total dust were collected during
one shift at a rate of 1-2 1/min using Casella personal samplers on the same
membrane filters as the outdoor samples. They were dissolved in 20 ml of
diluted nitric acid, evaporated to dryness, and treated with concentrated
hydrocholoric acid to dissolve metallic oxides and precipitate silica which
could interfere with analysis of samples of manganese. After that they were
reevaporated to dryness, wetted again with a few drops of hydrochloric acid,
dissolved with water and partly neturalized with a few drops of ammonium
hydroxide to an approximate pH of 5-6, and analyzed with atomic absorption
spectrophotometry.
In the electrode plant which is within the same factory grounds, three
types of samples were collected: a total dust on glass fiber filters, a
total dust on membrane filters, and respirable dust on membrane filters. The
glass fiber filters were determined gravimetrically, and the membrane filters
were analyzed for the content of manganese in the same manner as were the
samples from the ferroalloy plant.
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Measurements of manganese concentration in the indoor air of the ferro-
alloy and electrode plant were first made in April 1972 and then repeated in
July 1974.
Measurement of Manganese Concentration in Urine
Twenty-four-hour samples of urine were collected from a number of workers
in the ferroalloy plant, in the electrode plant, and in a light metal plant
which is situated about 5 km SSE of the ferroalloy and electrode plants. As
the concentration of manganese in the normal urine is very low (1-8 yg/1) ,
it was necessary to preconcentrate the sample before analysis. The precon-
centration was performed in two steps. In the first step a sodium-diethyl
dithio carbamate was used as a complexing agent, and the compound was
extracted with chloroform at pH 6.5. In the second step a thenoyl-trifluoro-
acetone-manganese complex was extracted with ethylpropionate at pH 8, and
this final extract was analyzed by atomic absorption spectrophotometry.
With the two steps of concentration of manganese, the analysis could be
done in only 100 ml of mineralized urine. The two different types of extrac-
tions were chosen because of the pH of extraction. Namely, at pH 8 the
precipitate was formed in the sample, and it was not possible to get a quan-
titative extraction. On the other hand, chloroform was not a suitable solvent
for analysis by atomic absorption spectrophotometry. Therefore, in the second
step the complex manganese compound was extracted with ethylpropionate.
Samples for the measurement of manganese in urine were collected in April
and May 1972.
RESULTS
Concentration of Sulfur Dioxide and Manganese in the Outdoor Air
Figure 1 shows the yearly cycle of monthly mean airborne manganese con-
centrations at all six sites for the whole period of measurement along with
the monthly production rate. Mean annual and maximum weekly concentrations
for the 4 years of measurement at each site appear in Table 1. Yearly cycles
of monthly mean sulfur dioxide concentrations for the whole period are shown
in Figure 2, and mean annual and maximum daily concentrations in Table 2.
Table 3 shows the frequency distribution, for the whole 4-year period, of the
obtained weekly concentrations of manganese at three measuring sites within
0.75-2.75 km from the ferroalloy factory.
According to the measured concentrations of manganese in the air, the
town area was divided into three zones. Zone I was defined as the part of
the town nearest to the ferroalloy plant, with mean yearly concentrations
of manganese between 0.236-0.390 yg/m3 and a population of 8,680. The
central part of the town, with mean yearly concentrations of manganese
between 0.164-0.243 yg/m3 and with 17,105 inhabitants, was defined as
Zone II. Zone III was the part of the town 3.5-6 km from the ferroalloy
plant, which had mean yearly concentrations of manganese ranging from
0.042-0.099 yg/m3 and 5,296 inhabitants. Figure 3 shows the map of the
whole area under study, and Figure 4 shows the zoning of the town area
polluted by emission from the ferroalloy plant.
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Concentration of Manganese in Indoor Air and in the Urine of Exposed Workers
Mean manganese concentrations and the range of the measured concentra-
tions to which workers were exposed during the working shift at a given
working place are shown in Table 4 for the ferroalloy plant and in Tables 5,
6, and 7 for the electrode plant. The measurements in Tables 4 and 6 were
mar'e in spring 1972, and those for Tables 5 and 7 in summer 1974. The
corresponding concentrations of manganese in urine are summarized in Tables
8 and 9.
DISCUSSION
Outdoor Air Pollution
From the result of the 4-year measurement of manganese in the outdoor
air, it can be seen that people living near ferromanganese plants are exposed
to considerably higher concentrations of manganese than are people in the
control areas. It should be stressed, however, that because of the entrance
characteristics of the sampling system, only particles of approximately
respirable size have been collected and, therefore, these data cannot be
cjmpared with the data obtained with a high-volume (HV) sampler, which col-
lects particles up to 100 ym. Depending on particle size distribution, an
HV sampler may yield results that are equal to or up to several times higher
than the results of a low-volume (LV) sampler. This assumption has been
supported in the results of some later measurements. From April to June
1976, at the three sites mentioned earlier, suspended particulate matter
was collected by high volume samplers of the type described in the PHS
Publication No. 999-AP-12.
Compared to the earlier data, obtained by analysing LV samples in the
same period over 3 consecutive years (1973-1975), the manganese concentra-
tions as measured by the HV sampler were 2 to 6 times higher (Table 10).
However, it is difficult to explain why the ratio of the results between HV
and LV samples was highest at the measuring site most distant from the
factory.
Yearly cycles of manganese concentrations show a tendency toward summer
maximums, partly because of climatic characteristics of the area (more fre-
quent calm periods in summer) and partly because of the fluctuations in the
production rate (Figure 1).
Manganese concentration decreases with the distance. At a distance of
5.5 km the concentration reaches the same level as in a city 60 km away that
is comparable in all other respects except for the manganese source. The
concentration is even lower at the control point 25 km away from the factory,
although we observed occasional fluctuations of manganese in the air similar
to those near the ferroalloy plant.
Sulfur dioxide concentrations were relatively low at all sites, with
irregular fluctuations over the year, but relatively higher concentrations
are more likely to occur in summer. The sulfur dioxide concentrations were
at the same level as in other coastal cities of similar size in this area.
-------
However, intermittent measurements of sulfate content in airborne suspended
particulates have shown that the concentration of sulfate in the air in the
vicinity of the ferroalloy plant is relatively higher than in other compara-
ble coastal cities (see Section 9).
Indoor Manganese Concentrations
The concentrations of manganese measured in the ferroalloy plant in 1974
were, in general, lower than those measured in 1972, with the exception of
the casting works, where the concentrations were at about the same level in
both years. The lower concentrations during the second measuring period
were expected because in 1974, only one out of four furnaces was producing
manganese alloys. In contrast, during the measuring period in 1972, three
out of four furnaces were producing manganese alloys. Even when only one
furnace was producing manganese alloy, the concentration of mangaense at
certain working places exceeded the maximum allowable concentration (MAC)
values of 2 mg/m .
In the electrode plant the concentrations of manganese in the total and
respirable dust, regardless of the amount of the total dust concentration,
were rather low, well under the MAC values.
Manganese in Urine
The mean concentrations of manganese in the urine of occupationally
exposed workers from the manganese alloy plant were only slightly above the
upper range considered normal. (1-8 yg/liter; Cholak and Hubband, 1960.)
On the other hand, they did not differ from the mean concentrations of
manganese in urine found in workers from the electrode plant. Mean manganese
concentrations in the urine of workers from the light metal plant situated
5,500 km from the ferroalloy plant were the lowest (6.7 yg/1). However, the
frequency distribution of manganese concentrations in urine (Table 7) shows
that in some cases even in workers from the light metal plant, manganese
in urine exceeded the values of 21 yg/1.
It is known that manganese in urine has proved rather disappointing as
a means of evaluating exposure to manganese aerosols. Only a small amount
of manganese intake is excreted by urine. Persons exposed to high concen-
trations of manganese do not necessarily show high urinary concentrations of
manganese. However, a rough correlation between urine levels and average air
concentrations of manganese may exist (Tanaka and Lieben, 1969). On the
other hand, manganese can be absorbed not only by inhalation, but also by
ingestion. So the elimination of manganese in urine reflects both means of
manganese absorption. It is possible that some of the workers in the rather
distant light metal plant inhale a little more manganese at their homes or
absorb it from some sources by ingestion.
-------
TABLE 1. ANNUAL MEAN AND MAXIMUM CONCENTRATIONS OF MANGANESE IN THE
AMBIENT AIR (pg/m3)
Position of
sd te in re-
lation to
ferroalloy
factory
1972 1973 1974 1975
c" c c" c of c c~c
m m m m
Close to 2>84? lg>474 2.321 9.709 1.861 6.857
the factory
750 m SE 0.272 1.104 0.236 1.031 0.384 1.241 0.390 1.138
2000 m ESE 0.206 0.696 0.186 0.675 0.222 1.323 0.188 0.794
2750 m SE 0.202 0.604 0.164 0.722 0.243 1.082 0.231 1.151
5500 m SSE 0.082 0.272 0.052 0.161 0.042 0.206 0.099 0.275
25 km WNW 0.029 0.083 0.041 0.141 0.024 0.084
-------
TABLE 2. ANNUAL MEAN AND MAXIMUM CONCENTRATIONS OF SULFUR DIOXIDE IN THE
AMBIENT AIR (yg/m3)
Position of
site in re-
1 4- ' 4-
ferroalloy
factory
Close to the
factory
750 M SE
2000 m ESE
2750 m SE
5500 m SSE
25 km WNW
1972 1973
c" c c~
m
25
18 73 16
19 63 27
25 119 23
13 47 17
7
C
m
86
72
65
75
64
41
1974
C~
23
15
27
22
20
14
C
m
122
59
108
70
82
65
1975
c"
18
11
19
17
19
11
C
m
57
52
54
84
145
51
10
-------
TABLE 3. FREQUENCY DISTRIBUTION OF WEEKLY MANAGEMENT CONCENTRATIONS AT THREE SITES WITHIN 0.75 TO
2.75 km FROM THE FERROMANGANESE FACTORY, 1972-1975
Site
Concentration
Range
0.0-0.1
0.1-0.2
0.2-0.3
0.3-0.4
0.4-0.5
0.5-0.6
0.6-0.7
0.7-0.8
0.8-0.9
0.9-1.0
1.0-1.1
1.1-1.2
1.2-1.3
1.3-1.4
1972
16
10
8
5
4
3
3
1
1
-
-
1
0.75
1973
14
9
5
5
6
1
3
1
km SE
1974
2
12
15
8
3
4
1
1
3
1
-
-
2
1975
7
10
7
10
5
3
1
2
2
-
3
1
1972-
1975 ^
39 20
41 12
35 9
28 6
18 1
11 3
8 2
5
6
1
3
2
2
2.0 km ESE
1973 1974 1975
21 17 15
13 16 16
684
346
321
1-1
31-
2
-
1
-
1
-
1
1972-
1975
73 22
57 11
27 6
19 1
7 8
5 3
6 1
2
-
1
-
1
-
1
2.75 km SE
1973 1974
21 14
12 20
8 8
7 1
1 3
1
1
1 1
1
1
1
1975
18
10
8
11
-
2
1
-
-
-
-
1
1972-
1975
75
53
30
20
12
6
3
2
1
1
1
1
-------
TABLE 4. MANGANESE CONCENTRATIONS IN INDOOR AIR AT THE FERROALLOY PLANT
(MEASUREMENTS IN APRIL 1972)
Measuring site
Stoker
Charging machine driver
Preparation of molds
Casting
Electric car driver
Craneman
Elevator operator
Electric furnace controller
Silo operator
Cleaner
Furnace foreman
Sinter transport
Raw material mixer
Belt-conveyer
Silo stoker
Sinter mixer
Cyclone
Sintering pan operator
N*
20
18
17
8
13
11
5
6
2
2
2
1
1
1
1
1
1
5
Mn concentration in mg/m3
Mean
4.933
0.856
0.600
0.442
3.991
0.301
16.347
2.025
1.056
1.897
0.391
0.421
20.442
9.480
0.469
11.062
2.386
3.004
Minimum
0.151
0.080
0.122
0.069
0.267
0.104
0.336
0.103
0.356
0.539
0.144
0.421
5.076
6.660
0.469
5.647
1.537
1.710
Maximum
47.767
5.612
4.165
1.959
30.030
0.584
216.320
16.417
1.569
4.368
0.722
0.421
41.250
12.183
0.469
17.409
3.223
5.774
*N - number of samples per work place; at the time of measurements three
out of four furnaces producing manganese alloys were in operation.
Underlined results represent values exceeding maximum allowable concen-
trations (2 mg/m3).
12
-------
TABLE 5. MANGANESE, COBALT, CHROMIUM, AND NICKEL CONCENTRATIONS IN TOTAL AND RESPIRABLE DUST IN INDOOR AIR AT
THE ELECTRODE PLANT (MEASUREMENTS IN APRIL 1972)
Measuring
Total dust
in
Mn
Total dust
in mg/m3
Co Cr Ni
Respirable dust
in mg/m3
Mn Co Cr Ni Mn
%*
Co Cr
Ni
Ma co
„, 62.830 0.302 0.001 0 0 0.005 000 1.66 000
preparation
E1gra£hltizing 2°>415 °-002 0 0 0 0.002 0 0 0 100.00 0 0 9
^burning 42.960 0.125 0.002 0.028 0.003 0.004 0.001 0.001 0.001 3.20 50.00 3.57 33.33
h->
Mechanical
electrode 190.321 0.016 0.001 0.004 0.002 0.003 0 0.001 0 18.75 0 25.00 0
processing
Pressing 46.925 0.025 0 0.029 0.001
Ball mills 93.385 0.042 0.001 0.044 0.001 0.004 0.001 0.008 0 9.52 100.00 18.18 0
Furnace 34.622 0.033 0.002 0.061 0.002 0.002 0.001 0.004 0.001 6.06 50.00 6.56 50.00
*% Mn, Co, Cr, and Ni in respirable dust in relation to Mn, Co, Cr, and Ni in total dust.
-------
TABLE 6. MANGANESE CONCENTRATIONS IN INDOOR AIR AT THE FERROALLOY PLANT
(MEASUREMENTS IN JULY 1974)*
Measuring site
Stoker
Charging machine
driver
Preparation of
molds
Casting
Electric car driver
Craneman
Elevator operator
Electric furnace
controller
Conveyer and mixer
operator
Sintering pan
operator
Crusher Si-Mn
(waste and slag)
Preparation of raw
material
Furnace II
electrode cleaning
Cleaner
Concentration mg/m3
Nf
6
11
12
18
7
1
2
1
11
4
4
6
1
2
Mean
0.634
0.280
0.404
0.373
0.708
0.147
1.099
0.707
1.251
1.753
1.737
0.205
3.504§
6.069
Minimum
0.143
0.079
0.067
0.091
0.163
0.147
1.081
0.707
0.216
0.191
0.535
0.140
3.504§
0.407
Maximum
1.010
1.645
1.536
1.521
2.188^
0.147
1.117
0.707
2.994
4.377
1.025
0.310
3.504§
11.732
*At the time of measurements only one out of four furances producing
manganese alloys was in operation.
N - number of samples per work place.
Results exceeding MAC values (2 mg/m ) are underlined.
Stationary sample (workers did not wear pumps because of difficulties
in cleaning).
14
-------
TABLE 7. MANGANESE CONCENTRATIONS IN TOTAL AND RESPIRABLE DUST IN AIR AT
THE ELECTRODE PLANT (MEASUREMENTS IN JULY 1974)
Concentration mg/m3
Measuring site
Chamber furnace
Electrode graphitizing
Mass preparation
Mechanical electrode
processing
Electrode burning
Ball mills
Total
dust
3.9
14.6
36.0
52.1
30.5
463.0
Manganese in
total dust
0.010
0.008
0.005
0.014
0.043
0.009
Manganese in
respirable
dust
0.002
0.003
0.004
0.003
0.007
0.007
%*
20.0
37.5
80.0
21.4
16.3
77.8
- manganese in respirable dust vs manganese in total dust.
15
-------
TABLE 8. FREQUENCY DISTRIBUTION OF MANGANESE CONCENTRATIONS IN URINE
(SAMPLES FROM APRIL-MAY 1972)
N*
Production of
manganese 37
alloys
Electrode ..-
production
Light
metal 24
plant
Concentration of manganese in urine yg/1
0-5 6-10 11-15 16-20 21-25 26-
7 17 7 2 22
324 1 1
13 7 - - 31
*N - number of workers (samples).
16
-------
TABLE 9. ARITHMETIC MEANS AND STANDARD DEVIATIONS OF MANGANESE
CONCENTRATIONS IN URINE (SAMPLES FROM APRIL-MAY 1972)
N*
Concentration of manganese in urine
yg/i
x
SD
a) Production of
manganese
alloys
b) Electrode
production
c) Light
metal
plant
37
11
24
11.5
12.4
6.7
10.2
8.0
6.7
*N - number of workers (samples).
a-c P<0.05
b-c P<0.05
17
-------
TABLE 10. COMPARISON OF MANGANESE CONCENTRATIONS IN HIGH-VOLUME (HV)
AND LOW-VOLUME (LV) SAMPLES
00
Average manganese concentrations yg/m
Period
April-
June
1973
1974
1975
1976
Type of
sampler
LV
LV
LV
HV
Position of site
Close to
the factory
3
3
3
7
.30
.81
.42
.80
in relation to the
750 m SE
0
0
0
1
.38
.26
.47
.20
3
ferroalloy
2750 m
0
0
0
1
.24
.16
.11
.00
plant
SE
-------
0.5 4
o.s:
0.5
WNW 25 km
SCALE 1:1
SSE 5500 m
SE 2750 m
SCALE 1:2
ESE 2000 m
CLOSE TO THE FACTORY
FLUCTUATIONS IN PRODUCTION RATE (Thousands of metric tons)
1972
1973
1974
1975
1976 YEARS
Figure 1. Yearly cycles of monthly "lean manganese concentrations in the
ambient air at six measuring sites cc>—ipared with monthly production rate
of ferroalloys for 1972 -1975.
-------
CL.OSE TO THE FACTORY
1972
1974
1975
MONTHS
Figure 2. Dearly cycles of monthly mean sulphur dioxide concentrations in
the ambier - air at six measuring sites for 1972- 1975.
20
-------
TOWN WITH THE
FERROMANGANESE
FACTORY
SCALE 1:120,000
CONTROL AREA (ISLAND)
Figure 3. The map of the area under study.
-------
SV. MARA
Figure 4. Zoning of the town area according to the measured concentrations of man-
ganese in the air.
22
-------
SECTION 5
WORK ABSENTEEISM CAUSED BY PNEUMONIA AND BRONCHITIS
MATERIAL AND METHODS
The data were taken from the workers' medical files in the factory
producing manganese alloys and electrodes, first for the 1959-1971 period
and then for the 1972-1975 period. Workers from an aluminum processing
factory which is situated about 5 km away served as controls. Both fac-
tories have a health unit with a physician who monitors the health of the
employees.
In the factory of manganese alloys and electrodes, the workers were
divided into two groups: (a) those employed in the production of manganese
alloys and (b) those employed in the production of electrodes, in workshops,
or in other places without a direct occupational exposure to manganese. In
both factories only male workers and only those who were employed in the
factories during the whole period of analysis were subject to observation.
For the first study (1959-1971) sinter workers as well as the workers
from maintenance workshops and all other services were grouped under the
heading "Production of electrodes and other." For the second study (1972-
1975) sinter workers were excluded from the group "Production of electrodes
and other" and included in the group labeled "Production of manganese
alloys." From the group "Production of electrodes and other" were also
excluded those from other services. So, for the second study this particu-
lar group consisted of workers from the production of electrodes and from
the maintenance workshops.
At the beginning of 1974 a new plant for the electrolytic extraction
of aluminum began operation with 303 workers in the light metal factory.
The cumulative incidence of analyzed diseases was calculated for the
first study by the number of workers in September 1971, and for the second
study, by the number of workers in September 1975.
RESULTS OF THE STUDY FOR THE 1959-1971 PERIOD
The number of male workers in direct production in the compared groups
is shown in Table 11. The cumulative number of workers with diagnosed
pneumonia and bronchitis for the period 1959-1971 is presented in Table 12.
Tables 13 and 14 show the number of absences due to pneumonia and bronchitis
for the same period by years. Tables 15 and 16 show the number of cases of
pneumonia and of acute and not specifically defined bronchitis, respectively,
per ill worker during the 1959-1971 period.
23
-------
RESULTS OF THE STUDY FOR THE 1972-1975 PERIOD
The number of workers In the compared groups for this study is shown
in Table 17. The results of the retrospective analysis of work absenteeism
due to pneumonia and bronchitis for the period 1972-1975 are shown in
Tables 18-22.
DISCUSSION
From the presented data it appears that the rate of pneumonia and
bronchitis in the first study (1959-1971) was highest in workers directly
employed in the production of manganese alloys. The other two compared
groups differed little in this respect, except in the case of bronchitis—
acute and not specifically defined—which had a higher rate in workers
from the production of electrodes than in workers from the light metal
plant.
