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HISTORY OF NEUROLOGY
Year : 2021  |  Volume : 24  |  Issue : 1  |  Page : 81-83
 

Chronic manganese toxicity in Indian Mines—An historical account of the contributions of Dr. T.P. Niyogi


1 Clinical Director and Head, Department of Neurology, Ramkrishna Care Medical Sciences Pvt. Ltd., Raipur, Chhattisgarh, India
2 Emeritus Director, Jaslok Hospital and Research Centre and Professor Emeritus, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India

Date of Submission17-Jun-2020
Date of Acceptance21-Jun-2020
Date of Web Publication07-Oct-2020

Correspondence Address:
Dr. Sarosh M Katrak
Emeritus Director, Jaslok Hospital and Research Centre and Professor Emeritus, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_630_20

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   Abstract 


The mining of manganese ore in India started in the year 1899, in Nagpur district of the Central Provinces. Almost six decades later, in 1957, Dr. T. P. Niyogi examined several young men involved in dry drilling of Manganese ore, who had symptoms of muscular pain, weakness, clumsy movements, asthenia, anorexia, insomnia, and gait difficulties. These patients were also emotionally disturbed and prone to falls and accidents. He concluded that these symptoms were due to chronic manganese toxicity with parkinsonian features and psychiatric manifestations which he published in 1958.[1] This lead to the formation of an Enquiry Committee by the Ministry of Labour and Employment, Government of India which instituted corrective measures in mining of manganese in India. Very few reports of chronic toxicity due to inhalation of manganese have been reported subsequently. This paper highlights the contributions of Dr. T.P. Niyogi who was the Civil Surgeon in Chhindwara, MP during that period.


Keywords: Manganese ore, manganese toxicity, parkinsonism, pseudo bulbar effect, psychiatric features


How to cite this article:
Sharma S, Katrak SM. Chronic manganese toxicity in Indian Mines—An historical account of the contributions of Dr. T.P. Niyogi. Ann Indian Acad Neurol 2021;24:81-3

How to cite this URL:
Sharma S, Katrak SM. Chronic manganese toxicity in Indian Mines—An historical account of the contributions of Dr. T.P. Niyogi. Ann Indian Acad Neurol [serial online] 2021 [cited 2021 Mar 3];24:81-3. Available from: https://www.annalsofian.org/text.asp?2021/24/1/81/297442





   Introduction Top


Manganese (Mn) is a crucial metal in the industrial age and is used in both ferrous and non-ferrous industries. Prior to 1957, the Indian state of Madhya Pradesh (MP) produced nearly 50% of Mn mined in India. Chemically the ore was one of the purest forms of Mn in the world with a very low phosphorus content. These mines situated in Balaghat, Chhindwara, Bhandara, and Nagpur districts were governed by Central Provinces Manganese Ore private limited (CPMO) restructured into the Manganese-Ore Mining Company limited (MOIL) in 1962. Most of the open cast and underground mines were operated by ten to fifteen thousand manual workers and supervisory staff. At these mines of the Central provinces, the saga of Manganese dust inhalation and toxicity unfolded, where the workers did dry drilling.


   The Beginning Top


In February 1956, the manager of a Mn mine, situated in the district of Chhindwara, MP, visited the office of the Regional Inspector of Mines, and met Mr. B. K. Sengupta, the then Junior Labour Inspector of Mines. The manager stated that some of the underground workers employed in his mine, showed definite signs of mental imbalance, and whose continued presence could be a threat, not only to themselves, but also to their co-workers. Hence, he needed to certify them as “medically unfit”. It was suggested to him to refer the patients to Nagpur Medical College Hospital or the Civil Surgeon, Chhindwara, for medical certification. Some of these patients were sent to the Nagpur Medical College, where they were admitted and investigated. A diagnosis of “Shaking Palsy” was made and they were recommended “rest”.[2] The others were referred to Dr T. P. Niyogi, the then Civil Surgeon, Chhindwara district, MP.


