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Heavy Metals in Some Asian IVied cines and Cosmetics

M. Aslam Ph.D. M,P.S,

S. S. Davis Ph.D.M.P.S.

Department of Pharmacy and

M. A. Healy B.Sc. C.chem, M,RJ,C.

Depa~-tnTent ofChemistry, University of Nottingham, University Park, Nottingham NG 7 2RD

Significant concentrations of heavy metals have been found in a number of Asian medicines and cosmetics. The herbal baby tonic, Bal Jivan Chamcho contained lead leached from the coating of the spoon with which it was supplied. Some samples of Surma were found to have a lead content as high as 86~o. Amongst other metals, mercury, lead and arsenic were found in the aphrodisiac and tonic Kushtay. A Warak "which purported to be gold was a copper/zinc alloy.

No mercury was found in the cosmetic Sandurs and Kum-Kum pastes we exam- ined. but unacceptably high concentrations o f lead and antimony were found in some pills, and of lead and arsenic in a powder intended for medicinal use.

The use of traditional Asian remedies involves a substantial risk o f heavy metal poisoning to which the medical profession should be alerted.

Control by legislation alone would not be effective as many of the preparations ar~ sent by relatives in Asia.

Introduction

Since t950 there has been a marked increase in tile number o f Asian immigrants to the Uni ted Kingdom, a high proportion coming from the lndo-Pakis tan sub-continent. Wi th this influx has come not only lhe religious and dietary prac6ces o f these peoples, but also their own system o f medicine. We report here some results from our research into the effects o f this.

Bal Jivan Chamcho

One o f the first Asian preparations we investigated was Bal Jivan Chamcho, which was being imported and sold through the Grocery trade as a baby tonic. In October 1976, a child achnitted t o hospital in Luton with clinical lead poisoning was found to have been admin- istered regular doses o f this baby tonic.

Medicines, such as Bal Jivan Chamcho, have been available on the Indian market for many years and in principle appear innocuous. They are compounded preparations from a

0038-3506179/050274 + 11 $01.00/0 ~ 1979 The Society of Community Medicine

HeaL1 hletuls t'tz Sot~l~" Asiean Mredicbles and Cosmetfi's 275

variety of botanical substances; the extracts and a-emainders of which are made into a paste and spread on a spatula-shaped spoon ~nd allowed to dry. The dried preparations, wilh the spoon as a carrier, are then packaged into a small carton, for sale. The label on the container of the Bal Jivan Chamch0 is printed ~n English, Gujera~i and Hindi with tile directions:

"'Children Diseases viz Varadha Capiltiary, Bronchitis, Greenish Diarrhoea, Ricke~s. Croup, Convulsions etc. Rubbing the medicine witb~ water o r milk until it gets colour. To be taken twice a day ."

The herbal preparation is, thus, attov~,ed to soak in :about 5 cm a of milk or waler for several minutes after which the milk is then administered to the child. The preparation itself is not taken but is reused in a similar rraanner for a period of up to seve~! months.

Our investigations revealed that when the recommended procedure for administering the medicine was followed, an average dose or 12ppm o f lead was inadvertently given every time the material was used. In addition, the quarttity o f lead ingested increased in propor- tion to the reuse of the herbal preparation, The plating on the spoon in all the samples we examined was found to show considerable corrosion before the material had been used (Fig. i). This increased with each period of 1use. By using atomic absorption spectroscopy to analyze the compound and the spoon, the results we obtained (Table 1) clearly showed the spoon to be the primary source of contamination from lead. The leaching action into the llerbal preparation was enhanced by addition of moi.~ture which, thus, caused further corrosion and increased solubility of the lead from the spoon.

As the high lead content of these herbal medicines was a toxic hazard, particularly in infants, for whose treatment it was recommended, it was proposed that an emergency ordcr prohibiting the import, sale and supply o f these preparations should be implemented. Such an order was made effective from Febrttary 1977 to May 1977 and a permanent order for Bal Jivan Chamcho was introduced in May o f that year.