The second study (1972-1975) is not completely comparable with the first
one because of the previously-described differences in the composition of
the compared groups. However, the rate of pneumonia again showed a tendency
to be highest in the production of manganese alloys. But the differences
were not statistically significant. The number of those with bronchitis—
acute and not specifically defined—remained slightly higher among manganese
alloy workers compared with those engaged in the production of electrodes
(Table 18). The accumulated incidence of bronchitis became highest in
workers from the light metal plant. Table 20 shows that the rate of absen-
teeism due to this disease began to increase in that factory in 1974 and
was particularly pronounced in 1975. This increase coincides with the
opening of a new production, electrolytic extraction of aluminum, within
the light metal plant at the beginning of 1974.
The process of electrolytic extraction of aluminum involves the
exposure to fluorine and sulfur dioxide. The anlaysis of data collected
in the light metal plant showed that a considerable number of sick leaves
due to bronchitis, particularly acute bronchitis, relates to workers
employed in the electrolytic extraction of aluminum. In 1975, 43 out of
97 sick leaves due to acute and not specifically defined bronchitis were
taken by workers in the electrolytic extraction of aluminum. So it seems
that the new production directly influenced the rate of bronchitis in
workers from the light metal plant, particularly in 1975.
From the results of the retrospective analysis, it is assumed that
the differences in the incidence of absenteeism caused by respiratory
diseases are not due to the differences in socio-econommic conditions.
Although medical documentation on which the retrospective analysis was based
did not contain information about smoking habits, from the data collected
in the course of subsequent epidemiological study presented in Table 27,
Section 6, it is assumed that there were no significant differences between
the compared groups with regard to smoking habits.
Medical records from which data about sick leave caused by respiratory
diseases were taken were kept in the same manner in both compared plants. In
24
-------
each plant an industrial physician was in complete charge of workers' health,
including the provision of necessary treatment. All diseases, particularly
those which caused absences from work were, therefore, recorded in the
worker's file, even in the case of workers who became ill at home and were
granted sick leave by general practitioners. Naturally, the question as to
what extent the criteria of industrial physicians in granting sick leaves
were uniform remains open. This question is pertinent mainly to the
cases of bronchitis.
As mentioned earlier, the analysis was based on cumulative data about
absences from work due to respiratory diseases for only those workers who
were continuously employed during the entire observation period. Because
a number of workers left the plant during the observation period, a question
arises, as to whether a selection took place which might have influenced
the rate of analyzed diseases. To check this, we analyzed for 1972-1975,
the rate of absences because of the same diseases in workers who had left
the plants. The pattern of absences in these workers was lower than that
in workers from the study. For pneumonia the cumulative rate was 0.8 in
the ferroalloy plant, 1.1 in the electrode plant, and 0.7 in the light metal
plant. For bronchitis the cumulative rate was 8.9 in the ferroalloy, 9.4
in the electrode, and 16.3 in the light metal plant.
The lower cumulative rates of absences due to pneumonia and bronchitis
in workers who left the plant than in those continuously employed is obviously
the result of the fact that the observation period for workers who left the
plant was shorter: 1.4 years in the ferroalloy plant, 2 years in the elec-
trode plant, and 1.5 years in the light metal plant. It appears accordingly
that the rates of absences due to analyzed diseases in workers who left the
plant were similar to the rates recorded in workers who were included in the
study. The higher rate of absences due to bronchitis in workers who left
the light metal plant relates mainly to those who were employed in the elec-
trolytic extraction of aluminum. Some of these left the plant because of
the workers' increased susceptibility to exposure at their working places.
25
-------
TABLE 11. NUMBER OF WORKERS IN COMPARED GROUPS (1971 DATA)
Years
of
work
<5 years
6-10 years
11-15 years
16-20 years
>20 years
Total
Production of
manganese
alloys
87
52
74
55
61
329
Production of
electrodes
and other*
243
148
187
202
132
912
Light
metal
plant
283
229
389
287
3
1191
*100 sinter workers are included as well as those working in maintenance
workshops and other services.
26
-------
TABLE 12. NUMBER OF WORKERS WITH PNEUMONIA AND BRONCHITIS DURING 1959-1971
(S3
No. of ill workers
Disease 1. Production of 2. Production of
manganese electrodes
alloys and other
Pneumonia 60 (18.2)* 97 (10.6)
Bronchitis —
acute and not 117 (35.6) 271 (29.7)
specifically
defined
Bronchitis-- 79 (24.0) 145 (15.9)
chronic
3. Light Significance
metal of
plant difference
119 (10.0) 1-2
1-3
291 (24.4) 1-3
2-3
213 (17.9) 1-2
1-3
P<0.01
P<0.01
P<0.01
P<0.01
P<0.01
P<0.05
*The numbers in parentheses are percentages of the total number of workers in each group.
-------
TABLE 13. NUMBER OF ABSENCES DUE TO PNEUMONIA BY YEARS (1959 to 1971)
Year
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
Total
No. of
1. Production of
manganese
alloys
4
6
2
6
3
6
12
5
9
7
4
9
8
81 (24. 6)1"
absences due to pneumonia*
2. Production of
electrodes
and other
8
5
10
10
13
11
16
10
9
15
7
13
8
135 (14.8)
3. Light
metal
plant
19
15
8
2
11
5
13
17
9
9
12
10
17
147 (12.3)
*Significance of difference: 1-2 P<0.01; 1-3 P<0.01
t.
Numbers in parentheses denote the accumulated rate of sick leaves due to
pneumonia per 100 workers from 1959 to 1971.
28
-------
TABLE 14. NUMBER OF ABSENCES DUE TO ALL FORMS OF BRONCHITIS BY YEARS
(1959 to 1971)
Year
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
Total
No. of absences
1. Production of
manganese
alloys
5
11
11
20
22
19
33
30
34
69
57
53
57
421 (128. 0)f
due to bronchitis (all
2. Production of
electrodes
and other
25
23
27
39
45
49
59
56
72
112
107
95
103
812 (89.0)
forms)*
3. Light
metal
plant
79
87
64
54
72
64
52
53
59
81
90
94
77
926 (77.7)
*Significance of difference: 1-2 P<0.01; 1-3 P<0.01; 2-3 P<0.01
Numbers in parentheses denote the accumulated rate of sick leaves
bronchitis (all forms) per 100 workers from 1959 to 1971.
29
-------
TABLE 15. NUMBER OF PNEUMONIA ATTACKS PER ILL WORKER DURING 1959-1971
No. of 1.
illnesses per
ill worker
1
2
3 or more
Total No.
of ill persons
Production of
manganese
alloys
46 (76.7)*
9 (15.0)
5 (8.3)
60
2. Production of
electrodes
and other
70 (72.2)
19 (19.6)
8 (8.2)
97
3. Light
metal
plant
98 (82.4)
16 (13.4)
5 (4.2)
119
Significance
of difference
NS
NS
NS
*Numbers in parentheses denote percents of the total number of ill persons with
one or more attacks of pneumonia.
30
-------
TABLE 16. NUMBER OF ACUTE AND NOT SPECIFICALLY DEFINED BRONCHITIS PER ILL
WORKER DURING 1959-1971
No. of 1.
O Inesses per
ill worker
1
2
3 or more
Total No.
of ill persons
Production of
manganese
alloys
58 (49.6)*
29 (24.8)
30 (25.6)
117
2. Production of
electrodes
and other
145 (53.5)
77 (28.4)
49 (18.1)
271
3. Light
metal
plant
150 (51.5)
86 (29.6)
55 (18.9)
291
Significance
of difference
NS
NS
NS
*Numbers in parentheses denote percents of the total number of ill persons with
one or more attacks of bronchitis.
31
-------
TABLE 17. NUMBER OF MALE WORKERS FROM DIRECT PRODUCTION IN THE
COMPARED GROUPS CSEPTEMBER 1975)
Years
of
work
< 5
6-10
11-15
16-20
?20
Total
Production of
manganese
alloys*
95
80
70
88
106
439.
Production of Light
electrode and metal,
maintenance plant
143
83
99
85
165
575 1265
*90 Sinter workers are included
Data about years of work were not included; 303 workers out of 1265 have
been employed since 1974 in the electrolytic extraction of aluminium.
32
-------
TABLE 18. NUMBER OF WORKERS WITH PNEUMONIA AND BRONCHITIS DURING 1972-1975
No. of ill workers
Disease 1. Production of
manganese
alloys
Pneumonia 16 (3.6)*
Bronchitis-
acute not 37 (8.4)
specifically
defined
Bronchitis 42 (9.6)
chronic
2. Production of 3. Light Significance
electrodes metal of
and other plant difference
11 (1.9) 30 (2.4) NS
39 (6.8) 190 (15.0) 3-1 P<0.01
3-2 P<0.01
57 (9.9) 75 (5.9) 1-3 P<0.01
2-3 P<0.01
*The numbers in parentheses are percentages of the total number of workers
in each group.
33
-------
TABLE 19. NUMBER OF ABSENCES DUE TO PNEUMONIA BY YEARS (1972 TO 1975)
Year
1972
1973
1974
1975
Total
No. of
1. Production of
manganese
alloys
3
9
3
2
17 (3.8)*
absences due to pneumonia
2. Production of
electrodes
and others
5
-
4
3
12 (2.1)
3. Light
metal
plant
6
6
10
10
32 (2.5)
*Numbers in parentheses denote the accumulated rate of sick leaves due to
pneumonia per 100 workers from 1972 to 1975.
34
-------
TABLE 20. NUMBER OF ABSENCES DUE TO ALL FORMS OF BRONCHITIS BY YEARS
(1972 TO 1975)
Year
1972
1973
1974
1975
Total
No. of absences
1. Production of
manganese
alloys
30
37
30
32
129 (29.4)*
due to bronchitis (all
2. Production of
electrodes
and others
29
59
45
44
177 (30.8)
forms)
3. Light
metal
plant
52
59
124
193
428 (33.8)
*Numbers in parentheses denote the accumulated rate of sick leaves due to all
forms of bronchitis per 100 workers from 1972 to 1975.
35
-------
TABLE 21. NUMBER OF PNEUMONIA ATTACKS PER ILL WORKER DURING 1972-1975
No. of 1.
Illnesses per
ill worker
1
2
3 or more
Total No.
of ill persons
Production of
manganese
alloys
15 (93.8)*
1 (6.2)
-
16
2. Production of
electrodes
and other
10 (90.9)
1 (9.1)
-
11
3. Light
metal
plant
28 (93.3)
2 (6.7)
-
30
Significance
of
difference
NS
NS
-
*Numbers in parentheses denote percents of the total number of ill persons with
one or more attacks of pneumonia.
36
-------
TABLE 22. NUMBER OF ACUTE AND NOT SPECIFICALLY DEFINED BRONCHITIS PER ILL
WORKER DURING 1972-1975
No. of 1.
illnesses
per ill worker
1
2
3 or more
Total No.
of ill persons
Production of
manganese
alloys
31 (83.8)*
6 (16.2)
-
37
2. Production of
electrodes
and other
34 (87.2)
3 (7.7)
2 (5.1)
39
3. Light
metal
plant
164 (86.3)
19 (10.0)
7 (3.7)
190
Significance
of
difference
NS
NS
NS
*Numbers in parentheses denote percents of the total number of ill persons with
one or more attacks of bronchitis.
37
-------
SECTION 6
EPIDEMIOLOGICAL SURVEY OF CERTAIN EFFECTS OF
OCCUPATIONAL EXPOSURE TO MANGANESE
MATERIALS AND METHODS
The study was carried out in a group of 369 workers employed in the
production of manganese alloys, in a group of 190 workers engaged in elec-
trode production, and in a group of 204 workers from the aluminum rolling
mill (light metal plant). Therefore, the study was conducted in the same
factories as the retrospective study described in the previous section.
The examination was performed with the standard epidemiclogical technique.
The study used the questionnaire on respiratory symptoms of the Committee
on the Etiology of Chronic Bronchitis of the British Medical Research Council
(1965) supplemented with questions relating to symptoms of manganism; forced
expiratory volumes were measured, consistency and volume of the early morning
sputum were determined, clinical and radiographical examinations of the lungs
were performed as well as the conduct of a neurological examination. Arterial
blood pressure measurements were also taken.
The workers were divided into the following smoking habit categories:
1. nonsmokers who never smoked or smoked not more than one cigarette
a day,
2. past smokers who had smoked more than one cigarette a day but had
stopped smoking at least one month prior to examination, and
3. present smokers divided into three groups according to the number of
of cigarettes smoked in their lifetime using the criteria employed
by Brinkman and Coates (1963):
a) light smokers if the product of the average number of cigarettes
smoked per day and the number of years of smoking was less than
200,
b) moderate smokers if the product was between 200 and 600, and
c) heavy smokers if the product was higher than 600.
In connection with the study of chronic nonspecific lung disease in
exposure to manganese, reasons for disability retirement of workers in the
38
-------
manganese alloy and electrode plants were also analyzed for a 5-year period
and compared to those from the light metal plant and to the total working
population of the town area.
RESULTS AND DISCUSSION
Tables 23 and 24 show the general characteristics and smoking habit of
workers in the study.
Chronic Nonspecific Lung Disease in Manganese Exposure
Table 25 shows the prevalence of phlegm part-day in compared groups of
workers categorized by smoking habit. Phlegm part-day is defined as expec-
toration in the morning or during the day on most days for as much as three
winter months each year.
The prevalence of regular wheezing in the chest is given in Table 26.
Table 27 shows the prevalence of chronic bronchitis. A person was con-
sidered to have the disease if phlegm production was present in the morning
and during the day and/or night for at least three winter months than had
been present during the past two years.
Table 28 shows the values of forced expiratory volumes in compared groups
of workers. The obtained values of forced expiratory volumes are expressed
as percentage of the values expected with regard to age and height of subjects
(Morris et al., 1971).
Table 29 shows the values of forced expiratory volumes, expressed in the
same way as in the previous table, for workers in manganese alloy production
categorized by the duration of exposure and smoking habit.
The prevalence of symptoms of chronic bronchitis in combination with
certain objective findings according to smoking habits is shown in Table 30.
The rate of disability retirement over the 5-year period 1968-1972, in
the manganese alloy and electrode plants as well as in the town area is
presented in Table 31.
As shown in the tables, the prevalence of respiratory symptoms was higher
among those engaged in the production of manganese alloys compared with two
other groups of workers. However, the differences were not statistically
significant.
A more detailed analysis of data shows that the compared groups of non-
smoking workers did not significantly differ with regard to the prevalence
of respiratory symptoms. In previous smokers the differences were also
negligible.
Among smokers, the rate of respiratory symptoms was higher in the
manganese alloy production than in the electrode production, while in
the aluminum rolling mill it was usually lowest. The prevalence had a
39
-------
tendency to increase with categories of smokers (light, moderate, heavy). The
tendency of the rate of symptoms to rise with the extent of the smoking habit
was most pronounced in the group of worlcers in the production of manganese
alloys.
As far as a combination of the symptoms of chronic bronchitis and certain
objective findings is concerned, it is also interesting that differences
between compared groups with regard to exposure were again more pronounced in
smokers, the syndromes being more frequent in smokers from the ferroalloy
group than from the other two groups of workers. Because of relatively low
rates, it has not been possible to elaborate the differences in the prevalence
of these syndromes statistically or to analyze them from the point of view of
smoking categories. Since other relevant factors under control in compared
groups of workers were more or less uniform, the results may even indicate a
synergistic action of manganese exposure and smoking habits in the occurrence
and rate of respiratory symptoms.
The analysis of forced expiratory volumes expressed as the mean percentage
of the predicted values did not show any difference between the manganese alloy
workers and two other compared groups. In all three groups of workers, the
values of forced expiratory volumes were within the normal range. Analyzed
by the length of exposure to manganese (in the manganese alloy group) the
forced expiratory volumes appeared to be relatively lower (compared with the
predicted values) in those exposed over 10 years. However, the difference
was statistically significant only for FEVi.o values in nonsmokers.
In the interpretation of these results, a "normal" fall in ventilatory
volumes with time has to be taken into consideration. As the duration of
exposure is usually paralleled by age, an age factor might be also involved
in the observed fall of the forced expiratory volumes. On the other hand,
it is posisble that a certain number of workers who had developed respiratory
impairment had left the factory and obtained a disability pension. As they
were not included in the study, the obtained ventilatory indices may be
partly biased showing better results than if those workers had also been
examined.
The presented analysis of the rate of disability retirement demonstrates
that the rate of retirement due to chronic nonspecific lung disease was
significantly higher in the manganese alloy (and electrode) plant than in the
light metal plant and in the overall working population in the town area.
This finding speaks in favor of the assumption that the exposure to manganese
may be a factor of importance in the development and occurrence of chronic
respiratory impairment.
Neurological Disturbances and Manganese Exposure
The prevalence of recorded subjective symptoms in the compared groups
is shown in Table 32. The groups did not greatly differ in the rate of
symptoms. In the "ferroalloy" group there were significantly more workers
in "bad moods" than in the two other groups. On the other hand, in the
group with the lowest exposure to manganese, those with the symptoms of
sleepiness, irritability, fatigue, tremor, tiredness, and stiffness in legs
40
-------
were also numerous—the prevalence of these symptoms was similar to that of
the "ferroalloy" group. In the "electrode" group the rate of symptoms was
lowest.
Tables 33-35 show the prevalence of some of the symptoms according to
the degree of exposure to manganese and smoking habit. Moderate and heavy
smokers in the "ferroalloy" group had a significantly higher rate of "fatigue"
and "irritability" than light smokers. Symptoms of cramps in arms and legs
were significantly more frequent in moderate and hoavy smokers than in light
smokers and in nonsmokers. In the "electrode" group the symptoms were almost
equally frequent in nonsmokers and in smokers with the exception of "fatigue"
which was more frequent in nonsmokers than in light smokers. In the group from
the aluminum rolling mill, there was no statistical difference in the pre-
valence of symptoms by smoking habits with only one exception: a "bad mood"
was more frequent not only in moderate and heavy smokers than in light smokers,
but also more frequent in nonsmokers than in light smokers.
If moderate and heavy smokers in all the three groups of workers (ferro-
alloy plant, electrode plant, aluminum rolling mill) are compared, it appears
that the rate of fatigue and cramps in arms and legs was significantly higher
in the "ferroalloy" group than in the "electrode" group (P<0.01). "Bad mood"
was more frequent in moderate and heavy smokers from the "ferroalloy" group
than in those from the aluminum rolling mill (P<0.05). Light smokers from
the "ferroalloy" group had a higher rate of "fatigue" than light smokers from
the "electrode" group (P<0.05).
Table 36 shows the prevalence of neurological findings in the compared
groups of workers. Such signs were recorded only in the group of workers
from the productions of manganese alloys and electrodes. They were more
frequent in the "manganese alloy" group. No regularity was observed with
regard to smoking habit.
Table 37 shows the rate of neurological findings in the "manganese alloy"
group in relation to the level of manganese exposure. The rate of neurological
signs seems to be higher in the most exposed group, but the difference was not
statistically significant. On the other hand, in the least exposed group the
number of neurological signs was also rather numerous.
Epidemiclogical and clinical studies showed three phases in the develop-
ment of manganism: a subclinical stage with a general vague symptomatology;
the initial period in which the psychic or neurological symptoms are pre-
dominantly acute psychomotor disturbances, dysarthria, disturbances of the
gait, and sialorrhea; and the fully developed stage which can be associated
with the acute manic or depressive psychosis but is most often linked with
a picture of parkinsonism with neurological disorders (Ansola et al., 1944).
The results of the study do not indicate any advanced forms of disease
in the production of manganese alloys. However, a certain number of neuro-
logical findings which might be connected with manganese effects were
recorded. Sixty-two workers out of 369 or 16.8 percent had some neurological
signs. In most cases the sign was tremor (47 workers). Tremor which usually
appears during rest and increases with movement is frequently observed,
41
-------
particularly in the tongue, arms, and legs (Penalver, 1955). In the group
of workers occupationally exposed to manganese, neurological signs were more
frequent than in those employed in the adjoining electrode plant who were
not occupationally exposed to manganese. The difference concerned the number
of pathological reflexes, which in the electrode group were found only in one
worker, as well as the combination of neurological signs (pathological reflexes
or cogwheel phenomenon and tremor at rest). The finding of the tremor at rest
was also statistically significant more frequently in occupationally exposed
workers.
In one worker from the "manganese alloy" group, a subsequent detailed
clinical examination showed a picture of manganism (initial period with
extrapyramidal symptoms). This worker was exposed to manganese concentrations
estimated to be about 5-16 mg/m3 for over 20 years.
The analysis according to level of exposure of other workers with some
neurological signs did not show a good correlation between the measured mean
manganese concentrations at working places and the rate of the disorders.
This might be due partly to the fact that the concentrations of manganese in
the air to which the workers were exposed were not always the same. Some of
the workers changed their working places from time to time, which again may
have influenced the exposure level. On the other hand, it is known that there
are marked differences in individual susceptibility to manganese. Only a
small percentage of those who are exposed to manganese dusts develop symptoms
and signs of chronic manganese poisoning. This finding may be due to vari-
ations in the excretory capacity of the liver and kidney which may lead to
accumulation of toxic levels of manganese in some and not in others (Rodier,
1955).