   Contributions of Dr. TP Niyogi Top


Dr. T.P. Niyogi [Figure 1] did his MBBS from Carmichael Medical College, Calcutta, now known as R.G. Kar Medical College and Hospital, Kolkata. He started his services as Assistant Surgeon, Medical Health Services, Central Province and Berar between 1942 to 1950. He then went to UK and obtained his diploma in Tropical Medicine and Hygiene from Liverpool University in 1952 and MRCP in 1955. On his return to India in 1956, he was appointed as Civil Surgeon, Chhindwara MP.[3]
Figure 1: Dr. T.P. Niyogi

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As the Civil Surgeon, Dr. Niyogi examined the patients mentioned above and after a period of close observation, came to the conclusion that they were cases of chronic manganese poisoning. He published his seminal work in the Indian Journal of Industrial Medicine in 1958.[1] This was the first report of chronic manganese poisoning in India. It is interesting to quote a paragraph from this article:

”During my tenure as civil surgeon of Chhindwara and Balaghat (M.P.), a number of cases of chronic manganese poisoning were detected by me about a year ago. These unfortunate victims were first produced before me for certifying them as unfit for further work as they were mentally unbalanced and had lost interest in their work.”

Interestingly, he described the symptoms and clinical signs of chronic manganese poisoning with great clarity. The earliest symptoms were anorexia, asthenia, muscular weakness and nocturnal cramps. He commented in detail on the parkinsonian features of Mn poisoning including the face “jovial but fixed”, the voice “thick and monotonous” and “lacking in pitch”, the stooped stance, retropulsion and propulsion and the classical “cock-walk” which he described as “the foot resting on the metatarso-phalangeal joints”. He also stated that “micrographia was demonstrated in more than half of the cases, especially the advanced cases”. The pseudo bulbar effect has been appropriately described as “euphoric in behavior” and “burst into spasmodic laughter on the slightest provocation”. The autonomic non-motor features of parkinsonism were also observed, “…….in one third of the cases………excessive salivation in some and sweating in others”.

In the pathogenesis, he pointed out that “the pulmonary tract was the principle route for penetration and absorption into the system” and that “individual susceptibility seems to be an important factor”. After inspecting other mines with different types of Mn ore but without any cases of toxicity, he concluded “toxicity also depends on the type of ore”.

In the latter half of his paper, he noted “as there is no specific treatment for the disease, prophylactic measure is the only remedy of minimizing the number of unfortunate victims of this crippling disease”. Having visited the mines personally, he gave recommendations against the practice of dry drilling, advised proper ventilation of the cast and underground mines, the settings up of dust traps, protective masks for the workers and mechanization of underground work. Lastly, he stated “……….a manganese commission should be set up, legislations formulated and the disease should be recognized as a compensable occupational disease”.

His work got the attention of the Ministry of Labour and Employment, Government of India. On 3rd November 1958, the Manganese Poisoning Enquiry Committee was formed under the Chairmanship of Dr. M.L. Rawal, Professor of Preventive and Social Medicine, B. J. Medical College, Ahmedabad. The other members of the committee were Dr. M.N. Rao, Professor of Physiology and Industrial Hygiene, All India Institute of Hygiene and Public Health, Calcutta, Dr. N. H. Wadia, Asst. Physician & In Charge of Department of Neurology, Sir J.J. Group of Hospitals, Bombay (now Mumbai), Dr. T. P. Niyogi, Civil Surgeon, Jabalpur, MP, Dr. M. N. Gupta, Deputy Chief Adviser Factories (Medical), Ministry of Labour and Employment, New Delhi, Mr. M. K. Chakraborty, Asst. Director, Central Mining Research Station, Dhanbad, and Mr. B.K. Sengupta, Junior Labour Inspector of Mines, Dhanbad.