Snlrlmlt

During the course of our studies into the r01e of ihe Hakim (healer) in Asian communities within this country, we became interested in the Surma (Fig. 2) which he manufactured for patients. This Surma is applied to the eye, apparently for medicinal purposes, and has the appearance of mascara. However, application is no t to the outside of the eyelid but to the eonjunctival surface (Fig. 3). Its use by Asian families can be traced back ,many centuries. They believe it strengthens and protects the eyes against disease and improves appearance. The Surmas used in our study ranged in col0ur from black, through various shades o f grey to white. From X-ray powder diffraction analysis of an initial batch from 13 different manufaelurers, 11 were found to contaira lead whilst carbon was indicated as the main constituent of the remaining two. More detailed analyses for metals, again using atomic absorption spectroscopy, revealed lead concentrations as high as 86 Yo in the grey surmas which were found to be composed, almost exclusively, of" lead sulphide. Indeed, this material formed the base for the majority ofg~arrnas we have analyzed. Carbon Js added in varying amounts in some compounds, the proportion used modifying the characteristic dark colouration. Various herbs, pearls an,d ~nenthol were also detected, whilst elements present in trace quantities (<0-5 ~o) included iron, copper, zinc, silver, antimony and strontium.

In 1976 we became interested :in a 4 year old Asian child who was suffering from lead poisoning. This appeared to be attributable t o the use of a Surma which was found to contain 8 6 ~ lead as lead sttlphide. The ~edical staff a t the hospital of admittance had warned the parents against continuous use of the eye cosmetic but because the child was

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Figure I. Bal Jivan Chamcho showing corroded spoon.

TABLE 1. Analysis of Bal Jivan Chamcho for lead content

Lead content of Lead content of spoon herbal preparation

Sample (percentage) (ppm)

1 26-5 310 2 83.3 1,040 3 32.7 225 4 30.1 265

a boy he was the subject of preferential treatment by his parents. On visiting the home o f this child it became obvious that each time the sample of Surma was collected from the parents by the Health Authorit ies a further sample was immediately for thcoming f rom anxious grandparents in Pakistan.

In addit ion 'to the usual application o f Surma, it is the cus tom with a Moslem child t o place a small dot o f the material on the forehead to ward off the "evil-eye". Because o f the

lh.alLr Melals hi Sopl~c .4siam Meclichtes aml Cosmetic.~" "~'7 - - J7

Figure 2. A sample of proprietary Surmas.

Figure 3. A decoralive Surma container complete with applicator.

superstitious nature o f this child's parents they had also tied ,lengths of blackened string. around his wrists for the same purpose. Their belief was that as a bIack mark is considered a blemish, the combination of the black dot and string would outwit the "'evil-eyed one" and cause him to think the child unattractive.

27S i~t..4 ~tam cz al.

In ]97S x~e collected lhrthcr ~amples o f Surma from this child's parents which o11 analysis ~c:e all found to be o f thc type containing around 867i, lead as lead sulphide. The mother o f the child admktcd that she had continued 'to adminisler Surma on a regular daii 5, basis after the child's releSase from hospital, but asked tha~ lhis information be withheld from her doctor "as hc would ~3t understand". The mean blood-lead levels measured in lhis child were

1976 2.4 pmol/l 1977 3-0 pmol/l 1978 3.4 lamol/l

He has now been readmilled to hospital with diagnosed plumbism. In z~ ft~rlher study, car ried out at the Childrens" Hospital, Nottin~:.hzm, measurements

were ran.de o f the blood-lead levels in a group o f Asian children m who"~,vere known tc~ have used Surma and a control group who had .~ol. Ttaewalues obtained gave a mean blood-lead level of 1.6 pmol/l for those children using Surma and 1-0 !Jmol/l for those Asian children who had not had i~e cosmetic regularly applied, l'n his recent paper Joseph ~ comments that 5 o f lhe '82 (6"~,) Asian children for which he measured blood-lead levels had levels in excess o f 1-8 pmol/1. O f the Surma users at N~ltingham. 10 o f the 26"(38~/~ i,) had greater thm~ !-8 pmol/l o f lead in'their bloc~.. It is also interesting to note that Dr 2~seph obtei:Jed a value of 1.01amo|/l for his controls on non-Asian children, the same value as in the Noltingham conlrols. It is apparent that these investigations at Nott ingham have shown a cle~,r association between blood-lead levels and the use of Surma. Indeed, recently, it was considered that Surma had contribuled to the death due to lead encephalopathy o f a 4-year-old Asian boy in Oldham.

Our most recent analyses of proprietary Surmas sold or imported in the United King- dora.but manufactured in India or Pakistan areshown in Table2.Thirty-six per cent o f these had lead concentrations in excess of °/ 50 .o. One sample contained zinc. The use o f menthol in Surmas could well exacerbate the risk of poisoning p.s it causes excessive lachrymalion.