Horiguchi and collaborators (1974) reported the presence of disturbances
of the central nervous system in four refinery workers. Fifteen others out
of 79 workers who were exposed to manganese concentrations of 1.9-21.1 mg/m3
were suspected of having some neurological signs. In the group which was
exposed to manganese concentrations of 3.1 to 8.1 mg/m3, 7 workers out of a
total of 55 were suspected of having some neurological findings.
The recorded subjective symptoms are not specific. They were found in
a relatively high percentage of workers, even in the control group which had
a minimal exposure to manganese. However, in the ferroalloy group some of
the recorded subjective symptoms which might be the symptoms of the subclinical
phase of manganism were more frequent in moderate and heavy smokers than in
light smokers or in nonsmokers. Smokers from the ferroalloy production showed
some of the subjective symptoms more often than the smokers from the other two
groups.
Exposure to Manganese and Arterial Blood Pressure
Tables 38 and 39 show the mean values of systolic and diastolic blood
pressure by age in the examined group of workers. The mean values of systolic
and diastolic blood pressure, not including hypertonics, are shown in Table
40. The results show that there is an association between exposure to manga-
nese and lower values of systolic blood pressure. The lowest mean values of
42
-------
systolic blood pressure were found in workers with occupationally exposure to
manganese, although this group was comparatively the oldest. These findings
point to a possibility that the airborne manganese in the working environment
acts by reducing the systolic pressure values. The mean values of diastolic
blood pressure did not follow those of systolic pressure. The lowest mean
diastolic pressure values were found in workers from the light metal plant,
i.e., those with the lowest manganese exposure.
There are very few data available on the effect of manganese on blood
pressure after the first observations of Robert, dated as early as 1883, that
some manganese salts can induce a fall in blood pressure. Schroeder and
collaborators (1955) showed that manganese and chelating agents may inactivate
pherentasine, which is a factor instrumental in hypertension. In humans
intoxicated by or exposed to manganese, no such changes have been reported.
The differences found in our study in the behavior of systolic and dia-
stolic blood pressures in the group occupationally exposed to manganese may
indicate an action of manganese ions on the myocardium. This remains, of
course, just an hypothesis. However, there is a recent experimental study
by Kamiyama and Saeki (1974) on myocardial action potentials in the canine
ventricle and effects of manganese ions which indicates that Mn*~*" decreases
the contractile tension of the muscle.
43
-------
TABLE 23. GENERAL CHARACTERISTICS OF COMPARED WORKERS
Age (years)
1.
2.
3.
Manganese
production
Electrode
production
Aluminum rolling
mill
No.
369
190
204
X
37.8
35.8
36.8
Height (cm)
SD X SD
8.8 173.3 6.6
9.4 172.8 7.1
8.7 173.6 6.3
Weight
X
76.6
75.2
75.2
(kg)
SD
10.4
11.3
10.4
Age: 1-2 P<0.01
-------
TABLE 24. DISTRIBUTION OF COMPARED WORKERS ACCORDING TO SMOKING HABITS
Manganese
alloy production
1.
2.
3.
4.
5.
6.
Nonsmokers
Past smokers
Light smokers
Moderate smokers
Heavy smokers
Smokers, total
No.
169
57
51
73
19
143
%
45.
15.
13.
19.
5.
38.
8
4
8
8
1
8
No.
102
19
35
25
9
69
Electrode
production
%
53
10
18
13
4
36
.7
.0
.4
.2
.7
.3
No
81
29
41
42
11
94
Aluminum
rolling mill
%
39.
14.
20.
20.
5.
46.
7
2
1
6
4
1
-------
TABLE 25. PREVALENCE OF PHLEGM (PART-DAY) IN COMPARED GROUPS OF WORKERS CATEGORIZED BY SMOKING HABITS
Manganese Electrode Aluminum
alloy production production rolling mill
1.
2.
3.
4.
5.
6.
Nonsmokers
Past smokers
Light smokers
Moderate smokers
Heavy smokers
Smokers, total
Total
Significance of
difference
f
10
2
9
11
3
23
35
1-3
1-4
1-6
% f % f %
5.9 11 10.8 6 7.4
3.5 3 15.8 1 3.4
17.6 4 11.4 1 2.4
15.1 6 24.0 7 16.7
15.8 2 22.2 0
16.1 12 17.4 8 8.5
9.5 26 13.7 15 7.4
P<0.05
P<0.05 NS NS
P<0.05
Significance
of
difference
NS
NS
NS
NS
NS
NS
-------
TABLE 26. PREVALENCE OF REGULAR CHEST WHEEZING IN COMPARED GROUPS OF WORKERS CATEGORIZED
BY SMOKING HABITS
Manganese
alloy production
1.
2.
3.
4.
5.
6.
Nonsmokers
Past smokers
Light smokers
Moderate smokers
Heavy smokers
Smokers, total
Total
Significance of
difference
f
9
2
3
15
7
25
36
1-4
1-5
1-6
%
5.3
3.5
5.9
20.5
36.8
17.5
9.8
P<0.01
P<0.01
P<0.01
Electrode Aluminum
-------
TABLE 27. PREVALENCE OF CHRONIC BRONCHITIS IN COMPARED GROUPS OF WORKERS CATEGORIZED BY
SMOKING HABITS
.p-
oo
Manganese
alloy production
1.
2.
3.
4.
5.
6.
Nonsmokers
Past smokers
Light smokers
Moderate smokers
Heavy smokers
Smokers, total
Total
Significance of
difference
f
14
4
6
29
11
46
64
1-4
1-5
1-6
3-4
3-5
4-5
%
8.3
7.0
11.8
39.7
57.9
32.2
17.3
P<0.01
P<0.01
P<0.01
P<0.01
P<0.01
P<0.01
Electrode Aluminum significance
production rolling mill bigniticance
f
11
3
5
8
1
14
28
1-4
» f ,. difference
/o I /o
10.8 4 4.9 NS
15.8 4 13.8 NS
14.3 5 12.2 NS
32.0 9 21.4 I-III P<0.05
11.1 3 27.3 NS
20.3 17 18.1 I-III P<0.05
14.7 25 12.3
P<0.01 NS
-------
TABLE 28. FORCED EXPIRATORY VOLUMES IN COMPARED GROUPS OF WORKERS
V£>
Manganese alloy
production
FVC%*
F£V! _ 0%*
FEV0 i/FEV(%)
X
98.1
101.5
80.0
SD
11.7
14.1
7.6
Electrode
production
X
97.0
99.0
79.7
SD
10.9
13.3
7.7
Aluminum
rolling
mill
X
97.0
100.8
80.3
SD
12.3
15.2
8.6
*Values are expressed as the percentage of expected (Morris et al., 1971).
-------
TABLE 29. FORCED EXPIRATORY VOLUMES IN MANGANESE ALLOY WORKERS CATEGORIZED BY LENGTHS OF
EXPOSURE AND SMOKING HABITS
Ui
o
*
FVC%
FEVi.o%*
FEVi.o/FVC(%)
FEVi . o - nonsmokers
Length of exposure
<10 years
10 years or more
<10 years
10 years or more
<10 years
10 years or more
•P<0, 05
Nonsmoker
N
97
72
97
72
97
72
X
99
96
105
99
83
79
.0
.4
.0
.7
.6
.6
-
SD
11.4
13.1
13.2
14.6
6.6
5.9
Past smokers
N
24
33
24
33
-24
33
X
102.6
95.6
107.9
99.0
-81.4
79.0
'
SD
10.2
12.9
11.8
16.8
6.5
7. 4
Current smokers
N
74
68
74
68
74
68
X
100.0
97.1
101.8
98.5
80.0
77.3
SD
11.6
11.2
13.2
15.3
8.2
7.7
Values are expressed as the percentage of expected (Morris et al., 1971)
-------
TABLE 28. FORCED EXPIRATORY VOLUMES IN COMPARED GROUPS OF WORKERS
Manganese alloy
production
FVC%*
FEVI€O%*
FEV0.i/FEV(%)
X
98.1
101.5
80.0
SD
11.7
14.1
7.6
Electrode
production
X
97.0
99.0
79.7
SD
10.9
13.3
7.7
Aluminum
rolling
mill
X
97.0
100.8
80.3
SD
12.3
15.2
8.6
*Values are expressed as the percentage of expected (Morris et al., 1971).
-------
TABLE 29. FORCED EXPIRATORY VOLUMES IN MANGANESE ALLOY WORKERS CATEGORIZED BY LENGTHS OF
EXPOSURE AND SMOKING HABITS
m
o
*
FVC%
*
FEVi.o%
FEVi.o/FVC(%)
FEVi . o - nonsmokers
Length of exposure
<10 years
10 years or more
<10 years
10 years or more
<10 years
10 years or more
P<0.05
Nonsmoker
N
97
72
97
72
97
72
X
99
96
105
99
83
79
.0
.4
.0
.7
.6
.6
SD
11.4
13.1
13.2
14.6
6.6
5.9
Past smokers
N
24
33
24
33
24
33
X
102.6
95.6
107.9
99.0
81.4
79.0
SD
10.2
12.9
11.8
16.8
6.5
7.4
Current smokers
N
74
68
74
68
74
68
X
100.0
97.1
101.8
98.5
80.0
77.3
SD
11.6
11.2
13.2
15.3
8.2
7.7
Values are expressed as the percentage of expected (Morris et al., 1971).
-------
TABLE 30. PREVALENCE OF CHRONIC BRONCHITIS IN COMBINATION WITH CERTAIN OBJECTIVE FINDINGS IN
COMPARED GROUPS OF WORKERS CATEGORIZED BY SMOKING HABITS
Manganese alloy
production
Electrode
production
Aluminum
rolling mill
Nonsmokers Smokers
N=169 N=143
Nonsmokers Smokers
N=102 N=69
Nonsmokers Smokers
N=81 N=94
Chronic bronchitis
with mucopurulent
or purulent sputum
Chronic bronchitis
with physical signs
of bronchitis
Chronic bronchitis
with reduced FVC%
(79% or less)
Chronic bronchitis
with reduced FEVi.o%
(79% or less)
2 (1.2) 15 (10.5) 3
7 (4.1) 28 (19.6) 4
7 (4.9) 0
7 (4.9) 2
6 (8.7)
4 (5.8) 0
1 (1.4)
1 (1.4)
6 (6.4)
7 (7.4)
1 (1.1)
4 (4.3)
The numbers in parentheses are percents. The obtained values of forced expiratory volumes
are expressed as percentage of the values expected with regard to age and height of subjects
(Morris et al., 1971).
-------
TABLE 31. DISABILITY RETIREMENT RATE FOR 1968-1972 IN THE TOWN AREA, FERROALLOY AND ELECTRODE,
AND LIGHT METAL FACTORIES*
Manganese alloys
and electrode
plant
Mean number of employed
per year over a 5-year
period
Retired regardless
of diagnosis
1,400
49 (2.6%)
Retired with diagnosis
of chronic obstructive
lung disease
Town area
Light metal
plant
20,000
2,600
982 (1.3%)t
127 (2.5%)f
260 (26.5%)§
65 (51.2%)§
36 (73.5%)
§
Ui
NJ
§
Data of the Health Insurance Society, 1973.
Percentage of the total number of employed.
Percentage of the total number of retired regardless of diagnosis.
-------
TABLE 32. PREVALENCE OF SUBJECTIVE SYMPTOMS IN COMPARED GROUPS OF WORKERS
u>
Ferroalloy plant Electrode plant £}!?minU?-M Significance of
Symptoms rollln8 mil1 difference
(N=369) (N=190) (N=204)
f % f % f %
Fatigue 152 41.2 55
Bad mood 68 19.0 18
Sleepiness 77 20.9 29
Irritability 161 43.6 63
Hypersalivation 38 10.3 17
Tiredness, stiffness, , n_ ,.. „ ,-..
, . * i JLUD JX • fL j JL
heaviness in legs
Trembling of hands 89 24.1 21
28.9 76 37.3 a-b
9.5 22 10.8 a-b
a-c
15.3 54 26.5 b-c
33.2 89 43.6 a-b
b-c
8.9 20 9.8
26.8 77 37.7 b-c
11.1 52 25.5 a-b
b-c
P<0.01
P<0.01
P<0.01
P<0.01
P<0.01
P<0.05
P<0.05
P<0.01
P<0.01
Cramps in arms and
legs (recurring)
45
12.2
17
8.9
16
7.8
-------
TABLE 33. PREVALENCE OF CERTAIN SUBJECTIVE SYMPTOMS IN WORKERS FROM FERROALLOY PLANT CATEGORIZED BY
SMOKING HABITS
1. Moderate &
Symptoms
Fatigue
Bad mood
Irritability
Cramps in
arms and legs
(recurring)
heavy
(N=
f
48
24
47
20
smokers
92)
%
52
26
51
21
.2
.1
.1
.7
2. Light
smokers
(N=51)
f %
19 37.3
4 7.8
13 25.5
1 2.0
3. Nonsmokers
Significance
of
difference
f
61
26
66
19
(N«169)
%
36.
15.
39.
11.
1
4
1
2
1
1
1
1
2
:3
:2
:2
:3
:3
P<0.
P<0.
P<0.
P<0.
P<0.
05
01
01
05
01
-------
TABLE 34. PREVALENCE OF CERTAIN SUBJECTIVE SYMPTOMS IN WORKERS FROM ELECTRODE PLANT CATEGORIZED BY
SMOKING HABITS
Ui
Symptoms
Fatigue
Bad mood
Irritability
1. Moderate &
heavy smokers
(N=34)
f %
11 32.4
6 17.6
13 38.2
2. Light
smokers
(N-35)
f %
5 14.3
1 2.9
8 22.9
3. Nonsmokers
(N-69)
f %
33 32.4
9 8.8
37 36.3
Significance of
difference
2:3 P<0.05
1:2 P<0.05
Cramps in
arms and legs
(recurring)
5.9
2.9
12
11.8
-------
TABLE 35. PREVALENCE OF CERTAIN SUBJECTIVE SYMPTOMS IN WORKERS FROM ALUMINUM ROLLING MILL
CATEGORIZED BY SMOKING HABITS
Symptoms
Fatigue
Bad mood
1. Moderate & 2. Light
heavy smokers smokers
CN=53) (N-41)
f % f %
21 39.6 12 29.3
7 13.2 1 2.4
3. Nonsmokers
(N-81)
£ *y
28 34.6
10 11.5
Significance of
difference
1:2 P<0.05
2:3 P<0.05
Irritability
Cramps in
arms and legs
(recurring)
27
50.9
11.3
14 34.1
2.4
32
39.5
3.7
-------
TABLE 36. PREVALENCE OF NEUROLOGICAL SIGNS IN COMPARED GROUPS OF WORKERS
Signs
Cogwheel phenomenon
Tremor at rest
Difficult starting
of voluntary
movements
Pathological
reflexes
Cogwheel phenomenon
& tremor at rest
Cogwheel phenomenon
pathological
reflexes
Pathological reflexes
& tremor at rest''
Ferroalloy Electrode Aluminum
plant plant rolling mill
* * *
Nonsmokers Smokers Nonsmokers Smokers Nonsmokers Smokers
(N=169) (N=200) (N=102) (N=88) (N=81) (N=123)
1 (0.5)f
24 (14.2) 23 (11.5) 2 (2.0) 8 (9.1)
1 (0.5)
4 (2.4) 4 (2.0) 1 (1.1)
1 (0.5)
1 (0.5)
1 (0.6) 2 (1.0)
Present and past smokers.
Numbers in parentheses are percentages.
-------
TABLE 37. FERROALLOY WORKERS WITH NEUROLOGICAL SIGNS BY LEVEL OF EXPOSURE
TO MANGANESE
Signs
Mean manganese concentrations at working places
mg/m3
0.301-4.933
(N=268)
9.480-11.062
(N=17)
16.347-20.442
(N=18)
Cogwheel phenomenon
Difficult starting of
voluntary movements
Pathological reflexes
Tremor at rest
Pathological reflexes
& tremor at rest
Cogwhell phenomenon
& tremor at rest
Cogwhell phenomenon &
pathological reflexes
6
42
1
2
1
2
Total
54 (20.1%)
3 (17.6%)
5 (27.8%)
58
-------
TABLE 38. MEAN VALUES OF SYSTOLIC BLOOD PRESSURE IN WORKERS BY CATEGORIZED AGE GROUPS
Ul
vO
20-29 yr
30-39 yr
40-49 yr
50-59 yr
Totals and
§§
averages33
Group
number
1§
**
2
3^
4
5##
Ferroalloy plant
*
I
N
60
144
133
30
367
X
134.3
136.2
143.4
150.1
139.8
SD
13.3
11.4
14.7
20.4
14.8
Electrode plant
N
43
80
52
14
189
X
134.5
142.1
146.7
152.8
142.6
SD
10.3
13.0
15.0
28.6
15.4
Rolling mill
(light metal plant)
III*
N
42
82
63
16
203
X
143.8
145.5
149.9
159.8
147.9
SD
14.7
14.0
15.2
18.3
15.8
1-3 P<0.01, 1-4 P<0.01, 2-3 P<0.01, 2-4 P<0.01
f 1-2 P<0.01, 1-3 P<0.01, 1-4 P<0.01, 2-4 P<0.05
1-3 P<0.05, 1-4 P<0.01, 2-4 P<0.01, 3-4 P<0.05
§ I-III P<0.01, II-III P<0.01
**
I-III P<0.01, I-III P<0.01
ftI-III P<0.01
##I-II P<0.05, I-III P<0.01, II-III P<0.01
§§
In two workers from the ferroalloy plant, in one worker from the electrode plant, and in one
worker from the light metal plant, the blood pressure was not measured.
-------
TABLE 39. MEAN VALUES OF DIASTOLIC BLOOD PRESSURE IN WORKERS CATEGORIZED BY AGE GROUPS
Age
20-29 yr
30-39 yr
40-49 yr
50-59 yr
Totals and
averages
Ferroalloy plant
Group *
number
N
§
1 60
**
2 144
3ft 133
4 30
5H 367
X
91.0
93.5
97.6
99.7
95.1
SD
10.5
9.8
10.5
14.4
10.6
Electrode plant
N
43
80
52
14
189
X
92.6
97.5
98.4
98.9
96.8
SD
8.4
11.4
11.3
6.8
11.0
Rolling mill
(light metal plant)
III*
N
42
82
63
16
203
X
86.4
92.5
92.3
93.1
91.4
SD
10.3
10.9
10.5
10.9
11.0
1-3 P<0.01, 1-4 P<0.01, 2-3 P<0.01, 2-4 P<0.05
f 1-2 P<0.01, 1-3 P<0.01, 1-4 P<0.01
* 1-2 P<0.01, 1-3 P<0.01, 1-4 P<0.01
§ I-III P<0.05, II-III P<0.01
**
I-II P<0.01, II-III P<0.01
P<0.01, II-III P<0.01
P<0.01, II-III P<0.01
-------
TABLE 40. MEAN VALUES OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE IN WORKERS
NOT INCLUDING HYPERTONICS*
Systolic pressure Diastolic
Group jt IT
number N
X SD X
Ferroalloy plant 1 191 130.8 10.4 86.5
Electrode plant 2 102 133.6 9.2 87.9
Rolling mill
(light metal plant) 3 132 138.7 9.6 84.7
pressure
#
SD
5.0
5.9
7.4
Hypertonics are persons with systolic blood pressure of 160mm Hg or higher
and diastolic pressure of 95mm Hg and higher, as well as those having a
combination of these values.
^1-2 P<0.05, 1-3 P<0.01, 2-3 P<0.01
*l-2 P<0.05, 1-3 P<0.05, 2-3 P<0.01
61
-------
SECTION 7
ACUTE RESPIRATORY DISEASES IN A MANGANESE-CONTAMINATED TOWN AREA
MATERIAL AND METHODS
A 4-year study of the incidence of acute bronchitis, peribronchitis and
pneumonia was conducted in the town whose atmosphere is polluted with emissions
from a manganese alloy plant. Data about acute respiratory diseases were
available through the local Chest Disease Clinic. Considering the current
organization of the local health service, the collected data can be considered
to reflect actual conditions. The incidence of the respiratory diseases
studied was analyzed by zones of manganese exposure, by age and sex of the
ill, and by seasonal factor (summer: April-September; winter: October-March).
As described earlier (see Section 4), Zone I was defined as the part of
the town nearest to the ferromanganese plant. The central part of the town
was defined as Zone II. Zone III was the part of the town 3.5-6 km from the
ferromanganese plant. Table 41 shows the structure of the population by zones
of manganese concentrations in air.
RESULTS AND DISCUSSION
Tables 42-45 show the incidence of acute bronchitis and peribronchitis
and pneumonia by zones and season for the years 1972 through 1975.
Table 46 shows the accumulated incidence (1972-1974) of the same diseases.
Tables 47 and 48 also show the accumulated incidence but present the data
separately for males and females.
Table 49 shows the accumulated incidence (1972-1974) of acute bronchitis,
peribronchitis, and pneumonia by age.
The presented results reveal that acute bronchitis and peribronchitis
occurred more frequently among the inhabitants living in the parts of the
town defined as Zone I and Zone II than among the inhabitants of Zone III.