The terms of reference of the Committee included a complete investigation of causation, extent, diagnosis, and treatment of the different varieties of manganese poisoning found in the workers of the manganese mines in India and to advise on the enforcement measures. The Committee decided to include as many mines as possible with underground working. They examined 1132 workers from both underground and surface mines, of which, 28 workers showed signs of manganese poisoning. Eleven of these patients were admitted under the care of Dr. N. H. Wadia at the JJ hospital Bombay for detailed investigations. He confirmed the parkinsonism and pseudo bulbar effect described by Dr. Niyogi.[4],[5] In addition to these, he drew attention to a spinal form of involvement “which has hitherto not been described in the literature”.[5],[6] This appeared to be clinically similar to the primary lateral sclerosis of Lathyrism. He stated “….it is then interesting to speculate if a separate form of manganism exists” and postulated that it could be due to ingestion rather than inhalation of manganese.

Though the Government appointed the Committee on 3rd November 1958, it could only meet for the first time in the middle of June 1959, on account of organizational difficulties. The Committee had sixteen meetings in all. Finally, on 30th November 1960. Dr. M. L. Rawal, the Chair of the Enquiry Committee, submitted a report to the Secretary, Ministry of Labour and Employment, Government of India with nine strong recommendations.[2] It is interesting to note that all these nine recommendations are practically a duplication of the recommendations made by Dr. T. P. Niyogi in his article.[1] Subsequent to this report, there are only a couple of reports of manganese toxicity in India.[7],[8]

The purpose of this article is to acknowledge the contribution of an alert Civil Surgeon, Dr. T. P. Niyogi whose astute clinical observations led to the diagnosis of chronic manganese poisoning in India for the first time. Unfortunately, Dr. T. P. Niyogi did not get the necessary acknowledgement as his article was published in the Indian Journal of Industrial Medicine and thus did not attract the attention of neurologists practicing in India.

Acknowledgments

We wish to thank Drs PK Niyogi, Aditi Poddar nee Niyogi, Sharmishtha Naidu nee Niyogi, and Mr. Abhishek Naidu.Thanks are also due to Dr. Brij Mohan, Director (IH), Central Labour Institute, Directorate General Factory Advise Services and Labour Institutes (DGFASLI), Government of India, and Mr. T. K. Biswas, Documentation Officer, DGFASLI, N. S. Mankiker Marg, Sion, Mumbai for providing the archival papers (references 1, 2 & 7) for this article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



[Additional file 1]



 
   References Top

1.
Niyogi TP. Chronic manganese poisoning. Indian J. Indust Med 1958;3:3-13.  Back to cited text no. 1
    
2.
The report of the Manganese Poisoning Enquiry Committee, Ministry of Labour and Employment, Government of India, Government of India Press; 1961. p. 1-151.  Back to cited text no. 2
    
3.
Sharma S. Medical geology: Manganese toxicity. In: Sharma S, editor. Baid, Hakim and Doctors – the Medicine Heritage of India. Mumbai: Body and Soul Books; 2012. p. 99-102.  Back to cited text no. 3
    
4.
Wadia NH. Manganese intoxications in Indian Mines. In Van Bogaert L, Pareyra Kafer J, Poch GF, editors. Proceedings of the First International Symposium on “Tropical Neurology”. Buenos Aires: Lopez Libreros Editores SRL; 1963. p. 271-7.  Back to cited text no. 4
    
5.
Wadia NH. The toxic effects of heavy metals on the nervous system. Neurol India 1964;12: 29-41.  Back to cited text no. 5
    
6.
Wadia NH. Clinical neurology. In Sunil K Pandya, editor. Neurosciences in India Retrospective and Prospective. The Neurological Society of India, Trivandrum, and Publication and Information Directorate Council of Scientific and Industrial Research, New Delhi; 1989. p. 437-507.  Back to cited text no. 6
    
7.
Mankiker NS. An Industrial Hygiene study in a Ferromanganese Plant. New Delhi: Report no. 22, Ministry of Labour and Employment, Government of India; 1962. p. 1-33.  Back to cited text no. 7
    
8.
Veerendra Kumar M, Gourie-Devi M, Chandra SV, Anisya V. Neurological disorder in chronic industrial exposure to manganese. Abstract from XXXIXth Annual Conference of Neurological Society of India, Indore, 16th-19th December 1990.  Back to cited text no. 8
    


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