TABLE 2. Chemiea! analysis of proprietary Surmas sold or brought inlo the United Kingdom but manufactured in India or Pakislan

Descriplion Powder colour Percentage lead

ttashmi Sunna Jowahar Chaharam, Karachi. Grey Surma Moqawi Basar Taj Company, Lahore. Grey Multani, Ayurvcdic 36-H Connaught Circus, Delhi. Grey Nag Jyoti, Murrari Brothers. Delhi. White

MD Hashim Surma, Bunder Road, Karachi. Bal Jyoti, Murrafi Brothers. Delhi. Indian Surma, Bhimsaini Kajal with Aela, Murrari Brothers, Delhi. Nargasi Surma, Hamdard, Pakislan, Binger Surma, Harndard, Pakistan. *(Bhimsaini Kajal With Aela.

Grey Grey-Black Cream Black Pasle Grey Black Black Paste

80"2 53"7 Trace Trace

(Zinc 4.5 ~ + Menthol) 82"9 38"4 Trace Trace 77-3 26-3 Trace)

Trace = < 0-5 ?~. *Carbon in soft paraffin b~se.

Many o f the infants we observed responded to the administration of th is type o f Surma with profuse tear format ion at which they invariably rubbed their eyes. Inevitably many then sucked their fingers, and hence swallowed the Surma suspended in tears. O f particular

Heavy Metals in Some Asian Medichz~:r aptd Cosmetics 279

concern are the claims made on ttle containers of these Surmas: "'Makes eyes beaulifal and protects eyesight", or "Use Co prevent eye disease and vision defects"'. Despile the evidence against Surmas it is clear their ,~se in immigrant Asian communities remains widespread. Somewhat to our surprise, on a recent random sampling of 20 homes o f Asian families in Bradford we were able to collect 20 samples of Surmas.

After our report on the analysis of Surma samples bought in Bradford and Nottingham a new safety code was announced by the then Prices Minister, Mr John Fraser in August 1978. Under these new regulations it will be a criminal offence for cosmetic manufacturers. importers or retailers to market any product which is liable to damage health. Our fear. however, is that legislation preventing the sale o f Surrnas will prove ineffective as our investigations indicate that the ~T.aj~rity are obtained directly from abroad by the user. his friends or relatives or the hakim.

Kush~a[ ~,,and Waraks

A further group o~ medicines w[dch we have recently examined also give rise to concern. These are fi~,e Kushtay (Fig. 4). The word Kushta is derived from the Persian and means "killed" .or "'conquered". It is applied to these preparations because o f their supposed efficacy at ";killing" or "conquering" the affliction for which they are prescribed. Their composition is mainly oxidized heavy metals including lead, mercury, arsenic, gold, silver and zinc ground together with various herbs. They are prescribed by the hakim as a tonic or as an aphrodisiac. Our study centred in Bradford which is believed to have a high incidence of nephropathy amongst its Asian population. We wished, therefore, to examine any possible connections this may have with Kushtay.

Figure 4, Some sample Kushtay powders al~d pills.

The preparations of Kushtay are set out in the Hamdard Pharmacopoeia but• our study revealed numerous other formulations listed in texts on Unani and Ayurvedic medical systems. In addition, many of the Hakims in Bradford devised their own Kushtay, and others were produced by individual members o f the community who purchased the ingredi- ents to prepare Kushtay in their homes.

Because Kushtay are oftert used as aphrodisiacs and hence are treated in a secretive manner, we recognized that difficulties would be experienced in obtaining a true assessment

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Figure S. A silver Warak.

o f the scale ofusage and, hence, the magnitude of the problem. However, during a 10 mon th period we investigated a series of patients consulting a Hakim and/or attending hospital in Bradford for t reatment of various psychiatric disorders, •Eighty per cent o f the 360 patients we interviewed were male adults and 18+ oij,, were female adults, the remainder of the group were children. From 37 of the 82 who admitted using Kushtay we were able to collect a sample. All 37 samples were subjected to analysis by X-ray fluorescence and diffraction techniques, in addition to these samples we obtained several Waraks (Fig. 5). Waraks are metal foils, supposedly elemental gold or silver, which are used to adorn sweet meats. They are prescribed for the same purposes as the Kushtay and we have therefore included these in our study.