In addition, the results show that the incidence of these diseases was
higher in the winter than in the summer periods. However, it is interesting
to note that the incidence of these diseases was usually a little higher in
Zone II, which represents the central part of the town, than in Zone I,
which is nearest to the ferroalloy factory and which usually had slightly
higher mean and maximum concentrations of manganese in air compared with
Zone II. However, on some occasions, particularly in 1974, maximum weekly
concentrations of manganese were higher in Zone II than in Zone I (see
frequency distribution of the weekly concentrations of manganese presented
62
-------
in Table 3). A slight difference in the incidence of acute bronchitis and
peribronchitis between the two zones might be partly connected with a higher
population density in the central part of the town, i.e., in Zone II. On the
other hand, because of the configuration of the town, it might be that the
number of measuring sites was not sufficient and that the locations do not
best represent the real situation as far as air pollution with manganese is
concerned.
There is another factor which should be considered. As shown in
Table 96, the concentrations of total suspended particulates seem to be
higher, on the average, in the central part of the town than in the part
nearest to the ferroalloy factory. This situation is true for the sulfate
concentrations.
Pneumonia incidence does not differ consistently in relation to the
pollution zones. It was never the highest in Zone III which is the zone
with the lowest manganese in air concentrations; on the other hand, it
tends to be slightly higher in Zone II compared with Zone I. In general,
the incidence of pneumonia did not seem to exceed significantly the pre-
dicted figures, nor did it differ in relation to season. As it was expected
that the rate of pneumonia would be higher in the winter than in the summer
period, a question arises whether this finding might not be associated with
usually higher summer concentrations of manganese. Data on the incidence of
pneumonia collected by the Institute of Public Health of Croatia (1975) show
that in the costal area, as well in other parts of the country, it is usually
higher in the winter than in the summer period.
A separate analysis by sex shows that acute bronchitis and peribronchitis
occur more frequently in men than in women. In both sexes their incidence is
higher in winter than in summer. As concerns the zones of living, the inci-
dence for both sexes was lowest in the zone with the lowest manganese concen-
tration. Pneumonia incidence was usually slightly higher in men than in
women. The observed lack of seasonal difference in pneumonia rate was seen
in males and females alike.
A detailed analysis of acute bronchitis and peribronchitis with regard to
age shows, as expected, a higher incidence at the ages of 0-4 and 5-9 years.
In these, as in almost all other age groups, the incidence also tends to be
higher in winter than in summer. The same is true for more polluted zones.
The difference in the incidence of acute bronchitis and peribronchitis in
zones I and II compared with Zone III is particularly evident in the 0-4-
year age group. Pneumonia was also more frequent in the 9-year age group,
but its rate was not consistently higher in the zones with higher manganese
concentrations. No significant difference was observed in the rate of studied
diseases by years of followup. As shown in Table 1 and Figure 1, no greater
difference in this respect was noticeable in manganese concentrations either.
It has to be mentioned that sulfur dioxide concentrations had an annual
mean below 30 yg/m3. Also there was no information indicating the presence
of any other pollutants which might be of importance for the occurrence and
rate of respiratory disease. However, it also has to be mentioned that
63
-------
within the light metal plant, which is (according to manganese in air con-
centrations) located in Zone III of the town area, a new facility for the
electrolytic extraction of aluminum began operation in the beginning of
1974. This facility has created a problem of potential fluorine pollution,
not only in the working atmosphere but also in the outer atmosphere, mainly
affecting people living in the close vicinity of the factory, i.e., in the
zone of the town with the lowest manganese exposure. It is possible that
fluorine as a respiratory irritant had a certain influence on the incidence
of the followup diseases in Zone III in 1974 and 1975.
The presented results need some additional comments regarding the
reliability of the data used. The local clinic for lung diseases through
which the data were collected has been operating for years. It began as
a clinic for tuberculosis and expanded later to treat other diseases of
the lungs and respiratory system.
The number of inhabitants in the town is not greater than 30,000, and
because of the good reputation of the clinic, it soon became customary for
general practitioners, pediatricians, school physicians, and industrial
physicians to consult the clinic in all matters regarding respiratory
diseases including their acute forms. Among other examinations, X-rays
of the lungs are performed at the clinic. The town inhabitants are also
free to consult the clinic directly. Thus, we can assume that practically
all cases of acute respiratory diseases are registered at the clinic.
Besides, the clinic is conveniently located and easily accessible. It
should also be mentioned that health insurance entitles the members of the
population to avail themselves of the clinic's services on an equal basis.
The data presented in this study can, therefore, be considered reliable.
Although it is not possible to say that some relevant factors in addition
to those mentioned earlier may not have been under adequate control, the
results of the study indicate that an exposure to manganese which is of the
order of magnitude of 1 yg/m3 might have an adverse effect on health. As a
matter of fact, the measured annual mean manganese in air concentrations in
the area of higher incidence of acute respiratory illnesses were between
0.164 and 0.390 yg/m3. Due to the sampling techniques described earlier
(see Section 4), only particles of approximately respirable size have been
collected and, therefore, it can be assumed that the total manganese con-
centrations in the air were considerably higher.
If the observed characteristics in the incidence of acute respiratory
diseases are partly due to manganese pollution, a possible mechanism of
manganese action could be that it disturbs some protective functions in the
lung, thus making the organism more susceptible to respiratory infection.
On the other hand, a possible catalytic effect of manganese on the oxidation
of sulfur dioxide and of the potential synergistic action of manganese
aerosol and the sulfuric acid and sulfates adsorbed on its surface also
have to be considered.
64
-------
TABLE 41. STRUCTURE OP THE POPULATION OF THE TOWN BY ZONES ACCORDING TO MANGANESE CONCENTRATIONS IN AIR
Zone
I
Sex
II
St-x
III
Sex
Total
Age 0-4
Total 669
i. 349
f 320
Total 1,163
m 606
f 557
Total 413
« 215
f 198
5-9
695
357
338
1,215
623
592
429
220
209
10-14
721
370
351
1,266
649
617
445
228
217
15-19
799
405
394
1,454
737
717
492
249
243
20-24
843
394
449
1,488
695
793
519
242
277
25-29
619
304
315
1,163
571
592
381
187
194
30-34
782
381
401
1,317
641
676
482
235
247
35-39
851
442
409
1,488
772
716
524
272
252
40-44
730
374
356
1,369
702
667
450
231
219
45-49
487
213
274
992
433
559
297
130
167
50-54
287
123
164
650
280
370
169
73
96
55-59
321
146
175
889
404
485
191
87
104
60-64
304
132
172
838
365
473
180
78
102
65-69
235
105
130
684
306
378
138
62
76
70-74
182
67
115
616
228
388
101
37
64
75-
165
56
109
513
174
339
85
29
56
Total
6,690
4,218
4,474
17,105
8,186
8,919
5,296
2,575
2,721
31,091
-------
TABLE 42. INCIDENCE OF ACUTE RESPIRATORY DISEASES IN 1972
Zones according to manganese
concentrations in air
II
III
Significance
of
difference
Acute bronchitis
and peribronchitis
Pneumonia
W* 158 (1.8)1" 349 (2.0) 67 (1.3)
S 83 (1.0) 178 (1.0) 30 (0.6)
W 15 (0.1) 7 (0.04) 3 (0.06)
S 5 (0.06) 13 (0.08) 5 (0.09)
I-III P<0.05
II-III P<0.01
I-III P<0.01
II-III P<0.01
NS
NS
W = winter; S = summer
t.
Numbers in parentheses denote percents of the total number of inhabitants in
particular zones or in particular age groups.
66
-------
TABLE 43. INCIDENCE OF ACUTE RESPIRATORY DISEASES IN 1973
Zones according to manganese
concentrations in air
I II III
Acute bronchitis
and peribronchitis
Pneumonia
* t
W 142 (1.6)
*
S 77 (0.9)
W 21 (0.2)
S 7 (0.08)
368 (2.2)
199 (1.2)
35 (0.2)
16 (0.09)
63 (1.2)
40 (0.8)
2 (0.04)
1 (0.02)
Significance
of
difference
I-II P<0.01
I-III P<0.05
II-III P<0.01
I-II P<0.05
II-III P<0.01
I-III P<0.01
II-III P<0.01
II-III P<0.05
t.
W = winter; S = summer
Numbers in parentheses denote percents of the total number of inhabitants in
particular zones or in particular age groups.
67
-------
TABLE 44. INCIDENCE OF ACUTE RESPIRATORY DISEASES IN 1974
Zones according to manganese
concentrations in air
Acute
and
bronchitis
peribronchitis
Pneumonia
I
W* 176 (2.
S* 136 (1.
W 11 (0.
S 27 (0.
II
0)*
6)
1)
3)
408
322
42
64
(2.
(1.
(0.
(0.
4)
9)
2)
4)
Significance
of
difference
III
96
71
12
13
(1.
(1.
(0.
(0.
8)
3)
2)
2)
I-II
II-III
II-III
I-II
II-III
P<0.05
P<0.01
P<0.01
P<0.05
P<0.05
W = winter; S
summer
t
Numbers in parentheses denote percents of the total number of inhabitants in
particular zones or in particular age groups.
68
-------
TABLE 45. INCIDENCE OF ACUTE RESPIRATORY DISEASES IN 1975
Zones according to manganese
concentrations In air
Acute bronchitis
and peribronchitis
Pneumonia
I
W* 114 (1.3)f
*
S 74 (0.9)
W 17 (0.2)
S 9 (0.1)
II
352 (2.1)
182 (1.1)
49 (0.3)
55 (0.3)
III
85 (1.6)
50 (0.9)
17 (0.3)
6 (0.1)
Significance
of
difference
I-II
II-III
NS
NS
I-II
II-III
P<0.01
P<0.05
P<0.01
P<0.01
t.
W = winter; S = summer
Numbers in parentheses denote percents of the total number of inhabitants in
particular zones or in particular age groups.
69
-------
TABLE 46. ACCUMULATED INCIDENCE OF ACUTE RESPIRATORY DISEASES DURING 1972-1975
Zones according to manganese
concentrations in air
II
III
Significance
of
difference
Acute bronchitis W* 588 (6.8)^
and peribronchitis
S 370 (4.3)
1477 (8.6) 301 (5.7)
880 (5.1) 191 (3.6)
I-II P<0.01
I-III P<0.01
II-III P<0.01
I-II P<0.01
I-III P<0.05
II-III P<0.01
Pneumonia
W
S
64 (0.7)
48 (0.6)
133 (0.8)
148 (0.9)
34 (0.6)
25 (0.5)
NS
I-II P<0.01
II-III P<0.01
*W = winter; S = summer
t.
Numbers in parentheses denote percents of the total number of inhabitants in
particular zones or in particular age groups.
70
-------
TABLE 47. ACCUMULATED INCIDENCE OF ACUTE RESPIRATORY DISEASES DURING
1972-1975 - MALES
Zones according to manganese
concentrations in air
Significance
of
difference
II
III
Acute bronchitis
and peribronchitis
Pneumonia
*
W
*
s
W
s
315
226
33
32
(7.
(5.
(0.
(0.
5)*
4)
8)
8)
795
508
73
84
(9.
(6.
(0.
(1.
7)
2)
9)
0)
172
111
21
15
(6.7)
(4.3)
(0.8)
(0.6)
I-II
II-III
I-III
II-III
NS
II-III
P<0.01
P<0.01
P<0.05
P<0.01
P<0.05
W = winter; S = summer
Numbers in parentheses denote percents of the total number of inhabitants in
particular zones or in particular age groups.
71
-------
TABLE 48. ACCUMULATED INCIDENCE OF ACUTE RESPIRATORY DISEASES DURING
1972-1975 - FEMALES
Zones according to manganese
concentrations in air
I II III
* t
Acute bronchitis W 273 (6.1)
and peribronchitis
*
S 144 (3.2)
Pneumonia W 31 (0.7)
S 16 (0.4)
682 (7.6)
372 (4.2)
60 (0.7)
64 (0.7)
139 (5.1)
80 (3.9)
13 (0.5)
10 (0.4)
Significance
of
difference
I-II P<0.01
II-III P<0.01
I-II P<0.01
NS
I-II P<0.05
II-III P<0.05
*
W * winter; S = summer
t
Numbers in parentheses denote percents of the total number of inhabitants in
particular zones or in particular age groups.
72
-------
TABLE 49. ACCUMULATED INCIDENCE OF ACUTE RESPIRATORY DISEASES DURING 1972-1975 BY AGE
Acute bronchitis
and
perlbronchitis
Significance
of difference
0-4
I W* 139
S 79
II W 271
5-9
(20.8)f
(11.8)
(23.3)
S 130 (11.2)
III W 61
S 28
W I-III
II-III
S I-III
II-III
(14.8)
(6.8)
P<0.05 W
P<0.01
P<0.01
P<0.01
I W 10 (1.5)
Pneumonia
Significance
of difference
S 4
II W 22
S 14
III W 4
S 2
(0.6)
(1.9)
(1.2)
(1.0)
(0.5)
94
57
237
104
65
45
I-II
II-III
12
10
22
31
14
11
(13.5)
(8.2)
(19.5)
(8.6)
(15.2)
(10.5)
P<0.01
P<0.05
(0.7)
(0.5)
(1.8)
(2.6)
(3.3)
It. 6)
10-19
61
29
155
90
28
24
U I-II
(4.0)
(1.9)
(5.7)
(3.3)
(3.0)
(2.6)
P<0.05
II-III P<0.01
S I-II
11
8
20
36
1
2
W I-III
P<0.01
(0.7)
(0.5)
(0.7)
(1.3)
(0.1)
(0.2)
P<0.05
20-39
106 (3.4)
80 (2.6)
309 (5.7)
213 (3.9)
70 (3.7)
32 (1.7)
W I-II P<0.
II-III P<0.
S I-II P<0.
I-III P<0.
II-III P<0.
17 (0.5)
9 (0.3)
34 (0.6)
25 (0.5)
10 (0.5)
4 (0.2)
40-59
127 (7.0)
79 (4.3)
322 (8.3)
213 (5.5)
71 (6.4)
42 (3.8)
01 W II-III
01
01 I-II
05 II-III
01
6 (0.3)
10 (0.5)
23 (0.6)
24 (0.6)
2 (0.2)
2 (0.2)
W II-III
60 or
•ore
61 (6
46 (5
183 (6
130 (4
16 (3
20 (4
Total
.9)
.2)
.9)
.9)
.2)
.0)
P<0.05 W I-III
P<0.05
P<0.05
8 (0
7 (0
12 (0
18 (0
3 (0
4 (0
P<0.05
II-III
.9)
.8)
.5)
.7)
.6)
.8)
588
370
1477
880
311
191
P<0.01
P<0.01
64
58
133
148
34
25
II-III P<0.05
S
I-II P<0.01
I-III P<0.01
S I-II
P<0.01
S II-III P<0.
05 S II-III
P<0.05
II-HI P<0.01
W - winter; S - summer
Nnmbeis in parentheses denote percents of the total number of inhabitants In particular zones or in particular age groups.
-------
SECTION 8
RESPIRATORY DISEASES IN SCHOOL CHILDREN AND THEIR FAMILIES
IN A MANGANESE-CONTAMINATED TOWN AREA
MATERIALS AND METHODS
From the 1st of November 1972 until the 30th of April 1973, the rate of
acute respiratory diseases was studied in groups of 288 children (2nd gra-
ders)* from three schools, at three different locations in the town contami-
nated by manganese from the ferroalloy factory, and in 44 children from a
town on an island situated about 25 kilometers southwest.
The study was repeated during the period from the 1st of November 1974
until the 30th of April 1975, in another group of school children of the same
age. In this later study 356 children were included: 296 from the town
contaminated by emissions of the ferroalloy factory and 60 from the same
island as in the first study. Among the children from the later group, 26
were 3rd graders, "f
The studies included:
1. Measurements of forced expiratory volume at the beginning (November)
and before the end (March) of the study.
2. Follow-up of acute respiratory diseases in the children and in
members of their families during the entire period of 6 months.
3. Medical examinations of the parents of children chosen for the
first study in 1972/73.
*The average 2nd grader is 8 years of age.
The average 3rd grader is 9 years of age.
74
-------
Three-quarter-second and one-second forced expiratory volumes (FEVo.?s
and FEVi.o) were performed by each volunteer child once weekly during the
months of November and March of the respective years. Ventilatory tests with
"Pulmonor" spirometers were conducted by a physician in both studies. In
addition to ventilatory tests, the standing height of each child was measured
once in November and once in March.
In the first study of 1972/1973, forced expiratory volumes were measured
in 273 children from the town contaminated by manganese and in 41 children
from the island which served as the control group. In the second study of
1974/1975, 298 children from the town were included in the ventilatory
measurements. Twenty-six children from the island were excluded from the
testing because as 3rd graders they were slightly older than the others.
All members of the household of each participating pupil were asked to
volunteer for the assessment of the frequency of acute respiratory disease.
At biweekly intervals from November through April, a post card was sent to
each household. A simple "yes" or "no" response to the question "Did anyone
in your household have a new cold or sore throat in the past two weeks?" was
requested, and a return envelope was provided. Households giving an affirm-
ative response to the post card and all nonrespondents were visited by a
nurse within a two-week interval and questioned about age, sex, and severity
of illness of household members. Severity indices included the presence of
fever, length of home confinement, and consultation of a physician for treat-
ment.
At the time of the first contact, the nurse recorded on a census list
age, sex, family position, and selected data on socioeconomic level of the
household and profession of the father. Questions were also asked about the
presence of asthma, bronchitis, or other chronic disease in volunteer child-
ren, duration of residence at current address, number of rooms in the house
(apartment), type of heating used, and whether there was a cigarette smoker
in the household. The method described is practically the same as used by
Shy and collaborators (1970) in the Chattanooga School Children Study.
Medical examinations of the parents of children who participated in the
first study were performed in April 1973. The examination included the MRC
questionnaire on respiratory symptoms, determination of forced expiratory
volumes, analysis of the early morning sputum, clinical examination, and an
X-ray of the lungs.
75
-------
RESULTS
Forced Expiratory Volumes of the Children
Study of 1972-1973—
Tables 50 and 51 show the mean age and the standing height of the com-
pared groups of children.
The mean age and height did not differ in the compared groups of children.
There was only one exception: children from the island were slightly older
than children from the town contaminated by emissions from the ferroalloy
factory. Girls from the island were also taller, on the average, than the
boys and girls at all locations.
Table 52 compares the mean FEVo.75 values for boys obtained in November
1972 and March 1973. Table 53 shows the same for girls. In Tables 54 and 55
are the mean FEVi.o values for boys and girls expressed as percentages of the
predicted (nomograms by Bjure et al., 1963). Mean FEVo.75 values obtained in
March 1973 were slightly higher than those obtained in November 1972 both for
boys and girls. It is most likely that the observed increase was due to the
normal growth of the children during that period.
The children from the island had higher volumes than the children from
the town with the ferroalloy factory. The differences were not statistically
significant except in boys from the island compared with the boys from the
school nearest to the ferroalloy factory.
The FEVi.o values show a relative increase in March 1973 compared with
November 1972, with the exception of boys from the island and boys and girls
from the school farthest from the ferroalloy factory.
In November 1972, the highest FEVi.o percent values were found in the
boys from the island and the lowest in the boys from the school nearest to
the ferroalloy plant. In March, the observed differences in volumes for boys
were not statistically significant.
In girls, both in November 1972 and in March 1973, those from the
school in the central part of the town with the ferroalloy plant had highest
FEVi.o percent volume.
As shown;-in Figure'1, the mean monthly concentrations of manganese in air
in the town with the ferroalloy plant were slightly lower in March 1973
compared with November 1972, and varied between 0.105-0.147 Ug/m3 in Zones
I and II. In Zone III they were at a level of about 0.040 yg/m3.
Study of 1974-1975—
Tables 56 and 57 show the mean age and the standing height of the com-
pared groups of school children. Boys and girls from the school in the cen-
tral part of the town contaminated by ferroalloy emissions were slightly
shorter than boys and girls from other groups.
76
-------
Tables 58 and 59 compare the mean FEVo.75 values (November 1974-March
1975) for boys and girls respectively. In Tables 60 and 61 the same is
presented for FEVi.o percent values. FEVo.75 values did not statistically
differ among groups. However, it is interesting that in children from the
island, FEVo.75 had a slight tendency to decrease in March 1975 compared with
"ovember 1974, while in other groups this was not observed.
FEVi.o percent values in all groups of children showed a decrease in
March 1975 compared with November 1974. In November 1974 the boys from the
school in the central part of the town had statistically higher FEVi.o
percent values than the boys from the school nearest to the ferroalloy
factory. In November 1974 as well as in March 1975, the girls from the
school in the central part of the town had higher FEVi.o percent volumes than
the girls from the school nearest to the ferroalloy factory, and also higher
than the girls from the island.
In November 1974 the mean monthly and maximum weekly manganese concen-
trations of air in the town with the ferroalloy plant were higher than in
March 1975 (Figure 1) except in Zone III. Mean manganese concentration in
November 1974 were also higher compared with those in November 1972 (first
study). Concentrations in March 1974 and 1972 did not differ practically.
Incidence of Acute Respiratory Disease
Study of 1972-1973—
General characteristics of compared 2nd graders and their families are
presented in Tables 61-66. Table 62 shows the structure of families (based
on the location of school of 2nd graders). Table 63 shows the structure of
families by location in the zones according to manganese concentrations in
air. This table shows that 25 familes of 2nd graders attending schools in
Zone II live in Zone III, i.e., in the area with the lowest manganese con-
centrations in the air.
Table 64 shows the number of families with children under the age of 10
by zones according to the location of schools of 2nd graders. Table 65 shows
data about socioeconomic status of the families in the study by schools of
2nd graders. Table 66 shows the density rate (number of members of the
families per one room) in the compared groups. Table 67 shows the smoking
habits of the children's parents on the same basis as in the previous table.
Table 68 shows the number of ill (November 1972-April 1973) out of the
total number of subjects in particular segments of the family. The compari-
son is based on the location of schools of 2nd graders. Distribution of ill
by the rate of disease is presented in Table 69. Table 70 shows the inci-
dence of acute respiratory illnesses, and Table 71 shows the structure of
"other diseases" in the category "Acute respiratory disease with elevated
temperature and staying in bed, physician consulted" from the previous table.
The results in these tables indicate that the incidence of acute respi-
ratory illnesses (all compared grades and categories taken together) was
higher in 2nd graders from the town contaminated by emissions from the ferro-
77
-------
alloy factory than in 2nd graders from the island. The same relates to other
members of the compared families.
However, it is interesting to note that the percentage of those with
acute respiratory disease who stayed in bed and consulted a physician was
highest in children and families living on the island, probably because of
the fact that in the actual conditions of a small town on the island, home
visits made by a local physician are generally more frequent than in a larger
town.
Pneumonia also appeared to be more frequent in the town with the ferro-
alloy factory than on the island, although the total number of pneumonia
cases was rather low.
A comparison of the incidence of acute respiratory illnesses in the town
contaminated by ferroalloy emissions shows that the group of 2nd graders from
one of the schools which is in Zone II, but not far from Zone III (so that
some children attending this school live in Zone III with the lower manganese
concentrations), had the highest rate of illnesses. The same was observed in
other members of the families of these children except in grandfathers and
grandmothers. It is true, however, that this relates mainly to the category
"acute respiratory disease" and not to other categories (acute respiratory
disease with elevated temperature, staying in bed, or physician consulted).
One of the explanations for this finding could be that more families in
this group had children under the age of 10 than in the other two groups from
the town with the ferroalloy factory. The number of members of the family
per one room (density rate) was also slightly higher in that group compared
with two others (Tables 64 and 66).
Study of 1974-1975—
General characteristics of compared 2nd graders and their families are
presented in Tables 70-74. Table 72 shows the structure of the familes
(based on the location of schools of 2nd graders). Table 73 shows the
structure of the families by home location in zones according to measured
manganese in air concentrations. This table demonstrates that out of 114
pupils attending the school, which is situated in Zone II but is not far from
Zone III, 51 live in Zone III. A number of pupils attending the second-grade
classes of the two schools from Zone II live in Zone I, and a rather small
percentage of pupils attending the school situated in Zone I live in Zone II.
Table 74 shows the number of families with children under the age of 10.
Table 75 shows data about socioeconomic status of the families compared by
schools of 2nd graders. Table 76 shows the density rate (number of members
of the families per one room) in the compared groups. Table 77 shows the
smoking habits of the children's parents. Table 78 shows the number of ill
(November 1972-April 1973) out of the total number of subjects in particu-
lar segments of the families. Data are based on the location of schools of
2nd graders. Table 79 shows the distribution of ill by the rate of disease.
Table 80 demonstrates the incidence of acute respiratory illnesses by cate-
gories. Table 81 shows the structure of "other diseases" in the category
78
-------
"Acute respiratory disease with elevated temperature and staying in bed -
physician consulted" from Table 80.
This study shows that the incidence of acute respiratory illnesses was
again higher in the school children, and members of their families, from the
town contaminated by emissions from the ferroalloy factory than in the school
children, and members of their families, from the island chosen as control.
Compared with the first study (1972-1973), this time the difference relates
also to the rate of "other disease" in the category "acute respiratory disease
with elevated temperature and staying in bed, physician consulted". Here, it
should be mentioned that the general practitioner who used to work on the
island left his position just before the second study started. The physician
who replaced him took the job on a temporary basis. This might have in-
fluenced to some extent the practice and the frequency of home visits on the
island.
The analysis of incidence of acute respiratory illnesses within the town
with the ferroalloy plant indicated again, a slightly higher rate of diseases
in those from Zone II but near Zone III. As shown in Table 71, 45 percent of
the children attending this school live in Zone III with the lowest atmos-
pheric pollution with manganese. As in the first study (1972-1973), this
related mainly to the category "acute respiratory disease," i.e., symptoms of
cold or sore throat without elevated temperature or staying in bed. Brothers
and sisters of the examined school children did not show the same tendency as
far as the rate of the followed-up diseases is concerned. In their case, the
incidence of the diseases was higher in the families from two other schools.
In fathers and mothers, the incidence was approximately the same in all
compared families. The groups of grandfathers and grandmothers, as well as
the rates of diseases in this segment of the families, were small and for
that reason inadequate for comparison.
In this study, in contrast to the first one, the number of families with
children under the age of 10 was lower in the group connected with the school
nearest the zone with the lowest manganese air pollution than in two other
compared groups of families.
As far as other characteristics are concerned, the compared families did
not greatly differ.
However, the potential exposure to fluorine from the new plant for the
electrolytic extraction of aluminium which, as already mentioned in Section
7, started to operate from the beginning of 1974, also has to be considered
in the evaluation of the results of this study. It is possible that a cer-
tain number of cases with acute respiratory illness in the area around the
factory was due to exposure to fluorine emitted in the air.
Respiratory Examination of Parents of Subjects of the First Respiratory
Study—
Tables 82-84 show the main characteristics of the examined parents.
Respiratory symptoms and forced expiratory volumes in men smokers by zones
79
-------
according to manganese concentrations in air are presented in Table 80.
Table 81 shows the same for men nonsmokers. In Tables 82 and 83 respiratory
symptoms and forced expiratory volumes are shown for women smokers and non-
smokers , respectively.
The results in the above tables indicate a certain difference in the
rate of respiratory symptoms in men and women according to the zones of
living. In practically all smoking-habit subgroups, the prevalence of respi-
ratory symptoms was higher in those living in more polluted zones of the
town.
Forced expiratory volumes also showed higher relative values (compared
with the predicted) in fathers and mothers living in the less polluted part
of the town. However, only in a few instances were the differences statisti-
cally significant.
A comparison between the study group of men and women in the town with
the ferroalloy factory and the controls from the island is difficult because
of a small number of subjects in the latter group. There was a lower rate of
respiratory symptoms in women from the island, compared with women from the
town polluted by manganese. In men, the rate of symptoms was practically the
same in both groups. It is interesting that men nonsmokers from the island
had lower FVC percent and FEVi^o percent values than men nonsmokers from the
town contaminated by emissions of the ferroalloy plant.
80
-------
TABLE 50. AGE AND HEIGHT COMPARISONS OF BOYS (1972-1973)
Location of school
N
November 1972
March 1973
Age*
Standing height Standing height
SD
X
SD
SD
oo
a) Elementary school -
Zone I - 0.75 km from 35 7.8
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 42 7.9
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 50 7.9
ferroalloy plant
d) Elementary school - 23 8.3
island
0.5 131.9
0.5 132.5
0.4 132.4
1.0 132.9
5.7 133.9 6.5
6.4 134.6 6.4
6.7 135.9 6.4
6.4 135.7 6.1
*Age:a-d P<0.05
b-d P<0.05
c-d P<0.05
-------
TABLE 51. AGE AND HEIGHT COMPARISONS OF GIRLS (1972-1973)
Location of school
N
November 1972
March 1973
Age
Standing height* Standing height
t
X
SD X
SD
SD
00
a) Elementary school -
Zone I - 0.75 km from
ferroalloy plant
b) Elementary school -
Zone II - 2 km from
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from
ferroalloy plant
d) Elementary school -
island
55 8.0 0.5 130.9 6.2 133.2 6.2
34 7.9 0.9 129.8 5.1 131.8 6.8
57 7.9 0.8 130.7 6.2 134.2 5.1
18 8.2 1.0 135.1 4.9 136.4 7.8
*Standing height: November 1972:
a-d P<0.01
b-d P<0.01
c-d P<0.05
t
Standing height: March 1973:
a-b P<0.05
a-d P<0.05
b-d P<0.01
c-d P<0.01
-------
TABLE 52. FEVo.75 IN COMPARED GROUPS OF BOYS (1972-1973)
November 1972* March 1973
Location of school N
X SD X SD
a) Elementary school -
Zone I - 0.75 km from 35 1503 213 1563 219
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 42 1577 213 1618 243
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 50 1545 226 1623 260
ferroalloy plant
d) Elementary school -
island 23 1636 268 1651 280
*November, 1972: c-d P<0.05
83
-------
TABLE 53. FEV0.75 IN COMPARED GROUPS OF GIRLS (1972-1973)
November 1972 March 1973
Location of school N
X SD X SD
a) Elementary school -
Zone I - 0.75 km from 55 1449 268 1523 244
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 34 1480 188 1542 179
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 57 1441 196 1485 214
ferroalloy plant
d) Elementary school -
island 18 1540 245 1571 245
84
-------
TABLE 56. AGE AND HEIGHT COMPARISONS OF BOYS (1974-1975)
Location of school
N
November 1974
March 1975
Age
* t
Standing height Standing height
SD X
SD
SD
oo
a) Elementary school -
Zone I - 0.75 km from 53
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 32
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 69
ferroalloy plant
d) Elementary school -
island 21
8.0 0.3 131.2 5.2 133.1 5.3
8.1 0.3 129.5 5.8 132.0 5.7
8.0 0.3 132.6 5.8 134.5 6.0
8.0 0.3 131.5 5.3 133.7 5.6
November, 1974: a-b P<0.05
t.
March, 1975:
a-b P<0.05
b-c P<0.01
b-d P<0.01
-------
TABLE 57. AGE AND HEIGHT COMPARISON OF GIRLS (1974-1975)
Location of school
N
November 1974
March 1975
Age
* 4-
Standing height Standing height
SD X
SD
SD
oo
oo
a) Elementary school -
Zone I - 0.75 km from 46
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 52
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 46
ferroalloy plant
d) Elementary school -
island 13
8.0 0.4 130.2 5.2 132.0 5.0
8.0 0.5 127.3 5.1 130.0 5.1
8.0 0.2 129.5 5.7 131.7 5.7
8.1 0.3 132.1 4.5 133.8 4.7
November, 1974:
a-b P<0.05
b-c P<0.01
b-d P<0.01
t
March, 1975: b-c P<0.05
b-d P<0.05
-------
TABLE 58. FEV0.75 IN COMPARED GROUPS OF BOYS (1974-1975)
.. November 1974 March 1975
Location of school «
X SD X SD
a) Elementary school -
Zone I - 0.75 km from 53 1613 218 1631 216
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 32 1640 258 1644 269
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 69 1645 218 1657 221
ferroalloy plant
d) Elementary school -
island 21 1710 245 1683 266
89
-------
TABLE 59. FEV0.75 IN COMPARED GROUPS OF GIRLS (1974-1975)
, „., * t. , XT November 1974 March 1975
Location of school N
X SD X SD
a) Elementary school -
Zone I - 0.75 km from 46 1509 198 1525 184
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 52 1535 171 1563 184
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 46 1534 209 1543 203
ferroalloy plant
d) Elementary school -
island 13 1576 240 1553 269
90
-------
TABLE 60. FEVi.o PERCENT IN COMPARED GROUPS OF BOYS (1974-1975)*
Location of school N November i974 March 1975
SD X SD
a) Elementary school -
Zone I - 0.75 tan from 53 100.2 9.6 96.4 9.4
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 32 104.6 10.8 98.6 11.3
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 69 97.9 9.0 94.3 9.6
ferroalloy plant
d) Elementary school -
island 21 103.2 8.7 97.9 7.3
FEVi.o values are expressed as percentages of predicted values.
(Bjure, 1963).
November, 1974: a-b P<0.01
91
-------
TABLE 61. FEVi.o PERCENT IN COMPARED GROUPS OF GIRLS (1974-1975)*
T 4 * t. i XT November 1974f March 1975^
Location of school N
SD X SD
a) Elementary school -
Zone I - 0.75 km from 46 94.2 9.2 91.9 8.3
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 52 100.6 9.5 97.4 8.8
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 46 97.1 8.6 94.2 8.5
ferroalloy plant
d) Elementary school -
island 13 94.8 8.7 90.3 9.3
FEVi.o values are expressed as percentages of predicted values.
(Bjure, 1963).
November, 1974: b-c P<0.01
b-d P<0.05
#March, 1975: b-c P<0.01
b-d P<0.05
92
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TABLE 62. STRUCTURE OF COMPARED FAMILIES BY SCHOOL LOCATION OF 2nd GRADERS (1972-1973)
Location of school Brothers Grandfathers &
of 2nd graders 2nd graders Fathers Mothers & sisters grandmothers
a) Elementary school -
Zone I - 0.75 km from 94 91 94 103 22
ferroalloy plant
b) Elementary school -
Zone II - 2 km from 79 76 79 85 11
ferroalloy plant
c) Elementary school -
Zone II - 2.75 km from 115 114 114 120 21
^ ferroalloy plant
u>
d) Elementary school -
island 44 29 41 58 35
TOTAL 332 310 328 366 89
-------
TABLE 63. STRUCTURE OF COMPARED FAMILIES BY ZONES OF LIVING (1972-1973)
Zones of living
(according to manganese
concentrations in air)
Zone I
Zone II
Zone III
Island
TOTAL
2nd graders
94
169
25
44
332
Fathers
91
165
25
29
310
Mothers
94
168
25
41
328
Brothers
& sisters
103
182
23
58
366
Grandfathers
grandmothers
22
27
5
35
89
-------
TABLE 64. FAMILIES WITH CHILDREN BELOW 10 YEARS* BY LOCATION
OF SCHOOLS (1972-1973)
Families with
School children under
the age of 10
Elementary school -
Zone I - 0.75 km from 41 (43.6%)
ferroalloy plant
Elementary school -
Zone II - 2 km from 39 (49.4%)
ferroalloy plant
Elementary school -
Zone II - 2.75 km from 59 (51.8%)
ferroalloy plant
Elementary school -
island 19 (43.2%)
*These children do not include 2nd graders
95
-------
TABLE 65. SOCIOECONOMIC DATA ON FAMILIES BY SCHOOL LOCATION OF 2nd GRADERS (1972-1973)
Elementary school- Elementary school- Elementary school- Elementary
Zone 1-0.75 km from Zone II-2 km from Zone II-2.75 km from school-
ferroalloy plant ferroalloy plant ferroalloy plant island
N=94 N=79 N=114 N=44
Number of
family
members
Housing
conditions
Father's
occupation
Apartment
heating
3 members
4 members
5 members
one-room apartment
two-room apartment
three-room or larger
apartment
worker
office worker
other
heating:
kitchen only
other premises
too
14
57
23
11
30
53
68
19
7
77
17
(14.
(60.
(24.
(11.
(31.
(56.
(72.
(20.
(7.
(81.
(18.
9)*
6)
5)
7)
9)
4)
3)
2)
5)
9)
1)
10
50
19
10
31
38
44
25
10
54
25
(12.
(63.
(24.
(12.
(39.
(48.
(55.
(31.
(12.
(68.
(31.
7)
3)
0)
7)
2)
1)
7)
6)
7)
4)
6)
20
61
33
13
53
48
61
28
25
66
48
(17.6)
(53.5)
(28.9)
(11.4)
(46.5)
(42.1)
(53.5)
(24.6)
(21.9)
(57.9)
(42.1)
6
12
26
3
13
28
34
4
6
39
5
(13.6)
(27.3)
(59.1)
(6.8)
(29.5)
(63.6)
(77.3)
(9.1)
(13.6)
(88.6)
(11.4)
*The numbers in parentheses denote percents of the total number of families.
-------
TABLE 66. MEMBERS OF FAMILY PER ONE ROOM BY SCHOOL LOCATION
OF 2nd GRADERS (1972-1973)
Location of school
of 2nd graders Density rate
Elementary school -
Zone I - 0.75 km 1.65
from ferroalloy
plant
Elementary school -
Zone II - 2 km
from ferroalloy 1.72
plant
Elementary school -
Zone III - 2.75 km
from ferroalloy 1.78
plant
Elementary school -
island 1.67
97
-------
VO
00
TABLE 67. PARENTS' SMOKING HABITS BY SCHOOL LOCATION OF 2nd GRADERS (1972-1973)
Smoking habit of parents Elementary school- Elementary school- Elementary school- Elementary
Zone 1-0.75 km from Zone II-2 km from Zone II-2.75 km from school-
ferroalloy plant ferroalloy plant ferroalloy plant island
Both parents smoke 3 (1-6)* 5 (3.0)
Father or mother smokes 38 (20.5) 45 (27.3)
TOTAL 41 (22.1) 50 (30.3)
10 (4.4) 4 (5.7)
69 (30.3) 20 (28.6)
79 (34.7) 24 (34.3)
*The numbers in parentheses denote percentages of the total number of parents (fathers and mothers)
-------
TABLE 68. NUMBER OF ILL PERSONS IN FAMILIES BY SCHOOL LOCATION OF 2nd GRADERS (1972-1973)
Location of school
of 2nd graders
2nd
graders
Fathers Mothers
Brothers
and
sisters
Grand-
fathers
and
grand-
mothers
so
Elementary school -
Zone I - 0.75 km from
ferroalloy plant
Elementary school -
Zone II - 2 km from
ferroalloy plant
Elementary school -
Zone II - 2.75 km from
ferroalloy plant
Elementary school -
island
49 (52.1)* 26 (28.6) 35 (37.2) 50 (48.5) 8 (36.4)
42 (53.2) 19 (25.0) 34 (43.0) 31 (36.5) 4 (36.4)
69 (60.0) 51 (44.7) 62 (54.4) 66 (55.0) 7 (33.3)
23 (52.3) 5 (17.2) 13 (31.7) 29 (50.0) 8 (22.8)
*The numbers in parentheses denote percents of the total number of persons in particular subgroups
of the family.
-------
TABLE 69. DISTRIBUTION OF ILL BY DISEASE RATE (BY SCHOOL LOCATION OF 2nd GRADERS); (1972-1973)
o
o
Location of school
of 2nd graders
Elementary school -
Zone I - 0.75 km from
ferroalloy plant
Elementary -
Zone II - 2 km from
ferroalloy plant
Elementary school
Zone II - 2.75 km from
ferroalloy plant
Elementary school -
island
Number of the 2nd
ill by rate graders
of disease
once
twice
three times
four times
once
twice
three times
four times
once
twice
three times
four times
once
twice
three times
four times
Fathers
Mothers
Brothers
and
sisters
29
16
3
1
24
16
2
0
40
22
6
1
13
9
1
0
(59.2)*
(32.6)
C6.1)
(2.0)
(57.1)
C38.1)
(4.8)
—
(58.0)
C31.9)
(8.7)
Cl. 4)
(56.5)
C39.1)
(4.3)
—
24
2
0
0
16
3
0
0
42
8
1
0
5
0
0
0
(92.3)
(7.7)
-
—
C84.2)
(15.8)
-
—
(82.4)
(15.7)
C2.0)
—
Cioo.o)
-
-
—
28
4
3
0
22
11
1
0
46
15
1
0
11
2
0
0
(80.0)
(11.4)
(8.6)
-
(64.7)
(32.4)
(2.9)
—
(74.2)
(24.2)
(1.6)
-
(84.6)
(15.4)
-
—
36
10
4
0
21
6
3
1
45
19
2
0
23
5
1
0
(72.0)
(20.0)
(8.0)
-
(67.7)
(19.4)
(9.7)
(3.2)
(68.2)
(28.8)
(3.0)
-
(79.3)
(17.2)
(3.4)
-
Grand-
fathers
and
grand-
mothers
5
2
1
0
2
1
1
0
7
0
0
0
6
1
1
0
(62.5)
(25.0)
(12.5)
-
(50.0)
(25.0)
(25.0)
-
(100.0)
-
_
-
(75.0)
(12.5)
(12.5)
-
*The numbers in parentheses denote percents of the total number of the ill in each group.