The anal~'tical data we obtained enabled classification o f the samples into four main categories. Eleven samples contained mercury, lead or arsenic as the major constituents with silver, zinc, iron, tin, copper barium and an t imony present as trace elements. Six Kush tay bad major components o f iron, copper and zinc with trace quantities oir tin, manganese and silver, although in two o f these samples the metals were contained only in the coatings of the pills, the pills themselves being compounded from herbs. One additional sample which fits into this group was a Warak which purported to be gold but on analysis the colouration was found to be provided by a c0pper/zinc alloy. One sample o f a silver

th'a~ 7" Atetals ht Some Asian Medichms rind Cosmetics

T,~Bu~ 3. Proprietary names of the KLashtay analyzed and their source of origin

2Sl

Samt3le names Dominant element Manufacturer~Origin

Akseri Gold Warak Cu, Zn Jawarish Jalinoos no heavy metals Kushta faulad Fe Kushta faulad mada Kushta gaodanti As K ushta jaist Zn K ushta Kali As Kushta Khubsul- Hadeed Ire Kushta mirgand Kushta nuqra Ag Kushta para Fe, Hg Kushta qalai Sn Kushta sankhia As (?) Kushta shangrof As Kushta surb Pb Kushla tamba safaid Cu Kushta tamesar Cu Kushla .tamesar Fe, Cu Kushta tim kalan Kushta Ilia marwaraidi Kushta zamarrud Kushta indet Kushta indet Kushta indet Maha sudarshan churna Nugra Kushta {Pill) Shaft Silver Warak Kushta Kushta

Birmingham Pakistan (note absence of gold ) Bradford Hakim. Bradford Bradford Sheffield, Hakim Hakim, Bradford Hakim, Bradford Hamdard

Bradford Home-made, Bradford Hakim, Bradford Home-made, Bradford

Hakim, Bradford Hakim, Bradford Hakim, Bradford Hamdard Hamdard

Hg Bradford, Hakim Calcite and Quartz As Home-made, Bradford Hg Home-made, Bradford Sn, Pb, Hg ttome-made, Bradford

Ag Bradford Ag (coating on pill only) Zandu, Bombay Ag, Fe Hamdard Zn, Cu Bradford no heavy metals (trace Pb) no heavy metals (trace Pb) Bradford

Warak was feund to be pure silver. O f the remaining samples, two were composed of calcite (CaCO3) and quartz (SiO~) whilst the rest were prepared from organic substaz~ces alone. In two o f the Kushtay containing arsenic, the element was found to be present as As~O~. Table 3 lists the proprietary names o f some o f the Kushtay analyzed together with their source of origin. Typical formulae are given in Table 4. The cowdung is included not as a drug but as a fuel providing heat for the oxidation o f the metals.

Because Kushtay are directly ingested they are potentially far more hazardous than Surma. However, it may be that the herbs and, indeed, the other metals present irt these preparations, may affect the rate of absorption in the body. It is common practice when Kush tay are prescribed to advise that they are taken together with an animal oil such as butter (ghee) which may also affect the passage o f the metal in the alimentary canal. Irrespective o f these possibilities, it is clear that the use o f Kushtay should be discouraged and that much additional work is required in the field o f metal-metal and metal-organic mat ter interaction.

O f particular concern is the presence of As(111) in several samples. From 100-300 mg o f As.~Oa may be lethal if absorption is rapid. It is most likely that insufficient heating and time for oxidation was allowed in their preparation; a likely occurrence, particularly with home-made preparations.

2S2 ,~[. .4sAtin c t al.

T)~.z 4. Some Lvpical formulae for Kushtay

Kushta Mirgang

Purified mercury (para mu~ffa) Purified fin (qaVai musaffa) Prc~essed sulphur (gandhak amia sar~ Ammonium chloride (naushadar desi) Saltpetrc (shora qalmi) Mica 2 sq. in. {abrak) Soft clay

60 g. 60g. 60 g. 60 g.

6g. 1

Kushta Para

Purified naercury (para mussafa) Purified lead (qal'ai mussafa) l.il,,.ea chine~is, lincly ground (meda iakri ~yida} Symplocos raeemosus finely ground (lodh pathani sayida) Cow-dung pieces (uplay) Large cow-dung pieces (baray uplay do-do kelo kay)

Kushta Musallas

60 g. 60 g.

180 g. 10 kg. 10 kg.

4

Tin (qal'ail Zinc 0ast I Lead (sin } Saltpetre (shora qalmi) Aloe barbadengis juice (ab ghaikwar] Bamboo pole, 2 yards tong (bans) Cow-dung pieces (uplay)

Kushta Sam-UI-Far (Sankhia)

White Ar~nic oxide (~m-ul-far) (sankhai safaid) Achyranthes aspera ash (rakh chirehitt.a) Cow-dung pieces (uplay)

250 g. 250 g. 250 g. 750 g. 500 g.

I 40kg.

60g. + 500 kg.