-------
TABLE 70. ACUTE RESPIRATORY DISEASES IN FAMILIES BY CATEGORIES; BY SCHOOL LOCATION OF 2nd GRADERS (1972-1973)
Location of school
of 2nd graders
Acute
respiratory
disease
Acute
respiratory
disease
with
elevated
temperature
Acute respi- Acute respiratory
ratory disease with ele-
disease with vated temperature
elevated tern- and staying in bed.
perature and Physician consulted.
staying in bed Pneumo- Other
nia diseases
Total
2nd Elementary school -
graders Zone 1-0.75 km from
ferroalloy plant
Elementary school -
Zone II-2 km from
ferroalloy plant
Elementary school -
40 C42.6)* 7 (7.4)
25 (31.6)
3 C3.8)
2 C2.1)
12 (15.2)
3 (3.2) 27 (28.7) 79 (84.0)
35 (44.3) 75 (94.9)
Zone II-2.75 km from
ferroalloy plant
Elementary school -
island
59
5
(51
(11
.3)
.4)
7 (6.1)
0
20
4
(17. 4)
(9.1)
2 (1.7)
0
28
25
(24.3)
(56.8)
116
34
(100.9)
(77.3)
Fathers Elementary school -
Zone 1-0.75 km from
ferroalloy plant
Elementary school -
Zone II-2 km from
ferroalloy plant
Elementary school -
Zone II-2.75 km from
ferroalloy plant
Elementary school -
island
14 (15.4)
4 (4.4)
8 (10.5) 2 (2.6)
36 (31.61 4 (3.51
0 -
1 (1.1)
5 (6.6)
9 (7.8)
2 (6.9)
10 (11.0) 29 (31.9)
8 (10.5) 23 (30.3)
1 (0.9) 12 (10.5) 62 (54.4)
3 (10.3) 5 (17.2)
(continued)
-------
TABLE 70. (continued)
Location of school
of 2nd graders
Acute
respiratory
disease
Acute
respiratory
disease
with
elevated
temperature
Acute respi- Acute respiratory
ratory disease with ele-
disease with vated temperature
elevated tern- and staying in bed.
perature and Physician consulted.
staying in bed Pneumo- Other
nia diseases
Total
Mothers Elementary school -
Zone 1-0.75 km from 27 (28.7) 6 (6.4)
ferroalloy plant
Elementary school -
Zone I1-2 km from
ferroalloy plant
Elementary school -
Zone II-2.75 km from
ferroalloy plant
21 (26.6) 6 (7.6)
57 (44.7) 12 (10.5)
Elementary school - 3 (7.3) 1 (2.4)
island
1 (1.1)
6 (7.6)
9 (7.9)
1 (2.4)
0 - 6 (6.4) 40 (42.6)
0 - 14 (17.7) 47 (59.5)
0 - 9 (7.9) 81 (71.1)
1 (2.4) 9 (22.0) 15 (36.6)
Brothers Elementary school -
and Zone 1-0.75 km from
sisters ferroalloy plant
Elementary school -
Zone II-2 km from
ferroalloy plant
Elementary school -
Zone II-2.75 km from
ferroalloy plant
Elementary school -
island
24 (23.3) 7 (6.8)
16 (18.8) 3 (3.5)
34 (28.3) 12 (10.0)
2 (3.4)
1 (1.7)
6 (5.8)
5 (5.9)
15 (12.5)
3 (5.2)
2 (1.9) 27 (26.2) 66 (64.1)
0 - 19 (22.4) 43 (50.6)
2 (1.7) 27 (22.5) 90 (75.0)
32 (55.2) 38 (65.5)
(continued)
-------
TABLE 70. (continued).
Location of school
of 2nd graders
Acute
respiratory
Acute disease
respiratory with
disease elevated
temperature
Acute respi-
ratory
disease with
Acute respiratory
disease with ele-
vated temperature
elevated tern- and staying in bed.
perature and Physician consulted.
staying in bed Pneumo- Other
nia diseases
Total
Grand-
fathers
and
grand-
mothers
Elementary school -
Zone 1-0.75 km from 7 (31.8) 3 (13.6) 0
ferroalloy p Lant
Elementary school -
1 (4.5) 1 (4.5) 12 (54.5)
Zone II-2 km from 4 (36.4) 0
ferroalloy plant
Elementary school -
Zone II-2.75 km from 5 (23.8) 1 (4.8)
ferroalloy plant
Elementary school - 1 (2.9) 0
0
1 (4.8)
2 (5.7)
4 (36.4) 8 (72.7)
0 - 0
7 (33.3)
7 (20.0) 10 (28.6)
*The numbers in parentheses denote percents of the total number of persons inparticular groups.
-------
TABLE 71. ACUTE RESPIRATORY DISEASE, BEDRIDDEN, WITH ELEVATED TEMPERATURE - PHYSICIAN CONSULTED;
BY SCHOOL LOCATION OF 2ND GRADERS (1972-1973)
Location of school of
2nd graders
Disease
2nd
graders
Fathers
Mothers
Brothers
and
sisters
Grand-
fathers
and
Grand-
mothers
Elementary school -
Zone 1-0.75 km from
ferroalloy plant
Diseases of the upper
respiratory tract
Diseases of the lower
respiratory tract
Influenza
18 (19.1)* 7 (7.7)
9 (9.6) 3 (3.3)
0 - 0 -
5 (5.3)
1 (1.1)
0
21 (20.4)
0
6 (5.8) 1 (4.5)
0 - 0 -
Elementary school -
Zone II-2 km from
ferroalloy plant
Diseases of the upper
respiratory tract
Diseases of the lower
respiratory tract
Influenza
19 (24.0) 3 (3.9)
13 (16.4) 0 -
3 (3.8) 5 (6.6)
8 (10.1) 12 (11.6) 2 (20.1)
1 (1.3) 4 (3.9) 2 (20.1)
5 (6.3) 3 (3.5) 0
Elementary school -
Zone II-2.75 km from
ferroalloy plant
Diseases of the upper
respiratory tract
Diseases of the lower
respiratory tract
Influenza
19 (16.5) 10 (8.8)
9 (7.8) 2 (1.8)
0 - 0 -
7 (6.1)
2 (1.8)
0
19 (15.8)
0
8 (6.7) 0
0 - 0
Elementary school -
island
Diseases of the upper
respiratory tract
Diseases of the lower
respiratory tract
Influenza
11 (25.0) 1 (3.5)
14 (31.8) 2 (6.9)
0 0 -
4 (9.8)
5 (12.2)
0
12 (20.7)
0
20 (34.5) 7 (20.0)
0 - 0 -
*The numbers in parentheses denote percents of the total number of persons in particular groups.
-------
TABLE 72. STRUCTURE OF COMPARED FAMILIES BY SCHOOL LOCATION OF 2ND GRADERS (1974-1975)
Location of schools
of 2nd graders
2nd graders
Brothers Grandfathers &
Fathers Mothers & sisters grandmothers
Elementary school -
Zone I - 0.75 km from 98
ferroalloy plant
Elementary school -
Zone II - 2 km from
ferroalloy plant
Elementary school -
island
84
Elementary school -
Zone II - 2.75 km from 114
ferroalloy plant
60
91
78
109
51
95
81
111
57
100
75
101
116
22
14
18
45
Total
356
329
344
392
99
-------
TABLE 73. STRUCTURE OF COMPARED FAMILIES BY ZONES OF RESIDENCE (1974-1975)
Zones of living
(according to 2nd graders
manganese concen-
trations in air)
Zone I 98
Zone II 147
Zone III 51
Island 60
Brothers
Fathers Mothers & sisters
91 95 100
139 142 134
48 50 42
51 57 116
Grandfathers &
grandmothers
22
28
4
45
Total 356 329 344 392 99
-------
TABLE 74. FAMILIES WITH CHILDREN UNDER AGE 10* BY SCHOOL LOCATION
OF 2ND GRADERS (1974-1975)
Location of schools No. of families with
children under age of 10
Elementary school -
Zone I - 0.75 km from
ferroalloy plant
Elementary school -
Zone II - 2 km from 42 (50.0%)
ferroalloy plant
Elementary school -
Zone II - 2.75 km from 51 (44.7%)
ferroalloy plant
Elementary school -
island 37 (61.7%)
*These children do not include 2nd graders.
107
-------
TABLE 75. SOCIOECONOMIC DATA OF FAMILIES BY SCHOOL LOCATION OF 2ND GRADERS (1974-1975)
o
00
Elementary school - Elementary school - Elementary school - Elementary
Zone 1-0.75 km from Zone II-2 km from Zone II-2.75 km from school -
ferroalloy plant
Number of
family
members
Housing
condi-
tions
Father's
occupa-
tion
Apartment
heating
3 members
4 members
5 members
one-room apartment
two-room apartment
three-room or larger
apartment
worker
office worker
other
heating:
kitchen only
other premises
too
15
52
30
23
24
50
58
33
4
72
25
(15
(53
(30
(23
(24
(51
(61
(34
(4.
(74
(25
.5)*
• 6)
.9)
.7)
.7)
.6)
.1)
.7)
2)
.2)
.8)
ferroalloy plant ferroalloy plant island
16
46
21
13
34
36
41
32
10
56
27
(19
(55
(25
(15
(41
(43
(49
(38
(12
(67
(32
.3)
.4)
.3)
.7)
.0)
.3)
.4)
.6)
.0)
• 5)
.5)
20
64
27
9
64
38
57
39
15
72
39
(18.0)
(57.7)
(24.3)
(8.1)
(57.7)
(34.2)
(51.4)
(35.1)
(13.5)
(64.9)
(35.1)
2
10
48
2
11
47
43
7
10
45
15
(3.3)
(16.7)
(80.0)
(3.4)
(18.3)
(78.3)
(71.7)
(11.7)
(16.7)
(75.0)
(25.0)
*Numbers in parentheses denote percents of the total number of families.
-------
TABLE 76. MEMBERS OF THE FAMILY PER ONE ROOM BY SCHOOL LOCATION OF
2ND GRADERS (1974-1975)
Location of school
of 2nd graders
Density rate
Elementary school -
Zone II - 2.75 km from
ferroalloy plant
1.78
Elementary school -
Zone II - 2 km from
ferroalloy plant
1.77
Elementary school -
Zone I - 0.75 km from
ferroalloy plant
1.81
Elementary school -
island
1.63
109
-------
TABLE 77. SMOKING HABIT OF PARENTS BY SCHOOL LOCATION OF 2ND GRADERS (1974-1975)
Elementary school - Elementary school - Elemenetary school - Elementary
Smoking habit of parents Zone 1-0.75 km from Zone II-2 km from Zone II-2.75 km from school -
ferroalloy plant ferroalloy plant ferroalloy plant island
Both parents smoke
Father or mother smokes
3 (1.6)*
52 (27.9)
5 C3.1)
49 (30.8)
11 (5.0)
58 (26.4)
26 (24.1)
0
Total
55 (29.5)
M
CD
54 (33.9)
69 (31.4)
26 (24.1)
*The numbers in parentheses denote percentages of the total number of parents
(fathers and mothers).
-------
TABLE 78. NUMBER OF ILL IN FAMILIES BY SCHOOL LOCATION OF 2ND GRADERS (1974-1973)
Location of schools
2nd graders Fathers Mothers
Brothers Grandfathers &
& sisters grandmothers
Elementary school -
Zone I - 0.75 km from
ferroalloy plant
57 (58.2)* 26 (28.6) 49 (51.6) 53 (53.0) 2 (9.1)
Elementary school -
Zone II - 2 km from
ferroalloy plant
46 (54.8) 29 (37.2) 29 (35.8) 40 (53.3) " 1 (7.1)
Elementary school -
Zone II - 2.75 km from
ferroalloy plant
63 (55.3) 45 (41.3) 57 (51.4) 51 (50.5) 3 (16.7)
Elementary school -
Island
22 (36.7)
10 C19.6) 12 (21.1) 29 (25.0) 6 (13.3)
*Numbers in parentheses are percentages of the total number of persons in particular
segments of the family.
-------
TABLE 79. DISTRIBUTION OF ILL BY DISEASE RATE AND SCHOOL LOCATION OF 2ND GRADERS (1974-1975)
Elementary
school -
Zone I -
0.75 km from
ferroalloy
plant
Elementary
school -
Zone II -
2 km from
ferroalloy
plant
Elementary
Z jne II -
2.75 km from
ferroalloy
plant
Elementary
school -
island
Number of the
ill by rate
of disease
once
twice
three times
four times
once
twice
three times
four times
once
twice
three times
four times
once
twice
three times
four times
2nd graders
38 (66.7)*
14 (24.6)
3 (5.2)
2 (3.5)
28 (61.9)
11 (23.9)
7 (15.2)
0
37 (58.7)
19 (30.2)
4 (6.3)
3 (4.8)
17 (77.3)
4 (18.2)
1 (4.5)
0 -
Fathers
17 (65.4)
9 (34.6)
0
0
20 (69.0)
6 (20.7)
3 (10.3)
0 -
34 (75.6)
8 (17.8)
2 (4.4)
1 (2.2)
10
0
0
0 -
Mothers
30 (62.2)
13 (26.5)
5 (10.2)
1 (2.0)
20 (69.0)
9 (31.0)
0
0 -
36 (63.2)
14 (24.6)
4 (7.0)
3 (5.2)
10 (83.3)
2 (16.7)
0
0
Brothers
& sisters
26 (50.1)
20 (37.7)
5 (9.4)
2 (3.8)
22 (55.0)
11 (27.5)
7 (17.5)
0 -
28 (54.9)
13 (25.5)
6 (11.8)
4 (7.8)
25 (86.2)
3 (10.4)
1 (3.4)
0 -
Grandmothers &
grandfathers
2
0
0
0
1
0
0
0
2
1
0
0
6
0
0
0
^Numbers in parentheses are percentages of the total number of the ill in each group.
-------
TABLE 80. CATEGORIES OF ACUTE RESPIRATORY DISEASES IN FAMILIES BY LOCATION
OF SCHOOL OF 2nd GRADERS (1974-1975)
Location of school
of 2nd Graders
Acute respi-
ratory
disease
Acute Acute respi-
respiratory ratory
disease disease with
with elevated tern-
elevated perature and
temperature staying in bed
Acute respiratory
disease with ele-
vated temperature
and staying in bed.
Physician consulted.
Pneumo- Other
nia diseases
Total
2nd Elementary school-
Graders Zone 1-0.75 km from
ferroalloy plant
Elementary school-
Zone II-2 km from
ferroalloy plant
Elementary school
Zone II-2.75 km from
ferroalloy plant
Elementary school-
island
24 (24.5)* 5 (5.1)
2 (2.0)
16 0-9.0)
36 (31.6)
0 -
1 C1.2) 3 (3.6)
1 (0.9) 7 (6.1)
0 -
2 (3.3)
3 (3.1) 44 (44.9) 78 (79.6)
1 (1.2) 42 (50.0) 63 (75.0)
3 (2.6) 48 (42.1) 96 (84.2)
2 (3.3) 23 (38.3) 27 (45.0)
Fathers Elementary school-
Zone 1.0.75 km from 8 C8.8)
ferroalloy plant
Elementary school-
Zone II-2 km from 15 (19.2)
ferroalloy plant
Elementary school-
Zone II-2.75 km from 22 (20.2)
ferroalloy plant
Elementary School-
island 2 (3.9)
2 (2.2) 2 (2.2)
0 -
0 -
3 (2.8) 6 (5.5)
0 -
0 -
0 -
19 (20.9) 31 (34.1)
1 (1.3) 23 (29.5) 39 (50.0)
0 -
25 (22.9) 56 (51.4)
2 (3.9) 7 (13.7) 11 (21.6)
(continued)
-------
TABLE 80. (Continued)
Location of school
of 2nd Graders
Acute respi-
ratory
disease
Acute Acute respi- Acute respiratory
respiratory ratory disease with ele-
disease disease with vated temperature
with elevated tern- and staying in bed.
elevated perature and Physician consulted.
temperature staying in bed Pneumo- Other
nia diseases
Total
Mothers
Elementary school-
Zone 1-0.75 km from 17 (17.9)
ferroalloy plant
Elementary school-
Zone II-2 km from 17 (21.0)
ferroalloy plant
Elementary school-
Zone II-2.75 km from 30 (27.0)
ferroalloy plant
Elementary school-
island 0
5 (5.3) 2 (2.1)
1 (1.2)
0 -
0 -
8 (7.2) 5 (4.5)
0 -
0 - 42 (44.2) 66 (69.5)
0 - 19 (23.5) 37 (45.7)
3 (2.7) 29 (26.1) 75 (67.6)
0 -
14 (24.6) 14 (24.6)
Brothers
a ad
s Lsters
Elementary school-
Zone 1-0.75 km from 14 (14.0)
ferroalloy plant
Elementary school-
Zone II-2 km from 13 (17.3)
ferroalloy plant
Elementary school-
Zone II-2.75 km from 25 (24.5)
ferroalloy plant
Elemantary school-
island 1 (0.9)
3 (3.0) 5 (5.0)
4 (5.3) 3 (4.0)
2 (2.0) 1 (1.0)
1 (1.0) 58 (58.0) 91 (91.0)
1 (1.3) 42 (56.0) 63 (84.0)
2 (2.0) 46 (45.5) 76 (75.2)
0 -
1 (0.9)
0 -
32 (27.6) 34 (29.3)
(continued)
-------
TABLE 80. (Continued)
Location of school
of 2nd Graders
Acute respi-
ratory
disease
Acute Acute respi-
respiratory ratory
disease disease with
with elevated tern-
elevated perature and
temperature staying in bed Pneumo-
nia
Acute respiratory
disease with ele-
vated temperature
and staying in bed.
Physician consulted.
Other
diseases
Total
Grandfathers
and
grandmothers
Elementary school
Zone 1-0.75 km from
ferroalloy plant
Elementary school-
Zone II-2 km from
ferroalloy plant
Elementary school-
Zone II-2.75 km from
ferroalloy plant
Elementary school-
island
1 (4.5)*
1 (7.1)
1 (4.5) 2 (9.1)
1 (7.1)
3 (16.6) 3 (16.6)
*The numbers in parentheses denote percents of the total number of persons in particular groups.
-------
TABLE 81. ACUTE RESPIRATORY DISEASE, BEDRIDDEN, ELEVATED TEMPERATURE - PHYSICIAN CONSULTED; BY
SCHOOL LOCATION OF 2ND GRADERS (1974-1975)
Location of school
of 2nd graders
Disease
2nd
graders
Fathers Mothers
Brothers
and
sisters
Grandfathers
and
grandmothers
Elementary school -
Zone 1-0.75 km from
ferroalloy plant
Diseases of the upper
respiratory tract
Diseases of the lower
respiratory tract
Influenza
19 (19.4)* 5 (5.5) 14 (14.7) 26 (26.0)
0
18 (18.4) 5 (5.5) 15 (15.8) 22 (22.0) 0
7 (7.1) 9 (9.9) 13 (13.7) 10 (10.0) 1 (4.5)
Elementary school -
Zone II-2 km from
ferroalloy plant
Diseases of the upper
respiratory tract
Diseases of the lower
respiratory tract
Influenza
8 (9.5) 6 (7.7) 5 (6.2) 19 (25.3) 0
21 (25.0) 8 (10.3) 8 (9.9) 17 (22.7) 0
13 (15.5) 9 (11.5) 6 (7.4) 6 (8.0) 0
Elementary school -
Zone II-2.75 km frcm
ferroalloy plant
Diseases of the upper
respiratory tract
Diseases of the lower
respiratory tract
Influenza
19 (16.7) 9 (8.3) 12 (10.8) 17 (16.8) 1 (5.6)
24 (21.0) 8 (7.3) 13 (11.7) 22 (21.8) 1 (5.6)
5 (4.4) 8 (7.3) 4 (3.6) 7 (6.9) 1 (5.6)
(continued)
-------
TABLE 81. (continued)
Location of school
of 2nd graders
Elementary school -
island
Disease
2nd
graders
Diseases of the upper
respiratory tract
Diseases of the lower
respiratory tract
Influenza
11
10
2
(18.3)
(16.7)
(3.3)
Fathers Mothers
0 - 4
7 (13.7) 5
0 - 5
(7
(8
(8
.0)
.8)
.8)
Brothers
and
sisters
10 (8.
17 (14
5 (4.
6)
.7,
3)
Grandfathers
and
grandmothers
1
4
1
(2.2)
(8.8)
(2.2)
*The numbers in parentheses denote percents of the total number of persons in particular groups.
-------
TABLE 82. NUMBER OF FATHERS IN COMPARED GROUPS BY HOME LOCATION
Zones according
to manganese
concentrations
in air
N Mean age
Present &
past smokers
Nonsmokers
Zone I
70 38.4 (SD=5.5)* 38 (54.3)
32 (45.7)
Zone II
120 39.0 (SD=6.6) 87 (72.5)
33 (27.5)
Zone III
21 38.7 (SD=5.1) 16 (76.2)
5 (23.8)
Island
21 40.2 (SD=7.7) 13 (61.9)
8 (38.1)
*The numbers in parentheses denote percents.
118
-------
TABLE 83. NUMBER OF MOTHERS IN COMPARED GROUPS BY HOME LOCATION
Zones according
to manganese
concentrations
in air
N Mean age
Present & Nonsmokers
past smokers
Zone I
82 34.2 (SD=5.0)* 6 (7.3)
76 (92.7)
Zone II
148
34.6 (SD=5.3) 29 (19.6)
119 (80.4)
Zone III
27 33.6 (SD=4.5) 4 (14.8)
23 (85.2)
Island
39 36.5 (SD=6.3) 7 (25.9)
32 (82.1)
*The numbers in parentheses denote percents.
119
-------
TABLE 84. RESPIRATORY SYMPTOMS AND FORCED EXPIRATORY VOLUMES IN MEN SMOKERS BY ZONES
ACCORDING TO MANGANESE CONCENTRATIONS IN AIR
ho
o
Zones according
to manganese N
Concentrations
in air
Zone I 38
Zone II 87
Zone III 16
Island 13
Phlegm per
day
f %
6 15.8
19 21.8
1 6.3
3 23.1
Chronic
bronchitis
f %
7 18.4
15 17.2
1 6.3
2 15.4
Regular
wheezing in FVC %
the chest
f % X SD
2 5.3 94.2 12.2
8 9.2 93.9 10.8
2 12.5 96.0 10.8
1 7.7 93.4 9.1
FEVi.o % FEVi.o/FVC %*
X~ SD X SD
96.1 17.9 78.5 9.8
97.6 12.2 79.4 6.6
101.4 12.3 81.0 4.2
98.8 10.9 81.0 5.1
*FEVi o/FVC (%) I - III P<0.01
II - III P<0.05
-------
TABLE 85. RESPIRATORY SYMPTOMS AND FORCED EXPIRATORY VOLUMES IN MEN NONSMOKERS BY ZONES
ACCORDING TO MANGANESE CONCENTRATIONS IN AIR
Phlegm per Chronic Regular
Zones according day bronchitis wheezing in FVC %
to manganese N the chest
FEVi,
a/
, 0 f*
FEVi. o /FVC %
concentrations
in air
Zone I
Zone II
Zone III
Island
f % f % f % X
32 4 12.5 2 6.3 1 3.1 97.1
33 1 3.0 94.2
5 93.6
8 1 87.8
SD
9.4
14.5
15.2
13.8
X
102.2
102.5
98.2
94.2
SD
14.1
15.6
15.5
16.4
X
81.4
83.7
82.6
81.5
SD
8.5
4.6
3.5
8.5
-------
TABLE 86. RESPIRATORY SYMPTOMS AND FORCED EXPIRATORY VOLUMES IN WOMEN SMOKERS BY ZONES
ACCORDING TO MANGANESE CONCENTRATIONS IN AIR
N3
NJ
Phlegm per Chronic Regular
Zones according day Bronchitis wheezing in FVC %
to manganese N the chest
concentrations
in air f % f % f % X SD
Zone 16 21 95.8 7.8
Zone II 29 1 3.4 2 6.9 2 6.9 95.7 11.3
Zone III 4 102.7 6.1
Island 7 1 1 93.4 5.5
FEVi.o % FEVi.o/FVC -
X SD X SD
97.4 9.6 81.2 3.1
101.2 13.9 84.2 6.5
107.0 4.5 83.5 2.7
99.0 9.1 84.0 3.3
-------
TABLE 87. RESIPRATORY SYMPTOMS AND FORCED EXPIRATORY VOLUMES IN WOMEN NONSMOKERS BY ZONES
ACCORDING TO MANGANESE CONCENTRATIONS IN AIR
Phlegm per
Zones according day
to manganese N
concentrations
in air f %
Chronic Regular
Bronchitis wheezing in FVC %
the chest
f % f % X SD
FEVi.o % FEVi.o/FVC ^
X SD X SD
Zone I
76
1 1.3
3 3.9
1 1.3 92.2 12.0 97.9 13.7 83.9 5.9
Zone II
119
3 2.5
4 3.4
4 3.4 93.5 12.6 99.4 13.1 84.7 6.8
U>
Zone III
23
92.2 10.6 102.3 11.6 88.3 3.2
Island
32
92.4 12.4 98.4 12.9 83.4 6.9
*FEVi.o/FVC (%) I - III P<0.01
II - III P<0.05
-------
SECTION 9
POSSIBLE CATALYTIC EFFECT OF MANGANESE IN FLUE DUST
ON SULFUR DIOXIDE
In order to clarify the possible catalytic effect of manganese containing
flue dust on the conversion of sulfur dioxide in the air, this study examined
differences in the relationship between sulfur dioxide and sulfur concentrations
in a polluted environment and the relationship between the two in a control
environment. In addition to manganese, other components in the airborne par-
ticulates, such as gaseous ammonia, ammonium ion, iron, lead, and copper, were
simultaneously measured. In the first experiments, the temperature and humidity
of the air were also recorded. A determination was made of the various relation-
ships among the components in summer, in winter, and at various distances from
the manganese source. In addition, the distribution of all the measured par-
ticulate components was determined.
At first, it was planned to determine sulfuric acid and sulfate separately.
However, as there is no satisfactory method either for preserving sulfuric acid
in the free form during the collection and handling of a sample or for separating
free sulfuric acid from sulfate, only the total sulfate was determined.
Within another project, the sulfur dioxide/sulfate relationship was studied
on other urban and industrial areas, and these data have also been compared in
the final evaluation of results.
MATERIALS AND METHODS
Determination of Sulfur Dioxide and Ammonia in the Air
Samples of sulfur dioxide were collected in a 1-percent solution of hydro-
gen peroxide from 2 m3 of air over 24 hours. The sulfate formed by oxidation
of sulfur dioxide was determined by titration with barium perchlorate in the
presence of thorin indicator by means of an EEL titrator (Methods for Measuring
Air Pollution, OECD, 1964). Samples of ammonia were collected in a 0.01 per-
cent solution of HaSOit from 2 m3 of air over 24 hours. The yellow color
developed with the Nessler's reagent was measured at 440 ym with a spectro-
photometer UNICAM SP 600.
Determination of the Total Suspended Particulate Matter (TSP)
The total suspended particulates were collected on glass fiber filters
from about 250 m3 of air over 24 hours. The filters were washed before use
according to the procedure described by Scaringelli and Rehme (1969). Before
and after the sampling, they were equilibrated to a relative humidity by a
desiccator and weighed.
124
-------
One quarter of the samples was extracted by distilled water in a Soxhlet
apparatus, cations were removed by ion exchange, the solution was evaporated
to a small volume, and the sulfate content was determined in the same way as
in the sulfur dioxide determination.
From the second quarter of the samples, ammonia was liberated by dis-
tillation with 20-percent NaOH and collected in 0.01-percent HaSOi,. The same
method of analysis was applied as for the gaseous ammonia. The third quarter
was extracted by nitric acid in a Soxhlet apparatus. The extract was evapo-
rated to dryness in order to remove the acid, and the residue was dissolve
in 1-percent EDTA and analyzed by atomic absorption spectrophotometry for
manganese, lead, iron, and copper.
Determination of the Distribution of Suspended Particulates
The selective sampling of suspended particulates was measured by means of
a modified Anderson cascade impactor on glass fiber filter media, from about
200 m3 of air over 24 hours. Samples were analyzed in the same way as the TSP
samples.
RESULTS
The first set of data was collected simultaneously in June 1974, over 20
consecutive days in an area polluted with manganese dust and in a comparable
control area. The arithmetic means and standard deviations of all measured
components in the two compared areas are shown in Table 88. The significance
of difference between the arithmetic means of the same components in the two
areas are presented in Table 89, and the correlation among various components
in each area appears in Table 90. The mass median diameters of particulate
components and the geometric standard deviations are shown in Table 91.
The second set of data was collected on 59 weekdays between April and
September 1975, in the area polluted with manganese dust only. Arithmetic
means, standard deviations, and range of results for all measured components
are presented in Table 92, and correlation between the components is shown
in Table 93. Variations in daily means of the measured components are shown
in Figures 5, 6, and 7, and the relationships between sulfate and ammonium
ion and sulfate and manganese concentration are illustrated in Figures 8 and
9. The third set of data was collected on 59 weekdays between October 1975
and January 1976. These data were compared with the summer results obtained
earlier in 1975. Arithmetic means and standard deviations of both summer and
winter results of all measured components are shown in Table 94 and the corre-
lation between the components appears in Table 95.
The fourth set of data was collected simultaneously on 34 weekdays between
April and June 1976 at three distances from the ferromanganese plant. Arith-
metic means and range of results from all three sites are shown in Table 96
and the correlation between the measured components at each site is given in
Table 97.
125
-------
The results of the. first set of data have shown that the correlation
between sulfate and ammonium ion was high in the control area, while no
correlation was found in the area polluted with manganese dust. In the
latter area sulfate was in good correlation with manganese concentration.
In both areas there was an excess of sulfate in TSP over the simultaneously
present ammonium ion, but the excess was much higher in the polluted area.
It was observed that the sulfate concentration does not rise necessarily
with the rising sulfur dioxide concentration, and that if it does, it rises
at a much lower rate. Therefore, there is a negative correlation between the
SOi^ /S02 ratio and S02. In all calculations sulfate was expressed as equiva-
lent S02 concentration and for simplicity reasons it will be called "sulfate S"
in further text. The sum of S02 and sulfate (as S02) will be referred to as
"total S".
The results of the second set of data have confirmed the first findings.
As shown in Figures 8 and 9 again, no correlation was found between ammonium
and sulfate ion, but a high correlation was observed between sulfate and
manganese in the TSP. Both sulfate and manganese were in good correlation
with the TSP, as were iron and lead, which may be an indication of their
common origin. In contrast, ammonium ion was in no correlation with the TSP
or any of the particulate components.
The distribution did not give more information on the possible mechanism
of sulfate formation. The largest fraction of sulfate was found in the fourth
separation stage, and the largest fraction of manganese in the first. The
smaller sulfate particles seem to be combined with ammonium, while the larger
probably come from sea salts. The distribution is similar in the polluted and
in the control areas.
The seasonal differences in the relationship between sulfur dioxide and
particulate components indicate that although lower concentrations of all
measured components were found in winter (because of the local climate and a
lower production rate in winter), a relatively larger part of the particulate
pollution comes from other sources, such as heating, than in summer. In winter
the correlation between sulfate and manganese or iron was lower, while between
sulfate and ammonia, it was much higher than in summer. The percent of sulfate
in the TSP and in the total S was, however, higher in summer (Table 94).
From the last set of data, it is noticeable that both relative and absolute
contents of manganese in the TSP decrease with distance from the major source.
TSP is the highest at site 1 and the lowest at site 2. The absolute sulfate
content is the lowest at site 2, but since the TSP concentration is also the
lowest at this site, it actually has the highest relative content of sulfate
in the TSP of all three sites. Site 1 has the lowest absolute and relative
content of ammonia, and site 2 the highest.
_l_ »
The correlations show that the S0i» /NHi» relationship varies from prac-
tically no correlation at site 1 to a good and a very good correlation at
sites 2 and 3 respectively. At the same time the correlation between sulfate
and manganese decreases with the distance as does the correlation between
manganese and the TSP. On the other hand, the correlation between ammonium
ion and TSP increases with the distance from the source.
126
-------
The results indicate that during transport, manganese particles are partly
removed from the air (larger particles may settle down) and partly diluted by
dispersion and mixing with dust of other origin. The increase in the relative
sulfate content of the TSP from site 1 to site 2 may be due either to a further
conversion of sulfur dioxide or to the contribution from other sources, for
example, combustion of fuel for various purposes and sea salts.
Most striking in this investigation, as well as in the investigation
carried out under another project which studied creas polluted by lead and
cement dust and other urban areas, are the characteristic regression equations
in urban and industrial areas for the relationship between absolute or relative
concentrations of the sulfate S and the total S. The relationship obtained in
various areas as well as from the 3-year averages of sulfate and sulfur dioxide
concentrations at 15 urban sites in the USA (Altschuller, 1976) are presented
in Table 98.
The relationship between the absolute concentrations of the sulfate S and
the total S shows a very slow rise of the sulfate S with the total S in the
three groups of urban data (slope Ii-s: 0.05). The two runs of data in the
manganese polluted area show that a higher concentration of the sulfate S than
in urban areas for the same total S concentration is obtained in the presence
of manganese aerosol (slope Is $: 0.14-0.19). In the presence of cement dust,
sulfate formation is further increased (slope ~Lj: 0.35).
As the slope of equation I increases, the slope of equation II decreases
and so does the correlation between the relative portion of the sulfate S and
the total S, ending with no correlation at all in the area polluted with cement
dust.
These findings indicate that the limitation of sulfur dioxide conversion
is significantly influenced by aerosol composition. The mechanisms of these
processes could be associated with those occurring in water phase according
to experimental data reviewed or obtained by Barrie (1976). These show that
both sulfur dioxide absorption and oxidation are pH dependent and slow down
below pH 6 unless catalysts like managanese salts are present. Alkaline
substances keep both processes going simply by increasing the pH.
To what extent our findings can be attributed to the sulfur dioxide con-
version at the relatively low concentrations of manganese and sulfur dioxide
in the ambient air and to what extent they reflect the results of the processes
within the plume is still to be answered.
127
-------
TABLE 88. ARITHMETIC MEANS AND STANDARD DEVIATIONS OF ALL PARAMETERS AT
TWO SITES
Parameter
S02
SOiT~
NH3
NHi,
Pb
Fe
Mn
Cu
t °C
RH %
Manganese
X
22.9
13.9
5.5
2.0
0.18
1.3
3.8
0.12
21.7
63
polluted area
S.D.
11.4
6.8
2.0
1.6
0.11
0.57
5.1
0.03
1.5
8.3
Control
X
24.6
9.9
4.8
2.1
0.13
0.65
0.03
0.09
22.2
75
area
S.D.
14.3
3.0
1.6
1.2
0.03
0.22
0.02
0.07
1.3
7.2
128
-------
TABLE 89. SIGNIFICANCE OF DIFFERENCE BETWEEN THE MEANS OF DATA SHOWN IN
TABLE 88
Parameter t . . , £_,_,, P
obtained critical
S02 0.42 2.02 »0.05
SO.T~ 2.42 2.03 <0.05
NH3 1.06 2.03 >0.05
0.07 2.03 »0.05
Pb 1.58 2.03 >0.05
Fe 5.07 2.03 <0.05
Mn 3.29 2.03 <0.05
Cu 2.13 2.03 <0.05
RH 4.95 2.03 <0.05
129
-------
TABLE 90. CORRELATION BETWEEN S04 ~, SO.* /S02 RATIO AND S02 AND OTHER
PARAMETERS
Correlated
parameters
S0i» and S02
SO 4 and NHif
SOit and Pb
SOi, and Fe
SOit and Mn
SO if and Cu
Sulfate S and Total S
Sulfate S and Total NH3
SOif /S02 and S02
S0i,~~/S02 and Mn
., Sulfate S j , „, „ i c
log Total S and log T°tal S
S02 and RH
SO if and RH
Correlation
Manganese
polluted
area
0.00
0.13
0.45
0.14
0.62
0.28
0.37
0.13
-0.53
0.63
-0.42
0.08
0.06
coefficients
Control
area
-0.02
0.83
-0.35
0.36
-0.03
0.09
0.12
0.54
-0.63
0.03
-0.73
-0.26
0.13
130
-------
TABLE 93. CORRELATION BETWEEN S02, RELATIVE HUMIDITY,
AND PARTICULATE COMPONENTS
Correlated
parameters
Linear
correlation
coefficient
and
and SO2
SOi,and NHi,
SO^ and Mn
SO i, and Pb
SOi, and Fe
SO i, and Cu
SO i, /SOa and
SOi,/S02 and Mn
SO2 and RH
SOi,/SOa and RH
SOi,
and total
suspended
particulates
Mn and total
suspended
particulates
and total
suspended
particulates
-0.14
0.48
-0.19
0.77
0.65
0.56
0.23
-0.43
0.32
-0.30
0.33
0.84
0.86
-0.34
133
-------
TABLE 94. ARITHMETIC MEANS AND STANDARD DEVIATIONS OF S02 AND SUSPENDED
PARTICULATE COMPONENTS NEAR A FERROMANGANESE FACTORY
Component
S(K~~
S02
NH/
Mn
Pb
Fe
Cu
TSP
SO.T~ in % of TSP
Sulfate S
in % of total S
Arithmetic
Summer
results
N = 84
14.7
18.5
0.9
5.4
0.2
1.1
0.2
121.8
12.1
34.6
mean yg/m3
Winter
results
N - 59
8.3
13.9
0.6
4.1
0.1
1.0
0.2
96.7
8.6
28.4
Standard
Summer
results
7.6
11.1
0.7
5.7
0.1
0.5
0.1
54.9
deviation
Winter
results
5.3
7.2
0.6
6.4
0.1
1.3
0.1
57.9
TSP = Total suspended particulates
134
-------
TABLE 95. CORRELATION DIFFERENCES BETWEEN S02 AND PARTICIPATE
COMPONENTS NEAR A FERROMANGANESE FACTORY
Correlated
components
so.
Nrlif
SO L,
SO,
SO,
SO,
so.
Mn
and SO 2
and SO 2
and NH,
and Mn
and Pb
and Fe
~~ and TSP
and TSP
Linear
correlation
coefficient
Summer Winter
results results
-0.04
0.30
-0.03
0.68
0.58
0.51
0.79
0.75
-0.06
0.14
0.64
0.43
0.75
0.23
0.68
0.75
TSP = Total suspended particulates
135
-------
TABLE 96. AVERAGE CONCENTRATIONS (X) AND RANGE OF SUSPENDED PARTICULATE COMPONENTS AT THREE
SITES (N = 35 DAYS)
Site 1*
Component
S04~~
NH/
Mn
Pb
Fe
Cu
TSP
Mn in % TSP
SOit"" in % of TSP
X Range
Ug/m3
15.7
1.2
7.8
0.2
1.9
0.2
135.6
4.4
11.8
4.7 -
0.04 -
0.2 -
0.03 -
0.6 -
0.04 -
45.2 -
0.1 -
6.1 -
49.0
3.0
46.1
0.3
4.2
1.2
358.2
17.2
17.9
Site 2f
X Range
Ug/m3
10.8
1.3
1.2
0.1
0.6
0.01
68.4
1.6
16.4
5.3
0.1
0.04
0.01
0.0
0.0
23.0
0.1
11.0
- 23.2
2.3
- 6.2
0.2
1.5
0.03
- 123.3
- 9.3
- 30.1
Site 3#
X Range
yg/m3
11.6
1.3
1.0
0.1
0.9
0.1
91.2
1.0
13.4
2.8 -
0.2 -
0.03 -
0.03 -
0.3 -
0.02 -
31.2 -
0.4 -
6.4 -
21.9
3.0
3.9
0.3
2.5
0.7
183.3
6.1
23.6
*
Site 1 - close to a ferromanganese factory
Site 2 - 0.75 km away from the factory
Site 3 - 2.75 km away from the factory
§
TSP = Total suspended participates
-------
TABLE 97. CORRELATION BETWEEN SOH AND PARTICULATE COMPONENTS AT THREE SITES
Correlated
components
so.
SO*
SO,
so,
so.
Mn
NH,
and NH,
and Mn
~~ and Pb
and Fe
~~ and TSP§
and TSP
+ and TSP
*
Site I
- 0.08
0.87
0.60
0.70
0.92
0.86
- 0.18
Linear correlation
coefficient
(N = 35 days)
Site 21"
0.61
0.39
0.26
0.48
0.78
0.54
0.63
Site 3"
0.85
0.33
0.26
0.60
0.81
0.31
0.67
Site 1 - close to a manganese factory
Site 2 - 0.75 km away from the factory
Site 3 - 2.75 km away from the factory
g
TSP = Total suspended particulates
137
-------
TABLE 98. RELATION BETWEEN SULFATE S AND TOTAL S IN VARIOUS AREAS
00
Area N
1.
2.
3.
4.
5.
6.
7.
Continental urban site 20
Coastal urban site 20
15 urban sites in the USA 67
Continental lead
polluted site
Coastal manganese polluted .
site (1st run)
Coastal manganese polluted
site (2nd run)
Coastal cement dust 50
polluted area
Sulfate S Sulfate
against total S total S
* Regression
rl equation I ril
0.40 y=0.05x + 6.12 -0.87
0.12 y=0.02x + 6.11 -0.73
0.80 y=0.02x + 7.60 -0.96
0.74 y=0.05x +4.64 -0.73
0.37 y=0.14x + 4.91 -0.42
0.43 y=0.19x + 4.21 -0.31
0.65 y=0.35x - 2.54 0.014
S in % of
against total S
Regression
equation II
Q1, -0.74
y = 316x
„,.,. -0.83
y = 355x
y = 378x-0'78
y= 91x-°'49
im "°-39
y = 107x
QQ -0.35
y = 98x
t
correlation coefficient
Calculated from 3-year moving averages reported by Altschuller (1976)
-------
S00
40-
I I I I I I I I I I I ' I I I I I I I
iiiiiiiiiiiiiMiiiiiiiiiiiiiiiiiiiiiiiririii TI ITIIT Ti IT i Tiir
40-i
20-
so:
i i i i i 11 11 i i i i i i i i i i i i i i M i i i 11 i i i i i M i i i i 11 i T rri IT MIL
10 20 30 40 BO DAYs 60
Figure 5. Variations in daily means.
-------
300-
200-
100.
SUSPENDED PARTICULATES
-t-
o
I I I I II II
40-
•a
a.
20
! I I I I I I I I I I I I I I I I I I I I 1 I
Mn
r i 11 i i i i i ir\ i i i i iIT i i i r i M n i iiii
rr
40 .