5 kg. I I I I I

TAm.E 5. Sandurs and Kum-Kum powders and pastes analyzed

Material Colour

Ambar Kajal Orange Shinagar Kumkum Orange Ambar Kumkum tube Blue Joina 13 Colour Kumkum Blue Ambar Kumkum Red Shrinagar Blue-Green Green

Sandurs and K u m - K e m Pastes

Suggestions have been made of the possible inclusion of mercury in some Asian cosmetics. 3 These were Sandurs and K u m - K u m powders and pastes. Sandurs are used by Bengali, Bihari or North Indian women to colour tl, e parting of the hair whilst the husband is alive, K u m - K u m powders and pastes are used as a spot on lhe forehead of married women, also only whilst their husband is living.

After discussing lhese materials further with the Environmental Health officials in

T^gLE 6. Heavy metal impurities in some Asian medicines

Impurities Major

Product name component Minor component Trace component Remarks

Khamira gaozaban zn 13o ppm contained with 41 ~ dextrose and silver particles. Silver Female fertility stimulant--

silver coated Male fertility stimulant, orange brown, pliable mass

Maha sudarshan. Churna powder

Cogoni oil Bajar, used by men and women (Nicotine)

Queen's balm

Bala guti pills (useful for Chi|dren's diseases)

Haft taki tablets chandraprapha pills

TerminalJa chebula powder Pushyanug churna powder

Khadiradl pills

Withania somnifera

Marayan chun~a

Iron

Iron Titanium, chromium, manganese, nickel, zinc, arsenic, strontium.

Zinc, rubidium Iron Iron

Iron

Iron

Zn. 168 ppm contained in 15 % sucrose together with vegetable matter. Titanium, manganese, zinc, rubidium, strontium

Iron, zinc. Manganese, iron, zinc, lead, copper.

Zinc

Lead 58 ppm, antimony 750 ppm, arsenic 2 ppm

Iron, zinc, rubidium.

Maximum acceptable 50 ppm. This could cause minor irritation in sensitive individuals. No evidence of the presence of hormones, steroids or aloes. No evidence of hormones or steroids.

Essentially soil components presumably derived from the large number of components in the formulation.

Powder of tobacco.like substance which is rubbed on gums and swallowed. Topical application. Zinc trace ~vt important. Lead and antimony too high for infant use. (It is used as a cure for calcium deficiency).

Titanium, manganese, nickel, zinc, arsenic~ strontium, lead.

Titanium. manganese. copper, zinc, rubidium, strontium. Titanium, manganese, zinc, arsenic (2 ppmL strontium. Manganese. zinc. strontium.

Lead and arsenic levels unacceptably high in view of the recommended dose 1,1.-4 daily)--maximum intake thus becomes As 4 g, Pb 160g.

2S4 .~I. ,-ls,/am ct aL

l~irmingham, x~e conducted our own series o~f analyses on the substances listed in Table 5 using atomic absorption spectrophotometry and X-ray diffraction methods. However, our results did not sho~ the presence o f any mercury in lhe samples we analyzed.

Other Asian Preparations

In addition to the materials discussed we analyzed a further range of Asian medicines which, according to the Pharmacopoeia should have been free from hea~' metals, the only exception to this being the Chandraprapha pills which contain iron.

As Table 6 illustrates, lhe materials contained a wide range of heavy metal impurities. Of particular concern are the Bala Guti Pills. which are prescribed (as a children's tonic) in a similar manner to the Bal Jivan Chamchos. In the pills we analyzed we found 58 ppm of lead and 750 ppm ofant imony as well as 2 ppm of arsenic.

Conclusion

Our study is tile tirsl to examine the role of Asian medicines in a Western community The results we reporl here give rise to much concern. At the present time there is considerable public interest centred on the role of lead in petrol and the possible environmental and health hazards which may occur because of this. However, if the lead levels in petrol are compared with the quantity of heavy metals which are regularly being ingested by con- sumption of some of the substances we have examined, the need for action becomes obvious. It is our firm belief, however, that legislation is only a partial solution and may, indeed, only serve to drive the problem underground. The prime requirement is for effective communicalion and education to bring about a change in attitude towards the use of these materials within the Asian community. Data we are still collecting indicates that the results we report here are but a small part of a much wider problem. The need for central- ization and collation o f this information is, we feel, paramount in order to assist in the treatment of Asian patients and bring about an awareness of the special risk to which 'they may be open.

References I. Ali, A. R., Smales. O. R. C. & Aslam, M. (1978). British A#edicalJourualii, 915, 2. Josephs, D. S. (1977). Public Health (Lol;don)91, 133. 3. Rao. V, R. (1979). Persona/Communication. Sandwell Area Health Authority.