20
i n r i r
10
r ( i i
i i i i i i i
20
30
III
40
50
DAYS
i I
60
Figure 6. Variations in daily means.
-------
0.5 -
0.25.
Cu
i i i i i i i i i I i i i i I i I i I i
ill iii
i i i i i i i i i i i i i i i i i I i i i i i I i I ri ijriiir«ijiiiiiiiir
10 20 30 40 50 60
c- T w • «.- • j• -i DAYS
Figure/, variations in daily means.
-------
40 •
30 •
E
•a
a.
If
20 -
r = - 0.19
10 -
I
\*
b
o
>
'0
\J
0°° °
00
o
1
0.5
e° o ° o
y 0 6° o QQO ° o
o °o o °
o o
®
0
1 1 1 1 . _
1.0 1.5 2.0 2.5 NH*Ltg/mJ
Figure 8. Relationship between sulfates and ammonium concentrations.
142
-------
4 6 8 10 12 14 16 18 20 Mnjug/m
Figure 9. Relationship between sulfates and manganese concentrations.
143
-------
SECTION 10
DISCUSSION.
As early as 1837, John Cooper reported in England a case of occupational
disease due to exposure to manganese. The description, however, remained
forgotten for a whole century. Not before 1901 did Jaksch in Prague and
Emleden in Hamburg provide an accurate clinical description of manganism.
Cases of manganese poisoning have been observed in mining and manganese
ore processing industries. In manganese mines, particularly in the rich
deposits, miners inhale a dust containing manganese dioxide. A large use of
manganese in industry represents a potential source of occupational manganese
poisoning. The use of manganese in metalurgy is particularly important, as
nine-tenths of the entire manganese production represent the manufacture of
manganese alloys which are of utmost importance in the steel industry.
Besides occupational exposure of workers, an important problem relates to the
exposure of the population residing in the vicinity of manganese processing
factories. And organo-manganese fuel additives, though presently a minor
source of exposure to manganese, could significantly increase exposure if
they come into widespread use.
While the effect of manganese on the central nervous system has been
quite well known, the action of manganese on the lung still remains to be
explained definitely. The notion of "manganese pneumonia" (manganese
pneumonitis) has been created mainly on the basis of epidemiological obser-
vations. The association between the exposure to manganese and a high rate
of pneumonia was first suspected by Brezina (1921) and then described by
Baader (1933). In 1939, Elstad reported a high rate of pneumonia among the
residents of Sauda, a small Norwegian town, after the opening of a manganese
ore smelting works. A high incidence of pneumonia in manganese exposure has
also been reported by other authors (Povoleri, 1947; Rodier, 1955). In
addition to these observations concerning "manganese pneumonia" in humans,
Lloyd Davies (1946 and 1949) succeeded in inducing acute changes in the lungs
of animals after inhalation of manganese dioxide.
Since the beginning of the era of sulfonamides and antibiotics, the
possible toxic effect of manganese on the lungs has been overshadowed by its
definitely much more important effect on the central nervous system. On the
other hand, it is true that in the meantime, no increase in pneumonia inci-
dence from exposure to manganese has been recorded. Only recently have there
been once again some reports suggesting an influence of manganese on the rate
of pneumonia and other respiratory ailments in groups of workers exposed to
manganese and in inhabitants living in the vicinity of a factory manufac-
turing ferromanganese (Suzuki, 1970; Nogawa et al., 1973; Kagamimori et al.,
1973) .
144
-------
The results of our investigations also indicate a higher rate of
pneumonia in occupational exposure to manganese. In the ferroalloy plant
which was included in our study, the level of exposure to manganese followed
the fluctuations in the manufacture of ferromanganese. These fluctuations
were primarily influenced by occasional restrictions in the supply of
electricity. Manganese concentrations measured in the plants ranged from
0.147 to 20.442 mg/m3 (mean values for 8-hour work). Although it is im-
possible to reconstruct exactly the level of exposure to manganese in the
conditions of the study, and to compare it with fluctuations in the morbidity
from pneumonia, the fact is that the average rate of pneumonia for the
analyzed period was higher in the manufacture of ferromanganese than in
two other groups of workers, one of which worked in the neighboring
electrode plant with a measured exposure level from 0.002 to 0.302 mg/m3.
Morbidity from pneumonia in this group did not differ significantly from
the morbidity in the other group with an average exposure to manganese
below 0.1 yg/m3.
The investigations performed over 4 years in the population of the town
with the ferroalloy factory did not show the expected significantly higher
rate of pneumonia. Nor was a more constant difference observed in the rate of
pneumonia with regard to the level of ambient exposure to manganese in differ-
ent residential areas of the town. While this level in two zones of the town
was within mean yearly values, ranging from 0.164 to 0.390 pg/m3, in the third
zone it amounted to 0.042-0.099 pg/m3, a range 4-5 times lower than in the
other two zones. As pointed out in the description of measurements and
sampling technique, the listed concentrations refer mainly to the particles
which belong to the respirable fraction. This means that the values obtained
must be multiplied by a factor of approximately 3-5 in order to obtain the
total concentration of manganese in air.
It is interesting to note that the analysis of the rate of pneumonia in
the population of the town did not show the expected difference between summer
and winter periods. Since the concentrations of manganese in the ambient air
were higher in the summer period than in winter, the question is raised of
whether this finding might not be, to a certain extent, associated with
observed seasonal variations in the level of manganese. This connection,
however, is still an assumption without enough firm evidence to establish it
as fact. Consequently, it is possible to conclude with comparative certainty
that the rate of pneumonia is influenced only by the exposure to manganese
which is at the level of occupational exposure in the production of manganese
alloys.
A higher rate of acute bronchitis was recorded at a level of compara-
tively low ambient exposure to manganese of about 1 Pg/tn . Still, it is
possible that some other factors, which had not been controlled, might have
influenced the obtained results and relationships. Provided that a higher
incidence of cute bronchitis is associated with the described exposure, the
question remains as to whether this respiratory effect can be exclusively
attributed to manganese or perhaps to the synergistic action of manganese
aerosol and sulfuric acid, i.e., sulfates adsorbed on the surface of
manganese particles.
145
-------
It is generally known that sulfur dioxide reacts readily with manganese
dioxide to form manganese sulfate. Data also exist about the catalytic action
of Mn ions on the oxidation of sulfur dioxide in aqueous solutions.
(Bracewell and Gall, 1967). Accordingly, it might be assumed that in the fuel
gases of the manganese processing industrial plants, a rapid oxidation of
sulfur dioxide could occur, catalyzed by the manganese particles. The process
might continue during the dispersion of emissions in the surrounding atmos-
phere, including in the reaction the sulfur dioxide emitted from other
sources.
The results of the investigations performed within our study under natural
conditions also indicate the catalytic action of manganese. The question still
remains as to what extent our findings refer to the conversion of sulfur
dioxide at comparatively low concentrations of manganese and sulfur dioxide in
the ambient air.
At any rate, regardless of whether manganese produces a biological effect or
acts in combination with sulfuric acid, the action seems to be primarily
manifest by a disturbance of immunobiological properties of the organism
(the effect on the ciliary epithelium, the inhibition of alveolar macrophages,
etc.), and by a growing predisposition to infection. Most probably, a higher
rate of pneumonia as it is associated with the exposure to manganese could be
explained in the same way.
Two separate studies on the relationship between the incidence of acute
respiratory diseases and exposure to manganese performed in groups of school
children and their families did not give convincing results that these
diseases depend on the level of the exposure to manganese.
Still, the data show that the incidence of respiratory diseases was somewhat
higher in the town with a ferromanganese plant than in the control area. In
the town with the ferroalloy plant, no consistent differences were found
between the zones in which the school, attended by the children included in
the studies, are located. However, there was a tendency towards a decrease
in the rate of acute repiratory disease as well as towards a slight increase
of forced expiratory volumes in children as one moves further from the
ferroalloy plant. As methodologically sound and conscientiously performed as
these studies may be, we are still confronted with the number of interfering
factors that cannot be completely controlled. Consequently, the interpreta-
tion of results is rather complex. In view of other approaches applied in our
investigations, the most important is that the results obtained in these two
studies have not denied the results obtained by other methods. If we compare
them with the results of a 4-year followup of the incidence of acute respira-
tory diseases in the popoulation of the town with the ferromanganese manufac-
ture, it should be pointed out that the children living in the zone with the
lowest ambient exposure to manganese attend school and spend a part of the
day in the zone where the concentration of manganese in air is higher. The
same applies, to a greater or lesser extent, to the members of their families.
This situation also might have influenced the results.
146
-------
In addition, it is worth noting that the concentrations of total sus-
pended particulates, as well as of sulfate concentrations, seems to be higher
in the central part of the town than in the part nearest to the ferroalloy
plant.
The problem of chronic respiratory symptoms as associated with manganese
exposure has never been studied separately. The results of our investigations
indicate that a higher rate of chronic nonspecific lung disease can be
expected from occupational exposure to manganese. A possible synergism between
the exposure to manganese and smoking may enhance this effect.
Our investigation supports the results reported by other authors who have
shown that a neurological effect of manganese is manifest in a relatively
small number of subjects, even in conditions of a comparatively high level of
exposure. More developed pictures of manganese poisoning are even more rarely
found. The worker with a clinical diagnosis of manganese poisoning (initial
period with extrapyramldal symptoms) in our investigation did not show, at the
time of examination, any signs of anemia; that is, he did not have low values
of serum iron, which are considered indicative of the degree of manganese
absorption and toxicity (Mena et al., 1969).
A possible hypnotic effect of manganese on systolic blood pressure repre-
sents an interesting and original finding as well. It is suggested that such
an effect of manganese might be produced through the heart muscle. This
hypothesis, of course, needs verification, just as we need to investigate more
precisely whether the observed hypnotic effect of manganese on systolic blood
pressure is persistent or whether it is manifest only temporarily at a certain
level of exposure.
147
-------
REFERENCES
Altschuller, A. P. 1976. Regional Transport and Transformation of Sulfur
Dioxide to Sulfates in the United States. J. Air Pollut. Control
Assoc. 26:318-324.
Ansola, J., E. Uiberall, and E. Escudero. 1944. La intoxicacion por
manganese en Chile (Estudio sobre 64 casos) 2-a communicacion:
Aspectos clinicos, incapacidad y reparacion medico-legal. Rev.
Med. Chile. 72:311-322.
Baader, E. W. 1933. Manganvergiftungen in Elementefabriken. Arch.
Gewerbepathol. Gewerbehyg. 4:101-116.
Barrie, L. A. and H. W. Georgii. 1976. An Experimental Investigation of
the Absorption of Sulphur Dioxide by Water Drops Containing Heavy
Metal Ions. Atmos. Environ. 10:743-750.
Bjure, J. 1963. Spirometric Studies in Normal Subjects: IV. Ventilatory
Capacities in Healthy Children 7-17 Years of Age. Acta Paediatr.
Scand. 52:232-240.
Bresina, E. 1921. Internationale iibersicht u'ber Gewerbekrankheiten nach
den Berichten der Gewerbeinspectionen der Kulturlander u'ber das Jahr
1912. Vol. 8. J. Springer, Berlin. 143 pp.
Bracewell, J. M. and D. Gall. 1967. In: Proceedings of the Symposium
on the Physico-chemical Transformation of Sulphur Compounds in the
Atmosphere and the Formation of Acid Smogs. O.E.C.D., Mainz,
Germany, pp. 17-21.
Brinkman, G. L. and 0. E. Coates. 1963. The Effect of Bronchitis,
Smoking, and Occupation on Ventilation. Amer. Rev. Resp. Dis.
87:684-693.
Cholak, J. and D. M. Hubbard. 1960. Determination of Manganese in Air
and Biological Material. Amer. Ind. Hyg. Assoc. J. 21:356-360.
Committee on the Aetiology of Chronic Bronchitis. 1965. Report to the
Medical Research Council. 1965. Definition and Classification of
Chronic Bronchitis for Clinical and Epidemiological Purposes.
Lancet. 1:775-779.
Cooper, J. 1837. On the Effects of Black Oxide of Manganese When
Inhaled into the Lungs. Brit. Ann. Med. Pharm. Vit. Stat. Gen.
Sci. 1:41-42.
148
-------
Elstadt, D. 1939. Beobachtungen uber Manganpneumonien. In; Berlcht iiber
den VIII. Internationalen Kongress fur Unfallmedizin and Berufskrank-
heiten, Leipzig, Thieme. 2:1014-1022.
Horriguchi, S., T. Utsunomiya, A. Kasahara, K. Shinagawa, K. lyoda, N. Tanaka,
N. Tsuyama, H. Ikutomi, and K. Miura. 1966. A Survey on the Actual
Conditions of Factories Handling Manganese Compounds (in Japanese).
Industr. Med. 8:333-342.
Jaksch, R. V. 1902. Cited in: Prager Med. Wochensch. 18:213-214.
Kagamimori, S., T. Makino, Y. Hiramura, S. Kawano, T. Kato, K. Nogawa,
E. Kobayashi, M. Sakamoto, M. Fukushima, A. Ishizaki, K. Kanagawa,
and S. Azami. 1973. Studies of the Effects on the Respiratory
Organs of Air Pollution Consisting of Dust Composed Mainly of
Manganese. (Second Report) Concerning the Changes in the Effects
on the Human Organisms When the Environment is Improved (in Japanese).
Jap. J. Publ. Health. 20:413-420.
Kamiyama, A. and J. Saeki. 1974. Miocardial Action Potentials of Right-and-
Left-Subepicardial Muscles in the Canine Ventricle and Effects of
Manganese Ions. Proc. Jap. Acad. 50:771-774.
Robert, R. 1883. Zur Pharmakologie des Mangans und Eisens. Arch. Exp.
Pathol. Pharmakol. 16:361-392.
Lloyd Davies, T. A. 1946. Manganese Pneumonitis. Brit. J. Industr. Med.
3:111-135.
Lloyd Davies, T. A. and H. Harding. 1949. Manganese Pneumonitis. Further
Clinical and Experimental Observations. Brit. J. Industr. Med. 6:82-90.
Mena, I., K. Horiuchi, K. Burke, and C. G. Cotzias. 1969. Chronic Manganese
Poisoning. Individual Suspectibility and Absorption of Iron. Neurology.
19:1000-1006.
Methods of Measuring Air Pollution. 1964. Organization for Economic
Cooperation and Development. Paris, pp. 39-45.
Morris, J. F., A. W. Koski, and C. L. Johnson. 1971. Spirometric Standards
for Healthy Nonsmoking Adults. Amer. Rev. Resp. Dis. 103:57-67.
Nogawa, K., E. Kobayashi, N. Sakamoto, T. Hukushima, A. Ishizaki, T. Makino,
S. Kagamori, Y. Hiramaru, S. Kouno, T. Katou, K. Kanagawa, and S. Asami.
1973. Studies of the Effects on the Respiratory Organs of Air Pollution
Consisting of Dust Composed Mainly of Manganese. (First Report) Effects
on the Respiratory Organs of Junior High School Students (in Japanese).
Jap. J. Publ. Health. 20:315-325.
Penalver, R. 1955. Manganese Poisoning. Industr. Med. Surg. 24:1-7.
149
-------
Povoleri, F. 1947. Bronchopolmoniti e produzione di ferromanganese.
Med. Lavoro. 38:30-34.
Rodier, J. 1955. Manganese Poisoning in Moroccan Miners. Brit. J.
Industr. Med. 12:21-35.
Scaringelli, E. P. and A. K. Rehme. 1969. The Determination of Atmospheric
Concentrations of Sulphuric Acid Aerosol by Spectrometry. Coulometry
and Flame Photometry. Anal. Chem. 41:707-713.
Schroeder, H. A., H. M. Perry, E. G. Dennis, and L. E. Mahney. 1955.
Pressor Substances in Arterial Hypertension. V. Chemical and
Pharmacological Characteristics of Pherentasine. J. Exp. Med.
102:319-333.
Shy, M. C., J. P. Creason, M. E. Pearlman, K. E. McClain, and F. B. Benson.
1970. The Chattanooga School Children Study: Effects of Community
Exposure to Nitrogen Dioxide. I. Methods, Description of Pollutant
Exposure, and Results of Ventilatory Function Testing. J. Air Pollut.
Control Assoc. 20:539-545. II. Incidence of Acute Respiratory Illness.
J. Air Pollut. Control Assoc. 20:582-588.
Suzuki, Y. 1970. Concerning Evironmental Pollution by Manganese (in Japanese)
Industr. Med. 12:529-533.
Tanaka, S. and J. Lieben. 1969. Manganese Poisoning and Exposure in
Pennsylvania. Arch. Environ. Health. 19:674-684.
150
-------
ADDITIONAL PERTINENT PUBLICATIONS
Hrustic, 0. 1973. The Effect of Occupational Exposure to Manganese on
Arterial Blood Pressure (Utjecaj professionalne ekspozicije manganu
na arterljski krvni pritlsak). M. Sc. Thesis, University of Zagreb.
Macek, V. 1974. The Relationship Between Ventilatory Lung Function and
Occupational Exposure to Manganese (Odnos ventilacijske funkcije
pluca i ekspozicije manganu). M. Sc. Thesis, University of Zagreb.
Saric, M. 1972. Manganese Exposure and Respiratory Impairment. In;
Proceedings of the XVII International Congress on Occupational
Health, Buenos Aires. Abstracts D2-16, p. 101.
Saric, M., S. Palaic-Lucic, R. Paukovic, and A. Holetic. 1974. Respiratory
Effects of Manganese (in Croatian). Arh. Hig. Rada. 25:15-26.
Saric, M. and 0. Hrustic. 1976. Exposure to Airborne Manganese and Arterial
Blood Pressure. Environ. Res. 10:314-318.
Saric, M., E. Ofner, and A. Holetic. 1975. Acute Respirtory Diseases in a
Manganese Contaminated Area. In: Proceedings of the International
Conference on Heavy Metals in the Environment, Toronto. Abstracts
B-121-123. (In press)
Saric, M. and S. Lucic-Palaic. 1977. Possible Synergism of Exposure to
Air-Borne Manganese and Smoking Habit in Occurrence of Respiratory
Symptoms. In: Inhaled Particles, IV. Pergamon Press, Oxford & New York.
pp. 773-778.
Saric, M., A. Markicevic and 0. Hrustic. 1977. Occupational Exposure to
Manganese. Brit. J. Industr. Med. 34:114-118.
151
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TECHNICAL REPORT DATA
(Please read Instructions on the reverse before completing)
1. REPORT NO.
EPA-600/1-78-001
2.
3. RECIPIENT'S ACCESSION-NO.
4. TITLE AND SUBTITLE
Biological Effects of Manganese
5. REPORT DATE
January 1978
6. PERFORMING ORGANIZATION CODE
7. AUTHOR(S)
Marko Saric
8. PERFORMING ORGANIZATION REPORT NO.
9. PERFORMING ORGANIZATION NAME AND ADDRESS
10. PROGRAM ELEMENT NO.
Institute for Medical Research and Occupational Health
Yugoslav Academy of Sciences and Arts
Zagreb, Yugoslavia
1AA601
11. CONTRACT/GRANT NO.
SFCP 02-513-3
12. SPONSORING AGENCY NAME AND ADDRESS
Health Effects Research Laboratory
Office of Research'and"Development
U.S. Environmental Protection Agency
Research Triangle Park, N.C. 27711
13. TYPE OF REPORT AND PERIOD COVERED
RTP,NC
14. SPONSORING AGENCY CODE
EPA 600/11
15. SUPPLEMENTARY NOTES
16. ABSTRACT
The biological effects of manganese were studied in a town on the coast of
Dalmatia in which a ferromanganese plant has been operating since before World War II
The study focused on the question of whether the exposure to manganese can cause a
higher incidence of respiratory diseases and, if it can, at what exposure levels.
The study also considered the effects of manganese on the central nervous system and
on blood pressure as well as a possible catalytic effect of dust containing manganese
on the conversion of sulfur dioxide in the air.
The results obtained show that the rate of pneumonia is influenced by the
exposure to manganese at the level of occupational exposure in the production of
manganese alloys. During a 4-year follow up a higher rate of acute bronchitis was
recorded at an ambient exposure to manganese at a level of one microgram per cubic
meter. The study also Indicates that a higher rate of chronic nonspecific lung
disease can be expected in occupational exposure at this level. The investigation
supports the observations of other authors that a developed neurological effect of
manganese is present in a very small number of subjects, even in conditions of a
comparatively high exposure. At the level of occupational exposure a hypotonic
effect on systolic blood pressure was observed.
17.
KEY WORDS AND DOCUMENT ANALYSIS
DESCRIPTORS
b.lDENTIFIERS/OPEN ENDED TERMS C. COS AT I Field/Group
Manganese
Ferromanganese
Absorption (biology)_
Toxicity
Air pollution
Biological surveys
Exposure
Dalmatia
Yugoslavia
06 C, F, T
13. DISTRIBUTION STATEMENT
RELEASE TO PUBLIC
19 SECURITY CLASS (This Report)
UNCLASSIFIED
21. NO. OF PAGES
20 SECURITY CLASS (This page}
UNCLASSIFIED
J57_
22. PRICE
EPA Form 2220-1 (9-73)
152
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